Jeannie Fontana and Robin Carhart-Harris discuss the Treat California initiative, the therapeutic potential of psychedelics, and the future applications of psychedelic medicine. They emphasize the need for large-scale clinical trials, patient education, and accessibility. The chapter also explores the financial challenges of conducting well-run studies, the effects of psychedelic drugs on the brain, and the need for non-denominational dialogue.
The TREAT Initiative in California aims to provide funding for research and affordable access to mental health treatments using psychedelic medicines.
Current research is making significant advancements in the field of psychedelic therapy, with some compounds already proven to be safe and effective in therapeutic contexts.
Psychedelic compounds have distinct safety profiles, and further research is needed to determine their safety and efficacy.
Deep dives
The Promise of Psychedelics for Mental Health Care
Psychedelic medicines are showing great promise for mental health care according to Jeannie Fontana and Robin Carhart Harris. Treat California, a citizen-led ballot initiative, aims to provide $5 billion in funding for research and affordable access to mental health treatments using psychedelic medicines. The initiative requires collecting 1 million signatures from registered California voters. The focus is on transforming mental health care delivery, ensuring safety, efficacy, and accessibility. The Treat Institute plans to run large-scale clinical trials to determine the best treatment parameters for different individuals, considering various administration methods such as individual therapy, group therapy, and ceremonial or religious settings. The initiative also aims to create a bioinformatics data bank to personalize treatment based on genomic sequencing, biomarkers, and phenotypic expression.
Advancements in Psychedelic Therapy Research
Current research is making significant advancements in the field of psychedelic therapy. MDMA therapy for post-traumatic stress disorder (PTSD) is on the verge of getting FDA approval, with positive results from phase III trials. Psilocybin therapy for treatment-resistant depression is also progressing in phase III trials. Other classic psychedelics like LSD are being investigated for depression and addiction treatment. Ketamine, while not considered a true hallucinogen, is used as a rapid-acting antidepressant. Ibogaine shows promise in treating addiction and mental health issues, but it may have cardio-toxicity risks. Research on the safety and efficacy of these compounds is ongoing, with some compounds already proven to be safe and effective in therapeutic contexts.
Differentiation of Safety Concerns Across Compounds
Each psychedelic compound has distinct safety profiles. Psilocybin and LSD have large therapeutic indices, making them physically non-toxic. However, high doses of LSD can pose risks, and MDMA and ketamine have toxicity concerns, especially with organ damage and addiction potential. Ibogaine carries risks of cardio-toxicity. It is essential to conduct further research and collect data to determine the safety and efficacy of these compounds. The Treat Institute aims to conduct rigorous trials using different psychedelic compounds and indications while prioritizing patient safety and personalized treatment.
The Neurobiological Effects of Psychedelics
Research shows that classic psychedelics, such as LSD, psilocybin, and DMT, have impact brain networks by breaking down their integrity and increasing inter-network communication. The serotonin 2 receptors play a critical role in initiating the action of classic psychedelics. MDMA, while not a true hallucinogen, releases serotonin and exhibits selective serotonin release properties. Understanding the neurobiological effects of psychedelics is an ongoing endeavor, and further research is needed to elucidate their mechanisms of action fully.
The Mystery of DMT as an Endogenous Neurotransmitter
DMT is an endogenous neurotransmitter that is still shrouded in mystery. While it is present in the body and the brain, its specific role and function are not fully understood. Some evidence suggests that DMT concentration may increase in a dying brain, leading to speculations about its potential role in near-death experiences and psychedelic-like states. However, the specificity and functional effects of DMT are still a hypothesis, and other established neurotransmitters like serotonin could also play a role in similar phenomenology.
Exploring New Compounds and Possibilities
The field of psychedelic research is just scratching the surface when it comes to exploring new compounds and their potential applications. Researchers are studying vast libraries of potential molecules and using computer modeling to understand their interactions with receptors. There are countless possibilities for new drugs that could offer improvements over existing compounds, such as reducing off-target effects. Additionally, psychedelic therapy extends beyond the drug itself, with potential advancements in understanding the holistic nature of these treatments and integrating multi-faceted approaches to mental health and well-being.
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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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