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Ketamine Therapy and Addiction Risk Management: Part III

In recent weeks, we’ve been speaking with ketamine therapy practitioners. trying to get a handle on the future of the industry. All of this has been based on the premise that there may well be unintended consequences to the proliferation of ketamine therapy.

Flor Bollini of NANA Heals, who helped us begin this conversation, added her view that “to pair ketamine with psychotherapy is incomplete. The key is lifestyle changes. That moment of neuroplasticity is the time to start weaving lifestyle practices like meditation and sexuality. When you create your own good feeling through these practices, you can eventually let go of the drug that is giving you the will to boost through these changes.” 

“Most psychotherapists out there, including my mother,” she adds, “don’t do these lifestyle practices themselves. Especially for women, they don’t ask if their menstruation has an effect on their mental health, if they’ve ever had a healing orgasm. These affect women in a powerful way. There is a lack of communication between lifestyle or functional medicine and the methods of Western medicine which determine your dose, and that only assess the body biologically. There is a lack of assessment of things beyond your biological and mental state. What is the patient’s emotional and spiritual state? Have they ever had a spiritual experience? Do you believe in God? Do you have any form of trauma? Many do. All of these things need to be taken into account and communicated.”

Managing Ketamine Therapy: Goals and Philosophies

It’s worth mentioning that the differences between these clinics and their operators mentioned in our previous installments have much to do with geography, law, and medical practices in their countries of operation in addition to their personal philosophies. Novamind operates in Utah, where prescribable, take-home options for ketamine are, if not common, then at least an option. The Canadian space works a little differently. Spravato is available, but must be administered under the supervision of a healthcare provider. Flor Bollini’s NANA Heals, located in Los Angeles, is a lifestyle platform with a telehealth and psychedelic component rather than a strictly medical practice.

When we searched for further comment, Dr. Tatiana Zdyb of MindSetting in London, Ontario answered, “While I share Flor Bollini’s concerns about ketamine addictions resulting from mismanaged treatment, the key is to avoid mismanagement of ketamine use. At MindSetting, the Chief Medical Officer only prescribes enough oral ketamine for each psychedelic-enhanced psychotherapy session, meaning the patient would not have any left over that they may be tempted to use on their own.” 

“I also know that at the Centre for Compassionate Care in Hamilton, Ontario, ketamine is kept onsite at the clinic rather than being dispensed to the patient,” she concluded.

Is it simply a difference of Canadian and American approaches to medicine, or take-home vs. administered ketamine? It’s tempting to say so, but it feels like a simplification. In and of itself, ketamine has a well-understood medical and therapeutic potential, and a bit of a sordid history. What concerns us now is that it might very well be viewed as the quick fix Dr. Flanders previously cautioned against. 

An aura of hope is being built around ketamine, and psychedelic medicine as a whole. This is not an accident. Psychedelics could well be a big business, and the wider world, now more than ever, is hungry for the hope and healing they promise. Many are building new enterprises to capitalize on that hope, including us here at Truffle Report. While ketamine in small doses is safe, and reasonable checks and balances can be undertaken to minimize risks, dependence is insidious, and not relegated to simple and instantly observable physical or psychological addiction.

A Hypothetical

Imagine that you are a severely depressed person, who is told that substance-assisted therapy might help you. Should you happen to be one of the fortunates who both qualify for and are able to afford ketamine therapy, you undergo the sessions. You then feel better, for a time. Perhaps you continue your therapy, perhaps not. Perhaps you then feel frustrated at your apparent progress evaporating as the glow of the substance fades into memory. 

It is a series of what-ifs, but not, we think, a terribly far-fetched one. It is precisely the chain of events that many addicts have followed before, albeit, generally with other medications for other conditions. Finding a substance that provides them relief, only to be told that it was temporary, and to be weaned off of it. Some cope, and find it in themselves to make the adjustment successfully. Others struggle, ending up back at square one. An unfortunate few turn to harder substances, acquired on the street or through other less than legal channels.

All of this, of course, is a generalization. Hypothetical.

But it’s precisely the sort of question that we’re obliged to consider in a society where mental health is so heavily commodified, and where we are now beginning to offer these substances as solutions. This is not to disparage the work being done with ketamine. There’s little doubt that it can help when needed, and even save lives. But the way in which we handle it may yet have the potential to cause harm. 

For these reasons, it felt best to close with another quote from Flor.

“The dissociation ketamine can provide for a sick person with a mental health disorder to gain that perspective — to be able to realize ‘wow, I am not my mind’ — is priceless. At the same time, we have to ask how we’re using that first experience to give people the courage and support to do the hard work of changing themselves. Unless you have that, very few people, especially those with mental health disorders, have the strength to just use the substance to make them feel better.”

Ketamine clinics such as Novamind, MindSpace, and MindSetting — as well as practitioners such as Flor Bollini through platforms like NANA — are the proving ground for the future of psychedelic medicine. How well we manage the practice, and navigate the consequences, of ketamine therapy in these settings will shape this new industry. We’re looking forward to measuring the results, and continuing the conversation.

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