The growing body of evidence that ketamine — once known as club drug "special k" — can be used to treat mental health disorders along with its increasing acceptance has caused a spring of clinics in Los Angeles ready to cash in on psychedelic mental health treatments. Ketamine Clinics Los Angeles was the first to open its doors to L.A. in 2014, and now Toronto-based psychedelic company Field Trip is establishing a presence in the city, utilizing ketamine as a vehicle for therapy.
"Cognitive behavioral therapy works, it just tends to take a long time to break down the defenses, get past the ego and get to really what's happening," said Field Trip co-founder Ronan Levy. "Psychedelic therapy just accelerates the process of breaking down those walls so you can start to do the work and the processing."
History of Ketamine
Developed in the wake of the Vietnam War, ketamine replaced phencyclidine (better known as PCP) as an anesthetic before its antidepressant properties were well-studied.
This allowed physicians like anesthesiologist Steven Mandel, who co-founded Ketamine Clinics Los Angeles in 2014, to use it for off-label purposes to treat depression and other mental health disorders.
At the same time, people were using it to get high. The Drug Enforcement Agency lists it as a Schedule 3 drug, along with low doses of codeine and testosterone.
In 2019, the FDA approved a version of ketamine called esketamine for mental health treatment. The drug is an antidepressant nasal spray. The move was a landmark for psychiatrists who were operating with an arsenal of oral drugs that stemmed from the 1950s.
"For the last 30 years, we've basically been using old old drugs," said David Olson, a professor at University of California, Davis. "And ketamine was really the first new exciting drug that worked differently than a lot of these previous drugs and that really opened up a whole bunch of new horizons."
Mandel has a brisk clientele. His Westchester clinic has administered more than 12,500 treatments, which consist of six ketamine intravenous treatments over a two- to three-week period. His patients run the gamut, from ages 18 and 80. Most come in for anxiety, post traumatic stress disorder and depression. But the treatments are also used to battle issues stemming from postpartum depression and suicidal ideation.
"Ketamine works for disorders, PTSD, and especially for suicidality — works in hours to a few days," he said. "This is the quickest, the safest and the most effective of all the agents that address major depression, bipolar depression and suicidality."
But the treatment has critics. Some argue the FDA was too eager to embrace the esketamine antidepressant, saying there wasn't enough evidence in the trials that the drug was better than a placebo. And, of course ketamine still has addictive properties.
Blue Cross Blue Shield Massachusetts is the only insurance company that covers intravenous ketamine injections. Treatments can cost thousands of dollars. Other insurance providers normally don't cover the procedure because it is not FDA approved, making it accessible only to those who can afford it.
Tbul came across ketamine while researching alternative treatments to the cocktail of medications she was put on as a child. She listened to a podcast interview in which Lamar Odom talked about using ketamine to cope with his struggles with mental health. Her daughter pointed out its reputation as a club drug, but after taking it, Tbul vehemently disagreed.
"It's completely wrong. Completely wrong," Tbul said. "It's somebody who's suffering from something they cannot erase from their mind."
Tbul's first treatment at Ketamine Clinics Los Angeles, in which she said she was able to console her teenage self, allowed her to forgive herself for the emotions that had weighed her down for years.
"After the treatment, it's like an acceptance. I'm very at peace with my own body," Tbul said.
The experience is common. Often patients say the drug allows them to confront traumatic situations from a distance, and look at situations with more objectivity and empathy.
New Drug Horizons
There are more than two hundred ketamine clinics scattered across the U.S., but Santa Monica caught the eye of Field Trip, which opened a clinic in September with the goal of collecting data from ketamine-based therapy sessions and studying the effects of psychedelic drugs, while also developing and testing its own psilocybin-based treatments.
"Because we're going to have access to so much data about what makes a difference in these therapies, we can actually take that data and make sure that when we pair the therapy with our own products, we're going to get to the best outcomes," co-founder Levy said.
The Canadian company — created in 2019 by former cannabis startup founders — is best known for its research and development into psychedelic drugs. The company rolled out an app to enhance the psychedelic experience and went public in October on Canada's stock exchange.
The clinic is outfitted with mid-century furniture, fluffed-up cushions and shaggy rugs, almost like an Architectural Digest spread came to life. In-person ketamine injections and subsequent therapy sessions at its Santa Monica center offer depression, anxiety and PTSD-related treatments for upwards of $5,000.
It's a hefty price for depression treatment (insurance doesn't cover it — the ketamine injection at Field Trip is administered through the muscle, not the vein). The price covers six sessions, each involving a ketamine shot that lasts 45 minutes to an hour followed by traditional psychotherapy administered by trained therapists. The process, Levy said, is meant to make therapy sessions more productive and allow patients to get more out of each session.
"The psychiatrist's arsenal — what they use to treat these illnesses — a lot of these drugs were identified kind of by accident many, many years ago and haven't really identified anything new," Olson said.
The world looks much different now.
Alternative treatments to health problems are becoming increasingly popular, and legal bodies are working to invest in their research. Oregon became the first state to legalize psychedelic mushrooms to treat depression — though the rules and restrictions around it are still being hammered out — and the FDA is conducting clinical trials on the efficacy of psilocybin as a mental health treatment. Field Trip itself is researching and developing psilocybin-based treatments.
Meanwhile, innovation around ketamine has fallen by the wayside, in part due to the fact the patent expired in 2002. Any new drugs that could emerge from it, through financially-intensive research and development and clinical trials, would not be as profitable as new patented compounds.
"They're super, super expensive," Olson said. "Companies want to ensure they can recoup those costs associated with the development."
Even as ketamine clinics continue to pop up their development, experts said, is likely to be limited. But, the use of these once recreational drugs isn't likely to die down for people like Tbul who are willing to shell thousands of dollars every year for treatment.
"I wish it was more accessible to people who are really suffering," she said. "Because not everybody can afford how much it costs per treatment."
Lead art by Carolyn Figel.
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