BHE Psychedelics Podcast, Episode 002 – Brian Mears, Alleviant Health Centers founder, president and CEO

Brian Mears, Alleviant Health Centers founder, president and CEO, explains what is driving providers’ interest in the use of ketamine for therapeutic purposes, what organizations need to know if they are looking to add a ketamine-based treatment option to their service offerings, and why an integrative psychiatric model is an ideal fit for these services. Mears also discusses which patients are good candidates ketamine-assisted therapy and whether ketamine is a viable option for patients with an active addiction. Finally, Mears offers advice to providers setting up ketamine-assisted treatment modalities so that they are better positioned to offer other psychedelic compounds as they receive FDA approval in the future.

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Music credit:

On The Wave by Groove Bakery | groovebakery.com
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TRANSCRIPT

Tom Valentino: Hello. Welcome to the BHE Psychedelics Podcast. I’m Tom Valentino, BHE digital managing editor on-site at the Treatment Center Investment & Valuation Retreat in Scottsdale, Arizona. I’m joined by Brian Mears, founder, president, and CEO of Alleviant Health Centers.

Brian, I enjoyed your presentation this morning on building an infrastructure to offer outpatient psychedelic services. I appreciate you taking the time to join us.

Brian Mears: Hi, Tom. Thanks for having me.

Valentino: Brian, you’ve been a clinician since 1997. Tell us a little bit about the work that you do with Alleviant today.

Mears: Yeah, Tom. I own a series of outpatient clinics. We do everything outpatient psychiatry. That means we have psychiatrists, psychiatric nurse practitioners, therapists. We also do escalated treatments. In escalated treatments, part of that are ketamine infusions, nasal ketamine called Spravato, and transcranial magnetic stimulation.

Valentino: As you outlined in your presentation, ketamine has been around for a long time. In recent years, we’ve started to see a real surge in interest for its use in therapeutic purposes. What’s driving that trend that we’re seeing right now?

Mears: Two things: Need. Anytime there’s a need, typically, there will be some change. It takes a long time, particularly in the United States. Behavioral health problems have been worsening, not getting better. If your children are affected, if you’re affected, if the payers’ children are affected, over decades, that starts to cause something to give.

In behavioral health, that give has finally reached that point. There’s been a lot of research behind psychedelics. It wasn’t the intent when using ketamine to see that it worked in behavioral health. It just happened that by using ketamine in an anesthetic basis, people that had behavioral health problems started getting better.

Researchers like Yale, Johns Hopkins, Harvard, different places, picked up on that. They started researching it. Now you’ve got major research organizations that’s behind the psychedelic trend that’s moving us into this new era of psychedelic medicine.

Valentino: What do provider organizations need to know if they are interested in adding a ketamine-based treatment option to their service offerings? Where do they get started with this?

Mears: That’s a great question. Thanks for asking it. First, you should add it. You should add it. It can be scary. You may not have the infrastructure for it. You may already have a designated facility and all your rooms are full. There’s a lot of questions about operationalizing it. The medical need is there.

Clinicians should have at the top of their priority list, “Is what I’m doing everything I can do to help my patients get better?” Psychedelic medicine, and I’ll consider that ketamine, is imperative to include, because of the physiology. This is not a magic hypnotic thing.

This is a medicine that goes in. It helps stabilize a part of the brain that’s unstable. That’s all it’s doing. It’s a very safe medicine. Reimbursement can be very good. There’s no reason not to. Your patients need it.

Valentino: You mentioned infrastructure needs. Talk to us a little bit about that. What are organizations looking at in terms of staffing, in terms of facilities? Anything else that they’re going to need to consider when they’re getting this off the ground?

Mears: I think infrastructure’s one of the hardest things for people to bite onto. It’s because, in an established practice, you may already have a comfort level of your employees doing certain things. Their license. You know what their license is allowing them to do.

As the provider yourself, you already have an idea on how to treat patients. Then you’re bringing in something new. That can be a little overwhelming and scary. What you need is not much. You do need a dedicated room. It needs to be very comforting.

One thing that people that have treatment-resistant disorders need is comfort. They don’t need a sterile environment. They don’t need people to be black and white and cold. They need empathy and compassion. They need hand-holding. They need to know that you love them and that they’re not just another number in your practice.

You need to build an infrastructure that shows that you love them. Put in a very nice room, very comfortable chairs, dim lights. You must control the noise. If somebody’s under some sort of a medicine that alters their mind, you’ve got to control noise as well. That’s one of the biggest things.

That’s one of the hardest things if you already have an established practice, is figuring out how to control the acoustics. You can absolutely create a very bad system. You can create a very bad experience, if you will, for a patient, if you have a bunch of noise.

What psychedelics do, or what particularly ketamine does, is it will heighten your awareness to everything in the environment while you’re under that infusion. That means noise will get louder. Lights will get brighter. The room will change size, also. It will feel bigger.

You’re not dissociated. If you are dissociating people, you’re probably not doing it really well. You need to get people near this disassociation point. That means we can still communicate with them. That helps us get the medicine to effect.

Operationally, you’ve got to control the environment. Again, that’s hard to do for established practices. It’s easier to do if you’re building a facility.

Valentino: Are there particular patients who are good candidates for ketamine-assisted therapy or using psychedelics? Are there patients within behavioral healthcare that this won’t work for as well?

Mears: Absolutely. Just like anything, any diagnosis you have, certain treatments are better, and certain treatments are not. In this case, people that have depression respond extremely well to ketamine, nasal ketamine, or other psychedelics.

People that have anxieties. There’s different types of anxiety, such as PTSD and OCD. They respond really well, too. Suicidal ideation. It’s the only known agent that breaks suicidal ideation. Lots and lots of research. That’s another question that people have, is, “Well, how much research is out there?”

Literally, more than you can read in a year. It’s hundreds, and hundreds, and hundreds of articles, and major research institutes. This is not a fringe science. This is mainstream science with medicines that have been used for 50 years. It is a wonderful thing.

Now, if I could add one more thing about the operationalizing this and protocols that can be another thing that’s hard to do. It’s figuring out, how do you do this? How do you write a protocol? How do you dose people? What monitors do you buy? How do you even develop protocols for monitoring patients?

All that’s really vital. It’s all a mandatory component when you’re building infrastructure.

Valentino: How do you figure those things out as you’ve gone along?

Mears: Before I started, I read as many research articles as I could find. The research articles told you about protocols because we treat a patient, though, and we’re not treating a piece of paper. We definitely learned a different system of the amount of medicine that we give and the adjunct medicines that we may give with it.

That’s not on a piece of paper in a book. We treat one patient at a time. For protocols, all the research shares with you similar things, such as monitoring patients. Meaning heart rate, pulse oximetry, EKG, blood pressure. You monitor those, continuously if you’re on an IV drip.

If you’re on nasal ketamine, we follow the FDA’s guidelines. The FDA, we’re a certified REMS center. They tell us the protocols that we have to establish within the practice.

Valentino: You’ve clearly put in a ton of research before you got your practice off the ground. You’ve also learned a lot along the way, it sounds like. Are there things that you know now that you wish you would have known when you got started in this area?

Mears: Absolutely. Any business owner that tells you otherwise, I would like to meet them. That’s because business is wrought with challenges. One thing I would like to share is that when I first started, I started as a cash-based ketamine practice.

I started independent. Meaning, it was just anesthesia-based services for behavioral health. I learned immediately I was out of my league, and that I should not be doing this. The reason is we were providing a great life-changing service. We didn’t have the behavioral health team to support us within our own practice.

As people had medication change needs, psychiatric medications needed to be changed, they needed their own therapist, it was impossible to coordinate care with third parties, and get them seen in the time that that patient needed to be seen.

As you know, in behavioral health frequently, you’re on wait times. Number one, the main thing that I learned was develop a multi-disciplinary team. Now, we have psychiatrists, psychiatric nurse practitioners, therapists, a gamut of licensing, all in every facility, because we have to. That’s the way that you optimize care.

Doing it as a solo practice, it didn’t make sense to me. I knew that we were not providing optimal care.

Valentino: You’d mentioned during your presentation this morning if I understood you correctly, that ketamine-assisted psychotherapy could be a good option for an addiction patient who is in recovery but not necessarily for someone who still has an active addiction, and they’re at that early stage of treatment. Why?

Mears: That’s an important question. Lots of research on addictions and using ketamine for that. The main reason is ketamine is a medication. It is not being used at some psychedelic to give you some mystical experience. That is not what’s going on.

This is a real medicine, going into your brain, clamping down on a receptor, and helping to regulate part of your brain that’s dysfunctional. That’s it. In addiction, people, they’re reaching out for something, generally, when they become addicted. That leads to other problems like depression and anxieties.

The depression itself may have led to addiction. There’s a lot of reasons that people become addicted to something. At the core, if you’re providing ketamine to somebody that’s not an active abuser, you’re doing a couple things. First off, you’re still giving their brain a reset in the area that’s turned off.

When you do that, and the brain starts becoming healthier, people begin making better choices. You don’t have the same desires you had before, where you’re trying to overcome your problems. Say, you’re depressed. Now you fill it up with alcohol, cocaine, heroin, or something like that.

If you’re not depressed, you don’t have that same desire. Ketamine can help take that desire away because you simply have a healthier brain. In addition to that, it is actively treating the area of the brain that’s turned off where depression is found. That’s vital to know.

There’s many other mechanisms by which it can happen. Those are the main important contributors.

Valentino: Brian, the last question I was going to ask you. What advice do you have for providers who are setting up ketamine-assisted treatment modalities, so that they, as an organization, are better positioned to offer other psychedelic compounds as those receive FDA approval in the coming years?

Mears: Great question. Thank you for bringing that up, because other psychedelics are coming on. Without the clinical infrastructure that we’ve learned by using ketamine, we’re not going to be ready when the time comes. Johns Hopkins comes out of phase III, and says, “Hey, psilocybin’s now approved.”

Coming out of the Imperial College of London, “Hey, MDMA is now approved.” Those are coming. We’re going to have the same infrastructure for ketamine. That means when a new medicine like this, it’s probably going to come under a controlled substance. It’s probably going to be a class three.

We’re going to have to certify each center as a REMS center. REMS center is risk evaluation mitigation strategies. That’s something that we have to enroll in and provide data to on every single patient. That helps researchers understand, is what we’re doing valid or invalid? Is the dose we’re providing good or is the dose we’re providing bad?

Then they can develop the articles around it. Anecdotally, we’re the ones treating. We must have that clinical infrastructure in place. Ketamine affords us that opportunity. It’s going to be the same monitors. Heart rate, blood pressure, EKG, pulse oximetry. The same couches or comfortable recliners that we’re going to have.

Then other vitally important thing is you must have a team. I cannot stress that enough. You need great therapists. You need great medical providers because when people start getting better, they’re only going to be as good as the goals that they set.

You’ve got to help them goal-set upfront. It’s an active process when you’re undergoing an infusion or another psychedelic service. That’s an active process. The follow-up has to be intentional. It has to be rapid. You have to help them with their life choices. There will be a lot of new life choices that they’ll face.

Valentino: Brian, so much great information in such a short amount of time. I really appreciate it. Thank you so much.

Mears: Thanks, Tom.

Valentino: That is Brian Mears, the founder, president, and CEO of Alleviant Health Centers. That’s going to do it for this episode. I’m Tom Valentino, digital managing editor for Behavioral Healthcare Executive. This has been the BHE Psychedelics Podcast.