Meet the Doctor Who Wants to Heal Brains with Psychedelics

Cannabis has been legal, medically, for a while in Canada. Even before 2018, it was successful — just not in all shapes and forms. Certainly, once legalization happened, it really opened a lot more research opportunities but it’s still difficult to do research. It’s still very expensive, because it’s highly regulated and maybe, to some degree, over regulated, one could say, but for good reason. It’s new, it’s emerging, and we’ve got to be extra safe here if we want to see a lasting cultural shift.

The cannabis research in Canada has certainly expanded and opened a lot more opportunities with legalization. It’s funny because there are parallels with psychedelics. I think that will very much be the case for various individual compounds within psychedelics once legalization occurs. From the patient’s point of view, after cannabis was legalized, there was a lot more interest and a lot more questions being asked. I think people who were sitting on the fence before, who were worried that they’d be judged or whatnot, are now coming forward. There are always going to be people on the other side of the fence and who’s to blame for that? They grew up in a time where this stuff was very highly stigmatized. There’s a lot of misinformation out there.

Most of my day-to-day is spent speaking with patients and talking to them about cannabis and clearing up a lot of misinformation. That’s begun to emerge with psychedelics too in the last few years. I’ll have conversations with patients, and they’re so afraid to tell me that they’ve gone off and done psychedelics on their own or whatnot — again, for good reason. It’s about chipping away at it. People are being a little bit more open about it but it’s just going to take time for these things to happen.

Ketamine, specifically in Canada, has been used in general anesthesia for some time. It has a good effect in terms of disassociating an individual from a conscious state. It really helps with the memory loss piece, to some degree, in that case, and it seems to be that, through its actions, which are much different from psilocybin or LSD, that it has secondary effects with psychedelic properties and that it seems to work well for depression. That’s opening it up to other indications, like PTSD and other areas.

What makes ketamine interesting is that it’s accessible right now in Canada. What happens when these things are available is that you can have doctors who can then use them off-label. As a result, you get people who have expertise in utilizing ketamine and expertise with the therapy who are starting to use it in other areas as well. There’s a lot of promise with ketamine in Canada since we have it available. Again, it’s label use is for depression, but it is being used off-label for other indications, too. There are quite a few ketamine-assisted psychotherapy clinics here now. It does hold great promise. We’ve also made good progress with other, likely forthcoming psychedelic medicines like psilocybin and MDMA too.

It’s so hard to predict. There’s a direction, I believe, that things are going in Canada. Right now, there’s a push to refine current studies. We’ve got solid evidence on some conditions, like PTSD and depression, but there are strong signals in other areas too, so I think the immediate future is about researchers defining what’s known already and then really crystallizing it in terms of safety and indication. Medical legalization for MDMA is pending and will probably happen very soon and psilocybin will follow suit. In terms of recreational legalization, that’s a bit harder to predict. I’m not sure how that happens.

Coming back to what we mentioned earlier, as soon as medical legalization with MDMA for PTSD happens, for instance, that’s going to result in off-label use. Then you’re going to have psilocybin: same thing. You’re going to have off-label use, and that’s not necessarily a bad thing at all. That will probably kick off a strong surge of proposed indications. There will be this big windstorm of everybody using it for totally different things but that will settle in time. That’s where, from my point of view, I really want to gear up from a neurology vantage. Knowing this is in the pipeline, that’s where we’re focused right now at Numinus.

In the short term, research efforts at our center are going to be focused on three main areas: safety, indications, and effectiveness within the context of individuals with neurological disease.

For instance, if you look at the studies and look at the characteristics of all the patients in [currently available] studies, outside of their psychological and psychiatric diagnoses, they are a relatively homogenous and healthy population. Where are the people with multiple sclerosis who also have concurrent depression? Where are the people who have Parkinson’s or ALS or another devastating neurological disorder that comes together, with significant psychological impacts?

They’re excluded from these studies because right now, the goal is to establish consistency amongst the population to prove these things work. So, logically, the next phase for me is to be able to help everybody, especially those patients in neurology who were marginalized out of these studies just because they have an underlying disease.

We also don’t know how psychedelics are going to affect people with underlying neurological conditions. That’s another area: what are the safety parameters for these populations? What are the indications? Are we treating the concurrent mental health conditions? Can we help with the neurological disease? Lastly: how effective are they? Circling back to the people from these studies, we’ve shown effectiveness in people who do not have brain conditions or brain diseases, right? Well, what if somebody has a stroke and has significant damage from the stroke or has a severe traumatic brain injury with long-lasting impact on the brain and its structure?

When you give somebody psychedelics in a situation like that, how effective is it? Can we knock out the area of our brains that will allow the psychedelic to be effective? Can we knock out the area of our brains that is possibly responsible for protecting people during psychedelic experiences, allowing them to tolerate higher doses? If so, does that mean maybe now those patients need lower doses because of, for instance, frontal lobe strokes? These are big, big questions that could affect a huge percent of us given neurologic disease is very, very common in our population.

You’re right. Stroke is a good example because a stroke is a significant brain injury. We have about 15 million people a year who suffer strokes. That’s a lot. 5 million — about a third of those people — are left permanently disabled or have long-term disabilities. That’s one reason strokes are so devastating: it’s not a gradual disease. One minute, you’re functioning totally perfectly, and then instantaneously, the next minute, you’ve become someone totally different.

If a third of these individuals are ending up disabled, just imagine the mental health conditions that are associated with that. I see it all the time. Then the question becomes: can we help those 5 million people a year? Can we treat them? Right now, we don’t know, so we need neurologists who understand psychedelics, who can intelligently investigate this — and that’s just one example.