🫠 Psychonaut POV

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Dylan Beynon used to think ketamine was for horses. (To be fair, lots of people did.) But once he experienced it himself, he set out to repair the drug’s reputation. Now he runs Mindbloom, the world’s largest consumer ketamine company, which will soon deliver its one millionth session right in someone’s living room.

We asked Dylan how he answers his critics on the risks of unsupervised use, why the temporary DEA waiver his whole model depends on doesn’t faze him, and where he sees at-home psychedelic therapy headed next.

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My family was obliterated by mental illness. I grew up in Anaheim in the bottom quintile of socioeconomic status. My mom was schizophrenic and an addict, so our home was violent and turbulent, and my only sibling, my sister, was severely mentally ill too. I came out of childhood with complex PTSD.

On paper, I looked like a success story. I was valedictorian and got into Wharton on a full scholarship. But on the inside I was full of anger, often blackout drunk and picking fistfights. I started studying positive psychology and quickly realized that what I was doing would never make me happy. Then a friend I trusted got me to try MDMA. For the first time in my life, I felt what it meant to be open-hearted, and it changed everything.

When I set out to build a mental health company, I already knew something most of the world didn't—that psychedelics work. The catch was that almost all of them were illegal, except ketamine, which I'd written off as a horse tranquilizer. Then one day I was eating lunch with a doctor friend who was raving about ketamine as a mental health treatment. He wrote me a prescription, and it was incredibly therapeutic. The problem was that almost no one could get it because it was stuck in a few clinics running IV drips at $800+ a session. The opportunity was clear as day. If we could crack access, we'd have a real shot at America's mental health crisis.

The timing was almost too good, because a new law was pushing the DEA to finally allow remote prescribing of controlled substances. So I started Mindbloom. Today we're the largest provider of ketamine therapy in the world, with over 850,000 sessions facilitated for depression, anxiety, PTSD, and more.

The biggest surprise has been how wildly effective it is. I knew the safety profile was well established, but the effectiveness went beyond anything I expected. In our peer-reviewed studies, 89 percent of clients reported improvement in their depression and anxiety symptoms, with just over half meeting the clinical bar for a full treatment response. For clients in our PTSD program who reported suicidal thoughts at the start of treatment, 83 percent saw improvement after just two sessions, and 79 percent reported those thoughts had fully resolved by the end of the program.

I've started thinking of psychedelic medicines as the GLP-1s of mental health. If you look at a chart of obesity in America, you'll see it climbed for decades, and now, after GLP-1s took off, the curve has turned. The curves for depression, anxiety, and suicidality look like obesity used to, still going up and to the right. Something like 40 million Americans are on antidepressants and 25 million are on benzos, which tells you the tools we're leaning on aren't bending the curves. Ketamine therapy can, and it's just the first generation of interventions that will.

The other thing that surprises me is that ketamine hasn't been adopted faster. Our clients don't just get better and keep it to themselves. They usually evangelize it. Yet there's still so much stigma, and maybe skepticism that the outcomes are real, that people can't take the leap.

The trade-off people imagine is that with no clinician in the room, patients will hurt themselves or abuse the medicine. But we’ve put measures in place to reduce the likelihood of that happening. We prescribe in structured programs of 6, 12, or 18 sessions; every prescription is overseen by a psychiatric clinician; and clients start their first session on a live Zoom call with a guide who checks their vitals and walks them through the protocol. Every dosing session also requires a Peer Treatment Monitor, a partner, family member, or trusted friend who's nearby the whole time. Our mobile app reminds them of the protocol every time.

On the dependency concern, people are routinely prescribed drugs with far higher abuse potential than ketamine, like benzos and Adderall, and nobody supervises those. The data behind ketamine therapy tells a consistent story, which is that when it's administered clinically and therapeutically, rates of misuse are very, very low.

When we introduced injectables, some people raised an eyebrow, but they're actually the safer option. With the sublingual lozenge, if someone swallows the medicine instead of holding it under the tongue, more of it goes through the liver first, which makes the dose hard to dial in. An injection can't be swallowed, so bioavailability is about 90 percent and far more consistent, which means we can hold someone at a therapeutic dose more accurately.

Our own peer-reviewed research on the injectable protocol found side effects in only about 3 percent of clients, with no serious complications tied to the injection itself. And 81 percent of clients tell us they prefer injectable over sublingual tablets. They're a better experience, too. An IV can feel like being blasted off in a rocket ship, zero to a hundred, whereas a subcutaneous injection feels like a smooth takeoff in an airplane.

The August cohort of Numinus's Fundamentals of Psychedelic-Assisted Therapy starts on the 13th. This 10-week course kicks off the fastest path Numinus offers to licensure. Payment plans and scholarships are available.

I have zero concern about that. Back in 2018, Congress passed and Trump signed legislation directing the DEA to create a registration for prescribing controlled substances through telemedicine, especially for mental health. The DEA simply never built it. Then COVID hit, the waivers came, and telemedicine crossed the rubicon. Once providers and hospital systems moved online, there was no putting that genie back in the bottle.

When the first waivers looked like they might expire, we led the charge building a coalition of providers across healthcare, not just ketamine. We also partnered with people in government to make sure the whole field's voices were heard. But at the end of the day, the reality is the government can't just end telemedicine access without a replacement. The gap in care would be enormous. 

A lot of the people who depend on telemedicine (not just for ketamine, but for any number of controlled substances) are rural or disabled, with no easy way to get to a clinic. The VA’s a good example. They care for 9 million veterans, and 3 million of them live in rural or remote areas. For people like that, it's telemedicine or nothing.

Yes, and that’s why Mindbloom was never Ketabloom. It's been about outcomes, client experience, and access from the start. Ketamine was just the first medicine that let us deliver all three.

Right now, we're building brick-and-mortar clinics. The reason for that, aside from the fact that not everyone is a fit for online care, is that the first wave of FDA-approved psychedelics will need to start in a clinic. Over a longer time horizon, though, I expect many of these medicines will follow the same path ketamine did, into in-home treatment.

I predict psilocybin, MDMA, methylone, and LSD will all be approved within the next 12 months. But psilocybin is the one I'm watching closely because I think its approval will push the whole field into the mainstream. Psilocybin just doesn't carry the same stigma the other psychedelics do. That’s the moment we'll point to and say this was when the mental health crisis in America finally started to break.

Learn more about at-home ketamine therapy, or read Mindbloom’s published outcomes research.

That’s all for today, Cyclists! Whenever you’re ready, here’s how we can help.

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.