“Focusing on the well-being and resilience of caregivers will have a compounding effect and reap dividends for public health, not only because of improved productivity and quality of care but also because of the diffusion of coping strategies such as physical activity, mindfulness, and healthy eating from caregiver to patient.”
The above conclusion to my Forbes article, “Why We Should Care for our Caregivers,” resonates more deeply today than when I wrote it four years ago. Since then the COVID pandemic has exacerbated the issue of burnout and moral injury among healthcare professionals. The 2023 Medscape US Physician Burnout and Depression report surveyed 9,100 clinicians and found that 53% report being burned out, which is up from 44% in 2019 and 39% in 2013. Nearly one in four physicians (23%) report being depressed. More broadly, 90% of US adults believe we’re in a mental health crisis with one-third reporting symptoms of depression or anxiety disorder.
Apart from the coping strategies I shared in that 2019 article, there is another potential intervention for addressing the mental health crisis that has dramatically (re)captured the public’s attention in recent years: psychedelics.
The broad interest in psychedelic-assisted therapy (PAT) has in part been catalyzed by the 2018 publication of the best-selling book by Michael Pollan, “How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence” which has since been adapted into an eponymous 2022 Netflix docuseries. There are now over 245 studies in the US alone assessing the use of psychedelics such as psilocybin, LSD, and ibogaine, as well as related medicines such as MDMA and ketamine, for conditions ranging from severe post-traumatic stress disorder and opioid use disorder to Lyme and Alzheimer Diseases.
One of the main reasons I’ve returned to medical school at Johns Hopkins is to learn from the pioneering scientists and clinicians at the Center for Psychedelic and Consciousness Research (CPCR) who helped reawaken the scientific community to the promise of psychedelics for – among many other indications – overcoming smoking and other substance use disorders, reducing depression and anxiety in cancer patients, and promoting human flourishing. The Director of the CPCR, Frederick Barrett PhD, told me that he is “inspired and motivated by the great deal of interest and support that has evolved for the potential of psychedelic therapies in both public and private sectors.”
On my podcast, Raise the Line, a key theme we have been exploring is how to help current and future clinicians thrive by addressing moral injury and burnout. Given the promise of psychedelic-assisted therapy for this and other issues, I’ve interviewed dozens of researchers, healthcare providers, and leaders ranging from Drs. Bill & Brian Richards at Sunstone Therapies to Dr. Rick Doblin at the Multidisciplinary Association for Psychedelic Studies (MAPS), which successfully completed two Phase 3 clinical trials with MDMA-assisted therapy for severe PTSD and organized the recent Psychedelic Science 2023 (PS23) conference in late June in Denver, Colorado.
More than 11,000 attendees ranging from indigenous shamans to world-renowned scientists attended PS23, which may best be described as “Society for Neuroscience meets Burning Man.” Indeed, keynote speakers included the National Institutes for Mental Health (NIMH) Director Dr. Joshua Gordon as well as the CEO of the Burning Man Project Marian Goodell, and featured over 450 sessions with titles as diverse as “Molecular and neuronal responses to psychedelic-induced plasticity” and “Channeling Plant Wisdom in an Afro-future, An Interspecies Galactic Council.”
Rick Doblin, the founder of MAPS, gives the opening address to thousands of people at PS23
While there were too many learnings to share in one post from the week-long conference, below are several key themes and perspectives gleaned from dozens of interviews and presentations. Dr. Manish Agrawal, an oncologist and CEO and co-founder of Sunstone Therapies, perhaps summarized it best: “Psychedelic Science 2023 helped people realize that this treatment is now real; we’re not just talking about it anymore: if we get this right, a lot of patients could benefit from these medicines. But we have to get this right – with approved, widely-accessible therapies delivered in gold-standard clinics.”
Balanced Enthusiasm
“While there was a great deal of breathless enthusiasm, I was glad to see a number of scientific presentations mention the reality of challenging experiences, adverse events, and instances of abuse,” said David B. Yaden, PhD, the Roland R. Griffiths, PhD, Professor in Psychedelic Research on Secular Spirituality and Well-Being at Johns Hopkins. “I remain cautiously optimistic about the therapeutic and well-being related potential of psychedelic experiences, especially when risks and benefits are communicated in a transparent and evidence-based manner.”
We’re on the cusp of something transformational in the world of psychedelic research. There’s a palpable buzz, with both the healthcare system and Wall Street tuning in. However, this promising frontier demands a balanced approach. As much as we’re tempted to ride the wave of excitement, it’s essential to anchor our progress in rigorous science. Our drive should be fueled by both optimism and evidence, ensuring we’re building the future of psychedelic medicine on a bedrock of genuine results.
“The danger here is that in the absence of scientific data, financial investment and policy decisions are being made on the basis of hype, celebrity endorsement, and political activism,” said Rachel Yehuda, PhD, the Director of the center for Psychedelic Psychotherapy and Trauma Research at the Icahn School of Medicine at Mount Sinai. “Anecdotes are not data since they favor good outcomes and potentially suppress less favorable outcomes. While the enthusiasm and chance for new tools is intoxicating, the sober voice of science really needs to prevail.”
Diversity and Unity
“I appreciate the broad interest in the medical potential of psychedelic medicine across the political spectrum. One of my takeaways is that many different factions were represented, many of which don’t share the same goals,” said Matthew W. Johnson, PhD, the Susan Hill Ward Professor of Psychedelics & Consciousness Research at Johns Hopkins. “In fact I question whether the term “psychedelic community” even makes sense because there is so little in common other than some type of interest in psychedelics. My hope is that people can show good faith, respect and empathy toward others even if goals don’t align. There seems to be dwindling good faith in the world, and the psychedelic domain is no exception.”
The psychedelic landscape is vast and diverse, encompassing practitioners, healthcare professionals, academics, entrepreneurs, policy-makers, patients, and a myriad of other stakeholders. Each brings their unique perspective, background, and ambition to the table. Despite these differences, there’s an underlying shared purpose that binds them together. It’s this balance between individuality and collective unity that gives the field its strength and potential. Embracing both the nuances and shared objectives will be the key to the field’s continued growth and success.
Incorporation into Society
“Real-world understanding of clinical effectiveness, adequate insurance coverage, and administrative burden placed on clinicians from new regulations are potential challenges for new psychedelic treatments,” said Lucia Huang, the co-founder and CEO of Osmind. “PS23 highlighted the excitement and opportunity that psychedelic medicine holds to transform mental health care and unite multiple fields across medicine. However, many of the conversations also highlighted the potential challenges to driving widespread access and evidence-based practice within the existing framework of our American healthcare system.”
Psychedelics are undergoing an image makeover. From being symbols of rebellious counterculture, they’re now tiptoeing into the medical limelight with MDMA and psilocybin expected to be FDA-approved in the near future. But this transition isn’t just about science—it’s about societal acceptance. As we decipher their therapeutic potential, we need to ponder their place in the wider healthcare fabric including how to provide access to the groups who most need them.
“One of the biggest takeaways is that not only is there a real path for MAPS MDMA program to achieve FDA approval but now the investor community sees a potential path to successful commercialization,” said Dina Burkitbayeva, the Co-founder and CEO of Freedom Biosciences. “The psychedelic therapeutics space is at an inflection point: while there is already strong evidence for therapeutic outcomes, the larger investor and big pharma communities are still questioning whether there is a potential for commercial viability based on big pharma standards.”
Tradition Meets Modernity
“The conference felt like a poignant coming-of-age moment for psychedelics in the Western world: a blend of enthusiasm, celebration, and anticipation for the impending transition to mainstream acceptance, punctuated by an undercurrent of concern, questioning our true preparedness for this significant shift,” said Jeeshan Chowdhury, MD, PhD the Founder & CEO of Journey Colab. “I was deeply moved by the cautionary insights shared by members of the Indigenous community, adding an element of sobering dichotomy to the experience. Their voices, I believe, serve as a crucial warning. It’s imperative that we include and respect their perspectives – they are the rightful critics in this context.”
There’s nothing ‘new’ about the allure of psychedelics. For millennia, indigenous societies have turned to these substances for insights and healing. As we propel ourselves into the future of psychedelic research, it’s worth pausing and drawing from this age-old wisdom. Integrating traditional knowledge with cutting-edge science may be the recipe for success.
Evidence and Public Perception
“There is so much enthusiasm in the field, but it is also essential to recognize that not everyone has the same assumptions, knowledge, or feelings about psychedelics,” said Imran Khan, the Executive Director of the UC Berkeley Center for the Science of Psychedelics. “For example, [according to our recent poll] over half of voters (52%) have a first-degree connection (use by themselves or someone close to them) to psychedelics, and 47% have heard something about psychedelics recently. The poll also found strong support for policy reforms for psychedelics, including 61% of voters supporting legalizing regulated therapeutic access to psychedelics. However, nearly half of the voters (47%) who support therapeutic access also believe psychedelics are not ‘good for society.’ What do we know about where the public stands on psychedelics? We hope to fill this knowledge gap with data and ensure the field can use our research to cut through hype, stigma, and assumption using these evidence-based insights.”
Outside of certain bubbles, perceptions about psychedelics are, at best, mixed. While some see promise, others harbor skepticism. It’s our duty to craft the narrative with a careful mix of hope and hard evidence. By debunking myths and providing a clear-eyed view, we can move the conversation from the fringes to the mainstream.
Future Challenges and Hopes
“The talk given by Dr. Roland Griffiths (who is suffering from Stage 4 colon cancer and one couldn’t help get the sense that this may be his last major address) was the most elegant reminder of why we were all at the conference: to honor the science and understanding of these compounds, to appreciate the beauty and brevity of this life, to remind of the mystery of it all, and to reconnect with the humanity all around us,” said Ronan Levy, the co-founder of The Non-Ordinary Therapy Company. “In many ways, that is exactly what psychedelics remind us to do. And in that sense, there is no shortage of opportunities in this emerging space.”
As we look ahead in psychedelic research, we see both challenges and opportunities. It’s important to move forward carefully and not rush things, especially when it comes to safety. If we do it right, we could change the way we treat mental illness, promote human flourishing, and – perhaps – understand consciousness itself.