Walking into Nushama, a new psychedelic wellness center in Manhattan, feels like entering a boutique hotel. There’s calming pastel art by Navina Khatib on the walls, murals and silk flowers, and at the recent opening of its new office, a harpist plays. The treatment rooms have pristine white zero-gravity chairs. Copies of books such as How to Change Your Mind by Michael Pollan sit on chic minimalist bookshelves.
At first glance, one wouldn’t think people coping with debilitating conditions such as treatment-resistant depression and eating disorders are here for therapy. But not just any therapy — ketamine-assisted psychotherapy, one of the few legal psychedelic medicines currently available and sanctioned by medical institutions.
Ketamine is FDA-approved in the form of the nasal spray Spravato (esketamine), for treatment-resistant depression. While generic, or “racemic” ketamine – the form that is used for intravenous infusions – is a mixture of two mirror-image molecules, “R” and “S” ketamine, the FDA-approved nasal spray, Spravato (esketamine) only contains the “S” molecule.
Most of the research on ketamine in clinical trials for mental health is done using off-label ketamine infusions, which tend to occur at ketamine clinics. As a result, clinics, which look like everything from a med spa to an art gallery, are cropping up all over the country, including progressive and wealthy cities such as New York.
Ketamine’s backstory is wild enough for a Hollywood thriller. It first gained fame on the battlefields of Vietnam, where it proved a safe and effective anesthetic. Ketamine is not considered a classic psychedelic, but rather a dissociative and is still regularly used in anesthesia. If you’ve had surgery recently, there’s a good chance that you’ve had ketamine. It is also widely used in veterinary medicine, earning its unpleasant “horse tranquilizers” nickname. If you have pets, there’s a good chance they’ve taken ketamine at some point, too.
Any therapeutic use besides the nasal spray is done off-label, meaning that it’s prescribed for mental health conditions outside of FDA-approved anesthetic purposes. This approach gives doctors the discretion to treat patients who may not meet DSM criteria, as stated in the diagnostic tool published by the American Psychiatric Association, as well as to work with their in-house psychiatrists. But it also means that the therapeutic approach the doctors take is determined by the clinics offering the ketamine.
“There’s a lot of places out there that look only at the medical sliver of it, which is they give you your ketamine, and you’re on your way. We believe that people need to be supported in the preparation, during their infusion, and after with integration,” says Jay Godfrey, co-founder of Nushama.
Increasingly, clinics seek to provide the experience of a wellness center, and that’s how they want to be addressed. “We provide an experience including preparation for one’s journey,” says Godfrey. “That includes intention setting, breathwork, and helping the participant become at ease in an environment that feels like a dreamscape itself.”
Nushama is even shying away from medical terminology, including the label “patient.”
Godfrey says, “We don’t want people to feel like patients, and we don’t want them to feel sick. We don’t even want to call them patients. We want to call them participants or journeyers.”
Nushama provides both intravenous infusions as intramuscular ketamine injections. Field Trip, another New York City-based provider of therapeutic ketamine, only does intramuscular injections, which they say allows for a more psychedelic experience.
“We do ketamine intramuscularly as opposed to IV, and that’s important because we want people to have a psychedelic experience,” says executive chairman and co-founder of Field Trip, Roman Levy. “We want people to be able to have the visions and revisit past traumas, past experiences, whatever the case may be. So that’s why we use intramuscular because it’s a more immediate onset to a more intense experience, which we want to encourage.”
The Field Trip location might as well be a secret ski lodge, covered in lush murals and greenery. Field Trip offers one introductory session for $750, followed by additional infusions for $750 and an integration session for $250. Six treatments cost $4,500, or $6,000 when included with integration sessions, a common price range for the high end treatment centers
It’s hard to get insurance to reimburse for the cost of these treatments. For instance, according to Nushama, insurance can cover infusions if there’s a dual diagnosis that includes a pain condition. However, insurance will not cover if a diagnosis is only for a mood disorder like depression, PTSD, or addiction on its own. In these scenarios, six ketamine infusions cost $4,000 and include a seventh booster session which is usually administered as needed.
Mindbloom, another increasingly popular New York clinic, takes a different approach that is meant to tackle the affordability issue. They only provide service through oral ketamine tablets that are taken at home. “Mindbloom’s ketamine treatment is convenient, affordable, and accessible, all from the comfort of your own home. We’ve helped reduce the cost of this treatment by 75% over in-person clinic experiences,” says board-certified psychiatrist and addiction psychiatrist Dr. Leonardo Vando of Mindbloom.
While taking ketamine at home removes the benefit of having a medical practitioner supervising the experience, the cost is significantly lower: at $1,068 for six sessions that take place over the course of three months. Each session at New York Ketamine Infusions, which does not include psychological support services, is also therefore less expensive, costing $475, bringing an initial six sessions to $2,850.
Not long after Vietnam, people began to figure out that taking ketamine is fun, and by the 90s its reputation shifted to that of a club drug taken by bright-haired party animals at raves. While popular as a recreational drug in some circles, ketamine’s burgeoning reputation as a mental health treatment is giving it a much-needed makeover. Side effects of ketamine include euphoria, dissociation, and other psychedelic experiences. While high doses of ketamine bring on these states, some doctors say that these outcomes are unnecessary side effects, and that the benefits of the medicine actually begin only after the infusion is finished.
“It’s not about the infusion, it’s not about the ketamine experience,” says Dr. Glen Brooks, founder of New York Ketamine Infusions. “What ketamine is doing is growing dendrites and synapses, which is totally independent of what goes on in the infusion, and doesn’t even begin for ten to twelve hours after the infusion.”
New York Ketamine Infusions has private patient rooms and friendly nurses on staff, but looks much more like a medical center than a spa. Patients who choose to include therapy as part of their treatment will work with their own outside therapist, rather than do integration with mental health therapists on site.
Since the emergence of ketamine as a mental health treatment, providers have been divided on best methods of administration. Some insist that the safest way to treat mental health with ketamine is to provide psychological or psychiatric care alongside the treatments, while others have made the case for administering the drug without trained mental health specialists on the treatment team. Providing onsite support from mental health specialists during the infusions and integration services afterwards increases the cost of these services, which is why some providers do not offer it.
Dr. Brooks of New York Ketamine Infusions says his center does not provide onsite integration services from mental health professionals because he believes that ketamine’s benefits come from its physiological rather than its psychological effects. He believes that it is also not necessary to have a psychedelic experience to find healing with ketamine.
“It’s not necessary for someone to go into a hallucinogenic experience to achieve [the results]. It can be very dangerous pushing some people into these dissociative or flashback experiences,” says Brooks. “Ketamine grows dendrites and synapses. It restores communication between mood center neurons.”
The ketamine therapy centers interviewed for this article describe an intake process that includes mental and physical exams to ensure that a patient doesn’t have any contraindications to the treatment. To ensure that patients have a positive experience, some providers offer check-ins and integration work to maintain safety and help patients chart their psychological process.
For Nushama, that means taking inspiration from practices developed by psychedelic therapists both underground and by participating in clinical trials, says Nushama’s Jay Godfrey.
“The treatment itself is about an hour. But we have about 15 to 20 minutes prior for intention setting, then 15 or 20 minutes after of just coming back to our consciousness. Then after that, another 15 minutes of integration talk therapy,” says Godfrey “If they’re still not ready to go on the subway, which, I don’t blame them, they can hang out and have a cup of tea, have some snacks, sit in our chill-out lounge and spend the day.”
Field Trip also takes this approach, providing a therapist in the room for the duration of a patient’s ketamine experience. At New York Ketamine Infusions, however, while nurses check in, the patient has much less direct support.
The missions of the major players in the New York ketamine scene are the same — to help people function and feel better. But with no standard guidelines it’s up to each provider to determine best practices and ethics of care and up to the patients (or journeyers) to do their research and determine what’s right for them.
“I think we’re all part of a broader solution. Mental health is broken, and I think we’re all brothers and sisters in this fight,” Godfrey says.