Can Psychedelic Medicine Fix Our Mental Health Crisis? - Transcript

Intro:
Coming on this episode of The Doctors Farmacy.

Rick Doblin:
There are tools that have been around that our culture has really not figured out a way to incorporate them. That time of suppression is coming to an end. The need for these tools is apparent to more and more people.

Dr. Mark Hyman:
Welcome to The Doctors Farmacy. I'm Dr. Mark Hyman, that's farmacy with an F, a place for conversations that matter. And if you've known anyone or yourself have suffered from depression, PTSD, or a myriad of psychiatric illnesses and have tried everything and nothing works, this might be the most important conversation of your life, because it's with someone who has been focused on studying how to deal with mental health through a very different lens of psychedelic assisted therapy, which is a whole different ball of wax than anything we've had in psychiatry to date.
This is going to be a great conversation with Rick Doblin. He's the founder and executive director of The Multidisciplinary Association for Psychedelic Studies, MAPS. He received his doctorate in Public Policy from Harvard's Kennedy School of Government. He wrote his dissertation on medical use of psychedelics. And he really has been part of the whole psychedelic renaissance over the last few decades. He's been in it when no one else was in it, and he has continued on Timothy Leary's work, the [inaudible 00:01:25] project and Timothy Leary's Concord Prison Experiment.
He studied with Stanislav Grof, who really was one of the pioneers in psychedelic therapy and has written a key book on this we'll talk about. And now, Rick has really spent his life focused on how do we make this therapy acceptable to all? How do we take the scary bits out of it? How do we look at it scientifically, and how do we determine whether or not there is a real role for these compounds in healthcare, in medicine, and in particularly psychiatric care.
He founded MAPS in 1986 and resides in Boston with his wife and his puppy and three empty rooms where his kids have all gone to college. And now, really, he's really moving through the FDA process with the legalization of MDMA, or molly or ectasy, as you might've heard. So, welcome, Rick. It's great to see you again. You have a lot going on. You're doing so much stuff. You were in the wilderness for 40 years when no one else was in it. And now, your organization is getting tons of funding. There's billions of dollars flowing into psychedelic research.
We're facing the reality of a society that is over-burdened with mental health issues. Aside from just the human toll of suffering, which is massive, I mean, one in four people suffer from severe depression at some point in their life. We're seeing increasing rates of suicide among all age groups. We're seeing increasing amounts of trauma related problems like PTSD, but just from even just daily life, living in a divisive, conflicted society. And as a doctor, the tools we got were pretty crummy.
Psychotherapy can be very helpful for some people. But most psychiatric medication is not much better than placebo, unless you have really severe problems or for certain conditions. But it's really a failed experiment. It's the third leading drug class sold, which is psychiatric medication after acid blockers, and then number one is statins, so it's right up there. The cost is staggering. In terms of not actual healthcare costs directly, but indirect healthcare costs and loss of productivity, and quality of life, it is the number one cost driver of loss of benefit to society from people who can show up and be present and connected, and actually be happy, and do their lives well.
So this is such an important moment in the history of mental health and psychiatry, and you're at the leading spear of it. So Rick, take us back to when the light bulb went on for you. You tell the story of when you were in college and like many of us back in the 70s or 60s, LSD was popular and you had a revelation.

Rick Doblin:
Yeah, actually 50 years ago. Or 51 years ago almost. But there's only one thing I wanted to comment on from your introduction where you talked about trying to take the scary bits out of it. So the scary bits are pretty inherent in it. But it's more about creating a safe context for people to work through the scary bits.

Dr. Mark Hyman:
Yeah. I was talking more about MDMA is going to cause holes in your brain, and-

Rick Doblin:
Oh, that. Oh.

Dr. Mark Hyman:
... chromosome damage, and make you jump off buildings, and all that nonsense propaganda from the 70s. Timothy Leary is the most dangerous man in America, according to Richard Nixon.

Rick Doblin:
Well, it's incredible how powerful those thoughts are still in people's mind. So I'll just say this, and then I'll get to my early revelation. But the first date that I had, I've been married 29 years, but the first date that I had and my wife now didn't even think it was a date, she just wanted to talk to me about a mushroom experience she had in college.
We were students at the Kennedy School of Government, so she's pretty alert and all. So this was actually in 1989. We had some good talks about her mushroom experience in college, but then she said that she would never want to have a real relationship with anybody like me. And I'm like, "Well, what's the problem?" She said, "Well, you've done so much LSD, you probably have terribly damaged chromosomes."

Dr. Mark Hyman:
So you're not good fatherhood material.

Rick Doblin:
And our kids would be like, giraffes are something. It's now a big family joke, because I said, "Well, it may be premature, but let me defend my sperm." So she was persuaded that this chromosome damage was not a real thing, and now I'd like to say that we do have three kids, but there is some signs of brain damage in them that occasionally, they think they know more than we do.

Dr. Mark Hyman:
I think that's inherent.

Rick Doblin:
And even worse, sometimes they're right.

Dr. Mark Hyman:
Yeah, that's a great part.

Rick Doblin:
All right. Yeah, so there's enormous fears. And actually, when she first met me too, she thought it was a noble lost cause, trying to bring psychedelics back into society, so.

Dr. Mark Hyman:
I mean, yeah.

Rick Doblin:
Yeah, so the revelation for me was in the spring of 1982, or excuse me, 1972. So the spring of 1972. Yeah. So I was 18 years old and I was in college at a place called New College in Sarasota, Florida. The college had only started in the 60s. So it was an experimental college.
It was terrific. The principle was that the students' curiosity was the most important thing. And that there should be no distribution requirements in your classes, that you could go wherever your curiosity went. If you wanted to major in something, you had to do certain prescribed set of classes, but you could do General Studies if you wanted. And a lot of times, schools now, if they let you do General Studies, they still have distribution requirements and stuff like that.
There was also no grades. There was written evaluations everybody got. Everybody had to do a senior thesis, a real emphasis on independent study and tutorials, and it was a small school of only about 350 people too.

Dr. Mark Hyman:
Wow.

Rick Doblin:
And my high school had been about 3,800 people. So I went from a 3,800-person high school to a 350-person college. But then there was two important things that they did not put in the college brochure, that I did not notice. Once I realized what they were, I realized why they didn't put them in the brochure, but they were great attributes for the kids, but not so much for the parents.

Dr. Mark Hyman:
And what happened?

Rick Doblin:
Well, it was all-night dance parties until sunrise, fueled by psychedelics with breakfast in the center. I.M. Pei the architect designed the school, the buildings. There's a big palm court in the center, we could dance all night. So there was that. And there was this strong culture of experimentation with psychedelics. Not just in this party setting, but also for spiritual reasons, for personal growth, individual sessions, so there was a lot of tripping going on.
Not by everybody, but a lot of tripping going on, and then the other part was I would say even more astonishing. There was a woman, a faculty member who had studied with Carl Jung. And she was-

Dr. Mark Hyman:
Oh, wow.

Rick Doblin:
... teaching Jungian Psychology.

Dr. Mark Hyman:
Wow.

Rick Doblin:
And the school was pretty new, as I said. Her husband was a wealthy developer, and he had donated this Olympic-sized swimming pool to the school. Now, this is again, in Florida, in Sarasota, Florida, and it's warm. And somehow or other, it had evolved into a nudist colony.

Dr. Mark Hyman:
So it was a hippie college?

Rick Doblin:
Totally hippie college. And I was just this shy boy from Chicago who could barely talk to a girl, and here I am in this nudist colony at the pool, and I'm thinking, "Oh, man. This is terrific."
So there was this sense of these underground energies, sex and drugs that were more brought to the surface. The campus police told us that their job was to protect us from the real police. So that was very reassuring. The campus police had two sets of books about where people were staying, in all these dorm rooms. Where you were assigned, and then where you actually were. And you could live with your boyfriend or your girlfriend or anything, if you switched rooms with people. So it was a pretty amazing set up.

Dr. Mark Hyman:
So in that context, you got to experience LSD?

Rick Doblin:
Yes, yeah. So it was in that. And the prior context also had been that I was very much you could say a child of privilege, and when I think about it, I think about I was born in '53. So I just absorbed this American exceptionalism, that somehow or other, America at the height of its power, we are somehow or another better people than other people. Just Americans are exceptional. Then I was white, as you can see, I'm male, so I got all of that. I'm Jewish, so I was the chosen people.
My dad was a doctor, my family was well-off. When I was 12, my parents had a house designed and built by a student of Frank Lloyd Wright's.

Dr. Mark Hyman:
Wow, nice.

Rick Doblin:
So I grew up in this incredible facility, but with all of this support, what really happened was that when I heard the stories, when I was really little about the Holocaust and about World War II, and I had loads of Israeli relatives and still do. So I was just educated on the stories of irrational hatred and cruelty, and what people can do to other people and how you could have a whole culture go insane in certain ways, or believe the Big Lie.
Now, we all understand a lot more about the Big Lie, but then, it was like, "How could people buy into these things?" Now, we know it's more tribalism. So I was educated, you could say, as part of this historical chain where in the 1880s, my mother's parents were refugees, came over with nothing from Russia. My father, the father of my grandfather came over from Poland in 1920 with nothing. So it was this idea of these refugees coming to America, fleeing antisemitism and poverty, and then finding the American Dream, you could say. And actually, my great-grandfather was the classic rags to riches, because he actually had a rags business.

Dr. Mark Hyman:
I know this is leading back to psychedelics somehow.

Rick Doblin:
Yeah. So I just was thinking that my charge you could say from my family was to think about deeper threats, that my food and shelter was going to be taken care of, but here it is, these irrational hatred. And then not too long after I was waking up to that was the... I was a young boy during the Cuban Missile Crisis, and that was duck and cover, and that was like, "Oh my God, the Russians and the US, we could blow up the whole world," and then my final confrontation with the irrational hatred that came close, it wasn't the Germans, it wasn't the Russians. Now it's Vietnam, and it's America doing this imperialistic, supporting dictators that we like.
So I just studied how do I respond to a world like this? A world where security is very tentative? And where the fate of the entire world is at stake? The other thing I should just mention I think that was going on in the background now that I reflect on it was going to the moon. The moon shots, so you have this darkness of the American spirit, and then you also have the brilliance of the human mind and our ability to start seeing in a cosmic way and moving to the moon, and all of that was happening at the same time.
So it was darkness and light. And I felt like as far as Vietnam was going to go, that it was my job or at least my understanding that I would protest, and I wasn't a conscientious objector because I wasn't against all wars. I think sometimes, like we see with Russia in Ukraine, sometimes you got to fight, or the Nazis in Germany, you got to fight. So I was a draft resister, and I was preparing to go to prison to not register-

Dr. Mark Hyman:
Wow.

Rick Doblin:
... for the draft. And I had read Martin Luther King and Gandhi and Tolstoy and all of this. So I was already separating myself from normal trajectories, and when I told my parents that I was wanting to be a draft resister, they were sympathetic, but they said, "You're going to be a felon, and you're never going to be able to get a license to be a doctor or a lawyer, or accountant, or anything like that."
And I'm like, "Well, that's a real price to pay, but I'm willing to pay that price." So that took also all of these normal job career trajectories off my plate, and I had a passport, I had a Social Security number, I had a driver's license, I was paying taxes. I was in high school.

Dr. Mark Hyman:
Sure.

Rick Doblin:
I figured they know me. My identity is well-known, and my birth date is not a hidden mystery or anything.

Dr. Mark Hyman:
No.

Rick Doblin:
So I did assume that something would happen, and that they'd come catch me, but that I would drain the energy from the system the most. Martin Luther King said that the person that sees a law is unjust and is willing to break it and suffer the consequences as an example to others that the law is unjust actually has the highest respect for the law. So he was trying to reframe civil disobedience as patriotism.

Dr. Mark Hyman:
Yeah, maybe.

Rick Doblin:
So all of that was great. So then when I arrive at this college and there is this culture of psychedelics, I didn't really smoke marijuana in high school. Either of my parents didn't drink, but I decided I would try LSD. The first experience that I had was difficult, because there was a lot of surrendering.

Dr. Mark Hyman:
And did you do it on your own, or were you at a party, or what was the situation?

Rick Doblin:
At first, I didn't want to do it in a party setting, so I did it on my own. Some friends knew that I was doing it. Back in those days, a standard dose was 250 micrograms.

Dr. Mark Hyman:
Oh, wow. That's a big dose.

Rick Doblin:
Yeah, so you go through a period of time where you can't really talk. You're nonverbal. It's in the range, maybe six or seven grams or so. Somewhere in there. It's a hefty dose of mushrooms, a healthy dose of LSD. And I had these feelings though that were really profound.
That I had been so much living in my head, that I was so out of touch with my emotions, and I felt the emotions of fear, the emotions of excitement, of anxiety, and moving beyond your sense of who you are, this dissolution of the ego orientation, and then this opening in a way to a larger world. So our brains are focused on what we need to do for survival, or according to Abraham Maslow, the Hierarchy of Needs, but the idea that we learn from modern neuroscience that psychedelics reduce what's called the default mode network, activity there, the sense of self.
So your sense of self is dissolving, and you can have this feeling of connection with something larger. So even though I had a lot of fear and a lot of anxiety, I had these intimations of this enormous sweep of evolutionary history, of just life and death, going beyond my little life and death. It just felt to me that there was a clue in here, the antidote to genocide and to environmental destruction and to racism and to prejudice, is this identification beyond how we think of ourselves in terms of our identities, our nationality, our religion, all the ways that I talked about how I felt privileged, in the sense that there's a way in which deeper than all of that is we're part of the human struggle.
We're part of evolutionary life on Earth, and if you have that sense of deeper connection in that way, then you understand how we're all more similar than different, and that I thought would be the anchor of a new consciousness, of a new understanding. Not just for me. Albert Einstein also said this great thing. He said, "The splitting of the atom has changed everything except our mode of thinking, and hence we drift towards unparalleled catastrophe, which will be required if mankind is to survive, is a whole new manner of thinking." So what is this new manner of thinking that Albert Einstein is talking about?
I think it's this shift from our isolated individual ego identification to we're thinking in terms of more the collective, and the thing I want to stress here is that you could be both a deeper part of this collective and also more of your own individual self. It's not like you surrender your individuality in the masses, and you could say certain kind of communism, certain kind of governments where it's all about the group and not the individual, so when I talk about this unity, we're all more similar than different, you could say it's even paradoxical in a certain way. That you can feel more unified and connected with everything that is, and also more uniquely yourself.
And I think that's a real key factor. So I felt that psychedelics were going to be a key to a new consciousness, and the fact that this was 1972 after the backlash, after Timothy Leary as you said was considered the most dangerous man in America, after psychedelic research was wiped out. So I realized-

Dr. Mark Hyman:
Timothy Leary was the Harvard professor that popularized the use of LSD.

Rick Doblin:
Yeah, he was-

Dr. Mark Hyman:
"Drop out, tune in," or whatever he said.

Rick Doblin:
Yeah. "Turn on, tune in, drop out."

Dr. Mark Hyman:
Exactly.

Rick Doblin:
And also question authority, and he had a lot of things like that. But all of this, the idealism of the 60s, the idealism of the hippies, all of that had crashed and burned. Nixon was elected, the war in Vietnam was escalating at this time. So in my confusion, and this is how it really happened, I went to the guidance counselor at school.
The guidance counselor took me seriously. I mean, you go to a guidance counselor now in college and you're like, "Hey, I'm struggling with my LSD experiences. They seem more important to me than my studies," even this class with Jung, this woman that studied with Jung, it felt too tame. I had this raw energy, so I asked him for help. And he took me seriously, and he gave me this book to read, which changed everything for me. And it was Stan Grof's Realms of the Human Unconscious. And now, the most amazing part is this book was not published until 1975. But my guidance counselor had a manuscript copy from Stan directly.

Dr. Mark Hyman:
Wow. Wow.

Rick Doblin:
So when I read this book, so what was so important about it was that it opened my eyes up to the scientific research that had been done with psychedelics. I didn't really trust religion as a guide for understanding the world. I felt there's a lot of myths and things that are there, but Stan was looking at mystical spiritual experiences from a scientific lens, and I trusted the scientific lens, so Realms of the Human Unconscious included spiritual aspects, birth trauma, things that happened during your life.
And I think what most did it for me was that Stan had within his whole approach was therapy. So it's not like it was a reality check. Because you have all these spiritual masters, and you can read encyclopedias about the spiritual world and what they're saying. But how do you move from here to there? What's the process? So Stan actually with psychedelics had a process of both therapy and spiritual evolution grounded in science, and in experiments to demonstrate whether people with substance abuse, with alcoholism or a heroin addiction, or anxiety about life-threatening illnesses that you could actually help. So it was this entire package that really said, "This is what I want to do."
And I thought because I'm going to be arrested soon for being a draft resister, and I'll have this felony and stuff, that I can be an underground psychedelic therapist. You're not going to need a license for that. That'll be my career, so that's how at age 18 in 1972, all this came about.

Dr. Mark Hyman:
There you go.

Rick Doblin:
And actually, my guidance counselor, I said I wanted to write a letter to Stan Grof, to ask for advice on what my education should be. And he was MD, PhD at Hopkins. And he was a-
PART 1 OF 4 ENDS [00:23:04]

Rick Doblin:
... and he was MD-PhD at Hopkins, and he was in his forties, and had been an illustrious career, and his research was being shut down. So I actually wrote him a letter, and to my utter astonishment, he wrote me back. So I'm this confused 18-year-old, and he said it was important that I pursue this interest, and that he was offering a workshop later that summer out in California with Joan Halifax, and he invited me to attend that workshop.

Dr. Mark Hyman:
Oh, wow.

Rick Doblin:
And I hitchhiked across America. And I want to make an homage to my parents. So at that point, once I read Stan and I was in the middle of my first year of college, I'm the oldest of four kids, too. So I'm the first to leave the nest. And then I called home and I'm like, "I'm sorry, but I want to drop out of college. It's not important to me anymore. This emotional balance, spiritual balance, is more important. I want to study LSD, and I want you guys to pay for it." You can imagine that that caused a little bit of consternation. But in the end, they agreed to do it.

Dr. Mark Hyman:
Wow.

Rick Doblin:
My dad was tremendous. He was a doctor. He's a pediatrician. To give you a sense, he was an only child, and his parents were very poor. They had a bookstore, and he learned how to read a book without breaking the spine so that they could sell it after he had read it.
And so he was programmed by his parents from the age of three or four to be a doctor, the classic Jewish doctor. And he loved being a doctor. But he decided that he wanted to raise his own kids in a different way, that he would help us find out what we really wanted to do and help us do that. And so he was convinced that it was a mistake, what I was doing, but he said, "You're a stubborn kid and if you don't get help from us, it's going to take you longer to realize it's a mistake, and then you're not going to want to admit it because then your parents would've been right. So therefore, we'll help you, and you will realize it's a mistake sooner." And then they said, "Maybe, there's a tiny, tiny fraction that of those probabilities, that maybe you know what you need to do."

Dr. Mark Hyman:
Yeah, yeah.

Rick Doblin:
So it turns out I did.

Dr. Mark Hyman:
It's so fascinating. I mean, it's so fascinating because the history of psychedelic research went way back in the '50s, and was done by the government, was done by legitimate scientists, and then it was just all shut down. And the counterculture took it over. There's a great movie if you want to understand how it kind of got popularized through Ken Kesey and the Magic Bus, the Merry Pranksters, the Magic Trip. It was quite a scene.
But the thing that's so important now about this study and all the work you've done over the last 40 years to bring this very, very challengingly to where it is now, which is unbelievable, like Colorado just legalized psilocybin, Oregon did a few years ago. There's clinics bopping up all over. There's literally billions of dollars of research money and investment money flowing into this space across the world. Some of it's a little shady, but it's fascinating how much this psychedelic renaissance. And Michael Pollan has been on the podcast, he wrote the book, How to Change Your Mind, talking about this. And that sort of got this more in the zeitgeist, this How to Change Your Mind. A television series on Netflix also is very powerful.
So I think this is reaching a moment where we're recognizing that the massive failure of traditional psychiatry and that the ways in which these drugs work or these compounds work, is to me mind blowing. I mean, just on a metaphysical level, how do these compounds in plants know exactly how to open up our neural pathways that increase neuroplasticity? And Charles Schultes is from Harvard, who studies these plants called the plants of the gods, it's quite amazing, from ayahuasca, to iboga, to San Pedro mescaline, to psilocybin. I mean, these are quite extraordinary molecules. And then there's even animal molecules like the toad people 5-MeO-DMT, which is called the God molecule.
And all these compounds work in very similar ways. And when I started looking at some of the research on this, what struck me most, Rick, was that these typical psychiatric drugs you're taking for life, and you're taking multiple compounds, and they kind of blunt the symptoms, but they don't really solve the problem.

Rick Doblin:
Exactly.

Dr. Mark Hyman:
Whereas these compounds seem to, in one dose or two doses, seem to relieve anxiety, depression, PTSD, to deal with addiction. Iboga literally can overnight shut down the physiology of heroin withdrawal, which, just as a doctor, makes me wonder what's going on here. And we've had Deborah Mash on the podcast as well, who's doing all the iboga research.
So to me, we're in this moment where we're kind of seeing the failure of traditional psychiatry as we see the psychedelic renaissance. And I'd love you to comment on how you see this rolling out, because currently, the problem with these therapies is that, and you can talk more about it, a lot of the research is, you take a dose of psilocybin and it's like six hours, or MDMA, it's four or six hours. And so it's a whole day for one therapist with a patient, which isn't really practical and scalable. So the question is, how do we begin to bring this to people who really need it? Because there's so much suffering.

Rick Doblin:
Yes. Well, I think it is practical and scalable. We have eight-hour MDMA sessions actually, and we have two therapists for one person. So you need to really look at the outcomes, and then look at the cost to society that's being averted. And then that's going to be the story to insurance companies.

Dr. Mark Hyman:
For sure.

Rick Doblin:
It doesn't fit into the normal model of therapy or psychiatry, where you have a one-hour meeting, or if you're lucky, a one-hour-and-a-half meeting, or whatever. We give MDMA, and then about two hours later, we give half the initial amount precisely to increase the length of the session. So I do believe that it's going to be demonstrably worth the time and money of the therapist when you look at the outcomes.

Dr. Mark Hyman:
The cost savings for sure, because it's like the biggest cost driver of healthcare cost, direct, indirect, is mental health issues. But still, you're trying to figure out how to get millions of people treated by therapists. We don't have millions of therapists. That's the problem.

Rick Doblin:
Well, there's two parts of that. Well, actually, just say that Michael Mithoefer, our lead psychiatrist doctor, he was an emergency room physician. And he saw that he would patch people up, but people would keep coming back. And he realized that a lot of it was their mental attitudes that put them in these situations. And so that's where he switched, to get closer to the core of a lot of the problems. I mean, there's a lot of trauma that you have, car accidents not related to psychedelics.
I also wanted to just, before I get into the scalable, just say one point about, you mentioned Ken Kesey.

Dr. Mark Hyman:
Yeah.

Rick Doblin:
It was Stan Grof's book that sort of solidified things. But in my senior year of high school, I read this book. A friend of mine gave it to me to read, and I loved it. And I handed it back to him and he said, "Do you realize that the author wrote some of this book under the influence of LSD?" And I'm like, "That's impossible. LSD makes you crazy. It's a delusion, it's hallucination. You take it six times, you're certifiably insane," and all of this. And he said, "No, it's true. Check it out."
And it turned out he was right, and it was One Flew Over the Cuckoo's Nest by Ken Kesey. And so it was that book that started shattering the propaganda that I had received.
So how is this then scalable? First off, what we're doing, what everybody is doing pretty much, is individual therapy. And that's after-

Dr. Mark Hyman:
Yeah. One on one.

Rick Doblin:
... we have to start out. Well, two on one.

Dr. Mark Hyman:
Two on one.

Rick Doblin:
Yeah, even the psilocybin often has two people in the room, or one person in the room and another person watching on video, or something like that.
So the question is, first off, group therapy, and we're just at the early stages of starting to explore group therapy. We have a project at the Portland, Oregon Veterans Administration that's going to be group therapy. So our normal approach is two therapists, usually a male/female team, but not always, with one patient. And the way we've negotiated this with the FDA, and it's taken a lot of negotiations and a lot of money, and lawyers, and formal dispute resolutions, but the first person of this two-person, co-therapy team needs to be licensed as a therapist. The FDA for a while wanted the first person to be an MD or a PhD. We knocked that out.

Dr. Mark Hyman:
Oh, wow.

Rick Doblin:
The FDA wanted somebody to have a doctor on site, rather than a doctor on call. We knocked that out. The doctor needs to do the screening and the prescribing. So those were poison pills that would make it not scalable at all, if it had to be an MD, PhD as the lead person, or if a doctor had to be on site. All right.
So then the second person doesn't need a license. Right now-

Dr. Mark Hyman:
But the group thing is interesting, though. You can do a group, and you can have people in a group, so it's bigger number. [inaudible 00:32:19]

Rick Doblin:
Yeah, in certain circumstances the groups may not work as well, when people are dealing with guilt and shame, and they need a lot of time to work through it. On the other hand, groups can sometimes help in that way, where if somebody else is acknowledging a similar kind of a problem, then you can feel that you can do it, too, in a way. So we have a lot to discover about group therapy.
But the second person needs to have a bachelor's degree. We think that's unnecessary. And the second person either has to have a thousand hours behavioral health experience, that's kind of vaguely undefined, or they need to be in a program to get a license. So while it's a two-person team, we want to try to make it so that the second person doesn't cost as much as the first person.
The other aspect of this is, now we've moved into what's called cognitive behavioral conjoint therapy. Now, conjoint means couples or dyads, and it's a form of treatment for PTSD, where one person has PTSD, and it affects the relationship, and both people are brought into the therapy. So it's in a way some couples therapy, but also focused on PTSD.
And we've done some studies there where both members of the dyad get MDMA. So that was where there was two people getting MDMA, one a patient and two people providing support. Then the group therapy is going to be four, excuse me, it's going to be, yeah, four therapists for six PTSD patients. So we're starting to change the ratios, and then we will study more over time as group therapy. All right.
The other part of this is that there's going to be... Our goal is to train 25,000 therapists in this decade. There's 12 million PTSD patients just in America alone.

Dr. Mark Hyman:
Yeah. I know. That's a lot.

Rick Doblin:
So how do we address that? I think that we need to start slow. We need to start getting really good results with very well-trained therapists. The key is going to be insurance coverage, and so can we really get insurance coverage? And I think the answer is yes, because there are people that are in... To give somebody SSRIs is not that expensive to do. But if it doesn't work that well, and you need to do it for 20 or 30 years, and you're muted your emotions and you have sexual side effects. So you have to take a longer view from the economic aspect of it.
But also, people with moderate to severe PTSD, a lot of times they can't work. They're not paying taxes. They're needing extra care. They have other high-stress illnesses. They go to the emergency room for panic attacks. It's an expensive condition to have.

Dr. Mark Hyman:
Yeah, for sure. It's a very expensive-

Rick Doblin:
So I think that it will be scalable. The other part to say is that what we're doing is a two-pronged, two parallel strategies. One of them is drug development. And we talked about this, making MDMA into a medicine. The other is drug policy reform. And so what we believe is, as you noticed, what's going on in Colorado and what's going on in Oregon, in so many cities that are starting to decriminalize plant medicines, is that we want to embed in the culture, we think it'll take us another decade or so, actually probably more than a decade, decade and a half, to have thousands, and thousands, and thousands of psychedelic clinics, tens of thousands, potentially hundreds of thousands of patients telling their stories. And we think that we can then embed in the culture with honest drug education, with harm reduction, with pure drugs, with treatment on demand, with taxes on the drugs that people are purchasing to pay for all this, to build kind of a psychedelic-literate society.
And that will be a lot of both preventative medicine, catch things early, but also for spiritual use, for other purposes than just medicine. So I think that the scalability, the drug policy reform is going to keep the check on the for-profit pharma companies, in that way.

Dr. Mark Hyman:
Yeah. That's all important work, and getting it covered, and dealing with the public policy around it. I want to explore a little bit, in addition to really that, which is really amazing that we can actually scale this up, that it's going to become legal very soon, that there be really a pathway for insurance and payments, that's just an incredible amount of work you've done. But I kind of want to dive into the biology of these molecules. How do they work? What do they do to the brain? From some of the studies I've seen, they literally can change the structure and function of your brain cells, the neuroplasticity, neurogenesis. And it doesn't even make sense that one dose or a few doses can have such profound impact, but it does, and then long-lasting impact. So can you share about how these compounds work? How are they different from one another? What is used for what? And just take us down that rabbit hole a little bit.

Rick Doblin:
Okay, yeah. The first thing I'll say is, I'm not a neuroscientist. In fact, we like to say I'm not even really a scientist. We do political science, in how we choose our drugs, how we choose our patient population, all of that, because it's been a political struggle. But the other prep thing I'll just say is that to make a drug into a medicine, the FDA wants you to prove safety, and you have to prove efficacy, but you don't have to have a theory of how it works. It helps if you have a theory of how it works, but it's not necessary. So as a consequence, we have not really put much money at all into figuring out how they work. We figured if we can show that they work, all sorts of other people will try to figure out how it happens.
So there is a fair amount of knowledge, quite a bit of knowledge about how they actually work. And I think the key to it is this idea of neuroplasticity, that psychedelics can produce new neural connections. But also what they do is they shake up patterns. So one question is to say, how does electroconvulsive therapy work? We don't even really know that much. But sometimes people that are in refractory depression, you just sort of give them a shock to the brain. And it's not as frightening as it used to be in one floor of the cuckoo's nest, with the electric ECT. Now, they give people medications so they don't have the shocks to the body and the muscles, and don't break bones. I mean, it was very barbaric in those days.
But ECT somehow changes your... It breaks a pattern. You've got a pattern, and we all know your computer gets caught in some kind of pattern, you turn it off, you turn it on, it works better. So what psychedelics do is they break up these kind of patterns of thought.
But let me start with MDMA, which fundamentally acts different than the classic psychedelics.

Dr. Mark Hyman:
Yeah. It doesn't give you the hallucinogenic kind of properties, and distortion of reality, and things like that.

Rick Doblin:
Yeah. So if you have PTSD, PTSD changes your brain. And what you have with PTSD is you have a hyperactive amygdala, which is the fear processing part of your brain. You have reduced activity in your prefrontal cortex where you think logically.

Dr. Mark Hyman:
The frontal lobe is the grown-up in the room. Amygdala's like a lizard brain, a reptile.

Rick Doblin:
So when you hear a sound, people with PTSD will automatically say, "Oh, that's a gunshot," or something, that you don't have that period of time, you're so hypervigilant, to process it. Also, there's reduced activity in the hippocampus where we're putting things into long-term storage for memory. So the trauma is always sort of about to happen, or happening, or easily triggered, or people are hypervigilant and high stress.
So what MDMA does is that it reduces activity in the amygdala. Now, if you were to design a drug to treat PTSD, these are the things that you would design it for. But chemists have figured out, made hundreds and hundreds and hundreds, particularly Sasha Shulgin, of psychedelic drugs, and through trial and error, the same way that indigenous people have figured out for ayahuasca, that you put roots and [inaudible 00:40:53] together, and you get this psychedelic component that you don't get from either one. People have learned a lot about other things.
So what we find, though, is that MDMA increases activity in the prefrontal cortex, and it increases connectivity between the amygdala and the hippocampus, so that you can, first off, experience things that have been previously fear-based and overwhelming. So with the fear muted, you can recall things in a way that at the time, they were so overwhelming, they were suppressed. You can think more logically about them, and you can then put them into long-term memory storage so that they're not always right about to happen.
And then, there's the release of oxytocin.

Dr. Mark Hyman:
That's interesting.

Rick Doblin:
So oxytocin is [inaudible 00:41:45] of love and nursing mothers, love and connection. And MDMA releases oxytocin, so you're filled with this sense of self-love, of self-acceptance. And your ego is not so vulnerable, this sense of self-acceptance is that, in a couples therapy context, you really want to hear what people have to say. You're not so guarded in your sense of that ego defensiveness.
And a neuroscientist, Gul Dolen at Johns Hopkins, showed that in the mice, when you end up giving MDMA, it's the oxytocin release that triggers the new neural connections.

Dr. Mark Hyman:
Oh, interesting. So oxytocin is sort of like a fertilizer for your brain, in a sense, for the good things of healing your brain.

Rick Doblin:
Yes. Yeah, yeah, that's a great way to think about it. And so-

Dr. Mark Hyman:
I only want to say one thing before you kind of continue, because I think what most of us don't realize is the difference between the mind and the brain. The brain is the structure and function of your nerve cells. The mind is what those nerve cells and brain connections are doing to our thoughts, and feelings, and emotions, and beliefs. And so healing the brain is very connected to healing the mind. And I always hear the quote in medicine that neurologists pay no attention to the mind, and psychiatrists pay no attention to the brain, and they need to start thinking about them as one continuing phenomena.
But I think that the beauty of these compounds is they seem to sort of reorganize the brain in ways that traditional psychiatric drugs don't, and they seem to have these long-lasting things that may be helpful. And I listened to Paul Stamets talk about, for example, the research on microdosing psilocybin and the effect on Parkinson's or Alzheimer's, which is fascinating to me. So this is not just about depression, but it's all the different kinds of brain diseases that may not be related to psychiatric problems.

Rick Doblin:
Yeah. Although I would say that this idea that neurologists pay no attention to the mind, and psychiatrists pay no attention to the brain, that that psychiatrist of the olden days, of the Freudian kind of psychoanalysis, and the problem that we have is that psychiatry has been captured by the pharmaceutical industry, and it's all about, here, let me adjust your biochemistry, and they don't even talk anymore. Psychiatrists often meet with people for 15 minutes to adjust your medications, because of the discredited aspect of a lot of the Freudian theories, that the psychiatrist and the psychoanalysis that you see from Woody Allen movies, of going through analysis four or five times a week and all that. So the problem has been that psychiatry has also abandoned the mind, and the psychedelics are bringing it back. And I think that's the healing that we're needing.
The other thing I just was going to say is about what's called fear extinction and memory reconsolidation. So fear extinction means that, again, you have these memories. And in animal models, there'll be an animal in a cage, and a certain square in the cage will have an electroshock. And then whenever the animal steps on that place, they get a tiny shock. And so they learn to stay away from that space, even when the shock is no longer there. And so fear extinction is, over time, they can sort of test it out, is it still there or not? And then if it's not there, then the fear of that space, or the fear of a memory, no longer is there.
And then memory reconsolidation is a more modern understanding of memory. It used to be that memory is like, you take a book off the shelf, you read the book, you put it back. But we know that memory changes over time, a lot of times, particularly in ways that we wish that the past had been. We start remembering it often in that way. But reconsolidation means that when you have a memory, it's not like it's a unique, discrete thing, and then you put it back. It's that you have to rewrite the memory. When you reconsolidate the memory, you're kind of recreating it. And if you've had a memory under a mood, and a motion of acceptance, and release, when you reconsolidate the memory, you're also-
PART 2 OF 4 ENDS [00:46:04]

Rick Doblin:
You reconsolidate the memory, you're also reorganizing the way it's stored in the brain. And so you're again placing it in the past and you've swapped out what's called the emotional memory with the episodic memory. So the episodic memory is what happened. And we see that under the influence of MDMA, people can remember their traumas much more in detail because so many parts of it were just too painful. And so then this memory reconsolidation, you're putting the memory into a new location with a different emotion. And then when you recall it again, you recall it with the new emotion of, "Okay, I've worked on it, I've accepted this, I've processed it." So I'd say that's a good way to think about how MDMA works.
One of the things that people have said about psilocybin and the classic psychedelics, both in the work in the '60s and the recent work for the last 20 years, is that there's a correlation between the depth of the mystical experience under the classic psychedelics and therapeutic outcomes. And that was pretty common in almost all of the classic psychedelic studies.
And that also distinguishes it from MDMA. So that in MDMA, we use the same mystical experience questionnaire that's used in the classic psychedelic research that was developed in the Good Friday experiment that Timothy Leary was the sponsor of back in 1962. And this idea that people do have remarkably high, some of them do, mystical experiences on this questionnaire under MDMA, but there is no correlation with therapeutic outcomes. It's about your memory, your trauma, what happened to you, and you need an intact ego for that.
All right, so that's a good overview of MDMA. What happens with the classic psychedelics is this reduction of the sense of self, the parts of our brain, this default mode network. There's also the serotonin 5-HT2B and 2A and 2B that help produce these psychedelic experiences, the visuals, the visual distortions, so that there is a kind of open... Aldous Huxley talked about this actually in the '50s after his first mescaline experience. And he talked about the brain as being like a reducing valve, that there's so much information coming to us from our own bodies or from the outside world, but how do we filter it? We filter it through our focus on what is important for our survival.
And again, we can get into Abraham Maslow and the hierarchies of needs. But this idea of the brain being a reducing valve to help us focus on what's important. And that reducing valve is weakened, again this sense of self, this default mode, so that you have a flood of perceptions.
So you know as a doctor, and people all know intuitively, that when you hurt your body, that the doctor is not actually healing you. The doctor is helping your body to heal itself in different ways. So you get a scratch, your body below your level of conscious awareness will restore the order. And there's limits. We can't regrow a lost limb, but there's general that.
So the theory that we have in the classic psychedelics is that there's this similar self-healing mechanism in the psyche, in the mind, you could say. And that when you take psychedelics... We all know that at night we have dreams. And so there's a barrier between the conscious and the unconscious mind. And under sleep, you have more of these feelings and thoughts. It's irrational in certain ways, but there's kind of an emotional logic to it.
So psychedelics also reduce this barrier. The permeability of the barrier between the unconscious and the conscious mind is increased and things come up. Memories come up into feelings, sometimes body sensations where if you're not able to really... If the memory is too traumatic or too difficult, a lot of times it'll come in the body. We work with Bessel van der Kolk who wrote the book The Body Keeps the Score which is one of the-

Dr. Mark Hyman:
Yeah, that's the somatic therapy, right.

Rick Doblin:
Yeah. So he's the principal investigator of our Boston site.

Dr. Mark Hyman:
Wow, amazing.

Rick Doblin:
Under the influence of psychedelics, there's this flow of material and the theory of this inner healing intelligence, so that the therapy approach is to support whatever is happening. We don't use the word guide. We're not the guide to the person. The person's unconscious is the guide. They're their own guide. We know a little bit about the process. The therapists support the process. But I think what we see is that there's a twofold part.
One is this idea of difficult material that needs to be integrated, that emerges under the influence of classic psychedelics. Our conscious control is weakened, so things that we've been repressed or embarrassed about or shameful about or haven't thought about can come to the surface. And so that's part of the therapeutic potential.
And the other is this sort of spiritual unitive sense of connection that you get more from the 5-MeO-DMT, from the toad or different... And then you draw strength from that. So you can do processing of split-off materials and then also draw strength from this sense of connection. And I think it's a important way to think about... The classic psychedelics are more this ego dissolution and opening up. And then MDMA is more ego strengthening in a way that you become less defensive so that then you can also see the wider world.

Dr. Mark Hyman:
Interesting. Yeah, it's sort of like the meditators who, Tibetans or people have been in a cave for three years or nine years, and they have 40,000 hours of meditation. They have the same things that are happening in their brain when they look at them on functional MRI testing. So rather than sitting in a cave for nine years, you can try these natural compounds that have no counter-effects.

Rick Doblin:
Yeah. There's a fantastic movie I'd like to recommend to people called Descending the Mountain. It's really good. Descending the Mountain. It's a movie about the combination of neuroscience and meditation. And so it's about lifelong Zen meditators who are experts in Zen meditation. From the history, back when the backlash came against the psychedelics, in the early '70s, a lot of people were like, "Okay, the psychedelics are illegal now." They went into meditation. And so there's a lot of people that were inspired by psychedelics to get into meditation.

Dr. Mark Hyman:
Like Ram Dass, right?

Rick Doblin:
Yeah. But haven't done psychedelics in decades and decades. So this is a group of Zen meditators, and they first go to the University of Zurich. The movie is about a experiment that took place in Switzerland. They go to University of Zurich for brain scans. Then they go to Lucerne for a meditation retreat. And in the middle of this meditation retreat, they all get a pill, and it's either psilocybin or a placebo. And they're told to meditate through it, whatever it is, during this event. And then at the end of the retreat, they go back and they have another brain scan. And then they have a long-term follow-up. And then they do it again, the crossover. All the people that got this placebo can do it again and get psilocybin.
So what they showed is that you can meditate for 30 years and you think that you're open to everything and that you're defenseless. But even then, we're channeling things in our brain. And so what they showed is that you can have this deeper dissolution under psilocybin for trained meditators. And they reach these states that then they can learn how to get to without the drug. The same way that we talk about the therapy, you only use the drug several times with the therapeutic process, but in this study in Descending the Mountain, what they showed is that people ended up learning how to deepen their meditation practice without drugs because they had this powerful experience with psilocybin. So again, it's moving towards this synthesis. It's not meditation or psychedelics. It's both.

Dr. Mark Hyman:
Yeah, you know, it's interesting. I actually studied Buddhism in college, and I did used to do these long meditation retreats, 10 days. You're meditating 12, 14 hours a day. And I remember coming out of those and you get a half hour a day to walk around. And I remember feeling like I was on LSD.

Rick Doblin:
Yes, yes.

Dr. Mark Hyman:
And I was like, "Holy crap." I had also went to college in the '70s and got to experience the psychedelic renaissance there and the revolution around mushrooms and LSD. It really helped me figure out what I was going to do with my life. When you go back and peel the layers back on people who are moving society forward or innovating in different areas or ideas, it's amazing how many people have taken LSD or mushrooms or psychedelics at some point in their evolution.
I found it very powerful for me to shift my childhood framework. It didn't obviously solve everything, but it really gives you a sense of why you're here, what you're doing, what's important. And I think you said it before, Rick. You said, "People have lost the plot line in our society."
And I think it helps regain the plot line of what your life is, what the meaning is, where we fit into the bigger context of life and how we can conduct ourselves in ways that actually make us more human, more connected, more loving, more present, more able to do the work we want to do in the world, love the people who are in our lives and actually be free from some of the incredibly difficult parts of being human that particularly in the 20th and 21st century have been just so rough. I don't think humans have had it easy all along, but I think just the amount of wars and violence and killing, it was the deadliest century in human history, last century.

Rick Doblin:
Oh, and the species extinction, when we talk about what's going on with the environmental crisis and all. But I do have a quick question, which was, I talked about how I had support from my parents, but when you were having these experiences, I'm curious, what was your parents' thinking?

Dr. Mark Hyman:
I don't think I was sharing a lot of it. I did drop out of college after my first year. I'm like, "This is dumb." That's when I did a lot of the Zen retreats. I was making bagels at 5:00 in the morning, and I was like, "Ah, I think I better go back to school." And I ended up studying Buddhism. It was okay. It worked out, it worked out.

Rick Doblin:
That's great. You were sort of the classic Timothy Leary of "Turn on, tune in, drop out"?

Dr. Mark Hyman:
Something like that. Actually, I heard him come to speak at Cornell when I was there. I heard him speak. I heard Ram Dass speak. It was interesting. Ram Dass talks about Neem Karoli Baba who was his teacher, and how he brought loads of LSD. And he gave it to him and nothing happened. It was just zero. I don't know if that's true or not, or if it's just kind of a fictionalized tale. But it makes me wonder about when you have really have healed your mind and your brain, and you have access to these altered states. These kind of people I've met in Tibet, these old lamas and meditators, they really are just joyous and happy and connected and present. It's really quite remarkable. And I think that's the beauty of these compounds is... they're called entheogens, right? They bring us closer to God, whatever that is for you.

Rick Doblin:
Now I don't actually use that word because I'll say that people have looked at the word psychedelic. And again, how do we do this public reframing? How do we take something so demonized and so beaten down and suppressed? And so a lot of it is framing and public education. That's where I'm so glad to be talking to you as part of this public education.
But the word for psychedelics before that was hallucinogens, psychotomimetics, mimic psychosis. And so entheogen was developed as a counter word to abandon the word psychedelics with all of its cultural connotations. But I think it's propaganda in the positive side. So hallucinogen is propaganda in the negative side, that you're going to take this, it's going to be fake, it's going to be hallucination, it's not going to be real. It's all a delusion.

Dr. Mark Hyman:
Right.

Rick Doblin:
And then entheogen is, "Oh, it's all about meeting God and you're connected to God." I see the value of that word, but I've focused... And you can see that MAPS has the word psychedelic in the title, that our mission was to try to reframe the word psychedelic, reclaim it the same way gay has done, or queer.

Dr. Mark Hyman:
Right, right.

Rick Doblin:
We tried to reclaim these.

Dr. Mark Hyman:
You quote Stanislav Grof and you say, "The study of psychedelics is what the telescope was to astronomers, and the microscope was to biologists." I think that's a very interesting frame because it's like we're on a frontier that we have just had so little understanding of it and so little effective treatment for. It's very hopeful to me to think about the ways in which these compounds can really help so many people who are really struggling and suffering.
And the amount of trauma is huge. I think one in four people, and I've talked about this in the podcast, have been sexually abused, including me. And I think that's a really big, big phenomena and that's a big trauma. But there's so much other trauma. Gabor Mate talks about the micro traumas there is living in our current society. The macro traumas are real abuse. So I think all these compounds have some role to play in our collective healing.

Rick Doblin:
Yeah, they do. The country of Bhutan has developed a National Index of Happiness. And many people have heard about this. What MAPS, we're talking about now, is to develop a National Index of Trauma. We just had a meeting with some people at the UN on how we might actually do this. And then the goal is a world of net zero trauma by 2070.
So now that it seems like we're maybe two years away or less than two years away from FDA approval of MDMA-assisted therapy for PTSD, it seems likely psilocybin I think will be shortly thereafter, psilocybin for depression. And so as we start mainstreaming psychedelics, we already have 500 or 600 or more ketamine clinics in the United States, we will eventually have thousands, hopefully tens of thousands of psychedelic clinics around the world.
And can we over time, over a generation or two, help reduce people's multi-generational trauma and move to a world of net zero trauma? There's some statistics that I recently have incorporated into one of my PowerPoints about how there are predictions that there'll be over a billion climate refugees by 2050.

Dr. Mark Hyman:
Yeah, yeah, there are, yeah.

Rick Doblin:
So the stresses on the human species are going to increase. We're really good at denial. That's the classic story of addiction. And so we still have people in the fossil fuel industry saying, "Let's do more of this." We tend to do things at the last minute. And so the species extinction is increasing, the environmental degradation is increasing. On the other hand, there is this hope of, through the brilliance of our mind, can we remedy some of the problems through the sort of primitive nature of our mind as well? It's a touch and go situation, I'm sure. And I think that-

Dr. Mark Hyman:
It's quite a vision.

Rick Doblin:
Yeah. So this idea of 2070, a net zero world. What we need is this idea of a spiritualized humanity. So that is really our goal is mass mental health and a spiritualized humanity. You could say that humanity is now like lemmings going over the cliff. How do we stop that? We need more people to wake up. And so one of the things that I think was also good about Timothy Leary is that he didn't say, "Oh, we need to give..." He did do this, but he didn't think about giving LSD to leaders. And there's an incredible story about-

Dr. Mark Hyman:
Put it in the G20 meeting water.

Rick Doblin:
Well, one of the mistresses of President Kennedy came to Leary and said that she and some of her friends were sleeping with the major political leaders. This is in the early '60s. Could he help train them so that they could be more effective with their LSD experiences with these guys to help them become more enlightened? There's a book. Mary's Mosaic is about this woman that supposedly did do LSD with John Kennedy.

Dr. Mark Hyman:
Wow, that's pretty-

Rick Doblin:
Trained by Leary.

Dr. Mark Hyman:
That's pretty wild. That's pretty wild.

Rick Doblin:
Mary's Mosaic. But the theory for me is slightly different, and I think it was also for Leary, is that you need to ground mental health in the mass of the population. That there's always going to be psychopaths but it's the mass of people that give them their power, that make them so destructive and that they can manipulate people's fears and anxieties. And if you can help people not have such fears and anxieties or find a process to work through it, then the psychopaths aren't going to do so much damage. So that's for me, the theory of change is more of this idea of mass mental health. And that's why we need drug policy reform.

Dr. Mark Hyman:
That's incredible, yeah.

Rick Doblin:
That's why we need these 25,000 or more therapists trained just in this decade and all these clinics. I think it's a vision of hope in a sense that the human species can pull itself out of this tailspin, hopefully not at the very last minute. And that's where I think public education, what you're doing with these podcasts, is so important for people. Particularly, I want to say this, that there's a lot of people committing suicide out of despair. There's what's called deaths of despair, which is alcoholism, drug overdoses, and suicide.
But the message, I think, the fundamental message coming from the field of psychedelic psychotherapy and psychedelic research is that there's a reason for hope, that it's going to be awhile before these things become mainstream, before everybody can have access, before it's insurance coverage. But there are technologies that are being developed that are not actually different from what we've done thousands of years ago.
We as a culture, you could say, as a Western culture, have suppressed the irrational or the emotional and the psychedelics, both for power reasons, to have hierarchies of the churches that are the intermediary between you and church, but also it helped facilitate the flourishing of our rational mind. And we have produced miracles of technology. The fact that we can talk like this, that I can see you, I mean this is amazing. Hopefully the brilliance of our mind will be able to overcome the primitive nature of our psyche and help us to evolve. And that's the race that we're in.

Dr. Mark Hyman:
These compounds have been used for millennia by humans throughout the world. And even some say early Christianity was influenced by ergot alkaloids that were from mold that was growing on grains, that created these mystical experiences and psychedelic experiences, like LSD. So I think this is not new to humanity. This is just something that's been suppressed and marginalized, but it's actually central to the human experience throughout history. We've co-evolved with these plants. One of my favorite courses I took in college is Plants and Humans. It was all about all of this stuff, all about the cultural use of plants, but for foods, medicine, for psychedelic experiences, healing.
And we're now seeing places where people can go and get help. A lot of it's underground right now. There's other countries that are doing this kind of work. For example, in iboga which is a West African bark is being used now in Mexico in these clinics to deal with addiction. It can end the physiological addiction, but also give these people a really profoundly different way to look at their trauma and their past and seems to reset their neuroplasticity. So there's these clinics opening around, there's these different centers around the world. Where do you see this, besides the United States, emerging? Is there places people can go?

Rick Doblin:
Well, it's already in Switzerland. Again, Switzerland is where Albert Hofmann lived. And he was the one that worked for Sandoz and invented LSD first off in 1938, and then had his unexpected experience where he realized it back in 1943. And then in '58, 15 years later-

Dr. Mark Hyman:
He got some on his fingers.

Rick Doblin:
Somewhere or how, yes. And then he also was the first one to identify psilocybin in the mushrooms. So there's a tradition of psychedelics in Switzerland, of psychedelic discovery. And so in Switzerland right now, they have compassionate use of LSD, MDMA, and there's a group of 30 plus psychiatrists that are permitted to give MDMA and LSD to their patients.

Dr. Mark Hyman:
Wow.

Rick Doblin:
So that is the advanced place. There are clinics. As you notice, because of the zeal of the drug warriors in America, ibogaine is illegal in the United States, but it's not criminalized most of the rest of the world. So it's legal in Mexico, it's legal in Canada, legal in England, much of Europe, much of South America. And it's not a drug of abuse.
The irony is that we could have over 100,000 people die of opiate-related and fentanyl-related overdoses, and yet we still have the National Institute on Drug Abuse is not funding research into ibogaine, even though it's clearly helpful for helping people overcome dependence on opiates. It resets the brain. It's incredible. And it gives a psychedelic, therapeutic, spiritual experience.
So I think we're at this situation where there is this recognition that there are tools that have been around sometimes for a millennium, that our culture has really not figured out a way to incorporate them. That time of suppression is coming to an end. And that the need for these tools is-
PART 3 OF 4 ENDS [01:09:04]

Rick Doblin:
Is coming to an end, and the need for these tools is apparent to more and more people. So we are involved... I began research... we've done studies with ibogaine clinics in Mexico and New Zealand and did long-term follow-ups. There's a for-profit company at [inaudible 01:09:19] that's trying to work with ibogaine. There's a study that we've supported in Barcelona with a group called ICEERS and Claire Wilkins and they're helping people withdraw from methadone with increasing doses of ibogaine. There's Bruno Rasmussen, this therapist psychiatrist down in Brazil and is doing work with ibogaine. So it's breaking through in different ways, but I think from the for-profit perspective, from for-profit pharmaceutical companies, these drugs are in the public domain and the traditional pharma investors want drugs that they patent.
MDMA was invented by Merck in 1912 and is in the public domain. LSD is in the public domain, psilocybin is in the public domain, ibogaine, so that's been a challenge, is to find the resources. And then you have your classic pharma tricks where you try to patent this and that of what you've done to prevent other people from doing it, to justify your hundreds of millions that you got to put in to making them into a medicine, so you can see both sides of it

Dr. Mark Hyman:
One of my questions I have is these compounds are extremely safe. We see the psilocybin, LSD, there's really no sort of lethal dose. There's not terrible side effects unless you have some very serious preexisting psychosis like schizophrenia, it can kind of trigger things. But what's fascinating to me is that despite that safety, they're now trying to come up with these new molecules that are altering the structure of function somehow, but we don't know what the side effects of those will be. So they're saying they're going to be shorter duration, or it'll be this or that, and that worries me a little bit.

Rick Doblin:
So this gets back to your earlier question about scaling. A lot of these for-profit companies are thinking the problem is that these experiences take longer and we've got to squeeze it into the normal therapeutic model that we have to have like an hour experience. Can we make a psilocybin experience that's 15 minutes or something? But you can do that with 5-MeO-DMT or things that are shorter. But I think that there's this assumption that somehow shorter is better where I don't think that's true. And also, as you say, well, with spice, so there was a whole lot of interest in cannabis alternatives, cannabis like molecules that wouldn't show up on drug tests and those are more dangerous than the cannabis itself. So a lot of times this search to get away from these tried and true things produce ones that are technically legal but they're more dangerous in many ways.
We do know, I think it's possible to produce psilocybin-like molecules, MDMA-like molecules that are comparably safe, I would say. But I do want to say that there's physiological safety and psychological safety. So when we think about the psychedelics, I would say that MDMA and ibogaine are more physiologically challenging in certain ways. You can take MDMA in non-therapeutic settings. This doesn't happen in therapeutic settings. But you can dance all night, you can overheat, and people have died from hyperthermia, and sometimes people are drinking too much water as a harm reduction method then they die from hyponatremia. So I would say that MDMA and ibogaine have more physiological challenges. Ibogaine has an impact on the heart that you have to be careful of, but that the classic psychedelics are safer physiologically. You won't overdose, you cannot overdose on psilocybin, but they're more challenging psychologically. And so I would say it's important for people to realize that you need a safe, supportive context when you're dissolving your sense of self.

Dr. Mark Hyman:
The set and setting, right.

Rick Doblin:
Yeah, also from Timothy Leary. Now, there's another thing, talk about sustainability, that I'll give credit to Timothy Leary for. So what I'm talking about is the future of drug policy reform. One way to think about it is what's called licensed legalization. And so if we think about alcohol, the way alcohol is regulated in our society, it's pretty light. You can go to a bar and you can get a bar fight and you get busted for that. But the next day you go back and you can go back into the bar and you can buy alcohol, you can go to a liquor store. You can be arrested for drunk driving and you could lose your driver's license, but you can still get alcohol in a bar or a liquor store. So I think there should be a license to do drugs, particularly for alcohol and other things, and also for psychedelics.
And the idea is that it's not that hard to get the license, but if you misbehave you lose the license and then it makes it a little bit harder and you have to do reeducation or something like that. And it turns out that the person that proposed that was Timothy Leary, where he talked about how it's like you need a pilot's license to drive a plane. Well, you should have a LSD license. And it's similar to that. So he did have that kind of relatively conservative theory. And I think the one downside of it is that we don't trust our governments. And a lot of times there's changes in policies and so if you have a license then there's a list of everybody that's got the license that the government has. Now the government has so much information already. They know your credit cards, they know what you're buying.
If you go to a marijuana dispensary, "Oh, you charged this marijuana dispensary." So I do think that the future, I would say, would be licensed legalization of some kind, and that these psychedelic clinics would be a site of initiation. The idea is that you wanted to have a license for LSD or MDMA you go to a clinic, you have it basically for free, paid for by all the taxes, and then you understand what it is. And if you don't have a terrible, terrible experience, then you get a license and you can go do it on your own. And that's the same way with driver's license. You have to drive in a car with an instructor making sure you know what you're doing before you get a license to drive on your own.

Dr. Mark Hyman:
Yeah, it's quite amazing. And what's really exciting to me, and where this is all going is, it's expanding in the legitimate world of mental health and psychiatry. There's articles in New England Journal about psilocybin and treatment for depression. I think at Yale, at Johns Hopkins, at UC Berkeley, and many other institutions around the country, there's now psychedelic departments of research and inquiry, and this is really a shift.

Rick Doblin:
Even at Harvard where Timothy Leary was, The Harvard Center for the Neuroscience of Psychedelics at MGH, Massachusetts General Hospital.

Dr. Mark Hyman:
Which is really remarkable considering how marginalized these were. And I guess my question to you is, how do you see traditional psychiatrists interacting with this information and knowledge? Are they resistant? Are they excited? Are they open to it? I mean, I think we really are in a moment where psychiatry is really about to change, and it seems to be potentially a big threat in traditional psychiatric paradigms.

Rick Doblin:
Well, Max Planck, who was a physicist, the Planck Constant is named after him, he had a saying that I have learned a lot from. And what he said is that science proceeds funeral by funeral. So if you think science, they're the most open to continual inquiry, and the whole idea of science is you try to disprove hypotheses or to prove hypothesis. That even in science people get entrenched ideas. And so for Max Planck to say science proceeds funeral by funeral, it's kind of a disappointing indictment.

Dr. Mark Hyman:
Well, basically it's just hard to change paradigms and views for sure.

Rick Doblin:
Yeah. So I would say that what we're seeing with traditional psychiatry has been more openness than I would've anticipated. And I think that it's because a lot of the young generation of psychiatric residents and people in medical schools and psychiatry, there's grown up now over the last 20 years with more and more stories about the therapeutic value and the spiritual value of psychedelics. And they've grown very disillusioned. A lot of people have grown disillusioned with psychiatry. Where, as I said before, you see a patient for 15 minutes, you adjust their medications, that's the way you maximize your income, but you're not really relating much on a human way with these patients. So I think that there's also an understanding among a lot of psychiatrists. We do a lot of work at the Veterans Administration also. It took us like 30 years or so to get into the VA, but now-

Dr. Mark Hyman:
You're a patient man, Rick.

Rick Doblin:
Well, the resistance was great, and the only way to get through it was being patient. But there are people that they've seen for 20 years or 30 years or 40 years, since Vietnam, that they're giving SSRIs to and they're not getting better. So the same way, I think, there's a sense in traditional psychiatry that the tools that they have work for a bunch of people, but there's a large bunch of people that they are not helpful for and they have significant side effects.

Dr. Mark Hyman:
Well, that's really exciting to hear.

Rick Doblin:
But one of the reasons why, when I say we do political science not regular science, the reason I chose MDMA as the drug that I thought would make it through the system first, rather than psilocybin let's say, or LSD, is because what we say is that the therapists who are working with the patients will be more effective if they've tried the drug themselves. And we don't say psychiatrists should get ECT, electroconvulsive therapy.

Dr. Mark Hyman:
They should get psychoanalysis, right?

Rick Doblin:
Yeah, but the ECT is the treatment, or you don't want a psychiatrist necessarily to take an anti-psychotic drug, but that's where the drug is the treatment. But in psychedelics it's the therapy that's the treatment that the drug makes more effective. It's the human relationship. So what we've said is that for therapists who are in our program, we have FDA protocols to give MDMA to therapists as part of their training.

Dr. Mark Hyman:
That's incredible.

Rick Doblin:
There is more resistance in traditional psychiatry to themselves doing LSD or psilocybin, more fear, more anxiety, than there is doing MDMA. But overall, I think that traditional psychiatry is warming up to psychedelics. The last annual conference in New Orleans of the American Psychiatric Association, they have 10 plus thousand or more psychiatrists go to this, and they have eight concurrent sessions or whatever, loads of concurrent sessions, but they have a track that's called President's Talks. So the president of the APA can pick certain kind of topics. And so Julie Holland, a psychiatrist, and I were chosen to speak about psychedelics.

Dr. Mark Hyman:
That's amazing. Wow. That's incredible.

Rick Doblin:
And the room was packed.

Dr. Mark Hyman:
I bet, I bet.

Rick Doblin:
So I think that the traditional psychiatry, people go into psychiatry because they want to help people, and when they see that people are being stuck for a very long time they look for new things. So I think the openness is there in traditional psychiatry. It's there in the regulatory agencies. And all of this is in the background of marijuana legalization and of the questioning of the drug war. So the drug war is what really suppressed the research for a long time. And it was also against the hippies and against the people challenging the status quo, and so a lot of that has diminished. So the resistance to psychedelic research has gone way down.

Dr. Mark Hyman:
What are you most excited about now going forward, as we close the podcast now, what are the things that you're seeing on the horizon, or what is the vision you have for the future that you're most excited about or what are you working on?

Rick Doblin:
Well, when I talk about a world of net zero trauma by 2070, what that really means is that we have to go into refugee camps and migrants, we have to go into prisons, we have to work with prisoners and prison guards. We have to go into countries like Rwanda where there's been genocide, that there's still... China, actually when you think about it. I've been to China, Amy Emerson, the head of our benefit corp, we've been to China. During the cultural revolution, when we had the psychedelic revolution, then we had the cultural revolution and that whole generation is traumatized from that still. And so what I'm looking forward to and excited by is this idea of first off regulatory approval, which is going to come over the next four or five years. We think in less than two years we should have FDA Health Canada and Israeli Ministry of Health approval for MDMA assisted therapy for PTSD.
We're working with the European Medicines Agency and the MHRA in England. We're in seven countries, 10 sites in Europe, we're in Australia and Brazil. So the globalization of the healing potential of MDMA and other psychedelics is coming. And the work that we're doing inside the Veterans Administration, I think one day, a couple years from now, maybe four or five years from now, the VA should adopt psychedelics as part of their standard offerings. We want to cross that line into the Department of Defense. Also we want to cross another line, which is into adolescence. So right now, the FDA is saying to us that we can only work with people that are 18 or older. But if we do succeed in getting FDA approval for MDMA assisted therapy for PTSD in people 18 or older, then we are required to do studies in 12 to 17-year-olds with PTSD.

Dr. Mark Hyman:
That's amazing.

Rick Doblin:
So the theory here is you move closer to the trauma and then it's easier to treat and they don't suffer as long. So we need to move into the Department of Defense. We need to move into adolescence, we need to work with refugees and prisoners. So I'm really excited about the globalization of all of this. And also MAPS is trying to do something different. I'm not sure how successful it will be, but we have formed the MAPS Public Benefit Corporation. That's our pharmaceutical arm. We have about 160 people there and about 35 people in MAPS the nonprofit. And so what we want to do is show how to market a drug without maximizing profit but maximizing public benefit, because the profit motive has warped healthcare in America-

Dr. Mark Hyman:
Terribly, terribly,

Rick Doblin:
... in a terribly way. What I'm looking forward to is also the world's biggest psychedelic conference ever. We're calling it Psychedelic Science 2023 Doorway to a New World. We've had these psychedelic science conferences, 2010 was the first one in San Jose, then 2013 in Oakland, 2017 in Oakland, and now 2023 in Denver. It's going to be at the Denver Convention Center. We're hoping for upwards of 10,000 people to come. We've already sold... it's more than six months away, we've already sold the 1250 tickets. Also Colorado just passed the Natural Plant Medicine Initiative. Denver made mushrooms the lowest enforcement priority. So we're looking forward to this big celebration. We'd like to encourage everybody to come.
There's going to be lots of opportunities to learn and to network. We're going to have Stan Grof is coming to do holotropic breathwork. We're having other experiential things. Naropa is a college that's going to do meditation retreats. So a lot of sort of spiritual things. But I think the key turning point for us is going to be FDA approval of MDMA assisted therapy for PTSD. And not just for us, but that's for the whole field. And so we are the leading edge, and we just would encourage people to check out MAPS to consider becoming a member of MAPS.

Dr. Mark Hyman:
That's maps.org? M-A-P-S.org?

Rick Doblin:
Yeah, yeah, thank you for that. And then psychedelicscience.org is the conference or just go to the MAPS website. I think where we're really moving to is a recognition that when we think about the Western culture, and you alluded to this too about the early Christian religion involving psychedelics, there's a book called The Immortality Key by Brian Muraresku that makes a really good case. So The Eleusinian Mysteries, were the world's longest lasting mystery ceremonies. It lasted 2000 years from 1600 BC to almost 400 AD but it was wiped out by the Catholic Church, and that had ergot. That was a psychedelic component. And the early Christianity, the wine was fortified wine with psychedelic aspects of it. And then the church wiped that out and they wanted to be an intermediary. And then we have the dark Middle Ages and they wipe out all the witches, and those are often women that were knowledgeable about plant medicines.
And then we get the exploring of the Western world and the conquistadors, and the first people they decided to kill were the shamans and the people that were the center of the culture. So many people think about it as, oh, there was the psychedelic sixties and then there was the backlash. And now that's 50 years ago and now we're trying to bring psychedelics back after 50 years. But really what we're trying to do to take a larger perspective is after 15, 1600 years, we are trying to mainstream psychedelic consciousness into Western culture at a time of incredible crisis. I think that there's a good chance that that'll happen. I think that regulatory approval is sort of the first stamp of official acceptance that this is moving forward. We have that a bit with ketamine already and once MDMA and psilocybin... so that's what I'm looking forward to and I want to celebrate with people.
And then the other thing is we are planning a party. I'll just say this, April 8th is when I started MAPS in 1986, so 2024 on April 8th is the 38th anniversary of MAPS and that should be right around the time that we get FDA approval. It could be within weeks or days. I mean, who knows as far as schedules are. I've never been right about my estimates of time or money. But in any case, April 8th, 2024 is the 38th anniversary of MAPS and the universe has decided to help celebrate with a full solar eclipse through much of North America.

Dr. Mark Hyman:
That's amazing.

Rick Doblin:
So we're going to try to find a place where we can have private land and we can have a big celebration for the MAPS anniversary and the solar eclipse.

Dr. Mark Hyman:
I love that, I love that.

Rick Doblin:
So I'm looking forward to that as well.

Dr. Mark Hyman:
Oh, that's great, Rick.

Rick Doblin:
And hopefully we'll get FDA approval the day before that or something.

Dr. Mark Hyman:
That's exciting. Well, Rick, thank God for that guidance counselor who gave you Stanislav Grof's book and that you wrote him a letter and that he wrote you back and that you started this journey, because I think it's going to be helping millions of people enter a world of healing and repair of their minds and their brains or hearts and maybe bring a little bit more connection and love to the world than we have right now, because it just seems like both the best of times and the worst of times. And it feels like this psychedelic renaissance is actually poised to make a huge difference in the global mental health that we see so problematic today. So thanks for your work, Rick. Thank you for doing what you're doing for so many decades, tirelessly. You seem more excited than ever, actually, about doing this, which is amazing. And I can see that.

Rick Doblin:
And thank you, Mark, because what we realized is that public education is the key. It was fear and anxiety in the public that squashed the research for decades. And so now this kind of work that you're doing with podcasts, that we're trying to communicate to people what we're doing so that they can be more excited about the future and understand it more rather than be frightened about it.

Dr. Mark Hyman:
Well, thank you, Rick. And if anybody listens to this podcast and love what you're hearing and know people who could benefit, share it with them on all your channels. Subscribe wherever you get your podcast. Leave comments. We'd love to know how maybe you can use psychedelics or various compounds to help you heal and we'd love to know more. We'll see you next time on The Doctor's Pharmacy.

Closing:
Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it-