A Brave New Mind - Psychedelic Medicine in Aotearoa

We wrap up season 1 back where we started, with Dr BJ Miller, one of the world's leading voices in palliative care. The connection between psychedelics and his field is a strong one, with a lot of the current research focused on easing suffering at the end of life. Amongst other things, BJ and Will talk about how they think about their own deaths, their visions for the future of their profession, the need for more humanity in medicine and where spirituality fits, and BJ's new online palliative care counselling service, Mettle Health.That's it from us this season - thanks for listening, and be sure to subscribe via your favourite podcast platform for updates on what's next. 

While we count down to the end of the year and the end of Season One, we thought it was timely to take stock of the emerging field of psychedelic medicine in New Zealand.In this episode, Will covers off the country's first psychedelic medicine conference, the momentum that's building in the research community, what's happening with the only psychedelic that's legal here for therapy - ketamine - and what lies ahead. Be sure to tune in next week as we wrap up the season the way we started it, with a conversation with BJ Millar.  And  don't forget to subscribe via Apple Podcasts, Spotify or your favourite platform so you don't miss the start of Season Two. 

Psychologist Dr Rosalind Watts is best known for her work at Imperial College London where she has done pioneering work in using psilocybin for depression.More recently, she became Clinical Director at  Synthesis Retreats, an organisation that offers medically supervised psychedelic retreats in Amsterdam.Having had experience working with psychedelics in both research and commercial settings, Ros brings a unique perspective to the conversation. Amongst other things In this episode, we explore some of the challenges of bringing these medicines into the marketplace, explore the treatment models Ros has developed,  discuss the dearth of diversity in the field, and get a reality check around the hype surrounding psychedelics. Ros has some thought provoking things to say about the need for clinicians to their keep egos in check when working with these medicines, too. 

Dr Marg Ross is a senior psychologist working in Palliative Care at St Vincent’s Hospital, Melbourne, and the clinical lead in Australia’s first ever psychedelic medicine trial, which is  looking at psilocybin and psychotherapy for end of life depression and anxiety.Marg had watched what was going on in the Northern Hemisphere with interest and waited for somebody to get a study off the ground in Australia before deciding nothing was going to happen in a hurry - so she’d better do it herself. It took a year to get approval from ethics committees, federal and state authorities, and then the study faced further delays when COVID hit. We talked with Marg about the challenges of getting approval for psychedelic research and the very real stigma and risk researchers can face, the sense of privilege she has felt working with the few patients who were treated in her trial before COVID intervened, what psychedelic therapy might look like in mainstream clinical use and why palliative care is such a magnet for this kind of work.Marg was so much fun to interview, despite the seriousness of the topic at hand - and we loved having both an Australasian and female voice to add to the mix.  

Dr Steven Mandel and his son, Sam, run Ketamine Clinics of Los Angeles - one of the first infusion clinics in the United States.At KCLA they do ketamine infusions all day, every day, and they have developed their own regimen of personalised dosing that takes patients to optimal 'altitude' to change their minds, as well as their brains. The Mandels are firm believers in the value of stand alone ketamine infusions, even without psychotherapy, and say they've seen near-miraculous and lasting transformations over the course of more than 10,000 infusions. We talked with them about their model and protocols, what they've learned over the past six years, why ketamine isn't the 'get rich quick' business some think it is, and how they believe the drug catalyses change that can be lasting - despite its short-acting nature. 

Professor David Nutt is the Chair of Neuropsychopharmacology at Imperial College London and a world-leading psychedelic researcher. He's a strong advocate for a rational, evidence based approach to  psychedelics, and continues to, in his own words, 'call out the lies' about them, wherever he can. David is currently Chair of DrugScience  and President of the European Brain Council, has edited the Journal of Psychopharmacology for over two decades and acts as the psychiatry drugs advisor to the British National Formulary. He is also the host of the very popularThe Drug Science Podcast.We covered a lot of ground with David, including: his latest study, looking into MDMA and alcoholismhis theory about why psychedelics appear to be especially effective in treating 'internalising disorders' like depression, anxiety and OCDthe nature of consciousness and where psychedelics fitthe risk that the high price tag for psychedelic assisted psychotherapy could leave it out of reach for most people and the role community healing could play

Saj Razvi has been involved in psychedelic therapy from almost every angle - as a researcher in the MAPS MDMA trials, as a psychotherapist, and now as a trainer of others looking to incorporate psychedelics into their practice. Saj believes that psychedelics don't necessarily fit with traditional therapy, and so has created a modality designed specifically for work with them.He's a passionate advocate for these medicines, but also knows from first hand experience that things can go horribly wrong. Saj continues to tell the story of what happens as a cautionary tale for others.We talked with Saj about why he believes therapy should start with the body,  the extraordinary results he's seen from people working with these substances, the enormous time commitment MDMA therapy demands, both in and out of session and his advice for therapists just getting started in the field.  

Dr Geoff Noller is a medical anthropologist specialising in psychotropic drug research, with an emphasis on drug use as a cultural practice.We talked with Geoff about his work looking at kiwi attitudes to cannabis use, the nature of consciousness and reality, fears and prejudices around mind altering states and substances, and his experiences as principal investigator on an ibogaine study for opioid dependence. Our interview took place on the morning of the cannabis referendum decision – and as a side note, he was keen for us to share this link to help explain some of the attitudes that endure when it comes to cannabis and all mind-changing substances.

Rick Doblin decided he wanted to be a psychedelic therapist when he was in his late teens, and has since dedicated his life to building the foundations needed to enable him - and others - to do the work legally, safely and effectively. He founded the Multidisciplinary Association for Psychedelic Studies (MAPS) in 1986,  a research and advocacy organisation that has spent decades researching the use of psychedelics and cannabis as medicines. MAPS is now closer than anyone has ever been to bringing MDMA therapy into the mainstream, with phase three trials underway into using MDMA for PTSD, and the achievement of 'breakthrough status' for this therapy with the US Federal Drug Administration. We talked with Rick about how long he thinks it will be before psychedelic therapy is approved for widespread use, the importance of specific training for Kiwi clinicians just starting out in the field, how just taking another substance isn't always the answer, and why the medicine alone, isn't enough. 

Psychedelic medicines have a long and chequered history - not the least because of wariness from the medical mainstream. That perception is changing fast, though, with a growing number of respected international researchers and clinicians pointing to the evidence of their potential to provide safer, faster and more effective treatments for mental illness and existential distress.There's a cultural shift going on, too, with support coming from unexpected quarters, including that of well-known writer, journalism lecturer and activist Michael Pollan, who brought the science to life by taking  readers on his own personal psychedelic adventures in the 2018 book, How To Change Your Mind.This week's guest,  the University of Auckland's Dr Lisa Reynolds, says Pollan’s book was one of the influences  that sparked her research interest in the potential benefits of psychedelic medicine for end of life anxiety and depression.  Lisa is also involved in some vital qualitative research to measure attitudes toward psychedelics as medicines of not only patients, but the clinicians treating them, too.