Hey everyone, welcome to the Peter Atiyah Drive. I'm your host, Peter Atiyah. The Drive is a result of my hunger for optimizing performance, health, longevity, critical thinking, along with a few other obsessions along the way. I've spent the last several years working with some of the most successful top-performing individuals in the world, and this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality, more fulfilling life.
If you enjoy this podcast, you can find more information on today's episode and other topics at PeterAtiyahMD.com. Hey everybody, welcome to this week's episode of The Drive. I'd like to take a couple of minutes to talk about why we don't run ads on this podcast and why instead we've chosen to rely entirely on listener support. If you're listening to this, you probably already know, but the two things I care most about professionally are how to live longer and how to live better.
I have a complete fascination and obsession with this topic. I practice it professionally, and I've seen firsthand how access to information is basically all people need to make better decisions and improve the quality of their lives. Curating and sharing this knowledge is not easy, and even before starting the podcast, that became clear to me. The sheer volume of material published in this space is overwhelming.
I'm fortunate to have a great team that helps me continue learning and sharing this information with you. To take one example, our show notes are in a league of their own. In fact, we now have a full-time person that is dedicated to producing those, and the feedback has mirrored this. So all this raises a natural question, how will we continue to fund the work necessary to support this?
As you probably know, the tried and true way to do this is to sell ads, but after a lot of contemplation, that model just doesn't feel right to me for a few reasons. Now the first and most important of these is trust. I'm not sure how you can trust me if I'm telling you about something when you know I'm being paid by the company that makes it to tell you about it. Another reason selling ads doesn't feel right to me is because I just know myself.
I have a really hard time advocating for something that I'm not absolutely nuts for. So if I don't feel that way about something, I don't know how I can talk about it enthusiastically. So instead of selling ads, I've chosen to do what a handful of others have proved can work over time, and that is to create a subscriber support model for my audience. This keeps my relationship with you both simple and honest.
If you value what I'm doing, you can become a member and support us at whatever level works for you. In exchange, you'll get the benefits above and beyond what's available for free. It's that simple. It's my goal to ensure that no matter what level you choose to support us at, you will get back more than you give.
So for example, members will receive full access to the exclusive show notes, including other things that we plan to build upon, such as the downloadable transcripts for each episode. These are useful beyond just podcasts, especially given the technical nature of many of our shows. Members also get exclusive access to listen to and participate in the regular Ask Me Anything episodes. That means asking questions directly into the AMA portal and also getting to hear these podcasts when they come out.
Lastly, and this is something I'm really excited about, I want my supporters to get the best deals possible on the products that I love, and as I said, we're not taking ad dollars from anyone, but instead what I'd like to do is work with companies who make the products that I already love and would already talk about for free and have them pass savings on to you. Again, the podcast will remain free to all, but my hope is that many of you will find enough value in one, the podcast itself, and two, the additional content exclusive for members to support us at a level that makes sense for you. I want to thank you for taking a moment to listen to this. If you learn from and find value in the content I produce, please consider supporting us directly by signing up for a monthly subscription.
My guest this week is Dr. Rick Doblin. Rick is the founder and the executive director of the Multidisciplinary Association for Psychedelic Studies, better known as MAPS. Now, if you listen to the podcast that I did with Tim Ferriss, that name may sound familiar.
We spoke quite a bit about Rick, but more so about MAPS and really the work that they've been doing to legalize specifically MDMA, but other molecules as well for medical use. Rick is a force of nature, and there's just no way I can describe this interview, how much I learned about a guy that I already sort of knew in terms of his background, his passion, what motivated him. He's really a unique individual, and at the very end of the interview, I even sort of comment to that effect that there's just not that many people that can really bend the arc of history the way I believe Rick is doing that. We spent about the first hour and 20 minutes or so putting some background together, both Rick's background, where his drive for this came from, and also the background of how these molecules, and we made broadly available and utilized quite liberally, and then ultimately how they were scheduled with the drug act of the early 70s.
At that point in the podcast, we then turn our attention specifically to MDMA because what I really wanted to focus on here was MDMA for several reasons. One, as I think I say in the podcast, whether right or wrong, my personal opinion is MDMA is the single most important synthetic molecule ever created by our species. Also, it's the closest one to being descheduled, meaning taken from being an illegal drug that is Schedule I to something that will have a medical application, and you'll see through this discussion how long it has taken to do that and what the implications of that are. And of course, more importantly, you'll probably appreciate why we would think that that's an important thing to do.
So when it comes to MDMA, we talk about a lot. We talk about how it was created back in 1912, how it was rediscovered and resynthesized, where it's used, where it found its use, and how the parallel use of ecstasy as the party version of this drug in some ways kind of, well, in some ways, in many ways really hurt the clinical application of MDMA, which was really where it started, how it was, of course, scheduled and made illegal in 1985, which is relatively late compared to all of the other psychedelics, and you can see that through this discussion, MDMA is sort of not your typical psychedelic, and then how a year later, Rick created maps and did everything from going off to the Harvard Kennedy School to get a PhD to help him understand the regulatory morass he was going to have to navigate his way through, and right to where we are today, which is truly being on the cusp of legalizing this incredibly powerful molecule that is going to help, in my opinion, literally millions of people. So I'll just give you one example of something that we dive into pretty deep that I think people are going to find very interesting, which is the toxicity of MDMA. So there are lots of rumors about the toxicity of this drug, and of course every drug has toxicity, so the point here isn't that it doesn't have it, but the point is, what is the toxicity, and is it really what we were led to believe with everything from depression, Parkinsonian syndromes, neuronal destruction, versus what's actually happening?
So a very nuanced discussion on that, and I think we end with a message of hope, which is one, there are going to be many people I think who listen to this who are going to wonder what can they do to receive this therapy, and we're going to talk about what those clinical trials look like, what the enrollment looks like, and perhaps more importantly, what a compassionate use license would look like, such that if there are patients who are in need of this therapy prior to its approval, what are the legal paths to do that? I have to say something very important that I feel strongly about, of course, the drug enforcement agency considers MDMA to be a schedule one drug. That means it is illegal. That means according to the DEA, at least at the time of that schedule in 1985, they do not believe there to be a medical use, and that they believe that it has a high potential for abuse.
Now, I think you'll see from the discussion, neither written or I agree with that at all, but we have to respect the letter of the law. So there's nothing in this podcast that I want to be construed as encouraging you and or endorsing the use of illicit MDMA. I think there are more than sufficient legal channels by which people could pursue compassionate extension for the appropriate treatment of PTSD, which is at this point in time where we believe MDMA is most valuable. So with that said, sit back and please enjoy my interview and discussion with Dr.
Rick Dalton. Before we begin this podcast, I want to point out something that we did here a little different from what we've done in previous podcasts. Rick and I sat down for a very lengthy conversation, and in the beginning, we spent a lot of time going really deep into his background. Now, while I think this conversation is really interesting, I also realize that the entire conversation is long, and many of you may be tuning in for more of what we talk about at the end, specifically as it pertains to MDMA.
So what we did is we took roughly the first hour and 15 minutes of this interview and put it at the end. So what you're about to hear is where we pick up the conversation, again, roughly an hour 15 into it, where we start to talk about maps and Rick's work on MDMA, which I think is what the majority of you are probably wanting to hear about. Then at the end of that podcast, we will roll directly into the initial conversation on Rick's background, which the diehards like me will find just as interesting. Because this is a different sort of format than we typically do.
Hopefully it makes sense, and you'll enjoy the interview. But it's our belief that this will create slightly better flow for what you're about to hear. Rick, thanks so much for opening your home today. Oh, it's a pleasure to have you here.
Every once in a while, I get ready to sort of interview somebody, and I think to myself, this is highly applicable. This is incredibly broad. This topic we're discussing is so important. And I don't know, as I was coming over here, I was talking to my wife, and she said, I can't believe I'm not there to listen to you guys have discussions, which I said, you've never once listened to me record a single podcast.
Why are you so interested in this? And she's like, I don't know, I just, you've spoken about Rick so much, and you've spoken about MDMA so much that I just don't want to miss it. And I said, well, don't worry, it's going to be recorded. You're going to hear it with everybody else.
But this is a discussion I wanted to have for such a long time. Now, in many ways, there's probably a few people, if any, that have done more to sort of right the wrongs of that era. And we're now 33 years into an organization that you started. That organization you started in 1986 called MAPS.
Tell me what MAPS stands for and what you set out to do. So MAPS is Multidisciplinary Association for Psychedelic Studies. I knew at the time that I wanted to have the word psychedelic in the title of the nonprofit. So just to go back a little bit further.
So in 1972, when I was at New College and having difficulties with my psychedelic experiences, I went to the guidance counselor at college, and I asked for help. And I said, I'm having powerful, important experiences, but I'm not able to fully integrate them. And I was just so fortunate. The guidance counselor gave me a copy of a book, Realms of the Human Unconscious by Stan Groff, about his work with LSD, before it was even published, a manuscript copy.
And it was reading that book that really helped me see that here's science, here is spirituality, but viewed through a scientific lens. And it had the reality check of therapy. It's focused on how do you help these people suffering from different conditions grow. And so I felt that this was now everything together for me.
Science, mysticism, spirituality, the sense of unity, and therapy, reality checks. So in 72 is when I decided to become a psychedelic therapist. And I wrote a letter to Stan Groff, and he ended up writing me back. And I took a workshop with him in the summer of 72.
And I did everything that I could to try to elevate and expand my consciousness, including I had the delusion that the more psychedelics I took, the faster I would evolve, which I underestimated the whole integration process. So I basically then took 10 years to integrate. I dropped out of college. I didn't see Stan anymore.
I spent 10 years trying to get prepared to make psychedelics the forefront. So I was in the construction business and built houses and built various things and got grounded in this 10-year period. And every once in a while, I would take LSD and work on my fear. And so I went back to college in 1982 at New College, the same college I had dropped out of.
I built houses for a couple of professors. I figured out how I could sort of frame what I was doing as studying transpersonal psychology and psychedelic psychotherapy. And so the very first semester that I went back to school, Stan Groff was giving a workshop, a month-long workshop at Esalen called The Mystical Quest. Where's Esalen?
Esalen is in Big Sur. It's about three and a half hours south of San Francisco. It's on the cliffs overlooking the ocean. There's hot springs that come up there.
There's bass. It's sort of the cradle of the human potential movement. You were just there. I was just there for a week-long program on psychedelics where the entire property, which fits around 120 people, it's sort of a commune, you could say, where they grow their own food.
Their job is to provide housing and workshops for people. They've been involved since the 60s, started by Dick Price and Michael Murphy. Fritz Pearls from the salt therapy lived there. Rolf and Stan Groff was there for almost 15 years as a scholar in residence.
All sorts of people have taught there and still going. And so this particular workshop that I was just at had the largest waiting list in the entire history of Esalen since the 60s. I had over 1,000 people try to get into this program for 120 people. But I went there in September of 82 as the beginning of my going back to school.
My first semester was going to be about creating a curriculum to become a psychedelic therapist. And so during this month long, at Esalen with Stan and Christina Groff, his wife, this woman named Debbie Harlow came by. She wasn't in the workshop, but she came by to Esalen, and she started talking about this new drug called ADAM, which was MDMA, and that it was used in therapy. It had been used in underground therapy circles since the middle 70s.
It was itself legal at the time, but it was kept quiet because this was again during the drug war period, and that if it were made public, chances are it would be criminalized. And when we learned about it in 82, when Debbie started talking about it, she also shared that it had escaped these therapeutic circles and was being sold as the drug ecstasy. So it was clear that it was doomed. It just wasn't clear when.
And my initial impression of it was that I underestimated it. You underestimated the drug or the backlash that would come against it? The drug. Okay.
Yeah. So she said it helps you feel love. It helps you feel connected. It helps you be a better listener.
It helps you talk to people. Speak from your heart. And I thought, I'm in love. I feel love.
I feel like I can talk. I saw a group of people doing it, and they were just sitting around in a circle talking to each other. And I thought, how profound can that be? When you take 250 micrograms of LSD, you can't talk.
You go into this nonverbal place. That's what's really profound. You go beyond your ego. At that time, Rick, was the language that we now use to describe that distinction known?
Was it understood that, for example, psilocybin was an entheogen while MDMA was an empathogen? Did we even understand what that meant in 82? In 82, not quite then. So entheogen, I don't actually use that word, because that's the God within, to generate a spiritual experience.
I think that that word was created by Jonathan Ott and others to try to create a counter to the word hallucinogen. So hallucinogen is pejorative, negative, it's an illusion. It's negatively loaded. Entheogen is sort of positively loaded.
It's going to be spiritual. Psychedelic is mind manifesting. It's neutral, and it describes what it actually does. So I've chosen to try to reclaim the word psychedelic.
The empathogen is a really good word for MDMA, that it produces empathy. Others, Dave Nichols, that was Ralph Messner's word, empathogen. Dave Nichols proposed empathogen to mean to touch within. And what was going on there, so that was really created, those empathogen and empathogen, those words were created once we needed in our legal case to try to protect the use of MDMA, but to try to say that it wasn't like a traditional psychedelic.
So I think in 82, when I was first learning about MDMA, when I was foolish enough to underestimate it, but smart enough to buy some, that it was clear that MDMA was not like a classic psychedelic. Right. There's no dissociation. There's no hallucination.
You remember it as though you're completely awake. It is really in a class of its own in that way, isn't it? Yeah, yeah, it's very good. And so that was the attempt to try to, the empathogen word was just to try to balance out hallucinogen, but empathogen and taxogen was part of our legal case to try to say this was a different class of drugs, and you couldn't criminalize it the way these others had criminalized it.
That in the end failed. And psychedelic is a broader word, mind manifesting. So I think that MDMA is a psychedelic, but it's not a classic psychedelic. So once I learned about it and actually underestimated it, but bought some and tried some, it was then just profoundly impacted by how subtle it was and how incredible the drug it was.
Do you remember the first time you took it? Oh, yeah. Oh, yeah. I remembered it really well.
I was with a girlfriend and we took it together. And at one point we said this love we're expressing and experiencing is it's really us. It's not a drug delusion. It's liberating us to express what we really feel.
I felt like the profundity and the depth of connection was genuine and also something that we could learn from. I think one of the things that makes us so helpful therapeutically in this drug is that because you're not dissolving your ego, it's easier to integrate what happened. It's not that far away from normal consciousness. It's a subtle shift with a reduction in fear and you make a lot of different areas.
It's just profound therapeutic. And so once I tried it, I thought that this was an incredible opportunity because there was going to be a backlash, but it was still legal. And I had learned about LSD, really the value of it in 71 and 72 after the backlash, which was 1970 and the Controlled Substances Act and criminalization of all the psychedelics and the effort to squash psychedelic research all over the world. So I felt I missed my moment.
You knew you had a small window, but you didn't know how big it was going to be. So I started a different nonprofit in 1984 before MAPS. What had happened actually, and again, it's great that you're wearing the Doors shirt because Laura Huxley was key to my whole life. So in 1983, after I had learned about MDMA, I read this book by Robert Mueller, who was the Assistant Secretary General of the UN.
He was from France, a French resistance fighter. He was the mystic of the UN. He'd been there for 40 years. The book was New Genesis, Shaping the Global Spirituality.
And so this book was about how the UN is for conflicts between nations, but actually a lot of these conflicts are religious conflicts and how he felt we needed a global spirituality that would enliven every particular religion. It's not like a one world religion, like one world language, but it was the sense that religions are like languages. They're all different. ways of expressing something similar a similar reality and that if we move beyond my religion is the one right religion and if you don't follow it you're an infidel or you're all these religious wars that we've had over the centuries this idea that there was this sort of we're all from the same planet we all have more in common than separate that's what Robert Mueller wrote about this global spirituality and as the key to human survival so I wrote him a letter as a college undergraduate and I said I agree with what you say but you don't say anything about psychedelics I told him about the good Friday experiment I mentioned MDMA as a tool that could be used and he wrote me back and introduced me to various people who are mystics to share MDMA with them and see what they have to say so this letter though that I wrote to Robert Mueller was Debbie Harlow saw it who introduced me to MDMA she showed it to a friend of hers who showed it to Laura Huxley and so Laura thought wow I'm trying to do important political work outreach work so I got invited to meetings that were taking place at Esalen organized by Dick Price and others to try to figure out how to protect MDMA and how to bring this MDMA had sort of revitalized the cycle underground because now there was a new tool that was tremendously effective and it was legal but there was a parallel sort of social drug that was coming out as well so when was ecstasy becoming the sort of parallel path for MDMA to become mainstream was that about the same time yeah that was about the same time so Michael Klee was one of the people that had gotten MDMA under the name Adam in these sort of therapeutic contexts in private homes not all done by therapists and patients but personal growth private homes out of public settings Michael had been involved with being a cocaine dealer others he knew other cocaine dealers and he thought this was a tremendous drug and more people should know about it and so he created ecstasy he created this ecstasy and started marketing in public ways and that was going to attract the attention of government particularly at the Star Club in Dallas was where it became a real party drug you could buy it over the counter 800 numbers Michael had a quite large operation and was it at the time ecstasy pure MDMA or was it typically included with other impurities or additional stimulants it was pure MDMA it was great quality and people had incredible experiences and started sharing it more and more and more and more people wanted to do it and so it was used a lot it was sort of the beginnings of the rave movement the dance movement it was used in these more public settings and so that was a concern for those of us that were interested in trying to protect the therapeutic use that this public use was going to doom it and we actually contacted Michael and others he approached us at different conferences and so we got to know who the underground manufacturers were and basically I said that they owed a debt of gratitude to the people who created MDMA and they should help us protect it and so they did make some donations for us to help in our legal efforts and just to give listeners a background I mean MDMA again like LSD completely synthesized man-made originally synthesized in 1912 I believe yeah somewhat forgotten about correct yeah so MDMA was invented by Merck pharmaceutical in 1912 they were actually looking to evade a competitor's patent on getting to a different drug and so they had a whole different synthetic route and they patented every step along the way MDMA being one of them but they weren't looking for MDMA it was just an intermediary towards the other ultimate goal yeah and then they did nothing with it World War I came along as a German pharmaceutical company and they actually didn't test it in animals until 1927 and at that point in time they found nothing of interest and abandoned it it's funny to me by the way to imagine animals on MDMA that's such an interesting concept like would it do anything to an animal do they well it does actually and so some researchers at Johns Hopkins have done studies with octopuses with MDMA so as it turns out octopuses you can make them less ornery yes you can they're solitary creatures unless it's mating season and so they've got this experimental contraption this is a digression but it's worthwhile they've got this experiment so they put an octopus in the center chamber and then they have two chambers off of each side one has an inanimate object in it in a kind of a bird cage so that it doesn't move in a larger area and the other has an octopus in this third bird cage so it doesn't move either so under normal circumstances the octopus will spend way more time with the inanimate object than with the other octopus they don't really like being with other octopuses we supplied the MDMA for this experiment we mean maps so we ended up that they figured out how to dose the proper amount of MDMA in the water so they soak the octopus in a bath of MDMA infused water for 10 minutes and then they put the octopus back in this experimental contraption and lo and behold now they spend way more time with the other octopus and humans and octopuses diverged 250 million years ago and so the big question that the experimenters had is first off would octopuses react to MDMA at all and then secondly even if they did would it have any kind of similar effect as it does in humans and it turns out that it does suggesting that whatever MDMA is doing is in a primitive enough part of our brain meaning it was still there before the bifurcation yes yeah yeah suggesting it's not in the cortex yes and also that it's something that we're not only in the cortex exactly not exclusively in the cortex and also that the FDA has told us that if we manage to prove safety and efficacy in adults they want us to do work in adolescence with PTSD and if that works they want us to go down to 7 to 11 year olds so it suggests to me that work with the octopus that young children who've been traumatized may still benefit from MDMA even if they don't have a lot of verbal facilities and so MDMA has also been given the same group at Hopkins just published a paper in Nature which we can we'll do all these things yeah yeah they just published a paper in Nature that was in mice and what they showed is that MDMA releases oxytocin which causes neurogenesis the birth of new neurons and new neural connections in prosocial areas of the brain and they speculated that that's what's underlying the increase in the therapeutic alliance between patient and therapist that MDMA catalyzes this oxytocin release hormones of love and bonding and nurturing nursing mothers and when you're alone so when Merck came back to it there's like this period where it was sort of forgotten about until Sasha came along and started synthesizing sort of so what happened then so invented in 1912, 1927 Merck does studies in animals and gives it up the next time that we know about it was in 1953 when the US Army Chemical Warfare Service tested eight different drugs for toxicity in animals this was classified it didn't come out until the early 70s so very few people knew about it but MDMA was one of those drugs and so what they did is they tested a series of eight drugs with mescaline on one side and methamphetamine on the other and MDMA more in the middle so I think that's a good way to understand MDMA is that it has the energy properties of methamphetamine that's why people can take it and stay up all night and dance it makes you alert but it doesn't make you jittery like methamphetamine you can take it and be alert but be perfectly still you can use it in meditation and many people have actually is it technically considered a stimulant?
I mean it is an amphetamine well it has stimulant properties for sure but it's also similar to mescaline but it doesn't have the eco-dissolving sort of visual classic psychedelic properties that mescaline has so MDMA is kind of between mescaline and methamphetamine but different from each end of the spectrum so that research was done in animals there's no evidence that they did anything in humans and that wasn't declassified until the early 70s so then what happened though is that a drug called MDA methylene-dioxylamphetamine was developed independently and it became quite popular during the 60s and it was called the miracle drug of America it's a little bit like an MDMA-LSD combination and a lot of people really used it during the 60s it was a pretty incredible experience and also kind of a different contrast to LSD, a softer version of LSD and so once all the drugs were criminalized in 1970 in this backlash in the Controlled Substanceses Act then chemists like Sasha and others were looking to modify drugs that were illegal to develop new versions that would be legal and might have therapeutic properties so it was because of the popularity of MDA that people started looking at that kind of molecule and then MDMA was actually rediscovered without people knowing that it had been invented by Merck or that the Army Chemical Warfare Service had used it and then it became used so Sasha Shulgin actually was told by a graduate student of his that he should check into that particular molecule and then he took it and the way Sasha worked was incredible that he and his wife and he would invent these new drugs he was looking for drugs for consciousness change he had been working for Dow and had invented a biodegradable insecticide and Dow had given him his own lab and said he could do whatever he wanted to do but what he wanted to do was going to be producing anything that Dow wanted to market and so he left and started on his own and taught chemistry but really became the premier American psychedelic chemist and so he resynthesized MDMA and his process was he would take things himself he and Ann would take them they had a group of 12 people and these were the same 12 people that they would test all these new drugs and he felt that individuals are so different from each other if you have 12 people and you all take the same drug you'll get a range of experiences and that gives you a good sense of what this drug might be and those drugs that this group of 12 thought might have therapeutic potential then he worked with a fellow named Leo Zeff who was a clinical psychologist PhD who had when the crackdown came decided to continue using psychedelics and so Leo was sort of the leader of the underground psychedelic psychotherapy movement and the first book that MAPS ever published was called The Secret Chief and then a few years after that we were able to publish The Secret Chief Revealed once his family was comfortable with us talking about Leo Leo was going to retire but once he did MDMA he realized that this had incredible therapeutic potential so he didn't retire and Leo was the one that trained lots and lots of therapists and psychiatrists and he really built up the therapeutic use of MDMA and so from the middle 70s to the middle 80s half a million doses much of it made at MIT secretly chemists at MIT were making MDMA for this underground therapy community and it was out of that then that it leaked and Michael Klee turned it into ecstasy Is it your belief Rick that ecstasy never made it to the public party scene that MDMA could have potentially evaded censorship that came with its criminalization as a schedule one is it possible this could have just at that moment in history been integrated into medically accepted psychotherapy? I don't think so no I think that there was the backlash against the classics like it all so the summer of 84 so I started going to these meetings at Esalen in 83, 84 and 85 and we were planning how to protect MDMA the summer of 84 is when I started Earth Metabolic Design Lab so that was a non-profit that actually had been started by Buckminster Fuller and a friend of mine had a branch of it in Sarasota, Florida for alternative energy my friend hadn't used it and so I was able to take over the non-profit and interpret the alternative energy to include mental energy as well and so that was the non-profit that we used to try to organize to protect MDMA once the eventual backlash happened so when the DEA first moved to criminalize MDMA in the summer of 84 Sasha had had connections with an attorney Rick Cotton with a big DC law firm Andy Weil had gone to Harvard as an undergraduate with Rick Cotton so Rick was monitoring the DEA and so once the DEA moved to criminalize MDMA he let Sasha know so that we had 30 days to go to Washington and so I went to Washington on like day 28 and filed for a lawsuit to try to a DEA administrative blood judge hearing so if there hadn't been a crackdown at that point that was still an era when all psychedelic research was banned that didn't change until 1992 when the FDA had an advisory committee meeting and decided that they would open the door to psychedelic research that was where in 1990 a new group of people at the FDA took over regulating Schedule 1 drugs and they decided to put science before politics let's pause for a moment and explain what are the criteria for Schedule 1 drugs so you have four schedules within the DEA I'll let you explain what Schedule 1 is and it'll work our way so Schedule 1 is for drugs that have a high potential for abuse no accepted safety under medical supervision and no currently accepted medical use that basically says this is incredibly harmful addictive etc and there's no benefit to using it medically and so heroin is a Schedule 1 drug conversely cocaine is nuts the listener might say wait how could cocaine which of those two does cocaine not satisfy well it clearly satisfies the first one it's highly addictive and harmful but it turns out it does have one very important medically valid use which is it's a remarkable local anesthetic in very vascular areas and so cocaine is used quite carefully in nasal surgery if you're having a nose procedure done by an D&D surgeon there's a reasonable chance to use cocaine so MDMA lands itself as a Schedule 1 drug meaning it's on the same level as heroin or methamphetamine well methamphetamine also has a medical use oh that's right so marijuana is a Schedule 1 drug so the way in which it's been interpreted high potential for abuse they emphasize the word potential so it doesn't have to have a lot of people using it it just has to have a high potential for abuse and the way they define abuse is non-medical use it's a very loose definition it can encompass anything because it doesn't have to actually have harm it just has the high potential for abuse so a grape technically could be a Schedule 1 agent well what's the potential for abuse of a grape well if you ate enough you could get diabetes yeah that'd be a bit I don't think grapes are likely to be scheduled but I see your point yeah I mean it's so ridiculous is my point yeah no accepted safety under medical supervision just means that it's not a prescription drug the definition becomes a bit of a topology yeah and no currently accepted medical use I think where people misinterpret what Schedule 1 means is that it doesn't mean that the government has determined that there is no medical use there's no currently accepted medical use and currently accepted has been interpreted as FDA approval it's not that you have a whole bunch of doctors that say this looks like it's got incredible potential they made it so to get out of Schedule 1 you have to have FDA approval so Schedule 2 is high potential for abuse but it has currently accepted safety under medical supervision and it's got currently accepted medical use so opiates fit into this category fentanyl, oxycodone, oxycontin, cocaine is we discussed yeah, methamphetamine for attention deficit disorder Schedule 3 is for drugs that have less than high potential for abuse Schedule 2 drugs whenever there's a prescription one copy goes to the DEA so there's a lot of special controls for Schedule 2 drugs even though they're medically available you can't write a prescription that's automatically renewed for a Schedule 2 drug every new prescription has to be written explicitly by your doctor you can't renew this every three months for the next couple years and it goes down there from Schedule 3 Schedule 1 drugs ketamine has been used as a dissociative anesthetic by an anesthesiologist and it's a prescription medicine it was just approved as ketamine an isomer of ketamine was just approved for depression and it's considered among the most important if not the most important new development in the treatment of mental illness in the last several decades because it's been used for depression and it's effective relatively immediately rather than the current antidepressants that sometimes take weeks and weeks of daily dosing so this schedule system what eventually I think should happen is that the psychedelics should be descheduled completely I think that there's a fundamental human right that people have to explore their consciousness particularly when you think about it as spiritual experiences that we should have this fundamental human right I believe we should have a system of licensed legalization is there a precedent for the DEA taking something that is on schedule 1 and moving it to schedule 2 yeah the oral THC pill Marinol which was used in 8586 for nausea control for cancer chemotherapy was switched from schedule 1 to schedule 2 GHB was in schedule 1 but it's now actually in schedule 3 yeah and last year there was like 1.4 billion in sales of Zyram it's for narcolepsy to help people sleep at night so that they don't fall sleep during the day isn't Zyram actually a chemical cousin of GHB and not actual GHB I'm not sure about that but GHB of course being what was its street name again well that's what's called the date rape drug the date rape drug does it have another name I'm not sure it's the date rape drug because you can put it in water and then it makes people sleepy particularly when mixed with alcohol so it does have a bit of a taste but you put it in alcohol so it's hard to taste it so there is a precedent of moving drugs off of schedule 1 into other schedules usually initially it goes schedule 2 and then depending on how it goes it could go down further so all of this is to get back around to this idea that the DEA moved to criminalize MDMA in 84 this non-profit that I'd started with Debbie Harlow and Elise Agar to protect it we got a hearing and we eventually triumphed and then they're inserted into the different agencies to administer disputes between people in the agencies and they make recommendations to the head of the agency about what they should do so they don't make binding decisions they are there as a quasi-neutral arbitrator of dispute yeah exactly if you don't like the decision that's been made by the head of the administrator of the agency then you can sue them in the appeals court so that's what we did so in 85 though we're winning in the court which is disneyed the DEA didn't even anticipate that we would file because they didn't know what therapy used to be made so they just thought they're criminalizing ecstasy they're criminalizing a party drug and in the final hour you guys show up and say wait please this has really important therapeutic benefit which by the way we should circle back and really talk through that and now all of a sudden quote unquote they're just although it's not really their judge, agrees with you guys and says, this should be a Schedule 3 agent. Yeah, but before the judge issued his ruling, it was clear that we showed up with doctors, with psychiatrists from Harvard Medical School, from all over, with testimony. We did a secret study, actually, of the safety of MDMA, so we had data to present to them.
We had all these things that we kept it secret because we didn't want it to be criminalized before the DA moved. So also, we were winning in the court of public opinion. So Robert Mueller, who had mentioned, was the assistant secretary of general, had referred me to various mystics to whom I had sent MDMA. So in the very first article, it was early 1985 in Newsweek, the first large media article about MDMA, Brother David Steingross spoke on behalf of MDMA and said that a monk spends his whole life trying to cultivate the mental attitude that you can get from taking MDMA.
There was this paper in the Washington Post that Rabbi Zalman Schachter, who had also experimented with MDMA, that I'd sent him, he compared MDMA to the Sabbath. So the idea of this as a party drug used by hedonistic kids just recklessly risking their brains, that narrative, which is what the DEA wanted to share, was contradicted by this narrative of rabbis and monks and therapists and psychiatrists talking about the value of MDMA. So we're winning in the court of public opinion, winning in the court, and the DEA freaked out and declared MDMA illegal on an emergency basis in the middle of 85 while the hearings were still going on. And that was actually heartbreaking because we had thought that the hearing might actually save it.
So DEA criminalizes it on an emergency basis. Later, it turned out that the DEA committed a crime in the sense that they didn't have the authority to emergency schedule. I was just going to ask you both, do they have the authority? And secondly, was there a precedent for that?
Well, no, there was not a precedent for that. What had happened is that Congress had given the Attorney General the power to emergency schedule drugs. The Attorney General, not the DEA. Yeah, all the Attorney General would have needed to do was to sub-delegate the power.
They would have just had to file a piece of paper in the Federal Register saying that the Attorney General sub-delegates down to the administration of the DEA. But that had not been done. Had not been done. Who was the AG at the time?
I don't actually remember. Presumably, the AG at the time was very sympathetic to the DEA. Oh, completely. Because this was, as you pointed out, I mean, this was one of Reagan's signature policy pieces.
Very much the escalation of the drug war. So you could argue that the DEA, though technically in violation of the reg, probably could have done it if they'd waited, gone through the proper channel, they probably could have received authority from the AG to do this. The bigger question is why? Why were they so afraid at that moment?
Well, because here was a drug that was being used by a lot of people, but it wasn't causing problems. Let's dig into this for a little bit. So I think there are many people listening to this who are up until this point in the podcast are thinking, what the hell are these two guys talking about? You're sitting here glorifying drugs.
And so let's talk very specifically about ecstasy. I think back to when I was in college, I had never touched this drug, and certainly a lot of kids were using it. And the conventional wisdom was, this drug gives you hyperthermia, so you run this risk of overheating, you run this risk of getting long-term really depressed because you deplete serotonin levels. I mean, there was certainly a lot of, you know, seemingly legitimate fear around this.
What was actually happening? Well, MDMA can cause hyperthermia. There are cases of people that have taken MDMA. Usually they're people that have danced in hot environments and got overheated, didn't have enough fluid replacement, and so some people have died from hyperthermia.
And is it actually the MDMA that's precipitating hyperthermia, or is it just that anybody who could dance that long in that heat could get hyperthermia, and the MDMA just sort of blunted their other ability to self-regulate? Well, people generally don't die from hyperthermia from dancing all night, so the MDMA contributes. It's a contributing factor. So the MDMA in therapeutic settings doesn't cause hyperthermia.
So there's something about MDMA combining with lots of movement and dehydration that creates this trifecta. Yeah, what also was happening is that in a lot of these environments where people were doing MDMA in these bars, people weren't buying alcohol. Alcohol kind of blunts the MDMA experience. People weren't buying alcohol, and so what the bars would be doing would be shutting off the water in the bathrooms and making people buy water.
And so that's why sometimes people wouldn't drink. Now, also, occasionally, people drink too much water. They dilute their blood. They get hyperthermia.
And so what we use in therapy is fruit juices or things with electrolytes. So for those people that are looking for harm reduction tips, it's better to drink stuff with electrolytes than water if you're doing MDMA. So you drink as much as you want. You're not going to dilute your blood and get hyperthermia.
It's very, very rare that people will have these side effects. MDMA doesn't cause the same kind of dissolution of ego that the classic psychedelics do. So generally, people don't have difficult experiences. However, there are people that have had traumas in the past or issues that are emotional issues, even without traumas.
Because MDMA reduces activity in the amygdala, reduces your fear response to difficult emotions, a lot of times when people do take MDMA, difficult things come to their awareness. And I've witnessed this in therapeutic settings where the tears of past events just come out in a way that you could never imagine is happening otherwise. Yeah, I mean, profound in ways that therapy, sometimes people are too scared to let it out. But MDMA helps them to do that.
And so people can have difficult experiences. One of the stories I told during my TED talk, which will link to it when it's out, was about a woman who I worked with in 1984 who had PTSD. And she had taken MDMA, not in a therapeutic setting, and this violent sexual assault that had happened to her years before came to the surface and intensified her suicidal feelings. And she actually checked herself into a mental institution to protect herself from committing suicide after having taken MDMA.
And when she got out with the same old drugs that had been given to her before, she was even more suicidal. And so a friend of hers, I didn't know her at the time, contacted me about her. And so I started talking to her and agreed to work with her. And under the influence of MDMA and then also an MDMA-LSD combination, she was able to overcome her PTSD.
So in 84 is when I learned about directly working with someone and seeing that MDMA could be helpful for PTSD. Was that, to your knowledge, Rick, the first time, I mean, first of all, were you guys referring to the term PTSD? Was that a term that was widely understood in 84? No, there was a lot of people that had...
I mean, clearly we'd seen it and all these poor guys coming back from Vietnam when you were in college beyond traumatized, but that term was not commonly used. I'm not sure the actual history of the term PTSD. I think it was used somewhat, but people weren't as aware of how much trauma impacts so many, many different people. So at that moment in 84, really what you knew was this is a woman who'd been traumatized, for lack of a better word.
And you saw the potential in this agent to, while on its own, do something potentially dangerous in a controlled setting, you actually felt, what, that she could relive this experience and do so safely and process it. Talk me through what you were really doing in 84 to understand that. Okay, so this woman's name is Marcella. So other people before this, so I had been working with various people with MDMA before, both taking it myself and also sometimes with people that had different issues and sometimes people just looking up to communicate others.
I had spoken to a soldier who'd been shot in the back and he told me under the influence of MDMA that he was able to relax in certain ways so that the pain in his back went away to a large degree, that sort of combination of the impact of the bullets, but also the fear connected to all of that. This was a key turning point in my life. So I had been back to Esalen for a month-long workshop in the spring of 1984 and this was again with Stan and Christina Groff and it was called the Spiritual Emergence Network. So there's a bunch of people that break down for different reasons and different ways where people break down their path in life that's not working for them and often it gets pathologized and people get tranquilized or they get hospitalized or different things but what Stan Groff and others were saying is that this can be a spiritual emergence.
It can be seen as a spiritual crisis that we're resisting so it comes in dramatic ways but the process, what's trying to emerge is healthy. The process is not. So I had studied how to help people who were struggling to integrate either spiritual experiences or psychological experiences that were coming back as part of my effort to become a psychedelic therapist and I was only home for about less than a week when I got a call from this friend of mine who I actually had sold the MDMA to when it was still legal and he said that he and Marcel had done this together in a romantic situation and that her past trauma had emerged he wasn't aware of that and that she was now suicidal and that whatever had been tried by traditional psychiatry including the psychiatrists in the mental institution had not worked for her she was suicidal even worse so I felt like I'm not qualified this is a terrifying situation somebody being suicidal but I didn't think that she had any other options she tried her best in traditional psychiatry and I thought this is what I'm trying to do learn how to be a therapist to work with this and I felt somewhat responsible for having sold them the MDMA and so I agreed to talk to her talk to her on MDMA or just talk to her on the phone so during the discussion she explained what had happened and I was saying that you'd taken this MDMA in a situation where you weren't really anticipating that this would emerge or that you would process this and that it made you destabilized and now you're suicidal however if we were to do this in a therapeutic setting where you're not trying to be with someone where you're able to focus on this the properties of MDMA may help you integrate it may help you fully experience it look at it come to peace with it and I said that if she were willing to promise not to commit suicide while we were working together I would be willing to try to work with her even though I said I'm not a fully trained therapist and we would work with you to try to help you integrate it so she agreed to do that and so we created this context the first MDMA experience that she had turned out to be like a tour of the traumatic experiences of her life this violent rape and assault where she was almost left her dead was not the only trauma that she had there was a series of those other traumas that she had kidnapped when she was young different things and she'd grown up in Colombia in South America so we got a tour of all of the various traumas in her life and it was progress a lot of tears a lot of processing she didn't feel as hopeless but it didn't feel like it had sort of solved her problem so I thought let's switch to LSD for the next experience and she agreed to do that just to say that the first use of a psychedelic for treating PTSD was done by a Dutch psychiatrist Dr. John Bastions and he had done this in the 50s, 60s, 70s and he did LSD for what he called concentration camp syndrome so it was for people that were in the concentration camps traumatized by that and that he had found that LSD would bring a lot of the memories back to the surface and then they could try to process them but LSD doesn't really reduce the fear there's an Israeli Holocaust writer which was his concentration camp number and then there's a number who wrote a book called Shaviti A Vision which is tremendous because he went to get LSD therapy with Dr.
Bastions and this is a book about his therapy and it was very difficult and a bunch of my Israeli relatives knew him and said that it helped him but he was still tormented a lot so in any case with Marcello we decided to switch to LSD and so during the LSD experience a lot of these memories again resurfaced what amount of time was separated between them two weeks so it's really important to integrate the experience before you're ready to do it again so during the LSD experience what happened was that she started having this vision of a double sun she was on a foreign planet and there was a double sun and she was baking to death and it was just terrifying to her and she was stuck she couldn't process it it was just overwhelming fear and so I suggested that she take half a dose of MDMA the full dose was like 125 milligrams so about 62 and a half and I thought the MDMA would soften the LSD and might help her process it and it turned out that's what happened and so once she took the MDMA it condensed from this symbolic foreign thing to actually her life where after she was raped and beaten and thrown out of the car and left under the sun sort of way out to die so it condensed the MDMA helped it turn into this experience that had actually happened to her and then she was able to share that this person had been in a date rape situation and there were times where she was seeing me as the rapist my feet were turning into his feet then they turned back to my feet different kind of things and so and you still had females there as well not at this one time but around her and before and after but at this point it was just very nice so I felt like I could take these projections onto me because that wasn't really me and so she was able to sort of clarify that she was seeing the world through her own distrust through what had happened in the past she wasn't sure what she could trust through her own filters and then when she could sort of feel more safe that it was me and not the rapist at one point I asked her when I realized it was date rape I said what did you like about this guy and she immediately vomited and then she started sharing that he liked animals and so what she was able to do and one of the things that was making her suicidal was that she felt that she could never find love again which is at some level she made a decision to at least be with this guy in some capacity socially or maybe they had a meal together or something and it's like her judgment failed her is probably part of this pain yeah very much so it meant she could never trust herself so how could she find love because it could always turn into something like another date rape but the fact that she could go back and say if you like animals okay so now I can know that somebody else who likes animals doesn't mean that I should automatically trust them she was recovering her ability to be discerning that's a really interesting story because it illustrates something I don't think I've ever thought of until you said it which is that a woman who's been raped in that situation has maybe an additional level of trauma that the equally tragic woman who gets yanked into the alleyway by some stranger doesn't have which is this sense of this loss of self-trust and maybe even this sort of self-loathing of how could I possibly let myself get into this situation yeah I think that's what made Marcella so suicidal is that knowing that she let herself into this in a way or she had made some fundamental misjudgment causing her to question everything that she would then do in the future and so I think once she was able to sort of say yes he liked animals but that's not a reason to automatically trust people she was starting to regain her discernment and regain her ability to feel hope that maybe she could go out and find out were you afraid during this situation I can't imagine what it would be like to be flying by the seat of my pants in a situation like that you're dealing with an incredibly fragile woman who is broken and on the verge of something awful and by your own admission you're not qualified to be doing this yet but at the same time there's no alternative it would seem which puts you in a tough situation I mean how frightened were you? Once she agreed not to commit suicide that reduced my fear a lot and then I did see progress from the first MDMA experience and she did too so that made it less scary and also I've had my own terrifying blockages with LSD where I reached places where I wasn't able to really make any further progress wasn't able to integrate it so it was scary but once I could see that the MDMA was taking an effect once it moved from something that she was just overwhelmed and then that she was able to process it then my fear went down and then when I saw her throw up it's almost like she was purging yeah very much it was like this I think what did you like about him the fact that she immediately threw up that was a clue that that was kind of part of the thing that was keeping her so this happened in 84? this happened in 84 and that was the breakthrough I mean she didn't have any more sessions we just did two sessions and then she felt able to also this person had told her that if she ever talked about what happened he'd kill her and so even though this was years before the fact that she hadn't been able to talk about it was prisoner in her own mind and you realize it's only going to be more difficult for patients like this woman to experience what she experienced and at that moment in time because one of the things that I'm so impressed about the work you've done at MAPS is the well one it's just been relentless it's hard to as someone myself who has dabbled in the sort of non-profit slash policy world only to immediately realize like this is not for me it's the fortitude of which you can do it but also it's sort of the clarity of purpose now I want to make sure we talk about certain concepts like the breakthrough therapy designation which is such an important piece of this story but before we get to that I guess what I want to ask you is in 1985, 1986 how much of what would transpire over the next 30 years was clear to you in other words how much of the strategy of we find an indication for which it is crystal clear that this is valuable the best indication would be one for which there is no other therapy hence this notion of breakthrough therapy did you think that that was going to be PTSD I mean what were you thinking about you hadn't even started at grad school yeah I was still an undergraduate yeah because your PhD is basically geared towards getting you ready to fight this fight yeah I think when I look back on my life it was really at this period when I was 18 in 1972 when I felt like I might be going to jail for being a draft for a church I just felt like the contribution I could make to the world that this support from my family this multi-generational process that permitted me to look at deeper threats that I was terrified of the world and terrified of what happens and terrified of our own human potential for murder and genocide and that I felt that I had this rare gift from my family this freedom to choose what I thought would be the most strategic thing I could imagine which was helping people to realize that we have more in common than separate and that we're all part of one big family and that you shouldn't dehumanize and kill that that decision at age 18 now that I've recently in November turned 65 it's always made sense so I feel incredibly lucky and fortunate that something that I stumbled on at age 18 still at this other period of my life still makes sense and it has made sense continually and I've also thought that if not but for an accident of birth I could have been born earlier I could have been in concentration camps or I could have been sent off to Vietnam or incinerated in nuclear warfare I always felt that whatever the struggles were I was having were nothing compared to what a lot of struggles that other people had to go through. And that this dream that I had of a Holocaust survivor telling me to be a psychedelic therapist, that that's where the motivation came from.
That I had this rare opportunity to try to work on long-term threats that didn't have to directly lead to a job that didn't exist. So when I was 18, I thought I would be an underground psychedelic therapist. The first day in the office of President Carter, he pardoned all the draft resistors. So that started me starting to think that I could have an above-ground career.
It's a far way from being pardoned as a draft resistor to the legalization of psychedelics. Are you saying that was just your first clue that the ice was melting a little bit? I identified myself as a counterculture drug-using criminal. So at age 18, that was my self-identity.
Counterculture drug-using criminal. A little bit of the criminal part was taken away, and then I thought I could sort of rejoin society in a certain way, but I was still criminal from abusing psychedelics. Going to college was now in 82, starting was now psychedelics were forefront, but they were always what I had been planning to in this 10-year period that I was building houses and preparing for doing this. And then the transition of being politically involved with a non-profit in 84 and then starting MAPS in 86, that also changed my attitude.
The fact that there was a non-profit that this friend had started, John Lambie, connected with Buckminster Fuller, there was a metabolic design lab. I started realizing that that was part of the system, this non-profit, and that the system permits you to fight the system. So I was sort of outgrowing this idea of myself as counterculture, and seeing that you could work within and that there are opportunities for reform from inside. And then the work with Marcella in 1984, and seeing her continually get better over time as the demonization of MDMA increased and as all of this NIDA, National Institute on Drug Abuse-funded research started talking about MDMA neurotoxicity and all the concerns about hypothermia and hyponatremia, and just the demonization of MDMA, the blocking of all MDMA research, the whole part of that.
The big transition for me, once MDMA was criminalized by the DEA on an emergency basis, the judge in 86 said it should be Schedule 3. The DEA rejected those recommendations, and then we sued in the appeals court, and we won twice in the appeals court. Both of the time, the appeals court tends to tell agencies, what you did is wrong. They don't normally say you should do this.
They just say what you did is wrong, go back and rethink it. Do they have authority to do anything other than just make a formal position on what was done? Yeah. So for example, in school integration, sometimes courts will take over school systems.
Courts can actually compel. The appeals courts can compel. But this is unbelievable. I mean, you have the DEA judge says make it Schedule 3, and then you have two subsequent appeals saying that basically what the judge said they agreed with, or what the DEA did was incorrect.
Yes, that's what they said. So the rationale for the DEA to reject the recommendation, the first rationale was that the DEA said they didn't have the authority to reschedule, only the FDA did. The Controlled Substances Act of 1970 clearly says either the Attorney that either could reschedule to make the drug into a medicine. And the FDA sits under which branch?
HHS. HHS, which is where, yeah, okay. And the DEA sits under what? The Attorney General.
The AG. And you're saying the Controlled Substances Act made it clear either had the power to reschedule. So the DEA basically said, it's sort of ironic, they had the power to schedule but not reschedule, is what they're basically claiming. Yeah, so the DEA lawyers, as I've learned over the decades, they don't really care if their arguments are flawed because they delay.
So delay is the same as victory to them. So if they put out a ruling that's wrong, it can take you years to go through the appeals court. And so justice delayed is justice denied. So they don't care about their arguments, they just want to delay.
So the first argument they made was that they didn't have the authority. So the appeals court said, yes, you do. Then they came up with an eight-part standard that they said you have to meet these standards in order for us to reschedule. To whom?
The DEA lawyers would then put a new ruling in the Federal Register justifying why they rejected the administrative law judge's recommendation. And so their new rationale was, okay, here's our eight-part standard. So then we appealed on that because that was essentially the same as FDA. And if the Congress had wanted the FDA to be the only agency to reschedule, that would be one thing.
But the fact that they gave the DEA the authority to do it, the DEA couldn't say it's exactly the same thing as the FDA. Why didn't you at this point go to the FDA, which is the problem with the DEA at this point is the cognitive dissonance is overwhelming. You're asking someone who's done something to openly acknowledge what they've done was incorrect. So why not go to a new body?
Well, we were also going to the FDA, but the FDA was rejecting all the protocols. So this was a period of time when the backlash against psychedelic research was so strong that the FDA was rejecting every single protocol. And so we were trying to go to the FDA, but they weren't responsive either. And so then the courts rejected this eight-part standard as being too equivalent to the FDA.
And then the DEA came up with a five-part standard, which the court accepted, which is still essentially the FDA. You still need phase three studies. And so basically the DEA gave away their authority to reschedule to the FDA because they didn't want to reschedule. They wanted to schedule but not reschedule.
Is that pretty much how it stands today? Yeah, the DEA is. But what's happened a few years ago is that Congress passed a law. It was always the case that if FDA says a drug is a medicine, the DEA must reschedule.
But they didn't have a time limit. So now they have 90 days that they have to reschedule. So we had MDMA criminalized in 85, kept that way, and 86, I started maps. And then I thought that I would go and get a clinical psych PhD.
So I graduated college in 87 with my Good Friday follow-up as my senior thesis. And because New College didn't have any grades, I knew that to get into graduate school, I had to really study well on the GREs. So I did great on the GREs. I had incredible recommendations from this professor that had been head of the PhD program in psychology and social change at Harvard, who had retired in Sarasota and who was my special teacher every semester.
I had one class with him on psychology. So in any case, I tried to get into clinical psych PhD programs, and nobody would let me in because I told them I want to do MDMA research. And I was saying, we can't do it now, but I don't want to spend five years getting a PhD and then I'm about to do my dissertation, and then you tell me you won't let me do it. So I want to tell you what I want to do now.
And if we get there and the system won't let me do it, I'll do something else. It's very hard to get into clinical psych PhD programs, but I came very close a couple times in programs that had psychotherapy outcome research as their specialties. And so I wasn't in the end able to get in. And so I was confused because since 1972 until now it was 1988 that I had been on this track for clinical psych PhD, learned how to do psychotherapy outcome research with psychedelics.
So I went home after the last rejection. I said, I'm going to figure out what I need to do with my life. And so I decided to smoke marijuana and think about it. And marijuana gives me a way to think about things from a different perspective.
I'll be trapped in a box. And so I had this realization that I want too much too soon, that I want to do the science, but the politics is in the way. And so I'm leaping over. The culture isn't ready.
I want too much too soon. And so I thought, okay, if I want to do the science, but the politics is in the way, maybe I have to study the politics. And I remembered reading an interview in Harper's Magazine with several people talking about drug policy. And one of them was a professor at Harvard at the Kennedy School of Government, Mark Kleinman.
And they talked about our lawsuit against the DEA. I wasn't even aware of all the policy schools or the Kennedy School of Government, but I remember that he had mentioned our lawsuit. So I called him up and I said, I want to study the politics. I can't do the research I want to do.
I can't do the education I want. So would you be my mentor? And he said, if you can get into the Kennedy School, I would be glad to be your mentor. And so I applied and I managed to get in.
I started the token left-wing hippie of the year at the Kennedy School. And so that also started changing who I thought I was. And now I'm even more becoming part of the system rather than becoming part of the counterculture. I'm at the Kennedy School of Government, Harvard, and people are planning careers in the federal government.
And so what they had was there was a program called Presidential Management Internships, now the Presidential Management Fellowship. And so it's for people who want careers in the federal government. It's a competitive situation. Federal employees watch you as you do group exercises.
There's all sorts of essays and things. And so I managed to, it was at the same time that the Native American church was having a Supreme Court case about whether the pay would be protected by religious freedom. So that was my essay. I was able to write an essay about a Supreme Court case, but it happened to be about psychedelics.
And so I managed to get a presidential management internship. And then I tried to get a job at the FDA. I figured I want to work at the FDA. And coincidentally, in 1990 is when I got my master's and when I was applying for this job at the FDA.
The group that regulated psychedelics switched in 1990 to a new group. So the group that had blocked research basically for two decades was now out of the picture. And a new group took over. And my application ended up with this new group.
It was called the Pilot Drug Evaluation Staff. They were there in response to the AIDS epidemic where the FDA had been criticized for being too slow to approve drugs. This was a group that was going to review new ways to approve drugs and faster. And so they were looking around to the FDA, to other parts of the FDA, which groups had drugs that they didn't care about that they could take over.
So they'd have real-life examples. And the Schedule 1 drugs had been blocked by Paul Lieber, who was the guy in charge of the division that took care of Schedule 1 drugs. So he gave them up to this Pilot Drug Evaluation Staff. My application ended up with them.
And we went through about a six-month process of review of whether I would be able to get this FDA job, including interviews with the number two guy, Carl Peck, who was in charge of all drug research at FDA. And the FDA decided that they would hire me. It was great. I was really excited.
I was willing to give up doing drugs. I was willing to wear a suit and dye and do all this stuff to go work into the FDA for a couple of years, learn how they work, and then come back and run maps and try to make MDMA into medicine. But at the last minute, right before I got hired, the DEA told the FDA that they would refuse to work with me because I'd sued them before. And this is the branch of the FDA that works with Schedule 1 drugs that deals with the DEA.
So the FDA said that I couldn't be hired, but they would work with me informally. It's hard to be listening to this story and have a lot of empathy for the DEA. I'm trying to sort of put my DEA hat on and sort of say, like, these are good people. They're doing their job.
They believe that they're doing the right thing. But they really come across as a petty bunch of, I don't know what the right word is, but just sort of intellectually not particularly curious, not especially thoughtful. I mean, to say we're not going to work with this guy just strikes me as a bit petty. Oh, extremely.
Yeah. And then shunning responsibility, deciding, well, we're going to schedule something, but we don't want to schedule it. But my guess is if anybody's able to muster up some empathy for the DEA, it's also you. Nothing about you resonates this disdain for them.
It's more of a, gosh, I wish I could help them see what I see and what I've seen and the potential benefit of this. Yeah. And what has really changed is I have started having some sympathy for the police and how difficult their job is. And so actually we have a senior retired DEA official who is now acting as a consultant for us.
The reason is because his son went into the military and has PTSD and uses cannabis for his PTSD. So that changed the father's mind. And actually October of last year, 2018, this fellow, Tony Colson, former from the DEA, arranged for us to give a talk at the International Association of Chiefs of Police. So it's a convention that was all over the world.
It was 10,000 police chiefs and police officers. And so we actually had a veteran, one of our therapists, me and our DEA consultants speak. And what's so exciting for me, what happened there is that it was such a politically ripe environment for President Trump that two days before we were supposed to speak, he decided he would speak there. And they scheduled his talk at the same time as ours.
And almost everybody went to his talk. But 30 people came to our talk, including a psychologist who works for the police, a police officer who helps other police with psychological issues. And he said that at the end of our talk, he wanted to go through our training. And he has.
And so next week, I'm meeting with, he's actually from the Boston area, so I'm meeting with his police chiefs about having police with trauma volunteer for our study. That was a big step for me, is trying to have sympathy for the police. And what's also ironic is that my sister, an oldest of four, two brothers and a sister, both brothers have done MDMA, but my sister will never do a drug. She's very conservative in that way.
Her son, her oldest son, Nathaniel, my nephew, is now a police officer in Washington, D.C. So I have a police officer in the family. So all these us and them kind of barriers are dissolving. And in December of 2017, we had a meeting with the police, with the DEA headquarters.
And it was to talk about what's called expanded access, which is compassionate use of MDMA. And all sorts of people are going to want to do that, and they're also going to need these DEA scheduling licenses. So we had a meeting with the DEA to talk about that, with our consultant again, to prepare them for all these licenses. And they said that they would do that.
One thing that happened that was so personally meaningful is that you can't go to DEA without an escort. When they take you into the building, they don't want you to see somebody's desk or whatever. So we had an escort. So we're in this elevator with the escort, and we're going up to the fourth floor to where our meeting is.
And for whatever reason, it's only our team and this escort. And the door opens on the second floor, the elevator door. Nobody got in, nobody got out. We didn't press number two.
But for whatever reason, the door opens, and the second floor closes, and then we go up to our meeting, and our DEA consultant whispers to me that the second floor is where the courtroom is. So I was previously in that building in 2005 suing the DEA, not on MDMA, but on another lawsuit for marijuana, trying to get a license to grow marijuana. So it felt like the door opened on the past conflict that we had with the DEA, and then closed. We noticed it, but nobody else noticed it.
And then we went up to have a cooperative meeting about how we could work together with the DEA. And the one part of the meeting that went flat, everything was really good. They're willing to give all these licenses. I just said to them, if any of you have DEA officials or officers that you know that have trauma they're in cities where we have studies, they can volunteer for our project.
And nobody smiled, nobody offered, but I just wanted them to know that this is for them too, that I did have that level of compassion for them. And I knew it would be awkward for me to say it, but I felt like I had to say that, that this is for them too. And now I understand more and more about how police are traumatized. This notion of, I don't know how to explain, there's a really nice video you guys made.
It's a map, it's maybe 10 minutes long. It can't be that old, because Sasha died how many years ago? Oh, quite a few. Like 2014, maybe?
Yeah, I'm not sure exactly what you are. It was that year, because at the end of the video, it notes that he died about four months after the filming. Like I said, it's maybe 10 minutes long, but there were many survivors in it talking about their experiences with MDMA. And it's very moving.
Do you know the video I'm talking about? We'll find this one, we'll link to it. But it's worth someone who either doesn't have experience with PTSD, trauma, MDMA, to maybe pause for a moment and watch that and get a sense of what it is that you saw in 1984 that kind of created an internal flame inside of you that said, look, until every person who has experienced trauma or is suffering from PTSD at least has the opportunity to experience this type of therapy, I'm not really going to stop. That's sort of what I sense in how you talk about this.
Yeah, yeah, that's true. I mean, even if I'd never discovered MDMA, I would have tried to legitimize LSD and the classic psychedelics. But seeing that there was a softer, gentler way of working with MDMA, I feel that it's very rare that people who work on social justice movements live to see the change that they're working for. Because a lot of these things are multigenerational.
If you think about civil rights or under slavery, yes, of course. Yeah, I think that through an accident of history, I was born just at the right time so that there was this backlash that I was able to see for psychedelics, the classic psychedelics, then this backlash against MDMA. But now I might actually live to see the medicalization of psychedelics. And that would be an arc of a life contained.
It would be incredible. When did you guys receive the breakthrough therapy designation? Sardamaps in 86. So from 86 to 92, we had five different protocols all rejected by the FDA.
And again, just for the listener to understand what we're talking about, you are proposing to the FDA clinical trials that would necessitate the FDA to create an exemption for the use of a Schedule I drug. It's a big deal. Yes, and DEA would also have to approve it as well, and institutional review boards or ethics committees. And in California, that's the only state that actually has an additional review body for scheduled drugs.
So it is a lot of regulatory affairs, and I did learn a lot about it in the Kennedy School how to work through it. But so in 92, the group at the FDA that regulated psychedelics switched, and that group decided to put psychedelics on a track for science. So from 92, we got permission for the phase one safety study, the first dose response phase one safety study. That took us till about 96.
Wow, I just want to pause for a second. That's 10 years of your life, and you spent six of them just getting rejected, being told you're not even allowed to play the game, get off the field. Then you spend four years demonstrating what you pretty much know is already true, which is at a given range of doses, there's no toxicity to this drug. But of course, that is a hoop you must jump through, understandably.
Yeah, we had to do that. And then the doctor that I was working with, Charlie Grove. Sorry, one other technical question. At any point in here, did you have to file an IND?
All the protocols that were rejected were INDs, yeah. Maybe explain to folks what that is and why that matters. IND stands for Investigational New Drug. It's a formal application to do research with a drug to try to make it into a medicine.
Before that, actually in 1985, even before MAPS, I funded through this first non-profit animal studies, 28-day animal toxicity studies in the dog and the rat. So that was a requirement to do phase one or phase two research. You have to have certain animal toxicity studies. So I did that already.
We had our MDMA manufactured by Dave Nichols at Purdue University in 1985. We're still using some of that today, three to four years later. Incredible stable molecule. We've had new MDMA made for phase three and for commercial uses, if we succeed.
But it took until around 96 to get the safety study done. And then Charlie Grove, the psychiatrist that we were working with, we were proposing a study on cancer patients with anxiety. I knew about PTSD, but there was such a concern about neurotoxicity, which was vastly exaggerated. Yeah, the other thing that people talk about a lot was Parkinsonian-like symptoms.
My recollection is a lot of that research, quote-unquote research, has been quite debunked. Is that the case? A hundred percent debunked. Because it turns out that the only claims of Parkinson's were, again, from George Riccardi and Unmucan, these researchers that were at Johns Hopkins, funded by NIDA.
And they claimed, well, from the middle 80s to near the end of the 90s, they were focused on MDMA supposedly hurting the serotonin system and causing functional consequences of a serious nature so that nobody should ever get MDMA even once. It was so serious. One dose, functional brain damage, stay away from... It completely shouldn't even be researched.
I was taught that in medical school. In 97, taking pharmacology, it was, this is a drug that can permanently alter your serotonin receptors. Yeah, totally not true. But we started challenging that.
So actually, George Riccardi was my first alliance. So I recognized that in the 60s, there was an exaggeration of the risks by the prohibitionists and a denial of research and a denial of the benefits. But the advocates, like Leary, were exaggerating the benefits. Both sides were doing the same thing.
So I felt that MAPS had to be the expert on the benefits and on the risks, that we had to be reliable. People had to rely on our risk estimates. And so once I started working with MAPS in 86, my first alliance for six years basically was with George Riccardi, the expert funded by NIDA to look at the risks of MDMA. And so I funded his first monkeys to move from rats to monkeys.
So this is a real team of rivals. Oh, yeah. You are funding the person who is being sponsored by your opponent and basically suggesting things that you believe are untrue. Now, presumably, you don't believe that there's any fraud in this.
It comes to that. So with George Riccardi, so first off was, I thought, okay, we're scientists. We want to find out what's really going on. I'm very interested in what's really going on.
What are the risks? I'm taking the drugs. I should know myself. Everybody should know.
And we got as far as we could with the animals. And in the primates, we found out what was called the no effect level for neurotoxicity. No as in NO. Yeah, so it's NOEL, no L.
So no effect level. So it turns out that five milligrams per kilogram in a primate, given every two weeks for four months, so eight exposures every two weeks, and at five milligrams per kilogram, there was some nerve terminal degeneration in the primate. At two and a half milligrams per kilogram, there was no nerve terminal degeneration. So again, I should say that there may be changes, but changes are not necessarily bad.
I mean, our brains are constantly changing. And in fact, when you have therapy with MDMA, you have a reduction overall before and after in activity in the amygdala. So certain things are definitely changing, which can be good. What were the changes that occurred phenotypically at the five milligram per kilogram?
Well, there's never a cell death. It's just nerve terminals degenerate. Did that manifest itself in any cognitive deficit or behavioral deficit? No.
The claim was that the only functional consequence that could be identified in ecstasy users were neurocognitive consequences, supposedly memory. However, we've since done studies. A member of MAPS contacted me to say that methodologically, all these studies that were done in ecstasy users were methodologically confounded because these users had done all sorts of other drugs. So how do you say what's from MDMA?
And also, there's no pre and post. It's only retrospective compared to supposedly controlled groups. So this guy said, I have the solution, that there's a group of people that have done only MDMA, and you need to study them. And so we're right here, right now, just about a mile from McLean Hospital, which is more psychiatric research, part of Harvard Medical School, more psychiatric research done there than any other private institution in America.
And there's some people there that are experts in neurocognitive studies. And so I told them, MAPS will give you a grant. There's this group of people. So we gave them a $15,000 grant.
It turns out they're fallen Mormons. The study took place in Salt Lake City. A bunch of Mormons who had never done coffee, never done tobacco, never done marijuana, never done alcohol, but had done ecstasy because it wasn't formally prohibited. And so this population did exist.
So they went and did a pilot study, then they prepared the data, and they submitted it to NIDA, and they got a $1.8 million grant to a major study of people who only used ecstasy, and they found virtually nothing. There really is no strong evidence, no weak evidence, even really about neurocognitive consequences in heavy ecstasy users. And we've done neurocognitive studies in our therapy studies, so we only get MAPS a few times. There's no evidence whatsoever.
So with Georgia Cardi, after we found him, he didn't publish the 2.5 milligram, he published the 5 milligram per kilogram where there was some evidence of nerve terminal degeneration, but he didn't publish the 2.5 milligram per kilogram. So I started thinking, this is not so much about science anymore. There is a political agenda. But then I went to him and I said, I don't feel hurt.
How can you go even further? And he said, well, the only thing we can do now is spinal taps. So I said, all right, I will volunteer for a spinal tap. And so it didn't hurt that much.
It was terrible. At that point in time, how often had you been at or above the 5 milligram per gig dose? I had never really been above it, but most people had not been above it. So I basically said, I'll be your guinea pig.
So I got a spinal tap. And I thought about it as, if women could give birth, I could give birth to my spinal fluid for my purpose. And once it wasn't so bad, then I got over 30 people to volunteer for spinal taps, which were done initially at Stanford and then at Hopkins. So all of this is to say that it didn't seem like there was any harm to dopamine.
We're still all focused on serotonin. It didn't seem like there was much evidence that there's any problems with our serotonin either. You only get serotonin metabolites in the spinal fluid. But what then happened was that the escalating fears of the rave movement and so the serotonin hypothesis of MDMA causing serious problems, it started being challenged more and more by other scientists, by people at the CDC Center for Disease Control.
So their neuroscientists started challenging this exaggerated risk estimates of serotonin. And so then what happened with George Riccardi and Nunez McCann is they realized this in the end of the 90s that the serotonin damage theories that they were using to try to block research was getting increasingly dubious and challenged. Plus, more and more people any evidence of harm and dopamine. Other studies have not shown any harm and dopamine.
They were just searching. They killed a bunch of animals, died during their experiments. But this was published in Science. I was just about to say, how did Science publish that?
There must have been something they saw. Alan Leshner, who was the head of NIDA, later left NIDA, he built it up, he pandered to Congress, he scared them about MDMA and other drugs, he increased the budget of NIDA up to over a billion dollars a year, and then he left to become the president of the AAAS, the American Association for the Advancement of Science, which publishes Science. Yeah, so that former head of NIDA, who was the main patron of George Riccardi. Which is a real shame.
I mean, people just might not appreciate the significance of what you just said, but Science and Nature are the two most high-impact journals in the entire field of science. So, in other words, most scientists will go their entire career and not even have the ability to submit an article to one of those journals, let alone have an article be accepted in one of those journals. I don't believe there is an equivalent outside of Science in terms of what the prestige it would mean to have your work published in that journal. So it is certainly troubling to hear that, not surprising, of course, but it's not the first time I've heard these stories, but I think for people to understand what the implications, this isn't the National Enquirer.
Right, and then there was an editorial in Science that talked about MDMA as being Russian roulette for your brain by Alan Leshner. And this study, though, that was published in Science, actually just why a couple weeks ago this paper in Nature about MDMA positively causing neurogenesis and oxytocin release, and that's why that's so significant. Yeah, exactly. Now you have Nature and Science being on book ends of this interesting story, this arc.
Michael Minhofer and I and others of our lead psychiatrists, we wrote a letter to Science and we said that this doesn't make sense, this paper to us. You've killed a bunch of animals. Other animals have not died in experiments. You didn't give the animals the MDMA orally in the way that people normally take it.
There's all this evidence that MDMA doesn't hurt, don't mean. Nobody we know has Parkinson's and so we challenged them. And so what we didn't know then is that they spent a year trying to replicate their results. So our letter did get published in Science, our critical letter.
But this whole year, they kept defending their studies in the media. But we later found out that they were having increasing problems in replicating their results. And they later, out of frustration, after they couldn't replicate their results, took some of the animals that had died, did a tissue analysis, and had discovered that they had given the animals methamphetamine instead of MDMA. It's a slight mistake.
It's just a slight difference. It's a subtle difference. Yeah, and so they should never publish that paper because they should have known Did they print a retraction? They did.
They had to retract it. That was 2004. End of 2003, 2004. So that was sort of the high watermark of the fear and paranoia about MDMA and neurotoxicity.
Okay, so that relates to that's when we got the first approval for our first PTSD study. So Charlie Grobe, after we finished the safety study, he started getting worried about MDMA being so identified with ecstasy and the wave movement and neurotoxicity. So from a procedural standpoint, you have your IMD filed. You've now documented through phase one that this is not toxic.
More importantly, you're not just winning that battle there. More broadly, the scientific community is now realizing actually this is not a toxic compound whatsoever. But in some ways, that's just the end of chapter one. Chapter two is great.
You have a safe compound. Now, what is the indication? What will be the medically valid use for this compound? We had thought initially MDMA for cancer patients with anxiety because cancer patients would die and they wouldn't live long enough to supposedly show the effects of neurotoxicity.
But Charlie, who I was going to work with on this, he decided that MDMA is too controversial and he wanted to switch to psilocybin. So that started the whole work with psilocybin with cancer patients. I knew from 84, working with Marcella, and just by the way, Marcella is now one of our lead therapists, training other therapists. She later became a therapist.
So it's a tremendous success in her life. So I returned to PTSD and Michael Mithoffer, who's our lead psychiatrist, came to me in 2000 at a conference, the first conference ever on ayahuasca in America, organized by Ralph Metzner in San Francisco. And he was a member of MAPS, but I didn't know him. And he'd also been trained in the holotropic breathwork by Stan Groff, which I'm also trained in.
So it's hyperventilation to bring out experiences that are sort of like LSD or psilocybin. So Michael came to me in 2000 and he said, I want to work with you on creating an officer or clinic somewhere in the world. Was there any developed country in the world or any country for that matter for which MDMA was scheduled? Because usually what happens is once the U.S.
schedules, other countries follow suit. Yeah, so very briefly, in 85, and so he helped me set up meetings at the World Health Organization in Geneva. So I went to Geneva in 85 and brought information there to slow down the DEA criminalizing internationally. And in some incredible coincidence, the head of that committee, the expert outside committee was Paul Groff, Stan Groff's brother.
And the committee endorsed the criminalization of MDMA except for one person, Paul. And he got a little footnote in there saying that this is an important compound. He was worried that the criminalization internationally would reduce research and that they encouraged the nations of the world to facilitate research, which led to the Swiss government from 88 to 91 permitting people to do compassionate use of MDMA and LSD. But when Michael came to me and said, so there's no place in the world because it did get criminalized internationally.
But Michael had been in St. Kitts where there was a clinic that was set up for Ibogaine. Ibogaine is something that I very much want to research. It's for opiate addiction.
We're in a massive crisis for opiate addiction. Ibogaine helps people through the withdrawals and it can give them spiritual experiences and brings up what they've repressed. So it can be very, very helpful in both going through withdrawal and also in reducing relapse. And it's illegal in the United States, but legal in Canada, Mexico, multiple places.
So Michael had a patient of his gone to St. Kitts and he went with. And so he came to me and said, let's set up a clinic. Maybe we can find some place where there's a DMV or LC we could set up a clinic.
And I said, I'm totally 100% not interested in doing that. Because it sort of undercuts what you're doing at Maps. It's sort of like saying, again, there's so many moments in your story, Rick, where I'm sort of struck by the maturity of the hippie. Like you're way smarter than anybody else.
I wouldn't have had the foresight to have, you just played the long game at every moment and I want to applaud you for that as someone who I just know personally I just wouldn't have had the discipline or the foresight to have played that long game over and over and over again, which was this is about the highest integrity of the policy level. This is about the highest integrity at the scientific level. And it's a hard decision because along the way fewer people had access to something that you felt very strongly could help them. But it was one of those examples of if it means that a few hundred people or a few thousand people are denied this opportunity today, as much as that's heartbreaking, this could mean millions of people can one day have access to this and we won't sort of taint or undermine the rigor with which we get them there.
Yeah, and I've always had people in the back of my mind from the Holocaust saying, if we don't bring this forward and mainstream it, we could have another situation. We have the rise of authoritarianness and the rise of hatred for the immigrants. We have a lot of that going on right now, we can see. And so that just is further motivation for me to try to mainstream it.
Even that's where the compassion for the police comes in. It's for them as well. And so I said, Michael, I'm totally not interested in setting up a washer clinic, but I think, first off, there's no place. But secondly, it's about going to the heart of the system and making change happen from the inside out.
Yeah, your fight is here. Your fight is in D.C. Yeah, exactly. And then the U.S.
is one of our most successful exports has been the drug war. And so other countries look around at us. If the U.S. is changing, then the drug war will erode all over.
So I said, Michael, I think that now is the time we can work with the FDA. Would you work with me? And he was an expert in PTSD. I'm like, fantastic.
Because PTSD is the next thing. And now that we don't have to worry about people saying, oh, neurotoxicity, PTSD became the number one thing, the top priority. And Michael said yes. Yeah, before we leave the toxicity and start talking about the oxygen, based on everything you know today, which patients would not be good candidates for MDMA from a safety perspective?
Are there some patients that we would still say today? Because, you know, any drug we can say, ibuprofen shouldn't be taken by certain patients. Tylenol shouldn't be taken by certain patients. They're over the counter.
Who in your mind is not a good candidate for MDMA therapy? The most important thing is people with compromised hearts so that MDMA increases blood pressure. Not overwhelmingly, not substantially, but significantly. I can show you.
But we work with people that have controlled hypertension. People that have had uncontrolled hypertension and only recently got it controlled will say you need to do a stress test. But of all the tens of millions of doses of MDMA that are being used every year in the world, there's almost nobody who ever has a heart attack. Almost nobody, really.
I mean, there's hardly any cases like that. But still, that's the concern. When people are on a lot of other psychiatric medications, we ask them all to taper off of them. The SSRIs blunt the effects of MDMA.
There's a remote chance that MDMA could trigger a seizure. Also, that seems to almost never happen, but so we will not at least initially work with people who are epileptic. I notice in the documentaries the patients in the study have blood pressure cuffs on. Yeah, we have to monitor blood pressure and temperature.
We exclude people that are psychotic. We exclude people with schizophrenia, although I think MDMA could be very helpful with schizophrenia, but it needs a different container because we basically do outpatient. I mean, they come in for the MDMA session, which is done under supervision. They spend the night after the MDMA session and then they get more integrative psychotherapy the next day, but then they go home.
So if somebody was schizophrenic, we would want more of a... They need a longer containment window. Yeah, bipolar. I don't think MDMA is likely to be helpful for people with bipolar.