When Yossi Fishler set out to launch Joyous, a mail-order ketamine company, in 2021, he knew he needed to dazzle. A veteran of Bay Area tech startups, launching into the burgeoning telemedicine business with the drug was the latest of his ventures. And, perhaps, the most audacious.
“The goal…is to make individuals, families, communities, and humanity more joyous,” he said.
Joyous is just one of a growing number of ketamine-focused telehealth companies that was spawned from a fertile Venn diagram of factors that has spawned a burgeoning, if nascent, industry. The first factor is ketamine’s legal status as a treatment for mental health: First manufactured more than 50 years ago, it’s long been used as an anesthetic in medical settings. Its hallucinatory effects are well-known; alongside its medical use, it made its way to clubs, parties and home use.
The second factor also stems from the global pandemic. In 2020, the federal government authorized a short-term policy that allowed doctors to see patients and prescribe medicine remotely. Savvy entrepreneurs, who were sometimes devotees of mind-altering substances themselves, leapt at the opportunity to bring ketamine to the masses. Almost overnight, ketamine went from underground psychotherapy treatment to mail-order modality.
Finally, and particularly important for Fishler, was the profound need for mental health treatment, especially for treatment-resistant depression. According to one estimate, even prior to the global pandemic, one in eight American adults took an antidepressant daily. Yet, said Fishler, antidepressants work for only 30% of patients (other studies put that percentage closer to two-thirds, and the research varies widely). Among mental health professionals, ketamine has long been a not-so-secret backup tool to help patients. The drug’s salutary effect on mental health has also been bolstered by research and observation.
For people suffering from depression and anxiety, ketamine can be a lifeline. One of Fishler’s co-founders and Joyous’s chief medical officer, Dr. Bobbi K. Leben, has witnessed ketamine’s positive results for veterans and other patients first-hand.
“I’ve seen our greatest warriors come back without the ability to function in daily life,” she said. “They were losing everything that was meaningful to them and not having any tools, feeling helpless.”
In collaboration with other medical professionals, Leben said, she prescribed micro doses of ketamine to some patients over 10 years. “I saw how [ketamine] transformed them and gave them their lives back.”
Joyous, she said, has allowed her to bring her clinical experience to even more people, thanks to its technology. The company communicates with patients daily by text message, digital journal submissions and sometimes phone calls. That degree of communication, Leben said, bridges a gap in modern health care, in which patients don’t often get frequent access to doctors.
Yet, while Joyous appears at first to be similar to other technology companies diving into K-hole-shaped investor spaces, it’s distinct in a number of ways. The first is how the company came to be. In contrast to Silicon Valley stories in which founders themselves turn their own life-changing, hallucinatory trips into cash-cow enterprises, Fishler didn’t decide to launch Joyous after a life-changing trip. Instead, he said he’d had a good run in successful tech companies. His only aim now is to give back and help people.
Profits, however, aren’t off the table. Joyous says it’s a Public Benefit Corporation—a for-profit company that sets some money aside annually for a cause of its choosing. There is some variation among the financial rules that govern such companies from state to state but in California, broadly speaking, the designation requires more transparency, more power for the board and directors than for shareholders, and a commitment to prosocial outcomes.
“This [company] is not to generate millions of dollars of value for investors,” Fishler said. “We are optimizing for the patient’s wellbeing.”
Recent reporting by the New York Times also suggests that Dr. Leben has additional financial ties: reportedly, her husband manages the compounding pharmacy that produces Joyous ketamine. In response, the company told the Times that patients may choose where they wanted to fill their prescriptions.
Yet, Joyous offers people something that many of its peers do not. Priced at $129 a month, its ketamine costs far less to obtain. According to Fishler, at least 10% of Joyous patients receive financial aid from the company to support their treatment.
Finally, the way Joyous approaches dosing ketamine is distinct from other mail-order companies. Joyous distributes what it calls very low dose (or VLD) ketamine, well below the dosage that prompts hallucinations. The effect, Fishler said, patients still experience the neuroplasticity that allows them to find healing and self-love. But it’s not a “meta-state,” as he called it, in which they dissociate.
When asked how exactly Joyous helps patients use that to get well, Fishler demurred. The company sends daily questionnaires to patients which seek to check in on their wellness and the impact of the drug. There is a phone number listed on the website but, in the recent New York Times story, several people reported having difficulty reaching a person by phone.
Joyous also allows patients to choose their own dosage and cadence. Fishler framed this approach as self-empowerment, where patients determine what they need and when. In that way, the patient is in charge of their own healing, said Fishler. While this approach has been successful for some, for others, it’s reportedly led to dependency and secondary problems.
However Joyous fares in the marketplace, its fate may, ultimately, lay beyond customer service, safety and other concerns that are surfacing amid the ketamine telehealth boom. The Public Health Emergency protocols that federal legislation enacted in response to COVID-19 are set to expire in May. Barring an extension or other policy changes, the end of looser telehealth practices may signal an end—or at least, a more complicated way forward—for companies like Joyous, whose entire business models rely on remote treatment.
For now, though, the mail-order ketamine remains a growing industry that, a growing number of patients and doctors say, could use more regulation—but not a shutdown. Until then, at Joyous, the dosing and high hopes (so to speak) continue.
“If you’re suffering, you’re in pain, we want to help reduce that and increase the amount of joy [you feel],” said Fishler. “That’s what we’re trying to do.”