As ketamine clinics pop up across the U.S. to offer experimental infusions for depression, anxiety, and a slew of other conditions, training programs to teach providers how to run these businesses have also started to appear. They promise to teach everyone from anesthesiologists to advanced practice nurses the ins and outs of ketamine, which has been used for decades as an anesthetic but is still under study as a therapy for psychiatric disorders.
The doctors and nurse anesthetists offering the courses say they’re urgently needed to try to bring some standardization to the booming ketamine treatment business. “I think [ketamine] is going to get wider spread use in one capacity or another. I’d like to see that be done appropriately,” said Dr. Gerald Grass, an anesthesiologist who runs the Ketamine Institute, a training program run out of the Sarasota, Fla., practice where he also treats patients with ketamine. But some mental health experts say there isn’t yet enough evidence about how to use ketamine to offer training. They fear some of those signing up for the programs might be trying to break into the business to make a quick buck.
“If I thought there was a standard protocol … then I think [training] could be very useful. But I’m not sure we have that yet,” said Dr. Gerard Sanacora, a psychiatrist, professor, and the director of the Yale Depression Research Program. “There is a real limited amount of data. It’s ethically a challenging and clinically a challenging situation.”
Sanacora said he understands, however, the growing interest in ketamine: Many patients who haven’t benefited from conventional depression treatments are in desperate need of relief.
Studies suggest that the drug holds potential as a treatment for major depression in some — though nowhere near all — patients. A dose much smaller than what’s used for anesthesia, given through an IV, stems symptoms of severe depression in some patients with treatment-resistant depression, often within hours.
But there are gaping holes in the data on long-term effects of ketamine, potential risks down the road, and the best way to integrate the drug into a broader mental health care plan.
A STAT investigation published last month found wide-ranging inconsistencies among clinics. Some clinics don’t thoroughly screen patients, and experts worry they’re offering the drug to anyone who can afford it. Providers charge anywhere from $350 to close to $1,000 per infusion and many patients get at least six rounds of the treatment. Some clinics, too, offer ketamine for uses that haven’t been well-studied, overhype its efficacy, and tout special blends that experts say aren’t supported by published evidence.
The Ketamine Institute offers two classes. The first, a $4,950 fundamentals course, is “directed to physicians who wish to quickly get the basic training necessary to [safely] and effectively provide ketamine infusion therapy to their patients,” according to the institute’s website. Grass said that course is targeted at providers who might want more information on the research and clinical care, but are familiar with starting IVs. The second, an $8,950 comprehensive course, takes a much deeper dive into the weeds of running a clinic and also gives physicians hands-on experience with patients.
Grass said he gets eight to 10 inquiries about the training courses each month. The number of people he’s actually trained: seven. He generally only trains psychiatrists and anesthesiologists and requires applicants to submit a statement about their intentions.
“There are people out there that are looking for alternate streams of revenue,” he said.
He gets inquiries from everyone from cosmetic dermatologists and chiropractors to venture capitalists. He even heard from a provider who was running an alternative weight loss program and wanted to add ketamine “to motivate his patients,” Grass said.
“People will read one or two research papers, see the protocol, and think, ‘Oh, my God, this is easy. I can do this in my office,’” Grass said.
To train under Grass, providers can spend several days shadowing at his clinic. Dr. Ricardo Febres Landauro, a psychiatrist in Austria, flew thousands of miles to take a course in January. He observed patient interactions, pored over his own cases with Grass, and left with a binder stuffed with information on ketamine’s effects, indications, and contraindications.
“After [training] with him, I felt confident,” Landauro said, adding that the course “was a magnificent experience.”
Grass said he trains providers using the evidence in consensus statements published by the American Psychiatric Association and the American Society of Anesthesiologists. In his own practice, however, he deviates in some instances from published research and treatment protocols. He offers a proprietary product called the “Restore Ultra-Rapid Infusion,” which includes three treatments in three days and which the clinic claims lasts longer and is more effective than other ketamine infusions. His clinic promotes the infusions to treat anxiety, depression, PTSD, and “burnout syndrome.” Grass said physicians just starting to use ketamine might not be experienced enough to deviate from the standard.
“It behooves them to learn how to do the standard protocol effectively and safely,” he said.
Another training program, Colorado-based Ketamine Consulting, promotes on its website “turnkey, comprehensive services that propel clients towards success” in establishing their own ketamine clinics. It promises clients will come away with a “profit-generating ketamine clinic, a renewed love of medicine, and the independence that all physicians crave.”
That program is led by Dr. Roman Langston, an anesthesiologist who also provides ketamine to patients at his Denver clinic. Langston said he taps into his own background to give guidance on treatment, but Ketamine Consulting also serves as a one-stop shop for the business side of a clinic. It builds a client’s website, brainstorms branding, creates logos, and sets up a presence on Facebook, Twitter, and LinkedIn. He charges $1,500 a month for a six-month contract.
Providers are keen on the idea of formal training and a helping hand in launching their clinics. Since starting his consulting practice in summer 2017, Langston has had about 10 clients. Jason Duprat, who runs an online training program called the Ketamine Academy, said roughly 100 people have signed up for the course in just over a year.
“One of my goals was to increase the number of providers,” he said.
The cost of his program: $2,499 upfront, or three payments of $999. Like the Ketamine Institute, Duprat’s online tutorials cover the evidence on treatment protocols and contraindications when using ketamine. His course also emphasizes the business aspects, from the paperwork to set up your own private practice to the best ways to design a website.
“Some of the most common questions are on the business side of things,” Duprat said. The bulk of his clients are nurse anesthetists, like him, or nurse practitioners, Duprat said. That means they don’t necessarily have the know-how to get a clinic off the ground.
Christy Hatcher, a certified registered nurse anesthetist and advanced practice nurse in Minnesota, found that material particularly useful, along with the information on patient care. She signed up for the Ketamine Academy when she was starting the process of opening a clinic in Maple Grove, Minn. She had spent 17 years working in a Minnesota hospital when she decided to open a ketamine practice with another CRNA. They bought the course earlier this year as an “investment” in their clinic.
“It took a lot of the information that is out there and it put it all together for you,” she said. It also led them to bring a mental health nurse practitioner on board.
Their clinic will open in early November. Patients are already calling for appointments.