Sam Harris speaks with Jeannie Fontana and Robin Carhart-Harris about the TREAT Initiative in California and the growing promise of psychedelics for mental health care. They discuss the therapeutic potential of psychedelics, the current landscape of psychedelic medicine, the approval process for psychedelic medicine, the costs and funding of well-run studies, the effects of classic serotoninergic psychedelics on the brain, and a modern approach to organized religion and unity.
The TREAT California Initiative aims to transform mental healthcare delivery through research, education, access, and therapies using psychedelic medicines.
Different compounds like MDMA, psilocybin, LSD, DMT, and ketamine are being studied for their therapeutic potential in treating various mental health conditions.
Psychedelics, such as psilocybin, LSD, and DMT, induce a breakdown of brain network integrity and increase communication between different brain networks, showing promise for therapeutic effects.
Deep dives
The Promise of Psychedelics for Mental Health
Psychedelic medicines show great promise for improving mental health through clinical trials and research. Treat California is an initiative aimed at providing access to mental health treatments using psychedelic medicines. The initiative seeks to transform mental healthcare delivery by focusing on research, education, access, and therapies. The goal is to bring these medicines to the public in a responsible, safe, and ethical manner. By collecting signatures, securing funding, and conducting large-scale clinical trials, Treat California aims to improve patient outcomes and make these treatments accessible to all.
The Key Compounds and Their Applications
Different compounds, such as MDMA, psilocybin, LSD, DMT, and ketamine, are being studied for their therapeutic potential. MDMA therapy is being tested for post-traumatic stress disorder (PTSD) and is on the verge of FDA approval. Psilocybin therapy is being investigated for treatment-resistant depression and shows promising results. Ketamine therapy is being used for rapid-acting antidepressant effects. Other compounds, like LSD and DMT, are also being explored in clinical trials. Each compound has its own unique characteristics and therapeutic applications.
Safety Concerns and Differentiation
The safety profiles of different compounds vary. Psilocybin and LSD have low physiological toxicity and large therapeutic indices, making them relatively safe at appropriate doses. MDMA and ketamine have some toxicity and addictive potential, especially at higher doses. Ibogaine carries some cardio-toxicity risks. It's important to note that well-conducted studies with proper set and setting guidance can minimize risks. However, recreational use without proper supervision and understanding of dosage and context can lead to adverse outcomes.
Mapping Brain Activity and Mechanisms
Studies using functional magnetic resonance imaging (fMRI) have shown that psychedelics, such as psilocybin, LSD, and DMT, induce a breakdown of brain network integrity and an increase in communication between different brain networks. The action of classic psychedelics is strongly linked to serotonin 2 receptors. MDMA, on the other hand, stimulates serotonin release, making it unique in its pharmacological action. Further research is needed to better understand the specific mechanisms of action and how they relate to the therapeutic effects of these compounds.
DMT as an endogenous neurotransmitter
DMT is an endogenous neurotransmitter that is naturally found in the body and brain. While its exact purpose and effects are still a mystery, there is evidence suggesting that DMT may be involved in the dying brain and extreme states of consciousness such as the near-death experience. However, the question of whether DMT is responsible for these phenomena or if other neurotransmitters like serotonin play a larger role remains unanswered. More research is needed to fully understand the function and effects of endogenous DMT.
Exploring new compounds and treatment applications
The field of psychedelic research is still in its early stages, with limited exploration of the vast range of compounds and their potential therapeutic applications. While there is excitement around the known psychedelics like LSD and psilocybin, there is a need for further investigation to discover new compounds and explore their effects. These compounds could potentially offer breakthroughs in treating various conditions such as traumatic brain injuries, neurodegenerative diseases, and even inflammatory diseases like asthma. Additionally, there is a need to explore the use of psychedelics beyond just the drug-centric approach and focus on the broader aspects of psychedelic therapy, including the psychosocial interventions that accompany it.
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Sam Harris speaks with Jeannie Fontana and Robin Carhart-Harris about the TREAT Initiative in California and the growing promise of psychedelics for mental health care.
Jeannie Fontana, MD, PhD, is a multifaceted leader in healthcare, specializing in Internal Medicine, Environmental Toxicology, and Biochemistry and Molecular Biophysics. She initiated an ALS-focused research team at Sanford Burnham Prebys and established the Cedars-Sinai ALS Center of Excellence, driving policy change and boosting federal funding for ALS research. As a founding trustee of the California Institute for Regenerative Medicine (CIRM), she played a pivotal role in creating the world's largest stem cell granting agency with an $8.5 billion budget. Under her influence, the agency has achieved FDA approvals, fast-track designations, and launched groundbreaking clinical trials. Additionally, CIRM catalyzed the creation of over 55,000 jobs, 50 new companies, and $10 billion in added state revenue. Now, Jeannie is poised to address California's urgent mental health crisis through her role in the TREAT California Initiative.
Robin Carhart-Harris, PhD, moved to Imperial College London in 2008 after obtaining a PhD in Psychopharmacology from the University of Bristol. He has designed human brain imaging studies with LSD, psilocybin, MDMA and DMT, and several clinical trials of psilocybin therapy for severe mental illnesses, including 3 key trials in depression plus 2 further trials in anorexia and fibromyalgia syndrome. Dr Carhart-Harris founded the Centre for Psychedelic Research at Imperial College London in April 2019, the first of its kind in the world. In 2020, he was named among the top 31 medical scientists by The Times newspaper. Dr Carhart-Harris became the inaugural Ralph Metzner Distinguished Professor of Neurology and Psychiatry at the University of California San Francisco in 2021, and in the same year, was listed in TIME magazine’s ‘100 Next’ - a list of emerging leaders from around the world who are shaping the future.
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