Oversharing - Are Psychedelics Useful In Therapy?

Episode Date: October 18, 2022

What’s the deal with psychedelics and psychotherapy? Jordana and Naomi are joined by Dr. Michelle Weiner to talk all about cannabis and ketamine-assisted psychotherapy. They start with a convo about Naomi and Dr. Weiner’s close friendship as teenagers, and what it’s like to reconnect after so many years apart. Then Dr. Weiner walks us through the process of drug-assisted therapy, including why it’s helpful (gotta drop that ego somehow), how she administers treatment safely, and when it’s the right option for a patient. Plus, they talk about other psychedelic therapy treatments, and what people are looking to get out of these therapy sessions. Learn more about your ad choices. Visit megaphone.fm/adchoices

A quick note before we get into the episode, Oversharing is a podcast for entertainment purposes only. It is not a medical podcast and does not constitute medical or psychological advice. Always seek the advice of your physician or mental health professional. Hello and welcome back to Oversharing. I'm Jordana Abraham. And I'm Dr. Naomi Bernstein. And we have a great guest on today.

It's going to be our whole episode. We have Dr. Michelle Wiener, who is a childhood friend of Dr. Naomi's. now she's in pain management. And we really pre-recorded this. So we're just going to like let you guys pretty much get into it right away. And that's going to be our whole episode. But it's really, really interesting and stuff we've touched on here before.

So I'm excited to have our guest on. We also just came back from our sister's weddings. We got like a great intensive bonding session. Yeah, that was that was amazing. It was actually one of my favorite weekends that I've had in a really, really long time. It was really nice. Everybody was there.

The love was afloin. And it was really, really cool. And I think we're going to kind of keep that train running with this guest that we have today. This is probably, she was my best friend in high school. We were like inseparable. You know, we went to different colleges. And then we came back together and went to the same graduate school. She went for medical school.

And I went for my doctorate. And along the years, we kind of drifted apart. And this is going to be our very first time reconnecting. So it's crazy that it's going to be on air. It was fun to see it for me. And it was funny. I was like, while you were saying that to her, I was like, is this just Dr. Naomi's way of like solving a friendship, like a question that we would almost like that someone would ask us? And then we'd be like, why don't you connect with her over something you have in common?

Right. Like this podcast or a mental health. Totally. But yeah, I saw from the conversation that you guys definitely have like, I understood why you were friends. and I haven't probably seen her since I'm like 10 years old. So this is really, really cool to watch you guys reconnect. And I hope the friendship continues. Yeah.

And it was, you know, over the years, it's been a weird thing seeing, you know, we're connected on social media. So I would see these posts that were so intriguing to me about everything that she's doing in her career. But we were, and sometimes I would comment on it or say, wow, this looks awesome.

Or I would, you know, make a little comment, but it never really turned into a whole conversation. So I've just been so interested in this. aspect of her life as well as obviously she has kids and you know we didn't get too much into that but it's you know i've been very interested and intrigued by everything that she's doing and i think it really is relevant to the show so yeah it was a chance to reconnect but also i i hope that our

listeners enjoy all the information that she had to share yeah and i'll get ready to it i guess we've been kind of vague about it in our intro but she's here to talk about like cadamine and cannabis as helpful tools for psychotherapy and pain management and it was great So let's just get right into it. Dr. Michelle Wiener, welcome. Thank you. Thanks for having me. It's been a while since I've seen you. I know. I feel like I was like maybe a teenager. I don't know, maybe younger than that. I don't know. I was such a little kid, but last time we spoke. Dr. Namibu, do you want to give a little background on how we know Michelle? Dr. Weirner. Sorry. Yes. Such an interesting dynamic here. Dr. Michelle. I know. Just regular,

unqualified me. So I'll be honest, coming into this, I was like super excited and somewhat anxious because, you know, Dr. Weiner, Dr. Michelle and I were like best friends in high school and we went to the same graduate school. So we, you know, we're close during that time, but lost touch and probably haven't spoken in, I don't know, maybe 15 years. And this moment is like, like the first time that we're having a conversation. So it's really super exciting and it's crazy to see you again and hear your voice again. And I've been, as much as we haven't been in touch, we're connected on social media. So I've been seeing all the stuff that you've been doing.

And just every time you post something, I'm fascinated by it because I think it really has a lot to do with my mindset for psychotherapy and just sort of the biggest thing that I'm really interested in hearing you talk about and you've mentioned it is the concept of using psychedelics to sort of disarm the ego because my one of my favorite and I don't know if you've read it and I talk spoke about on this podcast books is the untethered soul by Michael Singer I don't know if you've ever read it? Yes. I have it like right here actually. So it's like I've really, since discovering it, it's guided a lot of my psychotherapy with patients. And I feel like a lot of what you do is seems like, and I don't know, you can speak to this, like a bit of a shortcut in some ways

to everything that I try to talk to our listeners about and my patients about in terms of figuring out like your, the voice inside your head, your thoughts, and kind of separating out your true self from your thoughts. And I, I'm just really interested to hear how, you know, if you could tell us a little bit about psychedelic assisted psychotherapy, what it is, how it works. And also like, are you a psychotherapist? Like, is it like a psychiatrist type of field? That was like a great intro. And I am so happy to be here. And honestly, I think it's, I would the same way. I was like excited but anxious because we haven't seen each other in a while despite the fact that we kind of follow up with social media. However, we all know that social media just,

you know, shows the best of us. So, um, and, and honestly, we were best of friends. And I think it's really like important for us to mention that just because people are at different places in their lives at different times and they meet different people and they experience different things. And I think that a big concept with psychedelics is this concept of neuroplasticity and the fact that the brain is flexible and the brain can actually, like a lot of us are very rigid in our thinking and very rigid in the way that we believe who we are. And that's like what that's a lot of what ego dissolution and psychedelics do. So just to give you a little context of me, I'm a pain management physician. So I did interventional pain management and I practiced in South Florida.

And I got very frustrated with the lack of tools that I had for chronic pain patients. And so people who have acute pain, they take meds, they get better. But there's a huge population, like the fibromyalgia population, for example, why do their, why does their pain develop into chronic pain? And so a huge part of that, I realized just from being with patients and sitting in the room with patients is the experience of the patient. So someone who maybe has chronic pain also may have depression or also may have past trauma. And so I felt like a lot of the work I was doing in pain management was restricted to these FDA approved medications. And so cannabis became legal in 2016 in Florida. And I was one of the first physicians to start

recommending cannabis. And I trained the physicians in Florida. I was a chair of our advisory. committee and it was kind of crazy you know because you know me even from high school like cannabis to me then was a drug and now it's a medicine and I think that's a big distinction that we have to make is drugs versus medicine and a lot of that has to do the intent with the intention behind using it and the set in the setting which we'll discuss so I am a pain doctor but I do work with therapists and I have a lot of psychedelic and integration coaches in my practice but I'm not a psychiatrist and I'm not a therapist. therapist. So I'm really big about the team approach. I like to work with other people so that we

really, we call ourselves a therapeutic alliance. We really have everybody kind of looking at the patient and all different parts of the patient and we work better together in a team. So as a pain doctor, I started to treat more chronic pain and cannabis kind of opened me up to a lot of different things, but the fact that we can alter our consciousness. And we have different. states of consciousness that we can access. And some people have pain. Some people have trauma. And they're not able to access that because it's too painful.

And so the psychedelics act as a catalyst to or a lubricant to open them up so that they're comfortable with conversation about maybe their past trauma. But there's a great book called Body Keeps the Score by Vessel Vandercock. And I right now. So I actually did my ketamine training. was done and he was a facilitator and his wife is also amazing she's like a body worker she's i mean they're a really amazing couple but their whole concept is the fact that trauma gets stored in the body and shows up in different ways and so it can show up as physical pain it could obviously

show up in more of a psychological or cognitive type of change but the bottom line is when we're looking at someone we have to look at the whole person and so a lot of medicine these days has gone to really fast appointments and medication management and, you know, a lot of tools and band-aids, but not really getting to the root cause of the problem. And so as I started using cannabis with patients, I realized how personalized it is. Someone can take a certain dose of THC and not have any intoxication. Other people, you know, need a lot of CBD to counteract some of that high. So I loved the personalizing the regiments for patients.

And then being a pain doctor, I started integrating ketamine. into my practice since I had a lot of experience with that during my fellowship. But I started learning more about ketamine in the context of mental health. And the fact that we have this opioid crisis and mental health crisis as well, it just became a great tool right now. And it helps people to really get to like the root cause of their trauma. But by doing non-ordinary states of consciousness, they're able to get there and not feel the pain.

So a lot of times they're able to feel peace. They're able to feel love, something they haven't felt in a very long time. Or they're able just to get into that parasympathetic mode where they're able to calm their nervous system. So it's an exciting time for medicine because we're kind of bringing spirituality and science together. And we're realizing that, you know, there's this shift of instead of going towards a medicine, what else can we do, for example, meditation, exercise, breathwork, all that kind of stuff goes hand in hand with cannabis or ketamine-assisted psychotherapy. And it's all legal.

So ketamine is completely legal. It's been FDA approved for over 50 years. They use it in Vietnam War when people would have pain. They would inject them with ketamine. And then they would also not remember the trauma as bad. And so it's a dissociative anesthetic. And that's kind of the differentiation between the classic psychedelics like psilocybin, LSD, MDMA, and ketamine is that it's a dissociative. It's not a psychedelic.

And by dissociative, I mean it disconnects body and mind or you have more of an out-of-body experience. So it's not like where when people are using psilocybin mushrooms, they see, you know, different things are wavy or the colors or, you know, it's a different experience. With ketamine, you're in a recliner, you have eye shades on, you have a. very relaxing playlist that has no word so it doesn't direct you in any way. We set you up with a very specific intention to kind of like prime the session and then it's completely dose dependent. But the concept of dissociation means that essentially like your soul, your spirit, the energy, the essence of you and you talk about like your authentic true self, that is the thing that is actually leaving your body and traveling. And it's a very interesting feeling. And I've done it

because a lot of the physicians and therapists, we want them to try it before we give it to patients so that they really have a good understanding of what's about to happen and so that they can better support the patient. But the dissociation of, like, my experience, I became, I was in the cat skills for my experience. I became the, like, the road, and then I basically dissolved into the soil of the road.

Like, I was, like, the foundation of the world. and then I was like, like, I basically saw all the different parts. And so, you know, there's a lot that you can really take away from each session, which is why the therapy component, it's not just the drug. The therapy component is the biggest component. The person has to have someone that they can talk to about these sessions after to make sense of it and then integrate it into their lives. Otherwise, it's just taking drugs and, you know,

and not using it like with the proper intention. Is there any possibility of getting, like, addicted? to these kinds of things or because they're so managed with the doctors, they're like pretty safe from being abused? So I'm sure you heard of like a guy named Gabber Matte's a great psychiatrist. So his line is always with addiction. Don't ask why the addiction, ask why the pain. And I think like when I answer questions always about addiction for either cannabis or ketamine,

it's really the person and the tools they have. And then sometimes they find a substance that they like. too much, but the addiction really comes from the trauma or the unhealed pain, you know, so I really believe like it's a disconnection, like people have trauma and then they disconnect so that it's, or like essentially dissociate, you know, they're disconnected so that they don't have to feel that, so they don't, but the healing comes when they start to connect. But ketamine, like any other substance, someone can get addicted to, but that's why we're trying to keep it very much in the office. And so there's like some at-home ketamine businesses, which are effective

because the ketamine is not covered by insurance. And so it gives people access to ketamine at a cheaper price. However, that also comes with risk. And so that's kind of like, you know, that's like the issue. It's like we have no good solutions right now to some things. And psychedelics are helping with that, like certain conditions. maybe more effective with psychedelics, but there has to be the context of therapy. And the biggest issue is insurance coverage right now. So since they're not covering ketamine, only in a intranasal spray, it's a, it's a little bit of an issue. I don't really give patients prescriptions for ketamine, so they're less likely to abuse it. However, people can buy

ketamine illegally on the streets, you know, like any other drug. And so if they love that feeling of disconnection. It may be so it's like nitrous oxide. It's a very similar feeling. They may want that feeling, but that's essentially saying that we have failed in helping them go through the process to heal because they're just trying to disconnect from their feelings or trauma.

Got it. Okay. Yeah. So I mean, the point is like, yes, anyone can get addicted to ketamine, but we try to restrict it by having them come to the office. And honestly, like we need more research and we're all doing research to try to get things covered by insurance. But there's all different ways of using ketamine. It's kind of like cannabis.

You can use a tincture. You can use an edible. You can smoke. You can bat with ketamine. You can do an intramuscular injection. You can do an IV infusion. You can take an oral lozenge and intranasal. So again, it is very personalized.

So can you tell us a little bit more about the process of like what types of, you know, I think, and I'm sure that there are listeners out there that are struggling with. fibromyalgia or seizures or, you know, things like that. But as far as I think what I'm most interested is finding, I have a lot of patients that kind of stuck in their own story and we do therapy and years of therapy. And it seems like if there's, you know, the big ones are depression and anxiety that people just are living constant day in and day out with these feelings of depression and anxiety, how would something like this, first of all, like, how often do you have to do this? I've listened to a lot of your interviews, and it sounds like there's some more of a longer

lasting effect than just like, okay, I did this. I felt great. And then I left the office. I went home. And like you said, I need to do it again two days later. Maybe you could tell us a little bit about how it has, it can be effective with psychotherapy for depression and anxiety. And how those effects can last or how long the effects can last? Yeah. So there's like a very common phrase that says neurons that fire together, wire together. And so the whole loop thinking is really the fact that these neural networks in our brain,

we are reinforcing and sometimes we're reinforcing it in a negative way. And a lot of it has to do with, again, unhealed trauma or chronic stress. And I think that chronic stress is one of the main causes of depression. and that's why we have things like treatment-resistant depression, which means that SSRIs, SNRIs are not working for people who have depression. And chronic stress causes changes in the brain, where we're not able to learn new things, we're not able to reconsolate memories.

And so what we're doing is we're giving someone ketamine, for example, which works on glutamate, not serotonin, so a totally different neurotransmitter, but it also causes an increase in this protein called brain-deror neurotropic factor, which increases neuroplasticity. And neuroplasticity basically just means that parts of the brain that are normally not active and communicating are now communicating. And that whole loop thinking means that like someone has just has this belief about themselves

that limits themselves, I'm not good enough, I'm not worthy, I'm powerless, whatever the belief is that they have, that is something that dictates their life. And so what we're trying to do is figure out what's that limiting belief. leave and then get rid of it. And the process is something that has to happen with multiple sessions because, you know, like I did have this one patient who had a horrible trauma and she was raped and it was associated with significant anxiety and her one, her, she did two ketamine sessions and it was completely life changing.

She was totally like suicidal because of the anxiety. She had kids. She's married. And, you know, that happens sometimes where like they'll have one experience and it will just, you know, change their life in such a way that they wake up and say, oh, my God, I want a meaningful life. Like, what is the purpose of my life? And that, but most people who have been stuck in this rut for a long time, they need multiple sessions. So the sessions are reinforcing what's happening in the brain, but they're also reinforcing their personal narrative or like the story of

who they are. And a lot of us, there's a part of the brain called the default mode. And it's very simple because we all default to something. So, what do you default to about yourself? That's where your ego is stored. That's where your story is. And what we're trying to do is kind of get rid of that story and quiet the default mode so that we can create a new story or a new pathway or people are just limited. They just think there's no other possibility. And I'll even give you a personal story because I am divorced and I remember going through a time of my life when I couldn't imagine being divorced or I couldn't imagine only having my kids 50% of the time. I could not even imagine that, right?

Like the possibility of that wasn't even a possibility, you know? And so like there's so many people who are limited and believe only in the way that things are because it's uncomfortable to go to another option that at the same time will give them significant growth. It's just that they kind of have to go through that. And I actually did my ketamine session at that time of my life. And the whole session was completely about love. The facilitator who I was working with, he was like, put your attention into your heart. That was like his words. Put your attention into your heart. And my whole ketamine session literally was like heart emojis. Like it was just like these red hearts. I was with my kids on a,

Mary go around like it was like it was such a loving thing and to me like the significance of that was of course you can do anything anything is possible and for me the message was really like you know love is always the answer and that's really like how I've always lived and what is like most significant for me maybe something different for other people maybe they are needing to feel calm or peace or powerful or whatever it is so usually we'll do one session a week for four to six weeks. Sometimes if the person's very depressed, we'll do two sessions a week for three weeks. So it's usually like six sessions. And it's something that has to go hand in hand with therapy. And also the setting is really important. So like my office used to look like a typical pain

doctor's office. And now I have like it's very like, you know, I don't even know how to describe it. Like it looks like you're, you know, like you're going to get a massage. or something. Like there's essential oils. Like we have, it's just set up beautifully and very comfortable. We have a rug. We have recliners. Like we have beautiful things on the walls so that they feel comfortable. It's not like a medical, clinical type of setting. And then the multiple sessions are really important for the transformation because otherwise they get this afterglow effect where they feel amazing, but then it's not sustainable. Is there any kind of person that this doesn't work for or that you're kind of like.

So treatment resistant depression became like this term for like people who are not getting better with our typical, you know, treatments. And it seems like ketamine helps with depression 70% of the time. That's kind of what the research shows in terms of depression. So it is indicated for treatment resistant depression. It's not an indication for anxiety, but many people have anxiety and depression. And many people that I use ketamine on are really suffering from anxiety. but most of the anxiety is really unhealed trauma.

So it's either like a developmental trauma, PTSD as the underlying condition. And that's kind of the importance of like knowing the person. Like I don't give ketamine to anyone until I know who they live with, what their social, you know, situation is like, what their tools are in terms of like meditating or their daily practice. The biggest side effects would be it can mildly elevate your blood pressure while you're using it. It can cause nausea. we give you something to prevent that.

But it's really one of the safest medications. It's really managing the dissociation, which is like what is going to come up when we have these non-ordinary states of consciousness. And how do you decide cannabis versus ketamine? Well, so cannabis is not like a dissociative or a psychedelic, obviously, but cannabis is more to me like not, it doesn't have to be a daily thing,

but it's something that we're using for integration. So like, for example, maybe they're having issues with sleep. We'll use it for sleep. Maybe they're having anxiety during the day in between their ketamine session. So, like, I have many people who are just using cannabis for pain or insomnia or depression or things like cancer or Parkinson's. But then when we're dealing with ketamine patients, since we're doing it weekly, I usually like to give them cannabis as an option so that they can use that for their mood or for anxiety or to help with sleep or to, like, deepen their me. meditative practice. Like some people are, some people need like a little push, you know, to get to that state. And so like, I know people who use cannabis before they exercise or before they

meditate. So it's again, very much dose specific. Like you can use a tiny dose of cannabis and do your your everyday life or you can use a higher dose. And, you know, it's the same thing with, but ketamine we don't really give to people like to go home with. It's more you come to the office and you have these dissociative experiences where you literally feel like you're completely out of the room. Like you're transcending time and space. You're going through, you know, it's like a lot of movement is happening. It's really very unbelievable. That's awesome.

And can anyone, let's say like, let's say I don't have, I'm not suffering from depression or massive anxiety, but I just kind of like, I'm interested in like connecting more spiritually or, you know, or getting away for myself. Yeah. Is that allowed? Because this movement is like kind of new. So everything is pretty much off label, right? Like, first of all, cannabis is Schedule 1 drug, even though there's like almost 40 states

that have medical programs. But with ketamine, it's off label and it's self-pay. So essentially anyone can come in and have a ketamine treatment. But again, what is the intention and what are they going to do with that? And so it's, it's again, drugs versus medicine. So like people want to have, you know, I understand like I didn't have, when I I didn't have a condition. I wasn't like, you know, it wasn't because of that, but it was more like psychosperiritual growth or I felt stuck at a certain point in my life that I kind of wanted

to see a different avenue that I could potentially go down. But essentially like people are, I have like a lot of people who are very successful that kind of want to get to the next level in their business or like this whole concept of expanded awareness. Like we talk about like a like broadening the lens. Like for example, say you're just kind of looking very specifically at something and you're constantly looking at that. So that's like that's all you see as opposed to when you use psychedelics, you kind of take the step back and you really understand how many options there possibly, you know, there are. And in the process of that, what you're doing is you're essentially deepening the connection you have with

yourself. And I think like the, like, you know, alter levels of consciousness are very difficult to measure. same thing with like love and connection but you know essentially people have to connect with themselves and all of that means they just have to figure out who they really are you know once you do it's such a like liberating feeling because you're just your true authentic self and I know like even for me you know and I and obviously you guys know have a twin sister and you and even that is like really interesting because as we've gotten older we've really experienced we've really explored like who we are and there's so many things that are different even though we're twins and

and like so we always kind of look at that as like an example because now I know exactly who I am she does too and there's a lot of differences you know and a lot a lot of that has to do with just what we've been exposed to but also why we chose to expose ourselves to that so essentially it's helping people connect deeper with themselves and that to some people is very uncomfortable right What comes to mind, I'm so, I'm really glad that you shared that personal story about struggling with your divorce and then using something like this to help you see past that, you know, what felt impossible. Like, I cannot live like this. And Jordana does another podcast called You Up, which is all about being single and dating and so many people that I talk

to struggle with being single and not being able to find the love of their life and kind of have the story of like, I will never be happy until I find my person. Like, I'm just not going to be happy. And I think a lot of people get stuck in that, you know, in that place. So I think when you say stuff like, you know, being able to kind of connect with yourself and being able to, you know, feel that love with yourself or that safety just within your own body and mind and soul, I, you know, I wonder if something like this could be helpful for people to just, I always talk with people about acceptance, acceptance between what you, everybody has 90% of what you think about, most people think about is what do I want to be different and how can I make it different? What do I have to do to make it

different than whatever it is? Well, and I totally agree with the acceptance and for me, a lot of it was judgment. I was judging myself like, oh my God, I'm going to be divorced like out of my parents my siblings like I'm the one that's getting divorced you know like so a lot of it was that judgment of like how do I judge someone who's divorced which honestly now I look at it completely the other way is how do I judge someone who stays in a relationship that they're no longer in love with that person like so for me and imagine you meet the person you're with maybe at a time in your life when you haven't even figured out who you are and so like you have to grow together obviously and then you build a family and then it becomes more focus on the kids and, you know, things like that.

And even though I absolutely love my ex and we have a like wonderful, you know, not wonderful, but we have a much better relationship now. And also I have the best partner that I'm beyond in love with. So I was very fortunate to find someone. I look at it like in such a simple way now. Like why would I feel stuck? And for me, that feeling of being stuck is like debilitating. Like when I feel like I can't be free and I can't move in my life and I can't just like pivot as I want. And obviously I have kids and I put my kids first, obviously. But I also didn't want my kids to see me that way when I have the ability to love so much or to, you know, give them love. Like I wanted them to really see a really wonderful relationship.

And I know I have the capacity to love, but I felt very stuck. And so for me, it was so liberating when I realized. I always give the example of like a ski slope. Like everybody's going down the same path every single day. Sometimes you take a psychedelic or you change your consciousness in a little bit or you're just exposed to something different and you can kind of make a new path. And so the point is what do you need to have that new path be successful and not have the same rigidity that you used to have in your thinking or your feeling?

And for me, a lot of it was listening to my body. When I got comfortable listening to my body, like being exposed to something. something, where do I feel that in my body? Why do I feel that? And I know that from sitting in the room with patients. Like I could sit in a room with a patient and say, yeah, I know you have pain, but like I feel your anxiety first. You know what I mean? Like, or you, you know, you could be in a room with someone who's really, really depressed. You're feeling that energy. Like you go, you go in the room. Like you feel that. So it's, it's really a matter of like having the person trust what their body is telling them is accurate. And then also not having them be

as reactive, which is really like getting comfortable in the discomfort. How can I stay in this discomfort and kind of like just make it more of a way of being? You know, and I think, I think like, I'm sure you like, you know, teach your patients about meditation and breathwork and all that. And I think that's huge, but it's really finding what works for the person. And along with the ketamine, you need to establish a daily practice so that they can, when the ketamine is no longer there for them, they can access that. And that's the biggest issue is the durability is how long is this going to last?

How much work are they doing? It's not just, you know, take the medicine and then everything will get better. It's like understanding now how they're going to make changes in their life. So what's the research on that in terms of, let's say you do, I don't know if you said six weeks of sessions or, and then how, I'm assuming they continue in psychotherapy, like their individual weekly psychotherapy after that. So how does that, you know, a year later, how does that typically look? So that's like where we are right now is most of the studies have been using IV ketamine.

And most of the psychiatrists don't like IV anything because the anesthesiologists brought ketamine in an IV type of format. And that's what the studies are. So now the intramuscular way is like you give someone an injection in their arm. The difference is though you're as an IV, it's like, like this nice linear like over 40 or 60 minutes you're getting a dose that's kind of like you know like at a certain rate and as opposed to intramuscular within three to five minutes you get all the medicine but I like that way because then 15 minutes later we usually come in talk to them it's more relational understand where they are take some notes and then give them

a second injection based on how they're doing so it's like when I'm teaching like my coaches and nurses, it's really funny because you're like, okay, so how do I know, like, what dose to give them next? And it's like this, okay, well, do they sound like this or do they sound like this? You know, it's like, are they like in a whole other world or are you able to bring them back? And so the problem with a lot of these medicines, similar to cannabis, is it's completely personalized. Like someone can totally take a dose and be completely dissociated and other people have a total different response to it. So the biggest issue is, you know, is the fact that it's hard to standardize this.

And like the protocols become like a weight-based thing when it's not a weight-based thing. Like someone could be very heavy or very light and have a really big history of using psychedelics. And then other people can have significant anxiety and they're so scared of that dissociation. So it's really very personalized. But usually we'll like the patient will continue working with the therapist or the coach. And then we'll see them maybe like at three months to check in. and then depending on how they're doing, we do like a booster or two. So sometimes like at six months, at three months, sometimes I never see them again,

sometimes after a year. But, you know, usually we do like the first six and then it's not often that we'll repeat the full six again. And then if we do, that's fine. There's not really much of a toxicity with ketamine and it's pretty safe. And then what is your take on like recreational drugs? that enhance the mind, like, you know, someone who goes to Burning Man. Yeah, no, it's great.

Like, a lot of the people I work with went to Burning Man. Like, a lot of the, a lot of the people I know go to Burning Man. And, and that's really when we talk about drugs versus medicine. So the problem is that we fear that people will understand how safe these medications are. There's no, like, respiratory suppression. You know, they are very safe. but they are doing them in the wrong setting, right? So for example, like, let's say you're using psilocybin mushrooms

at a very loud concert. Like, that can be very uncomfortable for you, right? The other thing is all these drugs work for different amounts of time. Sillocybin can last, mushrooms can last six hours. So, like, you have to be prepared for that. Like, you have to know, like, the onset and how long things are going to last. MDMA or ecstasy for example as a little different it has more of that like love, trust type of feeling with it also has more of a amphetamine in it so that you get more energy,

but still kind of that same feeling. So how I look at it is really you have to test your drugs and that's really important. There's like actually places that like can send you kids and you can test your drugs because so much of the MDMA or ecstasy or Mali or whatever you call it is laced with things. There's such an issue with people putting fentanyl in drugs. And so we don't want bad outcomes, yet we know these drugs are safe. So it's really important to know the dose, meaning like you weigh your mushrooms, you know where you got them, you test them. And also what setting are you going to be in and for how long? And then who's going to be with you is huge. Like if you can't like surrender into the moment and let go and you're resisting it, when people resist like psilocybin mushrooms, it is very

uncomfortable. Like they're there, when their brain is telling them, you know, um, something that they're, that they weren't intending. Then it's, it's really like a fight, you know, within themselves. So I, I believe that a lot of these drugs can give healthy people that next like level, you know, and kind of like open up a whole bunch of spirituality and really like a deeper connection with themselves. But the set and the setting are huge. And then obviously, the dose. I remember someone told me, I don't know if this is like a myth that like when you take an MDMA or exorcet or something, that it kind of takes like a like ice cream scoop out of your like size amount of your brain out or like that is like damage causes brain damage or something.

Maybe that's what they used to scare us. I don't know. Yeah. Well, that's like the war on drugs. Like they said that cannabis kills your brain cells and that's because they took a bunch of like monkeys gave them and basically like didn't allow oxygen into their brains. by like putting a gas mask on them. And then like Nixon came out with the study that says it kills your brain cells, obviously, because they just suffocated them, you know. So MDMA is what we call like an empathogen. It's not exactly a psychedelic, but it has like the increase in oxytocin.

And oxytocin is like a hormone that's really good for like bonding and trust. So MDMA is actually going to be FDA approved for post-traumatic stress disorder probably in about a year, like by like 2024. And Maps is a huge organization that's like spent billions of dollars on this research. And they're looking at it in the sense that you can literally go to your psychiatrist. And after you tried and failed different things for PTSD, use MDMA in the office. I have a few friends who are psychiatrists who are doing research with one of them is doing research with LSD for anxiety. Another one's doing psilocybin for depression.

And so what the companies are, so like big pharma is kind of getting involved now. And they're taking these molecules and then they're changing them a little bit. So they're making them like a little bit more a faster onset, less duration, more synthetic. And like there's so much, I'm part of a psychedelic fund. We've actually raised $20 million. We've given like a lot of money to some biotech companies and to a lot of these pharmaceutical companies. because they have the money and they have the scientists and they're doing the research and they're just trying to figure out which molecule is best for which condition and at what dose

and they have to go through with the FDA you have to go through safety before you can get to effectiveness. So and then you and then you talk about durability. So it's a big process. It takes so many years to get this approved. But in the future, we'll probably have these drugs administered in the office for people who are resistant to the other drugs or maybe when the cause of their depression, you know, is not like a serotonin-based thing, which actually was just proven that like, even though we know

serotonin to be that happy molecule, that happy neurotransmitter, they realize like it's not a neurotransmitter thing. It's more of like a functional connectivity in the sense that what parts of the brain are communicating and how can we quiet parts that are not serving us and how can we kind to open up to the other parts so that they're allowed to think and feel differently. Right, and get detached from that looped thinking, which is like I think what so many people, like you said, default mode network where you're just thinking the same thoughts every single day over and over again.

Intrusive. I love, yes, I love the concept of, I mean, this stuff like you said has been around for so long, but I love the idea of doing it in a controlled, personalized setting with someone who's going to guide the session with intention, which I love that part too. It's like, I'm doing this with intention. And that's how you should do everything, especially something like this. Like you said, if you don't do it in the right setting, you're going to have a terrible experience or you're just going to get really high and be, you know, sit there and, you know,

wait for it to wear off and tell all your friends about how crazy it was and go on with your life and nothing's going to change. So I just, I love what you're doing with this and the fact that you're taking something that could be really, really helpful. And, you know, just because it's been used recreationally and maybe irresponsibly for so many years doesn't mean that we can't take it and use it in a way that's really going to be helpful. So I wish I lived in Florida. I wish I could have learned that so many things are driven by money and marketing. So like the whole opioid epidemic is really because, and like, I'm sure you've seen like dope sick and all these things on Netflix.

And there's a great show on Netflix, Michael Pollan's book called How to Change Your Mind. So that's a good one for people to watch. But like the whole opioid epidemic was because they told us that opioids are not addictive and they're for chronic pain. When really they're just for acute pain. And it's like the same thing like with antidepressants. Like they tell us these are great for depression, but what kind of depression and how many people actually don't get better from different antidepressants? how many antidepressants if people take and switch and think it's actually going to help, it's not going to help, honestly.

So it's really like getting away from taking pills and finding balance in your life where if we all have this like innate, you know, ability to heal ourselves, then we need to consume less pharmaceuticals and do more things that just like our diet is horrible, obviously. Like people don't move their body, you know, like things that can put people into these like states of like a parasympathetic like rest and digest type of mode is obviously helpful but we're all going going going constantly stressed and so so it just gives us more of an awareness like and I think psychedelics just open up different parts of the brain but then it's what you're doing with it that's really you know very important I think like the whole ego disillusion thing is a

really is a really cool concept and we talk about that a lot like does the person have there's a company, there's a few companies that are trying to take the psychedelic experience out. So like, for example, psilocybin mushrooms, they activate one of our 16 serotonin receptors called the 5HC2A. It's a psychedelic receptor. Are we able to activate that without causing a psychedelic, mystical experience? And if we do, is that going to have the same implications for depression? So, so like imagine taking out the high from cannabis or taking out the dissociation from ketamine will still do the same. There's many people who believe that mystical experience is essential to them getting

better. And there's studies that prove that. And so like ego dissolution is this concept where you essentially become nothing, right? And so your ego is no longer driving your consciousness. And when that happens, it's like a very scary for some people, unless they're not, you know, unless they don't have anyone with them and they're not prepared. So that's really important. But like when they realize what their ego does for them and and and also like how can

they operate without ego first. And so like people who do psychedelics, they hang out with people who do psychedelics because for the most part, they want to treat people better. They want to treat themselves better. They're not like ego superficial always first. That's like a huge generalization. But like in general, like someone else who does psychedelics. they go home to their spouse and then they think you haven't lived this, you haven't felt this,

you know, and it becomes this like comparison of like, wow, I really went to this level and became nothing. And it's such a cool feeling because you essentially leave your body and feel that this actually happened. Like I can close my eyes and go back to a ketamine experience that like is so salient yet it didn't really actually happen. Like my brain, you know, created this. And then it stays with me in such a strong way, but it also gives me, like, lessons. Like, I'm constantly reminded of things that I learned during my sessions. And I think, you know, the ego dissolution is really, it can, like, it can help so many people, but it also can help, like, big, important people be a little bit nicer, you know?

Like, we always say, like, we want to give, like, politicians, like, you know, these psychedelic so that they'll operate not from their ego always. Totally. I mean, we do a segment on this show called Triggered. were people write in about like something that somebody did to them that upset them. And most of the time, it's their ego that was hurt in some way. And how much time we spend like defending our ego is, it's kind of frustrating if you think about it. You know, like we've, like you said, you did your ketamine session and you like became the road and the earth and the dirt. And it's

sort of like, I don't need to be Michelle Wiener, the doctor, and the knowledgeable and the best mom and the best partner. And like I identify as like all of these wonderful things. You're almost like, I don't need to be any of that. I just need to sit back and watch the whole kind of world unfold and be at one with all of it instead of protecting and defending myself and who I think that I need to be. So like we'll get an email from somebody that says, oh, somebody called me fat or somebody told me that, you know, whatever it is. And like, we always say like, yeah, that was really rude and that was really triggering. But the truth is, if you could just detach in some ways from all of that and just realize, like, my body is just kind of, and I don't know if this is a little heady for you,

Jordy, or my body is just like the container for my soul. Like I don't, okay, if it's fat, it's fat. If it's, if I have pimples, I have pimples. It's not really about this. This is just what gets the privilege of carrying my soul while I'm on this earth. And maybe it sounds like something something like that helps you get a little bit more in touch with just separating all of that out. And also judgment, you know, like how you judge yourself is probably how other people judge you. So like I think, I mean, I guess that that's that was my thing is like I knew who I was and I just had to be comfortable stepping into it. And like a lot of it was like me judging based on how I grew up and whatever like, you know, trying to to fit into something. when I realize who I am and then I can just be that.

It's like it's just a very liberating type of, you know, feeling. Yeah, moving away from caring so much about, you know, what you think of yourself and what other people think of you, which takes up so much space in our minds, you know. Yeah, that sounds amazing. I fully want it. Does this legal in New York? It's a ketamine's legal everywhere. Yeah, look at that.

But, you know, you guys should come visit me in Florida. We'll do a business trip. Let's do. but we can expense it. Let's do a business. We can do a group ketamine session. I do group sessions, which are really pretty cool. Yeah, like we'll do like a low dose intramuscular or like a lozange for ketamine.

And we, and it has, it's a, when I did my ketamine, it was always groups. And it's, and then you have like a sitter with you, but you're still in a group. And we set them up in like a very spiritual way. it's unbelievable because you're willing to be vulnerable in front of people. So like there starts the process of like ego dissolution, right? Like you're willing to kind of and people always say like, oh my God, am I going to shit on myself? It's like no, Kennedy doesn't do that.

But you know, they're always like nervous like what's going to happen, what's going to happen. But we prepare them and, you know, regulate the dose obviously. But I've done, you know, group sessions for people. And afterwards they love the fact. that they get to share their experience. And sometimes there's actually like a common theme in like more than one person's experience where they're like, oh, I was there also or, you know, like I saw that too.

So like I think that's a big component is like our own energy and how, you know, I know like before I go start a ketamine session with a patient, I kind of like ground myself. I don't want to bring my anxiety like into the room, right? Or like my hyper like energy of the day. So I think that like the collective healing is how we can probably heal more people and in a less expensive way. Right. Do people ever leave those things and they have like, you know, the Brunei Brown kind of like vulnerability hangover or like once they get the ego back, they're like I shouldn't. I feel weird that I said that to people, you know, almost like when you, if you were drinking and you revealed something and then you feel like anxiety the next day.

It does happen. It does happen. But then we have to like say, okay, let's keep working on that. Like, then clearly like you like hit a block and then started second guessing yourself or like judging your experience as opposed to just allowing your experience to happen. I was going to ask about like couple therapy with this in terms of like, you know, connecting in a different way or having that shared experience with a romantic partner. We do, we do ketamine assisted psychotherapy for a couple. but generally it's while they're talking. So like we'll microdose someone with ketamine and have them do a therapy session. And we'll do that with like, you know, a couple so that they can kind of open up with like their armor down, you know.

Oh my God. I need this in my office. Yeah, like you give them like a low dose of like a lozenge like let's say 25, 50 milligrams, but normally we give 200 milligrams for like more of a dissociative experience. and then like the couples, you know, will speak to each other and they'll be able to do it in a way where like, again, their ego is not driving it. And, you know, they're able to access feelings, like access like, you know, like different things that they would normally have to be defending themselves.

So we do it for couples, but actually there's someone studying MDMA for couples because, because of the oxytocin, because of like the fact that it's going to like really allow them to bond while they're sharing. Yeah, I've heard of that just couples who kind of like rent a hotel room for the night and just like do away from their kids and do this kind of thing and then like reconnect or. I've heard of that. And that again is like not really, you know, it's drugs versus medicine. It's like we have an intention, you know. Right. And that's the, we know the dose.

We know the setting. We have the intention. and we're doing it to like connect deeper, you know, or to like talk about something. So people will do it to enhance their meditation. Like I have patients that I know very well that I'll give them like a lozenge of ketamine so that they can get deeper into their meditation. And they're like, you know, very spiritual people.

And they love it because it's a different, it's just a different feeling. Like they can just get like deeper into that moment. And it's, you know, it's especially for couple therapy because I do a lot of that it seems like it would be more cost effective to do like the micro dosing where they're going to open up because I'll spend 10 sessions just convincing someone or trying to get them to the point where their defenses are down and they can actually, you know, have the conversation that they need to have versus being able to speed up that process a little bit. But usually it's like you got to meet the person where they're at.

And so a lot of people are willing to open up, maybe their spouse is less. willing to open up, you know, and then also maybe they need a higher dose to really like disrupt their thought process and like to kind of sort of wake them up and say like what and that like that's actually what psychedelic means. It's like it means mind manifesting. So, you know, it's it's like we like we say they're like meaning making molecules like these these are meant to like find your purpose to make meaning in your life. And so sometimes the low dose. is good for therapy, but then, you know, sometimes in the middle, like, we'll do like a hybrid type of thing where we'll do a few sessions like this and then a higher dose and then we go back

and it's like a little, it's a little dance. So what other states, I know you're doing this in Florida and if people want to, we'll give out your information if people want to find you, but what other states can you do this medically assisted? Because like you said, you could get ketamine. I don't know. I guess you go to your doctor and you get it, but like where can you get it in a way where you can have some of these physician assisted or, you know. So ketamine is like a schedule three drugs. So you can get it in any state. It's just a matter of like making sure you're doing it with someone who knows about ketamine

and there's a therapist or a coach. Like it's not just taking the medicine. So there's some like in every state. Every state in the United States. For like 50 years you can use ketamine. Like it's a it's not a schedule one drug. But the therapists that are trained. in this exist in every state.

Yeah, the therapists that are trained exist in every state and there's actually training. Like there's a, I did the ketamine training center. There's a company called Fluence, Polaris, MAPS has an MDMA training. So there's all different companies that are training therapists how to use ketamine. And then eventually we'll do it for other psychedelics when they become legal. But that's a huge part is training the therapist. And like they say like healing the healers.

you got to usually take the medicine to experience what it is, make sure like you're, you know, doing well in your area so that you can be available to, to help someone else. So it, but it's really like, I would warn people not to go to infusion clinics where you're just getting ketamine and an IV with no preparation, no therapy, no integration. That is going to, that's like basically like going to like an opioid clinic like, you know, 10 years ago, right? So ketamine is available and there are training. programs. And it's really important that your therapist, first of all, like, I have people who come to me who have a

different therapist and they come to me and they're like, I don't really think I'm going to tell my therapist that I'm doing ketamine. I'm like, that's just not an option. So like, you know, they have to be willing to like have the conversation, but there also has to be therapists who are trained. Right. Okay. And then I just, I remember hearing again, I'm just throwing out like myths that I probably have heard of like the person who like knows someone who like did mushrooms or one of these things and they like never came back or they were like never the same again but like in a scary way. Yeah. There's like there's like a condition called like hallucinogenic, I don't know, just something disorder where like so like for example the main the main contraindication for

psychedelics is someone who's in a manic state. So like oftentimes. we don't give it to someone who's bipolar, definitely not in mania. Like so say, for example, that was the situation. And it's so funny because I think back to when I was in college, and I remember there was someone who did ecstasy one night. And then she was like, I feel like I'm rolling for like three weeks straight. I'm like, that's not a thing. Like the half life of the drug, like it's done.

But she was. She felt that. And so that usually is like a preexisting like mental health condition that may be not diagnosed or like maybe they're psychotic or manic then they take a psychedelic thinking it's going to help them and it kind of spirals them out of control. So that's one of the main things we we checked for. Yeah. I mean that's like that's another I guess reason to only do this kind of thing or at least to probably try if you've never tried it to try it under some sort of a supervision type. Yeah, there was actually a person who did ketamine at home and drowned in the bathtub

because they had no idea they were in the bathtub. You're in a whole other world. Right. So that's the fear of like these at home. They made at home ketamine available during COVID because, you know, they're like we have this huge mental health crisis. This could be an option. And then people started like working with coaches and sending the ketamine home.

But that is actually kind of risky if they're not having proper guidance and supervision. And also can create addiction. Right. I'm sure. Yeah. This is so interesting. I think I love the supervised aspect of it because I just, you know, I think you're doing it with purpose. You're not just doing it. You're like you said, you have someone watching to see, do you need a little more or have you had enough? And there's somebody that's sober and conscious and observing and making sure that you're having the experience

that you are going into it wanting to have. I mean, I looked into getting trained in this here. and unfortunately my kids take up too much of my time. It was like an intensive training, which it should be. But maybe one day when they're older, I would look into this because I think it's a great, we use so many medications. So I think it's, you know, people are afraid of this, but you're taking a bunch of other stuff or you're self-medicating and getting wasted every weekend or yourself medicating and, you know, just smoking weed all day every day.

So I get that people are afraid and I probably would be one of them that would be anxious about it. So the idea of doing it supervised makes it be like, okay, I'm taking this medication for a reason versus I'm just, you know, going to ignore it, be so scared to do this thing. You know, and it's like Michael Pollan's book where they kind of like squashed it and made it feel like it was just, you know, all these psychedelics were just like the worst thing and you're going to jump off a building. And so it scared everybody away. But I think it could, you know, I mean, even I think all the time, I'm not a big drinker. And if you go out anywhere on a Saturday night. And I have kids and we'll just go out to dinner on a Saturday night and there's

people falling off the bar stool and, you know, like, they're like, what's the matter with that guy? You know, so like people are abusing alcohol all over the place every single night of the week, but our society is afraid to try a, you know, medically supervised experience when if that could eliminate, like you're saying, or reduce the amount of self-medicating that you need to do, you'll end up saving a lot of money on your bar tab if you can you know yeah i mean i think i think it's like all the ways that people cope whether it's like eating shopping drugs alcohol whatever like they're kind of like neutral you know before the person consumes them and so i think it's really like understanding why the person needs to disconnect and what and like what's the underlying

source of their trauma and then really going back to like healing their trauma which i think just comes down to like connection and then balance you know like you can do certain things on certain nights but there has to be a balance does this help with like that kind of addiction or like substance abuse addiction or anything like cigarettes yeah we do we use ketamine assisted psychotherapy for addiction and we're actually getting into um some of the rehab facilities in south florida and then there's a company at imperial college of london of this guy named bencessa has a company called Awaken, and they're using ketamine for alcohol use disorder. Because again, it's like we're getting to the root cause of their trauma, why they're choosing

this substance. And what's kind of interesting, though, is that ketamine has a similar, so ketamine feels sometimes like a glass or two of wine at a very low dose because it blocks this NMDA receptor that alcohol also acts on. And so like a lot of times that alcohol feeling is sort of like familiar to these people, but the level and most of the time with addiction, we can get to higher doses to really like disrupt the thought process. But there's a, like I have this one guy who was so scared of ketamine. And I'm like, you, you're, you drink every night. Like, you know, you're an alcoholic. Like, you're so scared of the, the disconnect. Like, you literally disconnect, like constantly, you know. But he was so scared of

he had so much anxiety that we ended up just microdosing him during therapy to get everything out. So like honestly, I love this part of medicine because you can personalize it. And I think that people just need more experience with like experienced clinicians, obviously, so that they can get the right treatment for them. I could sit here and ask you questions literally all day. I should go to work. But I do have one more. One more.

One more. One more. One more. What are some of the common intentions that people have when they're going into their ketamine sessions? Like the common themes? Yeah. So a lot of times it's based on the limiting belief. So like a common one would be to feel calm or to like, you know, for someone who's anxious, like it's just to feel calm.

Like that's just what they want to like, or they'll say to find some clarity. by the therapist I work with, her name, Sherry Kaplan, she's unbelievable and she makes these beautiful intentions for everyone. So she's like, I am willing to release. And then it's like this whole beautiful thing. And so she like writes out a very specific intention for everyone. But it always starts with I am willing to release. And so it's like I am willing to release the belief about myself that I am powerless or I am not good enough or, you know, I'm willing to release the thought that I need to have chronic pain, you know, like that, that I'm defined by my pain. And a lot of it is really what is defining them. And then are they willing to release that?

So that's, those are the most important. And a lot of it comes down to just like feeling worthy. That's a big thing, you know, feeling, feeling strong in their body or like they want clarity about something. Those are like the most common intentions. This is amazing. I don't want to let you go. I don't want it to be another 15 years before we talk again. So hopefully we can find a way to stay in touch. Like I said, we always talk about like friendships and friendship breakups and how to communicate. And I feel like we just kind of. Well, I just think we have such a strong history. And I will always love you. I mean, I think that we have such a strong foundation. And we were with each other at such times in our lives that we were like evolving and like didn't even know who we were.

And, you know, there was like, especially with me, like there was so much that I still had to be comfortable with. So I think, you know, I think like whatever happens, you have to respect the foundation. You have to like respect the friendship. And like even with your family, like I see like. I see like all your siblings and like, I'm like, which one is this? Like this is a little one and this is a middle one and like, you know, you know, we'll always be family. Our whole family needs kind of therapy.

A big group family. We should. Like 30 of our sibling people in there. I don't think of all the dysfunction. She's the one who needs it most. She should sit in the center of the circle. Yes. I love that.

But we'll let you go because we know you are a working doctor. Where can people find you where if they're in South Florida or if they want to travel to South Florida? How do they find your practice? Sure. My practice is called spine and wellness centers of America. It's really a pain practice. And I have offices in Boka, Hollywood and Miami.

And probably my Instagram, Dr. Michelle Wiener is the best way to find me. And like I do lectures all the time and, you know, stuff like that. So thank you guys for having me on. And I'm proud of both of you too. Thank you. By the way, you look exactly the same.

You literally look exactly the same. Exactly the same. I mean, Georgie doesn't because she's grown up since I seen her, but they only have to. You look exactly. This was really great. And I really appreciate your,

I could tell that you are doing, that you've done this work on yourself because you're coming in here, willing to be vulnerable, off the bat, you know, on the air and just like, talk about your own personal experience and I just really value that. And I'm so glad that we reconnected.

You guys got to reconnect. Do you have the same like energy? I feel like it's definitely a friendship that makes sense to me. Yes. This was really great. Thank you so much for coming on. All right. Thanks so much.

Well, that was amazing. I definitely want to try this. But thank you guys so much for listening. We'll be back next week. Don't forget to rate review and subscribe to the podcast. anywhere you get it or if you have any questions about this, you can email oversharing at betches.com. That's our time. Great work today.

Oversharing is produced by Sean Kilby, Jorge Morales Picoe, and Rebecca Salis McCabe. Editing by Massilio Perez. Yes, booking by Allie Friedlander. Send your advice emails to oversharing at betches.com or leave us a voicemail at 646363-6294.