Pharmacy and Shipping:
We use OptioRX/Braun Pharma as our default pharmacy for KAP medication, and they ship the medication right to patients' doors for their convenience.
Patients do need to be present to sign for the prescription delivery. They can request delivery to an office or home, but an adult > 18 will need to be present to sign. Delivery can also be requested to a FedEx or UPS location, but it is important to note that patients will need to be over 21 and have an ID to be able to pick up.
Ketamine generally takes 3-5 business days for processing plus 2 business days for shipping. Patients will receive a text message from UPS with tracking information once their medication has shipped.
OptioRx/Braun's contact information is:
Braun PharmaCare OptioRx Hub
877-958-1601
1919 North Clybourn Ave.Chicago, IL, 60614
Common Ketamine/Pharmacy Questions:
Q: How can clients mask the taste?
A: If the taste of the RDT is unpleasant, clients may try sucking on a lemon, hard candy, or sipping a small amount of tea immediately before dosing to coat the mouth with some other flavor. It's not advised to eat during the dosing session after swishing until the session is complete. Patients can also request a flavored tablet if preferred.
Q: Why do you prescribe RDTs instead of lozenges? Can clients swallow the Ketamine?
A: Ketamine absorption varies greatly depending on the membrane it’s in contact with, and the cost of Ketamine can vary depending on its form. With other routes, there’s the risk of differences in absorption and duration of effects. At Journey Clinical, we prescribe oral dosing of rapidly dissolving tablets (RDTs) and use a swish and spit method. This is very cost-effective and minimizes the chance of unwanted effects including nausea or vomiting, while allowing patients to have a consistent experience of knowing when the effects will dissipate. This route of administration also allows us to provide patients treatment that can be utilized in-office with you or even in the comfort of their own home, unlike some other routes, which must take place in a clinical setting. At this time, our prescribers do not prescribe other forms of Ketamine.
It is very important to encourage clients to avoid swallowing the saliva while letting the tablet dissolve under their tongue. Clients should swish the saliva in their mouth for 10-12 minutes and then spit it out. In this process, they will get more of the active ketamine and less of the metabolites that occur when ketamine is swallowed, to prevent and minimize unwanted effects. We base our dosing with the swish and spit method in mind to account for the different bioavailability. We can always adjust dosing if needed at follow up, but do not endorse swallowing the saliva produced while swishing.
Q: Are there any ways to increase absorption for a potentially stronger experience?
A: Techniques you can share with clients to optimize absorption include:
- Swishing vigorously as opposed to passive/gentle swishing for 10-12 minutes (and up to 14 minutes if able to tolerate)
- Brushing the gums (buccal brushing) before swishing with a toothbrush
- Dissolving the tab directly under tongue before swishing the saliva (the tongue is very vascular)
- Sipping a small amount of warm lemon water before swishing
Please note that each dosing session can vary in intensity even if using the same dosage. Set and setting, as well as expectations play an important part in the overall experience. Using preparation and integration sessions is important to discuss goals and expectations.
Q: Can I request a different dose for a client? What if they want to change their dose?
A: It is important to remember that each session even among single individuals may vary. Psychedelics magnify what is present (psychologically related to "set" and physically related to "setting") at the time of each individual session. Additionally revising and releasing expectations based on previous experiences is key and can be freeing. It is also important to note that though dissociation is helpful, which may be described as a "floaty feeling," many patients continue to find post-experience benefit even in the occurrence of non-intense experiences. The integration space should be given as much credence as the session itself and continue to build on interventions in the space of cognitive flexibility. The goal is not just the psychedelics, but rather a combination of factors determining any revisions to treatment, which will be discussed in medical follow ups. Please follow the KAP dosing guidelines for first and subsequent dosing sessions, as outlined in the Resources section of the Portal.
Patients should continue sessions as recommended and assess for any additional improvement or decline in capacity to manage symptoms, regardless of the intensity of the psychedelic experience. We recommend continuing to be flexible with expectations, following protocol for evidence-based practice related to medication administration, and focusing on integration work between dosing.
For those wanting a stronger experience: If a client has not already done so, they may consider taking both half-dose tablets at T0 at their second or subsequent dosing sessions, and could take the booster at that time or 15 minutes later. The client could try to swish the medication for closer to 14 minutes if possible, and should vigorously swish during that time. The medical team will assess for any necessary changes in dosage during the follow-up appointment. Please also see the question above for tips on how to help increase absorption. Patients should never take more than the allotted full dissociative dose plus one booster per session, unless otherwise directed by their prescriber.
For those wanting a more mild experience: Clients are always able to opt to take less than the maximum allotted dose (just never more than the maximum). Some clients prefer a more psycholytic approach, and this can be accommodated by using only the booster doses.
Q: What is a booster dose? When should it be used?
A: The booster can be used to increase the depth and duration of the experience. The timing depends on the person’s preferences and session time, and there isn’t a specific cutoff. Most patients take the booster at T15 or T30. The patient would still need to be able to take vitals at the end of their session, and safely get home if they are not remote. You can always review the dosing options in the Resources section of the Portal. For the first dosing session, all clients (regardless of their experience) should start with only 1 half dissociative dose tablet. They may opt to take the second tablet and/or booster after at least 15 minutes. After the first session, there’s more flexibility on the dosing options, and the medical team will discuss the client's dosing during their follow up based on their first two experiences. Some clients like to use the booster to prolong the experience once they find that they're comfortable with their dose.
Q: Do you offer microdosing? How about psycholytic dosing?
A: There is currently no evidence supporting the efficacy of microdosing, so we do not prescribe for daily microdosing. Lower doses of Ketamine to be taken during KAP sessions for psycholytic experiences can be accommodated instead of weight-based full dissociative doses if requested by the patient during their consultation for somatic/psycholytic work. These preferences can also be noted by you in the referral note. The client should discuss the dosing options and their preference for psycholytic dosing during their intake session or their next follow up. If a client already has a prescription from Journey Clinical and wants to try a psycholytic dose, they may opt to take 1 booster or 1 half dissociative dose. They would still need to follow all of the guidelines of KAP session requirements regarding vitals, having a chaperone or their therapist present, and scheduling the session with their member therapist ahead of time. Please note that prescriptions can only be written during intake and follow up consultations.
Please also note that each KAP session and experience afterwards may differ. Clients have control in the dose they feel comfortable taking (as long as they do not take more than the maximum specified on their prescription, clients are always welcome to take less).