|What board certifications do you hold?
||Psychiatry and Neurology
|How many years have you been in ketamine practice?
|What percentage of your work is clinical versus research?
||I’d estimate clinical is 95%, research 5%
|Please describe any connections you have to major universities, research institutions and pharmaceutical companies, both financial and advisory/board?
||I’m currently partnering with UT Austin for a potential suicide prevention study using ketamine. It is not official just yet–grant applications in process. No connections to pharma.
|What are your views regarding desirability and appropriateness of including and fostering the variety of practitioners who presently administer ketamine for mood disorders?
||I am all about this idea regarding ASKP3’s primary role. One of the most effective strategies to educate, train, and advocate for the use of ketamine (for mood, pain, or surgery/procedures) is in having one unified congress. For too long I’ve witnessed petty debates and “turf wars” regarding who should be the expert in delivering care using ketamine. We all stand to learn from one another; it goes without saying that a psychiatrist has much to learn about the administration of ketamine (particularly IV and IM routes) from emergency medicine and anesthesia. Conversely, psychiatrists and other licensed mental health professionals also can impart expertise in selecting patients for appropriate treatment, accurately diagnosing, monitoring, etc.
|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?
||IM and IV, almost equally. We have also utilized oral and sublingual. I believe all routes have pros and cons and should be considered for the best fit for the patient.
|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?
||Our clinics administer ketamine-assisted psychotherapy and I’ve been a regional trainer for KAP for almost 2 years. As you likely know, one of KAP’s primary aims is to address the integration. However, the more experience I have in working with ketamine, the more I think about how some patients may not KAP or therapy support, just a staff member nearby in case of any adverse effects. KAP may not be for everyone.
|Please describe your present clinical practice. How will it look different in 5 years?
||I am the medical director for our two clinics. In my role, I supervise 7 PAs; I also write our clinical protocols, including KAP’s protocol. Both locations are full-service psychiatric clinics that also offer KAP as one treatment option. KAP represents no more than 10% of total visits at this time. We serve approximately 5500 patients in Central Texas. I stepped down from seeing my own patients about 8 months ago; doing that has allowed me to put much more energy into supervising, teaching, and research.
In the state of Texas, I am limited to supervising 7 PAs, so we are nearing a potential volume limit. We’re thinking of potential scaling options to meet demand for services in central Texas (primarily psychiatric services demand, not ketamine). This is to say that in 5 years, we may be about the same size, with some growth in our KAP program, though we’re open to scaling and hiring and MD to help make this growth feasible.
|How do you envision ASKP3 growing over the next 4 years?
||I’m hoping that the “big tent” approach will draw more clinicians from multiple disciplines from across the globe. Research is key as well; ASKP3 might consider ways to foster and support clinical research, especially for those of us who are not primarily working in academics. Additionally, continuing to build, edit, and revise clinical guidelines and best practices is smart, and perhaps one of the best benchmarks by which our colleagues can work with ketamine; this can help any of us should board complaints or lawsuits come up. Standard of care is often cited as one of the ideal defensive strategies as well as how to practice and not veer to far from what most of us are doing. ASKP3 can help set and maintain the standard of care. One final thought/concern: this organization is predicated on ketamine itself. We should remain open to the idea and possibility that ketamine may be superceded or replaced by something similar in the future.