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Ketamine Therapy and Addiction Risk Management: Part I

Ketamine therapy is having a moment. While technically a dissociative anesthetic, the substance now finds itself at the centre of booming interest in psychedelic medicines. Ketamine nasal sprays, infusions, injections, and lozenges are being offered in clinics springing up all over North America, and beyond. All of this feels much like a precursor to an impending wave of psychedelic therapy practices, promised by the results of clinical trials and the loosening of laws in places like Oregon and California.

Thanks to approvals for drugs like Spravato (esketamine), ketamine has moved from animal tranquilizer and party drug to find a home in our therapeutic toolbox. While the research proving it belongs there is sound, caution is essential. In a previous Truffle Report interview, Maria Florencia “Flor” Bollini, founder and director of psychedelic telehealth provider NANA heals, states that “if we’re not careful, we might see an epidemic of ketamine addiction soon.” 

We thought this was a danger worth exploring.

Some Key Facts

There’s no question that a patient receiving ketamine therapy from a reputable practitioner is in for a very different experience than that of a recreational user. More properly called ketamine-assisted psychotherapy, the practice involves considerable screening, as well as emotional and psychological preparation and physical safety precautions. None of these completely mitigate the potential for something to go wrong. Addiction and dependence take many forms, and can have many beginnings. 

It’s important to remember that this current interest, and the proliferation of new clinics, is also built on the shoulders of underground psychedelic therapy. While these practices are more often associated with natural entheogens, the lessons of the underground space, and of pioneering practitioners from many cultures and backgrounds who operated outside the law, can and should inform our decision making and our knowledge, if for no other reason than patients will suffer if they do not.

In this series, Truffle Report decided to reach out to the psychedelic community, and some of those in our sphere who are the most knowledgeable on ketamine-assisted therapy to discuss the risks, and the safety protocols currently in place. 

Flor Bollini on Ketamine Therapy

Our first step was to go back to Flor Bollini to ask her to expand on her position. She was happy to oblige. “The context in which I gave that quote is because as a medicine woman I mostly work with natural entheogens. When ketamine became legal under the FDA, I had to start working with it to understand the substance,” she tells Truffle Report. “Ketamine has two sides. On the light side, it’s a very easy compound to administer, less scary compared to some natural compounds. It’s very straight to the point, giving the insights that can help you, and clear in the messaging compared to say, ayahuasca. From a clinical perspective, it’s also shorter in duration. There are many benefits.”

“On the other hand, it’s kind of a shortcut, it’s not a quantum leap. When you take mushrooms or medicines that require more work, to face your fears, it’s not an easy experience, but then the lasting effects are way longer. The hardship that comes with these natural compounds makes it so you don’t abuse them. There is effort, there is difficulty. You are confronted with your shadow, the difficult part of yourself that you have to integrate. The thing with ketamine is that it really doesn’t have that. The effects don’t last. It’s much more addictive from that perspective.” 

Ketamine Is not a Magic Pill

Bollini expands on this point by adding that, “Unless we serve these medicines in the framework of giving these drugs first as a dissociative experience — which is to say the experience that you are not your mind, and second as a booster to give you the courage, to give you the hard work, to change your lifestyle, it’s very easy to get hooked into it. There are no magic pills. Psychoactives are not it, and for sure ketamine is not. The way the industry is unfolding, through telemedicine, without any framework for robust preparation and integration, or even the supervision of a prescribing nurse, a more complex level of support (and entourage of lifestyle practices) is required for a patient not to be dependent on drugs to feel better. It’s very likely that people will feel better, but will not do the work to sustain it.”

In simplest terms, this might be a difference of aims. Psychedelics can, without a doubt, be life-changing medicine, but ketamine, particularly the take-home therapeutic variety, also serves the function of acting as a rapid-antidepressant and anti-suicidality aid. In these contexts, something quick-acting and low effort might well be called for.

In our next installment, we’ll speak with ketamine therapy practitioners Dr. Reid Robison of Novamind, and Dr. Joe Flanders of Mindspace Wellbeing, with commentary from Dr. Tatianna Zdyb of MindSetting as well. 

When ketamine is called for, how is it administered?

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