Ketamine and psychedelics grow as medical options

DUSTIN WALSH

Soon after the needle enters her arm, the walls turn red and pulsate like the inside of a breathing whale, or the warm center of a lava lamp. e knots in her muscles, constricting her skeleton like a python begin to loosen. Her mind is euphoric.

Elissa Ray, a 68-year-old self-employed attorney from Dexter, is high. But she’s not in an opium den. She’s in therapy.

Ray, su ering from a complex post-traumatic stress disorder linked to early childhood trauma, is among a growing faction of mental health patients using psychedelics or psychedelic-like drugs at clinics cropping up across the state.

“It was the rst time in a very, very long time I felt hope,” Ray said of her therapy. “ at I can work through these things and nd peace. at’s what you carry with you after the infusions, the feeling that there is a place that is peaceful and maybe that’s the rst time in your life that you’ve found peace.” ere had to be a better way, and I do believe this is it.” ousands of ketamine clinics have cropped up across the U.S. in the last decade, and ketamine is likely the rst of many similar drugs to come. Psilocybin mushrooms, LSD, MDMA and more are currently in clinical trials at various research institutions, including the University of Michigan, as scientists get closer to unlocking the power of these hallucinogens to battle for mental health and wellness.

Ray is a patient at Royal Oak-based Michigan Progressive Health, a ketamine-assisted therapy clinic run by former emergency room physician Dr. Megan Oxley, M.D. e clinic administers doses of ketamine, a dissociative anesthetic prominently used during surgery, to treat chronic depression, anxiety, pain and other mental illnesses. e clinic mixes the often hallucinogenic drug with talk therapy as a treatment for more than 500 patients from its Royal Oak and Ann Arbor o ces.

Just like medical marijuana a decade ago, ketamine used to be classed as an illegal drug but has recently become more popular for medical uses. And like the medical marijuana industry of the past, there is now a growing number of businesses that are embracing what is recreationally called “Special K” for health care uses.

“We split the di erence between Eastern and Western medicine,” Oxley, 43, said. “Most of our patients have exhausted other avenues of relief. Many of them are suicidal when they get to us. I spent a decade in the ER witnessing the Band-Aid-system of mental health care in America.

‘It’s not scary’

Ketamine was approved by the U.S. Food and Drug Administration as an anesthetic in 1970. But research in recent years has found the drug also works for treatment-resistant depression in some people, and psychiatrists began using ketamine as a treatment for mental health disorders over the last 20 years.

It wasn’t, however, until the last decade that clinics began to o er the drug o -label as either an infusion or injection for those problems. “O -label” use means the drug hasn’t been speci cally approved for those conditions.

In 2019, the FDA even approved a version called esketamine, under the brand name Spravato. It’s an inhaled treatment that is required to be administered in a doctor’s o ce and is only approved for patients where other treatments have failed.

“Some patients don’t respond to traditional antidepressants,” said Dr. Avinash Hosanagar, M.D., psychiatrist at the Veterans A airs’ VA Ann Arbor Healthcare System and clinical associate professor at UM’s Michigan Medicine.

“At the turn of the century, there was interest in new ways to treat depression. We had discovered serotonin’s link to depression and wanted to try a di erent compound than typical treatments. We have found that with ketamine, symptoms of depression and suicidal ideation improved very rapidly.” e VA has been using ketamine to treat veterans’ mental health disorders since 2019 and UM Health began using it clinically in 2021, Hosanagar said.

Oxley opened her Royal Oak clinic in 2016 after being discouraged over mental health treatment as an ER doctor at Ann Arbor-based Emergency Physicians Medical Group, which employs physicians at several hospitals throughout the region.

She remained an ER doctor through 2019.

“ e system doesn’t adequately care about mental health,” Oxley said.

“ ere is no piecemeal approach. We look at all the things that are causing a patient’s distress and use ketamine as only part of the solution.” e rst ketamine regimen at Michigan Progressive Health is 90 minutes and includes meetings with a therapist and a doctor, like Oxley. e clinic employs 22, including ve therapists, two physicians and two physician assistants, Oxley said.

Ray found Michigan Progressive Health during an internet search looking to nd any new treatments that could alleviate her PTSD.

“I had been through ve or six medications, talk therapy, EMDR (eye movement desensitization and reprocessing therapy) and neurofeedback,” Ray said. “I was doing all of those things, and it was almost a full-time job to keep me functioning and working. I wasn’t really making any progress, and I was getting desperate.”

Oxley said about half of her 500 or so patients found the clinic during a Google search and another 25 percent were referred by a growing network of therapists.

Ray said the experience of dosing ketamine was like experiencing a different planet, one where her chronic troubles were alleviated, and she was able to think about her trauma without the typical mental and physical hang ups.

“It’s not scary. You don’t feel threatened or out of control,” Ray said. “It’s very comforting. It lets me think about all those things in my past without causing anger, sadness or stress. Even thinking about my experiences can throw me into a panic attack, but with ketamine I can think about those things without the terror and physical reaction.”

Ray has undergone about 20 ketamine sessions and is now active in the clinic’s virtual group therapy sessions as well as seeing a therapist individually once a month.

“After the rst infusion, I felt better for a couple of days,” Ray said. “ en with each infusion after, I felt better a little longer. I can go almost a year now between regimens. I do believe it saved my life.” e treatment, however, isn’t for everyone, Oxley said. Sometimes the ketamine doesn’t achieve the right af- fect and can make suicidal thoughts more prominent. And because the clinics are not federally regulated and this speci c use of ketamine is not an approved treatment by the FDA, some caution should be exercised.

“ e concern with these clinics popping up is that people are getting treatments that haven’t been well-proven, well-studied or following any guidelines,” Dr. Smita Das, M.D., an associate professor at Stanford University School of Medicine and chair of the American Psychiatric Association’s Council on Addiction Psychiatry, told NBC News in January. “My concern is that people who need treatment will spend their money and energy in these ketamine clinics that aren’t well-proven.” e treatments are costly. Ketamine use in these clinics is not covered by health insurance. At Michigan Progressive Health, a ketamine session costs between $350 and $600 and is usually coupled with a $250 consultation and $125 per hour ther- apy sessions.

Lucy in the sky

Ketamine is, coincidentally, the gateway drug to further research into other psychedelics to treat mental illness.

Hosanagar will help lead a clinical trial at UM and the VA this summer on the use of psilocybin mushrooms to treat depression. e initial trial, funded by U.K.-based life sciences company Compass Pathways plc, is expected to be carried out with 25 to 50 patients, Hosanagar said.

Initial research is hopeful, he said.

“ e early research seems to indicate two doses of psilocybin given a week apart reduces depression symptoms,” Hosanagar said. “In head-to-head comparisons, along with psychotherapy, those who were given psilocybin responded the same as patients taking regular antidepressants daily for six weeks.”

Research on psychedelics is in the trials are people who believe in drugs. ey are having these positive results because they want them to work. I believe the treatment e cacy is going to come down somewhere in the middle to closer to the e cacy of current antidepressants.

Ray said although she was in high school in the early 1970s, she never succumbed to the drug culture of the time and had never taken any drugs recreationally.

“I had no experience with this and the whole thing was creepy at rst,” Ray said. “But I was desperate. I wish I hadn’t been so desperate and had found this clinic sooner.”

Regardless, the federal government appears primed to bring more psychedelics to health care.