Ethical Guidelines for Ketamine Clinicians

Version 1.1 – Posted on 12/13/2020

The ethical ketamine clinician recognizes that therapeutic ketamine is a mental health treatment. In this document, “therapeutic ketamine” refers to ketamine that is administered to a patient primarily for a psychiatric indication, psycho-spiritual exploration, and/or psychological work. Therapeutic ketamine does not include ketamine that is administered primarily for anesthesia or pain management, which are considered separate fields (specialties) from therapeutic ketamine.

The ethical ketamine clinician recognizes that ketamine is a powerful psychoactive medicine with prominent dissociative and psychedelic properties. The ethical ketamine clinician recognizes that therapeutic ketamine patients require specialized psychological care before, during, and after receiving ketamine.

There are three roles in every therapeutic ketamine treatment: (1) a mental health professional; (2) a medical professional; and (3) the patient. In some cases, one person may be able to fulfill both professional roles, such as a psychiatrist who has substantial psychotherapy training.

— The responsibilities of the mental health professional include: doing the clinical intake interview and assessment; doing integrative treatment planning; providing psychological preparation before the ketamine administration; providing psychological support during the ketamine administration; and providing psychological support following the ketamine administration (a/k/a “integration”); and managing any psychological or psychiatric emergencies during the course of ketamine treatment.

— The responsibilities of the medical professional include: assessing the patient’s physical condition before ketamine treatment; attending to the physical and medical safety of the patient during ketamine treatment; and assessing and treating any adverse reactions during the course of ketamine treatment.

— The responsibilities of the patient include: communicating clearly and honestly with the clinical team; and actively participating in the integrative treatment plan as much as possible.

The ethical ketamine clinician recognizes that there are different approaches to ketamine treatment, and that each approach has advantages and drawbacks. The ethical ketamine clinician is skillful with the specific treatment(s) that they offer. In addition, the ethical ketamine clinician is familiar with all of the major routes of administration, different dosing strategies, and different conceptual paradigms for therapeutic ketamine treatment.

The ethical ketamine clinician understands and appreciates the importance of integrative psychiatric/psychological care for therapeutic ketamine patients (i.e., using multiple strategies to get better and stay well). The ethical ketamine clinician takes the time to explain this to each patient, and helps patients to connect to these resources in their community.

The ethical ketamine clinician practices within the scope of their professional license, and they recognize their limitations with respect to their professional training and experience. They actively seek consultation as needed, and they make referrals to other professionals as needed.

The ethical ketamine clinician upholds all of the responsibilities of their professional license with respect to all aspects of their clinical practice, including informed consent, record-keeping, professional boundaries, confidentiality, and general professional conduct.

The ethical ketamine clinician aspires to be compassionate, thoughtful, honest, and forthright in all of their personal and professional communications.

The ethical ketamine clinician actively tries to make therapeutic ketamine accessible to members of the community who do not have the financial resources to pay for the treatment that they need.

The ethical ketamine clinician is honest and transparent in marketing their services. They rigorously adhere to the FDA guidelines about advertising, and their clinical and advertising claims are supported by the research literature.

The ethical ketamine clinician has received special training and/or mentorship in working with therapeutic ketamine. A comprehensive training includes substantial education in the following domains: medical, psychological, and psychedelic. Additionally, the ethical ketamine clinician regularly reads the newly published literature and participates in continuing education to stay abreast of the latest developments in this rapidly growing field.

Update on 12/30/2020: These Ethical Guidelines were published (with additional commentary) in the Journal of Psychedelic Psychiatry (Vol 2, Issue 4, Dec 2020, pgs 19-23).