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Who Can Offer Ketamine Assisted Psychotherapy?

Ketamine assisted psychotherapy is becoming increasingly more known as an option for healing. While ketamine is a known dissociative anesthetic agent, it has only been used to improve and optimize mental health for the past 15 to 20 years. While not technically a "psychedelic" (it depends who you are talking to, though) and works through different mechanisms of action than classic psychedelics like psilocybin and LSD, ketamine certainly has psychedelic effects.

Logistically, ketamine assisted psychotherapy involves both a prescription medication (the ketamine) and therapy. The type of therapy provided varies among practitioners and research has not yet shown if there is one more effective/optimal type of therapy for ketamine work. Thus, offering ketamine involves the practitioner having experience, training, and credentials to provide both the therapy and ketamine or hire additional clinical members who complement your training/background/credentials. Collaboration is a beautiful and important aspect of ketamine assisted psychotherapy!

It's important to note that ketamine is a DEA Schedule III controlled substance so there are specific parameters in place per the DEA that practitioners need to be aware of and comply with.

Legal Perspective

From a current legal perspective, those who can prescribe ketamine are individuals who have 1) a DEA license in the state where they will be using ketamine with patients and 2) a license to practice medicine (physicians, nurse practitioners, physician assistants, and in some states, naturopathic doctors and psychologists) in the state where they will be using ketamine. They are legally able to order ketamine from compounding pharmacies and online pharmacies such as Henry Schein Medical. Therapists (psychologists in most states, social workers, marriage and family therapists, counselors) are not able to order ketamine since it is a prescribed medication, hence the need for collaboration.

Now, if it were just based on the legal perspective, there wouldn't be much else to say. But it's not that simple - let's go over the other factors to consider.

Malpractice Perspective

Many medical malpractice insurance companies have hesitation about providing coverage for ketamine assisted psychotherapy. As with most new or outside-the-typical box of standard medication prescribing/therapy in outpatient psychiatry, insurance companies remain cautious. It is a new modality, relatively unregulated - especially for a controlled substance - and many practices do not use the FDA-approved form, Spravato.

From a prescriber standpoint, insurance malpractice is more likely to cover your work in ketamine assisted psychotherapy if you are a psychiatrist or psychiatric nurse practitioner and don't prescribe outside of the clinic (ie you are only offering ketamine sessions in the clinic). Malpractice is also more likely to cover prescribers if they are physically on site for the extent of the ketamine therapy sessions.

For example, they likely will not cover malpractice if you as a physician or nurse practitioner are physically located at a different clinic from where a therapist is providing ketamine assisted psychotherapy. Some malpractice insurances also will not cover prescribers if they are not physically present for the extent of the ketamine session with a patient.

So do your homework and reach out to your malpractice insurance and if needed, find a malpractice insurance company who will cover you adequately. I utilize PRMS and they permitted a ketamine assisted psychotherapy rider as long as I meet the criteria as I stated above. Ask others in your speciality who they use for insurance and if there were any issues with getting coverage.

Ethical Perspective

Ketamine assisted psychotherapy is not like prescribing an antidepressant for depression. It requires experience and comfort with guiding people who often have significant mental health histories through difficult experiences. It really does require more than a weekend course to be competent in this work and ideally, those who are sitting for the 3 hour ketamine medicine sessions have trauma therapy training. And it is under your patients' best interest for you to have experiential training, which is experience taking ketamine under therapeutic supervision.

If you are someone with prescribing abilities, only you can answer the question honestly if you have adequate training to offer both the therapy and medication aspects of ketamine assisted psychotherapy. If not, you have several options! Collaborate with a therapist who has training in ketamine assisted psychotherapy or dedicate yourself to becoming competent in therapy modalities, under the scope of your practice.

Additionally, it's a good idea to seek out ongoing mentorship/consultation from someone with a lot of experience working in the ketamine assisted psychotherapy realm - either in a group setting or one on one.

Therapy Modalities that Complement Ketamine Assisted Psychotherapy

Therapy modalities that bode well with ketamine assisted psychotherapy include internal family systems, somatic experiencing, trauma therapy training, compassionate inquiry with Gabor Mate MD, and acceptance and commitment therapy. Internal family systems, or IFS, has a long waitlist currently for training; the other modalities typical require (and are helpful to have) some sort of experiential/practicum training and require more of a time investment than say, a weekend CBT course.

Now you have an understanding of why the question of "who is able to offer ketamine assisted psychotherapy" isn't so simple. What other questions do you have about offering ketamine assisted psychotherapy as a practitioner?

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