Ketamine Assisted Therapy - A Podcast Interview with Sam Ko, MD.

This is an edited excerpt from the transcript of a podcast episode Dr. Sam did on the Behavioral Health Integration Podcast with Jacob Minnig, MA, LADC. In this podcast, Dr. Sam discussed what got him into the ketamine therapy space, starting a clinic, and more. If you want to check out the rest of this episode, head over to his website or listen on your favorite podcast platform.

Looking back in my life, I realize that everything is connected and has led me to the ketamine clinic that we’re running today.

What intrigued us to start a ketamine clinic?

Jacob Minnig: Here’s my question, “What intrigued you to ketamine and ketamine assisted therapy?”

Dr. Samuel Ko: That's a great question. I look back on my life, and I see all of these synchronistic connections. I think of Steve Jobs and his talk at Stanford for a commencement speech. He mentioned how he couldn't tell when he was in it, how it would lead to Apple. But now looking backwards, he can see how certain events aligned. So for me, I look back upon my life and everything just makes sense. For example, when I was a research assistant in college, one of the medications that I was administering was ketamine, and I was using it in an animal research setting.  Then if you think about what specialties use ketamine, it's mainly emergency medicine and anesthesia. That's where we get the most amount of residency training on how to use it safely and how to monitor etc. for procedural sedation or operating room use. Also when I was working in the ER, I saw a lot of patients with psychiatric challenges. If someone is having a severe depressive episode, or severe suicidal ideation, they'll go to the emergency department. So I was seeing a lot of these patients and because there was a lack of mental health support, they would probably sit in the ER, waiting to go to a psychiatric facility. Sometimes they would sit there for 24 hours or 48 hours or 72 hours, just waiting for a psychiatric bed. And that was when I came across the first research study looking at ketamine. It was published in 2000, by a psychiatrist named Dr. Berman. His colleagues were administering IV ketamine. They were comparing IV ketamine versus placebo, just saline, basically over a 40 minute period. And what they found was a dramatic drop in their depression scores in the ketamine group.

So I started reading into the science behind the ketamine and the evidence. And I was like, “This is really interesting, maybe we can do something in the emergency department to help all these psychiatric patients that are having their struggles.” But medicine is slow to change. So at a certain point, this was something that I was personally really excited about and I love also getting results fast. One of the nice things about emergency medicine is sometimes there are some patients, they can come in, and we can fix their broken bone or popping back that dislocated shoulder.  Or they have some sort of irregular cardiac rhythm, and we can fix it. I loved that type of experience where we can make a rapid impact. I feel the same way with ketamine where we can make a rapid impact. By rapid, not necessarily a couple hours, but over a period of one to three weeks where we can make a huge impact.

Starting a business doesn’t fully require that you take an MBA or have a business background. Especially as doctors, you have the ability to pick up these skills on your own.

Do you need a business background or MBA to start a ketamine clinic?

Jacob Minnig: So would you say your MBA really helped you develop the skills to run your own business, or could someone very easily just learn that on their own?

Dr. Samuel Ko:That's a really good question. And I get that question frequently asked from other doctors who think of starting their own ketamine clinic. They ask, “Do I need to have an MBA?” I would say, “No, you don't need to, because if someone is able to make it through grad school, med school, residency, all of that training, then they can definitely pick up the skills”. But for me, I'm a learner. I remember in Med School, they said, “50% of what we teach you is going to be wrong. And we just don't know what that 50% is.”So what that means is everyone in class needs to become lifelong learners. I think people should learn what they're personally just passionate about and interested in. For me, that was that whole business side, like I really loved learning about marketing, finance, strategy, negotiation, business plans, and entrepreneurship. That was just really interesting to me, but I do find it incredibly useful. I wouldn't say it's absolutely required to start a practice.

Each state will have different legalities about starting a ketamine clinic. Be sure to consult with a business attorney.

Who can open a ketamine infusion clinic?

Jacob Minnig: Could a therapist like myself, or I'll say a psychologist, do the same thing, even though they're not a medical doctor, but run a ketamine clinic?

Dr. Samuel Ko:We get that question a lot. So it depends upon the state you’ll run the clinic in. So anyone who's interested should talk with a business attorney, because each state has various laws about who can open up a medical clinic. For example, in California State, only physicians can open up medical clinics. Conversely, in Florida, anyone can open up a medical clinic and hire physicians as employees. So another example like in Washington State, you don't have to be an MD or a DO to start up a clinic, you can actually be a nurse practitioner or a CRNA. It's going to be quite variable depending upon the state you live in, because each state sets their own laws and regulations in the medical practices.

We only practice evidence-based medicine, so whenever there are therapists who do not approve of what we do, we have them go through evidence and scientific data.

Navigating professionals who don’t approve of ketamine treatments

Jacob Minnig: So what would you do if you had a client coming in who had a therapist, but the therapist did not approve of your ketamine therapy? 

Dr. Samuel Ko:I love it. When we've had that, I say, let's have a conversation. So I'll talk with a therapist and say, “What are your concerns?” And I think a lot of it has to do with education, because there is that stigma that it's a club drug of abuse. I always ask the question, and sometimes I see this with psychiatrists where they're like, “Oh no, it's strange, and I don't believe in that”. One of the things I personally learned in medical school is something called evidence-based medicine (EBM). And I'm sure you're familiar with that. We look at the evidence, the scientific data, the systematic reviews, the meta analyses. And then if someone is open minded they’ll be willing to check out those articles. This podcast that we're doing as a part of that education is just letting people know there's scientific data, there's randomized, double blinded, placebo controlled trials. And that's what I was taught in med school. So, as I had mentioned earlier, 50% of everything that we're taught is wrong. We don't know what that 50% is, thus each clinician needs to stay on top of the data, and they need to read the latest scientific articles. And if they are able to do that, and they're open minded, I feel like the best clinicians would be willing to change their mind. Now, of course, some people get stuck, and they're rigid.

Ketamine isn’t the only solution out there. So if ketamine doesn’t work for someone, there are tons of other tools out there.

When patients aren’t a candidate for ketamine treatments

Jacob Minnig: Going back to your earlier question to, let's say, you have a patient that does not quite qualify for the ketamine-assisted therapy. Do you have any alternative therapies that you give them instead?

Dr. Samuel Ko: So I specialize in ketamine infusions, but so I personally don't offer them other medications or therapies, but I recommend them to talk with their psychiatrist or therapist, because ketamine is just one tool. I think of Batman who has hundreds of tools. It might be TMS, it might be ECT, it might be CBT, it might be EMDR, it might be acupuncture, it might be functional medicine. So there's a host of options out there and ketamine is just one of those options. I'm not one of those people who think this is the only thing you can do and everything else is a “no”. Let's open up our minds and perspectives and use all of the tools, rather than just one tool.

Jacob Minnig: I can imagine sometimes you'll get patients who are just really emotional, and they think that ketamine is the Holy Grail and the only way. That if I have this, their life's gonna be perfect.

Dr. Samuel Ko: Some patients may have a history of schizophrenia. Maybe they have a history of severe cardiac disease and there's various contraindications. So I tell them that ketamine won’t be safe for them and we don't want to take that risk. Because at the end of the day as a physician, the first thing for me is “Do no harm” which is what we're taught. So we frequently say, “No, it's not a good fit for you”. And there's more options so don't lose hope. There's more science, there's more evidence, there's more research. So don't lose hope, because there's more options available now and coming up in the future.

Seeing ketamine change the lives of our patients is what makes this whole practice so worthwhile.

Ketamine’s Ability To Change Lives

Jacob Minnig: I'm sure you have stories, like what are some of your greatest stories about seeing how happier patients are from their experience?

Dr. Samuel Ko: There's so many. One patient that stands out more recently was suffering from complex PTSD. And she had tried everything, yoga meds, etc. therapy, and she was only  getting a little bit of relief, but not a significant amount of relief. And she came and saw us and had her infusions. With each infusion that the patient gets, we're monitoring their score. So they're filling out the depression score or the PTSD score, the anxiety score, etc. So I remember just seeing her numbers just get significantly better. And it was like, “Wow,” this is getting amazing. And it's just getting better, better, better. We did a one month follow up. And she's like, “Hey, I'm doing great.” So it's just quite remarkable. How for some patients, where they've tried so many things, X, Y, Z and D, and then it's not working, and then they'll get the ketamine therapy and have that robust effect. That's really what makes this job worthwhile for me.

Starting a ketamine clinic requires action in the form of small steps in the right direction.

If you enjoyed this blog post here are a few others you could check out!

What is the most important thing you need to start a ketamine infusion clinic?

Starting a ketamine clinic requires a lot of time, effort, and resources on your end to get things up and running. In this blog, we talk about the most important thing you need to face the challenges and hardships of starting a clinic. 

5 Reasons Why You Should Open A Ketamine Clinic (2022 Update)

There’s no doubt that running a ketamine clinic is a fulfilling venture for those who want to change lives. But is it something for you? Read this blog on the 5 reasons why starting a ketamine clinic could be for you.

Should You Start a Ketamine Clinic or Continue Working In the Hospital?

On the fence on whether you should stay in your secure hospital job or take the risk to start your own ketamine clinic or private practice? We’ve been there too. In our blog, we talk about some questions you should ask before you decide to take the leap.

As ketamine clinic owners for almost 5 years, we’ve learned a lot throughout our journey so far. In this podcast excerpt with the Behavioral Health Integration Podcast, Dr. Sam shares his experience from deciding to start a ketamine clinic plus how to deal with some challenges along the way.