Okay, welcome so Just show of hands who is here for for Robin Carhartt Harris's talk this morning Yeah Fantastic talk and it sets us up beautifully So we've been invited to provide our perspectives on psychedelic science provide some of the history and The the current clinical trials that are ongoing as well as some what we think are pressing issues that are clinical and Methodological will end with some notes on science communication. It's been unmissable psychedelics in the press in the field and social media that's largely a Good thing, but we want to temper some of what we see to be Exaggerations both on the negative and the positive side and so we'll end with an invitation That will extend to all of you I'll say more about that later some disclosures Now this is a Hopkins heavy panel Three of the four of us are at Hopkins and then the one exception to that who's at Penn is coming to Hopkins, which we're very excited about and so most of what we'll be talking about today is Happening at the Center for Psychedelic and Consciousness Research. This is on Bayview campus in Hopkins There's a lot of wonderful research going on at Imperial College, London University of Zurich Yale UCSF, but we'll stick largely to the Hopkins research today so it's my honor and pleasure to introduce our Discussant our fearless leader the chair of our department who I think is a transformational leader Keeping alive a lot of great tradition, but also pushing us always to the the vanguard of the field. So welcome Dr. Jimmy Padash Thanks so much David Yeah, I'm gonna get us started. Well, welcome everybody. It's great. Great to see so many people coming out for this I'm gonna get us started by talking about what it's been like to preside over the Department of Psychiatry for the last five years I've been chair for five years preside over this absolutely fascinating Work that's gone on Led by Roland Griffiths who you'll hear from momentarily in psychedelics. So I arrived in 2017. I've been at Johns Hopkins from 1988 to 2011 23 years moved to University of Iowa to be chair there for six years came back in 2017 and When I came back that there had just Rowan had just put out this Roland and colleagues in our Hopkins Psychedelic Center had just put Out this paper psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer A randomized double-blind trial. So that this was this was very exciting work from a clinical perspective from a psychiatric perspective It's exciting to see psilocybin being used to treat psychiatric symptoms And then in addition the paper talked about replicating what Roland had shown ten years earlier and that is that in addition to relieving symptoms there was this fascinating and powerful finding that that two-thirds of the people who took psilocybin found the experience one of the five most meaningful of their of their life and And this was had just gotten all kinds of attention in particular I had read about it before arriving in Baltimore in the New York Times magazine Where there was this extremely compelling article how psychedelic drugs can help patients face death with not only which not only described some of the findings but had personal Descriptions of people's unique Powerful experiences going through the process of facing cancer and getting this treatment so the following year a Book came out that I imagine a number of you have heard about or read or read This book came out by the very well-known writer Michael Pollan how to change your mind with the new science of psychedelics teaches us about consciousness dying addiction depression and Transcendence and and the book It premiered at number one on the New York Times bestseller list And it featured Roland Griffiths And and and and it credited him with the first with producing the first important paper of the new Psychedelic era and that was the 2006 paper That that he published describing the effects of psilocybin and healthy volunteers The next year all of this attention the attention from Michael Pollan's book and from the New York Times and all kinds of other attention, you know Got a lot of people fired up about psychedelics and in fact got a lot of people with means fired up and so a whole lot of philanthropists came together and gave us 17 million dollars to create the Johns Hopkins Center for psychedelic and consciousness research Here you see the news about it in JAMA It was on 60 minutes Roland and associate director then associate director of the program Matt Johnson spoke on 60 minutes about it They were on the Today Show and it was in CNN and the Washington Post and all kinds of other places the next year Solved the public the e-publication of What I think of with my slight bias as a mood disorder With my slight bias as a mood disorders expert My my slight bias is the most important paper that has come out of this Of Roland's work to date and that is the paper in JAMA published in JAMA psychiatry which constituted the first rigorous controlled study showing that psilocybin-assisted Psychotherapy as they termed it is an effective treatment for major depressive disorder of 2020 also saw more philanthropists come forward and establish a professorship in the neuropsychopharmacology of consciousness that went to Roland 2021 we had the first NIH grant explicitly for a psychedelic treatment study That the NIH had given in over 50 years and it went to Matt Johnson In our Center, I said there's a typo here It's a U01 grant rather than an R01 grant but it is a three site study to look at psilocybin for the treatment of Smoking addiction and it's to Hopkins, NYU and Alabama More philanthropists came forward and gave another professorship in psychedelics and consciousness to Dr. Johnson and then this year a recent Commentary by Dost Ongar the editor-in-chief of JAMA psychiatry Looked back on 2021 and and reported that that the paper I mentioned a moment ago About the treatment of major depression with psilocybin was the most looked at and most cited paper in all of JAMA psychiatry in the prior year and The attention keeps coming just a month or two ago another Major article in the New York Times talking about the next big addiction treatment Said several psychedelic drugs are touted as effective treatments for drug and alcohol abuse But psilocybin combined with psychotherapy is emerging as the most effective So As you can imagine as a department chair It's been wonderful to get all this attention. It's been wonderful to have all this money rolling in As a as a mood disorders expert, it's wonderful to see The potential for for an exciting new treatment that can help the many people suffering with depression who don't respond to Existing treatments as a psychiatrist in general. It's exciting to see the possibility of great new treatments that can Potentially help people with a whole lot of illnesses To come back to David's point from a moment ago There's lots of reason for excitement and I've been pretty excited about all of this, but there's also reason There there are also caveats and reasons to be cautious. And so so Well, we'll we'll hear more about that theme as we go through This session now, I'm going to turn it over to to dr. Griffiths Roland Griffiths is the person who who set our our Center at Hopkins in motion back in 1999-2000 he is the Oliver Lee McCabe professor in the neuropsychopharmacology of consciousness And by many accounts, he's the person who set the new science of psychedelic research in motion. So Roland, it's all yours I Thank you for that so What I intend to do is give kind of a broad overview of where we are in our understanding of Psychedelics and clinical treatment and and a broader scope a little bit of the neuro pharmacology, so Jimmy mentioned we're doing this in a center at Johns Hopkins we have Six plus faculty people six plus postdocs a host of support staff And what I'll focus my comments on is psilocybin as just one of any number of the major classic psychedelics, but it's the one that's garnered the most Experimental attention and psilocybin is the principal psychotic component and psilocybe genus of mushrooms These psilocybin in the form of these mushrooms have been used for hundreds possibly thousands of years in indigenous cultures for healing or religious or or sacramental use Now by way of background the classic psychedelics there are structurally diverse set of compounds their primary site of action is serotonin to a and from which a cascade of Neurochemical sequelae Determine the effects but an interesting signature feature of these compounds as they produce this unique profile in changes and thoughts and perceptions and emotions That are often experiences deeply meaningful and so that's I think a Hallmark feature it differentiates the psychedelics from virtually any other psychoactive class of compounds I know and and There are various structures. So some of them are tryptamines like psilocybin DMT some of them are fenethylamines like mescaline and and DMO and DOM and And a variety of new compounds are going to you know be coming out soon so historically there was a bunch of research that was conducted in the 50s and 60s, and then we had the psychedelic 60s that brought this What what seemed to be a promising line of investigation to the unlikely? Outcome of a complete standstill and part of that was the the confounding of the the use of psychedelics with an anti-war movement and an anti-establishment Culture and Timothy Leary certainly didn't help coming from Harvard being a scientist and then Going Going AWOL and and promoting kind of widespread use of these compounds it almost undermined the scientific credibility of studying these So I just want to touch on the risks and abuse and and there are risks Significant risks that are seem to be underplayed very often by the psychedelic enthusiast crowd and that's a source of Concern to us and our in our Center, but so psilocybin is the schedule one compound So there's no recognized medical use. It's illegal lifetime prevalence of psilocybin is about 14% as of 2018 it's trending upwards as as you might imagine from all the media attention. It's gotten National Institute on Drug Abuse doesn't consider psilocybin or the classics psychedelics as drugs of abuse because they don't lead to Drug craving and and sustained use in the way that our classic drugs of abuse Do and medical emergencies from psilocybin are really quite rare, but despite the low risk of addiction in the road and relatively low Toxicity There is concern and there should be concern about exposure to these compounds Because of their ability to be associated with onset of new psychotic process that's that would be the Major and number one concern but also People are going to engage in dangerous behavior and sometimes it's just Dissociation or fear but But people can get harmed there can be suicides there can be homicides There can be accidents and so care needs to be taken and that's a risk that we feel in some of these decriminalizations initiatives and And and for me personally some concern about the organ initiative So the validity that we should be concerned Was really stamped in for us when we ran a rather large survey of almost 2,000 people Who and we directed them to tell us about their most challenging? Psilocybin experience and so we we don't know what the base rates of these are but among this cohort of people who had experience with Psilocybin and who were willing to report on their most challenging experience We have 11% of them reporting they put themselves or others at risk of physical harm 3% sought out medical help and and this is the most disquieting one to me 10% reported enduring adverse psychological symptoms lasting greater than a year, so caution needs to be exercises the the fact is that in our Clinical settings when we carefully screen people and prepare them and provide them aftercare such Such adverse events are extraordinarily rare, so I think I think we can manage the clinical use But if you take the brakes off that We have problems, so I'm gonna just say a little bit about the neuropsychopharmacology Which is fascinating, and I'm sure Robin went into some detail this morning, so The effects are mediated through serotonin 2a. You know and they function as agonists or partial agonists this is a Slide that David nut from Imperial put together just showing the different levels of analysis So this is just showing distribution of 2a receptors and in particular in in Region 5 Subcortical levels the red is showing high distribution And so what's happening at the single neuron level is you get increased neuron? excitability And lots of spiking of activity in pyramidal cells you move up to a global brain Level and again, I'll credit this to Robin this entropic brain activity, and it's It's really a dysregulation of normal patterning that comes into play and then you see the emergence of Different global network effects, so this is placebo. This is just showing interconnectivity among Different networks within brain and under acute psilocybin or LSD You see all kinds of communication patterns Breaking out and this isn't random the thickness of those lines indicate the Degree of interaction, so there's some unique aspects of brain connectivity Occurring and the best guess right now. Is that there's a small set of trigger neurons 5ht to a trigger neurons that initiate this cascade of downstream events that ultimately culminate in the effects of psychedelics both at the neuronal level and at the psychological or subjective level if you will and the Metaphor that sometimes used is that that in the case of treating a psychiatric disorder Were Creating dysregulation of these networks and after which they We may reconnect in more healthy ways and the metaphors given to resetting a computer is there simply Metaphors they're attractive Metaphors there are a number of network Hypotheses and so this is a real active area of investigation trying to explain So what is going on at the brain network level? And so there's One set of hypotheses that really prioritize the the effect of the thalamus and thalamus gating to That is unblocking incoming signals accounting for this flooding of information into cortex There's a colostral cortical Hypotheses that's been promoted by Fred Barrett from our lab where we were able to image the colostrum this very thin slice of brain that's located centrally that was hypothesized by none other than Francis Crick founder of DNA to be the seat of consciousness. And so it was a really attractive Target because it's highly innervated with serotonin 2a and it's interconnected across Of course a cortex and of course, it's more complex so when you go into the imaging, there's not going to be an easy answer and then there's this rebus model that that Robin has come up with and this is the relaxed belief under psychedelics and it's it's appealing to this hierarchical brain processing model whereby there's a Dampening of priors and Giving rise to in increased Information coming into consciousness that might otherwise be suppressed A little bit more on biological mechanisms. They these compounds have potent anti-inflammatory effects, which are interesting and very possibly Important to therapeutics but they also produce structural and functional and enduring Neuroplastic changes, so there's increased neurogenesis, spinogenesis Synaptogenesis mediated through different signaling pathways like serotonin 2a or mTOR So there's a lot going on here if I were going to summarize it I'd say that the neuropharmacology is a very Active area of research. We're making substantial progress in it There's some argument and we've gotten involved in this about whether or not subjective effects are necessary And some people are arguing that they may not be necessary for the effects at all And for some of those of us who work closely with psychedelics We simply don't believe that it's but what it's going to end up being is an interaction between the two. I mean there are basic Neurophysiological processes shared for instance with ketamine in terms of a glutamate system that actually may have antidepressant effects in and of itself But there are also these reworking of narrative structure of how people view themselves in the world that we think is key to getting full-on therapeutic effects. So we're learning a lot and that work is proceeding but I think the humbling piece to me is the, you know, the sense that these effects depend importantly on subjective experience, unconscious experience. And we know precious little about the nature of consciousness. I mean, it's called the hard problem of consciousness and that's a good term for it. It's not clear at all how that problem gets solved. So now I'm going to just turn to our clinical studies. So we've been at this now since the year 2000 when we initiated the development of our first protocol. And over that course of time, we've treated over 400 participants. We have almost 800 psilocybin sessions now in a variety of contexts and a variety of targets. But some of them have been in healthy volunteers and some of them have been in patient populations. So we've looked at in the healthy volunteers. We've looked at novice and long-term meditators as different cohorts. We're just finishing up a study in religious clergy. Clinically, as Jimmy mentioned, we've looked at depressed and anxious cancer patients. Major depression has been an interest. And then with the funding of the center, we've found ourselves with a whole range of therapeutic diagnoses that people are interested in us exploring there. They're still in their kind of nascent stage of investigation. But we've looked, we've done quite a bit of work on tobacco dependence. That's Matt Johnson's work. And Jimmy mentioned the NIH grant which is a big deal. But we're also working in the field of alcoholism. Michael Bogenschutz who's here in the audience has been working in this area very intensely at NYU looking at the effects of psilocybin to treat alcoholism. We're now looking at it to treat people with comorbid depression and alcoholism. And we're looking at anorexia nervosa. We're also looking at Alzheimer's patients with depressed mood. So a whole bunch of different clinical targets. So what I want to do is just run through some of the results that we get in healthy volunteers because it really paints the picture, the setup, and how we run these studies. And many of the outcomes, you know, are really quite similar across these different populations. So our healthy volunteer studies have been rigorous, double blind. In this case, our patients are, our participants are medically healthy. And for the most part in these studies, we have purposely picked individuals who are psychedelic naive because we didn't want to create a bias, a selection bias that might draw people who had good experiences with psychedelics into our clinical trial and then we wouldn't know what population rates are of adverse events or positive effects for that matter. In all cases, this is delivered in the context of what you could be called psychotherapy. So people spend at least eight hours clinically with their therapists or their guides or their sitters, whatever. You choose to call the people who provide some grounding during the session. They provide eight hours of contact time before the first session and then they meet on a number of occasions after the session. And we think that's really important. And in many of our studies, we've designed them, although it's very difficult to do, to minimize expectancy effects and maximize blinding of conditions. But there are unique challenges in doing so with these drugs. So what happens when people get a psychedelic drug? Well, not surprisingly, there are, you know, the expected effects of changes in perception, greater emotionality, and there can be some kinds of cognitive changes. But really what stood out to me in our initial study in 2006 was that in most volunteers, what we saw also were large increases on self-rated questionnaires that had been specifically designed to measure naturally occurring mystical or insightful kinds of experiences. And this just shows some post-session ratings of mystical experience and insightful type experiences in dose effect studies with psilocybin. And I can say that the degree to which people endorse these effects on the mystical experience questionnaire often correlates or corresponds or predicts positive therapeutic outcome. And this, we have a branding error having called this the mystical experience. It has nothing to do with supernatural beliefs. You know, this is an empirically derived set of subjective phenomenology that emerge from this. Now, you know, that's the acute effects. Now, this is where it becomes interesting. So this is a month after high dose sessions and we have about 80% of people endorsing that that experience a month ago was among the most personally meaningful and spiritually significant experience of their entire lifetimes. And when we, when I first came across that, I mean, it wouldn't have occurred to me to even ask that question. And it just seems so astonishing that we, I mean, we ended up developing questionnaires that we've used extensively since then. But there's something about the signature of these experiences that is retained and there's retained meaning and attribution of all kinds of positive effects to it. And about 90% are saying that they have increased sense of well-being, life satisfaction and positive behavior change. So these effects endure. This is just showing that at 14 months, the blue bars we still have 80 plus, 83% of people endorsing moderate to or higher life satisfaction. So are they delusional? Are they making this up? We think not. This is outcome of a measure of ratings made by community volunteers. This would be friends, family members, colleagues at work, rating the participant on various dimensions that relate to these kind of positive changes that they're reporting. And we've done that across a number of studies. OK. I'm going to now run through some therapeutic applications quickly. So we've done therapeutic trials in depression, anxiety in cancer patients, major depression, cigarette smoking. And this was that first study, 2016. These are all small studies. So these are, you know, you have to consider these to be kind of proof of concept studies. But they're run blinded and as rigorously as we know how to run them. And this was a randomized double-blind crossover design where people got two sessions and one was a trivial dose of psilocybin, one was a high dose of psilocybin. People were randomized to different orders of treatment. And this shows the, you know, the key outcomes. This is HAMD, clinician-rated depression. And you can see the orange, the green bar is low dose. The orange is high dose at five weeks. So you're seeing 92% significant clinically significant response that would have to be a greater than 50% drop in HAMD. And that's maintained at six months out to 80%. In remission, you're seeing 60% and 70% at five weeks and six months. So that's just quite remarkable. If you think about it, that's a single dose of psilocybin. And a similar thing happens with the HAMD. Where are we with respect to this? It really does show there's efficacy. It's been replicated at NYU. They co-published at the same time we did in a design very similar to ours. So major depression, and again, I'll feature our work. But Imperial and Robbins Group have also done a series of studies. This was the JAMA study, randomized delayed treatment control group examining efficacy, in this case, of two psilocybin sessions. And this is a grid HAMD. And you can see in the green, there's a, you know, a marked decrease, very different than the delayed treatment. You could argue that's a weak control. And it is, but it's not an unreasonable control to put in initially. Huge effect sizes, Cohen's d greater than 2 1⁄2, which is outrageous in the evaluation of psychiatric, psychopharmacology. This is long-term follow-up. This is just looking at HAMD scores going out to 12 months. And you can see that it's dropping off at, in this case, one week. But in fact, we have published data showing that after even the first session, you get a very substantial drop-off. So that's led to the possibility that the efficacy is going to be apparent with one dose. And indeed, that's exactly what's happening with the two companies that are now have received breakthrough therapy status to study psilocybin in major depressive disorder. And they're using a single dose. They're in phase two, and those results look very hopeful. Let's see. So in terms of facilitated treatment of drug addiction, so we've done work with cigarette smoking, huge effects. I'll skip over the data there, but Michael Bogenschutz has some very promising data that will become more public imminently on treatment of alcoholism with psilocybin. There's some interesting and promising data on cocaine use in really quite disadvantaged populations by Peter Hendricks at University of Alabama. So, I mean, isn't it curious that we have a single kind of treatment that has this kind of cross-diagnostic generality to it across all these classes? I mean, clearly, the pharmacotherapies we use to treat addictions are now are generally targeted molecularly. And in this case, there's something much more generalizable. I'm going to skip through the cigarette smoking data except to show this was the initial results that Matt Johnson came up with in a pilot study in which we were kind of marrying cognitive behavior therapy with psilocybin. In this case, there were up to three psilocybin treatments. But the first coincided with the target quit date in a cognitive behavior therapy model. And this is just showing median urinary codoning, you know, prior to the target quit date. And then it's dropping down median to zero out to six months where we have 80% abstinence. And if you know anything about treatment of addiction in cigarette smoking, 80% is just an unbelievable figure. But we're moving on and we are doing comparative efficacy studies now. I talked some about the neurophysiological mechanisms at play. And I just want to mention the psychological cognitive mechanisms. And again, there are different levels of analysis. But one is this so-called mystical experience. It's this enduring authoritative sense of a highly valued sense of connectedness that helps reorganize the kind of narrative structure of how people see themselves and the world around them. Related to that, ontological shock, again, a profound shift in worldview. And again, loosening of self-focused narrative, reconstruction of life story. There can be just flat-out insights, psychological insights that people have with these compounds apart from kind of the subjectively experienced effects and attributions to that. They may see what's going on in their life and the kind of defeating patterns of behavior that they've adapted. And that can change markedly. People often come out with this increased sense of self-efficacy or agency, increased sense of openness, personality domain of openness increases, curiosity about the nature of mind and mindfulness. And interestingly, a greater tolerance for and interest in benefiting from suffering. And I think that actually plays a key role and is part of the mindfulness dialogue. This is our, where we're coming to an understanding of what possibly was going on. This kind of emerges out of some of our survey data where this is a path model that just shows that the acute mystical experiences and the acute insightful experiences are flowing into what we think is a mediator of psychological flexibility. And there's some interesting measures of that. And that predicts therapeutic outcome and at least in terms of decreased anxiety and depression. The interesting bottom line is that there's so many different ways to take this work. But the bottom line is that under these conditions that we give psilocybin, we can occasion these reorganizational experiences in the majority of, in the great majority of people who participate. So we now have this working model that we can get at some of the profound effects of these transformative experiences. But now we can use perspective scientific studies to uncrack them. And there are just so many different directions as this research can go in terms of understanding biological psychiatry, neuroscience, behavioral science, the therapeutic applications and most broadly altruism and prosocial behavior. So the area is wide open for this audience of psychiatrists that, you know, the therapeutic opportunities are, well, we don't know. But they appear really quite broad, very interesting. We don't understand the mechanisms. There's a lot to do. It's really exciting. Thank you. So it's now my pleasure to introduce Mary Bitt-Yaden, wife of David Yaden, who will talk about the clinical challenges and opportunities. Thank you. So I have to say what an extraordinary privilege it is to be with all of you here. But also, you know, to be on a stage with Dr. Jimmy Potash, Chairman of the Department of Psychiatry at Johns Hopkins University, Roland Griffiths, who in so many ways is responsible for this work and the resurgence in this work in our country, two titans of psychiatry, and my husband. But yes, I'm a psychiatrist. And I'm here to talk about clinical challenges and opportunities in psychedelic science. So I think the first real clinical challenge is that what we know about these interventions clinically has occurred in a research setting. And so with that, we can make very specific claims about what happens in a highly controlled environment, which is going to look entirely different from what many of us are doing on a day-to-day basis in our practice and hope to do someday. And so I'm going to walk you through a prototypical psychedelic intervention as it has existed in these clinical contexts in research. And so really not for any particular intervention or for any disorder, but rather how these studies tend to run so you can get a sense of what this looks like for patients. And so I think one of the first challenges, or rather one of the things that really differentiates this in a research setting is how strict the exclusion criteria is. You know, depending on the disorder in which these studies have run, we're excluding patients with comorbidities of cardiovascular illness, seizure disorder, reproductive status. Additionally, psychiatric exclusion is incredibly strict in that individuals with personal or even family histories of psychotic spectrum illness, bipolar disorder, personal history of suicide attempt or current suicidal ideation, drug use, positive urine drug screens I should say, or history of substance use disorders all excluded from any of these trials. With these interventions, they start much like anything else we do in psychiatry with rapport building. And so this goes in eliciting a patient narrative, identifying treatment goals, understanding the context in which a patient experiences their illness, but also hopes for something different in the future. And of course, you know, evaluating for motivation to engage in this study altogether. And then, oops, sorry, I skipped ahead. Psychoeducation in this context is somewhat different. And so that instead of just preparing someone for, you know, psychotherapy, you're actually preparing people to go through several hours of session content. And the acute subjective effects that Dr. Griffith spoke to extensively, you know, patients come in asking, am I going to have a spiritual experience? Am I going to, you know, am I going to be scared? And providing them not just with an understanding of what these experiences may be like, but also some coaching on how best to interact with these experiences should they arise. And then the dosing section itself. I, when I, we put together this slide, I got a little nervous. I was like, oh my gosh, this is going to look so strange, a patient lying on a couch. And then I thought to myself, I'm speaking to a room of psychiatrists, our entire field was started with patients on couches. And so with that, I'm, no one should be too scandalized. But yeah, these are, you know, anywhere from four to six hours in which there are two, often two, supportive presences in the room. And it's not that during these sessions folks are conducting things like cognitive behavioral therapy. During this, you know, acute period of dosing, other individuals are here to provide support. And typically patients are blindfolded or listening to curated classical music or otherwise. And then it's much later that that more clinical intervention occurs. And so processing, this looks like discussing anything that comes up for a patient during a specific session, relating this back to their life circumstances and specific goals of treatment or therapy, and then thinking about those next steps. And of course, assessing for safety, monitoring outcomes, really looking at how effective are these treatments and actually targeting the disorders that we hope that they do target. So that's kind of a picture of where things have been so far in these very controlled clinical research settings. But I think thinking about the opportunities and psychedelic interventions, really a huge area I think of research interest now is what psychotherapies do we best couple psychedelics with? What are the interventions that are most effective in addition to the psychedelic dosing session itself? And so, so far clinical trials have looked at motivational interviewing, motivational enhancement therapy, CBT. There's been lots of theoretical discussion of ACT and other eclectic approaches. But again, this is something that is just in its infancy in terms of what we know, but a lot of really interesting questions to ask about therapeutic modalities. And so I'm going to pause here and just say how incredible it is to be at an APA meeting that is dedicated to the social determinants of mental health. I mean, it's just absolutely incredible. And so psychiatry on a whole and psychedelic medicine in particular must address structural inequality in science and practice. And so this means allowing structural competency to inform research practices. It means creating safety by practicing cultural humility during sessions and inclusion. And it means providing greater access to care. I should say that I'm actually from New Orleans. We're all in this exceptionally beautiful city. It is magical. I hope you're experiencing its magic. But unfortunately, New Orleans, like so much of the United States, has a history of institutionalized racism. Certainly here, the legacy of Katrina, of poverty, and access to mental health resources in the city is incredibly challenging. And so as we discuss the promises of psychedelics and other therapeutic approaches, it's so important to think about how we allow for greater access to care for those who need it the most. And then something that is very dear to my heart is thinking about medical education. And a project that I'll be helping with in the next few years is this intercollegiate collaboration on psychedelic education, specifically between Johns Hopkins, Yale, and NYU, looking at how do we train psychiatrists in conducting these sessions and providing psychedelic-assisted psychotherapies and the future of that. So maybe that'll be a future APA meeting presentation. And so with that, it is my great pleasure to introduce my husband, David Begade, an assistant professor at Johns Hopkins University School of Medicine. Okay, so I'm not going to entirely rain on the parade, no. So I'm going to talk about some methodological issues. I want to say before I do that, I consider Roland Griffith's work to be a national treasure. It inspired me a large portion of my scientific career to go into this subject. But we are at a point, I think, where there's a turning point in the field. We've now gotten past this pioneering point, and we're now getting to a broader, more generalized scientific inquiry across a number of different institutions. And so with that, I think there are challenges, but I want to point to the many opportunities as well. And I think there are many opportunities. Okay, but first a challenge. So many of you, like me, were trained in the midst of the replication crisis. It's now, there's a consensus among scientists that there is a reproducibility crisis. This was published in Nature a few years ago. I bet these numbers would be higher for yes, even today. And unfortunately, psychiatry and psychology are among the biggest offenders in this area. So publishing too many positive results and not enough null results. So this is a real challenge for the field of psychedelic research as we begin to become a broader and larger field. However, I think it's also an opportunity to do things right from the get-go. And so I think there are a number of researchers who are thinking a lot about this question and how we can make psychedelic science reproducible and replicable and open from the very beginning. That involves changing the way we think about samples. So far, out of necessity, the samples have been quite small and homogenous. Going forward, we need larger samples that are more diverse and therefore more generalizable. So this includes demographic diversity, socioeconomic diversity, psychiatric diversity in terms of comorbidities, and also cultural diversity. A lot of our research in psychology and psychiatry involves weird populations. I don't know if you've heard this term, Western, educated, industrialized, rich, democratic. We're weird. So we need to look at less weird populations in order to make sure that we're doing generalizable clinical science. In addition to these more diverse samples, we also need to look at self-selection bias. We've heard from Roland and Jimmy, there's a number of subcultures that are psychedelic enthusiasts, and some elements of the press that are promoting an extremely positive view of psychedelics are creating more enthusiasts by the day. So we need to look carefully at who is opting into our studies and whether there might not be some self-selection that's happening. So we talk about the term set and setting in psychedelic science. We can also just use the term expectancies. We talk about this all the time in psychopharmacology research. There are a number of ways that we can control expectancies and that I think we should do. One such way is managing these expectancies by keeping people guessing, keeping participants guessing about what they might be getting. So Roland pioneered some of this work in psychedelics by giving people a list of possible substances that they may get. Also with using drug-naive participants is another way of managing this. Also measuring these expectancies. So upfront, we can now more so than before, we have much better psychometric measures for measuring expectancies at the beginning of a trial, and then also looking to see, as Robin Carhart-Harris mentioned this morning, after the trial, looking at how effective the masking actually was. And we can build these measurements into our statistical models, controlling for them or checking for moderation or mediation. And of course, active controls. So it would be ideal if we had an active control for our psychedelic studies. That's a quite difficult proposition, actually. It's pretty complicated to think through how you effectively mask the characteristic acute subjective effects of psychedelics. Do you use a lower dose that's been done? Do you use other psychoactive substances that have intense effects, like methylphenidate, for example? Do you use other psychedelics that have different mechanisms of action? All of these options have pros and cons, and so this is a very tricky issue, but something I think the field needs to address and make progress on. So I point you to a great paper, it's a pun on the Dickens novel, The Great Expectations. This is put out by our colleagues at UCSF and Stanford, Jacob Aday is the first author. They go through systematically every part of the research process and identify points at which we can address the issue of expectancies. And so papers like this, guides like this, will help, I think, standardize the field and bring us all together, get us on the same page and producing better science for all of us. Another challenge, the psychometric measure of the acute subjective effects is pretty difficult. This is all happening inside the skull, so to speak. We might wish we had objective measures, but this is one of those instances in which there's no better way of doing it than just asking someone how they're feeling, albeit in a hopefully systematic and standardized way. So we have a lot of psychometric measures that are highly overlapping with one another and measuring slightly different things. This is, I think, a good sign that we're getting convergence across our psychometric measures. A lot of similar factors are replicating across studies. And I think that this is a wonderful opportunity for us to make progress on the careful study of the psychometric measure of altered states of consciousness, like those induced by psychedelics, through iterative factor analysis projects, like which resulted in the Big Five personality model. And also newer network analysis models are particularly promising. We'd like to go beyond self-report. Roland's mentioned some of his great work looking at community observers. We're also working on behavioral and physiological measures. I see a lot of smartphones out. We'd love to grab the data that is being generated by your smartphones, because these are quite transformative experiences that have very big effect sizes. And so we should be able to see a signal behaviorally as well as physiologically. Okay. So I want to say a few words about sensible and evidence-based science communication. I get back to that invitation I mentioned at the beginning of our introduction. So this is the Gartner Hype Cycle. Just show of hands if you've ever seen this before. Okay. A few. The idea here is you pick a technological trigger. It could be employee wellness programs. It could be SSRIs a decade or so ago. There's any number of things you could pick as your technological trigger. And this chart's just a pretty general progression that we often see. We see this peak of hype, we could call it. And then this very steep decline, this trough of disillusionment. So I think it's ‑‑ I didn't mean to go that far. But I'm curious, for psilocybin, just show of hands, who thinks that we're pre‑peak and who thinks we're post‑peak? So let's do pre‑peak first. So who thinks we're pre‑peak? All right. Maybe two‑thirds of the room. And how about those post‑peak? Who thinks we're after dark? Okay. Actually, so relatively balanced. Yeah, I don't know. You saw my guess is that we're just cresting the peak here. It's a dangerous place to be, because this trough of disillusionment doesn't look so nice. We're probably going to see a lot of very negative press in matching the highly inflated positive press that we've seen. You see on the top right some examples of real headlines. Can psychedelics save the world? Well, clearly not. Not alone, by any means. A cure for depression, I mean, big effect sizes, promising, but a cure? We have no evidence for that. And then miracle drugs, I mean, whenever you see the word miracle drug, you know that somebody is selling something. So this is a bad thing. These are exaggeratedly positive headlines. I think we're going to see exaggeratedly negative headlines probably in the next year or so. We've seen decades of highly negative headlines, right? We've seen the psychomimetic model that psychedelics are producing, psychosis, that's been decades of propaganda. What would be nice, I think, and here's the invitation, is if we can get to this slope of enlightenment and plateau of productivity, that's where the real work happens, that's where the research is communicated in a way that's well calibrated to the public and to patients, and so I invite you all to help burst this bubble. So whenever you see highly exaggerated claims, positive or negative, related to psychedelics, I invite you to cite some of the research that you've heard today in this talk and to provide a balanced perspective, whether this is a public venue or to patients. You can read our statements about this topic. We wrote a paper in JAMA a couple years ago. We talked about this swing from highly negative to highly positive public perceptions and how this can be dangerous and inflate patient expectations. We talked about the vulnerable and suggestible state of patients and how we need to up our ethical concerns about consent, clinical interaction, some of these methodological challenges must be addressed, but I still think that there's very, very good reasons for real optimism. So I want to leave you with a quote, how we end that article. So we owe it to the next generation of researchers and clinicians and the millions of patients with mood and substance use disorders who may benefit from these treatments to ensure that no exceptions be made in the standards of research or clinical application for psychedelics regardless of their seemingly exceptional potential. Thank you. And then I'll pass it back to Jimmy for a few comments. Thanks, David. Yeah, I guess I'm actually going to begin the discussion. Of course, we're going to be very interested in hearing what you all have to say and what questions and comments you have, but I'm going to start the discussion by really continuing on the same theme that David just ended on, and that is this theme of trying to find a kind of balanced place of judging things without undue skepticism or undue enthusiasm. You know, I guess when it comes to, I've talked to a number of skeptics about psychedelics over the last several years, and there are a couple things I say to them. I think that when people sort of make skeptical kinds of assertions that have all kinds of assumptions associated with them, I always say, well, let's just look at the data and let's be rigorous in assessing what we make of the data and try to stick to the data without too many assumptions. One of the things that I've heard some people speak skeptically about is this whole idea of focusing on mystical experience and spirituality and sometimes even meaning. And even there too, I think with things like the mystical experience rating scale and various other types of instruments, I think we can assess these things in very systematic ways. And as Roland pointed out, we're not talking about the supernatural, we're talking about empirically observable experiences that we can get some clarity about. You know, in my own experience in five years of working with Roland, I've come to realize that he is an extremely meticulous, careful, thoughtful investigator. And I think in a field where there has been so much hype and over-enthusiasm and conversely demonizing of the field over the years, you know, having the people doing the research be careful and thoughtful is really, really important. And others in our center like Matt Johnson and Fred Barrett and David, I think, are in this same mold, thankfully. So, you know, what I say to skeptics is that, look, I'm not saying I'm sold on the notion that psychedelics are going to save the world, but I'm sold on the idea that the studies are promising enough that they suggest we ought to keep doing this research and keep trying to sort out where this is going to take us. And then conversely, I think, as has been said, you know, there's reason to be worried about enthusiasts who try to get way out ahead of where the data is, you know, and I say to them that there are promising preliminary studies that they've been small and they don't guarantee that we're going to have new treatments that are ultimately going to be proven to work. We want to see data from large-scale studies and ideally several large-scale studies before we can have a sense of clarity about how effective and how safe these treatments are going to be. Again, we know we've been down this path before. We know how damaging it can be when the hype gets way out ahead of the data, as David was just alluding to. So, you know, I think, again, the promising data across the field from a number of investigators suggests that further studies are well worth conducting. It certainly doesn't say that we ought to be legalizing these drugs or promoting their unsupervised use outside of legal avenues, and, you know, that is something that comes up a lot these days. You know, you do hear about a whole lot of people suggesting, oh, well, okay, it's not FDA-approved, but people should just go out and find a place to use it. You know, I think that's potentially dangerous, could potentially lead to the kinds of events that will lead to that torrent of negative publicity that's in the trough that would lead to the trough of disillusionment. So that's not a recipe for success, to my mind. But I think for everybody, I do, you know, I'm very much heartened by the fact that the NIH has begun to fund this work, because I think the NIH has gotten to a point where they feel like, okay, there's something here worth trying to understand better and study. And, you know, as with any potential new treatment, I think it will be valuable to do the kind of mechanistic studies that will shed light on whether, on what's happening here. Mechanistically speaking, again, as we talked about earlier, are the effects biological, are the effects psychotherapeutic? Is there a combination of the two, which seems likely? Can these approaches be refined? If we figure out what the actual relevant targets are, can we improve target engagement in ways that will make treatment even better? So with that, I open it up to all of you for comments and questions. We have two microphones. This is a question I posed to Dr. Carhart-Harris, and I'll pose it to you, have you considered using nitrous oxide? And the reason I bring this up, William James talked about profound mystical religious experiences under the influence of nitrous oxide and his varieties of religious experience in 1890. And if anybody wants to know about this, you can just Google William James and nitrous oxide, and it'll point you to an Atlantic article from 1996 that summarizes all of this. And nitrous oxide has some very powerful advantages compared to psychedelics. Because if you take LSD, it's like getting on a roller coaster. There's going to be ups and downs, and you can't get off until you get to the end. There's no ramazakon or narcan for LSD or psilocybin, so you're pretty much stuck there. And sometimes it's good, and sometimes it's bad. Whereas with nitrous oxide, you can dial it up, dial it down, turn it off. You have moment by moment control on the intensity of the effect and on terminating the effect. Another interesting sideline is that nitrous oxide does not affect. I hate to jump in, but there's a whole lot of people with questions. Can we see if someone wants to take that? But it has a different mechanism than these things. It seems like the delirium is what's critical. Can you hear me? Yeah. Yeah, so I couldn't figure out a way to plug my book in the slides, so I'm glad that my audience plant did that. I have a book coming out on William James called The Varieties of Spiritual Experience, kind of a homage in some ways. Yeah, so William James used to rent out with his friends theaters where they would take nitrous oxide and then give a monologue one at a time. Can you hear me? OK. Anyway, they used to give monologues under nitrous oxide, which is funny, I think. But as for using it therapeutically, I don't know of research doing that, but I'll pass it to Roland, who may know better than I. No, no, I don't either. And I think the reason we haven't is that we're most interested in finding controls that we can compare directly to psilocybin. And of course, nitrous oxide is an entirely different route of administration, different profile of effect. That doesn't mean it wouldn't be really interesting to study and compare, and that would be one of many lines of research that should be opened up in this quest to figure out what's going on. Yeah, thanks for that point. I was just reading about Humphrey Davy, the British chemist, who I think played a key role in establishing, characterizing some of the effects of nitrous oxide. It's interesting. Well, thank you. Sure. Actually, you know what, I'm trying to think of how we should do it. Go ahead. We'll go to the back. We'll go to the back next. Go ahead. Thank you so much. My name's Jesse Benzel. I'm a medical student looking for a residency where I can help contribute to this important field of research. And I wanted to ask, I'm particularly interested in optimizing that therapy session with the psychoactive. So I'm curious what kind of variables you've tried modulating in that room, like different kinds of music, live versus recorded, group versus individual, and what you think that's evolving towards. Thank you. Let me just make a comment that Roland and I were just talking about. We've had a number of residents in our Hopkins residency program go join the center as fellows in the last couple of years, and some moved on to the faculty. And we could use more. So it's good if we encourage that. The answer is that virtually none of those studies have been done. I mean, these are complicated studies to run in and of themselves when you're just looking for an appropriate control group. As soon as you start manipulating context, set, and setting, you're into a very expensive proposition for which we simply don't have funding. But nonetheless, it's critically important. And we haven't begun to unpeel what are the necessary components and what's been thrown in there. So music is a good example. But the very model that we use, the introverted experience in which people have eyeshades and headphones on, I mean, there's some deep arbitrariness to that, because there are people who use psychedelics in an extroverted fashion in nature. They can have phenomenal experiences. We have no idea how that might compare. So there's decades of research here to be done. So I would welcome you into this club of people who are interested in understanding what's going on here. There's a lot to do. And it's really interesting. I'll say also, Fred Barrett published a study comparing classical music list, mostly classical music. You can look it up on Spotify, the Hopkins psilocybin playlist. The Imperial Group has one, too, I think. Compared that to a very droney kind of playlist, not even really music, and they found equivalent effect. So that's one interesting study. But I totally agree about the massive number of parameters we can test in the future. Thank you so much. Let's go to the back mic. Thank you for a very balanced and grounded talk on a subject that gets a lot of hype. My question is on how, let's say, the enthusiast version played out 10, 15 years from now. How mass-producible is psilocybin on a global scale? For example, there's huge public health implications if Johnson's work on tobacco use disorder plays out. Nicotine addiction kills one in 10 human beings. How easy would it be to produce it in the third world cheaply? Or would you need a Gates Foundation coming in and subsidizing things the way they've done for HIV medications? Highly speculative, I know. Yeah, it's speculative, but it's the kind of question that we need to start looking at, probably. Well, psilocybin is naturally produced in a number of different mushroom species. As for synthesized psilocybin, there's patents being pursued currently. It's unclear what the outcome will be. I think we just don't know. And so your question is a good one. I don't have a good answer for it. I guess I'll just make the point that I know some people have been thinking about the issue of whether it's possible to take what is currently a procedure that is very, very time-intensive, very personnel-intensive. We talked about 12 hours of talk slash psychotherapy time associated with treatment. I think there are people interested in varying parameters in ways that would ultimately pare down the amount of time involved to see whether you can get the same kind of effect in a way that would allow for more throughput. Is that fair? And I will just echo that in saying that, back to this question of access, in that it's not an easy challenge. And I think it's one that we're a panel of clinicians and scientists. And so with that, we aren't necessarily the people to answer that. And yet, there's been kind of an enormous upswelling of enthusiasm beyond this domain. And so I look to our colleagues in policy and beyond to think about how to creatively answer these questions around access. But I think it's an important one. Let's do one more from the back. Mike. Thank you. And thank this panel and the other researchers here who are doing these studies to keep things scientific and evidence-based. And I think that's really important. I'm in private practice. And I'm trying to be evidence-based as much as possible. And what I would worry about, and when you said, OK, there's two groups we need to worry about, skeptics, enthusiasts, I would throw in capitalists as well. Let's look at ketamine, for example. Now, I don't think there's great literature. Maybe you can correct me. But it looks like if you do the ketamine-assisted psychotherapy, you have a better result than if you just do ketamine. And I could be wrong on that. But that's what it looks like. And you have limited dosing sessions of ketamine. And then you can kind of stop and maybe have three or six months down the road, a repeat of one or two, that kind of thing. And yet, what is paid for is Spravato, which starts off twice a week. Usually have to do three nasal inhalers each session. So we're talking maybe a couple thousand dollars a week on Spravato, the insurers pay for, and no therapy. So what seems, again, the evidence isn't huge. But it looks like if you look at the classic psychedelics, it's the experienced guide, the experienced integrative therapist, that's where the magic is. But that's not being paid for. Because what makes the money is selling the drug, that molecule that can be patented. Yeah, that's a good point. What about, well, Roland, thoughts? I'm not sure. No, no, yeah. Well, it's sufficiently out of my wheelhouse to speak intelligently about that. And what we don't know is what FDA is going to end up approving. And it's surely going to be more than just approval of the drug. They're going to very likely approve and mandate structure around the delivery of that drug. And to what extent that gets encoded in the approval process, I don't know and can't predict. Yeah, no, I mean, I think we'd all agree that companies have a different set of incentives. But of course, there are some overlapping incentives. And the earlier question relates to this, in that if one could demonstrate that a whole lot less psychotherapy time was equally effective, it would in a sense be, it would help in some ways. But we certainly wouldn't want to implement a treatment program that had a whole lot less psychotherapy time if it was a whole lot less effective. That wouldn't be helping anybody. Just one comment. I mean, the field is already moving to explore some increased efficiencies. So there are a couple of sites that have run group cohorts. And we were biased against that for experimental reasons. We wanted independent observations, just statistically. As soon as you run a group, you have potential confounding of a group factor there. But there's a group in the Washington DC area that's just completed a study with 30 cancer patients treated with psilocybin. And they treated them in cohorts of four. And in that case, rather than having two therapists in the room, they have a single therapist in each of the rooms. They're run simultaneously. And then they have a couple of very experienced therapists monitoring via video what's going on. So they're on call to be able to intervene at any time. But one of the things that they've done that it's my strong impression is going to facilitate efficacy, not detract from it, is that they prepare people in groups. And they do group integration as well as individual. And our experience in having run a study of this sort, when you bring people together after these kinds of experiences, and they can share the meaning making that comes out of this. And they're so uniquely astonishingly different from everyday waking experience that there's this amplifier effect in a very positive direction. So yeah, there's lots to be explored with respect to increased efficiency. Go ahead in the front. Hi, my name is Monisa Solberg. And I have a private practice in Rhode Island. And I currently use, as ketamine, when insurance will pay for it. Or otherwise, I'll have intranasal ketamine compounded at a local pharmacy for patients. And so my question is, I've been coming to APA for probably 20 years since I was a medical student. And there's always been talks about psychedelics and research. And there was research at UCLA when I was a medical student. And here I am 20 years later. And so I'm just wondering, what's the timeline for clinical use of psilocybin? Or maybe I'm going to be in practice for another 30 years. But I'm just wondering. It's like every year I come to these. And I'm like, this is great. We have research. Let's do this. And we're stuck with ketamine right now, which seems to be working fine. But I'm constantly fighting insurance companies. And then I have this compounding pharmacy where I'm like, OK, make me some on the side. Give it to some patients at home. They're doing great. So I'm just wondering, where is this field going? What's the timeline? So a compound we haven't spoken about is MDMA, which is chemically different. There's some similarities as given to people. The primary indication is PTSD. Interesting compound. It also has breakthrough therapy status. It looks like it's leading the pack with respect to approval. And the best guess there would be two to three years for approval. My guess, and it's simply a guess, is psilocybin is probably four to six years out of approval. But this approval process is pretty fraught. It really depends on what data is on Earth and then what concerns FDA has to run different kinds of studies. To what extent are they going to mandate special populations? And all of that runs the cost up and the time for approval. But if I were just to throw out something, four to six for psilocybin. So in your practice lifetime. I hope so. OK, thank you. Go ahead. Next in the front. Oh, I'm just very curious how you guys manage patients who are on SSRIs. Because it seems like, do you find that there's a blocking effect on psilocybin if patients are on SSRIs? Or that it makes it not effective? And if so, do you select those patients out? OK. And then do you ever taper patients off prior to allowing them in trials? And then looking forward to when it is approved down the line, how do you imagine that as clinicians we'll be managing this? Because the populations that we'd be treating are going to mostly be on SSRIs probably. So will we be tapering them off? And then how long will we be waiting? Or maybe even increasing the dose? Just kind of curious. Both what you guys do in your research, and then maybe what we'll do as clinicians. Yeah, virtually all of the clinical trials have been run in individuals who are no longer using SSRIs. Initially, there was some concern for serotonin syndrome. But I think a bigger concern, and there's some empirical data to suggest it's the case, is that the SSRIs are going to block the effects. I mean, the serotonin levels are so high that if that's conferring cross-tolerance or some kind of receptor down regulation, don't know the mechanism. We've run a survey study. This is by one of our faculty members, Dr. Sandeep Nayak. A survey study in people who claim to have used psychedelics either during or after use of SSRIs. And those reports, but this is survey retrospective data, but it suggests at least a 50% drop in effect. And so there are certainly people who are on SSRIs not infrequently who report no effects at all, but not within clinical trials. But this deserves a lot more study. For the studies that we've run in populations for which SSRIs are commonly used, we simply tell people that we can't enroll them. There have been, not our trials, but some trials have offered to taper people off. We'll suggest to people if they want to be considered and their physician supports them doing so, then they should consider tapering off and see how they're doing. But for quite a number of people, that doesn't go well. And so they never effectively taper off. So we don't know all the answers there yet. And it's a problem. There's going to be a significant cohort of people who are on SSRIs that may never bring themselves to be able to taper off and have these experiences. That's a hugely important practical problem. Did you want to say a little bit? Oh, no. I was only going to say that, actually, I was recently learned about this very question and that I was thinking about the risk of serotonin syndrome, for instance, in these contexts. And I was reminded that the mechanism of serotonin syndrome has to do with synaptic serotonin. And whereas, and correct me if I'm wrong, psilocybin itself is a direct agonist. And so the kind of effects that you would expect from that specifically would not necessarily occur if you were taking both. That's my theoretical understanding. And again, to Roland's point, that this is not something that we have data on, which is, I think, a huge limitation. And so ideally, in the future, we'll know more about that. But as a practitioner, I think about it all the time of, my gosh, is my patient on a triptan? Is my patient on SSRIs? What are these contraindications? And at least from a theoretical standpoint, there's some, I think, reassurance, and yet the need for much more information. It seems like it could be a methodological problem with the research, too, right? If you can't include people who are on SSRIs, like just the selection bias of it. Let me try to just get one last question. We have one minute left, we'll go to the back. Thank you so much. I'd love to hear just a little bit more about how you manage the dosing sessions clinically. Is the patient actually on the couch listening to music the whole time? How much do you encourage conversation with the therapist? Or if they want to get up and walk around or do something creative, do you encourage or allow that? Or how restrictive are you? We're quite restrictive. So the intention here is to focus attention inward. For safety, we don't allow people to get up and express themselves. There are therapists within the community that think that's exactly what you should do, and that's exactly what we don't permit to have happen. So we constrain that environment really quite substantially. We don't allow people to change the music list or even request that the music goes off. This is all laid out in advance, and it's a great opportunity for further research. I mean, we may be quite arbitrary in some of the things that we're imposing. Interesting. I apologize for folks who had questions that we didn't have time for. I know all of us will be up here for a little while afterwards, so feel free to come up and ask your question. For all of you, thanks so much for attending. Thanks. Thank you. Thank you. Thank you. That was good.

Panel Discussion

Psychedelic Science

Clinical Trials

Research

Therapeutic Potential

Neuropharmacology

Johns Hopkins Center

Depression

Anxiety

Addiction

End-of-life Distress

Rigorous Research

Access to Care