Dr. Matthew Johnson: Psychedelics for Treating Mental Disorders

[0] Welcome to the Huberman Lab Podcast, where we discuss science and science -based tools for everyday life.

[1] I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

[2] Today, I have the pleasure of introducing Dr. Matthew Johnson.

[3] Dr. Johnson is a professor of psychiatry at Johns Hopkins School of Medicine, where he also directs the Center for Psychedelic and Consciousness Research.

[4] As many of you know, there's extreme excitement about the use of psychedelics for the treatment of various disorders of the mind.

[5] Dr. Johnson's laboratory is among the premier laboratories in the world understanding how these compounds work, how things like psilocybin and LSD and related compounds allow neural circuitry in the brain to be shaped and change such that people can combat diseases like depression or trauma or other disorders of the mind that cause tremendous suffering.

[6] Dr. Johnson is also an expert in understanding how different types of drugs impact different types of human behaviors, such as sexual behavior, risk -taking, and crime.

[7] Dr. Johnson and his work have also been featured prominently in the popular press, such as articles in the New York Times and Michael Pollan's book, How to Change Your Mind, and in a feature in 60 Minutes about psychedelics and the new emerging science of psychedelic therapies for treating mental disorders.

[8] During the course of today's conversation, Dr. Johnson and I talk about psychedelics at the level of what's called microdosing, whether or not it is useful for the treatment of any mental disorders.

[9] We also talk about more typical macrodosing, what those macrodoses entail.

[10] And he walks us through what an experiment of a patient taking psychedelics for the treatment of depression looks like in his laboratory from start to finish.

[11] The conversation was an absolutely fascinating one for me to partake in.

[12] I learned so much about the past, present, and future of psychedelic treatments and compounds.

[13] And indeed, I hope to have Dr. Johnson on this podcast again in the not too distant future so that we can talk about other compounds that powerfully impact the mind and human behavior, and perhaps can also be used to treat various diseases.

[14] Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

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[54] And now my conversation with Dr. Matthew Johnson.

[55] Well, Matthew, I've been looking forward to this for a long time.

[56] I'm a huge fan of your scientific work.

[57] and i'm eager to learn from you likewise big fan and happy to do this with you all right well thank you my first question is a very basic one which is what is a psychedelic we hear this term all the time but what qualifies a substance to as a psychedelic nomenclature is a real challenge in this area of psychedelics so starting with the word psychedelic it just if if you're a pharmacologist it's it's not very satisfying because that term really spans different pharmacological classes.

[58] In other words, if you're really concerned about receptor effects and the basic effects of a compound, it spans several classes of compounds.

[59] But overall, so it's really more of a cultural term, or it does have a relationship to drug effects, but it's at a very high level.

[60] So all of the so -called psychedelics across these distinct classes that I can talk more about.

[61] The way I put it is they all have the ability to profoundly alter one's sense of reality.

[62] And that can mean many things.

[63] Part of that is profoundly altering the sense of self acutely.

[64] So when someone's on the psychedelic.

[65] So the different classes that can be the specific pharmacological classes that can be called a psychedelic are one that what are called the classic psychedelics so in the literature you'll see that term and hallucinogen and psychedelic are all have traditionally been used synonymously um i think there was a little of a tendency to stay away from psychedelics of the baggage but there's been a return to that in the last several years but the classic psychedelics or classic hallucinogens are things like lsd Psilocybin, which is in so -called magic mushrooms.

[66] It's in over 200 species that we know of so far of mushrooms.

[67] Dimethyltryptamine or DMT, which is in dozens and dozens of plants.

[68] Mescaline, which is in the peyote cacti and some other cacti like San Pedro.

[69] And even amongst these classic psychedelics, there are two structural.

[70] structural classes.

[71] So that's the chemistry.

[72] There's the tryptamine -based compounds like psilocybin and DMT.

[73] And then there's the phenethylamine -based compounds.

[74] These are the two basically building blocks that you're starting from, either a tryptamine structure or a phenethylamine structure.

[75] But that's just the chemistry.

[76] What's more important, or at least to someone like me, are the receptor effects, and then ultimately that's going to have a relationship to the behavioral and subjective effects.

[77] So all of these classic psychedelics serve as agonists or partial agonists at the serotonin 2A receptor, so subtype of serotonin receptor.

[78] Then you have these other classes of compounds that you could call psychedelic.

[79] Another big one would be the NMDA antagonist.

[80] So this would include ketamine.

[81] PCP, and dextromethorphan, something I've done some research with, which folks might recognize from like robo -tripping, guzzling, like, you know, call syrup, which is something kind of like high school kids are known to do when they can't get a hold of real drugs, that type of thing.

[82] So a large overlap in the types of subjective effects that you get from those compounds compared to the 2A agonist classic psychedelics.

[83] But then you have – and by the way, this description, this framework I'm describing, not everyone will agree.

[84] Some people will say, no, psychedelic only means classic psychedelic.

[85] So there's different opinions here.

[86] But you have, gosh, salvinorin A, which is a kappa opioid agonist, which again – Where does that come from?

[87] Salvia Divinorum.

[88] It's a plant that became 20 years ago.

[89] It sort of popped onto the legal high scene.

[90] And there's a long history of this predating the internet, going back to like the stuff one could order in the back of High Times Magazine.

[91] And most of this stuff like never worked, you know, it's like smoke enough of anything, maybe a little bit lightheaded.

[92] But this is one of those things that popped around 20 years ago when it quickly got the reputation of like, holy shit, this stuff actually works and works really strongly.

[93] in these smoked extracts particularly people have these reality altering experiences on par with smoked dmt the classic psychedelic so often and we did the first blinded controlled human research with salvin orne so lots of entity contact so feeling that you in the experience of one is actually interacting with autonomous beings that type of thing and then you have Another big one I probably should have mentioned even before the, you know, Salvin or an A, but you have MDMA, which really stands in a class by itself.

[94] So it's been called an intactogen.

[95] And what does that mean?

[96] It means like touching within.

[97] It sort of eludes the idea that it can really put someone in touch with their emotions.

[98] It's also been called an empathogen, meaning can afford empathy.

[99] But I think intactogen is probably, that's the term that I, I tend to focus on, and I know I'm not telling you anything you don't know, but for the viewers, the primary mechanism of MDMA is serotonin release, and to a degree, other monoamine release, dopamine, serotonin.

[100] And so structurally, that's also in the phenethylamine class, which contains mescaline, the classic psychedelic, but also amphetamine.

[101] So just like Adderall is in that phenethylamine class.

[102] And so this is another example where chemistry doesn't dictate.

[103] I mean, you can tweak a molecule.

[104] It might have that same basic structure, but now you've profoundly changed the way it interacts with the receptor.

[105] So MDMA does not exert its actions by, I like to say, by mimicking the baseball, entering the glove, uh synaptic receptor side you know acting as an agonist so mimicking the the the endogenous neurotransmitter serotonin like the classic psychedelics do mdma works on the pitcher side of just basically throwing out more of the natural the endogenous dumping more serotonin dumping more serotonin flooding yeah the synapse so i get the impression that The psychedelic space is an enormous cloud of partially overlapping compounds.

[106] Right.

[107] Meaning some are impacting the serotonin system more than the dopamine system.

[108] Others are impacting the dopamine system more than the serotonin system.

[109] Given that the definition of a psychedelic is that it profoundly alters sense of self, at least that's included as a partial definition.

[110] Can we break that down into a...

[111] couple of subcategories.

[112] So for instance, hallucinating, either auditory or visual, synesthesia, perceptual blending, the sense that, you know, you can hear colors and see sounds, for instance, a common report of people that take psychedelics in sufficiently high doses.

[113] So hallucinating, synesthesia, and then in terms of sense of self, You know, as a neuroscientist, I think, okay, what does it mean to alter a sense of reality?

[114] Really, what the brain does in a very coarse way is to try and figure out what's happening in space, physical space, and that physical space could be within us or outside us, and what's happening in time.

[115] And as a vision scientist, the simplest explanation is when I move my hand from one location to another location, it's measuring the space, the location of my hand in space over time.

[116] And then you get a rate and a speed and all that kind of stuff, right?

[117] That gets more complicated as you get into the emotional realm.

[118] But is it fair to say that psychedelics are impacting the space -time analysis that the brain is performing and thereby creating hallucinations and thereby altering the blending of senses?

[119] Is it fair to say that?

[120] I think it's fair to explore that area, and here's what I'm thinking.

[121] Clearly, there is a changed relationship, certainly at the right dose, of orientation and space -time.

[122] I think as a—I'm primarily a behaviorist, and in terms of human behavioral pharmacology, I always go to comparative pharmacology.

[123] What can we say that is truly unique about the classic psychedelics?

[124] in general.

[125] So with that description, I'm thinking, okay, alcohol can really screw up your, you know, time -space orientation.

[126] And proprioception, your balance.

[127] Proprioception.

[128] You know, and in many ways, and in those gross motorways, like far worse, you know, of course, everything's dose -dependent, but in the classic psychedelics, you know, obviously the benzodiazepines being very similar to alcohol, same thing.

[129] So, you know, I'd want to...

[130] you know, dig in a little more in terms of like, maybe there's something more specific we could say about that relationship to time and space that the psychedelics are tinkering with.

[131] But I'm not sure.

[132] It's an interesting hypothesis that the idea that that's a mediator, that that's something, that there's something fundamental about changing that, the representation in time and space.

[133] There might be something to that.

[134] I think of these as psychedelics as profoundly altering models.

[135] We're prediction machines, and so much of that is top -down, and psychedelics have a good way of, loosely speaking, dissolving those models.

[136] Can you give us an example of a model?

[137] I throw a ball in the air, it falls down, not up.

[138] That's a prediction that I learned as a child.

[139] I did not come into the world with a brain that knew that relationship between objects and gravity.

[140] But one of the first things that a child learns is the relationship between objects and gravity and their trajectories.

[141] Yeah.

[142] And with a four -year -old, I mean, I saw that at earlier ages, like that experimentation of like, oh, yeah, that's what happens.

[143] Right.

[144] So if he were to throw a ball, if your child were to throw a ball and it went up into the sky, that would be absolutely mind -blowing.

[145] It would be for an adult, too.

[146] It'd be a pretty psychedelic experience, probably.

[147] Right.

[148] And so there's a rule there, you're saying.

[149] There's a kind of a prediction.

[150] There's a rule that underlies a prediction.

[151] that when that rule is violated, all of a sudden the circuit, presumably, for that prediction, it doesn't have a mind of its own, but somehow it creates a surprise element or a recognition element.

[152] And it's not filtered out.

[153] And this might sound extreme, but there are these cases.

[154] It was overblown in sort of the propaganda of the late 60s, early 70s.

[155] There are credible cases of people, and it's very atypical, of sounds like they really thought they could fly and, you know, jump out of a window.

[156] Now, far more people every year fall.

[157] I mean, who knows?

[158] You know, they fall and die out of, you know, from height.

[159] Because they're drunk, you know, so this is extremely rare.

[160] But, you know, there are some like pretty convincing cases.

[161] There was one research volunteer in our studies that she looked like she was in one of our studies, like she was trying to dive through a painting on the wall.

[162] She was fine, but she reviewing the video, it looked like she really thought that she was going to go through that painting.

[163] Who knows?

[164] Enter the other dimension.

[165] Yeah, so they're violating these predictions.

[166] Yeah, the reason I ask it the question the way I did is because given the enormous cloud of different substances and given the range of previous experiences that people show up to a psychedelic experience with, I feel like the ability to extract some universal themes is useful, especially for people who haven't done them before.

[167] who might not have an understanding of what their effects are like.

[168] Can we just briefly touch on the serotonin system and the dopamine system?

[169] I want to acknowledge that, as you already know, that there are many neuromodulator systems in the body, and the opioid systems, cannabinoid systems, but there's something so profound about the serotonin system and the dopamine system because the way I define a neuromodulator is It's a modulator.

[170] It changes the way that other circuits behave.

[171] And essentially, it increases the probability that certain circuits will be active and decreases the probability that other circuits will be active in a general sense.

[172] So compounds like LSD, lysergic acid, diethylamide, and psilocybin, my understanding is that they primarily target the serotonin system.

[173] How do they do that at a kind of general level?

[174] Why would increasing the activity of a particular serotonin receptor or batch of serotonin receptors lead to these profoundly different experiences that we're calling model challenges, challenging preexisting models and predictions?

[175] I mean, at the end of the day, it's a chemical and these receptors are scattered around the brain with billions of other receptors.

[176] What do we think is going on in a general sense?

[177] Yeah, yeah, and this is really the area of active exploration, and we don't have great answers.

[178] We know a good amount about the receptor -level pharmacology, some things about post -receptor signaling pathways.

[179] In other words, just fitting into the receptor.

[180] Clearly, you know, serotonin itself is not psychedelic, you know, or else we'd be tripping all of us all the time.

[181] Because when I eat a bagel, I get serotonin release, right?

[182] Uh -huh.

[183] Or turkey, I mean, there's triptophan, right?

[184] My understanding of serotonin is, is that in very broad strokes, that it generally leads to a state of being fairly, it pushes the mind and body towards a state of contentment within the immediate experience.

[185] Whereas the dopamine system really places us into an external view of what's out there in the world and what's possible.

[186] Yeah, need to do something.

[187] I mean, that's consistent with my - And I'll certainly not in terms of, I don't primarily identify as a neuroscientist.

[188] Definitely tell the viewers that we're far more in your domain here than mine, but in terms of how psychedelics and other drugs interface at the neuroscience level.

[189] Well, feel free to explain it at the experiential level.

[190] I mean, it doesn't have, I think, problem.

[191] There probably are some audience members that are interested in, is it the 5H2C?

[192] Is it the layer 5 neurons in cortex?

[193] That conversation we could hold, and that's an interesting conversation.

[194] But just in terms of the experience of serotonergic versus dopaminergic drugs, they do seem to create distinct… classes of experience.

[195] So I think that's the appropriate level for us to discuss them.

[196] And in terms of how they, and I'd like to explore the biology a little bit here and tell you like sort of what's known and what some of the ideas are.

[197] Please.

[198] You have this path, you know, as you know, like, you know, these are levels of analysis and it's not.

[199] which one is going on.

[200] It's almost like for the particular question, which level of analysis is most appropriate?

[201] Is it, you know, is a question best addressed by the biology, the chemistry, or the physics?

[202] That's how I think of like receptor level, post -receptor signaling, downstream effects and other neurotransmitters, and then activation level effects, and then coordination of activation.

[203] So you've got the, clearly with the classic psychedelics, the 2A.

[204] activation, we do know that there are downstream effects in terms of increasing glutamate transmission.

[205] So this is likely a commonality why, you know, ketamine is very psychedelic in a slightly different way.

[206] Do people hallucinate on ketamine?

[207] Yes, yes.

[208] And it's more dissociative.

[209] So someone is more likely to sort of be less behaviorally active.

[210] if they have a really high dose, they go into a K -hole.

[211] And if they go in a really high dose, like you get in surgery, you're just unconscious.

[212] Yeah, a K -hole.

[213] Not an A -hole, but a K -hole.

[214] A K -hole, yeah.

[215] It's very different.

[216] The K -hole and ketamine is interesting because people can take kind of bumps and kind of dance on it with the sort of an alcohol level strength of effect.

[217] And that's sort of the classic kind of raving, you know, use of it.

[218] But then those folks want to titrate their dose because if they do more of like a line, you get up to like 75, 100 milligrams, then you're talking about, you know.

[219] If you're on the dance floor, you're on the floor and your friends are trying to make sure people aren't stepping on you.

[220] So that's like - Yeah, why would somebody want to take a dissociative anesthetic?

[221] Like to me, it's completely mysterious as to why someone will want to dissociate from their body.

[222] People claim that these NMDA antagonist psychedelics are extremely insightful in a very similar way to the experiences with the classic psychedelics.

[223] And ketamine is now legal for therapeutic.

[224] Right, right.

[225] Spravato, the intranasal form marketed by Janssen, which is S -ketamine.

[226] It's prescription.

[227] Yeah, it's prescription.

[228] So people are taking in the nasal spray.

[229] And then are they undergoing talk therapy while they're doing this?

[230] Typically not.

[231] So this is very interesting, and there's so much work that needs to be done.

[232] It's not treated as psychedelic therapy.

[233] And by that psychedelic therapy, I mean you tell the person they're going to have an altered experience.

[234] You tell them to pay attention to that experience, that they might learn something from that experience.

[235] And afterwards, you discuss that experience.

[236] With Spravato… The model is...

[237] Spravato is?

[238] Is S -ketamine.

[239] Okay.

[240] It's the, yeah, the spray form of ketamine that's been FDA approved for treatment -resistant depression.

[241] But it's, you'll probably feel different.

[242] Ignore that.

[243] That's a side effect.

[244] That's an adverse effect.

[245] Just ignore it.

[246] We don't think that has anything to do with the way it works.

[247] But just get this thing.

[248] It's a direct, you know, sort of chemotherapeutic effect in a sense.

[249] It's not...

[250] facilitating a learning process.

[251] Now, there's older work.

[252] There was a guy, Kropitzky, in Russia that did extensive work with higher doses of ketamine.

[253] I should say Spravato at the prescribed doses isn't very, it's a pretty low dose.

[254] It's in the mild psychedelic range, but it's not very strong.

[255] But this older work that happened in the 90s and early 2000s in Russia, they were using very high doses and treating it like a psychedelic, treating it as if It was a psychedelic therapy, in other words, telling people you're going to have this experience.

[256] It's going to, you know, we're hoping you learn something from it.

[257] We're going to help you through it.

[258] We're going to discuss it afterwards.

[259] And they found incredibly high rates of success and some pretty well -controlled trials for both heroin addiction and alcohol addiction.

[260] So I think a whole lot of work needs to be done now.

[261] And you see some of the ketamine clinics that are using ketamine off -label, a lot of them are treating it like psychedelic therapy.

[262] There's essentially no research at this point on that.

[263] Do you get better results?

[264] Straight -up use of Spravato, there's some good variability, but its antidepressant effects last about a week.

[265] But they kick in immediately.

[266] Now, a week is a long time for most psychiatric drugs.

[267] You take it every day.

[268] So that's amazing.

[269] But it's still just a week.

[270] We're seeing effects.

[271] a year or more later with psilocybin and some of the classic psychedelics, that could be a pharmacological difference, or it could be that they get a lot more mileage out of ketamine if they treated it like psychedelic therapy.

[272] And so that's some work that needs.

[273] What would that look like?

[274] Really just like our psilocybin sessions, which I know I haven't described, but briefly.

[275] You have anywhere from four to eight hours of preparation, getting to know the people who are going to be the guides or the therapist in the room.

[276] Yeah, maybe you could walk us through this.

[277] So let's say I were to come to one of your clinical trials, because these are clinical trials, right?

[278] At your lab at Hopkins.

[279] And would I need to be depressed or could I just be somebody who wanted to explore psychedelics?

[280] We've had studies for all of these and a number of other disorders.

[281] So healthy normal studies, the code for.

[282] Not a problem to fix, but we're all here.

[283] That's what's amazing about psychedelics, though, because if you administer them under this model and you develop a relationship and give a high dose of psychedelic, you can be a healthy normal without a diagnosable issue.

[284] But man. we're all human and the issues seem to come to the surface.

[285] But we've done work with smoking cessation, so people trying to quit tobacco and haven't been successful.

[286] So a variety of reasons.

[287] So maybe I'll just ask some very simple questions that would kind of step us through the process.

[288] So let's say I were to sign up for one of these trials and I qualified for one of these trials.

[289] I'd show up.

[290] You said I would do several hours in advance of getting to know the team that would be present during this.

[291] psychedelic journey first there's screening so it's kind of like a couple of days of both psychiatric like structured psychiatric interviews about your whole your past and symptoms across the the dsm the psychiatric bible to see if you might have various disorders that that could um disqualify you like the main ones being the psychotic disorders schizophrenia and also including So the manic side of bipolar.

[292] So after that, and also cardiovascular screening, heart disease, after that screening, then the preparation where you get, you're both, you develop a therapeutic rapport with the people who are going to be in the room with you, your guides.

[293] But you're also then didactically sort of explained about.

[294] what the psychedelic could be like and that's kind of a laundry list because they're more known by their variability then you know it's gonna it's not like cocaine like you're gonna feel stimulated you're gonna feel like you know you can do any it's like you know or alcohol you're gonna probably gonna feel more relaxed it's like i call them uppers downers and all -arounders and the psychedelics are all -arounders it's like yeah you could be you could have the most beautiful experience of your life or the most terrifying experience of your life.

[295] So it's this kind of laundry list of like the things that could happen.

[296] So there's no surprises.

[297] I think it's so important for people to hear because the all arounders, they, the, you really can't predict how somebody is going to react internally.

[298] Right.

[299] I want to just briefly touch on something because we, we left that topic, but.

[300] It occurred to me that a lot of these effects of psychedelics and how they function, et cetera, is still very mysterious.

[301] But then I recall to mind that how most prescription antidepressants work is also very mysterious.

[302] They increase serotonin or dopamine or epinephrine, et cetera, but why they take weeks on end, several weeks to kick in, et cetera, is also mysterious.

[303] But going back to the experience of coming to your laboratory.

[304] Okay, so let's say that somebody passes all the prerequisites.

[305] And it's the day.

[306] Comes the day that they're going to have this experience.

[307] Are they eating mushrooms like you hear about?

[308] Or are they taking it in capsule form?

[309] And what sorts of doses are you prescribing?

[310] Is there a dose response curve?

[311] And then secondary to that, I'd like to talk about microdose versus macrodose.

[312] So how do they get this stuff into?

[313] How do people?

[314] receive it, and how do they get it into their body?

[315] So they receive pure psilocybin.

[316] So the mushroom, and there are many species, the most, people have taken mushrooms in the United States.

[317] It's most likely psilocybin cubensis.

[318] They're easy to grow.

[319] They grow in cow patties.

[320] It's easy for anybody to grow them in their closet.

[321] It doesn't take a thousand watt light, like cannabis.

[322] It takes like a little, you know, 10 watt light bulb in a Tupperware bin.

[323] So those are what Those are the types of mushrooms that people typically take.

[324] We're not administering those.

[325] Psilocybin is the compound.

[326] You could draw a molecule, psilocybin, again, based on the tryptamine structure.

[327] Like that's a single molecular entity.

[328] So it's a white powder.

[329] Does it look like serotonin molecularly?

[330] Yes, yes, yes.

[331] So if I were to show people the chemical structure of serotonin and the chemical structure of psilocybin, it would look quite similar.

[332] Right, right.

[333] So they're basically taking serotonin.

[334] A modified version of serotonin, which makes sense.

[335] But then again, this repeated theme of the chemistry doesn't always neatly line up because like mescaline looks more like dopamine than it does like serotonin.

[336] But yet at the receptor activation level, the pharmacological effect, those are similar.

[337] But yeah, I mean, and what it does at the receptor is an alternate.

[338] It's hitting the same switch, but then.

[339] having an alternate response at the receptor level.

[340] Yeah, so for people that don't necessarily understand the relationship between what we call ligand, the thing that parks in the receptor, and the receptor is the parking spot, one of the reasons that you can get such a variety of effects from different compounds is, for instance, serotonin might affect a certain pathway at a particular rate, and psilocybin might trigger activation of different components of that pathway at different rates, and so you can get vastly different.

[341] experiences from two things that look chemically similar.

[342] This is also a good reason why people shouldn't just assume that they can cowboy their own chemistry, right?

[343] That what you see on paper and what you can mix up in a vial is often vastly different than what you predict.

[344] Right.

[345] And there's a dose effect curve that's really interesting.

[346] Some of our early work with psilocybin in healthy normals.

[347] looked at a true placebo plus four active doses, five, 10, 20, and 30 milligrams of psilocybin.

[348] Body weight adjusted, so those milligrams per 70 kilograms of body weight.

[349] We've recently published a paper in our newer trials where we're dropping the body weight adjustment because going across hundreds of volunteers, we've kind of figured out that you shouldn't really be, you don't need to be adjusting by body weight.

[350] Interesting.

[351] So, yeah.

[352] Well, brain size doesn't vary that much between individuals.

[353] Yeah, yeah.

[354] And, you know, at the end, this is a brain effect, mostly.

[355] Probably body as well.

[356] Okay, so the person ingests the powder or capsule?

[357] In a little pill.

[358] Okay.

[359] Yeah, and it doesn't take 30 milligrams as a small.

[360] You could fit it into a tiny little capsule.

[361] And it'll take about a half hour, but anywhere from 15 minutes to an hour to kick in.

[362] And you said the dose range was?

[363] Most of our studies are looking at where we want a psychedelic effect are in the 20 to 30 milligram range.

[364] Again, because we have adjusted by body weight and the average American is over 70 kilograms, about 150 pounds.

[365] People, in fact, have gotten more like 40, 45 in a lot of cases.

[366] But it's still a small pill.

[367] for most of our studies, is not full of tasks.

[368] We really want to look at the therapeutic response.

[369] Obviously, if it's a therapeutic study, we want it to be a meaningful experience.

[370] And research has found, not surprisingly, that you get a less meaningful experience when you're in an fMRI or when you're doing a lot of cognitive tasks.

[371] We've done some research of that type, for sure, and plenty of colleagues have.

[372] But when you're in a therapeutic study or if you're trying to understand the therapeutic effects, you have to recognize there's this tradeoff of what you can do.

[373] So our typical therapeutic model, which, again, isn't just limited necessarily to the therapeutic studies where we're trying to treat a specific disorder, is to have that preparation so the person feels very comfortable with their guides.

[374] I mean, ultimately, what I tell people is like.

[375] Any emotional response, it's all welcome.

[376] I mean, you could be crying like a baby hysterically, like that's what you should be doing if that's what you feel like.

[377] And so in a lot of ways, sometimes people with psychedelic experience on their own, it can be harder to train them in this model because in the real world, people with psychedelic experience, a lot of times the rule is, you know, hold your shit.

[378] So, you know, several friends go to a party, they split a bag of mushrooms.

[379] It's like.

[380] you know, there's a social pressure for good reason not to be the guy, you know, in the corner of the room where everyone's trying to just have a good time, relax, like crying about your mother, your other friends are, they're having an experience too and you're being a drama king and blah, blah, blah.

[381] And so like, yeah, compose yourself, hold your - You're doing, I mean, you're doing therapy for people.

[382] This is, it's not just about the experience.

[383] Right.

[384] And the experience itself is very much shaped by - by that container, by the environment, and the degree to which one allows it to happen.

[385] Like, one should let go of control.

[386] Yeah, let's talk about the letting go of control, and then as we march through this hypothetical experience that does take place in your lab, so we're using a sort of generic case example, if you will.

[387] The letting go of control is an interesting feature, actually, because one of the common themes of of good psychoanalysis or psychotherapy of any kind is that there's a trust built between the patient and the analyst.

[388] And that relationship becomes a template for trust more generally and trust in oneself.

[389] It's actually the end goal of good psychoanalysis is that the patient actually, one of the end goals is that they develop an empathy for themselves, which almost sounds like an oxymoron.

[390] But if you spend a little time with that statement, it actually pans out.

[391] The psychedelic experience is one in which chemically you're under a new set of conditions, right?

[392] Let's coarsely, space and time are altered in some way, sense of self.

[393] For instance, I might be going to a strongly interoceptive mode where I'm focusing on everything within the confines of my skin.

[394] Whereas normally we're sort of interacting in space and pens and conversation.

[395] And I'm sort of, if I had, occasionally I'll pay attention to my breathing, but.

[396] I'm sort of dilating and contracting my focus for different things all the time.

[397] The letting go of control, it seems to me, could be sort of the expansion of one perceptual bubble to the point where you're not actually worried that that perceptual bubble is going to pop, meaning you're not worried about what people think of you.

[398] You're not worried whether or not your brain is going to explode, even though a thought could feel enormous.

[399] If I keep going like this, it'll almost sound psychedelic, but that's the idea here.

[400] Or if I'm paying attention, for instance, to some somatic experience, like the coursing of waves of heat through my body, that I'm not suddenly saying, you know, is that weird?

[401] I'm actually just going deeper and deeper into it.

[402] So it's essentially expanding our perceptual phenomenon.

[403] How do you convince people to go further and further down that path?

[404] What do you think allows them to do that?

[405] Because I think that to me is one of the more unusual aspects to psychedelics is that normally the social pressure, but also just our internal pressure from our own brain is pay attention to many things at once, not just one.

[406] Is that?

[407] Especially these days.

[408] Yeah, multitask.

[409] Yeah.

[410] Multitask.

[411] And the more that we focus on one thing, the more bizarre that thing actually can appear to us, right?

[412] Right.

[413] I mean, even if it's the tip of your finger and you're not taking any psychedelics, you spend a long enough looking at the tip of your finger, you will notice some very weird things, right?

[414] I think of that as the classic psychedelic effect or one classic effect and one I've used many times of this example of why.

[415] People shouldn't necessarily, you know, these aren't.

[416] These one should be judicious in putting themselves in these circumstances.

[417] Someone could be, you know, having a very strong psilocybin experience and they're trying to navigate their way in Manhattan, crossing the street, and they might be staring into the hand and like that's their hand is the most amazing miracle.

[418] Like the entire universe has essentially conspired to come to this one point.

[419] to make this absolutely breathtaking.

[420] It's almost like, I think of the simplest form of, well, we know the simplest form of learning is habituation.

[421] Simply keep applying stimuli and there's less response.

[422] Like, this is what organisms do.

[423] This is what we have to do.

[424] And it's like, there's this dishabituation component.

[425] Dishabituation.

[426] Yes, like we wouldn't be able to get through life if we wouldn't be able to cross that street if we were like.

[427] This is a miracle.

[428] No, I'm so glad you brought this up.

[429] I mean, here I'm reflecting my bias as a vision scientist, but most people don't realize this, but if you look at something long enough, it eventually disappears.

[430] It doesn't actually disappear, but perceptually it disappears.

[431] You have these little micro -saccades that ensure that it doesn't.

[432] But most of us don't look at any one thing for very long.

[433] The brain's default is to...

[434] perceptually jump around like crazy with the visual system, with the auditory system.

[435] We all, ADD, people talk about ADD a lot, is sort of baked into our underlying networks at some level.

[436] And then we can force attention.

[437] But it sounds like on psychedelics, one of the primary goals therapeutically is to really drill into one of these perceptual bubbles and expand that bubble.

[438] And the safety, it seems, is the safety, it's sort of like a permission to...

[439] to do that without worrying that something's going to happen right because you know i've had people there on the couch um yeah i remember one lady said this is probably uh 13 14 years ago said matt tell me again i can't die like i feel like my heart is going to rip through my chest i mean she was feeling her and i should say Typically, cardiovascular response is modest.

[440] The pulse and blood pressure go up somewhat.

[441] It can be dangerous for people if they're at severe heart risk, and we do - Are you monitoring this the whole time?

[442] We do.

[443] So they're plugged into a variety of devices.

[444] Yeah, so every half hour or so, we take their on protocol, and we space it out a little further, further into the time course, but we take their blood pressure and their pulse.

[445] And if it goes over a certain level, we have a protocol, and we've had to do this only a few times, but - The physician comes in, gives them a little nitroglycerin under the tongue and knocks the blood pressure down a little bit, doesn't affect the experience.

[446] So we have it all in place, even though they'd probably be fine out of an abundance of caution.

[447] But yeah, but someone can feel that, my God, I'm going to die.

[448] Like I have never felt my heart beat like this before.

[449] And like the experience of the breath can be just, you know.

[450] absolutely fantastic.

[451] And this sort of, and the breath is obviously interesting because it's this automatic, you know, control, but it can also be voluntary.

[452] So people can get into a sense of like, my God, what if I, it sounds silly.

[453] Like what if I forget to breathe?

[454] Exactly.

[455] But people can, that can be so compelling.

[456] And so one of the reasons, get back to one of your questions, it's like, what do we do to kind of allow them to go further into these?

[457] One is wearing the eye shades.

[458] We don't call them blindfolds because that has a negative connotation like being kidnapped.

[459] And they're probably seeing a lot in there anyway.

[460] So blind isn't the appropriate.

[461] Right, right.

[462] I've never thought of it.

[463] These should be like inner sight shades.

[464] But when you close the eyes, the levels of activity in the retina actually are maintained.

[465] It's just spontaneous activity.

[466] And it seems, and I'd be curious about your thoughts on this.

[467] I mean, but.

[468] The way I describe it is that the, you know, the mind's eye, you know, this kind of loose term we use can be on rocket boosters.

[469] So a lot of times for some people, like a compound like psilocybin, for some people, there's no perceptual effect.

[470] Like if they're looking at this room, it would pretty much look the same.

[471] Sometimes folks say, yeah, things seem a little bit brighter.

[472] Now, some people will say, oh my God, there's waves that wall is waving and these curtains are, you know.

[473] On these compounds, people don't typically see pink elephants.

[474] You do actually get that in another class.

[475] I didn't mention the anticholinergics, sort of like atropine and scopolamine, those drugs.

[476] Those are the true hallucinations where you thought you were having a conversation with someone who was never there.

[477] We will definitely get to those.

[478] But the reason I kind of cringe and say, oh my, when you talked about those is that knowing a little bit about the pharmacology of acetylcholine, the idea of manipulating that system to me sounds very uncomfortable because like the whole idea of witches and flying, there was a whole history there, you know, hundreds of years ago, so -called witches taking these agents and then thinking they were flying around on broomsticks and things of that sort.

[479] And there's a lot of mythology around the broomsticks that's complicated, but that sounds very unpleasant.

[480] One thing about the serotonergic, let's just, with psilocybin, So there's an expansion of a particular, fairly narrow percept.

[481] It could be sound, could be an emotion, could be sadness, could be a historical event or a fear of the future.

[482] And you've mentioned before that there's something to be learned in that experience.

[483] There's something about going into that experience in an undeterred way that allows somebody to bring something back.

[484] into more standard reality.

[485] Given the huge variety of experiences that people have on psychedelics, given the huge variety of humans that are out there, but what are now very clear therapeutic effects in the realm of depression, what do you think is the value of going into this fairly restricted perceptual bubble, what we are calling letting go or giving up control?

[486] Because if the experiences are many, but the value of what one exports from that experience is kind of similar across individuals.

[487] That raises all sorts of interesting questions.

[488] And this is not a philosophy discussion.

[489] We're talking about biology and psychology here.

[490] So let's say I decide I'm going to focus on the tip of my pen.

[491] I mean, in a psychedelic state, I could fall in love with this pen.

[492] I do happen to like these Pilot V5s and V7s very much, but I could feel real love for the pen.

[493] That's not an unreasonable thing to expect in a psychedelic journey.

[494] And in the context of your laboratory model, which I think is a great one, that experience would be just as valid as me going into the experience of some of the deep friction that I might have with a family member over my entire lifespan.

[495] And yet the export from those two vastly different experiences is one of feeling - a better relationship to the world and to oneself.

[496] Right.

[497] So what does this tell us about - Like how can the pen and the processing your childhood trauma both lead to - Right.

[498] Yeah.

[499] So what does this, I mean, at that level, it raises this question like, first of all, how, why?

[500] I mean, or just what are your thoughts on that?

[501] So this is definitely in the, this is in the terrain we're figuring out, you know?

[502] So there's no, the educated speculation is the best I can provide.

[503] But I - I think the common denominator are persisting changes in self -representation.

[504] Okay, tell me more about self -representation.

[505] That's the way one holds the sense of self, the fundamental relationship of a person in the world.

[506] I mentioned earlier that.

[507] these experiences seem to alter the models we hold of reality.

[508] And I think that the self is the biggest model, that I am a thing that's separate from other things.

[509] And that's, I am defined by certain, I have a certain personality and I'm a smoker that's having a hard time quitting, or I'm a depressed person that, you know, views myself as a failure and all of these things.

[510] Those are models too.

[511] And I think, I think.

[512] that change in self -representation may be an endpoint for these different experiences.

[513] I mean, maybe the falling in love with the pen, the whole idea that you're, especially in contemplation afterwards, and obviously I'm speculating here, but the whole idea that you could have such a deep connection with this random, obviously random aspect of the universe.

[514] could potentially lead to this, you know, transformed understanding of the self and like the pen may be a proxy for the miracle of reality in a way that relies nothing on, on no supernatural thinking.

[515] You know, you can be a hard atheist and take this, you know, ultimately, oh my God, like that, just like the pen, this is.

[516] You know, this is amazing, the fact that we exist.

[517] And so there could be an extrapolation chair.

[518] And you use the pen, but I think it sounds so similar to Aldous Huxley's classic description in the doors of perception of the chair and the drapes.

[519] Like he took 500 milligrams of mesclun.

[520] He was just like.

[521] Is that a high dose of mesclun?

[522] Yeah, yeah.

[523] And that's, you know, that's a heroic.

[524] for sure, and he's just going off on the chairiness of the chair, like this chair is exuding the quality of being a chair.

[525] So this is this expansion of the perceptual bubble, a narrow percept that then grows within the confines of that narrow percept.

[526] So sense of self is a very interesting phenomenon, and if we could dissect it a little bit.

[527] There's the somatic sense of self.

[528] So the ability to literally feel the self in this process we call interoception.

[529] And then there's the title of the self, the I am blank.

[530] And I noticed you said that several times.

[531] It's intriguing to me. I have a good friend.

[532] I don't think I can or should mention his name, but he had a very long and successful career within one of the more elite teams and within the SEAL teams.

[533] And he's a fairly philosophical guy.

[534] also a very practical guy, but he has said many times to me that the most powerful words in any language are I am, because whatever follows that tends, if you repeat it enough, tends to have this kind of feedback effect on how you are in the world.

[535] The first pass, it sounded to me a little bit like, you know, kind of like internet psychology type thing, like the secret or something, which frankly, I'm just not particularly.

[536] Yeah, you know, so if you kind of like the whole fake it till you make it, like I don't actually subscribe to any of that.

[537] But in dissecting that a little bit further with him, I came to realize that these words, I am, are very powerful.

[538] I don't think you reprogram your brain just by saying them, but how one defines themselves.

[539] internally, not just to other people, but how one psychologically and by default defines themselves, I think, is very powerful.

[540] And depressed people, as well as happy people, seem to define themselves in terms of these categories of emotional states.

[541] So I think it's so interesting that letting go and going into this perceptual bubble, which is facilitated by obviously a really wonderful team of therapists, but also the serotonergic agent allows us to potentially reshape the perception of self.

[542] That's a tremendous feat of neuroplasticity.

[543] Right.

[544] And I think - Certainly more work needs to be done.

[545] This is the horizon.

[546] And I should credit Chris Letheby, a philosopher in Australia who has a forthcoming book.

[547] It might be out right about now or soon within the coming months, Psychedelics and Philosophy.

[548] That's the title of the book?

[549] It might be psychedelic philosophy.

[550] It's really close.

[551] Chris Letherby, we'll put a link to it.

[552] Right, and so his conclusion in this, it's a really great book, and he really plays with the idea.

[553] It's like psychedelic experiences come along with a lot of supernatural stuff, experience.

[554] It can certainly go along with that, but the idea is like, can these experiences, including those therapeutic effects, be explained from a naturalist point of view?

[555] And his conclusion is that - Changes in self -representation may be the commonality.

[556] Now, that could go along with plant spirits and the Buddha and chakras and whatever your model system in Jesus, all of that.

[557] But it could also be completely devoid of any supernatural, any religious.

[558] And we do, in fact, see all of these varieties.

[559] So I think there's something about this change.

[560] in sense of self.

[561] There is, it seems to be something on the identity level, both with, I think of the work we did with cancer patients who had substantial depression and anxiety because of their cancer, and also our work with people trying to quit cigarette smoking.

[562] I mean, there's this real, there seems to be when it really works, this change in how people view themselves, like smoking, like really stepping out of this model, like.

[563] I'm a smoker.

[564] It's tough to quit smoking cigarettes.

[565] I can't do it.

[566] I failed a bunch of times.

[567] I remember one participant during the session, but he held on to this afterwards, said, my God, it's like, I can really just decide.

[568] Like flicking off a bike, I can decide not to smoke.

[569] And I call these duh experiences with psychedelics because people often, like in the cancer state, you say, I'm causing most of my own suffering.

[570] Like I can I can follow my appointments.

[571] I can do everything, but I can still plan for the I'm not getting outside in the sunshine.

[572] I'm not playing with my grandkids.

[573] I'm choosing to do that.

[574] And it's like they told themselves that before.

[575] And the smoker has told themselves a million times.

[576] I can.

[577] So it sounds when it comes out of their mouths and folks will say this is part of the ineffability of a psychedelic experience.

[578] Folks like I know this sounds like bullshit and this sounds like.

[579] But.

[580] My God, I could just decide.

[581] Like they're feeling this gravity of agency, which I think is interesting because regardless of the debates on the reality of free will, I think the philosophy of that, whether it's ultimately free will, like pure agency, if that exists, which I'm skeptical of, or just the idea that clearly we have a sense of agency.

[582] There's something there, whether it's the sense of agency even.

[583] that is the human being has.

[584] And that seems to be at times fundamentally like supercharged from a psychedelic experience.

[585] This idea like, I'm just going to make a decision.

[586] Like normally, like you tell a depressed person, like don't think of yourself that way.

[587] You're not a failure.

[588] Look at all that.

[589] It's just, yeah.

[590] It's like, and you can actually in one of these states have an experience where you realize like, my God, just like.

[591] using mdma to treat ptsd and we're going to be starting work with psilocybin to treat ptsd someone could really reprocess their trauma in a way that like has lasting effects and clearly there's probably something you know reconsolidation of those memories they are they are they are altered you know very consistent with what the our understanding of the way memory works so the whole idea people can actually in in a few hours have a such a profound experience that they they decide to make these changes in who they are and it sticks.

[592] There seems to be something like that.

[593] And that's profound.

[594] I mean, I think a few moments ago, I made some semi -disparaging statements about things like the secret and affirmations.

[595] And the reason I do that with a nod to the fact that the people who are putting those ideas forward are well -intentioned people is that the neural networks of the brain put language last.

[596] We tell stories, you know, and stories are very powerful.

[597] But I think one of the most cruel aspects of the whole self -help literature and popular psychology is this idea that everything you say, your brain and body hear it.

[598] That's actually a very unkind or even cruel thing for people who are depressed or anxious to hear, because if they hear that and believe that, and I want to be clear, I don't think it's true, that they think that it's very hard to control thoughts.

[599] It's very hard to control thoughts.

[600] So if somebody says, you know, I can't, and then somebody says, well, no, every time you say you can't, your brain hears that and it reinforces it.

[601] That's a very treacherous place to live.

[602] And language is powerful, but neural networks, the brain, and the networks that underlie emotionality and perception and sense of self, they don't change in response to language.

[603] they change in response to experience.

[604] And just fundamentally, there are some prerequisites.

[605] You need certain neuromodulators present, like serotonin or dopamine.

[606] You need them to be at sufficient levels.

[607] You don't need a drug necessarily to do it.

[608] You give a kid a kitten or a puppy, their first kitten or puppy, and the levels of dopamine and serotonin, I've never measured them, but we can be pretty sure that they are higher than baseline.

[609] And that experience will reshape them.

[610] Right.

[611] Yeah.

[612] Likewise with an adult in a certain circumstances.

[613] So I think I'm fascinated by this idea that a somatic and a perceptual experience, but a real experience of the sort that you're describing is what allows us to reshape our neural circuitry and to feel differently about ourselves.

[614] And I know there's been really tremendous success in.

[615] many individuals of alleviating depression, of treating trauma with these different compounds.

[616] I want to step from the experience under the effects of the psychedelic.

[617] So the person there with your team, they go into this expanded perceptual bubble.

[618] If things go well, they're able to do that to a really deep degree.

[619] Maybe it's the relived trauma.

[620] Maybe it's the beauty of their ability to connect to things in the world.

[621] Now I want to talk about the transition out of that state and then the export into life, because this is really where the power of psychedelics seems to be in the therapeutic sense, is the ability to learn, truly learn from that experience so that the learning becomes the default, that one doesn't have to remind themselves, oh, I am, you know, they don't have to do an affirmation.

[622] I am a happy person.

[623] I am a happy, you know, I always think of Bart Simpson, like writing on the chalkboard, right?

[624] Didn't work for him, doesn't work for this other stuff too.

[625] But.

[626] So as they transition out of this state, I know that there's a kind of a heightened, there's a so -called peak where everything seems to be kind of cascading in at such a level that the person just, they can't really turn it off at that point.

[627] It would be challenging.

[628] And then they start to exit the effects of the drug.

[629] Are those transition zones, are those valuable?

[630] Much like is the transition between a dream and the waking state.

[631] valuable because you're in a sort of mishmash of altered reality and new reality.

[632] Right.

[633] What do you do to guide people out the tunnel as they exit the tunnel?

[634] And I have to say, this is where we need more experimentation.

[635] Really, the clinical model goes back to literally the late 1950s.

[636] And there's been virtually no experimentation on, let's say, randomized people to We're going to talk more during the latter half of the session versus not.

[637] Versus we have them write an essay after their session versus not.

[638] Versus we have this amount of integration.

[639] What's the follow -up in your studies?

[640] Are they writing or talking as they're doing it?

[641] And it's called, you know, very loosey -goosey term integration.

[642] But for us means… As they're coming back from the experience is sort of five, six hours in, you know, so this is the afternoon.

[643] They've been dosed around nine o 'clock.

[644] So this is like four o 'clock or so.

[645] Just some initial tell us about the experience.

[646] Do you want to not unpacking it totally, but kind of initially just have a little bit discussion before they go home.

[647] So there's a little bit of that.

[648] But then that night, their homework is to write something.

[649] So it could be, you know, a few bullet points.

[650] It could be, you know.

[651] 20 pages and we we get everything you know in that range um but you know try not to be self -critical it's not great it like this is just to process and for a point of discussion the next day so they write something they come in the next day for a one to two hour depending on the study integration session basically just let's discuss your experience and depending on what study it's in like what you know what might that mean for You're dealing with cancer.

[652] What might that mean for your smoking or becoming a non -smoker?

[653] So you encourage them to simply take it seriously.

[654] And I think this, again, is sort of one of the points that could be the antithesis of what some just sort of social users use.

[655] I mean, this was written about by Houston Smith, the scholar of religion, in terms of these mystical experiences that can happen from psychedelics and how a lot of times.

[656] the attribution to a drug effect is dismissed.

[657] Like even if one has this, you know, this sense of being one with the universe and it totally like shakes their soul, so to speak, you know, but the next day their friends are like, oh, dude, you were screwed up.

[658] Too much acid for you.

[659] Woo.

[660] You know, like, man, next time you needed to have a few more beers to like bring that down, you know, like this sort of like, you know, social, you know, reinforcement for dismissing the experience.

[661] Oh, God.

[662] You're talking out of your head, man. Like, you know, even if it's, you know, good natured, but it's this dismissal.

[663] It's not like, you know, what you want to do, you know, is like, tell me more about that.

[664] You know, you were crying at one point, like in talking about your mom.

[665] Let's talk about that.

[666] What was that like?

[667] Do you remember that?

[668] Are you doing that follow -up or they're encouraged to do that in their own life with the various people in their life?

[669] Both.

[670] So we do that explicitly in the follow -up where we have these discussions.

[671] And depending on what the situation is, you might encourage the person to kind of follow up.

[672] The basics of it is supportive.

[673] therapy.

[674] It's non -structured.

[675] It's, you know, use all the, you know, reflective listening and the sort of the humanistic psychology, you know, unconditional positive regard for the person.

[676] But, you know, I think if, you know, if someone feels inclined to, you know, apologize to their, you know, to their sibling about something, it's like, yeah, go ahead and call them up.

[677] When it, with something big like a relationship change, it'd be like, Sit on that two weeks.

[678] Don't make any big.

[679] Don't end any relationship.

[680] Don't quit your job.

[681] Don't make any big.

[682] Do you also tell them not to start any relationships?

[683] I don't remember that ever coming up.

[684] Interesting.

[685] I'm not joking.

[686] I was just wondering, you know, but it makes sense.

[687] Like if they're dating and they're thinking like, ah, it might be time to take it to the next level.

[688] Should I ask this girl to marry me?

[689] If it did come up, I would say there too.

[690] Mind you sit on that a week or two.

[691] Yeah, don't get a puppy.

[692] And let your sober mind.

[693] Don't get a puppy.

[694] Certainly don't get four puppies until you're.

[695] I have a question about flashbacks.

[696] You know, one of the kind of things you hear is, you know, flashbacks.

[697] And that people, do people get flashbacks?

[698] And if so, what is the basis of flashbacks?

[699] The on the street lore about this is that somehow some of the.

[700] compound gets stored in body fat tissues and then released later like a is that complete nonsense no evidence for that so probably complete nonsense flashbacks are nonsense or the storage and body fat is complete the storage and body fat so to answer whether flashbacks are complete nonsense we have to define it so i really think these are multiple constructs that are going it's not the same thing that fall under that term There is a phenomenon that appears real that's called hallucinogen persisting perceptual disorder.

[701] It's in the DSM.

[702] A certain number of people, a very small number of people percentage -wise who have used psychedelics will have these persisting perceptual disorders.

[703] Like they'll see halos around things.

[704] They'll see some trails like the after images following an object in motion.

[705] they'll see distortions in color and it'll be like anything else that's a disorder in the dsm it has to be clinically distressing and it has to be persisting over some number of of months and and so very rare very mysterious some of the keys to that are amazingly it's never been seen in the thousands of participants either from the older era from the late 50s to the early 70s People in psychedelic studies with LSD, psilocybin, masculine, and it's never been seen in the modern era.

[706] Again, now with thousands of participants at a number of centers like ours throughout the world.

[707] So it seems to be something that is, for some reason, happening in illicit use.

[708] So that brings in, okay, is there polypharmacology?

[709] Because you're drinking during anything.

[710] Did you take what you thought you took?

[711] Yeah, what's the dose?

[712] What's the purity?

[713] But then also what I think is, Actually, even more so than that, what's likely going on is some sort of very rare neurological susceptibility.

[714] There is one paper that is a case series of individuals reporting these symptoms, and they didn't limit it to just people who had hallucinogen history.

[715] And the amazing thing about this is that a number of people...

[716] seem to have straight up HPPD diagnosis.

[717] What is HPPD?

[718] A hallucinogen persisting perceptual disorder who have never taken a psychedelic.

[719] So it's often prompted by alcohol, benzodiazepines, cannabis, even tobacco.

[720] And I believe in one individual, no lifetime history of any, it wasn't preceded by any of those substance uses.

[721] So I think it's, I think of it like the precipitation, exacerbation of psychotic disorders.

[722] It seems pretty clear through observation that some people with either predisposition or active psychotic disease, that this can destabilize them.

[723] The same way that a life experience can destabilize those person more easily.

[724] I think of it like that there's probably some pretty rare neurological susceptibility.

[725] We have tended, going, this goes back to the 80s.

[726] You know, clinical practice, it ended up in the DSM focused on hallucinogen because I relate it to the psychology of xenophobia.

[727] It's always the weird other thing that gets the attribution.

[728] You don't attribute to the thing like, oh, yeah, did you smoke cigarettes?

[729] Did you drink?

[730] It's like, well, yeah, but I see lots of people drinking and not ending up with this.

[731] Like you take a crazy like drug and you can get people.

[732] people to believe, all sorts of crazy stuff.

[733] The biggest example of that is the cathinone derivatives, so -called bath salts.

[734] And if you remember several years back, the guy in Florida that ate the other guy's face, there was a homeless guy that like literally ate part of someone's face off.

[735] Like, yeah.

[736] While the person was alive.

[737] While the person was alive.

[738] And all it took was one sheriff's deputy to say, well, I don't know, but I bet it was.

[739] some of that bath salts stuff that's been going on.

[740] The only thing - What was it?

[741] The only thing in his system - Maybe we could set the record straight for people.

[742] What was this?

[743] Why would he say bath salts?

[744] And was it bath salts?

[745] It wasn't.

[746] And so the only thing in his talks was cannabis, which we all know, typically people don't eat people's faces off after they get - Makes you hungrier, but not that hungry.

[747] Right.

[748] Right.

[749] So - It's just an example of the xenophobia.

[750] Like today, if you get on Google Images and look up bath salts, one of the most common images you'll see is this poor guy's face being eaten off.

[751] So we're just so ready to latch on, just like the people of another culture that we don't know about.

[752] It's very easy to assign attribution to a class that you're very unfamiliar with.

[753] So I think the psychedelics got that attribution with this very rare neurological.

[754] susceptibility the way that alcohol didn't so i think it's not specific to psychedelics but we don't really know we need but we look at it and our research have never seen an example of it but flashbacks can mean a number of other things i think the most common thing people experience is what we call state -dependent learning it's it's it's returning yourself to a similar context can bring back the same thoughts and emotions as the experience so Someone used mushrooms a week ago.

[755] Now they do something like they smoke some cannabis or they take a warm bath or they're simply relaxed.

[756] It seems to come out of the blue and all of a sudden these – or they follow a thought trail that takes them – that reminds them of their – and they find themselves in that same experience again.

[757] I think that's more state -dependent learning.

[758] not the distressing component that is in, and it's typically not perceptual.

[759] And then another class are just sort of perceptual anomalies within a day or two following the experience, which is not HPPD.

[760] Most people have joked that this is a free trip.

[761] Like you might see a few trails or halos the day afterwards.

[762] It doesn't last longer than that.

[763] And it's...

[764] doesn't screw you up.

[765] It's kind of fun.

[766] Like, oh yeah, I'm still seeing some trip.

[767] Most people will say.

[768] So it could mean any of those things.

[769] So flashback is, yeah.

[770] Interesting.

[771] No, I appreciate you clarifying that.

[772] I mean, one very common misconception about neuroplasticity is that it's an event and it's not an event, it's a process.

[773] And we have no understanding of the duration of that process.

[774] However, the experience of any drug or any life experience, right?

[775] Even if it's a trauma or a wonderful experience or a psychedelic experience, doesn't matter, sets in motion a series of dominoes that fall.

[776] And it's the falling of those dominoes that we call neuroplasticity.

[777] I mean, the reshaping of neural circuits could take years.

[778] We don't know.

[779] It's the trigger and then there's the actual change.

[780] And so I think that some of what you described could be Literally, the reordering of circuitry that in some individuals might extend longer than others.

[781] And there is one phenomenon that I've been told people experience.

[782] And I'm wondering whether or not any of the patients you've worked with or people in your trials have reported this.

[783] I've never done ayahuasca.

[784] which I'm assuming has some overlap with the serotonin system, probably hits a variety of systems.

[785] So it's DMT, the active, yeah, it's orally active, MAO inhibitors that allow the DMT to be orally.

[786] Right, I should have recalled that, absolutely.

[787] Well, I've never done it, but a number of people I know that have done ayahuasca, as well as people I know who have done MDMA, report an increased sense of what is sometimes called ASMR, these autonomic sensory meridian reflexes, which is, And it's interesting, a lot of people have these naturally and they hide these.

[788] It's actually something that many people keep hidden to themselves.

[789] I'll just ask you if you can do it.

[790] So some people are able to pass a shiver down their spine or up their spine consciously.

[791] I'm able to actually pass a shiver up my spine.

[792] I actually learned how to do this when I was a kid on a hot day.

[793] I was standing on a field in sports camp and I was like, it's really hot here.

[794] And I could actually create a cooling.

[795] a percept, cooled perception.

[796] Some people, I told someone this once, and then this led to a discussion of, oh, I can do it, but I always hid that from people because it's actually somewhat pleasurable.

[797] And this is a well -known phenomenon, ASMR.

[798] And some people I know who have taken MDMA therapeutically or ayahuasca will report that they feel great relief from this.

[799] They can generate these autonomic reflexes through their body more readily.

[800] Probably, I'm guessing, because they, we're able to tune into a kind of deeper sense of somatic self.

[801] Now on the internet, ASMR, if you look it up, it's a little bit like the bath salt thing, but in the other direction, like there were people that pay, let's just say there are accounts on YouTube that have many, many millions of viewers of people that will whisper to them about, like for instance, there's people that will go listen to it seems to be women in particular whispering about like car mechanics or something or about, or scratching.

[802] So there are certain sounds will do this, whispering, tapping, finger tapping, and people experience immense pleasure from it.

[803] It's not really sexual pleasure, but it's this kind of deep core of the body.

[804] It's the autonomic nervous system down the core of the spine.

[805] Probably what a certain number of people would call kundalini, which is another one scientifically, yeah.

[806] That's right.

[807] And people who do long duration kundalini breathing sessions.

[808] many of them will report later feeling as if their perception of self is outside of their head.

[809] That they're literally walking, it's very uncomfortable for them.

[810] That they feel like they're walking around with their sense of self extended beyond the body.

[811] And this is a clinically described neurologic phenomenon.

[812] Have any studies been done?

[813] I would imagine that person might actually like, would they duck?

[814] Like that would be an interesting experiment.

[815] That would be the kind of thing my lab would want to get into.

[816] Yeah, their body could clear, but their projection wouldn't.

[817] Yeah, the sense of self, I mean, there's a well -known phenomenon.

[818] It's very, in a few individuals, it's very sad where people actually avidly seek out amputation of their limbs because their limbs they feel don't belong to their body.

[819] Oh, yeah.

[820] This is very sad and fortunately very rare, but also very sad condition.

[821] Anyway, I think that the core of this.

[822] conversation that we're drilling into is this notion of reordering the self.

[823] And it's a relief to me to know that flashbacks are not something that is kind of, forgive the term, baked in to the psychedelic experience.

[824] And I suppose that's a good segue to ask about other sorts of drugs.

[825] Having said baked in, the temptation is to go to marijuana or cannabis.

[826] But if we could, I'd like to just ask about some of the more dopaminergic compounds, in particular MDMA.

[827] My understanding is that MDMA is a purely synthetic compound, that you're not going to find MDMA in nature.

[828] So far.

[829] So far.

[830] DMT was first synthesized in the lab, and then we thought it didn't exist in nature.

[831] And then like Richard Schulte's… found it like everywhere in South America.

[832] So who knows, a plant out there might be making MDMA, but as far as we know now, no. Right, and we'll talk about DMT and its sources within the body.

[833] But MDMA could exist elsewhere, but has been synthesized.

[834] And my understanding is that MDMA leads to very robust increases in both dopamine and serotonin simultaneously, which...

[835] from a neural networks perspective, is a very unusual situation, right?

[836] Normally, because dopamine puts us in this exteroceptive, looking outside ourselves, seeking things in the world beyond the skin, our own skin, and dopamine, excuse me, serotonin tends to focus us inward.

[837] Those are almost mutually exclusive kind of neurochemical states, although they're always at different levels.

[838] So why would it be that having this increased dopamine and increased serotonin would provide an experience that is beneficial?

[839] And how do you, to the extent that you can describe it, how do you think that experience differs from the sorts of experiences that people have on psilocybin or more serotonergic agents, just broadly speaking?

[840] Yeah, yeah.

[841] In terms of the effects generally on serotonin and dopamine, i can only you know speculate you know like sort of is that dopaminergic component necessary for, let's say, we know that the amygdala is less reactive under acute effects, and that may play a role in, there's less sort of control from the amygdala in terms of like one's experience of memory.

[842] So it may be part of this sort of reprocessing, this reconsolidation of these memories in a different way where the amygdala is not like going crazy, saying freak out, like, you know, fight or flight.

[843] What I should have said, seems like MDMA is being used clinically anyway, mainly for trauma, not just for depression.

[844] Although part of that, we really don't know.

[845] And maybe that MDMA is great for depression and some of these other, and it may be that, and I'm going to be looking at this soon, that psilocybin is great for treating PTSD.

[846] A lot of underground therapists say that, underground psychedelic therapists.

[847] So we don't really know yet which people doing illegal.

[848] But more like a professional therapist would, it's just illegal.

[849] And this is kind of a growing thing.

[850] So we don't really know which.

[851] It's speculating, but it may be that MDMA for a broader number of people is better for trauma because the chances of having an extremely challenging experience, what I call the bad trip.

[852] like really freaking out is much lower with MDMA.

[853] People can have bad trips, but they're of a different nature.

[854] It's not sort of like freaking out because all of reality is sort of shattering and it's less of this.

[855] It can take so many forms with the classic psychedelics, but like typically you'll hear something like, I didn't know it was going to be like this, no matter how hard you tried to prepare them that like this.

[856] is like, get me off this ride.

[857] You're talking about LSD or psilocybin?

[858] LSD, psilocybin, ayahuasca.

[859] Yeah, yeah.

[860] And just this sense of like, I'm going insane.

[861] This is so far beyond anything I've ever experienced.

[862] And it's scaring the shit out of me. I don't have a toehold on anything, even that I exist as an entity.

[863] And that can be really, I think, frankly, experientially, that's kind of the gateway to both.

[864] the transcendental mystical experiences, the sense of unity with all things, which we know our data suggests is related to long -term positive outcomes.

[865] Wait, I want to make sure I understand.

[866] So you're saying the bad trip can be related to the transcendental experience?

[867] Right.

[868] I think those are both speculating, but you have to pass through this sort of like.

[869] you know, reality shattering, including your sense of self.

[870] And one can handle that in one of two ways.

[871] You can either completely surrender to it or you can try to hang on.

[872] And if you try to hang on, it's going to be more like a bad trip.

[873] So again, I wish there was more and hopefully there will be more experimentation.

[874] There's a lot going on here in the black box in terms of the operant behavior of how you are, you know, within yourself.

[875] choosing to handle, like letting go, you know, and eventually we'll be able to see this in real time with brain imaging.

[876] Ah, there they are surrendering to the psychedelic experience.

[877] Here they are trying to hold on, but we're not there yet.

[878] But I think it's a good, through clinical observation, seems pretty clear that something like that is going on.

[879] And certain drugs like DMT, smoked DMT can be so strong.

[880] The reason I think that can be so extraordinary, you can compare to the others because it like forces people.

[881] Like there is no choice to hang out.

[882] I've never done it.

[883] I was told that DMT is like a high -speed locomotive into the psychedelic experience and out of the psychedelic experience.

[884] And there's no ability to hold on to the self while you're in the kind of peak phase.

[885] Is that correct?

[886] A lot of people say that, but Terrence McKenna, who's kind of the classic bard on DMT effects, he would say the sense of self.

[887] was intact, but everything else, the sensorium and what you navigated, what you oriented towards, everything else changed basically.

[888] But it's hard to, when everything's changing, it's hard to say like, what is the self that's changing?

[889] What is the rest of the world?

[890] Well, and language is totally deficient to describe experience anyway, much less on a psychedelic.

[891] What is McKenna's background?

[892] Like what is his qualification for being this?

[893] as you referred, this bard of DMT.

[894] And we're talking about Terrence, and there's also the brother Dennis, whom I know, who's - You can only imagine what Thanksgiving dinner is like at their house.

[895] Terrence passed away years, a couple decades ago now, but he's sort of the one who's known as being a bard, and you can find hundreds, if not thousands, of hours of him.

[896] on the lecture circuit in the 80s and 90s on YouTube.

[897] But his background was really, oh gosh, I don't recall what his college degree was in, but he basically, when he was like 19, he traveled to South America and actually on the initial trip with his brother, who was even younger than him, with some other friends and just...

[898] In search for a DMT snuff that they had read about in the Harvard archives from the work of Schultes from a generation before, but they had discovered all of these mushrooms growing down there, the psilocybin mushrooms, what they recognized and just took a lot of mushrooms and - And talked about it.

[899] And Terrence was basically a very intelligent, very well -read in literature and culture person.

[900] He was sort of the next generation's Tim Leary, someone who could really speak, get a little closer to the magnitude of what the psychedelic experience was like for people.

[901] And he served, like Leary, somewhat of an advocate.

[902] I mean, he would tell people.

[903] Folks, you could see the equivalent of a UFO landing on the White House lawn.

[904] It's right there.

[905] It'll take five minutes.

[906] It'll shake everything in your reality.

[907] He would sort of goad people into doing it.

[908] Well, certainly science and clinical medicine are just but two lenses with which to explore these things in life.

[909] But part of the reason I ask is I feel like in the world of health and fitness, you have this very extreme condition of like Arnold Schwarzeneggers and bodybuilders who have like 2 % body fat.

[910] And they look like, to most people, they look kind of freakish, especially now, right?

[911] Oh, especially now.

[912] Especially now.

[913] Yeah.

[914] And yeah.

[915] Made Arnold look like regular.

[916] Exactly.

[917] Back in his day.

[918] Yeah.

[919] And you have contortionists who can put themselves into a small box and wrap themselves into a pretzel.

[920] But from those two very extreme subculture practices, that I don't know anything about contortionism really, but except that they get really bendy.

[921] But it was a community that included lifestyle practices and nutritional practices and then drug practices.

[922] From those very extreme subcultures, there's been an export, which is that, you know, weight training is healthy, right?

[923] The general public has done that or that yoga is healthy.

[924] So contortionism to yoga.

[925] et cetera.

[926] And I feel like a similar thing is happening in the realm of psychedelics, where it was Leary and Huxley.

[927] I mean, I'm from the Bay Area.

[928] I'm not far from the Menlo Park VA, where One Flew Over the Cuckoos is basically based on, right?

[929] Ken Kesey and those guys.

[930] And there has been an attempt at creating this movement toward openness about psychedelics and their positive effects.

[931] This has happened before.

[932] The difference is that now there are people like you inside the walls of the university or publishing peer -reviewed studies and things of that sort.

[933] The reason I asked about McKenna was, you know, it seems like McKenna and his brother are, but, you know, just two of many people, Michael Pollan, et cetera, who have no real formal training in biology or psychology.

[934] the other guys who were at universities lost their jobs.

[935] They were actually removed from places like Harvard and other universities for their kind of cavalier explorations, right?

[936] And now things are kind of returning.

[937] So in the same way that bodybuilding led to weight training in every corner gym, you know, men, women, and children.

[938] And contortionism is one extreme, but people generally think that yoga is a pretty healthy practice, right?

[939] These are matter of degrees, right?

[940] And now here you are inside the walls of a very highly respected university, Johns Hopkins.

[941] You're on the medical school side of the undergrad.

[942] So in the med school, which is a serious health institution.

[943] The question is to me, you know, what are the valuable exports, right?

[944] And where does the extreme lie?

[945] I mean, clearly there's a problem with tinkering with reality through pharmacology.

[946] And there's a benefit, it sounds like, to tinkering with reality through pharmacology.

[947] And what's so striking to me is the elements of atypical experience, atypical representation of the self.

[948] So for the average person, right?

[949] Or for kids that are hearing this, kids that are in their teens, right?

[950] I want to talk about what are the dangers of psychedelics?

[951] This is something you don't hear a lot about these days, and it's not because I'm anti -psychedelic at all, but what are the dangers, right?

[952] If a kid or adult has a predisposition toward, let's say, psychotic thinking, right?

[953] Or auditory hallucinations, or is on the Asperger's side of the autism spectrum.

[954] Is there an increased risk of bringing the mind into these states?

[955] Because it sounds like a very labile situation.

[956] So could we talk a little bit about that?

[957] And are there classes of these different drugs, whether or not it be MDMA, LSD, or DMT, that you think are particularly sharp blades and therefore need to be wielded?

[958] particularly carefully?

[959] Yeah, so these can be profoundly destabilizing experiences and ones that, you know, ideally are had in a safe container, you know, sort of where someone, you know, what are the relevant dangers and what can we do to mitigate those?

[960] So there's two biggies.

[961] One, and I've already mentioned, it's people with very severe psychiatric illness, not depression, not anxiety.

[962] I'm talking about psychotic disorders like schizophrenia or mania as part of bipolar disorder.

[963] And diagnostically, this has shifted, so it's a little hard to say how many people today with bipolar would have been labeled as schizophrenia back in the 60s when some of this early research or just clinical observation was done.

[964] it seems very clear that folks with a predisposition or active disease, they could be destabilized.

[965] And so some of the cases that we know of, I always think of Sid Barrett, the first singer of Pink Floyd.

[966] Seems pretty clear, although I think the family - I don't know what happened there.

[967] I should be, sorry, Pink Floyd fans.

[968] I've never, the songs are just really long.

[969] Yeah, you're more of a punk guy, right?

[970] Yeah.

[971] So I've got my foot in a lot of worlds, definitely in part in the Floyd world.

[972] But he basically went crazy early on.

[973] I don't think his family ever admitted it, but he developed schizophrenia, classic pattern.

[974] And he was doing a lot of LSD.

[975] you know, some hints that he had that susceptibility before.

[976] And often this is hard to disentangle what causes what, because when do people typically, not always, but develop, when's the modal period for first break?

[977] It's adolescence, early adulthood, yeah.

[978] And when do people start playing with drugs?

[979] Same exact time period.

[980] So it can be hard to disentangle, but it seems pretty clear.

[981] Now, I should also say, There are cases of folks with schizophrenia that say psychedelics have helped them.

[982] There's anecdotes for everything.

[983] Do the people around those schizophrenics say it's helped them?

[984] I don't know.

[985] Because when schizophrenics say things, you have to, I mean, with all due compassion and respect for schizophrenia, it's a disorder of thinking.

[986] So if they're saying it helped them.

[987] Yeah.

[988] Can you trust them?

[989] Yeah.

[990] I wouldn't be surprised if there was some kernel of truth in some cases, but they're just so.

[991] It seems very clear that the other side is there too and that there ever is a therapeutic potential there for those disorders.

[992] That shouldn't be the first thing on our list.

[993] We need to learn a lot more because of the level of risk before we start doing research to see if psilocybin can help with schizophrenia.

[994] I don't think that that may never be the case, but even if it is, you'd have to be even more cautious and figure some more things out first with some of these other disorders.

[995] What about bipolar?

[996] Bipolar disorder, can it be exacerbated by these?

[997] Yeah, and it may be that sort of the manifestation of people having prolonged psychiatric issues after a psychedelic experience, as atypical as that is, when that happens, it may be that might be more like a manic episode than a psychotic episode, and that can be a blurry line.

[998] The folklore is that, you know, people go on a trip and they never come back.

[999] That's clearly not the case because, you know, the drug is metabolized like for anyone else.

[1000] And the next day there's not, you know, there's virtually nothing in the system.

[1001] But it was shaped circuitry, I mean.

[1002] Right.

[1003] And there's still, and I really do think, you know, much like the positive, you know, long -term effects that, you know, this class of problems is related to like the, to the experience and the destabilization.

[1004] that can happen from that experience if it's not in the right container.

[1005] And again, like these people are susceptible to, you know, some people with that psychotic predisposition, they're lucky to be born to a great family, stable environment.

[1006] They maybe never have a full break or the one that they have is not nearly as bad as what.

[1007] someone who's homeless and is coming from all kinds of early childhood trauma, the disease is probably going to be far worse.

[1008] So having a psychedelic experience is like one of those destabilizing experiences.

[1009] Now, fortunately, it's really easy to identify those people.

[1010] err on the side of extreme caution by eliminating people with, like, say, a first -degree relative.

[1011] In some studies, even a second -degree relative.

[1012] Given the heritability, there's some increased chance if you're a brother or you're—yeah.

[1013] So in an abundance of caution, even eliminating—I think eventually if it's approved for use, FDA use, we could dial back on that as we learn more.

[1014] I think it's, again— overly cautious, which is probably the appropriate place to start at this point in time.

[1015] But if you give a skid or another structured psychiatric interview with a clinician sitting down with this person for a few hours to delve into their history, you can very reliably determine at this person.

[1016] has either a psychotic disorder or bipolar disorder or a strong predisposition.

[1017] So you can screen for that, and that's how you address that.

[1018] The far more likely danger is the bad trip.

[1019] Anyone can have this.

[1020] The most psychologically healthy person in the world, probably.

[1021] You jack the dose high enough, and especially in a less than an ideal environment, you can have a bad trip.

[1022] You even get it in an ideal environment like ours at a high dose of around 30 milligrams of psilocybin.

[1023] After the best preparation we can provide, about a third of people will say, essentially, at some point, they have a bad trip.

[1024] At some point within the entire journey.

[1025] Right.

[1026] Now, they could have one of the most beautiful experiences of their life sometimes.

[1027] a couple minutes later.

[1028] But at some point, they had a sense of strong anxiety, fear, losing their mind, feeling trapped, something like that.

[1029] Now, typically when people have that, when they're just taken on their own, like a lot of things, they're fine.

[1030] They get through it.

[1031] They're more likely to be better off if they're not having to navigate the streets of Manhattan.

[1032] And if they're with other people with friends.

[1033] that those friends aren't also dealing with their own psychedelic experience, but probably having some friend of any type or whatever on there is better than having nothing.

[1034] So very dependent on context.

[1035] And so the tough thing here that in conveying to the public is that a lot of folks will say, man, I've taken psychedelics hundreds of times and this is like your fear mongering and.

[1036] You know, there's no, you know, you're exaggerating the danger there.

[1037] So I want to say it is atypical, but sometimes, and I have a file folder that grows larger every year of these cases, either in the medical literature or from the news of people that freak out on a psychedelic and they get hurt or they die.

[1038] They run into traffic.

[1039] They fall from a height, whether they thought they could fly or whether they just fell like they.

[1040] you can do when you're drunk or you're intoxicated on any substance.

[1041] Sometimes that's unclear.

[1042] Or, gosh, one of the craziest cases was a kid, like an 18 -year -old or so, in Oregon several years back that just, he even wrote about, I want to take the biggest, he had done mushrooms before, I want to take a heroic dose, the biggest dose I've ever taken.

[1043] He ended up just totally out of it, ended up in a neighbor's house.

[1044] He was just totally disoriented, disconnected from reality, and the cops ended up killing him.

[1045] And it was just tragic, obviously an overuse of force in that case because he was actually naked at the time, this naked like 120 -pound, I think, as I recall, kid that ended up dying.

[1046] Well, it's analogous to the reason I use the examples of like bodybuilding culture.

[1047] I mean, people there have taken excesses of amounts of anabolics and diuretics and died.

[1048] Then the contortionist culture, people have put themselves in a little plexiglass boxes to do, you know, at the extremes.

[1049] you're going to get deaths.

[1050] And at the extremes, and one of the extremes is the sheer number of people with different biological makeups taking the same drug.

[1051] And so you can create extremes through numbers.

[1052] You can create extremes through dosage, right?

[1053] It seems.

[1054] Well, this is why I'm such a fan of the fact that people like yourself are doing clinical trials inside the walls of universities, not because I think that psychedelics only have utility in those environments, but because it's so important toward creating their transition to legality and to understand what legality means for a compound like this, right?

[1055] Right, what model?

[1056] Right, I mean, again, we'll stay with the anabolic steroids.

[1057] There's now testosterone and estrogen replacement therapy.

[1058] Hormone replacement therapy is a common...

[1059] medically approved practice, but that's vastly different than people taking their own stuff or diet or deciding how much they need to take, right?

[1060] Like we said, there's yoga and there's contortionism in a plexiglass box and thinking of Houdini or something.

[1061] So these are a matter of degrees.

[1062] Speaking of dosage, I definitely want to ask you about microdose versus standard or macro dose.

[1063] Tell me that I'm wrong, but - I'm always a little bit, I'm microcynical, if you will, about this term microdose.

[1064] And the reason is that many people that I know who talk about microdosing are taking dosages of compounds that are very powerful at microgram levels.

[1065] So the word micro, I think, can be a little bit confusing to people because microdose implies less than something.

[1066] It's a mini dose, right?

[1067] And yet some of these compounds are tremendously powerful at microgram concentrations.

[1068] So what constitutes a microdose and what is the value of so -called microdosing, if any, and how does it differ from standard or what I can only assume is called macrodosing?

[1069] Yeah.

[1070] And so LSD would be the prototypical example of that super potent.

[1071] What size dosage of LSD will lead to hallucinations and kind of standards?

[1072] So sort of the entry point for psychedelic -type effects, which may not involve hallucinations.

[1073] Actually— Most classic psychedelics don't lead to true hallucinations as defined in psychiatry of, you know, thinking you're talking to the person that's not there, seeing the pink elephant.

[1074] No, it's more like tracers and things like that.

[1075] Right, and some people never get that even at a very high dose.

[1076] So I think more broadly in terms of the psychedelic effects, which isn't just perceptual, unless we get into the level of, as you were alluding to earlier, a broader definition of perception like.

[1077] one's models of the world, the model of the self, you can consider all of that perception in terms of, you know, truly not sensation, but the perception, the construction of putting together reality.

[1078] So yeah, yeah, yeah.

[1079] So the psychedelic effects are typically considered to start for LSD around 100 micrograms.

[1080] So a 10th of a milligram is 100 micrograms.

[1081] Right.

[1082] So someone taking 100 micrograms of LSD, they - Nowadays, people might mistakenly refer to that as a microdose because it's micrograms, but that's actually a macrodose of LSD.

[1083] Right.

[1084] And that's one of the most common mistakes or situations that people get into with microdosing is they intend it to be a microdose, but it ends up being a full -blown dose.

[1085] Now, people do, when they're working with LSD and they're microdosing, they'll shoot for something like, say, 10.

[1086] you know, something in that range, 10, 20 milligrams of LSD.

[1087] So, you know, a 10th, a 5th, something of kind of your entry -level psychedelic dose.

[1088] People's ability on the street to do this, you know, I say the street as if they're on the corner, but anyway, like outside of the medical profession to do this, like it varies as you can do.

[1089] And they're not measuring purity or molarity or things like that, typically.

[1090] And there's ways to do it.

[1091] So even if you don't ultimately know the dose that's in like the blotter paper of acid, One could at least get a sense of like, yeah, having one of those tabs is one of those hits is a psychedelic experience.

[1092] They could do something like put it in water.

[1093] It's 100 % aqueous soluble.

[1094] You could, you know, make sure it all gets into solution and then volumetrically measure.

[1095] It's going to be homogeneously distributed.

[1096] So you can take one tenth of that volume of water after it's fully dissolved.

[1097] You know that whatever you started with, you're going to have a tenth of that dose.

[1098] So the people that are more sophisticated.

[1099] We'll do things like that.

[1100] And when they're working with mushrooms, they'll grow a bunch of mushrooms, and then they'll, say, put it in a coffee grinder.

[1101] I'm not telling people to do this, by the way.

[1102] I'm just describing, so don't do this at home.

[1103] But, like, grind it all up so it's homogenous.

[1104] Because you can have, like, you know, sort of taking, you know, two caps and a stem.

[1105] Hey, this two caps and a stem that this buddy takes has a different potency than this two caps and a stem that the other buddy takes.

[1106] people that are kind of in the know will grind it all up into a homogenous powder, and they'll pack it into whatever size capsule, and they'll know that.

[1107] And again, even if they don't have, sometimes they might have a buddy that'll sneak it into the HPLC at their job or whatever, if they have.

[1108] Not your lab.

[1109] Not my lab.

[1110] That's never happened.

[1111] Seriously, it never happened.

[1112] But they'll at least know that, hey, I've got a sense of what two capsules do.

[1113] I've got a sense of what five capsules do.

[1114] But in reality, Like that's not what people do.

[1115] They'll take a piece of blotter paper and they get a tiny little pair of scissors, a Swiss army knife pair of scissors, and they'll cut up the tab of acid, which is like, you know, a quarter inch square or something.

[1116] And they'll cut it up in 10 little pieces.

[1117] And it's like, I got, you have no idea.

[1118] Like if it's equally distributed in that media.

[1119] Yeah.

[1120] And we can chuckle about it.

[1121] And, um, but to me, One of the reasons why this experiment around psychedelics, this cultural experiment and this legal experiment, we're seeing this now, but this was all attempted once before in the 60s and 70s.

[1122] The difference was it was all out in the street.

[1123] The people in universities who were dabbling with this stuff, most of them lost their jobs or were asked.

[1124] to leave through, you know.

[1125] They lost their funding for this research minimally and they had to move on to other topics.

[1126] That's right.

[1127] So these are precarious times.

[1128] I mean, we're at a key moment where everyone assumes that this is all going to be legal in a few years.

[1129] But I think that that's a premature assumption, frankly.

[1130] But, and let's touch on the legality and some of the things that are happening now.

[1131] But what is microdosing psilocybin versus the sorts of dosages that you described before in the 10 to 40 milligram range.

[1132] I've heard of people taking one or two milligrams of psilocybin every day as a way to quote unquote, and for those listening, I'm just making air quotes with my fingers, increase plasticity, which is a term that I personally loathe because what does that mean?

[1133] I mean, you don't really want your brain to be plastic because you need to maintain your ability to make predictions.

[1134] Yeah, I mean, plasticity.

[1135] Order and chaos, like prediction.

[1136] You need models of the world.

[1137] You need heuristics.

[1138] Plasticity is never the goal.

[1139] I'll repeat it.

[1140] Plasticity is never the goal.

[1141] Goal -directed plasticity is the goal, right?

[1142] Learning a language, reshaping your experience to a trauma, altering the perception of self.

[1143] But plasticity is a process.

[1144] Yeah, schizophrenia is… a lot of plasticity.

[1145] Exactly.

[1146] Right.

[1147] It might even be, there's one theory that it's extreme ongoing plasticity, and that's why people never create stable representations of anything.

[1148] That's a kind of a minority view out there.

[1149] But so what's the business with microdosing?

[1150] And is there any clinical evidence or peer -reviewed published evidence that it works, quote unquote, to make people feel better about anything?

[1151] So microdosing is, is the aim of taking, again, something around a 10th of what would be sort of an entry -level psychedelic dose for whatever compound.

[1152] So like, yeah, with psilocybin, usually people almost never do people have like pure psilocybin.

[1153] Like one milligram of psilocybin would be in the range of a microdose.

[1154] More likely people are going to have, you know, mushrooms.

[1155] So like something like a half of a gram of mushroom.

[1156] I know people that are doing this every day.

[1157] They're doing these every day.

[1158] It's like in their, like the same way that I take, like I'm personally, I'm not recommending other people do this, but I take some, I'm a fan of LCL carnitine lately.

[1159] I've been kind of experimenting with that a little bit, which is not a psychedelic compound.

[1160] I take it every day and they're taking their - That's their supplement.

[1161] Every day, that's their supplement.

[1162] Yeah.

[1163] So.

[1164] So yeah, the claims are, and there are a number of them.

[1165] There's two general ones.

[1166] One is sort of acting in place of the ADHD -treating drug, so the psychomotor stimulant.

[1167] So like a better version of Adderall.

[1168] The other claims are essentially a better version of the traditional antidepressants, a better version of Prozac.

[1169] So people are taking both for attention deficit and for depression.

[1170] Yeah, and the aspects of those disorders that— You know, we all have a degree of just like amphetamine is going to increase the focus of at the right dose of anyone who takes amphetamine pretty much, whether you're ADHD diagnosed or not.

[1171] The idea is that, you know, that there may not be a necessarily a clear divide between the therapeutic need and, you know, positive psychology, you know, even improving mood and focus, you know, you know, so it's not necessarily correcting, you know.

[1172] ADHD, but improving focus to supercharge your life.

[1173] And so those are the claims.

[1174] So none of the peer -reviewed studies that have much credibility, none of them have shown a benefit.

[1175] And they've tried.

[1176] Now, there's only at this point four or five studies that—and I think for things like this, you really need— double -blind research because the effects, I mean, there was one study done in Amsterdam where people knew they were taking psilocybin truffles, basically same as mushrooms.

[1177] They're more like the roots of the mycelia.

[1178] Microdosing them.

[1179] Well, taking what would be considered a microdose and then doing some cognitive measures before and after.

[1180] And the types of things that, you know, like a lot of cognitive measures are measured on the order of reaction time in milliseconds.

[1181] I mean.

[1182] And the types of effects you get, as you could imagine, are ones that like would be, you would totally expect could be there from either a practice effect or an expectancy effect, a placebo effect.

[1183] So, you know, for something like these claimed, you know, you can imagine a sort of an increased focus, you know, enhancement of cognition.

[1184] These are like going to be more subtle effects that you really need a good.

[1185] placebo control for.

[1186] The handful of studies that have done that have shown they've ranged from finding no effect whatsoever to just a little bit of impairment, like impairing someone's ability to do time estimation and production tasks.

[1187] So you want an accurate sense of time, at least if you're navigating in the real world.

[1188] It's different if you're on the couch on a heroic dose for therapeutic reasons where you're safe, but if you're crossing the street, if you're getting, you know, in your work life.

[1189] Which is the way people are claiming to use that helps them be a better CEO.

[1190] Like you want an accurate sense of time.

[1191] So if anything, the data suggests that it makes it a little bit less accurate.

[1192] And there's evidence that someone feels a little bit impaired and they feel a little bit high.

[1193] So in terms of, you know, you call that abuse liability in research, not surprising.

[1194] You take a little bit of a drug that can result in a. some type of a high and you take a little tiny bit of it, you'll feel a little bit high.

[1195] So, you know, none of the, so far, no studies have shown, you know, any increase in creativity, enhancement of any form of cognition or a sustained improvement in mood.

[1196] Now, no studies have actually looked at the...

[1197] the system of microdosing that the aficionados are claiming.

[1198] And there's a couple of models out there, but folks like Paul Stamets and others, they'll have particular formulas.

[1199] They're like, you need to take it one day and then take so many days off and take it every four days.

[1200] And I don't want to get into whose model is what, but it's always something like that, some pattern of use, usually not every day.

[1201] And the claim is that it's not just, you know, sometimes people get benefit that first time when they take it, but they really say you need to be on it for a while.

[1202] Like a few weeks in, you may start to notice through this pattern of using it.

[1203] And you're feeling the benefits on those off days, like the three or two days in between your active doses.

[1204] So those are the claims.

[1205] Again, we don't know that there's any truth to that working, but studies have not been done to model that.

[1206] So that's a big caveat.

[1207] We as a field, I say we as the scientific field, have not done the studies.

[1208] to really model, you know, what the real aficionados are claiming, you know, where the therapeutic benefits come from.

[1209] That said, it's almost assuredly there's a good amount of placebo there.

[1210] But the caveat to that is, like, almost everything in medicine or therapeutics is going to have some degree of placebo there.

[1211] Belief effects are – I have a colleague at Stanford, Aaliyah Crum, who has published really beautiful work on belief effects, show that essentially you give the same milkshake to two people, or two groups of people, you tell them that one contains a lot of nutrients, the other is a low -calorie shake.

[1212] The insulin response varies dramatically between the two, or two groups rather doing equivalent amounts of physical movement, and you tell one group that it's going to be good for them and help them lose weight, and they lose on average 8 to 12 pounds more doing the exact same.

[1213] patterns of movement.

[1214] So, and I think that these belief effects boil down to all sorts of kind of network -wide neuromodulation, things of that sort.

[1215] And then the work at Harvard suggesting that even if you don't have deception, you give a placebo and say, this is a sugar pill, you know, and tell them that.

[1216] And they could still treat things.

[1217] I think irritable bowel was the first thing they looked at.

[1218] And so there's a huge, so there's a reality there.

[1219] There's a necessity in developing drugs to make sure it's not only that, but in the actual practice of medicine, hopefully what you're always getting is some underlying direct efficacy plus the placebo that enhances that.

[1220] Now, it could be that this is, the real question is, is the microdosing, are those claims 100 % placebo or are they only part placebo and part real, you know, quote unquote effect?

[1221] My bet is.

[1222] and this is totally based on anecdotes, that I think there is probably a reality to the antidepressant effects.

[1223] I find that more intriguing because of the suffering with depression.

[1224] Even if it's, it wouldn't be as interesting as I think what we're doing with high -dose psilocybin or psychedelics to treat depression.

[1225] It would be, if this is developed and there's a reality, it would be more like a better, you know, perhaps a better.

[1226] SSRI, a better Prozac.

[1227] That being said, we need more tools than fewer tools in the toolbox.

[1228] And it shouldn't be that surprise.

[1229] Even before, going back to the tricyclics and the MAO inhibitors, going back to the 50s, like augmenting extracellular serotonin in one way or another, for many people, leads to a reduction in depressive symptoms.

[1230] It wouldn't be that crazy for chronically stimulating a subtype of serotonin receptor.

[1231] that you have an antidepressant effect.

[1232] So I think if I had put my bets on it, that if there's anything real, it is in that category.

[1233] Although I'm very open to like, maybe there is something to the creativity, to the improved cognition, which covers many domains in and of itself.

[1234] But my greatest hopes are on the antidepressant effect.

[1235] That said, in the big picture, I think all of the most interesting thing about psychedelics are the heroic doses.

[1236] I mean, the idea that you can give something one, two, three times and you see improvements in depression months later and in addiction over a year later and with these people dealing with potentially terminal illness.

[1237] I mean, I'm interested in big effects.

[1238] And I don't think you're ever going to get the really big effects.

[1239] There's also some concern that almost all of these common psych, the more common psychedelics, even counting MDMA.

[1240] they have serotonin -2b agonist effects.

[1241] And agonizing serotonin -2b has been shown to lead to heart valve formation problems, morphology issues, so valvulopathy.

[1242] And so this is why fen -fen was pulled from the market.

[1243] The diet drug.

[1244] Yes.

[1245] Very effective diet.

[1246] Right, right.

[1247] And it was the portion of that combination that had the serotonin 2B activity that was the problem.

[1248] And so we don't know.

[1249] So all of the toxicologists I've ever spoken to about this would say, and cardiologists say like, look, hey, if there was some concern there, it's not applicable to the whole idea of you taking something a few times therapeutically within a lifetime.

[1250] the idea of taking something like, you know, twice a week for years.

[1251] I mean, even the hippies back in the 60s weren't doing that, right?

[1252] Like there's not even these natural.

[1253] And even if there was some heart valve disease problem that stemmed from psychedelic use, who's connecting those dots?

[1254] That's not showing up in the clinical charts for anyone to figure out.

[1255] And just theoretically, there is more of a concern.

[1256] If something's going to happen with heart valves, it's more likely that those issues would arise when someone's taking these things like, yeah, like say twice a week for the next five years.

[1257] And so I do want to throw that out to people to really consider.

[1258] Right.

[1259] Yeah.

[1260] It's something I hadn't heard before that in micro sounds safer, micro dosing as opposed to heroic or macro dosing.

[1261] And yet, unless and in the context of your lab and other labs doing similar work.

[1262] You've got this people checking blood pressure.

[1263] You've got people that are really monitoring your psychological and physical safety.

[1264] When people are out there microdosing, it sounds like there's a potential either through this serotonin 5 -H2B receptor or other mechanism that maybe there could be some kind of cumulative negative effects.

[1265] And I think that's a really important consideration.

[1266] So I'm glad you brought it up.

[1267] What about kids?

[1268] So the brain is very plastic.

[1269] early in life it becomes less plastic as we age although it maintains some degree of plasticity throughout the lifespan um the the year 25 it not uh the year 25 but rather the age 25 years um is sort of an inflection point where um the rigidity of the nervous system seems to really take off of course people don't wake up on their 25th birthday and fine they have no neuroplasticity whereas the day before they had a lot these are you know it's plus or minus whatever it is a year or two but um depends on the individual um however the big the young brain is very plastic and i could imagine there could be great risks who knows maybe even benefits but i'm certainly not um thinking about those i'm mainly thinking about the risks uh for young people taking psychedelics.

[1270] Are there any trials looking at people in clinical trials?

[1271] This would be under the age of 18.

[1272] Has anyone explored this in a rigorous way?

[1273] Given the potential to exacerbate psychotic symptoms and bipolar symptoms in some people, is there a heightened risk of that?

[1274] What's the story with age of use and psychedelics for therapeutic purposes?

[1275] There's no formal research.

[1276] Although there's a very high chance that there will be.

[1277] And so this is one of the very interesting things folks may not realize or appreciate about the FDA approval process.

[1278] So the FDA already in multiple instances has signaled that they want to see those studies.

[1279] Well, not before it's approved as necessarily as, you know, for adults, but they're going to eventually want to see, in fact, so the MAPS group that's developing MDMA for PTSD, they've already signaled that that's kind of on the list of interest.

[1280] And there's even some incentives in the FDA.

[1281] pathways for incentivizing folks to explore that use in young people.

[1282] I know in some of the work that I helped with in pushing psilocybin into phase 2B clinical research, the FDA said, well, why can't you give this to kids?

[1283] It's like, are you aware that depression is a problem with adolescents?

[1284] And it's really interesting because this FDA is very concerned about pseudospecificity.

[1285] Can you define pseudospecificity?

[1286] You put out a drug and say, oh, this is good for men but not women.

[1287] This is good for black folks, but not white folks.

[1288] And now sometimes there's a very good rationale for that.

[1289] Like when we're talking about hormones and for a specific, you know, for men versus women.

[1290] And there's certain, you know, issues, you know, you know, certain disease states like maybe sickle cell anemia that's more relevant.

[1291] TASAX, things like that.

[1292] Yeah, exactly.

[1293] You know, but.

[1294] absent of something that they're very concerned about saying, oh, this is for this type of person, but not that type of person.

[1295] So age is one of those things.

[1296] And also this recognition, you know, much like the emphasis at NIH with, you know, with, you know, with rodent studies and human studies that like, you can't just say you're studying men or just you need a rationale if you're only stuck.

[1297] Yeah.

[1298] To be clear to people, there's, it's a recent switch, but there's a stipulation in every federally funded grant that both sexes we don't refer to gender in scientific studies unless it's a study of gender per se we refer to sex meaning biological sex so that there's a stipulation that in order to receive and continue to receive funding you have to do studies on both males and females of that species including humans and at least even if you're not powered for it at least looking at that in exploratory analysis like as a grant reviewer i'm charged with looking at you know did they address like sex as a biologically relevant variable?

[1299] Does the same drug have different effects in males versus females?

[1300] Right.

[1301] And you could at least look at the trends even again, if you're underpowered to look at those between subject type effects.

[1302] Which is a great shift that didn't exist in, you know, 10 years ago.

[1303] Sounds like we're both on grants panels.

[1304] As study section members, you didn't have to do that.

[1305] Now it's an important biological variable if you don't.

[1306] look at that, you essentially won't get your funding.

[1307] And age is a similar thing.

[1308] So it's the whole idea like, man, if something could help kids, like what's the rationale?

[1309] So I think there's going to be, now, obviously you're going to have in those studies, at least just as much, probably more, it should be more, you know, of a cautionary approach.

[1310] It's probably going to be, you know.

[1311] It would certainly whatever disease states are looked at are going to have to be probably treatment resistant, at least as a first step.

[1312] Suicidal depression.

[1313] Yeah, yeah.

[1314] And so all of that in the mix.

[1315] But hey, you know, if this stuff really helps people, you know, that are 25 or 30, like what's the rationale that it won't help a younger person?

[1316] You know, and there's these generic kind of concerns about the developing nervous system is more susceptible to.

[1317] I mean, it cuts both ways because it's also more plastic generally and adaptable, maybe resilient to injury in certain ways.

[1318] But, you know, you hear the rhetoric about kids, their brains and drugs, and it's like the developing brain is a special concern.

[1319] So, yeah, but I think we're going to be seeing research eventually.

[1320] That's interesting.

[1321] I went to the high school that is infamous, sadly, Gunn High School.

[1322] for having the highest degree, at least at one point, of high suicide rate.

[1323] Wow.

[1324] A very large number of suicides.

[1325] This was written up in the Times and elsewhere.

[1326] Is it a very academically successful school?

[1327] It's a very academically.

[1328] There's a lot of high pressure.

[1329] Yeah, a very academically demanding school to the point where they've restricted.

[1330] The kids will meet often.

[1331] 6 30 a .m or 6 a .m before school for study groups and things of that sort that so some of it may relate to that um but i have to say that even prior to all that academic pressure um when i went there it wasn't the pressure wasn't like that that you know we had a an unusual number of suicides for whatever reason.

[1332] And, you know, and so the idea of kids being prescribed, and I want to emphasize prescribed, not just using, but prescribed psychedelics for therapeutic purposes, I think might make some people balk.

[1333] But the idea of kids killing themselves should also make people balk.

[1334] And so I'm relieved to hear that there's going to be a rational, scientific, safe.

[1335] clinical trial -based exploration of this.

[1336] I want to ask you about the current status of these drugs and compounds.

[1337] I'm pretty active on social media, more so on Instagram than on Twitter.

[1338] But as I have been on Twitter a little bit more recently, I've noticed that there's a lot of dialogue around your account and other people's accounts around a couple of themes related to psychedelics.

[1339] First of all, What is the status of the transition to legality for prescription purposes?

[1340] So medical doctors, MDs prescribing it legally for therapeutic purposes.

[1341] That's the first question.

[1342] The second question is what is the status as it relates to possession and criminal charges?

[1343] So for a long time, I lived in Oakland where we were one day told not too long ago, it is now quote unquote decriminalized is what I was told.

[1344] Double check, people.

[1345] But what does that mean?

[1346] And then the other issue and the third question, and we can parse these one by one, is this issue of, let's just say I'm aware of a lot of investor dollars going into companies that are essentially companies focused on psychedelics as therapeutics or psychedelics generally.

[1347] I have to assume that they are investing in anticipation of a shift in the legal status.

[1348] And there's a lot of interest now, like will psilocybin become a taxable thing just like marijuana?

[1349] So let's start with the question of like, what is going on in the U .S. legally?

[1350] Is it illegal to possess and sell and use these compounds?

[1351] My understanding is you can still go to jail for having these compounds in your possession or for selling.

[1352] Right.

[1353] So even though the legal landscape is very different than with cannabis, there are some similarities.

[1354] So one of the similarities is that regardless of what local, municipal, you know, whether city or state is decriminalized, and that word itself can mean many things.

[1355] So some forms of decriminalization is close to what folks would call legalization, and others are like pretty weak, you know, just saying we suggest.

[1356] that the police make it their lowest law enforcement priority that sort of turn the other kind of thing right but even the the cops can still choose to but someone could get pulled over for one thing, searched, and then by definition, if it's illegal and they find it, then they have to do something about it.

[1357] And that'll probably be determined by, you know, like both judicial precedent, is it going to be thrown out?

[1358] And just the local prosecutor, you know, even before, like, are they going to choose, even at post arrest, are going to pursue to really, you know, go after those charges, make those charges stick.

[1359] So I think that's still in play and is going to depend on the municipality.

[1360] But like cannabis, And federally, these are all Schedule I compounds.

[1361] Which means they're illegal.

[1362] Which means they're illegal.

[1363] The caveat to that, just as has always been the case since Prop 215 in California with cannabis in 96, is that, hey, 99 % of drug enforcement is done at the local and state level.

[1364] The DEA, which is the federal level of law enforcement, is a tiny fraction of the arrests.

[1365] I mean, most people that are arrested for any drug are done by.

[1366] local or state -level authorities, but it's still technically illegal.

[1367] And so you can, and they could potentially, depending on the ambiguity of the local law, even those local officials could charge you with a federal crime.

[1368] And theoretically, the feds could always come in.

[1369] Now, although you'll, again, a similar case with the whole cannabis history, it was the The feds came in in the early days with the folks that were basically highly visible.

[1370] They went after Tommy Chong for selling bongs.

[1371] But, you know, I remember him being on The Tonight Show one time, and I think it was back in the Jay Leno days.

[1372] But all along the Santa Monica boardwalk, like every shop sells bongs.

[1373] How did you go to prison for a half year for bongs?

[1374] It's because he was in there.

[1375] Because he was famous.

[1376] Because he was Tommy Chong.

[1377] And there was some high profile cannabis groups of, you know, that were distributing it and they were very vocal.

[1378] Those were the ones rated by the DEA in the early days, not the ones kind of keeping to themselves, keeping it quiet and just doing their thing.

[1379] There's always the potential for selective enforcement.

[1380] And so, you know, in like this initiative in Oregon, which is a state level legalization of psilocybin therapy, which is really interesting, you know, part of their plan for two years is to figure out how to integrate with the federal level.

[1381] And I don't know how that's going to go, because like unless you rewrite the Controlled Substances Act, it seems like the best you're going to get is a. a tolerance from the federal government.

[1382] And, you know, and that could be very, you know, hey, you change administrations.

[1383] And this is psilocybin by prescription from a medical doctor, or you're talking about therapists who have master's degrees or PhDs or self -appointed coaches or something like that, administering psilocybin, but without any.

[1384] So this is all getting figured out in the Oregon case.

[1385] And again, there's that two -year period of basically we're going to figure this out.

[1386] What is it with Oregon?

[1387] They're ahead with a lot of euthanasia.

[1388] I love the state of Oregon.

[1389] But it's interesting how you have these pockets.

[1390] Oregon, Vermont seems to be one.

[1391] You know, you got these kind of pockets where people are experimental with plant compounds.

[1392] They seem to be green, woodsy areas, at least in my mind.

[1393] But there's sort of a culture around plants and the use of plants as therapeutics.

[1394] And combine that with the West, just more geographically, of more of the anti - you know federalism the anti i mean the oregon ranchers from several years ago that held up the uh you know the whatever wildlife place you know and that was a big showdown with the feds you know and the you know just kind of the west is kind of known for you know more of those issues so he combined the two the hippy dippy california oregon vibe yeah although i would argue it's becoming less hippy dippy the um then although it was that there's always been a tradition not just in the culture around drugs but um certainly in academia and in tech etc that the west has been a place where people have tried to throw off traditionalism and kind of lineage and like who your parents are what school you went to and um and the past as a determinant of what's next and exciting about the future.

[1395] Whereas, and here we are, an East Coast institution guy and a West Coast institution guy.

[1396] I think that it's this idea of kind of innovation and the future versus do we stay grounded in history and tradition?

[1397] And of course, there are great institutions on both sides.

[1398] What's interesting is that Hopkins, Johns Hopkins Medical School, I think of as a real like East Coast academic institution.

[1399] It is on the East Coast, but Here you are doing these very pioneering and important and exploratory studies in a certainly not a hippy -dippy environment.

[1400] Right.

[1401] Oh, yeah.

[1402] Very conservative psychiatry department, even amongst psychiatry departments.

[1403] And as a psychologist in the psychiatry department, psychiatry is certainly more conservative than psychology, even within academics.

[1404] But even amongst psychiatry departments, it's a very conservative department.

[1405] So we've got the law at the federal level.

[1406] We've got the law at the state and local level.

[1407] And then we've got this question of whether or not it's going to be physicians.

[1408] So MDs, people with PhDs or master's degrees, or whether or not it will be kind of a free -for -all for consumption.

[1409] The life coaches.

[1410] The life coaches and the general public.

[1411] I mean, cannabis, I'm not a pot smoker.

[1412] It's never appealed to me. That's just me and my pharmacology.

[1413] you know, you can buy cannabis most places in the U .S. without a ton of risk, it seems, right?

[1414] Are we going to see a time in which you can essentially go into a shop on Abbott Kinney Boulevard in Venice, California?

[1415] And right now you can go buy marijuana if you have a marijuana card.

[1416] That's my understanding.

[1417] I see a lot of people going in and out of these stores.

[1418] The police certainly have no problem with it.

[1419] Is there going to come a time where people can just go buy psilocybin?

[1420] Like they do in Amsterdam and have for a long time.

[1421] Do you think that time is coming?

[1422] I think so at a certain point.

[1423] And I don't know how long.

[1424] It's hard to imagine our current level of...

[1425] drug criminalization holding up for, and I'm thinking like large spans of time, like really in a hundred years, are we going to be doing this 500 years?

[1426] Like, how could that, it's not going to be sustainable.

[1427] But in five years, for instance.

[1428] So I don't think so in the United States.

[1429] I do think eventually you're going to see something like that because there's going to be no way.

[1430] And I think we're going to, I hope that we're going to eventually come so strongly.

[1431] We're going to move on from this model of criminalizing drugs that we're really going to focus on regulating drugs at the right level for that drug.

[1432] And I like the word regulation better than legalization.

[1433] So, I mean, I could imagine what one day regulation, smart regulation might mean for psychedelics.

[1434] Maybe it could mean that there will be whether or not you have a diagnosis of a problem.

[1435] It may be that even for personal exploration, you can do this legally.

[1436] But you first have to maybe take a court, get a driver.

[1437] And this has been, I'm not the first to say this, but get equivalent of a driver's license.

[1438] You have to go to get some sort of training.

[1439] Maybe your first number of experiences need to be with trained guides who can facilitate it.

[1440] And then the public health information for anyone using this, that this is what riskier use is.

[1441] All use is going to have risk.

[1442] This is what riskier use is.

[1443] This is less risky use.

[1444] These are the factors.

[1445] So I think eventually we're going to be getting – but I would say the same thing for like methamphetamine and heroin and cocaine.

[1446] Like all of these drugs, it's hard to imagine the current approach of just feeding a black market and really exacerbating a lot of the harms from drugs.

[1447] That happens under the current model.

[1448] It's hard to imagine that maintaining.

[1449] That isn't to say I think it should be.

[1450] And all of the 7 -Elevens sold to kids at the other extreme.

[1451] I would hope not.

[1452] But I do think it's probably not going to be soon in the United States.

[1453] I do want to make the major point that even if psychedelics had never been made illegal, I think the exact trajectory of the medical research right now would still need to happen.

[1454] If it's effective as an antidepressant, like we need it.

[1455] to be you know there's all the evidence suggesting that whatever disorder we're talking about the efficacy is going to be increased and the risks are going to be mitigated drastically in the types of models we're talking about with the screening with the preparation with the integration of cognitive behavioral therapy or what have you depending on the disorder you're treating with the integration afterwards with the professionals so um it We would be doing it anyway.

[1456] So it's not like this versus that.

[1457] So I don't see it as a race between the decriminalization or legalization of these compounds versus their medical development.

[1458] Some people who are psychedelic fans get all into a bunch about the medical development.

[1459] They say, you guys want to keep it only for your medical research and I retire and you want to be in control of it as academics.

[1460] My take is I didn't make it illegal for anyone.

[1461] We're only moving the needle in one direction.

[1462] And again, even if it was already illegal, and I've done plenty of survey research of people reporting they took mushrooms for fun or for personal exploration.

[1463] And they said, my God, why am I smoking?

[1464] And they quit smoking 20 years because of it.

[1465] Or it's helped with their depression or it's helped with them overcoming alcoholism or these different.

[1466] Sometimes that happens out of the blue when people use psychedelics.

[1467] Nonetheless.

[1468] obviously the efficacy rates are going to be higher when you bring it into these medical models and it's going to be safer.

[1469] So we need to be pushing that.

[1470] And my best guess is that MDMA is going to be approved within the next three years.

[1471] For a prescription by a physician.

[1472] Yes.

[1473] And not just take two and call me in the morning, but in the clinics, the way that those PTSD trials are being run.

[1474] So the MDMA would be approved for PTSD, and every disorder needs to be looked at separately, and it's going to only be approved for those things.

[1475] Now, there's going to be questions about - Right, because approved and legalized and regulated are, you know, now we're getting into the nuance.

[1476] I think when people hear it's going to be approved in two years, they think that they'll be able to - buy and sell and use MDMA without legal consequences.

[1477] And I do not think that's going to be the situation.

[1478] It's not the way it is.

[1479] And I will say that I think the quote unquote psychedelic community, I mean, they've been doing what they want to and will carry on doing what they want to anyway, right?

[1480] It's not like the legal status has prevented them from doing what they're doing.

[1481] In fact, unlike Leary and - Timothy Leary and Huxley and some of the others that were very vocal and lost their jobs and some of them even went to jail, et cetera.

[1482] I mean, you got a lot of public figures now like McKenna and others who are just basically out there talking about psychedelics.

[1483] Michael Pollan, who is more of a writer, foodie guy, gone psychedelic dabbler, writer guy.

[1484] I know he's kind of a polymath, but the legal status didn't seem to hinder their...

[1485] at least online careers.

[1486] I don't know.

[1487] I haven't looked at their bank accounts, but I'm imagining they're doing just fine, right?

[1488] So the fact that work is happening inside of big institutions, I think it's important that you point out, and I'm just trying to underscore that that's in no way antagonistic to what people are doing.

[1489] It's in support of a different sort of mission, which is to explore the validity in different contexts in a really controlled way, which I really, you know.

[1490] I think it's a really important mission.

[1491] I want to make sure that I ask you about the other really important mission that you're involved in with respect to psychedelics, which is not about depression per se, but is about neurologic injury or head injury.

[1492] I realize it's early days for this, but I think there's a lot of concussion out there, sadly.

[1493] There's a lot of TBI, traumatic brain injury, not just from sports.

[1494] I think people sometimes forget that it's not, The major source of traumatic head injury is not football.

[1495] It's not hockey.

[1496] It's not boxing.

[1497] It's not any of that stuff.

[1498] It's construction workers.

[1499] And it's people.

[1500] I mean, if you've ever seen the helmets that construction workers wear, I mean.

[1501] The jackhammer.

[1502] Oh my God.

[1503] The jackhammer.

[1504] I mean, how could that not be just like.

[1505] Yeah.

[1506] I have a colleague that works on this in bioengineering.

[1507] And when you look at the, you know, we always think sports, but there are many people who make a living in a way that is.

[1508] over time is detrimental to their brain.

[1509] And they don't have the option of just not being a professional athlete or something of that sort.

[1510] And if they're not doing the construction, someone else needs to do it.

[1511] Someone else has to do it, right.

[1512] And for some reason, and I too, it didn't occur to me until I heard it, like the people who are doing construction.

[1513] And then of course, bike accidents and falls and things like that as well.

[1514] Military.

[1515] Military, absolutely.

[1516] What do you think is the potential for these compounds, particularly psilocybin but other compounds as well, for the treatment and possible even reversal of neurological injuries?

[1517] And what sorts of things are you excited to do in that realm?

[1518] Yeah, so this is definitely on the more exploratory end.

[1519] So it's based upon – so this is sort of beyond the improvement of psychiatric disorders like… depression, you know, or depression and anxiety associated with a terminal illness or a substance use disorder, the addiction.

[1520] So those are sort of psychiatric, you know, disorders.

[1521] So this is, you know, there are anecdotes of people saying that psychedelics have helped heal their brain.

[1522] You know, they've been in one of these situations, like in sports.

[1523] a sport where there's repetitive head impact and they're claiming that, you know, using psychedelics has actually improved their cognitive function, for example, improved their memory, including improved their mood.

[1524] But it's kind of more of the, you know, the cognitive function, things like memory are...

[1525] Now, the caveat is if you've successfully improved someone's depression, you can get some cognitive improvement too, but that's more of a...

[1526] a weaker, more indirect effect.

[1527] But if you take these anecdotes and you combine it way across orders of analysis to the rodent research from several labs like David Olson, Brian Roth, these folks that have shown different forms of neuroplasticity unfolding.

[1528] after, like sort of post -acutely, so after, in the days following the administration of psychedelic compounds, a variety of psychedelic compounds, and even some non -psychedelic structural analogs, that you see these different forms of neuroplasticity, so the growth of dendrites and new connections being formed with different neurons.

[1529] So those effects...

[1530] may be at play in the psychiatric treatments that we're dealing with.

[1531] We don't know that.

[1532] It seems like a decent guess, and we're going to be figuring out whether that's the case.

[1533] But another potential that that sets up is that maybe that's what's going on with these claims of improvements from neurological issues, that there's actually a repair.

[1534] of the brain from injuries underlying, you know, things that, you know, situations where there's repetitive head impact.

[1535] Perhaps there's a potential for helping folks recover from stroke and disorders like that.

[1536] There's a wide variety of disorders.

[1537] Now, it's a bit of magic and a bit of like.

[1538] It's something that the enthusiasts kind of can do some hand -waving and claim that this is already known.

[1539] It is more exploratory.

[1540] But what I'm hoping to do is some work with retired athletes.

[1541] who have been exposed by the nature of their sport, for example, MMA athletes in the UFC who have been exposed to repetitive head impacts like a lot of sports, a lot of sports expose people to and who are retired from the sport and are suffering from, say, depression, which can in part result from those types of that history of head impact.

[1542] See if we can fix the depression.

[1543] But then also as a cherry on top and a more exploratory aim, see if we can have evidence of improvement in cognitive function and associate like using MRI, see if it affects gray matter over time, these types of things to see if there are actually some evidence of this improved, like this more direct repair of the brain.

[1544] But again, it is very sort of like, we've got some rodent data, we've got some human anecdotes.

[1545] acknowledged its early days and we look forward to seeing the data.

[1546] I appreciate how cautious you are and tentative you are.

[1547] You're not drawing any conclusions.

[1548] I think from a purely logical and somewhat mechanistic perspective, I mean, if we assume that lack of ability to focus or degradation in mood is the reflection of neurons in the brain, I think we can agree on that.

[1549] dialogue between neurons of the brain and that what needs to be changed is the nature of that dialogue aka neuroplasticity we know that reordering of neural circuitry require in the adult requires these things like intense focus followed by rest etc but the basis for that like beneath focus is the mechanism is a mechanism rather beneath the bin that we call deep rest is a mechanism and those mechanisms are neuromodulator driven So to me, I'm not reviewing your grant, but from a rational perspective, it seems that drugs that increase certain neuromodulators like serotonin or dopamine in a controlled way, and then coupling that with learning of some sort, sensory input of some sort, it makes sense that that would lead to...

[1550] could, I should say, lead to reordering of circuitry that would allow for better thinking, better mood, many of the same things that you've observed in the clinical trials for depression.

[1551] So the rationale is really strong.

[1552] I think that's a very exciting area.

[1553] You know, I get asked all the time about TBI and traumatic brain injury.

[1554] And right now, you know, it's kind of...

[1555] uh there isn't a whole lot that people can do and people are dabbling in the space of you know um hyperbaric chambers and people will do sauna and breath work and you know and people are kind of you know clipping at the margins of what really is a problem that resides deep to the skull so i think um i just want to applaud that the exploration i think it's great provided that exploration is being done in a controlled way it sounds like that's what you're doing um with the ufc They were really gracious and had myself and a few of my colleagues out to their headquarters in Vegas.

[1556] Impressive place, right?

[1557] It's in process.

[1558] There's a dialogue going on there.

[1559] I'm hopeful that there's going to be some work with them, but it's in process now in terms of exploring that there's a real interest.

[1560] I'm just really impressed by the organization and their commitment to athlete health.

[1561] We'll see.

[1562] Yeah, I am too.

[1563] We have a colleague out there.

[1564] We're doing a little bit of work with them, Duncan French, who's a serious academic in his own right.

[1565] And I think when people hear UFC, they just think about the octagon and fighting and, you know, pay -per -view fights and things.

[1566] But in talking with them, and I'm sure you've had these discussions as well, they are very much interested in the health and longevity of their fighters.

[1567] they are also interested in the health and longevity of their fighters being a template for how to treat traumatic brain injury and improve human performance in other sports and in the general public.

[1568] And I think it's not an image of the UFC that commonly comes to mind because they haven't been particularly - verbal about it in the press, but I think it's great they're bringing in academics.

[1569] I mean, geeks like us going out to the UFC Performance Center.

[1570] I mean, you do MMA, but I'm basically just a geek walking through the place.

[1571] But the fact that they're interested in talking to scientists is really, I'm biased here, but a point in their favor.

[1572] Along the lines of other groups and individuals that have impacted the space that you're working in and this pioneering of the psychedelic space.

[1573] You know, a few years ago, I think if someone submitted a grant saying, I want to study how psilocybin impacts human depression.

[1574] I'm guessing, having worked on these panels before, that the response might've been closer to, well, we need to do a lot of studies in rodents and a lot of studies in primates.

[1575] And then maybe, just maybe we could explore these drugs because the National Institutes of Health actually has a whole institute devoted to addiction.

[1576] of exploring compounds only in terms of their negative effects, right?

[1577] Which is a very - Which is where I've gotten all of my NIH funding.

[1578] Which is so interesting, right?

[1579] And it's a super important institute.

[1580] I want to be clear.

[1581] There are amazing people there.

[1582] But philanthropy and foundations have been very important in supporting pioneering research.

[1583] And so maybe we just talk a little bit about that.

[1584] So your lab receives - funding from taxpayer dollars through the National Institutes of Health?

[1585] Is that mainly where your funding comes from?

[1586] So our group has gotten some funding from, like, say, the National Institute on Drug Abuse, NIDA, for some, a small subset of the psychedelic work, but only for some work geared towards understanding these things as drugs of abuse.

[1587] Of course, when you do a study, though, you can - Show us how they're - Explore how they're bad.

[1588] Right.

[1589] But when you're doing that, you can explore like, you know, the good stuff too, you know.

[1590] But the large majority of the work and the most interesting work has been funded by philanthropy.

[1591] Private philanthropy.

[1592] Now, I still have some great support from NIDA outside of psychedelics.

[1593] I'm shifting more and more of my… my time towards you know focusing only on psychedelics and in fact us getting the the center level funding from some really big picture philanthropists helped me to start to make that transition.

[1594] But groups like the Hefter Research Organization, Dennis McKenna, which is one of the founding members, the brother of Terrence McKenna, who's, by the way, an ethnobotanist.

[1595] That's what his PhD is in.

[1596] What does that mean, ethnobotanist?

[1597] Studying essentially the anthropology of psychoactive plant use.

[1598] You can get a degree in that?

[1599] Yeah, yeah, yeah.

[1600] hanging out with cultures and studying their use of these compounds in the traditional ways.

[1601] At Hopkins?

[1602] That degree exists at Johns Hopkins?

[1603] I don't think that degree exists at Hopkins, but I mean, the kind of the most, you know, as you know from academia, I'm not, you know, sometimes folks, I'm not sure how many people's PhD is actually in ethnobotany or it's actually in something else, but the real focus is like my degree is general experimental psychology.

[1604] 10 ,000 kids out there just decided they're going to major in ethnobotany, but you know.

[1605] I mean, one of the pioneers of the psychedelic area before Leary and before, and actually he was late even for the human researchers, like folks like Humphrey Osmond and Abraham Hoffer and Sidney Cohen were earlier, but even before those folks, Richard Schultes at Harvard, he was, I mentioned him earlier in the conversation, discovered all of this, these various tribes using.

[1606] ayahuasca or yage, a different name for the same thing, throughout South America, and these DMT -containing snuffs and all of this.

[1607] So that was ethnobotany, this kind of intersection of anthropology and these psychoactive plant compounds.

[1608] The Hafter Research Institute, which Dennis is a founding and active member of, a board member, they have funded a lot of our early work.

[1609] There's also an organization called the Beckley Institute based in England that Lady Amanda Fielding has been the head of.

[1610] They provided the first funding for our… psilocybin, smoking cessation research, and the Hefter came in and provided subsequent funding.

[1611] But it's, and then there are other groups that counsel on spiritual practices.

[1612] A great guy named Bob Jesse funded some of the original work at Hopkins, looking at the nature of mystical experience outside of treating disease states or disorders, but just understanding these, like people take these compounds and.

[1613] you know, frequently will say that was the most important everything I've ever experienced.

[1614] It's like, what the hell is that?

[1615] Yeah, I had someone mentioned recently, I think this might surprise people a little bit, certainly surprised me. I had a friend who adores his children.

[1616] He's got three children.

[1617] He adores his children.

[1618] Happy marriage and great, great father.

[1619] They're both great parents.

[1620] And he told me that as part of a clinical trial, he had a DMT experience.

[1621] that he claims, he said, I'd love to tell you that the birth of my children was as profound, but that was a more profound experience than the birth of my children.

[1622] Any one of them and all of them combined.

[1623] And I was like, wow, now I've never done DMT, but I was like, wow, that's a pretty strong statement.

[1624] Now he did it in the context of one of these clinical explorations.

[1625] I assume that was part of a legal clinical trial, but I mean, that's saying something.

[1626] It's saying something.

[1627] I mean, he's a very rational, very grounded guy.

[1628] Otherwise, but so philanthropy, foundations, and then - Most recently, and sorry, just because I can't skip it.

[1629] Our center level funding, which changed a year and a half.

[1630] I see.

[1631] That's like, we, I mean, the Hefter group, the Beckley group, I mean, these are - Wonderful.

[1632] I mean, these are people that have been holding the flame alive during the darkest hours.

[1633] Same thing with the MAPS organization, more on the MDMA side, like holding that candle during the darkest years.

[1634] But smaller organizations connected to smaller, but growing over time, pockets of wealth.

[1635] But, you know, we basically limped along on a wing and a prayer until recently when we got the $17 million gift so that we could create a nominal center.

[1636] And as you know, basically to the university, that means you get a certain number of dollars and a lot of them you can call yourself a center.

[1637] You know, it's a capital investment, you know, staff, you know, equipment, salary support, which has always been the huge thing for us.

[1638] But the $17 million gift, which was split between the Cohen Foundation, so Stephen and Alexandra Cohen, they covered half of it.

[1639] And the other half, the Tim Ferriss collaborative, basically Tim and a few friends ponied up that divided the rest of that half of that $17 million gift and came together to just – I mean it just – it's completely transformed the work that we've done and our ability to – like to fully delve into this area and not worry that like, oh, if I focus on this rather than putting another three NIDA grants on some other topic that may or may not get funded, like if I focus too much on the psychedelics, am I putting my career at jeopardy?

[1640] But like, so - But you're now not only a tenured professor, you're also a full endowed.

[1641] Right, so that came - By the way, when you say somebody is a fully endowed professor, I want to be very clear what that means.

[1642] That means that there's funding - Well, it might mean all of the above, but no. I have no knowledge of your particular situation, but you probably do.

[1643] Just kidding.

[1644] But sure.

[1645] What we're essentially saying is that funding, which does not change somebody's salary level.

[1646] I just want to be clear because I think the general public isn't - There's no reason why they would understand all the nuts and bolts of how this works.

[1647] Academia is weird.

[1648] Yeah, academia is weird because we're not talking about increasing, we're not talking about an endowment or philanthropy that went to increase Matt's salary.

[1649] That's something that's set at the university level.

[1650] It's always been said, and at least it's still true now, which is that nobody goes into science for the money, at least not at the academic level.

[1651] not in academia, but allows people to devote more of their time and energy to these exploratory realms like psychedelic research, or in the case of my lab, the work that we're doing with David Spiegel's lab on respiration, breath work, and hypnosis for modulating brain states.

[1652] These are not typically areas that the National Institutes of Health and other major organizations have institutions set up to support.

[1653] Now, there is an exciting initiative which is the NCCIH, which is Complementary Health.

[1654] Right.

[1655] Used to be NCAM.

[1656] Yeah.

[1657] At NIH.

[1658] And now we're not just throwing out acronyms just to, you know, to bat back and forth acronyms.

[1659] But I think what we're looking, what we're seeing now is a movement toward science and scientists and clinicians and the general public.

[1660] and philanthropy being engaged in this dialogue, which says, okay, there are problems in the world, depression, head trauma, psychological trauma, PTSD, ADHD.

[1661] These problems clearly exist.

[1662] The solutions are going to involve behaviors that are going to involve nutrition, supplementation, social connection.

[1663] However, there are drugs, there are compounds that can change the brain and allow the brain to change its circuitry through experience.

[1664] And psychedelics are one of several others, but one of the powerful levers, it sounds like.

[1665] And I just want to say that I think the reason I reached out to you and I'm so excited to sit down and chat with you is because I see very few people inside the halls of academia who have thrown their arms around this issue of psychedelics in a way and gone through the trouble of trying to find the funding to get it done, gone through the trouble of trying to set up clinical trials.

[1666] I know what's involved in doing this.

[1667] It's so complicated.

[1668] It's so time -consuming and painstaking.

[1669] And you've made real progress.

[1670] I mean, you guys are publishing papers.

[1671] There's a new dialogue emerging that isn't just books on bookshelves and, you know, psych.

[1672] psychedelic, psychonaut gurus on the internet who also play an important role, but you're really moving this field forward.

[1673] And I know there are others as well.

[1674] There are colleagues in England and others as well.

[1675] We acknowledge them.

[1676] But I just want to say personally that I'm like, inspired and impressed by the way that you've gone about this and the level of rigor.

[1677] I mean, when I ask you a question about serotonin, most people just kind of kick back to me. Well, yeah, you got receptors and you got a ligand, but I mean, it's clear to me that you care about the details and that you care about the future of this area.

[1678] And you also really care about these patients and these individuals.

[1679] So I know I'm speaking on behalf of a ton of people now and in the future that don't even know.

[1680] what they're going to receive as a consequence of this.

[1681] I just want to voice a real sincere thank you for that effort.

[1682] It's like your lab and your work matters.

[1683] And that's a really special and unique thing.

[1684] I appreciate that.

[1685] I had a good colleague, in fact, shared some grant support under the multi -PI system years ago.

[1686] And she actually took a job at NIH as a review officer.

[1687] And I remember her telling me, And she actually left when she had multiple RO1s.

[1688] So it's like she didn't - The RO1s are kind of the bread and butter big grants that every card carrying, it's a mark of respect in our community to have one or several of these.

[1689] Yeah, yeah.

[1690] And it's like you eat what you kill in academia.

[1691] It gets to what we're talking about later.

[1692] It's like you don't make more money by pulling more grants, but you're able to pay the salary that like the university doesn't pay you.

[1693] your salary, it goes through them.

[1694] You're just able to do more work.

[1695] Yeah.

[1696] And you're able to like, and if you don't pull in the grants to cover your salary, your job can come to an end.

[1697] Even if you're.

[1698] tenured at a place like Hopkins, they can do tricks like slowly lower your salary over these.

[1699] Or they just take away your space.

[1700] Yeah, they put you in a closet and give you no support for trainees and basically make life hell for you.

[1701] So you can drive a cab in Baltimore and call yourself a full professor at Hopkins, truthfully, but you may have no ability to get anything done.

[1702] But yeah, I remember one of the things this colleague said who was successful but left on top said, I really don't know that I'm making a difference in the world.

[1703] And she did some great memory research and connected to drugs, also connected to aging.

[1704] But she said, I don't feel the impact of what I'm doing in the real world.

[1705] And it's, you know, unfortunately there for a lot of academia.

[1706] What we do, it stays in the Ivor Tower.

[1707] You know, the world is a, you know, it's a beautiful but messed up place.

[1708] And like a lot of this doesn't disseminate.

[1709] And because of...

[1710] the various structures, the way the world is set up.

[1711] And thankfully, this, I mean, because the work that our group, as well as a few others around the world over the last 20 years, it's like you do have an emerging psychedelic startup industry now with billions of dollars of investment.

[1712] And yeah, that's going to turn into both good and bad.

[1713] Like, you know, it's upping the ante.

[1714] Like there's going to be a lot of good and bad that comes from that.

[1715] But any new technology is going to result in that.

[1716] We've got psilocybin designated for two separate entities as a breakthrough therapy by the FDA.

[1717] And people may not realize.

[1718] And MDMA is designated as a breakthrough therapy for PTSD.

[1719] This is a really big deal.

[1720] That's a very high.

[1721] I mean, pharma companies would pay millions of dollars to get their new drug a designation like that.

[1722] And what it means is early research is saying it shows a high potential.

[1723] for treating disorders that don't have very good treatments.

[1724] So we're, and we're probably, you know, again, a few years away from both MDMA and probably a year or two after that psilocybin being treated for PTSD and depression respectively.

[1725] This is, you know, we have to wait for the phase three studies, but if the results hold up, even if the effect size is like halved of what we're seeing now, it's still going to be.

[1726] a lot larger than what you're seeing with the traditional medications.

[1727] And so it's going to be approved if the data hold up, and it probably will from my judgment.

[1728] So I feel like what I'm doing is actually having a positive impact in the world in a way that, and I feel lucky that I got interested in an area that happens to plug into a place in the world where there is that opportunity, where some great colleagues and friends are focused on areas where I wish they had the opportunity for their work to be disseminated.

[1729] I mean, I was lucky to be interviewed on 60 Minutes because of this work.

[1730] And I was like, oh my God, I know so many.

[1731] There's a bit of imposter syndrome.

[1732] Like, oh my God, I know so many scientists that deserve more so than me to have that level of exposure.

[1733] But if you happen to be in that place where it's...

[1734] You got to do your best to make it work, to take advantage of that luck and that intersection of the world and to push it.

[1735] And, you know, I've been lucky, but also did take a bit of a leap of faith early on.

[1736] I did have some advisors that told me, like, you've got a really promising pedigree early on.

[1737] Like, are you sure you want to focus?

[1738] Much time on the psychedelic stuff.

[1739] Yeah, you've embraced risk.

[1740] I mean, I think that, I mean, the world's changed since 2020, certainly.

[1741] But, you know, channels like social media, podcasts, and things of that sort, you know, your exposure is because people are interested in these topics.

[1742] And that's why people like myself are interested in.

[1743] Talking to you, I mean, you know, at Stanford, there are now a few labs starting to explore psychedelics more at the mechanistic level.

[1744] But so in animal models, excellent labs.

[1745] But also I can imagine and because of the pioneering work that you've done at Hopkins, it'll start to become more common.

[1746] I'm certain that people are going to have questions about how to get in contact with you and learn more.

[1747] If people have trauma, PTSD, depression, you know, you.

[1748] It's likely that they're going to start seeking ways in which they can potentially participate in clinical trials.

[1749] You're very active on Twitter.

[1750] Active, I should say.

[1751] You've got other obligations.

[1752] But where you are active on social media, you're active on Twitter.

[1753] It's drug.

[1754] It's at drug downscore researcher.

[1755] Right, right, right.

[1756] Okay.

[1757] Drug underscore researcher.

[1758] That's how to find me. Great account, by the way.

[1759] Matthew and I recently got into a dialogue there about some of the deeper effects of psychedelics in the literature versus how they're being discussed in the general public.

[1760] And I follow his account and it's a really wonderful account for whether or not you have a science background or not.

[1761] If people are, and I'm going to try and persuade you to be more active on Instagram, but I don't know if I'll succeed in that.

[1762] You're a busy guy and I get it.

[1763] I'm running a lab too.

[1764] I get it.

[1765] You're busy.

[1766] drug downscore researcher there as well.

[1767] Same handle.

[1768] Same handle.

[1769] Your lab at Hopkins is pretty straightforward to find through a Google search of your name, Matthew Johnson, Johns Hopkins University.

[1770] Are there portals for people to explore clinical trials, participation in clinical trials of various kinds?

[1771] Yeah.

[1772] And so in our group, so you go to hopkinspsychedelic .org, that's the website.

[1773] And if you can't remember that, just - Johns Hopkins Psychedelic.

[1774] Yeah, we will provide a link.

[1775] And you're going to find us.

[1776] It'll be the first thing that pops up.

[1777] And we have, trust me, if we have a study on something, it's going to be on that website.

[1778] That means he's being very polite.

[1779] So I will be a little bit more aggressive and say, don't email him directly.

[1780] He won't see that email.

[1781] Wait until there's a posting for a study and then sign up through the correct portal.

[1782] And I try to get back to those emails, but frankly, and it's because, you know.

[1783] I'm lucky the area has taken off so much, but there are many days where I simply get so many requests that I can't get through my day.

[1784] Yeah, if I answer all the...

[1785] So yeah, trust me. And something that a lot of folks don't get in being in academia like we are, it's easy to forget how people understandably don't realize this.

[1786] This is experimental research.

[1787] It's FDA approved.

[1788] as an experiment, you know, so we're working towards formal FDA approval for straight up clinical use.

[1789] But right now, someone can't bring me a case of some idiosyncratic thing and say I'm suffering from this complex constellation of depression.

[1790] You're not a clinician.

[1791] Yeah, I'm not a clinician.

[1792] And even if I was, I wouldn't be able to treat them with psilocybin or to send them anywhere that was legal to take it.

[1793] You know, so.

[1794] If we're going to be treating you, it has to be, or anyone else in the United States, or most other countries for that matter, it's going to have to be under the guise of a very specific protocol, this number of milligrams to treat PTSD, to treat major depressive disorder, to treat treatment -resistant tobacco use disorder, so nicotine addiction.

[1795] Very specific studies.

[1796] This is not one -off treatment.

[1797] Folks say like, oh, I can pay to go out to Baltimore if you see my son has this complex, like in their tragic cases.

[1798] So if you're interested in a study, go to our website.

[1799] If it's not on their website, we don't have a study on it.

[1800] There are going to be forthcoming studies.

[1801] So I'm going to be starting studies on opioid addiction and PTSD and an LSD study for chronic pain.

[1802] The day that those are open for recruitment, they're going to be up on our website.

[1803] So that's where you look to see everything.

[1804] And in fact, I would just recently, a couple of days ago, put up a couple of surveys.

[1805] So there's also where we.

[1806] post links to our survey studies.

[1807] So if you've had psychedelics and you've taken them for therapeutic intent for PTSD or for depression or anxiety, you can find a link.

[1808] And also if you've done breath work for those reasons, we have a link for a study of that type up there now, which is a holotropic style, very psychedelic type of breathing technique that can lead to some of these.

[1809] similar experiences.

[1810] So it's up there.

[1811] More broadly, outside of our group, because there's a growing number of groups in the U .S. and in Europe doing this research, but you can go to clinicaltrials .gov. And if you look in for the main search term of psilocybin or MDMA or psychedelic, plug in those terms, you can get a list of the growing number.

[1812] I mean, I think there's over 40, maybe.

[1813] It's been a while.

[1814] There might be over 50 now.

[1815] I don't know.

[1816] But studies with just psilocybin going on right now on clinicaltrials .gov. So check out clinicaltrials .gov to see what's going on.

[1817] But it's going to be, if you're going to do anything legal, it's going to be in the context of a very specific study.

[1818] It's not going to be one -off treatment.

[1819] Right.

[1820] And I should say, not just legal, but also supported in the right framework.

[1821] that you described of having a team, et cetera.

[1822] Obviously people will do what they will do and - Oh, yeah, go ahead.

[1823] I will say, if people, I never encourage people to take drugs of any, I don't encourage caffeine use.

[1824] Every drug has its risk.

[1825] I encourage my own caffeine use, but nobody else's.

[1826] I'm drinking up right now.

[1827] This is great.

[1828] Yeah, this is very strong.

[1829] Mate is what we're drinking.

[1830] It does not lead to an alteration in my perception of self to the extent that we talked about earlier.

[1831] However, this conversation wasn't a good example of how we can enter a perceptual bubble.

[1832] I learned so much about.

[1833] psychedelics and the future of this for sake of mental health and other aspects of health.

[1834] Matt, thank you so much for your time, for your knowledge.

[1835] And I think you put it best earlier for holding the candle in a very dark time.

[1836] And then now there's light.

[1837] Thank you.

[1838] Well, thanks for helping to spread that light.

[1839] And I really appreciate what you've been doing.

[1840] This is a great, great medium that you have going on.

[1841] So thank you for doing it.

[1842] It's my pleasure.

[1843] Thank you.

[1844] Thank you for joining me for my conversation with Dr. Matthew Johnson.

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