Meet Andrew Penn. With more than 25 years of health experience, he was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the UCSF. He has completed extensive training and psychedelic-assisted psychotherapy at the California Institute for Integral Studies and recently published a book chapter on this modality. A leading voice for nurses and psychedelic therapy, he is the cofounder of Open Nurses, a professional organization for nurses interested in psychedelic research and practice, and was a study therapist in the MAPS-sponsored phase 3 study of MDA-assisted psychotherapy for PTSD. Man, he’s done a lot of shit, let’s put it that way. Honored to get a glimpse into what he’s learning along the way. Come hang and check out our chat with Andrew, below!

Andrew: The way that we gain knowledge about these compounds is through research, and that’s kind of a slow dull process. Research is really about hundreds of small questions that have to be answered. If somebody’s appropriate to be a subject in a trial, if we can proceed, what to do with the data — there’s a lot of decisions that have to get made in there. But that’s how you find knowledge, and knowledge in the scientific method builds on its previous knowledge. That’s a different practice than faith. I think historically a lot of people come to this from a place of faith. They had a psychedelic experience once or twice and they know that it works for them. That’s what we call empiric knowledge. Part of what I’m doing is trying to temper expectations a little bit and just keep us realistic while at the same time remaining optimistic.

Haight Street Voice: As a journalist, what’s the best thing I can do help purport the awesomeness of the work that you’re doing. What can I do to help? 

AP: It goes back to that question of nuance: “Party Drug Treats PTSD!” is a really eye-catching headline, but it’s misleading, it undervalues the value therapy. Psychotherapy really is at the heart of this, the drugs just help to accelerate it. Seek to understand what happens between a person going into the study and coming out of the study feeling better, what happens in between those two points. This is something I’m particularly interested in as a nurse. I’m interested in the care that we deliver to patients during that time. A lot of the healing comes from that care. 

HSV: What would you like to say to the Haight community?

AP: We’re just up the hill from the Haight at UCSF, so it’s really part of our extended neighborhood, as is all of San Francisco. This is really an interesting incubator for ideas that come out into the world. Hopefully these are going to be findings that we can build upon going forward and really help change to the world. 

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FULL TRANSCRIPT

PART 1, August 2021

Okay, here we are with Andrew Penn on August 10th …

Andrew Penn: …Is it the 10th? 8, 9, 10 …

HSV: It’s the 10th, okay, thanks, great [laughter].

AP: It’s summer. 

HSV: I don’t know, it’s August, isn’t it? [more laughter] 2021 last time I checked. So we’re just kind of riffing, we’re at 1506 Haight Street and I like the idea, I wanted to know your background, have you ever taken drugs or does that ever come up, and I do find it interesting your response was, “It’s kind of none of your business.” A psychiatrist would say the same thing. 

AP: I think it’s just what people do with their own time and consciousness is sort of their business. 

HSV: Yeah. If someone’s treating me for depression I kind of want to know what is their experience with depression. I’m not gonna play devil’s advocate but it’s true. Quite frankly, I was anorexic when I was young, my mom died and she was sick for a long time, and when she died I just stopped eating. It wasn’t my body image, I was always the same size, I just — it was the only thing I could have control of.

AP: Yeah.

HSV: I was — in fact 2 people took me to the Grateful Dead, Blair Jackson and his wife Regan McMahon, she’s a journalist and Blair was my boss and they did an intervention and took me to an anorexic therapist — who was rail thin and completely out of her mind. 

AP: [laughs]

HSV: Seriously. [laughter]

AP: She knew the territory herself, yeah.

HSV: Yeah, she did, and I was thinking, oh that’s good. The point is, is — I guess I never really thought about it cuz I’ve never really gone through a lot of therapy but I mean, I would hope that somebody who is walking me through a mushroom or a psychactive, or psychedelic psychotherapy — I always have trouble saying that …

AP: [laughs] Psychedelic psychotherapy — It’s a mouthful … 

HSV: It’s a lot! I would hope they had been through it so they’d sort of know what it’s looking like to me.

AP: Right. Well, you know, historically when this was being done in the 1960s and through formal research it was very common that people working with these substances would have an experience of their own in a similar setting. That model has been replicated a little bit in the current studies. In MAPS studies, which is Multidisciplinary Association of Psychedelic-Studies — that is a mouthful also — that are working with MDMA-assisted therapy for PTSD, they did do a small study where had about — I don’t know how many study therapists, I think it was just a couple handfuls, had the opportunity to actually have their own MDMA therapy experience so that they could be familiar with the territory. 

HSV: Right. That seems right, like what was it like for them? All that. 

AP: Yeah, it’s not dissimilar from a lot of psychotherapy programs requiring trainees to go through their own therapy, which makes sense. You should know the ground that you’re exploring alongside your patient, right?

HSV: Right. And now that I think about it, someone who’s being treated for alcoholism, I wouldn’t want them to be drunk. 

AP: You wouldn’t want them to be drunk but would they necessarily have to be in recovery in order to be an effective clinician for substance abuse? I don’t think necessarily. I mean, you know, there are some people who that is — they got into substance abuse treatment because they’re in recovery and that informs their world view, and that’s fine. But I don’t think every psychiatrist needs to have experienced depression or schizophrenia in order to be a good clinician. But I do think psychedelics are particularly unusual in that the territory can be a little weird. 

HSV: [laughter]

AP: And it can be helpful to be okay with that from your own experience. But, yeah, unfortunately we do live — even though it’s easy to forget here in 2021 California that these are still illegal substances as far as the federal government’s concerned and people are still going to jail for them, which is, you know, ridiculous, but you know there it is. So a certain degree of caution and discretion and that, is reasonable. 

HSV: And then say, Ayahuasca is a bigger thing and going down there and that whole explosion …

AP: Sure. 

HSV: There are so many layers to this, as it were. This being the Haight Street Voice, if we were to sort of morph this conversation into this area, Dr. Dave’s office is right around the corner, his original Haight Ashbury Free Clinic was on Clayton there next to the post office … 

AP: Yeah, right.

HSV: How does this area resonate for you? People you’re treating, all that … is this sort of a vortex? Maybe I’m projecting that or do you see the connection or is there a connection?

AP: Well, you know, it’s an interesting full circle, right? When you look at the history of psychedelics, I mean I sometimes joke that the Beatles did not invent LSD, you know, despite popular misconceptions, right?

HSV: Lucy in the Sky, yeah.

AP: Right, which apparently it was actually about Alice in Wonderland and not about … it was referencing children’s bedtime stories, it wasn’t about … oh right, it does spell out LSD! How about that!

HSV: Lucy and the screaming dog, right? [laughter]

AP: Tomorrow Never Comes is definitely taken from a Timothy Leary talk at Millbrook. 

HSV: “Relax your mind and float downstream”, yeah.

AP: Yeah. 

HSV: Which feels really good, I mean that’s what it really does feel like.

AP: Yeah. So how does this place tie into it … 

HSV: I mean not really this place but rock and roll music, we can broaden it, counterculture, free love, a lot of Vietnam vets, there was war, there was all this energy that somehow psychedelics seemed to take all the chaos and somehow soften it for a little bit. 

AP: Yeah, well, you know it’s such an interesting history because here are these compounds that, you know, LSD was obviously synthesized in a laboratory kind of accidentally almost and was used in very serious psychiatric research in the 1950s and the 1960s, well before any young people ever heard of it. And they say there was like a thousand papers published on LSD before the youth culture ever got a hold of it. And psilocybin and these other plants medicines were used in a lot of indigenous cultures as sacraments, as visionary medicines. They weren’t used as intoxicants. I mean that’s the last thing anybody … you know, that’s like washing your face in the baptismal of the Vatican — you just don’t do that, right? 

HSV: Well said!

AP: You know, the idea of taking — 

HSV: Did you just make that up? 

AP: Yeah. 

HSV: That was good!

AP: Yeah, you just wouldn’t do that. And so this idea of using them as intoxicants was a new use for them, you know, in some ways. So they end up loose here during a very pivotal time in history, we had an awful war going on that a lot of young people are being pulled into, you’ve got a huge generational push of baby boomers who didn’t see the world the same way their parents did.

HSV: You’ve got amazing music. 

AP: You’ve got amazing music and so all these things come colliding in this 6 block area, right? And in some ways, you know, the Haight kind of feels like it’s a little stuck. There’s this 7 to 8 year period that was really pivotal here — maybe not even that long. Maybe ’65 to ’70, ’71 … 

HSV: And then the bad drugs come in. 

AP: And then the bad drugs come in and things kind of go downhill. But I can’t think of another area of the City that really ties its identity so closely to such a narrow period of time. 

HSV: Well, in North Beach …

AP: North Beach, maybe, yeah. 

HSV: They had the Beatniks. But sadly, North Beach is dying, there are so many closed down shops now, and that was even happening before the covid. North Beach just became this weird tourist place.

AP: Yeah, it was a novelty, like Little Italy.

HSV: The soul was kind of dying away. But I feel like the Haight, yeah it comes and it goes but even Bobby Weir says there is some sort of magnetism here, like an almost physical magnetism to these 6 blocks. 

AP: Yeah. 

HSV: People are really — maybe they’re projecting because they heard about it, but I see people, and I’ve lived here for a million years, but I still see people filled with joy, like, “Wow!” Like Alice in Wonderland. I do hear what you’re saying about it being stuck, but I also see it as a place that’s also sort of hopeful too. 

AP: I do too, and I think it represents … it’s a symbol, right? It symbolizes the possibility that comes with youth culture. It’s like, things can be made here, things can be created here, people come together in a way that changes them. 

HSV: You can dress weird, you can be weird … 

AP: You can be weird, you can be whoever you want to be here and that’s obviously attractive for a lot of people. It represents a time that American culture really got turned on its head. You know, I’m not a sociologist, I feel like I’m a little out of my wheelhouse [laughs] here … 

HSV: No, that’s okay! I’m just curious about your take on it. 

AP: You know, it’s interesting. We’ve kind of gone full circle: So we have psychedelics as serious research medicines, right? We have youth culture, there’s a backlash against youth culture and drug use under the Controlled Substances Act. That puts everything … one of the fallouts of that was that it became very difficult to study these things because the way the Controlled Substances Act is written is that by definition of being on Schedule 1 it has high potential for abuse and no medical use. And so when you say, “Well, we’d like to show you there’s medical use”, they say, “No, it’s a Schedule 1 drug. By definition it has no medical use.” So, you know, you kind of end up chasing your tail, right?

HSV: Mmhmm. 

AP: And through a lot of hard work by many people over the last — you know, I realized this the other day that if you pick the first psychedelic period, 1943 when Albert Hoffman realizes LSD is psychoactive to 1970 with the Controlled Substance Act — that’s 27 years. The first paper in the modern era on psychedelics was written in 1994 by a guy named Rick Strasberg investigating DMT. 1994 to 2021 is 27 years. 

HSV: Whoa! Okay! Pattern! That was Timothy Leary’s whole thing was patterns, watching patterns. 

AP: Patterns, yeah! And so now, very soon we will be in the modern era longer than the pre-prohibition era went for. So this is not a new thing, right? This is now going as long if not longer than the first go-round of this, which is interesting. 

HSV: Wow.

AP: Cuz you always think of that time as being this big chunk of time, but no, this time has been just as long now. 

HSV: Yeah, wow. 

AP: So yeah, the whole thing has gone from research, bacchanalia, crackdown, research and now I really wonder like is there room for some kind of synthesis? Can we have these things as part of our culture without them getting totally out of control, right? And I don’t know. I don’t know the answer to that. I mean, can we now have a greater respect for them? Because these are very powerful tools, these are very powerful medicines that are not to be played with. They’re not toys. 

HSV: But wouldn’t you rather have people playing with psychedelics than playing with crack-cocaine?

AP: Sure, but that’s sort of a false equivalency argument. It’s not like, “Hey, would you like crack-cocaine or would you like LSD?” It’s like … yes, in terms of safety they are considerably safer than a lot of other drugs that are used on the street. Most glaringly, obviously, would be opiates, and that’s a huge problem, right? But at the same time I don’t really think these are for kids, for example. These are some big experiences that, sure, plenty of 16 year olds have had. Do they have the bandwidth to metabolize that? I’m not sure they totally do. I mean sure, some might and I’m sure there are some people walking out here who would tell you one of the most experiences in their lives was when they were 17 and they had LSD for the first time. And I don’t doubt that. And there’s also people who that was just really disruptive to them and had they waited a few years to have that experience it might’ve been a lot less scary and a lot more meaningful and they could’ve drawn more from it. You know, we don’t let 12 year olds drive cars [laughs] because they don’t have the mind to think about what they’re doing. We make it a compromise and say, “Okay, 16 year olds can drive” and even that’s a little catastrophic sometimes, you know?

HSV: So Joel Selvin …

AP: Joel Selvin the music writer, SF Chronicle?

HSV: Yes. He was my teacher at SF State back in the day, Ben Fong-Torres as well, both had a lot to do with my love of music journalism.

AP: Oh yeah!

HSV: Joel was telling about the whole Pharma, psycho … 

AP: Pharmacology is the study of drugs … not just psychedelics, but any drugs.

HSV: Anyway he was talking about the whole psychedelic therapy thing, and he said in a safe environment there’s never been a bad trip.

AP: Oh, I don’t think that’s true. 

HSV: I don’t know where he got his stats but he was saying nobody in a safe environment has a bad trip. Maybe I’m getting it wrong. 

AP: Okay, this may be little bit about semantics. I mean, if you define a bad trip as somebody getting hurt or dying, yes, that’s true. Do people have difficult experiences in a controlled setting? Absolutely! But difficult doesn’t have to mean bad.

HSV: It’s getting across the abyss.

AP: Well yeah, exactly. And we don’t use the term “bad trip” in research. We talk about difficult experiences.

HSV: I think that’s what he was talking about.

AP: Yeah I think that’s probably what he was getting at. We prepare people to have difficult experiences and that’s not necessarily a bad thing, right? It’s actually to be expected. And part of what we’re helping people to do is to reframe that: difficult doesn’t not equal bad. That’s why we don’t use the term “bad trip”. Oftentimes people will tell you that a difficult psychedelic experience they had turned into a very meaningful one later once they made sense out of it. At the time, if they had the option of turning off the switch and going back to a regular mindset they would. That’s partially why when we do this in these controlled settings we have 2 therapists there, it’s a controlled setting, it’s comfortable, it’s safe.

HSV: Do you have cool music going? I don’t mean this to sound placating at all but is it groovy? You want the textures, you want the furry pillow … 

AP: Yeah, so our lab — our “lab” weird to say. We have a standardized playlist. So if you were to walk into our lab it’s a little room about, I don’t know, 12 x 14 or something. It’s not huge, it’s like a living room, couch on one end and 2 easy chairs for the therapists, we have a window, we have some tasteful but inoffensive art on the walls. And when people have their dosing session we have a pair of eyeshades, we encourage people to direct their attention inward, so eyeshades help with that. We have music that we play both headphones and in the room, which is a preselected soundtrack of music, and it varies. Anything from kind of quiet and oceanic to a little more driving. We tend to use music without lyrics or at least not lyrics in English. I mean we don’t play, you know, “Sugar Magnolia” or anything like that, you know! We intentionally choose music that people would tend not to know because we want to avoid somebody saying, “Oh, this is a song they played at my wedding!” Or something like that. which could be good or it could be bad. [laughter].

HSV: I’d want to hear something more tribal or of the earth, drums … 

AP: Yeah, there’s definitely some of that in there. Some of it is more bright and ambient kind of music. It’s intended to support the emotional aspect of the experience. And also the music in these serves as a kind of current to swim with.

HSV: Yeah, like “relax your mind and float downstream …”

AP: Yeah, exactly, what you were saying earlier!. But, as you know with psychedelic experiences there can be a sense of time dilation, like time is not moving and sometimes when people get in that state they’re like, “Oh my god, am I dead? What does this mean?” And the great thing about music is that it’s always traveling from point A to point B. Every song has a beginning and an end, even if it’s going over and over again. 

HSV: I tend to put it on over and over again when I’m really really high because I don’t want things to end. 

AP: Yeah, but eventually if you’re having a difficult experience, one of the things that we encourage people to do is to pay attention to the music as a current and it will take you downstream and you’ll be okay. 

HSV: These are all very personal questions and again, I wouldn’t print anything without your consent, but I’m imagining … like there might be a person who’s like, “I have to get out of here,” but I imagine it doesn’t happen that often because you’ve gone through the preliminary stuff. 

AP: Preparation helps to avoid that. So we have a set of agreements that we ask people to agree to when they’re going to be in a study. They’re pretty obvious things. Like we ask that you not harm yourself or us or the room — don’t trash the place. The most important — and obviously if someone had suicidal thoughts afterwards that we ask them to agree to tell us so that we can help them. That’s not been a problem but we establish that. 

HSV: Yeah.

AP: But one of the other agreements is that after you take the capsule, you’re agreeing to stay for 7 hours. And where this is probably more challenging is for people to get the placebo because half of our subjects get a placebo. They get niacin, which is …

HSV: I know niacin. Makes me all red.

AP: Yeah, it might give you hot flashes and make you feel a little weird but it’s enough that we’re trying to make a double-blinded placebo-controlled trial. “Blinding” is very difficult in psychedelic studies as you might imagine. People tend to know if they got the drug or the placebo, even to people who have not had psychedelics fairly quickly they can figure out if they’ve had the drug or not. We encourage people not to spend a lot attention focussing on “did I get drugged or not?”

HSV: Right!

AP: When is it working? Is it gonna work? And really to think of it more as they really are just there to really have this whole day. We start at 8am and we don’t leave until 5 or 6. So you’ve got this whole day, you’ve got 2 therapists here not matter if you got the drug or the placebo, we’re interested in supporting your experience. Take your shoes off, put your phone away, you don’t have to be anywhere, you’ve got no place to go and nothing to do other than be here. 

HSV: I think I read that your clients range from 93 to 17?

AP: Oh that’s in my practice. I think for our criteria we start 18 to 64 or something. 

HSV: And if I wanted to go in … is it a volunteer kind of thing? I’m just being the lay person here … 

AP: So any clinical trial there’s what’s called “inclusion” and “exclusion” criteria, so in order to be in our study you have to have a diagnosis of major depression, for example. There are certain things — that would be the “inclusion” criteria. Exclusion there are certain things, like I said 18 to 64, so someone who’s 75 we could not include. Certain medical conditions we would have to exclude people, certain psychiatric conditions we have to exclude people. And people have to be willing to come off their antidepressants, they’re psychiatric medications and  to suspend any psychotherapy that they’re in during the time of the study. There are people who don’t want to go off their meds.

HSV: Which is a shame cuz they might find something better, different, for a treatment. 

AP: Maybe. A lot of people are on meds because that’s what’s helped them and they’re really afraid going off of them.

HSV: Yeah.

AP: Or they live too far away, you know, we asked people … it takes a bunch of time. We only do the dosing session once but we have several visits for preparatory psychotherapy and several visits afterwards for what we call integration psychotherapy. And there are medical visits. You have to come in and get an EKG and blood work and all the stuff that happens in a clinical trial. If somebody lives 150 miles away, it’s probably not realistic. So there are lots of reasons why people are not able to be in this study. But if somebody’s interested in clinical trials in general, there’s a great resource that the National Institute of Health maintains called clinicaltrials.gov.

HSV: I have a lot of friends that want to get involved, not like “hey, let’s get fucked up on drugs” but they want more guidance but they don’t necessarily want to take an ayahuasca trip in South America. 

AP: Sure. 

HSV: So I’m just wondering, how accessible is that now, is that a possibility? It’s not like just, “Hey! Let’s go to the clinic!”

AP: Well, I think it really important to remember that we are — the question we’re trying to answer is, in our particular setting, is: Does psilocybin-facilitated therapy treat major depression?” So this isn’t really about giving people just the drug experience. This is about: Does this treatment actually help this medical condition? So that’s why it’s pretty clear and circumscribed who can be in the study and who can’t. Because otherwise, the information you get isn’t very meaningful. So that’s why we have to be fairly restricted. 

HSV: Oh I get it. That’s why we’re talking. If you’ve got a person and they have radical depression and they do this and have an amazing trip — again, I’m only speaking from the experience but  — the low, like, “Oh that was so magical! And oh no, now I’m even more depressed because that was so magical!” I imagine it’s not a danger, but it’s a possibility?

AP: It’s a possibility. The good thing is that it seems like from the studies done so far that a lot of the benefits that people get from these treatments persist for a long time afterwards, sometimes [inaudible] years, which is pretty impressive because in our current psychiatric paradigm of giving somebody medication that may help somebody and then they stop taking the medication and the benefit goes away. So this is unusual to give medication once in this particular context, in this setting, with a lot of support and for some people their improvement will last months, maybe even years. 

HSV: It seems like it’s in tandem with the language of the drug itself — or the plant, I should say, the medicine of the plant — and the professional guidance as well that integrates into the psyche, the body — everything.

AP: Yes. I mean, nobody knows exactly why this does what it does but one of the things that we think might be happening is that — especially when you take something like depression — depression often have this very well-formed but very negative story about yourself. That story might be that you’re a terrible person and the reason why you feel like shit is because you don’t deserve to feel well, or you’re a bad person or you’re cursed — whatever. You’ve had a terrible childhood therefore you can never feel joy. There’s a story we tell ourselves, and — 

HSV: You’re ugly, I heard that voice a lot … 

AP: Exactly. And in psychology we call this rumination: telling yourself this story over and over again not being able to change that story, and in that story there’s a lot of suffering. There’s a lot of suffering in that story. And what may happen in psychedelic sessions is that they get, they get — again, we don’t really know — but they get this opportunity to kind of step out of your own story for a little bit, and maybe see things from a slightly different angle, maybe a different elevation, right? And maybe be like, “Oh, maybe I don’t need to do that same thing I’ve been doing all along. Maybe I’m participating in my own unhappiness in a way that I don’t have to do anymore. 

HSV: Or like, “Oh my god! I feel happy right now!”

AP: Yes, to actually have that sort of brief moment of, “Oh is this what happiness feels like?”

HSV: Right. 

AP: I would say that compared to what most think of recreational drug use as being this sort of euphoric, blissful experience, I would say in our experience that is less common, in that context. And it probably kind of speaks to the seriousness of what we’re doing. If you’re going to a Dead show and you’re all excited and you’re taking your tab of acid in the parking lot of whatever — that’s a very different expectation than you’re coming to our lab and you’re saying, “I’m going to hunker down and talk about my difficult stuff for the next 8 hours.” 

HSV: Yeah.

AP: Those are very different mindsets going into that and so the experience is different. So I would say there’s a lot less sort of people being blissed out. I’d say there’s probably a lot more tears than laughter. Not to say that people don’t — as you know psychedelic experiences can be really variable, and so … I’m thinking of the last person I sat with who one minute was giggling and 5 minutes later was crying her eyes out. And it’s okay! We welcome it all, it’s okay. But there’s not a whole lot of twirling and dancing going on in our lab. [laughs]

HSV: [laughs] No, I get it.

AP: It’s a much more inner-directed experience. I think that’s one of the ways in which it’s different than what a lot of people are familiar with recreational use. 

HSV: It’s a safe space is what it is … 

AP: It is. And I wonder, too, would people have more — would there be fewer of those difficult experiences in recreational settings if people had a place where they could go and knew that they were safe.

HSV: I know at Burning Man they have those places if you’re really tripping out, and of course with Dr. Dave, there’s RockMed.

AP: Yes, RockMed were the folks to kind of start that. I worked — I’ve been going to Burning Man for 22 years or something … 

HSV: Oh I didn’t know that!

AP: Yeah, so I’ve worked with Zendo, which is the harm reduction place out there. That’s exactly what we do: we have a very comfortable space where people can come in and they can talk to someone if they want to or if they want to be by themselves they can do that, make sure they’re safe and hydrated and comfortable and have whatever they need until they feel better and are ready to go. We keep them from getting lost or hurt or arrested or any of a number of things that can happen … 

HSV: Isolating … 

AP: Yeah, exactly. People can get kind of despondent in that space. I mean the last thing we want is somebody harming themselves in that distorted mind space have decided that everyone hates them. 

HSV: That makes me want to ask you: when you walk up and down these streets — I don’t know if you hang out in this neighborhood but I live here — I know a lot of the street kids. But when you see — I don’t care if it’s this neighborhood — any sort person on the street, whether they’re homeless or not homeless or just fucked up, do you, being the awesome person that you are and the work that you’re doing, you must feel like, “I want to help that person but I can’t.” 

AP: Yeah. 

HSV: Especially the really drunk ones, or the ones that are on speed. The speed ones really freak me out because they’re so unpredictable and usually angry.

AP: Yeah, I mean I’ve worked at San Francisco General in psychiatric emergency. I love our City and I sometimes feel like we’re … I think sometimes sadly we mistake tolerance for … we allow people to suffer with really severe mental illness and have mistaken that tolerating — San Francisco has this great history for sort of tolerating eccentricities, right? Which is great, I love that.

HSV: And welcoming it too!

AP: And welcoming it! Weirdo USA. Weird Capital, USA, and I love that. That’s part of why I live here. And I think what’s sad, I mean you walk around the Tenderloin or walk around here, I think we sometimes allow people to really suffer and we think it’s freedom. And there’s nothing liberating about being severely mentally ill, or severely substance dependent. It’s its own kind of hell, and to think somebody taking off their clothes and shitting on the sidewalk out here is some expression of freedom, well that person is really sick. And when we all go, “Oh, well, they’re just doin’ their thing”, I think it’s neglectful, honestly. I think we have mistook tolerance sometimes for neglect.

HSV: I hear you. There’s one woman down here on Haight, she’s got all this … they’re letting her take over the sidewalk with all her stuff everywhere. It’s probably meth, maybe, I’m thinking it’s meth. But she’s always drawing or writing, she’s never — I mean I’ve never seen her mean or crazy. But apparently one of the merchants said they’ve heard her going off at night, out there, loud, yelling … 

AP: Yeah.

HSV: But there are some people — I don’t know about her but there are stories of certain people who have been taken in for treatment, they get cleaned up, they shower, they get off the drugs, and they want to be right back here. 

AP: It’s a revolving door.

HSV: That’s the addiction but it’s also a lifestyle. It’s not like, “I want to get back there and get drugs,” it’s more like, “I don’t want to get into the system. I don’t want to go do that.”

AP: Right.

HSV: So what is the solution? Everybody I talk to just says it’s a really difficult situation.

AP: It’s incredibly difficult. I mean I don’t pretend to know the answers. I think supportive housing is a huge part of it. I think it’s very hard to get people well when they’re living on the streets.

HSV: There’s one story — I know you’ve got to get going. But there’s a woman who works at a headshop here, her son came out here from somewhere in the south, he got off drugs, was doing great — smoking but and doing some psychedelics, but not doing the speed anymore, and checking in with his mom, and doing alright. He finally got sick of living on the street and they took him down to some facility in the Tenderloin. And he’s back on crack, shooting crack now. They sent him back into the belly of the beast, so there’s that. They’re sending them right back into it.

AP: Yeah. We concentrate — the Tenderloin is a good example of where we take all these people who are really struggling whether it’s mental illness or substance abuse or they’ve recently gotten out of jail or they’re recent immigrants or any other reasons … 

HSV: Your parents die. There’s all sorts of levels of misfortune. And you put people in what essential feels like an open-air asylum and then you expect them to get better? How the hell are you supposed to get better in that setting when everyone around you is just as ill as you are? And they’re predating on each other, there’s violence. Yeah, I don’t pretend that I know the answer to it, but what we’re doing doesn’t seem to be working so well. 

HSV: Yeah, and that’s not necessarily just here, it’s happening all over this country, all over the world really. Although not necessarily Sweden where everything is legal and there’s a lot less problems.

AP: Again, I want to be clear that I am not an advocate for criminalizing mental illness, poverty, substance abuse or anything like that. These I see as public health problems.

HSV: Dr. Dave said the same. 

AP: Harm reduction as a driving force. Any time that somebody is — I was just reading that we’re on track to, I think right now there’s, at this point of the year, there’s 3000 deployment of Narcan for opiate overdoses.

HSV: Yeah, that’s the one that makes you not die?

AP: Yes, it reverses the overdose. Narcan is a nasal spray that reverses opiate overdoses. So if someone’s overdosing — the way you die from opiate overdoses is you stop breathing, you suffocate to death. So if somebody’s taken an overdose of opiate, say fentanyl or heroin or oxycontin — and they’re unconscious and they’re not breathing, you give this to them and if it they haven’t not been breathing for too long, you can help revive them. 

About 20 years ago some very visionary people from the San Francisco Department of Public Health starting distributing Narcan to people who inject drugs because at that time a lot times of people were afraid to call 911 because they’d get arrested for possession and there was a lot of bad folklore about how you revive somebody who’d overdosed on heroin: throw cold water on them or inject them with speed or whatever — things that don’t work. And so these folks at the department of public health had this very visionary moment. This is one of these “I’m really proud of San Francisco” moments: “Let’s distribute Narcan to people who use drugs because they’re the people who are going to need it to save their friends. It was wildly successful and now it’s all over the country — unfortunately, you know, because we now have a huge opiate problem all over the country. So now, needle exchanges … 

HSV: Thank you, Dr. Dave!

AP: Yeah exactly. Pharmacies, you can get Narcan. I don’t have my workbag with me but I carry it pretty much everywhere I go cuz I don’t know if I’m going to walk in here and find some guy turning blue. 

Anyway, last year there was about 6000 uses of this — so 6000 overdoses were reversed in San Francisco. 

HSV: Sadly, because there shouldn’t be 6000 overdoses. 

AP: There shouldn’t, but think how many more dead people there would have been had that not been out there. That’s a great example of harm reduction: Sure, it’d be great if people weren’t using opiates, but since they are, let’s make it so they don’t die. 

HSV: The accidental fentanyl stuff — six kids — SIX KIDS — in this neighborhood who I knew really well, between January and April, died. Two of them were alcoholics — Stumbles and Halfpint — I knew them really well and everybody loved them for the most part. She was reading books all the time, anyway, another kid Loki … you know Dr. Dave was telling me that even marijuana is being laced with fentanyl. That just weirds me out. Why would they lace marijuana with fennel. 

AP: I don’t think it’s intentional. I think this is the problem with unregulated drug markets. That same table where somebody was cutting fentanyl — which is often added to heroin to make it stronger, and there’s fentanyl showing up in cocaine … I think it’s largely because illicit drug makers and distributors are sloppy. They’re not regulated, you know?! Think about it if a restaurant here had an employee who had hepatitis and they were spreading it to the customers because he wasn’t washing his hands after he went to the bathroom — the health department would shut that restaurant down until they sorted it out. Well, when people die from contaminated cocaine, who do you shut down?

Anyways that an outgrowth of drug prohibition is that you create this really dodgy black market. 

HSV: Okay, one more thing and I’ll let you go for now … to be continued!

AP: To be continued! 

HSV: Yeah! I think this will be great. I’ll transcribe it and then we can meet up for another session from that. 

AP: Yeah, sounds good. 

HSV: You were talk about in one of your interviews about mushrooms, how the FDA … my ex-boyfriend was a professional forager of mushrooms.

AP: Uh-huh. 

HSV: He would go stay by the ocean because they grow down there in beautiful patches. And a lot of my friends took them and I had some, this was a couple years ago, and the information from these fresh mushrooms, from the earth two months earlier, was just incredible. Sadly, if the FDA is involved, they’re going to have to take these beautiful mushrooms, process them and … 

AP: They’re actually not processing them. They’re synthesizing the psilocybin. An organic chemist can synthesize chemicals. I mean, remember that Albert Hoffman the other thing he was known for was figuring out how to synthesize psilocybin. Sandoz, where he was working when he was making LSD also sold something called Indocybin, which was psilocybin in a pill form. It wasn’t ground up mushrooms, it was synthesized in a lab. 

The reason for it is that the FDA has specifically stayed away from regulating herbal products and stuff like that. That’s why every time you go into the health food store you see those little labels saying “This is not intended to treat or diagnose any health condition” because the FDA said “Those were food supplements. We’re not getting involved in that.” But drugs have be made under what they call, “Good manufacturing practices” which means that their whole sequence is documented. It’s sort of like with cannabis, the same 8th of cannabis can have 5 percent THC or it can have 25 percent. That’s a 5-fold difference — same quantity, same look, same smell but 5 times more powerful than this one. So you have some degree of regulation over it. 

But yeah, I mean, to get to your point, people have been availing themselves to fungi probably for 6000 to 7000 years. This whole idea that this is like a prescription medicine or even a drug people use for fun, these are a very new idea. When you figure there were cave paintings in North Africa that are 6 thousand years old that show mushrooms, medicine men using mushrooms. So okay, this it not new! And the fact that the way we think about them as either pharmaceutical medicines, which is a more recent idea, or even the 1960s idea of, “Oh, this would be fun” it’s a very new concept in the grand scheme of things.

HSV: So if you could say anything to the people of the Haight-Ashbury community, this magazine is hyper-local with a global perspective, so basically you’re speaking to communities all over the world, what would you like to say about the work your doing or just to the people?

AP: Oh boy. [laughs]

HSV: You can just say, “Hey!” Some people know exactly what they want to say.

AP: I am not sure. Maybe I can say something to that: One of the things that people come out of the psychedelic experience having is often a very deeply felt sense of feeling connected to the world at large, to other people, or to put it in the inverse, they lose their sense of feeling disconnected. I think many of us go through the world feeling very disconnected from the world around and the people who are in it. And sometimes living in a city is hard. We’re all on top of each other, the woman you’re describing who lives down the street and scribbles on the sidewalk, you’re like “Oh Jesus, her again?” It’s like we’re all kind of up in each other’s shit all the time, right? [laughs]. If you don’t want that you go live in the country. But we live here in the city. 

I guess I would say one of the things that I hope that psychedelics have to teach us is that we are all of us together. That we are not alone in this. That as much as we like to close our doors and shut out the world … that’s one thing that climate change is teaching us, right? We’re all at home. That factory might be on the other side of that “border” but that air doesn’t know borders and that climate doesn’t know, those storms that are being changed by climate, and this drought that we’re having — it doesn’t matter that the carbon dioxide in the atmosphere that’s changing climate here came from California or came from Argentina — we’re all in this together. 

That’s one of the things that when I think about community, I think about how do we show up for each other? How do we take care of each other? 

HSV: And it’s also how psilocybin runs, right? 

AP: Yeah! That’s the amazing thing about psilocybin is that when you see a mushroom — and not just psilocybin but any mushroom, when you see a mushroom in the forest it, it’s kind of like seeing an apple on a tree, it’s like, “Oh that’s the whole thing.” And it’s like, “No actually that apple is connected to a branch which is connected to a trunk which is connected to this whole tree!” It’s just that with psilocybin, we don’t see the rest of the tree. We just see that mushroom popping up which is connected to all this network of mycelia that’s connecting those trees to those trees to those shrubs to those trees. They call it the wood-wide-web! Have you heard that phrase? 

HSV: And they recycle death! I just watched Fantastic Fungi — have you watched that? 

AP: Yes!

HSV: And the way it eats a mouse up and beautiful things grow out of it. So that fear of death becomes this beautiful thing, growing out of the ground! 

When I was hanging out with Timothy Leary, and John Perry Barlow, lyricist fo the Dead and Terrence McKenna, I asked Tim, “Why you hanging out with me? I’m just a person who went to SF State, I’m not exactly a genius. And he said, “Intelligence is the ability to see the relationship between things.” It’s about being aware. 

AP: Yeah, and seeing how things connect to each other. I would say as a shrink, I get paid to ask people personal questions!

But your whole point about psilocybin, mushrooms breaking things down … I think about fungi in the world, their job is to break down things that are no longer needed in order to make it possible for new life to appear. And I think metaphorically they do that in our psyches too. I think a lot of what I see people process in these psychedelic sessions, honestly it’s grief. I think a lot of times when people think of having a “bad trip”, what they’re actually feeling is grief, and a lot of us are carrying around a lot of grief for all the different reasons — not just for the obviously things like death and heartbreak and that, but things that we wished had happened in life and didn’t happen, or the ways were seen and not seen, and then there’s all the grief that’s in the world. So we’re carrying this around and I think one of the things that psilocybin does in our minds is that it clears out some of the dead leaves on the forest floor so that new things can grow. 

HSV: Yeah!

AP: And that’s kind of magical. 

HSV: Yes, it IS magical! Thank you so much for your time!

AP: You’re welcome! This has been fun! I should go because I have things I’ve got to do but this has been great!

 — 

PART 2, November 2021

Haight Street Voice: Hey y’all, welcome to Haight Street Voice. We are here with Andrew Penn who — I am going to read his amazing background because it’s just fantastic: More than 25 years of health experience, Andrew Penn was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. And I’ll get to the nuggets here: he has completed extensive training and psychedelic-assisted psychotherapy at the California Institute for Integral Studies and recently published a book chapter on this modality. A leading voice for nurses and psychedelic therapy, he is the cofounder of Open Nurses, a professional organization for nurses interested in psychedelic research and practice, and was a study therapist in the MAPS-sponsored phase 3 study of MDA-assisted psychotherapy for PTSD. Man, you’ve done a lot of shit, let’s just put it that way. It’s just amazing!

He’s also the co-author in a recent article in the American Journal of Nursing — bravo — on psychedelic-assisted therapies, the first in 57 years. As a steering member of Psych Congress he has been invited to present internationally on improving medication adherence, cannabis pharmacology, psychedelic-assisted psychotherapy and grief psychotherapy treatment resistant repression diagnosis and treatment of bi-polar disorder and the art and science of psycho-pharmacologic practice. 

Hello!

Andrew Penn: That’s a mouthful! Hey Linda!

HSV: That’s a lot! Hey. Hello! It’s so good to see you again! You and I had the pleasure of hanging out back in August and this is sort of Part 2 of our hang and I have, I think since I saw you, I’ve been turned on to the fact that Cal Berkeley is doing a fellowship called the “Psychedelic Journalism Fellowship”.

AP: Yes!

HSV: So it’s all about how journalism and the study of psychedelic therapy and all of that is …it’s a whole new terrain we’re on and I’m so stoked to have you here because it’s part of my research is going up to people such as yourself that I’m having the privilege to speak to and say, “How does this all work?

AP: Hmmm, yes.

HSV: You know, what is the deal? And I thought we would start with … last time I spoke with you I think you said you were off to Dallas or Texas, so I klnd of wanted to get an update of how you’ve been and what you’ve been doing.

AP: Yeah, thanks for having me, Linda. 

HSV: Yeah!

AP: Yeah, it’s been a busy fall. It’s conference season in the academic world so I’ve been doing a lot of traveling for that, talking a lot about psychedelic therapy and particularly the nursing angle, the care that we deliver during psychedelic therapy has been a topic that I’ve spoken on in a few different places. So yeah, I just got back from San Antonio last night where I was talking about this at Psych Congress, which is a really large continuing medical education meeting that happens every year. About 2500 people come to that, so it’s a pretty good sized meeting.

HSV: Yeah.

AP: I did a talk and it’s called “Reunited and it Feels So Good” …

HSV: [laughter]

AP: … just like the Peaches and Herb song, with the subtitle “Psychiatry and psychotherapy magnify each other with psychedelics.”

HSV: What is the vibe at these things? My silly brain I’m picturing Cheech and Chong are wandering around and all the nutbags, you know what I mean.

AP: No! A bunch of what, you know, you might imagine: psychiatrists, psychiatric nurse practitioners, psychotherapists might look like from all over the country who are interested in hearing about this because they’re hearing about it from Michael Pollen or Anderson Cooper on 60 Minutes or the New York Times. I mean Newsweek just had a cover article about psilocybin for depression. 

HSV: [pull up photo of Newsweek he’s talking about] See!

AP: Yeah, there you go, look at that, as if on cue! So it’s really everywhere. A lot of what we’re doing is kind of trying to get people with science behind that to understand what’s happening and also to manage some expectations I think. Because we have this bad history in psychiatry of thinking whatever is coming down the pipe is going to fix all our problems. In the 1960s, it was that anti-psychotics were going to make it so that we no longer needed custodial care for people with serious mental illness and we closed all the state psychiatric hospitals and that led to — it’s a multifactorial problem but a lot of the homelessness and that what we see, people with severe mental illness are suffering from. In the 1980s, antidepressants like prozac were gonna cure depression and that really didn’t quite pan out. So I think the psychedelic therapies are going to play a role in psychiatry, I don’t think that they’re going to be right for everyone and I don’t think they’re going to treat everything.

So part of what I’m doing is trying to kind of temper expectations a little bit and just keep us realistic while at the same time remaining optimistic. 

HSV: That actually was one of my questions is can psychedelic treatment rid society of the evilness of pharma? [laugh] That’s kind of a big question.

AP: Yeah, it’s also kind of a loaded question.

HSV: Yeah.

AP: I mean I wouldn’t necessarily say that pharma is inherently evil.

HSV: Yeah, I know. I’m being sort of gonzo.

AP: Yeah! You gotta be! It’s your job to ask the inflammatory questions and my job to bring the fire extinguisher [laughter]

HSV: Cool! That would make a great Halloween costume … 

AP: Right? There you go! The bomb thrower and the fire department.

Yeah, I mean you know, pharma certainly has a lot of problems, that’s clear. But they also bring a lot of force for innovation into this space as well so it’s a very complicated question. I don’t think we know. Pharma is very interested in these compounds. There was lot of sort of fear that pharma would try and contribute to making these things illegal. I have not really seen that, you know? I think there are a lot of parallel threads that are happening: We’re seeing what’s happening up in Oregon with Initiative 109. It’ll be very interesting to see how that all plays out where psilocybin really kind of is taking it out of the medical model and is probably more akin to a yoga retreat where it’s an intentional exercise that is done by people who hopefully have some training. That’s part of what they’re trying to look at legislation around is what will be required of people to be guides in Oregon. They are disentangling it from the business model, which will be interesting. That could be very successful, it could also have problems, you know? We don’t know yet. We don’t know.

HSV: That was another thing: How has aligning yourself with the large healthcare organizations affected your own personal journey? Does that sort of resonate with you, or you’ve already sort of been in these large healthcare organizations … I guess what I’m asking is they psych —so many “psyches psyche psych” — with the large healthcare organizations, has it affected your journey? Obviously, it has but I’m kind of curious as to, you know, the red tape that you’re having to go through and all of that — can you speak about that?

AP: Sure. You know, I trained, and I teach now at UCSF so I’m in the neighborhood. That gave me the foundation for understanding, say, things like the pharmacology of these substances. I think that’s real important and it helps me understand how clinical trials work, you know, the way that we gain knowledge about these compounds is through research. 

HSV: Mmhmm.

AP: And that’s kind of a slow dull process. You know I don’t people — it’s kind of like that old saying about watching laws and sausage get made?

HSV: What is that? I don’t even know.

AP: You know, there’s 2 things you don’t want to see being made: One is laws and the other is sausage just cuz of the things that go into it. And you know, research is really about 100s of small questions that have to be answered. If somebody’s appropriate to be a subject in a trial, if we can proceed, what to do with the data — there’s a lot of decisions that have to get made in there. But that’s how you find knowledge, and knowledge in the scientific method builds on its previous knowledge. That’s a different practice than fate, you know?

I think historically a lot of people come to this from a place of faith. They had a psychedelic experience once or twice or whatever, and they know that it works for them. That’s what we call empiric knowledge.

HSV: What’s it called again? 

AP: Empiric. So they tried it, they had an experience, they felt like it was beneficial. And that’s very helpful for that person but it’s not necessarily generalizable, so you have to use scientific method to be able to generalize knowledge and be able to say “Yes, this could be helpful for many people.”

HSV: Right. 

AP: There’s just different ways of knowing and sometimes they’re a little bit at odds with each other because sometimes I think people that have had their own experiences don’t see the need for research, they sort of know for themselves that it worked, so why do we need to study it?

HSV: Right.

AP: But you also have to understand that there are regulatory agencies like the Food & Drug administration that regulate … 

HSV: Those guys … 

AP: … that regulate medicine in this country. And the only way that they are going approve this as a medicine, as a prescribable medicine, is with evidence. And the only way you make evidence is with research. So that’s the process by which you bring these into at least medical legitimacy. I mean there are other paths to legitimacy; the decriminalization path is a different one, the religious practice use is another one, so there are different ways of bringing these compounds into sort of from out of the underground into society. 

HSV: I’ve been in touch with DecrimSF and they’re really making progress.

AP: Mmhmm [nods yes]

HSV: This is for real, guys. But it takes — again, it’s that slow chipping away thing but they’re really at it and it’s really exciting to witness all of this. 

AP: Sure … 

HSV: Going back to the therapy, I was curious because my upstairs neighbor she works at UCSF — Hi Erin! — she’s a physical therapist there and she was curious about if somebody does a treatment that you’re doing for depression. That’s been your main focus is: how does psilocybin treat depression, correct?

AP: That’s what we’re currently studying, yeah. In the past we looked at MDMA-assisted therapy for the treatment of PTSD.

HSV: She was curious about if they have 3 or 5 treatment or whatever the amount is there’s this …  I’m trying to sort of paraphrase because last night we were hanging out and I asked her “What should I ask him!?” I already knew a few questions but it’s nice to have other people. And she was curious as to let’s say a person gets 3 to 5 treatments — cuz she’s taken psychedelics — she wondered how do you incorporate that into “Oh my god I had an amazing trip but now I’m on the bus riding the Muni to work and it sucks! Not as fun as it was yesterday when I was … expanding my mind.” 

How does it translate into day-to-day life?

AP: Okay, let’s back up here and clarify a few things because …

HSV: Yeah, thank you … 

SP: I want to make it really clear that the way that we’re using these compounds is not the same way that they’re used recreationally.

HSV: Yes … 

AP: So this isn’t like “Here’s a dose, go to a concert, have fun” right? Totally different context. 

HSV: Like Outside Lands this past weekend. I’m sure there were a lot of those people. 

AP: [laughs] Right. I imagine there probably were, and, you know, that may have its own value but this is a different use of the tool.

HSV: I hear ya. ’m sort of just playing Devil’s advocate here, so I appreciate it. 

AP: Yeah. So the way that this works is it really —  I think where the journalism often gets a little confusing around this is that they over centralize the drug, right? I always say if I had a dollar every time I saw a newspaper headline that said, “Party drug treats veterans’ trauma” I could take us both to lunch, right?

HSV: [laughs]

AP: And that’s a mischaracterization of it. I mean it probably gets more clicks but what it really is is that psychotherapy treats these conditions and it’s catalyzed or enhanced or accelerated by the use of a psychedelic. We’re only using it a handful of times. And in our current study, we’re only using psilocybin once as a way of … we use it one time and because it’s a study it’s what we call a double-blind placebo-controlled trial so there’s a 50-50 chance that the subject gets a placebo and neither we nor the subject know what they’re getting. 

HSV: Yes, you were talking about that last time and saying the niacin is … 

AP: Niacin is the active placebo, yes. Niacin gives you some effects but they’re not psychedelic, and they’re presumably not an antidepressant either. And before we have that dosing day, we have several meetings with the subject. And when I say “we” — two therapists will meet with the subject for several hours to get to know each other, to get to know what their issues are, to answer their questions and concerns about the potential drug session. 

Then we have the all-day drug session, and then we do integration therapy in the days following and integration therapy is really important — and this is often a lot of what separates … the preparation and the integration are two of the things that really separate it from recreational use. And so in the preparation, you’re really setting an intention for what you’re planning on working on. This isn’t like kind of a grab-bag, let’s see what happens happen. This is really about, you know, I want to examine grief about when my parent died when I was a child or something like that. And then in the integration therapy, we make sense out of the experience. We spend several hours talking about what they make of the experience, how they might integrate some of those insights into their daily life and we really try to make use of that afterglow.

What the research has found so far is these antidepressant effects last far longer than the drug effects. So anywhere … there’s data up to four-and-a-half years after psilocybin treatment showing the antidepressant effect. 

HSV: Wow. 

AP: Now not everyone is going to have that. Some people may start to have systems coming back after a few months or maybe after a year or something like that. But what we’re really looking at is a different modality than taking a pill every day to treat your depression. So the idea with this is that maybe what we have is episodic treatment, so if somebody has depression, they go through a course of this therapy, they do better for awhile and then they don’t need to be taking a medication every day. And maybe once a year they come back and we repeat it. We don’t know what the durability effect will be but it definitely seems to last longer than the drug effects. So I think that’s the important thing to understand. 

HSV: Yes. I brought this picture up because of course that’s mycelium under the ground and I feel like my own intuitive thing is that it’s affecting peoples’ brains, it’s going into their brain and lighting up certain parts that have just been, you know, forgotten or lost or caved in, and it’s like that behind me, the way it looks … 

AP: Yeah. One of the ways you can think about depression is it is an experience of being disconnected. There’s a researcher in the UK named Roz Watts who’s done … 

HSV: Yeah, he’s great, I’ve seen that guy.

AP: “She” actually, Rosalind Watts …

HSV: Oh, I thought you said … okay, sorry! Different person [roll my eyes on myself, silly girl. You’re learning]

AP: Roz Watts has done some really nice qualitative work around just looking at what is peoples’ experience of depression and how does that contrast to when — if psilocybin has a positive effect, psilocybin therapy, what does that look like? And what she has identified is that when people have depression, their experience is often one of disconnection. They feel disconnected from other people, they feel disconnected from their own self, they don’t feel like themselves. They feel disconnected from pleasure, they can’t enjoy things. And they feel disconnected from kind of the larger world. 

What’s interesting about mycelium — as you point out there — is that, you know, mycelium is everywhere, fungi are everywhere. If you walk around Golden Gate Park, you won’t see them but they’re there. So when we see a mushroom pop up after the rain, what we’re seeing is kind of analogous to the apple on a tree. The apple is not the whole tree, obviously, it’s just the fruit of the tree, the apple tree is the whole thing. But when we see that mushroom it’s like that apple, but underneath the ground is this massive network of mycelial threads that connects — as in your illustration there — connects different members of the community, if you will … 

HSV: Mmmhmm [nodding]

AP: … of the ecological community. There’s this great term, the “Wood-Wide-Web”?

HSV: Yeah! You mentioned it last time and I did my homework and yeah! It’s beautiful! It’s wonderful. 

AP: Yeah, Richard Powers’ book, The Overstory, it’s a great work of fiction. It kind of touches on that a little bit. 

HSV: Awesome. 

AP: But, you know, it’s a real thing. It’s not just metaphorical. This mycelia connect trees in the forest and they actually share water that way, they share nutrients that way. It really is an information kind of superhighway that connects the larger system. And maybe, with the risk of getting a little metaphorical and fanciful here, what happens under psilocybin is often people will have an experience what they refer to as “awe”, and awe is this big sense of like, “Wow! The world is so much bigger and more intricate and more beautiful than I could have ever imagined. And I’m a part of it. But I’m not the center of it.”

HSV: Right. 

AP: It’s an interesting thing that … there’s a guy named Dacher Keltner at Cal who talks about the “small self”. That a lot of times maybe our unhappiness comes from really getting caught up in our own heads. There’s sort of an old saying in meditation practice: “Don’t believe everything you think” right?

HSV: [laughs]

AP: But when we’re depressed, our brain kind of lies to us. It says, “No. Nobody loves you. Nobody wants to be around you. You’re gonna feel this way forever.” And there’s this idea in the psychedelic … 

HSV: Kind of like Eeyore in Winnie the Pooh … 

AP: Yeah! Exactly! Yeah, and is sort of stuck in that depressed mode and there’s this idea in psychedelic neuroscience that in a non-depressed brain new information coming in — coming in from what they call “the bottom up” — can come in and sort of permeate through the brain. So let’s say you’re not depressed and you go to Outside Lands and you see a bunch of friends that you haven’t seen in a year and a half because of a pandemic and you have a great time, and I’m not even talking about drug use, I’m talking about seeing people that you care about and being hugged and saying “Oh I’ve missed you….”  If you don’t have depression, you can sort of take that in and that will lift your spirits and you’re like, “Ah, it’s so good to be together again!”

HSV: Yes!

AP: If you have depression, what may be happening is that your brain has become really good at suppressing that new information coming in. That’s what we call “top down” inhibition so that the brain sort of overuses this previous experiences which are reinforced in depression. 

So you see your friends and they’re hugging you but you’re thinking, “Yeah, if they found out what a jerk I am, man, they wouldn’t want to be around me.”

HSV: Right.

AP: “Like if they found out how lazy I’ve been during the whole pandemic, they’d think I’m a flake.”

HSV: Or they think my hair looks stupid or whatever … 

AP: Or they think my hair looks stupid or whatever. It prevents that new information from coming in and really sinking in. So what’s interesting about psilocybin is that for those few hours what it seems to do it seems to off that top-down inhibition in somebody who’s depressed so that for at least a little while this new information can come in. And when the psilocybin wears off, things have reorganized maybe in a more flexible way, in a way that people are more able to kind of take in a new perspective. 

Maybe that’s what has the antidepressant property, maybe that’s why it endures. But it’s also really reinforces why you really need that integration therapy, because if you just take the drug and then go to work on Monday, it’s not to say that that can’t have it’s own benefits cuz it probably can but it often — what it ends up being is a novelty. 

HSV: Yeah.

AP: It’s like, “Oh! Remember when we went to Phish and we took mushrooms?”

HSV: Yes, “that was that.” 

AP: “That was an amazing show” and that sort of full-stop. There’s no integration of that.

HSV: And that’s sad! That’s actually kind of depressing, you know? [laughs] “I was having so much fun yesterday and today is really …” I mean, it’s almost worse because you’ve had this really good time and then you’re like, “Uh, I’m back on the bus.”

AP: Exactly. This is why for people that do engage in recreational psychedelic use, integration circles like those that are offered by the San Francisco Psychedelic Society can be really helpful because you can talk to other people about those experience in a relative degree of confidentiality and really start to think about like, “What was it about that concert that was to amazing? Why did that have such a profound experience on me? Oh! Because there was beauty and there was connection with other people. And then the question becomes: How are you bringing beauty and connection with other people into your life now? Could you do that every day? Could you make a practice of every day you’re going to reach out to at least one or two friends — even if it’s just a short phone call. How could you bring beauty into your life? Could you make a practice of getting flowers every week at the Farmer’s Market?

HSV: I do that! [smile, thumbs up]

AP: Yeah, exactly! And it may not be huge things but those serve as integration of something which could otherwise kind of be relegated to a novelty. 

HSV: I would like to say there that, you know, even as a … I mean I hope I … I mean I’m a bit of a nutbag but aren’t we all [laugh]. But — even being “normal” and not having bi-polar or whatever, I’m pretty much a “normal” person — life is hard!

AP: Absolutely!

HSV: I mean it’s not like, “Oh, I don’t have any of those mental issues but it’s … “all life is suffering” … life is a challenge, but that’s the beauty of it. I just kind of wanted to point out that it isn’t like we wake up and it’s “zippity-doo-da” every day. It’s not unicorns and rainbows every day — even though it’s the Haight, you know!

AP: [laughs] Yeah! You might see more unicorns than average. More rainbows for sure!

HSV: Yeah! [laughs] 

AP: it really does point to — I mean, this last year and a half, right? I think we’ve all been through the ringer and many people are really hungry for reconnection. 

I just came back from this conference and there were a couple thousand people there. And even though we were still wearing masks and that, but it still feels really good to be back together again from this because we are social creatures, we are interconnected creatures … [laughs at “I’ve seen some weird shit” image of Dorothy and Alice] That’s great, the image behind you! 

HSV: I always want to know what Toto and Dinah, what they saw, right?

AP: Yeah, that’s right. I’m sure if they could say the same they probably would agree!

HSV: Sorry to interrupt!

AP: But so yeah, we have this — aside from the 750,000 people from the U.S. that died from this thing, one of the great injuries has been this disconnection that we’ve had. And a lot of people struggle with connection already because they’re anxious or they have depression, and for those folks it’s been doubly hard. So there’s a lot of healing to do. 

HSV: Yes. But also, I’d like to give a shoutout to covid — that sounds weird … 

AP: [big laugh]

HSV: … but it’s also, on the other end of the spectrum, it really made a lot of people that I’ve been in touch with, it really put a fire under their ass to really do what they’re here to do. Like for my magazine, personally, I mean I’ve always been doing it but now it’s GO time. Let’s start really diving in, connecting with the right people such as the SF Psychedelic Society — I’ve talked with Danielle Negrin, she’s awesome, and [James McConchie] who runs the Haight Street Shroom Shop — these great people. And this guy right here. Sorry I like to pull up my background so we ca see what’s going on … [pull up Dr. Dave holding Journal of Psychoactive Drug] … this guy right here!

AP: Ah! Dave Smith, yes

HSV: I just adore him! He is just so excited about … he feels like he stepped back in time but it’s now … 

AP: [laughs]

HSV: This whole … Of course he’s the founder of the Haight Ashbury Free Clinic everybody, I’m sure most people already know that. He’s a doll! He’s starting a center over here on Stanyan. The working title that we’re all calling it is the “Haight Ashbury Psychedelic Center” were you can come read, there’s going to be a library, there’s going to be — Sunny’s involved, so learning how to make tie-dye, so it’s going to become some sort of center in this area of learning, it might even be Haight Street headquarters, of where people can come talk about psychedelics, learn about psychedelics, learn about alternative therapies, be around people who are thinking the same way — just hang out. Thank you Dr. Dave! It’s beautiful.

AP: Yeah! Thanks Dave!

You know, a lot of people are unaware that before John Lennon invented LSD … 

HSV: [laugh]

AP: No, that’s not true. John Lennon did not invent LSD. [laughs] Albert Hoffman invented LSD a good 20 years before the Beatles were even making music I think. But there was this period for about 25 years that was happening where there was really respectable research going on in medicine, in psychiatry, particularly around palliative care and end of life — looking at psychedelics in a very sober way. The article we wrote in the America Journal of Nursing, we like to say it was the followup to a 1964 article that a woman named Kay Parley wrote about … it was called “Support the Patient on LSD Day.”She was a nurse in Canada working in a state hospital with people that we would now call having alcohol-abuse disorder, and she and Humphrey Osmond were using LSD to treat patients that couldn’t stop drinking.

So there was a lot of that kind of research that happened. There was research that happened in the U.S. at Spring Grove, Maryland … there’s a whole history that happened. There were 100s and 100s of papers that were written, there were international conferences, and then the Summer of Love happened and this sort of got out into the popular culture thanks to the people like Timothy Leary and Ken Kesey and all the usual suspects, and psychedelic rock. And it was transformative to a whole generation. Then of course there was the backlash that happened with the whole Controlled Substance Act and Nixon and such — and it really put all that research on to the deep freeze for a good 25 years. 

HSV: Forgive me for being … my girlfriend is very much into this whole … we’re not going to go down this road but this whole MK Ultra thing, mind control … 

AP: Yes. This is a fascinating idea, right? Jung had this term “Enantiodromia” — it’s like when you look at the Yin and the Yang the one gives way to the other, you know, opposites give way to each other. So on the one hand, during the 1960s you had the youth culture, Timothy Leary and Richard Alpert, Ram Das, talking about using LSD to expand your mind, to free your mind, right? 

HSV: [nods yes]

AP: And then you had the CIA through MK Ultra looking to see if this could be used as a mind-control drug! I mean these are total opposites with the same drug. Psychedelics tend to kind of inspire these sort of opposites. So yeah, it does have kind of a sordid history. To be clear, I am not an advocate of indiscriminate psychedelic use. I think these are very powerful tools, and even if they’re going to be available outside of a medical setting, which, something like Oregon might allow that to be the case, I think they need to be approached with a great deal of reverence. I mean these come from traditions where they are not intoxicants. The psilocybin tradition, the ayahuasca tradition, peyote tradition — these plant medicine traditions, these are not things you go out and party with your friends with. These are tools for deep inner healing work, not only of one’s own self but of one’s community for spiritual work — they’re sacraments. You could get drunk on communion wine but it would be pretty tacky to do so, right? 

So I think that psychedelics need to be approached with similar reverence because they’re not trivial. These are big experiences, and for somebody who’s unprepared for that, or in a setting … one of the things Dave did was Dave was doing harm reduction before that term existed. When they set up the Haight-Ashbury Free Clinic, Dave looked at the Haight and said, “This is gonna be a catastrophe if we don’t help these kids out” because they’re showing up with bad trips and syphilis and all the things. I mean the Summer of Love had some casualties too, you know? And Dave was kind of there to help clean up the mess, and all the people that helped him out. But what he was doing what we would call harm reduction. We do that at Burning Man through something called the Zendo Project where we have a space where people can come if they’re having a challenging time whether they’re on psychedelics or not, it doesn’t matter. A lot of people are just having a hard time there because they’re tired and they haven’t eaten for several days … 

HSV: And they’re dehydrated … 

AP: And they’re dehydrated and they just had a fight with their partner. They’re having a rough day and they need someone to talk to. We’re there for that too. But this idea “let’s take care of our community, let’s take care of each other”. The last place you probably want to be when you’re having a difficult psychedelic experience is with law enforcement or in an emergency room.

HSV: Yeah … 

AP: Sometimes people may need that to keep them safe. I mean we don’t want people to get hurt but ideally you can sort of prevent and mitigate that with good community support. Part of harm reduction is just understanding, appreciating, and respecting the power of these compounds, that they’re not this sort of trivial recreational — it’s not just like having a few drinks. It’s a lot bigger than that. 

HSV: I really like this whole thing of community. Obviously my magazine Haight Street Voice is hyper-local with a global perspective, and it really — it all starts with community.

AP: Mmhmm [nods yes]

HSV: I never thought I would hear myself saying that. Maybe 15 years ago I was a music journalist and “community schommunity”. But as I’m getting older I’m getting wiser or I’m just settling in more! I’ve lived in the neighborhood 35 years. It’s everything to be able to walk down the street and I know all of the street kids here and they’re starting to say the same thing — the ones I know at least, the majority of them, I can’t say all of them or speak for all of them — but they’re really hyper aware of really needing to take care of each other out there, be nice to the guy on the corner who owns the new store instead of like, “Oh, there’s the new guy” it’s like “Oh hi! Wow, okay, this is cool, this is the new guy, let’s protect him.” And they actually have guarded their store on just their own volition. When they see something bad going on, they’re out there protecting too, which is such a beautiful thing.

AP: Yeah, that’s wonderful. 

HSV: Which really leads me back to Dr. Dave and then I’ll let you go because I know you’re a busy man.

AP: [smiles]

HSV: But … I almost started crying! But when we were talking, when I interviewed him a couple issues ago, we were talking about the Haight-Ashbury and he had lived through that amazing explosion of counterculture and music and beauty … 

AP: Sure.

HSV: I mean he holds it in his heart. But he did say, he said, “The ‘60s were amazing but what can we learn? What did we do wrong? How can we not …” Because the renaissance is rumbling: “What did we learn and how can we make it better this time around?” Can you speak to that? What can we do differently?

AP: That’s a good question. It’s a really good question. I mean one of the things that I think happened — I’m not sure that a lot of good integration happened back in the ‘60s. Culture tends to be sort of pendulous, it goes back and forth. So if you look at the ‘60s and what happened within 10 years was this … in the ‘80s … was this hyper-materialistic culture. It’s always interesting to see what drugs are popular during a ??, right? So what happened in the ‘80s? Cocaine. I think of cocaine as almost being like the polar opposite of psychedelics.

HSV: Oh, a hundred percent!

AP: If psychedelics are about dissolving ego, stimulants can be about inflating ego, right?

HSV: [laughs] Yeah, yuck. 

AP: It’s so fascinating that within 10 years of the Summer of Love you see this pivot towards “It’s about ME.” It’s not about community, it’s about what’s in it for me and how can I get as many marbles for myself?

HSV: And another 8-ball.

AP: Yeah, exactly. 

HSV: But to answer your question [sighs] my hope is that these really will be treated with a lot of reverence, you know, that they will be appreciated for their power and they’ll be used with a lot more intentionality perhaps than they were back then. That this is not something … you know Alan Watts, the great English Buddhist philosopher of that era, the 1960s, said, with regards to repeated psychedelic use, he said, “When you get the message, hang up the phone.” 

HSV: [laughs]

AP: You don’t need to keep going back and doing the same thing over and over again in order to get that same message because you’ve already gotten the message. 

HSV: Yeah!

AP: So maybe this sort of … of course I was born just after that period so I didn’t live through it but from what I can kind of gather it feels like there was sort of a hubris that went with it. It’s like, “Let’s do it all now!” There’s a lack of — there’s this sort of bacchanal that was happening and it was really about in some ways about excess. I mean human culture has had periods of bacchanal — that’s where the term comes from, right? [laughs] The Greeks had Bacchanalia, right? But you can’t live like that year round, you can’t live like that every day. That should be a special occasion. The reason we don’t have Christmas every day is because it would no longer be special. 

HSV: [laughs]

AP: We call them special occasions because we don’t do them all the time, right? [laughter] So it’s actually the infrequency of the experience that makes it special. 

HSV: Right. As Bob Weir likes to say, “Everything in moderation including moderation.” 

AP: Including moderation, right!

HSV: There’s a happy area in there … 

AP: Right! There may be times for excess but then you can’t live like that year round. It’s like Jack Kornfield says: “After the ecstasy, the laundry.” You’ve got to get back to regular life and I think the challenge of this era is integrating this into regular life. Psychedelics in the ‘60s became a sigil for not being part of the larger culture, right? Timothy Leary infamously, “Tune In, Turn On, Drop Out”. Well, okay, that is a revolutionary path, and it bore a lot of fruit, but it also kind of arguably sort of fizzled out within a fairly short period of time. So, how do we more deeply integrate this so that we don’t have classic pendulum where — because what was the fallout of the Summer of Love? It was the Controlled Substance Act. Arguably there were a lot of other things that went into that. I think having an unpopular war that was being fought by young people was antithetical to psychedelic use. If you’ve had LSD you’re not gonna want to fight Nixon’s war, right? So it was sort of in the interest of the powers that be to prohibit that, to quash that.

HSV: And I think a lot of young kids were coming in, and again it comes down to communication. They came looking for … I mean it’s sad because they were people, young kids, that were looking for something more beautiful than their lives were and they came here and they took the drugs but they were educated about it. It was just thrown at them or they just took it and it wasn’t, like you said, it needs to be integrated and understood and communicated [about]. 

AP: Absolutely. And I think what we need to appreciate is nuance. The first casualty of war is truth; the first casualty on the war on drugs was credibility. There was a time when somebody like me, this academic licensed professional would be seen as a representative of The Man, right? 

So I think what we need to do going forward is to really … information, honest information, is a way of reducing harm. If people know that maybe starting out with 7 grams of psilocybin if you’ve never had psilocybin before might be a really terrifying experience. That’s good information to have so somebody doesn’t do that right off the bat and terrify themselves. Certain drugs shouldn’t be combined, for example. We need to give people honest information so that they can make safe decisions for themselves rather than saying, you know, all drugs are bad all the time, and then having people have to try and navigate that space without any good information. But there’s a responsibility on the part of the user, too, to remain in some place of moderation. And obviously some people with addictive disorders, part of what’s not working for them is their capacity for moderation. That’s why they have an addiction, right?

HSV: Right. 

AP: Fortunately, classic psychedelics are not terribly what we call “reinforcing”. Most people don’t take LSD and say, “You know, I’m gonna do that again tomorrow!” 

HSV: Whoa! [laughs]

AP: Most people are like, “Wow! I gotta digest that for awhile! That was a lot.” 

HSV: Gotta get my molecules back together!

AP: Exactly, right? So it doesn’t … whereas cocaine, as soon as it starts to wear off people say, “Oh, give me another bump.” That’s reinforcement in an addiction model. 

My hope is that the culture has gotten a little more mature in the last 50 years. My hope is that there can be a greater sort of nuance that happens in the conversation, and in peoples’ behavior.

HSV: I think covid blew a hole in a lot of … I think it helped. I mean it’s horrible to say that but in a lot of ways I do believe that it sort of blasted people to go, “What the … wait, wow, life is … this isn’t what I thought it was.” I think a lot more open-mindedness may have come out of it, you know, and more of an acceptance of the work that you do, hopefully. Maybe I’m just being hopeful and, I mean I live in the Haight, maybe I’m being a unicorns and rainbows girl. [laughs]

AP: [laughs] 

HSV: Okay. This is my last question to you, it’s 2-part: In 5 years, in 2027, do you see a huge change? What’s your vision, what do you see? Is that too hard to answer?

AP: No, I don’t think it is. I mean I reserve the right to be totally wrong on this but … I mean if I was … if I could predict the future I’d be investing in the stock market more!

HSV: [laughs] I would too!

AP: Where we are in terms of research is that MDMA for PTSD is in the second half of what we call Phase 3, which is the last phase before it goes out to the FDA for approval. And so if MAPS — the Multi-Disciplinary Association of Psychedelic Studies — is correct, they’re probably looking at FDA approval of that as a therapy … mind you, this is not going to be a take-home drug, this is not something you’re going to get prescribed and you’re gonna pick it up at Walgreens. This is something that is going to be done in a clinic or hospital setting, and this doesn’t mean it’s legalized. It just means it’s medicalized. It’s important to make that distinction. By about 2023. Psilocybin is a little bit further behind. There are two Phase 2 studies going on for psilocybin for depression and if I had to place a bet I’d say maybe ’25-’26. It really depends on how those trials go. You also have to remember, this is sort of an unpopular opinion but things can fail in clinical trials. 

HSV: Yeah. 

AP: You know? And they can fail in a number of different ways — especially Phase 3 trials. You have to have a much bigger pool of patients that are less cherry-picked. They look more like the patients you’re actually going to treat. And when you do that, sometimes it doesn’t work as well as it did when you were more kind of cherry-picking your subjects. Or there could be a bad outcome. There could be a suicide or something, god forbid, where the FDA says, “Ooh, this actually looks more dangerous than we thought” and may make the sponsors of the trials go back and look at that or look at how we’re going to take precautions against that.

So there are lots of things that could happen. This is not set in stone. That’s why it’s research. If we knew the answer to the question, we wouldn’t have to do the studies. But yeah, I think that will happen, depending on how things go in Oregon, I think you could see — I mean there’s already a move in California, Scott Weiner has introduced a bill to legalize … I don’t think it was the most well-written bill because conflated plant medicine with white powders. They put ketamine and MDMA in there, which, well they are psychedelics but they’re synthetic they’re not manufactured by plants, so it gets trickier to differentiate those things out.

But I think if that is successful in Oregon, then I think they probably will be the template for other states to look at, perhaps decriminalizing psilocybin or creating a … I mean we can see from the cannabis space, people forget that cannabis is still illegal under federal law. It’s still a Schedule 1 drug even though there’s now something like 35 states that have some degree of medicalization or as we have in California outright legalization for adult use. But, you know, those laws are in violation of federal law. It’s just the feds haven’t decided to enforce them.

HSV: Right. 

AP: But they could! It’s unlikely but they could. So there may be a similar path that happens with psilocybin. It’s hard to know. Everything’s changing so quickly that it’s really hard to know exactly what will happen next … [inadvertently 

HSV: Is that a tuba behind you? [laughter] Sorry!

AP: [laughs] It is a sousaphone, the top of a sousaphone that turned into a music … I have a bluetooth speaker in there!

HSV: Awesome! Good for you! And now I’m gonna let you go. One last thing: Myself being a journalist and applying for this fellowship which Cal Berkeley is so amazingly offering, what would like to say to future journalists, people like myself, what’s the best thing I can do help purport the awesomeness of the work that you’re doing. What angle or … what can I do to help? 

AP: Yeah. I think again it goes back to that question of nuance. All that sort of “Party Drug Treats PTSD” is a really eye-catching headline, it’s sort of misleading. And I also think it undervalues the value therapy. That psychotherapy really is at the heart of this, the drugs just help to accelerate it. And so to really seek to understand what happens … [dog bark]

HSV: Puppy!

AP: Yeah, sorry that’s my dog makin’ noise. 

HSV: I love it. Cute.

AP: To really try and understand what happens between a person going into the study and coming out of the study feeling better — what happens in between those two points. I mean this is something I’m particularly interested in as a nurse. My training is as a nurse. I’m interested in the care that we deliver to patients during that time. I think that’s a lot of the healing comes from that care. 

And so I think if journalism could look at the process as well as the outcome I think that would be great. And also I think to help to keep expectations modest. I think these sort of panacea stories where it’s like psychedelics are going to take big pharma out of business? I just don’t see that as happening. I mean there’s going to be people for whom psychedelics are not appealing, that they don’t want them or that they don’t work for them. No treatment treats everyone for everything. And I think there’s a lot of panacea stories going on right now. I think it’s a reflection of how hopeful we are and how desperate we are for better treatments but I think what that does is it really sets people up for disappointment because there are always going to be people that any treatment doesn’t help. We saw this happen with SSRIs in the ‘80s with Prozac. SSDIs were going to cure depression. Well, that didn’t really pan out. They helped a lot of people, so it’s important to make it clear that there will be benefit but it may not be as widespread as we had hoped. 

HSV: Right. 

AP: So modest expectations I think is part of what we need to focus on.

HSV: Okay, cool. Thank you so much for your time. And what would like — I always ask everybody this — what would you like to say to the Haight Street community as well as the global community? If this was a loudspeaker and you could say anything to anybody about community, about the work you do — whatever you want to say.

AP: Yeah. Well, you know, at UCSF, we’re just up the hill from the Haight, so it’s really kind of part of our extended neighborhood, as is all of San Francisco. This is really an interesting incubator for ideas that come out into the world. And a lot of the studies we’re doing in the lab where I work, we’re looking at psilocybin for depression right now but in the future we’ll be looking at psilocybin treatments for chronic pain for people with depression and Parkinson’s disease …

HSV: Wow. 

AP: … People with bi-polar depression and people with methamphetamine-use disorder … these are all studies that we’re going to do in the future. Hopefully these are going to be findings that we can build upon going forward and really help to change the world. 

HSV: Yay! Thank you! Much love. 

AP: Yeah, thanks Linda! Bye now. 

HSV: Have a good one! We’ll be in touch. Bye! Peace!