February 15, 2024 • 30 mins
Ketamine has been making major headlines for the past few years! Is it good or is it bad? Is it a fad? Discover the story of ketamine, a drug that's resurging in popularity for pain control and a variety of mental health treatments. Join co-hosts, Dr. Maleeha Mohiuddin, Dr. Dionne Ibekie and guest Dr. Sean Gamble, an expert in pediatric anesthesiology and pain medicine, as we unravel the complexities of this anesthetic drug. From its controversial reputation as a party drug to its promise as a lifeline for those grappling with chronic pain and depression, we navigate the nuances of ketamine's therapeutic potential and pitfalls.
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Maleeha Mohiuddin (00:02):
Matthew Perry , Chrissy Teigen, Pete Davidson,
Sharon Osborn, Heath Ledger,Deon.
Do you know what all thesepeople have in common, like
aside from being celebrities?
Dionne Ibekie (00:17):
Um well, they are celebrities, but I know where
you're going with this.
They all have been in the newsfor using ketamine.
Maleeha Mohiuddin (00:25):
Ding, ding ding.
That is correct, dude.
I really need that doublejeopardy sound effect thing I
can insert.
But you're right, ketamine hasreally exploded onto the scene
this last few years and we hearit in mainstream news a lot.
Now it's kind of turned intothe new uh, michael Jackson
juice, you know, with Propofall.
Dionne Ibekie (00:47):
Exactly.
Um, we've been wanting to talkabout ketamine therapy for a
while now.
As anesthesiologists, it's nota new drug to use, or it's not a
new drug for us to use.
We use it a lot in theoperating room for pain control,
but it's making headlines nowfor helping people treat a broad
range of issues, from chronicpain to depression and even
(01:09):
treating suicidal thoughts.
Unfortunately, it's alsogetting a lot of negative,
negative press because ofsubstance abuse.
Maleeha Mohiuddin (01:18):
Yeah, and it's really an interesting topic
.
I mean, the range of conditionspeople are using ketamine for
outside the hospital settingseems to be growing and it's
definitely out of our scope ofpractice.
But that is why today we havean old friend of mine, dr Sean
Gamble, who is a board certifiedpediatric anesthesiologist and
(01:42):
pain medicine specialist who,lucky for me, practices right
here in town at PhoenixChildren's Hospital.
What makes Sean so unique isthat he spends a significant
amount of his clinical timetreating complex chronic pain
for children, adolescents andadults.
A lot of his patients strugglewith conditions like chronic
(02:02):
migraines, fibromyalgia,neuropathic pain conditions and
cancer associated pain.
So he really deals with a lot.
Dionne Ibekie (02:11):
Wow, we are really lucky to have you as an
expert guest today, anotherperson to break down the basics
of ketamine.
On today's episode, we're goingto discuss what exactly is
ketamine, what it's used for,the short and long term effects
of it, as well as the risks andpotential for addiction.
(02:31):
We are also going to discusswho is and isn't a good
candidate for ketamine therapy,as well as the right questions
to ask a clinic that providesketamine therapy if you're
considering trying it out, sojoin us.
We feel like we're about tolearn a lot.
Maleeha Mohiuddin (02:49):
This is the IV drip, a podcast designed to
give you the dish on healthtopics you need to know but
didn't know to ask.
We are your hosts.
Dionne Ibekie (03:00):
Dr Malia Mohideen and Dr Deanna Beckey, both
Harvard, train anesthesiologistsand besties.
Join us as we explore hottopics that are rarely discussed
but can have a huge impact onyour life.
Maleeha Mohiuddin (03:13):
Sean, thanks so much for being here with us.
I want to start off by askingyou what are your thoughts about
how ketamine is portrayed inthe media?
Sean Gamble (03:24):
Hi guys, thank you so much for having me.
First of all, it's a hugepleasure to be here and yeah, I
think the media and tabloids canjust be a dangerously biased
place to receive one's news.
It's really hard to combatmisinformation in the news.
Anything, when used in thecorrect setting and under proper
guidelines, can actually be asafe, potent and effective
(03:46):
therapy, especially in some ofthe most challenging cases that
we see.
I mean, the media's goal, afterall, is to sell papers right,
and our goal is to treatpatients with evidence-based
medicine.
Unfortunately, there's justalways going to be reckless
abuse of any substance with aside effect profile similar to
ketamine.
So I think it's important thatpeople do their own research and
make educated guesses whenassessments are being made,
(04:08):
especially about controversialtropics such as this come up in
the news.
Dionne Ibekie (04:12):
Yeah, that is so true.
Real research and results areso hard to do right now.
We're in an era of TikTok andInstagram experts, with people
making all kinds of claimswithout real studies to back
them up.
Sadly, a lot of people believethem.
Reminds me of how Propofall gotsuch a bad rep because of its
(04:34):
inappropriate use with MichaelJackson.
We all know about that.
But I think, before we get intothe side effects you alluded to
, can we pause and review thebasics.
What is ketamine?
Sean Gamble (04:46):
Absolutely.
I think there's no better placeto start.
Ketamine's a dissociativeanesthetic that can have
hallucinogenic effects.
Dissociative means that it canmake people feel detached from
reality and therefore thatthey're detached from their pain
and their surroundings.
It's not an opioid likefentanyl and it works on
different receptors called NMDAreceptors, and it's routinely
(05:09):
used to treat pain, among manyother things which we can get
into in a little bit.
It's actually been around for avery long time and,
unfortunately, it's also beenabused for a very long time.
Maleeha Mohiuddin (05:19):
Yeah, I mean, I could definitely see how that
would happen with any drug thatgives you hallucinations.
Sean Gamble (05:25):
Yeah, so you know, I think it's really interesting
for people to know that it'sactually been around since, you
know, the early 60s, followingthe development of Fensiclidine,
or PCP, in 1950s.
Ketamine, a similar drug, wasfirst developed in 62, while
researchers were attempting toproduce a new pain medicine To
(05:46):
would have properties similar toPCP.
In 1964, ketamine treatmentswere first tested on volunteer
prisoners right here in theUnited States.
Actually well.
Participants described feelingsof floating in outer space and
being disconnected from theirbodies at lower doses.
At higher doses, they describedmore feel-full experiences,
like feeling that they weredying.
Dionne Ibekie (06:07):
Dying yikes.
Even on our side will havepatients who have had bad trips
with ketamine and Ask us tonever give it again.
So just goes to show dosing iseverything.
Sean Gamble (06:17):
Totally Dion.
Dosing actually really doesmatter.
Basically, ketamine was foundto have many of the same
properties as PCP, but less ofthe bad side effects, and so it
was classified as a dissociativeanesthetic.
There was a lot of researchdone in France during the 70s
and one of the main side effectsfound was hallucinations, which
was considered desirable orundesirable rather for clinical
(06:41):
practice at that time.
In the US around the same time,the FDA approved ketamine's use
as a field anesthetic forsoldiers that were injured
during the Vietnam War.
But because of ketamine'sperceived abuse potential it's
psychedelic like symptoms andthe introductions of newer drugs
like propa fall, ketamine'susefulness actually fell out of
favor as a medical drug at thattime.
Maleeha Mohiuddin (07:02):
Yeah, that's really interesting to hear the
his the full historical contextof ketamine that you just gave.
I mean, I remember reviewingsome of that stuff in residency
but because that abuse potentialis high, you know the 70s, the
70s.
Dionne Ibekie (07:19):
I.
Maleeha Mohiuddin (07:20):
Mean recreationally.
It's well known street drugthat can be found in all forms
Swallowed as pills, or liquid,put into drinks, snorted, you
know, in powder form, injected,smoked.
I mean stuff that I have nevereven heard of.
It seems to be in and is prettyfast acting and unfortunately,
like most other drugs, they areOften abused with other drugs,
(07:45):
like multiple drugs, and makingit especially unsafe.
Dionne Ibekie (07:49):
Right poly substance abuse is very
dangerous and there's no safedose when used recreationally.
Repeat no safe dose when usedrecreationally.
Now, sean, you touched on thisa bit, but can you explain what
the short and long-term effectsof ketamine are?
Sean Gamble (08:06):
Absolutely yeah.
So some of the short-termeffects of ketamine are very
much dose dependent, as we'vealluded to.
When used under like thesupervision of a pain physician,
usually in the forms of a lowdose infusion, most of our
patients actually report no sideeffects at all other than pain
relief.
It can be particularly helpfulfor patients where we want to
avoid either using opioids orescalating opioids or decreasing
(08:31):
their current opioid use doserequirements, especially when
they've been chronically exposedsure, and you know, we've
talked about Methods to decreaseopioids in a prior episode.
Maleeha Mohiuddin (08:42):
We've done Dion.
We talked about multimodal paincontrol and this idea that we
can treat pain using acombination of drugs that works
synergistically together,meaning when combined, when the
forces are combined, the resultsare better Than just using
things one by one.
So basically, you know thereare a lot of tools in the
(09:02):
toolkit and we don't have tojust use opioids or narcotics
for pain control.
In fact, that can be a very badthing.
Sean Gamble (09:10):
You're exactly right and to your point.
We often use small doses ofketamine to augment the effects
of other pain medications thatthey receive, like opioids.
This actually improves theirefficacy without having to
increase the doses of thosemedications themselves.
Most of the other short-termeffects from like low dose
therapy include symptoms ofincreased salivation or
(09:32):
secretions.
People report confusion, lossof motor coordination, some
dizziness, nausea, headaches oreven vomiting, but usually these
are mild and they can betolerated or treated while on a
therapy, especially in theinpatient setting.
However, you know, as weincrease the doses, patients do
start to report different rangesof symptoms and these often
(09:54):
start with a mild or pleasantvisual and auditory
hallucination.
They the dreams or feelings offloating feeling of leaving one
body, for example, has also beenreported to us.
But as we progress, the dosegets elevated and the
hallucinations can become morescary.
Folks develop anxiety, theydevelop elevated heart rate and
(10:14):
palpitations and even theirblood pressure goes up.
They start to sweat and theyget a feeling of dread or dying
at extremely high dosesEventually, if the doses are too
high.
People have reported feelinglike being trapped in a
dissociative out-of-bodyexperience where they perceive
themselves as being Overcome bylike a vortex of death, as one
(10:36):
patient has been described.
It to me Wow.
Dionne Ibekie (10:39):
Yeah, so.
Sean Gamble (10:40):
Some people, you know they may have heard this
feeling called like a k-hole insome of like literature or in on
the news.
It sounds horribly unpleasant,but clinically we just never see
that because we never escalateto the dose of To the level
right where patients areexperiencing those sort of side
effects.
So you know, thankfully, as wepreviously stated in, it's also
(11:03):
a short-acting drug andtherefore these effects tend to
wear off pretty rapidly.
So when the dose is lowered orthe drug is stopped, patients
negative symptoms resolve quitequickly.
Dionne Ibekie (11:13):
And that's a very good thing, because I can tell
you, k-hole is not somethingthat I've heard of or
encountered, and I'm so gladthat I haven't.
But anyways, dear I ask whatare the long-term effects of
ketamine for our audience?
Sean Gamble (11:28):
Well, dionne.
Some of the long-term effectsare really poorly understood,
unfortunately, and it's becausethey haven't been exhaustively
studied.
One long-term risk that doesexist, however, is the potential
benefit or sorry, developmentrather of a substance abuse
disorder.
This is pretty well documented.
Chronic ketamine use is alsothought to lead to some degree
(11:49):
of physiological tolerance,where the body requires higher
and higher doses to achieve thesame level of effect, whatever
that may be, and dependence andwithdrawal syndrome is also
thought to occur when the drugis stopped.
This can make it reallydifficult for some abusers to
give up using this drug.
Dionne Ibekie (12:09):
Right Sure and for our audience when we say
withdrawal, we mean all thoseunpleasant side effects that
take over your body when youstop taking a drug.
What happens when you stoptaking ketamine after continued
use?
Sean Gamble (12:24):
Well, again, it's not perfectly understood, but
ketamine withdrawal syndrome caninclude symptoms of depression,
excessive sleepiness and thenreally strong cravings for
ketamine and just thedissociative state that it
causes.
Dionne Ibekie (12:39):
So what you just described emphasizes that there
is a possibility of addictionwith ketamine like other drugs.
Sean Gamble (12:46):
Oh yeah, that's right.
People can become, or peoplethat have used the drug for over
time and need higher doses toachieve the same effect, is
basically the definition ofdependence, and we call that
tolerance right.
While the full addictionpotential is poorly understood,
the drug does activate thedopaminergic pleasure reward
(13:08):
systems in the brain that areassociated with the development
of addiction, so it's reallysafe to assume that the risk is
significant and although it'snot an opioid, people can
overdose when they keepincreasing their dose, trying to
get those same effects, casingthe high, so to speak.
Maleeha Mohiuddin (13:27):
Right.
Sean Gamble (13:28):
So ketamine can be a real dangerous drug,
especially in a recreationalsetting.
It alters perception and itcauses a strong dissociated
state.
So you can imagine if it'smixed with other recreational
drugs this effect is amplifiedand therefore the risks of
accidents occurring while onketamine increase as well.
You know, we have also mostcertainly read about the recent
(13:52):
death of the friend star MatthewPerry and so and how it was
linked to the ketamine found inhis system.
So while it's highly unlikelythat ketamine directly caused
his death, one can certainlyspeculate how it might be that
his altered mental state and hisability to make safe decisions
for himself while on ketamineled to the level of inebriation
(14:14):
and sedation that may haveultimately claimed his life in
that jacuzzi.
Maleeha Mohiuddin (14:17):
Yeah, yeah, I mean anytime you're adding
water to the mix too.
Dionne Ibekie (14:22):
Dangerous combination, yeah totally yeah.
Not good.
Sean Gamble (14:25):
Really a sad story.
Maleeha Mohiuddin (14:26):
Sad story.
Okay, so there's definitely adark side to the chronic use of
ketamine that has to becarefully monitored.
However, are there certaindiagnosis where low dose therapy
under direct supervision of adoctor is beneficial, like where
have you seen this be mosthelpful in your patients that
(14:48):
you treat?
Sean Gamble (14:50):
Great questions.
The number one Sort of used forketamine can be helpful for
acute pain Meaning duringsurgery or under anesthesia, and
you guys are both probably veryfamiliar with this usage.
Yeah you know, we mentioned itearlier.
It is a drug that you and usedin combination with opioids, for
example, for multimodalanalgesia, with the goal being
(15:12):
to get pain under controlwithout overusing opioids.
Ketamine is extremely effectivein this.
The other benefit is that itcan be used in oral and nasal
preparations for acute playingfair, acute pain, flares from
sort of all other causes really.
So you know, while it'sattractive for abusers because
it can be inhaled, smoked, eaten, injected, it's attractive for
(15:35):
medical professionals too,because you can deliver it in so
many effective ways, especiallywhen patients don't have IV
access right.
So an example would include likea trauma patient, for example,
or a sickle cell patient whocomes into the ER setting
acutely with no intravenousaccess and they can't really
access opioids, one can deliverketamine in a short you know,
(15:57):
which is very short, acting bymultiple different mechanisms,
and achieve a relativelypredictable pain relief for
those folks within a few minutes.
Dionne Ibekie (16:06):
Oh yeah, we've been there the IM and the
intranasal injections,especially to get those
difficult IVs.
Ketamine is so handy.
Yeah, we've definitely used itmany, many times before
definitely.
Sean Gamble (16:21):
So you know, in chronic pain, ketamine is also
becoming interestingly andIncreasingly popular, and it's
used especially with thenational push to avoid opioids.
Right, we're on those pendulumswing right now and so we're
going the other direction ahundred percent, and so ketamine
becomes another helpful tool inour toolkit, and in theory, it
(16:43):
can be utilized in just aboutany scenario that one can think
of, at a safe and well tolerateddose, depending on the goals of
pain relief for that particularpatient, the only caveat being
that, unfortunately, compoundedketamine is rarely, if ever,
going to be covered by insurancepairs, so patients need to be
prepared to pay out of pocketfor this medication.
(17:03):
It comes in capsules, spraysand lozenges, and sometimes it's
compounded with additionalmedications, like low dose
benzodiazepines, for exampleVersed.
You know it's a drug we use allthe time.
Parapetrally, but it can becompounded with ketamine to
minimize some of the sideeffects that do occur at the
higher doses for patients whorequire that higher dose to
(17:26):
develop some efficacy from thedrug.
We you know this is especiallytrue in some of our cancer
patients or our patientsutilizing ketamine during
end-of-life therapies.
Maleeha Mohiuddin (17:36):
Yeah, that's a great point, you know, and I
feel like one of the reasonswe've been seeing an optic in
ketamine clinics like and Presscoverage Everywhere, is because
of the opioid crisis in ourcountry that you know.
That's Been big in the news andpeople are looking for
alternatives.
I think it's harder to getopioids now and.
(18:00):
It's yeah, and it's like thisold drug that's been hanging
around on formulary, that's likebeen around forever, is now
kind of making a resurgence or acomeback because of its Other
properties that are differentthan opioids.
Sean Gamble (18:15):
Absolutely, and you know it's.
It's accessible as well.
So as we try to avoid opioids,you know the ketamine becomes a
Approachable and accessiblealternative.
You know, depending on theclinical scenario and what the
goals are sure, Sure you knowplenty of your listeners may
have already heard in the newsas well about the benefits of
(18:37):
ketamine for treating refractorycases of depression.
And Well, just to be clear,refractory means you know when
depression has failed to betreated with all the first-line
medications and traditionaltherapies, so you can imagine,
in these very difficultsituations People are desperate
for an alternative, and there'sa really ever increasing amount
of data supporting the profoundEffects that ketamine can have
(19:00):
in a very short term period forthese particular cases.
In fact, ketamine has even beenshown to be the most effective
therapy for reversing acutesuicidal ideation.
I'm gonna pause there for asecond, because there's really
no other effective therapy forReversing acute suicidal
ideation.
So it's it's amazing, you know.
(19:21):
Property of the drug.
Dionne Ibekie (19:22):
That's amazing.
Sean Gamble (19:23):
It's also showing very promising results in
treating anxiety, ptsd and evenrefractory cases of bipolar
depression.
So some of the most challengingmental health disorders to you
know get a grasp on.
The mechanisms of how they workare really unclear at this
point and more research isneeded, especially in the
pediatric and adolescentpopulations.
Dionne Ibekie (19:44):
Wow, yeah, what you just described.
I mean it's really phenomenalbecause we are dealing with an
increase in mental health issuesOver the past few years,
especially with, you know, thepandemic that we just or are
still currently going through,and it's hard to find effective
and immediate treatment.
So you know this is great newsfor a lot of people to be
(20:05):
hearing, and I know many arehearing it for the first time.
So this is great.
Sean Gamble (20:10):
No, you're absolutely right, dione, and you
know, during the height of thepandemic, hospitals, pediatric
systems included, foundthemselves absolutely Absolutely
overwhelmed with cases ofdepressed and suicidal patients
in their emergency rooms.
I mean, I know a lot of thatyou guys saw, but we saw so much
of it and you know hospitalsnearly collapsed from the
(20:31):
pressures and the patients thatyou know Spent extremely long
amounts of time in their ERswaiting for open beds.
In fact, one of the excitingthings that we're kind of
starting to look at is in ourown pediatric patients.
I'm working with some of thepsychiatrists at Phoenix
Children's to develop a protocolwhen we're going to study the
(20:53):
use of ketamine in the emergencyroom setting to quickly
stabilize suicidal ideation inadolescence.
The hope is that when theybecome safe for discharge they
can go home or at least getimmediate relief while they wait
for inpatient beds to becomeavailable for them.
So it's it's exciting.
We're still on the cusp, sostay tuned, but it's exciting
(21:13):
stuff for us.
Maleeha Mohiuddin (21:14):
Yeah, that's really interesting.
I don't think I've ever Ihaven't heard of that, um, so
that that's.
I can't wait to see the datafrom that intervention, I mean
you and me both.
Yeah, it's so sad that thenumbers of depression and
suicidal ideation are climbingin adolescence.
Um, I can't even imagine,though, what that approval
(21:34):
process is gonna look like foryou or to get filing.
Sean Gamble (21:38):
Yeah, a lot of it is to be determined, but those
are the ideas that we're tossingaround.
Um, and you know I'm thankfuland blessed to be able to work
with folks that have this levelof creativity, and you know also
the let's say the bravery totry and answer some of these
tough questions, sure.
Dionne Ibekie (21:56):
Sure, yeah, we thank you for that work because
it's helping you know thesociety at large.
That's what we hope to do.
Sean Gamble (22:04):
Um, you know, and in terms of addiction, you know,
we talked ketamine itself as apotential drug of abuse.
It's becoming even more popularamongst the youth of today, so
hopefully we'll gain some accessto some data on that as well.
Dionne Ibekie (22:17):
Yeah, you know, it's an interesting concept.
Um, you know, we use Ketamineis a drug of abuse, but then we
also use it to treat addiction.
Yeah, yeah, that's a paradox.
Sean Gamble (22:30):
It is a paradox and we're a lot of paradoxes in
medicine, as you guys know.
Sure sure, and you know itsounds really counterintuitive,
but researchers are activelylooking into this and they're
looking at using dissociativeanesthetics at really low doses
in guided sessions, one on oneUm, to treat these severe opioid
(22:51):
and alcohol addiction cases inthe community.
And you know, the hope is thatthrough these guided sessions
the therapist can helpindividuals tackle their
substance abuse disorder from acore level and an introspective
position Um, others are alsostarting to use, you know, maybe
you've heard about this, butmescaline or magic mushrooms and
even lsd has been talked aboutrecently to try and accomplish
(23:15):
the same thing.
So, while the jury is verystill much out on this, you know
, and whether or not it's goingto become mainstream treatment
option, um, the initial data atleast is encouraging.
Dionne Ibekie (23:26):
That sounds like some Very interesting stuff.
Maleeha Mohiuddin (23:30):
I know 70s yeah.
Dionne Ibekie (23:38):
So it sounds like all of this is still in the
experimental phase, but it'll beinteresting to see you know the
published data on, it'sexciting stuff.
Um, we popped yeah yeah, I'mexcited and we talked a lot
about who could potentiallybenefit from ketamine therapy.
So now let's switch gears andtalk about who.
Who isn't a good candidate forketamine therapy.
Sean Gamble (24:00):
No, thanks, dion, because it really is important
to know out the gate who is nota good candidate.
Of course, this isn't going tobe a therapy for all comers, and
so right out the gate, I wouldsay, anyone with a history of
uncontrolled hypertension orwho's at an increased risk for
stroke for example, maybe theyhave elevated intracranial
pressure these people would notbe considered good candidates
(24:22):
for ketamine because they canexacerbate the blood pressure
and the intracranialhypertension, thus leading to a
stroke and a really poor outcome.
Again, it's definitely acase-by-case judgment call, so
there's going to be situationswhere risks do outweigh benefits
and benefits outweigh risks.
It's an individual conversationto be had between the physician
(24:42):
and the clinician at the timeketamine is being considered.
Really, I would say thatbecause there are people out
there who have refractory orreally difficult to treat pain
conditions, who have failedtraditional regimens, including
moderate to high-dose opioidtherapy.
Those individuals really needan alternative.
Maleeha Mohiuddin (25:02):
Okay, and suppose you suffer from chronic
pain or treatment-resistantdepression we mentioned earlier
and you're thinking, like one ofour listeners is thinking you
know, maybe I'll try thisoutpatient ketamine therapy,
there's a possibility it mightwork for me.
Let me take a shot.
What questions should they beasking a pain clinic?
(25:25):
What should they find out first?
Sean Gamble (25:28):
Right, yeah Well, I think the best questions to ask
depends very much on your goalsfor therapy.
You know it's important to findhealthcare providers who have
your best interests at heart aswell.
Unfortunately, there has been areally recent trend for clinics
to just pop up all over theplace offering almost miracle
cures and benefits of repeatedketamine infusions in exchange
(25:49):
for cash.
Maleeha Mohiuddin (25:50):
Okay.
Sean Gamble (25:50):
So be wary of those .
They're out there, like mostthings in this world.
Unfortunately, individuals havediscovered that ketamine
infusions can potentially be anenormously profitable business.
So you know, they and thosefolks don't actually seem to
care who they treat as long asthey can pay their fees.
So you have to be mindful ofthis and be cautious when you're
(26:11):
going to explore this as anoption for yourself.
Dionne Ibekie (26:14):
Yeah, that is very true.
We were seeing an uptick ofthat.
It's definitely takingadvantage of a very vulnerable
patient population.
People just want to feel betterand they want to feel better
fast.
So, even if it might not be theright thing for them, it's not
a one size fit all.
Sean Gamble (26:34):
Exactly, and for this reason, you know, I would
suggest that your listenersavoid the ketamine clinics
unless they have beenspecifically advised by a doctor
who knows their clinicalsituation well enough and has
worked with them to explore andexhaust all the more traditional
therapies before thisparticular option is considered.
You know, ketamine mayeventually become a first or
(26:54):
even a second or third linetherapy for folks, but for now,
in my humble opinion, it shouldonly be considered when all of
their treatments have beenexhausted and, you know, once
more data has been collected,this may change.
Dionne Ibekie (27:06):
In your expert opinion.
Maleeha Mohiuddin (27:11):
I appreciate that.
That is really honest advice.
We're not selling anything.
We want you guys to be verycareful and cautious and very
well put and explained.
So I really appreciate that.
Thank you, Sean.
We learned a lot today.
We learned a lot.
We covered a lot in a shortamount of time.
Dionne Ibekie (27:31):
This is great.
This is an awesome conversationyeah.
Sean Gamble (27:34):
We can go on for hours.
I know, I know we could exactly.
Maleeha Mohiuddin (27:37):
We might have to, depending on you, know
where this data goes of yours,but you know to our listeners
out there.
I hope you feel like you have abetter understanding of
ketamine, what it is, how itworks.
You know, and if you'reconsidering ketamine therapy,
take time to find a doctor.
You trust that will help youthrough this journey, because it
(28:00):
is a journey it is.
It requires expertise and youknow.
That ends today's segment formore IV drip.
Head to our website at the IVdripco or follow us on Instagram
at the IV drip underscorepodcast.
Email us your questions andcomments at info at the IV
(28:20):
dripco or send usa DM.
We love hearing from you all,so share with us your experience
, thank you, thank you.
Thank you for listening.
Really appreciate all thecomments and all the support.
Um, you know.
Most importantly, don't forgetto subscribe to our podcast.
You can find it on allstreaming platforms and leave us
(28:40):
a review and spread the love.
Dionne Ibekie (28:46):
Okay, guys, it's now time for our tip of the day.
Sean, can you take it away forus?
Sean Gamble (28:52):
Absolutely Well.
Once again, you guys, thank youfor having me.
Um, I just wanted to share withyour listeners that I think a
quick tip for anyone strugglingwith or trying to manage chronic
pain would be to remember that,in all things, medicine
included.
Fads come and fads go.
Uh, it really remains unclearat this time of ketamine is
going to be another fad, but youknow, pain continues to be the
(29:14):
single largest comorbidity,affecting more Americans than
heart disease, cancer and stroke.
Living today, and while chronicpain can make you feel isolated
or helpless or even hopeless attimes, it's really important to
remember the fact that you arenot alone out there.
Finding a caring and empatheticand qualified pain management
(29:35):
specialist who is committed toensuring you the best outcome
will assure that you don't walkthat path alone.
Dionne Ibekie (29:41):
That was really heartfelt, I love that I mean,
yeah, no we can tell yourpatients are lucky to have you
yes yes, thank you.
Sean Gamble (29:55):
I'm lucky to have them.
Honestly, yeah, thank you somuch.
Maleeha Mohiuddin (29:57):
Well, thank you guys for having me.
It was a blast.
Matthew Perry , Chrissy Teigen, Pete Davidson,
Sharon Osborn, Heath Ledger,Deon.
Do you know what all thesepeople have in common, like
aside from being celebrities?
Dionne Ibekie (00:17):
Um well, they are celebrities, but I know where
you're going with this.
They all have been in the newsfor using ketamine.
Maleeha Mohiuddin (00:25):
Ding, ding ding.
That is correct, dude.
I really need that doublejeopardy sound effect thing I
can insert.
But you're right, ketamine hasreally exploded onto the scene
this last few years and we hearit in mainstream news a lot.
Now it's kind of turned intothe new uh, michael Jackson
juice, you know, with Propofall.
Dionne Ibekie (00:47):
Exactly.
Um, we've been wanting to talkabout ketamine therapy for a
while now.
As anesthesiologists, it's nota new drug to use, or it's not a
new drug for us to use.
We use it a lot in theoperating room for pain control,
but it's making headlines nowfor helping people treat a broad
range of issues, from chronicpain to depression and even
(01:09):
treating suicidal thoughts.
Unfortunately, it's alsogetting a lot of negative,
negative press because ofsubstance abuse.
Maleeha Mohiuddin (01:18):
Yeah, and it's really an interesting topic
.
I mean, the range of conditionspeople are using ketamine for
outside the hospital settingseems to be growing and it's
definitely out of our scope ofpractice.
But that is why today we havean old friend of mine, dr Sean
Gamble, who is a board certifiedpediatric anesthesiologist and
(01:42):
pain medicine specialist who,lucky for me, practices right
here in town at PhoenixChildren's Hospital.
What makes Sean so unique isthat he spends a significant
amount of his clinical timetreating complex chronic pain
for children, adolescents andadults.
A lot of his patients strugglewith conditions like chronic
(02:02):
migraines, fibromyalgia,neuropathic pain conditions and
cancer associated pain.
So he really deals with a lot.
Dionne Ibekie (02:11):
Wow, we are really lucky to have you as an
expert guest today, anotherperson to break down the basics
of ketamine.
On today's episode, we're goingto discuss what exactly is
ketamine, what it's used for,the short and long term effects
of it, as well as the risks andpotential for addiction.
(02:31):
We are also going to discusswho is and isn't a good
candidate for ketamine therapy,as well as the right questions
to ask a clinic that providesketamine therapy if you're
considering trying it out, sojoin us.
We feel like we're about tolearn a lot.
Maleeha Mohiuddin (02:49):
This is the IV drip, a podcast designed to
give you the dish on healthtopics you need to know but
didn't know to ask.
We are your hosts.
Dionne Ibekie (03:00):
Dr Malia Mohideen and Dr Deanna Beckey, both
Harvard, train anesthesiologistsand besties.
Join us as we explore hottopics that are rarely discussed
but can have a huge impact onyour life.
Maleeha Mohiuddin (03:13):
Sean, thanks so much for being here with us.
I want to start off by askingyou what are your thoughts about
how ketamine is portrayed inthe media?
Sean Gamble (03:24):
Hi guys, thank you so much for having me.
First of all, it's a hugepleasure to be here and yeah, I
think the media and tabloids canjust be a dangerously biased
place to receive one's news.
It's really hard to combatmisinformation in the news.
Anything, when used in thecorrect setting and under proper
guidelines, can actually be asafe, potent and effective
(03:46):
therapy, especially in some ofthe most challenging cases that
we see.
I mean, the media's goal, afterall, is to sell papers right,
and our goal is to treatpatients with evidence-based
medicine.
Unfortunately, there's justalways going to be reckless
abuse of any substance with aside effect profile similar to
ketamine.
So I think it's important thatpeople do their own research and
make educated guesses whenassessments are being made,
(04:08):
especially about controversialtropics such as this come up in
the news.
Dionne Ibekie (04:12):
Yeah, that is so true.
Real research and results areso hard to do right now.
We're in an era of TikTok andInstagram experts, with people
making all kinds of claimswithout real studies to back
them up.
Sadly, a lot of people believethem.
Reminds me of how Propofall gotsuch a bad rep because of its
(04:34):
inappropriate use with MichaelJackson.
We all know about that.
But I think, before we get intothe side effects you alluded to
, can we pause and review thebasics.
What is ketamine?
Sean Gamble (04:46):
Absolutely.
I think there's no better placeto start.
Ketamine's a dissociativeanesthetic that can have
hallucinogenic effects.
Dissociative means that it canmake people feel detached from
reality and therefore thatthey're detached from their pain
and their surroundings.
It's not an opioid likefentanyl and it works on
different receptors called NMDAreceptors, and it's routinely
(05:09):
used to treat pain, among manyother things which we can get
into in a little bit.
It's actually been around for avery long time and,
unfortunately, it's also beenabused for a very long time.
Maleeha Mohiuddin (05:19):
Yeah, I mean, I could definitely see how that
would happen with any drug thatgives you hallucinations.
Sean Gamble (05:25):
Yeah, so you know, I think it's really interesting
for people to know that it'sactually been around since, you
know, the early 60s, followingthe development of Fensiclidine,
or PCP, in 1950s.
Ketamine, a similar drug, wasfirst developed in 62, while
researchers were attempting toproduce a new pain medicine To
(05:46):
would have properties similar toPCP.
In 1964, ketamine treatmentswere first tested on volunteer
prisoners right here in theUnited States.
Actually well.
Participants described feelingsof floating in outer space and
being disconnected from theirbodies at lower doses.
At higher doses, they describedmore feel-full experiences,
like feeling that they weredying.
Dionne Ibekie (06:07):
Dying yikes.
Even on our side will havepatients who have had bad trips
with ketamine and Ask us tonever give it again.
So just goes to show dosing iseverything.
Sean Gamble (06:17):
Totally Dion.
Dosing actually really doesmatter.
Basically, ketamine was foundto have many of the same
properties as PCP, but less ofthe bad side effects, and so it
was classified as a dissociativeanesthetic.
There was a lot of researchdone in France during the 70s
and one of the main side effectsfound was hallucinations, which
was considered desirable orundesirable rather for clinical
(06:41):
practice at that time.
In the US around the same time,the FDA approved ketamine's use
as a field anesthetic forsoldiers that were injured
during the Vietnam War.
But because of ketamine'sperceived abuse potential it's
psychedelic like symptoms andthe introductions of newer drugs
like propa fall, ketamine'susefulness actually fell out of
favor as a medical drug at thattime.
Maleeha Mohiuddin (07:02):
Yeah, that's really interesting to hear the
his the full historical contextof ketamine that you just gave.
I mean, I remember reviewingsome of that stuff in residency
but because that abuse potentialis high, you know the 70s, the
70s.
Dionne Ibekie (07:19):
I.
Maleeha Mohiuddin (07:20):
Mean recreationally.
It's well known street drugthat can be found in all forms
Swallowed as pills, or liquid,put into drinks, snorted, you
know, in powder form, injected,smoked.
I mean stuff that I have nevereven heard of.
It seems to be in and is prettyfast acting and unfortunately,
like most other drugs, they areOften abused with other drugs,
(07:45):
like multiple drugs, and makingit especially unsafe.
Dionne Ibekie (07:49):
Right poly substance abuse is very
dangerous and there's no safedose when used recreationally.
Repeat no safe dose when usedrecreationally.
Now, sean, you touched on thisa bit, but can you explain what
the short and long-term effectsof ketamine are?
Sean Gamble (08:06):
Absolutely yeah.
So some of the short-termeffects of ketamine are very
much dose dependent, as we'vealluded to.
When used under like thesupervision of a pain physician,
usually in the forms of a lowdose infusion, most of our
patients actually report no sideeffects at all other than pain
relief.
It can be particularly helpfulfor patients where we want to
avoid either using opioids orescalating opioids or decreasing
(08:31):
their current opioid use doserequirements, especially when
they've been chronically exposedsure, and you know, we've
talked about Methods to decreaseopioids in a prior episode.
Maleeha Mohiuddin (08:42):
We've done Dion.
We talked about multimodal paincontrol and this idea that we
can treat pain using acombination of drugs that works
synergistically together,meaning when combined, when the
forces are combined, the resultsare better Than just using
things one by one.
So basically, you know thereare a lot of tools in the
(09:02):
toolkit and we don't have tojust use opioids or narcotics
for pain control.
In fact, that can be a very badthing.
Sean Gamble (09:10):
You're exactly right and to your point.
We often use small doses ofketamine to augment the effects
of other pain medications thatthey receive, like opioids.
This actually improves theirefficacy without having to
increase the doses of thosemedications themselves.
Most of the other short-termeffects from like low dose
therapy include symptoms ofincreased salivation or
(09:32):
secretions.
People report confusion, lossof motor coordination, some
dizziness, nausea, headaches oreven vomiting, but usually these
are mild and they can betolerated or treated while on a
therapy, especially in theinpatient setting.
However, you know, as weincrease the doses, patients do
start to report different rangesof symptoms and these often
(09:54):
start with a mild or pleasantvisual and auditory
hallucination.
They the dreams or feelings offloating feeling of leaving one
body, for example, has also beenreported to us.
But as we progress, the dosegets elevated and the
hallucinations can become morescary.
Folks develop anxiety, theydevelop elevated heart rate and
(10:14):
palpitations and even theirblood pressure goes up.
They start to sweat and theyget a feeling of dread or dying
at extremely high dosesEventually, if the doses are too
high.
People have reported feelinglike being trapped in a
dissociative out-of-bodyexperience where they perceive
themselves as being Overcome bylike a vortex of death, as one
(10:36):
patient has been described.
It to me Wow.
Dionne Ibekie (10:39):
Yeah, so.
Sean Gamble (10:40):
Some people, you know they may have heard this
feeling called like a k-hole insome of like literature or in on
the news.
It sounds horribly unpleasant,but clinically we just never see
that because we never escalateto the dose of To the level
right where patients areexperiencing those sort of side
effects.
So you know, thankfully, as wepreviously stated in, it's also
(11:03):
a short-acting drug andtherefore these effects tend to
wear off pretty rapidly.
So when the dose is lowered orthe drug is stopped, patients
negative symptoms resolve quitequickly.
Dionne Ibekie (11:13):
And that's a very good thing, because I can tell
you, k-hole is not somethingthat I've heard of or
encountered, and I'm so gladthat I haven't.
But anyways, dear I ask whatare the long-term effects of
ketamine for our audience?
Sean Gamble (11:28):
Well, dionne.
Some of the long-term effectsare really poorly understood,
unfortunately, and it's becausethey haven't been exhaustively
studied.
One long-term risk that doesexist, however, is the potential
benefit or sorry, developmentrather of a substance abuse
disorder.
This is pretty well documented.
Chronic ketamine use is alsothought to lead to some degree
(11:49):
of physiological tolerance,where the body requires higher
and higher doses to achieve thesame level of effect, whatever
that may be, and dependence andwithdrawal syndrome is also
thought to occur when the drugis stopped.
This can make it reallydifficult for some abusers to
give up using this drug.
Dionne Ibekie (12:09):
Right Sure and for our audience when we say
withdrawal, we mean all thoseunpleasant side effects that
take over your body when youstop taking a drug.
What happens when you stoptaking ketamine after continued
use?
Sean Gamble (12:24):
Well, again, it's not perfectly understood, but
ketamine withdrawal syndrome caninclude symptoms of depression,
excessive sleepiness and thenreally strong cravings for
ketamine and just thedissociative state that it
causes.
Dionne Ibekie (12:39):
So what you just described emphasizes that there
is a possibility of addictionwith ketamine like other drugs.
Sean Gamble (12:46):
Oh yeah, that's right.
People can become, or peoplethat have used the drug for over
time and need higher doses toachieve the same effect, is
basically the definition ofdependence, and we call that
tolerance right.
While the full addictionpotential is poorly understood,
the drug does activate thedopaminergic pleasure reward
(13:08):
systems in the brain that areassociated with the development
of addiction, so it's reallysafe to assume that the risk is
significant and although it'snot an opioid, people can
overdose when they keepincreasing their dose, trying to
get those same effects, casingthe high, so to speak.
Maleeha Mohiuddin (13:27):
Right.
Sean Gamble (13:28):
So ketamine can be a real dangerous drug,
especially in a recreationalsetting.
It alters perception and itcauses a strong dissociated
state.
So you can imagine if it'smixed with other recreational
drugs this effect is amplifiedand therefore the risks of
accidents occurring while onketamine increase as well.
You know, we have also mostcertainly read about the recent
(13:52):
death of the friend star MatthewPerry and so and how it was
linked to the ketamine found inhis system.
So while it's highly unlikelythat ketamine directly caused
his death, one can certainlyspeculate how it might be that
his altered mental state and hisability to make safe decisions
for himself while on ketamineled to the level of inebriation
(14:14):
and sedation that may haveultimately claimed his life in
that jacuzzi.
Maleeha Mohiuddin (14:17):
Yeah, yeah, I mean anytime you're adding
water to the mix too.
Dionne Ibekie (14:22):
Dangerous combination, yeah totally yeah.
Not good.
Sean Gamble (14:25):
Really a sad story.
Maleeha Mohiuddin (14:26):
Sad story.
Okay, so there's definitely adark side to the chronic use of
ketamine that has to becarefully monitored.
However, are there certaindiagnosis where low dose therapy
under direct supervision of adoctor is beneficial, like where
have you seen this be mosthelpful in your patients that
(14:48):
you treat?
Sean Gamble (14:50):
Great questions.
The number one Sort of used forketamine can be helpful for
acute pain Meaning duringsurgery or under anesthesia, and
you guys are both probably veryfamiliar with this usage.
Yeah you know, we mentioned itearlier.
It is a drug that you and usedin combination with opioids, for
example, for multimodalanalgesia, with the goal being
(15:12):
to get pain under controlwithout overusing opioids.
Ketamine is extremely effectivein this.
The other benefit is that itcan be used in oral and nasal
preparations for acute playingfair, acute pain, flares from
sort of all other causes really.
So you know, while it'sattractive for abusers because
it can be inhaled, smoked, eaten, injected, it's attractive for
(15:35):
medical professionals too,because you can deliver it in so
many effective ways, especiallywhen patients don't have IV
access right.
So an example would include likea trauma patient, for example,
or a sickle cell patient whocomes into the ER setting
acutely with no intravenousaccess and they can't really
access opioids, one can deliverketamine in a short you know,
(15:57):
which is very short, acting bymultiple different mechanisms,
and achieve a relativelypredictable pain relief for
those folks within a few minutes.
Dionne Ibekie (16:06):
Oh yeah, we've been there the IM and the
intranasal injections,especially to get those
difficult IVs.
Ketamine is so handy.
Yeah, we've definitely used itmany, many times before
definitely.
Sean Gamble (16:21):
So you know, in chronic pain, ketamine is also
becoming interestingly andIncreasingly popular, and it's
used especially with thenational push to avoid opioids.
Right, we're on those pendulumswing right now and so we're
going the other direction ahundred percent, and so ketamine
becomes another helpful tool inour toolkit, and in theory, it
(16:43):
can be utilized in just aboutany scenario that one can think
of, at a safe and well tolerateddose, depending on the goals of
pain relief for that particularpatient, the only caveat being
that, unfortunately, compoundedketamine is rarely, if ever,
going to be covered by insurancepairs, so patients need to be
prepared to pay out of pocketfor this medication.
(17:03):
It comes in capsules, spraysand lozenges, and sometimes it's
compounded with additionalmedications, like low dose
benzodiazepines, for exampleVersed.
You know it's a drug we use allthe time.
Parapetrally, but it can becompounded with ketamine to
minimize some of the sideeffects that do occur at the
higher doses for patients whorequire that higher dose to
(17:26):
develop some efficacy from thedrug.
We you know this is especiallytrue in some of our cancer
patients or our patientsutilizing ketamine during
end-of-life therapies.
Maleeha Mohiuddin (17:36):
Yeah, that's a great point, you know, and I
feel like one of the reasonswe've been seeing an optic in
ketamine clinics like and Presscoverage Everywhere, is because
of the opioid crisis in ourcountry that you know.
That's Been big in the news andpeople are looking for
alternatives.
I think it's harder to getopioids now and.
(18:00):
It's yeah, and it's like thisold drug that's been hanging
around on formulary, that's likebeen around forever, is now
kind of making a resurgence or acomeback because of its Other
properties that are differentthan opioids.
Sean Gamble (18:15):
Absolutely, and you know it's.
It's accessible as well.
So as we try to avoid opioids,you know the ketamine becomes a
Approachable and accessiblealternative.
You know, depending on theclinical scenario and what the
goals are sure, Sure you knowplenty of your listeners may
have already heard in the newsas well about the benefits of
(18:37):
ketamine for treating refractorycases of depression.
And Well, just to be clear,refractory means you know when
depression has failed to betreated with all the first-line
medications and traditionaltherapies, so you can imagine,
in these very difficultsituations People are desperate
for an alternative, and there'sa really ever increasing amount
of data supporting the profoundEffects that ketamine can have
(19:00):
in a very short term period forthese particular cases.
In fact, ketamine has even beenshown to be the most effective
therapy for reversing acutesuicidal ideation.
I'm gonna pause there for asecond, because there's really
no other effective therapy forReversing acute suicidal
ideation.
So it's it's amazing, you know.
(19:21):
Property of the drug.
Dionne Ibekie (19:22):
That's amazing.
Sean Gamble (19:23):
It's also showing very promising results in
treating anxiety, ptsd and evenrefractory cases of bipolar
depression.
So some of the most challengingmental health disorders to you
know get a grasp on.
The mechanisms of how they workare really unclear at this
point and more research isneeded, especially in the
pediatric and adolescentpopulations.
Dionne Ibekie (19:44):
Wow, yeah, what you just described.
I mean it's really phenomenalbecause we are dealing with an
increase in mental health issuesOver the past few years,
especially with, you know, thepandemic that we just or are
still currently going through,and it's hard to find effective
and immediate treatment.
So you know this is great newsfor a lot of people to be
(20:05):
hearing, and I know many arehearing it for the first time.
So this is great.
Sean Gamble (20:10):
No, you're absolutely right, dione, and you
know, during the height of thepandemic, hospitals, pediatric
systems included, foundthemselves absolutely Absolutely
overwhelmed with cases ofdepressed and suicidal patients
in their emergency rooms.
I mean, I know a lot of thatyou guys saw, but we saw so much
of it and you know hospitalsnearly collapsed from the
(20:31):
pressures and the patients thatyou know Spent extremely long
amounts of time in their ERswaiting for open beds.
In fact, one of the excitingthings that we're kind of
starting to look at is in ourown pediatric patients.
I'm working with some of thepsychiatrists at Phoenix
Children's to develop a protocolwhen we're going to study the
(20:53):
use of ketamine in the emergencyroom setting to quickly
stabilize suicidal ideation inadolescence.
The hope is that when theybecome safe for discharge they
can go home or at least getimmediate relief while they wait
for inpatient beds to becomeavailable for them.
So it's it's exciting.
We're still on the cusp, sostay tuned, but it's exciting
(21:13):
stuff for us.
Maleeha Mohiuddin (21:14):
Yeah, that's really interesting.
I don't think I've ever Ihaven't heard of that, um, so
that that's.
I can't wait to see the datafrom that intervention, I mean
you and me both.
Yeah, it's so sad that thenumbers of depression and
suicidal ideation are climbingin adolescence.
Um, I can't even imagine,though, what that approval
(21:34):
process is gonna look like foryou or to get filing.
Sean Gamble (21:38):
Yeah, a lot of it is to be determined, but those
are the ideas that we're tossingaround.
Um, and you know I'm thankfuland blessed to be able to work
with folks that have this levelof creativity, and you know also
the let's say the bravery totry and answer some of these
tough questions, sure.
Dionne Ibekie (21:56):
Sure, yeah, we thank you for that work because
it's helping you know thesociety at large.
That's what we hope to do.
Sean Gamble (22:04):
Um, you know, and in terms of addiction, you know,
we talked ketamine itself as apotential drug of abuse.
It's becoming even more popularamongst the youth of today, so
hopefully we'll gain some accessto some data on that as well.
Dionne Ibekie (22:17):
Yeah, you know, it's an interesting concept.
Um, you know, we use Ketamineis a drug of abuse, but then we
also use it to treat addiction.
Yeah, yeah, that's a paradox.
Sean Gamble (22:30):
It is a paradox and we're a lot of paradoxes in
medicine, as you guys know.
Sure sure, and you know itsounds really counterintuitive,
but researchers are activelylooking into this and they're
looking at using dissociativeanesthetics at really low doses
in guided sessions, one on oneUm, to treat these severe opioid
(22:51):
and alcohol addiction cases inthe community.
And you know, the hope is thatthrough these guided sessions
the therapist can helpindividuals tackle their
substance abuse disorder from acore level and an introspective
position Um, others are alsostarting to use, you know, maybe
you've heard about this, butmescaline or magic mushrooms and
even lsd has been talked aboutrecently to try and accomplish
(23:15):
the same thing.
So, while the jury is verystill much out on this, you know
, and whether or not it's goingto become mainstream treatment
option, um, the initial data atleast is encouraging.
Dionne Ibekie (23:26):
That sounds like some Very interesting stuff.
Maleeha Mohiuddin (23:30):
I know 70s yeah.
Dionne Ibekie (23:38):
So it sounds like all of this is still in the
experimental phase, but it'll beinteresting to see you know the
published data on, it'sexciting stuff.
Um, we popped yeah yeah, I'mexcited and we talked a lot
about who could potentiallybenefit from ketamine therapy.
So now let's switch gears andtalk about who.
Who isn't a good candidate forketamine therapy.
Sean Gamble (24:00):
No, thanks, dion, because it really is important
to know out the gate who is nota good candidate.
Of course, this isn't going tobe a therapy for all comers, and
so right out the gate, I wouldsay, anyone with a history of
uncontrolled hypertension orwho's at an increased risk for
stroke for example, maybe theyhave elevated intracranial
pressure these people would notbe considered good candidates
(24:22):
for ketamine because they canexacerbate the blood pressure
and the intracranialhypertension, thus leading to a
stroke and a really poor outcome.
Again, it's definitely acase-by-case judgment call, so
there's going to be situationswhere risks do outweigh benefits
and benefits outweigh risks.
It's an individual conversationto be had between the physician
(24:42):
and the clinician at the timeketamine is being considered.
Really, I would say thatbecause there are people out
there who have refractory orreally difficult to treat pain
conditions, who have failedtraditional regimens, including
moderate to high-dose opioidtherapy.
Those individuals really needan alternative.
Maleeha Mohiuddin (25:02):
Okay, and suppose you suffer from chronic
pain or treatment-resistantdepression we mentioned earlier
and you're thinking, like one ofour listeners is thinking you
know, maybe I'll try thisoutpatient ketamine therapy,
there's a possibility it mightwork for me.
Let me take a shot.
What questions should they beasking a pain clinic?
(25:25):
What should they find out first?
Sean Gamble (25:28):
Right, yeah Well, I think the best questions to ask
depends very much on your goalsfor therapy.
You know it's important to findhealthcare providers who have
your best interests at heart aswell.
Unfortunately, there has been areally recent trend for clinics
to just pop up all over theplace offering almost miracle
cures and benefits of repeatedketamine infusions in exchange
(25:49):
for cash.
Maleeha Mohiuddin (25:50):
Okay.
Sean Gamble (25:50):
So be wary of those .
They're out there, like mostthings in this world.
Unfortunately, individuals havediscovered that ketamine
infusions can potentially be anenormously profitable business.
So you know, they and thosefolks don't actually seem to
care who they treat as long asthey can pay their fees.
So you have to be mindful ofthis and be cautious when you're
(26:11):
going to explore this as anoption for yourself.
Dionne Ibekie (26:14):
Yeah, that is very true.
We were seeing an uptick ofthat.
It's definitely takingadvantage of a very vulnerable
patient population.
People just want to feel betterand they want to feel better
fast.
So, even if it might not be theright thing for them, it's not
a one size fit all.
Sean Gamble (26:34):
Exactly, and for this reason, you know, I would
suggest that your listenersavoid the ketamine clinics
unless they have beenspecifically advised by a doctor
who knows their clinicalsituation well enough and has
worked with them to explore andexhaust all the more traditional
therapies before thisparticular option is considered.
You know, ketamine mayeventually become a first or
(26:54):
even a second or third linetherapy for folks, but for now,
in my humble opinion, it shouldonly be considered when all of
their treatments have beenexhausted and, you know, once
more data has been collected,this may change.
Dionne Ibekie (27:06):
In your expert opinion.
Maleeha Mohiuddin (27:11):
I appreciate that.
That is really honest advice.
We're not selling anything.
We want you guys to be verycareful and cautious and very
well put and explained.
So I really appreciate that.
Thank you, Sean.
We learned a lot today.
We learned a lot.
We covered a lot in a shortamount of time.
Dionne Ibekie (27:31):
This is great.
This is an awesome conversationyeah.
Sean Gamble (27:34):
We can go on for hours.
I know, I know we could exactly.
Maleeha Mohiuddin (27:37):
We might have to, depending on you, know
where this data goes of yours,but you know to our listeners
out there.
I hope you feel like you have abetter understanding of
ketamine, what it is, how itworks.
You know, and if you'reconsidering ketamine therapy,
take time to find a doctor.
You trust that will help youthrough this journey, because it
(28:00):
is a journey it is.
It requires expertise and youknow.
That ends today's segment formore IV drip.
Head to our website at the IVdripco or follow us on Instagram
at the IV drip underscorepodcast.
Email us your questions andcomments at info at the IV
(28:20):
dripco or send usa DM.
We love hearing from you all,so share with us your experience
, thank you, thank you.
Thank you for listening.
Really appreciate all thecomments and all the support.
Um, you know.
Most importantly, don't forgetto subscribe to our podcast.
You can find it on allstreaming platforms and leave us
(28:40):
a review and spread the love.
Dionne Ibekie (28:46):
Okay, guys, it's now time for our tip of the day.
Sean, can you take it away forus?
Sean Gamble (28:52):
Absolutely Well.
Once again, you guys, thank youfor having me.
Um, I just wanted to share withyour listeners that I think a
quick tip for anyone strugglingwith or trying to manage chronic
pain would be to remember that,in all things, medicine
included.
Fads come and fads go.
Uh, it really remains unclearat this time of ketamine is
going to be another fad, but youknow, pain continues to be the
(29:14):
single largest comorbidity,affecting more Americans than
heart disease, cancer and stroke.
Living today, and while chronicpain can make you feel isolated
or helpless or even hopeless attimes, it's really important to
remember the fact that you arenot alone out there.
Finding a caring and empatheticand qualified pain management
(29:35):
specialist who is committed toensuring you the best outcome
will assure that you don't walkthat path alone.
Dionne Ibekie (29:41):
That was really heartfelt, I love that I mean,
yeah, no we can tell yourpatients are lucky to have you
yes yes, thank you.
Sean Gamble (29:55):
I'm lucky to have them.
Honestly, yeah, thank you somuch.
Maleeha Mohiuddin (29:57):
Well, thank you guys for having me.
It was a blast.
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