In this episode, Kyle interviews C.J. Spotswood, PMHNP-BC: author and board-certified psychiatric-mental health nurse practitioner currently enrolled in CIIS’ Psychedelic-Assisted Therapies and Research certificate program.
He talks about his introduction to psychedelics and his first patient immediately asking him about microdosing; why he changed his mind on microdosing and why he wrote his book; microdosing studies he’s most excited about; the terms: treatment-resistant depression, risk reduction, and flight nurses; Irving Kirsch’s work uncovering the bad science of research studies; the need for physicians to know enough about psychedelics to be able to meet their patients where they are; the importance of group work; and how, while they’re already so well-versed in caring for patients, using nurses to their full licensure could be the answer to the quickly growing psychedelics and scalability problem.
Notable Quotes
“When you look at the early research into the 50s in the 60s; they were doing microdosing research, they just didn’t have a title for it. They thought they were using placebo levels but they were actually looking for threshold levels; things like that. Really, it was what by today’s standards [would be an] amount that we would consider as a microdose.”
“I don’t like the term [treatment-resistant depression] when we use that because if you’re using [it] when you’re looking at the standard medications like SSRIs [or] SNRIs, they’re basically all the same. …So when you say that someone’s ‘treatment-resistant’ for three medications, four medications that are all basically working the same pathways and in the same amount; is that truly treatment-resistant, or are we just trying the same thing with just different medications, whereas doing microdosing is a different pathway [and] is a different approach?”
“My first patient I ever saw as a new clinician, like, literally my first patient: I come in and I’m starting to talk to them for the first interview and I got to the point and I’m asking them: ‘Where are we going, what do you need?’ and they said to me, ‘Do you know anything about microdosing?’ …I said to them, I go, ‘Yeah, I know a little bit.’ …So I asked her what she knew, and she knew quite a bit. And she goes, ‘What do you know?’ and I kind of just said to her: ‘I don’t really know how to put this, [but I] wrote a book on it and it’s going to be coming out next year.’ …It reinforced my feeling [that] I’m doing the right thing: this career suicide I’ve thought of, going into working with psychedelics and being open and talking about it, hearing my first patients talking about it – it’s got to be serendipity.”
In this episode, Joe interviews New York Times best-selling author, pioneer in the field of integrative medicine, and overall legend in the health and wellness space: Andrew Weil, M.D.
As the author of 15 books on health and wellbeing and a regular in the media, you’re probably familiar with Weil and some of his work, but you may not know of his more psychedelic connections: a long history of experimentation, leading Paul Stamets in the direction of functional mushrooms, co-writing one of the first papers about the Sonoran Desert toad and 5-MeO-DMT with Wade Davis, and being a strong advocate for psychedelics being the spark that could spur a global change in consciousness.
He talks about the connection between true osteopathy and integrative medicine; why the traditional Chinese medicine approach to mushrooms made so much sense to him; academia’s lost interest in pharmacognosy; how psychedelics may help people with autoimmune diseases; turmeric (he largely popularized it as an anti-inflammatory supplement); matcha; why we should be studying the placebo effect much more than we are; humanity’s innate drive to experience altered states of consciousness; and why a big part of the psychedelic revolution is so many people starting to believe in panpsychism.
We’re pumped to finally have him on the podcast, and we’re even more excited that he’s spreading the gospel of psychedelics to a health and wellness crowd who may still be a bit apprehensive about something they were taught to fear.
Notable Quotes
“I’m tremendously interested in [psychedelics’] potential at the moment for therapeutic use and ceremonial use, and actually, if I think about it, I would say I’m really interested in the possibility that they can save the world. I don’t see many other things out there that can do that.”
“I don’t know anything else that is so readily available and that, with at least some attention to how you do them, has such a potential to change how people interpret their perceptions and interpret their experience of the world around them. I’ve seen just such dramatic changes in people and in myself as a result of psychedelic experience. …My first book, The Natural Mind, that was published in 1972, said that only a global change in consciousness could really transform our world, and I think that the psychedelic revolution has the potential to do that.”
“I think the placebo response is the meat of medicine. That’s what you want to try to make happen. It’s pure healing response from within, mediated by the mind and unmixed up with the direct effects of treatment. …The commonest way I hear that word used is things like, ‘How do you know that’s not just the placebo response?’ or ‘We have to rule out the placebo response.’ I mean, we should be ruling it in. You want to make it happen more of the time.”
“Human beings have an innate drive to experience altered states of consciousness, not necessarily through the use of drugs (although drugs are a very convenient way to do it). One of the examples I gave was of kids learning to spin until they get dizzy and fall over and the world changed, and that’s universal as far as I can tell, in all cultures. So I got a lot of crap from people for saying that there was an innate drive toward altered states of consciousness, but I absolutely believe that, and I think that a part of the drug problem in our culture has been our failure to acknowledge that and teach people safe and better ways of satisfying it.”
In discussing these articles, much is covered: methylation and genetic memory; addiction; gut biome; cesarian births; how much inequality is built into the “psychedelic renaissance” due to it primarily evolving out of inherently unequal Western societal paradigms; permaculture; new ways to be together; Burning Man; the concept of the nuclear family; the power in working with your hands; creativity; harm reduction and the lack of readily available drug testing kits; and more.
I had years of experience in cold water training from my Aikido career, but as my depression had increasingly grown worse, I developed a severe cold intolerance. It had become painful to stand under the shower, with my scalp almost spasming in contraction, when I used to be able to stand in late winter melt-water waterfalls and rivers with ease. But post-dosing, my cold tolerance came roaring back; allowing me to stand under a cold shower for minutes at a time with no numbness and no pain – it was almost like it was happening to someone else or there was a micro-force field on the surface of my skin. I found myself having to leave the shower because I just had other things to do. Cold water tolerance is a gold-standard for measuring pain response in clinical trials, and in fact, later that year, the Department of Psychopharmacology at Maastricht University, sponsored by the Beckley Foundation, conducted the first LSD and pain study in nearly 50 years, showing that low-dose LSD significantly increased cold water tolerance without interfering with day-to-day activities.
I had been known for my mobility and flexibility throughout my career and my ability to train others to achieve the same results, but mine had been compromised for a good while at this point. But the day after my session, I was able to resume positions that I hadn’t been able to comfortably acquire in months, if not years. Movement now felt smooth and effortless once again, and I swear there was even improvement in the tissue quality in areas that had become “crunchy.”
There was also a significant change in my inflammatory baseline. Depression is seen as a disorder that also includes fairly significant neurological inflammation and is often bi-directional with chronic pain, but many of the same receptors that psilocybin operates on are also contained within the gastrointestinal tract, and mine had altered sensation for a month afterward. I believe my systemic inflammation significantly improved during that period because within three months of my dosing, I reacquired personal training records that had become elusive, and by summer, I passed those PRs and set new ones. I also felt incredibly less “puffy.” Accidentally banging into something didn’t hurt anymore and persistent joint aches and lack of motor activation disappeared. There were additional improvements in neurological issues that will be described in a future case study, but that was just as immediate and impactful.
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Lockdown Leads to the Lowdown on the First Psychedelic Pain Studies
Within the training and recovery world, patients and trainees can loosely be categorized as super, normal, non, and negative responders. I had stopped being responsive to both training and rehabilitation efforts at the peak of my depression, and was entering negative-responder territory, which was severely distressing. Fascinatingly, I now seem to be trending somewhere between a normal and high responder. I began proclaiming to the researchers at NYU that psychedelics were going to completely change chronic pain treatment within five years. And I also had a secret; the day after my dosing session, I had what’s referred to as a huge download: I realized that if you could consider things like depression, PTSD, and severe anxiety to be nociplastic outputs of the Central Nervous System (CNS) that causes iterative rumination (a.k.a. looping maladaptive outputs), that was no different from the looping maladaptive outputs that characterize chronic pain – the neurology of which I had been studying for years at that point. Due to the extreme visual qualities of the psychedelic experience and the rapidity of my own remission, I saw, in a flash, that since psilocybin was an impact booster for neuroplasticity, it would enhance the impact of mirror box therapy for phantom limb pain or likely any other neuromodulation.
“Remapping” is the term describing the tactic of using visual or other sensory receptor inputs to modify and change nociplastic or noxious/painful outputs of the brain. As this is part of the Z-Health process, I had been introduced to the concept of mirror box therapy years earlier as part of my certifications, but I thought I had come up with a whole new approach and kept it to myself, barely hinting at what I believed I had uncovered. But, since NYC was locked down and I was unable to work, I had nothing to do but go online and research what had happened to me.
Within two weeks or so, I found an old photocopied English abstract from a 1962 study in Japan, by Kuromaru, et al., using low-dose LSD to treat phantom-limb pain with 50% of its participants going into instant remission by the end of their session, and the authors pointedly declaring that stacking the LSD with movement had a far stronger impact on resolving both phantom limb pain and phantom limb syndrome. Stacking inputs is a common practice within the neuromodulation world for pain treatment, often coupling a weaker input with a stronger one, and I realized that this was what had clearly happened to me while I was in my post-dosing neuroplastic window. It finally felt like I was getting traction again; that drills and exercises were once again effective, and crucially, maintaining their own momentum. I didn’t have to be hypervigilant anymore in my daily routine for these drills to become “sticky.” I also realized that the Kuromaru study had, in fact, been released earlier than the Kast study from 1964 investigating the analgesic properties of LSD for terminal cancer and other painful conditions, which is frequently and incorrectly cited as the first psychedelic pain study. I became aware of other previous psychedelic pain studies, as well as recent ones like Dr. Charles Nichols’ work on the anti-inflammatory properties of psychedelics, and studies involving Dr. Robin Carhart-Harris’ REBUS model and cortical reorganization, which is what happens when a stimulus results in the creation of a new cortical map (essentially a vertical column in the brain cortex consisting of neurons performing specific processes).
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Both of these discoveries are crucial because cortical reorganization (or remapping) and inflammation are key drivers of chronic pain. Conditions like depression and anxiety are characterized by rigid, fixed beliefs or frameworks where the same negative thought loop keeps reoccurring repeatedly, with no amount of incoming contrary information able to alter that belief. It becomes what’s known as a “strong prior” in neurology, becoming a top-down driven process in the CNS, actively suppressing any bottom-up sensory input error correction. The same mechanisms of action occur with chronic pain, where, despite the healing or resolution of an injury; a rigid, fixed pain signal is continually being sent out by the brain as a maladaptive response of the CNS’ protective suite. These are referred to as nociplastic or noxious neurological conditions. The same is true for multiple chronic pain conditions where inflammation causes maladaptive signaling and perceptions, leading to negative structural or nociplastic changes in the peripheral and central nervous system. In psychedelic-assisted psychotherapy, a non-rigid, chaotic state is induced, which allows the cortical landscape to reorganize into a more efficient and positive state.
Landmark Study in Pain and Psychedelics Confirms Insights
I sat speechless for at least five minutes, shaking my head in a feeling of wonder and disbelief, as if the universe itself had just delivered this paper to me. Other than my remission and the pandemic, I had thought of nothing else but the application of how these two approaches could be combined. Of course someone else had invented it well before me; of course they had. I knew that resourceful, capable people had been working on this for a while, and chronic pain is a singular motivator, but it was still astonishing to see my vision so vividly applied and executed.
Check out this podcast with Court and Joe interviewing Dr. Castellanos and Dr. Timothy Furnish of PHRI!
I had learned in 2015 that cluster headaches had been effectively treated with psilocybin for 25 years, and of mirror box therapy a few years before that. I had even blogged about it because people in the rehab and training communities thought that my using visual inputs to treat pain was so weird they called it “voodoo.” But there is a neural hierarchy, and many pain and performance conditions in the body actually have higher-order components within the visual and vestibular systems. That’s often why, no matter how much manual/physio therapy one does, it is often a downstream compensation within the body in order to reconcile perceptual discrepancies between the visual and vestibular system. The visual system lets you assess the surrounding environment and predict any threats that exist within it, and the vestibular system helps you orient within that space, keeping your body in balance so that you might be able to execute any motor actions in response to any perceived threats. If your eyes are telling you the horizon is 5° tilted to the left, but your vestibular system, a.k.a. your inner ear, is telling you that it’s 5° to the right, your body will compensate so that those discrepancies are reconciled and you maintain a stable, level “sight picture” – your viewscreen of the world. Having an unstable sight picture makes for poor predictions; in other words, in an evolutionary survival context, having a “shaky cam” is not so great for avoiding saber-tooth tigers.
So, those downstream bodily compensations that keep your viewscreen steady are creating distortions and possible maladaptations in the structure of your body, and are now being cemented due to repeated compensatory use. The nervous system will protectively reduce motor output and increase pain perception as a response, to slow you down in order to avoid potential injury and survive another day. Ultimately, the body has evolved towards survival, not performance. And pain is an alarm/action signal designed to keep you alive.
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Mirror Box Therapy and Pain as An Output of Perception From the Brain
When we look at phantom limb pain, what we’re seeing is the phenomenon known as deafferentation: the loss of afferent or ascending inputs from the peripheral nervous system up to the brain. No limb equals no signal, and the loss of signal is very dangerous within an evolutionary context because limb loss due to injury or infection will mean, at the least, loss of sensation and loss of coordination for motor outputs/muscle contraction/movement, meaning a lost ability to gather food or to avoid threats. Or worse, it could mean signaling that you’re going to bleed to death in a matter of minutes.
Multiple pain conditions could be considered sub-clinical deafferentation: peripheral neuropathy from conditions like diabetes or shingles, or different types of phantom limb pain where the limb is still present but the nerves are so injured that they no longer transmit afferent signals – such as we see in cancer, stroke, or crush injuries. That loss of signal gets hardwired into the cortical representations of that limb, and never gets a counterbalancing signal, so the CNS registers it as an ongoing sense of threat. That creates a huge alarm signal in the form of pain perception.
What mirror box therapy does is replace that loss of signal with the image of an intact limb, generating input that dampens down that pain signal. And when you touch the remaining limb (which is generating normal signals) while seeing it reflected in the mirror in place of the missing or injured limb, it can immediately cause the pain signals to cease; so powerful are visual representations within the somatosensory cortex of the brain. Essentially, through seeing a limb appear where it wasn’t before, one tricks their own brain into thinking it’s still there, and the pain signals from the CNS for that lost limb stop being sent.
Mirror box therapy is often not enduring though; only being effective for as long as you do it, and that was the case with Albert Lin. It often takes a lot of repetition for it to become “sticky.” Neuroplasticity requires novelty and intensity, usually in the volume of work. But that can be hard to achieve, thus the issue in pain treatment that I had experienced directly as a practitioner and as a patient; everything works, nothing lasts. When it was suggested to Lin that psilocybin had strong neuroplastic properties that could impact cortical reorganization for chronic pain, he tried it a few times, taking a high dose of psilocybin mushrooms, which gave him approximately 3-12 pain-free hours, depending on the dose. But then the pain came back with a vengeance. Within the cluster headache communities, this is known as a “slapback effect” and can actually be a sign that the nervous system is adjusting and more permanent relief could be imminent.
Then, Lin’s wife suggested combining (stacking) mirror box therapy with psilocybin. He went out to the desert with a closet door mirror, and while under high-dose psilocybin, he would stare at the reflected image of his remaining leg and then at the space where his amputated limb had been, while repeating the phrase “You are safe. You are totally safe,” for approximately 45 minutes. This met all the conditions for driving neuroplasticity: novelty, intensity, and volume of work with deep assurance of emotional and physical security. Amazingly, it worked, immediately putting him into remission for the next 20+ hours, with 50% reduced pain for nearly two weeks. He shared his success with the lab, and experiments with different types of visual neuromodulation while under high-dose psilocybin quickly began.
Lin was dealing with a persistent pain in his phantom foot that felt as if a railroad spike was being driven through, suspected to be a sensory remnant from when the bones in his foot were surgically pinned together as they attempted to save it before ultimately deciding to amputate. An artificial foot and a pen with a telescoping pointer was introduced, and they covered the space between his stump and the plastic foot with a blanket, then “pulled” the telescoping pen out of his foot at the site of pain, mimicking the action of removing pins (or really, removing the pain). He felt instant relief.
Another experiment involved a novelty Halloween-store “flame” (bright light with orange and yellow fabric and a fan underneath that makes it flutter). Lin chuckled when he saw it, but when they brought it near his representational foot, he actually felt heat from the “flame,” which was intensely relieving.
Through these experiments and continued work, Lin went into full remission after five weeks, and has been free of chronic pain ever since. It’s worth noting that he had a top research team working with him that was extremely creative in creating novel inputs, and he is known for being an almost Michelangelo-type character, with a high degree of inventiveness and novelty-seeking, allowing him to discover unique, lateral approaches to solve problems. And, it bears repeating: chronic pain is a singular motivational force.
Additionally, post-dosing, cortical reorganization was happening during a psychedelically-induced “critical period reopening”; when the brain has a metaplastic quality that allows it to reset to an almost-new condition. As described in the work by Dr. Gül Dölen, critical period reopening happens during crucial phases of nervous system development in childhood, such as when toddlers can learn multiple languages without an accent or when adolescents are uniquely sensitive to social cues from peer pressure (and/or support), allowing them to quickly adopt different social customs and frameworks. This reopening is also seen post-stroke, when there is a limited window for rehabilitating from brain injury, so this likely applies very well here with chronic pain. We know that veteran groups like the Heroic Hearts Project, VETS (Veterans Exploring Treatment Solutions), and The Mission Within, who are employing psychedelics for treatment, are having striking results both in recovery from combat-induced PTSD as well as traumatic brain injury – typically seen as treatment-resistant conditions.
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Conclusion
If there’s anything I would like you to understand after reading this article, it’s that:
We don’t have to prove that psychedelics are effective for treating chronic pain; we have to establish that this has already been proven.
Psychedelics are not an instant cure for chronic pain, but they are strong impact boosters for neuroplasticity and can make physiotherapy/neuromodulation become “sticky,” creating enduring relief.
We know that many mechanisms that create psychiatric conditions that are responsive to psychedelic-assisted psychotherapy are extremely similar in nature to the same mechanisms that generate chronic pain; it’s just that psychiatric conditions have gotten far more focus in psychedelics, perhaps because the non-ordinary states of consciousness they are known for producing seem more applicable to conditions more traditionally thought to be related to the mind.
But both arise out of the central nervous system and are rigid, fixed states of cognition and perception. With depression, you have negative outlooks and self-perceptions: “Nothing I do makes a difference,” “People are just saying that to make me feel better,” etc. At one point, these thoughts may have helped you to cope with a traumatic incident, environment, or upbringing, but now they’re maladaptive, weigh you down, are out of step with reality, and have actually caused (or are the result of) structural deficits in the neurology of your brain. It’s the same with chronic pain: when there is an acute injury or even the possibility of one, pain is part of the protective suite of responses from our nervous systems to prevent further injury and allow healing to occur – an alarm bell/action signal to change a behavior. But it can be so overprotective that it gets embedded and cemented with movement, emotions, and surrounding environments long after all tissue healing is done – getting triggered by seemingly innocuous events, maladaptively hardwired into your neurology in a negative loop of conditioned responses.
This is exactly what happened to me when I went through NYU’s psilocybin trial; an adverse financial and work environment, repeated (and under-recovered) musculoskeletal stress/injuries, and (likely) sub-clinical post-concussion syndrome and PTSD, all topped off by the sudden death of a close friend releasing long-suppressed grief and leading to a significant nociplastic output in the form of increasingly treatment-resistant depression and moderate chronic pain. Many recovery efforts were attempted using every modality I knew, but there was too much of a deficit to overcome – until psilocybin was introduced to the mix. That life-changing experience allowed for metaplasticity, cortical reorganization, descending inhibition, and anti-inflammatory properties to take root, giving all post-dosing interventions the opportunity to gain traction and for me to flourish once again.
Future articles in this “Pain and Psychedelics” series will focus on old assumptions vs. new science, additional case studies, the suspected mechanisms of action behind the interaction between psychedelics and pain, and best practices and safety concerns for working with psychedelics to alleviate chronic pain.
An NYU psilocybin depression study participant discovers an unforeseen application for psychedelics: the treatment of chronic pain. Part 1 of the series: Psychedelics and Chronic Pain.
Everything Worked, but Nothing Lasted
In the fall of 2020, I was living a pretty successful and happy life – on paper. I had co-founded a very popular, leading-edge CrossFit gym in NYC; one of the first in the world. I held multiple advanced certifications in applied neurophysiology through Z-Health, helping clients with challenging pain and performance issues. As an early adopter of kettlebell training, I became a nationally top-reviewed instructor and trained Team 6 Navy SEALs, astronauts, pro athletes, wounded veterans, and members of the FBI, NYPD, NYFD, and ROTC. I was featured in Men’s Fitness, the NY Times Sunday Routine, and USA Today. I had 30 years in the pain & performance field, training and teaching at a high level, and was becoming widely known for helping people with difficult mobility problems or chronic pain, using unique methods from the leading edge of neurological rehabilitation. On top of all of that, I was 17 years sober.
However, not all that glitters is gold. A now ex-business partner was committing a Ponzi scheme to the tune of millions, and his case followed him like a shadow, turning my life’s passion into an emotionally and financially toxic nightmare that economically devastated my family. My best friend, Kirk MacLeod, who I had completely rehabbed from chemo & cancer surgery, died six months after being declared in remission. My first son had developed undiagnosed GERD and couldn’t sleep more than an hour and half at a time, which meant my wife and I slept even less.
Unsurprisingly, my episodic depression returned after more than a decade and a half, and I was now increasingly treatment-resistant; unresponsive to psychiatric drugs that had previously worked. All my pain neuromodulation interventions that worked on my clients no longer worked for me, and I had developed chronic pain myself.
I share all my background here to demonstrate that I was not under-resourced in either knowledge, networks, or diversity of approaches, practice, or experiences. I poured over all my certification materials looking for anything I had missed, but had fallen into an increasingly deeper recovery hole; everything worked, but nothing lasted. I was hitting a new bottom in my life, deeply sinking into the midst of an increasingly treatment-resistant depression episode that had likely been ongoing for five years.
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But then I became aware of ongoing studies on psilocybin for depression happening locally in NYC. I had experienced a few high-dose psychedelic sessions nearly a quarter century ago and had been an avid Terence McKenna fan (even speaking with him directly after a lecture in Seattle), but I had never taken psychedelics therapeutically, and my recreational interest had effectively vanished once I became sober from alcohol. Intrigued, I connected with the local clinical research coordinator, Leila Ghazhal, at the NYU for the clinical trial of Psilocybin for Major Depressive Disorder study (sponsored by the Usona Institute), and took all the online and over-the-phone assessments, passing them easily. The primary investigator (PI) on my study was Dr. Stephen Ross, who had been leading psychedelic research at NYU for more than a decade. Amazingly, I made it into the trial within a month and a half, learning that I’d actually beat out 8500 other applicants for just 100 spots nationwide.
Trying Not to Hope
When I first entered the trial, I was in a state of denial about how severe my depression was, but once I took the MADRS assessment, there was no avoiding that I had moderate to severe depression with suicidal ideation.
I remember a specific moment very well during this process, when I was finally cleared to enter the study and the study coordinator was speaking with me about the results of my assessment and my upcoming participation. I asked what would happen if I didn’t receive psilocybin during my session, and he reassured me that they would not just drop me off in the middle of the ocean to dog paddle – that there were other interventions and studies available and they would be sure to find me something, but there was a good chance I would receive psilocybin and hopefully get some good results. At this point, my mask cracked a little bit and some protective cynicism came out, and I quipped with a bit of a shrug: “Well, we’ll see.” I hadn’t meant it to be dismissive or sarcastic but it came out that way, and the conversational atmosphere rapidly shifted. He looked right at me and suddenly he wasn’t the primary investigator anymore, lost in the myriad details and logistics of a very involved study. Now he was the deeply experienced clinician and therapist, and, having heard something within the tone of my voice, dropped all the way in and asked softly: “What’s going on behind that, Court?” Suddenly, all the masking dropped and there was no more place to hide because I was so, so tired at this point, and had been waiting for this moment. In and out of therapy for years, dozens if not 100 self-help books, so many modalities, so many somatic systems, and here I was with a chance for something new to help me. When I realized why there was cynicism behind my statement, my voice cracked, I started crying, and I answered him: “Trying not to hope.”
The one glimmer of hope I did have was reading a 2018 paper by lead author Calvin Ly describing psychedelics’ neuroplastic activity in the prefrontal cortex. As someone who had studied the neurology of pain for years, this was revelatory. Many pain conditions are, in fact, nociplastic or noxious conditions arising out of the central nervous system (CNS); there’s no more injury or damage if there ever was, but your CNS is still continuing to put out a maladaptive alarm signal that is perceived as pain. So learning that psilocybin was creating actual structural change within my cortex – not “just” psychological change – was completely astonishing.
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My dosing date was on March 5, 2020, and I remember looking down at the capsule sitting in the cup, saying to it: “I really hope that’s you.” I was terrified inwardly that I would receive the placebo, that I wouldn’t respond to the psilocybin, or that it would only work just a little bit, only for its effects to slowly fade. But within half an hour, there was no denying that I had received psilocybin, and I earnestly pursued all the procedures everyone on my care team at NYU had worked with me on for weeks in preparation for this day.
I was genuinely shocked at the sheer volume of psychological material from my childhood and early adulthood that came up. I had profound transpersonal experiences and healing, revisiting instances that were pivotal in my childhood. I had an encounter with the first woman I had ever loved, who had committed suicide three years after we had broken up. Her death had caused a profound grief in me that drove my drinking for a decade after. I thought I had released the majority of my grief around her once I got sober, but clearly, there was so much more to heal that had been deeply suppressed as I tried to move forward with my life.
Reset, Renewed, and Reborn
The biggest shock of all, though, was waiting for me at the end of the day when one of my facilitators casually pitched a seemingly routine question while closely watching me out of the corner of his eye: “So, how do you feel?” Without thinking, I reflexively replied, “Good,” but then, just as reflexively, scanned more deeply inward, and in a sudden rush, realized my depression was completely gone – not just better, but vanquished, exclaiming: “Good! That fast? Are you fucking kidding me, that fast? Is it gone already?”
It felt as if a huge mass had been surgically removed from me or as if an entire continent within my interior was now suddenly revealed. No matter how many times you read the word “remission” and the percentages behind it in scientific studies, very little will prepare you for the shocking reality of it. The contrast between before and after was profound. All of the iterative rumination was gone, and it took no effort for that to happen. And it only seemed to strengthen as the days passed. Miraculously, all suicidal thoughts ceased on that day and never returned.
Shockingly, only ten days after my dosing session, NYC went into a complete pandemic lockdown, my entire industry closed, and my two young boys were now at home with me 24/7, tele-learning. I cannot imagine what 2020 would have been like for me if I had received the placebo. It’s almost unimaginable.
For more on this topic, make sure to check out episode 369, where Court and Joe interview Timothy Furnish, MD & Joel Castellanos, MD of UC San Diego’s Psychedelics and Health Research Initiative (PHRI).
But here is where the story takes an even more profound and impactful turn. During the session, my leg started intensely tremoring/spasming. I had been evaluated for musculoskeletal pain and dysfunction that I had acquired through a host of injuries over the years of my performance career, and in fact, had just been in the doctor’s office a few months earlier trying to determine if I had arthritis or something worse. But right there in the session room, I started having a neurological revision, with my muscles and nerves in my right inner thigh firing in an effort to recalibrate the sensory and motor inputs and outputs in that part of my kinetic chain. It was almost like a self-generated TENS unit (Transdermal Electromagnetic Nerve Stimulation, used to generate muscle contractions and neuromodulate pain signals with micro-electric pulses) getting my leg back online by creating intense motor activity in the muscles of my thigh.
I’ve since spoken with spinal injury survivor Jim Harris and read a case series from UC San Diego’s Psychedelics and Health Research Initiative (PHRI) published in PAIN Journal where the exact same thing occurred to them under the effect of psilocybin with the same positive results, but at the time, the facilitators were concerned enough to ask the primary investigator to come and evaluate me during the session. I had to explain to him, somewhat hilariously as I was going into my peak, that, in fact, the tremors felt intensely good. I’m grateful that he let them continue because it has made all the difference.
While I partially understood what had happened, I was understandably beyond eager to learn more, and to see where else this realization could take me: Why did this work so well? Has our understanding of chronic pain been wrong? And if psychedelics are the answer, what does treating chronic pain with psychedelics actually look like?
This is part 1 of a 2-part piece and part of a larger series on chronic pain and psychedelics. In part 2, I will dive into the research around remapping and mirror box therapy, and why my psychedelic experience seemed to be so effective.
Future articles will focus on:What is pain and what causes chronic pain, old assumptions vs. new science, the suspected mechanisms of action behind the interaction between psychedelics and pain, and best practices and safety concerns for working with psychedelics to alleviate chronic pain.
In this episode, David interviews Dr. Ben Medrano: Co-Medical Director with Nue Life, board-certified psychiatrist specializing in integrative psychiatry, and former Senior Vice President and US Medical Director of Field Trip Health.
He discusses his path to Nue Life; from growing up around mental illness, to the rave scene, to Buddhism, to his years working for the underserved in an East Harlem Assertive Community Treatment, and his biggest takeaway from that time: that the healthcare system he knew was not truly helping people. He talks about stigmatization (of some modalities like electro-shock treatment, of psychedelics, and of ketamine – which seems to be stigmatized even within the psychedelic space); his concerns that the at-home ketamine model is at risk as we make our way out of the pandemic; and how at-home ketamine can drastically reduce the cost of treatment.
Medrano tells a great story of a patient who saw incredible improvements through ketamine, and discusses some Nue Life highlights: their just-released 664 participant-study in Frontiers Psychiatry showing the safety of at-home ketamine (and that at-home is just as effective as other routes of administration); Nue Care, their model for aftercare using digital phenotyping, goals, and a scoring system (which he believes could be the new model for integrative psychiatry); and their Nue Network, which could be a solution for better education on ketamine and for granting access for patients through prescribers who typically don’t understand much about its efficacy.
Notable Quotes
“All the different interests, personalities, visions, [and] goals that are in this sort of circus of psychedelic commercialism is very necessary to understand. And for me, I think the biggest takeaway is that there is one thing that binds everybody who’s involved, and that is hope, really. I think there’s a lot of hope in this sphere.”
“The hazards of a benzodiazepine are well known, and to some extent, one might even argue that with some of these DEA-regulated substances that we do ship at home; that if we’re going to say that we need to subject ketamine to a higher standard, then we need to do it for the rest of these DEA-regulated substances, because they have very hazardous risk profiles. …I can’t help but think that there’s a little bit of …stigma [around] what it is that we’re doing.” [On an at-home ketamine patient’s success]: “He is able to get out of the house every day and enjoy the sunshine, and the way he views his trauma is at a level that I think all of us would aspire to: really, as something that has sort of made him into the man that he is today, with something really unique and powerful to offer as a human to others – rather than as a wound.”
In this episode, Joe invites Court Wing to co-host, interviewing two members of UC San Diego’s Psychedelics and Health Research Initiative (PHRI): Joel Castellanos, MD (Associate Medical Director of PHRI and board-certified physical medicine and rehabilitation and pain medicine physician), and Timothy Furnish, MD (Medical Director of PHRI and Associate Clinical Professor of Anesthesiology and Pain Medicine).
As one of the early participants of a psilocybin-for-depression trial in NYC, Court Wing (of REMAP Therapeutics) discovered that immediately after the session, his chronic pain had miraculously gone away. He began researching how psychedelics could be used (with or without other therapies) to continue the alleviation of pain psychedelics had brought him. Through the Psychedelics and Health Research Initiative, Drs. Castellanos and Furnish are following that that same road, and are currently recruiting for a randomized controlled trial on psilocybin for phantom limb pain.
They talk about the relationship between the mind and chronic pain: how people confuse pain with the simple act of nerves firing, but how it’s so much more. And they discuss how pain can become part of one’s identity (and how the Default Mode Network could be contributing); how physical therapy is related to neuroplasticity; mirror box therapy; microdosing for chronic pain; the unusual nature of phantom limb pain; and where the mystical psychedelic experience may come into play. If this topic is as fascinating to you as it is to us, stay tuned – we will be featuring much more on chronic pain and psychedelics, including a blog series from Court Wing coming soon.
Notable Quotes
“One of the things that may be unique about or interesting about chronic pain is that the longer it goes on, the more people start seeing pain as a part of their identity and that Default Mode Network is probably playing a role in that. And it’s possible that something like psychedelics could open up the possibility of changing that internal story so that pain is no longer so much a part of one’s identity.” -Tim “I think that people oftentimes confuse pain with simply nerves firing. …[But] there is this rich interplay between the way we think about pain, the way we perceive pain, and how we feel about it.” -Tim “When you’re not really dealing with chronic or severe pain on a daily basis, it’s really hard to think about how life-changing that is or can be.” -Joel
“When we hear things like ‘It’s only just in your head,’ I don’t think people quite get [that] the head can be a scary place to be trapped sometimes.” -Court
In this episode, Kyle interviews Dr. Steven Radowitz: Medical Director at Nushama, a wellness center in New York City primarily offering IV ketamine, with a strong focus on letting the experiencer explore their journey undisturbed.
Recorded in-person at Nushama’s flagship location just over a year after opening, Radowitz talks about his past and why he became interested in ketamine, the look and feel of Nushama, their process, and why they favor IV ketamine. He highlights his biggest takeaways from the year: the surprise in just how effective ketamine has been; the role of integration and what aftercare truly looks like; and the importance of learning to hold space and be a compassionate listener – that the doctor isn’t the healer and the psychedelic isn’t the magic bullet cure; instead, they are just tools that allow the patients to heal themselves.
He discusses how he sees psychedelics as a dimmer switch for the ego; how disorders are tools to deal with trauma; why he is reframing trauma as a learning experience; why he thinks ketamine will survive once psilocybin and MDMA are legal; why group work is so effective and powerful (and likely the new model for psychedelic therapy); and the importance of staying humble through all of this – humble to the power of the medicine and humble to the amazing capacity for people to heal and grow, simply by being allowed to explore their journey and be heard.
Notable Quotes
“I’m not a healer, and I often tell people [that] during their preparation, when I do my medical intake. I talk to them about that. I say, ‘I’m not here [to heal you], I’m here just giving you a tool. You’re the healer. All this stuff does is [that it] just takes away what’s blocking you from realizing that. It’s like a dimmer switch on the ego [and] on the mind.” “I’m trying to move away from the word ‘trauma.’ It’s a difficult life event that’s there to teach us. It’s there for something. And with every one of those events; there’s a little jewel within it, but you have to go in there and go through it. And it’s just a cloud, just a myst, almost, that’s preventing you. Just push [through it] and hold space. As long as people are in a safe place to go there and journey there, then they’ll realize that it’s just an event. It’s just an experience, and you move on. That wisdom is: a memory without the emotion.”
“I think any type of journey work, any type of psychedelic work, I almost think you have to be called to it in a way. You shouldn’t be coerced, ever, into this. …I find that the ones that are really ready to do the work are finding us on our own.”
In this episode, Kyle interviews Dr. Jennifer Montjoy: Tucson, Arizona-based psychiatric nurse practitioner with a private practice specializing in ketamine-assisted psychotherapy, and Medical & Research Director at TRIPP (Transpersonal Research Institute of Psychotherapeutic Psychedelics); a 501(c)(3) organization that provides psychedelic training and research opportunities largely for female and BIPOC scientists.
A Vital student introduced Kyle to Montjoy’s research on ketamine and PTSD and presented with her at the recent ICPR conference in Amsterdam, where this was recorded in-person (as Kyle and Johanna were there, representing Psychedelics Today). Montjoy talks about her protocol, the self-transcendent scale she’s using with clients pre- and post- induction, how ketamine can help people get over past trauma through shifts in emotional memory, and what she sees most in successful cases: a gradual shift toward self-agency.
She discusses how integral titration is to her process; how ACE (adverse childhood experience) scores work; how dissociation can help with childhood trauma; how clients often naturally fall into using Internal Family Systems to describe their process; and how physicians and therapists shouldn’t be afraid of the concept of ceremony and opening sessions with intention – and, as she likes to say, giving one’s mind coordinates on where it can end up.
Notable Quotes
“I do think it’s helpful to have a skillset and general understanding of that so you know what’s happening in real time, but for the most part, I subscribe to the philosophy that we all have an inner healer. We all have that inner wisdom, but most of us don’t have access to it because we have these managing protectors from our trauma.”
“Often [for the] opening, I’ll ask the higher self to step into the light, to take the reins and let all those parts know that the goal here is not to annihilate or bypass them. That’s the language I consistently use in opening, because as the facilitator, we want to align with those parts too. We’re not the enemy.”
“Don’t be afraid to incorporate ‘ceremony.’ …I think that makes a lot of physicians maybe uncomfortable; that idea. [But] opening and closing [the ceremony] can be very helpful tools, [and] making sure we’re asking about intention before each session. I call that the coordinates, because we want to give the unconscious mind the coordinates.”
In this episode, Joe interviews Christopher Dawson & Andrew Galloway: Co-Founders and CEO and COO, respectively, of Dimensions; a Canadian-based company creating retreats that blend traditional plant ceremonies with neuroscience and a luxurious, five-star environment.
Dawson realized what so many people were starting to learn about psychedelics after attending a 2015 conference in Peru that mixed neuroscientists with traditional healers, but for Galloway, it was direct experience, as he gives credit to plant medicines for helping him to heal from a 6-year addiction to crack cocaine. They each tell their story and how it led to the beginnings of Dimensions, where they worked for a year with a “Dreamlab” team of MDs, psychiatrists, practitioners from different fields, and even a design agency to create different programs for different substances – all with a focus on true set and setting and integrating perfectly with nature. They’re in the middle of a soft launch right now, offering cannabis in a ceremonial, group setting context to friends and families at their Algonquin Highlands location; perfecting everything before opening up to the general public. And once the law catches up with them, they hope to offer psilocybin and other psychedelic-assisted therapy across several new retreat locations.
They talk about Health Canada and the country’s trajectory towards legal psychedelics; critiques of traditional addiction treatment and the efficacy of 12-step programs; the tension between the psychedelic space and traditional healing space; investing in biotech; the polyvagal theory; how animals deal with trauma (and how we don’t); and the concept of integration: If you’re just taking a pill and not doing the work, are you missing the point entirely?
Notable Quotes
“We’re biased (we’re in the retreat business), but I don’t think that psilocybin, as an example, should be reduced to a pill that you take with your juice in the morning and you no longer take your SSRI because this is your new pill. For us, it’s the psychedelic-assisted therapy that actually maximizes the potential of the psychedelic experience, and that’s the mechanisms through which fundamental, behavioral change can take place. I think the idea that a pill can replace all of that means that you’re kind of missing the point about the whole experience.” -Chris “I don’t want to slam traditional treatment because it actually did work for me to some degree. …I had a crack-cocaine addiction for six-seven years and ended up in rehab for six months and came back and participated in 12-step programs and remained abstinent. That part worked. The difference for me when I got involved with plant medicine was something else: I got healed. Instead of just abstaining and not using to cope or to manage with whatever I was dealing with, I actually healed through plant medicine.” -Andrew “Is it a pill or is it the therapeutic process? If you don’t engage in integration, then you’re just taking a pill.” -Chris
“We talked about stigma earlier; it’s changing, and [for] the general public, the stigma around the war on drugs is changing too. I think people have finally figured out that it doesn’t work. No war works. We only declare war on things that we can make money from.” -Andrew
Christopher Dawson is the Co-Founder and CEO of Dimensions, a growing collection of retreat destinations combining neuroscientific research with plant ceremony in immersive natural environments. Prior to co-founding Dimensions, Christopher was the founder and CEO of Edgewood Health Network, where he oversaw the largest private network of residential/outpatient treatment providers in Canada and led the merger and acquisition of Canada’s top three treatment centers to create that network.
About Andrew Galloway
Andrew Galloway is the Co-Founder and COO of Dimensions, a new paradigm for healing, combining ancient ceremonial plant medicines with modern science in safe, legal, and nurturing natural environments. He leads the organization’s clinical teams and operations for Dimensions Retreats, a new collection of immersive, transformational healing retreats combining neuroscientific research with plant ceremony and luxurious hospitality. Prior to co-founding Dimensions, he was a National Director of Edgewood Health Network; leading 10 outpatient centers. Andrew was the former VP at GreeneStone Muskoka, an international certified alcohol and drug counsellor, and has 14 years of experience working directly for the NHL/NHLPA substance abuse program.
In this episode, recorded in-person at the recent From Research to Reality summit, David interviews one of the more well-known figures in the psychedelic space (who somehow hasn’t been on the show yet), David Nutt: Psychiatrist, Founder and Chief Scientific Officer at Drug Science, Chief Research Officer at Awakn Life Sciences, and Edmund J. Safra Professor of Neuropsychopharmacology in the Division of Brain Science, Dept of Medicine, Imperial College London.
At Awakn Life Sciences, amongst other projects, Nutt is working to set up clinics for legal psychedelic therapy (so just ketamine for now), and, after a successful study on MDMA in the treatment of alcohol use disorder, he’s doing something nobody has really done before in seeing if improvements can be made to MDMA. He tells the story of when he was fired as chair of the Advisory Council on the Misuse of Drugs due to telling the truth about the differences in harm between alcohol, tobacco, and “bad” drugs like LSD and cocaine, which led to the birth of Drug Science (and embracing the truth about drugs even more).
He covers a lot of ground in this episode: how serotonin seems to affect the default mode network; glutamate, cortexes, and the flexibility in the human brain; Robin Carhart-Harris’ “Trial of Psilocybin versus Escitalopram for Depression” study and the realization that psychedelics were doing something different in the brain; Measure 109 and the importance of how Oregon establishes a new paradigm around legal mushrooms; drug hysteria in the US and UK and how drastically that differs from Portugal’s incredibly successful approach to drugs; why real world evidence is the core of science; and why psychedelics seem best at disrupting internalizing disorders.
Notable Quotes
“The reality is that the psychedelic impact on depression has been so powerful, it’s changed the whole narrative about how we think about depression. Our one study in [treatment]-resistant depression spawned 40 companies now [that] are working on psilocybin for depression, which is amazing. …It’s been a spark to this amazing expansion. Why? Because for the last 40 years, there’s not been any innovation in terms of mechanisms in treating depression, ever. All the drugs we have today are essentially safer derivatives of the drugs we invented in the 1950s. So this is a new approach, and that’s really, really exciting.” “We’ve got to get our politicians, our policymakers to admit that these drugs should never, ever have been put in Schedule I. They were put in Schedule I [because] we said they were ‘very harmful’ (which they’re not), and they have no medical value (which they do), and it’s actually immoral now, reprehensible that politicians could not see that.”
“They just said, ‘Let’s try a different approach. Let’s try decriminalization and let’s treat drug addicts as human beings and help them get off the addiction rather than put them in prison.’ And that’s been one of the greatest success stories in the history of drug interventions. In the 15 years we have data since the Portuguese experiment was instigated, the Portuguese have reduced opiate deaths to one third of what they were before. In the same 15 years in Britain, using prohibitionist policies, we’ve doubled our deaths from opiates. And that, frankly, is an insult to humanity that we’ve pursued policies which we know are actually killing people.” “Real world evidence is the core of medicine.”
David Nutt is a psychiatrist and the Edmund J. Safra Professor of Neuropsychopharmacology in the Division of Brain Science, Dept of Medicine, Imperial College London. There, he uses a range of brain imaging techniques to explore the causes of addiction and other psychiatric disorders and to search for new treatments. He has published over 400 original research papers, a similar number of reviews and books chapters, eight government reports on drugs, and 36 books, including one for the general public, Drugs: Without The Hot Air, that won the Transmission Prize in 2014.
In this episode of the podcast, Joe interviews the CEO of Mindset Pharma, James Lanthier.
Mindset Pharma is a 3-year old biotechnology company built on discovering and developing new psychedelic compounds to be used as medicine for a variety of indications. While the efficacy of the psychedelics we know can’t be denied, the goal of science is to improve, and Lanthier believes optimizing these drugs will make them safer, more predictable, and more palatable for a far greater portion of the population. He envisions these new molecules leading to a future of highly personalized medicine, where people who would never eat a mushroom would likely take a related drug prescribed by their doctor.
Lanthier discusses what’s going on at Mindset Pharma; why patents alone will not be sufficient protection from competition; the long game of biotech, psychedelic stocks, and overreaction to slow growth; the Nagoya protocol; mescaline; the need for big pharma and capitalism; the art of formulation; and how microdosing could soon be revolutionized.
Notable Quotes
“I had some fairly well-known psychedelic investors say to me, ‘You’re just building a better mousetrap.’ And my reaction was: ‘Well, that’s the march of science. That’s what science is trying to do.’ Take the example of what the German scientist [Felix Hoffman] did in the nineteenth century to go from the bark of the willow tree, eventually going through a whole bunch of intermediate chemical steps to eventually get to Aspirin. Science hopefully tries to make things better, and that’s what we’re trying to do.”
“Big pharma has skipped right past psilocybin. Why? In my view, it would be because of the lack of strong IP rights. They’ve gone right to second and third generation drugs because they’ve made the assessment that even if you own the strongest IP in the psilocybin space, you’re still quite exposed, ultimately, to competition.”
“I think if there’s a future where you have relatively low-priced classic drugs potentially available alongside more optimized, specific drugs that have the full support of the medical community, that would be a great place to get to, I think – really great place to get to. And I think we only really get there with the machinery of capitalism moving forward.”
James Lanthier is the CEO of Mindset Pharma, and is a seasoned technology executive with strong expertise in corporate finance, public markets and M&A. Most recently, Mr. Lanthier was a co-founder and CEO of Future Fertility, an innovative early stage developer of AI applications for human infertility. As a C-Suite executive, Mr. Lanthier has assisted in the growth and successful exit of numerous technology-enabled businesses through the public markets, including Mood Media, the world’s largest in-store media provider, and Fun Technologies, a pioneer in online casual games.
Christopher Dawson is the Co-Founder and CEO of 
Andrew Galloway is the Co-Founder and COO of 
David Nutt 
James Lanthier