Drug Talk Q&A with Dr. Julie Holland

Psychoactive listeners. Today we're gonna do something different. It's not just gonna be me talking one on one with a guest. But I've invited an old friend of mine who I've known god for a few decades. It's the nineties now, Julie Holland, Dr Julie Holland, who's really just a spa tacular writer, thinker, clinician, you name it, I mean, and she's written numerous books. I mean, she wrote one about working in the emergency room at Bellevue Hospital in New York.

She's written books about medical marijuana and m d M a h. She wrote a book called Moody bitches about women and psychoactive drugs and all sorts of other things as well, and she's been on major national TV as a correspondent, you name it. So what we decided to do was that we were going to do a little things sort of like car talk on drugs, you know, but rest ashore. We're not driving when we're doing this, And actually I don't think we're on drugs at the

moment um. But Julie, it's great to have you joined me for answering these questions that have come in from our listeners. I'm very happy to be here. I don't have to pee in a cup to talk to you, do I ethan? Oh? Well, you know people used to say if you wanted a job at Drug Policy Alliance, you needed to fail a drug test, but that was

never true. I am not driving. Let's just say, um, you know, I have to give just one extra little plug, which is that my most recent book that came out is called Good Chemistry, and it about cannabis and psychedelics and antidepressants and lots of the things we're probably gonna be talking about. That sounds fascinating. So today we're gonna roll off a bunch of questions. So let's go to

the callers. Hey, um, you know, Michael Pollan has been doing a book tour for his latest book about psychedelics and keeps repeating the idea that the jury is still out on micro dosing, that it could all be placebo.

And if someone who's been micro docing for several years and has read James Fadiman's book, I'd like to get your perspective on whether you believe that uh, micro docing should be in completely subperceptual doses or you should be taking enough of a micro doce that you definitely feel something.

My impression and other people I've talked to who are micro dosing is that they're taking effective doses where the effects are noticeable and significant, whether or not it's a cure for anything ing or the impact that has UM. I can understand the jury still out, but I keep seeing Michael Pollen repeating that these are entirely sub perceptual doses, and that seems to me erroneous, And I wonder if

you have taught I definitely have thoughts. First of all, I think there's different ways to micro dos and you could have a goal that you want sub perceptual doses, and then you know what I usually recommend with my patients. Is One easy way to figure out whether it's sub perceptual or not is if you're trying to read a book and the words are sort of breathing and swimming and moving around, that's probably not sub perceptual. But I feel like I know a lot of people who feel

good when the micro dose. I was micro docing before it was called micro dosing. I didn't know that's what I was doing. But I'm not much of a drinker. When I was an undergrad and a premed I didn't really want to get drunk, but I wanted to have a certain levity in the proceedings for the night, and I would just have like a tiny little stem of a mushroom and I felt sort of a brilliant and connected and enjoyed myself and didn't have a hangover. I think there's a lot of different ways to micro dose.

The study that Michael Pollen is referencing came out of Imperial. It allowed participants to self blind at home, so they referred to this as citizen science. It's not a clinical study. As a psychiatrist, I will say that the psychedelics lend a certain cognitive flexibility that can be very, very helpful for a broad range of psychiatric diagnoses. Certainly there's less rumination, less fixation. You know, it's a mind opening, heart opening.

This can lead to creativity or emotional enhancement. I think there's a lot of pluses to micro dosing. And I will also say, don't knock the placebo effect. You know, it's real. People expect to get better. They do get better, and thank God for the placebo effect in psychiatry, or things would be even worse than they already are. Yeah. Well,

you know it's funny. During the beginning of pandemic, I was determined I was going to start micro docing myself, but I just kept spacing out on it every morning, so I never really got into it, never really tried it. I have done what I would call mini dozing, which is the twenty micrograms thirty micrograms which actually feel and I've enjoyed that. All I have to say, it does

kind of knock me out the next day. Now on this issue, I mean, I want to believe, and I have enormous respect for Jim Fattiman who has done so much of the research on this thing, and he's collected I think a couple of thousands of anecdotal reports from people. He's really done a huge amount of work and found real positive benefits, and so I tend to lean that direction. Now, that study you mentioned by the Hungarian fellow abolished Saghetti at Imperial College in London with Dave rit So he

found yeah, no better in the placebo. So and then there's Ilett Waldman's book, right, a very good book about her experience micro dosing and how she found it useful. So my sense is there's not much evidence of real potential harm. I understand why Michael is looking at Shaghetti study and saying, you know, the jury is out. Fatiman collecting thousands of reports suggests there's something really there, So I think it's definitely worth more research. Speaking of research

and Fatiman, I love Jim Fatiman. He is, you know, an elder in the psychedelic community. But I really want to give a shout out to Sophia Corb, who is the person who's really gathering and collating the data and doing a lot of the work. That may be an ongoing theme when we talk about things, and I'm citing studies as I am always trying to shed some light on the people right behind the people who are getting quoted ethan Um. I'm a huge fan of the podcast

and also high Julie, a huge fan of your books. Um. I'm curious to know if you guys take any psycho active of drugs yourself, and if you do, how you determine for yourself whether to use the drug or how frequently to use it, and if there's anything off limits. Thank you guys so much. Sorry to hear the answer. Well, Julie, you want to go first or show I jump in

on that. Oh, maybe you should start, okay. I mean, you know, I sort of regard as a professional obligation first of all, to try as many subs as I can that they are in the realm of safety, and that means, you know, I've tried not just cannabis and many of the psychedelics, but I also there have been where I have tried cocaine, and I have to say, cocaine I never really enjoyed it all that much. For me. It was like drinking too much coffee and having post

nasal drip and heroin. You know, years ago I did try it in various ways with friends I trusted, so it will load dose. I never did a high dose injection of heroin. I've never tried method on. I've never smoked cocaine, and I feel a little bit of professional and responsibility on my part for not having tried it. Um, But when it comes to which drugs I used, you know, I just try to follow all the principles of harm reduction and how my body feels and my mind feels.

When it comes to marijuana, I've been enjoying it, you know, since I was eighteen years old, and um, I've never really been a daily consumer. I can go weeks without it and then, may you know, in the right situation, do it for a few days in a row. Recently, my principal cannabis consumption is a weekly ritual I have, which is, uh, ten milligrams of marijuana, take my headphones, and go for a long massage. So that's part of

my healthy aging process. On the other hand, I also say with alcohol, I'm finding my body seems a little less tolerant these days, so I find myself just cutting back on that, and truth be told, I needed to cut back a bit on coffee as well when it seemed to be upsetting my stomach. So I still do my morning a day, and i still have my you know, drink of wall glass of wine occasionally with dinner. But I'm just waiting to see how my body feels about this. Now. I could go on and on, but let me give

Julia a chance to answer this one. Well, the joke I usually make is that I've been a drug researcher from a very young age. I really knew what I wanted to do in life, and I got an early start, and I'm a bit of a workaholic. So I grew up in the seventies, lots of drugs available to me, lots of things to try, unfortunately sometimes not knowing that

I was trying thing and getting another. I mean, I one of my sort of what do you call it when like the comic has a backstory, like their creation story, what is that called? I can't remember? Mine is that when I was in high school, in an effort to try mescaline, I inadvertently experienced PCP. So I had a pretty early, sort of not completely positive drug experience. Although honestly it gave me tremendous empathy for people who are

psychotic and going through a psychotic process. So it ended up being foundational to my wanting to be a psychiatrist, wanting to study drugs. But I, you know, I've tried just about everything. When I was an undergrad, I was also a singer in a band, and people were very generous with their drugs, so I got to try more things. And then as I became more sort of enmeshed and intertwined with the psychedelic research community, people would also offer

me various things to try. So I feel like I've had a lot of various drug experiences and they helped to inform me about the brain and how it works, and my mind and how that works. And I have found certain things that really helped me open my heart and feel more connected and helped to put me in a in a sort of a healing, parasympathetic state. I spent time going to raves in the nineties and and

had these really blissful, you know, group dance experiences. I went to Grateful Dead shows and had that sort of magical group experience. What was your worst experience, Julie, Well, the PCP was pretty tough. I'll tell you. Everything was sort of like a secret sign I had to interpret, and uh, you know, I thought that the because the radio was playing Jimmy Hendricks and Jimmy Hendricks had died of a drug overdose, that meant I was going to die of a drug overdose. It was It was pretty scary.

One of the really scariest, most powerful things for me was that I had UM five m e O d M T, which is more potent than d M T uh, and I had a pretty pretty solid dose and that was a lot. It took me a long time to sort of process that or integrate that, and it kept me away from psychedelics actually for about two or three years, because I was so kind of a canna say, literally blown away by it. And I feel like in this case it maybe it maybe living by a long time,

you mean, like weeks or months thereafter. No, I mean, I just I was impressed by how potent it was, how strong it was. I did have a little bit of like a flashback the next day where the towels looked like they were breathing to me and I wasn't on the drug, and that really upset me because I had spent a long time sort of arguing against this

idea that flashbacks even exist. So again, every experience as I have had has really informed me tremendously and been a sort of a jumping point for me to educate

myself even more about whatever I've been experiencing. Yeah, I gotta see if I think about some of my worst I remember one time, being eighteen or nineteen, I used to go to a sauna if they had at my college up at McGill in Montreal, and my friends and I was sometimes played backgam and see how long we could get into the game before we had to get out of sauna. But one time I got pretty high before I did that, and when I came out a sauna,

I almost passed out. And the next day it was like that high was impregnated, just buried in my brain. It took me a day and a half to clear it. And with alcohol, you know, I mean like most people going, you know, in their young twenties, you know, I had my drink too much throw up. I found getting too drunk on bourbon worse than getting too drunk on tequila. I'll tell you that one. But I remember there was one point I was starting to drink a little more and I realized one morning that I had had a

blackout like I saw in my room. I've been playing all these records for friends and had no recollection of it. And that was just a signal to me, like, uh, enough's enough here. You and I both are not really big drinkers. And I talked to you about my theory. I mean, I think it's more than a theory, but um, there are many people who really don't metabolize alcohol very well, and if they still want to alter themselves, they're gonna have to find something else to do. And I'm one

of those people. I really, I'm just not a good drinker. If I have more than two drinks, I feel absolutely nauseous and vomit and hangovers even from one or two drinks happened to me. So I'm not much of a drinker. Yeah, And I seem to know a lot of people of the Jewish persuasion who aren't great drinkers but are great drug takers or drug policy advocates or drug researchers. And the truth is that Jews don't have a lot of

alcohol dehydrogen ase. Hm. Well, it's what's interesting, man, is Jews, you know, probably a higher percentage of Jews drink some alcohol than most other ethnic groups. I mean, you know, I sometimes joked the first time I ever had any wine was when I was seven days old, and they came with that knife at my brists, you know. And then I grew up drinking you know, little bits of wine as a kid when I was just you know, eight, nine, ten years old, and stuff like that. So we sort

of grow up with familiarity. We do it in a familial context if it's done in that traditional way, and I sometimes think there was a real social protective element of that kind of a culturation, the same way some of these people talk about Italians and Italian families and drinking all that. Jews tend to drink less, I think. Um, but if you're doing in that ritual context, you get a certain familiarity. So Julie, is anything that you would

not try? Oh oh well, you know, I've always sort of drawn the line that I won't personally inject anything into my body for whatever reason. So you know, I have snorted things and smoked things, and on the very rare occasion, put things into other orifices of my body. But you know, my motto growing up was sort of moderation and all things including moderation, like sometimes you've got to kick out the jams and do things that you

wouldn't typically do, So maybe never say never. I think I could probably be talked into trying most things once as long as I knew it wouldn't you know, irreversible harm me m hmm, yeah, I used this funny I try.

I think there's probably a few of the psychedelics. I remember going to the Tell Your Ride Mushroom conference many years ago that Andy Wyle and others ran, and I met Gary Linkoff, the author of the Automo Guide to Wild Mushrooms, who was very interested in the psychedelic aspects of these things, and he described some experiences I think it was with Datura or some other very powerful fung u from mushroom out of Siberia just doing things to his body that you never want to have happened again.

So I could see some things that are kind of off limits. And I think also with the injecting, although I've done that one or two times just with a very trusted friends, uh ministering it, it's not something I pursue wherever would recommend, that's for sure. We'll be talking more after we hear this add Okay, well, let's go to the next question. Hey, Ethan, loving the show. I've got a question. You've talked a lot about the medical and legal implications of a variety of drugs. I'm curious

about the humanitarian implications Specifically, I'm wondering about cocaine. Is there a ethical way to do or buy cocaine or is the cocaine trade so sort of dirty and painted with humanitarian issues that it's not ethical at all. Yeah, I mean, there's no easy answer to that one, right, because on the one hand, you know, the fact that this stuff is illegal means that there's no real way

to get it. Otherwise, if you want to use it. Now, with cannabis, you could always argue the only ethical way to do it would be to say, grow your own, and that if you were buying it from people who had grown it, you know, whether in Mexico or Afghanistan or Columbia or California, that's somehow you are participating, contributing to an illicit market, you know, So is cocaine like

you know, blood diamonds. In one sense, that's true, right, there are people being exploited, there's violence, there's global criminal

organizations that are profiting on this stuff. On the other hand, it's also the case that there are hundreds of thousands, if not millions, of relatively impoverished people, whether you're talking about coca growing peasants in South America or whether you're talking about poor people are involved in the retail sale of this stuff who are earning a decent living, sometimes

in ways that they could not otherwise earn it. So I think the really responsible thing here is to say that the government should find better ways of legally regulating this so that people can obtain it in a legitimate, safe way without participating in a global black market. But

you know, you go back to alcohol prohibition. I mean, the same arguments were made back then, where the alcohol prohibitions were saying, anybody who drinks, which included at that point maybe a good third or more of the country, you know, you're aiding in at betting, the black market and the components and the gangsters and all that. And that was true as far as it went. On the other hand, it was an idiotic prohibitionist policy by the government that was putting this whole business in the hands

of the gangsters to begin with. So you know, I've never been much of a cocaine consumer. My principal elicits are something like mushrooms or cannabis, which don't really have all that much in the way of substantial ugly criminal organization markets. There's some of that, but it's with cannabis, but not a huge part of it. You know. Look, for most people, I'd say stay away from cocaine anyway, but if you do, it's not going to be the principal concern in the ethics of it. I want to

say a few quick things about cocaine. I mean, you know, whenever something is made illegal, we end up making it stronger and stronger, and that is certainly what happened. The coca leaf went from being something where a person would make a tea out of the leaves or put a leaf or two in there between their cheek and gum, to making a much more strong in terms of a white powder that you could snort or inject, and then even stronger with turning it into the free base crack cocaine.

So the truth is that you can buy coca leaves from a farmer and just make the tea or put them in your mouth, and I think that is the sort of safest and most natural way to use cocaine. When you make it stronger, you know, especially when you're snorting it, that is a really short half life. And you know, the joke I used to make back in the nineties is the only way you really appreciate cocaine is once you've been addicted to it and it makes your headache go away, then you like it. It's too

quick acting. I think that there are better stimulants that do a better job sort of opening your heart and mind, and I feel like cocaine is a bit of a narrower that it certainly helps with focus and motivation, but it's it's a bit fleeting. Okay, let's go to the next question. Hi, my name is Rachel. I've been working in mica shelters or shelters for people who are mentally ill with chemical addiction for about five years now in

New York City, and I've encountered all sorts of substance use. However, I have to say that the most common types of substance use that I see our alcohol used disorder and tobacco used disorder. And I've actually seen more casualties as a result of alcohol use disorder than anything else, and that's with the fentanel crisis in New York City and elsewhere throughout the States. I noticed that a lot of my clients, who especially clients who have psychotic disorders, choose

to use alcohol and tobacco to dull their symptoms. Um many of them wind up very physically dependent on alcohol, and some of the casualties that I've seen have actually been from a lack of alcohol or alcohol withdrawal. I'm wondering why there's so little media coverage about alcohol use disorder,

specifically because it's such a huge problem. Spending nine years running the Psyche or at Bellevue, I can tell you that the most casualties that we saw at the Psyche or at Bellevue were absolutely related to alcohol and cocaine and not really any other drugs in terms of statistically being significant. So I saw a real lot of fallout from people getting tremendously depressed, tremendously addicted, crashing hard, wanting to die, having spent money they didn't have or other

people's money, and selling people's positions. And it does seem like it really does a number on people and on communities more than a lot of other drugs that we have access to. I also got very frustrated that alcohol wasn't really being portrayed accurately, and there wasn't accurate information about alcohol really being disseminated, because alcohol is actually the

only drug that can kill you in withdrawal. It's medically dangerous to abruptly discontinue alcohol if you're using a high dose every day, and there's a thirty percent chance that you will have seizures that don't stop, and that is typically the thing that will kill you. Alcohol also is

absolutely toxic to your liver and to your brain. And as much as we have this idea, which is really wrong that drugs are toxic to your brain, for the most part, there's nothing that's going to compare with alcohol in terms of chronic consumption and shrinking your cerebellum and causing tremendous memory problems and causing dementia. So, you know, we're doing her a favor, and we're doing everybody a favor by really letting people know that alcohol is really

a toxic drug. There is a higher rate of addiction with alcohol than there is with some other drugs. I mean, I know that in the drug policy community we're not supposed to sort of put down one drug and elevate another. But I will say that at Bellevue, most of the casualties we saw were from alcohol and cocaine, and so it's hard for me to sort of vault their use

except for in very low dose, ritualized kind of settings. Yeah, but I mean this also will be clear, right, I mean we're talking about high dose alcohol, right, I mean, a large majority of our population others are doing low dose alcohol. Um, there's obviously I agree with the risk and about being the really bad drug out there in

many regards. On the other hand, there's also this really interesting evidence from around the world that moderate consumption is when goes older, it can reduce cardio rat vascular risks and perhaps lent in life. Um. You know, there's a campaign by World Health Organization that's almost an abstinence only campaign with alcohol now that we have to ward against. But when it comes to the shelters and things like that.

You know, one thing people should know about is there's a type of policy or innovation in some cities called quote unquote wet housing has other names for it as well. But it basically is the basic idea that you have people who are severely addicted to alcohol, who, as Julie would say, would quite likely, you know, go through the dts and die if they were suddenly withdrawn. They are

frequently being arrested, landing up in emergency rooms. So a number of cities, from Seattle to Toronto to a range of others, even some of the Midwest set up this housing where people can live there and they're allowed to drink, and there's some rules. I mean, you know, you can't be an asshole, you can't be violent, but you're allowed to drink in this place. Some places will even provide

some of the alcohol. And the evaluations of this wet housing have found, in fact that what happens is that the people in this wet housing land up drinking less than they did on the streets because they don't need it as much anymore. They land up being arrested less than even emergency is less more likely to reconnect with their families or get low level jobs and things like that.

So it's a great innovation, not unlike you know, other harm reduction programs, needle exchange programs, what have you, I wish we had more of this, you know, in New York City and a range of other places. I mean, it's almost like a supervised injection facility. So I support the idea of supervised injection facilities, and I definitely love this idea of what housing. It is harm reduction at

its finest, you're really reducing medical harm, social harm. You know, high dose alcohol is associated with violence, with homicide, and with suicide, which is something that we don't talk about very much. Suicide is a leading cause. It's one of the leading causes of death in America. It probably is the leading cause of accidental death. Now it's overtaken motor vehicle accidents. And you know, then there's all those overdoses,

and you can overdose on alcohol. So anything where you're supervised, where you're educated, where you're supported, you're gonna end up safer, maybe using less and more importantly, like you were talking about ethan, re establishing connections, creating a new support system so you're not so isolated, because the pain of isolation

sometimes drives unhealthy choices around alcohol and other drugs. Yeah, and it's not just right that you can overdose just by drinking too much alcohol by itself, but that until

the advent of fentonel, many or most opioid overdoses. When you saw that headline saying heroin over those he and over almost inevitably it involved combining heroin with either alcohol or benzos, which is the other drug like alcohol where if you suddenly withdraw you might die, and the other one that can be very deadly when you're combining with things like opioids or alcohol. In terms of dramatically increasing the risk of overdose, I mean, fentonel, of course, is

something we're all by itself. It's powerful enough that you can just dive in overdose. But with most street heroin that was not really the case. Alcohol was the hidden killer. But the headlines they could have say at alcohol over those deaths and then report in the background at all there was heroin evolved as well, but it was really the combo of those two things. Yeah, Hi, this question is for Dr Holland. I'm a big fan of your work and your writing and m appreciative that I get

to ask you a question. I was hoping you could speak to the potential benefits of psilocybin therapy versus the risks of people coming off of long term medications such as benzodiazepines and things that help with anxiety or depression, knowing that from what I understand, you have to kind of taper off those medications before you can try psilocybin for therapy. So I was hoping you could speak to um the protocol of coming off of meds and how soon a person can start to try to use mushrooms

therapeutically once they've come off of their meds. This is a really great question, and I get asked this uh in various forms a lot, which is this idea. Basically, I'm on psych meds, I want to try psychedelics. What do I do? And it's really complicated because there are different psychedelics that have different rules, and sometimes you're talking about medical safety and other times you're just talking about efficacy.

For instance, it may not be terribly dangerous to take m d M A with an S s R I, but you really won't feel the m D M A, so there's not much point and it probably is not good for you. But there's growing evidence that you may be able to take psilocybin even though you're on S S R I S for a long time, I was saying, we don't have data, we don't have data, but they just started to be the tiniest bit of data showing.

There was a study that I think it was Mattias Leakda, but I'm not positive and I don't want to misspeak, but there was a study that just came out showing that they gave S S R S for two weeks before they gave psilocybin and people still did feel the psilocybin. So, anyway, the most dangerous combinations really have to do with ayahuasca,

where there are certain medicines you absolutely cannot take. But the other question that got brought up, which is about coming off medicines so you can have an experience, right, and this is a really fragile, difficult experiment to do. If you've been on psycho medicine for a long time and you want to come off them for any reason, you have to do it with somebody who is a psychiatrist, who is at least a medical doctor who knows you, who can work with you, because you have to very

very slowly taper, preferably with something else in place. You know, there are some medicines that I use that you can safely combine with psilocybin or other medicine so that you don't have to be totally off meds. But it is a very vulnerable place if you've come off meds, and also if you've had a very intense psychedelic experience, you're in a vulnerable place. You need support and integration, and you're off meds. That's dangerous. So these things really have

to be done. I'm not saying it has to be a medical model, but I am saying that if you're coming off of medicines, that does have to be a medical model, and that anybody who's having macro doses needs a lot of support before, during, and after so they can process everything that happened. And sometimes you have to go back on your meds. It's just too much to have just unearthed the trauma and be off meds. It is a dangerous process, and I'm glad that people are

asking about it and talking about it. I mean, Julie, what do you think in terms of uh, you know, when people are saying that as psychedelic medicine proceeds, this could actually displace a not insignificant part of the broader s s R I and other sort of pharmaceutical treatments of mood disorders, depression, things like that. What's your thought about that? I say yes please, and when absolutely, I mean we you know, I've been doing psycho farm since

it has not changed very much. It's the daily dose. It's sweeping a lot of things under the carpet and just not minding that you have a lumpy carpet. And as you know, I mean a macro dose of psychedelics really takes the carpet out back and you whack it and you can vacuum up the floor in the meantime, I mean, you can get a lot of deep work done. And everybody's got trauma, right, every person, no matter how

easy your childhood was. Even if you were born with a silver spoon, at some point somebody was looking the other way and the spoon went into your eye. You know, you were not parented perfectly all the time, I guarantee it. And everybody has trauma and everybody needs to sort of

sift through some of that to feel better. And the way we've been doing in psychiatry lately is that you just take the meds to feel better and you don't necessarily deal with all the trauma um And I would even go further and say that our country has childhood trauma that you know, the way we treated indigenous populations and the way that we treated the Black community, our country has deep childhood wounding and trauma that needs to

be processed. And all of us on our screens and taking our meds and not dealing with our own trauma, not dealing with our country's trauma, it's creating a big mess. So I think psychedelics can help us really unearthed some of the causes for psychiatric symptoms. Yeah, you know, it was interesting on a discussion with Michael paul In a little while back, we talked about peyote in Native American church and how part of that, you know, the value there is in dealing with the sorts of traumas that

you're talking about right there. And it's also why I think there's you know, a more and more vigorous effort to try to engage with African American communities, black people about seeing it can there be because there's been this resistance, you know, to all drugs and psychedelics being thrown in with all the bad drugs, But could this actually play

a constructive and positive role in some of those regards. Well, you know, there was this work looking at racial trauma and using psychedelics to start to address the effects of racial trauma, and you know that was Monica Williams work just came out, and one of the things that they were looking at that really made a difference is just this sort of cognitive flexibility of starting to just open

up your perspectives a little bit. Yeah, but Julia, I have more and more people asking me like, hey, where can I find a guided session using psilocybin or something like that? And it's still unless you get yourself enrolled in some kind of research study, it's still essentially an underground enterprise, right. I mean, nobody's really be getting busted for this stuff, but nobody's really advertising it on the

internet either. Well I don't know. I mean I don't go on the you know, dark web or whatever, so I can't say what's available where. But you know, this is a really weird phase in psychiatry where we've got a bunch of new treatments that are really going to be at our disposal but not quite yet. And you know, the only one that's legal right now is ketamine and a lot of the ketamine clinics are set up and they've got the infrastructure set up, but they're planning on

offering other drugs once those things are available. M hm, well, I think we got a question about ketamine. Yeah, this is Jill By. I was calling to um read a message for Dr Needleman and Dr Hollard. Um. It's just wondering what her opinion is on psychotherapy. It's just and husion and she's done them and if she thinks they're valuable, thank you very much. So, I mean, Julie, what about the role of ketamine here? I mean it's like the one,

you know, legal thing out there. How big a role do you think it's going to play in all this, whether it's in depression or in other sorts of conditions. Um, Ketamine has has been a real bush whacker really for the field of psychedelic assisted psychotherapy. You know, this is an FDA approved drug for treatment resistant depression. First of all, what's a bush whacker Like somebody who goes ahead and cuts down all the bushes so that it's easier for

you to walk behind them. What would you call that? It's building a foundation for psychedelic assistant psychotherapy. It is the one that's legal now, and it's not nothing. I mean, it absolutely puts you in I'm not going to say that it's a psychedelic state exactly. I mean this, Look, I'm doing a whole interview pretty soon about whether ketamine is a psychedelic. Why are we calling it a psychedelic. It is a dissociative anesthetic. It's not officially a psychedelic.

It's not a classical psychedelic. It does not tickle the five H T two a receptor, which you could sort of think of as like the psychedelic receptor. Ketamine acts on the glutamate system. It actually acts in a way that is similar to both dexter methorphan, which is a copt suppressant, and PCP. So it is a dissociate anesthetic. But when you are in that dissociated state, you're in sort of a space where you can think about your issues,

or your behavior or your trauma um. You are in an altered state, and it is a state that you can engage in psychotherapy. You could be talking to a therapist, you could be taking notes, writing things. I know people who sort of surface right down some notes and then they go back in to see what's going on. Then they come up right in a few more things. I think that it is a catalyst to help psychotherapy go deeper and possibly be more efficient at getting to traumas

and starting to work through traumas. So in that way, it's great in terms of treating depression. Some people have really strong reactions to it and get better. Most people, even if they get better, they don't stay better, so they need sort of like booster treatments. But that tends to be just the IVY without the talking. Ken Amine assisted psychotherapy is when you're really talking through the therapy, which is what you would do with m D m A or with psilocybin um. I know it can be done.

It is done. I have patients who are slowly sort of unwinding their cognitive rigidity around certain compulsions or rituals or ways of thinking. You know, maybe you can sort of change the tapes that are running in your playing in your mind in the background. So I definitely think that it has therapeutic potential. But in terms of M D m A or psilocybin I would say, you know, you ain't seen nothing yet. If he think ketamine works.

Wait till what's coming down the pike. Yeah, I mean she'll say, you know, I think with ketamine for people are interested in One of the godfathers is not the guide father research in this area is a fellow named Phil Wolfson, and it's worth you know, googling him checking

out his website for his fantastic information. Interviews that are there, and a forthcoming episode of Psychoactive will be an interview with professionalized Daquar Columbia, who has one of the few federally approved grants in which he was doing ketamine administration with meditation in in order to help people deal with

substance abuse. So there really is potential there. There's also using it at a high dose intervention as well as low dose, so there's different methodologies that are people trying to work out well. Worries me is to see these kind of fly by night places beginning to pop up all around the country. You know, you get some anesthesiologists who wants it will make a little extra money on the side. They set it up there administering it in

a kind of non healthy environment. They're not doing the processing and the integration, and I think that's one of the concerns where Kennyman could actually land up getting a bad name because of this proliferation of people using it without even never having tried it themselves or really knowing the literature and knowing the proper way to do this. I absolutely agree. I've had patients of pretty bad experiences because they're just left on a stretcher with an I

V running and no one to talk to. And it's a pretty weird state to be in if you're not used to altered states. Um. The other thing it's worth mentioning is that it absolutely has a much higher abuse potential addiction potential than any of the classic psychedelics. My chire and I have patients who go to NA meetings or other twelve step meetings with all sorts of different people and groups, and they're saying that they're seeing more people coming in from Kenemine. So, you know, we have

heard over the years. I don't know even you and I know some of the same people. Every once in a while you heard about somebody having a little bit of an issue with Kenemine. They usually, you know, get through it, get around it, but it does kind of pull some people in for some reason. People it can be addicted. You gotta be careful, you know. I will say that I had my own experience doing it last year with somebody who was at Kennemine therapist. I was

surprised at its power. It was short, only hour and a half. You know. I'm usually pretty grounded even when I'm doing high dose psilocybe and lushrooms, but this one took me some places and I found it really valuable in terms of some of the insights that I took away from there. Definitely, it is a bit untethering, you know, so you do sort of end up out there a bit. And also the fact that it's short acting is great

for therapy, you know. One of the issues with these medicines like m D m A maybe maybe three or four hours little I've been made before to six hours LSD, you're looking at easily ten or twelve hours. That's a long time to sit and talk to your therapist, you know. So some of the companies are looking to make some of these drugs shorter acting so that you can have more like an hour or two experience and then kind of get your head together and go back out in

the world. And that will be interesting to see. But that is one of the advantages of ketamine is that it is fairly short acting. In fact, I understand that, you know, one of the reasons why you don't hear as much about LSD or mescaline as you do about psilocybin for some of these research studies is that there could be twelve hour experiences, and the amount of time and the cost of having a therapist sit there for that long is a major impediment to trying to make

this stuff more widely available. Yeah, it's too much. You know. The thing I used to say about LSD back in the day is like you're pretty much guaranteed to see the sunrise when you take acides. You know, it's just it's doesn't matter when you take it. You know, it's just you're still going. Maybe you're done, maybe you've got the message, you want to hang up the phone, but

the phone still calling you. So I think, especially if yeah, if you're doing research, you know, it's tiring for the patient, it's tiring for the therapist, everybody who's you know, monitoring the session. And you know, I think one of the things that mine met is looking to do is to basically cap the experience, so it's shorter. They and some other companies I believe are looking at ways too, so that they can use LSD, but that they can make it shorter. Acting. Let's take a break here and go

to an ad. Yes, this is Marcia Rosenbomb in San Francisco. My question to Julie and Ethan comes as a parent, I need to ask always with the drug issue, what about the kids? Specifically? I'm interested in your take on the new emergence of psychedelics and also vaping and e cigarettes. Those two, it seems to me, are key issues when it comes to kids today. And you're both parents, How did you deal personally with these issues when your kids

were teenagers? What did you say to them? What would you say to other parents who are concerned about kids and drugs? Well, I guess I should reveal our audience. That's a bit of a loaded planted question there. The caller Marcia Rosenbaum, um, who is my my dear, dear friend and longtime colleague, and also who Julian knows well.

She really pioneered and founded the safety first approach to drug education, basically introducing a sex education model or harm education approach to drug education with adolescence and emphasizing that you don't want kids using drugs, but if they do, the bottom line has got to be about keeping them safe. So you know, I mean what I would say to Marcia on this, and I really to our listeners, um is you know it's funny. I was talking to my

daughter about this. Who now? Who's now? And are you thirties? And you know our understanding is I don't talk about anything involving what she may or may not have done, or we might have done together or whatever. But you know what she said to me was Dad. You know what you can say is that you always talked very openly to me about this and honestly and non judgmentally.

And it meant that when there was an issue with me or my friends or something I knew, I could give you a call and get the best possible advice about whether it was a friend going through a bad trip with to deal with that, or had it relate to the whole cannabis stuff or tobacco and nicotine stuff. Um,

you know that that was valuable. And I can also say that when it comes to psychedelics, I know quite a number of people who either did mushrooms, typically with their teenage child or people who are now growing who did it with their parents when they were young. And I have to say in those cases, I mean, I tend to know more responsible people where those things generally worked out pretty well. That's not to recommend it, it's just to say it's not that remarkably unusual or heretical.

But Julie, what do you say. Well, I've been sort of preaching harm reduction since the mid eighties, and I had my kids in two thousand, two thousand four, so they were really born into Amilia where there was a lot of talk and of drug use and drug safety and benefit maximization and harm minimization and the importance of education. Like my kids have been hearing this since, you know, before they could talk. The biggest thing, I think it's

the same for me and for you, Ethan. You know, the biggest thing to me was always that I wanted them to be able to come to me. I wanted them to be able to ask me any question and know that they were going to get an answer. I wanted them to know that there was no shame in any of it. Sex, drugs, it's all natural, it's all normal to want to alter yourself, to want to connect with other people, or connect with yourself, or connect with nature. So, UM,

my daughter, she's not very into drugs at all. And you know, I think one of her ways of sort of defining herself, you know, apart from me, is that she does alcohol and she doesn't really like drugs very much. UM. Our son, his tastes go more towards where my taste go in terms of drugs he likes or drugs he's interested in. UM. But we you know, we are in a town where there really is a lot of stigma and shame around drug use. It's very conservative town. It's

a very churchy town. I love it here, but the drug education in the high school is terrible. And I've sort of decided my son as a senior now. And you know, one of the things that my to do list is that once he leaves and I won't embarrass him, I really want to work with them on their curriculum to change things. Because the drugs that are mostly used here with with my kids in this in this town

is alcohol and vaping. And either this is when we're going to kind of get into it, I'm afraid, but a lot of my son's friends are addicted to nicotine and are having trouble stopping. And I was a cigarette smoker for many, many years. I actually started smoking this is fun in fifth grade when I was ten. I was very tough with the girl James Dean was completely like my hero. I had like a denim jacket with the collar up and the cigarette hanging out of my mouth.

Nobody bothered to tell me I was a girl at that point. I was just like a total tomboy. But I've been smoking cigarettes offen on since I was ten years old, and it was hard for me to quit. As you can imagine. It took me several times. I quit for a couple of years, I would come back to it, quit for a couple of years, come back to it. And you know, I was honest with the kids about how hard it was for me to quit smoking, and how I really didn't want them to smoke cigarettes.

I really don't want them anywhere near white powders because they don't know what they are. And you know, it's pretty hard to counterfeit, and most people don't counterfeit things like cannabis and mushrooms and and things that you can easily look at them and know what they are. My kids know not to smoke pot if it's wet or smells like from aldehyde. Um. I know a lot about PCP and from the inside out, and you know, my kids know that that may be one that they would

like to avoid, and they tell their friends. So, you know, for for me, I feel like it's kind of worked out. My kids are good, they're healthy, they understand harm reduction philosophy,

and they've chosen really sort of different paths. Yeah, you know, Julia if I one of my outest moments was when my daughter Lila was I think in junior high school and the DARE officer was there and getting a little talk and Lyla raises her hand and says, first of all, have you read the book Marijuana Miss Marijuana Facts by John Morrigan and lind Zimmer, which was the outstanding book in the nineties and early two thousands, you know, analyzing

the dad of marijuana. And he shook his head, and then he said, and what about the medical value of marijuana? You know? So I was immensely proud of my daughter standing up to him. The other thing is this whole issue about parents being on in front of their kids. I mean in a way because I first became a public figure the year Lyla was born in and you know, I've been in a world where marijuana is just sort of part of the milieu. So she grew up knowing

that her dad would, you know, smoke this thing. And I was very anti tobacco, anti cigarettes, something of my friends who were professors, and she might be with us when she was a kid, and she would see us smoking and joint sharing a joint. We and we didn't change, our personalities didn't change. These were people who were like her uncles and aunts. So she developed a kind of understanding. And now I wasn't living in a community like you are.

That's so conservative, you know, Lila. I had to teach her at the age of six, in the age of nine and twelve as she grew up different ways of understanding that and how to relate to it, and how to talk about it, and talking to her about unjust laws and why this is not right, and also making a distinction between something that somebody does occasionally and something that people do too much of, and between cannabis on

the one hand and tobacco on the other. Now, when it comes to this issue of tobacco and with a whole vaping, e cigarette vaping thing and stuff like that. I mean, obviously, no kids out of lessons we know knowledge and they not smoke, they shouldn't be vaping. Let's just establish that, right. It's not a good idea, you know, for at all this to be doing any of these drugs quite frankly, right. But when you look closely at the evidence, just a number of things that I think

are really important to understand. The first one that is that overwhelmingly the evid it indicates that vaping, these e cigarettes, jeweling, you name it, are dramatically less dangerous than cigarettes, just because most of what's dangerous about cigarettes is the burnt particle matter. Right, It's not the nicotine. Nicotine hooks you, but nicotine is not a particularly bad drug for your health.

It's that it hooks you so easily, and if you then start consuming the nicotine and a smokable form, that's what's really deadly about it. And I think the evidence is still out and it's probably gonna turn out that vaping and thesics turn out to be less addictive than cigarettes. Secondly, when you look really closely at the evidence. It turns out that most kids who are vaping are not sticking

with it, and they're not getting dependent upon it. And oftentimes the one who do are the ones who already had some experiences consuming tobacco or cigarettes in other forms, right they were not necessarily there, tend to be less likely to have been the tobacco naive folks, or they're the ones who are more open to risk taking behavior. So I think we need to understand that variable as well.

There's almost no evidence of people moving from vaping into smoking cigarettes, although it concerns made is that a majority of Americans now believe that vaping is as or more dangerous than cigarettes. And that's one n eighty degrees different than the truth. But it's a kind of information that's being promoted by the anti you know, nicotine organizations and

by government agencies. Most people still believe that what happened a couple of years ago where people were landing up in the hospital with something called the Valley of vaping related disease and lung disease, and there were two thousand hospitalizations and dozens of deaths, They still think that was about the cigarettes, when in fact it had essentially nothing to do with these cigarettes. It was entirely about illegally produced tainted THHC cartridges. So I think there's reason for

concern about less and vaping. But when you look at the benefit for adult smokers, where e cigarettes turn out to be more effective than anything else we now have available, more effective than patches and gums and medications in helping people stop smoking. The benefits of making this stuff easily available, including in non tobacco flavors for adults, is a huge advantage, and the risk and downside for young people of getting

into this is you know, modest at best. When the leading experts in the world about this, Ken Warner, the former Dina University of Michigan School of Public Health, who's modeled this out, comparing you know, the potential risk to kids with benefits to adult smokers, what you see is an overwhelming benefit in terms of years of life saved if we can popularize the cigarettes among adults and hopefully

keep it down and discourage it among young people. But we shouldn't be freaking out and it shouldn't be driving policy the way it has. Hey, Ethan actually love the show. I know you're involved in drug policy and activism for a while. But now that you stepped down from that, have you begoten more involved in the business side of drugs? Have you invested in any cannabis and psyched Dallas businesses? And where do you think that whole industry is heading? Yeah,

or ethan? Are you on any payrolls of any of these vape companies. I take absolutely not a penny from anybody in the tobacco, nicotine, vape, you name it. And I think it's not because I have a huge ethical reservation against doing it. I just think that the smearing of reputations and the ad hominant attacks in this area around tobacco harm reduction versus absence only tobacco policies is more vicious than anything I ever encountered in the entire

drug war, drug policy reform areas. So I stay clear of that. I remember you saying that at Horizons a while back. Yeah, but you know, I'll tell you when it comes to it. Was interesting when I stepped down from running Drug Policy Alliance four or four and at years ago, all sorts of people you know, were saying ethan, ethan. I mean, you played a pivotal role in inventing this industry. It wouldn't exist at this point, but for the work you did, you should get in there and profit in it.

And so a whole bunch of companies were interested in having me on their advisory boards, and I would have been paid something for that, and I couldn't bring myself to do it. You know, it just seemed unseemly to jump from being a nonprofit advocate for policy reform for ethical and policy reasons to being on the for profit side.

And I was wary of getting involved with any one individual company because in case they got in trouble, you know, then my being involved with them publicly would be um kind of negative news item and affect my reputation and such. And I think, you know, I also just even avoided investing at all. But then this year I decided to change a bit. So what I've done is I'm still

not getting involved with any individual companies. I did earlier this year invest in one of the marijuana hedge funds, where basically I don't even know what they're invested in. So it's a way for me to kind of be involved in the industry when my own money without having any conflicts in the sense that I don't know which company they're doing or any of that sort of stuff. Of course, I invested exactly the wrong time early in the year, so my investment is probably down twenty five

percent since I put the money in UM. The second thing I did was that a few months ago I got a phone call UM from a fellow Tom Blaney, who had been the outside accountant and his firm for Drug Policy Alliance for like twenty years and done a great job. And he explained to me that his firm was actually involved with on the few big firms doing this,

p KF O'Connor Davies UM. So I just recently the summer signed a little contract with them to advise them and to try to open up some doors for them UM so that they can be you know, prideing financial services for people in the industry. So that's been my involvement there. And just very recently, after actually a little consultation with Julie, I joined the advisory board of one of the psychedelics investment funds. But Julie, what about you? What about me? So I am on the scientific advisory

board of a few companies. One is a cannabis grow operation called Maui Grown Therapies that's in Hawaii, And I advise a psychedelic VC firm called Paulo Santo UM and a few other things. I mean, there's a really interesting company called a Pathica that's working with artificial intelligence and the psychedelic space that I think is going to do well. So I'm advising them. Yeah, anything working out well for you as yet or right now, they're all kind of

long term bits. Yeah. Well, you know, actually one of the things I'm really excited about UM and you know, Dimitri mugianis and maybe Ross Ellenhorn, I know, you know Dmitri. I'm not sure if you know Ross, But they and I are trying to sort of create a psychedelic retreat company but also to have a presence in in Manhattan, and they're called Cardia UM. They want to have a retreat in Costa Rica and Jamaica and here in the United States once once that is legal to do, so

maybe Oregon, you know, if our listeners are interested. I mean, Dmitri Mugian is a wonderful human being. Here. There's a documentary about his work with Ibi Gaine. Do you remember the name of it. Julie. Yes. Dangerous with Love. Dangerous with Love I highly recommend is a very honest, uh documentary about his experience administering I Begain and then doing eboga, the the root origin of I begin himself. Yeah, and I'll tell them it's like yellice thing. I'm really just

learning it. I mean, I've begun speaking a few events, this one fund, the Jails Fund that's been you know, one of the startup funds in this I'm kind of intrigued to see if I can be helpful to them and learn as I go. So I don't feel the same um resistance I did before I sort of developed. And it was frustrating, of course, because when you do the work I do, you sometimes get a sense of which companies and which people are going to be most successful.

And so when I look back, I realized that some of the people I most liked and appreciated and who I might have invested with are the ones who in fact have done the best in this industry. So I do have little bits of regret, but I feel in the end, I'm doing okay, and uh, you know, I'm happy to have created this change without having profited from it. As yet yeah, you and I are also sort of involved in non various nonprofit projects and things like that.

I mean, I've always felt very uh maybe not officially involved with dp A, but certainly unofficially adjacently always involved with d p A. And you know, with MAPS, have been the medical monitor that's the Multidisciplinary Association for Psychedelic Studies MAPS dot org and be the medical monitor off and on for them for like twenty years, and now i'm their medical advisor. But none of these things really pay anything, I should say, you know, it's not really

about the money. No, that's right. You know, I decided on LEFTB I was not going to stand on the board, but I haven'tformally continued to advise, and I'm on the advisory board. I see US, for example, which is a wonderful organization that organizes the World Ayahuaska Congress. I'm on

their advisory board. There's another advisory board in terms of representing the perspectives and interests of people who are responsibly receiving opioid medications but are getting discriminated against because of the way the pendulum has swung against proper pain management because of some of the abuses on that we're done in the past. So yeah, I know there's a lot of that, but none of the service on these nonprofits

pays anything. It's really something we do because we care about the cause and never stop will that never will stop caring, never stop will. Couldn't have said a better myself. Yeah, yeah, big Stonor look at you, Yeah, Julie. Well you know we do. We do. We we live good lives, We have fun in this stuff. We fight the evils of the drug war, Yes we do. We're very healthy. People tell us how young we look all the time because we put anti inflammatories into our system on a regular basis. Okay,

that's when we're looking at it. A lot of people, I think, realize that cannabis is anti inflammatory, but many people don't realize that psychedelics also are really potent anti inflammatory medicines. And you're going to be hearing more about this and it will help to keep you young and healthy. You mean, so I should be supplementing my tumeric black pepper anti inflammatory with more of this stuff, huh like micro docing. Well, Paul Stammet's would tell you that, yes,

you you should. You should be having mushrooms and other mushrooms and be vitamins. Oh my god. I look forward to having Paul on the show. I mean I just watched that documentary Fantastic Fun Guy. That is fantastic thing. I probably know most of the people interviewed in it. But Paul will be a great guest and we eventually have him. I mean, he is really the guru of mushrooms. Absolutely too well, Julie listen, thanks ever so much for joining me on this in our car talk on drugs

without driving. But I hope we do this again. This was really good, really fun, and uh you know, let's let's see if we get some more questions in the future and we'll come back at this. I would love that. That would be great. Count me in. In the meantime, I would love for you to reach out to me on Twitter and over voicemail. The number we've set up is eight three three seven seven nine two four six, So I want to know what you find interesting and

what you disagree with. I want to hear your suggestions for topics and guests, and I want to hear your experiences. Please leave us a message at eight three three seven seven nine sixty. That's one eight three three Psycho Zero and if you couldn't keep track of all this, find the information in the show notes. Psychoactive is a production of I Heart Radio and Protozoa Pictures. It's hosted by me Ethan Nadelman. It's produced by Kacha Kumkova and Ben Cabrick.

The executive producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren Aronovski for Protozoa Pictures, Alex Williams and Matt Frederick for I Heart Radio and me Ethan Nadelman. Our music is by Ari Blusian and a special thanks to

Aviv Brio, SF Bianca Grimshaw and Robert Beatty. My next conversation will be with Professor Elias Dokuar, a research or at Columbia University doing fascinating work in using ketamine and meditation to treat drug addiction, reading about you know your research on dealing with people struggling with alcohol, cocaine, cannabis, and basically using ketamine as a way to get people to move into meditation correct by approximating the meditative experience,

by making it easier to practice, and also by motivating people. Demoralization is I think a big part of addiction. So I also hope that the medicine would disrupt that, that it would provide a sense of refresh possibility. Subscribe to Cycleactive. Now see it, an'll miss it.