Psychedelic therapy, without the jargon.

Ibogaine is a naturally occurring psychoactive alkaloid from the iboga shrub. It produces a 12-24 hour dissociative experience and is associated with meaningful reductions in opioid cravings in some studies. Ibogaine is a Schedule I substance in the US and is not available at any licensed clinic. Access typically means traveling to Mexico or Costa Rica. A separate US pathway exists through Kentucky's proposed veteran-focused fund (currently paused) and certain Right-to-Try frameworks.

IM ketamine is injected into a muscle and produces onset in 3-5 minutes with a total session length of roughly 45-75 minutes. It is less logistically intensive than IV, pairs well with KAP, and is often used by psychiatrists who do not have an anesthesia team on site. Cost is typically $250-$500 per session. Bioavailability is near-identical to IV but the pharmacokinetic curve is different.

IV ketamine is delivered as a slow infusion, typically 0.5 mg/kg over 40 minutes. It is the most potent ketamine delivery route and produces the most reliable clinical response. A standard induction course is 6 infusions over 2-3 weeks, followed by maintenance boosters. Not covered by insurance in most cases. Session cost is typically $400-$800 out of pocket. Delivered by anesthesia-trained clinicians.

Oral ketamine is typically a compounded lozenge or troche dissolved under the tongue or between cheek and gum. Bioavailability is 17-24%, so effective doses are higher in milligrams than IV. Onset is 15-30 minutes, effects last 60-90 minutes. This is the format used by almost every telehealth at-home program (Mindbloom, Joyous, Innerwell, Better U, Wondermed) and by some in-clinic providers as a maintenance option.

MDMA-assisted therapy for PTSD was the first psychedelic New Drug Application submitted to the FDA (by Lykos Therapeutics). The FDA rejected the application in August 2024, citing study design concerns. Lykos has not resubmitted. MDMA remains Schedule I and is not available at any licensed US clinic. Some states have Right-to-Try frameworks that may eventually apply, but practical access for the average patient does not currently exist.

Psilocybin is the naturally occurring compound in over 200 species of mushroom. It is a Schedule I substance federally, but two states (Oregon and Colorado) have created licensed programs for adult use in therapeutic settings. Typical session length is 5-7 hours. Requires a preparation session, a dosing session, and an integration session. No medical diagnosis required. Not covered by insurance. Cost is $1,500-$3,500 per session.

Spravato is the brand name for esketamine, the S-enantiomer of ketamine. It is the only FDA-approved psychedelic-adjacent therapy with broad insurance coverage in the US. Approved for treatment-resistant depression (TRD) and major depressive disorder with acute suicidal ideation. Self-administered as a nasal spray at a REMS-certified clinic, followed by 2 hours of required on-site monitoring. Cannot be taken home.

ASKP3 is the leading professional credentialing body for clinicians delivering ketamine therapy in the US. Board certification requires documented training, supervised hours, and continuing education. Not every practicing ketamine clinician is ASKP3 board-certified, but it is a meaningful quality signal - particularly for KAP, where therapist skill directly affects outcomes.

Bioavailability varies dramatically by administration route. IV ketamine is 100% bioavailable. IM is roughly 93%. Intranasal Spravato is about 48%. Oral/lozenge ketamine is 17-24% due to first-pass liver metabolism. This is why doses differ by route and why IV produces a more reliable clinical effect than oral. It is also why at-home lozenge programs require higher milligram doses than you would see in an IV setting.

Dissociation is a transient state of altered self-perception, time distortion, and reduced sensory input. It is expected during Spravato and ketamine sessions and is a marker of therapeutic dose. Typical duration is 40-90 minutes after dose. It is not dangerous in a monitored clinic setting, though it is the reason you cannot drive for 24 hours. Patients describe it as floating, drifting, or observing themselves from outside.

Induction is the loading phase of treatment designed to produce initial clinical response. For Spravato, induction is twice-weekly dosing for the first 4 weeks. For IV ketamine, it is typically 6 infusions over 2-3 weeks. If you respond during induction, you transition to a less frequent maintenance schedule. If you do not respond by the end of induction, most clinics will recommend stopping.

Integration refers to therapy sessions - typically 1-4 weeks after a dosing session - designed to translate insights or emotional material from the psychedelic experience into lasting change. Integration is standard practice in psilocybin and KAP programs, less common in Spravato (where the dissociative experience is shorter and less content-rich). Some clinics include integration in package pricing; others bill separately.

KAP pairs ketamine administration (usually IM or oral) with active psychotherapy. A therapist is present during the session itself and during integration sessions afterward. KAP differs from plain ketamine infusion therapy, where the medication is the intervention and therapy is not included. Clinics advertising KAP should be able to name the therapist and show their ASKP3 or other specialist credential.

Maintenance is the long-term dosing schedule that follows a successful induction course. For Spravato, maintenance is usually one session every 1-2 weeks, sometimes tapering to every 4 weeks. For IV ketamine, maintenance is often a single booster infusion every 4-8 weeks. Maintenance can continue indefinitely and is covered by most insurance plans for Spravato.

Clinically, TRD is defined as major depressive disorder that has failed to respond to at least two adequate trials of different antidepressants. Most psychedelic therapies (Spravato, ketamine IV, ketamine IM) are targeted at TRD specifically because standard first-line treatments have not worked. Diagnosis is made by a psychiatrist and your treatment history will be reviewed at intake.

Measure 109 passed in November 2020 and created the Oregon Psilocybin Services program, making Oregon the first US state with legal, licensed psilocybin therapy. Services launched in 2023 and are regulated by the Oregon Health Authority (OHA). Adults 21+ can access psilocybin at licensed service centers with a trained facilitator. No medical diagnosis is required. Session cost runs $1,500-$3,500 and is not covered by insurance.

An NPI is a 10-digit number issued by CMS (Centers for Medicare and Medicaid Services) to every US healthcare provider. It is the single most useful identifier for cross-checking a provider's credentials. We use NPIs to tie individual clinician records to the FDA Spravato REMS registry, state medical board licenses, and insurance panels. Every clinic profile on LicensedPsychedelics has a verified NPI behind it.

Off-label prescribing is legal and common in US medicine. Racemic ketamine (IV and IM) is approved by the FDA only as an anesthetic, but is routinely prescribed off-label for depression, PTSD, anxiety, OCD and chronic pain. This means ketamine infusion clinics operate under state medical board licensing rather than FDA REMS oversight. Off-label treatments are often not covered by insurance.

Proposition 122 passed in November 2022 and created Colorado's Natural Medicine Health Act. It legalized psilocybin at licensed healing centers, decriminalized personal use of several other natural psychedelics, and is administered by the Colorado Department of Regulatory Agencies (DORA). First licensed healing centers opened in 2025. Colorado's program moves faster than Oregon's and now has the largest licensed psilocybin footprint in the country.

REMS is an FDA safety framework for drugs with meaningful risks. For Spravato, REMS certification requires a specific clinic setup, trained staff, on-site monitoring, and ongoing reporting. The FDA maintains a public registry of every REMS-certified Spravato site in the country, which is the single source of truth we verify every Spravato listing against.

Right-to-Try laws let patients with serious or life-threatening conditions access investigational drugs that have cleared Phase I trials but are not yet FDA-approved. Several states (including Washington, Utah, and Virginia) have psychedelic-specific Right-to-Try provisions that may cover psilocybin or ibogaine for qualifying conditions. Practical access is limited - few clinicians participate, and most drugs still require specialty sourcing.

In Oregon and Colorado's psilocybin programs, a facilitator - not a psychiatrist or therapist - is the legally required attendant during dosing. Facilitators complete a state-approved training program (hundreds of hours, plus practicum) and are licensed by OHA or DORA. They cannot diagnose or treat medical conditions and psilocybin is not billed as medical care. This is a core structural difference between US psilocybin programs and medical ketamine therapy.

Prior auth is a process where the insurance plan reviews clinical documentation (your diagnosis, treatment history, failed antidepressants) before approving coverage for Spravato. Turnaround is typically 3-10 business days. Every REMS-certified clinic on our directory handles prior auth internally. If a clinic asks you to handle prior auth yourself, treat that as a signal to look elsewhere.

VA Community Care (formerly Choice) authorizes veterans to receive care from approved non-VA clinicians when the VA cannot deliver the service within required wait-time or drive-time standards. It has become the primary path veterans use to access Spravato outside VA Medical Centers. Not all non-VA clinics are in the Community Care network - confirm before assuming coverage.