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An interview with Dr. Rick Strassman

by Scotto and James Kent
as seen in Trip #4

From 1990 to 1995, Rick Strassman, M.D., conducted pioneering, federally approved DMT trials in human subjects. Strassman was born and raised in southern California, graduating from Stanford University in 1973, and Yeshiva University's Albert Einstein College of Medicine in 1977. He completed his internship and psychiatric residency at UC Davis (Sacramento) in 1981. Dr. Strassman spent a year at UC San Diego in a clinical psychopharmacology research fellowship, and two years of post-fellowship training at the University of New Mexico. At UNM, he attained the rank of tenured Associate Professor of Psychiatry. Currently, he is Clinical Associate Professor of Psychiatry at the University of British Columbia, and is consulting psychiatrist at Jefferson Mental Health Services in Port Townsend, WA.

Trip: What led you to study DMT in particular?

RS: Several factors drew me to study DMT. It is much less well-known than the other major psychedelics, such as LSD, psilocybin, and mescaline. The notoriety of those other drugs, and the media and political attention that might result from those drugs being given to people, worried me. I wanted to do this work quietly, with as little attention as I could manage. Also, I thought there would be less resistance on the part of the regulatory agencies in terms of their approving a study of a "minor," "obscure" drug, as opposed to a drug with a more glaring reputation.

DMT is formed and found in the human body. It was proposed as a potential cause for naturally occurring psychotic states in the 1950's to 1970's. These mainly included such conditions as schizophrenia and manic depressive illness. In formulating my projects, I drew upon this older literature, and reframed it in the context of the current vast explosion of information regarding serotonin. Serotonin is important because it happens to be the primary neurotransmitter whose receptors are affected by DMT and other hallucinogens. Interestingly, many of the newer, safer, and more effective antipsychotic drugs block the effects of serotonin. I proposed that if we understood how DMT worked from the viewpoint of serotonin, we might unlock some of the mysteries of, and develop newer treatments for, such disabling disorders as schizophrenia.

Of course, other naturally-occurring highly altered states of consciousness might be mediated by DMT: near-death experiences, and mystical states, for example. So, I thought that understanding how DMT worked in people might deepen our appreciation of other states of consciousness.

DMT is short-acting. I knew that the clinical research environment of a busy academic hospital would really stress our volunteers. I also wanted to give big doses, which might increase the risk of acute adverse reactions. Thus, I wanted a drug that was in and out fast. I hoped that no matter how bad someone's trip might be, at least it would be over quickly. I thought we could manage a 20 minute bummer, but a 6-12 hour one might tax our resources, especially as we were just beginning this work, and we didn't want to jeopardize our volunteers or our research project's chances of success.

Terence McKenna and I were just getting to know each other at the time I was positioning myself to study psychedelics. He extolled, or rather regaled me with, the virtues of DMT in no uncertain terms. I acknowledge and appreciate his influence in this area. DMT provides glimpses into absolutely unbelievable territory. At the same time, the sense of certainty and reality of what is glimpsed is so profound as to be undeniable. Perhaps it is the lack of time to prepare, build up to, or resist the effects. Maybe it's due to some unique chemical properties of DMT. Whatever the cause, DMT seemed like the best, most intense, most clear-cut psychedelic there was. What better drug to study?

Trip: When and where did your research actually take place?

RS: Approval for our DMT study was obtained from United States Food and Drug Administration November 5, 1990. We gave our first dose of DMT, 1.0 mg/kg intramuscularly (IM), later that month. All other doses were intravenous (IV), as the IM route was too slow. Also, more drug was required IM to give the same peak effect as seen with IV, and we wanted to conserve our supply of DMT. I moved to Victoria, British Columbia, Canada, in April 1995, and tried commuting for awhile between Victoria and Albuquerque. After two trips to New Mexico, I decided this wouldn't work, and we gave our last doses of DMT in July, 1995.

Nearly every administration of DMT took place on the fifth floor of the University of New Mexico Hospital in Albuquerque. On the east wing of this floor is the General Clinical Research Center, or GCRC. The few DMT administrations that occurred elsewhere were in the magnetic resonance imaging laboratory across campus. This was for a study looking at brain function changes while under the influence of DMT.

The first two years' worth of DMT research took place in whatever room was free the particular day of the study. For the second two years' of research we had our own room that was nicely painted and furnished, to give it a more homey feel. However, there still were oxygen tubes and suction hoses coming out of the wall behind the bed. In addition, the GCRC was the site of some high dose cancer chemotherapy research, so we had some pretty sick people on the ward at any time. Also, if other medical or surgical wards were full, the GCRC would take those overflow patients and provide nursing care until beds were available on the other wards.

In some ways, this was the most hellish space imaginable for giving high dose DMT trips. However, we were surprised to see how this evolved over time into an almost uniformly positive experience. First, as many people on their high dose of DMT were concerned about dying, or being dead, they were reassured by whatever vague recollection they could muster that they were in a high-tech hospital setting where immediate aid could be offered. Second, the dreary, oppressive, and threatening exterior circumstances volunteers found themselves in did a lot to encourage an introspective, inner-directed experience. It also helped enhance the bond between volunteers and the research team. We seemed like oases of sanity and support compared to the rest of the environment. All of these factors actually combined to strengthen and encourage the letting go attitude so important in getting the full effect of a high dose DMT experience.

Trip: In the course of your research, approximately how many volunteers did you administer DMT to and what dose ranges did you study?

RS: By the time we wrapped up our research in July, 1995, we had given 65 volunteers about 400 doses of DMT. These doses ranged from 0.05 to 0.6 mg/kg by the IV route. We gave 1.0 mg/kg IM to one volunteer. We gave 0.6 mg/kg IV to two volunteers but this overdosed them. Our normal dose range was 0.05 to 0.4 mg/kg IV. For the dose response study, we also gave two intermediate doses: 0.1 and 0.2 mg/kg. For the tolerance study, we gave 0.3 mg/kg IV repeatedly. For various pre-treatment studies, combining potentially blocking or augmenting medications before giving DMT, the dose varied depending on the pre-treatment agent being used, but never was outside our 0.05 to 0.4 mg/kg range.

Trip: Were these seasoned volunteers?

RS: All volunteers were experienced psychedelic users. Some were very experienced; some were not too experienced. Some had smoked DMT before, but most had not. Some were using psychedelics in their current life circumstances; others hadn't taken any for 10 or 20 years. I interviewed all prospective volunteers carefully to assess the level of their prior psychedelic experience. Even if someone had taken a moderate number of previous trips, but did not seem to have gotten very deep, or had panicked at some point or another in their trips, I was less inclined to take them, and turned some people away for those reasons. For example, one prospective volunteer told me how he always found himself on top of the roof of a tall building at some point in his high dose mushroom trips, and never knew how he got up there.

We enrolled experienced volunteers for three major reasons. First, we wanted people familiar with the terrain, who could give informed consent, and who could provide us with thorough and articulate reports of what they experienced. Second, we thought experienced people would be less likely to panic, having been in tight psychedelic spaces before, and having negotiated their way through. Third was the legal, but necessary, liability issues. We thought that any claims for damages would be less likely sustained if volunteers had taken, or were taking, psychedelics on their own.

Trip: What kind of measurable physiological reactions did you find when you administered DMT?

RS: We measured many physiological variables. These included heart rate and blood pressure. We measured these by using a machine that kept a blood pressure cuff wrapped around the volunteer's arm during the entire session, and that would give quite a firm squeeze when recording. Many volunteers did not feel even this rather intrusive grip at the first, or two minute, recording point of their high dose sessions. Later on, as they were coming down, most people actually felt the cuff as a reassuring link to the material world, that they had survived, and we were looking after their bodies.

We measured core temperature by means of a rectal thermometer. This might sound bad, and it was, at least somewhat. Only one volunteer flatly refused this. The thermometer was actually a 1/8 inch diameter flexible wire thermistor that was inserted about 4-6 inches at least a half-hour before DMT was given. The thermistor was connected to a little recording device attached to the bed rails.

We also checked pupil diameter, at least early on. This was by using a little card with black circles of various diameters printed on the card. I'd ask someone to open their eyes, and I held the card next to their face, comparing their pupil diameter to a circle on the card. I'd see which card circle was closest to the volunteer's pupil diameter and note it in my book. I tried to measure pupil diameter at our earliest data collecting point: two minutes, but someone had bad flashbacks for a night or two of my face emerging in the dark as they were falling asleep. We gave up on this after the first study. Too intrusive.

Finally, we drew a lot of blood samples from the arm that didn't have the blood pressure cuff wrapped around it. We used a fairly complicated rig with two little valve mechanisms and several feet of clear plastic tubing, that was attached to a saline bag hanging on a pole above the volunteer. This slowly dripped saline into their vein, to keep the vein from clotting for the two hours of blood collecting required. Blood samples were drawn for several pituitary gland hormones, including ACTH (adrenocorticotrophic hormone, which stimulates the adrenal glands to make certain steroid hormones), beta-endorphin (which may mediate euphoria and pain perception), prolactin (prolonged high levels of which mediate milk letdown in women, and with an unknown function in men), and growth hormone. We also measured levels of the pineal hormone melatonin. Later, a group at San Diego measured some of our bloods for vasopressin, which is thought to be an affiliative/bonding sort of hormone, in addition to its better known role in fluid and electrolyte maintenance. We also had a little IV in the arm that had the blood pressure cuff wrapped around it. This was the access point for me to administer the DMT.

All but one measured variable went up. The higher the dose of DMT, the greater the rise in the biological factor. ACTH and beta-endorphin rose to levels as high as any seen in other pharmacological studies using other, non-psychedelic drugs. The rise in vasopressin was greater than any previously noted in the literature. The one variable that did not rise was melatonin. I could get into this if you'd like, but the explanation gets a bit long-winded. Needless to say, this was disappointing, as I had proposed some time back that the pineal was intimately involved in mediating psychedelic (both drug, and non-drug induced) states.

Trip: What was the most profound physiological reaction you ever saw in one of your volunteers?

RS: We saw two people get close to trouble with blood pressure responses to 0.4 mg/kg IV DMT. One fellow had borderline high blood pressure on his screening physical examination. He lost weight, started exercising regularly, got a normal electrocardiogram done, and returned with normal blood pressure. He also did not exclude himself during the low dose DMT session by exceeding our predetermined threshold for blood pressure rise in that condition.

However, he was quite nervous before his high dose the next day, and his blood pressure really shot up by the time we took the first measurement at two minutes. In fact, it went up so high it set off the alarm on the blood pressure machine, an alarm whose existence we never suspected. He was right in the beginning of a giant DMT flash, being confronted by a large black female warrior with a spear, who was enraged and astonished to find him in her space. She said something like, "WHO THE HELL DO YOU THINK YOU ARE BURSTING IN ON ME LIKE THIS?" when the alarm bells started going off on the blood pressure machine. His eyes popped open, terrified. We tried calming him, but also wanted to get another blood pressure quickly, to see if it was going up or down, as we were concerned about him having a stroke, and whether we needed to call for immediate help. At the same time, we were fiddling with the back of the machine, trying to locate the "off" switch for the alarm. Within a minute, the machine was inflating again, another sky-high measurement, and the alarm went off again. It was chaos. He was too frightened to close his eyes again, rightfully alarmed at how his body was reacting. Another reading was a little lower, but the alarm still was on, and it rang again. Finally, at about 5 or 6 minutes, his blood pressure was low enough to not trip the alarm. By 10 minutes he was psychologically down enough to process what had happened. He had a stiff neck and a headache, both of which improved with some Tylenol and rest, and he went home in a couple of hours feeling physically well, but pretty shaken. Even though he wanted to participate in future studies, he got no more DMT.

Another fellow had a rather slow heart rate on his initial physical exam, and a minimally abnormal EKG that was felt to reflect the slowness of his rate. He did fine on his low dose of DMT, but the following day, got into some trouble with his high dose.

His heart rate and blood pressure both bottomed out at the two minute point. It was as if he was about to faint from the shock of what he was undergoing. Subjectively, he was approaching some sort of craft in a very strange deep space environment, but the astonishment was too great. He sat up with a start, looked pale as a sheet. We were worried about his blood pressure and heart rate, and tried to lower the head of the bed to below heart level, and raise his feet above heart level, the "reverse Trendelenburg position," in hopes of keeping him from passing out. He was too restless to lay flat right then, and we didn't know how to position the bed quickly. He was about to throw up. We didn't have an "emesis basin," and I looked around anxiously for something for him to vomit in. All I could think of handing him was a wadded up hospital gown. He looked down at it, at me, and our nurse, and became even more disoriented. He finally laid back down. By then his blood pressure was starting to climb to barely normal levels. All the moving around probably had gotten these functions a little more activated. Within 10 minutes, his blood pressure and heart rate were back to his normal, but low levels. Although he felt quite strongly about wanting to continue to participate in future sessions, we were too alarmed by his reaction and did not want to take a chance by repeating it.

Trip: What were some of the more interesting DMT experiences reported by the volunteers? Did anyone see hyperspatial elves or cross over into some kind of shadow dimension?

RS: This is the stuff of my book in progress: The Spirit Molecule. There were endless interesting experiences. They included physical, emotional, mental, and spiritual experiences. There were entities of varied shapes, sizes, intelligence, and messages. There were near-death experiences of dismemberment and re-integration. There was being devoured by spiders, dancing with DNA, and having sex with alligators. There were angels, machines, and implantations. There were highly personal recollections and healings, simply colorful visions, visions of the future. There were laughing Buddhas, great winged creatures, computer circuits, and cactus beings. There was enlightenment, there was paranoia, there was love, there was despair. There were women, there were men. There were Amazonian natives and porcelain dolls. There was Gumby. There was not very much, there was way too much. There was nothing to remember, there was too much to forget.

It's interesting that in all the various scientific venues I presented our findings, no one asked about what people experienced. Except once: at the Swiss Academy of Medical Science's 50th anniversary of LSD symposium in 1992, where Albert Hofmann was the guest of honor. Robert Forte stood up when I asked for questions at the end of my talk. He asked, "You know, you never talk about what people experience on high doses of DMT." I answered, "That's because no one ever asks."

Trip: What did you find out about physiological tolerance during the tolerance studies?

RS: Tolerance is the phenomenon of decreasing responses to the same dose of the same drug given repeatedly. For example, LSD, psilocybin, and mescaline all show significant tolerance development after 3-4 daily doses: the same dose causes less and less effects every day it's taken.

In one published report, DMT was given intramuscularly twice a day for 5 days and no tolerance developed. It's also quite difficult to induce tolerance to its behavioral effects in non-human animals. The street data on DMT tolerance in people are inconsistent; the whole issue is complicated by technical concerns: problems with repeatedly smoking DMT, the exhaustion that can set in, as well as pipe mechanics, and build-up of DMT in the bowl. To help clarify these issues, we wanted to see, using a short enough interval, if we could induce tolerance to a fully psychedelic dose of DMT.

We gave 0.3 mg/kg every half hour, four times in a morning, in this study. We saw varying degrees of tolerance to the physiological effects. ACTH, prolactin, cortisol (an adrenal steroid hormone), and heart rate responses decreased with each successive dose. Blood pressure responses did not decrease with successive dosing. Temperature probably hadn't peaked by the time we removed the thermometer; in addition, sweating (a compensatory mechanism) occurred, and this complicated our interpretation of the temperature data.

Trip: What was the emotional tolerance like? Could everyone handle being given DMT once every 30 minutes for 2 hours?

RS: There didn't seem to be much of a decrease in the intensity of the psychological responses to repeated DMT dosing in the clinical interview situation. That is, when I asked a volunteer to compare first, to second, third, and fourth doses, most didn't think there was a drop-off of effects. This clinical impression held up "objectively" using our rating scale, an abbreviated version of which was given after every injection. The only one of the six rating scale scores that even showed a trend, but not a statistically valid one, was our "Volition" score, which was the weakest of all six factors on the scale, and the one that we thought needed the most modification for future studies.

People did much more personal work during the tolerance study than on the single high-dose sessions. We also started using eyeshades on all volunteers, which made these trips even more inner-directed. It seemed that without eyeshades, opening the eyes would detract from the full DMT effect, and sometimes had a disorienting effect.

There was a typical sequence of sessions. First, there was the bracing for the high dose experience. Once people were able to talk easily at about the 10 minute point, we would briefly discuss, and get a summary of, the experience. The rating scale would then take about 5-8 more minutes to fill out. We'd discuss the trip again, and what they were hoping/expecting for their next dose. There would be only a few minutes for the volunteer to relax and get ready for the next dose. Usually the second dose was not very different from the first, as there was still a certain amount of holding on and anxiety, and many of the same issues or experiences from the first session would come up again. After the second session, however, fatigue would start setting in.

For many, the third session was the hardest. Volunteers often were mired in the first and second sessions' issues in even a greater way, and sometimes there was despair, depression, and frustration. After this session, many people asked if anyone had dropped out at this point. My answer was always the same, "Not yet, but of course you're free to stop now if you want." No-one ever did drop out of the tolerance study. However, most were exhausted by now, burned out, ready to quit. As it turns out, by the end of the third session, there remained a significant amount of DMT in the blood throughout the resting period; that is, they had never completely cleared the DMT from their system before getting the fourth and final dose.

The fourth session was nearly always the easiest, best, most refreshing and reviving, and full of joy, completion, satisfaction and resolution. The relief and letdown always were palpable in the room after the fourth session was successfully completed.

Trip: Throughout the study, did you or any of the volunteers ever reach a place where you were no longer comfortable with an increase in dose?

RS: We gave two volunteers 0.6 mg/kg IV one morning. That was a busy morning indeed. That day is written up in the Autumn, 1998, MAPS (Multidisciplinary Association for Psychedelic Studies) newsletter. Briefly, both volunteers were delirious and could remember little of their experience. They were disoriented, confused, and restless. Their reports were sketchy, spotty, and mostly incoherent. No amount of prompting could affect better recall.

Dave Nichols, who made the DMT, and I spent a lot of time discussing whether to reduce the high end dose to 0.5 or 0.4 mg/kg. We ended up settling for 0.4 mg/kg. While a handful of people said they could have done more than 0.4 mg/kg, there were just as many who said they would not have participated if the high dose were any more than 0.4 mg/kg. So, I think we chose correctly. In our preliminary work with the tolerance study, we started with hourly intervals, using 0.05 mg/kg. We then tried this low dose at 30 minute intervals. This was to see if there was any sensitization to repeated dosing, which can occur with some drugs, for example, stimulants. That is, the same dose, given repeatedly, causes a greater and greater response, sometimes to the point of toxicity.

We then went to 0.1 mg/kg every hour, and then every half hour. We then tried 0.2 every hour, then every 30 minutes. 0.3 mg/kg every hour was no problem; every 30 minutes seemed taxing. 0.4 mg/kg every hour was pretty tiring. The second of two volunteers at 0.4 mg/kg every half-hour asked us to stop after the third dose. She was exhausted, weakened, overwhelmed and unwilling to take any more. So, we settled on 0.3 mg/kg every 30 minutes. Again, we seemed to have chosen right, as I don't think we could have gotten any better results than we did using 0.3 mg/kg, and some people might have dropped out with a higher dose.

In our pre-treatment, combination drug studies, we also did a fair amount of pilot work. We first decided upon the effective blocking or augmenting dose of the pre-treatment agent, based on literature reviews in which it was used in combination with other serotonin-active drugs. We then began with 0.05 mg/kg IV DMT to make sure we weren't about to see any huge multiplying effect of the pre-treatment agent.

With one particular agent, 0.1 mg/kg of DMT seemed to be multiplied into a 0.2 or 0.3 mg/kg dose, both psychologically and in terms of blood pressure and heart rate. We gave one fellow 0.2 mg/kg without, and then with, the pre-treatment drug, and he said it was as much as, or more than, a 0.4 mg/kg dose. Later that morning, another fellow lost consciousness briefly at 0.2 mg/kg in combination with the pre-treatment drug. We ended up using 0.1 mg/kg DMT for this particular pre-treatment drug study. I am not naming this pre-treatment drug, because I'm reluctant for people to try the combination at home; the additive blood pressure effects might be dangerous, as might be the enhancement of the psychedelic effect of DMT.

Trip: Were there follow-up sessions with volunteers to determine if there was any kind of long term psychological change or impact?

RS: Several volunteers participated in more than one study, so we followed them for as long as they were in our projects. One fellow was in every study, and in every pilot project (in which doses, or combination of doses, were determined). We always asked these repeating volunteers how they were faring, what impact their participation in the research was having on their lives. About a year after the completion of the initial dose-response study, our research nurse contacted and interviewed each of those volunteers.

We had "socials" after the completion of each study. All the volunteers from that study, and the preceding ones, were invited to meet, bring food and drink (it was interesting to see how little alcohol was consumed at these get-togethers), and compare notes. This was a helpful debriefing processes for recent volunteers, and a good chance for old-timers to let us know how they were doing. An interesting phenomenon was the "support group" that spontaneously formed about a year into our second series of studies. Several volunteers felt the need to meet among themselves and with the research team, to discuss their experiences and how to make sense of them. For many, there were few, if any, friends or acquaintances with whom they could share their experiences. Some were concerned about being labeled "drug abusers" for the simple fact of their participation in our research. More commonly, they were wary of being misunderstood or blankly stared at when discussing DMT, aliens, implants, near-death, and out of body experiences commonly experienced during the high dose DMT state. This group met quarterly for about 12-18 months, and involved about 1/4 to 1/3 of the volunteers.

For the most part, while the high dose of DMT was the most intense psychedelic experience of volunteers' lives, the overall long-term impact wasn't very profound. For the majority of volunteers, participation in the study was a highly novel, unusual, and stimulating experience, not unlike a visit to a extremely exotic destination. They had memories and "photographs," but did not necessarily experience personal transformation as a result. This may have had a lot to do with the fact that they were all seasoned psychedelic takers.

Some people stated they were much less afraid of death or of dying, due to the tremendous letting go of their bodies and minds that they experienced while on DMT. Others were convinced of the existence of separate dimensions of reality, and developed a certainty that these different levels were now positively interacting with them in both subtle and powerful ways. Some had mystical experiences, and felt that a life-long quest for such an experience was now completed. One former member of an ascetic religious order was glad to see his meditation could "stand up" to the DMT experience, demonstrating his religious development was solid, substantial, and deep.

Others, however, found the experience detrimental. One fellow got depressed after his participation, but worked things out by returning to psychotherapy. Another got depressed and needed to get on antidepressants; he had been depressed in the past, however, and also was in a highly stressful transition period in his life. Another fellow was so frightened by his high dose of DMT that he stopped tripping altogether; he had enjoyed "recreational" doses of psychedelics in the past, but now was afraid to even get close to the substances again. One fellow stopped writing poetry for the first time in over 20 years, as he had met such overwhelming existential angst in the depths of his high dose of DMT that he decided, "What's the point?"

Trip: What kind of impact did these studies have on you as a researcher? Did you have any notable emotional reactions to the study as it progressed?
RS: My reactions to these studies evolved over the 4 plus years of their performance. Frank disbelief that I was actually able to give DMT quickly gave way to unbridled enthusiasm, and perhaps a little bit of recklessness after our first few handfuls of doses. This was dashed by our two harrowing 0.6 mg/kg studies in which our volunteers became delirious.

The next stage was wonder, honor, curiosity, gratitude, excitement, and gratification during our dose-response study. Many people had peak experiences on their first high dose sessions, and I was happy to see this. The number and degree of acute and obvious adverse effects were minor. I knew all but one of this first group of volunteers quite well, and that helped us in negotiating this unknown territory. As well, the tolerance study, which was the next one after the dose-response work, showed some more substantial promise as a potential therapeutic tool than the single high-dose sessions.

The next series of studies were more technology- and chemistry-intensive, and were both harder to recruit for, and more difficult to put into a context with which I was comfortable. I began feeling I was taking more than I was providing, and there was a discomfort with the humans-as-large-rats model that this type of work implied. The trust and honesty that are so crucial to the success of a high-dose psychedelic experience were being compromised.

Also, to my surprise, and sadness, people's initial high-dose breakthrough sessions were beginning to sound a little hollow. I think this was because, by following our early volunteers, I saw that the drug experience itself had little substantial impact on most people's lives. I was also seeing people have several, if not many, high dose sessions from participating in subsequent studies. While they certainly were "getting high," they weren't quite
"getting it." Without noticing it at first, I was being given the answer to the deepest unasked question of my research: Do these drugs have beneficial effects by themselves? And the answer was: "No." Then, the question arose, "Well, then, are you harming people?"

Trip: From your findings, do you believe it's safe to continue research with DMT in a clinical or therapeutic setting? What do you see as potential dangers, if any?

RS: Safety has to be taken in the context of risk:benefit. If a procedure is incredibly dangerous, but the potential utility is great for a condition with no other treatment, the risks might be justifiable. If a procedure is high risk, and the condition is mild, or there are other lower-risk and effective ways of dealing with it, it isn't ethical to expose the person to the high risk procedure. If the procedure is low risk, then most conditions would be amenable for its use.

I think DMT is a high risk procedure, especially the higher doses, at which its unique properties are manifest. Blood pressure effects are intense. People get scared. Some were traumatized. The effects are incredibly weird. And our volunteers were generally stout, experienced psychedelic veterans. How much more risky would it be giving DMT to psychedelically-naive individuals, especially those with medical or psychiatric problems? How much information could you provide them to feel they were actually giving "informed" consent?

There are a range of potential dangers with DMT and other psychedelics. This range is from subtle to gross. The gross dangers are obvious: bad trips, flashbacks, post-trip anxiety, depression, confusion. The more subtle ones have to do with a false sense of understanding, or wisdom, that can occur when psychedelic experiences aren't carefully examined from multiple perspectives. They can feed delusion, separateness, and illusory resolution of conflicts. This is a certain false piousness that is quite insidious and difficult to confront.

People assume that high dose psychedelic experiences, due to some overlapping features with the near-death experience, and mystical experience, can be helpful. For example, if DMT offers a glimpse of the intermediate state between life and death, maybe it could provide a dry-run for those afraid of dying, or for those who believe such an experience might prove beneficial later on. However, what if we're wrong on that count? What if the DMT state and death have nothing to do with each other? What if we are expecting death to be a certain way, and then, because of our assumptions, are absolutely shocked and confused when it's nothing like a DMT trip? Also, in the case of the dying, what if someone has a bad trip, with very little time to repair the damage? What if they die in a worsened psychological/spiritual state, with them and their family cursing you?

In terms of the mystical experience, again, what if we're wrong? What if, when undergoing a non-drug elicited mystical experience, we later compare it to a drug-induced state? Was it a flashback? Was it real? The certainty that otherwise would be ours might be subjected to doubts that otherwise would never have arisen. On a more subtle level, there is the "stealing" aspect of taking psychedelics, a reinforced, and reinforcing, sense of cynicism that we don't have "something," and that "taking" a drug will provide that something. We are feeding from the spiritual realms, what should be sought after in the other ones, such as physical, psychological, or emotional.

Maybe someone is lonely, and takes psychedelics to establish relationships with non-material beings or entities, or to experience an overwhelming sense of oneness or wholeness. It would make more sense, and be healthier, to have friends, or belong to a social group. Maybe someone is depressed, and takes psychedelics to experience euphoria. It might be more helpful to look at the relationships in their life, with people and ideals, that are dissatisfying. Otherwise, we could be using up capital from the wrong accounts.

There are the more wide-ranging dangers that involve issues of interdependence, or ecology, that involve our relationships with lower animals, particularly when it comes to biomedical research, and the development of new compounds. Look at the way data are derived from the basic, or animal, research. Animals are often given high doses of radioactive psychedelics, and then killed; they are decapitated, brains quickly removed and processed, then sliced and photographs taken to see where the drugs went. Or, the brains are removed before the drugs are given and a brain slurry is made to which radioactive drugs are added. Sometimes non-radioactive psychedelics are given, and other radioactive drugs are given to displace or otherwise affect the binding of the non-radioactive drugs. Other studies employ electrodes placed into a living animal's brain (or a barely living slice of brain kept in a solution of blood-like liquid) and psychedelics are given to see what the effects are on the electrical activity of particular nerve cells in the brain or slice. At a certain point, I had to decide to not involve our group in PET scan studies that would have involved injections of radioactivity while they were tripping.

Many of those engaged in this type of research are otherwise kind, gentle, and thoughtful people. However, there is a certain friction between what they are doing and what they wish are the results of their work. This tension affects all those involved with psychedelics, both those who give them and take them in this model.

There also are dangers in giving psychedelics. I don't think psychiatrists or psychologists generally are very good choices for those who give psychedelics. They often don't have the experience, sensitivity, nor training to support, contain, direct, and interpret many of the more unusual experiences that come up on high doses of psychedelics. Also, and this was something I had a very difficult time facing up to, even after years of therapy, analysis, and meditation, there are less than noble motivations driving the desire to give drugs. Unexamined sadistic, narcissistic, sexual, controlling, manipulative, needy impulses are readily activated when you give such powerful, debilitating, and dependency-producing drugs. I remember how we all laughed when one volunteer, a millionaire businessman, opened his eyes after his high dose of DMT and said, "This would be a great time to ask for a big donation."

Our research was subject to an incredible amount of checks and balances. I never gave high doses of DMT without a nurse or other assistant in the room. How much more prone to abuses are those who give drugs without peer review, regulatory boards, administrative oversight, and other moderating influences? There are also dangers in relying upon psychedelic research data. In the research environment, you always want something from someone: data. And, wanting something from someone in the research environment affects the psychedelic experience in negative ways. For example, if you don't get data when you expect it, you get greedy, angry, frustrated. You try harder to draw that blood sample, look at that dilated pupil, complete that rating scale. While I know this sounds a little naively idealistic or overdone, it is not trivial if you're a highly stoned research volunteer relating to a research team you want and need to place your well-being above all other considerations. Perhaps psychotherapy research might avoid some of these problems. And, the potential benefit of a new treatment for an untreatable condition might justify the stress put on volunteers. However, the quality of your data changes when you want things, and those data are then suspect when applied to a non-research setting. For example, the resentment and paranoia that might occur in a psychedelic psychotherapy research volunteer who can't, or won't, agree to a research intervention might have little to do with how a psychedelic psychotherapy patient might respond to the same drug at the same dose in an office setting, where no such expectations are in effect.

Trip: What kinds of unanswered questions are left open by your research? Do you have any plans to go back to it?

RS: My primary question: Is DMT a beneficial drug, in and of itself? was answered in the negative.

There are other clinically oriented questions that have come up with my and other people's research with psychedelics. These have to do with the best way to use psychedelics. From the medical model, one could ask what conditions would justify the high risk associated with DMT? What other treatments are available and how risky are they? What is the likelihood of DMT being effective versus how effective might alternative treatments be?

I don't feel a pull to get reinvolved with this research. The decision wasn't made completely until just a short while ago. The appeal is great, but I spent a month waking up every morning, imagining how it might feel to be going in to work giving DMT/LSD/psilocybin to someone that day. The feeling wasn't very good. I learned what I needed to learn. Anything more seems gratuitous. I opened the door to this research for our generation; let other people go through and take advantage of what I've set in place. If people think these drugs are so important to study, why don't they get themselves qualified and write the protocols, and do the research? It is now possible.

If drugs are to have any use at all (and this is by no means a given), they should be part of an overall life dedicated to self-knowledge and a more compassionate life. This partakes of the perennial question: Do drugs have spiritual/religious import?

In Brazil, I met and spent some time with members of the União de Vegetal, an ayahuasca-using church. Ayahuasca, as you know, is a combination of two plants, one of which contains DMT, and the other contains a compound that allows DMT to become orally active. Thus, it is a 3-5 hour, slow onset, slow offset, DMT experience. Their ceremonies were beautiful, moving, emotionally cleansing, and spiritually uplifting. The members were kind, the elders were powerful, wise, and inspiring. The ayahuasca was an integral part of their ceremonies. However, I don't believe the psychedelic brew informed the church. I think it was the other way around: the church fashioned the psychedelic experience. Or if you still want to believe that there is free-standing information that comes from DMT, and not from the person who takes it, I will put it another way. The church setting maximized the chances that one would selectively receive certain types of information "from" the DMT.

The tea powered and strengthened the processes that could have taken place without the tea; it was jet fuel, rather than weak coffee. Put weak coffee into a 747, and you stay on the ground; put in jet fuel, and away you go. The tea increased emotions, suggestibility, heightened thought processes, but the information, rules, teaching and ethics came from the people, not the drug. In the triad: drug, set and setting, the one that is least important, or most dispensable, is drug. The UDV church experience made this point even clearer to me.

How many of us really are willing to take the next step, and live a life fully informed and influenced by the psychedelic experience? Very few, and those who do generally stop taking psychedelics.

There are other unanswered questions that are more "fun" to think about, than "important." That is, where do the entities reside? What do they have to tell us, and how do we relate to them? Now, perhaps the more pressing unanswered question for me is: How do I tell this story in such a way as to not encourage people to take drugs?

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