Psychedelic Medicine Podcast with Dr. Lynn Marie Morski

In this episode of the Psychedelic Medicine Podcast, Dr. Ben Sessa joins to share results of his investigation into MDMA-assisted psychotherapy for alcohol use disorder. Dr. Sessa is a trained MDMA and psilocybin therapist and the chief medical officer at Awakn Life Sciences, a biotechnology company researching, developing, and commercializing therapeutics to treat addiction with specific attention on alcohol use disorder in the near-term.  Dr. Sessa begins sharing his story of how he got interested in the potential clinical uses of psychedelics as a psychiatrist, discussing his experiences of rave culture and making connections with Rick Doblin and MAPS early in the so-called “psychedelic renaissance,” a term he coined. Looking at the work MAPS was doing, he was inspired by the potential of psychedelics to heal trauma and began looking for ways to further contribute to this research.  When it came to alcohol use disorder (AUD) specifically, Dr. Sessa mentions how poor the current best treatments are, with relapse rates sometimes being as high as 90%. This being so, there is significant potential for novel treatments to provide better outcomes, and considering the prevalence of AUD, this could be a huge net positive for society. Dr. Sessa explains that AUD is particularly common in individuals with a history of trauma and/or adverse childhood experiences, so considering the potential of MDMA to address these underlying factors, he immediately saw the potential for psychedelic treatments of this condition.  Working off of these hypotheses, Dr. Sessa undertook a study of MDMA for alcohol use disorder which showed some extremely promising results. The study found that only 21% of the trial participants returned to previous levels of drinking following MDMA-assisted therapy. In addition to this, about half of the individuals for whom the treatment was effective were actually able to have an occasional drink without relapsing—an outcome that is exceedingly rare with current treatments, hence the insistence on complete abstinence. Though this was only a safety and tolerability study and thus additional research is needed to confirm these initial findings, Dr. Sessa is extremely encouraged by the potential of this novel treatment and he is happy to report that he and his colleagues have just submitted a clinical trials application for a placebo-controlled study of MDMA for AUD, so additional insights into the efficacy of this treatment are hopefully not far off.  Dr. Sessa concludes this conversation with an interesting discussion of MDMA “hangovers”—sometimes referred to as “blue Mondays.” He mentions that it is an established fact that many recreational ecstasy users experience a rather significant drop in mood and sense of wellbeing following using the drug. However he theorizes that this may be due more to confounding factors rather than the drug itself. Considering the typical contexts of recreational MDMA use, things such as lack of sleep, lack of food, excessive exercise, impure sample, and concomitant drug use could all contribute to negative emotion after a drug experience. And Dr. Sessa’s research seems to lend support to this theory, as the MDMA patients in the clinical setting of his study did not experience these side effects, and actually many experienced just the opposite—they felt an “afterglow” following MDMA therapy, where they noted elevated mood for up to a week after the experiences.   In this episode: How Dr. Sessa first became interested in MDMA-assisted psychotherapy Why Dr. Sessa decided to focus his work on alcohol use disorder The study design for Dr. Sessa’s MDMA for alcohol use disorder trial The types of talk therapy employed in this MDMA therapy trial Does MDMA-assisted therapy have potential for treating other kinds of addiction? Why patients aren’t seeing a “blue Monday” hangover after MDMA-assisted psychotherapy   Quotes: “In the MDMA state you can work with those forbidden, avoidant memories that normally you wouldn’t go to.” [5:20] “In fact, most addictions—apart from perhaps nicotine—have this link with childhood adversity and trauma.” [8:36] “We didn’t just look at drinking outcomes, we looked at mental health, physical health, relationships, quality of life—all these kinds of things… And there were improvements across the board in all of those people who responded well to the MDMA therapy, which was 80% of them.” [20:46] “Across 26 MDMA sessions (which was in 13 patients), we found no comedowns. So they all had MDMA and at the end of the day when the MDMA wore off, they didn’t feel low, they didn’t feel rotten, they felt fine—in fact they felt good.” [26:06] “I think if people took MDMA lying in silent darkness like they take mushrooms, I think we’d see a lot more in the way of mystical, spiritual experiences.” [32:42] “[Psychedelic-assisted therapy] is much more like surgery than it is psychiatry. It’s not daily maintenance treatment with SSRIs for the next sixty years of your life just to suppress symptoms. It’s an intensive, up-front piece of an intervention, like mending a broken bone, that gets you better so you don’t have to sit on antidepressants for the rest of your life.” [36:26]   Links: Dr. Sessa’s study on MDMA for Alcohol Use Disorder: First study of safety and tolerability of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in patients with alcohol use disorder Dr. Sessa’s study on MDMA hangovers: Debunking the myth of ‘Blue Mondays’: No evidence of affect drop after taking clinical MDMA Awakn Life Sciences website Dr. Sessa’s website Dr. Sessa on Twitter Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Rick Doblin joins to discuss the past, present, and future of MDMA-assisted therapy. Rick Doblin is the founder and executive director of the Multidisciplinary Association for Psychedelic Studies. He received his doctorate in public policy from Harvard and has also studied under the father of transpersonal psychology Stanislav Grof. Through MAPS, Rick aspires to develop legal contexts for beneficial uses of psychedelics and marijuana as prescription medicines, but also for self-development and personal growth in otherwise healthy individuals. Rick begins this wide-ranging conversation discussing the early days of MDMA. The compound was originally synthesized by famed chemist Alexander "Sasha" Shulgin and, unlike the classic serotonergic psychedelics, it was not scheduled under the Controlled Substances Act in the early 70s. It was during this period of legality that therapeutic uses of MDMA were first developed and it was only later that the drug became repurposed as a recreational substance to be used in social settings, which consequently led to its emergency scheduling by the DEA. Rick recalls his own initial experiences with the empathogenic compound, stating that he was initially skeptical of its value, prior to gaining first-hand experience. Following this experience, however, he became convinced of its therapeutic potential and he shares some of his own early experiences of using MDMA to help people heal, including a very touching tale of his own grandmother’s struggle with depression. From here, Rick discusses the founding of MAPS and his decision to pursue education in policy in order to better understand strategies for furthering MDMA-therapy even while living under prohibition. Since that time, MAPS has gone on to do incredibly impactful work in developing studies researching the safety and efficacy of MDMA-assisted therapy, specifically for post-traumatic stress disorder. Rick shares the progression of these studies, highlighting the results from the most recent phase three investigations which are the last step prior to FDA approval for the therapeutic protocol. These studies show high statistical significance and an amazing effect size resulting from MDMA-assisted therapy, with results being mirrored at all research locations and showing durability over time.  Because of this amazing progress, Rick believes we are at the final stretch prior to full FDA approval for MDMA use in a therapeutic context for PTSD, and subsequent rescheduling of the substance by the DEA, which he believes will take place in mid to late 2023. This development will have broad global impacts, spurring other countries to promptly follow suit. Rick closes out this discussion by emphasizing the need for mass mental health in our day and age, and sharing MAPS’ lofty goals of training thousands of therapists to hopefully bring psychedelic therapy to millions of patients in the coming decades.    In this episode: Rick Doblin’s personal journey The history of the MDMA’s synthesis and legality Rick’s first experiences with MDMA and early experiments with MDMA therapy MAPS’ “two-pronged” strategy for mass mental health Early efforts to get an MDMA therapy protocol approved by the FDA following prohibition The politics of concerns about MDMA neurotoxicity and how this impacted MAPS’ early approach The results of the first phase three studies of MDMA for PTSD How FDA approval of MDMA will lead to an international cascade of approval and rescheduling Rick’s predictions for psychedelic medicine in the years to come    Quotes: “What a lot of people don’t know is that MDMA was a therapy drug before it was a party drug. And it was the party drug nature of it that really got it criminalized.” [7:38] “Seeing what it was like when it was legal and experiencing that, and experiencing situations where people would take it, the kind of experiences and healings, and learnings that people would have, was amazing.” [19:12] “What we need is, I believe, legal access to medicinal MDMA, covered by insurance, by trained professionals, and psychedelic clinics. And we also need a whole different kind of drug policy for non-medical use that involves honest drug education, access to pure substances, harm reduction, peer support, and also treatment on demand.” [21:08] “The irony here is that the first legal move against MDMA was illegal. The DEA did not have the authority to emergency schedule drugs.” [23:43] “FDA is legally bound to approve MDMA for PTSD if these [phase 3] studies generate statistically significant evidence of efficacy, and there are no new safety problems.” [40:27] “We think by the third quarter of 2023 we will have FDA approval assuming the second phase 3 study goes well. And then by the fourth quarter, the DEA has to reschedule [MDMA].” [51:18] “What’s even greater is the 12-month follow-up data was 67% no longer had PTSD. So people kept getting better—not only was it durable, but they kept getting better.” [55:00] “The thing to emphasize here is that MDMA is not the treatment. The treatment is therapy. The MDMA makes the therapy more effective and there can be different kinds of therapy that are used with it.” [1:01:38]   Links: MAPS website Rick Doblin on Twitter Trip of Compassion Documentary The Way of the Psychonaut Books by Stanislav Grof Upcoming MAPS Psychedelic Science Conference 2023 Becoming an MDMA-Assisted Therapist with Shannon Carlin, MA, LMFT Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Steven Mandel returns to discuss ketamine treatments for alcohol use disorder. Dr. Mandel is an internationally recognized expert and pioneer in the use of ketamine-infusion therapy to treat mental health disorders and chronic pain. He is a board-certified anesthesiologist with a masters in psychology and over 40 years of experience working with ketamine. He is the founder and president of Ketamine Clinics Los Angeles and also the Founder and first president of American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3). In this conversation, Dr. Mandel explores the topic of using ketamine to address alcohol use disorder, discussing findings from research and sharing his professional experience with this treatment protocol. He begins by unpacking the specifics of alcohol use disorder before relaying an incredible success story from a client who was able to conquer a very significant alcohol addiction due to ketamine therapy treatment.  However, Dr. Mandel notes that actual scientific research for this particular therapeutic use of ketamine is still in the early days, though he notes that the first non-anesthetic use of ketamine was for treating alcoholism in Moscow, and this intervention appeared to be quite effective. He also shares results from animal studies, noting that one study found outcomes of ketamine treatment for alcohol dependent mice was significantly mediated by sex, with the female mice being less responsive to the treatment. However, Dr. Mandel notes that it is too early to know if these same patterns appear in humans.  In terms of the theoretical basis for this treatment protocol, Dr. Mandel discusses glutamatergic transmission and the nucleus accumbens as being important in both alcohol use disorder and ketamine treatment. He also mentions that ketamine potentiates the NMDA receptors which are desensitized in the case of chronic alcohol use.  But Dr. Mandel insists that these pharmacological mechanisms are not the whole story when it comes to the efficacy of ketamine therapy for alcohol use disorder. At his clinics, treatment consists of a five point model which also addresses things like sleep hygiene and diet to provide a more holistic approach to wellness. He also stresses the importance of including talk therapy in the treatment protocol, as patients are primed for effective therapy following infusions. This is due to the improved neuroplasticity resulting from the neurological effects of ketamine, but since this does not last forever Dr. Mandel maintains there is a sweet spot where therapy will be most effective, which is between a few hours after the ketamine treatment and a few days later.  In combination with therapy and other interventions to promote patient wellness, Dr. Mandel is confident ketamine therapy presents a promising treatment option for those struggling with alcohol use disorder, and he thinks it may even be a helpful support for those who’ve shaken their addictions but still struggle with cravings in abstinence.  Ketamine Clinics Los Angeles phone number: (310) 270-0625   In this episode: What is alcohol use disorder? Patient success stories from Dr. Mandel’s ketamine treatments The research on ketamine for alcohol use disorder How set and setting differentiates alcohol and ketamine use in important ways The importance of the experiential aspect of ketamine for its clinical efficacy Why Dr. Mandel’s clinic focuses on sleep hygiene and diet alongside ketamine therapy to help achieve the best patient outcomes Dr. Mandel’s protocol for ketamine infusions The history of AA and psychedelic therapies   Quotes: “[Ketamine’s] first major use… outside of the operating room for anesthesia was by Krupitsky in Moscow in a government program treating chronic alcoholism. That was the first behavioral use of ketamine! And it was profoundly effective.”  [9:25] “We’re really at a frontier here. Just getting ketamine in people and seeing the transformation is amazing. And trying to sort out how to optimize it—we’re not there yet.” [20:41] “There’s a whole other population of people who are successfully abstinent, but are beginning to have cravings. And those people are so helped by a little experience with ketamine. Ketamine is amazing at helping people to resist cravings.” [24:08]   Links: Ketamine Clinics Los Angeles American Society of Ketamine Physicians, Psychotherapists & Practitioner Previous Episode: Ketamine Practitioner Methods with Dr. Steven Mandel Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Tomas Frymann joins to discuss his recent paper where he developed scales for measuring dimensions of psychedelic integration. Tomas is a doctoral student at Columbia University’s Spirituality and Psychology Lab and the author of the Psychedelic Integration Scales and the Interbeing Identity Scale. He is also a practicing psychedelic integration coach for Veterans Exploring Treatment Solutions (VETS, Inc.).  Tomas begins by discussing the context for this research, mentioning that while integration is frequently considered a crucial element of psychedelic healing, the lack of metrics for analyzing it has meant that there has been comparably little attention given to integration in psychedelic research. As such, he hopes that the scales he proposes can both encourage additional research into this dimension of psychedelic therapy and also aid in the implementation of various integration practices and programs through providing a concrete structure from which such things may be developed.  Tomas also talks about the research process, mentioning how his team worked with integration experts working in traditional, medical, and independent psychedelic contexts. The team developed initial ideas that they then discussed with the experts in order to identify major patterns and narrow down their selection of relevant criteria.  In the end, Tomas realized there are two separate but related aspects of integration: integration engagement and experienced integration. The former refers to specific actions taken in order to facilitate integration. Tomas divides engagement into the categories of reflection and application. Though there are no hard boundaries between the two, reflection generally refers to contemplative attention given to the psychedelic experience after the fact whereas application is implementing lifestyle changes in accordance with the insights gained from the psychedelic experience. Here Tomas discusses his own experience of desiring to change his dietary habits to include less meat following a psychedelic session where he connected deeply with an animal.  When it comes to experienced integration, Tomas is seeking to emphasize the psychological feeling of having integrated a psychedelic journey. He divides this aspect into two subsets as well: feeling settled and feeling harmonized. Feeling settled refers to a sense of being at ease in everyday life again following a psychedelic experience, where one is no longer either struggling with integrating a difficult experience nor experiencing dissonance between the revelations of a beautiful experience and the realities of life. Feeling harmonized he explains as a sense of having drawn connections between the insights of a psychedelic journey and conventional existence, so that it feels like these things fit together in a positive way.  In closing, Tomas reiterates his excitement that this work may not only lead to additional scientific research into integration, but may also be a useful pragmatic tool for coaches and individuals as they seek to deepen their integration of psychedelic experiences.    In this episode: How quantifying integration could help encourage more research into integration and the implementation of these practices in more psychedelic contexts How Tomas researched integration to begin constructing these scales Tomas’ seed metaphor for integration What it means to be “settled” in the integration process Using these scales to prompt exploration in integration   Quotes: “The purpose of the scales is to have a metric so that we can show that integration is important.” [4:32] “When you follow these wisdoms, when you take them into account, when you reflect and apply, the output should be basically an improved wellness” [15:48] “When we were creating the integration scale we were really careful not to say integration has to go in any one direction or not—it’s really just about honoring what came up, and working with that.” [20:28]    Links: Tomas' article: "The Psychedelic Integration Scales: Tools for Measuring Psychedelic Integration Behaviors and Experiences"  As We Wake  Veterans Exploring Treatment Solutions (VETS, Inc.) Psychedelic Medicine Association Porangui

On this episode of the Psychedelic Medicine Podcast, Juliana Milligan joins to discuss her recent article (co-authored with Joshua White of Fireside Project) on warning signs when selecting a psychedelic facilitator. Juliana is an ibogaine specialist who has been working in the ibogaine treatment community for 10 years. Having been formerly opioid-dependent and incarcerated herself, she currently works at the Center for Optimal Living where she runs the psychedelic education and training program. Juliana additionally works with clients doing preparation and integration of Ibogaine treatments through her business Inner Vision Ibogaine. In this conversation, Juliana discusses each of the 10 red flags she identified in her article. First, she discusses potential issues around sexual misconduct on the part of facilitators, emphasizing that this is a topic which always requires careful and explicit discussion well prior to the psychedelic experience. One ought to also do some individual research, as potential allegations against a facilitator are also a red flag to take seriously. Next, Juliana talks about the importance of facilitators doing a thorough medical intake. This involves getting a medical history from a potential client and checking if there are any contraindications for this person to take a psychedelic, such as dangerous interactions with prescription medications. In a similar vein, Juliana also stresses the necessity of facilitators testing the psychedelics their clients will be consuming whether they themselves provided the psychedelics or if the client brought their own substances. Willingness to test the substances in the presence of the client is definitely a good sign and shows that the facilitator values both transparency and safety.  In terms of training, Juliana highly recommends ensuring that a facilitator is trauma-informed before committing to a journey under their guidance. Knowing that a guide will be conscientious and empathetic around issues of trauma helps to ensure that the psychedelic experience doesn’t itself turn in a traumatic direction. Similarly, Juliana emphasizes that facilitators should be open about the training they’ve received—even underground facilitators should ideally have mentors and be involved in a community of practitioners that encourages continued training. In closing, Juliana discusses the dangers of having inflated and unrealistic expectations around the healing potential of psychedelics. Facilitators who use hyperbolic language like “ten years of therapy in one night” may actually be setting up clients for more difficult experiences than they otherwise may have had due to these fantastical claims. Juliana emphasizes that psychedelic healing is a cooperative endeavor, and neither the substance nor the facilitator is solely responsible for any healing that results from the experience. Ultimately, it is the person themselves who does this work, so Juliana highly recommends finding a facilitator who acknowledges their role as primarily supportive of this healing journey, rather than someone who presents themselves as a miracle worker responsible for these positive results.   In this episode: Why having a trauma-informed facilitator is important, and what this means The dangers of psychedelic narcissism The importance of the harm reduction practice of chemically testing psychedelics Trusting your intuition and building this capacity Having healthy and reasonable expectations around the healing potential of psychedelics   Quotes: “Once you are on a psychedelic, you cannot properly consent to touch—it must be established in advance. And if [a facilitator] is saying ‘well no I need freedom in my work, I need to use my intuition’ that is a major red flag.” [7:19] “It’s really important that the facilitator knows exactly what is contraindicated with the medicine they’re administering, and if they’re not evaluating for this and if they’re not familiar with medical conditions and how they interact with the medicine they’re giving then they’re not properly trained to be giving this medicine.” [10:14] “The only person that can really heal you is yourself and a facilitator is just there to help empower you and support you in guiding yourself. It’s a collaborative relationship.” [13:44] “If a person isn’t willing to be receptive to feedback, self-reflective, and take accountability, psychedelics aren’t necessarily going to make them do that. And so you give psychedelics to somebody with those kinds of narcissistic traits and it can just make the narcissism worse.” [20:15]   Links: Juliana's Article with Fireside Project: Warning Signs When Selecting a Psychedelic Facilitator  Inner Vision Ibogaine: Guide to Finding an Ibogaine Clinic The Root Ibogaine Collective The Psychedelic Program at The Center for Optimal Living Juliana on Instagram Previous episode: Navigating Psychedelic Narcissism with Adam Aronovich Previous episode: Harm Reduction Through Testing Your Psychedelics with Mitchell Gomez Previous episode: When *Not* to Proceed with a Planned Psychedelic Journey with Rick Barnett, PsyD Previous episode: Fireside Project: The World’s First Psychedelic Hotline with Joshua White and Hanifa Nayo Washington Previous episode: Insights Gained from the First Year of Fireside Project with Joshua White Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Balázs Szigeti, PhD, joins to discuss his research on the intersection of microdosing psychedelics and the placebo effect. Dr. Szigeti studied physics at Imperial College, after which he earned a PhD in computational neuroscience from the University of Edinburgh. He has worked as a biomedical software engineer at the Icahn Genomics Institute and he has conducted the largest placebo-controlled study on psychedelics to date. In his research, Dr. Szigeti uses novel statistical and experimental techniques to explore the intersection of psychedelics and placebo effects. Dr. Szigeti begins this conversation by discussing the design of his placebo-controlled microdosing study, “Self-blinding citizen science to explore psychedelic microdosing” which appeared in the journal eLife in March 2021. For this study, Dr. Szigeti and his team employed citizen science to collect placebo-controlled observational data from participants, allowing this experiment to take place outside of a clinical environment. Participants self-blinded by preparing identical psychedelic and placebo microdose capsules and data was submitted using QR codes so that the researchers were knew whether the participant was in the psychedelic group or the control group, while the participants themselves remained in the dark. The results from this study showed a statistically significant improvement of wellbeing among both the microdose and placebo groups, with no statistical significant difference between the two groups in terms of any of the outcomes. Dr. Szigeti talks about the media reception of his research, which tended to present the findings as suggesting microdosing is ineffective since there was no difference between the two groups. However, Dr. Szigeti has a different takeaway. He suggests that the practice of microdosing can indeed lead to improved wellness as the study showed—the takeaway is simply that this effect is harder to distinguish from a placebo than originally anticipated. He emphasizes the very real medical power of this placebo effect, and discusses how triggering one’s own placebo effect either through microdosing or some other practice can be transformative.  However, beyond what the data may suggest about the impact of microdosing psychedelics, Dr. Szigeti emphasizes the broader takeaways from his study, which bring into question the efficacy of placebo-controlled studies as a gold-standard in the context of psychedelic trials. Because psychedelics cause notable shifts in perception, trial participants will quickly become aware whether they are in placebo or psychedelic groups, particularly in the case of trials exploring doses beyond the microdose range. This causes an immediate unblinding effect, and makes control groups less useful than in other contexts where a participant does not find out which group they were a part of until the trial’s conclusion. Dr. Szigeti affirms the methodology of placebo-controlled trials as an essential tool for researchers which deserves its reputation for providing high-quality evidence, but he urges the field of psychedelic studies to pay closer attention to questions of methodology, as there may be yet undiscovered modes of scientific investigation which would be better-suited to psychedelic trials.  Dr. Szigeti is currently working on a follow-up blinded study on microdosing which he hopes will address some of the shortcomings of the original investigation. In particular, he mentioned that the participants in the original study had high levels of well-being already at the start of the trial, so improvements may have been less significant than in a population with a lower level of well-being to start. As such, he and his team hope to recruit a more diverse sample in this upcoming trial to further explore the extent of both placebo and microdosing impacts on wellness. Information for the upcoming study can be found at the website: https://selfblinding-microdose.org/   In this episode: How Dr. Szigeti set up his self-blinded placebo-controlled study of microdosing outside of a clinical environment What is “citizen science” and how this differs from other methodologies The issue of tolerance in microdosing and how this may differ between LSD and psilocybin How Dr. Szigeti uses statistical analysis to further interpret data where participants realize which group of the study they are in   Quotes: “The results of this microdose trial were mixed because you can make an argument that this change over time is the more important outcome and that was statistically significant, but the comparison of the magnitude of change in the placebo group versus the magnitude of change in the microdose group, that was not significant anymore. It was not significant on any of the scales, I should add.”  [14:45] “Nobody ever checks whether the placebo control was really working as intended, which is just like—I don’t know how it could have happened. There is such a big emphasis on the methodological superiority of placebo-controlled trials and then nobody is checking whether its really working or not.” [21:09] “With psychedelics this issue [of placebo groups] is going to come to the forefront because, yes with microdosing there is some wiggle room in people recognizing their treatment, but when it comes to 200μg of LDS versus placebo, there is zero uncertainty. Everybody will recognize when you’re in the active placebo treatment.” [28:13]   Links: Upcoming trial website Dr. Szigeti’s study: “Self-blinding citizen science to explore psychedelic microdosing" Dr. Szigeti’s recent article: “On the fallibility of placebo control and how to address it: a case study in psychedelic microdosing" Dr. Szigeti on Twitter Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Joshua White returns to discuss the first year of the psychedelic peer-support line, Fireside Project. 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. Joshua begins this conversation by sharing the success of Fireside Project in its first year of operation. The peer support line has been called over 3,100 times in the 14 months since the launch of Fireside Project, where callers have been able to receive open-ended support from compassionate peers as they navigate a psychedelic experience or attempt to integrate a previous experience.  Joshua also shares some details about the kinds of calls the line has received, such as which psychedelic substances were involved in the caller’s experience, how callers were describing their experiences, and what mental health conditions callers self-reported. In terms of substances, psilocybin was the most commonly used by callers, though a wide range of different psychedelics were reported. For mental health conditions, PTSD stood out as the most frequently mentioned, though depression and anxiety were also common. Joshua mentions that he’s hopeful that this data may be incredibly useful in further developing harm reduction strategies, as the dataset may help uncover previously unknown correlations.  Another aspiration for Fireside Project is ensuring equity through their Equity Initiative, which allows callers to process past psychedelic experiences with someone of a similar background. Joshua shares that this initiative will also produce original research on this topic, showing for example the kinds of benefits a caller from the BIPOC community might get through having the opportunity to integrate a past experience with a BIPOC peer.  Joshua closes this conversation with powerful words about integration and harm reduction, saying that integration is a form of harm reduction. To that end, Joshua is hopeful Fireside Project can continue offering crucial harm reduction and integration services as the organization grows and reaches beyond the niche of psychedelic enthusiasts.    In this episode: Who has been calling the peer-support line and what kind of support they are seeking How Fireside Project could potentially offset the burden on emergency services in the case of negative psychedelic experiences The diversity of Fireside Project volunteers The problems of facilitator abuse and neglect in the psychedelic space The future of Fireside Project   Quotes: “Reflective listening—which is the core, the foundation of holding space—this is really a skill that we can continue to cultivate.” [8:03] “My hope is that there’s no barrier, there’s no stigma, and there’s no shame to reaching out.”  [12:53] “All of the lessons we learn, we really just want to share those with the public in the hope that this will lead to less risky and more fulfilling psychedelic experiences.” [17:30] “One of the things that I’ve noticed is—that we’ve noticed is—even though every single call is different in its own way, especially when someone reaches out to us in a heightened state, really validation, normalization, and reassurance often happen at the very beginning.” [25:34] “It’s amazing how some of our calls are just so short because someone just wants to know that we are there.” [28:44] “As a psychedelic community, people need to stop saying that psychedelics are ten years of therapy in one night. It’s just not true, and it sets people up for serious disappointment and can even be really dangerous for that reason.” [30:01]   Links: Fireside Project website Fireside Project app Fireside Project Instagram Fireside Project Twitter Fireside Project Tik Tok Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Felipe Malacara joins to discuss the safety considerations surrounding ibogaine therapy. Dr. Malacara is the chief clinical operations director for Beond, a Mexico-based Ibogaine clinic. He is also a general practice physician with a medical degree from Universidad Autónoma Metropolitana in Mexico City and has over 17 years of experience treating over 1,200 patients with Ibogaine therapy.  In this conversation, Dr. Malacara shares important safety information about ibogaine, starting with major contraindications to using the powerful substance. These contraindications fall into three main groups: heart issues, electrolyte deficiencies, and liver problems. As Dr. Malacara explains, all of these have the potential to make Ibogaine dangerous due to the way it interacts with the heart, particularly if there is a metabolism issue. In terms of negative outcomes, cardiac issues are the most common as ibogaine can cause bradycardia—a dangerous slowing of the heart rate.  Due to these potential risks, Dr. Malacara encourages a thorough evaluation prior to ibogaine therapy, including full blood work, an EKG, and occasionally an ultrasound of the heart. Another crucial part of the evaluation is taking an inventory of the patient’s prescription medication and drug use. Dr. Malacara explains that patients may need to be weaned off a particular drug or be given a shorter-acting alternative so that they can come into the ibogaine therapy without any substances in their system which could lead to dangerous interactions or render the treatment less effective. In particular, Dr. Malacara notes that SSRIs could interact with ibogaine to produce serotonin syndrome, and while this can be straightforward to treat, diagnosis can be difficult, so avoiding this entirely by weaning off the medication under the direction of a physician is strongly suggested prior to treatment.  In closing, Dr. Malacara emphasizes that Ibogaine is not a magic bullet despite its unique efficacy for treating addiction. The will to change on the part of the patient is still crucial, especially as preparation for ibogaine therapy itself requires a lot of commitment and dedication. If that is present, however, Dr. Malacara maintains that the treatment can be extremely effective.   In this episode: How Dr. Malacara got involved in Ibogaine therapy The inherent risks of Ibogaine What patients should be evaluated for prior to receiving Ibogaine therapy Weaning patients off drugs or onto different, shorter acting substances in preparation for Ibogaine The types of addictions may be successfully addressed by Ibogaine Monitoring a patient’s heart following Ibogaine, and when they can be released   Quotes: “In the event [that a patient] is not able to metabolize ibogaine in an appropriate way, the risk of heart toxicity of the Ibogaine increases.” [9:25] “Something which is important is drug screening before the treatment. We need to know that the patient has no traces of the drugs that we are going to treat in the system, because otherwise the treatment will be more difficult, the recovery will be more difficult, or it will be even ineffective.”  [26:48]   Links: Beond Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Wyly Gray and Dr. Andrea Lucie join to discuss the issue of healing military sexual trauma (MST) through ayahuasca. Wyly Gray is a former Marine and founding executive director of Veterans of War, a nonprofit which connects teams of veterans to psychedelic-assisted guided group therapy designed to heal the scars of war in community. Dr. Andrea Lucie is a native of Chile and a third generation healer who has been traditionally and non-traditionally trained in ancient healing practices in the United States and Mexico. She also holds a PhD in mind-body medicine. This conversation begins by discussing the tragic phenomenon of military sexual trauma and the current treatment modalities available for veteran survivors. Wyly explains that the current treatments, which primarily take a talk therapy approach, often fall short of what survivors need as they focus on treating the symptoms as they arise rather than being able to address these conditions at their root causes. Dr. Lucie explains the science behind ayahuasca as a treatment for trauma, highlighting the profound neurological and psychological impacts of this psychedelic medicine.  Seeing the particular need for better treatment options among the veteran population, and the potential for ayahuasca to have such a profound positive impact, Wyly founded Veterans of War with the hope of better addressing this need. He shares the details of the six-month fellowship program, which involves a small cohort of veterans who do significant preparatory work together prior to a communal ayahuasca ceremony, followed by many integration sessions after the ceremony. Dr. Lucie explains different forms of mind-body work that may be effective supports before and after ceremony, citing things such as Tai Chi, meditation, and even close relationships with animals.  Towards the end of this conversation, Wyly shares some profound stories of transformation he has witnessed first-hand through his work with Veterans of War. He has seen veterans who’ve struggled profoundly with panic attacks become incredibly joyful people, and others who were on the brink of suicide begin to heal and form deep and meaningful relationships. In closing, Wyly discusses plans to establish a healing center in Oregon for Veterans of War to further increase access to these opportunities without the need for international travel.   In this episode: The problems of the civilian service-member divide, and how ayahuasca can help break down these barriers The importance of supportive community in the context of ayahuasca therapy for veterans with MST Mind-body practices that can support veterans working through MST before and after an ayahuasca ceremony How trauma changes the brain and the neurological effects of psychedelics that can help reverse these changes Why tackling issues of sexual assault within the military can be so difficult    Quotes: “I think that Ayahuasca is unparalleled in its ability to create a safe and effective path towards recovery, but I deeply believe it also needs bookends on either side, or a structure to get the most out of it.” [8:19] “Sometimes we just don’t want to talk. We just want to feel and when we feel and we identify where in the body the trauma is stuck—because the trauma gets stuck in the body—then we know how to release it with movement.” [27:16] “Our response to trauma has seemed to be very one-dimensional. This is an effort to shift that, to start looking at people as whole units and at the same time, start speaking to the needs of that whole unit. If you are able to heal the trigger point of that trauma, you don’t have to heal its expression.” [31:18]   Links: Veterans of War website Veterans of War on Instagram Veterans of War on Twitter Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Sam Gandy returns to discuss the topic of psychedelic-induced mystical experiences, looking specifically at how to predict and potentiate these experiences. Dr. Gandy holds a PhD in ecological science from the University of Aberdeen and has conducted field research across the globe. He is a researcher and science writer who is also a collaborator with the Centre for Psychedelic Research at Imperial College London, with a research interest in the capacity of psychedelic substances to influence individuals’ connection with nature. Dr. Gandy begins this conversation by defining the topic of mystical experiences. He explains that while there are a number of competing terms for how to best address this subject, what is important is that the research has consistently shown that these types of experiences are closely correlated with beneficial therapeutic outcomes. Whether brought on by psychedelics or not, mystical experiences tend to produce positive psychological changes, so it is important for psychedelic researchers to take this topic seriously and thoroughly investigate these experiences and where they come from. However, Dr. Gandy notes that there are a number of hurdles to addressing this topic scientifically. Because of the mystical or spiritual quality of these peak experiences, it can be difficult for researchers to develop sufficiently neutral language in surveys while maintaining accurate descriptions of the qualities of the altered states. Similarly, Dr. Gandy explains that therapists have to walk a fine line between not introducing spiritual or religious bias into the session through decoration or suggestion which may prioritize a certain religious tradition, while also preserving a certain type of spiritual atmosphere which is conducive to mystical experiences and thus beneficial therapeutic outcomes.  Dr. Gandy then goes on to explain variables which can be predictive of psychedelic mystical experiences. Set and setting are of course crucial, but there are a number of additional parameters to consider. Dr. Gandy explains that dose, of course, is particularly important, stating that a standard has emerged in the research around psilocybin which has found that 25 milligrams of pure synthetic psilocybin is a sweet spot for encouraging mystical experiences without leading to additional adverse reactions due to the intensity of the experience. Additionally, different psychedelic substances produce mystical experiences at different rates, with 5-MeO-DMT being the most likely to lead to these experiences. Besides dose and substance, Dr. Gandy has also found that intention as well as the personality trait known as absorption are both predictive of mystical experiences in psychedelic therapy. To conclude this conversation, Dr. Gandy shares three possible potentiators of psychedelic mystical experiences: music, meditation and spiritual practice, and nature-based settings. Each of these items, if integrated into the experience intentionally can encourage a more immersive and intense mystical experience. For all of these, Dr. Gandy encourages further research for how they could best be integrated into psychedelic therapy practices.    In this episode: The psycho-social changes which often follow mystical experiences The connection between mystical experiences and “spiritual emergencies”The difficulty of working with a spiritual element in the context of psychedelic therapy and research How the typical Western protocols for psychedelic therapy encourage an inward experience Why people who rank highly in the personality trait absorption are more likely to have mystical experiences, both spontaneously and while under the influence of psychedelics Ways to train psychological states of surrender and acceptance prior to high-dose psychedelic therapy which can encourage mystical experiences and prevent adverse reactions   Quotes: “What makes psychedelics quite interesting is that they—under the right, appropriate conditions and contexts—they can reliably elicit these [mystical] experiences.” [4:39] “The psychedelic 5-methoxy-DMT is definitely an interesting substance to highlight here. … The data that is there shows that when it’s used in a supportive context, it can predict mystical experiences—three quarters of cases, over that in two separate studies that have been done so far.” [31:22] “Entering the experience with an emotional intent or a spiritual motivation seems to predict greater likelihood of mystical experiences” [34:36] “There’s this aspect that negatively predicts mystical experience called mental barriers. And this is where you enter the experience with in some sense an overly rational, analytical way of viewing things, and if you enter the experience like that that’s a potential block on mystical experiences happening.” [44:21] “People with meditation experience or with an ongoing practice, they seem more liable to report states of oceanic boundlessness tied to the mystical experience.” [49:16]“Nature-based settings seem to be quite conducive to mystical and spiritual states, just inherently.” [57:00]   Links: Dr. Gandy on Twitter Dr. Gandy’s article: predictors and potentiators of psychedelic-occasioned mystical experiences Dr. Gandy’s Research Gate profileCentre for Psychedelic Research at Imperial College London  Previous episode: Psychedelics and Nature: The Symbiotic Relationship with Dr. Sam Gandy Previous episode: Avoiding the Pitfalls of Psychedelic Medicine with Matthew Johnson, PhD Psychedelic Medicine Association Porangui