Ep15 Benjamin Malcolm - The Pharmacology of Healing: How Psychedelics Are Transforming Mental Health Treatment

Benjamin Malcolm  0:00  
So you've got all sorts of persons in this game with different backgrounds, experiences, doing all sorts of things. It's a bit wild Westie. They might be shopping for you as a client, but like you have power shop for them, and don't settle for something that is mediocre, because there is something out there that is just great. Welcome

Dr. Sandra Dreisbach  0:19  
to psychedelic source where wisdom meets practice in the evolving landscape of psychedelic medicine. I'm your host, Dr Sandra Dreisbach, and I'm here to help you navigate the complex intersection of ethics, business and personal growth in a psychedelic space, whether you're a practitioner, therapist, entrepreneur, or simply curious about this transformative field, you've found your source for authentic dialog, practical resources and community connection. In each episode, we'll dive deep into the stories, strategies and ethical considerations that matter most to our growing ecosystem, let's tap in to our inner source of wisdom and explore what it means to build a sustainable and ethical, psychedelic future together. The information shared

VO  1:12  
on this podcast, our website and other platforms may be triggering for some viewers and readers and is for informational, educational and entertainment purposes only. It is not a substitute for professional medical professional medical legal or therapeutic advice. While we explore topics related to altered states of consciousness, we do not endorse or encourage illegal activities or substance use. Always research your local laws and consult qualified professionals for guidance. The content provided is as is, and we are not liable for any actions taken based on the information shared. Stay supported and informed. Act responsibly and enjoy the podcast.

Dr. Sandra Dreisbach  1:43  
When working with psychedelics, it's very important to be aware of what medicines, or medications, including vitamins, could possibly have an interaction with the psychedelics you're considering using. Now the real question is, if you're even if you're going abroad or into an area that's legal, what do you do? Who do you talk to? Who can you get support from? And there's one person who I'm really excited that you're going to hear conversations about with today, who's really made it his mission to really help and support people who are navigating some of these challenges, from a pharmacist perspective. And if you have awareness of this space, you may already know him by the name spirit pharmacist, but his real name is Ben Malcolm, or Dr Ben Malcolm, and he is my guest today on psychedelic source. He earned his bachelor's degree in Pharmacology at the University of California of Santa Barbara, prior to his master's in public health and and working on his doctorate of Pharmacy at Toro, University of California, he then completed post graduate residencies in acute Cara Scripps, Mercy Hospital and psychiatric Pharmacy at the University of California at San Diego health after residency, he passed his exam to become board certified at psychiatric pharmacy, bcpp. So he began his career as an assistant clinical professor at Western University of Health and Sciences, College of Pharmacy, before transitioning to current entrepreneurial role in psychopharmacology, consultant psychedelic education and founder of spirit pharmacists. And he envisions a society in which access to psychedelic drugs in a variety of safe and supported settings is available for purposes of psychospiritual well being, personal development and ceremonial sacraments and treatment of mental illness, his focus on the intersection between psychiatric medications and psychedelic therapies. And I cannot tell you how many people make reference to his work giving credit, not given credit. And then this just a call for people to give, give him credit when, when you're referring to spirit pharmacists, when to Ben's actual chart of interactions and medications when you're when you're pre screening, or when you're considering because I feel like, you know, Ben probably doesn't get enough credit for his his influence and support and making supported and well informed choices for people who are approaching psychedelic medicines. Now, granted, we can't give medical advice here on this channel, so just another reminder here that please consult your medical professional or psychiatrist or whomever you consult with before you consume any sort of medications. This is not here to advertise for therapeutic purposes, but it's worth mentioning that, given that a lot of people in pharmacology don't don't focus on this sort of specific training area, and that there's a high demand for psychedelic medicines, this is a really important conversation to have now more than ever. Sure given how many people work with psychiatric medications, and then try and pursue these, these journeys and experiences, even at a micro dosing level. So please receive that proper medical advice. But I hope you'll enjoy this conversation with Ben Malcolm and I about himself, his journey, and also about, how do you do more safer, more supportive experiences in an informed way? Well, hi, Ben, it's so great to have you here on psychedelic source and being able to talk with you about you and your work and relationship, but maybe you could tell our community here a little bit about you and what you do?

Benjamin Malcolm  5:42  
Well, so wonderful to be here Sandra and yeah. So I'm a psychiatric pharmacist by training and background, which roughly means I completed pharmacy school, so I have a doctorate of pharmacy. And after pharmacy school, I spent a couple of years in residency programs. So I did a first year residency program, just in acute care or in hospital based pharmacy, and then I did a second year that specialized in psychiatric pharmacy. And from there, I passed a board certification exam in psychiatric pharmacy. So that's essentially when I say, like, I'm a clinical psychiatric pharmacist. Like, how does that? Like, what the heck is that, and how does it really even differ from probably where, like 70 or 80% of pharmacists are found, which is in the retail world, you know, places like Walgreens and things like that. So basically, I did a couple of years of postgraduate residency in different types of clinical or hospital based healthcare settings that got me to really specialized in psychiatric types of medications and mental health conditions generally. But I have to be frank in that I had a very long standing interest in psychoactive substances, even before I chose that specialized path. Towards the end or even after really pharmacy school. I mean, I just been fascinated with psychoactives, or even, like, addictive types of substances as a teenager. There was just an experiential and intellectual kind of curiosity there. But I think that was different, right? It's like a lot of teenagers I think have some sort of experiential curiosity, but mine was extremely intellectual at the same time. Like I just didn't like, I wanted to know, why is it that drugs that had physiologically opposite effects, like cocaine and heroin would converge in this like, behavioral pattern of addiction, like I didn't really like under stand that, and I wanted to and so it led me to, you know, every mother's wish come true. You know they come in and it's the evening time, and you know their teenage son is looking up illicit substances on the internet and just reading different anecdotes about them and things like that. And so it was through that process that I came across psychedelics, like psilocybin mushrooms or MDMA, and just reading anecdotes of things like methamphetamine, cocaine, heroin versus anecdotes around psilocybin mushrooms or MDMA, it became apparent to me that even though they're all regulated as illicit substances, the pharmacologic effects are very different, and the average trajectory of use is very different as well. And you know, I think that this speaks volumes, that by the age of 16 or 17, you know, just through reading on the internet, it's just apparent that the public health policies or the drug regulation policies of the country that you're living in are not evidence based. They're not altruistic, and they're not really set up to protect public health. And there are certainly examples of drugs in this category which don't even really fit the definition for being in the category which to be an illicit substance it should be it has a high potential for abuse and no therapeutic or ability to be used safely under medical supervision, right? And so that's a really important point. Those things were not true about psychedelics. I don't know when I was discovering this, like, 20 years ago, and they're definitively proven not true about psychedelics today. So it's been a long, circuitous, educational and interest based path. And I would say the, you know, I had no like, when I was, like, getting into this stuff, or, like, just kind of, like, feeding this interest as a as a teenager and going into undergraduate, I had no conception that this is what I would do in the in the future, but at this point in time, I've taken all my skill sets as a clinical psychiatric pharmacist, and I function as a psychopharmacology consultant through A website, spirit pharmacist.com, and I essentially try to be an informational bridge between a psychiatrist and an alternative health practitioner that facilitates psychedelic substances, or maybe less alternative, but maybe it's like a therapist, or there's lots of different professionals, I guess, in different settings, that could potentially facilitate a psychedelic experience. Variance, and I'm really trying to bridge an informational gap so that the person that's interested in this modality just has enough information about their mental health conditions, the existing medications they take, and the types of things that they're interested in doing or trying, so that they can make sound and empowered healthcare decisions for whatever they really want to do. And sometimes it's, I do want to do it after that conversation, and sometimes it's, wow, there's a lot more risks here than I really sort of thought or anticipated. And it doesn't seem like the kind of thing that I want to do right now. Perhaps,

Dr. Sandra Dreisbach  10:34  
yeah, yeah. And I love this, and I love your story, and I'm curious, like, what was the first drug or substance as a teenager that made you go, huh? Like, what? Where was the real Inception piece for that intellectual curiosity? Like, was there something you saw? Was there a person was, you know, there had to have been something. I kind

Benjamin Malcolm  10:58  
of said it backwards in the story, like I said experiential, when I meant intellectual, right? And so it was actually a and e, it was like that, that reality TV show intervention on a basically, like they had, like a person, and, you know, they'd be horribly addicted to some substance, and then it would be like, let's get all their closest friends and family invite them to a surprise meeting, and then basically be like, you go to rehab now, or you're cut off, right? Which is, frankly, just a horrible, horrible model for treating addiction and substance use disorder overall. But you know, this is the late 90s, early 2000s like the absolute peak of total trash reality TV, right on the heels of Jerry Springer and things like that. And so it was like, Wow. It was like, fascinating kind of stuff that stoked that intellectual type of curiosity. But it was, it was psilocybin mushrooms I ate when I was camping my senior year of high school, and I was 18, that really sort of like, oh yeah. Wow, wow, wow. Like nature is alive, and I'm a part of that. I didn't really realize that before, you know, my parents would drive me around to just gorgeous places like the Grand Canyon and stuff, and be like, All right, let's, let's get out and take a look and be like, Donkey Kong on Game Boy is more fascinating than this. Like, oh, I'm bored. Yeah, you know. And it's like, this is literally one of the most mystical, magical, natural things you could possibly lay your eyes on, and you can't even see it. You know what? I mean, you just can't even

Dr. Sandra Dreisbach  12:35  
see there really was, like, this combination of like that, intellectual stimulation and curiosity, but also noticing from your own experience a real shift of experience, after having had an experience with with the mushroom,

Benjamin Malcolm  12:49  
yeah, yeah. Like, I mean, that they always did something for me, right? And it's not like, as an 18 year old, I was kind of like, ooh, psychedelic assisted therapy. And, you know, like, that really wasn't, I mean, I'm sure it was a thing somewhere, but it wasn't a thing on the sources that I was reading about psychedelic trauma, and it wasn't something, yeah, well, I mean, this is like 2002 right? So it's like, I mean, Roland Griffith published his seminal article on the mystical consciousness of psilocybin that essentially, kind of repeated some of the themes of the Good Friday experiment in 2007 right? Like these are like real early days where the National Institute of Mental Health might be just starting some trials of intravenous ketamine for refractory depression. So it really isn't 2010 through 2016 yet where all of a sudden there's randomized trials for MDMA, psilocybin, s ketamine, spravato is getting approved. The FDA is giving breakthrough designations to MDMA or psilocybin, right? That was the era where I was just finishing my PGY two year in psychiatric pharmacy. So sometimes when people like, how did you get to be doing this? I'm kind of like, well, I had a long standing interest, but I also was just in the right place at the right time, and that the culmination of all my graduate school and training, just so happened to coincide with when the time that the world got really interested in this overall

Dr. Sandra Dreisbach  14:14  
but, but you obviously had an a personal interest, because, like, I mean, it's not like The standard fare that the clinical psychiatrists are like, Yeah, let's, let's integrate, you know, psychedelics in our work. You know, it's like, I'm not going to, I mean, as much as I love my Walgreens and my Walgreens pharmacist, thank you for your work. I don't ask them about psychedelics,

Benjamin Malcolm  14:33  
yeah, of course, right? But, but, but, I guess what I'm saying is sort of like, like, even in pharmacy school, like, 2000 them, two 2014 you know, it's like, we get to the where we talk about psychedelics. And, you know, the lecture is called, like, hallucinogens of abuse, or something like that. Ever getting into this lecture in this light, this and that? And, you know, there, it's like, it's like, well, blah blah, blah, blah, blah, blah, I can tell you about peyotism. And. Its origins as a religion, or, right? Like, I can't pronounce it, tell you that, like, no, it's like, oh yeah, to knock the, like, flesh of the gods. Like, that's what that means, as far as the mushrooms, right, and things like that. And, you know, the teachers and professors would be like, I mean, like, the, I mean, the students, I mean the other kids that, like, it was like, tongue in cheek, but like, a little bit real, they'd be like, Ben, you're like the captain of useless information. It's like, you know, like so much about things that are completely irrelevant to the world of pharmacy. You know so much about the world of drugs that's just irrelevant to pharmacy. Was like, how it was like 2008 through through, like 2014 or so. And then all of a sudden, the world got interested in the useless facts, right? And right, it became like, this is incredibly valuable information that we can't get anywhere else. And and so right, the world got interested in the things that I was just like nerding out on for a decade before that, but the fact

Dr. Sandra Dreisbach  16:03  
that it was even seen as like, not even useful in terms of your main training, right? You know that that not only was it not a focus, or not even like, Okay, here's a special class on psychoactive plants, and you know the medicinal uses, right? Or how to help that pharmacologically, if you have a patient who has those issues, it wasn't even on the official radar. It was not considered at least, at least some of the conversations, right, useful,

Benjamin Malcolm  16:32  
right? Well, I mean, like, how can it be useful? Like, like, from that, from the angle of your profession, like, how can it be useful if the substances are regulated as illicit substances, right? And you're training pharmacists in pharmacy school. Are you going to be training them to sort of be like, you know, what the lines of the law you decide where those go? And you know, this class of substance that the FDA has not approved for a medicine and is supposed to be, you know, too dangerous to be used, even under medical supervision, right? Like, like, from the angle of a profession, like, from the angle of the profession's ethics, the professionals should never cross Legal Lines, right? And so anything that exists over a legal line informationally is just going to be viewed from the angle of that profession as useless information, right? But from the angle of the public, it is not useless information, right? And I always just thought this, just like, generally, is kind of like, like, before I thought of spirit pharmacist, right? Like, I literally thought of street pharmacist, right? Because I was just sort of thinking along the lines of, well, here we are in inpatient psychiatry. And you know, this person came in and their urine toxicology lit up like a Christmas tree with cocaine and amphetamines and things like that, and they're coming down and crashing, and of course, they're horribly depressed and blue as far as coming down and crashing. And now the team is like, let's start Prozac a sip 2d six inhibitor. So let's get this straight. We're going to start an antidepressant that is actually going to interact with cocaine and bump its blood concentrations. It's like, is that going to be a smart plan for that person? Are we convinced that this 72 hour hold is going to be enough to stop their cocaine habit, or are they going to go out and unless we get them teed up with some kind of treatment, probably use again and we actually just increase the hazards of them using cocaine by giving them a strong sip 2d six inhibitor in the background now, right? So there's sort of like a relevance to considering that not all of your patients are going to stay within the sandbox of the lines and may not even be able to do those kinds of things, and unless you're going to provide a real intervention and plan for them, right, we probably shouldn't be prescribing any medications that just interact with the illicit things that they're doing on the outpatient side, because we want to reduce harm, not increase it by, you know, adding something that's going to be a metabolic monkey wrench to the illicit substances that they are most likely going to continue using, and

Dr. Sandra Dreisbach  19:12  
things like that, you know, pragmatics, you know, like it's really is, you know, I mean, and maybe, maybe this is too soon to bring this up. But like, people talk a lot about now, about fentanyl, and they talk a lot about opiate abuse and addiction, and part of the blame has been pointed to the pharmacological industry and the over prescription of oxycodone, right, and other you know, opiates right, that are legal, opiates right, that are trained, that are part of the official, you know, bread and butter that we can talk about as a trained pharmacist, like I am not a trained pharmacist, just be clear. And yet, there's this rift between talking about these other quote, unquote, illicit subs. Instances that actually, as you mentioned, right, half therapeutic use with medical supervision, which is, I think, the argument you're suggesting, which I would agree with you. And I cannot say from any of my professional I'm an ethicist, right? But, um, how do you, how do you show up as a pharmacist with the knowledge that you have to really help people in a grounded way, within the means of your profession and maybe outside. I don't know. I don't know what the strictures are given, given the environment, right? Because, you know, we can't just, like you say like, we can't ignore what people are really experiencing, what, what addictions or dependencies they may actually have, regardless of where they come from. If you really are going to serve people based on clinical pharmacology,

Benjamin Malcolm  20:50  
there's a lot of things there, right? So first of all, I really do believe that the pharmaceutical industry played a huge role in the current day, opioid epidemic, you know, it was probably the mid 80s, and at that point, it really was like, opioids are for acute surgical pain or pain associated with terminal illnesses like cancer, right? But it really was not for any kind of like, oh, I have osteoarthritis in my hips, or it really wasn't for any kind of, like chronic, ongoing pain kind of of indication. Was not really a use case for opioids. And then, you know, it was petitioned and petitioned and petitioned. It's like, well, this is cruel. We have a tool that we could relieve suffering with, and they're suffering chronically. And we're going to withhold the how cruel, right? But of course, there was no long term trials of opioids demonstrating that they actually reduce pain in the long run and reduce a person suffering in the long run. It's all limited to like acute surgical things and and stuff like that. And so you got this kind of creep of pain meds out of right like, almost like terminal situations or acute surgical pain, basically into any chronic illness that has pain, which I don't know for a population that's got some extra weights on their joints and needs a hyper inflammatory type of diet and things like that. Is like, you got a lot of people with chronic pain that all of a sudden qualify for for opioid use. So that was sort of on the outpatient side, and then the inpatient side of it, I mean, Jayco, like the Joint Commission of hospital associations, and around the year, 2000 added pain as the fifth vital sign, respiratory rate, heart rate, blood pressure, temperature, all of those are objective, measurable things. And then how much pain are you in one through 10? And you know, flipping the remote and having a pork sandwich and 11?

Speaker 1  22:59  
Yeah, or the smiley face. It was this, better, better bump

Benjamin Malcolm  23:03  
it up and have another shot of hydromorphone or what, right? So, so it sort of became this, like, Hey, why are we measuring a subjective pain score? Like it's a vital sign, like it's an objective kind of like measure, right? And it was like, well, pain must be treated if there is pain, right? So all of a sudden, you got a lot more pain bed use inside of inpatient settings or hospitals as well. And then, of course, you've got, you know, Purdue pharma and OxyContin and their pharmaceuticals rep strategies, which, I mean, right? The I think it's the city of Los Angeles who sued them for racketeering. And, you know, it's an alleged thing, but I would be willing to testify for the city of Los Angeles. Let's just put it that way, as far as, like, the strategies that they're using to sort of advertise these types of things. I mean, why the heck you're advertising schedule two controlled substances that are habit forming. Like, I mean, you shouldn't need to advertise those types of things. Slash, you know, every other country in the world would just make that illegal at baseline. So, yeah, that like, that's like, I do think that industry had a big piece in that. But I also wanted

Dr. Sandra Dreisbach  24:17  
to bring out I really appreciate. I want to take a pause on the notion of chronic pain, because I think that's a really important subject and and I know at least for myself, like I have friends who have, you know, severe chronic pain, and what first opened me up to micro dosing years ago was having a friend who had experienced chronic pain, who had done all the official like chronic pain management, she was told by her doctors, right and, and either she'd be too doped up, right and, and so start opening up to doing some intranasal ketamine, and some doing, you know, low dose of MDMA and some other things to try and literally self drug herself into the right of. Amount of a pain management strategy, including pharmaceuticals that were given to her by her physician, and finding herself in the sort of self subscriber prescriber situation. And it really made me think differently, because, simply because, like, she's just and she also would use kratom, right? And finding these different strategies to try and mix because, like, having opiates all the time wasn't really a functional option, you know, lots of different reasons, right? And I've met a lot of people within the chronic pain community who've turned to psychedelics and psychopharmacological solutions, or I did a lot of kratom advocacy just by that, just because it was an opiate alternative, right? It's not a solution in of itself. Anyone out there, but so I'm kind of curious, you know What? What? What I know a lot of times people associate, you know, spirit pharmacists, with you know how to find the right match, or that your lovely chart that has served a lot of people and you and you probably don't get enough credit for that chart, because I know it's helped a lot of people. I still remember meeting a UCSC student of mine before I was talking about psychedelics, showing me a chart. It wasn't, it wasn't yours. I think it was someone else's. But I was just like, shocked. It like he was looking at it, as if it was, like, the perfect recipe chart. I'm like, okay, I can do this. And then again, then I can do this. And I'm like, wait, that was really disturbing to me, but at the same time, I'm like, well, at least there's someone who's trying to tell people how to manage these things and give them some real world advice in a pragmatic sense, like, you know, people don't want to risk their health by working with psychedelics. And sometimes people are trying to help their health by working with psychedelics. Could you, could you speak a little bit about, you know, who are the types of people that you end up helping the most? Well, I

Benjamin Malcolm  26:55  
think it's less than like a person that has like, chronic pain that's like, kind of like on opioids, like I do meet some persons like that, but frankly, it's a lot of persons that usually they're over 35 usually, not always, right? I get quite a few. They're in the 20 to 30 range. But I'll say like 60% ish, 60% of the people that I speak with are age 35 to 75 probably about two thirds female, like, compared to male. A lot of them take antidepressants. They've been taking antidepressants, usually for a relatively long period of time. So I think that's like one like just mainstay person is a middle aged female that's been taking antidepressants for a period of time that they typically work for some period of time, or they helped a little bit, but they kind of tend to peter out. Maybe they've tried to stop them a couple of times and it's been not very successful, or, like, kind of like partially successful. And then they're looking at either micro dosing or using larger doses of psychedelic with guided support, kind of as an alternative. And then I meet a lot of persons that have, they're, they're somewhere with a bipolar spectrum, right? And so it becomes like, I think severe bipolar disorders are really thought of as almost a black and white contraindication for psychedelic use. But there are, sure are a lot of people out there that are diagnosed with either a very mild type of bipolar condition or it's really questionable, like, it's kind of like, maybe you have a bipolar condition and it's a lot of those types of people that we end up doing fairly individualized types of evaluations on and sort of trying to figure out, like, hey, which side of the fence might you be on the side that is, it really is kind of higher risk, to the point that it may not be in your favor to try that. Or, hey, you know, we could think about a couple of these things as red flags, but there's also some mitigation strategies and ways that we could reduce harm. You know, it's kind of like you have a few choices, right? You can say driving is dangerous so nobody gets a license. Or you can say driving is dangerous, so you need to pass the test to make sure that you have a license. And then if you go driving, you got to stay on this side of the road. And we want some safety features in that vehicle, like seat belts and airbags, and then there are some stop signs and red lights and things that you're gonna have to pay attention to as well. What are the choices here? Tell the person with a bipolar condition, nah, psychedelics aren't for you. We're not gonna touch it with a 10 foot pole because you're bipolar and crazy. And then what they're applying to the next retreat center and not disclosing their bipolar. Condition, or just ordering the psychedelics and eating them themselves at home, two situations that would that we probably really want to avoid because they're higher risk than just actually evaluating the person and trying to button it up with a harm reduction kind of approach.

Dr. Sandra Dreisbach  30:17  
And what are some of the strategies that you tell people, because I think you're absolutely right, because, like, people know about the whole like, oh, people only with unipolar depression were approved for a lot of the research studies simply for the simplicity of a research study. By the way, people you know doesn't mean that it's you know, counter indicated necessarily for bipolar. It just means it's simpler or what they chose. And I can't speak for that as a researcher, in that sense, but I think a lot of people are eliminated just because, like, Oh, if you have any history of psychosis, if you have any history of psychiatric disorders, if you have been diagnosed with bipolar depression, let alone the fact that people are misdiagnosed with that, that they'll either will not disclose it to people and still be a part of those experiences and increase their risks by not disclosing to people, or simply they They'll actually take on, you know, additional risks by combining it with their medication. Right? Well, what are some of the general pieces of advice that you give people who have some of these, you know, quote, unquote, counter indications. I know each case is different, and I know you can't, you know, well,

Benjamin Malcolm  31:28  
so, so, yeah, exactly. So each case is, is, is different. But what kind of things that we could we look at to, sort of, like, Tell those differences, I guess, right. So, one of them, I think, is just the age of the individual like overall, like bipolar conditions are usually diagnosed at late teens through mid 30s or so. So when I get a person that has a bipolar condition and they're 19, right? Or maybe they're 19 and they only have a unipolar condition so far, right, it's like that's an age range where there is a potential to unmask a more serious condition, and probably a good two thirds of the time, maybe three fourths of the time, the person is going to present with depression before they present with mania. And you spend usually two to three times more time in depression than in mania. So if you have a bipolar condition, usually you're more bothered by depression than mania. But if you're a society, you're a lot more bothered by mania than depression. So there's a little bit of like, we're not necessarily seeing the condition on an eye level. As far as like, what our goals are, I think society's goal is no mania ever. I think, like, the person's goal is, usually, I wish I could get out of bed and function, and I would much rather be going a little too fast than this slow. Like, overall, meet a lot of people in inpatient psychiatry that are like, floridly manic, and then you treat them with mood stabilizers or antipsychotics for a few days, and 345, days later, and they're like, Doc, and the insight comes back. They're like, Doc, I know I'm going too fast, but Don't slow me down too much, because they fear the depressive pull. Like, seriously, they're kind of like, oh no. After this mania ends, it's just I'm gonna crash flat, flattened out. So I think psychedelics are probably helpful for depression, whether it's unipolar depression or bipolar depression. I think particularly the serotonergic psychedelics may have a real risk of precipitating mania, and we've seen that before. I think dosing in sets and settings do make a difference as far as the risk of that goes. Some other things I like to pay attention to, right? Are the substances that you've tried in the past and what happened with them? Right? Because SSRI monotherapy, just antidepressants, can push a person with a bipolar condition towards mania, heavy cannabis use, particularly high THC varieties, things like nitrous or PCP, prednisone and corticosteroid types of medications, psychedelics, some of them have tried them before. And if they've tried psychedelics 15 times in the past, and it's never, ever been associated with mania, that starts to feel sort of reassuring in some ways, compared to a person that is 22 years old and psychedelic, naive and had a manic episode in response to taking Prozac the first time they were prescribed it, right? And so by looking at kind of like, the age, and I'll say like, like, like, how many episodes of mania Have you had? Have you ever needed to go to the hospital for it? What kind of treatments work for you, right? If they're kind of like, oh yeah, like 100 milligrams of ceracoal and a half milligram of Lorazepam twice a day, it's like, it puts the brakes on and it stops, and it's like, All right, well, maybe we need to make sure that we have a bottle of cerical and Lorazepam on hand. Then if we're gonna do this right, that feels like. A seat belt and airbag type of thing, right? Rather than, well, I haven't seen my doctor in a year, and I sure hope I don't get manic, and I'll have to call up their office in three weeks from now, they can see me, and it's like, Oh yeah, that was a bummer, huh? We probably should have nipped that in the bud ahead of time. Had emergency prescriptions on hand, or either called into the pharmacy to pick up then maybe even put an appointment with them on your calendar three or four days after whatever you're planning, so that you can check in with them and they can evaluate your their mental status, or a therapist that knows you well, or a partner that's seen you across years in a few different states, right? It doesn't necessarily have to be like a concierge doctor you hire for hundreds of dollars and things like that, it can really just be somebody that knows you well, that would be able to look at you and say, like you're talking really fast, and I can't get a word in this conversation right now, and that's concerning to me. And so this is whatever the next step is. I want you to take that 100 milligrams of Seroquel tonight, and I'm gonna call you again in the morning, right? And really start following close at that point. So that's what I mean. Like, there's a lot that we can do as far as checking under different kind of stones, as far as treatment responses, things you've tried, things that set set off mania, things that really didn't, treatments that have worked, treatments that have been adverse, and there's no way in heck we're going to retrial them. Right? Like, what does the support look like, as far as persons that have helped you in the past? Can we put that in place? No, probably not. Traveling to South America, where you're out of touch with the world and off grid, and gonna do, you know, eight ceremonies in nine days, or something like that, right? Like sometimes laying on the sauce really thick in places where you can't get immediate help, should you need it, may not. I mean, that's a higher risk scenario overall, right?

Dr. Sandra Dreisbach  36:59  
I really, I really love all of what you're sharing. Because, first of all, what I really appreciate hearing is this aspect of partnership that you're showing like, not just in terms of, you know, as a as a pharmacologist, you know, working with the patient, really listening to them, listening to their personal history, understanding that, which obviously I feel like all pharmacologists should do, but but also this aspect of, like, well, what has been your history? What, what can, what plan can you put in place if you are going to have these experiences, you know, given your risks, what kind of and having that sort of team approach, whether it's like a friend, a family member working with, you know, whoever they currently work with as a pharmacist, right? Or their their therapist, clinical or otherwise, so that it's not necessarily like, it's not a hell no, right? It's like, well, let's, let's really look at this. What really risks, you know, let's, let's really think about it from a real practical standpoint, and prepare you like you said. Put on, you know, have a seat belt, have the supply, you can still go driving. But you know, you know you may need, like, your set of glasses, or you may need someone else to who can drive if you really can't drive, or maybe you can only do one ceremony, or maybe it should be something more local, you know, a different, different way of looking at it, than, than just saying, like you can't. And who's our special guest here today?

Benjamin Malcolm  38:24  
Oh, we've got, well, this is her full her full name is Samadhi, but it's just Sammy. And have some people that are helping us out downstairs. And Sammy is very territorial. She's not a huge fan of intruders, huh? And even if it's an intruder that comes every single day and is, like, super friendly, it's like the same thorny welcome from this one, yeah? And

Dr. Sandra Dreisbach  38:50  
it's a good protector, well, and maybe, maybe we should take a tip from somebody here, you know, like, it's about, about having practical protection and support, right? You know? I mean, like, I think there's a lot of people who all hear like, Oh, you have to get off of all of your substances. You know, I don't care what it is, you know, wean off of everything is also like a sort of anti pharmacological, sort of orientation, sometimes in the psychedelic space, that's like, No, you shouldn't be having any any chemicals, any synthetics, in your system. And we need to get you off of all of it, even if they're quote, unquote tapering, and whatever their sort of version of tapering is, there seems to be, at least. And this is just my personal perspective. A lot of you know people winging a pharmacological mindset, um, but from an uninformed lens, they're like, oh, no, I've seen this multiple times. I've really experienced it. I've been, I've been working with people with this medicine for 10 years. I know exactly what I'm doing, right? Um, what? What kind of advice? Yes, would you? Would you give someone who's thinking about, I know, obviously, again, can't give an advice for everyone, because you have to work with them individually. But, but, but what do you say to the mindset of like, don't, don't use with any pharmacology?

Benjamin Malcolm  40:18  
Oh, it's very puritanical. It feels like Yeah, it kind of Yeah. I mean, on the one hand, it's almost like prescriptions are a bit rampant in in some ways, and I do think that there's a level of over prescribing with meds and classes of drugs were the sentiment of like, questioning and becoming curious about like, do we really need all of those, and is this really the best regimen that absolutely serves you overall? I think getting into psychedelics and doing psychedelic therapy, it's just a wonderful opportunity to reevaluate those things, because we're probably going to need to evaluate the drug regimen as part of the screening process anyway, and so it makes a heck of a lot of sense to me to motivationally interview about how you got to be Taking this prescription regimen, what parts of it works? What parts of it really doesn't work? Which parts I have no clue whether it works or not right, because I think that those are sore spots to me as a pharmacologist, like I'm kind of like persons should be taking medications, and they should know why they're taking them, what they're taking them for and there should be a clear upside for them. Even if there's some kind of side effect, there should be an upside that outweighs whatever kind of side effect burden or other thing that kind of like comes along with it. And if we're not clearly in a position where that's true, it does seem like something that should be questioned or reevaluated. And at the same time, if you question and evaluate it, and it becomes, thank God I started this one, because, you know what, it really pulled me back from the edge, and it's continued to work like a charm, and I don't really have any kind of problems with it. And you know what, I was interested in this psilocybin experience, because I was reading about the spiritual effects of it, and only when I applied to the center Did they say hell or high water. You have to stop all of these for six months. And I thought, really is that correct? And it turns out it's not correct. And it turns out that probably doesn't serve me very well, right? So, so it's about doing what wise and doing what works. And there's a lot of bath water in psychotropics and pharmaceuticals, but occasionally there's a baby in there too, right? And so it just becomes this process of, right, like, Okay, you want to sort of change treatment directions and do something a bit alternative. And those alternative things, frankly, may not be that compatible with your baseline prescription regimen. And a lot of people that I'm talking with, they want to try this other thing because their existing thing really isn't working that great for them. And so it's going to make a lot of sense in a lot of these persons to really take a hard look at the meds and evaluate them. But it's not going to make a lot of sense just to blanketly tell people to stop things that are helpful for them. Like, overall. And there is just so much right? It's kind of like, like, picking and choosing. As far as like, the stigma goes, right? Like, like, for example, here's a good one for you. Okay, that's kind of like I have, you know, Betty boo, who's 32 years old and started to take a low dose of an amphetamine for ADHD a year ago, and since taking 20 milligrams of Adderall extended release a year ago, the person has been able to complete more tasks, and that's made them feel a heck of a lot more confident about themselves. And their depression is actually sort of lifted, almost as a result. Their anxiety seems better because they're not like, on the brink of procrastinating and not being able to do the thing. It's kind of like I do it and like, I feel good that I did something, and it sort of like builds my motivation so I don't feel so like, low and depressed, and then I'm not, like, overwhelmed and stressed because of all of these, like, loose end things that I haven't like done. And so man, like, I'm a pretty happy campy HAMP camper with it overall. And then they talk with guide X, and guide X says, well, Adderall is clearly very dangerous with psilocybin mushrooms. You need to stop that two weeks ahead of time. But let me ask the spirit pharmacist if adding 100 milligrams of methylene deoxy Methamphetamine is going to be a good thing, right? And so that's just it, right? It's like, why is 20 milligrams of Adderall XR a clear contraindication with psilocybin mushrooms? But 100 milligrams of methylene Doxy Methamphetamine is boosting the healing and no safety issue, right? And so it's kind of like, well, if we're worried about the safety issues of 20 milligrams of Adderall, we should probably really be worried about the safety issues of 100 milligrams of MDMA. And I get the therapeutic intentions of using them in the context are very different, and it very well may be true that adding MDMA to psilocybin offers some depth and experience, or neuroplasticity, or like there might be some like additional healing effect. I'm not trying to say 20 milligrams of Adderall, XR is the same as, pharmacologically, as 100 milligrams of amphetamine, but guys, they're both true psychostimulants. And so if your concern was risk of stimulants with mushrooms, your risk, your concern has to be equal, if not more, because the dose of empti is just high compared to that 20 milligrams of Adderall XR at that point. And so that's what I mean about like the stigma of psychotropics is you could have a psychedelic that truly has stimulant effects, and it's seen as just like a friendly ally, where nothing can go wrong, yet, 20 milligrams of outer all amphetamine salts from the industry, stop putting that poison in you if you actually Want to

Dr. Sandra Dreisbach  46:20  
heal. So because this one's a friendly we decide that this one's okay, versus the fact that, like, in terms of the action or the chemistry, right, or or in terms of for the effect,

Benjamin Malcolm  46:30  
it's like, Mr. Mackey's wearing a tie dye shirt, right? And he's like, Mr. Mackey is totally stoked on LSD, but then he's like, drugs or bite, I'm Clay still, yeah, yeah. And I think that almost circles back to, like, part of the previous discussion. It's like, well, I believe psychedelics should be real medicines, because the safety and efficacy of them is there, like you can truly demonstrate they should qualify as medicines. But if it came down to sort of like, harm reduction, I would vote to just get rid of the c1 category, period, right? Even crack cocaine, okay, maybe it doesn't have the therapeutic upside to it. We're not going to do a randomized trial that show it works for asthma or something pretty, pretty soon, right? Or maybe it does work for asthma, but it blows up your heart at the same time, so that risk benefit trade off isn't so good. Yeah, right. But, but, but, would I want crack cocaine to be an illicit schedule one thing? No, not really, because it just perpetuates a drug war. It just perpetuates harms, right? So from like, I want harm reduction across the board, which, to me, would mean I don't think having a schedule one category reduces harm, and I don't think it's aligned with public health or just evidence based policy around drugs generally. So it's like, I would vote to just get rid of it, get rid of that for all substances, but like, which ones like, could be made a medicine relatively quickly. I think the psychedelics, because the data is there. But even then, like, like, let's just say we got rid of the illicit drug category, made everything a schedule two controlled substance. Doesn't change very much, to be honest, because if I get caught with a bottle of oxycodone, a schedule two controlled substance, that's a that's a criminal act, still, if I don't have a prescription for it, so you can still bust me right. You can still bust me right. It's not like I took law enforcement ability to, you know, bust people that have illegal prescriptions away. So what did I do? Really? I just made it so scientists can study the drugs easier, right? So the schedule one category is inherently not about public health policy and keeping people safe at all. It's about having a bucket that you can put stuff in so that you can't find out the information. And that's unethical. That like that, like that, shouldn't be anything that anyone wants, right?

Dr. Sandra Dreisbach  48:55  
And all the examples you've been giving are really, you know, showing this like you know, you know, by having these, these substances, criminalized to such a large degree, it's not only a barrier to those who actually want to have a healthy mental health and are trying to work consciously with the substances are currently working with, but a barrier in terms of even people's understanding with people who are trying to be even. And I would say a lot of people, you know, people in general, want to be responsible with their use, in my humble opinion, but I think there's a misunderstanding, like, about like you're saying, like, well, I want to combine their psilocybin experience with the MDMA, but they don't see it as the same as the amphetamine they were taking for their ADHD, and people see it as qualitatively different and and that's and that's because of the way that you know, the alleged you know drug war has has approached these substances, and how we've been educated and miseducated about. Risk and harm reduction on either side of the quote, unquote fence. What? What would you say? What advice would you give someone who's who's coming, you know, like, what? What kind of sources of information and support would you advise people who want to work with psychedelics in the environment that we find ourselves in right now to help educate and inform themselves.

Benjamin Malcolm  50:24  
Do your research. Do your research. And that doesn't mean sitting on YouTube and watching anecdotes of people's trips all day, right? What I mean by that is that, hey, I think psychedelics work, to be honest, and I think that they're relatively safe and controlled sorts of environments, but frankly, this is the wild west right now. Frankly, this is the just the Wild West, and if you have a mental health condition, like, if I'm doing research at a university or someplace and I'm trying to get a study approved, right? Like, ethically, there are special populations, right? There are, like, minors, pregnant women, prisoners, persons with mental health conditions, tend to be in buckets of special populations where we think there might be additional risks because of some level of desperation or, right, there's just other things kind of involved. Okay, there's a fetus in pregnancy as well. Like, like, the stakes are very, very high. The trials not going well, and things like that, to the point that it becomes very difficult to study in in some ways. So I think you need to sort of, first of all, I think a lot of people getting into this are under the impression that their options are really limited. Like, you're coming from the mainstream, you don't buy illicit drugs. You're probably likely to kind of like, come across someone and like, Oh, I found someone. Okay, well, there's 1000 and it's like, and it's like, therapy, you know, they fall on a bell curve. Some are great. Some are not so great. Some of them are great therapists, but they're not a great fit for you, right? Because, because it's another human being and their energy that you're essentially interviewing as well as the space, right? So I think my advice is like, take a breath, slow down, realize there's a bunch of options, probably some that you're not even aware of, like, frankly, if you're coming from the mainstream, there's hundreds of psychedelic compounds. There's lots of people serving them in all sorts of which ways and things like that. You come across the first person and they're an incredible fit, great. But if you come across the first person and they're an All right fit, keep looking ask hard questions, or not even hard questions, I don't think. But just ask questions, right? Like, how long have you been serving psychedelics to persons for? What was your background in either mental health or healing or the world of psychedelic substances before you were doing this, what kind of training or mentorship experiences did you have before you started serving persons psychedelics? How many people have you helped, and do you usually help people that have mental health conditions, that are taking psychiatric meds,

Speaker 2  53:24  
brilliant or not? Yeah, right.

Benjamin Malcolm  53:27  
Who do you think you're most qualified to help? Like, overall? Like, who do you? Who would you say is like, the ideal person for you to serve psychedelics to? And, you know, I know some persons that they work pro bono with trauma survivors, and it's like, beyond trauma, it's like almost torture, what they've been through and like things like that. And I know some other persons that are literally looking for, like whale diplomats, and that's the only person that they want to serve, because they think that if they can change one of their minds, then they can change the meeting in an international affairs room, which will change the world, just like that, right? So you got all sorts of persons in this game with different backgrounds, experiences, doing all sorts of things. It's a bit wild Westie. And so you're gonna need to really kind of right, like, like, they might be shopping for you as a client, but, like, you have power shop for them and don't settle for something that is mediocre, right? Because there is something out there that is just great. And, yeah, I think that's just, it is, there's, there's usually a lot more options than the person realizes it takes a look like it's not as it's not as easy as dialing up a pizza from Little Caesars like it sounds right? And in some way, and in some ways, I don't know, it's almost like, what like, should it be that easy? Yeah, you don't, or is it actually like, yeah, I don't know. It's like, like, like, I hate prohibition, but it's almost like the blessing of prohibition in this. Like wild Westy psychedelic environment. It's like, if we would have just like rubber stamped psychedelics in the year 2000 or something like that, it would probably just be so loose and fast, like the rest of the pharmaceutical industry, that you would just be kind of like running into all these misadventure types of things. But because it really is this sort of like, so we're gonna get it all right. I gotta have conversations with like, three or four people before I even, like, find a source. And then I learned something about this modality along the way. And then I finally found a source, and they told me I had to go watch this documentary over here, and I had to go talk with the spirit pharmacist over there. And then all of a sudden, I know so much more about psilocybin mushrooms than I ever knew about SSRIs. And they're actually empowered to choose something instead of just kind of like, oh my god, I share. I shed a tear in my doctor's office, and before I knew it, the Lexapro prescription was being slid across the desk, and I was like, What's this? And they're like, just take it. It's going to help you. And so I started it, and then 10 years later, I'm like, Why did I

Dr. Sandra Dreisbach  56:04  
start this? No, I've had that experience with certain things and and I just really appreciate that advice of just asking questions and knowing that there are other options and doing that research. I think that's really, you know, being an informed consumer, regardless of what you're working with and and taking and empowering yourself on your mental health journey and your spiritual journey, I just want to thank you again for for taking this time. Is there any anything else you want to leave people with, like, you know what resources or things have helped you in your journey?

Benjamin Malcolm  56:41  
Oh, gosh, different experiences, different experiences I've had. But, like, a lot of it is like, I just spent a lot of years doing literature synthesis, types of projects and things like that. But if I had to leave the audience with anything, I would say that, yeah, my website is spirit pharmacist.com, I'm an internet information dealer. I try to bridge the gap between like a psychiatrist or mental health professional and kind of like a shaman or alternative health practitioner. And I essentially have a few different things. So I have courses in psychedelic pharmacology. I do psychopharmacology consulting. So tailor things to individualize situations and whatnot. I have a member program so persons want to work longitudinally to help with screening related consulting and things like that. Also have a mastermind program that is really, I think, for professionals that even want to get into almost like a screening role or a screening position around this. So if you haven't checked it out, I would just recommend going to spirit pharmacist.com I've got some free resources and blogs there if you want to start with those types of things,

Dr. Sandra Dreisbach  57:51  
looking at your site for as a source, as a resource, and as community resource. So thank you again. So much. Ben, you've been generous with your time and your information, and I'm just greatly grateful for all the work that you do, and I know you've made a difference in this space because of your work.

Benjamin Malcolm  58:09  
Thank you so much. Sandra, it's been a pleasure being with psychedelic source today. Thank you

Dr. Sandra Dreisbach  58:15  
for joining me on psychedelic source. If you found value in today's episode, please subscribe wherever you get your podcasts and share with others in our community, and if you're a psychedelic practitioner, therapist or coach looking to identify blind spots in your practice or determine next steps for moving it forward, take the first step by visiting psychedelic source podcast.com Until next time, remember, start low, go slow and stay connected to your source. You.