January 14, 2025 • 60 mins
Thanks for joining Hospice Nurse Penny and Halley (Hospice Social Worker) on the journey to #NormalizeDeath!
Our guest is Lisa Yeager. Lisa earned her B.A. in Psychology from the University of Virginia, Masters in Social Work from San Jose State University and her Certificate in Psychedelic Therapies and Research from the California Institute of Integral Studies. She received her training in Ketamine Assisted Psychotherapy from Dr. Phil Wolfson and training in Psilocybin Assisted Therapy at Synthesis Retreat Center in Amsterdam. She has completed parts 1 & 2 of the MAPS MDMA therapist training program. Special areas of focus: hospice, palliative care, death doula support, grief counseling, depression, anxiety and mindfulness practices, with spiritual practices in Tibetan Buddhism and Lakota tradition. Lisa is a member of the Nansemond Indian Nation of Virginia. When not working, Lisa is likely spending time in nature with her two dogs.
The website is: https://www.bellinghamketamineclinic.com/
Instagram/Facebook: TBD
Thanks for joining Hospice Nurse Penny and Halley (Hospice Social Worker) on the journey to #NormalizeDeath! You can reach us at DeathHappensInsiders@gmail.com, on all places you find podcasts are found. A video option can be found on YouTube at https://www.youtube.com/@DeathHappensInsiders
Hospice Nurse Penny on the socials: @HospiceNursePenny
Halley on Instagram, TikTok, and Facebook: @HospiceHalley
Our intro music was composed by Jamie Hill http://misfitstars.com/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
He had a powerful,
experience
with his father within that ketamine experience. And
it brought a whole another level of healing
and he came out of it saying, I
had no idea that that was there still.
I had no I, idea, and it was
really profound for him.
(00:24):
Welcome to the death happens podcast, an insider's
guide to dying.
We're your insiders. I'm hospice nurse Penny. And
I'm Hallie, hospice social worker.
Today, we have Lisa Yeager. She is a
psychedelic assisted
psychotherapist, and we're gonna get into what all
that means in a minute. But first, since
we're talking about drugs,
(00:45):
I would love, Penny, for you to tell
us a bit more about the medications that
we use in hospice and specifically the medications
that we use that have illicit street drug
use that really freak people out.
Right, so
first of all let's talk about the comfort
kit because the comfort kit has morphine in
it. It also has lorazepam
(01:07):
and haldol and that's pretty standard across the
country. Most hospice agencies have at least those
3 drugs in their comfort kit and interestingly
now the morphine of course gets the bad
rap all of the time. People think we
give morphine to end people's life
and morphine
actually is less potent milligram per milligram than
(01:29):
oxycodone which is what is in Percocet.
But the other one that's kind of interesting
is the haloperidol because haloperidol
is an antipsychotic
medication
and we use it for other purposes in
hospice. We use it for nausea and vomiting.
It is like one of the best. It's
my favorite for nausea and vomiting.
We use it for hallucinations
(01:50):
if patients are hallucinating.
We use it for agitation. It works very,
very well. But people
are very concerned when they hear we're using
haloperidol if they do any kind of research,
and they're like, oh, that's for schizophrenia.
That's you know, it's stigmatized because it's an
antipsychotic
medication. It's a side drug, and so people
worry about that. And in fact, when we
(02:11):
have patients who are in nursing homes,
it's very challenging for us because they
are not now in the state of Washington
allowed to use haloperidol
unless the doctor is seeing the patient every
week. And so it's kind of a, you
know, real problem for our patients in nursing
homes.
But other drugs that we use that are
stigmatized
are methadone,
(02:32):
especially I I don't know how it is
in other states, but in the state of
Washington, methadone has been used for decades
decades decades decades,
as a replacement for heroin.
It's a way for people to get off
of heroin by going on the methadone replacement
program.
But methadone is a very good long acting
(02:53):
medication. It works very well for pain. It
works well for neuropathic
pain,
and we use it often. But, again, it's
a natural constipating, right, than other opioids?
Yeah. Less constipating,
and it's it's really effective. And it's a
liquid. It's it's con real con it comes
real concentrated so people can take it by
mouth even if they're having trouble swallowing.
(03:15):
And it can be given in a MACI
catheter. It can be injected. I've had a
person on a methadone infusion. It's a very,
very effective
drug for us to use, but it is
very much stigmatized.
Fentanyl is another one that is really stigmatized.
Fentanyl patches are very commonly used in hospice
because
(03:35):
if a person can't swallow,
slap a patch on them,
But it is now a street jug that
is killing a lot of people,
and so it's stigmatized.
Now one thing I will say about fentanyl
patches that is important for people to know
is that those patches are good for 3
days and you take it off and you
replace with a new patch. The patch that's
(03:57):
removed after 3 days still has Fentanyl in
it. And there have been situations where somebody
had a patch,
they did not dispose of it correctly or
slipped off the person's body, and a child
got a hold of it and actually has
caused the death of at least one child
that I read about that was exposed to
a fentanyl patch. So it's really,
(04:18):
important to be careful. People don't think of
a patch as being
a really potent medication, but it absolutely is
a potent medication that we use. And as
long as it's used safely,
medication that we use. And as long as
it's used safely, then we don't have to
worry about
the patients,
you know, being harmed from it. And I
think that's
kind of the important point to make here
(04:40):
is that when medications
are used in hospice,
they are prescribed by a medical provider and
we use them
safely.
The intent is never to cause harm to
the person or to cause them to die
faster.
It's meant to to relieve them of suffering
from their symptoms
by managing their symptoms, not by ending their
(05:02):
life.
Yeah. Don't we don't hasten. We don't hinder.
And the benefit of the hospice program, and
this is how I explain it to a
lot of folks, is we move a lot
faster to be able to control those symptoms
because we have access to our doctors and
our nurses, and
everybody's so involved, and you don't have to
wait a month to get in to see
(05:22):
your PCP to to get a refill.
Mhmm. We're also treating end of life symptoms,
and they require more management,
more medication.
And so you're seeing larger amounts as they're
going through their disease process, but it doesn't
mean we're doing it to off them sooner.
Right. We're not blasting them with those big
amounts to start with. We're ramping up as
(05:44):
we need to. And with cancer patients, oftentimes,
we have to ramp up pretty damn high
to control the kind of pain and suffering
that they can have. And the other thing
that's important about hospice, I've seen some comments
lately about people saying
that people that are dying should be able
to get the medications that they need and
the federal government is not allowing it blah
blah blah.
Hospices are not beholden to the same federal
(06:06):
laws around opioids.
We do not have to follow the same
laws that other
clinical practices have to follow.
We we have completely different laws complete not
not completely different laws, but but those laws
do not apply to us. Like, those limits
on medication guidelines.
Right. Exactly. Different restriction guidelines. Those laws, those
(06:29):
restrictions do not apply to hospice. We are
able to get the medications that our patients
need.
Unless,
and this is my devil advocate and you
already mentioned it, if we are in a
skilled nursing facility,
they have regulations that we then have to
work around with the facility to figure out
what they're able to give,
Assisted livings in particular, because they only have
(06:52):
med techs and not nurses,
this is something that's been a long time
struggle. It's not mainly me handling it. Obviously,
it's the nurse, but I've been part of
that conversation where we can't have PRN, which
is as needed, or we can't have
you know, it has the outline of the
as needed medications has to be extremely specific,
or they can't use liquid. They have to
(07:12):
crush a tablet because they're not able to
pull up a syringe and measure.
Yeah. I get it. I get it for
safety, but good lord.
Yeah. Yeah. It's a challenge for sure.
So it's just it's one more tiny component
of the reason to think about planning for
(07:33):
your end of life because there are things
you're not even gonna think about.
Just like with the lawyer, there are things
you you never know until you're in the
situation.
And then all of a sudden, oh, this
is why we can't do that or
may suggest don't understand
assisted living
maybe it's different in other states, but assisted
living facilities
(07:54):
in Washington
used to be
more assisted.
Like, there were more nurses that they provided
more assistance. It was closer to a skilled
nursing facility.
Whereas now,
an assisted living facility is
that people are walking, talking, living in their
(08:14):
apartment. They don't have a lot of assistance
from somebody else. So it's kind of changed
a little bit, and
it really isn't the best place for a
person to be at the end of their
life because they can't provide the care that
that person needs as they
become, you know, unable to care for themselves
anymore. We'll save that soapbox for another day.
(08:36):
Until then,
let's get to our guest.
Yes. Let's do it.
Yay, Lisa.
Thank you for coming out and being with
us. Welcome. You for inviting me. Of course.
Tell us a little bit about yourself.
My name is Lisa Yeager, and
I am from Virginia,
(08:57):
and I'm a member of the Nansemond
Indian Nation of Virginia.
I have a bachelor's in psychology,
from the University of Virginia
and a master's degree in social work from
San Jose State University.
I also have a certificate
degree,
from the California Institute of Integral Studies,
(09:19):
focusing on psychedelic therapy and research.
I am thrilled to pick your brain about
all the psychedelic
assisted therapies that you do or that you
work with. Me too.
I I wanna hear all about it.
Because full disclosure, I've done psychedelic therapy
off the record
for when I
(09:40):
was. I don't think you could necessarily call
it therapy,
but, definitely
back in the eighties, I participated in some
psychedelic
extracurricular
activities.
But that's, I'm sure, much different than what
you're gonna tell us about.
Probably. Maybe not. Maybe that's a good place
to go. Okay. What is the what is
the difference between
(10:01):
just doing recreational
well, first, let's back up. Let's tell the
people what do we mean by psychedelic and
psychedelic assisted therapy. Yeah.
Sure. So the classical
psychedelics
are LSD,
psilocybin,
otherwise known as magic mushrooms,
Ayahuasca,
MDMA,
(10:22):
sometimes known as ecstasy is not a traditional
psychedelic, but it can have psychedelic qualities.
Ketamine
also has psychedelic
qualities, but is not a traditional psychedelic. It's
a dissociative
anesthetic that has psychedelic qualities to it.
There's
many other ones, 5 MAO, DMT,
(10:44):
peyote, mescaline.
So they all
are substances,
medicines.
Some come from plants, some are chemical in
nature
that create a
altered state within the person where they are
experiencing
visual hallucinations.
They may be having auditory hallucinations.
(11:06):
They may have
mixing of sensations where they smell music or
they can feel music where their senses are
are kind of mixed. There's like a synergy
of the different senses that they have.
Well, I think we can all imagine why
people would use it recreationally,
but why would someone,
(11:27):
instead of just doing what would maybe be
traditional talk therapy, why might someone
venture into
psychedelic assisted psychotherapy
both as the therapist and as a patient?
Sure. For sure. Well, in
if we look back into history
for eons,
different cultures have ingested hallucinogens,
(11:51):
for
the benefit of their their village, their their
community,
and also for personal healing. So,
incorporating
psychedelics into
having a healthy village, having a healthy self
has really been a huge part of the
human experience.
(12:11):
And there are lots of different theories as
to how that initially
started. How did we,
originally
come to
know that a particular
medicine or a plant was going to have
those kind of properties.
And certainly in the Ayahuasca tradition,
the when Ayahuascaos,
the shamans who in Ayahuascaos,
(12:33):
the women and men who work with Ayahuasca,
when they're asked that question, they say the
plants told
us. So that there was there is this
belief within many indigenous cultures that plants, animals,
rocks can communicate with us.
So there's a long history of humans utilizing
psychedelics to
(12:54):
gain healing or insight answer, get questions answered.
And
so that has been a part of our
human experience.
Then in the late fifties, early 1960s,
there,
we started to have research where folks in
the lab were discovering by accident,
like Albert Hoffman discovering by accident that, oh,
(13:17):
the substance now that we know now know
as LSD has hallucinogenic
properties.
And that led other researchers like Gordon Wasson,
who is an ethnobotanist,
led him to go to,
Oaxaca in Mexico, and he met Maria Sabina,
who
is sort of
a matriarch
(13:37):
for many folks,
that she introduced the psilocybin mushrooms to Gordon
Wasson.
He then took that back to the states
that was eventually synthesized.
And the research started around that time of
wanting to explore how these psychedelics
could assist people who were struggling with depression,
(13:58):
who were struggling with anxiety
around end of life, who were maybe struggling
with,
drug or alcohol use that was,
more of an addiction. So the research the
researchers started to become curious as to whether
this
mind altering substance, any of these substances, could
be a benefit
(14:19):
for the different,
symptoms of distress that a person might be
struggling with. And so in the late fifties
early sixties, towards the late sixties, before the
FDA
rescheduled a lot of these medicines,
there were many, many research studies that were
going on in Europe, in the United States,
in Canada
that were showing pretty positive results that
(14:41):
one high dose psychedelic session in a supportive
environment
with what we call
a supportive set and setting. So set being
the mindset that the person is in and
the setting supportive environment with
therapist guides being with them, have the potential
to really help reduce symptoms of depression,
(15:03):
help reduce symptoms of anxiety around end of
life,
and also to help with,
addiction to alcohol and to drugs.
There are stories that
Bill w, who founded Alcoholics Anonymous,
part of his
journey towards recovery was having an LSD experience,
(15:25):
which really helped him and then led him
to formulate some of the 12 steps in
the program.
I can imagine a lot of people nowadays
are coming as patients
because they are resistant to traditional medications,
And there's been a lot of good studies
about that as far as, you know, especially
(15:46):
depression. I know I've seen some,
documentary
documentaries.
Wow.
Words are hard.
Documentaries
where they've talked about the use of different
types of psychedelics to help with resistant, treatment
resistant,
depression, PTSD, all of those kind of things.
(16:07):
So we we experienced
almost a complete stoppage of all of the
research when the FDA decided to make all
of these substances
schedule 1, meaning that there was not any,
medicinal healing benefit to them. So they all
were rescheduled into that realm, which put a
(16:29):
a halt to all of the research that
was going on. So we lost a huge
amount of time, but then the research started
resuming
in 2017,
2018,
looking again at how could these medicines help
with treatment resistant depression.
MAPS, the multidisciplinary
association for psychedelic studies
(16:51):
started their focus under the leadership of Rick
Doblin
to start studying MDMA
for the treatment of PTSD,
and that's really been
their focus.
So and their results, very high percentage,
of success with folks that were participating in
those studies
coming out of the study with a significant
(17:13):
reduction in their symptoms of PTSD.
Sorry, Penny. Just I'll let you go next.
I'm just thinking, I think a lot of
these I think I've heard you talk about,
Lisa, these a lot of these studies are
being done
until very recently outside of the United States
because of the class that they're the schedule
1 classification.
Right?
(17:34):
Not completely.
There is, it is possible to do the
research with a schedule
1 medication.
There are very
elaborate significant hoops that the researchers have to
go through,
to be able to do that research, but
it is possible.
So we've had pretty significant,
studies through Johns Hopkins,
(17:54):
through NYU,
UCLA.
UW
is now starting to do some research,
San Francisco. So there have been a number
of places in the states where we have
been seeing some really significant research, and in
Europe as well and in Canada. But it's
just an arduous process to get through the
(18:16):
IRB,
and the research all the all the steps
that you have to go through for a
schedule 1.
And for the research, they have to use
the synthetic
version of
whatever medicine that they are exploring because for
the research purposes, they have to be able
to
verify that the amount of the psychedelic medicine
(18:38):
is going to be the same in every
single dose, which
is not possible to do if you're ingesting
a mushroom that
has grown in the woods or grown in
someone's home that each one of those mushrooms
is gonna have a little bit of a
variation to how much of the medicine it
has.
Right.
(18:59):
I'm guessing that
the psychedelic
assisted therapy
is really truly different than recreational
use of l LSD
because you're saying that this therapy can actually
help people who have drug and alcohol addiction.
I did LSD,
like I said, in my teens. I'm
(19:22):
an alcoholic and was a drug addict, so
it didn't it didn't help me at all
in that regard. So so what exactly is
the difference between
just taking it on your own and the
therapy part of
of it in the
A huge part of it is the the
set and the setting. The set is the
(19:44):
mindset.
What is the person's intention of participating in
this kind of therapy?
If a person is ingesting a psychedelic in
a recreational setting,
their
intention is to have fun, have a whatever
their experience is, and they may be successful
in having fun, or they may be, they
may have a disturbing experience. We, we never
(20:06):
know. That's true in a supported psychedelic experience
too. But the difference is, is that when
a client is coming in either to a
research study or is working with a guide
or a therapist,
their goal is that they have some particular
intentions or aspirations
that they're coming in with, and they're coming
(20:26):
in with that in that intention. They're working
with the researchers or the therapist to,
really explore their intentions and their hopes for
the experience.
There's a lot of preparation that goes into
supporting that client before they even come in
to take the psychedelic medicine. And for many
(20:48):
of us, we feel that the preparation work
and then the integration work afterwards,
those are
as important, if not more important than the
actual psychedelic session. So it's really a difference
in the mindset
of the client and
there's, and the setting is also very different
where
(21:09):
things are very supportive,
for that client that's coming in for the
psychedelic session and the recreational
world. You know, person maybe is taking it
to right before they go to a concert.
And so
they're in a concert setting with many other
people.
And
in the research or working with a therapist,
(21:30):
there's a very safe, supportive environment that is
discussed and created with the client beforehand, before
they come in so that they understand
what the space is gonna be like, what
kind of support the therapist or guide can
offer,
how they're gonna be kept safe,
how they're gonna be supported.
So, it really is very, very different than
(21:52):
the recreational,
choice to,
to take a psychedelic versus having
a supported psychedelic session where someone is there
with you for that whole time, supporting you,
holding space,
and
helping to potentially navigate through
difficult arenas
(22:12):
that may come during the journey, that come
for the reason for healing. We say that
there aren't any
bad trips.
There are can be difficult moments within an
experience, but they're coming for a reason.
Well, I think that that talk about preparation
and the integration afterwards
is so vital of a conversation. Number 1,
(22:34):
because we're thinking about people that are coming
in to treat what could possibly be a
trauma event,
PTSD. And for veterans, that's really a big
push right now is to get that integrated
and and in work for PTSD.
And if they do have a
challenging experience in the middle of that session
(22:54):
that you have a trained professional there with
you,
and I really wanna mention that because of
these now that Ketamine because Ketamine is a
legal substance in the United States that
there are these Ketamine Clinics popping up now,
and they're not necessarily
clinics that have supportive therapy along with them.
So can you just differentiate that for the
(23:16):
listeners for people don't just go out and
pick the first available ketamine session that you
can get into?
There are reasons not to do that.
Yes. There definitely are reasons not to do
that.
Ketamine is,
in a different category. So it's a schedule
3 medication,
which means that it can be prescribed
(23:37):
by physicians,
for
a variety of different things. It's a dissociative
anesthetic, and it's often used
in military settings. They would use it out
on the,
out in in active wartime
where they could give pain medication
very quickly to get a soldier in to
be able to get treatment.
It's used in the emergency room setting really
(24:00):
quite frequently. That's where I first encountered it
when I was working as an ER social
worker.
And then it has this ability to be
a dissociative
anesthetic and psychedelic. And so we're using it
in an off label
method, which has been approved by the FDA.
But there are many
different ways that,
(24:21):
Ketamine can be administered.
So it comes in a sublingual
lozenge form that we can give that in
a tablet, which as Halle can remember,
does not taste very good.
Well, and chocolate raspberry flavoring
did not help. I don't think. Did not
help. No.
(24:42):
Yeah.
At our clinic here in Bellingham,
we, we experimented a little bit with different
flavors and kinda landed that mint is probably
the safest
bet that it so it's got that yucky
medicine taste with a little bit of mint
flavoring to it.
So there is the sublingual administration.
(25:03):
It can also be administered by a nurse
or a physician intramuscularly,
either into the bicep of the arm or
into the buttock.
It can also be
administered
by an infusion. So that requires a nurse
to a nurse or technician to start that
IV and give and administer it in an
infusion.
(25:23):
So there are big differences.
Some of the the infusion clinics
typically do not offer any kind of therapy
along with the the treatment that they're offering.
So the client comes in, they get an
assessment.
They come in, they get their their ketamine
treatment
via infusion, and
(25:44):
there isn't really any support,
therapeutic support that's offered to them during their
ketamine experience
and not really anything offered afterwards. They
are sort of left up it's up to
the
the client if they have a therapist that
they're working with on their own. And so
that can lead to some, you know, potentially
(26:07):
disturbing experiences
or something that's kind of disrupting their view
of the world.
And they don't really have the support in
place,
in many of the infusion clinics.
And that can be true, in in some
circumstances in the clinics that are just offering
intermuscular,
injections as well.
Myself
(26:27):
and the physician that I work with and
my therapist colleague, we were all trained to
provide ketamine assisted therapy. So it is
the combination of receiving the ketamine treatment and
receiving therapy. So they work with us for
preparation
counseling sessions to get them prepared and help
(26:47):
them to
hone in what their aspirations and hopes are
for the ketamine experience. And we also prepare
them for the fact that there could be
some
difficult aspects of the ketamine journey. And we
prepare them for that and say that this
is normal. This may happen. If it does
happen, it's not going to be,
(27:07):
a long experience. Everything is always changing within
the psychedelic experience, and then we're working with
them afterwards to help make sense of
what happened during their journey. And so in
our training,
we really believe that that's where the most
success can happen.
The most healing can happen is that they
have a supportive person that's
(27:29):
helping them with the preparation, is there with
them for their entire ketamine session, following up
with them afterwards, and then doing integration work
to help them make sense of what they
experienced.
It can be really important. And our goal
with ketamine assisted therapy is that the person
is gonna have enough of a reduction in
symptoms so that
(27:50):
they don't need to,
continue to have the Ketamine treatment, which is
a big difference between the Ketamine infusion clinics.
They're basically it's a maintenance program
where they're
it the sort of the expectation is that
the person is going to maybe they come
in twice a week for a little while,
then they taper to once a week, but
(28:11):
they're continuing to come in. There isn't really
the goal that the person is gonna have,
a full reduction in their symptoms that they're
gonna come in to have sort of a
maintenance.
So it's not that much different than taking
an antidepressant.
And is the purpose of the Ketamine infusion
clinics to address
mental
(28:31):
issues? Okay.
Because I'm thinking dosing must have
play into this somehow because we use Ketamine
at my hospice agency for pain management. We
use it IV and we use it orally.
My first experience
with giving a patient oral ketamine was in
a hospice care center, and it did not
go well,
(28:52):
because that patient and this was for pain,
but that patient experienced a lot of,
hallucinations,
and was very, very disturbed, and we had
to stop giving it.
So so dosing, like, do you are you
giving more? Are you doing microdosing? Like, what's
the difference in dosing when it comes to
treating pain so that you're not gonna get
(29:12):
these
hallucinations and things that that is actually kind
of the goal with the therapy. Right?
Is it more that you use or less
that you use? What's the difference there? The
sublingual
lozenges
are a little bit less in the dosage.
Our,
lozenges are a 100 milligrams,
and so we can incrementally go up,
(29:35):
with the dosage.
And the benefit of the lozenges is that
it has a,
gradual
coming on to the intensity. It takes about
30 minutes or 35 minutes
to get into that
peak ketamine experience, which is usually about 45
minutes long, and then there's a gradual coming
(29:56):
out of it.
And so that's all can be much more
gentle for clients to experience it with that
lower dose. They definitely can have a psychedelic
most of them have a psychedelic experience,
with the dosing that we use, but it's
a gradual going in and a gradual coming
out. Whereas with the intramuscular
injections that we offer,
(30:18):
the client is feeling the Ketamine and in
that space potentially within like 2 minutes.
So they're sort of launched into that deep
Ketamine experience very quickly,
and they're in the the deepest part of
that, and then they come out
more quickly.
And Penny, I'd say with you To speak
to your question, I know we when we've
used
(30:39):
Ketamine lozenges for pain in hospice,
it has been a much lower dose for
pain management closer to
the dissociative side,
for relief of their pain, but not necessarily
dissociative out of their body, which is closer
to the hallucinogenic
side. Right? Am I understanding that right? Right.
Right.
(31:00):
Right. And with the infusion
at the at the infusion clinics,
they they're using a dose where they can
have somewhat of a hallucinogenic
experience. They, I think, typically allocate about 2
hours for the person to be there to
get their infusion.
So they're using that sort of dosage, which
I I would agree with Hallie that for
(31:21):
pain, it's usually
a lower dose where we're trying to address
the pain without
creating that hallucinogenic
experience that
the client the patient might not be prepared
for.
Okay. Right. That makes sense. Yeah. And we're
doing a continuous infusion too. We're not doing,
like, a 2 hour blast. It's a continuous
(31:42):
Right. Probably low dose
infusion.
And it's important to, you know, talk with
clients about or patients about the fact that
they're could they could experience,
something hallucinogenic,
a psychedelic experience when they're getting ketamine for
pain to be able to prep them for
that. I've heard a story or 2 of
(32:04):
a woman in labor who was given Ketamine
because
of some aspect of her labor experience, and
she started to have a hallucinogenic
experience while in labor and was not prepared
for that. And it was very disturbing.
I think that's probably my my biggest worry
with the use of Ketamine in an ER
(32:24):
setting is people in a mental health crisis.
Ketamine does, intermuscularly,
like you said, work very, very quickly to
subdue someone, but it also can
exacerbate whatever psychotic break they're having.
Right. Exactly.
And when I was working as an ER
social worker, I
I was not aware. I don't know at
(32:45):
that time
if they were using,
ketamine,
on the ambulance
rigs,
because if they
if if it is a paramedic who can
administer medication, they can call into the ER
doc and get the order to be able
to give ketamine.
I don't know if they were doing that
(33:05):
one because that was back in, like, 95,
95
to almost 2,005.
But that in the more recent history, that
has been something that a paramedic out in
the field could give an get an order
to
administer Ketamine to someone who is having,
(33:27):
some sort of a mental health crisis,
and they get,
you know, injected with Ketamine without any kind
of warning. They don't know what's going on.
They're in a, you know, an ambulance rig
with really bright lights,
and it's most likely not gonna go very
well.
We used to give ketamine to cats
for spaying them, and they would go ballistic
(33:49):
when you gave them the injection.
My first the first time I ever heard
of Ketamine
was when there was a movie called Perfect
Victim, and it was about some guy that
was
administering
Ketamine to some women.
And then, you know, they were
showing you in the movie this dissociative state
(34:09):
that they had and,
and then he was, you know, raping them
and torturing them and and everything else. But
that was the first time I'd ever heard
about it and that it was a horse
tranquilizer.
So so then now when I worked in
the ER, we didn't
I would there was never a time when
I gave Ketamine, to a patient when I
and I only worked in the ER for
about 3 months, but so the first time
(34:30):
I ever heard about using it first on
cats was like, that's interesting because this is
a horse tranquilizer. But then when I worked
at the care center and and we got
the order to give it to the patient
orally, I was like, wait a minute. Isn't
this a horse tranquilizer?
So
but, yeah, I just always remember those cats
going crazy when we gave it to them.
So imagine Yeah. Probably has the same kind
(34:52):
of dissociative effect on them. Definitely. And my
first experience with Ketamine in the emergency room
setting was with a patient who had come
in and he was a roofer,
and he had gotten splattered with hot tar
all over his chest. Oh. And they needed
to,
you know, get the tar off,
and they didn't want to that was gonna
(35:14):
be excruciatingly
painful
to do without giving him some kind of
medication. And they gave him Ketamine,
and he was awake
and looking around, but totally dissociated.
And they didn't have to it doesn't suppress
the breathing, so they didn't have to worry
about him needing to be intubated.
He was dissociated
(35:36):
looking around.
They were able to get the the tar
pull the tar off of his skin. And
I sat with him afterwards, and I was
like, do you remember anything of what happened?
He was like, nope. Even though he was
awake, and and I've seen that with clients
that I'm offering ketamine assisted therapy to, that
sometimes they will
take off their eye cover. And
(35:56):
they are looking around, but they are not
seeing me. They are seeing something
Mhmm. Totally totally different.
Okay. So now you've piqued my interest with
the eye cover thing.
So when you're doing this ketamine assisted therapy,
are you blindfolding them?
It's, an eye cover.
(36:17):
We use we recommend something called the mind
fold, and
it
completely blocks out any light,
you but it has little,
cups so that you can open your eyes
completely,
but you're not seeing any light. And so
it's a it's an invitation for the client
to go inward, to have that inward experience.
(36:37):
And some people do
have those visionary states with Ketamine. It's not
quite as psychedelic as LSD or psilocybin
or Ayahuasca.
It really kind of varies from person to
person. Some people will see bright colors and
will see have visionary experiences. Other people, it's
more muted colors or grays,
(36:58):
and then some people don't have the the
colors and sights in that kind of way.
But having that eye cover on is an
invitation
to go inward and to not be distracted
by the things that are around them.
That makes sense because I can remember being
very distracted by a bag full of onions
in the basement when I
(37:19):
when I did LSD the first time.
Thought it looked like a monster.
Yeah. Yeah. Things look very different. I mean,
I I can remember one of my first
experiences
with
LSD, you know, coming back on public transportation
after seeing the grateful dead, which is sort
of the the door of entry for for
many people.
(37:40):
We were coming back on the BART train,
and the carpet was just fascinating
with all of the yeah. All the changes
and shapes and, yeah, how it was undulating
and yeah.
So
do you do other,
psychedelics
for your assisted therapy or just ketamine? Or
(38:00):
do you use IOSCA
or
LSD
or anything like that? Or is it all
strictly ketamine? And if so, why? Well, ketamine
is the only medicine that is legal to
administer to clients at
this point. So that's what we offer at
our clinic, here in Bellingham. That's called the
Bellingham Ketamine Clinic,
(38:21):
and that's what we're offering at this time.
We're hoping since all 3 of us at
our clinic,
we all went to the California Institute of
Integral Studies, so we're all trained to work
with,
psilocybin and MDMA.
Our hope is that we can expand to
those medicines once they get rescheduled.
And I think Oregon's working on something like
(38:43):
that. Right?
With
solar is yes. It's now legal. They passed
a law,
I think it was 3 years ago now,
and it took them they they took their
time in trying to get all of the
regulations and certifications
in process.
And so now they do have psychedelic centers
that offer psilocybin
(39:05):
to clients.
So it is possible,
to go have a a psilocybin session legally
in Oregon.
And you don't have to be an Oregon
resident
to be able to access that.
And then Colorado
has more recently passed a law legalizing
psilocybin therapy, and they're now in the process
(39:27):
of getting their regulations in process in in
place so that they can offer that legally
too. So it's legally within the state of
Oregon
and will be legal in Colorado,
but it's still federally illegal.
How how does that work?
The same as same as medical aid and
dying and
(39:47):
Yeah.
Pot? I guess so.
Mhmm. Mhmm. And if the federal government, you
know, chose the chose to focus on that,
they could come and shut down
those
treatment centers if they wanted to.
I am I imagine ketamine is a little
easier to work with on a therapy level
because it doesn't last as long either.
(40:09):
Mhmm. It's very true. So an LSD
session could be
12 hours, 10 to 12 hours long.
An MDMA session is usually around 8 hours,
depending on the person. A psilocybin session is
about 6 hours.
Ketamine
is we allocate 3 hours for our ketamine
sessions.
(40:30):
So that is it's easier on the client.
It doesn't interact with other medications in the
same way that other psychedelics
do.
So that's a benefit for working with someone
who
is struggling with depression and anxiety that they
don't have to taper off of their medications
typically,
to have a ketamine experience, and they can
(40:51):
still get the benefits from the ketamine.
And in working with clients who maybe are
on hospice or palliative care,
it's also a benefit that is a in
shorter duration. If you have a hospice patient
or a palliative care patient that is experiencing
anxiety,
that it's a, you know, an easier to
manage 3 hour session.
(41:13):
And it also
doesn't interact
poorly with some of the different medications that
someone on hospice or palliative care might be
taking.
The question I have is, so during the
session, when they're doing the
ketamine,
are you asking questions?
Are you talking to them? Or what what
(41:35):
kind of
therapy is happening as they are experiencing
their trip, if you will.
Our our approach is really to be nondirective,
that
our our goal is to be there,
participating
by,
(41:55):
being in the process
of doing by not doing. So we're holding
safe space for them.
We're there to offer support if they request
it, but we're also there not to intervene
in the process because we
feel, or at least I feel that there
is an intuitive healer within each client, and
(42:16):
this is an opportunity for that intuitive healer
to come forth and maybe have some conversation
with the ketamine.
My role is to offer that safe
container for them and
to then offer support if they request it,
but not to interrupt. So if they are,
if they're crying, I
allow them to have that emotional expression.
(42:40):
You know, I wait for them, and I
I coach them about that,
beforehand
of
this is your role to reach out to
me if you need support so that I'm
not interrupting
the process of what you're experiencing.
And a client will, you know, say, help.
You know, they can say something just as
simple as help or reach out their hand.
(43:01):
And so we talk in advance about what
kind of touch would be supportive and consensual.
So
can a hand on the shoulder for support
or if they reach out their hand and
like for me to hold their hand,
sometimes putting the hands on the bottom of
the client's feet for grounding.
So those are some of the things
that, I do in terms of offering support.
(43:24):
Some people are wanting to verbally process, and
when they start to verbally process, then I'm
taking notes for them, and I will
try to offer them support as they're processing
what they're sharing.
But I'm really following their lead in terms
of what they might might need during the
session.
So I'm guessing insurance doesn't cover this since
(43:45):
it's not a federally legal
program.
Is it expensive?
That's a tricky part, unfortunately.
We can bill insurance companies for
the prep and the integration sessions that we
offer using the standard
code for therapy.
(44:06):
But the ketamine sessions themselves that we offer
aren't covered by insurance. No insurance company is
covering
that kind of ketamine assisted therapy at this
point.
Interestingly,
the
infusion
clinics, they can bill insurance
for the type of infusion
that they're offering,
(44:28):
and they can also bill if they're offering,
which is
esketamine.
So it's Ketamine that has been
modified slightly in their in the molecular
structure, and so it's been patented by Johnson
and Johnson. And so
that is covered by insurance companies.
Yeah. So so what is the ketamine's
(44:50):
portion of the session cost
ballpark?
At our clinic, our we do offer a
sliding scale,
because we don't wanna turn anyone away.
And so our sliding scale is 350 to
550 for a ketamine session.
I I have so many soapbox
thoughts about insurances and what they will and
(45:10):
will not cover. So we're gonna we don't
have time for that.
Yeah. It's a I I share your your
sentiment and a it's just a it's a
whole different perspective of, do you want to
encourage a client to
be well and not need you anymore, or
do you want to encourage
maintenance on something that keeps them in the
(45:34):
the system?
Yeah. That's we all know the answer to
that. Right? Yeah. Keeps keep keep paying money.
So, you know, it's interesting because in Canada,
they have been
they keep pushing this law out. People think
it's active, but from what I understand, it
hasn't been yet that people can access medical
aid in dying for
depression.
(45:55):
And it seems like to me, like, why
wouldn't they instead
do with, you know, something like this that
that, you know, first or require this first
before
allowing somebody to, you know, legally,
end their own life because of depression
or or mental illness?
You know,
(46:15):
it seems like it it could be
another alternative to that.
And in Canada, they they do have
they have something called the right to try
in Canada.
And so there have been a number of
clients in Canada that have been able to
go through a whole application process
to be able to legally have
(46:36):
psilocybin assisted therapy. Mhmm. Initially,
they were they were clients who had a
terminal illness.
And my understanding,
I'm not a 100% sure, but my understanding
is I think they have had a couple
of clients who have gone through that process
who had treatment resistant depression as well, and
they were granted access to be able to
(46:58):
have supported psilocybin therapy.
So in Canada, they are they're trying.
I know you do individual sessions and group
sessions. Maybe you can speak a little bit
to the
benefit or not of either one and why
someone might do that in a group rather
than individually.
Well, the group sessions,
(47:19):
that's a great question. Thank you. The group
sessions
can lower the cost, so that's one benefit.
And there can be
an additional layer of healing that can come
in a group setting
where
there's a sort of a synergy that can
happen with the members of the group.
And there's also the benefit of the integration
(47:42):
work in a group setting afterwards,
where they're able to connect with other people
who are struggling
in similar ways to how they're struggling. And
that can be really helpful because we know
that mental illness is often very isolating.
So for those
those clients to be able to connect with
other people
(48:03):
and,
who share similar stories,
and then they can kinda support each other
through
the ups and downs of what they're experiencing.
And so there are benefits, I think, to
individual and group.
My
process is that I think it's important for
the person to have
1 or 2 individual sessions first,
(48:25):
before they consider going into a group experience.
I know you've worked in hospice bereavement as
well.
How do you feel about this,
psychedelic assisted therapy for grief
rather than, like, a treatment resistant mental illness?
Mhmm. Mhmm. I think that it can be
very powerful.
(48:45):
I think all of the psychedelics can be
could be very powerful in helping with
grief and anxiety.
And I believe that Ketamine is definitely one
of the tools that we can use.
I would say
probably 99%
of the clients that I have worked with
with Ketamine,
you know, they we all have experienced some
(49:07):
level of grief in our life.
And inevitably,
I would with 99.9%
of the clients at some point in their
Ketamine work grief comes up.
And then we we work with that, and
we look at that. Oftentimes,
there is
an opportunity
to maybe look at the relationship that they
had with their loved one in a different
(49:27):
way and maybe find some completion and acceptance
in a different way.
One, my name is my very first Ketamine
client when we very fur when we first
started. His,
father was deceased, and he had had a
complicated
relationship with his father.
And he felt like he, you know, was
okay
(49:47):
in being in a place of acceptance around
that. And in his very first ketamine session,
when she was coming in for depression,
he had a powerful,
experience
with his father within that ketamine experience. And
it brought a whole another level of healing,
and he came out of it saying, I
had no idea that that was there still.
I had no I and it was really
(50:08):
profound for him.
So I think there's a lot of potential
to be able to access Ketamine as a
as another tool to help people who are
experiencing grief.
I love that.
Well, I wanna be mindful of your time.
So in these last,
few minutes, is there anything that we haven't
(50:29):
covered?
I know we've pretty much been talking mostly
about ketamine, and that is because it's the
one legal use here.
But is there anything else that we haven't
covered that you want us to know about
psychedelic assisted therapy?
Well, I think to keep in mind that,
all of these psychedelics have huge healing potential
(50:51):
in the proper
setting where there is a safe container,
And there can be difficult experiences that can
come even in that safe container.
And with the proper amount of support, there
can be a lot of healing that can
come from that.
I can appreciate that. I'm gonna switch gears
(51:11):
real quick before we let you go, and
I'm gonna ask you our new season 2
coffin question.
What do you want to have done with
your body when you die?
That's a good question.
Because I think about that, doing this work
for as long as I've been doing this
work,
I think about that.
You know, I had initially,
(51:34):
for many years, I thought cremation was the
route that I wanted to go because it
was kind of simple and
okay. Box of ashes. Someone can decide what
to do with the box of ashes, but,
you know, as I think about that more
and more,
you know, the impact that that has on
the environment
leads me to be,
(51:54):
less inclined to that.
So green burial, I think, is the direction
I know. I have a friend who
has a funeral home, and he offers a
lot of different alternatives
in terms of the and
the human composting.
But green burial, I think, is what appeals
to me
the most,
(52:15):
you know, and there are a couple of
places
that you can do that.
Nice. So that that kind of appeals to
me. I would like to and I think
that that's connected with my indigenous roots that,
you know, my in my lineage originally,
you know, that's what would happen. We would
be
either
in my lineage, we would be buried in
(52:36):
the ground, and there would be and so
that's that really appeals to me. And I've
participated
in a couple of green burials, and they're
really beautiful
in terms of,
the ritual that can
be incorporated in that process.
So I would kinda like to go back
to the earth. And,
since I'm so connected with mushrooms, I would
(52:56):
like to you know, I would I love
the envision of the vision of my body
sometimes somehow being nutrients for mushrooms.
I like that.
Well, Lisa, where can people find you if
they wanna know more about ketamine,
or whatever else you're offering to the world?
(53:17):
Sure. Well, so I do have a private
practice,
and you can find me on psychology
today with my profile and
my private practice is focusing on
grief therapy,
depression, and
talk therapy, right, not Mhmm. Psycho. That's traditional.
So I offer traditional talk therapy.
(53:38):
I also am offering
nature therapy.
I have a geodesic dome
with trails that are connected with that. And
so for some clients who want to do
nature therapy,
connected with that. And so for some clients
who want to do nature therapy, walking and
being out in nature as a part of
the therapeutic process, that's available.
So on psychology today, if you look up
Lisa Yeager in Bellingham, Washington, you can find
(53:59):
me there.
And
then our ketamine clinic is the Bellingham
Ketamine Clinic, and I'm there offering
ketamine assisted therapy.
Excellent. And then lastly,
my colleague and I are also now offering
trainings for clinicians who want to learn more
about ketamine,
want to have a ketamine experience as part
(54:21):
of the training.
And so
that is another offering that we're putting out
there into the world.
Wonderful. And we're hoping to hoping to broaden
that out. Maybe at some point, trying to
collaborate with
some mindfulness instructors, because we've had some experiences
with clients who are doing mindfulness practices that
(54:42):
in combination with the ketamine therapy can be
really beneficial.
So that's something that we're brainstorming about of
how we can combine some mindfulness practices with,
ketamine experiences.
And we're also thinking about how we could
offer
ketamine,
experiences and support to
caregivers
and hospice staff, recognizing
(55:03):
that
hospice staff experience levels of burnout
and how could a ketamine experience be a
way to help them reset a little bit
and get some support?
Are you on social media?
Do you have a social media platform? We're
on Facebook, but
not not on on any of the other
(55:24):
platforms.
What's your Facebook username?
You know, we don't actually have one for
our Ketamine clinic. We're sort of,
not super
social media engaged.
We do have to get that way if
you wanna start training people. That's true. Yeah.
True.
(55:44):
We'll get you there, Lisa.
Yeah. Thank you. So much for coming on
with us today. On. Thank you for having
me. It's been a pleasure to chat with
you both.
Yeah. Thank you.
So when I was doing acid back in
the eighties,
never did it cross my mind that
potentially that that type of drug could be
(56:06):
used in the future for therapy for people.
And, wow, have we come a long way.
Yeah. And so much further to go. Oh,
yeah. I was gonna say it'd be great
if we could go even further and make
it legal and, you know,
I think it sounds,
really interesting and could really help a lot
of people.
Well, I think fascinating.
(56:26):
We really didn't have I mean, we there's
so much to know, and Lisa is just
this wealth of knowledge of the history of
it and what that looks like, but I
think
it's helpful for folks to know
what that actual experience is. I went through
the ketamine process
twice. I went through it with the oral
lozenges and with the inner muscular,
(56:48):
and
I have those documented. I don't talk about
my other podcast that I have not updated
first since we started this one. But if
you really wanna hear about it,
you can go to someday we'll all be
dead. It's on all the podcast platforms.
And I do have a a documented
2 part series about our psychedelic
experiences with Ketamine.
(57:10):
It
it is, yeah. Some some of us had
not very much of an experience, and some
of us had life changing
world healing
connections
with everything
experiences.
Wow.
So, yeah, it it was really amazing. And
that's when, you know, one of the reasons
we've all stayed connected, I think, is
(57:31):
not only did it help us personally, but
also helped connect us as clinicians together,
and we've stayed connected in that way because
we have this bond now.
Wow. You know? And we didn't really talk
a whole lot about the benefit for hospice
patients. We talked about it a little bit
offline.
But, you know, being able to address
(57:52):
people's fear and anxiety, especially when they first
get that terminal diagnosis, could make for such
a better
death experience for them and for their family
if they could go through this,
ketamine assisted
therapy and really Yeah. Upstream would be amazing.
Yeah. Because we see so many people, not
(58:13):
so many, but we see
enough people who have terminal agitation due to
existential
suffering
Mhmm. That we sometimes end up having to
sedate until their death. And how much better
would it be if we could let them
work through
whatever it is that's really troubling them so
that they could have a a peaceful death
and go
(58:34):
without having the the burden of whatever it
is that's distressing them on their heart and
on their mind.
And it really I mean, the studies that
have been done have shown,
you know, a reduction in
death anxiety. So we're specifically talking about not
just
healing of depression or healing of trauma, which
absolutely
can lead to this terminal agitation that we
(58:55):
see, but also just general death anxiety. What
is it gonna be like when I die?
You know? I'm I'm afraid of what's gonna
happen or actually going through the death process.
And it really has been shown
statistically significantly
to reduce the anxiety around that. And so
then by the time they get to that
end of life, last 6 months hospice experience,
(59:16):
then they can be focusing on what's important
and not worrying about their anxiety management, which
is gonna make them sleepier because then they're
on more meds.
Right. Exactly.
Exactly. Yeah.
Long way to go, but I'm glad we've
started it, and I'm glad we've opened up
the conversation. So Yeah. Me too. Baby steps.
(59:36):
Yeah.
Well, in the meantime, look. If you're gonna
listen to this out there and think that
ketamine or MDMA or Ayahuasca,
which we didn't really talk about because it's
definitely not legal here, but I
cannot imagine myself puking my guts out for
days.
If you're gonna go explore that, make sure
that you're doing the research, that you're not
(59:56):
just going to
freaking Joe Schmo down the road. And just
because insurance pays for it doesn't mean it's
the best option.
Right. Right. Good lord.
And until then, remember to live because someday
we'll all be dead.
He had a powerful,
experience
with his father within that ketamine experience. And
it brought a whole another level of healing
and he came out of it saying, I
had no idea that that was there still.
I had no I, idea, and it was
really profound for him.
(00:24):
Welcome to the death happens podcast, an insider's
guide to dying.
We're your insiders. I'm hospice nurse Penny. And
I'm Hallie, hospice social worker.
Today, we have Lisa Yeager. She is a
psychedelic assisted
psychotherapist, and we're gonna get into what all
that means in a minute. But first, since
we're talking about drugs,
(00:45):
I would love, Penny, for you to tell
us a bit more about the medications that
we use in hospice and specifically the medications
that we use that have illicit street drug
use that really freak people out.
Right, so
first of all let's talk about the comfort
kit because the comfort kit has morphine in
it. It also has lorazepam
(01:07):
and haldol and that's pretty standard across the
country. Most hospice agencies have at least those
3 drugs in their comfort kit and interestingly
now the morphine of course gets the bad
rap all of the time. People think we
give morphine to end people's life
and morphine
actually is less potent milligram per milligram than
(01:29):
oxycodone which is what is in Percocet.
But the other one that's kind of interesting
is the haloperidol because haloperidol
is an antipsychotic
medication
and we use it for other purposes in
hospice. We use it for nausea and vomiting.
It is like one of the best. It's
my favorite for nausea and vomiting.
We use it for hallucinations
(01:50):
if patients are hallucinating.
We use it for agitation. It works very,
very well. But people
are very concerned when they hear we're using
haloperidol if they do any kind of research,
and they're like, oh, that's for schizophrenia.
That's you know, it's stigmatized because it's an
antipsychotic
medication. It's a side drug, and so people
worry about that. And in fact, when we
(02:11):
have patients who are in nursing homes,
it's very challenging for us because they
are not now in the state of Washington
allowed to use haloperidol
unless the doctor is seeing the patient every
week. And so it's kind of a, you
know, real problem for our patients in nursing
homes.
But other drugs that we use that are
stigmatized
are methadone,
(02:32):
especially I I don't know how it is
in other states, but in the state of
Washington, methadone has been used for decades
decades decades decades,
as a replacement for heroin.
It's a way for people to get off
of heroin by going on the methadone replacement
program.
But methadone is a very good long acting
(02:53):
medication. It works very well for pain. It
works well for neuropathic
pain,
and we use it often. But, again, it's
a natural constipating, right, than other opioids?
Yeah. Less constipating,
and it's it's really effective. And it's a
liquid. It's it's con real con it comes
real concentrated so people can take it by
mouth even if they're having trouble swallowing.
(03:15):
And it can be given in a MACI
catheter. It can be injected. I've had a
person on a methadone infusion. It's a very,
very effective
drug for us to use, but it is
very much stigmatized.
Fentanyl is another one that is really stigmatized.
Fentanyl patches are very commonly used in hospice
because
(03:35):
if a person can't swallow,
slap a patch on them,
But it is now a street jug that
is killing a lot of people,
and so it's stigmatized.
Now one thing I will say about fentanyl
patches that is important for people to know
is that those patches are good for 3
days and you take it off and you
replace with a new patch. The patch that's
(03:57):
removed after 3 days still has Fentanyl in
it. And there have been situations where somebody
had a patch,
they did not dispose of it correctly or
slipped off the person's body, and a child
got a hold of it and actually has
caused the death of at least one child
that I read about that was exposed to
a fentanyl patch. So it's really,
(04:18):
important to be careful. People don't think of
a patch as being
a really potent medication, but it absolutely is
a potent medication that we use. And as
long as it's used safely,
medication that we use. And as long as
it's used safely, then we don't have to
worry about
the patients,
you know, being harmed from it. And I
think that's
kind of the important point to make here
(04:40):
is that when medications
are used in hospice,
they are prescribed by a medical provider and
we use them
safely.
The intent is never to cause harm to
the person or to cause them to die
faster.
It's meant to to relieve them of suffering
from their symptoms
by managing their symptoms, not by ending their
(05:02):
life.
Yeah. Don't we don't hasten. We don't hinder.
And the benefit of the hospice program, and
this is how I explain it to a
lot of folks, is we move a lot
faster to be able to control those symptoms
because we have access to our doctors and
our nurses, and
everybody's so involved, and you don't have to
wait a month to get in to see
(05:22):
your PCP to to get a refill.
Mhmm. We're also treating end of life symptoms,
and they require more management,
more medication.
And so you're seeing larger amounts as they're
going through their disease process, but it doesn't
mean we're doing it to off them sooner.
Right. We're not blasting them with those big
amounts to start with. We're ramping up as
(05:44):
we need to. And with cancer patients, oftentimes,
we have to ramp up pretty damn high
to control the kind of pain and suffering
that they can have. And the other thing
that's important about hospice, I've seen some comments
lately about people saying
that people that are dying should be able
to get the medications that they need and
the federal government is not allowing it blah
blah blah.
Hospices are not beholden to the same federal
(06:06):
laws around opioids.
We do not have to follow the same
laws that other
clinical practices have to follow.
We we have completely different laws complete not
not completely different laws, but but those laws
do not apply to us. Like, those limits
on medication guidelines.
Right. Exactly. Different restriction guidelines. Those laws, those
(06:29):
restrictions do not apply to hospice. We are
able to get the medications that our patients
need.
Unless,
and this is my devil advocate and you
already mentioned it, if we are in a
skilled nursing facility,
they have regulations that we then have to
work around with the facility to figure out
what they're able to give,
Assisted livings in particular, because they only have
(06:52):
med techs and not nurses,
this is something that's been a long time
struggle. It's not mainly me handling it. Obviously,
it's the nurse, but I've been part of
that conversation where we can't have PRN, which
is as needed, or we can't have
you know, it has the outline of the
as needed medications has to be extremely specific,
or they can't use liquid. They have to
(07:12):
crush a tablet because they're not able to
pull up a syringe and measure.
Yeah. I get it. I get it for
safety, but good lord.
Yeah. Yeah. It's a challenge for sure.
So it's just it's one more tiny component
of the reason to think about planning for
(07:33):
your end of life because there are things
you're not even gonna think about.
Just like with the lawyer, there are things
you you never know until you're in the
situation.
And then all of a sudden, oh, this
is why we can't do that or
may suggest don't understand
assisted living
maybe it's different in other states, but assisted
living facilities
(07:54):
in Washington
used to be
more assisted.
Like, there were more nurses that they provided
more assistance. It was closer to a skilled
nursing facility.
Whereas now,
an assisted living facility is
that people are walking, talking, living in their
(08:14):
apartment. They don't have a lot of assistance
from somebody else. So it's kind of changed
a little bit, and
it really isn't the best place for a
person to be at the end of their
life because they can't provide the care that
that person needs as they
become, you know, unable to care for themselves
anymore. We'll save that soapbox for another day.
(08:36):
Until then,
let's get to our guest.
Yes. Let's do it.
Yay, Lisa.
Thank you for coming out and being with
us. Welcome. You for inviting me. Of course.
Tell us a little bit about yourself.
My name is Lisa Yeager, and
I am from Virginia,
(08:57):
and I'm a member of the Nansemond
Indian Nation of Virginia.
I have a bachelor's in psychology,
from the University of Virginia
and a master's degree in social work from
San Jose State University.
I also have a certificate
degree,
from the California Institute of Integral Studies,
(09:19):
focusing on psychedelic therapy and research.
I am thrilled to pick your brain about
all the psychedelic
assisted therapies that you do or that you
work with. Me too.
I I wanna hear all about it.
Because full disclosure, I've done psychedelic therapy
off the record
for when I
(09:40):
was. I don't think you could necessarily call
it therapy,
but, definitely
back in the eighties, I participated in some
psychedelic
extracurricular
activities.
But that's, I'm sure, much different than what
you're gonna tell us about.
Probably. Maybe not. Maybe that's a good place
to go. Okay. What is the what is
the difference between
(10:01):
just doing recreational
well, first, let's back up. Let's tell the
people what do we mean by psychedelic and
psychedelic assisted therapy. Yeah.
Sure. So the classical
psychedelics
are LSD,
psilocybin,
otherwise known as magic mushrooms,
Ayahuasca,
MDMA,
(10:22):
sometimes known as ecstasy is not a traditional
psychedelic, but it can have psychedelic qualities.
Ketamine
also has psychedelic
qualities, but is not a traditional psychedelic. It's
a dissociative
anesthetic that has psychedelic qualities to it.
There's
many other ones, 5 MAO, DMT,
(10:44):
peyote, mescaline.
So they all
are substances,
medicines.
Some come from plants, some are chemical in
nature
that create a
altered state within the person where they are
experiencing
visual hallucinations.
They may be having auditory hallucinations.
(11:06):
They may have
mixing of sensations where they smell music or
they can feel music where their senses are
are kind of mixed. There's like a synergy
of the different senses that they have.
Well, I think we can all imagine why
people would use it recreationally,
but why would someone,
(11:27):
instead of just doing what would maybe be
traditional talk therapy, why might someone
venture into
psychedelic assisted psychotherapy
both as the therapist and as a patient?
Sure. For sure. Well, in
if we look back into history
for eons,
different cultures have ingested hallucinogens,
(11:51):
for
the benefit of their their village, their their
community,
and also for personal healing. So,
incorporating
psychedelics into
having a healthy village, having a healthy self
has really been a huge part of the
human experience.
(12:11):
And there are lots of different theories as
to how that initially
started. How did we,
originally
come to
know that a particular
medicine or a plant was going to have
those kind of properties.
And certainly in the Ayahuasca tradition,
the when Ayahuascaos,
the shamans who in Ayahuascaos,
(12:33):
the women and men who work with Ayahuasca,
when they're asked that question, they say the
plants told
us. So that there was there is this
belief within many indigenous cultures that plants, animals,
rocks can communicate with us.
So there's a long history of humans utilizing
psychedelics to
(12:54):
gain healing or insight answer, get questions answered.
And
so that has been a part of our
human experience.
Then in the late fifties, early 1960s,
there,
we started to have research where folks in
the lab were discovering by accident,
like Albert Hoffman discovering by accident that, oh,
(13:17):
the substance now that we know now know
as LSD has hallucinogenic
properties.
And that led other researchers like Gordon Wasson,
who is an ethnobotanist,
led him to go to,
Oaxaca in Mexico, and he met Maria Sabina,
who
is sort of
a matriarch
(13:37):
for many folks,
that she introduced the psilocybin mushrooms to Gordon
Wasson.
He then took that back to the states
that was eventually synthesized.
And the research started around that time of
wanting to explore how these psychedelics
could assist people who were struggling with depression,
(13:58):
who were struggling with anxiety
around end of life, who were maybe struggling
with,
drug or alcohol use that was,
more of an addiction. So the research the
researchers started to become curious as to whether
this
mind altering substance, any of these substances, could
be a benefit
(14:19):
for the different,
symptoms of distress that a person might be
struggling with. And so in the late fifties
early sixties, towards the late sixties, before the
FDA
rescheduled a lot of these medicines,
there were many, many research studies that were
going on in Europe, in the United States,
in Canada
that were showing pretty positive results that
(14:41):
one high dose psychedelic session in a supportive
environment
with what we call
a supportive set and setting. So set being
the mindset that the person is in and
the setting supportive environment with
therapist guides being with them, have the potential
to really help reduce symptoms of depression,
(15:03):
help reduce symptoms of anxiety around end of
life,
and also to help with,
addiction to alcohol and to drugs.
There are stories that
Bill w, who founded Alcoholics Anonymous,
part of his
journey towards recovery was having an LSD experience,
(15:25):
which really helped him and then led him
to formulate some of the 12 steps in
the program.
I can imagine a lot of people nowadays
are coming as patients
because they are resistant to traditional medications,
And there's been a lot of good studies
about that as far as, you know, especially
(15:46):
depression. I know I've seen some,
documentary
documentaries.
Wow.
Words are hard.
Documentaries
where they've talked about the use of different
types of psychedelics to help with resistant, treatment
resistant,
depression, PTSD, all of those kind of things.
(16:07):
So we we experienced
almost a complete stoppage of all of the
research when the FDA decided to make all
of these substances
schedule 1, meaning that there was not any,
medicinal healing benefit to them. So they all
were rescheduled into that realm, which put a
(16:29):
a halt to all of the research that
was going on. So we lost a huge
amount of time, but then the research started
resuming
in 2017,
2018,
looking again at how could these medicines help
with treatment resistant depression.
MAPS, the multidisciplinary
association for psychedelic studies
(16:51):
started their focus under the leadership of Rick
Doblin
to start studying MDMA
for the treatment of PTSD,
and that's really been
their focus.
So and their results, very high percentage,
of success with folks that were participating in
those studies
coming out of the study with a significant
(17:13):
reduction in their symptoms of PTSD.
Sorry, Penny. Just I'll let you go next.
I'm just thinking, I think a lot of
these I think I've heard you talk about,
Lisa, these a lot of these studies are
being done
until very recently outside of the United States
because of the class that they're the schedule
1 classification.
Right?
(17:34):
Not completely.
There is, it is possible to do the
research with a schedule
1 medication.
There are very
elaborate significant hoops that the researchers have to
go through,
to be able to do that research, but
it is possible.
So we've had pretty significant,
studies through Johns Hopkins,
(17:54):
through NYU,
UCLA.
UW
is now starting to do some research,
San Francisco. So there have been a number
of places in the states where we have
been seeing some really significant research, and in
Europe as well and in Canada. But it's
just an arduous process to get through the
(18:16):
IRB,
and the research all the all the steps
that you have to go through for a
schedule 1.
And for the research, they have to use
the synthetic
version of
whatever medicine that they are exploring because for
the research purposes, they have to be able
to
verify that the amount of the psychedelic medicine
(18:38):
is going to be the same in every
single dose, which
is not possible to do if you're ingesting
a mushroom that
has grown in the woods or grown in
someone's home that each one of those mushrooms
is gonna have a little bit of a
variation to how much of the medicine it
has.
Right.
(18:59):
I'm guessing that
the psychedelic
assisted therapy
is really truly different than recreational
use of l LSD
because you're saying that this therapy can actually
help people who have drug and alcohol addiction.
I did LSD,
like I said, in my teens. I'm
(19:22):
an alcoholic and was a drug addict, so
it didn't it didn't help me at all
in that regard. So so what exactly is
the difference between
just taking it on your own and the
therapy part of
of it in the
A huge part of it is the the
set and the setting. The set is the
(19:44):
mindset.
What is the person's intention of participating in
this kind of therapy?
If a person is ingesting a psychedelic in
a recreational setting,
their
intention is to have fun, have a whatever
their experience is, and they may be successful
in having fun, or they may be, they
may have a disturbing experience. We, we never
(20:06):
know. That's true in a supported psychedelic experience
too. But the difference is, is that when
a client is coming in either to a
research study or is working with a guide
or a therapist,
their goal is that they have some particular
intentions or aspirations
that they're coming in with, and they're coming
(20:26):
in with that in that intention. They're working
with the researchers or the therapist to,
really explore their intentions and their hopes for
the experience.
There's a lot of preparation that goes into
supporting that client before they even come in
to take the psychedelic medicine. And for many
(20:48):
of us, we feel that the preparation work
and then the integration work afterwards,
those are
as important, if not more important than the
actual psychedelic session. So it's really a difference
in the mindset
of the client and
there's, and the setting is also very different
where
(21:09):
things are very supportive,
for that client that's coming in for the
psychedelic session and the recreational
world. You know, person maybe is taking it
to right before they go to a concert.
And so
they're in a concert setting with many other
people.
And
in the research or working with a therapist,
(21:30):
there's a very safe, supportive environment that is
discussed and created with the client beforehand, before
they come in so that they understand
what the space is gonna be like, what
kind of support the therapist or guide can
offer,
how they're gonna be kept safe,
how they're gonna be supported.
So, it really is very, very different than
(21:52):
the recreational,
choice to,
to take a psychedelic versus having
a supported psychedelic session where someone is there
with you for that whole time, supporting you,
holding space,
and
helping to potentially navigate through
difficult arenas
(22:12):
that may come during the journey, that come
for the reason for healing. We say that
there aren't any
bad trips.
There are can be difficult moments within an
experience, but they're coming for a reason.
Well, I think that that talk about preparation
and the integration afterwards
is so vital of a conversation. Number 1,
(22:34):
because we're thinking about people that are coming
in to treat what could possibly be a
trauma event,
PTSD. And for veterans, that's really a big
push right now is to get that integrated
and and in work for PTSD.
And if they do have a
challenging experience in the middle of that session
(22:54):
that you have a trained professional there with
you,
and I really wanna mention that because of
these now that Ketamine because Ketamine is a
legal substance in the United States that
there are these Ketamine Clinics popping up now,
and they're not necessarily
clinics that have supportive therapy along with them.
So can you just differentiate that for the
(23:16):
listeners for people don't just go out and
pick the first available ketamine session that you
can get into?
There are reasons not to do that.
Yes. There definitely are reasons not to do
that.
Ketamine is,
in a different category. So it's a schedule
3 medication,
which means that it can be prescribed
(23:37):
by physicians,
for
a variety of different things. It's a dissociative
anesthetic, and it's often used
in military settings. They would use it out
on the,
out in in active wartime
where they could give pain medication
very quickly to get a soldier in to
be able to get treatment.
It's used in the emergency room setting really
(24:00):
quite frequently. That's where I first encountered it
when I was working as an ER social
worker.
And then it has this ability to be
a dissociative
anesthetic and psychedelic. And so we're using it
in an off label
method, which has been approved by the FDA.
But there are many
different ways that,
(24:21):
Ketamine can be administered.
So it comes in a sublingual
lozenge form that we can give that in
a tablet, which as Halle can remember,
does not taste very good.
Well, and chocolate raspberry flavoring
did not help. I don't think. Did not
help. No.
(24:42):
Yeah.
At our clinic here in Bellingham,
we, we experimented a little bit with different
flavors and kinda landed that mint is probably
the safest
bet that it so it's got that yucky
medicine taste with a little bit of mint
flavoring to it.
So there is the sublingual administration.
(25:03):
It can also be administered by a nurse
or a physician intramuscularly,
either into the bicep of the arm or
into the buttock.
It can also be
administered
by an infusion. So that requires a nurse
to a nurse or technician to start that
IV and give and administer it in an
infusion.
(25:23):
So there are big differences.
Some of the the infusion clinics
typically do not offer any kind of therapy
along with the the treatment that they're offering.
So the client comes in, they get an
assessment.
They come in, they get their their ketamine
treatment
via infusion, and
(25:44):
there isn't really any support,
therapeutic support that's offered to them during their
ketamine experience
and not really anything offered afterwards. They
are sort of left up it's up to
the
the client if they have a therapist that
they're working with on their own. And so
that can lead to some, you know, potentially
(26:07):
disturbing experiences
or something that's kind of disrupting their view
of the world.
And they don't really have the support in
place,
in many of the infusion clinics.
And that can be true, in in some
circumstances in the clinics that are just offering
intermuscular,
injections as well.
Myself
(26:27):
and the physician that I work with and
my therapist colleague, we were all trained to
provide ketamine assisted therapy. So it is
the combination of receiving the ketamine treatment and
receiving therapy. So they work with us for
preparation
counseling sessions to get them prepared and help
(26:47):
them to
hone in what their aspirations and hopes are
for the ketamine experience. And we also prepare
them for the fact that there could be
some
difficult aspects of the ketamine journey. And we
prepare them for that and say that this
is normal. This may happen. If it does
happen, it's not going to be,
(27:07):
a long experience. Everything is always changing within
the psychedelic experience, and then we're working with
them afterwards to help make sense of
what happened during their journey. And so in
our training,
we really believe that that's where the most
success can happen.
The most healing can happen is that they
have a supportive person that's
(27:29):
helping them with the preparation, is there with
them for their entire ketamine session, following up
with them afterwards, and then doing integration work
to help them make sense of what they
experienced.
It can be really important. And our goal
with ketamine assisted therapy is that the person
is gonna have enough of a reduction in
symptoms so that
(27:50):
they don't need to,
continue to have the Ketamine treatment, which is
a big difference between the Ketamine infusion clinics.
They're basically it's a maintenance program
where they're
it the sort of the expectation is that
the person is going to maybe they come
in twice a week for a little while,
then they taper to once a week, but
(28:11):
they're continuing to come in. There isn't really
the goal that the person is gonna have,
a full reduction in their symptoms that they're
gonna come in to have sort of a
maintenance.
So it's not that much different than taking
an antidepressant.
And is the purpose of the Ketamine infusion
clinics to address
mental
(28:31):
issues? Okay.
Because I'm thinking dosing must have
play into this somehow because we use Ketamine
at my hospice agency for pain management. We
use it IV and we use it orally.
My first experience
with giving a patient oral ketamine was in
a hospice care center, and it did not
go well,
(28:52):
because that patient and this was for pain,
but that patient experienced a lot of,
hallucinations,
and was very, very disturbed, and we had
to stop giving it.
So so dosing, like, do you are you
giving more? Are you doing microdosing? Like, what's
the difference in dosing when it comes to
treating pain so that you're not gonna get
(29:12):
these
hallucinations and things that that is actually kind
of the goal with the therapy. Right?
Is it more that you use or less
that you use? What's the difference there? The
sublingual
lozenges
are a little bit less in the dosage.
Our,
lozenges are a 100 milligrams,
and so we can incrementally go up,
(29:35):
with the dosage.
And the benefit of the lozenges is that
it has a,
gradual
coming on to the intensity. It takes about
30 minutes or 35 minutes
to get into that
peak ketamine experience, which is usually about 45
minutes long, and then there's a gradual coming
(29:56):
out of it.
And so that's all can be much more
gentle for clients to experience it with that
lower dose. They definitely can have a psychedelic
most of them have a psychedelic experience,
with the dosing that we use, but it's
a gradual going in and a gradual coming
out. Whereas with the intramuscular
injections that we offer,
(30:18):
the client is feeling the Ketamine and in
that space potentially within like 2 minutes.
So they're sort of launched into that deep
Ketamine experience very quickly,
and they're in the the deepest part of
that, and then they come out
more quickly.
And Penny, I'd say with you To speak
to your question, I know we when we've
used
(30:39):
Ketamine lozenges for pain in hospice,
it has been a much lower dose for
pain management closer to
the dissociative side,
for relief of their pain, but not necessarily
dissociative out of their body, which is closer
to the hallucinogenic
side. Right? Am I understanding that right? Right.
Right.
(31:00):
Right. And with the infusion
at the at the infusion clinics,
they they're using a dose where they can
have somewhat of a hallucinogenic
experience. They, I think, typically allocate about 2
hours for the person to be there to
get their infusion.
So they're using that sort of dosage, which
I I would agree with Hallie that for
(31:21):
pain, it's usually
a lower dose where we're trying to address
the pain without
creating that hallucinogenic
experience that
the client the patient might not be prepared
for.
Okay. Right. That makes sense. Yeah. And we're
doing a continuous infusion too. We're not doing,
like, a 2 hour blast. It's a continuous
(31:42):
Right. Probably low dose
infusion.
And it's important to, you know, talk with
clients about or patients about the fact that
they're could they could experience,
something hallucinogenic,
a psychedelic experience when they're getting ketamine for
pain to be able to prep them for
that. I've heard a story or 2 of
(32:04):
a woman in labor who was given Ketamine
because
of some aspect of her labor experience, and
she started to have a hallucinogenic
experience while in labor and was not prepared
for that. And it was very disturbing.
I think that's probably my my biggest worry
with the use of Ketamine in an ER
(32:24):
setting is people in a mental health crisis.
Ketamine does, intermuscularly,
like you said, work very, very quickly to
subdue someone, but it also can
exacerbate whatever psychotic break they're having.
Right. Exactly.
And when I was working as an ER
social worker, I
I was not aware. I don't know at
(32:45):
that time
if they were using,
ketamine,
on the ambulance
rigs,
because if they
if if it is a paramedic who can
administer medication, they can call into the ER
doc and get the order to be able
to give ketamine.
I don't know if they were doing that
(33:05):
one because that was back in, like, 95,
95
to almost 2,005.
But that in the more recent history, that
has been something that a paramedic out in
the field could give an get an order
to
administer Ketamine to someone who is having,
(33:27):
some sort of a mental health crisis,
and they get,
you know, injected with Ketamine without any kind
of warning. They don't know what's going on.
They're in a, you know, an ambulance rig
with really bright lights,
and it's most likely not gonna go very
well.
We used to give ketamine to cats
for spaying them, and they would go ballistic
(33:49):
when you gave them the injection.
My first the first time I ever heard
of Ketamine
was when there was a movie called Perfect
Victim, and it was about some guy that
was
administering
Ketamine to some women.
And then, you know, they were
showing you in the movie this dissociative state
(34:09):
that they had and,
and then he was, you know, raping them
and torturing them and and everything else. But
that was the first time I'd ever heard
about it and that it was a horse
tranquilizer.
So so then now when I worked in
the ER, we didn't
I would there was never a time when
I gave Ketamine, to a patient when I
and I only worked in the ER for
about 3 months, but so the first time
(34:30):
I ever heard about using it first on
cats was like, that's interesting because this is
a horse tranquilizer. But then when I worked
at the care center and and we got
the order to give it to the patient
orally, I was like, wait a minute. Isn't
this a horse tranquilizer?
So
but, yeah, I just always remember those cats
going crazy when we gave it to them.
So imagine Yeah. Probably has the same kind
(34:52):
of dissociative effect on them. Definitely. And my
first experience with Ketamine in the emergency room
setting was with a patient who had come
in and he was a roofer,
and he had gotten splattered with hot tar
all over his chest. Oh. And they needed
to,
you know, get the tar off,
and they didn't want to that was gonna
(35:14):
be excruciatingly
painful
to do without giving him some kind of
medication. And they gave him Ketamine,
and he was awake
and looking around, but totally dissociated.
And they didn't have to it doesn't suppress
the breathing, so they didn't have to worry
about him needing to be intubated.
He was dissociated
(35:36):
looking around.
They were able to get the the tar
pull the tar off of his skin. And
I sat with him afterwards, and I was
like, do you remember anything of what happened?
He was like, nope. Even though he was
awake, and and I've seen that with clients
that I'm offering ketamine assisted therapy to, that
sometimes they will
take off their eye cover. And
(35:56):
they are looking around, but they are not
seeing me. They are seeing something
Mhmm. Totally totally different.
Okay. So now you've piqued my interest with
the eye cover thing.
So when you're doing this ketamine assisted therapy,
are you blindfolding them?
It's, an eye cover.
(36:17):
We use we recommend something called the mind
fold, and
it
completely blocks out any light,
you but it has little,
cups so that you can open your eyes
completely,
but you're not seeing any light. And so
it's a it's an invitation for the client
to go inward, to have that inward experience.
(36:37):
And some people do
have those visionary states with Ketamine. It's not
quite as psychedelic as LSD or psilocybin
or Ayahuasca.
It really kind of varies from person to
person. Some people will see bright colors and
will see have visionary experiences. Other people, it's
more muted colors or grays,
(36:58):
and then some people don't have the the
colors and sights in that kind of way.
But having that eye cover on is an
invitation
to go inward and to not be distracted
by the things that are around them.
That makes sense because I can remember being
very distracted by a bag full of onions
in the basement when I
(37:19):
when I did LSD the first time.
Thought it looked like a monster.
Yeah. Yeah. Things look very different. I mean,
I I can remember one of my first
experiences
with
LSD, you know, coming back on public transportation
after seeing the grateful dead, which is sort
of the the door of entry for for
many people.
(37:40):
We were coming back on the BART train,
and the carpet was just fascinating
with all of the yeah. All the changes
and shapes and, yeah, how it was undulating
and yeah.
So
do you do other,
psychedelics
for your assisted therapy or just ketamine? Or
(38:00):
do you use IOSCA
or
LSD
or anything like that? Or is it all
strictly ketamine? And if so, why? Well, ketamine
is the only medicine that is legal to
administer to clients at
this point. So that's what we offer at
our clinic, here in Bellingham. That's called the
Bellingham Ketamine Clinic,
(38:21):
and that's what we're offering at this time.
We're hoping since all 3 of us at
our clinic,
we all went to the California Institute of
Integral Studies, so we're all trained to work
with,
psilocybin and MDMA.
Our hope is that we can expand to
those medicines once they get rescheduled.
And I think Oregon's working on something like
(38:43):
that. Right?
With
solar is yes. It's now legal. They passed
a law,
I think it was 3 years ago now,
and it took them they they took their
time in trying to get all of the
regulations and certifications
in process.
And so now they do have psychedelic centers
that offer psilocybin
(39:05):
to clients.
So it is possible,
to go have a a psilocybin session legally
in Oregon.
And you don't have to be an Oregon
resident
to be able to access that.
And then Colorado
has more recently passed a law legalizing
psilocybin therapy, and they're now in the process
(39:27):
of getting their regulations in process in in
place so that they can offer that legally
too. So it's legally within the state of
Oregon
and will be legal in Colorado,
but it's still federally illegal.
How how does that work?
The same as same as medical aid and
dying and
(39:47):
Yeah.
Pot? I guess so.
Mhmm. Mhmm. And if the federal government, you
know, chose the chose to focus on that,
they could come and shut down
those
treatment centers if they wanted to.
I am I imagine ketamine is a little
easier to work with on a therapy level
because it doesn't last as long either.
(40:09):
Mhmm. It's very true. So an LSD
session could be
12 hours, 10 to 12 hours long.
An MDMA session is usually around 8 hours,
depending on the person. A psilocybin session is
about 6 hours.
Ketamine
is we allocate 3 hours for our ketamine
sessions.
(40:30):
So that is it's easier on the client.
It doesn't interact with other medications in the
same way that other psychedelics
do.
So that's a benefit for working with someone
who
is struggling with depression and anxiety that they
don't have to taper off of their medications
typically,
to have a ketamine experience, and they can
(40:51):
still get the benefits from the ketamine.
And in working with clients who maybe are
on hospice or palliative care,
it's also a benefit that is a in
shorter duration. If you have a hospice patient
or a palliative care patient that is experiencing
anxiety,
that it's a, you know, an easier to
manage 3 hour session.
(41:13):
And it also
doesn't interact
poorly with some of the different medications that
someone on hospice or palliative care might be
taking.
The question I have is, so during the
session, when they're doing the
ketamine,
are you asking questions?
Are you talking to them? Or what what
(41:35):
kind of
therapy is happening as they are experiencing
their trip, if you will.
Our our approach is really to be nondirective,
that
our our goal is to be there,
participating
by,
(41:55):
being in the process
of doing by not doing. So we're holding
safe space for them.
We're there to offer support if they request
it, but we're also there not to intervene
in the process because we
feel, or at least I feel that there
is an intuitive healer within each client, and
(42:16):
this is an opportunity for that intuitive healer
to come forth and maybe have some conversation
with the ketamine.
My role is to offer that safe
container for them and
to then offer support if they request it,
but not to interrupt. So if they are,
if they're crying, I
allow them to have that emotional expression.
(42:40):
You know, I wait for them, and I
I coach them about that,
beforehand
of
this is your role to reach out to
me if you need support so that I'm
not interrupting
the process of what you're experiencing.
And a client will, you know, say, help.
You know, they can say something just as
simple as help or reach out their hand.
(43:01):
And so we talk in advance about what
kind of touch would be supportive and consensual.
So
can a hand on the shoulder for support
or if they reach out their hand and
like for me to hold their hand,
sometimes putting the hands on the bottom of
the client's feet for grounding.
So those are some of the things
that, I do in terms of offering support.
(43:24):
Some people are wanting to verbally process, and
when they start to verbally process, then I'm
taking notes for them, and I will
try to offer them support as they're processing
what they're sharing.
But I'm really following their lead in terms
of what they might might need during the
session.
So I'm guessing insurance doesn't cover this since
(43:45):
it's not a federally legal
program.
Is it expensive?
That's a tricky part, unfortunately.
We can bill insurance companies for
the prep and the integration sessions that we
offer using the standard
code for therapy.
(44:06):
But the ketamine sessions themselves that we offer
aren't covered by insurance. No insurance company is
covering
that kind of ketamine assisted therapy at this
point.
Interestingly,
the
infusion
clinics, they can bill insurance
for the type of infusion
that they're offering,
(44:28):
and they can also bill if they're offering,
which is
esketamine.
So it's Ketamine that has been
modified slightly in their in the molecular
structure, and so it's been patented by Johnson
and Johnson. And so
that is covered by insurance companies.
Yeah. So so what is the ketamine's
(44:50):
portion of the session cost
ballpark?
At our clinic, our we do offer a
sliding scale,
because we don't wanna turn anyone away.
And so our sliding scale is 350 to
550 for a ketamine session.
I I have so many soapbox
thoughts about insurances and what they will and
(45:10):
will not cover. So we're gonna we don't
have time for that.
Yeah. It's a I I share your your
sentiment and a it's just a it's a
whole different perspective of, do you want to
encourage a client to
be well and not need you anymore, or
do you want to encourage
maintenance on something that keeps them in the
(45:34):
the system?
Yeah. That's we all know the answer to
that. Right? Yeah. Keeps keep keep paying money.
So, you know, it's interesting because in Canada,
they have been
they keep pushing this law out. People think
it's active, but from what I understand, it
hasn't been yet that people can access medical
aid in dying for
depression.
(45:55):
And it seems like to me, like, why
wouldn't they instead
do with, you know, something like this that
that, you know, first or require this first
before
allowing somebody to, you know, legally,
end their own life because of depression
or or mental illness?
You know,
(46:15):
it seems like it it could be
another alternative to that.
And in Canada, they they do have
they have something called the right to try
in Canada.
And so there have been a number of
clients in Canada that have been able to
go through a whole application process
to be able to legally have
(46:36):
psilocybin assisted therapy. Mhmm. Initially,
they were they were clients who had a
terminal illness.
And my understanding,
I'm not a 100% sure, but my understanding
is I think they have had a couple
of clients who have gone through that process
who had treatment resistant depression as well, and
they were granted access to be able to
(46:58):
have supported psilocybin therapy.
So in Canada, they are they're trying.
I know you do individual sessions and group
sessions. Maybe you can speak a little bit
to the
benefit or not of either one and why
someone might do that in a group rather
than individually.
Well, the group sessions,
(47:19):
that's a great question. Thank you. The group
sessions
can lower the cost, so that's one benefit.
And there can be
an additional layer of healing that can come
in a group setting
where
there's a sort of a synergy that can
happen with the members of the group.
And there's also the benefit of the integration
(47:42):
work in a group setting afterwards,
where they're able to connect with other people
who are struggling
in similar ways to how they're struggling. And
that can be really helpful because we know
that mental illness is often very isolating.
So for those
those clients to be able to connect with
other people
(48:03):
and,
who share similar stories,
and then they can kinda support each other
through
the ups and downs of what they're experiencing.
And so there are benefits, I think, to
individual and group.
My
process is that I think it's important for
the person to have
1 or 2 individual sessions first,
(48:25):
before they consider going into a group experience.
I know you've worked in hospice bereavement as
well.
How do you feel about this,
psychedelic assisted therapy for grief
rather than, like, a treatment resistant mental illness?
Mhmm. Mhmm. I think that it can be
very powerful.
(48:45):
I think all of the psychedelics can be
could be very powerful in helping with
grief and anxiety.
And I believe that Ketamine is definitely one
of the tools that we can use.
I would say
probably 99%
of the clients that I have worked with
with Ketamine,
you know, they we all have experienced some
(49:07):
level of grief in our life.
And inevitably,
I would with 99.9%
of the clients at some point in their
Ketamine work grief comes up.
And then we we work with that, and
we look at that. Oftentimes,
there is
an opportunity
to maybe look at the relationship that they
had with their loved one in a different
(49:27):
way and maybe find some completion and acceptance
in a different way.
One, my name is my very first Ketamine
client when we very fur when we first
started. His,
father was deceased, and he had had a
complicated
relationship with his father.
And he felt like he, you know, was
okay
(49:47):
in being in a place of acceptance around
that. And in his very first ketamine session,
when she was coming in for depression,
he had a powerful,
experience
with his father within that ketamine experience. And
it brought a whole another level of healing,
and he came out of it saying, I
had no idea that that was there still.
I had no I and it was really
(50:08):
profound for him.
So I think there's a lot of potential
to be able to access Ketamine as a
as another tool to help people who are
experiencing grief.
I love that.
Well, I wanna be mindful of your time.
So in these last,
few minutes, is there anything that we haven't
(50:29):
covered?
I know we've pretty much been talking mostly
about ketamine, and that is because it's the
one legal use here.
But is there anything else that we haven't
covered that you want us to know about
psychedelic assisted therapy?
Well, I think to keep in mind that,
all of these psychedelics have huge healing potential
(50:51):
in the proper
setting where there is a safe container,
And there can be difficult experiences that can
come even in that safe container.
And with the proper amount of support, there
can be a lot of healing that can
come from that.
I can appreciate that. I'm gonna switch gears
(51:11):
real quick before we let you go, and
I'm gonna ask you our new season 2
coffin question.
What do you want to have done with
your body when you die?
That's a good question.
Because I think about that, doing this work
for as long as I've been doing this
work,
I think about that.
You know, I had initially,
(51:34):
for many years, I thought cremation was the
route that I wanted to go because it
was kind of simple and
okay. Box of ashes. Someone can decide what
to do with the box of ashes, but,
you know, as I think about that more
and more,
you know, the impact that that has on
the environment
leads me to be,
(51:54):
less inclined to that.
So green burial, I think, is the direction
I know. I have a friend who
has a funeral home, and he offers a
lot of different alternatives
in terms of the and
the human composting.
But green burial, I think, is what appeals
to me
the most,
(52:15):
you know, and there are a couple of
places
that you can do that.
Nice. So that that kind of appeals to
me. I would like to and I think
that that's connected with my indigenous roots that,
you know, my in my lineage originally,
you know, that's what would happen. We would
be
either
in my lineage, we would be buried in
(52:36):
the ground, and there would be and so
that's that really appeals to me. And I've
participated
in a couple of green burials, and they're
really beautiful
in terms of,
the ritual that can
be incorporated in that process.
So I would kinda like to go back
to the earth. And,
since I'm so connected with mushrooms, I would
(52:56):
like to you know, I would I love
the envision of the vision of my body
sometimes somehow being nutrients for mushrooms.
I like that.
Well, Lisa, where can people find you if
they wanna know more about ketamine,
or whatever else you're offering to the world?
(53:17):
Sure. Well, so I do have a private
practice,
and you can find me on psychology
today with my profile and
my private practice is focusing on
grief therapy,
depression, and
talk therapy, right, not Mhmm. Psycho. That's traditional.
So I offer traditional talk therapy.
(53:38):
I also am offering
nature therapy.
I have a geodesic dome
with trails that are connected with that. And
so for some clients who want to do
nature therapy,
connected with that. And so for some clients
who want to do nature therapy, walking and
being out in nature as a part of
the therapeutic process, that's available.
So on psychology today, if you look up
Lisa Yeager in Bellingham, Washington, you can find
(53:59):
me there.
And
then our ketamine clinic is the Bellingham
Ketamine Clinic, and I'm there offering
ketamine assisted therapy.
Excellent. And then lastly,
my colleague and I are also now offering
trainings for clinicians who want to learn more
about ketamine,
want to have a ketamine experience as part
(54:21):
of the training.
And so
that is another offering that we're putting out
there into the world.
Wonderful. And we're hoping to hoping to broaden
that out. Maybe at some point, trying to
collaborate with
some mindfulness instructors, because we've had some experiences
with clients who are doing mindfulness practices that
(54:42):
in combination with the ketamine therapy can be
really beneficial.
So that's something that we're brainstorming about of
how we can combine some mindfulness practices with,
ketamine experiences.
And we're also thinking about how we could
offer
ketamine,
experiences and support to
caregivers
and hospice staff, recognizing
(55:03):
that
hospice staff experience levels of burnout
and how could a ketamine experience be a
way to help them reset a little bit
and get some support?
Are you on social media?
Do you have a social media platform? We're
on Facebook, but
not not on on any of the other
(55:24):
platforms.
What's your Facebook username?
You know, we don't actually have one for
our Ketamine clinic. We're sort of,
not super
social media engaged.
We do have to get that way if
you wanna start training people. That's true. Yeah.
True.
(55:44):
We'll get you there, Lisa.
Yeah. Thank you. So much for coming on
with us today. On. Thank you for having
me. It's been a pleasure to chat with
you both.
Yeah. Thank you.
So when I was doing acid back in
the eighties,
never did it cross my mind that
potentially that that type of drug could be
(56:06):
used in the future for therapy for people.
And, wow, have we come a long way.
Yeah. And so much further to go. Oh,
yeah. I was gonna say it'd be great
if we could go even further and make
it legal and, you know,
I think it sounds,
really interesting and could really help a lot
of people.
Well, I think fascinating.
(56:26):
We really didn't have I mean, we there's
so much to know, and Lisa is just
this wealth of knowledge of the history of
it and what that looks like, but I
think
it's helpful for folks to know
what that actual experience is. I went through
the ketamine process
twice. I went through it with the oral
lozenges and with the inner muscular,
(56:48):
and
I have those documented. I don't talk about
my other podcast that I have not updated
first since we started this one. But if
you really wanna hear about it,
you can go to someday we'll all be
dead. It's on all the podcast platforms.
And I do have a a documented
2 part series about our psychedelic
experiences with Ketamine.
(57:10):
It
it is, yeah. Some some of us had
not very much of an experience, and some
of us had life changing
world healing
connections
with everything
experiences.
Wow.
So, yeah, it it was really amazing. And
that's when, you know, one of the reasons
we've all stayed connected, I think, is
(57:31):
not only did it help us personally, but
also helped connect us as clinicians together,
and we've stayed connected in that way because
we have this bond now.
Wow. You know? And we didn't really talk
a whole lot about the benefit for hospice
patients. We talked about it a little bit
offline.
But, you know, being able to address
(57:52):
people's fear and anxiety, especially when they first
get that terminal diagnosis, could make for such
a better
death experience for them and for their family
if they could go through this,
ketamine assisted
therapy and really Yeah. Upstream would be amazing.
Yeah. Because we see so many people, not
(58:13):
so many, but we see
enough people who have terminal agitation due to
existential
suffering
Mhmm. That we sometimes end up having to
sedate until their death. And how much better
would it be if we could let them
work through
whatever it is that's really troubling them so
that they could have a a peaceful death
and go
(58:34):
without having the the burden of whatever it
is that's distressing them on their heart and
on their mind.
And it really I mean, the studies that
have been done have shown,
you know, a reduction in
death anxiety. So we're specifically talking about not
just
healing of depression or healing of trauma, which
absolutely
can lead to this terminal agitation that we
(58:55):
see, but also just general death anxiety. What
is it gonna be like when I die?
You know? I'm I'm afraid of what's gonna
happen or actually going through the death process.
And it really has been shown
statistically significantly
to reduce the anxiety around that. And so
then by the time they get to that
end of life, last 6 months hospice experience,
(59:16):
then they can be focusing on what's important
and not worrying about their anxiety management, which
is gonna make them sleepier because then they're
on more meds.
Right. Exactly.
Exactly. Yeah.
Long way to go, but I'm glad we've
started it, and I'm glad we've opened up
the conversation. So Yeah. Me too. Baby steps.
(59:36):
Yeah.
Well, in the meantime, look. If you're gonna
listen to this out there and think that
ketamine or MDMA or Ayahuasca,
which we didn't really talk about because it's
definitely not legal here, but I
cannot imagine myself puking my guts out for
days.
If you're gonna go explore that, make sure
that you're doing the research, that you're not
(59:56):
just going to
freaking Joe Schmo down the road. And just
because insurance pays for it doesn't mean it's
the best option.
Right. Right. Good lord.
And until then, remember to live because someday
we'll all be dead.
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