In this conversation, Dr. Marc Smith shares his journey from hedge fund trading in New York's financial district to building an integrated ketamine psychiatry practice in California. 

After three years in finance doing trading and sales, Dr. Smith made the bold decision to completely pivot his career toward medicine, driven by a desire for purpose and meaning that his financial career couldn't provide.

Dr. Smith's path took him through Columbia University for medical school, followed by psychiatry residency at USC, where he discovered his passion for interventional treatments like TMS and ketamine therapy. 

His unique perspective, having worked in both profit-maximizing finance and purpose-driven healthcare, provides valuable insights into the challenges of maintaining ethical medical practice in an increasingly commercialized healthcare environment.

Dr. Smith's practice, Clear Ketamine + Psychiatry, represents an integrated model where he personally handles psychiatric evaluation, preparation therapy, ketamine treatment administration, and post-treatment integration sessions.

What You'll Learn in This Episode

· Career transition insights - How Dr. Smith navigated the complete pivot from finance to medicine, including the challenges and rewards of choosing purpose over profit in healthcare

· Mental health crisis analysis - Dr. Smith's perspective on factors contributing to rising depression, anxiety, and suicide rates, including social isolation, technology impacts, and healthcare access barriers

· Treatment-resistant depression understanding - Why 30% of patients don't respond to traditional antidepressants and how ketamine offers a different mechanism through NMDA receptor antagonism and neuroplasticity induction

· Integrated practice model - Dr. Smith's unique approach combining psychiatric evaluation, preparation therapy, ketamine administration, and integration sessions all under one provider rather than outsourcing components

· Intentions versus goals framework - How to help patients set internal emotional states they're striving for (intentions) alongside specific, measurable functional outcomes (SMART goals) for comprehensive treatment planning

· Ketamine as catalyst concept - Understanding how ketamine works like "jumpstarting a car" to improve mood and motivation, while ongoing therapy and lifestyle changes provide the maintenance needed for sustained improvement

· Ethical practice building - Dr. Smith's mission to combat ketamine stigma through evidence-based protocols while addressing concerns about recreational associations and inappropriate use in the field

· Private practice autonomy benefits - How owning your own practice allows values-driven decisions that may conflict with profit maximization, contrasting with private equity-driven healthcare models

· Business building practical advice - The importance of talking to other practice owners, understanding it's a marathon not a sprint, and knowing your limitations to outsource effectively

· Biopsychosocial treatment approach - Addressing biological, psychological, and social elements of mental health through medications, therapy, exercise, sleep, nutrition, social connection, and nature exposure

Episode 58 show notes:

00:00:00 - Teaser: Profit vs. Purpose in Healthcare 

00:00:35 - Episode Introduction

00:02:03 - Dr. Smith's Background: From East Coast to Medicine 

00:02:30 - Career Transition: Three Years in Financial Industry 

00:04:12 - Discovering Psychiatry Through Clinical Rotations 

00:05:32 - Why Psychiatry: Deep Relationships and Human Connection

00:08:50 - Tools in the Toolbox: TMS, Ketamine, and Treatment Options 

00:09:30 - The Leap: Stepping Away from Finance Success 

00:11:17 - The Marble Metaphor: Chiseling Away What We Aren't 

00:12:46 - Self-Actualization and Gratitude in Medicine 

00:14:01 - USC Residency and Academic Reception of Ketamine 

00:16:54 - Evidence-Based Medicine and the Slow Pace of Change 

00:19:17 - Mental Health Crisis: Social Isolation and Technology 

00:22:50 - The Invisible Nature of Mental Health Challenges 

00:25:28 - Private Equity vs. Patient Care: The Business Tension 

00:30:18 - Private Practice Autonomy and Values-Based Decisions 

00:32:15 - Clear Ketamine + Psychiatry: The Integrated Model 

00:36:11 - Treatment Protocol: Six Sessions with Therapy Integration 

00:37:56 - Ketamine as Jumpstart: The Car Analogy 

00:42:00 - Intentions vs. Goals: Internal States and SMART Outcomes 

00:46:30 - Ethical Standards and Combating Ketamine Stigma 

00:50:15 - Practice Building Advice: Talk to Other Providers 

00:52:55 - Rapid Fire Questions: Book Recommendation 

00:54:52 - Last Meal 

00:55:52 - Pickleball Obsession and the Philosophy of the Game 

00:56:50 - Time Travel

00:58:46 - Alternative Career

01:00:04 - Advice to 20-Year-Old Self

01:01:53 - Contact Information and Practice Details 

01:03:03 - Final Thoughts: Gratitude and Evidence-Based Care 

01:04:20 - Ending and Resources

Thanks for listening

Connect with Dr. Marc Smith at:

Website: https://www.clearketapsych.com

Instagram: @clearketapsych, @marcsmithmd

LinkedIn: www.linkedin.com/in/marcsmithmd

Google Maps: https://maps.app.goo.gl/GCHVy8q183c7WvfLA

📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-058

Follow us on

Linkedin

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this conversation, Dr. Michelle Weiner shares her evolution from chief resident in interventional pain medicine to pioneering integrative practitioner who treats chronic pain through a biopsychosocial-spiritual lens. Double board-certified in Interventional Pain Medicine, Physical Medicine, and Rehabilitation, Dr. Weiner reveals why traditional procedure-focused approaches often fail chronic pain patients and how she discovered more effective ways to create lasting healing.

Dr. Weiner's journey started with her background in nutritional science and athletics, leading her through physical medicine and rehabilitation before specializing in interventional pain. But day after day of performing procedures without truly connecting with patients left her frustrated and seeking deeper solutions. Her introduction to medical cannabis as chair of Florida's advisory committee opened her mind to personalized medicine and treating the whole person rather than just diagnosis codes.

You'll hear about her unique approach to fibromyalgia, which she reframes as "central sensitization" to empower rather than limit patients. Dr. Weiner explains how trauma and adverse childhood experiences prime the nervous system for hyperreactivity, leading to chronic pain that becomes centrally mediated rather than structurally based. Her practice now integrates cannabis protocols, ketamine therapy, and comprehensive team-based care to address the root causes of both physical and emotional pain.

Dr. Weiner also shares her personal ketamine experience during training, including a profound vision that later manifested in real life, demonstrating the spiritual dimension she now incorporates into treatment. You'll also hear practical insights about building an integrative practice, the importance of set and setting, and why true healing requires addressing the person with the diagnosis, not just the diagnosis itself.

What You'll Learn in This Episode

· Career transition insights - How Dr. Weiner evolved from high-volume interventional procedures to relationship-based integrative medicine and why she felt traditional approaches were "stringing patients along"

· Central sensitization framework - Why she avoids the term "fibromyalgia" and instead explains central sensitization to empower patients and create hope rather than diagnostic limitations

· Biopsychosocial-spiritual model - How incorporating the spiritual dimension creates awe-like effects and connections that traditional medicine misses, supported by neuroscience research

· Medical cannabis integration - Her role on Florida's Medical Cannabis Advisory Committee and how cannabis opened conversations about personalized medicine and treating individual endocannabinoid systems

· Trauma's role in chronic pain - How adverse childhood experiences and physical trauma prime the nervous system for hyperreactivity and chronic pain development

· Practice building strategies - Practical advice about insurance credentialing, marketing to other providers, creating therapeutic environments, and building multidisciplinary teams

· Set and setting importance - Why the physical environment, staff training, and patient preparation are crucial for maximizing ketamine therapy outcomes

· Patient education approaches - How she explains that healing happens during the neuroplastic window after ketamine, not during the infusion itself, and why "more is not better"

· Team-based care model - Working with coaches, therapists, and specialists trained in pain reprocessing therapy and somatic approaches to support comprehensive healing

Episode 57 show notes:

00:00:00 - Teaser: Heart-Forward Medicine and True Passion 

00:00:19 - Introduction and Dr. Weiner's Background Overview

00:02:00 - Educational Journey: From Nutrition Science to Pain Medicine 

00:05:13 - Colleague Reactions to Non-Traditional Approach

00:08:37 - The Pivotal Moment: From Procedures to Purpose 

00:11:04 - Cannabis Integration and Personalized Medicine Discovery 

00:13:43 - Biopsychosocial Model and Pain Neuroscience Education 

00:17:09 - Trauma Patterns and Chronic Pain Development 

00:19:54 - Reframing Fibromyalgia as Central Sensitization 

00:23:54 - Adding the Spiritual Dimension: Biopsychosocial-Spiritual Model 

00:29:07 - Personal Ketamine Experience and Training Story 

00:34:22 - Practice Building: From Employee to Business Owner 

00:38:18 - Set and Setting: Creating Therapeutic Environments 

00:41:48 - Patient Misconceptions and Education Strategies

00:47:08 - Rapid Fire Questions: 

00:53:55 - Advice to 18-Year-Old Self

00:55:34 - Final Thoughts: Pain Complexity and Nervous System Healing 

00:56:32 - Contact Information and Practice Locations 

00:57:29 - Ending and Show Resources

Connect with Dr. Weiner at:

Website: www.drmichelleweiner.com

LinkedIn: https://www.linkedin.com/in/michelle-weiner-do-mph-276b34b9

Facebook: https://www.facebook.com/drmichelleweiner/

👉 Disclosure: Some of the links in these show notes are affiliate links. If you choose to make a purchase through them, we may earn a small commission at no additional cost to you. Thanks for supporting the podcast!

Selected Links From the Episode:

📕The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

by Bessel van der Kolk M.D. 

📘The Awakened Brain: The New Science of Spirituality and Our Quest for an Inspired Life

by Lisa Miller.

📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-057

Follow us on

LinkedIn

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this news roundup episode, we're covering four major developments that have emerged in recent months, all pointing toward increased accountability and oversight in the ketamine and psychedelic therapy space. This isn't our typical interview content - it's breaking news analysis that every provider in this community needs to understand.

We start with the final chapter of the Matthew Perry case, where Jasveen Sangha, known as the "Ketamine Queen," received a 15-year federal prison sentence, while Dr. Salvador Plasencia was sentenced to 30 months for distributing ketamine outside proper medical supervision. 

Then we cover France becoming the first country to formally authorize IV racemic ketamine for adults in severe suicidal crisis, with rigorous hospital-based protocols that raise the bar for clinical standards globally.

We continue with updates on Texas Medical Board's proposed ketamine regulations moving toward mandatory clinic registration and stricter oversight, followed by analysis of President Trump's executive order accelerating psychedelic research and creating new federal pathways for investigational compounds. 

We wrap up by connecting all four stories to show how legal consequences, international standards, state regulations, and federal policy are collectively signaling that oversight conversations are now happening at the highest levels of government and the field is entering a new era of accountability.

What You'll Learn in This Episode

· Legal accountability implications - How the Matthew Perry case sentencing creates new precedents for physician responsibility when ketamine treatment moves outside supervised clinical settings

· International standards development - France's groundbreaking authorization of IV racemic ketamine for suicidal crisis and what their rigorous hospital-based protocols mean for global treatment standards

· State regulatory evolution - Current status of Texas Medical Board's proposed ketamine regulations, including mandatory clinic registration and enhanced oversight requirements moving toward a June 2026 vote

· Federal policy landscape changes - Analysis of Trump's executive order accelerating psychedelic research access and what new federal pathways mean for the broader psychedelic therapy field

· Clinical framework implications - How France's high-surveillance psychiatric intervention model differs from wellness-oriented approaches and why this distinction matters for field credibility

· Oversight trends analysis - Why legal consequences, international standards, state regulations, and federal policy are all pointing toward increased accountability requirements for providers

· Risk assessment insights - Understanding where legitimate treatment can break down and how unmonitored use creates legal and ethical liability that traces back to prescribing physicians

· Future preparation strategies - What these four developments collectively signal about where field standards are heading and how providers can prepare for increased scrutiny

Episode 56 show notes:

00:06 Episode Introduction

01:28 Matthew Perry Case: The Final Sentence

03:47 France Authorizes IV Ketamine for Suicidal Crisis

07:03 Texas Medical Board Update: PKT Rules Still Pending

08:37 Trump Executive Order: Federal Fast-Track for Psychedelic Therapy

10:43 The REMS Advantage: What Regulatory-Ready Looks Like

12:34 Final Thoughts

Thanks for listening

Selected Links From the Episode:

📖Prefer to read? Check out our related blog post: Ketamine Therapy Regulations Spring 2026: Perry Sentencing, Texas Rules, France Authorization, and Federal Policy Shifts

🎧Listen to the full story about what’s about to happen in Texas: Episode 049 - Texas Medical Board Proposes Comprehensive Ketamine Therapy Regulations - What It Means for the Industry

📋Episode references and sources

📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-056

Follow us on

Linkedin

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this conversation, Dr. Ruchir Gupta shares his unconventional journey from established anesthesiologist to successful pain medicine entrepreneur. After 10 years of practicing anesthesia, he made the bold decision to return for a pain fellowship at Mayo Clinic, where he was older than most of his attendings.

Dr. Gupta's story shows how strategic career reinvention can create competitive advantages in medicine. By combining his decade of anesthesia experience with pain medicine fellowship training, he identified a market opportunity that others overlooked: IV ketamine therapy for chronic pain patients. While other pain physicians were hesitant to offer ketamine infusions due to unfamiliarity with anesthetic protocols, Dr. Gupta's background made him uniquely qualified to bridge this gap.

You'll hear about how his specialized fibromyalgia protocols achieves 80% success rates, his insights about monitoring standards including the "fifth vital sign" of proper patient follow up, and practical business advice about overcoming analysis paralysis.

Dr. Gupta's journey from zero to building Mountain View Headache and Spine Institute offers valuable lessons for any medical professional considering practice ownership or career reinvention. His approach challenges common physician assumptions about entrepreneurship and shows how leveraging existing skills can lead to practice success.

What You'll Learn in This Episode

· Career reinvention strategy: how Dr. Gupta leveraged his anesthesia background to differentiate his pain practice and why returning to fellowship training became a competitive advantage rather than a setback

· Physician entrepreneurship barriers: why medical professionals create mental obstacles around private practice that dentists, chiropractors, and other healthcare providers don't experience, and how to overcome this mindset

· Clinical monitoring standards: detailed recommendations for ketamine infusion monitoring, including the importance of continuous EKG, pulse oximetry, and blood pressure monitoring for longer pain protocols

· The "fifth vital sign" concept: why proper patient follow up and outcome measurement are essential for maintaining medical credibility and avoiding the "med spa" trap in ketamine therapy

· Business development approach: practical strategies for practice growth including LinkedIn networking, physician education sessions, and building referral relationships with skeptical providers

· Cross-disciplinary medicine benefits: why Dr. Gupta believes future physicians should combine multiple specialties or degrees to offer integrated approaches and differentiated services

· Pain and mood disorder integration: clinical insights about treating patients with concurrent chronic pain and depression, including combination Spravato and ketamine protocols

📋 Professional Education Disclaimer: Content for licensed healthcare providers for educational purposes only. Does not constitute medical, legal, or business advice. Always consult qualified professionals for specific clinical and practice decisions.

Key Takeaways

· Reinvention requires strategic thinking, not just courage. Dr. Gupta's success came from identifying how his anesthesia background created competitive advantages in pain medicine, particularly with ketamine therapy that other providers avoided.

· Physician mindset creates artificial entrepreneurship barriers. Unlike dentists and chiropractors who routinely start private practices, physicians have developed cultural resistance to entrepreneurship that isn't based on actual capability or market realities.

· Clinical differentiation drives practice success. By offering IV ketamine when other pain doctors wouldn't, Dr. Gupta created a unique market position that generated demand for both ketamine services and traditional pain procedures.

· Fibromyalgia responds differently than other conditions. His 80% success rate comes from recognizing that fibromyalgia requires different protocols than CRPS or depression, using shorter duration but potentially higher dose infusions.

· Safety standards must match treatment complexity. Longer pain infusions require more comprehensive monitoring than depression protocols, including but not limited to continuous EKG and regular blood pressure checks every 15 minutes.

· The "fifth vital sign" prevents med spa perception. Proper patient follow up with objective outcome measures maintains medical credibility and guides treatment decisions.

· Cross-training creates competitive advantages. Combining anesthesia experience with pain medicine training allowed Dr. Gupta to offer services that single-specialty providers couldn't safely provide.

· Business planning overcomes analysis paralysis. The hardest step is going from zero to one. Once you start a business plan, even imperfectly, the momentum builds and subsequent decisions become easier.

· Multiple marketing channels compound results. Success came from combining LinkedIn professional networking, direct physician outreach, literature sharing, and educational presentations rather than relying on single strategies.

Episode 55 show notes:

00:00:00 - Teaser: The Physician Mindset Problem

00:00:31 - Episode Introduction

00:02:14 - Dr. Gupta's Background

00:02:34 - Education: From Political Science to Choosing Anesthesia

00:06:14 - The Decision to Pursue Pain Fellowship

00:08:23 - Fellowship Experience: Being Older Than Attendings

00:09:51 - Turning Setback into Asset: The Ketamine Opportunity

00:13:21 - Starting Mountain View Headache and Spine

00:16:59 - The Physician Entrepreneurship Mindset Problem

00:21:37 - Building Referral Relationships and Practice Growth

00:25:18 - Pain Fellowship Training: What's Missing

00:29:35 - Fibromyalgia Protocols and Success Rates

00:34:27 - Pain vs Mood Disorder Treatment Approaches

00:36:17 - The "Fifth Vital Sign" and Medical Standards

00:40:45 - Monitoring Standards and Safety Considerations

00:50:06 - Business Planning: From Zero to One

00:54:17 - Marketing Strategies That Actually Work

00:56:05 - Rapid Fire Questions: What's on Your Desk

00:57:42 - Relaxation and Pickleball with His Son

00:58:04 - Hidden Talent: Writing Historical Fiction

00:59:22 - Time Travel: Ancient Rome

01:01:04 - Alternative Career: Finance and Building Businesses

01:01:28 - Contact Information

01:02:04 - Final Thoughts and Show Resources

Thanks for listening

📝 Complete show notes with resources and links, please visit https://www.ketaminestartup.com/podcast/episode-055

Follow us on

Linkedin

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

🚨 Content Warning: This episode contains discussions about mental health challenges including suicidal ideation, psychedelic substances from cultural and therapeutic perspectives, and occasional strong language. Listener discretion is advised, as some content may not be suitable for all audiences. Please prioritize your well-being while listening.

If you or someone you know is struggling with mental health challenges, the 988 Suicide & Crisis Lifeline provides free, confidential support 24/7. Call or text 9-8-8 to connect with trained crisis counselors.

In this unique episode, we step outside our usual clinical focus to gain a cultural insider's perspective on how psychedelic therapy is perceived in the broader public consciousness. Comedian Shane Mauss brings an invaluable viewpoint as someone who has been immersed in psychedelic culture since 2016, touring extensively and observing how public attitudes have evolved around these treatments.

Shane offers a cultural timeline of how psychedelic perception shifted from 2004 when even mentioning mushrooms on stage was taboo, through the Michael Pollan watershed moment in 2017, to today's complex landscape where ketamine therapy exists alongside telehealth services, recreational use, and the lingering effects of celebrity deaths on public perception.

Drawing from his years of cultural immersion and personal experience, he provides insights that help clinicians understand the broader context their patients are navigating.

This conversation covers the cultural challenges ketamine providers face in a world where recreational and therapeutic ketamine coexist, where anesthesiologists are questioned about their legitimacy in the therapy space, and where the Matthew Perry tragedy continues to influence public perception. Shane shares his personal ketamine treatment experience and explains his perspective on why ketamine serves as the best "first psychedelic experience" for most people.

Perhaps most valuable for providers, Shane offers crucial insights about maintaining scientific rigor in an industry increasingly influenced by wellness culture hype, emphasizing the critical difference between evidence-based practitioners who hedge their bets and wellness influencers who make unfounded claims.

What You'll Learn in This Episode

· Cultural evolution timeline - Shane's firsthand observations of how psychedelic perception shifted from 2004 taboo through Michael Pollan's 2017 cultural impact to today's medicalization era

· Public perception landscape - The complex cultural context your patients navigate, from recreational associations to celebrity death fears to wellness industry hype

· Recreational vs clinical disconnect - How street users avoiding K-holes while clinicians may seek deep therapeutic experiences can create public confusion about treatment goals

· Shane's personal ketamine journey - His first clinical session and why it surprised him after 21 years of psychedelic experience

· Industry disruption insights - How telehealth ketamine services changed the landscape around 2022-2023 and created new competitive dynamics

· Celebrity death impact analysis - Shane's perspective on how the Matthew Perry tragedy creates disproportionate fear around statistically safe treatments

· Science vs wellness culture - The crucial distinction between evidence-based practitioners and influencers, and why scientific humility builds long-term trust

· Rapid intervention advantages - How ketamine's acute treatment capability makes it valuable for interrupting emerging mental health episodes

· Evolutionary psychology perspectives - Shane's exploration of why modern isolation amplifies ancestral mental health mechanisms and creates therapeutic opportunities

Episode 54 Show Notes

00:00:00 - Teaser: Science vs Wellness Hype

00:00:40 - Introduction and Content Warning

00:02:27 - Shane's Background and Comedy Journey

00:05:30 - The Evolution of Standup Comedy

00:08:00 - Psychedelic Culture Timeline: 2004-2026

00:13:00 - Michael Pollan's Cultural Impact

00:18:00 - Current Public Perception of Ketamine Therapy

00:24:22 - Shane's Personal Ketamine Experience

00:35:06 - Ketamine vs Classical Psychedelics

00:38:00 - Default Mode Network and Suicidal Ideation

00:46:33 - Evolution of Depression and Modern Society

00:54:32 - Advice for Clinicians: Education and Ethics

01:02:24 - Rapid Fire Questions

01:09:30 - Evolutionary Purpose of Altered States

01:14:30 - Shane's Projects and Where to Find Him

01:20:14 - Episode Wrap-up and Resources

Thanks for listening

Connect With Shane Mauss:

· Shane’s Website - check for a live show near you!

· Here We Are Podcast

· Instagram

· Youtube

Trips Comedy Specials:

· First Dose (Full Comedy Special)

· Second part of Trips 4/19 Youtube May 19th

📝 Complete show notes with resources and links, please visit www.ketaminestartup.com/episode-54

Follow us on

LinkedIn

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In Part 2 of our conversation with Charles Miller from Scenic City Neurotherapy, we get into the practical side of his controversial "collective lie" thesis from Part 1.

Charles walks through his MSKIT (Minimally Stimulated Ketamine Infusion Therapy) approach, explaining when he believes therapeutic integration should actually happen: weeks after treatment during the neuroplasticity window, not during altered states. He addresses how he manages patient expectations around epiphanies and insights, arguing these are retrospective brain noise rather than therapeutic mechanisms.

You'll hear Charles use memorable analogies—from cheese obsessions to rollercoaster highs—to explain why he believes the psychedelic experience itself isn't doing the heavy lifting. He makes the case that ketamine is upgrading synaptic function, not providing mystical cures, and that the real work happens when patients are sober and doing therapy afterward.

Through detailed audio sidebars, we explore the crucial relationship between BDNF and sleep (and why post-treatment rest matters more than most clinics acknowledge), and examine the metabolite pathway that creates ketamine's addiction potential.

Charles also shares his vision for the future of ketamine therapy, advocating for greater scientific rigor and proper medical oversight while critiquing the growing trend of unqualified providers administering ketamine.

If you're questioning whether the approaches many of us have been using actually serve our patients best, this conversation will give you a lot to think about.

What You'll Learn in This Episode

· Patient education strategies - How to remove performance pressure by explaining "you can't make this work better or worse" and framing treatment as physiology, not psychology

· Managing epiphanies and insights - Charles's perspective on why experiences are retrospective brain noise rather than therapeutic mechanisms, and how to validate without overemphasizing

· BDNF and sleep optimization - The critical relationship between post-treatment sleep quality and neuroplasticity consolidation that many clinics overlook

· Ketamine's addiction pathway - Understanding the hydroxynorketamine metabolite mechanism and why "more is not better" with dosing protocols

· Pain protocol applications - How he incorporates NAD, lidocaine, magnesium, and anti-inflammatories for comprehensive chronic pain treatment

· Future field vision - Charles's call for greater scientific rigor, proper medical oversight, and evidence-based protocols over speculative experiential approaches

Key Takeaways

· Therapeutic integration may be more effective up to weeks after ketamine treatment when the neuroplasticity window is active, rather than during altered states when processing capacity is diminished

· Patient education could focus on removing performance pressure by explaining ketamine as physiological process rather than psychological work, helping patients understand "you can't mess this up"

· Ketamine experiences might be retrospective rather than revelatory, reflecting existing knowledge without noise rather than generating new insights, which suggests focusing on post-treatment integration work

· Sleep quality in days following ketamine treatment could significantly impact neuroplasticity consolidation, as BDNF release during rest helps lock in synaptic changes initiated by treatment

· Ketamine's addiction potential may stem from the hydroxynorketamine metabolite binding to opioid receptors at high doses, supporting protocols that emphasize "more is not better" dosing approaches

· Mental health symptoms might represent accurate emotional responses to synaptic dysfunction rather than diseases themselves, with ketamine enhancing processing speed and accuracy rather than changing brain content

· Providers could benefit from understanding ketamine's "dirty drug" pharmacology, including sodium channel blocking effects that contribute to dissociation and can be addressed with targeted adjuncts like lidocaine

Episode 53 show notes:

00:00:00 - Teaser: This Is Not Magic, This Is Science

00:00:17 - Introduction and Part 2 Setup

00:01:54 - When Therapy Should Actually Happen: Physical Therapy Doesn't Occur During Surgery

00:02:48 - Optimal Timing for Therapeutic Integration: The Weeks That Follow Treatment

00:05:31 - The Science Behind Post-Treatment Rest: BDNF Release and Sleep

00:07:25 - Audio Sidebar: BDNF and Sleep Connection

00:09:29 - Managing Patient Epiphanies: The Cheese Story and Brain Noise

00:13:30 - Mental Health as Synaptic Processing Speed

00:16:45 - Why Experience-Driven Treatment Would Require Daily Ketamine

00:18:04 - MSKIT Protocol: Minimally Stimulated Ketamine Infusion Therapy

00:22:12 - Minimally Stimulating Environment: Binaural Beats and Brain Noise

00:25:30 - Pain Protocols and the "Dirty Drug" Concept

00:26:57 - Audio Sidebar: Ketamine's Metabolite Addiction Pathway

00:30:31 - Future Vision: Greater Rigor and Medical Oversight

00:34:56 - Rapid Fire Personal Questions

00:42:55 - Final Thoughts and Episode Wrap-up

Thanks for listening

📋 Professional Education Disclaimer: Content for licensed healthcare providers for educational purposes only. Does not constitute medical, legal, or business advice. Always consult qualified professionals for specific clinical and practice decisions.

Connect with Charles Miller & Scenic City Neurotherapy:

Website

Instagram

LinkedIn

📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-053

Follow us on

LinkedIn

Ketamine StartUp Website

YouTube

🚀Want to fast track launching your ketamine clinic? If so, download our free checklist.

In this first part of what became a two-part conversation, we sat down with anesthesia provider Charles Miller from Scenic City Neurotherapy for a discussion that challenged so many assumptions about ketamine therapy.

Charles presents what he calls the "collective lie" in ketamine therapy - the argument that the obsession with psychedelic experiences and mystical insights for a growing segment of providers in our industry is not just misguided, but actually making our patients worse. 

He walks through the neurobiological evidence showing that the real therapeutic action happens days after treatment during the neuroplasticity window, not during those profound moments when patients feel like they're talking to God or having life-changing realizations.

You'll hear Charles critique the research methodologies that seem to support ketamine-assisted psychotherapy, explaining why group averages can mask poor individual outcomes and why the frequently cited KAP studies may actually show lower success rates than standard ketamine protocols. He also shares refreshingly honest advice about starting a clinic - including his decision to open with folding chairs rather than go into debt for impressive furniture.

We're also trying something new with this episode: audio sidebars. As we talk, we’ll pause to provide additional context about complex concepts like psychoplastogens, research study limitations, and the cutting-edge science behind separating therapeutic effects from psychedelic experiences. Think of these as educational moments designed to help you fully understand and enjoy the episode.

This conversation will make you question whether the approaches many of us have been using actually serve our patients - or if we've been chasing the wrong mechanisms entirely.

What You'll Learn in This Episode

· Charles's entrepreneurial journey - How he started Scenic City Neurotherapy with minimal capital and his advice for keeping overhead low during startup

· The "collective lie" concept - Why Charles believes the field's emphasis on ketamine experiences actually reduces treatment success rates

· Neuroplasticity mechanisms - Detailed explanation of the NMDA-glutamate-BDNF pathway and why the therapeutic window occurs after, not during, ketamine administration

· Psychoplastogens vs psychedelics - Understanding David E. Olson's groundbreaking research on compounds that promote neuroplasticity without hallucinogenic effects

· Research methodology critique - Analysis of popular KAP studies and why methodological flaws may be masking poor individual patient outcomes

· Evidence-based positioning - How to counter the "ketamine is just anesthesia" criticism with solid neurobiological science

· Experience vs neuroplasticity - Why Charles argues that focusing on insights and visions during treatment may be counterproductive

Key Takeaways

· Ketamine may function primarily as a psychoplastogen rather than a classic psychedelic, blocking NMDA receptors to trigger neuroplasticity cascades instead of flooding serotonin receptors like traditional psychedelics

· The therapeutic neuroplasticity window occur days to weeks after ketamine administration, when BDNF-driven synaptic remodeling takes place, not necessarily during the acute dissociative experience

· Research comparing ketamine-assisted psychotherapy to standard protocols could show mixed results, with some studies reporting lower individual response rates despite promising group averages

· Providers who overfocus on experiential components during treatment may inadvertently create performance pressure that could reduce patient outcomes and increase perceived treatment failure rates

· Startup ketamine clinics might benefit from beginning embarrassingly small with minimal overhead, focusing resources on essential clinical equipment rather than impressive lobbies or furniture

· David E. Olson's psychoplastogen research suggests that neuroplastic benefits might be separable from psychedelic experiences, supporting approaches that prioritize physiological mechanisms over experiential components

Episode 52 show notes:

00:00:00 - Teaser: When Patients Feel They Failed

00:00:17 - Introduction and Episode Setup

00:02:06 - Charles's Journey into Ketamine Therapy

00:04:30 - The Entrepreneurial Leap

00:06:00 - Startup Advice: Think Embarrassingly Small

00:08:30 - Evolution of the Ketamine Field

00:10:00 - The "Collective Lie" Concept Introduction

00:12:30 - Neurobiological Mechanisms

00:16:30 - Psychoplastogens vs. Psychedelics

00:24:00 - David E. Olson's Revolutionary Research

00:27:27 - Audio Sidebar: Psychoplastogens & David E. Olson

00:30:00 - Research Critique: KAP Study vs Real-World IV Ketamine Data

00:34:27 - Episode Wrap-up

Thanks for listening

📋 Professional Education Disclaimer: Content for licensed healthcare providers for educational purposes only. Does not constitute medical, legal, or business advice. Always consult qualified professionals for specific clinical and practice decisions.

Connect with Charles Miller & Scenic City Neurotherapy:

Website

Instagram

LinkedIn

📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-052

Follow us on

Linkedin

Ketamine StartUp Website

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Every ketamine clinic goes through predictable life cycle stages, just like human development. And understanding which stage you're in changes everything about how you make decisions.

In this episode, we introduce a framework for understanding the four distinct phases every ketamine clinic experiences: infancy (startup survival), teenage years (identity formation), prime adult years (optimization and scaling), and midlife and beyond (legacy and transition planning).

We walk you through what to expect at each stage and the questions to ask yourself to identify where your clinic is right now. This helps you make strategic decisions aligned with your values rather than reactive choices based on fear or pressure.

Whether you're contemplating opening a clinic, surviving startup chaos, establishing systems, or considering your exit strategy, this framework helps you anticipate what's coming next and prepare accordingly..

This isn't theoretical business advice. We've experienced several of these stages firsthand with our own clinic and have supported many providers as they navigate phases we're still approaching ourselves. 

What You'll Learn:

🔹 The 4 predictable life cycle stages: how to identify which phase your ketamine clinic is currently in and what's normal for each stage

🔹 Stage specific challenges and solutions: understanding whether your current struggles are typical growing pains or signs of deeper issues requiring attention

🔹 Value based decision making framework: how to make strategic choices aligned with your goals rather than reactive decisions based on fear or external pressure

🔹 The "sane survival" concept: how to navigate the intensive infancy stage without burning out or sacrificing what matters most to you

🔹 Community and support strategies: why having the right network is crucial at every stage and how to build relationships that support your growth

Key Takeaways

・Every ketamine clinic goes through four predictable business stages, though timing varies based on your circumstances and external factors

・The "sane survival" approach during the infancy stage helps prevent burnout by making proactive decisions about what you're willing to sacrifice versus preserve

・Understanding your current stage helps you distinguish between normal growing pains and actual problems that need different solutions

・Value-based decision making works best when you clearly identify both your current stage and your long-term goals

・Community support networks are essential at every stage, just like parents rely on extended family and experienced caregivers

・Starting a ketamine clinic transforms you personally, not just creates a business entity - as we say, "clinics make entrepreneurs"

・Stage timing varies significantly between practices - some owners stay in infancy longer while others move quickly through all phases

Episode 51 show notes:

00:00:00 - Teaser - Clinics Make Entrepreneurs

00:00:12 - Episode Introduction

00:01:35 - Introduction to the Stages Concept

00:03:38 - The Four Stages Overview

00:04:03 - Stage 1: Infancy Stage

00:08:01 - Stage 0: Pre-Opening Contemplation

00:20:55 - Mid-Episode CTA

00:21:43 - Stage 2: Teenage Years (Identity Formation)

00:23:00 - Stage 1.5: Early Childhood Foundation Years

00:28:27 - Stage 3: Prime Adult Years (Strategic Growth)

00:32:42 - The Four Seasons Metaphor

00:33:36 - Stage 4: Midlife and Beyond

00:38:00 - How to Use the Life Cycle Framework

00:39:56 - Step 1: Identify Your Stage

00:42:29 - Step 2: Clarify What You Want

00:43:17 - Step 3: Make Stage-Appropriate, Value-Based Decisions

00:45:27 - Stages Recap and Community Importance

00:46:37 - Ending and Resources

Thanks for listening

Prefer to Read?

This episode covers similar content as our comprehensive blog post, which includes infographics and quick reference tables showing key indicators, challenges, and decisions for each life cycle phase—perfect for quickly assessing where your clinic currently stands.

Read the full guide with visual frameworks: What Stage Is Your Ketamine Clinic In? A Complete Guide

📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-051

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What happens when a 20 year mental health veteran has her own existential crisis then undergoes her own psychedelic therapy? In Inna Zelikman's case, it completely transformed how she practices medicine.

Inna Zelikman, RN, MS, ANP, PMH-NP, is the Director of Integrative Mental Health at Recovery Without Walls and a MAPS certified MDMA practitioner. Five years ago, her own psychedelic healing journey changed everything about how she sees and treats patients. Now she's challenging the cookie cutter protocols that dominate our field in favor of what she calls an "organic" approach to treatment.

In this conversation, Inna shares her comprehensive patient assessment strategies, the medication categories that secretly block healing (even though they're not contraindications), and why some patients have profound psychedelic experiences but can still struggle.

From consulting with psilocybin centers in Oregon to treating ketamine addiction, Inna offers a nuanced perspective on the complexities of psychedelic medicine and why proper preparation, support, and integration actually matter for lasting results.

What You'll Learn:

🔹 Why doing your own healing work changes how you practice: Inna's personal journey and how it transformed her ability to truly see patient needs

🔹 Comprehensive assessment before treatment: evaluating family dynamics, support systems, and trajectory of care

🔹 The hidden medication barries: CNS depressants that don't contraindicate psychedelics but stall healing and integration

🔹 Set and setting beyond the treatment room: why the therapeutic container includes entire support systems

🔹 Real world psilocybin consulting: challenges and solutions for complex patients seeking therapy in Oregon

🔹 Psychedelics in recovery landscape - Understanding the historical bias in traditional recovery communities and emerging shifts toward acceptance of psychedelic therapy as legitimate treatment

Key Takeaways:

・Healthcare providers who address their own trauma may provide more effective patient care

・Ketamine therapy dosed based on individual patient response could benefit patients who don't improve with standard twice-weekly protocols

・Sleeping pills and benzodiazepines may prevent psychedelic therapy success even when not contraindicated

・Patients may need 1-4 weeks of integration support during the neuroplasticity window for optimal results

・Comprehensive patient assessment including family dynamics and support systems may improve treatment outcomes

・Traditional recovery communities may be slowly shifting attitudes toward psychedelic therapy, though bias still exists against viewing these treatments as legitimate healing tools rather than drug substitution

Episode 50 show notes:

00:00 Teaser - How Healing Informed Patient Care

00:28 Episode Introduction

02:16 What Drew Inna to Psychedelic Medicine

04:38 The Problems with Modern Psychiatry

07:38  Inna's Personal Transformation Story

11:53 The Hero's Journey to Healer's Journey

16:02  How Personal Healing Transformed Patient Care

17:08 Comprehensive Assessment Process

20:20 Beyond Cookie-Cutter Protocols

22:32 Ketamine Therapy Dosing Philosophy

26:00 Psilocybin Work and Vision Story

28:52 Oregon Psilocybin Industry Challenges

31:33 Set and Setting Beyond the Room

33:07 Patient Screening and Assessment Criteria

35:17 The Hidden Medication Problem

42:31 Managing Complicated Cases 

49:33 Patient Examples

55:43 Psychedelics in Recovery and AA

1:00:04 Rapid Fire Personal Questions

1:03:18 Contact Information and Services

1:04:49 Closing Thoughts

1:05:56 Resources

Thanks for listening

📋 Educational Disclaimer: Content for licensed healthcare professionals only. Does not constitute medical advice. Always consult qualified professionals for specific patient care decisions and regulatory requirements.

Connect with Inna Zelikman RN, MS, ANP, PMH-NP:

[email protected]

www.innazelikmanhealth.com

Recovery Without Walls

📝 Complete show notes with resources and  links, please visit www.ketaminestartup.com/podcast/episode-050

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We're breaking into our regular schedule with urgent news that affects everyone in the ketamine therapy space, not just Texas providers.

On January 2, 2026, the Texas Medical Board published proposed regulations in the Texas Register that could fundamentally change how ketamine therapy is delivered in the state. These would be the first comprehensive regulatory rules specifically for ketamine therapy clinics in Texas, and honestly, they could set a precedent for nationwide regulation.

Why should you care if you're not in Texas? Because Texas is the second most populous state with one of the largest medical communities in the country. When Texas moves on healthcare regulation, other states often follow.

These proposed rules cover mandatory clinic registration, onsite physician requirements, enhanced monitoring standards, a complete ban on take home parenteral ketamine, and enforcement mechanisms that would put ketamine clinics under the same scrutiny as pain management clinics.

What You'll Learn:

🔹 Mandatory PKT clinic registration requirements: what Texas providers need to know about the new registration process and renewal deadlines
🔹 The onsite physician mandate: why remote supervision models would no longer be acceptable under these proposed rules
🔹 Enhanced monitoring and training standards: new equipment requirements and airway management training mandates
🔹 Complete ban on take home parenteral ketamine: how this would eliminate certain treatment models entirely
🔹 National implications: why every ketamine provider should pay attention regardless of location

Episode 49 show notes:

00:00 Teaser - Remote Supervision Is Over

00:20 Episode Introduction

02:55 Mandatory Registration Requirements

03:51 The Onsite Physician Requirement

04:42 Enhanced Training and Monitoring Standards

05:49 Documentation and Safety Protocols

06:37 Complete Ban on Take-Home Parenteral Ketamine

06:57 Enforcement Framework

07:14 What This Means for Texas Clinics

08:10 The Broader Industry Implications

09:16 The Access vs. Safety Tension

10:01 Who This Favors and Who It Challenges

10:34 Public Comment Opportunity

10:56 What You Should Do Now

11:38 Final Thoughts

12:42 Where To Get Further Information

Thanks for listening

Links Relevant To The Episode:

Is Your Ketamine Clinic Ready? Texas Proposes Mandatory Registration and What It Means for the Industry includes a Quick Reference Table

Texas Register January 2, 2026 Volume: 51 Number: 1

Texas Medical Board Rule Changes

Chapter 173, Office-Based Anesthesia Services, Subchapter B, concerning Parenteral Ketamine Therapy, §§173.6-173.15.

Comments on the proposed rules may be submitted online or via email

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🚀 Want to fast track launching your ketamine clinic? If so, download our free checklist.