North Memorial Health

Brian Johns, MD

What Category Provider type are you? Psychiatry
What board certifications do you hold? ABPN
How many years have you been in ketamine practice? 8
What percentage of your work is clinical versus research? I previously published several studies and am now practicing clinically full time.
Please describe any connections you have to major universities, research institutions and pharmaceutical companies, both financial and advisory/board? I previously published research through the University of Minnesota and Minneapolis VA and was a consultant for the development of Spravato. I am now practicing independently.
What are your views regarding desirability and appropriateness of including and fostering the variety of practitioners who presently administer ketamine for mood disorders? Hippocrates wrote, “The physician must be able to tell the antecedents, know the present, and foretell the future; must mediate these things, and have two special objects in view with regard to disease, namely, to do good or to do no harm.” With this in mind, I believe that it is both desirable and appropriate for ketamine to be administered by a variety of practitioners as long as it is done in a safe and responsible manner.
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 of ketamine for mood disorders is determined by patient preference and efficacy. Some patients respond sufficiently to oral or intranasal dosing, while others require intravenous or intramuscular administration.
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? It is important for patients to receive advanced preparation regarding the experience they may have while receiving ketamine. The physiological effects alone may be sufficient to improve the emotional well-being of many patients. An additional benefit is that many patients discover they are able to undergo more intensive psychological work following ketamine therapy. As such, we have had people participate in partial psychiatric hospitalization, intensive outpatient or weekly group therapy programs, as well as undergo individual psychotherapy, which has proven immensely beneficial. Having these resources available offers a well rounded approach to provide comprehensive support, which I feel is critical.
Please describe your present clinical practice. How will it look different in 5 years? I performed over 1,800 infusions and injections in a hospital-based clinic setting prior to Spravato being FDA approved. Since that time, our health system has preferred to offer intranasal and oral administration of ketamine with close monitoring and comprehensive support available through our mental health clinic, including the availability of mind-body skills groups and individual therapy. Due to the limitations of working within a single healthcare system, I am currently in the process of developing an independent clinic with the goal of expanding availability for anyone in the region; regardless of payor.
How do you envision ASKP3 growing over the next 4 years? I envision ASKP3 as the authority on ketamine administration for treatment resistant depression and believe that further strategic partnerships with organizations such as the American Psychiatric Association (which issued its own Consesus Statement on the Use of Ketamine In the Treatment of Mood Disorders) moving forward may be of benefit. This field will only continue to grow exponentially and ASKP3 is well positioned to guide providers looking to offer these services safely, as well as be a clearinghouse for patients to vet providers. The rollout of Spravato has been fraught with complications, and over a year later is still not widely available due to reimbursement and monitoring parameters. ASKP3 could help facilitate clear billing guidelines and work with the FDA regarding the existing REMS protocol.
There is also ongoing stigma from the general public, media, academic institutions and individual providers regarding the appropriateness of ketamine in treating depression. In sort, there is no end of work to be done to advance ASKP3’s agenda over the next many years.