This is an edited excerpt from the transcript from a podcast Dr. Ko did on Episode 39 in the Consciousness Podcast with Stuart Preston. In this episode, we talk about my ketamine practice, NDE, and my insights on consciousness.

If you want to check out the rest of this episode, head over to their website or listen on your favorite podcast platform.

Stuart (00:02)

Hello, this is the Consciousness Podcast, and I'm your host Stuart Preston. Each episode, I have a conversation with an expert in human consciousness. In this episode, I had the honor of speaking with Dr. Sam Ko, owner of Reset Ketamine. We discussed his insight into consciousness while working with ketamine. He and his East-meet-West approach to healing. This is also the first episode that has also been published on my other podcast, the stoned ape reports, which covers healing with psychedelic medicines. So please enjoy this episode with Dr. Sam Ko.

Well, Dr. Ko, thank you so much for joining me here on the Consciousness Podcast. You and I had a great conversation at a psychedelic conference about a year and a half ago and actually, we recorded a podcast episode and then I accidentally deleted it. So like I said, I'm truly grateful for you to come back here and do this again because I know it's hard to try to re-energize that magic. So, first of all, I'm really grateful for you coming back here and doing this so welcome and thank you.

Dr. Ko (01:07)

Yeah, thanks, Stuart. I'm honored to be back on the podcast and have it actually available to the public and I trust that everything happens for a reason. So, I'm honored to be here, and thank you for the opportunity.

Stuart (01:22)

Awesome. Likewise, likewise. So this is also going to be the first crossover podcast. This is going to appear both here on the Consciousness Podcast and on my other podcast, the Stoned Ape Reports, which is a podcast about the healing powers of psychedelic medicines. Because ketamine, which is what we're here to talk about, has some tremendous benefits, obviously for mental health, including helping those with suicidal thoughts, suicide reality, which is obviously close to my heart, after having lost my son to suicide. And I think you bring a really unique perspective to consciousness through your work at your practice. So let's just jump in with that and maybe we can start off and tell us a little bit about your practice, Reset Ketamine, tell us what you do and what you guys are all about.

Dr. Ko (02:12)

Reset Ketamine was started in April 2018. We’ve been open for about two and a half years, and we're really focused on using ketamine as a rapid transformational medication for treatment-resistant depression, PTSD, anxiety, OCD, and neuropathic pain. I'm focused on using a holistic approach to ketamine treatments, so this is looking at not only the biology but the psychology, the sociology, as well as the spirituality of a patient. We’re blending this bio-psycho-social-spiritual model combined with a Eastern and Western approach, and as well as this modern allopathic medical approach of monitoring a patient's vital signs like blood pressure, heart rate, pulse oximetry, respiratory rate, and et cetera. So yeah, it's a nice blend of East and West and kind of a holistic approach for ketamine therapy.

Ketamine is known to treat people with suicidal ideation and even prevent suicide.

Ketamine For Suicide Prevention

Stuart (03:15)

Awesome. And like I mentioned there in the intro, ketamine is used to treat people with suicidal ideation and prevent suicide. Is that correct? And have you had good results with that?

Dr. Ko (03:28)

It’s really interesting because there are research studies that show that ketamine can be rapidly effective for patients with suicidal ideation and as a potential medication to prevent suicide. But the other thing I wanted to mention is that ketamine is not FDA-approved for this indication. So, there is generic racemic ketamine which was FDA-approved in 1970 for use in the operating room, in the emergency room. And as far as for mood disorders and suicidal ideations and suicidal thoughts, it's not FDA-approved. So although it has been used clinically and in the research setting, it's not the standard of care for someone with suicidal thoughts or suicidal ideation.

Stuart (04:19)

Okay. That makes sense. So is that what you call off-label?

Dr. Ko (04:23)

Yeah, so that's the off-label use of ketamine. There are more research studies that are coming out saying, "Hey, this can be rapidly beneficial.” But it's unfortunately not FDA-approved for this indication, and so it's off-label. However, I do want to mention that there is another medicine that Johnson & Johnson recently patented and is FDA-approved and that's esketamine, the brand name is called Spravato. So that one actually just recently did get FDA approval for treatment-resistant depression and suicidal thoughts. What's interesting about racemic ketamine is that racemic ketamine contains both esketamine and R- ketamine. So in a way, someone could argue, "Hey, if esketamine nasal spray is FDA-approved, then shouldn't the racemic generic ketamine also be FDA approved as well.

Stuart (05:20)

Yes, somebody out there making that argument?

Dr. Ko (05:22)

I think the ketamine clinics, the American Society of Ketamine Physicians, yeah, they're making that argument, but the only problem is that to get FDA-approval, one needs to go through phase one, phase two, phase three, phase four studies, and that takes a lot of money. It takes a lot of time and in particular, pharmaceutical companies are not going to have a vested interest to place a lot of money into something that's generic and readily available.

Ketamine-Induced, Non-Ordinary States of Consciousness

Stuart (05:59)

Okay. That makes sense. Now some of my questions to you came from attending your presentation at that conference. A lot of amazing things that you shared and obviously really sparked my curiosity. And one of the things I think you said was that ketamine infusion treatment can produce a dissociative experience known as a quote, "ketamine-induced non-ordinary state of consciousness." So first of all, did I get that right? And if so, can you explain to us what that is and what that means?

Dr. Ko (06:33)

Ketamine-induced, non-ordinary state of consciousness, NOSC. Ketamine is a dissociative agent, so it's going to disconnect the mind from the body. And this is incredibly useful when we're doing these anesthetic procedures in the operating room and the emergency room, because if we're going to put someone's bones back together or reduce a shoulder joint that's been dislocated, it's very painful. So you want that person's mind to be elsewhere so they're not really feeling this pain during the procedure. So the question is, well, what is going on? Well, where is the mind going? And there was a doctor, his name is Dr. Eli Kolp, and he did some research on this and he described four types of experiences or states that someone can have during a ketamine experience.

And there are four stages. Number one is the empathogenic experience. So this is where someone has an awareness of their body, it's very comfortable, it's relaxing, their ego defenses are reduced, they're feeling compassion and warmth, love, peace, euphoria, and maybe some non-specific visual effects.

The next level is the out-of-body experience where there's actually a complete separation from one's body. The ego defenses are significantly diminished. They may feel like they're visiting mythological realms of consciousness, they may have encounters with non-terrestrial beings, they might have some intense, emotional visions, like seeing deceased relatives or spirits. They may think of vivid dreams of the past and future.

The third one is the near-death experience where it's a complete departure from one's body. You might have a loss of identity. It might feel like someone is experiencing an actual physical and psychological death. They may experience a single point of consciousness that's simply aware of itself, or they might relive their own life thinking about their actions and how that's affected others and a moral judgment of the self.

And then the final non-ordinary state of consciousness one could have is this ego-dissolving transcendental experience, where there's this ecstatic state of disillusion of boundary between the self, the external reality, where you have complete dissolution of a one's body and self-transcending normal mass time-space continuum of feeling of a collective consciousness and unity with nature, universe, God, and a real sense of sacredness. So those are the four states of a non-ordinary consciousness that one can have with ketamine. And it seems like the higher the dose of the ketamine, the more likely they are to have this level four experience of ego dissolving, transcendental experience.

Near-Death Experiences from Ketamine

Stuart (09:29)

Interesting, and so my next question was really about near-death experiences. If you and your patient said, I mean, I guess if your patients had experienced an NDE, if they provide you any feedback or if you had seen that, but I guess I'm also curious about these other three non-ordinary states of consciousness. So in addition to NDE, what have they reported back to you on these things?

Dr. Ko (09:54)

So yeah, while patients have definitely had near death experiences, and again, it depends upon the dose. So, when I start a patient on their infusion, it's usually the lowest dose, which is typically about 0.5 milligrams per kilogram. And then with each infusion, we will gently titrate the dose upwards depending upon the patient. So at that first dose, they just feel really relaxed and calm and really peaceful, and tranquil. And someone described it as feeling like I was getting a thousand massages at once. So, it's a really calm environment but then the higher the dose, the more likely the patient is to have an NDE, near-death experience. And I can recall one patient, I was thinking about where we did a pretty high dose on him, and after the infusion, he came out and his first words were "Wow, Dr. Ko, I died." And he said," That was the biggest fear I've ever had in my life. And I died and I was okay with it. And I accept it."

And of course, just to note that even though he felt like he was dying psychologically, he was physically stable because we measured his blood pressure and oxygen level, et cetera, the vital signs, everything was normal on my end when I was seeing his body, his biologically, his reaction. But for him, his experience was that he faced death and he was able to overcome it. He was able to accept it. And as a result, he just had a sense of peace that has stayed with him for quite some time. The other interesting thing, Stuart, was a study by Dr. Martial, et al, which was published last year 2019, where they looked at comparing real near-death experiences and the stories that people had written about these experiences.

So these were patients who were involved in heart attacks, car accidents, strokes, et cetera, other things that caused them to have NDEs. And they compared those reports with 15,000 other reports of patients using various substances like ketamine, DMT and LSD, et cetera, and they plugged in all the stories from those two groups, one group having real NDE’s, the other group, having these experiences with drugs, and out of all of the substances, they found that ketamine experience was most similar as far as the narrative and the experience to their actual near-death experience.

Stuart (12:39)

Well, it's interesting because I would've thought it would've come out DMT because you'd actually hear about DMT creating a kind of a near-death experience type of experience. So it's really interesting that actually ketamine is what gets you there.

Dr. Ko (12:52)

Yeah. So I think ketamine was number one and I believe DMT was number two, as far as the similarity.

According to Freud, the mind consists of the unconscious and conscious mind. And just like an iceberg, a lot cannot be seen beneath the surface.

The Conscious and Unconscious Mind

Stuart (12:58)

These treatments can put you into these altered states. And you mentioned, I think that they allow one to access the quote "unconscious part of the mind" like memories, emotions, stories. So, what do you think is going on there which allows this experience to occur under the influence of ketamine?

Dr. Ko (13:19)

Oh, that's a really good question and I was thinking about the unconscious and the conscious mind, and the first thought that comes up was Freud's idea and it was a model proposing how the mind is, but physiologically, I'm not sure if, "Hey, you know, this portion of the brain is where the conscious lies and this is where the unconscious lies." So assuming the metaphor and physiologically that the unconscious mind doesn't reside in a certain portion of the brain. What I think ketamine does is it seems to calm down that conscious part of the mind, that kind of background noise that commentators and reduces the volume of that, and then it allows one to see what's really going on. So, extending this metaphor of an iceberg, when Freud first talked about the conscious and the unconscious mind, he described an iceberg and how, when you look out into the ocean, you'll see the tip of the iceberg at the very top, but underneath, you'll see this vast remaining portion of the iceberg, which is all underwater.

And so he says that the conscious mind is just this tip of the iceberg that we see, whereas the unconscious mind is what's underneath. And so if I think about that metaphor, what I make up is that ketamine seems to allow that water that is between the upper portion of the iceberg and what's underneath to calm down. And so if you look at the ocean and it's choppy and that's churning and there's water and all the bubbles coming up, you're not going to be able to see underneath. However, if that water remains really calm and it's smooth and it stays really peaceful, then you're going to be able to see deeper down into the water. And so it's possible that ketamine, by calming the surface of the ocean, will allow one to see what's going on underneath and to look actually down deeper at that iceberg.

Stuart (15:25)

Interesting. And do you think that the calming of the water, is that the default mode network? I mean, because I know you mentioned the ketamine blocks the DMN, do you think that's what you're describing here?

Dr. Ko (15:39)

Yeah. So the DMN is the default mode network, which is like various structures of the brain that seem to become activated when we're doing non-specific things like just daydreaming or imagining when we're not focused on a task. And so the default mode network has also been correlated that the higher levels of the DMN, there's more rumination going on, more stories that are related to the stories that don't support us like, "Hey, I'm not good enough" or "I'm not worthy." And ketamine is known to decrease activity and connectivity of the default mode network. So, yeah, physiologically or from a functional MRI perspective, turning down the default mode network, the ketamine can also increase access to what's going on underneath; access portions of the brain that necessarily aren't activated when we're awake.

Stuart (16:41)

And that's how somebody can experience a different state of consciousness is when that default mode network has quieted down, then they enter into an after-state.

Dr. Ko (16:51)

Yeah. And what's interesting is it can happen in other ways too, so like deep meditators they find that the default mode network can become quieted down when you're in a deep meditation as well. And what's interesting in addition to the default mode network is the changes that are happening in patients EEGs, so electroencephalograms, and ketamine seems to create the same type of EEGS that are seen in these meditators who've been practicing for 10 or 20 years when they enter a meditative state, they'll enter into a certain brainwave state physiology, and ketamine seems to mimic that similar type of brainwave state. So by doing that, it seems like they're just entering a a calmer, more Zen, more meditative state of mind.

Stuart (17:45)

Wow. Because I meditate, and I think part of what I'm thinking before and after, and sometimes unfortunately during, is settling down the ego. It's kind of like "Shut up ego, leave me alone, and is that the default mode network tied to the ego and, whether or not it is, during a ketamine treatment, do you think it's the ego that's being quieted down to allow that meditation state that shows up on the EEG?

Dr. Ko (18:19)

Yeah, it's interesting. In Michael Pollan's book, he talks about how the default mode network might be where the ego resides, and yeah. So if you're turning down the volume of the ego and egocentric focused on me, me, me, and there's this other component that rises up which might be more focused on others, might more focused on universal consciousness and when we're less focused on ourselves it may allow us to focus more on other things beyond ourselves.

Human consciousness is something that is hard to comprehend and is something that is incredibly powerful.

The Human Consciousness

Stuart (18:55)

Yeah. Interesting. And how does this relate specifically in your opinion to one's consciousness then? I guess to combine it with another question is in your work with your patients and in the work you do with ketamine and the infusion treatments, what have you learned about what human consciousness is and how it works and what's your general feeling about it?

Dr. Ko (19:19)

So, human consciousness is really, very challenging to really fully know and understand. I think there was an idea that studying human consciousness is like an eyeball, trying to look at itself. So, first off that's the caveat I want to throw out there that knowing and studying human consciousness is challenging and we may never fully understand it. But what I've come to learn more about human consciousness is incredibly powerful.

There's definitely, in my opinion, something that goes beyond our individual consciousness, and I do get a sense of feeling of universal consciousness and one of the themes that actually comes up frequently is our patients will come out of the treatments and they will state, "Hey, I have this feeling or had this sensation that I'm really connected to everyone. I was thinking about my relatives and my friends and just this sense of interconnectedness with each other." And I think there's something really powerful about that, about how ketamine can create these feelings of interconnectedness. And, yeah it also makes me think about Carl Yoon, who mentioned that when we dream, we actually enter a state of accessing the universal consciousness. So, maybe there's something going on when someone is dreaming as well as when they're receiving a ketamine infusion where we're all just returning to this core consciousness or this universal consciousness.

Stuart (21:07)

And so when you and I talked before, and I think you're bringing that up now, it seemed like you had this notion that you have a physical brain and there's stuff going on in the brain, the default mode network and neurons and other networks and schema, and then you have a consciousness which may be part of the brain, may be outside of the brain, and then you bring in another layer of spirituality, the Eastern aspect to it, and this universal consciousness. So is that the architecture that you see? Is there the physical, the mind consciousness, the spiritual part, and then universal, or how did that model line up for you?

Dr. Ko (21:53)

Yeah, so I was trained under a model called the bio-psycho-social model of medicine, which was founded in University of Rochester and that's the biology of disease when you have to look at how that affects the psychology of a patient. And then if you think about a disease, you have to think about, "Hey what are the social factors and implications of that disease? But then the fourth component is that spiritual component, and I think I really got that from my training when I was at Loma Linda University where it's a religious institution. And I remember seeing one of the attending physicians after a surgery praying for one of his patients. And he said, "Hey, man, pray for you." And just seeing that component of in addition to treating someone's bones and on the biological cellular level, we can make an impact on the spiritual level. And by spiritual, I mean, anything that's not measurable, something that's beyond the physical, something that can not be seen or heard necessarily. And yeah, I think when we consider a human being, we have to definitely include that spiritual component. And there's this quote by a French philosopher Jesuit Priest, which I love, and he says, "We are not human beings having a spiritual experience, we are spiritual beings having a human experience.”

Stuart (23:22)

Wow, never heard that before. I've heard the notion that there's a larger consciousness obviously, and that we are dissociative aspects of that consciousness. Is that what you're saying? Is that the universal consciousness out there and we are basically like an entity formed from that and our consciousness we experience comes from that?

Dr. Ko (23:47)

Yeah, I think now that you mentioned it, I think we talked about this in our last conversation and I had this idea or hypothesis of how there was like a giant sphere of consciousness, maybe like the sun, for example, and how from that giant sphere of consciousness, like little sparks of consciousness, are coming out from it. And each being comes from that spark of consciousness or it comes from that giant solar sign of consciousness and we're all just little sparks of it, and it's always within us and we're always connected to it in my opinion.

Stuart (24:27)

Yeah. So what do you think about the survival of consciousness after death then? Have you given that any thought? What do you think happens after we die, after our brains turn off?

Dr. Ko (24:40)

I don't know. I don't know. I don't know but what I loved, I believe it was Keanu Reeves and someone asked him the same question. I loved his response and I think I'll share it with you as well. He said, "I don't know what happens, but what I do know for sure is that when we die, the people who love us, who loved us, and who were a part of our lives will miss us tremendously."

Yes, plan medicines can be amazing tools to cure depression and other illnesses, but it is not a panacea. It still must be used wisely, and not abused.

Use Plant Medicines Wisely

Stuart (25:08)

Hmm, Yeah that is beautiful. That is beautiful. Okay. Dr. Ko, what else do you have on your mind in terms of consciousness of ketamine? Any other plant medicines about your practice? Is there anything else that you'd like to share with us before we wrap up?

Dr. Ko (25:28)

Yeah. I would say ketamine is an amazing tool and medicine but it's simply one tool. It's not a panacea. So I think people have to recognize that we have to use it responsibly and that it's not actually for everyone and to get a consultation with ketamine specialists they can go check out www.askp.org. There's a listing of ketamine clinics nationwide and see if it's a good fit for them. Yeah, so just be aware that it's not for everyone, it's not a panacea and to use it responsibly.

I think in general, for other plant medicines, there needs to be more research, more funding. I'm a big believer in evidence-based medicine. So the more data we have, the more blinded randomized controlled trials, looking at the effectiveness of these various medications, the more we can use it and leverage it. And I think there's science behind it, the more science, the more data we have, the better it can be.

Stuart (26:40)

Yeah. Awesome. Awesome. And your practice is www.resetketamine.com.

Dr. Ko (26:44)

Yeah, so yeah, we're in Palm Springs in Southern California and we're resetketamine.com. People can find us on Instagram, Facebook, Twitter, et cetera, and they can check out our website.

Stuart (26:56)

Okay, awesome. Well, Dr. Ko, I’m truly grateful that you came back after that fiasco last time, and the information you shared is just really insightful. And I love your angle on it and your opinions on this. So truly grateful to have you back, and share all this with us. Thank you very much.

Dr. Ko (27:15)

Okay. Thanks, Stuart.

Stuart (27:16)

That concludes another edition of the consciousness podcast. Thanks again for listening. Please find us on Facebook at facebook.com/Theconsciousnesspodcast and our Twitter handle at Comcast and don't forget to subscribe to our feed at www.theconsciousnesspodcast.com. Thank you for listening.