Episode 62 - What It Takes to Be the First: Building a Ketamine Practice in a Resistant Healthcare System with Dr. Lowan Stewart

Dr. Lowan Stewart is not just someone who opened a ketamine clinic. He is someone who built the infrastructure for an entire country to access it.In this conversation, Sam sits down with Dr. Stewart, an emergency physician who co-founded the first ketamine clinic in New Mexico in 2016, brought ketamine therapy to Norway two years later, established the first public ketamine treatment unit in Scandinavia, and played a central role in Norway becoming the first country in the world to approve national public reimbursement for off-label ketamine in treatment-resistant depression.What makes Dr. Stewart's story particularly resonant for our audience is how familiar the starting point will feel. An EM physician who loved his work but felt the limits of what emergency medicine could do for the river of suffering flowing through the department. A side project that became a calling. An uphill battle against institutional skepticism that most providers in this space will recognize immediately.He also brings a perspective on the future of psychedelic medicine that is worth hearing. His argument is straightforward: ketamine is not just a treatment. It is the infrastructure that will make everything else, psilocybin, MDMA, and what comes after, possible in clinical and public health settings. Getting ketamine right now is how the field prepares for what is coming next.This is a wide-ranging conversation covering career pivots, pioneering in resistant systems, the mechanics of moving a national healthcare system, and the daily reality of doing work that genuinely transforms lives.What you’ll gain:• The full arc of Dr. Stewart's career pivot from emergency medicine to ketamine therapy, including what pushed him toward something with more systemic and sustainable impact than the ER could offer• A firsthand account of what it actually looks like to be the first mover in a resistant healthcare system, from opening the first ketamine clinic in New Mexico to fighting a formal complaint from the Norwegian Psychiatric Association• How Dr. Stewart built the first public ketamine treatment unit in Scandinavia and the strategy behind getting ten major Norwegian hospitals to implement ketamine therapy simultaneously through a multi-site clinical trial• What Norway's landmark decision to become the first country in the world to approve national public reimbursement for off-label ketamine in treatment-resistant depression means for the global field and what other countries can learn from it• Why Dr. Stewart believes ketamine is not just a treatment but the infrastructure that will determine how ready clinical and public health systems are when psilocybin, MDMA, and other psychedelic medicines arrive• His honest reflection on why this work is worth it, including what it feels like to shift from focusing on the quantity of life in the ER to focusing on the quality of life in ketamine therapyEpisode 62 show notes:00:00:00 Teaser: "Once somebody says, 'I'm alive today because of this treatment,' you can't not do it."00:00:24 Episode Introduction00:02:19 Sam Welcomes Dr. Lowan Stewart00:02:53 Background Overview: Emergency Medicine, Norway, and the Journey to Ketamine00:08:56 Why Neuroscience: Starting an MD-PhD and the Rat Brains Advice00:10:09 From Space Medicine Dreams to Emergency Medicine Reality00:12:14 The Decision Point: Going Away from EM or Toward Something New?00:15:37 Opening the First Ketamine Clinic in New Mexico: What the Ketamine World Looked Like in 201600:17:55 Bringing Ketamine to Norway: Opening Axon Clinic in 201800:20:06 Approaching the Norwegian Psychiatric Association and Health Department with the Data00:26:40 Psychiatrist Skepticism: "I Don't Know What to Do with These Patients If They're Fine"00:28:29 The Formal Complaint from the Norwegian Psychiatric Association00:31:23 Establishing the First Public Ketamine Treatment Unit in Scandinavia00:34:34 Axon Clinic's Acquisition by Awaken Life Sciences and the Ukraine War Impact00:40:18 Norway's Landmark Approval: National Public Reimbursement for Off-Label Ketamine00:44:20 The Multi-Site RCT Strategy: Implementing Ketamine Across Ten Major Norwegian Hospitals00:50:17 Why Ketamine Gets Overlooked at Psychedelic Conferences and Why That Needs to Change00:55:14 One Piece of Advice for Any EM Physician or Clinician Considering This Pivot00:58:34 Rapid-Fire Questions00:59:07 How Dr. Stewart De-Stresses: Cold Ocean Swims and Sauna in Norway01:02:17 How to Connect with Dr. Lowan Stewart01:04:03 Episode EndingThanks for listeningConnect with Dr. Stewart at:Clinic Website - Axonklinikken http://axon.no/ Email: [email protected]: https://www.linkedin.com/in/lowan-stewart-27349616/📝 Complete show notes with resources and  links, please visit https://www.ketaminestartup.com/podcast/episode-062