At the fringes of treatment options, some Montanans find hope through psychedelics

When Sheila settled into the recliner and slid the blindfold over her eyes, she didn’t know what to expect.

She had tried every treatment she could think of – several medications, therapy, meditation and others. None of them worked. Sheila is diagnosed with severe post- traumatic stress disorder, obsessive compulsive disorder and attention-deficit/hyperactivity disorder.

Her father, along with a few of his 19 wives, abused her throughout her childhood. After her father was arrested on a stolen vehicle charge, she went into foster care when she was 17. Sheila is a pseudonym, and she has asked to remain anonymous so her father cannot find her.

For years, Sheila put her mental health on the back burner to raise her four children and work as a nursing assistant. Now 45 and living in southern Montana with mostly grown-
up kids, she’s prioritizing finding solutions.

In the summer of 2023, she turned to something unconventional. She participated in a trial where people with PTSD were given ketamine, a dissociative drug commonly used for sedation or anesthesia that has psychedelic effects.

She was skeptical, but her first treatment shocked her. She saw aliens, nebulae and stars, but, more than anything, she felt at ease.

“With that medication, that was the first time in my life that I’ve ever been able to relax and actually see what relaxed means. I was pretty stoked about that,” Sheila said.

This summer day was her sixth or seventh time having one of her children drive her to Bozeman to get the treatment, and she hadn’t had any profound images that the doctors said she might see. She’d tried to force them, but her therapist told her to just let it flow.

So that day, her goal was just that: Let it flow. After a few minutes, it happened.

She saw herself as an infant, one that was cared for, one that was loved. She sunk into it, reveling in it. It reset her.

Then she went back to Washington, where she spent much of her childhood, and most of the progress she made through the treatments faded away. But for that one serendipitous moment, that one subsequent week, she was rejuvenated.

Research shows some drugs with psychedelic properties are emerging as a new frontier for treating some mental health issues and disorders. Now that multiple centers have popped up across Montana to offer ketamine, the only legal form of psychedelic treatment in the state, the findings from research boasting these unconventional treatments as effective for mental health issues are no longer a distant dream.

But between high costs, the need for follow-up treatment courses and limitations to certain diagnoses, ketamine and future psychedelic treatments may not be right — or accessible — for all Montanans.

A new ‘journey’

Ketamine was first created in the 1960s and authorized for use in medicine in the United States in the 1970s. On the World Health Organization’s essential medicines list, ketamine is FDA-approved for use as an anesthetic and is commonly used for pain and sedation.

Researchers have also seen promising results of ketamine’s mental health treatment potential, with studies showing its effectiveness in addressing treatment-resistant depression, PTSD and suicidal ideation.

Ketamine works differently than traditional antidepressants. The most commonly used antidepressants, selective serotonin reuptake inhibitors, block chemicals in the brain that break down serotonin, leaving it in the brain longer. Ketamine, however, “dramatically reorganizes activity in the brain,” according to Penn Medicine. Ketamine is also found to promote neural plasticity, meaning the nervous system’s ability to change itself, though how exactly it works is unclear.

Ketamine’s use for treating mental health issues is not FDA-approved, except for in the form of Spravato, a nasal spray derived from ketamine. Since it is a controlled substance, all clinics must have a Drug Enforcement Administration license and a state medical license. Clinics also must store doses safely and track them closely.

Rob Miller has given patients ketamine thousands of times, but initially not for mental health.

From Mendenhall, Mississippi, the certified registered nurse anesthetist often uses ketamine for sedation and anesthesia. Before he was aware of its use to treat mental health issues, some of his patients reported their depression improved after surgeries.

“I know the drug very well. It was an easy transition,” Miller said.

Miller moved to Kalispell in the summer of 2021 with his wife, who is a nurse practitioner, and opened Alpine Health and Wellness, where they offer a litany of wellness services. Miller estimates about 25% of people who come to Alpine are there for ketamine treatments.

“There was a different cowboy mentality here, maybe, but I think people are starting to see the benefits from it,” Miller said. “Seasonal affective disorder is a real deal and it gets people here.”

Miller works at various hospitals across the state on top of running the clinic. Although Miller has never taken any medications for anxiety or depression, he’s seen his friends struggle with the time they’ve spent trying out medications. Miller said he has not treated a single person with ketamine who has not benefited from it in some way.

Some studies show positive results from antidepressants, but others show different results for different individuals. One study showed more than a quarter of participants taking an antidepressant had their symptoms return in a matter of months. Many antidepressants also come with their fair share of side effects, including increased suicidal ideation in some cases.

“There’s no emptiness-type feelings that you can get with SSRIs,” Miller said. “Even though ketamine doesn’t last forever, it’s gotten patients to that point where they can function at a higher level than they used to and they don’t drop off into depression again.”

Miller’s patients most often encounter nausea as a side effect of ketamine treatments. But the Mayo Clinic lists a variety of other possible side effects, and many treatment centers avoid giving the treatment to patients with a history of strokes or unmedicated high blood pressure.

Unlike Miller, the brother-sister duo who founded Harvest Wholeness Center in Missoula both had their own experiences with ketamine.

Kavan Peterson and Kaley Burke’s father was diagnosed with cancer in October 2020. They made arrangements so he could come home, and he died about two weeks later.

Peterson and Burke started a business together called Harvest Home Care in 2016 for palliative care. Burke is a holistic guide for people facing terminal illness or death and their loved ones. But their professional lives could not prepare them for the grief after their father’s death.

Peterson took it as a wake- up call. Having heard of its possible benefits, he found a ketamine-assisted therapy practice in Seattle and wanted to try it himself.

“I figured this is the avenue and the only way I can support it is to go through it myself,” Peterson said.

He went through multiple treatments during the course of a year, and said he was “radically changed” by it. He told Burke to try it, and she had similar revelations.

“It took all the tools that I’d already been building with my self-care and just enhanced them and strengthened them,” Burke said.

Peterson and Burke were united in bringing ketamine-assisted therapy to Missoula. They did an intensive training to guide people through treatments, then acquired a space and their DEA licensing to open in the summer of 2022.

Harvest shares many similiar practices to Miller’s clinic. Both determine initial doses based on height and weight, and they both generally start with six treatments, usually twice a week for three weeks. The two centers have individuals wear eye masks, and they both use lyricless music to create the proper setting.

While Harvest only delivers ketamine through intramuscular injections, Alpine Health also has lozenges for at-home use and IV treatments. Intramuscular injections cannot be tapered, so it affects the patient all at once. With the IV, Miller is able to taper the dose to have greater impact at different times or stop it completely if one becomes overwhelmed or too nauseous.

The centers’ true differences lie in their level of involvement during the actual ketamine “journey.” Miller always stays in the room with patients during their first infusion, but will usually monitor them from outside unless asked to stay for subsequent treatments. Alpine Health doesn’t have in-house therapy but recommends it.

In contrast, Harvest requires integration session follow-ups after every treatment to take advantage of the neural plasticity the ketamine creates, according to Peterson. Burke is always in the room with individuals on “journeys.” She said they want people to succeed not because of the ketamine, but because of the tools it gives them to rewire their brains.

“If you are combining your own self-work, therapy or coaching, your outcomes are extraordinarily better than if you’re just doing it passively,” Peterson said.

Have a safe trip

Nick Peterson had set criteria he wanted his treatment center to meet when he started seeking out ketamine therapy.

He wanted a staff that had experienced the drug themselves, a proper patient screening process and integration of the ketamine “journeys.” He found Harvest was a perfect fit.

Nick, 50, had grappled with depression since he was a teenager, and it worsened in college. Growing up mostly in the D.C. area, he went to Harvard and committed much of his life to rowing, competing in the Olympics in 2000. Though he experiences generalized depression, finding a career outside of his athletic endeavors was also difficult for him.

“You’re at the top of your game doing this crazy thing. Then you stop and it’s like – OK, now what?” Nick said.

He now works as a coach and trainer and has done talk therapy on and off for years. He felt some relief while taking Wellbutrin, an antidepressant, but it didn’t maintain its effectiveness. He is also diagnosed with ADHD and took Adderall for some time but had to stop after developing a heart condition.

He turned to ketamine after a rave review from a friend.

While he had some unpleasant experiences during his first treatment – tinnitus, total ego dissolution that could be frightening, all abstract imagery and none of the flashes of people from his real life that he heard were possible – the lasting impact it had on him was profound and different than he ever intended going in.

He found he could break out of his brain’s rigid patterns. He was able to set boundaries and was less reactive when he experienced negative emotions. Sure, he gets sad, but now he can pull himself out of the “stuck” feeling, at least to an extent.

“It pulls you out of the water, and it’s not like you don’t have work to do,” Nick said “It’s not like you’re just dry and not coughing up water or whatever, but it was a huge boom for me. I feel like I just have the tools to get my s—t together. It’s not like I have my s—t together now completely, but I feel like I’m on the path.”

But such overwhelmingly positive takeaways from ketamine treatments are not guaranteed. Grace Porges, a 19-year-old sophomore at the University of Montana, tried one ketamine treatment and did not go back.

Porges describes her depression as wearing “s—t-stain goggles.” From Atlanta, she started grappling with depression and anxiety in high school. She began trying SSRIs before she graduated.

“I noticed my baseline was lifting up, but it wasn’t consistent,” Porges said. “I would still have consistent episodes that would last weeks. I was so sick of relying on something that’s making me feel worse when I forget to take it.”

She eventually tried microdosing psilocybin on and off over the course of two weeks during her freshman year at UM. Microdosing involves taking a small dose of psilocybin so the “tripping” effect doesn’t happen.

For Porges, it ended up feeling like it was a “good flip switch” to her brain and helped for about a month. Johns Hopkins University research has shown evidence of psilocybin’s effectiveness for treating addiction, treatment-resistant depression, OCD and anxiety.

She wanted to find further relief, so she researched ketamine with her mom and went in for a treatment.

In her one treatment in Atlanta, providers did not give her an eye mask, so she ended up having unpleasant external trip visuals.

She felt unsupported by the provider, as they started her IV and left the room. A nurse simply came in once or twice to check her vitals without doing thorough check-ins.

“My main issue was like, yeah, it’s so great that this is so available to people,” Porges said. “The science is starting to become a thing, but we cannot let people just sit in a room by themselves and expect them to walk out and be like– OK, I’m good.”

Rob Miller, one of the owners of Alpine Health and Wellness in Kalispell, said he would never leave a patient completely unattended in the way Porges described.

“That would be a terrible, terrible way to do things, just start the pump and walk out,” Miller said. “That would be scary for people. We’re there for whatever they need, let’s do what works for you.”

Although her experience was negative in the moment, she did experience lasting effects even after just one treatment. She noticed a consistent increase of her baseline mood for about two months after the treatment.

She was initially planning to seek out more ketamine treatments when she returned to Missoula, but she’s now microdosing psilocybin as needed and has completely transitioned off of her SSRIs. She has backup capsules to microdose if she’s feeling like she’s in a multi-day slump and said her mental health is better than at any other point in the last three years.

“There’s no trip, no high, it’s just like you feel really productive,” Porges said. “It’s almost like the world feels a little bit brighter.”

The cost of care

Sheila doesn’t remember how she received partial insurance coverage for the eight ketamine treatments she did, but knows it saved her hundreds of dollars. It cost her $750 for her entire treatment course, less than the cost of a single treatment at other clinics in Montana.

Sheila recommended it to everyone – her therapists, her friends, even strangers at gas stations. She also said since her treatments, she hasn’t let her “downs” affect her as much as they used to.

The treatment center she went to in Bozeman recommended she go through an additional course, but between the lack of insurance coverage for more treatments and the payments for a car accident she got in, she hasn’t gone back.

“It’s supposed to be like years of therapy at once, but it didn’t work that way for me,” Sheila said. “They said I’m supposed to do more and more to get there, but I have to figure out rides and stuff. That makes it very hard.”

Ketamine centers require patients to arrange a ride home from the treatment center since the drug’s effects often haven’t gone away when they depart. Now that most of Sheila’s kids have moved out of the house, rides are impractical. It’s another reason Porges isn’t seeking treatments, carving out the hours amid a busy college schedule is difficult.

Because ketamine’s use for mental health treatments is not FDA-approved, most major insurance companies do not cover it. Miller and Burke both said some people have found ways to charge an “office visit” to receive partial coverage.

“I know ketamine is a superior medication (to SSRIs),” Miller said. “I know that it’s not covered by insurance and not a lot of people can afford it, but I feel like it’s a better treatment.”

A regular IV ketamine dose at Miller’s clinic costs $425 per infusion. Although not the preferred method for Miller, he also offers intramuscular injections for about $200 per session.

“We’ve increased and decreased the prices and give discounts for veterans and first responders…It really comes down to not how expensive ketamine itself is but your operating costs,” Miller said. His main burden comes not from the staff, but from the extensive documentation they maintain per their DEA license and their medical equipment.

At Harvest, intramuscular injection treatments are $835 per session, and they require integration session follow-ups after each treatment, which are $150 an hour. This means a six-treatment course costs patients about $6,000. Since Harvest is a fairly new business, Kaley also attributes their prices to the need to keep up with operating costs.

“You mostly only really hear middle-aged white people talking about it because they’re the only ones who can afford it,” Nick Peterson said.

Patients also often seek more treatments than the initial six-dose course. Burke said it’s a “mixed bag” whether people come back. Miller estimated about a third of his patients come back for more treatments.

“Ketamine is kind of like a curve with a plateau,” Miller said. “At some point, that plateau is going to start to drop off, and I tell (patients) that it’s much easier to keep our results if we can do an infusion when you feel like you’re starting to drop off that plateau.”

Miller also prescribes at-home ketamine treatments for as cheap as $8, which are not as effective but can prolong the time between visits and relieve some financial burden.

Ketamine practitioners are some of the first to say the treatments are not suited for everyone. Miller and Burke said they do not offer treatments to those diagnosed with schizophrenia or other disorders that could cause people to experience psychosis.

A couple of ketamine providers in Montana have garnered poor press for their practices recently. In August 2023, Dr. William Stratford, a psychiatrist based in Missoula who operated clinics in Missoula and Kalispell, settled a federal court case for $85,000 for allegedly distributing ketamine from an unregistered location and failing to maintain proper records.

In September 2023, a complaint was filed in federal court accusing Dr. David J. Durkin from Ketamine Infusion of Montana in Kalispell of picking up a woman in a bar, dosing her with ketamine then sexually assaulting her in May 2022.

Burke said she found the lawsuit involving Durkin “extremely shocking and really disturbing,” and she said it’s important for people to determine if the clinic they’re considering will prioritize their needs. She also thinks it’s important for providers to have taken ketamine themselves, though that’s not required by any federal regulations.

Miller ensures that he makes it clear in consultations the type of experience patients will embark on under ketamine’s influence if they haven’t taken another psychedelic before, and he is sure to stress to his patients the abundance of medical equipment he has to respond to any emergency situation.

He thinks it’s key to know how often providers are in the room, the provider’s medical and training background and whether one can receive talk therapy in the ketamine center or has to find it elsewhere.

“They’re not going to be 100% with it as far as cognitively or functionally, and they just need to know that they’re going to be super safe,” Miller said.

Phasing in psychedelics

While ketamine treatment centers have started opening in larger towns in Montana during the past couple of years, the state still does not have similar access to other psychedelics.

Psilocybin is currently only decriminalized in certain cities outside Montana and fully decriminalized in Oregon and Colorado. In 2023, the Montana State Legislature tabled a bill in committee seeking legalization for its use in regulated therapy settings for PTSD, anxiety, depression and substance use disorders.

Faith Price, a community prevention coordinator with All Nations Health, wants to exercise caution before moving forward with legalizing psychedelics. She also is concerned with commercialization of substances and bad actors possibly getting into the business just to capitalize off of it.

“Once you’ve let the proverbial horse out of the barn it’s hard to get it back in,” Price said. “We could be on the cutting edge of this new market, but maybe not looking deeply enough into the potential harms.”

Providers in Montana and those that have tried psychedelics hope the stigma surrounding their use will start to fade away. Miller is starting a mental health nurse practitioner program in January so he’s ready to become a provider if psilocybin becomes legal.

Porges is optimistic that more options are becoming available. To her, finding new options felt like a way out, and she hopes more people will explore other ways to contend with their diagnoses.