The Future Of Psychedelics: Medicalization, Microdosing, And The Mainstream

Podcast Highlights

• Will’s beliefs about the sources of “psychiatric illnesses” and the roles psychedelics can play in treating or curing them, informed by his experience working with psychedelics and his formal medical training
• Will’s view of ketamine as a legal psychedelic that can facilitate transpersonal experiences and how it can be used beyond its current applications
• How we’ll navigate underlying socioeconomic dynamics like race and cost in a world where professionals with specific training with these substances strive to meet the needs of a diverse patient population

Show Links

1. Op-Ed in NYT about Schizophrenia being 'cured' by bone marrow transplant
2. Join us on Patreon!
3. Synthesis retreats in Amsterdam

Podcast Transcript

0:00:27 Paul Austin: Hey listeners, and welcome back to The Third Wave podcast. We have a special little episode coming your way. We recorded this on October 23 in Brooklyn at Future Space. We were hosting our first three Third Wave Node events. Now our new projects, Third Wave Nodes are bringing the dialogue about psychedelics to cities all over the globe, eventually, and we're starting in New York and San Francisco. In fact, we have an upcoming event in New York on November 29th. And an event in San Francisco on December 6th, and we will be doing monthly events to start in each of these cities as a way to incubate community around the intentional, responsible use of psychedelics. So the podcast that you're listening to today is from a live conversation that I had with Dr. Will Sui, who is a psychiatrist in New York City, on the MAPS phase three trials, and also owns a private clinic where he does Ketamine treatments. So basically, what we explored in this conversation is the future of psychedelics, medicalization, microdosing, and the mainstream. So this is a little bit of a different sort of vibe than your typical podcast. I think you'll really, really like it. It starts with about an hour-long discussion between Will and I about the topic. And then, we have 30 minutes of Q&A from the audience, where we go into discussion about various elements of what we spoke about.

0:02:09 PA: As I said, this is part of our new Third Wave Node projects. We'll plan to do these in New York and San Francisco to start, with plans to expand to LA, Vancouver, Amsterdam, Berlin, and maybe a couple of other cities in the United States. We're getting up and off the ground slowly, making sure that we have a really solid foundation before we scale even bigger. Now, obviously, I did this interview. However, as part of scaling this Third Wave Node Projects, we will be looking for moderators, people who are comfortable with public speaking, and interviewing in various cities. If that sounds like something you might be interested in, or if you know of someone who might be a good fit for that, please let us know by reaching out to us through Third Wave's website. Now, Will's a good friend of mine in New York, as you'll hear in the podcast. We've known each other for about a year now. And so it was really a true honor to welcome him and do this event. And we had an excellent turnout for the event. We had about 110 people who attended. We had Four Sigmatic there. And we had an intra-meditation. So these are really fun events, and they are great way to meet other people who are interested in the emerging professional space around psychedelics. Anyway, without further ado, let's go right into my conversation with Dr. Will Sui.

[music]

0:03:36 PA: Welcome to the space. I'm just so happy to see all of you here. This is, hopefully, the start of something very special in building an above-ground community in New York City around psychedelic use. So for those of you who may not know me, my name is Paul Austin. I'm the founder of a website called Third Wave, which focuses on psychedelic literacy. In other words, how do we start having a rational, science-based conversation about psychedelic substances as tools for healing, as tools for self-awareness, as tools for creativity, for leadership and how do we bring those discussions into spaces where we all have a chance to connect as a community of people who have had meaningful experiences with psychedelic substances. Or are curious about what that may look like for those of us who maybe haven't worked with these substances yet. And so the idea with this Third Wave Node project, is how can we start to incubate and help grow conversations around the responsible use of psychedelics. In not only New York, but also places like SF and LA, overseas, in Amsterdam, where I seem to be finding myself a lot lately. And just really helping this to grow on a grassroots level.

0:04:57 PA: Because of the momentum that we have so far with the medicalization, which we'll get further in tonight, some of those particulars. There's this fantastic opportunity to start having a really public conversation around why these tools are going to be so important for us in the next five to 10 to 15 to 20 years. So I just wanna express my gratitude and appreciation for all of you in coming here, for showing up, for being in this space. I think it still takes a lot of courage for us to be public about this because it is still somewhat stigmatized. Michael Pollan, how many of you have read Michael Pollan's new book? So I was at a recent conference, Horizons, they do a conference every year in New York. And it was a couple of weeks ago, how many of you were at Horizons by chance? So a good... A fair amount of you, great. And one of the great things about Horizons was this little term I picked up from another attendee where he kind of dawned a lot of these new people who are getting interested in psychedelics because of Michael Pollan's book, Pollinators.

0:06:04 PA: Which I thought was so explanatory and such a great way to conceptualize what this is about, because within that context, is this idea of once we have a message, once we have an experience, once we own that as part of ourselves, how do we then go out and have honest conversations with people, with our family, with our friends, with our co-workers, to normalize what are, historically have been, very normative substances, in various contexts of course. And with this sense of the third wave of psychedelics, it's really about how can we then re-integrate this into Western culture in particular, at a time where it needs it, needs it more than ever, because of this existential crisis that we're facing, brought on by things like climate change and other cultural elements that are really starting to affect us directly, and these substances are great for that, that waking up process of understanding our interconnectedness to not only community but also the earth to our friends, to our family, to our food and these are really, really important concepts to be aware of and to spread education, and literacy about, because ultimately, this is about creating a new cultural infrastructure that supports the true well-being of human beings and doesn't just support the, what I would call extracting of our energy and our value for purposes that we sometimes don't have or aren't in full agreement with.

0:07:38 PA: So how can we own these experiences, how can we heal ourselves, how can we be present and therefore contribute back in a way that helps to rebuild the social fabric of what we're doing. So we'll explore some of these concepts and topics tonight. I'll get in a little bit into my personal stuff but really the focus is gonna be on our guest Will, who I'll introduce. So I will be interviewing Will Sui who is a friend of mine and a practicing psychiatrist. He's on... He's working on the MAPS phase three clinical trials, up in Connecticut and also owns a private practice, which we'll talk more about during our discussion. And what we're going to explore in our discussion is, medicalization. So there are two, possibly three substances that will be available by the end of 2019, for medical use, one of which is ketamine, which is already available. How many of you are familiar that ketamine is a legal treatment here in New York? Okay, so ketamine is a legal treatment option here in New York. And then MDMA, and we'll talk more about this a little bit, but projecting potentially end of 2019, early 2020 for expanded access sites, which we'll dig into a little bit in our conversation to treat PTSD.

0:08:57 PA: So with that on the horizon that's gonna be the first sort of bubble. And then, I'll also talk about microdosing some of the... I'll probably focus somewhat on some of the business elements that we've been developing, one of which is Synthesis, our retreat center in Amsterdam, where we do legal psilocybin retreats. So, I'm gonna talk about how those two might intersect and we're gonna kinda play this out in conversation live form. We didn't really have any questions. I sent him over a Facebook message about two hours ago, saying like, "This is what we'll kinda talk about." But I'm really excited to bring Will up onto the stage and introduce him as both a friend of mine and also someone who we're looking at more and more collaboration at in the professional space. So, I'm really excited to welcome you, so thank you so much for sharing your time and energy with us and please join us.

[applause]

0:10:00 PA: Okay. Thanks for being here. So, I'd love just to start with a little bit about you. Who's Will Sui? What's your background? How did you find yourself here in New York in 2018? And take that in any direction that you wish.

0:10:16 Will Sui: Okay. So, as Paul mentioned, I am a psychiatrist. I've a private practice in Midtown, which is what I spend most of my time on right now. As he also mentioned, I'm a... I'm trained as a therapist for the MDMA, for PTSD clinical trials through MAPS. It's interesting how I ended up in this work, it's probably not... I always tell people when I talk publicly about this stuff 'cause they see I have long hair and piercings and they assume I've been a burner all my life and I've been doing drugs since as long as I can remember, but actually, and Paul has for sure, but no.

[chuckle]

0:10:51 WS: So I think it was it was about 2013 when I was training as a psychiatrist at Harvard Medical School and it was about the end of my first year, and I had worked a long, long time to get to where I was, and I had achieved everything that I thought was worthwhile, and it was the end of my internship, which is the first year after one finishes medical school. And I got to my first rotation in psychiatry and I saw so much suffering and we were getting, I think our first lecture on anti-depressants, where they talked about this clinical trial. Where in the first phase of the clinical trial, they were talking about how really the best evidence we have for a psychiatric treatment, at least in this particular lecture that we were getting, was anti-depressants for depression. And they talked about how I think after this first phase of the trial, about 30% of people that got anti-depressants, no longer had depression at the end of the trial. I think it was like a maybe three month or six month trial. And that was compared to 19% for placebo.

0:11:53 WS: So all of a sudden I was like, our best treatment is about 10% better than placebo. And really at that point, I had also had a very hard time during my residency. Lots of hours and lots of emotional abuse. If there's any physicians or any mental health or health care treaters in here... Internship and medical training in general is not a walk in the park. And so I was at this point where I was not very happy with myself, I was depressed, I was like all of a sudden like, "Holy shit, what did I do?"

0:12:26 WS: Working all these years to get to this career that I thought was gonna make me happy and I wasn't even happy myself. And so then, it was around that time, that I really sought treatment for the first time. I tried anti-depressants and they're full of side effects as probably many, many of you in this room have tried before and so... And all of a sudden I was like, "Wait, I'm at literally the best institution in the country. I'm in the field, and I can't even get good treatment for myself." And so at that point, really I'd gone into a pretty deep depression and I had at that time also, I had considered leaving and so I actually applied to a bunch of consulting companies like McKinsey, Bain, I was gonna leave medicine and... But before I made that decision luckily, I got into psychotherapy where I found a lot of help. And then I entered about a five-year period of doing three to four-day-a-week psychotherapy, psycho-analysis on the couch, kinda traditional Freudian stuff to start. And I found a tremendous amount of help there, but then I realized, I myself, A, I had access to some of the best therapists in the country. And B, I had the time and the finances, because really it was provided to us for free. But I'm like, really this is not the vast majority of people.

0:13:40 WS: It was around that time that my childhood best friend who I had grown up with, who also really... We didn't really do drugs when we were growing up, and he was like dating... He did the opposite, where he did his life first and then went back to school. He actually just graduated college and we're 38 and so, he just graduated this May but he started dating his Physics tutor around that time, and she introduced him to a molecule that many of you may or may not be familiar with called DMT. And he had kind of gotten really excited about and he was telling me all about these hallucinogens and I was like, "You're crazy." I was like, "You're doing drugs. What's wrong with you?" I almost called his mom, and I was like, "Something's wrong."

0:14:21 WS: What ended up happening was, for months and months, he was trying to convince me to try this thing and then eventually I was like... I was just like "No." And then he told me, he's like, "But Will, there's some scientific evidence that shows that this is what's actually made in the brain and it's released during REM sleep when we dream and another time when there's near-death experiences, when people have their life flash before their eyes, a bright white light."

0:14:44 WS: And it ended up being that that's not been fully shown in humans but it was enough to pique my interest 'cause I ended up going to PubMed which is the medical search engine. And it was actually true that in the 40s, 50s, 60s, that psychiatrists were really excited about psychedelics. And so it was the first time I was like, "Woah this is interesting." because I was getting such benefit from Dream Analysis in my therapy where I was like, "Oh, if we give some of these molecules, maybe we can analyze the experiences, and then we can get healing for people because not everyone remembers their dreams and again, it's not that easy to spend a lot of time and money doing therapy.

0:15:16 WS: And so yeah, shortly after that, I realized that MAPS, which is the Multi-disciplinary Association for Psychedelic Studies, was doing research actively with MDMA. And then I had read about the psilocybin treatments and happened to be that Rick Doblin, luckily, lived down the street from me, in Boston and I met him and he quickly got me in the loop with everything. And so it was really kind of being in the right place at the right time, that really got me interested in this work. And I got to train with MAPS and then last year, early 2017, I got a chance to take MDMA myself legally, as part of the training to become a MAPS therapist and that was life changing in and of itself. And we can talk about that a little bit later if you want but... So the other thing is obviously I haven't talked about doing any illegal drugs because one of the difficult things about this work and these substances is that they're illegal. And so, how do we talk about these professionally? I'm not gonna come up here and say that, you guys know what I mean. And so, luckily, I was able to have this opportunity with MAPS to take MDMA legally, and really it's important for me to become an advocate of the medicines for their healing potential.

0:16:26 PA: So let's go into that a little bit... A bit more. This medical element with MDMA, potentially having expanded access sites by the end of 2019. What could that... What is the rollout potentially look like for MDMA in the next two to three years?

0:16:44 WS: Yeah, so right now, MAPS has... And I'm not a MAPS employee myself, I should make that clear. So MAPS sponsors studies. I am a faculty member at the University of Connecticut, which is one of the, I think, 10 or 12 sites that's doing the phase three work. Jade, who's here in the front row, who does work for MAPS, if you wanna... She has these beautiful ears on, if you wanna talk to her afterwards, I'm sure she could tell you a lot more about MAPS. But in terms of MAPS, so I think there's a little... There's over a 100 therapists who have been trained already by MAPS, not all of them are working on Phase 3 and I think the goal for 2019 is for MAPS to train another 150 therapists across the country. So hopefully by the end of 2019 when the expanded access... So actually I should probably talk a little bit, about... So Paul mentioned the term expanded access, and that basically means it's a system by the FDA that says there's a therapy that's on it's way that's so important, and that there's not an alternative to, so we should start allowing some treatment before everything becomes rescheduled, and the phase three trials are over.

0:17:49 WS: And it's basically honoring that, this is important. People may die if we don't actually give this treatment. And so, expanded access allows for a limited way of prescribing and using these medicines. And so, after those 200 or 50 so therapists have an opportunity to have a patient that they see with MDMA, that the videos are reviewed and then they're approved to go start their own clinics to treat PTSD specifically. So for the expanded access sites, it will be specific to PTSD and people who have already been trained by MAPS, but the goal is really, by the end of 2019 to have these treatments more publicly available for pay. So it won't just be through the clinical trials anymore.

0:18:32 PA: And that would be through a prescribing position, how would it then roll out after expanded access potentially?

0:18:32 WS: Yeah, so each expand access site will have to have at least one physician who's been trained by MAPS, who's able to prescribe and has a schedule one license and schedule... I'll mention the scheduling, really quickly. So the DEA has scheduling which basically means some pharmaceuticals are thought to be so dangerous or so addictive, that they have to schedule them and regulate them. So MDMA and most of the psychedelics, if not all the psychedelics are schedule one, which are supposed to be by definition, highly addictive and of no medical benefit, which neither really is true as you guys... Well, some of you may know. I think MDMA has its addictive potential... Psychedelics in general, I don't think are addictive, nor are they... And they do have...

0:19:21 PA: Classic psychedelics. Very classic psilocybin, LSD, DMT.

0:19:22 WS: The classic psychedelics and they do have I think medical benefit potential. And it's really the classifications I think are kinda silly. I think it more reflects the war on drugs. I think of the two things that are most addictive and no medical benefit, I think of as alcohol and... Sorry alcohol and nicotine, neither which are scheduled one and both are not just available, but really promoted so.

0:19:48 PA: Well, that's another interesting angle to explore, which is why is it that alcohol, nicotine and caffeine are all substances that are accepted, which they should be legal and regulated and why not psychedelics for example, and cannabis. And one point that you made that is really relevant to this is, when one of Nixon's aides came out in the '90s, saying that basically, they knew these drugs weren't harmful, but that they made them illegal because they wanted to affect certain left-leaning populations essentially. So, cannabis was the hippies and heroin was the blacks, and that's how they contextualized it. And that has started this really destructive, really war on drugs, since the late '60s that has affected the global span of how we perceive these substances.

0:20:44 PA: And it almost seems like it's kind of the last holding on of this industrial kind of era, so to say, that started in the 1600s. And if you track Colonialism, we went to the new world, we got all these substances, we came back to Europe with tea and coffee and we came back to Europe with nicotine, tobacco. We came back to Europe with hard spirits that started to really be made like gin and we've seen this rise of popularity, this rise of normalizing those as Industrialism has really grown. And then I think that's why cannabis is so interesting and psychedelics then becoming normalized and regulated because it's representative of a shift, I think in cultural values. So that concept I think, is really important to understand as these conversations develop.

0:21:44 WS: Yeah, no, I think I agree with pretty much everything you said and so, I think that's why there's this is one important thing of some people will say or criticize that these substances are coming back into the mainstream through medicalization, because some people argue that these are... A lot of these are naturally occurring like mushrooms or ayahuasca and that these really should be available freely to everyone.

0:22:06 WS: I don't know, I've heard Rick Doblin who runs and founded MAPS say something like, "Medicalization leads to legalization." Marijuana is an example of that where 15 years ago, I couldn't even imagine of anyone thinking that we were actually gonna legalize these things recreationally, and it's happening quicker and quicker every year. And I do think that there is some risk with some of these substances, MDMA, if someone has an unhealthy heart, potentially could cause arrhythmias and having a heart attack. So I don't think it's all bad and I think, at least for what you called the war on drugs, and there's a guy, Gabor Maté who's a Canadian physician, who's been doing a lot of work for decades really, with drug addicts in Vancouver, who says, "This isn't really a war on drugs, it's a war on drug addicts." We can't really have a war on something that's inanimate.

0:22:54 WS: But really, it was against, as Paul said, a lot of the populations that the government, I feel was trying to control and so... And it's really something that hasn't worked, and so, I do think that there's good reason and it is also good to just have if we're gonna promote these and say that they work for X, Y, Z disease, we should have some amount of study, and other people, 'cause it's interesting 'cause I sit in a interesting position, I am a physician, so I kind of have the... A certain talk when I... Or a certain spiel when I talk to my physician friends but I do go to Burning Man, I'll admit and I do have friends in that realm. And so I kind of think that there is really a middle ground to all of this stuff. I don't think that just free-wheeling... Free-wielding all these drugs is necessarily or substances or medicines are necessarily the best case. And so yeah, I...

0:23:42 PA: What is that spiel?

[chuckle]

0:23:44 WS: Well, it depends on the person, 'cause I do a lot of my...

0:23:47 PA: And how do you discern that, understand that, 'cause I think that's also valuable for probably and relevant to many people here it's like...

0:23:52 WS: So which part of that, sorry?

0:23:54 PA: Just the talking with people who are in different camps about these medicines.

0:24:00 WS: Yeah, so I think again, so for my friends who are physicians, or when I give talks at medical schools or psychiatry departments, I tend to focus on the data and showing that this really... These things work a lot better than anything else we've ever had. Last July, the FDA designated MDMA for PTSD as a breakthrough therapy. It's the first time a primary psychiatric illness has ever been labeled a break through therapy by the FDA. Up until today, actually where psilocybin for major depression was actually designated a breakthrough therapy. I think it was either today or yesterday. Which is a pretty big deal so it's...

0:24:32 PA: Really? Oh that's great news, yeah, it's great news.

[applause]

0:24:38 WS: Not sure why they're clapping, I didn't do it but...

[laughter]

0:24:41 WS: It made me pretty happy to read it too. But you know, it's a big deal. Now we have... Again, that's only two psychiatric indications for breakthrough therapy and they're both illegal, dangerous, addictive drugs, according to schedule one. And so again, things are coming around and I think we're seeing that shift as the medical evidence is coming out for it. So when I talk to physicians and scientists, I focus on the data and you could also talk about cost about how these are medicines that aren't used long-term in the case of MDMA for PTSD. It's three treatments using the medicine over three months. People are... Most people are not going back on anti-depressants. So it's also like a healthcare cost issue.

0:25:00 WS: I think on the other end of the spectrum, when I'm talking to more burner friends or partiers it's like, a lot of people are like, "Yeah, I've done tons of healing with this stuff." And I think... I don't think... I'm not against using any of these medicines as... For fun, or for recreation, or creativity. I mean, I think really we should be able to work with our own consciousness and explore that the way we want as long as it's not harmful to other people. I just think we shouldn't fool ourselves when we're taking them in that situation and saying that we're doing healing work for ourselves or someone else. I do think that in certain instances, using these recreationally can be healing even if it's not the intention. But it's not that it happens every time and it can be harmful at times to kind of open up your consciousness to certain states, is kind of the way I think about it.

0:26:03 PA: And let's explore that relationship a little bit more between having these trained therapists who are offering a medical service in clinics, to this healing that happens at places like Burning Man, or with people... You know, I... All of my psychedelic work has been in the woods, or in small groups of friends, or you know alone. So what's your take on that, those two camps, and how we might see some sort of collaboration or some sort of relationship to make these treatments more accessible? So for example, if you can have a sitter who can then just sit for you in like a public setting, you know that you won't get in trouble, for example, legally, 'cause they're not prosecuting it. Is there a way to start to build kind of a grassroots movement that would be oriented towards like decriminalization?

0:26:57 WS: In terms of orienting it to decriminalization, I don't know, I'm not a lawyer. I don't really know too much about kind of drug policy and stuff. I would add at least a third camp to that, maybe four camps, which is... You know, 'cause Paul was talking... Or we were talking about using these at raves or at Burning Man, the other end is purely in a medical setting. I think of like the underground therapy kind of community as a separate one of these. And then maybe also, just holding space ourselves for loved ones, or just using these ourselves on our own intentionally. You know, I think for me, I am a supporter of the underground therapy movement, or of people using these responsibly themselves for intentional healing or for loved ones.

0:27:37 WS: I think 250 therapists being trained, that are available next year, potentially, for expanded access for MAPS, I mean that's still... That's not enough people, not even close. And the reality is, some people are starting to talk about cost for these and availability financially. I don't think there's gonna be any regulation of how much people charge for this stuff, and there's gonna be a massive market for this stuff. And so you know it's something that people haven't really started addressing publicly.

0:28:11 WS: The reality is I don't necessarily think for MDMA therapy, you're gonna need two therapists in the room, during the MDMA sessions. It's eight hours, the patients are gonna be required to stay overnight and then you're gonna have to have another integration therapy session the next morning for a couple of hours. So I think the total therapy for the MDMA for PTSD trials is around 60 hours or so, 60, 65 hours. If you're paying me my New York City rate and a psychologist who has a PhD, you're talking between $15,000 to $20,000, which is unaffordable for the vast majority of people. That's if people stay at kind of the going rates.

0:28:50 WS: But I don't think that it's necessary to have that kind of... Like, the training and professional supervision for all of these things. The way I think of it, you know, if the underground therapy movement does develop and I think the more it develops, and the more formal it becomes even though it's underground, I think the more we can insure integrity. I think there's a lot of good... I do know a lot of underground therapist, some are doing great work, and I know a lot who are not doing great work. And I think there's also some that are doing harmful work. I don't think that having training as a therapist equals being able to do great work either. I think having psychotherapy training is helpful, but I really think that and a combination of having personal experience, and really just having the right temperament to do this work is the most important thing.

0:29:42 WS: And so for me, I think it is incredibly helpful to have had psychotherapy training, especially kind of like classical Freudian Analysis. I was also trained in Jungian Psychoanalysis, so Carl Jung and that school of psychology which is I think is much more helpful for addressing the trans-personal experiences, or some of the visions you have with certain parts of these molecules. We can get more into that if you like too. But...

0:30:05 WS: You know, but I think... You know, I think... You know, the phrase I use is to kind of Heal Our Deepest Wounds which is actually a title of Stan Grof's book. So, I kind of I'm stealing that, but really I think the really deep, deep wounds that people have, the trans-generational traumas, or childhood abuses, I think it's very helpful to have a professional working with that sort of stuff. But for more bread and butter depression, anxiety, I think one can have a lot of healing without having that level of professional involvement.

0:30:34 PA: And this is a topic and a concept that I've just been exploring with the team that I've been working with Synthesis, where we've been looking at how could we build a kind of grey area model to offer legal psilocybin experiences. 'Cause psilocybin is legal in the Netherlands through psilocybin truffles. So basically in 2008... And this is classic Dutch, in 2008 a French tourist something... There was something involved with a French tourist and magic mushrooms which were legal in the Netherlands up until that point in time. And then... So to appease the French government, the Netherlands made magic mushrooms illegal. But to keep things open and accessible, they still made truffles legal. Which were these really disgusting roots or kind of bulbs or something you... We make a tea out of it, if you eat it, it makes you really nauseous.

0:31:26 PA: And so we've been looking at how we can start to develop potentially models of a more retreat place, like if you get a retreat center, and you can bring in groups of people, right? If you have three guides for 15 people, and then we've been basically screening out anyone with clinical issues to minimize any sort of, you know...

0:31:46 PA: To kinda take care of the bread and butter things that you were mentioning in which a lot of people are going through transition, and because of Michael Pollan's new book, which many of you are familiar with or have read, there's this huge interest in these legal psilocybin experiences, but they're only available in Jamaica and the Netherlands as far as I know. There's a couple that have popped up in Mexico, but it's only decriminalized in Mexico, just good to be aware of. And then, I believe it's legal in Brazil as well. So there are all these developing gray area opportunities with psychedelics where they might be illegal here, in this jurisdiction, but Canada just legalized cannabis as a country, I think what might be next is psilocybin. And it might be medical at first, but it looks like that could be a movement that's generating interest.

0:32:33 PA: So there's lots of I think intersections and not only in the medicalization, which is the more completely kind of, by the standards of the USA in particular. And looking at how do you start to build other models in places where this is accessible? One of which I wanted to explore a little bit more, which is ketamine, which is legal here. Can you just give us a run down of what ketamine is, and then it's legal status here in New York, in terms of who can access treatment and what are the particulars around that?

0:33:10 WS: Sure, I'll address that but I wanna address little bit kind of what you were saying. So there's a lot more interest in use of these medicines in either legal settings as Paul said, outside of other countries where people... I actually think there was a study done that was about 10, 12 years ago, where they looked at the number of ayahuasca circles in San Francisco and New York City alone and it was estimated back then, that there was about 200 every weekend. And so there's a lot of use of these medicines and or going abroad to retreats in Peru for ayahuasca for instance. An important thing that... It's another thing that's not being spoken about much at all, but I think it's incredibly important is that of psychedelic integration or making sense of the experience that you have, after really opening up your psyche. I haven't finished Michael Pollan's book, but really when I think of what's interesting or what's hot in the media right now, people are talking about the visions that you have or accessing memories that you had never remembered and feeling... Or the vomiting during ayahuasca.

0:34:20 WS: And there's something kind of like, I feel like it's kind of Western and capitalistic in terms of just the sexiness of the actual psychedelic experience and very few people are actually talking about the work that it takes the sober work in the weeks and months after. There hasn't been a study obviously, but I really think about... I've thrown out numbers like 80, 90% I think of the healing that is lasting with psychedelics happens in the sober work in the weeks and months after and really nobody or very few people are even talking about this. So, it is good, I think that these are becoming more accessible in some form to have the actual psychedelic experience, but it's important to make sure that you've got really the right support. And that's not... And I'm not trying to say that psychedelic integration is psychotherapy, okay? Psychotherapy is one form of being able to integrate but it does not require a therapist. You could do a movement practice, it could be a meditation practice, it could be really a circle, with your friends, it could be journaling, it could be doing creative arts.

0:35:20 WS: So I'm not someone who pushes the western model and saying, everyone has to do psychotherapy. I happen to think it works really well but I don't think it's the only thing. But that's something I wanna emphasize because I do think if you're going to these retreats or doing these things, just make sure that you've got the right support after, 'cause I have seen people... The stories that you don't hear about, is people getting more depressed, getting... Having manic episodes, having psychotic episodes, not to say that these are things that... I hesitate to say things like, "Manic episode, psychotic episodes." Because there's some evidence, especially from the 50s and 60s of these medicines, being able to treat bipolar and being able to treat schizophrenia. So I'm not saying that these are things to be avoided but they're serious issues that if they come up one needs the right support. And again, those aren't stories that people come and tell publicly that, "Oh yeah, great. I went to do ayahuasca and I came back and was not able to function and couldn't go to work and I lost my job. Those are not the stories that you hear about and this does happen.

0:36:21 PA: Is this common though?

0:36:24 WS: I don't think anyone... There's numbers. I went to an ayahuasca retreat in Peru, and I was supposed to spend about a month there with the healers and there was a lot going on that I was not in agreement with and one person did... Was in a lot of trouble kind of medically and physically and she was put back on a plane to go back to the US. And I don't know what happened to this person, but it was very clear that she was not in a good situation. So, again, I don't... I'm not gonna say this happens every retreat, every time, but the point is really to be careful that these are not... These can be serious medicines to take and you're really putting yourself in a vulnerable position, opening up your psyche in that way, so.

0:37:05 PA: And that's where ketamine is an interesting potential...

[laughter]

0:37:10 PA: Nice first step into some of the more deeper realms of psilocybin or ayahuasca which is interesting that it's a legal option then for people. Right?

0:37:23 WS: Yeah...

[laughter]

0:37:27 WS: Well, I wouldn't necessarily kind of say that ketamine is a solution to any of this thing. Ketamine is in an interesting position, because it is something that's legal already and I think it's kind of helped usher through these experiences of having trans-personal experiences. Trans-personal I kind of... Most of you probably at least can insinuate that, I mean, something consciousness altering or accessing the unconscious etcetera.

0:37:45 WS: So, ketamine was, you guys... Well anyway, I'll just explain, so ketamine is a dissociative anesthetic. I think it was discovered in the early '60s. It's an analog, meaning a similar molecule to PCP. So I think it was in the process of being developed, as an anesthetic. PCP was discovered first but obviously has a lot of behavioral issues that come along with it. And so, the molecules are often altered in chemistry. Ketamine was found and it was found to be a very beautiful dissociative in terms of anesthesia. And so it's probably used, I don't know, tens of times if not hundreds of times in every single hospital across the country. I can't remember the actual time, a decade or two ago.

0:38:31 WS: It was noticed that people who were using... Who got injections of ketamine or ketamine infusions in a surgical setting ended up having less depression and suicidality. So people were like, "Huh, I wonder what's happening?" And they connected it to ketamine really having this impact, and so that's where the ketamine clinic started, was really giving people IV ketamine, just like they were in the medical setting.

0:38:55 WS: And so, really, most of ketamine clinics that one hears about these days are run by non-psychiatrist physicians, usually anesthesiologists or primary care doctors, where they're infusing IV ketamine. And it is significantly helpful, it appears, for depression and suicidality. I think of it as working a little bit like electro-convulsive therapy, which is a very effective, it's actually the most effective treatment for depression outside of psychedelics, I think, and has the lowest side effects. So there's a lot of stigma around ECT, but I think it's a beautiful treatment.

0:39:25 WS: But ketamine in that instance isn't really, I think, working as a long-term solution. Most of these clinics, if not all these clinics, are not really using them where you have a ketamine IV experience and then having psychotherapy after. You're going in, there's often numerous chairs in a room, a nurse comes in, they'll inject you with ketamine, and a couple of hours later, you leave. So what I'm doing and what's gaining a lot more interest is ketamine-assisted psychotherapy. And so, unlike these ketamine IV infusion clinics, I'm using ketamine lozenges, so oral ketamine. And then, the set and setting is very similar... Oh, sorry, the setting is similar to what... It's like in an MDMA therapy treatment room for the PTSD studies where I have the person lie down, there's music playing and there's an eye mask and they have their experience with ketamine for about an hour, hour and 15 minutes, and then as they're coming out of the experience, I engage with them in psychotherapy.

0:40:24 WS: At this point, I haven't treated anyone who I'm not already seeing in therapy, 'cause I see these kind of as adjuncts or helpers along the way of normal psychotherapy. I think I would never open up a clinic myself where someone comes in and they pay me X amount, I give them a ketamine lozenge once and I thank them as they walk out of the door.

0:40:43 PA: Sure.

0:40:43 WS: It just wouldn't be that helpful.

0:40:44 PA: You wouldn't do that for me? [chuckle]

[chuckle]

0:40:48 WS: So yes, I see ketamine as a nice alternate because it is available, I think it has its advantages to MDMA, for instance. Again, we're talking about the expense of ketamine... Oh, sorry, of MDMA with the hours that you need the therapists there. Ketamine, I've got it down to where you're essentially treating someone for about an hour-and-a-half to two hours. They can go home. They're not gonna go straight back to work but you can go home. And so because these aren't as highly regulated right now as MDMA or psilocybin you can do these with one therapist. There just isn't that many people practicing ketamine psychotherapy right now.

0:41:22 PA: Because a lot of what I've heard is just ketamine infusions where you go into a room, you get a ketamine infusion, it's about 45 minutes to an hour, and then you leave and people will do that up to sometimes two or three times a week. And if you don't bring in, kinda like you said, it's the integration process, if you don't bring in some of the psychotherapy or some of the other elements to help consolidate it, then it's just another, as Michael Pollan said in his book, it's just another drug experience in a way.

0:41:48 WS: When people, yeah, so people if they typically are getting treatment for depression with IV ketamine you'll usually have an induction period, where in the first two or three weeks you'll get ketamine about three or four times a week. And then most people tend to spread it out to once or twice per month. And again, the studies are pretty good. Most people are getting off anti-depressants, but you still have some regular treatment period. So some people will argue that's better than having to go in every single day or take a pill every single day, but it is still something that's long-term people are, it's looking like we'll continue to need kind of a boost of IV ketamine. So my goal with oral ketamine is similar to the psychedelics where you can treat someone for some short amount of period of time of months and then have them go on their way and not needing treatment anymore.

0:42:32 PA: Let's talk about microdosing a little bit.

0:42:34 WS: Okay. [chuckle]

0:42:35 PA: What's your... What's your understanding of microdosing?

[chuckle]

0:42:40 WS: This is like a test...

0:42:42 PA: First... So what do you know about it. I'm curious... And yeah, just... Tell me about microdosing, Will.

0:42:54 WS: So I'll tell you, I guess, my perspective on microdosing, which I find is pretty interesting. I think from what I've heard about microdosing, I suppose, again, so I'm very careful about not... I'm a physician with a medical license and I don't admit to doing, everything I've done is in legal countries...

0:43:10 PA: Legal. It's legal.

0:43:10 WS: Or in their legal settings. So in terms of microdosing, I think of microdosing as sort of like, I hate using alcohol as something analogous, but if you were to go out to a social setting, use alcohol, if you have a drink or two, it usually opens you up, you're a little bit more flexible, you're willing to cross boundaries and kind of play with life a little bit more in everyday life or sorry... In a normal setting. And so, I think of microdosing in that way for me, where you're not opening up the complete floodgates, where you're getting visuals and hearing sounds differently and aren't able to really function kinda just walking around or at least function without getting into trouble on the streets in a city.

0:43:55 WS: Where you can... Where kind of the opposite, I think of, when you're having a really high dose experience of any of these and you're working with a therapist or when I'm working with a therapist or, sorry, with a patient, we're kind of talking about the certain areas of their life, and I'm talking about now sober work of things that they wanna work on, things that they would like to do, but it still takes practice to leave the therapy room, and then go out and change your life every day. Where I think of at the right doses, in the right situations one can take a microdose of LSD or take a microdose of mushrooms and go out and kind of practice a little bit more. I think technically microdosing means it's sub-perceptual, so you're not feeling anything.

0:44:30 PA: But we have mini-dosing...

0:44:30 WS: Yeah, so most people I...

0:44:30 PA: We have museum-dosing. There's the five Ms, it's microdosing, mini-dosing, museum-dosing, moderate-dosing and mega-dosing is the [chuckle].. Is the thing. It's a really easy way to remember. These are the different calibrations, the different levels that when we can work with it in a way we can facilitate more of an expansion or less of an expansion, more chaos, less chaos.

0:44:30 WS: Interesting, no, I had never heard that. That's interesting. Five Ms, okay.

0:44:30 PA: Yeah.

0:44:30 WS: Okay, and so... So I think of microdosing in a way that you can kind of do this. Whether it's go out socially, or... Some people, I guess, in the... It's popular in tech right now to actually use these to go out and go to work or to explore creativity, writing, drawing etcetera. So I think it's a kind of more manageable, yeah less in depth or less of a commitment also where you're not gonna be feeling this for 8, 10, 12 hours at the time.

0:45:26 PA: Right. I keep comparing it to a supplement of sorts, where it's kind of a mind, body, health well-being supplement.

0:45:33 WS: It's like a Flintstone gummy. Just a little bit different.

[laughter]

0:45:36 PA: Well, it's a... You know, it's a little more natural, I would say. There's no added sugar.

[laughter]

0:45:42 PA: So they're not that sweet, you know, they're really not that sweet.

0:45:44 WS: Okay.

0:45:46 PA: But it's not something every day, it's more like like a fish oil. You know, it's like... So what I'm really interested in is what's this co-evolutionary relationship? So you know... You're familiar with Terence McKenna's Stoned Ape Theory which is basically that ancient hominids were eating potentially psilocybin mushrooms on the savannas of Africa to help to lead to a development in our cognitive abilities. And so I think it's interesting to explore microdosing as this tool that helps to facilitate, I don't know, the next evolution of where consciousness is heading. And not just microdosing, but also psychedelics as just this general movement towards body, mind, spirit wellness. And how can we work with tools that help facilitate physical well-being, that help to facilitate emotional well-being. And then also some sense of spiritual connection which I think many people are lacking. As these old stories that we lived within have kind of dissipated, and now we're trying to... Like, what's the new story? Is it Burning Man, is that the new story, Will?

0:46:53 WS: New story...

0:46:54 PA: Oh yeah, is that the new story? The new infrastructure, the sort of type of culture or society that we're trying to build on a more global scale, does it have similarities to Burning Man?

0:47:09 WS: I'm not sure, I guess it would be fun to have that.

0:47:11 PA: That, it would. Yeah, yeah, yeah.

0:47:11 WS: But I mean... I think, I'd just be happier if people were kinder to each other, I think and were less competitive. And, you know...

0:47:18 PA: Okay.

0:47:19 WS: We'd see less crime and less war, and we kinda stayed with the world that we're in right now. If we could have heart cars and big heart structures that would be great but...

0:47:27 PA: We could do that, I think we could be... Yeah.

0:47:29 WS: I think just not being so violent with each other, would be a great step...

0:47:32 PA: So small steps.

0:47:33 WS: Yeah.

0:47:33 PA: In small steps. Okay, great. What else do you wanna explore?

[chuckle]

0:47:40 PA: What else do you wanna discuss or talk about? Anything that is on your mind that we haven't explored yet, related to Ketamine?

[laughter]

0:47:51 PA: Or the MDMA work, tell us about that. Can you talk a little bit about your work with the Phase 3 trials? What's that involvement like, to whatever length you can?

[chuckle]

0:48:05 WS: Okay. So I think what Paul's insinuating... So I have some interest in Ketamine. So like I said, right now, I now have a solo private practice, but I'm looking at some point next year to open a Ketamine group practice and have some other ideas. So that'll be to come sometime in 2019, here in New York. But there's a few kind of novel like ideas, I think and offerings, I think that'll come, that'll be interesting. But won't get more into that today but... Sorry, the other thing that you had mentioned was...

0:48:32 PA: Your work with the Phase 3 trials, what's that like?

0:48:36 WS: Yeah, so for me it's been a mix. So the site that we have at the University of Connecticut is a... It's been a beautiful kind of venture by MAPS. So our site is unique that all of the therapists at our site are non-white, they're people of color as we call them. And meaning... So we're really trying to address the fact that psychedelics, you know, we hope are accessible to everyone at some point. And really the Burning Man culture, the psychedelic movement is really a white movement. And it's really like a middle class, upper white... Upper middle class movement. And so especially when we think of these medicines, you know, namely mushrooms and ayahuasca, that are really coming from Latin America, and really that most of these populations are not using psychedelics. And I think that there's unique things about people of color, especially Black Americans where really the... I think... I can't remember who said this recently, it may have been my... The professor I work with at the University of Connecticut. Really, she's like, "If a Black American admits publicly to drug use, they get... Obviously, get into a lot of trouble, get thrown in jail. Where a white man does it, I.e Michael Pollan, and you get a New York Times best seller.

[chuckle]

0:49:45 WS: As funny as it is, it's true. And so there's barriers, not only culturally, but socio-economically to psychedelic medicine. And again, there hasn't... Again it's all really in the last month or two that there's been some prosecution for people bringing in ayahuasca from other countries, but there's been like two. Again, and there's these hundreds of ayahuasca circles every single weekend in the major cities in the United States, there's never been a group that's arrested. But again, and we don't even have to get into the numbers of... The number Black Americans and Hispanic Americans that are in jail for life really for drug crimes having to do with marijuana. So you know I think... Not that our site is focused on all these issues, but it's at least bringing attention to these issues.

0:50:28 WS: And I think that's where it's important to talk about this stuff publicly, because I think the more we talk about these... And people have positive experiences, meaning everybody, that that will have some influence, hopefully, on law enforcement and on politics because the barriers are... You know, there's very few therapists of color in... That have been trained by MAPS, very, very few. Even though there's attention to try to raise this next year, it's still a problem. And to get then people of color interested in taking psychedelics is another story. And are they gonna have people who are trained that look like them, who they feel comfortable with, you know, allowing to take these substances and expand their consciousness. So that's at least two ways.

0:51:09 WS: And then are the therapy approaches that we're using so far, geared towards really... Is it really gonna be culturally appropriate for everybody, or is there certain blind spots that we have that these studies are being really designed by white men really mostly? And how does that impact the studies? Is this really as effective in all groups? And so, those are different things that we're working on or issues that we're trying to raise at the University of Connecticut.

0:51:38 PA: And the sense that I get is as medicalisation happens, there will then be more opportunities for research which will help to answer not only some of these strictly medical or clinical questions but also potentially some of the socio-economic questions. I just saw... Cannabis, there's tons of research now coming out about cannabis because it's now been medical for 20 years, and I think that'll happen pretty quick with MDMA and psilocybin and ketamine, for example. I think we'll see a huge growth of that, and I think that could be partly in the socio-economic elements that you spoke about. 'Cause it seems to be a more and more important conversation that at least I'm seeing circulated at conferences like Horizons, for any of who were there. The whole Sunday was largely about social elements.

0:52:25 WS: I'd like to think that that's the case. But even if we look at a regular health care and accessibility right now it's vastly different for different socio-economic statuses. So I would hope that that's gonna be different for psychedelics but I would say that I'm not that optimistic of saying... Hopefully just because we're medicalizing, this will take care of itself. I think we need to be a lot more active about this with our neighbors, with our friends etcetera to really bring more attention to this.

0:52:49 PA: And so how can we be active?

0:52:53 WS: I think it depends on each of us I think for me and our group, it's really about, again, getting the word out, talking about this and just making sure that the people, in really our circles, are interested. I've got some ideas around with different people of, Can we take people of color to other countries to get legal experiences, say, in Peru or in Amsterdam to be able to provide these experiences safely? So, it's really any number of things as you can imagine. And it's interesting 'cause I've talked to a lot of Hispanic and black folks, friends of mine, really, who are into psychedelics and are interested in more often than actually... I don't know if I've met any who were introduced by a friend who wasn't white, actually. So really, that was really the intro, so even if you are interested in this, it's just trying to be as inclusive to everyone as possible, I think is a way to start about it.

0:53:46 PA: Great, well I think I just wanna wrap up by asking one last question which is, what are your plans for the next six months to a year, just in New York. Professionally, where do you see yourself a year to maybe a year and a half from now, in terms of your work and what you're involved with?

0:54:09 WS: For me, it's to continue to work with MAPS. I have this... The dream is really that these medicines are all being used right now for psychiatric illness. I do think that MDMA and psilocybin as we all know that the mind-body connection, now it's normal to think that that is actually something that's real. I think when I started medical school, 15 some odd years ago, acupuncture was in... We had a whole department of Complementary and Alternative Medicine, and really we've seen things moved pretty quick. People actually are believers in this stuff, so it's really great. But I think there's a lot of potential for psychedelic healing to impact medical illness. So, chronic pain, auto-immune illnesses all these things that we know get worse with stress, I think can also be impacted by psychedelics. So I've been talking to Rick Doblin and MAPS about doing a pilot study or two on some more medical illnesses with MDMA. So that's something that's in the works for me right now.

0:55:09 WS: Really, I'm not really focused on building my practice, right now, but really focusing on opening this, hopefully a set of ketamine clinics where we could do good work, train people to do this well and to expand it within the community to really have some psychedelic or trans-personal healing available quicker and to add to the repertoire of not just MDMA. So those are the kind of things that in the next year I'm focused on and also just talking more and writing more publicly about the medicines to just increase education, and just have people be... Just more food for thought for people.

0:55:47 PA: More food for thought. Yeah, yeah, more conversation, more discussion. And this was a great way to start. So Will, I just wanna thank you so much for all of your insight and all the work that you're doing and continue to do. It was so much fun to get up here and chat a little bit, so, thank you.

0:56:02 WS: Thanks for inviting me.

[applause]

0:56:14 PA: So we're gonna move into a little Q&A. We have about 20, 25 minutes for Q&A, and we're just gonna set up a mic up front. We don't have any wireless mics I believe so this might... Should we... Yeah, we'll just do Q&A and then we'll kind of go from there. So, anyone with questions please come and ask.

0:56:40 Speaker 3: I think one of the questions that have come up is... Can you hear me?

0:56:43 PA: Can you hear him?

0:56:47 S3: That what kind of communities are we facing with nowadays 'cause we live more and more in isolation? Which I think leads to many of these problems, compounds them. And talk about support systems within communities and how we build that when there's so much suppression legally.

0:57:04 PA: So I think this is good, this is a really good example of doing exactly that, right? So this is just one element of community. I was just talking with someone about this last week, and we were exploring what will it take to create resilience, in the psychedelic space and a big part of that is community development. So it can be more Speaker Series events like this, and I'm talking very specific to psychedelics right now. There are other meet-up groups that will meet in various cities, so there are these psychedelic societies that are in various cities that have popped up, who do various events, not just speaker series. There's an opportunity to get people together to volunteer and I think the big question to explore then in this re-building of community, particularly around psychedelics is it just about psychedelics, or is it really about something greater than that?

0:57:54 PA: And I think that's what we're really trying to explore through dialogue and conversations, through some of the content that we've done is, it's psychedelics are one of the entry points into this, creating the social fabric of well-being. But how does meditation play a role in this, and yoga, and breath work, and some of these other altered states, so to say. So, on a very practical level, I think yoga studios and meditation places and the psychedelic clinics that will open soon, these will... Spaces like this, events, those are all really good opportunities to start to build this and create this.

0:58:33 PA: And then it takes involvement and it takes proactivity. I think for people who have had meaningful experiences who say, "Okay I wanna become involved, how do I contribute in whatever way, whether that's energy or time, whether that's donations to organizations like MAPS or Usona or other non-profits, who are doing work in this space. There's a lot of opportunity to, I think, feel like we're part of something that's growing and that has momentum, and that regardless of the legal status... This doesn't seem to be catching the attention of the legal authorities. And I think that's largely because of some of the things that we explored earlier in our conversation. I think it's because of cannabis, I think on a conceptual level, it's just efficiency there's not the resource is available to continue to pursue the war on drugs like they have for the last 50 years. It's just... It's a bankrupt sort of operation. Yeah, so anything to add to that?

0:59:31 WS: No.

0:59:31 PA: No, well...

0:59:31 Speaker 4: Got a kind of a double question now. One brought up by something you spoke about. You talked about treatment and therapy, but a person who's dealing with, you mentioned all the people who you've done this treatment with, people you've already been treating, people speak a lot in medicine about lead time bias and how you can discover things early, "Oh my God, this person is... " Now with genetic code and all of this, has any of your experience, especially with your patients and such... Have you, as a diagnostic tool is what I'm getting at. Besides, it's generally understood, many of us have had anecdotal experiences of a friend typically in their mid-20s, the schizophrenia seems to be triggered or become more obvious after they've tripped or something like that. So I was wondering, the diagnostic part. And my other question was about, there's a lot of smoking of DMT for 10 minute, 15 minute thing, and you're talking about Ketamine, less time in the market-driven therapy, less expensive, less time and all of that thing. So if you can address those two, diagnostic and smoking DMT.

1:00:48 WS: I'm sorry. You said what about smoking DMT that's kind of a big one.

1:00:50 S4: In terms of... 'Cause you're mentioning Ketamine clinics and things, because it's an hour and a half instead of 12 hours, well, then what about smoking DMT for 10 minutes and, you know.

1:01:00 PA: This guy is on to something. I'm like, "Yeah, this guy is on to something." 2030 maybe? Is it really feasible?

1:01:08 WS: Diagnostically... So you're referring to the exclusion criteria for the MDMA and all the psychedelic studies so far. Exclusion criteria basically means if someone has something, they're not allowed into the research study. So, pretty across the board if one has a psychotic illness, you're not allowed into one of these studies. I've found more and more where... I don't... It might be helpful to think of psychiatric illness as genetic. There's been a movement of that in medicine in the last like 20, 30 years, or since DNA has basically just been discovered. And there's the whole nature versus nurture. Is this behavioral? What happens in terms of what you grow up with and what influence does it have? I think, obviously, it's a combination of both, but the more I've worked with these medicines, I think of... I don't know, I see more and more... Seemingly miraculous things that go against everything that I've been taught that people tend to get a lot more healing than what the textbooks say that they do. Or they get cured really, when the textbooks say that that's not possible.

1:02:18 WS: I think for psychiatric illness because when I think of disorders, I don't actually think of anything wrong with people, I think of symptoms as being really signs that something... There's been a trauma that's not been fully healed or expressed. And we I think pathologize by calling these disorders, but for someone that has PTSD if you've experienced a significant life-threatening event, to yourself or someone around you, and you have hyper-vigilance, that's not a disorder, you're actually protecting yourself. And because to be hyper-vigilant is again protective, same thing with anxiety disorders.

1:02:55 WS: I think they're essentially behavioral ways of coping with an un-healed trauma and I think the more we can heal these with MDMA, or psychedelics that we see that those essentially go away, or they're a lot better than anti-depressants or anti-anxiety drugs will lead you to believe. So... And really, the last... Really, I think the most difficult to make that argument for is schizophrenia. I think that that's one that's been a little bit more tricky, but I do think... I'm optimistic that actually we will see with time that these can actually treat schizophrenia, and I think most most doctors will think I'm insane for saying that, but I think there's evidence from the late '40s, '50s. So there's this psychiatrist named Stan Grof, who's still alive, he unfortunately had a stroke recently, but he was friends with Albert Hofmann, he's probably done more legal LSD psychotherapy sessions than anyone alive. I think...

1:03:54 WS: So he did about 5,000 total between the Czech Republic and then at the Baltimore Psychiatric Institute, where he was recruited before LSD was made illegal, and he treated numerous people with schizophrenia. And he wrote a number of books and says that he essentially cured many, many people. Interestingly, there was actually a New York Times op-ed within the last month, I'm not sure if any of you read it, but essentially there was a pair of people that they talk about. One person that had schizophrenia got bone cancer. Then got a bone marrow transplant and was cured of his schizophrenia.

1:04:29 PA: Whoa.

1:04:29 WS: And the other side there was a guy who got a bone marrow transplant from a person who had schizophrenia and then got schizophrenia.

1:04:36 PA: Whoa.

1:04:36 WS: So that didn't make the news that big, but I read it. And that is significant because essentially, we're saying that this isn't just in the brain perhaps, this is an inflammatory process, etcetera. So I was really excited to see that 'cause probably my dream project, would be to do something with psychedelics or MDMA with schizophrenia. I don't think that's anything that's gonna be approvable by any IRB any time in the next few years, but to me, it's really an exciting thing. So in terms of diagnosis, I think depending on one's genetic makeup and one's environment if one is stressed, or has a trauma you'll have a series of symptoms that look like PTSD or that looks like alcoholism or that looks like OCD. I don't think of these as things that were kind of set in stone. We're gonna have for the rest of our life because of something that is innate in us when we're born. The second question [chuckle] about smoking DMT...

1:05:29 PA: [laughter] Let's go back to that.

1:05:31 WS: I don't know. I know one person that does intentional healing work underground with DMT and who has and I believe has significant success with it. That person combines it with Syrian Rue, which extends the amount of time that it's available from a peak time of five, 10 minutes to probably double that. I don't know. Certainly, I think it's possible. There's not that many people that do it. There's definitely nothing published about using smoked DMT. So in theory, I suppose, one shorter-acting would allow for cheaper and perhaps less time and cost-intensive therapy. But it's not really something I can comment about or know too much about.

1:06:14 PA: DMT vape pens, though. [laughter]

1:06:17 WS: Sold by Third Wave, starting in 2020...

1:06:21 PA: No, no, no, yeah. That's future product development, potentially, just kidding. There was a really good article that was written about DMT vape pens, it was in the Seattle magazine, where this guy went on this really good adventure... If you Google "DMT vape pens," it'll probably pop up. Our website might also pop up. For educational purposes. Any other questions, please yeah?

1:06:52 Speaker 5: So, there's a lot of money in play here or a loss of money, maybe for Big Pharma. I guess I have a couple of questions like, are you seeing any kind of resistance coming from that side? Where we're gonna lose our stuff here? You can't really market or sell psilocybin, can you? You can't... It's not patentable. I don't know what the deal is with MDMA. Ketamine seems to be pretty commonplace. Is there any kind of resistance coming from those companies? And also with our current judicial climate and the conservative now Supreme Court, is there a potential for that to just squash this right now? Is there anything like that happening? Is that a concern? I feel like that should be a concern.

1:07:50 PA: An emerging one, yeah, as of recent activity I think. Do you want to handle the first part of that? What's your understanding of pharmaceutical interest in...

1:08:03 WS: I think you're aware of some... There's controversy within the psychedelic community.

1:08:08 PA: Some drama going on.

1:08:09 WS: Psychedelic drama about this. There's this company called Compass, who one of the major funders is Peter Thiel, which I don't know too much about, but I've heard he's not the kindest person.

1:08:19 PA: He created PayPal.

1:08:20 WS: Created PayPal.

1:08:20 PA: Elon was in that deal as well. Elon Musk and it was Peter Thiel, yeah, okay, yeah.

1:08:27 WS: I don't know the full facts of it, but something like they've patented a way of producing what's called "GMP psilocybin." GMP means, I think it's "Good Manufacturing Practice." So before any drug goes to market you have to have a GMP purity to it. So that's not true for phase one or two, but, for phase three for MDMA or phase three for psilocybin, there's a special purity that you need for any pharmaceutical. So this company, I think, has patented or is trying to work on a process that they have exclusive rights to essentially a way of producing psilocybin. So some people are saying is that a way of getting a monopoly? And I don't know the full details about that, so I haven't decided one way or another if that's good or bad. I do think it's an issue to be paid attention to that is of interest 'cause they're obviously... Even though medicines, psilocybin, MDMA, are technically off-patent, because they're molecules that have been around, that doesn't stop pharmaceutical companies from altering these molecules slightly. You can package them differently, so if you put something in an extended release that's automatically something new, and you get another 12 or 14-year patent extension...

1:09:38 PA: Johnson & Johnson is doing this with ketamine.

1:09:41 WS: And ketamine. I'll say a recent study that shows actually, that the... I think it's esketamine, it essentially that doesn't work or it's as good as mixed ketamine. So I wouldn't... That's just going forward I don't think it's necessary whatsoever to use this new Johnson & Johnson ketamine. I think it's a way again of getting around patents and trying to make more money around it.

1:10:03 WS: But anyway, so I'm actually surprised that there hasn't been more resistance actually, from pharmaceutical companies. Maybe it's because they're not up to speed on what can actually... How it can impact them. At least when I was finishing medical school, about... Some number, it's seven or eight years ago, there was a number that, I think, three of the top five selling pharmaceuticals in the United States were anti-depressants. And so I can't imagine that eventually, psychedelics and MDMA are gonna have a massive impact on anti-depressant use. And so, I actually worry or again, I'm surprised that there hasn't been resistance from the pharmaceutical companies. One thing I actually worry about it is, is could they basically put out a lot of bad press saying, "These are dangerous, et cetera." And try to sway politicians. But I think at this point for re-scheduling purposes, I've talked to Rick about this, he really feels that politics won't have a role in re-scheduling, really, if the data shows... It's almost as if the big step was the FDA approving, or making way for a phase three trial, not the step after. It's really shown to have efficacy in phase three, that anyone can stop it. If it works for phase three, it's supposed to be re-scheduled. Obviously the government is the government, but Rick doesn't worry too much about the rescheduling process in politics, at least last I checked with him.

1:11:26 PA: And when it comes to the cultural right, so-to-say, I think that's also been a strategic decision from MAPS, is to focus on treating veterans with PTSD, 'cause then you start to build a block of support within some of these communities, a network. So I think that's also just an element to be aware of.

1:11:49 WS: And then there was a second part to your question? Was there two? No...

1:11:52 S5: No, I'm just kind of curious. We've got Sessions and he thinks anybody who smokes weed is a bad person.

1:12:00 PA: Oh yeah, yeah, Jeff Sessions.

1:12:01 S5: Could the stuff to be approved and then, "Sorry. That's a drug."

1:12:06 WS: Yeah. But you also got, I mean, then John Boehner, and people pushing it through now because they're investing in marijuana, and so I think it's shifting quickly because of money. But I think Jeff Sessions, again, this isn't something I know the details, but Rick Doblin, again of MAPS has said that really, the Trump administration if anything, including... They've actually been clearing the path for pharmaceuticals to actually make it to market. And it's easier than it's been in a long time. And whether that's really to help out big pharma or not, at least so far, it's made it easier for these molecules.

1:12:36 S5: I'm just concerned that the results of these medicines are empathy and a change in culture, and once that's recognized, there might be...

1:12:49 PA: That's why I like microdosing. Microdosing is a nice subtle way to slip it...

[laughter]

1:12:56 WS: I mean, that's the hope that this will...

1:12:58 PA: Just kidding.

1:13:00 WS: This is the way of changing culture, again, well, hopefully people be less focused on work, and less focused on greed and accumulation, and be less willing to go to war, etcetera, etcetera. It's like what happened in the '60s, but hopefully if it happens through the medical community, hopefully, there isn't as much resistance.

1:13:21 PA: Yeah.

1:13:23 Speaker 6: First of all Paul, I want to thank you for putting this together tonight. I really appreciate it. One thing I'm surprised with that Horizons, and just in general, I really haven't heard any conversation around how those of us who do the underground movement, are used to doing this... Working with these medicines in groups, that there doesn't seem to be any talk in the medical world around doing things in groups. The same way with psychotherapy, it can be individual or it can be group, that the effect sometimes of doing this in groups can be exponential to doing it individually. And I'm just curious, is there anybody in the medical community, looking at the potential of group work?

1:14:05 WS: There isn't really anyone. Yeah, there's some chatter. There's been a study with MDMA for couples therapy, the couples when one person has PTSD. I do think some of these molecules have potential for group therapy. It's an interesting one, because then it could get costs down significantly, if you can have the ratio of therapists to participants a lot lower. Some, I think, are not made for that. I think MDMA, you really want and need someone that's available to talk that knows the person, and is available constantly. I think others, perhaps, are more apt to grouped experiences. The classic one would be ayahuasca, where people are doing ayahuasca, you don't need to be talking to each other while it's happening, you can have a few experienced people watching over this. So I think there is potential for group work with psychedelics, but it's not something that... I haven't even heard of a proposed study for a group therapy experience with a psychedelic yet, but it's a good thought.

1:15:06 PA: For Synthesis, we have our participants, they fill out a survey from Imperial College, where they take a survey before, they take a survey right after, and then for weeks after. So I think Imperial is collecting some initial survey-based data. In terms of clinical, I think that will prove to be tricky, but I can't speak to that so much. I just know that that's part of what we're also trying to do at Synthesis, is bring in research to then... And right now it's with Imperial but we're hopefully gonna continue to develop that. So I think that also is an opportunity where they're probably retreat centers that could start to take care of some of this research, or coordinate with people who can help them putting together research programs to study these things. Yeah, okay. Go ahead.

1:15:56 Speaker 7: Okay, hi. My question is about ketamine, but first I just wanted to say, I taught a lecture on schizophrenia this morning, and one of my students who's actually here, Michael, there he is. He actually asked the question about MDMA and schizophrenia. I couldn't answer it, so thank you. You have your answer. But for ketamine, my main question is, you were talking about the IV clinics, and the reason they do it with IV is for the bio-availability. It works on the glutamate receptors, and it turns around the suicidality in a matter of hours. So my question for you is, why lozenges rather than IV?

1:16:36 WS: The reason I think that they started, the medical committee started using IV is simply because it was being used IV, when it was first observed that these were, this is effective for depression and suicidality. Interesting, there's four forms of ketamine at least that are medically available right now. It's intramuscular injections, so like a flu shot, you have lozenges which you put under your tongue, you have IV which is in the vein with an IV machine and what's the last one, intranasal so they make nasal sprays for it. They all work pretty differently. So ketamine is fascinating, and it's very, very different than any other psychedelic. It's a dissociative, which in and of itself is interesting and it also works very differently at different doses, which is also something that's unique about it. So there's not been a ton of research done on the other formulations of ketamine. There's two camps of people in the ketamine world within the medical community. I think some people think it's working purely biologically on the NMDA receptors in the brain and people think "oh, it's not about the therapy, it's really the the neuro chemistry that's happening in the brain after you give someone IV ketamine."

1:17:45 WS: And that's really the... The people who are doing IV ketamine, I think are more in that camp. Or you have the camp that I'm in, which I think is not that I discount the the neuro-chemistry but I think I definitely honor the the psychology part of it more and I like working with people and having it, again, just facilitate the psychological process and feeling that the psychological process is going to improve mental health and possibly physical health. And, there's probably both going on to some extent, but I think what supports really the view I have is more that people again are, who are doing IV ketamine without psychotherapy are continuing to need it. And so if it's really fixing something at the neurological level why isn't it maintained, and why are some people using ketamine therapy, really again, getting to the point where they don't need need to use either.

1:18:34 Speaker 8: I was just wondering what the reaction's been from the more mainstream psychiatric establishment. The APA, places like that to psychedelic research in general?

1:18:45 WS: I don't know if there's been any formal, really response. I'm just thinking of my own response. When I was a trainee, and I was a resident, and this wasn't that long ago, in 2013, 2014, we were almost... We were whispering in the hallways, some of my mentors were like "Don't do this, you're gonna ruin your career", etcetera. They were wrong. But I actually went back to the hospital where I trained and I gave a talk earlier this year, and I was speaking to one of the higher ups in the department who I told my exit project, right before I moved here was on MDMA for PTSD. And at that point, I was like, "Hey, how about we start a clinic here?" and he was like, he loved the data, but I was like, "How about we do this here?" And he's like, "Never", and I'm like, "Why not?" He's like, "We won't take the PR hit." And then I visited it again this year and gave the talk and he was very excited. And they're actually starting a program there. And I was like, [laughter] "What happened?" He's like, "Well, things are different now." [laughter] Again, I still don't think that it's that, I don't know, I would imagine 85, 90% of psychiatrists are not that supportive of this.

1:19:51 WS: They don't get it. We're just not taught about this, I did not have a single lecture on psychedelics, and the little bit that it was mentioned was in the substance abuse, part of the training where these are drugs to be avoided. One thing that I forgot to say that I tend to say is that how different these are than normal treatments. The way I think of our treatments so far is that they're suppressive therapies. We have anti-depressants, we have anti-psychotics, we have anti-anxiety meds where we're saying any emotion basically, let's get rid of it. I don't want to see it. I'm uncomfortable with it. And I think that reflects society. I think society is extremely uncomfortable with certain emotions, especially sadness and fear. We think they're weak, we judge them versus other emotions like anger, we actually reward if we look at our, even our presidency.

1:20:43 WS: And I think what's different about psychedelics and MDMA is that they're evocative therapies, is they bring up things that have been suppressed. And I think that the people... And this is where I really... An example I give people is that we're gonna need a really an entire generation of therapists that is used to working with these types of medicines and are comfortable with having someone scream, someone yell, someone writhe in pain while you're working with them, because that's what needs to come up. And so all of a sudden, if you have every therapist in the country, and you start giving their patients MDMA, it's not going to work as well as it did with the studies because we haven't been trained to do that. And so that's one of my goals is raising awareness around this and hopefully the centers that I start is to actually get people to understand that these are different treatments that really we need to think of differently and patients need to also realize that these are very different than taking traditional pharmaceuticals which are really about suppressing.

1:21:38 PA: We have time for one more question.

1:21:40 Speaker 9: Traditional treatments pay a lot of attention to rituals and environmental music, is there any research done in that sphere to see what's the impact of environment on the treatment?

1:21:54 WS: There is some research on it, but I'm glad you brought that up. So one thing that yeah... So we've talked about the therapy and some of the things that come up but two big things, I think, that are critical with therapy with these, especially with MDMA, not necessarily so much with psilocybin or other... We don't have time to get into it. But music is absolutely huge in the experience, I think it can help guide people through things, it can get people in different places and then we don't have enough time to talk about music, but there is some studies that have been published already about the impact and people are looking at different types of music, etcetera. So we use non verbal music or not... Music that doesn't have language and the people who are taking it can understand just 'cause that would be distracting. And the other big piece that also people aren't talking too much about is body work. And so a lot of the experience that comes up for people, especially during MDMA is physical symptoms and physical feelings and they're not coming out in words.

1:22:33 WS: And so we also need to have therapists or at least therapists work with people who know how to work with the body. And that's something that again, I don't even talk about that because it's something that I feel like is gonna probably become more obvious when these things become rescheduled. But also again, so a lot of therapists that have worked with MAPS through the first two phases are well versed in body work but most, again, if anything, these days, there's such boundaries between patients and therapists where you don't even touch a patient. So talking about body work is going to take some time also in terms of integrating this work more fully into Western mental health.

1:22:33 PA: Great, well, just again, thank you Will for all your insight. One more round of applause.