Matthew Johnson

April 28, 2020
Spotlight

A Professor at Johns Hopkins University, Matthew Johnson is an expert on psychedelics, drugs, and addiction. A much sought-after expert, Matt has been interviewed by the BBC, CNN’s Wolf Blitzer Show, Fox Business News, National Public Radio, the New York Times, the Washington Post, the Globe and Mail, the Daily Mail, USA Today, CBS News, Scientific American, and Vice, among others. Psychedelic Finance interviewed Matthew to get his take on the current psychedelic landscape.

What do you believe is the most important thing for people to understand about the future of psychedelics as medicine?

Beware of the dark side.

We need to understand that these are extremely powerful tools, and there will be casualties when used incautiously. When safety standards are minimized and unqualified individuals attempt to harness high dose psychedelics as therapeutics, folks will suffer. You don’t have to go too far back to find examples. In the 1990s Strassman had someone run from his laboratory on a high dose of psilocybin. Not one, but two people ran from the “Good Friday Study” in the early 1960s. One had to be chased down the streets of Cambridge and injected with Thorazine because he was on a mission to find the president of Harvard and tell him about the Second Coming. Not only will such events hurt patients, they will be front page news and serve to jeopardize the entire enterprise of psychedelic medicine.

Panic reactions and unmasking psychiatric vulnerabilities are not the only risks. A subtler risk is for the practitioners to forget their role and get sucked into the guru complex. One doesn’t have to go full “Tim Leary” for this to play out. Some researchers and clinicians have a hard time not letting it go to their heads – being associated with some of the most meaningful experiences in people’s lives. Researchers or clinicians can get tempted to see the entire scenario from their own idiosyncratic supernatural beliefs, and lose sight, or not care, about the fact that they are pushing their own ideologies, introducing concepts to patients that are not empirically grounded in clinical science. I’m not talking about care and rapport– these are absolutely critical and I am not saying you need to be cold.  But one should not push their particular beliefs that are not supported by mainstream empirical evidence and practice. You can see this play out even in the use of religious iconography in sessions. This is a real concern. I fully support the rights of religions, such as the Native American Church, or the UDV, to practice their religion with the use of plants they consider sacred. But folks operating from empirically grounded medical or psychological traditions should not see the use of these compounds as an excuse to “play guru or priest” and co opt such traditions. This will result in psychedelic medicine having a fringe, new-age, cult-like vibe. Folks need to know this could be for them. I’ve seen this work in plenty of folks one would never consider a likely psychedelic enthusiast – grandmas who would never take an illegal drug, traditional religious folks, atheists, political conservatives, to name just a few.

The most realistic risks discussed above will come from folks not recognizing the risk in themselves, and from folks who are operating within what might largely appear to be responsible practice. But there are deeper levels. There is a critical need to adhere to the boundaries learned through accepted clinical practice. Without them, abuses will occur, including sexual abuse. And then there is the potential for the most egregious schlockmeisters who will completely overstate guaranteed benefits and minimize all risks. And if one wants to have a full scope of psychedelics and their potential, one needs to be aware of the darkest levels, for example, the histories of Charles Manson and the MKUltra program.

I’ve made a broad understanding of ethics, risks and risk assessment in this area a critical part of my work from the beginning. We need to keep our eyes on these issues, and impose strict guidelines in clinical practice, including through the FDA REMS (Risk Evaluation and Mitigation Strategies) system, to ensure safety, broadly speaking.

What is the most common misconception you hear about psychedelics?

Maybe one of the most common in the addiction treatment work with psychedelics is that these are substitute treatments.  In my smoking cessation research, we only provide 1 to 3 psilocybin sessions, and see positive effects long term. This isn’t about taking psychedelics on a regular basis.  Now, the micro dosing model does involve administering psychedelics on a regular basis, but virtually all the modern science is with high-dose, limited-occasion models, and the very few studies with micro dosing have not yet shown any benefit.

Another misconception that folks always get is what I call the “Full Monty” experience. For example, one in which all domains of mystical experience are strongly endorsed. There are multi-dimensional landscapes of gradation in the nature of these experiences, and we are in our infancy in terms of understanding what experiences lead to the most beneficial long-term outcomes. Many folks have nothing like the full mystical experiences and feel a session was nonetheless very helpful. Some who meet criteria for a full mystical experience don’t see any impact on their ongoing functioning or behavior. This is critical for patients to know – if they come in thinking that only the incredible experiences they have read about are going to help them, they may be setting themselves up for disappointment.

What made you personally want to get involved in psychedelic research?

I came across the older literature on psychedelics when I was an undergrad, and learned that they had promising effects that were left dangling when the research stopped in the 1970s. In the preceding years I had also learned a lot about the major role psychedelics had played in society during the 1960s and 1970s. It was pretty clear that these drugs had the ability to radically change behavior under certain conditions. I had been conducting university research with cocaine and was becoming more interested in the world of behavioral pharmacology. So I naturally wanted to eventually extend this to psychedelics. I like to say, given the ancient sacramental use and the countless anecdotes of life-changing experiences in our own culture, if you are interested in the behavioral effects of drugs, and you AREN’T interested in psychedelics, then you probably don’t know much about psychedelics!

Also, I’ve long been interested in the big questions – the nature of reality, human behavior or mind, ethics. Psychedelics have not provided any hard answers in these domains, but it’s remarkable that folks often feel like they gain some type of insight into these big questions. Psychedelics intersect these big questions with pharmacology, medicine, behavioral science, ancient human use, and an almost unbelievable cultural history. It’s hard to imagine a more cross-disciplinary topic to attract interest.

Which current studies are you most excited about and why?

I’m in the last half of my study comparing psilocybin to nicotine patch for smoking cessation. Of course, I’m terribly interested in how that plays out. Right now, for the folks who have gotten to 1 year past their quit date, the psilocybin group has more than double the success rate of nicotine patch. Results could change, but I am very curious to see where they land. We also collecting brain imaging data from before and after people quit, so I’m looking forward to learning something there in terms of long term biological changes that correlate with long term behavior change. And I’m also extremely excited about two funded studies that I’ll be leading –using psilocybin to treat opioid addiction and to treat PTSD. I’m also excited to start a small project testing LSD to treat chronic pain.

How do you feel about all of the recent hype and investment interest in the psychedelic space?

Overall it’s a good thing, but it also introduces new levels of challenge. Broadly, investment and business interest is wonderful as this is the way that things will actually get to patients should safe and efficacious results hold up. So, if we are on to something, business interest will be inevitable, and rather than being antagonistic toward it automatically (like a minority of psychedelic enthusiasts) I think we need to play an active role in helping to shepherd the field in a safe way, including in terms of how businesses develop psychedelic medicines.

Bad actors or actions can occur in all sectors, both the corporate and the non-profit. I’ve spent too much time in nonprofit universities to be under any illusion that there is no unethical behavior in the nonprofit sector. So we have to use wisdom and evidence to evaluate entities by their actions, regardless of their designation. No medicine has ever been brought to and maintained on market outside of a for-profit business model, so it is likely that businesses are needed if we are to use these compounds, if approved, to full clinical utility and maximally alleviate human suffering. That said, non-profit models are experimental but absolutely worthwhile, because if they are successful, they will provide access to non-patentable compounds and make sure that prices for these compounds are not inflated in the market.

Which achievements are you most proud of at Johns Hopkins to date?

I would put the smoking cessation work and the cancer work at the top of the list. I’ve been fascinated by the nature of people’s experiences and claims of changed lives, but as a behaviorist, I started the smoking cessation research because I knew this was an area where we could see if the rubber meets the road. Sure, you might say, and truthfully think, you are changed a year later. But what if we have you provide breath and urine samples to show that you have actually changed a behavior that you’ve struggled with for decades?  And the cancer work was just so meaningful. It truly changed people’s lives, including the lives of patients’ families. I’m also very proud of the safety guidelines paper I published in 2008. It has come to be viewed at the go to manual for safety standards in the psychedelic field.

Are you personally investing in or partnering with any psychedelic-focused companies? If so, what criteria did these companies have to meet for you to get involved?

I’m serving as a scientific advisor to several companies. To serve in this role, I need to know that the organization has a realistic plan to do credible work with psychedelics. I need to know that they are driven by science at the core, and that they have expertise in the FDA (or international equivalent) regulatory area. Beyond these, I need to have a good personal relationship with key folks and have a personal sense that helping people is truly a part of the mission.

Who would you like to see Psychedelic Finance interview next and why?

How about Adam Halberstadt, Ph.D. at UC San Diego? Researchers who conduct human clinical research tend to get more media attention, but so much of the innovation in this field and mechanistic understanding comes from those who focus on nonhuman research. Adam is one of the best scientists conducting nonhuman pharmacology and behavioral models with psychedelics, including novel compounds.
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