My Ketamine Journeys

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A KETAMINE JOURNAL

In earlier journal entries, I talked about my decision to register for the Psychedelic Research and Training Institute (PRATI)’s course on fundamentals of ketamine assisted psychotherapy in Colorado. I mentioned that I had been warned that the course sold out quickly and was poised at my computer when registration opened. My daughter expressed concern that the course takes place on the grounds of an intentional community—what she viewed as a cult. And finally, in my last entry, I talked about my concerns about trying ketamine as part of an experiential learning process.

It felt like a lot of waiting, planning, and travel, but in August of 2023, I arrived at the PRATI course I had been anticipating for months. It was the afternoon of the second day, and we were preparing for our personal experiences with intramuscular (IM) ketamine. The classes were held in a large multi-purpose room with high ceilings and a step-up stage at the front—the sort of room that might be found in a church or elementary school. Sunlight streamed in as the music, choreographed to be a mix of primal and provocative, played over a speaker system. Camping mattresses were placed on the floor, roughly 2 feet apart, and we were assigned partners. Each dyad was sent to ‘nest’ on the mats, with a pillow and a small blanket, a set of wireless headphones, and an eye mask. Each person also had a plastic emesis basin, as ketamine can cause nausea and vomiting. The first group to receive ketamine had skipped lunch, the second group would skip dinner. In all, there were 28 participants and I believe I was the only psychiatrist among the students, though I met 3 other physicians in other specialties.

My partner went first and I sat beside her on the floor. One of the instructors, a psychiatrist, came to each of the 14 individuals on the camping mats, verified their name and dose, and injected the ketamine into the deltoid muscle. The dose was determined by the participant’s weight, their past experience with psychedelic agents, and their desire for a lighter or deeper experience. After the injection, the participant put on the eye mask and earphones, then lay down and let the medication take effect—which it does very quickly after IM administration. I watched my partner, taking her hand when she held it out, and provided support.

Experiencing ketamine was only 1 aspect of the 4-day course on the fundamentals of ketamine assisted psychotherapy. To be clear, this was not a ‘medical’ training. There were no CMEs, and the training included a session where a faculty member who identified as both a nurse and a shamanic practitioner beat on a drum while we walked about outside experiencing nature.Participants were required to stay on-site, some did so in tents, others in dorm rooms or apartments. Breakfast was served at 7:30 AM and classes, activities, and ketamine journeys went until 9 PM.

Two of the 9 faculty members were psychiatrists who gave talks on the medical aspects of ketamine treatment. Psychotherapists who practice ketamine-assisted psychotherapy (KAP) gave presentations about preparation and postketamine integration. There were PowerPoint presentations and small group sessions to discuss case scenarios. On the last day, there was a ‘prescribers table’ at lunch where participants could ask questions to experienced medical faculty—most of whom were psychiatrists. Some of the training was about education, and some of it was about group cohesion as we all prepared for the experiential part of taking ketamine ourselves.

I was eager to learn the protocols for administering sublingual and IM ketamine, and I learned there are no set protocols for KAP. I garnered wisdom and suggestions from those who were doing it based on their experiences and asked what they do in their own practices.

Between the high altitude and nervous anticipation, the first part of me that shot into space was my blood pressure. By the time it was my turn to journey, 3 doses of clonidine had brought my diastolic blood pressure down to a reading deemed safe to proceed, but still much higher than my norm. “If I die, tell my family I love them,” I said, mostly in jest, as the psychiatrist injected ketamine into my left deltoid.

Shortly after being injected, something drastic changed—I said aloud, “Oh, I like this.” There was a shifting dark gray metal wall—and a shaft that was either the entrance to a mineshaft or maybe it was an amusement park ride I once went on with my children. Ineffable is the word that is so often used to describe psychedelic experiences or journeys, and, in fact, there really is no way to describe what I felt under the influence of ketamine. The world as I knew it simply dissolved. I wondered if I was dead, but it was not scary and I decided it was okay if I was. I remember thinking that the life I knew, one with schedules, obligations, and boundaries, did not make sense. The music was an integral part of the experience, much more so than I had expected, and at moments I felt melded into it. It did not last very long, I do not think. Time did not really exist, and I was giddy and talkative as I emerged. I had a stream of consciousness conversation that I later learned was loud enough to be heard by everyone in the large room; most notably, I asked my partner if she had seen the movie “Barbie.”I liked the experience—it felt profound in a way that normal experiences are not. And yet, it was also quite jarring—it was not something I wanted to repeat, and I was not sure this was something I wanted to provide for patients.

The following day, we repeated the experience with new partners and with sublingual ketamine.My partner told me, “You’re going to like this, it’s like a warm hug.”

I set my intention for a beautiful and joyous experience, yet everything was again gray and the consistency of mud, and I found myself thinking about the things I usually think about. I questioned if this was a nonordinary state of consciousness. I had taken the lowest dose offered (160mg), and I decided this did not actually qualify as a ‘journey.’ I held the ketamine in my mouth for 12 minutes, then elected to spit it out—we were told that swallowing would give a longer and more intense journey. While I did not have a dissociative experience, others in the group did, and individuals talked of resolving painful past relationships and finding insights that gave them peace.

I had gone to the PRATI training with the idea that I would incorporate KAP into my clinical practice with groups of 3 to 4 patients, with 3 administrations of ketamine: 2 sublingual and 1 IM. With no evidence-based protocols for KAP, I was advised to “take it slow,” and I decided I would use only sublingual administration, at least at first, and I would start with a single patient whom I knew well, not a group of patients referred just for the treatment.

I found the training to be reassuring. While we discussed what to do in a variety of troublesome scenarios, I watched 2 groups of 14 people get both IM and sublingual ketamine as an unremarkable event. It looked, in fact, like naptime at daycare with bigger bodies and better music. There had been talk of people getting agitated or distressed, and there was my own terror of medical emergencies, but nothing awful happened. We had been warned that the medicine could bring up disturbing emotions, but most of the distress I saw was that many of my classmates were very sentimental about leaving, and in a followup call I learned that some found reentry to their workday lives to be difficult.

Was I changed by the experience of using ketamine? I had gone in with my Santa’s wish list of things I wanted to change alongside the fear that I would learn something that would topple my sense of self. The essence of who I am remained exactly as it was—I did not emerge shaken or distressed. I did find a sense of being more in control of some aspects of myself I considered compulsive. It has now been almost a year, and I hold something about that experience with me. Most importantly, I left PRATI feeling confident that I could administer ketamine safely to patients.

Dr Miller is a clinical psychiatrist and writer in Baltimore. She is on the faculty at the Johns Hopkins School of Medicine.

Note: In these commentaries, Miller will discuss her experiences and thoughts as she explores issues associated with ketamine-assisted psychotherapy.