Cutting Through the Hype Surrounding Psychedelics: An Interview With Dr Rick Strassman
Dr Rick Strassman, currently an Adjunct Associate Professor of Psychiatry at the University of New Mexico, is one of the leading pioneers of modern psychedelic research. His studies on DMT, which took place between 1990 and 1995, broke the 20-year gap in psychedelic research.
Strassman’s work on DMT, which kickstarted what has become known as the ‘psychedelic renaissance’, led to the highly successful book DMT: The Spirit Molecule (2000) and a documentary of the same name, released in 2012. Both detailed the strange entities and worlds that his study volunteers encountered. His next book, DMT and the Soul of Prophecy (2014), would draw parallels between DMT trips and the prophetic experiences described in the Hebrew Bible — the visions of Hebrew prophets, such as Ezekiel, Moses, Adam, and Daniel.
His latest book, The Psychedelic Handbook: A Practical Guide to Psilocybin, LSD, Ketamine, MDMA, and DMT/Ayahuasca — as you can see from the subtitle — goes beyond the DMT experience. It covers not just the psychedelics mentioned in the subtitle but also mescaline (and the cacti that contain it: peyote and San Pedro), 5-MeO-DMT, ibogaine, and salvia. (You can read my book review here.)
I discussed with Rick this new direction he’s taken, as well as many crucial questions in the field of psychedelic research.
Thank you for agreeing to this interview, Rick. I wanted to say, firstly, that I really enjoyed reading your new book and appreciate that it gives such a comprehensive overview of many different psychedelics. Since your previous books have focused on DMT, what inspired you to take a broader approach in your new book?
Thank you for your kind words about the book. I feel some responsibility for the direction the psychedelic movement is taking, as our 1990s studies in Albuquerque initiated the North American renewal of human research with psychedelics. Much of the information people are exposed to comes from non-experts and/or those with overriding financial and/or religious stakes in the matter. So, this seems like a good time to present a brief yet thorough, comprehensive, and user-friendly review of the field: what psychedelics are, how they work, potential benefits and risks, legal and microdosing issues, and how to make the most of your own psychedelic experiences.
As part of the broad view of psychedelics you take, I noticed that you dedicate a fair bit of information about the risks of psychedelics. As you say, the “rush of enthusiasm regarding psychedelics” can mean that potential adverse events get overlooked or dismissed. Talking about the risks is valuable for the sake of balance and harm reduction. But given that there is still some stigma surrounding these substances, do you think risks need to be discussed in a certain way so that people aren’t overly fearful of them? I’m thinking here of how many people associate psychedelics with permanent insanity, suicidality, or frightening ‘flashbacks’.
I would rather people be afraid of taking psychedelics than take them casually. Terence McKenna used to say that before one smokes DMT, “one’s hand always shakes lighting the pipe.” Not everybody should take psychedelics–they carry risks, and I think the pendulum needs to swing back to a realistic assessment of the benefit-risk ratio. At this time, the ratio is heavily biased toward the benefit.
Psychedelics can lead to chronic unremitting psychosis, accidental or intentional suicide or violence, and flashbacks. All of those are real risks. Just like with any other powerful drug — cancer chemotherapy, steroids, or antipsychotic medications — informed consent requires a clear description of risks and benefits.
Unfortunately, we do not yet have good current data regarding how often psychosis, suicidality, or flashbacks occur. In a recent study from Amsterdam, 70% of 5-methoxy-DMT users reported flashbacks after a 5-methoxy-DMT retreat. In our studies of DMT and psilocybin, six people out of 53 had some serious adverse effects, and these were normal volunteers that we screened carefully and who all had previous experience with psychedelics.
In the preface to the book, you say, “By various means and in various settings, I am personally familiar with the effects of every substance I discuss in this handbook.” I’ve also heard you speak openly about your psychedelic experiences or what you’ve learned from them on some of your recent podcast appearances. Since you didn’t use to disclose your personal experiences, which I imagine many academics are hesitant to do, what made you decide to be more open about that? Was this a difficult thing to decide to do?
For many years I would answer questions about my own use of DMT along the lines of: “If I say I have, I’m accused of being a zealot; if I say I don’t, people will say I don’t know what I’m talking about.” That is, a yes and a no.
I shared my first big DMT experience in a public interview with Graham Hancock in 2019 in Sedona. And I’ve been more forthcoming since then. I think researchers can benefit the field by discussing their own experiences if they do not use them to justify a conviction that psychedelics work because of the kind of experience they had. That is, if someone had a mystical-unitive experience, and they feel a profound impact from that experience, that does not mean that the mystical unitive experience is necessary for everyone or that it’s valid to conclude that mystical experiences heal — this is how psychedelics work.
On the other hand, I think it’s useful to talk about one’s own psychedelic experiences if it is in the service of describing the experience as much as an observer as a participant, and using that experience as a springboard for research. In addition, I am less exposed than many scientists who are currently working in the field in terms of grants, permits, regulatory boards, university responsibilities, etc., and can speak more freely than many.
One point I found interesting in your book was how psychedelic researchers and users favour the mystical experience model, even though the mystical-unitive state may not be necessary for benefits, and, as you say, interactive-relational spiritual experiences can be just as profound and meaningful. I was reminded here of the Jewish philosopher Martin Buber, who spoke about relation — not unity — being fundamental and the ultimate source of meaning. How do you imagine that research could be more inclusive of interactive-relational experiences? Do you think that there should be questionnaires that try to measure them?
I think one can develop an interactive-relational rating scale in a similar manner to ones that measure the mystical-unitive state. In my book [DMT and the Soul of Prophecy] comparing the DMT state with that described in Hebrew biblical figures experiencing the prophetic state, I detail many different types of interactions occurring between a prophetic figure and his/her visions. Those types of interactions could be assessed using a rating scale that scores the presence and strength of those kinds of interactions.
You talk in the book about the potential benefits of non-psychedelic psychoplastogens: tweaked versions of psychedelics that help improve brain health but don’t cause psychedelic effects. I’ve seen some pushback against the idea of taking the trip out of psychedelics, as it’s seen as a way of favouring the biomedical model of distress, as well as for the related reason that true healing requires the psychedelic experience. How would you respond to these concerns?
In animals, both nonpsychedelic doses of typical psychedelics and “nonpsychedelic psychedelics” both stimulate neurogenesis and neuroplasticity. So, it does not seem necessary for behavioral effects to accompany these psychoplastogenic effects in rodents. Antidepressants also increase neuroplasticity.
My sense is that these nonpsychedelic compounds (or nonpsychedelic doses of typical compounds) will work much like antidepressants. More or less effective on their own but more helpful when combined with psychotherapy. I think they should be the default for most people who would simply like to feel less depressed and not have to experience the rigors of a major psychedelic experience.
On the other hand, the psychological effects of a psychedelic experience may produce even greater benefit and be indicated in more severe or difficult-to-treat cases. It’s again a matter of informed consent: does someone want a possibly — but not necessarily — less effective treatment with fewer side effects or a higher-risk treatment that may be more beneficial?
And people will always want to trip for various nonmedical reasons: meditation, creativity, prayer, fun, intimacy, nature appreciation, etc. I think there ought to be a model in which that kind of use can take place.
I was hoping we could now shift to the topic of microdosing, which has become a popular way of taking psychedelics. You point out that some studies on the benefits of microdosing deal with “a host of placebo-related factors — expectation, selection bias, and suggestibility.” If these reported benefits are largely down to the placebo effect, do you think it is morally problematic for companies and individuals to sell microdosing kits, courses, and coaching?
Much of the data regarding microdosing suggests that placebo response plays a major role in the described benefits. But placebo is a good thing if it is directed in the proper manner. One of the reasons psychedelics appear to be panaceas is perhaps due to their placebo-enhancing effects, and if small non-psychoactive doses of psychedelics also enhance the placebo response, I don’t see any harm if people feel better and there are no troubling toxicity issues.
Microdosing may also stimulate neurogenesis and neuroplasticity, as well as produce some of the same serotonin receptor effects as SSRI antidepressants–these two factors play an additional role.
When people sell microdosing kits, courses, and coaching, ethical considerations dictate they ought to be forthcoming regarding what’s known about efficacy, mechanisms, and potential side effects. They could even emphasize the potential placebo-enhancing effect of microdosing, rather than offering unproven biological theories.
You mention in the book that there is a lot we don’t know about how psychedelics work. In light of this, what kinds of studies do you think are especially needed right now?
I think the placebo question is critically important. It could be a unifying theory of why psychedelics appear to do so many different things and in so many different contexts. It may be that the intensity of any psychedelic experience is the key determinant in activating the placebo response regardless of the specific type of experience: mystical-unitive, interactive-relational, pleasant or unpleasant, visual or emotional. Then this placebo response recruits the mind-body’s innate healing mechanisms — biological and psychological.
To the extent the placebo response relates to suggestibility, studies could assess baseline suggestibility of subjects and see if the more suggestible someone is, the more they respond to psychedelic-assisted therapy or other interventions. In addition, placebo-responsive conditions may be more responsive to psychedelic-assisted psychotherapy than non-placebo-responsive ones; for example, depression vs cancer.
The presence of high levels of endogenous DMT in the mammalian brain is of interest here. Concentrations are as high as those for recognized neurotransmitters like serotonin. If there turns out to be an endogenous DMT neurotransmitter system, what role could such a neurotransmitter be playing that stimulates the same receptors that psychedelics stimulate? A compound that may regulate placebo responsiveness in all of us all of the time?
At the end of the book, you say you look forward to further research into psychedelics and “applying their effects for the common good”. What do you believe are the most substantial benefits that these compounds can offer to communities and society at large?
Psychedelics are “mind-manifesting/disclosing”. What the person has in their mind more or less conscious is what the drugs work on. Psychedelics can magnify the importance and meaning of both good and evil beliefs, feelings, or behavior. Neo-Nazis take psychedelics just like progressive eco-feminists.
Stepping back, then, it seems as if psychedelics increase our commitment, the intensity of our relationship, to the things we have already been exposed to and are considering. Psychedelics can increase our determination and conviction regarding the best way to live our lives. But this doesn’t come from the drug, but from the drug interacting with what you bring to the experience.
Originally published at https://www.samwoolfe.com on November 21, 2022.