Frequently Asked Questions

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There are many common questions surrounding ketamine therapy and the type of treatment we provide at Klarisana. Here are our answers to them.

Ketamine can be administered by a variety of routes. The two that lead to the most predictable dosing and response are intravenous (IV) administration and intramuscular (IM) administration. The Klarisana model is based on intramuscular injections of ketamine. For the first several years of our company history we provided IV ketamine. In 2020 we did a reevaluation of our operations and switched to an IM model. There were several reasons for this.

First off, the goal of treatment with ketamine in our clinics is very different from how ketamine was used in emergency departments (ED) and operating rooms (OR) traditionally. We are using ketamine to facilitate a powerful transformational experience by leveraging a non-ordinary state of consciousness…commonly thought of as a “psychedelic experience.” The doses we use are much less than what would be used in an anesthesia context and the purpose is fundamentally different. In our setting, we refer to it broadly as Ketamine for Non-Anesthetic Indications (KNAI). This is totally different from using the medication as an anesthetic.

One of the first things we realized is that the process of starting an IV can be traumatic. Many of our patients have significant anxiety to start with. Even the best clinicians will miss IVs. Having one or two missed attempts at an IV can really put a patient in a bad mental space.

The other thing is the way in which the ketamine is delivered. With an IV, the pump starts delivering it at a set rate over an hour. The point of maximum intensity where the patient has a profound experience does not occur until well over half way through the session. When they finally have a powerful experience the session is almost over. 

Our protocol is to give two IM injections spaced apart by 10-15 minutes. This allows our patients to achieve the desired effect in the first third of their session. They then have much longer to explore that space and have a more constructive experience. Additionally, they also have more time for the medication to wear off prior to being discharged from the clinic. This increases patient comfort and safety as they are in a much clearer mindset when they leave the clinic.

After the switch to an IM model we published a case series of 40 patients with major depressive disorder. The results are very much in line with (and actually better than) the published literature using an IV based model. In 2022 we performed close to 20,000 IM ketamine sessions with a great deal of success and an excellent safety record.

Klarisana was founded in 2015 and is one of the oldest and most experienced ketamine centers in the US. The company was founded in San Antonio, Texas and now has five clinics covering Colorado and Texas. Dr. Carl J. Bonnett was one of the founding Board Members of the American Society of Ketamine Physicians, Psychotherapists, & Practitioners (ASKP3). 

Klarisana has over 25 medical providers; many of whom have significant experience in the therapeutic administration of ketamine. We have a robust and collaborative process of clinical review and protocol development based on best practices in the industry. 

Klarisana has published two research papers. In the year 2022 we had over 20,000 patient visits. We have a robust program of quality improvement and patient safety. Additionally, we have a team who’s whole focus is obtaining patient feedback and refining the patient experience.

Ketamine elicits changes in the perception of sights, sounds, time, and space. The experience can be described as “psychedelic” but that term is clouded by various characterizations in popular culture which do not accurately describe the experience. Generally, patients do not see things that are not there but they may have dreamlike visions. Many patients use terms like feeling “more connected to the universe.” This gets back to our treatment principle that these alterations are what “show” patients a new way to look at their reality. It is what leads to our axiom that “if you could put the experience into words then talk therapy would have already helped.”

As far as the clinical environment, our rooms are decorated in order to convey sensations of relaxation, tranquility and peacefulness. Rooms have large screen TVs where patients can watch naturescape videos. Some patients choose to use an eye mask and turn off the TV. 

Patients receive their IM treatments in privacy while under constant observation during the ketamine session. We use high resolution video monitoring to augment direct observation by our clinical staff. The provider performs an initial evaluation and physical exam and steps out of the room once the IM treatment has started. Most ketamine sessions last about one and a half hours. 

We are not able to submit claims for ketamine-based services to any commercial insurance programs. This is unfortunate but we have been directly informed by several commercial payers that they will not cover any part of a visit in which ketamine is being administered.

Many patients however have had success submitting a superbill and getting at least some reimbursement directly from their insurance carrier.

We do participate with HealthFirst Colorado (Medicaid) and will submit claims for the non-ketamine component of the visit. For Colorado Medicaid patients, there is an element of a visit that will be the patient’s responsibility as it is considered a “non-covered service” by Medicaid.

Our behavioral health professionals are in network with a variety of commercial insurance payers as well as Colorado Medicaid. There is a good chance that (non-ketamine) psychotherapy with one of our therapists may be covered by your insurance.

Our behavioral health professionals are in network with a variety of commercial insurance payers as well as Colorado Medicaid. There is a good chance that (non-ketamine) psychotherapy with one of our therapists may be covered by your insurance.

There is some very promising research about the use of psilocybin and MDMA for mental health conditions but neither of these have been cleared by the Drug Enforcement Agency (DEA) for clinical use outside of controlled research settings. We are closely monitoring these therapies and will incorporate them into our treatment offerings if and when they are approved on the federal level. 

Colorado recently passed a measure to decriminalize psilocybin and set up a pathway for its clinical use. We applaud this effort and are closely watching how this plays out. Given that our clinics operate with a federal DEA registration, we will not be offering psilocybin until a pathway is developed that is supported by federal law. 

Ketamine is approved by the US Food & Drug Administration for use in humans as an anesthetic agent and as an analgesic agent to supplement low-potency medications such as nitrous oxide. The use of ketamine for mental health conditions and the treatment of chronic pain is considered “off-label” by the FDA. Once a drug is approved by the FDA for one indication, then clinicians may use that same medication for other indications if they feel that the evidence supports the practice.

Ketamine is off-label because no one has invested the millions of dollars necessary to go through the multi-phase process of getting ketamine “approved” by the FDA for these indications. The fact that ketamine is a generic medication means that it is unlikely that any company or organization will ever spend the money to get ketamine “FDA approved.” The issue of whether there is good evidence to support the use of ketamine for the indications for which Klarisana is using it is separate from the simple discussion of FDA approval.

There are many medications that are prescribed and administered every day that are off-label. For example, Compazine (prochlorperazine) is indicated for nausea but is frequently used to treat migraine headaches. A common misconception is that just because a medication is not “FDA approved” for a certain indication, it means the FDA has prohibited its use for that indication. If the FDA wanted to prevent the use of any medication, it would issue a “black box” warning; this is not the case for ketamine.

Patients are not allowed to drive or operate dangerous machinery on the calendar day that they receive ketamine. Ketamine is a powerful mind-altering medication and it would not be safe to drive oneself home. Given the public health ramifications of this, we have a very strict policy on driving after receiving ketamine. If we observe a patient driving after a ketamine session we are obligated to notify the police. Additionally violating the Klarisana policy on driving is grounds for having the clinician-patient relationship with Klarisana terminated. 

At this time we do not write prescriptions for home use ketamine. Currently this is an area of significant regulatory scrutiny nationally and we are closely monitoring the national discussion. With regards to the treatment of mental health conditions, we do believe that the powerful transpersonal experience that can lead to significant change requires relatively strong doses. These are very safe if given in the controlled environment of one of our clinics. To achieve these kinds of doses with oral ketamine in an unsupervised home environment would be very difficult to do while maintaining the level of safety we feel is required for our patients.

We were heavily influenced by the work of Dr. Phil Wolfson and Dr. Terry Early. These gentlemen are psychiatrists who have been working clinically with ketamine for a very long time and are real pioneers in the field of outpatient ketamine therapy.

Patients eighteen years of age and older do not require a referral. Prospective patients will be evaluated by one of our Advanced Practice Providers who will determine whether any further clarification is required. Subsequently, patients will often have a psychological screening completed by one of our Licensed Behavioral Health professionals. For patients younger than 18 years of age, we do require communication with, and approval of, the patient’s primary care provider.