Woman writing therapy notes during a Ketamine therapy session

The Importance of Ethical Guidelines for Ketamine Assisted Therapy

Ketamine Assisted Therapy is Exploding

Ketamine’s use as an alternative to traditional therapies has been exploding over the last few years. Ketamine assisted therapy (KAT) is now being used to treat treatment-resistant depression, post-traumatic stress disorder, bipolar affective disorder, and chronic pain. The indications for the use of ketamine continue to widen as a growing body of evidence is published in the medical literature. With this burgeoning use of KAT to treat serious psychiatric conditions comes concerns about who is providing the treatment and what training they have. Many KAT providers have little to no formal psychological or psychiatric training. Some provide the drug with a promise of it being a “cure” to their patient’s condition or exaggerating the efficacy of ketamine.

Raquel Bennett Responds with Ethical Guidelines

I was very concerned…

In light of this, Dr. Raquel Bennett, Post-Doctoral Fellow in Psychology and the founder of the KRIYA Institute and organizer of the KRIYA Conference, developed the ‘Ethical Guidelines for Ketamine Clinicians. The KRIYA institute is devoted to treating patients with ketamine and educating clinicians who use the medication in their practices in the most scientifically rigorous way possible. The KRIYA conference was the first of its kind to focus specifically on ketamine. According to Dr. Bennett, the guidelines were written because “I was very concerned about the number of ketamine clinics that were popping up that were advertising ketamine treatment for mental health indications but were not providing psychologically-informed care.” These guidelines are specifically geared towards the use of ketamine to treat psychiatric conditions and not for its use in chronic pain conditions or anesthesia. 

According to the guidelines, the ethical KAT provider first acknowledges that ketamine is a powerful psychotropic medication that can cause dissociative and psychedelic effects, both of which can be distressing to some patients. Because of these properties, patients require psychological care before, during, and after receiving the medication. Models of care where patients are given the medication and left in a room by themselves and do not receive psychological after-care would not be considered ethical. 

What do Ethical Ketamine Assisted Therapy Guidelines Entail?

The guidelines outline the three roles that are present in every KAT session: the mental health professional, the medical professional, and the patient. The mental health professional is responsible for doing a clinical intake interview and assessment before the medication is provided, providing psychological support before, during, and after the session; and managing any mental health emergencies that arise during the session. The medical professional’s responsibilities are to assess the patient’s physical condition before, during, and after the treatment, and to manage any adverse reactions to the treatment. Finally, the patient should communicate clearly and honestly with the team and actively participate in the integration process.

The ethical provider is familiar with the various conceptual paradigms within which ketamine is used in its therapeutic application, the usual ways ketamine is administered, and its dose for each route of administration. With these factors in mind, the provider can tailor the KAT process to the patient’s unique circumstances and goals for therapy.

Recognizing that there are many professions involved in KAT, each with its own governing body and regulations, the guidelines ask that each professional practice within their scope of practice. Consultations and referrals with other professionals and good communication with these professionals are encouraged. In addition, keeping accurate medical records, obtaining informed consent, maintaining professional boundaries and professional conduct are all important parts of being an ethical KAT provider.

The guidelines also address the accessibility of KAT, which can be an expensive modality and is not always covered by provincial or private insurances. Because of this, it can often be limited to those with significant financial resources. The guidelines ask that providers actively try to make KAT available to those with limited financial resources who need it.

Transparency is crucial in earning the trust of patients who seek out KAT

Honouring this, the guidelines ask the ketamine clinician to be truthful when advertising the claims around ketamine and to follow the FDA guidelines. In Canada, one should follow the guidelines in the province within which the professional is practicing. Asked whether the guidelines are applicable in countries outside of the United States, Dr. Bennett says “These ethical guidelines can and should be used by patients, providers, and healthcare organizations worldwide.”

Finally, the guidelines emphasize the need for “substantial education”, training and mentorship for ketamine providers including the medical, psychological, and psychedelic aspects of KAT which are all skills that can be learned.  There is a list of available training on our KATA Canada Resources for Professionals page as well as at the KRIYA website.

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