Plant Medicine Podcast

In this episode of the Psychedelic Medicine Podcast, Dr. Michelle Weiner joins to discuss the research on ketamine assisted psychotherapy for chronic pain conditions. Dr. Weiner is Double board-certified in Interventional Pain Medicine, Physical Medicine and Rehabilitation and the Director of Integrative Pain Management at Spine and Wellness Centers of America. She uses a unique personalized approach to treat the root cause of one's pain using a biopsychosocial model including lifestyle and plant medicine to empower her patients to cultivate health, optimize quality of life and decrease pharmaceuticals.

In this conversation, Dr. Weiner discusses her recent research into ketamine therapy for chronic pain and comorbid depression, which compared psychedelic and psycholytic doses of the dissociative. She emphasizes the importance of a biopsychosocial approach to pain treatment and sees the psychotherapy aspect of the ketamine treatments as crucial to their efficacy, as this approach allows doctors to have a better understanding of the complex etiology of the patients pain beyond just what shows up on imaging and empowers patients to actively take ownership of their pain management. While the results from Dr. Weiner’s study were very encouraging, she mentions that ketamine therapies typically require maintenance and that more longitudinal research is needed to further understand how durable these changes are. 

In this episode:

• The issue of central sensitization in chronic pain

• The difference between psychedelic and psycholytic doses 

• What led Dr. Weiner to study chronic pain and comorbid depression

• Neuropathic, nociceptive, and nociplastic forms of pain

• The influence of trauma and stress on chronic pain

• The intersection of pain and identity

• Dr. Weiner’s biopsychosocial approach to pain treatment

• The differences between cannabis and ketamine as pain treatment medications

Quotes:

“A lot of [patients’] pain is really similar to fear—fear in the brain—and… if we’re not able to understand where this fear is coming from we’re not able to extinguish their pain. So I really changed the way I practice and use ketamine because I started to think more about how the psychiatrists are using it, in terms of preparation and integration.” [6:59]

“What I’ve seen is that ketamine does require maintenance in the sense that even if we do six sessions, a lot of patients do need to come back after a few weeks or a few months for maintenance treatment with ketamine as well as therapy.” [20:09]

“Pain doctors [should try to] be a little bit more aware of the set, setting, and preparation and integration so that we don’t need to use benzos and [patients] can actually have this dissociative experience to allow them to have hope or get out of that fight or flight.” [33:04]

Links:

Dr. Weiner's study: Ketamine-assisted psychotherapy treatment of chronic pain and comorbid depression: a pilot study of two approaches

Dr. Weiner’s website

Dr. Weiner on Instagram

PMA webinar with Dr. Weiner: Treating Pain and Functional Neurologic Disorders with Psychedelics

Spine and Wellness Centers of America 

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Michelle Wiener joins to discuss the research on ketamine assisted psychotherapy for chronic pain conditions. Dr. Weiner is Double board-certified in Interventional Pain Medicine, Physical Medicine and Rehabilitation and the Director of Integrative Pain Management at Spine and Wellness Centers of America. She uses a unique personalized approach to treat the root cause of one's pain using a biopsychosocial model including lifestyle and plant medicine to empower her patients to cultivate health, optimize quality of life and decrease pharmaceuticals.

In this conversation, Dr. Wiener discusses her recent research into ketamine therapy for chronic pain and comorbid depression, which compared psychedelic and psycholytic doses of the dissociative. She emphasizes the importance of a biopsychosocial approach to pain treatment and sees the psychotherapy aspect of the ketamine treatments as crucial to their efficacy, as this approach allows doctors to have a better understanding of the complex etiology of the patients pain beyond just what shows up on imaging and empowers patients to actively take ownership of their pain management. While the results from Dr. Wiener’s study were very encouraging, she mentions that ketamine therapies typically require maintenance and that more longitudinal research is needed to further understand how durable these changes are. 

In this episode:

• The issue of central sensitization in chronic pain

• The difference between psychedelic and psycholytic doses 

• What led Dr. Wiener to study chronic pain and comorbid depression

• Neuropathic, nociceptive, and nociplastic forms of pain

• The influence of trauma and stress on chronic pain

• The intersection of pain and identity

• Dr. Wiener’s biopsychosocial approach to pain treatment

• The differences between cannabis and ketamine as pain treatment medications

Quotes:

“A lot of [patients’] pain is really similar to fear—fear in the brain—and… if we’re not able to understand where this fear is coming from we’re not able to extinguish their pain. So I really changed the way I practice and use ketamine because I started to think more about how the psychiatrists are using it, in terms of preparation and integration.” [6:59]

“What I’ve seen is that ketamine does require maintenance in the sense that even if we do six sessions, a lot of patients do need to come back after a few weeks or a few months for maintenance treatment with ketamine as well as therapy.” [20:09]

“Pain doctors [should try to] be a little bit more aware of the set, setting, and preparation and integration so that we don’t need to use benzos and [patients] can actually have this dissociative experience to allow them to have hope or get out of that fight or flight.” [33:04]

Links:

Dr. Wiener's study: Ketamine-assisted psychotherapy treatment of chronic pain and comorbid depression: a pilot study of two approaches

Dr. Wiener’s website

Dr. Wiener on Instagram

PMA webinar with Dr. Wiener: Treating Pain and Functional Neurologic Disorders with Psychedelics

Spine and Wellness Centers of America 

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Jules Evans joins to discuss his work with the Challenging Psychedelic Experiences Project. Jules is a research fellow at the Centre for the History of Emotions at Queen Mary University of London and author of four books including The Art of Losing Control and Breaking Open: Finding a Way Through Spiritual Emergency. He is also the Director of the Challenging Psychedelic Experiences Project and the editor of the substack Ecstatic Integration.

In this conversation, Jules shares how he first became interested in psychedelics and the kinds of ecstatic experiences they can produce, as well as what prompted him to turn his attention to the challenging experiences that can result from consuming these substances. He discusses the initial research from the Challenging Psychedelic Experiences Project, sharing the typical ways challenging experiences manifest, as well as the coping strategies people employ to work through these experiences. In closing, Jules reiterates the newness of the psychedelic field, encouraging more research into difficult forms of ecstatic experience and ways to effectively navigate the challenges these pose. 

In this episode:

• What got Jules interested in the topic of difficult psychedelic experiences

• Common impacts of challenging psychedelic experiences

• Depersonalization vs derealization

• What helped people integrate challenging psychedelic experiences

• How people used “cognitive self care” to process challenging experiences

• The history and meaning of the term “spiritual emergency”

• Psychedelic “flashbacks” and hallucinogen persisting perception disorder (HPPD)

Quotes:

“30% of our respondents reported anxiety, panic attacks, social anxiety—and then all these sub-themes related to fear like fear of losing your mind, fear of dying, fear of the experience repeating, fear of being alone.” [17:04]

“Feeling you don’t have anyone to talk to about [a psychedelic experience] will make extended difficulties more likely. Not knowing the dosage that you take seems like it makes extended difficulties more likely.” [24:44]

“The overwhelming majority [of people who had challenging psychedelic experiences], like more than 85%… still believe in the therapeutic potential of psychedelics.” [32:41]

“Our culture has a lot of ecstatic illiteracy. We’ve lost the maps and guides and safe places to having ecstatic experiences, so we’re ecstatically naive. And we need to develop ecstatic literacy to learn to get better at having these kinds of experiences.” [51:11]

Links:

Challenging Psychedelic Experiences Project website

The first study from the Challenging Psychedelic Experiences Project: Psychedelic integration challenges: Participant experiences after a psilocybin truffle retreat in the Netherlands

Ecstatic Integration Substack

Jules’ book: Breaking Open: Finding a Way Through Spiritual Emergency

Jules on LinkedIn

Jules on Twitter

Jules on Instagram

Centre for the History of Emotions at Queen Mary University of London 

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Reid Robison joins to discuss managing medical risk in patients seeking psilocybin therapy. Dr. Robison is a board-certified psychiatrist and Chief Clinical Officer at Numinus, overseeing the company's psychedelic and mental health services across the US and Canada. He has led over 200 clinical trials in neuropsychiatry, including the MAPS-sponsored MDMA-assisted therapy for eating disorders study, and several other psychedelic studies with psilocybin, LSD and DMT.

In this conversation, Dr. Robison begins by sharing how researchers have been determining guidelines for managing medical risks associated with psilocybin and how this guidance may shift as research continues in real-world settings at larger scales. He also discusses the intricacies of psilocybin’s pharmacokinetics and how the substance interacts with common psychiatric medications such as SSRI antidepressants. In closing, Dr. Robison emphasizes the importance of keeping a close eye on potential psychological risks of psilocybin and other psychedelics, especially amid the excitement stemming from the incredible potential of these medicines.

In this episode:

• The emerging medical indications for psilocybin therapy

• How the research into psilocybin has developed in the past few years

• The pharmacokinetics of psilocybin

• Medication interactions with psilocybin

• Risks of serotonin syndrome

• Absolute vs relative contraindications

• Psilocybin’s effect on QT interval and heart valves

• The Psychedelic Medicine Association’s “Psilcobyin-Informed Clinicians” database comprised of practitioners who have completed the course

Quotes:

“There’s a lot to learn [about the interaction of psilocybin and SSRIs] and it's a little bit unpredictable. And some people anecdotally would say that their SSRI interfered with their trip or diminished the experience and others would say it did not.” [26:22]

“Psychological risks are nontrivial, including the risk of a difficult experience—something that may even need some mental health treatment afterwards, something that may be meaningful, nontrivial for the individual for a while, and can coexist with the mystical experience. And having the most meaningful experience of your life can coincide with the most difficult.” [40:43]

Links:

Course: Managing Medical Risk in Patients Seeking Psilocybin Therapy

Dr. Robison’s website

Dr. Robison on Twitter

Dr. Robison on Instagram

Numinus website

Previous episode: Psychedelics for Eating Disorders with Reid Robison

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Kevin Franciotti, MA joins to discuss the intricacies of psychedelic-assisted therapies for substance use disorder. Kevin Franciotti is a Denver-based writer, therapist, advisor, and thought leader in the fields of psychology, psychedelics, and substance abuse counseling.

In this conversation, Kevin shares his expertise on the existing research on psychedelic medicines for substance use disorder (SUD) and also discusses the limitations of the results of this research. He talks about the difficulties of designing trials and protocols for psychedelic therapies that target SUD, touching on how this disorder can interact with the neuro-physical and psychological effects of psychedelic medicines. He also contrasts emerging psychedelic treatments for SUD with dominant abstinence-based models and shares where he thinks psychedelic therapies may be a healthier alternative. In closing, Kevin reiterates that it is crucial to continue integrating harm reduction perspectives as psychedelic therapy continues to gain more mainstream traction.

In this episode:

• Contraindications which can arise during detox periods which may require a person to be fully detoxed prior to pursuing any psychedelic-assisted therapy for SUD

• The neuro-physical effects and the psychological effects of psychedelic substances

• The role of peer support in psychedelic-assisted therapy for SUD

• The stigma around psychedelic therapies within traditional recovery programs and communities

• How psychedelic therapy protocols interface with current guidelines from the American Society of Addiction Medicine

• The future of insurance coverage for psychedelic therapies

• Issues of “psychedelic exceptionalism”

Quotes:

“Ibogaine has somewhat of a miraculous quality of being able to attenuate some of the most painful, acute symptoms of opiate withdrawal—but that is only specific to opiate withdrawal.” [11:33]

“What’s miraculous about a medicine like ibogaine or even psilocybin… is it's designed to enhance somebody’s ability to confront their underlying issues.” [16:57] 

“The future of addiction treatment embracing psychedelics is really going to hinge on the treatment industry being willing to construct innovative ideas.” [30:37]

“Drugs are drugs. Drugs don’t have an inherent moral quality around them. [What’s important to highlight] is the risk of stratifying people who use drugs as somehow being superior or inferior based on which category of socially accepted drugs that they’re doing.” [42:39]

Links:

Kevin’s website

Kevin on Twitter

Kevin on Instagram

Kevin on LinkedIn

Psychedelics in Recovery

Journey Colab

All Points North (APN)

“Dispelling Lies the Psychedelic Community Believes About Drugs” presentation by Carl Hart, PhD at Horizons 2019

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Wilhelmina De Castro, LCSW joins to discuss the ways psychedelics may be used to support goals of queer liberation. Wilhelmina is a psychedelic therapist in the San Diego area and serves as a DEI officer for Integrative Psychiatry Institute. She is also lead faculty for the Psychedelic Research and Training Institute and is committed to creating access to psychedelic healing for historically marginalized populations.  

In this conversation, Wilhelmina discusses the major topics at the intersection of psychedelic healing and queer identities. She shares her own journey of how psychedelics helped with self-discovery and acceptance of her queer identity, discussing the ways these substances can help gender and sexual minorities step outside of forms of normativity that are enforced in the culture. She also discusses creating safe spaces for queer folks where they can access psychedelic healing with facilitators and other participants of a similar background. In closing, Wilhelmina reiterates the continuing issues of access and trust queer people face in the current psychedelic landscape, emphasizing the significant work which must be done to improve this situation. 

In this episode:

• How psychedelics can help with self discovery and self exploration

• What inspired Wilhelmina to begin working professionally with psychedelics

• Creating spaces for psychedelic healing tailored to queer-identified people

• Dealing with microaggressions in the context of a psychedelic retreat

• Working with a therapist or facilitator who shares a queer identity

• The queerness of psychedelics

Quotes:

“When I began to explore with psychedelics, there were moments of this connection beyond… the way I was socialized or conditioned to think was normal. I was able to just be myself [and] found that this attraction and this embodiment that I was feeling was actually where I was supposed to be.” [4:41]

“Psychedelics can be really helpful in challenging, in questioning, in dissolving those oppressive narratives that keep people oppressed, that keep them from accessing their liberation. And so if we can do this consciously, and if we can do this in a safe space where harm is not perpetuated, then we actually have this beautiful opportunity for collective liberation” [14:25]

Links:

Wilhelmina's practice, Integrate 

Integrate on Instagram

Integrative Psychiatry Institute

Psychedelic Research and Training Institute

Queering Psychedelics: From Oppression to Liberation in Psychedelic Medicine

SoundMind Institute Psychedelics and Identity Initiative

Queer Psychedelic Society

Psychedelic Liberation Collective

Previous episode: Psychedelics and the LGBTQIA2S+ Community with Dr. Angela Carter

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Jöel Brierre joins to discuss the important topic of safety when working with 5-MeO-DMT. Jöel is the founder and CEO Tandava Retreats and co-founder of the 5-MeO-DMT education and training platform F.I.V.E. Jöel and his team are focused on shepherding 5-MeO into the world in a safe and effective manner. 

In this conversation, Jöel shares his expertise on the screening that should be done prior to 5-MeO-DMT experiences, discussing both physical and psychological considerations. He also talks about synthetic 5-MeO-DMT vs the extract from the Bufo alvarius toad and explains why his retreat center only uses the synthetic version. In closing, he discusses the nuances around drug-drug interactions and how he navigates these with participants, exploring the nuances of the pharmacology involved.  

In this episode:

• What inspired Jöel to start F.I.V.E.

• The physical medical considerations when screening patients for 5-MeO-DMT

• Why it is theorized that 5-MeO-DMT could trigger conditions like multiple sclerosis to recur 

• Psychological red flags for people seeking 5-MeO-DMT experiences

• Jöel’s thoughts on navigating psychedelic narcissism

• Safety considerations working with patients with significant trauma

• Determining the dosage of 5-MeO-DMT and why Jöel thinks there’s a lot of value in lower doses

• Alternative routes of administration for 5-MeO-DMT other than smoking

Quotes:

“It’s very important to us that [5-MeO-DMT] is shepherded out into the world in a safe and effective way, with a good understanding of how it can go wrong—because another bad headline can really harm the progress that it has seen.” [7:14]

“Where we used to feel you really had to work your way up to 5[MeO-DMT], we found with the right amount of prep and with a good individualized approach it’s right for anyone—as long as they’re in the right place for it. So if they make it through the screening and intake process, we’re good to go.”  [23:09]

“There’s no need to turn it into a goal-oriented thing where [the participant] needs to get to a full release. We see plenty of full resolutions happen where we never even have to take a participant to a mystical experience.” [29:43]

Links:

Tandava Retreats website

F.I.V.E. website

Previous episode: How to Choose a Psychedelic Facilitator or Retreat Center with Joël Brierre

Previous episode: Navigating Psychedelic Narcissism with Adam Aronovich

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Joël Brierre joins to discuss the important topic of safety when working with 5-MeO-DMT. Joël is the founder and CEO Tandava Retreats and co-founder of the 5-MeO-DMT education and training platform F.I.V.E. Joël and his team are focused on shepherding 5-MeO into the world in a safe and effective manner. 

In this conversation, Joël shares his expertise on the screening that should be done prior to 5-MeO-DMT experiences, discussing both physical and psychological considerations. He also talks about synthetic 5-MeO-DMT vs the extract from the Bufo alvarius toad and explains why his retreat center only uses the synthetic version. In closing, he discusses the nuances around drug-drug interactions and how he navigates these with participants, exploring the nuances of the pharmacology involved.  

In this episode:

• What inspired Joël to start F.I.V.E.

• The physical medical considerations when screening patients for 5-MeO-DMT

• Why it is theorized that 5-MeO-DMT could trigger conditions like multiple sclerosis to recur 

• Psychological red flags for people seeking 5-MeO-DMT experiences

• Joël’s thoughts on navigating psychedelic narcissism

• Safety considerations working with patients with significant trauma

• Determining the dosage of 5-MeO-DMT and why Joël thinks there’s a lot of value in lower doses

• Alternative routes of administration for 5-MeO-DMT other than smoking

Quotes:

“It’s very important to us that [5-MeO-DMT] is shepherded out into the world in a safe and effective way, with a good understanding of how it can go wrong—because another bad headline can really harm the progress that it has seen.” [7:14]

“Where we used to feel you really had to work your way up to 5[MeO-DMT], we found with the right amount of prep and with a good individualized approach it’s right for anyone—as long as they’re in the right place for it. So if they make it through the screening and intake process, we’re good to go.”  [23:09]

“There’s no need to turn it into a goal-oriented thing where [the participant] needs to get to a full release. We see plenty of full resolutions happen where we never even have to take a participant to a mystical experience.” [29:43]

Links:

Tandava Retreats website

F.I.V.E. website

Previous episode: How to Choose a Psychedelic Facilitator or Retreat Center with Joël Brierre

Previous episode: Navigating Psychedelic Narcissism with Adam Aronovich

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Joshua White returns to discuss the role of peer support in the psychedelic ecosystem. Joshua (he/him) is founder and executive director of Fireside Project and has prior experience as a volunteer counselor on a hotline and as a volunteer at the Zendo Project. He has also practiced law as a deputy city attorney at the San Francisco City Attorney’s Office, where he focused on suing business exploiting vulnerable communities. He also co-taught a nationally-renowned clinic at Yale Law School.

In this conversation, Joshua shares updates from the first two years of Fireside Project, the psychedelic peer support hotline. He mentions that the hotline has grown nearly 1,000% since their first month, with the number receiving 1,500 calls this past month. Joshua also discusses the intricacies of peer support, sharing why he thinks this form of support is particularly well-suited to psychedelic experiences and how he understands the relationship between psychotherapy and peer support. In closing, Joshua reminds listeners that Fireside Project is available to take calls from anyone working through a psychedelic experience—whether they are in the midst of an altered state of mind or seeking to integrate a past experience. 

In this episode:

• When to call the psychedelic peer support hotline

• The history of peer support and when it may be helpful

• Why Joshua believes its important for peer support volunteers to have had their own psychedelic experiences

• The ways peer support and psychotherapy differ

• The limits of peer support

• How peer support is similar to the methods used in MDMA-assisted therapy

• Critiques of peer support Joshua has heard and his responses

• The relationship between peer support and theoretical frameworks in psychotherapy 

Quotes:

“In non-psychedelic peer support, often the peer-ness starts with a pathology—alcohol use disorder, tobacco use disorder, etc. Psychedelic peer support, the idea is that having had a psychedelic experience by itself is the layer of peer-ness that’s needed to go deeper with someone regardless of other aspects of your identity you may have.” [8:55]

“One of the, I think, key parts of peer support is that we don’t interpret a caller’s experience for them. We are present with them so that they can interpret their experience and we can create a safe and non-judgmental space for them to engage in that kind of interpretation.” [18:32]

“I think especially with an experience as vast as the type that can be precipitated by psychedelics, having multiple forms of support is essential.” [22:23]

Links:

Fireside Project website

Fireside Project on Instagram

Fireside Project on Twitter

Previous episode: Insights Gained from the First Year of Fireside Project with Joshua White

Previous episode: Fireside Project: The World’s First Psychedelic Hotline with Joshua White and Hanifa Nayo Washington

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Hannah Cross, LCSW joins to discuss group ketamine assisted psychotherapy for frontline healthcare workers. Hannah is a licensed clinical social worker and therapist who specializes in trauma healing and psychedelic integration, including work on LSD and psilocybin clinical trials. 

In this conversation, Hannah shares details from the study exploring group ketamine therapy in a cohort of ten frontline healthcare workers, discussing the study design, the intricacies of group therapy, and the specific dosing protocol and therapy regimen for the patients. She reveals the very promising results of this early study and also shares a number of emotional stories of transformation from the patients. In closing, Hannah discusses the early indicators of the durability of positive effects from this kind of ketamine assisted therapy and lists a number of additional on-going and upcoming studies of group ketamine treatments for other populations.

In this episode:

• The inspiration for this ketamine study

• How the frontline healthcare workers in the study were chosen

• What makes a person a good candidate for group therapy

• The protocol for the ketamine assisted therapy used in the study

• Why the therapy began with a low, sublingual dose of ketamine

• How psychotherapy was integrated with ketamine treatments in this study

• The reductions in PTSD, depression, and anxiety that resulted from the ketamine assisted therapy

• Why Hannah sometimes sees an increase in anxiety towards the beginning of the therapeutic process

Quotes:

“Ketamine can help people access more of that self-healing energy and when that’s present in a group setting and people are essentially able to shine this healing energy on each other, there’s this exponential healing I think can happen.” [7:16]

“When you wrap a ketamine experience up in experienced and effective therapy, there is this safety in the container that really allows people to have the inward focused journey under ketamine for that forty-five minutes to an hour.” [20:03]

Links:

Full study: Ketamine-Assisted Group Psychotherapy for Frontline Healthcare Workers with COVID-19-Related Burnout and PTSD: A Case Series of Effectiveness/Safety for 10 Participants

Numinus website

Group ketamine assisted therapy by Numinus

Hannah’s private practice, Wild Sunflower Counseling

Cedar Psychiatry website

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Arsalan Azam joins to discuss the potential of ketamine therapy for helping to address the stress of major life transitions. Dr. Azam is a board-certified Emergency Medicine physician and medical director of Daydream MD. He attended medical school as a Dean’s Scholar at Case Western Medical School and completed his clinical rotations at the Cleveland Clinic. He has also worked as an emergency medicine physician around the country, including as a relief physician for hospitals impacted by staffing shortages.

In this conversation, Dr. Azam shares patient experiences from his own ketamine practice and discusses the complexities of different approaches to ketamine treatment and different indications, including how some individuals may benefit especially from ketamine assisted therapy, while others may be well served by stand-alone ketamine infusions, especially considering the cost differential of these treatments. Additionally, Dr. Azam explores the role integration and peer support can play in the context of ketamine treatments, mentioning these may be less cost-prohibitive ways for patients to get the most out of their experiences.

In this episode:

• The kinds of life transitions ketamine is helpful with in Dr. Azam’s experience

• What kinds of patients Dr. Azam’s practice serves

• The unique mechanism of ketamine

• Leveraging ketamine treatment to navigate breakups or professional transitions

• Ketamine assisted psychotherapy vs stand-alone ketamine infusions, and when having the extra support of therapy may be especially beneficial

• The role of integration and peer support in ketamine treatments

• The research into ketamine treatment for suicidal ideation

• How Dr. Azam sets up treatment programs for different kinds of patients

Quotes:

“The magic of this neurobiology is that, unlike our existing tools which take weeks to kick in often, this one works within hours. And so it really becomes more of a rescue medication or a supportive medication for these transitions of life that works quickly.” [8:32]

“Think of our mind and our mental patterns as a piece of cold steel—and it’s kind of locked in that structure, in that pattern. Psychedelics, like ketamine and others, can heat that steel up, and make it much more moldable and then when it cools back down it’ll maintain a persistent new structure. So ketamine assisted therapy is a tool that helps us leverage that hot piece of steel to mold it into something else.” [11:56]

“Ketamine works very quickly to reduce suicidal thinking and its degree of effect directly corresponds to the degree of symptoms. So someone who has really severe suicidality is more likely to experience a response to ketamine and is more likely to experience a significant response to ketamine.”  [18:36]

Links:

Daydream MD website

Daydream MD on Instagram

Fireside Project website

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Ben Malcolm, PharmD joins to discuss the research surrounding the intersection of psychedelics with pregnancy and nursing. Dr. Malcolm is a psychopharmacology consultant, psychedelic educator, founder of Spirit Pharmacist, LLC and a board member of the Psychedelic Medicine Association. Dr. Malcolm recently wrote an overview article on the existing research into psychedelics, pregnancy and breastfeeding.

In this conversation, Dr. Malcolm shares the current state of research that he explored in his article, highlighting the few points where data does exist while emphasizing that there are still major unknowns. Overall, Dr. Malcolm describes how most are very conservative when it comes to psychedelic use while nursing or pregnant, though pregnancy seems to present more concerns than nursing.

Dr. Malcolm also discusses ketamine and the interesting findings in patients who were given this substance as an anesthetic for cesarean sections. In conclusion, Dr. Malcolm suggests moving beyond a black and white perspective on this topic, emphasizing that there are also opportunity costs to not pursuing healing. However, in this area especially, more research is needed before clear guidelines can be developed. 

In this episode:

• The lack of treatment options for postpartum depression

• Why it is likely for a fetus or infant to be exposed to psychedelics if a mother ingests them while pregnant or nursing

• Psychedelics and the developing brain

• Ritual use of ayahuasca and mushrooms among pregnant women in traditional ceremonial contexts

• The research into negative impacts of ecstasy use during pregnancy and the variables that confound the results

• The unknowns about microdosing while nursing

• The research into whether LSD is a teratogen

• The effects of psychedelics on hormones

• Pregnancy as an aspect of set and setting

Quotes:

“Psychoactive drugs or psychotropic drugs typically end up in breastmilk more than other types of substances because they are usually more fat-soluble. Usually to get into brain tissue they have to be a little more fat-soluble than drugs that act in the periphery.” [10:15]

“In the nursing period I think that there’s more potential to use psychedelics safely and without really taking much risk as far as exposing the [child], whereas in pregnancy, yeah, you just don’t really have that choice—the fetus is going to be exposed.” [24:42]

Links:

Dr. Malcolm’s recent article: “Psychedelics, Pregnancy, and Breastfeeding”

Spirit Pharmacist website

Spirit Pharmacist on Facebook

Spirit Pharmacist on Instagram

Spirit Pharmacist on YouTube

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, PhD candidate and psychedelic science YouTuber Manesh Girn discusses his recent research on psychedelic brain action. Manesh is in the final stages of obtaining his PhD in neuroscience at McGill University and is an author on over a dozen peer-reviewed articles on psychedelics and related topics. He is also chief research officer at EntheoTech Bioscience and runs the YouTube channel the Psychedelic Scientist. 

In this conversation, Manesh discusses his recent article in Trends in Cognitive Sciences titled “A complex systems perspective on psychedelic brain action.” He explains the complexity science approach used in the article, which emphasizes the brain is a holistic, interconnected system, rather than individual component networks that can be isolated. From this standpoint, Manesh critiques some simplistic explanations of the neural mechanisms of psychedelics which focus exclusively on interactions with the default mode network isolated from other brain systems.

He also explains how individual some of the neural effects of psychedelics are, citing different findings from different studies and observed variations between brain scans of different people. By better understanding these individual differences, and placing these different responses into a complexity science framework, Manesh believes that more individually-tailored psychedelic therapies are possible once the systems involved are more comprehensively understood. 

Manesh closes this discussion by explaining the difference between genuine complexity and sheer chaos.  Complexity, he explains, is a delicate balance of novelty and order, which is why psychedelic experiences can be both destabilizing and productive of novel insights and personal transformation. 

In this episode:

• The research into psychedelics and the default mode network

• Using frameworks from complexity science in psychedelic research

• Measuring entropy in the brain

• Differences in neurological effects from taking between different studies and different individuals

• How a complexity science approach to neuroscience could better inform precision psychiatry

Quotes:

“You can’t just look at a specific brain region or network [in psychedelic research], you’ve gotta talk about the brain as a whole, in this sense of seeing the brain as a system of interacting parts.” [4:49]

“The core idea of this paper is that psychedelics put our brain into this state that is more dynamically flexible, it’s more diverse in its activity patterns, and it’s more sensitive to inputs that come in.” [14:17]

“What we find in the brain imaging findings is that different studies disagree, but also if you look at individual people, they can have radically different effects on their brain—almost opposite.” [21:37]

Links:

Manesh’ recent article in Trends in Cognitive Sciences: “A complex systems perspective on psychedelic brain action”

Psilocybin vs Placebo Brain Connectivity Diagram from Dr. Robin Carhart-Harris

The Psychedelic Scientist YouTube Channel

The Psychedelic Scientist on Instagram

The Psychedelic Scientist on Twitter

Manesh on LinkedIn

EntheoTech website

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, PhD candidate and psychedelic science YouTuber Manesh Girn discusses his recent research on psychedelic brain action. Manesh is in the final stages of obtaining his PhD in neuroscience at McGill University and is an author on over a dozen peer-reviewed articles on psychedelics and related topics. He is also chief research officer at EntheoTech Bioscience and runs the YouTube channel the Psychedelic Scientist. 

In this conversation, Manesh discusses his recent article in Trends in Cognitive Sciences titled “A complex systems perspective on psychedelic brain action.” He explains the complexity science approach used in the article, which emphasizes the brain is a holistic, interconnected system, rather than individual component networks that can be isolated. From this standpoint, Manesh critiques some simplistic explanations of the neural mechanisms of psychedelics which focus exclusively on interactions with the default mode network isolated from other brain systems.

He also explains how individual some of the neural effects of psychedelics are, citing different findings from different studies and observed variations between brain scans of different people. By better understanding these individual differences, and placing these different responses into a complexity science framework, Manesh believes that more individually-tailored psychedelic therapies are possible once the systems involved are more comprehensively understood. 

Manesh closes this discussion by explaining the difference between genuine complexity and sheer chaos.  Complexity, he explains, is a delicate balance of novelty and order, which is why psychedelic experiences can be both destabilizing and productive of novel insights and personal transformation. 

In this episode:

• The research into psychedelics and the default mode network

• Using frameworks from complexity science in psychedelic research

• Measuring entropy in the brain

• Differences in neurological effects from taking between different studies and different individuals

• How a complexity science approach to neuroscience could better inform precision psychiatry

Quotes:

“You can’t just look at a specific brain region or network [in psychedelic research], you’ve gotta talk about the brain as a whole, in this sense of seeing the brain as a system of interacting parts.” [4:49]

“The core idea of this paper is that psychedelics put our brain into this state that is more dynamically flexible, it’s more diverse in its activity patterns, and it’s more sensitive to inputs that come in.” [14:17]

“What we find in the brain imaging findings is that different studies disagree, but also if you look at individual people, they can have radically different effects on their brain—almost opposite.” [21:37]

Links:

Manesh’ recent article in Trends in Cognitive Sciences: “A complex systems perspective on psychedelic brain action”

Psilocybin vs Placebo Brain Connectivity Diagram from Dr. Robin Carhart-Harris

The Psychedelic Scientist YouTube Channel

The Psychedelic Scientist on Instagram

The Psychedelic Scientist on Twitter

Manesh on LinkedIn

EntheoTech website

Psychedelic Medicine Association

Porangui

In this episode of the psychedelic medicine podcast, Dr. Johnathan Edwards joins to discuss the potential of ketamine treatments for mental health conditions in adolescent populations. Dr. Edwards is a board-certified anaesthesiologist and author with a key focus on treating mental health conditions with ketamine. He has provided ketamine in his practice for over 20 years and has worked with psychiatrist Dr. Sam Zand to help patients with mental health conditions. 

In this conversation, Dr. Edwards shares the current state of research exploring ketamine for adolescents, mentioning that there are currently 120 studies of ketamine treatments for mental illness in this population. He shares how he works with these young patients to ensure they are well prepared to experience the effects of the dissociative anesthetic, saying that adolescents typically do very well when adequately prepared. 

From Dr. Edwards’ experience, treatment resistant depression, suicidal ideation, and eating disorders seem to be the conditions where ketamine seems to have the biggest effect for adolescents. In closing, Dr. Edwards emphasizes how significant it is to be able to help kids struggling with these hard to treat conditions, especially as teen suicide remains a significant issue, so he’s hopeful that pediatricians, psychiatrists, and anaesthesiologists can continue to collaborate to safely bring ketamine therapy to more patients. 

In this episode:

• The existing research on ketamine in adolescent populations

• The danger of airway obstruction during ketamine infusions among people prone to sleep apnea

• Preparing adolescents for ketamine journeys

• Historical and cross-cultural precedents for psychedelic journeys in adolescents and young adults

• Potential indications for ketamine treatments in adolescents

• Is there an established protocol for adolescent ketamine therapy?

Quotes:

“I go through a lot to reassure the parents, to reassure the child, ‘Hey, this is gonna be a different voyage for you and you’re gonna be in a different place but tell yourself at all times you’re safe…’ and it goes very well.” [5:06]

“As long as you have a medical clearance from your pediatrician and a medical clearance from the psychotherapist/psychiatrist/psychologist… and you put those two together, along with parental consent, you’re pretty well covered to go ahead and do a ketamine treatment on a child… It’s not standard of care but again, you’re trying to save a kid’s life.”  [24:39]

Links:

Dr. Edwards’ website

Dr. Edwards’ forthcoming book: The Revolutionary Ketamine: How a Little-Known Drug Can Cure Depression and Prevent Suicide

Previous episode: Psychedelics for Eating Disorders with Dr. Reid Robison

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Paul Thambi, MD joins to discuss insights on the optimal delivery of psychedelic experiences stemming from his recent trial on psilocybin therapy for cancer patients suffering from major depressive disorder. Dr. Thambi is a medical oncologist with nearly 20 years of experience treating patients in a private practice. He now serves as CMO Sunstone Therapies, a company focused on how to best deliver psychedelic therapies. 

In this conversation, Dr. Thambi shares the details of the design of his recent study, which involved two preparatory sessions, a treatment session, and two integration sessions. He also discusses the efficiency of delivering psychedelic therapy to a group rather than to individuals, allowing the therapist to help more patients at once while still providing focused one-on-one guidance during the psychedelic experience. Additionally, Dr. Thambi discusses the importance of music and space design to provide an optimal state of mind going into the therapy and while under the influence of the psychedelic. 

Dr. Thambi is happy to report very positive data from this initial trial, with both patients with active cancers and those with no current signs of disease showing great improvement in depression scores. He looks forward to continuing to work to better optimize the delivery of psychedelic therapies, not only for the patients but also for the therapists. Currently, he is pursuing a new “diad trial” of psychedelic therapy for cancer patients and a loved one which may have the potential to ease the suffering caused to a family system by these diseases. 

In this episode:

• The design of Dr. Thambi’s study of psychedelic therapy for cancer patients struggling with depression

• Group versus individual forms of psychedelic therapy

• Crafting an ideal setting for psychedelic therapy with music, artwork, etc.

• Changes in depression scores, anxiety, and pain amongst the participants in Dr. Thambi’s trial

• Optimizing the experience for psychedelic therapists as well as patients

• Dr. Thambi’s on-going “diad trial” for cancer patients and a loved one 

Quotes:

“What we were trying to do was create something that… could be used when it needed to be for a lot of people—something that was scalable. So something that was efficient, but still had compassion to it. And that’s how we came up with the [study design].” [22:16]

“80% of [participants] had their MADRS score cut in half or greater within one week of the treatment. And half of those people had what we called a sustained remission, which means a MADRS score of less than or equal to ten on each of the measurements we took, including the last one, which was done at week eight.” [23:54]

Links:

Sunstone Therapist website

“Psychedelics may ease cancer patients’ depression, anxiety” article by Manish Agrawal

California Institute for Integral Studies (CIIS) Certificate in Psychedelic-Assisted Therapies and Research

Previous episode: Psychedelics and the Chemistry of Connection with Dr. Julie Holland

Previous episode: How Setting Can Affect Psychedelic Journeys with Frederick Barrett, PhD

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Dr. Joel Castellanos and Jim Harris join to discuss the possibilities of addressing spinal cord injuries using psychedelic medicine. Dr. Castellanos is a board certified physical medicine and rehabilitation and pain management physician and an associate professor in the department of anesthesiology at University of California, San Diego School of Medicine. Jim Harris is a National Geographic photographer who suffered a spinal cord injury during one of his adventures who became notable in the psychedelic space with the article in Outside “Jim Harris Was Paralyzed. Then He Ate Magic Mushrooms.”

Jim starts off by sharing his own backstory of how he broke nine vertebrae in his spine during a 2014 ski expedition in Patagonia, Chile, leading to significant loss of motion and sensation. After some promising success in traditional rehabilitation and physical therapy settings, Jim details his surprising experience of healing with psilocybin. 

In this vein, Dr. Castellanos discusses the importance of neuroplasticity in healing for spinal cord injury patients. He talks about how forming new neural pathways can help a patient regain function and sensation in a part of the body that had previously been paralyzed, and leveraging this neuroplasticity using psychedelics and other tools may be a promising way to improve outcomes among these traditionally underserved patients. 

Considering the unique needs of spinal cord injury patients, Jim wonders whether lower doses of psychedelics may be more beneficial for this population, as it would allow them to maintain a greater degree of sobriety and groundedness to pursue physical therapy and rehabilitation activities while under the influence of the substance. 

Dr. Castellanos expresses excitement about the possibilities of psychedelic therapies for these patients, as not only does early anecdotal evidence such as Jim’s story suggest that these substances may be effective in helping to facilitate regain of function and sensation, but also because of the mental changes brought on by a psychedelic experience. Patients may feel more optimistic and eager to apply themselves following a psychedelic experience, which will facilitate healing beyond just what occurs as a result of the effects of the substance itself. He is also encouraged by current research into different forms of neuroplasticity which have different mechanisms. Dr. Castellanos suggests employing these in combination, such as using psychedelic therapy alongside vagus nerve stimulation, may offer more effective treatment options for spinal cord injury patients. 

At the end of this conversation, Jim poses Dr. Castellanos a fascinating question: whether there may be any downsides to over-encouraging neuroplasticity. Dr. Castellanos responds that there could be certain risks of increasing pain in patients, as neuroplasticity encourages new connections to be formed in the brain, but it matters what specifically becomes more interconnected. As such, there is reason to proceed with caution even as neuroplasticity offers significant benefits. 

In closing, Jim shares some hard reduction tips for other spinal cord injury patients interested in exploring psychedelic healing. Both he and Dr. Castellanos are optimistic at the possibilities of psychedelic therapies used in conjunction with other treatments for patients like Jim. 

In this episode:

• Leveraging neuroplasticity using psychedelics and other tools to help physical medicine and rehabilitation patients regain function

• Anecdotes of other spine injury patients who’ve regained function or sensation following a psychedelic experience

• The connection between spasticity and psychedelics

• How the response to psychedelics has changed over time for Jim 

• Connecting physical therapy and psychedelic therapy to improve efficacy of rehabilitation

• How different mechanisms of neuroplasticity may be used in concert to promote recovery

• Harm reduction tips

Quotes:

Jim: “[when I first took psilocybin] all of a sudden I had an ability to contract my hamstring and… lift my heel off the ground, like up toward my butt, and I hadn’t been able to do that up until that time.” [9:12]

Joel: “My primary focus is on neuroplasticity and ways that we can creatively modulate the nervous system to optimize recovery and optimize quality of life, whether that’s from a pain perspective or a regaining motor strength perspective.” [13:34]

Joel: “If we can demonstrate that through psychedelics we can optimize and improve and make recovery more efficient, it is something that will be a huge deal for a great number of patients, and make my job as a rehab physician easier.” [14:37]

Jim: “The reason I’ve become interested in psychedelics as medicine has been trying to figure out… what are all the ways that I can have some sort of personal efficacy in my own recovery.” [19:22]

Jim: “I do know of other anecdotes kinda similar to mine, of people—maybe especially it seems like with a first psychedelic experience—suddenly regaining sensory or motor functions.” [22:41]

Jim: “It seems there’s maybe some reason to suspect that some of the nerve plasticity that psychedelics can allow may reopen the critical period of this pivotal mental state where, say having a psychedelic and doing physical therapy in that state and maybe even the days afterwards, might result in a bigger functional change than just doing the therapy alone.” [24:28]

Jim: “My hypothesis would be that a useful physical therapy dose [of psychedelics] might be a lot less than what Johns Hopkins and other institutions are dosing as a therapeutic dose. It seems to me that maybe a really high dose psychedelic experience is going to make it harder to stay connected to your body, connected to doing a task.” [29:17]

Joel: “If I can identify three or four different ways to open up neuroplasticity that each have different mechanisms, it allows me to leverage those to give robust functional recovery and that’s what I’m interested in.” [33:56]

Joel: “If psychedelics can reframe someone’s cognition and reframe their situation where that gives them a little bit of hope, along with having a supportive therapy team, along with it working on descending inhibition and activating muscles that were previously paralyzed, that’s multiple different levels of approaching someone that just had the worst thing in their whole life happen to them… It builds resilience and then it’s also working on the neuromuscular pathway to improve functional recovery.” [37:30]

Joel: “I don’t think just taking a psychedelic or other medication on its own is always going to be efficacious in solving that maladaptive pattern. But, when combined with specific and guided therapy, whether that’s physical therapy, or psychotherapy, or cognitive therapy, I think that’s where you can guide those neurons to a healthier connection through neuroplasticity.” [50:17]

Links:

“Outside article: Jim Harris Was Paralyzed. Then He Ate Magic Mushrooms.”

Psychedelics and Health Research Initiative at University of California San Diego

Dr. Castellanos on Twitter

Jim on Instagram

Previous episode: Psychedelic Therapies for Pain with Joel Castellanos, MD

Fireside Project website

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Agnieszka Sekula joins to discuss her research into the applications of virtual reality in psychedelic-assisted therapy. Agnieszka is a researcher at Swinburne University and co-founder of Enosis Therapeutics. Her research focuses on investigating therapeutic mechanisms in psychedelic treatment that can be strengthened through experience design and translating findings of this research into real-life applications by developing virtual reality scenarios. Additionally, she has recently conducted the first ever case study of VR and psychedelics.

In her research, Agnieszka considers many possible uses of virtual reality in the context of psychedelic therapy, as well as potential dangers. The first application she discusses is using VR to promote relaxation prior to a psychedelic journey. Similar to the synergy between psychedelics and meditation, Agnieszka suggests that the immersive experience of VR could be useful in promoting states of calmness which are ideal for a person about to enter into a psychedelic experience. Additionally, she suggests that the otherworldly imagery and soundscapes possible with VR technology can help prime a client for the shifts and intensifications of perception caused by psychedelics. Having the opportunity to explore these states prior to the experience helps the patient to feel more prepared for the experiences, especially since with VR these explorations occur in a context where one maintains a connection with sober consciousness and can easily opt out if things become overstimulating. 

Next Agnieszka discusses the potential of augmenting peak psychedelic experiences with VR. Considering both psychedelics and virtual reality have the potential to occasion dramatic shifts in consciousness and affect, pairing these together is likely to be synergistic in promoting mystical experiences in the therapeutic process—something which appears to be closely tied to the efficacy of psychedelic-assisted therapy. Though little research currently exists in this area, Agnieszka believes that VR may have the potential to more reliably facilitate experiences of ego dissolution and deep awe during the psychedelic journey.

Perhaps one of the most novel proposals in Agnieszka’s research is using VR to facilitate greater recollection of the psychedelic journey in order to promote more effective integration. She proposes that by building models of the psychedelic experience in the VR space, a patient can more readily return to the experience in sober consciousness by encountering these same stimuli again in virtual reality. The immersive experience of virtual reality may help facilitate access to feelings, memories, and intuitions which arose during the psychedelic session, leading to an easier process of integration. 

However, Agnieszka’s research also considers potential dangers in combining VR and psychedelics. These include the risk of overstimulation and the potential of a trauma being triggered by certain imagery or auditory input. More mundanely, there is also the possibility of “cyber-sickness” and physical discomfort caused by the VR headset. Despite these potential drawbacks, however, Agnieszka is confident there are powerful applications of VR in psychedelic therapy, particularly in allowing for a more holistic and integrated approach to the altered states of consciousness theorized to be at the center of the efficacy of these new treatments. 

In this episode:

• Using VR to induce relaxation in preparation for psychedelic journeys

• Augmenting peak psychedelic experiences with VR

• VR as a technology which may promote therapeutic alliance

• Using VR to store memories of psychedelic experiences to facilitate integration

• Transitioning between normal consciousness and altered states with the help of VR

• VR as a “digital diazepam” for decreasing the intensity of a psychedelic experience without pharmacological intervention

• The potential dangers of overstimulation or triggering traumas with VR and psychedelics

Quotes:

“VR in itself is just a tool—it’s a method of delivery—but in itself it's not the active ingredient. So whenever we speak of VR we think about the way of delivering the content, and the content is that active ingredient.” [2:22]

“The best way to prepare someone for what an altered state experience feels like is by actually experiencing an altered state, and here again VR can be very helpful in approximating… what that psychedelic experience might feel like.” [18:51]

“VR is used as a multi-sensory canvas where the patient is building the model of their psychedelic experience so that they can store it for themselves and return to it later.” [28:17]

“Using VR just as beautiful content, or… contextual design for the entire experience might not be beneficial because it might work more as a distraction than as something that supports the journey.” [49:15]

“For me the most important thing is to start looking at psychedelic treatment as an experience in its totality and to look a little bit more deeply into design principles that could be used to maximize that experience of the patient, of the client.”  [53:46]

Links:

“Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy”

Enosis Therapeutics website

Agnieszka on LinkedIn

Psychedelic Medicine Association

Porangui

In this episode of the Psychedelic Medicine Podcast, Andrew Penn joins to discuss the recent BrainFutures white paper on the elements of psychedelic-assisted therapy which he co-authored. Andrew is a psychiatric nurse practitioner and a professor at UC San Francisco who is also a psychedelic psychotherapy researcher and nationally invited speaker. Additionally, Andrew is the co-founder of the Organization of Psychedelic and Entheogenic Nurses (OPENurses).

In this conversation, Andrew discusses his white paper and breaks down the five key elements which need to be present in all psychedelic-assisted psychotherapy to ensure safety and efficacy. These five elements are safety and establishing set & setting; screening and assessment; preparation; the medication session; and integration. 

In terms of screening and assessment, Andrew mentions the interesting place the field finds itself in currently, as up to this point screening practices have been rather intensive and erring on the exclusionary side since this is the standard when drugs are being tested in clinical trials. However, with psychedelic therapy continuing to become more accessible with patient options outside of these trials on the horizon, the field will need to decide what makes the most sense in terms of balancing accessibility with potential risks, and in doing so more data will be collected which will give a better picture of exclusion criteria. Andrew also stresses the need for psychiatric screening in addition to focusing on medical consideration, mentioning that it’s essential for a psychedelic therapist to know a patient’s trauma history, as this is something that may come up in a session and the more preparation the better. 

When it comes to preparation, Andrew suggests that this should include establishing a relationship of trust, educating the patient, obtaining informed consent, and establishing safety measures. On the topic of consent, Andrew discusses the intricacies of dealing with this gracefully in a context where a patient will be undergoing a drug experience where consent cannot be adequately given in that moment. As such, he stresses the importance of explicit conversations between the patient and therapist around topics such as whether or not the patient would want their hand held during an intense moment. Rather than dry, procedural conversations, Andrew thinks discussions of consent are actually crucial moments where the therapist and patient can establish a relationship of trust and also more thoroughly explore the possibilities of what may come up for the patient in the session so that they feel better prepared.

In terms of the psychedelic therapy sessions and integration, Andrew suggests that the therapists play different roles in these two contexts, with the medicine sessions being more about supporting the patient in their experience without providing too much direction or prompting so that the experience may unfold naturally and autonomously, whereas in integration the therapist can take a more active role in helping the patient explore what the experiences brought up. One interesting feature about psychedelic therapy, and a reason why integration is so important, is that the intensity of the medicine experiences and the insights triggered during sessions can actually be destabilizing initially. As such, Andrew maintains that integration is a crucial aspect of psychedelic therapy in order to better ensure that these experiences can lead to deep and lasting healing. 

Andrew hopes that this white paper can introduce the crucial elements of psychedelic therapy to a wider audience and encourage a standard of practice.

In this episode:

• How might screening and assessment change once psychedelic therapies are more widely authorized and not only accessible as clinical trials? 

• Reckoning with the exclusion criteria around psychedelic therapies

• The importance of thorough preparation in achieving the best patient outcomes

• The dynamics of consent in preparation versus in the midst of the session and how therapists can more intentionally approach these questions

• What should therapists do when a patient is not in a calm state of mind at the time of the scheduled psychedelic therapy?

• Why integration is critical to facilitating healing in psychedelic therapy

Quotes:

“Trauma is likely to come up during the session and we want to at least know if there’s something there then we can anticipate that and also start to create a safer environment for that patient.” [7:53]

“We’re gonna have to figure out what is the right dose of medical screening, and then, certainly, introducing some level of psychological screening will be really important.” [10:27]

“Informed consent is this ongoing conversation with the patient where the patient can withdraw their consent at any time—they can revoke that—but people really need to know what they’re getting into if they’re going to make meaningful informed consent.” [16:12]

“What we’ve learned from psychedelic therapy is that there’s a lot of value in just letting things unfold… really the goal of the therapist should be to support that inward focus, and not try to influence the session itself in one direction or another other than to maintain safety.” [33:19]

“Psychedelics are things that tend to shove your face in whatever you’ve been avoiding and that’s something that therapists need to be really aware of—that they might encounter patients who get worse after the session, at least for a transient period of time.” [44:41]

Links:

Andrew's full white paper on BrainFutures: "An Expert-Informed Introduction to the Elements of Psychedelic-Assisted Therapy" 

Previous episode: When *Not* to Proceed with a Planned Psychedelic Journey with Rick Barnett, PsyD

OEPNurses website 

Psychedelic Medicine Association

Porangui

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