Ketamine

• Priority is given to qualifying patients with terminal or serious illness, who are suffering from significant anxiety, depression or fear, as well as their loved ones who may be experiencing similar distress.
• Front-line healthcare providers such as hospice, ICU or emergency medical staff dealing with mental health struggles are also given priority.
• Studies show that ketamine can be effective for treatment-resistant conditions such as depression, anxiety, addiction, Obsessive Compulsive Disorder, and PTSD. Dr. Charfen is open to working with anyone with these mental health conditions, as long as they currently have or are open to having psychiatric support from a mental health care professional. Dr. Charfen is not a psychotherapist but believes that Ketamine Therapy is most effective when applied in the combination with psychotherapy.
• Every patient must complete a detailed medical intake, which will be reviewed by Dr. Charfen. A medical consultation will be arranged either in-person or via telemedicine to complete the initial evaluation and determine whether a person qualifies for ketamine-assisted therapy.
• Ketamine is never given on the same day as the initial evaluation, except in rare circumstances such as suicidal ideation.

• you are allergic to Ketamine
• you are pregnant or plan to become pregnant during treatment or are breast feeding
• you have a psychotic disorder
• you have uncontrolled high blood pressure or significant heart/liver disease

Dr. Charfen will determine if you are a candidate after reviewing your medical intake and any medical records that you supply, in addition to considering information provided to her in your consultation meeting.

It has also been utilized successfully in managing acute and chronic pain conditions due to its analgesic (pain relief) properties. It has been used quite extensively on the battlefield.

In the last two decades, ketamine has been increasingly applied clinically at subanesthetic (lower than anesthesia level) doses as an off-label treatment for various chronic treatment-resistant mental health conditions, such as depression, anxiety, alcoholism, substance dependencies, post-traumatic stress disorder, obsessive compulsive disorder, and other psychiatric diagnoses.

The present understanding of ketamine’s mode of action is as an NMDA antagonist working through the glutamate neurotransmitter system. (This is a different pathway than that of other psychiatric drugs such as the SSRIs, SNRIs, lamotrigine, antipsychotics, benzodiazepines, etc.).

In depression, the spindly receptors on neurons that facilitate signal transmission may recede, and the amygdala and hippocampus (both which help govern mood) may shrink.

Animal research has shown that ketamine can stimulate neural growth within days (and sometimes hours). One hypothesis is that there is similar action in humans.

Research is ongoing and there is no current consensus on ketamine’s mode of action, and other mechanisms may be found central to ketamine’s effects as more research is performed.

What we do know is that approximately 70-80% of qualified patients will respond to ketamine’s antidepressant effects, which is a level unheard of with other standard mental health modalities. This response is often felt in a few hours to a few days after treatment.

Ketamine is a novel and incredible treatment in the field of mental health, yet it is not a magic pill or a cure. It is one of various tools that can be used to help our mind-body connection heal. Most responders will need at least six treatments over a short period of time and sometimes monthly boosters thereafter.

Though research has demonstrated an antidepressant response to low doses which are minimally psychoactive or sub-psychedelic, this effect tends to be cumulative, requiring repeated administrations over short periods of time. The view of some practitioners is that the psychedelic and dissociative experiences that occur at higher doses tend to provide a more robust and longer-lasting outcome.

Though experiences vary greatly, it is generally thought that lower doses provide empathogen-like (heart-opening) responses, while higher doses create dissociative, psychedelic, out-of-body, ego-dissolving peak responses.

Dr. Charfen uses a range of dosing and route of administration (ROA) strategies to tailor a personalized approach for each client.

The choice of dose and route of administration also depends on multiple factors, including client preference, therapeutic goals, prior exposure to ketamine and other psychedelics, body height and weight, and sensitivity.

All of these factors are discussed during the initial medical consultation.

Initial Medical Consultation for qualification: $200 

• Dr. Charfen can submit billing to those with Medicare and HMSA plans for this consultation.
• Other insurance plans may accept a super bill for partial reimbursement, which will be provided after payment in full is received prior to the scheduled appointment.
• This consultation can be done in-person or via telemedicine.

Ketamine Administration Sessions:

• Sessions are typically at least 2 hours long in the North Kohala office. Dr. Charfen is the provider present throughout the treatment session.
• Unfortunately most insurance providers like Medicare will not cover the actual ketamine sessions for off-label use and patients must pay out-of-pocket.
• Oral or Sublingual administration: $395
• IM (intramuscular) or SC (Subcutaneous): $495
• IV (intravenous): $695
• Reduced rate packages are also available when 3 sessions or more are booked.

(Residents of Hawai’i: Please note that GET tax (4.712%) will be added to all rates.)

Terminally-Ill, Veterans and Senior Applicants:

• Dr. Charfen offers a discounted rate of 25% to these applicants or others who have economic hardships or are members of a marginalized group. Please inquire further if you need assistance.
• Life & Death Wellness, the nonprofit founded by Dr. Charfen, is also attempting to procure grants to provide equal access for qualified patients that can not afford this therapy.
• Dr. Charfen is open to group sessions and other innovative ways for all to obtain access until insurance companies agree to cover this much-needed therapy.

To learn more about Dr. ChaCha’s Death Doula & Psychedelic training using Ketamine, please click here.