PODCAST- DR. Craig Heacock: Psychedelics and the Future of Psychiatry

About Our Guest- Dr. Craig Heacock- Psychedelics and the Future of Psychiatry

Dr. Craig Heacock is an adolescent and adult psychiatrist and addiction specialist in Colorado, He is the co-producer and host of the psychiatric storytelling podcast Back from the Abyss and was a co-therapist and study physician in the MAPS Phase 3 MDMA-assisted psychotherapy for PTSD study. He is an expert in the use of ketamine to treat depression and PTSD and has a deep interest in the emerging psychedelic revolution in psychiatry. Dr. Heacock is a graduate of the University of New Mexico School of Medicine and did his psychiatry training at Brown University.

Full Podcast Transcription

Dr. Craig Heacock 00:12
So yeah, so the response to ketamine to me is really helpful in understanding etiology. And because I think it\’s tempting for non psychiatric people to think like, oh, ketamine is a good treatment for depression. But really, ketamine is an amazing treatment for certain subtypes of depression – you may or may not be able to suss those out in eval. And as I said, it may not be till post sessions that you sit down and think, hmm, you\’re only moderately better. Why is that?

Diva Nagula 02:01

Hello, everyone, and welcome to another episode From Doctor to Patient. Today I\’m joined with Dr. Craig HiHeacock. He\’s an adolescent and adult psychiatrist and addiction specialist in Colorado. He is a co-producer and host of the Psychiatric Storytelling Podcast Back From the Abyss and was a co-therapist and study physician in the MAPS phase three MDMA-assisted psychotherapy for PTSD study. He\’s an expert in the use of ketamine to treat depression, and PTSD, and has a deep interest in the emerging psychedelic revolution in psychiatry. Dr. Heacock is a graduate of the University of New Mexico School of Medicine, and did a psychiatric training at Brown University. Dr. Heacock, how are you today? It\’s great to have you on the show.

Dr. Craig Heacock 03:00 Thank you for inviting me.

Diva Nagula 03:03

You know, this is really interesting, I really enjoy talking to physicians who have practiced Western medicine, and have also started to delve into the field of psychedelic-assisted psychotherapy. And I got many questions because this is kind of how I have chose my path as well. I was a interventional pain management physician then did some integrative medicine work, and then found psychedelics. And now I\’m actually mostly the work that I do now is around facilitation. So it\’s really been a great process for myself, and very rewarding seeing the transformations that can occur with psychedelic-assisted psychotherapy. And I\’m really curious with you, like, how did you entertain the idea of psychedelics? Was it a personal transformation that led you to want to be able to find more information about these topics for your patients?

Dr. Craig Heacock 03:56
Well, yeah, this is a long answer. I\’ll try to keep it relatively brief, but I\’ve been interested in psychedelics for decades. And in 19, let\’s see, when was that…1997 I was in Rick Strassman\’s DMT experiments at U&M. And he wrote a book about that called The Spirit Molecule. So I was one of the volunteers. And I remember telling him during that time, I was applying to med school and he said, oh, what do you want to do? I said, I want to be a psychiatrist and want to work with psychedelics. And this was, what, 20, 24 years ago and he said, oh, that\’s, that\’s a long ways off. He said, I hope for that, too. But that isn\’t coming anytime soon. It\’s always been in the back of my mind. And then, you know, like so many things with social change, like when are things going to change? When when when when? And all of a sudden, right now, I think we\’re in this psychedelic renaissance, and a thrilling time to be working in mental health.

Diva Nagula 04:50

It really is. So since you were one of the volunteers at the study in New Mexico, I\’ve got to ask some questions because I read that book and that was fascinating. Did you receive the control, or did you receive the actual experimental medication?

Dr. Craig Heacock 05:07
I don\’t know if they were doing placebo, because in the part of it I was doing was more like dose response. So he had a medium dose and a high dose. I got the medium dose.

Diva Nagula 05:19 How was that experience?

Dr. Craig Heacock 05:22
Well, I didn\’t have the, like, alien encounter or anything like that. But I had total ego dissolution. And essentially, that my energetic self left my body and went out of the room somewhere. And, it was a whole, you know, wild journey that lasted like, I think it was eight minutes. It IV – it was just a quick bolus. And then when I came back, I said, How long was that? And he said, like, well, that was 11 minutes or nine and a half minutes. Whew. Not the ideal set and setting with all this hovering, in a hospital, with all these machines, you know, being monitored. So, I mean, he was a sweet guy, but it was not, ideally what you\’d want to do for….but we weren\’t doing psychedelic therapy. It was really, I think, experiment, you know, yeah. The first time coming back to doing human psychedelic research and 30 years. So yeah, it\’s really more about safety and dose response.

Diva Nagula 06:19

Post experience, did you feel….how did you feel? Did you feel like you\’re, I don\’t know, you actually had the ego dissolution. So you\’ve probably felt the universality, the Oneness experience. That often changes people dramatically afterwards.

Dr. Craig Heacock 06:35
Just being probably like you, being an achiever and driven, when I heard I got the medium dose….I said, I want to try the high dose. But I think it was 10 to 15% of people had a hypertensive response at the medium dose, and I did just enough to put me out of qualification for the high dose. In some ways I feel like I got the silver medal in the Strassman study, like, that\’s good, but I really wanted to go the full experience, but it definitely, completely supported my vision of like, I want to work with these kind of compounds. And, and it just seemed like for years and years and years. I mean, I was a MAPS member and following psychedelic research, but I just thought, okay, this is not happening. And then in the last few years, boom, you know, ketamine is blown up, and psilocybin is going to probably be coming online, medically in three years, and MDMA, hopefully three years. And there\’s some people even working on DMT pumps, where you could do very carefully titrated DMT sessions in an office. One of the advantages of working with something like DMT, if you could manage the dose response curve of it – it\’s so quick acting. That\’s what\’s nice about ketamine too, you can do ketamine work, or potentially maybe DMT work someday, and people could leave, you know, hour and a half later, with the others, psilocybin with MDMA, you know, you\’re really in for six, seven hours minimum. So that\’s a big time commitment. But more than that, I think that just adds a lot of cost to it. Put together with the MDMA work, which I think most people who do that work would agree that it\’s probably best done with a male female therapist. So yeah, I\’m just gonna double the cost of it.

Diva Nagula 06:56

Got it. Yeah, I\’m really interested in…I mean, you did the MAPS training. And so you probably know a little bit more on the inside as to what\’s going on with MDMA. It is in phase three, currently. And I mean, I keep hearing dates and potential dates where it\’s going to be legalized, and I heard end of next year, and now you\’re saying 2023? So how close are we?

Dr. Craig Heacock 08:51
Yeah. So phase three, which is the final phase before hopeful FDA approval is halfway done. And you may have seen these numbers, I mean, half of phase three, I think represents 100 and some people, 150, 175. And that\’s half done, which is mind blowing, because most phase three studies involve 1000s, or even 10s of 1000s of patients, but the effect size of MDMA has been so high that they think they\’re gonna be able to get FDA approval with 250, 300 people, which I think it\’s only ever been equaled by a few cancer drugs. Because they\’re so effective. But what slowed it down – well COVID put a halt on everything – to get in the study, you pretty much have to have what I would call pure PTSD, meaning not any other comorbid stuff like addiction or personality disorders or severe depression. You know, you have to come off all your psych meds, if you\’re on those. So it\’s, you know, I think this is true of a lot of medical studies – I\’m sure with MS studies, they\’re trying to find people just with MS with no other conditions. Well, who are those people? But I think with trauma, it\’s even harder because what is trauma do to your heart and your body and your immune system and your tendency towards substance use? I mean, trauma wrecks everything. So it\’s been difficult to find these kind of pure PTSD folks. So there\’s been a lot a lot of ruleouts in the early stages, people not screening in.

Diva Nagula 10:34
And it\’s interesting you say that, because my last client had no idea about underground work. And he was really interested in the MAPS, and trying to get into one of the studies. He was a perfect candidate because of his PTSD. The problem was, was that he was taking cannabis on a regular basis for pain for the last 10 years. And that was an exclusion criteria. And he was not able to participate. He was really bummed out because he fit, he checked all the boxes, but because of the cannabis history…. So we did a session, so his very first session that he\’s ever had was with us three weeks ago – he had a remarkable, remarkable response to it and doing really great, he\’s with my integration coach. And and they\’re really making some headway within. So it\’s really rewarding in that sense. But I\’m really looking forward to seeing what\’s on the other side, after these trials are completed and after it\’s FDA approved.

Dr. Craig Heacock 11:32
If I have somebody come to my office for initial eval, with severe depression or PTSD, and they don\’t have an active substance problem, I\’m amazed. How are you doing that? Like, how are you suffering so much? And not using substances? That\’s amazing. But that\’s part of the thing that MAPS is facing – you have people in just some of the most horrific psychological, psychiatric distress. And yet you just have to somehow have that, hold that, not have really any other significant stuff going on.

Diva Nagula 12:04

Right. And are you allowed to be on antidepressants? I mean, I guess, obviously, coming off of them prior to getting on the MDMA therapy, but are you okay with having a history of antidepressants in your system?

Dr. Craig Heacock 12:16
Yeah, you can have had a history of them, but to be in the study essentially have to be way off, come off all psych meds. Even lately, they\’ve decided you can\’t have had any ketamine exposure for few months, because ketamine is such a powerful antidepressant and because it has such utility for PTSD, not as a cure for PTSD, but as a way to alleviate PTSD. A lot of people are doing ketamine treatment for PTSD, so they had to exclude that. And that\’s hard too because I\’ve had people that I would like to refer to the study, and they\’re on maintenance ketamine, and it\’s keeping their head above water, but, you know, to go off it for months, and have that big washout, and then join the study, that\’s tough. It\’s brutal.

Diva Nagula 13:02

You know, in your, in your world, as a psychiatrist, I mean, you see lots of mental health issues, and having all the tools at your disposal is fantastic. So what is your criteria? You know, when you treat a patient who\’s suffering from mental health disease, do you go straight towards SSRIs? Or conventional antidepressants? Or do you go the alternate route? Do you do the ketamine? I mean, what\’s what\’s your algorithm?

Dr. Craig Heacock 13:28
Well, let\’s talk about maybe treatment resistant depression, which is a fairly common thing. So that\’s actually a huge umbrella, which represents, you know, 100,000 different ideologies, but it used to be that I would recommend ketamine, for example, is like the third or fourth or fifth line thing, maybe if people are suicidal, or just really not wanting to do a daily med, but for specific types of depression, there\’s really nothing else better. So now I have people coming for initial email and I\’ll say, you know, we could do X and Y or start this medication, but if you\’re open to it, I think we should go right to IV ketamine and to do a couple treatments and see, and people are into that. I mean it\’s interesting. Then when I describe the side effects – okay, depression meds, common side effects are weight gain, sexual side effects, constipation, sedation. Ketamine really only has three side effects, it can make you motion sick, it can raise your blood pressure, and it definitely can be scary if you don\’t set the setting properly. SSRIs – they\’re effective, but they just have a lot of nasty side effects. I\’m still not one of those psychiatrists who – I want to use what works – SSRIs are not depression meds for most people. They\’re anti-rumination, anti- obsessional meds. So for people with pure OCD or OCD like syndromes, SSRIs are great for many people. Somebody walks in the door with significant depression, I\’m thinking, usually Lamotrigine, which is probably my favorite med, and ketamine. You know, I hope very soon that we\’re going to have MDMA and psilocybin as options too. I don\’t think that\’s going to be long at all. And I can imagine where, in the very near future people come in to do MDMA treatments for trauma that they\’ll be on various depression meds or psych meds, and then will taper off those for the MDMA treatment, maybe use ketamine as a bridge to prevent breakthrough. And you break through depression as people do their med taper and basically get them ready for their MDMA sessions.

Diva Nagula 15:51

Yeah. That\’s that\’s actually smart. I like that idea. And that\’s, that\’s really interesting. So with your protocol for ketamine, is it more like….what I\’ve seen a lot of these clinics that are opening up now, it\’s like you do four to six treatments, one weekly or even two weekly. I don\’t know what the studies show in terms of the frequency that\’s optimal for relief? Or is it just basically one at a time and then you just kind of reevaluate in between?

Dr. Craig Heacock 16:19
So yeah, that\’s a great question. So the question is not whether ketamine is effective, I mean, ketamine, I would argue, is the best thing to come along since Lamotrigine. So I would argue it\’s the best depression treatment we\’ve had seen since Lamotrigine came online in 1994. So 27 years. The question with ketamine is all about routes, IVPO. Dose. Mostly sub-dissociative or fully dissociated, and then frequency, and there\’s huge controversy on all those. So it turns out that a couple of the original studies were done with this protocol of six low dose IVs over 2, 3, 4 weeks. And like so many things in medicine, however the original studies happened, people just latch on to that like, okay, this is the way we need to take this vitamin, you got to stand on your right leg and close your eyes and say your prayer and swallow in one gulp. Ketamine has to be 0.5mg per kilogram, six treatments over three weeks. But what I think what we\’re finding it\’s there\’s sort of a bifurcation and ketamine treatment, so the anesthesiologists and ER doctors who run clinics, they tend to stick to that. The psychiatrists who are doing ketamine are mostly doing what I\’m doing, which is using substantially higher doses and way less frequency. So what I\’ve found is, most everyone, no matter how profoundly vegetatively catatonically depressed they are, will get mostly better or all the way better with two treatments,

Diva Nagula 17:53
So 0.5mgs per kgs is typically the start?

Dr. Craig Heacock 17:57
Yeah, so I usually start people on IV at 0.7mg, 0.75mg which again, doesn\’t sound like much. That\’s a 50% bigger dose. And, the dose response curve of ketamine is very steep. See the difference between 0.1 and 0.9 is like the difference between a Calistoga wagon, a go-kart and a Tesla – they\’re all vehicles but not the same thing. So I usually try to do a sub-dissociate first treatment, so not to scare people, but get them right up to the point of ego dissolution. And then the second treatment is what I call deep dip, or fully dissociated treatment. I think what the thing is…..that\’s usually 0.8mg 0.9mg. A lot of people don\’t want to do that dose with their patients, because you need a lot of support. If people get scared, you may need to hold their hand, you may need to do some intense post session processing. I mean, it\’s a very intense treatment. And so my medical assistant and I, she\’s awesome. And I\’m a psychiatrist. So, you know, strong psychological reactions, or trauma catharsis or some of the stuff that comes out of these high doses…I mean, that\’s what we do. But I think if you\’re doing the ketamine treatment model, like the dialysis clinic, we have six people lined up, you know, in chairs watching the Eagles game or something, you can\’t be giving people fully dissociative does of ketamine. So I mean, the cynical part of me says economically, you know, it makes sense why people are doing these low dose multiple ones, because that\’s a lot more profitable and it\’s just easier. I think, I think it\’s effective as well. But we don\’t have good data yet. You know, this whole idea of say, six or eight low dose IVs versus a couple higher dose IVs like I do, and a lot of psychiatrists do, I think that data is coming. But it would make sense to me if you\’re going to treat anything like someone with a severe migraine, if you said, okay, we\’re gonna give you half of an ibuprofen every day for two weeks, or we\’re gonna give you four ibuprofen now. I mean, dose matters so why, you know, why wouldn\’t it matter with ketamine?

Diva Nagula 21:16

I agree with you, I mean, my experience when I\’ve done ketamine treatments for treatment resistant depression is that I do an escalating dose just to get them acclimated to the medicine. So I\’ll always start with 0.5mg and it depends on how their response is for 0.5mg. If they\’re really scared, then I\’m going to go really slow in the escalation. So I might go 0.6mg and then maybe stay there, I will do probably six treatments, one or two a week, and then if they have a really good response, then I can probably go to four treatments, but I\’ll be escalating with the last one at 0.9mg or 1.0 mgs per kg. And by the time they get to that 1.0, 0.9, they\’re kind of used to it, and then they\’re already feeling better because their depression is starting to recede. So they\’re anticipating the next session with optimal results. My only thing is that, and maybe this is something that I need to work on, but definitely integration or some sort of therapy is needed in between and post, because I\’ve seen people who\’ve had this type of algorithm, and within three, four weeks, they\’re back in a depression. My guess is because there\’s not enough post-care that\’s present for them. Or they might need a maintenance booster, which is fine. You know, I don\’t think it\’s necessary to do the sequential series again, but I think a booster would be appropriate and I don\’t know what in your experience, what you\’re finding.

Dr. Craig Heacock 22:46
I\’ve talked about this in my podcast, how depression is like pain. You know, we talked about depression, like it\’s a thing, but it\’s a huge final common pathway of all sorts of things. But what I\’ve found is that people, for example, in a bipolar or mixed depression, ketamine is a home run. And they can often do, for example, like a September, October, November, December treatment, and that will hold them for the year. Because you know, the fall, winter is such a brutal time for people with bipolar disorder. But if people\’s depression is coming out of PTSD, primarily, they\’re probably going to need to do ketamine….I would say my chronic PTSD folks, most of them are monthly maintenance. And that, again, doesn\’t fix their PTSD, but it just calms down the forest fire of their fear and helps them to function. And then it\’s the other people who come in in more of a situational crisis, that they can do a couple treatments, and I don\’t see them again. So everybody, when they come in and wants to know, what\’s the algorithm, how often, and I say, look, first we\’re gonna see if you respond. The response to ketamine will actually help us understand more if this is a primary mood disorder, PTSD, some other kind of…..for example, I\’ve had some people come in super depressed, who didn\’t respond at all. You know, I said to them….this happened last month, and I told the guy that I\’ll bet you $1,000 that you\’re better. But he didn\’t improve at all and he had hypersonic, kind of vegetative, what I call black bear depression, like the home run thing for ketamine and didn\’t respond at all. And then we had a post-session I said, we need to understand why and then he just out of the blue, he said, you know, I think I should get a sleep study. He\’s a skinny, skinny guy, way skinnier than me. Yeah, I snore so badly that people can\’t even be like within 50 feet of me. So then we do a sleep study. He\’s got severe sleep apnea. I thought, Oh my gosh, this medical problem was making it so we couldn\’t treat him. You know, again a classic thing – that is why we go to med school. But it just it took a failed course of ketamine for then him to start thinking like, oh, maybe I should tell you more about my snoring. So the response to ketamine to me, is really helpful in understanding etiology. And because I think it\’s tempting for non psychiatric people to think like, oh, that ketamine is a good treatment for depression. But really, ketamine is an amazing treatment for certain subtypes of depression. You may or may not be able to suss those out in the eval, and it may not be until post sessions that you sit down and think, hmm, you\’re only moderately better. Why is that? For some people I\’ve found a lot of people with a primary mood disorder, if they just do ketamine, and they don\’t have any med underneath it, it won\’t hold. But put Lamotrigine underneath, so daily Lamotrigine plus ketamine, for many people like that is the magic ticket. So Lamotrigine is just helping the keep them stablized. Then when they have breakthrough stuff, they come in and do ketamine. And I would say, gosh, I don\’t even know – two thirds of my maintenance ketamine patients are on Lamotrigine, with ketamine. Now that you probably know this, but your listeners may not – but tricky thing about Lamotrigine, you have to do a quick wash out before ketamine. So it has a 38 hour half life. So it\’s tricky. I usually people skip it for two doses, and then you have to bump the ketamine dose probably 25% higher to compensate for the dissociative blocking effects of Lamotrigine.

Diva Nagula 26:34
Right. So interesting. It\’s like, that\’s the one medicine that I like to use, you know, instead of all the other psychedelics that are out there, because you don\’t have to really taper or discontinue most antidepressants. With Lamotrigine, I wasn\’t aware of the washout period. That makes sense, because there\’s some clients that I\’ve had that I left them on it and they just didn\’t have that great response.

Dr. Craig Heacock 26:57
Even when people skip a couple doses, I find that you can still push them into deep full dissociation but they pop out – it\’s almost like they\’re like a cork – the Lamotrigine will only….even if you hit him with a big dose…will only let them stay down in full dissociation for a few minutes and then they pop out. Again, we don\’t know. Is it that full dissociation is a goal or how much time you spend there? I mean, I definitely have some patients, especially my trauma patients report much, much longer lasting, deeper healing sessions the longer they\’re in the dissociative state. Again, this is just self-report.

Diva Nagula 27:35
And then just for listeners, what is the definition of dissociation? You know, what constitutes dissociation?

Dr. Craig Heacock 27:44
That\’s a word like depression or panic that\’s thrown up and thrown around a lot. When I speak of ketamine, what I\’m meaning is, to be dissociated, is to lose your autobiographical self, your ego. As I tell people in my office, I say when we when you hit full dissociation, there will be no Fort Collins, there will be no International Space Station, there will be no Dairy Queen, there will be no Jimmy or whatever, you\’re going to just sort of melt into….oftentimes I find it\’s this kind of subterranean, tectonics plate magma chamber. A lot of people have a sort of geological experience. That is different, though, when trauma therapists talk about dissociation that\’s actually used in a very different way. I\’m glad that you mentioned that. Because when we talk about dissociation in the clinical sense, where we\’re often talking about people going into this kind of checked out numbing. You know, if you imagine someone being assaulted, that the defense strategy is to just kind of take your brain offline, and while the assault is happening, you\’re there, but you\’re not there. You\’re just gone. So that\’s the more common usage. Thank you for pointing that out – it is tricky that we use that word, a very important word in two totally different contexts.

Diva Nagula 29:02

So the ego disillusion is very powerful. And a lot of people go through that with other psychedelic medications. You know, psilocybin at a specific dose, you can have that ego dissolution, or what\’s called the ego death. Other substances like Ayahuasca, it can happen as well. What\’s unique about the ketamine, and also with DMT, you could have that experience – the advantage, if you want to call it an advantage for those two – it\’s quick. It\’s an experience, 10 to 20 minutes long, you know, and then you\’re back. But it can be so psychologically impactful for the individuals going through that experience. I\’ve had it done before many times on my own and it\’s a very, it\’s interesting how you can compare something that\’s synthetic like a ketamine versus something that\’s like DMT or Ayahuasca or psilocybin – the ketamine is so very digital – that\’s how I describe it. It\’s just it\’s synthetic, it\’s not plant-based is not natural. The others – it\’s hard to describe unless you\’ve gone through it.

Dr. Craig Heacock 30:09
I think the tryptamine psychedelics are very organic of life, of connection, of nature. And ketamine is like being shot into a hard drive. A spinning centrifuge, magma chamber hard drive, video game.

Diva Nagula 30:26

Yep. Yeah. One of the protocols or cocktails that I like to use, I like to use all three for my clients. I don\’t have to use them in large doses. So I use MDMA, I put them in that for a couple of hours, and then I\’ll have them drink the psilocybin tea. And then right when they finish the tea, I\’ll go ahead and do an intramuscular of ketamine at 0.5mg/kg. So by the time that that ketamine wears off, the psilocybin starts to take off. And I\’ve found that to be very useful and people have phenomenal results with that treatment protocol. And I don\’t have to go and give high doses. And I think it\’s just because they work, they potentiate one another, and they work synergistically, and they give the outcome that they\’re looking for, and what I\’m wanting without having to worry about side effects.

Dr. Craig Heacock 31:18
Yeah, I think you bring up a good point there that so much of this is art, and the art of medicine. It\’s gonna be really fun and challenging to figure out what are the best ways to use these things that come online. Let\’s just take ketamine – it\’s compound, it\’s been around for 50 years. We don\’t know the best ways to use it in mental health, but we\’re learning – it\’s great stuff. I\’m often wondering, what did I do before ketamine? I think my answer was, a hospital has tons of people, I had a lot of people on handfuls of atypical antipsychotics and I sent people to ECT regularly. I mean, I still send some people to ECT, but almost all the people I send to ECT do ketamine now. I feel badly some of the people that I sent to ECT, and some of the long term memory issues they have, and this was pre- ketamine, and but just wish they could have tried that first.

Diva Nagula 32:17

How do you think when these psychedelics, specifically MDMA and psilocybin, when they become legalized, how are they going to go about allowing physicians like myself and yourself to prescribe and treat with these medicines? I mean, I do it, I have the experience, but I\’m not a psychiatrist, you know, so are they going to only allow people in the mental health field to be prescribing these medications?

Dr. Craig Heacock 32:42
So what I\’ve heard with MDMA, and this may have changed – this is what I heard maybe eight months ago – is that the tentative plan is that MAPS will be the central pharmacy. So maps will produce and distribute MDMA directly, and they will send it directly to authorized physicians, who will then be responsible to distribute it. Now, what does that mean to be an authorized physician? Does that mean you have to have done the MAPS training? Or are they going to have a prescriber program? That\’s still being worked out with the FDA, but clearly, you\’re going to have to have some relationship with MAPS. So you can\’t just be a dermatologist and just say, hey I want to order up 100 doses of MDMA from MAPS, like that\’s not going to happen. That\’s what they\’re thinking for MDMA. Psilocybin doesn\’t have this one champion behind it, you know, MAPS is the MDMA champion. I can\’t imagine that you can go pick it up at Walgreens. But, you know, it\’s already essentially been legalized – psilocybin has in Oregon. And I wouldn\’t be surprised if it gets legalized in Colorado in the next four to five years. Then we could be like, where we are with weed – there\’s a medical track, there\’s a legalized track, and I\’m really hoping with psilocybin that it\’s medicalized first because it\’s such a powerful substance. I just hate for it to just kind of break out into the mass mainstream, suddenly, and then bad things happen. And then okay, we\’ve got to shut it down. I hope that we get a few years of medicalization to just build some respect for this compound and practice using it before we just bust it loose.

Diva Nagula 34:29
And the issue is that – I\’m right outside of DC. And so DC had passed the ballot initiative 81, which went into force this past year, and essentially decriminalizes the use of psychedelics including psilocybin. So with that being said, what I\’ve seen and heard is that there are a lot more people that are curious and are getting their hands on it. They\’re not doing this in a in a clinical setting or where there\’s intention and you know, the whole intention of healing, but it\’s more for recreational usage and for people to just experiment with. So that\’s where I\’m scared. These municipalities across the nation that have decriminalized – that\’s where I feel, that\’s where you\’re going to see these problems where people are going to have issues with overdosing….overdosing and dying I\’m not worried about with psilocybin, that\’s not gonna happen. But it could lead to an individual who is on psilocybin, and they do things that could be harmful to themselves or other people. That\’s what I\’m worried about.

r. Craig Heacock 35:35
Yeah, these you know, these are powerful substances that can be powerfully healing. Bad things happened in the 60s when people took too much LSD.

Diva Nagula 35:45
And that\’s why it was, you know, deemed as schedule one drug.

Dr. Craig Heacock 35:51
Yeah. I mean, one of the things we\’re seeing in Colorado….I don\’t know if you\’re seeing this, I did a podcast episode on this – is that with the commercialization of marijuana, there\’s been an arms race of competition – who can make the strongest stuff. So it used to be who could breed the strongest sativa flower, but now it\’s just pure THC. It\’s almost like the people in Colorado said, yeah, we\’re gonna legalize beer and wine. And now we\’re six years in and people want Everclear. Dabbing to me, I tell my patients, it\’s like Everclear. It\’s from the marijuana plant, but it is not – Everclear is not like beer in any way, shape, or form. I\’m regularly seeing people have psychotic breaks from THC, which 10, 15 years ago if someone said, hey, you\’re going to regularly see people having psychotic breaks for THC, it would have been unimaginable. It\’s a staple in my practice now, because especially young men, are saying, hey, it\’s cheaper and more powerful just to go straight to the THC extract, and some percentage of them have a genetic probable vulnerability to psychosis and flip out and do often violent, scary things. And fortunately, it seems that the THC-induced psychosis, it usually clears once people stop using. But yeah, you wonder what would what would happen if psilocybin is is legalized? What kind of extracts might people have?

Diva Nagula 37:21

It\’s interesting you talk about THC and I\’m curious – I want to find out a little bit later and discuss how you\’re using it in your practice. I have the snip where that can, if I could have THC-induced psychosis. And so it really makes sense for me, because I\’ve had, you know, a handful of really, really bad trips with THC. So and then when I had, you know, my genetic sequencing done and everything or my DNA stuff done, it showed that I had that propensity to have psychosis with THC. And it\’s a real thing. But it\’s it really goes to tell you that you know, getting your DNA done, it\’s very valuable, not only with the THC component, but across the board.

Dr. Craig Heacock 38:03
Yeah, I spent so much my practice talking to people about sleep and weed. I mean, I joke with my my daughter sometimes, like, I\’m a sleep and weed doctor. The thing I try to talk to my patients about with marijuana is like, look, think of it like alcohol, and drink beer and wine. If you\’re going to drink, drink beer and wine, don\’t drink hard liquor. And because the window of safety for the pure THC compounds or you know, Everclear vodka is very small, especially if you\’re vulnerable. So I think people can kind of get that, that there are safer ways to use cannabis and there are less safe ways, just like alcohol. And if you tend towards alcohol problems, either probably shouldn\’t drink or you should probably stick to beer. So it seems it seems like there\’s something with the CBD-THC balance, that the CBD is like the brakes and THC is accelerated – as long as there\’s some CBD in there you can get potentially the benefits of both directly. But boy, you can start messing around with unopposed THC, which again, I think can be a really powerful treatment like for somatic based trauma work – I know a bunch of people who are doing that. But it has to be very carefully titrated because you can send people quickly into a pretty agitated delusional place.

Diva Nagula 39:26
For your for your practice. I mean, are you using cannabis primarily for sleep or do you have any other indications in which you use cannabis?

Dr. Craig Heacock 39:35
I\’ll encourage some of my people to use CBD-THC gummies for sleep, heavier in the CBD. But for some reason having a little bit of THC in there seems to help us sleep which is interesting because if you\’re dependent on THC or using pure THC preparations, your sleep is shot. But there\’s something where having a little bit in there helps. Look at the side effect profile – we look at the common sleep meds, the benzos Ambien, Remeron – those have some really significant side effects. And so if you\’re looking at well, CBD gummy with all THC in it, I mean, for someone who truly has a lot of sleep problems, I mean, that\’s arguably much safer. In general, I\’m just trying to give people this idea of brakes and accelerator – think of CBD as the brakes. Like if you\’re going to use THC, fine, but you have to balance it, you have to use it mindfully. If you wake up using it in the morning, I think you got to ask yourself, why? lf I wake up and have a beer, I can say I just had one beer when I woke up. Well, to me, that\’s like people who wake and bake. Like, you have to wake up and smoke, you just should ask yourself, why? What exactly are you doing?

Diva Nagula 40:58
Yeah, exactly. So what\’s the ratio from THC to CBD that you\’d recommend people stick with for sleep purposes?

Dr. Craig Heacock 41:05
Yeah, you know, it\’s interesting. It just seems like such a wide range with people I used to recommend. I often say now that there\’s a couple dispensaries in town in Fort Collins that have really knowledgeable people. And I\’ll often just say, you know, go to this dispensary and ask them, tell them, you\’re not here to get high – just ask for the recommendations. And that seems to work really well. Like they actually have a lot of expertise in that, in the different strains. I don\’t think that\’s true at all of the dispensaries but there\’s a couple in Fort Collins that have really knowledgeable people. So I usually just defer to them. Because it does seem highly variable.

Diva Nagula 41:46
Yeah. It depends on their metabolism and there\’s so many different things that can take effect. Yeah, fantastic. Tell us a little bit about your podcast.

Dr. Craig Heacock 41:58
So I have a podcast called Back From the Abyss. And it\’s a psychiatric storytelling podcast. So it\’s a little bit like This American Life meets psychiatry. So we have awesome people come on and tell their story, how they plunged into psychiatric darkness and how they got out. And we have cool music and sound beds. And it\’s not really an interview. I mean, my voice is sometimes on there talking to people, but it\’s really more people telling their deep dive into psychosis or addiction, or the most recent episode is called Spiritual Gaslighting. It\’s a woman who is a Christian cult and sexually violated and then found a lot of healing through running and friendship and finally, psilocybin. So it\’s really fun. The episodes are a lot of work to make. It\’s a super meaningful – originally, the people were largely my patients. And now, it\’s mostly people who are approaching me wanting to tell their story.

Diva Nagula 42:59
That\’s awesome. How long you\’ve been doing it for?

Dr. Craig Heacock 43:01
It\’s been two years, and we just started third season. So if anyone\’s interested, probably a third of the episodes have a psychedelic flare with a really amazing story called MDMA and The Inner Healer, which is the story of the first guy I worked with in the MAPS study, describing how he healed his sexual assault through the MDMA trial. It\’s just a beautiful, beautiful story. There\’s another really powerful one called Mushrooms In the Magic of Life for women who experienced really awful physical, emotional abuse by her father was finally able to come to peace with that through psilocybin and MDMA work.

Diva Nagula 43:40
Fantastic. Well, Dr. Heacock, I appreciate you taking the time to be on the show. And for our listeners, where can people find more about you?

Dr. Craig Heacock 43:49
So Back From the Abyss is on all the podcast platforms. And my website is also the website for the podcast. That\’s craigheacockmd.com.

Diva Nagula 44:04
All right, well, thanks again. It was a pleasure.