Psychedelic Medicine Podcast with Dr. Lynn Marie Morski

In this episode of the Psychedelic Medicine Podcast, Dr. Reid Robison joins to discuss managing medical risk in patients seeking psilocybin therapy. Dr. Robison is a board-certified psychiatrist and Chief Clinical Officer at Numinus, overseeing the company's psychedelic and mental health services across the US and Canada. He has led over 200 clinical trials in neuropsychiatry, including the MAPS-sponsored MDMA-assisted therapy for eating disorders study, and several other psychedelic studies with psilocybin, LSD and DMT. In this conversation, Dr. Robison begins by sharing how researchers have been determining guidelines for managing medical risks associated with psilocybin and how this guidance may shift as research continues in real-world settings at larger scales. He also discusses the intricacies of psilocybin’s pharmacokinetics and how the substance interacts with common psychiatric medications such as SSRI antidepressants. In closing, Dr. Robison emphasizes the importance of keeping a close eye on potential psychological risks of psilocybin and other psychedelics, especially amid the excitement stemming from the incredible potential of these medicines.   In this episode: The emerging medical indications for psilocybin therapy How the research into psilocybin has developed in the past few years The pharmacokinetics of psilocybin Medication interactions with psilocybin Risks of serotonin syndrome Absolute vs relative contraindications Psilocybin’s effect on QT interval and heart valves The Psychedelic Medicine Association’s “Psilcobyin-Informed Clinicians” database comprised of practitioners who have completed the course   Quotes: “There’s a lot to learn [about the interaction of psilocybin and SSRIs] and it's a little bit unpredictable. And some people anecdotally would say that their SSRI interfered with their trip or diminished the experience and others would say it did not.” [26:22] “Psychological risks are nontrivial, including the risk of a difficult experience—something that may even need some mental health treatment afterwards, something that may be meaningful, nontrivial for the individual for a while, and can coexist with the mystical experience. And having the most meaningful experience of your life can coincide with the most difficult.” [40:43]   Links: Course: Managing Medical Risk in Patients Seeking Psilocybin Therapy Dr. Robison’s website Dr. Robison on Twitter Dr. Robison on Instagram Numinus website Previous episode: Psychedelics for Eating Disorders with Reid Robison Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Kevin Franciotti, MA joins to discuss the intricacies of psychedelic-assisted therapies for substance use disorder. Kevin Franciotti is a Denver-based writer, therapist, advisor, and thought leader in the fields of psychology, psychedelics, and substance abuse counseling. In this conversation, Kevin shares his expertise on the existing research on psychedelic medicines for substance use disorder (SUD) and also discusses the limitations of the results of this research. He talks about the difficulties of designing trials and protocols for psychedelic therapies that target SUD, touching on how this disorder can interact with the neuro-physical and psychological effects of psychedelic medicines. He also contrasts emerging psychedelic treatments for SUD with dominant abstinence-based models and shares where he thinks psychedelic therapies may be a healthier alternative. In closing, Kevin reiterates that it is crucial to continue integrating harm reduction perspectives as psychedelic therapy continues to gain more mainstream traction.   In this episode: Contraindications which can arise during detox periods which may require a person to be fully detoxed prior to pursuing any psychedelic-assisted therapy for SUD The neuro-physical effects and the psychological effects of psychedelic substances The role of peer support in psychedelic-assisted therapy for SUD The stigma around psychedelic therapies within traditional recovery programs and communities How psychedelic therapy protocols interface with current guidelines from the American Society of Addiction Medicine The future of insurance coverage for psychedelic therapies Issues of “psychedelic exceptionalism”   Quotes: “Ibogaine has somewhat of a miraculous quality of being able to attenuate some of the most painful, acute symptoms of opiate withdrawal—but that is only specific to opiate withdrawal.” [11:33] “What’s miraculous about a medicine like ibogaine or even psilocybin… is it's designed to enhance somebody’s ability to confront their underlying issues.” [16:57]  “The future of addiction treatment embracing psychedelics is really going to hinge on the treatment industry being willing to construct innovative ideas.” [30:37] “Drugs are drugs. Drugs don’t have an inherent moral quality around them. [What’s important to highlight] is the risk of stratifying people who use drugs as somehow being superior or inferior based on which category of socially accepted drugs that they’re doing.” [42:39]   Links: Kevin’s website Kevin on Twitter Kevin on Instagram Kevin on LinkedIn Psychedelics in Recovery Journey Colab All Points North (APN) “Dispelling Lies the Psychedelic Community Believes About Drugs” presentation by Carl Hart, PhD at Horizons 2019 Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Wilhelmina De Castro, LCSW joins to discuss the ways psychedelics may be used to support goals of queer liberation. Wilhelmina is a psychedelic therapist in the San Diego area and serves as a DEI officer for Integrative Psychiatry Institute. She is also lead faculty for the Psychedelic Research and Training Institute and is committed to creating access to psychedelic healing for historically marginalized populations.   In this conversation, Wilhelmina discusses the major topics at the intersection of psychedelic healing and queer identities. She shares her own journey of how psychedelics helped with self-discovery and acceptance of her queer identity, discussing the ways these substances can help gender and sexual minorities step outside of forms of normativity that are enforced in the culture. She also discusses creating safe spaces for queer folks where they can access psychedelic healing with facilitators and other participants of a similar background. In closing, Wilhelmina reiterates the continuing issues of access and trust queer people face in the current psychedelic landscape, emphasizing the significant work which must be done to improve this situation.    In this episode: How psychedelics can help with self discovery and self exploration What inspired Wilhelmina to begin working professionally with psychedelics Creating spaces for psychedelic healing tailored to queer-identified people Dealing with microaggressions in the context of a psychedelic retreat Working with a therapist or facilitator who shares a queer identity The queerness of psychedelics   Quotes: “When I began to explore with psychedelics, there were moments of this connection beyond… the way I was socialized or conditioned to think was normal. I was able to just be myself [and] found that this attraction and this embodiment that I was feeling was actually where I was supposed to be.” [4:41] “Psychedelics can be really helpful in challenging, in questioning, in dissolving those oppressive narratives that keep people oppressed, that keep them from accessing their liberation. And so if we can do this consciously, and if we can do this in a safe space where harm is not perpetuated, then we actually have this beautiful opportunity for collective liberation” [14:25]   Links: Wilhelmina's practice, Integrate  Integrate on Instagram Integrative Psychiatry Institute Psychedelic Research and Training Institute Queering Psychedelics: From Oppression to Liberation in Psychedelic Medicine SoundMind Institute Psychedelics and Identity Initiative Queer Psychedelic Society Psychedelic Liberation Collective Previous episode: Psychedelics and the LGBTQIA2S+ Community with Dr. Angela Carter Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Joël Brierre joins to discuss the important topic of safety when working with 5-MeO-DMT. Joël is the founder and CEO Tandava Retreats and co-founder of the 5-MeO-DMT education and training platform F.I.V.E. Joël and his team are focused on shepherding 5-MeO into the world in a safe and effective manner.  In this conversation, Joël shares his expertise on the screening that should be done prior to 5-MeO-DMT experiences, discussing both physical and psychological considerations. He also talks about synthetic 5-MeO-DMT vs the extract from the Bufo alvarius toad and explains why his retreat center only uses the synthetic version. In closing, he discusses the nuances around drug-drug interactions and how he navigates these with participants, exploring the nuances of the pharmacology involved.     In this episode: What inspired Joël to start F.I.V.E. The physical medical considerations when screening patients for 5-MeO-DMT Why it is theorized that 5-MeO-DMT could trigger conditions like multiple sclerosis to recur  Psychological red flags for people seeking 5-MeO-DMT experiences Joël's thoughts on navigating psychedelic narcissism Safety considerations working with patients with significant trauma Determining the dosage of 5-MeO-DMT and why Joël thinks there’s a lot of value in lower doses Alternative routes of administration for 5-MeO-DMT other than smoking   Quotes: “It’s very important to us that [5-MeO-DMT] is shepherded out into the world in a safe and effective way, with a good understanding of how it can go wrong—because another bad headline can really harm the progress that it has seen.” [7:14] “Where we used to feel you really had to work your way up to 5[MeO-DMT], we found with the right amount of prep and with a good individualized approach it’s right for anyone—as long as they’re in the right place for it. So if they make it through the screening and intake process, we’re good to go.”  [23:09] “There’s no need to turn it into a goal-oriented thing where [the participant] needs to get to a full release. We see plenty of full resolutions happen where we never even have to take a participant to a mystical experience.” [29:43]   Links: Tandava Retreats website F.I.V.E. website Previous episode: How to Choose a Psychedelic Facilitator or Retreat Center with Joël Brierre Previous episode: Navigating Psychedelic Narcissism with Adam Aronovich Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Joshua White returns to discuss the role of peer support in the psychedelic ecosystem. Joshua (he/him) is founder and executive director of Fireside Project and has prior experience as a volunteer counselor on a hotline and as a volunteer at the Zendo Project. He has also practiced law as a deputy city attorney at the San Francisco City Attorney’s Office, where he focused on suing business exploiting vulnerable communities. He also co-taught a nationally-renowned clinic at Yale Law School. In this conversation, Joshua shares updates from the first two years of Fireside Project, the psychedelic peer support hotline. He mentions that the hotline has grown nearly 1,000% since their first month, with the number receiving 1,500 calls this past month. Joshua also discusses the intricacies of peer support, sharing why he thinks this form of support is particularly well-suited to psychedelic experiences and how he understands the relationship between psychotherapy and peer support. In closing, Joshua reminds listeners that Fireside Project is available to take calls from anyone working through a psychedelic experience—whether they are in the midst of an altered state of mind or seeking to integrate a past experience.    In this episode: When to call the psychedelic peer support hotline The history of peer support and when it may be helpful Why Joshua believes its important for peer support volunteers to have had their own psychedelic experiences The ways peer support and psychotherapy differ The limits of peer support How peer support is similar to the methods used in MDMA-assisted therapy Critiques of peer support Joshua has heard and his responses The relationship between peer support and theoretical frameworks in psychotherapy    Quotes: “In non-psychedelic peer support, often the peer-ness starts with a pathology—alcohol use disorder, tobacco use disorder, etc. Psychedelic peer support, the idea is that having had a psychedelic experience by itself is the layer of peer-ness that’s needed to go deeper with someone regardless of other aspects of your identity you may have.” [8:55] “One of the, I think, key parts of peer support is that we don’t interpret a caller’s experience for them. We are present with them so that they can interpret their experience and we can create a safe and non-judgmental space for them to engage in that kind of interpretation.” [18:32] “I think especially with an experience as vast as the type that can be precipitated by psychedelics, having multiple forms of support is essential.” [22:23]   Links: Fireside Project website Fireside Project on Instagram Fireside Project on Twitter Previous episode: Insights Gained from the First Year of Fireside Project with Joshua White Previous episode: Fireside Project: The World’s First Psychedelic Hotline with Joshua White and Hanifa Nayo Washington Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Hannah Cross, LCSW joins to discuss group ketamine assisted psychotherapy for frontline healthcare workers. Hannah is a licensed clinical social worker and therapist who specializes in trauma healing and psychedelic integration, including work on LSD and psilocybin clinical trials.  In this conversation, Hannah shares details from the study exploring group ketamine therapy in a cohort of ten frontline healthcare workers, discussing the study design, the intricacies of group therapy, and the specific dosing protocol and therapy regimen for the patients. She reveals the very promising results of this early study and also shares a number of emotional stories of transformation from the patients. In closing, Hannah discusses the early indicators of the durability of positive effects from this kind of ketamine assisted therapy and lists a number of additional on-going and upcoming studies of group ketamine treatments for other populations.   In this episode: The inspiration for this ketamine study How the frontline healthcare workers in the study were chosen What makes a person a good candidate for group therapy The protocol for the ketamine assisted therapy used in the study Why the therapy began with a low, sublingual dose of ketamine How psychotherapy was integrated with ketamine treatments in this study The reductions in PTSD, depression, and anxiety that resulted from the ketamine assisted therapy Why Hannah sometimes sees an increase in anxiety towards the beginning of the therapeutic process   Quotes: “Ketamine can help people access more of that self-healing energy and when that’s present in a group setting and people are essentially able to shine this healing energy on each other, there’s this exponential healing I think can happen.” [7:16] “When you wrap a ketamine experience up in experienced and effective therapy, there is this safety in the container that really allows people to have the inward focused journey under ketamine for that forty-five minutes to an hour.” [20:03]   Links: Full study: Ketamine-Assisted Group Psychotherapy for Frontline Healthcare Workers with COVID-19-Related Burnout and PTSD: A Case Series of Effectiveness/Safety for 10 Participants Numinus website Group ketamine assisted therapy by Numinus Hannah’s private practice, Wild Sunflower Counseling Cedar Psychiatry website Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Arsalan Azam joins to discuss the potential of ketamine therapy for helping to address the stress of major life transitions. Dr. Azam is a board-certified Emergency Medicine physician and medical director of Daydream MD. He attended medical school as a Dean’s Scholar at Case Western Medical School and completed his clinical rotations at the Cleveland Clinic. He has also worked as an emergency medicine physician around the country, including as a relief physician for hospitals impacted by staffing shortages. In this conversation, Dr. Azam shares patient experiences from his own ketamine practice and discusses the complexities of different approaches to ketamine treatment and different indications, including how some individuals may benefit especially from ketamine assisted therapy, while others may be well served by stand-alone ketamine infusions, especially considering the cost differential of these treatments. Additionally, Dr. Azam explores the role integration and peer support can play in the context of ketamine treatments, mentioning these may be less cost-prohibitive ways for patients to get the most out of their experiences.   In this episode: The kinds of life transitions ketamine is helpful with in Dr. Azam’s experience What kinds of patients Dr. Azam’s practice serves The unique mechanism of ketamine Leveraging ketamine treatment to navigate breakups or professional transitions Ketamine assisted psychotherapy vs stand-alone ketamine infusions, and when having the extra support of therapy may be especially beneficial The role of integration and peer support in ketamine treatments The research into ketamine treatment for suicidal ideation How Dr. Azam sets up treatment programs for different kinds of patients   Quotes: “The magic of this neurobiology is that, unlike our existing tools which take weeks to kick in often, this one works within hours. And so it really becomes more of a rescue medication or a supportive medication for these transitions of life that works quickly.” [8:32] “Think of our mind and our mental patterns as a piece of cold steel—and it’s kind of locked in that structure, in that pattern. Psychedelics, like ketamine and others, can heat that steel up, and make it much more moldable and then when it cools back down it’ll maintain a persistent new structure. So ketamine assisted therapy is a tool that helps us leverage that hot piece of steel to mold it into something else.” [11:56] “Ketamine works very quickly to reduce suicidal thinking and its degree of effect directly corresponds to the degree of symptoms. So someone who has really severe suicidality is more likely to experience a response to ketamine and is more likely to experience a significant response to ketamine.”  [18:36]   Links: Daydream MD website Daydream MD on Instagram Fireside Project website Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Ben Malcolm, PharmD joins to discuss the research surrounding the intersection of psychedelics with pregnancy and nursing. Dr. Malcolm is a psychopharmacology consultant, psychedelic educator, founder of Spirit Pharmacist, LLC and a board member of the Psychedelic Medicine Association. Dr. Malcolm recently wrote an overview article on the existing research into psychedelics, pregnancy and breastfeeding. In this conversation, Dr. Malcolm shares the current state of research that he explored in his article, highlighting the few points where data does exist while emphasizing that there are still major unknowns. Overall, Dr. Malcolm describes how most are very conservative when it comes to psychedelic use while nursing or pregnant, though pregnancy seems to present more concerns than nursing. Dr. Malcolm also discusses ketamine and the interesting findings in patients who were given this substance as an anesthetic for cesarean sections. In conclusion, Dr. Malcolm suggests moving beyond a black and white perspective on this topic, emphasizing that there are also opportunity costs to not pursuing healing. However, in this area especially, more research is needed before clear guidelines can be developed.    In this episode: The lack of treatment options for postpartum depression Why it is likely for a fetus or infant to be exposed to psychedelics if a mother ingests them while pregnant or nursing Psychedelics and the developing brain Ritual use of ayahuasca and mushrooms among pregnant women in traditional ceremonial contexts The research into negative impacts of ecstasy use during pregnancy and the variables that confound the results The unknowns about microdosing while nursing The research into whether LSD is a teratogen The effects of psychedelics on hormones Pregnancy as an aspect of set and setting   Quotes: “Psychoactive drugs or psychotropic drugs typically end up in breastmilk more than other types of substances because they are usually more fat-soluble. Usually to get into brain tissue they have to be a little more fat-soluble than drugs that act in the periphery.” [10:15] “In the nursing period I think that there’s more potential to use psychedelics safely and without really taking much risk as far as exposing the [child], whereas in pregnancy, yeah, you just don’t really have that choice—the fetus is going to be exposed.” [24:42]   Links: Dr. Malcolm’s recent article: “Psychedelics, Pregnancy, and Breastfeeding” Spirit Pharmacist website Spirit Pharmacist on Facebook Spirit Pharmacist on Instagram Spirit Pharmacist on YouTube Psychedelic Medicine Association Porangui

In this episode of the psychedelic medicine podcast, Allison Feduccia, PhD joins to discuss the intersection of psychedelic medicine and women’s health. Dr. Feduccia is a neuropharmacologist, psychedelic researcher, and builder of virtual and in-person communities. She is cofounder of two prominent organizations, psychedelic.support and Project New Day, and is additionally a scientific advisor for Eastra. Alli has been researching psychedelics since 2004 when she first began studying MDMA and has subsequently been involved in the field through work at numerous universities, the NIH, and MAPS. In this work she seeks to spread evidence-based knowledge, connection to resources, and strategies for individuals to maximize potential therapeutic benefits of psychedelics through safe and responsible practices. In this conversation, Alli responds to questions touching on all areas of women's health and the impact psychedelics could have specifically for female patients. A major theme of the discussion is the interplay between psychedelics and hormones. While this is a topic with little in the way of scientific research, Alli shares some interesting ideas about how the neuromodulation of psychedelics could interact with endocrine systems, and how serotonin receptors within the uterus could explain certain anecdotal reports of various effects of psychedelics on menstrual pains or irregularities.  In a similar vein, Alli discusses some of the physiological effects of psychedelics, particularly in relation to blood flow, and how these non-experiential features of these compounds could actually be helpful properties for women with certain conditions. This insight leads to interesting avenues for future drug development and also stresses the importance of studying psychedelics at different doses so that the positive health effects can be isolated. Alli also talks about the potential for psychedelic healing in the context of postpartum depression, sharing an evocative family story which illustrates simply how crucial and overlooked this issue has been in healthcare. The advances in mental healthcare coming out of psychedelic research provide a promising path forward for such conditions, however.    In this episode: How psychedelics could help with premenstrual discomfort Concerns about taking psychedelic substances while pregnant Psychedelics and postpartum depression How psychedelics could impact hypoactive sexual desire disorder   Psychedelics interactions with menopause Potential role for hormones alongside set and setting for impacting the psychedelic experience   Quotes: “It may be that psychedelics could really affect women’s moods as they go through these different life stages, and help them feel better.” [4:45] “Maybe this concept of neurotransmitter modulation with our sex hormones may be a target for drug development work as well.” [23:42] “This is also pertinent to transgender women who may be using hormones. This type of modulation on mood or physiological symptoms—this could be really applicable too for helping to really have the body adjust and be more balanced to changes in hormonal fluctuations in the body.”  [26:59]   Links: Psychedelic.support website Project New Day website Eastra Health Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, PhD candidate and psychedelic science YouTuber Manesh Girn discusses his recent research on psychedelic brain action. Manesh is in the final stages of obtaining his PhD in neuroscience at McGill University and is an author on over a dozen peer-reviewed articles on psychedelics and related topics. He is also chief research officer at EntheoTech Bioscience and runs the YouTube channel the Psychedelic Scientist.  In this conversation, Manesh discusses his recent article in Trends in Cognitive Sciences titled “A complex systems perspective on psychedelic brain action.” He explains the complexity science approach used in the article, which emphasizes the brain is a holistic, interconnected system, rather than individual component networks that can be isolated. From this standpoint, Manesh critiques some simplistic explanations of the neural mechanisms of psychedelics which focus exclusively on interactions with the default mode network isolated from other brain systems. He also explains how individual some of the neural effects of psychedelics are, citing different findings from different studies and observed variations between brain scans of different people. By better understanding these individual differences, and placing these different responses into a complexity science framework, Manesh believes that more individually-tailored psychedelic therapies are possible once the systems involved are more comprehensively understood.  Manesh closes this discussion by explaining the difference between genuine complexity and sheer chaos.  Complexity, he explains, is a delicate balance of novelty and order, which is why psychedelic experiences can be both destabilizing and productive of novel insights and personal transformation.    In this episode: The research into psychedelics and the default mode network Using frameworks from complexity science in psychedelic research Measuring entropy in the brain Differences in neurological effects from taking between different studies and different individuals How a complexity science approach to neuroscience could better inform precision psychiatry   Quotes: “You can’t just look at a specific brain region or network [in psychedelic research], you’ve gotta talk about the brain as a whole, in this sense of seeing the brain as a system of interacting parts.” [4:49] “The core idea of this paper is that psychedelics put our brain into this state that is more dynamically flexible, it’s more diverse in its activity patterns, and it’s more sensitive to inputs that come in.” [14:17] “What we find in the brain imaging findings is that different studies disagree, but also if you look at individual people, they can have radically different effects on their brain—almost opposite.” [21:37]   Links: Manesh’ recent article in Trends in Cognitive Sciences: “A complex systems perspective on psychedelic brain action” ​​Psilocybin vs Placebo Brain Connectivity Diagram from Dr. Robin Carhart-Harris The Psychedelic Scientist YouTube Channel The Psychedelic Scientist on Instagram The Psychedelic Scientist on Twitter Manesh on LinkedIn EntheoTech website Psychedelic Medicine Association Porangui