Sitters play an integral part of each ketamine experience, and having a sitter present for every ketamine experience is a requirement for treatment at Innerwell. Their presence should create a sense of safety and tranquility. In addition, they are there to ensure that their friend or loved one is safe and well cared for each time they embark on a ketamine experience.

While each person’s journey will be different, here’s how sitters can assist before, during and after each ketamine experience. Please print these instructions and keep them on hand during your loved one’s ketamine experiences.

Before:

• Be fully available and present on the day and time of your friend or loved one’s ketamine experience.
• If your friend or loved one is working with an Innerwell psychotherapist, briefly join their Zoom sessions at the start of their ketamine sessions (not applicable to self-guided sessions), so the therapist knows you are there and you can exchange phone numbers.  
• Discuss how your friend or loved one would like you to comfort and support them during the session if they appear anxious or in distress. Some people welcome a hand on their shoulder or having someone hold their hand; others prefer to just have someone by their side without physical contact. This should be discussed prior to starting a session.

During the Session:

• Maintain a quiet and calm atmosphere including making sure all children, pets, noises and distractions are kept to a minimum.
• Be present and aware. If your loved one is undergoing a therapist-guided session, their therapist will need to be able to call or text you to check on them if they have any concerns about their safety or wellbeing. 
• Stay within earshot of your friend or loved one in case they need anything. Please do not wear headphones.
• Periodically check on your friend or loved one during their experience (yes, poke your head through the door), but do not interrupt their experience to ask if they’re okay unless they look like they’re in distress. 
• Assist them in moving around the house if needed - such as walking them to the restroom.

Post-Session:

• Offer tea, water, snacks, fruit, blankets, or any other comforts to help them enjoy a smooth after-care.
• Make sure their journal and pen are by their side.
• Remain onsite for the entirety of your friend or loved one’s experience (approximately 2-3 hours). 
• Do not leave them alone in their home until they are back to their baseline (i.e., they are able to hold a regular conversation with you; they are able to walk, talk, eat, and drink normally; they display no significant residual effects other than the following: slight intoxication, mild mental fogginess, mild nausea, and/or slightly blurry vision).

Please note, you are not responsible for “guiding” or actively influencing your friend or loved one’s journey in any way. However, you are welcome to offer emotional support when it is solicited.

FAQ:

Q: How will they consume the ketamine?

A: Your friend or loved one will place their prescribed amount of ketamine lozenges in their mouth, hold and periodically swish the medicine in their mouth without swallowing, and then spit out the medicine into a cup after 10 minutes.

Q: How long do the effects last?

A: Ketamine’s effects begin within 5-10 minutes of ingestion, and the psychoactive effects last for about an hour. Feelings of physical imbalance or being “out of it” may persist for a few hours following their dose.

Q: What should I expect from them during the session?

A: Your friend or loved one will most likely be lying down and remain calm and quiet, listening to music while in a mildly dissociated state throughout the experience. However, it is not uncommon to emote in various ways, such as crying, laughing, screaming, squirming or making loud noises. This kind of response is not a need for concern and may be a part of their psychological process.

Q: Are there any side effects?

A: Physical symptoms such as nausea, drowsiness, and fatigue are common side effects, and should subside within 1-3 hours. 

Vomiting can occasionally occur if nausea is severe, but will generally subside within 1-2 hours. Your friend or loved one will have been instructed to not eat for 4 hours prior to the start of each ketamine session (water is OK) to reduce the risk of nausea and vomiting. 

Here’s what you should do if your friend or loved one starts to vomit:

• If they’re alert and awake enough to walk, assist them to the bathroom and keep their head above the toilet or trash can.
• If they’re too groggy to walk to the bathroom with assistance, help them sit up and hold a large bowl or trash can in front of them in case they continue to get sick.
• If they’re too sedated to sit up, move them into the recovery position so they will not choke on their vomit. 

The Recovery Position

1. Raise the arm that is closest to you above their head. Prepare to roll them towards you.

2. Gently roll them toward you, guarding their head from hitting the floor. The head should rest in front of the arm, not on it.

3. Tilt the head up to maintain their airway. Tuck their nearest hand under the cheek to help maintain head tilt and raise the face off the floor.

4. Check on them often.

If you are worried about your friend or loved one, call 911, especially if you can't awaken them to the point that they can talk to you. Furthermore, If they’re vomiting continuously and not improving, or if you notice blood in the vomit, call 911.

Q: What should I do if my friend or loved one appears to be uncomfortable or in distress?

While we encourage you to give them space to experience the highs and lows that can come with psychedelic experiences, there are a few things you can do to help:

• Remind them to return to their breath, remain in the moment, and let thoughts pass by
• Reassure them that they are safe and that this is a temporary experience
• Make sure they are warm and physically comfortable
• Offer a drink of water
• Place a hand on their shoulder for comfort, or hold their hand if you have previously agreed this is something they would want you to do for reassurance.

Q: What if my loved one is having a psychologically challenging experience, or is having difficulty processing their experience after it ends, emotionally or otherwise?

A: If you or your loved one would like someone to talk to during a psychologically and/or emotionally challenging psychedelic experience, you can contact the Fireside Project by calling or texting 62-FIRESIDE. They’re open every day from 11:00 am - 11:00 pm PST. Their Psychedelic Support Line is staffed by rigorously trained, compassionate, supportive volunteers from diverse backgrounds who listen deeply and from a place of non-judgment.

If your loved one doesn’t need to talk to someone immediately during or after a challenging experience, remind them that they can reach out to their psychiatric clinician and/or therapist at Innerwell to discuss their experience. They can contact their clinicians in the Innerwell Portal (located in the Care Team section of the Support tab). Innerwell’s Member Support team can also be reached during business hours by calling (909) 679-3482 or emailing care@helloinnerwell.com.   

Q: What should I do in case of an emergency? 

A: Call 911 if you suspect an emergency. Signs of an emergency [such as a heart attack or stroke] can include complaints of new chest pain, chest pain that travels down the left arm, shortness of breath, excessive sweating, severe headache, vision loss, facial drooping, one-sided arm weakness, or slurred speech.

You should also call 911 if your friend or loved one reports any thoughts of suicide or hurting others, or begins behaving in an erratic, paranoid, bizarre, impulsive or physically aggressive manner, or in any other way that is concerningly out-of-character for them.

The 988 Suicide & Crisis Lifeline also provides 24/7, free and confidential support for people in distress, as well as prevention and crisis resources for you or your loved one. For crisis counseling, please call or text 988.

Q: Is it possible to overdose?

A: The doses of ketamine that we prescribe do not put anyone at risk of overdose.

If you are interested in learning more about ketamine treatment for mental health, please see our blog post here.