If there is a silver lining to the pandemic, it’s that the underlying mental health crisis in Calgary is being more widely talked about, and treated.
For some patients, who have been previously treatment-resistant to pharmacological or psychological options, newly-approved psychedelic medicines are giving their doctors additional avenues for treatment.
Ketamine, a commonly used anaesthetic and one of the World Health Organization’s essential medicines, is available for use by physicians in Alberta to treat major depression and chronic pain. Esketamine under the trade name of Spravato was approved for use in treating major depression in 2020 by Health Canada. And other psychedelic compounds are also currently being reviewed for safety and efficacy and could be approved for use mid-decade.
SABI Mind, a clinic located in Sunalta, offers Ketamine-Assisted Psychotherapy, was founded in October 2020.
“I think more than anything, what we’ve learned is that mental health impacts us all,” said Heesoo Cho, co-founder of SABI Mind.
Cho was a former member of the hospitality industry, that founded SABI Mind after having his own complications with substance abuse during his time in that industry.
Treatment an option for some patients
Cho said that through psychedelic-assisted therapy, he was able to re-frame his relationship to the substances he was using. Calling that experience for himself “transformative,” he said that it was able to offer him benefits over traditional talk therapy.
Cho was also very careful to mention that what SABI Mind offers might not have the same outcome as it did for himself. He emphasized that the Ketamine therapy offered is not a panacea. The clinic, he said, was very serious about taking a scientific, evidence-based approach to patient care.
“By no means are we saying we’re the one-stop shop for mental health solutions. We’re just trying to contribute and ensure that if this potential treatment solution works for a specific individual, that they know about it and have access to it,” he said.
“It’s not a quick fix drug by any means. There is significant work associated with our treatment program, and we like to manage those expectations from the jump.”
Patients are first referred to the clinic by their physician or psychiatrist, and are then screened by a professional clinical care team to ensure that the Ketamine-Assisted Psychotherapy is an appropriate one for the patient. When you’re dealing with people’s lives, said Cho, providing an “ethical framework has to be front and center.”
“It’s a very multidisciplinary approach, and while Ketamine is the medicine, there’s a lot that happens before during and after that’s incorporated into the healing model,” he said.
Dr. Philippe Lucas, the president of SABI and an internationally-recognized researcher on the medicinal uses of psychedelic compounds, said that between 60 to 65 per cent of patients with treatment-resistant depression would experience immediate anti-depressant effects with Ketamine. He said that this effect could last up to two to three weeks, and then when combined with psychotherapy, for longer periods.
“That’s really interesting, and that talks about the kind of neurochemical effects of Ketamine,” said Dr. Lucas.
“But what’s more fascinating as a researcher, and us as a treatment facility is that when you add on to that the exponential effect on altered state of consciousness and ego dissolution effect that comes with psychedelic medicines—including ketamine—it allows patients to re-conceptualize, and revisit in some ways, within a safe setting, some of the trauma or some of the causal factors which reduce depression, but also for trauma, for problematic substance use, PTSD, etc.”
Hospitality Healing Project launching in the spring
The clinic acknowledges that when it comes to private novel forms of treatment, cost can be a barrier to access. SABI Mind is able to leverage Alberta Health billing codes for medical and psychiatric screening, as well as for psychiatric consultations so that patients aren’t paying out of pocket or out of their insurance for those services. And depending on what insurance provider a patient has, much of the psychotherapy could be covered—either directly or through health spending accounts.
“There is a bit of out of pocket, but for us, we’re willing to work with a client to figure out how best to navigate that for them, and the last thing we want is someone not to be able to go through treatment because of financial considerations. We want to figure out a way to make it work,” said Cho.
With the cost of professional treatment in mind, Cho is planning on launching the Hospitality Healing Project later this spring.
He plans on working with members of the hospitality industry and companies to find out how to better meet the needs of hospitality workers. Whether that includes the psychedelic-assisted therapies that SABI Mind offer to pyscho-educational sessions about hospitality industry-specific topics like substance abuse. The eventual goal is to spin the project off into its own standalone non-profit to create a pool of resource providers.
On the topic of cost, Cho is also exploring the idea of working with restaurants to provide a hospitality healing plate. The premise being that the restaurant would pick a menu item that would have an additional dollar-or-so added to the price, which would then be used to subsidize employees getting treatment at whatever facility they choose.
Ketamine offers safer treatment than opioids
One of the major benefits to using Ketamine is that it is much safer than using opioids, said Dr. Lucas.
“The nice thing about Ketamine is it doesn’t have some of the respiratory depression effects of opioids, making it a much safer anaesthetic than opioids. It’s also less dependence forming than opioids and has fewer side effects or body tends to go through it very cleanly,” he said.
Ketamine affects NMDA receptors in the brain. It bonds with those receptors, affecting the amount of glutamate, a neurotransmitter, in the body. It is for this reason, believed by Dr. Lucas, that it has an anti-depressant effect in patients.
In a clinical toolkit bulletin released by the College of Physicians and Surgeons of Alberta, the potential adverse side effects included high risk of dissociation and sedation post-administration requiring monitoring, increased blood pressure, impaired coordination and concentration, and respiratory depression in an overdose situation.
Within Alberta, it is tightly regulated. Clinical uses are limited to a narrow window of conditions, and prescriptions are monitored on the Tracked Prescription Program Type 1 medications list.
Because of Ketamine’s well-known side effects, and the long history of safe use in virtually every operating room and emergency room worldwide, it was placed onto the WHO’s list of essential medicines in 1985.
Dr. Lucas said that its use as an anti-depressant, and for the treatment of trauma, addiction, and chronic pain is newer. The research into its use in this way goes back to the 1970s. But he emphasized while its use as a standalone medication was useful, the benefits come from employing its use with a full clinical treatment team.
“In combination with psychotherapy, you can really not only minimize the potential harms, but really maximize the potential benefits of this Ketamine experience, particularly when given doses that induce the psychedelic experience,” he said.
SABI Mind wants to use other psychedelics, too
Dr. Lucas said that the potential for the clinic to use other psychedelic compounds once they are approved for patient use could offer additional treatment options.
He said that MDMA is currently being re-medicalized and that it could be available in a clinical setting by 2024. Psilocybin is another compound that he said could be approved shortly after MDMA. He said both were available legally in Canada currently, but only through Health Canada’s special access programs.
“So for those patients that may not respond well to Ketamine treatment, or who we still find that they have active symptomology for their Ketamine treatments, they might qualify for some of these other treatments as well—whether it be MDMA, psilocybin, or other psychedelics,” he said.
In time, Dr. Lucas believes that the greater use of psychedelic compounds as medicine will lead to improvements in the treatment of mental health and chronic pain, and also to reduced costs to the health care system.
“I think what we’re seeing right now is a huge paradigm shift in how we understand and how we treat, particularly mental health and chronic pain in our society,” he said.
“So having these successful, short, sharp interventions to deal with pain and mental health can really help us get a grasp of these conditions, and hopefully provide some rapid relief to patients who’ve been suffering for a very, very long time.”