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The Dark Side of Ketamine (and how to Stay in the Light) with Dr. Mark Braunstein

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In this episode of the Plant Medicine Podcast, Dr. Mark Braunstein returns to discuss potential concerns surrounding the use of ketamine, especially use which is not overseen by a knowledgeable medical professional. Dr. Braunstein is a whole-health psychiatrist with 22 years of clinical experience. He is the medical director for multiple mental health and psychedelic psychotherapy clinics in Colorado, New Mexico, and Utah and he also runs in-patient and out-patient programs for addiction. Additionally, Dr. Braunstein is involved in multiple projects focused on expanding access, awareness, research, and safety in the field of psychedelics. To begin this conversation, Dr. Braunstein shares how his original exposure to ketamine wasn’t in a medicinal context, but rather as a recreational drug of abuse. However, since then he has seen the transformative effects this substance can have on patients when used in a physician-directed context and for therapeutic purposes. Nonetheless, Dr. Braunstein stresses that this does not mean ketamine use does not come with certain risks. Ketamine can be addictive and even carries a risk of overdose, particularly when used recreationally in a context where the purity of the substance is unknown. Dr. Braunstein distinguishes recreational and therapeutic uses of ketamine, explaining that recreational doses are often lower and dosing is more frequent, whereas ketamine is used in high doses in a therapeutic context, with extended periods between sessions. Dr. Braunstein stresses both the responsibility of physicians and of patients to ensure ketamine is prescribed responsibly and used as directed. Despite the dangers posed by recreational ketamine use Dr. Braunstein describes in this conversation, it is still a medicine he believes can have significant positive impacts for patients. This requires, however, that it not be treated merely as yet another quick fix pill. Instead, Dr. Braunstein emphasizes that ketamine treatment ought to coincide with psychotherapeutic work. This combination, he says, will maximize the therapeutic potential of ketamine while also helping to ensure that the medicine is used responsibly, under the close direction of a medical professional. In this episode: The addiction and overdose potential with recreational ketamine use How dosage can dramatically change the effects of ketamine Responsible prescribing practices for physicians working with ketamine The psychological and physiological harms of ketamine abuse How Dr. Braunstein talks to his patients about responsible use before prescribing ketamine The importance of combining psychedelic medicines with psychotherapeutic work Quotes: “Part of why ketamine works is because it lights up your brain in all these different ways and when done occasionally, intentionally, it moves you. But if you’re always doing that, it ends up having the reverse effect, causing damage.” [12:56] “This is a heavy-duty medication that, if you cross the line, can cause you to stop breathing and then die. So there is an actual, real danger to ketamine.” [16:25] “I think the organ that is most prone to damage from overuse of ketamine is the same organ we are touting it fixing: the mind.” [18:39] “When we think about these medications, we should think about combining them with therapy and not just taking these medications as medications… So that’s why with ketamine I’m really recommending it with therapy.” [25:04] Links: Reconscious Medical Psychedelic Medicine Association Porangui