AMA on Wed 6/17/20: Founder of Koshland Pharm (ketamine compounding pharmacy)

We are excited to announce that Peter Koshland, PharmD, the founder and head pharmacist of Koshland Pharm, will be joining us for an AMA on Wed Jun 17 from 5-6pm PT.

Koshland Pharm Custom Compounding Pharmacy is a specialized pharmacy that makes high-quality, customized prescription medications. Koshland Pharm is the leading ketamine compounding pharmacy of the Bay Area (e.g. for oral ketamine).


Peter Koshland, PharmD is a graduate of Georgetown University and the UCSF School of Pharmacy. He started out his pharmacy career working in independent community pharmacies, including Elephant Pharm, a Bay Area pharmacy that integrated Eastern and Western medicine. Here, Peter learned about the resurgence of modern compounding — the customization of prescription medications to meet individual patient needs.

In 2009, Peter opened Koshland Pharm: Custom Compounding Pharmacy in order to further the availability of customized medications to patients in the Bay Area and across the State of California. In addition to his current CEO role at Koshland Pharm, Peter is an Adjunct Clinical Professor of Pharmacy at UCSF, introducing pharmacy students to compounding. He also trains and consults with doctors across the state in the areas of hormone replacement, thyroid disorders and compounding applications for a variety of medical disciplines.

Topics Peter can speak to:

  1. Innovation in ketamine treatment - trends towards ketamine-assisted psychotherapy
  2. Pharmacy and custom prescriptions
  3. Ketamine and psychedelic medicine formulations
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what do you think about IV vs other routes of administration of ketamine?
why is the bay area more focused on oral ketamine?

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wow. thank you so much for helping people access oral ketamine treatments. Your work seems like it has impacted a lot of people :pray:

I have a question - I heard from some that oral ketamine and lozenge use might not be legal everywhere. Could you give some context about the legality of ketamine compounding? How about shipping across state lines? How can we make sure people get access to life-saving treatments that they need?

also dumb question - could you give a bit of background on what compounding entails in the first place? I know ketamine is usually used as anesthesia / IV, so how do you actually turn that into a lozenge/troche? thank you!

Thank you so much for being here. I have several questions and would greatly appreciate your input on any of them.

  1. Can you tell us a little bit about the physiologic (if any) differences between ketamine and it’s enantiomer: esketamine? For example - how will this alter receptor binding, pharmacokinetics, etc?

  2. We have data on the safety and efficacy of ketamine, how translatable will that be to esketamine in the FDA’s opinion? In your opinion?

  3. In your opinion, what are some major barriers to clinical trial success in the psychedelic medicine space?

  4. What are some clinical trials in the psychedelic medicine space you are most excited about?

  5. While there is currently a nice wave of clinical trials for psychedelic medicines in the mental health space, innovation in this space has been sparse (relative to cardiology, for example). In your opinion, why is this the case? Does it have to do with difficulty with clinical trials leading to investors not being interested?

Thank you for your time!

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How do you see the ketamine space changing in terms of protocol? Seems like IV has always been more mainstream and has the most research in the clinical literature. But you are obviously a key part of the ketamine-assisted psychotherapy (KAP) space with the oral ketamine that you provide. Others do IM, etc. Do you see a broader trend towards KAP? Is there a reason KAP seems to be very popular in the bay area but other (if not most) other geographies tend to be dominated by IV?

Thank you for your time

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Let’s say we fast forwarded 50 years from now, and the technological and life sciences revolutions have been in full swing. What will pharmacy look like then? Personalized medicines and personalized formulations? 3D printing/personalized manufacturing of medications? Curious what you think :smiley:

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Do you have any thoughts about plant-based medicines? How does/should that fit in to our medical system? Both psychoactive plant-based medicines and also others

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What does the integration of Eastern and Western medicines look like? In what ways do you customize prescription medication?

Doctor,
I can find plenty of clinics that will do IV ketamine for me at 500 dollars a pop (no insurance accepted!) but I am having a lot of trouble finding doctors that will do sublingual/quick dissolve or at home intra-muscular treatments. Is there a website or network that could help me find such a doctor out here on the East Coast (between Washington DC and Baltimore)? Or a doctor that will do so by telemedicine?

Hello!

I’m a psychotherapist and let’s say I may or may not have worked already with patients in psychedelic settings, following strict guidelines and having had as much of an official, research oriented training with other experienced pyschotherapists as one can get in psychedelic therapy.

I want, one day, for this to be a legal way to work with patients outside of clinical trials.

What can I do to make this happen other than to go the academic way? Is political activism the only way? What have you seen in this field that you could pass on?

Thank you very much in advance!

What is the dosage range (mg/kg) of ketamine for off-label therapeutic use for each route of administration? I would guess it’s a lower dose than on-label applications for anesthesia.

Is it known at what magnitude and frequency of therapeutic administration of ketamine patients might begin to experience the deleterious effects that were in the past strongly associated with chronic abusers of ketamine e.g. interstitial cystitis?

Is it parcel to the emerging therapeutic protocol for ketamine-assisted psychotherapy that the patient experience subjective effects that include a dissociated state? Alternatively, the protocol might suggest that only a slightly altered, not fully dissociated, state is expected.

I ask because other psychedelic-assisted therapies seem to entail a “heroic dose” and proponents uphold that the subjective (and often mystical) experience of “the trip” is the goal rather than some direct effect of the drug.

hi all, thank you for having me, will share my video answers shortly

I don’t have a lot to say about this as a pharmacist but, clearly, getting FDA approval for currently unapproved therapies will go a long way in establishing their nationwide acceptance and hopefully open up opportunities to utilize these therapies in a number of ways. The clinical trials are a key part of establishing regulatory and popular acceptance. If the trial are able to show real benefit for suffering patients, it will be hard to deny the need to make these therapies available.

Interstitial cystitis (IC) is certainly a concern with chronic ketamine therapy and can be a limiting factor in the patient’s therapy. This adverse effect is typically associated with higher, more frequent dosing. If patients gets symptoms of IC (pelvic pain, frequent urination, etc.), therapy should be halted until symptoms resolved. Patient will neeed be reevaluated about the appropriate dose and frequency if the benefits outweigh the risks of continuing on ketamine therapy.

I believe this is a debate going on now. Some believe disassociation with ketamine is a key feature of it’s therapeutic benefits, allowing the patient to get some distance from their negative self-talk or other negative mental experiences, thus allowing them see their mental state in a different way. There is clearly more to ketamine therapy than the potential benefits of disassociation, however. Patients who take lower doses that don’t cause the disassociated effects still often show an antidepressant response. I believe this is at least partially explained through our knowledge of the role of NMDA receptors in the brain. NMDA receptor blockade (through ketamine) in the brain allows for neuronal regeneration and branching.