Hello, I'm Jessica Samuels. Welcome to A Way Forward presented by Beam Credit Union. I'd like to acknowledge this podcast takes place on the ancestral traditional and unceded lands of the Okanagan Syilx people. Psychedelic Assisted Therapy, that's what I'm talking about today. And joining me is Doctor.

Michelle St. Pierre and Doctor. Zach Walsh. They're going to talk about how these drugs have gone from stigmatized substances to breakthrough treatments. And they're not only being offered in private clinics, they're also being offered in the hospital.

Bean Credit Union is proud to sponsor today's episode. With deep roots in BC and a commitment to your financial journey, Bean believes wellness, mental and financial starts with support you can count on. Zach, Michelle, thank you so much for being here as we talk about psychedelic assisted therapy. A few words going on there. Let's start from the beginning.

Zach, can you tell us what do we mean when we're talking about that?

Well, we're talking about the combination of psychotherapy with the careful administration of psychedelic substances, usually psilocybin, also MDMA sometimes, ketamine sometimes, some debate over how much that fits within the psychedelic framework, but certainly psilocybin is sort of the classic, so that's associated with magic mushrooms, psilocybin mushrooms. And it has to be joined with therapy because certainly people use these psychedelic substances for a variety of reasons. But if there's no therapy, it's not psychedelic assisted therapy. It's just psychedelics and that's its own thing.

Well, I'm just going to ask you about that too, because you say that and is that as your advice in the use of therapy? Because I think when I think about prescription medication that has typically been associated with supporting mental health issues or mental illness, isn't the idea that that should also be supported by therapy as well? Or what's the difference here?

I think ideally, you know, we don't you know, if someone is struggling with mental health, some kind of therapy can be helpful. I think the integration of the psychedelics with the talk aspect of therapy is a little closer. So you're getting prepared for the psychedelic experience. It's really the acute psychedelic experience that provides a lot of the material to work with. So people will prepare for the experience, get a sense of what they're looking to get out of it, how they can work with the altered state of consciousness that comes with it.

Then with the So they prepare with a therapist and then they'll unpack it and what we normally call integration afterwards. So unlike, say, taking SSRIs or other antidepressants, you're not talking in those cases about so much about the experience of being on SSRIs, whereas the experience itself, the acute experience provides a lot of the material for the therapy. So they're bound in a way that I think is a little closer than what we normally think of, even though, of course, you are right that people will combine psychotherapy with, with, pharmaceutical interventions. But this is the, in this case, the two are closely bound.

And can you guys tell me like you're using acute experience. And can I ask is does that mean like when you're high? Okay.

In fact, you know, when you're you're, if you're using SSRIs, want to see like a change in your mood and the way you cope and different things, but it's not like, Oh my goodness, here's the SSRI. What am I here to learn? And how do I deal with this experience after it's something you're going to take daily and it's going to change your, mood Whereas and your this is more like a surgical intervention where you're going in for an afternoon, something big happens, and then you work around that event to try to change the way your life is lived outside of it.

Okay, really different way of looking at it. How long have you been, I mean, researching and talking and learning about this?

My, I think we're, you know, there was a lot of research in general in the sixties and early seventies. And then it stopped for a while and started again around 2010. We started to see an uptick, and I've been involved with it pretty much since then. So around 2010, 2011, I started getting involved in what some people call the Psychedelic Renaissance.

Psychedelic Renaissance. Okay, when did the Renaissance hit you, Michelle? So it was about 2014, 2015, you started getting involved. Talk about what drew your interest to it.

Yeah, for sure. Well, I mean, call it naivete. I don't know, being a young person, whatever it might have been. But I read this book called Acid Test. And in that book, it presented these really compelling stories of how psychedelics were being used therapeutically and how the government didn't necessarily support it.

And up until that point, I'd thought like, well, obviously the government would support things that were helpful. Drug policy would be informed by evidence. And so I really had to wrestle with this incompatibility. And I think that that's what made me so curious and passionate just about digging into, okay, what is going on here? And can I be part of sort of the this next generation of scientists that are going to try to really demonstrate how these things could be used and hopefully to advocate for more sensible policies?

It's interesting to me that you said that you had to wrestle with these kind of two thoughts that were going on. And here we are eleven years later now. And and that is fascinating to me that this this that it has gone from, I don't know, in my mind I keep thinking from zero to hero, but these substances has gone from a huge stigma associated with using them to them being used in private clinics, in our hospitals. How the heck did that happen? It seems to me like it was very fast.

Yeah, well, know, when you and I first

chatted, I

mentioned how Stephen Harper was the Prime Minister when I first got interested in all of this stuff. And that just goes to show how much has changed since then. We had a conservative government and not to make this political, but obviously, they're much more conservative when it comes to drug policy and things like that to then be at this place where the government's funding the research. So I think in terms of how did we get here, one, I think the science maybe got harder to ignore. And two, I think that nowadays our society, it's so easy to access science.

You have podcasts like this, television shows, Netflix, etcetera. And so the science is reaching the general public in a way that it probably wasn't during that first wave of psychedelic research that Zach mentioned.

Okay. And Zach did mention earlier the difference between kind of that the the effects of SSRIs or what I was calling prescription drugs or that acute, feeling that you get or experience or result that you get from psychedelics. Just we're going to talk about a few of them. But overall, like, why is that different? How is it impacting?

What is it doing to our brains?

Okay, well, I'll say, of course, I'm not a psychiatrist. So but the way the way that I personally see it is that, SSRIs, antidepressants, can be incredibly helpful for helping people manage their symptoms day to day. Maybe they're reducing the emotional intensity of things. They're taking the edge off, some clients will say. When it comes to psychedelics, it seems as if they're perhaps helping to get at some of the root causes or helping to uncover some of those root causes.

Perhaps it's like having that time, that surgical time, to wrestle with, Are there things I need to let go of from my past? Are there things in my life that are currently out of alignment? I think that the psychedelic experience with the aid of therapists is helpful in bringing some of that

to the surface in ways that SSRIs may not be sort of designed to do. It's interesting there that you said that the experience can help folks get to sometimes the bottom or really the nut of the issue. Is this where sometimes I've heard this term treatment resistant depression. Is this specifically for that type? Are treatment resistant mental health issues?

Or is there anyone really who is interested in getting to the heart of what they want to able to take this?

Well, the research on treatment resistant depression suggests that there's some cognitive rigidity, or psychological inflexibility that someone has. So that's patterns of thinking, patterns of ways of being that are keeping people stuck in some of these states. And I think what's unique about psychedelics, and the research demonstrates this, it's sort of unique in that it can increase psychological flexibility. Definitely many things can increase psychological flexibilities. There are talk therapies that are also well suited for that, like acceptance and commitment therapy.

So this isn't just unique about psychedelics. I want to make that clear. There are ways to treat treatment resistant depression and other stubborn conditions that don't involve psychedelics. But perhaps that increase in psychological flexibility is enough to be a catalyst for someone getting in that upward spiral and starting to think a little bit differently and then behaving a little bit differently and then

in turn feeling a little bit different. Okay, so we've talked generally about them, I'd like to get into kind of the the attributes of a few of the ones that you mentioned off the top. Zach, can you tell us, well, let's start with psilocybin. You mentioned mushrooms. What's kind of the effects and what are the key markers with that one?

Well, you were just talking about treatment resistant depression. And I think that's where we're seeing some of the most movement when it comes to psilocybin. And there's that kind of rigidity where people can get stuck in a bit of a rut. And the psilocybin experience can help people get a different perspective, see your life from a different perspective, which is really, I think, a pretty profound and valuable thing. It's one of the hardest things we can do is to see ourselves in a new way and see our problems in a new way.

And the psilocybin experience seems to facilitate that, especially if you're prepared, sort of get a sense of where you're going to be looking, what do you want to be looking at, what are some things to look out for, when do you go deeper, when do you want to pull back? And the psilocybin experience lasting about four to six hours gives people an opportunity to really examine some key areas of their life in a way that can then help them engage in therapy. So that's part of where the treatment resistant part comes in is when you're depressed, you don't feel like doing much. So even if there are therapies that might be effective, the puzzle is how do you get someone to engage with them when they're feeling so stuck and so hopeless, which are key features of the disorder. So this is something new that can give people a sense of perspective and a sense of hope and maybe help them to do some of the other stuff, some of the acceptance and commitment therapy or other modalities that can then lead to a more sustained recovery.

So it's like an adjunct or a boost to conventional therapy. Just that experience can really can sort of open people's eyes and give them some hope and some new perspective when they've tried so many things, which is sort of embedded in that treatment resistant ideas. You don't know you're treatment resistant until you've tried a few things and it hasn't stuck. So this gives you something new to try and maybe some sense of hopefulness that is

so important. Right. And so another one that you mentioned or we've mentioned is MDMA. Would that be exactly the same or slightly That

one's actually quite a bit different. I should say psilocybin is also showing some good promise for addictions. Another case where people are stuck in a rut of thinking certain ways and putting certain values first. MDMA is being used almost exclusively for trauma right now. And when it comes to acute PTSD, severe PTSD, And part of that has to do with often revisiting the trauma and reprocessing it.

And it's such a painful thing to do, and it can be such a long process of building up trust with a therapist and then slowly sort of tip, you know, putting a toe into the trauma and pulling it back, because it can be overwhelming, you don't want people to become destabilized. The MDMA seems to really open people up and make them feel safe and trusting, And it allows them then to go in and revisit some of those traumatic experiences with the help of a therapist and reprocess them with a feeling of safety love, even self compassion. So it's a slightly different thing. They're both, you know, what they have in common is that psychedelic piece where it's about the actual experience. It's not a medication you're taking to dampen down systems.

It's about what happens in that six to eight hours of psychedelic experience and then the preparation and the integration. But I think the mechanism is a little different. One is about getting you unstuck. The other one is about making you feel safe so that you can go in and explore some of the stuff that might be too painful otherwise.

Right. Can we talk about Michelle cannabis? Now, that considered a psychedelic? Depends who you ask.

Oh. So, yes, some people would say cannabis, especially edible cannabis, can be quite psychedelic. I don't think, though, like the sort of the conventional definition of psychedelics, I mean, correct me if you feel otherwise, but cannabis isn't typically included in that, like we don't have psychedelic assisted therapy protocols that use cannabis yet. But cannabis can certainly be therapeutic. You know, as many people probably know, cannabis is is cool, it isn't one thing.

So there's so much that we still have to learn about cannabis, you know, different compounds and yeah, parts of cannabis that are that are now under investigation for things like anxiety, depression, etc. But yeah, it certainly is a bit of a different psychoactive substance compared to say psilocybin or MDMA. Okay.

And so I would like to spend a bit of time on ketamine and, and just kind of going back to that meteoric rise rise that it has had. But I'd like to first hear from you from that, because you part of your practice is at EntheoMed, and EntheoMed was the first ketamine clinic in Kelowna. And can you tell me, you're also a practicing psychologist, how that impacted your practice and the folks you were helping to add this to, I guess, the toolkit of supports? I mean, I

would say one of the biggest and most important things that I can help my patients find is hope. And I think what's great about this new frontier of psychedelic assisted therapies, including ketamine, is that it can provide hope that there is another option when some people feel out of options. So certainly it doesn't work for everybody. But it can be one of those, like we've been talking about today, something that can help people get unstuck. I see it as a little bit of like a catalyst.

And I know I've used that word here already, but it seems like people are looking for some sort of transformational experience. Ketamine doesn't fix everything by any stretch, but it can be that type of experience that someone can go through where they then think, Okay, for the next few weeks, I'm willing to try to do those things that I know might help, that I've been resistant to or reluctant to or had trouble to get out of bed to try. Yeah, it's definitely a part of a bigger program of treatment.

Right. And it's not only, as I mentioned, in private clinics, such as Enthiozac, it's also in public institutions. Know, I know that, you know, some hospitals are doing inpatient, some hospitals are doing outpatient. And for me, interest in this is really why I wanted to do this on this season. What is it about ketamine that has hospitals saying, this is what we're going to use to help you over, I don't know anything else.

So let's let's let's assume that the individual has done the prescription drugs. Over that. What is it about ketamine specifically that where doctors and hospitals are saying, Okay, we're going to give you a few of these and see how it goes.

I think ketamine is an easier fit for the classical medical model. Hospitals are very familiar with ketamine. You know, if a young, even a child breaks their arm and they go into the emergency room, they get a dose of ketamine that's larger than what you'd get for the treatment of mental health for the psychedelic assisted therapy. Ketamine is in the back of most ambulances. It's widely used as a dissociative anesthetic.

So there's that familiarity. The hospital already has ketamine.

See, I don't know that people know that.

No, it's widely used. Yeah.

Yeah. I know it's Okay. I was going to thought you were like, oh, it is widely known. I'm like, maybe you all know that, but we don't know

That's why people are surprised at how common it is. But I think it's one of the don't if it's the list of 10, but it's one of the most widely used drugs, especially in the developing world where people don't always have access to other types of anesthetics. It's everywhere. So it's one of the most widely used drugs in the world. So we know the safety.

And also, physicians are familiar with it. In order to get something like psilocybin, you need a special authorization from Health Canada. It's on a case by case basis. So there's that practical piece to it. Also, it's quicker.

Ketamine, you're looking at, you can get in and out in a few hours. Whereas with the other psychedelics, it's the better part of a day. And there's a couple of different ways that people look at ketamine. I think for some folks, they see it as a sort of a gentler replacement for electroconvulsive therapy. And in those cases, it's not really a psychedelic assisted therapy.

It gives people a bit of a reset. There's a dramatic decrease in depressive symptoms right after, and that's even without preparation and too much discussion. You'll just feel better afterwards when you treat it as a psychedelic though, and the way that Michelle and I work with it is you do the preparation. You say, Okay, you're going to have this experience. You may be free of your depressive symptoms for a time.

You may be able to see things in a different way. What are you going to do with that window? Because just on its own, ketamine can most of the evidence shows that the effects last for about a week. Now, if you've been depressed with no break for years on end, a week free of depression, that's one heck of an important window where you can start to make some changes, engage in therapy, even just to remind you of what it feels like to not be depressed. So I don't mean to say it only lasts for a week, therefore it's negligible.

But unlike the kind of sea change that we sometimes see with things like psilocybin or MDMA, without the kind of preparation integration, ketamine is more of a temporary relief, which is huge. We use all kinds of medicines all the time that where the effects aren't, you know, one and done.

Right. And I should clarify for all of these, like we're talking about small doses, right? Or I should ask you, what are the doses that we're talking about for

these doses of ketamine is a funny one because, you know, the dose that you'd give a kid with a broken arm is certainly larger than what you would use as therapy. But the dose that you use in therapy is probably also larger than what people use in a club if they're using it as recreationally. So is it a small dose? It's larger than what people would consider a recreational dose And you are not able to do anything when you're getting your ketamine dosed. You're laid low.

You're reclined and you're really pretty out of it. So it's not I wouldn't want to say it's like a small dose. Yeah, it's a strong experience. But when it's used in surgery or as an anesthetic, then you have no memory. So it's less than that, but more than what people might consider a recreational dose.

Right. You both have said that we're having a psychedelic renaissance here, but I feel like it's still evolving, and there's still more to find out from a research perspective. And I'm interested in this from both of you because you've done a ton of research on various aspects. What are some of the things, Michelle, let's start with you, that you would like to see? Or what don't we know yet and still is coming out in research or you would like to

know more about? Well, yeah, I mean, when I think about the actual, like, practical clinical application of using psychedelics, for me, it always comes down to who is best suited for these therapies. What are the symptoms that are being most adequately relieved with psychedelic assisted therapy? And what are the modalities that are most supportive? So sure, we have some research that suggests some of these what we call third wave therapies, so acceptance and commitment therapy, dialectical behavior therapy, mindfulness based therapies.

These are really well suited to help psychedelic assisted therapy. But just as a practicing clinician, I'm like, Hey, if we're going to use these powerful tools, how can we best use them? How can we get the most out of it? Especially if patients have to go through the arduous process of getting access, then let's make the most of it.

Yeah. Yeah. And what about you, Zach? What are what are you? I mean, what I should also say to you guys, what are you working on?

Because I I was looking at your little what was it? Google Scholar, your little your lengthy Google Scholars. And I'm like, I think you guys are about due for a new one research paper. But all joking aside, what are you hoping to see more of?

You know, I think on one hand, there's a lot more research to be done around finding out, as Michelle was saying, what works for who and when and what's the best way. So there's that piece. I also think it's important that we look at how to make sure that these are accessible to the people who need them the most. Right now they're quite expensive, and it's hard to access them, and we don't want to see some of the healthcare disparities that are already entrenched in the system expanding into this new, this is a chance for us to do different, I hope. And especially, you know, I think what we're seeing now the pharmaceutical industry is people trying to find patentable molecules that are maybe shorter acting or maybe slightly different in ways that they promote, but are they really that different?

The main difference is that they're patentable. Whereas with things like psilocybin, they're in the public domain. So is this a chance for us to liberate these effective medicines and make them accessible to everyone, or are we going to continue to keep them marginalized and develop new, expensive, exclusive treatments that are just going to continue to have this bog down the health care system with expense and access issues. So I'm interested in how do we make sure that these get out in a good way because they're coming, and that's for sure. And with something like psilocybin, they've been around long before the war on drugs, long before Europeans were in North America.

So the safety is well known. The potential effects are well known to a bunch of cultures. You know, when it's a psychedelic renaissance, only for some people. For some people, it's a longstanding practice for many of the indigenous people of The Americas. So how do we make sure that these get out in a good way so that people who might benefit can access them and they don't end up being just another more fuel for pharma to make more money?

Right. My next question was going to be, where would you like to see this evolve in the next five, ten, two years? I feel like that is part of the answer. Anything else either of you would like to see as this, you say it's coming, it's more accessibility, increased accessibility, increased use. What else do you think is going to happen?

You know, think we talk about treatment resistant depression and these being seen as sort of an alternative for people who haven't responded to typical treatments like SSRIs, like some of the other antidepressants. I'd like to know, could they be something that people try before they start taking a medication that is going to be sometimes difficult to stop, that doesn't have a clear end date. If you could go in and have a psychedelic experience early in your depression, maybe that's something that could be interesting to see. Right now we're trying with treatment resistant depression because in part we want to make sure that you've tried the normal things first. And then if that doesn't work, let's try this as a last ditch chance.

I would like to see that be explored, whether there's a way that this could be a way to prevent the people getting to the point of being treatment resistant.

Prevention, such a key piece, particularly when we're talking about mental health issues. Would you like to add to that, Michelle?

Yeah, mean, just to leapfrog off what Zach said, and, you know, I think that we're so reactive in our health care system. And, I mean, certainly we have to focus first on serving the people that need these medicines most. But what about well-being? And what about being proactive? We have new things in medicine like prehab.

I think it's called prehab, where you do like, rehabilitation, you do a workout routine or plan before you go for some type of orthopedic surgery. So you recover easier. So is there an opportunity perhaps for us to sort of change our approach a little bit where people with maybe subclinical levels of depression and anxiety, PTSD are given an opportunity to work through some of that before they become sort of more entrenched and, and possibly disabled by those conditions. Right.

Thank you so much for both of you for chatting with us today about this. Okay, so we've provided some links about psychedelic assisted therapy on the notes page or the podcast page on the AwayForward podcast page at cmhacolona dot org. It's not going to be all the links. So if you're finding more about it, please do your own research, but some of the ones, that I came across in preparation for this episode. And you can always email me if you have questions about this episode or any other episode at awayforward@cmhacolona.org.

And in the meantime, as always, please do take good care. Beam Credit Union supports mental health initiatives across British Columbia because caring for each other builds stronger, more connected communities. United as one, Beam's founding credit unions now serve 190,000 members across BC.