Romain Lasser/The Globe and Mail
The first time Julian Uzielli took ketamine, he did not have visions or travel to new realms of existence. But the second—and third, fourth, fifth and sixth—times he took the psychoactive drug, his consciousness seemed to spring loose from his body. His thoughts were shaped by the soothing music flowing through his headphones. One time, he found himself slaying demons inside the first-person-shooter game Doom. “I’m actually in my soul right now,” Uzielli thought. “These are my demons, and I have to slay my own demons.” On another occasion, Uzielli’s mind turned to BoJack Horseman, the titular character of the animated Netflix series, and a self-destructive, broken man (well, anthropomorphic horse, to be accurate). “I have a choice to be different from him,” Uzielli told himself later. “I’m going to engage with my issues, and I’m not going to push people away.”
Away from ketamine’s afterglow, these insights are almost embarrassing for Uzielli to talk about. But in the moment, he says, every revelation felt profound. More important, the experience helped relieve his suicidal thoughts—and that’s where ketamine’s promise lies.
The drug is an anaesthetic whose psychedelic properties made it popular on the party circuit, where it’s better known as Special K. More recently, it’s been touted as the future of mental health medicine, applicable to a whole range of illnesses. Janssen Pharmaceuticals has already won approval in both Canada and the United States for a ketamine-based nasal spray called Spravato for patients with treatment-resistant depression. And dozens of start-ups are now hoping to push psychedelics further into the mainstream, both among consumers and investors.
The potential is massive. One in four Americans experience a mental illness in any given year, and the market for antidepressants in the U.S. alone could be worth US$98 billion by 2025. Even if psychedelics capture a small slice of that, it could be significant.
The research is moving beyond the mental health realm, too. A report from the global investment bank Stifel estimates psychedelics like ketamine, psilocybin and MDMA could help more than three billion people and potentially treat 20-plus conditions, including chronic pain and obesity. Not surprisingly, money is starting to flood the sector: In 2019 psychedelics start-ups received roughly US$60 million in investment, according to research firm LEK Consulting. Last year, investors poured in an estimated US$2 billion.
Field Trip Health Ltd., a small publicly traded start-up in Toronto, provides a glimpse of what a psychedelic future could look like. Uzielli’s ketamine trips were part of a highly curated program offered at Field Trip’s 11 clinics across North America (plus one in Amsterdam that administers psilocybin, the active ingredient in magic mushrooms). A full three-week round, which includes six ketamine dosings and three appointments with a psychotherapist, costs roughly $5,000. (Group sessions bring that down to about $2,875.) According to Stifel analyst Andrew Partheniou, the clinical business in the U.S. alone could be worth US$10 billion—though so far, Field Trip has generated just $3.1 million in revenue in its latest three quarters. It also has an R&D division dedicated to developing psychedelic medications.
To be clear, the industry is nascent. “There’s way more enthusiasm than data,” says Dr. Susan Abbey, director of the Nikean Psychedelic Psychotherapy Research Centre in Toronto, which launched within the University Health Network last October. For instance, there’s limited research on whether the kind of treatment Field Trip offers—a combination of ketamine and talk therapy—is any more effective than ketamine on its own. And while Field Trip’s slick branding leans heavily on the psychedelic experience—in fact, it wants people to have the most intense trip possible—it’s not clear whether that’s necessary. Some people who’ve received ketamine for depression see symptoms improve without entering an altered state of consciousness at all.
Today’s market is reminiscent of the early years of the cannabis craze: bold claims, huge uncertainties and a swath of money-losing companies angling to lead the way. In fact, Field Trip’s executive chair and chief ambassador, Ronan Levy, once ran a chain of medical cannabis clinics and has the sort of vibe you’d expect from an affluent business guy who’s gotten very into mindfulness. His head is shaved, and he wears a stubbly goatee and beaded necklace. He meditates. “I come across as pretty easygoing,” says Levy, one of five co-founders, “and a lot of people have said that’s what the psychedelic industry needs.”
It’ll take more than a chill vibe to ensure Field Trip prevails—like a deft strategy, medical and scientific rigour, and buckets of capital. (Just ask any of the dozens of cannabis growers and retailers floundering today.) And those are the factors within Field Trip’s control; it can’t do much about the glacial pace of research and regulation.
None of that dampens Levy’s fervour. He sees a much bigger market ahead, with Field Trip treating a wide array of conditions with a variety of psychedelic drugs. “I have always had this archetype of a 28-year-old bro dude in Pittsburgh who would probably rather be dead than caught in a therapist’s office,” he says. “We can’t reach those people with conversations about therapy and meditation. But can I get that guy to try mushrooms once? Yeah, probably.”
Co-founder Ronan Levy says Field Trip's Insta-chic clinics, complete with zero-gravity chairs in the dosing rooms, are designed to sooth patients and ensure no one has a bad tripHandout
When Uzielli walked into the upscale lobby of Field Trip’s Toronto clinic—with a moss wall behind reception, and trendy furniture dotted with fiddle-leaf figs and succulents—he wondered what he’d gotten himself into. For him, ketamine-assisted psychotherapy straddled the line between “real” and alternative medicine, and the essential-oil diffuser in particular added a whiff of pseudoscience. On arrival, he was handed a Field Trip tote bag containing a journal, a reishi mushroom tincture and a copy of Michael Pollan’s book How to Change Your Mind, an exploration of the benefits of psychedelics.
The 30-year-old radio producer had a long history of depression. In 2020, he found he could barely get out of bed, let alone do his job. During video calls, he could see his resistance exercise bands dangling from the ceiling behind him; in his mind, they looked like a noose hanging over his head. He took two leaves of absence, overcome with intense suicidal thoughts. By the time he came across Field Trip—whose patients must be referred by a doctor for treatment-resistant depression, a label that applies to roughly 30% of cases—he was ready to try anything.
He was led to one of six dosing rooms (with names like Sea, Sunset and Mountain), where a nurse and a respiratory therapist tucked him under a weighted blanket on a zero-gravity chair meant to mimic weightlessness. The nurse gave him a lozenge packed with about 200 milligrams of ketamine that slowly dissolved in his mouth. Feeling woozy, he put on a sleep mask and headphones, where music curated for tripping flowed into his ears. (Franklin Chavez, a soft-spoken nurse practitioner and the clinic’s manager, says Field Trip has assembled several playlists of largely ambient music. “If the client’s intention is to feel love,” he says, “our therapists have put together playlists specifically for that.”)
Uzielli’s first trip didn’t yield much in the way of revelations, but his mood improved, and he returned for five more sessions. Each ketamine journey lasted 45 minutes to an hour. As the ketamine wore off, he debriefed with a Field Trip therapist and had separate weekly sessions. The drug left him emotionally vulnerable, making it easier to open up.
Until then, Uzielli was convinced he’d always be depressed. But after three weeks, he simply wasn’t anymore. He felt exuberant. The feeling faded after a couple of months, and a year later, Uzielli is still on antidepressants. But he says he is nevertheless transformed. Most days are good, and his suicidal thoughts have disappeared. “I feel like it gave me my life back,” he says.
Field Trip Health is one of dozens of companies to leap into a sector reminiscent of the early days of the cannabis craze.Romain Lasser/The Globe and Mail
Ketamine was first synthesized as a painkiller some 60 years ago. At low doses, it induces dissociative psychoactive effects and was later co-opted as a recreational drug. Clinicians kept experimenting, though. Research into ketamine’s effect on depression began in the 1990s at Yale University, and it was found to relieve symptoms within hours, though only briefly.
A wide body of research has since shown it can alleviate symptoms of depression for which other interventions have failed, with up to 65% of users receiving at least some benefit. Between 20% and 30% of those treated with ketamine go into remission. Exactly why isn’t completely understood, but the drug seems to regulate glutamate, a neurotransmitter that helps facilitate the brain’s ability to change and form new connections.
Today, ketamine can be prescribed off-label in Canada and the U.S. And it’s not the only psychoactive drug being studied in labs worldwide, following a long government clamp-down after the 1960s that has since eased. Since August 2020, Health Canada has allowed psilocybin, which can help reduce depression and anxiety, to be administered to nearly 80 people with terminal illnesses. In January, the department further modified regulations to allow doctors to request access to psychedelics for patients with serious or life-threatening conditions for whom other options had failed. Field Trip immediately announced it would apply to Health Canada for permission to administer psilocybin and MDMA, which research has shown to be effective in treating PTSD.
Field Trip opened its first clinic in Toronto in March 2020 (just as the pandemic sent rates of depression and anxiety soaring). Outlets in New York, Los Angeles, Vancouver and Fredericton soon followed. By 2024, it plans to have 75 branches worldwide. “I genuinely believe it’ll be a drop in the bucket relative to anticipated demand,” says Levy.
He’s a relative newcomer to the psychedelics field, a corporate lawyer who left Big Law behind and co-founded a cash-for-gold business before finding his way to medical cannabis in 2014. He and his partners (including Joseph del Moral, now Field Trip’s chief executive) started a chain of clinics called CanvasRX Holdings. “We got into the cannabis industry as entrepreneurs, certainly not as advocates,” says Levy. “As soon as we saw the work our clinics were doing on a humanitarian basis, we were really moved.” They sold CanvasRX to Aurora Cannabis in 2016, in a deal valued at $10.3 million (with further payments contingent on hitting performance goals), and left two years later, just as interest in psychedelics was building.
To get a feel for the field, Levy and a few associates procured some mushrooms, holed up in a rented office and tripped. As Levy and his partners honed their business plan, experts suggested there was a need for new clinics. Most medical centres and doctors’ offices, they were told, didn’t have the proper staff or accommodations for patients to trip and come back to Earth, which can take a few hours. The partners also knew from their cannabis days that producers stood to make far more money than medical clinics. So they created Field Trip Discovery to develop psychedelic medications. Its lead candidate is a synthetic molecule called FT-104 that has a potency similar to psilocybin and binds with the serotonin receptor in the brain believed to be responsible for psychedelic experiences. So far, Field Trip has only tested the molecule in animals, but Phase I trials in humans are set to begin this year in either the Netherlands or Australia.
Field Trip is bullish on FT-104 because of its relatively short trip time. A psilocybin experience can last for hours, which isn’t practical in a medical context. FT-104, however, has a trip time of two to three hours. Field Trip believes it could be used to address treatment-resistant depression, a US$21-billion market in the U.S., as well as postpartum depression. The company expects to gain approval for the drug sometime between 2026 and 2028.
Field Trip's 5 co-founders, left to right: COO Mujeeb Jafferi, president Hannan Fleiman, chief clinacl officer Dr. Ryan Yermus, CEO Joseph del Moral and executive chair Ronan LevyHandout
Developing drugs is highly capital-intensive, of course, with different funding needs from the retail operation. In the first three quarters of their latest fiscal year, Field Trip lost $40.5 million, in part from building new clinics, but also due to its drug research. Levy says Field Trip is reviewing whether to separate the two units. In the meantime, the clinics remain its primary money-maker—and things can get a little weird.
Field Trip describes itself first and foremost as a wellness company, one that offers a “deeply human experience” that combines modern medicine with the “wisdom of the psychedelic approach.” It has imbued ketamine with an almost spiritual aura. One client told me that during a group session, participants were asked to place a personal object on an altar to help focus their intentions. The session, she said, felt like a religious retreat.
Indeed, a recent article in Wired criticized Field Trip and some of its peers for blurring the line between “medical treatment and spiritual healing.” Michael Pollan himself—the revered author whose psychedelics book has its own neon-lit shrine at Field Trip’s Toronto clinic—tweeted the article and described it as “a warning against the Gooping of psychedelics,” a reference to actor Gwyneth Paltrow’s lifestyle brand, notorious for its dubious health advice.
Levy contends the high-end aesthetic serves a purpose: to ensure clients can relax and avoid a bad trip. (After all, ketamine has been known to send recreational users into an unresponsive state known as a K-hole.) When Kristine Iglesias began researching ketamine facilities, she found them to be overtly medical. “I would feel like I was in a treatment centre for psychiatric help,” says the 49-year-old from Connecticut. Iglesias had been suffering from depression and suicidal thoughts. After a three-week cycle at Field Trip’s Manhattan clinic last year, she no longer felt suicidal. She has since returned for a group session and a booster dose. “That process changed the way my mind works.”
Field Trip’s approach is at odds with competitors like Braxia Scientific, which opened Canada’s first private clinic offering ketamine for depression in Mississauga in 2018. It now has four. “We are not a spa,” says Braxia’s CEO, Dr. Roger McIntyre. “We’re a medical company that treats a very, very, very serious medical problem.” His strategy is informed by his background: Dr. McIntyre is a professor of psychiatry and pharmacology at the University of Toronto and heads up a mood disorder research unit at UHN.
Braxia doesn’t offer therapy in conjunction with ketamine, either. “The scientific question is, if you combine the two together, do you get an additive effect?” That, he says, is a work in progress, and he’s conducting a study into whether intravenous ketamine followed by cognitive behavioural therapy (CBT) is more effective at reducing suicidality than either treatment alone.
Indeed, most of the research on ketamine examines the effect of the drug itself, not when it’s administered alongside therapy. “It’s very new,” says Dr. Yuliya Knyahnytska with Toronto’s Centre for Addiction and Mental Health (CAMH), who is conducting her own ketamine research. “All the trials available are very small.” Another complication: There’s no consensus on what ketamine-assisted psychotherapy actually is and how it’s delivered. Field Trip, for example, says its sessions can involve a number of techniques, including CBT and motivational interviewing. “If we have an unstandardized treatment,” says Dr. Knyahnytska, “we cannot evaluate it, and we cannot measure it.”
Field Trip’s own data is limited. It encourages clients to fill out a questionnaire before and after each visit to gauge effectiveness. Dr. Michael Verbora, Field Trip’s medical director for Canada, says patients report a 50% reduction in the severity of depression, anxiety and trauma after a three-week cycle. Three to six months later, their self-reported depression scores are roughly the same. “They’re massively decreased compared to when they first came to see us,” says Dr. Verbora, who also serves as chief medical officer of cannabis firm Aleafia Health. The data is based on roughly 100 patients, and collecting it is tricky since there’s no incentive for clients to respond. “The data set is not as ideal as we’d love it to be,” he says.
There’s not even consensus on the importance of the trip itself, which is key to Field Trip’s pitch. In Dr. Knyahnytska’s own clinical experience with ketamine, she has seen patients for whom an altered state is integral to healing and others who improved with no trip at all. For her, it points to the need for further research. Dr. McIntyre, meanwhile, says not only is a psychedelic trip not necessary, but “we see it as an aspect of the treatment we wish to avoid.”
The gulf between the enthusiasm for psychedelics and that data gap is challenging. “As an academic, I like data. And I also really feel very compassionately for the suffering of people with major mental illness,” says the Nikean Centre’s Susan Abbey. “It just speaks to how desperately people want these treatments.”
In a sign of just how volatile the psychedelic sector is, even some pretty good news can send stocks plunging. In November, Compass Pathways, one of the more prominent players in the space, released the results of the largest ever randomized controlled trial on psilocybin.
The results showed patients who received a high dose reported a significant decrease in depression. But investors sold shares across the board. Stifel’s Partheniou wrote at the time that investors were concerned some patients may require additional dosing; given a psilocybin trip can last from four to eight hours, the results raised questions about its clinical practicality.
Field Trip’s own stock is down by 70% in the past year, leaving it with a valuation of roughly $105 million. Its plans to boost revenue by opening more and more clinics won’t be straightforward, either. There are capacity constraints, for one. Each clinic has just a handful of dosing rooms, and the process takes hours, limiting the number of clients it can treat. And Levy admits finding trained therapists who have psychedelic experience will be tough.
The cost could also be prohibitive. While some insurers might cover the therapy component of Field Trip’s program, at least some would have to pay out of pocket. And the benefits don’t last forever. Studies have shown that people who receive ketamine intravenously relapse within one to three months, although their depression may not be as severe. That means clients might have to come back for top-ups—if they can afford it in the first place.
Such limitations provide an incentive to expand the range of conditions Field Trip can treat. Levy points out there’s promising research showing ketamine is effective for alcohol use disorder, which will afflict roughly one-fifth of Canadians throughout their lifetime, according to Statistics Canada. “There are natural struggles in life that don’t fit into this very rigid box we call the DSM 5,” says Levy. “Our physicians are becoming progressively more open—not being flagrant about it, but satisfying themselves that maybe you don’t have major depression, but you still have some sort of condition that can justify treatment.” The U.S. is considerably looser in that regard; patients don’t need a referral or pre-existing diagnosis.
When I ask Field Trip’s Dr. Verbora if the company might some day accept someone like me, with no history of depression but exhausted by the general anxiety of life, his answer is, “Absolutely.” Interest in psychedelics is only growing, he says. Those trying them, especially for the first time, need an appropriate setting in which to do so, with trained individuals to guide them—the very infrastructure Field Trip is building. “I always joke that once a year, people will go and they’ll do this reset,” says Dr. Verbora, “and it’ll just give them fresh perspectives on their life.”
Field Trip’s branding is certainly designed for mass appeal. The company sells clothes featuring its undulating rainbow logo, and it has a meditation app for “consciousness expansion.” It’s similar to the approach taken by Tweed, the cannabis company co-founded by Bruce Linton in 2013. (He went on to back a psychedelics company, too.) Tweed, which became Canopy Growth Corp., built a consumer brand long before the recreational market was established, helping it cement an early lead.
Levy goes so far as to say Field Trip is, at its core, a lifestyle company. Lately, he’s been devoting thought to what a “psychedelic-informed” life can look like. “When you support people who are leaning into changing their lifestyle, tapping into meditation, eating healthier, exercising, being more empathetic,” he says, “that’s how you’re going to change the world.”
Patients like Janine, meanwhile, just want relief. (She asked that we not use her last name for privacy reasons.) After surviving a suicide attempt a few years ago, the 34-year-old Torontonian began taking antidepressants. Two years later, she hit a low. In June, she had her first session with Field Trip. Afterward, she looked in the mirror and told herself she was beautiful. “That was the first time I actually believed it,” Janine says. “After that first week, it sort of ripped out the skeleton of how I treated myself.” By the end of the three weeks, she felt reborn.
When she noticed her old thought patterns returning, she booked another treatment in July, attended a group session in October and recently had another maintenance dose. Janine, who works in web development, likens it to updating computer software: It can be buggy, and sometimes legacy programming can gum up the works. “Each subsequent session has helped to remove more of that old programming,” she says. “I’ve rewired so much of what I used to be. I’m okay for a while now.”
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Joe Castaldo