148 - Grand Rounds_ Psychedelic Psychotherapy

Program Notes

Guest speaker: Dr. Preet Chopra

[NOTE: All quotations below are by Dr. Preet Chopra.]

“The ’set’ is talking about what the individual who ingests a psychedelic brings to the table in terms of their life experience, their mood, expectations, family history, their personality structure, significant relationships, and their systems of belief. ‘Setting’ accounts for all the other factors that are not internal to the person, the physical environment, location, all sorts of sensory stimuli that might be present during intoxication, and the other participants, particularly a therapist or facilitator.”

“A term that’s out there among recreational psychedelic users is ‘psychonaut’, which really means, from Greek, ’sailor of the mind’, and I think this is kind of the experience those folks are going for.”

“In terms of reducing risk, I certainly feel that anybody with certain medical contra indications, and taking prescription drugs, should really avoid taking a psychedelic.”

[In response to a question about the fact that there was very little dialogue between the study participant and the attending psychatrists:] “Minimal dialogue during the actual experience. And that is based on the work that Grof did, and Panke saying, hey, let this medicine do its own work.”

“There are some people who believe that by putting on eyeshades and listening to music there is less incidence of sensual kinds of phenomena, and that allows for more of a psychological benefit.”

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Transcript

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Greetings from cyberdelic space.

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This is Lorenzo and I’m your host here in the psychedelic salon.

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Well, this summer I seem to be a little later each week in getting these podcasts out,

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so I’ll do my best to get another one out yet this week.

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I’ve been wanting to hear the rest of that trilogue we started a few weeks back,

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and so I’ll try to get that thing out in the next few days and get back on a little better schedule again.

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And talk about incentive to get back on schedule.

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All of a sudden, we received a whole bunch of donations that will certainly offset the next few months’ expenses in producing these podcasts.

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The generosity of these donors has really blown me away.

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And now I guess I’m starting to feel guilty about being so lazy this summer.

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So if I actually do get that trilogue out before next Sunday, you’ll also have the following people to thank.

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Andrew D., Stephen B., TheBallP, Janice O., John A., and MediaWell.

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Janice O., John A., and MediaWell.

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And that goes for me, too, Andrew, Stephen, Janice, John, MediaWell,

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and longtime salonner and frequent donor, Vipal.

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I thank you all for your wonderful generosity.

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And now I guess I better get to work.

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Today we have a rare treat.

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At least it’s a treat for us non-doctors.

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What I’m talking about is Grand Rounds.

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According to Wikipedia, the tradition of Grand Rounds began in the 17th century and are a ritual of medical education consisting of presenting the medical problems

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and treatment of a particular patient to an audience consisting of doctors, residents,

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and medical students.

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And Grand Rounds have evolved considerably over the years, with the most current sessions

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rarely having a patient present and being more akin to lectures.

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At least that’s what Wikipedia says, and from what little I know about it, I think that’s

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probably accurate.

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and from what little I know about it, I think that’s probably accurate.

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And the doctor delivering the Grand Rounds lecture that we’re about to hear is our very own Dr. Preet Chopra.

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Back in April of 2007, I podcast the talk that Preet gave at our 2006

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Palenque Norte lectures at the Burning Man Festival.

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So you longtime listeners already

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know him. But for our newcomers to the salon, I’ll give you some more background on Dr.

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Chopra. To begin with, he’s one of a very small number of psychiatrists in the U.S.

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who have even ever worked on a government-approved study in which humans have used psychedelic

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medicines. And in his generation, I believe he’s definitely one of the leading psychedelic researchers.

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Now, in the interest of maintaining the confidentiality of this grand round,

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I’ve removed all personal details about particular participants

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and about the Northern California Hospital where this lecture was given.

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I guess I should also give full disclosure here.

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My wife was Dr. Grobe’s original research assistant on the study Preet talks about,

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and I can still remember her talking about him after their first meeting.

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If you know any nurses, then you probably also know that they don’t always have the highest opinions of doctors,

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but that certainly wasn’t the case with Charlie.

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My wife had known him for several years before the study began,

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and she held him in the highest regard.

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But one summer day in 2003, she came home from work and said

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Charlie was bringing a young resident psychiatrist on board for the study

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and that he would be there the next day.

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Well, needless to say, this caused a little anxiety around our house that night,

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wondering what this new team member would be like.

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Well, you can only imagine our happiness that evening when my wife came home and said,

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guess what? He’s a burner.

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Not only that, he even got married at Burning Man.

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Now, if you’ve ever been to Burning Man, you know that there really isn’t anything more to say about someone than that.

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He was family right away.

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And my wife and I have been good friends with Preet and Eva ever since.

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And now I’m really grateful to Preet for letting me podcast him conducting grand rounds about psychedelic psychotherapy.

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Why don’t we get going?

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So I’m going to talk about psychedelic psychotherapy today.

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I’m going to talk about the characteristics of the psychedelic experience,

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kind of a way to think about it phenomenologically,

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to help in its description,

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and talk about how psychedelics can be utilized safely,

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really for therapeutic benefit

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and to avoid the classic bad trip,

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the kind of psychological adverse event.

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I’m going to specifically talk about psilocybin,

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since I have experience using that in a clinical trial

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at Harvard UCLA,

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and there’s been two other studies

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completed with psilocybin.

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And, yeah, get into our study.

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So when it comes to characterizing the experience,

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I think it’s important to remember that psychedelics do not produce

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a specific drug-induced state.

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This is well described by Stan Grof,

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who did a lot of the early work with psychedelics in the 50s and 60s in Maryland.

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Rather, we must consider the sort of extra-pharmacological influences,

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such as understanding the effects of the drug, purpose and ingestion, the preparation,

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and environmental and interpersonal elements.

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So these sort of ideas led to the development of this very important concept with psychedelics known as set and setting.

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These were originally described by Timothy Leary and his colleagues at Harvard when they were using LSD in some

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research.

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So SET is really talking about what the individual who ingests a psychedelic brings to the table

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in terms of their life experience, their mood, expectations, family history, their personality

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structure, significant relationships, and their systems of belief.

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SETing really accounts for all the other factors

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that are kind of not internal to the person,

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the physical environment, location,

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all sorts of sensory stimuli that might be present during intoxication,

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and the other participants, particularly a therapist or a facilitator.

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Walter Pankey is an important figure in psychedelic research.

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He was a Harvard-trained psychiatrist and minister who wrote a Ph.D. thesis at Harvard Divinity School about the psychedelic experience.

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And through his research, he basically defined five distinct experiences.

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Now, these experiences really shouldn’t be thought of as separate occurrences with each individual.

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Any experience can have aspects of all of these.

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But he kind of classically divided these into these five experiences. And again, this was not dose-related.

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He and others related. This was really most related to the set and the setting of the

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individual during the use of the substance. So the psychotic experience is kind of the

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classic bad trip. This is like an intense fear to the point of panic, paranoia, delusions,

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really loss of a sense of self, and often a lot of kind of physical discomfort.

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For a time in the 60s, there was a psychotomimetic paradigm

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where psychiatrists and other researchers thought that they could model schizophrenia with a substance-induced psychosis using LSD, psilocybin, DMT, PCP.

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However, this was abandoned because it really didn’t fit that model.

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And not everybody becomes psychotic, and actually most people don’t.

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But that kind of was an interesting bit of history.

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Now, the psychodynamic experience is really about the emergence of unconscious material into the consciousness

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that can later be integrated through depth psychotherapy.

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So this was practiced by depth psychotherapists,

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mainly in Europe, a little bit in the United States, again in the 50s and the 60s.

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And the model of psycholytic therapy was low-dose psychedelics over multiple sessions,

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and this was integrated through depth psychotherapy.

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Another class is the cognitive psychedelic experience,

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which is really characterized by this amazing, astonishing, lucid thought,

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where maybe a problem or some sort of project can be seen from a new perspective.

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Or, you know, interrelationships can be reexamined.

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Two kind of notable maybe examples of this,

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the person is Kerry Mullis who developed PCR.

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He publicly acknowledged in his kind of interesting autobiography

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that he used LSD when kind of contemplating how to develop a technology for the research

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he was pursuing. And another person

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who spoke, but not publicly,

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about using LSD

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was Francis Crick, who, according to many

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sources, was

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using LSD when he was contemplating

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the structure of DNA.

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Now, I know somebody who’s writing a book about

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the history of psychedelics who recently,

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or at one point, interviewed Watson, who will not admit to saying that.

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The aesthetic experience is probably what most recreational users are going for.

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This is some of the well-known phenomena of the psychedelic intoxication.

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There’s synesthesia, visions of beautiful colors, intricate geometric patterns, forms, architectural patterns.

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So this is really kind of an aesthetic experience.

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And a term that’s out there among kind of recreational psychedelic users is psychonaut,

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which really means Greek sailor of the mind.

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And I think this is kind of the experience that those folks are going for.

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Now what I’m most interested in my research, and what many researchers have been interested in again recently,

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is what Pankey called the mystical experience,

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what might be called the peak psychedelic experience,

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the transcendental experience, the cosmic experience.

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And in his PhD thesis,

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he argued that this experience was identical

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to the kind of mystical experience

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described in all the major religions

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of the world.

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And he felt that there were nine universal qualities of both the psychedelic mystical

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experience or one of the more aesthetic religious mystical experiences, that these were really

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identical.

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So these nine universal qualities of the mystical or peak psychedelic experience are a sense

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of unity of oneness, there’s a transcendence of time and space, deeply felt positive mood,

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a sense of sacredness, there’s a noetic quality, meaning there’s some sort of insight gained

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from this process, there’s paradoxicality where logical contradictions become apparent if descriptions are strictly analyzed,

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ineffability, really an inability to really put to words what this experience means,

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transiency, and a persisting positive change in attitudes or behavior.

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Now, for those of you familiar with Abraham Maslow and his book,

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Tour of Psychology of Being, These nine universal qualities are very similar to the characteristics he described

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as occurring more commonly on self-actualized people

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when he was studying the great NFL player at the moment when they scored their first touchdown

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or a nursing mother during that kind of period of joy connecting with their infant.

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So these kind of qualities have been described and studied in other areas

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of psychology. Oh, so just kind of looking at this, I was trying to find some sort of

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cross-cultural evidence, and I’ll give you a lot more of that later. But it’s interesting,

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there’s one study recently in the Journal of Psychoactive Drugs, which looked at psychedelic

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users versus non-psychedelic drug users versus social drinkers in two sites, Australia and

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Israel.

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Again, this is not indigenous use of plant medicine.

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And users of psychedelics scored higher on mystical beliefs, life values, and spirituality

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and concern for others than the other groups.

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And also in 2006, this is an article in Psychopharmacology, Roland Griffiths and his team at John Hopkins University did a study with psychedelic naive individuals

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trying to see if they could induce a mystical experience in healthy volunteers.

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And it’s a great paper to read,

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but 22 out of the 36 individuals in the U.S. had a mystical experience in psilocybin.

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And in fact, two-thirds of those participants, again, who had never used psychedelic drugs,

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endorsed it as being among the top five most important experiences of their life.

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And one, I believe it was one-third, said it was the most powerful transcendent experience

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they’d ever had in their life.

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So, you know, the idea of this peak psychedelic experience

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brings us to the concept of psychedelic psychotherapy,

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which was known as the psychedelic method practiced in the United States.

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A lot of research was done.

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About 40,000 patients were treated across the U.S. and Canada during that time.

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And the idea with this was that the peak psychedelic experience should be the focus

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because they found that this had the most dramatic effect

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in terms of taking care of fear, anxiety, depression, and pain.

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And they also felt when people were able to integrate these experiences

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either through spiritual work or other kinds of therapeutic work,

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this really can leave a long-lasting effect after just one kind of treatment

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with the psychedelic, if there was

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a mystical experience.

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So a lot of people have written about how do we, you know, set and setting are the most

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important factors that influence the psychedelic experience.

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How do we manipulate those to best go for a therapeutic benefit?

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So Myron Stolaroff is a veteran psychedelic researcher

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who ran psychedelic research lab in Palo Alto in the 50s and 60s.

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And he writes that the set is the most important

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and the key characteristics of having kind of a mystical experience

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and a powerful psychedelic experience are really honesty,

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to be seeking knowledge, appreciate life in all its forms,

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and to have some sort of ongoing spiritual discipline

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to help really integrate the experience.

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Now, in terms of the setting,

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he felt that the facilitator or the sitter

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is the most important aspect of the setting.

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And it’s really important for the facilitator

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to be supportive, reassuring, and nourishing to the individual

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and maintain a safe and beautiful environment for the experience.

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Now, a conceptative facilitator is really the person who kind of leads somebody during

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a psychedelic experience.

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Now, this can be an individual or a team, so there must be a therapeutic alliance and

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a relationship with the person.

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And this person is someone who remains sober and really is there only to provide gentle

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redirection when needed, because as we’ll get to in a minute, psychedelics are generally very well tolerated in appropriate settings.

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You know, this is something about, yeah, it’s important for the facilitator to become familiar with the substance

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because there are a variety of somatic side effects with some psychedelics.

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So it’s really important to know what those are so the sitter can provide kind of gentle reassurance to an individual.

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And also to know if there’s some sort of irregular side effect.

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Right, so when talking about psychedelic safety, psychedelics really are well tolerated.

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Healthy folks who aren’t taking prescription medications and who don’t have any undiagnosed

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conditions.

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In a recent study in Lancet,

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Nutt and colleagues looked at the abuse potential of 20 different drugs

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weighed on a variety of characteristics.

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And the only two psychedelic drugs that they looked at,

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LSD and MDMA, which is kind of an atypical psychedelic,

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they ranked relatively low, 14th and 17th out of 20,

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versus alcohol and tobacco ranked high, 14th and 17th out of 20, versus alcohol

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and tobacco ranked high, 5th and 9th.

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You know, some of the psychostimulants and narcotics were among the most dangerous in

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that review.

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So the most common psychological adverse effects really are kind of mild psychosomatic discomfort,

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a little nausea, stomach tightening, maybe a little dizziness.

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a little nausea, stomach tightening, maybe a little dizziness.

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There can be extreme anxiety and it can go on to paranoia in a predisposed individual in a sub-ID setting.

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There has been an association with acute psychotic episodes and psychedelics.

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Most people feel this is a triggering or an uncovering

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maybe of a first presentation of a major mental illness,

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such as a psychotic or manic episode.

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There certainly will be one-time psychotic episodes as well.

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There also is a concept in the transpersonal literature about the spiritual emergency.

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I’ve read several case reports of folks who had a spiritual emergency

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after a psychedelic experience that they were later able to contextualize through spiritual work.

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Some of those folks required antipsychotics for a period, others didn’t.

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But it really didn’t lead to a lifelong debilitating psychotic illness.

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And there really is no absolute method of predicting this, obviously,

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since we don’t have that much research about this.

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In terms of reducing risk,

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I certainly feel anybody with certain medical contradictions

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and taking prescription drugs should really avoid taking psychedelics.

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Probably if you have a personal history of a major mood disorder or thought disturbance,

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particularly bipolar or schizophrenia, I think that should be avoided.

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There may even be a case for someone with a very strong family history of bipolar or psychotic disorder

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to be very, very cautious when using psychedelics.

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And certainly anyone receiving treatment for an Axis I disorder or psychotic disorder to be very, very cautious when using psychedelics.

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And certainly anyone receiving treatment for an Axis I disorder really should think twice about using these kind of agents

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because they really are pretty powerful.

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Now, there’s a couple exceptions to that.

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I just wanted to share with you some of the other studies that are out there.

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There was a pilot study with psilocybin for OCD

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completed at the University of Arizona, I believe in 2005, which showed really, really good results after one dose with psilocybin for OCD completed at the University of Arizona, I believe in 2005,

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which showed really, really good results after one dose of psilocybin.

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Some interesting history behind that.

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The PI of that study, he’s an OCD specialist,

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and he just heard several reports of his patients who would go visit kind of mestizo healers

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and have mushroom sessions.

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visit kind of mestizo healers and have mushroom sessions and sometimes their OCD symptoms of Buddha would would remit for three four or five months and that’s

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what gave him this idea to look into it they have some good results there’s

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currently an MDMA study for PTSD at University of South Carolina in

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Charleston I believe they’re treating their last two subjects right now and

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after six months that will be published.

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They’ve actually treated two U.S. Army veterans as well with PTSD.

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There’s our study with psilocybin for anxiety associated with terminal cancer.

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There’s also the same group that did that study on mysticism.

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Johns Hopkins now has approval for treating 40 patients with psilocybin

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for any stage of cancer at a higher dose, but they haven’t been able to recruit anybody

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yet. And I believe there is an MDMA study for anxiety related to cancer in approval

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at Harvard that is now being begun. Okay, just really briefly regarding bad trips. I

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get a lot of questions about that. Stan Grof has a really good chapter about this in LSD psychotherapy.

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Basically, he feels that they’re generally time-limited and they resolve on their own.

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He looks at the phenomena that kind of comes up in these experiences

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later than a person’s psyche.

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So really, he feels it’s important to allow the person to go through the process,

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remain grounded, and not to kind of curtail the experience abruptly, either by, you know, kind of talking intervention or a psychotropic,

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and that later that material can be integrated.

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Houston Smith is a pretty well-known religious scholar.

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He’s written a book about psychedelics called Cleansing the Door of Perception.

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He was involved in a study while he was a student at Harvard Divinity School

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giving psilocybin during the Good Friday experience. So he has a pretty lifelong perspective on

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psychedelics. And he has written that maybe some of the most dramatic and challenging

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experiences provide the most potential for growth when they’re worked through in an appropriate

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manner.

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Why avoid tranquilizing?

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Well, the idea

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is there’s a

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process that’s

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going on

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involving

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unconscious

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material coming

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to consciousness,

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so don’t

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abrupt that

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softly.

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I think he

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really recommends

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using physical

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to physically

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restrain someone,

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hold them down

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when needed,

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allow them to

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work through it,

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and if absolutely

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needed, maybe a

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benzodiazepine.

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But the idea,

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you don’t want to

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just curtail that

00:20:44 ►

right there. He feels that actually leads don’t want to just curtail that right there.

00:20:45 ►

He feels that actually leads to kind of more psychological trauma, not letting that process

00:20:50 ►

kind of finish.

00:20:53 ►

Okay, so now we’re going to talk about psilocybin.

00:20:58 ►

We’ll do a little bit about the ethnobotany of psilocybin.

00:21:02 ►

So psilocybin is an alkaloid coming from what are really commonly

00:21:06 ►

known as magic mushrooms, psychedelic mushrooms, from this genus psilocybe. And

00:21:11 ►

this is the most important kind of group of mushrooms used by Mexican healers.

00:21:15 ►

They were also used in Guatemala. And this map kind of shows where they just

00:21:19 ►

occur across the world. You know, when we talk about psychoactive plants,

00:21:25 ►

there’s evidence going back about 7,000 years

00:21:27 ►

of humans using plant medicines

00:21:30 ►

in healing and also for religious use.

00:21:34 ►

This is a scratching of a cave

00:21:37 ►

I believe in the south of France.

00:21:40 ►

If you can see in this depiction,

00:21:42 ►

it’s a shaman who’s dressed like a bee

00:21:44 ►

and there’s all these mushroom appendages.

00:21:46 ►

And they found that in some of these older societies,

00:21:50 ►

mushrooms, when collected, can’t stay forever.

00:21:52 ►

They would actually store them in honey.

00:21:55 ►

And there were honey pots found with remnants of psilocybin mushrooms

00:22:01 ►

in some of these kind of older societies.

00:22:07 ►

So they’re really found in most parts of the world, really in kind of more disturbed areas.

00:22:10 ►

And I mean disturbed areas by humans.

00:22:12 ►

As humans domesticated cattle, this would disturb different areas.

00:22:16 ►

It would change the kind of flora and fauna.

00:22:18 ►

And as many people might know, a lot of mushrooms grow in cow dung,

00:22:22 ►

particularly psilocybin mushrooms.

00:22:24 ►

It’s really their ideal place to grow.

00:22:27 ►

So ironically, as, you know, Matt has settled the world, you know, mushrooms have kind of

00:22:32 ►

come with him.

00:22:34 ►

There’s about 100 species that produce psilocybin, which produces a very kind of typical psychedelic

00:22:40 ►

effect.

00:22:43 ►

So this was not unnoticed by the Spaniards when they came to Central

00:22:48 ►

America. The Florentine Codex is kind of this interesting collection of writings by this

00:22:55 ►

kind of member of the Inquisition, I believe, just kind of writing descriptions of what

00:23:00 ►

was going on in the New World. And what he noticed was, and when the effects of the mushrooms had left them,

00:23:05 ►

they consulted among themselves

00:23:07 ►

and told one another what they had seen and envisioned.

00:23:09 ►

So even in kind of the Inquisition’s literature about this,

00:23:13 ►

it really shows kind of a sacramental or ceremonial

00:23:16 ►

or kind of a psychological use of the mushroom.

00:23:21 ►

And in 1616, you know, the Inquisition really got involved

00:23:25 ►

and really ordered

00:23:26 ►

the killing of all users of these platin medicines

00:23:29 ►

anyone using herbs and roots

00:23:31 ►

with which they lose and confound their senses

00:23:34 ►

and illusions and fantastic representations

00:23:36 ►

they have

00:23:38 ►

judge and proclaim afterwards

00:23:40 ►

as revelation or true notice of things to come

00:23:42 ►

and here’s another quote from actually an inquisitor

00:23:48 ►

talking about what these mushrooms did,

00:23:51 ►

which when drunk deprive of the senses

00:23:53 ►

because it is very powerful

00:23:55 ►

and by this means they communicate with the devil

00:23:56 ►

because he talks to them

00:23:58 ►

when they are deprived of judgment and the said drink

00:24:00 ►

and deceives them with different hallucinations

00:24:03 ►

and they attribute it to a god they say is inside the seed.

00:24:06 ►

So this really was noticed by the Inquisition.

00:24:11 ►

Just a little bit of history to get you to now.

00:24:14 ►

During the 20th century, there was an argument in the anthropological literature

00:24:18 ►

whether these things were mushrooms or not.

00:24:20 ►

There were some folks, until mushrooms were rediscovered in the 50s by the West, that really

00:24:25 ►

the Spaniards are incorrect.

00:24:27 ►

Actually,

00:24:28 ►

these areas in Guatemala and Mexico

00:24:31 ►

were actually using peyote, which was well

00:24:33 ►

understood and categorized.

00:24:37 ►

So for

00:24:38 ►

many years, really, in the West, we knew nothing about

00:24:40 ►

psychedelic mushrooms.

00:24:42 ►

Then there was a famous

00:24:43 ►

investment banker named Gordon Wasson

00:24:45 ►

who married a Russian aristocrat.

00:24:48 ►

And for their honeymoon,

00:24:49 ►

they went back to Russia

00:24:50 ►

and spent some time out in the country.

00:24:52 ►

And one of the mornings there,

00:24:55 ►

his wife went out

00:24:56 ►

and picked some wild mushrooms

00:24:58 ►

and cooked them for a breakfast.

00:25:00 ►

And first, Wasson was very scared of the mushrooms

00:25:02 ►

because being from the West,

00:25:04 ►

we’re very mycophobic

00:25:06 ►

but his wife insisted that they were safe

00:25:08 ►

and healthy so he ate it and really liked

00:25:10 ►

the mushrooms. Now these weren’t psychedelic mushrooms

00:25:12 ►

just really nice tasting kind of wild mushrooms

00:25:14 ►

so after that he became

00:25:16 ►

fascinated with mushrooms and became an amateur

00:25:18 ►

mycologist and this was a man of

00:25:20 ►

extreme resources

00:25:22 ►

so he got wind of

00:25:24 ►

the use of mushrooms in a

00:25:26 ►

cult

00:25:27 ►

in North Mexico and managed to go down

00:25:30 ►

there and actually meet a woman named Maria

00:25:32 ►

Sabina, who’s a famous

00:25:34 ►

mestizo curandera of the Mazatec tribe.

00:25:37 ►

And he actually was invited to a mushroom

00:25:38 ►

ceremony, and he brought time

00:25:40 ►

life photographers with him.

00:25:42 ►

And he documented all this

00:25:44 ►

in a pretty interesting kind of Time Life magazine article.

00:25:47 ►

I didn’t keep the clip in here.

00:25:49 ►

And that’s kind of how Timothy Leary first heard about mushrooms,

00:25:53 ►

was reading that Time Life magazine.

00:25:55 ►

I think it was from 1950 or 1951.

00:25:59 ►

And then it actually took some time.

00:26:01 ►

In the U.S., there wasn’t a chemist who was able to extract anything

00:26:03 ►

that was psychoactive out of a mushroom.

00:26:05 ►

They tried all the best U.S. chemists.

00:26:07 ►

So then they sent it off to Europe to all the labs there,

00:26:09 ►

and it was Albert Hoffman, who is the discoverer of LSD,

00:26:13 ►

who was able to extract psilocybin from mushrooms.

00:26:17 ►

So that’s how we get it today.

00:26:19 ►

So for our study, psilocybin is made in a research lab in Massachusetts.

00:26:22 ►

It’s not coming from a mushroom.

00:26:24 ►

It’s a synthetic version. Okay, so this is a little bit about the chemistry of psilocybin.

00:26:30 ►

It’s in the tryptamine family. If you take a look at it, it looks an awful lot like serotonin.

00:26:37 ►

It’s 4-phosphoryl-oxy-NN-dimethyltryptamine. it’s active at 5H2A and 2C receptors.

00:26:47 ►

Medium dose, about 12 to 20 milligrams, produces a well-controlled altered state of consciousness.

00:26:52 ►

I think getting higher at 20, 30 really is a really profound dose.

00:26:56 ►

Generally, if it’s medium dose, it’s kind of what we’re using in our study.

00:26:59 ►

The effect lasts for about four to six hours.

00:27:02 ►

The state, you know, there’s stimulation of affect,

00:27:06 ►

enhanced ability for introspection,

00:27:09 ►

induction of primary psychological processes,

00:27:12 ►

similar to a dream and hypnagogic state,

00:27:13 ►

and some perceptual changes.

00:27:20 ►

This is just a list of some psilocybin species and their relative percentages of psilocybin, psilocin, and beocysteine.

00:27:25 ►

So psilocin and beocysteine are two other psychoactive compounds that are available

00:27:34 ►

out of mushrooms.

00:27:35 ►

So talking about toxicity, you know, mice can survive 200 milligrams per kilogram, which

00:27:40 ►

is a lot.

00:27:40 ►

And the ED50 to LD50 ratio, the ED is your effective dose, the LD is your lethal

00:27:46 ►

dose, is extremely high for psilocybin, 641 versus aspirin and nicotine.

00:27:54 ►

So now I’ll tell you a little bit about the trial we’re doing down at Harbor UCLA.

00:27:58 ►

So we originally approved to treat 12 subjects with advanced cancer.

00:28:04 ►

Unfortunately, two of our subjects

00:28:05 ►

passed away before finishing the six-month follow-up work, so we petitioned the FDA and

00:28:12 ►

they allowed us to recruit in one more. So we’re going to treat 13 patients. We’ve treated

00:28:16 ►

11 so far. We’re doing the first session of our 12th patient this weekend, and I may be

00:28:22 ►

consenting a 13th patient tomorrow, hopefully.

00:28:28 ►

Subjects for this trial can have any CNS involvement,

00:28:32 ►

no cardiac disease, and no history of major mental illness.

00:28:35 ►

And we’re approved for adults up to age 70.

00:28:40 ►

The study is really looking at the effect on anxiety associated with an advanced cancer diagnosis,

00:28:43 ►

and we’re also looking at pain.

00:28:44 ►

This is an experimental treatment.

00:28:46 ►

You know, there is no FDA approval for psilocybin right now.

00:28:50 ►

It’s a double-blind placebo-controlled methodology.

00:28:53 ►

Each subject serves as their own control, so they’re admitted twice for the research protocol.

00:28:58 ►

One time they’re given niacin, the other time they’re given psilocybin.

00:29:02 ►

The psilocybin is kept in a safe in the basement of the hospital,

00:29:06 ►

and only the research pharmacist has access to that.

00:29:08 ►

So she produces a capsule on the morning of the session for each session.

00:29:17 ►

So in terms of we do a lot of preparation with our subjects before the actual treatment

00:29:23 ►

to make sure they meet the team.

00:29:25 ►

You know, we really serve as the sitters, the facilitators.

00:29:28 ►

All, you know, myself, Charlie Grove was the PI,

00:29:31 ►

and our research coordinator now is Alicia Danforth,

00:29:33 ►

our bedside with the subject, the entire experience.

00:29:38 ►

We want to help them think and contemplate their intention or motivation of entering the study.

00:29:44 ►

I didn’t put this on an earlier slide,

00:29:45 ►

but there’s a lot written about intention going into a psychedelic experience.

00:29:49 ►

It can kind of set the trajectory of the experience.

00:29:52 ►

It’s a way to kind of work with set a little bit to help,

00:29:56 ►

to help have an experience that might be more beneficial to an individual.

00:30:01 ►

And we really want them to learn as much as they can about psychedelic therapy.

00:30:05 ►

Now, a lot of people ask me, are these folks who have had psychedelics before, or are these

00:30:09 ►

all naive folks who come here to study? You know, it’s really been a mixture. You know,

00:30:13 ►

we don’t have a rule out for having past experiences with psychedelics, though we have treated

00:30:18 ►

some people who have had psychedelic experiences, some maybe, you know, once or twice in the 60s, some more recently, and some never.

00:30:27 ►

So the setting, so there’s a designated GCRC down at Harbor UCLA.

00:30:33 ►

Luckily, it’s a double-door room with extra sound insulation because this room was kind

00:30:38 ►

of retrofitted for a sleep study that was done in the past.

00:30:41 ►

So we tried to deinstitutionalize it a little bit.

00:30:44 ►

This is how Alicia kind of decorates the room

00:30:48 ►

and things like that, you know.

00:30:50 ►

We encourage people to bring in personal objects

00:30:52 ►

and photographs, which they do.

00:30:54 ►

So really kind of customize it.

00:30:57 ►

You know, try to make it less hostile settings.

00:31:01 ►

This is the participant’s point of view,

00:31:03 ►

a shot by one of our participants.

00:31:04 ►

I think that’s kind of a nice shot.

00:31:09 ►

So during the actual session, we encourage patients to really go deeply within

00:31:14 ►

and really enter the experience.

00:31:17 ►

We provide them with eye shaves and noise-canceling earphones.

00:31:21 ►

We have preselected music that they listen to.

00:31:24 ►

Now, we do have to check in once each hour to check a blood pressure and a pulse,

00:31:27 ►

and at four hours there’s one pain measure that we have to do.

00:31:30 ►

But the idea is really to allow them to go deep into their own process.

00:31:33 ►

Do you select the music for that?

00:31:34 ►

We select the music.

00:31:36 ►

Well, you know, it’s not pre-selected across, standardized across all the boards,

00:31:41 ►

but, you know, we found certain music is helpful to kind of get into a relaxed kind of state.

00:31:47 ►

Now, there have been folks,

00:31:48 ►

and one person in particular

00:31:49 ►

who had some experience with psychedelics

00:31:51 ►

had some strong ideas about what she wanted to listen to.

00:31:55 ►

So we just had those CDs and incorporated them some.

00:31:58 ►

I think there’s some benefit

00:31:59 ►

not having music actually that they’d never heard,

00:32:02 ►

particularly instrumental music,

00:32:04 ►

or if there are lyrics in another language,

00:32:06 ►

just to make it as abstract as possible.

00:32:11 ►

There’s a lot written about music in psychedelics.

00:32:15 ►

I can see Susana Pustos just walked in.

00:32:16 ►

She did a great thesis on the use of music with ayahuasca.

00:32:22 ►

It’s really an important area to look at.

00:32:24 ►

We’re not in this study,

00:32:26 ►

but it’s a hugely important influence on the setting.

00:32:30 ►

People with instrumental music and tribal music?

00:32:34 ►

Yeah, some tribal, some instrumental, you know.

00:32:36 ►

So, you know, kind of world music,

00:32:38 ►

there can be lyrics if it’s not in a language

00:32:40 ►

that’s known to the participant.

00:32:42 ►

So generally if it’s not English, we’ll use some of that.

00:32:45 ►

Because I think human voice can be very powerful, too, for compelling someone.

00:32:49 ►

You know, one of the classics we use is the soundtrack from The Mission.

00:32:52 ►

You get familiar with that movie and that sound.

00:32:55 ►

It’s a really, I mean, it’s a beautiful soundtrack.

00:33:01 ►

All right, so this is one of our participants who remarked,

00:33:04 ►

it was kind of remarkable how this weird music I would never normally listen to became a part of my trip. All right, so this is one of our participants who remarked,

00:33:09 ►

it was kind of remarkable how this weird music I would never normally listen to became a part of my trip.

00:33:13 ►

So she was very reluctant during her placebo session.

00:33:15 ►

You know, sometimes it’s fairly apparent when it’s placebo.

00:33:19 ►

She started really complaining, you know, about the music, but we stuck with it.

00:33:21 ►

She’s like, I don’t like this. These are my preferences.

00:33:28 ►

But interestingly enough, when she had her her what we assume is that you know the active session she was just blown away by the music in terms of where it took her and things like that so that’s why

00:33:32 ►

include that quote so if the conclusion of the session you know generally about

00:33:37 ►

after five five four five hours you know we do some integration we ask folks to

00:33:42 ►

invite their family in and get them together.

00:33:45 ►

And then this is kind of a list of some of the study measures.

00:33:48 ►

One is a profile of mood states, which is one day before, six days after, and then monthly for six months.

00:33:54 ►

There’s an anxiety inventory, the Beck Depression Scale, symptom distress.

00:33:58 ►

This 5DASC, that’s the Five-Dimensional Altered States of Consciousness. It’s translated from German.

00:34:05 ►

It looks at kind of, you know, at six hours,

00:34:08 ►

was the person’s consciousness altered or not?

00:34:11 ►

And then the Brief Psychiatric Rating Scale,

00:34:13 ►

which is really to look at kind of any kind of psychosis

00:34:15 ►

or anything that would emerge from this.

00:34:17 ►

And there’s some pain scales as well.

00:34:24 ►

Yeah, speaking of pain, you know, most folks that we’ve

00:34:26 ►

screened who have significant pain have opted not to go into the study

00:34:31 ►

because it requires going off narcotic

00:34:35 ►

analgesics for the study. That really would blunt the psychedelic experience.

00:34:39 ►

That’s going to be a measure that we’re really not going to get that much information about.

00:34:43 ►

Really, most of our folks don’t have significant pain.

00:34:47 ►

Because also they’re able to come in, you know, into the hospital,

00:34:49 ►

spend a night at this stage of their life.

00:34:51 ►

So, yeah, so it’s a little early for any data analysis,

00:34:56 ►

but hopefully that will be coming soon.

00:34:58 ►

Every participant is described as beneficial, just to us.

00:35:03 ►

And let’s see, since I have some time,

00:35:04 ►

I’ll throw you a couple of other quotes

00:35:06 ►

from some participants.

00:35:11 ►

I’ve always felt my mind was altered enough

00:35:13 ►

having OCD that I didn’t need to stretch it out

00:35:15 ►

to see what else might come out.

00:35:16 ►

I had heard that psilocybin might relieve

00:35:18 ►

my OCD symptoms, so I decided to try it.

00:35:20 ►

So this is a very interesting participant

00:35:22 ►

because she is somebody who had contacted

00:35:25 ►

Francisco Moreno at University of Arizona about the OCD and psilocybin study. And she

00:35:32 ►

was disqualified from that study because she had end-stage cancer. So she was referred

00:35:38 ►

to us. And I did the screening with her, and she did not meet criteria for OCD. According to any structured interview, we do a skid for that.

00:35:47 ►

So we could bring her in.

00:35:50 ►

And OCD technically wasn’t one of our absolute contraindications.

00:35:54 ►

So that was really kind of interesting.

00:35:57 ►

So she found it really, really beneficial.

00:35:59 ►

Also, she was a psychedelic, actually a pretty much drug-naive individual,

00:36:05 ►

which was kind of interesting.

00:36:09 ►

Okay, I was comfortable, not afraid, and in touch with something that made me happy.

00:36:14 ►

I would very much like to repeat the study and compare experiences.

00:36:19 ►

Okay, so those are also comments by that subject.

00:36:22 ►

Now, this is another subject.

00:36:25 ►

My first perception of the psilocybin’s effects was a feeling of being supported by many hands.

00:36:30 ►

I thought about my relationships with my husband, members of my family, and my Buddhist teachers.

00:36:36 ►

During a bathroom break, I saw myself in the mirror and started to cry,

00:36:40 ►

grieving the effect of two rounds of chemotherapy,

00:36:42 ►

the loss of my long curly hair, and my relatively

00:36:45 ►

youthful appearance.

00:36:47 ►

I saw the cancer as part of my spiritual path.

00:36:51 ►

Prior to the psilocybin session, I had been plagued by obsessive thoughts that I would

00:36:55 ►

suffer horribly while going through the dying process.

00:36:58 ►

Death would not be the end of my life, just a transition.

00:37:02 ►

Throughout the session, I felt a strong sense of spiritual presence and the connectedness of all

00:37:06 ►

things and that everything is perfect just the

00:37:08 ►

way it is.

00:37:10 ►

Realistically, no type of treatment could

00:37:12 ►

completely eliminate the fears associated with

00:37:14 ►

having a terminal illness. But when

00:37:16 ►

I am able to tap into the memory of that blissful

00:37:18 ►

state, it is of great comfort to me.

00:37:20 ►

So that subject

00:37:22 ►

was someone who was

00:37:25 ►

kind of raised with a Judeo-Christian background

00:37:27 ►

but had adopted kind of Buddhism

00:37:29 ►

mindfulness practices, meditation

00:37:30 ►

probably for the last 25 years

00:37:33 ►

and though she I think felt

00:37:35 ►

she benefited a lot in her life

00:37:37 ►

from a lot of those concepts

00:37:38 ►

it was really difficult to actually put that experience into effect

00:37:40 ►

when it came to this diagnosis of cancer

00:37:43 ►

and in her kind of life story she was really hoping to be able to make it through to the

00:37:49 ►

marriage of her son, which she has.

00:37:52 ►

And so those are kind of the kind of personal issues she was grappling with.

00:37:56 ►

But she really felt a connection to kind of her own adopted spirituality, more of a kind

00:38:02 ►

of transcendental karmic spirituality through this process,

00:38:05 ►

which is really kind of a gratifying thing for all of us to kind of work with her around.

00:38:11 ►

So I’d just like to acknowledge all the volunteers, our 11 subjects who’ve been so generous with

00:38:17 ►

their time, with so little that left to come to the study.

00:38:20 ►

Charles Grove for putting this study together.

00:38:22 ►

Mary C. Haggerty was our first research coordinator for about the first two years of this study.

00:38:27 ►

We’ve been doing this since 2004.

00:38:28 ►

And Alicia Danforth is our current research coordinator.

00:38:34 ►

And for some more information,

00:38:36 ►

you can get information about this study at clinicaltrials.gov.

00:38:40 ►

There’s also a website for this study.

00:38:42 ►

And this website, Matrix Masters, has a couple of talks by Charlie Grove,

00:38:46 ►

I think one by Alicia Nettle and one by me about the study.

00:38:48 ►

There’s also, I think, a testimonial from a patient on there.

00:38:52 ►

So thanks for listening so intently.

00:38:54 ►

We have some time for questions.

00:39:02 ►

I just wanted to ask you if you have ever heard of a Mexican psychiatrist named Salvador Roquet.

00:39:10 ►

Yes.

00:39:10 ►

He did some extensive work with psychedelics.

00:39:15 ►

So the real question is, hey, have I heard about a Mexican psychiatrist named Dr. Roquet

00:39:19 ►

who worked with psychedelics in Mexico, I believe in the 60s and 70s.

00:39:26 ►

Yeah, so I have heard about him, not much.

00:39:28 ►

It’s interesting.

00:39:29 ►

That quote from Houston Smith is from an article

00:39:32 ►

when he writes about his experience with Dr. Roquette in Mexico

00:39:36 ►

where he felt the whole,

00:39:39 ►

the setting was to set up this incredible destruction of the self

00:39:43 ►

and then have this gentle rebuilding of it during this process.

00:39:48 ►

So that’s all I know about it, but I’ve heard a lot of things about it.

00:39:51 ►

I’m wondering if there’s a spirituality part to that.

00:39:57 ►

All right, so the question is about what kind of spirituality did our subjects endorse

00:40:01 ►

and did we screen for that?

00:40:03 ►

So we didn’t screen for that.

00:40:04 ►

I mean, I kind of assume

00:40:05 ►

everybody has a spirituality.

00:40:06 ►

So when I include that in the set,

00:40:08 ►

I include that as some sort of

00:40:10 ►

maybe system of belief

00:40:11 ►

or experiences,

00:40:12 ►

either chosen personally

00:40:13 ►

or kind of adopted from parents,

00:40:15 ►

that someone kind of emulates

00:40:17 ►

and that kind of affects

00:40:18 ►

their experience with things.

00:40:21 ►

So with that in mind,

00:40:22 ►

I mean, we’ve treated people

00:40:23 ►

who, you know, define themselves as Jewish, so with that in mind we’ve treated people who

00:40:25 ►

define themselves as Jewish

00:40:29 ►

as Buddhist, as Catholic

00:40:31 ►

as agnostic

00:40:32 ►

people who switch back and forth

00:40:34 ►

I’d say it’s fairly wide range

00:40:37 ►

comes in naturally

00:40:39 ►

to this kind of work

00:40:40 ►

working with end stage cancer folks

00:40:43 ►

regardless of the power of a

00:40:45 ►

psychedelic experience.

00:40:47 ►

So, I mean, spirituality is on the table.

00:40:49 ►

Everybody’s, you know, we’re wrestling kind of with the good questions.

00:40:53 ►

You know, what does this mean?

00:40:56 ►

Thank you for that.

00:40:57 ►

Yeah, I missed the first part of this.

00:40:59 ►

You said at the end that all 11 clients, they all reported things.

00:41:07 ►

What were the parameters used to measure?

00:41:10 ►

Yeah, so we haven’t done any data analysis yet.

00:41:13 ►

I’m just, their subjective report after coming in,

00:41:16 ►

no one said, hey, this was a really bad experience.

00:41:18 ►

There’s been no adverse effects.

00:41:20 ►

Everybody felt they would do it again.

00:41:22 ►

They said it was beneficial.

00:41:23 ►

Generally they felt more relaxed, less anxious.

00:41:26 ►

So there was no anxiety pre-test?

00:41:30 ►

We have anxiety measures beforehand and afterward.

00:41:33 ►

We haven’t completed the study yet,

00:41:34 ►

so we haven’t analyzed that data yet.

00:41:37 ►

I’m wondering, were these all psilocybin-naive subjects?

00:41:41 ►

No, some were. Some weren’t.

00:41:44 ►

I don’t believe anybody had actually ever taken psilocybin.

00:41:47 ►

I know, I can remember at least one or two of the subjects

00:41:51 ►

had tried mushrooms at some point in their life.

00:41:53 ►

It seems a lot gentler when using LSD or something like that.

00:41:58 ►

Yeah, I think psilocybin is a much better choice

00:42:00 ►

with end-stage cancer folks

00:42:02 ►

because it’s a shorter duration of effect.

00:42:07 ►

Yeah, absolutely.

00:42:07 ►

Yeah, I used to, in college, I was on a team that would talk people down from bad trips.

00:42:12 ►

Oh, right.

00:42:13 ►

And never had to talk anybody down from suicide.

00:42:17 ►

I had mescaline sometimes, mostly from the vomit, and definitely else.

00:42:23 ►

Well, you could have given the first part of my talk then.

00:42:23 ►

involvement and definitely else.

00:42:24 ►

Well, you could have given the first part of my talk then.

00:42:31 ►

I just wanted to ask a little bit of a two-part question.

00:42:38 ►

One was if you know anything about, I just know a little bit about the history or at least rumors that there were government studies where people were not contented with hallucinogenic research.

00:42:45 ►

And then the other part of it, of my question, has to do with,

00:42:50 ►

regardless of whether they’re naive or not,

00:42:52 ►

it’s your responsibility to instruct them about what they may expect.

00:42:56 ►

I understand that ethically.

00:42:59 ►

But I also question, I’m just curious, how do you handle their expectation,

00:43:05 ►

regardless of whether they’re naive or not to hallucinogenic drugs? I also question, I’m just curious, how do you handle their expectation,

00:43:09 ►

regardless of whether they’re naive or not to those contended drugs,

00:43:13 ►

their expectation that they are going to have a spiritual experience,

00:43:16 ►

that they may experience anesthesia or any of these things. How does one handle that?

00:43:19 ►

Because it seems like niacin would not be, would not control for that adequately.

00:43:27 ►

Just curious.

00:43:29 ►

Those are my two questions.

00:43:31 ►

So the first question about, you know,

00:43:33 ►

did the government give people psychedelics

00:43:36 ►

without telling them they were on psychedelics?

00:43:38 ►

Now, I have no way of knowing that.

00:43:39 ►

Yes or no?

00:43:40 ►

I don’t have that information.

00:43:42 ►

But I have heard that rumor.

00:43:43 ►

I do know that there was an internist named Eric Kast, who was a pain specialist,

00:43:49 ►

who treated patients with really bad pain with LSD, you know,

00:43:53 ►

basically just giving them an injection and coming back later to see if the pain was better,

00:43:56 ►

and he actually published really good results.

00:43:58 ►

So I do know there was a time in research when psychedelics were administered

00:44:03 ►

without really understanding what was going on.

00:44:05 ►

That was in the very, very early days that happened,

00:44:08 ►

so I wouldn’t be surprised.

00:44:10 ►

Now, the second question, remind me again so I can answer.

00:44:12 ►

It was about the placebo.

00:44:13 ►

Okay.

00:44:14 ►

Just about, yeah, about how do you control for that expectation.

00:44:18 ►

I think what we’ve learned in this process is that niacin is not an effective placebo.

00:44:22 ►

Again, psilocybin, okay?

00:44:23 ►

is that niacin is not an effective placebo against psilocybin.

00:44:31 ►

It’s so obvious when someone’s not on psilocybin or on niacin, almost.

00:44:32 ►

There’s probably those two individuals.

00:44:35 ►

We don’t know which was the psilocybin because they must have had relatively kind of mild effects.

00:44:39 ►

But both of their sessions,

00:44:40 ►

they felt kind of the emergence of some material,

00:44:43 ►

the ability to get some perspective, and kind of

00:44:45 ►

some comfort after spending the time with us.

00:44:47 ►

The other thing we’re not controlling for is the effect

00:44:50 ►

of doing a five, six

00:44:51 ►

hour session with two therapists

00:44:54 ►

and another very therapeutically

00:44:56 ►

minded research

00:44:57 ►

volunteer. And just the whole process

00:45:00 ►

of doing this kind of pilgrimage in

00:45:01 ►

to come in twice to kind of work

00:45:04 ►

on this kind of rite of passage.

00:45:08 ►

Oh, yeah.

00:45:09 ►

So, you know, I think the FDA would be totally open

00:45:12 ►

to changing the scheduling of psilocybin

00:45:14 ►

if there’s good evidence out there.

00:45:17 ►

I mean, psilocybin isn’t abused on the street, you know.

00:45:20 ►

There’s some other safety studies that have been done.

00:45:22 ►

So I think it’s a possibility.

00:45:24 ►

We have to demonstrate how it can be done safely and effectively.

00:45:28 ►

You know, it’s clearly not for everybody, the psilocybin.

00:45:33 ►

Yeah, so there’s some people have these ideas that maybe they’d have to be…

00:45:36 ►

So the question is, hey, it seems like you can’t,

00:45:38 ►

this wouldn’t be a medication you can just prescribe and take home

00:45:41 ►

with you and take by yourself.

00:45:43 ►

Yeah, that’s a very astute observation.

00:45:44 ►

So there’s some, I mean, I’ve heard some people conceptualize prescribe and take home with you and take by yourself. Yeah, that’s a very astute observation.

00:45:50 ►

So there’s some, I mean, I’ve heard some people conceptualize this concept of a treatment center where someone would go in for a session, and this would be with somebody who has a

00:45:54 ►

special training or expertise in facilitating the psychedelic experience.

00:45:58 ►

Maybe that would be an MD, maybe not, right?

00:46:01 ►

And then afterwards, you know, there’d be integration kind of through therapy or whatever kind of

00:46:05 ►

spiritual work they’re doing.

00:46:07 ►

So it’s not a very,

00:46:08 ►

it’s,

00:46:09 ►

one thing about,

00:46:09 ►

I think,

00:46:10 ►

psychedelics,

00:46:11 ►

you know,

00:46:11 ►

it kind of defies

00:46:12 ►

the Western paradigm

00:46:14 ►

of medicine,

00:46:15 ►

you know,

00:46:15 ►

so we have to,

00:46:16 ►

we have to rethink

00:46:17 ►

a lot of things.

00:46:18 ►

There’s also some folks

00:46:19 ►

who feel like,

00:46:19 ►

okay,

00:46:19 ►

these things shouldn’t

00:46:20 ►

be in the hands

00:46:20 ►

of physicians.

00:46:22 ►

They’re really more

00:46:22 ►

spiritual aids

00:46:23 ►

and really belong

00:46:24 ►

in the hands

00:46:24 ►

of kind of spiritual leaders.

00:46:27 ►

And that’s how it is in other societies.

00:46:31 ►

Can you describe what some of the interventions

00:46:35 ►

of the guides or the support staff were?

00:46:38 ►

What issues arose?

00:46:40 ►

Did the subject request their intervention?

00:46:42 ►

Did they intervene on their own?

00:46:44 ►

So this question is, hey, what came up sitting for the subjects?

00:46:47 ►

So we haven’t had to intervene at all for anything.

00:46:51 ►

All we’ve had to do is occasionally when someone has to go to the bathroom,

00:46:53 ►

remind them, please take your time standing up.

00:46:56 ►

Knock if you need us.

00:46:58 ►

There’s been no agitation.

00:47:00 ►

There’s been no paranoia.

00:47:02 ►

One subject at one point during a check-in said, whoa, this is coming on really intense,

00:47:06 ►

I didn’t realize it could be this rocky, I’m a little fearful.

00:47:11 ►

And Charlie said, hey, you know, it can be a little intense in the beginning, it’s fine.

00:47:14 ►

You need to check back in in five minutes.

00:47:16 ►

We kind of then changed the music to a little bit more gentle music.

00:47:20 ►

She went back in for the rest of her session.

00:47:22 ►

And that was just verbalized to us.

00:47:23 ►

So there’s really virtually very little dialogue between the participants.

00:47:28 ►

Minimal dialogue.

00:47:29 ►

Minimal dialogue during that actual experience.

00:47:31 ►

And that’s kind of based on the work that Groff did,

00:47:34 ►

Hankey saying, hey, let’s let this medicine do its own work.

00:47:38 ►

And one more quick question.

00:47:39 ►

Did any of the participants report no alteration in consciousness?

00:47:47 ►

Yeah, you know, I haven’t looked through all the altered states of consciousness scale,

00:47:52 ►

but, you know, the one subject, there’s two subjects that was very,

00:47:57 ►

everybody’s not sure which one was which.

00:47:59 ►

I wouldn’t say they were very altered, you know,

00:48:02 ►

versus some subjects were quite altered during the check-ins.

00:48:04 ►

They would say, well, you know, I can see some colors, this and that.

00:48:08 ►

The other thing is there’s some people who believe

00:48:10 ►

by putting on the eye shades and listening to music,

00:48:12 ►

there’s less incidence of the kind of sensual kind of phenomena,

00:48:18 ►

and that allows for more of the kind of psychological benefit.

00:48:20 ►

That’s another reason to keep the eye shades on

00:48:22 ►

and just use internal stimuli versus being out

00:48:26 ►

here and things like that that’s that that’s that’s a way of affecting set and setting you

00:48:30 ►

know often folks who have these bad experiences on psychedelics it’s like you know they’re buying a

00:48:35 ►

drug they don’t even know what it is from a drug dealer at two o’clock in the morning and in a back

00:48:40 ►

alley they take it they don’t know the onset of action next thing another trying to find their

00:48:43 ►

car and there’s all this I, it’s a horrific experience when you

00:48:47 ►

have an altered level of consciousness. So, I mean, it’s really that influential with

00:48:53 ►

it. So realistically, that’s why we really make sure people are comfortable with us,

00:48:57 ►

with the hospital. And there’s really, they’re quite comfortable in the setting. So it makes

00:49:03 ►

our job really kind of easy. The hardest thing for us is recruiting patients.

00:49:09 ►

Well, yeah, so his question is, hey, you know, did the double blinding fail because of this?

00:49:14 ►

I’m not actually sure because, you know, it takes some time for the psilocybin to have its effect anyhow,

00:49:19 ►

with, you know, all these other things we’re talking about.

00:49:21 ►

But again, I’m not sure if it means a failure.

00:49:23 ►

I think maybe it doesn’t fit the paradigm of a placebo-controlled study.

00:49:28 ►

Now, I think, you know, at the Hopkins study,

00:49:32 ►

they actually used Ritalin as the placebo.

00:49:35 ►

And they told people they were getting either, like, one of, like, six drugs.

00:49:43 ►

You know, either psilocybin or Ritalin, DM, I don’t remember what it was.

00:49:47 ►

So they really did this elaborate method to kind of keep the blind.

00:49:52 ►

And then they even did these interviews with the sitter and the patient having them report,

00:49:56 ►

did they think this was active session or placebo session, and they were so off base on it.

00:50:01 ►

So they kind of really did this huge kind of elaborate way to kind of keep a blind

00:50:04 ►

or at least show that it was blind.

00:50:06 ►

But to me, I think the effect of the medicine is still there either way.

00:50:10 ►

And the other thing is we’re looking at acute measures of anxiety and pain too.

00:50:14 ►

We’re kind of hoping some of that will separate out.

00:50:17 ►

It seems like a challenging thing.

00:50:19 ►

You’re going to ask them later what they feel and if they know what medication they got.

00:50:24 ►

Right, no, of course.

00:50:25 ►

Yeah.

00:50:27 ►

The other thing, this is also a feasibility study.

00:50:30 ►

Right.

00:50:30 ►

You know, so that’s, you know, we’re not going for an indication.

00:50:33 ►

You know, just showing, it’s really kind of a, you know,

00:50:36 ►

it’s a stage one feasibility study.

00:50:38 ►

If I could just add one thing, if I remember right,

00:50:40 ►

I think the Johns Hopkins people, I think with the Ritalin,

00:50:42 ►

it was like over 50% of the people with just the Ritalin had the mystical experience.

00:50:47 ►

Oh, they had some on the scales?

00:50:49 ►

I forget how high the number went, but I remember being jaw-dropping sick here.

00:50:55 ►

I’m wondering about movement.

00:50:58 ►

Because my experience in working with people on psychedelics is the ones who don’t physically move around have a bad time.

00:51:07 ►

From his experience kind of sitting with people having bad trips, you know, movement’s important

00:51:11 ►

to like work out things. Yeah, I think that’s a really good point for someone who’s educated,

00:51:14 ►

you know, who needs to move. But we’re preparing these folks that this is what’s going to happen.

00:51:19 ►

You know, we’re going to be laying in this bed, you know, they’ve seen the bed before

00:51:23 ►

with the eye shades, you know, with the music,

00:51:25 ►

we’re right here all the time.

00:51:27 ►

And there was one person who actually had quite a lot of psychedelic experiences

00:51:31 ►

who really kept pulling on the eye shades,

00:51:34 ►

wanted to look out the window,

00:51:35 ►

wanted to do a lot of that distracting kind of thing,

00:51:37 ►

and she took a lot more redirection to stay with the process,

00:51:41 ►

which she finally did.

00:51:44 ►

How long did you wait between crossing people over and getting the crossover?

00:51:50 ►

Yeah, you know, my opinion, there really is no residual psychedelic effect beyond a day or two.

00:51:54 ►

I mean, that’s kind of like where I’m looking at it, you know.

00:51:57 ►

Certainly no, you know.

00:51:58 ►

So I think it’s either two or three weeks is what we’re doing.

00:52:02 ►

I don’t, not with psilocybin.

00:52:04 ►

In terms of integrating into one’s life

00:52:06 ►

for the longer term, longer amounts.

00:52:09 ►

Yeah, that’s going to be very hard to argue

00:52:11 ►

what is like that.

00:52:13 ►

Again, that’s not one of our outcome measures,

00:52:14 ►

so I don’t think that’s important.

00:52:15 ►

But that, I mean, I think about that myself

00:52:17 ►

kind of in the study.

00:52:18 ►

You know, ideally there’d be matched controls, right?

00:52:22 ►

But that, we just felt it wasn’t ethical

00:52:23 ►

to ask people to come in for a placebo

00:52:26 ►

at this stage in their life.

00:52:27 ►

That’s why everyone is serving as their own placebo.

00:52:30 ►

So I think that’s the downside.

00:52:32 ►

Yeah, that’ll help with recruitment, too, of course.

00:52:34 ►

And, yeah, sure.

00:52:35 ►

People are coming in thinking that they may get something

00:52:37 ►

that can help them, you know?

00:52:40 ►

But your intervention probably would help them.

00:52:42 ►

Well, I don’t know. We’ve never done it that way.

00:52:44 ►

Right.

00:52:44 ►

Yeah.

00:52:41 ►

But your intervention probably would help us.

00:52:42 ►

Well, I don’t know.

00:52:43 ►

We’ve never done it that way.

00:52:44 ►

Correct.

00:52:44 ►

Yeah.

00:52:48 ►

Did you have a terminal?

00:52:55 ►

Yeah, we actually, the FDA allowed us to relax the criteria from terminal to advanced,

00:53:01 ►

which generally means a note from their oncologist saying, you know, advanced cancer.

00:53:04 ►

There’s some argument on terminal meaning 12 months or not. There’s many folks who are beyond treatment who don’t have a cancer that is that acute.

00:53:09 ►

So, for example, several folks we’ve treated with ovarian cancer

00:53:12 ►

who eventually probably will succumb to fluid overload.

00:53:16 ►

And so basically the hypothesis is that this therapy would increase their general fluid weight.

00:53:21 ►

Help with anxiety associated with that diagnosis.

00:53:25 ►

What were the prescriptions that you said were contraindicated?

00:53:29 ►

Well, it depends on the psychedelic,

00:53:30 ►

but certainly I think you’re warranted to avoid MAOI inhibitors

00:53:34 ►

with any psychedelic that has MAOI activity.

00:53:37 ►

The most prominent of that would be ayahuasca,

00:53:39 ►

which is kind of a vine beverage from the Amazon,

00:53:42 ►

or DMT compounds, you know.

00:53:44 ►

I also think people with cardiac disease should avoid MDMA.

00:53:48 ►

Those are the two biggest ones, you know.

00:53:51 ►

Can I just have one more thing,

00:53:53 ►

and that kind of touches on what the gentleman over there said about legal issues

00:53:58 ►

and what are the future directions you think these studies are headed towards?

00:54:07 ►

Well, I mean, I think this could be beneficial for anybody getting a diagnosis of cancer.

00:54:11 ►

I mean, the irony is, you know, we’re more likely to be allowed to do research on folks who are, you know, beyond treatment.

00:54:17 ►

That’s this kind of strange value in our medical research system, you know.

00:54:23 ►

Hopefully, you know, we can demonstrate this is very safe,

00:54:26 ►

and then we can treat anybody just for the existential concern of,

00:54:29 ►

what am I going to do?

00:54:30 ►

What does this mean for my life?

00:54:31 ►

How does this reorganize me?

00:54:33 ►

So I’d like to look at any kind of anxiety associated with a kind of a life change,

00:54:38 ►

still ruling out lifelong access to anxiety disorders,

00:54:42 ►

this kind of situational thing.

00:54:46 ►

And cancer is such kind of a heavy diagnosis, even today,

00:54:50 ►

though it means so many different things to different people.

00:54:53 ►

It’s really ubiquitous.

00:54:56 ►

What sort of vital signs change?

00:54:59 ►

So generally with psilocybin, there’s a slight increase in heart rate

00:55:02 ►

and a slight increase in blood pressure at about hour one or hour two.

00:55:06 ►

So we’re looking at that.

00:55:07 ►

Also, I didn’t put it in the slide.

00:55:09 ►

Everybody is getting a cardiac monitoring for the duration of it.

00:55:13 ►

There hasn’t been anything, you know, on there.

00:55:16 ►

So there’s generally a slight bump.

00:55:17 ►

You know, one thing we have noticed when we’re just kind of watching the vitals

00:55:20 ►

is you don’t get that bump with the niacin.

00:55:23 ►

You know, but some people don’t get a bump with the psilocybin.

00:55:28 ►

Patients on IVs?

00:55:30 ►

Oh, the question, are patients on IVs?

00:55:31 ►

Yeah, there’s no IVs.

00:55:33 ►

Yeah, there’s no IVs.

00:55:36 ►

There hasn’t been any intervention necessary

00:55:37 ►

for any of these folks who are really,

00:55:40 ►

I should say, quite medically frail.

00:55:42 ►

You know,

00:55:44 ►

by the way.

00:55:52 ►

How did you recruit them? Did you how to recruit it’s been a long time and we started this

00:55:55 ►

the study was open for recruitment at 2004 when I was a third year resident

00:56:00 ►

and I’m flying down there this weekend to help finish it up right now so So, you know, it’s been a lot of word of mouth. Unfortunately,

00:56:07 ►

we could only take English speakers for this study, so that majority of the patients

00:56:11 ►

kind of on the psych C&L service and receiving

00:56:15 ►

kind of their oncology treatment at Harbor are Latinos.

00:56:19 ►

That wiped out a lot of folks. And there really

00:56:23 ►

wasn’t that much openness among, I think, oncologists in the area, you know, to the study.

00:56:29 ►

Most of it, I think, was being open to allow us the time to explain to them what this might offer their patients.

00:56:34 ►

You know, everyone just being so busy and things like that.

00:56:37 ►

So, you know, two subjects have been referred by two other different subjects.

00:56:43 ►

One subject I met on CNL.

00:56:46 ►

Actually, I wasn’t on CNL,

00:56:48 ►

but one of the other residents knew that I was on CNL.

00:56:50 ►

It was a woman who just got diagnosed

00:56:51 ►

with advanced breast cancer.

00:56:55 ►

She diagnosed the pathological fracture of her hip,

00:56:57 ►

and she had heard about the study somewhere,

00:56:59 ►

had no idea about the cancer,

00:57:01 ►

and just so she wanted to do it.

00:57:02 ►

And then other people, just a clinical trial at website showed me the one person was referred from another

00:57:09 ►

psilocybin study oh by the way she was really hoping that it would help with the ocd too

00:57:15 ►

not just the cancer and anxiety when she was coming up that really was her primary motivation

00:57:19 ►

getting to the study which has been really really um you know slow there’s been some people who didn’t make it because they passed away before we got slow. There’s been some people who didn’t make it

00:57:26 ►

because they passed away before we got them in.

00:57:28 ►

There’s been some people who didn’t want to go off their

00:57:29 ►

narcotics. There was one person

00:57:32 ►

who, when they saw Harbor UCLA,

00:57:34 ►

this county hospital, was like, there’s no way I’m

00:57:35 ►

admitting myself into there.

00:57:37 ►

Just looking at it.

00:57:40 ►

I think if it wasn’t

00:57:41 ►

end-stage cancer, just any cancer, I think it would be

00:57:43 ►

a lot easier to recruit,

00:57:45 ►

or even folks who have recovered from cancer.

00:57:48 ►

The other thing that makes it hard is we can’t have any cardiac disease,

00:57:51 ►

any significant organ involvement,

00:57:54 ►

and they have to have advanced cancer.

00:57:56 ►

Originally, for the first three years, with less than one year to live.

00:57:59 ►

So how do you get somebody who’s just about to die from an advanced disease

00:58:02 ►

who is totally medically stable?

00:58:03 ►

So there’s a bit of that catch-22 in the beginning.

00:58:06 ►

So this last two years has done a much better job recruiting.

00:58:10 ►

And also they’ve removed hypertension.

00:58:12 ►

Hypertension was a rule-out, and we got that changed to treated hypertension.

00:58:16 ►

How about expanding it to Spanish?

00:58:19 ►

Yeah, I would love to do that.

00:58:20 ►

I speak Spanish, you know.

00:58:22 ►

It would require the whole team to speak Spanish, though.

00:58:24 ►

This isn’t something

00:58:25 ►

you can do kind of halfway

00:58:28 ►

with them. I mean, it would push my

00:58:29 ►

Spanish skills. I’ve done psychotherapy

00:58:32 ►

in Spanish, but not nearly

00:58:34 ►

as adept.

00:58:35 ►

Your instruments also aren’t all available

00:58:37 ►

in Spanish translation.

00:58:40 ►

Yeah. But I think that

00:58:41 ►

altered state of consciousness was actually

00:58:43 ►

translated from German to English.

00:58:45 ►

Couldn’t we just get that German to Spanish?

00:58:48 ►

I mean, that’s a German instrument, right?

00:58:49 ►

The translation is a little dicey.

00:58:52 ►

But it can be done.

00:58:53 ►

You’d have to get the psilocybin from the black forest.

00:58:56 ►

Right. Great.

00:58:59 ►

Okay, well, let’s thank Fritz again for… You’re listening to The Psychedelic Salon,

00:59:13 ►

where people are changing their lives one thought at a time.

00:59:19 ►

So, there was our little peek into what is going on today

00:59:23 ►

in some of the more advanced hospitals and medical centers in the U.S.

00:59:28 ►

While there still may not be hundreds of psychedelic research projects taking place, the logjam has at least been broken.

00:59:36 ►

Human research studies are taking place at Harbor UCLA, Johns Hopkins, with the Mithoffers in South Carolina,

00:59:43 ►

Francisco Moreno in New Mexico,

00:59:45 ►

and several others who are in various stages of psychedelic research.

00:59:50 ►

The overall effort, of course, is still nowhere close to the number of active projects there were

00:59:56 ►

when the prison industrial complex declared war on these substances,

01:00:00 ►

but at least it’s a start once again.

01:00:03 ►

And my hat is off to Preet and all the other professional researchers

01:00:06 ►

who are willing to risk their careers to push this research back to the preeminent position it deserves.

01:00:14 ►

One thing I want to be sure that you caught is the fact that what Preet was talking about here

01:00:19 ►

when he mentioned the importance of a facilitator

01:00:22 ►

is that this was all in the context of using psilocybin in psychotherapy.

01:00:28 ►

I’m only talking for myself here,

01:00:30 ►

but when using this sacred medicine for personal spiritual growth and insight,

01:00:35 ►

I’m still in Terence McKenna’s corner,

01:00:38 ►

where he recommends taking a high dose alone in silent darkness.

01:00:42 ►

However, I don’t subscribe to the silent part,

01:00:45 ►

because I like music during my solo experiences.

01:00:48 ►

But in a clinical setting, I think that if you spend some time

01:00:51 ►

reading the old reports of the early research that was done,

01:00:55 ►

then it will be clear just how important a trained and skilled therapist can be

01:00:59 ►

when someone is trying to work through what may seem to them to be unsolvable problems.

01:01:05 ►

And I probably should also mention that Preet has been doing this work for longer than he took credit for.

01:01:13 ►

Because even though he says a couple of times that the study began in 2004,

01:01:18 ►

I can tell you for sure that it began in 2003,

01:01:21 ►

and Preet was right there from the very first participant experience, which,

01:01:26 ►

now that I think of it, may not have actually taken place until early 2004.

01:01:31 ►

But that’s a trivial detail, right?

01:01:34 ►

Anyway, this study, along with Dr. Charlie Grobe, has been getting a lot of publicity

01:01:41 ►

lately, and I’ll put a link to some of those stories along with the program notes for this podcast

01:01:46 ►

on our Notes from the Psychedelic Salon blog,

01:01:50 ►

which you can find at psychedelicsalon.org.

01:01:53 ►

Let’s see.

01:01:55 ►

There was one other thing I wanted to mention.

01:01:57 ►

Oh, yeah.

01:01:58 ►

There was some discussion in Preet’s Grand Rounds

01:02:01 ►

about the government at one time

01:02:03 ►

giving psychedelic substances

01:02:05 ►

to people without their consent.

01:02:07 ►

I guess I need to get busy and do an interview with Jim Ketchum about this pretty soon and

01:02:13 ►

put it all up on record.

01:02:15 ►

But there were two government projects involving psychedelics back in the 50s and 60s.

01:02:20 ►

One was run by the military where everyone gave their consent before participating, and

01:02:26 ►

Dr. James Ketchum, who ran that program, has written an excellent history about it. And

01:02:32 ►

Jim is a good friend of Sasha Shulgin’s, by the way, and when we met at Burning Man last

01:02:37 ►

year, he agreed to do an interview for the salon, so I guess it’s about time I took him

01:02:42 ►

up on his offer. The other government program, though, was the shady one.

01:02:46 ►

It was run by the CIA and was called MKUltra.

01:02:49 ►

And if you’re interested in that one, Wikipedia is a good place to begin.

01:02:55 ►

Now, so that I don’t have to close this podcast after talking about something negative,

01:02:59 ►

let me pass along some news to those of you fortunate enough to go to Burning Man this year.

01:03:05 ►

As you know, I’m not going to be able to make it myself, but even so, the fever has now caught me.

01:03:12 ►

So the night before last, I was at this party up in the hills,

01:03:16 ►

and besides some old friends like Mateo and Cactus Phil,

01:03:20 ►

I saw some of my long- time but young friends like Violet

01:03:25 ►

And Violet is the wonderful young woman who organized Brain Village at Burning Man for several years

01:03:30 ►

And it was thanks to her that the Palenque Norte lectures stayed alive

01:03:35 ►

Well a few weeks ago Violet married one of my favorite visionary artists, Michael Brown

01:03:41 ►

And I think there’s two Michael Brown visionary artists out there

01:03:44 ►

Not sure about that but anyhow Michael is here in the local area Michael Brown. And I think there’s two Michael Brown visionary artists out there.

01:03:48 ►

Not sure about that, but anyhow, Michael is here in the local area.

01:03:54 ►

And together they’ve received an art grant from the Burning Man organization for a major installation on the playa.

01:03:57 ►

And it’s going to be called McLightenment.

01:04:00 ►

That’s M-C-L-I-G-H-T-E-N-M-E-N-T.

01:04:06 ►

And you’ll find it on your way out to the man from center camp.

01:04:11 ►

And if you want to see what it’s going to look like right now,

01:04:14 ►

go to mclightenment.com and see their conception of the final piece.

01:04:20 ►

Now, the reason I’m mentioning this is to see if some of you will have your pictures taken in front of it

01:04:25 ►

and send them to me to post on the Salon blog.

01:04:28 ►

That way those of us who can’t make it this year can at least feel connected with the mutual thread of this art.

01:04:36 ►

And if you happen to see Michael and Violet while you’re out there,

01:04:39 ►

well, please tell them that Lorenzo sends his love.

01:04:42 ►

Well, that’s about it for today.

01:04:44 ►

But before I go, I want to mention that this and all of the podcasts from the Psychedelic Salon

01:04:49 ►

are available for your use under the Creative Commons Attribution Non-Commercial ShareLike 3.0 license.

01:04:56 ►

If you have any questions about that, just click the Creative Commons link at the bottom of the Psychedelic Salon webpage,

01:05:01 ►

which you can find at psychedelicsalon.org,

01:05:05 ►

and that’s also where you’ll find the program notes for these podcasts.

01:05:09 ►

And for now, this is Lorenzo, signing off from Cyberdelic Space.

⚗️ alembic

Explorer

148 - Grand Rounds_ Psychedelic Psychotherapy

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Program Notes

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