1 00:00:00,280 --> 00:00:07,760 Speaker 1: Hi, I'm Ethan Nadelman, and this is Psychoactive, a production 2 00:00:07,800 --> 00:00:11,600 Speaker 1: of I Heart Radio and Protozoa Pictures. Psychoactive is the 3 00:00:11,640 --> 00:00:15,040 Speaker 1: show where we talk about all things drugs. But any 4 00:00:15,160 --> 00:00:18,760 Speaker 1: views expressed here do not represent those of I Heeart Media, 5 00:00:18,920 --> 00:00:23,480 Speaker 1: Protozoa Pictures, or their executives and employees. Indeed, Heed, as 6 00:00:23,520 --> 00:00:26,400 Speaker 1: an inveterate contrarian, I can tell you they may not 7 00:00:26,560 --> 00:00:30,760 Speaker 1: even represent my own and nothing contained in this show 8 00:00:30,840 --> 00:00:33,680 Speaker 1: should be used as medical advice or encouragement to use 9 00:00:33,800 --> 00:00:45,200 Speaker 1: any type of drug. Hello, Psychoactive listeners. So today our 10 00:00:45,240 --> 00:00:49,519 Speaker 1: guest is a Columbia professor, Elias Dakwar, who's done this 11 00:00:49,680 --> 00:00:56,400 Speaker 1: fascinating research on using ketamine combined with mindfulness meditation to 12 00:00:56,520 --> 00:00:59,800 Speaker 1: help people struggling with drug addiction. And he's actually one 13 00:00:59,840 --> 00:01:02,240 Speaker 1: of the few people in the United States to actually 14 00:01:02,240 --> 00:01:07,600 Speaker 1: have received federal funding for research on psychedelics. I'm delighted 15 00:01:07,720 --> 00:01:10,440 Speaker 1: to have you on the program and lives so just God, 16 00:01:10,480 --> 00:01:12,960 Speaker 1: just start off, just tell me your name and introduce 17 00:01:13,040 --> 00:01:15,600 Speaker 1: yourself and your title and where you are right now 18 00:01:15,680 --> 00:01:20,319 Speaker 1: and such. Thanks for having me. My name's Liastkwar. I'm 19 00:01:20,360 --> 00:01:24,360 Speaker 1: currently at the Columbia Medical Center, calling from my office 20 00:01:24,360 --> 00:01:27,360 Speaker 1: here in New York City. I'm an associate professor here 21 00:01:27,520 --> 00:01:32,640 Speaker 1: of psychiatry, and I've been interested in research with ketamine, 22 00:01:33,040 --> 00:01:37,200 Speaker 1: combining it with therapy for a variety of addictions and 23 00:01:37,200 --> 00:01:39,240 Speaker 1: but addiction. I mean you started off in all this, 24 00:01:39,360 --> 00:01:41,920 Speaker 1: even before you get into the kid amine about working 25 00:01:42,000 --> 00:01:45,520 Speaker 1: on addiction and addiction treatment. Isn't that right? Correct? Yeah? 26 00:01:45,560 --> 00:01:50,560 Speaker 1: I started my foray into addiction treatment with meditation. I 27 00:01:50,680 --> 00:01:53,360 Speaker 1: was very interested in how meditation might be helpful for 28 00:01:53,840 --> 00:01:58,920 Speaker 1: disrupting some of the automaticity and reactivity that can happen 29 00:01:58,960 --> 00:02:03,480 Speaker 1: with addiction, and developed an interest in combining meditation with 30 00:02:03,560 --> 00:02:07,840 Speaker 1: other modalities. Meditation alone wasn't quite cutting it, and this grew. 31 00:02:07,880 --> 00:02:10,200 Speaker 1: I mean you first got these insights from your own 32 00:02:10,320 --> 00:02:13,800 Speaker 1: personal experience with meditation and its value in your own life. Yeah, 33 00:02:13,880 --> 00:02:18,200 Speaker 1: both personal experience with meditation, also with non ordinary experiences 34 00:02:18,240 --> 00:02:22,000 Speaker 1: more generally, what do you mean in ordinary experiences? I 35 00:02:22,040 --> 00:02:27,959 Speaker 1: guess psychedelic type experiences, fasting, mystical experiences, those sorts of things. 36 00:02:28,760 --> 00:02:33,119 Speaker 1: Meditation has been the most I think durable and reliable 37 00:02:33,520 --> 00:02:38,000 Speaker 1: for me route towards those sorts of states. And you 38 00:02:38,040 --> 00:02:40,600 Speaker 1: know there's a practice associated with it and a practice 39 00:02:40,680 --> 00:02:45,080 Speaker 1: that enjoys a lot of social legitimacy, at least here 40 00:02:45,200 --> 00:02:49,000 Speaker 1: in the United States, so it seemed something that could 41 00:02:49,160 --> 00:02:54,320 Speaker 1: lend itself to treatment in Western models for addiction. Things 42 00:02:54,360 --> 00:02:56,240 Speaker 1: have changed quite a bit since I started doing that 43 00:02:56,280 --> 00:03:01,639 Speaker 1: research with greater interest and incorporating substances that previously had 44 00:03:01,680 --> 00:03:06,080 Speaker 1: been deemed inappropriate and medical settings like the psychedelics. But 45 00:03:06,200 --> 00:03:10,600 Speaker 1: at the time it seemed like a fairly straightforward strategy 46 00:03:11,360 --> 00:03:14,760 Speaker 1: think about meditation. Were you aware of that kind of 47 00:03:14,840 --> 00:03:18,880 Speaker 1: earlier era, back in the sixties where Timothy Learry and 48 00:03:18,960 --> 00:03:21,079 Speaker 1: Richard Albert In a whole host of other people were 49 00:03:21,080 --> 00:03:25,480 Speaker 1: actually experimenting madelsty and I think mess Glinn perhaps philocybin, 50 00:03:25,639 --> 00:03:27,680 Speaker 1: psilocybin and addiction. I mean, did you did you know 51 00:03:27,760 --> 00:03:30,160 Speaker 1: that history when you first got interested in this stuff? 52 00:03:30,480 --> 00:03:32,440 Speaker 1: I did now. I grew up in the Bay Area 53 00:03:32,560 --> 00:03:37,720 Speaker 1: and my uncle's were part of the counterculture during the 54 00:03:37,760 --> 00:03:43,160 Speaker 1: sixties and would browse their bookshelves growing up reading R. D. 55 00:03:43,360 --> 00:03:48,000 Speaker 1: Lange and Carlos Kostayeta and ram Das and all of 56 00:03:48,000 --> 00:03:52,480 Speaker 1: those things, So it wasn't completely unusual or foreign to me. 57 00:03:52,920 --> 00:03:56,120 Speaker 1: I didn't anticipate that it would gain the level of 58 00:03:56,400 --> 00:03:59,880 Speaker 1: social currency that it has now. It's it's quite impressive 59 00:04:00,080 --> 00:04:03,400 Speaker 1: and it's beautiful to see that it's being embraced as 60 00:04:03,440 --> 00:04:06,680 Speaker 1: it is now. There are some challenges we'll talk about later. 61 00:04:07,400 --> 00:04:11,480 Speaker 1: I was well aware of the earlier attempts to understand 62 00:04:11,520 --> 00:04:15,800 Speaker 1: how these substances could be helpful the unfortunate end to 63 00:04:15,880 --> 00:04:19,520 Speaker 1: that research because of criminalization of these substances back in 64 00:04:19,560 --> 00:04:23,520 Speaker 1: the late sixties and such. Yeah, exactly. And in terms 65 00:04:23,560 --> 00:04:26,159 Speaker 1: of your mentors and such when you started to study 66 00:04:26,200 --> 00:04:28,839 Speaker 1: addiction treatment, right, I guess in your earlier years of 67 00:04:29,200 --> 00:04:33,520 Speaker 1: training in psychiatry, Um, were you encouraged by them to 68 00:04:33,600 --> 00:04:36,600 Speaker 1: look into these avenues of the role of the ketamine 69 00:04:36,680 --> 00:04:41,280 Speaker 1: or psychedelics at that time. There's an interesting story I, Um, 70 00:04:41,320 --> 00:04:44,680 Speaker 1: you know Karl Hard of course. Um, he's been a 71 00:04:45,360 --> 00:04:49,480 Speaker 1: mentor to me and big source of support when I 72 00:04:49,680 --> 00:04:52,600 Speaker 1: first mentioned to him that I was interested in in 73 00:04:52,640 --> 00:04:55,800 Speaker 1: doing this sort of work. I was interested in psilocybin. Actually, 74 00:04:55,800 --> 00:04:59,920 Speaker 1: at the time, Roland Griffith at Johns Hopkins had come 75 00:05:00,040 --> 00:05:04,400 Speaker 1: out with the repeat of the Good Friday experiment, where 76 00:05:04,400 --> 00:05:08,279 Speaker 1: he showed that psilocybin given to healthy volunteers can lead 77 00:05:08,279 --> 00:05:12,560 Speaker 1: to sustained improvements and well being and these very profound 78 00:05:12,640 --> 00:05:16,480 Speaker 1: mystical experiences that they remember as among the most important 79 00:05:16,520 --> 00:05:18,680 Speaker 1: in their lives and maybe just explain, actually, what's that 80 00:05:18,760 --> 00:05:22,560 Speaker 1: initial Good Friday experiment was sure. It was an experiment 81 00:05:22,600 --> 00:05:28,400 Speaker 1: done at Harvard investigating psilocybin. The experiment took people who 82 00:05:28,440 --> 00:05:33,520 Speaker 1: have an interest in spiritual matters, people from the seminary clergy, 83 00:05:33,920 --> 00:05:39,320 Speaker 1: and investigated what happens when psilocybin is given, whether there's 84 00:05:40,080 --> 00:05:46,520 Speaker 1: an improvement and spiritual understanding, whether it occasions experiences comparable 85 00:05:46,800 --> 00:05:51,960 Speaker 1: to mystical states. And Roland Griffiths, who himself has a 86 00:05:52,000 --> 00:05:57,960 Speaker 1: longstanding interest in meditation, did an experiment that basically duplicated 87 00:05:58,000 --> 00:06:02,440 Speaker 1: those effects and found that psilocybin has the propensity to 88 00:06:02,520 --> 00:06:07,120 Speaker 1: cosmistical states, changes in time and space, a sense of 89 00:06:07,160 --> 00:06:11,760 Speaker 1: knowing something that's beyond words, a sense of revelation of 90 00:06:12,279 --> 00:06:16,119 Speaker 1: seeing things in a profoundly new way. And these experiences 91 00:06:16,160 --> 00:06:22,280 Speaker 1: went on to be remembered for um years subsequently as 92 00:06:23,200 --> 00:06:27,440 Speaker 1: among the most powerful the person's life and also impactful 93 00:06:27,839 --> 00:06:33,000 Speaker 1: with friends spouses, noting that there was a clear difference 94 00:06:33,040 --> 00:06:36,760 Speaker 1: in the person after versus before. So that was the 95 00:06:36,760 --> 00:06:40,119 Speaker 1: the experiment that Roland Griffiths had done, and that pretty 96 00:06:40,200 --> 00:06:42,599 Speaker 1: much opened the door to this research being done again 97 00:06:42,640 --> 00:06:46,640 Speaker 1: on a mass scale. Actually, actually, Lass, if I recall correctly, 98 00:06:47,040 --> 00:06:50,200 Speaker 1: even before Roland Griffiths had done that study, I think 99 00:06:50,320 --> 00:06:55,040 Speaker 1: Rick Doblin, the founder of MAPS and Multidisiplinary Associated Cycholic Studies, 100 00:06:55,240 --> 00:06:57,520 Speaker 1: had done his own twenty five year follow up on 101 00:06:57,600 --> 00:07:00,839 Speaker 1: that Good Friday experiment and had tracked a lot of 102 00:07:00,839 --> 00:07:04,360 Speaker 1: these participants. I think these Boston University Divinity students down 103 00:07:04,720 --> 00:07:06,920 Speaker 1: to see what they thought about this experience twenty five 104 00:07:06,960 --> 00:07:09,600 Speaker 1: years later, and I think it found that many of 105 00:07:09,640 --> 00:07:12,840 Speaker 1: them still regarded it as one of the most profound 106 00:07:12,880 --> 00:07:16,080 Speaker 1: spiritual experiences in their lives. They wish they could talk 107 00:07:16,120 --> 00:07:18,960 Speaker 1: openly to their congregants about it, uh, you know, they 108 00:07:18,960 --> 00:07:21,240 Speaker 1: wish they could do it with their kids. Things like this. 109 00:07:21,600 --> 00:07:24,520 Speaker 1: Some of them felt it had brought them closer to Jesus. 110 00:07:24,560 --> 00:07:26,800 Speaker 1: But you were saying about Karl Hart. So then Carl, 111 00:07:27,200 --> 00:07:30,560 Speaker 1: our mutual friends, says to you, so I had mentioned 112 00:07:30,600 --> 00:07:34,760 Speaker 1: that I that I'm interested in potentially doing treatment study 113 00:07:35,000 --> 00:07:38,280 Speaker 1: with psilocybin for addiction and said, well, you're not going 114 00:07:38,360 --> 00:07:40,160 Speaker 1: to be able to get an I H funding for it. 115 00:07:40,240 --> 00:07:44,040 Speaker 1: My friend Um he's spoken with Nora Valkao herself, who 116 00:07:44,080 --> 00:07:47,480 Speaker 1: said that ni H NEIDA, in particular our death set 117 00:07:47,520 --> 00:07:50,200 Speaker 1: against funding any of that research and just explained Nora 118 00:07:50,280 --> 00:07:53,760 Speaker 1: local is. She's the head of the National Institute on 119 00:07:54,200 --> 00:08:01,720 Speaker 1: Drug Abuse NIDA, which is the premier funding agency within NIH, 120 00:08:01,960 --> 00:08:04,640 Speaker 1: fueling a lot of the research being done to investigate 121 00:08:04,760 --> 00:08:08,440 Speaker 1: treatments for addiction and also the harms associated with drug use. 122 00:08:09,200 --> 00:08:13,160 Speaker 1: NIDA emerged in lockstep with the War on Drugs as 123 00:08:13,240 --> 00:08:17,640 Speaker 1: the science arm two identify what the risks of drugs 124 00:08:17,720 --> 00:08:20,840 Speaker 1: might be and how to best deal with any problems 125 00:08:20,840 --> 00:08:25,239 Speaker 1: that might emerge. So he was emphatic that I would 126 00:08:25,240 --> 00:08:28,360 Speaker 1: be wasting my time trying to pursue that kind of 127 00:08:28,400 --> 00:08:30,600 Speaker 1: research if I hope to get funded by NIDA. He 128 00:08:30,680 --> 00:08:33,479 Speaker 1: thought there might be a better chance looking at ketamine. 129 00:08:33,840 --> 00:08:38,360 Speaker 1: Ketamine has comparable effects to psilocybin, but it's not scheduled. 130 00:08:38,720 --> 00:08:43,040 Speaker 1: It's Schedule three, which means that it has known medical 131 00:08:43,360 --> 00:08:47,440 Speaker 1: use with some risk of abuse. It emerged in the 132 00:08:47,480 --> 00:08:53,560 Speaker 1: fifties as an anesthetic that lends itself to very easy use. 133 00:08:54,320 --> 00:08:57,840 Speaker 1: It can be given to people in the battlefield, in 134 00:08:58,760 --> 00:09:04,000 Speaker 1: accident settings without requiring intubation, because it doesn't depress respiration, 135 00:09:04,160 --> 00:09:06,920 Speaker 1: doesn't cause people to stop breathing, doesn't have any effects 136 00:09:06,960 --> 00:09:12,520 Speaker 1: on cardiac functioning, so it lends itself to easy administration. 137 00:09:12,720 --> 00:09:16,679 Speaker 1: You can innesthetize people in settings that don't require the 138 00:09:16,760 --> 00:09:19,880 Speaker 1: usual supports that hospitals provide. So in the Vietnam War, 139 00:09:19,920 --> 00:09:22,600 Speaker 1: for example, it would it be too exactular what you're 140 00:09:22,600 --> 00:09:24,960 Speaker 1: dealing with that And it was also used for in animals, 141 00:09:25,160 --> 00:09:28,480 Speaker 1: right what animal surgery, veterinarians used to, etcetera. Yes, and 142 00:09:28,600 --> 00:09:31,319 Speaker 1: it continues to be used in those capacities, both in 143 00:09:31,600 --> 00:09:35,480 Speaker 1: veterinary and human medicine. And you may know as well 144 00:09:35,520 --> 00:09:41,760 Speaker 1: that ketamine is a descendant, let's say, of PCP, So 145 00:09:41,920 --> 00:09:45,720 Speaker 1: PCP works in a very similar way to ketamine. It 146 00:09:45,840 --> 00:09:50,960 Speaker 1: binds to the PCP site of the glutamate receptor. Glutamate 147 00:09:51,040 --> 00:09:54,080 Speaker 1: is one of the most abundant excitatory neurotransmitters in the 148 00:09:54,080 --> 00:09:58,960 Speaker 1: brain and can lead to dissociation. With that effect, it 149 00:09:59,000 --> 00:10:02,240 Speaker 1: binds to the site antagonize his glutamate, and it can 150 00:10:02,320 --> 00:10:05,880 Speaker 1: lead aspects of experience that are usually coupled to become decoupled, 151 00:10:06,320 --> 00:10:10,800 Speaker 1: so the feeling and the thinking part, the conscious and unconscious. Well, 152 00:10:10,880 --> 00:10:13,640 Speaker 1: it's when I remember about PCP though, was all the 153 00:10:13,760 --> 00:10:17,520 Speaker 1: hysteria in Washington, d c. Where it became one of 154 00:10:17,559 --> 00:10:20,920 Speaker 1: the most popular drugs of use and abuse for a while, 155 00:10:21,120 --> 00:10:23,960 Speaker 1: and you'd have cops telling these stories about people crazed 156 00:10:24,000 --> 00:10:26,719 Speaker 1: on PCP, you needed five cops to tie them down 157 00:10:26,760 --> 00:10:28,960 Speaker 1: and all this sort of stuff. But um, I didn't 158 00:10:29,000 --> 00:10:32,960 Speaker 1: realize the connection between PCP and kennemine in that regard. Yeah, 159 00:10:33,000 --> 00:10:36,360 Speaker 1: PCP definitely became one of the scare drugs of the 160 00:10:36,440 --> 00:10:40,040 Speaker 1: DARE program. Growing up in the Bay Area, every year 161 00:10:40,080 --> 00:10:43,160 Speaker 1: we had the same story from the cops who came 162 00:10:43,240 --> 00:10:45,880 Speaker 1: with the suitcase of drugs to tell us about why 163 00:10:45,920 --> 00:10:48,960 Speaker 1: to stay away from heroin, why to stay away from acid, pot, 164 00:10:49,480 --> 00:10:53,360 Speaker 1: and PCP always involved a story of you know, someone craze, 165 00:10:53,720 --> 00:10:57,200 Speaker 1: either ripping out his eyeballs or jumping out of a 166 00:10:57,240 --> 00:11:00,800 Speaker 1: building or trying to do something of hercue lee in excess, 167 00:11:01,000 --> 00:11:03,600 Speaker 1: like trying to flip over a cop car. But PCP 168 00:11:04,160 --> 00:11:09,240 Speaker 1: is basically ketamine, except it's longer acting and has greater 169 00:11:09,280 --> 00:11:13,840 Speaker 1: affinity for the glutamate receptor. So with proper dosing. It 170 00:11:13,880 --> 00:11:17,480 Speaker 1: can work functionally like ketamine does. The one difference is 171 00:11:17,520 --> 00:11:20,880 Speaker 1: that it is longer acting. Ketamine is incredibly short acting 172 00:11:21,280 --> 00:11:25,959 Speaker 1: um It has a very rapid clearance right the half 173 00:11:26,000 --> 00:11:29,600 Speaker 1: life short so after a single administration of ketamine, the 174 00:11:29,640 --> 00:11:33,640 Speaker 1: person is fairly back to normal after forty minutes. But 175 00:11:33,720 --> 00:11:36,640 Speaker 1: where people feel actively under the influence of the kenemine, 176 00:11:36,720 --> 00:11:38,480 Speaker 1: is it only that length of time as well? Or 177 00:11:38,679 --> 00:11:42,440 Speaker 1: depends on how it's administered um so intranasally, which is 178 00:11:42,480 --> 00:11:45,200 Speaker 1: the way that it's most commonly administered in recreational settings. 179 00:11:45,600 --> 00:11:50,679 Speaker 1: The last about twenty minutes intramuscularly, last about forty minutes intravenously. 180 00:11:51,200 --> 00:11:53,559 Speaker 1: It can last as long as it's being infused, as 181 00:11:53,559 --> 00:11:57,120 Speaker 1: long as it's stripping into the person's bloodstream. You know, 182 00:11:57,200 --> 00:11:59,840 Speaker 1: as I say, I think the first time I ever 183 00:12:00,679 --> 00:12:05,000 Speaker 1: read about ketamine, I think it was reading some kind 184 00:12:05,040 --> 00:12:09,400 Speaker 1: of autobiographical book by John Lily right. And John lily 185 00:12:09,520 --> 00:12:12,880 Speaker 1: was a founder of stay teaching communications, you know, communications 186 00:12:12,920 --> 00:12:15,679 Speaker 1: buying among dolphins and whales, and also the guy who 187 00:12:15,720 --> 00:12:20,040 Speaker 1: invented the isolation tank. And he talked about taking ketamine 188 00:12:20,120 --> 00:12:22,559 Speaker 1: and he had suffered from migraines and he felt the 189 00:12:22,640 --> 00:12:26,400 Speaker 1: migraines just kind of separating from his head, and then 190 00:12:26,440 --> 00:12:29,200 Speaker 1: he got into a much more exploratory phase. I think 191 00:12:29,240 --> 00:12:32,360 Speaker 1: of taking ketamine like every hour on the hour in 192 00:12:32,440 --> 00:12:34,960 Speaker 1: one of his isolation tanks and almost killing himself that 193 00:12:35,000 --> 00:12:37,240 Speaker 1: way or something. But it was the first time I 194 00:12:37,240 --> 00:12:39,319 Speaker 1: realized that there was this drug called kenemine. I don't 195 00:12:39,320 --> 00:12:40,920 Speaker 1: even know if I was aware at the time of 196 00:12:41,000 --> 00:12:43,960 Speaker 1: its role in surgery and things like that, but it 197 00:12:44,040 --> 00:12:49,559 Speaker 1: does seem like this incredibly versatile drug exactly. The versatility 198 00:12:49,640 --> 00:12:53,360 Speaker 1: comes from the variety of effects that can have based 199 00:12:53,360 --> 00:12:57,000 Speaker 1: on dose. So it was originally intended to be used 200 00:12:57,160 --> 00:12:59,959 Speaker 1: in the anesthetic range where it would put people out, 201 00:13:00,400 --> 00:13:02,160 Speaker 1: but it can also be used, as you said with 202 00:13:02,280 --> 00:13:06,319 Speaker 1: John Lilly's self experimentation and exploration, can be used in 203 00:13:06,360 --> 00:13:09,600 Speaker 1: a sub anesthetic range where it doesn't lead to loss 204 00:13:09,600 --> 00:13:12,720 Speaker 1: of consciousness, but it leads to fairly profound changes in 205 00:13:12,920 --> 00:13:18,080 Speaker 1: experience and perception. And that's really been where the most 206 00:13:18,160 --> 00:13:21,880 Speaker 1: recent interest has been and what it might do psychiatrically 207 00:13:22,280 --> 00:13:26,520 Speaker 1: within that sub an aesthetic range. So the resurrection of 208 00:13:26,640 --> 00:13:32,360 Speaker 1: ketamine came initially through if Jenny Kropitski's work actually if 209 00:13:32,440 --> 00:13:35,800 Speaker 1: Jenny Krpitski was also funded by MAPS. You mentioned Rick 210 00:13:35,880 --> 00:13:40,600 Speaker 1: Doblin earlier. He did some fascinating work in St. Petersburg. 211 00:13:40,760 --> 00:13:45,200 Speaker 1: St Petersburg, Rushia and not Florida. Let's I thought the 212 00:13:45,240 --> 00:13:48,319 Speaker 1: name gave it away. Um. Yeah, So he he gave 213 00:13:48,679 --> 00:13:52,760 Speaker 1: an intramuscular dose of ketamine, you know, enough to occasion 214 00:13:52,800 --> 00:13:57,560 Speaker 1: a psychedelic state in combination with what he called ketamine 215 00:13:57,600 --> 00:14:01,960 Speaker 1: psychedelic therapy, and there were lots of iterations of this therapy. 216 00:14:02,000 --> 00:14:06,079 Speaker 1: What what he ultimately landed on was a therapy framework 217 00:14:06,640 --> 00:14:09,760 Speaker 1: comparable to what was used in the fifties and sixties 218 00:14:09,800 --> 00:14:15,240 Speaker 1: with LSD and psilocybin, where the experience was central to 219 00:14:15,559 --> 00:14:19,480 Speaker 1: the treatment. The therapy was intended to help a person 220 00:14:20,040 --> 00:14:25,200 Speaker 1: and prepare for a potentially transformative experience, and then subsequently 221 00:14:25,240 --> 00:14:27,680 Speaker 1: to help the person makes sense of it, integrate it, 222 00:14:27,960 --> 00:14:32,440 Speaker 1: and find a way to consolidate those benefits in pursuit 223 00:14:32,480 --> 00:14:35,480 Speaker 1: of a healthier life, whatever that life might look like, 224 00:14:35,520 --> 00:14:40,080 Speaker 1: depending on the challenges the person's facing. So if Jenny 225 00:14:40,240 --> 00:14:43,440 Speaker 1: investigated ketamine in a similar way for alcohol addiction and 226 00:14:43,440 --> 00:14:47,720 Speaker 1: heroin addiction and found remarkable effects, I think we'd be 227 00:14:48,640 --> 00:14:51,280 Speaker 1: really in a different place right now if he was 228 00:14:51,320 --> 00:14:55,360 Speaker 1: allowed to continue this research. Unfortunately, ketamine is now illegal 229 00:14:55,800 --> 00:14:59,560 Speaker 1: and has been so for decades in Russia, and so 230 00:14:59,640 --> 00:15:03,560 Speaker 1: he to end the research, a reprisal in a way 231 00:15:03,600 --> 00:15:06,720 Speaker 1: of what happened in the States in the fifties and sixties, 232 00:15:06,720 --> 00:15:11,680 Speaker 1: where some promising results were aborted because of policy. Yeah, 233 00:15:11,760 --> 00:15:14,160 Speaker 1: Alias should actually tell you, Um, I actually met a 234 00:15:14,280 --> 00:15:16,440 Speaker 1: Ginny back in the nineties, and it was when I 235 00:15:16,480 --> 00:15:20,960 Speaker 1: was starting up the International Harm Reduction Program through Soros Foundation, 236 00:15:21,440 --> 00:15:24,120 Speaker 1: and we actually did a conference in St. Petersburg on 237 00:15:24,280 --> 00:15:27,960 Speaker 1: drugs and HIV and harm reduction, and there was this 238 00:15:28,040 --> 00:15:30,320 Speaker 1: kind of opening period. There was even a period in 239 00:15:30,320 --> 00:15:32,840 Speaker 1: the early years of Putin of his being open to 240 00:15:32,920 --> 00:15:36,600 Speaker 1: decriminalization of possession and things like this, and then this 241 00:15:36,960 --> 00:15:40,200 Speaker 1: massive hard turning in the opposite direction. But I mean, 242 00:15:40,200 --> 00:15:42,280 Speaker 1: it's interesting to think that some of the pioneering work 243 00:15:42,280 --> 00:15:45,880 Speaker 1: in this area came out of Russia. And what I 244 00:15:45,880 --> 00:15:51,400 Speaker 1: think is also unappreciated is how formative if Jenny was 245 00:15:51,640 --> 00:15:56,560 Speaker 1: to biological psychiatryes embrace of Kenemine. So if Jenny had 246 00:15:56,600 --> 00:16:00,760 Speaker 1: gone to Yale as a fellow while engaged in this 247 00:16:00,920 --> 00:16:06,120 Speaker 1: research and in St. Petersburg and Yale, as you may know, 248 00:16:06,800 --> 00:16:12,400 Speaker 1: is where ketamine was serendipitously found to have antidepressant effects. 249 00:16:12,840 --> 00:16:15,400 Speaker 1: And I didn't know that when was that? The first 250 00:16:15,480 --> 00:16:19,880 Speaker 1: paper was in two thousand is John Crystal, who is 251 00:16:20,360 --> 00:16:25,480 Speaker 1: the editor in chief of Biological Psychiatry, and that really 252 00:16:25,480 --> 00:16:27,960 Speaker 1: set the stage for how ketamine has been received by 253 00:16:27,960 --> 00:16:33,960 Speaker 1: mainstream psychiatry. It was being approached as a purely biological intervention, 254 00:16:34,400 --> 00:16:39,040 Speaker 1: as a medicine comparable to e c T electro convulsive therapy. 255 00:16:39,360 --> 00:16:42,920 Speaker 1: So this is emerging at Yale at the same time 256 00:16:43,080 --> 00:16:46,560 Speaker 1: that ketamine a K A special K is becoming popular 257 00:16:46,720 --> 00:16:48,720 Speaker 1: in the gay dance clubs in the city. I mean 258 00:16:48,760 --> 00:16:52,440 Speaker 1: as an Arnold's almost simultaneously happening about twenty years ago. 259 00:16:52,960 --> 00:16:55,160 Speaker 1: And does the fact that it's emerging is such a 260 00:16:55,200 --> 00:16:58,720 Speaker 1: popular party drug and in the media complicate the efforts 261 00:16:58,720 --> 00:17:01,280 Speaker 1: at Yale to look at it's role in depression. I 262 00:17:01,320 --> 00:17:05,720 Speaker 1: think the foresight perhaps that the psychiatrist that Yale had, 263 00:17:06,359 --> 00:17:10,160 Speaker 1: but also ultimately the great blind spot, was to not 264 00:17:10,560 --> 00:17:13,840 Speaker 1: look at ketamine for what its psychoactive effects might be, 265 00:17:14,160 --> 00:17:17,119 Speaker 1: to look at it purely as a biological intervention. That 266 00:17:17,240 --> 00:17:21,359 Speaker 1: separated it quite dramatically from why it might be used 267 00:17:21,640 --> 00:17:26,040 Speaker 1: in recreational settings, which is to elicit these usually enjoyable, 268 00:17:26,080 --> 00:17:30,920 Speaker 1: interesting effects. So, in developing the story behind how ketamine 269 00:17:30,960 --> 00:17:35,320 Speaker 1: might be impactful, the hope was that it would create 270 00:17:35,440 --> 00:17:40,280 Speaker 1: space for ketamine like compounds without those psychoactive effects to 271 00:17:40,280 --> 00:17:43,520 Speaker 1: be developed. And what do you think I mean, I'm 272 00:17:43,520 --> 00:17:45,600 Speaker 1: going to ask you about your studies shortly, But in 273 00:17:45,720 --> 00:17:49,200 Speaker 1: terms of uh, this notion of separating out the psychoactive 274 00:17:49,240 --> 00:17:51,919 Speaker 1: effects from the medical effects, I've seen people try to 275 00:17:51,920 --> 00:17:53,600 Speaker 1: think about what that can be done with cannabis, Where 276 00:17:53,640 --> 00:17:55,960 Speaker 1: we can you know, other drugs. I mean, is the 277 00:17:56,119 --> 00:18:01,199 Speaker 1: psychoactive element of ketamine essential to its sickacy in dealing 278 00:18:01,240 --> 00:18:05,359 Speaker 1: with whether it's depression or addiction. Well, the short answer 279 00:18:05,440 --> 00:18:09,359 Speaker 1: is it's complicated. I think it's foolish, first of all, 280 00:18:09,400 --> 00:18:14,320 Speaker 1: two discount the psychoactive effects to say that they're totally 281 00:18:14,359 --> 00:18:19,359 Speaker 1: irrelevant and unimpactful. It's foolish for the reason that we 282 00:18:19,400 --> 00:18:23,680 Speaker 1: don't give enough attention. If we see those effects as irrelevant, 283 00:18:23,720 --> 00:18:26,520 Speaker 1: we don't give it enough attention to setting the stage 284 00:18:26,560 --> 00:18:29,800 Speaker 1: for them to emerge and providing a safe space and 285 00:18:29,880 --> 00:18:34,560 Speaker 1: recognizing that they can potentially be impactful, and it's foolish 286 00:18:34,600 --> 00:18:38,760 Speaker 1: because there may be some very powerful ways of harnessing 287 00:18:38,760 --> 00:18:44,280 Speaker 1: those effects to mobilize the efficacy of ketamine. But I 288 00:18:44,320 --> 00:18:48,080 Speaker 1: think the larger question you're asking is what is the 289 00:18:48,200 --> 00:18:53,720 Speaker 1: role of subjective experience in our healing? And might there 290 00:18:53,760 --> 00:19:00,040 Speaker 1: be some paradigmatic deficit in the psychiatric framework that a 291 00:19:00,640 --> 00:19:04,560 Speaker 1: doesn't recognize the importance of subjective experience. It's all about 292 00:19:04,560 --> 00:19:10,240 Speaker 1: symptoms and the brain and behavior. What about consciousness? What 293 00:19:10,320 --> 00:19:14,919 Speaker 1: about the mystery of what it means to experience and 294 00:19:15,040 --> 00:19:19,840 Speaker 1: dream and imagine? Have we been missing something as psychiatrists 295 00:19:20,760 --> 00:19:26,560 Speaker 1: by over emphasizing neurobiology, symptoms, behavior? I mean, is that 296 00:19:26,640 --> 00:19:30,879 Speaker 1: a general failing of psychiatry and psychiatrists even we compare 297 00:19:30,960 --> 00:19:34,800 Speaker 1: to other forms of psychotherapy. That that's the focus on 298 00:19:34,840 --> 00:19:38,399 Speaker 1: the pharmacological and the focus on the medical element of 299 00:19:38,440 --> 00:19:41,480 Speaker 1: this just as kind of become. Whether we call it 300 00:19:41,520 --> 00:19:43,800 Speaker 1: a crutch or a barrier to thinking of in the 301 00:19:43,840 --> 00:19:46,200 Speaker 1: ways that you're describing right now, I think it is 302 00:19:46,240 --> 00:19:50,960 Speaker 1: a general challenge with psychiatry. The missing link here, I 303 00:19:51,000 --> 00:19:55,480 Speaker 1: think is that ketamine was also for a period and 304 00:19:55,600 --> 00:19:59,040 Speaker 1: continues to be so to some extent, a pharmacological model 305 00:19:59,040 --> 00:20:02,399 Speaker 1: of psychosis, mean ing that ketamine was being approached as 306 00:20:02,440 --> 00:20:06,920 Speaker 1: a medicine that can simulate what it means to be psychotic, 307 00:20:06,960 --> 00:20:12,880 Speaker 1: schizophrenic hearing voices, having unusual thoughts, and this was an 308 00:20:12,880 --> 00:20:17,240 Speaker 1: effort to better understand the neural underpinnings of psychosis. So 309 00:20:17,320 --> 00:20:22,719 Speaker 1: John Crystal's work with ketamine originally using sub anesthetic doses 310 00:20:22,720 --> 00:20:28,159 Speaker 1: of ketamine to investigate what psychosis might be and what 311 00:20:28,280 --> 00:20:31,520 Speaker 1: the role of glutamate might be in psychosis. And the 312 00:20:31,560 --> 00:20:35,919 Speaker 1: serendipitous finding came from doing that research, according to John Crystal, 313 00:20:36,000 --> 00:20:39,359 Speaker 1: that he was providing it to healthy volunteers and finding 314 00:20:39,359 --> 00:20:42,840 Speaker 1: that people were reporting that they were feeling better afterwards, 315 00:20:42,920 --> 00:20:45,600 Speaker 1: that there was an improvement in mood, even if they 316 00:20:45,640 --> 00:20:50,480 Speaker 1: weren't necessarily depressed beforehand, and that led to investigating ketamine 317 00:20:51,200 --> 00:20:54,360 Speaker 1: again in a in a biological frame, meaning there's no therapy. 318 00:20:54,480 --> 00:20:57,520 Speaker 1: The psychoactive effects are there, but they're not prepared for 319 00:20:57,720 --> 00:21:01,400 Speaker 1: or integrated or anything like that. It's given to depressed 320 00:21:01,400 --> 00:21:04,480 Speaker 1: people one occasion and then they were followed for a 321 00:21:04,480 --> 00:21:07,720 Speaker 1: few weeks to see how the depression was affected, and 322 00:21:07,840 --> 00:21:13,439 Speaker 1: that spurred a variety of studies looking at ketamine in 323 00:21:13,440 --> 00:21:20,200 Speaker 1: a similar way for depressions through ideality PTSD obsessive compulsive disorder, 324 00:21:21,080 --> 00:21:23,439 Speaker 1: giving a single dose in the absence of any kind 325 00:21:23,480 --> 00:21:28,040 Speaker 1: of psychotherapeutic framework, without much regard for the psychoactive effects, 326 00:21:28,720 --> 00:21:33,399 Speaker 1: to see how symptoms might change. Now, that's not really 327 00:21:33,440 --> 00:21:37,960 Speaker 1: different than how ketamine in a psychedelic framework might work. 328 00:21:38,160 --> 00:21:40,960 Speaker 1: What's different is the lens that was brought to ketamine. 329 00:21:41,440 --> 00:21:44,719 Speaker 1: The lens in this case was very biological, looking at 330 00:21:44,800 --> 00:21:49,840 Speaker 1: it as something that's entirely pharmacological in the sense that 331 00:21:49,880 --> 00:21:54,320 Speaker 1: it's entirely brain based without the psychoactive effects or effects 332 00:21:54,359 --> 00:21:56,520 Speaker 1: that might lend themselves to therapy being a part of 333 00:21:56,560 --> 00:22:01,439 Speaker 1: the process and investigating from there are other compounds that 334 00:22:01,520 --> 00:22:08,560 Speaker 1: might work like ketamine, but with reduced psychoactive effects. We'll 335 00:22:08,600 --> 00:22:24,639 Speaker 1: be talking more after we hear this add I'm curious 336 00:22:24,680 --> 00:22:26,800 Speaker 1: to hear. I mean, now that you've been doing these 337 00:22:26,840 --> 00:22:30,760 Speaker 1: studies right with people struggling, you know, with alcohol problems, 338 00:22:30,760 --> 00:22:34,520 Speaker 1: of cocaine problems, and cannabis problems. Um, could you just 339 00:22:34,720 --> 00:22:41,440 Speaker 1: describe a couple of your patients and what that was like. Yeah. Sure. 340 00:22:41,840 --> 00:22:45,199 Speaker 1: As I mentioned before, I've been interested in how the 341 00:22:45,520 --> 00:22:50,600 Speaker 1: meditative state might be helpful at disrupting addiction, and how 342 00:22:50,640 --> 00:22:54,640 Speaker 1: it might lend itself to a practice whereby the usual 343 00:22:54,680 --> 00:22:57,840 Speaker 1: automaticity and reactivity of addiction have my automaticity, you mean 344 00:22:57,880 --> 00:23:01,280 Speaker 1: people sort of just reflexively doing something on consciously, not 345 00:23:01,359 --> 00:23:05,400 Speaker 1: necessarily unconsciously, but there's such a pronounced reactivity. If there's 346 00:23:05,400 --> 00:23:09,200 Speaker 1: a particular feeling, the compulsion to respond to that feeling 347 00:23:09,400 --> 00:23:16,359 Speaker 1: by using something or craving becomes so impactful. People aren't able, 348 00:23:16,720 --> 00:23:18,959 Speaker 1: who are in the throes of severe addiction that are 349 00:23:18,960 --> 00:23:22,359 Speaker 1: not able to allow the craving to simply pass. There's 350 00:23:22,359 --> 00:23:24,679 Speaker 1: a feeling of needing to act on it at the 351 00:23:24,720 --> 00:23:29,560 Speaker 1: same time that we can surmise that a meditative practice 352 00:23:29,640 --> 00:23:33,760 Speaker 1: might help with those things. Of course, a meditative practice 353 00:23:33,800 --> 00:23:37,239 Speaker 1: requires some suspension of those things as well. Otherwise you're 354 00:23:37,240 --> 00:23:39,480 Speaker 1: not gonna be able to meditate if you're feeling agitated, 355 00:23:39,560 --> 00:23:42,480 Speaker 1: and if if your thoughts are causing you to move 356 00:23:42,520 --> 00:23:45,760 Speaker 1: in this way and that. So the hope was that 357 00:23:45,840 --> 00:23:50,200 Speaker 1: by providing an experience that is easier to come by 358 00:23:50,440 --> 00:23:53,879 Speaker 1: comes through a medicine, that the meditative state that happens 359 00:23:53,880 --> 00:23:56,800 Speaker 1: would serve as a stepping stone for understanding how to 360 00:23:56,840 --> 00:24:00,760 Speaker 1: continue meditating. And what to aim at. And also the 361 00:24:00,840 --> 00:24:04,960 Speaker 1: hope was that the medicine might provide an enduring opening 362 00:24:05,080 --> 00:24:11,639 Speaker 1: with improved craving sensitivity, improved mood, improved anxiety, so that 363 00:24:11,760 --> 00:24:16,320 Speaker 1: the usual vulnerabilities aren't so compromising. It noticed, it's using 364 00:24:16,400 --> 00:24:20,119 Speaker 1: ketamine as a way to get people to move into meditation, 365 00:24:20,280 --> 00:24:23,760 Speaker 1: integrating meditation and life right, and that's somehow that would 366 00:24:23,760 --> 00:24:26,560 Speaker 1: be helpful in that regard correct yet by approximating the 367 00:24:26,600 --> 00:24:30,720 Speaker 1: meditative experience, by making it easier to practice, and also 368 00:24:30,800 --> 00:24:33,600 Speaker 1: by motivating people to do it. You know that there's 369 00:24:33,640 --> 00:24:36,800 Speaker 1: been a lot of research suggesting that one of the 370 00:24:36,880 --> 00:24:42,520 Speaker 1: critical vulnerabilities to engaging fruitfully with any treatment is tenuous 371 00:24:42,520 --> 00:24:48,240 Speaker 1: motivation is just not feeling inspired or capable of doing something, 372 00:24:48,680 --> 00:24:51,720 Speaker 1: and that demoralization is I think a big part of addiction, 373 00:24:52,240 --> 00:24:56,720 Speaker 1: that sense of having resigned oneself to the addiction, having 374 00:24:56,720 --> 00:24:59,399 Speaker 1: tried again and again to stop it, and feeling like, 375 00:24:59,480 --> 00:25:03,840 Speaker 1: what's the why It's it's no good. So I also 376 00:25:03,920 --> 00:25:06,520 Speaker 1: hope that the medicine would disrupt that, that it would 377 00:25:06,520 --> 00:25:10,320 Speaker 1: provide a sense of refresh possibility. Well, let me just 378 00:25:10,320 --> 00:25:12,280 Speaker 1: back up for one second, so just to get a 379 00:25:12,280 --> 00:25:15,479 Speaker 1: picture of this so when these people are in your studies, 380 00:25:15,520 --> 00:25:17,600 Speaker 1: First of all, these people are generally more middle class 381 00:25:17,720 --> 00:25:19,639 Speaker 1: or people are more living on the street kind of 382 00:25:19,680 --> 00:25:23,720 Speaker 1: living rough. It cuts through different cuts across and and 383 00:25:23,800 --> 00:25:27,840 Speaker 1: they're coming into a facility at Columbia UM. They're in 384 00:25:27,840 --> 00:25:30,879 Speaker 1: a room. Are they wearing blindfold? Is their music in 385 00:25:30,920 --> 00:25:34,600 Speaker 1: the background? Are you sitting by them while they're going 386 00:25:34,640 --> 00:25:37,000 Speaker 1: through it? Are they hooked up to an ivy? What 387 00:25:37,040 --> 00:25:40,320 Speaker 1: does it look like? Yeah, so it happens at Columbia 388 00:25:40,320 --> 00:25:44,000 Speaker 1: Medical Center. But we created a space for administering the 389 00:25:44,040 --> 00:25:49,520 Speaker 1: medicine that is as warm and comfortable as possible. The 390 00:25:49,600 --> 00:25:53,920 Speaker 1: old you know catchphrase of set and setting remains very 391 00:25:53,920 --> 00:25:59,040 Speaker 1: important to respect. You know, these medicines, because of how 392 00:25:59,440 --> 00:26:06,080 Speaker 1: profoundly they can change experience, require an environment where people 393 00:26:06,119 --> 00:26:10,960 Speaker 1: can continue feeling safe. Environment conducive to allowing different experiences 394 00:26:10,960 --> 00:26:14,800 Speaker 1: to emerge safely and in a manner that allows the 395 00:26:14,840 --> 00:26:19,240 Speaker 1: person to feel heard and respected. So having a sterile 396 00:26:19,280 --> 00:26:23,040 Speaker 1: medical environment did not seem appropriate given what we were 397 00:26:23,080 --> 00:26:26,560 Speaker 1: trying to do. So we took a room that was 398 00:26:26,680 --> 00:26:29,520 Speaker 1: ordinarily used for laboratory experiments and made it look like 399 00:26:29,520 --> 00:26:35,200 Speaker 1: a living room. They are guided through a meditation exercise 400 00:26:35,600 --> 00:26:38,760 Speaker 1: prior to the ketamine being delivered. It's delivered through an ivy. 401 00:26:39,480 --> 00:26:43,200 Speaker 1: They're wearing an eyemask, laying down on a bed. I'm 402 00:26:43,240 --> 00:26:45,360 Speaker 1: sitting next to them or another physician is sitting next 403 00:26:45,400 --> 00:26:48,439 Speaker 1: to them, as well as the therapist, And throughout the 404 00:26:48,480 --> 00:26:52,040 Speaker 1: experience they're being guided through what's called a body scan 405 00:26:52,720 --> 00:26:58,120 Speaker 1: in mindfulness, that means paying attention to one sensations, one's breathing, 406 00:26:58,359 --> 00:27:01,960 Speaker 1: if thoughts come up, noticing the thought, but maintaining a 407 00:27:02,040 --> 00:27:06,560 Speaker 1: mindful stance, which means being open, being non judgmental, accepting, attentive, 408 00:27:07,000 --> 00:27:09,920 Speaker 1: and no music in the background. No music, and we 409 00:27:09,920 --> 00:27:13,800 Speaker 1: we keep it very silent. So and another hypothesis of 410 00:27:13,880 --> 00:27:18,000 Speaker 1: tacit hypothesis I was operating under here is that a 411 00:27:18,040 --> 00:27:21,320 Speaker 1: lot of the suffering that comes with addiction comes from 412 00:27:21,520 --> 00:27:27,000 Speaker 1: losing sight of the primordial mystery of experience. You know, 413 00:27:27,040 --> 00:27:30,359 Speaker 1: what can't be known, what can't be reduced to words, 414 00:27:30,920 --> 00:27:36,560 Speaker 1: concepts that the experience of someone in addiction is very 415 00:27:36,600 --> 00:27:40,879 Speaker 1: overdetermined and over interpreted to organize too knowing in a 416 00:27:40,880 --> 00:27:44,840 Speaker 1: way for its own good. And I wanted the experience 417 00:27:44,920 --> 00:27:50,520 Speaker 1: to allow for accessing what is beyond knowledge basically what 418 00:27:50,720 --> 00:27:53,879 Speaker 1: can't be put into words, And for that reason I 419 00:27:54,440 --> 00:27:58,000 Speaker 1: wanted the experience to remain as unanchored in things that 420 00:27:58,400 --> 00:28:04,280 Speaker 1: are ordinarily intelligible, like music, going deep into ineff ability. Basically, 421 00:28:04,760 --> 00:28:07,359 Speaker 1: it sounds like what you're describing. When I read about 422 00:28:07,520 --> 00:28:11,439 Speaker 1: some of the psychedelics therapy, sometimes it seems like something 423 00:28:11,440 --> 00:28:14,439 Speaker 1: that's almost more explosives the wrong word, but I mean 424 00:28:14,560 --> 00:28:19,640 Speaker 1: kind of more profound transformational that causes people to rethink 425 00:28:19,680 --> 00:28:22,600 Speaker 1: their lives, to rethink their experience. And it sounds like 426 00:28:22,640 --> 00:28:26,400 Speaker 1: what you're describing is a more modest form of that. 427 00:28:27,080 --> 00:28:32,359 Speaker 1: Is that right? Well, listen, if an explosive transformation is coming, 428 00:28:32,480 --> 00:28:36,919 Speaker 1: I welcome it. What and they do happen? They do happen. 429 00:28:37,000 --> 00:28:41,560 Speaker 1: Even having one's systems of knowledge dissolve in you know, 430 00:28:41,600 --> 00:28:46,120 Speaker 1: the primordial silence, it's not an easy thing to go through. Um. 431 00:28:46,160 --> 00:28:49,160 Speaker 1: At the same time, I think you're picking up on something. 432 00:28:49,160 --> 00:28:53,840 Speaker 1: I am skeptical of these kind of fantastical narratives of 433 00:28:53,880 --> 00:28:58,560 Speaker 1: communing with the divine or having some kind of pivot point. 434 00:28:59,000 --> 00:29:01,680 Speaker 1: They may be helpful, I'm sure, but in my mind, 435 00:29:01,800 --> 00:29:06,440 Speaker 1: what's most helpful is to find one's footing and have 436 00:29:06,680 --> 00:29:11,360 Speaker 1: some kind of regular, enduring practice that helps one navigate 437 00:29:11,840 --> 00:29:14,040 Speaker 1: the trials and tribulations of life. Yeah, well, you know 438 00:29:14,080 --> 00:29:15,680 Speaker 1: what you make me think of. You know, one of 439 00:29:15,720 --> 00:29:19,680 Speaker 1: the historical pieces that many people don't know is that 440 00:29:19,880 --> 00:29:23,520 Speaker 1: one of the founders of Alcoholics anonymous Bill Wilson, right, 441 00:29:23,600 --> 00:29:25,480 Speaker 1: and this was all about, you know, dealing with very 442 00:29:25,560 --> 00:29:29,120 Speaker 1: serious alcoholics and uh, you know, and the the whole 443 00:29:29,160 --> 00:29:32,680 Speaker 1: twelve step model. And then at some point he began 444 00:29:32,800 --> 00:29:36,440 Speaker 1: taking I can't remember this LSD or mescal in LSD, 445 00:29:37,120 --> 00:29:40,640 Speaker 1: and he came to believe that basically this could play 446 00:29:40,720 --> 00:29:45,200 Speaker 1: an important role in very serious inebrious alcoholics coming to 447 00:29:45,240 --> 00:29:48,120 Speaker 1: a kind of come to Jesus moment um in terms 448 00:29:48,160 --> 00:29:50,160 Speaker 1: of their own self awareness, you know, that kind of 449 00:29:50,200 --> 00:29:52,840 Speaker 1: moments that they're seeking for. And then I guess in 450 00:29:52,920 --> 00:29:56,040 Speaker 1: his case what followed from that was less the meditative 451 00:29:56,080 --> 00:30:00,560 Speaker 1: practice and more the fellowship of the whole twelve step approach. 452 00:30:01,280 --> 00:30:02,800 Speaker 1: But I wonder how you see what you were doing 453 00:30:02,880 --> 00:30:06,040 Speaker 1: comparison to what he experienced and talked about, or was 454 00:30:06,200 --> 00:30:09,120 Speaker 1: actually discouraged from talking about once he started talking about it. 455 00:30:09,360 --> 00:30:13,000 Speaker 1: I I, as I said, I'm supportive of anything that 456 00:30:13,040 --> 00:30:19,040 Speaker 1: could be hopeful and a transformative experience clearly can be impactful. 457 00:30:19,080 --> 00:30:21,840 Speaker 1: I mean, many scholars have written about this, starting with 458 00:30:21,840 --> 00:30:25,760 Speaker 1: William James. Bill Miller, the founder of Motivational Dansmo Therapy, 459 00:30:25,800 --> 00:30:30,040 Speaker 1: also wrote about the role of transformative experiences in recovery. 460 00:30:30,120 --> 00:30:33,600 Speaker 1: So I'm very supportive of them. I just wanted to 461 00:30:33,720 --> 00:30:38,560 Speaker 1: ensure that I maintained as comprehensive a model as possible, 462 00:30:38,720 --> 00:30:42,680 Speaker 1: so that while the experience can lend itself to that 463 00:30:42,920 --> 00:30:45,680 Speaker 1: if it were to occur, that if it doesn't occur 464 00:30:45,720 --> 00:30:49,200 Speaker 1: and someone merely, if merely is the right word, enters 465 00:30:49,240 --> 00:30:52,680 Speaker 1: into an eff ability, then that's fine too. We'll make 466 00:30:52,760 --> 00:30:56,160 Speaker 1: do what we can. Let's take a break here and 467 00:30:56,200 --> 00:31:09,760 Speaker 1: go to an ad Among your patients or the subjects 468 00:31:09,760 --> 00:31:12,400 Speaker 1: in the study, is there one that one or two 469 00:31:12,400 --> 00:31:15,080 Speaker 1: they just sort of stand out that you could describe 470 00:31:15,200 --> 00:31:20,680 Speaker 1: their experience? Yeah? What one, very powerful story, which I 471 00:31:20,720 --> 00:31:25,640 Speaker 1: think also indicates just how severe some of the addictions 472 00:31:25,640 --> 00:31:28,080 Speaker 1: we were dealing with our It was a laboratory study 473 00:31:28,400 --> 00:31:33,680 Speaker 1: investigating how ketamine might disrupt cocaine self administration. So woman 474 00:31:33,920 --> 00:31:38,080 Speaker 1: who had worked as a sex worker at a cocaine addiction, 475 00:31:38,720 --> 00:31:44,000 Speaker 1: very significant history of trauma, had multiple um scars all 476 00:31:44,040 --> 00:31:48,360 Speaker 1: over her body that came from having been abducted by 477 00:31:48,400 --> 00:31:51,280 Speaker 1: several men and mutilated and what sounds like some kind 478 00:31:51,280 --> 00:31:54,680 Speaker 1: of bizarre ritual um. She was able to get away 479 00:31:55,520 --> 00:31:59,080 Speaker 1: with severe wounds all over her body, but it was 480 00:31:59,120 --> 00:32:01,720 Speaker 1: able to escape. She worried that if she hadn't she 481 00:32:01,840 --> 00:32:04,960 Speaker 1: might have died, and it's haunted her as continued to 482 00:32:05,000 --> 00:32:09,560 Speaker 1: be an important part of her pathology, unfortunately. But she 483 00:32:09,600 --> 00:32:14,560 Speaker 1: came in with a fairly significant crack cocaine addiction, and 484 00:32:15,360 --> 00:32:18,280 Speaker 1: the experience that she had with ketamine is one of 485 00:32:18,280 --> 00:32:22,040 Speaker 1: the most remarkable I've seen speaking of transformative So this 486 00:32:22,080 --> 00:32:24,720 Speaker 1: was a study that wasn't really intended to help people 487 00:32:24,960 --> 00:32:29,880 Speaker 1: stop using. It was, as I mentioned, a lab study 488 00:32:30,000 --> 00:32:33,080 Speaker 1: to investigate a very specific question whether it reduces cocaine 489 00:32:33,080 --> 00:32:36,920 Speaker 1: self administration. Beyond the mindfulness training to help the person 490 00:32:37,000 --> 00:32:40,520 Speaker 1: prepare for the infusion, et cetera, there wasn't much support 491 00:32:41,240 --> 00:32:46,160 Speaker 1: and she had an experience where she began with moaning 492 00:32:46,240 --> 00:32:49,160 Speaker 1: in a in a kind of aroused way. Then it 493 00:32:49,200 --> 00:32:55,960 Speaker 1: went into sobbing to um trying to escape something, writhing 494 00:32:55,960 --> 00:33:00,680 Speaker 1: on the bed, and that's where the support of physician 495 00:33:00,760 --> 00:33:03,840 Speaker 1: therapist can be crucial when you know, it's not simply 496 00:33:03,840 --> 00:33:07,520 Speaker 1: a meditative state, but this kind of intense ab reaction 497 00:33:07,640 --> 00:33:14,080 Speaker 1: or or a reliving means to occur. And she ultimately, 498 00:33:14,120 --> 00:33:16,360 Speaker 1: by the end of the infusion, had calmed down and 499 00:33:17,000 --> 00:33:20,640 Speaker 1: was just repeating over and over again how the knife 500 00:33:20,640 --> 00:33:24,120 Speaker 1: had been removed, that it had been half out without 501 00:33:24,120 --> 00:33:26,680 Speaker 1: her realizing, but finally been removed. And she said something 502 00:33:27,040 --> 00:33:29,960 Speaker 1: very powerful, which I think of quite regularly. You know, 503 00:33:30,000 --> 00:33:32,120 Speaker 1: when you have a knife in you, she said, you 504 00:33:32,160 --> 00:33:34,760 Speaker 1: get used to it, and it's not until it's coming 505 00:33:34,800 --> 00:33:39,040 Speaker 1: out that it really hurts. And it was really the 506 00:33:39,040 --> 00:33:43,080 Speaker 1: the space that the ketamine provided her that allowed her 507 00:33:43,320 --> 00:33:49,080 Speaker 1: the safety, the the relaxing of defenses to finally allow 508 00:33:49,160 --> 00:33:52,880 Speaker 1: the knife out. And what was remarkable is that, as 509 00:33:52,920 --> 00:33:57,240 Speaker 1: again because this was not intended to necessarily provide treatment, 510 00:33:57,320 --> 00:34:00,400 Speaker 1: it was to ask a very specific question, she nonetheless 511 00:34:00,400 --> 00:34:04,600 Speaker 1: stopped using cocaine for the duration of the follow up 512 00:34:04,640 --> 00:34:07,840 Speaker 1: period after this this laboratory study. We continued seeing them 513 00:34:07,880 --> 00:34:10,920 Speaker 1: for four weeks after. And that's an example I think 514 00:34:10,960 --> 00:34:14,760 Speaker 1: of how there are things going on here which remain 515 00:34:15,520 --> 00:34:21,320 Speaker 1: very untapped, you know, the capacity for these single experiences 516 00:34:21,360 --> 00:34:25,480 Speaker 1: to shift things so dramatically. Again, I'm not hanging my 517 00:34:25,560 --> 00:34:27,560 Speaker 1: hat on that for every patient, and I'm trying to 518 00:34:27,600 --> 00:34:32,399 Speaker 1: find a very durable, resilient framework by which we might 519 00:34:33,239 --> 00:34:37,120 Speaker 1: tap into those benefits. I think using meditation and having 520 00:34:37,160 --> 00:34:41,600 Speaker 1: a psychotherapeutic framework important for that. But it can happen. 521 00:34:41,800 --> 00:34:44,920 Speaker 1: It's not simply anecdote. And well, I tell me, have 522 00:34:45,000 --> 00:34:47,080 Speaker 1: you done the follow up with her or others? You know, 523 00:34:47,120 --> 00:34:49,520 Speaker 1: not just four weeks later, but six months later, a 524 00:34:49,640 --> 00:34:52,600 Speaker 1: year later, and to see how they're doing. Yeah. So 525 00:34:52,680 --> 00:34:57,800 Speaker 1: we we've had two clinical trials that UM involved fairly 526 00:34:57,840 --> 00:35:01,480 Speaker 1: long follow up, one with cocaine addicted people and one 527 00:35:01,520 --> 00:35:06,480 Speaker 1: with alcohol dependent individuals. They were both several week trials 528 00:35:06,920 --> 00:35:10,400 Speaker 1: that involved several months of follow up after they completed 529 00:35:10,400 --> 00:35:13,799 Speaker 1: the trial, and we continued to ask how they were 530 00:35:13,840 --> 00:35:17,960 Speaker 1: doing and what their youth patterns were. And in both 531 00:35:18,239 --> 00:35:22,839 Speaker 1: UM studies, the rates of abstinence with the people who 532 00:35:22,920 --> 00:35:27,319 Speaker 1: received ketamine were significantly higher than with the control group. 533 00:35:27,520 --> 00:35:31,120 Speaker 1: So these are durable effects and all based upon the 534 00:35:31,160 --> 00:35:33,720 Speaker 1: one session. Was it just one session or two sessions 535 00:35:33,760 --> 00:35:36,200 Speaker 1: you did with them? Yea, for these studies it was 536 00:35:36,239 --> 00:35:39,040 Speaker 1: one session. I see. But when I think about like 537 00:35:39,080 --> 00:35:42,400 Speaker 1: a friend of mine who was suffering very seriously from 538 00:35:42,680 --> 00:35:47,359 Speaker 1: depression and trauma. Man having some pain, and he did, 539 00:35:47,480 --> 00:35:49,319 Speaker 1: I think what many people do, and man, you know 540 00:35:49,360 --> 00:35:52,360 Speaker 1: more and more where he did six ketamine sessions in 541 00:35:52,360 --> 00:35:54,520 Speaker 1: the space of a month, followed by one a month 542 00:35:54,640 --> 00:35:57,399 Speaker 1: for a year and did get some lasting many years 543 00:35:57,440 --> 00:36:01,080 Speaker 1: thereafter benefit. But have you considered doing that model as well, 544 00:36:01,200 --> 00:36:02,759 Speaker 1: or is there a reason to keep it to the 545 00:36:02,840 --> 00:36:06,680 Speaker 1: more a model which involves giving fewer administrations. It's a 546 00:36:06,800 --> 00:36:10,840 Speaker 1: very important question, and I think this gets at some 547 00:36:11,000 --> 00:36:15,560 Speaker 1: of the strictures that come with doing controversial research. So 548 00:36:15,600 --> 00:36:18,000 Speaker 1: I should mention that all of the research I've done 549 00:36:18,040 --> 00:36:21,719 Speaker 1: has been NIH funded either um NEIDA, which we talked 550 00:36:21,719 --> 00:36:24,160 Speaker 1: about before, and I Triple A, which is the wing 551 00:36:24,239 --> 00:36:28,160 Speaker 1: of ni H that's focused on alcohol treatment. And in 552 00:36:28,600 --> 00:36:32,759 Speaker 1: getting funding from both agencies, I needed to do a 553 00:36:32,800 --> 00:36:36,480 Speaker 1: lot of politicking because even though the grants that I 554 00:36:36,480 --> 00:36:40,920 Speaker 1: had submitted had received great scores from the Science Committee, 555 00:36:41,239 --> 00:36:46,800 Speaker 1: the more bureaucratic wing of both agencies was not interested 556 00:36:47,160 --> 00:36:51,040 Speaker 1: in investigating a mind altering substance for addiction because they 557 00:36:51,040 --> 00:36:53,560 Speaker 1: were worried about the political fallout, or because of their 558 00:36:53,600 --> 00:36:58,000 Speaker 1: own ideologies or ignorance, or there's a notion which is 559 00:36:58,120 --> 00:37:03,080 Speaker 1: erroneous that people who are prone to addiction whatever that means, 560 00:37:03,760 --> 00:37:08,200 Speaker 1: are also prone to getting addicted to other substances if 561 00:37:08,200 --> 00:37:12,000 Speaker 1: they were exposed to them. So if you're providing something 562 00:37:12,280 --> 00:37:16,359 Speaker 1: like ketamine to someone with cocaine problems, it's like you're 563 00:37:16,400 --> 00:37:22,920 Speaker 1: introducing potentially problematic, addiction prone substance to someone. Is there 564 00:37:22,960 --> 00:37:26,359 Speaker 1: any rational, evidence based approach for people within the NIDA 565 00:37:26,400 --> 00:37:30,440 Speaker 1: bureaucracy to take that view. No, No, it's a prejudice. 566 00:37:30,960 --> 00:37:33,160 Speaker 1: I have to tell you. It's just infuriated me. No end. 567 00:37:33,239 --> 00:37:36,359 Speaker 1: I mean it's a tragedy because NIDA provides I think 568 00:37:37,200 --> 00:37:39,560 Speaker 1: of all the funding for drug abuse research, not just 569 00:37:39,600 --> 00:37:42,120 Speaker 1: in the US but globally, and to be in this 570 00:37:42,280 --> 00:37:46,719 Speaker 1: incredibly rigid, ideological, you know, perspective on this stuff. I mean, 571 00:37:46,760 --> 00:37:51,600 Speaker 1: are they even funding any psychedelics research now apart from ketamine? No? Nothing. 572 00:37:51,719 --> 00:37:54,560 Speaker 1: I mean, well that's I should say, they're not funding 573 00:37:54,600 --> 00:37:58,759 Speaker 1: any therapeutic um, only looking at the harms of these 574 00:37:58,760 --> 00:38:03,279 Speaker 1: things exactly. Uh. Yeah, And to your point, a lot 575 00:38:03,320 --> 00:38:08,279 Speaker 1: of the substances that have been helpful for addiction, methadone, 576 00:38:08,480 --> 00:38:12,520 Speaker 1: puper nor pine if they were, for whatever reason, illegal, 577 00:38:13,280 --> 00:38:16,560 Speaker 1: we would be missing out on a tremendous opportunity. Those 578 00:38:16,600 --> 00:38:22,520 Speaker 1: substances are psychoactive, They activate receptors that other so called 579 00:38:22,600 --> 00:38:25,880 Speaker 1: drugs of abuse do. So, you know, the the argument 580 00:38:25,920 --> 00:38:28,600 Speaker 1: is definitely specious, but that was the argument I was 581 00:38:28,640 --> 00:38:31,200 Speaker 1: contending with. And as you seem aware, the challenge here 582 00:38:31,239 --> 00:38:33,719 Speaker 1: is that we're not really dealing with only science. We're 583 00:38:33,760 --> 00:38:37,399 Speaker 1: dealing with politics. We're dealing with ideology. We're dealing with 584 00:38:37,640 --> 00:38:42,160 Speaker 1: a particular perspective on drugs and addiction that comes less 585 00:38:42,200 --> 00:38:46,759 Speaker 1: from evidence and careful experiment and more from you know, 586 00:38:47,239 --> 00:38:50,840 Speaker 1: the drug war. I mean, I'm curious if you imagine 587 00:38:51,280 --> 00:38:54,600 Speaker 1: in the future, let's assume that at some point the 588 00:38:55,120 --> 00:38:59,960 Speaker 1: the other psychedelics actually become as legally available and permissive 589 00:39:00,160 --> 00:39:05,920 Speaker 1: to work with um for you know, drug treatment, ptsd, O, 590 00:39:06,120 --> 00:39:09,800 Speaker 1: c D, depression, whatever it might be. When more of 591 00:39:09,840 --> 00:39:13,120 Speaker 1: these are available, well ken amine play a lesser role. 592 00:39:13,320 --> 00:39:16,239 Speaker 1: I mean, is ketamine having some of its time in 593 00:39:16,280 --> 00:39:18,880 Speaker 1: the sun because the other ones are so hard to 594 00:39:18,960 --> 00:39:23,960 Speaker 1: get funding for except from private sources. That's a great question. Yeah, 595 00:39:24,000 --> 00:39:27,359 Speaker 1: I would not dismiss the power of ketamine. I don't 596 00:39:27,360 --> 00:39:30,480 Speaker 1: think it's simply that it has it's fifteen minutes due 597 00:39:30,520 --> 00:39:34,640 Speaker 1: to the other drugs being inaccessible. It has its own power. 598 00:39:34,960 --> 00:39:37,600 Speaker 1: And I should tell you a story a colleague of mine, 599 00:39:37,760 --> 00:39:41,760 Speaker 1: I keep her anonymous. I've been struggling with fairly severe 600 00:39:41,760 --> 00:39:45,960 Speaker 1: psychiatric issues for most of her life and did not 601 00:39:46,640 --> 00:39:52,279 Speaker 1: receive benefit from the conventional approaches. Met a healer who 602 00:39:52,400 --> 00:39:56,800 Speaker 1: worked with various types of psychedelics m d m A, psilocybin, 603 00:39:57,160 --> 00:40:02,360 Speaker 1: d MT LSD, and went through all of those, tried 604 00:40:02,400 --> 00:40:05,359 Speaker 1: every single one, but it wasn't until ketamine. It wasn't 605 00:40:05,440 --> 00:40:09,120 Speaker 1: until high dose intramuscular ketemine that she found relief. So 606 00:40:10,160 --> 00:40:14,399 Speaker 1: you know, these are ultimately different compounds, and there will 607 00:40:14,440 --> 00:40:18,280 Speaker 1: always be a place, I think for the very unique 608 00:40:18,280 --> 00:40:21,279 Speaker 1: effects that ketamine has. I should also say that ketamine 609 00:40:21,520 --> 00:40:27,800 Speaker 1: lends itself to easy administration much more than psilocybin. For example, 610 00:40:27,840 --> 00:40:32,040 Speaker 1: does it shorter acting, it doesn't last for hours and hours, 611 00:40:32,640 --> 00:40:37,279 Speaker 1: it doesn't require the same level of psychological preparation, hand holding, integration. 612 00:40:37,560 --> 00:40:39,719 Speaker 1: It lends itself to all of those things. So they 613 00:40:39,760 --> 00:40:43,280 Speaker 1: mentioned with the case of the sex worker who definitely 614 00:40:43,320 --> 00:40:47,200 Speaker 1: needed support and guidance, but in in a lot of cases, 615 00:40:47,320 --> 00:40:50,640 Speaker 1: people have a fairly calm experience and they're able to 616 00:40:51,160 --> 00:40:54,719 Speaker 1: move forward. I mean, unless I should tell you. You know, 617 00:40:54,760 --> 00:40:58,600 Speaker 1: I had my own experience with kenemine a guided session 618 00:40:58,719 --> 00:41:01,720 Speaker 1: last summer, and I hadn't really done it that way before, 619 00:41:02,040 --> 00:41:06,960 Speaker 1: and I was struck that compared to mushrooms, it was 620 00:41:07,239 --> 00:41:10,719 Speaker 1: comparably powerful and as you say, much shorter acting, but 621 00:41:10,840 --> 00:41:14,240 Speaker 1: it came on in my body in a much gentler way, 622 00:41:14,760 --> 00:41:16,040 Speaker 1: you know, And maybe this's is part of it as 623 00:41:16,040 --> 00:41:18,480 Speaker 1: I get older, mushrooms kind of you kind of a 624 00:41:18,480 --> 00:41:21,400 Speaker 1: little bit raggedy effect coming in. But the kennemy was 625 00:41:21,520 --> 00:41:25,400 Speaker 1: very calm and easy. And then after it's over, um, 626 00:41:25,440 --> 00:41:27,759 Speaker 1: you know, barely an hour later and one could re 627 00:41:27,880 --> 00:41:30,759 Speaker 1: engage in normal activities that one wanted to. Well, let 628 00:41:30,760 --> 00:41:34,120 Speaker 1: me ask you this whole thing with the commercialization. You know, 629 00:41:34,200 --> 00:41:37,200 Speaker 1: you can't pat into stuff is basically a generic substance now, 630 00:41:37,520 --> 00:41:40,520 Speaker 1: but pharmacitic companies find their way to do it right. 631 00:41:40,520 --> 00:41:42,520 Speaker 1: You see, with the locks, you know, the thing that's 632 00:41:42,560 --> 00:41:46,839 Speaker 1: so crucially important for reversing overdose, but manufacturers find ways 633 00:41:46,880 --> 00:41:48,920 Speaker 1: of selling them in a form this administer that costed 634 00:41:49,000 --> 00:41:51,640 Speaker 1: dramatically more money than the few bucks and knocks on 635 00:41:51,760 --> 00:41:54,600 Speaker 1: the cost, and you started talking about something that's happening 636 00:41:54,680 --> 00:41:57,960 Speaker 1: in this area as well, where kenemine is now this 637 00:41:58,040 --> 00:42:00,319 Speaker 1: thing called esketamine or something like that. Just can you 638 00:42:00,360 --> 00:42:04,759 Speaker 1: explain what's going on there, what your concerns are about it? Well, 639 00:42:04,840 --> 00:42:10,879 Speaker 1: Ketamine is a receimate, meaning that it has two molecules 640 00:42:10,880 --> 00:42:14,720 Speaker 1: in equal proportion. One is the right handed ketamine molecule, 641 00:42:14,760 --> 00:42:17,600 Speaker 1: the others the left handed kenemine molecule. There basically mirror 642 00:42:17,600 --> 00:42:20,799 Speaker 1: images of one another, and each molecule may have its 643 00:42:20,840 --> 00:42:25,400 Speaker 1: own role to play in the benefits. Kenemine provides. What 644 00:42:25,560 --> 00:42:29,719 Speaker 1: Jansen has done which has s ketamine or spravado on 645 00:42:29,760 --> 00:42:33,240 Speaker 1: the market currently is It's taken the left handed molecule 646 00:42:33,360 --> 00:42:38,360 Speaker 1: s ketamine and patented it for depression. Also packaged it 647 00:42:38,360 --> 00:42:40,160 Speaker 1: in a way that it could be administered in a 648 00:42:40,200 --> 00:42:44,160 Speaker 1: clinic without necessarily I V S or needles involved. It's 649 00:42:44,280 --> 00:42:50,120 Speaker 1: done intranasally, and took it through the usual pipeline to 650 00:42:50,200 --> 00:42:54,680 Speaker 1: get FDA approval and just barely skated by. Didn't do 651 00:42:54,920 --> 00:43:00,560 Speaker 1: nearly as well as they think broadcast um and the 652 00:43:00,600 --> 00:43:04,320 Speaker 1: FDA in fact made an exception. Usually you need a 653 00:43:04,400 --> 00:43:09,280 Speaker 1: few trials that are positive to grant that a drug 654 00:43:09,400 --> 00:43:12,040 Speaker 1: might be used in a certain way. There was only 655 00:43:12,040 --> 00:43:14,360 Speaker 1: one that worked. There was only one trial that showed 656 00:43:14,360 --> 00:43:18,720 Speaker 1: efficacy in the case of stemine. In any case, it 657 00:43:18,760 --> 00:43:23,759 Speaker 1: has its challenges. Um from a clinical perspective, may not 658 00:43:23,800 --> 00:43:26,279 Speaker 1: be as effective as ketamine. But I think the most 659 00:43:26,760 --> 00:43:30,920 Speaker 1: problematic aspect of it, in my mind is how mercenary 660 00:43:30,960 --> 00:43:35,320 Speaker 1: it is. So ketamine costs a dollar or two to administer, 661 00:43:35,640 --> 00:43:39,280 Speaker 1: I mean, in terms of the medication costs, s ketamine 662 00:43:39,800 --> 00:43:42,680 Speaker 1: is about a thousand dollars. It does, so it's it's 663 00:43:42,719 --> 00:43:47,279 Speaker 1: half the compound, but you know thousand times as much. 664 00:43:47,440 --> 00:43:49,200 Speaker 1: And why did if why did f D a fast 665 00:43:49,200 --> 00:43:53,640 Speaker 1: track it? Because it's dealing with a severe issue, depression, 666 00:43:54,160 --> 00:43:58,680 Speaker 1: treatment resistant depression especially very problematic. I was hearing that 667 00:43:59,000 --> 00:44:01,320 Speaker 1: if you look at which of the clinics and clinicians 668 00:44:01,360 --> 00:44:04,239 Speaker 1: are doing a better job, typically the ones making the 669 00:44:04,239 --> 00:44:08,680 Speaker 1: effort to use ketamine are having better results and being 670 00:44:08,680 --> 00:44:11,319 Speaker 1: more responsible towards their patients. Then are the ones that 671 00:44:11,360 --> 00:44:15,239 Speaker 1: are trying to profiteer off of using this asketamine approach. Well, 672 00:44:15,239 --> 00:44:18,600 Speaker 1: the profiteering is only on the industry side. Yeah, the 673 00:44:18,640 --> 00:44:22,200 Speaker 1: doctors who are involved are more often kind of more 674 00:44:22,200 --> 00:44:26,279 Speaker 1: conventional types who told the line, let's say they're given 675 00:44:26,320 --> 00:44:30,040 Speaker 1: this medicine drug, reps come provide information on how to 676 00:44:30,080 --> 00:44:34,279 Speaker 1: provide it. They may not be operating from a more 677 00:44:34,280 --> 00:44:38,000 Speaker 1: holistic framework where therapy is integrated into the process. With 678 00:44:38,120 --> 00:44:42,040 Speaker 1: ketamine clinics, therapy is invariably a big part of it. 679 00:44:42,840 --> 00:44:46,520 Speaker 1: There's an understanding that a proper framework is important, that 680 00:44:47,120 --> 00:44:50,400 Speaker 1: the psychoactive effects need to be attended to with provado 681 00:44:50,600 --> 00:44:53,720 Speaker 1: not so much. Again, it's just a procedure. Yeah, somebody 682 00:44:53,800 --> 00:44:56,960 Speaker 1: described to me, you know, and entsiologists just trying to 683 00:44:56,960 --> 00:45:00,239 Speaker 1: make some additional money on the side basically and having 684 00:45:00,320 --> 00:45:03,280 Speaker 1: some experience with kennemine by virtually being an a thesiologists 685 00:45:03,280 --> 00:45:06,080 Speaker 1: and saying, here's another opportunity for them to make money 686 00:45:06,120 --> 00:45:09,960 Speaker 1: without basically investing the time or the energy to understanding 687 00:45:09,960 --> 00:45:12,320 Speaker 1: all the dimensions that you and I have been talking about. 688 00:45:12,880 --> 00:45:15,920 Speaker 1: Because can be abused, right, people do get in trouble 689 00:45:16,000 --> 00:45:20,560 Speaker 1: with it. I'm just wondering if that whole more commercialized 690 00:45:21,440 --> 00:45:25,279 Speaker 1: approach might lend itself to giving in trouble as well. Absolutely, 691 00:45:25,719 --> 00:45:27,560 Speaker 1: you know, I think one of the big challenges we're 692 00:45:27,560 --> 00:45:32,680 Speaker 1: going to be facing in these sorts of compounds entering 693 00:45:32,680 --> 00:45:38,319 Speaker 1: into therapeutic settings, is the eagerness with which they might 694 00:45:38,360 --> 00:45:43,239 Speaker 1: be pushed. You know, this transformative potential story can also 695 00:45:43,320 --> 00:45:45,600 Speaker 1: have its dangerous Oh we need just need to keep 696 00:45:45,640 --> 00:45:49,600 Speaker 1: trying until we get that transformative experience. And you know 697 00:45:49,640 --> 00:45:51,359 Speaker 1: that could be a road to nowhere or a road 698 00:45:51,400 --> 00:45:55,319 Speaker 1: to real problems as you're suggesting. So yeah, there there's 699 00:45:55,360 --> 00:45:58,719 Speaker 1: a definite danger with ideological interests or maybe a pecuniary 700 00:45:58,760 --> 00:46:02,920 Speaker 1: interest and phasizing continuing to try the medicine, continuing to 701 00:46:02,960 --> 00:46:04,960 Speaker 1: try the medicine even as it doesn't seem to be 702 00:46:05,000 --> 00:46:08,560 Speaker 1: doing much. So, Elias, I want I want to finish 703 00:46:08,600 --> 00:46:11,400 Speaker 1: up by asking you two questions, one backward one forward. 704 00:46:11,760 --> 00:46:14,200 Speaker 1: Which was I noticed in looking at your CV that 705 00:46:14,239 --> 00:46:17,120 Speaker 1: you were born in Haifa, Israel, right, And I remember 706 00:46:17,160 --> 00:46:20,160 Speaker 1: you're describing some of your your origins, and I wonder 707 00:46:20,239 --> 00:46:22,520 Speaker 1: if you could just say something about that. Can you 708 00:46:22,600 --> 00:46:25,719 Speaker 1: discern any impact of your early years growing up in 709 00:46:25,760 --> 00:46:28,680 Speaker 1: your identity on the work that you're doing now? Well, 710 00:46:28,719 --> 00:46:33,160 Speaker 1: I I'm not quite a refugee, but in many ways 711 00:46:33,200 --> 00:46:36,480 Speaker 1: that the story is comparable to that. I am able 712 00:46:36,520 --> 00:46:38,800 Speaker 1: to go back to Israel and all of those things, 713 00:46:38,840 --> 00:46:43,440 Speaker 1: but it was an environment that my parents felt wasn't 714 00:46:43,480 --> 00:46:48,880 Speaker 1: as conducive to raising us, my brother and sister and I, 715 00:46:49,760 --> 00:46:53,960 Speaker 1: So we went to the States to find greater, greater opportunity, 716 00:46:54,400 --> 00:46:59,120 Speaker 1: greater tolerance because you're growing up in Israel, not Jewish, 717 00:46:59,160 --> 00:47:05,359 Speaker 1: but growing up is a Palestinian, Arab Christian ISRAELI exactly, yeah, um, 718 00:47:05,400 --> 00:47:08,480 Speaker 1: you know, and I'm speaking as someone who's parents were 719 00:47:08,920 --> 00:47:12,280 Speaker 1: like my mom spoke Hebrew better than any other language, 720 00:47:12,320 --> 00:47:15,440 Speaker 1: and my dad went to UM a lot of the 721 00:47:16,080 --> 00:47:20,839 Speaker 1: good universities there, so they were definitely acculturated. But there 722 00:47:20,920 --> 00:47:25,680 Speaker 1: was this this element of distance, nonetheless that has stayed 723 00:47:25,719 --> 00:47:28,680 Speaker 1: with me. So when you ask how that might have 724 00:47:28,719 --> 00:47:32,239 Speaker 1: informed the work I'm doing, I've I've definitely felt like 725 00:47:32,280 --> 00:47:37,760 Speaker 1: an outsider and always investigating the systems that are foisted 726 00:47:37,800 --> 00:47:45,080 Speaker 1: on us for their absurdity, their violence, their unreality. That 727 00:47:45,080 --> 00:47:48,920 Speaker 1: that's been a big part of my um my perspective 728 00:47:49,120 --> 00:47:53,879 Speaker 1: and has definitely allowed me to recognize where things might 729 00:47:53,880 --> 00:47:57,120 Speaker 1: be done differently. As with ketamine, it's a look at 730 00:47:57,160 --> 00:47:59,959 Speaker 1: just the last question thinking forward. I mean, you're still 731 00:48:00,160 --> 00:48:02,759 Speaker 1: you know, you're early in your career, You're young. You've 732 00:48:02,800 --> 00:48:06,880 Speaker 1: been doing some fascinating research about kenemine. What's your hopes 733 00:48:06,920 --> 00:48:10,560 Speaker 1: and ambitions for yourself over these coming decades in terms 734 00:48:10,640 --> 00:48:14,160 Speaker 1: of do you see yourself committed to doing this research 735 00:48:14,480 --> 00:48:18,000 Speaker 1: even more so on kedemine and towards psychedelics. UM. Do 736 00:48:18,040 --> 00:48:19,839 Speaker 1: you think it will continue to be connected to your 737 00:48:19,880 --> 00:48:23,920 Speaker 1: research and drug treatment? Is there some grand hopes that 738 00:48:23,960 --> 00:48:26,680 Speaker 1: you have for all of this? Well? I I went 739 00:48:26,719 --> 00:48:30,000 Speaker 1: into this research personally with a sense of injustice at 740 00:48:30,520 --> 00:48:35,480 Speaker 1: how this model, which had shown such promise in the 741 00:48:35,480 --> 00:48:40,680 Speaker 1: fifties and sixties and Jenny's work, was so dismissed or 742 00:48:40,719 --> 00:48:44,279 Speaker 1: even demonized, And in that regard, I feel like I've 743 00:48:44,600 --> 00:48:47,520 Speaker 1: done what I need to do in an academic setting, 744 00:48:48,239 --> 00:48:51,640 Speaker 1: you know, my own small role in helping rehabilitate this 745 00:48:51,719 --> 00:48:54,840 Speaker 1: model and and apply it to a drug that had, 746 00:48:54,880 --> 00:48:59,399 Speaker 1: you know, just narrowly escaped being a purely a biological intervention. UM, 747 00:48:59,440 --> 00:49:02,719 Speaker 1: so that art, you know, I'm not so sure what 748 00:49:02,719 --> 00:49:04,600 Speaker 1: else I can do in academic settings that would be 749 00:49:04,680 --> 00:49:07,600 Speaker 1: interesting to me. I think now it's about helping people 750 00:49:07,680 --> 00:49:13,040 Speaker 1: more generally, and I'm under no illusion that that feeding 751 00:49:13,040 --> 00:49:16,400 Speaker 1: the academic industry helps people. So I'm you know. I 752 00:49:16,400 --> 00:49:20,960 Speaker 1: think the question now is what I might do to um, 753 00:49:20,719 --> 00:49:26,319 Speaker 1: you know, bring healing, understanding, social change beyond academia. Yeah, well, 754 00:49:26,400 --> 00:49:29,479 Speaker 1: as we should talk, because there's somebody who my first 755 00:49:29,520 --> 00:49:32,239 Speaker 1: seven years in this area worlds in academia and then 756 00:49:32,280 --> 00:49:35,040 Speaker 1: I moved outward from there, um you know, and hopes 757 00:49:35,120 --> 00:49:38,080 Speaker 1: that doing so we get it outside of the of 758 00:49:38,120 --> 00:49:41,439 Speaker 1: the university and into the broader world. So I look 759 00:49:41,480 --> 00:49:44,439 Speaker 1: forward to future discussions with you, not just on air, 760 00:49:44,520 --> 00:49:48,480 Speaker 1: but also over coffee as the pandemic recedes. But I 761 00:49:48,480 --> 00:49:50,600 Speaker 1: did really really want to thank you very very much 762 00:49:50,640 --> 00:49:53,000 Speaker 1: for joining me on this and it's really been a 763 00:49:53,040 --> 00:49:56,319 Speaker 1: pleasure and edification. So thanks so much, and best of 764 00:49:56,400 --> 00:49:59,839 Speaker 1: luck with all your research and other plans ahead. Thank 765 00:49:59,880 --> 00:50:06,279 Speaker 1: you so much. Psychoactive is the production of I Heart 766 00:50:06,360 --> 00:50:10,240 Speaker 1: Radio and Protozoa Pictures. It's hosted by me Ethan Naedelman. 767 00:50:10,480 --> 00:50:14,320 Speaker 1: It's produced by Katcha Kumkova and Ben Cabrick. The executive 768 00:50:14,320 --> 00:50:18,440 Speaker 1: producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren 769 00:50:18,440 --> 00:50:22,560 Speaker 1: Aronovski for Protozoa Pictures, Alice Williams and Matt Frederick for 770 00:50:22,600 --> 00:50:26,279 Speaker 1: I Heart Radio and me Ethan Nadelman. Our music is 771 00:50:26,320 --> 00:50:29,560 Speaker 1: by Ari Blusian and a special thanks to a Vivit Brio, 772 00:50:29,640 --> 00:50:34,040 Speaker 1: Sef Bianca Grimshaw and Robert Beatty. If you'd like to 773 00:50:34,040 --> 00:50:37,319 Speaker 1: share your own stories, comments, or ideas, please leave us 774 00:50:37,320 --> 00:50:42,280 Speaker 1: a message at eight three three seven seven nine sixty. 775 00:50:43,040 --> 00:50:48,560 Speaker 1: That's one eight three three psycho zero. You can also 776 00:50:48,680 --> 00:50:52,279 Speaker 1: email us as psychoactive at protozoa dot com or find 777 00:50:52,280 --> 00:50:55,080 Speaker 1: me on Twitter at Ethan Nadelman. And if you couldn't 778 00:50:55,160 --> 00:50:57,600 Speaker 1: keep track of all this, find the information in the 779 00:50:57,640 --> 00:51:04,200 Speaker 1: show notes. Tune in next time and hear me talk 780 00:51:04,320 --> 00:51:06,520 Speaker 1: with Carl Hart, a dear friend of mine who's a 781 00:51:06,560 --> 00:51:10,319 Speaker 1: neuroscientist at Columbia University, best known for his recent book 782 00:51:10,560 --> 00:51:14,320 Speaker 1: Drug Used for Growing Ups. No matter how many drugs 783 00:51:14,360 --> 00:51:17,560 Speaker 1: this particular person was selling or led to him, So 784 00:51:18,200 --> 00:51:21,400 Speaker 1: you shouldn't be able to kick someone's door down and 785 00:51:21,440 --> 00:51:24,120 Speaker 1: then murder them on top of that, And so I 786 00:51:24,160 --> 00:51:27,960 Speaker 1: think people were starting to put together Philanderer still uh, 787 00:51:28,160 --> 00:51:32,240 Speaker 1: he had marijuana and that cop of shot him to death. 788 00:51:32,719 --> 00:51:35,799 Speaker 1: We think about Lakwan MacDonald, the seventeen year old kid 789 00:51:35,880 --> 00:51:38,880 Speaker 1: in Chicago where they said that he had PCP in 790 00:51:38,920 --> 00:51:41,880 Speaker 1: a system. And he was shot sixteen time. And people 791 00:51:41,880 --> 00:51:44,799 Speaker 1: are starting to see that drugs are always used as 792 00:51:44,800 --> 00:51:49,560 Speaker 1: this convenient scapegoat to justify this awful behavior. Subscribe to 793 00:51:49,600 --> 00:51:51,319 Speaker 1: Cycleactive now see you don't miss it.