A TEDxsalon on Psychedelic Science and Medicine presented in Marin County, CA on June 10 offered an overview of psychedelics for what has become an increasingly mainstream audience.
Picking up where documentaries like “How to Change Your Mind” and “Have A Good Trip” leave off, the sold-out, 800-seat event provided a well-structured, substantive summary of the current psychedelic ecosystem for a mature, professional crowd. This event’s success represents the growing appetite for live psychedelic culture from those new to psychedelics who want to find others interested in the field.
UCSF School of Nursing clinical professor Andrew Penn opened the proceedings by detailing the whys and hows of psychedelic-assisted therapy. He said we should all temper our expectations about how quickly the science around psychedelics is moving.
Nicole Howell, founding board member of the Psychedelic Bar Association, articulated a values-oriented approach to navigating the mercurial legal and business environment for psychedelics. She suggested it may be time to overturn the Controlled Substances Act that makes many psychedelics illegal under federal law.
In his presentation, Dr. Kwasi Adusei described a nuanced, experiencer-centered practice for therapeutic approaches rooted in his experiences as a psychiatric mental health practitioner, festival medic, and community organizer. He shared best practices and advocated for shifting some deeply rooted notions about holding psychedelic space.
David Presti, who teaches neurobiology, psychology, and cognitive science at the University of California at Berkeley closed the night with an overview of psychedelic intellectual history. He advised that the growing influence of psychedelics on society is unlikely to be contained within the “narrowly defined biomedical framework” that the evening’s talks explored.
New Hope For Common Struggles
“Have you ever had a time in your life where you felt stuck?” Penn asked the audience, describing the joyless, disconnected fog that can characterize symptoms of depression, substance abuse disorders, obsessive-compulsive disorder, eating disorders, PTSD, and chronic pain. Penn noted that these diagnoses are on the rise. One in three adults will experience depression and suicide is the twelfth leading cause of death in the United States.
Penn explained that psychedelic-assisted therapy combines therapy and medication modalities. “Instead of taking a drug on a daily basis as we do now, we use a drug a handful of times to catalyze psychotherapy.” He noted that psychedelic therapies may use ketamine, MDMA, LSD, and psilocybin at full doses, where a few treatments “can produce an enduring effect within a therapeutic container.”
Bad Trips May Be Spiritual Vaccines
“This is psychotherapy that is catalyzed by a drug,” Penn said. Each patient’s experience represents “25 to 50 hours of concentrated therapy work over the course of two or three months,” including preparation, the psychedelic session, and follow-up integration.
Penn notes that the idea of a bad trip is so prevalent in the culture that it colors the expectations of prospective patients. “Many of our subjects come in and ask, ‘what if I freak out?’ We say, ‘if you freak out that’s gonna be ok.’”
“What’s interesting about ‘bad trips’ – we call them challenging experiences – is that they often predict antidepressant response,” Penn observed. “It’s a little bit like getting a vaccination where you’re introduced to some of the pathogens to make you a little bit sick so that when you are exposed to the real thing, you’re actually a little bit stronger and more resilient. Perhaps this is what’s happening during some of these difficult experiences.”
Penn cited recent results from Phase 2 psilocybin trials published in the New England Journal of Medicine that he said showed an “antidepressant response which goes on for many weeks” from a single dose in people with major depressive disorder. “Similar findings were found in treating PTSD with the drug MDMA,” he said. “At the end of the Phase 3 study that was recently published, two-thirds of people who were in the MDMA plus therapy group no longer had a PTSD diagnosis at the end of the treatment versus about one-third of people who got placebo.”
Penn noted that the Phase 3 MDMA research is in the FDA’s hands now and a decision related to its therapeutic availability could be rendered this year. Psilocybin, he noted, “is probably about four or five years out.”
Important to Do This Right
“There’s a lot of reason for caution,” Penn stressed. While acknowledging that the current progress is exciting, “there are a lot of things we don’t know yet.” He warned that the field and culture are both “getting ahead of the data.” The growing expectancy around the promise of psychedelics as a new category of mental health intervention “leads to some challenges when you’re trying to do good science.”
“It’s really, really important that we do this right,” he said. “I feel like the urgency around this is driving it much faster than the science. I don’t want to see what happened in the 1960s, where some high-profile adverse events occur and then all of this hard work that many of us have put many years of our lives into gets shut down.”
Making the Mainstream More Psychedelic
“As we end prohibition,” Nicole Howell asked, “are we to be satisfied with simply bringing psychedelics to the mainstream or are we interested in making the mainstream more psychedelic?” As a founding board member of the Psychedelic Bar Association, which launched in 2020, she seeks to explore that question by shifting the way lawyers in this space approach their work.
“We see our role as lawyers less as the ones who know it all,” Howell said, “and more as those who can facilitate legal relationships that contribute to our clients’ evolution and make the world a better place.”
“As far as law and policy goes, we really don’t know what we’re doing,” continued Howell. “It’s all really a big experiment at this point and we’re at the very, very beginning.” She cautioned that, “Despite the way we may be behaving or seeing others behave in this space, buying and selling and making and branding” psychedelics is still federally illegal “with some very narrow exceptions for ketamine and religious use. And your retreat center is probably not a religion that the federal government is going to recognize.”
Howell explained that Oregon abolished criminal penalties for possession of all drugs including heroin, methamphetamine, and cocaine. The state also legalized adult access to psilocybin at licensed service centers providing facilitated sessions that Howell views as “very expensive.”
Colorado Measure 122 decriminalized noncommercial possession, growing, sharing, and use of plant and fungi-based psychedelics and allows facilitators and guides to be paid without criminal penalty. The law anticipates regulating licensed service centers and continues to prohibit all retail sales.
California SB 58, which is currently moving through the legislature, would decriminalize personal use and noncommercial possession of some plant-based psychedelic compounds including psilocybin, DMT, ibogaine, and mescaline excluding peyote.
“You’re thinking, what about Oakland and Santa Cruz, I thought it was legal there,” Howell remarked. “The truth is that it’s really not. The city council said to the police department, ‘if there’s anything else happening that day, we don’t want you to arrest people for possession. But otherwise, sales are not legal and it didn’t change state law.”
Avoiding The Cannabis Legalization Mistakes
For Howell, the current environment provides an opportunity to focus on the big-picture philosophical and structural issues related to integrating psychedelics into society. This includes changing the law and establishing ethical best practices and guidance for businesses entering the field.
Howell argues that lawyers and policy makers need to be thinking about all avenues of access, including regulated and unregulated therapeutic use; religious, ceremonial community use; FDA-approved medical use; and the existing underground. “People are already accessing psychedelics for a variety of reasons in all of these many ways and they will continue to do so. We can’t simply pick the one that’s easiest for local and state governments to tax and regulate and think that’s going to change people’s behavior, because it won’t. It didn’t work in cannabis and it’s not gonna work here.”
Howell added that in her view, “We think psychedelic businesses ought to consider their role as stewards of public benefits and engage in dialogue with the stakeholders that are impacted by their actions.” She advocated for establishing multi-stakeholder approaches that provide indigenous participation and durable public benefits as bedrock aspects of governance.
During her remarks, Howell criticized the Controlled Substances Act and articulated a bold approach to overturning it. “It’s started to dawn on us collectively that [the law] is wrong-headed. It’s oppressive, it’s racist, and it doesn’t really make a lot of logical sense at this point for all psychedelic medicines to be federally illegal with the exceptions of ketamine and some very narrow religious use exemptions.” Framing psychedelics as having no medical value “doesn’t have any basis in science.” She credited a colleague for suggesting, “Why don’t we just legalize everything and make the government demonstrate that there is actually harm to put things on the schedule.”
Radical questions of that sort are a hallmark of the types of conversations Howell sees occurring within the Psychedelic Bar Association. The 100+ person group has adopted the North Star Ethics Pledge as a framework that informs the organization’s governance and programming.
Building Healing Containers
“The narrative of mental health itself needs to go through a metamorphosis,” said Adusei, who described a mindful, client-centered, best practices approach to psychedelic space holding.
Adusei found his calling volunteering as a medic at music festivals where he observed that the majority of his guests “were going through difficult psychedelic experiences.” He co-founded the Psychedelic Society of Western New York, where he developed The Sanctuary Project, which trained more than 200 space holders.
“We take on the role of an attendant to follow, match, and support individuals through their journeys,” he explained. “Our role was to stay attuned to whatever was emerging with curiosity. We recognized that challenging experiences were always an opportunity for growth and healing.”
Adusei credited Vanja Palmers and the Zendo Project with creating “the psychedelic risk reduction program that has trained thousands in these principles,” many of whom are among today’s population of psychedelic medicine practitioners.
Adusei says he prefers the term “risk reduction” to “harm reduction.” He explained that, “When we refer to psychedelic harm reduction, we’re implying there’s an inherent harm in psychedelics, and that’s not simply true. There is an inherent risk.” He says, “the policies that are putting people in prison” are more harmful than the drugs themselves.
He also wants the tripper’s cornerstone to become “set, setting, and support.” Adusei says, “Community is an essential facet of mitigating psychedelic risk. Too often we are moving through this world thinking of ourselves, our own agency. [We’re] not thinking enough about how we need this network and mosaic of support so we can really move forward together as a community.”
A Gateway Drug to Mindfulness
“We all have the innate capacity to heal and to grow towards wholeness,” Adusei said, introducing the psychiatric concept of “inner healing intelligence.” In his view, the psychedelic therapist helps their clients cultivate that intelligence by “putting the patient in the seat of the expert.”
Adusei says the therapist should follow the client’s lead from moment to moment in a way that’s similar to a meditation practice. They must “stay attuned and present for hours and hours on end, remaining endlessly flexible to whatever is materializing. Tuning into their breath to stay focused. Creating a new, constant reminder that all thoughts and feelings are welcome.” This client-centered focus on the present moment “makes it clear that psychedelic therapy is, in fact, a gateway drug,” he said. “It’s a gateway drug to mindfulness.”
Adusei believes that psychedelic therapy is “a modality of care that allows individuals to learn to sit with themselves and find a deeper sense of truth once they’ve wiped away some of the stories that they’ve grown accustomed to telling.” He says patients gain “the power to transform adversity into opportunity and imbue their lives with a profound sense of purpose that they didn’t know they had the capacity for.“
“Psychedelics have been in relationship with humans for a very long time,” Presti said in his remarks that took place at the end of the event. “Millennia, at least, and probably a lot longer. The word psychedelic, however, is relatively recent.”
Presti noted that Humphry Osmond, the pioneering psychiatrist, coined the word “psychedelic” in 1956 while engaged in then-emerging research into LSD and mescaline. At the time those drugs were known as “psychotomimetic” substances, which Presti explained meant “materials that may evoke the signs and symptoms of psychosis.” Unsatisfied by this descriptor, Osmond “sought a name for this category of exceptional materials that was clear, euphonious, and uncontaminated by other associations,” Presti said, quoting the psychiatrist. After rejecting terms like psychenzymic, “meaning mind fermenting, like enzyme,” Osmond arrived upon the term we now understand to mean “mind manifesting.”
How Mind Was Washed Away
“For most of the history of modern science, mind or consciousness has been off the table for serious discussion and investigation,” said Presti. “As science endeavored to define itself and its methods all the more precisely and mechanistically, mind was messy, to say the least.”
The term psyche was similarly restricted. It was imported into English usage as psychology in the 1600s to denote the study of the soul. The term was changed a century later to refer to the study of mind. In the 20th century, Presti said, the term was more severely limited to “observable and measurable behaviors with mental experience even off the table for consideration.”
Presti observed, “Many would argue that the psyche contains qualities far larger than those of a local personal mind or consciousness. That psyche together with our physical brain body allows connection with a much larger reality than our present mathematical physical theories are capable of describing.”
He advocated for this expanded understanding of the psyche-body relationship as “something that operates through a deep interconnectivity with a larger mental-like quality of reality, transcendent across beings, and across space and time, in ways our physics cannot yet capture.”
Making Nice With Gaia
Presti observed that every indigenous culture with a relationship to psychedelic plants and fungi “has world views that hold mind, that hold psyche and spirit, as central to the nature of reality.” He argued that it’s only the Western framework that gave rise to modern science that differs. He’s respectful but critical of this mechanistic worldview for contributing to exploitation, ecological damage, “and assimilating, suppressing, and exterminating indigenous cultures.”
The rising presence of psychedelics in clinical practice, Presti suggests, may provide opportunities for “decolonizing consciousness. Decolonizing our relationship with nature. Decolonizing scientific metaphysics. Decolonizing reality itself. Bringing psyche, writ large, back into the mix.” He adds, “it may well force us to. I do not believe a narrowly defined biomedical framework will suffice to contain these materials and the effects they contain.”
Presti remains hopeful that the influence of psychedelics on society will promote greater appreciation of the “deep interconnectivity of all beings. May it be that this leads us a bit more in the direction of respecting and honoring the psyches of all beings, of all our relations, and remembering, renewing, and recreating our ancient relationship with Gaia, who nourishes and sustains us all.”