Psychedelic Medicine Podcast with Dr. Lynn Marie Morski

In this episode of the Psychedelic Medicine Podcast, Dr. Kurt Rasmussen joins to discuss the potential benefits of non-hallucinogenic psychedelic drugs currently in development. Dr. Rasmussen is the Chief Scientific Officer at Delix Therapeutics and was previously at the National Institutes of Health where he led the Division of Therapeutics & Medical Consequences since 2018. Here, he directed the medications development program and played an integral role in evaluating the safety and efficacy of pharmacotherapies, behavioral therapies, and devices to treat substance use disorders. He is also Fellow in the American College of Neuropsychopharmacology and has over 100 publications and patents to his name. Dr. Rasmussen begins by discussing the ways psychedelics can bring out physical changes to brain structure, mentioning that this is an important mechanism for the therapeutic effect of these medicines. He mentions that these structural changes are theorized to be relatively distinct from the experiential, hallucinogenic component of psychedelics, and as such it may be possible to develop new drugs which condition the same cascade of events in neuronal structure without leading to intense subjective experiences and major alterations in perception. But what would the benefits of such drugs be? Dr. Rasmussen explains that the availability of non-hallucinogenic psychedelics could have the potential to significantly increase the accessibility of these substances and their associated therapies—both in populations for whom contraindications exist for traditional psychedelic medicines (such as patients with schizophrenia) and for individuals who may be resistant or fearful of the hallucinogenic experiences that can come with psychedelics. Rather than attempting to replace traditional, hallucinogenic psychedelics, Dr. Rasmussen hopes that these non-hallucinogenic alternatives would be able to serve populations or conditions where current psychedelics are not the best option. In fact, Dr. Rasmussen suggests that perhaps hallucinogenic and non-hallucinogenic psychedelics could be used powerfully in conjunction with one another, hypothesizing that the personally meaningful journeys conditioned by traditional psychedelics may be more effective for kickstarting healing from a condition like depression, but perhaps the non-hallucinogenic substances could be more convenient maintenance, as they would not require regular intense experiences facilitated by specially trained therapists to continue promoting neuroplasticity. Dr. Rasmussen does emphasize, however, that a psychotherapeutic component would still be recommended even with non-hallucinogenic psychedelics, as the combination of medication and therapy leads to greater efficacy. But, this also depends on the particular condition being treated. A patient with a mental health condition will likely benefit from the addition of therapeutic work, but a patient who is exploring psychedelic treatment for something like migraines or cluster headaches may only need the structural changes caused by these substances in the brain in order to feel better—another reason why non-hallucinogenic psychedelics may be preference for certain patients with various conditions.  In closing, Dr. Rasmussen reiterates that the exploration of non-hallucinogenic psychedelics is all about increasing patient options and broadening the cools in the psychiatric toolbox to tailor treatments to particular patients and conditions. Whether hallucinogenic on non-hallucinogenic, Dr. Rasmussen sees psychedelic medicine as an important and promising paradigm shift in psychiatry.    In this episode: How both hallucinogenic and non-hallucinogenic psychedelics may be used together to reach a greater patient population Why the hallucinogenic component of psychedelics may not be necessary for their efficacy Contraindications involving the hallucinogenic component of psychedelics Potential cardiovascular concerns with regular psychedelic use due to action on serotonin receptor 5-HT2B  Why it may be desirable to have a range of psychedelic medications which produce different intensities of subjective effects to treat a wider range of patients   Quotes: “There are changes in your brain as a result of administration of these compounds that occur. It’s not just a sensory and emotional experience, but actually there are physical changes in your brain, in different circuits, very specific circuits.” [5:28] “SSRIs and other antidepressants can have effects by themselves, psychotherapy can have an effect by itself, but the real efficacy, the magic is when you combine the two and I have no doubt that these compounds [non-hallucinogenic psychedelics] will benefit from psychotherapy associated with it.” [11:07] “We need more options for patients for sure, and hopefully the psychedelic medications with the hallucinations will help a certain set of patients and hopefully we’ll have other non-psychedelic compounds that are neuroplastic that will help patients.”  [18:25] “I think different compounds will be affecting different circuitry or different microcircuits… in the brain so that different compounds will have varying levels of efficacy for different indications, and like I said the indications can be from neurology to psychiatry.”  [25:58]   Links: Dr. Rasmussen with his puppy Ruby Dr. Rasmussen on LinkedIn Delix Therapeutics website  Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Max Wolff joins to discuss his 2020 study exploring how psychedelics can facilitate the healing process of “letting go.” Dr. Wolff is a psychologist, psychotherapist and head of psychotherapy training and research at the MIND Foundation. He is also therapist and researcher in the EPIsoDE Study, a government funded clinical trial investigating psilocybin-augmented psychotherapy for treatment resistant depression at CIMH Mannheim and Charité Universitätsmedizin Berlin.  In this conversation, Dr. Wolff shares insights from his study, “Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance,” which appeared in Frontiers in Psychiatry in February 2020. In this paper Dr. Wolff and colleagues explore how psychedelic assisted therapies can help patients work through maladaptive avoidant behaviors at the root of many mental health conditions. Dr. Wolff explains that there are two fundamental motivations systems at work in human beings—the approach system and the avoidance system. In healthy individuals, both of these have important and adaptive roles to play as people work towards goals and seek balance in life. However, adverse experiences in unsafe environments can cause individuals to develop unhealthy avoidance, often leading to mood disorders such as anxiety and depression in more severe cases.  One of the goals of psychotherapy—psychedelic or otherwise—is to facilitate a safe container where an individual can work through avoidance, says Dr. Wolff. Psychedelic assisted therapy may be especially effective to this end, as the introspective nature of the experience precludes avoidant thought patterns or behaviors and there is nothing to use as a distraction in the therapeutic context. However, this isn’t the only way psychedelics facilitate the process of letting go.  Dr. Wolff also discusses the effect of psychedelics on relaxing the beliefs of the patient. This recent theory, called “relaxed beliefs under psychedelics” (REBUS), considers how psychedelics encourage an open mindedness and curiosity around perceptions and ideas that would often be dismissed or ignored in sober states due to rigid structures of beliefs and assumptions. This is important in the context of avoidance, Dr. Wolff explains, as it means that the patient is primed to explore issues where typically an avoidant response would be triggered due to a fixed belief about the stressfulness of the topic at hand.  As a result, psychedelic assisted psychotherapy can be particularly effective in empowering patients to revise avoidance-related beliefs at the root of many mental health conditions. By helping patients work through fear and let go of traumas and stress around tender topics, Dr. Wolff thinks psychedelic therapy can make an important contribution to the broader field of psychotherapy.    In this episode: The approach and avoidance systems of human motivation How avoidant behaviors can develop into mental illnesses  How working through avoidance is crucial for both conventional and psychedelic therapies The experience of avoidance in psychedelic therapy and how this can be conducive to acceptance  How the idea of relaxed beliefs under psychedelics intersects with avoidance Different mechanisms for MDMA and classic psychedelics for facilitating letting go   Quotes: “The less favorable the environment is, or the conditions in which we develop are, the more likely we are to have interactions with our environment that are threatening to our psychological needs, or even perhaps violating to our psychological needs—that is where a lot of avoidance behaviors or avoidance schemas can develop.” [5:43] “Only by withstanding the urge to run away, and only by breaking this vicious circle of avoidance, you get the chance of revising the assumptions that underlie the anxiety.” [27:42] “In psychedelic experiences, one factor that may work in concert with this operant conditioning process of learning to let go is the emotional depth and richness that comes with psychedelic experiences and also the increased likelihood of actually encountering deeply felt fears.” [30:00]   Links: Dr. Wolff’s study: “Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance” MIND Foundation website MIND Foundation training for aspiring psychedelic therapists Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Aaron Cherniak joins to discuss the intersection between psychedelic experiences and psychological attachment styles. Aaron is a clinical psychologist and researcher who examines a variety of topics in psychedelic science, including subjective experiences, outcomes, and mechanisms. He is also a Rabbi and the director of the JPSYCH lab of Jewish spirituality and mental health. His recent research looks at how psychedelic experiences are integrated into peoples’ narratives of life-long religious and spiritual development and contribute to culturally competent therapeutic models. In this conversation, Aaron shares the science of attachment styles and explores its implications in psychedelic therapeutic contexts. He frames attachment theory as a form of personality psychology, mentioning that someone’s attachment style is typically something that stays consistent for long periods of time, though certain traumatic events such as abusive relationships can influence one to develop insecure attachment.  The two forms of insecure attachment are avoidant attachment and anxious attachment, which are two different behavioral expressions resulting from an underlying sense of insecurity or lack of safety within a relationship. This is contrasted with a secure attachment style in which a person feels safe in a relationship and does not feel a compulsion to engage in either avoidant or anxious behaviors out of a sense of self-preservation.  Aaron explains that there are many potential points of relevance for exploring psychedelic experiences and attachment styles together. For example, it may be the case that therapeutic psychedelic experiences could actually shift a person away from insecure attachment—a finding which would be very significant considering how stable attachment styles typically are. Another idea would be to consider the existing attachment style of a patient entering into psychedelic-assisted psychotherapy, and explore how this could affect the patient-therapist relationship and the efficacy of the therapy.  In the context of spirituality and religiosity, Aaron explains that a person’s attachment style often influences how they hold spiritual beliefs. In an Abrahamic religious context, a person with a secure attachment style stemming from a healthy home life is more likely to interpret God through lenses that emphasize divine love and God’s all-embracing concern, whereas someone with an insecure attachment that developed out of an early childhood experience that was colored by neglect or even abuse is more likely to see God primarily as responsible for bad experiences and potentially even capricious. In the context of spirituality outside of traditional religion, this could be the difference between a person viewing the universe as having a purpose and meaning within it, or seeing the cosmos as only cold and uncaring towards the wellbeing of the creatures within it.  Aaron suggests this is relevant for psychedelic research as patients often report transcendent experiences of divine realities during psychedelic experiences, but how such experiences can be integrated may vary significantly based on a person’s interpretation of religion and spirituality stemming from their attachment style. Though this work is still in the theoretical stage, Aaron is excited about the potential findings from research into psychedelic experiences and attachment styles.    In this episode: What are the different attachment styles? Could attachment style influence the connection between a patient and a psychedelic therapist? How attachment styles impact peoples’ interpretations of mystical experiences Psychedelic research as an opportunity to study the psychology of spiritual experiences    Quotes: “Attachment theory has provided a very fruitful model of life-long personality development generally, and specifically religion and spirituality.” [5:41] “If a psychedelic session can change something that is normally stable over 35 years, that would be a very impressive finding.” [14:12] “People talk about the psychedelic substance in attachment terms—people talk about the grandmother or the plant healer… An attachment figure is a stronger, wiser other to whom we seek proximity for closeness, to help us overcome challenges.” [19:47] “I think we have a responsibility to develop therapeutic frameworks to help people translate those experiences of safety, of love and all those things into long lasting therapeutic change.” [34:55]   Links: Aaron’s article: Psychedelic Science of Spirituality and Religion: An Attachment-Informed Agenda Proposal Aaron on Twitter JPSYCH Attached: The New Science of Adult Attachment and How It Can Help You Find—and Keep—Love  Psychedelic Medicine Association Porangui

In this episode of the Plant Medicine Podcast, Adam Aronovich returns to discuss the phenomenon of psychedelic narcissism. Adam is a doctoral candidate at the Universitat Rovira i Virgili in Spain, focusing on Medical Anthropology and Cultural Psychiatry. He is an active member of the Medical Anthropology Research Center (MARC) and part of the Ayahuasca Community Committee at the Chacruna Institute for Psychedelic Plant Medicines. In the last four years he has conducted extensive fieldwork in the Peruvian Amazon, where he has been doing qualitative research in collaboration with ICEERS, the Beckley Foundation, and, more recently, the Centre for Psychedelic Studies at Imperial College. Beyond his work conducting and coordinating research, Adam regularly facilitates workshops at the Temple of the Way of Light, a prestigious healing center in the Iquitos area. In this wide-ranging conversation, Adam unpacks some of the darker sides of the modern psychedelic movement, discussing the psychosocial dynamics around psychedelic use which can lead to things such as ego inflation, conspiratorial thinking, and narcissism. Adam recalls his own experiences slipping into messianic fantasies during a period of initial enthusiasm around psychedelic experiences. He views issues of alienation and lack of social support as being instrumental in leading to these types of delusions following profound spiritual experiences. While it is difficult to reach people who’ve slipped into psychedelic narcissism, Adam suggests that communal support is the best safeguard against these dangers and the most effective strategy for grounding people who’ve lost touch with reality. Drawing on his academic expertise, Adam distinguishes traditional uses of plant medicines from the Western paradigm for approaching psychedelics. He stresses the relational and communal aspects of the spiritual traditions which use psychedelics ceremonially. The pro-social aspects of these wisdom traditions, he claims, help safeguard against the traps of psychedelic narcissism and ego inflation, as there are established mechanisms for keeping people grounded following intense spiritual experiences.  Adam closes the discussion with an insightful analysis of modern gurus and self-proclaimed shamans. Adam encourages people to beware of deeply held spiritual fantasies, where a master can appear as more than human. Instead, he emphasizes that even skillful and well-intentioned healers are themselves nothing more than human beings, so there will always be imperfection and messiness. This does not, however, mean that impactful work cannot happen—in fact, this insight helps protect against the idolization of charismatic psychedelic personalities, which can lead to harmful experiences.   In this episode: Defining psychedelic narcissism Clinical vs colloquial understandings of narcissism The intersections of the psychedelic movement and conspiracy theories The importance of social and communal support for avoiding ego inflation following psychedelic or spiritual experiences How psychedelic experiences can actually deepen ego attachments and accentuate narcissistic tendencies The importance of humor in combating spiritual narcissism   Quotes: “Many of the underlying ideologies upon which Western cultures were built, like hyper-individualism and so on, kind of predispose us and prime us for certain aspects of narcissism.” [5:36] “Ego inflation, spiritual narcissism, messianic episodes—all of these are things that are fairly common within both people who are in some sort of spiritual or psychedelic path.” [12:17] “In traditional societies for the most part really there isn’t such a thing as a self-proclaimed shaman. A person doesn’t wake up one morning and is like ‘oh, I’m the shaman’—that’s a title or a role or a recognition given to that person by the community.” [38:03] “The best measure of whether somebody is genuine and helpful is not whatever credentials or titles he assigns to himself, but rather what other people feel. So, you know, you will know a tree by its fruits.” [45:08] “Having these experiences by themselves does not necessarily mean spiritual growth or psychological development or any enhanced benefit if we’re not constantly, painfully, mindful of how we actually integrate and embody those things in daily life over very long periods of time.” [54:29]   Links: Adam on Instagram Temple of the Way of Light Psychedelic Medicine Association Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Ben Medrano joins to discuss the intricacies of meaning making in psychedelic healing. Dr. Medrano is the former senior vice president and US medical director of Field Trip Health and has extensive experience in the evolving field of integrated approaches. He is also the current co-medical director of Nue Life Health where he is continuing his efforts in expanding access to ketamine therapies. Dr. Medrano additionally still serves as medical director of Field Trip NYC and DC clinics while continuing his private practice. Dr. Medrano begins this conversation sharing a bit about his background and how he came to be interested in psychedelic medicine and the issues surrounding meaning making. He talks about his experience growing up in a family where mental illness was prevalent and how this planted the seeds for taking an empathetic approach to treating these conditions in his career as a psychiatrist. He also discusses his initial exposure to psychedelics in the Chicago rave scene of the 1990s. It was then that he first realized both the transformative potential of psychedelic-induced altered states and the potential dangers of using these substances without proper precautions or care for set and setting.  Following these formative experiences, Dr. Medrano began a practice of meditation within the Tibetan Buddhist tradition. It was through exposure to these spiritual practices and deep teachings that he began to see the importance of this process of meaning making and cultivate various resources suited to this project. Dr. Medrano stresses the importance of self-awareness in realizing one’s own approach to meaning making and how this has been shaped by unique personal experiences. This self-awareness helps one realize that a given patient may be approaching their own experiences from a very different angle, but there are still ways in which it is possible to support and encourage this personal meaning making. Dr. Medrano stresses the importance of working with narratives in psychedelic healing. Psychedelic-induced peak experiences can be packed with insights and symbols which may be brimming with significance, but there’s a lot of work to be done in understanding this material in light of the personal narratives of a patient’s life. Through therapeutic integration, a patient can use their psychedelic experiences to critically examine their narratives and reflect more personally on the potential meanings of given revelations in light of how they understand themselves.  Additionally, Dr. Medrano distinguishes the roles a facilitator should play to support meaning making in high dose versus low dose contexts. When a patient is in the midst of a high dose psychedelic experience, Dr. Medrano emphasizes that the facilitator should primarily seek to affirm the experiences of the patient, being a calming and secure presence that doesn’t introduce any additional complexity or uncertainty into an already intense experience. On the other hand, in lower dose, “psycholytic” experiences, the facilitator may take a more active role, helping facilitate the patient’s meaning making in the midst of the experience through asking questions and engaging with ideas as they arise.  In terms of preparation and intentionally building psychedelic experiences more conducive to meaning making, Dr. Medrano emphasizes the importance of ceremony. Through a more ceremonial approach, a psychedelic experience can be given additional structure which may be reassuring for the patient, and additionally this provides an opportunity to more proactively incorporate things which may already be extremely meaningful for a given person. These can be practices such as prayers, or physical objects which have a certain deep personal significance. All of these help to encourage more meaningful content in the psychedelic experience, while also providing something grounding and familiar in the midst of altered consciousness. Because of how effective Dr. Medrano has found various psychedelic therapies to be in helping people make meaning in life, he is primarily focusing his energies on expanding access to these powerful medicines at this stage in his career.    In this episode: Dr. Medrano’s background and how he got involved in psychedelic medicine and spiritual practices How does Dr. Medrano help clients make meaning out of drug-induced altered states Why Dr. Medrano refers to ketamine as “the great imitator” The importance of understanding a patient’s cultural and meaning making background How to work more intentionally with set and setting and incorporate ceremonial practices Shifting away from a “goal-oriented” perspective of psychedelic experiences   Quotes: “I think telling our stories is part of this process of healing.” [5:20] “Just getting your mind blown by a psychedelic substance is not going to fix things. That’s something I had to learn really quick.” [11:00] “I think for us to do this work, we all need to actually have a good sense of who we are and how we’re approaching the conversation.” [19:01] “Trying to really invite in a sense of inspiration, energy, and support is really what the goal—or part of the goal—of ceremony is.”  [28:20] “Really your role as a guide is honoring and affirming the experience. It’s as simple as that. And being supportive. So, having a dialogue is not necessarily encouraged in higher doses.” [31:22] “Basically the process of integration is to not let anything that comes into the experience not be honored or seen in some way, to allow it to be explored, and of course not to push too much.” [38:27]   Links: Dr. Medrano’s website Nue Life Nue Network Field Trip Health New article: Safety, effectiveness and tolerability of sublingual ketamine in depression and anxiety: A retrospective study of off-label, at-home use Previous episode: Psychedelic Apprenticeship: Validating Psychedelic Insights and Revelations with Chris Timmermann, PhD The Body Keeps the Score by Bessel van der Kolk Psychedelic Medicine Association Porangui

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