I’m Ethan Nadelmann. Taught drugs at Princeton. Founded the Drug Policy Alliance. Played a leading role in legalizing marijuana & challenging drug prohibition. Described by Rolling Stone as “the real drug czar.” Now host of PSYCHOACTIVE podcas...

Hey Ethan, my life dramatically changed when I was depressed and decided to grow mushrooms. Drugs, drug policy, and plants have since evolved into a passion and I’m consuming (intellectually) everything I can get my hands on: books, documentaries, and podcasts! Yours is excellent!

What’s the best thing a guy like me can do to fight the war on drugs? I am changing the minds of those around me but I live in a very conservative state

Depends where you live but typically the best thing to do is get involved locally. See if there are any local or state groups working to reform drug policy; or organizations working on broader or related issues that have some stake in a drug policy issue. And be willing to work on sub issues -- re harm reduction, or reducing criminalization, or psychedelics, or the overdose issue, or cannabis reform.

And, apart from that, you're doing the right thing but trying to read and learn as much as possible. And, of course, listen often to my podcast PSYCHOACTIVE!

Thanks for the response! Your podcast is one of my favorites. I’ve heard every episode and even got a question answered on the Q&A episode with Julie. :)

I am delighted! And please spread the word!!!

What book recommendations do you have for mushrooms and, I assume, mental health?

Check out books by Paul Stamets.

Also publications at https://hopkinspsychedelic.org/ and https://med.nyu.edu/departments-institutes/psychiatry/research/center-psychedelic-medicine and other university research centers on psychedelics.

Hey, thanks for the AMA.

Is there any one book you could recommend for the general public, that confronts drug war policies versus alternative policies such as harm reduction, with the best current available evidence?

Thanks

Wow, a hard question to answer, in some resects because there's so many fine books and other sources of information. You might read Johann Hari's Chasing the Scream as well as Michelle Alexander's The New Jim Crow, which has little about harm reduction but is excellent on the racial dimensions of the drug war.

Also check out the websites of the Drug Policy Alliance, Harm Reduction Coalition and Harm reduction International, all of which have lots of great info.

And of course watch my TED talk for a good 15 minute summary.

And the books mentioned below are very good.

Hi Ethan, can you talk a little about nicotine vaping, which is the target of a moral panic very similar to the drug panics of the 70s-80s-90s? It seems like the mainstream press is bent on remaining deliberately ignorant about the benefits of encouraging the use of non-combustible nicotine for people who smoke.

i am passionate about this issue, not least because the ignorance, misinformation and deliberate lying by govts about nicotine vaping reminds me so much about what drew me to drug policy reform in the 1980s. The more one looks at the scientific and other evidence, the more one concludes that harm reduction, decriminalization or legal regulation and health-focused strategies are the way to go. But the public, mainstream media and politicians all head the other way.

Take just a few examples of widespread ignorance and misinformation about nicotine vaping. According to polls:

Most Americans believe that vaping nicotine (with ecigs or heated tobacco products) is as or more dangerous than smoking. But all the evidence says exactly the opposite.

Most Americans, and even most doctors, believe that nicotine causes cancer. But there is virtually no evidence that nicotine actually causes cancer. Nicotine is the drug that can hook you but it's a relatively benign substance apart from that. What causes cancer is primarily consuming nicotine in cigarettes and other forms of combustible tobacco.

Most Americans believe that EVALI -- the vaping related illness that killed about 70 people back in 2019 (right before the pandemic) and put a few thousands in the hospitals - -was a consequence of using nicotine e-cigarettes. In fact it had virtually nothing, indeed perhaps nothing at all, to do with vaping nicotine - and was caused almost entirely by a few knuckleheads inserting Vitamin E acetate into THC vape cartridges in order to make more money. What those knuckleheads didn't know was that Vitamin E is perfectly fine to swallow but quite dangerous when heated and inhaled. As soon as that situation was remedied, the problem went away. But the CDC, remarkably, still refused to acknowledge this fully

Put it this way, if all of the 30-35 million cigarette smokers in the US, or the 1.1 billion cigarette smokers worldwide, were to suddenly switch entirely to e-cigarettes and other nicotine harm reduction devices like heated tobacco products (eg IQOS), SNUS and nicotine pouches, it would represent one of the greatest advances in public health in US and global history. And that would still be the case even if millions of young people started vaping nicotine - although we'd of course prefer they didn't.

Check out Cilive Bates' Counterfactual online for great information, as well as https://gsthr.org/ - Here's my interview with Clive from September:

As someone whose had to use smokeless tobacco, how much more dangerous is chewing tobacco versus smoking?

Chewing tobaccos vary a lot in how dangerous they are. My understanding is many are somewhat less dangerous than smoking cigarettes. But try your best, if you like oral forms of tobacco, to try tobacco pouches like SNUS or even non-tobacco nicotine pouches like Zyn, On!, etc. They are dramatically safer than smoking or chewing tobacco.

Ethan,

What role, if any do you see the psychedelic renaissance and accompanying psych advocacy organizations playing in an overall push to destigmatize drugs?

Is the psychedelic exceptionalism seen in some circles doing more harm than good or can it be seen as incremental progress for psychoactive compounds as a whole/ an opportunity to start a conversation for broader efforts?

Furthermore, what can advocacy/policy groups in the psychedelic space do to ensure to that the legislative momentum they have carries over into initiatives for other psychoactive compounds?

I think the psychedelic renaissance is overall a very good thing for broader drug policy reform - so long as people involved in that renaissance don't go out of their way to demonize other psychoactive drugs or advocate for tougher penalties on other drugs.

Generally, anything that helps to de-stigmatize and decriminalize one drug that's been illegal for a long time has a spillover effect vis a vis other criminalized drugs, and also provides possible models for moving from prohibition to decrim to legal regulation. I'm pretty sure we would have seen the progress on psychedelics reform (and especially the decrim as distinct from research./medical side) or on all drug decrim if we haven't progressed so successfully and quickly in recent years on cannabis reform.

I think we have some chance to make progress re opioids, eg., when one sees a significant reduction in restrictions on methadone maintenance due to COVID, or when one sees ever growing support for harm reduction. (See today's article in the NYTimes re drug czar Gupta embracing harm reduction these days.)

What would really help is some leveling and injection of greater common sense and science and reason into thinking about psychoactive drugs. Too many prescription pharmaceuticals still get favored over potentially more effective but still illegal substances, for all the wrong reasons. (See the book, White Market Drugs by David Herzberg.)

How do you feel about the complete commercialization of legalized weed by big business? I work in Marijuana and literally every small time grower I know has been forced out of growing by the new laws, especially do to the influence of Steve Wynn who I am sure you aware of. It had really destroyed the soul of weed in California, and I’m assuming everywhere else in the country.

I don't like the complete commercialization, and I especially don't like the potential Budweiserization and Malborization of cannabis. I'm a sort of "small is beautiful" kind of guy and would much prefer a microbrewery sort of model.

But I also recognize that we live in perhaps the most dynamic capitalist society in history, so I always knew, as we were advocating to end cannabis prohibition, that the major downside of success would be the sort of commercialization we're seeing now, and that will likely get only worse with federal legalization.

So I think it's good that states, and federal bills, are trying to remedy some of this with provisions and efforts to help folks who have been in the illicit industry, as well as those who were harmed by the drug war, to get first dibs and various forms of assistance to help them succeed in the legal market.

But I'll also say that what drove me to advocate for legalizing cannabis all along was my desire to reduce and end the 750,000 people getting busted each year for weed (90% for possession) and the vast numbers losing their driving licenses, scholarships, govt benefits and even homes, children and freedom simply for consuming marijuana. The great thing about legalization is that it's making a huge difference in reducing these injustices. Sadly, no great reform happens without some people being worse off, and some trade-offs are inevitable.

80% of Americans saying the war on drugs has failed and Congress refuses to pass even basic common sense reforms like making lowered sentences retroactive. There are so many problems Congress is failing to address; and the American Union has put them together into one big package of reforms. (The three planks of the package are end poverty, end mass incarceration, and end the endless wars.)

Would you support an effort to end the federal drug war by including a repeal in a larger package of reforms, or should it be done through a stand alone bill as a matter of principle?

i think whatever will get smart drug policy reforms enacted is the right way to go.

How do you see the international cannabis market playing out? Will there be room for traditional growers to access the marketplace, or is there going to be giant American/Canadian companies entering international markets and gobbling up all the market share? What can we do to help enable traditional cannabis growers from places like the Caribbean have access to the legal market?

It's eventually going to be mostly the mega companies but some places will carve out places for traditional growers. Legislation in Jamaica, and Colombia, and part of the US, have tried and others will as well - but it's hard to make it meaningful in practice because eventually most consumers, apart from those perhaps who live in traditional growing areas, are going to switch to legal suppliers.

I also think there's a good possibility that this will continue to evolve. Let me give an example. When I first moved back to NYC (where I was born) n 1992, there were lots of coffee shops; then Starbucks put most of them out of business. But now I walk around and see more non-chain cafes than ever before. I think something similar happened with beer markets, where following the repeal of alcohol Prohibition, a few big companies took over the entire market with fairly homogeneous products but now every year we see the microbrewery share of the markets steadily growing. That's a likely model for cannabis.

What's it like being such a frontrunner?

We all knew drugs were gonna win. The DEA were always the Washington Generals

Yeah, I never was much of a follower. Much better for me to be a pioneer, and all the better that we were so successful on various fronts even as there's a long way to go re the powder drugs and reducing unnecessary incarceration and getting rid of all the civil and other non-criminal penalties that still screw up people's lives because they get caught using one drug or another.

Hopefully the DEA eventually gets merged into the BATF (alcohol, tobacco and firearms).

And our victories to date were by no means inevitable. That took lots of hard work and discipline and committed activists and courageous academics and elected officials and generous philanthropists. The only thing that was inevitable was the failure and harms of the punitive prohibitionist policies. But those don't change themselves. We made it change!

Any hope all drugs are going to be decriminalized in the US, Oregon/Portugal style?

There may be an initiative like Oregon's all drug decrim on the ballot in Washington State this year. And other states are likely in the works for 2024, hopefully including California. I generally think of the first states to legalize medical marijuana in the 90s and to legalize marijuana more broadly in the 2010s as the most likely candidates to go first on all drug decrim. That's Oregon, Washington, California, Colorado, Alaska and Maine. And Nevada could be a good candidate. Meanwhile, various state legislatures are having all drug decrim bills introduced, but they generally take longer to get thru than ballot initiatives and are more at risk for getting watered down in problematic ways

Hey Ethan! Thanks for doing what you do.

What do you think about the new treatments that use ketamine to help with alcoholism, depression, and a number of other conditions?

Do you see it promising?

Both anecdotal accounts as well as an increasing amount of scientific evidence show real promise for ketamine in treating these sorts of conditions. You might listen to two episodes of PSYCHOACTIVE, Elias Dakwar, professor at Columbia who's done research on treating addiction with ketamine, and Gita Vaid, a talented psychiatrist who does ketamine-assisted psychotherapy. Also take a look at the websites associated with "the Godfather of ketamine, Phil Wolfson." http://philwolfsonmd.com/ketamine-assisted-psychotherapy.html

Hey Ethan!

What would you say to organizations like the Truth Initiative who argue that nicotine vaping is not a valid form of harm reduction (https://truthinitiative.org/our-top-issues/truth-initiative-statement-harm-reduction)?

I'd say they're being disingenuous and even lying. It's a real shame because the Truth Initiative, under the earlier leadership of Cheryl Healton, and with key staff like David Abrams and Ray Niaura, was very much pro-harm reduction. The evidence in favor of harm reduction is incontrovertible. The question of what to do about teens who never smoked starting to vape is a distinct issue and concern but it never justifies obfuscation and dishonesty about the benefits of harm reduction for smokers who can't quit. And the fact that Big Tobacco is increasingly invested in harm reduction should not be used an excuse to oppose health-based interventions and innovations that could save countless lives.

Hi Ethan, im a pharmacist who plans on specializing in psychopharmacology. I have had patients come to me saying that they are using psychoactive substances as an adjunct (or replacing) to their drug therapy. Currently the guidelines do not encourage the use of these substances, so Im stuck between saying stay away and waiting for new research to come out. Any ideas?

My best suggestion is to know the scientific literature and point your patients toward things to read, while making clear they need to take care re substances that are not illegal both because of law enforcement and because of risks of adulteration, unknown purity and potency, etc. Also worth pointing out that sometimes mini-doses of even pharmaceutical drugs may be the best option. I just heard from one friend who found that taking a small fraction of a prescribed ADHD drugs worked best -- just a mg or two. I don't know if there's much research on that but worth checking out.

Hello, thanks for the ama. I will dive into your podcast over the next while, sounds like an interesting show.

Over the years I have found that psychedelic experiences can be an amazing tool to enhance understanding of complex concepts, increase idea generation, and integrate diverse experiences into something more holistically meaningful. I have also read that several famous scientists and entrepreneurs credit psychedelics with helping them to develop models, theories, or visions for society which have led to breakthroughs. Areas such as genetics and information technology have benefited as a result. The book ‘What the dormouse said’ by John Markoff explores some of this in detail.

Two questions:

Do you think there could be a shift in perception and policy to the point that access to these substances could be seen as beneficial to science and industry, and therefore the economy? I have also read articles in major publications like Forbes stating some companies are beginning to desire psychedelic retreats for their employees so it seems like a demand is already there.

If so, do you have any advice how someone such as myself with no medical or therapeutic background (I’m an engineer) could begin to make a career in that area? It seems like a mix of trip sitting, event planning, R&D, some elements of therapy, and more.

Thanks!

You're right. It's incredible how many remarkable people, including Nobel Prize winners, Steve Jobs and other prominent people in Silicon Valley have credited psychedelics use with some of their breakthrough ideas. These accounts typically involve higher doses of psychedelics.

But there's also the increased practice of microdosing, which many people claim improves their productivity and other aspects of work performance - altho hard evidence is still quite limited. And of course there's the use of MDMA and psychedelics for things like conflict resolution and improving communication and empathy.

One suggestion would be to enroll in MAPS' training program: https://mapspublicbenefit.com/training/

Hi Ethan, do you find it non-sensical when states like Wash and Oregon are on board with decriminalizing cannabis and possibly other recreational drugs yet won't embrace nicotine vaping as harm reduction? I don't understand the rationale.

I will say I find it infuriating that many of the elected officials who were my allies on all sorts of good drug policy reforms involving cannabis, harm reduction, de-incarceration and now even psychedelics reform are supporting and sometimes leading the charge in opposing tobacco/nicotine harm reduction. It's the principal example i can think of where Democrats who typically favor science-based policies are acting like Trumpian Republicans in denying and rejecting the science.

if I ask why, part of the answer is that it's in good part about liberal-minded affluent parents in urban and suburban Democratic neighborhoods freaking out about their kids' vaping (in part because they fail to appreciate how much less dangerous than smoking it is). It's also about a significant part of the tobacco control complex deciding that it's more important to oppose anything that Big Tobacco is involved in rather than focusing on the core objective of reducing the cumulative harms of tobacco use. And maybe also because this issue still lacks the racial justice elements that enhanced the appeal of drug policy reform to many progressive and Democratic voters and politicians - altho that inevitably will change the more punitive the penalties on tobacco and nicotine products become.

I'm ever hopeful that tobacco harm reduction will eventually become the dominant frame for dealing with tobacco products, simply because the evidence is so compelling, but, as with drug policy reform, it's going to take time to overcome the ignorance and other factors blocking tobacco harm reduction right now.

Hey there, Ethan!

Thank you for doing this AMA.

This is sort of an odd question, but I’m curious how being such a vocal advocate for psychedelic drugs has affected your relationships. Have you experienced people cutting ties with you in the past due to your vocal passion for psychedelics? I’ve always wanted to do more to support the cause, but I’ve always been afraid of how my family, my friends and my peers would perceive me.

I truly can't think of a single case of that happening to me (although perhaps there are people who pulled back without telling me). But then again I've been in a special position given my public profile on drug issues. It's probably helped that I always try to mention the potential risks and downsides of psychedelics and other psychoactive drugs, and make clear that they're not for everyone and need to be used, esp at high doses, with some care. And of course I try to talk about all this not as a proselytizer but just in terms of my personal experience as well as what's been written about this by scientists, scholars and others. I do think that Michael Pollan's book, How to Change Your Mind, and now the new Netflix 4 part series based on that book, has been tremendously influential in good part because so many people who would not have been curious about psychedelics decided to learn more because they already liked and respected his writing about food and other issues.

Thanks for doing this! It seems like cannabis took a long time to be as socially accepted as it is now. Do you think the future of drug legalization and decriminalization will move faster now that we have all mostly learned that WEED isn't going to terrorize us and our communities? Are people more open minded to drugs and people who use drugs now?

Well, we're definitely seeing that with MDMA and psychedelics (in many cases, "plant medicines"). Tremendously positive media these days even if some swinging back of the pendulum is inevitable. The fact that Oregon voters approved both a psychedelics reform initiative and an all drug decrim one in 2020 was remarkable. Now we have to see how Colorado voters respond to the more far reaching psychedelic "plant medicine" reform initiative that just qualified for the Nov 2022 ballot.

I'm also inspired by all the bills being introduced in state legislatures re psychedelics reform - and Texas's reform was quite something!

But as for other drugs, hard to say. Kratom is an interesting case; it's legal in most places and hopefully stays that way. And it was good to see the DEA back away recently from scheduling five psychedelic substances, in good part because of vigorous criticisms. (Kudos to Hamilton Morris for leading some of this effort!).

What most worries me is the foolish way that state legislators and others are responding to the fentanyl OD fatality crisis. There's no evidence that more and tougher criminal sanctions will help with this. Much smarter things that govts could be going, including more imaginative harm reduction measures and a far more extensive commitment to understanding fentanyl markets and how and why people are using it.

What's the best psychoactive drug you've taken? How was the experience?

So hard to say. Probably mushrooms, which is the psychedelic I've most often used at high doses. I've had quite a number of experiences and insights that remain powerful and valid 30 and even 40 years later, and that impacted my life in positive ways.

But I also have to say that cannabis has been a major net benefit in my life, enhancing all sorts of pleasures and offering occasional insights of value.

Hi Ethan! I wonder if you could briefly talk about some of the work you've done in the field of harm reduction, and what exactly that term means to you? I consider myself an advocate of harm reduction, and these kinds of practices have influenced the way I interact with recreational drugs very deeply. I was enamored in my teen years by figures like Hamilton Morris, discussing the effects of different drugs, the chemistry, and the culture surrounding them. However, I often find myself somewhat confused as to what harm reduction really is. I consider it personally to simply be proper education on drugs' effects so users know exactly what they're getting into before consuming a substance and how they can do it as safely as possible, but there are a lot of people on the internet sporting the harm reductionist title with vastly different interpretations - the youtuber PsychedSubstance comes to mind as someone who proclaims harm reduction but has some rather questionable implementations of it at times (not to completely disparage him, I found a lot of value in his content in my early days of exploration). Thank you for doing this AMA, and I'll definitely be listening to your podcast!

Perhaps start by watching this 10 minute video in which I offer four definitions of harm reduction: https://www.youtube.com/watch?v=w0FPp9j22oM&feature=youtu.be

Keep in mind that the notion of "harm reduction" is really just common sense, as you suggest. But it emerged as a phase during the 1980s, when public health experts and drug users were trying to prevent injecting drug users from contracting HIV/AIDS. The Dutch were pioneers, initiating needle exchange programs in the early 80s. These now exist in many dozens of countries and have proven effective in reducing the incidence of the disease, as well as hep C and other infectious diseases, among people who inject drugs.

But then the idea expanded to teaching people how to inject more safely, and how to avoid and care for wounds; and then expanded more to deal with overdoses, such as by encouraging people not to use opioids alone, and to make sure naloxone is readily available, and to get local governments to pass 911 Good Samaritan laws so that people could feel safe in calling 911 for help, without fear of arrest, if a friend overdoses.

Some of what you're referring to is simply staying as safe as possible when one uses psychoactive drugs, be it, opioids, stimulants, psychedelics, cannabis, alcohol, nicotine, whatever. The organization I founded and directed for many years, Drug Policy Alliance, put out a booklet and program called Safety First. Check it out.

I cant find much information on this. Does microdosing psilocybin negatively affect the brain of teenagers?

I don't know how much hard evidence there is about this but it is notable that teenagers, especially male, living among indigenous groups that use psychedelic plant medicines, are included in ceremonies by their elders.

Ethan! Long time fan, first time caller. Thanks for being you.

I'm curious about the policy implications of the expanding understanding of cannabinoids. Now that the cannabinoid system is being better understood and "new" cannabinoids are being studied, it seems like enforcement will be harder to both justify and to effectively regulate and be too burdensome to be effective. What then, re-classification under the CSA? What's on the horizon for medical understanding of cannabinoids?

I'll check out the podcast. Rock on!

I think the issue of regulating the "new" cannabinoids is ultimately going to be less about the Controlled Substances Act (CSA) and more about the FDA playing an ever greater role in regulating cannabinoids and cannabis products more broadly. As for the research, I'm not keeping up on all of it, but I must say I'm very impressed with what I see coming out of Israel. It's not just that it's the home of Raphael Mechoulam (the godfather of cannabis research) but also of younger great researchers like professor Dedi Meiri.

Hi Ethan, the US is signatory to a number of treaties, like the 1961 Single Convention on Narcotic Drugs, that require us to maintain the drug war and keep recreational drugs illegal. The Constitution (Art 6, Clause 2) says that all treaties are "the supreme law of the land." Are you encouraging state legislatures to violate the Constitution when you push for legalization?

Actually the US is among the countries in which a domestic (federal) law can trump an international convention that the US govt had previously signed.

The Obama administration struggled in 2013-14 with the issue you raise, after CO and WA voted to legally regulate cannabis. And Uruguay also did when they legalized in 2013, as did Canada some years thereafter. All concluded, with one analysis or another, that it was OK to proceed with legal regulation notwithstanding the 1961 Convention.

I think part of the Obama administration's rationale was that if CO and WA, and subsequently other states, could demonstrate that legally regulating cannabis better advanced the public health and safety objectives of the 1970 Controlled Substances Act than did persisting with failed prohibitionist policies, then the state legalizations were not inconsistent with the principles of federal drug law, and by extension, the international convention.

Definitely worth taking a look at the statement by the head of State Department's INL at the time, William Brownfield. He'd been something of a drug warrior but the new "Brownfield doctrine" in 2014 articulated a major change in how the US would view the international conventions moving forward

Thanks! I'd never heard of the Brownfield doctrine and looked it up.

Actually the US is among the countries in which a domestic (federal) law can trump an international convention that the US govt had previously signed.

I didn't understand this - are you saying the federal government can legalize marijuana (or other drugs) and not be in violation of the treaties?

Yes

I've always heard that when it comes to magic mushrooms, the stems give you the body high and the caps give you the hallucinogenic effect. Is there any truth to this?

Why do many users of Mushrooms/LSD experience a one-ness with the universe? Is it tapping into something in our psychology, some hope we have, or is there something to it?

What do you think of MAPS and their efforts in using MDMA and Magic Mushrooms to treat PTSD and Terminally Ill patients come to terms with their death respectively?

Feel free to answer any and all of the above, thanks for taking the time, keep up the good work.

I'm not a mushrooms expert but I'll do my best. First, read Paul Stamets, the magic guru, and listen to my chat with him on PSYCHOACTIVE podcast.

I think both stems and caps contain psilocybin but easy to find out for sure.

As for that one-ness, which one can also attain without using psychedelic and other psychoactive substances, yes i do believe it's part of human nature and psychology. Check out some of the studies on psychedelics and spirituality, eg., at Johns Hopkins w. Roland Griffiths, Bill Richards and Matt Johnson -- but so many others also being smart about this.

Ohh, and I am a huge fan of Rick Doblin and MAPS. My chat with Rick is the latest episode of PSYCHOACTIVE. Just went up a few days ago

Hi Ethan, thanks for doing this!

In terms of drug policy, in your view, what would the principles of a decriminalized drug policy be? Do you think that Portugal, for example, is a good model to follow, or are there aspects that raise concern there?

Portugal is a pretty good model. It basically boils down to making a commitment not to put anyone behind bars for simple drug possession, no matter how often they're caught in possession, and to be as creative as possible in trying to help people struggling not just with drug misuse issues but also with all the things that can make drug use more risky and problematic like mental illness, lack of housing, employment, decent healthcare, etc.

But I like what The Netherlands has done since the 1980s, with its very serious commitment to innovative, pragmatic harm reduction. And also Switzerland, which pioneered both safe injection sites and heroin prescription programs beginning in the late 80s and early 90s, respectively. And I see the movement toward "safe supply" in British Columbia as innovative and essential and providing important models for the US and elsewhere.

Hello, and thanks for the AMA.

How do you build an advocacy organization into something the Drug Policy Alliance (https://drugpolicy.org/)? Where do you start with something like that, and what are you in practice doing most of the time on most days?

Also, as someone who is interested in housing and transportation policy in the US, I was wondering with your background in advocacy if you have any thoughts on the messaging being used today by the linked movements to 1) build more housing to address the supply crisis and 2) de-centering cars.

It's hard to generalize from my specific case because I was unusually fortunate. I was teaching at Princeton in 1992 when i received a phone call out of the blue from the philanthropist, George Soros, inviting me to lunch to talk about drug policy. The rest is history. I left Princeton in 1994 to start my organization, which I called The Lindesmith Center, as one of the first projects of Soros's new Open Society Institute. Six years later, I spun the growing center out of OSI, merged it with the Drug Policy Foundation (which had fallen on hard times), and created the Drug Policy Alliance.

So the real question is how does one start an advocacy organization if you're not lucky enough to have a billionaire call you out of the blue? My first suggestion is to first see if it's possible to go work for an existing organization that's working on the things you want to accomplish. Too many people simply start their own organization because they want to be the head of something, or because they haven't don the due diligence to see what else is out there. and the result is a disproportionate amount of energy and money spent putting an organization together rather than focusing for as much time as possible on achieving the policy reforms one desires.

But if one is insistent upon starting a new organization, understand it's going to take relentless energy, ever-greater time and ability to raise money, and a commitment to taking on whatever challenges arise, which means growing as quickly (on a personal, emotional, psychological level) as possible.

It's worth pointing out that one of the costs of success in building an advocacy organization is that the founder inevitably spends more and more time on the management and sustenance of the organization and comparatively less on actually personally advocating for reform. I never regretted making the transition from academia to full time advocacy because it enabled me to accomplish dramatically more in terms of real policy and real policy reform, but on a personal level it meant i had less time to engage in some of the writing and learning and public speaking that I loved.

With respect to your questions about messaging, it's very hard to know how to translate our experience and successes in messaging around drug policy reform with very different issues like building more housing or de-centering cars. It's of course crucially important to keep one's ears ever open to shifts and nuances in the discourse around these issues. And to look for examples where advocates from another part of the political spectrum who agree with you to some extent on these particular issues, are employing somewhat different sorts of argumentation and rhetoric. And keep in mind the principal challenge is rarely about trying to convert our opponents but rather about trying to move those who are undecided and/or leaning against our perspective to come over to our way of thinking.

Thanks for being here and the work you do!

I'm new to learning about psychedelics as a therapeutic treatment. I know one researcher studying psychedelic's impact on the neuroscience of trauma. They received a small grant from the National Institute of Mental Health but a lot of the money for the study they fundraised themselves.

It seems like the big organizations like the National Science Foundation and the National Institutes of Health aren't as willing to fund these types of studies.

How can that be changed? Does that change with decriminalization/legalization or is there another way to affect that change?

I feel like the more research there is the more likely psychedelics are to be decriminalized/legalized but perhaps they need to be decriminalized/legalized before there is money and researchers available to do those studies.

It's slowly beginning to change. NIDA, which had only been funding ketamine research, at last approved funding last year for a study at Johns Hopkins on psilocybin for smoking cessation. And the former NIH director, Francis X Collins, said favorable things about beginning to fund more in this area. And NIH has hosted some webinars on the potential benefits of psychedelics. So it's all slow going, but things are looking a lot more promising than they were a few years ago - for all sorts of reasons, the changing political climate, the rapidly growing number of distinguished scientists working in this area, and the proliferation of psychedelics research centers at major universities, including some of the most prestigious. And of course more and more scientific studies, mostly funded with private money, getting published, showing lots of promise for psychedelics.

Do you ever hear of talk about giving people access to prescription medications without prescriptions?

My backstory is a clusterfuck of mistakes by living in a poor area with terrible psychiatrists.

I was put on Ativan (lorazepam) 4 mg per day at age 14. That's a huge dose and bizarre prescribing.

I spent my 20s trying to find a psychiatrist who was willing to do the Ashton Method for tapering off of it, which involves a cross taper with Valium and was told Valium was too "dirty" of a drug.

If you're not familiar, getting off benzos is exponentially more difficult and dangerous than heroin.

I'm nearly 40 and still on lorazepam. I'm in tolerance withdrawal (withdrawal symptoms at a steady state).

I can't tolerate cutting without some adjunctive med. I'd like to take gabapentin (which despite its name doesn't work on GABA-A receptors like benzodiazepines do), as in terms of adjunctive meds for benzodiazepine withdrawal it's the one I've found the best evidence for assisting withdrawal symptoms. When I talk about withdrawal I mean that between doses I lose the ability even to type and have to turn all the lights off, etc. It's neurological at a severe level.

Unfortunately I live in a state where gabapentin became scheduled and my psychiatrist says prescribing it would look bad on her record in addition to a benzodiazepine even though I came up with a taper schedule. She'd rather just keep prescribing the benzo indefinitely.

My main psychiatric diagnosis is benzodiazepine dependence. In other words, my diagnosis is my treatment. I've never taken it other than as prescribed exactly.

I feel like if I could have been the prescriber I could have gotten myself off of this decades ago.

I don't want to take more. I want to take less. And maybe if I am lucky, none. But I know I can't do it without some sort of adjunctive med. There really is no protocol for benzos like there is for opioids. The withdrawal is so much longer and more dangerous.

Crazy the ways that stupid laws stand in the way of effective prescribing; and also pitiful how few doctors truly understand the best ways to tailor prescriptions for particular patients. Not sure what to tell you, and you're right about the risks of trying to get off benzo's too quickly. I'm sorry I can't advise you more effectively but email me at [[email protected]](mailto:[email protected]) and i'll keep you in mind and get back to you if I learn anything that might help.

Hey, I hope you're doing well. I wanted to know what you think about shrooms as medicine?

👍👍👍

Do you feel that some of your actions have caused the death of others by pushing the usage of drugs that may ultimately lead to death from opiate overdose?

Well, one never knows all the unintended consequences of one's actions but I don't think my actions have caused any deaths for the simple reason that I don't promote the use of drugs but rather teach and advocate for how to avoid getting hurt or dying if one does in fact use drugs. So, for instance, I don't advocate for people to use illicit opioids but I do advocate for employing harm reduction measures if one does use, eg., ensuring a friend is nearby with naloxone - and also for trying to get effective drug treatment, whether that involves methadone, buprenorphine or anything else.

Just want to say you are the man and you have lived a noble life. I’m proud of you and thankful for you.

Do you see the federal government decriminalizing drugs much like Oregon has, in the near future?

Many thanks for your kind words!

As for the federal gov't decriminalizing drugs any time soon, sadly no. For a few reasons: the vast majority of laws involving drug possession are state law and there's really very little that the federal gov't can do about that, even if they wanted to apart from trying to incentivize state governments to decriminalize by making federal grants conditional on their doing so. Simply decriminalizing drug possession under federal law would affect relatively few people, e.g. people getting busted in national parks and on other federal properties.

But beyond that, even to the extent that elected democrats are increasingly sympathetic to all drug decrim, the vast majority of republicans are not. And it's republicans who are almost certainly going to control the House of Representatives and quite possibly the Senate as of the beginning of next year.

You "taught drugs" at Princeton? How does one "teach drugs?"

That was just a provocative shorthand for saying I taught courses on "drugs and drug policy" at Princeton.

Thanks for the AMA, do you think the legalisation of cannabis will happen in the UK anytime soon?

I can't believe how slow and backward the UK has been on this, notwithstanding the efforts of good activists and folks like Dr. David Nutt. I'm hoping that Germany legalizing in the next year or two will love other European countries, including post-Brexit UK!

How many joints do you smoke a day, on average?

I've never been a daily consumer of cannabis. In fact, when I use for a few days in a row, I find myself wanting to stop for a while. One of the pleasures I enjoy the most is smoking a joint after not having consumed one for ten days or more. Those are typically, for me, the best highs.

As for edibles, typically once a week - although I must confess to more than that in recent weeks.

Grateful Dead or Phish??

The Dead. Also, I love the documentary by Amir Bar-lev, Long Strange Trip, about the Dead.

And stay tuned for an episode of my podcast, PSYCHOACTIVE, in which I talk with Carolyn "Mountain Girl" (MG) Garcia, the widow of Jerry Garcia. Should be up in a few weeks.

What are your thoughts on drugs like adderall?

I'm no expert. My sense is that they're incredibly helpful for some people, both adolescents and adults, but also that they've been prescribed far too liberally, in ways that have done quite a lot of harm.

I am curious about a few issues related to the use and prescription of stimulants:

first, whether micro or mini dosing might merit greater investigation.

and, second, whether other stimulants might prove more useful than Adderal, Ritalin and similar sorts of stimulants. My sense is that very low dose dextroamphetamine merits greater consideration, and i also wonder about low dose coca/cocaine proving effective for the sorts of conditions typically treated with Adderal etc.

and, third, I keep hearing anecdotal accounts of people finding psychedelics - both macrodosing and microdosing -- helpful in stopping the use of Adderal type drugs as well as addressing underling conditions that led to the prescribing of Adderal etc in the first place.

Our society drugs children, our society has a major suicide problem, I’d like to know how many school spree shooters were on SSRIs? I bet quite a few.

I have no idea - but one development that really concerns me is that the pendulum on prescribing opioids for pain has swung from gross over-prescribing in the early 2000s to gross under-prescribing, to the extent that some people who had been successfully maintained on opioids for many years to treat pain are now being cut off by their physicians and sometimes killing themselves. Take a look at the website of the National Pain Advocacy Center https://nationalpain.org/ . They're doing important work and I serve on their advisory board.

Hey man - thank you!

Now for my question - what is your favorite strain of THC and why?

I must admit I don't have a favorite.

Thanks for doing this! Where and how do you obtain all the psychedelics you consume, given that they are illegal mostly everywhere in the US?

I've long relied on the kindness of friends

When is microdosing better than the "full" does?

when you get more out of it, or something different, that's important to you. Listen to my episode of PSYCHOACTIVE on microdosing with Sophia Korb.

Was just listening to this podcast as I drove. Haven't finished it, but I noticed a glaring incorrect statement on Korbs behalf. I assume a simple mistake.

Can you retroactively correct Korbs error stating that San Pedro cactus can have DMT extracted from it?
Just before the 32:00 mark on Spotify.

The principle psychoactive chemical of San Pedro is Mescaline. To my knowledge San Pedro does not contain DMT.
Perhaps Korb got ahead of herself intending to reference MHRB after speaking about San Pedro & Mescaline.

Not sure, but will try