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What to Expect in This Episode

Episode 102 of Utah in the Weeds features Thomas Swahn of Swahn Balanced Health, a clinic specializing in ketamine infusion therapy and Medical Cannabis evaluations.

Podcast Transcript

Tim Pickett:
Welcome everybody out to episode 102 of Utah in the Weeds. My name is Tim Pickett, and I’m the host. Here, a podcast about Utah cannabis and cannabis culture, and medical cannabis. And today, another discussion about psychedelics and these psychotropic medications. Ketamine, is the topic, mostly, of our discussion today, with Tom Swahn, of Swahn Balanced Health. They have a clinic in northern Utah, and specialize in major depression treatment with Ketamine infusion therapy. This discussion goes right along the lines of our discussion with Steve Urquhart in a previous podcast, where we talked about psilocybin and The Divine Assembly, with Steve’s church, and those developing research and studies regarding all of this psychedelic medications that’s coming down the pipeline.

Tim Pickett:
In fact, additionally, my discussion with the president of The Libertas Institute, Connor Boyack, about the psilocybin bill here in Utah that was recently passed, which develops a task force to study the effects of psilocybin, and what the program would look like, if in fact, Utah was able to put a program for these psychedelics and this type of treatment therapy together.

Tim Pickett:
I’m excited to introduce you to Tom Swahn. He’s a great guy, and knows a lot about this therapy, has been doing this for quite a while. Just a really interesting new concept of treatment that you go to every couple of weeks. Or you could go to a retreat and find these experiences, and really get in touch with what’s happening deep inside the brain, changing perspectives, and associating a different perspective to certain events. It has the potential to be really powerful for people, and I’ve known a lot of people who have had great success with this.

Tim Pickett:
Make sure you’re subscribed on any podcast player that you have access to, Utah in the Weeds. You can also find us on YouTube at Discover Marijuana. We have a lot of videos there for cannabis and cannabis therapy. Keep doing this program with cannabis here in Utah, and just excited it’s a beautiful June day here. Welcome. The birds are singing outside. Enjoy the summer and this discussion with Tom Swahn.

Tim Pickett:
Where did this all start? Because it looks like you went to Westminster. Are you from here, Utah?

Thomas Swahn:
Yes, I’ve always lived in Utah, ranging from cities between Farmington, is the furthest south, and right on the line between Ogden and north Ogden is the furthest north, but always in the little bubble.

Tim Pickett:
You have slightly gauged ears. I don’t even think they would’ve let you live in Farmington.

Thomas Swahn:
It’s true, that I was not well received there. And I’ve always been a little eccentric with my appearance, and so that was one of my first [inaudible 00:03:26] when I was young, growing up in an LDS family, that kind of free-thinking and doing whatever you felt like, wasn’t well received. Made you a bad person, accordingly a lot of the church leaders and the neighborhood where I lived.

Tim Pickett:
Right.

Thomas Swahn:
So from a young age, I was raised in an LDS family, but around 10 years old, I was telling my mom, “I don’t think God is real. I don’t think these are good people here. I don’t know why would take our advice on how to be good people from people who are like this.” And she would tell me, “If you talk bad about God, you’re going to get hit by lightning.” And I’ve always just been super logical, and I was like, “Then why do I not get hit by lightning?” That seems … I just always needed evidence.

Thomas Swahn:
And that’s the thing about Ketamine and other psychedelics, is that the experience was a spiritual experience. For me, that was evident. I was from this staunch atheist too, now, I feel like a pretty spiritual person.

Tim Pickett:
How did you get into medicine?

Thomas Swahn:
Frankly, it was just, I didn’t really feel when I was younger like I had a sort of a calling. But I knew I really liked science, I wanted to do something where I can help people. So I was like, “Well, maybe I’ll go to medical school.” So I started to doing premed in college, and within a couple of years realized, “That’s not something you can do on a whim.” Sure, I felt like I could have the capability to do that, but without the drive to do it, that’s so much work. So I was like, “Well, what can I do with all the prereqs I’ve already done in premed?” So I applied to nursing school, and they were like, “Yeah, you got all this prereq coursework done. You got great grades. Come on in.”

Thomas Swahn:
So I did that, and I just practiced as a nurse for a while. I worked in variety of different areas, from long-term care in hospice, and physical therapy rehab, to, I went to the operating room after that, and I left that-

Tim Pickett:
Where? Where were you in the operating room?

Thomas Swahn:
At Davis Hospital.

Tim Pickett:
Oh, cool. That’s what I did for six and a half year, is GI surgery and trauma.

Thomas Swahn:
Oh, nice.

Tim Pickett:
Right, for the general surgeons in West Valley. And the OR nurses there, you’re way too young for that, right? That’s where they go to retire.

Thomas Swahn:
Yes, yeah. But, I mean, there wasn’t a whole ton of critical nursing skills you needed. And so the fact that I was smart and could move like the wind, I was perfect there. I excelled at it.

Tim Pickett:
Yeah.

Thomas Swahn:
Get everything prepped and good, and move fast. But that was one of the most fun areas to work, but it was not going anywhere from a [inaudible 00:06:22], kind of watching my bills slowly get lost.

Tim Pickett:
Sure.

Thomas Swahn:
So moved to ICU, I wanted to do something else, but didn’t know what. And I went there to just get all the skills that I could. And while I was there and watching people pretty much go through this worst case scenario of almost dying, but then we pull them back from the brink, just enough to survive, but their quality of life is garbage. And then we just send them home like we did a good job, and everybody pats themselves on the back. That was-

Tim Pickett:
I know. It is true, right? They leave, they go home. They’ve just spent 10 days intubated, 27 days in the ICU, then they … couple of, five, six days on the floor. And then you just send them home.

Thomas Swahn:
Yeah.

Tim Pickett:
And you’re like, “Oh, this is cool. Way to go.” We operated on a guy who he blew a hole in his small intestine, just by running into a pole. He was playing some football and ran into a pole. And it took him … I saw him later, six months later after he was discharged from the hospital, and he was skinny, still. Because he’d lost the weight in the hospital, and then he decompensated so much that he never … it’s just so long to recover.

Thomas Swahn:
Yeah.

Tim Pickett:
And he was a normal healthy guy, before and after. You would’ve considered him, after, a really healthy guy. But it just, so long to recover. And there’s not a good support system, even still. You have to know how to navigate that after-care system, you feel like, to get the help you need. Home physical therapy, home health. Your insurance will pay for all this stuff, but I never ordered it. And I’m a PA, I discharge people from the hospital. It wasn’t my wheelhouse really, so I didn’t really manage it.

Thomas Swahn:
I feel like each of these patients needs a social worker just to manage their own case, because our system is so fragmented that there’s … Yeah, how do you keep track of all the things and work your way through it? And the insurance is the one that gets to call the shots at every turn.

Tim Pickett:
Sure.

Thomas Swahn:
We have the people who stand to lose money if you actually get the care you need, deciding if you need the care.

Tim Pickett:
Yeah, that’s true. So when did you decide to go into NP school? And you went to Westminster, yeah?

Thomas Swahn:
Yes. When I was in the ICU and seeing us just send all these people home, and not even just physically damaged, but mentally traumatized from the experience, we’d just send them home and say, “Good luck.” So I was considering doing CRNA, and that was based on my time in the OR, just because I thought it was a lot of fun. But I decided that a nurse …. that I wanted to help prevent these issues that land people there. So that’s why I decided to go to NP school. I also am a very ADD person, and so figured if I got bored, that would afford me the chance to switch specialty every time I felt like I needed to, keep it fresh.

Tim Pickett:
Yeah. Describe nurse practitioner school. Because the way we heard it in … Okay, this is not a slam to NPs, but I always think this is funny, that I was told this is NP school. Right? So I’m a PA, a physician assistant. In Utah, we are very, very similar. We used to be a little less similar until there was a bill passed two years ago that independentized PAs, allowed us to be independent, and actually bill people. And we’re one of the only states that does that.

Tim Pickett:
But in school, I was told that nurse practitioner school is nurses teaching nurses how to be doctors. That’s literally how it was described to me. Of course, this is a doctor who said it that way. But what was it like for you?

Thomas Swahn:
I really had a good experience at Westminster. Through the clinical rotations, I was able to choose pretty much all of my preceptors. The school would provide them, but I had so many connections to doctor who I knew personally. So I would just cast a line out for different specialties. It’s like, “Can I come follow you for a few months?” And so that, it was beneficial for me, and a lot of my preceptors were MDs or PAs.

Tim Pickett:
Sure.

Thomas Swahn:
I guess all my instructors at the school were nurse practitioners as well, so that’s literally true. It was nurses-

Tim Pickett:
Yeah, nurses teaching nurses how to be doctors.

Thomas Swahn:
Uh-huh.

Tim Pickett:
I mean, it’s funny, because your model, the nursing model, the lamplight of learning … My best friend in the world is a ICU nurse at IMC. Great guy, very, very smart guy. And there’s some things about nursing that are really, really great. And then there’s these other things that are … they’re traditional nursing care model that is … I don’t know, we don’t talk about it a lot. Do they have that at Westminster? At UU, it was like, “The lamplight of learning,” or something. And in PA school, we have the same thing. We have these things that were dumb.

Tim Pickett:
Does that taint you? Do you look back and think, “Oh, yeah. That part, I could do without.” Or, “I wanted a little more clinical diagnostic skills compared to the nursing skills.” Or, alternatively, because you had all the ICU experience and all the nursing experience, it was a lot easier for you to move towards, “Oh, that’s the pathophysiology of why that was the way we cared for the patient in the ICU. Now I understand how to diagnose that.”

Thomas Swahn:
That was a lot more my experience, was just, “I’ve seen these things done for years,” and I knew already, basically, what we would do. But school was, then, taking it up the ladder to why, why are we doing these things. And so I do feel like that was a major benefit, to have had so much clinical experience. But a little bit of the problem was everybody in my cohort had different backgrounds. And so depending on what you had seen in your clinical practice so far, certain subject would be a breeze. And then for me, I hadn’t done anything with children, so I struggled with pediatrics a little bit.

Thomas Swahn:
Almost to an embarrassing level, because between me and my wife, she had five kids and I had three when we got married. So we’ve got eight kids, but I’m still looking at milestones I could never quite nail down, like, “What is age was that? Why are you looking at …”

Tim Pickett:
Yeah. “When do you get hair there? You got to be way too early.”

Thomas Swahn:
Yeah, I thought it was a pretty good education overall. I do feel like we took a lot of the diagnostic information and a lot of the other stuff we learned from medical literature, than just nursing.

Tim Pickett:
Do you feel like there were things in that program that you, right off the bat … Okay, so you’re into Ketamine and alternative therapy, you do some cannabis stuff. But did you feel like even through the program, you were already a little skeptical, or did that come later?

Thomas Swahn:
Skeptical of Ketamine?

Tim Pickett:
No, skeptical of what we were taught. I don’t know. I remember our pharmacology and depression section, there were five medication types that we could give as first line. SSRIs, Wellbutrin. And really, it came down to, one of the things they told us in school, was just ask your patient if they know somebody who’s taken a medication, what that medication was, and did it work. Because if you diagnose depression in somebody, and they know a friend who took Zoloft, and they had success, they’re actually more likely to have success with Zoloft than a different medication. Just by the fact of knowing somebody who took it.

Thomas Swahn:
Yeah.

Tim Pickett:
Which made my ears perk up like, “What the … are you talking about?” You’re leaning into the placebo effect.

Thomas Swahn:
Yeah.

Tim Pickett:
And some of these, yeah, that power of subjection is real. And so I started getting a little skeptical right from the beginning in certain aspects of medicine.

Thomas Swahn:
Yeah. In our covering of depression and stuff, there wasn’t really anything like that they told us. It was actually broken down pretty thoroughly. And like, “These ones are energizing anti-depressants. These ones are more calming. In these cases, you want to use this. In these cases, you want to do this.” But overall, we didn’t hammer on that really all that much. We did a basic amount of [inaudible 00:15:35] and stun testing. But mostly, it was just providing us tons of resources to reference, once we were in practice.

Tim Pickett:
Oh, nice.

Thomas Swahn:
So that was nice. But overall, we didn’t do any education on Ketamine. That was something that I became personally interested in. I got really interested in it, because it has this instant anti-suicidal effect, and I had a lot of suicide in my family growing up. I lost my dad to suicide when I was eight years old, I lost my aunt a few years later, and there were a variety of other family members who had attempted or succeeded in their suicide attempts. And this was something that could’ve changed my whole life.

Thomas Swahn:
So I just became really interested in it personally. And the more people I talked to about it, I was finding this … We all went through the D.A.R.E. program as kids, and thought, “If you use any of these illegal drugs, they’re all scary, and you’re going to trade a moment of fun for your brain. You’re literal … destroy your brain just to have fun times.” So that was when I was like, “Yeah, I would never be interested in that.” I value my intellect. But then, we find out from the evidence, actually, these things are really good for your brain. Psychedelics, Ketamine, they promote all this mental wellness, even in normal people without depression.

Thomas Swahn:
So I became really interested once I saw that safety and efficacy data. And I found that the people I was talking to were consistently like, “Oh, but it makes you hallucinate. I would never do that. I’m not that kind of person.” And that was wild to me. I’m like, “What does that even mean? What are you talking about? What kind of person?” The fact that it’s a pleasant experience and good for you, to me, that’s a win-win. But to them, there was something evil about a substance that makes you high, regardless of its effects.

Tim Pickett:
Yeah. So say a patient come into you, and they’ve … I would imagine, most, there’s a lot of patients who come into you now, and they have never experienced anything like this in the past. Even with cannabis, they may have smoked weed and gotten high and understand what that feeling is. but there are a lot of patients, I bet, that come in with nothing like that, especially in Utah.

Thomas Swahn:
Right.

Tim Pickett:
With no experience of being, “high”. How do you explain Ketamine to that person?

Thomas Swahn:
I’ve written a whole Ketamine preparation guide that I send out to them and tell them a little bit about what to experience, how to get … the treatment. But when they come in for their treatment, I tell them, “We could talk about this all day long, and you will still have 0% of an idea of what the experience you’re about to have is actually like. The only way to know is to go through it.” And that why, if you think about what language is, t’s based on shared understandings. You can I can use words, because we both understand what that means. But if one of us has an experience that is completely outside of anything the other person could’ve possibly experienced, then there’s no words for that.

Thomas Swahn:
And so I tell them, “It’s going to be very bizarre. It’s going to feel like an ineffable, strange journey that you’re about to go on. But 95% of people feel incredible during it just regardless. It strips away anxiety, it covers you in a blanket of serenity. And your body is totally safe and fine. We’ve got a good environment. I’m here for you if you need. I’ll be checking on you regularly. You got a [inaudible 00:19:28] thing. You’re going to do great. But it is strange.”

Tim Pickett:
“But just plain and simple, this is going to feel strange. Let it go. Try to enjoy it, or just see where it takes you.” The initial treatment, how long is the effect?

Thomas Swahn:
So the IV infusion itself is over 40 minutes that I do here. Usually about 10 to 15 minutes after that, the strongest effects are wearing off, but then there’s residual effects for a few hours to the rest of the day, at least as far as the physical effects. The mindset changes. People will usually experience a benefit right away. That first couple of days after, they suddenly are aware of joy again. It’s kind of brought awareness to things in their life they can change and it’s given them a diff perspective of their problems.

Thomas Swahn:
But for that first one, they usually only last a couple of days, maybe up to a week or two or most, and that’s where we start doing the repeat treatments and a series. For most people, especially in more treatment resistant cases, they’ll need a full series of six treatments done twice a week. And then after that, we usually are able to achieve a pretty robust and durable response. And I’ll see most patients about once a month when their symptoms start to come back, they’ll come in for a booster treatment.

Tim Pickett:
About once a month. What’s the duration, the lifespan of a typical patient? Are they coming in for kind of a blast of treatment and therapy, and then you do once a month for … I don’t know do people do this for years and years?

Thomas Swahn:
Yeah, a lot of people, it’s going to be … so basically, we know from depression, your brain wants to build itself a certain way, and we can modify that with drugs. But as soon as you don’t have the drugs, it’s going to build itself back the only way it knows how. So usually, it tends to be a long-term thing, but I have noticed, I’ve been doing this for a year, and I’ve noticed that my longer-term patients, I will start to see them less and less over time.

Tim Pickett:
Yeah.

Thomas Swahn:
And at first, worried that was just they couldn’t afford it, or were just dealing with it. But when I came to see them again, they were, “I’ve just been doing great.”

Tim Pickett:
I don’t really know a lot of the research behind this, but is there a rebuilding of neuro connections in the brain? With psilocybin, just the fungus, that is affecting something in the brain, where you’re creating new neural connections, or you’re disassociating some, and then allowing others to, I don’t know, develop, or you’re finding new connections. Because in PTSD, you have this emotional part of your brain that’s connected to the logical part, and it builds these calluses where it’s just firing over the same thing, so people get in the thought loop. Every time they go to a certain experience, they experience that trauma again. Where psilocybin is starting to show that these things are changing these neural connections. Is that the same with Ketamine?

Thomas Swahn:
Yeah, it’s a lot of the same stuff. With the classical hallucinogens, like psilocybin, or LSD, or ayahuasca, those are all serotoninergic in nature, they’re [inaudible 00:23:04]. This one, is an MDMA receptor, which is works with glutamine, and that’s our brain’s main excitatory neurotransmitter. And so you get a different feeling with the experience. And psilocybin and other of the classical hallucinogens can be very emotional. They’re very mood augmenting. And so whatever you’re experiencing is just an amplified version of that.

Thomas Swahn:
But Ketamine works through, they call it a use-dependent blockade, so as soon as those neurons are trying to fire, the most active one for those thick neural tracts of those ruminating negative thoughts are, those neurons will start to get plugged up with Ketamine. And so a lot of patients will, during their experience, try to be telling me what their experiencing, and then suddenly be like, “Lost my thought.” And I’m like, “yeah. We know. That’s what’s supposed to happen.”

Tim Pickett:
Right.

Thomas Swahn:
But it interrupts them by blocking them with ketamine, the most used neurons. But at the same time, it has a blockade effect on inhibitory neurons. It keeps our subconscious quiet, so we can think. And so, it’s similar to psilocybin, we get widespread brain communication through these back channels, areas that don’t normally communicate. They’re been able to identify a cascade of effects that results in an increase of brain-derived neurotrophic factor, for, they call it BDNS. And that actually does increase dendritic branching and synaptogenesis, people will have new neural connections forming at an increased rate.

Tim Pickett:
Wow. From an illegal standpoint too, obviously, your clinic can’t do psilocybin treatments.

Thomas Swahn:
Not …

Tim Pickett:
Did you say not yet?

Thomas Swahn:
I said not yet, but one day, we … I mean, they did pass through the Utah legislation, it was totally done, signed by the governor, house bill 167. I think it’s called the psychotherapy mental illness task force, something along those lines.

Tim Pickett:
Yes.

Thomas Swahn:
And so, they’ve put together this task force to make recommendations for currently illicit substances, like psilocybin or MDMA, and make recommendations on it, if and how, and how much, and who can use these for their therapeutic benefits. And I think that it’s good news that we’ve identified these things definitely are helpful. It’s to a point, we can’t really deny it anymore, so how do we use them?

Tim Pickett:
Sure.

Thomas Swahn:
And their report is due by the end of this October. I’m hoping that we’ll get some progress, and at that point, maybe will change the clinical [inaudible 00:25:45] on psychedelics and offer more things.

Tim Pickett:
Nice. Is there a difference between … you mentioned psilocybin, MDMA, Ketamine, ayahuasca. Is Ketamine closer to MDMA than psilocybin, or is there known differences?

Thomas Swahn:
Well, MDMA is, itself, an interesting middle ground. People will argue whether it’s a psychedelic or an empathogenic, or an entheogenic. I mean, it depends on how you’re interpreting it. Psychedelic just means mind-manifesting, and so it’s these mind-expanding drugs, I think, that encompass all of those. Entheogens are like God-manifesting, or it’s a class of these drugs that just increase feelings of love and social connection. And MDMA technically is methylenedioxymethamphetamine. It’s a form of methamphetamine that’s tweaked in a way that makes it both less harmful, and slightly psychedelic.

Thomas Swahn:
And they’re using that, specifically, in people with PTSD, because it promotes self-love and forgiveness and connection to other people in a way that helps people stop feeling like they’re worthless, or these traumas were their fault, or that it needs to control their lives. As far as the classical hallucinogens and Ketamine, they work through a much different mechanism. Mostly, they’re considered psychedelics together, because of the experience Ketamine creates is a very intense psychedelic-type trip, just like the other ones. But whereas some of those, I think will be better ultimately for depression, because they bring that freshness and joy back to life.

Thomas Swahn:
I think, Ketamine, with its ability to ease anxiety and feeling of fear or shame or guilt, I think that that’s ultimately a better tool to face some of these traumatic memories. Although they are finding with psilocybin studies, the benefits in some cases have lasted up to six months, a year. So I think that that will be a better option in a lot of cases.

Tim Pickett:
Yeah. It will be really nice, to that point, to have multiple options.

Thomas Swahn:
Yeah.

Tim Pickett:
Because right now, we have … Well, I mean, it’s nice to have just the options we have, frankly. But it will certainly be better when there’s more options. And they’re already out there, MDMA, psilocybin, Ketamine, cannabis, even ayahuasca, peyote. They’re out there. They’ve been used for centuries, but we just don’t have them in traditional medicine, because we need pharmaceutical companies to sign off on these things. Unfortunately, the way our system works.

Thomas Swahn:
One of the [inaudible 00:28:42] I think will be beneficial going into the future as we get more data on all these things, on their safety and their effects, will be to be able to combine in ways that will amplify effects. I mean, if you read some of these … what do they call them? Trip reports. Online, people talk about mixing Ketamine and MDMA, or psilocybin and Ketamine, or whatever, cannabis and these other substances. And the synergistic effects could, I think, provide invaluable things that none of them could do alone, but we’ll have to wait until we have more safety data.

Tim Pickett:
Right. Yeah, how to blend them together. And then, boy, you’re going to have to be monitored. Speaking of monitoring and Ketamine, so you’ve got a twice a week therapy, you can come downtown and you can get this therapy or go to Clinton and get this therapy. But what about going to retreats? Is there a place where Ketamine therapy can be done in a retreat setting, where you go somewhere? Because for me, it seems like Memorial Day weekend would be a perfect time, to where I could show up Saturday morning, I could meet the provider, I could have a little lunch, I could get a little intro to the system. Then I could have my first Ketamine session that day, see how that feels, do another one Sunday, cleanse on Monday, come home. Or a six-day. Does that work? Or do these … you can’t do them day after day?

Thomas Swahn:
So, I mean, Ketamine, there are plenty of studies that have shown … have down consecutive day treatment. Or even, you could find some that were like, “Oh, it’s 72-hour continuous infusion done in the hospital.” And that sounds crazy, because it has a time dilation effect. It would feel like you were there for three infinities.

Tim Pickett:
Oh, wow. So when you’re in the K-hole … this is how we call it in the … I mean, I use Ketamine in the emergency department for … the kids cut his tongue open, and I’ve got to sew up his tongue, so we’re going to use Ketamine. We Ketamine for that. I guess off-topic here, what’s the dosage difference in what I’m using in the ER to put a person down so that I can do a procedure versus what you’re using in clinic?

Thomas Swahn:
So I think the IM dosing for sedation was six to 13 milligrams per kilogram, something like that. At the clinic here, I give it from 0.5 to 2 mg per kilogram. Because with the dosing of Ketamine, there’s actually an increase in neural activity up to a certain point, and then that Ketamine blockade of the neurons shifts from blocking certain channels while they’re open but just blocked, to totally shutting them down. And that’s when we get that total anesthesia sedation. But usually though, for OR sedation, they’ll mix it with Benzos or whatever else to promote amnesia of the experience, and to give a little more sedation.

Thomas Swahn:
The funny thing about kids, is they still have a layer of magical thinking. So whereas adults will get the emergence delirium when they have super heavy doses, and that’s why they stopped using it as much for anesthesia. Just fine with that. They go on these magical journeys, and they’re just cool with it.

Tim Pickett:
Yeah. We use it more in kids than we do in adults, for that exact reason. The adults tend to not have … those heavy doses can tend to have like little mini nightmares. And then not only are you dealing with the injury that you have to fix, but you’re dealing with a grownup human being who’s not having a good time at all. But these doses that you’re giving are much, much lower.

Thomas Swahn:
Yeah, they’re much lower. And two milligrams per kilogram gives us a healthy buffer before we would reach any sort of sedation when given over 40 minutes. And even with that dose, the experience is quite intense. I don’t give most patients anywhere near that dose.

Tim Pickett:
I see. Do you build up a tolerance, like you do with cannabis and THC?

Thomas Swahn:
It’s not real clear, at this point, in the literature. What I’ve seen here at the clinic is that people will … are to build up more of a tolerance to the negative effect before they do the positive effect, similar to cannabis. I don’t really think that there is that much tolerance. Either that, or it must build quickly and maybe wear off quickly. By the time we get done with the induction series, we’ll get month out and do a dose of the same one, and people will report that it feels stronger. So that could be potentially a mild tolerance that was built. Or frankly, I kind of think it’s just, you had that gap between a series of these intense experiences, after you take them, a little more intense than you remember.

Tim Pickett:
Yeah. And you’re also, I could see, getting used to, not that you’re building up a tolerance, just getting used to the effects and getting used to that journey. Where the mind goes, and being okay with … we can do that just a little more intensely, because now I’m used to it.

Thomas Swahn:
Yeah.

Tim Pickett:
Whereas, same thing with cannabis, right? You use your first time, maybe that causes some anxiety if you use too much. But after you get used to it, and you understand the sensation at that intensity level, then you seek that out in a lot of ways. Right? That’s your therapeutic dose.

Thomas Swahn:
Yeah. I usually will describe to my patients … dog getting used to riding in a car. At first, that time, it might be this flying metal death box, because they have no idea what’s happening.

Tim Pickett:
Sure.

Thomas Swahn:
[inaudible 00:35:03] stick your head out the window on the freeway on your little space cruise.

Tim Pickett:
Right, and now all of a sudden, you really want to get in the car, all the time.

Thomas Swahn:
Yeah.

Tim Pickett:
That’s a good way to put it, because you’re right, you wouldn’t understand. That’s a really good analogy. Have you worked in a place where you’re doing daily sessions, like a retreat setting?

Thomas Swahn:
I haven’t. I’ve done daily consecutive sessions for just a few patients, like if they came from out of state, or something like that, where it’s not practical for them to stay and do twice a week for three weeks in a row. So in those cases, I’ve done three treatments in a row. And the first time they do great. Second day, they’re like, “Oh, I still feel a little overwhelmed from my first.” And then by day three, they’re like, “Got a little bit of a hangover, and I don’t know if I can do this hero’s journey for three days in a row.”

Tim Pickett:
Yeah.

Thomas Swahn:
Because some of the experiences, especially if we’re going up in dose, can feel like you’ve literally spent a lifetime on this journey.

Tim Pickett:
Wow. Does Ketamine therapy work in conjunction with behavioral therapy really well?

Thomas Swahn:
Yeah.

Tim Pickett:
Is that part of the decompression of all of these things that are coming up from your patients?

Thomas Swahn:
Yeah. The optimal way to do it would be to have a therapist, discuss with them that you’re going to do Ketamine therapy, go over some grounding techniques, some intention setting to decide what you want to get out of the therapy. And then when you come in, that can kind of act as your GPS for where experience goes. But then, once they start the … like you said earlier, the best thing, and really the only thing you can do is let go and float downstream. Just go with the experience, fully surrender to it.

Thomas Swahn:
And I’ll coach my patients like you might have emotional content or even traumatic memories come up. But if you trust the Ketamine, trust yourself, trust the experience there, lean into it, then you will be able to get a different perspective and process these things in a way that might’ve been impossible for you. And so, after they go through those experiences, I usually recommend trying to get into your therapist again in the next couple of days, while we have that increased period of synaptogenesis so that new neural connections happening at an increased rate. And that way, they can really capitalize on the fact that they’ve been knocked out of their rut, their ruminated thoughts, as well as this opportunity to develop new skills, faster.

Tim Pickett:
Yeah. I can just see how that would be really helpful for people who go through this experience and then want to talk about what it means, and how it can affect them and what to do next. And that change in perspective, for PTSD, we know that being able to see the event from a different perspective, essential, it’s one of the key pieces to curing, if you could cure PTSD.

Thomas Swahn:
Yeah.

Tim Pickett:
Death, do you have people that come in and do Ketamine treatments who are dealing with cancer diagnoses and facing their own death or the death of a loved one?

Thomas Swahn:
That’s something that is a really useful aspect of Ketamine therapy, or other psychedelics. I, personally, have many of those patients. Actually, [inaudible 00:38:53] know people in my personal life dealing with cancer and I’m unable to get them to come in. But it’s one of those things, that quite frankly, it makes you feel connected to the … way that it makes it seem like you won’t be gone if you die. You just will return to the ocean that is the universe we’re all swimming in.

Tim Pickett:
Yeah. What are those barriers? How do we get past that? How do we get past people’s resistance to therapy like this? We’ve been trying. I’ve been trying with cannabis.

Thomas Swahn:
Yeah.

Tim Pickett:
I almost think it’s easier with cannabis than it is with Ketamine.

Thomas Swahn:
It certainly is. And I’m a QNP as well, as you know. I can far more readily convince people to try cannabis than Ketamine. It still has a scary aspect to the journey, because you tell people it’s life-changing. But it’s very intense, strange. And especially the people I’ve known who are going through chemotherapy and cancer and the dying process, they seem to be kind of stuck in that fear. And they’re, I guess, just afraid of what they’ll experience. It seems like if you tell them, “This will make it not seem scary that you’re dying, or at least will help change your perspective on it,” I think that that just in the moment sounds extra terrifying. I’m not sure how to really go about that, but it is something I think about pretty frequently.

Tim Pickett:
I mean, it seems like society is moving it forward slowly. But I talked to Connor Boyack, he’s the president of The Libertas Institute, was really influential in getting the cannabis law passed. And he was influential in the psilocybin bill, the task force that was passed this session. And we talked about how generationally things will change, and we’ll probably get to a point where Ketamine is much more normalized, where cannabis is much more normalized throughout the population.

Tim Pickett:
But on the other hand, the person who needs it tomorrow, right? That 62-year-old with major depression, who needs a Ketamine treatment to save their life, to your point about your family, we can’t really afford to wait to let society catch up. We really have an obligation, I feel like, as providers, especially to educate people that there’s something else out there, in order to push that conversation. When that 62-year-old needs it tomorrow, or else they die on Friday, we need to figure out a way to get that conversation … speed it up.

Thomas Swahn:
Yeah, and it’s something that, ultimately, I feel like we should even be doing when patients come, but the problem with giving it at that instance is that that’s a horrible environment to do it.

Tim Pickett:
Yeah.

Thomas Swahn:
You’re in there, everything’s sterile, people screaming up and down the hallway. That’s a recipe for a bad experience. I don’t know what the ultimate infrastructure would look like, but I do feel like we need to take this seriously and consider, how do we implement this? Even the … ultimately, for depression are kind of baffling to me. We’re still on this, sort of in this position that Ketamine’s new, that it should only be used as a last resort. Why do we reserve these therapies that I feel like could stand to improve almost anyone’s quality of life and experience like this. And we reserve it for people who already at rock bottom, and everybody else is just expected to deal with whatever they’re dealing with.

Tim Pickett:
Yeah. That’s surprising to me too. Why is this last-line therapy, instead of first or second-line therapy? Why can’t we change the mentality of prescribing two or three pills, to, “Okay, maybe, which do you want? Here are the three options. We can do a prescription medication, and you can try that for a month, and that’s totally okay. We can give that a shot. Maybe you’ll feel more comfortable with that in the beginning. We also have this treatment protocol with Ketamine therapy. Both are in conjunction with behavioral therapy.” And you can kind of decide, that here’s the evidence on both sides. Let the patient be part of the conversation.

Tim Pickett:
I mean, I know the answer is probably just, “Well, I have 15 minutes with the patient. The easiest thing to do instead of explain this whole thing to them is just to write a prescription and see them in three weeks. Just be done.

Thomas Swahn:
Yeah.

Tim Pickett:
Oh, besides that Swahn, they don’t take insurance, right?

Thomas Swahn:
Yeah.

Tim Pickett:
Sorry.

Thomas Swahn:
Exactly.

Tim Pickett:
But the pill, totally covered, no problem.

Thomas Swahn:
Yeah. And then that gets us to kind of, frankly, the bullshit around S-Ketamine, of like, “Oh, it’s this. We just filtered out the left-handed molecules from Ketamine, called it a new medication.” Now it’s $800 a dose, instead of $3. And you still need two hours of monitoring, but we’ve got a patent on it, so we can charge whatever we want.

Tim Pickett:
Yeah. What is up with that?

Thomas Swahn:
It’s a case where we’ve let the pharmaceutical company decide, “This is how we make money, so this is how it needs to be done,” rather than using these tools we have and know are effective. It’s considered off-label and came off patent in 1990, so nobody’s interested in trying to push it for FDA approval, because they can’t make any money back.

Tim Pickett:
Do you use nasal Ketamine at all?

Thomas Swahn:
I don’t, [inaudible 00:44:57]. But you can get racemic Ketamine, which is just the 50/50 mixture, for people that know. You can get that just compounded in a nasal spray. I could easily prescribe that to a patient. And there’s no clear evidence whether S-Ketamine or the right-handed molecule, R-Ketamine are any more effective. I’m sure they have minor differences in psychoactive effects and duration and whatever. But when we already know one form is very useful just in its super cheap form, it seems strange to me that we would allow our insurance companies to only cover the super expensive form that’s not proven to be any better.

Tim Pickett:
Wow. So how do patients get in touch with you and get associated with this type of therapy, if they have major depression, or if they want to explore it and just come talk to you? What’s the process?

Thomas Swahn:
Yeah. So what I usually do is just have patient … there’s a self-scheduler on our website. Our website is SwahnBalancedHealth.com. Swahn is S-W-A-H-And, and then balanced with a D, health.com. They can schedule an appointment right on there. They can give us a call, 801 613 8842. And I’m happy to answer calls when I can, anytime. They can even text that number. And we can do a phone consultation. There’s very few contraindications to Ketamine therapy that would make it unsafe. Some of them are unstable hypertension, more sever cases of cardiac, kidney or liver disease, active psychosis, elevated pressure in the brain or eyes. We proceed with caution in cases where there’s substance abuse issues. But outside of that, there’s very few reasons that it’s contraindicated.

Thomas Swahn:
So people can even schedule online themselves. As soon as they do that, I will send out intake paperwork. Then they’ll fill that out. We’ll meet for first appointment and go over everything, make sure that they are an appropriate fit, and then we can get started right …

Tim Pickett:
And how long does it usually take to get in?

Thomas Swahn:
I mean, right now, the clinic’s still young. I’ve been doing this for a year total, but we moved into this location October 1st, 2021. And so we’ve only been here seven months.

Tim Pickett:
Yeah, so still building up a patient base, still plenty of availability is essential what you’re saying.

Thomas Swahn:
Yeah. Yeah, I should have openings pretty much every day that we’re open. It’s pretty rare that the entire day is fully booked out. People can get in, right away.

Tim Pickett:
And then you do this, you do cannabis. And what else does the clinic do? Those are the two things.

Thomas Swahn:
So right now, that’s all I do. Yeah. Basically, when I started offering Ketamine therapy, the improvement in people’s quality of life was phenomenal. I’d never seen that promising in medicine. And so I wanted to build a place that went away from the sterile, clinical feel. And so this clinic that we’ve opened here, I’ve got different themes for each patient room. Each room has a different nature-based theme. I’ve got a forest room with tapestries and different plant stuff. There’s an Echo Dot in every room to play music. There’s two recliners, so they can bring a guest. And I’ve got light projectors that actually will reduce a lot of the dizziness some people can feel from visual effects.

Tim Pickett:
Oh, cool.

Thomas Swahn:
So they can wear an eye mask if they want, but the projectors have done a really good job of changing it from these kaleidoscopic visuals to more of just a flow. It feels very incredible. I wanted it to feel more like the spiritual experience that I feel like it is. And like you said with these retreat settings, I think ultimately, that will be a beautiful option.

Thomas Swahn:
And Ketamine was known as the buddy drug when it was first being used. It made its debut in 1970 in the Vietnam war. And they called it the buddy drug, because anybody could grab a syringe and sedate your buddy. It was just that safe. It preserves cardiovascular function, it preserves respiratory function and protective reflexes, so there’s no life support needed. Even in here, in the clinic, honestly, I feel like checking vital signs at all is more of a medical formality than anything. There’s rare [inaudible 00:49:46] anybody with any issues. And usually, it’s if they’re stopped taking their blood pressure medication that we’ll even see a problem.

Tim Pickett:
Sure.

Thomas Swahn:
They’ll have to postpone treatment until their blood pressure’s under control. But in general, yeah, if you were able to establish with a bunch of people at a retreat that they had a good health history, were good candidates, their vitals were stable, I don’t even think you would need to check them again for the rest of the weekend. Granted, that’s, I guess, sort of a-

Tim Pickett:
Talking from experience, right? You’re comfortable with it, you know what to expect, you know what to look for, which is awesome. This is awesome. Have we missed anything that you want to talk about?

Thomas Swahn:
In general, no. I think that that covers most of it. I mean, there’s a lot of specifics, and I spend all day talking about this. I’m very passionate. So people are welcome to ask me any personal questions about their case, or what to expect. But yeah, I mean, I think that’s a good overview.

Tim Pickett:
This is good. I want to hear … I think we should get back together down the road, and talk about how the clinic is going, and also, talk about the … especially with psychedelics, as we expand the access to other psychedelics and we talk more about more psychedelics than just Ketamine. I mean, I’m interested, because you’re in this field, you’re a subject matter expert, so I think this will be an interesting conversation to have again. I appreciate you coming on.

Thomas Swahn:
Yeah. Thank you for having me.

Tim Pickett:
SwahnBalancedHealth.com, right? You’re in Clinton.

Thomas Swahn:
In Clinton, yep. Clinton, Utah.

Tim Pickett:
SwahnBalancedHealth.com, Thomas Swahn. Thanks. Thanks, man. Thanks for coming on.

Thomas Swahn:
Yeah, absolutely. Thanks, Tim. It was a pleasure.

Tim Pickett:
Yeah. All right, everybody. Stay safe out there.

 

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