Since 2006, psychedelics have experienced a true renaissance in the United States and across the world. People have been using these powerful substances for recreational, spiritual, and medicinal purposes–and in varying ways. While high doses of psychedelics, such as LSD, psilocybin, MDMA, and ketamine, among others, have been found to have profound effects on mental illnesses, there is a burgeoning interest in the use of lower doses outside of the medical environment.
Microdosing of psychedelics as a practice is becoming more popular. Taking psychedelics in doses so low as to not produce perceptual changes has been anecdotally touted to decrease depression and anxiety, as well as improve energy levels and creativity. A 2019 survey conducted earlier in summarizes experiences of people microdosing on classic psychedelics (2019, Hutten et. al). The survey showed that many had positive perceptions of microdosing psychedelics, even stating that microdosing was more effective than conventional treatments, while less effective compared to higher dose psychedelics.
The implications for microdosing are two-fold: lowering the amount of a substance decreases the risk of side effects and decreases the potential cost. The decreased risk of side effects may also change the need for the substance to be administered in a controlled medical environment.
Ketamine is the only legal psychedelic to date. While any medical provider with a DEA license can prescribe ketamine, it takes a provider with a special skill set and education to optimally treat patients with chronic pain or treatment-resistant mood disorders with this drug. Ketamine is given intravenously (through a vein, directly into the bloodstream) which allows for the greatest bioavailability and ability to adjust the dose to the desired response. Ideally, IV ketamine for treatment-resistant mood disorders elicits deep relaxation, personal insights, and regrowth of neuronal connections.
The focus on ‘set’ (mindset) and ‘setting,’ as well as comfort with the guide or healthcare provider, are touted in the psychedelic community as especially important for the outcomes of psychedelic experiences. However, the possibility of microdosing in the home environment, instead of a medical office, has the potential for capitalizing on the comfort of a patient, enhancing relaxation and perception of the experience overall.
Oral ketamine, in the form of a ‘troche’–a waxy, dissolving tablet–has become a part of many ketamine providers’ practice over the years. The purpose of these troches is to extend the benefits of IV ketamine, earning them the nickname ‘oral ketamine extenders.’ Because the bioavailability with oral ketamine is so much lower, the experience is usually not psychedelic, and it is safe for home use. This allows patients to enjoy a longer period of relief and save money, as it increases the amount of time between infusions.
Of course, Alchemy Wellness only advises the use of oral ketamine troches under the direct supervision of a qualified medical provider. We do not advocate the use of any illicit or illegal substances.
Rachel Featherstone is a nurse practitioner practicing at Alchemy Wellness, the newest ketamine clinic in Richmond, Virginia. Her professional focus is on the intersection of reproduction, sex, and mental health. She is a proud graduate of Frontier Nursing University, where she studied women’s health. When she’s not reading journal articles or kayaking, she’s spending her time resurrecting the Greater Richmond Maternal Mental Health Coalition.
1. Front. Psychiatry, 13 September 2019 | https://doi.org/10.3389/fpsyt.2019.00672