In a conversation with Sandhya Prashad, MD, Cara explores Ketamine — its pros, cons, and controversies. Dr. Prashad discusses her introduction to ketamine treatment and the diverse therapeutic approaches she employs. Emphasizing the positive impact on patients with 'treatment-resistant' depression, they discuss the nuanced customization levels associated with ketamine treatment. Dr. Prashad addresses safety concerns, highlighting the risks of unsupervised at-home use. Additionally, she clarifies the disparities between medical and recreational ketamine, underscoring the need for widely adopted guidelines backed by research to ensure public safety and patient benefits.
Sandhya Prashad, MD is a board-certified psychiatrist specializing in interventional modalities for treatment resistant disorders with a particular interest and expertise in ketamine therapy. She completed both medical school and psychiatry residency at Baylor College of Medicine. She has been in private practice in the Houston area since 2011 and has been utilizing intravenous ketamine since 2016. She has personally administered over 17,000 treatments with ketamine or esketamine. She is a founder and the current president of the American Society of Ketamine Physicians, Psychotherapists and Practitioners. Dr. Prashad presents frequently on a national level both to the public and to other physicians regarding the use of ketamine for psychiatric disorders. She also serves on several advisory panels for ketamine related research.
Key Takeaways
- [02:41] Introduction to today’s topic and guest.
- [17:03] The safety profile associated with ketamine treatment and the risks of unsupervised at home use.
- [28:52] The essential distinctions between the ketamine utilized for medicinal purposes and the ketamine that has acquired an unfavorable reputation as a recreational substance.
- [38:12] The necessity for widely adopted Ketamine guidelines supported by research, and how such guidelines would safeguard the public and benefit patients.
- [44:30] Closing thoughts and goodbyes.
Episode Transcript
This transcript was generated automatically. Its accuracy may vary.
Cara Lunsford
Oh, hey, nurses. Welcome to the Nurse podcast, Giving nurses validation resources and hope. One episode at a time. Oh, today on Nurse Dot podcast.
Sandhya Prashad
So important to not throw the baby out with the bathwater on this kind of thing because, you know, as we've been talking about anesthesia versus mental health treatment versus abuse, those are all three very, very different scenarios in terms of how it's absorbed, how it's administered. Right. Like, they're all very different. Understanding the like, subtlety of those differences is is so important.
Cara Lunsford
In light of the recent media surrounding ketamine. We've invited Dr. Sonja Prasad to help shed some light on this controversial subject. Sonia is a board certified psychiatrist specializing in interventional modalities for treatment resistant disorders with a particular interest and expertise in ketamine therapy. I'm your host. Kara Lunsford, registered nurse and VP of community at Nurse Ecom. Oh. So, Sonya PRASHAD, Dr. Sonya PRASHAD.
I'm really thrilled that you joined me on this podcast. And I had the privilege of being able to meet you in person. Not too long ago in Texas, in Austin, Texas, where their motto is Keep Austin weird. Okay. I love it. I love it. But I'm going to have you introduce yourself, because the reason I asked you to come on this podcast with me, we had talked about this before.
We wanted to do this podcast together and we were going to talk about ketamine and ketamine therapy. We're going to talk about all the cool things and then ketamine made the news.
Sandhya Prashad
Yeah.
Cara Lunsford
Yeah. So we're like, Oh, what better time than now to talk about stuff that has made its way into the news? And the general public is now talking about ketamine on a rather regular basis. So that being said, would you give me a little intro as to who you are and you know how you got into this this area of medicine?
Sandhya Prashad
Yeah. So, you know, so I'm Sonia and I'm a board certified psychiatrist in Houston, and I'm in private practice and I started my practice in 2011. But then and I was doing just med management. So typical traditional psychiatry, primarily kind of some of the similar earlier things, treatment resistant depression and anxiety disorders. I kind of stuff. And I actually had a patient that became quite depressed and suicidal, and I had sent him to the hospital and when he came out, he was it was even worse.
And it was one of those where, you know, in your bones as that this is somebody who's motivated. And I was like, we have to do something. Or. And I had started hearing about can anti suicidal effects. And so that started my journey. And to kind of learn about it, I even tried to refer this guy to somebody and nobody called me back and he was like, You do it.
I was like, Well, I've got to learn how to do it. So I actually reached out to an anesthesiologist in Boston and she graciously said, Fly up and I'll teach you. So I went up and she trained me. And then I started going to some conferences, met some other people, and that sort of started my journey on this.
I came back, built out an office that catered more to doing those treatments because we can talk about this later, but the environment in which it's given is really important and the setting and staffing and stuff. And so I built that out and then it kind of took on a mind of its own. And at one of those meetings, I met some other doctors who were doing the treatment, and that's how we started the American Society Academy Physicians at that time.
And so now I'm the current president, and that was back in 2016. So I've been using this treatment in my practice since then, and my practice has now evolved into all treatment resistant depression and what they now call interventional psychiatry. So I do intravenous ketamine, but there's also an intranasal version that's FDA approved called spray bottle. We do that in the office and that one has insurance coverage.
So it's a lot more accessible and affordable to a lot of patients. We have therapists that do ketamine, assisted psychotherapy, and a lot of times will use intramuscular or ketamine for that. And then I also do TMS treatment and summit management, things like that. So that's how my practice has evolved over the past couple of years.
Cara Lunsford
That's amazing. I did not really realize how long ketamine had kind of been around owned and how long ago people started using it for treatment resistant depression and and anxiety. I, you know, personally just totally candidly went through a whole series of ketamine treatment myself. And I did that back in 2019. Mainly, I was experiencing a lot of PTSD from my work as a nurse.
Actually. And some of the trauma and the things that I had experienced and I was having really dark thoughts and realized this is this is scary. I scared myself, actually, with my with my own thoughts. So I had thought back actually to a time where I had a patient who I had taken into the hospital and they had given her ketamine, but it was actually for pain.
But this patient actually had a lot of experiences with depression and anxiety and some stuff like that. But after having like just received some ketamine for pain, I remember walking into her room and she looked at me and just said, Oh, my gosh, I feel so well, look at me walking around. Do you? She's like, I think that this is what happiness feels like.
And I couldn't believe it. And so when I found myself in this situation in in 2019, I remembered her saying that I actually remembered her saying, I think that this is what happiness feels like. So I thought maybe there's an option here for me. And so I started looking into it, and I found the Ketamine clinic of Los Angeles.
And Dr. Mandel. And so I went there and I did the whole the whole experience. And after the very first infusion and I'm not saying that this is true for every person, but for me, after the very first infusion, I felt hope. That's what I felt. I felt like a like there was a light at the end of the tunnel.
I think oftentimes suicide or suicidal ideation, it's preceded by that element of feeling like a lack of hope.
Sandhya Prashad
Right.
Cara Lunsford
And so immediately after the first infusion, that's what I felt. I felt hope. And then I was like, oh, I don't I don't feel like I, I that that's my only recourse.
Sandhya Prashad
And that is the experience of a lot of people who have kind of dark thoughts or suicidal thoughts that almost immediately, a lot of times those will get better. And so I'll go ahead and say it. Now, one of my takeaways always when I do a presentation is remember one thing that I say today, it's that this could save someone's life.
If you know a patient that is struggling with acute suicidality, ketamine can save their life because it can often stop those suicidal thoughts right away.
Cara Lunsford
Yes. Yes, absolutely.
Sandhya Prashad
And, you know, we don't have a lot in psychiatry that that works quickly like that that offers such immediate relief.
Cara Lunsford
That's so true. And it is what ended up making me very passionate and what made me so interested in and wanting to be able to provide that kind of treatment as a nurse, which is something that we'll talk about in this podcast, as well as just the opportunities that are out there for nurses who are looking to be able to work with physicians like yourself working for practices where maybe this is something that you're really interested in, or you want to be able to provide this type of treatment because I will say that as a nurse, it has been probably one of the greatest opportunities for me to be able to provide something that has
that kind of result because it's very satisfying as a practitioner.
Sandhya Prashad
Exactly right. Right. I mean, we talked about this some in Austin, right. But especially post COVID and just with like burnout, like how just a lot of nurses and probably just providers in general find that doing work like this feels very rewarding and helps with that burnout in a way. Right. And so, you know, I know a lot of clinics use some nurses that kind of do a couple of different jobs, so they might work in an ER setting, but then they work in a ketamine clinic a couple days a week and, and they, they find that it helps them find a better balance.
Cara Lunsford
Yes. Because sometimes you don't want to pick up that extra shift. Right. Like sometimes you want to work two or three days at the hospital and you're, you're doing that type of nursing and you want to moonlight somewhere where it almost doesn't feel like work. Honestly. I feel like when I'm able to provide these types of therapies for people and I'm able to hold space for them while they're in that journey and I'm able to help integrate them a little bit coming out of that journey.
So helping them get in and also holding space while they're there and then helping integrate them out is just such incredibly rewarding experience. And I think it really is what nurses went into nursing to be able to do.
Sandhya Prashad
Absolutely. I mean, I would say the same for a lot of doctors, right. I think one of the reasons people are drawn to this is people get better. And what we want, right? We want as providers and nurses and everybody in health care, we want to see our patients get better. I'm excited that we're doing this podcast because there's not a whole lot that I think has been out there in terms of specific education.
Just for nurses. But there's such an important part of the treatment team with this because they are often the ones providing support and holding space. And that is that's very, very important during this treatment that the patients feel comfortable and that they have that support team.
Cara Lunsford
Exactly. I mean, that's we nurses, we signed up to do the the educating, you know, the bedside education, the bedside. Yeah. To really truly be at the bedside. And when you have the opportunity to do these ketamine infusions and it depends on what type of clinic you working in and there's clinics where they require you to sit in the room and have one on one monitoring the whole time.
Then there's other clinics where that's not exactly the case, where it's almost like circulating, circulating nurses, where they've got several people that are all receiving infusions at the same time and maybe you're checking in on them, but you're not necessarily staying in the room the whole time. So there's a variety of different models and I don't necessarily feel that there's one right way.
I do think that there's I've I've experienced a couple of different ways. And my preference personally is when I get to have some level of say in the type of music that I'm listening to, the environment, the chair, the blanket, if I want to be able to bring somebody who does energetic work, I want to be able to bring somebody who does that kind of energetic work.
So I like to have a little bit of autonomy over.
Sandhya Prashad
And you're bringing up a great point that this is so specific to each individual person. So also finding what works for that person. So we may have a way that we do it for the majority of people, but somebody might say, Hey, you know, I've had ketamine before this other clinic, this is how I used to do it.
And I'm like, I'm open to how you used to do it. I just did a consult a few days ago with a patient who says that the clinic she was going to would shut down, but she was using VR to do like positive affirmations, kind of like during and what I'd be open to letting her do that. I was like, Sure, if that's what works for you and you've been doing it.
Absolutely.
Cara Lunsford
Wow. I'm trying to actually picture that how that works because, you know, normally we we cover our eyes and we don't open them because there's a little bit of visual disturbance.
Sandhya Prashad
And again, now this goes into how the experience is really different, a different dosage. So maybe she wasn't getting a particularly high dose at the other clinic.
Cara Lunsford
Yes.
Sandhya Prashad
And this is where, you know, ketamine has this art to it, in my opinion. Like with the dosing and that's why sometimes we do, you know, low dose with like IM and patients do therapy during it and they can they're bit more conversational versus you know, Ivy and higher dose IV where they are more introspective, just kind of focusing on music and you know, but I think again, being able to be flexible and not for the patient, but that's why this is this is such like high touch work, right?
Like, you really do have to like, know the patients, know what they like. You know, my staff, my nurses, they they know like what kind of room each patient is. You know, this person likes the room that's dark and this person likes the room. But as a bit more light. And, you know, and so there is a lot of just like personal touch that's really, really important for this.
Cara Lunsford
And isn't that where we're going anyway, or at least where I think where we want to be going anywhere is like personalized medicine, right? That's really where the art of medicine comes in. And I think that sometimes that's where it can make certain practitioners a little uncomfortable, right? Because there's certain practitioners or prescribers that want they want an exact dose, right?
They want to know this is exactly how I give ketamine, this is how long I give it for, this is how I titrate it. This is the bolus I give, this is the and they don't want to deviate. You know, they it's it's like, just tell me what I'm supposed to do and I'm going to do that and that's all I'm going to do.
Cara Lunsford
And it's not to say that a patient can't get some benefit from something like that. I mean, I think that it's a little cookie cutter, but it will they get some benefit? Probably. Probably something.
Sandhya Prashad
You know, we maximize the benefit. Maybe not, maybe not. But that's part of what I like about this, though. I think I like that it's not algorithmic, right, that I get to do that part. I get to kind of figure out what are the things that I need to adjust to get this to work really well for this patient, because all the patients I see are technically treatment resistant, like they've had treatment before.
They I always think of it as kind of like a puzzle. So what are all the pieces? So I a lot of times we'll be looking at labs and thyroid and like making sure their meds are right and how is their sleep and are they exercising and just all those pieces. And then do we have their ketamine right?
You know, are they prepared for their academy? Like are they in the right headspace when they're getting it? You know, all those things?
Cara Lunsford
Well, this this is a very nice segway into the safety profile of ketamine. So one of the reasons why I think that we can feel very comfortable about not being very algorithmic or about how it's being given or very prescribed in not the traditional prescribed word, but like not being so boxed in to how we give it is because it actually has a pretty good safety profile.
Sandhya Prashad
Absolutely. So I think a couple of things come to mind when we talk about this. One is how we use it for, you know, in this case mood. I'm going to just say, because I'm a psychiatrist, I won't talk much about pain. But if we're talking about mood, most of those studies were done at half a milligram per kilo over 40 minutes.
It's again, it's common practice for people to adjust somewhat within giving that anywhere from like up to maybe 60 minutes and then adjusting the dose upward depending on the patient. So that's really, really common practice. But that's still a really, really tiny dose even compared to ketamine. Anesthesia, which tends to be more like five milligrams per mil. You know, I kind of give it all at once.
And so one, it's a very controlled dosing. So they're getting a very small amount at those kind of doses. You don't have respiratory suppression. So that's the first piece that also makes it, I think, very, very safe. But the therapeutic window is just very, very large with ketamine. So, yes, that is one of the reasons why outpatient setting is a safe way to administer the nasal form of ketamine bravado, which you still get decent blood levels of ketamine, you know, the monitoring that's recommended for that and that's an FDA approved product is pretty minimal.
It's really blood pressure primarily. They recently added, you know, getting a pulse ox at the beginning and end kind of. But for the most part, it's very, very, very safe. A patient selection is important with this kind of stuff also. I mean, obviously, but for most patients, this is going to be a very safe kind of drug.
Cara Lunsford
Yeah, Yeah. And I think you you mentioned pretty briefly just so that everyone can understand the the levels that are given in anesthesia are much, much higher. I think you mentioned like five milligrams per kilo.
Sandhya Prashad
Right? Yeah.
Cara Lunsford
So five milligrams per kilo. So that is a half number comparatively to 0.5 milligrams per kilogram of weight.
Sandhya Prashad
Over 40 minutes.
Cara Lunsford
Over 40 minutes. Right.
Sandhya Prashad
And not just like IV push.
Cara Lunsford
Right. Yeah. And that's that's like if someone's going to set a bone in the E.R., Right. They're going to do something where they might give a big whopping dose, but give it under a very quick push just to kind of knock someone out temporarily. The half life is also very short. So coming back out of it is pretty quick.
So the minute the infusion stops running, you know, within 10 to 15 minutes you're really fully awake and exactly.
Sandhya Prashad
And that's the thing, you know, when patients ask about that, they're nervous and like, there's a lot of control that I have over the process, right? I use a syringe pump. Fine or tubing, and at any point I could stop the infusion. And like you said, it'll wear off pretty quickly. Like once a patient comes into the office and they get it treatment within 15, 20 minutes of it being over, they're ready to get up, go to the restroom, walk around.
You know, they're pretty conversational. It does. We're all pretty quickly.
Cara Lunsford
Yeah. We joke and say that you might feel like you're on a boat, but mentally you feel like you're completely back to where you you were usually prior to to sitting down in the chair. But hopefully better better than how you felt before you sat down in the chair. So we know that the safety profile is, I venture to say, better than Tylenol against Tylenol as there that safety profile is not that great.
It's like we recommend three three grams used to be four grams, but then they dropped it down to three grams because anything really over four grams, they were considered they were worried about liver failure. Right. Like so that is, you know, for extra strength. Let's see for how many extra strength Tylenol is that. Eight.
Sandhya Prashad
Yeah.
Cara Lunsford
Eight extra strength Tylenol. And that's something that you can buy just over the counter that has like some major implications if you take too much of it.
Sandhya Prashad
Right.
Cara Lunsford
Now. Yes. Is ketamine available on the streets? Yes. People are taking it recreationally. Now, that's not necessarily recommended. And I think we've seen a lot of things like mine bloom, for example, do you want to talk a little bit about mine?
Sandhya Prashad
BLOOM Yeah. So, you know, just to give a little background for people who may not know, I guess so mine bloom And so during let me back up a bit. During COVID, they changed some rules about how you could prescribe controlled substances to patients. So it used to be you had to see the patient in person at least once before you could prescribe a controlled substance.
And that changed during COVID. And that's why they had you probably remember, the telehealth companies that were doing like Adderall and sending scripts to people. So they have started companies that are telehealth or for oral ketamine at home. You know, there is there's a lot of there's a lot there. You know, they have some of their own kind of guardrails in place to try to monitor.
But again, it's all kind of remote. And, you know, they're they are sending some pretty high doses to patients. And I think for me.
Cara Lunsford
These are like in a lozenge. Like a lozenge form.
Sandhya Prashad
Yes. It's kind of like a cough drop. And so the bioavailability of a lozenge is much lower than when we do IV, but they are sending pretty high doses that can get levels higher than maybe even what we would do for an I.V., because the bioavailable of oral is not great. A lot of people end up needing to be dosed pretty frequently with it.
And that kind of frequent dosing we don't have long term data. And so, you know, there is and then and so what I was going to say is that I go through a pretty lengthy process to determine appropriateness for patients before they ever get treated, and then just educating patients about what it's going to be like. And then also really hand-holding through that first infusion a bit.
I always have to teach you how to do ketamine. And so, you know, with the homework piece, you know, they're not they're not getting that. And then the question comes up with, are they taking it as prescribed? Is it being diverted? Right. There is. There's a lot of that. When we talk about appropriateness, patients who may be actively psychotic, those are not really appropriate patients or ketamine.
They can be worse with that.
Cara Lunsford
Yeah, and not necessarily to name names. There's other companies. Yeah, we're not trashing mine, Bloom, but like, we're just saying like, that was a pretty common one that people were seeing like on Facebook and, and all this stuff and and.
Sandhya Prashad
I and I think it's important that people so I think people see that and they think it's the same as I infusion but it's not right So bioavailability is much much lower. You're just not going to see the same kind of response. And so I think one issue with it is that some people feel like, Oh, I've tried ketamine, and I'm like, Oh, you haven't really tried ketamine.
Cara Lunsford
Yes. Yes. I also think that there's kind of that interesting sweet spot in a way. You almost to me, in a lot of ways, like you don't want to be hanging around in that middle space of ketamine. That's not always like a fun to me. That's not really a fun place to be. I kind of like either want to fully be in that journey and in that place, but I don't really like the purgatory, like I don't want to be hanging out in the middle.
Sandhya Prashad
My understanding is that oral gives you a lot of that purgatory because because of the way it's metabolized so kind of hangs out for a long time afterwards and people sort of feel, Yeah, yes.
Cara Lunsford
And I've also like from what I've understood and correct me if I'm wrong, but usually when you're when you're getting these orals, they want you to put it under your tongue. They don't really want you to swallow because of first pass metabolism and all of that. You're supposed to kind of swish keep it under your tongue so that you can kind of have it absorbed like the.
Sandhya Prashad
Sublingual.
Cara Lunsford
Sibling Willy, like the mucosal, right? And and then you spit it out. So also you don't really want it activating later on, like you don't want to kind of have like these delayed. I have heard a little bit if people swallow it, that they've had kind of these strangely delayed reactions.
Sandhya Prashad
Also kind of lingers on that like, yeah.
Cara Lunsford
Yeah, you don't want to be driving and suddenly go, Oh, I feel a little weird, right? So that's that's another for me personally, I like the predictability of the IV medication. I know when it's starting, I know when it's ending, I know when I'm writing the.
Sandhya Prashad
Dry cleaner, it's a lot cleaner. Like, I mean, even just how it falls off, like you were talking about, like as soon as a pump is off in, you know, in ten, 15 minutes, a person is going to be pretty clear. Whereas some of these other routes of administration, they're they're not as straightforward. And so it can be different every time.
I think the other thing, too, is the idea of doing it at home. Know people with trauma. Sometimes things related to their trauma might come up. And so having that, you know, we're talking about like the support team is, you know, being home alone. I know for some of my patients, I can see that being really problematic.
Cara Lunsford
Yes, absolutely.
Sandhya Prashad
And then I mean, we haven't talked any about like monitor ringing or like what can kind of go wrong, What are the things that that are you know, we talk a lot about A, B, C, but hypertension is during the treatment is common. We do expect transient increases in blood pressure. But we we monitor that during the clinic.
So again, that sort of thing is not being done at home, really.
Cara Lunsford
And there's medications that you give that you can give if if the blood pressure is too high or you can slow you slow it down or.
Sandhya Prashad
Right. It's very manageable. And that's the beauty of I.V. as well. Oral, if it's in, it's in. And if your blood pressure starts to go up in your home, I mean, there's not much you can do there, I guess. But if you're in a clinic, you've got it. I've like you said, you could take your pump off. You could give a little bit of blood pressure medicine through the I.V. and very quickly address any issues.
Cara Lunsford
Yep, absolutely. Some people get nauseated, so some people get pre medicated with Zofran prior to their infusion. Not everybody, but some people do. And so those are all things that can be managed in a more clinical setting with an actual practitioner who is there with you who can do all of that stuff for you. Now, I'm sure there's people who are listening to the podcast who say, You know, when I was a kid I used to do Special K as they called it.
I remember when I was a teenager, that's what people used to call ketamine, and they would talk about things like a keyhole and they're like, Oh my gosh, no, I'll never do ketamine again. Because one time when I was 16 years old, I ended up in a K hall. Do you want to talk a little bit about what a K Hall might be?
Sandhya Prashad
So here are these different. You know, we've alluded to this without really explaining it, but there's sort of these different levels of dissociation that people get with Kennedy, and it's very dependent on the dose. And also just like how you get it. So very, very low dose given really slowly is kind of like with you glasses of wine.
I think most people would say a little deeper is more of that dissociated state kind of feeling like you're floating. You might feel like you're somewhere else seeing colors. You can go too far where you sort of don't know that you exist. It's basically kind of a keyhole. And you feel like usually people say they feel like they're a speck in the universe or they can't move.
And it can be very scary for patients when we're talking about, you know, using special K versus like how we would use it in a clinic. Again, usually really much larger doses when used recreationally. And my understanding is like I think normally it's snorted. So it's like again, this like high dose all at once. So you know, the amount I might use like a vial, I could probably treat maybe six patients with or so one person would probably store two of those.
So what I would give 12 patients in clinic, they would get all at once. And so it's very different. And obviously when you're starting something, you're talking about the experience being predictable with Ivy and obviously in something like this, not going to be very predictable. But if you are giving this like high dose all it was, of course your chances of having something like a keyhole is is higher, but it can be really scary for people.
Definitely not. Our intention when we're using it with Ivy can happen, but it's definitely not our intention.
Cara Lunsford
Yeah it's I think it's it's a lot less likely and also a lot easier to.
Sandhya Prashad
Reverse.
Cara Lunsford
Reverse simple pull people out of pretty quickly. I've had people kind of raise a hand when they get uncomfortable or that, you know, they've gotten into a place where and then I can just slow things down. I just I slow the infusion down. Sometimes they've stopped it. And that has usually been reported by the patients as being a positive experience.
So like, yeah, I started to feel a little uncomfortable. I raised my hand and I could feel the shift. I felt that there was a change in the experience I was having. And to what you said, if you are snorting something up your nose, some of that is going to go down. You're going to swallow some of it because it's going to go down the back of your throat.
Anybody who's ever had a cold or post nasal drip knows that you can swallow. And so there's definitely that can be a delayed reaction. It can come up a little bit later where it feels very prolonged because of the whole it's first pass metabolism thing.
Sandhya Prashad
So I think there's also the issue of when you're buying something off the street that it's not pure ketamine like and you don't really know what else is going on, Right.
Cara Lunsford
Yeah. So yeah, let's let's not disregard the fact that we have a major issue with things like fentanyl. So you do not want to just be buying things off the street from random people that you do not know and ingesting them because we do not know what they are made up of. And fentanyl is a very real risk in, in today's culture.
So even more reason to find a reputable clinician and physician who is providing this type of care. So talking about going rogue, that is the classic example of Matthew Perry. We know that he has a long, long history of abuse, and that's out in the public. We already know that he was very forthcoming about the fact that he struggled with addiction for a very, very long time and also was using ketamine as a as a therapy for possibly was for mental health.
And they found very large quantities of it in his system upon autopsy, which is likely very likely because we just talked about how fast the body metabolizes ketamine when it's given I.V. And we know based on what they talked about in the news, that he had had, I think it was about a week prior.
Sandhya Prashad
I think a week and a half hour a.
Cara Lunsford
Week and a half or so prior, he had had an actual ketamine infusion by a clinician. And that then he died about a week and a half later with a large amount of ketamine in his system, which I think we can probably deduce was something that he had taken on his own in some kind of form.
Sandhya Prashad
Yeah, it's I mean, obviously such a tragic story. I think a couple things that come to mind, though, thinking about his case in particular. You know, I've had I've done a lot of education around. This is obviously come up a lot in the news and so did a lot of it. We did a lot of interviews this summer on this, but with Ivy, the blood level is about 100, 200 nanograms per milk of ketamine.
He had 3500 nanograms, million ketamine. Right. So, I mean, we're talking a lot, lot, lot more. And he was in a body of water. So the you know, we talked about the safety profile of it, even though that is a very high dose. Had he taken that high dose and he was in his bed, probably would k whole and wake up a couple hours later, most likely.
So if you do anything that knocks you out in a body of water, drink too much tequila and pass out, I mean, you're going to drown. So what might probably happen is he lost consciousness and he drowned.
Cara Lunsford
Yes. Yes. I had this conversation with a lot of people because when I saw it hit the news, I cringed, to be honest. I was like, Oh, God, I was like, this is the last thing that we need for those of us in this community where we have seen it help so many people and really be utilized as a way of preventing suicide and and such.
And to see this come out in the news and say that he died from the acute effects of ketamine.
Sandhya Prashad
Exactly. The headlines were so sensationalized. Oh.
Cara Lunsford
It it drove me nuts because I was like, well, how about he drowned?
Sandhya Prashad
Like.
Cara Lunsford
I was like, how about the fact I'm like, because any amount of anything, right? Add to that excess while sitting in a hot body of water, by the way. And so you're sitting in a in a Jacuzzi. And so that's it's the temperatures are high that's going to throw off a lot of things. And then you take something that, you know, can be dissociative and and have a sedative effect.
Yeah, you're you're going to drown. Right. So I think that it's really, really important for nurses who are listening to this podcast because are educators. That's our job. Our job is to educate the public any time we are at the bedside. And a lot of times we get asked questions about things like this we it may not even be because the patient is having ketamine or anything like that.
They could just be in the hospital and say, Hey, what do you think about the whole Matthew Perry thing? Or what do you think about ketamine? And it's important for nurses to be educated about this, not to resort back to their 16 year old self that may have some experience with special K or that kind of level of information.
But to have real strong information from reliable sources like yourself and from others, like in AC, CP3 like that can go places where the information is reliable and then you can educate your patients.
Sandhya Prashad
It's so important to not like throw the baby out of the water on this kind of thing because, you know, as we've been talking about anesthesia versus mental health treatment versus abuse, those are all three very, very different scenarios in terms of how it's absorbed, how it's administered. Right. They're like they're all very different, understanding the, like, subtlety of those differences is is so important.
Cara Lunsford
Yes. Yes, absolutely. And so what would you say is your major concern, kind of on the heels of all of this? What is your major concern with just maintaining access to this type of therapy and just what you could see as potentially happening if things are not regulated in a in in the right way so that the misuse of it does not affect the fair use of it and that and that kind of thing.
Sandhya Prashad
Yeah. You know, one of the that is challenging with this particular field is there's no one specialty that owns it. So no residency program is teaching their residents how to do this really. Right. So right now, psychiatrist, anesthesiologist your doctor is family medicine doctor right. There's all sorts of different providers that are offering it crannies. There's there's a whole variety and that has that makes it challenging because there are a specific set of guidelines necessarily either.
So this is something ASKAP actually created very recently a faculty. What we did was we took people in the community that we knew that had been practicing with a high level of integrity for a period a long period of time. They were well-regarded in their community and we invited them to basically be kind of a think tank. And one of the projects that that group is working on is to create a set of standards and guidelines.
So I think one of the reasons I helped with starting escaping is I was so blown away by this treatment and knew it was so valuable, but it was so vulnerable and it needed protection. And if you don't create a set of guidelines and you don't draw the line in the sand, then how can you say these people are doing it right and these people are on the other side?
And so I think the key really is going to be to create not the we have actually created a set of guidelines that are on our website, but I think something broader than that that's published, that's accepted by all the different specialty of people who are practicing. They're saying this is the standard of care and this is really how it needs to be.
And but it's it is, again, one of those situations where I think we have to regulate ourselves and we don't want people who don't understand the treatment to come in and try to create those guidelines because it is a very different way of using the medication with a lot of wear, a lot of nuance. Yeah.
Cara Lunsford
And and I think that any time there's a certain level of profitability on a type of therapy, it can become a little bit the Wild West. Right? And it's tough because the medication itself is really not that expensive. Right? It's relatively affordable. And so that's not really where the cost lies. And the cost is really in the more of the service, the overhead, the liability, the insurance that the practitioner has to carry their their time.
I mean, just to go to a therapist these days, or at least a really good therapist, you're looking at $200, you know, just to go see a therapist. And that's not including the overhead necessarily that you have to have when you are administering a drug. Exactly like like ketamine.
Sandhya Prashad
And where that gets really great, like you're saying, it's something for most people with a cash pay service, there are places that are able to fill some parts of it through insurance, but for the most part, there's not like a prior authorization process or something. There is with supermodel, but not for Ivy. And because of that, you do have clinics that kind of promote.
It is like snake oil, right. And that's again, where that gets a little dicey.
Cara Lunsford
Yeah. Yeah. I think that the other reason why you really do have to have I think we have a responsibility to protect the public and to make things accessible for them. I think socioeconomically, it's it's important to be able to have access to these types of medications and the sliding scales and and all of those those things. And that's really only going to happen if there's certain types of regulatory practice that's put into place.
Because right now I hear some practitioners, they're like, while we charge $1,000 for a dose of ketamine and some people are charging 500 or $600 for a ketamine infusion, and maybe the people who are doing it for 500 or $600 are providing this kind of full service. There's integration, There's all this, you know, there's therapy, there's all this great onboarding that's being done and monitoring all of that, and someone else is doing it and charging $1,000 and they're sticking you in a room and no one's in there.
And maybe you did a little check off sheet before you went in the room and that's it.
Sandhya Prashad
And and no one told you what it was going to be like. And No, exactly right. So there's no again, that's a that's like standard of care. And I think also the other thing that's important to note when we talk about all of this is there actually is a really large body of published literature around ketamine with regards to the safety and efficacy and what conditions they have studied to see efficacy with.
So the first paper that mentioned ketamine being helpful for depression, I believe was in 1989. And so I mean it was quite a while ago and then in the early 2000 there were lots of kind of single infusion efficacy type of studies and safety and tolerability. So there there is a real body of research around this. And then, of course, we have an FDA approved version.
So to have gotten the FDA approval, there's those pretty rigorous studies as well. So we are talking about not I think it's important to say that because I think sometimes people think this is like totally alternative type medicine. And I don't think of it that way. I really think of it as like this has a very real body of evidence.
I think that's really important, but it needs to be practiced within that set of guidelines that says these are the things that it's helpful for. Yeah.
Cara Lunsford
I'm I'm really, really excited about the work that as KP three is doing and and just grateful for being included in the process with you guys. And thank you for for bringing me into, into the fold. I think that this is kind of the, the cornerstone of what is what is needed so that we can keep this available to the public, to people who who do need and hopefully be able to get other forms FDA approved so that it is, you know, something that can maybe someday be covered by some level of insurance and that it's not just available to people who have thousands of dollars to spend.
I it's personally it's really important to me that this becomes available to to the masses because I do think that it's very it's showing so much promise in the area of mental health. And we need that We need now more than ever.
Sandhya Prashad
Absolutely. You know, that's the other thing, too, that I find myself talking about a lot. Back when I was in med school, which was a while ago, they had published a very large study looking as called study. And they when it showed, was that after someone had had two antidepressant trials, their chances of responding to a third was only 14%.
And so I that just highlight. And then with each trial it got lower. So if you had tried three and I know your chances of responding were like 7% and yet the practice in psychiatry has been to continue to just give oral antidepressant after oral antidepressants, even though after several trials down the road it's low single digits. So that person is going to get better.
And so now we have other options that are helping patients who wouldn't otherwise probably respond to anything. So I think not only is this such a great option, but there's such a dire need within the field for better treatments. Yeah.
Cara Lunsford
Well, I'm glad you're at the helm and again, so grateful for as three. Tell us where people can go to find your organization and learn more about what you're doing.
Sandhya Prashad
Yeah. So escape three dot org. So we have a patient portal on there that you could send your patients to to get like you were seeing reliable information. So that was put together by doctors as well as patients. And so that's a good set of information you can always direct to. There. We have lots of articles online as well.
Nurses can join the organization as members. We want to start doing some more specific training that it's geared towards nurses. It's been amazing to me. Cara It's like open a whole set of new thoughts and possibilities for us. We're so we're excited to be working together more in that way. And then we do an annual conference every year, which is amazing.
And Cara, that's when she was in Austin. We had our conference last month and so it's kind of all things latest and greatest that we know research wise, ketamine, but it's also just a fantastic networking opportunity meeting other people in the space. So that's always an amazing event to attend. This is a appeal that you're interested in.
Cara Lunsford
Yes, I, I think that was what maybe one of the first things I said to you when I met you, the as KP three annual conference as I was, I looked around and I thought we should have like 200 or 300 nurses here at this event because nurses are so passionate about doing this type of work. And we need to get this out to more people and they will spread the word as well.
And so I.
Sandhya Prashad
Was just kind of mind blown when we had that conversation. It was like, Oh my gosh, you're so right. Like, and so we need to do it.
Cara Lunsford
Yes. Well, this is the first opportunity we're getting you out here on Nurse Dot podcast. So all of our incredible listeners can learn more about ketamine therapy and the benefits of that and be able to educate the public and and their colleagues.
Sandhya Prashad
So we thank you so much for having me as exciting to do this.
Cara Lunsford
Well, thank you for making yourself available. I know we pulled you in kind of last minute, but I, we we really are so grateful that you you jumped on with us and we were able to shed a little light, especially in light of everything that has hit the news. So thank you so much. And I hope you have a wonderful, wonderful weekend.
Sandhya Prashad
You, too.
Cara Lunsford
All right. Talk to you soon.
If you are a nurse or a nursing student who enjoyed this episode, don't forget to join us on the nurse dot com app where you can find the nurse dot discussion group, a place where we dissect each episode in detail and delve deeper into today's topics. Nurse Dot is a nurse dot com original podcast series, production music and sound editing by Dawn Lunsford, Production Coordination by Ryan Wade, Additional editing by John Wells.
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