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Psilocybin & Ibogaine: Can Psychedelics Cure Addiction? · RECOVERable: Mental Health and Addiction Experts Answer Your Questions

• 0:13
  SPEAKER_01: Anyone who says this compound is as safe as safe can be and has not one even iota of a conversation around risk, just take that into consideration like we should with everything else.
• 0:27
  SPEAKER_04: Clinical psychologist and research facilitator Dr.
• 0:30
  SPEAKER_04: Chantel Thomas joins us to discuss the therapeutic potential of psilocybin and ibogaine for treating trauma and depression.
• 0:37
  SPEAKER_04: Is the use of ibogaine in these clinical settings safe?
• 0:46
  SPEAKER_04: Hello and welcome to Recoverable.
• 0:47
  SPEAKER_04: I'm your host, Terry McGuire.
• 0:49
  SPEAKER_04: So in the first half of this conversation, we explored ketamine and MDMA, compounds reshaping conversations around depression, trauma, and psychedelic assisted care.
• 1:00
  SPEAKER_04: Today we turn to psilocybin and ibogaine, compounds with very different histories, effects, and treatment possibilities.
• 1:07
  SPEAKER_04: We'll look at what the research suggests, where hope meets caution, and what these therapies could mean for the future of mental health and addiction treatment.
• 1:16
  SPEAKER_04: Again, while we recognize that all of these compounds can be and are used recreationally, our focus is on psychedelic assisted therapy.
• 1:24
  SPEAKER_04: We are joined again by psychologist Dr.
• 1:26
  SPEAKER_04: Chantel Thomas, a therapist, researcher, and expert in psychedelic assisted therapy.
• 1:32
  SPEAKER_04: Thanks for continuing the conversation.
• 1:34
  SPEAKER_04: I'm happy to be here.
• 1:35
  SPEAKER_04: Thank you.
• 1:35
  SPEAKER_04: So we're going to start again with a quick myth or fact and just try to run through some of the misconceptions and fears and urban legends about both ibogaine and psilocybin.
• 1:45
  SPEAKER_04: Myth or fact.
• 1:46
  SPEAKER_04: If you take too high a dose of psilocybin, you can get permanently trapped in a leucinogenic trip and never come back down.
• 1:55
  SPEAKER_01: It's what came up.
• 1:57
  SPEAKER_01: It did, yes.
• 1:58
  SPEAKER_01: I would not say permanently trapped.
• 2:02
  SPEAKER_01: That being said, I think there can be long, longer lasting negative effects from a very challenging trip or a difficult experience with psilocybin that has actually been studied by there's an individual named Jules Evans who runs the challenging experiences uh project, I think, for and looks at people who've had really difficult or challenging experiences that were persisting.
• 2:28
  SPEAKER_01: But being trapped in the exact state that you're in in that high-dose psilocybin experience, I would say that that's not likely to happen.
• 2:35
  SPEAKER_01: People will return to some sort of a baseline.
• 2:38
  SPEAKER_01: For vulnerable brains or people who are predisposed to maybe even psychosis or other underlying conditions, there can be some risks of persisting effects.
• 2:48
  SPEAKER_04: Myth or fact.
• 2:48
  SPEAKER_04: Using ibogaine to treat an opioid addiction is just replacing one highly addictive, dangerous drug with another.
• 2:55
  SPEAKER_01: I would say that's a myth.
• 2:56
  SPEAKER_01: The way that ibogaine works and kind of mechanistically what's happening with it is very, very different than using opiates as part of an addictive process.
• 3:09
  SPEAKER_01: And so I would say that's not true.
• 3:12
  SPEAKER_04: When I looked up the answer to the question, because I was like, oh, that's an interesting question.
• 3:15
  SPEAKER_04: It said ibogaine is not habit forming.
• 3:18
  SPEAKER_04: In fact, the experience is so intense, exhausting, and emotionally draining that most people would never want to repeat it.
• 3:25
  SPEAKER_01: I think that's probably true for a lot of people.
• 3:27
  SPEAKER_01: Yes.
• 3:28
  SPEAKER_01: Very interesting.
• 3:28
  SPEAKER_01: Gru I've said the word grueling used a lot of times to describe an ibogaine experience, yes.
• 3:34
  SPEAKER_04: Uh, mitherfact.
• 3:35
  SPEAKER_04: Out of the two, ibogaine carries a much higher risk of life-threatening side effects during a session than psilocybin.
• 3:41
  SPEAKER_01: Yeah, that is true.
• 3:42
  SPEAKER_01: Yeah.
• 3:42
  SPEAKER_01: There's cardiotoxic effects with ibogaine that require very close monitoring.
• 3:47
  SPEAKER_01: Um, people say those risks are much lower if they're done in a medical setting, um, obviously, and there's close monitoring.
• 3:54
  SPEAKER_01: Um, psilocybin has not been deemed by its very nature to be organ toxic.
• 3:58
  SPEAKER_01: I was, in fact, involved in one of the first high-dose psilocybin studies, say pharmacokinetic studies here at UW Madison over four, 13, 14 years ago, um, demonstrating its safety profile across individuals that were deemed healthy.
• 4:11
  SPEAKER_01: Um, but there's still monitoring that you need to do prior to, but not continuously during the study.
• 4:16
  SPEAKER_01: Whereas I believe with uh ibogaine, that's different.
• 4:19
  SPEAKER_01: You want continuous medical monitoring.
• 4:21
  SPEAKER_01: Because of the risk of heart attack?
• 4:23
  SPEAKER_01: I think it's actually a slowing of the rhythm.
• 4:27
  SPEAKER_01: Um this is not in my area of expertise, but I actually think there's a risk of a slowing down of the heart firing that results in some sort of cardiac arrest for um ibogaine.
• 4:38
  unknown: Okay.
• 4:39
  SPEAKER_04: Myth or fact.
• 4:40
  SPEAKER_04: People use psychedelic therapy as a form of escapism to tune out the real world and avoid dealing with actual problems.
• 4:47
  SPEAKER_01: Did it say, did you start it by saying using psychedelic therapy?
• 4:51
  SPEAKER_01: It did say that.
• 4:52
  SPEAKER_01: Interesting.
• 4:52
  SPEAKER_01: Yeah.
• 4:53
  SPEAKER_01: I think anyone who's trying to use these compounds therapeutically, and that's not, I mean, people will say all the time, like I use it as with as part of a spiritual practice or a contemplative practice.
• 5:03
  SPEAKER_01: I think that intentionality matters greatly.
• 5:07
  SPEAKER_01: I do think that some people can get so fascinated with the idea of leaving here and exploring out there that some people would rather be out there than here.
• 5:19
  SPEAKER_01: And that is definitely a risk for doing high-dose psychedelic work and doing it repeatedly.
• 5:23
  SPEAKER_01: And that's not the same thing as the abuse potential that I'm talking about, but more just being inclined to want to live in those spheres of existence as opposed to wanting to be here in this one.
• 5:36
  SPEAKER_04: Myth or fact.
• 5:37
  SPEAKER_04: A single dose of ibogaine or psilocybin will cure a person's addiction or depression without them having to do any extra mental work.
• 5:45
  SPEAKER_01: Myth based on my personal lived experience in clinical trials.
• 5:50
  SPEAKER_01: And again, I haven't worked directly with ibogaine.
• 5:53
  SPEAKER_01: That being said, I know that there, I have anecdotally heard, and lots of people will say, after one session, I dramatically shifted my perspective on this.
• 6:03
  SPEAKER_01: X, Y, and Z.
• 6:04
  SPEAKER_01: It was never the same to me.
• 6:06
  SPEAKER_01: I never looked at it the same.
• 6:08
  SPEAKER_01: I've heard people report this.
• 6:09
  SPEAKER_01: I there's not a clinical trial that supports that necessarily.
• 6:13
  SPEAKER_01: Um, but they have these compounds do occasion profound shifts in people where they might never look at a certain thing the same way again.
• 6:24
  SPEAKER_01: So I could see how technically that could happen.
• 6:27
  SPEAKER_01: But the complexity of what I know is associated with a cycle, a pervasive and kind of life-entrenching cycle of substance use.
• 6:35
  SPEAKER_01: That miraculously does not shift with one session.
• 6:38
  SPEAKER_01: I've never personally witnessed that.
• 6:40
  SPEAKER_01: I've never read any trials that about that happening.
• 6:43
  SPEAKER_01: Um, so I think that's kind of a misrepresentation of the complexity of recovery.
• 6:47
  SPEAKER_04: So that's a no.
• 6:48
  SPEAKER_01: No.
• 6:48
  SPEAKER_01: Yeah.
• 6:49
  SPEAKER_01: Okay.
• 6:50
  SPEAKER_04: Myth or fact.
• 6:51
  SPEAKER_04: Psilocybin has been shown to physically stimulate the growth of new brain cells and create new neural pathways.
• 6:58
  SPEAKER_01: Yeah.
• 6:58
  SPEAKER_01: So this idea of neurogenesis is kind of an exciting one.
• 7:01
  SPEAKER_01: And there's definitely data to support this idea of changes in synaptic density and growth of synapses or dendritic growth.
• 7:10
  SPEAKER_01: There's also this really interesting effect of changing the way that brain networks work and the way they communicate with one another that happens in the presence of psilocybin.
• 7:19
  SPEAKER_01: So we have parts of the brain that would normally not communicate, communicating with one another in ways that are a little unpredictable, but also seem kind of uh aligned with the idea of experiencing things in a completely new and interesting, profound way.
• 7:33
  SPEAKER_04: Is it a matter of perspective shifting?
• 7:35
  SPEAKER_01: Just like, oh, now I I think some people experience it that way.
• 7:39
  SPEAKER_01: Sometimes it's like a felt sense that things are connected, that you previously couldn't connect together.
• 7:44
  SPEAKER_01: Sometimes it's literally a thought of making a connection that has never occurred to you before.
• 7:50
  SPEAKER_01: And is that happening as a result of different pathways opening up or becoming available as a result?
• 7:56
  SPEAKER_01: That seems good to wonder that that might be the case.
• 7:58
  SPEAKER_01: But again, research is still forthcoming on the specificity of that.
• 8:02
  unknown: Okay.
• 8:03
  SPEAKER_04: Myth or fact.
• 8:04
  SPEAKER_04: Going to a music festival with friends and taking mushrooms is fundamentally the same thing as undergoing psilocybin assisted therapy.
• 8:12
  SPEAKER_01: I would say that that's a myth.
• 8:13
  SPEAKER_01: While something quite profound could happen to someone in a setting like that, um, I would not say that it's anywhere close to the same thing just because the preparation that's not involved, the therapeutic support that's not alongside of it, the integration that doesn't follow.
• 8:28
  SPEAKER_01: Always trying to be really mindful of not being dismissive of the idea that profound things could happen in recreational settings, but they are very fundamentally different processes, I think, in most instances.
• 8:40
  SPEAKER_04: It's a very open way of saying it, right?
• 8:43
  SPEAKER_01: Because you don't want just good, bad, but well, these hopefully working with these compounds over time should make us more open, not less.
• 8:50
  SPEAKER_01: And so I'm always mindful that just because the path and the lens that I use is the one that I've studied the most, that there are many different ways of working with this, the most obvious of which is this long historical indigenous tradition that supports both of these compounds that I am a nowhere expert in.
• 9:06
  SPEAKER_04: Another myth or fact.
• 9:08
  SPEAKER_04: In clinical trials, just one or two supervised sessions of psilocybin therapy have shown the ability to reduce severe depression for up to a year or more.
• 9:17
  SPEAKER_01: I think that is true.
• 9:19
  SPEAKER_01: Um there are long-term follow-ups, but I don't actually know if how much data there is on the depressive symptomatology results persisting at one year.
• 9:32
  SPEAKER_01: Um I think that might be the case for some people.
• 9:35
  SPEAKER_01: This is why we're studying different administrations of psilocybin, because I think um it was the group in the UK that did the single dose study.
• 9:43
  SPEAKER_01: I think Uson Institute also did a single dose study for a phase two trial.
• 9:49
  SPEAKER_01: But most um of the psilocybin sponsors at this point in time are looking at the indications for at least two dosages and the idea of redosing based on symptomatology.
• 10:00
  SPEAKER_01: So it's more rare, I think, that someone would have one session and then be certainly not cured of depression.
• 10:07
  SPEAKER_01: But um, yeah, that's that's part of what's being researched is persisting effects and how might we might better optimize them.
• 10:14
  SPEAKER_04: Okay.
• 10:14
  SPEAKER_04: We're gonna start with psilocybin.
• 10:16
  SPEAKER_04: It's what you're most familiar with, correct?
• 10:19
  SPEAKER_04: Tell me about the research you've done.
• 10:20
  SPEAKER_01: Well, I've had the privilege to work at uh the University of Wisconsin-Madison um alongside of the Protea lab and the within the School of Pharmacy on various different clinical trials, um, starting with a high dose psilocybin trial, pharmacokinetic study, which is basically like a physical safety study of higher dose psilocybin to demonstrate its physical safety.
• 10:40
  SPEAKER_01: I've had the opportunity to work on depression trials with psilocybin, um, both in the room, but also providing support to facilitators across various sites in their training and their ongoing consultation and supervision during those trials.
• 10:54
  SPEAKER_01: I've been involved in that with the USON Institute.
• 10:57
  SPEAKER_01: And I've also had the privilege of working on a number of trials targeting uh folks with substance use disorders.
• 11:04
  SPEAKER_01: So I've worked on a methamphetamine use disorder study with psilocybin and also an opiate use disorder study with psilocybin.
• 11:10
  SPEAKER_01: So it's been really interesting looking at depression indications versus those for substance use disorders.
• 11:16
  SPEAKER_01: Um and um it's been fascinating what I've learned over time, you know, having done this for close to 13 years now and appreciated some of the nuances of what it looks like and how it looks differently.
• 11:27
  SPEAKER_01: And then lastly, I'm involved in a study right now for low well-being for um psilocybin for individuals at the University of Wisconsin-Madison, which is still actively recruiting.
• 11:37
  SPEAKER_01: What kind of well-being?
• 11:38
  SPEAKER_01: Low well-being.
• 11:39
  SPEAKER_01: So not full criteria of um depression, but low mood.
• 11:44
  SPEAKER_01: Oh, wow.
• 11:45
  SPEAKER_01: Yeah.
• 11:45
  SPEAKER_01: And that is um that's a study called Enhance, and it's looking at using psilocybin alongside a vagal nerve stimulation to see if it has an impact on how persisting the effects are for individuals.
• 11:59
  SPEAKER_01: Are clinical trials the only way to experience psilocybin legally?
• 12:05
  SPEAKER_01: In Wisconsin, yes.
• 12:06
  SPEAKER_04: Okay.
• 12:07
  SPEAKER_01: Um, more broadly, in Oregon and in Colorado, there are in Oregon, there are wellness centers where you can go and receive psilocybin.
• 12:16
  SPEAKER_01: That is a non-clinical model.
• 12:18
  SPEAKER_01: So that is essentially they're not doing rigorous clinical intakes.
• 12:23
  SPEAKER_01: Um, they're looking for certain profiles of individuals who are more safely able to have that experience.
• 12:29
  SPEAKER_01: Those are not licensed mental health providers in some instances.
• 12:33
  SPEAKER_01: They're individuals who become certified as facilitators.
• 12:36
  SPEAKER_01: Um, but the I think the requirement is a high school degree and having gone through the uh facilitator training program in Oregon, which I believe is close to 200 hours.
• 12:47
  SPEAKER_01: Uh, whereas in Colorado, they are exploring a practitioner-based model, which is looking at licensed health practitioners, uh, mental health practitioners being able to administer psilocybin um at what they call healing centers, where they get designated by the state to do so.
• 13:02
  SPEAKER_01: So those are two other pathways in the United States right now.
• 13:06
  SPEAKER_04: So when we think of psilocybin assisted therapy, is it more focused on mental health, on addiction treatment, um both equally?
• 13:15
  SPEAKER_01: Well, um, if we look at what's gonna come up for the FDA, depression will come up first as the indication.
• 13:22
  SPEAKER_01: Uh, there's another sponsor called Compass Pathways that has been studying um treatment-resistant depression, whereas the USONAT um sponsor has been looking at major depressive disorder.
• 13:35
  SPEAKER_01: So those are gonna be the first two indications that will presumably go in front of the FDA for new drug application for the treatment of those conditions.
• 13:42
  SPEAKER_01: So depression has got more robust research behind it, but not too far behind that is um psilocybin for nicotine use disorder and also psilocybin for alcohol use disorder.
• 13:54
  SPEAKER_01: Um, I would say the opiate use disorder studies are a little further behind because there's not as many of them.
• 14:00
  SPEAKER_01: Um, but that would be probably what's coming next down the pathway in terms of indications for psilocybin.
• 14:05
  SPEAKER_01: And then now there are actually some psilocybin trials for PTSD, which is also a first.
• 14:11
  SPEAKER_01: And some um environments where they're looking at doing that in a group setting.
• 14:15
  SPEAKER_01: Actually, in New Mexico, there has been a regulation that's passed that allowed them to work with in group settings with psilocybin.
• 14:24
  SPEAKER_01: And I think they're targeting PTSD populations.
• 14:26
  SPEAKER_01: Larry Lehman is the physician that's been involved with that work down there.
• 14:30
  SPEAKER_01: Um, and another colleague of mine named Hanifa has also been involved in that work.
• 14:34
  SPEAKER_01: And it's kind of exciting to see what they're doing in New Mexico in terms of burgeoning trials with different indications and also looking at group and community settings as an opportunity for um for delivering care.
• 14:46
  SPEAKER_04: So let's talk about psilocybin generally.
• 14:49
  SPEAKER_04: Most of the searches, of course, they're using terms like magic mushroom.
• 14:52
  SPEAKER_04: What is psilocybin therapy?
• 14:54
  SPEAKER_04: And what are you seeing in terms of potential results?
• 14:58
  SPEAKER_01: Yeah, so psilocybin is uh considered a classic psychedelic, and it's that's due to its um action on the serotonergic receptor sites.
• 15:06
  SPEAKER_01: And so we're seeing promising results in terms of it having a noteworthy signature, treatment signature for treating depression.
• 15:18
  SPEAKER_01: Oftentimes it's being compared to placebo therapy, or it's being compared.
• 15:24
  SPEAKER_01: I think one of the other trials was looking at comparing it to an SSRI signature and how much of a difference might we see there.
• 15:31
  SPEAKER_01: An antidepressant.
• 15:32
  SPEAKER_01: Yes, exactly.
• 15:33
  SPEAKER_01: Sorry.
• 15:34
  SPEAKER_01: Um, one thing that I think is important to note, and I think anyone who's done psilocybin research will say a real limitation of the research is the fact that these compounds are working so differently than, say, a classic psychotropic or an antidepressant, because they're broadening the range of what people experience, and they're actually fundamentally shifting for many people their experience of themselves.
• 15:58
  SPEAKER_01: And that's not to say that that couldn't happen with something like Zoloft, right?
• 16:02
  SPEAKER_01: You tell yourself I'm the kind of person that only feels this way, and then all of a sudden you start feeling differently.
• 16:06
  SPEAKER_01: So you start asking different questions.
• 16:08
  SPEAKER_01: But I think kind of the depth and profundity of which people are asking bigger questions about themselves and their conditions is just being kind of brought up for revision in a very different way with psilocybin because you're having these longer sessions, four to six hours.
• 16:23
  SPEAKER_01: I would say on average, six to eight for some people, where you're encountering experiences, you're getting this experiential engagement with your emotions, with your history.
• 16:34
  SPEAKER_01: Um, you're asking big questions about life, death, meaning, purpose, worthiness that are kind of emerging as a result of being in this non-ordinary state of consciousness that fundamentally for some people can shift perspective in these ways that another way to think about it is that oftentimes when people are stuck in a condition that feels kind of limiting and rigid and just um makes the world feel small and makes them feel small.
• 17:03
  SPEAKER_01: They've got very restrictive ways of thinking about the world and what's possible.
• 17:08
  SPEAKER_01: It's like the way they predict what's possible is very narrow.
• 17:12
  SPEAKER_01: Whereas uh one theory about what's happening with something like psilocybin, for example, is it's turning down the volume on prediction and turning up the volume on experience.
• 17:23
  SPEAKER_01: So that the experience that you're having in real time is somehow reshaping the story you have about what's possible, not only about the condition you're navigating, but also about you yourself.
• 17:36
  SPEAKER_01: It's kind of like a nouveau way of cognitive restructuring that's not simply about thought exercises or challenging your beliefs, because you're not trying to like fight a predominant thought.
• 17:49
  SPEAKER_01: You're actually moving away from thought territory all altogether as the sole place where things get determined and moving into experience as the way that gets to dictate what the story is or what your experience is.
• 18:02
  SPEAKER_01: So that's kind of interesting and new and quite novel as we in terms of how we might think about something like um an SSRI or an antidepressant.
• 18:11
  SPEAKER_04: Yeah, I never I've been on antidepressants for decades and never had that kind of experience.
• 18:16
  SPEAKER_03: Yeah.
• 18:16
  SPEAKER_04: So if someone goes through a six to eight hour psilocybin assisted therapy session, it's not very hard to say all that sometimes.
• 18:26
  SPEAKER_04: What difference beginning to end?
• 18:28
  SPEAKER_04: Now that I have been opened to different possibilities, what's likely to be different in my actual life?
• 18:34
  SPEAKER_01: Okay.
• 18:34
  SPEAKER_01: So one thing I want to clarify because it's important to make this clear.
• 18:38
  SPEAKER_01: I previously talked about in the last episode about how MDMA went to try to get approval through the FDA attached to a very specific therapeutic protocol.
• 18:47
  SPEAKER_01: These other the psilocybin that's coming from Eusona and the psilocybin that's coming from compass pathways that's moving towards the FDA finish line, they're not attached to a specific standalone therapy.
• 19:00
  SPEAKER_01: They're attached to uh both of them are attached to what's called a psychosocial support model.
• 19:05
  SPEAKER_01: You are being supported in your experience.
• 19:07
  SPEAKER_01: There's preparation that goes into that.
• 19:09
  SPEAKER_01: You have at least two therapists in the room the whole time, or clinicians in the room, depending on how it's designated.
• 19:15
  SPEAKER_01: And then those people are present largely in the integration window that follows.
• 19:20
  SPEAKER_01: But it's not a very specific standalone therapy that's being introduced alongside of these.
• 19:26
  SPEAKER_01: So even using the term psilocybin therapy is a little misleading because many therapists would say what's happening in the room is, of course, a therapeutic process, but it's not being packaged as a standalone therapy alongside of psilocybin.
• 19:42
  SPEAKER_01: The purpose of the psychosocial support is very focused on drug effects, informed consent, and how to prepare someone for a non-ordinary state experience that could be occasioned by psilocybin.
• 19:54
  SPEAKER_01: And their role in the room when the psilocybin is on board to provide comp safety, support, choices, comfort.
• 20:03
  SPEAKER_01: But they're not being tasked with wearing a therapist hat in that moment in a traditional sense.
• 20:08
  SPEAKER_01: Okay.
• 20:09
  SPEAKER_01: So that's just important to distinguish and differentiate.
• 20:12
  SPEAKER_01: And then in the process of integration, it's there to help people make sense or meaning of what has happened in that experience.
• 20:19
  SPEAKER_01: Now, the purpose of that feels more vital for people who've had a very difficult or challenging or disappointing experience.
• 20:26
  SPEAKER_01: This is also something that's not often talked about, is there's actually a high percentage of disappointment that happens alongside of psychedelics because, like we talked about before, people are attempting to predict what will happen.
• 20:39
  SPEAKER_01: Then we've got the backdrop of media and culture saying these are miraculous drugs that change people's lives.
• 20:45
  SPEAKER_01: So people go into them expecting a certain kind of thing to happen.
• 20:49
  SPEAKER_01: I'm sure if someone just zoned into one section of what you said, what have you seen happen?
• 20:54
  SPEAKER_01: They think that will happen for me.
• 20:56
  SPEAKER_01: And when it doesn't show up in that exact way, people can get very disappointed or frustrated or feel like they are doing it wrong, or somehow they weren't chosen to respond to it.
• 21:06
  SPEAKER_01: So a lot of the support that's being mediated is actually in navigating the nonlinearity.
• 21:12
  SPEAKER_01: So things aren't A to B to C to D, and the unpredictability of these compounds.
• 21:17
  SPEAKER_01: And it's actually a lot of the work is going into how do you stay open to something that may be different than you think it's gonna be?
• 21:23
  SPEAKER_01: How do you engage with the content as it's emerging?
• 21:26
  SPEAKER_01: And how will we you choose to make sense of it afterwards?
• 21:30
  SPEAKER_01: So that's a little bit of a different nuance that I want to um underscore.
• 21:34
  SPEAKER_01: Uh, and that's not to say that that that, but anytime you see psychedelic, fill in the blank, whichever compound, assisted therapy, that should be a strong component of what's happening is supporting someone in addressing these drug effects and what are the impacts of it.
• 21:50
  SPEAKER_01: But it's important to note that the therapy is not being attached to these drugs as they're going towards the FDA finish line.
• 21:58
  SPEAKER_04: Okay.
• 21:58
  SPEAKER_01: Which is different than saying Well, well, now MDMA assisted therapy was going to the finish line attached to a therapy, even though the FDA can't regulate therapy.
• 22:07
  SPEAKER_01: Then then it's this very interesting conundrum of a drug being approved, and then it's this.
• 22:13
  SPEAKER_01: Sponsors that get decide what gets attached to it to some extent.
• 22:16
  SPEAKER_01: But it's just the drug that's being approved under a certain set of circumstances and certain sort of safety profile.
• 22:22
  SPEAKER_01: And they will have risk mitigation strategies that they'll have to put in place.
• 22:26
  SPEAKER_01: But this is just real complex.
• 22:28
  SPEAKER_01: And I think it's important that listeners understand the different nuances in terms of the way these things are being talked about.
• 22:33
  SPEAKER_01: For example, if you went to Oregon to one of these wellness centers, probably be a very limited amount of preparation that's happening for that process.
• 22:42
  SPEAKER_01: And the way that you're supported in it is really about giving you an experience to have you with the drug itself in a somewhat monitored environment.
• 22:49
  SPEAKER_01: But you're not going to get a lot of nuances there in terms of the therapeutic container because they're not technically doing therapy in those wellness centers.
• 22:57
  SPEAKER_01: So I think that's just an important thing for people to know is if you're looking to explore these out of state or maybe in a retreat abroad, really ask important questions about what is the role of the facilitators, if you will, if they're not considered therapists, what does that mean for me in my experience?
• 23:13
  SPEAKER_01: And how is it handled when things get challenging or difficult, or what does that look like in terms of long-term follow-up?
• 23:19
  SPEAKER_04: So while a therapist might would not likely be uh present at that sort of a situation, is it your recommendation that afterwards someone works to integrate some of the things that came up with a therapist?
• 23:31
  SPEAKER_01: I think there is no downside to integration.
• 23:34
  SPEAKER_01: Um, and I think it's underwhelmingly wait, it's there's not enough people talking about the critical importance of integration.
• 23:43
  SPEAKER_01: Because especially when these experiences are big or deep or profound, they are also happening in a different state of consciousness.
• 23:52
  SPEAKER_01: And so when we kind of return to baseline, people will often want to hold on to certain parts of it, but they'll struggle to do so.
• 23:59
  SPEAKER_01: They're like not sure how to build that bridge.
• 24:01
  SPEAKER_01: That's what integration work is doing, is building a bridge from this non-ordinary state of consciousness into ordinary consciousness to figure out do I want to integrate this into my lived experience?
• 24:11
  SPEAKER_01: And if I do, it's not just about those pathways becoming available during the drug itself.
• 24:15
  SPEAKER_01: How do I keep firing them without the drug present?
• 24:18
  SPEAKER_01: And a lot of that is going to be based on choices, behavior, the conversations that you're having, the approach that you have, the story you tell yourself about what happened.
• 24:27
  SPEAKER_01: Someone who walks out of a psilocybin experience and says, Oh, that drug did X, Y, and Z versus I can't believe that I was able to experience, I was able to experience where's the locus of control?
• 24:39
  SPEAKER_01: How is it being internalized?
• 24:41
  SPEAKER_01: What is being said about that moving forward?
• 24:43
  SPEAKER_01: All of those things have impacts on how the experience is held long term for individuals.
• 24:48
  SPEAKER_04: When you use the phrase non-ordinary state experience, you're talking about what most people call a trip.
• 24:54
  SPEAKER_01: Yeah, an altered state of consciousness, but we call them non-ordinary states of consciousness because altered has kind of a pejorative term associated with it, I think, or a kind of a tone to it.
• 25:05
  SPEAKER_01: But as I mentioned in the other episode, you can have a non-ordinary state of consciousness through lots of different modalities.
• 25:12
  SPEAKER_01: I was actually just watching a documentary last night about called The Dark Wizard about uh someone who did kind of extreme bass jumping and wingsuiting.
• 25:22
  SPEAKER_01: And I thought the whole time, yeah, that these extreme sport athletes are experiencing non-ordinary states of consciousness when kind of they push themselves through the limit and time disappears.
• 25:32
  SPEAKER_01: And, you know, their sense of who they are and their connectedness and their how they fit in the spectrum of the universe.
• 25:39
  SPEAKER_01: I mean, people will experience that through music and through prayer and through spirituality practices.
• 25:45
  SPEAKER_01: And um, that's not just the territory of psychedelic compounds, but childbirth could be considered a non-ordinary state of consciousness.
• 25:53
  SPEAKER_01: So there's lots of different ways to access it.
• 25:55
  SPEAKER_01: Um, and so I think that's important for people to recognize as this is one vehicle that pers you know more predictably induces that.
• 26:03
  SPEAKER_01: There's there's a lot to be said about what comes before and what after, and not just focusing on the the drug experience itself.
• 26:11
  SPEAKER_04: Well, my next question is gonna ask about the drug experience itself.
• 26:14
  SPEAKER_01: Because it's is psilocybin safe?
• 26:17
  SPEAKER_01: I'm never have easy answers for this, right?
• 26:20
  SPEAKER_01: Because it's okay, what is the setting?
• 26:22
  SPEAKER_01: What is the environment?
• 26:23
  SPEAKER_01: What are the circumstances?
• 26:25
  SPEAKER_01: Who's the individual?
• 26:25
  SPEAKER_01: What is the condition they're navigating?
• 26:27
  SPEAKER_01: I will say that the safety profile is quite high on psilocybin because of the safety studies that they've been able to do in terms of the the physical safety profile on this compound.
• 26:39
  SPEAKER_01: Um, but could it be risky for individuals with hypertension?
• 26:43
  SPEAKER_01: Absolutely, because it causes an increase in hypertension.
• 26:46
  SPEAKER_01: And if someone has a vulnerability from a cardiac standpoint, that would not be good for them.
• 26:50
  SPEAKER_01: But there's other nuances there that I'm not going to speak to exhaustively.
• 26:54
  SPEAKER_01: But in controlled settings where there's not repeated administration over and over and over again, we have good data to support its safety.
• 27:03
  SPEAKER_01: Psychological safety is a different question, depending on, you know, what people are able to access and what's in their history and what's been kind of maybe pushed off to the side and the challenge of that.
• 27:15
  SPEAKER_01: I would say more predictably, there's a good chance that you will have a very some aspect of your journey be quite challenging with something like uh psilocybin.
• 27:25
  SPEAKER_01: Many people who were part of the earliest clinical trials that had um terminal diagnoses and they were doing psilocybin to see if they could have an impact on the way they approach death and their experience of everyday life.
• 27:37
  SPEAKER_01: Many people had an ex a death experience in their psilocybin journey.
• 27:41
  SPEAKER_01: So then so you can ask the question, is this a safe drug?
• 27:45
  SPEAKER_01: And it's like, well, depends on what your definition of safety is.
• 27:48
  SPEAKER_01: If you would rather not have the experience of feeling as though you're dying, then you probably should not willy-nilly be taking these compounds because bigger states of consciousness shifts can also occasion something called ego dissolution, where you lose your sense of who you are and reality, or your ego dissolves to a large extent.
• 28:08
  SPEAKER_01: You lose figure ground for the way to or orient yourself to the world.
• 28:12
  SPEAKER_01: Some people could feel that as completely freeing.
• 28:16
  SPEAKER_01: Other people could see that and experience that as completely terrifying.
• 28:20
  SPEAKER_01: So it's a qualitative question that varies depending on, you know, the nuances and the context and the individual that you're speaking about.
• 28:29
  SPEAKER_04: If someone is wants to experience psilocybin, wants to open up in the ways that it can allow us to do that.
• 28:38
  SPEAKER_04: How do they do that?
• 28:39
  SPEAKER_04: Is it all in the two states that it's legal or in a clinical setting at this point in the US?
• 28:44
  SPEAKER_01: Yes.
• 28:45
  SPEAKER_01: Yeah.
• 28:45
  SPEAKER_01: I mean, I think there are retreats further abroad.
• 28:48
  SPEAKER_01: I think there's retreats in Jamaica, um in the Netherlands, maybe.
• 28:52
  SPEAKER_01: I think Switzerland has different policies on uh clinical settings that offer psychedelic treatments.
• 28:58
  SPEAKER_01: But yes, within the context of the United States, outside of the work that's being done in New Mexico right now, and I'm not sure what stage it's at.
• 29:05
  SPEAKER_01: I know that they're right now they're just looking at implementation.
• 29:08
  SPEAKER_01: Colorado and Oregon, um, those are the places to go if you're gonna have it, what we consider above ground, um, which is all that I'm really comfortable speaking to, because that's I'm not expertise in the underground world.
• 29:24
  SPEAKER_04: Is there an expectation that other states will legalize psilocybin use?
• 29:29
  SPEAKER_01: Yeah, I mean, I I certainly, I mean, you can just do a quick Google search on all the different states that have started to decriminalize or authorize it for recreational use or have that on their bills.
• 29:41
  SPEAKER_01: I mean, it's happening all over the place.
• 29:43
  SPEAKER_01: Again, that's not my area of expertise, so I wouldn't uh expect to give you the most up-to-date information about that.
• 29:48
  SPEAKER_01: But there is a great resource called Psychedelic Alpha that has um Josh Hardman who uh runs that online essentially website.
• 29:57
  SPEAKER_01: And um it's a major news source for individuals who are interested in learning the most up-to-date information about psychedelic policy and also where things are at in terms of drug companies and the drugs that they're sponsoring and how close they're getting to the approval line.
• 30:10
  SPEAKER_01: He has this great bullseye chart that shows you all the different compounds that are so it's called psychedelic psychedelic alpha.
• 30:16
  SPEAKER_01: Put a little plug in for Josh's uh website.
• 30:19
  SPEAKER_01: But um, yeah, there's there's a lot of things shifting and changing.
• 30:22
  SPEAKER_01: And now with this executive order that was um uh put in place by President Trump, um, there were specific vouchers that were um determined for different drug sponsors to help fast track the review of their drug applications once they get to that point.
• 30:43
  SPEAKER_01: And so um things are shifting in a quite a significant way.
• 30:47
  SPEAKER_01: That executive order was a pretty big um inflection point.
• 30:51
  SPEAKER_01: I think a lot of people are seeing it that way in terms of friendliness of the government to supporting um the regulation of specifically psilocybin and the other compound that they were looking at was methylone, which is um we haven't talked about that.
• 31:04
  SPEAKER_01: That's another podcast episode.
• 31:07
  SPEAKER_04: So if the government is shifting its acceptance, its perception on medications on compounds like psilocybin, is society, because I mean, I'm a child of the 60s, and I think mushrooms, Timothy Leary, you know, I'm not I never thought of it, was not raised to think of it as therapeutically significant.
• 31:27
  SPEAKER_01: Yeah.
• 31:27
  SPEAKER_01: I think there's a lot of things that are helping public consciousness to shift around this, one of which was Michael Pollen.
• 31:33
  SPEAKER_01: I don't know if you know about the Pollen effect, but we all joke about it in clinical research, which is essentially he's such a compelling writer.
• 31:41
  SPEAKER_01: He's uh reaches a certain demographic that would not otherwise, I don't think, be Googling psychedelics.
• 31:47
  SPEAKER_01: And so I think his book, How to Change Your Mind, and also the documentary series that he did on Netflix, um, it's being pushed into public consciousness in a very big way.
• 31:59
  SPEAKER_01: And so I think, yeah, there are a lot of things that are starting to shift this.
• 32:02
  SPEAKER_01: And, you know, podcasters like Joe Rogan and Tim Ferris have had a really significant imprint on the way that we think about these compounds, sometimes for good, sometimes maybe not so much for good.
• 32:13
  SPEAKER_01: But I think generally speaking, I mean, there's there's good rumors to support that Joe Rogan had a hand in kind of uh shifting the needle to some extent in terms of President Trump's executive order.
• 32:27
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• 32:31
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• 32:37
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• 32:41
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• 32:44
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• 33:00
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• 33:06
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• 33:10
  SPEAKER_04: As a psychologist and researcher, when you see access and acceptance of compounds like psilocybin changing and increasing, is that are you hopeful?
• 33:23
  SPEAKER_04: And do you think, oh, more people will find relief?
• 33:27
  SPEAKER_04: I'll use that word.
• 33:28
  SPEAKER_04: Or do you think, oh, this is this is a can of worms?
• 33:32
  SPEAKER_01: Can I say both?
• 33:33
  SPEAKER_01: Yeah.
• 33:33
  SPEAKER_01: Yeah, I would say both.
• 33:35
  SPEAKER_01: I think it is incredibly exciting what's happening and the potential of what's happening.
• 33:42
  SPEAKER_01: I think the concern is that these are complex um compounds and they are not, they don't fit well into the way our current healthcare system is organized.
• 33:54
  SPEAKER_01: And um my concern or my worry is that they'll be reduced or oversimplified into being a thing.
• 34:05
  SPEAKER_01: And that anyone who's worked alongside of these compounds long enough knows it's almost impossible to say one or two sentences about what they do because there's so much nuance in terms of how they impact different people differently.
• 34:19
  SPEAKER_01: It's an interaction effect with the individual.
• 34:22
  SPEAKER_01: And so um I think there's, you know, our society loves things to happen quickly and loves to oversimplify the idea that something can shift like this.
• 34:34
  SPEAKER_01: Great.
• 34:35
  SPEAKER_01: Um, and that's I don't think that's a good representation for what they do.
• 34:40
  SPEAKER_01: Would I want to be working in the mental health field without having access to them as a tool?
• 34:46
  SPEAKER_01: Absolutely not.
• 34:47
  SPEAKER_01: I wouldn't leave the field, but I am much more invigorated by the work I'm doing, knowing that we have access to them, because the thing that excites me most about them is this idea that they give people greater access to themselves.
• 35:01
  SPEAKER_01: And that to me is the most exciting part about potentially what's happening.
• 35:06
  SPEAKER_01: The tricky part about that is that the way they get access in some times can feel really great.
• 35:14
  SPEAKER_01: And there are also other aspects of the experience that isn't just their own experience.
• 35:20
  SPEAKER_01: There's parts of the drug effects that make you kind of question what is real and what is not real, ask bigger questions.
• 35:26
  SPEAKER_01: There can be ways in which the psyche amplifies things that feel dangerous or threatening or terrifying.
• 35:32
  SPEAKER_01: And, you know, so we also have to take that into consideration too, that sometimes these experiences can be very profound, but also some people can feel like they've broken their brain forever because of a psychedelic experience.
• 35:46
  SPEAKER_01: That happens to some people.
• 35:47
  SPEAKER_01: It's not the majority of people, but it definitely happens.
• 35:50
  SPEAKER_01: And what does that mean?
• 35:52
  SPEAKER_01: Well, when someone has an experience or they get exposed to something they wish they hadn't, had a thought that they wish never occurred to them, open something up inside of them that they never were navigating before, or they just feel at a mental level differently.
• 36:07
  SPEAKER_01: I was watching someone give a talk on this at uh the trauma conference that's run by the uh the trauma foundation that Bessel Vanderkalk is associated with.
• 36:16
  SPEAKER_01: And this woman was speaking about a young man in his 20s that couldn't stop hearing music in his head after an experience and it was dry, he felt like he was losing his mind.
• 36:27
  SPEAKER_01: So something even that subtle can be a perturbation of someone's psychic experience of themselves.
• 36:34
  SPEAKER_01: We want that to shift for good, but what if it shifts in a way that doesn't feel like it happens for good?
• 36:38
  SPEAKER_01: We need to be talking about these cases as well.
• 36:41
  SPEAKER_04: You use the phrase greater access to ourselves.
• 36:44
  SPEAKER_04: Do psychedelics give us greater access to ourselves?
• 36:47
  SPEAKER_04: And what's the benefit of having that access?
• 36:49
  SPEAKER_04: Well, I feel like I want to know what it means.
• 36:52
  SPEAKER_01: To yourself is an inalienable right of existence.
• 36:55
  SPEAKER_01: And unfortunately, I think most mental health conditions clip our access to ourselves, right?
• 37:01
  SPEAKER_01: 100%.
• 37:02
  SPEAKER_01: And so if there's something that can make you feel more in touch with the things that are already inside of you, that feels like it should be, it's like a civil liberty issue, right?
• 37:13
  SPEAKER_01: I mean, that so many people will have very loud access to a certain part of themselves, but very diminished access to other parts, right?
• 37:22
  SPEAKER_01: So part of them that feels suicidal, they can hear it every single day.
• 37:26
  SPEAKER_01: But this part of them that experiences gratitude is just like quietly humming so softly in the distance they can't ever hear it.
• 37:34
  SPEAKER_01: So this idea of kind of reshifting the organization inside, I also believe that the full emotional range is also a right of existence.
• 37:44
  SPEAKER_01: And many people don't feel like they have permission to access sadness safely or joy safely.
• 37:51
  SPEAKER_01: They don't feel they can act access anger safely.
• 37:54
  SPEAKER_01: So from my lens, and this is very specific to the way that I work, giving people a broader range of emotional access is just allowing people to have a deeper, more human experience.
• 38:06
  SPEAKER_01: And unfortunately, I think when people get stuck in certain cycles, survival cycles, they protectively tune out or shift uh away from their own self-experience to survive it.
• 38:20
  SPEAKER_03: Yeah.
• 38:21
  SPEAKER_01: And then that's where they get stuck, is in a in a very truncated experience of themselves and their own kind of emotional range.
• 38:30
  SPEAKER_04: Which leads, I'm assuming, to a very limited uh experience of life.
• 38:35
  SPEAKER_01: I think a lot of people would describe that if they're talking about severe debilitating depression, anxiety, PTSD, substance use disorders, and their life experience becomes very truncated and dictated by what in many ways doesn't feel safe otherwise to venture out or to feel in certain ways.
• 38:55
  SPEAKER_01: There's not enough safety to feel those things.
• 38:58
  SPEAKER_01: And so then, you know, do these compounds play a role in disrupting those ideas?
• 39:04
  SPEAKER_04: It's hard to discuss compounds that could offer real relief and expansion and potential joy to people and say they're not available or they're not legal.
• 39:16
  SPEAKER_04: So we're for somebody watching or listening saying, I want that experience, it's just go somewhere else and get it.
• 39:24
  SPEAKER_04: Well, things are happening right now, right?
• 39:26
  SPEAKER_01: I mean, we hopefully within the next year, we should be hearing about FDA approval on psilocybin.
• 39:33
  SPEAKER_04: You expect FDA approval on psilocybin within the next year?
• 39:36
  SPEAKER_01: Oh, I don't want to, I don't have information, sure.
• 39:40
  SPEAKER_01: Okay.
• 39:40
  SPEAKER_01: I think in the next year we're gonna have a lot more information about this.
• 39:42
  SPEAKER_01: Okay.
• 39:43
  SPEAKER_01: I really do.
• 39:44
  SPEAKER_01: And two year stops.
• 39:46
  SPEAKER_01: That's not that far away.
• 39:48
  SPEAKER_01: And again, um, I've talked just as much about how it could go badly as how it goes well.
• 39:55
  SPEAKER_01: So I I just I think people need to be very mindful about educating themselves about if you've seen a documentary on the miraculous powers of these things, try to do a Google search for what it looks like when it goes badly, as as much as you're just looking at where it goes well for people.
• 40:15
  SPEAKER_01: I'm not trying to scare people.
• 40:17
  SPEAKER_01: I'm just saying um there are nuances that are hard to demonstrate, even in the when things are approved in research.
• 40:25
  SPEAKER_01: I mean, look at these drugs that we have existing in our current society.
• 40:29
  SPEAKER_01: Um, you know, SSRIs or antidepressants get prescribed very frequently with almost very limited discussions about the risks associated with these.
• 40:39
  SPEAKER_01: And I'm not faulting the healthcare professionals for that, but we have a tendency to focus on the opportunity and not be really informed about the risks and benefits.
• 40:48
  SPEAKER_01: What I would say to people who have access to it, if they're wanting to prepare for psychedelic therapy, is go into therapy.
• 40:56
  SPEAKER_01: Start therapy as a preparation process for psychedelic work.
• 41:01
  SPEAKER_01: You becoming more familiar with yourself and what it is inside that you block or that you don't connect to through regular therapy pathways.
• 41:09
  SPEAKER_01: I understand that's not available to everyone.
• 41:11
  SPEAKER_01: Right.
• 41:11
  SPEAKER_01: And there are access issues with that.
• 41:13
  SPEAKER_01: But any sort of self-reflective inquiry is going to be good preparation work for psychedelic work.
• 41:20
  SPEAKER_01: Meditation, everybody knows that it works.
• 41:22
  SPEAKER_01: People who are meditators and have a meditative practice do much better in psychedelic experiences, oftentimes, from my own anecdotal experience.
• 41:30
  SPEAKER_01: People who can sit inside themselves, people who journal, you know, these practices that are really good preparation work for psychedelic work can be starting for people before they may be available to them in their local areas.
• 41:43
  SPEAKER_01: So I would just say self-inquiry is the best preparation work you can do for psychedelic work.
• 41:49
  SPEAKER_01: And it's really people that concern me the most are people who have a very um narrowed view of all of the potential and none of the self-understanding.
• 41:59
  SPEAKER_01: Because this, these drugs will interact with you personally, your history, your emotional range, your story not just happen to you.
• 42:11
  SPEAKER_01: There's an interaction effect.
• 42:12
  SPEAKER_01: And we don't talk as much about that a lot of the times when we're talking about psychedelics.
• 42:17
  SPEAKER_04: So starting with therapy before you start in whatever way that's available to you, before you start a psychedelic experience would also better resource you to deal with the potential of a bad experience.
• 42:31
  SPEAKER_04: 100% or in incorporate the good one.
• 42:34
  SPEAKER_01: Yeah.
• 42:35
  SPEAKER_04: Okay.
• 42:35
  SPEAKER_01: I think I mean, I've been saying this for a long time.
• 42:37
  SPEAKER_01: My husband's in clinical trial research as well.
• 42:39
  SPEAKER_01: He's a neuroscientist and he laughs when I say this, but I think we both kind of think it's true.
• 42:44
  SPEAKER_01: I my greatest hope for psychedelics is that they're a gateway drug for therapy.
• 42:49
  SPEAKER_01: Is that psychedelics actually just help people understand more about what good therapy is.
• 42:54
  SPEAKER_01: And that often happens in the clinical trials.
• 42:57
  SPEAKER_01: Is I've worked with a number of different on the methamphetamine use disorder.
• 43:01
  SPEAKER_01: One of our first participants who I loved working with was really wonderful, but had avoided intersecting with any part of the mental health system because of the stigma attached to methamphetamine use disorder and was so careful about disclosing that because of I can only presume because of the tremendous shame.
• 43:20
  SPEAKER_01: And uh was so guarded, in fact, that I was a little bit nervous about bringing him into the trial because I thought, well, if he can't develop a relationship with us or a baseline level of capacity to kind of have those kind of conversations, will this be safe for him if we don't know him well enough to be able to adequately prepare him?
• 43:38
  SPEAKER_01: Because that is also part of the preparation process.
• 43:40
  SPEAKER_01: Is tell me about the things that are most difficult in your life, the things that would be hardest to encounter.
• 43:44
  SPEAKER_01: And you want people to be able to talk about that.
• 43:46
  SPEAKER_01: And anyone who couldn't talk about that in preparation in the trials, we wouldn't have felt comfortable proceeding with them.
• 43:51
  SPEAKER_01: So back to my kind of boost for therapy like, talk about the difficult thing.
• 43:55
  SPEAKER_01: Even if you can't talk about it, talk about how difficult it is to talk about that thing as part of the preparation process.
• 44:01
  SPEAKER_01: And I remember in his session uh deep into it, he was like, I just needed someone to talk to.
• 44:11
  SPEAKER_01: I just needed therapy.
• 44:14
  SPEAKER_01: And I was like, yay.
• 44:15
  SPEAKER_01: I mean, of course, I'm totally biased because I'm a psychologist, but I think a lot of people do realize that some of what's so challenging about these conditions they're navigating is they leave them in complete isolation from other people.
• 44:28
  SPEAKER_01: And so this idea of connectedness, I mean, this is also a thing that's being studied mechanistically around these component compounds.
• 44:34
  SPEAKER_01: How they increase our sense of connectedness to each other, to the world, to nature, Rosalind Watts has done as a nature connectedness scale that she developed as a result of people who've been through psilocybin experiences who actually feel more connected to the natural environment as a result of their experience and how you can use nature as an integration tool.
• 44:52
  SPEAKER_01: So it's just like all a lot of these really restrictive ways that we think about mental health and how it's delivered and what it includes.
• 45:00
  SPEAKER_01: You know, we all of a sudden we can't just not talk about spirituality because the preponderance of people having a psychospiritual experience with this are much higher than maybe they would in CBT, depending on how it's structured, right?
• 45:13
  SPEAKER_01: So these domains like nature, existence, um, phenomenology, um, all of these are entering into the space.
• 45:21
  SPEAKER_01: So we can't really, and we're not trying to restrain that based on what we think is allowed in healthcare.
• 45:28
  SPEAKER_01: Um, so also the way someone looks in their experience or what they say, or, you know, we give people permission to scream and yell, and um, vocalizations are welcome.
• 45:38
  SPEAKER_01: And the same way that you walk past a labor delivery ward, you're not going to go through the ward and be like, can you keep your voices down?
• 45:45
  SPEAKER_01: Right.
• 45:45
  SPEAKER_01: Like there's something is happening, there's a process that's unfolding that is going to be um processed, digested, and released with lots of different modes and ways of being, well beyond what's typically allowed in our healthcare system.
• 46:00
  SPEAKER_04: I love the language you use to say if you're not ready to talk about something extremely difficult, to talk about why you're not ready or what's extremely difficult about sharing it, because I think a lot of people avoid therapy because they don't want to go there.
• 46:15
  SPEAKER_00: Yeah.
• 46:15
  SPEAKER_04: And yeah.
• 46:16
  SPEAKER_04: Or they're in, they've been in therapy for decades and they haven't gone there to say there's this part of me.
• 46:22
  SPEAKER_04: Yes, that I that feels safest hidden.
• 46:25
  SPEAKER_01: I think that is like, yeah, I'm glad that that resonated with you and that you're spotlighting it because I actually think that's the difference between between in many cases really good therapy and therapy that doesn't move the needle, is being able to have a certain level of transparency about saying, and I think this is where really good therapists are really good at saying, what is it like to be with me?
• 46:47
  SPEAKER_01: How do you feel about coming here?
• 46:49
  SPEAKER_01: What do you notice yourself censoring?
• 46:51
  SPEAKER_01: What do you feel you have to edit out for my benefit?
• 46:54
  SPEAKER_01: Just to get a sense of like what's happening here in this work that we're doing together, instead of like, okay, tell me about your weekend, right?
• 47:01
  SPEAKER_01: This is like very narrow.
• 47:03
  SPEAKER_01: And then we go through the motions and you talk through a thing, but you don't feel it shifting you.
• 47:09
  SPEAKER_01: Right.
• 47:10
  SPEAKER_01: That form of therapy does not move the needle for many, many people.
• 47:14
  SPEAKER_01: That's how people end up in therapy for 10, 15 years and nothing changes.
• 47:18
  SPEAKER_01: It's like the real art of very skillful, thoughtful therapy is you're right on the edge of discomfort, but you're also feeling so validated that it's okay to feel that way.
• 47:31
  SPEAKER_01: And there's really good reasons to feel that way.
• 47:34
  SPEAKER_01: And let you and I sit on the edge of this discomfort.
• 47:38
  SPEAKER_01: So at least you're not alone in how uncomfortable you feel to be here.
• 47:43
  SPEAKER_01: And if therapy was framed that way, I'll bet a lot more people would go.
• 47:46
  SPEAKER_01: I think so.
• 47:47
  SPEAKER_01: Yeah.
• 47:47
  SPEAKER_01: I think so.
• 47:48
  SPEAKER_01: And that kind of work is brilliant preparation work for then the psychedelic therapy, which is like, I don't care if you're comfortable or not, you're going in, right?
• 47:56
  SPEAKER_01: So it, you know, depending on the compound, right?
• 47:59
  SPEAKER_01: Um, yeah, let's talk about those protective edges and why they exist.
• 48:03
  SPEAKER_01: And what would you need to feel differently inside in order to feel ready to go there, right?
• 48:09
  SPEAKER_01: Back to that idea of resourcing from within.
• 48:12
  SPEAKER_01: Right.
• 48:12
  SPEAKER_01: You know, this these models around trauma have always a lot of them have been hinged on this idea that people are not courageous enough or brave enough.
• 48:18
  SPEAKER_01: We have to force them towards the most difficult thing.
• 48:21
  SPEAKER_01: Well, you know what we learned when we did resource-based trauma models is when you help people feel safe enough inside, they would more spontaneously move towards the difficult thing because they felt like they could handle it.
• 48:32
  SPEAKER_01: That is such a different model than, oh, you have to be brave or more courageous, or, you know, there's something diminutive in that framework that feels a little less, there's a less of an emphasis on honoring why the protective reflex is so needed to survive, you know?
• 48:52
  SPEAKER_01: Yep.
• 48:53
  SPEAKER_01: And so how can we work with that differently as we're looking towards working with these compounds that shake those things up that disrupt our protective structures in very interesting and unpredictable ways?
• 49:04
  SPEAKER_04: Speaking of compounds, let's shift to ibogaine.
• 49:07
  SPEAKER_04: Yes.
• 49:07
  SPEAKER_04: Tell me the background on ibogaine, how it's used and how it can help.
• 49:12
  SPEAKER_04: I should say that I am not an expert in ibogaine.
• 49:14
  SPEAKER_01: We have never worked it for last trial settings, but yes, it's I think you had mentioned earlier that it's an alkaloid that's derived from a shrub found in Central Africa.
• 49:25
  SPEAKER_01: It's got a a hundred year history of being um used in spiritual practices with the buiti.
• 49:32
  SPEAKER_01: Um, again, please do some research on that and look that up on your own because I think that's incredibly important.
• 49:39
  SPEAKER_01: And um, and it's a different compound from something like psilocybin, for example, because it actually interacts with lots of different neurotransmitters beyond serotonin.
• 49:49
  SPEAKER_01: It actually has glutamaturgic action, dopamaturgic action.
• 49:53
  SPEAKER_01: So working with dopamine, glutamate, and also opiate receptor sites, that's fascinating.
• 49:58
  SPEAKER_01: So it's actually got a lot more complex chemical structure that actually works on a number of different neurotransmitters at the same time, which is kind of fascinating and differentiates it.
• 50:09
  SPEAKER_01: And there have not been as many clinical trials on ibogaine, um, not nearly as many as psilocybin.
• 50:16
  SPEAKER_01: And much of the work that's been done around it outside of Africa has been in these retreat centers that are happening in Mexico or um outside of the United States.
• 50:27
  SPEAKER_01: And um, I just learned recently about the history of uh an American learning about its opiate uh benefits accidentally in a recreational setting.
• 50:37
  SPEAKER_01: He was a heroin user.
• 50:39
  SPEAKER_01: Um, but there are there are thoughtful experts on this topic, and it's important for people to do that research that's necessary.
• 50:46
  SPEAKER_01: But so basically, in these retreat settings, they're using them.
• 50:50
  SPEAKER_01: Most commonly, uh, the interesting component about ibragain is it has this interesting affinity at the opiate receptor sites that allows people to more rapidly go from opiate dependence and they have to start going through withdrawal in the same way that we have to do that with suboxone.
• 51:09
  SPEAKER_01: We use suboxone for people who are transitioning off of opiates onto Suboxone.
• 51:13
  SPEAKER_01: Um, from my understanding, they start to go into withdrawal and then they introduce the ibogaine.
• 51:18
  SPEAKER_01: And something about the mechanism of ibogaine is able to more rapidly and robustly allow them to move out of opiate withdrawal faster and leave them on the other end.
• 51:33
  SPEAKER_01: Um, I think ibogaine can last up to 36 hours a journey.
• 51:38
  SPEAKER_01: So it's very different in terms of mechanistically how long it stays in the system and they come out of the other side of this in a state around their opiate receptor sites that would be virtually impossible to obtain if you were going the traditional withdrawal detox route long-term opiate use.
• 52:00
  SPEAKER_01: So that is quite astounding.
• 52:03
  SPEAKER_01: And it makes good sense that people have been very curious about it.
• 52:07
  SPEAKER_01: That experience that people endure in that non-ordinary state of consciousness from Ibegain can look very different across different people.
• 52:16
  SPEAKER_01: But many people were reported as like an autobiographical kind of life review that can at times feel very harrowing and difficult and challenging.
• 52:27
  SPEAKER_01: There's a documentary that was released on this called Of Waves in War, and it was looking at Navy SEAL vets that found this clinic.
• 52:35
  SPEAKER_01: I think it was in Mexico where they went to experience ibogaine, and they describe their experiences in vivid detail.
• 52:42
  SPEAKER_01: And it is, I don't look at those and go, I can't wait to try that drug.
• 52:47
  SPEAKER_01: Right.
• 52:48
  SPEAKER_01: Uh, very harrowing, challenging, difficult.
• 52:51
  SPEAKER_01: Um and so, yeah, I mean, that's an interesting question, right?
• 52:56
  SPEAKER_01: But if you're dealing with a condition that feels life-threatening, yeah, and people have been through multiple iterations of treatment.
• 53:04
  SPEAKER_01: Um, again, the cautionary uh plug I would like to make for people who are looking at alternative clinics in this way, who've been tried maybe um methadone or maybe suboxone, but have been primarily psychopharmacologically exploring pathways, is to think about therapeutic pathways that are also about self-discovery, because that is part of what will happen through that journey with Ibogaine, from what I understand.
• 53:30
  SPEAKER_01: And also, I have treated many people in my treatment center.
• 53:34
  SPEAKER_01: We have a residential substance abuse treatment center because some people also will use this as a treatment for alcohol use disorder.
• 53:40
  SPEAKER_01: Again, not FDA approved, but have these pretty impactful experiences and then come out and return to relapse very quickly after leaving those environments.
• 53:51
  SPEAKER_01: So despite that being profound and catalytic and leaving them feeling better than they've ever felt, there are behavioral strategies and integration that needs to happen on the back end to really sustain those practices.
• 54:06
  SPEAKER_01: And so I think by their by very virtue of the retreat model, um, and probably not unlike many retreat settings, right?
• 54:14
  SPEAKER_01: Where people go and have, you know, like Tony Robbins experience, right?
• 54:19
  SPEAKER_01: And they go and they're part of this big experience and they have this like profound impact and they have a big opening and then they walk out the doors.
• 54:27
  SPEAKER_01: And if they never touch anything that they did in there ever again, are they changed?
• 54:32
  SPEAKER_01: Many people, I think, no matter how profound of an intensive experience you have, if they if you don't have the ongoing experience to integrate that meaningfully, then it's not going to sustain itself for most individuals.
• 54:47
  SPEAKER_04: I'm glad you brought up a other, you know, like a Tony Robbins experience, because it can be very easy to look at a therapist and say, of course you think we need therapy.
• 54:55
  SPEAKER_04: Yeah.
• 54:56
  SPEAKER_00: Yeah.
• 54:56
  SPEAKER_04: But I understand that it's like, okay, now you've been given whatever this was, this experience.
• 55:02
  SPEAKER_04: Yes.
• 55:03
  SPEAKER_01: How will you use going to be the long-term integration of it?
• 55:07
  SPEAKER_01: And my fear is that, again, we will just over-medicalize the model, put the emphasis on the compound, and then we'll come back in for another treatment, come back in for another treatment instead of the thoughtful, like, well, what what happened afterwards?
• 55:23
  SPEAKER_01: And what are you, how are you set up differently?
• 55:26
  SPEAKER_01: And what's your plan around this?
• 55:28
  SPEAKER_01: I just I think these compounds are sophisticated enough to keep teaching us over and over again that that's not how they work.
• 55:36
  SPEAKER_01: And the unfortunate reality is that people will be casualties to that mindset and they will keep spending more money in the same way that a ketamine infusion clinic might keep treating someone with more ketamine when it's not working, instead of going, wait, maybe the conditions here are not optimized for you.
• 55:52
  SPEAKER_01: Maybe you need to look at a different way of receiving this or experiencing this instead of saying, like, oh, well, let's do another round.
• 55:58
  SPEAKER_01: Let's do another round.
• 56:00
  SPEAKER_01: I just think there's tremendous risks and oversimplifying things in that way.
• 56:04
  SPEAKER_01: And we're dealing with people's psyches and their souls.
• 56:08
  SPEAKER_01: This is not territory that should be handled lightly or um insensitively.
• 56:16
  SPEAKER_01: Is Ibogaine use the use of Ibogaine in these clinical settings safe?
• 56:22
  SPEAKER_01: Um, I think it depends on the safety monitoring and the medical monitoring of the retreat center.
• 56:27
  SPEAKER_01: And I think some people have more rigorous protocols.
• 56:29
  SPEAKER_01: And I think unfortunately, people might have less rigorous protocols in some environments.
• 56:33
  SPEAKER_01: I have heard stories of people dying in retreat centers.
• 56:37
  SPEAKER_01: Um and so I think anytime there's a documented history of that, I think people are, it's very appropriate to be incredibly cautious about how to go through the process of vetting programs like this.
• 56:51
  SPEAKER_01: And to be honest, I do not think there are good systems in place to vet them appropriately.
• 56:56
  SPEAKER_01: So take caution and do your research as best you can and read reviews.
• 57:01
  SPEAKER_01: And ideally, I this is this is also what I think about just like implementation in general.
• 57:06
  SPEAKER_01: We need better stewards, we need better education, we need consumer agencies that take complaints.
• 57:13
  SPEAKER_01: I have a very um lovely colleague and now friend, Juliana, who works on the East Coast and has a lot of experience with these sort of things.
• 57:23
  SPEAKER_01: And she's become an unofficial repository for abuse happening in these clinics and also harms happening in these clinics.
• 57:30
  SPEAKER_01: So I just think we have to be very careful and cautious about making sure that these are meeting the standards of care.
• 57:36
  SPEAKER_01: And when they're happening outside of a healthcare system that you're not familiar with and you don't know how those regulatory processes are happening, it gets much more complex, which is again another challenge of going outside of the states to do that work.
• 57:47
  SPEAKER_04: So so if somebody is interested in that experience and needs more help than they're getting or more support than they're getting to stop an addiction, to treat an addiction, what what's the best recommendation?
• 58:00
  SPEAKER_04: Because if it's not available here, but it might help, but it might kill you.
• 58:06
  SPEAKER_04: I mean, I don't know really how someone's supposed to internalize what we're saying.
• 58:10
  SPEAKER_01: I just I personally don't feel like they're I for me to make a recommendation on something, I want to meet the standards of research in this country.
• 58:19
  SPEAKER_01: And we are not there yet.
• 58:21
  SPEAKER_01: So my recommendation is to not go and do something that hasn't met research standards that are required within the context of the United States.
• 58:30
  SPEAKER_01: And um, I understand that that's a difficult thing to hear.
• 58:34
  SPEAKER_01: One, I'm not an expert in Ibogaine, so I don't feel like I can speak to it, the nuances as many other people can.
• 58:41
  SPEAKER_01: And the good news, I think, about this is there is a massive uh public campaign of awareness around Ibogaine right now, where many states are putting lots and lots of money towards funding for Ibogaine research.
• 58:56
  SPEAKER_01: So again, it is happening here in the United States.
• 58:59
  SPEAKER_01: Texas has um millions of dollars being put towards ibogaine research.
• 59:04
  SPEAKER_01: And I think this new executive order that happened with President Trump also talked about matching state funds with federal funds for research, and Ibogaine is included in that um, in that mix of research.
• 59:18
  SPEAKER_01: So it is happening here.
• 59:19
  SPEAKER_01: Okay.
• 59:20
  SPEAKER_01: Um, I just think, and we still also have very good treatment to for some people, unfortunately.
• 59:28
  SPEAKER_01: This is the difficulty for individuals with use disorders.
• 59:32
  SPEAKER_01: You know, the disparity in what's accessible to people based on the number of resources and the insurance they have is limited, but those are still pathways that might improve readiness when this does become available here in the United States.
• 59:45
  SPEAKER_01: Okay.
• 59:45
  SPEAKER_04: We're gonna wrap this up.
• 59:46
  SPEAKER_04: Is there a final message you want to leave people?
• 59:49
  SPEAKER_04: We've talked about four different compounds now and the use of psychedelics in therapy.
• 59:55
  SPEAKER_01: I mean, I think people should just keep doing their own research too.
• 59:58
  SPEAKER_01: I mean, it's a very different era.
• 1:00:00
  SPEAKER_01: If you go on to um Apple uh podcasts and you type in one of these psychedelic compounds, you'll get hundreds of um podcasts that talk about using them in different settings.
• 1:00:12
  SPEAKER_01: Listen to people who make sense and listen to people who talk about them in balanced ways.
• 1:00:18
  SPEAKER_01: Anyone who says this compound is as safe as safe can be and basically has not one even iota of a conversation around risk, just take that into consideration, like we should with everything else, right?
• 1:00:34
  SPEAKER_01: I mean, how do we evaluate whether or not what's being brought to us is there is nothing that doesn't have risks associated with it.
• 1:00:41
  SPEAKER_01: So I just encourage people to listen to people who can have a balanced conversation around it.
• 1:00:46
  SPEAKER_01: And I know it maybe may not feel the most satisfying, but oftentimes um the the place that we're at with these compounds is one where people should be like, that's interesting.
• 1:00:58
  SPEAKER_01: I need to learn more, not oh, I get it, I want it, let's do it.
• 1:01:03
  SPEAKER_01: That should not happen after an hour-long conversation for anyone.
• 1:01:07
  SPEAKER_01: So instead, you should be like, oh, interesting.
• 1:01:10
  SPEAKER_01: Let me educate myself more.
• 1:01:13
  SPEAKER_01: That's what I would love for people to do.
• 1:01:14
  SPEAKER_01: And then, you know, learn to use the decision-making capacity that you have around any big decision that you're making in your life.
• 1:01:21
  SPEAKER_01: Weigh the pros and the cons.
• 1:01:22
  SPEAKER_01: Talk about those things thoughtfully.
• 1:01:24
  SPEAKER_01: Ideally, talk about them with a therapist that is open to having those conversations.
• 1:01:28
  SPEAKER_01: And if you're therapists, learn about these compounds so we can help educate people in discernment.
• 1:01:33
  SPEAKER_01: That's the other big tagline that I would love to bring alongside of the miraculous potential for transformation is the critical importance of ethics and discernment in the face of these compounds.
• 1:01:44
  SPEAKER_04: I am very grateful that you walked us through some of these to start, because I think it's good to have a professional expert person who has done this research give us an understanding.
• 1:01:57
  SPEAKER_04: And then when we go into the rabbit holes of the internet, yeah, you know, or or podcasts, we can then say, oh, that's really different than what she said, or but they're not addressing this risk or something.
• 1:02:08
  SPEAKER_04: So thank you.
• 1:02:09
  SPEAKER_01: You're welcome.
• 1:02:10
  SPEAKER_01: It was very helpful.
• 1:02:11
  SPEAKER_01: I know there's so much more.
• 1:02:12
  SPEAKER_04: I will probably be on the internet this very afternoon.
• 1:02:15
  SPEAKER_01: Yeah.
• 1:02:15
  SPEAKER_01: Thank you.
• 1:02:16
  SPEAKER_01: It was a pleasure.
• 1:02:17
  SPEAKER_04: As we wrap up this discussion on psilocybin, ibogaine, ketamine, and MDMA, we are reminded that psychedelic assisted therapy is not one single approach, but a rapidly evolving field with many different medicines, compounds, risks, and possibilities.
• 1:02:31
  SPEAKER_04: Our thanks to Dr.
• 1:02:32
  SPEAKER_04: Chantel Thomas for walking us through all of them.
• 1:02:35
  SPEAKER_04: Please join us again next week as we explore a new topic in behavioral health and addiction on recoverable.
• 1:02:40
  SPEAKER_04: In the meantime, be good to yourselves and each other.