Sadness is natural and normal. But depression ruins lives. Kyle Buller knows.
Buller is a counselor in the small township of Denville, New Jersey, an hour west of New York City. A man came to him depressed and asked him to help.
Buller is co-founder of Psychedelics Today, one of the top psychedelic podcasters and education organizations.
Buller thought ketamine-assisted psychotherapy could treat this man’s depression. Although not a psychedelic, ketamine is similar enough to wear the label, since it gives you some distance from your problems. And it can be prescribed.
Buller had options. He could have sent his client to one of many dedicated ketamine clinics, where you typically sit in a chair with a stranger and are pumped full of the dissociative anesthetic. Then typically sent home, occasionally still wobbly.
But evidence suggests ketamine works better if you combine it with therapy. For this, Buller could have sent his client all the way to New York City, where a few companies like Field Trip Health have clinics that combine ketamine with preparation and integration therapy.
But how to combine ketamine with therapy in tiny Denville, New Jersey, population 15,000?
For Buller, it was “challenging.” He struggled to find a doctor to work with to prescribe the ketamine, and Buller wasn’t sure how he’d keep track of the paperwork many find helpful to provide solid care. Plus, what music should he play? Was he adequately trained?
Buller found that solutions to these problems are available.
Companies are popping up focused on decentralizing and democratizing psychedelic-assisted psychotherapy. They are empowering individual counselors to help clients do psychedelics while staying in their home practices, on comfortable couches they know with healers they have a relationship with, to create safe, viable ketamine clinics as small, cozy and local as each person’s office. These companies are handling the music, the actual ketamine, the electronic health records, and the training.
Buller turned to Journey Clinical, a New York-based startup that launched in April and has enrolled 22 therapists, with a growing waitlist. Journey gives therapists nearly all of what they need to turn their normal office into a space for ketamine experiences. Journey connected Buller to one of its prescribers to get the actual ketamine. The prescriber, a Psychiatric Nurse Practitioner, worked with Buller’s patient to make sure ketamine wasn’t contraindicated and was clinically appropriate for his treatment. A ketamine lozenge was mailed to the patient’s house. Journey mostly works with lozenges, which are a gentler trip than the intramuscular or IV methods used in many standalone clinics, and allow the therapist and client to talk. The client can take the lozenge either with their therapist, at home, or during video chat with the therapist.
“We’re talking about a paradigm shift,” says Jonathan Sabbagh, Journey CEO. “We’re now adding something that really is changing our approach to mental health.”
Buller next needed an electronics health record platform, to keep track of his clients’ ketamine use in a way compliant with privacy laws like HIPAA. Journey partners with Osmind, a new software platform designed by two Stanford graduates. An app lets providers and patients track how the sessions are affecting their mood and enables them to text their therapist and even call 911. Osmind co-founder Lucia Huang tolid Lucid News that the private company has raised more than $17 million to hire more staff and expand into more clinics, and is now working with a couple hundred providers.
“Without automation, ketamine administration can be really cumbersome,” says Mikaela Schwab, account executive for Osmind. Osmind even works with insurance companies to try and get reimbursement. Most ketamine treatment is not covered by insurance. Schwab says Osmind has helped some patients get 100 percent of their treatments covered.
Like with all mind-altering drugs, a ketamine journey is affected by the music you play during the session. So Buller turned to London-based Wavepaths, which creates “supportive musical environments” for the patient to listen to during therapy. Wavepaths has playlists geared for different goals, like dealing with trauma or depression.
Buller has so far guided only one client through three sessions. Ketamine helped the client examine, “Who am I when I have a break from my normal thought patterns?”
“I’m really about that relational aspect of healing,” Buller says. “How much trust is in the room for them to let go into the experience. This is allowing us to keep our practice the way we want to practice, instead of trying to turn it into another ketamine clinic.”
The National Institute of Mental Health estimates 7 percent of people suffered a major depressive episode in 2017. To address depression, the ketamine treatment industry is growing exponentially, from an estimated 60 U.S. clinics in 2015 to several hundred today. In an era of decentralization, when offices spread to home offices and banks fragment into crypto wallets, a similar spreading-out may happen with psychedelic-assisted therapy.
Ketamine-assisted therapy is, of course, merely the first wave of a new swell of above ground psychedelic-assisted healing. There are already legally sanctioned mushroom retreats in the Netherlands and Jamaica. MDMA-assisted psychotherapy is likely to be FDA-approved by 2023. Magic mushroom-assisted therapy is on track to be legal in Oregon around the same time, thanks to a ballot initiative that passed last year, and other drugs may become available in new decriminalized environments in other parts of the country.
Many of the companies now working with ketamine are positioning themselves to offer other types of trips as they become legal in the future. Osmind and Journey say they’ll both add MDMA or psilocybin to their programs, if and when those become available.
“We should look at ketamine as a step in the process of what we’re going to be supporting,” says Sabbagh, Journey Clinical CEO. With the right tools and the right rules—most of which haven’t been written yet—psychedelics can potentially be incorporated into existing patient-therapist relationships, without having to outsource the psychedelic experience to new clinics. “There’s no way to effect change at scale without working with the existing system,” Sabbagh says.
Image: Nicki Adams