Hard News by Russell Brown


Psychedelic Therapy: an expert discussion at Splore 2019

What follows is an edited transcript of the Splore 2019 panel discussion about psychedelic therapy, with Otago University researcher Geoff Noller, Will Evans, an advanced trainee in palliative care at Auckland District Health Board, who is part of a proposed LSD microdosing trial in Auckland and who wants to establish the country's first psychedelic therapy centre, and Amadeus Diamond, the founder of the Psychedelics New Zealand Facebook group.

This was the first session in this year's Listening Lounge talk programme and I was a little concerned that the crowd would arrive late. I was wrong. At 10.30am when we started, there were more than a hundred people waiting to listen, and more arrived as we began. I guess that's testament to the interest in the topic – which has undoubtedly grown since the publication of journalist Michael Pollan's fascinating book, How to Change Your Mind: The new science of psychedelics.

Amadeus, tell me about the Facebook group, and why you founded it. What's your personal history with this?

AMADEUS: Well it's a bit strange, because most people tend to think, you'd assume, that I had used psychedelics to improve my life. But at the time that wasn't actually true. So I am an ex heroin addict, an ex problem drinker, an ex depressive, all these sorts of things. But I was actually over them by the time I had found psychedelics. Once I found psychedelics and realised both the therapeutic potential and the sort of psycho-spiritual potential it became really obvious to me that, had I found them 10 years earlier, it would have saved me a whole lot of trouble, basically, and my family a whole lot of trouble and my friends a whole lot of trouble.

And so I spent a lot of time researching, reading books, reading papers, getting in touch with the right people, and it just became really obvious that this was one of the most important things that was happening in science and medicine. And that especially in a country like New Zealand where we have one of the highest youth suicide rates in the world, we have high rates of domestic violence, high rates of alcohol abuse, high rates of meth abuse, all these sorts of things, the applications of psychedelics were pretty much perfectly in line with things that we're trying to do here in terms of helping socially and culturally. So it just seemed like the right thing to do, and looked like it had enough interest as well. It's been going really really well ever since.

Who is the community? Do you have a feel for it?

A: It's actually really hard to tell. I mean, Terence McKenna, I hope a lot of people know who that is, one of the things that he has said is that one of the successes of the psychedelic community is that you can't tell who they are. You couldn't really pick somebody out of the crowd and assume whether or not they understood at least the psycho-spiritual aspects behind psychedelics.

What I'm quite struck by is the interchange between you and people like Will and Suresh Muthukumaraswamy at Auckland University, the School of Medicine. How long has that been going on, you crazy freelance people talking to actual doctors?

A: I'm not throwing shade on Suresh here, he's an absolutely wonderful guy, consummate researcher, everything else,. But I think when he first reached out he was actually probably looking at more a portal for funding as anything else. We had a couple of sit-downs, in April-May last year, and he said look, we're looking at doing some research at the uni, we're going to need some funding for it. It's notoriously difficult to get any sort of official grants or government funding for this sort of work. Even if you know exactly what you're doing and your protocol's good and everything, it's just a bit scary. 

I think he sort of realised that I knew a bit more than he expected, and so since then I've helped out a little bit looking at what's called the "gray literature", which is literature that's not published by scientists necessarily – or if it is, it's not published in journals necessarily, and it's not really admissible when you're looking at putting together an actual protocol. So I had nothing to lose, because I'm not a scientist, I'm not a professor or anything, so I was able to go and look at that research, bring it to the table, given them some information that they couldn't necessarily have got through other means.

Geoff, I wonder whether – because this was a factor in the observational study you did on ibogaine treatment – these things tend to be driven by motivated laypeople. Like Amadeus, like Tanea Patterson who was the treatment provider for your study. Has that been your experience?

GEOFF: Kia ora tatou, thank you everybody for turning up, this is fantastic, and Splore as well, brilliant. You're absolutely right Russell, say with ibogaine,  it was 'do we have people who know a little bit about ibogaine? One or two, awesome.'

Explain ibogaine, quickly.

G: So ibogaine is a plant-based – you can call it a medicine or a substance – from West Africa. It's got 12 alkaloids in it, some of which are psychoactive, with ibogaine being the principal one. It's used in rituals in West Africa, but in the 1960s, a New York heroin addict by the name of Howard Lotsov, a friend of his gave him some ibogaine, and said, 'Oh try this and tell me what you think about it.'

It's a powerful psychotropic drug. It's what's called an oneiric. So it produces a kind of dream-like state. It's not the same as LSD or psilocybin – your eyes are closed and it's a really full-on experience. So he had this, and not long after that, 36 hours later, because it was a pretty full-on experience, he realised, I don't want to take heroin any more. So what seems to be the case is a single dose can be effective in stopping people using opioid drugs.  A one-off treatment, this is crazy!

And it also completely nukes the withdrawals. That's one of the big things. You don't get any withdrawals, they just stop. And so it developed a tradition of being used, sort of with these online people doing treatments, and there was a young woman in New Zealand by the name of Tanea Patterson who had a treatment, probably about 11 or so years ago now.

I had this sort of thing at Otago called Drugs and Society, a series of talks where we explored drug use from an anthropological perspective, and Tanea came along to that and said, 'Hey, have you heard about ibogaine?' I knew a little bit about it, and we caught up also with another guy I knew who was in the Ministry of Health at the time, and he said, It's just been made available on prescription in New Zealand.

So that was in 2010.

G: There are three places in the world where ibogaine is available on prescription – Brazil, South Africa, and New Zealand. So we set this study up, it was an observational study, so basically people were being treated, and Tanea was doing treatments and then a colleague of hers joined her later on, and we followed it through. It was driven by Tanea though, she was just brilliant.

And we followed 14 people who were treated, and at the end of that 12-month period, half of them were opioid-free, and they were all dependent on opioids when they started. Eleven out of the 14 were on methadone, which on the one had can be really helpful to stabilise people if they're using opioid drugs and they're in a difficult situation, but on the other hand, bloody hard to get off. So half of these people were opioid-free at the end of 12 months, which is an incredible thing.

Having said that, the downside with ibogaine is it can kill you. Yeah, I know, that's a bit of a downside. It's unlike the other psychedelics like LSD – no one's ever going to die from taking too much LSD. You can take too much LSD and crazy things happen, but you're not actually going to die. You can jump out of  a window, but it's actually the fall that's going to kill you, it's not going to be the LSD. It has an interaction with the heart, and this was actually just a poorly-done treatment, even though that treatment was done by a medical person, 

This is the one ibogaine death in New Zealand.

G: Here are these laypeople doing really good work treating people, and they're having incredible outcomes. And yet a treatment's been done by a medical doctor, and they fuck it up. They just didn't do what they should have done, and this person died. When this happened, it was right in the middle of our study and I thought, fuck, this is the end of it. But all the medical people, and this is something that you'll appreciate, all the medical people said, well, there are these risks.

You go into any medical intervention and there's always going to be risks. You go into hospital to have an operation, as a friend of mine did recently, and it turned to custard and he only just managed to get out alive after about four months, so those risks are there.

It's really interesting. On the one hand, you're dealing with these full-on substances which for various reasons people can have these really strong reactions to, just psychologically 'Am I into this as an idea, do I think it's a terrible thing?' On the other hand, the medical community, potentially, is not necessarily going to throw its hands up in the air and go, no we can't do this any more.

Just before I talk to Will, we should explain who Suresh is, who I mentioned earlier. If you've read Michael Pollan's book, some of the key studies, the ones done by Robin Carhart-Harris, the brain imaging for those studies was done by Suresh Muthukumaraswamy who is now at at the Auckland School of Medicine. So we have that little hold on this emerging story. Will, you and Suresh, I think you've gone to ethics approval for a new trial? What is it about?

WILL: Just about to. So we've co-authored a study, along with a number of other researchers, psychiatrists, psychologists, pharmacists, all within various District Health Boards and Schools of Medicine, for a microdosing study using LSD. We're planning to start recruiting in June for a 60-person microdosing study. Just looking at the general effects, as an initial foray into a really, really big field of potential research.

The 60 initial volunteers may expand to hundreds on a population basis, just to get the data we need. The medical hypothesis is that we suspect microdosing, which is a sub-hallucinogenic dose of LSD or psilocybin, generally speaking one tenth of the active dose, taken every three days over a period of six weeks, will have positive changes in terms of personality, more openness – which is what they've found in previous psilocybin studies – but also increased creativity, productivity, and just a general sense of wellbeing. So we're going to be measuring all of those.

And I get the feeling that if you get good results, this is probably going to be an easier sell to health authorities – giving people a subperceptual dose on a therapeutic basis, rather than a great big hundred microgram whack that sends them on a trip.

W: Just to give it a bit of background, in 2016, November 2016, they published, the Journal of Psychopharmacology, published two concurrent randomised trials, one out of Johns Hopkins University, one out of NYU, both with sample sizes about 30-50 patients, showing that after a single dose of magic mushrooms in a population of palliative care patients or patients with advanced incurable cancer, who were suffering depression and anxiety, essentially 80% of them were cured of their depression and anxiety for six months. From one dose.

Were these in general people who were naive psychedelics users?

W: Generally speaking.

How does that change things? Are those people with past experience with psychedelics welcomed into trials, or are they considered unsuitable?

W: Certainly in those trials I think maybe half of them had experience in the past with them. And there were certain exclusion criteria, just as we have fairly strict inclusion/exclusion criteria for our volunteer study. And I think previous use is not an exclusion criteria. I think we say something like, 'Hasn't taken a psychedelic in the last three months or six months.' So you guys [to crowd] have time, just hold off for a few months and then enrol in our study.

To demystify some of the fears around ibogaine as well that you were speaking to, Geoff, it's a very safe drug from my understanding. Like any medication, there will be side-effects. If you screen for risk factors, which is a very easy thing to do, then the risk of a poor outcome is diminishingly low. And that needs to be really emphasised. With all the psychedelics, the truly exciting thing is that not only do you get an effect – there are plenty of drugs that give effect – but the side-effect profile is just so profoundly low with psychedelics. They may have catastrophic effects in terms of mind, but in terms of physiology there's almost no death recorded.

A: Even then it's probably worth pointing out that in pretty much every study, and I think Jeff this is probably the case in the study you observed, is that, even in cases where somebody doesn't necessarily achieve the expected benefit in terms of maybe reducing their place on a PTSD scale, or their addiction level, I don't think anyone reports any actually clinically adverse reactions.

W: 2000 doses given in clinical, this is for psilocybin, over 2000 doses given in clinical settings, without a single adverse event recorded. So that speaks for itself. There isn't an SSRI or psychotropic drug that has even close to that. And I think that has the pharmaceutical companies worried to some extent.

I have to say while we're talking about the safety profile, I spoke to Suresh last year, and he was at pains to emphasise that if you do have mental health issues or depression, something similar, don't just freelance and take a whole load of LSD in the belief that it will fix you. There are risks in that, aren't there?

W: Yeah, set and setting is a tried and true phrase that is used, and that speaks to the environment that you're in, and your own personal inventory and personal psychological state. And I think having a bit of support around that is important. A place like this is actually very beautifully supported and this is all psychedelic therapy as far as I can tell, but without a clinical oversight.

Do you agree with that, Amadeus? Because the setting is here for us, it could be considered therapeutic here? What is the gulf between recreational and therapeutic use?

A: Well I think it's probably a lot smaller than a lot of people imagine, I mean the same therapeutic effects that someone is feeling if they have, say, chronic depression, and they're trying to rise out of that, the same subjective effects tend to happen in healthy populations.

It's just that you're sort of rising from the middle to higher, or maybe moving out laterally rather than rising up, because if you're not specifically having a bad time regulating your emotions, that's not something that it necessarily has to effect, but it might affect creativity, openness, tolerance, conscientiousness, all these sorts of things, and they're definitely parameters that get looked at in the science,.

But they're also quite obviously affected in ceremony and when people come to festivals like this, and in private settings as well. As long as people, as Will and yourself pointed out, if you've done your reading, your set and setting is sound, and you know what you're doing, there's not a huge amount of difference. But obviously in a clinical population where you have something like depression, or an addiction syndrome, or anything of that kind, you need to be a lot more careful, because the person's neurophysiology is going to be on a lot finer of a line. 

G: I'd almost like to take that a bit further actually, Amadeus. If you're thinking about a clinical setting, and you're thinking about the kind of work that Will is doing, your colleagues are doing, that's a very focused approach to engaging with people through their use of these substances.

But if you take it back to the other extent, and you say you've come to a festival like this and you've brought your little treats with you and so on. It's that notion of how – and this for me as an anthropologist, is one of the things that's of interest – our everyday life that we just take for granted, is made up of all of our thoughts and our conversations and as human beings we're constantly putting our meaning onto our world to make sense of it.

Even within our own friend circle or our families, work, everything like that, than can get a little bit out of kilter, and just personally, if I come to an event like this, and you take these substances, and your sense of self changes. It expands out.

And you find yourself maybe moving away from some of the neuroses or anxieties or just these thoughts that have been in the back of your brain through the last few weeks or months or whatever, and then you find yourself talking to people, you're staggering down the Goat Track at 3 am trying not to fall over and you're smiling and you're talking to strangers and it's not like a big deal, there's nothing weird going on.

There's a sense of community that's generated out of that, that's actually a very therapeutic process. Ultimately I would suggest that, the research for example, Will, that you're doing, that whole process around that psychotherapy stuff is actually about integrating people back into their community. And you folks are doing this, when you come here and you're engaging and you're just having this experience. 

I think that's really interesting.

G: For me it's a spectrum of therapy, or therapeutic action, where you've got the kind of everyday therapeutic action that's just for us as people, and then you extend that through to people who are genuinely struggling, and you have to have people who've got very specific skills.

One other thing we need to get onto: we know, partly through Suresh's work, what happens to the brain on psychedelics. The default mode network, which is the part that we run our lives with, gets quietened down, and a whole lot of unusual brain activity begins. Parts of the brain that don't usually talk start talking to each other. But where does the therapeutic value lie? Is it something biomechanical, or is it in the psychedelic experience? Do we know?

W: That's part of the question, really, that we're trying to answer with this work. One interesting data point from the Hopkins NYU data that came out was that the therapeutic effect, so six months of sustained decrease in depression and anxiety, they stopped following up, so they don't  know how long that was carried out to, but those outcomes were correlated with degree of mystical and, I guess, altered state of consciousness experience. 

So they measured it – you can measure an altered state of consciousness quite quantitively using all sorts of questionnaires and scales – and the people who had those moments described it as oceanic boundlessness, ego dissolution, and mystical experiences.

I mean, I think ego dissolution is not necessarily a comfortable or pleasant experience, and I think that's what it speaks to, you almost die a death of sorts. My hypothesis, and I think this is shared by a lot of people, is that to some extent psychedelics catalyse you to confront your mortality. Coming from a palliative care background I see that constantly, when people are faced with their mortality they can go either way, they can deal with all of the darkness and get through the fear and transcend and come out the other side and have a good death.

And that's where it's really shown some results, end of life care, because people grieve for their lives and are incredibly anxious about dying often. There seems to have been real therapeutic benefit here.

W: It's almost like a simulation in a way, and then you come out and say, Okay, it wasn't that bad. 

A: I think it's also interesting to note, sort of as a dovetail to that, that that's actually how these things are used traditionally as well. The idea behind it is that shamans and ritual functionaries, to put a catch-all term on it, use these substances to travel beyond what they consider the physical veil, so they've gone beyond death and come back, and they're able to bring back certain information and certain confidences and attitudes and philosophies that come along with that. And it seems to be backed up by science – this is the same sort of effect that's coming out of the actual clinical data as well. 

Although, it is interesting because there are in the community, I think you'd know, some people who want to import the whole ethnic experience, whether that's authentic or not. The story I wrote last year included a businessman in his 60s who had an ayahuasca experience, and it was wonderful for him. And it was also quite different from the one that former Waitakere mayor Bob Harvey wrote about around the same time, where they had a shaman flown in and everyone saw a big black snake and it wasn't actually entirely pleasant. And it maybe wasn't as beneficial as a more rational setting along with some nice hippies in Amsterdam.

G: It's very interesting, this whole business of having that experience, and the drug that perhaps many people may be familiar with in this regard is ketamine, and this idea of going through the k-hole. I don't know who else has gone through the k-hole. I've gone through it on one occasion, it was the most terrifying experience.

But the thing was, and this is the point, and this comes back to the palliative care thing. A colleague of mine, Paul Glue, he's the head of the psych-med department down in Dunedin at the med school down there. They've done some studies with ketamine, which is very effective in terms of reducing chronic depression, and when they were setting that study up, they wanted to speak to a few people who had had this experience and who knew people within that, but also within a research context, and so it was a case of getting the right dose.

Because there is actually real therapeutic traction to having this really confronting experience where you actually, I don't know, have many people had that experience? The thing is, you actually, you're horrified at what's happening, and then you realise you don't have control over it, and then you let go. And that stays with you. And if you are a person who is in a terrible situation with a terminal illness – some of these people that Paul Glue is working with, these are young people, and it's this terrible thing that's happening to them, and their whole life's ahead of them and then it's gone. Having that experience and letting go, you have to learn to let go, and that's actually a really significant thing. So it's not, 'this is really nice and look at those colours', this is 'Oh my god!', then you pass through this thing. And that's actually very therapeutically powerful.

Will, this is effectively the kind of service you would hope to be providing at Mana, if you're able to?

W: Yeah, sure. So my wife and I have started an organisation, and we have a base in Parnell where we want to do mind-body integration, and use that as a platform to have either psychedelic experiences with clinical oversight, or at the very least the integration, because I think that's a huge part of it. You can have the experience, and almost, confront your death and come out and let go, but then you go back to your nine to five job and start drinking coffee and start smoking cigarettes because you're still stressed with the mortgage. There is an integration of that experience into your life for transformation and for change. It would be great to produce an environment that could speak to that. 

G: I absolutely agree, and certainly we've seen this with ibogaine too, is that there's a window of opportunity post that experience where if you have people with the appropriate therapeutic and clinical skills, who can then integrate for you the meaningfulness of your experience, that's actually a crucial thing, and it's all well and good to have the experience, but you've actually go to do something with it.

A: That just speaks to what you were saying before about the spectrum as well,. Because you think about what happened in the 60s and it was all down the one end of not much oversight. There was pretty much no clinical data – there was, but it wasn't really publicised

It wasn't robust.

A: And the substances weren't particularly well-regulated or anything like that. So you had a situation where a lot of people were being broken apart, and not being able to come back and not being able to integrate it. So it speaks to the spectrum, that you have to find somewhere along there that you're comfortable with, where you're able to have the experience, and have the confronting experience, and have the difficult thing, and deal with your demons, but then also have that space. For some people, clinical's going to be better, for some people, talking with their friends is going to be good.

This is a really important point. We've been talking about people who need help, who have anxiety or grief – but would you also conceive of settings where 'healthy normals' could go and have a fulfilling trip? How would you structure that, how would you regulate that?

A: I think initially, probably, unfortunately, we would have to keep ibogaine off that for the time being, simply because it does have a death rate. So I think if we're looking at policy change, we have to look at something like psilocybin, LSD, that has absolutely no death rate, very small side effects.

You might come back and prove me wrong on this, but what it looks like to me, once you have something like that that you can screen, and as Will said, over 2000 doses, no clinically adverse reactions, there's absolutely no reason why once you've got the data, that you can't put this into practice with healthy volunteers.

And if you have something you want to learn in your life, you have something you want to explore, people are already flocking to the Amazon, flocking to Amsterdam, flocking to Mexico, Brazil, places like that, to have the same experience, so why can't we just do it at home? Remove the middle man, remove the danger, regulate it properly and help as many people as we can.

G: I absolutely agree, but I do feel that ibogaine's still on the menu. For a start, it's actually prescribable in New Zealand. So it's the only one that is, for a start, so that's there. I think one of the things that we've learned with the research that we've done, and it's still ongoing, is it's all about dosage.

If you're talking about drugs, and you're talking about medicine, it's all about dose, and it's about learning that dose, and with the death rate, it's an absolute clear dose-response situation, there's no question about that. And recently I think there's been an awareness of that, and in fact people are, and have done for quite a while, using ibogaine to have these what they call psychosocial experiences. I know that's a big thing with ayahuasca and I suspect with LSD as well, so it's that spectrum thing.

The rate of use of antidepressants in New Zealand is massive. It's about 15% nationally, which is insane. And a lot of it is this kind of generalised anxiety, and I think a lot of these drugs work really well with engaging with anxiety. I don't know what  your thoughts about that are, Will?

W: I think with anxiety, the data is mixed, certainly on microdosing. Microdosing seems to be effective for depression, just from preliminary epidemiology. But anxiety I think in the long term you get decreases in anxiety but in the short term you get potentially increases and flares.

But I guess, to answer one of the questions earlier on from you, Russell, whether it is the qualitative experience or whether there is a neurophysiological phenomenon, we've talked about this question back and forth constantly, obviously it's going to be both. There are biological markers that change after a psychedelic experience – your brain networks are reconfigured, it's kind of a reset button type phenomenon in many ways. But that itself is experiential in nature. So Roland Griffiths, who's one of the key researchers in this field, said that mindfulness is the tried and true way, but psilocybin is the crash course. So that's kind of the way to think about it, and I think there is a place to talk about psychedelics not just as a drug phenomenon, but just as an experiential mind-state phenomenon. So it's not just about taking the crash course every time. It's building in practices, integration.

A: Something we've not mentioned is MDMA. MDMA actually appears to be incredibly effective for anxiety. Incredibly effective for PTSD. There are success rates of over 80% in some of the studies that have been done. They're now on to phase 3 trials in the US, the chances are it'll probably be a prescribable medicine within about 2 or 3 years, given that the trials go as well as they have been trending. We didn't mention MDMA much, but it actually seems to be pretty much at the frontier of the policy side of things, in terms of integrating it fully into a medical practice. So I just wanted to bring that up.

J: I should have mentioned that. So there are two concurrent trials happening in New Zealand at the moment, both planned to start this year. One is a collaboration with the Otago School of Medicine and Auckland University, and it's going to be using MDMA for end-of-life related anxiety and depression in palliative care. And then we have the microdosing study. So it's going to be a very interesting year ahead.

Now Amadeus, I really want to get on to your announcement, because this is kind of interesting. We have a Splore exclusive announcement ...

A: So pretty much since the release of Michael Pollan's book last year, the psychedelic scene, whatever you want to call it, has really just accelerated and taken off. I've been running the page for a number of years and it's gone up and down, we've had some fun times, but nothing's really happened. But in the last 12 months it's been absolutely phenomenal. The response from academics, from the media, from all sorts of places.

So we decided late last year, that we would start a foundation to continue funding research in New Zealand. And that has, just in the last 72 hours, expanded to a point where we have seven-figure amounts of money [from people] interested in getting this thing going. We'll be looking at doing harm reduction, education, events, speaking events, screenings of films. Things like this, conversations like this all the time. Policy outreach, all this sort of thing. 

Within 12 months it looks like we'll have an organisation together – probably the three of us on stage will all be involved I imagine –where we'll keep funding this research, keep getting the policy information out, and educating, helping everyone get this to a point where we can actually start helping the thousands of people that we should be helping.

And if people want to stay up with any news on that in the interim, Psychedelics New Zealand on Facebook.

A: It should turn up pretty quickly, follow along [applause]. Thank you very much.

We're nearly out of time, but do you have one more thing?

A: I was just going to say, I'm going to be around for the rest of the weekend if anyone wants to speak to me, come up and talk to me, I don't bite or anything.

Just not while he's dancing. Okay we've got about five more minutes. I'm interested that you said you thought that MDMA would be approved for end-of- life use in two to three years. What sort of time frames, at a guess, all of you, are we looking at for these to become approved therapies? It seems it's closer than most people think.

G: Well okay, so we've got ibogaine on the books already. And there's obviously this clinically accepted work with ketamine and LSD and MDMA. And I'm normally a glass half full kind of guy, but for something that we could just say, 'yep, you need that', I'm picking 10 years. I don't want to be a negative Nancy about it, but it's a conservative environment that we're working in.

A: That's absolutely right. When I mentioned MDMA, I do mean in the US, where they're already onto phase 3 multi-site trials. That's something that, if we were at that point now I'd say sure, but in New Zealand we're not anywhere there that sort of point at the moment. We might be able to get it prescribable at some stage soon, in the next five years maybe, but to the point that we're talking about I'd say 10 years is probably realistic. 

W: Ten years does feel outrageous, really.

A: Ethically it does.

W: Every year that goes by where these things are still, you can go to jail for treating yourself appropriately, is ridiculous. I think if we get this foundation really well backed with a lot of funders – so a call-out for anyone who knows someone who's super-rich who wants to change the world

A: Any money they want to throw at us

W: Contact Amadeus through Facebook. Realistically, if we lobby our government appropriately, we've got enough rational minds behind it, enough professors and departments to push the agenda, and to make the changes, just as they've done with ibogaine. So I think a positive mindset going forward is going to be the best way. But, five years.

I should mention that there's one interesting bit of news that we haven't mentioned, and that's that out in West Auckland, just by Lincoln Rd, Douglas Pharmaceuticals are into phase 2 of trials of ketamine for treatment-resistant depression. The problem with using ketamine has been that you give people some ketamine and they're great for a month. And then the reset wears off and they're back where they were. Douglas is trialling a slow-release formulation that they think will work. So that's going to be pretty interesting. That could be the first of these things that we see after ibogaine, given that it's already a medicine.

Anyway, thank you for coming in such numbers, and these guys, Geoff's staying with us on stage, but these guys will be around, ask them anything you want, and please thank them.


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