The conversation between two Duluthians occurred at one of the places Minnesotans are most likely to bump into each other.
It was at the state boys’ hockey tournament in March, and the conversation involved Patrick Bailey and Natalie Johnson, who share the same profession — they are nurse anesthetists — and social connections.
Bailey described it like this:
“Natalie said, ‘Hey, I’ve got to talk to you about something.’
“I said, ‘What’s that’?
“She said, ‘Do you know anything about ketamine’?”
“I said, ‘Yes, I do.’
“She said, ‘Well, we have to start up a clinic.’
“I said, ‘Yes, let’s do it.’”
Thus, six months later, a clinic on Central Entrance called Ketamine North and today — if the schedule holds — the first infusions of the drug for mental health treatment in Duluth in well over a year.
Long a tool of the trade in anesthesiology and with a more notorious history as a party drug, ketamine has made a more recent appearance as a treatment for the sort of mental health disorder that doesn’t respond to standard treatments. It’s new enough in the war on mental illness that long-term studies simply aren’t available. The American Psychiatric Association, in a “consensus statement” published in April 2017, cautioned that “while ketamine may be available to some patients with mood disorders, it is important to consider the limitations of the available data and the potential risk associated with the drug when considering the treatment option.”
But the studies that are available show as much as an 85 percent success rate, Johnson said, and also show a much faster rate of improvement than with traditional antidepressants.
Certainly, there are patients who swear by it. When the Essentia Health-Duluth Clinic discontinued ketamine therapy with the retirement of psychiatrist Dr. Michael Messer in July 2018, a couple of patients described the treatments they had received there as life-transforming and expressed concerns for themselves and fellow patients with no such service available in Duluth.
At the time, the closest remaining locations for the therapy were in Ely and in the Twin Cities. In addition to the distance alone, there are a couple of other complications for people traveling to get treatment: Initially infusions typically are given six times over two weeks; and the patient needs to get a ride home.
Johnson, whose practice is at the St. Luke’s Pavilion Outpatient Surgery Center; and Bailey, who’s at Community Memorial Hospital in Cloquet; independently came to the conclusion that Duluth had a gap that needed to be filled.
“We knew there was a need, and there’s already a shortage of mental health everything,” Johnson said.
The chance meeting at the hockey tournament was followed by a more formal meeting in early May. They took training sessions, came up with a name — Ketamine North — and a logo, ordered scrubs, materials and supplies. They scouted around for an office that met their needs, and found it at 1003 E. Central Entrance. It’s space shared with Zenith Spine & Wellness on the ground floor of the building occupied by Planned Parenthood.
There’s no such thing as a walk-in patient. The patient must be referred by a mental health professional and must have been prescribed standard drugs with little effect. Johnson and Bailey are clear about the fact that they aren’t mental health professionals but will be collaborating with the patient’s prescriber to offer a specific element of their treatment.
They are, however, medical professionals whose experience includes ketamine. Although side effects are rare, they’re prepared with a “crash cart” should a medical emergency occur. A small number of patients can’t be treated with ketamine, such as those whose heart health couldn’t tolerate even a slight increase in blood pressure. But the risk is so low, Johnson said, that some clinics they’re aware of have never had to turn anyone away.
In fact, low risk is one of the attractive aspects of ketamine treatment, both said.
“You do maintain your breathing,” Johnson said. “It’s not like a narcotic or fentanyl where you stop breathing. It’s very low-risk.”
But it’s also an off-label treatment. Although the Food and Drug Administration recently approved a variation of ketamine in a nasal spray for some uses, the infusions that will take place at Ketamine North aren’t yet approved. That means they aren’t covered by insurance, and the patient will have to bear the $399 cost per infusion.
That could add up. After the six initial infusions, the patient will need maintenance doses. The need will vary with the patient, but it typically could be once a month for a year to a year and a half, Bailey said.
Although Bailey and Johnson expect most patients to benefit, if a patient hasn’t experienced improvement after six sessions, there won’t be any point in continuing, they said.
Even the patient who benefits won’t be cured. Johnson and Bailey described it as helping someone who is virtually unable to function to reach the next level.
“It’s not like the guy is going to be skipping down the street, happy, but it’s going to bring him back to a functioning state,” Bailey said.
Then the patient will be able to go back to his therapist and continue to work on the things that will improve his quality of life, Johnson added.
The infusion itself will take place in a private or semi-private room that Johnson describes as “spa-like.” The patient will sit in a leather reclining chair with a weighted blanket, Tranquil Sound machines and — in the two private rooms — access to aromatherapy. They can treat as many as four patients at a time, and both will be present whenever even a single patient is treated.
The infusion itself takes 40 minutes, although patients are told their total time at the clinic could be as long as two hours. The dosage is nowhere near what was used in the “Special K” party drug or in anesthesia.
“At these doses, the people are just kind of floating for 40 minutes,” Bailey said. “They’re going to be responsive. They’ll be able to answer questions.”
The immediate effects will wear off in about 15 minutes after the infusion, Johnson said, although patients will be told not to drive for 24 hours.
Sessions will be by appointment and will take place on nights and weekends, since both Johnson and Bailey already have full-time day jobs. In addition to those jobs, each has a family — two children apiece. “(We have) supportive spouses,” Johnson said.
They have a website up and a sign facing Central Entrance, and a letter will be sent out to mental and behavioral health professionals this week. The mental health professionals they’ve talked to have welcomed the return of ketamine for mental health treatment to Duluth, they said. But they’re aware that might not be a unanimous opinion.
“I’m sure there are some people who are not going to refer their patients,” Johnson said. “I hope if the patient wants it they would support it, and we’d love to work with them.”
To learn more
Visit the Ketamine North website at ketaminenorth.com.