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
Related to this episode:
Resources for Mental Health
Listen to the series on Psychedelic-Assisted Therapy
Check out the Psychedelic Medicine Association or follow them on Twitter, Facebook, LinkedIn and Instagram
Stay in touch with 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.
Georgie Kovacs:
I'll do it. And I can just imagine with mental health, what are some realistic criteria someone can take into account now?
Dr Lynn Marie Morski:
Yes. So it depends on what you're looking for, what drug we're talking about. If you're talking about individual versus retreats. But let me say if you are at the end of your open, this person is looking to go to an international location, they're going to do a retreat. One, verify that the facilitators have actually done a training. Now this is kind of hard because some drugs, like 5‐MeO‐DMT didn't have a training for a number of years. Now there is, but there wasn't. And so how do you know if the person is well trained? That's hard to say.
Dr Lynn Marie Morski:
And this is, again, really hard. If you don't have a psychedelic community. I was going to say talk to other people that have experienced with those same people. And I want to just asterisks here that none of this is 100% protection because I have done all this for a retreat and still had a bad experience happen. Like it is impossible to prevent everything. Just like it's impossible to go into a surgery and say that there will be no complications. Same thing, right. You can have the best doctor on earth.
Dr Lynn Marie Morski:
Something can slip. You have no idea. Right? Anyway, so make sure that there's been training. Ask them what their refund policy is. If they will not refund you. If you get down there and for any reason feel unsafe going ahead and they don't give you a significant amount of your money back. I would say no. Another thing, if they're doing an intake with you and not if they must be doing an intake with you.
Dr Lynn Marie Morski:
And on that intake they must be doing a thorough medical history. They need to ask all your medications. And if you're on a number of medicines, they need to make sure that they send you to your primary care doctor to verify that there is not going to be a problem with that because most people running these retreats are not medical doctors. Right. But that's another question. Will you have medical staff on site? And that's another important especially, I mean, by the way, the other asterisks here is if you're doing, I begain this is all to the nth degree, much more important. You have to have a cardiologist do your clearance. There has to be cardiology on site, has to be an EKG monitoring going on like that one has specific cardiotoxicity and so all the stakes are higher there.
Dr Lynn Marie Morski:
But talk to the facilitators, ask them. And you know what this is? What's so terrible is that this is an awkward question. Asking somebody who's like you're coming to for help, like what you qualified. It's something we would never have to do in the regular world. Right. We can just Google and see oh, doctor so and so went to Harvard that here this is sometimes they should say on their website. But if they don't, you have to ask and that's a little bit uncomfortable sometimes. Especially somebody's already struggling with mental health problems.
Dr Lynn Marie Morski:
Like unfortunate. But I'd start with those questions and you can get a sense with how open they are with you. If any of these questions give them like they start to be a little defensive about the refunds, a little defensive about their training, just run. Nope. There will be other options. Right. See what kind of affiliations they know. I run the psychedelic Medicine association.
Dr Lynn Marie Morski:
Are they a member of some association like that where they are constantly learning and being updated on information? There's a lot of things you can do, but also kind of go with 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 kind of from the beginning. So intuition, check their training. Check that they marie doing a thorough screening with you and that they insist that you do a thorough screening with your physician. If you're at all medically complicated, make sure they have a refund. I think that those things kind of get over the majority of if you're sending someone for like an out of the country retreat, also look at your own comfort level. I have gone to out of the country retreats where I am sleeping in the middle of the jungle and roosters are crowing at three in the morning. And there were chainsaws going off during our ayahuasca.
Dr Lynn Marie Morski:
This was just absolutely terrible. Maybe if I were like Bear Grylls or whatever that guy is who loves to sleep out in the net, that would have been fine. But no, this was like a total disaster. So just know your comfort level. Also, something else to consider is, do you prefer to do your healing in a group or individually? I don't love groups because then if one person is, I don't know, chewing too loudly, I'm going to be like, I have sensory issues. Right? Yes. Right. Like, the visophonia is real and so I just can't.
Dr Lynn Marie Morski:
Right, so that same ayahuasca where the chainsaws are going on, somebody brought a baby and the baby was crying the whole time. I was like, this is a nightmare, right? Like, absolutely the worst. And that's what I'm saying, is that there are things that you can't even know that could happen until you get there. I would never think to ask, will there be a baby at this retreat? Because obviously there wouldn't until there was, right? And so these are the best you can do. But if we're talking a ketamine clinic, now, that's different. There are different forms, and I wish that I could give you like an algorithm for how to go through this, but there are different forms of ketamine. There is intramuscular, which is a shot, one time shot, maybe a second booster shot, but it's in one session. All of the ketamine sessions are usually somewhere between an hour to two and a half, 3 hours at the very longest.
Dr Lynn Marie Morski:
And either you can sit there with an iv the whole time, or you could have an injection, or they now have sublingual. There's also like rectal ketamine. There's all kinds of ties, but the most common are intravenous, intramuscular and sublingual. They also have spravato, which is the one FDA approved, covered by insurance, esketamine nasal spray. But usually with the losses and with the nasal, you're not having the full psychedelic dose. It's a more psycholytic dose, they say. So things are opened up in your brain, but not quite in the same dissociative way, necessarily. With that, you have to decide, do I want to go in and just do have ketamine put into me, or would I like ketamine assisted psychotherapy, which is where there is a trained psychotherapist with you, at least for part of it.
Dr Lynn Marie Morski:
And they can talk through things with you, especially as you're coming out of it. Maybe as you're going into it, maybe if you're taking like a psychedelic dose during the middle, you're not talking about it, but as you're coming out, it's good to have somebody there. So that's another level. Again, you can say, like, are you a trained ketamine assisted psychotherapist? Well, they can tell you what program they've done, but whether or not that is a program that has been certified by a certifying body, no, that doesn't exist yet. And so maybe ask like, how long was your program? Some are a weekend, some are a year. Right. And so just look at that and you can even say, what program did you do? And maybe go investigate that. Just google that program and see does it look like it was pretty thorough? Okay, then maybe that's a good option.
Dr Lynn Marie Morski:
So I'd say those are long winded answer, but those are some ways to kind of vet where you may be going.
Georgie Kovacs:
So real quick with the ketamine clinic, if I heard you correctly, it seems like you could go in and just get a dose and then you can also get therapy with it. Is it safe to ever just get a dose without someone monitoring what might happen to you? Or is it one of those, oh, I've been there. I know the reaction. Let me just like, how does that work?
Dr Lynn Marie Morski:
So monitoring, they will. Like I said, when I went to the iv ketamine clinic, there was a medical assistant monitoring my blood pressure, but she's not there for any type of therapy. And there are a lot of very established ketamine clinics that have been doing ketamine without psychotherapy for years. And what they will say is we make sure the person has a psychiatrist or a psychotherapist and we send them back to that person afterward. This is the problem. We don't have a head to head comparison. We don't have a study yet of one to the other, which would be a hard study to do, but we should at least try to approximate what it would be like. One to one, the exact same type of therapy, but one with a psychotherapist there and one without, because just the ketamine itself actually does help a lot of people.
Dr Lynn Marie Morski:
So we don't know that having a psychotherapist there, I don't think we can say for medically, like research, certain evidence based that that's better. But I think there's a lot of reasons that it would seem better, right? I remember the person who put the drip in my arm. She was like, yeah, it's going to be kind of like you had two margaritas and then goes about her business. And none of that was accurate, right? I knew going in that it wasn't going to be like that. Thank goodness. Again, like you said, I knew, right? So I was just like, what kind of margaritas do you make? But if somebody else is new to it and that's the instruction they get, they may think like, oh, my God, I'm having ego disillusion, where suddenly you're so dissociated from who you are and they're like, this is too strong. I was only supposed to feel like a margarita. That would not have been helpful for them, right? And so at that point, if they started freaking out to have a trained psychotherapist in the room be like, no, this is absolutely normal.
Dr Lynn Marie Morski:
Breathe through it. You're doing fine. That would have been very helpful. So I guess if we wanted to say on the safest side for a brand newbie, have academy assisted psychotherapist there, right? I think that's probably the safest default we can guess at this point, at least for the first session.
Georgie Kovacs:
Okay. I have to say, when I was first learning why they were banned and how they're quote unquote, coming back to life, I'm like, this is great. I would so love to try it. But the more I'm diving in, the more I have to say I'm becoming nervous because I also have a mental health condition that I think is contraindicated. And so my like, oh, what the heck, let's just try it. I'm like, I don't know. I may be full on. Heck no.
Georgie Kovacs:
Do not do this, Georgie.
Dr Lynn Marie Morski:
Thank you for being cautious. Right? Because so many people, they don't think about it. And then there have been times where it can uncover a psychotic disorder or something that was like latent bipolar disorder, something like that. And then they're finding with borderline personality disorder, it has different effects than it does of people who don't have that. And so, yes, we need to be more cautious than, and I think that's a lot of why I was saying that that intake is so important. If you don't have somebody asking your medical history, they would not know about what other condition you had. That might be a contraindication. So that's why we really, like, I'm such an advocate for educating the primary care and psychiatrist force of the country to be able to at least help on the clearance side.
Dr Lynn Marie Morski:
They don't have to know how to do these. I'm not at all advocating that every psychiatrist learn how to become a psychedelic assisted therapist, but I want them to know enough so that they can say, I know that my patient has ABC condition that is probably not going to make them a safe candidate or this patient is going to be a great candidate and then they can hand them off to their PCP. And we say yes, their cardiac and their liver and their lung status, they all look great enough and safe enough to do these psychedelics, right. That's what I want to have happen so that this can be safe from all angles.
Georgie Kovacs:
Some have said, unless you've been there, done that, don't bother treating the patients.
Dr Lynn Marie Morski:
Right. That is the everlasting debate is that can you be a psychedelic assisted therapist if you have never done psychedelics? And I would say something. My answer, my view on this is somewhere in the in between, which is I think if you have had some type of altered state of consciousness where you can understand what your patients are describing to you, that should be enough for you to have that common ground. So breath work is my favorite example. You can do types of breath work that can put you in altered psychedelic states. I have been there. It is impressive to see how you just breathing your own breath in a certain way can lead to the same place that these hardcore psychedelics can. But it is possible, and I think that without forcing every potential therapist to undergo psychedelics, that is a way to kind of level the playing field.
Dr Lynn Marie Morski:
Because most people are safe to do breath work. Some people, very few people might not, not be able to. But compared to psychedelics, it's a wider swath of people that would be able to. And the reason I think there should be some knowledge of an altered state of consciousness is that if I just went like, remember I was describing a second ago, I just dropped the term ego disillusioned. And if you are trying to describe, and I'm assuming, let's say a large swath of your audience has not experienced ego disillusion, wouldn't you, dear listener, want to, if you were my therapist, know what I was talking about? Right. And that's something that if you've been there, you know exactly what it is as opposed to me telling you what it's like. But then the argument always comes back, well, for years doctors have been prescribing things or doing surgeries that they've never taken, the drugs they've never taken, and surgeries they've never had themselves. So for sure, if somebody says like, man, I took this chemotherapy and now something is tingling in my hands and feet, the doctor may not exactly know what that chemotherapy induced tingling of the hands and feet is, but they've had a tingling somewhat like that if they sat on their hands and feet too long in a cross legged position or something.
Dr Lynn Marie Morski:
Right. So I think it's kind of akin to that. It's like you don't have to have had the exact same nitis of the experience, but as long as you had something similar enough to have the conversation, okay, then I think that's important. Okay. But the asterisk always is. If there's a therapist out there and for whatever reason, they medically cannot even do a breath work or something like that, that's where I have a harder time because I never want to be ableist. But I'm like, how could we find a way that everybody could glimpse a little bit of alter state of consciousness just to better understand their patients? That's something I would love to figure out.
Georgie Kovacs:
Okay, I really like your answer. I think it's a fair one because we always want the perfect world. And again, there's so many complications in this. So do you see psychedelics potentially being part of mainstream healthcare?
Dr Lynn Marie Morski:
Oh yeah, I won't stop until they are. My mission is because I have a lot of clinicians come and they say, is it going to put me in a liable place for malpractice if I discuss psychedelics with my patients? And my mission is to make it malpractice to not discuss psychedelics with your patients when there is a psychedelic option that is appropriate. Because imagine that there's something that is significantly more effective than everything else out there, and your doctor just didn't tell you about it. You went ahead and just took your say, it's PTSD, and we know how effective MDMA assisted psychotherapy is for PTSD, but you just keep giving your patient the therapy and maybe antidepressant or antipsychotic you've been doing for years, they continue to take it for the rest of their life. They continue to have a decreased quality of life. They might not even be able to work. A lot of people are on disability for PTSD and you never tell them about MDMA assisted psychotherapy. That to me should be malpractice.
Dr Lynn Marie Morski:
So yes, I absolutely see a time when this is just integral. Will it be overnight? No, but I think once people start seeing the results, it's already getting enough. Like you said, you've seen the Netflix series, et cetera, et cetera. I mean, it's so much Marie effective, and your average person doesn't want to be on a medicine that they have to take every day. And if we're talking mental health in just. In this instance, a lot of them numb people out or they have side effects. By the way, I'm not anti pills, not anti antidepressants. They are very useful for a lot of people.
Dr Lynn Marie Morski:
But we know there's about 40% of people they're not helping. So why wouldn't we want to give those people every last chance to have a better quality of life? So, yeah, absolutely, we will find a way to make this work.
Georgie Kovacs:
What could be some legal challenges that we may need to take into consideration? You've put in all these precautions, but we are a very litigious society, so what can happen? Because we've talked about all these possibilities, which, by the way, I didn't even think about it until just now. Do any folks who have bad experiences sue, even these retreats?
Dr Lynn Marie Morski:
Yes, I believe they have. But again, it's very difficult, because generally, the retreats are outside of the country. So an international lawsuit is very difficult. I don't even know of one right off the top of my head where that happened. But there are definitely, like, one retreat center was recently taken off of a retreat kind of Yelp site because they had had so many complaints about the people of the. And by the way, the amount that people get away with in the underground, like Mike Tyson's facilitator had killed four people. And this continues to practice because it's just in a country where you can't.
Dr Lynn Marie Morski:
And by the way, killed, like, people died during his ceremonies and seemingly of things that could have been prevented. I'm not naming a name, but there's plenty of things on the Internet about this that you can read, and that person is able to continue to practice because there's no set of regulations or proof. Or if you can't say this is the gold standard for facilitating, then how do you say he didn't do the gold standard? Right. So that's the thing, is that once we have gold standards, then as a clinician, you follow them just like you would with anything else. And then accidentally, I went in for a bunion surgery. They had a resident do it, because in a teaching hospital, you can have residents do it. He cut out too much of my bone. My toe doesn't work right.
Dr Lynn Marie Morski:
But you can't predict that. When I went in, they never said we might accidentally take too much of the bone. Like, this comes down to informed consent. You cannot. What if the power goes out during a procedure and the patient dies? Because the power went out, at no point before going to the procedure does the doctor ever say, no, you might die from a power outage. Right. You cannot prevent every last thing from happening. And especially with these psychedelics, you have no idea what's going to happen in this altered state of consciousness.
Dr Lynn Marie Morski:
Like if somebody takes an antidepressant, we've known enough that, yeah, there might be these adverse effects. So we can tell you there might be suicidality, you might sleepwalk, you might eat more, gain weight, whatever. But these are wildly different. You might see a memory that never actually happened, or you might learn something that did happen and you had no idea it was there. Or you might see your idea of God. Right. Like such a wildly different amount of things that can happen that informed consent is a real challenge. So to answer your question, which is like, what can go wrong? Is basically like an informed consent lineup.
Dr Lynn Marie Morski:
Like, usually when you go into a procedure, you're like, okay, I'm going to inform you of everything that can go wrong before I get your consent. And with psychedelics, that is very difficult. And also the other reason it's difficult is because to tell the person who's never had a psychedelic before, you might see this and this, you might experience ego disillusioned and blah, blah. Then you're setting up an expectation which you do not want to do. So how do you get informed consent without putting things in their head and setting an expectation that if they don't reach, then they feel they failed, or if they get something different, they failed. Or they're just waiting. Like, hey, it didn't work for me because I didn't get to this certain thing they described. Right.
Dr Lynn Marie Morski:
So, like, informed consent is a big topic in this whole. Yeah. Getting back to your wyatt is not just one podcast.
Georgie Kovacs:
Do you have any knowledge of how this can help women uniquely?
Dr Lynn Marie Morski:
As I was waiting to start this interview, I was doing some work for another contract that I have, and this article came up and I'm trying to pull it up here now. It says, from the British Medical journal, explore psilocybin and other psychedelics for women's cancer distress urge doctors. And it goes on to talk about why so many women with ovarian cancers and other gynecological cancers have a lot of physical and psychological challenges. They were suggesting that psychedelics have been shown to be both helpful, often for pain, and also for the kind of distress, anxiety and depression that come with what can be terminal diagnosis. So I love that this article popped out right before you and I were chatting. But what other things that are being looked at, and this is the problem, is that, as you talked about before, healthcare is a business. And so there was a company that was going to look at psychedelics for female sexual arousal disorder, but it wasn't able to raise enough money. There are companies that I think are going to look at different ways for psychedelics to be used to address either PMS, postpartum depression, various things in that realm.
Dr Lynn Marie Morski:
I can't wait till they're looking at like, perimenopause, menopausal symptoms, right. If anybody's out there and they have lots of funding, they want to distribute. I would love to see somebody support studies that find out when in a woman's cycle it is best to do psychedelics, because that is a thing, right? We know we are very different at different times of the month. My guess is that in that time, right after your period before ovulation, that's probably the least volatile time hormone wise to do it. But who knows? Without testing, we don't know that maybe the second half of your cycle is better. We don't know. So I want that to be tested. There's also many anecdotal reports that psychedelics affect your menstrual cycle.
Dr Lynn Marie Morski:
People will cycle early. Their cycle will sync up with the people on their retreat. Like, lots of different kind of mystical looking things happen in that realm. And so that research should be done. But currently, I did an episode on microdosing, and Dr. James Fadiman had done this research, and he polls like 10,000 people and was seeing what they were using microdosing for. Now, again with the caveat that when we do rigorous studies, we show that microdosing for the things that we have been checking, which is like improved mood. We haven't been checking, like, PMS symptoms, but mostly your mood gets better if you think it will.
Dr Lynn Marie Morski:
A lot of microdosing has been shown to be the placebo effect. However, the placebo effect is still in effect. So this study showed that there were a number of women who were microdosing just the five days before their period for PMS symptoms. So might that be something that if it can boost mood or it can decrease pain, well, obviously that would make PMS significantly more tolerable. So those are a lot of the avenues that I am very much hoping get funding and get looked at sooner rather than later. Ladies we are 50% of the population. I know we need to rattle some cages and get research done.
Georgie Kovacs:
Wow, I'm even thinking endometriosis. But here's my fear, and I think endo is a great example. And speaking of the dollars impacting so much of the population, not an understood disease. Let's pretend we look at psychedelics for endo. My question and caution is, if we don't even understand why women get it, we're not all aligned around the diagnosis and treatment because of the complexity. There's some consistent thinking, but some of the nuances are inconsistent for a lot of reasons. What I would hate is, let's say we test psychedelics. If we test, and to me it's always, what's the question you ask? So if the question is, does it help women with endometriosis and their pain? Yes or no? And the answer is yes.
Georgie Kovacs:
Great. However, my question would also be, but what does it do otherwise to not treat the endo but just the pain?
Dr Lynn Marie Morski:
We don't really know exactly what causes depression or anxiety or any of these things. Like, we have hypotheses, right? And we have some correlations, but they're not all 100%. And we also don't know 100% how psychedelics work. Right. But we know that depression and anxiety do exist and that psychedelics do help. Right? So endometriosis, but I see where, like, okay, if we leave the lesions in, what else is that causing? Then I see that that is an issue, and I think that then it's not an either or. Then it's like, can psychedelics help the person who is awaiting surgery?
Georgie Kovacs:
But it's all in the question and how they're doing the research. And that's my caution is like, okay, if we do get the funding, please look at it right, so that we don't put some mask or sweeping statement when there's nuances to it that we need to take into consideration.
Dr Lynn Marie Morski:
Right. Well, that's why when they do investigations on cancer, they're not saying psychedelics for cancer. They're saying psychedelics for cancer pain. They are still trying to take out the cancer. And so I think that's the important to remember, is that we're never not trying to treat the underlying thing. In fact, with psychedelics, we are generally trying to treat the underlying thing. But when the underlying thing is a cancer or endometriosis or something that doesn't specifically, and by the way, I'm not going to say it doesn't treat or treats or doesn't treat those things because we have not investigated it. But until we know that, on the off chance it did, until we would know that, yes, we still have to treat the underlying thing separately.
Georgie Kovacs:
So what advice would you give to physicians today who may be referring patients or even patients who are like, I kind of want to try this. We've talked about so many details, but maybe there's like, a summary bit of advice that you would like to give to them.
Dr Lynn Marie Morski:
Yeah. Well, short of the very self serving, please join the psychedelic Medicine association because it is our entire mission to make sure that you're ready for those. I mean, because we are the first organization in the world entirely designed with that as our mission. Right. We want to make sure that doctors are not deer in the headlights when your patients show up asking about psychedelics and that you feel comfortable having those conversations and referring when appropriate. And so, like, let's just talk about ketamine. That's the easiest one. If your patient has maybe treatment resistant depression, or maybe if we're talking to psychiatrists here and your patient has suicidality and you're thinking, well, ketamine might be an option, then look at what's in the area.
Dr Lynn Marie Morski:
I think I would default to a place that had a ketamine assisted psychotherapist and look who's been maybe around the longest, who's got the most, let's say, qualified, trained, experienced staff running it. Those kinds of things can be helpful because different clinics can pop up and disappear. But look at longevity. Look at the therapist situation. I would say for psilocybin, right? You cannot aid and abet a patient in getting something illegal. So outside of Oregon, you can educate patients on substances just like you can educate patients on heroin. If a patient came to you and said, what about heroin? You would tell them all of the negatives, right? And that is just research has shown heroin does this. Right.
Dr Lynn Marie Morski:
You can just as easily say, research has shown psilocybin has done this. Just the fact is that psilocybin has a few more positive benefits than something else, like heroin. But legally, you're allowed to talk about both of them. It only becomes a legal issue when you start aiding in a bedding. Like, oh, my neighbor can get you some psilocybin, or, my friend runs this clinic, like, those, you cannot do. But education wise, it's fine to educate them. And then you can even educate them from a harm reduction perspective, and you can tell them things like, look, if you're going to do psilocybin, it is best to ask the following questions we just talked about. And so it's all like, if you can frame things from a harm reduction perspective, we are trying to reduce harm for our patients.
Dr Lynn Marie Morski:
We're not aiding and abetting. I think that's kind of the like, look at which side of that line you're on, and then you could feel safer having that conversation. But if you're actually going to be referring, I think that might be more of a ketamine situation. And then I would say look at the experience and try to find a place that has a therapist present, at least for one of the first experiences.
Georgie Kovacs:
Wow. Thank you. That's really great advice. And I guess we've talked so much about what needs to be in place, and we know there's all this research. Is there anything exciting that's coming out that we haven't discussed yet or we haven't brought up that people that's exciting you about this field because it's one of these where a lot still has to be done, but a lot is still happening. So it's like this crazy train of the different rails moving at different speeds, but it's all happening.
Dr Lynn Marie Morski:
I'll give you my top three for right this minute. One, I should just let people know that the things that we're talking about, that certification and having a license and all that, in theory, there are a lot of people working on that. It is just going much more slowly than we would like. But know that this is something that will happen at some point. We are working on it. Not me personally, but as an industry, we are trying very hard to make that a reality so that we can be safe and safely incorporated into the medical system. On the research side, one of my favorite things is the investigation of whether DMT will help people recover from strokes. Because DMT has this property of neurogenesis where if you can regrow some neurons that you have lost in a stroke, that might be extremely helpful.
Dr Lynn Marie Morski:
That is one of my favorite studies because it's kind of the last place you imagine people going to take psychedelics who are generally younger, able bodied, not in a post stroke state. Well, psychedelics could have a purpose and a place and an efficacy in many other populations. And I think I'm excited to finally look in that post stroke population and how maybe having psychedelics with a friend of mine at UCSD has done, or is actually still recruiting for a study on psychedelics for phantom limb pain. Because if you take a psychedelic while you're retraining your body to do things, then those new pathways that form can be really functional in different ways. And so the same thing might be true of the patients who have had strokes. And then the final thing that I'm excited about is another, if you like the debate along the lines of, should the therapists have done psychedelics? Another debate that I think should not even be a debate is whether there should be psychedelics that do not have a hallucinatory component. And I absolutely think that there should be for the widest swath of people to be able to use them. If it's the hallucination that is going to somehow impact with whatever your mental health condition is, you're saying, but if there was a non hallucinatory version where you could still get a lot of the benefits, and then suddenly you would be able to take a psychedelic without maybe even the fear of what's going to happen when I go to this hallucinatory state, but you still get the neurogenesis or neuroplasticity properties.
Dr Lynn Marie Morski:
Wouldn't that be amazing? Right? And so I'm not saying that the hallucination doesn't have an absolutely crucial component for some conditions, right? That might be where you finally confront your trauma, and then it's no longer so scary to you, and your PTSD is gone, like you see in these MDMA studies. But who knows? In the stroke study, do they have to go on a hallucinatory trip to fix their neurons? I don't think so. Right. So I'm very happy that there are places doing research on non. They can kind of say, like, psychedelics without the trip. I am definitely in the camp that the more options we have, it's not an either or, it's a yes. And, like, there should be psychedelics with the trip. There should be psychedelics without the trip, so we can get the most types of healing to the most people.
Georgie Kovacs:
Wow, that's cool. I had not seen anything about that one. Oh, my. Was this blew? My mean, I'm so intrigued by my conversation with Andrew, too. Like, each interview has been just so different, and I'm so curious of people's reactions because this is absolutely fascinating stuff. And keep doing what you're doing. I know it's really hard when you're starting something new. Healthcare is so hard.
Georgie Kovacs:
Everyone's trying to tackle it, and this in and of itself has its own complexities. So thank you for your commitment, and thank you for making time. This was awesome.
Dr Lynn Marie Morski:
Thank you for your great questions and for bringing this to your audience. I really appreciate it.
Disclaimer
The information shared by Fempower Health is not medical advice but for informational purposes to enable you to have more effective conversations with your doctor. Always talk to your doctor before making health-related decisions. Additionally, the views expressed by the Fempower Health podcast guests are their own and their appearance on the program does not imply an endorsement of them or any entity they represent.