The history and future of psychedelic-assisted recovery
With Jeff Walker, The Psychedelic Science Funders Collaborative
ABOUT
The Psychedelic Science Funders Collaborative is a community of philanthropists dedicated to enabling access to psychedelic healing for all who can benefit.
TRANSCRIPT
CMHI: Jeff, thank you so much for joining us. We're going to speak a little bit about funding and psychedelics. You are one of the absolute foremost funders in this area and we're so grateful to have your wisdom, and to hear from you today. So psychedelics, of course, both a very ancient practice and a really exciting area for new innovation in mental health. Can you just tell us a little bit to get us started about the history and the future of psychedelics as you see it? I am conscious that is a big question, but itching to hear what you say.
Jeff Walker: That is a huge question and there's lots of books that have been written on it. So I'll give it a little start. You know, psychedelics, plant medicines have been around for thousands of years and they've been used across Latin America, they're throughout India, Africa, variety of other places. And so they're used to do transitions for, you know, males growing up and going through, you know, transition to men. And they're also used for healing, a variety of different places in Peru and India, in India and Colombia, and Mexico. And so they were used for a long time.
And in 50s, late 50s and 60s, they were discovered, again by the Western world. And then 60s came and Timothy Leary came and it got too, crazed. So people just started using it.Variety of different ways and shapes and forms and really didn't take a medical model. They really were just taking it and saying, hey, we're gonna understand, you know, what this experience is and we're gonna use it and it's just gonna free us. I think there was obviously some overreaction in allowing that to happen. And there's also very little science, supporting what these molecules are doing.
So there was obviously, a big change in the Nixon administration and others and caused it to become illegal. And so research actually was prohibited. It was very hard to figure out whether these were useful molecules or not. And so there, for a long time, people didn't use them in the early days before it was made illegal. There was hints that there was some really interesting things that, these molecules could help do. For example, use in treating alcoholism. And there was a number of different studies in the early days showing this actually helped alcoholics kick the habit. And, there's some little science going on.
So, during the 70s, there wasn't much happening. And then it started coming back a little bit. There was a couple of, different studies that started, occurring Johns, Hopkins, very credible institution, started doing some research and supporting it. And so this is what typically happens in system change models. And that's something I spent a lot of time thinking about these larger systems and how do you change them?
And we did it with, meditation, where it was very weird, you know, 30 years ago. And now it's generally accepted as to, something that is accessible and something people can do. And we did research and showed that the brain actually changes during long periods of meditation. So kind of taking the same strategies for psychedelics and saying, you know, what are those tools that are useful?
And so then different universities and researchers started to come together and, and say, you know, this is worthy of pursuit, so it's not just a very weird thing. And some odd hippies are doing it. You know, let's add credibility to it. So when they started looking at some of that research, Hopkins started saying, hey, you know, we've done some research and end of life. And it turns out that, people, you know, benefited from that, you know, cancer patients, you know, leading toward end of life, all of a sudden had a better experience.
And so they're saying, why is that? And then they said, you know, gee, there's some other things going on with, things like depression, anxiety. And using these tools seem to also make sense. But when you use them, it's not just, hey, here's the pill. Go away and come back and you're fine. It is a process. And so what they're finding is, you know, what was done for a thousand years makes sense.
Which is there needs to be a process, there needs to be a guide, there needs to be a therapist. There needs to be somebody actually saying, let's make sure everybody's safe. And then there, was starting to be research saying, you know, these molecules don't really change you. What we're finding is the molecules open you up for change. And so they're a tool, but you have to do your own work. And so how do you prepare people ahead of time for what they're going to experience? And so B, things like meditation might be useful so they can calm themselves and experience and open up to what these medicines have to offer. And should the therapist just sit there or should the therapist interact or should the therapist help you afterwards during a period of integration? And turns out the integration period is really important.
So then there's a role for therapists, there's a role for guides, there's a role for social workers in this. And so I said they're going, these are important tools for medical models for the mental health strategies and treatments. They're not replacements for it. They're just another tool in the tool belt to allow people to do the work.
And so what they've then found is that the integration goes over, lasts for a longer period of time than they originally had thought. And there's a great researcher out of Berkeley, University, Gul Dolen, who's done a lot of research on learning periods. And what tends to happen with these molecules is they reopen a learning period. Learning period defined as when you're 2 to 9 years old and you can learn languages. And it's easier than today when you and I would have a harder time doing that.
Well, what happens, surprisingly is that these molecules open learning periods again. The synapses are restimulated for learning and its different periods of time depending on the molecules. What they found is, you know, there is ketamine, which, you know, reopens the learning period for, I don't know, for six days or so. Psilocybin might be for four to six weeks. Same with LSD. And then ibogaine, which is another molecule. It's not yet - none of these are approved other than ketamine, though others will soon be, ibogaine, which is, done in Mexico and a variety of other places, seems to have a two to three month learning period. And so these are very long periods of time that you can - during those periods - reprogram yourself, stop addictions, work on the anxiety issues, open up to change.
And what they started finding is when they started doing research. And this is when the philanthropists started coming in for, MAPS, for example, which brought together funding for MDMA, which had been called ecstasy and been a bit party drug in the old days. What they found is using MDMA in the trials decreased PTSD in veterans. They used a lot of it in veterans and others. PTSD, post trauma stress syndrome, where they were reliving their horrors of war or whatever it might have been. It allowed them instead of to relive them continuously. The MDMA seemed to stop the default mode network and quiet it down, which is in the brain, and allow you then to start putting behind yourself the experiences that you're continuing to relive. Instead, look forward. And when that occurred, they could start replanning their lives and rethinking about themselves and learning healthy habits and learning how to meditate or do whatever you want to do.
And then therapist can be helpful saying, hey, here's some tools. And what they're finding is, gee, getting around peers and having a group of people is probably useful. Doing some somatic work and body movement probably was helpful, you know. And so all the different tools start coming into play for mental health. And what happened was these molecules open that period and open that opportunity for the therapist to start doing the work.
And so the philanthropist came in and said, okay, we want to support that. And MAPS was set up, it was a nonprofit at the time, to do research on it. So it did. It was one of the first to do that. And getting Rick Doblin in to help lead that process.
Long story short, the research, was successful. They submitted it to the FDA but they didn't get approval because the practitioners actually started saying, we don't understand this drug. We don't understand how we integrate into our system. And they didn't do the research probably as well as they should have.
Other companies along the way, Compass, started doing research on psilocybin. Usona started doing research on psilocybin. They started applying to the FDA for phase one, two and three approvals. So they started doing the work, started being able to raise money philanthropically, and then started being able to raise money for investments.
So the philanthropists were there to kickstart some of this effort. And then funding started coming in but what happened was, the FDA kind of said, we only approve molecules. We don't really understand this integration period. We don't really understand this long period of analysts and therapists doing the work. We don't approve that. You know, that's just what's typically done by therapists. But, you know, we approve molecules, whether healthy or safe and useful.
So, the drug company said, okay, well then we're going to go for approval, just the molecule. We're not going to start doing in our tests integration. We're not going to require that when we get these drugs authorized.
So, what we as philanthropists said is for this to really truly be effective, we need to help support that other side. The other side of what are therapists going to do? And so we started working with the American Psychiatric Association, the Psychologists Association, the APA's national social workers. You know, this is all mainly here in the United States, but it's definitely applicable to across Europe and others,who are also very interested.
And so, you know, how do we as philanthropists start saying, how do we make this available to everyone? Because what happens when you get the drug approval is who pays for it? Right now it's whoever can afford it. So therefore middle and upper class people who can afford it can get access. But those that probably really need it for high depression, anxiety, PTSD issues, women's sexual trauma is a big one. Actually that one is, ten times more prevalent than male, PTSD. And so that's something that research is being done on as well.
So how do we as philanthropists start looking at it and saying, how do we change the reimbursement systems? How do we change the national health systems in the United States? It's one where you have Medicaid. Medicaid is a state by state system where they will pay for people who don't have, income to get access to health care. How do we get them to authorize it? How do we go state by state and start working with the governments there and the governors and legislatures to get approval? And we're in process of funding that process.
How do we start working with the different practitioners? Because it changes everything about how they treat somebody. A typical MDMA experience is, you do it three times with a therapist, you will be there for four to five, six hours.
And, that's not typical. A therapist normally had a 50 minute session, got paid for it, and then people came back again and they did. One worked there. And whether it was cognitive Behavioral therapy or whatever they did. And so the therapist kind of going, oh, my whole practice is going to be changing.
So we as, philanthropists started looking at gathering practitioners together to find, figure out, how is it going to change, how am I going to get paid? How am I get reimbursed for therapy? Because typically they get reimbursed for just molecules. Oh, maybe this is part of a behavioral health process. Maybe this is, you know, integrating it into the larger behavioral health system rather than just having what I call psychedelic exceptionalism, which is go into a room or go into the therapist, do one molecule and you'll be done. That never is true.
You know, these are molecules that you come into a therapist and they decide whether you take, you can use it or not. There are a lot of times when somebody goes to a therapist and they say, you need to just learn breath, practice, breathe better. You need to learn, how to work with others and build a collaborative group of people you can work with as well.
Then other times they'll say, hey, maybe you could benefit from some molecules here. Let's bring those in, let's use them. And how does that change your practice? That, to me, is the new world of, behavioral health and how we're looking at it.
Some of us are for profits, some in the nonprofit side, and so we philanthropies are used to come in and start helping and work with the practitioners, work on investing in set and setting, work on investing in the things that the drug companies are not doing.
And so when the drugs are approved within the next year, they will be, better supported than they would have been if they're just thrown out there as molecules.
CMHI: Jeff, thank you. That is an incredible summary. And these interviews are by funders, for funders, and you started to kind of segue into the funding, which, of course, is so crucial to your point, particularly about, how these extra tools in the toolbox are used safely. And also to your point, also about, equity of access and how we make sure that those who actually really need it most are able to access it. Can you just say a little bit more about the funder collaboratives? Because there is a really, actually very large collaboration of funders. And perhaps just a little bit about to your point, how some of this is philanthropy, but also how it can be blended with investment, Because I think, you know, using all of our financial tools and our financial toolbox is just as important as well.
Jeff Walker: Yeah, no, that's exactly right. There was a group of people that came together, as I said, with the MAPS funding. It was called PSFC, which is a psychedelic science funders collaborative. And it's, almost 400 people now. So it's a lot. And people interested in supporting it. They came together around MDMA and MAPS support. And then they started saying, oh, other things need to be funded and supported, like indigenous support. There's people that have been doing this for thousands of years. How do we protect them? How do we learn from them and bring them in? So there was a nonprofit called IMC set up.
There is on the other side, we're sort of going, you know, how do we set up structures to get reimbursement? There's another group called PMHA, Psychedelic Mental Health alliance, to support bringing it to people who couldn't afford it.
There was a group of people funding set and setting research with Johns Hopkins and McGill University and University of California, San Francisco, doing work there as well. People started getting together and working on these core issues.
What happened then was PSFC acted as a catalyst to start bringing people together to talk with each other, to connect with each other, expose them to researchers and expose them to different ideas.
And then there was, and I've been spending a lot of time on system change and catalysts for a long time.
These individuals I call catalysts, which we said, you know, how do we identify people who could be the core that unites all the funders around a common problem or common initiative? And so we hired, for example, just Jojo, Joanne Maislin, who is one of the great catalysts out there, which is somebody who says, I don't know all the answers. I'm here to unify you around a common problem or a common issue.
And so the issue of, how do we bring these medicines out and surround them with the tools that they need so that they'll be successful, so that people won't have harm, so that they'll be more safe, to use and more effective.
So, how do we set up a group of people who have common interests? And so Jojo was that catalyst to help unify it. We helped set up. How do we allocate funding to PMHA, which I talked about, or set and setting, and how do we evaluate it? How do we watch it? How do we get on a call, which we do every two weeks, and say what's going on so we can all learn? So we're not just treated as funders with just a chequebook. We're actually involved having our networks supported. Having, you know, I can help you there, I can help you introduce over here. I knew the Governors of certain states and so how do we get them access to those individuals in some of the state legislatures and understanding Congress, et cetera.
So there's more to funders obviously than just money. And I think that's you know, a key issue that we need to address is each time we're working on some of these problems. So JoJo was helping do that.
And then there was a smaller group of people who were focusing on PMHA, which is a psychedelic funders network, I mean psychedelic mental, Health alliance. And the two women, Dara and Hanifa, led that.
And so we started setting up smaller groups to focus on core issues, reimbursement, or getting the practitioners together. There was somebody who was able to bring in the heads of the APAs so that when another drug is brought to approval in the FDA, the practitioners will go, oh, we understand it now, we understand how it'll change our practices. So we'll help there.
So the funders started learning from each other. They started saying, oh,we think we can have an impact. We can measure that and we can move approval and we can move acceptance of these drugs up, so that they are going to probably be more effective and in place in the medical system in five years when it could have taken five, 10 to 15 years. So how do we hurry and speed up this process? How do we reduce the number of people who have harm and how do we make it accessible to people who could not have afforded it?
These are the role of philanthropists and we're all enjoy doing it. It's actually really fun. It's actually fun to have getting together every two weeks and hearing that the progress and saying, hey, I can be helpful over here and you know, and then know where our funding is going so that it has impact to it and we can see where it connects into the larger behavioral health system.
And that's one of the other interesting opportunities, and you mentioned it, there's for profit opportunities like Beckley Clinical, which is using ketamine, to do treatment and are building different locations around the country, to provide those services.
Not doing it at home, that's a problem. That started out to be a strategy that people were using at home, ketamine, but that wasn't supervised. There were just people taking it themselves. And again no integration period was used and no therapists were brought together. So he said that's not going to work.
There's other, groups now funding, strategies to say, let's build these clinics. There's one called Wholeness up in Colorado that's really good so that when people come in, we willattach, will connect them with therapists. Then we'll determine what's necessary and what's useful. It won't necessarily be a psychedelic.
Colorado has been one of the states that's liberalized access to, different plant medicines. And so, that's a good thing, but it's not meant to be a sole, strategy.
And so what Wholeness does is saying, you know, we will be the place that's already getting reimbursement for mental health strategies. But we also have an additional tool, as we've said before, to use in treatment systems.
So the philanthropists are there to support practitioners, they're to support reimbursement models, they're to support, legalization through the different states as well as the federal level. And they're to do research and support research saying, how does integration work? How does group work? You know, to have an affordable access, you're going to need to use groups. It's just cheaper to do it that way.
But what they're also finding, and we need to do a little more research to do it though, is that it's more effective in integration. You may not take the molecule with a group, you may, may not, depends on what the issue is. But you can easily be treated afterwards and integrate saying, how did, how did it affect you? What are you processing? How are you kind of thinking about that?
That's been proven for decades, you know, as an effective tool. But how do you use that for itself?
Then you add on other tools like a TMS, which is another one, which is trans magnetic cranial stimulation.And that's also now seeing that can be used to treat people in depression, et cetera. So let's roll that in as another tool in the tool belt. After that you also may use for depression.
So again, this is figuring out the mix. And every person is different and every person has to take responsibility for their own problems and their own, issues. But what we're also seeing is philanthropists being in joy because they're helping and also because they're working with other philanthropists in a collaborative way.
And those catalysts are helping them come together, for that tool, which I love, you know, I think it's like playing in a band where you sit there going, hey, we're creating this sound and creating something we couldn't have done by ourselves and then having an impact.
And to me that's a joyful strategy, to do that. So it's not just psychedelics. You use that tool for lots of different, other things that you can work on in the philanthropic world.
CMHI: Where are you headed next? What is exciting that is coming down the pipeline? I know there's quite a lot. And for a funder who's listening to this, who thinks, how can I get involved? What would you say to them?
Jeff Walker: Yeah, I'd say, if you want to dip your toe in, you know, join the PSFC, the psychedelic funders, they have gatherings. You can meet. You can see people that, you know have been through this before. You can figure out where your interests are and kind of how they should be coming together. And then you can start saying, hey, what am I leaning forward into?
If, for example, we're building a collaboration on women's sexual trauma, there's a study now going on at Sunstone on that particular issue. And they're seeing whether psilocybin or MDMA are the most effective tools, and then how to use group work, that is just starting. And it's, a big movement, around it as well.
Working at the state level, is still in process. We're still trying to figure out exactly how a rural model works, how you work with indigenous, how you work with veterans. So there's certain funders that are particularly focused on veterans and that's fine. So how do we kind of set them up? Because in the United States the Veterans Administration is one of the largest health systems in the entire country. And so how do you use them to be a model for how to use this? And so funders coming in, supporting that makes tons of sense, as well.
And then when the international funders come through and people that are in Europe, et cetera, I think this is total opportunity because you're going to start working in your own governments in figuring out how can you bring these tools because they are effective and they will be brought in.
And so how do you start taking responsibility for those places where youare resident and then learning from what we've been doing in the United States. So being part of what's going on in the United States will allow you to then fast track activities, overseas.
So you just pick where you're interested and how to come through it as well, figuring out what the problems are and what things to go after.
There's a new molecule called ibogaine, which the state of Texas has allocated $50 million to do research around, which Republicans, in Congress are very interested in. The state of Kentucky's interested, Colorado's interested, Texas is moving forward with it.
And Ibogaine is a very unique substance. Doing a lot of research out of Columbia University, this guy named Dalibor Sames, doing research. And what happens is, Stanford has found that if you use this molecule, makes you, your brain younger by a year and a half, it stops all addictions.
So that if you have a heroin or an opiate addiction, if you go through this process, which is about a ten day process, it stops that addiction completely without withdrawal. That's unheard of.
And so the Navy seals have been going through this and two friends of mine did produce the movie called Of Waves and War which is on Netflix. You can watch it and it shows people going through, Navy Seals going through that process where they were at wit's end, they were alcoholic, they were abusive, they had major PTSD problems and they come out of it going, the world is different. And their families talk about how different they are. They're still trying to understand the molecule, exactly how it works. And so it's not even started in phase one, going through approval process in the fda. So if you're interested in new things. This is definitely a new thing that people are all excited about
And doing research on, as well. I think that also the best opportunity is saying how does this fit into the larger mental health model?
And I know you've been interviewing lots of different people around mental health and those issues as well. And I think that's it.
You take the system, view things, let's step back a little bit, let's figure out where this fits in and let's figure out how it embeds into the current, behavioral health model and how does it affect people that are young, people that are old, people that have cancer, people have depression. Each one's going to be a little different.
And how we start changing the health system and working with the health ministers and how do we finance it? We're going to be working on this for a while. There's plenty of room for people to come in and work on it.
CMHI: Jeff, thank you. That has been the most fascinating interview. Really appreciate your wisdom and your leadership in this field. Thank you so, so much.
Jeff Walker: Sure. Thanks for having us.