(Adapted from “A Market Analysis of Psychedelic Clinics and Retreats,” a reMind special report written by Josh Hardman of Psychedelic Alpha)
The advent of for-profit psychedelic treatment clinics in the United States dates back earlier than commonly known. In fact, at the same time middle-class Americans began bringing televisions into their homes, many of the rich and famous began getting LSD therapy.
Although Nixon’s War on Drugs put a decades-long pause on psychedelics as medicine, the evolution of the psychedelic clinic — from LSD to ketamine — has many curious twists and turns, including the definition of “psychedelic” itself.
In the 1950s and ‘60s a number of LSD therapy clinics cropped up in North America: from Hollywood Hospital in British Columbia through to the Psychiatric Institute of Beverly Hills in Los Angeles.
These clinics would administer LSD — supplied, at the time, by Swiss pharma company Sandoz — alongside talk therapy to the rich and famous, including star-studded clientele like Cary Grant and Betsy Drake. With the latter clinic charging around $100/session (over $1,000 in today’s money) this experimental treatment certainly wasn’t an option for the average American.
Beyond this mid-century exploration, it’s tricky to find an example of a true psychedelic clinic in the United States. That is, a site at which psychedelics are legally administered, outside of clinical trials, within the western medical model.
What we have seen since the turn of the 21st Century, however, are a growing number of interventional psychiatry treatment clinics and, in the past decade, ketamine clinics.
Some of these ketamine clinics have sought to position themselves as psychedelic clinics; whether through the casting of ketamine itself in a psychedelic light and positioning it within a therapeutic protocol that resembles that of psychedelic-assisted therapies, or by emphasizing their preparedness and intention to deliver ‘true’ psychedelic therapies if and when they’re approved.
(Indeed, given that ketamine occasions dissociative effects at certain doses, it’s not hard to see why some might hope to include it under the psychedelic banner. It’s also worth noting that MDMA is not considered a true psychedelic, either! See our Psychedelics 101 primer for more.)
A Lack of Innovation in Mental Health Therapeutics
Since the approval of Prozac (fluoxetine) for the treatment of depression in 1987, the development of novel and truly differentiated therapeutics for mental health conditions largely stagnated as drug developers and pharmaceutical incumbents shifted focus to more lucrative therapeutic areas like oncology.
This lack of innovation was even more stark when contrasted against the enormous unmet need within psychiatry, with existing pharmacological treatments failing to impact large portions of patients suffering from diseases like treatment-resistant depression and PTSD.
This demand propelled a new suite of interventions which sought to break from the siloes of psychotherapy or pharmacotherapy. These included transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS), as well as the rehabilitation of older modalities like electroconvulsive therapy (ECT).
These ‘interventional psychiatric’ treatments adhere to a more procedure-based doctrine of care, falling somewhere “on the spectrum between standard care and surgery.” (Williams et al., 2014)
‘Rapid-acting’ antidepressants with side effects that require monitoring are also included in this subspecialty. These types of interventions may require greater practitioner involvement or oversight, such as the use of ketamine as a psychiatric treatment.
The Proliferation of Ketamine Clinics
Despite having been used as an anesthetic agent since the early 1970s, a small number of studies explored ketamine’s use in an array of psychiatric disorders.
It wasn’t until 2000, however, when the publication of a small randomized controlled trial by Robert Berman and colleagues generated interest in formally studying its potential antidepressant effects in the United States.
As subsequent studies appeared to corroborate Berman’s earlier findings, healthcare providers began to use ketamine as an ‘off-label’ psychiatric treatment in clinical practice, with ketamine clinics emerging in earnest in the late 2010s.
Within a half-decade, more than 1,000 facilities offering ketamine for psychiatric disorders have emerged around the United States. Some of these facilities are standalone ketamine clinics, while others offer ketamine as part of a broader suite of interventional psychiatry services.
The array of conditions for which these clinics tout ketamine’s potential benefits goes beyond depression, with conditions as diverse as alcohol use disorder and pain-related ailments making the homepages of ketamine clinic websites and the focal points of advertisements.
Janssen’s Spravato on Track to Become a Blockbuster
The promise of ketamine as a psychiatric intervention led Johnson & Johnson subsidiary Janssen to develop a nasal spray treatment using ketamine’s S-enantiomer (esketamine).
Spravato received its first breakthrough therapy designation in 2013 and was approved by the FDA in 2019 for use alongside an oral antidepressant as a treatment for treatment-resistant depression. The FDA would subsequently approve Janssen’s supplemental new drug application (sNDA) which expanded the authorized use of Spravato to include Major Depressive Disorder with acute suicidal ideation or behavior.
Despite a slow start since its initial approval, Spravato sales have picked up significantly of late. In its Q1 2023 results, Johnson and Johnson broke down Spravato sales for the first time since its launch in 2019. The drug has shown consistent growth in sales over the last five quarters, and is on track to exceed $1 billion in 2024.
Future of MDMA and Psilocybin Clinics?
Despite the FDA’s rejection of MDMA as a therapy in August, many ketamine clinics are still hoping to offer MDMA- or psilocybin-assisted therapies in the future. They would then graduate to being true psychedelic clinics, in the eyes of many.
However, given that psychedelic therapies will likely be predominantly used on-label, and that there will likely be strict controls around how psychedelic and the associated therapies are delivered, it is very unlikely that we will see the level of diversity of delivery seen in ketamine in the case of psychedelics.
For now, the evolution of psychedelic clinics in the United States remains in a wait-and-see period.
