Psychedelics May Help Solve Addiction

disability across the United States. About six out of every one hundred people will have PTSD at some point in their lives. That's about fifteen million adults. During a given year. Over one quarter of all Americans over eighteen suffer from a diagnosable mental illness. The antidepressants we have now are somewhat safer than the ones going back to the nineteen fifties, but they work on the same basic mechanisms of taking a drug daily and at augmenting the amount of serotonin.

Matthew Johnson is a professor of psychiatry and behavioral sciences at Johns Hopkins University. With so many suffering, he thinks it's urgent to expand to tools we use for treatment. The potential approval of psychedelic drugs, this could happen in a few years, and I think this has the potential to really be a paradigm shift in mental health treatment.

Psychedelics are reality altering drugs with names like molly, ecstasy, mescaline, LSD, psilocybin, and they're all classified as Schedule one drugs government defined as having no accepted medical use and a high potential for abuse. But Johnson's team is working to change that. A significant leap in understanding a human mind is possible with psychedelics, and we can use that to help solve addiction. You are a doctor, you're a scientist. Can you tell

me about your first personal experience with psychedelics? Sure, well, I'll tell you something about that. Um, so you get a little bit of the politician's answer with this question. Yeah, it's a sensitive field because you know these are illegal drugs, and so you know a lot of people are curious

if you've done psychedelics yourself. And the sensitivity in this area is if you had said, sure, I had some experiences back when I was younger, and you say something about that, and a whole lot of folks are out there will say, man, you're you're biased. We can't trust this guy. You're a promoter. Okay, Now let's let's explore the the the opposite. Let's say, you know, it's always been a subject of interest, but no, I've never taken them.

I didn't want to do them for whatever reason. A whole other swath of folks would say, Oh my word, how dare you give these things to people I have no idea about the profound effects? They like, this is unethical. How dare you get into this? So it's kind of

like a no win situation. But I will say I became fascinated with psychedelics when I was in my late teens early twenties, learning the cultural history of these compounds and in our society going back to the sixties, and then also the ancient you know, sacramental use by various indigenous peoples, but but also the academic history, the earlier era of research and from the fifties through the seventies.

It's hard to find a more cross disciplinary topic that just you couldn't make up the crazy history behind psychedelics in our culture and all the twists and turns with it, and the profound effects they have on the mind, and the idea that some molecule does this in the brain, and just from chemistry to pharmacology to sociology, it's just it's always fascinated me. For listeners who don't know what psychedelics are, can you break down what is a psychedelic?

A lot of folks will say a psychedelic properly only refers to compounds like LSD and psilocybin, which is in magic mushrooms, or mescaline, which is in peyote, or DMT, which is in ayahuasca. Those are all classic psychedelics, and they they're in the same pharmacological class, meaning they have their primary effects by activating one particular subtype of serotonin receptor serotonin. Two way. Now, you have other compounds that we also broadly call psychedelic, like MDMA or folks called molly,

or ecstasy, ketamine or PCP. But broadly speaking, the thing that makes all of these compounds a psychedelic is that, compared to other drug classes, they have a profound effect on one sense of reality, including one sense of self.

And so you know, you can have a drug like cocaine that has a powerful effect on the mind, but one's basic conception of reality is typically held intact and the same thing with all you go down the line, alcohol, the opioids, other sedatives, but psychedelics had this profound reality

shifting aspect to them. As you were describing that, something that I've thought about is like, I've been going to church all my life, and I've had spiritual experiences at church, Like there's definitely feelings that I felt at church that have probably could be considered similar. But I think for most people who've tried psychedelics, it's hard to put those

experiences into words. I think besides church, the only other time I hear people talk about having religious experiences is at sporting events, and they always describe it as they're having a religious experience. So are there some common effects or reactions that people you've worked with have reported feeling.

People pressed it in different ways, But this overall sense of unity is part of this mystical experience, the dissolving of the sense of self and feeling that you're just one with the universe, the world, with God, whatever your vocabulary is. Other aspects of a mystical experience are having a sense of timelessness and spacelessness, like one has stepped beyond the balance of time and space, like you know being in the ever present, now, the past, and the future.

Just our scene is just sort of illusions and it's all you know, it's all about right now. And then there's other aspects, such as a sense of paradoxicality, this idea that people are moving outside of this sort of linear way of thinking, that one could hold mutually exclusive ideas at the same time, the universe and world is completely full, but it is an ultimately all an emptiness

at the same time. These types of counterintuitive concepts, people often say this is beyond words, and when they do a decent job trying to describe it, they'll say they haven't even scratched the surface. And oftentimes people get frustrated because as they start to describe it, they just they want to let you know, like whatever they're saying, it's just it's falling so short, it's almost embarrassing. Can you

describe a session and how it works? Sure, First, they're screening, because we do know there's certain people that could be harmed, namely folks that have either a history or an identifiable predisposition for disorders like schizophrenia or the manic side of bipolar disorder. And so there's that screening and also people at more severe levels of heart disease because it can

raise your blood pressure somewhat, for example. And then you prepare the person and this can be anywhere from four to eight hours across several sessions depending on the study, but something on the order of four to eight hours where you have this discussion with two people are with we often call them guides. They're sometimes depending on the city their therapists. A major point is to develop that rapport, that trusting relationship that ultimately you would want from any psychotherapist.

It's all done better if you have that that trust for that person. Discussing the person's life, their childhood, there whatever they do, whether it's a career or a job,

you know what's meaningful to them. And then what are the you know, what's their worldview, whether it's religious, whether it's spiritual but not religious, whether it's people that don't endorse any any of the above, but nonetheless everyone has some of that high level worldview if you think the world is just you know, sort of materialism, but nonetheless feel connected to your family and your loved ones, to

feel part of something, your community. When you also prepare them for the drug experience, which is basically a laundry list of you could be crying, you could be laughing, you can be terrified. You do have to prepare people, especially for the dark side, for the so called bad trip, which in our setting we characterize as a challenging experience, because the bad part is really if you do something

stupid that get yourself hurt. Here again, it might be really difficult, it might be terrifying, or it might be you know, sad. But oftentimes those experiences people will credit as powerful learning experiences, Like if they go through an experience where they feel that they're dying, which sometimes happens, you know, oftentimes people felt like they were able to go through that experience and let go and just trust,

let go and be open into experience. It feel like they really learned something from that experience, like they ran the gauntlet, they faced their demons, and so again, the bad trip isn't necessarily bad if it's in a safe space. You know, it's it doesn't look like a hospital room. It looks like, you know, like a pash yoga studio. I mean, it looks like, you know, esthetically pleasing. We want people to feel comfortable, and there's a nice rug.

There's artwork on the walls. You know. Any medical equipment is like tucked underneath, Like the end table has a blood pressure kind of tucked underneath it, Like we have to take blood pressure during the session, but we have them take the capsule. Most of our work has been with psilocybin. We have some white discussion until the effects kick in. How long does it take for the effects to kick in? Anywhere from fifteen minutes to an hour.

Typically around a half hour is about the average. Why so much of psychedelic research focused on mental health and addiction, specifically on treating those conditions, especially when we see that a lot of people that are using psychedelics recreationally aren't necessarily thinking about mental health and addiction in those cases, if you know what I mean, absolutely, Why why so much focused on this particular area. We're now seeing people

living less long than their parents and grandparents. Why The data show it's because of substance problems. People are drinking themselves to death and taking drugs to death, including by the way, smoking, which is the biggie out of ball and that kills more than all the other drugs combined. But it's essentially addiction and it's suicide, you know, obviously depression being the major contributor to that. So these are all mental health issues and it's like the need is

so great. So the antidepressants we have now are somewhat safer than the ones going back to the nineteen fifties, but they work on the same basic mechanisms of taking a drug daily and at augmenting the amount of serotonin. And that's an important thing to have. A lot of people's lives have been saved because of the the availability of those medications. So I'm all about having more tools in the toolbox rather than a fewer. So, you know, developing

psychedelics is in a replacement for other therapeutics. Necessarily, we need a lot of help and mental health. You know, folks are suffering. We're really at our wits end in terms of mental health treatment. These various addiction are just really intractable. We need to innovate to to solve well, So let me ask I think, I mean, I got a good idea of what the sessions like, but can you talk a little bit more and then you briefly touch a little bit on after um, talk to me

a little bit about how this contributes to your research. Yeah, so after we you know, clinically, you know, to make sure that to maximize the therapeutic benefit, we discussed the experience with the person's day after, we have them write something about it, like a few bullet points, you know, on a paper, or it can be like twenty pages and we get everything in between, but write something about it and and and just to bring in the next day and kind of well read it together as a

point of discussion. These are ways of just kind of again processing, it's the word I use. It's a way to psychologically deal with and explore what the session was like. And there's no easy answers in terms of what what it's means for them. It's not like dream analysis or something like, oh, well, this was your experience. And hopefully people have meaningful experiences where they have insights, where they feel empowered to change things in their life that need

to be changed. We've done a lot of work helping people quit tobacco smoking. Well not only ask them about that, have you been smoking how much if so, but we'll also have them blow through a machine basically a breathalyzer for cigarette smoking to tell us what we'll get a urine sample to see whether they've that picks up on a metabolite of nicotine. That also tells us whether they've been smoking. So we can have these data for the scientific literature, so we can write up papers and say, hey,

whether it's working or not. And one of the reasons I was attracted to smoking is because, as fascinated as I am about people describing extraordinary experiences that are meaningful to them. Hey, if we really want to talk about helping people, ultimately, I like to see behavior change. So let's and biological evidence of it. Like here the data this person hasn't been smoking, and so you know that's evidence that they've they've really done something. Where do you

think that this actually goes in the long game. The major focus is in leveraging them as therapeutics, in other words, to treat various disorders, mainly psychiatric disorders, like various forms of addiction, like depression, like helping cancer and other serious illness patients face death, people who are really debilitated by a cancer diagnosis. That's the major focus. But I think I see the power of these psychedelics as as much

broader than that. They really are powerful tools to understanding human experience, to understanding the mind, to understanding human behavior, and just the leveraging of those to treat disorders is just a sub a very important subcomponent of that. What's

the ultimate goal? Like when when do you know that you've been successful in therapeutic sessions and endo therapeutic benefits to folks, Like at some point somebody has still has to say yes to using psychedelics in this manner, right right, So for the therapeutic use of these compounds, that's very well defined. That's FDA approval for therapeutic use. So all of the research going on right now has been research that's been FDA approved. In other words, FDA has approved

us to yes, you can do these studies. But at some point the FDA will say yes or no, you can give these to patients and straight up medical practice. And so we call that it has to pass phase three trials. That's the lingo research using MDIAMA to treat PTSD is in that phase three process. There's been one

very successful looking phase three trial. They need to run one more, and so we may be about two years away if depending on the data from that second trial, and I bet it is going to look good, because the first trial looked very good. We may be two years away from MDMA being approved for the treatment of PTSD. For psilocybin, there's two entities in terms of the treatment of depression. There's two entities that are in Phase two

B trials, so this is just before phase three. If those trials are successful, we may be somewhere on the order of three to four years away from psilocybin being approved for the treatment of depression, and the work with addiction is probably very close to that. We may be three, four or five years away again, all depending on the data in those phase three trials of psilocybin being approved

for tobacco addiction and alcohol addiction. That has to be pretty exciting to have done some research that is actually shifting the actual classification of drugs that for decades were considered to be illegal, harmful, and you know, completely scified differently. How do you feel Is that exciting for you? I really love this area that I'm working in because I feel like there's the opportunity to have an impact at this time. I mean, so much of science necessarily as incremental.

Your work might add to something that adds to the work of others, and you know, a generation or two or three down the road, the big shift happens. But I really think that with the potential approval of psychedelic drugs, which I've helped contribute towards, that this could happen in a few years. And I think this has the potential to really be a paradigm shift in mental health treatment.

I think it's a fundamentally different way. It's really getting more at the roots of mental illness than it is just treating symptoms. And so it's just I feel lucky and so excited and happy to be involved with work that can actually have that type of real world impact in my lifetime. Can you talk a little bit about some of the actual risks that using psychedelics, whether therapeutically or recreationally, can cost to a person. Right, we know

a lot about the risks. Certain people have a susceptibility to disorders like schizophrenia. Those people can be destabilized the same way a traumatic life event can destabilize those people and either trigger or make their symptoms worse. There's also for anyone taking these drugs that are high enough, those there's the so called bad trip, which in a recreational or an unsafe environment. It's pretty rare, admittedly, but sometimes it leads to people getting harmed. I mean, it's kind

of like not wearing your seat belt. Most any one given day of not wearing your seat belt, you'll probably be fine. But if you step back and look at the big picture, yeah, it's pretty clear there's a definitely risk of not wearing a seat belt. So sometimes people do things that get themselves hurt. They wander into traffic, they freak out, they you know, they fall from a height, and sometimes, you know, a lot is made out of those that are pretty rare, they can happen. So there's

are real risks people at severe heart disease. It can trigger a reaction because it psilocybin raises the blood pressure and certainly MDMA even more so raise the blood pressure and pulse. So that could be a problem for some people, even though psilocybin itself for most people is very safe at the physiological level. There's no known lethal overdose. So those are the major risks, but importantly, we have a way to address them all in research and clinical use,

through screening, through preparation, and monitoring. Because of these risks, I certainly don't encourage anyone to use these on their own. If listeners want to learn more about psychedelic treatment or how they can support research into psychedelics, what can they do? They can find out more about our research at Hopkins Psychedelic dot org. If you're looking for psilocybin research, you

can find our studies that are posted there. You can also search for studies on clinical trials dot gov really across the US and the world for other sites that are conducting research with psychedelics. If you want to learn about some of the work that with MDMA that I mentioned, you can go to maps dot org. So yeah, hopefully that's helped the people. Doctor matt Johnson, this has been a great conversation. I thank you so much for being

with us. Thank you, Ronald, I really enjoyed it. Matthew Johnson is a professor of psychiatry and behavioral sciences at Johns Hopkins University. Be sure to check out our show notes to find links to the resources Matthew mentioned in this episode. Solvable is produced by Jocelyn Frank, research by David Jah, booking by Lisa Dunn. Our managing producer is Sasha Matthias. And our executive producer is Mio LaBelle I'm Ronald Jung Jr. Thanks for listening.