PODCAST- Dr. Michael Verbora & Sabina Pillai: Field Trip and Ketamine-enhanced Psychotherapy

About Our Guest- Dr. Michael Verbora & Sabina Pillai: Field Trip and Ketamine-enhanced PsychotherapyPsychedelics

Dr. Michael Verbora earned an MBA from the Odette School of Business in 2009 and an M.D. from Schulich School of Medicine at Western University in 2013, before entering Family Practice residency at the University of Toronto. To date he has completed over 5,000 cannabinoid therapy consultations, and is a global medical expert in the field of cannabinoid therapy. He serves as Chief Medical Officer of Aleafia Health, a Canadian Producer of medical cannabis and cannabinoid research. Dr. Verbora also is the medical director of Field Trip Health and mental wellness company focused on psychedelic assisted therapy. His passion and focus is on helping patients heal through botanical medicines while developing scientific evidence on these therapies.

Sabina Pillai is a Registered Psychotherapist with a Master\’s in Clinical and Counselling Psychology from the University of Toronto. Her research interests, psychotherapeutic perspectives and personal passions lie at the intersection of science, art, and spirituality. After working on mindfulness and addictions research for many years, she saw the incredible potential for psychedelic medicines to deepen the psychotherapeutic process and open up new avenues for healing. She believes that the use of novel evidence-based therapies can transform clients\’ lives and help to move them towards greater wisdom and wholeness.

Full Podcast Transcription

Sabina Pillai 00:00
Accessing an experience that is so outside of your day to day life, and knowing that happiness is possible, knowing that connection is possible, knowing that there\’s beauty in this world when you all you\’ve experienced in your life is suffering and pain can be healing in and of itself.

Diva Nagula 00:22

Hello everyone and welcome to another episode of From Doctor to Patient. Today I am joined with Dr. Michael Verbora and Sabina Pallai who are both with Field Trip Ventures. Dr. Berbora earned an MBA from the Odette School of Business in 2009 and an MD from Schulich School of Medicine at Western University in 2013, before entering family practice residency at the University of Toronto. To date he has completed over 5000 cannabinoid therapy consultations and is a global medical expert in the field of cannabinoid therapy. He serves as Chief Medical Officers at Ophea Health – a Canadian producer of medical cannabis and cannabinoid research. Dr. Verbora is also a medical director of Field Trip Health, a mental wellness company focused on psychedelic-assisted therapy. His passion and focus is on helping patients heal through botanical medicines, while developing scientific evidence on those therapies. Sabina Pillai is a registered psychotherapist with a master\’s in clinical and counseling psychology from the University of Toronto, Her research interests, psychotherapeutic perspectives and personal passions lie at the intersection of science, art, and spirituality. After working on mindfulness and addictions research for many years, she saw the incredible potential for psychedelic medicines to deepen the psychotherapeutic process, and open up new avenues for healing. She believes that the use of novel evidence based therapies can transform clients lives, and help to move towards greater wisdom and wholeness. Hi, everyone, how are you both?

Dr. Michael Verbora 02:07 Doing well, thank you.

Diva Nagula 02:08

Thank you so much for joining me today. I\’ve been really excited to have you on board and to really have a great discussion about psychedelic-assisted therapy. And usually, when people are kind of involved in psychedelic-assisted therapy or anything in the field of psychedelics, a lot of times people have had personal experiences that have transformed them, they\’ve had family members, or they\’ve witnessed transformations. How did you guys get into this field?

Dr. Michael Verbora 02:33
Sabina, do you want to go ahead and take it first, ladies first?

Sabina Pillai 02:54
So you know, I think I mentioned a little bit I started my career in psychology, with the belief that a holistic approach was missing from the biomedical model of care. I think it tended to pathologize the human experience and decontextualize the roots of mental and physical imbalances. So I pursued a research interest in Buddhism and psychology during my master\’s, and I believe that mindfulness meditation could fill that gap. So I see many similarities between the psychedelic experience and the meditative one. And I was really compelled to move into this direction after seeing the research that has come out in recent years. So I began working as a ketamine-assisted psychotherapist after doing some research on ayahuasca. I had been doing some research on ayahuasca for eating disorders. And I saw the incredible potential that it had for something that was so incredibly treatment resistant, like eating disorders, and so incredibly lethal. So the legal status of ketamine-assisted psychotherapy was definitely a motivator. And I saw its potential to kind of break through these plateaus that you start to see after working as a psychotherapist for many years. So it\’s been exciting to have a new tool that can help individuals experience new perspectives, learn new ways of being in the world. And I think there\’s incredible potential here to not only heal the individual who is suffering, but to address the suffering that\’s happening within local and global communities as well as the environment right now. You know, I know this has been talked about a lot, whether facilitators need to have experiences with psychedelics, in particular, to be able to do this work. And I\’ll say that, you know, while it is helpful and beneficial, you know, I really think that therapists and guides and facilitators can get that experience through a variety of means, you know, learning how to be comfortable with altered states of consciousness, and an understanding of the transpersonal nature of these experiences is so important. So these states can be accessed through meditation, through breathwork, through long- distance running, so psychedelic experiences are not the only way. But it is incredibly compelling. Because of how quickly we can see transformation happen.

Diva Nagula 05:32
And it\’s a new, sexy hot thing out there. And Michael, how about you?

Dr. Michael Verbora 05:39
Yeah, so my story comes from the medical side. I\’m a western-medicine trained physician, family doctor. And, when I was graduating, the conversation was always about the opioid crisis, and how opiods were probably doing more harm than good. And I was really looking for alternatives, not just for my patients, but I had personal people in my life who died of overdoses of opioids, and a lot of mental illness and chronic pain and close people to me. And so I was inspired from personal experiences and connections, as well as trying to find alternative options for patients. And that really led me down the cannabis route. And so for the past five years, I\’ve been working with the cannabis plant, and I helped transform so many people through that botanical, and I look at THC as kind of a mild psychedelic. And while cannabis has been very therapeutic for a lot of my patients with chronic pain or children with epilepsy or autism, or anxiety and insomnia when used properly, a lot of them still are looking for a deeper transformation. So I find cannabis really takes the edge off, and it can really help with your day to day symptomology, but to kind of revisit past traumas or experiences that really weigh you down, emotionally and physically, we need a much more potent psychedelic, and that\’s where drugs like psilocybin or MDMA, or ketamine come into play. And so I joined Field Trip, coming up on about a one year anniversary now, with a goal to take some of that learning from cannabis, which was to institutionalize knowledge and expand across Canada, we opened up about 20 clinics and trained, you know, hundreds of doctors and nurses to prescribe cannabis, treated over 80,000 patients, and we want to take that same philosophy and experience and bringing it to psychedelics. And obviously it requires a lot more personalized touch and a lot more sensitivity around these drugs. And that\’s what we\’re trying to do, we\’re trying to provide the very best experience for patients, which is a combination of using these therapeutic drugs to open up the healing opportunity with therapy, and really let individuals be their own healers and I\’m just excited, motivated and inspired to be here today, to provide this service to patients.

Diva Nagula 08:02

You have some great experiences. And I have personally had a lot of experience with psychedelics, and that has aided me in a lot of the healing that I needed from a lot of the trauma that I\’ve experienced in my life. And I\’ve actually had a few patients, that I\’ve actually helped transform their lives by ketamine-assisted psychotherapy. And I just wanted to get into that. So we all know, our listeners are probably all know about psychotherapy, but what is psychedelic-assisted psychotherapy? Can we talk about that a little bit and what it entails?

Sabina Pillai 08:39
Sure. So you know, psychedelic-assisted psychotherapy uses psychedelic medicines to facilitate the psychotherapeutic process. So in general, I would say that what\’s different about this paradigm is that we start with the belief that the individual is not broken, that they already have within them the wisdom that can help them thrive in this world. In this therapy we help them access those parts of themselves, those parts of themselves that might be quiet, that might be hidden, and amplify them through these medicines, right? Help them encounter parts of themselves, they may feel like they lost or they weren\’t developed. So things like connection, things like acceptance, compassion, are acknowledged and normalized even when the surrounding culture may have given the individual a very different message about what is important and what will make them happy. So I see that as the the difference in psychedelic psychotherapy in particular.

Diva Nagula 09:46

And Michael, I guess this might be a question for you but Sabina feel free to if you want to chime in on this, but why ketamine? What are the the useful properties of ketamine that allow this specific therapy to work well?

Dr. Michael Verbora 10:00
Yeah, well, first and foremost, ketamine is really the only legal psychedelic that physicians can prescribe, at least here in Canada and in the US as well. So, one, we\’re kind of trapped in that box but there\’s research over the last 10 to 20 years that demonstrate ketamine that typically sub-anesthetic doses are anti-depressive, or anti-anxiety, have neuro anti- inflammatory properties. And there\’s a whole host of evidence now with IV ketamine as well as observational studies with ketamine-assisted psychotherapy and lozenges that demonstrate that this drug, when combined with psychotherapy, has positive effects for some of the most treatment-resistant conditions, particularly treatment-resistant depression. So we\’re kind of trapped in that box. And we\’re developing the paradigm around ketamine because it\’s the most legally accessible drug. But I think with time through through maps and other organizations who are doing a lot of this research, we\’re going to see a whole host of different combinations of psychedelic-assisted psychotherapy from psilocybin to MDMA to ayahuasca or DMT. And then we\’re going to develop specific therapies that go with these drugs to ultimately heal the individual from a biochemical, psychosocial, spiritual perspective, which is what a lot of Western medicine is missing is encompassing that whole individual and these drugs allow for that.

Diva Nagula 11:29
Yeah, I mean, ketamine is one of my favorite medicines. And sorry, Sabina, you\’re gonna say something?

Sabina Pillai 11:33
They\’re just gonna add to that, Mike, that, you know, yes, it\’s legal. And yes, ketamine is, is considered a dissociative, and yet it can produce incredibly, classically psychedelic experiences much in the way that you might normally think of a psychedelic experience. And that\’s because psychedelic medicine research has shown that certain parts of the brain called the default mode network are quieted during these experiences, as well as in meditative experiences and other states where people experience flow. So this brain network is responsible for a sense of self, and ego, really. So this is the part of you that\’s thinking, judging, categorizing, analyzing – it\’s disconnecting you from the world, but it\’s trying to keep you safe. So in ketamine-assisted psychotherapy, those defenses are softened, that ego is softened, and it allows the individual to open up, be more vulnerable, access forgotten memories, repressed emotions, and really engage in the psychotherapeutic process. So it allows them to see their past experiences with a gentler perspective. A lot of people say that with ketamine in particular, and I\’ve worked with a few others, but ketamine in particular can give them some space from their thoughts, where they\’re watching their thoughts. And I actually find that in particular, compared to all the other psychedelics, it allows them to access a meditative state. And through my experience, facilitating meditation and long term meditation I see that my clients are accessing similar places through ketamine in particular.

Diva Nagula 13:24

Yeah, and I think that\’s great. I mean, I love talking about the default mode network. I mean it\’s exactly where our ego lies and our self-critic lies. And a lot of times, we need this reset and a lot of these medicines, such as psilocybin and ketamine can facilitate this reset of the default mode network. And additionally, with the ketamine, like I was saying, it\’s such a powerful molecule, and it\’s very versatile. And not only can it achieve the psychedelic space for people, but it\’s 20 minutes. So it\’s not like a long trip where people might be fearful of engaging in other psychedelic medicines like psilocybin, or even MDMA, or other types of medicines where the trip can be hours long, and people are very fearful of going in that trip because they don\’t know if it\’s going to be a bad trip or a good trip. So ketamine is wonderful and I and the way it acts, it acts on so many receptors, serotonin, the dopamine pain receptors, and it actually alleviates anxiety as you\’re actually going into the space, the trip space. So it\’s one of my favorite medicines. People are always scared, I\’m like, you\’re not going to be scared – as soon as you feel it hits you, you\’re going to be feeling really relaxed and that heavy feeling and people just easily surrender to the medicine. And one of the things I find that\’s great about this medicine is it has an ability to achieve neuroplasticity. And for those listeners, that really means about the brain being moldable or malleable, and I feel like because of its neuroplastic nature, it\’s really awesome to take advantage of that. And I assume this is why the psychotherapy is so useful.

Sabina Pillai 15:07
That\’s for sure. The window, I think, research has suggested that window for ketamine in particular is about a day and a half. So when clients come into clinic, the way that their treatment is structured is that they have their journey for about 60 minutes to 90 minutes. And it\’s variable how long the medicine lasts, but typically compared to other psychedelics, it\’s not very long, and they have a window of time afterwards, where we can process and integrate that experience. And that is really what we believe is the key to lasting change beyond the effects of the medicine itself, right? Because people can learn and integrate new perspectives, new ways of being, try questioning their patterns, question their previous habits, see things that aren\’t working for them, and start to implement change in their lives.

Diva Nagula 16:02

And do you find that these changes are easier to make when their brain is sort of malleable? And does it stick? And if it does stick, how long? Does it need multiple sessions after the first?

Dr. Michael Verbora 16:15
Yeah, we don\’t know, I don\’t think we really know the long term benefits particularly with ketamine. And we definitely have observational experience, which maybe Sabina can speak to, some of the clients she\’s met. We do see some patients just go back to the same environment. We get some of the busiest CEOs who struggle to make time for themselves and they get this beautiful experience, they commit to the program, they do so well, and it\’s two months later, they\’ve fallen trap into the same routines and habits, and they recognize it, and they\’re insightful, they\’ll come back for what we call a booster. And again, we hope that the medicine with the therapy again, will gently remind them, of the path that they need to take forward to be their healer. But yeah, we need to collect more data as well. We need to know like the Hopkins studies on psilocybin for end-of-life – with the use of psilocybin we know that for that end-of-life anxiety up to five years, potentially, that one dose can still be therapeutic. I personally believe just having a transformational experience and having that mystical experience, just a memory of it alone, I think, really reduces a lot of anxiety, just being able to visit that experience again, in the future, whenever you\’re feeling anxious or worried and kind of just reframing where you are in life and being like, oh, yeah, I remember that experience. I think that\’s therapeutic in and of itself. But how do you teach educate patients to continually access that? But yeah, I don\’t know, Sabina, do you have any, like, patient experiences about the long term effects and how it\’s working for patients in our clinic?

Sabina Pillai 18:02
What\’s really exciting is that we\’re starting to get observational data that we\’ve been collecting at the clinic, from the first kind of cohort of patients that have finished. So now, we are getting a longitudinal data at one month, two months and three months mark. And what\’s really, really exciting is that we\’re seeing a further reduction in symptoms. I would say that 80% of my first clients at one month, two months, in three months mark, do not meet the criteria for depression anymore, severe depression. And again, this is such a limited sample, right. But it\’s really encouraging. It\’s really exciting. And to what Mike said, accessing an experience that is so outside of your day to day life, and knowing that happiness is possible, knowing that connection is possible, knowing that there\’s beauty in this world, when all you\’ve experienced in your life is suffering and pain can be healing in and of itself. And yet I really do think it\’s important to find a way to access these states afterwards without the help of the medicine, right. And that\’s what we work on in the psychotherapy portion of our program is really to translate those insights into action. Right? Because as much as it would be nice to do ketamine every month when you\’re feeling bad, that\’s not realistic. And that\’s probably not advice for most people, right? We need other ways of supporting these experiences. And I think that\’s possible.

Diva Nagula 19:49

Right. And it\’s interesting, I tend to have a mindset of less medication is better. I mean, except for the case of ketamine, which I\’m not saying that you need to be using it on a daily basis, but it can really help people get off of their antidepressants. And the whole reason why people are seeking ketamine therapy is because they have treatment resistant depression. So meaning that they are already have been treated for depression for many years. And they\’re not getting anywhere because they\’re taking multiple medicines that have different effects or synergistic effects. And unfortunately, it\’s not helping. And so what I found is that when I\’ve started to use ketamine, and the beautiful thing about it is that you don\’t need to wean people off their medicines, when you\’re actually going to try ketamine-assisted therapy or ketamine, in general, other psychedelics, you have to have a weaning process to remove them off of their antidepressants, because it can blunt the effect of other psychedelics. But for me, I really like ketamine, because as I see patients getting better and their depression is improving, I\’ll start weaning off of their antidepressants. And there\’s no rebound effect, because that ketamine is still strong in their system. And that coupled with the psychotherapy is magic, and people are able to wean off the antidepressants, and some people can just cut cold turkey. And it\’s fascinating, their sleep improves, their obsessive compulsive behavior is improving, their thought processes are much more clear. I mean, it\’s just a fascinating medication. And the effects are so quick. It\’s not like you wait – when you ramp up the person on Prozac, you might not see the effect for four weeks, with ketamine you\’re seeing it literally after the client or the patient is leaving your office, and the next day you\’re calling them back just to check on them. They\’re saying, oh my god, I slept the night and I felt so great. I mean, I can\’t say enough pleasant things about this medicine.

Dr. Michael Verbora 21:42
It\’s absolutely remarkable to be able to have patients who are extremely sick and oftentimes suicidal. And then just a day later, after coming to the clinic, completely have a light shined on their life and totally feel differently. So the work we do is just so rewarding. And we\’re working with extremely complex patients, and they think with time, we\’re also gonna see that ketamine is safe and probably helpful for people who aren\’t just treatment resistant and extremely sick, but probably for a lot of folks who just have a lot of chronic anxiety, stress, and depression,

Diva Nagula 22:20

Especially right now, I mean, with all what\’s going on in the world with COVID. I mean, there\’s such an increase in anxiety and depression and fear. And unfortunately, what\’s going on is that there\’s much more of an increase in prescription based drugs to treat these things, you know, versus sending them out to people like yourselves, you know, for ketamine-assisted psychotherapy. And it\’s unfortunate that insurance companies aren\’t really paying for this. But there are other means of administering ketamine besides the the intravenous or intramuscular route. What are your thoughts on the S ketamine, which is the nasal spray, and then the oral troches that are out there for people? Are they sufficient to reset the brain? Or is the IV and intramuscular route the best way?

Dr. Michael Verbora 23:03
So there\’s what the scientific literature says, with the best evidence really being for IV ketamine and also the S ketamine, the drug made by Johnson and Johnson, the literature definitely shows those to be the best. But they\’re again, they\’re very biomedical approaches, it\’s again, just taking beautiful drug like ketamine and then packaging it like an antidepressant and just, you know, I find it so cold and impersonal to give people these transformative drugs, and then just put them in a room all by themselves. And who knows what type of experience they\’re going to have. And they have no nurse sometimes available to them, they don\’t have a therapist available to them, and then they have that window of change. And there\’s no one there to kind of coach them on, on leveraging that opportunity. So I think, you know, the opportunity is really wasted when you go down the IV and the intranasal routes, just because the modality doesn\’t involve assisted psychotherapy. And so when we designed our clinics and our model, we spent hours and hours consciously thinking about what is really the best way to use ketamine. And this isn\’t just what the literature says – like the literature is important. But you know, historically, we have so much experience with psychedelics. So we can learn from, you know, other healers and other individuals who\’ve worked with potent drugs to understand how do they combine the synergy of therapy with drugs to maximize outcomes, and I think that\’s where you\’re going to see long-term that you don\’t maybe need to use the drug as often as maybe the intranasal or the IV routes, because you are trying to teach that old brain new tricks through the therapy. So yeah, I have a little bit of bias there. And I think with time as we do our own research and our observational collections, I think you\’re going to see that this assisted psychotherapy model – most definitely we know with psilocybin and MDMA and probably DMT – that is going to be the model. You\’re not going to get any of those drugs and IV or intranasal from my knowledge and in a white room and in a hospital setting – you\’re going to do those with therapy. So I think that\’s really going to be the long-term model. And I think this IV, intranasal thing might just be a temporary stopgap. But iit\’s unfortunate because these companies who make these drugs are very clever, I getting the insurance companies to cover it and doing the right research to get that and so they make it a little bit more accessible for some individuals, but it might not really be the best model.

Diva Nagula 25:33

Hey, Dr. diva here, thank you to all my listeners who supported my book and helped to make it a huge success. You all have helped us hit number one in Barnes and Noble. Number one in oncology, cancer, healing, and medical ebooks, and number 21. In all the Kindle Store, you\’ve also helped us hit number three on the Wall Street Journal bestseller list. If you haven\’t received your copy, you can find it on Amazon, Barnes and Noble, or books and million.com visit from doctor to patient.com to become part of our growing community of health and wellness aficionados. And to learn more. If you like our book and podcast, please go to amazon.com to write a five star review and go to Apple podcasts to also write a five star review on this podcast or any of our episodes that you enjoy. We need reviews to attract insecure top notch guests for this show. Thank you so much for your support. And I really wanted to get some information from you, Sabina, because you\’re with the patients during their sessions. Can you take us through a session in terms of what the patient goes through from the beginning to the end and how the therapy sessions are lined up? And how the actual ketamine therapy session plays out? Sure, yeah.

Sabina Pillai 26:54
So you know, individuals, at least in Canada, they are assessed by a psychiatrist, and then they are referred here. And we have a psychotherapy, intake assessment, that\’s really both for information gathering and to establish a therapeutic rapport, which we believe really is the ground in which a client, you know, can achieve transformation, right, they need to feel safe with us, they need to feel understood. So we really tried to develop that strong relationship. And really that container in which a psychedelic experience can happen. So they come in, and they will have essentially six ketamine assisted psychotherapy sessions, and three integration sessions. So for every two ketamine sessions, they\’ll have one integration session. So in that sense, you know, the, the ketamine kind of builds up in their system. The psychotherapy also kind of builds over that time. So a journey kind of happens in this clinic. So you won\’t find necessarily, of course, there are outliers. But this is a process that unfolds over the course of time over the course of six to ten sessions. So clients will come in, they get fitted with monitors so that they can monitor their heart rate, their blood pressure by a nurse. And we have recliner chair, a weighted blanket, headphones, eye shades, that really allows clients to feel safe enough to go inwards and explore their internal landscape. I, as a therapist, sit with them throughout that experience. And ketamine is kind of different from other psychedelics and that it is quite an internal experience. So a lot of clients don\’t feel like talking during the experience. So we allow them to have their experience in this safe, comfortable, warm, inviting setting, and then they come out of it. And then that period after is such potent, psychotherapeutic work happens during that time, because client\’s defenses are down, they feel a little more open and vulnerable, little less anxious. So, you know, if they\’ve had a classically psychedelic experience, you know, that\’s very symbolic. We do something that might look like dreamwork and explore the themes and images that came up from that. And sometimes it might be a milder experience, that facilitates and accelerates the psychotherapeutic process; allows them to access emotions and memories they may have forgotten. They get an opportunity to have a bird\’s eye view on their issues. And with that distance allowing for an easier ability to face themselves and their experiences. So while some of the research has suggested that mystical experiences, lead to better outcomes, what I\’ve been seeing in in the clinic, actually, is that the psychotherapeutically-focused sessions really are the ones that lead to life changing experiences, because clients get to process a lot of the things that they\’re coming in with. And it leads to more durable change, right, because the mystical experience can fade, right, we want them to be able to really work through some things while they\’re here. So each experience adds a different dimension to the overall journey. And I really think that what happens in the clinic is that a meaning making process happens in the experiences so clients have an opportunity to rewrite and reframe their story, maybe one from a victimhood to one that\’s empowering. They come to understand that the worst experiences of their lives don\’t have to define who they are, there\’s so much more. So they really get an opportunity for an experiential understanding of things that previously were just ideas, you know, so broadly speaking, some of the things that we\’re seeing in the clinic, would be an expanded sense of self, increased cognitive flexibility, increased mindfulness, increased self-awareness, increased contact with emotions, both positive and negative, right. Acceptance of oneself and one\’s experiences, increase self-compassion, reduction in self-evaluation and judgment. Clients are more able to move flexibly through the world. Whereas before, it was rigidly defined by their past experiences. So I really think that love and connection are at the heart of these experiences. And it\’s at the heart of the human experience. So it\’s so exciting to see people come into contact with that, when they haven\’t had that experience in their daily life.

Diva Nagula 31:58

I couldn\’t agree with you more. And it was really well said. I just want to add, in you also have a greater sense of self-love going through these experiences. I wanted to ask you what your thoughts were, because when I do these with patients, I have been kind of experimenting. And from my knowledge of the literature, the brain becomes plastic pretty quickly when the medicine hits the system. And during that 20 or 30 minutes, when they\’re really under, it seems to me that the brain is….they can\’t resist anything, because it\’s just so in that space, and the medicine has really affected their brains so much that anything that\’s being said to them, they can really take in and not have their ego fight it. So what I\’ve been doing is like, I will sit there and plant seeds of positive affirmations during that time where they\’re under, and I don\’t know if you\’ve had an opportunity to do that. But I mean, obviously, you do the therapy after and even sessions after, but during that 20 minute window or so, right after about five minutes when they\’ve dropped in – it\’s about 20 minutes. I\’ll start like every few minutes – just say some positive affirmations. I don\’t have any data, if that really says anything, they don\’t have good longitudinal data. I haven\’t seen that many patients. But I\’m curious if you\’ve done that, or what your thoughts are on that.

Sabina Pillai 33:15
It\’s great that you bring that up, because I do actually think that period of time is so potent. And you\’re right, they can take things in more of both the positive and the challenging as well. In Toronto, we use sublingual lozenges, so that gives about a 15 minute period of time, where they\’re absorbing the medication. And I usually start with a guided visualization or mindfulness exercise. And I infuse that with their intentions that they\’ve come in with to remind them of why they\’re here, what they\’re trying to achieve, and encourage them really to let go, be curious, and embrace the experience. So that is definitely a big part of this process. And it\’s so potent at the beginning. So it makes sense to capitalize on that.

Diva Nagula 34:09

That\’s what I\’ve been trying to do. Mike – I want to change the subject a little bit. We know that ketamine is being used for assisted therapy, but there are also other medications that have been researched for psychedelic-assisted therapy, and specifically, that is MDMA. And can you kind of compare and contrast the ketamine-assisted psychotherapy with with the MDMA-assisted psychotherapy?

Dr. Michael Verbora 34:37
I can give you a little bit of my knowledge. I don\’t have first hand experience treating patients with MDMA. Mind you, we are in the process at Field Trip Health in Toronto to be a MAPS site for MDMA anorexia study. And so that process is started and we\’re just waiting for some approvals. And I do anticipate in hopefully the next you know, couple of months, we\’ll be able to start that trial and have some first hand experience with MDMA and debilitating patients with anorexia, which is a horrible mental illness. But nonetheless, one of the main differences is probably time. With a drug like MDMA, it\’s predominantly serotonergic. So you\’re gonna get this huge boost of serotonin, and that floods the receptors. So it\’s like a love drug – it\’s very heart opening as we describ it. Predominantly, the science being built around MDMA is mostly in trauma. And so it\’s probably going to be the first indication, I think, in the next year or two, it\’ll be MDMA-assisted psychotherapy for people with PTSD. Whether there\’s specific types of psychotherapy that\’s utilized there, I\’m not 100% sure on. But yeah, that experience is going to be somewhere between, let\’s say, four to maybe even six, eight hours, it\’s going to be a lot more intense. You\’re going to have to commit an entire day\’s time to doing that. On the contrary, ketamine is you know, does give you a boost in serotonin. However, it\’s mostly modulated through glutamate, you know, super neurotransmitter I call it. Through the glutaminergic system it\’ll flood a whole host of different receptors. And it will also affect the default mode network. It could be hard opening, people definitely have those experiences. But it\’s predominantly anti-anxiety and anti-depressant is what what we see predominantly. I know, the literature is mostly depressive, but anecdotally, more patients actually say there\’s anti-anxiety effects than depressive effects. So experience tells me that it\’s probably going to be proven to be the best for anxiety, in my opinion. But the experience of ketamine is wonderful, because, you can kind of get in and out in about two hours and the drug experience is only about 45 minutes to an hour, hour and a half, some people metabolize the drug slower, some people like to kind of slowly come out and talk about their experience. Other people, they quickly transition from the psychedelic state, back to reality. But it just lends itself to probably a little bit more frequent use and kind of like quick little resets, rather than something like MDMA, which I think is more of a harder, deeper reset – a much more physically intensive process. But yeah it\’s gonna be interesting to see, not just with MDMA, or ketamine, but like psilocybin fits somewhere in there LSD fits somewhere in there. And these are what we\’re calling macrodosing, psychedelic transformation experiences. And then, you know, in a whole other category, you got even these microdoses, which are sub-perceptual doses, and those might have some mild therapeutic processes. So there\’s this whole spectrum that we\’re just filling in these gaps of knowledge; we have a whole bunch of experience that\’s anecdotal but now we\’re doing the research to understand what\’s the right protocol, the right dose, the right client, to maximize it. I\’m so excited for this future. And it\’s so nice to have a renaissance, and it couldn\’t be coming at a better time for the world, truthfully.

Diva Nagula 38:05

The other thing that I wanted to add, with MDMA – you\’re actually depleting your neurotransmitters, so you\’re flooding your whole system with not only the serotonin, but dopamine and oxytocin. So you\’re just….it\’s that four to six hour window where you\’re just feeling really good and heart open, because everything is just dumped into your system. But the consequence of that is unfortunate, because you\’re left with a little bit of depletion, and it takes a while to replete those net neurotransmitters. So compare that with ketamine, where you don\’t have that depletion, you\’re actually going to be acting on those receptors in a positive way, and not going to be you know, in a situation where the next day or two, you could be a slightly depleted. Now, mind you, there\’s going to be some supplements that people take in regards to, you know, with the MDMA therapy that can help them limit their amount of depletion. But for me, I just feel that it\’s just my experience, I\’ve used both medicines, and they both have different indications for definitely for PTSD and traumatic issues. You know, I see that MDMA psychoassisted therapy is phenomenal – it\’s really been working great. MAPS is the organization that\’s been doing a lot of research with this. But, ketamine is an amazing drug, and you can literally, in two or three hours, you\’re out of the trip, and then the next day you\’re feeling fine, and go back to your work in a positive mindset that you didn\’t have before the session started. So I find that both are fascinating, and both have different indications. But I I\’m just a big believer and proponent of the ketamine. One of the other things that I\’ve been toying with – I don\’t know if you guys have used this – I\’m all about a integrated and holistic approach with anything that I do. It seems like with ketamine therapy, it\’s focused with the therapy and the medicine. But on the other side of it, what I\’ve been focusing on with my clients or patients is also making sure that they\’re transforming themselves in their daily lives. For example, I want them to go to nutritionist to really fix their gut and fix their whole body because that\’s where our microbiome is producing the neurotransmitters that are needed for depression and anxiety. Also with exercise, we know that it has a positive impact on our mindset. And so, it\’s these things that I\’m actually doing with my clients in addition to the ketamine-assisted psychotherapy that I feel is going to make the difference. And that\’s going to stick in the long run. Have you have you guys experienced any of this, or using any kind of an integrative approach with your clients or patients?

Sabina Pillai 40:38
Yeah I agree 100%, that that is important. And that is the key to well being in the long term. So we use an integrative approach here, using the ketamine to facilitate the psychotherapy. And as much as possible, we really try to individualize treatment based on the client\’s unique needs. So I think a key insight of the psychedelic experience is that the individual is not an island – we are fundamentally connected to everything around us. So the food we eat, the air that we breathe, the relationships that we cultivate or don\’t. And the jobs we work all affect us in deep and unseen ways. So with that being known, we strongly encourage clients to engage in other supportive practices to sustain the physiological and mental benefits of their ketamine experience. So these practices can help individuals integrate their experiences, and are essential for long lasting change. So part of the work that happens in the clinic is helping clients notice these connections, which gives them an opportunity to do things differently, or add these activities to their life. So clients are really coming to this clinic, and intentionally caring for and prioritizing their health. That\’s part of what\’s happening here as well. So that is something that they can continue to do through things like mindfulness, diet, yoga, exercise, somatic and body -ocused work, art therapy, music, therapy, developing social connections, all of those things are so important, this doesn\’t happen in isolation.

Diva Nagula 42:21

Right – I think it\’s really important. And Michael, with your experience with the ketamine, is it dose dependent in terms of the results that the patients are getting? Or does it just the fact that the medicine is in their system? And it does the work?

Dr. Michael Verbora 42:39
Yeah, it\’s hard to say for sure. Our approach is really start low and go slow. It\’s just the philosophy we use for now. Although, you know, some people think you should go big and go fast with psychedelics. So there\’s controversy there with the right approaches. But again, it\’s so personalized – we really listen to clients. We strongly believe that our clients and our patients have a lot of intuition. And so when they say I\’m really sensitive to drugs, I think I should start at a lower dose, we listen to them. Or if they say it always takes more drugs than normal to get effects, so I think I should start at a higher dose -we listen to them, we don\’t just say, oh, the science says this, this and that, and you\’re one of a million people in this study so we\’re just going to treat you like that. No, our approach is very customized. And it\’s hard to say what percentage the drug is responsible for. We know nasal and IV work by themselves. We know biochemically. ketamine does help depression. But the psychotherapeutic process is probably extremely synergistic. And so it\’s hard to put numbers on what dose of the drug and to what extent is the drug doing the work versus the psychotherapeutic process. But again, we look at it holistically, we look at it as a program that we\’ve developed that has multiple parts, and that we really strongly believe that this is going to maximize outcomes long term.

Diva Nagula 44:00

Absolutely. Now, I know we\’re kind of getting close to the end here. But I wanted to see if you were willing to share a patient\’s story, because I think you were just telling me before we got on the show that you had some really awesome transformational experiences today in the clinic. Do you mind speaking to that?

Sabina Pillai 44:16
I would love to, unfortunately, I can\’t because of patient confidentiality. But across the board, you know, clients are accessing parts of themselves that they\’ve never experienced, and it is beautiful to witness. It is incredibly rewarding work to see change happen in six sessions, which is really unheard of in psychotherapy. So I will say that.

Diva Nagula 44:41
And at six sessions, we\’re talking – are you guys doing a session a week or two sessions a week?

Sabina Pillai 44:47
Two ketamine sessions and then one integration session. Prep and integration are as essential to this process as the experience itself.

Diva Nagula 44:56

So we\’re talking about a major transformation in such a short period of time, it\’s amazing. I know you guys have your flagship location in Toronto. And you guys are basically going all over the place across North America. Where else do you have clinics located currently?

Dr. Michael Verbora 45:13
So we\’re in LA, we\’re in New York, and I think we\’re in the process of Chicago and Washington. But honestly, I can\’t even keep up because it\’s happening so rapidly. You know, I blink my eyes. And next thing….I\’m actually like, we\’re actually in Amsterdam as well. I forgot. We\’re looking at truffles there and Amsterdam and building a clinic out there. So it\’s honestly happening so rapidly, that you know, it\’s such an exciting movement. It\’s so exciting that Toronto, and the work that we\’ve done and the work that we\’ve learned from our clients is kind of the foundation of what we\’re building here. It\’s just so rewarding to be part of helping people transform for the better and I think, at the heart of all of this is, we talk about ketamine, we talk about the program, and it\’s got a lot of merits, but we really want to be focused on just elevating people\’s consciousness and awareness. And whether that\’s through diet, nutrition, whether that\’s through meditation – we want to be a conscious company, and we want to be a company that helps individuals elevate their consciousness and whatever modality that is, that leads to individual healing, we\’ll be supportive of that.

Diva Nagula 46:24

And that is so needed right now in the world, not only in North America, but all over the world. I am obviously a huge fan of Field Trip, and I can\’t wait for you guys to open up your clinic in my backyard. But for for people who are looking for you guys, what\’s the best way that they can find you?

Dr. Michael Verbora 46:44
Probably online would be the best way. So fieldtriphealth.com would be the best way to get in touch with us. We\’re doing webinars every week or two. So you\’re welcome to join along. Follow us on all our social media channels, where we do a lot of updates, and feel free to reach out at any time. You know, we love building this community. We know there\’s a lot of great people with experience as well that\’s come before us and we\’re trying to take a lot of that experience and bring some science and routine to it. So we\’re open to conversations everywhere.

Diva Nagula 47:17
Thank you you both for taking the time out of your busy schedule to be with me today. And I look forward to talking with you further.

Sabina Pillai 47:25 Thank you so much.