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Joe Moore (00:12): Hi, everybody. Joe Moore here, Psychedelics Today, joined by Roman Palitsky and Josh Lipson. We're going to talk about this psychedelic harms research project at Emory University, get into the why, why you should contribute, and much more. Roman, Josh, thanks for joining me.

Roman Palitsky (00:32): Thanks, Joe. It's a pleasure.

Josh Lipson (00:34): Thanks for having us.

Joe Moore (00:36): Yeah, Josh, this is your second time on, I think it was two years ago, maybe, was your visit on psychedelics today?

Josh Lipson (00:44): Yeah.

Joe Moore (00:45): So welcome back. And Roman, welcome for your first time. So Roman, can you tell us a little bit about what this project is?

Roman Palitsky (00:53): Yeah, this project is a… It's probably our big chance to get a really clear understanding of what's happening when people say that they're experiencing a post-psychedelic harm or post-psychedelic challenges. What it involves is it's a large study of eight hundred people who will have all experienced post-psychedelic challenges. And then there's a longitudinal component to it where the people that we catch who are actually actively experiencing difficulties right now, we're going to be able to follow them for a year to really prospectively understand what it looks like when somebody has these challenges, what helps them recover, what makes them better or worse. A lot of the time, the kind of data that we get about difficulties, it's all retrospective. It's all people looking back at the past. And guess what? Whatever you did, if you're feeling better now, you're going to say that that's what helped you recover. But we don't always know that that's true. And so being able to monitor this prospectively is going to really give us some important data that we could base treatments, responses on.

Joe Moore (02:01): Yeah right and you know we have nothing this helpful um in the data set at this point and you know like light pessimism is that we we're gonna need a sample set of like two hundred thousand five hundred thousand before we can like you know super duper base everything on it but that's gonna take us a really long time to get there and this is the first step in a project like that in my opinion

Roman Palitsky (02:25): Yeah, and I think that's one of the reasons that we really focused in on this group of eight hundred, what we call an enriched sample. All right. So people will ask us, you know, can you get something like prevalence? How often do these harms happen? And you can't because we're already targeting on those people who are saying that they're experiencing the difficulties already. And I guess the flip side of that is, are you just sensationalizing? Are you just focusing on kind of a weird, strange group of people? And, you know, I used to study grief and I still study grief a lot. And I think if you want to understand grief, you're not going to learn much about it by talking to people who are not currently grieving. So what we're doing right now is doing the equivalent, actually learning from that large and rich sample of people who have the difficulties. And I actually think that gets you a lot of very good, reliable data, way better than anything we have today.

Joe Moore (03:23): I love that. And Josh, are you particularly excited about this for any reason in particular that you want to speak to?

Josh Lipson (03:30): Yeah. I'm excited about it for the reasons that Roman already described, but I would say more than anything else, I've always been interested in the question of psychedelics and their heterogeneity, right? There isn't one psychedelic experience. It's kind of hard to get at what is the least common denominator psychedelic experience. And even more difficult for a number of reasons that Roman already mentioned is getting at a universal definition of what psychedelics do to impact people down the line. And even when we talk about people who categorically say I've experienced adversity and harm down the line from psychedelics, there is so much variability. We're talking about harms that you know, on paper would seem not to be related to each other at all. Somatic disturbances, changes in perception, existential and spiritual struggles. And I just don't think there's anywhere out there where anybody is asked in nearly as fine-grained detail as we are right now. And getting a sense for how these things relate to each other and beginning as you were saying you know eight hundred is nice but we'd love a few hundred thousand uh individuals in our sample beginning to map this very heterogeneous landscape and find associations has been something i've been animated by for years amazing yeah so what

Joe Moore (05:15): Kind of um Well, okay, so I'll start kind of with a little storytelling and I want to hear kind of from you all. So psychedelics have this kind of, oh, they're going to heal everything, silver bullet kind of storytelling out there in the ethers and popular media and whatnot, you know, and we're about to see some action around Ibogaine theoretically from the executive order that we're kind of expecting to go through, maybe already did. Anyway, like, With Ibogaine, that's really scary. We know for sure that there's some substantial physiological risk, like death. Things like LSD, MDMA, we want to say they're really safe. Dr. David Nutt is of the opinion that MDMA is safer than riding horses. You know, he got fired for saying similar things. And then, you know, LSD generally looks really safe, but there can be some impacts on people that can be really stressful. Not to mention like the acute terror and potential trauma from that kind of thing. But, you know, things like HPPD, where your vision can have issues for days, months, or years. All of all of these things not being studied well enough to speak all the way skillfully to them. You know, the data sets just not there yet. But, you know, so what was there a story or anything that really kind of came forward for you that made you want to address this one, Roman?

Roman Palitsky (06:57): Yeah, well, so I'm a clinical psychologist, and I have a background in, I also have a Master's of Divinity, so I have a background in kind of studying the unusual kinds of experiences that people can have. And that really took shape a lot in the study of meditation. And there's this probably better developed area of better developed in some sense and worse developed in other sense of understanding what happens when people go on these intensive long retreats and something goes wrong because that is another sort of risk area. The interesting thing is that the adverse effects or the difficulties people can experience, they can look pretty similar, including the somatic stuff, including the sensory stuff. And we stumbled across this when I was working with a researcher named Willoughby Britton at Brown. This was during my postdoc. And she's got this organization that helps meditators in distress. And what started happening was people started showing up to this organization. It's called Cheetah House. And they were like, well, I'm having all the same stuff you're talking about, but it's happening after a psychedelic experience. And I just don't have anywhere else to go. Nobody else seems to really understand what's happening for me. And then you start to look more into psychedelic communities and it becomes very clear. This is sort of like an open secret, right and you know I am convinced that psychedelics have amazing potential to enhance wellbeing, connection, and to treat really difficult psychological problems. But in order to use them as a treatment, you need to have a solid grasp of their side effects. Like any very powerful intervention, which I believe they are, you do get some very powerful side effects and that's not necessarily a problem unless you're sweeping them under the rug. So I'm a big fan of Dr. Nutt's research and I love the comparison of riding horses. The place where I would maybe take a little bit of issue with that is if you fall off a horse, the physicians who are treating you know what your injury is. They understand how to treat it. They understand what it's going to take to get you back on the horse. And we don't have anything like that for post-psychedelic challenges.

Joe Moore (09:17): Yeah, that's interesting. And I like that. And that's a good way to characterize it. So, you know, it's going to take a long time. You know, we're dealing with what a trillion dollar war on drugs and fifty years of a gap in science. And what do we do? So, you know, yes, let's say, hey, there are potential concerns here. Like people can be injured and it's not it's not like treating a bone break or a concussion. It's different.

Josh Lipson (09:46): Yeah. And what's interesting is it's certainly different from treating a bone break or a concussion where there are established protocols. What we're also curious to know is how different or similar treating post-psychedelic difficulties may be from treating other psychological and psychiatric symptoms or syndromes, which is also something we don't really know. we'll look at somebody's post-psychedelic difficulties and say the best approximation for what this is, is a manic episode or a psychotic episode, or perhaps something that doesn't meet full diagnostic criteria, but is similar to something that's characterized out there in the wild unrelated to psychedelics. But we also don't know if we're really talking about the same phenomena or if psychedelics cause distinct profiles of challenges that require distinct approaches.

Roman Palitsky (10:53): Yeah, you're absolutely right, Josh. I mean, like, we're just woefully under informed, right? So we talked to folks experiencing these kinds of difficulties every single week. And the thing is, that doesn't mean this lack of information doesn't mean that there are not a lot of opinions out there. Right. So there's the there's no such thing as a bad trip crowd. There's the anything unpleasant is going to be an adverse event crowd. Right. And most of our data is with these really small samples or it's so general that you can't really use it to inform psychedelic care. Right. So.

Joe Moore (11:37): I love that you know such thing as a bad trip. I love that because there's so much nuance behind what are we even saying? You know, like any bad feeling is a bad trip. Like I got itchy and had to go to the bathroom too many times. Like, you know, and then, you know, the people that are having like a real deal hell experience for eight hours or longer. Right. That's that's a robust one. and um yeah like was there spiritual growth i don't know that's not for me to say but there's possibly some harm so what do we do what do we do i think study it is the appropriate answer um given where we are in history um i remember being in some really loud arguments with people Roman about this topic I bet it was pretty much like oh daddy government's gonna save you from this by making it illegal and I'm like well you know hasn't worked yet so like why would you believe that um and you know no names but published authors right so what are what do we do with that um like how i think jail is a negative experience from psychedelics like if we do it wrong um or hospitalization you know from somebody you know if you could buy this at seven eleven and you knew it was two hundred micrograms like theoretically you'd eat half or less um and instead of you ate ten And you had to go to the hospital and that set off a whole cascade of expensive things. Right.

Roman Palitsky (13:18): Yeah, and I think anybody who comes out here with some kind of a very simple one-line solution, whether it's ban them all or make them all freely and openly accessible without any kind of insight or information or sort of, you know, if you're using them as a treatment, I think treatments should be accountable to patients, to bodies that inform standards.

Joe Moore (13:45): How do you mean that?

Roman Palitsky (13:48): Well, I think that if we're going to claim that we're going to offer a treatment to somebody that's going to improve their mental health, we need to be accountable to that person. If I hang out a shingle and I'm taking insurance or I'm taking their money and I'm offering some kind of remedy for what ails them, I need to have some kind of accountability to that person. I think that that is what differentiates me from a huckster.

Joe Moore (14:18): Liability insurance, we're working on it, everybody. But it's a real thing. We need enough data for liability insurance people to base their calculations on. You need to know what's a good practice and what's a malpractice. All of these things. And so I think these are pretty complex issues that it's going to take a lot of people to resolve.

Josh Lipson (14:40): Absolutely. I would also just emphasize again, I think that our findings will have implications for above board psychedelic therapies where there is formal accountability process. But most of the people who we're speaking to are taking psychedelics outside that kind of context, across a range of different contexts. out there in various niches in the ecology of the psychedelic wild. And I think that our hope is that what we find here about what is likelier or not to precipitate psychedelic related challenges, what seems to work best at remedying them, which are complex questions in and of themselves, can hopefully be helpful to people who are doing work with psychedelics in the underground or having experiences that are broadly painted as recreational, whatever that means, but we're definitely not here to knock that and create a hierarchy of preferred contexts. We hope that we can speak to something relevant to all psychedelic experiences.

Roman Palitsky (15:59): Yeah, I think sometimes people ask like, oh, does that mean that you think that psychedelics should only be offered in medical offices and things like that? And I'm actually not convinced that that's the best model. I'm not convinced that that's really the best approach for psychedelic use generally. I know that they have a lot of potential within the context of medical models. Right. So there are things that we're trying to do therapeutically that psychedelics can help. Right. And if we do them that way, then we should adhere to our standards. But that doesn't mean that everything needs to be under that medical umbrella. Right.

Joe Moore (16:37): Right. Especially with there being, you know, ostensibly a really long history of use of substance, or I guess not ostensibly if I just say the word substance. But I think we have just a lot of complexity to get through. What kind of pushback are you seeing when you all came forward and said we want to study this particular thing?

Roman Palitsky (17:04): Yeah, luckily we've been able to learn from the experiences of those who've come before. So we've partnered a lot with the meditation adverse effects research crowd. And what I'm learning is that actually the landscape in psychedelics has been way friendlier. So in the meditation world, I think there was an era where if you even insinuated that something negative could happen as a result of meditation, you'd be ruining the movement, you'd be throwing the guru under the bus. People who had adverse effects, they were silenced because it would jeopardize a movement, and a lot of these movements were religious in nature. in psychedelics it has i've actually been very positively surprised by the reception and the interest now that doesn't mean that there hasn't been negative kind of pushback and a lot of this again it can have those kinds of uh qualities right again well you know and the pushback comes from the most different places so one of the things that we're working on this is not not in the purview of this specific study but measuring adverse events in clinical trials And I think clinical trialists get into some pretty hot water when they start to think, okay, oh gosh, this looks like it might be an adverse event, but that might cause problems for us. So is there any way that we can kind of not really call it an adverse event? And my opinion has been like, listen, if a person is suffering, you need to acknowledge it. And that's gotten some pushback. And then broadly in the kind of psychedelic ecosystem, there are definitely people who take serious issue with any claims of, you know, this can harm somebody. It's all going to the best. It's all going to be beneficial. You just wait and see, right? And this is… i'm not really trying to you know we're trying to steer carefully and be very empirical here um but but i think the fact that you're even looking at challenges and harms raises suspicion yeah

Joe Moore (19:21): Two things i think or did you want to add anything josh

Josh Lipson (19:26): I was, no, not really, no.

Joe Moore (19:31): I have a question about adverse events from meditation. I generally tell some stories here and there about people ending up in a psych hospital after Vipassana. I'm sure that's not the only method or framework. But how do you, what do you hear from that field in terms of like, what are the kinds of adverse events?

Roman Palitsky (19:54): Well, so interestingly enough, this study, one of the ways it's building on that field is we're using an epidemiological comparator. So what that means is you can't randomize people to have an adverse effect or a difficult experience, and you shouldn't, right? Every time we get somebody in the study, it's like, well, I'm glad we're getting the data, but I'm very sad that this happened to you. But you need some kind of a comparison. Right. One reason to compare is you want to understand what's due to the action of a pharmacological agent and a chemical cascade potentially. Right. Versus something that you could just do on your own with your mind, which isn't to say that what happens with your mind and brain isn't chemical. Right. But so the the thing that we've seen is actually there's a lot of overlap. There's a lot of overlap between the meditation and the psychedelic issues. Now, we're still in the first trimester of our study. Recruitment is ongoing. So a lot of this is yet to be described. I'd really point folks to the Varieties of Contemplative Experiences project. which does a really deep dive into the kinds of adverse effects that have shown up around meditation. Now, sleep problems happen. And we're seeing some of this in our sample, perhaps more so than with psychedelics. issues with uh you know what what might look like psychosis sometimes and it's not clear whether that's truly psychosis but if you show up at an ed and you know you're you're saying that you're receiving communication or that you can read minds that's a lot of the time that's the the label that you'll be given Mania, right? So bipolar episodes, we see things like that. But also things, and we've published on this, these kind of really interesting, we've called them energy-like somatic experiences. People meditate and they feel these kinds of flows of energy moving through their body. And, you know, this is stuff that if you go to a neurologist, they'll say, well, this is like a functional neurological disorder. Right. If you go to a complimentary practitioner or a yogi, they might say, oh, you're having like a Kundalini episode. Right. But these are definitely things that we see people coming forward with these kinds of somatic experiences. And what's really curious is we're also seeing people come forward with them in the psychedelic space as well.

Josh Lipson (22:34): Yeah. And whether somebody primarily tags that as a positive or negative experience is another dimension of it. You know, you have the pure phenomenological aspect of it. And then there's the question of what valence does someone assign to it? What meaning do they make of it? What meaning have other people in their lives assigned to it? And we ask about all of these factors in relation to any change that somebody experienced after a psychedelic experience or after meditating. So we don't just leave it at, did you experience this? We really look at multiple layers of processing and sense-making around it.

Joe Moore (23:25): There's so many possible things. I'm kind of going back to the clinical trial adverse event thing for a moment. What kinds of things, like what would somebody like myself consider like some of the most minor of adverse events that I might want to just like shrug my shoulders at that are getting tracked? You know, I had a headache for three seconds or like I had an uncomfortable feeling about my dad for two seconds. You know, like how do I don't want to minimize people's things because those can be really serious sometimes. But like what what are we looking at?

Roman Palitsky (24:03): So I think the problem generally with clinical trial adverse event reporting is a lot of these focus on the acute, the actual psychedelic experience. And in that sense, what we're really drawing on is the pharmacological toolkit. So if you're testing an antidepressant, if you're testing a headache medicine, you're going to use a very similar vocabulary of adverse events. Did you have a headache, right? Nobody's going to ask you if you had a weird thought about your dad, right? If they're trying out ibuprofen or something like that. And so, you know, do you have a stomach ache? Did you feel nauseous, weak, dizzy? Did you feel suicidal? People are tracking that pretty well. But then what we get to in the time afterwards is there's a lot of reliance on what we call passive monitoring. So passive monitoring is we don't actually solicit the things that could go wrong. We just say, hey, anything wrong happen? And then it's up to you to tell us. The problem with that, of course, is people will often not think of problems as something adverse. My example for this is a dear friend, actually, who I was telling about the study when it was in its formative stages. And this is a person who's taken psychedelics hundreds of times. And he's like, well, you know, I'm not really sure I've ever experienced an adverse event. And I was like, man, we were just talking like a week ago about how you were on mushrooms and you punched the ground because you thought that would break you out of your current reality. And that led you to break your hand, right? And he was like, oh, but that was a broken hand. I wouldn't really think of that as an adverse event. right what would it have happened if you hadn't taken mushrooms um and that's actually outside of the clinical trial area i think something we're not tracking well enough at all is just injuries i mean how many people do we know who just you know climbed a tree or you know as went down a slide or whatever right but but the point is right if we rely on passive monitoring people are going to make their own sense of what's good and bad and research has shown that that can underestimate detection of adverse events up to twentyfold or over twentyfold rather um which that could indicate that could lead into why a lot of drugs are rejected after they hit market right Yeah, yeah. And some of these things you just, you won't be able to detect until you have much larger numbers than a clinical trial can afford, right? And there is an important converse to that argument, right? So if we ask about every little thing, people might over-report, right? And you don't want that either. And I understand, you know, like all of these concerns of clinical trialists. So what we've actually done is we've come up with a list of those adverse events. This is for the clinical trials work, right? that are not currently being detected or even monitored in the medical model, but which we think are actually really important. So people report all of these really positive effects on spirituality and psychedelics, right? This is like one of the hallmarks sort of mystical experience components, right? Okay, well, what happens to somebody who has a psychedelic experience, expects to meet God, And then finds out that the world is an abysmal empty place without any meaning or sense to it. And comes out and six months later they're still struggling with that. That's something we should be looking at. Totally. Yeah. The philosopher in me says, good, like you, maybe you made some progress, but also like that can lead towards suicide. Right. Like that's not, you know, always the right conclusion we're going for. But, you know, a brute force encounter with reality. I don't know. Sometimes that gets you to stop eating McDonald's or something, but, you know, maybe it ruins the rest of your life. I mean, this is why we don't just ask, well, have your thoughts about this changed? Is it causing you serious problems in your life? And I think that's the real hallmark. We really want to be impact-based. Are these things contributing to meaningful difficulties? Yeah. And what will be fun is, I think, having a data set to start with. Mm hmm. More more meaningful conversations with later, because obviously a philosophical crisis, ontological shock, et cetera, is it's not useful for your job. Or perhaps for how you show up for your toddler. You know, maybe it is, but probably not. I mean, this is something that comes up in the meditation world, right? Where I think you really get this very clearly. So there are people in a very, for example, a very Buddhist mindset who say, well, great. You have found that all things are disappointing. All things are empty and illusory. And now you're not sure if you have a self anymore. You're making progress, right? But if this is like your grandma who came into the therapist's office to, you know, try to improve her health, that's not what she was looking for. And maybe that's not even her belief system, right? Or let's say, you know, you've got somebody, I mean, we could talk about this for a long way, but Buddhism as a philosophy, right? One of the things is that it is against the stream. It is actually taking people and removing them ultimately from the goal of Buddhism is not the same as the goal of self-optimization. It's not the goal, like you said, of showing up for your toddler or, you know, the Buddha left his family, right? So I think we want to be very careful about goals. Mm-hmm.

Joe Moore (29:57): Yeah, absolutely. When we spiritualize, it becomes complicated. And I think characterizing those well as part of our conversation is going to be hugely important. Are we talking about purely lowering your treatment-resistant depression scores or PTSD scores? Great. That's a different thing. The grandma thing is an important story because this is the story why I'm really excited about these kind of non-trip psychedelics. um because we could theoretically have people not need to suffer that you know aren't really there for the adventure you know that said i think there is some data indicating the trip is important but what if you don't have to do it and you just do three non-trip treatments and then instead of one trip treatment like that still seems pretty worth it to me um so we'll see where all this stuff ends um but yeah um so have you received much on HPPD yet

Roman Palitsky (30:55): Josh, you want to speak to that?

Josh Lipson (30:58): It hasn't been a hallmark of most of the conversations that I've been privy to with our participants. We've done some very cursory glances at the data, but no formal analyses yet. um given you know that we're we've got a ways to go um but something that we can speak to a bit uh are the many many screening calls we've done with participants who've come to us we make a point to talk to literally every single person who indicates an interest in enrolling in our study to actually talk to them face to face on zoom for something like fifteen minutes can go longer um And sometimes people speak to perceptual disturbances. I don't know if anybody I've spoken to has used the frame of HPPD to describe what they've dealt with. We're seeing such a wide range. Roman, I don't know if you can speak to a different perspective on that.

Roman Palitsky (32:04): No, I think you're right. We see symptoms that are likely consistent with HPPD, but one issue is not everybody gets that diagnosis, right? So as a formal diagnosis, I think it's just your clinician needs to be educated about it, and then it has to sort of fit you, right? And we do talk to people who get a diagnosis of some kind, not necessarily HPPD, and they're like, I didn't find that very useful.

Joe Moore (32:34): Yeah. Okay. Yeah. I think it's one of the things, if it started getting out, that it happens with some frequency. I think it could really impact clinical trials. I had an argument a while ago where I was saying that If HPPD is happening in the general population from these substances, it appears to be true that it does. People are running drug trials on these drugs. It'll be in the pharmacopoeia and prescribable. These drug companies, there should be some incentive to actually research HPPD and come up with treatments ahead of time before going at scale. kyle like kyle and i over here at psychedelics today had a couple treatment protocols we wanted to get funded um for for researching we had some pretty decent data that it was going to make a dent on people so you know i hope others kind of understand that this is just one of many indications that that will likely come after some you know expansion in psychedelia

Roman Palitsky (33:39): And, you know, I think one of the things this study can do, so HPPD is a fascinating and really important diagnostic indicator. What this study allows us to do is to really look at HPPD symptoms, right, not diagnosis. And I think people take issue with DSM-type diagnoses for very good reasons. right there there are nine symptoms of depression you have to have five of them which means that depression can look like any permutation of five within nine uh post-traumatic stress disorder is even more complex than that right so these are good for for sort of billing for recognizing for sort of thinking about treatments generally but what We're in conversation with a lot of groups that think about symptoms in a much more global way and how they hang together, how they interact, right? So by not just looking at perceptual symptoms, but also looking at somatics, also looking at meaning, looking at mood, looking at wakefulness and arousal, I think you get a much clearer picture of what this actually looks like. Because I… My sense is that HPPD for many people doesn't travel alone, right? And that some symptoms will likely have knock-on effects. We talk about something like tinnitus, right? Which if you get it for half an hour, it's really not a big deal. You probably, you know, it might come up as an adverse event in a clinical trial, just something that gets noted on a checklist, but very minor. If you have it for a year, it's profoundly debilitating so i think that uh in tracking these symptoms on whole and and all together understanding the networks that link these symptoms together uh we're actually gonna be able to understand even something like HPPD uh much better yeah for sure and to to second your um

Joe Moore (35:50): Tinnitus tinnitus tinnitus is how i always say it but tinnitus is how i hear clinicians say it so the um i i know of one suicide from an extreme case and um also my my partner can't sleep without noise on account of it so it's it's um definitely a debilitating thing um and similarly these kind of uh let's call them phantom nervous system signals or you know they can be they can show up in many ways psychedelics can help create weird things too or resolve things it's a strange thing

Roman Palitsky (36:34): Yeah, I mean, I really think, so right now, when something like that emerges, I think a clinician or somebody at a retreat center, honestly, somebody who's not clinically minded at all, something that they have in common is somebody shows up with very difficult symptoms and just put it in a black box called problem, right? And kind of use, you know, let's throw our usual set of remedies at it, whatever that set of remedies is, right? And I think there's a real opportunity here to educate those folks at the front lines, right? We can absolutely create, on one hand, evidence-based models, which on the other hand, don't reduce people to a diagnosis, right? Yeah. All right. And I think that's really important, especially because psychedelics are used in a plethora of ways that we don't want to take meaning away from any of those contexts.

Josh Lipson (37:33): Yeah. I would also say just to add to your point, your last point, Roman, Given that, so many of the people we speak to do not or take care to say that their adverse effects do not mean that they view the experience they had as globally negative or overwhelmingly negative. And a lot of people speak to the experience they had as well as the after effects of their experience as a complex mix. I think it's worth also acknowledging that there are psychedelic experiences people will say were worth having, even if they made their lives more complicated in certain measurable ways, in certain clinically legible ways. And that's not the only valid way to look at psychedelics and their balance of benefits and harms.

Roman Palitsky (38:36): Yeah, oh my God, that is such an important point that it's not an either or, right? We get folks coming in like writing to our study and say, I'm not sure I'd be right for you because I did have a difficult time for a few months, but now I'm so glad that that happened to me. I've really grown as a result. That's kind of your experience of facing that sort of that emptiness. But now I think I've taken sort of, I've taken a hard look at what matters and I'm now more aligned with that. And we say, fantastic. Please join us. We want to learn what you did, what it took to get you to that space of growth and flourishing and betterment versus the person who's a year has gone by and they're still struggling. We want to know whether there's any way that we can sort of reverse engineer what happened to you for that other person. The other important thing that you mentioned, Josh, is like a lot of things in life it's not either good or bad right it's not either beneficial or harmful benefits and harms can go together very easily i love to work out and sometimes i get injured and both you know i've derived tremendous benefit from from my physical activity and i've also you know i've also been put on the sidelines a few times both are true and and you can have both

Joe Moore (40:00): Yeah, you know all about my history with cycling. So I mean, same deal. Yeah. So exactly. We'll compare cycling war stories later. Yeah, I only hospitalized once. So I think there's, yeah, I think having this kind of data trying to eliminate this inability for us to do science here you know thankfully there's a lot of institutions with resources to work on these things now was not the case for many decades um i think that is going to help us as a species understand how to have a better relationship with these substances and i think that's really the goal here right is what what is the proper place for these things and how should we be relating to each other around them

Roman Palitsky (40:55): Yeah, I couldn't agree more. And, you know, I think I have been really encouraged by how many people who often find themselves on different sides of issues in the psychedelic space, right? So organizations that we know are, you know, well, if group A thinks this, I'm going to think the opposite, right? And they've really come together and supported, because I think At the end of the day, I think you can get folks to agree that if you really care about the person who has taken a psychedelic and you're worrying that they not fall through the cracks, that they get the kind of help that they deserve, that we want to give them, then you want to do what you can. I don't think that's a very controversial point at all.

Joe Moore (41:43): Yeah. I think there's some opposing parties that are like, we shouldn't look at these things at all, ever. Like, we shouldn't do science here. I don't really know what their case is. I haven't been able to figure out what they're getting at. But I think, you know, if the RAND report shows that there's a substantial amount of Americans using psychedelics annually… we should be understanding what is that? What can we do? Do we need to get ready for anything? Go ahead.

Josh Lipson (42:17): And I think also, you know, the evidence that a higher percentage of Americans are taking psychedelics than at any point in several decades, if I'm interpreting the stories right, raises some interesting questions too. We have certain assumptions about why people take psychedelics and under what circumstances, But the pattern of risks and benefits may be very different for people who are coming to psychedelics for very different reasons. Like this is something that I thought about a little bit in the analyses I did for my dissertation, which I discussed last time I was on psychedelics today. But it's also something that's come up in some of my conversations with participants. Some people, when they come to a psychedelic experience with the singular goal of getting better, of recovery from a mental health condition, I think that that in its own way comes with its own set of uh, distinct risks and challenges potentially. I, I can't speak from the data yet, but this was not such a big category. Uh, you know, people who are explicitly saying my main reason here for taking psychedelics is to treat depression, uh, twenty years ago relative to today. And, and I think, um, you know, we ask in great detail about people's motivations, context, you know, all the classic aspects of set and setting. And I think that will also help us better understand, you know, not just because the stakes are so many people are taking psychedelics, but the profile of psychedelic users has changed so much.

Joe Moore (44:13): There's a phenomenon that the Groffs profiled in their, in their books, spiritual emergence and spirit context of spiritual emergency. We don't have any kind of way to predict frequency of these things happening, but they kind of characterize this, phenomenal where people would need to be cared for and supported for in kind of like a peer based context for, you know, sometimes over six weeks or something along those lines. This kind of mirrors what was happening at Diabasis House in San Francisco with John Weir Perry and then um burlington vermont kyle worked at a place called soteria house that had a very similar model after hurricane sandy took out the psychiatric infrastructure of vermont they needed some backup facilities so for first break psychosis they would bring people in and kind of a peer-based facility um i think they had optionality to stay on meds if they wanted to but it wasn't like a med first facility and they had really really great performance and people would you know it would look really scary for a while but It was a safe community and people got back to their lives and back to their jobs and seemed remarkably normal after becoming quite abnormal. So these kinds of things can happen from somewhere between one and ten thousand psychedelic experiences. We don't have the odds for people. But I think people should know that it is a phenomenon that can happen. And Kyle and I have been speaking about the need for the community to take these things into account and perhaps to plan for what does this look like. And I talk about bringing people to some sort of farm. You know, I was I was at risk of going to like RFK's farm for a little bit. What was it? The Adderall farm for being an addict, for having ADHD. So like, you know, snarky everybody. It was a joke almost. But like, you know, how how can we develop a really nice facility that's affordable for the psychedelic biotech world and community to help collaborate on so people can have that support? and not need to go into inpatient care if they don't need it.

Roman Palitsky (46:27): Yeah, I didn't expect that I'd be giving a plug to this organization here. But I used to work for a place called Gould Farm. And they are just a model for this. They're in Western Massachusetts. and yes folks living with with serious mental illness and it is it yeah it's it's kind of you you that they're psychiatrically informed you can take psychiatric medications and there's nurses and psychiatrists but there's also you know you're working on the land you are you have community you can't tell when you're there who's a clinician and who's a patient And it's a really important marker, right? That there's none of this kind of hospital hierarchy that you get, you know, there's art, there's music, there's fellowship, people, and there's continuity of care. I think that's something we miss a lot is, something Gould does is people leave the farm, they live in town and they're connected. You're always welcome for dinner. You're always welcome to join. You have resources and people, you know, there's people who like graduated, right? Thirty years down the line, they're still coming around for dinner and they're helping out, you know, people who have recently kind of gotten back on their legs. And it's great. So, yeah, I think these models can be very helpful. And I'll say, you know, this really kind of this dovetails with a bugaboo in our psychedelic clinical trials model, which because, you know, I think there's there's a lot of artificiality to the clinical trial structure of how you provide psychedelic care. that can if we're not careful be imported into the care delivery system when this stuff is implemented where okay you get two preparation sessions with strangers at first right you get your your dose so you get like a one or two integration sessions and then you know if you travel to oregon you have to go back to pittsburgh and try to figure out who you're going to talk to and how you're going to make sense of all of this um like what is that that's not how any of the rest of our mental health care works when it's working well speaks

Joe Moore (48:38): To a data issue in a lot of the clinical trials as well because people will wrap the clinical trial or you know halfway through say these psychiatrists are not doing it for me what can i do because this feels like my only hope to stick with the trial but they're not going to help me enough so what do i do potentially seek other drugs which could confound data um potentially seek community like you know i spent a lot of time building psychedelic communities in the real world for people you know i wasn't thinking clinical trials at the time but you know now that is valid um yeah so it's it's interesting when when scientists out there criticizing each other's data maybe keep that in mind

Roman Palitsky (49:21): Especially if you're in a city like Pittsburgh actually has a decent psychedelic scene.

Joe Moore (49:24): Yes. Good people. You know, if you're, you know, yeah, I didn't mean to, I didn't mean to rag on Pittsburgh. I love the town, but it's a good example. It's a, it's a, like, ten years ago, it's a spot on example. You know, shout out to Gina. Gina, I was with her on Thursday. Absolutely. Great person. So, yeah. How do we, how do we just, how do we support you and support this research?

Roman Palitsky (49:51): Is that a question?

Joe Moore (49:53): Yes.

Roman Palitsky (49:54): Or rhetorical?

Joe Moore (49:56): Either of you. So I have this podcast. I'm including you here, but I'm also emailing in my emails that this is a study that people should participate in.

Roman Palitsky (50:07): Yeah, gosh, I mean, really spread the word. I really think we're in a really special kind of Goldilocks moment with a study where somehow all the planets have aligned and we're able to make a really ambitious shot. at getting a large data set that can meaningfully inform what we know about psychedelic risks, psychedelic challenges, right? And I just, maybe I'm a pessimist, but I don't know when the next chance that we're going to be able to do something like this And this is not, by the way, a data set that we're going to hoard and hold on to, right? This is going to be available to other researchers, available to researchers. It's all going to be completely anonymized, of course. But this is meant to be a resource for the entire psychedelic science, psychedelic advocacy community to meaningfully understand what's happening. As ambitious as it is, this thing lives or dies on people knowing about it and participating in it. We are paying for participation, but if people don't know about it, then they can't be in it.

Josh Lipson (51:21): Something I'll just add, and I think you make the case for it beautifully, Roman. And yes, the study is compensated. What I'll say is the impact has the potential to be huge. And I think a lot of participants we've spoken to are excited about that part, contributing to the field's understanding and the possibility of developing new new best practices for supporting people through post-psychedelic difficulties. And I don't want to speak directly for our participants. I'll speak for myself as someone who's been in conversation with probably upwards of a hundred participants in one form or another. The experience of enrolling in the study going through an initial conversation with our team, completing the survey and then potentially getting directed to enroll in other parts of our study, interview in greater depth about their experience. I have found it immensely enriching and rewarding in a human sense. And I've also gotten the distinct sense and heard directly from a bunch of participants that they've found it extremely meaningful and relieving to have the opportunity to tell their story in their own terms. We, again, talk face to face with every single person who expresses interest in the study to figure out whether they're eligible to establish a human connection. And then the surveys we send out give people the chance to address so many different aspects of their experience. We really try to communicate the point that every story and every detail of every story is inherently valuable. And I think people feel that.

Joe Moore (53:21): Well, thank you for that. Is there a website or URL you can point people to?

Roman Palitsky (53:27): Yeah yeah and i and i hope that there's some way to also include it with with any materials here but it's actually it's it's very simple it's uh psychedelicchallenges.org one word right so psychedelicchallenges.org uh there's there's two c's next to each other in that um so yeah please uh that that's the study website you can learn all about the study who we are what we're doing what you might expect and there's a link to fill out a pre-screener there And if you do that, we will speak with you, which isn't a threat. That's an invitation into a cozy conversation. We don't make people share any more than they want to, but we certainly welcome it.

Joe Moore (54:15): Yeah. And I would urge everybody that if you're excited about psychedelic medicine or rescheduling of these things, then contribute here. It's really important. We have clean, amazing data. And this is going to be an ongoing project for decades, but this is an amazing start. So thank you both. Thank you, Roman. Thank you, Josh. And I hope we can do this again, especially once you have some data to share.

Roman Palitsky (54:36): Thanks so much, Joe.

Josh Lipson (54:37): Yeah, this has been a real treat, real pleasure. Really a pleasure. Thank you so much.

Joe Moore (54:43): Thank you all. Let's hang out backstage in just a moment.