Speaker 1: Hi, I'm Ethan Nadelman, and this is Psychoactive, a production
Speaker 1: of I Heart Radio and Protozoa Pictures. Psychoactive is the
Speaker 1: show where we talk about all things drugs. But any
Speaker 1: views expressed here do not represent those of I Heeart Media,
Speaker 1: Protozoa Pictures, or their executives and employees. Indeed, Heed, as
Speaker 1: an inveterate contrarian, I can tell you they may not
Speaker 1: even represent my own and nothing contained in this show
Speaker 1: should be used as medical advice or encouragement to use
Speaker 1: any type of drug. Hello, Psychoactive listeners. So today our
Speaker 1: guest is a Columbia professor, Elias Dakwar, who's done this
Speaker 1: fascinating research on using ketamine combined with mindfulness meditation to
Speaker 1: help people struggling with drug addiction. And he's actually one
Speaker 1: of the few people in the United States to actually
Speaker 1: have received federal funding for research on psychedelics. I'm delighted
Speaker 1: to have you on the program and lives so just God,
Speaker 1: just start off, just tell me your name and introduce
Speaker 1: yourself and your title and where you are right now
Speaker 1: and such. Thanks for having me. My name's Liastkwar. I'm
Speaker 1: currently at the Columbia Medical Center, calling from my office
Speaker 1: here in New York City. I'm an associate professor here
Speaker 1: of psychiatry, and I've been interested in research with ketamine,
Speaker 1: combining it with therapy for a variety of addictions and
Speaker 1: but addiction. I mean you started off in all this,
Speaker 1: even before you get into the kid amine about working
Speaker 1: on addiction and addiction treatment. Isn't that right? Correct? Yeah?
Speaker 1: I started my foray into addiction treatment with meditation. I
Speaker 1: was very interested in how meditation might be helpful for
Speaker 1: disrupting some of the automaticity and reactivity that can happen
Speaker 1: with addiction, and developed an interest in combining meditation with
Speaker 1: other modalities. Meditation alone wasn't quite cutting it, and this grew.
Speaker 1: I mean you first got these insights from your own
Speaker 1: personal experience with meditation and its value in your own life. Yeah,
Speaker 1: both personal experience with meditation, also with non ordinary experiences
Speaker 1: more generally, what do you mean in ordinary experiences? I
Speaker 1: guess psychedelic type experiences, fasting, mystical experiences, those sorts of things.
Speaker 1: Meditation has been the most I think durable and reliable
Speaker 1: for me route towards those sorts of states. And you
Speaker 1: know there's a practice associated with it and a practice
Speaker 1: that enjoys a lot of social legitimacy, at least here
Speaker 1: in the United States, so it seemed something that could
Speaker 1: lend itself to treatment in Western models for addiction. Things
Speaker 1: have changed quite a bit since I started doing that
Speaker 1: research with greater interest and incorporating substances that previously had
Speaker 1: been deemed inappropriate and medical settings like the psychedelics. But
Speaker 1: at the time it seemed like a fairly straightforward strategy
Speaker 1: think about meditation. Were you aware of that kind of
Speaker 1: earlier era, back in the sixties where Timothy Learry and
Speaker 1: Richard Albert In a whole host of other people were
Speaker 1: actually experimenting madelsty and I think mess Glinn perhaps philocybin,
Speaker 1: psilocybin and addiction. I mean, did you did you know
Speaker 1: that history when you first got interested in this stuff?
Speaker 1: I did now. I grew up in the Bay Area
Speaker 1: and my uncle's were part of the counterculture during the
Speaker 1: sixties and would browse their bookshelves growing up reading R. D.
Speaker 1: Lange and Carlos Kostayeta and ram Das and all of
Speaker 1: those things, So it wasn't completely unusual or foreign to me.
Speaker 1: I didn't anticipate that it would gain the level of
Speaker 1: social currency that it has now. It's it's quite impressive
Speaker 1: and it's beautiful to see that it's being embraced as
Speaker 1: it is now. There are some challenges we'll talk about later.
Speaker 1: I was well aware of the earlier attempts to understand
Speaker 1: how these substances could be helpful the unfortunate end to
Speaker 1: that research because of criminalization of these substances back in
Speaker 1: the late sixties and such. Yeah, exactly. And in terms
Speaker 1: of your mentors and such when you started to study
Speaker 1: addiction treatment, right, I guess in your earlier years of
Speaker 1: training in psychiatry, Um, were you encouraged by them to
Speaker 1: look into these avenues of the role of the ketamine
Speaker 1: or psychedelics at that time. There's an interesting story I, Um,
Speaker 1: you know Karl Hard of course. Um, he's been a
Speaker 1: mentor to me and big source of support when I
Speaker 1: first mentioned to him that I was interested in in
Speaker 1: doing this sort of work. I was interested in psilocybin. Actually,
Speaker 1: at the time, Roland Griffith at Johns Hopkins had come
Speaker 1: out with the repeat of the Good Friday experiment, where
Speaker 1: he showed that psilocybin given to healthy volunteers can lead
Speaker 1: to sustained improvements and well being and these very profound
Speaker 1: mystical experiences that they remember as among the most important
Speaker 1: in their lives and maybe just explain, actually, what's that
Speaker 1: initial Good Friday experiment was sure. It was an experiment
Speaker 1: done at Harvard investigating psilocybin. The experiment took people who
Speaker 1: have an interest in spiritual matters, people from the seminary clergy,
Speaker 1: and investigated what happens when psilocybin is given, whether there's
Speaker 1: an improvement and spiritual understanding, whether it occasions experiences comparable
Speaker 1: to mystical states. And Roland Griffiths, who himself has a
Speaker 1: longstanding interest in meditation, did an experiment that basically duplicated
Speaker 1: those effects and found that psilocybin has the propensity to
Speaker 1: cosmistical states, changes in time and space, a sense of
Speaker 1: knowing something that's beyond words, a sense of revelation of
Speaker 1: seeing things in a profoundly new way. And these experiences
Speaker 1: went on to be remembered for um years subsequently as
Speaker 1: among the most powerful the person's life and also impactful
Speaker 1: with friends spouses, noting that there was a clear difference
Speaker 1: in the person after versus before. So that was the
Speaker 1: the experiment that Roland Griffiths had done, and that pretty
Speaker 1: much opened the door to this research being done again
Speaker 1: on a mass scale. Actually, actually, Lass, if I recall correctly,
Speaker 1: even before Roland Griffiths had done that study, I think
Speaker 1: Rick Doblin, the founder of MAPS and Multidisiplinary Associated Cycholic Studies,
Speaker 1: had done his own twenty five year follow up on
Speaker 1: that Good Friday experiment and had tracked a lot of
Speaker 1: these participants. I think these Boston University Divinity students down
Speaker 1: to see what they thought about this experience twenty five
Speaker 1: years later, and I think it found that many of
Speaker 1: them still regarded it as one of the most profound
Speaker 1: spiritual experiences in their lives. They wish they could talk
Speaker 1: openly to their congregants about it, uh, you know, they
Speaker 1: wish they could do it with their kids. Things like this.
Speaker 1: Some of them felt it had brought them closer to Jesus.
Speaker 1: But you were saying about Karl Hart. So then Carl,
Speaker 1: our mutual friends, says to you, so I had mentioned
Speaker 1: that I that I'm interested in potentially doing treatment study
Speaker 1: with psilocybin for addiction and said, well, you're not going
Speaker 1: to be able to get an I H funding for it.
Speaker 1: My friend Um he's spoken with Nora Valkao herself, who
Speaker 1: said that ni H NEIDA, in particular our death set
Speaker 1: against funding any of that research and just explained Nora
Speaker 1: local is. She's the head of the National Institute on
Speaker 1: Drug Abuse NIDA, which is the premier funding agency within NIH,
Speaker 1: fueling a lot of the research being done to investigate
Speaker 1: treatments for addiction and also the harms associated with drug use.
Speaker 1: NIDA emerged in lockstep with the War on Drugs as
Speaker 1: the science arm two identify what the risks of drugs
Speaker 1: might be and how to best deal with any problems
Speaker 1: that might emerge. So he was emphatic that I would
Speaker 1: be wasting my time trying to pursue that kind of
Speaker 1: research if I hope to get funded by NIDA. He
Speaker 1: thought there might be a better chance looking at ketamine.
Speaker 1: Ketamine has comparable effects to psilocybin, but it's not scheduled.
Speaker 1: It's Schedule three, which means that it has known medical
Speaker 1: use with some risk of abuse. It emerged in the
Speaker 1: fifties as an anesthetic that lends itself to very easy use.
Speaker 1: It can be given to people in the battlefield, in
Speaker 1: accident settings without requiring intubation, because it doesn't depress respiration,
Speaker 1: doesn't cause people to stop breathing, doesn't have any effects
Speaker 1: on cardiac functioning, so it lends itself to easy administration.
Speaker 1: You can innesthetize people in settings that don't require the
Speaker 1: usual supports that hospitals provide. So in the Vietnam War,
Speaker 1: for example, it would it be too exactular what you're
Speaker 1: dealing with that And it was also used for in animals,
Speaker 1: right what animal surgery, veterinarians used to, etcetera. Yes, and
Speaker 1: it continues to be used in those capacities, both in
Speaker 1: veterinary and human medicine. And you may know as well
Speaker 1: that ketamine is a descendant, let's say, of PCP, So
Speaker 1: PCP works in a very similar way to ketamine. It
Speaker 1: binds to the PCP site of the glutamate receptor. Glutamate
Speaker 1: is one of the most abundant excitatory neurotransmitters in the
Speaker 1: brain and can lead to dissociation. With that effect, it
Speaker 1: binds to the site antagonize his glutamate, and it can
Speaker 1: lead aspects of experience that are usually coupled to become decoupled,
Speaker 1: so the feeling and the thinking part, the conscious and unconscious. Well,
Speaker 1: it's when I remember about PCP though, was all the
Speaker 1: hysteria in Washington, d c. Where it became one of
Speaker 1: the most popular drugs of use and abuse for a while,
Speaker 1: and you'd have cops telling these stories about people crazed
Speaker 1: on PCP, you needed five cops to tie them down
Speaker 1: and all this sort of stuff. But um, I didn't
Speaker 1: realize the connection between PCP and kennemine in that regard. Yeah,
Speaker 1: PCP definitely became one of the scare drugs of the
Speaker 1: DARE program. Growing up in the Bay Area, every year
Speaker 1: we had the same story from the cops who came
Speaker 1: with the suitcase of drugs to tell us about why
Speaker 1: to stay away from heroin, why to stay away from acid, pot,
Speaker 1: and PCP always involved a story of you know, someone craze,
Speaker 1: either ripping out his eyeballs or jumping out of a
Speaker 1: building or trying to do something of hercue lee in excess,
Speaker 1: like trying to flip over a cop car. But PCP
Speaker 1: is basically ketamine, except it's longer acting and has greater
Speaker 1: affinity for the glutamate receptor. So with proper dosing. It
Speaker 1: can work functionally like ketamine does. The one difference is
Speaker 1: that it is longer acting. Ketamine is incredibly short acting
Speaker 1: um It has a very rapid clearance right the half
Speaker 1: life short so after a single administration of ketamine, the
Speaker 1: person is fairly back to normal after forty minutes. But
Speaker 1: where people feel actively under the influence of the kenemine,
Speaker 1: is it only that length of time as well? Or
Speaker 1: depends on how it's administered um so intranasally, which is
Speaker 1: the way that it's most commonly administered in recreational settings.
Speaker 1: The last about twenty minutes intramuscularly, last about forty minutes intravenously.
Speaker 1: It can last as long as it's being infused, as
Speaker 1: long as it's stripping into the person's bloodstream. You know,
Speaker 1: as I say, I think the first time I ever
Speaker 1: read about ketamine, I think it was reading some kind
Speaker 1: of autobiographical book by John Lily right. And John lily
Speaker 1: was a founder of stay teaching communications, you know, communications
Speaker 1: buying among dolphins and whales, and also the guy who
Speaker 1: invented the isolation tank. And he talked about taking ketamine
Speaker 1: and he had suffered from migraines and he felt the
Speaker 1: migraines just kind of separating from his head, and then
Speaker 1: he got into a much more exploratory phase. I think
Speaker 1: of taking ketamine like every hour on the hour in
Speaker 1: one of his isolation tanks and almost killing himself that
Speaker 1: way or something. But it was the first time I
Speaker 1: realized that there was this drug called kenemine. I don't
Speaker 1: even know if I was aware at the time of
Speaker 1: its role in surgery and things like that, but it
Speaker 1: does seem like this incredibly versatile drug exactly. The versatility
Speaker 1: comes from the variety of effects that can have based
Speaker 1: on dose. So it was originally intended to be used
Speaker 1: in the anesthetic range where it would put people out,
Speaker 1: but it can also be used, as you said with
Speaker 1: John Lilly's self experimentation and exploration, can be used in
Speaker 1: a sub anesthetic range where it doesn't lead to loss
Speaker 1: of consciousness, but it leads to fairly profound changes in
Speaker 1: experience and perception. And that's really been where the most
Speaker 1: recent interest has been and what it might do psychiatrically
Speaker 1: within that sub an aesthetic range. So the resurrection of
Speaker 1: ketamine came initially through if Jenny Kropitski's work actually if
Speaker 1: Jenny Krpitski was also funded by MAPS. You mentioned Rick
Speaker 1: Doblin earlier. He did some fascinating work in St. Petersburg.
Speaker 1: St Petersburg, Rushia and not Florida. Let's I thought the
Speaker 1: name gave it away. Um. Yeah, So he he gave
Speaker 1: an intramuscular dose of ketamine, you know, enough to occasion
Speaker 1: a psychedelic state in combination with what he called ketamine
Speaker 1: psychedelic therapy, and there were lots of iterations of this therapy.
Speaker 1: What what he ultimately landed on was a therapy framework
Speaker 1: comparable to what was used in the fifties and sixties
Speaker 1: with LSD and psilocybin, where the experience was central to
Speaker 1: the treatment. The therapy was intended to help a person
Speaker 1: and prepare for a potentially transformative experience, and then subsequently
Speaker 1: to help the person makes sense of it, integrate it,
Speaker 1: and find a way to consolidate those benefits in pursuit
Speaker 1: of a healthier life, whatever that life might look like,
Speaker 1: depending on the challenges the person's facing. So if Jenny
Speaker 1: investigated ketamine in a similar way for alcohol addiction and
Speaker 1: heroin addiction and found remarkable effects, I think we'd be
Speaker 1: really in a different place right now if he was
Speaker 1: allowed to continue this research. Unfortunately, ketamine is now illegal
Speaker 1: and has been so for decades in Russia, and so
Speaker 1: he to end the research, a reprisal in a way
Speaker 1: of what happened in the States in the fifties and sixties,
Speaker 1: where some promising results were aborted because of policy. Yeah,
Speaker 1: Alias should actually tell you, Um, I actually met a
Speaker 1: Ginny back in the nineties, and it was when I
Speaker 1: was starting up the International Harm Reduction Program through Soros Foundation,
Speaker 1: and we actually did a conference in St. Petersburg on
Speaker 1: drugs and HIV and harm reduction, and there was this
Speaker 1: kind of opening period. There was even a period in
Speaker 1: the early years of Putin of his being open to
Speaker 1: decriminalization of possession and things like this, and then this
Speaker 1: massive hard turning in the opposite direction. But I mean,
Speaker 1: it's interesting to think that some of the pioneering work
Speaker 1: in this area came out of Russia. And what I
Speaker 1: think is also unappreciated is how formative if Jenny was
Speaker 1: to biological psychiatryes embrace of Kenemine. So if Jenny had
Speaker 1: gone to Yale as a fellow while engaged in this
Speaker 1: research and in St. Petersburg and Yale, as you may know,
Speaker 1: is where ketamine was serendipitously found to have antidepressant effects.
Speaker 1: And I didn't know that when was that? The first
Speaker 1: paper was in two thousand is John Crystal, who is
Speaker 1: the editor in chief of Biological Psychiatry, and that really
Speaker 1: set the stage for how ketamine has been received by
Speaker 1: mainstream psychiatry. It was being approached as a purely biological intervention,
Speaker 1: as a medicine comparable to e c T electro convulsive therapy.
Speaker 1: So this is emerging at Yale at the same time
Speaker 1: that ketamine a K A special K is becoming popular
Speaker 1: in the gay dance clubs in the city. I mean
Speaker 1: as an Arnold's almost simultaneously happening about twenty years ago.
Speaker 1: And does the fact that it's emerging is such a
Speaker 1: popular party drug and in the media complicate the efforts
Speaker 1: at Yale to look at it's role in depression. I
Speaker 1: think the foresight perhaps that the psychiatrist that Yale had,
Speaker 1: but also ultimately the great blind spot, was to not
Speaker 1: look at ketamine for what its psychoactive effects might be,
Speaker 1: to look at it purely as a biological intervention. That
Speaker 1: separated it quite dramatically from why it might be used
Speaker 1: in recreational settings, which is to elicit these usually enjoyable,
Speaker 1: interesting effects. So, in developing the story behind how ketamine
Speaker 1: might be impactful, the hope was that it would create
Speaker 1: space for ketamine like compounds without those psychoactive effects to
Speaker 1: be developed. And what do you think I mean, I'm
Speaker 1: going to ask you about your studies shortly, But in
Speaker 1: terms of uh, this notion of separating out the psychoactive
Speaker 1: effects from the medical effects, I've seen people try to
Speaker 1: think about what that can be done with cannabis, Where
Speaker 1: we can you know, other drugs. I mean, is the
Speaker 1: psychoactive element of ketamine essential to its sickacy in dealing
Speaker 1: with whether it's depression or addiction. Well, the short answer
Speaker 1: is it's complicated. I think it's foolish, first of all,
Speaker 1: two discount the psychoactive effects to say that they're totally
Speaker 1: irrelevant and unimpactful. It's foolish for the reason that we
Speaker 1: don't give enough attention. If we see those effects as irrelevant,
Speaker 1: we don't give it enough attention to setting the stage
Speaker 1: for them to emerge and providing a safe space and
Speaker 1: recognizing that they can potentially be impactful, and it's foolish
Speaker 1: because there may be some very powerful ways of harnessing
Speaker 1: those effects to mobilize the efficacy of ketamine. But I
Speaker 1: think the larger question you're asking is what is the
Speaker 1: role of subjective experience in our healing? And might there
Speaker 1: be some paradigmatic deficit in the psychiatric framework that a
Speaker 1: doesn't recognize the importance of subjective experience. It's all about
Speaker 1: symptoms and the brain and behavior. What about consciousness? What
Speaker 1: about the mystery of what it means to experience and
Speaker 1: dream and imagine? Have we been missing something as psychiatrists
Speaker 1: by over emphasizing neurobiology, symptoms, behavior? I mean, is that
Speaker 1: a general failing of psychiatry and psychiatrists even we compare
Speaker 1: to other forms of psychotherapy. That that's the focus on
Speaker 1: the pharmacological and the focus on the medical element of
Speaker 1: this just as kind of become. Whether we call it
Speaker 1: a crutch or a barrier to thinking of in the
Speaker 1: ways that you're describing right now, I think it is
Speaker 1: a general challenge with psychiatry. The missing link here, I
Speaker 1: think is that ketamine was also for a period and
Speaker 1: continues to be so to some extent, a pharmacological model
Speaker 1: of psychosis, mean ing that ketamine was being approached as
Speaker 1: a medicine that can simulate what it means to be psychotic,
Speaker 1: schizophrenic hearing voices, having unusual thoughts, and this was an
Speaker 1: effort to better understand the neural underpinnings of psychosis. So
Speaker 1: John Crystal's work with ketamine originally using sub anesthetic doses
Speaker 1: of ketamine to investigate what psychosis might be and what
Speaker 1: the role of glutamate might be in psychosis. And the
Speaker 1: serendipitous finding came from doing that research, according to John Crystal,
Speaker 1: that he was providing it to healthy volunteers and finding
Speaker 1: that people were reporting that they were feeling better afterwards,
Speaker 1: that there was an improvement in mood, even if they
Speaker 1: weren't necessarily depressed beforehand, and that led to investigating ketamine
Speaker 1: again in a in a biological frame, meaning there's no therapy.
Speaker 1: The psychoactive effects are there, but they're not prepared for
Speaker 1: or integrated or anything like that. It's given to depressed
Speaker 1: people one occasion and then they were followed for a
Speaker 1: few weeks to see how the depression was affected, and
Speaker 1: that spurred a variety of studies looking at ketamine in
Speaker 1: a similar way for depressions through ideality PTSD obsessive compulsive disorder,
Speaker 1: giving a single dose in the absence of any kind
Speaker 1: of psychotherapeutic framework, without much regard for the psychoactive effects,
Speaker 1: to see how symptoms might change. Now, that's not really
Speaker 1: different than how ketamine in a psychedelic framework might work.
Speaker 1: What's different is the lens that was brought to ketamine.
Speaker 1: The lens in this case was very biological, looking at
Speaker 1: it as something that's entirely pharmacological in the sense that
Speaker 1: it's entirely brain based without the psychoactive effects or effects
Speaker 1: that might lend themselves to therapy being a part of
Speaker 1: the process and investigating from there are other compounds that
Speaker 1: might work like ketamine, but with reduced psychoactive effects. We'll
Speaker 1: be talking more after we hear this add I'm curious
Speaker 1: to hear. I mean, now that you've been doing these
Speaker 1: studies right with people struggling, you know, with alcohol problems,
Speaker 1: of cocaine problems, and cannabis problems. Um, could you just
Speaker 1: describe a couple of your patients and what that was like. Yeah. Sure.
Speaker 1: As I mentioned before, I've been interested in how the
Speaker 1: meditative state might be helpful at disrupting addiction, and how
Speaker 1: it might lend itself to a practice whereby the usual
Speaker 1: automaticity and reactivity of addiction have my automaticity, you mean
Speaker 1: people sort of just reflexively doing something on consciously, not
Speaker 1: necessarily unconsciously, but there's such a pronounced reactivity. If there's
Speaker 1: a particular feeling, the compulsion to respond to that feeling
Speaker 1: by using something or craving becomes so impactful. People aren't able,
Speaker 1: who are in the throes of severe addiction that are
Speaker 1: not able to allow the craving to simply pass. There's
Speaker 1: a feeling of needing to act on it at the
Speaker 1: same time that we can surmise that a meditative practice
Speaker 1: might help with those things. Of course, a meditative practice
Speaker 1: requires some suspension of those things as well. Otherwise you're
Speaker 1: not gonna be able to meditate if you're feeling agitated,
Speaker 1: and if if your thoughts are causing you to move
Speaker 1: in this way and that. So the hope was that
Speaker 1: by providing an experience that is easier to come by
Speaker 1: comes through a medicine, that the meditative state that happens
Speaker 1: would serve as a stepping stone for understanding how to
Speaker 1: continue meditating. And what to aim at. And also the
Speaker 1: hope was that the medicine might provide an enduring opening
Speaker 1: with improved craving sensitivity, improved mood, improved anxiety, so that
Speaker 1: the usual vulnerabilities aren't so compromising. It noticed, it's using
Speaker 1: ketamine as a way to get people to move into meditation,
Speaker 1: integrating meditation and life right, and that's somehow that would
Speaker 1: be helpful in that regard correct yet by approximating the
Speaker 1: meditative experience, by making it easier to practice, and also
Speaker 1: by motivating people to do it. You know that there's
Speaker 1: been a lot of research suggesting that one of the
Speaker 1: critical vulnerabilities to engaging fruitfully with any treatment is tenuous
Speaker 1: motivation is just not feeling inspired or capable of doing something,
Speaker 1: and that demoralization is I think a big part of addiction,
Speaker 1: that sense of having resigned oneself to the addiction, having
Speaker 1: tried again and again to stop it, and feeling like,
Speaker 1: what's the why It's it's no good. So I also
Speaker 1: hope that the medicine would disrupt that, that it would
Speaker 1: provide a sense of refresh possibility. Well, let me just
Speaker 1: back up for one second, so just to get a
Speaker 1: picture of this so when these people are in your studies,
Speaker 1: First of all, these people are generally more middle class
Speaker 1: or people are more living on the street kind of
Speaker 1: living rough. It cuts through different cuts across and and
Speaker 1: they're coming into a facility at Columbia UM. They're in
Speaker 1: a room. Are they wearing blindfold? Is their music in
Speaker 1: the background? Are you sitting by them while they're going
Speaker 1: through it? Are they hooked up to an ivy? What
Speaker 1: does it look like? Yeah, so it happens at Columbia
Speaker 1: Medical Center. But we created a space for administering the
Speaker 1: medicine that is as warm and comfortable as possible. The
Speaker 1: old you know catchphrase of set and setting remains very
Speaker 1: important to respect. You know, these medicines, because of how
Speaker 1: profoundly they can change experience, require an environment where people
Speaker 1: can continue feeling safe. Environment conducive to allowing different experiences
Speaker 1: to emerge safely and in a manner that allows the
Speaker 1: person to feel heard and respected. So having a sterile
Speaker 1: medical environment did not seem appropriate given what we were
Speaker 1: trying to do. So we took a room that was
Speaker 1: ordinarily used for laboratory experiments and made it look like
Speaker 1: a living room. They are guided through a meditation exercise
Speaker 1: prior to the ketamine being delivered. It's delivered through an ivy.
Speaker 1: They're wearing an eyemask, laying down on a bed. I'm
Speaker 1: sitting next to them or another physician is sitting next
Speaker 1: to them, as well as the therapist, And throughout the
Speaker 1: experience they're being guided through what's called a body scan
Speaker 1: in mindfulness, that means paying attention to one sensations, one's breathing,
Speaker 1: if thoughts come up, noticing the thought, but maintaining a
Speaker 1: mindful stance, which means being open, being non judgmental, accepting, attentive,
Speaker 1: and no music in the background. No music, and we
Speaker 1: we keep it very silent. So and another hypothesis of
Speaker 1: tacit hypothesis I was operating under here is that a
Speaker 1: lot of the suffering that comes with addiction comes from
Speaker 1: losing sight of the primordial mystery of experience. You know,
Speaker 1: what can't be known, what can't be reduced to words,
Speaker 1: concepts that the experience of someone in addiction is very
Speaker 1: overdetermined and over interpreted to organize too knowing in a
Speaker 1: way for its own good. And I wanted the experience
Speaker 1: to allow for accessing what is beyond knowledge basically what
Speaker 1: can't be put into words, And for that reason I
Speaker 1: wanted the experience to remain as unanchored in things that
Speaker 1: are ordinarily intelligible, like music, going deep into ineff ability. Basically,
Speaker 1: it sounds like what you're describing. When I read about
Speaker 1: some of the psychedelics therapy, sometimes it seems like something
Speaker 1: that's almost more explosives the wrong word, but I mean
Speaker 1: kind of more profound transformational that causes people to rethink
Speaker 1: their lives, to rethink their experience. And it sounds like
Speaker 1: what you're describing is a more modest form of that.
Speaker 1: Is that right? Well, listen, if an explosive transformation is coming,
Speaker 1: I welcome it. What and they do happen? They do happen.
Speaker 1: Even having one's systems of knowledge dissolve in you know,
Speaker 1: the primordial silence, it's not an easy thing to go through. Um.
Speaker 1: At the same time, I think you're picking up on something.
Speaker 1: I am skeptical of these kind of fantastical narratives of
Speaker 1: communing with the divine or having some kind of pivot point.
Speaker 1: They may be helpful, I'm sure, but in my mind,
Speaker 1: what's most helpful is to find one's footing and have
Speaker 1: some kind of regular, enduring practice that helps one navigate
Speaker 1: the trials and tribulations of life. Yeah, well, you know
Speaker 1: what you make me think of. You know, one of
Speaker 1: the historical pieces that many people don't know is that
Speaker 1: one of the founders of Alcoholics anonymous Bill Wilson, right,
Speaker 1: and this was all about, you know, dealing with very
Speaker 1: serious alcoholics and uh, you know, and the the whole
Speaker 1: twelve step model. And then at some point he began
Speaker 1: taking I can't remember this LSD or mescal in LSD,
Speaker 1: and he came to believe that basically this could play
Speaker 1: an important role in very serious inebrious alcoholics coming to
Speaker 1: a kind of come to Jesus moment um in terms
Speaker 1: of their own self awareness, you know, that kind of
Speaker 1: moments that they're seeking for. And then I guess in
Speaker 1: his case what followed from that was less the meditative
Speaker 1: practice and more the fellowship of the whole twelve step approach.
Speaker 1: But I wonder how you see what you were doing
Speaker 1: comparison to what he experienced and talked about, or was
Speaker 1: actually discouraged from talking about once he started talking about it.
Speaker 1: I I, as I said, I'm supportive of anything that
Speaker 1: could be hopeful and a transformative experience clearly can be impactful.
Speaker 1: I mean, many scholars have written about this, starting with
Speaker 1: William James. Bill Miller, the founder of Motivational Dansmo Therapy,
Speaker 1: also wrote about the role of transformative experiences in recovery.
Speaker 1: So I'm very supportive of them. I just wanted to
Speaker 1: ensure that I maintained as comprehensive a model as possible,
Speaker 1: so that while the experience can lend itself to that
Speaker 1: if it were to occur, that if it doesn't occur
Speaker 1: and someone merely, if merely is the right word, enters
Speaker 1: into an eff ability, then that's fine too. We'll make
Speaker 1: do what we can. Let's take a break here and
Speaker 1: go to an ad Among your patients or the subjects
Speaker 1: in the study, is there one that one or two
Speaker 1: they just sort of stand out that you could describe
Speaker 1: their experience? Yeah? What one, very powerful story, which I
Speaker 1: think also indicates just how severe some of the addictions
Speaker 1: we were dealing with our It was a laboratory study
Speaker 1: investigating how ketamine might disrupt cocaine self administration. So woman
Speaker 1: who had worked as a sex worker at a cocaine addiction,
Speaker 1: very significant history of trauma, had multiple um scars all
Speaker 1: over her body that came from having been abducted by
Speaker 1: several men and mutilated and what sounds like some kind
Speaker 1: of bizarre ritual um. She was able to get away
Speaker 1: with severe wounds all over her body, but it was
Speaker 1: able to escape. She worried that if she hadn't she
Speaker 1: might have died, and it's haunted her as continued to
Speaker 1: be an important part of her pathology, unfortunately. But she
Speaker 1: came in with a fairly significant crack cocaine addiction, and
Speaker 1: the experience that she had with ketamine is one of
Speaker 1: the most remarkable I've seen speaking of transformative So this
Speaker 1: was a study that wasn't really intended to help people
Speaker 1: stop using. It was, as I mentioned, a lab study
Speaker 1: to investigate a very specific question whether it reduces cocaine
Speaker 1: self administration. Beyond the mindfulness training to help the person
Speaker 1: prepare for the infusion, et cetera, there wasn't much support
Speaker 1: and she had an experience where she began with moaning
Speaker 1: in a in a kind of aroused way. Then it
Speaker 1: went into sobbing to um trying to escape something, writhing
Speaker 1: on the bed, and that's where the support of physician
Speaker 1: therapist can be crucial when you know, it's not simply
Speaker 1: a meditative state, but this kind of intense ab reaction
Speaker 1: or or a reliving means to occur. And she ultimately,
Speaker 1: by the end of the infusion, had calmed down and
Speaker 1: was just repeating over and over again how the knife
Speaker 1: had been removed, that it had been half out without
Speaker 1: her realizing, but finally been removed. And she said something
Speaker 1: very powerful, which I think of quite regularly. You know,
Speaker 1: when you have a knife in you, she said, you
Speaker 1: get used to it, and it's not until it's coming
Speaker 1: out that it really hurts. And it was really the
Speaker 1: the space that the ketamine provided her that allowed her
Speaker 1: the safety, the the relaxing of defenses to finally allow
Speaker 1: the knife out. And what was remarkable is that, as
Speaker 1: again because this was not intended to necessarily provide treatment,
Speaker 1: it was to ask a very specific question, she nonetheless
Speaker 1: stopped using cocaine for the duration of the follow up
Speaker 1: period after this this laboratory study. We continued seeing them
Speaker 1: for four weeks after. And that's an example I think
Speaker 1: of how there are things going on here which remain
Speaker 1: very untapped, you know, the capacity for these single experiences
Speaker 1: to shift things so dramatically. Again, I'm not hanging my
Speaker 1: hat on that for every patient, and I'm trying to
Speaker 1: find a very durable, resilient framework by which we might
Speaker 1: tap into those benefits. I think using meditation and having
Speaker 1: a psychotherapeutic framework important for that. But it can happen.
Speaker 1: It's not simply anecdote. And well, I tell me, have
Speaker 1: you done the follow up with her or others? You know,
Speaker 1: not just four weeks later, but six months later, a
Speaker 1: year later, and to see how they're doing. Yeah. So
Speaker 1: we we've had two clinical trials that UM involved fairly
Speaker 1: long follow up, one with cocaine addicted people and one
Speaker 1: with alcohol dependent individuals. They were both several week trials
Speaker 1: that involved several months of follow up after they completed
Speaker 1: the trial, and we continued to ask how they were
Speaker 1: doing and what their youth patterns were. And in both
Speaker 1: UM studies, the rates of abstinence with the people who
Speaker 1: received ketamine were significantly higher than with the control group.
Speaker 1: So these are durable effects and all based upon the
Speaker 1: one session. Was it just one session or two sessions
Speaker 1: you did with them? Yea, for these studies it was
Speaker 1: one session. I see. But when I think about like
Speaker 1: a friend of mine who was suffering very seriously from
Speaker 1: depression and trauma. Man having some pain, and he did,
Speaker 1: I think what many people do, and man, you know
Speaker 1: more and more where he did six ketamine sessions in
Speaker 1: the space of a month, followed by one a month
Speaker 1: for a year and did get some lasting many years
Speaker 1: thereafter benefit. But have you considered doing that model as well,
Speaker 1: or is there a reason to keep it to the
Speaker 1: more a model which involves giving fewer administrations. It's a
Speaker 1: very important question, and I think this gets at some
Speaker 1: of the strictures that come with doing controversial research. So
Speaker 1: I should mention that all of the research I've done
Speaker 1: has been NIH funded either um NEIDA, which we talked
Speaker 1: about before, and I Triple A, which is the wing
Speaker 1: of ni H that's focused on alcohol treatment. And in
Speaker 1: getting funding from both agencies, I needed to do a
Speaker 1: lot of politicking because even though the grants that I
Speaker 1: had submitted had received great scores from the Science Committee,
Speaker 1: the more bureaucratic wing of both agencies was not interested
Speaker 1: in investigating a mind altering substance for addiction because they
Speaker 1: were worried about the political fallout, or because of their
Speaker 1: own ideologies or ignorance, or there's a notion which is
Speaker 1: erroneous that people who are prone to addiction whatever that means,
Speaker 1: are also prone to getting addicted to other substances if
Speaker 1: they were exposed to them. So if you're providing something
Speaker 1: like ketamine to someone with cocaine problems, it's like you're
Speaker 1: introducing potentially problematic, addiction prone substance to someone. Is there
Speaker 1: any rational, evidence based approach for people within the NIDA
Speaker 1: bureaucracy to take that view. No, No, it's a prejudice.
Speaker 1: I have to tell you. It's just infuriated me. No end.
Speaker 1: I mean it's a tragedy because NIDA provides I think
Speaker 1: of all the funding for drug abuse research, not just
Speaker 1: in the US but globally, and to be in this
Speaker 1: incredibly rigid, ideological, you know, perspective on this stuff. I mean,
Speaker 1: are they even funding any psychedelics research now apart from ketamine? No? Nothing.
Speaker 1: I mean, well that's I should say, they're not funding
Speaker 1: any therapeutic um, only looking at the harms of these
Speaker 1: things exactly. Uh. Yeah, And to your point, a lot
Speaker 1: of the substances that have been helpful for addiction, methadone,
Speaker 1: puper nor pine if they were, for whatever reason, illegal,
Speaker 1: we would be missing out on a tremendous opportunity. Those
Speaker 1: substances are psychoactive, They activate receptors that other so called
Speaker 1: drugs of abuse do. So, you know, the the argument
Speaker 1: is definitely specious, but that was the argument I was
Speaker 1: contending with. And as you seem aware, the challenge here
Speaker 1: is that we're not really dealing with only science. We're
Speaker 1: dealing with politics. We're dealing with ideology. We're dealing with
Speaker 1: a particular perspective on drugs and addiction that comes less
Speaker 1: from evidence and careful experiment and more from you know,
Speaker 1: the drug war. I mean, I'm curious if you imagine
Speaker 1: in the future, let's assume that at some point the
Speaker 1: the other psychedelics actually become as legally available and permissive
Speaker 1: to work with um for you know, drug treatment, ptsd, O,
Speaker 1: c D, depression, whatever it might be. When more of
Speaker 1: these are available, well ken amine play a lesser role.
Speaker 1: I mean, is ketamine having some of its time in
Speaker 1: the sun because the other ones are so hard to
Speaker 1: get funding for except from private sources. That's a great question. Yeah,
Speaker 1: I would not dismiss the power of ketamine. I don't
Speaker 1: think it's simply that it has it's fifteen minutes due
Speaker 1: to the other drugs being inaccessible. It has its own power.
Speaker 1: And I should tell you a story a colleague of mine,
Speaker 1: I keep her anonymous. I've been struggling with fairly severe
Speaker 1: psychiatric issues for most of her life and did not
Speaker 1: receive benefit from the conventional approaches. Met a healer who
Speaker 1: worked with various types of psychedelics m d m A, psilocybin,
Speaker 1: d MT LSD, and went through all of those, tried
Speaker 1: every single one, but it wasn't until ketamine. It wasn't
Speaker 1: until high dose intramuscular ketemine that she found relief. So
Speaker 1: you know, these are ultimately different compounds, and there will
Speaker 1: always be a place, I think for the very unique
Speaker 1: effects that ketamine has. I should also say that ketamine
Speaker 1: lends itself to easy administration much more than psilocybin. For example,
Speaker 1: does it shorter acting, it doesn't last for hours and hours,
Speaker 1: it doesn't require the same level of psychological preparation, hand holding, integration.
Speaker 1: It lends itself to all of those things. So they
Speaker 1: mentioned with the case of the sex worker who definitely
Speaker 1: needed support and guidance, but in in a lot of cases,
Speaker 1: people have a fairly calm experience and they're able to
Speaker 1: move forward. I mean, unless I should tell you. You know,
Speaker 1: I had my own experience with kenemine a guided session
Speaker 1: last summer, and I hadn't really done it that way before,
Speaker 1: and I was struck that compared to mushrooms, it was
Speaker 1: comparably powerful and as you say, much shorter acting, but
Speaker 1: it came on in my body in a much gentler way,
Speaker 1: you know, And maybe this's is part of it as
Speaker 1: I get older, mushrooms kind of you kind of a
Speaker 1: little bit raggedy effect coming in. But the kennemy was
Speaker 1: very calm and easy. And then after it's over, um,
Speaker 1: you know, barely an hour later and one could re
Speaker 1: engage in normal activities that one wanted to. Well, let
Speaker 1: me ask you this whole thing with the commercialization. You know,
Speaker 1: you can't pat into stuff is basically a generic substance now,
Speaker 1: but pharmacitic companies find their way to do it right.
Speaker 1: You see, with the locks, you know, the thing that's
Speaker 1: so crucially important for reversing overdose, but manufacturers find ways
Speaker 1: of selling them in a form this administer that costed
Speaker 1: dramatically more money than the few bucks and knocks on
Speaker 1: the cost, and you started talking about something that's happening
Speaker 1: in this area as well, where kenemine is now this
Speaker 1: thing called esketamine or something like that. Just can you
Speaker 1: explain what's going on there, what your concerns are about it? Well,
Speaker 1: Ketamine is a receimate, meaning that it has two molecules
Speaker 1: in equal proportion. One is the right handed ketamine molecule,
Speaker 1: the others the left handed kenemine molecule. There basically mirror
Speaker 1: images of one another, and each molecule may have its
Speaker 1: own role to play in the benefits. Kenemine provides. What
Speaker 1: Jansen has done which has s ketamine or spravado on
Speaker 1: the market currently is It's taken the left handed molecule
Speaker 1: s ketamine and patented it for depression. Also packaged it
Speaker 1: in a way that it could be administered in a
Speaker 1: clinic without necessarily I V S or needles involved. It's
Speaker 1: done intranasally, and took it through the usual pipeline to
Speaker 1: get FDA approval and just barely skated by. Didn't do
Speaker 1: nearly as well as they think broadcast um and the
Speaker 1: FDA in fact made an exception. Usually you need a
Speaker 1: few trials that are positive to grant that a drug
Speaker 1: might be used in a certain way. There was only
Speaker 1: one that worked. There was only one trial that showed
Speaker 1: efficacy in the case of stemine. In any case, it
Speaker 1: has its challenges. Um from a clinical perspective, may not
Speaker 1: be as effective as ketamine. But I think the most
Speaker 1: problematic aspect of it, in my mind is how mercenary
Speaker 1: it is. So ketamine costs a dollar or two to administer,
Speaker 1: I mean, in terms of the medication costs, s ketamine
Speaker 1: is about a thousand dollars. It does, so it's it's
Speaker 1: half the compound, but you know thousand times as much.
Speaker 1: And why did if why did f D a fast
Speaker 1: track it? Because it's dealing with a severe issue, depression,
Speaker 1: treatment resistant depression especially very problematic. I was hearing that
Speaker 1: if you look at which of the clinics and clinicians
Speaker 1: are doing a better job, typically the ones making the
Speaker 1: effort to use ketamine are having better results and being
Speaker 1: more responsible towards their patients. Then are the ones that
Speaker 1: are trying to profiteer off of using this asketamine approach. Well,
Speaker 1: the profiteering is only on the industry side. Yeah, the
Speaker 1: doctors who are involved are more often kind of more
Speaker 1: conventional types who told the line, let's say they're given
Speaker 1: this medicine drug, reps come provide information on how to
Speaker 1: provide it. They may not be operating from a more
Speaker 1: holistic framework where therapy is integrated into the process. With
Speaker 1: ketamine clinics, therapy is invariably a big part of it.
Speaker 1: There's an understanding that a proper framework is important, that
Speaker 1: the psychoactive effects need to be attended to with provado
Speaker 1: not so much. Again, it's just a procedure. Yeah, somebody
Speaker 1: described to me, you know, and entsiologists just trying to
Speaker 1: make some additional money on the side basically and having
Speaker 1: some experience with kennemine by virtually being an a thesiologists
Speaker 1: and saying, here's another opportunity for them to make money
Speaker 1: without basically investing the time or the energy to understanding
Speaker 1: all the dimensions that you and I have been talking about.
Speaker 1: Because can be abused, right, people do get in trouble
Speaker 1: with it. I'm just wondering if that whole more commercialized
Speaker 1: approach might lend itself to giving in trouble as well. Absolutely,
Speaker 1: you know, I think one of the big challenges we're
Speaker 1: going to be facing in these sorts of compounds entering
Speaker 1: into therapeutic settings, is the eagerness with which they might
Speaker 1: be pushed. You know, this transformative potential story can also
Speaker 1: have its dangerous Oh we need just need to keep
Speaker 1: trying until we get that transformative experience. And you know
Speaker 1: that could be a road to nowhere or a road
Speaker 1: to real problems as you're suggesting. So yeah, there there's
Speaker 1: a definite danger with ideological interests or maybe a pecuniary
Speaker 1: interest and phasizing continuing to try the medicine, continuing to
Speaker 1: try the medicine even as it doesn't seem to be
Speaker 1: doing much. So, Elias, I want I want to finish
Speaker 1: up by asking you two questions, one backward one forward.
Speaker 1: Which was I noticed in looking at your CV that
Speaker 1: you were born in Haifa, Israel, right, And I remember
Speaker 1: you're describing some of your your origins, and I wonder
Speaker 1: if you could just say something about that. Can you
Speaker 1: discern any impact of your early years growing up in
Speaker 1: your identity on the work that you're doing now? Well,
Speaker 1: I I'm not quite a refugee, but in many ways
Speaker 1: that the story is comparable to that. I am able
Speaker 1: to go back to Israel and all of those things,
Speaker 1: but it was an environment that my parents felt wasn't
Speaker 1: as conducive to raising us, my brother and sister and I,
Speaker 1: So we went to the States to find greater, greater opportunity,
Speaker 1: greater tolerance because you're growing up in Israel, not Jewish,
Speaker 1: but growing up is a Palestinian, Arab Christian ISRAELI exactly, yeah, um,
Speaker 1: you know, and I'm speaking as someone who's parents were
Speaker 1: like my mom spoke Hebrew better than any other language,
Speaker 1: and my dad went to UM a lot of the
Speaker 1: good universities there, so they were definitely acculturated. But there
Speaker 1: was this this element of distance, nonetheless that has stayed
Speaker 1: with me. So when you ask how that might have
Speaker 1: informed the work I'm doing, I've I've definitely felt like
Speaker 1: an outsider and always investigating the systems that are foisted
Speaker 1: on us for their absurdity, their violence, their unreality. That
Speaker 1: that's been a big part of my um my perspective
Speaker 1: and has definitely allowed me to recognize where things might
Speaker 1: be done differently. As with ketamine, it's a look at
Speaker 1: just the last question thinking forward. I mean, you're still
Speaker 1: you know, you're early in your career, You're young. You've
Speaker 1: been doing some fascinating research about kenemine. What's your hopes
Speaker 1: and ambitions for yourself over these coming decades in terms
Speaker 1: of do you see yourself committed to doing this research
Speaker 1: even more so on kedemine and towards psychedelics. UM. Do
Speaker 1: you think it will continue to be connected to your
Speaker 1: research and drug treatment? Is there some grand hopes that
Speaker 1: you have for all of this? Well? I I went
Speaker 1: into this research personally with a sense of injustice at
Speaker 1: how this model, which had shown such promise in the
Speaker 1: fifties and sixties and Jenny's work, was so dismissed or
Speaker 1: even demonized, And in that regard, I feel like I've
Speaker 1: done what I need to do in an academic setting,
Speaker 1: you know, my own small role in helping rehabilitate this
Speaker 1: model and and apply it to a drug that had,
Speaker 1: you know, just narrowly escaped being a purely a biological intervention. UM,
Speaker 1: so that art, you know, I'm not so sure what
Speaker 1: else I can do in academic settings that would be
Speaker 1: interesting to me. I think now it's about helping people
Speaker 1: more generally, and I'm under no illusion that that feeding
Speaker 1: the academic industry helps people. So I'm you know. I
Speaker 1: think the question now is what I might do to um,
Speaker 1: you know, bring healing, understanding, social change beyond academia. Yeah, well,
Speaker 1: as we should talk, because there's somebody who my first
Speaker 1: seven years in this area worlds in academia and then
Speaker 1: I moved outward from there, um you know, and hopes
Speaker 1: that doing so we get it outside of the of
Speaker 1: the university and into the broader world. So I look
Speaker 1: forward to future discussions with you, not just on air,
Speaker 1: but also over coffee as the pandemic recedes. But I
Speaker 1: did really really want to thank you very very much
Speaker 1: for joining me on this and it's really been a
Speaker 1: pleasure and edification. So thanks so much, and best of
Speaker 1: luck with all your research and other plans ahead. Thank
Speaker 1: you so much. Psychoactive is the production of I Heart
Speaker 1: Radio and Protozoa Pictures. It's hosted by me Ethan Naedelman.
Speaker 1: It's produced by Katcha Kumkova and Ben Cabrick. The executive
Speaker 1: producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren
Speaker 1: Aronovski for Protozoa Pictures, Alice Williams and Matt Frederick for
Speaker 1: I Heart Radio and me Ethan Nadelman. Our music is
Speaker 1: by Ari Blusian and a special thanks to a Vivit Brio,
Speaker 1: Sef Bianca Grimshaw and Robert Beatty. If you'd like to
Speaker 1: share your own stories, comments, or ideas, please leave us
Speaker 1: a message at eight three three seven seven nine sixty.
Speaker 1: That's one eight three three psycho zero. You can also
Speaker 1: email us as psychoactive at protozoa dot com or find
Speaker 1: me on Twitter at Ethan Nadelman. And if you couldn't
Speaker 1: keep track of all this, find the information in the
Speaker 1: show notes. Tune in next time and hear me talk
Speaker 1: with Carl Hart, a dear friend of mine who's a
Speaker 1: neuroscientist at Columbia University, best known for his recent book
Speaker 1: Drug Used for Growing Ups. No matter how many drugs
Speaker 1: this particular person was selling or led to him, So
Speaker 1: you shouldn't be able to kick someone's door down and
Speaker 1: then murder them on top of that, And so I
Speaker 1: think people were starting to put together Philanderer still uh,
Speaker 1: he had marijuana and that cop of shot him to death.
Speaker 1: We think about Lakwan MacDonald, the seventeen year old kid
Speaker 1: in Chicago where they said that he had PCP in
Speaker 1: a system. And he was shot sixteen time. And people
Speaker 1: are starting to see that drugs are always used as
Speaker 1: this convenient scapegoat to justify this awful behavior. Subscribe to
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