Title: Fast-Tracking Psychedelics Research

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Brian Lehrer: Brian Lehrer on WNYC. On our Tuesday shows, we like to bring the science on a topic in public health, often climate-related, often other health-related science. As it happens, we will talk a lot about environmental health tomorrow because tomorrow is Earth Day, as we just mentioned in that break.

Here's what we'll do today. Did you catch the announcement by President Trump over the weekend that he's going to make it easier to research the potential health benefits of certain psychedelic drugs? These include LSD, MDMA, also known as ecstasy or Molly, psilocybin, and ibogaine. Veterans groups have been especially interested in this after some reported success treating war-induced PTSD. At the announcement, Trump was flanked by several of his health-related appointees, RFK Jr. and others, but the origin story of this announcement came from perhaps a surprising source who was there, the podcaster Joe Rogan. Here's 40 seconds of what he said.

Joe Rogan: I sent President Trump some information. We have a gigantic opiate problem in this country, obviously. In 2024, more than 80,000 people died of overdoses. It's a horrible number. There's more than 5 million people that are addicted to opiates right now in this country. With one dose of ibogaine, more than 80% of people are free of that addiction. With two doses, it's more than 90%. I sent him that information. The text message that came back, "Sounds great. Do you want FDA approval? Let's do it." It was literally that quick.

Brian Lehrer: Yes, it was that quick. Podcaster with connections calls the president. The president says, "Hey, cool, man, let's do it," and poof. To be fair, the executive order does not legalize any of those drugs for treatment. It makes it easier to research them. That includes risks as well as benefits, and frankly, from what I'm seeing, almost nobody opposes that. To be clear, this is not about legalizing for recreational use. Don't look for ecstasy dispensaries anytime soon.

Let's see what we know and what we don't know about the mental health potential of certain psychedelics to treat addiction, as Joe Rogan was emphasizing, post-traumatic stress, and more. With me for this is Frederick Barrett, PhD, director of the Center for Psychedelic and Consciousness Research at Johns Hopkins University. Dr. Barrett, thanks for coming on. Welcome to WNYC.

Dr. Frederick Barrett: Oh, thank you so much for having me, and thank you for highlighting what I think is an important area, of course.

Brian Lehrer: Perhaps the substance getting the most press since the president's announcement is ibogaine. That's what we heard Joe Rogan reference in the clip. For the uninitiated, can you explain what ibogaine is and why Joe Rogan or veterans groups or others think it's already been helping some people?

Dr. Frederick Barrett: I'd be happy to do so. Ibogaine is a psychoactive compound that is naturally occurring, and it can be found in the iboga plant, which is native to West Africa and traditionally used in West African spiritual practices. It is a very unique compound in a few different ways. One of the ways that it's unique is that, unlike other classic psychedelic drugs that you listed, such as psilocybin or LSD, that only interact with a small number of brain systems directly, ibogaine seems to interact quite widely with a much larger number of brain systems, including the serotonin system, the dopamine system, and the opioid system.

Serotonin is involved widely in a number of processes, such as sleep and mood. It's implicated in depression. The dopamine system is involved in substance use disorder, but also just normal everyday learning and responding to rewards and punishments. The opioid system, of course, is responsive to pain relievers in some cases. It's involved in the regulation of pain, but ibogaine seems to interact with even a much larger number of brain systems than just those. It's thought that because of its much more intense interaction with the brain, and specifically with the opioid system, that ibogaine may have unique properties above and beyond other classic psychedelics.

One of the claims that's made about ibogaine is that after only a single dose, people, especially who are suffering from opioid use disorder, and of course, this is in the context of the opioid epidemic, which is still ongoing in this country. Ibogaine may reset craving and withdraw for opioids, which dealing with craving and withdraw is a huge challenge in patients with opioid use disorder. If these claims are true, it would represent a remarkable advance in our ability to treat these illnesses.

Brian Lehrer: You say, if these claims are true, you heard the Joe Rogan clip. He said 90% of people who take two doses of ibogaine kick their opioid addictions. Is that real science or is that podcaster chatter?

Dr. Frederick Barrett: I'd say somewhere in between, frankly. There have been surveys and reviews of people who have gone overseas to receive this treatment, but none of this to date has been done within a controlled experimental context, and I'll tell you why, because ibogaine is one of the very few psychedelic compounds that actually has a really known and substantial cardiovascular risk. It's this cardiotoxicity that sadly has led to some deaths in overseas retreats, and it makes it a much higher bar for screening and assessment and monitoring during treatment. Also, because of this, it's been almost impossible to get permission to study these drugs in the US because of this known cardiotoxicity.

Brian Lehrer: As we continue with Frederick Barrett, director of the Center for Psychedelic and Consciousness Research at Johns Hopkins University, on President Trump's executive order over the weekend intended to make it easier to research certain psychedelic drugs for treatment of trauma-induced PTSD. I guess by definition, post-traumatic stress disorder has to be trauma-induced, and addiction and some other things.

Listeners, I wonder if anybody among you right now has any experience with this. Have you ever taken a psychedelic drug specifically for therapeutic purposes, or maybe you're a therapist who, legally or not, has worked with patients using psychedelics? 212-433-WNYC. We have about 15 minutes for this segment because we did go long with Brigid. This is going to be a little shorter than it might otherwise have been, and we do have to end at our end time for a few reasons, but we could get in a call or two or three for Dr. Barrett if anybody has direct experience with this or wants to ask him a question. 212-433-WNYC, 212-433-9692.

You just talked about the cardiotoxicity of ibogaine. I see that there is-- I'm just looking for the exact language. It's something to the effect that there's going to be human clinical trials for the first time pursuant to this executive order. It's going to pave the way for human clinical trials for the first time. I imagine that's something that you might do or might want to do at your center at Johns Hopkins. How do you do something like that with something like a psychedelic drug, where you know you're treating trauma patients or people fighting addiction, and you know there's a risk of deaths from heart implications?

Dr. Frederick Barrett: This is going to be a very tricky question to answer when people do go about applying for permission and approval to conduct these studies. One of the sources of the cardiotoxicity of ibogaine have to do with the feature of the chemical structure that, I'll be honest, is a little beyond me. I'm a cognitive neuroscientist, not a chemist. There are aspects of the chemical structure of this compound that lead it to bind to certain receptors on the heart that cause arrhythmias and other things.

From what I understand, there are ways to try to approach this specific cardiotoxicity to either monitor and intervene if it becomes a problem or even go as far as engineering the compound to engineer out that cardiotoxicity. Either way, that is going to have to be addressed within any clinical trials that occur with this compound.

Brian Lehrer: Ben in Yorkville, you're on WNYC. Hi, Ben.

Ben: I'm very disappointed in this report because until there's a double-blind study, we have no idea if this really works. It's very much like they have staples in people's ears to cure addiction, and maybe prayer works. Who knows? Believing that a drug really works because people reported, there's always reports on cancer drugs, all kinds of medical things that people say work tremendously, and then we never hear from it again. Encouraging people to take psychedelics as a cure for addiction is just bad. It's wrong and probably dangerous.

Brian Lehrer: Thank you, Ben. That's exactly what they're setting up here, is actual clinical trials to see what's really what, right?

Dr. Frederick Barrett: Are you asking me?

Brian Lehrer: Professor? Yes.

Dr. Frederick Barrett: I'm sorry. I want to amplify that caller's comments. None of the psychedelics that we're studying right now are approved as medicine, and so certainly they shouldn't be recommended for the treatment of substance use disorder, depression, trauma, or anything else yet. I think one of the things that the executive order has done right is to direct this further into the research pathway.

Even then, for the clinical trials that are being conducted, they're being conducted in patients who are very carefully screened to make sure they're as appropriate as possible for the experimental intervention. Also, participants are heavily prepared and monitored during drug effects such that we can put as many kind of guardrails in place as possible to ensure patient safety. I'm certainly not advocating right now that people go out and do this on their own or that it can be or should be prescribed right now for these indications.

Brian Lehrer: In fact, Olga Khazan wrote in The Atlantic in 2024 that there's a "problem for psychedelic research. Many of the studies underpinning these substances' healing powers are weak, marred by a true believer mentality among its researchers and an underreporting of adverse side effects, which threatens to undermine an otherwise bright frontier in mental health treatment." How do you, who runs the Center for Psychedelic and Consciousness Research, have to fight, if you think you do, what she called true believer mentality among its researchers?

Dr. Frederick Barrett: I can't speak for all researchers in the field, but I can certainly speak for myself and my colleagues here at Hopkins, that we take the responsibility of doing this research as objectively as possible incredibly seriously. I think it's incredibly important to hold great equanimity, if you will, and objectivity when approaching this research. We do everything we can to inform potential study participants of the complete range, positive or negative, of outcomes that may occur after engaging with psychedelic studies.

Truly, these compounds do not work for everyone, and they shouldn't be expected to. On that note as well, people often lump psychedelics in with other substances that are misused and that cause intoxication. I can tell you with certainty that some of the experiences that people encounter with these compounds, even in very controlled settings such as ours, are incredibly difficult. Some of these are harrowing experiences, and some of the most challenging psychological experiences of a person's life. I think we have to be as careful as possible to follow the science and really follow the data.

That being said, of the hundreds of study participants and patients that I've followed in clinical trials that I've been involved with over the past 13 years, we have seen some remarkable success stories, some people that have suffered even a lifetime of illness who, after one or two doses of psilocybin, have shown remarkable recovery. Again, that's not to say that that will happen for everyone, or that's even necessarily the modal response. Even the most effective therapies can have side effects. I think that we owe it to the millions of Americans who are suffering from mental illness to try as hard as we can to conduct objective science so that we can explore all possible options.

Brian Lehrer: Bill in Jersey City, you're on WNYC. Hi, Bill.

Bill: Hey, how are you doing, Brian? Back in 1974, I was designing to build a house for a psychiatrist from the Menninger Clinic in Topeka, Kansas. I'd had experience with mushrooms. Anyway, he says, "I'm going to bring a bunch of patients out," and they had a pond there. He brought about seven or eight patients of his along. We all dropped mushrooms, and it was just, oh, I can't use the word, but it was crazy. It was like a scene out of One Flew Over the Cuckoo's Nest. Everybody was just running around like mad. I wouldn't think that it was a successful experiment.

Brian Lehrer: Professor?

Dr. Frederick Barrett: No, that does sound a bit uncontrolled, and frankly, a little scary, if you ask me.

Bill: I won't give his name. He's dead now, but he was a renowned psychiatrist. I was surprised it was 1974, a long time ago. It was scary, to say the least.

Dr. Frederick Barrett: Go ahead. Sorry.

Brian Lehrer: No, no, you go ahead, Professor.

Dr. Frederick Barrett: I was going to say a lot has changed since the '60s and '70s. There are actually thousands of papers written on psychedelic drugs from clinic or laboratory perspectives in the '50s and '60s through the '70s, but the vast majority of those studies would not meet modern criteria for rigor or reproducibility. We don't see those as generating valid evidence that we can actually objectively assess today. That's one of the reasons that we're going back and looking at some of these compounds, hopefully in as controlled of a way as possible, so we can get a better idea of what the real values, what the possible risks and possible benefits are.

Brian Lehrer: I know you got to go in two minutes. You're the director of the Center for Psychedelic and Consciousness Research at Johns Hopkins. I just got to ask you a curious question. What does the consciousness part of the center's name refer to that's different from or a part of psychedelic research?

Dr. Frederick Barrett: That's a great question. At this point, it's a bit of an aspirational aspect of the title. People like to discuss and describe psychedelics as consciousness-altering compounds, and possibly even claiming that they expand consciousness, whatever that means. The word consciousness itself, we could spend an hour and a half just talking about what do we mean by that. Suffice it to say that I think that with our current scientific tools, we're really not completely prepared to dig into the question of what is consciousness scientifically. That's a nod to the aspiration that maybe one day we will have those tools. Psychedelics represent such powerful modulators of consciousness.

I think when people say that psychedelics affect consciousness, they mean that maybe they reveal some aspect of an individual's consciousness to themselves that they may not have seen before, but that doesn't mean we can study it. It's really just aspirational that one day we may be able to crack the code and better understand consciousness.

Brian Lehrer: On President Trump's executive order over the weekend, making it easier to get FDA approval to study psychedelics as possible treatments for addiction and post-traumatic stress disorder, Frederick S. Barrett, PhD, director of the Center for Psychedelic and Consciousness Research at Johns Hopkins University. Thank you so much for joining us.

Dr. Frederick Barrett: Thank you so much, Brian.

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