Soon after the needle enters her arm, the walls turn red and pulsate like the inside of a breathing whale, or the warm center of a lava lamp. The knots in her muscles, constricting her skeleton like a python, begin to loosen. Her mind is euphoric.
Elissa Ray, a 68-year-old self-employed attorney from Dexter, Michigan, is high. But she’s not in an opium den.
She’s in therapy.
Ray, suffering from a complex post-traumatic stress disorder linked to early childhood trauma, is among a growing faction of mental health patients using psychedelics or psychedelic-like drugs at clinics cropping up across the state.
“It was the first time in a very, very long time I felt hope,” Ray said of her therapy. “That I can work through these things and find peace. That’s what you carry with you after the infusions, the feeling that there is a place that is peaceful and maybe that’s the first time in your life that you’ve found peace.”
Ray is a patient at Royal Oak-based Michigan Progressive Health, a ketamine-assisted therapy clinic run by former emergency room physician Dr. Megan Oxley. The clinic administers doses of ketamine, a dissociative anesthetic prominently used during surgery, to treat chronic depression, anxiety, pain, and other mental illnesses. The clinic mixes the often-hallucinogenic drug with talk therapy as a treatment for more than 500 patients from its Royal Oak and Ann Arbor offices.
Just like medical marijuana a decade ago, ketamine used to be classed as an illegal drug but has recently become more popular for medical uses. And like the medical marijuana industry of the past, there is now a growing number of businesses that are embracing what is recreationally called “Special K” for health care uses.
“We split the difference between Eastern and Western medicine,” said Oxley, 43. “Most of our patients have exhausted other avenues of relief. Many of them are suicidal when they get to us. I spent a decade in the ER witnessing the Band-Aid system of mental health care in America. There had to be a better way, and I do believe this is it.”
Thousands of ketamine clinics have cropped up across the U.S. in the last decade, and ketamine is likely the first of many similar drugs to come. Psilocybin mushrooms, LSD, MDMA, and more are in clinical trials at various research institutions, including the University of Michigan, as scientists get closer to understanding how these hallucinogens might help in the battle for mental health and wellness.
‘It’s not Scary’
Ketamine was approved by the U.S. Food and Drug Administration as an anesthetic in 1970. But research in recent years has found the drug also works for treatment-resistant depression in some people, and psychiatrists began using ketamine as a treatment for mental health disorders over the last 20 years.
It wasn’t until the last decade that clinics began to offer the drug off-label as either an infusion or injection for those problems. “Off-label” use means the drug hasn’t been specifically approved by the FDA for those conditions, though doctors are allowed to prescribe drugs for off-label conditions.
In 2019, the FDA even approved a version called esketamine, under the brand name Spravato. It’s an inhaled treatment that is required to be administered in a doctor’s office and is only approved for patients with depression where other treatments have failed.
“Some patients don’t respond to traditional antidepressants,” said Dr. Avinash Hosanagar, a psychiatrist at the Veterans Affairs’ VA Ann Arbor Healthcare System and clinical associate professor at UM’s Michigan Medicine.
“At the turn of the century, there was interest in new ways to treat depression. We had discovered serotonin’s link to depression and wanted to try a different compound than typical treatments. We have found that with ketamine, symptoms of depression and suicidal ideation improved very rapidly.”
The VA has been using ketamine to treat veterans’ mental health disorders since 2019 and UM Health began using it clinically in 2021, Hosanagar said.
Oxley opened her Royal Oak clinic in 2016 after being discouraged over mental health treatment as an ER doctor at Ann Arbor-based Emergency Physicians Medical Group, which employs physicians at several hospitals throughout the region.
She remained an ER doctor through 2019.
“The system doesn’t adequately care about mental health,” Oxley said. “There is no piecemeal approach. We look at all the things that are causing a patient’s distress and use ketamine as only part of the solution.”
The first ketamine regimen at Michigan Progressive Health is 90 minutes and includes meetings with a therapist and a doctor, like Oxley.
The clinic employs 22 people, including five therapists, two physicians and two physician assistants, Oxley said.
Ray found Michigan Progressive Health during an internet search looking to find any new treatments that could alleviate her PTSD.
“I had been through five or six medications, talk therapy, EMDR (eye movement desensitization and reprocessing therapy) and neurofeedback,” Ray said. “I was doing all of those things, and it was almost a full-time job to keep me functioning and working. I wasn’t really making any progress, and I was getting desperate.”
Oxley said about half of her 500 or so patients found the clinic during a Google search and another 25 percent were referred by a growing network of therapists.
Ray said the experience of dosing ketamine was like experiencing a different planet, one where her chronic troubles were alleviated, and she was able to think about her trauma without the typical mental and physical hangups.
“It’s not scary. You don’t feel threatened or out of control,” Ray said. “It’s very comforting. It lets me think about all those things in my past without causing anger, sadness or stress. Even thinking about my experiences can throw me into a panic attack, but with ketamine I can think about those things without the terror and physical reaction.”
Ray has undergone about 20 ketamine sessions and is active in the clinic’s virtual group therapy sessions as well as seeing a therapist individually once a month.
“After the first infusion, I felt better for a couple of days,” Ray said. “Then with each infusion after, I felt better a little longer. I can go almost a year now between regimens. I do believe it saved my life.”
The treatment, however, isn’t for everyone, Oxley said. Sometimes the ketamine doesn’t achieve the right effect and can make suicidal thoughts more prominent. And because the clinics are not federally regulated and this specific use of ketamine is not an approved treatment by the FDA, some caution should be exercised.
“The concern with these clinics popping up is that people are getting treatments that haven’t been well-proven, well-studied or following any guidelines,” Dr. Smita Das, an associate professor at Stanford University School of Medicine and chair of the American Psychiatric Association’s Council on Addiction Psychiatry, told NBC News in January. “My concern is that people who need treatment will spend their money and energy in these ketamine clinics that aren’t well-proven.”
The treatments are costly. Ketamine use in these clinics is not covered by health insurance. At Michigan Progressive Health, a ketamine session costs between $350 and $600 and is usually coupled with a $250 consultation and $125 per hour therapy sessions.
Lucy in the Sky
Ketamine is, coincidentally, the gateway drug to further research into other psychedelics to treat mental illness.
Hosanagar will help lead a clinical trial at UM and the VA this summer on the use of psilocybin mushrooms to treat depression. The initial trial, funded by U.K.-based life sciences company Compass Pathways plc, is expected to be carried out with 25-50 patients, Hosanagar said.
Initial research is hopeful, he said.
“The early research seems to indicate two doses of psilocybin given a week apart reduces depression symptoms,” Hosanagar said. “In head-to-head comparisons, along with psychotherapy, those who were given psilocybin responded the same as patients taking regular antidepressants daily for six weeks.”
Research on psychedelics is spreading rapidly. Nick Glynos, a doctoral candidate in molecular and integrative physiology at UM and vice president of the Student Association for Psychedelic Studies at the university, is researching the neurochemistry of rats who ingest the psychedelic N, N-Dimethyltryptamine, or DMT.
“This whole psychedelic renaissance happened right when I was going to grad school,” Glynos said. “We’re facing the biggest mental health crisis right now and it’s coupled with massive interest in decriminalizing and the liberation of these substances and this whole psychedelic renaissance. There’s a huge amount of potential with the therapeutic effects of psychedelics.”
Ann Arbor and the city of Detroit have decriminalized the possession and use of psilocybin mushrooms. It is still, however, illegal to sell or buy the drugs on the street.
Glynos and his colleagues at the student group host doctors, professors and others with insight into the field in hopes of propelling the discussion on psychedelic therapies forward.
Glynos, however, believes the warm feelings toward these drugs will wane as more studies come online.
“It’s the wild west right now,” Glynos said. “I am deeply skeptical of the biases present right now. The people in the trials are people who believe in drugs. They are having these positive results because they want them to work. I believe the treatment efficacy is going to come down somewhere in the middle to closer to the efficacy of current antidepressants.
Ray said although she was in high school in the early 1970s, she never succumbed to the drug culture of the time and had never taken any drugs recreationally.
“I had no experience with this and the whole thing was creepy at first,” Ray said. “But I was desperate. I wish I hadn’t been so desperate and had found this clinic sooner.”
Regardless, the federal government appears primed to bring more psychedelics to health care.
In May, the U.S. Department of Health and Human Services said it was likely the FDA would approve not only psilocybin, but also 3,4-Methylenedioxymethamphetamine (MDMA, also known as ecstasy or molly) by the end of 2024.
This has the support of President Joe Biden, who is expected to create an interagency task force to explore deployment of these psychedelics to treat mental health disorders.
“We are now clearly recognizing the importance of mental health and treatment far more than before,” Hosanagar said. “We simply don’t have the resources to care for everyone, so a lot of money is flowing into this because there is a need. The small effects in early trials are so profound, there is a lot of interest to erase the stigma in hopes of developing enough evidence that these drugs work effectively and can make an impact in the mental health community.”
Ray said she is interested in how psilocybin could improve her mental health, and Oxley plans to offer it and other psychedelics as soon as it is legal to do so.
“The world would be a lot better place if people did more mushrooms,” she said.