Speaker 1: Pushkin, this is solvable. I'm Ronald Young Jr. The major
Speaker 1: focus is in leveraging them as therapeutics, in other words,
Speaker 1: to treat various disorders, mainly psychiatric disorders like various forms
Speaker 1: of addiction, like depression, like helping cancer and other serious
Speaker 1: illness patients. According to the National Institutes of Health, mental
Speaker 1: health disorders account for several of the top causes of
Speaker 1: disability across the United States. About six out of every
Speaker 1: one hundred people will have PTSD at some point in
Speaker 1: their lives. That's about fifteen million adults. During a given year.
Speaker 1: Over one quarter of all Americans over eighteen suffer from
Speaker 1: a diagnosable mental illness. The antidepressants we have now are
Speaker 1: somewhat safer than the ones going back to the nineteen fifties,
Speaker 1: but they work on the same basic mechanisms of taking
Speaker 1: a drug daily and at augmenting the amount of serotonin.
Speaker 1: Matthew Johnson is a professor of psychiatry and behavioral sciences
Speaker 1: at Johns Hopkins University. With so many suffering, he thinks
Speaker 1: it's urgent to expand to tools we use for treatment.
Speaker 1: The potential approval of psychedelic drugs, this could happen in
Speaker 1: a few years, and I think this has the potential
Speaker 1: to really be a paradigm shift in mental health treatment.
Speaker 1: Psychedelics are reality altering drugs with names like molly, ecstasy, mescaline, LSD, psilocybin,
Speaker 1: and they're all classified as Schedule one drugs government defined
Speaker 1: as having no accepted medical use and a high potential
Speaker 1: for abuse. But Johnson's team is working to change that.
Speaker 1: A significant leap in understanding a human mind is possible
Speaker 1: with psychedelics, and we can use that to help solve addiction.
Speaker 1: You are a doctor, you're a scientist. Can you tell
Speaker 1: me about your first personal experience with psychedelics? Sure, well,
Speaker 1: I'll tell you something about that. Um, so you get
Speaker 1: a little bit of the politician's answer with this question. Yeah,
Speaker 1: it's a sensitive field because you know these are illegal drugs,
Speaker 1: and so you know a lot of people are curious
Speaker 1: if you've done psychedelics yourself. And the sensitivity in this
Speaker 1: area is if you had said, sure, I had some
Speaker 1: experiences back when I was younger, and you say something
Speaker 1: about that, and a whole lot of folks are out
Speaker 1: there will say, man, you're you're biased. We can't trust
Speaker 1: this guy. You're a promoter. Okay, Now let's let's explore
Speaker 1: the the the opposite. Let's say, you know, it's always
Speaker 1: been a subject of interest, but no, I've never taken them.
Speaker 1: I didn't want to do them for whatever reason. A
Speaker 1: whole other swath of folks would say, Oh my word,
Speaker 1: how dare you give these things to people I have
Speaker 1: no idea about the profound effects? They like, this is unethical.
Speaker 1: How dare you get into this? So it's kind of
Speaker 1: like a no win situation. But I will say I
Speaker 1: became fascinated with psychedelics when I was in my late
Speaker 1: teens early twenties, learning the cultural history of these compounds
Speaker 1: and in our society going back to the sixties, and
Speaker 1: then also the ancient you know, sacramental use by various
Speaker 1: indigenous peoples, but but also the academic history, the earlier
Speaker 1: era of research and from the fifties through the seventies.
Speaker 1: It's hard to find a more cross disciplinary topic that
Speaker 1: just you couldn't make up the crazy history behind psychedelics
Speaker 1: in our culture and all the twists and turns with it,
Speaker 1: and the profound effects they have on the mind, and
Speaker 1: the idea that some molecule does this in the brain,
Speaker 1: and just from chemistry to pharmacology to sociology, it's just
Speaker 1: it's always fascinated me. For listeners who don't know what
Speaker 1: psychedelics are, can you break down what is a psychedelic?
Speaker 1: A lot of folks will say a psychedelic properly only
Speaker 1: refers to compounds like LSD and psilocybin, which is in
Speaker 1: magic mushrooms, or mescaline, which is in peyote, or DMT,
Speaker 1: which is in ayahuasca. Those are all classic psychedelics, and
Speaker 1: they they're in the same pharmacological class, meaning they have
Speaker 1: their primary effects by activating one particular subtype of serotonin
Speaker 1: receptor serotonin. Two way. Now, you have other compounds that
Speaker 1: we also broadly call psychedelic, like MDMA or folks called molly,
Speaker 1: or ecstasy, ketamine or PCP. But broadly speaking, the thing
Speaker 1: that makes all of these compounds a psychedelic is that,
Speaker 1: compared to other drug classes, they have a profound effect
Speaker 1: on one sense of reality, including one sense of self.
Speaker 1: And so you know, you can have a drug like
Speaker 1: cocaine that has a powerful effect on the mind, but
Speaker 1: one's basic conception of reality is typically held intact and
Speaker 1: the same thing with all you go down the line, alcohol,
Speaker 1: the opioids, other sedatives, but psychedelics had this profound reality
Speaker 1: shifting aspect to them. As you were describing that, something
Speaker 1: that I've thought about is like, I've been going to
Speaker 1: church all my life, and I've had spiritual experiences at church,
Speaker 1: Like there's definitely feelings that I felt at church that
Speaker 1: have probably could be considered similar. But I think for
Speaker 1: most people who've tried psychedelics, it's hard to put those
Speaker 1: experiences into words. I think besides church, the only other
Speaker 1: time I hear people talk about having religious experiences is
Speaker 1: at sporting events, and they always describe it as they're
Speaker 1: having a religious experience. So are there some common effects
Speaker 1: or reactions that people you've worked with have reported feeling.
Speaker 1: People pressed it in different ways, But this overall sense
Speaker 1: of unity is part of this mystical experience, the dissolving
Speaker 1: of the sense of self and feeling that you're just
Speaker 1: one with the universe, the world, with God, whatever your
Speaker 1: vocabulary is. Other aspects of a mystical experience are having
Speaker 1: a sense of timelessness and spacelessness, like one has stepped
Speaker 1: beyond the balance of time and space, like you know
Speaker 1: being in the ever present, now, the past, and the future.
Speaker 1: Just our scene is just sort of illusions and it's
Speaker 1: all you know, it's all about right now. And then
Speaker 1: there's other aspects, such as a sense of paradoxicality, this
Speaker 1: idea that people are moving outside of this sort of
Speaker 1: linear way of thinking, that one could hold mutually exclusive
Speaker 1: ideas at the same time, the universe and world is
Speaker 1: completely full, but it is an ultimately all an emptiness
Speaker 1: at the same time. These types of counterintuitive concepts, people
Speaker 1: often say this is beyond words, and when they do
Speaker 1: a decent job trying to describe it, they'll say they
Speaker 1: haven't even scratched the surface. And oftentimes people get frustrated
Speaker 1: because as they start to describe it, they just they
Speaker 1: want to let you know, like whatever they're saying, it's
Speaker 1: just it's falling so short, it's almost embarrassing. Can you
Speaker 1: describe a session and how it works? Sure, First, they're screening,
Speaker 1: because we do know there's certain people that could be harmed,
Speaker 1: namely folks that have either a history or an identifiable
Speaker 1: predisposition for disorders like schizophrenia or the manic side of
Speaker 1: bipolar disorder. And so there's that screening and also people
Speaker 1: at more severe levels of heart disease because it can
Speaker 1: raise your blood pressure somewhat, for example. And then you
Speaker 1: prepare the person and this can be anywhere from four
Speaker 1: to eight hours across several sessions depending on the study,
Speaker 1: but something on the order of four to eight hours
Speaker 1: where you have this discussion with two people are with
Speaker 1: we often call them guides. They're sometimes depending on the
Speaker 1: city their therapists. A major point is to develop that rapport,
Speaker 1: that trusting relationship that ultimately you would want from any psychotherapist.
Speaker 1: It's all done better if you have that that trust
Speaker 1: for that person. Discussing the person's life, their childhood, there
Speaker 1: whatever they do, whether it's a career or a job,
Speaker 1: you know what's meaningful to them. And then what are
Speaker 1: the you know, what's their worldview, whether it's religious, whether
Speaker 1: it's spiritual but not religious, whether it's people that don't
Speaker 1: endorse any any of the above, but nonetheless everyone has
Speaker 1: some of that high level worldview if you think the
Speaker 1: world is just you know, sort of materialism, but nonetheless
Speaker 1: feel connected to your family and your loved ones, to
Speaker 1: feel part of something, your community. When you also prepare
Speaker 1: them for the drug experience, which is basically a laundry
Speaker 1: list of you could be crying, you could be laughing,
Speaker 1: you can be terrified. You do have to prepare people,
Speaker 1: especially for the dark side, for the so called bad trip,
Speaker 1: which in our setting we characterize as a challenging experience,
Speaker 1: because the bad part is really if you do something
Speaker 1: stupid that get yourself hurt. Here again, it might be
Speaker 1: really difficult, it might be terrifying, or it might be
Speaker 1: you know, sad. But oftentimes those experiences people will credit
Speaker 1: as powerful learning experiences, Like if they go through an
Speaker 1: experience where they feel that they're dying, which sometimes happens,
Speaker 1: you know, oftentimes people felt like they were able to
Speaker 1: go through that experience and let go and just trust,
Speaker 1: let go and be open into experience. It feel like
Speaker 1: they really learned something from that experience, like they ran
Speaker 1: the gauntlet, they faced their demons, and so again, the
Speaker 1: bad trip isn't necessarily bad if it's in a safe space.
Speaker 1: You know, it's it doesn't look like a hospital room.
Speaker 1: It looks like, you know, like a pash yoga studio.
Speaker 1: I mean, it looks like, you know, esthetically pleasing. We
Speaker 1: want people to feel comfortable, and there's a nice rug.
Speaker 1: There's artwork on the walls. You know. Any medical equipment
Speaker 1: is like tucked underneath, Like the end table has a
Speaker 1: blood pressure kind of tucked underneath it, Like we have
Speaker 1: to take blood pressure during the session, but we have
Speaker 1: them take the capsule. Most of our work has been
Speaker 1: with psilocybin. We have some white discussion until the effects
Speaker 1: kick in. How long does it take for the effects
Speaker 1: to kick in? Anywhere from fifteen minutes to an hour.
Speaker 1: Typically around a half hour is about the average. Why
Speaker 1: so much of psychedelic research focused on mental health and addiction,
Speaker 1: specifically on treating those conditions, especially when we see that
Speaker 1: a lot of people that are using psychedelics recreationally aren't
Speaker 1: necessarily thinking about mental health and addiction in those cases,
Speaker 1: if you know what I mean, absolutely, Why why so
Speaker 1: much focused on this particular area. We're now seeing people
Speaker 1: living less long than their parents and grandparents. Why The
Speaker 1: data show it's because of substance problems. People are drinking
Speaker 1: themselves to death and taking drugs to death, including by
Speaker 1: the way, smoking, which is the biggie out of ball
Speaker 1: and that kills more than all the other drugs combined.
Speaker 1: But it's essentially addiction and it's suicide, you know, obviously
Speaker 1: depression being the major contributor to that. So these are
Speaker 1: all mental health issues and it's like the need is
Speaker 1: so great. So the antidepressants we have now are somewhat
Speaker 1: safer than the ones going back to the nineteen fifties,
Speaker 1: but they work on the same basic mechanisms of taking
Speaker 1: a drug daily and at augmenting the amount of serotonin.
Speaker 1: And that's an important thing to have. A lot of
Speaker 1: people's lives have been saved because of the the availability of
Speaker 1: those medications. So I'm all about having more tools in
Speaker 1: the toolbox rather than a fewer. So, you know, developing
Speaker 1: psychedelics is in a replacement for other therapeutics. Necessarily, we
Speaker 1: need a lot of help and mental health. You know,
Speaker 1: folks are suffering. We're really at our wits end in
Speaker 1: terms of mental health treatment. These various addiction are just
Speaker 1: really intractable. We need to innovate to to solve well,
Speaker 1: So let me ask I think, I mean, I got
Speaker 1: a good idea of what the sessions like, but can
Speaker 1: you talk a little bit more and then you briefly
Speaker 1: touch a little bit on after um, talk to me
Speaker 1: a little bit about how this contributes to your research. Yeah,
Speaker 1: so after we you know, clinically, you know, to make
Speaker 1: sure that to maximize the therapeutic benefit, we discussed the
Speaker 1: experience with the person's day after, we have them write
Speaker 1: something about it, like a few bullet points, you know,
Speaker 1: on a paper, or it can be like twenty pages
Speaker 1: and we get everything in between, but write something about
Speaker 1: it and and and just to bring in the next
Speaker 1: day and kind of well read it together as a
Speaker 1: point of discussion. These are ways of just kind of
Speaker 1: again processing, it's the word I use. It's a way
Speaker 1: to psychologically deal with and explore what the session was like.
Speaker 1: And there's no easy answers in terms of what what
Speaker 1: it's means for them. It's not like dream analysis or
Speaker 1: something like, oh, well, this was your experience. And hopefully
Speaker 1: people have meaningful experiences where they have insights, where they
Speaker 1: feel empowered to change things in their life that need
Speaker 1: to be changed. We've done a lot of work helping
Speaker 1: people quit tobacco smoking. Well not only ask them about that,
Speaker 1: have you been smoking how much if so, but we'll
Speaker 1: also have them blow through a machine basically a breathalyzer
Speaker 1: for cigarette smoking to tell us what we'll get a
Speaker 1: urine sample to see whether they've that picks up on
Speaker 1: a metabolite of nicotine. That also tells us whether they've
Speaker 1: been smoking. So we can have these data for the
Speaker 1: scientific literature, so we can write up papers and say, hey,
Speaker 1: whether it's working or not. And one of the reasons
Speaker 1: I was attracted to smoking is because, as fascinated as
Speaker 1: I am about people describing extraordinary experiences that are meaningful
Speaker 1: to them. Hey, if we really want to talk about
Speaker 1: helping people, ultimately, I like to see behavior change. So
Speaker 1: let's and biological evidence of it. Like here the data
Speaker 1: this person hasn't been smoking, and so you know that's
Speaker 1: evidence that they've they've really done something. Where do you
Speaker 1: think that this actually goes in the long game. The
Speaker 1: major focus is in leveraging them as therapeutics, in other words,
Speaker 1: to treat various disorders, mainly psychiatric disorders, like various forms
Speaker 1: of addiction, like depression, like helping cancer and other serious
Speaker 1: illness patients face death, people who are really debilitated by
Speaker 1: a cancer diagnosis. That's the major focus. But I think
Speaker 1: I see the power of these psychedelics as as much
Speaker 1: broader than that. They really are powerful tools to understanding
Speaker 1: human experience, to understanding the mind, to understanding human behavior,
Speaker 1: and just the leveraging of those to treat disorders is
Speaker 1: just a sub a very important subcomponent of that. What's
Speaker 1: the ultimate goal? Like when when do you know that
Speaker 1: you've been successful in therapeutic sessions and endo therapeutic benefits
Speaker 1: to folks, Like at some point somebody has still has
Speaker 1: to say yes to using psychedelics in this manner, right right,
Speaker 1: So for the therapeutic use of these compounds, that's very
Speaker 1: well defined. That's FDA approval for therapeutic use. So all
Speaker 1: of the research going on right now has been research
Speaker 1: that's been FDA approved. In other words, FDA has approved
Speaker 1: us to yes, you can do these studies. But at
Speaker 1: some point the FDA will say yes or no, you
Speaker 1: can give these to patients and straight up medical practice.
Speaker 1: And so we call that it has to pass phase
Speaker 1: three trials. That's the lingo research using MDIAMA to treat
Speaker 1: PTSD is in that phase three process. There's been one
Speaker 1: very successful looking phase three trial. They need to run
Speaker 1: one more, and so we may be about two years
Speaker 1: away if depending on the data from that second trial,
Speaker 1: and I bet it is going to look good, because
Speaker 1: the first trial looked very good. We may be two
Speaker 1: years away from MDMA being approved for the treatment of PTSD.
Speaker 1: For psilocybin, there's two entities in terms of the treatment
Speaker 1: of depression. There's two entities that are in Phase two
Speaker 1: B trials, so this is just before phase three. If
Speaker 1: those trials are successful, we may be somewhere on the
Speaker 1: order of three to four years away from psilocybin being
Speaker 1: approved for the treatment of depression, and the work with
Speaker 1: addiction is probably very close to that. We may be three,
Speaker 1: four or five years away again, all depending on the
Speaker 1: data in those phase three trials of psilocybin being approved
Speaker 1: for tobacco addiction and alcohol addiction. That has to be
Speaker 1: pretty exciting to have done some research that is actually
Speaker 1: shifting the actual classification of drugs that for decades were
Speaker 1: considered to be illegal, harmful, and you know, completely scified differently.
Speaker 1: How do you feel Is that exciting for you? I
Speaker 1: really love this area that I'm working in because I
Speaker 1: feel like there's the opportunity to have an impact at
Speaker 1: this time. I mean, so much of science necessarily as incremental.
Speaker 1: Your work might add to something that adds to the
Speaker 1: work of others, and you know, a generation or two
Speaker 1: or three down the road, the big shift happens. But
Speaker 1: I really think that with the potential approval of psychedelic drugs,
Speaker 1: which I've helped contribute towards, that this could happen in
Speaker 1: a few years. And I think this has the potential
Speaker 1: to really be a paradigm shift in mental health treatment.
Speaker 1: I think it's a fundamentally different way. It's really getting
Speaker 1: more at the roots of mental illness than it is
Speaker 1: just treating symptoms. And so it's just I feel lucky
Speaker 1: and so excited and happy to be involved with work
Speaker 1: that can actually have that type of real world impact
Speaker 1: in my lifetime. Can you talk a little bit about
Speaker 1: some of the actual risks that using psychedelics, whether therapeutically
Speaker 1: or recreationally, can cost to a person. Right, we know
Speaker 1: a lot about the risks. Certain people have a susceptibility
Speaker 1: to disorders like schizophrenia. Those people can be destabilized the
Speaker 1: same way a traumatic life event can destabilize those people
Speaker 1: and either trigger or make their symptoms worse. There's also
Speaker 1: for anyone taking these drugs that are high enough, those
Speaker 1: there's the so called bad trip, which in a recreational
Speaker 1: or an unsafe environment. It's pretty rare, admittedly, but sometimes
Speaker 1: it leads to people getting harmed. I mean, it's kind
Speaker 1: of like not wearing your seat belt. Most any one
Speaker 1: given day of not wearing your seat belt, you'll probably
Speaker 1: be fine. But if you step back and look at
Speaker 1: the big picture, yeah, it's pretty clear there's a definitely
Speaker 1: risk of not wearing a seat belt. So sometimes people
Speaker 1: do things that get themselves hurt. They wander into traffic,
Speaker 1: they freak out, they you know, they fall from a height,
Speaker 1: and sometimes, you know, a lot is made out of
Speaker 1: those that are pretty rare, they can happen. So there's
Speaker 1: are real risks people at severe heart disease. It can
Speaker 1: trigger a reaction because it psilocybin raises the blood pressure
Speaker 1: and certainly MDMA even more so raise the blood pressure
Speaker 1: and pulse. So that could be a problem for some people,
Speaker 1: even though psilocybin itself for most people is very safe
Speaker 1: at the physiological level. There's no known lethal overdose. So
Speaker 1: those are the major risks, but importantly, we have a
Speaker 1: way to address them all in research and clinical use,
Speaker 1: through screening, through preparation, and monitoring. Because of these risks,
Speaker 1: I certainly don't encourage anyone to use these on their own.
Speaker 1: If listeners want to learn more about psychedelic treatment or
Speaker 1: how they can support research into psychedelics, what can they do?
Speaker 1: They can find out more about our research at Hopkins
Speaker 1: Psychedelic dot org. If you're looking for psilocybin research, you
Speaker 1: can find our studies that are posted there. You can
Speaker 1: also search for studies on clinical trials dot gov really
Speaker 1: across the US and the world for other sites that
Speaker 1: are conducting research with psychedelics. If you want to learn
Speaker 1: about some of the work that with MDMA that I mentioned,
Speaker 1: you can go to maps dot org. So yeah, hopefully
Speaker 1: that's helped the people. Doctor matt Johnson, this has been
Speaker 1: a great conversation. I thank you so much for being
Speaker 1: with us. Thank you, Ronald, I really enjoyed it. Matthew
Speaker 1: Johnson is a professor of psychiatry and behavioral sciences at
Speaker 1: Johns Hopkins University. Be sure to check out our show
Speaker 1: notes to find links to the resources Matthew mentioned in
Speaker 1: this episode. Solvable is produced by Jocelyn Frank, research by
Speaker 1: David Jah, booking by Lisa Dunn. Our managing producer is
Speaker 1: Sasha Matthias. And our executive producer is Mio LaBelle I'm
Speaker 1: Ronald Jung Jr. Thanks for listening.