Video: Explorations in Interdisciplinary Psychedelic Research: Group Two

On April 1, 2023, The Harvard Psychedelics Project at Harvard Divinity School, a student organization, held the "Explorations in Interdisciplinary Psychedelic Research" conference gathering together faculty, researchers, and students from across Harvard University to explore their diverse, interdisciplinary, and promising research on psychedelics. Speakers came from across the University’s Schools, units, and departments, including the Dana Farber Cancer Institute, Harvard Business School, Harvard College, Harvard Divinity School, Harvard Graduate School of Arts and Sciences, Harvard Graduate School of Education, Harvard Law School, Harvard Medical School, Massachusetts General Hospital, and POPLAR at the Petrie-Flom Center. This third series of talks featured Suzannah Clark, Max Ingersoll, Logan Fahrenkopf, Jeffrey Breau, and Paul Gillis-Smith.

Explorations in Interdisciplinary Psychedelic Research: Group Two

SPEAKER 1: Harvard Divinity School.

SPEAKER 2: Explorations in interdisciplinary psychedelic research. University speakers group two. April 1st, 2023.

JEFFREY BREAU: So I now have the distinct pleasure of welcoming our second round of university speakers. As Paul and I mentioned in the introduction, an element of both of our research is looking into the hidden religious origins of the modern clinical psychedelic paradigm. There is truly no part of psychedelic studies that isn't in some way informed by cross-disciplinary collaboration, which is the heart of today's conference.

This will be made abundantly clear with the next round of speakers who represent some of the incredible work that is happening in the clinical, therapeutic, and interdisciplinary spaces at Harvard Medical School and the Harvard teaching hospitals. As before, I will again introduce each speaker with a snippet from their biography. The full biographies of all of our amazing speakers can be found in the program, the virtual program at that QR code. And for those on the livestream, it should be pasted in the chat.

Again, same as in the morning, we will have a Q&A with all of the speakers from this university block at the end. So please save your questions for individual speakers for that time. With all that said, I'm now very excited to welcome to the stage Dr. Franklin King.

Dr. Franklin King is the Director of Training and Education at Mass General Center for Neuroscience of Psychedelics and a clinical instructor at Harvard Medical School. In addition to sharing his work, Dr. King has also generously offered to speak about the work at Mass Gen broadly as his colleague Sharmin Ghaznavi was unable to attend for family reasons. Thank you so much, Franklin. Welcome to the stage.

FRANKLIN KING: All right. This is my phone timer on to make sure that I don't go over. Hi, everyone. So this is amazing. This is an area that I've been interested in for so long and this goes back into medical school. A lot of failed starts in residency trying to get involved in research, trying to get research started. Raised eyebrows, people looking askance that this is a valid interest in psychiatry and it's just incredible.

I mean I see change over the last few years is unbelievable. And I think the roster of speakers that you're seeing today is a testament to that. We're really lucky in Boston in the Harvard community to have so many different areas and niches, and what's really cool about psychedelics-- you're getting a little editorial here before I tell you about what I actually do. But what's really cool about psychedelics is that they have applicability to almost any area of academic study.

And that's why we're seeing all these amazing speakers from the GSD, from the Divinity School, the law school, the business school, and medicine. So I think it's important to frame the discussion about psychedelics particularly medicalized psychedelics by sort of drawing the focus away a little bit from the exoticism and the titillation that people feel about psychedelics.

These are things that are sort of symbolic of rebellion and they're disruptive and other than ketamine, they're still all completely illegal if you're not working with them in a research setting. And I think that's not really the thing that we should be thinking about with psychedelics particularly if we're using them as tools for healing.

What I find most interesting about psychedelics is that they really cut through a lot of conventional paradigms in medicine and I think that's really important in this day and age. Right now, we are in the middle in psychiatry and in medicine generally, in the midst of a crisis. We're seeing suicides increasing year-over-year. It's one of the most common cause of young people.

We are seeing rapidly rising rates of depression, anxiety, PTSD, overdose deaths particularly since the pandemic have been skyrocketing. The so-called deaths of despair that you read about in the New York Times. And then generally in medicine in this country, the wealthiest place in the world we're seeing a sharp decline in life expectancy.

And so I don't say all this to trash medicine, I'm a practicing physician, most of my work is actually clinical, but really despite the fact that we have so many amazing medical advances, when you work at a place like MGH, I mean, it's incredible. People are getting treated for cancers and conditions that you can't get anywhere else in the world or even in the United States. So I'm a big believer in the wonders of modern medicine but there are vast swaths of people in patients that are not being touched and in a lot of ways, we're actually going in the wrong direction.

And so I think it's important to just be open and admit the fact that this is what's happening, this is the landscape in psychiatry. And this I think is why people are so willing to consider giving these agents that until recently, were demonized. These are the last things that anybody should be taking, let alone our most vulnerable patients, people with depression and PTSD.

And it's really the background of this crisis that is leading us all I think to be more open to looking at these, and because psychedelics cut through this whole conventional medical paradigm. So normal medical paradigm, no offense, when you go see your doctor, your doctor is just trying to have a nice interpersonal relationship, manipulate information out of you that can be written down in data. They're going to get some blood work, going to get imaging, they're going to process the data, give you a diagnosis, which is a label and writes you a prescription, and this works for a lot of things.

This is not how psychedelics work. Psychedelics can't work that way, they never are going to work that way. And so I think this is one of the major challenges that we're going to be looking at as we medicalized psychedelics that they are so different from the way that clinicians are trained, particularly physicians.

All right. So I think this is both a challenge in terms of how to educate people, but it's also a great potential benefit because it just transcends and gets right outside this whole medical paradigm that just isn't working for so many people. So that's kind of my spiel on why I'm interested in these things. I want to tell you a little bit about what we're doing at the CNP, I want to acknowledge Jerry Rosenbaum who ran our Mass General Department of Psychiatry for many years.

He's a friend, he's a mentor, and he's now the director of our center. I also want to acknowledge Dr. Sharmin Ghaznavi who is the Associate Director of the center and doing a lot of really amazing research. Without them, the center wouldn't be here and both of them really wish that they could be here today. Unfortunately, they could not so you're stuck with me.

What is the center? So the Center for Neuroscience of Psychedelics, you can look it up, but really it is a center that essentially is more of a collaborative I like to think of. It's a number of different researchers and clinicians were truly interdisciplinary. I mean, we have people doing bench research, we have people that are doing primarily neuroimaging, not with patients. Ranging up to people in psychiatry. We have a cardiologist who's a member of our center. We have a study in gastroenterology that I'll tell you about.

And really, we're sort of United in a shared vision of researching psychedelics to enhance neuroscientific understanding of mental disorders, and also to advance progress in healing all of these treatment-resistant conditions. The folks that come to MGH who've tried everything and nothing has worked.

So I'm going to tell you a little bit about some of the studies just to sort of say there's a lot of studies that I can't talk about or that would just be kind of bad form to talk about because they're so early on in planning. That we have a lot of hope in terms of funding and regulatory processes, that I think in another couple of years, we're going to have many more things that we can actually speak of publicly that are definitely happening, IRB approved, et cetera.

I also don't want to speak too much in terms of other people's research, but I'll mention that I think the flagship study of this center is the one being run by Sharmin Ghaznavi right now. This is a study that is currently enrolling. This is really the study that kind of got everything going. It's a psilocybin-assisted therapy study enrolling people with treatment-resistant depression with a neuroimaging component while people are actually in the middle of their psilocybin session.

So this is a really bold study and I think it's going to yield some truly amazing information about how psilocybin works, not just in the brains of healthy normal people, which is basically all the research that we have at this point, but actually figuring out what's going on in the depressed brain of patients under the influence of psilocybin. You can look up if you're interested more about this study. You can look up on YouTube, Dr. Ghaznavi has given some talks and also check out the center website if people that might want to enroll in this.

And there's a number of other studies that Dr. Ghaznavi is also working on that are sort of in various stages of the pipeline. In terms of what I do from a research standpoint, so this is a really exciting week for me. I am working-- I'm the principal investigator of this study. I'm working with a friend and colleague Dr. Erin Mauney who's actually a pediatric gastroenterology fellow.

It's really her study but she's still a fellow so she needs an attending to be the PI, that's me. And we're going to be doing two courses of psilocybin-assisted therapy for patients with irritable bowel syndrome. So this week, we just trained up our team of study therapists. We're probably still a year away from actually enrolling people in this study, but it really-- once you bring the team together and you have the people that are going to be doing the work, it's sort of like this huge step. Really feeling pretty good about the folks that we have working on this.

Another interdisciplinary study obviously, IBS, and there's going to be an imaging component and also some cardiac research, looking at heart rate variability and some other cardiac parameters with this. I'm also the study psychiatrist on another pilot that's going to be using MDMA-assisted therapy for the treatment of fibromyalgia. I did mentioned at the beginning but I did a fellowship in psychosomatic medicine, which is now called CL psychiatry, but it's basically psychiatry the interface of medical disorders and psychiatric disorders. And that's really kind of the area of interest I have for psychedelic work.

This study is being led by Vitali Napadow, that's the PI. He is a Professor and a pain neuroimaging researcher at Mass General and at Spaulding Rehab. And for this study, we're going to be doing two rounds of MDMA-assisted therapy and conducting hyper scan. What that means is that we are going to-- during the MDMA session, we're going to be doing simultaneous neuroimaging of the participant and one of the two study therapists.

And part of the goal of this is to look at the therapeutic relationship between the therapist and the participant while they're actually on MDMA. For those that know a little bit about MDMA, we expect that there's going to be an enhancement of the therapeutic relationship. That we might be able to see some of that in data form. All right. So stay tuned about that.

You're going to hear a lot more of some of the other work that we're doing at the center from Dr. Stephen Haggarty in a few minutes. And lastly, one of the things that I'm really interested in is educating clinicians. As I mentioned earlier, I think this is just-- there's so much in this work that is anathema or has become unfortunately anathema to kind of the modern way of practicing medicine.

And if this is really going to be something that can enter into medical practice without a lot of harm and people getting bad treatment and people that never should have been referred in the first place or unrealistic expectations, another huge issue in psychedelics, we really need to start educating doctors and therapists and psychiatrists who really largely don't know anything about this.

I mean, I'm sure there's a bunch of physicians in the audience. I'm sure you've been interested in psychedelics for a very long time. Most people in this space tend to already be interested in it. You're not the folks that we need to reach, we need to really get this cast a much broader net. So I work with the Mass General Psychiatry Academy. The Academy has a huge reach across the world and does a lot of conferences and educational missions.

And in 2021, we started what's now become an annual conference. We did one day in 2021, we did two days this year. For various reasons, I think we're going to push the next one into spring 2024, but hopefully, expanding it. We had speakers come from around the world. Had almost 500 attendees, mostly psychiatrists, psychiatric nurse, practitioners, psychotherapists, and the like. We just kind of teach them about the landscape and how the therapy works.

And I think this is a really critical time, right. I mean, it's expected that we're going to have MDMA-assisted therapy probably approved in 2024. So it's like a year away from actually being a real thing. And we really got to start getting people educated in this. So that's one thing that I'm involved in.

And lastly, an area that's really exciting to me is educating junior faculty and junior clinicians. These are the folks that are in residency right now who by the time they graduate, are actually going to be able to be doing legally psychedelic-assisted therapy. These are the folks that really we need to get trained in this and I've been working with MAPS, which is the organization that has been studying MDMA-assisted therapy for PTSD.

With a couple of my colleagues at Brigham, [INAUDIBLE] and Beth Israel, Dr. Michael Alpert, Dr. Roxy Sholevar, and we are going to in October do a five-day residential educational retreat for all Harvard psychiatry residents who want to participate. Probably, also some junior faculty, social workers, and psychologists who are HMS-affiliated and get them trained up and educated in MDMA-assisted therapy with a series of seminar series and other didactic sessions that we're going to put together to address some of the other psychedelics.

So this is-- we actually haven't sent the emails out. We're hoping to do that next week, but it's called the Harvard Interdisciplinary Program in Psychedelics. It's the first time it's been publicly announced right here. So super exciting. And hopefully, that will also--

[APPLAUSE]

Thanks. Yes. And we hope to make that an annual thing as well as part of the residency training program across the Harvard network. So I'm going to stop there. I think maybe a little bit of extra time maybe 12:26. And I'll give it over to Jeff, but thank you so much.

[APPLAUSE]

JEFFREY BREAU: All right. Thank you so much, Dr. King. I will say that is probably the first time I've heard a contented happy murmur through a crowd at the mention of irritable bowel syndrome.

[LAUGHTER]

Something to be proud of. Next up, I'm welcoming to the stage Dr. Yvan Beaussant, who is a hematologist and palliative care physician investigator trained in psychedelic-assisted therapies and serving as instructor of medicine at Dana-Farber Cancer Institute and Harvard Medical School. Welcome to the stage, Dr. Beaussant. Thank you so much.

[APPLAUSE]

YVAN BEAUSSANT: Hello, everyone. Hi. I will echo many things that Dr. King said, starting to say how excited I am to be here and to see all of you here. Thank you to Jeff and Paul and all those who organized this meeting. It's really an honor to be here.

And so I also was interested in psychedelic very early in my medical school. My favorite book when I was in medical school, which started right after high school in France, where I did my training. So my favorite book was The Doors of Perception by Aldous Huxley. And for somehow there was this shift for me between my interest for this field of work and my medical school.

I never heard about psychedelics in a way that was constructive or exploratory or curious about their effect, and how they had been used for millennials by Indigenous cultures, and how they might have a therapeutic value. It was all like produce of abuse that could not-- that led to the emergency room and that we had to know about the side effects and how to deal with them in the emergency room.

And so I had to say, I was very interested in psychiatry and during my secondary rotations, I actually really did not recognize myself in the way psychiatry was practice in very reductionist way of human suffering. And I ended up choosing to orient my career towards oncology and hematology, and then palliative care. And for the same reason that Emma presented this article of 2012, in the New York Times, I suddenly realized that there was this whole field of medical use of psychedelic-assisted therapy that really excited me to pursue further.

And so the reason of that trajectory is as a hematologist, the perspective of illness, of medical illness is that it's an enemy that we need to fight, and that suffering is also the enemy that we need to alleviate, and that death is a failure for the clinician, the physician. And so you can see how there is a whole range of the human experience that is not recognized here in how people experience illness and death and dying. But that's never addressed or very rarely addressed in the medical field or less so now.

So palliative care developed over the past few decades as a way to balance that and to address the different needs, clinical, physical needs, and the emotional needs, the social needs, and the spiritual needs of people who face serious illness and their families because all this happens in community. And so I was really interested to learn more about how to practice this medicine but still when it comes to the psycho existential experience of serious illness, I think we very often fell short of how we can help people really improve.

And there is so much that we can do to address suffering, especially when we have no longer control over the disease progression, but still, like what can we do first? And when I became interested in psychedelic-assisted therapy in France, there was a whole debate around terminal sedation and the lowest changing around terminal sedation. And we were allowing people to be really to be lowered consciousness for existential distress, for what we call refractory existential distress.

And so what is refractory existential distress in medicine and how do we even define existential distress and how do we address the existential experience of people? And so all these questions I think resonated a lot with the work that was emerging through psychedelic-assisted therapy, and really got me excited to further my training and my research on this topic.

And so I was fortunate enough to complete a two year research fellowship at the Dana-Farber Cancer Institute, learning how to conduct research on psychosocial oncology and palliative care. And I also completed the certificate program in psychedelic therapies and research at the California Institute of Integral Studies.

And so during my research fellowship, this is where I find fascinating this idea of interdisciplinary work around that. But really the questions that we addressed were bringing stakeholders that [INAUDIBLE] in this care. So the clinicians, the psychologist, the psycho-oncologist, psychiatry, the social workers, the chaplains, and the researchers and spiritual research. And to have them consider the question of the potential role of psychedelic-assisted therapies in patients with serious illness and how do we do that.

And so from that, we define the research priorities for this field and what are the essential questions that the research needs to address. And so some of them are very practical. So, what are the patients who will benefit from psychological therapy? And when during their disease trajectories, how according to which therapeutic modalities which drug, which psychotherapy, and how many preparation and integration sessions? And who needs to be the clinicians?

So really like very practical questions around how we implement that and then measuring the effect. How do we measure the effect? And we have all these psychiatric categories depression, anxiety, the trauma, et cetera, but there is something around distress that is not necessarily captured by that and that many people experience in serious illness. So how do we refine our measurement tools to assess the efficacy?

And then there is all the questions of implementation and access and irritability. How do we make it such that those who might benefit from this treatment can actually access it? So about two years ago, we've been able to start our first clinical trial that actually has been enrolling over the past year. And so these I believe are the first patients at Harvard who receive psychedelic-assisted therapy since their 60s.

And we've been amazed by how much work it is to integrate psychedelic-assisted therapy among existing structures of health care, serious illness care, but how important it is like. So we work with-- so this first study is a study of psilocybin-assisted therapy in patients who received hospice care. And we addressed demoralization, which is a syndrome of existential distress where people are struggle with meaning and purpose and with coping.

And so it's different from depression and it's more about the existential nature of their suffering. So people who qualify for-- so there is a whole screening process and then the people who qualify for the study, there is a lot of communication with their hospice team and then they go through their psilocybin-assisted therapy and then there is a handoff to the hospice team. And I think the way we approach that is how important it is to build this knowledge and this practice and existing structures of health care.

And that's what makes the meaning and the therapeutic value sustainable and also coherent with a global approach of care. So I just want to tell you about a couple of patients maybe that we've treated. The first patient that enrolled the study was this 60-year-old man with metastatic colorectal cancer. And this man was really able to feel alive again after the psilocybin-assisted therapy through his like the renewed ability to feel connected to himself, to others, to nature, and to music.

He was a gardener, who was a musician, and who loved hanging around with his friends, and the disease had made him unable to access these coping mechanisms. And through his journey, he was able to revisit his relationship with what meaningful for him and really to find new ways of implement that in his life and he lived like several months with a lot of meaningful relationship with his family, and the hospice team and that really helped me have-- helped him have a peaceful death.

We treated this 47-year-old woman who had teenage children and who was receiving hospice care for a pulmonary disease. And so she qualified for the study meeting the criteria for demoralization, and her narrative was I won the lottery. I have this disease and I feel alone and isolated with it. I think that from my family and from my role as a mother, and I'm going to die alone and leave everybody behind.

And after the psychedelic-assisted therapy, she actually no longer qualified for demoralization on the scale we use, which translated by being really at peace with herself and present for her family. And she had this really beautiful, profound experience of connecting with the primordial river during her experience. And also did a lot of grief work and find herself much more accessible and available for her family, as a mom, and was able to provide actually to continue really relate with her identity. So bringing back to a sense of wholeness despite the disease and despite the loss of function.

So I know I'm at time so I'm going to stop here. There is as I said, there is a lot of research questions to be addressed. We have studies coming up to address opioid refractory pain with psilocybin. We work on studies of MDMA-assisted therapies in patients and family caregivers. We're very interested in implementing group and peer support to offer-- to increase accessibility and scalability.

We learn a lot about how to involve family caregivers in patients' care. And something that we are really interested as well is the use of music in psychedelic-assisted therapy. We've been working with a music therapist, guided imagery, and music therapy, and have really learned a lot about how to use music as a therapy in the room. So thank you very much. [INAUDIBLE]

[APPLAUSE]

JEFFREY BREAU: Thank you so much to Dr. Beaussant for that truly moving and I think critical work. And as you can see, any one of these speakers could take an entire conference, so we appreciate them being here and sharing a little snippet. And we hope that the reception afterwards in the Q&A will allow more time to discuss the nuances of all of this.

Next up, I'm inviting Grant Jones to the stage. Grant is a musician and researcher currently enrolled in the clinical psychology PhD program at Harvard University. His research and life work centers around developing and implementing contemplative and laboratory tools for diverse populations. Doctor already or soon to be? Soon to be doctor.

GRANT JONES: Soon to be. [INAUDIBLE] in.

[APPLAUSE]

Hello, folks. It's really sweet to be with you all this morning. Again, my name is Grant Jones and I'm a fifth year clinical psychology PhD here at Harvard. And I wanted to take the next eight minutes to tell you all a little bit about my research.

So like we just mentioned, my research centers around contemplative tools particularly for supporting, flourishing, and well-being in diverse populations with a particular focus on Black American wellness. And in graduate school, my research is focused on two domains that I fully intend to continue forward throughout my life and career.

The first domain has centered around psychedelics, as is probably surprising. And the second is focused around meditation music. So I look forward to telling you about both domains right now. So the first domain around psychedelics is a question that I came to graduate school and just sat with for a couple of years because I think the question was like, how am I actually going to research this for real as a graduate student who can't actually administer psychedelic treatments, who with all of the barriers and all of the hurdles around what it will actually take to do this research?

And so I sat with the question, I sat with the question, I sat with the question, tried a few things, bounced a few things off my advisor, and just spend for a little bit for sure. But what emerged for me as a viable pathway was actually using large epidemiological data sets to look at the associations that psychedelics share with mental health outcomes.

As some of you may be familiar with, there are data sets that the National Survey on Drug Use and Health that collects data on thousands of Americans each year, and also collects data on thousands of different variables related to substance use and health. And actually, some foundational research within psychedelics prior to my enrollment in graduate school had looked at associations within these data sets to start to lay preliminary groundwork for the associations between how psychedelics might be linked in protective manners with some of these variables.

So I'm caring of the mantle of that research, I developed an analytical framework based on some of the research that had been developed before. And what I did was I systematically looked at various mental health outcomes and addiction variables within those data set and a very clear pattern emerged across a number of different studies, which was that if you control for the same exact set of demographic variables, same exact set of substance use variables, you see a very consistent pattern where classic psychedelics and also synthetic psychedelics like MDMA, and pathogen as we all have talked about here at the very least.

You see this very consistent pattern whereby these substances are conferring lowered odds of outcomes that we've discussed, such as depression, psychological distress, and also some novel ones. Cocaine use disorder is one domain I've looked at. Also have looked at the associations between MDMA use and various markers of social impairment showing that even within a large population based data set with hundreds of thousands of people, you're actually seeing very similar patterns that we know intuitively that MDMA is conferring-- MDMA specifically and uniquely is conferring lowered odds of these data sets-- of this variable in a way that is consistent with what we know clinically.

And again, although my research is very clearly not cause and I always like to say that very clearly as a limitation, what excites me about this research particularly in being able to engage it now and being a steward of it now is that as psychedelic research paradigms develop further and as more funding continues to flow into the space and it becomes a bit easier to conduct clinical research around these substances, this foundational correlational research will be there as the springboard for more direct causal inquiries. So that's part one.

Part two is really now where I get particularly excited because this is around how psychedelic use exists within communities of color. And so it might be news to some of you but probably unsurprising to many that psychedelic research has thus far been extremely homogeneous. There's very, very few papers published about what psychedelic use looks like in communities of color, let alone psychedelic use as it impacts the mental health and behavioral outcomes within diverse populations.

So what I've done with in graduate school is I've taken some of the correlational data that I've looked at, some of the associations that I just previously named, and have started to look at how race and ethnicity might moderate some of these associations. And also, using race and ethnicity as a variable by which I stratify these associations look specifically at how these associations might vary by different races and ethnicities.

And what I found now across a few different these associations is not only does race and ethnicity moderate these associations, but when you actually stratify some of these associations by race and ethnicity, you're actually seeing many few or many weaker associations between psychedelic use and lowered odds of some of the deleterious outcomes that I've named. And actually, all much of the effects that I've actually documented in some of the association studies that I mentioned previously has been driven by the white participants within the study.

And I think again while this is not a causal, I cannot make any causal claims, I think why at least it raises important questions is because if you look at, again, the clinical research that's been done in this space and you realize the extreme limitations to external validity, it brings up natural questions of what does it actually mean to bring these substances into communities of color. Even at the correlational level, you're seeing radically different associations already there.

And again, probably unsurprising to many of you there are already issues coming up around harm and implementation within clinical research. And so for me, these questions are important to ask now rather than down the line when structures have been built that systematically harm people in very familiar ways, that many of us are probably acquainted with or at least have heard of at the very least I hope. That's part two.

Part three is now around my music and meditation research, which is particularly exciting for me because right now, I'm in the middle of an extreme grant writing marathon around it. So send me blessings for that. But my dissertation and really the beating heart of a lot of my graduate work has centered around developing a music-based mindfulness intervention that can blind's originally composed Black American music that I made with contributions from a few world renowned Black collaborators.

And I'm blessed to be able to work with, such as Lama Rod Owens who is a world renowned meditation teacher, and LA Times bestselling author, and also Terry Edmonds who is the former chief speechwriter for President Bill Clinton. And Lama Rod Owens contributed guided meditations to the intervention and Terry contributed contemplative poetry. And what I have done is create this contemplative intervention that's meant to reduce race-based anxiety in the Black community and also inspire mindfulness and self-compassion.

So what I've done is across two pilot studies that utilize the multiple baseline design, which just for a brief overview, just entails taking repeated measures of one's outcomes of interest across two different phases, a non-intervention phase where you're not playing any music or any of the intervention, then an intervention phase in which you are actually administering the intervention. And then seeing just in a very simple way how do people change across these outcomes when you administer intervention versus non.

And it's very small end study, so I've only run it within 13 people generally. But what I have seen across this preliminary inquiry is that my hypotheses have been supported the stage, which is exciting. So you do see significant reductions in race-based anxiety and also increases in mindfulness and self-compassion. And I think for me again, even though it's a small and I said I think what excites me most is around feasibility and acceptability.

So within participants, the average score of recommending the intervention thus far has been 94 out of 100, which is really exciting. So people really into at least exploring this as a form of healing for themselves. And so what I hope to do now like I said, is acquire greater resources to further build this intervention and test it for persisting clinical outcomes and eventually combine it with psychedelic therapies for communities of color. Thank you for receiving my talk.

[APPLAUSE]

JEFFREY BREAU: Thank you so much soon to be, Dr. Jones. Many blessings on that journey. Phenomenally interesting work. And I should note that Lama Rod Owens is a graduate of Harvard Divinity School is doing phenomenal. I'm so excited to hear you're collaborating with him. An amazing essay on his experiences of healing trauma using ayahuasca with his plant medicine work in Black and Buddhist, which is a phenomenal text I would recommend to folks. And just cannot wait to hear more about your work, Grant.

So next up, we have Dr. Fernando Espi Forcen who is an Attending Psychiatrist at the inpatient unit of Massachusetts General Hospital, and an Assistant Professor at Harvard Medical School. He also has a PhD on the state of mental health in the middle ages. Welcome to the stage, Dr. Espi Forcen.

[APPLAUSE]

FERNANDO ESPI FORCEN: There you go. Well, it's amazing to be here. When I came this morning, I was like, Oh, my God. Harvard Divinity School. This is amazing. I mean, I'm from South Spain and I'm still integrating this experience of being a speaker of Harvard. Yeah, I really appreciate being here [INAUDIBLE] by this so thank you for attending this.

Well, I want to thank Jeff and Paul as well for organizing this. I want to thank Franklin as well who has been my guardian angel at MGH, and he's the one who has been putting me in all these conferences and helping me. So thank you all. So I'm talking about ketamine. I had so many slides but when I saw the vibe today, I told them, remove the slides. Let's just talk here because we're all talking and sharing feelings now.

Like many of us who are here, my interest in psychedelics is started with a personal experience with psychedelics. And then I was in training, I was thinking, Oh my God, if everybody tried this, there wouldn't be a war. There wouldn't be conflicts. We all would love each other. And I think psychedelics are really helpful for that. It really--

[LAUGHTER]

So it's a little bit like cognitively, you see it like, yeah, we are all part of the same, blah, blah, blah, and we're all stardust. But then you feel it, you're like, man, now I feel it emotionally. So it's so amazing. And ever since when I meet other people who are a psychedelic experience, we are like, yeah, we know. We don't have to talk about the real estate market, we can talk about all the things that are more important.

So this is part of the thing. Now, as I'm talking about ketamine, which is the talk today-- actually, I must say that this comes very timely because I'm doing my ketamine psychedelic psychotherapy training right now at the Boston Psychedelic Research Group. And yesterday, I had my 300 milligrams myself of lozenges of ketamine.

And I was thinking, when I was there very far away I was thinking, how can I talk about ketamine? How can I talk about what I'm experiencing right now in a way that it makes sense verbally because it's very numb very well that experience and it's so powerful. And I will talk about my ketamine experience-- but I don't want to miss out the topic, which is ketamine in the in-patient psychiatry unit.

So I work as a psychiatrist in an in-patient psychiatry unit and I work with psychiatry residents. I met students every day, which is a gift because I get like the smarter people in the world I think. You guys are so smart. And I'm thinking, Oh my God, how can I teach these people? But it's very amazing. And what we see in many of our patients, they have active psychosis, active mania, or suicidal ideation, and the most effective treatments that we have in psychiatry for suicidal ideation was psychotherapy or electroconvulsive therapy.

But ketamine came out as a new treatment that not from the psychedelic world, from psychiatry. NIH is thinking, wow, this really helps suicidal ideation. So we're thinking, why I cannot give ketamine to my patients with suicidal ideation because this is something that a problem that we have our in-patient psychiatric units. And eventually, with some effort, we've been able to make some exceptions and I'm talking about MGH. I work in a med psych unit.

In most units in psychiatry nowadays, despite being in a hospital, we don't have IVs. So we couldn't do ketamine IV because we don't have IVs. And we're going to do IMs because sometimes the staff don't feel comfortable doing an IM. I mean, they feel very comfortable doing the Haldol IM, but they don't feel comfortable with the ketamine IM because they've never done it. So it's really a limitation that we have in in-patient psychiatry unit.

So when I was working at the in-patient psychiatry unit, we had patients-- by the way, we had a patient that was not getting better on ECT, and she had severe trauma from 9/11 because it was one of the person who sold a tickets to the terrorists twice and she was like, what's going on. And then she felt very guilty that for the Boston flight. And we brought the case now, it's under review now-- well, it's about to second review the case report. But after that case, I was like, we need to make an exception for this patient.

And we have another patient as well that was not getting better with anything. I was like, we need to make an exception like two patients really changed how we are shifting-- how my unit and my department is thinking about these. These two patients were extremely suicidal. One of them was very suicidal with gunshot attempts to shoot himself. Another one was a survivor of 9/11, who was extremely suicidal and I was saying myself, I'm standing on this one. I'm not discharging these patients.

So if the unit director or somebody else wants to discharge a patient, I'm not discharging them. And after 12 sessions of ACD, one patient in the end they approved, they approved ketamine. So I was able to send the patient to the academic clinic that we have and I was like, I'm going to go to a psychedelic integration therapy here. So we started doing psychedelic integration therapy and it really helped the patients. And some of the patients they said, the ketamine helped me but the therapy really helped me.

And this is another problem that we face in in-patient psychiatry. So for some reason, ketamine because it came from pharmacology or NIH, they don't consider that a psychedelic. So it's considered now in neuromodulation. So they put ketamine under the neuromodulation department together with electroconvulsive therapy and transcranial magnetic stimulation. And when I tried to say, hey, I want to do psychedelic psychotherapy they're like, no, you don't want to do that. We took it already. You cannot take it. And this is how things work.

But now we are hoping that maybe with MDMA, they don't want to take it and they allow us to take it because this is where we are. So I'm doing ketamine integration psychotherapy with patients that we can refer to the academic clinic. No, I have like four minutes here but that's fine. I'll finish in two minutes.

So I'm doing this and then I'm trying to figure out, OK, so we're having seven cases now where [INAUDIBLE] is a case here is. We're doing a ketamine study as well with CAMS, which is a complex assessment and management of suicide therapy. And we thought also which therapy might work for these people. So we have-- many center psychotherapy it makes sense for suicidal because many center psychotherapy like Viktor Frankl helps existentially. So we have existential therapy, we had dynamic therapy.

I found myself reading Jung again. I found myself reading dream interpretation and doing dream because in ketamine, you have dreams as well. And with these patients, all these therapies resonate, and this is something I'm trying to understand and that's part of the reason I'm doing my ketamine training right now. So I have to end because I have only a couple more minutes.

Ketamine neuromodulation versus ketamine psychedelic psychotherapy, this is the conflict we're dealing with now. I think ketamine without psychotherapy is potentially harmful to patients because many of the patients when I was going to ketamine clinic, they were freaking out. They were like, Oh my God, because they are told these are just side effects that they get, and this is potentially harmful. So we have to really think about this as a community.

And then I just want to talk about my experience. Actually, yesterday, I was like I'm talking about ketamine all the time, ketamine in this model but yesterday, I took the ketamine and me as a ketamine researcher, as a ketamine psychiatrist, I experienced ketamine. I took 300, I had my sitter there. And I was holding the hand of my sitter and I was going really, really far. I mean, I was-- at some point, I was so far I forgot if I was on ketamine or MDMA or LSD or psilocybin.

All of them look the same to me. And I started thinking of my friends that I love so much. I was in Mexico with recently and I was thinking about them and I was thinking about my family and I was thinking about my girlfriend. And I was thinking how much I love everybody. I was thinking all of the 30 people that were with me that I love so much and I felt this universal love.

And then when they were waking me up they had to wake me up but they couldn't, and they were like-- I was like and I was like, I cannot come back and I grabbed the sitter away even further away. But eventually, when they managed to wake me up, I just told the first person who woke me up who was like one of the organizers said, man, I love you so much. I love everybody. I love you guys. So I think love is the answer. It sounds cheesy, but love is the answer. So that's all. Thank you.

JEFFREY BREAU: I have a new and very intense interest in existential therapy now. Thank you so much, Dr. Espi Forcen. So our final speaker for this block before we move over to Q&A is going to be Dr. Stephen Haggarty. Dr. Stephen Haggarty is an Associate Professor of Neurology at Harvard Medical School. He is the Director of the Chemical Neurobiology Laboratory at the Mass General Center for Genomic Medicine. And he is Scientific Director of Neurobiology for Mass General Center for the Neuroscience of Psychedelics in the Department of Psychiatry. Welcome to the stage, Dr. Haggarty.

[APPLAUSE]

STEPHEN J. HAGGARTY: I'm so thrilled to be here today, and to be connecting with you all. That was a really going to be a hard act to follow here in terms of inspiration, but this is I think just an amazing ability for our community to come together in moments like this. And I want to take the theme today of explorations and tell you a little bit about what I think is most exciting on the frontiers of psychedelic research.

Before I do so, I do have a few disclosures. I work very actively with members of the biotech and pharmaceutical industry that's very present in our Boston Cambridge environment. And think they're actually really important partners in having the opportunity to deliver medicines and actually impact patient care.

For me, psychedelics indeed are something that can connect our community together and has been doing so for millennia. In fact, we're all here today because of this common interest. But beyond just connecting the community together, they provide really powerful tools to study the human nervous system at a variety of different levels both spatially and temporally. Whether it be trying to understand where the receptors are for such agents such as psilocybin is depicted here in an image using positron emission tomography to localize a receptor within the human brain or using other modalities, such as functional magnetic resonance imaging, allowing us to see changes in connectivity or brain function.

Or also at a more molecular and cellular level, the changes in activity of different cell types that may ultimately underlie the phenomena that we're so interested in. And these tools I really think are a gift and a gift for us to study the nervous system, and think about the applications for mental health.

25 years ago, when I was a graduate student wandering the streets here of Divinity Avenue, a member of the chemistry and chemical biology department, I started to become interested in the concept of brain plasticity. And started to think about who were the members of our community that have studied plasticity. And one of the first quotes I came across then here is from our great William James, who to the young chemist in me, piqued my interest because he described these as the nature of plasticity having an organic basis.

And that this degree of plasticity that the brain can undergo is something that we really want to turn our attention to to study. Now, I don't know that this is true but William James to me is actually one of the first psychedelic researchers at Harvard through his experience, both with mescaline and nitrous oxide. He actually didn't like mescaline from his descriptions. He liked nitrous oxide a little bit more and perhaps it was these agents that really inspired his notion of this so-called noetic sense.

And it was this reading for a chemist in me that really piqued my interest about these other areas of medicine. But I have to come back to someone who was already mentioned here today in particular in the theme of exploration and the critical role that Harvard has played historically in this exciting field of psychedelics. Those of you that don't the great Professor Richard Evans Schultes really should spend some time this weekend reading a little bit and discovering some of his amazing work.

Many consider him to be a founding figure of the field of modern ethnobotany, the systematic study of the relationships then between plants and humans and how they've been used over time. Schultes is fascinating in a number of facets in part because he's a home grown Bostonian. Grew up in East Boston 276 Lexington Ave, an area of Boston that's almost completely void of any plants or trees if you go to there.

He was such a remarkable student though that his professors realized his special potential and he obtained a scholarship to come to Harvard. Working with the great Oakes Ames, who recognized again, Schultes talents he began to work within the Harvard Herbaria just across the street here. Schultes spent his entire life here at Harvard besides the time that he escaped to the Amazon as was mentioned for over a decade.

He not only was critical for the creation of the Harvard Botanical Museum but most importantly, I think educated and inspired a whole generation of botanists that became interested in this area of psychedelic research. Now, it is said that Schultes became interested in psychedelics from reading this little book as a class assignment that he had. A book written by a German psychiatrist named Heinrich Kluver.

Why this book was in the Harvard Herbaria is a question I would love a historian of science to answer for me, but it inspired and exposed Schultes to the wonders then of psychedelics. This led then to Schultes in his entire research career at Harvard to make fundamental contributions to the very nature of the phytochemicals that are the basis of the psychedelic renaissance. Not only studying the sacred cacti peyote and the source of mescaline, but [INAUDIBLE], the mushroom then that gives rise to psilocybin and other alkaloids.

His PhD work in on [INAUDIBLE], Morning Glories, again, fundamental contributions. But Schultes really set the stage for the need for interdisciplinary collaboration, not only being inspired by a psychiatrist but working with the great Swiss chemist Albert Hofmann. In some of his seminal work then summarizing the nature of this vital chemistry became really inspirational to me to think about the power of using chemistry to study the nervous system. And these fundamental contributions then really capture I think this critical need for interdisciplinary research.

As was mentioned already this morning here, Schultes was not only an expert in passionate follower of field thinking about plants such as banisteriopsis caapi and members of that family, that may seem distanced to all of you, but if anyone has had any coffee this afternoon, you've had other members of that same family. But it's the great other discoveries of Schultes that really excite me.

A plant, such as [INAUDIBLE], or [? stellera, ?] as mentioned here, we has an unknown characteristic psychedelic activity. And we know that from in Schultes own words, his own self experiments. Schultes recognized this plant was special because unlike ayahuasca, it was consumed not as an admixture but alone. And to this date, we still don't know what the active psychedelic agent is in there. And while there's speculation that it may be a member of the Harmine family, scientifically, that remains unproven.

What's so exciting is to think that this type specimen shown here in the middle of the slide actually lives and exists within the Harvard Herbaria if one can gain access to it to begin studying it. And indeed, in 2023, I think the amazing legacy of Schultes and his students and the knowledge that he created provides an incredible roadmap. It was this quote that I have to admit inspired me to pursue a career leading to my activities at Mass General Hospital.

And Schultes and Albert Hoffman posed this as a question here whether if we thoroughly understood the whole nature of the chemical composition, perhaps we would be able to have new tools for psychiatric research. This is amazing that this was work and thought done almost 50 years ago, again, providing a real exciting roadmap. The book here, Plants of the Gods, is for me in many ways a type of Bible that I've carried with me. I couldn't afford a first edition version of this when I was a graduate student and it's a pleasure to read each one of these because they're really not only works of science, they're works of art.

It was with great pleasure then as was mentioned by Dr. King, that we had the opportunity to launch in 2021 the Center for Neuroscience of Psychedelics. This mission to really fundamentally change how we provide care, I think, is, again, an incredible opportunity for our community to come together and think about the impact that we can have on mental health. This image here on the right shown of Dr. Jerry Rosenbaum, the center director and the notion here of being able to study [INAUDIBLE] and those magic mushrooms, I think would make Schultes really pleased today if he were still alive.

The center then purposely combines together some leaders not only in clinical care but opportunities such as that led by Bruce Rosen and colleagues to use the state of the art neuroimaging techniques to finally map what circuits and cell types perhaps are affected by these agents. Again, fundamental work not only on the use of these agents, but really understanding then how they modulate neuroplasticity on that range of temporal and spatial scales.

But I want you to, for a moment, pretend with me and dream about what the future is going to look like. So please reach under your chair hypothetically and put on your future goggles for a moment and I want to imagine that this is a member of your family that comes in to the hospital, perhaps a member with treatment resistant depression or anxiety. And a clinical and family history is collected of the individual, maybe a cognitive assessment in a desire then to provide care to that patient is extended.

Imagine aspects of modern translational research where we may neuroimage that person to understand if there's particular circuits altered in that case. Let's assume that we could readily sequence the genome of that individual to understand if they had risk factors, all of which then may help us determine what therapy to provide. But the technology that we're particularly passionate about and excited to bring into this realm is this remarkable ability to use human stem cell technology that we can collect from each of you a somatic sample, a skin sample, or perhaps blood, using Yamanaka and colleague's remarkable techniques to reprogram that into a stem cell, allowing access to the human nervous system.

This fundamental technology, again, provides an opportunity to study human neurobiology and our opportunity then to use this so-called to do an ex vivo psychedelic test, we think has the opportunity to enhance our understanding of how psychedelics work. But we're not limited to studying those distant associated neurons in a culture. Using technologies to create these so-called mini brains, forming a little tissue like structure allows us now to think about the complexity of the human nervous system.

In that little bowl in the petri dish here if we were to section it, we could actually see that we have different layers of cell types corresponding to the amazing laminar structure in the human cortex. This, again, provides us an opportunity for the first time study what psychedelics do to the human nervous system ex vivo in the culture from this.

We're interested in the notion of that plasticity whether it be changed by neurogenesis, synaptogenesis, and all of those mechanisms. So the opportunity now to systematically study these plants gets us extremely excited. We're assembling a collection of plants, beginning to fractionate them to identify active compounds and test those back onto those organoids.

I'll tell you though that it isn't just the lab techniques that we're most excited about. We think about this notion of the resources here within the herbaria in larger herbaria across the world, incredible knowledge is still present. This experiment here done by Siri von Reis took the entire Harvard Herbarium took roughly four and 1/2 years to ask the question, how many of those plants were medicinally relevant?

Today, using exciting technologies and AI machine learning, we can rapidly digest knowledge and connect knowledge together, providing really we think exciting opportunities to revitalize the field of ethnobotany. And we think for those reasons, the opportunity to bring together these technologies, to think about the human and film in the broadest sense as was mentioned, is really something worth doing here.

This notion of combining together aspects of botany, genomics, and pharmacology, we think has long lasting implications for this. And to give you just an example of what I mean by inspirations from other disciplines here, please excuse my Nahuatl language, but this particular Aztec rain God, Tlaloc, if you study the language and words associated with that, you'll notice that they're often the description of a plant called Tagetes lucida or Mexican Marigold.

This is a plant that still has an entheogenic use as in an example though that we know nothing again about its activities providing though a really exciting direction. And in that context, we've been working on growing and expanding our access to these. Thanks to COVID, we have the opportunity to now really begin working with these in this case at home. This is a picture here of Tagetes lucida that I grew last summer, and a whole collection then of plants that really have remained understudied but provide an incredible opportunity for gaining insight.

And to help make this possible, we're really excited about a concept here of revitalizing an existing greenhouse that exists at Mass General Hospital. I find it sort of interesting that the location of this is right proximal to where some of the first studies on Ether and agent that course causes a loss of consciousness. We're talking about molecules that we hope can enhance consciousness.

Fundamentally, though, I think what's key for the Future here is to expand our opportunities for students interested in training in this field and area. This is a picture of Hannah Hilton, class of '21, to my knowledge one of the first thesis done at Harvard in half a century on the topic of the mechanisms of psychedelic agents. We're lucky that we've been able to work again with members of the pharmaceutical industry to provide support for a fellowship, which is now going to enter its second year, the so-called Atai Pioneer Fellowship.

Those of you interested and excited about this, please reach out. Our next deadline for this is May 1st. And with that, I'll end and just again, thank the amazing group of colleagues who's inspired me. And thank the great work both traditional knowledge keepers and others that have helped create this field. Thank you.

[APPLAUSE]

JEFFREY BREAU: Thank you so much, Dr. Haggarty. We are now at a point for Q&A. As before, I'll invite all of the speakers from this block up to the stage.

AUDIENCE: Hi. Thanks so much everybody. A very basic question. I'm interested in age of participants when we think about the mental health challenges that young people are facing, and the sorts of drugs that are oftentimes administered to them that in many cases lead to drug abuse later in life. I'm curious if there are any studies. I imagine it's very difficult to get IRB approval, and there are ethical and developmental questions that need to be answered. But what are the youngest participants that are being worked with?

FRANKLIN KING: So actually the IBS study that I mentioned, the irritable bowel syndrome study because I'm doing it with someone from the Department of Pediatric Gastroenterology, initially, we were thinking that we would do it with the population known as transitional age youth, which can be defined variously but usually it's 16 to mid 20s. And we were going to modify that to be 18. We're going to do 18 to 25 and only focus on those folks, because that's really when you start solidifying maladaptive behaviors in response to both psychiatric conditions but also medical conditions.

So the idea of other than her being a pediatrician was that we could focus on the young population that really weren't sort of dug in. We ended up just we're going to start at age 21 for various reasons. A number of studies have started enrolling at age 18. I'm not familiar with any studies that have been done with anybody younger than that. And a lot of studies start at age 21.

There are issues-- I mean, I think the one thing that nobody really knows is this-- is psychedelic exposure kind of the equivalent of heavy cannabis exposure. We know that heavy cannabis exposure, daily, repetitively, during a vulnerable time when the brain is developing does predispose and it does lead to an increased risk of developing schizophrenia.

And so one of the theories behind that is that if you really induce a lot of stress to the brain that that could be one of the sort of final common pathways to developing a first episode psychosis, and potentially, there might be a similar risk with psychedelics. We don't know and we ultimately just decided that it probably would be more difficult and more ethically questionable to only focus on people in that putative risk state, but I don't think anybody knows.

In regards to the risk of addictive behavior, the evidence is pretty strongly against the fact that psychedelics lead to addictions. There's a lot of studies and some that are going to be starting at Brigham, looking at using psychedelics to actually treat various forms of addiction. And I think the evidence base at this point is pretty solid that for the vast majority of people that using psychedelics is not a risk factor or like a gateway drug to using other things.

YVAN BEAUSSANT: For the ketamine study is youth. So it's 16 to 24 but we're going to get enough people so now it's 16 to 30. But there are a lot of adult studies and this will be like a study in youth.

AUDIENCE: First of all, I'd like to thank all the speakers for your pioneering work in this area. I think it's incredibly exciting. My question is probably directed towards Dr. Franklin King, but maybe more generally. And the question is, in these pioneering studies at MGH on the use of psychedelics for depression, what's kind of the primary factors for success in terms of the person sitting with them, the environment that they're in.

Do we expect to just give someone psychedelics and put them in a room with somebody with a notepad and hope that that's the experience that will be effective for them? Or, kind of what factors are we able to change and I guess do you have opinions on things that are like first order importance for somebody's success in one of these trials?

FRANKLIN KING: I'll answer part of that just since you addressed it to me, but I think Yvan and Fernando could also speak to that. But in terms of some of the stuff I said about how kind of alien a lot of the critical parts of psychedelic therapy are, one of those is the appreciation of set and setting, and really the appreciation just of context, which we don't pay much attention to.

We sort presume that a patient going into a horrible drop ceiling with flickering fluorescent lights and an unpleasant aesthetic environment is really going to achieve the same benefit even in psychiatry as a really nice, thoughtful, soothing environment. So actually, I don't think set and setting is limited to psychedelics but it is crucial.

There were a number of studies done in the 1960s in very medical appearing environments where people had a much higher rate of having an untoward reaction or feeling like while they were on psychedelics, they were the victim of medical experimentation, or sort of feelings and/or thoughts in that regard.

So I think, yes, for the studies that are being done at MGH, there are specific rooms that are going to-- have been basically outfitted to be nice, really to essentially mimic the environment of a living room and that's really important. I think you've actually started and have a room so maybe you could speak to that Fernando as well.

YVAN BEAUSSANT: Yeah, I think that's really a critical question. In our team-- it's a small pilot study but we nevertheless have six therapists who conduct the therapy in dyads for each patients. And among our therapy team, our therapy team includes people from palliative care, psychiatry, music therapy, social work, chaplaincy work.

So I say that because it's critical to our way of embodying interdisciplinarity and approaching patients from multiple perspective. But the way we conduct therapy is very simple and it's very based on relationships and being in relation with the person. I heard one of the speakers this morning was saying-- really talking about how in that space, various restorative relationship patterns can happen, and how the quality of presence and how somebody-- how far can the therapies go in really being present for the core of the patient's experience.

And so I think that's critical to how far the therapeutic healing can go for the patients. And so the way we do that is really the importance of-- first, in our study situation, building our understanding of the patient situations and the work that our colleagues in hospice care have already done. So we collect a lot of information on the patient's medical and psychosocial situation ahead of time. And then we engage in the relationship with the patients.

And during the preparation time, it's really a lot about getting to the person getting to the patients and the patients getting to know us and establishing the therapeutic relationship, therapeutic reliance and then also working on intention, and working on what is the person hoping to get from this treatment.

And then really being in a non directive, very respectful of the person's inner process and encounter with the medicine, and then helping debrief. I guess it's very agnostic of how this should be done but it's really based on the relationship with the person.

And the reason why we do that is because also we observe and that's our work on the qualitative work we're talking about phenomenological work but we realize that psychedelic-assisted therapy and psilocybin in particular or MDMA are intense experiences. Very demanding and intense experiencing where people experience a lot of tensions between surrendering to the experience and resisting to it. So it pushes towards people's boundaries and limits.

So it places people in a place of vulnerability and dependency and suggestibility, that we have to be very mindful in the therapy and the therapy of how we approach that. So I think-- the core of the-- the importance of the training I think is really in that aspect of the therapeutic work and how we can create the trusting relationship that allows people to go in those vulnerable place, and really the ethical boundaries where the person is doing the work and not the therapist projecting stuff on them. Sorry, that was a long answer.

AUDIENCE: My question sort of build on that actually. So from a legal perspective, it's very interesting the FDA when it is expected to approve psychedelic-assisted psychotherapy from my knowledge and correct me because it's your discipline but it'll be the first time they're approving a drug prescribed with therapy as opposed to just a substance and new waters for the FDA. So what are some of the challenges, opportunities? We heard therapies a really good thing but just in terms especially of bringing it to scale.

YVAN BEAUSSANT: I mean to your point, there is no pre-existing box in how we develop a combined drug and psychotherapy approach. There is no-- even for the FDA or IRB reviews, it's hard to convey the fact that both are a combined single entity and the one doesn't work without the other or is not safe or effective without the other. And so we have to reinvent the frame within which we even we regulate around that and think about it.

FRANKLIN KING: I mean, I think there's huge, huge issues that we didn't even get into in terms of scalability, which is a word that I've kind of distaste for because that's like CEOs figuring out scalability, how are we going to make money? But how is this going to actually be accessible and who's it going to be accessible for, are huge questions.

So the therapies themselves and the protocols are hugely time consuming. I mean the psychedelic sessions themselves just alone are usually eight hours of therapy, with two therapists present in most of the protocols, plus you have a certain number of sessions of therapy with usually both therapists before and after. So you're talking about a lot of upfront time.

The people that are really pushing this in pro psychedelic-assisted therapy seem to believe that the upfront cost is worth it if it actually reduces medical contact and expenditure later on. And there's some evidence to suggest that that's the case but even so, most medical treatments that are expensive end up sorting to people who have really good insurance or people who have a lot of money.

And I think there's a very realistic risk that that's exactly what it's going to look like, especially in the early days. You'll have to have not responded to a million other treatments, you'll have to have good insurance. And I think that is a real issue that people need to be thinking about.

One other thing is sort of the question of who is best suited to deliver psychedelic-assisted therapy. And the irony is when you apply for an investigational new drug permit from the FDA to do these studies, they feel much more assured if the people who are in the room are either MDs or PhD psychologists usually at an academic medical center. Usually, PhD psychologists academic medical centers are doing cognitive behavioral therapy, which is pretty far from the type of therapy using psychedelic-assisted therapy.

So it's sort of ironic that I think that that's kind of the folks that are probably most trained in being prescriptive rather than open, which is what we want psychedelic-assisted therapy are the people that are considered by the government at least best suited to deliver this. But in reality, probably people that are more versed in kind of psychodynamic therapy or other forms of non-traditional therapy or even things outside of the mental health world altogether like chaplains and pastoral care counselors, who are well versed at sitting with people in distress and walking beside them rather than imposing their viewpoint on them might actually be better suited. There's no data nobody's looked at this as far as I know but that's another kind of question, who should be doing this.

FERNANDO ESPI FORCEN: I'm going to add something. It's like a big issue for billing as well. We're trying to do a academic clinic and you can bill one hour of a medical visit or one hour of therapy for people who are therapists, but if you're going to do the ketamine, it's going to be three hours. The insurance may cover the first hour but the other two hours, you have to pay out of pocket.

So if people are billing $200 an hour, you have to pay $400 out of pocket. If you're talking about psilocybin, when it comes out, we are talking about, I don't know $2,000 or whatever people bill. For inpatient unit, we have the chaplain and everybody is just a normal-- I just make it as a normal visit as a psychedelic integration therapy with the regular basis. So it's not extra cost to the patient. But that's something you can do only in inpatient.

In outpatient, you have to be the medical visit, the psychotherapy visit, maybe you can combine those two depending if you're-- it's an MD, the person who prescribed ketamine or otherwise, it will be two visits. You can do a medical clearance visit. Sometimes some doctors are comfortable doing that, half an hour for $200 and they take insurance.

But then for the psychotherapy, the first hour you can bill, but the other two hours they have to pay out of pocket. So it's how it is. That's the state. Hopefully, insurance will cover. They are trying to do that with-- I think MAPS is trying to do a model for MDMA saying, hey, $24,000 is the whole treatment, but I will save admissions. I have my patient who the insurance wouldn't cover outpatient ketamine and it will cover inpatient ketamine.

So in outpatient ketamine she relapsed and they still didn't want to cover, so she got readmitted to [? McLean ?] for two months, which is like I don't know like $300,000 admission, and they refused to still cover outpatient because they cannot see, that they don't have a model. So if you can convince insurance that they're going to save two months of admission after that, they will start covering more because they do have a transplant, for example, it's $90,000. So it's not much more expensive actually than regular medical care.

AUDIENCE: So I can't tell you how excited I am to be here and listening to the quality of your presentations. I mean, it's really a psychedelic experience for me. And one of the reasons for that is that more than 40 years ago, I created an MDMA laboratory to help Alexander Shulgin. And in 1984, I brought MDMA to the Harvard Medical School and turned on some of the professors here, including Lester Grinspoon who said that it was the most valuable drug in psychiatry.

So now here we are, 40 something years later, and you guys are doing great work and I'm so excited to meet and speak with all of you. But my question is, why have these incredible gifts been squandered? Why has it been four decades that we're just now seeing permission? If it's permission-- so here are these drugs that supposedly make us more creative, more inner-oriented, more courageous, why have we submitted to such a foul and corrupt medical pharmaceutical situation with the FDA and the DEA, why are we just now-- we're actually not overcoming the corrupt system.

We've somehow found a way to maybe align ourselves with it and then what sort of sacrifices have we made to be in this position. I'm so interested in the phenomenology and the chemistry of these states, but in the last decade or so, my interests have become political and sociological. And what's the deeper layer for this-- the paucity of research and why is it just getting going now? Thank you.

[APPLAUSE]

FRANKLIN KING: I mean, those are all amazing points. I would love to talk to you after this. I think I'm sure we all have kind of similar viewpoints on this but I think one of the things is that we are in the midst of all of these crises across the board. And I think there is kind of A desperation for something totally different that is breaking down a lot of barriers to resistance that hadn't been there before.

I was talking with someone during lunch about this, what's really interesting to me about psychedelics is that now that they're kind of back in boat, people are willing to admit prior psychedelic experience and yet not necessarily still are they willing to admit some of the deeper stuff that psychedelics work through. Things like love and cosmic unity and all these things that people repetitively come out with psychedelic insights, and that those are the things I think that actually are much more threatening to our system in the way it works than the fact that the drug is illegal or that these are drug experiences.

So I think it's that. I think it's we are not a culture that is really open to being open, and we got a lot of work to do. But certainly, I think we've talked about this a lot. What are the sort of sacrifices that you have to make in research just to do a study that feels kind of like is-- is Mass General down by Charles MGH, it's like the best place to be giving people psilocybin even if we design the room right. So I don't know-- I don't think there's an easy answer for that. I'm sure everybody has a--

GRANT JONES: I would love to speak to this. First of all, I love your question so deeply. It's such a special question, truly. And for me, in some ways, it's been the primary motivated question around not only what drives me in this work but how do I do this work in a way that simultaneously allows the phenomenological experiences that these substances give rise to, how does it allow the heart of contemplative practice, which for me is also a beating heart of what it means to integrate psychedelic therapies into experience.

What does it mean for me to bring that work into myself simultaneously so that I get to actually alongside navigating the structures that we all do in some way, shape, or form, really receive benefit, the benefit of what I get like Franklin mentioned these substances really can put you on to it can wake you up to.

And I think for me, we all have our answer. I think I don't think that there's one answer, but I think what's inspiring about being here today is that in naming this question, it's also a naming of the need not only to implement these substances within current systems but also actively be challenging along the way what are we actually doing.

When we bring these substances into these systems, what are we sacrificing? Not only what are we sacrificing, in sacrificing certain elements of this experience, are we actually using them to ratify the various systems that we ostensibly are trying to disrupt but not really? You know what I mean?

So that really for me is the thing. It's like if we're actually going to use this to supercharge the same things that we've already been doing, which I think that again in the exploration around psychedelics. Something that hasn't been talked about is the way that they-- in my experience, I really see them as really powerful super charges for harm actually, powerful super charges for gaslighting, powerful super charges for so many of the ways of imposing realities that have-- that we, again, have our naming have names, that we actually need to be using these things to disrupt.

So if we're not doing this work along the same-- if we're not using this work to actually be investigating, be contemplating at the same time that we're actually implementing, I think it's such a huge disservice. So that for me is why I don't know, the music work that I named frankly is just like I just really love making music. It's healing for me. That keeps me very connected to this. And I think, again, I think we all have our own answer but I just urge us to keep asking this question because I love the question, it's the question for me. So thank you.

AUDIENCE: Hello. Hi. My name is--

YVAN BEAUSSANT: I just wanted to echo with what my colleagues say, but also say that I learn a lot from our medical model in how to implement psychedelic-assisted therapies, especially in patients with serious illness. So I work with psychiatrists who know much more than me on potential drug-drug interactions. And our patients receive a lot of drug because they are very sick.

And having an in-depth understanding of the potential-- like our pharmacist is involved for each patient and we really reflect on potential complications, the risk that people take in engaging in psychedelic-assisted therapies. Two of our patients, because of their lung condition, were constantly on 5 liters of oxygen. And I haven't seen anywhere published clinical case of people undergoing like a psychedelic-assisted experience with oxygen requirements.

So the questions that we were asking ourselves where, maybe the emotional intensity of their experience make them [? decompensated ?] on the respiratory function. And so having this very rigorous and scientific and medical approach also was really helpful in us finding a way for these people to have a safe access to that, or to anticipate potential complications.

So just maybe it's a way to balance like the fact that-- I think I don't want to demonize too much our medical model or knowledge. I think that can be really helpful also to learn how to integrate these into our society and models.

AUDIENCE: Hello. Hi my name is Diana [? Munn. ?] I'm afraid that I'm going to have a couple of comments. I don't have a specific question. I am Mazatec from Oaxaca, Mexico. Some of you may be familiar with the use of psilocybin mushrooms in this region.

And this is one of the areas or communities that safeguarded the use of psilocybin mushrooms for we know at least 500 years. So there is a striking lack of information about how Indigenous doctors and specifically Mazatec doctors, and I call them doctors on purpose because they are doctors.

There's a lack of information here and I'm sure there are opportunities to bring in their expertise, their knowledge about guidelines, rules before taking psilocybin, the settings, the timing, the schedules, the diet pre and post ingestion, the role of poetry, song, the role of language. The avoidance of certain things like sexual activity before and after sessions. The role of touch, the post session debriefs, the use of water, tobacco, candles, cleansings, and the fact that this healing has been provided at no cost.

So that's just one comment. There's an opportunity there and maybe there's some barriers to get to that knowledge, but the knowledge is there. And then the other comment is that while in the United States and other countries, there is a movement to learn how to use these medicines in a community like the Mazatec community, we are going in an opposite direction.

So there is a tendency to prefer Western medicine than to have mushrooms for healing. And so there is also an opportunity for cross-cultural sharing, the use of psilocybin for those experiences or close to death. I don't believe that in our culture we would ever take them for that but there's an opportunity there. And there was someone who asked about adolescence and use.

So this is not something my mom would have allowed me to do 30 years ago, but I started taking psilocybin when I was about 12 and children are commonly-- eight and above are commonly part of this communal ritual experience. And to this day, my family does not allow me to take psilocybin if it's not the mushroom, if it's not in my community, if it's not in a ritual setting with very specific guidelines.

So thank you for listening. There's a lot to learn. But I am so deeply appreciative of the work that you're doing and I'm learning so much. And I can't wait to go back to my community and tell them about what's happening. They know what's happening, but I don't think that there's clarity on these multiple directions and what our community should be doing. Thank you.

[APPLAUSE]

JEFFREY BREAU: Thank you so much for the comments and all of the questions. I, again, have the unenviable job of having to cut conversation short, but hopefully for good purpose. So we are now going to go into a short coffee break and bio break until quarter of. And then we're going to come back for three more speakers from the university and then move into our keynote panel, which to the gentleman's question about regulation will be specifically focused on regulation and law in psychedelic studies.

And that panel will begin at 3:30, but please come back here at quarter of 3:00 for our next three university speakers. See you soon. Thanks.

SPEAKER 2: Sponsors, the Harvard Psychedelics Project at HDS. The Center for the Study of World Religions at HDS and Harvard Divinity School.

SPEAKER 1: Copyright 2023. The president and fellows of Harvard College.