Ketamine is not a miracle pill, the actual outcome of treatment also depends on the client's inner work, says psychedelics expert
How would you define psychedelics and how do they differ from other psychoactive substances?
Psychedelics are a very specific group of psychoactive substances that alter consciousness, emotions, thinking and the way we experience reality. They act primarily on the serotonin system of the human body and, unlike many other psychoactive substances that are associated with addiction, classic psychedelics do not have this property - i.e. they do not cause physical or psychological dependence.
Is it really not psychological? Is there no risk of addiction?
It can happen that one becomes fond of an expanded state of consciousness, especially if one has so-called mystical or spiritual experiences in it. In this case, he may seek out these experiences repeatedly, often without the necessary integration of the psychedelic experience. Sometimes we can also speak of a so-called spiritual bypass, where the individual excessively escapes to the spiritual plane in order to avoid the relational and emotional demands of ordinary reality. Even so, we cannot say that this is a classic addiction as we know it, for example, with alcohol or opiates. Rather, psychedelics can be "abused" in the sense that one seeks out repetition of these unusual states, but it is not addiction in the standard sense.
Let's talk about what substances actually qualify as psychedelics...
The classic psychedelics include LSD, psilocybin - the active ingredient in so-called magic mushrooms, mescaline found in psychoactive cacti, DMT, which is the active ingredient in the drink ayahuasca, and 5-MeO-DMT found, for example, in the secretion of the Colorado toad. From an extended spectrum, psychedelics can also include substances with similar therapeutic and phenomenological effects, such as ketamine or MDMA.
What about marijuana?
It acts on a different receptor system. Although there may be some experiential similarities, marijuana does not belong in the category of classical psychedelics. As far as new substances are concerned, so-called research chemicals or designer drugs - chemical compounds designed to evade legislative restrictions - are constantly emerging. They may have similar effects to conventional psychedelics, but they are not immediately included in the list of banned substances. Such substances are created in uncontrolled laboratories and their safety is not tested in any way, making them significantly more risky and unsuitable for recreational use.
What is the current level of recreational use of psychedelics in the Czech Republic?
Population studies show that approximately 5-6 percent of the adult population in the Czech Republic has experience with classical psychedelics. There has been a lot of media coverage of psychedelics recently, with new books being published, documentaries and Netflix series appearing, which is certainly contributing to a greater interest in these substances and probably to an increase in their use in a recreational context. However, we will have to wait for the actual data from the last few years.
Is that a high number in your opinion? Where do we stand on this compared to other European countries?
I don't have exact figures, but given that we are a nation of mycophiliacs - mushroom picking is part of our culture - and some species of bryophytes are common here, I imagine that the level of use may be slightly higher than in some neighbouring countries.
Psychedelics have been heavily demonized in the past. Their prohibition was linked to the so-called war on drugs. What is the situation today? Is society's attitude changing?
Certainly. The biggest wave of prohibitions came in the 1960s and 1970s, when the UN adopted international conventions and created lists of controlled substances. Psychedelics irrationally made it to the strictest one. In recent years, attitudes have been slowly changing - thanks in part to pressure from the professional community. In 2022, the UN agreed that a zero-tolerance approach was unworkable and unsustainable. This was a naive idea - that drugs would be completely eradicated from the planet. But history shows that people have been using psychoactive substances since time immemorial and will continue to do so. The war on drugs has cost society a huge amount of money and many lives. A more balanced approach is therefore beginning to be advocated that takes into account the complexity and reality of human behaviour and experience. Some countries around the world have already begun to remove psychedelics from the most strictly controlled category, especially for medicinal use. It is slow going, but a steady shift is taking place.
What about the therapeutic use of psychedelics in the Czech Republic? I know ketamine is used therapeutically, but what about psilocybin or LSD?
In our country I would divide it into two levels - clinical trials and psychedelic or ketamine-assisted psychotherapy itself, which is available to the general public. In clinical trials in the Czech Republic, the work is mainly with psilocybin and ketamine, for example, at the National Institute of Mental Health, where two larger trials are currently running. Other clinical trials are also underway at the Psyon clinic in Prague.
Outside of clinical trials, only ketamine-assisted (psycho)therapy is currently available in this country. Ketamine is therapeutically exceptional in that it is not on the strictest list of controlled substances. This fact allows it to be used off-label, i.e. outside its primary indication, but on the basis of sufficient scientific evidence of its efficacy in other psychiatric diagnoses.
In practice, this means that ketamine-assisted therapy is used, for example, for depression, anxiety disorders, OCD, PTSD or eating disorders. The safety of ketamine is well substantiated, among other things, because it is commonly used in anaesthesiology, even in children.
And in what cases are psychedelics, on the other hand, not recommended?
The principal contraindication is a personal or family history of psychotic illness - especially schizophrenia. If someone has a direct family history of such an illness, they will generally not be eligible for clinical trials or therapy.
Further, psychedelic experience is not recommended for individuals at high risk of suicidal behavior or with acute substance dependence. Somatic contraindications include pregnancy and breastfeeding or significant cardiovascular disease. However, it always depends on the individual case and the physician's assessment.
Could you describe what the actual therapy session looks like - for example, with ketamine treatment?
I have experience mainly with the Psyon clinic I work with, so I can describe the model of how it works there. But nowadays this clinic is not the only one - recently the New Elysium in Brno was established, which also offers ketamine-assisted psychotherapy.
At the Psyon clinic, the client typically first undergoes a comprehensive psychiatric and internal examination to rule out the contraindications mentioned above. This is followed by two preparatory sessions with a therapist where the client's expectations and intent are primarily worked on. Here, all relevant information is conveyed to both parties and a therapeutic relationship and trust is built.
This is followed by the ketamine experience of the expanded state of consciousness itself, and then two key integrative sessions which serve to enable the client to take important insights from the experience into their daily life. Integration is thus an essential part of the whole therapy and reinforces long-term improvement in psychological state.
It is possible to continue in integration groups at the clinic or in individual psychotherapy. A list of mental health professionals dedicated to integrating the psychedelic experience is available on the Space of Integration website.
Suppose I am a person with depression, conventional treatment is not helping and I am considering ketamine therapy. How can I access it - and how much will it cost me? Insurance companies probably won't cover it completely...
In order to take ketamine legally and therapeutically, the client must be currently suffering from the psychological difficulties we mentioned - for example, severe depression, anxiety, OCD, and so on. And at the same time, he should have had at least one unsuccessful attempt at another form of treatment - either pharmacotherapy or psychotherapy.
In other words, it's not enough to have a diagnosis, you need to have evidence that conventional treatment hasn't worked.
And how much does such therapy cost?
The Psyon Clinic currently works with six health insurance companies, including the largest ones. The price of one therapeutic process for the insured ranges between 14 and 19 thousand crowns. For self-payers, the price is significantly higher.
Is one therapy session enough to cure me?
This is very individual. In some cases, just one session is enough to improve the psychological state in the long term, in others clients return for repeated treatment. Biologically, ketamine is effective on the neurobiology of the brain, especially for depression, but this purely biological effect persists for about a week.
The length of the therapeutic effect enhanced by the integration of the ketamine experience varies person to person. The client's setting, support from the therapist, social background, or how involved the person is in society all play a role. It is not a magic pill - the long-term effect is also very dependent on the subsequent inner work of the client.
Can you think of a particular story of a client who has been really helped by ketamine therapy? Do you have a personal experience with it?
I can certainly think of some case histories, but rather than describing one particular story, I would recommend to listeners and readers the Psyonauts podcast, recently launched by the Psyon Clinic. It features authentic testimonies from clients who have undergone this therapy. I think this is the best way to get an idea of the benefits and progress of this treatment.
Within the Czech Psychedelic Society you are also involved in the principles of so-called "harm reduction". Could you tell the readers what are the basic principles of safer use of psychedelics?
Harm reduction, or risk reduction, is based on the assumption that although it would be ideal not to use any substances, the reality is different, as we have already said. And if a person decides to use a psychedelic substance, they should have at least the basic knowledge and tools to do so as safely as possible.
There are three basic pillars of harm reduction: set, setting and substance. Set means the internal setting - what mental state the person is in, what they are currently experiencing and how they are feeling. For example, if someone has just broken up with a partner, it's probably not a good time to have a psychedelic experience. The setting is the environment - where I am taking the substance, who I am with, what conditions surround me. A safe, calm environment with trustworthy people is absolutely key. The substance - the substance itself. It is important to know exactly what one is taking, where the substance comes from, what its purity is. There are test kits that can easily be ordered online that can reduce the risk significantly. It is also advisable not to combine substances - interactions can be erratic, very unpleasant to experience and some even life-threatening.
And what if a person has already taken a substance but gets into a 'bad trip' - a negative experience? What should one do in such a situation?
Ideally, he or she should always have someone with them who remains sober. Such a person can be an important support and help in coping with a challenging psychedelic experience. Psychedelics powerfully amplify our internal states and external stimuli. Therefore, it is important to remain calm, speak slowly and respectfully, reassure the tripper that all is well and the effect of the substance is wearing off, provide for physiological needs, encourage deep breathing or redirection of attention. Simple grounding - touching something tangible, wrapping oneself in a blanket, or gentle physical contact such as pressure on the soles of the feet or grasping the hand - also helps. Similar interventions can change the nature of the whole psychedelic experience.
And when do you think it's appropriate to call an ambulance?
When a person is endangering themselves or their surroundings, or when symptoms of serotonin syndrome - such as tremors, loss of consciousness, overheating, fever, sweating, skin discoloration, vomiting, etc. - are present. When a person is unsure and has a valid concern, it is always better to call in the help of professionals. In most cases, however, a calm, empathetic approach and the presence of someone the person trusts is enough.
Are you optimistic about the future of psychedelics? Will we see them routinely in treatment?
I'm a firm believer. By the way, today is an important day - the third reading of the law on the medical use of psilocybin is being debated in the House of Commons (the interview took place on Friday 30 May 2025 - the law finally passed, editor's note). If it passes, we will become one of the few countries in the world where it will be possible to legally treat with psilocybin in a medical context. We would then become a very progressive country in the field of mental health.
But also in general I feel that this direction is already unstoppable. There are a lot of people, institutions and funding involved in research and therapeutic projects. I believe that within a few years psychedelics will become a normal part of the mental health care system - at least in the health sector.
