Truffle Report Talks with Novamind’s Chief Medical Officer About Building Psychedelic Infrastructure and the Change it can Create
Medicalized psychedelics are slowly moving out of their infancy. As laws begin to change, research is being done and private companies are expanding their range of treatment options. Dr. Reid Robison, Chief Medical Officer of Novamind, is at the centre of many of these advances. Under his belt are years of experience studying and administering ketamine from the University of Utah to his current work at Cedar Psychiatry’s Springville Clinic.
“I’m a psychiatrist focused on the therapeutic use of psychedelics and the therapy that goes with it,” he tells Truffle. “From the beginning of my career I’ve focused on helping patients with mental health conditions who have been failed by traditional treatments. Finding new treatments, studying them, helping people access them. I started my career in academia, on a tenure track at the University of Utah doing clinical trials. I think it was in 2011 that I did my first ketamine study. The literature was particularly interesting to me. I was in a good position to give ketamine, to study it and develop protocols. In recent years that’s expanded to really focus on psychedelic medicines including ketamine and Spravato. I’m also working with MAPS on their eating disorder study that’s starting soon, and working with ayahuasca internationally in jurisdictions where we can.”
Robison on a “New Chapter of Interventional Psychedelic Medicine”
Going by what I’d been able to glean from Novamind’s website, I wanted to understand how Robison’s expertise informed their overall strategy of building psychedelic infrastructure. “The way I look at that is that these tools can be effective and even life-saving in certain conditions. The challenge is opening up access to the individuals who need it. Novamind is building clinics, therapeutic retreats, and research sites to help bring psychedelic medicine into everyday healthcare. We have four full service mental health clinics across Utah and more on the horizon in various stages. We’ll be moving outside of Utah and beyond, but where I am now treats individuals and families with both traditional methods and new treatment modalities as they become available. We’ve guided and held space for over 5,000 ketamine journeys. When Spravato was approved by the FDA in the spring of 2019, we made the decision to adopt it. This is the first insurance-funded psychedelic medicine. We jumped in, but there were challenges. The billing codes didn’t exist yet, it was a heavy lift administratively. It’s just a new chapter of interventional psychedelic medicine. We’ve given over 2000 doses since then. Compare that to the next highest clinic in Utah by volume, which has maybe given a dozen or two. We’ve seen over fifteen thousand people in the state last year.”
Novamind Retreats and Partners: How Does it all Fit Together?
Having read up on Novamind’s partners and collaborators, I asked if it was fair to characterize their current therapeutic options at Synthesis in Amsterdam and Circadia in Costa Rica as luxuries rather than immediate medical interventions.
“I’d put it somewhere between those. Especially since Covid, it’s hard to fly anywhere. The retreats aren’t designed to be emergency interventions. Hopefully one day, before too long, we’ll be able to give psilocybin to someone who’s in crisis the way we can now with Spravato for suicidality. The way I see retreats fitting into the ecosystem are as options for individuals in need of healing and growth in jurisdictions where these tools can be given. We can do the screening and preparation here, send them to a retreat, then receive them back and do the integration. One of the care delivery models I’m excited about in the year ahead is a hybrid clinic/retreat model. We’ll have people fly in for ketamine-assisted psychotherapy for a serious condition. For example, the last group was parents and an adult child with a serious eating disorder. They were here for a week, we did two or three ketamine sessions, a bunch of therapy, and structured it with retreat modalities like nature yoga and group work. Then they went back to their team at home and we collaborated from there with groups and family work from out of state.”
“A Challenging Year for Our Collective Mental Health”
Novamind went public at the beginning of January of this year. I asked Robison more about the pace of work required to build the company, and the urgency surrounding mental health in the current global pandemic.
“Covid made it a challenging year for our collective mental health, and made the work we do at Novamind more urgent. For a number of reasons, there’s never been a better time to be in psychiatry and mental health, at the dawn of this new era as new compounds are coming down the pipeline. We’re working on the infrastructure now. We do in-office psychedelic sessions with therapy on a daily basis with these existing compounds such as ketamine and Spravato. When MDMA is approved, when psilocybin is approved, we already have the prescribers, the therapy teams and the facilities in place to deliver these. We can also refer them to clinical trials in the meantime as an additional treatment option through Cedar Clinical Research.”
It’s about here that I mentioned my own mixed feelings about the timing of the psychedelic renaissance. Like many others, I found myself suddenly unemployed in March of 2020. This opportunity fascinated me, and despite the changes and challenges of the past year I’ve become genuinely excited for what the future holds in this new field. “Awareness is half the battle in terms of advancing this work,” Robison agrees. “Look at the overscheduling,” he says, in reference to the classification of psychedelics as Schedule I substances under the Controlled Substances Act. “Look at the paradigm shift that is happening today. I’ve been pleasantly surprised at how well this is being adopted by the community and clinicians alike. To me, this shows how strong the need is for tools for supporting people in their mental health journeys.”
It was an interesting turn. I wanted to know about Robison’s work to have ketamine adopted by patients and fellow doctors. Had it been a battle for acceptance?
Robison on “A Huge Global Burden of What Depression Brings”
“Less of a battle than I thought it would be. I did my first ketamine study in 2011. It was an IV ketamine study along the path of Spravato drug development. Recruiting for that study on ketamine for treatment-resistant depression was one of the easiest recruitment processes in terms of getting participants from individuals and referring clinicians. This is a condition where a third of patients still have symptoms after three or more courses of antidepressants. There is a lot of suffering, a huge global burden of what depression brings that I think was reflected in the open arms toward this in the medical space and mental health where traditional treatments have failed.”
“Stories of Hope and Healing”
It’s not news to us here at Truffle Report. The inefficacy of conventional treatments for Major Depressive Disorder and the potential for psychedelic treatments is a drum we beat often and loudly. In that vein, our conversation drifted to our shared admiration for psychedelic therapy pioneers TheraPsil, and Truffle’s previous coverage of their patients. “It’s one big thing that’s come from this work for me personally,” Robison says. “I’m always touched by the stories of hope and healing that come from witnessing the psychedelic modalities in action. There’s a pressing need. I’m remembering early last year, I was in this office seeing a client for anxiety. He was in hospice care with cancer, and had come with his wife, shaking. He didn’t know what had hit him when this surprising wave of anxiety had come on, and I was convinced that it was related to end-of-life distress. I was treating him with ketamine as best I could. I started looking for ways to access psilocybin for compassionate use, but during the process he passed away, before I could get him that medicine. It screams at me the urgency of banding together and greasing the wheels of this system so we can help the people who need it most.”
Wrapping up, Robison shares on final reminiscence. “I met my colleagues at Novamind at the MAPS conference in 2019. I remember Marcela Ot’alora, a MAPS therapist and trainer, and Tim Ferris having a conversation. She said something like ‘you can only help people’s suffering if you aren’t afraid of your own.’ I like to remind clinicians I train that we can only go as deep as we’ve gone ourselves. As we’re chatting here and you’re asking about the reception of clinicians toward depression, I started remembering back in the early days. I used to get asked questions like: ‘Why in the world are you giving ketamine for depression?’ So many people would say it was just an anaesthetic or a club drug, this or that. At the time I remember saying ‘how can I not give it, when there is strong evidence to support it, and when people are suffering?’ There’s an urgency to build the infrastructure and work on accessibility to help address this unmet need.”