Ketamine's Role in the New Frontier for Addiction Treatment & Mental Health with Brad Masters

Dive into the captivating realm of ketamine therapy for addiction and mental health in this thought-provoking episode. Join us as we navigate the complexities and controversies surrounding its potential to revolutionize addiction treatment and mental health recovery. With Brad Masters, a visionary paving the way for health and growth through ketamine therapy, we explore its role in treating treatment-resistant depression and relieving suicidal ideation, shedding light on its saving nature for those in need. From its origins as an anesthetic to its emergence as a innovative treatment, we uncover the latest research supporting its efficacy in reducing cravings, withdrawal symptoms, and relapse rates among individuals struggling with substance use disorders. But can this therapeutic drug truly help addiction treatment? We address this pressing question along with ethical considerations, potential risks, and ongoing debates surrounding its use. Whether you're a family member, skeptic, clinician, or someone personally affected by addiction and/or mental health, tune in for a nuanced exploration and gain valuable insights into this cutting-edge approach to a form of healing and recovery.

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Transcript

Speaker 1: 0:03

Welcome to A Therapist, a Buddhist in you, a sanctuary of contemplation and insight where we explore the profound intersection of therapy, mindfulness and holistic well-being. Today, our journey takes an intriguing turn as we delve into the realm of innovative healing modalities. So picture this a gentle wave of transformation sweeping through the landscape of mental health care, a new horizon illuminated by the promising glow of ketamine therapy. And no, folks, you're not hallucinating. This is one trippy narration you can trust. In this episode, we embark on a journey guided by the wisdom of a therapist, the compassionate teachings of a Buddhist and the shared curiosity of all who seek healing. Ketamine, a substance once known primarily for its anesthetic properties and hallucinations, has truly emerged as a beacon of hope for those grappling with treatment-resistant mental health conditions In therapy rooms, research universities. In therapy rooms, research universities and medical circles alike. Its ability to heal and bring about transformation is being meticulously investigated, sparking both curiosity and hope. Today, as we gather in the sacred space, we invite you to join us on a voyage of discovery, a journey beyond the confines of conventional medicine and into the realms of possibility. Together, we'll explore the nuances of ketamine therapy, seeking insight and understanding amidst the complexities of mental health and addiction. And amidst these discussions, there's a pivotal question on many minds how might ketamine therapy intersect with a delicate journey of recovery from substance use?

Speaker 1: 1:49

Today, we'll delve into this crucial inquiry, shedding light on its potential benefits and addressing the valid concerns surrounding its usage. As we navigate this terrain, we recognize the unique challenges and complexities faced by individuals in recovery, and we aim to provide insight and guidance that honors their journey towards healing and wholeness. So take a deep breath and allow yourself to be fully present in this moment of exploration and inquiry, for in our shared quest for understanding, we illuminate the path toward healing and liberation. And if you're so liberated, share this episode with others, as collectively we can do things together that we can't do by ourselves. And like and follow also goes a very long way for us, and an offering of gratitude from us in the form of US dollars will help pay for this platform that you're hearing us on and courses put on by Zoll in the near future. So let's get started. So, zoll, we have a potential spicy topic today, don't we? Yeah, we do. I'm excited. So, as a Buddhist Zoll, what are your initial thoughts on ketamine as a treatment or a modality, as he's smiling already?

Speaker 2: 3:08

I don't know, I have different thoughts, different opinions about it. But I'm more curious about um the conversation. But I mean from the point of view of the mind. I'm always fascinated by the mind because I've had some trips in my active addiction too. So, like that control way of supervised, way of what is being revealed by the mind, it's quite fascinating.

Speaker 1: 3:30

So yeah, yeah yeah, this is going to be a fun topic today, isn't it For sure? Well, let's welcome Brad Masters. He's a recognized leader in the mental health sector, with a wealth of experience and a passion for driving positive change. Brad's journey began in the residential addictions field before he transitioned to his role at Discovery Behavioral Health, where he quickly rose to the position of group chief executive officer. In this role, he oversaw the management of residential and outpatient facilities, demonstrating a commitment to enhancing patient care and experiences. Currently serving as the director of Client Experience at the Mood Center, brad's expertise aligns seamlessly with his dedication to creating impactful and successful patient journeys in mental health care. We are thrilled to have him join us today as we explore the realm of ketamine therapy and its potential benefits for addiction treatment and really all forms of health and well-being. Welcome, brad. Thanks for joining us.

Speaker 3: 4:25

Yeah, thank you. Thanks for having me, guys.

Speaker 1: 4:27

Yeah, well, let's get into it, shall we? Yeah, let's do it. Can you provide just a general overview of ketamine therapy and very open? We'll start there.

Speaker 3: 4:37

Yeah, I mean I guess we can start with, used in this form, what's actually happening? You know how does it work. Ketamine's been around for 50 years. It's been widely used as an anesthetic for surgeries Very, very safe. So do you think people?

Speaker 1: 4:55

know that Like ketamine's used like opiates are used for therapy and surgeries. I mean, I think that might surprise people.

Speaker 3: 5:01

It might. I mean, what's interesting is a lot of times I'll mention ketamine to people oh, the horse tranquilizer, and it's like no, it's actually soldiers carry it on the battlefield. Almost every ambulance carries ketamine with them. They actually use it even to put adolescents under for surgery. I mean, it's a very safe substance and it's been used for a very, very long time in a lot of different ways. It wasn't until, I would say, probably mid-2000s, somewhere in there they started to realize how well it worked for depression, and one of the theories is that when depression scales started to become more mainstream, they started noticing that when they would use ketamine as an anesthesiologist to put people under and people were rating high on their depression scales, they were coming out of surgery and those symptoms weren't there anymore.

Speaker 1: 5:50

They usually don't go together. Yeah, surgery and lack of low mood.

Speaker 3: 5:54

Yeah, exactly. So they started to do some research around it and essentially what they found so there's really four primary ways when it comes to treating mental health, that ketamine works. So the first thing is it blocks the NMDA receptor, which in turn affects chemical called glutamate, which in turn affects something called neuroplasticity, so literally the brain's ability to reorganize itself and build neural networks and open pathways. It's all enhanced, and this happens one to three days during and post your infusion, right. Second thing is a chemical called BDNF, or brain-derived nootropic factor. So this follows that same pattern. So this surges during and post infusion.

Speaker 3: 6:35

These are all controlled infusions, controlled dosages, those kinds of things right, all medically monitored and above board. When BDNF affects neuroplasticity as well. Well, but what's really cool about bdnf is its ability to to heal cells and neurons that have been damaged due to depression, anxiety, trauma, ptsd, even chronic stress, right. So you have this, this co-occurring thing happening, where you've got the brain's ability to adapt and the brain's ability to heal kind of happen happening simultaneously. The third thing is something called the default mode network in the brain. So this is where it's hypothesized, this is where the ego is so let's break it down first.

Speaker 1: 7:16

So there's a medically monitored intake of ketamine, yep, and then it goes to the brain and then what happens? So you've got the NMDA receptor that gets blocked. So the receptors are like there's a receptor for opiates, receptor for, like, serotonin, and feel good. So okay, so we got that receptor.

Speaker 3: 7:37

So that receptor gets blocked and then that affects the chemical glutamate. Glutamate then affects neuroplasticity, so it's a cascading effect. Bdnf something totally separate. That's something that that happens as well. Right, so there's really four separate mechanisms, four primary mechanisms on why they think ketamine works so well in treating treatment resistant conditions. Right, the default mode network in the brain. It's really interesting because there's a lot of mechanisms that there's a lot of reasons. This is important, but it's hypothesized that that's where the ego is. Interestingly natural things that can quiet down the default mode network of the brain when it's overactive. Meditation is one of them. It takes a long time to develop, though Ketamine shuts it down immediately. What's really interesting about that is when the default mode network of the brain is overactive, negative self-talk is ramped up. You might be internalizing things external to a very unhealthy level. It can allow you to almost step outside of yourself for a minute and gain a different perspective.

Speaker 1: 8:39

So when medically monitored ketamine is given, it inhibits or it blocks part of the belief system. Is the ego, part of the brain, correct, interesting? Yeah, okay. And the reason why that is so beneficial for people with suicidal ideation or depression. Explain that to us.

Speaker 3: 9:02

So suicidal ideation. For example, negative self-talk, default mode network. You got negative self-talk ramped up. The default mode network's overactive. So in turn you've got that negative self-talk that's ramped up that the person's seeing no relief from whatsoever, right, so consistent negative self-talk. They can't see a way out of it. It's happening over and over and over and over again. So imagine having that prevailing thought all the time and not being able to see a way out of it, and then all of a sudden, instantly, it's gone.

Speaker 1: 9:35

So, for example, that internal critic that says you're a piece of shit, you don't deserve this, you're not worthy of that, you suck. You're never good enough.

Speaker 2: 9:46

During this treatment during goes away infusion.

Speaker 1: 9:47

Yeah, so the brain all of a sudden goes.

Speaker 2: 9:50

Ah, exactly, okay, exactly, fascinating yeah, how do you call that again?

Speaker 3: 9:56

default mode default, mode network default mode network yeah, and then finally, it's a. It's a powerful um-inflammatory, which is also one of the reasons it works so well for pain, so it treats chronic pain too, really, really well. But also been able to link depression and anxiety to inflammation in the brain.

Speaker 1: 10:14

So I think this is one of the reasons really for years now that the whole quote-unquote wonder drug For some people. They've tried, like you said, treatment-resistant right Certain medications for years and it's never been able to stop the intrusive thoughts and or stop the horrible dark, low depressive mood, yep, and during this treatment it can do potentially both.

Speaker 3: 10:42

It has the potential, yeah, yeah can do potentially both they. It has the potential, yeah, yeah. And and I mean imagine it can also help, you know, when that's shut down help a lot with perception on things. I mean a lot of times when the ego's in the way, we can't see a way out, right we're. We're stuck kind of in the middle of a situation like it's not uncommon going into somebody's room after after an infusion and saying, hey, how was that the person's like? Why it's like I was on the outside of my life looking in for the very first time. That can offer a glimpse of a shift in the way you think about things and the way you perceive certain situations in your life.

Speaker 1: 11:19

What are you thinking right now, Zal?

Speaker 2: 11:20

Yeah, I have a lot of questions, but one thought that comes to mind. I don't want to go so far backtrack, but as you're talking, it makes me think about, since you mentioned about meditation too, so maybe you can expand more on that. But the analogy that comes to mind is about if there's a destination, if I figure out how to get there, I get there, and when I get back home, I know how to get back there. But then what if I get transported to that destination and I don't even know how I got there, how do I figure out how to get back there? So that's the analogy that I'm thinking about the difference between ketamine and meditation, and we've got relief, and that can happen through meditation or a ketamine treatment.

Speaker 1: 11:57

So how does that happen?

Speaker 3: 12:00

Practicing meditation, you learn how to get there on your own is what you're saying, and if there's something that's providing that instantaneously, how do you know how to get back there Is that.

Speaker 3: 12:11

I can't. I don't know the answer to that specifically, but what I do know is that there have been and I'd have to find the exact articles, but I read somewhere the link between meditation practice is actually getting stronger post ketamine therapy well, I think one thing that we've seen a lot and you'd certainly talk about is the possibility for new neural pathways, correct? Their neural networks.

Speaker 2: 12:36

Yeah, yeah it does sound very beneficial, like the way you describe about that ego getting out of the way, because for some people like you're describing, when you're stuck in that negative self-talk, it's impossible to imagine life without negative self-talk. So when you end up having like a glimpse of how it feels, like maybe it becomes like a motivation for that person to maintain that.

Speaker 3: 12:58

Well, 100%, absolutely, and I think you know specifically when we're talking about suicidal ideation and conditions like that. I mean, I personally believe right now we've got somewhat of a broken system in the mental health field. If you have somebody who's suicidal, essentially if they're not willing to go inpatient or be hospitalized and monitored on their own, as a clinician, you have to EP them, emergency, petition them to where they go into the hospital and they're on hold. A lot of times that situation doesn't work out that well. You know what you're really doing is you're kind of shoving people down further inside themselves.

Speaker 3: 13:34

There's a trauma response to that. A lot of times the police are involved. You're being hospitalized. The tools that we're using in all those different levels of care are all the same, meaning the medications that we're using right, whether you're in hospital or you're going down through the levels of care. We now have something that potentially has the ability to and it's not necessarily potentially I've actually seen it happen where, as long as somebody is appropriate, instead of going to the hospital or coming from that environment, from the hospital, you're going into a ketamine chair and almost instantly you're getting relief from those thoughts.

Speaker 1: 14:09

As opposed to the shot of Thorazine, where all of a sudden you're in a making this more dramatic zombie-like state. Yeah.

Speaker 3: 14:17

Yeah, and we're opening you up. You're being opened. What do you mean by that? So it's not uncommon that people can be resistant to talk therapy. They've had bad experiences in the past. They haven't been able to make a connection with a therapist in the past. It hasn't worked for them right. I've had many people who have come through and we always recommend talk therapy in conjunction with ketamine therapy. I think it's a very important piece of it being able to process. In fact there's ketamine therapy. I think it's a very important piece of it being able to process. In fact, you know there's. There's ketamine assisted psychotherapy, which is a whole modality around it. Um, but patients who are resistant like I've had many patients come through who are resistant to therapy and about halfway through their sessions, uh, with ketamine, they're ready for a therapist, they want to talk to somebody, they're opened up.

Speaker 2: 15:03

You know, know, they see things a little bit differently, or or things are, things are coming to the surface yeah, another approach that I'm thinking about, uh, maybe you're familiar with this inputism like mine is one of the organs, uh, just like the hearts or the, the, you know, lungs or things like that. So in that way I don't own my mind, but it responds to how I treat it.

Speaker 2: 15:25

So if I'm feeding negative thoughts into it, it responds back with negativity. So it's like an organ which is also like a little living thing. If I'm kind to it, it's kind back to me. So I'm looking at it from that point of view too. About if ketamine as a treatment it's like you're treating it in a kind way, so in response it's responding in a kind way again. That's how I'm makes total sense we had.

Speaker 3: 15:47

We had a patient, um, come through who, uh, was dealing with suicidal ideation. Um actually had to go to the hospital before we could get in for an assessment, because safety first in all situations always. But we were able to coordinate care with the hospital and they were able to come directly to us from the hospital and they went into the ketamine chair and I went in to check on them afterwards and a big smile, just a large smile on their face and I was like well, how was it? How are you? What's going on? They said. I don't really know how to explain what just happened. Like I came in here not being able to think about tomorrow and now I'm sitting here thinking about my finances and going back to school. I don't, and this was in an hour and a half, so it just the perception shifts that can happen are quick.

Speaker 1: 17:55

I'm trying to think of this like a medical model where I often use this the pancreas produces insulin, sometimes it doesn't, so then diabetic receives insulin. So if the brain is not functioning appropriately, or stuck, okay good, what do you mean by stuck? Because I know you'll take that somewhere.

Speaker 3: 18:25

Yeah, we can become stuck and trapped in our own patterns, in our own brain, in our own thought patterns right.

Speaker 1: 18:32

So the neuroplasticity, the way it's wiring the active parts of the brain, are doing something where it's looping in a dark, negative way.

Speaker 3: 18:43

Absolutely actually to go back to, to your question like how do you learn to get back? I think that's actually a really good example of neuroplasticity, right. I think you build these patterns over time and you're right, like a solid meditation practice, over time You're training your brain to do something over and over and over again and to respond a certain way. Right, ketamine is basically priming your brain to be able to change that and to build those patterns quicker, right? So we talk a lot about when you're going through ketamine therapy. Sometimes the patients see these profound shifts, profound changes quickly. I, I mean, I'm talking in like two to three weeks. I've seen people their whole demeanor's changed. Other times people start to see small little shifts in their life, like they're just thinking about something a little bit differently, or, um, you know, we, we had somebody come through with a ptsd reaction to loud noises and they had a toddler in the house. So you can imagine that was creating a lot of issues at home and after I think it was two or three sessions, the patient reported the noises would happen and he would know how he would normally react to the situation. But he was able to think about it and not react and kind of change his mind right. And so we talked. We talked a lot to patients about no matter how small or seemingly insignificant the change is in your life, celebrating that and reinforcing it and building that, building new patterns. So I mean, we had um, we had a pay and it comes through. So, like the current treatment model for ketamine iv and im ketamine is six sessions over the course of two to three weeks. The reason for that is is, as we talked about the, the glutamate response and bdnf response, you're looking to kind of keep those things elevated over that. That initial phase. It's almost like a springboard right. And then you do boosters. Essentially most people start once a month and then eventually you try that back to once a quarter and then eventually, with ketamine, eventually the plan is you don't have to come back because you've kind of built those new neural networks and those new patterns. And this is what I mean by kind of seemingly small we.

Speaker 3: 21:01

We had a patient come through who, uh, the older couple, the wife, was uh pretty severely depressed for for many, many years and, um, they had come through for the all six and they were on their booster. And I remember talking to her before she went into the room and I'm like hey, how are you doing, how are you? I don't know, I'm not, I'm not a hundred percent sure, which also you know, a lot of times we do industry standards score, score scoring on everybody. So PHQ nines, gad, sevens, that kind of where people are A lot of times their scores, their depression scores, will show improvement before, sometimes, before they recognize things have changed, or family members start to notice things are changing, depending on the person. So this in particular person, I'm not sure, maybe a little, you know, I don't know. And then the husband comes out and grabs me, he goes. I got to tell you something Like what she's been getting up every single morning for the past week and a half and making the bed. For the first time in 20 years that hasn't happened.

Speaker 3: 22:04

She hasn't never gotten out of bed that early, seemingly small, oh big, oh she, he or she showered every day consecutively, all week, right, huge, yeah, those are huge things, and so a lot of it is awareness too and in building those new patterns, and I think it actually aligns really well with what you were just talking about in terms of it's just enhancing that ability to train the brain to get there, if that makes sense.

Speaker 2: 22:32

Yeah, it does.

Speaker 1: 22:34

I think that also highlights for me advocating for people getting this type of treatment. Do this with processing, with a therapist yeah, you know, getting the ketamine treatment and then a therapist can really help you identify what are the differences, what are what feels like stuck points, how can we create new neural pathways, whether it's a therapist or a coach that understands this process? I mean, that's huge for the I'll say, the acceleration of creating those new neural pathways.

Speaker 3: 23:05

Completely agree. I would say the two components of that that are probably the most important are setting intentions prior to the session. So coming in prepared, preparing the mind for kind of what your intention is, what you're hoping to get out of it, and then the processing session. So coming in prepared, preparing the mind for kind of what your intention is, which you're hoping to get out of it, and then the processing afterwards. So there's actually a documented 24-hour post-infusion to take advantage of therapeutically, where I don't want to use maybe the word open is too strong, but people are more. It's more fresh. What happened in the room is more fresh.

Speaker 3: 23:38

We give every patient a journal so you can journal about it. The infusion time is anywhere from 45 to 50 minutes but you're in the room an hour and a half so you have time to kind of journal about anything that might have come up and kind of recoup so that you know you can process that later. But the intention setting is also super important. So you know what we talk about a lot, for intention setting is core beliefs are important in that I think. So let's say, you're coming through and social anxiety is severe, social anxiety, right, and we you know you're talking about with your therapist and and the core belief driving that anxiety is I'm not good enough. It's self-esteem issues, right. So you might come into the room with a mantra of I am good enough, I'm whole, I am enough, and you might be repeating that going into your session and then that kind of gets reinforced.

Speaker 1: 24:33

Yeah, the way I relate it where the energy goes, the energy flows if there's not a blockage, correct. Really, where the energy goes, the energy flows if there's not a blockage, correct, right. So if that that brain is not functioning the way it could be in a healthy way, if it's blacked, you're saying the ketamine can help, like you, setting the intention can have the energy go in the right direction and then the treatment happens and then it begin the new neural pathways right there and then yeah, yeah, yeah, it's um.

Speaker 1: 25:00

People can have some, some pretty amazing experiences one more piece of the medical aspect in the physiological aspects. I'm sure there's some listeners that are thinking well, why, for a lot of people potentially why does an ssri or an snri or wellbutrin or prozac? Why is that not doing this for them?

Speaker 3: 25:23

completely different mix. So since prozac came out in the 80s, essentially, um, the medications have all essentially worked very similarly. Which is it really what they're doing? Is they're turning the volume up on different chemicals. The brain brain so, like different classes of what you just mentioned work on different chemicals, whether it's dopamine, serotonin, gaba. But that's been the prevailing theory is we're just turning the volume up to correct a chemical imbalance, which a lot of times there is. One Can be that for some people, yeah, and then sometimes there's a source to that.

Speaker 1: 25:59

You know, chemical imbalance, like, sometimes there's a cause, and so the analogy I give and it's not for all, I'm speaking in general terms that, like the SSRIs for a lot of people, can be looked at as I'm trying not to get myself in trouble here but like a vitamin, when, like, okay, you have so much serotonin, however much you have have, and it inhibits the reuptake of the serotonin, so it okay, you've got this serotonin floating around. However much you got will get absorbed. Oh, is it similar to like a vitamin? I guess it's like let's give you the, the resources that you have and not lose it. You know that's. I'll probably keep this in and not edit it out.

Speaker 2: 26:38

Yeah, the other thing that I'm thinking about as you, as listeners know and as you know, that's I'll probably keep this in and not edit it out. Yeah, the other thing that I'm thinking about, as you as listeners know, and as you know too, is the. The root problem of all mental illness comes from a place of isolation. That, that's that disconnection. Uh, but that part is taking care of it sounds like, because there's a team supervising, you're checking in, you're reporting where you're at, you're setting intentions. So that's like a very open learning experience where this patient is open to suggestions. Because the difference is that in my active addiction days I've gone to places by myself and then I cannot fix my mind with my own mind, because it's kind of funny to think about it. But in my tripping days I've been put up by the waterfall, had conversation with it, all these things, but then it was all by myself.

Speaker 2: 27:28

So I'm thinking about it that way too so that's a very good point.

Speaker 3: 27:31

So everything is 100% clinical, clinically supervised. So it all starts with a clinical assessment by either a psychiatrist or a psychiatric nurse practitioner and everything is prescribed right. Everything's medically monitored. There's a team of individuals there. We're talking about attention setting. We've put a lot of thought into every single room in terms of visuals and how those affect neuroplasticity Visuals and how those affect neuroplasticity. Also, music and different guided meditations and stuff and noise-canceling headphones and how that works with neuroplasticity during the ketamine treatments. But this isn't about isolation. This is actually about bringing that stuff out and it's also controlled.

Speaker 3: 28:14

There's a big difference between going in the street and buying ketamine and not exactly knowing what dosage you're getting, going in the woods with your friends and doing it, or isolating in a room and doing it right. That would be abuse right, whereas this is medically monitored. The intention is healing right Rather than the intention being escape, and doing it appropriately with professionals, I think is super important. So you know, ketamine is also very safe. But all of the risk of ketamine when it comes to side effects is during the infusion process, which is why we medically monitor everything. So those things include, like high blood pressure, nausea anxiety is listed as one. Nausea anxiety is listed as one, which is interesting because ketamine works really well to on with anxiety. My experience with that is it's all over what to expect like in the session anticipation and the anticipation of the session itself.

Speaker 3: 29:12

But that's also one of the very beautiful things about ketamine is, you know, the medications you just listed typically come with a whole host of side effects.

Speaker 2: 29:20

Very much so.

Speaker 3: 29:21

Weight gain, sexual side effects, those kinds of things. Ketamine doesn't have any of those risks.

Speaker 1: 29:27

So let's talk about some of the other risks potentially a field of people that are in recovery or have a history of abusing mind-altering, mood-altering substances, history of abusing mind altering, mind altering substances. What are your initial thoughts about this population potentially using this as a modality for change in health and wellness for them? Good question, so.

Speaker 3: 29:47

I I mean, you know, I got my start in the substance use industry, so full transparency. When I first heard about ketamine using this purpose, I was like huh, we're using what for what? Like I was very, very confused but also extremely curious. You know, I think I would never, ever, ever say that any one treatment is right for everybody. You know, it's always an individualized thing. I think that everybody's in a different place with it. I think there needs to be a clinical assessment. I think I can make a very, very, very, very strong case for a person, no matter what stage of recovery they're in, if their depression is severe enough. What's going to be more harmful or drive them out First, the depression or ketamine treatments in a medically monitored environment.

Speaker 1: 30:31

I think Isn't that why some people use substances. Substances I don't like the way I'm feeling and I can self-medicate with alcohol, with my primary care physician is prescribing me pot to deal with my anxiety or depression and I smoke three, four, five times a day like these are some rationales people would fear of using yeahamine.

Speaker 3: 30:58

So I would think the word that comes to mind most often is escape. Okay, typically, I think people are looking, you know, with substance use disorder it's the escape right.

Speaker 1: 31:11

Yes, instead of coping, escaping, running from Escaping as a coping skill. Okay.

Speaker 3: 31:19

Ketamine when using this way is the exact opposite of that. Okay, it's almost running to. You're opening up. You're bringing things up intentionally.

Speaker 1: 31:26

Okay.

Speaker 3: 31:27

Right In a controlled environment, it's growth Right. I think that the substances have never really been the issue. It's how we've used them in our relationship to them.

Speaker 1: 31:40

Right, use them in our relationship to them. Right. It's a solution to other problems, which I enjoy doing as a therapist and zah does as a recovery coach.

Speaker 3: 31:43

Yeah, looking at underlying cause, conditions and what's really going on, exactly and and I think that you know these substances can have and not just ketamine, other substances as well can have profound positive uses when used appropriately. The dosaging, the dosage is monitored. I think we talk a lot about in recovery knowing your why, especially even early in recovery, you're going to a wedding that's going to be alcohol there. Know your why. Why are you there? If it gets to leave? You know what I mean. Know your why. Right Personal responsibility, I think, using something like this. Know what's your why, why are you using it? Typically speaking, if somebody is drug seeking, they're not coming to a clinic like ours and you know, going to pay the money to be medically monitored and the dosage controlled and actually go through the steps of actually doing it appropriately. I haven't seen a lot of that Because they get snuffed out pretty quickly.

Speaker 3: 32:52

I imagine, yeah, and I talk to a lot of the people that are coming through the clinic. The amount of calls I've gotten like that are few and far between I mean maybe less than than a handful, and typically they all go the same way hey, are you guys doing? You guys do ketamine there? Yeah, what's the process? Can I just come in? No, you have to have an assessment by a clinical professional and then you know you're medically monitored. And well, what's the dosage? Well, we start off at you know it's a micro dose, it's 0.5 milligrams per kilogram. And then we move up from there. And how much is it? And then you get into pricing for the medically monitoring and all that. And once you're done talking, they're like okay, no, it's like click, it's like I don't. You know their, their questions are more money and escape rather than the motivation is. Here's what's going on with me. How can this help?

Speaker 2: 33:35

yeah, it makes me think about, because in buddhism, uh, the eightfold path which a translation. But the key word that I've been thinking about is the path. So if it's a path, it's taking you somewhere. So, which is what you're saying? That if I have a purpose or intention of where I'm going, if I'm using this as a factor to get there, it's different from checking out, it's different from I just want to feel this way, I don't take care about where I'm going, I'm just going to be stuck here. So that's also how I'm drawing the parallel between why am I doing this and is it leading me towards something fulfilling? Because there is a really big emphasis on the sustainability too, because I've been high, I've used drugs, but then they weren't sustainable. That low is really sudden. But if it's like medically monitored and if you still have that purpose of I just want to be happier, I want to have better quality relationship, I want to be more successful, whatever it is, if there is like that noble goal, this can fit into that.

Speaker 3: 34:29

Yeah, and what's interesting is, like the patients that I've seen, you know they're coming through. The dissociative side effect from ketamine is typically not what our patients are chasing. It's like I've had patients that have come through where it's like I've never known what it's like to not feel depressed.

Speaker 3: 34:52

Or intrusive thoughts Outside of the treatment itself. So this is like three, four days later after they've had their treatment and the dissociative side effect and all that has happened. It's like I've had patients come through where their anxiety ramps up, so like they come through for treatments, depression is almost like gone quickly because of that. It's like they start getting anxiety because they've never known what that has felt like and they're worried it's going to come back, yes, yeah. And then it all kind of balances out and they're like I didn't even know life could feel like this.

Speaker 1: 35:27

So foreign. Yeah, the way I can relate to different forms of serenity, and especially for the brain, is that mental exhale, that ah, and just the brain quieting down or not racing or just not constantly going with darkness or depression or ideation, or just their own personal hell. And it's just like to see people like that and part of the reason why I've brought on for their whole life, since they're seven years old, have been in this ideation in their own personal hell. And this person was after the treatment processing with me. They were angry and the reason why this person was angry is they said, this is what normal people feel like, because I'm angry that I haven't had the opportunity to feel what this is. And if I've been able to feel this for my whole life, I'd be able to function.

Speaker 1: 36:35

And he was kind of angry. And then it was the angry at God or all these things and like, well, why has mine been broken? You know all these things and like, well, why has mine been broken? And just seeing that beginning stages of one of my favorite quotes was it's like you shook my Etch-a-Sketch brain and it was finally clean. All of the Etch-a-Sketch was just shaken off and it was a clean slate. It's like oh, we got something to work with now.

Speaker 3: 37:01

It's wild. I mean I um I've never seen. Actually, what's really interesting is the the closest thing I can relate it to like when I was working in substance use primary. Um, there's that thing called there's the pink cloud, sure, where somebody comes in and they have a couple weeks clean. You know they're what're out of detox.

Speaker 1: 37:23

What would I want to use again? Life is great.

Speaker 3: 37:25

And then all of a sudden it's like Crashes, they're a different person. It's like boom, they're on this pink cloud and it's like, you know, there was something kind of gratifying about that from a provider standpoint, because you see, this instant shift.

Speaker 1: 37:41

You earned it, congratulations.

Speaker 3: 37:43

You see kind of this instant shift in somebody and if they can maintain it there is always the fear that it's going to crash and you've got to teach them to balance that out. But you see people they can like. If they get it they can change pretty quickly. And it's cool to see Mental health primary. You don't see that a lot. You don't see people shift that quickly. Sure you health primary you don't see that a lot. You don't see people shift that quickly. Sure, you see it with ketamine. I mean, you know some of the quotes.

Speaker 3: 38:13

I hear one of the things I hear a lot from a lot of different patients is the blocks are gone. I hear that in different forms, like the things that were holding me back. The blocks are just gone. I hear that a lot. Um one patient one of the one of the really cool things I heard was he he put it really well he goes. After the first treatment. I could see pieces of my old self after the sixth. I am my old self, which is pretty profound yeah, I also have another question.

Speaker 2: 38:42

I don't know if it's an unanswerable question. Uh, pretty much like, from that point of view, at the intersection between science and spirituality. So, since this is like a medically monitored process, like is there, how would you think of it as spirituality fitting into this? Is there any aspect for that too?

Speaker 3: 39:00

hard to answer, but a hundred percent I would say. Say for sure I've had patients have like I had one patient have a complete inner child experience. Their inner child came to them and they had a conversation that was so liberating and free, like from that moment on she was a different person. That was halfway through her series of treatments. I've had people who have lost loved ones, who have really struggled with end of life stuff and like you know, crisis is a faith Go in the room and in one session just come out of there knowing that everything's okay. One patient you know was like I couldn't see my loved ones that have passed, but I could everything but see them. They were in there with me, I could feel them and it was just beautiful. There is absolutely a spiritual component happening in that room.

Speaker 2: 39:52

Yeah, because I'm also thinking about when somebody's depressed I draw the analogy like a flower that is withering the spirit. The essence is dying. When you water it, give, give nutrients, the spirit comes back. You know, so it sounds one of those, sounds like it's one of those things, too, where life becomes light, springs out of you again that feeling yeah, it's um, it's, it's really, it's really cool to see so we'll get back to the addictions piece.

Speaker 1: 40:25

I'll paint the picture and you might know where I'm going with this, but anybody 30 years or older knows about the death of Friends star, matthew Perry. He was apparently receiving ketamine infusions and, I think, off-label application of IV ketamine. But the amount of ketamine in his system at this time of death meant that he must have also been obtaining additional ketamine from another source to use at home, and I imagine in your field that this was, oh geez right. This doesn't look good. Someone that's in recovery, very vocal about his recovery, helping other people recovery very vocal about his recovery, helping other people at the week prior, a few days prior, taking medically monitored ketamine and then, um, he dies. So give us your perspective on that, because that's a fear for a lot of people. Hey, it's not my drug of choice, but I could see how I could have cravings or what.

Speaker 3: 41:22

Yeah. I well, first of all tragic, yeah, right.

Speaker 1: 41:27

Um horrible. Such an advocate for recovery Big time.

Speaker 3: 41:32

Yeah, um, and just a beautiful person, I think so he was. He was definitely an advocate for ketamine therapy, I mean, as he writes about it in his book, about how much it helped him and how much he was an advocate for it. I think you know, in doing some research around it he, I would say probably from the very beginning, when he first started using it, was going too often, like there's a pretty standard medical model that you want to stick to and you don't really want people there's some exceptions with chronic pain and stuff like that but you don't really want to be letting anybody come to the clinic more often than what is appropriate. Right, he was doing it probably more often than what I would deem appropriate from the very beginning, and then at his time of death I know he had other things in his system as well- bupuprenorphine, ketamine and buprenorphine those who knew and maintained that he was clean and sober to his death.

Speaker 1: 42:31

but he did have his treatment earlier in the week. But how do you get take-home ketamine and not have it medically monitored?

Speaker 3: 42:42

Well, maybe you don't go on a tangent about this. So, um, yeah, his last recorded medically monitored, supervised above board ketamine session was, I think, one week prior, five, five days, roughly one week prior to that. The thing about ketamine is it's got a extremely short half-life. The effects effects of ketamine almost instantaneous. That's one of the really interesting things about it is somebody. They can come in for an infusion and once the IV comes out within a couple hours, typically people are back, maybe a little fatigued, right Back to normal, but it's out of your system completely within a couple of days typically. So what was in his system at the time of death had no nothing to do with the medically monitored, supervised ketamine session that he had gone through. So essentially it leads it would lead one to believe that he must've been getting it illegally off the streets or at home now.

Speaker 1: 43:37

Um or not professionally prescribed by that initial prescriber. Correct yeah.

Speaker 3: 43:42

Correct. So you know, I think, anybody with substance use disorder. Is there the risk that ketamine could induce cravings and stuff like that? Sure, I think that's why it's a case-by-case scenario. Is it a complete rule out? I don't think so.

Speaker 1: 44:00

How do you assess that at the Mood Center?

Speaker 3: 44:03

Well, it would start with a clinician I mean, it would be the psychiatrist or the psychiatric nurse practitioner and I think it's just risk versus reward, right. Is the risk benefit of this treatment? Is it worth it, right? Like I said, if somebody is struggling severely with depression, treatment-resistant depression, even if they're in early recovery, how many people are dying by suicide in early recovery because of depression? Sure, many, many, many, many, many, many many. And we have something here that could help right, or what's going to drive them back out that depression or medically monitored ketamine sessions yeah, I I kind of am processing my thoughts.

Speaker 1: 44:47

As you know, people that listen know that I'm a therapist hat and Zal's a Buddhist-inspired coach. But we're also people in recovery and 12-step recovery. So we have two different hats and our personal recovery model in some ways is a lot different from me as a professional appropriately so, and I often use the SAT analogy that heroin is to cotton or oxycodone or fentanyl as alcohol is to benzodiazepines Xanax or fentanyl as alcohol is to benzodiazepines xanax. So for a lot of the clients that come here and they see a psychiatrist that hey, they're here because they're sober off of alcohol now and gosh, I relapse and some psychiatrist is giving them xanax for anxiety and I go let's look at this and what receptor and things like that. And yeah.

Speaker 1: 45:42

Do you see how that puts you at risk? Oh, I never thought that before. So I educate and inform them because sometimes psychiatrists just suck, or primary care physicians and don't look at the whole picture and risk factors. So how do you help people determine that? I help my clients determine that are considering this form of treatment, pros and cons and risk factors and why this is a viable, safe option for them. So I guess explore more of that.

Speaker 3: 46:13

Yeah, so that would be all gone over in their assessment with their psychiatric nurse practitioner. Our practice manager is also a licensed substance use therapist, so that expertise is in the building during treatment teams and stuff like that. So I mean we take that, we take that side of it seriously.

Speaker 1: 46:30

Yeah, um, you know, our, uh, our medical director is actually a do who wears another hat as medical director of a substance use facility, um, and he has a lot of experience with ketamine I was shocked by this I guess pleasantly, when I was doing some of my research and learning more about it that ketamine is being used more and more for alcohol and opiates yeah, so talk about that yeah, so they're actually in some ways like oh well, this cannot help minimize risk factor of cravings, potentially for, specifically, opiates or even alcohol, so talk about that.

Speaker 3: 47:10

So there is. There's research being done currently about specifically opiates one helping the detox from opiates. Also bridging the gap between. So like fentanyl binds to the receptor so strong these days that there's a large gap between when somebody stops before they can go on something like suboxone.

Speaker 1: 47:35

You don't want precipitated withdrawal, and yeah, and the risk of precipitated withdrawal, which just, which just means, uh, it took it too early and this sucks and I feel miserable.

Speaker 3: 47:44

It's a withdrawal on steroids, essentially. It's basically going in there and kicking any of the opiate out that was in there and it's putting you right smack dab where you didn't want to be in the first place. Oops.

Speaker 1: 47:56

Yeah, exactly, Don't lie about your drug use. Exactly right.

Speaker 3: 48:00

So they've been using ketamine with some success on being able to bridge that gap in terms of getting people from fentanyl, opiate use to Suboxone and even being able to continue with ketamine trips. We always do an assessment on somebody on what's appropriate right, what's the appropriate level of care, especially with something like alcohol. I mean, you're talking about something that can be life-threatening, right. If somebody needs to go through detox or needs to be in residential, that's where they need to be and then you can talk about something afterwards. But we've had folks come through who binge drinking. They're kind of on that border. They're teetering with using the substance inappropriately. Maybe they are using it inappropriately but they're not quite ready for residential. They're not meeting that criteria yet. One patient in particular I can think about was dealing with some pretty significant grief and was what I would call binge drinking really on the edge, and completed all six treatments and completely lost the will to drink through those six treatments Completely, just hasn't had a drop of alcohol since, which is pretty profound.

Speaker 1: 49:32

And I think it has a lot to do with getting to the core, getting to the root, you know, getting to the core of some of the issues that was going on. That was've had people that had the intention um had aids, not professional medical aids. You might know where I'm going here and whether it's trauma, whether it's grief, whether it's whatever it might be that we're going through um ayahuasca. Yeah, you know, for years, people that used asked me my thoughts and I said you're an inpatient right now with me. So that's my thought on ayahuasca. How is this? Because some of the conditions are the same, spiritual in nature right the intention. A lot of people do ayahuasca for that growth and change. How is it different?

Speaker 3: 50:26

Oh man, well, very different. It's a very different experience. Ketamine is a lot less of an intense experience than something like ayahuasca. The potency the potency is a completely different ballgame. Also time frame, time frame completely different ballgame. Also Time frame, time frame in the journey itself. Yeah, I mean, you're talking big difference, you know? One of the other things about this that's important is, I think, psilocybin, mdma. That'll actually probably be out for use later this year. I think all of these things have a place clinically, but we're not there yet with ayahuasca in a medically monitored environment. That's appropriate, in my opinion. So if somebody wanted to have that journey and they were aware of the risk factors or anything like that, I wouldn't discourage it.

Speaker 1: 51:21

But comparing ayahuasca to ketamine is a very hard thing to do because they're very, very different substances and I mean ayahuasca, I imagine, is on a different receptor of the brain and, yeah, it's a psychedelic. But one thing that you mentioned with ketamine is the different receptors and how it opens the chance for neuroplasticity and I wonder if there's a significant difference in terms of that aspect.

Speaker 3: 51:51

I have no idea so I know, like psilocybin plays on the serotonin 2a receptor, which is is and I believe I believe ayahuasca does the same thing, which is essentially the brain's ability to communicate in ways that it is unable to before, like it just communicates differently and kind of opens things up. But it's a very different, very different experience. What are you thinking, zal?

Speaker 2: 52:17

I'm thinking about what Brad said earlier. Very descriptively, you use the term priming the brain, which I really like, but also it brought a lot of thoughts too about the recovery process. So that means that what do I do with it? I have a window to do something with that, and a lot of people who are in recovery knows that too, that it's not just about stopping the use. You got to do something about that within that window to sustain it. So I'm thinking about it, and there's a mentioning of this in a bali canon in the buddhist tradition. I don't think they were talking about addiction at all, but that analogy comes to mind. I love analogies, but like if you have a cut at the bottom of your feet, every time you touch the salt it's going to be painful yeah so, like wherever you go, it's going to be painful.

Speaker 2: 53:01

So while you're not touching the salt, that wound has to heal, and after that, when you touch the salt, it doesn't hurt anymore. So I think about it the same way that this is what happened to people who are in long-term sobriety they have less craving, they will do something, but since they're in that quote-unquote spiritually fit condition, they're touching the salt, but then they're not hurting, it's not creating more craving. So it makes me think about that too, about that priming stage, about what do I do with it.

Speaker 3: 53:30

To go further yeah, and that relationship to substances has shifted, I think, if I'm hearing you correctly, and you know. Let me ask you what is recovery? If you had to sum it up in one word, I can tell you a little bit.

Speaker 1: 53:48

Part of it is discovery, part of it's growth that's the word I would use. Part of it could be change. I mean, it's all three of those things, I think.

Speaker 3: 53:58

I tend to use the word growth, I think, because personally I think recovery ceased when you stop growing, when you stop learning, when you stop seeking to grow from experiences. Recovery stops happening. When you're you, when you're trying to escape you're, you're moving backwards, you're not growing from experiences, you're not, you're not applying yourself. So in that, in a lot of ways, the way ketamine works on neuroplasticity and the brain's ability to enhance change, I mean it actually fits really well in that concept. But you always do have to take into consideration where is the person's relationship with substances?

Speaker 1: 54:56

You know, are we going to affect that treatment, whether it's for physical therapy for a knee, whether it's a medication that a doctor's giving them for high blood pressure, Some people don't care.

Speaker 1: 55:06

The specifics, the first aspect of telling them what's happening to the brain and why, and then the journey that they're going to be on and we haven't even talked about dissociation and things like that and the hallucination process potentially we haven't gotten to depth of that and then the processing afterwards, whether it's with therapy or the full range of possibilities that can happen outside of the treatment and what could happen for those five, six weeks. To intensively help someone every step of the way and I use this analogy frequently it's setting up the conditions. So a farmer can just throw some seeds down, but it's better, if you turn the soil, pull the weeds, cover it up, wait for the right season, water it, and to best set up the conditions for this change and this rewiring to take place. And looking inwards, man, if we can intensively help people every step of the way and like same thing with the treatment plan and any treatment plan.

Speaker 2: 56:09

Yeah yeah, I mean I'm enjoying the conversation. I don't want to be. I guess I've never really approached it like to or against, for or against kind of thing, but I'm just really curious Because nowadays there are just so many different ways, and whatever helps is great. I think the more open the conversation is, the better for people.

Speaker 3: 56:30

I think curiosity is great. I think that's important and that's where it started with me. Like I said, when I first heard about ketamine being used in this way, it was huh, but I was also. I'm curious by nature typically and I know that you know if something's getting a lot of, if there's a lot of talk about something, there's usually something there.

Speaker 1: 56:54

I think most people are fearful and apprehensive, which is fair, and I think that's I think most people are fearful and apprehensive, which is fair.

Speaker 1: 57:01

Because of change of growth, because it's uncomfortable right Even though in this treatment there's some benefit and euphoria, where often I tell my clients whether they're sitting in a chair and I'm doing experiential work that most forms of treatment there's going to be a lot of discomfort, and then to lean in the discomfort and then you'll rewire your brain that way. This is in some ways not counterintuitive from that, but like hey, it's not always. This might actually alleviate some of that discomfort, while it can lead to change and growth.

Speaker 3: 57:37

It can ways this might actually alleviate some of that discomfort. While it can lead to change and growth, it can. And I mean there there can be some you know in I I haven't had anybody have a quote, unquote bad experience I've had people have some really powerful experiences okay.

Speaker 1: 57:51

so never the panic attack, never the dissociation where they're like oh my, my God, I mean, that's what people are going to worry about.

Speaker 3: 57:57

I can think of maybe one or two times where that's and generally what the root of that is is not coming in in the right, the inability to let go, and not coming in in the right frame of mind. It's almost like they're fighting letting go too much, and that's kind of where that comes from, but not like the quote-unquote that person's all therapists afterwards, yeah well they did.

Speaker 3: 58:28

Yeah, the quote-unquote bad. Yeah, trip, yeah, you know that everybody ayahuasca I hear like the bad. Yeah, that is is very, very, very uncommon. Now I've had some people have some powerful sessions with tears and things, but not in a bad way, more just kind of like, okay, this stuff came up and it's supposed to let me journal about it and this was this was powerful um, even powerful or foreign, and maybe not to the level of discomfort, but maybe because it's so foreign.

Speaker 3: 58:58

Discomfort, yeah, because it's so foreign, almost in an enlightening way, these things can come up and people are, these things that have held such power over you for a very long time. You all of a sudden can see it from a different angle, and I think that's more. What I see is like you know, you have these situations in your life we all have them where we're kind of stuck. You know, it's almost like you get to look at yourself, you know, from a in a different perspective. You get, you just get to see things that perceptions everything. You know, perception drives everything. It's almost like you can these powerful situations in your life that have held such, you know, meaning and strength in a sometimes in a very negative way, all of a sudden you see it a little bit differently and it's like oh, Zala, you're a life coach, recovery coach, meditation coach.

Speaker 1: 59:51

Based on what you were talking about, what intention or what meditation skill set or practice or advice would you potentially give someone based on what you heard today?

Speaker 2: 1:00:02

Yeah, I mean to emphasize again too, I'm not although I'm not for or against if I were to take a stand, I really take a stand for a connection, a community, like as long as you're doing it openly with other people, there's always something to be learned. So, because you know, I do believe from my own experience, uh, is that mind in its nature is infinite, like it's limitless, but that are capable of seeing, are capable of perceiving what's happening is limited so like that.

Speaker 2: 1:00:29

That, to me, is where the the connection with other people helps, because sometimes I'll be able to see my own mind through other people, you know. So as long as I'm staying connected in that way, it's safe.

Speaker 3: 1:00:40

Yeah, you remind me I had a patient come in who brought me in the room. She sat me down. She was like I just got to tell you something. I'm like what? Tell me you know what happened. How was it, brad, everything is connected and I can finally see that she just she walked out of that session with. It was like she just knew, like for the first time in her life that and she like in her core, that everything's connected and it's all one. And it was such a profound thought to her. I still still talk to her sometimes and she'll always bring that up.

Speaker 1: 1:01:22

I think you'll have to tell your Moodsetter clients to come to the Recovery Collective for the mindfulness communal meditation here every Sunday, you know, so that way they can all stay connected together. But I really think that, man, how cool would it be to have some kind of processing communal group, for you know I just whether it's processing it or just being connected with other people that have gone in this experience, whether it's a weekly or bi clinicians, I think you know, since getting into this, I can really put people into kind of almost buckets right.

Speaker 3: 1:02:08

You've got people who are really excited about where this is going, and ketamine is really, really paving the way for a lot of other stuff. You know, psilocybin, mdma is coming, like these kinds of things are coming. These therapies are coming and there's a lot of really good research behind them and a lot of people are really, really excited about it. I would say the vast majority of the people probably in this, in this area, that I've met are what I would call closet excited about it.

Speaker 3: 1:02:32

So they're like I don't know, enough to like say vocally that I'm excited. They're like I don't know enough to say vocally that I'm excited. But it's kind of cool where this is headed and we need something new and this is different. Then you have people who just haven't heard about it at all, who just don't know, and then you have resistance. I think curiosity is important in our profession mental health profession, I think. Personally, I think the smartest people in the world realize they know absolutely nothing. I think the best clinicians realize it's not about them and that keeps them learning, keeps them growing. I would never, ever, ever say that any treatment is right for everybody, but I can pretty much guarantee you that there will be somebody that walks through an office if it's a clinician and this would work really, really well for potentially change their life, and if that clinician hasn't taken the time to get to know the new treatment modalities that are out there, I think that's a shame.

Speaker 1: 1:03:26

It certainly closed off because the Recovery Collective provides some really neat integrative, holistic services where I've had clients have outer body experiences during acupuncture and early life regression and therapy sessions. It was like the maybe ego. Maybe the recovery had me going. My clients don't need to alter their mind to experience that form of healing. Now, that's without me knowing all aspects of what this is or can be, but that was my initial concern and a fear of okay, they're taking a mind-altering, mood-altering substance. Is that numbing them? What are your thoughts on some people's fear with that? Hey, they're taking this medication and it's numbing them. What are your thoughts on some people's fear with that?

Speaker 3: 1:04:19

hey, they're taking this medication and it's numbing them I think it's the exact opposite, based on what I say it's not numbing, it's opening. You know, again, it's not people aren't coming in for the escape, it's to face it. It's to face the things that are inside. You know they, they can, they tend to come up in that session. Um, they tend to, you know, show up and um, it's when you're doing it with intent and purpose. So I see it as the exact opposite of of numbing or escaping. Um, I think it's, it's brave, I think you're, you're facing, you're, you're healing, you're growing. I think you're facing, you're healing you're growing.

Speaker 1: 1:05:00

Part of the intention of this episode is to identify our listeners and go okay, hearing what we're talking about. What concern or counter would they have and fear or worry? And one of the things is is it FDA approved? And things like that, and I'll segue or add this to the question what are the different types of ketamine or services that your program offers?

Speaker 3: 1:05:30

So we do ketamine IV and IM, which is basically the only difference is how it's administered. It's either via an IV or an intermuscular injection. Essentially the difference is the IV is titrated over about 40 to 50 minutes, so it's kind of the medicines being delivered over that timeframe. With the IM it's all going in kind of in one shot and it's a very different experience from a journey standpoint. Then there's Spravato. Spravato is S-ketamine. S-ketamine Spravato has been FDA cleared for the use of treatment resistant depression and suicidal ideation. So it's a nasal spray. It's essentially it's a derivative of the ketamine molecule, so it's the S portion of the ketamine molecule and it it works really really well.

Speaker 1: 1:06:21

Different protocol, but it works really well. Who and how determines treatment-resistant depression?

Speaker 3: 1:06:28

Typically it's the patient's history. So the general rule of thumb is two failed attempts at two different classes of antidepressant, and then you have to be on an antidepressant while you're going through the treatment of antidepressant and then you have to be on antidepressant way to go through the treatment.

Speaker 1: 1:06:40

So meaning, whether it's a primary care psychiatrist doctor gives a medication for specifically depression yep, not anxiety, correct. Not PTSD, correct, depression correct. And then failed attempt, meaning that didn't work. So the doctor gave you another medication, correct, and then that didn't work correct and then or it or it's not working, and you're on it.

Speaker 3: 1:07:01

Okay, and you're on it.

Speaker 1: 1:07:03

And then that could be enough. They see you guys and potentially you guys would do your part and then send to insurance and then Yep.

Speaker 3: 1:07:13

So we would do the assessment and then we would send off to, we'd send the authorization off to insurance for approval and they would give us either approval or denial on a reason, and then we would work with that patient.

Speaker 1: 1:07:24

How friendly are the insurance companies with this?

Speaker 3: 1:07:29

It's been an interesting experience because it's new and they're not used to it. This is the reality of what I know about right.

Speaker 1: 1:07:34

What did you say this is kind of the reality of this world, right, when it comes to insurances, go ahead.

Speaker 3: 1:07:42

Yeah, it's it. It's a newer treatment and so the insurance companies are very large and and a lot of times there's a lot of different departments and a lot of different um, you know people you have to talk to to get authorizations, and a lot of them didn't even know that this was even an option, so it's been challenging, but I think it's becoming more and more prevalent and we actually really proud of the team. We've been able to really put together something that is working and getting our patients authorizations in a timely manner.

Speaker 1: 1:08:15

Some people might have a stigma against FDA and non-FDA Medical doctors make medical judgment all the time, giving a medication that is not. We'll call it off-label. So how does that work in your world? How is that okay? Doctors do it all the time, yeah.

Speaker 3: 1:08:37

So Spravato is FDA cleared for treatment and that's why insurance we get authorizations for insurance for treatment-resistant depression. So insurance we'll pay for it because it's been FDA cleared for the use. Ketamine the full molecule. It's interesting because Spravato is a derivative of ketamine and that's been FDA cleared, um, ketamine the full molecule has not. It's been fda cleared for a very long time as safe and effective drug. It just hasn't been cleared for the use of treatment resistant depression. Yet. Um, I'm sure it's coming. The data is just too profound for it not to. I mean it's just too kind, too kind of in your face and the kind of the market strife patients are seeing that it's working. There's enough of a collective out there that data around what it would be clinically indicated for for our clinicians to be able to assess and make judgment.

Speaker 1: 1:09:36

I say this because I don't want people to that be the reason why it scares people off, because you know there's things like prosocin, which is given for, approved for hypertension, but it's also used to treat all the time for nightmares and ptsd. And clonidine, approved commonly for hypertension but off labeled for, adabeled for ADHD and off-labeled for cancer, pain and hot sweats and certain psychiatric disorders and nicotine-dependent opiate withdrawal.

Speaker 3: 1:10:07

So there's so many drugs that are used off-label in a very safe way want to bring up about ketamine when, in regards to the fda, a lot of times I feel like, um, you know, data around drugs can sometimes become skewed when too much money is involved from pharmaceutical companies. I think you know you can. There's a lot of data and there's a lot of indication. We were talking about this earlier and the opioid epidemic was a perfect example of that. Talking about this earlier in the opioid epidemic was a perfect example of that could be seen as a perfect example of that ketamine not being fda cleared for use. A lot of the data around ketamine has been done and when used in this purpose, by doctors who have been seeing it working and are using it off label, and so the research is still kind of pure.

Speaker 1: 1:10:56

And by pure do you mean that there's scientists and doctors and researchers at universities that don't make any money off of? These researchers and assist to find Right. That's what you mean by pure yeah. Okay, yeah, makes sense.

Speaker 2: 1:11:14

This is our FDA related.

Speaker 1: 1:11:16

I have no thoughts on these. This is our FDA-related and I have no thoughts on these.

Speaker 3: 1:11:19

We certainly touched upon a lot of diagnoses, symptoms, disorders, but why don't you give us a list of all potential symptoms or treatments that ketamine could benefit? Benefit? Yeah so. Depression, anxiety, trauma, ptsd, even conditions like fibromyalgia pain, lyme disease works really well for the. The link between chronic pain and mental health, mm-hmm is very interesting hmm, what it's like a trauma response yeah, absolutely, and it's interesting that you know a lot of the mechanisms that make ketamine work so well for mental health mm-hmm it's the same reason why it works so well for for pain.

Speaker 3: 1:12:11

Specifically blocking the NMDA receptor helps block the perception of pain and also then the neuroplastic effect, where you know the brains ability to reorganize, can actually help pain makes sense.

Speaker 3: 1:12:21

um, it's pretty interesting, so, like clients, that because we also treat chronic pain and clients that come through for chronic pain, we'll also give a journal to and, and you know, explain everything that can be happening. And I think it's important. I've had a couple chronic pain patients. I don't need the journal, I'm here for pain. I'm like, take the journal, take the journal. You never know what your intention is going to be and they follow it and it's, it's pretty amazing.

Speaker 1: 1:12:47

They, they, they see some pretty interesting the mindset with living in pain constantly. It's just like a trauma response. Yeah, absolutely. Yeah, interesting, I guess. Two questions Looking ahead what do you envision the future of ketamine therapy for One, addiction treatment or therapy in recovery, but also for all the clients seeking ketamine treatment?

Speaker 3: 1:13:23

the client seeking ketamine treatment. So, uh, specifically for um in recovery, I definitely see a really a fit in terms of bridging that gap between, like fentanyl and some of these more dangerous drugs and kind of really safely getting people to a place where they can be on suboxone and stabilized. I think that's amazing. I'm really excited about that. There's even some clients have been able to successfully just detox completely from opiates with something like ketamine without having to go. I've seen some research on it too um, something like suboxone, um, something like suboxone um. So that's that's really exciting. And I also think typically people in recovery you know inactive addictions have been running from things for quite some time. They're not used to dealing with their emotions and their feelings and and there's a root cause driving a lot of those you know the.

Speaker 1: 1:14:15

The use of the substance is a symptom, um, and I think ketamine can help get to the root when used appropriately it's funny, for some reason there's so many people at like week three of residential treatment, whether it's feeling more comfortable and I think the brain has begun to change and the detox is farther away. But you know, I'm thinking about it, what we're talking about today. But the ability, for a lot of different reasons, to look N-words often happens at that third week of safe and security and doing that. So I love the people that stayed two months, but rarely did that happen, as opposed to the brain going I'm getting out of here in a week. So it was like oh so maybe one way to help set up the conditions for sure.

Speaker 3: 1:15:06

I'm really excited about ketamine therapy for suicidal ideation. I think that I really think there's a. I think we need a lot of help in that area. When it comes to mental health and you know I'm very passionate about that personally you know I've lost people close to me but you know, died by suicide and what I've seen as a professional what ketamine has the potential to do, rather than driving people down further inside of themselves and kind of re-traumatizing, opening and giving instant relief from those thoughts. It's powerful. It's really powerful. So I'm really excited about the future there.

Speaker 1: 1:15:52

It's a good collective solution to health and wellness.

Speaker 2: 1:15:55

Yeah, I learned a lot from this conversation, so thank you so much. The final thought that I have is, you know, like it's all about the mind, and that's why I was excited about this session too, about this podcast, because in Buddhism we have this thing called epidharma, which is translated as like a Buddhist psychology, but it's like a very detailed analysis of the mind, to the point of like a minute moment of how mind works. So it's so crazy how for me to see something, for me to exist in this moment in my mind, billions and billions of factors have to come into, they have to meet each other. So, like the thing about depression, the thing that I'm hearing about ketamine is that it's not about making the problem go away, but it's about becoming aware of all the other things opening up to the spaciousness. So whatever that helps with that, that's my takeaway from this conversation. So my mind opened up a little bit.

Speaker 1: 1:16:48

Very cool. Thank you. We'll put it in the episode notes, but tell the listeners more about your practice and where they can reach you.

Speaker 3: 1:16:55

Yeah, so Mood Center. We're located in Annapolis, maryland, right off of West Street. You can look us up on the web, wwwthemoodcentercom.

Speaker 1: 1:17:05

Awesome. Well, thanks for being here, Brad.

Speaker 3: 1:17:07

Appreciate you guys having me.

Speaker 1: 1:17:09

In concluding our discussion with Brad Masters on ketamine therapy and its potential benefits for addiction and other forms of treatment, it's important to acknowledge the profound impact that this treatment modality has had on countless individuals. Many clients, including my clients, have reported miraculous changes following their ketamine treatment experiences that have persisted for weeks, months or even years and afterwards vanished just like a brain exhale. While this subjective evidence holds immense weight and speaks to the transformative potential of ketamine therapy, it's crucial to approach these findings with a balanced perspective. While individual anecdotes are powerful, it's exciting for additional research to fully understand ketamine's efficacy and safety profile. As we move farther, as we continue to navigate the evoking landscape of addiction treatment, let's remain open to the possibility of ketamine as a viable tool, while also advocating for further research to validate and really contextualize these subjects' experiences. So far, we're tracking the right direction. We extend our sincere thanks to Brad for shedding light on this topic and we encourage our listeners to remain curious, informed and open-minded as we collectively explore new horizons in mental health care. My name is Luke.

Speaker 2: 1:18:25

This is Zal. Thank you very much, Brad. See you next time, see ya, thank you.