1 00:00:00,000 --> 00:00:19,060 *36C3 preroll music* 2 00:00:19,060 --> 00:00:25,090 Herald: OK! Let’s come to the talk. So, next up is Andrea Jungaberle. She is 3 00:00:25,090 --> 00:00:35,050 talking about drugs and how drugs affect the psychiatry. Oh, that is a hard word. 4 00:00:35,050 --> 00:00:43,700 Why don't you do it, huh? I know now. And the question is, after the—what 5 00:00:43,700 --> 00:00:46,600 is “Verbot” in English? Andrea Jungaberle: Prohibition. 6 00:00:46,600 --> 00:00:50,480 Herald: Prohibition right, after the prohibition in the ’70s, not much thinking 7 00:00:50,480 --> 00:00:58,589 about how these drugs work and how could they improve psychiatry, has been done, so 8 00:00:58,589 --> 00:01:04,109 now everybody’s asking, is this the magic bullet cure? I don’t believe so. But more 9 00:01:04,109 --> 00:01:07,713 about this by Andrea. Well, warm welcome, please. 10 00:01:07,713 --> 00:01:14,110 *applause* 11 00:01:14,110 --> 00:01:19,550 Andrea: So hello, everybody. I'm very happy to be here and able to talk to you 12 00:01:19,550 --> 00:01:23,470 on a topic that is very important to me and I think very important to many people 13 00:01:23,470 --> 00:01:28,660 now and in the future. So the topic today is psychedelic medicine, hacking, 14 00:01:28,660 --> 00:01:33,150 psychiatry. And just to give away the punchline, it's not a magic bullet and 15 00:01:33,150 --> 00:01:36,910 will never be. But on the other hand, there are lots of things to know and think 16 00:01:36,910 --> 00:01:40,950 about in this context that I would like to introduce you to. But first, a few 17 00:01:40,950 --> 00:01:46,000 words about myself. I'm a medical doctor, specialized in emergency medicine / 18 00:01:46,000 --> 00:01:50,320 intensive care. I work and live in Berlin. And I'm also one of the founders of MIND, 19 00:01:50,320 --> 00:01:56,280 the European Foundation for Psychedelic Science, and its current medical director. 20 00:01:56,280 --> 00:02:01,590 One more sentence about us. That's our core team. So MIND is a members-based 21 00:02:01,590 --> 00:02:07,560 Psychedelic Science Association. We have run 450 members worldwide and a core 22 00:02:07,560 --> 00:02:13,250 team of about 50 people. That is a nucleus of paid staff, lots of very dedicated, 23 00:02:13,250 --> 00:02:17,040 very good volunteers and great interns from different disciplines like the 24 00:02:17,040 --> 00:02:23,240 neurosciences, psychiatry, psychology, and pharmacology, for example. So we work to 25 00:02:23,240 --> 00:02:27,630 establish psychedelic science as an evidence-based method and also educate 26 00:02:27,630 --> 00:02:34,489 about it in Germany and Europe around it. Okay, but let's dive in at the deep end. 27 00:02:34,489 --> 00:02:42,230 Psychedelics. What are psychedelics? Well, the term comes from the Greek Psyche 28 00:02:42,230 --> 00:02:46,909 Delos, which could be translated as “manifesting the mind of the psyche.” So 29 00:02:46,909 --> 00:02:52,535 many were talking about psychoactive substances with a certain, well, capability 30 00:02:52,535 --> 00:02:57,629 of transforming one's perception, introspection, sensory qualities in a very 31 00:02:57,629 --> 00:03:03,009 typical way that is sometimes described as dreamlike, but not necessarily so. The 32 00:03:03,009 --> 00:03:07,260 classic psychedelics that are also called hallucinogens, which I don't like as a 33 00:03:07,260 --> 00:03:12,340 term because they don't induce hallucinations. What they do is induce 34 00:03:12,340 --> 00:03:17,959 pseudo-hallucinations; so somebody on a psychedelic substance, usually in 99% 35 00:03:17,959 --> 00:03:21,369 of the time is aware that they have taken a substance and what they're 36 00:03:21,369 --> 00:03:25,080 experiencing is due to the substance. So it's not a hallucinogen, but a pseudo- 37 00:03:25,080 --> 00:03:30,938 hallucinogen. But these substances, like the classics—LSD, psilocybin, or DMT— 38 00:03:30,938 --> 00:03:37,340 function in a very specific way and they all are working on the serotoninergic system. 39 00:03:37,340 --> 00:03:41,510 So serotonin is one of the key neurotransmitters and there's one receptor 40 00:03:41,510 --> 00:03:47,029 which is the 5-HT2A receptor, which is, like, the smallest common denominator of 41 00:03:47,029 --> 00:03:51,390 all those substances, which doesn't say that they all work just on this one, but 42 00:03:51,390 --> 00:03:56,119 they affect a whole plethora of neurotransmitters and receptors. But this 43 00:03:56,119 --> 00:04:00,780 is the key where they all work. There are other substances that are classified as 44 00:04:00,780 --> 00:04:04,930 somehow psychedelic, like the entactogens—ecstasy, MDMA is one of the 45 00:04:04,930 --> 00:04:09,840 kind—which works also on the serotonin system. Dissociatives, like ketamine, 46 00:04:09,840 --> 00:04:14,079 work more on the NMDA receptor and some others; they are just basically chemical 47 00:04:14,079 --> 00:04:20,120 random, like Amanita, which is the Fly Agaric Mushroom, or Datura, or Salvia. OK. 48 00:04:20,120 --> 00:04:24,085 This is the only slide I'm going to bother you with this dry kind of science. But I 49 00:04:24,085 --> 00:04:29,050 think it's important to be clear about this because even though psychedelics are 50 00:04:29,050 --> 00:04:34,170 a pop cultural meme, hardly anybody knows anything about it, to be honest. Most 51 00:04:34,170 --> 00:04:41,290 people associate them with being drugs of the same danger profile as methamphetamine 52 00:04:41,290 --> 00:04:45,950 or opioids. Think there is an addiction factor which in fact does not exist with 53 00:04:45,950 --> 00:04:51,390 classic psychedelics. And basically it has been the dirty corner of perception for 54 00:04:51,390 --> 00:04:57,296 many people for a very long time. Recently, things have changed a bit. Psychedelics 55 00:04:57,296 --> 00:05:03,120 have come mainstream. Firstly, because there is a perception shift on drugs in 56 00:05:03,120 --> 00:05:09,510 general due to the cannabis perception and medication changing. And also because 57 00:05:09,510 --> 00:05:13,440 people like, for example, Michael Pollan, who's a classic mainstream author writing 58 00:05:13,440 --> 00:05:19,020 on cooking and nutrition, have turned to writing about psychedelics. And another 59 00:05:19,020 --> 00:05:23,485 factor that has helped psychedelics in one way and harmed them and another is the 60 00:05:23,485 --> 00:05:28,870 whole microdosing craze we have seen, especially in the tech and developmental 61 00:05:28,870 --> 00:05:36,530 scenes, and especially in the Bay Area and Silicon Valley. OK, but where do they come 62 00:05:36,530 --> 00:05:43,000 from? In this talk, I am not going to speak about psychedelic, psychoactive 63 00:05:43,000 --> 00:05:48,160 substances in other cultural frameworks. There are cultures like in the Amazonian 64 00:05:48,160 --> 00:05:54,260 basin or some Aztec people in Mexico who have been using psychoactive 65 00:05:54,260 --> 00:06:00,750 substances, psychedelics, in a very ritualized sense for millennia, perhaps, 66 00:06:00,750 --> 00:06:05,760 or at least centuries. But this is not us. So let's talk about what happened here in 67 00:06:05,760 --> 00:06:12,510 Europe or in the Western world, including America. This guy up here, sorry, that's 68 00:06:12,510 --> 00:06:19,390 the wrong one. The pointer isn't strong enough. We'll work like this. This nice 69 00:06:19,390 --> 00:06:26,820 guy up here is Albert Hofmann. In 1938, he was developing several substances that 70 00:06:26,820 --> 00:06:32,620 were supposed to work on atonia and in postpartum women, but also on other 71 00:06:32,620 --> 00:06:36,780 problems like blood pressure and he, among other things, developed the 72 00:06:36,780 --> 00:06:42,180 thing that later became LSD. But back then, he didn't see any sense in 73 00:06:42,180 --> 00:06:46,291 pursuing it medically because it didn't work the way he wanted it to and he 74 00:06:46,291 --> 00:06:51,170 shelved it. And for some reason in ’43, he took it out the shelf again to retest it 75 00:06:51,170 --> 00:06:59,000 for other purposes, and accidently gave himself the first noted LSD trip. This 76 00:06:59,000 --> 00:07:03,251 happened not because he was a shitty chemist, but because the amount that is 77 00:07:03,251 --> 00:07:09,020 needed to induce an effect is so low as it has never been noted before in any other 78 00:07:09,020 --> 00:07:14,890 substance. So 20 micrograms of LSD can already produce a notable change in 79 00:07:14,890 --> 00:07:20,360 perception. So when he came out of that experience, this first one he had, after 80 00:07:20,360 --> 00:07:25,610 accidentally dosing himself, he decided to go for, well, a trial on himself and 81 00:07:25,610 --> 00:07:29,690 trying to be safe. He used what he thought was a very low dose of the substance he 82 00:07:29,690 --> 00:07:37,100 discovered, which turned out to be 250 micrograms of LSD, which was his… I hear 83 00:07:37,100 --> 00:07:42,400 the laughter. It’s rather a high dose trip, especially for somebody who just 84 00:07:42,400 --> 00:07:48,270 didn't know what was expecting him out there in his own mind. And this is the 85 00:07:48,270 --> 00:07:52,290 famous bicycle day trip where he rode home on his bike thinking that the world was 86 00:07:52,290 --> 00:07:57,250 collapsing around him, basically. So even this wasn't a nice trip, the first one. So 87 00:07:57,250 --> 00:08:01,430 what happened next was that he reported to his superiors at Sandoz Chemical in Basel, 88 00:08:01,430 --> 00:08:06,400 and they had the idea of turning this into a substance for many doctors, 89 00:08:06,400 --> 00:08:13,000 psychiatrists, psychologists, to experience what it would be like to be psychotic. So 90 00:08:13,000 --> 00:08:20,110 its first application of LSD was as a psychotomimetic. And as a psychoto- 91 00:08:20,110 --> 00:08:24,020 mimetic, thousands of dosages were distributed worldwide from the 92 00:08:24,020 --> 00:08:30,210 Czech Republic to Harvard University to everywhere. And doctors tried it out. What 93 00:08:30,210 --> 00:08:36,020 happened then was that a small group of young, ambitious psychologists around 94 00:08:36,020 --> 00:08:40,060 Timothy Leary tried it out too, and thought this is not just something for 95 00:08:40,060 --> 00:08:45,640 doctors. This is not just a psychoto- mimetic and brought it out basically into, 96 00:08:45,640 --> 00:08:51,760 yeah, the real world. And people were experimenting with LSD quite a bit in the 97 00:08:51,760 --> 00:08:57,610 ’60s before it was forbidden in ’71. Not because it turned out to be so dangerous. 98 00:08:57,610 --> 00:09:02,800 They were not so many accidents. Not so many people had dire side effects. But 99 00:09:02,800 --> 00:09:07,710 because the political will to cope with the substance and its implications wasn't 100 00:09:07,710 --> 00:09:16,130 existent in the Nixon era. So. ’71, underground goes into subculture. But the 101 00:09:16,130 --> 00:09:20,740 genie was out of the bottle and it was not going to go back in. And psychedelics, not 102 00:09:20,740 --> 00:09:28,390 only LSD, but also Psilocybin, later on MDMA. And these days, more than 500 new 103 00:09:28,390 --> 00:09:32,570 psychoactive substances that have been brought up on the black market are around 104 00:09:32,570 --> 00:09:38,600 us. And people use them. It's a societal reality that our juridical system doesn't 105 00:09:38,600 --> 00:09:43,890 keep up with, to be fair. So it's been in many subcultural setting from people just 106 00:09:43,890 --> 00:09:49,240 going dancing and having a good time to self-exploration to pseudo-chamanic or 107 00:09:49,240 --> 00:09:55,410 chamanic settings. And I think most people will at least know somebody who have 108 00:09:55,410 --> 00:10:01,640 experienced psychedelics at least once. And then something else changed. A few 109 00:10:01,640 --> 00:10:08,270 years ago, let’s say, 10-ish, 10 years ago, psychedelics started coming back. There 110 00:10:08,270 --> 00:10:13,950 had been research, for example, at the University of Zürich around psychedelics 111 00:10:13,950 --> 00:10:20,580 before that already. There had been trials before. But the big comeback of substances 112 00:10:20,580 --> 00:10:29,230 like psilocybin, LSD, and MDMA as tools to augment psychotherapy was within the last 113 00:10:29,230 --> 00:10:35,460 10 or 15 years. So these people up here are some of the people worldwide working 114 00:10:35,460 --> 00:10:41,740 with these substances, trying to develop them into medications. So … not 115 00:10:41,740 --> 00:10:46,380 over-the-counter, but prescription medications to be applied within the 116 00:10:46,380 --> 00:10:50,510 setting of psychotherapy. So the idea is never that somebody can walk into a 117 00:10:50,510 --> 00:10:54,790 pharmacy saying, oh, I'm depressed, I want to buy psilocybin to treat myself, but to 118 00:10:54,790 --> 00:10:59,710 have a structured therapeutical session in which the effects can be contained and the 119 00:10:59,710 --> 00:11:06,060 benefits enhanced. So the ones that are most promising these days are psilocybin 120 00:11:06,060 --> 00:11:11,050 for depression, which is already heading for the third stage, third and final stage 121 00:11:11,050 --> 00:11:17,388 of approvement as medication within the USA and consecutively hopefully in Europe. And 122 00:11:17,388 --> 00:11:23,279 MDMA, so what is used? What people want to find if they buy ecstasy, not that they 123 00:11:23,279 --> 00:11:27,220 always get it, but MDMA is the substance they're trying to get, for post-traumatic 124 00:11:27,220 --> 00:11:31,920 stress disorder (PTSD). In the U.S., even the Veterans Association has jumped on the 125 00:11:31,920 --> 00:11:37,800 bandwagon and has sponsored this research, which is interesting at least. But isn't 126 00:11:37,800 --> 00:11:45,930 that harmful? Aren't these substances very dangerous? Well, not in the way you 127 00:11:45,930 --> 00:11:51,480 think and not as much as you might think. This graphic up here is something that was 128 00:11:51,480 --> 00:11:56,950 put together by a group of 40 experts who discussed what substances have what harm 129 00:11:56,950 --> 00:12:03,610 on the user and what harm on the people around the users. So, for example, alcohol 130 00:12:03,610 --> 00:12:09,100 is harmful for the person, giving them a liver disorder, making them addicted and 131 00:12:09,100 --> 00:12:14,220 so on, so on. But also because people get aggressive when they use it or drive 132 00:12:14,220 --> 00:12:18,530 dangerously, for example, when they're intoxicated, it's dangerous to others. If 133 00:12:18,530 --> 00:12:24,250 you check out. I have to walk over here now. Sorry to the camera people. The 134 00:12:24,250 --> 00:12:27,800 substances we're talking about for treatment are not up there with the very 135 00:12:27,800 --> 00:12:32,010 dangerous ones. We have the shrooms down here, the LSD is there, ecstasy is there. 136 00:12:32,010 --> 00:12:39,250 So very low danger to the user and almost no danger to other people. If you compare 137 00:12:39,250 --> 00:12:47,880 that to alcohol, heroin, tobacco, it's all up there. And, to be quite fair, we’re all 138 00:12:47,880 --> 00:12:53,980 part of a giant field study anyway. Because these substances *are* being used. This is 139 00:12:53,980 --> 00:12:58,790 data from the 2017 Global Drug Survey, which is a self-reporting study where 140 00:12:58,790 --> 00:13:04,630 people talk about their own drug use and fill in forms online. This is not a 141 00:13:04,630 --> 00:13:09,490 statistically sound sample of the general population because to fill out that trial, 142 00:13:09,490 --> 00:13:13,600 you have to have a certain interest. But the people that have filled this out— 143 00:13:13,600 --> 00:13:20,880 we're talking about a number of over 115.000 worldwide—say that 144 00:13:20,880 --> 00:13:29,020 they have, in their lifetime, partially used LSD. … were the numbers …? MDMA, 145 00:13:29,020 --> 00:13:37,051 mushrooms and LSD, so MDMA 35%, mushrooms almost 25%, LSD over 22%. 146 00:13:37,051 --> 00:13:41,130 And if you look around you, of how many people do you know who 147 00:13:41,130 --> 00:13:45,660 ended up in an emergency department or in a psychiatric ward due to _only_ using 148 00:13:45,660 --> 00:13:51,190 those substances? Actually, looking at this giant field study that the illegal 149 00:13:51,190 --> 00:13:56,430 market has provided us with, it seems to be rather safe because these people 150 00:13:56,430 --> 00:14:02,180 are not using clear dosages of a clean substance and still there's hardly 151 00:14:02,180 --> 00:14:18,089 anything happening. OK. But what about microdosing? Well. We don't know much 152 00:14:18,089 --> 00:14:25,330 about microdosing, in fact. There are no scientifically randomized controlled 153 00:14:25,330 --> 00:14:31,620 studies, as to yet; the first ones are just starting. There are self-reporting studies 154 00:14:31,620 --> 00:14:37,780 where people have filled out online forms. And it seems to be that what people are on 155 00:14:37,780 --> 00:14:43,730 one hand trying to achieve is, yes, enhancing creativity, getting better work 156 00:14:43,730 --> 00:14:52,300 performance. But a lot of them are trying to treat, cure, enhance that latent or 157 00:14:52,300 --> 00:15:01,750 apparent depression, and the other thing is: microdosing—which is defined mostly as 158 00:15:01,750 --> 00:15:09,120 using a very low, almost subliminal dose of a psychoactive substance such as LSD—is 159 00:15:09,120 --> 00:15:13,740 being done by people with all sorts. There are people microdosing MDMA and ibogaine, 160 00:15:13,740 --> 00:15:17,720 which is, if you look at the receptor profiles, just insane basically and 161 00:15:17,720 --> 00:15:24,770 frankly can't do what they hope it does. And when we took a look at people who 162 00:15:24,770 --> 00:15:31,070 microdose, we can't say how much of the effect they’re feeling is really from 163 00:15:31,070 --> 00:15:37,450 microdosing that substance or if we have a top-notch, first-grade placebo effect going 164 00:15:37,450 --> 00:15:43,160 on where people feel much better because they have taken this and believe in it. 165 00:15:43,160 --> 00:15:49,959 Let's not turn down placebo. Placebo is extremely valuable medically. It’s 166 00:15:49,959 --> 00:15:54,940 actually shown that placebo effect, for example, enhance the endogenous opioid 167 00:15:54,940 --> 00:16:00,290 production. So your body revs up towards healing, towards feeling better with the 168 00:16:00,290 --> 00:16:05,740 placebo effect. But this could also be done with a sugar pill. And there's one 169 00:16:05,740 --> 00:16:09,450 thing I just want to leave with you in this group. If anybody of you is 170 00:16:09,450 --> 00:16:16,620 microdosing and has preexisting heart condition: don't! Simply because some of 171 00:16:16,620 --> 00:16:20,560 the subreceptors, especially with LSD that are being activated in prolonged micro 172 00:16:20,560 --> 00:16:28,180 dosing for a long time can be cardiotoxic and possibly harm your heart. Just again, 173 00:16:28,180 --> 00:16:32,140 there's not clear data about this yet. Just to leave it with you, if you suffer 174 00:16:32,140 --> 00:16:37,700 from a heart condition: don’t! Depression. That keyword I had with the 175 00:16:37,700 --> 00:16:42,430 microdosing as well. But let's go deeper into this, because if we want to 176 00:16:42,430 --> 00:16:49,160 talk about how psychedelic medicine can really make a difference in psychiatry, 177 00:16:49,160 --> 00:16:56,839 depression is like, yeah, the first-line thing to think and talk about and why is 178 00:16:56,839 --> 00:17:04,100 that? Depression is a very serious psychiatric disorder. People who are 179 00:17:04,100 --> 00:17:09,049 severely depressed—and that's many people; statistically, in Germany, every 8th 180 00:17:09,049 --> 00:17:13,789 woman is likely to suffer from a severe depressive episode. At one point in their 181 00:17:13,789 --> 00:17:20,180 life or the other. People who are depressed lose social functioning. They 182 00:17:20,180 --> 00:17:24,899 have very decreased life expectancy partially through suicide, partially 183 00:17:24,899 --> 00:17:28,790 because they don't manage to care for themselves. These people lose themselves 184 00:17:28,790 --> 00:17:35,990 and are being lost for others, too. And there is treatment for depression, yes, 185 00:17:35,990 --> 00:17:42,380 but in many cases it only has a limited capacity. And even though depression is a 186 00:17:42,380 --> 00:17:49,180 worldwide epidemic—with rates from 3% of the population in China to 187 00:17:49,180 --> 00:17:54,210 22% of the population in Afghanistan suffering from it—there have not really 188 00:17:54,210 --> 00:17:59,809 been new forms of treatment for two, two and a half decades‽ So the stuff we're 189 00:17:59,809 --> 00:18:05,160 working with is partially working, partly not: about one third of patients don't 190 00:18:05,160 --> 00:18:10,750 react to the medication at all, even though there's different types. And those 191 00:18:10,750 --> 00:18:16,670 who do usually have very low rates of acceptance because of the side effects. 192 00:18:16,670 --> 00:18:21,130 Because many people use antidepressants, and the best combination is cognitive 193 00:18:21,130 --> 00:18:24,910 behavior therapy—so what is called in German “Verhaltenstherapie,” cognitive 194 00:18:24,910 --> 00:18:32,860 behavioral therapy—in conjunction with antidepressants. That might work, but for 195 00:18:32,860 --> 00:18:38,135 some it doesn't. And those who take the medication don't feel well. It's not that 196 00:18:38,135 --> 00:18:42,170 they're back to normal. They're just less depressed. But usually they're like dimmed 197 00:18:42,170 --> 00:18:46,249 in on all sides. So they are still not getting happy. The libido is decreased. 198 00:18:46,249 --> 00:18:49,910 Their activity levels are decreased. People are suffering quite a bit from the 199 00:18:49,910 --> 00:19:00,910 side effects and it's really not nice. So. I was just … just to tell you one 200 00:19:00,910 --> 00:19:05,549 little story. I told you I’m an emergency medicine doctor. And just 201 00:19:05,549 --> 00:19:14,040 to illustrate how bad depression can get: A few weeks ago, I was being called out to 202 00:19:14,040 --> 00:19:20,380 an attempt of suicide. A woman had jumped out of her window on the fourth floor. We 203 00:19:20,380 --> 00:19:27,670 found her lying in her yard and she was... injured, badly injured, but still alive, 204 00:19:27,670 --> 00:19:34,530 and we stabilized her and took her to hospital, and when the nurse kind of 205 00:19:34,530 --> 00:19:40,270 pulled up her data in the emergency room, she went like, oh, no, not again, because 206 00:19:40,270 --> 00:19:46,570 this woman had jumped out the same window just half a year before. That's how bad 207 00:19:46,570 --> 00:19:54,110 this disease can be. So how desperate people get and how terribly important it 208 00:19:54,110 --> 00:19:59,950 is for us not to look away, but try to find better new therapies. And this is, in 209 00:19:59,950 --> 00:20:04,070 my opinion, with psychedelic medicine … Psychedelic therapy can be a real game 210 00:20:04,070 --> 00:20:12,200 changer. The one therapeutic application we have the best data for is psychedelics 211 00:20:12,200 --> 00:20:17,450 for treatment-resistant depression. There are several studies going on in the UK, in 212 00:20:17,450 --> 00:20:23,640 the States, and Switzerland, but also in the Czech Republic and so on, so on. And 213 00:20:23,640 --> 00:20:27,510 what they seem to be finding is that even though they're still working with small 214 00:20:27,510 --> 00:20:32,830 samples because you have to fan out; if you try to bring out a medication like 215 00:20:32,830 --> 00:20:37,180 that, you have to show first that it's safe with healthy people and then you 216 00:20:37,180 --> 00:20:41,016 start with a small sample of sick people and then you enlarge it from there. And 217 00:20:41,016 --> 00:20:47,980 they’re now in this enlarging process … that's treating depression with psilocybin 218 00:20:47,980 --> 00:20:53,260 especially does not only decrease depression in those patients, but also 219 00:20:53,260 --> 00:20:58,790 does one great thing: it decreases anxiety! Not only talking about state 220 00:20:58,790 --> 00:21:04,500 anxiety, so how anxious people are at this very moment in living their lives, but 221 00:21:04,500 --> 00:21:09,990 that trait anxiety. So how anxious people are as a part of their personality, which 222 00:21:09,990 --> 00:21:16,930 is a good thing to gauge how likely people are to relapse back into depression, 223 00:21:16,930 --> 00:21:20,500 people that are very anxious, very insecure about life, are far more likely 224 00:21:20,500 --> 00:21:29,270 to relapse. OK, so you see, there's a lot happening worldwide studying this, but 225 00:21:29,270 --> 00:21:37,580 this is Germany on that. A scientific desert. We're in the largest country; 226 00:21:37,580 --> 00:21:41,710 It’s also the scientifically perhaps most important country when it comes to medical 227 00:21:41,710 --> 00:21:45,290 research in Europe. There’s zilch happening. There hasn't been a study on 228 00:21:45,290 --> 00:21:50,532 psychoactive compounds in this context, forever, like 30 years, the last one on 229 00:21:50,532 --> 00:21:56,169 entactogens like 20 years ago. But studying psychedelic here hasn't happened. 230 00:21:56,169 --> 00:22:08,279 And we want to change that. Let’s … *applause* 231 00:22:08,279 --> 00:22:14,140 So we as the main foundation had, perhaps, let's call it groundbreaking, what a 232 00:22:14,140 --> 00:22:19,090 groundbreaking conference this September in Berlin at the Charité buildings. 233 00:22:19,090 --> 00:22:23,770 We had 600 participants, over 50 speakers from worldwide, everybody 234 00:22:23,770 --> 00:22:29,470 basically, almost everybody who's important in this dialog scientifically 235 00:22:29,470 --> 00:22:33,990 was around. So from the pharmacology, the psychiatrist, the psychologist, the 236 00:22:33,990 --> 00:22:41,580 therapist, but also philosophers talking about a culture of older sets of mind have 237 00:22:41,580 --> 00:22:46,049 been around. And we have been trying to bring this to the German public and try to 238 00:22:46,049 --> 00:22:55,320 lay groundwork for doing new science in Germany. And what's to come next is this. 239 00:22:55,320 --> 00:23:01,260 With our P.I., so a principal investigator, Gerhard Gründer, who is a 240 00:23:01,260 --> 00:23:09,220 new pharmacologist from the University of Mannheim ZI. We are about to apply for the 241 00:23:09,220 --> 00:23:16,020 1st psilocybin depression study in Germany this next year. So in 2020, we're 242 00:23:16,020 --> 00:23:20,040 putting in the applications, we've already put the first paperwork in, and what we 243 00:23:20,040 --> 00:23:26,360 want to do is do a double standard study, both at the ZI Mannheim and the 244 00:23:26,360 --> 00:23:30,192 Charité Berlin. Those are the two most renowned psychiatric research facilities 245 00:23:30,192 --> 00:23:35,040 in Germany. And it's a collaboration from the ZI, Charité, and the MIND Foundation. 246 00:23:35,040 --> 00:23:40,799 Each group contributing their knowledge, their capabilities, and their strengths. 247 00:23:40,799 --> 00:23:47,210 And what we want to do is this. We want to do a double blind, randomized 248 00:23:47,210 --> 00:23:54,690 controlled phase IIa study. Big word. this basically means that … It’s a 249 00:23:54,690 --> 00:23:59,240 top-notch level, internationally acclaimed study. This is how these studies need to be 250 00:23:59,240 --> 00:24:03,780 done to have any value. So it's double blind, meaning that neither the patient 251 00:24:03,780 --> 00:24:09,690 nor the therapist know what this patient is getting. It's randomized. So this gets 252 00:24:09,690 --> 00:24:14,650 assigned without anybody playing around with it. And phase II means that it's a 253 00:24:14,650 --> 00:24:20,840 safety and efficacy study, so not yet dose testing and not yet comparing dosages, but 254 00:24:20,840 --> 00:24:26,730 just trying to make sure it works. And we are going to do that in a 144 participants 255 00:24:26,730 --> 00:24:32,780 sample in total, in two locations, which is huge. This will be the second or third 256 00:24:32,780 --> 00:24:37,260 biggest sample worldwide doing this. And the first one in Germany, as we said and 257 00:24:37,260 --> 00:24:42,390 what we are going to test is 25 milligrams of standardised GMP. So 258 00:24:42,390 --> 00:24:47,049 Medical Grade Psilocybin versus two active placebos. One being a small dose of 259 00:24:47,049 --> 00:24:52,500 psilocybin, which used to be the standard thing to do. But now talking about 260 00:24:52,500 --> 00:24:58,400 microdosing, what is if the small doses already does something? And testing it 261 00:24:58,400 --> 00:25:02,950 against another placebo that isn't psilocybin, which is: there’s some physical 262 00:25:02,950 --> 00:25:10,620 reaction, but is not psychedelic in this sense. So in this design, every patient 263 00:25:10,620 --> 00:25:15,690 will receive at least one—some two—high dosages of psilocybin. So everybody who 264 00:25:15,690 --> 00:25:22,039 gets accepted will have his try. And the study design consists of preparation 265 00:25:22,039 --> 00:25:27,150 sessions, dosing sessions where people receive either placebo or psilocybin and 266 00:25:27,150 --> 00:25:32,930 integration sessions. Integration is so important and not only in a scientific 267 00:25:32,930 --> 00:25:36,830 study on this topic, but if people are working with psychedelics, experimenting 268 00:25:36,830 --> 00:25:41,850 with psychedelics themselves, integration is the key to do something with the 269 00:25:41,850 --> 00:25:46,259 experience. Because if you don't work with it actively, the experience is going to 270 00:25:46,259 --> 00:25:50,770 fade. And you might remember something about what you learned, but it will not 271 00:25:50,770 --> 00:25:56,880 have the impact on you, your life, and how you—yeah—benefit from what you've seen 272 00:25:56,880 --> 00:26:02,890 and learned in that way. Right. Just one more sentence. It's mixed funding, its 273 00:26:02,890 --> 00:26:07,010 funding and progress. So we have some public money coming in, but we're also 274 00:26:07,010 --> 00:26:12,669 looking for donations and investment just at the side. And this is almost the end of 275 00:26:12,669 --> 00:26:18,610 my talk. What I want to say is the following: What we try at the moment 276 00:26:18,610 --> 00:26:25,070 is to establish safe and legal psychedelic therapies in Germany, Europe, and the 277 00:26:25,070 --> 00:26:30,250 world. This is going to take time. If things go well, we might be there in five 278 00:26:30,250 --> 00:26:35,340 to ten years—five if things go really well. And I know that it's very tempting 279 00:26:35,340 --> 00:26:40,490 for many people to say: “Well, I can just go to somebody and have a 280 00:26:40,490 --> 00:26:44,520 psilocybin session. I can go to somebody, have an ayahuasca session.” And yes, you 281 00:26:44,520 --> 00:26:49,000 can. But be aware if you do that, because you're really suffering from psychiatric 282 00:26:49,000 --> 00:26:53,130 disease, if you have a mental illness, if you really are in distress. Be very 283 00:26:53,130 --> 00:26:57,340 careful with yourself, because the thing is, you need somebody to really support 284 00:26:57,340 --> 00:27:01,180 you, really help you through somebody who really knows what they're dealing with, 285 00:27:01,180 --> 00:27:06,210 because otherwise you can do yourself more harm than good. This picture down there 286 00:27:06,210 --> 00:27:11,921 with the ambulance is a real picture. Right. That's what I wanted to say. 287 00:27:11,921 --> 00:27:15,839 Thank you very much for having me. If you're interested in what we're doing, 288 00:27:15,839 --> 00:27:23,740 check it out! *appplause* 289 00:27:23,740 --> 00:27:29,360 Herald: Andrea, thank you very much. That gives us plenty of time for some 290 00:27:29,360 --> 00:27:34,730 questions. People are lining up on the microphones already. So we start with 291 00:27:34,730 --> 00:27:39,540 microphone number two, please. Mic 1: Thank you for this amazing talk. 292 00:27:39,540 --> 00:27:43,510 That's really great. Just one question. Wouldn't that be a problem for a double 293 00:27:43,510 --> 00:27:48,980 blind study if a person can surely tell if they're experiencing psychedelic effects? 294 00:27:48,980 --> 00:27:54,980 Andrea: That is a problem. Yes, but this is the way the authorities request the 295 00:27:54,980 --> 00:27:59,039 study to be done. And interestingly enough, there have been cases where people 296 00:27:59,039 --> 00:28:07,630 couldn't tell. If people thought they were either on a small dosage or on a high 297 00:28:07,630 --> 00:28:16,057 dosage, or even if they where on an inactive placebo. Right. So the self… 298 00:28:16,057 --> 00:28:20,590 Yeah, self-suggestive capabilities of people should not be underestimated 299 00:28:20,590 --> 00:28:23,759 either. Herald: Okay, then we're going to jump 300 00:28:23,759 --> 00:28:28,260 over to number six. Mic 6: Thank you very much for the 301 00:28:28,260 --> 00:28:36,880 talk. I would like to hear your opinion on the fact that, uh, like in the last 150 302 00:28:36,880 --> 00:28:46,549 years, most drug agents were discovered in Germany, and meanwhile, we have 303 00:28:46,549 --> 00:28:53,640 the pity of scientifically Germany lying in Arizona. 304 00:28:53,640 --> 00:29:05,690 *laughter* Andrea: Right. Germany has two points that 305 00:29:05,690 --> 00:29:12,650 historically hold us back. One is the forced human trials during the Nazi era 306 00:29:12,650 --> 00:29:19,349 where substances, techniques, were tested on concentration camp prisoners. And we have 307 00:29:19,349 --> 00:29:27,460 the Contergan scandal that harmed so many people and led to, in all of the world, 308 00:29:27,460 --> 00:29:34,690 the stricter rules we have now. That's two reasons why Germany is so reluctant to 309 00:29:34,690 --> 00:29:41,660 expose itself in this kind of process. But still, it is a pity. And I think it is 310 00:29:41,660 --> 00:29:46,011 about time that the German not only government, but also the scientific 311 00:29:46,011 --> 00:29:53,160 establishment gets to understand that they lose out and they are trading behind a 312 00:29:53,160 --> 00:29:57,950 development that has started and will continue. 313 00:29:57,950 --> 00:30:01,920 Herald: And now we have a question from the Internet, I hear. 314 00:30:01,920 --> 00:30:07,120 Signal Angel: Yes! For people struggling with depression, anxiety, or 315 00:30:07,120 --> 00:30:12,150 mental illnesses: What specific options are there in Europe with regards to 316 00:30:12,150 --> 00:30:18,240 psychedelic-assisted therapy? Andrea: Well, one is that you can try to 317 00:30:18,240 --> 00:30:22,820 participate in the existing trial. So, for example, in London, there's Kings College 318 00:30:22,820 --> 00:30:28,350 and Imperial College, there's a group in Bristol working, there's also therapy 319 00:30:28,350 --> 00:30:34,530 happening in Switzerland and so on. And there's also, if you happen to be lucky 320 00:30:34,530 --> 00:30:38,260 enough to live in Switzerland, there's the so-called compassionate use where 321 00:30:38,260 --> 00:30:44,020 psychiatrists with special permits are allowed to use LSD and MDMA as therapeutic 322 00:30:44,020 --> 00:30:49,127 agents on a case-to-case basis that they have to discuss with the authorities. 323 00:30:49,127 --> 00:30:54,079 So that's all we can say for now: study participation or compassionate use. 324 00:30:54,079 --> 00:30:57,420 We just really hope that things will rev up and we'll be able 325 00:30:57,420 --> 00:31:02,050 to offer more in the future. Herald: And microphone number 4, please. 326 00:31:02,050 --> 00:31:05,071 Mic 4: Yeah. Hello. Thank you very much for your talk. 327 00:31:05,071 --> 00:31:10,110 My question is more related to the history of the uses of psychedelics 328 00:31:10,110 --> 00:31:17,890 in the US and to the MAPS Association founded by Rick Doblin, but I was curious, 329 00:31:17,890 --> 00:31:25,510 how would you explain that MAPS is so actively criticizing the experiments led 330 00:31:25,510 --> 00:31:35,509 in the 1950s and ’60s by the CIA, and yet they accept donations of several million 331 00:31:35,509 --> 00:31:42,010 dollars coming from the Mercer family, who are among the largest shareholders of 332 00:31:42,010 --> 00:31:47,720 Cambridge Analytica, Breitbart News, and they also accept, they accepted recently 333 00:31:47,720 --> 00:31:54,300 about three millions from members of Tea Party. Isn't it a bit of an irony here? 334 00:31:54,300 --> 00:32:03,429 *applause* Andrea: That is a very good question. The 335 00:32:03,429 --> 00:32:11,200 way I know Rick Doblin and many people from MAPS personally, I know that they're 336 00:32:11,200 --> 00:32:16,860 pursuing an honest goal. What they’re trying to do is bring this into the world 337 00:32:16,860 --> 00:32:22,929 and they have been doing that since 1986. So they've been on this for almost 35 338 00:32:22,929 --> 00:32:27,830 years. He's dedicated his life to doing that. I don't fully understand his 339 00:32:27,830 --> 00:32:32,740 motives. I don't have to, to be honest, because I'm not speaking for him. I think 340 00:32:32,740 --> 00:32:39,980 there is a huge necessity for integrity because if we don't—as people working 341 00:32:39,980 --> 00:32:46,440 with it scientifically—if we don't move along with the necessary integrity, we're 342 00:32:46,440 --> 00:32:52,070 opening the doors for other people to don't care at all. But on the other hand, 343 00:32:52,070 --> 00:32:57,150 finding the money, getting this done and a lot … he was … Rick was criticized a lot, 344 00:32:57,150 --> 00:33:03,699 for example, for accepting veterans; snipers from Iraq into his therapy 345 00:33:03,699 --> 00:33:08,079 program. Like, okay, are you not getting people fit again to go out back to the 346 00:33:08,079 --> 00:33:15,581 battlefield? And I find this all very difficult because there is a thing that is 347 00:33:15,581 --> 00:33:20,690 called perpetrated PTSD. There is a thing of people only realizing afterwards what 348 00:33:20,690 --> 00:33:26,809 they have done. And I would not … I would be very careful in judging people in 349 00:33:26,809 --> 00:33:32,780 distress. But you're very right. It's a very delicate topic. And I think we all 350 00:33:32,780 --> 00:33:36,900 have to be very aware that there are thin paths we are threading in what we're 351 00:33:36,900 --> 00:33:41,230 doing there. When we accept money that comes from sources that don't follow 352 00:33:41,230 --> 00:33:45,240 ethical standards. Herald: Then we're going to switch over to 353 00:33:45,240 --> 00:33:49,730 microphone number five. Mic 5: Hello, I guess you have a really 354 00:33:49,730 --> 00:33:55,730 nice answer to the following statement. So I hope you will share your answer: 355 00:33:55,730 --> 00:34:01,950 Little Greta twittered today that the house is on fire and just that. So 356 00:34:01,950 --> 00:34:07,781 actually that means an adequate reaction would be to jump out of the window. So you 357 00:34:07,781 --> 00:34:12,210 could argue that actually we should rescue all the people that are really down, like 358 00:34:12,210 --> 00:34:16,970 down and out, because they cannot help us anymore. But actually, we should get the 359 00:34:16,970 --> 00:34:22,210 people that are still happy to be a little depressed instead of all getting them 360 00:34:22,210 --> 00:34:30,570 happy. What do you say? Andrea: There's always two ways of dealing 361 00:34:30,570 --> 00:34:40,429 with a system: You can step out of it, and you can try to change it from within. 362 00:34:40,429 --> 00:34:47,020 It is always very difficult to go from caring for the individual to things that 363 00:34:47,020 --> 00:34:53,889 are right for all. And me being a doctor, for example, I have simply decided to put 364 00:34:53,889 --> 00:34:59,170 the individual in the center of my concern, and I think others need to put 365 00:34:59,170 --> 00:35:03,790 the greater good in the center of their concern. I think it's inconsolable. We 366 00:35:03,790 --> 00:35:08,030 can't do both at the same time. So it's good to make your decision and do this 367 00:35:08,030 --> 00:35:12,099 what you do with all your heart. Herald: Then we're going to switch over to 368 00:35:12,099 --> 00:35:15,730 the Internet again. Signal Angel: Yes. And do you know of any 369 00:35:15,730 --> 00:35:21,290 studies or evidence corroborating the other side, like triggering mental 370 00:35:21,290 --> 00:35:26,760 illnesses by using psychedelics, for example, if you have a family history of …? 371 00:35:26,760 --> 00:35:31,880 Andrea: Well, doing a randomized, controlled study with that would be 372 00:35:31,880 --> 00:35:38,330 unethical. So what we have is the epidemiological and the anecdotal 373 00:35:38,330 --> 00:35:44,020 evidence that is found. So, yes, if you have a predisposition for 374 00:35:44,020 --> 00:35:49,890 psychosis, for schizophrenia, for mental instability, there is a large chance of 375 00:35:49,890 --> 00:35:54,570 triggering that if you use psychedelics. But on the other hand, many people try to 376 00:35:54,570 --> 00:35:58,920 self-medicate with substances, be it psychedelics or cannabis, because they're 377 00:35:58,920 --> 00:36:04,470 feeling they're already on the edge of some instability. But the current paradigm 378 00:36:04,470 --> 00:36:09,470 for the studies is to exclude people whose direct family is affected by 379 00:36:09,470 --> 00:36:13,280 psychosis. Herald: Number two just disappeared, so 380 00:36:13,280 --> 00:36:18,720 we're gonna go straight over to four. Mic 4: I would like to ask you whether you 381 00:36:18,720 --> 00:36:23,460 changed your mind about anything related to psychedelics in last few years or if 382 00:36:23,460 --> 00:36:33,010 you have seen something in the research that really surprised you? 383 00:36:33,010 --> 00:36:43,839 Andrea: Let’s … Well, I am worried. In a few respects. Like, for example, the whole 384 00:36:43,839 --> 00:36:52,170 development around the 5-MeO scene, people using bufo alvarius toxins for very, very strong 385 00:36:52,170 --> 00:36:56,020 psychedelic experiences, sometimes risking their live doing it. This whole scene 386 00:36:56,020 --> 00:37:01,301 kind of lifting from the ground and going in a very strange direction, in my 387 00:37:01,301 --> 00:37:05,030 opinion. This is kind of worrying me because I think people are not taking the 388 00:37:05,030 --> 00:37:11,550 care they should be taking of themselves in what they are doing. But otherwise, I 389 00:37:11,550 --> 00:37:16,260 think scientific results we're seeing are rather consistent. It's very important to 390 00:37:16,260 --> 00:37:21,007 know that these are not magic bullets and not expect too much. You can’t expect 391 00:37:21,007 --> 00:37:25,930 something to cure everything. And psychedelics seem to be a good idea 392 00:37:25,930 --> 00:37:31,178 for people who are rigid, transfixed, not able to transcend something. But people 393 00:37:31,178 --> 00:37:35,005 who are already like in a chaotic state are very unlikely to benefit. And I think 394 00:37:35,005 --> 00:37:38,350 that's a very good basic rule. And this is something I see proven 395 00:37:38,350 --> 00:37:41,740 time and time again. Herald: Number five, please. 396 00:37:41,740 --> 00:37:46,940 Mic 5: Hi, thanks. Regarding certain setting and how it can have such a huge 397 00:37:46,940 --> 00:37:52,940 influence on one's experience, can you comment on the setting of the new 398 00:37:52,940 --> 00:37:58,140 psilocybin study in the upcoming year? Andrea: Like all the studies that are 399 00:37:58,140 --> 00:38:03,030 being ta… being done, certain settings are being taken into consideration. These 400 00:38:03,030 --> 00:38:09,650 people don't trip in a sterile white hospital bed. They get to have their 401 00:38:09,650 --> 00:38:14,480 psychedelic experience in a warm, comfortable, organic, welcoming 402 00:38:14,480 --> 00:38:22,030 environment. For example, on a couch with a nice cushion, nice dim light, flowers, 403 00:38:22,030 --> 00:38:27,340 music is extremely important. There have been released scientific works around what 404 00:38:27,340 --> 00:38:31,146 kind of music is beneficial for those. Mendel Kaelen, for example, at Imperial 405 00:38:31,146 --> 00:38:36,160 College is a specialist in this kind of music and is being taken very seriously. 406 00:38:36,160 --> 00:38:43,008 Also, those questions of how much physical contact is beneficial, is allowed. What 407 00:38:43,008 --> 00:38:48,020 could harm the patient is discussed very precisely in all those groups I know, 408 00:38:48,020 --> 00:38:52,330 because this is so much more than just a pill. This is really about making sure 409 00:38:52,330 --> 00:38:58,700 that people have a safe experience where they can, yeah, come to healing inside 410 00:38:58,700 --> 00:39:01,060 themselves Mic 5: Thank you. 411 00:39:01,060 --> 00:39:05,800 Herald: So we have time for one more question. Number one, please. 412 00:39:05,800 --> 00:39:09,770 Mic 1: I don't know if I want to hear the answer, but do you think it would help 413 00:39:09,770 --> 00:39:16,750 your cause if you would stop take these drugs for fun? 414 00:39:16,750 --> 00:39:25,690 Andrea: My answer to this is the following: Imagine there was a food 415 00:39:25,690 --> 00:39:33,020 thing, something that tasted nice; let’s say chocolate and there were people 416 00:39:33,020 --> 00:39:37,850 who could only survive if they got chocolate. But because everybody else was 417 00:39:37,850 --> 00:39:41,690 doing it too, and it was somehow not okay, it would be forbidden for 418 00:39:41,690 --> 00:39:47,940 everybody. Then I would say, well if you replace chocolate with LSD, I think there 419 00:39:47,940 --> 00:39:53,260 are people there who really need it. And we have to be careful that recreational 420 00:39:53,260 --> 00:39:59,260 use and playing around with drugs doesn't spoil their chance to something lifesaving 421 00:39:59,260 --> 00:40:03,710 because they need the chocolate. You might get along without, but it's something we 422 00:40:03,710 --> 00:40:08,890 have to take into consideration. This doesn't mean it's wrong to have psychedelic 423 00:40:08,890 --> 00:40:13,330 experience for your own benefit, for your own betterment, for your own fun. But just 424 00:40:13,330 --> 00:40:17,070 keep in mind, if you're hindering with your wanting to have a good time that 425 00:40:17,070 --> 00:40:22,790 somebody gets a life-saving therapy, perhaps, then this is an ethical problem 426 00:40:22,790 --> 00:40:28,520 we are facing. Herald: Andrea, thank you so much. 427 00:40:28,520 --> 00:40:32,454 That's your applause. *applause* 428 00:40:32,454 --> 00:40:38,410 *36c3 rollout music* 429 00:40:38,410 --> 00:40:58,884 subtitles created by c3subtitles.de in the year 2020. Join, and help us!