“We’re in the midst of a renaissance in understanding how psychedelics work”
Una Meistere
An interview with Steve Jurvetson, one of the world’s most successful venture capitalists and the co–founder of Future Ventures
Steve Jurvetson is an American venture capitalist of Estonian origin who has led early investments in several industry–redefining companies, representing $800 billion in aggregate value creation. He has served on the boards of directors for Planet, SpaceX, and Tesla. Before co–founding Future Ventures and Draper Fisher Jurvetson (DFJ), Steve was an R&D engineer at Hewlett–Packard and worked at Apple, NeXT, and Bain & Company.
He completed his undergraduate degree in Electrical Engineering at Stanford in just 2.5 years, graduating #1 in his class, and went on to earn both an MSEE and MBA from Stanford. Steve has been recognized as one of “Tech’s Best Venture Investors” by Forbes and named “Venture Capitalist of the Year” by Deloitte. In 2017, he received the Visionary Award from SV Forum, and in 2016, President Barack Obama appointed him as a Presidential Ambassador for Global Entrepreneurship.
Known for investing in pioneering companies that create entirely new sectors, Jurvetson has also emerged as a leading investor in psychedelic science. After gaining substantial experience in the field, he became one of the first investors to fund psychedelics, including an early stake in Atai Life Sciences. He has also invested in Osmind Inc., a software solution designed for practitioners of legal psychedelic–assisted therapy.
In 2023, together with his wife, Genevieve Jurvetson, he founded The Jurvetson Family Foundation. The foundation supports individuals, organizations, policymakers, and research efforts focused on mental health, veteran suicides, human rights, and climate change. It invests in cutting–edge research into psychedelic compounds, advocacy efforts, equitable access initiatives, education, and the delivery of care.
The foundation supports the Human Rights Foundation, the Good Food Institute’s efforts to create plant–based and synthetic meat, Veterans Exploring Treatment Solutions (VETS), the Multidisciplinary Association for Psychedelic Studies’ (MAPS) investigation into psychedelic drugs, and other causes.
Among his other passions, Steve Jurvetson arguably owns the most complete collection of space–flown hardware in private hands and has transformed his office into a museum showcasing it.
Our conversation focuses on Steve’s extensive experience in the field of psychedelic research and his advice on what small countries, like the Baltics, could do to approach it effectively.
When and why did you become interested in psychedelics?
It all started just before the release of Michael Pollan’s book How to Change Your Mind. There was a dinner organized in San Francisco by a group called PSFC (Psychedelic Science Funders Collaborative). There were maybe ten people or fewer at the gathering, and at that time, our eyes were opened. My wife and I were amazed – we had never heard about the therapeutic uses of MDMA, psilocybin, and potentially many other compounds.
Michael Pollan is a wonderful spokesperson. He comes across as the antithesis of a stereotypical hippie or someone you might think is overly enthusiastic or biased. At that point, he had never used these substances; he wrote about them as an outsider. He was captivated, as we all know now, since the book has been released.
At that dinner, we decided to donate, I believe, half of what they estimated was needed to get through FDA approval. However, it turned out their estimate was way off – by more than ten times the actual cost required to complete three FDA trials. At the time, though, we thought we were fully funding the completion of MAPS’ clinical trials. So, that was on the philanthropy side.
Simultaneously, we became connected with a company called Atai, leading to our first investment in a psychedelic science company. As you may know, Atai is a holding company with many assets, one of the largest being Compass Pathways – a publicly traded psilocybin company focused on treating various forms of depression.
We were early investors in Atai, which has since gone public. Additionally, we invested in a company called Osmind, which specializes in data collection for mental health clinics focused on novel treatment modalities. In the U.S., this primarily includes ketamine treatments but also extends to transcranial magnetic stimulation (TMS), a fascinating technology. These efforts have provided valuable insights into collecting data and feedback on the progress of these treatments.
Fast forward to today – psychedelic science has become our primary philanthropic focus. My wife now dedicates all her work time to this cause and has joined the board of PSFC. Together, we’ve organized numerous events and conferences. We’ve also become involved with state ballot initiatives in Oregon and Colorado, which have effectively decriminalized psilocybin and plant medicines for therapeutic use – not for street sales. It’s not like cannabis in the U.S.; these measures focus strictly on therapeutic settings, which is essential for ensuring safety and taking measured steps forward.
The goal is to minimize risks and proceed cautiously, taking baby steps rather than rushing too far, too fast. That’s the story of how we got started and how we’ve arrived where we are today.
Psychedelic science has become our primary philanthropic focus.
One of your goals is to promote human flourishing, advancement, and happiness for as many people as possible. What role can psychedelics play in achieving this?
At Future Ventures, we strive to invest in companies that aim to make the world a better place and promote human flourishing. The reason we emphasize this is that we deliberately avoid investing in businesses that exploit human frailties or weaknesses. For example, we would never invest in an alcohol company, a gambling company, or even an online gaming company if the product is addictive and causes people to waste countless hours on something non-productive. We simply don’t want to be involved in that.
In some cases, we believe it’s unhealthy for humanity, and in others, it just feels a bit preachy, if you will. When it comes to cannabis, for instance, the cost-benefit analysis doesn’t align with our values, so we avoid it.
However, we firmly believe psychedelics fall on the side of creating more benefit than harm, which is why we support and invest in this space. When it comes to harm, there is almost no addictive potential. If we look at classic psychedelics – LSD, psilocybin, mescaline, DMT, etc. – the risk of addiction is minimal, and the lethal dose is much higher than many substances we routinely take. For instance, Tylenol is a far more dangerous drug than psilocybin or mushrooms.
In fact, there was a compelling chart published in The Economist (www.economist.com/graphic–detail/2019/06/25/what–is–the–most–dangerous–drug – Ed.) that compared various drugs based on the harm they cause to individuals and society. As you might expect, alcohol topped the list, followed by nicotine and heroin. At the very bottom, however, were substances like LSD and psilocybin, indicating that these compounds cause very little harm overall.
Now, let’s consider the benefits. Sadly, for about 50 years in the United States, we haven’t studied these benefits due to political reasons unrelated to safety. The Nixon administration launched the war on drugs specifically to target marginalized populations, not for medical or scientific reasons. As a result, research came to a halt for decades.
The Nixon administration launched the war on drugs specifically to target marginalized populations, not for medical or scientific reasons. As a result, research came to a halt for decades.
Recently, however, research has been reignited and is flourishing. To make a provocative statement: we are finding that therapeutically delivered psychedelic medicine is more efficacious than any other mental health treatment since the FDA was established. The closest comparison is lithium, introduced in 1948, which has severe side effects and is rarely used today because it’s harmful, though its benefits were the only ones in the same ballpark.
In contrast, we have SSRIs like Prozac, which are largely ineffective. About one-third of people experience improvement with these drugs, but they spend up to seven years trying to find the right one. The remaining two-thirds aren’t helped at all. In fact, the term “cure” isn’t even used in mental health; the focus is on lifelong management of symptoms, which benefits the pharmaceutical companies, as they continue to sell pills indefinitely without truly helping people. This is a key reason we’re facing a mental health crisis.
Now, we believe we’re in the midst of a renaissance in understanding how psychedelics work. How do they help? And for whom do they help? It seems they are effective for the majority of mental health conditions, which is profoundly exciting. This has us very optimistic about the near future in this field.
We are finding that therapeutically delivered psychedelic medicine is more efficacious than any other mental health treatment since the FDA was established.
Yes, it’s very interesting because we know that the effectiveness of the psychiatric drugs currently on the market is often limited or even ineffective. They haven’t changed in many years. But in the meantime, psychedelics are still stigmatized. And overcoming this stigma is still challenging, despite all the research that has been done. Why is that? Why is there still stigma surrounding psychedelics, despite all the research, the promises, and the crisis we are in with no clear way out?
I think stigma is hard to shake. If you’ve been raised in America, for example, with the war on drugs influencing your entire life, you’ve been told lies about the dangers and risks of certain substances. Some of the more extreme cases involved completely falsified or misinterpreted research – like the claim that MDMA creates holes in your brain. It was utterly ridiculous. They were simply misreading a visual graph and wrongly labeling parts of the brain in a study that had nothing to do with brain damage.
But when people are scared of something, it takes a lot to undo that fear. Those who are afraid of psychedelics are probably not the ones using them. If you think about certain generations in America and around the world, they’ve been told psychedelics are scary. They were told they could make you jump off balconies or subjected to other scare tactics. These messages are deeply ingrained and hard to shake.
I’ll point out, for example, that in Europe, it seems just as ridiculous if you live in Germany and are afraid of nuclear power. It’s an analogy, but we know nuclear power is safer than coal. It kills a million fewer people each year than coal does. Even if we had a Chernobyl disaster every single year, it would still be less harmful than coal. But Germans, along with other Europeans, are afraid of nuclear power, and it’s an example of how difficult it can be for people to change their minds.
The same applies to GMOs. Many people in Europe believe genetically modified crops are unhealthy, even though we’ve served over 2 trillion meals with GMOs, and the data just doesn’t seem to sink in. The policy doesn’t change.
Now, when it comes to psychedelics, the situation is similar. If you’ve grown up believing they’re dangerous, and they’re still illegal – which is the key point – it’s hard to change that perception. In the U.S., you can’t just take psychedelics unless you live in places like Oregon, Colorado, or some cities in California, like Oakland, where things are slowly shifting. But it’s still a gray area because, federally, the legal status isn’t entirely clear. It’s certainly not legal at the federal level, nor within the Veterans Administration, which is ironic.
For example, in Oregon and Colorado, everyone could access psilocybin therapy – except veterans through the Veterans Administration (VA). That’s pretty unfortunate, but I digress. The stigma surrounding psychedelics comes from a lack of knowledge. People who are afraid of something don’t typically seek out the latest data on it. If I’m afraid of nuclear energy, I’m not going to read the latest reports on its safety, right? For instance, I doubt many people in Germany have read the World Health Organization’s analysis of Chernobyl, which points out that their fear of nuclear power is actually more dangerous than the power itself. It probably hasn’t sunk in.
The stigma surrounding psychedelics comes from a lack of knowledge. People who are afraid of something don’t typically seek out the latest data on it.
The same is true for psychedelics. People aren’t reading the headlines or articles; they aren’t seeing the research and progress in the field. To change that, ideally, we need to change the laws. There’s a kind of virtuous cycle: as more data comes out showing that psychedelics are safe and efficacious, there are more opportunities for approval and use.
When the FDA finally approves psychedelic medicine, I think that will be a watershed moment for changing public perception. It will serve as a federal stamp of approval. After that, it will likely be lowered on the DEA’s schedule, making it less illegal, and it can be used in research and clinical settings. We’re waiting for that moment. We thought it might come earlier this year with MDMA, but it didn’t. It looks like another study is needed, but hopefully, it will come in the next couple of years. Psilocybin might even be the first to gain approval. It’s neck and neck between MDMA and psilocybin. We believe that once one gets approved, it will kick off a more virtuous cycle of acceptance and approval.
When the FDA finally approves psychedelic medicine, I think that will be a watershed moment for changing public perception.
But what is your opinion? Why didn’t Lykos receive FDA approval? Really, everyone hoped it would, because the research was done, everything was in place. Why do you think that happened?
There are many factors at play, but they all boil down to, how should I put it, a cautious approach the FDA takes toward major changes. There was a time when the FDA overruled its advisory committee, which had recommended not accepting a particular drug, and decided to approve it anyway. That drug was fentanyl, and it has since become an embarrassing black mark on their historical decision–making process.
Fast forward to this year: the advisory committee was formed, and it’s interesting to note that, to avoid conflicts of interest, they specifically excluded people with research experience involving these substances. The idea was that those with experience might be biased. If you think about other types of drugs, like a new SSRIs, the kind of analysis you’re doing is not too dissimilar from other psychiatric medications, as they belong to similar families. So, it makes sense to exclude someone who has worked specifically with Prozac and instead bring in someone with experience with other medications. This wasn’t as problematic in those cases.
However, in the case of psychedelics, it was problematic because there was a lack of understanding of the therapeutic context – the “set and setting”, if you will, and the belief that psychedelics could actually be a solution. I personally believe there’s a bit of cognitive dissonance at play. If you’re a career psychiatrist who’s been practicing traditional therapy, you know it doesn’t work for many people. Then you hear about psychedelics promising to cure two–thirds of people after a single experience, and you might think, “How can that possibly be? It must be a flawed study, not properly conducted.” There’s also the issue of “functional unblinding”, meaning that people in the placebo group can often tell they’re in the placebo group, which undermines the results. Especially since, as in this case, 40% of the patients had prior experience with MDMA. Frankly, I think that was a mistake on Lykos’s part. It would have been better and cleaner to include naïve patients who had never taken MDMA before. If they were in the placebo group, they might have wondered, “Am I on MDMA or not?” It would have made it more believable that they were actually in the placebo group. Anyone with prior experience likely knows what it feels like, which makes it harder to trust the blinding process. I can understand that criticism – it’s a tough issue to work around, but they could have done a better job.
By the way, Lykos is working with the FDA to conduct another clinical trial to address these open issues, so it’s not a lost cause. However, it was definitely a setback in terms of time and money, which is tragic, especially for people who need this therapy.
So, if you look at this advisory committee, many of its members didn’t have direct experience with psychedelics. For example, there were people with expertise in toxicology, but that wasn’t really the relevant area for this type of approval. Yes, understanding the toxic limits is important, but that wasn’t the primary question here. The focus should have been on efficacy in a therapeutic context.
I also think that Lykos didn’t quite have the political savvy to understand that they needed to advocate more effectively. They should have focused on making sure there were real domain experts on the advisory committee, rather than just letting it be randomly chosen. They needed to work on getting the messaging right around their actual concerns, taking those concerns seriously, and not just dismissing them. I’m not saying these topics are black–and–white, but on a spectrum, they could have done more.
At the end of the day, I think the FDA just didn’t trust the management at Lykos. There’s been a significant change in leadership at Lykos – new management, a new clinical director, and major changes. We’re hopeful that things will be better the next time around. Ultimately, the FDA should be a data-driven, science-driven body, not one influenced by politics. Our fingers are crossed that it will be.
What is your opinion on how this has affected the promising psychedelic industry and the many startups that were founded?
I think this situation has had a bit of a chilling effect on late-stage investors’ enthusiasm. One way you can judge this is by looking at public stock valuations, which reflect the excitement – or lack thereof – around potential IPOs. Late–stage investors often want to invest in something they believe they can take public within a year or two. If the public markets are uncertain or volatile, they’re less likely to invest, and that hesitation ripples down to early–stage investors as well.
Now, I’ll add a caveat: I’m not completely up-to-date on the first-hand data about how easy or hard it is for new startups to raise capital in the psychedelic medicine space. You’d think I’d be more informed, but at Future Ventures, we haven’t invested in new psychedelic medicine companies over the last couple of years. We haven’t been meeting with them either, mainly due to our own investment filters. We prefer to back projects that are pioneering entirely new areas and doing things that have never been done before. It might seem strange, but we made our investments in this sector five or six years ago, and now we’re focused on other areas, including mental health.
Things might be going great, and I may just be unaware of it, but I’d assume it’s harder right now. That said, this is typical for any emerging sector. Think about the internet: there was a period of intense over-enthusiasm, followed by the dot-com crash, and then the long, substantial growth cycle that followed. Today, the internet is obviously much bigger than it was in 1999, but that transition was painful.
I think we’re currently in that transition phase in the psychedelic space. Every industry goes through it. So, I’d urge entrepreneurs to stay true to their convictions and push through. Finding ways to grow when capital is harder to come by is tough, especially in biotech where the FDA keeps you from going to market. You can’t sell anything until you clear that hurdle.
But I believe things will improve in the next couple of years, especially once the first approvals come through. That’s my hope, and I think it’s the hope of the entire industry.
But why you said that you are thinking that maybe psilocybin will be the one who will be approved first, not MDMA?
I mentioned that it’s neck and neck, but what remains to be seen are two key factors: how efficacious and how quickly psilocybin will be approved. The latest results from Compass show that they’ve delayed their Phase Three readout, which is an interesting new development. This could indicate a slowdown in progress.
Similarly, we don’t yet have the final, negotiated outcome between the FDA and Lykos, or a clear sense of what needs to be done to resubmit. That process could take another two or three years, so it remains uncertain.
So, in this “horse race”, we don’t know which one will be approved first. However, we certainly want both to be approved. In the long run, it doesn’t matter whether one is six months ahead of the other – what matters is that both are on fairly rapid tracks toward approval. As for MDMA, this has been a 30-year journey, so if it takes another couple of years, it’s unfortunate, but it’s not the end of the world.
Just too many people are not getting the treatment they need...
Exactly. Every hour, like the hour we are going to spend having this conversation, another veteran in the United States could be dying by suicide. Every day, 22 veterans die by suicide. Think about that – whether it’s from the post-9/11, Iraq War, Afghanistan, or any other conflict – each veteran who dies in battle is matched by 22 who take their own lives.
There is also speculation that revenues from psychedelics, drugs currently under development, could reach nearly $4 billion by 2029 if approved. Do you agree, or do you think this is overly optimistic?
No, I think Lykos alone could potentially reach that figure if it secures the best possible approval and focuses heavily on both international and domestic sales. However, they only have a five-year data exclusivity window, which is a unique aspect of their FDA approval approach. Unlike Compass and other companies that are pursuing proprietary compositions of matter and arguing that their products are unique, Lykos is taking a different path.
This raises questions about how quickly they can scale, but I believe the potential is enormous. Here’s one way to look at it: You might ask, “Can we really believe those numbers?” As a venture capitalist investing in entrepreneurs, I sometimes reflect on whether I would have believed Tesla’s projections when I first invested – the rate at which it would go on to literally transform the automotive industry – or SpaceX’s numbers before they succeeded. It seems almost unbelievable, right? These things had never been done before.
Now, think about the mental health crisis and how much urgency it should inspire. Mental health represents the largest global disease burden, according to the World Health Organization. By 2030, it is projected to cost the global economy a staggering $1 trillion annually. That’s the cost side. But what’s it worth to solve these issues? And when I say solve, I mean truly curing conditions once thought to be incurable – deep addictions to opioids like fentanyl, major depressive disorder, alcoholism, PTSD (which drives high suicide rates in veteran populations), or even traumatic brain injuries.
There are neurological conditions now being studied, such as stroke. For example, Gül Dölen (vcresearch.berkeley.edu/faculty/gul–dolen – Ed.) at Berkeley is currently recruiting participants for a trial aimed at helping stroke survivors regain physical function – literally restoring body motion control.
But it doesn’t stop there. Psychedelics seem to address a wide range of conditions found in the DSM – the extensive compendium of mental health disorders that have traditionally been treated with piecemeal solutions. This family of compounds appears to apply across an array of challenges: OCD, eating disorders (which are among the deadliest of mental health conditions), Lyme disease, and even inflammation-based phenomena where psilocybin shows promise. The breadth of potential applications is truly mind-boggling.
And again, the efficacy rates are higher than almost anything else we’ve seen. Here we have a single substance that is non-addictive, not harmful, and pan-diagnostic – meaning it seems to work across a variety of conditions when used in the right set and setting. It’s truly exciting! This is what motivates us to keep going. We know we’re on the right side of history.
We understand that the stigma surrounding these substances originated from politically driven agendas – rooted, quite literally, in racism and a desire to marginalize political opposition in the United States. It’s astonishing that this stigma has persisted until today. However, we firmly believe that in the long run, data, truth, and science will prevail. Despite the challenges and the fear–driven opposition we’ve discussed, the potential here is undeniable.
Psychedelics seem to address a wide range of conditions found in the DSM – the extensive compendium of mental health disorders that have traditionally been treated with piecemeal solutions.
From your perspective, which research has been the most mind-blowing for you personally, where you see psychedelics helping in ways you never imagined?
Traumatic brain injury, particularly in diagnosing neurological conditions, stands out. While we don’t yet have the results, if the outcomes in humans for stroke recovery mirror what Gül Dölen has observed in mice and rats – and this field tends to translate fairly well – it would indeed be mind-blowing. And I mean that quite literally.
Gül Dölen is best known for her groundbreaking research, such as giving MDMA to octopuses. Her hypothesis challenges the conventional understanding of the mechanism of action for MDMA and other psychedelics. Contrary to the widely accepted view that these substances work through regions like the amygdala or the frontal cortex, she posits that the mechanism operates at a much lower level – specifically within the functional block of neurons. The reason she used octopuses in her research is that they are highly intelligent animals but lack an amygdala or frontal cortex, possessing instead a very different type of brain structure. Her fascinating paper in Nature (www.nature.com/articles/s41586–023–06204–3 – Ed.) last year provided evidence suggesting that the mechanism of action for classic psychedelics, MDMA, and ketamine involves the reopening of critical periods in the brain.
A critical period refers to a phase in our early development – infancy, childhood, or young adulthood – when the brain exhibits heightened plasticity, allowing it to learn and rewire itself more effectively. Gül Dölen discovered that psychedelics can reopen these critical periods. Her research specifically traced the genetic changes in gene expression that relax the extracellular matrix, which can be thought of as the “potting soil” through which neurons grow and form new synapses. This physical relaxation of the extracellular matrix enables greater neuronal plasticity, effectively reopening these critical periods.
A critical period refers to a phase in our early development – infancy, childhood, or young adulthood – when the brain exhibits heightened plasticity, allowing it to learn and rewire itself more effectively. Gül Dölen discovered that psychedelics can reopen these critical periods.
This insight is why she turned her attention to stroke recovery. After a stroke, the brain naturally experiences a brief critical period of about two weeks during which it has an enhanced ability to heal itself. However, this ability diminishes afterward. Dölen’s hypothesis is that psychedelics could reopen these critical periods, potentially enabling the brain to regain its capacity for self-repair even beyond the initial recovery window.
That’s just fascinating. It also varies depending on the type of psychedelic. For example, Ibogaine reopens these critical periods for the longest duration, which is why it’s been used by Special Forces personnel in Mexico to treat addiction and PTSD. On the other hand, ketamine is at the shorter end of the spectrum. Interestingly, this seems to correlate with the length of the subjective experience: Ibogaine, being a long-acting psychedelic, has a longer duration of effect, while ketamine, a short-acting psychedelic, has a much shorter duration. Essentially, if you plot the length of the subjective experience, it correlates with how many days or weeks afterward a person remains in a position to learn. That, to me, is the most fascinating research.
The question you asked is, “What indication most surprised you?” So, I’ll come back to traumatic brain injury. This is something that happens to Navy Seals and Special Forces operators, who are often near detonations. For example, they’ll put a bomb on a door, duck around the corner, and set it off to blow open the door, or they’re in close-quarters combat where things are exploding, and they experience the equivalent of concussions, like football players or boxers. This is what’s known as TBI (traumatic brain injury).
Nolan Williams, an Associate Professor of Psychiatry and Behavioral Sciences at Stanford University studied 30 Special Forces veterans who went to Mexico to receive Ibogaine treatment. This was a single course of treatment. They did MRI and brain scans before and after, as well as three-month, six-month, and, I believe, one-year follow-ups. What’s astounding is that it essentially took all 30 people, who had a traumatic brain injury diagnosis, and removed that diagnosis. Only one person out of 30 didn’t fully recover. So, 29 out of 30 no longer had a TBI diagnosis. They also had a range of other comorbidities, including PTSD, depression, and alcoholism, among others. Depending on the condition, 80 to 93% of those comorbidities disappeared as well. Essentially, they were completely cured of multiple issues from a single treatment. That is mind-blowing – literally.
Also, Ibogaine treatment has been the first and only substance found to reverse Brain Age, actually making you look a year and a half younger than you were before the treatment – just a week later. How is that possible? It’s never been done before. One way to quantify that is by using a Brain Age diagnostic, which is one of the most commonly used tools in psychiatric analysis. You take an MRI, and an AI algorithm looks at that brain scan and, with no other data or inputs, guesses your age. It’s pretty well correlated with your actual age. There was a hint, by the way, from Robin Carhart-Harris that perhaps psilocybin will be the second substance shown to have this effect. If the two longest-acting psychedelics, some of the most commonly studied, have this effect, perhaps all psychedelics do, to varying degrees.
Ibogaine treatment has been the first and only substance found to reverse Brain Age, actually making you look a year and a half younger than you were before the treatment – just a week later.
But speaking about the treatments you mentioned, I think one very important aspect of making them successful is set and setting, because you also mentioned Ibogaine. It’s one of the most serious psychedelic treatments because it really requires medical assistance as well. The question of set and setting is one of the aspects that is quite challenging regarding psychedelic treatments. Do you agree?
Yes, absolutely. So, it’s both challenging and powerful. The challenge is that it’s expensive and takes time. There’s also the aspect of set and setting, meaning you don’t just take a drug and get cured. I think that’s worth amplifying. For example, ketamine delivery is often done in a way where you’re simply put on a blindfold, take the ketamine, and it’s short-acting. This allows clinics to cycle through patients more quickly. From a business perspective, if something like Ibogaine impacts you for 48 hours and requires therapists to be nearby at all times, it becomes expensive.
In the case of Ibogaine, you also need to monitor the heart for a condition called QT prolongation. They think they’ve solved that with magnesium as an intravenous adjunct. But again, this is not something you would do at home – it’s a medical treatment. And it should never be used as a party drug either. It’s not that fun of an experience. I haven’t done it myself, but that’s what I hear from people who have.
So, that’s the first thing about set and setting. The second point is that the FDA is not used to this. You don’t normally have something that is adjunct to therapy, like MDMA–assisted psychotherapy, which is challenging the FDA in ways they haven’t been challenged before. What rules and regulations, or REMS protocols (as they’re sometimes called), need to be in place for its use and safety profile after use? What training do therapists need? Do they need to be like nurses with really good bedside manners? Or do they need to be more analytical clinicians? Probably not the latter – probably more of the former. There’s a lot of indigenous wisdom that has accumulated over generations of underground use, and frankly, legal use in other countries like Brazil, Africa, and elsewhere, where there’s a reason they do things the way they do, often at night in a group setting.
For example, with the Ibogaine work, many of the Special Forces folks have gone down with people they’ve either served with or others they relate to. So, a group of Special Forces people participates in group therapy, and there’s a reason for that, as opposed to isolated therapy. They all share a somewhat similar healing modality, realizing they’re not alone and that they’re not the only ones who’ve been suffering the way they have. There’s a commonality or a theme in the PTSD that many of them have suffered, which is really important. Set and setting are crucial for that kind of healing, especially for PTSD in a combat situation. However, for a rape victim, the approach might be different. It might not involve the same group therapy; we need to study that.
We’ve funded a study with Robin Carhart-Harris at UCSF specifically about set and setting, which is quite remarkable, but there’s no published work yet. Is music effective? What kind of music? What kind of environment? What kind of intention-setting actually works? We need to look at variations and see if some approaches work better than others. Right now, all we have to go by is what has worked in underground or overseas settings, such as ayahuasca circles, and say, “Well, let’s loosely copy that”, and it seems to work there. That’s the best we have right now. Most of the best work also comes from the MAPS trials, which, for 30 years, have been thinking about and trying to optimize treatments for PTSD. So, yes, it’s important, and there’s still a lot to learn.
Yes, because actually civilization has this knowledge from ancient times; we just need to relearn it and accept that this knowledge exists. But it’s also not always so easy.
Well, it’s true, but it may not always be the only answer. So, I both agree with you and think there’s more to learn. In my opinion, indigenous wisdom is underappreciated and should be actively studied. How can we possibly not want to learn from what is, in some cases, thousands of years of learning, trial and error, and experimentation? A lot of the simple things, like whether it’s in a group or at night, when it’s dark – these things come from what they do. Is it a rite of passage at certain times in people’s lives? Some groups, like Native Americans, realized they could cure alcoholism. How did they discover that? Perhaps by accident at first, and then it became part of their treatment modalities. There’s so much skill, insight, and hints to learn, but they don’t know everything. For example, did they have an equivalent to traumatic brain injury? They probably didn’t even think to study that. They’re not doing brain scans. Modern science can teach us new things beyond what indigenous wisdom has learned, and it can do it more quickly – it won’t take 1,000 years. So, if I make a provocative statement: we will learn more in the next five years from the scientific process, even if it’s still illegal, than we will from new indigenous wisdom. There’s a difference between studying indigenous people for the history of accumulated knowledge and using science to learn more rapidly. Indigenous wisdom has been passed down over generations, and while it’s valuable, it’s not evolving as quickly as science can. They don’t run huge experiments like scientists do. So, you need both.
Indigenous wisdom has been passed down over generations, and while it’s valuable, it’s not evolving as quickly as science can. They don’t run huge experiments like scientists do. So, you need both.
As we mentioned the indigenous people, there is also an ethical question connected to the psychedelic industry and startups. There are many efforts to commercialize everything, and patent compounds found in mushrooms, ayahuasca, and other natural sources. I know that Dennis McKenna speaks out a lot against it, questioning how ethical it is. From your viewpoint, how do you see this race to commercialize psychedelics?
That’s a good question. I think there’s a very clear and obvious area where it is unethical and just wrong, and that is trying to patent something or use any strategy to lock up supply – whether it’s through import restrictions or laws that limit the current usage in indigenous populations that have been using it for centuries. Restricting someone else’s use is inappropriate. I think it is very hard to make those laws. It’s very hard to patent something that’s publicly used. The whole point of a patent is that you have to defend that you made a unique discovery.
There is, however, a very bizarre corner case with Compass Pathways, for example, where they claim to have patented a polymorph of psilocybin that they argue is more easily manufacturable. So, the actual advantage is not that it’s a better substance, but that it’s easier to make. Now, if that’s all correct, it shouldn’t restrict in any way people growing mushrooms and eating them all around the world, the way they have in the past. But if they want to build a high–volume manufacturing facility, maybe this patent will be a burden for making synthetics – not mushrooms, but synthetic psilocybin in a particular polymorph of that psilocybin molecule.
In another case, like with esketamine (SPRAVATO), Janssen, which is part of J&J, will bring to market one of the chiral versions of ketamine. You have two different versions – the left and right–handed sides of a molecule. Normally, they occur in roughly equal amounts, but you have the S version and the R version. People are doing research on this with MDMA as well, which is synthetic. In fact, Atai is working on that.
So those are unusual, again, because they have nothing to do with indigenous medicine, right? This is about how you build a factory to produce metric tons of something. Hopefully, those worlds won’t collide as much as people initially feared they might. When Compass Pathways started, they were trying to get patents, and they were shut down, which I think is informative. They did try to patent things that might have been more chilling to free use, and they got rejected. That’s the way it’s supposed to work. So, I’m not as worried about it as some others. I think it need not be a source of tension the way it appeared a couple of years ago. There were some battles – verbally, on blogs, and so on – between some philanthropists and investors who jumped in. There were concerns, but I don’t think those concerns are playing out as expected.
So, coming back to it, what worries me the most is, ironically, the use of the original plant medicine when it’s scarce. Take Iboga, for example, which comes from Gabon – there’s only so much of it, and it’s a slow-growing shrub. You don’t want to deplete that, and the same goes for peyote.
Interestingly, you can relieve pressure on these ecosystems by developing synthetic equivalents, such as synthetic mescaline. This would help reduce the need to harvest from Native peoples in their lands. The worst scenario, I think, would be if you suddenly legalize it, and a bunch of Westerners, unfamiliar with it, travel to these areas and deplete the local supply – almost like deforestation. To me, that would be tragic.
It’s very hard to patent something that’s publicly used. The whole point of a patent is that you have to defend that you made a unique discovery.
Yes, it’s already happening with ayahuasca in Peru and other countries.
I think the answer is that, ideally, everyone would agree it would be great if more people had access to this form of healing. But if you agree with that, then why would you want to limit who can access it? At the same time, you’d want to make sure it’s sustainable. Like anything, it has to be sustainable. You can’t destroy ecosystems to obtain it – you have to be able to synthetically manufacture it. I believe that’s true for meat, like steak and chicken, just as much as it is for ayahuasca. We can’t deforest Brazil to produce beef for fast food chains like Burger King and McDonald’s. Yet, this is the main driver of deforestation in Brazil, though it’s rarely discussed.
Like anything, it has to be sustainable. You can’t destroy ecosystems to obtain it – you have to be able to synthetically manufacture it. I believe that’s true for meat, like steak and chicken, just as much as it is for ayahuasca.
How can these treatments be made accessible, considering that patients may need to cover not only the cost of the drug but also the professional fees for supervisors? Since sessions can last several hours, the cost per session could reach $5,000–$10,000. Do you see any ways to offset or reduce these expenses?
So, I’m trying to think of the staging, because there are a variety of things that need to happen. The question is, how do you get the ball rolling most effectively? You need a lot of therapists and a lot of infrastructure for therapist training. It’s possible that you will discover that it doesn’t require quite the same intensity as a physician might need going through medical school. A nurse or nurse practitioner might be plenty. In fact, MAPS has a training protocol. My wife went through it just to learn what it’s like, and it’s something that a lot of people could probably do.
So, there’s the chicken and egg, of course: Are there enough patients that you could treat to make it economical? But I think people will come, become trainers, go through the training, and do that once you have approval. For example, Oregon has already treated more people with psilocybin therapy than all clinical trials for psychedelics combined.
Oregon has already treated more people with psilocybin therapy than all clinical trials for psychedelics combined.
Starting in January, by law, they’re going to have to gather outcomes data. Strangely, they forgot to implement this from the beginning. In Colorado, they’ll be better at this. How many people got better? What kind of set and setting, and what kind of training for therapists, etc.? What correlated with success? Starting in January, they will gather that data and will do it more rapidly than the FDA ever will. So, hopefully, we’ll find some things that work. Hopefully, we can also conduct more trials overseas and figure out what works. Then, hopefully, the cost will come down.
By the way, the substances are dirt cheap. There’s no reason they should cost more than five to 20 bucks and still make a profit, because that’s the street price. Clearly, someone’s making money off these drugs in the market today.
We should not forget that we have a natural experiment: every single weekend, millions of people are taking these substances, and they’re not getting addicted. They’re not reporting to the ER with addiction to mushrooms – this never happens. Addiction to LSD never happens. Overdosing from LSD never happens. Overdosing from psilocybin is impossible. So, let’s keep that in mind.
There, are some medicines that are expensive, you know, antibody therapies, cellular therapies, gene therapies, the actual process of making those things involve some major costs. The synthetic chemistry for psilocybin, MDMA is really cheap. I mean, LSD is a little more complex. But even then, there’s no reason these things shouldn’t cost five to 20 bucks per patient. Now, the question I sometimes like to think about is: 500 years from now, what’s the solution? It’s obviously going to be AI therapists. To me, I’m not sure anyone agrees with me yet, but I’m willing to go out on a limb here. There’s no reason in the world that it needs to be a human in the room holding your hand for 24 to 48 hours. We may think that the emotional connection is essential, but I believe we’ll get over that. I think we’ll find that once you trust that this AI therapist has done it a million times in simulations and thousands of times with humans, and they’re really good at it, it’ll be fine. But we haven’t built that yet. We haven’t tested it yet.
Humanity’s acclimation to AI in the emotional sphere is just starting. You’ll hear stories about people falling in love with AIs, weird corner cases where emotional attachment becomes possible. I think the therapeutic envelope for AI is there. If so, you could imagine a completely untrained human in the room as a backup – someone who is literally just there to sit with you. That would be the lowest-cost labor you can imagine. They wouldn’t need any medical training, in my opinion. You’d have the AI, camera-based system, watching for any signs of concern – like if the patient suddenly jumps up and tries to run out of the room.
Long story short, no one is doing this today. Some people think about it, dream of it, but I’m not sure how many years off it is. Still, it seems like the obvious long–term solution.
We should not forget that we have a natural experiment: every single weekend, millions of people are taking these substances, and they’re not getting addicted. They’re not reporting to the ER with addiction to mushrooms – this never happens.
There are discussions about whether insurance coverage for psychedelic therapy could be one option to make these treatments more affordable. While it is challenging, could this be a viable solution?
Absolutely. Thank you for reminding me. The key question over the next five years will be whether you can get Medicaid and other insurers to reimburse these therapies—and they should, because the long–term cost benefit is so much better. It’s more effective than other treatment modalities. How many years of therapy and SSRI treatment are needed if you’re just treating symptoms, or what is the cost of medical treatment for people addicted to fentanyl or alcohol? Their medical and cost burdens are huge. The same is true for the VA. Mental health is one of the largest cost burdens for the Veterans Administration in the U.S., and they have more PTSD patients than any other group. They use a treatment called prolonged exposure therapy, which is just not very effective. The compliance rate is very low. While it is somewhat effective, very few people stick with it. It’s just a terrible way to try to treat PTSD, but that’s what they use. Sadly, many of the practitioners say they just grow old with their patients, seeing them for the rest of their lives. To know there’s a cure is both incredibly hopeful and deeply discouraging that we haven’t embraced it more quickly or sooner.
The key question over the next five years will be whether you can get Medicaid and other insurers to reimburse these therapies—and they should, because the long–term cost benefit is so much better. It’s more effective than other treatment modalities.
My last question is about the Baltics. From your perspective as an investor, what advantages could small countries like the Baltics have in getting this right, if any?
Well, I’m not sure, so let me first add a caveat by saying I’m not aware of the regulatory environment. But you could imagine that different countries might have different policies. Any country that looks at this and considers the data might decide to liberalize more quickly. For example, just allowing clinical trials to take place more freely would be really helpful for people running clinical trials. I know there was a group called EGeen that conducted clinical trials in Estonia and other Eastern European states, and it’s still around. My guess is they could help with recruiting patients for clinical trials if the regulations were more liberalized. You could also decide to decriminalize, as Australia did. It’s not a tiny country, but it’s not huge either. Still, if you look at what they’ve done, the Baltic States could follow their path.
I will point out, though, that from a reputational standpoint, there may be incidences of alcoholism (ec.europa.eu/eurostat/statistics–explained/index.php?title=Alcohol_consumption_statistics#General_overview – Ed.) in Finland, Russia and the Baltic states, and the northern region. Whether it’s due to genetic heritage, socialization to drink, or perhaps the ferries or “drunk Finns” coming across to Tallinn every weekend, it’s an obvious problem. An early focus on that could be beneficial, given the remarkable efficacy in treating alcoholism. That alone might be something to study for the benefit of all.
The economic burden of alcohol addiction on society is enormous. In Oregon, for example, one of the northern U.S. states, the amount of money spent on alcoholism treatment and crises exceeds almost any other medical condition. That alone could fund all psilocybin treatment. I haven’t looked at the data in Latvia or Estonia, but I wouldn’t be surprised if it’s similar. If untreated, the social and economic consequences are tragic.
The economic burden of alcohol addiction on society is enormous. In Oregon, for example, one of the northern U.S. states, the amount of money spent on alcoholism treatment and crises exceeds almost any other medical condition. That alone could fund all psilocybin treatment.
Thank you very much.
