Running the Medical Side of a KAP Clinic: Lessons Learned

Dr. Meidad Goldman, MD, is the Medical Director of Concierge Medicine and Psychiatry’s Ketamine Clinic and Living Medicine Institute, which offers psychedelic-assisted psychotherapy training programs. He is a board-certified physician in emergency and addiction medicine and has worked in multiple hospital- and clinical-based settings. With over 17 years of experience administering ketamine for multiple conditions, Dr. Goldman is a certified provider of Psychedelic Assisted Therapies and Research through the California Institute of Integral Studies and has completed training through the Multidisciplinary Association for Psychedelic Studies (MAPS).

Here’s a glimpse of what you’ll learn:

[1:52] Dr. Meidad Goldman provides an in-depth overview of treatment and staffing inside a ketamine clinic
[10:11] Customizing ketamine drip rates to achieve individual psychotherapeutic goals
[12:33] The communication system between therapists and medical staff
[15:04] How to determine initial ketamine dosages
[20:35] Music’s role in the psychedelic therapy experience
[28:28] A typical psychedelic psychotherapy treatment session
[33:44] Dr. Goldman’s philosophy on integrating additional medicine with ketamine
[37:11] Advice for clinicians entering the ketamine-assisted psychotherapy space

In this episode…

Administering ketamine in therapy sessions requires a team of trained medical professionals to monitor the patient’s vitals during periods of altered consciousness. What is involved in the clinical side of psychedelic-assisted psychotherapy, and how can clinicians maintain safety and efficacy during the process?

With nearly eight years of experience managing a ketamine clinic, Dr. Meidad Goldman highlights the importance of creating a supportive and individualized treatment environment. He notes that ketamine should be part of a comprehensive therapeutic program, with careful attention to dosing and real-time collaboration between therapists and medical staff. Medical providers must prioritize client comfort, use controlled settings to shape the therapeutic experience, and customize doses based on body weight. These practices maximize the clients’ ability to process and integrate their experiences effectively.

In this episode of Living Medicine, Dr. Meidad Goldman joins host Dr. Signi Goldman to share his experience managing a ketamine-assisted psychotherapy clinic. Dr. Goldman talks about the role of music in the psychedelic experience, how therapists and medical staff communicate during the sessions, and how to customize ketamine drip rates.

Resources mentioned in this episode:

Quotable Moments:

“Our goal in the clinic is to really make our client and patient comfortable. It is very important that [comfort] is part of the setting.”
“Less is more. I’ve been saying it all along, and I’m approaching our eighth year since we opened our clinic.”
“Ketamine has a short half-life; we can really adjust the rate to get the client where they need to be.”
“Music is almost like a flying carpet. It just allows the client to kind of float and reanchor their thought process.”
“Be ready for that. If this part of the job is not your cup of tea, then running a ketamine clinic may not necessarily be the best route for you.”

Action Steps:

Create a comfortable and therapeutic environment: Ensuring that clients feel as if they are in a familiar and safe space akin to their living room can significantly enhance their comfort and openness during sessions. This creates a therapeutic setting that encourages clients to relax and engage fully in the process of psychedelic-assisted psychotherapy.
Optimize medical staffing for safety and support: Having a well-staffed clinic with a ratio of one provider to two rooms ensures that clients receive the necessary medical supervision and support during their sessions. This operational strategy improves client safety and allows them to relax, knowing they are well cared for.
Individualize dosing based on client needs and experience: Start with a conservative dosing approach, such as 0.5mg/kg, and adjust based on the client’s feedback and therapeutic goals. This method tailors the psychedelic experience to the client’s unique needs, avoiding overmedication and maximizing therapeutic benefits.
Control the setting with carefully selected music: Using music with alpha wave binaural beats helps guide clients without influencing their experience with personal associations that could arise from familiar music. This approach provides a neutral backdrop that supports the therapeutic process rather than directing it.
Emphasize integration and reflection post-session: Allowing time post-session for integration helps clients process their experiences and apply insights to their personal and therapeutic goals. This supports clients in deriving long-term benefits from their sessions, enhancing the overall impact of ketamine-assisted psychotherapy.

Sponsor for this episode…

This episode is brought to you by the Living Medicine Institute.

LMI is a training, resource, and membership program educating providers about the legal and safe use of psychedelic-assisted psychotherapy.

To learn more or participate, visit https://livingmedicineinstitute.com.

Episode Transcript

Intro 0:03

Welcome to the Living Medicine podcast, where we talk about ethical medical use of psychedelic psychotherapy, teaching skills, examining the issues and interviewing interesting people. Now let’s start today’s show.

Dr. Signi Goldman 0:18

Hey everyone. This is Signi Goldman, one of your hosts on Living Medicine. These podcasts are brought to you by the Living Medicine Institute, where we run training programs for therapists interested in becoming psychedelic therapists. And we also talk to a lot of physicians and medical personnel who want to get into this field. So we have a guest today who can talk with expertise about that angle on things. So I’m going to introduce today Meidad Goldman. Meidad has a clinic that specializes in ketamine assisted psychotherapy in Asheville, North Carolina, called concierge medicine and psychiatry. And this was one of the longest running psychedelic clinics in the southeast, definitely the first in the Asheville area. And so Meidad has a lot of experience working with this specialty, and in this clinic, he’s using ketamine specifically with psychedelic trained therapists, and he has become an expert over the years on dosing specifically for this use. So Meidad is also married to me, so we’ll see how this goes. We’re interviewing each other today, so thanks for coming on Meidad, and let you say hello, and then I’ll just kind of launch into a little bit of things that people interested in the medical side may need to know, as well as therapists may need to know about dosing and medical monitoring.

Dr. Meidad Goldman 1:35

Sure. Well, thank you for having me. It’s a real privilege.

Dr. Signi Goldman 1:40

So why don’t you first just give the audience a little bit of a sense of what the clinic setup is like. If I was talking to you from one of the clinic offices, and what would you be surrounded by on a typical day?

Dr. Meidad Goldman 1:52

So our goal in the clinic is to really make our client and patient comfortable. It is very important that the setting is part of the setting. Setting, that the setting will be as such, that the client can feel as if they’re sitting in their living room. Our clinic is designed for that where each room, if you can imagine your own living room, wherever you are, most of our room have an old fireplace and a recliner and a couch and a little desk, and the therapist is right by their side. So really, from the setting, is trying to get our client to be as comfortable and to just imagine they’re sitting back at home.

Dr. Signi Goldman 2:41

Thank you. And I’m going to ask you a little more about the clinic, only because I want to set the scene for what it’s like day to day running the medical side of Academy and practice, leading into me asking you some specific questions people need to know about dosing and other sort of nuts and bolts issues. So can you talk about the staffing that you have, and about how many clients you can see with the staff that you have, so that people get a sense of the flow.

Dr. Meidad Goldman 3:08

So currently we have 562, and five and six treatment room. One of the room can be used as an overflow or recover room for our client after treatment, if they need additional time, if they’re waiting for a ride. And the flow in the office is typically as such that when the client comes in, we have an appointment every about half an hour, we can run multiple room. We have a nurse, there’s another clinician, either a psychiatric nurse practitioner or an MD that works by my side with a nurse, and when the client come, the initial check in is with me, or Dr. Lentini and one of our provider, including set a vital sign and exam to make sure that the client in is ready for today’s treatment, that there’s no issues that medically needs to be addressed, and then we try to quickly, kind of dive in and Prepare the client into their journey.

Dr. Signi Goldman 4:21

So you have theoretically four to five sessions maybe going simultaneously at your maximum. Yes, okay, and what kind

Dr. Meidad Goldman 4:30

of at max, we will have about four concurrent client at the same time.

Dr. Signi Goldman 4:38

And what is the medical staffing needs, in your opinion, to run that many people at once safely.

Dr. Meidad Goldman 4:44

In our clinic, we have a nurse and two clinician. It’s either me and Dr. Lentini or me and rose but two clinician with a nurse. And I think that the ratio that you have one provider to two room. That is a good ratio. We’re probably more staff than the average clinic out there, but we decided to do that because we really emphasize and we want the client to feel cared for and to feel supported, and to be able to support our client in that manner. And so that’s where our ratio is a little bit on the heavier stuff. But I think it’s important for the client, and it show result when the client are really feel at ease that they can drop into their session very easily.

Dr. Signi Goldman 5:38

Yeah, I agree that the amount of medical supervision actually helps the clients relax into that. And just to be clear, when you say clinicians, you’re referring to medical staff, so physicians or pas the nurse that

Dr. Meidad Goldman 5:53

are the nurse, yes, on top of the nurse that help us track him, each client also have a little ring, like the ring device that tracks their oxygen saturation, their heart rate, any type of movement, and that is being transmitted via Bluetooth to our personal phones that will alert us if there’s anything that we need to be aware of,

Dr. Signi Goldman 6:24

and we’re specifically talking in this podcast, and this is for the audience, about ketamine assisted psychotherapy, often referred to as KAP, or the psychedelic work using ketamine. So we’re not necessarily discussing our ketamine infusion treatment that you often seen in ketamine clinics that are just giving the medicine as a pharmaceutical treatment, which that, in itself, is a beneficial thing. But just as a reminder, when we’re discussing these parameters, it’s really about what you feel is useful for KAP or ketamine assisted psychotherapy. So along those lines, you also have therapists in the room with the client, just to give the audience is just a visual for what’s going on. You have. The client is in the room with the therapist, and then the nurse and the doc are kind of going in and out as needed.

Dr. Meidad Goldman 7:08

Yes, that is correct. So the client has the therapies that is coming before the infusion is even started. The client already have an IV. The client is situated on the recliner. They have their eye Master Blanket ready. The music is ready. Therapist is right by their side, and therapist will be with the client throughout the entire infusion and about 15 to 20 minutes beyond infusion, as well as part of their psychotherapy.

Dr. Signi Goldman 7:41

So given that how often are the medical staff in and out of the room, what do you feel is like the ideal amount I can imagine, it could be too little or sometimes too much.

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