With the pressure on the scale, some ketamine clinics might hurt. Here’s what consumers need to know.

Over the past few years, ketamine has gone through a massive rebranding. Once reserved for operating theaters and underground warehouse parties, today medicine is used to treat substance abuse, depression, anxiety, PTSD, OCD, eating disorders and chronic pain. Seeing the potential behind the miracle drug’s apparent effect on mental health, investors took notice. Between July 2021 and July 2022, Ketamine-related startups have raised $236 million— and the psychedelic therapy industry, valued at $3.6 billion in 2021, expected to be valued at $8.3 billion by 2028.

As a passionate mental health therapist and executive coach, the growing industry is both promising and alarming to me. On the one hand, there seems to be so many possibilities: a fast-acting alternative to side-effect heavy antidepressants and anti-anxiety medications.

Yet, on the other hand, it looks like a recipe for mismanaging power: With pressure to scale, venture-backed startups now face the ethical dilemma of growing at the expense of quality care. One of the challenges of scaling up any mental health service is the challenge of depth versus breadth: prioritizing one usually means sacrificing the other. Adequate mental health interventions require a certain degree of depth, often achieved only through repeated experiences of individual or small group support; however, scaling a startup means prioritizing width—acquire and retain as many customers as possible, often at a rapid pace to prove a viable business model to investors.

To illustrate this tug of war: in a race to reduce burns and increase client acquisition, some clinics are offering home-based treatments – a model they say makes treatment more accessible for people constrained by the location or finances. This initiative was made possible by the Covid-19 related suspension of the Act Ryan Haightwhich previously limited the prescribing of controlled substances to in-person visits.

However, the home treatment model has been rejected by experts who have serious concerns about lack of adequate support and risk of abuse and addiction. Critics also argue that the offer of home treatment suggests that the drug itself is enough –without emphasizing the importance of ongoing care.

“When you give someone a psychedelic drug alone without that security and containment, they have the potential to go sideways,” explains Dr Jenny Cundarinaturopathic physician and somatic therapist who has extensive experience treating patients with psychedelic drugs.

“Sometimes ketamine experiences can be very pleasant, and sometimes they can help to delve into traumatic psychic material. This can be powerful for transformation, but can also be difficult if there is no support or guidance. This can sometimes make things worse before they get better.

She goes on to warn that despite its tendency to rapidly decrease suicidal ideation, ketamine can also increase suicidal thoughts in some cases. “With its dissociative quality, it can bring some people to a place where they feel like nothing matters. For some the nonsense space can be very helpful and for others it can create despair and suicidal thoughts. This is why it is important to work with a qualified practitioner, in conjunction with therapy, when working with this drug for healing purposes.

Even with the addition of profitable telehealth services, many ketamine startups have failed to demonstrate viability: earlier this year, Field Trip Health closed five of its branches in an attempt to stay afloat. Ketamine wellness centers closed every thirteenth of its locations. And Michael Brotherton, investor and co-founder Dragonfly 44 Capitalanticipates “massive consolidation in space” when the Ryan Haight Act is revisited in late 2024.

Despite the difficult economic climate, a company that currently refuses to compromise all of its services is God a Vancouver-based company with additional clinics in Arizona, Utah, Ontario and Quebec. Founder and CEO Payton Nyquvest was forced to create the mental health company following his own life-saving psychedelic experience, and is therefore determined to put patient care first. He believes it’s the preparation and “integration” – the therapeutic work done with a trained professional in the days and weeks following the psychedelic trip – that really makes the change.

“Yes, psychedelics are really exciting tools, but if you don’t have that model of community and care around it, it can be ineffective and even harmful,” he pointed out during our conversation for The Fail Factor Podcast. He goes on to reveal that Numinus has become a haven for “ketamine refugees” whose treatment has been mishandled by other providers.

Nyquvest and his team are exploring alternative sources of low-overhead revenue that do not compromise care: for the past year, Numinus has also been offering a rigorous approach certified practitioner training program. Their goal is to reduce the damage caused by untrained and unequipped “guides” to support individuals on their psychedelic journeys. Nyquvest believes that as the industry continues to grow and legislation reduces stigma and increases access to these drugs, it is imperative that we have enough trained practitioners to ensure safe and effective treatment. The training includes basic and advanced courses on ketamine, MDMA and psilocybin assisted therapies.

What should a consumer know?

Psychedelics have the potential to transform the way we approach mental health. When used wisely, they can raise consciousness, heal relationships, and save lives. Yet if the industry prioritizes profit over ethical care, we risk mass malpractice and the resulting legislative and regulatory burdens.

And how is a vulnerable potential patient supposed to deal with the potential dangers of an unstable industry prioritizing conversions over care?

I spoke to Dr. Reid Robinson, Clinical Director of Numinus, to better understand how to be a better informed consumer. Robinson explained that it is important to first understand the three types of publicly available ketamine experiments:

• “Psychedelic” (aka “spirit manifestation”): ketamine is administered, often by injection, but can be administered by other routes (i.e. sublingual or intranasal, in doses adapted to each individual), with preparation beforehand and integration afterwards. Dosage day usually involves eye masks, headphones with music, and a supported setting for travel.
• “Psycholytic” (aka “relaxation of the mind”): a low dose of ketamine is administered (usually via a lozenge) before a talk therapy session to facilitate openness, perspective, and insight during the session.
• “Psychiatric”: ketamine and esketamine (Spravato) are given as “rapid-acting interventions” for treatment-resistant depression or suicidal depression. Ketamine is meant to be a bridge to other treatments (such as talk therapy or even longer-term medication if needed), which can help people in times of crisis. In this case, Dr. Robinson stresses the importance of involving experienced mental health practitioners: “The medication itself is only part of the equation.”

Look for these “green flags” when selecting a ketamine clinic:

Dr. Robinson echoes Dr. Cundari’s concerns and advises seeking clinics with experienced team members, ideally with board-certified mental health professionals such as psychiatrists, psychotherapists and psychiatric nurse practitioners. . He also recommends looking for clinics offering “ketamine-assisted psychotherapy” (KAP) or “ketamine-assisted therapy” (KAT) rather than just “ketamine infusions.” This implies that the clinic emphasizes preparation and integration. He notes that most states have databases where you can search for your healthcare provider to make sure their license is in good standing.

…And these “reds”:

Dr. Robinson cautions against working with clinics offering virtual care, clinics without mental health practitioners on the team, and clinics that do very brief assessments at the start of treatment.

The dosage is also important. “At higher doses, ketamine can get you into a dissociative or anesthetic space and that’s not always achievable.” said Dr. Cundari. “Some people may not remember their experience, which is not always constructive. It’s important to start low and go slow.

Not a magic pill

Finally, it is important to manage expectations when working with ketamine or any other psychedelic drug. “Ketamine is a tool. It’s not a panacea, it’s not a panacea. Yes, it has deep healing potential. But there is more to consider when working with it for healing purposes. said Cundari.

Listen here to hear my full interview with Numinus Founder and CEO, Payton Nyquest.