Ketamine as a Path to Healing for First Responders
In rural western North Carolina, a police sergeant who spent nearly two decades in the line of duty found herself grappling with sleep deprivation, depression, and recurring trauma. Waynesville Police Sgt. Paige Shell’s journey to recovery began with talk therapy that didn’t suffice and culminated in ketamine-assisted psychotherapy—a relatively new approach that blends medication with psychotherapy to address severe depression and post-traumatic stress. Her experience reflects a broader, evolving trend among first responders who face extraordinary trauma in service to their communities.
What Ketamine-Assisted Psychotherapy Entails
Ketamine is a dissociative drug historically used as an anesthetic. In low doses, it can induce a mildly altered state of consciousness that helps patients confront traumatic memories from a distance, potentially accelerating psychotherapy. In Shell’s case, sessions typically last about two hours, with roughly 45 minutes of active drug effect. The medication can be administered through an IV drip, intramuscular injection, sublingual lozenges, or a nasal spray, and its acute effects usually wear off within an hour.
Proponents describe its potential as an “accelerant” to traditional therapy, helping individuals access memories and emotions that have been difficult to process. Rick Baker, founder of Responder Support Services, notes that first responders often resist conventional therapy and may benefit from a treatment that provides deep access to trauma memories. Yet this accelerant must be paired with skilled, trauma-informed care to guide patients through difficult recollections without retraumatization.
The Evidence and the Regulated Landscape
The science around ketamine for mental health is promising but still maturing. Early research suggested rapid antidepressant effects, and the FDA approved esketamine, a ketamine derivative, for treatment-resistant depression in 2019. However, other ketamine forms used in mental health care remain off-label and are not uniformly regulated. Experts warn that while clinical practice may outpace robust evidence, rigorous trials are needed to clarify efficacy, optimal dosing, and long-term safety, particularly for PTSD and trauma-focused care common among first responders.
Regulatory oversight varies by state, and federal guidelines do not comprehensively address dosing, administration, or required training for providers. This patchwork has contributed to the proliferation of ketamine clinics—over 1,000 nationwide—and a growing market for at-home treatments, which have drawn FDA warnings about safety and quality control.
Practical Barriers: Cost, Access, and Stigma
Access to ketamine-assisted psychotherapy is uneven. Insurance coverage is inconsistent; many plans do not reimburse the service, making individual sessions—often exceeding $1,000—an out-of-pocket burden for many first responders. Some veterans can access VA coverage on a case-by-case basis, but for police, firefighters, and other responders, coverage remains inconsistent. For Sgt. Shell, a charitable donation covered the cost after insurance fell short, underscoring how financial barriers can shape who receives care.
Stigma within law enforcement further complicates uptake. National wellness leaders note that many officers view ketamine with suspicion due to its history as a party drug and its portrayal in popular culture. This stigma can deter officers from seeking help, even when clinically indicated.
A Cautious, Compassionate Path Forward
Supporters argue that, with proper safeguards, ketamine-assisted psychotherapy can be a meaningful option for first responders facing intractable trauma. Advocates emphasize careful clinical oversight, informed consent, and evidence-based protocols to minimize risks such as nausea, blood pressure changes, respiratory effects, or psychological distress during sessions. The presence of a knowledgeable, trauma-informed guide is key to helping individuals navigate the vulnerable space created by the treatment.
Shell’s story—of progress and ongoing work—highlights a broader question about how to care for those who protect communities. She says treating her own mental health has not only helped her personally but also made her more effective and safer on the job. Her experience is a call to continue advancing research, expanding access to evidence-based care, and reducing stigma so first responders can seek help when they need it most.
If you or someone you know is in crisis
If you or a loved one is experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting 988. In urgent situations, call 911 or go to the nearest emergency room. Support is available.
