PT285 – Andrew Penn, NP – The Need for Nurses in Psychedelics, The Placebo Effect, and Appreciating the Subtle

In this episode of the podcast, Kyle and David interview Andrew Penn: nurse practitioner, Co-chair for Sana Symposium, Associate Clinical Professor at the University of California–San Francisco School of Nursing, and Co-founder of OPENurses; a professional organization for nurses interested in psychedelic research.

Penn discusses how he came into the world of psychedelics and how in his early days, the only way to talk about psychedelics for therapeutic use was in a sidebar to speeches on drug abuse. He talks about reframing that conversation, the progress he’s seen, why psychedelics and SSRIs may actually work together, microdosing and the placebo effect, how the placebo effect may play into other aspects of healthcare you might not have thought about, why psychedelics needs more skeptics, and the importance of care in healthcare. 

He talks about OPENurses (The Organization of Psychedelic and Entheogenic Nurses), which he co-founded to make sure more nurses are involved (and front-facing) in the psychedelic space. He feels that nurses are more prepared for psychedelic treatment than other professions, but the biggest hurdle they’ll face will be learning when to not intervene and just let something play out (something that’s very common in psychedelic therapy but not at all in traditional medicine).  

And lastly, he talks about how we need to stop romanticizing the idea that you need to have a huge experience with re-lived trauma in order to heal, and that we should have an appreciation for the subtle – that change is gradual, and often it’s more about creating a better relationship with the thing we can’t change than eliminating it.

Notable Quotes

“Back in those early days, the only way I could talk about psychedelics was, essentially, embedded in a talk about drug abuse. In fact, the very first time I talked about MDMA as a therapeutic agent was in a talk about bath salts.”

“I think it’s interesting that as a community of people who really are not necessarily rational materialists – you know, we’re not necessarily mechanistic in our way of thinking – that people get really mechanistic about microdosing; that it’s like, ‘Oh, it’s this tiny little dose of LSD or whatever that is making this change.’ And I’m a little puzzled why people want to essentially take a regular dose of a psychedelic. I mean, how is that any different than taking a regular dose of Fluoxetine or Lexapro or something like that? I just don’t see it as being that radical, quite honestly. …LSD is not a naturally-occurring compound. It has to be synthesized. So does Fluoxetine. I mean, maybe psilocybin, but I’m just a little puzzled by the phenomenon.”

“I think psychedelics needs more skeptics, honestly. I think we either have to bring the skepticism ourselves, or other people and other forces who are not as convinced as people in the psychedelics community will do it for us. I used to have a therapist years ago who liked to say, ‘Do you want to be uncomfortable on your terms or on somebody else’s?’. And I think that’s a great question that the psychedelics field could ask themselves, because if we don’t bring this level of scrutiny and skepticism to our work, then other agencies like the FDA will.”

“When you’re trained in healthcare, we’re often explicitly taught (or implicitly taught) that we need to do something; you know, what’s the intervention? What’s the thing you’re going to do? And often in psychedelics, the thing to do is to hold still. …I think the drive to intervene is well-intended but often, ultimately can be incorrect. What we all need to learn (not just nurses, but just all of us in this profession) is that sometimes the right answer is to watch this unfold. Choosing not to intervene is actually an active process.”

Links

AndrewPennNP.com

Twitter: @UCSF_AndrewPenn

Linkedin

OPENurses.org

OPENurses YouTube

Psychedelics.ucsf.edu

The Doors of Perception and Heaven and Hell, by Aldous Huxley

Sanasymposium.com

Sagepub: Psychedelic-Assisted Psychotherapy Practices and Human Caring Science: Toward a Care-Informed Model of Treatment

Core Concepts of Jean Watson’s Theory of Human Caring/Caring Science

Psychedelics Today: PT231 – Dr. Hassan Tetteh – Human Care Over Health Care

Chacruna.net: How I Joined the Secret SSRI Circles of 1985

Pubmed: Depression Is the Leading Cause of Disability Around the World

American Journal of Nursing: Supporting the Patient on LSD Day (from 1964)

American Journal of Nursing: CE: Psychedelic-Assisted Therapy (their follow-up)

About Andrew Penn, NP

Andrew Penn, NP was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. He has completed extensive training in Psychedelic-Assisted Psychotherapy at the California Institute for Integral Studies and recently published a book chapter on this modality. A leading voice for nurses in psychedelic therapy, he is a cofounder of OPENurses, a professional organization for nurses interested in psychedelic research and practice and was a study therapist in the MAPS-sponsored Phase 3 study of MDMA-assisted psychotherapy for PTSD and is a Co-I in the Phase 2 Usona sponsored study of psilocybin-facilitated therapy for major depression. Additionally, he is a co-author in a recent article in the American Journal of Nursing on psychedelic assisted therapies, the first in 57 years. He is the Co-chair for Sana Symposium, a leading national CME meeting on psychedelic therapies.

Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing and is an Attending Nurse Practitioner at the San Francisco Veterans Administration. He has expertise in psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. As a steering committee member for Psych Congress, he has been invited to present internationally on improving medication adherence, cannabis pharmacology, psychedelic-assisted psychotherapy, grief psychotherapy, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice. He also keeps regular blogs on all things psychiatric and has been interviewed in Forbes, the Los Angeles Times, and on the BBC World Service.


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PT284 – Jonathan Sabbagh – Ketamine-Assisted Psychotherapy and Collaborative Care

In this episode of the podcast, Joe interviews co-founder and CEO of Journey Clinical, Jonathan Sabbagh.

Journey Clinical is a telehealth platform specializing in remote and in-person ketamine-assisted psychotherapy, but what makes them a bit unique is their larger focus on the needs of the psychotherapist, by helping approved psychotherapists integrate KAP into their practices, and by building out a platform to facilitate the delivery of customized treatments of all modalities to their patients under the same umbrella – the idea being that more specialized treatments can lead to more patient progress and less therapist burnout, which is a bigger problem than many people realize. 

Sabbagh tells the story of his own burnout after 20 years in finance, which led to ayahuasca and a career change, and discusses data privacy; why ketamine is just an adjunct; how Journey’s process works; the importance of building a safe container (in therapy and digitally); wearables and the future of combined tools; what he’s most excited about; what it meant to see his company’s banner hanging at Horizons; and why it’s important to have a growing industry be led by true believers. 

Notable Quotes

“I think people don’t talk about this enough – about the impact of being with patients who are stuck and who are not progressing in their therapy for years – and that’s really a big driver of therapist burnout. And we’ve had people work with patients who were stuck, really stagnant in their progress, have a few ketamine sessions and have major breakthroughs at a reasonably low dose, and say, ‘Wow, this person has never been so open, this has changed the psychotherapy.’ And that really re-energizes them and I think that is just really wonderful.”

“People are looking for ways to feel better, mental health isn’t taboo anymore. And so I think that as we progress, we’ve got technology, psychedelics, there’s a lot of work being pushed forward, openness to mindfulness-based practices; and I think they’re all going to support each other.”

“I think one of the beauties of the stage where we’re at in our industry (and also the nature of our industry) is that it’s still believers that are building it out. And so we’re all figuring ourselves out a little bit but we care about doing this. We’ve got a personal stake and personal experience into it and I think that’s true for the majority of people involved.”

Links

Journeyclinical.com

Instagram: @journeyclinical

Twitter: @JourneyClinical

Linkedin

ChooseMuse.com

Headspace.com

NPR.org: New York City allows the nation’s 1st supervised consumption sites for illegal drugs

AwaknLifeSciences.com

Nushama.com

Horizons.nyc

About Jonathan Sabbagh

Jonathan Sabbagh the co-founder and CEO of Journey Clinical. He spent the first 20 years of his professional career working in finance, where he occupied a variety of roles including building two businesses from the ground up. While building one of them, he suffered a burnout that was the result of undiagnosed post-traumatic stress disorder. After being heavily medicated, suffering from substance abuse issues, and undergoing a lot of psychotherapy, Jonathan finally found relief in a series of traditional ayahuasca ceremonies and ketamine-assisted psychotherapy; experiences where he discovered he needed to lead a more integrated life and to be in service to others. He quit finance and went back to school to study clinical psychology. While he was on his path to becoming a clinician, he felt the need to integrate his background as an entrepreneur with his long-term goal of becoming a psychedelic therapist in order to expand access to psychedelic-assisted psychotherapy. This is the genesis of how Journey Clinical was born.


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PT283 – Greg McKee – Nociplastic Pain and Psychedelics

In this episode of the podcast, Joe interviews Chairman and Chief Executive Officer of Tryp Therapeutics, Greg McKee. 

Tryp Therapeutics, a fairly young, early-stage biotech company, is focusing on nociplastic pain (the hard-to-explain pain where nothing seems physiologically wrong, but a nerve signal related to pain seems to be stuck in the “on” position) and how it could be alleviated through the rewiring often possible in the psychedelic experience. They are first looking at psychedelics for chronic pain and eating disorders, and when this podcast was recorded, had just received FDA clearance to begin a fibromyalgia study at the University of Michigan (with studies on phantom limb pain, complex regional pain syndrome, binge eating disorder, and hypothalamic obesity likely coming after). They are also working on a psilocybin derivative-based novel compound and novel route of administration/protocol, possibly with the ability to stop a difficult trip when necessary.

McKee discusses the origins of Tryp, the benefits of using synthetics, 5-MeO-DMT, how the Nixon administration killed research progress, the positives to take away from Compass Pathways’ preliminary psilocybin Phase 2B trial results, MAPS and possible insurance models, Robin Carhart-Harris, why a lot of early psychedelic investors may be mistakenly panicking, and the idea of insurance covering the treatment of a patient for a period of time rather than number of visits. 

Notable Quotes

“We think that there’s a huge opportunity to unleash the full potential of psychedelics, well beyond traditional mood disorders.”

“It’s a fascinating field, no doubt. There’s a lot to be learned and there’s still a lot more questions, frankly, than answers. That’s the thing that’s really quite surprising. I mean, I’ve been on a learning curve [and] I got right to the edge fast, because I realized, ‘Oh shit, nobody has the answers to these questions.’” 

“The thing about synthetic is that it just allows you not only to have consistency and all that that we just [talked] about, but it allows you to scale so you can impact so many other people’s lives. So it is a little bit of a pain in the backside to go through this process, and I can totally get why certain people are saying, ‘Hey, why do we need the pharma industry to do this?’, but on the other hand, if life science investors and biotech and pharma companies do get involved and push this through to market; boy, you’re going to be able to treat so many more patients.”

Links

Tryptherapeutics.com

Tryp Therapeutics Linkedin

Twitter: @TrypTherapeutic

YouTube: Stanislav Grof: Psychedelics and the Future of Humanity, from Psychedelic Science 2017

Psychedelics Today shop: Save a Toad Short-Sleeve Unisex T-Shirt (it’s “exploit a chemist,” not “squeeze,” Joe)

Chasing the Scream: The First and Last Days of the War on Drugs, by Johann Hari

University of Michigan: Chronic Pain & Fatigue Research Center (where Dr. Dan Clauw works)

Compasspathways.com: COMPASS Pathways announces positive topline results from groundbreaking phase IIb trial of investigational COMP360 psilocybin therapy for treatment-resistant depression

Gwpharm.com

Epidiolex.com

Psychedelics Today: PT245 – Robin Carhart-Harris – Psychedelics, Entropy, and Plasticity

About Greg McKee

Greg McKee serves as Chairman and Chief Executive Officer of Tryp Therapeutics. Greg has served in executive management positions for more than 20 years. He started his career in life sciences with Genzyme before serving as Chairman and CEO of publicly traded Nventa Biopharmaceuticals. Greg also served as CEO of CONNECT, a startup accelerator, and as Co-founder and Managing Director of Torrent Ventures. Greg earned a BA in economics from the University of Washington, an MA in international studies from the University of Pennsylvania, and an MBA from the Wharton School. He has worked in Tokyo for seven years and has been a member of YPO since 2006.


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