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Joe Rogan Experience #2319 - Rick Doblin

Rick Doblin, Ph.D., is the founder and president of the Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit established in 1986 to advance evidence-based psychedelic therapy and end prohibition. MAPS incubated Lykos Therapeutics (formerly MAPS Public Benefit Corporation) which is leading drug development of MDMA-assisted therapy for PTSD. Learn more about Psychedelic Science 2025, June 16–20 at the Colorado Convention Center in Denver, at https://www.psychedelicscience.org, and visit https://www.maps.org for information on MAPS

Rick DoblinguestJoe Roganhost
May 9, 20252h 14mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:000:46

    From a scheduling mishap to a global trauma mission

    1. RD

      (drumbeats) Joe Rogan podcast, check it out. The Joe Rogan Experience.

    2. NA

      Train by day, Joe Rogan podcast by night, all day. (instrumental music plays)

    3. JR

      Quick talk, what a turn of events.

    4. RD

      This is-

    5. JR

      So... (laughs)

    6. RD

      ... absolutely incredible, Joe. Absolutely. A series of unexpected things have led to this day.

    7. JR

      So you were supposed to do Duncan's podcast, and then Duncan and I got on the phone and he was saying, you know, trying to move tickets for the psychedelic event.

    8. RD

      Yeah.

    9. JR

      And then, uh, Duncan said, you know, "Hey man, you can have him on your show."

    10. RD

      (laughs)

    11. JR

      And I said, "Well, why don't you come on too? It'll be really fun." And then this morning, Duncan has a root canal. Like, uh-

    12. RD

      (laughs)

    13. JR

      ... an unexpected emergency root canal. So-

    14. RD

      Okay.

    15. JR

      So it was a, just a crazy turn of events and fortunately, you're here.

  2. 0:463:54

    Ukraine: training clinicians amid war and restrictive drug laws

    1. RD

      Yeah, I just came in from Ukraine, actually.

    2. JR

      Oh, wow.

    3. RD

      Yeah.

    4. JR

      Ooh, what were you doing over there?

    5. RD

      Training therapists and psychiatrists.

    6. JR

      Wow.

    7. RD

      So Ukraine has, um, enormous amounts of trauma, and so what I'm trying to do and, is to go to high-trauma areas and try to talk about MDMA-assisted therapy and how that could be helpful.

    8. JR

      What is the legality of it over there?

    9. RD

      Well, right now it's illegal. They have these terrible laws left over from when Russia was in control and you cannot even do research with Schedule I drugs.

    10. JR

      (clicks tongue) Wow.

    11. RD

      Not with psilocybin, not with MDMA. You can't even do research. But over the last couple years, there's been a lot of efforts by their military, by other people to change that, because they're aware that they have so much enormous trauma.

    12. JR

      Mm.

    13. RD

      So a couple months ago, the Ukrainian government put out draft legislation to change the law. And so the training that we did was for, uh, 55 psychiatrists and therapists from throughout Ukraine. We did it in the western part of Ukraine, Lviv, which is not really a dangerous area. But even while we were there, there were multiple air raid sirens. Um, but then they look at their phone and they see the area that the air raid sirens are supposedly about and they could be, like, 100 miles square, something like that. So nobody seemed to care.

    14. JR

      Wow.

    15. RD

      Nobody, nobody moved to shelters, and we just ignored these air raid sirens and heard nothing. But it's just, it was so emotionally moving because we went to the cemetery in Lviv, and they have these in cities all over Ukraine, and they have something that I've never seen before, is that they have just enormous numbers of graves. Terrible. They've lost about 250,000 people. But the graves all have flags for Ukraine, but they have the pictures of the person that's dead that's the person that's buried there. And I've never seen that anywhere else, is you just... It has even, even more of an emotional impact-

    16. JR

      Mm.

    17. RD

      ... because you're actually not just thinking all these people are dead, but you're seeing their pictures, and-

    18. JR

      Right.

    19. RD

      ... most of them are younger, and, you know, tragically interrupted their lives, uh, a fair number are women. And so a- and they put them in the center of the, the cities. Th- they're, they're having to build new grave sites all over.

    20. JR

      Right.

    21. RD

      And this was next to a really large, um, old historic cemetery.

    22. JR

      Oof.

    23. RD

      Yeah. And so it, it feels to me like what I'm trying to, um, do is to really go to where people, I think, have lots of trauma but don't understand some of these new technologies, meaning psychedelic-

    24. JR

      Right.

    25. RD

      ... therapies.

    26. JR

      Mm-

    27. RD

      Yeah.

    28. JR

      Hardly new.

    29. RD

      Well, new to them.

    30. JR

      Right, that's crazy.

  3. 3:544:49

    Taking the model to Beirut and other under-resourced trauma zones

    1. RD

      ... and be there with them, even though it's in this more safe part of the country. And so the, the thought that we would, uh, the next steps would all be philanthropy. So I should say by, that I'm here, um, representing myself. I'm not talking on behalf of MAPS and I'm not talking on behalf of Lykos, the pharmaceutical company that MAPS, uh, helped start a while ago. So I'm just talking for myself personally. But what, what, what we're trying to do is, um, really respond to where the trauma is, and next week I'm going to Beirut, which is something I never thought I would be going to, but I've been invited to speak at the American University of Beirut and also a YPO sort of business group.

    2. JR

      Mm.

    3. RD

      And there's the possibility of potentially at least starting research with MDMA therapy in, in Lebanon as well.

  4. 4:496:11

    Why progress feels so slow: MDMA’s path from 1982 to criminalization

    1. JR

      Do you ever get frustrated at the lack of progress with legalization? 'Cause it seems like so much headway has been made on the ther- made on the therapeutic front, like so many people have anecdotal stories of sh- uh, like a lot of soldiers with ibogaine in particular-

    2. RD

      Mm-hmm.

    3. JR

      ... MDMA in particular, that these people have had incredible experiences, turned their life around. It just, I, I, I'm so baffled by the snail's pace of acceptance of these things.

    4. RD

      Well, I first tried MDMA in 1982, so we're talking about 43 years ago. And as soon as I experienced it, I thought, "This has incredible therapeutic potential." It should, it was legal at the time, and...

    5. JR

      When did it become illegal?

    6. RD

      1985. And so it had been, MDMA had been a qui- it had been legal, but it was sort of quietly used in therapy circles from the, um, around 1976 to the-

    7. JR

      Really.

    8. RD

      ... early '80s. And then it started leaking out of these therapy circles and started being used as a party drug, ecstasy.

    9. JR

      Wasn't a lot of that in Dallas?

    10. RD

      Yes, a lot of it was, at the Star Club-

    11. JR

      Yeah.

    12. RD

      ... in Dallas. Yeah, that is really where, uh, MDMA became ecstasy.

    13. JR

      Lorenzo from the Psychedelic Salon-

    14. RD

      Mm-hmm.

    15. JR

      I learned all about that from him.

  5. 6:119:10

    Celebrity culture, psychedelics, and changing minds (Larry Hagman stories)

    1. RD

      Yeah, yeah. There's, uh, a fellow named Michael Caine is working on a movie about the Star Club.

    2. JR

      Oh, wow.

    3. RD

      Th- there's an incredible story because, uh, Larry Hagman, who was the star of Dallas, uh, frequented this, uh, nightclub with a bunch of the people from the cast, and they had, um ... The police had decided to bust it, uh, because they knew that there was all these, um, experiences.

    4. JR

      They busted JR Ewing?

    5. RD

      No, no.

    6. JR

      (laughs)

    7. RD

      Th- th- the ... They had to ... They, they were all prepared to bust the Star Club that night, and unexpectedly, JR Ewing, (laughs) Larry Hagman showed up and they canceled the bust 'cause they thought it'd be too embarrassing (laughs) so they bu- busted him and they busted it another time.

    8. JR

      He was on CNN once and he was talking about how he's not afraid of death because he had an incredible LSD experience.

    9. RD

      Yeah.

    10. JR

      Did you ever see that?

    11. RD

      I did, yeah. And, and the reason-

    12. JR

      They were like, "What?" (laughs)

    13. RD

      Well, he did LSD therapy in the '60s.

    14. JR

      Mm.

    15. RD

      Uh, the, the reason that I even, uh, knew that is my mother-in-law read his autobiography, and-

    16. JR

      Oh.

    17. RD

      ... he talks about being, uh ... doing LSD therapy in the '60s.

    18. JR

      Wow.

    19. RD

      And so my mother-in-law said, um, "Uh, you might want to try to contact this guy 'cause maybe he's got overlapping interests and he'll, he'll help out." And, um, it took me a couple years to get to him, but eventually I did. Um, I, I'll tell ... One funny story is that I got to know him pretty well and I would stay over at his house a bunch of times in, in-

    20. JR

      Oh, wow.

    21. RD

      ... Santa Monica. And, and but, um, i- i- he was also in I Dream of Jeannie.

    22. JR

      Oh, yeah.

    23. RD

      S- so I ... So I Dream of Jeannie is about this, uh, genie that comes out of this bottle; he's an astronaut. Um, and a friend of his had made a bong out of the genie bottle.

    24. JR

      (laughs)

    25. RD

      (laughs) And, and, uh, they, they wanted to market it and, and Larry said, "No way." You know, so there was only, um, you know, two versions of this, uh, genie bong, and I, I had ... One of my, uh, more, uh, humorous moments was smoking pot with Larry Hagman on the genie bong. (laughs)

    26. JR

      (laughs) That's hilarious. It's so funny when a guy plays this, like, straight-laced, greedy, kind of-

    27. RD

      Yeah.

    28. JR

      ... psycho on a television show, a soap opera show, and then-

    29. RD

      (laughs)

    30. JR

      ... in real life he's a stoner.

  6. 9:1014:21

    MAPS origin story and the DEA legal battle: winning twice, losing the war

    1. RD

      Um, but about your question about frustration. Um-

    2. JR

      Yeah.

    3. RD

      Yes. The answer is yes, but it's important not to be, um, overwhelmed, I guess, by frustration, is just to continue plodding along. Um, we've just passed MAPS's 39th anniversary, um, April 8th. Um, I had, um ... 1986 is when I started MAPS, and when I started MAPS I didn't really know that it would ever succeed, that we would ever make MDMA into medicine. It was the height of Nancy Reagan and Just Say No-

    4. JR

      Mm.

    5. RD

      ... and the escalation of the drug war.

    6. JR

      The worst times.

    7. RD

      And I realized that it was worth doing, working towards bringing psychedelics forward whether it worked or not. And that's what really gave me the, um, the mindset to not be overwhelmed by the frustration, by how, um, many obstacles there's been. 'Cause I always had this feeling that, um, we need this kind of healing, we need this access to these experiences, and it's been an- an ... Tragic, when we think about the number of, uh, veteran suicides, for example, that are happening every year, and if ... The Drug Enforcement Administration, when they made MDMA illegal in 1985, they did that on an emergency basis. We were in the middle of a lawsuit against the DEA, um, what's called an administrative law judge lawsuit, and we were challenging this, uh, arguments for making it, um, into a Schedule I drug, and we actually won the case.

    8. JR

      Wow.

    9. RD

      The, the judge said it should be Schedule III, which means it should be available as a medicine but it should be, um, illegal otherwise, for recreational use. But administrative law judges only give advice to the agencies that they're working in. They don't compel. You have to get out of that into the civil courts. So the judge said Schedule III and, uh, the Drug Enforcement Administration said, "No way. We're not going to do that." And their rationale was so wrong, so we sued them in the appeals court. What they said initially was that only the FDA could make a drug into a medicine, not the DEA, but the law was clear that it could be the attorney general could do that. So the appeals court, wh- when they, um, review agencies' decisions, they don't tell them what to do, they say, "You did something wrong. Now rethink it." So then the DEA said, "Okay, we're going to rethink it," and then they came up with a new reason why they were against it, and this was this eight-part standard that was essentially the same as the FDA. So then we sued them again the second time and, uh, we won again in the appeals courts. And so they, they went back to the DEA and said, "You have to come up with another rationale. This one doesn't work either."

    10. JR

      Oh my God.

    11. RD

      And then they came up with a five-part standard that was sufficiently different but still had phase III studies, so it's essentially the same as FDA approval, and finally the courts upheld that. And that's ... During this process, it was clear to me that the DEA would not do anything to make this available as a medicine, that we would have to go through the FDA, and that's where MAPS began as a nonprofit psychedelic-... pharmaceutical company, focused entirely on donations, and the intention was to turn it into a generic drug. That, because MDMA had been invented by Merck in 1912, it was in the public domain, it was used as a therapy drug before I even knew about it. And then it turned out that the emergency scheduling that DEA did in 1985 was itself, um, illegal. It turned out that the Congress had given, um, the attorney general the power to emergency schedule drugs, but the attorney general had never subdelegated that power down to the DEA. So they didn't have the authority to do that.

    12. JR

      Oh.

    13. RD

      So the people that got busted in the first year were all let go once their lawyers figured this out.

    14. JR

      Oh, wow.

    15. RD

      So, so the first move to criminalize MDMA was a crime, (laughs) you could say.

    16. JR

      Wow.

    17. RD

      And, but we're stuck, and so when we think about if MDMA had not been criminalized, how many people's lives would've been saved?

    18. JR

      Wow.

    19. RD

      How many people would've been able to, um, benefit from psychedelics? That's one of the things that we're gonna be talking about at the Psychedelic Science 2025 Conference, uh, the 16th to the 20th in June in Denver. We have over, um, 500 speakers. We had over 1,500 applications. There's an enormous amount of research taking place with psychedelics, with psilocybin, with ibogaine, with MDMA, with 5-MeO-DMT, with a whole host, and the healing potential of these are incredible, and yet they've been, um, kept away from people by these, uh, prohibitionist laws. And so it's, it's enormously frustrating and tragic. And yet, if we let that overwhelm us, then, uh, we're not gonna work as hard to make it happen. So I've had to learn how to deal with that frustration.

    20. JR

      Well, it's just a gross distortion of the legal system. You know, there's no reason why this should be illegal. W- as lo- as long as you have whiskey m- and you can get Adderall easily on a prescription, like, and oxycodone is readily prescribed.

    21. RD

      Mm-hmm.

    22. JR

      Like, this is crazy.

    23. RD

      Well, it's counterproductive.

    24. JR

      Yes.

  7. 14:2118:57

    Drug war harms and policy whiplash: from ‘crack babies’ panic to Portland

    1. RD

      It's not even, you know, like, stopping a lot of the benefits. It's actually creating more harms. Um, just as one example, my father was, uh, a pediatrician. He's no longer alive, but he worked on the first study with crack babies. He and his partners did the pediatric evaluation.

    2. JR

      Oh yeah.

    3. RD

      And you remember this in the '80s.

    4. JR

      Yeah.

    5. RD

      This idea was that there was going to be this whole generation of super predators and these women that were pregnant with crack were having, uh, babies that were addicted and they were gonna be, um, mentally deficient and prone to violence and this whole scenario that Reagan amplified.

    6. JR

      Right.

    7. RD

      And what my father and his partners found out was that, um, that really these kids could recover, that they could do better, um, that it was mostly malnutrition, poverty. It's not like fetal alcohol syndrome, that it was really not this direct connection between the crack cocaine and the problems with these kids. But what he found was that the women that were pregnant and were addicted were driven away from-

    8. JR

      My fucking phone is dinging again, man. Just put it on do not disturb.

    9. RD

      Yeah, let me just-

    10. JR

      (laughs)

    11. RD

      ... turn, (laughs) turn it off though.

    12. JR

      All you boomers and your-

    13. RD

      Yeah. (laughs)

    14. JR

      ... goddamn gadgets.

    15. RD

      (laughs) What boomers?

    16. JR

      (laughs)

    17. RD

      (laughs)

    18. JR

      Yeah.

    19. RD

      Um, but he found that these women were, um, dissuaded from seeking treatment.

    20. JR

      Why?

    21. RD

      Because they were worried that they would have their babies taken away from them-

    22. JR

      Oh.

    23. RD

      ... because they were worried they were gonna go to jail.

    24. JR

      Mm.

    25. RD

      So the drug war is counterproductive-

    26. JR

      Mm.

    27. RD

      ... in that the people that need the help the most are driven away from seeking it because of the stigma and shame and criminality.

    28. JR

      Right. But then they screw up sometimes and do like what Portland did where they just go, "Everybody just do whatever you want." And then unfortunately, you've already set a culture where you've allowed people to do fentanyl on the street and meth and whatever they, else they want, and then, then the laws pass where you decriminalize everything and sort of, it's legal free for all.

    29. RD

      Yeah.

    30. JR

      And then unfortunately, you have chaos, and then they pulled back the law 'cause it was just too much.

  8. 18:5721:30

    Bridges to the mainstream: military/veterans, ibogaine, and bipartisan credibility

    1. JR

      Like, there's just too many... Well, luckily, we have guys like Rick Perry, Rick Perry. And Rick Perry, who was the Republican governor of Texas, is now in, really in full support of this ibogaine initiative. It's wonderful.

    2. RD

      Yes. Well, Rick Perry will be speaking at the conference.

    3. JR

      Fantastic.

    4. RD

      As will-

    5. JR

      Love that guy.

    6. RD

      ... Brian Hubbard. So, you-

    7. JR

      He's such a nice guy. Love Brian Hubbard too.

    8. RD

      So, the work that you did to have, uh, Rick Perry and Brian Hubbard on your show and how much that brought attention to the ibogaine possibilities was incredible.

    9. JR

      Well, it's my f- feeling is, if a guy like Rick Perry, who's this, like, straight-nosed, conservative, you know-

    10. RD

      Yeah.

    11. JR

      ... right-wing kind of a guy, if he can open up his eyes to that and open up his heart to that, it's a- available for everybody. And there's this very binary position that people take in regards to their, th- their, their thoughts on psychedelics. It's either it's for losers and people that wanna escape reality or, you know, if you're on the side of the people that have experienced it, you don't get any of that, which is what it's, which is so weird for me. So, the, the people that think that it's for losers and it's all just a bunch of people just trying to escape reality and they're lazy and they're... None of those people saying that have ever done it.

    12. RD

      Mm-hmm.

    13. JR

      So if you can get s- just a few of them to do it and tell their friends, you know, if we had, like, legitimate therapy centers, 'cause everybody needs a little help-

    14. RD

      Yes.

    15. JR

      I'm not saying you need to get off heroin. You know, like, I'm not saying you're, you're coming back from Afghanistan. I'm not saying anything crazy help, but like, everybody could use just a little therapeutic help to give you a fresh perspective. And I f- think if that was available to a lot of people that are just generally depressed, I think we could change the tone of the country. I really do. 'Cause one of the things that bums me out the most about, especially, the interactions that people have on social media is like, it's all negative. There's, it's all negative. You're, you're, you're living in these rare moments. You have a, a s- a finite amount of time. 100 years is so quick. It goes by so fast, and you're wasting it yelling at people on Twitter. For what?

    16. RD

      Right.

    17. JR

      For what? Like-

    18. RD

      Right.

    19. JR

      ... co- commenting on things all day long in anger and disgust-

    20. RD

      (laughs)

    21. JR

      ... and look where this country is. Like, what are you talking about? Everyone's perspective needs a little help, needs a little pick-me-up, just a little something to go, "You know, I think we're okay. I think we're gonna be okay."

  9. 21:3025:38

    What makes psychedelic therapy work: set/setting, integration, and neuroplasticity

    1. RD

      (laughs) I think that there are so many possible benefits from having psychedelic clinics all over.

    2. JR

      All over, yeah.

    3. RD

      I mean, we're talking about right now, there's several thousand ketamine clinics. But one of the, um, issues with ketamine clinics is that many of them provide, um, ketamine without therapy.

    4. JR

      Whoops. (laughs)

    5. RD

      So I, I, I, I've... (laughs)

    6. JR

      Yeah, I met a lot of those people.

    7. RD

      Yeah, yes. So, I think the key point is that when we talk about psychedelics, when we talk about the clinics, it's not, "Here, take this pill."

    8. JR

      Right.

    9. RD

      It's, "Here, take this pill in a therapeutic context with therapists there to help you-"

    10. JR

      Right.

    11. RD

      "... process the emotions."

    12. JR

      With an expert, someone who's experienced it themselves who can help you.

    13. RD

      Yeah.

    14. JR

      Yeah.

    15. RD

      And then with the therapy afterwards-

    16. JR

      Yes.

    17. RD

      ... which we call the integration process. So, it's not just the experience itself. It's the preparation to be open-

    18. JR

      Right.

    19. RD

      ... to whatever happens. It's the experience. And then, I, I just was the other day with a woman, Gul Dolen, who is a neuroscientist, and what she's talked about and what she's discovered is that psychedelics are these rare substances that have, um, they'll open up what they call the critical periods. So it's neuroplasticity. It's this ability to rewire your brain that stays for sometimes weeks or longer. With ibogaine, it can be several months after you have the experience. So that the therapy that happens afterwards, the work that you do to integrate it has special potential to-

    20. JR

      Mm.

    21. RD

      ... make long-term changes in your behavior, in your brain circuitry.

    22. JR

      Mm.

    23. RD

      And so psychedelics are unique among, uh, substances. Um, people are trying to develop non-psychedelic psychedelics that do have this neuroplasticity property, but they open up this potential for long-term change if you do the therapy afterwards, if you focus on trying to, what the insights that you had during the experience, and then try to make them into permanent behavior patterns.

    24. JR

      That's really fascinating. It's also so typically human that we try to develop non-psychedelic versions of the same thing. (laughs) Like, "We can-"

    25. RD

      Yeah.

    26. JR

      "... we can do better than nature."

    27. RD

      (laughs) Yeah.

    28. JR

      "God was onto something, but, you know, he had an early plan. It wasn't really fleshed out yet."

    29. RD

      Right. Well, one, one of the things that, that was really, um, impactful for Rick Perry was, uh, uh, Morgan Littrell.

    30. JR

      Mm-hmm.

  10. 25:3840:01

    Non-psychedelic psychedelics in practice: cluster headaches and Bromo-LSD

    1. RD

      Yeah. The, there is actually a, a, a situation with cluster headaches. So, cluster headaches-

    2. JR

      Mm-hmm.

    3. RD

      ... are like, um-

    4. JR

      Yeah.

    5. RD

      ... suicide headaches. They're worse than migraines. And there was a ... This is now back around 2003. A bunch of the people who had cluster headaches, one of them went to a, a party, did mushrooms, and found that it postponed the cycle, and would interrupt the cycle of these cluster headaches, which are terrible. And so they contacted me, and th- they form- formed this group called Cluster Busters. And they said, "We don't wanna be criminals anymore. We would like to study this. Can you help us study this?" And I, um, live in Boston right next to McLean Hospital, which is a part of Harvard Medical School, and I approached them and I said, "Would you want to study these people with, um, cluster headaches?" And they said, "Sure, this is really interesting." So they brought in all these people and checked their medical records and, and determined that this was really the case, that, that, um, psilocybin and LSD blocked, um, cluster headache cycle and, and postponed the next cycle. And so, we did all this research and then, um, the next step would've been to actually give LSD or, uh, psilocybin to people with cluster headaches, and the people at Harvard are like, "Oh, Timothy Leary, he was here. We don't wanna do this."

    6. JR

      Ugh.

    7. RD

      You know? So ...

    8. JR

      Goddammit, MKUltra.

    9. RD

      All of that.

    10. JR

      They ruined it for everybody.

    11. RD

      Uh, well, we're trying to get over that, but they did, and, um, but then the people at Harvard said, "Well, we will do this LSD or psilocybin, but only if it's the last resort. Only if everything else fails." So the scientists, um, Torsten Pasley and Jon Halpern, um, decided that they would use a non-psychedelic version of LSD-

    12. JR

      (laughs)

    13. RD

      ... called Bromo-LSD. And the plan was that they would give this Bromo-LSD to a bunch of people with cluster headaches, it would not work, and then they would come back and say, "Hey, we, we need to do this LSD and psilocybin research." So, I said, "Okay, that makes sense. We have no idea why LSD or psilocybin works, but it's probably connected to the psychedelic properties of it."

    14. JR

      Mm-hmm.

    15. RD

      And so they did this study at Hannover University in Germany, and I, I kept waiting for the results, and waiting for the results, and they wouldn't ... I, I heard nothing. And then after months, they finally said, "We didn't wanna tell you, but the Bromo-LSD works even better (laughs) than the-"

    16. JR

      Oh, no.

    17. RD

      "... than the LSD and the psilocybin." Because with LSD, you know, it's effective in micrograms, you know? You ... For psilocybin, you take 25 milligrams for a major, major trip, but with Bromo-LSD you can give large amounts of it because you're not getting high.

    18. JR

      Oh ...

    19. RD

      And whatever it does, it's still a mystery what it does in the brain, but it works better.

    20. JR

      Yeah.

    21. RD

      You just flood the brain. So that's actually a good example of a non-psychedelic psychedelic for a physiological problem that, uh, could make sense as a medicine, um ...

    22. JR

      Yeah, that makes a lot of sense.

    23. RD

      Yeah.

    24. JR

      It makes a lot of sense with the dose, especially.

    25. RD

      Yeah, yeah.

    26. JR

      But that's great though. At least that way, like, we found something out.

    27. RD

      Yeah, yeah.

    28. JR

      Yeah.

    29. RD

      And, and actually when I ... You know, when they finally told me that it worked and that they didn't want to tell me, I said-

    30. JR

      (laughs)

  11. 40:0154:11

    Ceremony, rites of passage, and how culture shapes outcomes

    1. JR

      But not kids. You know, that's the other thing, like we need education for children to let them know, like it's not good to alter your state of consciousness, especially on a regular basis when you're young. There's some developmental issues that come along with abuse.

    2. RD

      W- well, this is, with abuse, for sure.

    3. JR

      Abuse, yeah.

    4. RD

      Abuse, definitely for sure. O- one of the things that's, um, pretty interesting is look at the cultures that have successfully integrated psychedelics, like for example, the ayahuasca churches that are in Brazil, or the Native American church that uses peyote, often for Native Americans that have problems with alcohol. I was out on a Navajo reservation, this is about 20 years ago, and it was for a, a Native American peyote church, peyote ceremony. And one of the Navajo men brought his nine-year-old son-

    5. JR

      Oh, wow.

    6. RD

      ... to take peyote and spend the night with us.

    7. JR

      Whoa.

    8. RD

      And-

    9. JR

      Peyote is mescaline, right?

    10. RD

      Peyote is mescaline. Yeah. And, um, uh, wachuma is from San Pedro-

    11. JR

      Mm-hmm.

    12. RD

      ... cactuses also that has mescaline in it. But this nine-year-old did not take the same amount of peyote as the, the rest of us, but he took more appropriate for his body weight. And it's within a cultural context, within a family context, within a religious supportive context, these cultures tend not to have age limits.

    13. JR

      Right.

    14. RD

      So I think when you talk about the developmental problems that come from abuse, that's totally the case.

    15. JR

      But I think the-

    16. RD

      But when you talk about occasional use for inspiration, um, particularly when-

    17. JR

      In a ceremonial setting.

    18. RD

      ... in a ceremonial setting-

    19. JR

      Yeah.

    20. RD

      ... which has been, for centuries and centuries, they've refined it. There's no neurological damage that comes to your brain from mescaline.

    21. JR

      Right. There's, c- ceremonial settings are very important. And I used to think it was foolishness. I think ceremonies, like get the fuck out of here with your ceremony.

    22. RD

      (laughs)

    23. JR

      I was cynical, you know? But I think that in even rites of passages, like into adulthood, I used to think that was foolish too. But then I realized like, wow, a lot of people have a hard time determining if that they're an adult and they stay kind of infantile for their entire life. And especially someone that's like really coddled by their parents and over- overprotected, helicopter parents, you never developed, uh, ability to be solitary and just to be out there on, on your own and autonomous. And things that are important should be treated with respect, and that's where I think ceremony comes in.

    24. RD

      Yeah, one of the things that I think has led to my, um, interest in lifetime use of psychedelics was been the failure of my bar mitzvah-

    25. JR

      (laughs)

    26. RD

      ... (laughs) to, to actually turn me into a man.

    27. JR

      Oh, that's hilarious.

    28. RD

      Because I'm the oldest-

    29. JR

      You thought you were gonna be a man. That's it.

    30. RD

      Well-

  12. 54:111:07:18

    Scaling treatment: VA timelines, couples work, and the move toward group MDMA therapy

    1. RD

      Yeah. One of the speakers at the Psychedelic Science Conference is Shereef Elnahal, who was the Under Secretary of the VA.

    2. JR

      Wow.

    3. RD

      And he's, uh, become very, uh, passionate about what he's seen from those people that have done, um, the veterans that have done MDMA-assisted therapy inside the Veterans Administration. But it took, maps, 25 years. Starting in, um, 1995, we were offering money to the VA to do MDMA research, until 2021 when the first veteran received MDMA inside the VA from VA therapists.

    4. JR

      Wow.

    5. RD

      So, talk about frustration. Think about the number of people that have committed suicide-

    6. JR

      Right.

    7. RD

      ... from when we started offering to the VA to do it. But it was the propaganda, it was the stigma that made it so that they were not willing to do it. What's most amazing today is that Congress gave $10 million to the Department of Defense for MDMA-assisted therapy research into active-duty soldiers.

    8. JR

      Oh, wow.

    9. RD

      So, there's a $4.9 million grant that went to a Dr. Aaron Wolfgang at Walter Reed, and it's gonna be giving MDMA-assisted therapy. There's another $4.9 million grant that went to s- a group called, um, StrongStar that's in San Antonio, here in Texas, elsewhere, and they're connected with Emory University. And so, they're gonna combine MDMA with a therapy called prolonged exposure-

    10. JR

      Mm.

    11. RD

      ... where you talk about the trauma over and over, but that's very re-traumatizing. There was a study that the Veterans Administration did that took them about six years. It was 916 veterans, and it compared two therapies that they use, both non-drug therapies, for treating PTSD. One was called prolonged exposure, the other was cognitive processing therapy. And what they showed is that around half the people are in the study drop out because the therapy itself is re-traumatizing.

    12. JR

      Oh, God.

    13. RD

      Because you're just forced to go over the trauma, over the trauma, over and over, and that's supposed to desensitize you. And if you can stay in it, it can be helpful, but it re-traumatizes so many people. So, what-... we've shown is working with the MDMA with veterans is that they're able to process the trauma, th- th- the fear reduction from the MDMA reducing activity in the amygdala, the, the fear processing part of our brain, that you can... Once you can approach these things that have felt like will tear you apart, th- th- they'll be overwhelming, you c- can't really go away from them, but they never really leave either, that then you can process it. So this, uh, study that will be done here in Texas with active-duty soldiers, again, is gonna be a combination of MDMA with prolonged exposure. The Walter Reed study is, um, combining MDMA with what they call acceptance and commitment therapy, different kind of approaches. Um, and so-

    14. JR

      How do they det- decide which approach?

    15. RD

      Well, this is gonna be research trying to different-

    16. JR

      Oh, okay.

    17. RD

      ... different kinds of-

    18. JR

      So it's gonna be, do multiple ones, just see what's the most effective?

    19. RD

      Yeah. Yeah. And, and I think that, um, w- MAPS has started, uh, funding studies combining MDMA with cognitive, uh, processing therapy as well. But the one that I think is the most, um, potentially the most valuable is called cognitive behavioral conjoint therapy. Conjoint means couples or dyads. And so what happens is the designated patient, the veteran with PTSD, is where the attention is focused. But when they have PTSD, it affects their families, it affects their partners. And so cognitive behavioral conjoint therapy was developed by this woman, Candice Monson at the Boston VA, and that's where they bring in the partner as well as the veteran, and they both get therapy. And so back in 2014, when finally, um, I was working with Richard Rockefeller and his cousin, Senator Jay Rockefeller, who was on the Senate Veterans Affairs Committee, and they finally convinced the FDA, I mean, the VA to be willing to let MAPS support research with MDMA. They said that they would not let it, uh, they wouldn't refer veterans, they couldn't do it inside the VA, we had to pay for it, but that the first thing they want us to do was combine MDMA with cognitive behavioral conjoint therapy, where both people now get MDMA.

    20. JR

      Mm-hmm.

    21. RD

      And the results were better than anything they've ever got before in studying this therapy, both in reduction of PTSD, but also in strength of the relationship.

    22. JR

      Do they combine it with 5-HTP or anything like that to sort of bring back your levels?

    23. RD

      Um, the answer is no. Um, people do use 5-HTP and it can be helpful, but-

    24. JR

      Can you explain what that does?

    25. RD

      Yeah, so 5-HTP is your, uh, precursor for serotonin. So when we started research with the FDA, this was now 1992, the very first time that they permitted MDMA research was, uh, 1992. And as I said, MDMA had been used as a therapy drug since the, the middle '70s through the, the '80s, criminalized in '85. And people have felt that sometimes, uh, and I think it's, it's very much the case, that you're tired after MDMA, that, that people talk about a serotonin depletion.

    26. JR

      Right.

    27. RD

      And so when you take 5-HTP, that can, uh, be helpful. But when we started with the FDA, they said, "All this information that you've got from before, from underground use or from before when it was still legal, doesn't matter to us, really. Everything has to be done under direct supervision of FDA-approved studies." And they said, "Don't assume that you're gonna have problems and you're gonna use MDMA plus 5-HTP or something. Just start with the MDMA, see what problems you get, and then-"

    28. JR

      Mm-hmm.

    29. RD

      "... then you can start." So the way we think-

    30. JR

      That makes sense.

  13. 1:07:181:23:28

    FDA rejection, the double-blind problem, and what approval could take next

    1. RD

      So it's kind of a modified. So I think in terms of timeframe, um, it's probably four or five years before FDA will approve group therapy, maybe longer. The, the, the other issue is that, um, the last time that we spoke, it was before the FDA advisory committee and before the FDA meeting to decide whether to approve MDMA-assisted therapy for PTSD. And, um, the advisory committee recommended against it and the FDA voted against it. This was August of last year. And so, um, that was heartbreaking because I, I thought that the data really did justify, um, approval, and it did demonstrate safety and efficacy. Um, but there was enough, um, doubts that were raised. Um, one of the big problems to do research with psychedelics is, how do you do a double-blind study?

    2. JR

      Right.

    3. RD

      You know, when you take a, a powerful drug, (laughs) you know you've taken it. And if, uh, you give an inactive placebo, people can tell the difference. Um-A lot of my dissertation, which I did in 2001, was how to do a double-blind study with psychedelics, particularly with MDMA. And I, my, my solution, which made sense, was, um, to do therapy with low-dose MDMA versus therapy with full-dose MDMA. So everybody knows they're getting MDMA, they all have the same expectations, and they might not be aware, though, which dose, you know, is it a full dose, is it a lower dose? So the challenge was (clears throat) to pick the low dose so that it's high enough to cause a certain amount of confusion, but not so high that it has so much, so much therapeutic potential that you can't tell the difference between the groups. So for 16 years, from 2000 to 2016, MAPS did a series of what are called phase two studies to try to figure out how to do phase three, and we looked at therapy with no MDMA, therapy with 25 milligrams, 30 milligrams, 40, 50, 75, 100, 125, and 150. So sort of like a dose response. We did all these different doses and what we discovered (clears throat) , fortunately after I'd got my PhD, was that my theory was partially right and partially wrong, that, um, you know, a microdose of, of, of anything is not gonna be very good as a placebo because you'll be able to tell. So what was surprising to us was that the lower doses, 25, 30, 40, 50 milligrams did indeed, um, cause a certain amount of confusion, but when you're working with PTSD patients and you get this activation from the drug, but you don't have enough, uh, of the fear reduction, it made people uncomfortable. So we showed that the people that got therapy with no MDMA did better than the people that got therapy with the low doses of MDMA.

    4. JR

      Hm.

    5. RD

      They still got better, but they didn't get as much benefit. So the, the analogy is you're taking off in an airplane and there's all this turbulence at the beginning, and then you get above the clouds and it's smooth sailing. So it's, it's kind of like that with, with MDMA. But the part that we discovered that was very surprising was we did a study with veterans, firefighters, and police officers, and one group got 30 milligrams, one group got 75 milligrams, and one group got 125 milligrams. And in that particular study, when you, it was about 26 people, um, when you randomize, it doesn't mean that everything's equal. It just means it's random. So the people that had 125 milligrams with PTSD had more depression than the people that had 75 milligrams. But the 75 milligram dose group did better than the 125.

    6. JR

      Interesting.

    7. RD

      Just slightly better. So what it meant was that the dose that's therapeutically effective was lower than we thought.

    8. JR

      Can I stop you for a second?

    9. RD

      Yeah, please.

    10. JR

      When you said the people that did 125 had more depression-

    11. RD

      Yeah.

    12. JR

      ... do you mean before the study?

    13. RD

      Yes. Yes.

    14. JR

      Okay.

    15. RD

      So, sorry, yes.

    16. JR

      So they were, so it was chosen that they would get the higher dose because they were suffering more.

    17. RD

      Well, well, no, it, again, this is randomization.

    18. JR

      Right, but you said that they were, had more depression-

    19. RD

      Yeah.

    20. JR

      ... before the therapy.

    21. RD

      Well, well, yeah.

    22. JR

      So how did you determine that?

    23. RD

      Well, well, we evaluate everybody's PTSD symptoms and their depression symptoms, and so just by the randomization, it turned out that those people that were higher on depression ended up more of them in the 125.

    24. JR

      Just randomly?

    25. RD

      Randomly, yeah.

    26. JR

      Oh, interesting.

    27. RD

      Yeah, 'cause when you randomize, again, it doesn't mean that you're making things equal.

    28. JR

      Right, right, right.

    29. RD

      So it was just a, a chance.

    30. JR

      Just turned out that way.

Episode duration: 2:14:11

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