Hello Phil, welcome and thank you for agreeing to answer some questions for our upcoming training in Ketamine-Assisted Psychotherapy. Can you start by telling us a bit about your current goals?
Hey Synaptica friends, I am very honored to be coming to Barcelona and to be helping to bring ketamine awareness through this wonderful training, and awareness of psychedelics and psychedelic psychotherapy to enhance what’s going on in Europe and other parts of the world. My motivation has always been the same for decades, and that is that we have a very valuable resource in psychedelic medicine for people, in all manner of psychedelics, from ayahuasca, which you pioneered in, to ketamine, which is legal and short and has its own particular virtues, like MDMA.
Regarding this, do you think each substance is better suited for different pathologies?
I don’t think one medicine is better than another. Each medicine has its own particularity, what I call its signature, and each medicine does things differently and can be combined, can be used successfully for many different diagnoses. So one of the unfortunate aspects of what’s happening in the world as we make medicines legal for prescription, like MDMA and eventually psilocybin, is that it gets restricted by the legalization process, by the regulatory process. So it becomes then, oh MDMA is only good for PTSD and psilocybin is only good for depression, and that’s not true. All of the medicines we work with work for everything, they work for consciousness, relationships, they work for heartbreak, they work for PTSD, they work for depression, and so there is this narrowing of ideas that comes with the regulatory process.
Ketamine is the only one in which we have the capacity legally to work in a broad spectrum, so we don’t use it only for treatment resistant depression, we use it for that, but we also use it for PTSD, we use it for obsessive compulsive disorder, we use it for relationship issues, I’m using it in adolescence for adolescent turmoil, I’m using it just for traumatic brain injury, depression, and it’s very flexible, they really all are flexible.
Are there any unique aspects of ketamine in contrast to other psychedelics? In regards both to its acute effects and to the therapeutic process.
So, what are the particularities of ketamine that make it appealing? One, the first is it’s short-acting, so you can embed it in a clinical practice. The actual time spent in ketamine trance or transformation is, you know, 30 minutes if it’s really short, to an hour, an hour and 15 minutes. With recovery time, all the other medicines that we hope to be working with are 4 to 6 to 8 hours, and that restricts what we can do, and because it’s in a pharmaceutical, and it’s in a medical setting, those time lengths are prohibitive of really having much of a practice, and they make the medicine very, very expensive. With ketamine, that’s the second good thing, is that it’s inexpensive. The third good thing is it can be repeated, so you can do daily dosing if you’re careful for anxiety. I will do three sessions, even at a significant dose, in a week to prolong an effect, so those are some of its economic and nature perspectives.
Then there’s the effect, and the effect of ketamine is profound, so it depends on dosage, so we have a very, very wonderful spectrum of potentiality. For instance, you can do, we’re talking intramuscular, we’re talking injection, you can do a 10-milligram injection in a group where it facilitates dialogue, it just acts quickly to make people more at ease, and it has no side effects, and people are more relaxed. You can do in a group 25 milligram as we do, and we call it a psycholytic experience, where people are able to converse eventually after a short period, depending on sensitivity. Remember a key point is that ketamine effect relates to a person’s sensitivity, not to their weight, only partially to weight, but we don’t know, even big people may have tremendous sensitivity and only need a little bit, and small people may need a lot, and so that’s part of the workup of a ketamine session, is to determine sensitivity. We don’t do like an intravenous 0.5 milligrams per kilogram, we are doing a dosage that we learn from the oral, or we learn from starting slowly, and remember we can always add more, but we can’t take away more, and so we start to learn how people react to the medicine. So the virtue of the reaction is as we go higher in dosage, people have more of what we call ego dissolution, that is that they leave their own experience over here, which is troublesome and difficult, and they have a period of time in which they are journeying to some extent or more, and that period of time is free of daily concerns, and that period of time is also generally positive, so ketamine is reliably a positive affective medicine, it makes for emotions from neutral to really very pleasant, and sometimes you see people coming in who are weeping and terribly despairing, and they do a ketamine session and they come out and they are laughing, why? Because they have left behind where they were, and they are starting anew.
People with very rigid personalities, people who are really obsessive compulsive, return quickly to their old state, but for most people it’s a break, and a break in which you can reform your being and you can enter a meditative state. Within the ketamine journey, and this new article tries to talk a lot about it, within the ketamine journey you journey to various extents, so the higher the dose, the more complete you have a visual stream, that may be thematic, that may be storytelling, that may be spiritual in the extreme, that may make people feel close to God, or may feel that they are dying but it’s okay. It’s a very potent and interesting experience, and we generally recommend three intramuscular high dose experiences, because there is a kind of learning and relaxation as you get into it, first time people are nervous, so it’s a very flexible approach, flexible based on your and my assessment of the sensitivity of the human, of the human’s needs, and of our therapeutic engagement in the issues that they bring to us.
The first week of June, the KRF, Clinica Synaptica and Instituo Dr. Sheib will promote the first training in Europe about ketamine assisted therapy. In Europe, we are in the early days of this clinical approach. What’s the future you would like for this continent, as a pioneer and having the perspective of what has happened in North America?
In Europe and the rest of the world, we’re talking about Latin America, we’re talking about anywhere, we have very positive material, which in good hands does wonderful things for people. Not always, it’s not perfect, but it does wonderful things, it speeds up personal change, it speeds up growth, it gives people a larger sense of imagination. It has enough positive aspects to it that we would like to see it embedded in a therapeutic modality, wherever, that it becomes a tool for people. People in Europe are no different than people in the U.S. They suffer, they’re struggling, we’ve got all kinds of political issues, and we want people anywhere to have availability of these medicines, whether it’s MDMA, whether it’s ketamine. Ketamine is legal now in Europe and most of the world, and so we can bring methodologies in to ketamine work that really help people to provide a therapeutic strategy for people that’s personal, that helps them to grow, and that adds to our abilities and shortens a lot of psychotherapy, makes it more personal and makes it more profound on average.
What about in relation to the corporatization of ketamine, like what’s happening with Spravato, that it is being sold without a psychotherapeutic approach. In the U.S. we have also seen some companies doing bad practices, so do you expect this to be any better, for example, in Europe, that we have a different healthcare system?
I have always had the same opinion, that the issue is making consciousness-raising substances illegal. I come from the legal period, you know, I started fully working with MDMA and other medicines in 1983 with Sasha Shulgin, and it was legal, and we could do an enormous number of things with different medicines. And then when it became illegal, suddenly it became this three-part structure. So now we have ketamine we can prescribe, MDMA maybe at the end of this year at some point will become prescribable, but it will be so costly because of its development through the strict rules of the regulatory structure, that nobody will be able to use it. We have that one kind of structure. The middle structure is people underground, who make money, who are not licensed or are licensed, and who make money because they have the medicine, and people come to them to have an experience. And the third, an overwhelmingly large number of people buy this stuff, they don’t know what they’re getting, and it’s adulterated, but they do that with friends and journeys with themselves, and they have really too little support for most of them, that’s why we wrote this paper in part to help define how you can control yourself, so you don’t get hooked on things.
Ketamine has a potential for being dependent if you do it too much, but any substance does to some extent. So the main problem is that the making of something illegal, which will happen in various ways in Europe, whether it’s EU-wide or it’s UK or whatever, each country or each unit will make its own regulations that will prohibit this. The Spravato thing is just a waste of money and time. It’s empty. It’s ineffective. So the FDA, because it was its first psychedelic, constrained it, and they made it not psychedelic, and the manufacturer, Janssen, cooperated to make it as little psychedelic as possible. But we also know that psychedelic effects are linked to the success of the medicine. We’re still proving that statistically, but we know that from our massive work. We’ve done massive work.
So in Europe and elsewhere, we don’t know how open it will be. In the United States, there are mass movements that are changing laws in different locations. So here, a referendum can make Oregon have legal use, or Oakland, a city in California, or Colorado, a state, so that each political entity has some control beyond the federal. In Europe, it’s all federal. You’re not going to have Galicia or Catalunya have its own regulations. You’re going to have statewide. So some of that depends on the literature. Some of that depends on mass movement that people are saying, we really want this, like with marijuana. And I don’t know what the future is. But I’m sure there’ll be a middle period where there will be restrictions. And then as people get used to this, and as the ideas spread of the utility, the worthwhileness of it, that it will change over time. But then we have all kinds of governments that are constrictive. I don’t know what the Hungarian government’s going to do. I don’t know. But sometimes even people who are near fascists have better drug policies. They don’t care. So it’s a crapsheet, as we call it. What the hell is going to happen in Europe? We hope that it will be available through clinics for sure. We’re not supporting the underground because people do get hooked on it. But the underground exists and will grow. And as the medicine is attractive, manufacturers are attracted to a market, so we’ll see different substances come up. I hope that answers that.
Do you want to briefly talk about this last publication so we can advertise it also in the interview?
You know, we published a bunch of things recently. We did a scientific article in Frontiers in Psychiatry, which you have, which I think is a very important article for this group of people. That’s more academic. It really goes into the wealth of ketamine use. Here in the U.S., there’s been a bit of a reaction. We had this strange death of Matthew Perry. He was this actor, and he didn’t die from ketamine. He died from doing a stupid thing. He was on multiple substances, and he fell and dove into a hot tub on a high dose of ketamine. He became unconscious and drowned. It was stupid, and he was a long-term addict. I’m sorry he died, inadequate treatment, but that’s not an example of a ketamine death. In fact, ketamine is so safe, it’s nearly impossible to overdose and fall asleep. Its safety in that way is dramatic.
The new article that we did is for public discourse because there’s much more awareness of ketamine and of its hazards, of people getting dependent on it. That’s almost all white powder stuff. If you look at the amount of white powder coming into the U.S., or if you look at it in Asia and the tons of stuff, of meth, of MDMA, being manufactured and consumed, it is enormous. We’re concerned about misuse because many substances have a dual nature, like opiates. Opiates are wonderful for pain. Without them, we’re up the creek on pain, but they also cause dependency. We have to deal with both sides of that. Not keep opiates away too restrictively from people who need it for pain, but also manage people’s pain in different ways.
The same is true with ketamine. On the street, as it develops into more and more people using it, there will be some who become dependent. We don’t want people to get to that point because it’s difficult, and the cravings for ketamine are difficult. The paper talks about the risks, the abuse, not about getting rid of ketamine, but about how best to use it, and if people are going to use it outside the clinical system, which they will, what’s the best way to use it so you’re safe? Because the overwhelming number of people in the world who use psychedelic medicine don’t use it in clinics. The overwhelming number of people are using it with friends, on their own, buying it from the street, and that’s tens and tens of millions of people. So we need to really not pretend that we have the clinical control of this. We don’t. Within the clinical spectrum, we can have great practices with therapeutic strategies. So that’s the idea of the paper.
Do you want to add something else?
I just look forward to being with brothers and sisters from all over the world, including you, who’ve been so wonderful, and to have a great time together and to really learn how to be with people together. That’s the whole idea.
Great, thank you for your time, Phil, we are deeply grateful for this and for all the work you have done helping to build the psychedelic renaissance.
