Ketamine: The Promise and the Peril with Mark Braunstein, DO

In this episode of the Psychedelic Medicine Podcast, Mark Braunstein, DO joins to discuss the promise and the peril of ketamine. Dr. Braunstein graduated medical school in 1997 then completed a General Psychiatry Residency at the University of New Mexico and then a fellowship in Child and Adolescent psychiatry at Maine Medical Center in 2002. Upon graduation from his fellowship and becoming board certified in general psychiatry he established a private practice in Durango, Colorado where plant medicine became part of his everyday integrative psychiatric practice. 

In this conversation, Dr. Braunstein shares some of the developments in the world of ketamine in the past three years since his previous episode, drawing on his own experience providing ketamine-assisted therapies. He stresses issues of grandiosity that can arise both when working with ketamine and when taking the medicine—issues which in the worst case and fuel ketamine use disorders. Dr. Braunstein stresses the importance of clinicians providing ketamine treatments being realistic and upfront about the potential harms of ketamine when advising prospective patients. In closing, he warns against the dangers of being in an echo chamber which reinforces potentially pathological substance use, especially for clinicians in the ketamine space. 

In this episode you'll hear:

• Why ketamine has an addictive potential and how ketamine addiction presents
• Ways to treat ketamine use disorder 
• The importance of informed consent
• What patients should look for when seeking a ketamine provider
• The importance of ketamine providers working with multiple modalities and having multiple tools in the toolbox besides ketamine 

Quotes:

“Here’s what’s scary to me about ketamine: these people that I’ve seen having problems [with ketamine use] are largely lifetime recreational psychedelic/drug users without problems. And these are people who have made it to age fifty, smoking [cannabis], tripping a little bit, their whole life without having a problem—then at fifty years old, find themselves hooked on something for the first time.” [12:30]

“[Ketamine] is not a microdosing medication… There is no such thing as ketamine microdosing. You think of microdosing as sub-perceptual. Everyone that I’ve met that’s abusing ketamine, it was not a sub-perceptual effect—they were very much abusing it to have that perceived effect. Maybe not a psychedelic effect—usually an intoxicated wonky effect is what they’re going for. And people refer to that as microdosing. It’s not microdosing. It’s abusing small doses.” [17:11]

“What do I see that makes me concerned with someone I’m talking to—a clinician or a client? That grandiosity. So that gets me concerned right away when I hear about these ‘downloads’ because that’s where … other psychedelics can have dependency too. You see people … they go for aya ceremonies every week after week after week. So there can be an addiction to the download or to the release.” [34:35]

“The people I know that have been successful in this line of work (from a patient standpoint), whether they’re a clinician or not, have been the ones that have embraced the work. And just knowing that this is going to be a process and I’m in it to win it, for life. I’m working on myself.”  [35:40]

Links:

Dr. Braunstein on LinkedIn

Ketamine Research Foundation website

NeuPath Mind Wellness website 

Ketamine Training Center website

Previous episode: Ketamine for Alcohol Use Disorder with