Many people report unprecedented relief from chronic ailments through KAP, and many have mystical experiences and discoveries that allow for new thought patterns and behaviors. However, ketamine is not for everyone. Absolute contraindications include clients with uncontrolled hypertension, cerebrovascular or cardiac disease, as well as those with a history of schizophrenia or bipolar disease and concurrent symptoms of mania. All clients considering KAP should be engaged in an active relationship with a mental health provider. All prospective clients will be screened in detail for both medical and psychological suitability.

Ketamine is a Food and Drug Administration (FDA) Schedule III medication. When used as an anesthetic, ketamine induces a dissociative state, meaning that the brain becomes temporarily disengaged from the body. Since the early 1970s, ketamine has commonly been used as anesthetic for procedural sedation in settings such as emergency and critical care departments, as well as by paramedics and by military personnel on the battlefield. Ketamine is a predominantly safe medication with few serious side effects and has been listed on the World Health Organization’s (WHO) Essential Medicines List (EML) for all healthcare systems.

Ketamine has a multitude of effects on various neurotransmitters in the brain, but its putative psychological benefit is achieved through inhibition at the NMDA receptor. Like classic psychedelics, ketamine down-regulates activity in the default mode network or DMN2 while increasing connectivity and activity in other regions in the brain. Ketamine also plays a role in neuroplasticity – the ability for the brain to change its connections and even structure – by stimulating the growth of new brain cells as well as by creating new synaptic connections between brain cells that didn’t previously exist. These effects likely explain some of the changes in consciousness in the minutes, hours, and days after administration of ketamine.

Since the late 1990s, clinical use and research has shown that ketamine is a safe and effective treatment for certain mental health conditions such as depression, anxiety, PTSD, substance use disorders, eating disorders and chronic pain syndrome among others. There is a patented nasal spray form of ketamine called Spravato® (or esketamine) that has been approved by the FDA specifically for treatment resistant depression. Ketamine’s use for most other mental health conditions is considered “off-label” (i.e., not officially sanctioned by the FDA).

The use of ketamine to treat mental health conditions is more broadly referred to as ketamine-assisted therapy or KAP. KAP entails the administration of ketamine within a therapeutic setting by trained providers using established guidelines set forward by decades of experience and research to achieve treatment goals. Phases of KAP include the following:
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 • Preparation: Clients should be provided with information regarding risks and benefits of the treatment, as well as what to expect from a session. There should be opportunity for the client to meet with the provider prior to the session to establish goals of treatment and to disclose any significant personal background information. Ideally a mutually trusting bond is developed prior to a treatment session, such that the client may enter treatment with some degree of surrender, and thus achieve maximum benefit. 
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 • Treatment: Sessions should be conducted in a safe and compassionate setting, characterized by the abiding presence of providers in a private, pleasant, and comfortable environment. Music, headphones, and eyeshades are hallmarks of KAP sessions, though they can be tailored and individualized as needed.

• Integration: An often under recognized phase of KAP is integration, where the client will meet with a therapist within 1-3 days of each session. For sessions that are challenging or confusing, integration can provide psychological support and even prevent harm. Integration also allows for processing of content from each session to facilitate insight or meaning making, bringing the client closer towards personal transformation. In the absence of integration, there are subtleties that can be overlooked or dismissed, and which may have substantial clinical application. The full benefits of KAP are rarely reached without proper integration.

^*It is important to distinguish KAP from ketamine use outside of these guidelines, otherwise referred to as recreational use.

Ketamine can be delivered by various routes:

 • Oral/mucosal: This form is most often delivered via the mucous membranes of the mouth using oral dissolving tablets (ODT), rapid dissolving tablets (RDT) or troches. Mucosal routes offer roughly 25-30% bioavailability (otherwise known as the percentage of dose effectively absorbed into the bloodstream). 

• Intramuscular injection or IM: This route involves a needle and syringe to inject ketamine into muscle, most commonly the deltoid, or shoulder. The IM route for ketamine offers roughly 93% bioavailability and does not require continuous monitoring nor medical equipment. 

• Intravenous or IV: This is the route most often used in hospital settings, as well as in some KAP practices. Here, a needle and catheter are inserted directly into a vein where ketamine is infused as a drip, providing for a constant and predictable absorption in the bloodstream. For safety reasons, this method of delivery requires various medical equipment, including a cardiac monitor and leads that are connected to the client to provide continuous measurement of vital signs. Bioavailability for the IV form of ketamine is 100%. 

‍At Kanopy, we administer ketamine using both RDT and IM routes. While each method of delivery has its own character in terms of rapidity of onset, depth of experience and duration of experience, we find that by starting with the RDT route, we are best able to establish trust and ease with our clients, as well as determine an appropriate IM dose moving forward. While the IV route has many benefits, we find that the associated equipment and monitoring requirements can be burdensome and disruptive to the client experience. 

Classic psychedelics, such as psilocybin, LSD, DMT, and peyote, exert their effect at serotonergic receptors, specifically through agonism at the 5-HT_2A site. Ketamine, meanwhile, has minimal interaction with serotonergic receptors. For clients who are on SNRIs or SSRIs (most  prescription antidepressants), psychedelics are not always a viable option. When SSRIs are combined with psychedelics, there is risk for serotonin syndrome, a potentially life-threatening condition. Conversely, there is a risk that the psychedelic effect will be significantly blunted in the presence of these medications, given that both substances are competing for the same receptor site. By contrast, there are very few drug-drug interactions when it comes to ketamine. Many in the field of psychedelic medicine affectionately refer to ketamine as the drug that “plays well with others.”

An added benefit of ketamine is the average trip lasts roughly an hour. This allows for more flexibility when it comes to scheduling, not to mention cost. Most psychedelics, on the other hand, have a half-life of 4-8, and in the case of LSD, up to 12 hours, commanding significantly more resources to support a full journey. 

While ketamine does not fall into the class of classic psychedelics, it can occasion similar hallucinogenic effects, psychic expansion, mystical experiences, and even ego dissolution that approximates a psychedelic journey. Furthermore, because ketamine is a Schedule III drug, it can be legally dispensed and administered. Psychedelics remain Schedule I and cannot legally be administered outside of the research setting.

There is no one-size-fits-all with KAP. Every person will have a unique experience, and in fact, every session for every person will produce a unique experience. Formost people,ost of the time, the KAP experience is described as profoundly meaningful and positive. A small percentage of the time, the experience is described as neutral, disappointing, or, rarely, unpleasant.Most people experience a non-ordinary state of consciousness – an experience where the body is deeply relaxed, and the mind is open, curious, and ready to receive. Some people can have an experience of deeply felt or even euphoric empathy, compassion, and open-heartedness; some may experience synesthesia, a mingling of the senses (such as “seeing” or “smelling” sound); some may have an out-of-body experience or a loss of identity; some may have a mystical experience, touching a deeper universal reality or collective unconscious; and some may have what may initially seem like an unremarkable or underwhelming experience. Whatever the case, we believe that there is no such thing as a negative experience – that while you may not get what you want or expected, you get what you need, and every experience is equally valuable when properly integrated.

We allot 3-4 hours per treatment session. This time frame allows for roughly one hour of preparatory work, followed by one hour of the actual ketamine experience, and finally one hour for landing and processing. Some clients are done in 90 minutes, and some will require up to 4 hours to be stable on their feet. We honor each client’s needs and schedule our sessions accordingly. 

There is some variability in the optimal number of sessions needed, depending on client and the challenge being faced, not to mention cost and scheduling. Research has shown that for treatment resistant depression, a standard protocol involves six IV sessions over the course of 2-3 weeks. At Kanopy we encourage our clients to commit to a minimum of 3 sessions spaced 7-10 days apart. We find that there is more reliable benefit with more than 2 sessions, and specifically when given in sequence within a window where neuroplasticity is at its peak. Booster sessions may be provided on an as-needed basis for maintenance. Typically, two boosters are needed, one to two days apart. On average, patients enjoy around three months of relief be fore needing a booster. It is not unusual for patients to enjoy six months of relief, or longer.

Ketamine has predictable effects on the cardiovascular system, namely increased heart rate and blood pressure. Because these effects can pose risk to certain individuals with cardiovascular disease, it is important that all clients are medically screened, and that those suffering with these conditions are properly monitored and/or treated by a primary care physician.  

‍Some clients experience mild to moderate nausea during a session, especially those prone to motion sickness. A prophylactic anti-nausea medicine may be given just prior to the session in such cases. Headache is another potential side effect that can be remedied with Tylenol or ibuprofen. Patients commonly feel tired or groggy, woozy, or spacey after a ketamine session. This usually subsides completely after a full night of sleep. Interstitial cystitis is a rare inflammatory condition of the bladder that only tends to occur with frequent and long-term use of ketamine. 

As a controlled substance, ketamine has potential for abuse and dependence, especially in clients with an active or previous history of substance use disorder. It is important that all clients refrain using other substances while working with ketamine. Frequency and dosing are carefully monitored, and ketamine is not prescribed for home use in most cases.

Kanopy subscribes to the two-sitter model, such that an experienced physician and therapist will be present to guide each client during their session. We find that this approach ensures both medical and psychological safety. Furthermore, the dyadic model closely approximates that used in psychedelic assisted therapy, ensuring a complimentary and nuanced approach that is curated to meet the individual needs of each client.

We strive to provide a setting that is both private and comforatble, anticipating various needs and preferences. We offer a variety of seats and blankets, complimentary eye mask to promote inner exploration, noise-cancelling headphones to promote an immersive experience, and a custom curated playlist tailored in consideration of client intention and with attention to ketamine’s pharmacodynamics.

Having an intention helps to organize your thoughts and your process around what’s most important to you, and to your experience. Intentions are general areas of focus on which we can set our sights. We start by asking the question, why are you doing this? And what would you like to get out of this experience? What does healing look like for you? What do you want clarity around? To let go of? We believe that while setting a specific intention is integral to mindful engagement, it is paramount to maintain a beginner's mindset, remaining open to whatever comes forward. The medicine may not give you exactly what you want, but it will give you what you need.