TRANSCRIPT

CENTURY OF LIES

MAY 15, 2019

DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, and welcome to Century of Lies. I'm your host Doug McVay, editor of DrugWarFacts.org.

This week my guest is the best-selling author Michael Pollan. We talk about psychedelic medicine, decriminalization, and his latest book How To Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.

But first: On May 9, the US House Committee on Oversight and Reform held a hearing on federal drug control policy.

Witnesses included Director of the Office of National Drug Control Policy James Carroll; Brevard County, Florida Sheriff Wayne Ivey; Acting Director of Homeland Security and Justice at the Government Accountability Office Triana McNeil; Acting Director of Health Care at the GAO Mary Denigan-Macauley, and Delaware Division of Public Health Director Karyl Thomas Rattay, MD.

We’re going to hear questions from Representative Katie Hill, Democrat from California, and Representative Alexandria Ocasio-Cortez, Democrat from New York. The first voice you hear will be that of Representative Ocasio-Cortez.

US REPRESENTATIVE ALEXANDRIA OCASIO-CORTEZ: While I'm pleased to hear that the Administration is supporting efforts to combat the opioid crisis, and then that the president's budget requests some discretionary funds for this purpose.

It seems that upon closer inspection, he's actually gutting the very programs that are critical to combating the opioid epidemic. The Medicaid program is the nation's single largest payer for behavioral health services, and it covers nearly four in ten non-elderly adults struggling with opioid addiction.

And adults with Medicaid are more likely than even the privately insured and the uninsured to receive substance use disorder treatment.

So at the same time we should be dedicating greater resources to this critical program, the president's budget is proposing $1.5 trillion dollars in cuts to the Medicaid program over the next ten years, the very program that is the largest payer and largest assistant in the behavioral health services.

So, I have a question, Doctor Rattay. In your written testimony, you speak about the importance of Delaware's Medicaid expansion. What would it mean for your state if, and how would this impact your ability to respond to an opioid epidemic, if the ACA were repealed?

KARYL THOMAS RATTAY, MD: We would have great concerns that if the ACA were repealed, and we went backwards in regard to Medicaid expansion, that many people would lose access to life saving treatment services.

So, on the flip side, Medicaid expansion not only has been able to enable us to increase access to services for individuals, but it's also enabled us to use resources, other resources, differently, so, for example, whether it's wraparound services or peer recovery coaches.

REPRESENTATIVE ALEXANDRIA OCASIO-CORTEZ: Have you seen any sort of relationship, whether it's correlative or otherwise, between states that have not expanded Medicaid and the depth of the opioid crisis and the ability of people to seek treatment?

KARYL THOMAS RATTAY, MD: I know that there has been a look at that, but I have not studied that closely.

REPRESENTATIVE ALEXANDRIA OCASIO-CORTEZ: Thank you.

In addition to the opioid crisis, and I think one of the issues that we've had here is that we don't see these crises hit until they're crises, especially in the legislative side as well, but, we have to be able to identify emerging threats, and what I've been seeing here is, one of the lessons that we learned from the opioid crisis, and the rapid rise of fentanyl and synthetic opioids is that we need to be prepared to react quickly when new crises and new drugs emerge as threats.

Doctor Carroll [sic: technically accurate in that Carroll received a Juris Doctor degree from George Mason University's law school], can you update us on the process of identifying emerging threats, when it comes to drugs and public health, and when can we expect the emerging threats committee to be up and running.

JAMES CARROLL, JD: Thank you. If I ma'am, may just spend thirty seconds responding to Congresswoman Maloney, Congresswoman Maloney referenced about reimbursement rates and tying it to pain, it's an interesting idea, maybe we should take a reverse approach, for people --

REPRESENTATIVE ALEXANDRIA OCASIO-CORTEZ: I'd like to reclaim my time, Doctor Carroll, I'm so sorry, she -- her time is expired.

REPRESENTATIVE KATIE HILL: I'll give you -- I'll give you an extra thirty seconds.

REPRESENTATIVE ALEXANDRIA OCASIO-CORTEZ: Great. Thank you.

JAMES CARROLL, JD: The -- maybe that's a great idea, to say, people, if you -- when you cut down your prescriptions for opioid -- while protecting chronic pain people, your reimbursement rates will go higher, the fewer opioid prescriptions you write.

One of the things that we're also doing is working with medical --

REPRESENTATIVE KATIE HILL: I want to be sensitive to time. Can you please answer -

JAMES CARROLL, JD: Yes.

REPRESENTATIVE KATIE HILL: - the Gentlewoman from New York?

JAMES CARROLL, JD: Thank you. I apologize, Congresswoman.

And I appreciate the Committee's, when you reauthorized us to make that a centerpiece, and so, we have sent invitations out to fourteen members across the country from every disciple - every discipline, and we'll be hosting our first meeting with our new emerging threats coordinator on time.

REPRESENTATIVE ALEXANDRIA OCASIO-CORTEZ: All right, great, thank you very much.

JAMES CARROLL, JD: I apologize for thirty seconds.

REPRESENTATIVE ALEXANDRIA OCASIO-CORTEZ: No worries, no worries. You know, in fact, at our hearing in March, the Houston HIDTA Director McDaniels testified that, quote, "our major threats in Houston are methamphetamine, cocaine, and synthetic drugs."

You know, our country unfortunately has a history of racial inequity when it comes to how we pursue either enforcement or treatment, depending on the type of drug, and I was wondering if you agree that one of our goals should be to increase treatment for all drug addiction, including addiction to methamphetamines, cocaine, and other drugs in addition to opioids.

JAMES CARROLL, JD: Absolutely. I think we need to -- we have -- people say opioid crisis because that's what's killing so many people, but at its core, you're right, this is an addiction crisis, and we have to treat people as we find them.

REPRESENTATIVE ALEXANDRIA OCASIO-CORTEZ: Okeh. Thank you very much, and I'll yield the rest of my time to the chair.

REPRESENTATIVE KATIE HILL: Thank you. With that, I'll recognize myself for five minutes. This question is to, well, first of all I want to say thank you so much to everyone for testifying, especially to those who joined us earlier today.

But, Director Carroll, I'm particularly glad to hear that you're testifying about the importance of evidence based treatment, and we actually see extensively in the GAO testimony that highlights that one of the key -- that medication assisted treatment is - demonstrated that it reduces opioid use and increases treatment retention compared to abstinence based treatment.

One of the challenges identified in increasing access to MAT really about access to coverage. Right? And the availability and limits of insurance coverage for MAT. You state that patients with no insurance coverage for MAT could face prohibitive out of pocket costs that could limit their access to it, and if coverage for MAT varied for those individuals with insurance, and coverage varied, insurance plans including state Medicaid plans did not always cover the medications, and they sometimes imposed limits on the length of treatment.

That said, we have the study that I earlier introduced from the American Journal of Public Health that stated that the ACA provides greater access to substance use disorder treatment through major coverage expansions, regulatory changes requiring the coverage of substance use disorder treatment, and existing insurance plans and requirements for SUD treatment to be offered on par with medical and surgery, as well as opportunities to integrate substance use into mainstream healthcare.

A Kaiser study, as mentioned previously, shows that four in ten adults with opioid addiction are covered by Medicaid, and 21 million Americans have gained coverage through the ACA including twelve million through Medicaid.

So, Ms. McNeill, do you believe that if the ACA is overturned, that this issue of coverage would be better or worse?

TRIANA MCNEIL: I'll invite my colleague Mary Denigan-Macauley to answer that.

REPRESENTATIVE KATIE HILL: The question was, given all of the information I just shared, and your belief that access to coverage and provisions around coverage that makes it more difficult for people to get MAT, is this something that you believe would be made worse or better if the ACA was overturned?

MARY DENIGAN-MACAULEY: The GAO certainly would encourage any increased access to treatment, and Medicaid is one program that does access -- does improve access to treatment. So our concern would be ensuring that that remains.

REPRESENTATIVE KATIE HILL: Do you have any estimates of how much was provided by Medicaid, or how much was spent by Medicaid on such treatment?

MARY DENIGAN-MACAULEY: We do not, but we do know that in those states that had Medicaid expansion, that there were more people that had the access, but we do not have a number.

REPRESENTATIVE KATIE HILL: Thank you. And Director Carroll, one of your goals listed in your performance reporting supplement is that increasing the percentage of specialty treatment facilities providing MAT for opioid use by a hundred percent within five years.

I recently visited one such facility in my district. It seems to be a great program, but they spoke extensively about the challenges around coverage. And, the majority of their patients are covered by Medicaid, and others are covered by health insurance that, in many cases, they did not have prior to the ACA.

So, my question is, if the issue of coverage is exponentially exacerbated by a successful overturn of the ACA, how do you think you'd be able to accomplish this objective?

JAMES CARROLL, JD: Thank you. The - what's - I am bipartisan on this issue. We have to save lives regardless, and providing treatment to everyone is critical to do this.

REPRESENTATIVE KATIE HILL: Well, and to be clear, I'm not - I'm not making this about partisanship. I want to know -

JAMES CARROLL, JD: Oh, me neither.

REPRESENTATIVE KATIE HILL: - if, I'm concerned about what the courts are going to do so I honestly want to know what is going to happen if the ACA is overturned.

JAMES CARROLL, JD: In terms of, first, to talk about the Medicaid and the reimbursement, and as well as health insurance, we have to make sure that it's sustainable going forward.

And so to be able to make - give states the authority to help more at that level than at the federal level, to determine the, how they're going to provide treatment for people I think is critical.

And one of the things that we're also seeing is making sure for those people that do have insurance under the ACA, what we're seeing are copays that are so high that it's really not effective, and there is a report this week that was talking about copays for individuals under some of the ACA plans, I think it's six or eight thousand per year and twelve thousand for families.

And at that point, you really have to wonder whether it's working or not.

REPRESENTATIVE KATIE HILL: Right. Well, I mean, in large part that's because of the increasing pressure we've seen from other attempts to undermine the ACA, that the costs have gone up and copays have gone up as exponentially.

But, for me, I'm wondering, and I don't know if this is possible to request, but I would love to see some contingency plans, or other efforts from GAO and from your office on how that would - how such an overturn of the ACA would effect treatment.

JAMES CARROLL, JD: I'll see what we can get you as soon as possible.

REPRESENTATIVE KATIE HILL: Thank you.

DOUG MCVAY: That was from a hearing on federal drug policy held by the US House Committee on Oversight and Reform on May 9. You’re listening to Century of Lies. I’m your host Doug McVay, editor of DrugWarFacts.org. Now, let’s hear my interview with best-selling author Michael Pollan.

Now, your new book, How To Change Your Mind, I understand the idea for it came about when you were interviewing cancer patients who had undergone psychotherapy using psychedelics. I should mention by the way that I'm a cancer survivor, fifteen years and counting. Anyway, tell us about your book, first of all.

MICHAEL POLLAN: Sure. Well, you know, it did start with a magazine article I did for The New Yorker a couple of years ago, called The Trip Treatment. And for that piece, I'd heard about these trials going on at both NYU and Johns Hopkins, where they were giving psilocybin, which is the active ingredient in magic mushrooms, to cancer patients, people who were struggling with what the doctors called existential distress, the terror and anxiety that accompanies that diagnosis and the fear of death.

And this struck me as the weirdest idea, that you would take a psychedelic when you were in that situation. But, they were finding that a single guided experience, and I'll explain in a minute what I mean by that, would really completely reset people's attitude toward death, and their cancer, and in many cases remove their fear of dying to an extraordinary degree.

And it was in the course of talking to a handful of these volunteers that I just became intensely curious to understand how a molecule could change something as profound as your existential predicament.

DOUG MCVAY: It's a thing - it, afterward, too, there's the PTSD, frankly, because you cannot deal with that dread while you're undergoing treatment. If you survive, when you survive, that's when suddenly it hits. It's ...

MICHAEL POLLAN: Yeah, and you know, a lot of these survivors, actually, struggled of course, even when they'd been treated successfully, there is the fear of recurrence, and I'm sure you're familiar with that.

I remember interviewing this one woman, her name was Dinah Bazer, and she was about sixty, she had had ovarian cancer, it had been successfully treated, it was in remission, and she - but she was paralyzed by fear and she could not go about her life.

She heard about this trial at NYU, and participated, and had a guided psychedelic journey, and in the middle of that journey, like a lot of the cancer patients, she went into her body imaginatively, and she saw this black mass under her rib cage. She knew it wasn't her cancer because it wasn't in the right place, but she recognized it at once.

And she said, that's my fear. And when she saw her fear, this black mass, she screamed at it. She said, get the F out of my life. And with that, at that moment, it vanished. And it never came back, she said, and she said she realized during that experience that while she couldn't control her cancer, it was either going to come back or not, she could control her fear.

And it was the drug that allowed her to have that insight, and to really believe in it. And she has - she said her life was changed by it, and again, this is one day, not a drug you take every day, but one you take, you know, once or twice.

And she had, after that moment when the fear disappeared, she had this ecstatic experience, and she said - she said that I kissed the face of god. And I was really surprised when she said that to me because she had told me she was an atheist, and I said, but wait, aren't you an atheist? And she said, yes, I'm still an atheist.

And I said, well, you just said you kissed the face of god. And she said, well, we don't have any word big enough for what I felt, so I used the biggest word we have, and that's god. But I'm still an atheist.

DOUG MCVAY: Wow. Now, of course, you're not limiting your work on psychedelics, you're also looking at LSD, ayahuasca, ...

MICHAEL POLLAN: Yeah. DMT, a drug called 5-MEO-DMT, which is a very powerful and strange psychedelic. Yeah, no, I looked at the whole range of them. Not all of them. I didn't look at mescaline very much.

But, I, you know, they're similar drugs in that they all effect the same receptors in the brain, the serotonin 2A receptors. So they have similar modes of action, but interesting distinctions, too.

So for example, LSD is not being used in the clinical research, at least in the United States, for a couple of reasons. One is it's a more controversial drug than psilocybin, which many people have never heard of, and also because it takes so long. The LSD experience is about twelve hours, and the psilocybin experience is about half that.

So, you know, you'd have to pay all the therapists and guides overtime if you were giving LSD to patients. It's just not practical.

DOUG MCVAY: I know there are various - there's some, there's a couple of pharmas that are working toward developing psilocybin as a medical therapy. What do you think, down the road, how far do you think we are from having, from FDA approval, of having actual psilocybin available for psychotherapy?

MICHAEL POLLAN: You know, not as far as you might think, or that I assumed a few years ago when I started on this work. The FDA, who obviously has to approve our drugs, just gave breakthrough therapy designation to psilocybin in the treatment of depression.

That means that the FDA will help the researchers, in this case a pharmaceutical company from England called Compass Pathways, to go through the approval process, and help them in the design of their trials and basically speed things along. So it could be in just a couple of years.

You know, they're basically - they've got to do - we've done phase two trials of psilocybin for several things, and the last phase is phase three, where you give it to a larger group, and that's - we're getting started on those phase three trials now.

So it may be, you know, within five years that doctors will have access to this treatment. But, I hasten to add, it's not going to be a deal where you, you know, get a prescription from your doctor for psilocybin and go to CVS, or Walgreen's, to get it filled.

It really is psychedelic assisted psychotherapy, so that the role of the therapist is as important as the role of the molecule, and you need someone to prepare you very carefully. There are usually two guides, a man and a woman, and they tell you what to expect before you even take the drugs. They give you advice, if something really terrifying happens, which often does, or sometimes does, how to deal with that. They call them flight instructions.

And the basic overall recommendation is that you surrender to whatever is happening. If you feel you're going crazy or dying or dissolving, go with it, don't try to fight it. It's when you fight it that you get a bad trip.

And then during the experience, which as I said lasts from four to six hours, the guides are with you the entire time, not saying much, but available to you, giving you a sense of comfort, you know, that somebody's watching over your body while your mind is traveling. And that's incredibly important.

And then, you come back the next day or two, and meet with your guides and tell them what happened, and they help you make sense of it. They kind of interpret it, and it's called an integration session. And that too is very important.

So it's important to understand, we're not just talking about a drug therapy. This is a hybrid of drugs and psychotherapy.

DOUG MCVAY: Here in Oregon, there is a ballot measure that's being circulated - well, an initiative petition that's being circulated to become a ballot measure, which would medicalize, in some respects, pretty much, the psilocybin. Of course, that would sort of - it's a short cut, not waiting for FDA.

MICHAEL POLLAN: Yeah.

DOUG MCVAY: What do you think of the - have you had a chance to look at the thing, do you have any thoughts?

MICHAEL POLLAN: Well, I gather - I gather that the language is still being worked on, so there's really nothing definitive to look at [sic: language was finalized, the ballot title and summary were certified by the Oregon Attorney General on Nov 16 2018, and petitioners are gathering signatures to have the measure placed on the 2020 ballot].

I understand the basic idea is to legalize in the state of Oregon psychedelic therapy, whether for sick people or not, and that that's a, you know, that's a pretty bold move. I have to read it before I can really make a judgment.

I think it's a very well intentioned effort to take the really good work that's going on in the underground, where I worked with several therapists who were working underground, because otherwise there's no access to this unless you're part of the trials, to make that work legal, and decriminalize it, or legalize it, I'm not sure exactly what it specifies.

In general, I think that ballot initiatives are not the best way to make law. I know we've made progress with cannabis using ballot initiatives, but cannabis is a very different drug, and, you know, it's just - this is a much bigger experience, you need - you need some guidance, you - the risks are much greater psychologically, and so, I worry a little about making these decisions right now while we're going through this FDA process.

I feel very protective of the research going on and I'd hate to see a backlash, if we begin having a political battle about psilocybin before people really understand it or know what it's about.

That said, you know, I gather it's a very carefully crafted initiative with training specified and will be done in consultation with state, you know, regulatory and health authorities and that kind of thing.

So I gather it's a very thoughtful approach. I just don't know, you know, why we don't wait for this process that is unfolding right now at the federal level. Is this the right time? You know, the thing about politics is, you not only have to decide what you want to fight for, but you have to decide when's the best time to fight for it, and my gut is this isn't quite the time. Maybe by 2020 it will be, and that's when it will be on the ballot.

But anyway, I'm coming to Portland on Saturday to speak, and I'm hoping to learn more about this initiative then, and with luck meet with the people behind it.

DOUG MCVAY: What kind of takeaways do you hope people will come away with?

MICHAEL POLLAN: Yeah. Well, it's - it's actually an on-stage interview, and so I never know what we're going to talk about, but I - what I usually talk about is, tell a little bit about how I got involved in this work, why I think it's so important and actually promises a potential revolution in mental healthcare in this country.

You know, we have a mental health system, mental healthcare system that's really broken. Rates of depression, suicide, addiction, are climbing, the tools of psychiatry are even by psychiatrists' own admission really imperfect. They only deal with symptoms, many of them are addictive, they have really bad side effects.

And here comes a drug that's remarkably non-toxic, non-addictive, that you don't have to take every day for the rest of your life, that can not just address symptoms but in many cases cure people of things like alcoholism and smoking addiction and cocaine addiction and potentially other things as well.

So, it's a very exciting time, and I like to talk a little bit about what the researchers are up to, tell some stories about the volunteers I've interviewed, and then I go into my own experience, because I felt I couldn't write this book without knowing from the inside what psychedelic therapy looks like.

So I had a series of guided journeys on psilocybin, but also on LSD and ayahuasca, and 5-MEO-DMT, and, you know, they were amazing travel stories, and so I'll share some of those also.

And we always of course take questions from the audience, and this debate over - it's very timely to be in Portland because this, you know, you are, as often is the case, you're going to be on the forefront.

There was a decriminalization initiative that was passed last week in Denver that would basically make psilocybin crimes, at least for possession and use and cultivation, the lowest priority for the police department. I would have supported that if I, you know, lived in Denver and had the vote there. But in general, I'm a little cautious about legalization because I think that people are using the model of cannabis and the drugs could not be more different.

This drug is - the stakes are much higher, it has to be treated with a lot of reverence and preparation, and I just don't think we know exactly how to - yet, how to fold this into our society in a way that will be safe and constructive.

DOUG MCVAY: There would obviously have to be some very specific training for the guides, I mean, this doesn't sound like - it's certainly not standard psychotherapy, from my understanding.

MICHAEL POLLAN: No, and there are, you know, that training is going on. I mean, there is a program in San Francisco at an institution called the California Institute for Integral Studies that is offering now a certificate in psychedelic therapy. That's how far we've come.

The MAPS organization, Multidisciplinary Association for Psychedelic Studies, is offering trainings, and then of course there are underground trainings going on all the time. So, yeah, training is very important.

You know, the other thing you have to do is qualify people to take the drug. In other words, it's not for everyone. People at risk of serious mental illness, things like schizophrenia or manic depression, they are disqualified from the university trials, and so it's very important that you be interviewed by someone, and the doctor has signed off, I think, before you take this drug.

You know, in my case, you know, I was nearing sixty when I first took the drugs, and I went to my cardiologist to get his opinion, because I had something called afib, which is an irregular heartbeat, occasional irregular heartbeat, and so, you know, people need to be careful, and I think we send the wrong message if we simply legalize these drugs by ballot initiative.

DOUG MCVAY: I should probably ask you to give us your social media so people can follow you out there on twitter and such, and then if you have any closing thoughts for our listeners?

MICHAEL POLLAN: Yeah. Well, I am on twitter, @MichaelPollan, and I have a website with a lot more resources and information on psychedelics, and also all my articles that I've published are there for free, and it's MichaelPollan.com.

You know, as usual, I'm excited to come to Portland. It's one of the great book towns in America, and I was there last year on publication. This is actually the paperback that's coming out now, but I was there on publication and we had two thousand people in the Symphony Hall there, it was a very exciting evening, and I'm hoping this will be the same, so I'm hoping people will come. I'll be there to answer questions, sign books, and engage in I think what is one of the most exciting debates going on.

We have the potential here, as I said, to revolutionize mental healthcare, and boy, do we need to do that.

DOUG MCVAY: That was my interview with Michael Pollan, best-selling author of many books including The Botany of Desire and his newest work, How To Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence.

You can find information, details of his appearances, dates, et cetera, at his website MichaelPollan.com.

And that's it for this week. I want to thank you for joining us. You have been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at DrugTruth.net. I’m your host Doug McVay, editor of DrugWarFacts.org.

The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs, including this show, Century of Lies, as well as the flagship show of the Drug Truth Network, Cultural Baggage, and of course our daily 420 Drug War News segments, are all available by podcast. The URLs to subscribe are on the network home page at DrugTruth.net.

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We'll be back in a week with thirty more minutes of news and information about drug policy reform and the failed war on drugs. For now, for the Drug Truth Network, this is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.