Meet the Utahns using ketamine to treat drug-resistant mental illnesses. 

• Cover art by Henry Halsey

Lisa, a 55-year-old widow and mother of two living in Sandy, has been working in therapy to overcome severe childhood trauma, as well as the loss of her late husband.

And for the last two and a half years, Lisa (who asked to withhold her last name because of privacy concerns) has been treated by Morgan Gonzales, a licensed clinical social worker (LCSW) at Therapy Transformed in Salt Lake City. Part of that therapy includes ketamine-assisted psychotherapy.

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• Morgan Gonzales

"I was beaten by my adopted father," Lisa said. "I watched my adopted dad beat my mom and abuse her emotionally. I endured a lot."

The ketamine, combined with therapy, has helped Lisa immensely. "Emotionally, it opens up the doors to things you never thought you could do," she reported. "You look and think differently at things."

Ketamine has come a long way from what it was originally intended to be used for. It was developed in the mid-20th century and used as an anesthetic during the Vietnam War. The Food and Drug Administration (FDA) classifies it as a Schedule III controlled substance.

However, due to a legal loophole, ketamine can be prescribed "off label," meaning it can be administered as medication outside of the purposes specifically approved by the FDA.

That's why today, ketamine is increasingly being used to treat a variety of illnesses, including depression, anxiety, post-traumatic stress disorder (PTSD) and chronic pain.

Practitioners employ the psychedelic and dissociative properties of ketamine to achieve results for people whose symptoms are resistant to traditional talk therapy and SSRI (selective serotonin reuptake inhibitors) medication.

And like many emerging alternative treatments, ketamine has reportedly offered relief to many people who were suicidal due to their severe depression.

The financial rewards for prescribing ketamine are significant, and clinics catering to people who want to try ketamine treatments have sprung up all over the country, including Utah. Clinics charge anywhere between $350 and $500 per session, and insurance companies don't always cover these treatments, which puts ketamine out of reach for many Americans.

Ketamine clinics exist in a regulatory gray area and government agencies have struggled to keep up with the changing landscape of psychedelic medicine.

Jenny Johnson, Assistant Communications Director with the Utah Department of Health and Human Services, said in an email that, to prescribe ketamine, most providers will fall under the regulation of the Utah Division of Occupational and Professional Licensing (DOPL).

"The Utah Department of Health and Human Services would only license them if they meet the outpatient rule requirements," Johnson explained. "However, if this was the case, they would be identified as outpatient clinics, not ketamine clinics specifically."

Patrick Fitzgibbon, a spokesperson for DOPL, said via email that the division is responsible for licensing healthcare practitioners. "However," he said, "we do not license clinics or have specific policies regarding ketamine use."

In the same vein, when asked what long-term approach the DEA (Drug Enforcement Agency) was going to take to regulate and enforce the sale of ketamine to the public—especially since ketamine is being used off-label by so many clinics—DEA Public Affairs Officer Steffan W. Tubbs said via email that the DEA is committed to preventing the diversion of controlled substances, which can lead to addiction and harm to patients.

"We will continue to hold accountable any practitioner who operates recklessly outside the usual course of practice," he expressed.

Morgan Gonzales at Therapy Transformed doesn't pull any punches about some of the ketamine clinics in Utah.

"It's hard to find ethical people doing this work," Gonzales said. "I'm not popular with other providers and clinics because I keep saying this. There should be an honor to this type of work."

In fact, she feels so strongly about it that, along with Dr. Stephanie Coleman, Gonzales is working with the State of Utah to help create an ethical framework for practitioners who wish to incorporate ketamine into their treatment of clients.

"We are working with DOPL to help facilitate discussions about making Utah the standard of practice for other states," Gonzales reported. "We want to be the best state and give the most ethical care we can."

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• Sherilyn Gustafson

Solid Ground
The psychedelic pioneer Timothy Leary once said, "I am 100 percent in favor of the intelligent use of drugs, and 1,000 percent against the thoughtless use of them, whether caffeine or LSD. And drugs are not central to my life."

In that vein, many practitioners agree that a regulatory framework to protect patients would be ideal, because if it's administered correctly, ketamine can help to save lives and give therapists additional options in treating severe depression.

Sherilyn Gustafson, a 55-year-old stay-at-home mom who is undergoing treatment at American Fork's Utah Ketamine Clinic for severe depression, said that ketamine changed her life.

"It's definitely taken away all my suicidal ideation and thoughts," Gustafson noted. "I definitely want to live. I didn't think anything would work for me. I still take anti-depressants, but [ketamine] takes away the desire not to live."

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• Tasha Seegmiller

Tasha Seegmiller—a 46-year-old English Professor who is being treated for persistent depressive disorder, C-PTSD (complex post-traumatic stress disorder) and generalized and social anxiety disorder—echoed Gustafson. "I had significant suicidal ideation and an overwhelming desire to just be done," Seegmiller recalled. "Ketamine not only stopped that, but gave me some solid ground to start climbing out of the seemingly endless abyss."

Peter Brownstein is a 65-year-old retiree being treated for depression and anxiety by Dr. Ben Lewis, director of The Huntsman Ketamine-Assisted Psychotherapy program (KAP) at the University of Utah. Brownstein said that he's been using ketamine in therapy for about six months.

"It seems to increase neuroplasticity," he said. "It lets you be more open minded and try new things."

Zachary Taylor, co-owner of the Utah Ketamine Clinic, said that he has a success rate close to 72% with his ketamine patients. Taylor is passionate about ketamine as a tool for severe depression and is glad the drug is available today as an option.

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• Dr. Ben Lewis

Utah Ketamine Clinic was one of the first clinics in the state to administer ketamine as part of therapy.

"This isn't our primary source of income," Taylor said. "It's a labor of love."

Lewis said his clinic treats a variety of people—those whose depression and anxiety do not respond to traditional treatments as well as those who are uninterested in the standard psychopharmacological approach.

"Our KAP clinic involves a robust psychotherapy process as well," Lewis said. "So it selects for people who are interested in doing that kind of work alongside ketamine treatments."

Gonzales, of Therapy Transformed, uses a "psycholytic" approach to incorporating ketamine with therapy. She explained that psycholytic refers to work done when a patient is under the influence of some sort of substance, hypnosis or deep meditation.

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• Zachary Taylor

"I work when the person is coming out from under a larger dose of ketamine," she said.

Gonzales added that she has seen this work result in profound changes with deep-seated trauma.

"The psycholytic approach can be particularly valuable for individuals seeking to address deep-rooted psychological issues and explore their inner world in a safe and supportive environment," Gonzales said. "By working with a skilled therapist during the post-psychedelic integration period, individuals can gain valuable insights, heal from past traumas and cultivate greater self-awareness and emotional well-being."

Gonzales is very proud of her success rate. She said she's never had a client who expressed regret for incorporating ketamine into their mental health regimen.

"I'm not sure, numbers-wise, but all of my clients get better if they want to do the work," she observed. "Our ketamine work is not easy, because we want to get to the root cause of issues and not keep taking money and giving a drug."

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• “I definitely want to live. I didn’t think anything would work for me.”—Sherilyn Gustafson.

Path Forward
Given the laissez-faire atmosphere surrounding some Utah ketamine clinics, experts suggest that prospective patients should vet practitioners and clinics before settling on one. And Taylor—who has a master's degree in nursing (MSN) and is a certified registered nurse anesthetist (CRNA)—said that understanding the nuts and bolts of how ketamine works should be something your therapist is familiar with, as a bare minimum.

"My background is anesthesia," he said. "Ketamine was used as an anesthetic. As such, if a provider doesn't have a basic understanding of ketamine, that's a big red flag—or if a provider can't tell you how it works."

Lewis added that while ketamine is a useful tool, it is not a panacea.

"We feel strongly that it is important that patients are evaluated by a psychiatrist and that any ketamine administration involves direct on-site MD oversight and support," he said.

Gonzales also had a few suggestions about what to look for, or avoid, in a ketamine clinic. In particular, she suggested that patients should work with in-person therapists and "integrationists" who have specific training in using the drug itself, and in harm reduction strategies.

"I have seen the wild west of ketamine these past eight years and we call it the McDonalds of ketamine," she remarked. "There is no integration, or [there are] non-family members sitting with clients. People are just being sent home with lack of follow up care."

Gonzales also worried about people practicing outside their area of training.

"This is not just a clinic issue." she said. "Therapists are getting in trouble and practicing outside of their scope, having someone prescribe sublingual ketamine and having a client come into a therapy office take ketamine and there is no medical monitoring."

"This work should be done in partnership," she continued, "in relationship with each other as providers, and not solo."

Lisa echoed this. "I have met people and they have done ketamine at places that weren't reputable," she mentioned. "You need to be in an environment that is supportive. You have to do the work too—it's not an automatic cure."