October 21, 2021 • 51 mins
Professor Elias Dakwar at Columbia University has conducted research studies – supported by federal funding -- into the use of ketamine combined with mindfulness meditation to help people struggling with addiction and depression. I wanted to understand everything about this: Why is he among the very few researchers to receive funding from the National Institute on Drug Abuse for this sort of work? How does ketamine compare to psilocybin and other psychedelics? What is the experience of subjects in his studies? How does his approach to administering ketamine compare to others? What’s the added benefit of including mindfulness mediation? And what does he think about the future of psychedelic studies and his role in this burgeoning field?
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Episode Transcript
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Speaker 1 (00:00):
Hi, I'm Ethan Nadelman, and this is Psychoactive, a production
of I Heart Radio and Protozoa Pictures. Psychoactive is the
show where we talk about all things drugs. But any
views expressed here do not represent those of I Heeart Media,
Protozoa Pictures, or their executives and employees. Indeed, Heed, as
(00:23):
an inveterate contrarian, I can tell you they may not
even represent my own and nothing contained in this show
should be used as medical advice or encouragement to use
any type of drug. Hello, Psychoactive listeners. So today our
(00:45):
guest is a Columbia professor, Elias Dakwar, who's done this
fascinating research on using ketamine combined with mindfulness meditation to
help people struggling with drug addiction. And he's actually one
of the few people in the United States to actually
have received federal funding for research on psychedelics. I'm delighted
(01:07):
to have you on the program and lives so just God,
just start off, just tell me your name and introduce
yourself and your title and where you are right now
and such. Thanks for having me. My name's Liastkwar. I'm
currently at the Columbia Medical Center, calling from my office
here in New York City. I'm an associate professor here
of psychiatry, and I've been interested in research with ketamine,
(01:33):
combining it with therapy for a variety of addictions and
but addiction. I mean you started off in all this,
even before you get into the kid amine about working
on addiction and addiction treatment. Isn't that right? Correct? Yeah?
I started my foray into addiction treatment with meditation. I
was very interested in how meditation might be helpful for
(01:53):
disrupting some of the automaticity and reactivity that can happen
with addiction, and developed an interest in combining meditation with
other modalities. Meditation alone wasn't quite cutting it, and this grew.
I mean you first got these insights from your own
personal experience with meditation and its value in your own life. Yeah,
(02:13):
both personal experience with meditation, also with non ordinary experiences
more generally, what do you mean in ordinary experiences? I
guess psychedelic type experiences, fasting, mystical experiences, those sorts of things.
Meditation has been the most I think durable and reliable
for me route towards those sorts of states. And you
(02:38):
know there's a practice associated with it and a practice
that enjoys a lot of social legitimacy, at least here
in the United States, so it seemed something that could
lend itself to treatment in Western models for addiction. Things
have changed quite a bit since I started doing that
research with greater interest and incorporating substances that previously had
(03:01):
been deemed inappropriate and medical settings like the psychedelics. But
at the time it seemed like a fairly straightforward strategy
think about meditation. Were you aware of that kind of
earlier era, back in the sixties where Timothy Learry and
Richard Albert In a whole host of other people were
actually experimenting madelsty and I think mess Glinn perhaps philocybin,
(03:25):
psilocybin and addiction. I mean, did you did you know
that history when you first got interested in this stuff?
I did now. I grew up in the Bay Area
and my uncle's were part of the counterculture during the
sixties and would browse their bookshelves growing up reading R. D.
Lange and Carlos Kostayeta and ram Das and all of
(03:48):
those things, So it wasn't completely unusual or foreign to me.
I didn't anticipate that it would gain the level of
social currency that it has now. It's it's quite impressive
and it's beautiful to see that it's being embraced as
it is now. There are some challenges we'll talk about later.
I was well aware of the earlier attempts to understand
(04:11):
how these substances could be helpful the unfortunate end to
that research because of criminalization of these substances back in
the late sixties and such. Yeah, exactly. And in terms
of your mentors and such when you started to study
addiction treatment, right, I guess in your earlier years of
training in psychiatry, Um, were you encouraged by them to
(04:33):
look into these avenues of the role of the ketamine
or psychedelics at that time. There's an interesting story I, Um,
you know Karl Hard of course. Um, he's been a
mentor to me and big source of support when I
first mentioned to him that I was interested in in
doing this sort of work. I was interested in psilocybin. Actually,
(04:55):
at the time, Roland Griffith at Johns Hopkins had come
out with the repeat of the Good Friday experiment, where
he showed that psilocybin given to healthy volunteers can lead
to sustained improvements and well being and these very profound
mystical experiences that they remember as among the most important
(05:16):
in their lives and maybe just explain, actually, what's that
initial Good Friday experiment was sure. It was an experiment
done at Harvard investigating psilocybin. The experiment took people who
have an interest in spiritual matters, people from the seminary clergy,
and investigated what happens when psilocybin is given, whether there's
(05:40):
an improvement and spiritual understanding, whether it occasions experiences comparable
to mystical states. And Roland Griffiths, who himself has a
longstanding interest in meditation, did an experiment that basically duplicated
those effects and found that psilocybin has the propensity to
(06:02):
cosmistical states, changes in time and space, a sense of
knowing something that's beyond words, a sense of revelation of
seeing things in a profoundly new way. And these experiences
went on to be remembered for um years subsequently as
(06:23):
among the most powerful the person's life and also impactful
with friends spouses, noting that there was a clear difference
in the person after versus before. So that was the
the experiment that Roland Griffiths had done, and that pretty
much opened the door to this research being done again
on a mass scale. Actually, actually, Lass, if I recall correctly,
(06:47):
even before Roland Griffiths had done that study, I think
Rick Doblin, the founder of MAPS and Multidisiplinary Associated Cycholic Studies,
had done his own twenty five year follow up on
that Good Friday experiment and had tracked a lot of
these participants. I think these Boston University Divinity students down
to see what they thought about this experience twenty five
years later, and I think it found that many of
(07:09):
them still regarded it as one of the most profound
spiritual experiences in their lives. They wish they could talk
openly to their congregants about it, uh, you know, they
wish they could do it with their kids. Things like this.
Some of them felt it had brought them closer to Jesus.
But you were saying about Karl Hart. So then Carl,
our mutual friends, says to you, so I had mentioned
(07:30):
that I that I'm interested in potentially doing treatment study
with psilocybin for addiction and said, well, you're not going
to be able to get an I H funding for it.
My friend Um he's spoken with Nora Valkao herself, who
said that ni H NEIDA, in particular our death set
against funding any of that research and just explained Nora
local is. She's the head of the National Institute on
(07:54):
Drug Abuse NIDA, which is the premier funding agency within NIH,
fueling a lot of the research being done to investigate
treatments for addiction and also the harms associated with drug use.
NIDA emerged in lockstep with the War on Drugs as
the science arm two identify what the risks of drugs
(08:17):
might be and how to best deal with any problems
that might emerge. So he was emphatic that I would
be wasting my time trying to pursue that kind of
research if I hope to get funded by NIDA. He
thought there might be a better chance looking at ketamine.
Ketamine has comparable effects to psilocybin, but it's not scheduled.
(08:38):
It's Schedule three, which means that it has known medical
use with some risk of abuse. It emerged in the
fifties as an anesthetic that lends itself to very easy use.
It can be given to people in the battlefield, in
(08:58):
accident settings without requiring intubation, because it doesn't depress respiration,
doesn't cause people to stop breathing, doesn't have any effects
on cardiac functioning, so it lends itself to easy administration.
You can innesthetize people in settings that don't require the
usual supports that hospitals provide. So in the Vietnam War,
(09:19):
for example, it would it be too exactular what you're
dealing with that And it was also used for in animals,
right what animal surgery, veterinarians used to, etcetera. Yes, and
it continues to be used in those capacities, both in
veterinary and human medicine. And you may know as well
that ketamine is a descendant, let's say, of PCP, So
(09:41):
PCP works in a very similar way to ketamine. It
binds to the PCP site of the glutamate receptor. Glutamate
is one of the most abundant excitatory neurotransmitters in the
brain and can lead to dissociation. With that effect, it
binds to the site antagonize his glutamate, and it can
(10:02):
lead aspects of experience that are usually coupled to become decoupled,
so the feeling and the thinking part, the conscious and unconscious. Well,
it's when I remember about PCP though, was all the
hysteria in Washington, d c. Where it became one of
the most popular drugs of use and abuse for a while,
and you'd have cops telling these stories about people crazed
(10:24):
on PCP, you needed five cops to tie them down
and all this sort of stuff. But um, I didn't
realize the connection between PCP and kennemine in that regard. Yeah,
PCP definitely became one of the scare drugs of the
DARE program. Growing up in the Bay Area, every year
we had the same story from the cops who came
with the suitcase of drugs to tell us about why
(10:45):
to stay away from heroin, why to stay away from acid, pot,
and PCP always involved a story of you know, someone craze,
either ripping out his eyeballs or jumping out of a
building or trying to do something of hercue lee in excess,
like trying to flip over a cop car. But PCP
is basically ketamine, except it's longer acting and has greater
(11:09):
affinity for the glutamate receptor. So with proper dosing. It
can work functionally like ketamine does. The one difference is
that it is longer acting. Ketamine is incredibly short acting
um It has a very rapid clearance right the half
life short so after a single administration of ketamine, the
(11:29):
person is fairly back to normal after forty minutes. But
where people feel actively under the influence of the kenemine,
is it only that length of time as well? Or
depends on how it's administered um so intranasally, which is
the way that it's most commonly administered in recreational settings.
The last about twenty minutes intramuscularly, last about forty minutes intravenously.
(11:51):
It can last as long as it's being infused, as
long as it's stripping into the person's bloodstream. You know,
as I say, I think the first time I ever
read about ketamine, I think it was reading some kind
of autobiographical book by John Lily right. And John lily
was a founder of stay teaching communications, you know, communications
(12:12):
buying among dolphins and whales, and also the guy who
invented the isolation tank. And he talked about taking ketamine
and he had suffered from migraines and he felt the
migraines just kind of separating from his head, and then
he got into a much more exploratory phase. I think
of taking ketamine like every hour on the hour in
one of his isolation tanks and almost killing himself that
(12:35):
way or something. But it was the first time I
realized that there was this drug called kenemine. I don't
even know if I was aware at the time of
its role in surgery and things like that, but it
does seem like this incredibly versatile drug exactly. The versatility
comes from the variety of effects that can have based
on dose. So it was originally intended to be used
(12:57):
in the anesthetic range where it would put people out,
but it can also be used, as you said with
John Lilly's self experimentation and exploration, can be used in
a sub anesthetic range where it doesn't lead to loss
of consciousness, but it leads to fairly profound changes in
experience and perception. And that's really been where the most
(13:18):
recent interest has been and what it might do psychiatrically
within that sub an aesthetic range. So the resurrection of
ketamine came initially through if Jenny Kropitski's work actually if
Jenny Krpitski was also funded by MAPS. You mentioned Rick
Doblin earlier. He did some fascinating work in St. Petersburg.
(13:40):
St Petersburg, Rushia and not Florida. Let's I thought the
name gave it away. Um. Yeah, So he he gave
an intramuscular dose of ketamine, you know, enough to occasion
a psychedelic state in combination with what he called ketamine
psychedelic therapy, and there were lots of iterations of this therapy.
(14:02):
What what he ultimately landed on was a therapy framework
comparable to what was used in the fifties and sixties
with LSD and psilocybin, where the experience was central to
the treatment. The therapy was intended to help a person
and prepare for a potentially transformative experience, and then subsequently
(14:25):
to help the person makes sense of it, integrate it,
and find a way to consolidate those benefits in pursuit
of a healthier life, whatever that life might look like,
depending on the challenges the person's facing. So if Jenny
investigated ketamine in a similar way for alcohol addiction and
heroin addiction and found remarkable effects, I think we'd be
(14:48):
really in a different place right now if he was
allowed to continue this research. Unfortunately, ketamine is now illegal
and has been so for decades in Russia, and so
he to end the research, a reprisal in a way
of what happened in the States in the fifties and sixties,
where some promising results were aborted because of policy. Yeah,
(15:11):
Alias should actually tell you, Um, I actually met a
Ginny back in the nineties, and it was when I
was starting up the International Harm Reduction Program through Soros Foundation,
and we actually did a conference in St. Petersburg on
drugs and HIV and harm reduction, and there was this
kind of opening period. There was even a period in
the early years of Putin of his being open to
(15:32):
decriminalization of possession and things like this, and then this
massive hard turning in the opposite direction. But I mean,
it's interesting to think that some of the pioneering work
in this area came out of Russia. And what I
think is also unappreciated is how formative if Jenny was
to biological psychiatryes embrace of Kenemine. So if Jenny had
(15:56):
gone to Yale as a fellow while engaged in this
research and in St. Petersburg and Yale, as you may know,
is where ketamine was serendipitously found to have antidepressant effects.
And I didn't know that when was that? The first
paper was in two thousand is John Crystal, who is
(16:20):
the editor in chief of Biological Psychiatry, and that really
set the stage for how ketamine has been received by
mainstream psychiatry. It was being approached as a purely biological intervention,
as a medicine comparable to e c T electro convulsive therapy.
So this is emerging at Yale at the same time
(16:43):
that ketamine a K A special K is becoming popular
in the gay dance clubs in the city. I mean
as an Arnold's almost simultaneously happening about twenty years ago.
And does the fact that it's emerging is such a
popular party drug and in the media complicate the efforts
at Yale to look at it's role in depression. I
think the foresight perhaps that the psychiatrist that Yale had,
(17:06):
but also ultimately the great blind spot, was to not
look at ketamine for what its psychoactive effects might be,
to look at it purely as a biological intervention. That
separated it quite dramatically from why it might be used
in recreational settings, which is to elicit these usually enjoyable,
interesting effects. So, in developing the story behind how ketamine
(17:30):
might be impactful, the hope was that it would create
space for ketamine like compounds without those psychoactive effects to
be developed. And what do you think I mean, I'm
going to ask you about your studies shortly, But in
terms of uh, this notion of separating out the psychoactive
effects from the medical effects, I've seen people try to
(17:51):
think about what that can be done with cannabis, Where
we can you know, other drugs. I mean, is the
psychoactive element of ketamine essential to its sickacy in dealing
with whether it's depression or addiction. Well, the short answer
is it's complicated. I think it's foolish, first of all,
two discount the psychoactive effects to say that they're totally
(18:14):
irrelevant and unimpactful. It's foolish for the reason that we
don't give enough attention. If we see those effects as irrelevant,
we don't give it enough attention to setting the stage
for them to emerge and providing a safe space and
recognizing that they can potentially be impactful, and it's foolish
(18:34):
because there may be some very powerful ways of harnessing
those effects to mobilize the efficacy of ketamine. But I
think the larger question you're asking is what is the
role of subjective experience in our healing? And might there
be some paradigmatic deficit in the psychiatric framework that a
(19:00):
doesn't recognize the importance of subjective experience. It's all about
symptoms and the brain and behavior. What about consciousness? What
about the mystery of what it means to experience and
dream and imagine? Have we been missing something as psychiatrists
(19:20):
by over emphasizing neurobiology, symptoms, behavior? I mean, is that
a general failing of psychiatry and psychiatrists even we compare
to other forms of psychotherapy. That that's the focus on
the pharmacological and the focus on the medical element of
this just as kind of become. Whether we call it
(19:41):
a crutch or a barrier to thinking of in the
ways that you're describing right now, I think it is
a general challenge with psychiatry. The missing link here, I
think is that ketamine was also for a period and
continues to be so to some extent, a pharmacological model
of psychosis, mean ing that ketamine was being approached as
(20:02):
a medicine that can simulate what it means to be psychotic,
schizophrenic hearing voices, having unusual thoughts, and this was an
effort to better understand the neural underpinnings of psychosis. So
John Crystal's work with ketamine originally using sub anesthetic doses
(20:22):
of ketamine to investigate what psychosis might be and what
the role of glutamate might be in psychosis. And the
serendipitous finding came from doing that research, according to John Crystal,
that he was providing it to healthy volunteers and finding
that people were reporting that they were feeling better afterwards,
(20:42):
that there was an improvement in mood, even if they
weren't necessarily depressed beforehand, and that led to investigating ketamine
again in a in a biological frame, meaning there's no therapy.
The psychoactive effects are there, but they're not prepared for
or integrated or anything like that. It's given to depressed
people one occasion and then they were followed for a
(21:04):
few weeks to see how the depression was affected, and
that spurred a variety of studies looking at ketamine in
a similar way for depressions through ideality PTSD obsessive compulsive disorder,
giving a single dose in the absence of any kind
of psychotherapeutic framework, without much regard for the psychoactive effects,
(21:28):
to see how symptoms might change. Now, that's not really
different than how ketamine in a psychedelic framework might work.
What's different is the lens that was brought to ketamine.
The lens in this case was very biological, looking at
it as something that's entirely pharmacological in the sense that
(21:49):
it's entirely brain based without the psychoactive effects or effects
that might lend themselves to therapy being a part of
the process and investigating from there are other compounds that
might work like ketamine, but with reduced psychoactive effects. We'll
be talking more after we hear this add I'm curious
(22:24):
to hear. I mean, now that you've been doing these
studies right with people struggling, you know, with alcohol problems,
of cocaine problems, and cannabis problems. Um, could you just
describe a couple of your patients and what that was like. Yeah. Sure.
As I mentioned before, I've been interested in how the
(22:45):
meditative state might be helpful at disrupting addiction, and how
it might lend itself to a practice whereby the usual
automaticity and reactivity of addiction have my automaticity, you mean
people sort of just reflexively doing something on consciously, not
necessarily unconsciously, but there's such a pronounced reactivity. If there's
a particular feeling, the compulsion to respond to that feeling
(23:09):
by using something or craving becomes so impactful. People aren't able,
who are in the throes of severe addiction that are
not able to allow the craving to simply pass. There's
a feeling of needing to act on it at the
same time that we can surmise that a meditative practice
(23:29):
might help with those things. Of course, a meditative practice
requires some suspension of those things as well. Otherwise you're
not gonna be able to meditate if you're feeling agitated,
and if if your thoughts are causing you to move
in this way and that. So the hope was that
by providing an experience that is easier to come by
(23:50):
comes through a medicine, that the meditative state that happens
would serve as a stepping stone for understanding how to
continue meditating. And what to aim at. And also the
hope was that the medicine might provide an enduring opening
with improved craving sensitivity, improved mood, improved anxiety, so that
(24:11):
the usual vulnerabilities aren't so compromising. It noticed, it's using
ketamine as a way to get people to move into meditation,
integrating meditation and life right, and that's somehow that would
be helpful in that regard correct yet by approximating the
meditative experience, by making it easier to practice, and also
by motivating people to do it. You know that there's
(24:33):
been a lot of research suggesting that one of the
critical vulnerabilities to engaging fruitfully with any treatment is tenuous
motivation is just not feeling inspired or capable of doing something,
and that demoralization is I think a big part of addiction,
that sense of having resigned oneself to the addiction, having
(24:56):
tried again and again to stop it, and feeling like,
what's the why It's it's no good. So I also
hope that the medicine would disrupt that, that it would
provide a sense of refresh possibility. Well, let me just
back up for one second, so just to get a
picture of this so when these people are in your studies,
First of all, these people are generally more middle class
(25:17):
or people are more living on the street kind of
living rough. It cuts through different cuts across and and
they're coming into a facility at Columbia UM. They're in
a room. Are they wearing blindfold? Is their music in
the background? Are you sitting by them while they're going
through it? Are they hooked up to an ivy? What
does it look like? Yeah, so it happens at Columbia
(25:40):
Medical Center. But we created a space for administering the
medicine that is as warm and comfortable as possible. The
old you know catchphrase of set and setting remains very
important to respect. You know, these medicines, because of how
profoundly they can change experience, require an environment where people
(26:06):
can continue feeling safe. Environment conducive to allowing different experiences
to emerge safely and in a manner that allows the
person to feel heard and respected. So having a sterile
medical environment did not seem appropriate given what we were
trying to do. So we took a room that was
(26:26):
ordinarily used for laboratory experiments and made it look like
a living room. They are guided through a meditation exercise
prior to the ketamine being delivered. It's delivered through an ivy.
They're wearing an eyemask, laying down on a bed. I'm
sitting next to them or another physician is sitting next
to them, as well as the therapist, And throughout the
(26:48):
experience they're being guided through what's called a body scan
in mindfulness, that means paying attention to one sensations, one's breathing,
if thoughts come up, noticing the thought, but maintaining a
mindful stance, which means being open, being non judgmental, accepting, attentive,
and no music in the background. No music, and we
(27:09):
we keep it very silent. So and another hypothesis of
tacit hypothesis I was operating under here is that a
lot of the suffering that comes with addiction comes from
losing sight of the primordial mystery of experience. You know,
what can't be known, what can't be reduced to words,
(27:30):
concepts that the experience of someone in addiction is very
overdetermined and over interpreted to organize too knowing in a
way for its own good. And I wanted the experience
to allow for accessing what is beyond knowledge basically what
can't be put into words, And for that reason I
(27:54):
wanted the experience to remain as unanchored in things that
are ordinarily intelligible, like music, going deep into ineff ability. Basically,
it sounds like what you're describing. When I read about
some of the psychedelics therapy, sometimes it seems like something
that's almost more explosives the wrong word, but I mean
(28:14):
kind of more profound transformational that causes people to rethink
their lives, to rethink their experience. And it sounds like
what you're describing is a more modest form of that.
Is that right? Well, listen, if an explosive transformation is coming,
I welcome it. What and they do happen? They do happen.
(28:37):
Even having one's systems of knowledge dissolve in you know,
the primordial silence, it's not an easy thing to go through. Um.
At the same time, I think you're picking up on something.
I am skeptical of these kind of fantastical narratives of
communing with the divine or having some kind of pivot point.
(28:59):
They may be helpful, I'm sure, but in my mind,
what's most helpful is to find one's footing and have
some kind of regular, enduring practice that helps one navigate
the trials and tribulations of life. Yeah, well, you know
what you make me think of. You know, one of
the historical pieces that many people don't know is that
(29:19):
one of the founders of Alcoholics anonymous Bill Wilson, right,
and this was all about, you know, dealing with very
serious alcoholics and uh, you know, and the the whole
twelve step model. And then at some point he began
taking I can't remember this LSD or mescal in LSD,
and he came to believe that basically this could play
(29:40):
an important role in very serious inebrious alcoholics coming to
a kind of come to Jesus moment um in terms
of their own self awareness, you know, that kind of
moments that they're seeking for. And then I guess in
his case what followed from that was less the meditative
practice and more the fellowship of the whole twelve step approach.
(30:01):
But I wonder how you see what you were doing
comparison to what he experienced and talked about, or was
actually discouraged from talking about once he started talking about it.
I I, as I said, I'm supportive of anything that
could be hopeful and a transformative experience clearly can be impactful.
I mean, many scholars have written about this, starting with
(30:21):
William James. Bill Miller, the founder of Motivational Dansmo Therapy,
also wrote about the role of transformative experiences in recovery.
So I'm very supportive of them. I just wanted to
ensure that I maintained as comprehensive a model as possible,
so that while the experience can lend itself to that
(30:42):
if it were to occur, that if it doesn't occur
and someone merely, if merely is the right word, enters
into an eff ability, then that's fine too. We'll make
do what we can. Let's take a break here and
go to an ad Among your patients or the subjects
(31:09):
in the study, is there one that one or two
they just sort of stand out that you could describe
their experience? Yeah? What one, very powerful story, which I
think also indicates just how severe some of the addictions
we were dealing with our It was a laboratory study
investigating how ketamine might disrupt cocaine self administration. So woman
(31:33):
who had worked as a sex worker at a cocaine addiction,
very significant history of trauma, had multiple um scars all
over her body that came from having been abducted by
several men and mutilated and what sounds like some kind
of bizarre ritual um. She was able to get away
(31:55):
with severe wounds all over her body, but it was
able to escape. She worried that if she hadn't she
might have died, and it's haunted her as continued to
be an important part of her pathology, unfortunately. But she
came in with a fairly significant crack cocaine addiction, and
the experience that she had with ketamine is one of
(32:18):
the most remarkable I've seen speaking of transformative So this
was a study that wasn't really intended to help people
stop using. It was, as I mentioned, a lab study
to investigate a very specific question whether it reduces cocaine
self administration. Beyond the mindfulness training to help the person
prepare for the infusion, et cetera, there wasn't much support
(32:41):
and she had an experience where she began with moaning
in a in a kind of aroused way. Then it
went into sobbing to um trying to escape something, writhing
on the bed, and that's where the support of physician
therapist can be crucial when you know, it's not simply
(33:03):
a meditative state, but this kind of intense ab reaction
or or a reliving means to occur. And she ultimately,
by the end of the infusion, had calmed down and
was just repeating over and over again how the knife
had been removed, that it had been half out without
(33:24):
her realizing, but finally been removed. And she said something
very powerful, which I think of quite regularly. You know,
when you have a knife in you, she said, you
get used to it, and it's not until it's coming
out that it really hurts. And it was really the
the space that the ketamine provided her that allowed her
the safety, the the relaxing of defenses to finally allow
(33:49):
the knife out. And what was remarkable is that, as
again because this was not intended to necessarily provide treatment,
it was to ask a very specific question, she nonetheless
stopped using cocaine for the duration of the follow up
period after this this laboratory study. We continued seeing them
for four weeks after. And that's an example I think
(34:10):
of how there are things going on here which remain
very untapped, you know, the capacity for these single experiences
to shift things so dramatically. Again, I'm not hanging my
hat on that for every patient, and I'm trying to
find a very durable, resilient framework by which we might
(34:33):
tap into those benefits. I think using meditation and having
a psychotherapeutic framework important for that. But it can happen.
It's not simply anecdote. And well, I tell me, have
you done the follow up with her or others? You know,
not just four weeks later, but six months later, a
year later, and to see how they're doing. Yeah. So
we we've had two clinical trials that UM involved fairly
(34:57):
long follow up, one with cocaine addicted people and one
with alcohol dependent individuals. They were both several week trials
that involved several months of follow up after they completed
the trial, and we continued to ask how they were
doing and what their youth patterns were. And in both
(35:18):
UM studies, the rates of abstinence with the people who
received ketamine were significantly higher than with the control group.
So these are durable effects and all based upon the
one session. Was it just one session or two sessions
you did with them? Yea, for these studies it was
one session. I see. But when I think about like
(35:39):
a friend of mine who was suffering very seriously from
depression and trauma. Man having some pain, and he did,
I think what many people do, and man, you know
more and more where he did six ketamine sessions in
the space of a month, followed by one a month
for a year and did get some lasting many years
thereafter benefit. But have you considered doing that model as well,
(36:01):
or is there a reason to keep it to the
more a model which involves giving fewer administrations. It's a
very important question, and I think this gets at some
of the strictures that come with doing controversial research. So
I should mention that all of the research I've done
has been NIH funded either um NEIDA, which we talked
(36:21):
about before, and I Triple A, which is the wing
of ni H that's focused on alcohol treatment. And in
getting funding from both agencies, I needed to do a
lot of politicking because even though the grants that I
had submitted had received great scores from the Science Committee,
the more bureaucratic wing of both agencies was not interested
(36:47):
in investigating a mind altering substance for addiction because they
were worried about the political fallout, or because of their
own ideologies or ignorance, or there's a notion which is
erroneous that people who are prone to addiction whatever that means,
are also prone to getting addicted to other substances if
(37:08):
they were exposed to them. So if you're providing something
like ketamine to someone with cocaine problems, it's like you're
introducing potentially problematic, addiction prone substance to someone. Is there
any rational, evidence based approach for people within the NIDA
bureaucracy to take that view. No, No, it's a prejudice.
(37:30):
I have to tell you. It's just infuriated me. No end.
I mean it's a tragedy because NIDA provides I think
of all the funding for drug abuse research, not just
in the US but globally, and to be in this
incredibly rigid, ideological, you know, perspective on this stuff. I mean,
are they even funding any psychedelics research now apart from ketamine? No? Nothing.
(37:51):
I mean, well that's I should say, they're not funding
any therapeutic um, only looking at the harms of these
things exactly. Uh. Yeah, And to your point, a lot
of the substances that have been helpful for addiction, methadone,
puper nor pine if they were, for whatever reason, illegal,
(38:13):
we would be missing out on a tremendous opportunity. Those
substances are psychoactive, They activate receptors that other so called
drugs of abuse do. So, you know, the the argument
is definitely specious, but that was the argument I was
contending with. And as you seem aware, the challenge here
is that we're not really dealing with only science. We're
(38:33):
dealing with politics. We're dealing with ideology. We're dealing with
a particular perspective on drugs and addiction that comes less
from evidence and careful experiment and more from you know,
the drug war. I mean, I'm curious if you imagine
in the future, let's assume that at some point the
(38:55):
the other psychedelics actually become as legally available and permissive
to work with um for you know, drug treatment, ptsd, O,
c D, depression, whatever it might be. When more of
these are available, well ken amine play a lesser role.
I mean, is ketamine having some of its time in
(39:16):
the sun because the other ones are so hard to
get funding for except from private sources. That's a great question. Yeah,
I would not dismiss the power of ketamine. I don't
think it's simply that it has it's fifteen minutes due
to the other drugs being inaccessible. It has its own power.
And I should tell you a story a colleague of mine,
(39:37):
I keep her anonymous. I've been struggling with fairly severe
psychiatric issues for most of her life and did not
receive benefit from the conventional approaches. Met a healer who
worked with various types of psychedelics m d m A, psilocybin,
d MT LSD, and went through all of those, tried
(40:02):
every single one, but it wasn't until ketamine. It wasn't
until high dose intramuscular ketemine that she found relief. So
you know, these are ultimately different compounds, and there will
always be a place, I think for the very unique
effects that ketamine has. I should also say that ketamine
lends itself to easy administration much more than psilocybin. For example,
(40:27):
does it shorter acting, it doesn't last for hours and hours,
it doesn't require the same level of psychological preparation, hand holding, integration.
It lends itself to all of those things. So they
mentioned with the case of the sex worker who definitely
needed support and guidance, but in in a lot of cases,
people have a fairly calm experience and they're able to
(40:51):
move forward. I mean, unless I should tell you. You know,
I had my own experience with kenemine a guided session
last summer, and I hadn't really done it that way before,
and I was struck that compared to mushrooms, it was
comparably powerful and as you say, much shorter acting, but
it came on in my body in a much gentler way,
(41:14):
you know, And maybe this's is part of it as
I get older, mushrooms kind of you kind of a
little bit raggedy effect coming in. But the kennemy was
very calm and easy. And then after it's over, um,
you know, barely an hour later and one could re
engage in normal activities that one wanted to. Well, let
me ask you this whole thing with the commercialization. You know,
you can't pat into stuff is basically a generic substance now,
(41:37):
but pharmacitic companies find their way to do it right.
You see, with the locks, you know, the thing that's
so crucially important for reversing overdose, but manufacturers find ways
of selling them in a form this administer that costed
dramatically more money than the few bucks and knocks on
the cost, and you started talking about something that's happening
in this area as well, where kenemine is now this
(41:58):
thing called esketamine or something like that. Just can you
explain what's going on there, what your concerns are about it? Well,
Ketamine is a receimate, meaning that it has two molecules
in equal proportion. One is the right handed ketamine molecule,
the others the left handed kenemine molecule. There basically mirror
images of one another, and each molecule may have its
(42:20):
own role to play in the benefits. Kenemine provides. What
Jansen has done which has s ketamine or spravado on
the market currently is It's taken the left handed molecule
s ketamine and patented it for depression. Also packaged it
in a way that it could be administered in a
clinic without necessarily I V S or needles involved. It's
(42:44):
done intranasally, and took it through the usual pipeline to
get FDA approval and just barely skated by. Didn't do
nearly as well as they think broadcast um and the
FDA in fact made an exception. Usually you need a
(43:04):
few trials that are positive to grant that a drug
might be used in a certain way. There was only
one that worked. There was only one trial that showed
efficacy in the case of stemine. In any case, it
has its challenges. Um from a clinical perspective, may not
be as effective as ketamine. But I think the most
(43:26):
problematic aspect of it, in my mind is how mercenary
it is. So ketamine costs a dollar or two to administer,
I mean, in terms of the medication costs, s ketamine
is about a thousand dollars. It does, so it's it's
half the compound, but you know thousand times as much.
(43:47):
And why did if why did f D a fast
track it? Because it's dealing with a severe issue, depression,
treatment resistant depression especially very problematic. I was hearing that
if you look at which of the clinics and clinicians
are doing a better job, typically the ones making the
effort to use ketamine are having better results and being
(44:08):
more responsible towards their patients. Then are the ones that
are trying to profiteer off of using this asketamine approach. Well,
the profiteering is only on the industry side. Yeah, the
doctors who are involved are more often kind of more
conventional types who told the line, let's say they're given
this medicine drug, reps come provide information on how to
(44:30):
provide it. They may not be operating from a more
holistic framework where therapy is integrated into the process. With
ketamine clinics, therapy is invariably a big part of it.
There's an understanding that a proper framework is important, that
the psychoactive effects need to be attended to with provado
(44:50):
not so much. Again, it's just a procedure. Yeah, somebody
described to me, you know, and entsiologists just trying to
make some additional money on the side basically and having
some experience with kennemine by virtually being an a thesiologists
and saying, here's another opportunity for them to make money
without basically investing the time or the energy to understanding
all the dimensions that you and I have been talking about.
(45:12):
Because can be abused, right, people do get in trouble
with it. I'm just wondering if that whole more commercialized
approach might lend itself to giving in trouble as well. Absolutely,
you know, I think one of the big challenges we're
going to be facing in these sorts of compounds entering
into therapeutic settings, is the eagerness with which they might
(45:38):
be pushed. You know, this transformative potential story can also
have its dangerous Oh we need just need to keep
trying until we get that transformative experience. And you know
that could be a road to nowhere or a road
to real problems as you're suggesting. So yeah, there there's
a definite danger with ideological interests or maybe a pecuniary
(45:58):
interest and phasizing continuing to try the medicine, continuing to
try the medicine even as it doesn't seem to be
doing much. So, Elias, I want I want to finish
up by asking you two questions, one backward one forward.
Which was I noticed in looking at your CV that
you were born in Haifa, Israel, right, And I remember
you're describing some of your your origins, and I wonder
(46:20):
if you could just say something about that. Can you
discern any impact of your early years growing up in
your identity on the work that you're doing now? Well,
I I'm not quite a refugee, but in many ways
that the story is comparable to that. I am able
to go back to Israel and all of those things,
but it was an environment that my parents felt wasn't
(46:43):
as conducive to raising us, my brother and sister and I,
So we went to the States to find greater, greater opportunity,
greater tolerance because you're growing up in Israel, not Jewish,
but growing up is a Palestinian, Arab Christian ISRAELI exactly, yeah, um,
(47:05):
you know, and I'm speaking as someone who's parents were
like my mom spoke Hebrew better than any other language,
and my dad went to UM a lot of the
good universities there, so they were definitely acculturated. But there
was this this element of distance, nonetheless that has stayed
(47:25):
with me. So when you ask how that might have
informed the work I'm doing, I've I've definitely felt like
an outsider and always investigating the systems that are foisted
on us for their absurdity, their violence, their unreality. That
that's been a big part of my um my perspective
(47:49):
and has definitely allowed me to recognize where things might
be done differently. As with ketamine, it's a look at
just the last question thinking forward. I mean, you're still
you know, you're early in your career, You're young. You've
been doing some fascinating research about kenemine. What's your hopes
and ambitions for yourself over these coming decades in terms
(48:10):
of do you see yourself committed to doing this research
even more so on kedemine and towards psychedelics. UM. Do
you think it will continue to be connected to your
research and drug treatment? Is there some grand hopes that
you have for all of this? Well? I I went
into this research personally with a sense of injustice at
how this model, which had shown such promise in the
(48:35):
fifties and sixties and Jenny's work, was so dismissed or
even demonized, And in that regard, I feel like I've
done what I need to do in an academic setting,
you know, my own small role in helping rehabilitate this
model and and apply it to a drug that had,
you know, just narrowly escaped being a purely a biological intervention. UM,
(48:59):
so that art, you know, I'm not so sure what
else I can do in academic settings that would be
interesting to me. I think now it's about helping people
more generally, and I'm under no illusion that that feeding
the academic industry helps people. So I'm you know. I
think the question now is what I might do to um,
(49:20):
you know, bring healing, understanding, social change beyond academia. Yeah, well,
as we should talk, because there's somebody who my first
seven years in this area worlds in academia and then
I moved outward from there, um you know, and hopes
that doing so we get it outside of the of
the university and into the broader world. So I look
(49:41):
forward to future discussions with you, not just on air,
but also over coffee as the pandemic recedes. But I
did really really want to thank you very very much
for joining me on this and it's really been a
pleasure and edification. So thanks so much, and best of
luck with all your research and other plans ahead. Thank
you so much. Psychoactive is the production of I Heart
(50:06):
Radio and Protozoa Pictures. It's hosted by me Ethan Naedelman.
It's produced by Katcha Kumkova and Ben Cabrick. The executive
producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren
Aronovski for Protozoa Pictures, Alice Williams and Matt Frederick for
I Heart Radio and me Ethan Nadelman. Our music is
by Ari Blusian and a special thanks to a Vivit Brio,
(50:29):
Sef Bianca Grimshaw and Robert Beatty. If you'd like to
share your own stories, comments, or ideas, please leave us
a message at eight three three seven seven nine sixty.
That's one eight three three psycho zero. You can also
email us as psychoactive at protozoa dot com or find
(50:52):
me on Twitter at Ethan Nadelman. And if you couldn't
keep track of all this, find the information in the
show notes. Tune in next time and hear me talk
with Carl Hart, a dear friend of mine who's a
neuroscientist at Columbia University, best known for his recent book
Drug Used for Growing Ups. No matter how many drugs
(51:14):
this particular person was selling or led to him, So
you shouldn't be able to kick someone's door down and
then murder them on top of that, And so I
think people were starting to put together Philanderer still uh,
he had marijuana and that cop of shot him to death.
We think about Lakwan MacDonald, the seventeen year old kid
(51:35):
in Chicago where they said that he had PCP in
a system. And he was shot sixteen time. And people
are starting to see that drugs are always used as
this convenient scapegoat to justify this awful behavior. Subscribe to
Cycleactive now see you don't miss it.
Hi, I'm Ethan Nadelman, and this is Psychoactive, a production
of I Heart Radio and Protozoa Pictures. Psychoactive is the
show where we talk about all things drugs. But any
views expressed here do not represent those of I Heeart Media,
Protozoa Pictures, or their executives and employees. Indeed, Heed, as
(00:23):
an inveterate contrarian, I can tell you they may not
even represent my own and nothing contained in this show
should be used as medical advice or encouragement to use
any type of drug. Hello, Psychoactive listeners. So today our
(00:45):
guest is a Columbia professor, Elias Dakwar, who's done this
fascinating research on using ketamine combined with mindfulness meditation to
help people struggling with drug addiction. And he's actually one
of the few people in the United States to actually
have received federal funding for research on psychedelics. I'm delighted
(01:07):
to have you on the program and lives so just God,
just start off, just tell me your name and introduce
yourself and your title and where you are right now
and such. Thanks for having me. My name's Liastkwar. I'm
currently at the Columbia Medical Center, calling from my office
here in New York City. I'm an associate professor here
of psychiatry, and I've been interested in research with ketamine,
(01:33):
combining it with therapy for a variety of addictions and
but addiction. I mean you started off in all this,
even before you get into the kid amine about working
on addiction and addiction treatment. Isn't that right? Correct? Yeah?
I started my foray into addiction treatment with meditation. I
was very interested in how meditation might be helpful for
(01:53):
disrupting some of the automaticity and reactivity that can happen
with addiction, and developed an interest in combining meditation with
other modalities. Meditation alone wasn't quite cutting it, and this grew.
I mean you first got these insights from your own
personal experience with meditation and its value in your own life. Yeah,
(02:13):
both personal experience with meditation, also with non ordinary experiences
more generally, what do you mean in ordinary experiences? I
guess psychedelic type experiences, fasting, mystical experiences, those sorts of things.
Meditation has been the most I think durable and reliable
for me route towards those sorts of states. And you
(02:38):
know there's a practice associated with it and a practice
that enjoys a lot of social legitimacy, at least here
in the United States, so it seemed something that could
lend itself to treatment in Western models for addiction. Things
have changed quite a bit since I started doing that
research with greater interest and incorporating substances that previously had
(03:01):
been deemed inappropriate and medical settings like the psychedelics. But
at the time it seemed like a fairly straightforward strategy
think about meditation. Were you aware of that kind of
earlier era, back in the sixties where Timothy Learry and
Richard Albert In a whole host of other people were
actually experimenting madelsty and I think mess Glinn perhaps philocybin,
(03:25):
psilocybin and addiction. I mean, did you did you know
that history when you first got interested in this stuff?
I did now. I grew up in the Bay Area
and my uncle's were part of the counterculture during the
sixties and would browse their bookshelves growing up reading R. D.
Lange and Carlos Kostayeta and ram Das and all of
(03:48):
those things, So it wasn't completely unusual or foreign to me.
I didn't anticipate that it would gain the level of
social currency that it has now. It's it's quite impressive
and it's beautiful to see that it's being embraced as
it is now. There are some challenges we'll talk about later.
I was well aware of the earlier attempts to understand
(04:11):
how these substances could be helpful the unfortunate end to
that research because of criminalization of these substances back in
the late sixties and such. Yeah, exactly. And in terms
of your mentors and such when you started to study
addiction treatment, right, I guess in your earlier years of
training in psychiatry, Um, were you encouraged by them to
(04:33):
look into these avenues of the role of the ketamine
or psychedelics at that time. There's an interesting story I, Um,
you know Karl Hard of course. Um, he's been a
mentor to me and big source of support when I
first mentioned to him that I was interested in in
doing this sort of work. I was interested in psilocybin. Actually,
(04:55):
at the time, Roland Griffith at Johns Hopkins had come
out with the repeat of the Good Friday experiment, where
he showed that psilocybin given to healthy volunteers can lead
to sustained improvements and well being and these very profound
mystical experiences that they remember as among the most important
(05:16):
in their lives and maybe just explain, actually, what's that
initial Good Friday experiment was sure. It was an experiment
done at Harvard investigating psilocybin. The experiment took people who
have an interest in spiritual matters, people from the seminary clergy,
and investigated what happens when psilocybin is given, whether there's
(05:40):
an improvement and spiritual understanding, whether it occasions experiences comparable
to mystical states. And Roland Griffiths, who himself has a
longstanding interest in meditation, did an experiment that basically duplicated
those effects and found that psilocybin has the propensity to
(06:02):
cosmistical states, changes in time and space, a sense of
knowing something that's beyond words, a sense of revelation of
seeing things in a profoundly new way. And these experiences
went on to be remembered for um years subsequently as
(06:23):
among the most powerful the person's life and also impactful
with friends spouses, noting that there was a clear difference
in the person after versus before. So that was the
the experiment that Roland Griffiths had done, and that pretty
much opened the door to this research being done again
on a mass scale. Actually, actually, Lass, if I recall correctly,
(06:47):
even before Roland Griffiths had done that study, I think
Rick Doblin, the founder of MAPS and Multidisiplinary Associated Cycholic Studies,
had done his own twenty five year follow up on
that Good Friday experiment and had tracked a lot of
these participants. I think these Boston University Divinity students down
to see what they thought about this experience twenty five
years later, and I think it found that many of
(07:09):
them still regarded it as one of the most profound
spiritual experiences in their lives. They wish they could talk
openly to their congregants about it, uh, you know, they
wish they could do it with their kids. Things like this.
Some of them felt it had brought them closer to Jesus.
But you were saying about Karl Hart. So then Carl,
our mutual friends, says to you, so I had mentioned
(07:30):
that I that I'm interested in potentially doing treatment study
with psilocybin for addiction and said, well, you're not going
to be able to get an I H funding for it.
My friend Um he's spoken with Nora Valkao herself, who
said that ni H NEIDA, in particular our death set
against funding any of that research and just explained Nora
local is. She's the head of the National Institute on
(07:54):
Drug Abuse NIDA, which is the premier funding agency within NIH,
fueling a lot of the research being done to investigate
treatments for addiction and also the harms associated with drug use.
NIDA emerged in lockstep with the War on Drugs as
the science arm two identify what the risks of drugs
(08:17):
might be and how to best deal with any problems
that might emerge. So he was emphatic that I would
be wasting my time trying to pursue that kind of
research if I hope to get funded by NIDA. He
thought there might be a better chance looking at ketamine.
Ketamine has comparable effects to psilocybin, but it's not scheduled.
(08:38):
It's Schedule three, which means that it has known medical
use with some risk of abuse. It emerged in the
fifties as an anesthetic that lends itself to very easy use.
It can be given to people in the battlefield, in
(08:58):
accident settings without requiring intubation, because it doesn't depress respiration,
doesn't cause people to stop breathing, doesn't have any effects
on cardiac functioning, so it lends itself to easy administration.
You can innesthetize people in settings that don't require the
usual supports that hospitals provide. So in the Vietnam War,
(09:19):
for example, it would it be too exactular what you're
dealing with that And it was also used for in animals,
right what animal surgery, veterinarians used to, etcetera. Yes, and
it continues to be used in those capacities, both in
veterinary and human medicine. And you may know as well
that ketamine is a descendant, let's say, of PCP, So
(09:41):
PCP works in a very similar way to ketamine. It
binds to the PCP site of the glutamate receptor. Glutamate
is one of the most abundant excitatory neurotransmitters in the
brain and can lead to dissociation. With that effect, it
binds to the site antagonize his glutamate, and it can
(10:02):
lead aspects of experience that are usually coupled to become decoupled,
so the feeling and the thinking part, the conscious and unconscious. Well,
it's when I remember about PCP though, was all the
hysteria in Washington, d c. Where it became one of
the most popular drugs of use and abuse for a while,
and you'd have cops telling these stories about people crazed
(10:24):
on PCP, you needed five cops to tie them down
and all this sort of stuff. But um, I didn't
realize the connection between PCP and kennemine in that regard. Yeah,
PCP definitely became one of the scare drugs of the
DARE program. Growing up in the Bay Area, every year
we had the same story from the cops who came
with the suitcase of drugs to tell us about why
(10:45):
to stay away from heroin, why to stay away from acid, pot,
and PCP always involved a story of you know, someone craze,
either ripping out his eyeballs or jumping out of a
building or trying to do something of hercue lee in excess,
like trying to flip over a cop car. But PCP
is basically ketamine, except it's longer acting and has greater
(11:09):
affinity for the glutamate receptor. So with proper dosing. It
can work functionally like ketamine does. The one difference is
that it is longer acting. Ketamine is incredibly short acting
um It has a very rapid clearance right the half
life short so after a single administration of ketamine, the
(11:29):
person is fairly back to normal after forty minutes. But
where people feel actively under the influence of the kenemine,
is it only that length of time as well? Or
depends on how it's administered um so intranasally, which is
the way that it's most commonly administered in recreational settings.
The last about twenty minutes intramuscularly, last about forty minutes intravenously.
(11:51):
It can last as long as it's being infused, as
long as it's stripping into the person's bloodstream. You know,
as I say, I think the first time I ever
read about ketamine, I think it was reading some kind
of autobiographical book by John Lily right. And John lily
was a founder of stay teaching communications, you know, communications
(12:12):
buying among dolphins and whales, and also the guy who
invented the isolation tank. And he talked about taking ketamine
and he had suffered from migraines and he felt the
migraines just kind of separating from his head, and then
he got into a much more exploratory phase. I think
of taking ketamine like every hour on the hour in
one of his isolation tanks and almost killing himself that
(12:35):
way or something. But it was the first time I
realized that there was this drug called kenemine. I don't
even know if I was aware at the time of
its role in surgery and things like that, but it
does seem like this incredibly versatile drug exactly. The versatility
comes from the variety of effects that can have based
on dose. So it was originally intended to be used
(12:57):
in the anesthetic range where it would put people out,
but it can also be used, as you said with
John Lilly's self experimentation and exploration, can be used in
a sub anesthetic range where it doesn't lead to loss
of consciousness, but it leads to fairly profound changes in
experience and perception. And that's really been where the most
(13:18):
recent interest has been and what it might do psychiatrically
within that sub an aesthetic range. So the resurrection of
ketamine came initially through if Jenny Kropitski's work actually if
Jenny Krpitski was also funded by MAPS. You mentioned Rick
Doblin earlier. He did some fascinating work in St. Petersburg.
(13:40):
St Petersburg, Rushia and not Florida. Let's I thought the
name gave it away. Um. Yeah, So he he gave
an intramuscular dose of ketamine, you know, enough to occasion
a psychedelic state in combination with what he called ketamine
psychedelic therapy, and there were lots of iterations of this therapy.
(14:02):
What what he ultimately landed on was a therapy framework
comparable to what was used in the fifties and sixties
with LSD and psilocybin, where the experience was central to
the treatment. The therapy was intended to help a person
and prepare for a potentially transformative experience, and then subsequently
(14:25):
to help the person makes sense of it, integrate it,
and find a way to consolidate those benefits in pursuit
of a healthier life, whatever that life might look like,
depending on the challenges the person's facing. So if Jenny
investigated ketamine in a similar way for alcohol addiction and
heroin addiction and found remarkable effects, I think we'd be
(14:48):
really in a different place right now if he was
allowed to continue this research. Unfortunately, ketamine is now illegal
and has been so for decades in Russia, and so
he to end the research, a reprisal in a way
of what happened in the States in the fifties and sixties,
where some promising results were aborted because of policy. Yeah,
(15:11):
Alias should actually tell you, Um, I actually met a
Ginny back in the nineties, and it was when I
was starting up the International Harm Reduction Program through Soros Foundation,
and we actually did a conference in St. Petersburg on
drugs and HIV and harm reduction, and there was this
kind of opening period. There was even a period in
the early years of Putin of his being open to
(15:32):
decriminalization of possession and things like this, and then this
massive hard turning in the opposite direction. But I mean,
it's interesting to think that some of the pioneering work
in this area came out of Russia. And what I
think is also unappreciated is how formative if Jenny was
to biological psychiatryes embrace of Kenemine. So if Jenny had
(15:56):
gone to Yale as a fellow while engaged in this
research and in St. Petersburg and Yale, as you may know,
is where ketamine was serendipitously found to have antidepressant effects.
And I didn't know that when was that? The first
paper was in two thousand is John Crystal, who is
(16:20):
the editor in chief of Biological Psychiatry, and that really
set the stage for how ketamine has been received by
mainstream psychiatry. It was being approached as a purely biological intervention,
as a medicine comparable to e c T electro convulsive therapy.
So this is emerging at Yale at the same time
(16:43):
that ketamine a K A special K is becoming popular
in the gay dance clubs in the city. I mean
as an Arnold's almost simultaneously happening about twenty years ago.
And does the fact that it's emerging is such a
popular party drug and in the media complicate the efforts
at Yale to look at it's role in depression. I
think the foresight perhaps that the psychiatrist that Yale had,
(17:06):
but also ultimately the great blind spot, was to not
look at ketamine for what its psychoactive effects might be,
to look at it purely as a biological intervention. That
separated it quite dramatically from why it might be used
in recreational settings, which is to elicit these usually enjoyable,
interesting effects. So, in developing the story behind how ketamine
(17:30):
might be impactful, the hope was that it would create
space for ketamine like compounds without those psychoactive effects to
be developed. And what do you think I mean, I'm
going to ask you about your studies shortly, But in
terms of uh, this notion of separating out the psychoactive
effects from the medical effects, I've seen people try to
(17:51):
think about what that can be done with cannabis, Where
we can you know, other drugs. I mean, is the
psychoactive element of ketamine essential to its sickacy in dealing
with whether it's depression or addiction. Well, the short answer
is it's complicated. I think it's foolish, first of all,
two discount the psychoactive effects to say that they're totally
(18:14):
irrelevant and unimpactful. It's foolish for the reason that we
don't give enough attention. If we see those effects as irrelevant,
we don't give it enough attention to setting the stage
for them to emerge and providing a safe space and
recognizing that they can potentially be impactful, and it's foolish
(18:34):
because there may be some very powerful ways of harnessing
those effects to mobilize the efficacy of ketamine. But I
think the larger question you're asking is what is the
role of subjective experience in our healing? And might there
be some paradigmatic deficit in the psychiatric framework that a
(19:00):
doesn't recognize the importance of subjective experience. It's all about
symptoms and the brain and behavior. What about consciousness? What
about the mystery of what it means to experience and
dream and imagine? Have we been missing something as psychiatrists
(19:20):
by over emphasizing neurobiology, symptoms, behavior? I mean, is that
a general failing of psychiatry and psychiatrists even we compare
to other forms of psychotherapy. That that's the focus on
the pharmacological and the focus on the medical element of
this just as kind of become. Whether we call it
(19:41):
a crutch or a barrier to thinking of in the
ways that you're describing right now, I think it is
a general challenge with psychiatry. The missing link here, I
think is that ketamine was also for a period and
continues to be so to some extent, a pharmacological model
of psychosis, mean ing that ketamine was being approached as
(20:02):
a medicine that can simulate what it means to be psychotic,
schizophrenic hearing voices, having unusual thoughts, and this was an
effort to better understand the neural underpinnings of psychosis. So
John Crystal's work with ketamine originally using sub anesthetic doses
(20:22):
of ketamine to investigate what psychosis might be and what
the role of glutamate might be in psychosis. And the
serendipitous finding came from doing that research, according to John Crystal,
that he was providing it to healthy volunteers and finding
that people were reporting that they were feeling better afterwards,
(20:42):
that there was an improvement in mood, even if they
weren't necessarily depressed beforehand, and that led to investigating ketamine
again in a in a biological frame, meaning there's no therapy.
The psychoactive effects are there, but they're not prepared for
or integrated or anything like that. It's given to depressed
people one occasion and then they were followed for a
(21:04):
few weeks to see how the depression was affected, and
that spurred a variety of studies looking at ketamine in
a similar way for depressions through ideality PTSD obsessive compulsive disorder,
giving a single dose in the absence of any kind
of psychotherapeutic framework, without much regard for the psychoactive effects,
(21:28):
to see how symptoms might change. Now, that's not really
different than how ketamine in a psychedelic framework might work.
What's different is the lens that was brought to ketamine.
The lens in this case was very biological, looking at
it as something that's entirely pharmacological in the sense that
(21:49):
it's entirely brain based without the psychoactive effects or effects
that might lend themselves to therapy being a part of
the process and investigating from there are other compounds that
might work like ketamine, but with reduced psychoactive effects. We'll
be talking more after we hear this add I'm curious
(22:24):
to hear. I mean, now that you've been doing these
studies right with people struggling, you know, with alcohol problems,
of cocaine problems, and cannabis problems. Um, could you just
describe a couple of your patients and what that was like. Yeah. Sure.
As I mentioned before, I've been interested in how the
(22:45):
meditative state might be helpful at disrupting addiction, and how
it might lend itself to a practice whereby the usual
automaticity and reactivity of addiction have my automaticity, you mean
people sort of just reflexively doing something on consciously, not
necessarily unconsciously, but there's such a pronounced reactivity. If there's
a particular feeling, the compulsion to respond to that feeling
(23:09):
by using something or craving becomes so impactful. People aren't able,
who are in the throes of severe addiction that are
not able to allow the craving to simply pass. There's
a feeling of needing to act on it at the
same time that we can surmise that a meditative practice
(23:29):
might help with those things. Of course, a meditative practice
requires some suspension of those things as well. Otherwise you're
not gonna be able to meditate if you're feeling agitated,
and if if your thoughts are causing you to move
in this way and that. So the hope was that
by providing an experience that is easier to come by
(23:50):
comes through a medicine, that the meditative state that happens
would serve as a stepping stone for understanding how to
continue meditating. And what to aim at. And also the
hope was that the medicine might provide an enduring opening
with improved craving sensitivity, improved mood, improved anxiety, so that
(24:11):
the usual vulnerabilities aren't so compromising. It noticed, it's using
ketamine as a way to get people to move into meditation,
integrating meditation and life right, and that's somehow that would
be helpful in that regard correct yet by approximating the
meditative experience, by making it easier to practice, and also
by motivating people to do it. You know that there's
(24:33):
been a lot of research suggesting that one of the
critical vulnerabilities to engaging fruitfully with any treatment is tenuous
motivation is just not feeling inspired or capable of doing something,
and that demoralization is I think a big part of addiction,
that sense of having resigned oneself to the addiction, having
(24:56):
tried again and again to stop it, and feeling like,
what's the why It's it's no good. So I also
hope that the medicine would disrupt that, that it would
provide a sense of refresh possibility. Well, let me just
back up for one second, so just to get a
picture of this so when these people are in your studies,
First of all, these people are generally more middle class
(25:17):
or people are more living on the street kind of
living rough. It cuts through different cuts across and and
they're coming into a facility at Columbia UM. They're in
a room. Are they wearing blindfold? Is their music in
the background? Are you sitting by them while they're going
through it? Are they hooked up to an ivy? What
does it look like? Yeah, so it happens at Columbia
(25:40):
Medical Center. But we created a space for administering the
medicine that is as warm and comfortable as possible. The
old you know catchphrase of set and setting remains very
important to respect. You know, these medicines, because of how
profoundly they can change experience, require an environment where people
(26:06):
can continue feeling safe. Environment conducive to allowing different experiences
to emerge safely and in a manner that allows the
person to feel heard and respected. So having a sterile
medical environment did not seem appropriate given what we were
trying to do. So we took a room that was
(26:26):
ordinarily used for laboratory experiments and made it look like
a living room. They are guided through a meditation exercise
prior to the ketamine being delivered. It's delivered through an ivy.
They're wearing an eyemask, laying down on a bed. I'm
sitting next to them or another physician is sitting next
to them, as well as the therapist, And throughout the
(26:48):
experience they're being guided through what's called a body scan
in mindfulness, that means paying attention to one sensations, one's breathing,
if thoughts come up, noticing the thought, but maintaining a
mindful stance, which means being open, being non judgmental, accepting, attentive,
and no music in the background. No music, and we
(27:09):
we keep it very silent. So and another hypothesis of
tacit hypothesis I was operating under here is that a
lot of the suffering that comes with addiction comes from
losing sight of the primordial mystery of experience. You know,
what can't be known, what can't be reduced to words,
(27:30):
concepts that the experience of someone in addiction is very
overdetermined and over interpreted to organize too knowing in a
way for its own good. And I wanted the experience
to allow for accessing what is beyond knowledge basically what
can't be put into words, And for that reason I
(27:54):
wanted the experience to remain as unanchored in things that
are ordinarily intelligible, like music, going deep into ineff ability. Basically,
it sounds like what you're describing. When I read about
some of the psychedelics therapy, sometimes it seems like something
that's almost more explosives the wrong word, but I mean
(28:14):
kind of more profound transformational that causes people to rethink
their lives, to rethink their experience. And it sounds like
what you're describing is a more modest form of that.
Is that right? Well, listen, if an explosive transformation is coming,
I welcome it. What and they do happen? They do happen.
(28:37):
Even having one's systems of knowledge dissolve in you know,
the primordial silence, it's not an easy thing to go through. Um.
At the same time, I think you're picking up on something.
I am skeptical of these kind of fantastical narratives of
communing with the divine or having some kind of pivot point.
(28:59):
They may be helpful, I'm sure, but in my mind,
what's most helpful is to find one's footing and have
some kind of regular, enduring practice that helps one navigate
the trials and tribulations of life. Yeah, well, you know
what you make me think of. You know, one of
the historical pieces that many people don't know is that
(29:19):
one of the founders of Alcoholics anonymous Bill Wilson, right,
and this was all about, you know, dealing with very
serious alcoholics and uh, you know, and the the whole
twelve step model. And then at some point he began
taking I can't remember this LSD or mescal in LSD,
and he came to believe that basically this could play
(29:40):
an important role in very serious inebrious alcoholics coming to
a kind of come to Jesus moment um in terms
of their own self awareness, you know, that kind of
moments that they're seeking for. And then I guess in
his case what followed from that was less the meditative
practice and more the fellowship of the whole twelve step approach.
(30:01):
But I wonder how you see what you were doing
comparison to what he experienced and talked about, or was
actually discouraged from talking about once he started talking about it.
I I, as I said, I'm supportive of anything that
could be hopeful and a transformative experience clearly can be impactful.
I mean, many scholars have written about this, starting with
(30:21):
William James. Bill Miller, the founder of Motivational Dansmo Therapy,
also wrote about the role of transformative experiences in recovery.
So I'm very supportive of them. I just wanted to
ensure that I maintained as comprehensive a model as possible,
so that while the experience can lend itself to that
(30:42):
if it were to occur, that if it doesn't occur
and someone merely, if merely is the right word, enters
into an eff ability, then that's fine too. We'll make
do what we can. Let's take a break here and
go to an ad Among your patients or the subjects
(31:09):
in the study, is there one that one or two
they just sort of stand out that you could describe
their experience? Yeah? What one, very powerful story, which I
think also indicates just how severe some of the addictions
we were dealing with our It was a laboratory study
investigating how ketamine might disrupt cocaine self administration. So woman
(31:33):
who had worked as a sex worker at a cocaine addiction,
very significant history of trauma, had multiple um scars all
over her body that came from having been abducted by
several men and mutilated and what sounds like some kind
of bizarre ritual um. She was able to get away
(31:55):
with severe wounds all over her body, but it was
able to escape. She worried that if she hadn't she
might have died, and it's haunted her as continued to
be an important part of her pathology, unfortunately. But she
came in with a fairly significant crack cocaine addiction, and
the experience that she had with ketamine is one of
(32:18):
the most remarkable I've seen speaking of transformative So this
was a study that wasn't really intended to help people
stop using. It was, as I mentioned, a lab study
to investigate a very specific question whether it reduces cocaine
self administration. Beyond the mindfulness training to help the person
prepare for the infusion, et cetera, there wasn't much support
(32:41):
and she had an experience where she began with moaning
in a in a kind of aroused way. Then it
went into sobbing to um trying to escape something, writhing
on the bed, and that's where the support of physician
therapist can be crucial when you know, it's not simply
(33:03):
a meditative state, but this kind of intense ab reaction
or or a reliving means to occur. And she ultimately,
by the end of the infusion, had calmed down and
was just repeating over and over again how the knife
had been removed, that it had been half out without
(33:24):
her realizing, but finally been removed. And she said something
very powerful, which I think of quite regularly. You know,
when you have a knife in you, she said, you
get used to it, and it's not until it's coming
out that it really hurts. And it was really the
the space that the ketamine provided her that allowed her
the safety, the the relaxing of defenses to finally allow
(33:49):
the knife out. And what was remarkable is that, as
again because this was not intended to necessarily provide treatment,
it was to ask a very specific question, she nonetheless
stopped using cocaine for the duration of the follow up
period after this this laboratory study. We continued seeing them
for four weeks after. And that's an example I think
(34:10):
of how there are things going on here which remain
very untapped, you know, the capacity for these single experiences
to shift things so dramatically. Again, I'm not hanging my
hat on that for every patient, and I'm trying to
find a very durable, resilient framework by which we might
(34:33):
tap into those benefits. I think using meditation and having
a psychotherapeutic framework important for that. But it can happen.
It's not simply anecdote. And well, I tell me, have
you done the follow up with her or others? You know,
not just four weeks later, but six months later, a
year later, and to see how they're doing. Yeah. So
we we've had two clinical trials that UM involved fairly
(34:57):
long follow up, one with cocaine addicted people and one
with alcohol dependent individuals. They were both several week trials
that involved several months of follow up after they completed
the trial, and we continued to ask how they were
doing and what their youth patterns were. And in both
(35:18):
UM studies, the rates of abstinence with the people who
received ketamine were significantly higher than with the control group.
So these are durable effects and all based upon the
one session. Was it just one session or two sessions
you did with them? Yea, for these studies it was
one session. I see. But when I think about like
(35:39):
a friend of mine who was suffering very seriously from
depression and trauma. Man having some pain, and he did,
I think what many people do, and man, you know
more and more where he did six ketamine sessions in
the space of a month, followed by one a month
for a year and did get some lasting many years
thereafter benefit. But have you considered doing that model as well,
(36:01):
or is there a reason to keep it to the
more a model which involves giving fewer administrations. It's a
very important question, and I think this gets at some
of the strictures that come with doing controversial research. So
I should mention that all of the research I've done
has been NIH funded either um NEIDA, which we talked
(36:21):
about before, and I Triple A, which is the wing
of ni H that's focused on alcohol treatment. And in
getting funding from both agencies, I needed to do a
lot of politicking because even though the grants that I
had submitted had received great scores from the Science Committee,
the more bureaucratic wing of both agencies was not interested
(36:47):
in investigating a mind altering substance for addiction because they
were worried about the political fallout, or because of their
own ideologies or ignorance, or there's a notion which is
erroneous that people who are prone to addiction whatever that means,
are also prone to getting addicted to other substances if
(37:08):
they were exposed to them. So if you're providing something
like ketamine to someone with cocaine problems, it's like you're
introducing potentially problematic, addiction prone substance to someone. Is there
any rational, evidence based approach for people within the NIDA
bureaucracy to take that view. No, No, it's a prejudice.
(37:30):
I have to tell you. It's just infuriated me. No end.
I mean it's a tragedy because NIDA provides I think
of all the funding for drug abuse research, not just
in the US but globally, and to be in this
incredibly rigid, ideological, you know, perspective on this stuff. I mean,
are they even funding any psychedelics research now apart from ketamine? No? Nothing.
(37:51):
I mean, well that's I should say, they're not funding
any therapeutic um, only looking at the harms of these
things exactly. Uh. Yeah, And to your point, a lot
of the substances that have been helpful for addiction, methadone,
puper nor pine if they were, for whatever reason, illegal,
(38:13):
we would be missing out on a tremendous opportunity. Those
substances are psychoactive, They activate receptors that other so called
drugs of abuse do. So, you know, the the argument
is definitely specious, but that was the argument I was
contending with. And as you seem aware, the challenge here
is that we're not really dealing with only science. We're
(38:33):
dealing with politics. We're dealing with ideology. We're dealing with
a particular perspective on drugs and addiction that comes less
from evidence and careful experiment and more from you know,
the drug war. I mean, I'm curious if you imagine
in the future, let's assume that at some point the
(38:55):
the other psychedelics actually become as legally available and permissive
to work with um for you know, drug treatment, ptsd, O,
c D, depression, whatever it might be. When more of
these are available, well ken amine play a lesser role.
I mean, is ketamine having some of its time in
(39:16):
the sun because the other ones are so hard to
get funding for except from private sources. That's a great question. Yeah,
I would not dismiss the power of ketamine. I don't
think it's simply that it has it's fifteen minutes due
to the other drugs being inaccessible. It has its own power.
And I should tell you a story a colleague of mine,
(39:37):
I keep her anonymous. I've been struggling with fairly severe
psychiatric issues for most of her life and did not
receive benefit from the conventional approaches. Met a healer who
worked with various types of psychedelics m d m A, psilocybin,
d MT LSD, and went through all of those, tried
(40:02):
every single one, but it wasn't until ketamine. It wasn't
until high dose intramuscular ketemine that she found relief. So
you know, these are ultimately different compounds, and there will
always be a place, I think for the very unique
effects that ketamine has. I should also say that ketamine
lends itself to easy administration much more than psilocybin. For example,
(40:27):
does it shorter acting, it doesn't last for hours and hours,
it doesn't require the same level of psychological preparation, hand holding, integration.
It lends itself to all of those things. So they
mentioned with the case of the sex worker who definitely
needed support and guidance, but in in a lot of cases,
people have a fairly calm experience and they're able to
(40:51):
move forward. I mean, unless I should tell you. You know,
I had my own experience with kenemine a guided session
last summer, and I hadn't really done it that way before,
and I was struck that compared to mushrooms, it was
comparably powerful and as you say, much shorter acting, but
it came on in my body in a much gentler way,
(41:14):
you know, And maybe this's is part of it as
I get older, mushrooms kind of you kind of a
little bit raggedy effect coming in. But the kennemy was
very calm and easy. And then after it's over, um,
you know, barely an hour later and one could re
engage in normal activities that one wanted to. Well, let
me ask you this whole thing with the commercialization. You know,
you can't pat into stuff is basically a generic substance now,
(41:37):
but pharmacitic companies find their way to do it right.
You see, with the locks, you know, the thing that's
so crucially important for reversing overdose, but manufacturers find ways
of selling them in a form this administer that costed
dramatically more money than the few bucks and knocks on
the cost, and you started talking about something that's happening
in this area as well, where kenemine is now this
(41:58):
thing called esketamine or something like that. Just can you
explain what's going on there, what your concerns are about it? Well,
Ketamine is a receimate, meaning that it has two molecules
in equal proportion. One is the right handed ketamine molecule,
the others the left handed kenemine molecule. There basically mirror
images of one another, and each molecule may have its
(42:20):
own role to play in the benefits. Kenemine provides. What
Jansen has done which has s ketamine or spravado on
the market currently is It's taken the left handed molecule
s ketamine and patented it for depression. Also packaged it
in a way that it could be administered in a
clinic without necessarily I V S or needles involved. It's
(42:44):
done intranasally, and took it through the usual pipeline to
get FDA approval and just barely skated by. Didn't do
nearly as well as they think broadcast um and the
FDA in fact made an exception. Usually you need a
(43:04):
few trials that are positive to grant that a drug
might be used in a certain way. There was only
one that worked. There was only one trial that showed
efficacy in the case of stemine. In any case, it
has its challenges. Um from a clinical perspective, may not
be as effective as ketamine. But I think the most
(43:26):
problematic aspect of it, in my mind is how mercenary
it is. So ketamine costs a dollar or two to administer,
I mean, in terms of the medication costs, s ketamine
is about a thousand dollars. It does, so it's it's
half the compound, but you know thousand times as much.
(43:47):
And why did if why did f D a fast
track it? Because it's dealing with a severe issue, depression,
treatment resistant depression especially very problematic. I was hearing that
if you look at which of the clinics and clinicians
are doing a better job, typically the ones making the
effort to use ketamine are having better results and being
(44:08):
more responsible towards their patients. Then are the ones that
are trying to profiteer off of using this asketamine approach. Well,
the profiteering is only on the industry side. Yeah, the
doctors who are involved are more often kind of more
conventional types who told the line, let's say they're given
this medicine drug, reps come provide information on how to
(44:30):
provide it. They may not be operating from a more
holistic framework where therapy is integrated into the process. With
ketamine clinics, therapy is invariably a big part of it.
There's an understanding that a proper framework is important, that
the psychoactive effects need to be attended to with provado
(44:50):
not so much. Again, it's just a procedure. Yeah, somebody
described to me, you know, and entsiologists just trying to
make some additional money on the side basically and having
some experience with kennemine by virtually being an a thesiologists
and saying, here's another opportunity for them to make money
without basically investing the time or the energy to understanding
all the dimensions that you and I have been talking about.
(45:12):
Because can be abused, right, people do get in trouble
with it. I'm just wondering if that whole more commercialized
approach might lend itself to giving in trouble as well. Absolutely,
you know, I think one of the big challenges we're
going to be facing in these sorts of compounds entering
into therapeutic settings, is the eagerness with which they might
(45:38):
be pushed. You know, this transformative potential story can also
have its dangerous Oh we need just need to keep
trying until we get that transformative experience. And you know
that could be a road to nowhere or a road
to real problems as you're suggesting. So yeah, there there's
a definite danger with ideological interests or maybe a pecuniary
(45:58):
interest and phasizing continuing to try the medicine, continuing to
try the medicine even as it doesn't seem to be
doing much. So, Elias, I want I want to finish
up by asking you two questions, one backward one forward.
Which was I noticed in looking at your CV that
you were born in Haifa, Israel, right, And I remember
you're describing some of your your origins, and I wonder
(46:20):
if you could just say something about that. Can you
discern any impact of your early years growing up in
your identity on the work that you're doing now? Well,
I I'm not quite a refugee, but in many ways
that the story is comparable to that. I am able
to go back to Israel and all of those things,
but it was an environment that my parents felt wasn't
(46:43):
as conducive to raising us, my brother and sister and I,
So we went to the States to find greater, greater opportunity,
greater tolerance because you're growing up in Israel, not Jewish,
but growing up is a Palestinian, Arab Christian ISRAELI exactly, yeah, um,
(47:05):
you know, and I'm speaking as someone who's parents were
like my mom spoke Hebrew better than any other language,
and my dad went to UM a lot of the
good universities there, so they were definitely acculturated. But there
was this this element of distance, nonetheless that has stayed
(47:25):
with me. So when you ask how that might have
informed the work I'm doing, I've I've definitely felt like
an outsider and always investigating the systems that are foisted
on us for their absurdity, their violence, their unreality. That
that's been a big part of my um my perspective
(47:49):
and has definitely allowed me to recognize where things might
be done differently. As with ketamine, it's a look at
just the last question thinking forward. I mean, you're still
you know, you're early in your career, You're young. You've
been doing some fascinating research about kenemine. What's your hopes
and ambitions for yourself over these coming decades in terms
(48:10):
of do you see yourself committed to doing this research
even more so on kedemine and towards psychedelics. UM. Do
you think it will continue to be connected to your
research and drug treatment? Is there some grand hopes that
you have for all of this? Well? I I went
into this research personally with a sense of injustice at
how this model, which had shown such promise in the
(48:35):
fifties and sixties and Jenny's work, was so dismissed or
even demonized, And in that regard, I feel like I've
done what I need to do in an academic setting,
you know, my own small role in helping rehabilitate this
model and and apply it to a drug that had,
you know, just narrowly escaped being a purely a biological intervention. UM,
(48:59):
so that art, you know, I'm not so sure what
else I can do in academic settings that would be
interesting to me. I think now it's about helping people
more generally, and I'm under no illusion that that feeding
the academic industry helps people. So I'm you know. I
think the question now is what I might do to um,
(49:20):
you know, bring healing, understanding, social change beyond academia. Yeah, well,
as we should talk, because there's somebody who my first
seven years in this area worlds in academia and then
I moved outward from there, um you know, and hopes
that doing so we get it outside of the of
the university and into the broader world. So I look
(49:41):
forward to future discussions with you, not just on air,
but also over coffee as the pandemic recedes. But I
did really really want to thank you very very much
for joining me on this and it's really been a
pleasure and edification. So thanks so much, and best of
luck with all your research and other plans ahead. Thank
you so much. Psychoactive is the production of I Heart
(50:06):
Radio and Protozoa Pictures. It's hosted by me Ethan Naedelman.
It's produced by Katcha Kumkova and Ben Cabrick. The executive
producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren
Aronovski for Protozoa Pictures, Alice Williams and Matt Frederick for
I Heart Radio and me Ethan Nadelman. Our music is
by Ari Blusian and a special thanks to a Vivit Brio,
(50:29):
Sef Bianca Grimshaw and Robert Beatty. If you'd like to
share your own stories, comments, or ideas, please leave us
a message at eight three three seven seven nine sixty.
That's one eight three three psycho zero. You can also
email us as psychoactive at protozoa dot com or find
(50:52):
me on Twitter at Ethan Nadelman. And if you couldn't
keep track of all this, find the information in the
show notes. Tune in next time and hear me talk
with Carl Hart, a dear friend of mine who's a
neuroscientist at Columbia University, best known for his recent book
Drug Used for Growing Ups. No matter how many drugs
(51:14):
this particular person was selling or led to him, So
you shouldn't be able to kick someone's door down and
then murder them on top of that, And so I
think people were starting to put together Philanderer still uh,
he had marijuana and that cop of shot him to death.
We think about Lakwan MacDonald, the seventeen year old kid
(51:35):
in Chicago where they said that he had PCP in
a system. And he was shot sixteen time. And people
are starting to see that drugs are always used as
this convenient scapegoat to justify this awful behavior. Subscribe to
Cycleactive now see you don't miss it.
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