The topic of the Academy of Integrative Health & Medicine (AIHM) 2022 Conference is “Disruptive Innovation + The Future of Health.” The live event will take place October 28 - 30, 2022 at Paradise Point Resort & Spa in San Diego, California. The event will also be available online.
The event will include more than 50 global leaders in integrative health and medicine. It is dedicated to help you expand your practice with the latest in integrative health and medicine and receive up to 54.25 CME credits.
Dr Scott Shannon is one of the key presenters. We spent some time with Scott to learn more about his presentations.
Integrative Medicine: A Clinician’s Journal (IMCJ): Today we’re going to talk about your presentation at AIHM, Psychedelics and Innovative in Mental Health. To begin, can you just tell me a little bit about your background and a brief overview of your presentation?
Dr. Scott Shannon: I got interested in consciousness as an undergraduate at the University of Arizona and had the opportunity to have Andrew Weil advise my honor’s thesis. My the time I graduated from medical school there six years later I was convinced that psychedelics offered an opportunity to more deeply understand consciousness and to create transformative change. Following my internship at a Columbia hospital in New York I worked as a general practitioner in isolated rural Arizona. One element of my practice there involved the use of MDMA for couples therapy. I was devastated when the DEA scheduled MDMA in 1985 and decided to finish my psychiatry training while exploring other pathways for healing such as acupuncture, Jungian dreamwork and natural supplements. Child psychiatry enticed me with the power to change a life early and to explore a creative interface with consciousness via play therapy and art. I then moved to Albuquerque to do a child psychiatry fellowship. I ended up in northern Colorado and was working in integrative mental health when psychedelics called out to me again twenty years later. My sense was that we were doing the mind and body pretty well in integrative medicine, but really did not address the spiritual side of our being very well. Soon after, I found my way back to working with MDMA in Phase II and Phase III studies sponsored by MAPS, the Multidisciplinary Association for Psychedelic Studies. Around this time we began to work with ketamine at my clinic, Wholeness Center. It became clear to us that it was the ability of ketamine to access deeper mental, emotional and spiritual perspectives in psychotherapy that created lasting transformative change. We are just about to step into research with LSD and are exploring how the power of group therapy may be synergistic with psychedelic exploration. My presentation will explore psychedelics and how they represent a paradigm leap in mental health that moves us to greater dialogue with the Self and our spiritual being. I want this presentation to give folks a better understanding of what psychedelics are and how they can promote root cause healing.
Well, as you know, psychedelics have been around for a long time, probably 70 years or better in terms of active interest. But they went dormant with Richard Nixon and the Controlled Substance Act in 1970. And since then, there was very little activity until about 15 years ago, and it’s come on strong. And now we’ve got 3 major trials that are getting close to completion and possibly being rescheduled. There’s been a couple hundred businesses start up in the last few years focused on psychedelic medicine. It’s reminiscent of what happened with cannabis 10 or 15 years ago when it came online. But the difference is that cannabis was recreational and it’s not particularly a therapeutic medicine, but these medicines are therapeutic in a much different way than any of our existing medicines have been.
And we’ve had this promise of the decade of the brain revolution, with the release of Prozac in 1988. And then the during the 90s the focus was around a chemical imbalance theory that was never well-proven. It was just an urban myth that the drug companies leveraged to gain market share and penetration. And they’ve got that now, but the downside of this is that these medicines don’t cure anyone. They have very weak effects. And for many people, they’re difficult to get off once they get on them. And we really need something much different.
We have 30% to 40% of the population who have depression or are treatment-resistant, which means they have not responded to multiple medications and psychotherapy. We just don’t have very good tools. PTSD is another one. I mean, we have veterans dying by suicide in the thousands every year and we just don’t have a very good tool for treating PTSD. It’s a chronic, debilitating illness that is one of the major drivers of healthcare, mental healthcare and medical costs in this country. The people with chronic PTSD and severe treatment-resistant depression are very high utilizers of the healthcare system because of their suffering and chronic unrelieved distress.
So now, with psychedelics, we have the promise of something that actually may get to the root cause and may actually provide lasting, sustained relief for people. And this is with only 1, 2 or 3 doses of the medicine. It’s a very different model that’s transformative instead of palliative that we have with our current treatments, which just try to manage people’s misery. We actually, with psilocybin, MDMA, and even ketamine, have tools that can really deeply address people’s suffering and help them to transform their lives.
IMCJ: What are psychedelics?
Dr. Shannon: Psychedelic drugs are a loosely grouped class of drugs that are able to induce altered thoughts and sensory perceptions. At high doses some of them, such as LSD, can cause visual hallucinations. Many people have heard of “magic mushrooms,” which contain the active ingredient psilocybin. Psilocybin can also alter perceptions and cause hallucinations at high doses. Other drugs such as ketamine, have traditionally been used as anesthetics, but also act as hallucinogens and can cause dreamlike states.
Some of these drugs, such as MDMA, are considered to be potential drugs of misuse, given the euphoria they can cause. Possible adverse effects of some psychedelics could include dizziness, drowsiness, extreme dissociation from reality, panic attacks and nausea. In our studies, these side effects are minimal and easily managed.
Despite their burgeoning promise in the field of psychiatry, psychedelic drugs are not yet considered to be mainstream medicine, and their use is still largely condoned only in experimental or monitored settings. These substances can cause severe impairment and should not be used without a guide who is not under the influence, who can provide calming support and/or call for help if someone is having a bad trip or an adverse reaction. Recreational use is much different from therapeutic use with a trained guide or facilitator.
On the plus side, for many conditions, they present a novel and incredibly promising treatment avenue for some of the most difficult-to-treat psychiatric conditions, such as PTSD or treatment-resistant depression. With proper supervision, they are relatively safe. Some patients say the experience of psychedelics can truly be life-altering. This is thought to be in part because the use of psychedelics frequently helps people to have what is best described as mystical experiences, and that these experiences have been associated with improved outcomes.
IMCJ: How do you get the pharmaceutical companies to assist you in a product for which they’re only going to get 3 or 4 sales and then they have to move on to the next one? Because that doesn’t fit their model of current products like Prozac, that, as you say, are difficult to get off.
Dr. Shannon: I call their model “the annuity model,” because once they get you on it, they have you for years creating steady sales. I’m involved in a study, a phase 3 study of severe PTSD with MDMA-assisted psychotherapy. We have been treating folks in this study for the last 4 years and the results have been impressive. We’re being sponsored by the Multidisciplinary Association for Psychedelic Studies (MAPS), which is a nonprofit. And they’ve raised more than $80 million for this phase 3 trial. And it’s being run through a public benefit corporation, for the good of the people instead of the good of the shareholders.
IMCJ: What are the psychedelic products based on?
Dr. Shannon: Well, psilocybin is based on magic mushrooms. There are many different varieties of mushrooms around the world that contain psilocybin, and they’ve been used for millennia in ceremonies. But the psilocybin that’s being used in the two phase 3 studies right now are synthetically-derived psilocybin. MDMA is a chemical that was actually synthesized in 1912, and was generic for decades until it was scheduled by the DEA in 1985. But if MAPS succeeds, or I should say when MAPS succeeds, they’ll be given 5 years of product exclusivity to help them earn back the money they’ve invested in it.
Two of the three companies that are in this market right now are nonprofits: Usona and MAPS. The third company is Compass, a large corporation, whose objective is to leverage this for profit.
IMCJ: Mushrooms have been kind of like the poster child this year for the supplement side. Do you see companies who are extorting the success that you’ve had and are creating—I’m going to say knockoff products—that just may not have the efficacy that the products you’re working with do?
Dr. Shannon: Well, psilocybin is a Schedule I substance. So, the only sales and market availability is in Schedule I FDA-approved research. There are no legal products on the market right now with psilocybin. And the same thing is true of MDMA. It’s a Schedule I compound. Illegal in all settings, except for FDA-approved research.
There’s many different kinds of mushrooms—Lion’s Mane and Shiitake, etc—that have medicinal value. But psilocybin is a highly controlled Schedule I substance.
I think the difference is that when psilocybin and MDMA come on the market, they’re only going to be able to be used in a controlled setting. They won’t be sold over-the-counter. Now, there are 3 different processes going forward with psychedelics in this country at the same time. First, you have medicalization, which is what I’m talking about with our research. This is FDA approval, prescription by a physician, treatment in a controlled, approved setting and part of conventional healthcare–hopefully covered by insurance.
The second pathway is decriminalization, which is happening in Oregon soon. Colorado’s going to have an initiative on the ballot in November. We just found that out. This creates a light regulatory framework around use, but it is not recreational or indiscriminately available.
The third pathway is religious freedom. Someone just told me there are 20 psychedelic churches now in Austin, Texas. And they’re waiting for the DEA to challenge them and make it a court case. But so far, the DEA does not appear to be that interested. So, these 3 different pathways are going to be for different populations, for different providers and obviously different settings and circumstances. These 3 different pathways are happening simultaneously. And the pathway that I’m most interested in and most involved in is the medicalization pathway that makes this an approved, conventional medical treatment.
IMCJ: One of the big areas that you briefly touched on was PTSD in veterans. That’s a huge issue in causing veteran homelessness. So, it’s kind of like a double win when you can treat them.
Dr. Shannon: This is leading to the enormous number of veteran suicides that we see every year. The Department of Defense and the VA are very interested. There are trials with MDMA going on at multiple VAs around the country being led by Rachel Yehuda and the VA in the Bronx.
A letter from President Biden to a representative in Michigan was recently released, in which he said the federal government is preparing for the broad rollout of psychedelics within the next 2 years. And that will be institutionalized in the federal government, but also it will create a regulatory environment that makes it simpler and easier for the medicalization of PTSD.
IMCJ: And have you gotten some benefit because of all the pushback on the opioids right now, that people are looking for an alternative?
Dr. Shannon: Well, what’s interesting is that psychedelics look to be anti-addictive. They don’t have intrinsic addictive capacity. For example, psilocybin and LSD tend to be anti-addictive. They don’t have addictive tendencies. They’ve done studies to show that people who have been exposed to psychedelics have better mental health and less suicidal ideation than the general public. There are now many studies coming out about the value of psychedelics for treating addiction.
In the 50s and 60s, there were about 1500 studies published on LSD. And the majority of them were with alcoholism. And the majority of those studies were also positive. We just don’t have very good treatments for addiction. And I think psychedelics represent a new path forward. Studies at Johns Hopkins in treating smoking cessation were pretty incredible.
IMCJ: And do you think that most practitioners know about them, or do they need to be educated on what they are? Or are they going to be confused?
Dr. Shannon: I think practitioners understand the difference between psychedelics and opioids. And I think ketamine was 1 substance in particular that has some risk for abusive behavior. And I think it’s really because of COVID and the ability to prescribe remotely that it is being abused in some places and not being used in a true psychedelic framework. It’s being used perhaps excessively, and without adequate controls and supervision and without the needed psychotherapy. This creates real risk and may bring calls for oversight. I’m very concerned about ketamine, and we’re trying to create some structure around it with some rules and structure via certification that will help clarify what is appropriate practitioner behavior and what is not. But right now, it’s a little bit of the wild west out there with ketamine.
IMCJ: And what about safety usage in children and teens who have issues? Is it safe for them, or is it really more designed for adults?
Dr. Shannon: At this point, all the studies, with the exception of a couple of studies of ketamine in adolescents with depression out of Yale, all of the studies with psychedelics are in adults. And the phase 3 trials, the one that I’m involved in is with adults. If, and when MDMA and psilocybin are approved, the federal government will then mandate pediatric studies to look at safety and dosing. So, those are likely coming within the next few years. But at this point, I’d say the only treatment in adolescents that we’re seeing is with ketamine, and that’s still off-label.
IMCJ: What would you hope that a practitioner who sits in on a session would get out of it? What type of questions should they be asking about their own practice to see if it works for them?
Dr. Shannon: Well, these are not yet approved. So, I think what the practitioner would look for is, what is the research? What are the indications that we’re looking at? What do the regulatory timeline and indications look like? What are the safety and side effect profiles of these substances? And they’re likely to require some specific training for practitioners. I think practitioners who are curious may want to engage in this session to see if this is a path they want to pursue, if they want to get additional training. I would think of this pre-con as a good overview and introduction to psychedelic medicine and how it can change healthcare and Mental healthcare.
IMCJ: Is psychedelic medicine covered in conventional medical school?
Dr. Shannon: Probably not. Not to any great degree. And there are now 3 programs at Yale, Johns Hopkins, and NYU that are developing a psychedelic medicine fellowship. And this will become a track for medical graduates to have specific training in psychedelic medicine. We’re likely to see much more of that over the next few years, as specific training programs come online.
IMCJ: What are you seeing in more conventional healthcare facilities; do they embrace it?
Dr. Shannon: We’re seeing universities across the country show interest in this, because this is an area of excitement in psychiatry and mental health. And because our current treatments are so lousy, there is a lot of interest.
And people are raising money. Berkeley is just coming online. Michael Pollan sits on their board. His book, How to Change Your Mind, and then the recent Netflix special with the same name, is really introducing these topics to a lot of people and building both lay and professional interest, I would say.
IMCJ: Just to wrap up, when do you think products will be available on the market?
Dr. Shannon: Well, we completed enrollment in our phase 3 study in May. We hope to finalize treatment in November. And we hope to submit our final results to the FDA by this time next year, maybe a little before. And then within 6 months, hear back from the FDA about their decision. So MDMA would be the first medicine to become rescheduled and available in a conventional medical setting. That would be about an 18-month timeframe as the best case.
IMCJ: Have you seen a lot of interest from other people asking you questions about it who know you’re involved in it?
Dr. Shannon: Oh, my God. I get calls from professionals about every week who want to do this work. They are willing to drop everything and come work in this area. It’s created more professional interest than I’ve seen in any topic since I got into medicine 40 years ago. It makes the interest in Prozac pale in comparison.
IMCJ: Have you done other presentations on the topic this year?
Dr. Shannon: Yes. I presented at the institute for Functional Medicine (IFM) conference earlier this year. It was similar to this one, but I did some other things on brain science that I won’t be doing and covering in this presentation. And I’m presenting a specific workshop for IFM in October on this topic. And the University of Arizona’s Integrated Medicine Program is rolling out a psychedelics curriculum under the guidance of Joe Tafur, MD, who sits on the board of our nonprofit, PRATI.
IMCJ: And what is PRATI? What does that stand for?
Dr. Shannon: PRATI is the Psychedelic Research and Training Institute. It’s a nonprofit that we have that trains practitioners in psychedelic psychotherapy, using ketamine as a legal tool. It has been around for about 2 years. Our trainings now sell out in under 15 minutes. The interest in this is phenomenal. There are 50 new training programs in psychedelic medicine in the last 2 or 3 years.
One of the tasks I’m working on is creating a board, a certifying board that will pave the path to insurance reimbursement for these agents, because we want this to be readily available in conventional medical settings. And because these treatments require full day supervised sessions, they’re going to be expensive. And we want to make sure they’re available.
IMCJ: Yep. All right. Was there anything else you’d like to share about the conference?
Dr. Shannon: Let’s see. We’ve got Shannon Carlin, who’s one of the leaders in the MAPS, and she’s going to be presenting on ethics and challenges in the field. And I think that’s going to be a really good discussion.
IMCJ: All right. Well, it’s going to be exciting to have a live event again at AIHM.