Episode 50 - The 101 On Psychedelic Therapy With Julia Mirer M.D. (Full Transcript)
This is a full transcript of the Nirvana Sisters podcast Episode 50 The 101 On Psychedelic Therapy With Julia Mirer M.D.
Editor’s Note: Please know that this podcast transcript is automatically generated and may contain minor errors such as typos and word switches. For more information, be sure to listen to the podcast here or view our podcast episode guide.
Amy: 0:06
Welcome to Nirvana sisters podcast where we take the intimidation out of well being and beauty to help you achieve your highest state your nirvana. We are sisters in law and your hosts. I'm Amy Sherman.
Katie: 0:18
And I'm Katie Chandler. So let's get into some real conversation Welcome back to the show Nirvana sisters. Today we are tackling a super interesting topic that Amy and I are really curious about. And it's been a big buzz lately and our fantastic guest is going to enlighten us on it. So, our guest today is Dr. Julia mirror. She's a consultant in the emerging field of psychedelic medicine. She serves as a bridge between eastern and western practices is committed to merging them to help create a new paradigm for Integrative Health and Wellness which sounds so interesting. She was on the road to a career in pediatrics, but seeing the pitfalls of the current healthcare system decided to shift gears to explore transformative medicine, where she found her calling and advocacy and education. Julia's passion lies in education and advocacy for the responsible use of these medicines. Dr. Mayer believes that a successful future for this field depends on the interplay between policy research in clinics and is therefore positioned herself to play a role in each nationally. Dr. Mira is an advisor for the plant medicine coalition lobbying the NIH for $100 million for psychedelic research in Florida. She works in psychedelic clinical research at Segal trials. As a facilitator for us Oh, and AES phase two trial using psilocybin, I always have a hard time saying that word for major nail depression. Now that most recently Dr. Mayer joined New Shama as Director of Strategy, where she hopes to combine all of her experience to create the vision of a new kind of health care system and facilitate new Shammas goal of humanizing medicine. And I can't wait to get into what you guys are doing in your shop. It's very interesting. So welcome to the show, Julia.
Julia Mirer M.D: 2:19
Thank you. Thank you for having me on. Yeah. Welcome.
Katie: 2:22
We're so excited. So why don't we kick it off? Julia, we always start with a little highlight of your week. We call it our nirvana of the week. Maybe something that brought you joy today or yesterday, little thing can be big or small. I'll let Amy get us rolling.
Amy: 2:36
Yeah. So I had to think about this one today. Because this week has just been really, really busy with so many things happening at work and with the podcasts, etc. And it's also been rainy all week. So it's just kind of like, I know, Julie, you're in Miami, so you probably haven't had as much rain as we've had up here. Or maybe you have because I heard the weather has been a little bit crazy. But it's literally been raining every single day and gray. So today is the first day that it's sunny and like perfect, crisp weather. So I walked outside this morning, and I just like took a breath. And I was like, Oh, like that feeling of just that good, crisp air. So that was my little nirvana of the day. What about you, Katie?
Katie: 3:14
That's nice. I like that. Mine is alright. I've been racking my brain all week trying to figure out what it's going to be because my Nirvana really this week is kind of
Amy: 3:22
sad that we have to be like, wait, what what brought me joy this week. Let me yell it back was
Katie: 3:26
one of those weeks, but honestly, what brought me joy. It's like it could get really deep and heavy. So I'm just going to scratch the surface and maybe one of these days we'll get into it, but I've had some hormonal imbalances and I got them ballet. It's
Amy: 3:43
huge for me staying need to hear more I can get into the sounds like in another time.
Katie: 3:47
But But yeah, I figured out what the problem was and tweaked some of my medication and have been feeling great. Like the best I thought in so long. So. So yeah, that was a super super Nirvana moment. What about you, Julia,
Julia Mirer M.D: 3:59
my Nirvana moment. So I with crypto week, this week, there's been a lot of people that are flying in because they're they're adjacently involved or whatnot. So it was really cool. There was a moment yesterday when, like five of my closest friends were all together with me for the first time like some of them are meeting for the first time. And just that moment when I was like surrounded by people who are just, you know, like family like the chosen family. It was really, really minor random moment. Oh, I love that.
Katie: 4:33
That sounds so good. We all need stuff like that right from time to time for sure. That's great. Well, good for you. Alright, well, let's dive into it. Because there's so much digging into here. Essentially, we are diving into the use of psychedelics as therapeutic medicine. And Julia, tell us what do you do as a consultant in this emerging field and how did you get into it?
Julia Mirer M.D: 4:59
So Oh, I'll go in reverse. So how I got into it was completely by accident. I was, I was in New York, I was in my pediatric residency because I always wanted to be a doctor. So I'm finally you know, in it. And towards the end of my second year, I realized that I'm not buying what I'm selling. So I resigned from a career in medicine, I joke that I left medicine to pursue a life of healing. And I moved to Miami and kind of like restarted from scratch. And I initially, you know, quarterlife crisis. I very accidentally discovered psychedelics, and very intentionally proceeded to study them. So when I first tried them, I realized, wait a second, there's something really medicinal here. This is not a drug. This is medicine. And I, when I started looking online at all the research, I was like, Oh, my goodness, like, we're not talking about this, but there's research happening everywhere. So with my medical background, and you know, my field research, if you will, I realized that there's an opportunity to bring both of these together and actually get involved in this emerging space early on, because I just started seeing how like, everything was starting to the discussion was starting. And for me, when I, when I first experienced this, I was like, Oh, this is the thing that's going to save the world, you know, like the evangelism and all that that some people experience. But then when I looked at it more critically, I realized, like, no, but this is an opportunity for us to shift things, this isn't going to change things on its own. This is something that if we can roll this out in a good way, it's really going to make a difference. So for me, I, you know, having seen the way that the Western model works, I kind of started to talk to the people to the right, people who were doctors in the space scientists in the space. And over time, the way that I got involved in this consulting stuff was because I saw that there's several different areas that are moving this industry forward. There's psychedelic research that's coming, there's clinics that are opening, there's policy that is changing. And so in my consulting work, I kind of do a little bit of everything for all those different organizations.
Katie: 7:30
It's interesting that you're able to kind of break your way into this emergent, and I would imagine somewhat like hush hush. And under the radar field, like you said, it was you had to find the right people, how did you how did those doors open?
Julia Mirer M.D: 7:45
So, you know, in 2020, everybody was on a webinar. And you know, I have a medical degree that gets my foot into doors that it doesn't necessarily belong in. So when I would watch a webinar, a panel conference, I would reach out to everyone who I resonated with everyone that was saying something that I really believed in, I would call them and I find out more. And I would ask the experts in this field, like, you know, what do you think this industry needs? Where do you think it's going? What are the like, what are the blind spots from your perspective, and every time that I would talk to someone, I would realize, Wait, there's a connection here. So if I can bring these two people together, they might actually move forward faster. And so when I first started, it was really just out of my own curiosity. And I love people. So I was getting to talk to people that were like my version of celebrities, which to me was like, very cool. It's like, I read this book, and then Oh, my goodness, yeah, you're talking to them on Facebook. This is so incredible. Yeah.
Amy: 8:49
So to back up for a second for our listeners, can you give us a one on one on like, what is psychedelic therapy? And what are the various types of psychedelics use just to kind of educate and set a baseline for everyone?
Julia Mirer M.D: 9:02
Absolutely. So there's the classical psychedelics, which are, you know, LSD, magic mushrooms, which psilocybin is the active ingredient. We have mescaline. Those are Ayahuasca those are the traditional, we call the five HTT to a receptor agonists, which means they work on the certain serotonin receptor, the other psychedelics that are discussed in the context of the clinical research going on, and existing clinical practice that includes MDMA, which is, you know, ecstasy or Molly, and ketamine, which is an anesthetic, which is already legal, and I'll go into that a little bit as well. So, when, back in this, like before the controlled substance act in like 1971, these medicines were being studied in the clinical setting in Harvard, like psychiatry, they were looking at this for a lot of different indications and And so that research has been happening, like it was already happening. And then the psychedelics came into the mainstream, you know, they came, it was kind of a cat was out of the bag, and it was being used recreationally. And then that's when they stopped, they created these laws, and then they stopped research essentially for many decades. And so the classic psychedelics work a little bit differently. Currently, ketamine is that people will sometimes say it's like the only legal psychedelic. And it's important to separate the groups because ketamine is actually a dissociative anesthetic that has psychedelic properties, while the other ones are actually, you know, the classic psychedelic when we think of it, and ketamine was synthesized in the 1960s, it was used on veterans for acute pain eventually became used for chronic pain, and pediatric populations, we'd love to use this in the emergency room instead of sedating them, because it has less effect on their respiration. So it's less of an invasive procedure, we don't have to put a tube down. And in 2019, the FDA granted breakthrough therapy designation to ketamine, for use in mental health conditions. So PTSD, depression, suicidality, it's very, very good for that. And so in the last few years, what's happened is that we've been able to start prescribing this, like clinicians are able to prescribe this to their patients in many different ways. And they've been having incredible results. With the MDMA, it's currently finishing phase three clinical trials are just finished phase three, and they are expecting to have MDMA legal like by 2023, for PTSD. And this is in the context of a lot of therapy. And the idea here, it's a heart opener, it allows you to recall the events of your trauma without the emotional link the visceral response to it like sometimes through people, it's very difficult to remember trauma. And so this creates a safe space to remember it. The other psychedelics that are currently being studied, this is actually one of the projects that I'm working on. It is the usoda study using psilocybin for major depression. So there, we use a synthetic form of it. So it's not that it's the magic in the mushrooms, but it's only a synthetic form. And we watch patients while like me and my colleagues, we sit there with the patients while they're getting this dose. And here, it's placebo controlled, but if they do get the dose, it's a very high dose. And it's really like the typical high, like, ego dissolution kind of experience. And I can talk more about that, like a little bit later and how that works. I'm curious, I just
Amy: 13:01
wait somebody. Just really quickly. Just psychedelics more so treat mental health issues and challenges? Or can it also help with other chronic diseases?
Julia Mirer M.D: 13:14
So great question. Right now, we're kind of it, it's an interesting moment in research, because we're used to having a hypothesis about a drug, and then testing the effects. Since the psychedelics have been around for so long, we actually know it's already, like, we pretty much know that it's safer than most drugs that are out there. We know that it works. And now we're reverse engineering these studies to be like, Okay, let's like start from the beginning. And we're doing very, not I don't want to say simple, but like, you know, single condition, very common condition, and we're seeing how it works there. I think the future is going to start looking at a lot of different things. And one of one of the things that with psychedelics is it's also an anti inflammatory, that the classic psychedelic, so that can help with pain. Ketamine does help with pain. One of the, as I said, it was initially used for chronic pain. So that is still a condition that it is effective for. But we are going to be looking at it for dementia, we're going to be looking at for PMS, like this is all it's alcohol for alcohol use disorders, the next study that we're going to be I believe, that we're going to be doing so it's, I think that there's going to be an opportunity to really expand on the different conditions that could be used for another one is eating disorders. You know, there's anecdotal evidence where people who tend to misuse food, like as a coping skill, a coping mechanism, they are able to kind of change their relationships. to food. And so they ended up eating less people who suffer from anorexia. They changed their relationship to themselves, thereby changing their relationship to the food. And they end up also change, like shifting out of their behavior patterns. So there's going to be so many things we don't know at all yet, like on paper. But if we ask the traditions that have been sitting with these medicines for, like millennia, I think they, they would say that they treat many things and especially like, elements of the spirit.
Katie: 15:35
Yeah, that's a really good way of putting it. But my question, help us understand how so ketamine is being used, like you said, in hospitals, essentially, as an anesthetic? How is the administration of ketamine for these intensive purposes different than in the hospital that it achieves a different effect.
Julia Mirer M.D: 15:59
So the ketamine that we use in the hospital is for sedation is a much higher dose. And this ketamine is sub anesthetic, meaning you don't get you know, you don't get put out. But you have that psychedelic experience. And then within this use, there's a number of different ways to deliver it, there's a number of different effects. So the there's three ways that are currently being used. So in the clinic, and this is what we do at New Shama, we have IV infusions, and this is 100%. bioavailable, meaning however much you put in is how much is going to be in your bloodstream. So this allows us to fine tune the dose and be able to, if the person is having a really tough experience, you actually can turn off that IV. And the experience stops shortly thereafter, which can be good for anyone who has any issues with blood pressure, because you can also give the medication for blood pressure, high blood pressure. And it will also I guess, serve to, you know, be feel a little bit more comfortable for people who aren't sure how they're going to react to this high dose, the other. And then this is a psychedelic dose. So there's psychedelic assisted therapy. And then there's psychoanalytic therapy that can be done. Or rather, psychedelic therapy and psycholytic. Psychedelic therapy is looking at the experience, like the psychedelic experience, as a mainstay of that session. psycholytic therapy uses a lower dose, and it could be IV, it could be intramuscular, it could be oral dose, but it uses a lower dose to do talk therapy during, and there's value to both. And this is going to be a very different kind of medicine just because the degree of personalization that is possible. And kind of necessary in order for people to really get the most out of this. And the other route of administration is intramuscular. So here, you know it, you're not able to just turn it off. So you kind of committed to the hour, hour and a half that you're going to be there. But this is also very beneficial when you want to do group therapy with ketamine. And this is something that we are expanding now at New Shama. And I'll dive into that a little bit as well. And then the third option, which is the oral dosing, so they said, like, there are companies that you can get an online consultation, this is a much cheaper option. But you're not in the clinic, you're getting this medicine sent to your home, and you it's not the tastiest, but you essentially are the depending on the dose that you have, you can again have a different effect. So for some people who have OCD, one of the doctors that I know, when they work with patients, they'll go for a much lower dose, because it's slightly higher dose may give them a little bit too much discomfort and the anxiety increases, and then their OCD gets worse. So there's different ways to use that as well. The issue with the fact that it's FDA, the FDA granted this breakthrough therapy designation, they're not actually able to regulate the delivery yet of the of these medicines. So they don't, they don't they don't regulate off label use. So there's currently a it's kind of like a, there's a gray zone. And we know that most doctors want to do the best. We also know that there are some people who take advantage of these gray zones, and there are places that are sending ketamine to the home. Very little kind of exploration of what the patient's past medical history is. If they have a safe place to do this medicine if they have a safe person to talk to or have they're. So those kinds of companies are the ones to be aware of. And like you realize that there's the there's like the good, the bad and the ugly. So this is the ugly part of it. And one of the things that we do in the Shama is really educate people and try to get people to understand that of all the psychedelics, ketamine is the only one that might be addictive. But if you think about it a little bit simpler, it's like morphine is addictive. But if we need it, we're still going to use it, we're going to use this in the right set and setting and it's not going to become a problem. But when you start sending it to the home, you send people homeless biking and a purpose, and then that's when the risk for dependency, and then addiction can come. Same thing is going to be with ketamine. We know if you educate the patients, then the the results are incredible. But it's really a matter of informing people and letting them know what the potential risks are, and being there for them as a support, if they feel like there's a problem.
Katie: 20:53
It's essentially like any man, it's gonna send them in that respect that you can take it home, and you can do what you will with it. And so that's kind of scary, because it's, there's no way of regulating that. But that's not new to ketamine, per se. So for people to be afraid for that reason, you know, that's why it's important to find people such as yourself, and new Shama, if you're interested in it to go about doing it, do it the right way. And we'll get into that and a little bit what all of that looks like, yeah,
Amy: 21:22
I was just gonna say for most people that are doing it typically under like doing it with a doctor or under evaluation, so it feels more safe. They're not administering it themself. And then also, is the treatment, I guess it depends on what you're treating for. But is it like you do it one time? And that's it? Or you do it over time? Or does it kind of depend on what you're treating?
Julia Mirer M.D: 21:42
So it's, so there's different ways of thinking about it. So there's a lot of research about these, you know, twice a week doses for three weeks. And because the evidence shows like, there's evidence for that working, a lot of times people just adopt that. And one of the things that we look at at New Shama is like, well, we don't know, 100%, what's right for every person. So it's up to us to actually check in with the people and see like, how are you doing? Are you ready for your next dose? Or do you want another week or so to integrate? So there's many different ways for some people, you know, they come in, they are at their wit's end, and they have this one dose, and all of a sudden, like, they're just, they reboot. And with this, you know, sudden relief from their symptoms, they do all these things in after their session, to bring joy back into their life, they start seeing their friends, again, they start gardening, they start doing the things that used to bring them joy that they haven't been able to do since their depression or anxiety kicks in. And now they just kind of run with it. So some people may only need this, you know, once some people may need it several, you know, several sessions in a row. This is an added thinking, particularly with IV dosing. With intramuscular, it's, you know, there's, there's something to be said about the fact that we, when we're under a psychedelic experience, like after a psychedelic experience, we have what we call neuroplasticity, like our mind is a little bit more malleable. And we're able to see things a little bit differently. So it's up to us to really like monopolize on that moment, and do all these different things. It depending on how long you've been, you know, in your story about whatever, you know, depression, anxiety, or whatever, you kind of whatever's become your default functioning. If that's really ingrained, maybe you do need this twice a week, for like a few weeks, just to start practicing thinking differently. The effects of ketamine within the first like 36 to 48 hours, that's your golden window, that's a lot of times, I would suggest that they follow up with a therapist that they already have, or with an integration person that we're able to offer. Because that's when you can really dig into some stuff and rewire some of those bias beliefs. And for the most part, like about seven to 10 days later, most people experience the return of some kind of symptoms, a lot of times it's less than tense. A lot of times it's like to the point that it's manageable, and they may come back in for a booster maybe in three months or so. But they also start being able to maybe lower their doses of medication, like change, change whatever the things were that were causing them anxiety, depression. So there's, yeah, it's hard for me to say that there's any kind of one way to do it. I think if we start thinking about this in terms of protocols, we're going to really miss an opportunity for some personalized medicine. Right?
Katie: 24:54
The people that are like who is this right for right? Obviously, anyone that is dealing with depression and anxiety? Is it? Is it right for people that are resistant to traditional depression? Medication Therapy? Is it? Like who is it? Because I know, you know, this. We've also heard like, it's trendy for the super wealthy banker to come in and wants to have this experience. And so he you know, it's like, that's one thing, right? That's, that's whatever, but who who are all of your research and all of your work? Who is it really targeted for?
Julia Mirer M.D: 25:34
So it does. So ketamine removes suicidal thoughts within 45 minutes. Wow. Wow. So I actually think that the future of ketamine once the other psychedelics come online and are able to be used in a clinical setting, ketamine, sweetspot, is going to be in the emergency room, in the ambulance in any setting where you get that person in their moment of like, despair. And then you have seven to 10 days to figure out what got you here? Is it your addiction? Here's an Ibogaine clinic. Is it your couples problems, here's MDMA couples counseling, traumas coming up here, psilocybin and your trauma coach or trauma therapist. So I think that that's where it's going to go. Right now, treatment resistant depression is one of the conditions that has been that is being used for major depression, anxiety, like I said, eating disorders. But the thing is that this medicine on its own is only so effective, it's really what you like, I always say that 80% of a psychedelic experience is what happens before and what happens after, it's the preparation that you do beforehand, and the application of the insights that you have the you, like, actively take part in, that really create the healing. So I think in the future, we'll be able to see how like different psychedelics work better for different conditions. At this point, we're using ketamine, for most of them, I'll say the ones that it's not, right for right now is any schizophrenia is but like, you know, either you, yourself or psychosis, or in a first degree relative. And then with bipolar, it can be tricky. So really good therapists who are able to spend the time with their patients, and monitor them closely, are able to offer the ketamine for their depressive, like depressive periods, and then they keep up with them. And they're able to make sure that they don't slip into a manic episode. And so that's a very delicate thing. So a lot of places will kind of steer clear of it, just because they may not be able to fully support that. And then in terms of the comments on, you know, the corporate wellness, yeah, the yes, people can come in, and especially right now, where they're doing this for some kind of a spiritual reason. You know, for people that want to have more performance, like improve their performance and all of that. I sometimes caution people, because sometimes we have traumas that are lurking below the surface that we're not aware of. And at times, you know, there, there can be a case where someone in the super successful, who has been working, since they were 19 years old, non stop, they may come in for, you know, two for increased performance, or whatever it is, but then they might remember a trauma that happened at 18, that put them on this path of making work, they're kind of like, if I just keep working, then everything is gonna be okay. So I always caution people where it's like, you know, there may be something that comes up that you're not comfortable with. And if that happens that, you know, make sure you have someone to talk to, to someone in that position, they may not even have the words to describe what comes up. So the last thing I want to happen is for someone to come in to be better at work, and then be crippled by a memory that they're not ready to kind of address or unable to address now that it came up.
Katie: 29:12
So the spiritual journey isn't necessarily turned away. It's just you're you're very cautious with that person and making sure that they know what they're getting into and doing it for the right reasons. Yeah,
Amy: 29:24
that's interesting. It reminds me I was just looking this up. Have you all seen Julia specifically this show that was on Netflix nine perfect strangers? Have you seen a calf?
Katie: 29:36
Yeah. I don't know if Julia would want us to talk about that or not.
Amy: 29:41
I know I made up and silly or do you think it was interesting? Or do you think it brought anything to the forefront? Like what are your thoughts on it?
Julia Mirer M.D: 29:49
So the general psychedelic community was like, What is this right? That's because like, we know we don't dose people without letting them No, like, not a thing that we do. And then you know, some of this, like the exposure therapy and like the, like locking them in a thing. Not right. Oh, like that. But that being said it definitely we can't people are people. So the same way that there are awful people in like corporate America that you know, violate human humans, you're gonna see this everywhere. So it is important to have the discussion of what should your shaman you know, or your facilitator, your guide? What should they be asking you? What should they be revealing to you about the process? So, one of the there's like a lot of conversation about women, particularly, who get sexually, like, taken advantage of under the influence of these medicines, they get, you know, you can be men and women, but there's manipulation, there's all this transference with these people. And that's devastating, because you're already vulnerable, going into this thing, experience that's making you even more vulnerable. And then someone takes advantage of this. And then how do you reconcile that later? It's very difficult to police all the bad players, but it's going to, I think, be easier to educate the consumer, you know, get influencers to start talking about, here's the questions that your facilitator should ask you, if they're not asking you about your medication, good run, there's no follow up. Like if it's just you come from the experience, there's no discussion about how you're going to be, you know, called, you know, week later or the next day, and then options for integration throughout. Like, that's not, that's not where you want to go. Like, if they're trying to upsell you on things, or like, it's just weird. Yeah,
Amy: 31:59
trust is just such an important piece. Obviously, for any one you're, you know, working within the medicine field, but specifically this because to your point, it could go really wrong if you're not careful. It also reminds it also, I wanted to ask you about that I got introduced to this field or topic. I mean, I don't know, obviously anything about it. But there was I wanted to get your opinion on this, too. There was a documentary from goop labs on Netflix, I believe, that did an episode on group therapy setting. And I think it was ketamine. And I watched the experience. And it was interesting. Have you seen that? And what were your thoughts on that program?
Julia Mirer M.D: 32:40
So I haven't seen the one on group? Was there anything in particular that stood out to you that I can comment on?
Amy: 32:47
No, it was just, it was interesting. They they took the goop people that did this show this documentary, every episode was like a different sort of experimental type of whether it was medicine or theory or whatever. So they took like a group of maybe eight to 10 people down to Costa Rica and did it it was it was sort of group therapy, but they each had their own person guiding them through the process. And it was like a 24 hour experience. So they each have their own individual experiences, but as a group, and some people freaked out to your point of like, remembering things that they didn't remember. And some people it was like life changing for so no real comment there. Just I mean, maybe for our listeners, it's like an educational piece, I would say. But I also wanted to ask you Are there things that our listeners could read or watch that you actually think are really good pieces of content that to get educated to understand a bar?
Julia Mirer M.D: 33:41
I can share, I'll think of something and I'll share with you guys put it in the notes. Off the top of my head, the one that comes to mind is fantastic fungi, which is on Netflix, it's a documentary about mushrooms. beautiful cinematography, yeah, yes. Yeah, so that's a good one. And it's a good one for all ages, like, you know, it's got beautiful imagery for kids. But it really hits home for adults, like they go into not only the way that mushrooms are helping us from like a biological kind of the Earth, but also the effects that it has on us. And then the potential effects that it might have on cognition as we age, which is a sensitive subject for a lot of people as we start seeing, you know, rising rates of dementia and cognitive decline. So that's one that I would think of in terms of the group sessions like the way you describe this one on one. That is that probably was very beneficial for the people who were having a tough experience. Because sometimes what happens when you have these group sessions, it's like, you know, one facilitator, one, they call them sometimes angels, helpers, one person to like two or three And sometimes it's a much bigger ratio. And the question becomes, are you like, are you going to be able to support people if they're going through this tough time? And are you going to be able to do it in a way that doesn't disrupt everyone else that's there. And kind of. And that's, that's tough. So for us at New Shama, so we're working on doing group cohorts. And the idea here is that it's not just people that come in together, and they do a dose together, because we really don't know what's going to come up. And then we don't know how people are going to feel sometimes, you know, if they're having this really emotional feeling, depending on their level of awareness of what's going on, there might be guilt, like you feel bad that you're causing disturbance to the others. There might be fear of judgment, there might be fear, that just like any kind of hero is going to take this experience. And then you think about the people who are having a good experience, maybe now they're taken out of theirs, because they're worried about the person, like so, in order to kind of help with that, what we're creating is cohorts. So they're together for six weeks, the first week, there's no medicine involved, we are just getting together, we are framing the experience for them. They're getting to know each other. And then every week, we have a different topic, where we all get to talk about, you know, how do you relate to your mind? How do you relate to your body? How do you relate to your spirit, and so on and so forth over a six week period. And what we hope to see is that the container of a group is healing in and of itself, like we heal in community. And we've had over two years of kind of like, a very fragmented sense of community. And for some people, they're struggling to reconnect, they're not like, it's like a muscle memory that the muscle is atrophied. And so one of our goals, even to the way that we talk to the people that come through our doors, they're not patients, they're members, or members of our community, because we don't want to call them a patient and remind them of anything that they feel they feel they're sick, they need to be healing and all of that. And we like we're certain that the group container is going to help them foster relationships with people who have had similar experiences. Because at the end of the day, there was a one quote that I blanking on, exactly, but it was like, loneliness isn't having nobody around is having nobody to share your experience with. Hmm. So when you do what Jared said, Sure, yeah, you you know, if you go back to your regular world, your parents don't know about this, your significant others, like at some woowoo stuff, you you kind of it just becomes this thing that happened. When you're in a community of people who experienced it together, you can continue to grow and learn from each other as you move forward. And that's, I think, going to be the real benefit for people. Because at the end of the day, whether it's addiction, depression, anxiety, at some core level, there's a sense of disconnection. And so connection is, I think, what we need more than anything, it's why the doctor that listens to you, seems to cure you better.
Amy: 38:08
So true. That just made me think of something. Is this being explored, and it's probably, I don't know, like, the opposite or controversial or something. But for people who go to rehab, because they're going to rehab to like get off drugs or alcohol, but I'm just wondering, because what you're saying sounds like it would be really healing for someone that has addiction, but if they have addiction, is it like a counter to?
Julia Mirer M.D: 38:31
So the ketamine has been used in research for alcohol use disorder, and it was very effective, there was a lot of therapy involved, and then they're able to kind of apply all of that therapy after this dose. So it actually, it's a really, really good question, because that happens a lot with AAA it's like, or Na Na, that 100% abstinence is the goal. And when you look at it that way, and you look at you know what happens to people, okay? They're abstinent from drugs, but they are addicted to caffeine, they're addicted to cigarettes, they're addicted to sugar. So the addiction is still there. And it's a craving. And so changing your relationship to the substance, I think is the most profound. Like, that would be the result that I would hope for people think opioid is a little bit different, because opioids kind of just grab you and hold on to you. Yeah. But I've seen anecdotally so many people say, you know, I used to be an alcoholic and now I can have a glass of wine with my dinner and that's it.
Amy: 39:41
Interesting. So it really works on the the actual addiction to whatever substance versus something that you have to keep going back to because it makes you feel a certain way like it actually can not cure but like change your mindset around it, which is really fascinating, actually. Well,
Julia Mirer M.D: 39:58
and if you and it's like The intentional use,
Katie: 40:01
yeah, if you look at it as well, there's I mean, it's it's essentially just a medication that you're applying to the addiction. It's not necessarily like saying here, here's another drug to get addicted to, which is in regards to opioids that can be given naltrexone to help get rid of that dependency and everything. So I can see the similarities there. Before we get into, I would like you to walk us through a quick kind of outline of what a patient's experience would be. I know, you just touched on it a little bit, but like, I want our listener to hear what it's like to come in, sit down and go through the process. So who's in the office with them? How are you giving it to them, you can, I mean, choose any way of administrating any type. We should start by saying New shaman is a clinic in New York City, where Julia is the director of strategies. And it is where ketamine therapy is being done. So I would love to hear what what that looks like if someone comes in and they're, and they're getting started.
Julia Mirer M.D: 41:00
Okay, so a lot of times we get these inquiries online, and so they initially they get a phone call, so we make sure that there's nothing that disqualifies them from receiving ketamine. And so when, when they kind of are able to go through based on the initial screening, then they get an appointment with our medical director, who is this incredible, he was an internal medicine doctor who shifted completely into this work, because this was aligned with his not only his career, but his spirit. And so he does the medical evaluation. And we make sure that people are clear, you know, we check their medical history, there are medications, like basic testing, and if they are clear to go, then we schedule their appointment. And one of the coolest things about new Shama is that it looks nothing like a like a clinic. So you walk in, and there's these elaborate, like, elaborate artwork throughout as a wallpaper, there's plants, there's like, you know, the ambient music, and it just doesn't feel like the typical sterile environment. And when they get in, you know, we have 17 rooms. So when they come in, they, they're greeted, they are prepared, you know, they do whatever paperwork they need, and then they're brought into the room in the room, there's either a sofa, but most people are preferring the gravity chairs. So they get a little bit of kind of introduction to the space, the doctor comes in the same one that that their evaluation comes in, and they discuss, you know, final intention setting. They talked to them about, you know, they do some breathing techniques with them, and they start the IV, they start the dose. And then while we check on the patients, this is, as I mentioned earlier, a psychedelic dose. So we checked them for safety, but they're not, we were not talking to them, there is no therapist that's in there speaking to them, we make sure that they are, you know, they have their blindfold, they have their headphones, and that they are comfortable. And then when the session is over, it's about 60 to 90 minutes. And they we have one of our facilitators come in and so the facilitators are people who work with people in you know, the, in the preparation and then the integration, and they're there just to get some key takeaways to sit with the patient, bring them back into their body, you know, ketamine is a dissociative, so anything we can do to kind of welcome you back in this was really helpful so the last thing we want is for people to like you know, think that you know, that experience was really the benefit the benefit is feeling different once you're back in here you know, we don't want them stuck in the caregivers are seeking that kind of experience. So afterwards different people are different so some people need a little longer to recover you know, we're we're early so we actually are able to let patient's kind of ease into it and you know, it's not like we're trying to get them out for the next person to come in. Like we're able to really let them come back and then we offer them their snacks you know, we have to we have whatever their their preferences are, or some healthy snacks and then they get a follow up will they go home, we usually recommend that you that they either have somebody to pick them up, or just try to avoid the busy city life afterwards. It might be a little bit jarring once you kind of went into this expansive state. And then the following day we call and we check on your we find out how you're doing. We listen for any kind of sign that maybe you need some further support. We have a psychiatric nurse practitioner who is available For that follow up care as well. And if they have their own therapists, you know, we may recommend that they scheduled appointment. And we oftentimes recommend that they do that in preparation just ahead of time. So they have that the experience itself, we use higher doses. So there are some clinics that use these lower doses and it feels nice, we use doses that they are just like you are in the cosmos, people report feeling like they're floating that their body is not there, that they are, for the first time separate from that, from their thoughts. They're observing themselves almost like from a third person view. And if you think about people with chronic pain, like imagine the relief it is to not feel your body for a little bit. And that can be really healing for mental health as well, where it's like, for a minute, you just snapped out of the rumination that has defined your existence for however many years. And so what the way that our medical director talks about it, he says that it is a that ketamine strips away everything that isn't you so you get to kind of connect with that core essence of who you are. And remember that that is always there. Remember that that is always that that's who you always have been. And then everything that has caused you distress are things that you've learned, that are no longer serving, like, these are things that are these are learned behaviors that you don't have to choose to keep engaging in. So, you know, there we have, we have testimonials from patients that were we just recently recorded. And, you know, those are worth checking out as well, like a chair that,
Amy: 46:52
that's so interesting, I didn't realize that was the experience, I thought in my head, I don't know why I thought this, I just thought you go in, you get it. And then it's like a all day thing where you like, talk to a therapist and like figure out your trauma. So it's almost like your, your, your, your evaluating yourself, I mean, or do people after they get this treatment, then go to their therapist and like talk through things, it just seems to me like there there there should or could be a talk part of it, where you're like, processing and reflecting and processing.
Julia Mirer M.D: 47:26
Absolutely. So the period of time. You know, sometimes when you first come back, and even that next day, you might still be a little bit off. And then some people say like, oh, but the day after I was like, you know, really, really on top of it. So because sometimes it could just be taxing on the body or the mind even so, and I I completely agree with you that there's that 36 to 48 hour window afterwards, where it's really valuable to get into those therapy sessions to like review the things that came up for you. And we do talk, you know, the key takeaways immediately afterwards for people to kind of start thinking about, you know, what did these things mean? Because it could be a very interesting experience. But like, what does that mean to be here? Right. And for our group sessions, that's actually part of it. So on, it's a four hour dose day. So the first hours, we're talking about all the, you know, the questions that we have from the week prior, you know, how do you connect to your body. And then we have that to our dos session with the group. And then there's an hour afterwards where we sit around and we share your share what came up for you? Listen, you know, some people get so much healing out of listening to other people's experiences, and other people's interpretations. And then you have an entire group of people that can say, oh, maybe this means X, Y, and Z when you share yours. So yeah, we definitely do that. In the group, when we're doing in the group. That's That's what our plan is,
Katie: 48:55
and why you said blindfold and headphones during the hour or two. What's the reason for that? And are they listening to music, I suppose.
Julia Mirer M.D: 49:05
Yeah, so we have playlists that have been curated, that that we share with them with our members. And music has such a huge role in the psychedelic experience it can really like because the visuals that you get can shift with the music. And this is something that we hear from people with the psilocybin study. The music doesn't it's not like a DJ set, where it just flows into the next song. There's stark differences in songs. And in the psilocybin study in particular, the purpose of that is to snap you from one reality to or you know, change the visuals they have and see how it can evoke different things. There is a company called wave paths, which is it's run by a guy who was founded by a guy who like leading expert in music and psychedelics, and and this application is able to it's the music is put together in such a way so that you're able to elicit a certain feeling. And depending on what dose you're using, what route of administration and what goal you have with the feelings like you can really play around with the different sets. The blindfolds are to kind of, you know, you can open your eyes, you could see things but when you close your eyes, you get a much more internal and like immersive experience makes sense. And it helps like, you know, the blindfolds on, you're you're able to keep your eyes closed more easily. Yeah,
Katie: 50:36
sure. No, that makes sense. looking inward. I suppose I
Amy: 50:38
note on a personal note, I wonder if this would help me with claustrophobia, or fear of heights.
Julia Mirer M.D: 50:45
Interest I like just got this visual of like your visions being you and like crazy heights.
Amy: 50:51
Yeah, probably. It's funny. This is like, totally not related. But it's funny. My son has this like VR thing that he plays all the time. And there's this one game, it's called Walk the plank. And for I mean, for anyone, it's scary. But for someone who's like afraid of heights, it's crazy. And you put this thing on, you're in an alternate universe, you go up an elevator, and then you cross a little plank to another building. No one can do it, we do it on everyone that comes to our house. It's like a joke just to see. So many people are scared across this plank. And it's just virtual reality. But it's so real. And that's like, the only thing I could probably compare this experience to I'm sure it's nothing like it. But it's like wild how like your mind can just be stuck in certain ways. So one of the things I was going to ask you as I'm listening to this, and it sounds like it can be an incredible therapy for people that really need it. You're doing a lot of lobbying for psychedelic therapy. And I want to hear about that, because I imagine I don't know how expensive it is. But it seems like it might be expensive, not attainable for the average person insurance clearly probably doesn't cover it. So like, What's your thoughts on all of that?
Julia Mirer M.D: 52:02
Yeah, so one of the biggest hurdles, like I was saying is access. And currently These are expensive treatments. And I think one of the one of the things that happened with ketamine research is that a lot of the ketamine research didn't really involve a lot of therapy. So when it was, it's a lot harder to talk to insurance companies about it. So one thing is, we're trying to get more research that shows the therapy with the ketamine is effective and in you know, more effective, or just to get the information out there. So we have legs to stand on when we talk to these insurance companies. The other thing is, ketamine is since it is used for pain, and pain oftentimes shares a co diagnosis with mental health because if you've had pain for long enough, you're probably going to feel a little depressed about it, or anxious that it's going to get worse all these things. So there are opportunities to get it partially or covered by insurance when there's a diagnosis of pain. There's also a company called Anthea, which is one of the companies that is looking to serve as like a third party insurance for corporations to be able to give their employees to cover their employees ketamine assisted therapy. So there's what there's like people working on this from a research standpoint, so they know we would get this, ideally get this grant for research. But if we don't start creating research that includes therapy in it's like, the MDMA is, like 60 hours of therapy over you know, full therapy hours, because you have two therapists. So there's a lot of therapy that's involved. So that's going to be how it has to be rolled out. And I'm hoping to see the same thing for psilocybin for LSD for five me like all the medications for the other thing is, you know, when we talk about the home model, if you are a company that is truly screening and preparing your patients, this can be a good option. So there's room for everyone. You know, some people want to do group I am some people want to do, I can't afford IV in person, but the home model does offer a less expensive option, but slightly more risk for people who maybe are worried about their addictive tendencies, like you know, like the personalities or people who are already feeling lonely and don't really have a lot of support. Maybe a dissociative might make that a little bit, you know, more uncomfortable. So, I think that group therapy is going to end up being the most effective and cheaper, like the most affordable and effective in the like next couple of years before we start getting broad coverage. And you know, the other thing is There is this conversation, you know about the only people who can afford this, you know, and there's like, you know, some some debate about, you know, is that fair? And no, you know, access to medicine, effective medicine, being limited is not fair. But I think it's also important to recognize that we all suffer the same, we may have different contexts, but the same way that somebody can feel lonely and isolated, because, you know, their lower end of the fight like, you know, lower wealth. And people who are very wealthy can also feel a sense of disconnection, they can also suffer from, you know, sense of loss, people also lose people. So like, I think it's important to also remember that the fact that this is available at all, is really important, because the more people that can start to find healing, the more people start to exhibit pro social behavior, and the more people will be, you know, hopefully inclined to figure out how to get this to the world. Yeah, so you know, it's, it's really and for clinics, it's really frustrating that we can't make this cheaper, like, extremely frustrated, like, when I came into this, I was like, Oh, we're gonna let you could totally do this. And then you realize, like, oh, the logistics are actually really more difficult. And even the best of the best with most ethical practices are charging, you know, $5,000, because that's how, like, they're not going to be able to stay around to get it to insurance coverage, if they're trying to kind of, I mean, two things, that it's gonna be tough to stay afloat if you're not charging enough. And then also, you don't want to start taking away services in order to charge less, right? You want this to be effective and as effective as possible, and
Amy: 56:55
you need to be handheld through the experience. I mean, it's not like you can just Yeah, right. So yeah, and to your point, I mean, the more education, the more research, the more mainstream it will get, hopefully, more insurance companies will be open to it, and it will become more accessible for people because it just sounds like such a incredible therapy for people that really, really need it. So thank you for educating us today. This has been so just fascinating. Really.
Julia Mirer M.D: 57:23
Thank you for having me on. Yeah.
Katie: 57:25
Well, before we wrap up, we have a couple of things. First of all, if our listeners wanted to find you or reach out to you or you know, read what you're doing with the lobbying and everything get involved, how can they find you?
Julia Mirer M.D: 57:38
So they can find me on LinkedIn, I usually post over there. And then information about new shamans. It's new schema.com Okay, great.
Katie: 57:49
All right. So last thing, just like some fun little stuff that we like to do, we're going to do our rap session. First question is, what is your favorite wellness or beauty hack? Julia?
Julia Mirer M.D: 58:03
Um, wellness hack, so I, I have this like, love hate relationship with coffee. And so I started doing something a little bit different. So because I would realize that okay, I drink coffee in the morning. And then like, around noon, I'm like, like, I think I'm hungry. But I'm like, oh, I need more coffee. And or I have a crush. And so what I started doing is in the mornings, I do my smoothie before I have my coffee. And I if I end up even needing my coffee, I don't have that crash afterwards. And for me, I think that that from like a wellness standpoint, I feel like that was a really fun hack for me to learn in the last few months. That's yeah,
Katie: 58:44
that's a good one as I'm like, generate from my second cup of coffee over here.
Amy: 58:51
And what kind of smoothie is it? Yeah,
Katie: 58:53
what is your smoothie that you so Oh, yummy.
Julia Mirer M.D: 58:55
Um, I throw in everything. So I put in like I have the different from Whole Foods. I have the chaga the Reishi Lion's Mane, their collagen and their protein powder, the vanilla one that tastes like cereal milk, so everything else tastes better because I throw in like, I'll throw in celery ginger, like dill, sometimes cilantro. Interesting. Or I'll do like beets and carrots. And so I throw whatever stuff in there because I'm like, I'm just gonna give myself the nutrients I need. So like a drink the coffee.
Katie: 59:24
Yeah, smart.
Amy: 59:25
I love it. Okay, so the next one we call our five minute flow. And this is just a fun one where you get out of the shower, you're dried off and you're drying off and Uber just alerted you. They're five minutes away. You know, what's your quick beauty routine? What do you put on? What are your go twos to get out of the house on time and I'm sure you're such a busy person and doctor that like you don't have time to do anything. So it'd be good to hear what you're what you're putting on.
Julia Mirer M.D: 59:49
Um, so I'm a recovering physician. So there's very little in clinical like settings that I work on. And so for me, I pretty much like drawn my eyebrow Throw on a sports bra and leggings.
Amy: 1:00:03
Sounds good. Yeah.
Katie: 1:00:05
All right. And last one, how do you maintain your daily nirvana?
Julia Mirer M.D: 1:00:12
So, morning meditation sets me up in the mornings. And then outdoors being outdoors, if I like on the days that it's just a little bit rainy here in Florida, like what? How do people what do I do? So minor Ron is definitely like, we always think about, oh, I don't have time to do this, I don't have time to do like the meditation. But for the most part, we all have five minutes. And I try to do it for as long as I can choose like 10 to 15. Without any alarms without anything, just and then throwing myself into this parasympathetic state in the morning, really allows me to stay more in that place. And I recognize when I don't do it for a while it starts my morning starts to get thrown off my coffee affects me differently. So yeah, that's been like an incredible practice that I've been able to maintain for a couple of years now.
Katie: 1:01:08
Nice. Awesome. Yeah, I feel you're on. Alright. Well, Julia, thank you so much for giving us so much of your time. And this has been incredibly interesting. Our listeners, I think, are just really going to like want to sink their teeth into this episode and learn all about it. And hopefully, the lobbying keeps going the way we need it to go. And this all really comes into fruition Marceau. So thank you. Thank you, Katie. And Amy,
Amy: 1:01:31
we always end the show with a mantra to just set our listeners up for the day or just something to think about and my found one that I think is really relevant for this discussion we just had, and it delete the old version of me in your head, it expired new roles.
Julia Mirer M.D: 1:01:46
Like I just got goosebumps. Yeah.
Amy: 1:01:49
That's a good one. So yes, thank you again for being on the show. And we look forward to staying in touch and following all of your updates. Yeah, absolutely. Thanks for listening to Nirvana sisters. For more information on this episode, check out the show notes. Please subscribe and leave us a review. also find us on Instagram at Nirvana sisters. If you loved what you just listened to or know someone that would please share it and tag us. Tune in next week for a fresh new episode of Nirvana sisters will continue to watch out for all things wellness, so you don't have to. Bye.