Why Ketamine Therapy at Canto Is Fundamentally Different — and Why That Difference Matters
Why Ketamine Therapy at Canto Is Fundamentally Different — and Why That Difference Matters
In March 2026, the Wall Street Journal published a sweeping investigation into the largely unregulated online ketamine industry — and the results were sobering. The article documented the deaths of patients who received ketamine through telehealth platforms, described providers prescribing the drug despite known dangerous drug interactions, and quoted an addiction psychiatrist who called the industry "a dangerous, addictive drug being given with minimal oversight."
As the founder of Canto Integrative Psychiatry and a clinician who has dedicated her doctoral work and clinical practice to ketamine-assisted psychotherapy, I read that article with grief for the patients described — and with a profound sense of urgency about the need for clearer public understanding of what responsible KAP actually looks like.
The practices described in the WSJ piece — at-home lozenges prescribed after a quick remote consultation, refills dispensed through online surveys, doses increased despite alarming symptoms, no therapist present — are not ketamine-assisted psychotherapy. They are ketamine delivery services. The distinction is not semantic. It is, in some cases, the difference between healing and tragedy.
What the WSJ Investigation Found
The article profiled multiple companies offering ketamine through remote consultations, often to patients who had never been seen in person. One patient — already taking Xanax, a combination the FDA warns can cause respiratory failure and death — was prescribed ketamine anyway. She died after taking a dose alone at home. Another patient, treated for postpartum depression, had her dose increased after reporting frightening dissociative side effects; her subsequent ketamine-induced psychosis ended in the deaths of her four children and herself.
The investigation also found that over 500 businesses nationwide now offer ketamine under wildly inconsistent safety standards, that prescription rates exploded more than eightfold in the first nine months of 2025 alone, and that more than half of ketamine provider websites fail to mention any risks associated with the drug at all.
"It feels like they're becoming their own doctor." — Jeffrey Gold, psychiatric pharmacist, on patients taking at-home ketamine on their own schedule
This is the landscape into which many people searching for relief from depression, anxiety, and trauma are walking. And it is exactly why the how of ketamine therapy matters as much as the whether.
Ketamine-Assisted Psychotherapy Is Not a Prescription — It Is a Clinical Relationship
At Canto, ketamine is never the treatment. It is a tool that, in the right conditions and with the right support, creates a window of neuroplasticity — a brief period of openness in which the brain can form new connections, old patterns can be examined with fresh perspective, and genuine psychological healing can occur.
That window requires a container. Without preparation, without presence, without integration, ketamine's dissociative effects are simply dissociative effects: unmoored, unsupported, and potentially destabilizing for anyone with complex trauma, attachment disruption, or a history of psychosis.
Here is what that container looks like at Canto:
Before Any Ketamine Is Prescribed
Every prospective patient at Canto undergoes a thorough psychiatric evaluation. This is not a remote checkbox intake, but a genuine clinical conversation. I take a full psychiatric and medical history, review all current medications for dangerous interactions, assess trauma history and structural supports, and screen carefully for contraindications including active psychosis, dissociative disorders, cardiovascular instability, and active substance use. I hold MAPS training in psychedelic-assisted psychotherapy and approach every evaluation through an integrative, trauma-informed lens.
Not everyone who wants ketamine is a good candidate for it. Saying so is part of responsible care.
Preparation: The Work That Makes the Work Possible
Before a patient's first ketamine session, we engage in dedicated preparation. This is where we establish safety, clarify intentions, address fears, and build the clinical trust that allows a patient to surrender to the experience without terror. For patients with significant trauma histories (which describes many people seeking KAP) this preparation is not optional. It is what separates a healing experience from a retraumatizing one.
Every Session Is Supervised
Ketamine sessions at Canto take place in our purpose-built clinical & therapeutic space a in Chapel Hill. No one journeys alone. I am present throughout every session to monitor safety, provide grounding as needed, and hold the therapeutic container. Vital signs are monitored. The environment is crafted with intention — sound, light, comfort — because the set and setting of a psychedelic experience are not peripheral; they are part of the treatment.
At-home use eliminates all of this. A patient dissociating in an uncontrolled environment, alone, with no trained clinician present, has no safety net if something goes wrong.
Integration: Where Healing Actually Happens
The insights and emotions that emerge during a ketamine experience are raw material. Integration is the therapeutic work of making meaning, building new narratives, and translating altered-state revelations into lasting behavioral and relational change. Through integration, raw material becomes healing. At Canto, integration is built into every treatment plan, through individual sessions and, for those who benefit from shared experience, group integration work.
Without integration, patients are left holding pieces of something profound they cannot assemble. In some cases, that can increase distress rather than relieve it.
Telehealth Ketamine Mills vs. Canto Integrative Psychiatry
Online Ketamine Platforms
Remote intake, often no in-person evaluation
Lozenges mailed to your home
No licensed medical provider present during sessions
Refills via online survey or message
Minimal or no preparation support
Integration rarely included or offered
Doses increased despite adverse symptoms
Drug interactions sometimes missed or ignored
Licensed medical provider never physically present
Canto Integrative Psychiatry
Full psychiatric evaluation before any prescription
All sessions in our medically-supervised Chapel Hill clinic
Licensed medical provider present throughout every session
Ongoing assessment before any dose adjustments
Dedicated preparation sessions included
Individual and group integration support offered
Adverse responses addressed as clinical information
Full medication reconciliation and contraindication screening
MAPS-trained, doctorally-trained, medical provider (PA) who specializes in psychiatry and psychedelic assisted psychotherapy (with emergency medicine background).
Who I Am and Why This Work Calls Me
I am a psychiatric physician associate with doctoral training in ketamine and psychedelic-assisted psychotherapy, MAPS certification, and over 13 years of clinical experience across emergency medicine, oncology, and integrative psychiatry. I approach this work from a non-dual clinical framework, informed by contemplative traditions that recognize the interface of medicine, consciousness, and meaning-making as intrinsic to healing.
I founded Canto Integrative Psychiatry in Chapel Hill because I believe that ketamine, used responsibly and with skilled clinical support, can be genuinely transformative for people who have not responded to conventional treatments, and because I believe that the current telehealth gold rush is putting vulnerable people in harm's way.
The people seeking ketamine therapy are, by definition, suffering. They deserve care that honors that suffering — not a subscription model.
A Note on Safety Standards
The WSJ investigation described ketamine being prescribed to a patient already taking Xanax — a combination the FDA warns can cause respiratory depression and death. At Canto, a full medication review and contraindication screening is part of every initial evaluation. Known dangerous combinations are absolute contraindications. No exception. No workaround. The standard of care exists because people have died when it isn't followed.
Ketamine Has Genuine, Evidence-Based Value — In the Right Hands
None of this is an argument against ketamine as a therapeutic tool. The research supporting its use for treatment-resistant depression is meaningful and growing. For the right patient, prepared and supported by the right clinician, ketamine-assisted psychotherapy can offer something that years of antidepressants and conventional therapy have not: a profound disruption of entrenched neural patterns and a window of genuine openness to change.
Dr. Gerard Sanacora of the Yale Depression Research Program, quoted in the WSJ piece, described the evidence well: at low, intermittent doses under medical supervision, with adequate recovery time between sessions, ketamine can stimulate the formation of healthy new neural connections and support lasting cognitive and behavioral change. That is the promise. The delivery model determines whether that promise is kept or squandered.
At Canto, we are committed to keeping it.
Serving the Triangle — With the Care This Work Demands
Canto Integrative Psychiatry serves patients in Chapel Hill, Durham, Raleigh, and across the Triangle region of North Carolina. We offer individual ketamine-assisted psychotherapy, group KAP sessions, couples work, and retreats — all in our Chapel Hill clinic.
We do not offer unsupervised, at-home ketamine. We will, however, treat you in your home if you are unable to come to our clinic. Learn more
We do not offer remote-only treatment.
We do not prescribe without knowing you.
If you have been considering ketamine therapy and are wondering whether the convenience of an online clinic is worth the tradeoffs — I hope this gives you some of what you need to think it through clearly. The door at Canto is open for those ready for the real thing.
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