As psychedelic medicines become more accepted and adopted into medical and health care, it is important for therapists who are psychedelic practitioners to practice with the highest degree of excellence in order to promote safety and effectiveness.

Below we have compiled some best practices for ketamine clinics offering psychedelic assisted therapy. This is not an exhaustive list: it is a starting point.

‍‍If you find gaps, wording that could be changed, missing components or any other way this document could be made better, please submit your solution-oriented ideas here.

More and more ketamine clinics are emerging in Canada, and guidance on what constitutes solid care is provided here for clinics to follow and for patients/clients to know what services should be provided. If you are exploring ketamine therapy as a patient/client and the clinic you are considering does not appear to be following best practices, please consider using another clinic. Not all clinics are equal. Your healing matters and you should only work with skilled practitioners.

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Providing psychedelic assisted therapy with ketamine is a serious and rewarding service. Clinics offering this service must be well-trained and thorough in their process.

First intake - the clinic gets to know the potential client/patient and determines if ketamine assisted therapy is appropriate.

Psychological assessment - confirms ketamine assisted therapy is indicated and appropriate. Patients and clients should be screened for psychological safety, support systems, ensuring no contraindications. This is done by a RN, MD, psychologist or clinical counsellor.

Medical assessment - patients and clients are screened by a medical professional to ensure there are no medical contraindications, ketamine is safe to take and all patients’/clients’ questions are answered.

Confidentiality in Group Ketamine Therapy

At first group sessions, agreements on confidentiality are discussed

At the first group meeting, agreements on conduct are discussed - consider revisiting this at the halfway mark of the program

Program provides clinical contacts for participants should they need additional support. This should happen before or at the first group meeting. Emergency contacts should be provided at the first ketamine session.

Proper preparation prior to medicine sessions includes many factors (but are not limited to)

Fulsome information session on ketamine assisted therapy with opportunity for Q&A

The issue of touch should be addressed. Many in the field believe that wanted and appropriate touch can be an important part of healing and yet appropriate boundaries need to be identified and adhered to. Therapist and client should determine what level of touch, if any, will be permitted in a session if and only if it is requested by the client. These boundaries should be clearly documented in the notes and must not be altered during a medicine experience.

Fulsome consent process ensuring multiple opportunities to have all questions heard and answered

Fulsome conversation on what is involved in ketamine assisted therapy

Discussion on types of therapy possible

Which therapy members will be present and what their roles are

Establishment of rapport between therapists and the participant prior to ketamine sessions

Time commitment on day of therapy

Music that will be used

Self preparation ideas

Ideas for setting intentions

Friends and family resources including Q&A sessions

Supports for integration

Provide safety suggestions for the days after the medicine session

Ensure the person has enough time to emerge from the medicine prior to discharging them - this may mean you need to have a ‘chill’ room separate from the session room

Provide self-care suggestions for the days and weeks after a session

Integration sessions within a few days of medicine session

Ongoing support as long as requested from client/patient

Clear communication on how long support & therapy can be provided and any limitations to that care.

Therapy room must be a private space, a calm and relaxing room, reducing noise and potential interruption from other activities in the clinic if in a larger shared space

Emergency Protocols (basic standards for medicine administration)

9-1-1 listed

*CPR and BLS supplies onsite and inspected regularly (weekly)

Identified team members with CPR, BLS, ACLS training are known by all team members onsite

AED in known location & inspected regularly (weekly)

Full support after all ketamine medicine sessions

24/7 after hours phone number for support

Integration sessions in the days after ketamine

Ongoing counselling services (internal or external) after medicine sessions are completely individualized to the needs of the client/patient

An explicit invitation to discuss any problems or concerns with a team member of the participant’s choosing, including an explanation of how concerns will be handled by the organization

Ongoing development of clinical team

At least monthly Quality Improvement meetings

Anonymous feedback forms for participants to submit to clinical team

Team attends ongoing professional development (minimum 25 hours a year)

Team debriefs and has case discussions at least monthly

Consider regular clinical consultation with a supervisor outside of the organization (i.e Elders, psychologist, psychiatrist, wise mentors, etc).

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* Acronyms:

CPR - Cardiopulmonary Resuscitation

BLS - Basic Life Support

ACLS - Advanced Cardiac Life Support

AED - Automated External Defibrillator

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The Psychedelic Association of Canada would like to thank and acknowledge the volunteers who created this document for the community:

Lauri Comoli, BSW

Tracy Lowe, RCC, CCC

Michelle Gagnon, PhD(c)

Dr. Pamela Kryskow, MD

If you would like to kindly & compassionately suggest edits - the link is at the beginning of the document.

If you would like to join the Ethics Working Group at the Psychedelic Association of Canada please email pkryskow@psychedelicassociation.net

Your assistance is welcome

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Ketamine Clinics in Canada practicing Psychedelic Assisted TherapySuggested Practice Standards

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