Speaker 1: Welcome to the Therapy for Black Girls Podcast, a weekly
Speaker 1: conversation about mental health, personal development, and all the small
Speaker 1: decisions we can make to become the best possible versions
Speaker 1: of ourselves. I'm your host, Doctor Joy Harden Bradford, a
Speaker 1: licensed psychologist in Atlanta, Georgia. For more information or to
Speaker 1: find a therapist in your area, visit our website at
Speaker 1: Therapy for Blackgirls dot com. While I hope you love
Speaker 1: listening to and learning from the podcast, it is not
Speaker 1: meant to be a substitute for a relationship with a
Speaker 1: licensed mental health professional. Hey, y'all, thanks so much for
Speaker 1: joining me for session three twenty of the Therapy Black
Speaker 1: Girls Podcast. We'll get right into our conversation after a
Speaker 1: word from our sponsors. Which friend are you? And your
Speaker 1: sister circle? Are you the wallflower, the peacemaker, the firecracker
Speaker 1: or the leader? Take the quiz at Sisterhoodhels dot com
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Speaker 1: about how you can be a better friend and how
Speaker 1: your circle can do a better job of supporting you.
Speaker 1: Order yours today at Sisterhoodheels dot com. When you think
Speaker 1: of psychedelics, what comes to mind? Is it images of
Speaker 1: magical mushrooms and colorful hallucinations. Did you know that psychedelics
Speaker 1: are being used in the healthcare space to treat individuals
Speaker 1: who suffer from chronic pain, anxiety, and depression. To dive
Speaker 1: into the world of psychedelics in their medical utility, I'm
Speaker 1: joined by doctor Danielle Doyle, a double board certified in
Speaker 1: caesiologists and pain doctor dedicated to providing comprehensive and integrated wellness,
Speaker 1: psychedelic education and services for individuals dealing with chronic pain.
Speaker 1: Danielle is also the co founder of Culture Therapeutics, a
Speaker 1: specialized ketamine and psychedelic practice that offers comprehensive solutions for
Speaker 1: mental health and chronic pain to underresourced populations. In our conversation,
Speaker 1: doctor Doyle and I discussed how psychedelics such as ketamine
Speaker 1: are effective for patients who deal with chronic pain, how
Speaker 1: doctor Doyle and others are working to increase equity in
Speaker 1: psychedelic care, and how to discover if ketamine care is
Speaker 1: the right course of treatment for you. If something resonates
Speaker 1: with you while enjoying our conversation, please share with us
Speaker 1: on social media using the hashtag TVG in Session or
Speaker 1: join us over in the sister Circle to talk more
Speaker 1: about the episode. You can join us at community dot
Speaker 1: therapy for Blackgirls dot Com. Here's our conversation. Thank you
Speaker 1: so much for joining us today, doctor Doyle.
Speaker 2: Thank you for having me on, Doctor Joy.
Speaker 1: So I want to hear a little bit about your
Speaker 1: formal education in how you got introduced to the world
Speaker 1: of ketymines.
Speaker 2: Sure. So, I'm doctor Doyle and I'm a double board
Speaker 2: certified anesesiologist and pain doctor. I'm from the DC, Maryland area.
Speaker 2: I'm a proud Howard University graduate and I went to
Speaker 2: the University of Maryland for med school and I also
Speaker 2: went there for my Interventional Pain fellowship. And while I
Speaker 2: was there, I had one of the only black women
Speaker 2: as a fellowship director, doctor Thelma Wright, and I had
Speaker 2: an interest in Ketymine therapy and she encouraged me to
Speaker 2: study that for my fellowship project. And I saw how
Speaker 2: many people could get relief and benefit with Ketymine for
Speaker 2: pain management. As an anesthesiologist, I had used Ketymine in
Speaker 2: the operating room and I'd had patients for cover from
Speaker 2: catastrophic injuries and their pain was so well managed with ketymine,
Speaker 2: and it really left an impression upon me. And also
Speaker 2: I have an interest in health equity, and I wanted
Speaker 2: this medication and these sort of substances and medicines to
Speaker 2: be available for all people with our full consents and
Speaker 2: with our full permission. So most recently my role as
Speaker 2: an assistant professor in DC, and I helped teach residents, patients,
Speaker 2: and medical students about pain management and about ketamine care.
Speaker 2: And I helped run DC's most inclusive ketymine care program
Speaker 2: for the last several years and it was just amazing
Speaker 2: being able to help patients with pain and mental health
Speaker 2: in that way.
Speaker 1: So what is kenemine, doctor Doyle? And it feels like
Speaker 1: we are going to get into this, but it feels
Speaker 1: like there's a lot of misinformation about what it is
Speaker 1: and how it's used. But it's clearly something that has
Speaker 1: been used in medical settings. You're saying you've used it
Speaker 1: as a part of your work as an anesthesiologist. So
Speaker 1: what is ketamine and how is it traditionally used?
Speaker 2: Ketamine is a medication. It's considered what we call an
Speaker 2: anesthetic medication. So it was originally developed in the early
Speaker 2: nineteen sixties, so about sixty years ago. Ketamine is considered
Speaker 2: by the World Health Organization as an essential medicine, so
Speaker 2: that means that it's a medicine that they think every
Speaker 2: patient should have access to. And when they used it
Speaker 2: for anesthesia for humans and for animals, they noticed that
Speaker 2: patients were getting intense pain relief. And also along the
Speaker 2: way they noticed that it really helped with mental health
Speaker 2: and depression. And so now it's very common to use
Speaker 2: ketamine in the hospital to treat acute and sometimes chronic pain,
Speaker 2: and it's also being used more and more in the
Speaker 2: mental health setting to treat depression anxiety PTSD along with
Speaker 2: other mental health conditions.
Speaker 1: Got it and what kind of class of medicine is it?
Speaker 2: So it's a Schedule three medication legally, that means you
Speaker 2: need a prescription for the medicine. It is a medicine
Speaker 2: that is made in a lab. It's synthesized in a
Speaker 2: lab by chemists and experts, so that means that it's
Speaker 2: made in a very controlled way, So that means somebody
Speaker 2: comes in, there's a protocol on how to make it.
Speaker 2: They have a certain mixture of chemicals, there's a certain
Speaker 2: protocol that everyone's washing their hands, bottling the medicine in
Speaker 2: the same way, putting an expiration date on it, storing
Speaker 2: the medicine in a certain way, and then there's regulations
Speaker 2: on how the medication should be dispensed and used and
Speaker 2: also disposed of.
Speaker 1: Gut it okay, okay. So how does kenamine impact the body?
Speaker 2: So Kennybine can be taken into the body in several ways.
Speaker 2: I've prescribed it as a cream that patients can put
Speaker 2: on the skin if they have nerve pain. It can
Speaker 2: be used internasally through the nose for pain or for
Speaker 2: mental health. It can also be taken by mouth as
Speaker 2: a tablet or a pill. And it's most powerful, and
Speaker 2: the way that I prescribe it most commonly is through
Speaker 2: an iv or an intravenous route into the body. That's
Speaker 2: if you get blood drawn, or if you look and
Speaker 2: you see the veins in your hands, that means we
Speaker 2: put a little iv in and we give the medicine
Speaker 2: so it can flow through the body. When that ketamine
Speaker 2: hits your bloodstream, it is absorbed by the brain and
Speaker 2: by the spinal cord, and that is really where things
Speaker 2: start to get interesting. It works in the brain on
Speaker 2: a receptor called the NMDA receptor, and it causes a
Speaker 2: downflow effect that increases a substance called BDNF, or brain
Speaker 2: derived neurotrophic factor, and that factor helps kind of almost
Speaker 2: make some of the connections in the brain very malleable
Speaker 2: or changeable. And it means that for mental health and
Speaker 2: for pain, some of those processes in the body that
Speaker 2: are perceiving pain, that are perceiving the way you interpret
Speaker 2: your mental health or the way your body processes move
Speaker 2: it can help change those processes.
Speaker 1: Got it, And that is how you use it most often.
Speaker 1: And your work is with chronic pain.
Speaker 2: It's with chronic pain. There's a lot of overlap with
Speaker 2: chronic pain and depression and anxiety. So chronic pain is
Speaker 2: if you have pain for more than three to about
Speaker 2: six months. At that point, the pain can sometimes get
Speaker 2: almost ingrained into the nerves and into your nervous system.
Speaker 2: It's kind of like if you get a shirt with
Speaker 2: a stain on it. The longer it sits there, the
Speaker 2: harder it is to get out. The body treats chronic
Speaker 2: pain the same way. So if we're not able to
Speaker 2: treat and cure that pain immediately, and sometimes it can
Speaker 2: get harder and harder to treat. So I'll typically use
Speaker 2: ketamine for chronic pain, but most of my patients, unfortunately,
Speaker 2: once you get into that chronic pain setting, about seventy
Speaker 2: five percent of people will develop depressive and anxiety symptoms.
Speaker 1: You mentioned that you typically like to prescribe it intravenously
Speaker 1: as opposed to like appeal. Is there a peal form
Speaker 1: of ketamine?
Speaker 2: There is a pill form of ketamine, and ketamine can
Speaker 2: be made by a compounding pharmacy into a pill form.
Speaker 2: It's not a brand name medication. It's not an over
Speaker 2: the counter medication. So if your doctor even gives you
Speaker 2: a pill prescription and you walk into your average pharmacy,
Speaker 2: they probably won't have it. But it is made into
Speaker 2: a pill form by special compounding pharmacies, and I have
Speaker 2: used it for patients sometimes that use ketamine infusions, but
Speaker 2: the effects wear off after a few months. Sometimes I'll
Speaker 2: prescribe a ketamine by mouth or pill to take several
Speaker 2: times a week until they can get in for their
Speaker 2: next infusion. So I've used it a lot that way,
Speaker 2: but I've used it a little more in the infusion form.
Speaker 2: It's also available as an injected form, so we can
Speaker 2: just inject it into the muscle. And so that's another
Speaker 2: way that we can use ketamine as well.
Speaker 1: Got it okay? And who is typically going to be
Speaker 1: a good candidate for kenemi as treatment?
Speaker 2: So typically with ketamine therapies, we want someone that is
Speaker 2: not allergic to ketamine, no history of severe heart disease issues.
Speaker 2: That means no heart failure, no irregular heart rhythms, no
Speaker 2: severe kidney or liver disease. You don't want to be
Speaker 2: pregnant while you're taking ketamine. You want to make sure
Speaker 2: patients that have a history of psychosis or schizophrenia that
Speaker 2: you closely evaluate those patients for ketamine candidacy and will
Speaker 2: often collaborate with their psychiatrists or psychologists to make sure
Speaker 2: that that's a possible choice. Many times it may not be,
Speaker 2: and so you want to do a full medical screen
Speaker 2: before you introduce ketamine. But ideally the patient has a
Speaker 2: reason to use ketamine, meaning that they have a chronic
Speaker 2: pain syndrome like nerve pain. Things like diabetes or radiation
Speaker 2: therapy autoimmune diseases sometimes can increase risk for nerve pain,
Speaker 2: cancer related pain. I've used it for sickle sell related pain,
Speaker 2: pain after amputations, migraines, fibromyalgia, or mental health issues like
Speaker 2: depression or anxiety.
Speaker 1: So it doesn't sound like ketamine is necessarily like a
Speaker 1: first choice for pain, Like you may try a couple
Speaker 1: of things before you go to ketymene. Or would you
Speaker 1: start somebody at ketamine even on their initial appointment, not as.
Speaker 2: An initial therapy. I would hold off on using ketamine
Speaker 2: until the patient has tried traditional therapies. But you want
Speaker 2: to make sure that traditional therapies are tried carefully. So
Speaker 2: as an interventional pain doctor, I take a very multidisciplinary
Speaker 2: approach to pain management. So someone comes in, I want
Speaker 2: to ask them, have you tried physical therapy? What kind
Speaker 2: did you try? If you didn't like that kind, let
Speaker 2: me find you a kind that will better suit your needs.
Speaker 2: Have you tried medications? There are several classes of medicines
Speaker 2: that we often use for migraines, nerve pain, cancer pain.
Speaker 2: If you've tried them, were you on the correct dose
Speaker 2: for the correct amount of time to give it an
Speaker 2: adequate trial. Also, I've done a lot of interventional injections
Speaker 2: and implants for chronic pain syndromes, and I see if
Speaker 2: the patient wants something like that, or if they want
Speaker 2: to trial that, sometimes that can be effective too. So
Speaker 2: it's really having an open and honest dialogue with the
Speaker 2: patient to say, these are all the things that I
Speaker 2: can do to help treat your chronic pain, and you
Speaker 2: can kind of choose the things you're comfortable with, or
Speaker 2: if you're uncomfortable with something, let's have a conversation about
Speaker 2: maybe why you're uncomfortable, and then we work collaboratively to
Speaker 2: come up with the plan. And I may mention that, yes,
Speaker 2: we do have ketamine as an option, so we'll start
Speaker 2: with option A option b obstion C. But typically ketamine
Speaker 2: is reserved for patients that don't respond to traditional therapies.
Speaker 1: Got it, And the list of things that you shared
Speaker 1: when I who would be a good candidate and the
Speaker 1: kinds of things you're screening out for leads me to
Speaker 1: believe like this is a pretty strong medication, right, Like
Speaker 1: it sounds like there may be some heart impact, like
Speaker 1: kidney and so it sounds like it can be a
Speaker 1: pretty hard medication on the body.
Speaker 2: It depends. It's all dose dependent, so all substances can
Speaker 2: be dangerous if they're not used at the right dose
Speaker 2: with the right patient, with the right supervision. That's something
Speaker 2: I explained to patients when I have them undergoing anesthetic.
Speaker 2: Like many years ago, everybody was very scared of propofol
Speaker 2: because of everything that happened with Michael Jackson. Propofol is
Speaker 2: a wonderful medication. If you're giving me or my family
Speaker 2: member a general anesthetic, I would prefer you use that
Speaker 2: versus the alternatives. But when patients come to me with
Speaker 2: that concern, you really have to validate them and say,
Speaker 2: I understand why you would be apprehensive about using something
Speaker 2: like that, But because I know your medical history, I
Speaker 2: know exactly the dose to you, I know exactly how
Speaker 2: to monitor you, and how to treat any side effects
Speaker 2: of the medicine, we can come up with a plan
Speaker 2: that's going to be the safest for you.
Speaker 1: Got it more from our conversation after the break. So
Speaker 1: what do these sessions typically look like with a patient?
Speaker 1: Like if you're doing an infusion, what do the sessions
Speaker 1: look like?
Speaker 2: So it depends on the indication or the reason that
Speaker 2: we're doing the session. So in my new company that
Speaker 2: I've co founded, Culture Therapeutics, we're bringing safety, expertise and
Speaker 2: culture to the ketymine care experience, and so we want
Speaker 2: to have a setting that is conducive for all types
Speaker 2: of people to benefit from keteviine. So we pay a
Speaker 2: lot of attention to the setting where the patient is
Speaker 2: getting the infusion. So you want to meet with the
Speaker 2: patient beforehand, do a careful medical screening. You want to
Speaker 2: have a setting where the patient feels relaxed, feels comfortable
Speaker 2: and respected, and they know what to expect. Generally, if
Speaker 2: you're using ketamine for pain relief or for mood, we'll
Speaker 2: set an intention with the medication and we'll say this
Speaker 2: is what we can reasonably expect to happen. Do I
Speaker 2: have a particular therapeutic goal? Do you want to sleep better?
Speaker 2: Do you want to be able to walk a little
Speaker 2: bit further? Do you want to have more social interactions?
Speaker 2: Do you just want to be able to kind of
Speaker 2: sit and watch TV without as much pain? Because we
Speaker 2: have shown with ketamine that setting an intention can be
Speaker 2: very powerful. And then during the infusion itself, we try
Speaker 2: to have things around that are comforting to the patient,
Speaker 2: so we may provide call me music and music is
Speaker 2: very often personal and cultural in nature, so we make
Speaker 2: sure that that is something the patient can really benefit from.
Speaker 2: A lot of times when people think about psychedelics or
Speaker 2: ketamine therapies, they kind of imagine like more eurocentric euro
Speaker 2: American type music, Pink Floyd and things like that. But
Speaker 2: we use more traditional drum therapies, more R and B,
Speaker 2: more soul music for patients or whatever their preferences. And
Speaker 2: after the infusion, we have the patient do some after
Speaker 2: work and that means they kind of go back to
Speaker 2: that initial intention that they set and they start keeping
Speaker 2: track of their pain scores and their mood scores, especially
Speaker 2: for the first seventy two hours after a session.
Speaker 1: How long did the session last?
Speaker 2: It depends for mood. Usually the session will last forty
Speaker 2: five minutes to an hour. For chronic pain will often
Speaker 2: go up to three to four hours, And for chronic
Speaker 2: pain often our doses much higher.
Speaker 1: And is it kind of like you would if you
Speaker 1: were getting like a blood infusion, Like you're just laying
Speaker 1: there with the ivy and like letting the ketymene kind of.
Speaker 2: Drip exactly, so the ketemy would be given over an
Speaker 2: exact certain period of time through the ivy infusion. Like
Speaker 2: if you know anyone who gets iron infusion, or hydration
Speaker 2: infusion or if you know you're feeling dehydrated, and people
Speaker 2: will go and get IV hydration infusions. It infuses in
Speaker 2: over that time and then when it's done, you remove
Speaker 2: the IV, put a band aid on. The patient will
Speaker 2: be evaluated for about a half hour to an hour,
Speaker 2: and then they have someone take them home.
Speaker 1: Got it. And when you said for those like first
Speaker 1: seventy two hours after the session, are they kind of
Speaker 1: like journaling? Are they meeting with somebody every day? How
Speaker 1: does that work?
Speaker 2: So, depending on what their diagnosis is, they may have
Speaker 2: a meeting with their psychologists, they may do some afterwork
Speaker 2: and therapy workbook that we have for the patient. And
Speaker 2: it doesn't have to be an extensive set of homework.
Speaker 2: It's not meant to burden the patient, but it's really
Speaker 2: just taking some time during the day to think about
Speaker 2: what happened and to think about the therapeutic goals.
Speaker 1: Got it? And typically, how are people reporting feeling after sessions?
Speaker 1: Like what can someone expect after they've had a session.
Speaker 2: So the day of the infusion or the day of
Speaker 2: the session, you may have a little bit of grogginess.
Speaker 2: So we tell patients not to drive or to sign
Speaker 2: any contracts that day, and you may want to go
Speaker 2: home with someone with you, eat a light dinner or
Speaker 2: a light snack later in the day, be on the
Speaker 2: lookout for any nausea. Some people get a little bit
Speaker 2: of nausea with ketamine, but usually I would provide an
Speaker 2: anti nausea medicine to either go home with or take
Speaker 2: before they leave. And then patients usually report that they
Speaker 2: sleep very well that night because they're still a little
Speaker 2: bit sleepy, and over the next several days they really
Speaker 2: pretty much feel like back to baseline.
Speaker 1: Got it okay? And as they are getting the infusion,
Speaker 1: are you or someone else sitting there talking to them
Speaker 1: or is it kind of like a silent thing and
Speaker 1: they're just listening to like the music list that they
Speaker 1: may be prepared.
Speaker 2: Typically it's the music list they've prepared, so if they
Speaker 2: have depression or exactnciety or PTSD, sometimes we do provide
Speaker 2: additional guidance during the infusion itself. People can get varying
Speaker 2: levels of sedation with it, and sometimes getting stimulation or
Speaker 2: talking to them too much during it can be a
Speaker 2: bit too much, so I'll usually say make sure your
Speaker 2: morning's really calm. If you tend to be in an
Speaker 2: anxious state, will be with you. And if you feel
Speaker 2: a little anxious during the infusion, because sometimes it does
Speaker 2: cause a little bit of anxiety. Sometimes people might see
Speaker 2: really mild hallucinations. It can be a very vulnerable time
Speaker 2: for the patient. So if someone is feeling a little anxious,
Speaker 2: will evaluate them for an anti anxiety medication that they
Speaker 2: can receive, and we'll kind of just talk to them
Speaker 2: a little bit and we'll say, hey, doctor Doyle, I'm
Speaker 2: sitting right here with you. I'm feeling fine. You're in
Speaker 2: the office, you're safe, your vitals look perfect. Take a
Speaker 2: couple deep breaths, and if you're not feeling better in
Speaker 2: a minute or two, I'll give you an anti anxiety medicine.
Speaker 2: But you're doing great, And usually that works about ninety
Speaker 2: percent of the time.
Speaker 1: Okay, And how soon would they need another session? Like
Speaker 1: how long do you expect the impact to last?
Speaker 2: So at culture Therapeutics, we typically follow the best evidence
Speaker 2: treatment protocols. So for chronic pain, when I was a professor,
Speaker 2: we would do two to three sessions of a higher
Speaker 2: Joe's ketamine within a week and patients would get good reliefs.
Speaker 2: Sometimes for three to six months with that. For mental
Speaker 2: health conditions, the typical protocol is six sessions over about
Speaker 2: three weeks, and that can last up to six to
Speaker 2: twelve months depending on your response.
Speaker 1: Got it okay? So in your experience, have you noticed
Speaker 1: or observed a reluctance from black patients to trying ketamine.
Speaker 2: I think so, and I think it's justified distrust. I
Speaker 2: think being a doctor, especially a pain doctor especially, I've
Speaker 2: always worked in areas where I'm within my own community
Speaker 2: in DC, or in Baltimore or in Georgia, and so
Speaker 2: I think we do have to acknowledge that it's been
Speaker 2: a very fraught road for black people to deal with
Speaker 2: the medical system, and when it comes to things like
Speaker 2: pain and mental health, we have to really address it
Speaker 2: at the forefront. So at Culture Therapeutics and at my
Speaker 2: prior practice, we always have the idea that you have
Speaker 2: to get belief to get to relief. So it's that
Speaker 2: belief to relief pathway. It's hard to treat somebody for
Speaker 2: something if you don't believe them. So when I often
Speaker 2: sit with the patient, the first thing I do is
Speaker 2: I validate them, and I say, I know you're in pain.
Speaker 2: I know you didn't just get up this morning, put
Speaker 2: your clothes on, get your hair together, get on the metro,
Speaker 2: come to the office, wait, do all the paperwork, and
Speaker 2: then come in here because of nothing. I know something
Speaker 2: is going on. I'm going to be your partner in
Speaker 2: trying to figure out what is going on, and I
Speaker 2: can answer any questions that you have. A frequent question
Speaker 2: or concerned that I get is that a lot of
Speaker 2: Black people they don't want to be experimented on, which
Speaker 2: is very understandable given our history, like with the experiments
Speaker 2: that went on in Alabama with the Tuskegee Airman and
Speaker 2: just throughout our history in the United States. So I
Speaker 2: explained to them that this is the evidence that I have.
Speaker 2: No medication is perfect. No medication works for everyone one
Speaker 2: hundred percent, but there are things I can do to
Speaker 2: safeguard your care and monitor your care. And some patients
Speaker 2: may have a preference for more natural substances, and that's fine.
Speaker 2: You know, for a long time, I was one of
Speaker 2: the only providers in DC who would prescribe medical cannabis
Speaker 2: for paying patients, especially for patients with DC Medicaid or
Speaker 2: medical assistance. That company a lot of African American patients,
Speaker 2: and I think explaining kind of like I did before,
Speaker 2: that it's synthesized in the lab, and this is how
Speaker 2: it's made and this is how it gets to you.
Speaker 2: I think that can help a lot too, And just
Speaker 2: explaining it like I would explain it to any patient,
Speaker 2: and kind of taking the time to answer concerns.
Speaker 1: So why did you feel the need to work as
Speaker 1: a co founder in starting Culture Therapeutics, Like was there
Speaker 1: a concern that maybe black and brown communities were not
Speaker 1: getting this kind of care in other places?
Speaker 2: I think we are always at a disadvantage historically when
Speaker 2: it comes to access to medical care, especially to treatment
Speaker 2: resistant care, and so we face this double barrier where
Speaker 2: we have issues getting the additional therapies, and then if
Speaker 2: we may find that those don't work, then we have
Speaker 2: issues accessing alternative therapies. And we created Culture Therapeutics to
Speaker 2: kind of answer that question, to bring that safety and
Speaker 2: that expertise, and to demystify some of these medicines and
Speaker 2: to let people know that this is a part of
Speaker 2: our history kind of using medicines like this, This is
Speaker 2: not necessarily a white thing or an indigenous thing or
Speaker 2: anything like that. This is also an African thing. This
Speaker 2: is an African American thing, and we formed our practice
Speaker 2: as a love letter to our community because we want
Speaker 2: to make sure that we have a stake in these
Speaker 2: sort of therapies going forward.
Speaker 1: You know, I often hear this kind of stereotype that
Speaker 1: a lot of physicians, it seems, and other medical professionals
Speaker 1: have when they have black patients right about being medicine seeking, right,
Speaker 1: or even having higher thresholds of pain. Can you speak
Speaker 1: to that and maybe any of the work that you
Speaker 1: have to do around spelling some of those myths.
Speaker 2: So definitely, it's definitely a misconception that black patients are
Speaker 2: drug seeking. And I teach medical students and residents. I
Speaker 2: dissuade them from describing patients that way or writing that
Speaker 2: in a medical note, and to say, if they suspect
Speaker 2: someone has a substance use disorder, to ask them and
Speaker 2: discuss it with them in a frank nature. I educate
Speaker 2: everyone that people of color, black people do not have
Speaker 2: higher pain thresholds. We do not make up pain, and
Speaker 2: we do not have higher rates of addiction or substance
Speaker 2: use disorder. Actually, there's some studies that say our rates
Speaker 2: might be slightly lower than other groups, especially in North America,
Speaker 2: but it's definitely something that patients encounter when they are
Speaker 2: in the hospital setting many times unfortunately.
Speaker 1: M So, it does feel like there is like a
Speaker 1: renewed interest. It feels like maybe people were kind of
Speaker 1: using kenemine maybe years ago, I think specifically in more
Speaker 1: mental health kinds of spaces, and it feels like there's
Speaker 1: now a renewed interest, but also some pushback. Can you
Speaker 1: talk to me a little bit about what's going on
Speaker 1: generally in the field and like what is the field's
Speaker 1: reception to using ketamine for both mental health concerns and pain.
Speaker 2: So, I think right now it's kind of like a
Speaker 2: renaissance period for ketymine and for psychedelic care in the
Speaker 2: United States. A lot of these substances have been around
Speaker 2: for a very long time. Over the last five to
Speaker 2: ten years, you've seen more commercialization of ketymine use. You've
Speaker 2: seen more venture capitalists and larger corporations forming ketamine care
Speaker 2: companies and mailing ketymine out to patients for home use.
Speaker 2: And with the COVID era, there was actually the suspension
Speaker 2: of something called the Ryan Height Act, and the Ryan
Speaker 2: Height Act was something that was put forth about twenty
Speaker 2: years ago to decrease substance misuse from controlled substances, and
Speaker 2: so they put the DEA put certain rules in place,
Speaker 2: like you need to see the patient in person, you
Speaker 2: need to make sure that the patient has a condition
Speaker 2: that qualifies. And some of those rules were suspended briefly
Speaker 2: during the COVID period because you know, people couldn't get
Speaker 2: out of their homes. But now the emergency COVID period
Speaker 2: is being legally ended by the government. So a lot
Speaker 2: of those companies now are some of them are shutting down,
Speaker 2: some of them are having to completely change the way
Speaker 2: that they practice, and a lot of the companies that
Speaker 2: weren't growing organically have shut down.
Speaker 1: Got it more from our conversation after the break So,
Speaker 1: I know I mentioned earlier that it feels like there's
Speaker 1: often a lot of misinformation related to kenemine and psychedelics.
Speaker 1: What are some of the most common myths that you
Speaker 1: hear about ketamine and psychedelics and can you put those
Speaker 1: to rest for us?
Speaker 2: Sure? So common misconceptions that we've seen at Culture Therapeutics.
Speaker 2: One is that ketamine will cause people to lose their sanity,
Speaker 2: or that ketamine is gonna cause some sort of psychotic
Speaker 2: break in patients, and that people who commonly use it
Speaker 2: are going to have that as a very common side effect.
Speaker 2: And traditionally with what we've seen patients who get ketamine
Speaker 2: sometimes there can be some short lasting, you know, agitation
Speaker 2: or anxiety depending on who takes it. But in general
Speaker 2: that's a misconception and that's why we also carefully screen
Speaker 2: to see if someone has psychosis or schizophrenia prior to
Speaker 2: trying a trial of ketamine. I think another myth is
Speaker 2: that it increases the risk for addiction and that people
Speaker 2: will develop an addiction to ketamine immediately. And that's where
Speaker 2: close medical care comes into play. So if someone is
Speaker 2: receiving ketamine, they should be screened like anyone receiving any
Speaker 2: controlled substance, they should be ACTSD. You know, do you
Speaker 2: have a strong family or personal history of substance use disorder.
Speaker 2: Do you have a strong history of adverse childhood events
Speaker 2: or or a history of abuse, do you have a
Speaker 2: history of alcohol use disorder? And you should kind of
Speaker 2: come up with a risk factor or a risk score
Speaker 2: for a patient and let them know that in general
Speaker 2: you may have a higher or lower risk of substance
Speaker 2: use disorder based on your history. It might just be
Speaker 2: a genetic factor, an environmental factor. With that in mind,
Speaker 2: these are the steps we can take to safeguard you
Speaker 2: from that. But by and large, patients who use ketamine
Speaker 2: and a therapeutic setting under physician guidance very rarely develop
Speaker 2: a ketemine use disorder.
Speaker 1: Got it, Got it, so, doctor Doyle. And this may
Speaker 1: be my ignorance because I feel like I hear people
Speaker 1: talk about mushrooms, but I'm not quite sure like how
Speaker 1: that fits into all of this. I feel like maybe
Speaker 1: people are using mushrooms as like a clearly not physician
Speaker 1: assisted psychedelic kind of treatment. Where do mushrooms fit as
Speaker 1: a part of this conversation.
Speaker 2: So, mushrooms are psilocybin, that's the botaqu as psychedelic plants.
Speaker 2: It's a mushroom and it works in the brain on
Speaker 2: the serotonin pathways, and so it can cause patients to
Speaker 2: sometimes hallucinate, dissociate a little bit. It can cause increase sociability,
Speaker 2: and patients can have kind of existential experiences. Some people
Speaker 2: will have ancestral experiences, some people will have profound experiences
Speaker 2: where they gain insight about how they want to live
Speaker 2: their lives. And it's interesting because a lot of those
Speaker 2: medicines do work on the serotonin pathway. A lot of antidepressants,
Speaker 2: a lot of pain medicines work on the serotonin pathway
Speaker 2: in the body, and so does psilocybin, and so do
Speaker 2: chemicals like LSD. So now we're trying to untangle why
Speaker 2: a lot of these things work for mental health and
Speaker 2: why they work for chronic pain. So there are a
Speaker 2: lot of states now like Oregon, that are legalizing psilocybin
Speaker 2: for public use, so patients are able to grow this
Speaker 2: or on their own. And I think that is a
Speaker 2: new area that is going to have a lot of growth,
Speaker 2: just like the cannabis industry and cannabis care industry had
Speaker 2: a lot of growth. I think this is a new
Speaker 2: area for growth. And I just say, you know, have
Speaker 2: healthy skepticism and have safety protocols in place with substances,
Speaker 2: and be careful about what you put in your body
Speaker 2: because again, you may not know dose, you may not
Speaker 2: know potency of what you're taking. And always be mindful
Speaker 2: of what the laws are where you live. There's still
Speaker 2: certain places where you can't consume cannabis and in the
Speaker 2: US now, the majority of places there may be some
Speaker 2: legal repercussions for psilocybin use, but hopefully some of those
Speaker 2: laws we think going through Congress right now, there are
Speaker 2: a lot of acts that are passing to provide more
Speaker 2: access to that.
Speaker 1: So what are some safety measures that patients who are
Speaker 1: interested in perhaps having kadamine sessions? What kinds of things
Speaker 1: should they be looking for in safety midas to put
Speaker 1: in police to make sure they're getting good, adequate care.
Speaker 2: So you want to go to a provider that has
Speaker 2: a lot of experience with ketamine care. So at Culture Therapeutics,
Speaker 2: myself and my co founder, we have over two decades
Speaker 2: of experience with ketamine care for pediatrics, adolescents, and adults.
Speaker 2: We've taken care of a lot of patients who have
Speaker 2: medical conditions and ketamine. You want to make sure that
Speaker 2: you know your full health history, allergy history, and once
Speaker 2: you found an expert provider, you want to make sure
Speaker 2: that you have the time and the space to try
Speaker 2: the therapy, so that you have time set aside for
Speaker 2: an infusion and you have time afterwards to do the
Speaker 2: afterwork after the infusion.
Speaker 1: And I would imagine that it sounds like especially you
Speaker 1: know the way that you practice. It's a very team
Speaker 1: oriented thing, and so you're also maybe talking with their
Speaker 1: primary care doctor or other physicians or other medical professionals
Speaker 1: they've worked with. Can you talk a little bit about
Speaker 1: that approach.
Speaker 2: Absolutely, the patient has certain medical conditions, like if they
Speaker 2: have bladder issues or a liver disease history, kidney disease history,
Speaker 2: heart disease history, I would definitely want to see their
Speaker 2: medical records or talking with their primary care provider. If
Speaker 2: they have a psychologist or a psychiatrist that has reservations
Speaker 2: about them using ketamine therapy, I would want to know
Speaker 2: what those reservations might be. If they have prior history
Speaker 2: of treatments that they've tried, I would want to know, Okay,
Speaker 2: what exactly did you try, what worked, and why didn't
Speaker 2: it work? And it really is a multidisciplinary group approach.
Speaker 2: So within psychedelic care and within ketamine care, there are
Speaker 2: people who can serve as guides that can sit with
Speaker 2: the patient during the therapies and do follow up work with
Speaker 2: them on the intentions that they've set. They're psychotherapists, psychologists,
Speaker 2: psychiatrists who are also very interested in the area. They're
Speaker 2: antithesiologists who have experience providing high doses of very potent
Speaker 2: medications and how to provide that to a patient in
Speaker 2: a way that makes sure they're vital signs and their
Speaker 2: overall safety needs are met. So I think it's an
Speaker 2: exciting time and I think it's creating this really wonderful
Speaker 2: mosaic of care for patients that it's going to provide
Speaker 2: a really beneficial therapeutic response.
Speaker 1: So, doctor, do I want to go back to something
Speaker 1: that you mentioned earlier because it just occurred to me.
Speaker 1: So you said that you are sometimes seeing good results
Speaker 1: for mood improvement for clients who struggle with anxiety and depression.
Speaker 1: And is it that the ketamine works on different receptors
Speaker 1: because typically when we hear about medication for anxiety and
Speaker 1: medication they tend to be like SSRIs or some other
Speaker 1: And so are you seeing that it's effective because it's
Speaker 1: working on this did you say B and DF Is
Speaker 1: that the mechanism for why they are effective.
Speaker 2: There are a few reasons we think it might be effective.
Speaker 2: It works on a receptor called the NMDA receptor, there's
Speaker 2: a receptor called the AMPA receptor, and all of those
Speaker 2: things are causing neural plas plasticity, so they're causing a
Speaker 2: malleability almost like if you had clay or plato. So
Speaker 2: we're kind of reforming some of those connections in the
Speaker 2: brain that have gone a little haywire when you have
Speaker 2: chronic pain or depression, and so it's really able to
Speaker 2: reset things. And ketymine is interesting because it works for
Speaker 2: both pain and depression, but it's not that unique because
Speaker 2: a lot of medicines work for pain and depression that
Speaker 2: we currently use, like tricyclic antidepressants, medicines like deloxetine, which
Speaker 2: is symbalta, those use the serotonin pathway and they're very
Speaker 2: commonly used to treat nerve pain.
Speaker 1: Got it, Okay? And I'm also curious, So I know
Speaker 1: a lot of times when psychiatrists and other medical professionals
Speaker 1: are prescribing things for anxiety and depression, they will ask
Speaker 1: about a family history of like other medications that have worked. Right,
Speaker 1: So would it be the case like if I had
Speaker 1: a mom who has had depression in ketamine was found
Speaker 1: to be the most effective thing, would that then make
Speaker 1: me a better candidate? Like if I were strungruggling with
Speaker 1: depression to also maybe start at ketemine because my mom
Speaker 1: has had good experiences with it or not.
Speaker 2: I think it's a really good question. I don't know
Speaker 2: that we've studied it exactly to say that, yes, that
Speaker 2: would happen. But I believe a good family history and
Speaker 2: a good personal history is always really important. So if
Speaker 2: a patient came to me and shared that with me,
Speaker 2: I would certainly think they had every other reason to
Speaker 2: have ketamine. I would say, well, this is a good
Speaker 2: prognostic indicators. That makes me think you might respond because
Speaker 2: perhaps we have similar genetic pathways causing the depression. So
Speaker 2: I think it would be something that would increase your
Speaker 2: risk of getting a good response.
Speaker 1: Got it. So you mentioned that there are currently legislation
Speaker 1: looking at, you know, expanding some of the laws. Can
Speaker 1: you talk about like some of the roadblocks that people
Speaker 1: like you and other black people in this space are
Speaker 1: facing in terms of getting legislation passed through.
Speaker 2: I think a lot of times with people of color,
Speaker 2: black people who are getting into the industry, a lot
Speaker 2: of times we get there a little a little bit later,
Speaker 2: or we don't have as many resources. I think there
Speaker 2: are a lot of parallels with the cannabis industry where
Speaker 2: in a lot of areas, a lot of the companies
Speaker 2: or wide owned companies or venture capitalists owned companies or
Speaker 2: companies that have received outside grants resources, the majority of
Speaker 2: those funds tend not to flow within our community, so
Speaker 2: that can definitely be a barrier. However, I think with
Speaker 2: ketymine care and psychedelic care, I'm actually been surprised by
Speaker 2: how accepting a lot of legislators have been. So a
Speaker 2: lot of people who work in legislation or work in
Speaker 2: DC have been pretty accepting of this, and I don't
Speaker 2: know if that's because they've had the benefit of ketymine care.
Speaker 2: When I worked in DC and worked at a really
Speaker 2: large hospital and we took care of a lot of
Speaker 2: people who had very high powerful positions in governments and
Speaker 2: a very robust ketymine care program, and it was people
Speaker 2: like doctor Karen William, doctor Paul Dangerfield. They were really
Speaker 2: pioneers and getting patients ketamine care for the last twenty
Speaker 2: to thirty years, and also doctors like may Chin and
Speaker 2: so I think over time, as they themselves have had
Speaker 2: access to the most cutting edge therapies, that has likely
Speaker 2: trickled down to their feelings about some of the legislation,
Speaker 2: because everybody is affected by this. It doesn't matter how
Speaker 2: powerful you are, if you're in the White House, if
Speaker 2: you in Congress. Everybody is affected by pain, everybody is
Speaker 2: affected by mental health issues. You're equally susceptible to those things.
Speaker 2: The difference usually is what access to care that you have.
Speaker 1: Anything we didn't get to, doctor Doyle, that you feel
Speaker 1: like you want to make sure people know, so I just.
Speaker 2: Want them to note it's okay to advocate for yourself
Speaker 2: in terms of pain management. There are a lot of
Speaker 2: disparities in pain management and mental health care, and I
Speaker 2: want people to feel comfortable embracing some of the alternative
Speaker 2: therapies that are available. I don't want people to lose hope.
Speaker 2: So if you've tried everything and there's still things that
Speaker 2: you haven't tried, just know that there's an opportunity there
Speaker 2: and if we can get you to the right provider
Speaker 2: in the right space, you can have a really good result.
Speaker 1: Well, this has all been so incredible, doctor Doyle, I
Speaker 1: really appreciate you sharing this information with us. Tell us
Speaker 1: where people can stay connected with you. What is your
Speaker 1: website as well as any social media handles you'd like
Speaker 1: to share.
Speaker 2: Sure, so again, thank you, doctor Joy. I'm doctor Doyle
Speaker 2: and you can find me at www dot Culturtheapeutics dot
Speaker 2: com and as Culture Therapeutics on Twitter, TikTok, LinkedIn, YouTube,
Speaker 2: and Facebook and Instagram.
Speaker 1: Perfect, well, we should include that in the show notes.
Speaker 1: Thank you so much for spending some time with us.
Speaker 2: Absolutely, thank you for all your great questions.
Speaker 1: I'm so glad doctor Doyle was able to share her
Speaker 1: expertise with us today. So learn more about her and
Speaker 1: her work. Visit the show notes at Therapy from Blackgirls
Speaker 1: dot com slash Session three twenty and don't forget to
Speaker 1: text two of your girls right now and tell them
Speaker 1: to check out the episode. If you're looking for a
Speaker 1: therapist in your area, visit our therapist directory at Therapy
Speaker 1: for Blackgirls dot com slash directory. And if you want
Speaker 1: to continue digging into this topic or just be in
Speaker 1: community with other sisters, come on over and join us
Speaker 1: in the Sister Circle. It's our cozy corner of the
Speaker 1: Internet designed just for black women. You can join us
Speaker 1: at community dot Therapy for Blackgirls dot com. This episode
Speaker 1: was produced by Frieda. Lucas, Elise Ellis, and Zarius Taylor.
Speaker 1: Editing was done by Dinnison Bradford. Thank y'all so much
Speaker 1: for joining me again this week. I look forward to
Speaker 1: continuing this conversation with you all real soon. Take good care.
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