Frequently Asked Questions
There are many common questions surrounding ketamine therapy and the type of treatment we provide at Klarisana. Here are our answers to them.
What To Expect
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.
Yes. Ketamine has been used extensively in emergency departments, operating rooms, and military conflicts with a very safe track record. Ketamine causes very little depression in a patient’s respiratory drive, which is why it has been highly reputed as an anesthetic agent in the military and in developing countries.
Outpatient IM treatments at Klarisana are fundamentally different than the use of ketamine in an ER or operating room. The doses of ketamine are much lower than those used in a hospital setting. Patients are still conversant and very aware during the IM treatments. Ketamine is administered through injections and the sessions last up to two hours. The patients’ are under continuous visual observation by the clinical staff and their vitals are monitored at regular intervals to ensure they are maintained within safe parameters.
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 prioritize accessibility and accept various insurance plans for medical and behavioral health services. Our commitment is to make ketamine therapy accessible and affordable to the largest number of patients possible and we are working hard to increase the number of Health Plans we are in network with.
Visit our insurance page regularly to track Klarisana’s expanding insurance coverage options for treatments and updates on which new services are covered by our in-network insurance providers.
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.
While ketamine is generally safe when administered properly, it can have side effects such as dissociation, increased blood pressure, or nausea. We educate patients about potential effects and closely monitor them throughout treatment. Additionally, if patients have a medical or behavioral health condition that may impact treatment outcomes, we make contact with their external providers to better understand if our treatment is the best option for them prior to proceeding.
Generally not. Ketamine definitely elicits changes in the perception of sights, sounds, time, and space. We find that carefully explaining what to expect ahead of time alleviates most of the anxiety that might otherwise occur. Also, creating a private, safe and comfortable space helps alleviate any anxiety about the experience.
Klarisana staff is always available to join the patient in the event that they feel more comfortable with the presidential guidance of an experienced staff member. The vast majority of our patients report that it is a very positive, relaxing and enlightening experience.
Ketamine is extensively used in emergency medicine and, in fact, it is the “go-to” medication for procedural sedation in kids. It is routinely used in ER services across America every day in young children who require sedation for painful procedures such as facial lacerations and reduction of broken bones. We have a number of patients with mental health conditions and chronic pain who are teenagers. When we consider ketamine therapy for patients under the age of 18 we require approval of and close cooperation with the patient’s primary care and mental health provider.
At Klarisana we assure safety in several ways - we do not permit concurrent treatment with external prescriptions for ketamine and we track this through a tool called the PDMP which allows for us to review prescriptions our patients receive at their intake session. We prioritize safety through rigorous screening, professional oversight, and controlled environments during ketamine administration. Our protocols adhere strictly to medical guidelines, and our patients are monitored through video, as well as providing “call buttons” in each treatment room in order to provide an additional level of support when required.
Klarisana is not just a clinic, it’s also the fruition of our belief that we can help people who are in a dark season of life realign themselves with the unique mission for which each of them was created. We believe that each person was created for a purpose and has an important mission to fulfill in this lifetime. Chronic pain, severe depression, post-traumatic stress disorder (PTSD), and other mental health conditions derail a person’s ability to carry out their mission. We offer ketamine therapy, which represents a totally different paradigm in treatment.
Klarisana was born out of a response to the alarming veteran suicide rate in the United States. Our founder, Dr. Carl J. Bonnett, MD is a twenty-year veteran of the Army National Guard with four overseas deployments to the Middle East. He has a great deal of experience with PTSD and the toll that it takes on veterans and their families. As the number of lives lost to suicide grew higher, he became more and more frustrated with the limited options available to give patients with severe PTSD and depression any meaningful relief. As more and more research articles demonstrating that ketamine could be a powerful treatment for depression, PTSD, and chronic pain were published, Dr. Bonnett recognized how important it was to make ketamine therapy available to patients.
In response to this panorama, Carl opened the first Klarisana center in San Antonio, Texas. Klarisana quickly expanded beyond this initial vision and now provides care to people from all walks of life and from all backgrounds. Our goal is to make ketamine therapy accessible to the largest number of people possible so that we can truly help people “Break Through Chaos”.
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.
Yes we do. We have a number of patients who will continue to see our therapists for ongoing psychotherapy. We also have a number of patients who either don’t want or are not good candidates for ketamine who will see our therapists for talk therapy.
Our behavioral health professionals are in network with a number of insurance plans and we are able to submit claims for non-ketamine psychotherapy.
Klarisana patients are welcome to continue to see our Licensed Mental Health providers for therapy outside of ketamine-assisted psychotherapy. However, Klarisana does not manage medications nor do we prescribe them for our patients. We are a healthcare organization that works very hard to perfect the art of administering ketamine for mental health conditions and chronic pain, as well as providing quality mental health care access.
Although in certain locations we do provide mental health services outside of ketamine therapy, we still work closely with psychiatrists and psychologists in our communities to partner with them to offer a valuable treatment option to their patients. Patients without a psychiatrist or psychologist can still access our mental health providers.
The environment in which ketamine is administered and the experience that a patient has is absolutely vital to increasing a patient's chance of success. This is not the kind of therapy that lends itself to just being an “add-on” revenue stream for a clinic that has an “extra office.” We do it right and we do it effectively. We feel that the role of the psychiatrist in a patient's care is vital but there is nothing to be gained from having them present during the actual session. Far from trying to replace or compete with local psychiatrists, we strive to be an effective resource that they can have at their disposal to treat their patients.
At Klarisana, we embrace the concept of Evidence-Based Medicine (EBM). The foundational principle of EBM is that the evidence for a given treatment and/or procedure is clearly laid out for scrutiny by the medical community. In that way, patients can have a reasonable assurance of safety and effectiveness. In certain circumstances, the evidence for treatment is either very questionable or otherwise not very robust.
In these cases, a patient can at least make an educated decision as to whether the potential benefits outweigh any potential risks. At Klarisana, we will let you know our dosing protocols and every medication we plan to administer, as well as all the evidence behind it.
We work closely with regulatory authorities, follow their guidelines, and undergo regular assessments to ensure compliance with safety standards and regulations. Our founder and Chief Medical Officer, Dr. Carl Bonnett, is also on the Expert Faculty Committee for ASKP3, The American Society of Ketamine Physicians, Psychotherapists and Practitioners. This group of experts is currently working on ethical and scientific standards for providers to use, including for at-home prescribing, and educating on best practices. We also have published several studies in which we have laid out our protocols and results to allow for scrutiny by the medical community.
Ketamine treatment is exclusively covered by Medicaid Colorado at Klarisana, but we also work with a number of private insurance programs that cover other Behavioral Health Services. Please visit our insurance coverage page to see an updated list of insurance carriers that we work with.
Klarisana also works with out-of-network benefits, which means that if we are not in-network with your carrier, but you have out-of-network benefits, Klarisana will file those claims out of courtesy so that our patients do not have to go through the trouble of filing for reimbursements. For services such as Psychotropic Therapy that do not have a CPT code, a small non-covered services fee will be applied. Contact Klarisana to find out more about insurance coverage and costs.
You will not stop breathing. Ketamine has a very reassuring safety profile. The most common side effect is mild nausea in some patients. We do offer anti-nausea medication prior to treatment. We feel that the alterations in perception with ketamine should not be categorized as side effects, once they are an integral part of the therapy.
There have been case reports of brief periods of apnea (no breathing) with a rapid push of a large amount of ketamine such as might be used to induce anesthesia in an operating room. However, with a low-dose administration at Klarisana, there is no respiratory depression. Our patients are responsive and able to talk throughout the session.
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.
This issue can be very challenging for patients because the field of ketamine therapy is relatively new and has not been well defined. Many interested parties have recognized that ketamine represents a potential “game changer” for mental health and for the management of chronic pain. Some clinicians see this as an amazing opportunity to change the lives of countless people. Some, unfortunately, see this as a way to make more money.
A quick search on the internet will show that some groups offer training programs to teach clinicians how to set up ketamine clinics in order to make extra money from this “amazing revenue stream”. Against this backdrop, Dr. Bonnett was one of the founding members of the American Society of Ketamine Physicians (ASKP.org) which is the first professional society of ketamine providers. ASKP was formed by the leaders in the field of ketamine therapy to try and establish some basic standards and better practices for ketamine therapy. We would recommend you chose a center that is a member of the ASKP.
No, we haven't. When we opened in 2015, Dr. Bonnett made the conscious decision to not register for OBA because he felt strongly that what Klarisana offers is not OBA, it is Ketamine for Non-Anesthetic Indications (KNAI), a fundamentally different clinical entity. In 2017, one of our competitors filed a complaint with the Texas Medical Board against Klarisana and several other clinics in Texas that offer ketamine therapy and haven’t obtained an OBA certificate.
Klarisana and other clinicians in Texas presented their argument to the TMB as to why this clinical use of ketamine should be considered KNAI and not OBA. The TMB agreed with us and the complaint was quickly dismissed. We appreciate the forward-thinking of the TMB and are pleased that their decision set an important precedent for the clinical use of outpatient ketamine in the United States.
Ketamine therapy is a rather unique entity because it represents a fundamentally different use of a time-tested medication. Ketamine has traditionally been used as an anesthetic by emergency physicians and anesthesiologists. The way in which ketamine is currently being offered at centers like Klarisana represents an entirely different paradigm.
At Klarisana, we feel that ketamine for mental health and chronic pain conditions should be more accurately described as Ketamine for Non-Anesthetic Indications (KNAI). In this light, one will see clinics that come from several different specialties. There are many clinics that are operated by either emergency physicians or anesthesiologists, which makes sense given the historical familiarity with ketamine by these disciplines. One will also see clinics that are operated by psychiatrists, which is understandable given the important role that ketamine can play in the treatment of mental health disorders.
We feel that the important thing is not so much the specialty of the clinicians who opened the clinic but rather the way in which they have structured their practice and the intent behind it. Ketamine is a relatively safe medication but still needs to be treated with respect. The important thing is that the clinicians who operate the clinic have ensured that they place a top priority on safety and have taken the time to undergo any additional training necessary to administer intramuscular ketamine therapy. The founder of Klarisana is Dr. Carl J. Bonnett, MD who is Board Certified by the American Board of Emergency Medicine and has extensive clinical experience with ketamine.
We provide comprehensive support, including mental health evaluations, counseling, and follow-up care to monitor patients' progress and well-being post-treatment. At each session our clients receive a brief questionnaire to understand their current state, along with the in-depth self-reported questionnaires patients complete prior to their intake session, and again upon the completion of their induction series. Additionally, our team provides recommendations for ongoing support, whether those resources be internal to Klarisana, or external resources such as free or low cost support groups.
Like most things in life, there is a linear relationship between the money spent and the quality received. At Klarisana, we offer very personalized service and treatment in a private and fully monitored setting.
In our experience, we believe that the setting and the experience are critical to success. After you contact us, you have a non-pressured discussion with our Behavioral Health Coordinators. If you are seeing us for a mental health condition, you will then have an intake session with one of our Licensed Behavioral Health professionals. You will also have an intake session either via telehealth or in the clinic with one of our Advanced Practice Providers (NP or PA). Once you start your ketamine treatments, you will be treated in a private room with constant clinical observation. As one of our patients, we will develop a customized dosing protocol that works for you.
It is Klarisana’s mission to make quality mental health treatments as accessible as possible. Know more about insurance coverage at Klarisana.
Ketamine is administered at Klarisana in a manner we refer to as “Ketamine for Non-Anesthetic Indications” (KNAI). At all times our patients must be responsive to questions and gentle tactile stimulation (e.g. a tap on the wrist). Additionally in the clinic we use safety protocols that have been adopted from the aviation industry. This includes having two staff members verify and read out loud the dose for every syringe. We also incorporate the principle that “there is no rank in the cockpit.” This means that if any staff member has a concern that a medication may have been drawn up incorrectly they are encouraged to speak up. At that point the syringes are wasted and we start over. All patients begin at a relatively low dose (30-60mg), and as they move through their series we incrementally increase based on patient response.
