The new mRNA vaccines that have blunted the deadly COVID-19 pandemic signal only the beginning of a true revolution in modern pharmacology. New treatments are on the horizon for almost every major disease, and there is even talk about significantly extending life spans. But what about mental health? In this area, treatment still relies on the kinds of drugs that dull the senses and cover up symptoms.
What, if anything, is ahead for getting to the root of diseases like depression, PTSD, trauma, substance abuse, and other brain disorders?
The answer may lie not on the cutting edge, but in the use of drugs we’ve known about for decades: psychedelics. Treatments with mind-altering substances like MDMA, LSD, and psilocybin are having heartening results — so much so that they are slowly overcoming the resistance that has long kept these therapies from wider acceptance.
Leading this effort for many years has been my guest on this week’s WhoWhatWhy podcast, Rick Doblin. Since 1986, Doblin and his organization, the San Jose-based Multidisciplinary Association for Psychedelic Studies (MAPS), have been on a mission to create safe, legal opportunities for the use of psychedelics in society.
Doblin talks about the checkered history of psychedelic research — how what started in the 1950s and ‘60s as a serious inquiry into the nature of the human mind was melded into the counterculture, criminalized in the ‘70s, and not fully appreciated as a legitimate scholarly enterprise until today.
Doblin explains how new technologies — like MRI scans, that allow us to actually see the brain reacting and functioning in real time — have guided some remarkably successful efforts to treat PTSD, addiction, and depression with drugs like MDMA, psilocybin (“magic mushrooms”), and ketamine.
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(As a service to our readers, we provide transcripts with our podcasts. We try to ensure that these transcripts do not include errors. However, due to a constraint of resources, we are not always able to proofread them as closely as we would like and hope that you will excuse any errors that slipped through.)
Jeff Schechtman: Welcome to the WhoWhatWhy podcast. I’m your host, Jeff Schechtman. The pandemic and the resulting vaccines gave all of us some insight into what the cutting edge of medicine is capable of doing. What the public has not fully appreciated is the cutting-edge work that’s going on with respect to mental health. Not just with drugs to dull the senses and cover up the symptoms, but with treatments that when combined with real therapy get to the root of diseases like depression, PTSD, trauma, substance abuse, and other brain disorders. This work is going on in large part in the area of psychedelics. Treatments like MDMA, LSD, and psilocybin are having amazing results. So much so that they’re slowly but surely transcending the negativity that has, for so long, surrounded such drugs and treatment.
Leading this effort for so many years into this brave new world of mental health is my guest, Rick Doblin. Since 1986, Rick and his organization San Jose-based MAPS, the Multidisciplinary Association for Psychedelic Studies, has been on a mission to create safe and legal opportunities for the use of psychedelics in treating patients. Joining me today along with Rick Doblin is Ismail Ali. Ismail is the acting director of policy and advocacy for MAPS and has dedicated himself to helping to eliminate legal barriers to psychedelic therapy and research.
It is my pleasure to welcome Rick Doblin and Ismail Ali, here to the WhoWhatWhy podcast. Rick, Ismail, thanks so much for joining us.
Rick Doblin: Yes. Yes, we appreciate the opportunity.
Jeff: Well, it’s great to have you both here. Rick, I want to start with you a little bit first about how you got into this whole arena. I know it goes back a long time but give us this thumbnail version of how this became your life’s work.
Rick: Okay, well, it does go back a long time. It goes back to 1972, when I was 18 years old when I decided to focus my life on psychedelics and go through psychedelic therapy and become a psychedelic therapist, and try to bring back the whole field of psychedelic research. But what led to that decision at age 18 was a series of encounters with the murderous nature of human beings. And so from a very early age, I was educated about the Holocaust. And my family’s Jewish, I had distant relatives killed in the Holocaust, I had relatives in Palestine since 1904 and so I was just very much appalled by what happened. And just the thought was that it’s — you can have all the material wealth in the world, but if the culture around you goes crazy, your survival is limited.
At a slightly older age than like five or six or seven, when I started being taught about the Holocaust, was for me, the Cuban Missile Crisis, and then also, all these drills that we would have in school about what happens if there’s a nuclear war. People had heard about it as ‘duck and cover.’ So it just extended now from, okay, one group is trying to kill the Jews and gypsies and homosexuals and others, now, the whole world could go up. And then as I got older in high school, I started encountering the Vietnam War, and that I had to be subjected to the draft in Vietnam. That was one of the last years of the lottery.
So it just steered me towards thinking about what I like to call deeper threats. And my family told me the story of who I was in the sense of a multi-generational story — in a way, you say, going back thousands of years — but also, more recently, just immigrants into the United States, being antisemitism in Russia, my great grandparents on one side came in 1880, my grandfather came on the other side in 1920 to the US, so immigrants, the American dream, becoming successful, and then giving me the freedom to work on deeper threats. So all of that really led to me thinking that I had the responsibility, in a way, to respond to what seemed like humanity and mass being mentally unbalanced and destroying the world, destroying the environment, killing each other. And that just led me to depth psychology.
And so when it was trying psychedelics, my first psychedelic experience gave me this intimation of beyond ego states and my connection with everything, and everything’s part of me and I’m part of all. And I thought that’s the antidote to genocide, fundamentalism, racism, environmental destruction. If we really feel and know that we’re part of everything, then we’ll see people that are different from us as more similar than different.
So, for example, just to talk about Izzy. So he’s a Muslim. I’m Jewish. But does that mean we should fight each other? Does that mean we should — absolutely, not. There’s no reason for that, and in fact, I can appreciate when he fasts for Ramadan and think that’s a lot harder for me when I just fast for a day on Yom Kippur. So I’ve learned to really appreciate Ramadan. I’ll say also, I went to Egypt with my family, and we had some Egyptian tour guides and guards, and they were celebrating Ramadan while it was in the middle of the summer. And we’re just drinking, guzzling water, and drinks the whole day. It’s super hot, and they’re abstaining from food and liquids during the day. I was just super impressed.
So, in any case, the psychedelics gave me this hint that if you’re going to experience this connectivity, that’s the antidote. And then the final step is when I saw the backlash against psychedelics from the Controlled Substances Act of 1970, Nixon saying that Leary was the most dangerous man in America. And that led me to think, ’What is Nixon thinking that Leary’s doing? What is Leary doing right to have such an important enemy?’ And I saw that the crackdown against psychedelics was not really psychedelics going wrong and bad experiences, although it happened, but it was psychedelics going right, people getting inspired to be more politically active.
And so I felt like, ’Here it is. I’m going to go to jail for being a draft resistor,’ or at least that’s what I thought. And it’s a crazy world and here’s this thin thread of hope, this kind of mystical experience and working through traumas that you can have a psychedelic something like that. That’s what I’ll do.
Jeff: Before we get into the specific ways in which this can work, talk a little bit about the spiritual aspect of this because it often gets overlooked within the broader context. But as you’ve laid it out, it is a significant part of how this healing process can work.
Rick: One reference that people can have to maybe help them understand this is to think about the pictures of the Earth from space. And the whole idea of the astronauts, a lot of them became more spiritual after they were up in space, and that they see the Earth as one thing, as one planet. They don’t see the borders. They don’t see the religions. They don’t see the races. They just see this thin blue marble, you could say it different ways, hanging in space. And that had an impact on these astronauts, and it had an impact on humanity — thinking of us, seeing us from the perspective of outer space.
So psychedelics have a similar role to play in that — instead of being grounded in our ego and seeing things from our own individual perspective, the ego dissolution that leads to this mystical experience that people can have under psychedelics or any other ways. It’s that same kind of thing where you shift from this perspective of, ’I’m the center of the universe and everything matters based on my birth and my death, and it’s all about me,’ and then this shift to, ’It’s about something bigger. I’m part of something bigger and something enormously bigger.’ And I think that that connects you up to this enormous sense of spirituality.
And I would differentiate that from fundamentalist religion, in that you can have a spiritual experience without having to be linking it up with particular dogmas, particular symbols, particular saviors, or messiahs, or prophets. You can have a spiritual experience without it necessarily being encased in a particular religious symbol system. But at the same time, you can have both. You can have a spiritual experience, and then you can see your religion as like, one of many attempts to put into stories and symbols this fundamental perception. Aldous Huxley called it the Perennial Philosophy.
So I think that spiritual sense is very similar to what humanity went through when Galileo and Copernicus were talking about whether the Earth is the center of the universe. And then we saw how the Catholic Church burned Father Bruno at the stake for saying that the Earth was not really the center of the universe. So that kind of shift from an individual basis from its, ’I’m the center of the universe,’ to ’I’m part of this enormous historical sweep of things,’ that I think is spiritual, and psychedelics have been used for thousands of years for this mixture of spirituality and healing. And that is the — what really got me involved in this is political understanding, that this spiritual experience had political implications and that’s why I felt like it was worth devoting my life toward it.
Jeff: And when did you make the connection that all of this — that these drugs and that spiritual aspect — could really result in helping people that were suffering from trauma, or PTSD, or depression?
Rick: Well, it was really in 1972, when I went to the guidance counselor at New College, which was in Sarasota, Florida, it was in my freshman year, and I had come across the work of John Lilly, who had developed the floatation tank, the isolation tank. He worked on the intelligence of dolphins. And he was funded by the Navy to do work with taking LSD inside the floatation tank. He wrote a book about it called Programming and Metaprogramming in the Human Biocomputer.
So this is early on in technology and he was just trying to explore how the mind works and so it’s more of, you could say, a mechanism of action. It wasn’t a therapy project, but I read about that book in the Whole Earth Catalog and ordered that. I did a bunch of LSD. I did a bunch of mescaline. I had very difficult experiences. It wasn’t like I took it and blissed out, and I’m part of everything and everything is part of me. It was very difficult. I had a hard time letting go but it opened me up to my emotions, but a lot of them were jumbled. There was fear of losing control. I didn’t understand who I was. I felt that my bar mitzvah failed to turn me into a man and that the psychedelics were starting to do it. It was making me ask these existential questions, but I couldn’t handle it. I went to the guidance counselor, and he took me seriously, and he gave me a book to read, which was Realms of the Human Unconscious: Observations From LSD Research by Stan Grof. And that’s where I really understood the therapeutic potential. Whereas before I’d been looking at it from a more political perspective and looking at what happened with the ’60s, and the Beatles and doing LSD, and being against the Vietnam War, and getting into meditation, things like that, I saw the spiritual side of things, I saw the political side of things, but it was reading Stan Grof’s book that really opened my mind up to both the scientific and therapeutic.
And his book was not actually published, Stan’s book, till 1975, so this guidance counselor had a manuscript copy years ahead of time with the book being published, and he also had Stan’s address. So I’m just this confused 18-year-old and I write this letter to an MD PhD who was in charge of this research at Johns Hopkins. And in one of the most important experiences of my whole life, Stan actually wrote me back and said, ’Yes, this is important. It’s being shut down. I’m going to be giving a workshop in the summer of ’72. Would you like to come?’
So I actually started my apprenticeship, you could say, with Stan in the summer of ’72 when I was just 18. But it was really through Stan Grof that I understood the scientific and therapeutic potential, and then, later on, it was through more of my own experiences, where I could see myself how they were helping me with different issues, and helping other people.
Jeff: How tough has the battle been over the years, getting other people to realize this potential, given this remnant of the 1970s and all the pushback that was against all of this, and then turning it around to get people to realize that there’s real potential here?
Rick: Well, how tough? Here’s a good way to think about it: I started this work when I was 18, I’m now 67, and we’re still not there, meaning, they are meeting FDA approval that these drugs are now available by prescription. And it was just incredibly tough. There were several decades of suppression of psychedelic research. When I started MAPS, it was still in the midst of this suppression of psychedelic research.
And actually, I had decided that I was going to get a clinical psych PhD and that I would learn psychotherapy outcome research, learn to do work with psychedelics, and demonstrate they were valuable for psychotherapy. But when I graduated college in ’87, I had dropped out for 10 years, I couldn’t get into any graduate schools with a PhD in clinical psychology because I tell them I want to do MDMA research for my dissertation, and then they would say, ’That’s exciting but maybe there’s a better place for you to do it than here.’
That’s where I realized that it was the politics blocking the science and that’s where I veered off and said, I got to study politics, and that’s where I ended up at the Kennedy School of Government at Harvard for my Master’s and PhD. So it’s switched from being a scientific problem to being a political problem and that took quite a few years to address. And then it became a fundraising problem because the government, pharmaceutical industry, none of the traditional foundations were funding this. We’ve raised over $115 million in philanthropy, in MAPS’ history so that was a big challenge. And then institutions didn’t want to do this because of the stigma so it’s just been a massive problem.
But, in my early 20s, I had a dream of a Holocaust survivor telling me that I should study psychedelics, and that was his dying wish, and that was his mission in life to tell me this story. So no matter how hard it was, it never seemed really that hard, or it never — the only time I ever really felt that I had to give up for a little bit was about 16 years ago. We had FDA-approved protocol for our first MDMA PTSD study and no Institutional Review Board — we went through nine or seven of them — they wouldn’t approve it. And I was just super frustrated. So I felt like I had to take a week off and paint the house so that I could actually see I could do something and the world changed.
Okay, so after that week, I went back with renewed enthusiasm. So I’ve never really thought about giving it up but it has been hard.
Jeff: Talk about the period of time when the government was particularly interested in this work, and particularly, the LSD and what they thought they could do, that led to things like MK-Ultra and other government research projects.
Rick: Yes, there’s a tremendous book, LSD: The CIA, and The Sixties Rebellion by Bruce Shlain and Martin Lee, and I would highly recommend that book. It’s incredible. There’s another one called Storming Heaven. It is excellent as well. But a lot of people don’t realize that in the ’50s, when LSD was being used and more widely distributed by Sandoz, people didn’t know even about neurotransmitters and that LSD actually played a major role in us understanding the serotonin system. Because people thought if such a small amount of a molecule in millions of grams, in micrograms, can actually have such a powerful impact, it must be mimicking something that’s going on similar in the brain.
So the discovery of LSD actually helped contribute to the discovery of serotonin and other neurotransmitters. And that led to an enormous amount of research funded by governments, but also, as you said, by the CIA, and others for mind control and, what they call, non-lethal incapacitance.
Actually, the history of MDMA is that it was invented in 1912 by Merck. They didn’t do anything with it. They were just using it as a one chemical on a path to get somewhere else. And they did studies in ’27, near the patent expiring date in animals, nothing interesting, but then the next use of MDMA that we’ve now been able to learn was by the military, by MK-Ultra. It was in 1953 and they tested eight drugs for toxicity. Now on one side it was methamphetamine, on the other side it was mescaline from peyote or San Pedro, and in the middle was MDMA. And as far as we can tell, it was never studied in humans.
But we really owe a lot of the ’60s rebellion, you could say, to the CIA because Ken Kesey had his first LSD experience in a CIA study. And he got so inspired that we developed out of that the Merry Pranksters, the Grateful Dead, the whole thing. So the CIA was really instrumental and it’s a great example of unintended consequences. But it was something that, I think, was very negatively oriented. At least, the CIA — it was for mind control and military purposes — but they were secretly funding a lot of stuff.
So when Gordon Wasson went to Mexico to try to learn about mushrooms and went to Maria Sabina, a woman, a Mazatec Indian, and she shared this ceremony with psilocybin mushrooms, there was actually a member of the CIA on that trip in disguise. They didn’t know that. So from the very beginning, the CIA has been really watching this and trying to understand what the weapon potentials are. And I think the irony, you could say, is that our hope is that this could help end wars. If we all end up understanding our commonality, why do we need to kill each other? Maybe there’s better ways of resolving conflicts.
Jeff: And, of course, the other use which really brings us up to the present is the way it is being used particularly on veterans, and those that fought in wars that have come back with trauma. Talk about that, particularly, the MDMA research.
Rick: Yes, so we started MAPS in ’86. It’s now 31 years. We’re in phase III which is the final phase of research to make MDMA-assisted psychotherapy for PTSD into a medicine.
So let me just go back a tiny bit to say that I needed to do a strategic analysis of which drug to work with, which psychedelic drug to work with which would break through all these barriers, and then which patient population. And so MDMA was the drug that I chose because it’s the most gentle of all the psychedelics, it’s the easiest to integrate, it’s the most loving, the most interconnected, the release of oxytocin, it builds the therapeutic alliances. And when we talk about training therapists, we feel that the therapist would be more effective if they’ve done the drug themselves than not and so there’s less resistance, more openness for psychiatrists and psychotherapists to try MDMA, than there is psilocybin or LSD. So all of that led me to MDMA.
Then we needed a sympathetic patient population and we needed a patient population that was underserved by currently available medications and therapies, large numbers of people that were treatment-resistant, and also serious consequences and that led to PTSD. We have a lot of support in America, more so than in many countries for the veterans and for our soldiers and the sacrifices that they make for the country.
And there’s just been an — you know when I first started doing this with PTSD, it was 1984, before even I started MAPS. It was the first time I worked with a PTSD patient. I talked about it in my TEDTalk. But that’s where I knew MDMA was great for PTSD. But I was thinking there that it was more for Vietnam vets. And in 1990, we started working with the VA to say, ’We will pay you money and train your therapist to study MDMA for PTSD.’ The VA therapist and psychiatrist wanted to work with us but then the senior political leadership said no, and every five years, we’d try since. We’re now just weeks away from starting research inside the Bronx VA, the Loma Linda VA, we’ve got a protocol for group therapy that we’re going to do at the Portland VA.
So things are moving forward a lot but the results of our phase III study — and you need two phase III studies to make a drug into a medicine — we finished the first one, we published it May 10 in Nature Medicine, the results were outstanding. But just to give you a sense, we work with the hardest cases, we work with people who’ve previously attempted suicide. A lot of PTSD studies don’t enroll people that have tried to kill themselves for fear that they’re an unstable bunch, but we thought we got to work with the hardest cases. We work with people that have chronic, moderate to severe PTSD, and we ended up demonstrating — we compare a therapy without MDMA versus therapy with MDMA.
And so in these hardest cases, people who had PTSD average of 14 years, one-third over 20 years, 32 percent no longer had PTSD at the two-month follow-up. This is after therapy without MDMA. And it’s 42 hours of therapy, a male-female therapy team, so it’s a lot of therapy. 32 percent no longer have PTSD from the therapy which is terrific, but you add MDMA and it’s 67 percent no longer have PTSD. It’s enormously enhanced this therapeutic process through MDMA. Of the one-third that still has PTSD, almost all of them, four-fifths of the remainder, had clinically significant reductions of PTSD symptoms, meaning, if we could have given them a fourth session, maybe they would no longer have PTSD, and we haven’t reached the one-year follow-up. But in our phase II studies, what we showed is that the results at one year were even better than the results at two months, and we don’t do anything. At the two-month follow-up, there’s no more interventions that we do. People can do anything that they want too, so we can’t say the gains are just from MDMA, but people keep getting better, and I think that’s the most important thing. This is a short-term intervention, it is labor-intensive, but it gets at the root of the problem. And through neuroplasticity, through what’s called fear extinction and memory reconsolidation, through good therapy, through expressing the fears that — people are able to really learn how to process traumatic memories in a different way, and they’re able to keep getting better on their own.
So we anticipate that when we do the one-year follow-up that we will have even better results than the two-thirds no longer having PTSD. And what we think now is that the second PTSD phase III study will be done in October of 2022 and we think by the end of 2023, we should have FDA approval, and we think one year later will be approval in Europe.
Jeff: Talk about the mechanism by which MDMA works. What do we understand about that?
Rick: Well, there’s a researcher, Gul Dolen, at Johns Hopkins that has given MDMA to octopuses and also to mice. And what they showed in mice, and this was a paper published in Nature, was that MDMA releases oxytocin which we already knew, which is the hormone of nursing mothers, of being in love, it’s the affiliate of hormone, but the release of oxytocin promotes new neural connections, so neuroplasticity. And so I think that that’s one of the explanatory mechanisms by which a few deep and profound experiences can have long-lasting effects; because you actually are rewiring how your brain processes certain memories and certain emotions.
The other part that’s about the therapeutic mechanism of action is that there’s a reduction of activity in the amygdala, which is where we process fear so that the fear-based memories are no longer, so fearful. And MDMA increases activity in the prefrontal cortex where we think logically so people with PTSD are often triggered, reminders of the trauma, make them think like it’s still happening or it’s about to happen. Noises or smells or sights are wired to bring back these traumatic memories, and that’s not in a logical way so that you have more logical capacity by this increase in activity in the prefrontal cortex, you have more ability to look without negative reactions to fear-based memories or other memories. There’s a sense of self-love, as well as connection with others from the oxytocin. And there’s a connection between increased connection between hippocampus and MDMA, hippocampus where memories are put into storage.
So we’re able then to take these traumatic memories that have, previously, been overwhelming to help people address them. People often say that they remember more of the trauma when they’re under the influence of MDMA than ever before, because those memories have been so painful, they’ve been suppressed. People also say, ’I don’t know why they call this ecstasy.’ It’s not like you pop a pill and all of a sudden your problems go away and you’re happy and you’re dancing all night because it’s hard work and it’s painful but it’s painful, you could say, like a rain after a storm or tears after grief or something, that it’s cleansing. And then this memory fear extinction, the memory reconsolidation is when you reprocess these memories after you’ve had them in storage. You are actually changing the wiring in your brain and the way these memories are recalled later so that when you recall them later, you’ll think about them as, ’This memory is in the past. It’s not now about to happen and I was able to address it. I wasn’t overwhelmed by it and I’ve been able to potentially even learn something from that trauma.’
We use a measure called Posttraumatic Growth Inventory, which is about how sometimes when you almost die or you’re in this very dire situation, traumatic situation, it causes you to reflect on what’s the purpose of your life? What’s the meaning of your life? What do you really want to do? So if you’re not overwhelmed by trauma, you’re able to learn from it and grow. So we also look at that Posttraumatic Growth Inventory.
I’ll just say one last thing, sorry, which is that in the work with LSD and psilocybin, in the ’50s and’’60s and in the current research over the last 20 years, they’ve reported that there’s a link between the depth of the mystical experience and therapeutic outcomes, and that has been held up. That’s a common statement from multiple different studies with LSD, psilocybin in multiple different patient populations. We use the same questionnaire for mystical experiences. People don’t score as high with MDMAs as they do with psilocybin or LSD, but they do score pretty high on it and we find no correlation.
So I just wanted to say that this idea with MDMA is that when you think about it for treating PTSD, you have to have your memory of PTSD of what happened to you to really work through those memories. So it’s not about ego dissolution or mystical sense of connection. It’s really about recovering your trust and your ability to handle these emotions, trust in humans, or at least awareness of how some humans are trustworthy and some are not, but this idea that there is a necessity for a mystical experience, we have not found that to be the case in therapy with MDMA assisted therapy for PTSD.
Jeff: MDMA being the most effective for PTSD, what have been the therapeutic breakthroughs and the therapeutic direction with respect to psilocybin and LSD at this point?
Rick: Well, let’s just say that the very first use ever in psychiatry of a psychedelic for PTSD was LSD. And it was Dr. Bastiaans in the Netherlands in the ’50s and ’60s, ’70s. He was the last person in the world still able to legally give MDMA to patients. And he developed LSD therapy for what he called concentration camp syndrome. But LSD doesn’t really reduce the fear the same way that MDMA does so it can be very helpful to bring traumatic memories to the surface, but it can also overwhelm people. So I do think that MDMA is ideal for PTSD. Although in the future, it will be psychedelic psychotherapy so that people will get MDMA and then they could get psilocybin or LSD at a later time and it can help them in different ways.
The breakthroughs for LSD and psilocybin, in the ’50s and ’60s, the main breakthrough for LSD was alcoholism, and people with anxiety about life-threatening illnesses, particularly, cancer, and also with heroin, people addicted to opiates. So LSD was really helpful in the treatment of addiction. Bill W, who co-founded AA, did LSD in the ’50s and thought it could play a major role. Since then, there has been further studies over the last 20 years with a whole range of patient populations, particularly, alcoholics, cocaine addicts, cancer patients with anxiety, people in general with depression. So there’s been some really promising phase II studies with psilocybin for depression, either cancer-related or not.
There’s been studies with obsessive-compulsive disorder. There’s going to be studies — we’re going to start an MDMA study with eating disorders. There’s also going to be a psilocybin study for eating disorders, obsessive-compulsive disorder, as I said. MDMA is great for couples therapy. So I think when we think about it, what’s really going on here is psychotherapy enhanced by these psychedelics. So when you say, ’What are these good for? What are the breakthroughs for?’ It’s whatever psychotherapy is for, these drugs can enhance that process. So it’s for a wide range of things.
And it’s also for people that, you could say, sub-threshold. We all have anxiety just living in the world. We’re all traumatized by reading the newspaper. So it has an enormous effect for people in spirituality, personal growth, couples therapy — that are not clinical diagnoses. And I think we’ll need the drug policy reform to get us there to where we’ll have legal access, not just for medical, but also for that. But I think as far as what the FDA has said, they’ve given breakthrough therapy only to MDMA for PTSD, psilocybin for treatment-resistant depression, and psilocybin for major depressive disorders.
Jeff: Where is the broader medical community in all of this? Are they coming along? Is there resistance? And I want to talk to Izzy in a minute about the legal aspects of this, but in terms of the medical community, where are they at this point?
Rick: I think they’re very enthusiastic now. So, for example, there are now psychedelic research centers that have been started up at Harvard, at Yale, at NYU, at UC San Francisco, at the Medical University of South Carolina, at Johns Hopkins, before at UC Berkeley, all of these places. So I’d say academic medicine is, finally, after basically half a century, is recognizing that there’s enormous therapeutic potential with these drugs and also that the overall climate of the drug war is diminishing so there’s not a lot of resistance, and big pharma has, in a sense, abandoned drugs for mental illness. The last ones that we really heard about were SSRIs but those were 30 years ago. The biggest breakthrough in the last 30 years was ketamine for depression and not developed really with therapy, but still.
So just to give you one story, and then we can turn to more political stuff, and Izzy, is that I was approached by psychiatric residents at UMass Worcester Medical School and they wanted to start a monthly group discussing psychedelics, and they asked me to give the first talk. And I was very enthused because I knew that the President of the American Psychiatric Association was on the faculty of UMass Worcester, Jeffrey Geller. And I asked him would they let him be the discussant after my presentation and he agreed to do that. And then Paul Summergrad, who was head of Psychiatry at Tufts, was also a former president of the American Psychiatric Association, I asked him to be a discussant as well.
So the psychiatric residents all over the country are really thrilled by psychedelics. They’ve seen the problem of the capture of psychiatry by big pharma where you adjust people’s doses, you see them for 15 minutes, give them medicines, but you don’t even really talk to them about what’s going on. And so in this discussion after my presentation, both the person that was about to be the president of the American Psychiatric Association and one that had been a few years ago, we all three were in agreement that psychedelics are going to be a big part of the future of psychiatry. So we don’t see any resistance at this point at all and, in fact, enthusiastic adoption by the medical mainstream.
Jeff: And Izzy, talk a little bit about the way in which political barriers and legal barriers are breaking down in conjunction with the things that Rick is talking about.
Izzy: Yes, this has been such a rich conversation so far. It’s interesting to think about the decades of work that got us to where we are now and a combination of ingenuity and perseverance from folks like Rick and others, but also, I think, a concurrent breakdown of other aspects of society that have really shown the need for these treatments in these systems. It’s become increasingly clear, I think there’s increasing levels of desperation among people with respect to mental illness, substance use disorder, and related things that I think has created a landscape in which conversations politically about these topics are less about, ’Ooh, the scary drugs’ and more about, ’Wow, we have some really big social problems that we need to figure out how to fix,’ and it seems so far Western pharmaceuticals are not really cutting it in like a traditional way.
So regarding this kind of larger breakdowns, these other shifts that you’re discussing, I would say, that there’s a couple of things happening in addition to this background shift around mental health broadly. One of them has to do with this increasing bipartisan, and I would say, multipartisan approach toward criminal justice reform. So I think over the last 20 years, especially, and really in the last 10, in particular, there’s been a pretty big increase in awareness around not only prohibition specifically, but also in general, how incarceration as a criminal justice strategy has failed or at least fall short at a number of places, not only the incredible cost, of course, financially, but also the social cost of ripping families apart of not really having ways to navigate what we see as criminality.
So when it comes to the drug war, in particular, I think the awareness that people are bringing to the effects of the war on drugs that Rick spoke about, the effects of how this push toward prohibition, not just the United States, but globally has actually increased and impacted other kinds of social determinants of health totally separately from addiction. And I think as people are becoming more aware of that, becoming more aware of concerns around suicide, concerns around other kinds of mental health disorders, trauma disorders, and so on, there’s an awareness that there needs to be something done differently, and so much of that is not just looking at the treatments like the available options for care, but also some of these underlying social factors that are contributing to that.
And I think that although we’re still getting to this point, it’s become increasingly clear that the way that the global drug control scheme has worked has not only slowed down and really, for decades stopped research as we just start to see that unravel, but also prevented people from getting access to treatments or substances that may have pretty significant benefit, Rick touched on this, not just for people with diagnoses, but for people who are just dealing with the everyday stresses of life.
And that’s not to say that psychedelics are right for every person in every situation, but I think that there is a sense that us criminalizing the behavior, it’s not stopping their behavior, it’s certainly not keeping people safer and at the end of the day causing us to spend a ton of money on solutions that don’t actually work. So I think a combination of all these factors in conjunction has led a lot more scrutiny to criminal justice frameworks in general, which avoids drug policy reform I see as being a major part of one.
Jeff: With respect to some of the change in laws, we’re even seeing in California where the legislature has made some very specific changes in this regard, talk about that.
Izzy: Yes, it’s in process. I’ll zoom out a bit and start with general shifts in the United States that I think are really relevant over the last few years. So Rick just talked a lot about this FDA approval process and the process of medicalizing, but he also touched on this issue that for some of these things, we have to go outside of the medical framework. And I think that’s something that as the research has come out, as people had become more desperate, as it’s become clear that a lot of the early drug war hysteria was just totally off base, there is an awareness that the way that we’ve been dealing with drugs is no longer appropriate and the alternative should be considered.
So in 2019, you started to see a shift, especially with respect to psychedelic drug policy. You see municipalities like the City of Denver, the City of Oakland, a few other places, start to reduce enforcement about psychedelics to the lowest law enforcement priority, which essentially looks like decriminalization at the local level. So psilocybin was decriminalized in the City of Denver. Other plant-based entheogens, as well as psilocybin, were decriminalized in Oakland, you see this in a few other cities. This all occurred over the course of 2019 with a couple of shifts in 2020.
At the end of last year, there was a pretty big shift when voters in the State of Oregon approved Measures 109 and 110. Measure 109 was the shift that actually created — it’s in the process of creating, I should say — a psilocybin services system, so like a regulated adult-use system with licensure for manufacturer, for production, for facilitation. Then, also, Measure 110, which is a big deal because it was the first shift in US drug policy to fully decriminalize the personal use and possession of all drugs in the State of Oregon.
So Oregon’s in the early stages of implementing both of those now, which takes us to California. Although there are, I would say, probably about a dozen legislators are serious advocates in states all over the country or, I should say, in about a dozen states over the country, thinking about what psychedelic policy reform could look like moving forward. The experiment and the process in California has been quite fascinating. And over the course of the last six to seven months, it’s been making a way through the California legislature. That bill is a slightly different approach from the ones that we’ve seen so far. It’s really focused on decriminalization of personal use. So unlike Measure 110 in Oregon, it only limits to a small series of drugs. It’s six substances, MDMA, psilocybin, LSD, mescaline, ibogaine, and DMT. Ketamine was originally in it, but unfortunately, was removed due to a campaign that really focused on its reputation, I think, inaccurate reputation to a certain extent as a date rape drug. But ketamine was removed earlier on in the process. It also creates room for assisted use.
One of the things about psychedelics is that in many cases, not all, but in many cases, guided use or group use is safer use. So to emphasize the harm reduction possibilities or possibilities within harm reduction for the use of these substances, which we all know, is already happening all over the place, whether we like it to or not, to really think about how it can be done in the best possible way. The bill also would create a commission that would spend the next two years studying possibilities for building out education, harm reduction, crisis response training in the State of California, as well as the potential of future regulated adult access, but that’s a longer conversation that we think needs a lot more fleshing out to really see what it would look like at the state level.
Jeff: Given all of that progress on the legislative level, the legal level, Rick, talk about where you want to see this all go next. You’ve talked about lots of clinics around the country to continue this work, and now that the legal framework is moving in this direction pretty quickly, as Izzy indicates, quickly at least as far as legislative processes go, where do you want the research and the work to go next?
Rick: Well, let me say that our long-term goal is mass mental health, and that was the goal from the very beginning when I was 18. What that means is, first off, a two-pronged strategy, the first being drug development, the second being drug policy reform. So where I want it to go next is on these two mutually synchronistic and supportive tracks. The more positive research we have, the more people understand that there are ways in which there’s more benefits than risks, and then that impacts this drug policy reform. The more drug policy reform, the less resistance to finding positive medical uses and making them into medicine.
The main things that we need to think about in terms of moving next are insurance coverage. So while we’re doing this work on getting it approved, that doesn’t do a whole lot if the only people that can access it are those that can pay for it themselves without it part of insurance. So moving into developing health care economic analyses, cost-effectiveness studies, and that also brings up something that Izzy was just saying about group use sometimes being safer, is we want to look at group therapy. So we’ve done all this initial work on individual therapy, but we really need to explore group therapy. That’s what we’ll be trying to do, probably, starting early 2022 at the Portland VA. So I’d like to see it there.
Couples therapy is one important area. It’s not a disease. We’re not going to be able to medicalize it in the same way as depression, PTSD, anxiety, substance abuse, things like that, but I’d like to see more research into MDMA for couples therapy. The other thing that we’re really wanting to see next is globalization. And again, because we’re doing this in a non-profit public benefit context, we’ve been in touch with researchers in South Africa, Somaliland, Rwanda, Bosnia, Armenia, all these places that have large amounts of trauma, Palestine as well, but don’t have large amounts of money.
So what we want to do is really globalize it and make it accessible to those people that are suffering the most that need the healing, and we may need to find new forms of treatment. That’s where I think group therapy will come in. It can’t all be delivered by psychiatrists and psychotherapists. We need local healers. There’s not a lot of psychiatrists and psychotherapists in a lot of these countries and yet enormous amounts of trauma.
Refugee camps, I’d like to see MDMA therapy being used in refugee camps and elsewhere. I’d like to see government funding for this. That’s another next step. The Australian government is now putting $15 million towards MDMA and psilocybin research, which is really good. We don’t have that from the National Center For Mental Health, from NIDA. They’ll look at mechanism of action maybe, they’ll look at the abuse liability, but we haven’t had any real funding support from the government for drug development for beneficial uses.
I’d also like to see more religious freedom, and in particular, religious freedom for people that don’t have a religion. So what I mean by that is sort of secular spirituality, which we started talking about earlier. There should be a carved out areas for people who use these things for spiritual purposes but don’t necessarily have a religion that’s focused around the use of the drug. That’s what it took to get peyote legal for the Native American Church because their religion centered around peyote and if you took peyote out of it, there was nothing there. The same was true for Ayahuasca churches. So I’d like that to be a more individual freedom for spiritual purposes that gets us towards legalization.
And I’d like to see what we were calling honest drug education combined with harm reduction and drug checking. So until we get to legal access with pure drugs, we’d like to see that it’s possible legally to have test kits or on-site analysis at different events where people may be using a lot of these drugs, but they don’t know exactly what they’re getting or taking. So drug checking is legal in Canada, at some places in Europe, but it’s dicey here in the United States. So I’d like to see the drug policy reform move towards more harm reduction, more drug testing, more honest education. And what I’d like to see, also, is a general appreciation more and more for the fact that this is about therapy. That it’s really — the drug helps the therapy but to take it away from it’s a magic pill and all you need to do is swallow a pill and you’ll be where you want to be — but just to really help more in that.
So all that is to say more public education and that’s why we’re so glad to be talking to you today, but we also need a psychedelic coming out, the same way that we had that for the gay movement. We need a big psychedelic, all sorts of people. If those people that had benefited from psychedelics acknowledged the role that psychedelics have played in their development, people would be astonished at how widespread throughout our culture these drugs have been and these experiences have been. So we need a big psychedelic coming out. That’s what I’d like to see, too.
Jeff: And finally, from both of you, Izzy, start with you, what are the pitfalls that you see ahead? What are the landmines that are sitting out there that you worry about?
Izzy: I think one of them goes to something that Rick was saying around how we should be thinking about psychedelic therapy and healing in the first place. And I worry sometimes that the pendulum is going to swing in the opposite direction and people just see psychedelics as a silver bullet that fix all their problems, and that’s just not true. The truth is that psychedelic therapy and psychedelic healing is challenging and requires a person to really confront and engage with themselves in a really meaningful way.
So I think I’m worried about that narrative overtaking because people are desperate and for good reason, they’re seeking solutions, and I totally understand that, but I think it’s really important for people to remember that psychedelics are tools, powerful ones that should be respected that should be understood, that should be thought about and researched before being used, just so when people do have experiences with them, they can have them in the most optimal way possible, in a way that’s really good for them and that doesn’t exacerbate things that are already going on. We really want to see this movement toward more access also come with more responsibility and I might even use the word reverence, more reverence, and awareness of the power that these substances can have. I think that’d be the biggest thing for me.
Jeff: And, Rick, what are the things that keep you up at night worrying about this? What are the dangers out there?
Rick: Well, MAPS, we just had our board of directors meeting and what we decided to commercialize, to globalize, and to reach sustainability, MAPS needs to raise $150 million, $50 million a year for three years, and then we’ll have a non-profit owning a public benefit corp that will generate resources that will support psychedelic research into the future for decades to come. But what I’m worried about is the influence of what compromises we might need to make to take money. Can we raise this all from philanthropists? So I’m concerned about this balance between public benefit and profit and what happens if we have to take money, if we borrow money, or how we get the funds we need. That’s one thing.
The thing that I’m not worried about and this will help me get to the thing I am worried about, but the backlash against psychedelics in the ’60s was because of psychedelics and the counterculture and political activities challenging the status quo. I think we’re over that because we have bipartisan support, because we’re working so much with veterans, even police officers, firefighters, there’s a whole range of people that we’re working with that don’t fit the hippie label. So I think this idea that psychedelics are going to cause a counterculture and everybody’s going to go live on a commune and drop out, that’s not going to happen.
The next big thing in the late ’70s and the ’80s and ’90s was the parents’ movement saying, ‘Oh, we got to protect our kids from drugs,’ and that was driving the drug war. And that’s still driving the drug war today, but that’s going less and less as well. And also, the FDA has required us if we succeed in adults with PTSD, we have to do an adolescent study, 12 to 17-year-olds with PTSD. And if that works, we have to work with 7 to 11-year-olds with PTSD. So I think we’ll get over this idea that to protect the kids you have to criminalize drugs and throw people in jail. And we see that from the medical marijuana, marijuana legalization states where it has not led to a vast explosion and underage use.
Izzy: In fact, you see an increase in use of 65 and up. It’s actually elders who are using more in legal states.
Rick: Yes, a lot of it is for pain and a lot of them used it when they’re kids and gave it up and now. But the one thing that I’m worried about, I’m not that worried about it, but it’s this idea that we started out with about mysticism and spirituality. So I think the most concern I have is with fundamentalists of all different religions, and this idea. Because the subversive thing that we’re talking about, in a way, is that the truth claims that each religion makes, that they’re the one and only one. The Jews are the chosen people, and nobody else is chosen or you need to believe in Jesus, or you’re going to hell, or Muhammad is the only prophet and everybody else is an infidel, even with fightings between Sunni and Shia.
What I’m concerned about is, as we speak more and more about the spiritual aspects of this, I think that we see fundamentalists clinging more and more to their ideologies and to their dogmas. And I think our challenge is to show them that you can actually have a deeper spirituality and you will not be left with nothing. In fact, you will be enriched and you don’t have to give up your religion, your culture, your symbols. It’s not like this means that we’re all going to be part of one world religion and everything needs to disappear. So I think that the concern I have is about how fundamentalists will react and how we educate them.
And then the other big concern is just are we able to persuade insurance companies to do this, to fund it? Because I think that’s the real need for scaling and to get to all the people that are traumatized and suffering because a lot of those are the people that have the least resources to be able to pay for treatment and so they’re going to need the insurance coverage.
Jeff: Rick Doblin, I thank you so much for spending time with us today, and Ismail Ali, thank you so much for joining our conversation.
Izzy: Yes, terrific.
Rick: Okay, Jeff, that was wonderful.
Jeff: Take care, Rick. Thank you so much. And thank you for listening and joining us here on the WhoWhatWhy podcast. I hope you join us next week for another Radio WhoWhatWhy podcast. I’m Jeff Schechtman. If you like this podcast, please feel free to share and help others find it by rating and reviewing it on iTunes. You can also support this podcast and all the work we do by going to whowhatwhy.org/donate.