Abid Nazeer, MD, FASAM

What Category Provider type are you? Psychiatry
What board certifications do you hold? Psychiatry + Addiction Medicine
How many years have you been in ketamine practice? 4
What percentage of your work is clinical versus research? 90
Please describe any connections you have to major universities, research institutions and pharmaceutical companies, both financial and advisory/board? 4th year psychiatry residents at University of Illinois Chicago complete elective rotations with me to learn about Ketamine Therapy
Janssen Pharmaceuticals – Last year I was on the Advisory Board for the new Suicidal Ideations indication and speaker bureau for Spravato.
Myriad Genetics – Speaker Bureau for Genesight
What are your views regarding desirability and appropriateness of including and fostering the variety of practitioners who presently administer ketamine for mood disorders? I support measures to increase patient access to this treatment. Having a variety of practitioners administer ketamine for mood disorder can help accomplish this goal. I believe the concept of a treatment team approach to implementing care, whether for ketamine therapy now or psychedelic medicines in the future. Most patients seeking out ketamine therapy are high risk and complex from a psychiatric standpoint. Co-morbid substance use disorders, personality disorders, bipolar mania, and psychotic disorders need to be screened for and managed. Psychiatric drug interactions and management approach in the context of ketamine therapy can not be ignored. Patients that have suicidal intentions should have intervention from a specialist in this area. Psychiatrist involvement is crucial. Psychotherapists are better equipped to help the patient journey and breakthrough. Anesthesia and ER physicians help safe medical administration and dosing. The ideal approach is a team, not solo.
What is your preferred route of administration of ketamine for mood disorders. What are your thoughts about the appropriateness or therapeutic value of other routes? My preferred route of administration is IV. Ketamine is not a one size fit all medication, in fact the opposite. IV route allows for full control of dosing (being 100% bio-available helps us to know how much medication is being delivered). I can extend the infusion time and slow the drip rate when needed, stop the infusion in rare circumstance, adjust dosing precisely, and offer a smoother treatment. I offer intranasal dosing in my practice with Spravato, which can have advantages as well. It is easier to administer and more affordable. Sublingual or IM routes can be less predictable but also have therapeutic value, especially in KAP. All these routes are appropriate as long as they are administered under medical supervision. At this time I do not support use of any ketamine formulations in a home setting due to safety concerns, diversion and misuse risk, and lack of support by other professional organizations (APA). With further research this can change in the future, but for now the bar is set by the FDA Spravato REMS program. We need to better understand the effects of increased ketamine dosing frequency, often seen with home prescriptions, on a long term basis.
How do you approach the problem of integrating the transient altered state we induce into the patient’s overall psychic economy? What is the practitioner’s responsibility in this regard? I believe it is important to spend more time in setting treatment expectations and counseling prior starting ketamine therapy. The focus is on what to expect when they enter into an altered state, and how to utilize that transient state for the most possible benefit. As you achieve a new vantage point and perspective, and your brain is primed for lasting change due to neuroplasticity, remaining in negative fixed patterns of thought and behavior will blunt the benefit. We focus on lifestyle change, departure from the sick role, processing of root issues such as trauma, and employ motivational interviewing along supportive or insight oriented therapy approaches.
Please describe your present clinical practice. How will it look different in 5 years? My clinical practice, called APS Ketamine, offers full psychiatric services in conjunction with ketamine therapy. There are two Illinois locations, one in downtown Chicago, and the other in a nearby suburb called Oak Brook. Along with myself, the staff includes a psychiatric moonlighting resident physician, two Psychiatric Mental Health Nurse Practitioners, two full time Registered Nurses, practice manager, and support staff. We on average complete between 6 and 12 infusions per day, and since inception 4 years ago have completed over 2000 infusions. All new ketamine patients see both the PMHNP and Psychiatrist as part of the screening and evaluation process to ensure appropriate patient selection. Outcome tracking is digital, and involves rating scales (PHQ-9, GAD-7, NSESS for PTSD, PDQ, ASRS, and YBOC). Psychiatric medication management is provided for those who don’t have a psychiatrist, or coordination with treating psychiatrist for those that do have one. Psychotherapy is provided by us during infusions for those patients that want it. Dosing starts at 0.5mg/kg and increases based on efficacy and how tolerable the infusion is, up to a maximum of 2mg/kg. The initial course is 4-6 infusions over 2-4 weeks, and the clinic average for maintenance infusion is every 7 weeks. We do not treat pain disorders as that is out of my scope of practice. Currently we are studying the effects of ketamine on neuro-cognition, and hope to publish results in Q1 of 2020. Pharmacogenetic testing is done often. Payment model is insurance hybrid with self pay.
How do you envision ASKP3 growing over the next 4 years? I joined this organization very early, soon after it was formed. I’ve attended both annual conferences, presented in a webinar, watched the other webinars, and have gotten to know many people involved with it. I’m thrilled at how much ASKP3 has grown in such a short time! To be honest I never had a doubt and knew from the beginning that this will become the primary national society dedicated to ketamine therapy. The role ASKP3 has nationally is a crucial one with great responsibility. Furthering education and knowledge base of the membership will continue to happen. It will continue to provide a platform of support and networking opportunities. The annual conference is a defining experience for new and experienced ketamine practitioners. I leave the event with changes each year that implement in my own practice. The membership base will continue to grow larger. It will be important to work on creation of practice guidelines, and standards. Establishing a certification examination will help provide validity and demonstrate a level of quality/knowledge for all those that pass it. The society can also impact real reform and change in both the public perceptions, medical community acceptance, and insurance coverage. In my role as CMO for a national Opioid Treatment Program (Symetria Health), I’ve been able to network with insurance company leadership. I’m currently working on compiling my clinic’s outcome data to Blue Cross Blue Shield and initiate a trial contract for full insurance coverage of IV Ketamine.