INCREASING ACCESS to Psychedelic Ketamine Assisted Psychotherapy vs a narrative of the "proliferation of ketamine clinics"
(ongoing edits...)
If you've ever been written a psychiatric medication prescription by your primary care provider, their NP, PA, or a psychiatric specialist, you’ll have noted the questions to assess for a mental health diagnosis like anxiety or depression take 5 minutes to fill out, at most. An ER visit for acute kidney stone pain where after a 9 hour wait, the attending physician prescribes an amount of opioid drugs for pain, after 37 seconds of seeing you takes 9 hours and 37 seconds. Regular primary care doctor appointments in the US are billed in 15 minute increments. If you tell your medical provider you're anxious or depressed, meet the diagnostic criteria, and have decided the risks outweigh the benefits, you may walk out of the appointment for a medication that for some, a side effect is literally not being able to stop taking the daily medicine or risk withdrawal symptoms,thoughts of suicide, and risks of all types of misuse leading to harm to your Self or others.
How many millions of people around the world are on some form of daily psychiatric medication as a treatment for their mental health? The clinicians who follow this approach see the issue as an individual's medical problem, with a daily treatment that may improve some symptoms based on how you answer the diagnostic criteria. Licensed medical clinicians practicing this way were trained this way and are practicing within their scope. It is not, however, within a physician's scope of competency (usually) to provide psychotherapy.
Psychotherapy (i.e., cognitive behavioral therapy, interpersonal therapy, behavioral activation, problem solving) may yield comparable results [4]. However, compared to pharmacotherapy, it may present a few disadvantages (patients need motivation for psychotherapy; competent psychotherapists may not be available; remission from depression tends to be slower than with pharmacotherapy) [4, 5]. Combined treatment, in particular pharmacotherapy and psychotherapy, may offer slight advantages compared to each of the treatments alone in the average case of depression. The benefits are, however, clearcut in chronic forms of mood disorders and double depression [4].
If a patient suffers from severe depression there is little doubt that pharmacotherapy may yield substantial benefits, even though, of course, response may vary from patient to patient, and meta-analyses have challenged the notion that the magnitude of benefit compared with placebo increases with severity of depression [6]. However, if symptoms of mild or moderate intensity are present, clinical trials indicate that benefits may be minimal or nonexistent [7].
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Antidepressant drugs offer a number of advantages in specific clinical situations: they are readily available, they can be administered by nonpsychiatric physicians without specialized training, they act in a few weeks.
Medicine-assisted psychotherapy is supported by more than 100 years of research. In this approach, a medicine intended to have a change in your mental health, regardless of what that medicine is, is not presumed to fix, cure, or give your life meaning just because you ingested it into your body. Working concurrently with a licensed mental health counselor or a licensed marriage and family therapist who is specially trained in medicine approaches, such as ketamine-assisted psychotherapy, supports what the drug is doing in your brain and body, and sets you up for transformation and lasting change, something experienced in your mind. While the time your therapists sit with you under the medicine may or may not be covered by insurance, the preparation before you do this medicine, and the integration of your experience afterwards, can absolutely be covered by insurance using a medical structure that exists more or less around the world without the need to invent new licenses. In the United States, that insurance will UNDERPAY your therapist, in most cases, so many psychotherapists prefer to charge a sliding scale, or offer a superbill to submit to the client's insurance plan to help with some sort of financial reimbursement to the client. Decriminalizing access to medicine so that trained clinicians can support the personal decision to access this approach is essential across the range of medicines that have such effects on the human experience.
Licensed psychotherapists are some of the many types of people and professions who may support you in your experience of being alive on the planet which include teachers, ministers, yogi, death doulas, elder care assistants, nurses, hospice care workers, tripsitters, life coaches, couples counselors, sex therapists, massage and physical therapists, ministers, physicians– to name but a few. Some of these specialists are licensed professionals, and others require no such license. Licensed certified professionals have a minimum standard of training and professional authority within their local communities (at the state level, for example). Any further invention of new licenses of "psychedelic facilitators" adds to the acceptance and recognition of a variety of people and pathways that may help support psychedelic practice.
Psychedelic-assisted psychotherapy is a specific modality of accessing a medicine, while working with a medical provider, a mental health clinician, and in some studies, a second trained psychedelic practitioner in the room, all of whom have to have been licensed as well as specially trained to do this work, in addition to a specially certified pharmacist. This may be in person, or at home, with individual clinicians offering the services they provide under their scopes of practice and competency.
The experience that may be elicited from medicines like MDMA or psilocybin can be 6-8 hours. These medicines are being tweaked, then patented and brought through an FDA approval process, requiring expensive, extensive quantitative research review by competing interests. Ketamine, on the other hand, elicits a predictable experience lasting from 1-3 hours, and has been prescribed in various forms in various out-of-clinic settings for decades. Racemic ketamine was FDA approved as an anesthetic, safe in high and low doses in humans and animals in 1970. Ongoing research on ketamine in humans and animals spans 60+ years. Recently...
It doesn't take long to get a prescription if you don't have the medical or psychiatric contraindications to be prescribed this medicine, and your medical provider is not attempting to see 20 patients per hour for 37 seconds at a time. Social media click-bait headlines warn of easy access to mental health care and medicine, as if this were a bad thing, and will, no doubt, move on to other hot takes on psychedelic practice about which to panic. It is important to consider medicine given with the right support can be prescribed just as quickly and easily as prescribing medicine without that support. Ketamine has been studied and prescribed off-label in conjunction with psychotherapy for treatment-resistant mood disorders ranging from anxiety to trauma. Proper screening and support requires prescribers to collaborate with certified psychedelic-assisted psychotherapy and/or psychedelic support specialists who have had documented experience with that particular medicine at the usual dosing range. "How long" it takes to get proper access to your medical provider and to some level of mental health support is a larger issue, and where the personal becomes "political", and requires advocacy from each of us to demand proper medical care and mental health care, which is accessible at home and in remote locations around the world. It's not about "easy access" to ketamine. It's about "proper access" to care, and the support needed to work towards healing.
While it may sound like media hype, when this approach is successful, clients do report profound changes that are sometimes described as mystical and lasting. Cultures around the world take various approaches to working with medicines and with the non-medicine approaches related to what has been coined "the psychedelic experience". The people within each culture, who work with these medicines and practices, are fulfilling the same aforementioned roles (medical, mental health, spiritual, or other type of care provider) generally recognized and accepted within the local community. Psychotherapists and medical providers are encouraged to have first-hand experience with the medicines they prescribe when not medically / psychiatrically contraindicated to truly begin to understand what a patient may experience in the process of psychedelic-assisted psychotherapy.
On Advertising
Sample of Johnson & Johnson's advertising, top of search results. Only certified providers may prescribe this medicine, sold from certified clinics, which also exactly describes a pyramid scheme? Aren't the Spravato doctors who have a vested interest in prescribing one brand-name medicine over medicine they know exists at $12 a vial in its generic, racemic form? Isn't Johnson & Johnson hiring doctors to prescribe their drug which they sponsored the studies for? It's a problematic system that extends way beyond whether there is a new IV-ketamine clinician practicing or what new startup finds a tech-savvy way to provide accessible care. Neither Spravato clinics nor Mindbloom collaborate with mental health providers of cognitive behavioral therapy.
Over 60 years of research has shown the predictable and replicable effects of ketamine in humans, and there are proven mental health benefits that are maximized by work with mental health specialists and support. With no contraindications, and meeting the criteria to work with this medicine, we can reframe the concern for how quickly someone can be prescribed ketamine to being concerned about making this lifesaving medicine more accessible, with proper support, to as many people as possible. The standards of practice are dictated by each provider's local license as a medical provider allowing the prescription of ketamine (or other medicines that may have effects on your thoughts/feelings/behaviors). Licensed psychotherapists specialize in medicines that assist psychotherapy, ensuring both a standard for practice (by being licensed mental health providers) and competency (by specialized training with each medicine approach). Important context for the next headline that includes something about the Wild West of ketamine. In working towards healing, any approach comes with risks that should be reasonably weighed, and not ignored, whether working with a synthetic medicine like Prozac or Zoloft... or ketamine, or a traditional plant medicine like ayahausca or psilocybin mushrooms. Now let's talk about the problems of quick access and impulsive/compulsive use of alcohol, nicotine, botox, testosterone, CBD, THC, Viagra, sugar...
THE SEQUENTIAL INTEGRATION OF PHARMACOTHERAPY AND PSYCHOTHERAPY IN THE TREATMENT OF MAJOR DEPRESSIVE DISORDER: A META-ANALYSIS OF THE SEQUENTIAL MODEL AND A CRITICAL REVIEW OF THE LITERATURE (GUIDI, ET AL, 2015)
COGNITIVE BEHAVIORAL THERAPY TO SUSTAIN THE ANTIDEPRESSANT EFFECTS OF KETAMINE IN TREATMENT-RESISTANT DEPRESSION: A RANDOMIZED CLINICAL TRIAL (WILKONSON, ET AL, 2021)
EFFECTIVENESS OF COGNITIVE-BEHAVIOURAL THERAPY PLUS PHARMACOTHERAPY IN INPATIENT TREATMENT OF DEPRESSIVE DISORDERS (KÖHLER, ET AL, 2011)
NON-PARENTERAL KETAMINE FOR DEPRESSION: A PRACTICAL DISCUSSION ON ADDICTION POTENTIAL AND RECOMMENDATIONS FOR JUDICIOUS PRESCRIBING (2022)Feb 23, 2023ADVERSE EFFECTS OF KETAMINEFeb 23, 2023PSYCHEDELICS: ALTERNATIVE AND POTENTIAL THERAPEUTIC OPTIONS FOR TREATING MOOD AND ANXIETY DISORDERSFeb 23, 2023
Additional Harm Reduction Resources:
Ketamine Psychedelic Therapy Telehealth | CA, NY, UT, VT | Palm Springs | Joshua Tree
Ketamine psychedelic therapy via telehealth for residents of CA, NY, UT and VT. In person / on location / home visits available | Palm Springs psychotherapist collaboration with a medical provider of your choice or by referral.
Psychedelic medicines assist psychotherapy, especially evidence-based methods such as cognitive behavioral therapy in individuals, families or groups.
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