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ASHEVILLE, N.C. — A few months ago, Waynesville Police Sgt. Paige Shell was about to give up hope of recovery. The daily dose of violence, death and suffering in nearly 20 years in law enforcement has left its mark. Her sleep was poor, depression was a persistent companion, and suicidal thoughts took root.
Schell, who works in a rural area about 30 miles west of Asheville, tried talk therapy, but it didn't work. When her counselor suggested ketamine-assisted psychotherapy, she was skeptical.
“I didn't know what to expect. I'm a police officer. It's a matter of trust,” she said with a thin smile.
Combining psychotherapy with low doses of ketamine, a hallucinogenic drug long used as an anesthetic, is a relatively new approach to treating severe depression and post-traumatic stress, especially in populations with high trauma rates such as firefighters, police officers and military personnel. However, evidence of the effectiveness and safety of ketamine for treating mental illness is still emerging, and the market remains largely unregulated.
“First responders experience a disproportionately high burden of injury and are often left without many treatment options,” said Signy Goldman, psychiatrist and co-owner Concierge Medicine and Psychiatry in Asheville, which began incorporating ketamine into psychotherapy sessions in 2017.
Law enforcement officers in the United States experience an average of 189 traumatic events during their careers. little research suggestscompared to two or three in the life of the average adult. Research shows that the pace depression and burnout are much higher among police officers than among the civilian population. More officers have committed suicide in recent years than have been killed in the line of duty, according to the advocacy group First Responder. First aid
Ketamine is a dissociative drug, meaning it makes people feel disconnected from their body, physical environment, thoughts, or emotions.
The Food and Drug Administration approved it as an anesthetic in 1970. In the 1990s, it became a popular party drug, and in 1999, ketamine was added to the Schedule III non-narcotic substances under the Controlled Substances Act.
Death of Friends actor Matthew Perry in 2023 associated with ketamine usefurther ruined the drug's reputation.
But starting from 1990 animal study and followed by a landmark human trialResearch has shown that low doses of ketamine can also quickly reduce symptoms of depression. In 2019, the FDA approved esketamine—derived from ketamine and administered as a nasal spray—for the treatment of treatment-resistant depression.
All other forms of ketamine remain FDA-approved for anesthesia use only. If the drug is used to treat mental disorders, it should be prescribed off-label.
“This is a situation where clinical practice is likely to outpace the evidence supporting it,” said John CrystalChairman of the Department of Psychiatry at Yale Medical School and a pioneer in ketamine research.
The crystal has studied the effect ketamine exposure to veterans and active-duty military personnel, a population comparable to first responders in terms of injury susceptibility. While research shows strong evidence of ketamine's antidepressant effects, he said further research is needed into its potential role in treating post-traumatic stress disorder.
The regulatory framework for ketamine also remains a challenge, Crystal said. Government controls vary, and federal regulations do not specify dosage, methods of administration, safety protocols or training for providers.
In this regulatory confusion, more 1000 ketamine clinics sprang up all over the country. At-Home Ketamine Treatments Flood Market, Prompting F.D.A. issue a warning.
Side effects of ketamine can range from nausea and spikes in blood pressure to respiratory depression. The drug may also cause adverse psychological effects.
“Taking psychedelics puts people in an extremely vulnerable state,” Goldman said. People can become retraumatized by reliving disturbing memories. That's why it's important to have a psychiatrist guide the person through a ketamine session, she said.
Rick Baker believes that when proper precautions are taken (and when other treatments have failed), ketamine-assisted psychotherapy is a good first-line treatment. Baker is the CEO and founder of Emergency Services, which provides mental health services exclusively to police officers, firefighters and other first responders in North Carolina, South Carolina and Tennessee.
First responders are more resistant to traditional therapy than civilians, said Baker, a licensed clinical mental health counselor. Ketamine provides potential access to traumatic memories and acts “as an accelerator for psychotherapy,” he said. “He rips people’s armor off.”
When used to treat mental illness, a dose of ketamine—usually half a milligram per kilogram of body weight, less than anesthesia—creates a slightly altered state of consciousness, Goldman said. This forces people to look at their traumatic memories from a distance “and tolerate them differently,” she said.
Ketamine sessions in her practice typically last two hours, and clients are on the drug for about 45 minutes. The drug is administered in the form of droppers, intramuscular injections, lozenges under the tongue or nasal spray. The drug is short-acting, meaning its dissociative effects mostly wear off after about an hour.
But most insurers won't cover the cost of ketamine-assisted psychotherapy, which can cost more than $1,000 per IV session.
“This is certainly prohibitive for first responders,” Goldman said.
Department of Veterans Affairs covers some forms of ketamine treatment, including ketamine-assisted psychotherapy, for eligible veterans on an individual basis.
In Shell's case, the donation made to Defendant Support Services covered what her insurance didn't cover when she decided to try ketamine-assisted psychotherapy with her counselor Baker this spring.
Schell didn't want to go back to the worst calls in her nearly two decades as a police officer. But Hurricane Helen, which caused catastrophic flooding in western North Carolina last year, has pushed the 41-year-old over the edge, she said.
“Some of the sessions were tough,” said Shell, who is also a member of her agency’s SWAT team. “Things came to light that I didn’t want to think about, that I had buried throughout my career.”
A severely maimed victim of a fatal car accident. A murder-suicide in which a man slit his pregnant girlfriend's throat and then slit his own.
Under the influence of ketamine, she said, the images came to life as still images, like a surreal slideshow replaying some of her darkest memories. “Then I sat there and cried like a baby.”
As of early October, Shell had completed 12 ketamine sessions. They did not provide a sudden miracle cure, she said. But her sleep has improved and bad days are now bad times. She also finds it easier to cope with stress. “And I smile more than before,” she said.
She was hesitant to share her experiences in her department because of the ongoing stigma associated with asking for help in a tough police culture.
“I just didn’t want my people to think I couldn’t do the job,” she said. “I didn’t want them to feel like I was a threat to them.”
Perception of ketamine also plays a role, said Sherry Martin, national director of wellness services at Fraternal Order of Policean organization representing more than 377,000 sworn law enforcement officers. Many police officers are accustomed to ketamine as an illegal street drug or think of it as a countercultural psychedelic, she said.
“So when they have to accept it as a treatment, they have a hard time understanding it,” she said.
Few police departments make clear recommendations for ketamine-assisted psychotherapy. If it had been prescribed by a doctor, it would likely have been treated like taking an antidepressant, Martin said.
Shell eventually shared her story with her colleagues, most of whom were curious and supportive, and she now encourages other officers to talk about their struggles. She believes that seeking mental health help—in her case, ketamine-assisted psychotherapy—has made her a better cop and made her safer.
“It’s hard to help other people when you can’t take care of yourself,” she said.
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