Psychedelic-Assisted Therapy

Ketamine is classed as a hallucinogen, though it shares many of the same effects as psychedelics. Ketamine is legal and can be prescribed by licensed medical practitioners. It is either administered by a licensed medical practitioner (either intravenously or via intra-muscular injection) or self-administered (by a nasal spray or in oral lozenge or tablet form). The bioavailability of these different modes varies widely, so dosages are adjusted to make up for the difference. 

Psilocybin, found in magic mushrooms such as psilocybe cubensis and psilocybe cyanescens, is a Schedule I controlled substance. At the federal level, psilocybin accounts for under 1% of DEA enforcement actions.

Currently, Oregon has established a legal framework for the administration of psilocybin therapeutically in designated service centers by trained and licensed practitioners. While I have completed a training program aligned with the Oregon PAT training criteria, I am not licensed in Oregon for PAT.

In 2023, Washington's governor signed the Washington Psilocybin Services Act. This act created a task force to consider whether and how psilocybin may be used clinically, as well as a University of Washington clinical study exploring how psilocybin may be used to treat certain mental health disorders. Bills are in process now that would legalize and regulate psilocybin-assisted psychotherapy, not unlike how the state allowed medical marijuana. Additionally, the cities of Seattle and Olympia, as well as Jefferson County have decriminalized the possession and use of psilocybin. 

MDMA, another Schedule I controlled substance, was evaluated by the FDA in 2024 for treating PTSD, in tandem with psychotherapy. The FDA declined to approve this treatment, and mandated another round of Phase 3 clinical trials before re-evaluation. This is not likely to happen until 2027. 

Ketamine, psilocybin, and MDMA haven’t been shown to carry significant risks of physiological addiction. However, in rare cases, psychological dependence may happen with very frequent use of high doses of ketamine.

Ketamine is most often used as an anesthetic, in hospital settings. Even this use is usually safe; ketamine is routinely given even to infants for this purpose.

Your safety and well-being is my utmost concern. Your ketamine use in a KAP context should never approach a level that would create either danger of death or addiction, as long as you dose as recommended by your prescriber and also disclose any conditions you have that might contraindicate safe use.

PAT and KAP have three stages: preparation, dosing, and integration. 

Our KAP preparation and integration sessions may take place in person, or virtually over a HIPAA-compliant video telehealth platform, as long as the client is in the state of Washington.

I always prefer in-person sessions, when possible, since it is easier to understand micro-expressions and body language in person. Trust and mutual understanding are important parts of any psychotherapy process, and even more so for this type of therapy.

Where you take the dose is up to you! For their dosing journey, many people enjoy being in nature, or the comfort of their home, or at another inspiring, comfortable, or meaningful location. The most important thing is that wherever you dose, you are safe, you have access to everything you might need: i.e., food, water, and a bathroom. I suggest you also take steps to prevent yourself from communicating with anyone you shouldn't be communicating with while impaired (e.g., your boss or your mom!). That means no electronics, usually.

It's worth noting that a ketamine journey will last about an hour, while a psilocybin journey will last four to five hours, or even longer.

A "contraindication" is a mental health or medical condition that is associated with a negative outcome during or after a particular treatment. Before recommending any medicine, responsible clinicians screen for contraindications. 

Responsible precautions should always be taken to stay safe and protect others while under the influence of psychedelics. Both psilocybin and ketamine are contraindicated for people with certain medical and mental health conditions. 

The contraindications for psilocybin, ketamine, and MDMA are similar. Clients with the following conditions are not good candidates for KAP at Intima:

• Active mania or psychosis
• Uncontrolled hypertension (high blood pressure) 
• Significant, daily substance abuse, including acute alcoholism
• Acute or unstable cardiovascular disease
• Previous negative response to ketamine
• Currently pregnant
• Glaucoma or recent ocular surgery
• Intracranial pathology, such as intracranial pressure 
• Personality disorders with high levels of symptoms
• Currently taking high doses of benzodiazepines or lamotrigine

Though it is rare, some people with recent suicidal thoughts may be at risk for experiencing a rebound of suicidality from ketamine. If you struggle with suicidal thoughts, please let me know! Creating a safety plan and involving support people in your treatment are two important steps we will want to take, to help ensure you have a safe and supported experience.

At high doses, ketamine is an anesthetic, and with frequent, repeated use it can become addictive. For this reason, it's not a good treatment for people with significant substance use disorders. For these reasons, the prescribers I collaborate with are careful to limit dosages and monitor usage to prevent these harms. For people wishing to address substance abuse issues, cravings, and compulsions, psilocybin is recommended as a better alternative.

Yes. There are several pharmaceuticals that affect the way your body reacts to ketamine. If you are taking any of these medicines, be sure to tell the KAP medical screener, as well as your prescriber:

• Benzodiazepines, like alprazolam (Xanax), lorazepam (Ativan), and diazepam (Valium). These can cause drowsiness and slow breathing.
• Opioids, including methadone, These can lead to nausea, drowsiness, dizziness, and more seriously, slowed breathing
• Barbituates, including phenobarbitol. These can make you feel off-balance or sleepy, or slow your breathing.
• Stimulants like Adderall and methylphenidate (Ritalin) can cause high blood pressure. 
• MAOIs, like selegiline (Eldepryl, Emsam, Zelapar) and rasagiline (Azilect), can raise blood pressure.

Similar to benzodiazepines, alcohol can both decrease the effectiveness of KAP on depression symptoms, and cause drowsiness and breathing problems. Please don't drink alcohol the day of your treatment. Please be honest about your alcohol use—it's important!

Several other medications can decrease—or increase!—ketamine's effects. Please share your full medication list with your medical screener!

If you take these medicines, your prescriber may be able to help you taper down in advance of your PAT dosing sessions.

Important! DO NOT change your dose or stop taking any prescribed medicine without speaking to your doctor first!

No, I don't. I do not prescribe, provide, or administer drugs of any kind.

For clients pursuing ketamine-assisted therapy, I recommend Wondermed as a licensed prescriber. A medical provider at Wondermed who is licensed in Washington State will perform your medical screening, determine an appropriate dose (prescription), and fulfill that prescription by delivering your doses to you through the mail. The medicine will come in the form of under-the-tongue troches (quick-melt lozenges). They customize the strength and number of troches to each patient's specific needs. 

Wondermed is quite affordable compared to other ketamine prescribers, and they offer a 20% discount to my clients. I am happy to provide a referral to Wondermed so you can take advantage of this discount.

Ketamine sometimes causes brief nausea. If you are prone to nausea, please let your prescriber know. They may recommend an over-the-counter or prescription medicine to help with those symptoms. I have ginger chews on hand in my office I am happy to share if needed. 

For journeys I am present with you for, after you take your dose, I will help you settle in for a comfortable trip. I'll be with you every step of the way. 

If you plan to use psilocybin, please let me know. I want to advise you that in Seattle (and other locations in Washington State, such as Olympia and Port Townsend), psilocybin possession and use has been decriminalized. However, buying and selling it remains illegal under both state and federal law.