Latest / What the Hal?? 2.0 / WHAT THE HAL? PODCAST 2.0 – EPISODE 21: Psychedelics and Mental Health: Hope, Hype, and the Science

Transcript

WHAT THE HAL? PODCAST 2.0 – EPISODE 21: Psychedelics and Mental Health: Hope, Hype, and the Science · What the Hal?? 2.0

• 0:00
  Psychedelics are moving from the fringes of medicine into serious scientific and regulatory conversations about treating mental health conditions.
• 0:08
  I'm Hal Eisner, along with also Ramona Nadir Lowry, and this is what the Hell.
• 0:15
  Smart, fresh, and uplifting.
• 0:21
  We've got the stories that make you want to say, what the hell.
• 0:27
  A recent executive order is opening up research on psychedelics and treating mental illness.
• 0:34
  Today we're talking with Dr.
• 0:35
  Michael White, distinguished professor and Chair of Pharmacy practice at the UConn School of Pharmacy.
• 0:42
  That's a handful.
• 0:43
  He'll help us unpack the latest federal developments, tell us what the research really says.
• 0:48
  Yeah, there's a lot to go over.
• 0:50
  First of all, welcome, Dr.
• 0:52
  White.
• 0:52
  Thank you so much for joining us.
• 0:55
  I'm sure you get a lot of jokes from people who don't know a lot about how psychedelics are being applied to mental health these days.
• 1:05
  Everyone has their own opinions and ideas of what it means to be on psychedelics, but they are having a serious impact on people who are trying to better their mental health situations.
• 1:18
  What are we talking about, first of all, when we talk about psychedelics?
• 1:22
  Yes.
• 1:23
  There's a lot of different types of psychedelics, and I think that's important for people to understand.
• 1:29
  What we're probably going to find as more clinical trial evidence comes out, is that some are better suited for certain ailments than others.
• 1:41
  Right.
• 1:41
  But each one, in their own way, seems like they have some place in the treatment of at least some mental health disorders.
• 1:50
  So let's start with the ones that are FDA approved, and those are the dissociatives.
• 1:55
  So the dissociatives would be ketamine and esketamine.
• 2:00
  So how does a dissociative work?
• 2:03
  A dissociative works kind of like when your computer is on the fritz and you call the IT guy, Right.
• 2:09
  And you say, you know, my computer's having all these issues.
• 2:13
  And they say, well, have you tried turning it off and turning it on again?
• 2:17
  Right.
• 2:17
  That's what the dissociatives end up doing.
• 2:20
  One of the great things about the dissociatives is that you can receive benefits very, very quickly after you're dosing those products, like within hours.
• 2:34
  Right.
• 2:34
  Or a day, rather than if you had depression or you have, you know, another mental health issue, and you're using, like, an ssri, like Zoloft or Paxil, you might have to wait several weeks in order for you to
• 2:50
  start getting the effects and maybe, you know, a couple of months before you really.
• 2:56
  The good effects that you have with, with that therapy, the dissociatives may not last as long, but it may give you some more immediate benefits.
• 3:05
  Now, we know the dissociatives are not free of risk, right?
• 3:08
  Matthew Perry can tell you that, because, you know, when you turn it off and you're in a body of water, you may drown before it turns back on and you're able to do something about that.
• 3:20
  The second class is the classical psychedelics.
• 3:23
  So these are the ones like the hallucinogenic mushrooms, the LSDs, the DMTs that, you know, people talk about.
• 3:30
  These are the ones where, you know, you may get to see your spirit animal, you may get to talk to Jesus.
• 3:35
  You have, you know, the colorful psychedelic type experiences.
• 3:40
  So these drugs seem to work because people who end up having things like depression, more and more of their blood flow is going specifically to a place in your brain called the amygdala.
• 3:54
  And the amygdala is like this little brain pouch that's down there in the bottom.
• 3:58
  And it seems like it is a reservoir for bad or sad memories, right?
• 4:05
  So even though you had this whole world worth of experience and your brain is filled with all of these memories, people become more and more focused and they have more and more blood flow that goes into this one
• 4:18
  area that creates this reaction loop where you go through certain memories at a much greater ability than you have with some of the others.
• 4:28
  So when you take a classical psychedelic, the idea is that you're lighting up the entirety of your brain.
• 4:34
  You're having a hallucinogenic experience.
• 4:38
  And then on the flip side, when you come out of that experience, your brain has now been more able to go through and access the totality of all of the different parts of your brain and all of those
• 4:53
  memories that can, that can help you make, make a change.
• 4:58
  The ibogas, which, you know, ibogaine and nor ibogaine is like the, the Joe Rogan drug of, of choice, right?
• 5:10
  For the psychedelics, it works a little bit like the dissociatives and a little bit like the classical psychedelics.
• 5:17
  And then the last class is called the intactogens.
• 5:20
  So the intactogens may make you feel like you could feel the music a little bit more.
• 5:25
  It may cause a little bit of, you know, coloration and, you know, but it doesn't really give you a traditional psychedelic type experience.
• 5:35
  But what it does is it causes this big outflow of oxytocin and serotonin.
• 5:41
  So the serotonin makes you feel better, and the oxytocin Is the same chemical that's released when a pregnant woman gives birth to the baby, where you feel like you and this baby have this really, really special bond, even
• 5:55
  though the baby is just, you know, this lump that's looking at you and demanding that you do what it wants for the next three months with no sleep.
• 6:03
  Right.
• 6:03
  And all these interruptions, you believe that you have this really special relationship because of that oxytocin.
• 6:10
  So it's great for survival of the species.
• 6:12
  But you can get that with mdma.
• 6:15
  And this drug is mostly being used for post traumatic stress disorder, where somebody has visualized or experienced something that was so horrible that their brain has shut away some of those memories in the deep recesses of the mind.
• 6:30
  You try to go to those places and get those memories, to talk about it with your therapist, to work through it.
• 6:36
  But it causes panic attacks, severe anxiety when you try to access those memories.
• 6:41
  If you do it along with mdma, they've found that it helps to enhance the effectiveness of the psychotherapy that you're receiving, because it does seem a little like a surreal environment.
• 6:56
  And you really, really trust your therapist because of the oxytocin.
• 7:00
  And the serotonin is helping to raise your overall mood.
• 7:03
  So people have been able to access those memories like they hadn't been able to before.
• 7:08
  And then afterwards, you work without MDMA with your psychotherapist to work through them.
• 7:14
  And some of those people have finally been able to get over some of that trauma.
• 7:18
  Let's get back to my childhood.
• 7:20
  We're talking, you know, a long time ago on a planet far, far away.
• 7:23
  And during that time, psychedelics were, you know, black lights and, you know, neon and, you know, pot and all kinds of things in the 60s that, you know, we never dreamed of legalizing during our lifetimes.
• 7:39
  And here we are.
• 7:40
  We have, of course, here in California, we have recreational marijuana, we have medicinal marijuana.
• 7:46
  It's popping up more and more, and it's in the discussion for federal approval.
• 7:50
  But what has moved us to mushrooms, psilocybin, to the things that we're talking about today and trying to find a route for that.
• 8:01
  What's moved us in that direction?
• 8:02
  We've seen the president put out an executive order to expand on moving it down the fast track.
• 8:10
  What's your take?
• 8:11
  Yeah, so in the 60s, there were some studies that were starting to be done that had looked at things like alcohol use disorder, that had looked at things like for anxiety and depression, some for trauma.
• 8:28
  But what happened is that, you know, along with reefer madness and you know, all of that, you know, backlash against, you know, those products and you know, with the crazy things that people were seeing that people on psychedelics
• 8:45
  were, were doing.
• 8:46
  The people who were experiencing really bad trips, you know, that ended up getting reported or that ended up causing them trauma, even though it was based on something that wasn't actually occurring in reality had scared people.
• 9:01
  And they ended up passing laws making all of those products Schedule 1.
• 9:05
  And once they hit Schedule 1 designation, they weren't able to be researched anymore.
• 9:12
  So a lot of those studies ended up getting shut down in the United States.
• 9:15
  So for mdma, the first studies were actually conducted outside the United States in places like, like Israel and then other countries.
• 9:26
  And then it started, you know, where people were looking at and taking this information to the US Government and saying, hey, we should also be doing some of that research here, look at what's happening overseas.
• 9:38
  And they made a carve out that allowed them to be able to do research and to use those products.
• 9:44
  So then, you know, from that point on, we've seen that a lot of that information is starting to come out and the information is very positive.
• 9:54
  But the big difference is, right, that all of the these things are all being done in a very carefully controlled environment, right?
• 10:03
  So not your parents basement, right?
• 10:06
  Not out when you're walking on the street, because you know what these experiences are like when you're talking like psilocybin or mdma, you go into a place and then you stay there for six to eight hours.
• 10:20
  So they're sure that the effects of the drug is outside of your body.
• 10:24
  If you're looking at ibogaine, you may have to be in a facility for 72 hours afterwards until they're sure that the drug is out of your system.
• 10:33
  They're playing calming music.
• 10:35
  You have a guide or a psychotherapist that's there with you, that helps keep you on track and helps to stop it from spiraling out into a bad type trip, right?
• 10:46
  But if you're doing it at home, let's say that you're there at home and you're alone and you're doing it and you're talking to Jesus and you got, you know, elephants are dancing around and everything is great.
• 10:56
  And then somebody comes and they knock on your door and then they run away.
• 10:59
  Just a neighbor, neighborhood kid, right?
• 11:01
  They ring the doorbell and then they dash away.
• 11:03
  You open the door and suddenly you could have a change in your psychedelic experience where one that was very positive suddenly changes and turns into something that could be terrifying and Then you're running out into traffic, you're drowning
• 11:18
  in a pool, right?
• 11:19
  You're doing something that is.
• 11:22
  That's there.
• 11:23
  So they try to put guardrails around the psychedelic experiences that people are having and then combining them with other form of therapy to make sure that you're putting those things in the right context.
• 11:37
  Well, so my mom was right.
• 11:38
  You'll stare into the sun and go blind.
• 11:40
  Right?
• 11:43
  So we.
• 11:44
  You know, I had.
• 11:44
  I had an.
• 11:45
  I had an experience.
• 11:46
  Sorry.
• 11:47
  I had an experience.
• 11:48
  Got hit by a drunk driver a couple years ago, ended up in the hospital, and they.
• 11:52
  They had me on.
• 11:53
  I want to say morphine.
• 11:55
  I didn't think it's anything more than that.
• 11:56
  And all of a sudden, the room started to move, and there were.
• 12:00
  There were blue lines, wavy lines on the.
• 12:02
  On the walls, and pink lines on the ceilings.
• 12:06
  And I was like.
• 12:08
  I couldn't stand it.
• 12:10
  It was like a bad trip.
• 12:13
  And is that kind of what you're talking about?
• 12:14
  I mean, things can spiral out of control and.
• 12:17
  And you can get to a point where it's like, whoa, you know, somebody needs to intervene.
• 12:22
  Yeah.
• 12:23
  You know, so I think it is.
• 12:25
  You know, some people would look at that same experience and they'd be like, wow, that was fantastic.
• 12:29
  I should try to get that again.
• 12:30
  Right?
• 12:31
  People don't like the feeling of being out of control, and they want to be, you know, in that way.
• 12:40
  But yes, you know, when it.
• 12:41
  When it moves past the point that.
• 12:43
  That you feel, you know, comfortable with it, it could be bad, but it could also be much worse, where you're having an experience where you're talking to Jesus, but then Jesus turns into somebody with a knife, right?
• 12:54
  Or it turns into a monster, and then the monster is chasing you, right?
• 12:58
  And then you're fleeing for your life.
• 13:00
  And those things can change on a dime, right?
• 13:04
  And that's why, you know, you really need to be monitored and you really need to be kept safe during that experience because you're vulnerable.
• 13:13
  Mdma.
• 13:14
  When I was first looking at mdma, I was, you know, trying to review the available evidence on the product for harms, because people were using it at raves, and I think the main reason they use it at raves
• 13:28
  is because the music is so bad that you need something, right, that's going to help it become an enjoyable experience.
• 13:35
  But, you know, with the mdma, what they were finding is, you know, that some people were overheating because they felt like they had this boundless energy, and then they were hurting their.
• 13:46
  Their muscles, you know, they were doing things that could end up, you know, hurting their kidneys as a result of, of taking those products because they were drinking regular, you know, amounts, and then they were breaking down some
• 13:58
  of their, some of their muscle.
• 14:01
  But the oxytocin effect was making people go with people places that they never would have done if they didn't have, you know, drug induced trust in those other people.
• 14:15
  So physical assaults and sexual assaults and other issues ended up resulting.
• 14:20
  So when you're taking these products, you need to understand that you're very vulnerable.
• 14:24
  Right.
• 14:25
  And that you need to be in a place with people that you can trust.
• 14:30
  Yeah.
• 14:31
  Now we talk about psychedelics used for mental health benefits as if, you know, mental health was just one big glob.
• 14:42
  But I mean, there's a million different ways that issues can manifest.
• 14:47
  Everything from anxiety and depression all the way to schizophrenia.
• 14:52
  What are we looking at in terms of these psychedelics as far as who they can help and how they can help?
• 15:00
  Yeah.
• 15:00
  So the first thing is never, ever use a psychedelic if you have schizophrenia or you have diseases or disorders where you could be experiencing delusions.
• 15:10
  So people who have Alzheimer's, people who have vascular dementia.
• 15:15
  Right.
• 15:16
  Because they have tried it in some of the studies and they find out that it doesn't work.
• 15:21
  And in some cases it could make things worse.
• 15:24
  Worse.
• 15:25
  Right.
• 15:25
  So your ability to be able to discern reality from fantasy is a big problem that the people have.
• 15:33
  And if you introduce additional fantasy, that becomes a specific, you know, negative type effect.
• 15:44
  But for the others, right, There is some potential for, for benefit.
• 15:49
  And so some of the big advantages that they're seeing with psychedelics is that you don't need to take a therapy day in order for it to be effective.
• 15:59
  Right.
• 15:59
  It may be something that you have two or maybe three sessions, or maybe you have one session every three or four months.
• 16:07
  Right.
• 16:07
  Depending on the, on the drug and the disease state.
• 16:10
  And they're still working out what some of those regimens are that are going to, that are going to be the best.
• 16:17
  But, you know, the idea that you could take something, right.
• 16:21
  And then you could move past it is important.
• 16:25
  And so, you know, one of the things that we looked at was in people who had anxiety and depression that was related to a diagnosis of a very severe or terminal illness, what they found was that it was
• 16:43
  actually extremely cathartic in order to be able to have that experience.
• 16:48
  Right.
• 16:49
  And so, like people who've experienced, you know, other forms of trauma, learning that you have a very severe diagnosis is also extremely traumatic.
• 17:02
  And they know that the traditional anti anxiety and antidepressant drugs for people who have trauma that also has anxiety and depression don't work as well as when people have other forms of anxiety or depression.
• 17:15
  And it's probably because they're not actually dealing with the core issue, which is the trauma itself.
• 17:22
  And that when they had the MDMA sessions or they had some of the psychedelic sessions that they were having, they were able to actually see that traumatic event, but in a different way, see it in terms of a
• 17:37
  greater context, and they're more willing, I think, to forgive themselves or understand that it's not a personal fault.
• 17:46
  You know, that is just something that ended up happening and that was the first time that it allowed them to truly be able to move past that.
• 17:54
  Right.
• 17:54
  So when you think about one of those traumatic events, you find out that you have severe cancer and maybe you're going to make it through, or maybe you don't.
• 18:02
  You want to be strong for your family, you want to be strong for other people.
• 18:06
  So you push down those emotions, you don't deal with all of them.
• 18:10
  And you think that since you're surviving day to day, that that's okay, but over the course of time, that may lead to anxiety and depression.
• 18:19
  Right.
• 18:19
  And if you can actually go back and, and truly grieve for what it was that you experienced, you can take the first step towards being able to move past it.
• 18:32
  And some people have the ability to do that just with counseling or just by themselves, but other people don't seem like they have that ability.
• 18:39
  And this is another way of being able to, to get around your normal defenses to getting that kind of access.
• 18:49
  Sounds like there's a lot of different ways to approach using psychedelics.
• 18:56
  You obviously just pointed out it, it is a certain kind of trauma that this therapy works on versus others.
• 19:04
  It just seems like there's a lot of different criteria for different levels of psychedelics that could help people.
• 19:12
  Because I've done stories in the past when I was still working in TV news with military veterans who have tried everything under the sun with cognitive behavioral therapy and, and, you know, you name it.
• 19:30
  And many of them throughout my career have told me that psychedelics or psilocybin or whatever form of psychedelic that they were using was really the only thing that helped them.
• 19:44
  Some of them even claimed that saved their lives.
• 19:48
  Being able to get past trauma, PTSD from what they witnessed and survived at war or in combat, you know, in the military.
• 19:59
  So how is that being figured out?
• 20:03
  As we watch, you know, the administration Start to open their minds about using this kind of therapy for mental health and other things.
• 20:13
  How is that broken down for people to make the right decisions on?
• 20:19
  Yeah.
• 20:19
  So, I mean, what we're ultimately going to find, I think, is that, you know, when you talk about psychedelics, people are putting them all into one bucket.
• 20:31
  Right?
• 20:31
  But that's why we tried to start to say that there are different ones and that you may not respond to one, but you may end up responding to another.
• 20:41
  So it's just other tools that are in the toolbox for people, right.
• 20:45
  That if they're not responding to the standard, traditional options, it actually gives them something else that may be of benefit.
• 20:54
  Right.
• 20:55
  So let me give you an example.
• 20:56
  Somebody comes in and they have really severe depression and they're thinking about committing suicide, right.
• 21:03
  Or, you know, they.
• 21:04
  They are just so depressed they didn't have the ability to function.
• 21:09
  Right.
• 21:09
  Is there anything that you can do other than institutionalizing them and then giving them psychotherapy and then waiting for the multiple weeks to go by for the antidepressant drugs to be able to work?
• 21:22
  Well, the answer used to only be electroconvulsive therapies that they would bring you in, right.
• 21:28
  And then they would shock your brain, and you would literally turn off your brain, and then it would turn back on again.
• 21:35
  Right.
• 21:35
  And then people were reporting relief from those therapies.
• 21:40
  And so, you know, the idea of using ketamine, right.
• 21:47
  Ended up coming from that notion that you could do something similar, but you could do it without shocking the person's brain and then looking at it.
• 21:56
  Right.
• 21:56
  So they did that as a clinical trial, and then what they found was that electroconvulsive therapy was still better.
• 22:03
  And that surprised some people.
• 22:04
  For other people, it didn't surprise them, but they both seemed like they were effective.
• 22:09
  But electroconvulsive therapy was more effective, but it wasn't effective in 100% of the people, or at least in a magnitude that would be optimal for those people.
• 22:19
  And this is where it got really interesting.
• 22:21
  So one of the things that we looked at when we went back through those studies that were conducted is that in order to get electroconvulsive therapy, you have to be under anesthesia first, because when you get electroconvulsive therapy,
• 22:36
  it hurts.
• 22:36
  Kind of like, let's say somebody was shocking your brain with electricity, okay?
• 22:42
  So you needed to be on anesthesia or it would have been incredibly painful and traumatic in its own.
• 22:48
  Right.
• 22:49
  Well, ketamine is used and was FDA approved as an anesthetic.
• 22:55
  Agent.
• 22:56
  Right.
• 22:56
  So people could use propofol, they could use thiapentone, or they could use ketamine.
• 23:02
  So we went back through and we looked at the studies where people had used ketamine along with the ECT versus any of those other anesthetic drugs along with ECT to see whether or not there was a combination effect
• 23:17
  or whether you got all the benefits from the ECT and that the ketamine didn't do anything.
• 23:21
  And what we found was that you actually got better benefits if you had ketamine along with your electroconvulsive therapy than if you use another anesthetic agent.
• 23:31
  However, you did have a lot more side effects.
• 23:35
  Right.
• 23:35
  So it isn't something that everyone, when they come in, should get ketamine along with their ect.
• 23:41
  They probably should try it without it.
• 23:43
  But if you didn't get enough of a benefit when you come back for your next therapy with ect, using it with ketamine may give you better effects or longer lasting effects than you would have before.
• 23:55
  But both of those therapies are not forever therapies.
• 23:59
  Those are just therapies that are tiding you over so that you're not suicidal, that your depression isn't that bad while you're waiting for those other options to provide benefit.
• 24:09
  And one of the things in the future may not just be SSRIs or SNRIs, you know, and psychotherapy.
• 24:17
  It could be another psychedelic therapy that may take a little longer for it to start to work, but may give you several months worth of benefit before you need to come in and get another treatment.
• 24:32
  So for somebody who's watching this or listening to this and they're popping up question marks in their minds about, well, that might be good for me.
• 24:44
  This isn't something you can go to your local dispensary and get.
• 24:47
  This is something that's under strict control right now.
• 24:50
  It's.
• 24:50
  It's being exper.
• 24:51
  Is being studied.
• 24:53
  Well, what do you tell those folks?
• 24:54
  What's the takeaway?
• 24:56
  That we're moving in the direction to where there's light at the end of the tunnel?
• 25:00
  Yeah.
• 25:01
  So lsd.
• 25:02
  Right.
• 25:03
  A form of lsd, had just finished coming out with a phase three clinical trial versus placebo for people that have depression.
• 25:12
  And they ended up showing that, you know, the effects were, were pretty robust.
• 25:18
  The onset of effects were faster than what you would normally see with, with SSRIs.
• 25:24
  And that is the last phase before you submit for FDA approval.
• 25:30
  MDMA has already had phase 3 clinical trials and they have submitted for approval to the fda.
• 25:37
  That was a couple of years ago.
• 25:39
  The FDA turned them down and said they wanted them to do one more valid in order to be able to show whether or not, you know, that effect was, you know, a true effect or it wasn't.
• 25:53
  And we'll talk in a, in a minute about the placebo effect and what the FDA is a bit nervous about.
• 26:00
  But.
• 26:03
  So we have a couple therapies that are right on the doorstep that within the next year or two are going to be re.
• 26:10
  Reviewed by the FDA that ends up, you know, having the possibility of being approved.
• 26:16
  And then we have, you know, things that are kind of in the, in the middle zone that are being studied.
• 26:22
  And then we have some that are just at the starting gate.
• 26:25
  So the ibogaines are at the starting gate.
• 26:27
  The clinical trials there don't have any control groups.
• 26:31
  They're just studying it versus baseline.
• 26:34
  And that's prone to a lot more potential for bias.
• 26:37
  So we have to be a little more skeptical, even though it's promising, be a little more skeptical about those results that at, at this time.
• 26:46
  Right.
• 26:46
  So I do think based on.
• 26:49
  Can I ask one question?
• 26:54
  Sorry, you, you keep mentioning ibogaine and I, I freely admit I'm not up to speed on this stuff.
• 27:00
  Is that something that there's a street name of?
• 27:03
  Is that something that people would be familiar with by a different name?
• 27:08
  So I'm not familiar with ibogaine.
• 27:10
  Yeah, until recently, not a lot of people.
• 27:13
  It wasn't really in the conversation about a lot of people that are, that are scientifically in the field.
• 27:21
  But there's a couple of trials that came out.
• 27:24
  One for traumatic brain injury, Right.
• 27:27
  Which is, you know, football players and other people and veterans who have psychiatric issues, but as a result of brain trauma.
• 27:38
  Right.
• 27:38
  Not because they experienced a traumatic event, but literally having brain trauma that ended up showing some decent effects.
• 27:45
  And there are some studies in substance use disorder that ended up coming out that even though they're very preliminary, small numbers of people and no control groups, the benefits versus baseline have been pretty, have been pretty good.
• 28:03
  And.
• 28:05
  You know, this is the one that, on the Joe Rogan experience, right.
• 28:09
  That, that, you know, he had people that were talking about they had, you know, gone overseas and they had, you know, had some of, you know, this type of therapy and, you know, they believed that it was, that
• 28:21
  it was effective.
• 28:21
  Does he truly believe it's effective or is somebody, you know, paying him for promotional consideration to say that it's effective?
• 28:28
  I don't know.
• 28:29
  Right.
• 28:30
  But you know, that was something that really put it in the national consciousness.
• 28:36
  And he's the one that, that I believe actually, you know, had advocated at where Texas is now, you know, devoting like $50 million to, you know, studying psychedelics.
• 28:48
  And, you know, the present administration is more interested in, in these as a result of that.
• 28:57
  So, you know, we add it to the conversation, even though it's not nearly as far along as the psilocybin from hallucinogenic mushrooms or the MDMA or the LSD that we have a lot them.
• 29:13
  So I world is a world of Alphabet soup, isn't it?
• 29:16
  Yes, I, I know we're going a little longer than we normally do, but this is so incredibly interesting and I think people are, especially with what's happening in the Trump administration right now and their approach to these types
• 29:31
  of, of therapies.
• 29:33
  But I, I'm wondering, like, since you break things down with maybe how certain traumas should be treated, certain ways with certain psychedelics and others should not be, what about things like people who are in the neurodiverse category, who
• 29:51
  are neurodivergent?
• 29:53
  Adhd.
• 29:55
  A lot of people with ADHD suffer with severe anxiety and depression.
• 30:01
  People who are autistic or maybe both suffer from the same things due to a myriad of different reasons.
• 30:10
  Social anxiety, bullying, you know, just things that they've had to experience growing up with.
• 30:16
  Is there any research into how you would approach those types of difficulties with people who are newer, diverse and what they experience versus someone who has physical trauma to the brain, someone who has, you know, trauma from loss,
• 30:35
  that type of thing?
• 30:36
  Yeah, yeah.
• 30:37
  So, you know, right now we don't have good information specifically on those populations.
• 30:43
  And, you know, you would approach it very much the same if it's, you know, one step to the left of information that you're also, you're already pretty confident about.
• 30:52
  You redo that type of study, you just change the population, and then if you get effects that are less robust or they don't last as long, right.
• 31:02
  You start to build a regimen that ends up being as good as it is.
• 31:07
  Or maybe there's something about that specific disease or disorder, Right.
• 31:12
  That makes it be different and maybe it won't be amenable to, to that type of therapy.
• 31:19
  So right now, you know, they're trying.
• 31:20
  To diagnostic though, like.
• 31:22
  I'm sorry to interrupt, but what if it's more like really just diagnostic, like somebody just, you know, was, was the victim of constant bullying because they were quote, unquote, different.
• 31:32
  They didn't know why they were different, that type of thing.
• 31:36
  What if it's just taking them out of that situation and, you know, do you try those things first before you, you move on to those kinds of therapies?
• 31:46
  Yeah, I mean, I think when it first comes out, the best bet is going to be that you try traditional options first.
• 31:54
  Right.
• 31:54
  If those traditional options are giving you what it is that, that you need and you're getting back your functioning and you're feeling better, then you don't need to explore some of those other options.
• 32:05
  Right.
• 32:06
  But if you fall into a situation where those therapies are not tolerable for you for a variety of different reasons, or they are less than fully effective, or they're completely ineffective, right.
• 32:18
  Then you do have new potential options that you can, that you could look at.
• 32:23
  So, you know, like for the trauma, they've looked at both people who've had sexual trauma, and they've looked at people who've had military trauma, and they've looked at trauma for first responders of police and firemen who've seen grisly,
• 32:36
  horrible, you know, things.
• 32:38
  And the effects seem to be very similar.
• 32:41
  So, you know, the chances are if you have trauma from other things, that you can hold a lot of promise or a lot of hope, right.
• 32:50
  That, you know, you'll end up getting similar types of, of effects because it's been working in a lot of different traumas.
• 32:58
  So one additional trauma, right.
• 33:00
  Would probably work, but there's probably going to be a couple that they're going to do the studies.
• 33:05
  They're going to be like, oh, well, I guess this is an exception.
• 33:08
  And then they need to understand why.
• 33:10
  Right.
• 33:10
  And then science continues to fill its way back in, you know, on the, on the backside.
• 33:17
  And there's a lot of researchers who are not necessarily pioneers, who are out on the avant garde doing stuff, but they do great quality research and they have access to different populations and they can be the ones that
• 33:30
  go in and fill in the blanks.
• 33:32
  Right.
• 33:32
  And then do the, the cleanup work to really help people understand, you know, where those boundaries are.
• 33:40
  Well, let me, let me just sort of wrap us up here with a couple of thoughts.
• 33:44
  One, what is a website where people can get more information?
• 33:49
  Do you have one, for instance?
• 33:50
  And then the other question really is, what is, what is the bottom line here?
• 33:56
  Yeah.
• 33:56
  So the bottom line is that the main reason the FDA continues to have some skepticism is because it's impossible to truly do a placebo control.
• 34:08
  Right.
• 34:08
  So if they bring you in and they give you A psychedelic.
• 34:11
  And then the elephants are dancing and you're talking to Jesus, you know, and the people that are administering it, who are writing down the.
• 34:19
  The results and doing the things, also know, right.
• 34:23
  If you get the placebo, even if they try to give you, you know, something other than an inert placebo, so they tried to give people niacin, right?
• 34:31
  Well, niacin can make you have a flushing sensation, make you feel warm, right?
• 34:36
  But if you're taking niacin and you're talking to Jesus, you got some other underlying problems that you need to be dealing with.
• 34:46
  So, you know, the FDA is going to have to.
• 34:48
  It's going to have to reconcile with that and it's going to be different.
• 34:53
  But I don't think that it should be, you know, something that.
• 34:56
  Because you can't do a true placebo control, that these therapies could never be approved.
• 35:02
  Right.
• 35:03
  And so what they've looked at is that it doesn't seem like the effect of the drugs are being overstated versus baseline, but it does seem like the placebo effects are a lot less when you're talking about psychedelics than
• 35:16
  when you were using placebo and SSRI studies.
• 35:20
  So what I'm guessing that they're going to do, and they should be able to have the ability to do it now, is to create a correction factor, right.
• 35:27
  Where they've looked at it, and based on the correction factor that I think we're looking at, it ends up putting these drugs along the lines for depression of what you would see with SSRIs.
• 35:39
  Right.
• 35:39
  So it isn't that these drugs are so much better than SSRIs, even though the studies would look like it is based on the difference between the drug and placebo.
• 35:49
  But they definitely seem like they are good enough to be similarly effective to the ssri.
• 35:54
  And in a lot of cases, they're working in people who have already failed ssri SRI therapy, Right.
• 36:00
  So it's a completely different option.
• 36:03
  So I think once the FDA can get moved past that and be able to see more broadly, maybe they need a psychedelic experience to help them expand their mind, Right.
• 36:13
  To be able to see beyond the traditional clinical trial risks and paradigms, you know, that those therapies will start moving in, people will have new potential option.
• 36:25
  And we.
• 36:25
  We certainly do have a giant gap when it comes to.
• 36:30
  When it comes to that.
• 36:31
  I don't know of any single website that would have.
• 36:34
  That would have really good information.
• 36:36
  But, you know, if people did want to, you know, reach out to me, go on the University of Connecticut website and look me up, send me an email.
• 36:44
  I'm happy to send you any of the information that, that I have.
• 36:48
  Yale School of Medicine has a number of different researchers in this area, and they probably have the greatest expertise and they're running a wide variety of clinical trials and other people all around the country.
• 37:00
  So even if they don't have an option available that's FDA approved, you may be able to get into a clinical trial and at least get a 50% chance of getting in the active group and getting one of those
• 37:09
  therapies while you're, while you're waiting.
• 37:13
  It's also phenomenal.
• 37:15
  I have one last question.
• 37:16
  Yeah.
• 37:17
  Do you think that after generations of being told that, you know, these drugs are evil, they'll mess up your mind, you'll, you'll jump off a bridge.
• 37:28
  What do you think is the public perception of this?
• 37:31
  And is that something that needs to be overcome in order to get these people into clinical trials, to get people to trust that this could benefit them?
• 37:41
  I think it's going to be generational, right?
• 37:43
  So people that don't have a lot of memory of the, you know, late 1960s and early to mid-1970s are going to have a different impression than older people.
• 37:54
  But I can tell you that, you know, the studies of people who had, you know, terminal illnesses, that is going to be a big potential market.
• 38:05
  And there's a lot of people who right now are out there suffering, they've made it through cancer, but they still can't seem to turn it back on and, you know, to get back to, to normalcy because they haven't
• 38:16
  dealt with all of those issues and the fear and everything else that was associated with, with, with having that.
• 38:21
  And, you know, so I think the clinicians that are looking at the people and helping to triage them are going to have to understand that there may be some of this resistance and, you know, just be able to,
• 38:32
  to talk to people.
• 38:33
  But, you know, I, I think the big takeaway is always going to be that, you know, a lot of these substances can have potential risks, and you have to understand those potential risks.
• 38:44
  Like during the psychedelic sessions, the people's blood pressure does increase quite a bit because you're having this cathartic experience and you're experiencing things that you've been trying to push away.
• 38:55
  And there are some potential risks that are associated with, you can't get up and exercise, you can't do other things.
• 39:01
  But we know what some of those risks are, and they've developed regimens in order to help, to support people and be able to help to keep them safe as they're going through, you know, those types of, of sessions.
• 39:15
  Now, if you go down to Mexico and you go to a clinic right now and you try to get that therapy, I don't know what kind of safeguards that they have or what they're going to do in order
• 39:25
  to be able to protect you.
• 39:26
  Maybe it's great, maybe it's not.
• 39:27
  Maybe you're going to go down and you could be sexually assaulted and they take your wallet, right?
• 39:32
  Or maybe everything is, is perfectly fine, but you got to be really, really careful, right?
• 39:37
  Especially before you go to a foreign country where you really have no inherent rights and then you pay people to do things where you're, you're mentally going to be very, very compromised, right?
• 39:51
  And then you're going to come out of it and you're gonna have to deal is that, that you had.
• 39:56
  I mean, some people may be so desperate that they don't have anything else that they can do.
• 40:00
  And, you know, maybe the risk is worth the potential for benefit.
• 40:03
  But do your homework and, you know, really try to vet that and don't take it, don't take it for granted that everything is going to, everything's going to be fine and everything's going to be great, you know, because
• 40:19
  you, you are taking on some inherent risks.
• 40:22
  Dr.
• 40:22
  Michael White, thank you.
• 40:24
  Thank you so much.
• 40:24
  I mean, there's so much information out there and we're obviously going to have to have you back here to keep, you know, talking about it and educating us on it.
• 40:33
  Yeah, it will be interesting to follow.
• 40:35
  Thank you so much.
• 40:37
  And that's what the hell 2.0.
• 40:39
  I'm Hal Eisner along with Elsa Ramon and Hunter Lowery.
• 40:42
  This podcast is produced by Hunter.
• 40:45
  Jamie Knapp is our technical director editor and he handles all of the post production.
• 40:50
  Our original theme music is composed by Stuart Pearson.
• 40:54
  Earlier versions of the podcast were produced at the studios of Fox 11 in Los Angeles and are available through the link in our show Notes.
• 41:03
  This version of the podcast is available on YouTube and wherever you listen to podcasts.
• 41:08
  And what the Hell 2.0 is produced in Los Angeles, California.