For some people who suffer from treatment-resistant depression, anxiety, PTSD or other mental health challenges, psychedelic-assisted therapy has proven to be a magic bullet after first-line treatments have failed.
This article appeared at Fortune.com on January 19, 2024.
This past open enrollment season, employees around the country decided once again whether they’d stick with their same insurance plan from last year or maybe add on perks like vision, dental, or an FSA. And for a small but growing segment of the U.S. workforce, another health benefit is on offer—psychedelic drugs.
A slowly increasing number of employers—mostly those who’ve experienced the benefits themselves—are giving their employees access to psychedelic-assisted psychotherapy as part of their health plan.
“Depression is a leading cause of disability, absenteeism, and presenteeism in the workplace,” says Dylan Beynon, founder and CEO of Mindbloom, the largest provider of ketamine-assisted therapy in the U.S. The company offers direct-to-patient treatment and works with employers to offer its services as a workplace benefit.
The CDC estimates that depression results in 200 million lost workdays each year, which costs employers $17 to $44 billion. Traditional treatment for depression, like SSRIs, doesn’t serve everyone. These drugs take weeks to act and may have little to no effect for as many as half the people who try them. Yet, coverage of alternatives, such as generic ketamine, that might just stand to get people off of ineffective SSRIs altogether, is scarce among major commercial health insurance plans.
“People should have access to these substances that are transformational relative to traditional pharmaceutical solutions for depression, anxiety, pain and PTSD. It’s not for everybody, but everybody should have access to it if it’s right for them,” says Peter Barsoom, CEO and co-founder of 1906, a cannabis edibles company. 1906 offers its employees mental health coverage through Enthea, the only third-party administrator of health insurance plans that offers psychedelic medicine as a workplace benefit.
But it is far from just purveyors of cannabis who have found value in offering psychedelic medicine to their workforce. Employers across industries, from trucking, to software, gaming, financial services, healthcare, and retail, are adding this medicine to health benefits packages.
What is psychedelic-assisted psychotherapy?
For some people who suffer from treatment-resistant depression, anxiety, PTSD or other mental health challenges, psychedelic-assisted therapy has proven to be a magic bullet after first-line treatments have failed. A growing body of research supports this.
“Ketamine is perhaps the most effective and most rapidly acting medication treatment for antidepressant-resistant symptoms of depression,” says Dr. John Krystal, the professor of psychiatry at Yale School of Medicine who led the research that confirmed ketamine’s rapid antidepressant effects. He is a co-inventor on patents related to intranasal administration of ketamine for depression, which supported the development of Johnson and Johnson’s Spravato (esketamine).
The idea of psychedelic-assisted therapy is that you take the drug—be it ketamine, psilocybin or MDMA —under supervision, go through the hallucinogenic experience, and a day or so later, have a sit-down with a therapist in which you unpack or, as professionals call it, “integrate” the experience, then repeat.
As for why this works for people who’ve tried so many other things that didn’t, some studies that involve brain MRIs cite the drugs’ ability to seed the growth of new brain cells and pave new pathways in the brain. Other studies point to instructive visions that happen during a psychedelic trip that the patient comes to understand later in the therapy session. Potentially a combination of both gives psychedelics their healing effects.
A number of psychedelic or dissociative drugs have been shown to provide these benefits. Among them are ketamine, a pediatric anesthetic also known as the party drug Special-K; MDMA, or ecstasy; psilocybin, the psychoactive compound in magic mushrooms; mescaline, found in the peyote cactus native to Mexico; and ayahuasca, a brew that combines Amazonian plants containing the hallucinogen DMT with plants that act like first-generation antidepressants MAOIs.
Ketamine is the only FDA-approved medication among these, but with caveats.
Spravato (esketamine) is the only type of ketamine with FDA approval to treat depression. Patients must go to their doctor’s office for each dose (about twice a week for the first month) and stay there through the dissociative experience. FDA’s approval says patients should keep taking their standard antidepressant, which hasn’t worked for them so far, in addition to esketamine.
Generic ketamine, which comes in an IV drip, an intramuscular injection, or a dissolving tablet or lozenge, is not approved for any psychiatric disorder. Doctors prescribe it off-label for mental health conditions. Patients get it under some degree of supervision depending on the route of administration and the level of risk. For example, under Mindbloom’s protocol, a client takes a fast-dissolving tablet at home, while a member of the household is present. For the first dose, a trained professional is also accompanying them via video conference.
Many people first heard of ketamine in December 2023, when actor Matthew Perry’s drowning death was attributed to the drug. That his death happened while he was in a hot tub, unsupervised by a health professional, underscores the high risk for misuse, Krystal says.
“The death of Matthew Perry is a strong reminder that this drug also carries substantial misuse liability. Because of the risks associated with misuse, ketamine and esketamine treatments are most safely delivered in clinical settings.”
A healthier workforce
Employers who offer psychedelic medicine to their teams have typically gone through treatment themselves. They’re sold on the benefits and undaunted by the risks. Another commonality, says Mindbloom’s Beynon, “They’ve been leaders at the forefront of building employee-first innovative and transformational cultures.” Perhaps answering the arguably largely unanswered 2019 call of the Business Roundtable for corporations to put employees before profits.
That’s the way David Kennedy, founder and CEO of Kennedy Care, sees it. The company employs in-home caregivers who take care of the elderly, disabled veterans, and children, as well as therapists who provide clinic-based autism therapy.
“As soon as I finished my first Mindbloom session, I called the company the next day and said, ‘Can I offer this to my employees?’” As an employer of caregivers, Kennedy says, “They are probably selfless and want to be taken care of last. And they are probably just as broken as I am. As their boss and the CEO, it’s my job to take care of my people.”
Whether CEOs’ initial motivation is altruism or economics, it’s tough to separate the benefits to employee wellbeing from those to the company’s bottom line.
“Esketamine (Spravato) is multiple times more expensive than generic ketamine,” says Sherry Rais, CEO and co-founder of Enthea, whose network of providers treat patients with generic ketamine. Both Enthea and Mindbloom plan to roll out MDMA programs once the drug gets FDA approval, which is expected this year. Enthea also has a psilocybin program in the works for states where it’s legal, currently Oregon and Colorado.
The cost to treat major depressive disorder with esketamine for one year ranges from $18,564 to $45,591 depending how many doses are needed to maintain the effects. A yearlong treatment with generic ketamine costs $270 to $811. Payers save even more when patients come off their antidepressants as a result of ketamine, which is not a goal of esketamine therapy.
“With our medical protocol, the idea is ‘Let’s get you off the antidepressants and to a place where you feel cured,’” says Rais, whose company counts Dr. Bronner’s among its first and most high-profile clients.
When workers’ depression is cured, it brings direct savings to the employer but also indirect savings that result from a company that runs better.
“When we think about how we can help organizations make better decisions, it’s hard to debate that if people are dealing with anxiety and depression, they are not at their best,” says Joe Mechlinkski, CEO and founder of SHIFT, a workforce engagement consultancy that covers Mindbloom’s services for its employees. “So it’s kind of undeniable that this should be a menu option for folks.”
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