Truffle Report Talks Clinical Innovation, Accessibility, and Mainstreaming Emotional Health with Field Trip’s Executive Chairman
The first thing Ronan Levy does when we begin our virtual meeting is apologize for being late. It was three minutes past our agreed-upon time, and a very Canadian start to a rainy Tuesday’s conversation. I asked if he was running behind due to Psy-Tech, an online psychedelic business conference taking place that day. He said no, that he’d hoped to spend more time there, but he’d been busy. It’s not hard for me to imagine why. Levy is the Executive Chairman of Field Trip Health, an integrated psychedelics company in the midst of rolling out a series of clinics in major North American cities. They’ve been making waves, and not just with their treatments. During a perilous time for mental health, when psychedelic medicine and psychedelic assisted-therapy are increasing in viability, it doesn’t surprise me that his time is in demand.
Coming from Cannabis, not a Ketamine Business
I started off by asking Levy a bit about himself, and how exactly one gets into what I characterized as the ketamine therapy business. He explains that, “myself and three of the other co-founders came out of the Canadian medical cannabis industry. We’d started two sister companies, Canadian Cannabis Clinics and CanvasRx.” Levy tells me that the former grew quickly, becoming the largest network of its kind in the country, whereas CanvasRx became Aurora Cannabis’ first acquisition. Citing previous success at introducing new therapeutic modalities, Levy tells me, “we estimated at one point that half of family doctors in Ontario had referred a patient to one of our clinics.”
In 2018, Levy, along with several of Field Trip’s other co-founders, left Aurora and began exploring new opportunities. Becoming aware of the growing body of activity around psychedelics (Levy mentions MAPS Breakthrough Therapy designation, Michael Pollan’s How to Change Your Mind, and Peter Thiel’s initial investment in COMPASS Pathways all piquing his interest) the team started looking seriously at the opportunities in the psychedelics space. “We realized that based on our experience with [Aurora] Cannabis that we could bring a new therapeutic modality to the fore for broad adoption.” Levy also states his belief that “cannabis is a very different modality, people like to lump them together [with psychedelics], but I think they’re very different. We think psychedelics will be even more significant.”
Not satisfied with my earlier classification of Field Trip as a ketamine therapy business, Levy offered a designation of his own. “Field Trip is an integrated psychedelics company, and what that means is that in our point of view, psychedelic medicine is more accurately described as psychedelic therapy, and that it’s about the interplay of the drug and the therapy. The drug is a catalyst for the therapy, not an end in and of itself, the way antidepressants are traditionally treated. We think the best therapeutic and business outcomes are going to be driven by integrating the drug development with the delivery and the administration. Set and setting have an impact on the outcome, as potentially significant as the molecule itself. If you’re not working with all of these aspects, then you’re probably not generating the best therapeutic outcomes, and you’re leaving the success of your business in the hands of third parties.”
Field Trip Clinics as Innovation Hubs
Field Trip is a relatively young business, publicly listed at the start of October. I asked Levy about the first wave of clinics, his plans for expansion, as well as the novel compounds Field Trip is working on. “The clinical rollout is starting with ketamine because that treatment is legal now, but really, they’re there as innovation hubs for psychedelic therapy. Yes, we want to help patients and generate revenue, but they’re also the forum where we’re going to learn what is most efficacious around any drug. It was the logical starting point.”
“The legality is a challenge, it means the opportunities are more limited. We spent almost a year just analyzing the opportunities and the market before we launched Field Trip. From the drug-development perspective, there are obvious opportunities with so many of these compounds, and I see psychedelic medicine as being different from conventional medicine, much more proactively involving the patient. I think you’ll see people consciously choosing to triage amidst different psychedelic experiences, and that’s not just a guess on my part, it’s something that happens a lot in the underground therapy.”
“Other opportunities are really building the infrastructure, being either the brick and mortar clinics like we have here, or the technology; music, ergonomic chairs to support longer experiences, but there’s a very limited legal market right now. We’re still in the batter’s box. We have to ask ourselves sometimes if we’re too bleeding edge, and if there’s enough of a market to support what we’re doing.”
Clinical Operations, Affordability, and Accessibility at Field Trip
I asked Levy to clarify some points of clinical practice and drug administration, for those of us not familiar with Field Trips clinical practices, and to say a little about what exactly a typical course of therapy looks like. He explained, “In Toronto we use a lozenge, in LA, New York, and Chicago we’ll be using intramuscular injection. Either way, we’re pretty focused on making sure our patients are comfortable the whole time, very high-touch, very responsive. All our clinics are exceptionally designed, to make people feel comfortable. We screen patients carefully to make sure that ketamine is appropriate as a therapy. It’s safe, has a long history of use, but isn’t for everybody. Once you’re approved for treatment, you’ll come in, meet the therapist, have a physical exam. On the first day of dosing, you’ll come in, ideally with a spouse, family member, or friend who can assist with transportation before and after. You can spend a long time in the clinic. A typical ketamine experience is forty-five minutes to an hour and a half, but it can be an emotionally opening experience, and might take some time to process. Call it two to three hours in the clinic total, maybe four, or beyond. Patients can stay as long as they like.”
This led me pretty naturally to some questions about Field Trip’s price point. It wasn’t an idle discussion. Psychedelic therapy tends to cost thousands of dollars, and the research infrastructure behind it is, understandably, new and expensive itself. Access to these therapies, and how they will benefit those in need, is a topic worth exploring for anyone interested in psychedelics. With all this in mind, I mention to Levy that the figures I’d seen for a full course of treatment at Field Trip came in at just under $5000 dollars. “$4700 dollars,” he answers. “All of our pricing is on the website, for each location. Different jurisdictions allow us to offer us different programs. In Toronto, we’re only really able to offer the full program at that price, which is sixteen total sessions, including six ketamine sessions, six exploratory therapy sessions, and three integration sessions.” I asked Levy rather bluntly if he were interested in maintaining that price point, or if he intended to adjust, and how Field Trip intended to become profitable.
He took a moment to answer, and fair enough. It was a big question. “The current pricing is intentionally competitive to what senior a psychologist would be charging on an hourly basis,” he answers. $300 per hour is the figure he offers. The cost of a therapist is a number too varied for me to offer one conclusive comparison, but it can certainly be that expensive. “There is enough of a margin there to make it profitable and enable us to expand.” Levy agrees, adding, “It’s still priced better on average than most ketamine infusions.” This I can verify, with some cursory research showing ketamine treatment costing up to $2000 per injection depending on the provider. “We want to expand access,” Levy continues, saying, “we’re investing heavily in digital tools. We can’t offer ketamine remotely, but being able to do therapy and integration remotely helps bring our costs down. We’re also exploring ways to get into compassionate access, for people who can’t afford it. We realize it’s expensive. Balancing expansion and access is something we don’t have a perfect answer for, but we realize that it’s frequently the marginalized people that need this the most who suffer from lack of access. It’s definitely on our minds.”
Mainstreaming the Conversation
With all this information about cost and operational goals still fresh, Levy offers me a bit about his own role, his goals, and something like a personal view on what psychedelic therapy is about. “I spend a lot of time trying to mainstream the conversation around psychedelics and emotional health more broadly. A lot of the conversation is in the context of mental health, but I think it’s really a conversation about emotional health. Even though it’s couched in the language of psychedelic drugs, this conversation really gives people the ability to unpack their trauma. It could be something that leads to a clinical diagnosis, or just something that makes you grumpy, or whatever, but this movement is really creating a catalyst for people to be real about their emotions, and I think that’s a powerful opportunity. It makes it all less about psychiatric disorders, and really humanizes it, makes the conversation about quality of life.”
Psilocybin Cultivation in Jamaica
The discussion of mainstreaming begs the question of what comes next. Field Trip’s operations, after all, aren’t limited to their growing number of clinics. There’s also the development of novel compounds like FT-104, and the cultivation of psilocybin at a facility in Jamaica. Levy is understandably tight-lipped about the novel compound, informing me of an upcoming press release, and saying that “psilocybin and MDMA are great molecules, the challenge is that they’re very long experiences. Probably between six to twelve hours in a clinical setting, which is expensive and not very clinically optimized. One of the nice things about doing drug development with psychedelics is that you know, by and large, that they’re safe and effective, just based on the tons of anecdotal evidence out there. We wanted to find a molecule that was de-risked in that respect, shorter duration, and still potent enough to give similar therapeutic outcomes. And, of course, something which we could build some intellectual property around, which is why we aren’t talking about the indications or the chemical structure just yet.”
“With respect to the psilocybin work in Jamaica, that’s completely separate. Our perspective is that psychedelics are going to emerge from a therapeutic perspective in similar ways to cannabis, in that there’ll be a purely medical program in conjunction with a wellness program. I see the medical program based around synthetic compounds, with the upside to that being the likelihood of some actual pretty good insurance coverage. The wellness program, on the other hand, is probably going to look a lot like what’s proposed in Oregon, more focused on natural products. That work in Jamaica is designed to give us a leg up in anticipating what the market will be. We learned in cannabis that scaling from an underground to a corporate model is not just as easy as building a larger facility.”
Experiential Training Collaborations, and the Future of Field Trip Health
As our talk drew to a close, I mentioned my previous Truffle Talks conversations, and how consistently the issue of clinics and trained clinicians kept coming up. I wanted to know what Field Trip, an active and visible clinical therapy venture, was doing about it. “Our goal is to scale up to seventy-five locations in the next three or four years. We’re currently focused on finding high-quality therapists. It’s obviously preferable that they have some experience with psychedelics, but we’re happy to pursue hands-on experiential training, and we’re looking to develop into a more established training program as we continue to scale. We’re certainly open to collaborations, and we’re discussing some around training right now, but I’m not able to share any details on that at the moment.”
It’s worth mentioning that in the few weeks between my conversation with Ronan Levy and the publication of this article, Field Trip has been anything but idle. Election news from Oregon about the legalization of psilocybin was quickly followed by a press release promising Field Trip’s future expansion into that state. Truffle Report looks forward to bringing you more on the story as it develops.