The Promise and Peril of the New Psychedelic Era - Dr. Matthew Johnson, Professor in Psychedelics and Consciousness at Johns Hopkins University

Shiv Gaglani: Hi, I'm Shiv Gaglani, and today I'm really happy to welcome one of the scientists responsible for the renaissance in psychedelic research that we've been exploring recently on the Raise the Linepodcast. Here are just a few of Dr. Matthew Johnson's contributions to the field:  he's one of the world's most published scientists on the human effects of psychedelics;  he helped establish psychedelic safety guidelines; he published the first research on psychedelic treatment of tobacco addiction in 2014; he received the first grant from the US government in over half a century to directly study therapeutics of a classic psychedelic; and he is a co-founder and president of the International Society for Research in Psychedelics. 

Dr. Johnson is also a professor in Psychedelics and Consciousness and Psychiatry and Behavioral Sciences at Johns Hopkins University, and has conducted widely cited research in behavioral economics, behavioral pharmacology, and behavior analysis. Areas of focus include the decision-making underlying addiction and the effects of drugs on sexual risk behavior. 

You may already be familiar with him because Dr. Johnson has established himself as a go-to resource for journalists at major outlets such as the New York Times, Washington Post, and 60 Minutes, and you may have also seen him on Big Think, the Andrew Huberman podcast, and the Lex Friedman podcast.

So, Matt, thanks for taking the time to be with us today.

Dr. Matthew Johnson: Thanks Shiv. Pleasure to be with you. One thing I'll update is I'm a former president of the International Society for Research in Psychedelics.

Shiv: You already were doing so much, so I'm glad to hear there's one less thing completely on your plate. So, we always like to start with just getting your background. What got you interested in psychiatry and behavioral pharmacology, and then ultimately psychedelics?

Dr. Johnson: Well, I'm a psychologist, so what got me interested in psychology is really wanting to understand what drives human behavior. To me, these are interesting questions... the ability to apply a natural scientific understanding to understanding behavior. I was really attracted to the work of, when I was in college, of B.F. Skinner. I was a former engineering major and took a leap out of that because I didn't really see that path as being one that led me in a direction that I really wanted to go into. 

So, the idea that one could understand behavior from a truly scientific perspective, and then the idea that one could bring those tools to bear on helping people and addressing the many problems that are behaviorally mediated -- which is essentially all of the problems individually and planetarily -- I was really attracted to.

And then the interest in psychedelics were a subset of my broader interest in psychoactive substances that interface with that interest in behavioral science. The idea that these compounds -- anything from caffeine to alcohol to the illicit substances, including psychedelics -- could have such a profound effect on behavior, on the mind, if you will. And so, yeah, those were sort of the seeds that led to my interests.

Shiv: Yeah, and I'm glad you talk a bit more about how behavior does result in pretty much all the problems and all the solutions, ultimately. I went to med school at Hopkins initially to be a surgeon, but changed my course because I met a Stage 4 cancer patient who had been smoking for decades, many pack years of smoking. And the financial and emotional cost to him and his family to treat this cancer that may have been prevented had he been able to intervene behaviorally through education, counseling, et cetera -- maybe psychedelics -- got me really more interested in primary care, psychiatry, and ultimately now psychedelics, too. So, that was first how I heard about your work, is the landmark smoking cessation work. Can you take us back to the origins of your work on that and for our audience that may not be familiar with it, some of the highlights of the work around smoking cessation?

Dr. Johnson: I have been very interested for a long time, dating back to my undergraduate years, about the history of research with psychedelics. There was a sort of initial heyday from the late fifties to the early seventies before the rug was pulled out for a lot of reasons including the association with the counterculture and some very real casualties from reckless use by a lot of people. That said, there are a lot of people with credible claims of it having profoundly benefited their life, but it's complex as most things that are powerful are. And in part of that history, I was very interested -- consistent with my interest in psychoactive drugs and their effect on the mind and behavior -- in that older research on alcoholism being treated by LSD. There was also a little bit of research on treating opioid addiction with LSD, and then there's all these anecdotes of people quitting all sorts of different substances.

I had had a history going back to very early grad school conducting research on nicotine and tobacco from various perspectives, and I've done all kinds of work in the years since with nicotine and tobacco: basic behavioral economic analyses; looking at the role of nicotine and the tobacco reinforcement; really what motivates and drives continued behavior; treatment questions; and the interactions with other substances, even substances like cocaine and caffeine. So, nicotine and tobacco were in my wheelhouse as a scientist.

And the emerging picture that I was seeing with psychedelics and addiction was a very different one from other forms of addiction treatment -- certainly very different than typical addiction medication, anti-addiction medication -- in the sense that it seemed like we were dealing with a generalized anti-addiction potential efficacy with psychedelics that transcended the particular substance of abuse that was the source of the addiction. With most addiction medication, the effects are typically relatively specific to that particular substance. In other words, you're treating tobacco use with nicotine replacement therapy, either patch, gum, lozenge, etc., even e-cigarettes, really broadly defined as essentially substitutes... ways to quell the reinforcement, withdrawal, craving effects by stimulating or interacting with that primary receptor mediating the effects of the substance of concern, but in a way that's less harmful to the person. It’s the exact same story with any other so-called agonist or substitute treatment, including methadone and buprenorphine for opioid addiction.

It really looked from the scattering of older research and, really rounding that out, the complement of stories that were just anecdotes at that point, that when people recovered, it sounded more like good psychotherapy or a twelve-step program in the sense that, you know, this is not about just sort of quelling the response to that drug of abuse and addressing it that way. You can put it in many different ways, but it's about the narrative of your life. It's about what's meaningful to you, these big picture decisions about what is life about, people finding themselves going down the primrose path. They never would have wanted a priori to be spending so much of their time, their money, taking the health risks, etc., dedicated to using whatever the particular, substance is.

So, big picture insights and successful treatment with these methods... therapy, twelve-step, things like that. And I should say, most people that recover from virtually any substance don't get any formal treatment of any of these types. But more consistent with those stories, too, where someone just comes to a point in their life and they, in one way or another, say, “I'm done. This does not fit with me anymore.” Usually there's a narrative there. It's something about this big picture stuff. It's not that you can describe it through humanistic or humanistic

psychology terms -- spiritual terms, if you will -- about the big picture of your life and what is meaningful in life. What is life about? But the way I would put it as a behavioral psychologist, is it's about your behavioral economy, the degree to which one reinforcer in life has hijacked things such that other aspects of your life you recognize are suffering. It's complete.

There's a narrowing of this behavioral -- which in my view includes the mental -- but this narrowing of the behavioral and mental repertoire in a suboptimal way. 

So, the picture to me was that these stories of people overcoming addiction with psychedelics sound more like that stuff, you know, successful psychotherapy or successful twelve-step or just successful coming of age... getting to that point in your life and deciding enough is enough and taking some big picture changes in your life. It’s that ‘why not?’ Why not smoking? There were a few questions I had about some of the narratives with addiction recovery, particularly when we're talking about very intoxicating substances like alcohol and opioids that typically have more life disruption than something like, you know, tobacco addiction. Very rarely does someone ruin their marriage or have their kids estranged from them or ruin their job or their career because of cigarette addiction. But, although it’s not necessarily typical, it's certainly more common with these other more intoxicating substances. 

So, there is some question like, is this psychedelic recovery dependent on a rock bottom

effect? In fact, the very early researchers in Saskatchewan, Canada, doing work with LSD and alcoholism, that was their model: when do a lot of people get better with alcoholism? It's when they get the DTs and they nearly die and then they sober up because they're scared to death because they've hit rock bottom. Some huge portion, something like a quarter, I believe, of folks at the time that had some full-scale DTs ended up dying. And so their thought was, is there a way we can instigate this type of dramatic, scared straight effect without killing someone? And here's this newfangled drug, LSD, that in the prevailing model at the time

temporarily makes people feel like they're psychotic, but it's freakishly safe at the physiological level. There are some risks for some particularly vulnerable populations -- and we can talk about that later if you want -- but for most people that aren't suffering from, let's say, severe heart disease, there's no known lethal overdose. 

Now, people can die from, you know, being intoxicated and wandering into traffic, et cetera. But it doesn't kill your liver, doesn't make you stop breathing, doesn't give you a stroke, you know, hard track the way that if you lethally overdose on most substances, it's one of those types of ways. It doesn't have those effects. So it's like, can we model those DTs? And so there's a little bit of a question that since people don't have rock bottom effects on tobacco, will this really work? So, there's some curiosity there. 

But I also went through and scoured websites like Blue Light and Erowid for stories. And lo and behold, even though no one had really ever made a thing out of this, there's these little trip reports out there -- sprinkled in amongst millions of reports -- that said, “I took a big dose of acid or mushrooms and I just quit smoking and this was like a month ago or a year ago or five years ago or more.” And then I got interested. I started asking stories of people and I remember meeting someone actually at Burning Man in 2005 that said he quit smoking. It was something like 40 years ago on a big therapeutic LSD trip for something else. He wasn't taking it therapeutically to quit smoking. So, all of that together, just, you know, I thought, hey, let's test this. It was interesting. If it worked, it kind of would complement the older science. It would be consistent with this idea that there's this very general anti-addiction advocacy, which would be exciting. It would be somewhat of a test of whether it only worked with drugs that typically come with a rock bottom effect, as I described.

And then, you know, smoking is a great model system of addiction. Basically, because it's a regulated commercial product, everyone knows how many cigarettes you smoke a day -- whether they buy a pack once every day or once every two days or three days or once a week. This is a big advantage compared to alcohol, which I was considering getting into. There's a big advantage with smoking that there are multiple ways to pretty cheaply biologically verify with a pretty accurate time course. With alcohol, if you want anywhere close to that type of accuracy, you have to get people to wear essentially a SCRAM bracelet, like basically a prison bracelet, around your ankle or something, or do hair analyses which can tell you something about whether someone's used a substance over the last several months. But there's essentially no temporal resolution around it. So, there's a lot of methodological scientific advantages as a model system of addiction to look at tobacco. 

But then you step back and also it's like, oh, yeah, it's a good model system of addiction, but it's kind of a problem in itself. I mean, just to take one metric, the number of deaths: it absolutely wipes the floor with everything else in the U.S. We're talking about almost a half million people a year that die from smoking, with about 69% of adults in the U.S. who smoke wanting to quit. And that that number of a half million a year is orders of magnitude beyond most other substances. It's four times the number of people that die from alcohol. If you plot these things on the same figure on a linear scale, all of the illicit substances put together are barely visible on the same graph when you compare it to alcohol and then tobacco deaths.

So, besides being a good model system of addiction, it's kind of important in itself. It's like if we could bring this to bear to help a small percentage of those people, I mean, it would be huge.

Shiv: Absolutely. That's super compelling. I appreciate your thought processes, you know, which is useful for our audience, because many of them are early-stage researchers and health care professionals and as they decide what paths to follow -- what diseases to focus on, et cetera -- hearing your thought processes is helpful for them and many of them probably are interested in this problem of smoking cessation. 

To add to the death toll you were mentioning, I pulled up the CDC data, which as of 2018 -- which is the latest I could see -- cigarette smoking costs the US over 600 billion dollars. So, 240 billion in health care spending; 185 billion in lost productivity from smoking related illnesses -- COPD, asthma, lung cancer -- and then 180 billion in lost productivity from smoking-related premature death. So, yeah, it would be huge if this could be effective for that. You're one pioneering a lot of that research, so what did you find? Like what have you found as far as how efficacious the psilocybin trials were or other psychedelic trials were, relative to the patch or other interventions for smoking cessation?

Dr. Johnson: So, the pilot study we published had fifteen people. It was a non-randomized, small pilot study and, you know, we wanted to test the waters. Unless I saw a good signal with a small sample like that one, I couldn't hustle up more money for further study. So, that pragmatically limited things. But also, I wouldn't have wanted to spend the time with a very large, randomized trial unless I thought there was a potential signal there. You might try it in ten, fifteen people and it's a complete flop. And so, yeah, test the waters, but it looked really promising. 

So all of that said, that size of study would not produce the results that prove anything about the drug itself. You could only show whether it's worthy of continued research. So, 80% of people at six months after their quit date were biologically confirmed as free from nicotine -- with both urine, cotinine and breath carbon monoxide, two of those biological metrics I mentioned --and self-reported abstinence. And that held up with a very long-term follow up of two and a half years, which is well beyond what most studies probe. 

Our initial results were so interesting that we actually applied to the Institutional Review Board to invite people back to do another biologically confirmed assessment. On average, it was two and a half years after their quit date and that was 60% percent of people. Those are just, you know, insanely high numbers for the field. Again, with the caveat that this isn't a randomized study compared to these other things, the best medication that's ever been looked at in the field is varenicline, which people may know by the brand name Chantix. Those studies vary from the mid-20s to mid-30s in terms of efficacy, maybe close to 40% at six months compared to our 80 percent in terms of point prevalence abstinence. So, if that question is, is this worthy of follow up, the answer was absolutely. 

We recently conducted the final session for the six-month data on the second trial, which is a randomized trial. It was a comparative efficacy trial, randomizing over eighty treatment resistant smokers to either nicotine patch treatment or the psilocybin intervention. In this case, just one psilocybin session. The initial study was three psilocybin sessions, but there are some reasons why we scaled it down to one. These aren't official results yet. The most recent analysis that I have to report today is based on a peek I took at sixty-one patients. It's not a blinded study, so I can still speak to the results without taking a statistical hit. I really have to emphasize that the only results that count are the ones at the end, but the last stab at sixty-one people with about 30 in each group, the results were -- depending on how you how you count it -- in the 50 percent range at one year follow up. For example, 52% in the in the psilocybin group compared to 27% in the nicotine patch group at one year, which is certainly on the upper side of what you get when you look at the results across the literature for nicotine replacement, including nicotine patch one year out. Twenty seven percent is very good. And so that's very encouraging.

Stay tuned because we'll be submitting our results of that trial relatively soon with the final results, which looks like a sample of 82 people. A little bit earlier we used this data to apply for a National Institute on Drug Abuse grant. Long story, but eventually got it. So, we have that funding. We've had some logistical problems in starting the study, getting a hold of the medication and some legal issues. But we're close to starting that trial. That's going to be a blinded trial with University of Alabama, Birmingham and New York University as other sites in the study. That's where we're at now. 

The study we're finishing up is a comparative efficacy study. As I mentioned, there wasn't blinding. I really wanted that as the next step, because as someone who's been in the field for years -- and I've personally been in dozens of psychedelic sessions -- you really are modeling something weird with double blind studies with psychedelics. I'm not saying it shouldn't be done. There's no such thing as the perfect experiment. There's always pluses and minuses to any particular design. The real overall results come from a human being looking at those different studies and sort of triangulating across those results. 

But, you know, you do see these weird things, like you warn the person in a psychedelic study, “This may be one of the most terrifying experiences of your life.” All of these wild things that are just to some degree impossible to fully describe to them may happen. “You may think you're dying, but we'll hold your hand through it.” I mean, it's a clinical vulnerability that really rivals perhaps anything else in medicine. I mean, certainly going under surgery, there's complete trust. It's like, yeah, I'm trusting these people to cut me open, but at least I'm unconscious during that time. 

You know, I've had multiple vets in psychedelic sessions. They've experienced combat and have said this has replaced that as being the most intense experience of their life. I mean, it's hard to overstate how seriously people describe this experience. And so, when you set that scenario up and then, on a particular placebo-controlled trial, you might be guessing that an hour into the session I haven't felt anything. I don't know. You know, you're modeling something that is very bizarre, as you could imagine, like people are really, really worked up and then nothing happens. You're modeling something that's never going to happen, basically, and straight up

clinical. And I could tell you it's really, really weird. 

Again, I'm not saying we shouldn't do placebo-controlled trials, but it needs to be complemented by that imperative efficacy study, which basically means that's the way you treat a new psychotherapy where blinding is impossible. We have tons of evidence and we know a lot about mental health treatment through psychotherapies. I mean, some of our most effective treatments of mental health are, I would say, psychotherapy, such as the treatment of anxiety disorders and phobias through systematic desensitization and prolonged exposure therapy. It’s very effective. None of that's been done under blinded conditions because it's not possible.

You take someone who has the disorder, they're willing to do one of the multiple treatments, the two different treatments, you randomize them and you follow the results. And yes, some or all of it, you know, could have been driven by placebo effect. But, hopefully in other studies, you can determine whether it's all driven by placebo effect. I mean, we do know with psychedelics that the subjective experience is not just placebo effect. Some really dramatic things happen biologically that account for the very altered state of awareness during psychedelics. What we don't know, for example, is how much expectancy is driving those ultimate therapeutic response results with decreases in depression or addictive behavior. 

So, that's where we're at now with the smoking cessation work. And so we'll have to wait for the final results of that current randomized comparative efficacy study and then those results from the newer soon to start double blind multi-site trial.

Shiv: That's fascinating. I'm really excited to read those papers when they come out. And thanks for the preview. I like your analogy to surgery because actually just last week at the Psychedelic Science Conference in Denver, which I'll ask you about in a second, I met the co-founder of Journey Colab, which is working with rehab centers. His name is Jeeshan Chowdhury. We've covered a lot on AI on this podcast and his executive board member, Sam Altman, is the CEO of OpenAI. There's a very interesting intersection between AI and psychedelics. We can talk about it a bit, too. 

But Jeeshan talks about rather than calling it psychedelic-assisted therapy, maybe calling it psychedelic surgery or something like that that speaks to how serious this can be and puts health care providers and patients in the mindset of there's a pre-op, there's the operative and there's post-op. There's often an acute hospital stay after surgery. In psychedelic-assisted therapy there is real follow up, too, like the integration period that people talk about. So, I like your surgery analogy there. 

You can respond to that, but also talk about P.S. 2023. I assume you were there. What were your takeaways from it? And if you can prognosticate about the next year or couple of years, what are you most excited about or worried about when it comes to psychedelic assisted therapy?

Dr. Johnson: It was a really fascinating meeting. There's exciting things. There's a lot of good friends and colleagues that have been in this field, so it's good to catch up with folks. What a demonstration that the field has expanded and it's coming with all kinds of things as it expands. Especially when you're talking about a powerful tool, things are getting complicated, and there's going to be good and bad. One of the critiques is about this “new religion” component. I actually read a really good article, in part drawing from the meeting, by Jules Evans, about that.  

I've been really concerned about that because I see even within the deepest layers of science, it’s very difficult to trust people with this with magnitude of effect in people. I still have my hopes and my bets on the idea that there's going to be more good than bad, but it's going to get really ugly. I mean, there's going to be cults. There already are. There's this bizarre hero worship of scientists and some of them are... let's just say some of them embrace that role and really kind of want to play the guru as if they have the mystical secrets to everything. I can tell you, people can get really unbalanced and I think there's going to be a lot of harm.

I think we saw threads of that the meeting and some concern about the new religion kind of aspects of this. It's hard to overstate the magnitude with which many people describe these experiences. That's just a very difficult thing to hold in a responsible way and at

the same time, the field is really exploding in popularity. I tell you what, anyone who thinks that people who have used psychedelics or have an interest in psychedelics and have learned about psychedelics are somehow more moral and ethical people...well, I've been in this field for about twenty years. There's a lot of hatred. There's a lot of all the ugly stuff. Everyone is like grabbing for their piece of this. There's people protesting things where you're not even clear about what's being protested. You just get the sense that there's these deeply seated grievances, more about the state of the world. There's people with very strong, anti-capitalist feelings and that when the private companies started coming in, it's like psychedelic medicine has become a target.

I take a balanced perspective. Yes, when the profit motive comes in, it opens a relatively increased concern about those particular perverse contingencies, and that's to be taken account of. But, you know, every communist revolution I've been aware of has been an abysmal failure, to say the least, with, you know, the death toll in the dozens, if not hundreds of millions. Every medical intervention that me and any family member have gone through has been in the dirty old for-profit system that somehow has still helped a lot of people. And yes, we’ve got to be aware of those perverse contingencies, but I can also say I've been around nonprofits, including universities, for my entire career and the perverse contingencies may just take a different flavor on average, but there are perverse contingencies everywhere.

I just think people can be blindsided. I often think of the psychedelic bard, if you will, Terrence McKenna -- sort of the Tim Leary of the 90s -- who really emphasized this. He said, look, ‘psychedelics don't make you better people’ and that's a real big problem because people think they become better people. I think he said something like he had just gone through a pretty nasty divorce. He said, you know, ask my ex-wife how ethical and how wonderful of a person I am. Humans are humans, and that's a real issue with this area. 

I went into a lot there. But I do have some very big concerns about where things are headed. Again, I'm still betting it's going to be more good than bad, but compared to five, ten years ago, I'm more pessimistic. I'm more concerned about how ugly this is going to get.

Shiv: Wow. Yeah. Thanks for sharing all that. I agree with a lot of your sentiments as a fairly new person to the space, as an outsider who's talked to a lot of researchers and CEOs of different psychedelic-assisted therapy companies. I agree. Like, I was actually kind of surprised that for medicines that are described as leading to ego dissolution, there's actually quite a bit of ego. I mean, just we're humans. And, you know, people like to be tribal and follow a leader. 

We had a guy on the podcast named Scott Carney, who's based out in Denver. He's a friend now. He's written several great books as a medical anthropologist, including The Wedge, where he describes an MDMA couples therapy session he did with his wife. And his New York Times bestseller was What Doesn't Kill Us, which helped popularize the Wim Hof Method. And Wim Hof -- who's the leading cold ice man, they call him -- Scott actually introduced me to Wim and I met with Wim. I went to his expedition in January in Poland and I was amazed. 

He does not position himself as a guru. He's like, “Hey, anyone can do this. It doesn't require me to do it.” And he said this multiple times. But the natural inclination of the people who attended was to basically deify him. One guy had a tattoo of him on his leg and took a picture of Wim and the tattoo. And whatever he said, it felt very much like a new religion. Hopefully, we can at least check some of those negative impulses, or normal impulses that lead to negative consequences. I think it's a very balanced approach and I'm glad you mentioned that. I think you’re the first person on the podcast who's talked openly about some of those kind of more humanistic impulses we have.

Dr. Johnson: Yeah, and it's very interesting what you say about Wim. I've never met him, and I can't claim to be an expert, but I've spent some time reading and trying the methods. And from what I know of him, from what I've seen, he seems like a guy that tries his best to portray himself as just a regular dude. He tells people, “I drink a Heineken at dinner every night.” He's a regular kind of sounding dude. It doesn't sound like he's going for the guru angle. But despite that, people just, yeah, as you're describing, have that tendency. Because like psychedelics, the framework that he has developed and refined from other traditions is one that can potentially gain access to -- call it what you will -- the transcendent, the spiritual, the mystical and humans are weird in their orientation towards that. 

It's just that religious leaders and others -- whenever anyone is seen as the conduit to the, you name it, god, divine, mysteries of the universe -- there is such a temptation to take advantage of that by that person and for the people surrounding them to conflate that individual with that transcendent reality that they may believe in. Frankly, I think psychedelics are the most extreme. As great as breathing techniques are, when you really compare the stories, as a technology to induce profoundly altered experiences, I mean, I don't think there's anything beyond the psychedelics.

Shiv: Yeah, I agree. I mean, it's in their name, their alternative name, ‘entheogen’ right? As you know better than I do, it helps you tap into the god within. And if some people tap into the god within, they may ultimately believe their god. I think, who was it...maybe Huxley or someone said in Jim Fadiman's book -- we had Jim Fadiman on the podcast a year ago -- The Psychedelic Explorer's Guide, he quoted one of these original researchers who said, if you take a little bit of psychedelics, you may believe you can talk to God; if you take a little bit more, you believe God is talking to you; and if you take a lot more, you don't know the difference between you and God. And so that lends itself to this issue. 

We work with five of the six med schools in Israel, so we have a lot of Israeli medical students who learn by Osmosis. I went to Jerusalem for the first-time last year to visit them, and there were warning signs everywhere that, hey, if you're feeling faint or you suddenly feel like you're Moses, be on the lookout for this because you may get such an impact from the, I guess, the vibe, the energy or expectations of what Jerusalem is that you could eventually succumb to what’s called “Jerusalem syndrome.” Supposedly fifty to 100 people every year succumb to it and it takes a couple of months for them to get out of it. Some of them believe that they're prophets. So, it's something in our psyche. 

You have all these people who, as you said, treat people as prophets or conduits to what, frankly, most people in most cultures say psychedelics should be a way for you directly to communicate with yourself or with your version of spirituality or God. Anyways, there's a lot of interesting stuff there. I'm sure we could talk for a couple hours over that, over some beer or whatever.

I want to be respectful of your time. I only have two other questions for you. The first is, what are you working on now? What do you want our audience to know about you, about your research agenda that you're excited about? And how can they find you and follow up with your work?

Dr. Johnson: I'm taking my research in different directions. I'm certainly continuing with the smoking cessation work. But I've got some approved protocols. There have been some road bumps, but I've got protocols that are FDA approved and IRB approved for LSD to treat people that are misusing opioids to treat chronic pain. I'm really excited about that. One, just kind of doing work with LSD, which is a fascinating compound that hasn't gotten the attention that I think it deserves in this modern research era. As well as addressing anything related to opioid use and certainly chronic pain, obviously are such huge, important topics. If we could find some efficacy there, it could help a lot of people, potentially. There’s another protocol to treat PTSD with psylocibin and one using psilocybin to treat straight up opioid addiction. So I'm excited about all of that. 

I am excited about some of these stories on the more neurological side. There are people, athletes, claiming recovery from cognitive problems due to sports associated head impact.

There's these very interesting anecdotes -- but not just the mood and addiction stuff -- of people saying they feel like their memory and other aspects of cognition have improved because of psychedelics. That could be consistent with some of the neuroplastic findings in animals such as rats. We don't know if those neuroplastic findings are at play with humans. They probably are. We don't know exactly what role they play. 

So, it opens up the potential world of, oh, is there the possibility of helping with stroke recovery? Or kids that are born who have gone through hypoxia ischemia. Are these

potential technologies that could really help repair the brain at what you would call a neurological level, not just the treatment of mental health disorders. So, I think that work is fascinating. I hope to get into that as time continues. 

I'm also just very interested in shining light on some of the topics that I've discussed with you, that big picture stuff about where this is going. It's just going to get so weird. And as someone who obviously believes in the power of this stuff and is not operating in a place where I'm just responding to some of the propaganda...I mean, I've seen hundreds of people go through this for a couple of decades now. I've been in sessions, I've designed studies. I've talked to hundreds at least, maybe thousands of people about their experiences with psychedelics. I feel like I need to spend more time with a focus on helping to navigate how we're going to address those big picture issues. You know, how do you harness what many people believe is a conduit to the sacred, however they define that? And how does that fit into secular medicine? How does that fit into a species where we seem to be primed to look for the new religion, look for the new cult leaders? Hopefully, along with others with the same concerns, I can provide some advice that may be helpful to some people out there to nudge things in a healthier direction to get as much benefit as we can and to minimize -- we're not going to eliminate it -- but to minimize some of these adverse effects. To use a metaphor here in terms of the society, what are the adverse effects for society and how can we minimize those and maximize the positive effects for society?

Shiv: Yeah, it's very nuanced and very exciting and kind of mirrors what's happening with the AI renaissance or revolution right now, too. It's a very powerful man-made technology. Well, obviously, psilocybin is not man-made, but, you know, the studies and the delivery

systems and everything around that are human-made and maybe too powerful sometimes. And now we have this Christopher Nolan movie on Oppenheimer coming out as maybe a reminder of the aspects of the Manhattan Project. It's very interesting, and the next couple of years will be fascinating to see or partake in. 

My last question for you is, is there any advice you want to leave our audience with about approaching their careers, or changing their careers in some cases...just advice you'd give to any mentee of yours?

Dr. Johnson: One of the generic pieces of advice that I think fits into all kinds of niches, no matter what someone's interested in, is if you're looking to be a straight-up clinician -- a physician, psychologist, social worker, nurse, et cetera -- wanting to specialize in psychedelics early in training, just don't forget to first become an expert in that thing you want to interface with. I tell people, if you have an opportunity to do so, work with someone who's really well-established and grounded in their field first. 

Let's say you want to use psychedelics to treat PTSD, and let’s say you're going to grad school as a clinical psychologist or experimental psychologist, and you had the opportunity to work with a new, gung-ho assistant professor who's doing something with psychedelics but is not very established in the field. Maybe you'll learn something about PTSD, or maybe that's not even their main focus. Maybe they don't know anything about PTSD. Contrast that with working with a really established person, maybe a full professor, someone who would put you on a really good track record to being an expert in PTSD. Do that, even if it means putting your professional interest in psychedelics on hold. And that overstating it. It's not putting your interest on hold, it's just in terms of actually being directly involved with psychedelic work. You can still be interested, you can still read the literature and sow those seeds, but become an expert in PTSD, and then you can wait till your postdoc or your residency to move into the psychedelics. 

Sometimes you don't have to make those trade-offs. Like if you could find the best of both worlds and, you know, jump into the psychedelics more immediately, that's great, but that sort of trade-off might show up in more subtle ways. So, really just become the best physician of whatever specialty, and make that your focus, rather than letting psychedelics become the exclusive focus, and putting your interest and your potential to fully develop and be respected in the field, and to have the advantages of developing that expertise in the area you want to combine with psychedelics. I think that's important. 

And then I'd say, you know, just try to take a balanced approach to this stuff. Listen to all the voices, I mean, gosh, there's not many left, but if you meet physicians that were around in the early 70s, late 60s, who know what it's like when the average dose of LSD on the street was 300 micrograms -- way higher than today -- there were some real bad trips, and there still are, it was just more frequent back in those eras.  Try to really find the truth, and there's usually at least a kernel of truth even in some of the concerns that might be blown into propaganda at their most extreme. It is humbling. I mean, these are powerful tools, and try to just be familiar with that.  

I would advise people to really know the history. I became, especially in the early years, very obsessed with the history of this work, reading the classic books. If you're going into psychedelics, you should know what the MK Ultra program was, you need to read Acid Dreams, you need to know about this very real history. Read the classics like Storming Heaven, and there's many others. And then there’s the older scientific literature. People might think they're the first coming upon something, and, I mean, you just read stuff in papers from the 1950s,

it's like, my God, this could be, like, today. On certain things, we haven't figured out anything new. It's very humbling. 

Back in the day people could just be like, ‘we’re doctors’ and in the late 50s they'd be willing to give some LSD to anyone interested in research. There were some issues with that, but it also was an environment where people were trying wild stuff, including very interesting things, and they weren't as constrained. So in a sense, they were at the cutting edge in terms of really just being able to try stuff clinically that we're still not at. I think we'll probably be a little bit back into that once there's approval for MDMA and psilocybin and there’s off-label use. You're probably going to be back in that, to some degree, where there's that clinical experimentation which is going to come with both good and bad. But here I'm talking about the good.  

So, know that history, and remind yourself that this isn't new. I should also say, of course -- it is different, and it's all to be taken in the appropriate context -- but be familiar with the ancient history of indigenous use. Not that we can use that as a direct role model, but it's relevant. Just be as aware as you can about where we came from, where we are now. I love it when I'm writing a paper, and I'm like, “Oh, yeah, there's a paper from 1962 or 1959 that makes this point.” I cite that to remind people, like, yeah, some of this thinking has been around a long time, and just to, you know, delve into that history, because it can really serve you. 

Shiv: That's really great. Both of those are very great advice. I'll just respond really quickly before I let you go, but the first point is one of the guys I met last week was an author. I had read his book before, Brian Muraresku...

Dr. Johnson: Oh, yeah, I know Brian. Great guy. 

Shiv: You know Brian? Yeah, great. The Immortality Key. Excellent book. He talked about the Eleusinian Mysteries, and it's interesting, because kind of the undertone last week at the conference was that, yeah, we could screw it up again, right? Just like the 60s and 70s with Timothy Leary, like, this could go bad and be put underground again. So, a lot of people think about that history, because that's within people's lifetimes. We had Bill Richards on the podcast two weeks ago. It was within his lifetime. He went to Tim Leary's mansion and talked to him and whatever. So, the stories are very interesting. And Jim Fadiman, too, was there. You know, with Ram Dass, he took his first psilocybin experience before going to see Aldous Huxley speak in Copenhagen. It's kind of cool that we're within arm's reach of that still, but the Eleusinian Mysteries, of course, we aren’t. And there's probably hundreds of examples of that emerging, ....you know, birthing, rebirthing, and dying, and so this could happen. This will happen again eventually. It's just a matter of time. 

Dr. Johnson: Yeah, the rug being pulled out...the late 60s wasn't the first time when that happened. In ancient Greece, my take is -- we still don't know definitively -- but my take would be, it seemed more likely than not that there was an ergot derivative, very LSD-like compound at the heart of what was the kykeion, that was at the heart of the Eleusinian Mysteries. If that was the case, then yeah, the church came in, even though it had gone on for hundreds or I think even thousands of years, the rug was pulled out then for centuries. 

Shiv: Yeah, it's Dark Ages. Same thing for a lot of different things, not just psychedelics, but literature, women's rights, I mean, all sorts of things have gone through phases. The second one, this is interesting, when I was in Israel last year, I met in Tel Aviv the founder of Waze, a really cool guy named Yuri Levine, and he just came out with a book this past year called Fall in Love with the Problem, Not the Solution, which I think speaks to your first point, which is psychedelics could be a solution for things, right? They could also be a problem, but right now a lot of people seem to be wanting to enter the field. “I want to do psychedelics so I want to use the solution for whatever problems are out there.” Your take is similar to his, which is the problem is PTSD. There could be ten different interventions for it, psychedelics being one of them. So, fall in love deeply with the problem, understand PTSD deeply, and then, you know, let that guide you on what the solutions may be, as opposed to the other way around of like, “I love this psychedelic solution. I have a hammer, everything's a nail. Let me figure out how to solve everything with psychedelics.” I think just the nuance that you've expressed here is important. 

Dr. Johnson: If the idea is to have a powerful tool to probe the mind, if you want to put it that way, or to probe this interface between experience and the nervous system, it's like, yes, even with that, psychedelics are a tool, but it may lead to other and interact with other tools as ways to explore that interface and address those more basic questions. So, what you're saying is, I think, right on. It's like, focus on the problem and in many cases, psychedelics may be the thing that is the most fruitful way to make forward, but it may not always be, and it may not be the only thing, and it might be interactive. 

We're still in our infancy in terms of how we're using psychedelics. There's virtually zero science on how to conduct different styles of therapy with psychedelics. So that's an example of what you're talking about, like. Rather than all the studies being about psychedelic versus placebo, or this psychedelic versus that psychedelic, what about the same psychedelic therapy with...I don't know, cognitive behavioral therapy versus motivational enhancement therapy? For addiction, for example, there's basically no research at all like that. So, yeah, focus on the problem however you define it. 

Shiv: That's awesome. I think those are inspiring words to end on for our audience, so Matt, I really want to thank you for your time on this podcast and thanks for going over. But also, more importantly, thanks for the work that you've done directly to help lead to this renaissance that has so much potential for smoking cessation and many other conditions. 

Dr. Johnson: Oh, thanks, Shiv. It’s been a pleasure chatting with you, and thanks for your focus on the psychedelic topic. I appreciate it. 

Shiv: Totally, and with that, I’m Shiv Gaglani. Thank you to our audience for checking out today's show, and remember to do your part to raise the line and strengthen our health care system. We're all in this together. Take care.