“What these substances have in common is that they are widely considered to fall into the category of psychedelics. What else they have in common is that the vast majority of us physicians learned nothing about them in medical school or residency, as most psychedelics are classified as Schedule 1 substances, which suggests they have no currently accepted medical use and pose a high potential for abuse.

With these psychedelic-based therapies, clinicians are now presented with options to help patients who haven’t benefited from traditional treatments. These therapies are vastly different from current medical models in that there is generally no pill to take every day, and some treatments need to be done only one or two times to have a lasting effect.

As some psychedelic therapies are already available, and more are coming soon, now is the time for us to get up to speed on what these psychedelic medicines are, how they work, what conditions they may be able to treat, how they interact with other medications, possible dangers, and what our role may be in facilitating patient access to these medicines.”

Lynn Marie Morski is a physician, attorney, and president, Psychedelic Medicine Association.

She shares her story and discusses her KevinMD article, “What doctors need to know about psychedelic medicine.”

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Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow.

On today’s show we have Lynn Marie Morski. She’s a physician, attorney, and president of the Psychedelic Medicine Association, and she wrote the KevinMD article “What doctors need to know about psychedelic medicine.” Lynn, welcome to the show.

Lynn Marie Morski: Thanks so much for having me.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Lynn Marie Morski: Absolutely. Well, first off, thank you for having me on. My story starts, I was actually a multimedia designer and a video editor before medicine. But my medical journey, I did family medicine as my specialty and sports medicine as my fellowship. After finishing fellowship, I started working at the VA while I was in law school, and I worked at the VA for nine years. I saw about 9,000 vets in that period of time.

I’m from a very conservative family. I had not touched cannabis, I had not touched psychedelics, nothing, my entire life. Very conservative upbringing, southern Illinois. Somewhere in those nine years where I was working at the VA, I did experience psychedelics for the first time, and I felt a lot of healing and saw a lot of potential for healing. I wasn’t aware at all, though, that that was something that was being investigated. But a few years later I found out, nope, there’s an entire field of psychedelic science that’s looking into these therapeutic potentials. Generally it’s psychedelic-assisted psychotherapy. It’s not that you take the psychedelic by itself, but sometimes. But anyway.

Once I realized that was a field and I got more into it, I was hearing stories about veterans. They’re on the brink of suicide, nothing else is working for their PTSD, they try a psychedelic, something like maybe ayahuasca or MDMA, and now they’ve got their life back in a way that they didn’t think was possible before. So here I am, working at the VA. I’m a Department of Defense employee. I can’t talk about drugs at all, psychedelics. And in my post-work life, I’m hearing more and more how these can help veterans, and it just became really out of alignment for me to not be able to share what I know. Doctors, “First, do no harm,” and I’m like, “I’m doing harm by omission here.”

So in 2019, without any kind of backup job or idea how I was going to do it, I left the VA, and I made it my mission to spread the word about psychedelic-assisted psychotherapies, or psychedelic medicines, to clinicians. Because you educate one patient at a time, great. But educate one clinician, and that person is seeing 60 to 70 people a week. That’s really how we can get this message spread.

So the first thing I did was I started the Psychedelic Medicine Podcast, which is now two and a half years old, and that’s how I thought I was going to educate clinicians. Then I realized clinicians don’t have time to sit down for 45 minutes to listen to, you know, psilocybin for depression. So I was like, “How can I get this to clinicians in a way that they can easily digest it?” That’s when I founded the Psychedelic Medicine Association. So now we have over 800 physicians, nurse practitioners, PAs, therapists, anybody to whom a patient may go and say, “I’m struggling in one way or another.” We educate them through monthly newsletters, webinars, et cetera, on the benefits of psychedelics, some which are already available and some which are likely to be FDA-approved soon.

Kevin Pho: Sure. So you talk more about that in your KevinMD article, “What doctors need to know about psychedelic medicine.” So let’s get everyone on the same page. What’s your definition of what a psychedelic medicine is, and what’s the current state of how physicians are or are not using them today?

Lynn Marie Morski: That’s a very interesting question, the definition. Psychedelic medicine is any therapy, and like I said, it may be psychedelic-assisted, where it’s actual talk therapy and a psychedelic is being used, or sometimes the psychedelic is used on its own. And psychedelics, even within the industry, you can’t get a great consensus on a definition. But generally these are substances that alter your consciousness in one way or another.

Some examples that you may have heard of, from the ’60s, we’ve heard of magic mushrooms and LSD. Well, magic mushrooms, the ingredient’s called psilocybin, and that will actually be legal for medicinal use in Oregon in 2023. So less than a year from now, there will be psilocybin centers in Oregon. So Oregon doctors out there listening, this is going to be very relevant to you very soon. A few of the examples of others are ayahuasca, which is from the Amazon, and then we have ketamine. We even throw ketamine in very often, and ketamine is the one that is currently legal in the U.S.

It is used off-label at this point for treatment-resistant depression, or there’s Spravato, which is an actual on-label use product that is a version of ketamine for treatment-resistant depression. So as far as what doctors can and cannot prescribe right now in the U.S., doctors across all 50 states can prescribe or recommend, refer somebody, to ketamine-assisted psychotherapy. And that comes in IV, intramuscular, there are lozenges, there are nasal sprays. Ketamine for depression, and ketamine is good for depression, pain. It’s very effective in breaking acute suicidal ideation. So there’s a number of forms and there are a number of ways, and that’s one of the things we talk about with our members, like how to know to whom to refer and what method is best. But that’s what’s available right now.

But like I said, in 2023 there will be legalized psilocybin use, with kind of a medical model, in Oregon. And then it is likely that MDMA, which is the active ingredient in what’s very often called ecstasy, is scheduled to likely be, it’s in phase three, likely be FDA-approved by 2024. And then psilocybin, which is the active ingredient in magic mushrooms, is in phase two, entering phase three trials, and is likely to be right behind that. And then many of the other psychedelics that I mentioned, or that are in that category, are entering phase one and phase two trials at this point.

Kevin Pho: So let’s talk about ketamine, because that’s what’s available now. I’m a primary care physician, so what kind of patient story should I consider when I want to potentially consider ketamine as a part of the treatment plan?

Lynn Marie Morski: One of the most common uses for ketamine is treatment-resistant depression. Very often it looks like the patient will go in for six sessions, and it’s very often two sessions per week over three or four weeks, and that seems to be resolving treatment-resistant depression for a period of time. It’s pretty durable. Now, they very often do have to come back for booster doses. So ketamine for depression isn’t necessarily kind of the one-and-done of MDMA for PTSD, which is showing more that you do two or three sessions and then they no longer even qualify to have the diagnosis of PTSD. But ketamine for depression is showing that there are long-lasting effects.

What’s great about ketamine is that you don’t have to get off any of your current antidepressants to take it, so that’s a nice, low barrier for entry. The sessions are about 45 minutes. Like I said, there’s a wide variety of ketamine clinics out there, but to maximize your experience, we often recommend that you go to a ketamine provider that is offering a therapist to sit there with you, in case there’s something you want to process while you’re in the therapy. Because ketamine works on two levels. It works on the glutamate receptors, so there’s a physiologic thing that’s happening, but then there’s also kind of the more existential processing that you can do when your mind is opened up in these different ways.

What I refer to in the article is that these are so effective because you’re able to get to the root cause. This is not just chasing symptoms, like we do with a lot of other therapies. Are we depressed because we have a traumatic experience from childhood, or a maladaptive thought pattern? If we can go into a slightly altered state of consciousness, work with a therapist to identify that trauma and address it, or identify that thought process that’s keeping us stuck in a pattern, then we’re able to make real change, and not just numb out a little bit so that the symptoms aren’t so painful.

Kevin Pho: How difficult is it to find a ketamine-certified clinician?

Lynn Marie Morski: So interesting that you refer to it as ketamine certified, because there is not, at this point, a certification. That’s why we have people in our association, and we talk a lot about how you know the best referral to make, because at this point it’s a little bit of a Wild West. The entire psychedelics industry is working on making these certifications, because we want there to be higher standards of care.

But first off, it’s not hard to find ketamine, especially in larger cities, but it’s even working its way into rural areas. Some of the things I would recommend: Before you refer to a clinic, have a conversation with the clinician. Do they offer preparation beforehand, integration afterward? That is hugely important. You come out of this altered state with maybe all this new information. You need somebody to work with you to integrate that into your nervous system, to integrate that into your daily life. So ask that clinic, does somebody sit with them while they’re doing the ketamine? Is there a therapist on hand? And then, is there adequate preparation beforehand and integration afterward?

Kevin Pho: Now, you talked about some other psychedelics that may soon be available in the coming years. So to summarize that, what do we have to look forward to in our near-term future?

Lynn Marie Morski: In 2024, like I said, MDMA is likely to be FDA-approved for PTSD. And MDMA, like I said, is the ingredient in ecstasy. They’re doing this with two therapists in the studies, and it’s an eight-hour session. It’s showing that after two of these sessions, with psychotherapy before and after, a lot of this preparation and integration work, something like 67 percent of the people that are going through this no longer qualify for a diagnosis of PTSD. So that’s a really exciting development, because anybody who’s treated PTSD knows how challenging it can be, and how ineffective the therapies we have now are at actually addressing those root causes. We’re just trying to barely get people back to having a quality of life. This is completely changing their life. So that’s the next one that’s likely on the horizon.

And like I said, psilocybin after that, which is the ingredient in magic mushrooms. That’s being investigated for major depression, and that’s what’s going into phase three trials. However, psilocybin is also being investigated, as is MDMA, for a number of other things. A study out of Johns Hopkins shows that psilocybin was extremely effective for tobacco cessation: two sessions of psilocybin therapy with cognitive behavioral therapy, and 60 percent were smoke-free at, I think, 16 months. So those are two medicines that are likely to be available soon.

Other medicines are available in other countries, and so that’s a question I get a lot from doctors: “What’s the legality of me referring to something in a different country?” That’s a very gray area at this point. What clinicians can safely do is educate. That’s kind of where the law draws the line, between education versus aiding and abetting. That’s why we provide our clinicians in the association with, like, “Here’s education you can spread to your patients. You can share with your patients: This is what ayahuasca does. This is what the research has shown about ayahuasca. This is what ibogaine does.”

Ibogaine is maybe the least talked about and one of the most effective. It’s super effective at addressing opioid use disorder without withdrawals. Amazing, like, things that really could change the lives of so many of our patients, but they’re only available in other countries. So as clinicians, we’re allowed to discuss them, but at this point we can only really refer to ketamine.

Kevin Pho: So one of the sections in your article is addressing physicians’ concerns, and you mentioned two common questions that you get from physicians: Are these substances addictive, and is it legal to discuss them with patients? So you talked about that, but talk about the habit-forming potential of these substances.

Lynn Marie Morski: Thank you for bringing that up, because you’re absolutely right. That is probably the number one question I get, or the number one kind of knee-jerk reaction, especially when I talk about psychedelics for addiction. They’re like, “Why would we give an addictive substance to somebody suffering from addiction?”

The majority of these psychedelics are not only not addictive, they don’t have the addictive properties. They’re not working on the dopamine receptors. If you use them too much, they just stop working completely. It’s not as though there’s a tolerance that builds up. So most of them don’t have an addictive potential. The two that have any, and it’s low, are ketamine and MDMA. However, the addictive potential even in those is so much lower when used in a clinical setting. We’re not handing you ketamine and saying, “Just go do this on your own, whatever.” With ketamine-assisted psychotherapy, when you’re doing it with a therapist, it dramatically decreases the chance that there’s going to be an addictive pattern that shows up.

But as I had referred to with the tobacco cessation, and with ibogaine, many of these are actually anti-addictive. So ketamine is being studied for alcohol use disorder, psilocybin has been studied for tobacco abuse, and ibogaine has been studied for opioid and cocaine addiction, and they’re all being shown to be more efficacious than anything we’re currently using.

So it’s interesting, the thing that clinicians are very often most afraid about. And of course, because we’ve been sold on the drug war and “Just say no,” and these drugs are like that commercial you see with the frying egg in the pan, “This is your brain on drugs,” obviously that’s what everybody’s first thought is going to be. But then when you look into the research and realize most of these are not addictive, and many of them are very helpful in combating addiction, then hopefully we can start to change the minds around that topic.

Kevin Pho: So let’s say in the coming years MDMA and psilocybin get approved by the FDA. Tell me a case study or story of how you would use these psychedelics in a clinical setting.

Lynn Marie Morski: Somebody comes to you as a patient, and this is where I love that you’re a family med doc, and I think about this a lot from the family med doc perspective. Somebody comes, and they have PTSD. PTSD may be something that a family med doc is trying to address, but it may be something that we would refer out. I’m a family med doc by training too. We’d refer out to psychiatry.

So say we refer to psychiatry. They evaluate, they give them a diagnosis of PTSD. At that point, they could refer to an MDMA-assisted psychotherapist. So when MDMA becomes available, they will. That is a certification that you will have to have, too. And then there’s a REMS program, risk evaluation management, where you have to go through that REMS program to be able to prescribe the MDMA. So maybe that psychiatrist has gone through the REMS, and they prescribe the actual substance. And then there’s an MDMA-assisted trained psychotherapist that actually does the therapy, because that psychiatrist is probably not going to be the one that sits for eight hours with the therapist. It’s going to be somebody who is specifically trained in that. It can be. Psychiatrists can, of course, go ahead and get that training.

But that’s kind of what the pipeline will look like: There will be somebody prescribing that medicine and then a therapist that’s administering. In the trials there have been two therapists, but it is yet to be seen what actually comes down in the actual FDA approval. It’s about an eight-hour session, and there will probably be sessions before and after the actual medicine session, where there’s that preparation and integration. And with MDMA for PTSD, it’s showing to be two or three sessions that are leading to the results seen in the trials.

Kevin Pho: We’re talking to Lynn Marie Morski. She’s a physician, attorney, and the president of the Psychedelic Medicine Association. She wrote the KevinMD article “What doctors need to know about psychedelic medicine.” So Lynn, what are some other things clinicians need to know about psychedelic medicine that we didn’t bring up already?

Lynn Marie Morski: I think just some of those crucial components that we talked about, and just a paradigm shift in how we think about medicine, period. Because we’re so used to, “Here, take two of these every morning.” If you hand out Lipitor, there’s no preparation beforehand or integration afterward. You just take the Lipitor. Same thing with Paxil or Zoloft. A lot of the things we’ve been handing out, yes, sometimes people do therapy in conjunction, but very often it’s just, “Take these medicines.”

With psychedelics, it’s not like that. We are not aiming to have somebody on psychedelics for the rest of their life. With these, you take two sessions, three sessions, maybe even with ketamine you do the six sessions, and maybe you have to come back later, but maybe not. We want to really work as much as we can in those sessions to get to the root causes, and that completely changes how we have to look at these.

I don’t know of too many other therapies besides something like a surgery, where you prepare for it, you go in once or twice, and then you do physical therapy afterward. It’s more like that. This is much more akin to that kind of thing. There will be a medical clearance that has to happen, depending on the substance and the patient, but it’s going to require an entire change in how we think about patient care and what’s important.

What I’m hoping is that this brings kind of a continued focus on root causes, and the effects that trauma can have not only in our mental health, but it very often plays out in our physical health as well. So I’m really interested to be part of this kind of re-education of what treating something and addressing it at its core can look like.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Lynn Marie Morski: I would love for the audience to realize that your patients are going to come asking about these sooner rather than later. We’ve done some studies, and about half of the psychiatrists polled, their patients have already asked about that. As this gets more and more press, patients are going to start coming. So as a family doc, it’s great to know the basics, just like we know the basics about anything else. I want to be able to know as much about psychedelics as I do about urology, which is I know when to refer, and maybe how to do a clearance, and just have enough information that I feel comfortable having a conversation with that patient.

Because so many of these therapies that are on the horizon, and that are available now, are more efficacious than the options we have. So it’s doing a disservice to our patients to not at least have that initial conversation and tell them when one of these is an appropriate and available option. So I would just love the clinicians out there to keep their ears perked when they hear about psychedelic medicine. If they’re interested, come join the Psychedelic Medicine Association to learn more. But there is some hope in the future for a lot of these things that have been challenging to treat in the past.

Kevin Pho: Well, thank you so much for sharing your time and insight, and thanks again for being on the show.

Lynn Marie Morski: Thanks for having me.