Thinking outside the box with ketamine
K-Hole Sun, Won't You Come?
It has been a month now since Missouri began approving licenses for dispensaries to sell recreational marijuana, and the state’s 200 dispensaries have already outpaced Illinois in recreational sales.
Medical marijuana has been legal in Missouri for three years now, and the legalization of recreational marijuana speaks to a certain validation or curiosity in its redemption following several decades of stigma.
The majority vote in favor of Amendment 3—which promises to expunge low-level drug offenses—speaks to the growing sentiment amongst Missourians that individuals should not be detained, cited, or arrested for minor possession of a drug now legal in more than 20 states. Although it is far from a perfect solution to the deeply problematic war on drugs that has been waging since the end of the ’60s, its approval reflects a growing affinity for a different approach toward drug regulation.
Whereas marijuana pertains more to symptom management, psychedelics—a specific type of psychoactive drug (like psilocybin, LSD, MDMA)—are following a similar trajectory. On a national scale, after several decades of suppression and neglect, research groups around the country, the most prominent being Johns Hopkins and NYU, are conducting clinical trials to recover something precious that has been lost in both science and culture.
Ketamine, much like the aforementioned psychedelics, holds potential in the realm of healing psychological disorders, particularly major depressive disorder, anxiety, trauma disorders, and chronic pain. This might come as a surprise to you, considering you might know ketamine as a party drug whose overindulgence ends in a dreaded K-hole. Or perhaps you know it as a horse tranquilizer, and in this case, you might request one when you learn that it’s used as a sedative on children, just the same. It’s F.D.A approved, so seriously, calm down.
Both are true (although both K-holes and anesthesia occur at significantly higher doses than administered in a therapeutic setting). Ketamine was synthesized by a researcher named Calvin Stevens in 1962. Stevens did consulting work for the pharmaceutical company Parke-Davis. He sought to replace the volatile PCP with an equally anesthetic, less unpleasant alternative.
Two years later, a doctor named Edward Domino conducted the first human trials of ketamine with men incarcerated at Jackson State Prison. Domino observed that ketamine, when administered at higher doses, completely knocked patients out. At lower doses, however, it produced psychoactive effects on otherwise lucid patients.
Parke-Davis did not want to characterize ketamine as a psychedelic, and Domino’s wife suggested the term “dissociative anesthetic” to describe the way the drug separates the mind from the body even as the mind retains consciousness.
Evidently, the term stuck. Despite ketamine’s ability to elicit psychedelic effects under the correct circumstances, it has enjoyed immunity from the stigmas and legal limitations imposed upon drugs like psilocybin and LSD. Following continued research, the National Institute of Mental Health concluded that a single intravenous dose of ketamine had rapid antidepressant effects in 2006.
Currently, the research and debate surrounding ketamine do not consider whether it can treat depression, as this reality is solidified. Rather, the focus is on the most effective delivery method and how drug companies and healthcare providers can best profit off an “off-label” drug.
Ketamine is what’s called a “dirty drug,” meaning that it acts on different parts of the brain at once. Several neuroscientific theories exist regarding its ability to lessen depression, and most acknowledge its effects on certain receptors in the brain, particularly the neurotransmitter glutamate.
An individual ready to spend several hundred dollars who does not demonstrate active mania or psychosis, a predisposition to schizophrenia, or drug-seeking behaviors can access a wide array of ketamine treatments: a titrated dose given intravenously by a nurse practitioner in a private practice, an oral lozenge sent in the mail by a startup taking advantage of pandemic-era changes to the regulation of remote prescriptions (red flag!), or an insurance-covered, questionably effective nasal spray under the brand Spravato.
Beyond cost prohibitions, ketamine is widely accessible. It’s on the frontier of a renaissance in psychedelic medicine and perhaps a shift in medicine and science at wide.
“I like to do things I don’t know anything about,” says Kelly Funk regarding her experience with sublingual ketamine therapy. Funk’s background is in social work, but after an extended hiatus, she transitioned into life coaching as an intentional step away from the hierarchical dynamics associated with social work.
This hierarchy-averse, client-centered approach reappears among patients and practitioners of ketamine therapy. It’s a selling point for the visionaries and disillusioned, and it’s a source of skepticism for individuals immersed in a more medical model of healing.
Tara Haddon works as a Licensed Clinical Social Worker and Licensed Clinical Addiction Counselor who specializes in substance abuse and trauma and also administers sublingual ketamine therapy through her private practice, The Awaited Journey, LLC.
“I trust in people’s innate wisdom and their ability to heal themselves,” says Haddon.
Haddon’s approach might seem radical—woo woo, perhaps—to the skeptics of the bunch. She begins her sessions with guided meditations, intention setting, and, occasionally, poem readings. Her office space is laden with Himalayan salt lamps and crystals, and she sits on the floor next to her patients—who may opt for a couch or mat—as they ascend into their ketamine trip. She is straightforward about who she is, and if a client does not resonate with her space or approach, she is happy to redirect them toward better-suited services.
Zach Dillon, a nurse practitioner who administers intravenous ketamine therapy at a private psychiatry office in Kansas, follows a more classical psychology approach. A couch rests against a massive window that consumes the north wall of Dillon’s office space, and it’s on this couch where his patients, hooked up to an IV, lay on their backs with a face mask, blanket, and headphones that stream an instrumental playlist curated specifically for their needs.
If you’re familiar with the theories surrounding psychedelics, you may have heard of the importance of set and setting. Set refers to one’s state of mind, whereas setting refers to the environment in which an individual trips. Prior to inserting an IV, Dillon ensures that he and his patients have set intentions and cultivated a safe space where they feel comfortable to explore the depths of their minds.
“It is important that individuals who take ketamine are with someone who understands the psychedelic experience and who can help them and guide them,” says Dillon.
Brigman Bell, a 23-year-old living in North Kansas City, connected with Dillon after a simple Google search: “Antidepressants left me feeling dissociated a lot of the time. I was having a mental breakdown in my car during work hours—the third one that week, and for no apparent reason. So I literally googled ‘I’m at my wit’s end,’ and it generated results for ketamine therapy.”
Bell completed the last of his six sessions of intravenous ketamine therapy a few months ago.
“I felt like I met God. My first time going under, I felt like I was hovering over the planet, but I also felt I was the planet. It was this sense of oneness. It made my problems feel small. I could remember instances of anxiety and depression, but I could no longer connect to my feelings of anxiety and depression.”
Bell’s father drove him home after his first session. Bell remembers that his dad laughed and told him, “You look high as hell.” Following Bell’s final session, his father arranged to try ketamine therapy himself.
Matt Soer, a paramedic and firefighter in KCMO who finished his fourth dose of intravenous ketamine therapy three months ago, echoed this psychospiritual sentiment as he described his first session as “an exceedingly spiritual out-of-body experience, inside my body.”
“For the rest of the day [after my first session], I felt awesome,” Soer says. “You can ask my wife…I just had a grin on my face.”
Soer’s second session took a slightly darker route. He recalls reliving painful experiences from childhood and his twenty years as a career firefighter.
“Simultaneously, I felt protected, as if I was safe enough to explore these dark thoughts and they could not hurt me,” Soer says.
“Psychedelic medicine like psilocybin or ayahuasca can flood the nervous system, whereas ketamine does not. Neuroscientifically, ketamine is considered a sedative, analgesic, and dissociative, so at the right dosage, it can help individuals, particularly with trauma, tune into their thoughts and emotions without panic,” says Haddon.
This explains why ketamine, at lower levels, is employed to relieve individuals of chronic pain or lubricate individuals for talk therapy. It’s the higher levels–typically produced via IV or intramuscular injections–that induce the psychoactive effects.
Funk chose sublingual ketamine as she perceived the risks to be lesser. She admits that she also wanted to avoid nausea, which is more common with IV and intramuscular injection deliveries. Nonetheless, Kelly Funk’s recollection of her sublingual ketamine therapy session reads like a classic mystical trip.
“The closest thing I’ve ever done to it was a lightly hypnotized past life regression, during which I asked myself, ‘Am I making this up?’ I was in this hollow room filled with multi-colored snake toys. It became very apparent that I was the room and also journeying through this room, and all of a sudden, it would bend, and I would feel absolute terror. At some point, the room was closing in on me, and I remember wondering to myself, ‘Will this kill me?’ I was not panicked at this point, but I believed that it was a distinct possibility. So I went with it, and I felt this unbelievable freedom…just like…wow. I’ve had a lot of predatory men in my life, and what I emerged from this experience with was the realization that they cannot hurt me. For the next three weeks, I just felt…easy. Like so easy.”
She acknowledges that as time passes, she feels further from that sense of ease.
“My worry would be that for people who do not have the discipline or a sense of self-worth…like a drive to integrate the therapy into their lives…is that they might lose the therapeutic effects,” says Funk.
Her fear is legitimate. Ketamine is not a cure-all. To tune out requires a level of openness and loss of control, and to tune back in with sustained positive change requires effort and persistence.
Dillon provides 50 minutes of talk therapy following his patients’ 40-minute ketamine sessions as a start of an integration process. He also recommends booster therapies as necessary.
Phil Wolfson, who co-edited “The Ketamine Papers” and currently offers sublingual and intramuscular injections, in an article with The New York Times said, “Ketamine really makes no sense. It’s not attached to subjective experiences—themes don’t occur, or, if they do, they might not be particularly psychological in nature. I’m not reformed by neuroplasticity; I’m reformed by having had a break from the obsessions of my mind.”
He suggests that while ayahuasca or mushrooms produce visions that coalesce into narratives, ketamine gives a brief experience of the void.
“The essence of ketamine is for individuals to tune out to reconnect to the world in a way that they want,” Hadden says.
“I do not think I would have been as receptive to ketamine had I not been involved in talk therapy for a year and a half. And I do not think the EMDR following ketamine would have been as effective had I not tried ketamine,” says Soer. He would recommend ketamine therapy to others with a caveat: “Involve your therapist. Be intentional about the space in which you try ketamine therapy.”
The risk for individuals who dabble with psychedelic states is, as Wolfson puts it, “the loss of the monitor that overrides and guides us through the labyrinth of life, as best as it can.”
Individuals lose this monitor when they become too attached to drugs. In the ’80s, John C. Lilly, a doctor and psychoanalyst famous for sensory deprivation tanks, dabbling in human-dolphin communications, and advocating for ketamine, became addicted to ketamine. A researcher who crossed paths with him recalled Lilly spending most of his time in his Volkswagen minibus, injecting himself with ketamine multiple times a day.
The lesson? With privilege comes responsibility. As we approach psychedelic medicine a second time, it is essential to proceed with courage, humility, and respect for ourselves and the substances. Lilly’s narrative was not a great look for ketamine. It fused with the moral panic that emerged in the early ’70s (with an emphasis on LSD) and stunted promising research conducted on psychedelic medicine since the ’30s.
It seems that the U.S. functions as a pendulum, swinging from one extreme to another and never really settling at a middle ground. Maybe the middle ground is unattainable, or maybe it exists here and now in this space of possibilities and unknowns. The unknown is a space we resist. As we become disillusioned with elements of our current reality, it’s important that we don’t rush to define another.
Perhaps we all take a deep breath and allow reality to unfold around us.