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Psychedelic Therapy: Safety, Legal Standards, and Clinician Education

Listen to Dr. Lynn Marie Morski, physician and attorney, discuss the safety, legal, and clinical considerations regarding psychedelic therapy in the U.S.


Episode Summary

In this second episode of the three-part series on psychedelic-assisted therapy, Dr. Lynn Marie Morski, a physician and attorney specializing in psychedelics, discusses various aspects of psychedelics and their integration into healthcare. 


Dr. Morski shares her journey and how she became passionate about educating clinicians on psychedelic medicine. We discuss the current legality of psychedelics in healthcare, safety concerns, and the lack of protocols. Dr. Morski talks about what to consider when choosing a psychedelic therapy provider, emphasizing the importance of training, ethics, and safety measures. We touch on the debate of whether therapists should have personal psychedelic experiences before offering guided psychedelic therapy, and the potential for psychedelics to become part of mainstream healthcare. 


Listen to this insightful conversation to explore the challenges of psychedelic therapy, the potential benefits of psychedelics for women's health, and advice for physicians and patients interested in exploring psychedelic treatments. Learn about the exciting developments in psychedelic research, including the investigation of psychedelics for stroke recovery and the exploration of non-hallucinatory psychedelics.


Key Takeaways

  • The need for clinician education on the use and potential benefits of psychedelic-assisted therapy

  • The legality of psychedelics as medical treatment medicine in the U.S.

  • The need for safety protocols and guidelines in psychedelic therapy 

  • The importance of vetting facilitators and retreat centers that offer psychedelic therapies, and how to go about that process 

  • The debate on whether therapists should have personal psychedelic experiences to have common ground with patients

  • Legal challenges and potential lawsuits that currently limit the mainstream use of psychedelics in healthcare

“There are a lot of things you can do [when choosing guided psychedelic therapy]. But pay attention to your intuition because you are handing over your consciousness to this person. And if you have any doubts in your gut about that, that's going to be setting you up for failure from the beginning." — Dr Lynn Marie Morski 

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Guest Bio

Lynn Marie Morski, MD, JD, is the president of the Psychedelic Medicine Association, host of the Psychedelic Medicine Podcast, and the Director of Education at Unlimited Sciences. She sits on the advisory boards of Psychedelics Today, Cybin, VETS, Inc. (Veterans Exploring Treatment Solutions), the Oxenberg Foundation, and the Ketamine Task Force.


Dr. Morski received her medical degree from St. Louis University School of Medicine, completed family medicine residency at Mayo Clinic, and did her sports medicine fellowship at the University of Arizona. She later received her law degree from Thomas Jefferson School of Law and is a member of the California Bar.


Transcript

Georgie Kovacs:

Hi Lynn Marie. Thank you so much for joining me on the Fempower Health podcast. Discuss a very important topic, psychedelics. And originally, I've been thinking on Fempower Health, like, what innovative medical topics should I be covering that I haven't yet? And this was one of them. And then it turns out I go to the health conference and there is a panel on psychedelics, and you are on it. And you were so impressive with what you had shared, and I wanted to make sure to have you on the Fempower Health podcast to discuss your area of expertise. And so I so appreciate you making time and joining me today. So before we dive in, why don't you give us your background and how you even got into the realm of psychedelics?


Dr Lynn Marie Morski:

Absolutely. Well, first off, Georgie, thank you for having me. My background is my training is as a physician and attorney in the medical world. My specialty was family medicine, and my subspecialty, which is totally unrelated to anything I do now, but was sports medicine. And then after fellowship in sports medicine, I started working at the VA. And during my years at the VA is when I went to law school. But somewhere in that nine years that I spent at the, and if you can imagine, obviously, I'm seeing service members, and I'm seeing them as they're leaving the service. Generally, I was doing these exams that they had to get as they left the service.


Dr Lynn Marie Morski:

And I'm hearing the same complaints from almost every single one of them. So many of them had anxiety, depression, PTsd, traumatic brain injury. Those four were very common. And somewhere in that nine years, I had my first experience with psychedelics myself. I grew up very conservative. I hadn't even touched cannabis. I had no experience with anything. But I started to have my own experiences.


Dr Lynn Marie Morski:

And then afterward, I learned that psychedelic science and research was an actual field of research. And, oh, it wasn't just me who was having these realizations when I would occasionally do a psychedelic. And so that's when I got very interested. And it was somewhere in 2018 that I had my first ayahuasca experience. And the amount of people continue to over exaggerate and say it's like 50 years of therapy in one day, or whatever the exaggeration of the day is. But for me, it was not the amount of therapy, it was the effectiveness of the therapy, because the answers were coming from my own brain, which I trust more than some other external therapist or some kind of external locus. And that was so effective to me that I remember thinking, how can I go to work and not tell the veterans about this? But I couldn't because it's illegal and because I was a department of defense contractor. And so over the next year, that kind of little itch in the back of my brain just grew stronger.


Dr Lynn Marie Morski:

And I thought, I have to make this my mission. I need to educate people on psychedelics, but more specifically clinicians, because it's one thing to get word out to people, but still a lot of people get their medical information and their medical recommendations from their family doctor or their practitioner. And so I decided that is what I needed to do. I needed to make it my mission to educate clinicians on these medicines. And so, starting in 2019, I left the VA, and with no real backup plan, but just a mission. And I started the psychedelic medicine podcast. And then about a year later, I realized that that's not how clinicians get their information. They don't have 45 minutes to sit down and listen to a podcast.


Dr Lynn Marie Morski:

So then I started the psychedelic Medicine association so that clinicians could join and we could have a more streamlined way of educating them.


Georgie Kovacs:

The first interview in this series, I'd spoken with Jordana, who specializes in public policy, and she just gave me this whole world of how psychedelics even fits into medical practice. And in that episode, we talked about, okay, so let's say we start having psychedelics approved because of how you practice that versus taking a pill and seeing a doctor for an hour is so different. So, like, if it really transforms that's different. And then meeting you and hearing you talk on the stage, the world opened up on how physicians play such a huge role in understanding it, how they're treating patients, and then patients understanding how to vet physicians because there's care there. And then the last in the series will be around the research and clinical practice of this. And they're all like, at a surface just to have people have awareness. But this is such an important topic to dive into. And so I really appreciate you sharing that.


Georgie Kovacs:

So I guess my first question would be, in this education that you've been doing, what has been most surprising to you?


Dr Lynn Marie Morski:

There is nothing surprising in this world except for maybe how much sexual assault there is. And so maybe that was a surprise because I tried to, I think everybody else in the industry, we want this to get out so badly that I think your first instinct is to hide the warts of the industry and like, please just get it out there. And the warts aren't that bad, and we'll deal with that later. And those are outliers and they're not. And I think maybe that is surprising on the negative side. So that was not a surprise in education. That's just a surprise in learning more about the current industry as it stands itself. But the current industry is not legal, most of it.


Dr Lynn Marie Morski:

And so talking about what surprises you about psychedelic therapeutics as an entire field versus what will be surprising about the medicalized version thereof are going to be two, hopefully very different things.


Georgie Kovacs:

I admit, in the research that I've been doing, I'm a bit confused. Right. So I've started to read Michael Pollan's book, but I started also watching the Netflix series. And the themes are the same, like back in the day when LSD 25, I think it was, was first discovered, which, by the way, ironically, I did not know this. It was originally found through this gentleman who was hired by Sandos to create a drug for women post pregnancy. And here we are. I'm on a women's health podcast, and now we're talking about, like, I just found that kind of, that just stood out to, you know, then the series even talks about how there became this fear and a lot of misunderstanding, which basically led everyone to, instead of clarifying the misunderstanding and correcting things, just said they're now illegal, and now we're trying in this. So do you mind even just clarifying the nuance on where we are with the legality?


Dr Lynn Marie Morski:

Sure. And I'm even going to clarify a little bit about that because I don't think it was entirely misunderstandings that led to it becoming illegal. I think it was a lot of Richard Nixon and his people knowing that these were not actual problems, but you don't want people free thinking when you want to control them. And we were in a time of war, and the people who were hell bent at not serving were very often the people who had their minds open by psychedelics and felt connected to everyone. And it's really hard to go attack villages when you feel very connected to everybody and nature and all of the things. Right. And so I think that's. I mean, I don't think.


Dr Lynn Marie Morski:

I think. I'm pretty sure that people have come out from that administration and said we knew that this was not an actual problem. There were very nefarious reasons why these became illegal. So currently in the purview of what I discuss on my podcast, and in our association of psychedelics, we include ketamine, which is not a traditional psychedelic, but it does have like hallucinatory kind of components. But it is the only currently widely legal psychedelic medicine. It is a schedule three medicine. Most of the other ones are schedule one, which if you've heard that same argument with cannabis, schedule one means that there's no acceptable medical use and there's high abuse and danger potential. All of which, as you will hear from myself and Andrew Penn and probably the people who came before me, does not apply to psychedelics.


Dr Lynn Marie Morski:

So there have been a number of attempts to get these descheduled. But outside of ketamine, currently we have a legal framework only in Oregon and only for psilocybin and only at their very prescribed. It's adult use and at their centers. Yeah, I think on the know, we have other places that are decriminalized, which means you can't set up a framework to sell or tax it or regulate it. It just means that if you are arrested and you have a small amount of it, probably nothing will happen. It's like some low priority decriminalization means different things in different townships, et cetera. But there are a number of cities and a couple of states that have decriminalized different amounts. Like some just psilocybin or some just natural psychedelics or some all psychedelics depending on what you're talking about.


Dr Lynn Marie Morski:

But again, difference between decriminalization and legalization. So as far as legalization, only psilocybin, only for very specific use in Oregon, when I say specific, I mean adult use in their centers with the prescribed psilocybin. And I don't mean like for specific conditions. It's not condition related. And then the other legal one is ketamine. Outside of the US, that varies widely. There are places where it's in a gray area, different psychedelics are. And then places like Amsterdam, you can not have psilocybin mushrooms, but you can have psilocybin truffles, which is like this part that grows beneath the ground.


Dr Lynn Marie Morski:

And there's all these different regulations, so I can't give you a worldwide view, but I can tell you what's going on in the US, and there are a lot of different. Every day there's like, okay, this bill and this state is trying to pass this, and it's just nothing. Besides, Oregon and Colorado have actually passed anything.


Georgie Kovacs:

So today, legally, this is the right word. If I'm in Oregon or Colorado, I can access psilocybin.


Dr Lynn Marie Morski:

Just Oregon currently. So now psilocybin is decriminalized in Colorado, they are setting up a legal framework for natural medicines that is not yet in play.


Georgie Kovacs:

Oh, my gosh, this is overwhelming. And then ketamine is being researched.


Dr Lynn Marie Morski:

Ketamine has been legal since the. It's generic. We would research it more if it were less generic. Unfortunately, companies have to have a financial incentive to do research sometimes. And since it's been generic for so long, that's been harder to do. But yes, there is research still ongoing on ketamine.


Georgie Kovacs:

Okay, here's what I guess. Maybe if we could just do a bottom line here, which is people use the term psychedelics, and is it fine to use that umbrella term just for the sake of conversation and not mince words between the five different. The DMT, the LSD, the MDMA, all that. We don't necessarily.


Dr Lynn Marie Morski:

Yeah, I think we covered twelve on the podcast. Yes, but like I said, I keep them all under the same umbrella for specific reasons. You can parse one out versus the other, but for this purpose of this conversation, you can just throw them under one umbrella.


Georgie Kovacs:

Okay, so there have been some concerns around the safety of psychedelic therapy, such as reports of psychedelic facilitators abusing their patients. So, can you clarify these issues and address the safety protocols that are in place?


Dr Lynn Marie Morski:

Oh, I wish there were safety protocols in place. That would be amazing. That is part of what needs to be coming online as this field goes medical, because this has been underground for forever outside of ketamine. Right. Ketamine is not underground because it is legal. But the use of ketamine as an antidepressant is only not more than 20 years old, and there are still no specific protocols for its use there's commonly used protocols, but not everybody has a certain same type of monitors. Let's say we're talking about a ketamine IV facility. Yeah, you'll probably have like a medical assistant in the room to make sure the patient's blood pressure doesn't go too high.


Dr Lynn Marie Morski:

But do you have a trained psychiatric provider in the room if the patient starts having psychiatric issues? Well, not the places I've gone. And so safety protocols are like, there are organizations working on making ethics guidelines and protocols for the psychedelic practitioners, and it will be a much safer place. And that's why I said beforehand, if the underground world looks like and what psychedelics as part of the medical system hopefully will look very different. Because once you move to the medical system and we have something akin to a specialty like, let's say cardiology, if as a primary care doctor, I want to refer to a cardiologist, I am going to refer to a board certified cardiologist. And that means I know they have done a cardiology fellowship and they have taken their boards and they're keeping up on their continuing medical education credits. There isn't currently an equivalent in psychedelics, and that is a problem. So it's a problem for many reasons on the patient side, there are no safety protocols at this point. The American Psychedelic Practitioners association is working on ethics Guidelines and has put out some general guidelines, but those are guidelines.


Dr Lynn Marie Morski:

Nobody is enforcing them at this point. And so when we talk about abuse, it can come in a number of forms. And if somebody really wants to do a deep dive, if you go to the Psychedelic Medicine podcast, one of our most recent episodes, right now it's November, so probably maybe October, September, October. We did an episode on supporting survivors of psychedelic abuse. And the abuse can be in many forms. One, the most obvious and the most profitable, one of the most unfortunate is that there can be sexual abuse. I mean, these can put you in a very amorous state, in another state of consciousness. And like with anything that can create a power differential, then people can abuse that.


Dr Lynn Marie Morski:

And so having somebody as your guide and you're the one in an altered state of consciousness, and you have to look to them and you're going through an amazing thing, and you're like, wow, this person facilitated this for me. Well, that sure creates an interesting dynamic. You feel very indebted to them, and they have a person who's kind of under their control, really. And in the underground, that has been a big problem. It's something that I think a lot of us wanted to pretend at the beginning. Wasn't as big a problem as it was, but it is. And so that is a major thing, that having these guidelines and having people be accountable to licensing agencies will improve. Now, just to point out in the regular worlds of medicine, they did a survey of regular therapists, and I'm going to botch the actual numbers here, but they did a survey of therapists, again, not psychedelic.


Dr Lynn Marie Morski:

Regular therapists seeing patients without psychedelics, no altered state of consciousness. Some non small percentage self reported that they had had an inappropriate relationship with their patient. And that's self reporting. Right. So, you know, the actual number is larger and that's outside of the psychedelic world. So I want to point out that this is not only in psychedelics, this is a problem anytime you have a power dynamic. Just the problem with psychedelics is that you have one person that is basically dependent on the other during the period of time where they're in an altered state of consciousness. And so that just makes it even more important for us to have these guidelines.


Dr Lynn Marie Morski:

One, two, for people to know how to, as you alluded to the beginning, know how to vet your facilitator, vet your retreat center. That should decrease issues. We have to tell the actual guides, hey, this isn't appropriate. Like, okay, you can touch on the hand. If you've asked, can I touch on your hand? But let's say no touching in other places, right? Here's the thing, is that these states of consciousness put people in. There's such ecstatic, very often amazing people feel better for the first time in forever. This might be the first time they felt not suicidal in weeks. They are so grateful and so loving that they do want to just wrap their arms around the person who's bringing this to them.


Dr Lynn Marie Morski:

It's just a natural reaction. That's why this is hard, because people who get in situations are not always the facilitators being nefarious. It's just that the situation lends itself to this really intimate contact and that's why we just have to be extra careful. But other types of abuse that we talk about on the episode is that, again, this is mostly underground, is that some people get in financial abuse situations. Like, okay, now you have to come to me every month for your healing, and I'm responsible for your healing. You have to keep paying. And again, it's all power dynamics and all those kinds of things that will be helped when we have an actual medicalized model.


Georgie Kovacs:

Wow, I'm listening to you and I'm thinking, well, the underground exists. It's going to take time to look at this medical model for a variety of reasons. And in the previous episode we talked about another way. We worded the underground was the wellness category. So there's like the medical and then there's the wellness. And we could use many other terms. There's probably subcategories if we wanted to dissect it further. So it is happening.


Georgie Kovacs:

We have the underground, the wellness, whatever. What should someone consider today? Like you've had the experience? Because I guess here's what I will say. People, when they need help for anything, they're going to do what they need to do. I went through four years of fertility. I got to a point where I'm like, I don't really care. I even disagreed with one of the things I needed to do. And I'm like, but you know what? I'm out of options. I don't even care anymore.