Speaker 1: Hi, I'm Ethan Nadelman, and this is Psychoactive, a production
Speaker 1: of I Heart Radio and Protozoa Pictures. Psychoactive is the
Speaker 1: show where we talk about all things drugs. But any
Speaker 1: views expressed here do not represent those of I Heeart Media,
Speaker 1: Protozoa Pictures, or their executives and employees. Indeed, as an
Speaker 1: inveterate contrarian, I can tell you they may not even
Speaker 1: represent my own and nothing contained in this show should
Speaker 1: be used as medical advice or encouragement to use any
Speaker 1: type of drug. Hello, Psychoactive listeners. Uh, Today's guest is
Speaker 1: a really interesting one for me. It's Dr Nora Vocal,
Speaker 1: who has been the head of the National Institute on
Speaker 1: Drug Abuse in the US government since two thousand and three.
Speaker 1: That's under four different and presidential administrations, so it's been
Speaker 1: a remarkably long run overseeing the lead agency which provides
Speaker 1: the majority of funding for drug research, not just in
Speaker 1: the US, but really the majority all around the world.
Speaker 1: Those of you who know me, you'll know I've been
Speaker 1: highly critical of NIDA, Nationals Drug Abuse and Dr Volka
Speaker 1: over the years, in part because I think they've so
Speaker 1: overemphasized trying to establish that addiction is a brain disease,
Speaker 1: and and putting a lot of research into the neuroscience
Speaker 1: and brain imaging and all of that. And I personally
Speaker 1: think that they should be spending dramatically more money on
Speaker 1: things like ethnographic studies and setting things like the ways
Speaker 1: in which people control their drug use and more research
Speaker 1: on the benefits of drugs. Now, you should also be
Speaker 1: aware that a few years ago Nyder receives some dedicated
Speaker 1: funding from Congress, specifically UM to address issues involving the
Speaker 1: drug overdose. At the demo, and those of you have
Speaker 1: been listening carefully know that just a few episodes ago,
Speaker 1: in episode five, we had Professor Dan Chacheroni talking about
Speaker 1: what's going on with the overdose epidemic? Why did almost
Speaker 1: a hundred thousand people die last year? Uh? And so
Speaker 1: I started off the interview really by pressing uh Dr
Speaker 1: Volcale on that question, UM, And I will admit I
Speaker 1: was frustrated by some of her answer. She kept saying,
Speaker 1: we need more research on this, more research on that,
Speaker 1: you know, and of course Night has been spending more
Speaker 1: money and anybody in the world on doing research. But
Speaker 1: I'll tell you I was pleasantly surprised that she agreed
Speaker 1: to be a guest on Psychoactive. Nora grew up in
Speaker 1: Mexico City, has a fascinating family history that will get
Speaker 1: into early in the episode. She was an outstanding medical student,
Speaker 1: became a psychiatrist, held all sorts of influential positions, became
Speaker 1: a real leader in the US and around the world
Speaker 1: trying to understand addiction by looking at the brain through
Speaker 1: neural imaging and brain scans, and has had really quite
Speaker 1: a remarkable run. So, without further ado, here's my conversation
Speaker 1: with Nora vocal Nora, thank you so much for joining
Speaker 1: me today on Psychoactive. That's for having me and listen.
Speaker 1: My job here, right, I mean here, I've led until
Speaker 1: recently the leading drug policy reform institute, which was intensely
Speaker 1: critical of many government policies and oftentimes of Naida's work
Speaker 1: and priorities. But it's my job both to be the
Speaker 1: gracious host and also to press you on a lot
Speaker 1: of questions which have been on my mind that I'm
Speaker 1: sure in the minds of others. But let me just
Speaker 1: start off on a little bit of a personal thing,
Speaker 1: which is you have this remarkably interesting background familiar background,
Speaker 1: you know, growing up in Mexico, but growing up in
Speaker 1: the house in which your great grandfather, the Russian revolutionary
Speaker 1: Leon Trotsky, was murdered by Stalin's agents. And yet there's
Speaker 1: another part of your family history involving I think your
Speaker 1: grandfather of ears, which I understand it first sensitized you
Speaker 1: and made you start thinking about the issues of drugs
Speaker 1: and addiction and what you might do to address it.
Speaker 1: And I wonder if you could just tell us a
Speaker 1: little more about that. Yes, and and indeed, my my
Speaker 1: story comes from two different countries. I my father came
Speaker 1: from Russia and his grandfather was escaping from Stalin and
Speaker 1: ultimately the only place that gave asylum to his family
Speaker 1: was was Mexico, Whereas my mother was born in Spain
Speaker 1: and there was the Civil War, and again Mexico was
Speaker 1: a place that gave political asylum to all of those
Speaker 1: refugees that were escaping Franco. So I always like to
Speaker 1: say that I was born of the two Wars, or
Speaker 1: the last century Russian Revolution and the Civil War, and
Speaker 1: so that's that's how I came to be born in Mexico.
Speaker 1: What you were saying as in terms of what led
Speaker 1: me to think about addiction. And indeed, Um, the father
Speaker 1: of my other unbeknownst to me as as a child,
Speaker 1: I had never met him because he was in Spain
Speaker 1: and I was in Mexico, had a history of alcoholism,
Speaker 1: and when I was approximately probably six years of age,
Speaker 1: he committed suicide because he couldn't control the strong urge
Speaker 1: to to drink and had relapsed. So I did not
Speaker 1: find this until later, when I was already in medical school.
Speaker 1: But in the meantime, my favorite tone call of all times,
Speaker 1: my mother's older brother, also had a problem with alcohol,
Speaker 1: and to me, it was very contrasting to see the
Speaker 1: component about what an extraordinary individual he was, how generous,
Speaker 1: how smart, how charismatic on the one hand, and yet
Speaker 1: when he was drinking, his personality changed so much. And
Speaker 1: I was also intrinked about the family dynamics because nobody
Speaker 1: wanted to speak about it was like this antic secret.
Speaker 1: It gave me that insight that, I mean, people are
Speaker 1: not bad because they have a problem of addiction. They
Speaker 1: just have a problem that it's more powerful that they
Speaker 1: can't control, and it's not that they are doing this voluntarily.
Speaker 1: So as I went to medical school, I was also
Speaker 1: uphold at the way that our doctors were treating addiction.
Speaker 1: They were ignoring it, actually refusing sometimes to give treatment
Speaker 1: to someone that have a history of addiction because they
Speaker 1: thought that they were doing this to themselves and whatever
Speaker 1: happened to them, they deserved it. And I saw this
Speaker 1: even as I went after my residency training in psychiatry,
Speaker 1: where we would admit patients that have depression with an
Speaker 1: alcohol use disorder, and I would inquire to the attendance,
Speaker 1: how do we address the alcohol use disorder and do
Speaker 1: not worry about it, treat the depression and once the
Speaker 1: person leaves the host bital, then they will deal with
Speaker 1: their alcohol use disorder. And later on, as I became
Speaker 1: an attendant, directly forbidden to admit patients with an addiction
Speaker 1: into the inpatient unit of the hospital because they were
Speaker 1: patients that misbehaved under quote. So to me, all of
Speaker 1: these experiences were actually activating Miami Dallas, which are the
Speaker 1: centers of emotions of the brain, because it seemed completely
Speaker 1: counter factual with what we knew then on the pharmacology
Speaker 1: and the neuroscience of the brain, and we knew that
Speaker 1: we could make animals actually get compulsive in administering a
Speaker 1: drug to the expense that they would stop eating or drinking,
Speaker 1: and they actually j pordize their life. And so they
Speaker 1: are very in wire wire biological circuits that make us
Speaker 1: vulnerable to these drugs and in some people to that
Speaker 1: complete loss of control. So that's ultimately what led me
Speaker 1: to try to provide knowledge that could illuminate further her
Speaker 1: calpus understand what happens in the brain of people that
Speaker 1: lose control, with the idea that hopefully science will serve
Speaker 1: to change policies and reduce the stigma, and basically changed
Speaker 1: the notion of criminalizing people to that of treating and
Speaker 1: helping people and preventing them from relapsing. Yeah, so I'm
Speaker 1: trying to think, um, if I look at what natives
Speaker 1: priorities have been, and I think it was true under
Speaker 1: to some extent your predecessor listeners as well, But for you,
Speaker 1: really it feels like the major thrust of the agency
Speaker 1: really has been on the brain research, right and then
Speaker 1: your imaging in that the biggest share of the resources
Speaker 1: have gotten there, And what I have always felt has
Speaker 1: been a sort of inadequate attention to funding the sort
Speaker 1: of ethnographic work the deep analysis into drug using communities
Speaker 1: and drug cultures into truly understanding what's going on there,
Speaker 1: especially we're dealing with the overdose issue and the opioid issue.
Speaker 1: I mean, I know you find some stuff in that area,
Speaker 1: but it seems like it's relatively modest, very modest compared
Speaker 1: to the work that's being done. And they were imaging
Speaker 1: in the brain stuff, and I mean, what's the rationale
Speaker 1: for that? Is that you believe that the brain work
Speaker 1: is going to lead to the big breakthrough. I mean,
Speaker 1: here we're focusing on the opioid epidemic, right, which is
Speaker 1: now what we're approaching a hundred thousand people dying overdose
Speaker 1: and all sorts of other ills associated with this. Why
Speaker 1: is such a focus on that well, I mean, obviously
Speaker 1: we are very much interested on basic neuroscience to help
Speaker 1: us understand how it affects the brain. But we invest
Speaker 1: much more money on research that relates to those very
Speaker 1: important components that you discuss the issue of how socio
Speaker 1: economical factors, cultural factors influence the vulnerability of resilience for
Speaker 1: drug taking, and so our dollar amounts spent in research
Speaker 1: that relates, for example, to prevention services in implementation epidemiology,
Speaker 1: in fact, is greater than what we've spent in basic neuroscience.
Speaker 1: We have this need in humans of polarizing things into
Speaker 1: this or that, and ultimately that reality is that our
Speaker 1: social systems are product of our brains interacting with one another,
Speaker 1: and our brains are a product of our circumstances. So
Speaker 1: the challenge in science is how do we integrate these fields.
Speaker 1: For example, a very important story we have been doing
Speaker 1: since twenty sixteen is a developmental study of children as
Speaker 1: a transition into adulthood. And yez, we're studying their brains,
Speaker 1: but yez, we're doing a very in depth phenotypic characterization
Speaker 1: of their social environment. And as a result of these
Speaker 1: longitude in our study, large longitude in our story, researchers
Speaker 1: have been able to document some extremely powerful relationships between
Speaker 1: these adverse social environments and how the brain develops. And
Speaker 1: also important in sites on how very early owned children
Speaker 1: as mistreating if they come from certain racial backgrounds. And
Speaker 1: we are about to start a similar study in initiating
Speaker 1: early in infancy to follow it up, and it will
Speaker 1: give us some much better understanding about how our environment
Speaker 1: influences the brain. Well, but now when I'm really getting
Speaker 1: at those. I remember back in the seventies and eighties
Speaker 1: there was this incredible richness of ethnographic studies going on,
Speaker 1: and and famous ethnographers Michael Agar and others, and a
Speaker 1: whole cohort who are really doing in depth studies. And
Speaker 1: now I look at the questions that emerged around say,
Speaker 1: fentonyl on the opioids, the question about how our consumers
Speaker 1: responding when people know that fentanyels out on the street,
Speaker 1: that they run forward to run away for it. What
Speaker 1: sorts of precautions are they taking us to be their
Speaker 1: own use to what exentered? The people who's selling these drugs,
Speaker 1: the lowest level retail sellers, to what extent do they
Speaker 1: know what's in their drugs? Are they exercising any sort
Speaker 1: of harm reduction measures us to be their own consumers?
Speaker 1: Right to what ex center? These drugs all being mixed,
Speaker 1: Why is ventinyl landing up and the stimulants apply with
Speaker 1: cocaine and methamphetamine. And there's these hosts of questions, and
Speaker 1: it seems to me that essentially nobody has the answers.
Speaker 1: And when I talked to, you know, the sociologist, the
Speaker 1: ethnographers the others who are getting funded. They're saying, Ethan,
Speaker 1: You're right, those are really important questions. But the truth
Speaker 1: of is it, there's only a handful of us really
Speaker 1: getting this abundance of funding to do this stuff. Isn't
Speaker 1: a part of the job of NAIDA to be digging
Speaker 1: deeply into what's actually going on in these active markets
Speaker 1: right now, finding these things out, and trying to dig
Speaker 1: into what sorts of interventions you can do with active
Speaker 1: drug users and even low level sellers in order to
Speaker 1: reduce the harms that are resulting from ventanyl and these
Speaker 1: other opioids being on the street. Absolutely, we have a
Speaker 1: responsibility to bring a light that can help address these
Speaker 1: very challenging times. And what I can tell you I mean,
Speaker 1: and this is in terms I mean. One of the
Speaker 1: main drivers about why we have synthetic opio is now
Speaker 1: widespread through the United States is because the profits for
Speaker 1: the dealers and those that are generating these drugs are
Speaker 1: much greater than they are for something like heroin or
Speaker 1: many of the other drugs that require cultivation. So one
Speaker 1: of the reasons why you see so many drugs being
Speaker 1: laced with fentannel is that the dealers are going to
Speaker 1: be making much more money. And we do have ethnographic
Speaker 1: reports that actually go and speak with people on the
Speaker 1: streets and for example in Baltimore, John heroin users maybe
Speaker 1: in some instances seeking out fentannel, but the older ones
Speaker 1: are actually afraid of it, but they cannot afford to
Speaker 1: buy pure heroin because it's more expensive. Also many instances
Speaker 1: it is very difficult to get pure heroin even if
Speaker 1: you have the money to pay for it. So it
Speaker 1: is a reality that unfortunately, the enormous amount of money
Speaker 1: that can be made by selling fentannel is driving the market.
Speaker 1: And so I mean in terms of scientific questions is
Speaker 1: how do we counteract that negative effects and the strong
Speaker 1: aggressive distribution of fentanyl and its contamination of the other drugs.
Speaker 1: That's unfortunately, at an essence part of the normal challenges
Speaker 1: that we have. But we need to understand also that
Speaker 1: diversity of the markets and too to meet one of
Speaker 1: the key important issues for addressing, for example, the obvious
Speaker 1: crisis is to have more timely data, just like like
Speaker 1: we had with COVID, Right, you see immediately you know
Speaker 1: when you're starting to have the new variance. We don't
Speaker 1: have that for fentanil. So if I get data, it's
Speaker 1: at least six months later of over those mortality across
Speaker 1: different areas of the country, and by then many people
Speaker 1: have died. And the technology is out there that would
Speaker 1: enable us to detect early on when we see in
Speaker 1: a community the emergence of these very little drugs. I
Speaker 1: know my own I just to say, my own sense
Speaker 1: is that if you were the funding army of hnographers
Speaker 1: going out there doing snowball research, paying drug users to
Speaker 1: connect with other drug researchers, finding out what they're doing
Speaker 1: around these new drugs emerging, what sorts of precautions are doing,
Speaker 1: and even funding studies that try to enlist drug sellers,
Speaker 1: whether they're currently incarcerated or whether they're still operating the
Speaker 1: community to find out. Look, drug sellers don't want dead customers.
Speaker 1: It's bad for business, right, or even trying to find
Speaker 1: out what I mean, I don't know if you know
Speaker 1: the answer. Why is it that cocaine and methamphetamine are
Speaker 1: being cut now with fentanyl? I mean, are they trying
Speaker 1: to make some form of new speedball or is it
Speaker 1: just out of ignorance on the part of retail sellers.
Speaker 1: Are the customers actually want that. I mean, what do
Speaker 1: we know about that right now? What we know is
Speaker 1: that many of the debts associated with stimulants our own
Speaker 1: beknowns to the person that they were getting actually a
Speaker 1: stimulant that was contaminated with fantaniel in some instances. Yes,
Speaker 1: as you know that speed bowling was the way that
Speaker 1: people used to want to get tired. Um, you don't
Speaker 1: have just one reason why people maybe combining, but I
Speaker 1: need a very important contribution is people not knowing that
Speaker 1: they are getting fantonil, being stimulant users having no tolerance
Speaker 1: for opious and therefore that drug combination is particularly little.
Speaker 1: And yes, I mean I think that one of the
Speaker 1: issues that you need to consider in terms of how
Speaker 1: we have to make decisions. Absolutely, we need to understand
Speaker 1: the problem in better ways, in more efficient ways, but
Speaker 1: we also need to develop tools that will allow us
Speaker 1: to address it. So it's not just that we are
Speaker 1: actually have the resources just to do epidemiology and ethnography research.
Speaker 1: We need to help develop medications. We need to develop
Speaker 1: models that will ensure that individuals that need care will
Speaker 1: be given care. We need to actually develop models for
Speaker 1: prevention of relapses, for prevention into drug taking. It's not
Speaker 1: just one thing that we can allocate all of our resources.
Speaker 1: It is crucial that we understand the age share of
Speaker 1: the problem. And it's also crucial in that respect that
Speaker 1: with partner with other agencies so that we maximize the
Speaker 1: resources and we can achieve more. And they're speaking about
Speaker 1: something that is very very intriguing, and it's an area
Speaker 1: that has been not thought much at and and so
Speaker 1: I'm curious that you asked me about it, which is
Speaker 1: the notion about the dealers. How do that dealers end
Speaker 1: up dealing with these very dangerous strokes And that is
Speaker 1: is something that we don't have research into that area.
Speaker 1: It would be a great thing to solicit proposal for
Speaker 1: because quite frankly, whether or not the lowest level retail
Speaker 1: suppliers um actually know what's in their drugs and what
Speaker 1: precautions they take and what's going on in that dynamic
Speaker 1: would be fantastically valuable giving the amount of accidental overdose
Speaker 1: that's happening right now. We'll be talking more after we
Speaker 1: hear this add You know, I saw recently that you
Speaker 1: wrote a piece in which you said you supported drug decriminalization,
Speaker 1: and I know you've never been a fan of the
Speaker 1: War on drugs. But here you've been operating in a
Speaker 1: political context in which punitive prohibitionist policies, mass arrests, you know,
Speaker 1: the heavily racial biases that go with all of that
Speaker 1: has been pervasive. Now, one of the other criticisms has been,
Speaker 1: you know, they're always looking for what's wrong with drugs,
Speaker 1: but what about what's wrong with drug policies. I'm gonna
Speaker 1: taking example. I'll see you write an article about all
Speaker 1: the harmful consequences of marijuana, right, and we can agree
Speaker 1: that one has to identify the harmful consum marijuana. But
Speaker 1: there's nothing coming out of nightA that I'm aware of
Speaker 1: that's looking at the harmful consequences of marijuana arrest or
Speaker 1: marijuana related loss of employment, or even from a health context.
Speaker 1: When you put somebody in jail for marijuana or arrest them,
Speaker 1: restript them of the job, that has consequences for their
Speaker 1: broader life. It also can be traumatic and cause things
Speaker 1: that might impacked their brains in ways like that. So
Speaker 1: what has been the resistance to this? Isn't that important?
Speaker 1: I mean? And if not, you whop you know? And
Speaker 1: it's crucial And I basically from day one. I've been
Speaker 1: against criminalization of people that because they have a problem
Speaker 1: with substantious disorders. I've been very, very vocal. We found
Speaker 1: that research to show how negative the consequences are of
Speaker 1: imprisonment into the brain. It actually increases the risk of
Speaker 1: drop taking and it basically also increases right now even
Speaker 1: more than before when it was known that risk for
Speaker 1: overdosing and dying. A very important project that we have
Speaker 1: been doing now for year years and now we've actually
Speaker 1: expanded because we got extra resources, is with a criminal
Speaker 1: justice setting exactly to provide alternative models that will ensure
Speaker 1: that people, if for whatever reason first of all end
Speaker 1: up in jail on prison, that they get treatment and
Speaker 1: that they get support, and also to determine how one
Speaker 1: can intervene to avoid that incarceration. We have funded research
Speaker 1: showing that, as you mentioned, when you have a relative
Speaker 1: of father and mother that ends up in jail or prison,
Speaker 1: the risk of the child to have a substance to
Speaker 1: use this order is much greater, and that is known
Speaker 1: and no one is questioning it. So we've been trying
Speaker 1: to disseminate this information. And when I am I have
Speaker 1: to actually speak in Congress or the Senate. I bring
Speaker 1: up this issue because I feel very very strongly, and
Speaker 1: in fact, one of the reasons why I took this
Speaker 1: position was because I say we can develop the science
Speaker 1: in such a way as that that policy changes. I've
Speaker 1: also been openly active criticizing the policy of incarcerating for
Speaker 1: crack versus cocaine, which made absolutely no sense, and there's
Speaker 1: record on those things. The issue comes about, I mean
Speaker 1: that there are structural systems in such a way that
Speaker 1: promotes certain behaviors, and science as not enough to change
Speaker 1: those policies. So my question that I always say is
Speaker 1: what is it that science cannot cover to change policies
Speaker 1: that would get rid of these structural characteristics that are
Speaker 1: leading to these inequalities. And we are very much interested,
Speaker 1: for example, in policies. We found several researchers to identify
Speaker 1: policies across the states as on how they are legalizing marijuana,
Speaker 1: because as you look through the states, for example, you
Speaker 1: see that the adverse effects of marijuana use are much
Speaker 1: worse in some states, whereas other states that have legalized
Speaker 1: actually have better outcomes. So understanding what policies basically protect
Speaker 1: from negative effects and may actually lead to better outcomes,
Speaker 1: it's crucial and we're funding it. So yes, the answer
Speaker 1: is yes. Yeah. There's one issue I think, going back
Speaker 1: a number of years ago, where if I pat myself
Speaker 1: on the back, I think I was more right than
Speaker 1: you were, which is people were saying, if you're gonna
Speaker 1: legalize marijuana, you're gonna see this explosion in adolescent usaid
Speaker 1: mari juana and problematic use. And I think you were
Speaker 1: part of that group saying that. And what hit me
Speaker 1: at the time, you know this is back six seven
Speaker 1: years ago, was that adolescents have for fifty years always
Speaker 1: had the best access to marijuana. Right, even as mari
Speaker 1: wanna use among adolescents has gone up and down the
Speaker 1: ust fifty years, the surveys that ask about access consistently
Speaker 1: show eighty percent of high school seniors saying they have
Speaker 1: easy access. So my sense was that marijuana use among
Speaker 1: adolescents was not going to change much as a result,
Speaker 1: for the simple reason that access was already so abundant,
Speaker 1: but that where you were going to see the jump
Speaker 1: was going to be among people our age and a
Speaker 1: little older and a little younger people using it because
Speaker 1: they preferred it to alcohol or pharmaceuticals. And in point
Speaker 1: of fact, it looks like there's been a tripling or
Speaker 1: quadrupling of marijuana use among people you know, our age
Speaker 1: or older um, whereas the adolescents have stayed relatively constant.
Speaker 1: And my job, I wouldn't be surprised if he jumps
Speaker 1: in the future. Part of the other research I think
Speaker 1: suggests that use of drugs oftentimes goes up and down
Speaker 1: independent of what the policy is. There's a whole range
Speaker 1: of other variables out there. And I guess when my
Speaker 1: question now comes to you is when you write a
Speaker 1: piece about the harms of marijuana, why not write a
Speaker 1: piece about the benefits? What about a piece about the
Speaker 1: controlled juice? What about one piece that looks at it all.
Speaker 1: You know, many people were so frustrated that NITA did
Speaker 1: not support the medical marijuana research. It took forever and
Speaker 1: ever and ever. Or you look at the fact that
Speaker 1: the vast majority people use marijuana don't really have a problem.
Speaker 1: It is clearly problematic and even addictive for some, and
Speaker 1: we have to be aware of that. But why not
Speaker 1: have a more holistic, comprehensive approach to Let's just take
Speaker 1: the drug marijuana as one example, yeah, no, and I
Speaker 1: think that one of the reasons why is because the
Speaker 1: data on the benefit from marijuana is very limited, and
Speaker 1: it is very limited because there is limited research. And
Speaker 1: so one of the things that I have been involved
Speaker 1: now for more than a decade, and I must say
Speaker 1: that I have been unsuccessful, is to stry to change
Speaker 1: the policies that make it so very difficult for researchers
Speaker 1: to have marijuana. So marijuana is a scalle one draw.
Speaker 1: So if you, as a researcher want to do work
Speaker 1: with marijuana, you have to get a d A license
Speaker 1: and get approval from the FDA, and that takes at
Speaker 1: least one year, and then if you change your protocol,
Speaker 1: you have to go through the process again. So it's
Speaker 1: extraordinary comberson and as a result of that, researchers don't
Speaker 1: want to get into the field. That's one second. We
Speaker 1: are also mandated, actually this is not my choice. We
Speaker 1: are mandated to provide the marijuana for research purposes, and
Speaker 1: so we contract these to a farm in Mississippi that
Speaker 1: produces the marijuana. But this system is actually not ideal
Speaker 1: because when you are testing a marijuana, say, for example,
Speaker 1: you're interested on its potential value, for PTSD or for cancer,
Speaker 1: for whatever you want, you are going to be working
Speaker 1: with a particular plant, and it's unlikely that we have
Speaker 1: such a plant, so it has hinder research. And I
Speaker 1: think it was last week that finally that government has
Speaker 1: identified to other producers that can provide marijuana, and if
Speaker 1: that happens, of course that will facilitate the research into
Speaker 1: the medical use of cannabis. I also want to comment
Speaker 1: that neither those fund research on medical marijuana, but we
Speaker 1: limited to potential beneficial effect for treatment of addiction, for
Speaker 1: treatment of pain, and for treatment improving outcomes from the
Speaker 1: individuals that may have HIV. So we limited to risk
Speaker 1: conditions because otherwise all of our money would go into
Speaker 1: research on medical properties of marijuana for US skimmers, for
Speaker 1: carter aspolarisis for inflammation. We are hoping that the other
Speaker 1: institutes will take those projects that pertains to the diseases
Speaker 1: that they are working on. And you were right. I
Speaker 1: was expecting that use of my juana mo cadolescens would
Speaker 1: go up, and overall it hasn't. But what we are
Speaker 1: starting to see, which is again important to keep an
Speaker 1: eye on, is that regular use of marijuana appears to
Speaker 1: be going up among other lessons, and that's that's of
Speaker 1: course of concern. Yeah, nor you know, I so much
Speaker 1: share your concern that with legalization that marijuana almost becoming
Speaker 1: overly normalized in the way that people begin to sort
Speaker 1: of lose its specialness and use it in ways that
Speaker 1: are problematic. So we share some overlap there. But you
Speaker 1: know you mentioned the Schedule one thing. You know, there
Speaker 1: were lawsuits some years ago to try to get the
Speaker 1: d A to reschedule marijuana from Schedule one to Schedule two,
Speaker 1: and another lawsuit reguarding m d m A, And in
Speaker 1: both cases the d AS administrative law judge ruled that
Speaker 1: in fact, based on the evidence, it should be rescheduled.
Speaker 1: But under U S Law, the head of the d
Speaker 1: e A has a legal power to dismiss the recommendation
Speaker 1: by his administrative law judge and just keep it where
Speaker 1: it is now. I'm curious, I mean, do you think
Speaker 1: it's appropriate for a police agency like d e A
Speaker 1: to be control of that. Shouldn't it instead be national
Speaker 1: in stuite of health for me to be even better
Speaker 1: and independent body like Institute of Medicine at the National
Speaker 1: Academies of Science. Well, I mean, I think that, in
Speaker 1: my view, is not what I think. I mean, it's
Speaker 1: the way that this system is organized. What I can
Speaker 1: tell you is a very specifically explicitly describe this as
Speaker 1: a problem in the meetings that I have at the
Speaker 1: United Nations to state that the scandaling has made it
Speaker 1: hard to do research, which is impedding again, investigations that
Speaker 1: relate to the potential medical utility of cannabinoids that are
Speaker 1: in marijuana. So I represent the science, and there are
Speaker 1: other people that make the rules about regulations and and
Speaker 1: that's what the missions of the agencies are. So yeah,
Speaker 1: now I hear you, But you know, I was thinking
Speaker 1: about this. There is only one other person I can
Speaker 1: think of who has headed a drug related agency in
Speaker 1: the federal government for longer than you. Right, You're the
Speaker 1: longest at NIDA, You're the longest d e A, the
Speaker 1: only one I can think of. It. It's not putting
Speaker 1: you in I don't want to put you in bad company.
Speaker 1: You're goill be Harry Anslinger, right, the guy around the
Speaker 1: thorough Vieau of narcotics for like thirty two years or
Speaker 1: something like that. But you are in a position of
Speaker 1: tremendous influence by virtue of your tenure, and I have
Speaker 1: to ask you this question, and as frankly as you
Speaker 1: can answer it, I'd be curious. You came in under
Speaker 1: President Bush in two thousand and three when the drugs
Speaker 1: are John Walters was a fanatical anti drug guy. I
Speaker 1: saw some of your testimony in front of that congressman
Speaker 1: Mark Suitor, I mean, real drug ward nutcases, and I
Speaker 1: admired the fact that you were telling him what the
Speaker 1: evidence was on needle exchange. And then you go under
Speaker 1: Obama and things open up, especially in the second term,
Speaker 1: and then you're dealing with Trump and the first head
Speaker 1: of Health and Human Services, your boss, I guess twice removed,
Speaker 1: who like doesn't know his asked from his elbow about
Speaker 1: method on and now under Biden, where things are opening
Speaker 1: up somewhat. Can you say anything, frankly about what it's
Speaker 1: like to deal with that political context, especially at the
Speaker 1: federal level. Well, I've always spoken up, and I've said
Speaker 1: it very specifically. We are an agency of science and
Speaker 1: we need to be allowed to do science. Let the
Speaker 1: evidence speak. The moment that our actions become politicized, we
Speaker 1: lose any credibility. Obviously in some instances it maybe you
Speaker 1: just have to be a little bit more diplomatic on
Speaker 1: the way that you present these things. But I do
Speaker 1: believe that that is our job, that's our responsibility. We
Speaker 1: need to bring the science that can help guide decisions,
Speaker 1: because if we don't do it, then we shouldn't be
Speaker 1: in these positions. Well, okay, so let me repeat to
Speaker 1: you something I've been saying since the nineties, and and
Speaker 1: you know, please don't take offense at it, but it
Speaker 1: was kind of my broader perspective on this thing. And
Speaker 1: I don't think it's as true today as it was then,
Speaker 1: but I still think there's truth to it. I would
Speaker 1: say they're trying to do innovative drug abuse research in
Speaker 1: the United States is a little like trying to do
Speaker 1: innovative social science research in the old Soviet Union. That
Speaker 1: curious researchers quickly learned that there are certain questions the
Speaker 1: authorities don't want to have asked and certain answers they
Speaker 1: don't want to have given. And then if you persis
Speaker 1: often asking the wrong questions, you're giving the wrong answers. Well,
Speaker 1: you're less likely to have your grants fundedge, you're less
Speaker 1: likely to be asked to serve on grant review committees,
Speaker 1: you're more likely to have your publications or things sent
Speaker 1: to hostile reviewers. And what happens then is that many researches,
Speaker 1: especially in the hard scientists, basically developed, you know, political blinders,
Speaker 1: and that over time those political blinders become intellectual blinders
Speaker 1: where they even forget to really ask some of the
Speaker 1: most interesting questions that might happen. And so then I
Speaker 1: asked people in the U S what does it feel like,
Speaker 1: and they'll say, well, you know, Ethan, I'd say, we
Speaker 1: were constantly advised by night A grant officers until maybe
Speaker 1: around Obama's second term not to use the phrase harm
Speaker 1: reduction and our grand proposals. Um we are even now
Speaker 1: don't use the words control drug use and a grand proposal,
Speaker 1: or it's just gonna say forget it. If I ask,
Speaker 1: why isn't night OF funding research on the prescribing of
Speaker 1: pharmaceutical heroin the way the Europeans are, or safe injection sites,
Speaker 1: or a whole range of other things. And there don't
Speaker 1: seem to be any good scientific reasons for not funding
Speaker 1: that stuff. It seems to be about a political context
Speaker 1: in which funding for this stuff is politically disapproved, and
Speaker 1: that even if the people in your agency or yourself
Speaker 1: approve of it, there's a realization that members of Congress,
Speaker 1: you know, could get furious for funding things like this.
Speaker 1: So what's your frankisty answer to all of that? My
Speaker 1: Branco law answer to this is absolutely there were certain
Speaker 1: terms that when you have it in the grand we
Speaker 1: would be questioned about why we were founding science and
Speaker 1: sort and such a subject matter. So my perspective was,
Speaker 1: as you cannot go into an argument like that openly
Speaker 1: when the arguments are so irrational, So you just change
Speaker 1: that terminology is used, so you don't use carm reduction,
Speaker 1: use other terms. I mean, again, we need to have
Speaker 1: flexibility in our brains to accomplish what is it that
Speaker 1: we want to accomplish. We want science that can bring
Speaker 1: up actions that can improve It's not just because it
Speaker 1: is academically interesting. So if I can keep on funding
Speaker 1: things without having them come in and and removing asking
Speaker 1: us to cut the funding by changing the terminology, what
Speaker 1: do I lose? I mean, it is again, what battles
Speaker 1: do you want to do? Right? I mean? And I
Speaker 1: certainly I do navigate that they are tremendous prejudices as
Speaker 1: still and tremendous stigmatization against addiction and its treatments. And
Speaker 1: so my job is how within this environment and we
Speaker 1: continue doing the work to minimize actually negative effects. Now
Speaker 1: you're bringing something because of course I think about these things.
Speaker 1: I mean sort of actually in terms of the Europeans
Speaker 1: have been using high doses of morphine to treat people
Speaker 1: that actually are not responding to other treatments of heroin
Speaker 1: and those we've looked into that and one of the
Speaker 1: reasons why it was not it did not make sense
Speaker 1: for us at that time definitively on the basis of
Speaker 1: the analysis to bring that as a treatment that could
Speaker 1: be tested in the at that states. It was much
Speaker 1: more consuming in resources to set up those injection sides.
Speaker 1: And also the other problem with it is that patients
Speaker 1: were developing arrhythmias with these guy doses of heroin, so
Speaker 1: they were not so benign. And as it relates to
Speaker 1: m safe injection sides, I mean, we've been not directly
Speaker 1: funding the research on the safe injection sides, but we've
Speaker 1: been funding the researchers that are doing that work to
Speaker 1: understand downstream how these support systems as a community can
Speaker 1: help people, for example, engage in treatment, how they can
Speaker 1: prevent them from getting infected from HIV, and how they
Speaker 1: can prevent them from overdosing and time. But let me
Speaker 1: just ask you, I mean, just take example, the Heroin
Speaker 1: maintenance thing, you know, back actually before your time, in
Speaker 1: the late nineties, I pulled together a group of researchers
Speaker 1: from the US and Canada and the Europeans who are
Speaker 1: all interested in getting trials going on in North America.
Speaker 1: We called it NAOMI, the North American OPI Medica Asian Initiative.
Speaker 1: And what happened was that the Canadian leg took off
Speaker 1: and they actually did it, and they now have it
Speaker 1: in many cities in Canada, and you now see it
Speaker 1: in many countries in Europe, and it is proving overwhelming successful.
Speaker 1: It's not perfect, as you said, there are some problems resulting,
Speaker 1: but it's reduced crime, reduced over those, reduced problems of addiction,
Speaker 1: all this sort of stuff. But in the US, what
Speaker 1: happened was the researchers said, Ethan, we're never going to
Speaker 1: be able to get the funding. And even more recently,
Speaker 1: the last meeting I had organized before I left Drug
Speaker 1: Policy Lines four years ago it was a meeting to
Speaker 1: bring together a younger generation of researchers, and people are saying, well,
Speaker 1: why can't we at least give it a shot here,
Speaker 1: or even if we don't use heroin pharmaceutical heroin, why
Speaker 1: not use hydromorphone. You know, delouded, right, a drug that's
Speaker 1: given out in American hospitals two hundreds of thousands of people.
Speaker 1: We know from control double blind studies that long term
Speaker 1: heroin attics can't tell the difference between delouded hydromorphone and heroin.
Speaker 1: And then the public value benefit, which I mean part
Speaker 1: of what happened in Europe was they started doing these
Speaker 1: things and it helped transform people's understanding of heroin and
Speaker 1: addiction that you meanize it. Rather than people being these
Speaker 1: junkies chasing this dirty drug, people began to realize that
Speaker 1: the drug itself was not as dangerous and it was
Speaker 1: more the fact that it was illegal. So it seemed
Speaker 1: that some allocation of nita's resource is something like this
Speaker 1: would be usually advantageous. And I know when I talked
Speaker 1: to mayors and police choose around the country, they said, hey,
Speaker 1: as a research study, sure we won't object to it.
Speaker 1: Why not make that a priority, especially given the issues
Speaker 1: with sentinel now and so many people dying. Well, you
Speaker 1: know what has made a gigantic difference, and the data
Speaker 1: is out there, I mean, because this helps a very
Speaker 1: restricted number of people. But what has made a magnificent
Speaker 1: difference in terms of over those mortalities and outcomes is
Speaker 1: what France has done with bupren orphins. So, if we
Speaker 1: have alternative medications that actually are safer and that can
Speaker 1: be deployed, and we're not doing that because the insurance
Speaker 1: companies are not willing to reimburse, my focus is going
Speaker 1: to be on how can I affect practices that are
Speaker 1: likely to have a larger impact. And again, and it's
Speaker 1: the issue of when you don't have all of the
Speaker 1: resources of the world, you have to strategize which are
Speaker 1: the ones that are going to have the largest impact.
Speaker 1: And if you just look at the data in the
Speaker 1: United States, the majority of people that are on treatment
Speaker 1: for opiot disorder are on buoprinorphin. And so right now,
Speaker 1: for example, one of our priorities is to actually expand
Speaker 1: our basically knowledge base on clinical trials for the use
Speaker 1: of booprenorphin on people that are being exposed to fantonil,
Speaker 1: for which there is no clear call evidence about how
Speaker 1: to properly treat them, what doses to use, why not
Speaker 1: use extended formulations, how to initiate them in boopernorphin, and
Speaker 1: also the sustainability of these practices in terms of costs.
Speaker 1: So I see it as you know, there's not enough
Speaker 1: money to be poured into the treatment of people with
Speaker 1: substance use disorder, so trying to come up with models
Speaker 1: that will ensure that the treatment will be provided it's
Speaker 1: also key component. Let's take a break here and go
Speaker 1: to an ad. When I was calling around, one person
Speaker 1: who sang your praises, said that you've been very supportive
Speaker 1: of expanding the access to method on rupernurphine behind bars, right,
Speaker 1: You've been a big advocate that. I remember ten fifteen
Speaker 1: years ago Drug Policy Alliance, we'll be organizing side sessions
Speaker 1: at the annual meetings of American Correctional Association, and it
Speaker 1: was just incredibly difficult to get correctional officials to come
Speaker 1: along with this. And when I asked my friend what
Speaker 1: was most significant about that, he said, you know, what
Speaker 1: we found was that people they appreciate the opportunities you
Speaker 1: just figure out what worked for them. For some, bruperophine
Speaker 1: work better than method on. For others, method on work
Speaker 1: better for some, nel trek Zone was the preferred one,
Speaker 1: you know, for our listeners. The first two of those
Speaker 1: drugs are basically sort of agonists, and there's like giving uh, say,
Speaker 1: a nicotine patch to a cigarette addict, and al trek
Speaker 1: Zone is an antagonist, which you know blocks the dealing
Speaker 1: of these drugs. But it seems like just when we're
Speaker 1: dealing with depression, we tried different antidepressants. When we're trying
Speaker 1: dealing with pain management, we ideally are trying different opio
Speaker 1: s see will work better. It does seem that when
Speaker 1: it comes to dealing with heroin adjection and other illicit
Speaker 1: drug opioid adjection, we should be making as many options
Speaker 1: available as possible. I mean, I mean you basically agree
Speaker 1: with that D percent agree And I use the same
Speaker 1: analogiens as how many antidepressants we have, how many antibiotics
Speaker 1: we have, and we are the only condition for we
Speaker 1: said we have three. That's enough. In many ways, and
Speaker 1: I perhaps shouldn't use this word. We've been very constrained
Speaker 1: in many ways by the need to actually document that
Speaker 1: the medications and the treatment are producing abstinence. And we've
Speaker 1: been knowing that certain treatments, while not producing abstinence, will
Speaker 1: improve the quality of life of people and protect them.
Speaker 1: And so we've been trying to have a dialogue and
Speaker 1: we've had a dialogue with the FDA. This is the
Speaker 1: outcomes that they required to change those outcome so that
Speaker 1: we can allow for treatments that, while not producing abstinence,
Speaker 1: are going to be beneficial for the patients. They are
Speaker 1: willing for us to consider this if we can provide
Speaker 1: them evidence that this is meaningful. So we're funding researchers
Speaker 1: to show this. And so now there is data that
Speaker 1: we indicates, for example, that whooprint orphin or metal or
Speaker 1: other medications, even if they don't produce abstinence, they reduce
Speaker 1: the negative outcomes with HIV, They improve retention into anti
Speaker 1: retroviral therapy, they decrease the likelihood of being incarcerated. So
Speaker 1: these are meaningful consequences to that person. So we are
Speaker 1: again negotiating towards also discussing possible medications that we may
Speaker 1: have tested in the past that we're found nonefications because
Speaker 1: the outcomes was impossible to reach complete abstinence a very,
Speaker 1: very difficult work to achieve, and I think it is
Speaker 1: different from what we demand for antidepressants or for an analgestic.
Speaker 1: You don't demand that the pain become completely you didn
Speaker 1: and a fifteen percent reduction, I mean, so we are
Speaker 1: this has made the development of medications much harder. Uh so,
Speaker 1: I mean you essentially see the dealing with this sort
Speaker 1: of twelve step absinence only ideology has a real challenge
Speaker 1: for you that it really gets in the way of
Speaker 1: effective drug treatment and changing policies. Is that fair to say? Well,
Speaker 1: what I mean, I'm not so categorical in my thinkings.
Speaker 1: I mean, my perspective is recognizing that there is a
Speaker 1: diversity of people and for some individuals that of Step
Speaker 1: programs maybe um life saving, but for many others they
Speaker 1: are not. And so in my perspective, I value that
Speaker 1: all Step programs because I do recognize that they offer
Speaker 1: support for people and have been able to help people recover.
Speaker 1: So why would I be critical of that? What I
Speaker 1: am critical of is their categorical rejection by many of them,
Speaker 1: of the use of medications for treatment of substance use disorders.
Speaker 1: I was actually speaking with a volunteer patient with an
Speaker 1: opiate use disorder who is on boubernorphine and who was
Speaker 1: very much in conflict because he wanted very much to
Speaker 1: be part of the twelve step program, but he didn't
Speaker 1: want to lie to them that he actually was taking
Speaker 1: Boobern norphin and he didn't want to stop taking Boobern
Speaker 1: rphin because he recognized that it helped him enormously. Why
Speaker 1: I put individuals that are already with tremendous challenges in
Speaker 1: a conflict to have to decide one versus the other?
Speaker 1: What else it tell us that both of them can improve.
Speaker 1: We do it for cancer, we do it for HIV,
Speaker 1: we do it for everything. Why do we need to
Speaker 1: have one or the other? So do you remind me?
Speaker 1: I remember coming across a twelve step program being run
Speaker 1: out of Bellevue Hospital years ago, which was a twelve
Speaker 1: step program for people and that slimated it who felt
Speaker 1: discriminated against the normal twelve step programs, like the methodology,
Speaker 1: like the community there, but felt Tay can do it.
Speaker 1: But now let me switch back to this thing. You know,
Speaker 1: part of the promise, supposedly, I think of the focus
Speaker 1: on the brain and the way you've put the resources
Speaker 1: between the brain and addiction. Was hoped that new medications
Speaker 1: would come out for dealing with addiction. But if we
Speaker 1: look at the basics, right, methanon, ruper norphine, nil tracks on,
Speaker 1: and niloxon for dealing with overdose. All four of those
Speaker 1: drugs were patented between fifty and seventy or more years ago,
Speaker 1: and really nothing new, really of significance has come along.
Speaker 1: I mean, part of what was interesting about the heroin
Speaker 1: hydromorphone stuff in Europe and some other innovations there was
Speaker 1: at least it was another thing that worked for people
Speaker 1: for whom method on a grouper rhine was not working.
Speaker 1: But is there anything on the horizon, whether with opioids
Speaker 1: or whether in dealing with the stimulants. I think you
Speaker 1: you're out there saying the best thing we have is
Speaker 1: contingency management, a behavioral approach rather pharmacological approach. Is there
Speaker 1: anything promising on the horizon, the short horizon for adding
Speaker 1: some other drug to this mix? Yeah, there is. And
Speaker 1: I don't think that we should minimize celtic interventions because
Speaker 1: one of the things that the neuroscience has enabled us
Speaker 1: to do is to understand how these behavioral interventions are
Speaker 1: affecting neurocircuits influenced by drugs, and so you can tailor
Speaker 1: then the intervention in such a way that it will
Speaker 1: maximize its efficacy. And in terms also the understanding of
Speaker 1: the neurow secretry that is engaged in addiction has offered
Speaker 1: an opportunity to start to work with a neural modulation technologies.
Speaker 1: For example, I think it was last year that the
Speaker 1: FDA approved the use of transparential magnetic stimulation for the
Speaker 1: treatment of nicotine addiction. We are also taking advantage of
Speaker 1: the peripheral system which impacts on the brain and in
Speaker 1: in cortical regions and it modifies our sensations, and that
Speaker 1: in turn has resulted on approval of a peripheral stimulation
Speaker 1: device for the treatment of opiate withdrawal. I mean, the
Speaker 1: problem of developing medications, as you know is it takes
Speaker 1: something like twelve years from the idea until it comes out,
Speaker 1: and the process it requires an enormous amount of money.
Speaker 1: So what we do as an agency is try to
Speaker 1: engage industry, whether it's big or small industry, to buy
Speaker 1: into that product and develop it. Because it's like two
Speaker 1: point five billion dollars to take that treatment into that clinic,
Speaker 1: which of course will completely kill our budget for two years.
Speaker 1: Well let me ask you, so another category of drugs,
Speaker 1: the psychedelics psychologs research was pretty amply funded in the
Speaker 1: fifties and sixties by the federal government, and then with
Speaker 1: all the counterculture stuff and Timothy Leary, it was basically
Speaker 1: obliterated in the US and much of the world. And
Speaker 1: now it's beginning to come back. And I know, you know,
Speaker 1: my friend Rick Doblin, who heads the Multi Distmary Associate
Speaker 1: Psychologic Studies, has raised tens of billions of dollars of
Speaker 1: philanthropic funds, but still there's been no government funding there
Speaker 1: at all. And now you have this issue of four
Speaker 1: profit players coming in, as you're saying, is sometimes needed
Speaker 1: for drug development. But I wonder we'll be seeing something
Speaker 1: coming out of NAIDA. I mean, I just saw that
Speaker 1: in late May. You know, your boss Francis Collins, the
Speaker 1: head and a Student Health, said to Congress really interesting
Speaker 1: stuff going on with psilocybin. And National Cancer Institute just
Speaker 1: hosted something on psychedelics and end of life care, right,
Speaker 1: and I think National Student Mental Health another one of
Speaker 1: your sister agencies has been holding webinar seminars about the psychedelics.
Speaker 1: So what about National Student Rug Abuse? I mean, I
Speaker 1: think I saw there was a couple of things maybe
Speaker 1: about ketamine in addiction, But can we expect to see
Speaker 1: you beginning to fund stuff on psulocybin and treatment of
Speaker 1: addection or even or pain or things like that. Is
Speaker 1: that on the horizon for the short term. I mean,
Speaker 1: it was an eye opener to uncover that ketamine it's
Speaker 1: actually has turned out to be an extremely useful intervention
Speaker 1: for treatment resistant depression, and it is a result of
Speaker 1: research that led to these really important advancement on the
Speaker 1: way that we treat people with depressive disorders. So yes,
Speaker 1: and there we have been funding research that it's ongoing,
Speaker 1: and keptamin for opiate treatment and also keptamine for pain
Speaker 1: also has potential for PCP. If you look at that data,
Speaker 1: actually the evidence is strongest form showing potential benefits for depression,
Speaker 1: and the strongest data on depression, I would say it's
Speaker 1: on individuals that suffer from cancer terminal illnesses and they
Speaker 1: have pretty dramatically positive results that persists that at eight months.
Speaker 1: That is the area where there is probably the most
Speaker 1: ongoing treatment. There is a story, there's a couple of
Speaker 1: stories that have shown some benefit in a nicotine addiction,
Speaker 1: but they were not blinded, so it's very difficult to
Speaker 1: actually know the potential signal. So we are open they
Speaker 1: have to come up with that proposal that will be
Speaker 1: deemed meritorious and we rely on review committees to evaluate
Speaker 1: the likelihood of success. And the data for addictions is
Speaker 1: in terms of the evidence, it is much more limited.
Speaker 1: But but no, I mean, let me just press you
Speaker 1: because I mean, obviously with psilocybin there's research being privately
Speaker 1: funded that is showing great promise. We know with ayahuasca,
Speaker 1: lots of interesting things are emerging in terms of people
Speaker 1: processing not just trauma but also times addiction. And you know,
Speaker 1: there are people talking about the promise of psychedelics in
Speaker 1: the treatment of depression and things like this. They could
Speaker 1: revolutionize the pharmacological you know, treatment in some of these areas.
Speaker 1: I mean, I'll tell you it wasn't long ago that
Speaker 1: a prominent researcher who I think you know well, um,
Speaker 1: who had done research on other drugs, you know, cocaine, nicotine,
Speaker 1: it was getting interest in psychedelics and he was hopeful
Speaker 1: of getting a national student drug abuse funding for research
Speaker 1: on psilocybin, and what he ended up doing was telling
Speaker 1: the organizers of a conference on psychedelics to disinvite me
Speaker 1: because if he showed up at a conference where Ethan
Speaker 1: Naedelman was talking, that would show that psychedelics is all
Speaker 1: political and therefore he won't get funding. Now I think
Speaker 1: he still hasn't gotten funding. But given the enthusiasm coming
Speaker 1: out and all of the intriguing research out there, why
Speaker 1: not go more strongly into this area? Now? I mean,
Speaker 1: is there a fear of the political fallout or what? No,
Speaker 1: I don't think that there is a person a fear
Speaker 1: of the political fallout. I think that we are seeing.
Speaker 1: I mean m d m AS is an addictive draw.
Speaker 1: Psilocybing is not an addictive draw. And yet I mean
Speaker 1: it's being utilized in a way that it's safe for
Speaker 1: the treatment of people with depressions. So the notion of
Speaker 1: when you get proposals, you are competing with other grants
Speaker 1: in terms of likelihood of success in the proposal that
Speaker 1: you have and likelihood of implementation, so they are the
Speaker 1: review process is important and you cannot just come in
Speaker 1: and with an idea without showing as you know, for
Speaker 1: the grant, most of the ground mechanisms requires that you
Speaker 1: do provide a background that supports the likelihood that you
Speaker 1: will be successful. And the reason why why this is
Speaker 1: done is again limitation of resources. So you have to
Speaker 1: take risks, but you want to take risks that are
Speaker 1: more likely to be successful. So Northlesia with the n
Speaker 1: d M A, right, I mean n DMA seemed Night
Speaker 1: have spent a lot of money trying to establish the
Speaker 1: neurotoxicity of m d M A, and I remember there
Speaker 1: was this sort of embarrassing thing that happened. Not it
Speaker 1: was after you, I think, before you came in. Right,
Speaker 1: We're Night given a big grant to researcher at Hopkins,
Speaker 1: George Ricardi, who came out with this big study and
Speaker 1: Science saying that all these monkeys that died from m
Speaker 1: d M A and then it turned out lo and
Speaker 1: behold he had given them large doses of amphetamine and
Speaker 1: people were highly suspicious of the results even before I
Speaker 1: got published in Science. And the day that article came out,
Speaker 1: your predecessor Alan Lester said, got you Using m d
Speaker 1: M A is like playing Russian roulette, which was an
Speaker 1: incredibly irresponsible thing for a former head of NADA and
Speaker 1: head of the American Academy Arts to Science say, now
Speaker 1: you have the f d A, right, it's about to
Speaker 1: proceeds in phase three trials with doing m d m
Speaker 1: A for treating PTSD. Right, they've established the safety margins.
Speaker 1: Right are you concerned? I mean, given all the that's
Speaker 1: happened last fifteen twenty years and with m d m
Speaker 1: A going through all these incredibly expensive long trials and
Speaker 1: now the possible expansion of m DMA to treat PTSD,
Speaker 1: do you have any concerns about that? Or you enthusiastic
Speaker 1: about this development? I basically I support science that can
Speaker 1: help bring new treatments. I actually was one of the
Speaker 1: ones that was very skeptical when the paper came up
Speaker 1: in science because we have been looking into the effects
Speaker 1: of drugs in the brain and and and and also
Speaker 1: the Europeans have a long history of actually studying the
Speaker 1: effects of ecstasy and no one has reported anything like that.
Speaker 1: And overall, the issue with with ecstasy has has had
Speaker 1: more to do and I guess everybody what is concerning
Speaker 1: the potential of john people using it in situations where
Speaker 1: they are very crowded and that can result in HYPERTERMI
Speaker 1: or there have been some debts associated with it. If again,
Speaker 1: and it's this the history. I mean, we've learned, we
Speaker 1: need to learn from what what the evidence is showing up.
Speaker 1: If we can use gatamine for the treatment of severe
Speaker 1: depression in a way that is safe, this is an
Speaker 1: example of really that we can do. We can use
Speaker 1: drugs that we thought were dangerous and using in ways
Speaker 1: that are therapeutic. In fact, we use fentanyl extensively for
Speaker 1: surgical procedures and it's a very valuable drug. So we
Speaker 1: cannot demonize fentanyl because they elicit drug is being market
Speaker 1: it in the streets. Because fantaniel also has a very
Speaker 1: valuable application in medicine and can be life savings. And
Speaker 1: the same thing with prescription opius. And this is something
Speaker 1: that I've also been very vocal about. And so again
Speaker 1: we polarize everything. It's either good or bad and I
Speaker 1: and you know, my brain is why can't we not
Speaker 1: have this and that these two things are correct. We
Speaker 1: are over prescribing, but at the same time we are
Speaker 1: restricting it to people that needed. They are not exclusive.
Speaker 1: You know, one thing that worries me, right you know,
Speaker 1: I oftentimes describe the War on drugs is being justified
Speaker 1: in terms of being one great big child protection act.
Speaker 1: And when you would say that politicians, why can't we
Speaker 1: legalize marijuana for medical purposes? And they go what about
Speaker 1: the kids? Or I remember what about needle exchange? And
Speaker 1: the former governor of New Jersey, of Christie Whitman others
Speaker 1: would say what about the kids, and always go what
Speaker 1: about the kids? What about the kids? What about the kids?
Speaker 1: And when we hear that now is on the issue
Speaker 1: of nicotine and vaping, right, I mean, here you have
Speaker 1: a kind of breakthrough technological innovation that has the potential
Speaker 1: that's dramatically less staydangerous. The cigarettes and heat not burned
Speaker 1: vaping devices are dramatically less dangerous than cigarettes. You're not safe,
Speaker 1: but dramatically less dangerous. And then we see the rapid
Speaker 1: uptake of jeweling among kids a few years ago. And
Speaker 1: now it seems just like this massive miseducation campaign of
Speaker 1: which the U. S. Government, including the Center Disease Control,
Speaker 1: has been an ample part. I mean, you have now
Speaker 1: a majority of Americans believing that the cigarettes are as
Speaker 1: are more dangerous than combustible cigarettes. You have a majority
Speaker 1: of Americans and even certain fields of medicine believing that
Speaker 1: nicotine is what causes cancer. Rather than nicotine being the
Speaker 1: hook that addicts people to cigarettes. You have people believing
Speaker 1: that that whole the Valley syndrome where people were landing
Speaker 1: up in the hospital was about nicotine e' cigarettes, whereas
Speaker 1: we know now and in fact, there was a good
Speaker 1: reason to believe in the beginning it was about illegally
Speaker 1: produced tainted THHC cartridges. So the question I'm asking is
Speaker 1: what is the responsibility what is your obligation as the
Speaker 1: head of NAIDA to make sure that these massive public
Speaker 1: misperceptions get corrected. This is going to be my last
Speaker 1: answer because I do have to run to another meeting,
Speaker 1: but it there's I mean, I cannot know not respond
Speaker 1: to this extremely important question because it's another example about
Speaker 1: how we swing back and forward and and the reality
Speaker 1: is that jazz vaping of nicotine can result in people
Speaker 1: that are naive to become addicted very rapidly and can
Speaker 1: actually lead to toxicity because in the cartridges you can
Speaker 1: actually concentrate high doses of nicotine that you would never
Speaker 1: be able to smoke with combustible on the other hand,
Speaker 1: as you say, electronic cigarettes offer an alternative delivery for
Speaker 1: nicotine on people that cannot stop smoking, and in the
Speaker 1: process at the European data has shown that actually they
Speaker 1: are benefits. So one of the things that we have
Speaker 1: been very interested on doing is funding research that will
Speaker 1: document benefits of the use of the electronic cigarettes on
Speaker 1: for nicotine's cessation or for alternatives for treatment. So there
Speaker 1: is true on both of those things. I mean, although
Speaker 1: I am impressed by the evidence coming from Ken warrener
Speaker 1: many other people pointing out that from a public health perspective,
Speaker 1: the net benefits for smokers and switching so exceeds any
Speaker 1: potential risk to young people from vaping, and that the
Speaker 1: evidence of kids starting to vaping moving into cigarettes unless
Speaker 1: they were already engaging with two bustibles beforehand, is so
Speaker 1: low that you have an overwhelming case for responsible public
Speaker 1: health policy that I wish say, yes, it's so simple.
Speaker 1: I think that I believe I'm saying it's a balancing
Speaker 1: I see the other side of of the coin, and
Speaker 1: I actually because I know that data on both sides,
Speaker 1: but but that I think if we are actually ultimately
Speaker 1: trying to understand I mean a very specific question that,
Speaker 1: believe it or not, there's very little work. How does
Speaker 1: nicotine exposure during brain development influence that trajectories? I mean,
Speaker 1: what are its effects? And as you know, one of
Speaker 1: the things that nicotine is associated with, once you've been
Speaker 1: taking it and you stop, you have greater likelihood of
Speaker 1: depressive symptoms of anxiety. So I have a fascination for
Speaker 1: nicotine is another extremely interesting comp own board. It can
Speaker 1: be very addictive. Okay, my last, my very last question
Speaker 1: here here you've been supporting decriminalization, supporting a public health approach,
Speaker 1: opposing the drug war. Can you envision in your life
Speaker 1: post night to Um joining up with drug policy reform
Speaker 1: organizations to push for policies that are more grounded in
Speaker 1: public health and human rights and harm reduction and opposing
Speaker 1: the punitive prohibitionist policies if they are effective. Yes, great, Okay,
Speaker 1: I don't just like to think about problems. I'd like
Speaker 1: to solve them. I agree, we're in the same milk
Speaker 1: that way. Listen, Nora, thank you ever so much for
Speaker 1: taking the time to do this. I really appreciate it
Speaker 1: is a very highly engaging conversation and I wish you
Speaker 1: the best of luck. Under this current administration. Thanks very much, guys,
Speaker 1: a la vista. Psychoactive is a production of I Heart
Speaker 1: Radio and Protozoa Pictures. It's hosted by me Ethan Edelman.
Speaker 1: It's produced by Katcha Kumkova and Ben Kibrick. The executive
Speaker 1: producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren
Speaker 1: Aronovski for Protozoa Pictures, Al Williams and Matt Frederick for
Speaker 1: I Heart Radio and me Ethan Nadelman. Our music is
Speaker 1: by Ari Blusian and a special thanks to a vit Brio, SF,
Speaker 1: Bianca Grimshaw and Robert Beatty. If you'd like to share
Speaker 1: your own stories, comments or ideas, please leave us a
Speaker 1: message at eight three three seven seven nine sixty. That's
Speaker 1: one eight three three psycho zero. You can also email
Speaker 1: us as Psychoactive at protozoa dot com or find me
Speaker 1: on Twitter at Ethan Nadelman. And if you couldn't keep
Speaker 1: track of all this, find the information in the show notes.
Speaker 1: Listen in next time for my conversation with Tim Ferris,
Speaker 1: the investor and productivity guru who has been funding research
Speaker 1: on psychedelics and it also has a fair number of
Speaker 1: experiences to share himself. Here's a bunch of college kids
Speaker 1: eating handfuls of mushrooms, no measurement involved to see what
Speaker 1: would happen. Nonetheless, I knew, just after these experiences, which
Speaker 1: I did once a year for a number of years,
Speaker 1: that there was an antidepressant after glow optimism that lasted
Speaker 1: for several months. Subscribe to Psychoactive now see it, don't
Speaker 1: miss it.