The Promises and Perils of Psychedelic Health Care

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Many recreational drugs known for mind-altering trips are being studied to treat depression, substance use and other disorders. Here’s what you need to know.

Oregon is legalizing mushrooms. Ketamine can be delivered to your home. People are microdosing LSD to treat pandemic-related anxiety and Wall Street is pouring billions into companies that sell mind-altering drugs. It seems like psychedelics — though mostly still illegal — are everywhere.

While the federal government does not recognize a medical use for most of these drugs and says they have potential for abuse, some of the most prominent universities in the world are studying four substances in particular: psilocybin, ketamine, MDMA and LSD. The bulk of available research suggests that these substances hold promise as part of larger treatment plans.

There is also growing evidence that psychedelic drugs operate differently in the brain than addictive drugs, and advocates have been consistently calling for legalization. But psychedelics remain expensive and difficult to gain access to legally, unless you are part of a research study for mental health purposes.

These drugs are not all the same and do come with risks. One quality they share is the ability to create an altered state of consciousness, commonly referred to as a trip. That effect can either provide a sense of perspective — or be downright terrifying.

“You’re not likely to overdose on them, but you can have life-changing negative experiences,” Katharine Neill Harris, a drug policy researcher at Rice University in Texas, said.

To avoid these experiences, while receiving the benefits these drugs can offer, people have started microdosing smaller amounts at regular intervals — but they are often doing so without professional guidance, and some remain uninformed about significant downsides with very little evidence of benefits.

Here’s what researchers are learning about the psychedelic drugs most prominently involved in mental health research.

As the active chemical in magic mushrooms, or ’shrooms, psilocybin is the most studied of the psychedelic chemicals found in plants and fungi, and it’s the most likely to become an accepted mental health therapy soon. After last year’s legalization in Oregon, entrepreneurs began investing tens of millions in psilocybin research there, and other cities and states are following suit.

Potential mental health uses: Research conducted in the last decade suggests that psilocybin, typically taken in pill form, has the potential to treat substance use disorders, including alcoholism and nicotine addiction, as well as depression.

That research isn’t conclusive yet, said Paul Hutson, a professor at the University of Wisconsin-Madison who studies psilocybin and leads the school’s center for psychedelics research. But he anticipates there will soon be enough evidence for the Food and Drug Administration to approve psilocybin capsules to treat at least some of these disorders — most likely in the next five years or so.

In the meantime, clinical trials of psilocybin for a variety of conditions are taking place across the country, though they can be difficult to find or have long waiting lists. Still, it’s safer, Dr. Hutson said, to try psilocybin as part of a study than on your own or in one of the treatment clinics that have popped up. In these trials, patients attend appointments to prepare for and process their psychedelic trip with a professional in an environment where any side effects can be managed.

What it does: According to users who have participated in trials, a mushroom trip may induce euphoria and an increased awareness of parts of their environment. For instance, solid objects might seem to breathe in and out. A trip can last more than six hours, and some people describe a positive “afterglow” lasting for months.

Risks: Psilocybin can cause distressing hallucinations or feelings of panic and anxiety in some patients, especially at high doses. You can’t be guaranteed safety standards — having a trained professional who can reassure you, protect you and even administer drugs during a bad trip — in therapy outside of a research trial, Dr. Harris said.

One use of psilocybin, which should not be confused with standard treatment described above, is microdosing. By taking small doses — perhaps 10 percent of a standard dose — every few days, some people might experience mental health benefits without the high. But microdosing psilocybin can be harmful, and there is some evidence that it can damage the heart over time. Recent research also suggests that the positive impacts of microdosing in humans may be largely caused by the placebo effect.

First synthesized in 1956, ketamine, sometimes called Special K, is used today as an anesthetic by veterinarians and in emergency or combat medicine. Because it is the one psychedelic that’s never been illegal, researchers have been able to explore ketamine’s potential as a mental health treatment — and build a case for its use in humans.

Potential mental health uses: Many brain disorders — like schizophrenia, depression and anxiety — are characterized by atrophy in the prefrontal cortex. The evidence is strong, though not yet conclusive, that ketamine helps people with psychiatric disorders by promoting regrowth over time in neurons in this area. That could help explain the near-immediate feelings of relief that users report, which is one of the reasons it has been used in the treatment of suicidal patients.

Esketamine, a form of ketamine, showed such promise for treating major depression, often faster than other drugs, that the F.D.A. approved its limited use in early 2019.

What it does: Ketamine can create euphoria and provide a sense of detachment from reality. Users taking a low dose might feel as though they’re floating or that their body is numb. Higher doses can temporarily make people clumsy and forget where they are or even who they are. Blurred vision or hallucinations are common.

Ketamine works differently from other psychedelics. Most psychedelics — like LSD, MDMA and those derived from plants — operate by affecting serotonin receptors, which alter mood and happiness. Ketamine affects a different class of brain receptors that are important for learning and memory. Both kinds of receptors are found in the brain’s prefrontal cortex, which might explain why ketamine and the other psychedelics seem to have similar impacts on mental health.

“The prefrontal cortex is a brain region that’s really critical,” said David Olson, a chemistry professor at University of California, Davis, who studies chemicals that affect brain function. “It talks to a whole bunch of brain regions that regulate things like mood, emotion, fear, reward.”

Risks: Ketamine is also known for a specific and scary side effect nicknamed the “k-hole.” It’s rare in clinical settings, but users may feel disassociated from themselves and their surroundings and panic or feel paranoid.

“Turn on, tune in, drop out.” “Lucy in the Sky with Diamonds.” Silicon Valley microdosing. Suffice it to say, LSD, also known as acid, has a storied place in American popular culture.

Potential mental health uses: It’s shown promise for treating alcohol addiction and has been studied for other conditions like depression. As with psilocybin, some new LSD adherents microdose to achieve mental health benefits without the trip.

What it does: LSD users have reported feelings of bliss during their trip, being able to see sound and having mystical experiences as well as a sense of closeness with others.

Risks: Some people experience lasting psychological trauma caused by a bad trip, especially when they take higher doses or use LSD often.

Microdosing LSD may have physical risks, too. In a study on rats, microdosing LSD had the opposite effect of a trip; it made the rats display signs of psychiatric illness, like aggression and poor grooming. Similar to microdosing psilocybin, it may also strain the heart by overworking the neurons around the organ.

“If you’re constantly stimulating these neurons, even with a small dose of these compounds, the neurons just can’t take it,” Dr. Olson said.

A well-known club drug, also known as ecstasy or molly, MDMA has been researched on and off for decades for potential mental health benefits. While the drug remains illegal, the F.D.A. allows its use in research and treatment for life-threatening illness.

Potential mental health uses: In 2010, results from a study on treatment-resistant PTSD renewed interest in MDMA research. Since then, it has also been explored as a treatment for other conditions like substance use disorder or social anxiety in autistic adults, although it has more potential to cause damage than some other psychedelics.

What it does: MDMA is often known by its street name — ecstasy — from the feeling of euphoria and connectedness it promotes in users.

Risks: MDMA can cause lasting kidney and organ damage as well as heart arrhythmias during a trip, especially in patients with related pre-existing conditions.

***

Psychedelic drugs aren’t simple substances. More time and research will provide answers about their effects on the brain and whether it’s possible to use them for medical treatments. For now, Dr. Hutson cautioned that evidence supports psychedelic treatments only in cases where other forms of treatment haven’t worked.

“They’re not a panacea that everybody is going to respond to,” he said.

Kat Eschner is a science and business journalist based in Toronto. She is a contributing editor for Popular Science and a contributor to Fortune magazine.

Psychedelic Drug From Magic Mushrooms – Psilocybin – Can Be Safely Administered With No Detrimental Effects in Healthy People

Psychedelic Drug

New research from the Institute of Psychiatry, Psychology, & Neuroscience (IoPPN) at King’s College London, in partnership with COMPASS Pathways, has established that psilocybin can be safely administered at doses of either 10mg or 25mg to up to six participants simultaneously.

The research, published in The Journal of Psychopharmacology, is an essential first step in demonstrating the safety and feasibility of psilocybin – a psychedelic drug isolated from the Psilocybe mushroom – for use within controlled settings alongside talking therapy as a potential treatment for a range of mental health conditions, including treatment-resistant depression (TRD) and PTSD

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that develops in some people who have experienced or witnessed a shocking, scary, or dangerous event.

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Current treatment options for these conditions are ineffective or partially effective for many people, resulting in a significant unmet need. Early research has indicated a potential for psilocybin therapy to treat these groups, but no trials have been undertaken at the scale needed for regulatory approval to make the therapy available.

The trial is the first of its kind to thoroughly investigate the simultaneous administration of psilocybin. 89 healthy participants with no recent (within 1 year) use of psilocybin were recruited. 60 individuals were randomly picked to receive either a 10mg or 25mg dose of psilocybin in a controlled environment. In addition, all participants were provided with one-to-one support from trained psychotherapists. The remaining 29 participants acted as the control group and received a placebo, also with psychological support.

Participants were closely monitored for six to eight hours following administration of psilocybin and then followed up for 12 weeks. During this time, they were assessed for a number of possible changes, including sustained attention, memory, and planning, as well as their ability to process emotions.

National Institute for Health Research Clinical Scientist Dr. James Rucker, the study’s lead author from King’s IoPPN and honorary consultant psychiatrist at South London and Maudsley NHS Foundation Trust said: “This rigorous study is an important first demonstration that the simultaneous administration of psilocybin can be explored further. If we think about how psilocybin therapy (if approved) may be delivered in the future, it’s important to demonstrate the feasibility and the safety of giving it to more than one person at the same time, so we can think about how we scale up the treatment. This therapy has promise for people living with serious mental health problems, like treatment-resistant depression (TRD) and PTSD. They can be extremely disabling, distressing, and disruptive, but current treatment options for these conditions are ineffective or partially effective for many people.”

Throughout the study, there were no instances of anyone withdrawing from the study due to an adverse event, and no consistent trends to suggest that either of the psilocybin doses had any short- or long-term detrimental effects on participants.

Professor Guy Goodwin, Chief Medical Officer, COMPASS Pathways, said: “This study was an early part of our clinical development program for COMP360 psilocybin therapy. It explored the safety and feasibility of simultaneous psilocybin administration, with 1:1 support, in healthy participants, and provided a strong foundation to which we have now added positive results from our phase IIb trial in 233 patients with TRD, and from our open-label study of patients taking SSRI antidepressants alongside psilocybin therapy. We are looking forward to finalizing plans for our phase III program, which we expect to begin in Q3 2022.”

The investigators have since completed Phase II of the study, which has explored the efficacy and safety of psilocybin in people living with TRD and PTSD, and are analyzing the data.

Reference: “The effects of psilocybin on cognitive and emotional functions in healthy participants: results from a phase 1, randomised, placebo-controlled trial involving simultaneous psilocybin administration and preparation” by James J Rucker, Lindsey Marwood, Riikka-Liisa J Ajantaival, Catherine Bird, Hans Eriksson, John Harrison, Molly Lennard-Jones, Sunil Mistry, Francesco Saldarini, Susan Stansfield, Sara J Tai, Sam Williams, Neil Weston, Ekaterina Malievskaia and Allan H Young, 4 January 2022, Journal of Psychopharmacology.
DOI: 10.1177/02698811211064720

Washington City Votes To Decriminalize Psychedelics

City leaders in Port Townsend, Washington voted this week to decriminalize entheogenic plants and fungi, joining a growing list of communities that have relaxed their policies on psychedelic drugs.

Under a resolution adopted unanimously by the city council on Monday, laws against natural psychedelic drugs such as psilocybin mushrooms, peyote, and ayahuasca will be among the lowest law enforcement priorities in the city. The measure also expresses the city council’s support for decriminalization of psychedelics by the State of Washington and at the federal level.

City staff modeled Port Townsend’s psychedelics decriminalization resolution after one approved by the Seattle City Council in October, making it the largest U.S. city to make such a move. Denver was the first major municipality to decriminalize psychedelics in 2019, and similar measures have been passed by Oakland, Washington, D.C., and Cambridge, Massachusetts. And in November, voters in Oregon approved a ballot measure that decriminalized psilocybin and legalized the compound for therapeutic use.

Activists Advance Decriminalization

The Port Townsend Psychedelics Society (PTPS), a group dedicated to decriminalizing entheogenic plants and exploring their potential for healing, also contributed to the drafting of the resolution. The city now “maintains that the abuse of controlled substances should be understood primarily as a public health issue,” the text of the resolution reads, according to a report by Marijuana Moment.

Before the council voted on the measure, PTPS activists recommended changes to an early draft of the resolution. Under amendments supported by the group, the text of the resolution was changed to make entheogens “among the lowest” law enforcement priorities, instead of a “low” priority.

“After two and a half years working on this issue, we are extremely excited that the City of Port Townsend has passed a resolution supporting the decriminalization of entheogens,” Erin Reading of PTPS told Marijuana Moment after the vote. “We received only support in the passing of this resolution and are grateful for the vibrant community that has congealed around this work.”

“Now, we can focus more of our energy on the other facets of the PT Psychedelic Society which include increasing accessibility to these medicines, providing educational workshops and trainings, developing support structures (such as our monthly integration groups), and strengthening community connections,” she wrote in an email.

Psychedelics As Medicine

Researchers continue to study the potential medicinal applications of psilocybin and other natural psychedelic drugs, which are often also referred to as entheogenic plants and fungi. Research published last year in the journal JAMA Psychiatry found that psilocybin-assisted psychotherapy was a quick-acting and effective treatment for a group of 24 participants with major depressive disorder. A separate study published in 2016 determined that psilocybin treatment produced substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer.

Greg Rovner, CEO of Heally, a California-based telemedicine platform for psychedelic clinics and patients looking for alternative medicine treatment, applauded the unanimous decision to decriminalize entheogenic plants and fungi by city leaders in Port Townsend.

“This is a great first step that we believe will significantly reduce the number of people arrested for possession of entheogenic plants, as we’ve seen in Oakland, Denver and the whole state of Oregon,” Rovner wrote in an email. “We’re seeing an upswelling of grassroots support for psychedelics and hope it will lead to the end of federal prohibition and create more opportunities for medical research into the benefit of psychedelics.”

Ketamine, Psilocybin and the Rise of Missouri Psychedelics

Inside the salt room, Scott Mickey flew above the bright expanse of his own consciousness. His eyes were closed. A weighted blanket pressed his body into a recliner. In his arm, an IV delivered a few dozen milligrams of ketamine to his bloodstream.

His mind was somewhere else.

“I ain’t gonna lie, I was very skeptical,” recalls Mickey, a 45-year-old business owner who runs a chain of head shops in rural Missouri. Before ketamine, the Rolla native had spent much of his life gripped by a deep social anxiety that made crowded indoor spaces, even a trip to the grocery store, intolerable to the point of breakdown.

He had gone to a psychiatrist. They prescribed him the antidepressant Xanax, but he says it felt like “wrapping your head in a blanket.” So, one day this past October, he went to a different doctor, one located in a compact strip mall opposite the Saint Louis Galleria in St. Louis.

Ketamine is undergoing something of a renaissance. First synthesized in 1962, the substance has been used for decades as a surgical anesthetic, and not just because of its ability to safely render a person unconscious. For reasons scientists are still studying, the introduction of ketamine releases the mind to dissociate — that is, to be blissfully unaware, in all sensation and memory, of the physical trauma happening to their body.

However, with smaller amounts of ketamine, a person can experience that disassociation without the amnesia. That experience, as shown in the growing body of scientific research and widening availability of treatment options, acts as a profoundly effective antidepressant.

But it’s not just ketamine that holds such promising possibilities for treatment. Currently, a combination of state and federal laws block patients from using an even more powerful line of psychedelics, substances that have long been used in indigenous rituals and which are well known to the crowd of self-experimenting “psychonauts” for their mind-expanding effects.

For Mickey, attending music festivals in his twenties had brought him into contact with hallucinogens like LSD and magic mushrooms, but it had been many years since he had taken a psychedelic trip. That day at the clinic in St. Louis, as the salt vapors flowed, he found himself settling into a comfortable chair and listening to the music coming from the wall speakers, the melody soft and meditative.

“I was sitting there, they started the IV, and I just got this little bit of a tiredness that came over me,” he says now. “It was like, ‘Oh, I could probably lay back and get comfortable.’ When I laid my head against the pillow, it was like a light switch. It was, boom, there I was, flying. And there was no fear to it.”

He remembers looking down at an endless landscape beneath him. He says, “I started thinking about my anxiety — why do I get uncomfortable in various situations? I flew close to the ground and saw this dark spot in the center of this snow-covered region. I instantly knew that it was either trauma or something that had happened in my life that created that inside of me.”

As easy as thinking, Mickey flew down to the dark spot, and “exchanged energy.” The spot turned light, and, he says, “as it happened, I would feel the release of this incredible weight.”

Today, he describes it as one of the most powerful sensations of his life. He was sold.

“Once I had tried it once, I was like, ‘Alright, I’ll take the package.'”

After decades of legal restrictions and fear mongering, Americans are finally coming around to the notion that psychedelics are legitimate medicine. Even as the law and science lag behind, people in Missouri like Scott Mickey are already embracing ketamine; and these aren’t hippies or followers of the sort of LSD utopia envisioned by Timothy Leary in the 1960s — these are simply people in pain.

During a recent visit to the Radiance Float + Wellness clinic in Richmond Heights, psychiatrist Dr. Zinia Thomas walks through a short hallway to the salt room, the same room in which Scott Mickey tuned in, dropped out and started flying through his mind. The back wall, built of rock salt bricks, is lit with cool blue lights. A flier on a table features a friendly message, “Enjoy your K-Cation,” beneath a photo showing a line of multicolored cottages on a perfect beachfront.

Thomas founded the clinic in 2017, one year before then-President Donald Trump signed the federal Right to Try Act that made some classifications of drugs, including ketamine, open to therapeutic use if patients had exhausted FDA-approved treatment options.

At first, Thomas says she considered ketamine treatments as an option of last resort. But two key events shaped her current stance that ketamine is for everyone.

First came Missouri’s legalization of medical cannabis. In 2020, Thomas began prescribing medical marijuana licenses to hundreds of patients across the state through virtual appointments. Quickly, she says, it became clear that people were seeking more substantial relief than even high-potency cannabis could offer.

“They wanted it to cure their depression, PTSD, their pain, migraines. They wanted it to cure everything,” she says. “People put so much hope in it, but this is just a plant.”

Thomas says she began suggesting ketamine as a possible treatment for her medical marijuana patients’ more serious health needs. Around the same time, the pandemic hit — and with it, the crush of isolation, job stress and the ever-present tragedy of the rising death toll. She believes the pandemic inflamed a mental-health crisis that was already burning out of control.

“Even high-functioning people have suffered so much loss in the pandemic,” she notes. “I just thought, ‘Why should you have to fail other antidepressants before trying something like ketamine?'”

Finding the Light at the End of the Tunnel with Advanced Wellness and Pain

“The light at the end of the tunnel” is a phrase I found myself turning to much more frequently since 2020. Nobody is walking out of the events of the last 18 or so months unscathed, but the hope is that we emerge wiser for the wear.

The problem with the light at the end of the tunnel is that, by definition, you rarely see it when you embark on this journey. You have no choice but to dive headlong into darkness, hoping that the light will be there to greet you soon.

There’s no sugar-coating it: this is hard – to get in the car, fasten your seatbelt, put the keys in the ignition and depart without any sense of where you’re going or who you’ll be when you get there. It’s during these times we most often could use a hand.

Not a helping hand; no, we can make it ourselves. Not a guiding hand, either – the road is long but we know we’re on the right path. What we need most is a handshake, someone who’s been down this road before who can assure us that, yes, it is difficult but in time we will emerge on the other side bathing in the light of new hope that was once just a far-off glimmer.

That, more than anything else, is the goal of the providers at Advanced Wellness and Pain. It was made abundantly and refreshingly clear to me over our recent Zoom call – the new normal, it seems – that their mission is to create a treatment center that patients can trust. Trust not just to be experts in their fields, but also trust to know they have been there, and they understand.

Advanced Wellness and Pain was born out of its founders – James Leathem, DO, Gregory Wong, MD, and Deepak Sharma, MD, MBA – and their understanding that 2020 exposed us to the gaping wounds of our healthcare model; their understanding that not only do we need new treatments, but most importantly we need providers who understand them and how they make patients feel.

Continue reading for our full conversation about their backgrounds, their commitment to patient care, and the new clinic facility they have moved to.

What separates Advanced Wellness and Pain from other clinics?

First, we are three board-certified physician anesthesiologists who directly participate in each patient’s care. We intake each patient and directly administer the ketamine ourselves. In addition, we optimize dosing both during and between infusions. We will often micro-bolus patients during their infusion to achieve optimal ketamine experiences in our clinic. Then, depending on the patient, we will escalate our dosing to achieve dissociative experiences by their 5th or 6th infusion.

The most important distinction is that we have worked tirelessly to create a comprehensive integrated program that helps our patients create life-long results for their mood, chronic pain, and substance abuse disorders. Furthermore, we have a unique partnership with a psychedelic integration coaching company. We are the only ketamine clinic in the state of Arizona with this partnership. They are experts in psychedelic integration and help our patients prepare, process, and integrate their ketamine experiences into their lives. We also collaborated to author a ketamine preparation and integration workbook that combines our knowledge and expertise. This helps to create a more consistent experience for our patients and encourages them to be an active participant in their healing journey. 

This is key for immediate and long-term results. It’s common for patients to be confused with some of the ideas they encounter during or after their infusion sessions. Our coaches are able to help clarify and assist our patients by insightfully unpacking their revelations in the 24-48 hours post-infusion. Coaching them with integrative and cultivative techniques are critical and necessary for sustained results. On top of that, we teach meditation, mindfulness, breathwork, journaling, visualization, and other life hacks to sustain a positive mindset. This has allowed us to create a success rate of over 95%, compared to the reported national average of 70%.

How much time do you spend taking care of each individual patient?

The time involved for our first infusion session is two hours, subsequent sessions are one-and-a-half hours. In addition, there are three hours of 1:1 integration coaching. The induction or stabilization phase of six infusions, over the course of two to three weeks, involves over 12 hours of time with each individual patient.

What can you tell me about your commitment to patient care?

Our commitment to patient care is unprecedented and another key to what sets us apart from other facilities. Not only is our set and setting pushing beyond typical expectations, but our patients have messaging access to us at any time of the day as part of our program. They will have two, often three physicians interacting with them during any visit. We converse with our patients before starting each infusion and after each infusion to help them optimize their sessions.

There is a lot of excitement around our ongoing clinical study for first responders affected by PTSD that started earlier this year and should be completed by this year’s end. The early data has been fantastic and we should be publishing our results soon.

How does the new office facility help you treat your patients?

We just built a brand-new beautiful state-of-the-art clinic in Scottsdale, Arizona. It was designed specifically for ketamine infusion treatments in order to optimize the patient’s setting, which is crucial to the experience. We have five private rooms with integrated healing music, LED color lighting, vibro-acoustic meditation cushions, zero-gravity chairs, and exquisite artwork. We have created the safest setting for our patients to heal from within.

Can you each tell me a little bit about your background and expertise?

James Leathem, DO

 I completed my Osteopathic Medical Degree at Midwestern University in Glendale, Arizona in 2011. I have been an anesthesiologist since 2015 and trained at Michigan State University. In hindsight, I was lucky to have trained at a very ketamine-centric program. Not all anesthesia programs embrace the use of ketamine equally. We embraced a multimodal approach and ketamine was often part of the anesthetic plan. That is the beauty of anesthesia, it is both an art and a science. In my professional opinion, I think ketamine often improves the anesthetic picture for the patient.

When I was a medical student, having to decide which specialty to pursue, I was conflicted between anesthesiology, family medicine, and psychiatry. Ironically, what I do now is essentially a merger of those three fields. I have administered ketamine to thousands of patients in my career, perfecting my understanding of its dosing and pharmacodynamic effects.

I do a thorough medical history on my patients so I can better understand them from a bio-psycho-social-spiritual point-of-view. I have a passion for exploring consciousness and helping others to evolve their perspective. I also recently became a certified psychedelic integration coach in order to strengthen my ability to care and connect with my patients.

I realize we are all a work-in-progress and societally we are amidst a mental health crisis in the United States. I want to be a part of the solution by catalyzing the healing of patients through the careful administration of psychedelics, ketamine being the only currently-legal psychedelic. We are likely to see a lot of changes in the next two-to-four years involving psychedelic medicines, also known as entheogens, due to the tireless efforts of MAPS.

These are exciting times and I feel fortunate, through the use of my knowledge and skills, to play an integral role in the healing journeys of my patients. Providing hope and attaining positive results for those that have tried so many other options and have been labelled as “treatment-resistant” is truly fulfilling.

Deepak Sharma, MD, MBA

I completed a dual degree in medicine and business at Drexel University in Philadelphia in 2012. I did my residency training at Mount Sinai Morningside-West Hospital in New York City and have been an anesthesiologist since 2016. In my training, we frequently administered ketamine infusions in the operating room as a multimodal approach to managing surgical pain. Patients required significantly less amounts of opioids to control their pain after surgery because of ketamine. 

Our pain management service also administered ketamine infusions to treat patients with Complex Regional Pain Syndrome (CRPS). Most of these patients had accompanying mental health problems, such as anxiety and depression. They would notice that after ketamine infusions, not only would their pain reduce, but their anxiety and depression would also diminish. Had I not been exposed to the powerful benefits of ketamine in my training, I would likely not have gone down this path of becoming a psychedelic medicine physician today.

Unfortunately, most practitioners don’t get enough exposure to ketamine so they have misguided opinions about its value. Even more unfortunately, I’ve found in my career as an anesthesiologist that the healthcare industry has misguided opinions about the value of anesthesiologists and physicians as a whole.

After working in multiple large organizations, both corporate and academic, I realized that I was just a cog in the wheel of a massive machine. I had very little autonomy over how I practiced and I was constantly under pressure to produce. Quantity mattered more than quality to the CEOs. This is the current state of healthcare: big conglomerates merging to form even bigger entities; controlled by private equity forms; managed by bloated administrative staff; with doctors, nurses, and other providers serving as the labor force.

But most of us providers put up with it because of the competitive salary. Kevin O’Leary, a prominent businessman and television personality on Shark Tank, once said that “a salary is the drug they give you to forget your dreams.” That phrase really stuck with me. Although I’ve given up the comfort of a salary to start this venture, I feel much more spiritually satisfied that I’m part of this revolutionary psychedelic movement and that I’m helping to build a resource for struggling patients.

I’ve struggled in many instances in my own personal life, and I know how it is to feel incapacitated from stress, anxiety, and depression. In fact, residency was so stressful that two of my colleagues I trained with committed suicide. It was through my own journeys with psychedelics that I was able to gain a new perspective on life and be resilient enough to persevere through adversity.

My mission now is to show others this new perspective. Helping others navigate through their mental blocks and potentially saving lives in the process is exactly what I want to be doing.

Gregory Wong, MD

I graduated from the Chicago Medical School in 1992 and completed my anesthesia training at the University of Arizona in Phoenix in 1996. I trained using ketamine frequently during high risk obstetrics cases. Although many people believe that ketamine is a dangerous drug, it is actually one of the safest anesthetics that we have available to use. Ketamine’s safety profile makes it one of the preferential drugs during emergency surgeries. 

Over time, us anesthesiologists found secondary benefits that began showing up during patient’s times of stress. We discovered that at low doses of ketamine, patients’ pain syndromes as well as depression were improved. The secret is that when ketamine is used at low doses, it partially blocks the NMDA receptor. This has a very different effect than when given at large doses as in a typical anesthetic. It literally causes neuroplasticity, or new neural pathways.

When used properly, this allows our patients to heal from within. As we have all become more aware of the mental health and substance abuse crisis in our country, I believed it was important for me to take an active role as a physician leader for a solution. The ability to shape the future of patient care through psychedelic medicine is both an intriguing and extremely rewarding practice. We are in the middle of a paradigm shift in mental health care.

We are offering our patients the chance of healing and repairing past emotional traumas with our ketamine-based wellness program. It is unlike typical pharmacologic antidepressants and central nervous system medications that function more like a band-aid than a healing process. Although quite a few ketamine clinics have opened up over the last two or three years, we are still at the infancy of psychedelic medicine. The clinical trials of MDMA and psilocybin show us that new legal compounds will be available in the next two-to-four years.

Our clinic’s plan is to demonstrate how these compounds are even more useful when combined with an integration process. This is precisely why we launched our own clinical study using ketamine and integrative coaching for PTSD patients over a multi-month time frame. For this reason, I feel we run one of the top ketamine clinics in the country. We have scrutinized every aspect of the process and worked to optimize the patient experience.

The results have produced an amazingly high success rate of over 95%. This is well above the national average, so I know our clinic is performing at a very high level.

What led you to start a ketamine clinic?

Our anesthesia business slowed down quite a bit during the COVID crisis in 2020. We saw the amount of mental health illness rising in our country. We looked at the landscape of care and thought we could do an exceptional job of taking care of patients with ketamine, since we were all experts using ketamine in our combined 40+ years of clinical anesthesia practice. We saw that mental health/depression is predicted to be the leading cause of disability by 2030. This led us to believe that we could be leading contributors to shaping psychedelic medicine treatment in the future and evolving the paradigm surrounding mental health care.

What lessons have you learned about mental health during your time at Advanced Wellness and Pain?

We learned that there are a lot of people suffering with their mental health and COVID exacerbated the problem for many. We also learned that most ketamine clinics are not supporting their patients optimally during their acute phase of care. Most do not offer services beyond just the infusion of ketamine itself.

Ketamine is not a magic bullet. Rather, it is a powerful tool and catalyst to healing when set and setting are optimized, the ketamine is precisely dosed, and the patient receives proper preparation and integration coaching. We have had several patients receive care from us after having received ketamine infusions elsewhere. They all resoundingly confirmed we have a truly unique process.

We realize that having strong mental health is a result of conscious daily practice. You have to be an active participant in your healing. Just like we need a good diet and exercise to optimize  our physical health, we need a good diet and exercise for our mental health. In this case, diet is composed of our social media feed, news, screen time, human interactions/relationships, nature exposure, sleep and consumption of psychotropic substances; and exercise is daily meditation, mindfulness, breathwork, activities, guided journaling, and recognizing your internal narrative.

We also offer patients infusions of essential vitamins, minerals, anti-oxidants, and NAD+ to further optimize the patient’s internal milieu as they heal.

We personally guide our patients through this often anxiety provoking or confusing foreign process. It is paramount to a patient’s success. Asking a patient to navigate their subconscious when they have debilitating depression or general anxiety is a huge task to ask someone to conquer on their own.

What should I ask you about that I didn’t know enough to ask?

A question that many people probably wonder about a physician who administers ketamine to help others heal would be, “have you ever tried the infusion yourself?” The short answer is yes. You can only lead someone as far as you have gone yourself.

In our professional opinion, you can read about ketamine all you want. Unless you have personally experienced it in an optimized safe-setting, you will not fully understand its effects on the mind and its healing potential. It is our understanding that less than 10% of ketamine practitioners have in fact tried an infusion themselves. Maybe most won’t be honest and admit it. Maybe it’s higher than 10%.

Regardless, if I were a patient, I would want to go to a doctor who has actually journeyed with the medicine. Otherwise, how do you truly relate? The experience at times is ineffable. Would you take swim lessons from an instructor who can’t swim? I think not. In our professional opinion, you must have walked the walk in order to fully understand the unique healing potential of ketamine and the potentially transformational impact of the psychedelic medicine renaissance that is before us.

In Conclusion

To learn more about Advanced Wellness and Pain’s innovative treatment options, visit their website here or call them at (480) 546-5615.

Simone Biles Ignites a Movement: How One Voice Sparked a Fire for the Future of the Olympic Torch

How the Public Views Our Olympic Athletes

Most stories stemming from the Olympics share the impossible-sounding feats performed by the best athletes from countries around the world, and the most iconic are ones where said athletes push through pain, tragedy, and mental blockades.

Kerri Strug, a retired American gymnast from Arizona, once part of the 1996 Olympic team dubbed the ‘Magnificent Seven’, won gold for Team USA after completing her vault routine with an injured ankle. Thanks to her, the country won the team competition for the first time ever.

Michael Phelps remains one of the most decorated Olympians ever, and has his sport to thank for making him a household name. He’s earned 23 gold medals, 3 silver, and 2 bronze for a whopping total of 28. He is the face of the sport, and his accomplishments are the drive for many who are striving to be the next Phelps.

What many don’t know is Phelps struggled to find his own identity after retiring from the sport in 2016. In his HBO Sports documentary, “The Weight of Gold,” he says, “Yeah, I won a s–t ton of medals. I had a great career. So what? I thought of myself as just a swimmer. Not a human being.”

Remember Strug? She was a teenager during the ‘96 Olympics, where she injured her ankle on her first vault attempt. It was thought that her next attempt was the difference of gold or silver for Team USA. The weight of the country was on her shoulders, or so she thought.

“Do we need this?” she had asked her coach, desperate to find an alternative that didn’t mean landing hard on her injured foot. She was given no way out and had to be carried off the mat after her second attempt—where she stuck the landing.

It was because of that final vault that won her country gold that she left the Olympic Games a hero, but she was soon forced to retire after struggling to keep up thanks to her injured foot.

Glamour Magazine collaborated with Elite-level gymnasts prior to their participation in the Olympic Prelims of June 2021 for a documentary called, “Defying Gravity: The Untold Story of Women’s Gymnastics” where they reveal that Strug never needed to compete in that final vault. Team USA had already won the gold. Her sacrifice was for naught.

These are the stories that people take away from the Olympics. We cheer for the medal ceremonies and shed tears for the sob stories, but it’s the sacrifices that stick with us, for better or for worse. These sacrifices of self, of health, of mental toughness have been viewed as strength.

Strug and Phelps rocked the boat by speaking out about their mental health post-Olympics, but then Simone Biles appeared, and she’s set on capsizing it.

The Greatest of All Time

Simone Biles is an American gymnast from Texas who got an early start in the sport, beginning when she was around six years old. With a combined total of 32 Olympic and World Championship medals under her belt, Biles is tied with only one other person as the most decorated gymnast of all time. She has four skills named after her, a feat that only occurs if the gymnast performs it at a major international competition, like the Olympics. With her capabilities she is, quite literally, considered to be the greatest athlete of all time.

She was a no-brainer for Team USA, and her scores blew her fellow competitors out of the water at the June Preliminaries. With Biles on the team, America could rest easy knowing no other country had the talent to compete for gold.

Then Tokyo happened, and Biles messed up on vault, which is one of her personal favorites.

Announcers were unable to hide their shock, the crowd emitted worried gasps, and her teammates tried to look away.

She unexpectedly withdrew from the women’s team finals following the vault event, citing mental health concerns as well as fear for her safety should she continue on. Biles admitted that she had lost sense of where she was in the air after launching herself from the vault, which is a major deal in a sport where landing on your feet means everything.

The world watched on, scouring social media while waiting for Biles herself to comment on what had happened. As many speculated that she was embarrassed by her blunder and came to their own conclusions that she was selfish not to continue, many more stepped forward to rally around their Olympic hero.

She eventually did release a statement, tweeting, “the outpouring of love & support I’ve received has made me realize I’m more than my accomplishments and gymnastics which I never truly believed before [white heart emoji].”

Biles returned to the floor days later, after finding refuge in a private Japanese gym to prepare for her Olympic comeback, for the beam event where she earned a bronze medal to add to her repertoire.

What This Means Moving Forward

Hours after being awarded her seventh Olympic medal, Simone Biles said that her biggest takeaway from the 2020 Olympics was to “put your mental health first.” Often this is an epiphany that doesn’t befall athletes until long after they’ve stepped away from the spotlight, their sport, the Games as a whole.

But with Biles still in the running and rumored to be preparing for the 2024 Olympics, with this movement encouraging others to speak up about their own mental health, it’s possible we’ll see less Phelps’ and Strugs’– people who lose themselves in the sport with no resources to fall back on.

We’ll see athletes at their physical best, wowing audiences and inspiring future generations who watch on from their television screens.

We’ll see them with broad smiles as they stand on podiums, cross finish lines, prepare for their dives.

We’ll see less of our heroes crashing and burning, and watch as their names trailblaze the path for those who will come after them.

For more reasons than just what she can do in the air, Biles continues to show she is, in fact, one of the greatest of all time.

Depression in the Wake of Milestones

Maybe you’ve recently completed the marathon you’ve been training six months for, published the book you’ve spent two years writing, received the degree you’ve been working towards your entire academic career. You’ve crossed the finish line, seen your work in print, walked across that stage and threw your cap into the air.

Now the crowd has dissipated, the reviews have stopped rolling in, and your grad cap is lost in the sea of scattered polyester and acetate.

Everyone else is moving on, but you’re still standing there trying to relish in the glory of your achievement.

Or, if you’re like some people, maybe that euphoric high of achieving the milestone doesn’t reach its peak upon completion. For some, the fun is in the challenge, in the anxiety of wondering if you’ll ever make it to see the finish line at all.

Which doesn’t sound like an inherently bad thing, but it can leave you feeling guilty if you find yourself not sharing the same excitement as the people around you. If people come to watch you cross the finish line, for example, or send you pictures of them holding your book or clearing a spot for it on their shelf. You don’t want to seem bummed in comparison or make everyone wonder if something is amiss, so you put on a face.

This can lead to questions like: What’s wrong with me? Am I depressed? Why am I not happy?

Why am I not happy?

Why am I not happy?

You know, the kind of questions that leave you spiraling if you continue to keep everything bottled up.

In fact, even looking for answers online doesn’t come up with much. When I turned to Google for answers, I had maybe three articles to choose from. The rest were just the search engine zeroing in on the word “milestone” which left me with a bunch of articles about the stages of being a child.

Which, while helpful to new parents, I myself am not one. No where close. My dog is my child, and he surpassed all his major milestones in the second month I had him when he conquered potty training.

So why do some of us face an almost, if not explicitly, depressive episode in the wake of a major achievement?

Understanding Why

Ron Friedman describes the sensation in his article for Harvard Business Review, “Staying Motivated After a Major Achievement” where he writes, “When we think about achieving a major goal, we picture the exhilaration of reaching new heights. What we often fail to anticipate, however, is that once we’ve scaled that mountain, it can be surprisingly chilly on the other side. After a period of massive productivity we have to revert back to life as usual and settle back into an established workplace routine.

For one thing, it’s because of the emotional letdown of going from an exciting, challenging, or pressure-filled situation to one that’s considerably less demanding. High-stress situations and the adrenaline rush they produce can be addictive. When the constant sense of urgency we’ve adapted to comes to an abrupt halt, we experience withdrawal.”

Friedman goes on to say that, for many of us workaholics, to be fully engaged we need to “experience an ongoing sense of growth on the job.” Which basically boils down to the idea that we view reaching a milestone as a setback instead of an achievement, because there’s no longer obstacles in place to challenge us further.

He then goes on to talk about something that I should have recognized immediately, if not for the fact that we are often blind to our own shortcomings. In this case, many of us fail to recognize the symptoms of burnout.

Burnout, essentially, is reaching our peak exhaustion levels when it comes to our emotional, physical, and mental states. Often, by the time many of us reach our goals, we’re so stressed that we’re ready for it all to just be over with. You don’t want to take a victory lap or attend a book release party because maybe you’re antsy to start the ‘Next Big Thing,’ or maybe you simply want to wipe your hands of the stress that comes from big projects and simply catch up on some much-needed sleep.

(Sidenote: A deeper dive—with some tailored search filters—led me to an article that introduced me to the arrival fallacy, which, Forbes explains, operates under the assumption that if you’re working towards a goal, you will reach the goal, which preemptively triggers the brain’s reward center. This feeling persists and adjusts along your journey, until it’s no longer stimulating your brain enough by the time you reach your goal. In a way it’s kind of like burnout, but instead of being exhausted at your finish line, you’re simply bored instead).

In the aftermath of a large milestone, if you find yourself feeling underwhelmed, first understand that your feelings are not not normal. If you don’t feel like attending a party in your honor or feel the adrenaline rush that comes with finishing a big project, don’t simmer in it. My advice would be to take a much needed break, no matter what that timeline looks like, and then set your sights on the Next Big Thing.

Life is long, and after a time it’s on us to create our own milestones to keep us from being caught in a monotonous cycle. Or worse, finding yourself one day waking up from autopilot.

Don’t let the depressive episode following one accomplishment keep you from reaching for that high again.

So have your moments, and then sit down at your desk to write or lace up your running shoes and go get it, whatever it is that you’re running towards.

There’s always something to work towards.

Provider Spotlight – Christi Myers, Flow Integrative

The search for knowledge is never-ending and can lead to new and wonderful opportunities, as made evident by Christi Myers, owner of Flow Integrative of Encinitas, CA. Even though she already had quite the list of credentials under her belt, Myers wasn’t satisfied knowing that there was more that could be done for those who suffer from mood disorders.

Besides being a seasoned paramedic and educator, Myers has taken on the task of helping those who suffer from their mental health by opening a clinic for the residents of Encinitas. There, they can expect innovative treatment for conditions like depression, anxiety, post-traumatic stress, and more.

When we sat down with Christi we asked a series of questions that she answered with grace, showing the compassion behind the hardworking mindset that this field requires.

Continue reading to see a transcript of our conversation below.

Can you tell me about your education?

My profession began with the fire service and emergency medicine. I have an associate’s degree in paramedicine as well as fire science. I hold a bachelor’s in public safety and a master’s in leadership.

So what turned you to ketamine?

I have been a paramedic for 16 years. I transitioned into a teaching role about a decade ago. And in that, I teach pharmacology, where we as providers started to incorporate ketamine in this county. Part of what I teach is all the drugs that we hold in our scope of practice, ketamine being one of them. Now I had to actually take the time to learn more about this medication. I came into this with the preconceived idea that ketamine is essentially a horse tranquilizer, as well being used recreationally as having street names such as, “Special K.” There are two perspectives with this type of medication: the recreational side, then the conscious sedation side. Working in an emergency room prior to and during paramedic school, ketamine being used as conscious sedation to help with certain procedures. It’s different in the sense that those patients are completely inundated with the drug which puts you in a lucid state where the effect is amnesic in a sense.

Now my perception has shifted and being able to break the stigma and share how wonderful ketamine is, when used mindfully. The mental health component in our profession, as well as my own personal journey through the Covid-19 pandemic, all of the research has allowed me to see the benefit of ketamine and how it helps provide perspective shifts. Psychedelics as whole such as; psilocybin, MDMA, and now ketamine are FDA-approved, and are now being integrated for mental health. So really, it was in the teaching spectrum, not only to my students, but to myself is where I discovered ketamine.

What was your first exposure to [ketamine] for mental health treatment?

The first exposure was at MAPS which is a conference of beautiful sound-minded experts that discuss the revelations of medicine and new treatment modalities. Early 2020 I attended this conference where ketamine and PTSD were becoming more spotlighted in the mental health community, which led to infinite amounts of research. Once I was exposed to the new found knowledge and opportunities, I immediately became invested. Starting out by becoming invested in myself and willing to experience ketamine and begin to heal myself as a human, which in turn helped me grow into an even better medical provider.

Wow. So when you say personal experience… Did you have infusions?

I did. I had an intravenous infusion so that I could speak from a place of understanding in addition to solely the intellectual side of this process. The realization that these types of psychedelics are able to give us a sense of awareness. Which would give clarity and allow us to actively look into the self, where true change and progress can manifest. . I do a lot of inner work consistently on my psychology. I have now been able to make the proper adjustments to my lifestyle which has given me the strength to live with a sober mind. Living with a clear and sober mind evokes self actualization in the sense that you are experiencing emotion and introspection in its rawest form. I’ve come full circle with my journey in mental health, being able to see, love, and appreciate my own spirit and self.

I allow for that to be a catalyst in my ability to sort through, and grow in that healing. I truly go into these experiences with the intent of achieving a deeper awareness that was not presented initially.. So my experience with ketamine was a reminder of how autonomic or self-regulated our body truly is. The reality being I need my body, my body doesn’t need me. We don’t have a healthy awareness and understanding of our parasympathetic nervous system, which is the Rest and Restoration phase our bodies should be experiencing. The goal of therapy is to understand how important our bodies are and how we need to learn to sufficiently take care of it. Rather than abusing and overindulging our bodies. When we understand correct self-care and self-love we would be able to identify what is really needed for our bodies to thrive, not just survive.

So is there anything more you can speak to about the importance of ketamine? It’s not just a medicine. It’s not a Band-Aid. It’s a tool as part of a broader mental health treatment plan.

Absolutely. It is a tool. It’s a catalyst. A lot of times we get stuck in our belief systems or in the program that we’re currently running. We sometimes don’t have a true awareness of just how complex and programmable it is. Our perspective lenses become limited or distorted, which can be altered with a catalyst. Those catalysts are in the form of plant medicine and psychedelics. With my whole heart, I believe that there is a better way of treatment outside of the current modalities such as antidepressants or medication that has been essentially created or in use just temporary avoidance or dismissal of our own emotions.

So allowing yourself to see it and experience it through emotion and feeling is incredible. Then the proper tools are able to continuously be put it into practice when we are feeling either limited, stuck, scripted or habitual in our ways of being. The understanding of this concept and realization of the correct tools needed, will allow us to evolve into a greater version of self because we are not harboring or holding onto all those previous thoughts, emotions, or wounds.

So what is the process then at your clinic in terms of making sure patients feel like they’re in that safe place, but also like they’re taken care of?

Yes, of course. So we have a few collaborative pieces embedded that help reassure patients they are comfortable and safe when stepping outside of their comfort zone, as well as being vulnerable. The set and setting is a commonly discussed component of the ketamine treatment. Rightfully so, because it is about the expectation of what each patient plans with specific intentions to address, accomplish, and release through ketamine therapy treatment. We optimize set and setting in an attempt to provide an experience that will have a long term positive impact on you. This includes customizing your ketamine dosing based on a variety of factors. Set is the current state of mind of the individual patient. Setting is the physical space treatment will take place. Which includes the room, our presence and guidance through your treatment session experience. The continuum of care outside of the conversations that are had beforehand or the ability to have access to providers and resources. When questions arise, using Osmind as another way of communicating, journaling, and tracking mood.

They’ve done such a good job with creating an app that allows your medical care to be handled remotely by phone. With that convenience and how much we are on our phones already it’s not an inconvenience to document how you feel or what you’re going through in real-time. Which then allows us to communicate directly and indirectly to see how patients are really processing what they’re experiencing, as well as if they have questions or concerns arise. There’s a means of continuous communication so that you don’t feel as if you’re alone throughout your journey.

So, on the note of ketamine’s accessibility, do you think psychedelics are going to follow suit within the next five years?

Absolutely I do. I believe that with my whole heart that psychedelics are coming to fruition, MDMA and psilocybin being first and then DMT, LSD, and ayahuasca to follow suit. A lot of this is truly about debunking the stigmas set in place decades ago.

What have been some of the highlights or things that you’re most proud of?

Developing the quality of perseverance despite adversity, resulting in being graced by grit. Incorporating how to reset your human and allow expansion in consciousness. Realizing that when we help ourselves we in return help all. So it is very fulfilling and it is very challenging in the same sense. So it’s idealistic in continuously progressing forward and becoming a better version of self each and every day.

Provider Spotlight – Nykol Rice, Boise Ketamine Clinic and Mindful Infusions

Ketamine, it’s thought, works through connection – a reconnection of old neuronal activity or sparking new connections. This makes it useful for the treatment of conditions like depression, anxiety, or chronic pain, according to current science.

The thing about connection is that it’s therapeutic across the board. No person is an island, truly. As humans, we are happier and healthier if we surround ourselves with people that encourage us, inspire us, or challenge us.

My experience in the ketamine infusion space has been no different. I have never felt more sure of the urgency or importance of what we contribute in this space than when I have reached out and connected to others.

Those whose lives have been touched by ketamine infusions, either directly or indirectly, remain the most inspiring part of the job. That’s the strength of the community: our ability to connect to each other and encourage growth.

With Zoom and Google Meet now the norm, it’s easier than ever for us to have conversations. I recently reached out to Nykol Rice, CRNA and owner of Boise Ketamine Clinic and Mindful Infusions.

We talked about the importance of sharing these stories, the effect of a safe and comfortable patient experience, and the future of mental health treatment. Check out a transcript of our conversation below.

Can you tell me a bit about your background and education?

Sure. I’m a certified registered nurse anesthetist, so I have a master’s degree in anesthesia and just a couple of weeks ago I completed my psych nurse practitioner degree, so I’m dual-certified.

I’m pretty passionate about including the mental health component, and so I went back and got a second degree.

What can you tell me about your experience in healthcare?

I have been a registered nurse since I was 19 years old, so I have been in health care for well over 15 years which is crazy. So I’ve been in healthcare a long time.

I was a critical care nurse. I did some neurocritical care for the University of Utah. I was a critical care fellow for their critical care internship program. I helped train registered nurses to function in the various ICUs. So they had a neuro, a surgical, a burn, the ER.

I did that for a number of years, then I went back to anesthesia school and I attended Westminster College in Salt Lake City, Utah, and completed my master’s there in the fall of 2014. So I’ve been in anesthesia now six years.

What was it that led you to start a ketamine clinic?

So it was kind of an interesting pattern of events that led to opening the clinic. I lost someone to suicide in my early 20s, I actually lost a fiancee to suicide. And I had always been searching for something that was a little quicker than traditional antidepressants, something that was effective and safe.

Pretty early on into my anesthesia career, I came across a continuing education article that was talking about using microdose ketamine in a clinic setting for refractory depression and suicidality.

As soon as I read it, my interest was piqued. From there, I spent about a year and a half talking to other clinics and [doing] a lot of research, buying a lot of books, and really working towards opening ketamine clinics. When I opened, I could find online about 10 clinics. So I called and talked to a few different clinic owners and got some good advice on how to proceed..

Then I spent a lot of time talking to the Idaho DEA and the Board of Nursing and then ending up taking the risk and opening up. It’s just been one of the most rewarding things I’ve ever done.

I can’t help but notice the treatment room. Can you tell me a little bit about the environment?

So what I have here is a custom bed that you can program the firmness or softness. You can adjust the height and feet, and this is for our pain patients. It massages and adjusts so that they’re totally comfortable in our setting here.

We’re pretty unique as far as our setting goes. It’s a little different than what you see in a lot of traditional clinics. When people come in, the whole room is set up for “psychedelics”

We’ve got this light show that plays really cool music. It’s just kind of customized and quiet and private. All of our rooms are like this. They all have different lights that people can put on. People really like it.

What else can you tell me about making sure patients feel comfortable?

I think it’s part of helping people feel comfortable having good collaborative care, as well as having open lines of communication and reasonable expectations.

I think you need to be honest with patients about what you can provide and also really make sure that you’re involving the whole person. With ketamine, you really need a variety of approaches to include all aspects of a person.

You want to make sure that they’re getting some counseling, that they’re adhering to medication regimens, that they’re getting the help they need outside of the clinic as well because ketamine is wonderful but it’s not a magic cure.

[Everyone] really needs to be doing the work outside of the clinic as well as coming and doing the work in the clinic. If they understand that, they tend to do pretty well.

The other thing that we offer is preparatory and integration work with a psychologist as well as a certified life coach. They do a really good job of helping people prepare for their sessions and then put what they’re getting out of their sessions into their lives.

They have these big life-changing experiences and they don’t know how to implement the changes that they’re feeling like they need to make. It’s really no good if they have these big revelations and then they don’t know what to do with them from there. So having that component available, I think, is really beneficial for patients.

What are some of the transformations you’ve seen in patients who are able to understand that aspect of it?

Sure, we have some people that have had anything from feeling like they really need to change career paths to people feeling like their sexual identity isn’t what they thought it was, and they’re going to have to work through that. People really have some major stuff come up during these sessions and just working through those impressions and the things that they’re feeling they need to act on is a pretty big deal.

What have you learned about mental health?

That it’s really not a one-size-fits-all approach. If you’re going to get into mental health, it’s very important to come up with some customized plans and approach the patient as an individual and get a thorough history. Ketamine is just a piece of the puzzle. Making sure that you can help patients get all of the pieces they need to really become well is a really important approach.

I think helping patients get lined up with counseling, addressing diet, addressing rest, addressing stressors at home, and having the professionals in place that can help guide them in those areas is paramount to success..

What does that look like at your clinics? Say I’m a patient, how do you connect me to these resources?

So, we have a patient resource guide that goes over different practices that work well with ours. We also have practitioners in-house. We have a psychologist on board as well as the life coach, and they offer some of those integration sessions.

They’re separate counseling sessions where they would come in and they would talk about the things that are coming up in their ketamine sessions or in their life that they feel like they want to really make some meaningful changes, and they would go through a plan of action with these mental health professionals.

I think our set and setting is incredibly unique. We offer the private rooms and the whole clinic is private from door to door. We’re in a commercially zoned home, so it’s kind of an interesting setting. Patients comment all the time how comfortable they are being in this type of setting, because it’s not your standard “whitewalls, no decor” kind of clinic.

We have everything pretty honed in where each room is very comfortable, very private, and patients can really have a personal experience here in a very safe way.

How important is that to making sure it’s a pleasant experience for patients?

Well, if you’ve read anything about the different greats in the psychedelic space – Tim Leary, Hoffman – they all talk about set and setting. So I think it’s important to pay close attention to the setting because it can be very impactful for how patients do in your clinic, and that refers to the mindset that a patient presents.

So what’s going on in their home lives? How are they feeling that day? Are they acutely stressed? The setting is something that the clinic controls and the mindset is something that the patient controls, and having those two pieces come together makes for good sessions.

You mentioned Tim Leary and psychedelics – I wanted to get your opinion on the psychedelic movement.

Psychedelic is not a naughty word. Psychedelic just means mind-manifesting, and that really is what you’re doing here.

When you’re using ketamine in micro-doses the way that most clinics are, it’s functioning as a psychedelic. People are getting vision changes, they’re having out-of-body experiences. I think we’d be remiss to dismiss the fact that it is working very similarly to how psychedelics work.

You’re changing people’s perceptions of their current reality. That’s a psychedelic. You’re bringing up the things that they’re holding on to in a very deep way, things that they can’t seem to get over. Those things come up in their sessions. Their minds are manifesting in these sessions. So I think that you would be silly to say that ketamine is not a psychedelic or that we need to avoid those kinds of side effects. I think there’s a lot of power in being able to access a little bit different state of mind.

Where do you see ketamine being in five years?

Ideally, I would hope that ketamine sees more widespread acceptance and legitimacy. We’re seeing promising research come out of major academic institutions all over the country. You’re seeing Johns Hopkins, you’re seeing Yale, you’re seeing Stanford release a lot of promising high-quality data that shows that there’s many clinical indications for ketamine. There’s a lot of utility with this medication. I think as you see other psychedelics hopefully hit the market in the next five years, you’re going to see psilocybin, MDMA, possibly even LSD.

I think that we were a little remiss in dismissing these medications so quickly. We’re seeing now that there is clinical utility in each and every one of these medications. You just have to find the appropriate patient selection and the criteria for people who can benefit from this.

As long as we can do this in an ethical, responsible way where we’re not causing harm to anyone. I think there’s millions and millions of people that can really be helped by these medications.

So I think what’s going to happen in the next five to ten years is you’re going to see a mental health renaissance with the option of all sorts of different psychedelics.

My hope for ketamine in that time is that it only strengthens its position. Ketamine is very predictable, so it makes it very user-friendly to use in a clinical setting the way we are in. It’s really hard to get a medication that has a 10-minute onset and offset in a predictable manner like ketamine tends to work.

Ketamine is not an expensive medication, and I think that people deserve to have some reasonable access to it. People need other options. It’s very clear that we’re really just not meeting the mental health care needs that we have in this country.

People are in crisis and I think they deserve to have some options available to them in an affordable way.

The bottom line is for the average cost of an ER stay or two, you could really treat someone with ketamine for many, many months to prevent those days. If you look at inpatient stays, even a day or two of inpatient stays, you could maintain someone on ketamine in a much, much more affordable manner and less disruptive to people’s lives. Now, there’s always going to be a clinical indication for inpatient status. That’s not going away.

But if we could cut back on the need for ER visits due to suicidality or cut back on inpatient admissions or length of stays by really utilizing this medication to its fullest potential, it’d only save both the health care payor and the patient’s time and money in the long term.

One hundred percent may not be realistic, but if we get 70 percent of people with treatment-resistant depression feeling better, that’s a really big deal.

What are some of your favorite patient stories?

A 17-year old male went from suicidal with around-the-clock parent supervision and unable to attend school to being able to resume playing on his high school football team and completed his high school diploma.

A 33-year old female with autism presented for severe social anxiety which prevented her from being able to leave the house. After her 3rd session, she was able to go downtown with her family to the farmer’s market and out to eat. She had not been able to be in a social setting in nearly two years.

A 32-year old female presented with CRPS which caused her such crippling pain she was unable to work. After ten sessions she was able to return to work and has been gainfully employed and on a booster regimen for over 3 years.

What are you most proud of?

The thing I’m really most proud of is the team and setting we’ve created at Boise Ketamine Clinic. Over the course of our 5 years in business we’ve worked diligently to improve our services and provide people the support they need to implement lasting change in their lives.

Between myself, Marisa Weppner (life coach) and Dr. Mike Sapiro (psychologist) we’ve evolved into offering nearly all forms of ketamine as well as adding preparatory and integration counseling sessions in addition to Ketamine Assisted Therapy options. This approach offers both a unique medication and a very specialized type of guidance.

Provider Spotlight – Trey Slann, Exodus Health

During our lives, we walk through many landscapes and endure many conditions. It’s a system of give-and-take, push and pull. There are times where we dance in the rain and others where we trek through the storms. Sometimes these paths lead to dead ends, and there is nothing to be done other than taking a breath, tightening your shoes, and doubling back.

Along these paths that we take are doors, and some are locked while others are already half-cracked with a welcome mat out front. These doors symbolize opportunity, choice, and often lead down paths where there are no road signs letting you know if you’re headed for a road block. It takes courage to come across one of these locked doors and knock, which is exactly what Trey Slann, owner of Exodus Health of Pearland, TX did.

“I’ve always kinda been entrepreneurial,” Trey responds when asked why he decided to open a ketamine clinic, “but every time I tried to do something the door would get shut–and even slammed–in my face sometimes.”

Trey earned his anesthesia degree from Texas Christian University and has been a nurse since 2004. After becoming a CRNA in 2010, he worked in Odessa and then at a hospital in Angleton, Texas before opening his own clinic in Pearland.

“I had a good friend of mine who owned a ketamine clinic and told me about it. I had thought about it and thought that it sounded interesting, but I didn’t really pursue it for a good while. I just kind of served as a support for her and encourager for her in opening up her clinic.

A couple years went by and I thought about ketamine and happened to get in touch with Chris [Walden]. We had a pretty long conversation about it and things just started to happen.”

Chris Walden and his wife Cassy Walden founded Ketamine Media in 2016 after working on a national rollout plan for another provider.

“I decided from that point to seriously consider it. So I told my wife that I felt like God was preparing me for a change. I didn’t know what, but I was just open.”

For Trey, this was more than just a new business venture. Opening up a ketamine clinic would mean being able to open the door for treatment that many had been turned away from, like his wife.

“My wife suffered from postpartum depression with the birth of both of our children. It was a really rough time in our lives. There were several times where I didn’t think my wife would make it through it.

But she did, with the help of really good support and family and medicine. Of course, we didn’t know about ketamine at the time. She got through it, but was left with chronic anxiety, PTSD, and lot of OCD with intrusive thoughts. After finding out about ketamine and all it can do, I suggested she try it.

She did, she went through the infusion process, and I got my wife back. It was just amazing, what it did. It helped her to process a lot of things that she was still dealing with and didn’t know .”

Trey shares that the desire to help his wife was one of the driving forces to start Exodus Health. He figured that if he could help even one person, and help a family the way ketamine helped his, then he was doing the right thing. He was so dedicated to the new path set before him that he gave up his anesthesia job and dipped into his savings so that he could continue to take one step after another.

“You talk about walking by faith,” says Trey, “this is definitely one of those times; but to walk on water you have to get out of the boat.”

Since Exodus Health’s opening, the clinic has seen its fair share of patients, but one in particular stands out to Trey when asked about ketamine and how it sees success when other treatments fail.

“There is a particular patient, talking about what it does for people when nothing else works. I had a Vietnam vet who suffered with PTSD ever since. We’re talking 40, 50 years of really bad PTSD. He’s tried everything.

Nothing worked, nothing ever worked. So he just lived with it. With the pandemic, it was becoming essentially all-consuming for him and debilitating. It was starting to interfere with his family interaction and he knew it but couldn’t stop it.

He told me he knew about ketamine but was afraid or too proud to do it. But he finally did and trusted Exodus Health to help him through this process.

This is someone I’m told is back to the man he was 45 years ago before he went to war. He’s laughing, he’s smiling, he’s having fun, he’s not thinking about destructive things or suicide. It’s been miraculous in what it has done for him when nothing else worked, nothing else even came close to working.

At most, all anything else did was provide a numbing and that’s it. Now he’s actually living life. That’s what I tell people: before ketamine, you’re existing. After, you’re living.”

After hearing a story like that, it’s hard to imagine that things can get even better after working in a clinic for some time, but Trey says helping someone never gets old. When asked what his proudest moment has been from his time with Exodus, he responded:

“I don’t think I can pin it down to one specific moment because every time I see a patient that makes it through the process, and tell me, ‘You saved me. This saved my life,’ that’s my new proudest moment.

That means what I’ve done has really impacted somebody’s life. I get stoked every single time- so excited! – every time I hear a patient has had a successful outcome. I get new proudest moments every week.”

Trey brings up that working in a ketamine clinic setting has taught him a lot in the time that his clinic has been open. When prodded as to just what exactly he’s learned, he says:

“I’ve learned that mental health is just as vital for a person’s wellbeing as anything else. I’ve found that people who struggle with mental health issues a lot of times feel alone. They struggle and they fight and they feel as though they are doing it all by themselves, or that there’s a stigma with mental health and seeking treatment.

I think it’s getting better but there’s still a pretty big stigma with mental health. More than anything it’s helped me to see how prevalent it is and how real of a struggle it is for so many people–way more people than I thought.

I don’t think there’s anybody out there that doesn’t have a close connection in some way with someone who struggles with mental health in some capacity.

And now we finally have a truly effective treatment for it. Is it a cure? No, it isn’t a cure. But it’s extremely effective and it doesn’t come with all the untoward side effects that traditional medications bring. It’s a total game changer.

I really feel like we’re on the cusp of the next big thing for mental health treatment and ketamine is a part of it. A big part of it.”

Now, you may be wondering just what Trey means by ‘next big thing,’ and he was open with his answer:

“[In a perfect world], we see a drastic reduction in traditional depression treatments like SSRIs or antidepressants and more ketamine clinics. In five years, we might have psychedelics. New innovative treatments should be emerging.

You have ketamine, you have psychedelics coming up, you have TMS. All of those things take different roads to the same destination. All of the roads are much better in my opinion than traditional antidepressant medicines.

Right now, ketamine is considered off-label use and it’s not covered by insurance. In 5 years I would hope that not only is it covered by insurance but it’s the next gold standard of mood disorder treatment options.”

Hopefully the world shares Trey’s optimism for mental health, but in the meantime residents of Pearland, TX and the Houston area can take solace in knowing there is someone like Trey fighting in their corner.

If you are currently on a path where every door feels locked and you have been barred entry, consider Exodus Health for treatment, where with the help of Trey and his team you may just find the key you’ve been seeking.

If you would like to learn more about Exodus Health or speak with Trey you can visit or reach them at:

2743 Smith Ranch Rd #504
Pearland, TX 77578
Phone: (281) 603-1722
Email: info@newexodushealth.com
Website: https://newexodushealth.com