Ethical Guidelines for Ketamine Clinicians

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Authors: Wesly C Ryan, MD; Raquel G Bennett, PsyD

Version 1.1 – Posted on 12/13/2020

The ethical ketamine clinician recognizes that therapeutic ketamine is a mental health treatment. In this document, “therapeutic ketamine” refers to ketamine that is administered to a patient primarily for a psychiatric indication, psycho-spiritual exploration, and/or psychological work. Therapeutic ketamine does not include ketamine that is administered primarily for anesthesia or pain management, which are considered separate fields (specialties) from therapeutic ketamine.

The ethical ketamine clinician recognizes that ketamine is a powerful psychoactive medicine with prominent dissociative and psychedelic properties. The ethical ketamine clinician recognizes that therapeutic ketamine patients require specialized psychological care before, during, and after receiving ketamine.

There are three roles in every therapeutic ketamine treatment: (1) a mental health professional; (2) a medical professional; and (3) the patient. In some cases, one person may be able to fulfill both professional roles, such as a psychiatrist who has substantial psychotherapy training.

— The responsibilities of the mental health professional include: doing the clinical intake interview and assessment; doing integrative treatment planning; providing psychological preparation before the ketamine administration; providing psychological support during the ketamine administration; and providing psychological support following the ketamine administration (a/k/a “integration”); and managing any psychological or psychiatric emergencies during the course of ketamine treatment.

— The responsibilities of the medical professional include: assessing the patient’s physical condition before ketamine treatment; attending to the physical and medical safety of the patient during ketamine treatment; and assessing and treating any adverse reactions during the course of ketamine treatment.

— The responsibilities of the patient include: communicating clearly and honestly with the clinical team; and actively participating in the integrative treatment plan as much as possible.

The ethical ketamine clinician recognizes that there are different approaches to ketamine treatment, and that each approach has advantages and drawbacks. The ethical ketamine clinician is skillful with the specific treatment(s) that they offer. In addition, the ethical ketamine clinician is familiar with all of the major routes of administration, different dosing strategies, and different conceptual paradigms for therapeutic ketamine treatment.

The ethical ketamine clinician understands and appreciates the importance of integrative psychiatric/psychological care for therapeutic ketamine patients (i.e., using multiple strategies to get better and stay well). The ethical ketamine clinician takes the time to explain this to each patient, and helps patients to connect to these resources in their community.

The ethical ketamine clinician practices within the scope of their professional license, and they recognize their limitations with respect to their professional training and experience. They actively seek consultation as needed, and they make referrals to other professionals as needed.

The ethical ketamine clinician upholds all of the responsibilities of their professional license with respect to all aspects of their clinical practice, including informed consent, record-keeping, professional boundaries, confidentiality, and general professional conduct.

The ethical ketamine clinician aspires to be compassionate, thoughtful, honest, and forthright in all of their personal and professional communications.

The ethical ketamine clinician actively tries to make therapeutic ketamine accessible to members of the community who do not have the financial resources to pay for the treatment that they need.

The ethical ketamine clinician is honest and transparent in marketing their services. They rigorously adhere to the FDA guidelines about advertising, and their clinical and advertising claims are supported by the research literature.

The ethical ketamine clinician has received special training and/or mentorship in working with therapeutic ketamine. A comprehensive training includes substantial education in the following domains: medical, psychological, and psychedelic. Additionally, the ethical ketamine clinician regularly reads the newly published literature and participates in continuing education to stay abreast of the latest developments in this rapidly growing field.

Update on 12/30/2020: These Ethical Guidelines were published (with additional commentary) in the Journal of Psychedelic Psychiatry (Vol 2, Issue 4, Dec 2020, pgs 19-23). JPP article (PDF)

About the authors:

Wesley Ryan, MD

Dr. Ryan is a psychiatrist and psychotherapist based in Los Angeles with additional fellowship training in addiction psychiatry, and specializing in consultations regarding psychedelics as well as the use of ketamine assisted psychotherapy.

He has trained and practiced in various clinical and research settings, both inpatient and outpatient, across Los Angeles and Seattle including the UCLA Neuropsychiatric Institute, Olive View-UCLA Medical Center, University of Washington, Harborview Medical Center, several Veteran Affairs medical centers, Kaiser West Los Angeles, Loyola Marymount University, as well as in his own private practice. In his work with St. Joseph Center, Ocean Park Community Center (AKA The People Concern), and Venice Family Clinic he has worked in the field in tandem with a homeless outreach team and full service partnership (FSP) program, practicing “street psychiatry” as it’s called.

He has extensive and diverse training in state-of-the-art mental health and addiction treatment, combining medications and psychotherapy to attend to individuals with mental health needs, substance abuse issues, or both (dual diagnosis).  Additionally, he has worked in various research settings, accumulating published articles and presentations on such topics as ketamine for treatment resistant depression, the advantages of combining ketamine with psychotherapy, cannabis, psychedelics, club drugs, hallucinogens, and addiction.  Pulling from this extensive body of knowledge, and ongoing reading of new publications, allows for nuanced perspective and informed consultations regarding psychedelics and obscure psychoactive substances.

Through his diverse experiences and training in both pharmacology and psychotherapy, Dr. Ryan’s approach integrates individually tailored therapeutic interventions, typically including lifestyle changes and sometimes medication options, with novel treatments such as ketamine assisted psychotherapy, in an empathic, non-judgmental, safe space, helping individuals find meaning, understand themselves, and motivate to make positive changes.  He has applied these principles in those suffering from PTSD, anxiety disorders, depression, bipolar disorder, psychotic disorders, and substance use disorders.  In terms of psychotherapeutic alignment, he integrates knowledge and practices from psychodynamic psychotherapy, cognitive behavioral therapy (CBT), and motivational interviewing, and particularly enjoys working with individuals in helping them achieve meaningful personal growth.

Dr. Ryan is a graduate of University of California, Davis and went on to complete medical school at the University of California, Irvine.  He is board certified by the American Board of Psychiatry and Neurology (ABPN) in both general psychiatry as well as addiction psychiatry.  He completed psychiatry residency at the UCLA-San Fernando Valley Program and an addiction psychiatry fellowship at the University of Washington.  He has presented to colleagues and the public on ketamine and ketamine psychotherapy many times.

 

Raquel Bennett, Psy.D.

Dr. Bennett is a Post-Doctoral Fellow in Clinical Psychology (PSB 94022544), working under the supervision of Dr. Bravo. Dr. Bennett primarily works with people who are experiencing severe depression, who are on the bipolar spectrum, or who are contemplating suicide. She has been studying the therapeutic properties of ketamine since she first encountered it in 2002. In addition to her clinical work, Dr. Bennett’s practice has evolved to include consultation services for medical professionals who wish to add ketamine services to their offices. She also lectures frequently about therapeutic ketamine. Dr. Bennett is the Founder of KRIYA Institute and the Organizer of KRIYA Conference.

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