Ep #7 Transcript | Peter Addy: Salvia divinorum, Dissociation & Psychotherapy
Updated: Sep 30, 2021
Full episode transcript below. Beware of typos!
Nick Jikomes 0:27
Peter Addy. Thank you for joining me. Yeah. Thanks for having me. So I looked you up a while ago. And you've got a pretty interesting background. You are a therapist, I believe. But you also have quite a background in academic research. Is that right?
Peter Addy 2:10
Yeah, that's right. I was a postdoc, and then faculty at Yale School of Medicine and pharmacology lab and a medical informatics lab. And now I'm a therapist in private practice in Portland, Oregon.
Nick Jikomes 2:25
Interesting. So how did you? How did you make that transition? What made you want to go from research into therapy was your research informing a therapy practice that you knew that you wanted to go into or what happened there? Well, it
Peter Addy 2:40
was partly on purpose and partly just sort of circumstances I i've been. I was looking at both paths for a long time, I have a PhD in clinical psychology. So I had an extensive training in a number of different clinical populations and inpatient and outpatient settings and things like that. my postdoc at Yale, I was doing research and clinical at the same time. So I, half of the week, I would be in a lab where I would paying people, I would pay people to take drugs. And then the other half of the week, I would go to a substance abuse clinic and counsel people who wanted to stop taking drugs. And that was a fun balance for me. So I always wanted to pursue both of those who's very interested. But then when I, my family, and I moved from Connecticut to Oregon, about four and a half years ago, and I thought that I was going to be able to continue my my research appointment at the Department of Veterans Affairs, but that did not go as planned. And so I started to look at other opportunities. And eventually I came around to back into the clinical world from there. So part of that was not planned at all that move was just, man, none of that went as I thought it was going to go. But that part of it was very much on purpose. I've always been much more interested in helping people individually, the research that I had been doing was not clinical research. I wasn't like working with patient populations to try to help them get better. It was basic research, trying to understand pharmacology, how substances work in the brain, which could eventually down the road be used to help people, but I was not, you know, personally improving people's lives. And that was of interest to me. So I wanted to make that shift back into the clinical focus.
Nick Jikomes 4:46
Gotcha. So, so when you were in your postdoc, you were seeing patients on the one side and on the other you were doing this basic research where you were giving people drugs. So what what type of drugs were you giving them and why why Did you choose to study the ones that you did?
Peter Addy 5:03
Well, the focus of the lab that I joined has been THC and they've been doing THC research since the late 90s. So they have that down. I joined because of my my expertise and interest in salvia divinorum, which is an atypical, plant based psychedelic. And at the time, that was my doctoral research project, at the Institute of transpersonal, psychology, I studied that. And then when it was time for me to graduate, and look for a new look for a job, I wanted to do research. There were two labs in the entire world, as far as I know, that were doing human subjects. salvia research, Yale was one of those. Johns Hopkins was the other so I applied to both and I went with Yale because they were doing a salvia project. I was, I was interested in salvia. So that was my main interest, the labs main interest, which was THC, and they also researched. I helped on a project with ketamine and various research chemicals. And then shortly after I left, they started doing psilocybin research, which is very exciting.
Nick Jikomes 6:19
So for those that don't know, what is salvia, and how did you get interested in that particular plant?
Peter Addy 6:26
Yeah, there are about 1000 salvia plants in the world. But one particular species is called salvia divinorum. It's native to southern Mexico, the state of Oaxaca. in the, in the highlands, the mountains there is the only place that it grows. And it's been used by the native people the mass attack, they have a relationship with this plant for hundreds, maybe 1000s of years. They use it in their rituals, as a way to heal physical and spiritual problems to contact their ancestors, deceased relatives, find lost objects, pray for healing. So they have a long history with this plant this plant contains the leaves of it contain many, many unique chemicals that aren't found in any other plant, the most common chemical is called salvinorin. A. And that is what I call in a typic, or in a typical psychedelic, so when we think of psychedelics, most people think about psilocybin mushrooms or LSD, and those all work on serotonin. salvia does not work on serotonin, it does not interface with that receptor system at all. So it's not a typical psychedelic, but it has definite psychedelic like properties. So I call it a typical psychedelic and I, I knew about it, I don't even remember how I first heard about it, probably just poking around on Arrowhead, which is a fantastic website and resource. But in my grad school, it was time for me to pick a dissertation topic, and this would have been 2007. I think it was time for me to pick my my doctoral dissertation research and I wasn't really sure what I wanted to do. And then I read a newspaper that said that an Assemblyman in the California State Senate wanted to outlaw salvia. So currently here in 2020, as well as back in 2007, or I guess we're in 2021. Now, wherever, whatever state whatever year we're in now, it's hard to tell. There are no federal laws controlling salvia. So it's state by state, and sometimes even county or town by town. So in 2007, I lived in California, and they wanted to outlaw salvia on the state level. And so I thought to myself, all right now it's not outlawed, so I might be able to actually do some research on it. And if I don't do it, if someone doesn't do research on salvia today, pretty soon, no one's going to be allowed to do research on salvia at all. So what, what tiny little piece can I do? What's the lowest hanging fruit because I don't have a lab. I don't have money. But I could do something for my doctoral dissertation. So I picked salvia I figured better do something while before it's too late.
Nick Jikomes 9:35
Interesting. So it's it's case by case but there's no federal laws against it. It's an unusual psychedelic, it doesn't work the way that something like LSD or psilocybin does. How do people consume it? How do people consume it in the United States today and how is it traditionally consumed?
Peter Addy 9:54
in the United States today, you usually will smoke it and you'll usually smoke the drug leaves or more commonly a concentrated extract of the leaves. So there's a process by which you take, I'll just make up some numbers. But let's say you take one kilogram of salvia leaves, and then you extract all of the salvinorin A from it, and then put it back on to, let's say, 1/10 of a kilogram of leaves. And so now, that final product is 10 times as potent as the original leaf. And so usually, if you go to a head shop or an online store, you're going to see salvia extracts which are labeled as 10x, or 20x, or 50x. So 50 times more potent than the natural leaf, but they probably not doing it on purpose. But the way they're labeling that is actually a it's algebra, because it's 10 10x, where x is an unknown variable. You don't know how potent the salvia leaf was, originally, you just know that it's 10 times more potent, but 10 times what? Yeah, that varies over time. So it's so anyway, most people in the United States will smoke, this concentrated extract, traditionally, the mass of tech people do not they consider that sacrilegious. That is, the absolute worst thing you could do with salvia salvia is related to the spirits of the earth and the water. And so you don't want to add fire to water, just the bad combo. So traditionally, you will take fresh leaves, always in pairs, and chew them either in your it's not absorbed in the mouth, if you were to just take like a handful of salvia leaves, or even pure crystalline self and RNA and just eat it and swallow it, it will not be absorbed into your brain, it's absorbed very well in the lungs, which is why we can smoke it. And it's absorbed in the lining in your mouth. So you can take fresh pairs of leaves and chew them and just kind of keep them in your mouth and your gums and absorb the salvinorin A that way. So the traditional route is kind of chewing or holding the leaves here. And then the in the United States and Western society, society, right, I should say northern society, we smoke it.
Nick Jikomes 12:30
And how long did the effects last? When so let's just stay on the traditional side for now. So it's native to the Oaxaca region of Mexico. It's used in various ritual settings there and they're typically chewing it holding in their mouth, it's absorbed through the mouth. And then how, how would the mouth attack people describe the length and the phenomenology of the effects?
Peter Addy 12:55
Let's see, I would say I'm gonna go with two or three hours for an experience, hard to say, you know, exactly, it's usually done at night. The salvia spirit is timid, like a deer and bright lights and loud noises will scare her away. So you have to sit and quiet in the dark. And you have to chant or saying this is its participation is required. So I I went to Mexico in 2014, I was part of a documentary team to learn about salvia and how the mass attack use it, what kind of changing relationships that people have with it. And so I participated in two ceremonies. It's currently salvia is considered the to be connected to the Virgin Mary. So you have you go to a Catholic like altar, and you have to first Pay your respects to St. Peter. He's the gatekeeper. And St. Peter's represented by tobacco, but it's different than we think of in the West, this is fresh green tobacco leaves, which are ground up into powder. So it's not, you know, smoking or dried, cured leaves. You want to use cold, Pol, smoke, eggs, unfertilized eggs are very powerful. And so you kind of set the stage for what you want to do. When I was there, I was, you know, in my Yale scientist, hat, you know, I was wearing that the whole time. So I was wondering how can I take this paradigm and kind of squeeze it into the western reductionistic science paradigm, which, of course, is a fool's errand, but I wanted to see if there was any kind of overlap or what people were We're doing there, you know, no one, no one in Mazatec cultures are holding the DSM and trying to look at mental disorder. So it's kind of silly for me to think that I could go down and do something like that. But I wanted to just kind of see what sort of overlap or patterns there might be. So you go in there at night, usually, you and the healer, the curandero, will take salvia together, rather than the western paradigm where the patient takes the drug, and the doctor, you know, remains aloof. So you take this together, and you sing or chant to the saints and to, to God and the angels sometimes, and then you have an experience, this was, for me, at least I was sitting up in a chair the whole time. And in the dark, like I couldn't see if someone was sitting right next to me, I wouldn't have been able to notice. And then you kind of have an experience. And the best healer is who was kind of leading things kind of determines when it's over. And also the pharmacological effects last maybe two hours, so that that's also part of it, and then it's over, and then you can talk about it, you can rest and just kind of have some reflection afterwards. You have to really purify yourself before and after. So in terms of avoiding certain kinds of food, avoiding all sexual interactions for 40 days before and after. So this is an order to purify your body and your soul so that you can more appropriately commune with the divine. And if you don't do that, if you don't follow these rules, then it can lead to what we might call a bad trip, or madness, or your soul leaving and not coming back. So very important stuff is there.
Nick Jikomes 17:01
So the broad strokes here are somewhat similar to the way people describe an Oscar ceremony where there's this purification and abstinence from eating certain foods that happens. Usually it's described in the the religious or spiritual framework of the local populations. But also in the case of Iosco, you've got Ma Li, which is a drug that can affect the metabolism of drugs and can also pose a danger if you're eating certain foods. So is there something similar going on with salvia and the active ingredients? Is there any known effect on metabolism that might pose a risk?
Peter Addy 17:45
Not in that way. So certainly taking if you're eating a bunch of bacon, and then you take an ml inhibitor, you can have a pretty unpleasant experience. So in the case of Iosco, they're certainly physiological reasons for some of the data, but not so with salvinorin A does not affect any stomach enzymes or CYP metabolism or anything like that. But even with the Iosco diet as well, it's more than just a physiological reaction. So, avoiding again, like sexual contact or depending on how you prepare the meat, some meat might have high levels of tyramine, which you don't want to mix with me Oh inhibitors, but, you know, fresh lean meats you could eat, but they still often will say, just to avoid meat entirely. So it's more about the spiritual or psychological cleansing.
Nick Jikomes 18:48
And so you said the effects last approximately two hours, it's in the dark, are you? What's the phenomenology like? Are you completely disassociated from your surroundings? Are there visual hallucinations? What, what kinds of phenomena Do you experience?
Peter Addy 19:05
Yeah, it's not. There are some visual distortions or things hallucinations that can happen, especially with closed eyes, but that's not really the primary piece of it. So certainly, if you ask someone about Iosco or LSD, they will probably talk to you a lot about their individual experiences. And that happens with salvia. But in my research, I would ask my first project, I recruited 30 people, and I had them self administer one of these concentrated extracts and I just sat next to them holding space. And then when you smoke it, we're talking traditionally notice, when you smoke it, it lasts much shorter. It's 10 or 15 minutes and so then I would ask them afterwards What happened? What did you see? What did you hear? What did you taste and sure, they were corded some visual experiences, but it was much more of a kind of a mental experience when you and also a physiological or a body experience. So traditionally, people will be able to see things like you're going up a mountain path in order to see St. Peter at the top, something like that. And so you know, like, you can kind of visualize that that's happening, but it's more of a maybe like, imagination. I can, when I'm reading a book, I can close my eyes and just sort of picture the scenes that are happening in the book, but that's not really a visual experience. So it's more of a mental or a cognitive experience.
Nick Jikomes 20:53
I see. And so when people are smoking or vaporizing the concentrated extract, it's a much shorter duration. And what do we know about the biology there? So you said it's an atypical psychedelic so it's not acting on serotonin to a receptors, like something like LSD would, but it is interfacing with other receptor systems and what do we know about what's going on there?
Peter Addy 21:19
Alright, salvinorin is a potent and selective kappa opioid receptor agonist. So it works on one receptor site, and only one LSD works on something like 20 psilocybin, I don't have 10 or 15 salvinorin, I only does one thing, and it does that one thing very well, it is an agonist, it actually increases activity at the kappa opioid receptor. There are three opioid receptors, at least three, maybe more, but definitely three of them Delta, mu, and Kappa. And if you think about opioids, like heroin or fentanyl, those are going to be very strong, mu and delta agonists. And when you increase activity on delta and mu receptors, you get pleasure and pain relief and things feel very good. And along with that, unfortunately, you get abuse liability, this reinforcing effects itself, an RNA doesn't do that it doesn't feel good. And it's not reinforcing. It's not habituating. It's kind of the opposite when you activate the capo receptor system it leads to and the clinical term is dysphoria instead of euphoria. So things don't feel great. And you can feel kind of distanced or dissociated from people. One one person in my study said that he could see he was fully aware of everything going on in the room around him. But it was as if he was looking through a cardboard tube, or like, looking through, binoculars backwards, where it's there, but it's just farther away. It's it's potlucks, it's the most potent, naturally occurring psychedelic we know of it's a full on psychedelic experience, what we do in the research world is we want to give people about one milligram. It's something like 20 times more potent than the psilocybin molecule. The only thing more potent than that is LSD, which is active, a full psychedelic dose of LSD is going to be about a quarter of a milligram. So salvinorin, a very small amounts of this molecule will affect your consciousness in very obvious profound ways. I mean, I said that the visual component isn't primary, but you still like you, you can leave your body forget that you ever had a body, you can travel through time, you can travel through space, you can be pulled into multiple different dimensions all at once, where you're contacting the dead, or aliens and all sorts of things happen from through a very, very small amount of this molecule. And that's fascinating today.
Nick Jikomes 24:18
So it sounds like the salvinorin a, so it's unique in that it's not a typical psychedelic, it's selective. So it's only interacting with this one receptor. It's an opioid receptor. But it's not an opioid in the way that more famous drugs, perhaps traditional pain, killing opioids are working. So it's a different kind of opioid interaction. And when it's inhaled, it's a short duration experience that's very intense. And based on your description, now, it's sort of sounds like DMT in some ways in terms of maybe the intensity and the duration, but perhaps different, which makes sense given the very different mechanism of action. So What? Where in the brain? Are these Kappa opioid receptors? Are they all over the place? Are they in very specific locations? Do we know where the brain is being affected?
Peter Addy 25:11
Yeah, we can see that the parts of the brain that I've been most interested in are the particularly the basal ganglia, which is the reward circuitry. So when you, you know, take morphine or cocaine, and it feels good, or to a lesser extent, when you're on one of your free to play games on your phone, and it gives you those little hits. That's it, those things are designed very purposefully to hit the reward centers of your brain, and you just want to keep coming back for more and then spend real money to get your fake money in the game. And that all works on the basal ganglia. So there, there are a lot of opioid receptors of all types in the basal ganglia. There's also so that there we see morphine and cocaine and things like that they increase dopamine levels in the reward circuitry, which again, that feels good. dopamine in the reward circuitry is very pleasurable, dopamine and other parts of the brain may not feel so pleasurable, but in the basal ganglia, yeah, that's great. Do you want more of that. So salvinorin, a, on the other hand, decreases dopamine levels in the basal ganglia. So again, it's not rewarding, it's not addictive, it's not something that you want to keep doing. There are also a lot of Kappa opioid receptors into areas of the brain that I've never heard of in grad school, or in any of my trainings, I came across some of this stuff trying to figure out what is salvia doing. And it is probably, this is just theoretical at this point, but it's likely that salvinorin A strongly affects the claustrum and the insular cortex. So the these two areas have high concentrations of copper receptors, and relatively low concentrations of delta and move receptors. So again, morphine is probably not disrupting or affecting these areas too much. The the insular cortex is in charge of interior reception, which we can talk more about that but that's basically your sense of, of your body in space, I think of in the first matrix film, Neo, goes back into the matrix after after they yank him out. And, you know, in the real world, Neo is, he's has a shaved head, and he's just wearing rags and eating protein goo. But then he goes back into the matrix, and suddenly he has hair and clothes again, if he looks as you as he expects himself to luck, and so he says to Morpheus, why, where did this come from? This isn't real, like, my brain knows that this isn't real. And Morpheus says, Well, you, you have an expectation of what you, you know, think you look like you think that you have hair, and that you wear clothes, even though you know you don't. And so, interior reception is like that, that I think I know what my body is doing. And if I'm upright or horizontal, things like that, if I know that I'm hungry, you know, just what my organs are doing. If I have a full bladder, not these senses, this all these sensations are called are kind of grouped together as interoception. And that is put together in the insular cortex.
Nick Jikomes 28:49
I see. So interoception it's really the the perception your brain has of the internal world, your body and what it's doing and all of your insides. So you mentioned the insula and the classroom where, approximately, for people that don't know, where in the brain is that? Well, they're,
Peter Addy 29:09
they're all kind of in the middle, the basal ganglia, and the classroom and the insular cortex, are, like right next to and kind of connected with the basal ganglia, and it's kind of, it's kind of deep in there, I can't really point at it because it's, it's close to the middle. I have never been great with a narrow anatomy. I've never, you know, apparently, if you go to med school, you can actually like play with brains. I never got to do that. So I couldn't really tell you more than that, but it's pretty deep down in there. It's not a surface
Nick Jikomes 29:42
structure. Interesting. And then the cloud from the classroom I know is kind of mysterious, and also famous part of the brain. So what what is known about that, what do we know anything about the normal function of the classroom is it similar to the insula?
Peter Addy 30:01
Well, this, we're guessing, we don't really know. But one idea is, it's been referred to, perhaps as the conductor of consciousness. So it doesn't generate consciousness because there's no one thing that generates consciousness. It's a very complex interplay of 100 different things. But perhaps, the classroom is involved in coordinating all of those disparate pieces in some way. One of the reasons that we don't know is because it's, it's small, and it's pretty deep in there. So it's hard to image it like we can't get that good of resolution and PET scans. And it's, it's, it's deep in there. So it doesn't get damaged very often, which normally is great, just for you know, human beings running around the world. But a lot of what we know about how the brain works is when it stops working. So when when someone gets lesions when Phineas Gage got a stake through his brain back in the day, that was like the first neuroscience experiment. And so if we can't damage a brain region, or then we can't learn how it works by its lack of, so we can't, we can't get in there and damage your ears, but you know, a rats, or an animal's insular cortex, or claustrum, and they're very small and all kind of bunched up next to each other. So I'm told we can't really get good imaging resolution for it. So a lot of this is based on guesswork, where these things connect to what what they connect to, and what connects to them. And we can get a sense of receptor densities. In animals, at least it's easier.
Nick Jikomes 31:56
Wow. So these areas, so the insula and the claustrum, they're tucked in the brain, they're responsible in some ways for your, your sense of your internal world. So interoception, as opposed to extra reception, like, you know, light hitting your retina from the outside the body. They've got these opioid receptors, these Kappa opioid receptors, but they don't have the other opioid receptors, that something like morphine or heroin are going to act on that cause pleasure. they've, they've got these other receptors in the causing dysphoria, rather than euphoria. People don't want to do them again. And you know, I've been around a number of people who've tried salvia, and no one, no one comes out of the experience saying, I'll have another one. It's usually described as a very bizarre, not necessarily terrifying, or overtly negative, but certainly not pleasurable. Experience. People always say that was that was just weird. And it causes dissociative effects. So does all this mean that it could have potential for treating something like addiction, you've almost described it as sort of an anti opioid opioid or something?
Peter Addy 33:07
Yeah, there's been a lot of research in synthetic Kava agonist as potential treatments for addiction and pain. As far as I know, self and RNA is the only naturally occurring Kava agonist, selective cop agonist I should say. And before we knew that, that was not discovered until 2002. So before that, scientists had created synthetic cop agonists in the lab, and they thought that this might be a great way to treat pain or addiction without those pesky addictive side effects, because usually, like with morphine, if something treats pain, it also has an addictive property, it's really hard to disentangle those two and that's kind of the holy grail of pain management is to find something that manages pain without addiction and a cop agonist might do that. But and these human trials, the they saw that it leads to dysphoria, and sometimes hallucination, so it's not fun. It's not like a euphoric kind of pleasurable experience, but it is. Well, in the clinical trial jargon, they would say these are adverse effects. And if you're just trying to treat someone's pain, and they start hallucinating, then that is not a good idea. That's not beneficial. So those trials never really went anywhere.
Nick Jikomes 34:43
Take will take us back to your research. So you you're administering salvia, to people, how are they consuming that? Was it the concentrated extract? Or was it simply the leaves like what was the the dosage and the concentration of what you administered
Peter Addy 35:00
I wanted generalizability or ecological validity. So people out in the street are using, like a 10x like a concentrated extract. So that's what I wanted to use. One of the leading salving researchers in the world is Daniel Siebert, and Malibu, California, he's kind of an independent scientist, and he has his own salvia shop, where he has extracts that are standardized. So it's not just 10 times and unknown value. It's these have been standardized to contain approximately, I forgot the exact number, I think it was 1037 micrograms, some some number like that. So I use that. So it's a concentrated extract, but it's it's standardized, so that everyone gets the same amount. And then I also bought an equivalent amount of just plain old dried salvia leaf, which I then weighed, and cut cut up into individual portions for a placebo dose, or what you might call an ultra low dose. And 100, what was it 25 milligrams of plant material, that's very small. So 25 milligrams of salvia leaf, you're not gonna have an experience, there's not going to be psychoactive, it's just too too small, but 25 milligrams, with that extract, put on top of it, yes, you're gonna have a full blown experience there. So I use that part of the approval process at my school Institute of transpersonal psychology was that I am not qualified to administer drugs to people. So they did it themselves, I just kind of handed them a pipe and a lighter and the capsule, and they they did their own thing. And I just sat there and watched basically, we had a, an emergency medical technician or a nurse to check them out before and after and sat in the next room just in case, there was no just in case they never, you know, we never needed that. But it's good to be there. I had 30 people go in twice. So a placebo Center, a high dose, random counterbalance double blind conditions. I wanted very much for them to have a relaxing, inward focused experience. So we were in a very nice, comfortable room with soft lighting, they got to sit in a recliner with their feet up. I gave them a mind fold, or I think it was just a blindfold. But they were encouraged to close their eyes, or just kind of look inward. I, I practiced a body scan relaxation script, we had classical music playing in the background, so is everything I could think of was set for people to just feel at peace and relaxed and wanting to look in. And then they inhaled on their own, close their eyes and fell back. And then if an outside observer had locked in, most of the time, it would seem like I'm just kind of sitting there staring off into the distance while someone next to me is taking a nap. Most of the time, they just kind of laid there and didn't really do anything until 15 or 20 minutes later, they would kind of come back on their own. And then I had a set of questions, which mostly it was just let's go through the senses. What did you see? What did you hear? What did you smell etc. You know what what was your experience? Like? That was my main focus. I I wanted to just get the phenomenology of it, where do you go and what happens to you?
Nick Jikomes 38:58
And who were these people? Were they college students had they tried it before? Have they not tried it before?
Peter Addy 39:04
You inclusion criteria, you had to have experience with a psychedelic which I defined rather broadly. You did not have to have experience with salvia. And I want to say about a third of the population did so maybe 10 out of 30 had used salvia in the past. But everyone had used some kind of psychedelic I think most frequently mushrooms, adults, just anyone I could find in the Bay Area, I'd say probably half of them were either either went to my school or knew someone or were like you know, a family member from someone who went to my school. So as a convenience sample. The only kind of strict thing that I was looking for is I wanted Half Men and half women. At the time I assumed gender to be binary. So I just wanted you know, half and half
Nick Jikomes 39:59
interesting So, and this was in California. So it actually is, is it still legal in California? Approximately how many states would you say it's legal or unregulated in?
Peter Addy 40:11
Well in California, so they, when I heard that this law was was being debated, I did, I dipped my toes into activism for the first time I contacted my representative, I contacted the bills, author, everyone involved in the committee who was going to look at it. I called I sent them like paper, copies of letters and the articles they said, Don't trust me. Here's the research studies themselves. And don't outlaw salvia. It's a bad idea. And they did not pass the bill. So success. The next year, he wrote just a modified version of the bill to make it illegal to sell to children. And that did pass. So currently, in California, you can't sell it to children, but you can sell it to adults. here in Oregon, you I don't think there's any age restrictions. I think it's available to anyone. And Connecticut, where I did most of my work, it was completely illegal, they outlawed it the same year that I moved there in 2011. So it's it's it varies widely. As far as how many states I, I haven't kept track recently, to be honest with you. But last time I checked, which was probably four or five years ago, I think that it was completely 100% illegal. And I want to say 12 states. Gotcha. So
Nick Jikomes 41:37
some states, it's completely illegal. Some states, it's legal and regulated in terms of the age you need to be to buy it. And in some states, it's wide open. Interesting. And so you're doing this research, it's having all of these interesting effects. It's not addictive, which is something it's true for pretty much all psychedelics. What about toxicity? Is there any risk of organ damage? Or is there any physical toxicity?
Peter Addy 42:04
Not that we've been able to see there certainly isn't as much research there as I would prefer. But there there's been the only tox studies have been done in rodents. And there's no indication whatsoever, and especially because of how you have to take it, if you're smoking, even something like a 100x extract, like you would have to smoke a lot of that in order to like overload your system with it. And if you think about the traditional way, where you're just holding leaves in your mouth, like you just cannot physically put, there's a limit on how many leaves you can put in there at once. So it seems very unlikely that anyone would ever overdose in the kind of standard sense of that term. So we don't know of any obvious danger or like medical contraindications.
Nick Jikomes 43:00
Interesting. So and it's also a dissociative. So, you know, something like psilocybin and LSD are not considered associative. They're considered classical psychedelics, something like ketamine is typically discussed as a dissociative. What, what is dissociation? How would you describe that as a psychologist? And does that have anything? It must have something to do with these Kappa opioid receptors and interoception? The sense of your own body, right? But what how would you define dissociation? Hmm.
Peter Addy 43:36
Mostly Good one. I mean, I could, I'm sure the DSM has a definition of it. But I couldn't quote that for you. As it shows up, in my practice, dissociation is where you maybe in a more extreme case, you do something and don't remember it afterwards. Or you something happens to you. And it's and you observe it as if from the outside. But that's, those are extreme cases, more commonly, what I see with my clients is that you're kind of not really aware of what you're doing just that you're kind of preoccupied. I tried to, since COVID, hit, there's really like, there's nowhere for me to go. But I at least like to go for walks in my neighborhood. And sometimes I will leave the door. And then I will blink. And suddenly I am five blocks away from my house. And I have no idea how I got there. Because I've just been in my mind, I've been thinking about my grocery list or what clients I have that day or a project I'm working on. And I'm just a little dissociated from that I hadn't I was not at all aware of my experience. Other times, I'll go for a walk and I'll leave leave my house and I can really pay attention to it. The sights and the sounds and the smells, the Pacific Northwest, in the fall is one of the best smelling places I've ever been especially right before or right after it rains, which is very often, it rains a lot here. And just noticing flowers and dogs, and we have some of my neighbors have chickens in the yard. And so sometimes I can really pay attention to all of that. And other times I'm dissociated, and I have no idea what's going on. And then suddenly, I come to 10 minutes later.
Nick Jikomes 45:35
And so what, as part of your clinical practice as a psychologist, what are what would you say are the major ways that dissociation manifests itself in pathological cases, what what does someone typically look like when they have a negative form of dissociation that is preventing them from functioning at their full potential?
Peter Addy 46:00
Well, one of my clients struggles with alcohol use. And so he, he might say, I, I'm not going to drink today. And then he come home from work, he comes home from work, and then suddenly, there's a beer in his hand, and he didn't like, decide, I'm going to walk to the fridge, I'm going to open the door, I'm going to pull out the beer, you know, find the can open the bottle opener, it just sort of happened. And often, at that point, for many people, once you've had one, you might as well have two or 12, at that point, which is a cognitive distortion, you can in fact, stop after one. But it's very difficult to do that. So but stopping that first one, that's really what we want to do. That's the goal. And he, you know, he didn't decide to drink a beer, it just sort of happened.
Nick Jikomes 47:00
Interesting. So in neuroscience, you often make a distinction between top down and bottom up processing. So bottom up would be just normal sensation. So you're walking around, and you're really tuned into the sensory experience that's coming into your walking and smelling the smells and the Pacific Northwest, you know, feeling your own footsteps against the pavement, you're, you're really paying attention to the present moment, and the sensations that are coming into your brain. And then top down processing would be what we normally think of as higher order cognitive control, you know, deciding to do something through planning ahead of time imagining the future, and going, planning, planning your movements in anticipation of something that's not there yet. And so it almost sounds like dissociation is somehow related to this, where you're not tuned into the bottom up moment by moment sensations as much as you might need to be. And you're somehow lost in thought, or there's too much top down processing going on such that in the case of your client, something happens, in this case, grabbing a beer or a drink. And you're not aware of the actual bottom up sensations of doing that while they're happening. Is that does that sound like it's in the ballpark of how you might describe neurologically? What is going on here?
Peter Addy 48:26
Seems reasonable. I'm not sure about what kind of neurological underpinnings people have come up with. But that that makes sense. I do know that. disruption disruptions and interoceptive ability has been well documented in depression, and substance use and body dysmorphic disorders. So you there's a it was really mind opening for me to realize that it's not. When we think of interior reception, it's not yes or no. So in this in the example I gave, you know, I'm, I'm just sort of a zombie walking through my neighborhood, there's no signals, or there are signals, but I'm just not like, they're not coming up into consciousness. But it's not just that the missing piece is that you can. So for instance, the example right now, I don't notice my heart beating, it is in fact beating, but I'm not aware of it. If I were, let's see, if I were to, you know, touch my chest or my wrist or something, I could feel it, but I don't normally just feel my heart beating. So there's no interoceptive signals. Someone who has an anxiety disorder has heightened interior reception. They've got really good awareness of their body signals, but they also it's not just the signal. It's the emotional balance that you put on that. So someone with an anxiety disorder, they're just sitting around minding their own business and they start feeling their heart beating in their chest, and they They say, Oh my god, I'm having a heart attack, I need to go into the hospital. So they feel that, and then they put an emotional thing on it, which just exacerbates anxiety and it just kind of snowballs from there. So it's not just paying attention to your heartbeat or not. It's also the emotion that you add to it. So how. So yeah, depression, anxiety, some disorders like that we see altered interoceptive ability, where it's either the awareness of your body signals and or the emotions that you ascribe the kind of the story that you tell yourself about those body signals. And so we've also seen how it's not just in psychiatric disorders that we see altered into your perception, but we also see how certain psychological interventions can specifically improve interoceptive abilities, particularly mindfulness, meditation, yoga, tai chi, things like that, that you're increasing your ability to understand and be in relationship with your body.
Nick Jikomes 51:15
Gotcha, that makes perfect sense. Those are really practices where you're using your body, and you're paying attention to exactly how you're using it and what it feels like. And that was actually going to be my next question is how do you how do you train this ability to stay aware of immediate sensation? And what's going on immediately in your sensory environment? Is that the main way? Do you talk about neurological mechanisms with your patients? Are there other techniques in addition to those physical practices?
Peter Addy 51:47
Well, it is mostly physical practices. I mean, I, the more I do and learn about talk therapy, the more convinced I am that talk therapy isn't always so great. Especially with trauma, you can't talk your way out of trauma. You didn't. My my clients who have panic attacks you didn't, you don't talk yourself into a panic attack. So you can't talk yourself out of it. It's a physiological response. So I've been learning a lot more about Vegas nerve theory and more of the somatic based psychotherapy is that you can just work directly on your body, and you can kind of bypass the thinking and feeling brain entirely, you're just sometimes the thing to do is just work on your nervous system. And you don't have to talk about it.
Nick Jikomes 52:38
Interesting, and how effective Would you say that is for a lot of people? Or does it really vary? Do some people respond or naturally conduct meditation practice more readily than they would more intensive exercise routine, or more intensive yoga practice?
Peter Addy 52:57
Yeah, there's a lot of variables for sure. I used to work, I used to answer the phone lines for the National Suicide Prevention Lifeline. And I could hear people like all I have is a voice. I don't know what their faces look like or anything. And I could tell that they're breathing very rapidly. And that'll give anyone a panic attack, if you just get the most chill person around. And you get them to start taking a lot of short, shallow breaths, where they're not really getting any oxygen and the co2, two starts to build up. Anyone is going to feel anxiety from day one, that so I want people to take slow, deep breaths, to just regulate their nervous system, and be able to actually have a conversation, some people are gasping in such a way that they can't, they can barely get words out. So I just literally cannot talk to you, if you're breathing like that. And so sometimes that helps really well, most of the time, that helps a lot. And I could, if I could get someone on the phone to breathe with me, I do with them. And if we can just breathe together for 60 seconds, that's really all it takes to slow down to feel more settled and more regulated so that we can have a conversation about what's going on in your life. But sometimes minority of the time. It makes things worse. And I'm not sure why. But I think that if you cuz again, I only have a voice to go on. If I were in the room with a person. I'm guessing that I can help like I can give you a timer. I can say Breathe in, breathe out and you can just kind of time it to a second hand on a clock, but I don't know what they're doing with their bodies. So my guess is that some people maybe they're so distraught and or they have a low interoceptive ability that they just don't really know where their lungs are at that time. So I might say, take a deep breath in their gut. And they're thinking, Oh, yeah, I'm gonna take a deep breath, and they take a shallow breath, because they just literally don't know what's going on in their chest and torso at that moment. And if you so in that case, what ends up happening is that I'm kind of encouraging them or they're encouraging themselves to hyperventilate, which is not good.
Nick Jikomes 55:30
Interesting. So this interoceptive ability seems to be crucial. If you're not able to pay attention and get a good signal from inside of your body, it literally can prevent you from physically helping yourself.
Peter Addy 55:45
Yeah, a lot of my work now is with people with chronic pain and related chronic health conditions, I have a chronic pain condition. And so they're paying attention to my body equals pain. So I don't want to do that. That's the last thing I want, I want to dissociate in order to just get through the day. And so if you're, you're asking me to like do a body scan or, or pay attention to all my muscles, that's excruciating. That is, I will just run out of the room rather than do that. So getting someone to pay attention to their body there is very difficult, understandably, so it's a survival mechanism to not pay attention to your pain. But what I tried to tell myself, what I tried to tell my clients is that long term, you get to pay attention to your body. And also there's that emotional balance piece where you get to them have a sense of the pain is it's it's just pain, like pain doesn't have to be bad, which is a weird thing. Like I still I don't think I fully grasp that, to be honest with you, but I try. It's a practice. But sometimes you can get to the point where pain is just pain, it's just there. It's not a bad thing. It's not a good thing, but it's just part of it.
Nick Jikomes 57:07
Yes, it sounds like the real optimal. Psychological toolkit is not one where you've got interoception tuned up all the way or one where you've kind of got the opposite, but it's actually the ability to selectively turn up or turn down interoception versus external attention, when it best suits you, if you've got intense pain, you might actually want to dissociate a bit to literally dissociate yourself from the feeling of pain. And in other cases, you might be dissociating, and that's actually preventing you from knowing what you're actually doing, like grabbing that next drink.
Peter Addy 57:41
Yeah, I would say, decoupling the body signals from your story about the body signals a lot of times. So I'm going to guess with my, my client who reaches for the beer unconsciously, if I, if I were able to peek into his head, I'm going to guess that he comes home from work, and he starts thinking about a lot of stressful things. You know, he's having trouble in his marriage. And money is pretty tight. And so he comes home from work, and he's just kind of flooded with all of these things. And so to avoid the emotional pain, he reaches for alcohol, which in the short term is very good, at at its job of avoiding the emotional pain, it's terrible, long term solution. But in the moment, it's pretty good. You know, I come home and I start thinking about all these terrible things in my life. And I want to avoid that pain. So I'll drink. And a long term goal would then be to notice physical or emotional pain, and to decouple that from having to do something about it, or having to just habitually numb it, or medicate from it, because it's just there. It's just a thing that you can look at, like anything else. It's not overwhelming, it's not going to destroy you.
Nick Jikomes 59:06
And so if we kind of go back to the phenomenon of addiction, so let's talk about something like drug addiction, we kind of touched on the opioid receptor system, and how it's really hard to dissociate the effects of something like an opioid painkiller from the addictive potential of those have because, you know, getting rid of the pain is very closely related to the circuits that are actually generating pleasure, right? drugs of abuse feel good, that's a big part of why they're reinforcing and addictive. We talked about dissociation a little bit and how that could be related to regulating or not regulating your behavior appropriately. So as a psychological phenomenon, how do you think about addiction and, and how it actually starts and grabs ahold of someone?
Peter Addy 59:56
Hmm, that's a that's a big question. I mean, that's a whole No to our conversation, but addiction to, you know, drugs or gambling or sex or anything. There's something that I don't want to see. And so I, you know, like, so I'm my body is in pain, and I don't want to see that. So I use morphine or alcohol, or whatever it is. And that's not necessarily a bad thing. But sometimes we get so enamored with the thing that we use to avoid the pain that we forget that we're, we forget about the pain, or I could say that better, but. So morphine for can be a wonderful tool. But if we just look at that all the time and forget about the other thing, then it becomes dangerous. So if I say, you know, I, I'm in a lot of pain, but I have a lot of work to do today. And I just need to kind of get through the day and see my clients or you know, do an interview or something like that, then, you know, you can take, I could take something or I'm feeling tired, so I'm going to drink some coffee, right? Coffee is addictive. You go through withdrawal, you build up tolerance, it's, it meets all the classic criteria. It's an addictive drug. But I'm feeling tired, and I got an interview to do so I'm going to drink a cup of coffee. That's not bad. Nothing wrong with that. But then do I, once the coffee wears off? Do I do something to do I think about my energy and other ways. Let's let me eat some healthy protein to give myself a better energy burst. You know, let me take some time to think about my sleep schedule. My, my bedtime and my wake up routine? Like, can I look at the bigger picture? Like why am I feeling tired in the first place? Like let me actually look at that. And I could use caffeine as kind of a temporary boost to help me cook some food or you know, rearrange my bedroom by some blackout curtains, whatever it is, which in the long term is a way better way to manage my energy. And that's healthy, and less healthy thing is I feel tired. So I'm going to drink coffee. And now I'm not tired anymore. So I don't have to like do any more work.
Nick Jikomes 1:02:45
Interesting. And so, you know, right now addiction is front and center in a lot of people's minds just because there's so much of it going on these days, whether it's opioid addiction, or any number of other things. This is probably being exacerbated by the current situation we faced in 2020. So when you think about addiction treatments, there's there's a lot of stuff going on today. It's very exciting in terms of addiction treatments. You've got you know, people talking about psychedelics, ranging from psilocybin to Ibogaine, is there any work being done on the potential usefulness of salvia excuse me on salvia for addiction treatment?
Peter Addy 1:03:29
Not that I know of there, there has been in the past, so the only the closest there have been no clinical trials for salvia for anything. So all the human research to date has been basic research where we're just trying to learn what it's doing, either to your experience or to your brain. But there have been some case reports so Australia, there's a psychiatrist named Dr. Haynes in Australia and he published two case series where he was seeing patients with treatment resistant depression. And he and they, the his client, just all on her own started taking salvia and what we might today call a micro dose that she would take a doses of salvia maybe twice a week that we're not psychoactive or like just a little bit like barely psychoactive and our depressions cured. And so he encountered that. I think he wrote about eight people, I think, who did that. And then Australia became the first country outlaw salvia. So there's no more case reports coming out of there. That's depression, not substance abuse. But I think that there's there might be some sense there similar mechanisms there for a lot of reasons. I think it's likely that that micro dosing or taking salvia in a mindful way might help someone who has either depression or addiction. But we don't actually know. Like there's no actual, like research or writing about that in humans and the animal literature, it's a much clearer picture that Yeah, absolutely, that's going to help you give, you know, you get non human primates or rodents addicted to cocaine, and then you treat them with self and RNA, and they no longer reach for the lever that pushes the, you know, they no longer push the cocaine button. Once you can kind of, there's a few different paradigms, we can kind of pre treat with salvinorin A and the salvinorin kind of blocks the rewarding effects of the cocaine, or you can kind of give give the monkey cocaine and then stop. So they're back to baseline, but they're kind of primed to want the cocaine and then you give them salvia or cocaine or both. And it's just it's less pleasurable because you can kind of detect pleasure based on behavior and dopamine release. So there's a few different paradigms for it. But in the animal research, it seems pretty clear that salvia can help with addiction. But in humans, we haven't really seen that yet, but it seems reasonable to suspect.
Nick Jikomes 1:06:21
Interesting. So there's that animal research out there that indicates that potential, are there any other so this is a selective Kappa opioid receptor agonist. So salvia is this kind of weird, special drug. It's not a typical psychedelic. It has this unique property where it's binding to a particular opioid receptor. And you mentioned earlier that there was a synthetic opioid drug that had a similar pharmacological profile. Is there anything in use in humans in terms of synthetic Kappa opioid receptor agonists or anything like that?
Peter Addy 1:06:55
Well, actually, there's a ton of them. I had mentioned they, I don't even remember the names now. But in the 80s, people had looked created some like selective kapa agonists to try out and those trials never really went anywhere. But we didn't know what at the time, but we found out much later that try psych a lot of tri cyclic antidepressants have capa agonist properties. So before the age of Prozac, the most popular antidepressants were were a class of drugs called tri cyclic such as amitriptyline, lean, ummet, bromine, things like that. And they're not used so much these days, but they are still used, and they were the go to antidepressant for a long time. And those are primarily serotonin agonists. I think they work on search, but I don't remember. But they, so they're mostly the thing they do with serotonin. But we found out more recently, maybe five years ago, that they also have copper agonist properties. And so that's there's a huge amount of people who have been using copper agonists to treat their their depression. They just didn't know about it.
Nick Jikomes 1:08:13
Interesting. So why, why was there that move from the tri cyclic to the SSRIs? I think in the 90s, what did they have side effects that were not popular?
Peter Addy 1:08:23
Yeah, there can be more of a sedative effect than Prozac. Hmm. Man, it's been a while. But certainly the there's kind of a two book series, there's, of course, listening to Prozac and forgot who wrote that. And then, as a counterpoint to it is the book of talking back to Prozac, which I think is by Peter breggin, if I remember, right, but these two books offer kind of two diverging points as to like why Prozac changed the landscape in the way it did. But and there are a lot of factors including things like Prozac you can patent and a lot of the tri cyclic 's were coming off patent. So money is certainly a big factor, but also the side effect profile. And just the the level of effectiveness, that anytime when a new drug comes on market, it is really effective. And then over time, it becomes less effective. And we see that for a variety of psych drugs. And so in the early 90s, late 80s, I forgot when Prozac hit the scene now, but it's it's the hot new thing. And so it's it's hugely effective. And nowadays, Prozac has been around for a long time, and people don't really prescribe it very much. None of my clients are on Prozac. They're all on like the newest, the hottest and latest antidepressants,
Nick Jikomes 1:09:51
is that because when something's new, there's this expectation that the new thing is the best thing and so maybe the placebo effect is even stronger. than it otherwise would be? Or is it because when people take SSRIs for a long time, they're their body, and their physiology actually adapts to the drug? Both? Gotcha. And then. So with something like SSRIs, there's they've been so common, what do you know about the effectiveness of those standard treatments for depression? So like a big a big area right now in psychedelic drug research is, you know, everything about psilocybin, for example. And one of those is end of life anxiety. And another one that's related is major depression, especially depression, that might be refractory that's not responded well to other treatments. What are like how effective are things like SSRIs? What percentage of people that have an SSRI with therapy are actually going to recover from major depression? And what percentage approximately, are not gonna respond? Well, to that?
Peter Addy 1:10:57
I don't know. I'm sure there's a ton of reviews and meta analyses out there. But I honestly couldn't tell you.
Nick Jikomes 1:11:05
Peter Addy 1:11:06
I know that I could say that. This is kind of the difference between a lab in the real world efficacy versus effectiveness that what I usually see is that a psychiatrist or nowadays it's actually it's usually your PCP prescribes an anti depressant. And then that's it. Which was never the plan was never it's not, it's not supposed to happen like that. It's supposed to be an antidepressant plus therapy. But that's not what we actually see in the real world. So that's going to reduce effectiveness quite a bit, I'm sure. Whereas in a research trial, if you get individualized care, and you get an SSRI, plus there have been a lot of people asking how you're doing and doing a phone check in with you once a week, or once a day, or whatever it is, for for several months, then you're getting a lot of great support, and there's going to be a much higher efficacy in the lab because of that, and then in the real world, you just sort of hear some Zoloft Go, go live your life. And that's not going to work as well.
Nick Jikomes 1:12:13
Gotcha. So, this phenomenon of drugs, being less effective over time could in part be something like that, in the beginning, you're supposed to have psychotherapy, plus the drug, like the SSRI, and if more and more people are just getting that script from their psychiatrist and never actually going into the therapy, they're, they're never really getting the full treatment that they should have been getting the whole time.
Peter Addy 1:12:37
Yeah, and I fear that psychedelics will fall into that same trap, if you just say, here, you know, have a psychedelic experience. And even if it's under, you know, controlled, like, you know, well done conditions here in Oregon, we're going to be able to offer psilocybin services in two years, super excited about that. But it might be, so the way the law is written is that you have to have one preparation session, and then one medicine session, and then you have to offer one integration session, you don't even have to do it, you just have to offer it. And so just kind of doing that people could kind of come in and out. And you could you could just churn clients through that, like a factory. And that's not ideal, for many reasons. But it's, it's the same sort of thing like it's Prozac plus therapy is better than just throwing Prozac at a problem. And so silicided assisted psychedelic therapy or psilocybin. Let's see, the Oregon law doesn't call it therapy, I think they call it services, psilocybin services. So having a silicides in service, and then that's it, I think is going to be much less effective than psilocybin plus support plus therapy or a spiritual community or something.
Nick Jikomes 1:14:08
Do you think there's, like a fundamental conflict between the the economic and financial structures of mental health care services, and our ability to actually use a lot of these medicines the the right way. So basically, you just described, you know, situations where you might take a medication, whether it's a psychedelic, or anything else, you might take it in the context of therapy, but for maximum effectiveness, maybe you need to be going to therapy for weeks or even months, and have therapy sessions both with and without the medication, to have the integration set sessions after using the psychedelic, for example, to do it, almost like maps does the MDMA studies for PTSD where there's actually many weeks of therapy and you're only getting the drug once or twice and it's interspersed within this, you know, six eight plus week set therapy sessions. But you know, in the in the real world outside of the clinical trials, is there I mean, there's probably an incentive to churn through as many patients as quickly as possible. And so is there is there basically two things rubbing up against each other there?
Peter Addy 1:15:20
Oh, man, get me riled up. So first of all, you said something about like the, you know, doing this the right way. And there is no right way to take psilocybin or salvia or any of these things. There are absolutely wrong ways. So taking mushrooms and then driving the car. That is the wrong way to take mushrooms don't do that. But there's no right way to do this the Mazatec devil element. pharmaceutical companies don't own it. There's 100 different ways to take these medicines. I've been. I've been this year. Well, last year in 2020. I've read. I've been getting into Alan Ginsburg's poetry again, his most famous poem is how it's phenomenal. I can't recommend it highly enough, especially the footnote, you gotta read it with the fourth part. He ginsburg and Kerouac took masculine and wandered around San Francisco, and had a psychedelic experience, which ginsburg turned into the poem. How
Nick Jikomes 1:16:30
was his 16th?
Peter Addy 1:16:32
Yeah, early 60s. And it's, it's a profound experience. And I had nothing to do with the DSM, mental health, you know, research studies that wasn't medical in any way. And yet, it's, it's a profound piece of work. There's 100 different ways that are the right way to use mescaline, psilocybin, or any of these things. So the medical route is getting a lot of press. But it's not the only way to do it. And it's not necessarily the best way to do it. Being able people. In my research days, people talked a lot about, or they would write a lot about recreational use of drugs. And that was pejorative, that's a bad thing. So medical use of psychedelics is maybe there's a place for that. You have to really, like, fight and yell a lot and argue to suggest that maybe there's a place for medical use of psychedelics, but certainly not that recreational use. But no, but I mean, what is what's recreational use? So you, let's see, one of my clients took like a medium dose of mushrooms, and went hiking in the woods. And he was feeling this was during the debates, the presidential debates. That was a low point, I saw, you know, the first I saw the first presidential debate, and I almost had a panic attack. That's just the most horrifying thing I've ever seen on TV. So my client that weekend, or maybe the next weekend, he took a low dose of mushrooms and what hiking in the woods, and was able to just reconnect with himself and nature, he was able to feel love emanating from the sun. And there's nothing you know, that's got nothing to do with a medical model. And in the silicided Services Act that will go into effect in Oregon. It's an open question. We don't know if people will be allowed to go outside or not.
But it was absolutely the right way to use mushrooms for him and that scenario to go hiking in the woods alone.
It's not something that I recommended that he do. I should probably should have said this earlier. But disclaimer, as a mental health provider, I do not advise or encourage people to break the law. Using mushrooms and going hiking in the woods is illegal. And breaking the law is really bad for your mental health if you're caught, so don't don't do anything that will make your mental health worse and going to jail will absolutely make your mental health worse. So but my client did this totally on his own, and he told me about it afterwards. And that's there's nothing medical about that. But it was healing for him.
Nick Jikomes 1:19:40
Yeah, what Um, so the laws in Oregon are shifting. And it sounds like it'll be ambiguous whether or not someone could go outside and and have their psilocybin. What? What do you think so as a therapist and with your experience, what do you think the appropriate scheduling regulation of these drugs looks like something like psilocybin.
Peter Addy 1:20:05
I believe rather strongly that all drugs should be decriminalized. And so three days of the week, I think that all drugs need to be decriminalized three days of the week. I think that all drugs need to be legalized. And then on Sundays I take the day off and I try not to think about it, but I do not adhere to psychedelic exceptionalism. There's this idea like the decriminalized nature movement. I have a lot of respect for that movement. They're doing some good things but it's they're saying that psychedelics are the good drugs you know, it's not like heroin or crack those drugs are bad but mushrooms are good that's it's logically inconsistent you know like to say it's it's not even decriminalized nature it's decriminalize these certain parts of nature. They're not saying anything about coca leaves, opium poppy, caught credo many of those drugs, they're just saying, psychedelic plants are okay. And that's Yeah, now, I don't hold to that. So, as far as scheduling, I don't think any, any drugs should be scheduled for any reason.
Nick Jikomes 1:21:17
Interesting. So what do you think the what would be the basic, you know, arguments for decriminalization as opposed to legalization? versus the other way around? What what are the pros and cons of outright legalization compared to decriminalization?
Peter Addy 1:21:35
When it comes down to regulation, so I like so here in Oregon, we had this great thing where psilocybin mushrooms, psilocybin services will soon be legally available. And then at the same time, we measure 110, decriminalized personal possession of all drugs, and that'll come into effect next month, February 2021. So we have two different things going on at the same time. And that's, that's really great. So the pros to D cram, which we've, you know, Portugal did this 12 years ago, something like that, and they've had a great time of it. Oregon, we're going to see what happens. But when you decriminalize things, you take the criminal justice aspect out of it, a lot of the arguments in opposition to the de krembil in Oregon, were that the only way that you can convince people to get help for their addiction is to threaten them with prison. There was this pearl clutching Mrs. Lovejoy kind of letter that this mom wrote just won't, won't anybody, please think of the children, my my children misbehave, and you know, they go out and party and the only the only way I can control my children is to threaten them with the police and jail for their drug use. And if I don't have that leverage, then I've got nothing. Which says far more about her parenting than anything else. But threatening people with jail in prison is just not the way to go. Most people who use drugs can use drugs in prison. A significant I don't have the statistic in front of me, but a significant number of people who use heroin in prison, first used heroin in prison. They didn't use it before that prison is a gateway drug. Prison is inherent the prison system in our country is and always has be been inherently racist. And adding people to this violent industrial complex is not a good idea for anyone.
Nick Jikomes 1:24:02
Interesting, I actually didn't know that I've ever heard that prison is a gateway drug literally. Because you can still acquire I think most people probably understand you can acquire drugs in prison. That's, that's so embedded in the culture that we put into movies, in fact, and what you're saying is there's actually a significant amount of people who become drug abusers in prison. So prison is literally a gateway drug for that.
Peter Addy 1:24:28
Yeah. Or at least, you know, the, you know, maybe switching from one drug to another, something like that. I mean, in terms of smuggling, you have to I am by no means an expert of how to smuggle drugs into prison, but I would guess it seems reasonable that volume is of concern. And so cannabis, it's just you know, it's it's less dense, it's fluffier, whereas something like heroin, any kind of white powder, you can just get a lot more of it into the same space. So that's going to be a lot easier to get in. So things like cocaine and heroin are just gonna work better in a way that. So that is David nuts, book drugs without the hot air. I have read many, many books about drugs in my years and David pnets book is top on the list. And that's where so he's in the UK. So I don't know about the US prison system but in the UK prison system he he was the one who wrote that some percentage of people who first who use heroin in prison first use heroin in prison.
Nick Jikomes 1:25:36
Interesting. And then the league, what would the the pros and cons of legalization be? I think the big one is probably, you know, if you decriminalize drugs, you take the justice system out of the picture in the ways that you just described, but you don't actually do anything to regulate the quality of the substances themselves. And that's, that's also I think, an important piece to this.
Peter Addy 1:25:57
Yeah. So again, here in Oregon, we have recreational cannabis where you can just go to any store, and you can know like this, like, I guarantee you that this doesn't have mold or heavy metals in it. Now, the testing and reporting system isn't perfect, but but it's better than nothing. And you can know like, this is 20%, this and 4% that, and if you just get something from a guy who knows a guy, you have no idea which with cannabis, like you want to know what you're getting. But it's not as big of a deal. If you're buying a white powder from someone that can be anything that can buy soap, or fentanyl, or you don't know what and you can get testing kits, Dad safe. I'm going to plug dance safe.org you can get testing kits. These are just some kind of qualitative reagent kits. They're not great, but it's accessible for most people who so you can kind of rule out certain substances. But if you think that you're buying a pill of MDMA, and you're actually buying a pill of ketamine, you can have a bad time. Like, if you're thinking I purposefully would like to have Academy and experience tonight, you will, you know, set up your surroundings in a way to do that. But if you think I'm, I'm going to have an MDMA experience, but actually, it's ketamine then and you didn't prepare for that then that is not going to go well. So right before all the stay at home orders, I was really excited to see there's a shop there's a company in Colorado and they just expanded into Portland. That sounds crazy. There's a lot of shops that sell create them crave them not to go too far into a tangent but crave them is a plant from Southeast Asia and it contains some very unique opioid like chemicals. I first encountered it during my salvia research days because it the chemicals in kratom contain both mu agonist and kapa antagonists properties, never seen that before in nature. And so very interesting how it can Dult pain and help with addiction, but it has less abuse potential because of the capa effects. And there's no federal laws about it. It's also a state by state basis.
Nick Jikomes 1:28:22
So cram Yeah, I've never encountered trade in myself, is it? Is it one drug? Or is it a mixture? How are people taking this
Peter Addy 1:28:31
it's a plant and you take the you have you usually buy dried leaves like that have been crushed into a powder, and he can add that powder to food or drink. You can get extracts, like with salvia, but it's far less common because you don't really need to. And there are at least two alkaloids that have psychoactive and pain relieving properties, my tragen needed seven hydroxy my tragic name, but I bring this up because there's this company that I can't remember the name of right now. But right before the pandemic, they opened shop in downtown Portland and they were selling kratom that was testing that they had tested just like recreational cannabis that you buy in creative and you know, this is, you know, 3% my tragedy and and point 5%, seven hydroxy my tragedy, never seen that before. You can't find that online or at any other shop. But this was specifically you know, we're doing the same kinds of testing as recreational cannabis. And, you know, I can prove to you that my product doesn't have heavy metals or pesticides, and that it has a known quantity of active ingredients. And I don't know if they shuttered if they're, if they're still around or not, because you know, what a terrible time to start a new business early 2020 a brick and mortar business. But um, but anyway, that's exciting because that's more of the legalization route. And as you were Saying D cram does nothing about purity and potency, and legalization, you can do something about that you can regulate that to make sure that what you're buying doesn't have fentanyl in it.
Nick Jikomes 1:30:13
And I think on the legalization side, a lot of people get confused. I think a lot of people hear legalization and they think, oh, that's going to mean that you can buy any drug anyone can manufacture it and sell it at any corner store. And that's certain, almost certainly not what it would actually mean, right. There's all kinds of things that are legal, but don't operate that way. Like cannabis, for example, not anyone, you have to get a license to grow and manufacture cannabis products, they have to get lab tested at specific facilities. And there are specific stores that sell them. So drug legalization doesn't need to be, you know, Walgreens is going to start carrying bags of heroin. It could mean that, you know, some drugs are legal to sell in some kinds of stores. But anything that is actually gonna be put out there has to meet some level of quality control standards that are established by regulators.
Peter Addy 1:31:05
Yeah, absolutely, there are a lot of different ways to do it. And then so there are gatekeepers. And sometimes gatekeepers can have a useful role. Sometimes gatekeepers just kind of get in the way and help maintain imbalances of power and authority that don't need to be there. But sometimes gatekeepers can serve a public good of you know, alcohol is legal. And you're not supposed to be able to use it if you're a child, but plenty do. And if you get in, if you are caught selling to minors, then you can get fined, you can get your license revoked. If you drink and drive a car and get into an accident, you can have your car license revoked, but you don't get your drinking license revoked. You can like no matter how irresponsible you are, you can always buy alcohol, even though it's legal. But there are other things, you know, driving a car is legal, but you can have that privilege taken away again. So there's a lot of different ways to do legal use of something or legal access to something.
Nick Jikomes 1:32:17
Interesting. So we've talked about a lot so far, Peter. So we've talked about, you know, salvia, and various other drugs, we got into addiction, and we got into your clinical or your therapy practice and essentially self care routines, or at least some of the ones that are out there. Maybe we'll wrap up by just asking you in the context of COVID. You know, everyone's stuck at home, for the most part, people are generally more stressed right now than they have been historically, there's a lot going on in the world that's not helping with that. How do you recommend people stay sane, in this current environment?
Peter Addy 1:32:59
I think that I think about three relationships that we all have, the three most important relationships we have one is to ourself, so that includes your body, as well as your feelings and your thoughts. So foster that relationship. And that could be something like, going for a walk or practicing yoga, or journaling or just doing things consciously. There's a big difference between I've had a hard day, and the world is ridiculous. And I want to just, you know, watch a comedy on Netflix for two hours. Okay. And that's very different from Whoops, I guess. I've been watching comedies on Netflix for two hours. How did that happen? I was supposed to do I was supposed to make dinner, which, you know, we've all done that Netflix is great for that you just seem to get sucked into it. But doing it on purpose is different than it just sort of happening. So your relationship with yourself and just being aware of what you're doing for in with yourself, your relationship with other people that could be family, friends, neighbors, just anyone just human interaction, which nowadays is in some ways a lot harder. in other ways. It's kind of easier because we're all experts with zoom and video conferencing now. So it's, in some ways, it's easier to reach out to other humans, but it's also a lot harder. And then third is your relationship with nature. And so again, going for walks. We are in fact allowed to go outside people like to throw around the word lockdown. I used to work in a lockdown psychiatric hospital. We are not in lockdown. Anyone can leave the house anytime they want. So you can go even if it's just you know, if you're lucky enough to have a backyard, you can just go into your backyard if you're able to go to a park or the beach or the river safely and physically distanced Of course, but just being out in the nature the natural world with fresh air so your relationship to nature, other humans and yourself your own internal process. Those are the three relationships to foster.
Nick Jikomes 1:35:12
Alright, well, Dr. Peter attea, thank you for taking the time. And I hope to talk to you again at some point. Yeah, thank you. Thanks for having me.
Transcribed by https://otter.ai