Dr. Jonathan Leake is a Board Certified Emergency Department Physician and the Co-owner and CEO of Dérive Health, a clinic specializing in ketamine-assisted therapy for PTSD, depression, and other treatment-resistant mental health conditions. With over a decade of experience treating dehydration and illness with IV fluids and medications, Dr. Leake also co-founded Hydrate Medical, which administers IV vitamin infusions. He is certified in psychedelic-assisted therapy from the California Institute of Integral Studies (CIIS) and MAPS and holds a certification in ketamine therapy from the Living Medicine Institute.
Many physicians are burned out by the limitations of traditional medicine, especially when treating mental health crises in high-pressure environments like the ER. While they may feel called to do more, the pathway to practicing psychedelic therapy can seem unclear and overwhelming. How can medical professionals transition into ketamine-assisted care?
After noticing a lack of effective treatment for mental health conditions, emergency medicine physician and ketamine clinician Dr. Jonathan Leake transitioned from the ER to providing ketamine therapy. Ketamine therapy requires maintaining supportive care throughout each treatment session, so physicians must build patient rapport, assess and manage the environment’s energy, and recognize psychological vulnerability. When treating patients with complex trauma, Dr. Leake advises physicians to recognize the limits of their training and partner closely with licensed therapists who can guide a deeper therapeutic process.
In this episode of Living Medicine, Dr. Jonathan Leake, the Co-owner and CEO of Dérive Health, joins Dr. Sandy Newes to discuss how physicians can provide ketamine therapy. He highlights the importance of patient care during ketamine therapy sessions, insights from various psychedelic therapy conferences, and the role of training in physician performance.
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.
Intro 0:00
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. Sandy Newes 0:18
Well, hello everybody. I am Dr. Sandy Newes, and I’m with the Living Medicine Institute, which is a business that provides content, training and resources for clinical and medical providers who are specifically interested in learning about ketamine assisted psychotherapy, as well as skills, general skills, in psychedelic medicine. And I’m really excited to have Dr. Jonathan Leake here on the show. Jonathan is a physician, and he is one of the people who has transitioned from being an emergency room doc to actually starting an academy clinic. And a little bit more specifically, Jonathan went on left the ER, transitioned out of the ER. I just talked to, talked to him, and he still is doing some of that work. And went on started a series of hydration clinics in the Charlotte, North Carolina area, and really got involved in helping people in that way. And then began to get interested in mental health applications, so providing ketamine infusions, as well as NAD and some other types of support for mental health. And then we actually met him, because he came to Living Medicine Institute training and began to also offer cap. So some people may not be aware that most clinics don’t really do both, but it’s our understanding that at Dream, which, again, is in the Charlotte area that you all are doing both where you provide it both internally, and then you also have outpatient therapists come in and bring their clients to you and so, so, anything else that you’d like to add about the bio there?
Dr. Jonathan Leake 1:54
Yeah, no, I think that’s a that’s a great summary. You know, I also completed the CIS training certificate in psyched therapy and research. So we’re really dove in deep here.
Dr. Sandy Newes 2:05
Good, good. Well, I love that. So you know, like I said, you’re definitely one of the pioneers in the area that one of the few clinics that do both ketamine and ketamine assisted psychotherapy. And I honestly just recently became aware of how rare that is in talking to other people in different parts of the region. Because, you know, at concierge medicine and psychiatry, where I still see clients, we do that, and I’m aware of you do that. So, so, you know, one of the pathways to providing ketamine and cap is on the physician side. So we’ve talked to lots of therapists, but you know, you kind of come in from the physician side, and so tell us how you got here, kind of, you know, what’s your, what’s your professional path, and how does that work for ER docs? And I’ll ask you in a minute, kind of, what you need to do that. So we’ll get more into the nitty gritty of it. But what about personally too? Like, what’s, what’s your draw to this, working in these non ordinary states and working with this person,
Dr. Jonathan Leake 3:02
yeah, so, you know, I think this story is a little bit funny in that I was a psychology major in undergraduate and became really, you know, super into particularly Neuropsychology and like, hey, how does the brain and all these things that are happening inside our head, you know, make our thoughts, feelings, emotions and those sort of things and and so I actually went to medical school to become a psychiatrist. I was, you know, completely hooked on psychology and psychiatry. And, you know, really had a lot of debate between going and getting a doctorate in psychology and going the medical route. And decided
Dr. Sandy Newes 3:33
to go. I had the same debate, actually,
Dr. Jonathan Leake 3:39
you know, which way to go, so, but got drawn into medicine, and I think particularly I was so kind of hooked on the science side, decided to go that route. But once I got into medical school, I kind of found that there were a lot of frustrations in psychiatry. You know, a lot of the medicines came with horrible side effects, or had, you know, caused even more problems for people sometimes, but really there was just this lifelong suffering. You know, we really saw depression and PTSD, as, you know, chronic life long conditions that we tried to kind of mitigate symptoms and manage symptoms. And, you know, there I didn’t see the kind of, you know, healing that I wanted to see happening. And so I ended up kind of putting psychology psychiatry to the side, and going to a place where you could kind of dive in and fix problems and make rapid changes. And that was emergency medicine for me, so it was a big shift. But, you know, finding the emergency department, I just loved the diversity of what we saw, and being able to kind of act on things, you know, quickly and make quick differences in people’s lives. And so ended up going on to be coming emergency medicine physician. So that was medical school, and then three years of residency here in Charlotte to become a ER doc. And you know, certainly as an ER doc, you know, I continue to be really interested in neuropsychology and neurology and how that all works. But what we see in psychiatry and emergency department is, you know, certainly frustrating and difficult. You know, we see people when they’re really. Really sick and have very limited resources to help them. And so I think, you know, psychiatry continue to be kind of a hard thing to really practice from the emergency department
Dr. Sandy Newes 5:09
Well, I imagine so, you know. And one of the things I know about ER docs is that it’s kind of, you know, fast paced and ever changing. So, yeah, yeah. So what about that kind of pressure with the mental health? I mean, that is something I hear repeatedly from physicians that, you know, is really hard, especially in the ER, where you’re trying to treat people with, you know, the resources that you have under high stress, high pressure conditions. And you know, we’re increasingly aware of, you know, prevalence of PTSD and chronic stress among providers in those situations. And, yeah, just curious what your thoughts are about that.
Dr. Jonathan Leake 5:46
I think it’s, you know, it’s tough. I think practicing in the emergency department mental health and mental health emergencies are extremely challenging for us because, one, we don’t necessarily have the training and resources to provide that care. Two, we’re in a really, really really busy place, you know, where maybe you have someone having a heart attack next door, and so you’re trying to think about how to care for both these patients. And then, kind of three, there’s just really limited resources. And so people often spend days to weeks in the emergency department with, you know, essentially zero psychiatric care for their psychiatric emergency waiting to be placed and cared for. So, you know, it’s really tough, and I think it really is going to require a systems approach, you know, to how do we, you know, help these people better, right? You know. And probably the ER isn’t necessarily the right place, you know, for them, but then, you know, it does this kind of also summarize, like, what we’re faced with as providers. You know that this kind of moral injury of not being able to provide the care that you feel like someone needs, or not be able to help someone that they need in a way that they need, and the little chunks that takes out of us as health care providers, you’re looking for time, I think, up as well, you know, right?
Dr. Sandy Newes 6:50
And no support for ER docs, right? Yeah, right. Nobody’s like helping you process what you’ve seen or witnessed or experienced or the, you know, the effect on your nervous system,
Dr. Jonathan Leake 7:01
yeah. Now there was a, you know, I was actually had gone back, was watching some scrubs episodes recently, you know, great show. And there was one, you know, where they talk about, you know, the this doctor being in the room with a family, telling them that their loved one is dying or about to die. And, you know, they’re like, no one in that room is going back to work except for the physician, you know, and the physician is immediately going on to see more patients and care for more people. And so it’s, it’s, you know. And I think there’s not as much training around that as there probably should be of, how do we hold that space for physicians and providers and nurses and, yeah, help support them through those things well,
Dr. Sandy Newes 7:38
and even acknowledging that it’s a thing, right? Right? Like, oh, here you go. Like, you know, here’s somebody like, you know, struggling with a heart attack, may or may not, you know, live. Here’s somebody with a psychiatric emergency. Here’s, you know, some kind of accident coming in and, you know, here’s some mandates from administration. And then you come and be like, Hi, you know, how’s the dog? How’s the kid? How was your day? Like, oh, you need me to vacuum? Like, oh, okay, I’ll back. Yeah, it’s just a lot. So, yeah, so how did you make that leap? Like, you know, here you are, like, working as an ER physician with, you know, tons and tons of training and background. And here you are in the ER and, you know, now here you are running clinics, and, you know, ketamine infusion clinic. So how’d you get from here to there? Like, what impetus? And, you know, yeah,
Dr. Jonathan Leake 8:33
yeah. So, you know, basically, my business partner, Keith Parris, and myself had worked together in the emergency department, and we’d worked together for several years, and we started, you know, looking at, obviously, taking care of people when they were sick and run down. And so the overall thought that we had was, how can we help people live healthier lives? How can we help people live healthier so they’re not getting to the point they’re showing up in the ER, yeah. And so kind of our first solution to that was these hydration clinics, you know, and really, kind of opening Hydrate Medical we opened that in 2014 with kind of this concept of helping boost people’s health and wellness. And so what we did is we wanted to be this beautiful space where people could go and relax and receive vitamin infusions and kind of focus on, how do we, you know, help them just kind of boost their overall body’s wellness so that they could feel better overall. And so we opened our first clinic. There was really that focus. And, you know, found that it went really well. You know, people were getting better. And, you know, it’s kind of funny. I know now that I think the set and setting of Hydrate Medical is really important too, that it was this beautiful place that people could take a little time out of their day and come and relax. And so, you know, we continued that work. And then around 2016 2017 you know, I started seeing this research really coming out about ketamine and ketamine infusions and for mental health. And so that came together in that, you know, we had a clinic where we could do IV things. And, you know, I felt very comfortable with ketamine. I use it almost daily. My practice in the emergency department for sedation and. So I kind of knew the medicine, and knew the safety and efficacy of it from that side, and so put
Dr. Sandy Newes 10:05
like a little bookmark on that, like we’ve heard it might have even have been you we’ve heard in our trainings, you know, er, Doc say, like, you know, we use this in the ER, like, water, absolutely an incredibly safe medicine. So I just want to, always wanting to highlight that for people, that the adverse effects often come from psychological, absolutely influences and or over sweeping claims about what ketamine can and can’t do, but not really physiological. Yeah,
Dr. Jonathan Leake 10:31
no, I think 100% you know, it’s we get to see the safety data every day in the emergency department, we’re using much higher doses on very medically ill patients and seeing how well they do. Right, right, yeah,
Dr. Sandy Newes 10:41
yeah. So, okay, so it was, Are you saying that you were following the research? And suddenly you’re like, oh, wait a minute, we could actually do this at Hydrate, yeah. So, you
Dr. Jonathan Leake 10:51
know, the the research was coming out, and I kind of dove into it. I always said, you know, this, this looks interesting, but let’s see what the science says. And so, you know, being the kind of neuropsychologist that I was on the on the side, you know, I kind of dove into it. It was like, Man, I really like how this is working. We’re seeing that it’s actually changing the brain the way that the brain works. And we’re seeing kind of amazing results anytime in medicine that you see 70 or 80% of people responding to a treatment, first, you have to be a little bit suspicious, like, hey, you know, is this real? But then when you’re seeing this repeated in multiple studies, and those numbers coming out of numbers coming out over and over again, it’s like, super exciting. We’re like, and this is cool to see, you know, something, a medicine that’s actually working like this. And so we decided to kind of put it together and design a protocol and bring it into Hydrate Medical and start doing some, some kind of main infusions there. Yeah. And so it was, it was an amazing transition to kind of jump in and be part of that and to see kind of the practice develop from there. Okay, well,
Dr. Sandy Newes 11:48
and so, you know, what do you think having been through it, you went through CIS you’ve been through living Medicine Institute. You’ve continued your study like, you know, if you if somebody you know is a physician or medical provider or even a therapist, because you, you know, been witnessing that pathway too, like, what’s the pathway? How do you want to recommend? What are you know? What’s the most important thing for people to know? So I think it’s hard
Dr. Jonathan Leake 12:15
as a medical provider, you know, it’s easy to jump into the literature on ketamine and kind of say, okay, what are people doing? What works? And then think you’re going to bring it into your practice. And unfortunately, ketamine research is very, very clinical. It’s like, hey, we give people six infusions at point five makes per gig, and 70% of people will get better. And you know, they might need occasional other infusions. But there’s really nothing about what does that actually look like, right? I mean, if someone’s just coming in and laying on the floor and we’re giving them ketamine, them ketamine? Are they like sitting in a chair? Are they in a doctor’s office? You know, what did they do while they got ketamine? And so that kind of came up for us, I think naturally, when we started this at Hydrate and then, you know, kind of roll it into to Reve was seeing, you know, oh, the more we support people, the more we prepare them for what their experience, the better the room is set up for, you know, kind of introducing this comfort, the better they do. And so, you know, I kind of quickly saw that as we started practicing with ketamine, and it led me to kind of dive into all this other training, like, Hey, let’s go, you know, dive into psychedelic therapy and training and bring some of that into the treatment. Let’s go have experiential training at living medicine. And, you know, kind of see what this actually feels like, and how they incorporate that into our process. So,
Dr. Sandy Newes 13:26
so you like, a lot of people get into the field, are like, you know, I mean, even though it’s not legal, people are like, Oh, I, you know, I had my own psychedelic experiences. You know, that, like, changed things for me and I wanted to pursue but it sounds to me like you were very literally following the science, yeah, following the research, following the science, and also following the business, right? Like, you know, your business plan, and you work independently, so I can respect and appreciate that most of the people who you know want to do this work are as well, right?
Dr. Jonathan Leake 13:55
Yeah, and I think that that’s focus, you know, you know, from in Hydrate, we were really super client focused already, and so we were very much looking in that experience for our clients already, you know, hey, what made this experience better for you? What made it worse for you, what was distracting? And I think we were tuned in from that, both from a provider standpoint and from a business standpoint, of like, hey, what makes our client have the best experience? And naturally, we were finding that the more we supported them, the more we cared for them, the better the room was set up, you know, the better they did. And that kind of drew us into the psychedelic kind of research by accident, you know, because it was just kind of like, well, I hear they’re working with other psychedelics. What are they doing in those studies? And in those studies, it’s all about set and setting, and exactly what they’re doing for the clients, to support them and prepare them. I mean, the more that we brought into the practice, the more we found, or the better we found people were doing, which was just super cool and exciting
Dr. Sandy Newes 14:44
well, and for people who don’t know, let’s just kind of take a little side bar and talk about the differences in different types of ketamine clinics. Because, you know, my impression, and you would know this even better than I do, because again, you’re kind of, you know, surveying the business side of the. At, which is that, you know, in some infusion clinics, it can be just like, kind of set up, almost like nail salons. People are, like, scheduled at 15 minute intervals. And, you know, sometimes there’s a television there. Do you all have televisions in your in your okay? Because I would tell people, I’m like, if they tell you that you can watch Netflix, like, that’s not a good clinic, because it’s not like visual,
Dr. Jonathan Leake 15:21
you know, not in that way, right? Yeah, right. And
Dr. Sandy Newes 15:25
it can be kind of, you know, set up, get people through, get people moving, you know, versus like, you know, your clinic, because I’ve been at some of the sites and, you know, the clinic that I work at, where it’s all about, you know, that set and setting people, and attending to the client and making sure that they feel comfortable and they feel safe and that we have a relationship. Can you speak to the importance of that? Yeah, I mean, I’m witnessing even just in the field, versus what you all are doing, and throw anybody under the bus rather, really, you know, hit this piece about the importance of the care part.
Dr. Jonathan Leake 15:59
Yeah, there’s this huge divide, you know, that this is more than just ketamine infusions or ketamine shots, that is really ketamine plus care, you know? And I think that that’s where this field needs to go, is that we have to understand that we’re doing something that is is very deep and very transformative for people. And so it’s a huge responsibility that comes with that of like, this isn’t just ketamine, it’s ketamine therapy, or it’s ketamine plus care. And so I think you do, you have this range of clinics that are just kind of bringing people in, you know, maybe there’s a group room, and not in a really great psychedelic, you know, therapy Design Group room, but just a room of chairs where people are staring at each other and getting ketamine infusions, and there’s not really any support or preparation for the experience,
Dr. Sandy Newes 16:42
just like hanging out, like, kind of staring at each other, yeah,
Dr. Jonathan Leake 16:46
you know, without no weird, right? And very weird, and they’re strangers. There’s no, like, focus on the group, or, you know, group dynamic of that, I’ve had heard stories of that you you know, said where it’s like, oh, yeah, what do you want to watch on Netflix today while you’re getting your ketamine infusion, exactly,
or the news is on, how about that? Here you go. We’ll just have a little like news while you’re doing this. And so
Dr. Jonathan Leake 17:10
maybe it dives a little bit into like, what is really, like ketamine therapy all about. And, you know, it’s, it’s, I think that some of the early literature, and hopefully this is starting to change, but was really seeing the psychedelic experience with ketamine as a side effect. And it was like, you know, hey, yes, ketamine, you know, it causes neuro plasticity and works on glutamate receptors. That’s great, and unfortunately, it might make people have this little psychedelic experience too. And we wish that didn’t happen, but it does. Sorry, but if you put on Netflix, they do find right? And you even have some clinics start adding, you know, really powerful, dangerous sedative medications to infusions to avoid the psychedelic experience. So maybe they’re adding other anesthetics to try to put people asleep so they’re not having that psychedelic experience. But we found the more you lean into it, the more you support people that it’s actually this huge healing part of the process, and now maybe actually people have long term effects and long term gains because of the psychedelic experience and the support around that, you
Dr. Sandy Newes 18:06
know, right? How do you differentiate this? This becomes relevant again, because you’re doing both, right, you’re doing the you know, you’re doing the infusions and you’re doing the therapeutic side. So how do you differentiate care from cap, like you’re saying ketamine care, which I appreciate, the care with which that word is chosen, because it’s, it’s broad versus, you know, one of the things that we’re kind of standing for is like, let’s get clear on a definition of what cap is. Ketamine is psychotherapy. And, you know, ketamine treatment and ketamine therapy are often used interchangeably. So, you know, when we kind of go into this piece about ketamine, the care associated with it, versus ketamine assisted psychotherapy, like, can you speak to that? Like, what you’re seeing, how you do it in your clinic, you know, what you see is the differences there.
Dr. Jonathan Leake 19:03
Yeah, I think there’s almost this continuum, right? That it’s like, all the way on one side is like, just ketamine treatment, or, you know, ketamine infusion, and all the way on the other side is like, cap, okay, right? And so, and ketamine care, plus care, or ketamine therapy, as we described, I think kind of falls somewhere in the middle of that. And, you know, I think that really ketamine alone, or just ketamine treatment, it carries a lot of risk with it in a like, psychological way. I think, because no matter how you frame this, or do this, this treatment, you’re going to end up getting this psychedelic experience in this psychedelic, you know, opening that’s going to come up. And so, what kind of container are we holding people you know within that you know, so, you know, if you just go into an infusion place, you’re put into some small room. You’re given, you know, Netflix is turned on. You’re given ketamine. All this psychedelic stuff’s happening, all this mind opening is going to happen no matter what. And so how do we hold that for that person, and make sure that the right things are done? And even if we look at. From a neuro plasticity standpoint, like, Hey, we’ve turned on this switch in the brain to rewire, and so how do we hold and put the right things in so the brain is rewiring in a way that we want it to right.
Dr. Sandy Newes 20:10
One of the people that I you know, really follow and admire, who I interviewed a while ago, Dr.Ron Siegel. He does mindfulness teaching, and he will talk about optimizing the conditions in your life that allow for you to remain or stay more deeply in a mindful state. And that’s what I’m hearing there. Like, how can we optimize the conditions that people are going to get the positive benefits of this neuro mind? Is that accurate? Is that
Dr. Jonathan Leake 20:34
so, yeah, and I think that the you know, studies and our experiences, and we’ve talked about this, and I think you guys agree, like, the more we surround people with that care and that therapy and those parts to this, the better they do long term, the more likely they are to have transformative change, you know, where this is something that you’re talking to someone about two years ago, and they’re saying, Yeah, I still feel really, really good, and still have some amazing tools from that experience, you know, rather than just kind of focusing on just the medicinal side of like, yeah, you got some ketamine to change some things in your brain, and maybe you feel better for a little bit, but it’s harder to have permanent change without kind of looking at the therapy side. I think, you know, well,
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