In this episode, Joe interviews Priyanka Wali, MD: board-certified practicing physician in Internal Medicine, MAPS-trained psychedelic facilitator, comedian, and co-host (with Sean Hayes of “Will & Grace” fame) of the HypochondriActor podcast, where they discuss interesting medical issues in a funny (and hopefully uplifting) way.
She talks about recognizing and protecting the humanity of healthcare professionals, and how medical school is creating a cycle of hurt people trying to help other hurt people. She believes we need to become more holistic, especially in embracing Indigenous ways of thinking, as their frameworks may be the only way to explain phenomena with which Western science can’t yet come to terms.
They talk a lot about ancient psychedelic use: the use of a soma described in the Rigveda; Egyptian culture and mushrooms observed in statues; Plato; the work of Brian Muraresku and Graham Hancock; and Vedic chants, Kashmiri Bhajans, and how singing (especially in a group) can be especially healing to the nervous system. And as Wali experienced first-hand the Kashmiri Pandit genocide of 1990, she discusses how much colonialism has changed cultures, and how much our cycles of oppression relate to our collective inability to experience pain and fear.
They discuss the psychological impact of living through major catastrophes; the special and hard-to-describe feeling of returning to your home (especially in a world changed by colonization and constant conflict); the sad case of Ignaz Semmelweis and hand washing; ghosts of Japan’s 2011 tsunami, the concept of ‘future primitive,’ and more.
Notable Quotes
“We’re only thinking about it from a certain perspective. And this is where you think about principles of colonization come in: looking at things only from one perspective. If you start to bring in Indigenous systems [and] Indigenous ways of looking at data, then suddenly, we do actually have ways to account for these other phenomenon that can’t be objectively tabulated.”
“In traditional Kashmiri culture, it was routine to gather together and sing together. We humans: we’re supposed to gather around the fire and dance and chant. There’s actually something very healing for our bodies. And let’s not forget how our nervous systems regulate with each other, so being physically together as a group, as a collective, singing, using our bodies: it’s actually very healing for the nervous system. We need more of that.”
“I think the next shift in consciousness is recognizing that we experience fear as part of the human experience, but we can choose not to give into it. We can be with it, we can allow it to be there, we can even honor it, but we don’t have to act on it. And we can, instead, choose the path of peace or love, or not even choose those paths, but just choose not to do anything with the fear; choose not to oppress someone, judge someone, lash it out, [or] numb it. …Unless we, in the present day, begin to start being with our fear, we will continue to perpetuate these cycles of oppression.”
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In this episode, David interviews two of the founding members of Fireside Project: activist, healing justice practitioner, musician, and Chief Ambassador, Hanifa Nayo Washington; and lawyer, aspiring researcher, and Executive Director, Joshua White, Esq.
Fireside Project was created after White volunteered for a help line for years and realized a few things: that follow-up calls made a big difference; that the state of mental health in the U.S. was a disaster (he was talking to some of the same people for years); and that while psychedelics were becoming popular, they would likely only be accessible to the wealthy. Alongside Washington, they realized the most effective thing they could do would be creating a free help line where people could call for peer support during a psychedelic experience, and receive support in integrating that experience afterward. They’ve focused on finding volunteers who may be marginalized or who have been persecuted from the war on drugs, but most importantly, have real experience and true compassion (rather than letters after their name proving their credentials). They are on track to receive 10,000 calls over their first two years.
They discuss Fireside’s Burning Man origin story; the serendipity they’ve seen in the organization’s beginnings and so many calls; where the name came from; how they prepare volunteers; what true equity looks like; and how, while it’s a common challenge for therapists and facilitators to hold back and not try to fix a problem, that may be even more important here.
Fireside Project takes calls every day from 11am – 11pm PST, and while there is an app you can download, they recommend saving their number in your phone for when you need it (62-FIRESIDE). And to destroy the notion of being afraid to ask for help, they encourage everyone to share their stories on social media: the times that you’ve used Fireside Project or the times you had a challenging experience and wish you had known about them. Many newcomers have no idea this support exists, and it could truly be life-changing for them.
Notable Quotes
“What’s revolutionary about what we’re doing in this idea of democratizing care is that these are volunteers, and they come as peers. They come to the experiences having had their own experiences, and desiring to hold space for others as they navigate their experiences and navigate their processing afterwards. …They’re not doing therapy. They’re not diagnosing. They’re really with the person (the caller, the texter) as somebody who gets it.” -Hanifa
“I think some of the most powerful moments on the line come when we say absolutely nothing at all, when we just allow the silence to become almost palpable, to really feel that ember. I think silence has led to so many of the most beautiful moments that I’ve been lucky enough to see on the line.” -Josh
“By being able to create a safe and non-judgmental space for people by phone, then yes, that absolutely can reduce the risks of their psychedelic experiences. And I think there’s kind of a yin and yang here, which is that when a person is in a space of non-judgment, and when they do feel deeply seen and heard and listened to, then that not only reduces the risks, but it also allows someone to really turn towards their psychedelic experience and to unwrap the gift that’s before them.” -Josh
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In this episode, Joe lets Court Wing take lead in interviewing two of the leaders behind Clusterbusters: Founder and Executive Director, Bob Wold; and President, Eileen Brewer.
A long-time friend of the show, Court Wing has become our resident expert on chronic pain, writing articles about how psilocybin relieved his chronic pain, and hosting Timothy Furnish, MD & Joel Castellanos, MD in their episode about phantom limb pain. Now he speaks with Clusterbusters, a non-profit dedicated to educating people about the horrors of cluster headaches, funding ongoing research into new treatments, and normalizing the miracle that psilocybin has been to so many sufferers in alleviating their headaches.
Wold and Brewer discuss their past struggles (Wold is a cluster sufferer and Brewer has migraine disease) and discovering the amazing intervention of psychedelics; the battles they’ve gone through in spreading this knowledge; how using psychedelics is also helping people work through PTSD; the barriers that legal psilocybin is creating; the concept of schools having a drug education program; the research looking at cluster headaches and other headache diseases; their creation of the Pain And Psychedelics Association, and more. While cluster headache sufferers have a lot to be frustrated about; as psilocybin becomes more mainstream and more and more research is funded, they now have a lot of hope.
Notable Quotes
“A couple of people started growing their own mushrooms and self-treating themselves just to try it to see if it might actually help, and the results were incredible. It was better than anything that any of them had tried in the past. It wasn’t really an abortive (it wasn’t treating one headache) and it wasn’t really a preventive, where you would take it and you would prevent some of your cluster attacks. It was something that was actually doing both of those things, and people were getting long-lasting results by one or two doses of magic mushrooms.” -Bob
“It makes sense that that would happen within a disease community, it happens outside of disease communities too. Some people just use psychedelics occasionally just to get that perspective back and to work within themselves (and without themselves) to sort it all out, [and] get themselves back together. And I think there’s a real division there between people who do that and people who don’t.” -Eileen
“The two or three years before my first dose of psilocybin, my medical bills were like $20,000 a year trying to treat my clusters. That included hospital stays and specialists and travel. …The first time I grew my own mushrooms, it cost me a hundred dollars to grow a year’s supply and I didn’t have to go to Walgreens to pick up my medicine. So my medical treatment for the following year for my cluster headaches was $100 versus $20,000 and I was able to take as much as I needed when I needed it. And at this point, that’s what most people with headache disorders are doing; they’re growing their own because the system is going to take years and years to be built into something that’s actually accessible to everybody – and affordable.” -Bob
“People are dying while we’re waiting for these policies to happen, and I’m really struggling with the fact that we are setting up more barriers. I know that all the intentions are good, but we are hurting people.” -Eileen
In this episode, David interviews neuroscientist, artist, and educator, Melanie Pincus, Ph.D.; and Ph.D. candidate in Neuroscience, lead or co-author on over a dozen scientific publications, and regular contributor to PT, Manesh Girn.
They tell their stories of how they became interested in neuroscience, and stress the importance of staying radically open-minded (or “epistemically naive”) when it comes to how much we can claim we understand about the brain, the mind-body connection, and consciousness itself – that while fMRI and other advances have brought us a long way, there are still a ton of “unknown unknowns,” especially around creativity, decision making, and imagination. They discuss the misconception that we only use 10% of our brains; comparisons between the brain and the universe; society’s misunderstanding of “happy hormones” (dopamine, serotonin, etc.); how chronic stress takes a toll on all parts of the body; how MDMA works with memory processing; and how stacking modalities with the psychedelic experience (like play or activities focused on emotion regulation) can really help with personal goals and growth.
They have taken their understanding and fascination with neuroscience and applied it to a new course in our Psychedelic Education Center: “Psychedelic Neuroscience Demystified: How Psychedelics Alter Consciousness and Produce Therapeutic Effects“: an 8-week live course with 10 hours of prerecorded material and a built-in community. It was designed with practitioners and clinicians in mind, but with the goal of still being as accessible as possible for anyone who is curious about the neuroscience of psychedelics, and how that knowledge can help with preparation, the journey, integration, and working with a heightened window of neuroplasticity.
Class begins on May 17, and if you sign up before April 12, you can get $100 off!
Notable Quotes
“There’s so much good science now, and good neuroscience that can inform how people work with their clients in terms of helping them set up for and make sense of their psychedelic experience and ways to optimize the preparation before going into a psychedelic journey, the actual psychedelic journey in terms of thinking about dosing and type of substance to work with, and then also in the integration period, where there’s this heightened window of neuroplasticity and how one could really work with a client to best take advantage of that window of opportunity to lead to lasting change.” -Melanie
“It’s just this blob, this squishy blob of matter. And you think: for that person, their entire life, experiences, memories, [and] hopes were all happening in this little blob that’s in my hand. And just seeing all the layers of blood vessels and how everything’s connected to each other, it’s just fascinating and it’s downright bizarre that somehow, this thing can give rise to experience and consciousness. It’s like, how the hell is that even possible?” -Manesh
“For people who are interested in stacking modalities, there’s other modalities that are really potent at promoting neuroplasticity. So if you want to synergize with the window of plasticity during the integration period, you could for sure partake in regular exercise, because that’s one of the most well-known plasticity promoters.” -Melanie
“How do we respond adaptively to times of change? How do we adjust ourselves? How do we create homeostasis in a changing environment, and how do we adapt to new circumstances? And this is also a whole brain/nervous system/body affair as well, on how to regulate your entire organism to deal with change and to be resilient and to be adaptable. It’s not just in the brain. It’s not just in the brain at all.” -Manesh
In this episode, in celebration of International Women’s Day, Victoria interviews Tracey Tee: co-founder and CEO of Band of Mothers Media, co-producer and co-host of the Band of Mothers podcast, and founder of Moms on Mushrooms, an online educational community for psychedelic-curious moms outside the prying eyes of social media.
With similar histories of womb trauma, self discovery, and body reconnection, Victoria and Tracey discuss the complications of motherhood, substance use and embracing psychedelics in a broken culture, in which engaging with small, approved coping mechanisms is fine – where the “wine mom” archetype and numbing yourself with medications is celebrated, but where we don’t often talk about how challenging motherhood can really be, and the lasting mental, physical, and spiritual impacts of birth, loss, and grief. Tracey’s goal with Moms on Mushrooms is to bring mothers together for personal growth, healing, and most of all, for the safe, supportive container that so many women considering plant medicine need.
She tells her story of creating and performing “The Pump and Dump Show” and the psychedelic journeys that led her to creating M.O.M., and discusses much more: how those large dose journeys reconnected her with her body; how microdosing has helped her feel more vulnerable, honest, and in tune with her daughter; how psychedelics can help parents realize where problematic core beliefs came from; how teaching children the ways of the world forces parents to confront and reaffirm what they truly believe; and the challenges mothers face in even talking about wanting to try psychedelics.
“Had I not had this divine intervention, I think I would have been pretty stubborn, which I can tend to be. I would have not wanted to be vulnerable with my daughter because I think I was raised to say that that wasn’t something that is good or that I should show – I’m a parent: ‘My way is the highway.’ Instead, I’m much softer. I ask for forgiveness, I tell her when I screw up, I admit my mistakes, [and] I ask her what she thinks. I always talk about Old Tracey and New Tracey (Old Tracey and ‘Shroom Tracey’): Old Tracey would have never been like that, and I think that’s a real gift, because in asking forgiveness [and] in admitting my mistakes, I’m changing.”
“What is the most upsetting to me is the fear, like this push/pull of hearing either my story or your story or reading How to Change Your Mind or watching a Netflix thing and saying: ‘My soul is telling me this makes sense, my soul is telling me to give this a shot. I might have a way out of this,’ and then my head is like: ‘You cannot do this. You’re a bad person, this is shameful, you might die (which is ridiculous) and at the very least, your children will be taken away from you.’ And that is why I’m talking to you, because that has to stop. It has to stop.”
“I don’t love rehashing the past. I don’t love carrying victimhood, but I am sad for what I lost. And when I work with the medicine (again, intentionally, safely; all the things that we’ve been talking about), I am shown, piece by piece, [that] I’m calling all those parts back. And it’s not easy, but it’s like I’m rebuilding. I’m like a Lego project right now, and I would never be able to do that without the shrooms.”
Psychedelics, once heavily restricted for research, are now being rigorously tested through clinical trials to explore their potential therapeutic benefits. But how are women represented in the search to uncover the efficacy of psychedelic medicines?
While the inclusion of women in psychedelic clinical trials is clearly important – both to understand the effects of these medicines on all genders as well as to develop effective treatments for conditions that primarily affect women – women have historically been underrepresented in clinical trials.
Why has this become the norm? Is it because women aren’t as available as men to participate in studies? Or perhaps women don’t suffer from the illnesses being studied as often as men?
Spoiler: it’s neither.
The Clinical Trial Process – An Overview
The clinical trial process is, largely, a series of research studies that evaluate the safety and effectiveness of new drugs, treatments, or medical devices on human subjects. To fit into a pharmaceutical model, a.k.a. develop a drug or treatment protocol that clinicians can prescribe and health insurance will cover, psychedelic medicines must follow the same clinical trial process that all new drugs and treatments undergo.
If it seems like there’s a new clinical trial announced each week – from psilocybin for depression to MDMA for PTSD to LSD for cluster headaches – it’s because these trials are crucial (and non-negotiable) for biotech companies seeking to bring their compounds and modalities to market. These trials aim to prove the effectiveness of a particular compound or method of use, and ultimately secure the holy grail of U.S. Food and Drug Administration (FDA) approval.
Clinical trials are conducted in several phases, each with specific goals:
Phase 1: A small number of healthy volunteers receive the drug or treatment to evaluate its safety and determine the appropriate dosage.
Phase 2: A larger group of volunteers with the condition that the drug or treatment is designed to treat receive the treatment to assess its effectiveness and side effects.
Phase 3: An even larger group of volunteers with the condition receive the treatment in a randomized and controlled study to confirm its effectiveness and monitor side effects.
Phase 4: The drug or treatment is approved and marketed for public use, and ongoing studies continue to monitor its long-term safety and effectiveness.
Throughout the clinical trial process, participants are closely monitored and data is collected to evaluate the drug or treatment’s safety, efficacy, and potential side effects.
The objective was to avoid unforeseen birth defects in babies born to women in clinical trials. The result, however, is that most currently prescribed medications were approved by the FDA before 1993 – which means they’re prescribed to women and men at the same dose and were unlikely to have adequate representation of women in their clinical trials.
Francesca Minale, President of Vici Health Sciences and an expert at working with the FDA to bring new medications through clinical trials to approval, says the lack of gender differentiation in dosing persists despite known differences in disease states by gender.
“There is a lack of incorporation of gender data and generic specific dosing and administration on FDA-approved prescription labels,” said Minale. “This gender bias in the research needs to be addressed, especially as it is well documented that many diseases, such as mental health or heart disease, are recognized to have gender differences.”
Excluding women from early-stage clinical trials led to a vast shortage of data around how today’s drugs affect women – a knowledge gap that scientists are still trying to fill. Even though the NIH now requires women to be included in all clinical research funded by the government agency, there are still many criteria that make it difficult for women to participate in clinical trials.
Women in Psychedelic Clinical Trials
The results of clinical trials play a critical role in informing regulatory decisions about whether to approve new medicines for widespread use. However, in the past, clinical trials often failed to accurately reflect the populations they intended to serve – especially women.
As psychedelic clinical trials seek to determine the safety and efficacy of new psychedelic treatments, it’s imperative we learn from past mistakes. A recent study identified 86 medications approved by the FDA that are more likely to cause complications for women than men.
But yet it’s common practice to prescribe equal doses of medications to men and women – contributing to the overmedication of women and female-biased adverse drug reactions.
In fact, because women were excluded from many pivotal clinical trials, many drugs have been withdrawn from the market or have had their labels changed to include warnings about increased risks for women after they were already approved by the FDA and widely used.
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Modern Barriers to Women’s Participation in Clinical Trials
Amy Reichelt, Ph.D.,Director of Neuropharmacology at Cybin explained, “In early-stage clinical trials (i.e., Phase 1) where drugs are tested in healthy volunteers, key inclusion/exclusion criteria can bias genders tested.”
Typical protocol wording includes: “Women of childbearing potential (WOCBP) must be non-lactating and have a negative pregnancy test. Females who are not WOCBP must be either surgically sterile or post-menopausal.” Reichelt said. “This immediately excludes a number of women, particularly when age ranges of trials can have cut-offs of 55-60 years.”
Moreover, it is often written into the trial protocol that a woman of childbearing potential must agree to practice an effective means of birth control/contraception during their participation in the clinical trial, and following the trial for several months. This could impact individuals who are trying to start a family for many months, again discouraging women from participating.
Reichelt pointed out, “Later stage trials (i.e., Phase 2b, Phase 3) can be less restrictive as they are testing in patient populations and initial safety tests are fulfilled in the healthy volunteers in early stage trials, but still there are often requirements for contraceptive use that fall upon the women’s responsibility.”
In addition, body weight restrictions may also prevent women from participating if they are below the protocol threshold i.e., less than 60 kg/132 pounds.
Biological Gender Differences and Why They Matter
The differences between the sexes in circulating levels of sex hormones, such as testosterone and estradiol, can affect pharmacokinetic or pharmacodynamic parameters – which help determine how the drug is absorbed, distributed and metabolized in the body, and how the drug affects the body, Reichelt explained.
Body composition can impact how a drug is processed and eliminated from the body, too. “Women typically have a lower body weight than men, so when the same dose of a drug results in a higher level of drug circulating by body weight. As women generally have a greater body fat content than men, some drugs can be distributed through the body differently,” said Reichelt.
The impact of sex can differ across life stages, too. After menopause, the reduction of estrogen can alter aspects of brain plasticity. Preclinical studies have shown that at the neuronal level, estrogen can increase the density of dendritic spines.
This brain phenomena may subtly affect mood and cognition during a woman’s estrous cycle, and could affect clinical outcomes. More studies are needed to fully understand these impacts, especially when it comes to psychedelic medicines which are closely tied to brain plasticity and dendritic spines.
“We don’t yet have a clear understanding of how different biological factors, such as hormonal fluctuations, including menstrual cycle and menopause, may impact the psychedelic experience. However, it does seem that psychedelics may have an impact on menstrual function,” she said.
Gukasyan co-authored a recent study published in the Journal of Psychoactive Drugs on the impact of psychedelics on menstrual function. While the study looked at only three women ranging from 27 to 34 years of age, the results were significant enough to warrant more research.
“Although phenomena related to menstrual and reproductive function have been largely overlooked in the psychedelic literature to date, these effects may have therapeutic utility and warrant further study,” the study concluded.
Where To Go From Here
In the field of psychedelic medicine, where compounds are being extensively studied scientifically for the first time, the underrepresentation of women in clinical trials could have serious consequences for the safety and efficacy of these treatments. Without data on the experiences of women, it is impossible to accurately assess the potential benefits and risks of these new medicines before bringing them to the masses.
By working to increase the representation of women in clinical trials for psychedelics, we can help to ensure that these treatments are developed in a way that is safe, effective, and equitable for all.
Thankfully, many psychedelic clinical trials are moving forward with this ethos. For example, two-thirds of the participants in the MAPS’ Phase 2 and 3 clinical trials of MDMA therapy for the treatment of PTSD were women.
Rick Doblin, the founder of MAPS, said, “When it comes to PTSD, we talk a lot about the veterans, but it’s mostly women who are sexually abused or have childhood traumas that have PTSD. I think that the media attention on veterans sort of distracts people from the understanding that it’s mostly women that we are treating. Two-thirds of the people in the [MAPS] study are women.”
Other groups conducting clinical trials actively seeking women participants include Psycheceutical Bioscience, which has partnered with clinical research organization (CRO) iNGENū in Australia to conduct its Phase 1 and Phase 2 trials of a topical ketamine cream to treat PTSD.
“iNGENū takes gender balance in clinical trials very seriously and the diversity of participants is one of the key metrics we strive to achieve. We naturally want our clinical trials to recruit participants who closely match the intended population who will benefit from the drug when it is eventually approved,” said iNGENū CEO Dr. Sud Agarwal.
Women-Only Trials
While the inclusion of women in psychedelic clinical trials is critical to the success of this new paradigm in medicine, there’s also a whole realm of largely untapped research on the benefits of psychedelics for health conditions experienced only by women.
Felicity Pharma is a psychedelic biotech company focused on women’s health that’s secured a proprietary psilocybin-based drug for premenstrual dysphoric disorder (PMDD), a very severe form of premenstrual syndrome that affects up to 10 percent of women globally as well as postpartum depression.
Olivia Mannix, Felicity Pharma co-founder and CEO, said “We are passionate about transforming women’s healthcare. Women have been traditionally excluded from clinical trials because of hormonal fluctuations and general biological makeup. We are making a stand to develop female-focused therapeutics, where women will be the only patients used in trials.”
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.
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).
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.
This self-guided class investigates the history, science, and best practices for safe and effective microdosing; hosted by Adam Bramlage, founder of Flow State Micro, Dr. James Fadiman, the “father of modern microdosing,” and a dozen expert guest faculty. Enroll today!
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.
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.
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.
Applications close on March 26 for this year’s edition of Vital.
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.”
