Early MDMA Therapy, The Heffter Research Institute, and the Need for Psychedelic Therapists
Dr. George Greer is, in my opinion, the best kind of interview subject: knowledgeable, good-humoured, and not shy about expressing different views in both a personal and professional capacity. Recently, I had the privilege of speaking with this forty-year veteran of psychedelic research about his role as board chair and co-founder of the Heffter Research Institute, and his views on the evolving psychedelic space. In the process, I learned a bit more about the history of psychedelic research, and the early years of MDMA therapy, as well as getting Dr. Greer’s personal take on just what will have to happen for psychedelics to live up to their medical and therapeutic potential. It was an eye-opener.
“My interest in psychedelics started in college,” he tells me, “then in medical school, I learned about Stan(islav) Grof doing therapy with LSD. That would have been about 1973. I knew about Tim Leary, and young people having experiences, but I’d never heard about it for therapy. I was going into psychiatry, then, fortunately, just this fortuitous thing, a friend told me Stan Grof was doing a six-week workshop at Esalen Institute about LSD therapy, shamanism, all sorts of things. I went to that during med school, and that was amazing, that really got me interested as a professional activity. When I finished med school in ’76, Stan introduced me to Ralph Metzner, who suggested I offer people ketamine. It was a legal drug, and has psychedelic effects, so I started doing that with a peer review committee of physicians and informed consent.”
It was then that friend, colleague, and fellow psychedelic notable Leo Zeff introduced the young Dr. Greer to MDMA therapy. “Leo was giving it. Leo had been my roommate actually, about five years before at Esalen. In 1980, I got introduced to MDMA. Back then, I found out that as a doctor, that if I made it myself, then I could legally give it to my patients with informed consent. So, I did. Sasha (Alexander) Shulgin and I made a batch of MDMA that I used for five years.”
Excuse me while I exhibit my millennial bias for a moment. It was at this point, listening to the friendly and pleasant older gentleman on the other end of my screen casually discussing his friends collaborating on a batch of MDMA this way, that I felt a bit displaced in time. I had to remind myself that Drugs (with the capital D) as we see them now, are not always seen so when discovered, and that most psychedelics were not immediately banned. Dr. Greer, thankfully, did not notice or chose not to comment on the widening of my eyes, and kept right on speaking. We got onto the subject of his early work with MDMA, and just how far psychedelic research has come.
1980s MDMA Therapy on the Worried Well
“My wife, who’s a psychiatric nurse, and I gave MDMA to about seventy-five or eighty people, call it around one hundred sessions in total.” He clarifies that his patients at the time “were all what you might call the ‘worried well.’ No serious mental problems, no PTSD, no major depressive disorder. Everyone had some good experiences, and felt they got some benefits. The couples felt their intimate communication improved, even well after the session, and they learned to communicate in a more direct way. But there were no serious problems. A few minor panic attacks,” he admits.
“In 1980, it was kind of the darkest of dark ages for psychedelic research, because almost nothing was happening. When MDMA came along, it woke everybody up. We could do it legally in the open, people had good experiences. There was some criticism. I started in San Francisco, then moved to Sante Fe. In 1985, it hit the media. The first story came out in Newsweek. People magazine sent someone out, he was with us for a couple of days and we had a great time. Then he went back to his editor. The editor asks, ‘where’s the negative half?’ The reporter says ‘there isn’t one. This is it.’ Apparently, the editor said there had to be a negative half and the reporter refused to publish the story. MDMA was eventually Scheduled in 1985, and we knew it would happen. There was this positive mood and this clarity. We knew people would like it, it’s simple to make. It was inevitable that it was going to become a street drug.”
Recreational MDMA Use and the Character of Psychedelic Therapy
“Stuff started getting out about recreational use. News about serotonin nerve-damage in rats was on the airwaves. It was a hard time. One of the members of the local psychiatric society filed a complaint against me for one, promising it cured people, and two, making it in my garage. Neither of those allegations was true at all,” Dr. Greer tells me.
“Around 1983 a psychiatrist professor friend of mine sent a review of LSD to the American Journal of Psychiatry. The letter got back saying that they didn’t think “a journal of the American Psychiatric Association could be associated with positive statements about LSD.” Contrast that with this past year, the current editor of the American Journal of Psychiatry was the co-author on a positive review paper of all the treatment research into psilocybin for depression with a dozen other authors. They published it as the cover story. It’s an amazing contrast.”
It was at about this point that I stopped to thank Dr. Greer for sharing these parts of his story. Despite Truffle Report’s attempts at due diligence in researching psychedelic history, much of this was news to me. I mentioned our efforts, and the talk wandered for a moment onto the topic of psychedelic pioneers past when I brought up Alfred Hubbard. “Al Hubbard was the teacher of my teacher, Leo Zeff,” Dr. Greer tells me, “and I think they had a lot in common. They had their own personal styles, which I relate to, with music, a more informal approach, humour…the feel of that, the personality and approach, it’s important to the therapy, to how the sessions get done.”
Dr. Greer on the Early Years of the Heffter Research Institute
“In the early ’90s, Dave Nichols founded Heffter with me and a few other people. I’ve been the secretary, medical director, and basically run the institute’s operations since our founding in 1993” Dr. Greer tells me.
“We’re a research institute,” he says “an independent organization that performs scientific review on all the projects we fund. We get at least three anonymous experts, some in psychedelics, some experts in PTSD or OCD, or what have you who know their field. They’re the audience for our research, and we want that research to be as strong as possible. We review all of them, our investigators tweak their proposals, we approve them, and then we’ll raise the money and fund the research at the universities. We’re not involved in any for-profit work, but I’ve done informal consultations with people. We’ll have conversations, but we’re not directly involved.”
“One of the first things we funded was heroin addiction research with ketamine in Russia. Then there was a psychiatric safety study with the Native American Church on the use of peyote. That went well; they were all fine. Some early MDMA mechanism research in Switzerland as well. It was around the late nineties that Charlie (Charles) Grob–who had done the first (U.S. Food and Drug Administration) study of MDMA just in normal people, a safety study, wanted to try that on terminally ill people, but thought MDMA can be a bit rough on the heart, and psilocybin was probably safer. So, in 2000, we started planning that at (the) Harbor-UCLA (Medical Center). It took forever to get done. We treated twelve people and some of them made videos, which are posted on the video page of our website. It was hard to recruit people, but once they saw the videos it helped them get over the anxiety a bit.
Current Research Work at Heffter
“After that, I guess it would have been about 2007 to 2016 was when NYU and Johns Hopkins worked on their psilocybin projects for emotional distress in cancer patients. They had about eighty people I think, and found just amazing results. It was astounding to us, too, and it led to the Usona Institute founding and instituting Phase-III work to get psilocybin approved for medical use by FDA. That was a pretty big milestone for us, to get that cancer research done, to lead into a drug approval phase,” Dr. Greer explains.
“Right now, most of our studies are about addiction treatment. Smoking at Johns Hopkins, alcohol at NYU, cocaine at the University of Alabama, now two studies of psilocybin treatment of opioid addiction at the University of Wisconsin and on at the British Columbia Centre for Substance Abuse, which will be studying the treatment of polysubstance abuse. A lot of the deaths in Vancouver being associated with opioids are not just from opioids. They’re from opioids, meth, and alcohol used together, so that’s their public health need; plus the health minister of Canada asked them to do some research on this population. Finally, at Hopkins, we’re funding research into LSD treatment of people with chronic back pain who abuse their opiates. That’s in the planning stages.”
“That’s seven addiction studies we have in various stages. It’s exciting to me because addiction is such an enormous public health problem. My sense is people don’t even think about it. They’ve just kind of given up. I think psychedelics have shown the ability to produce lasting changes and improvements that no other treatment has shown in these small studies. The pilot studies of psilocybin for alcohol and smoking were done a few years ago, the placebo control studies will be out in the next year probably for both. In terms of treatment research, I think that’s going to be Heffter’s biggest contribution, because it has the potential to help so many people. There’s some other work in progress as well, a depression study in Zurich, and psilocybin in long-term meditators study at Hopkins that’s being written up now.”
“For the future, we’re looking at young investigators, young researchers getting started. There was a whole generation of lost momentum. It’s been an explosion of interest in recent years, with the media and recently all these for-profit companies. It used to be that everybody knew everybody who was doing this. In 2013, we hosted a lunch with all the psychedelic neuroscience researchers at the psychedelic science conference in Oakland. There were fifty there, and that was about all there were in the whole world.”
Dr. Greer on the Commercial Psychedelic Space
That explosion of momentum is a fitting motif. Up to this point, Dr. Greer hadn’t needed so much as a prompt from me. Moving on from his own background and the institute’s ongoing projects, we spoke a bit about the business aspect of psychedelics. To get us started, I mentioned Truffle Report’s previous coverage of ICPR 2020, and how that conference had spent considerable time on making sense of the mainstreaming of psychedelics, with some academic and journalistic speakers being vocally critical of the commercial space.
“Understand, I can’t really comment here on Heffter’s behalf. It’s just not what we do. For me personally, I know COMPASS Pathways was the first of the big ones. I don’t really claim to understand their economic model or the patent situation. I do know they have a good trainer and therapist, Bill Richards, but it was a difficult shift for us when they came into the US. Now it looks like it’s really a non-issue.”
“Most of the business people I’ve had contact with who are interested in this have had their own personal experiences that were extremely helpful to them, either with diagnosed conditions, drug problems, personal transformation, or family issues. My take is that these business people are doing what they can do to get this medicine out to people. Researchers generally know little about business, and vice-versa. I feel like we’re getting to know each other this past year, and a lot of the researchers are now consulting. There are different models, and there are a few businesses that are actually donating to research, not out of expectation for patents or intellectual property, but just to build this infrastructure. To me, that’s very farsighted. It’ll help a lot of people.”
“Frankly, I’m a total amateur at business, I feel kind of naïve about business, but I think there are better, surer ways to make more money for less work than in psychedelics.”
The Need for Clinics and Therapists
Moving along, Dr. Greer theorized that business has an important role to play in building clinical infrastructure. “Clinics are the main thing I see that is going to be needed. Once these drugs are approved, there are going to be lots of therapists needed that have gone through special training. Usually, these people don’t have the money lying around to invest in buildings and businesses, I see that as a big role. I know some entrepreneurs are looking at patents on limited indications and new molecules, and who knows where that’ll go. Psilocybin, MDMA, LSD, you can’t patent the drug itself. It makes it challenging, but it’s good to see the activity.”
Building on Dr. Greer’s point, I asked what steps he thought were necessary for legitimizing psychedelic therapy, and what challenges might arise in bringing these substances forward. Again, he answered separately for Heffter and for himself. “Heffter is only involved in medical research and treating people with illnesses, that’s all done at universities, that’s all we do. We don’t study the harms related to psychedelics. We don’t fund that. The government funds plenty of that. So, Heffter can’t really comment on decriminalization initiatives. Legally, that’s what we have to do. My personal goal, which is way beyond my lifetime, would be that everyone on the planet has access to a psychedelic experience with a well-trained guide from their own culture or religion. We’ll never get there, but that’s the goal, the horizon I’d like to shoot for, and that’s what inspires me to do what I can as a doctor to move that forward. I feel like the business people who are here are just trying to move it forward from their perspective and with their knowledge and skills.” Dr. Greer likens the experience to the early days of the internet, sharing a laugh with me as he says, “when the internet got started, no one knew how to make money off of that, either.”
Obstacles and Hopes for Future Psychedelic Research
In terms of obstacles, Dr. Greer believes “the biggest challenge is going to be getting enough high-quality therapists trained and set up in practice, I don’t know of any plan that covers that, from anyone. I have a local group of therapists working on it, but it’s all volunteer time. Even for MAPS, who is getting MDMA approved by FDA, it’s still a long way away. A lot of the therapists are making big personal sacrifices to get it going. That’s what I see as the next big thing. We got research started, got it to where it can be on a drug development path, that feels great. We could lay back on our laurels, but we’re still alive with nothing more important to do, so we’re still doing it.”
“Another thing would be to get the US government to start funding treatment research to study how psychedelics might help people, rather than harm them. That has not happened in a direct way in the US at all. Other countries such as Switzerland, England, and The Czech Republic, have paid for some of this research, but not the US yet.”
The Source as a Part of Set and Setting, and Parting Thoughts
Before we finished, I asked Dr. Greer if there was anything else he wanted Truffle Report readers to know. “I guess one other concept that’s come into my mind while we’re talking, just about this whole for-profit source vs. non-profit source, is that the knowledge of the source of the medicine affects the patient’s experience. It affects their mindset, it affects the therapist’s mindset. The knowledge that people donated to help pay for their medicine, that feels good. For a person experiencing addiction and depression, they find it hard to feel loved, they often feel lost, that no one cares about them, and then they can feel the support when the medicine is partly a gift. It makes a difference. Dave Nichols made huge batches of MDMA and psilocybin for the research. We’re still using some of it, and using the medicines that he made with his own hands might have a deeper meaning than it being from some anonymous company. This is just something to throw out from the clinical experience end.”
It’s an interesting idea, and not a hard one to wrap our heads around. Compassion, and a genuine interest on the part of a caregiver, are factors in the success of any therapy, for any patient. Psychedelics will be no exception. The time seems to be fast-approaching when the production of these substances will be a distant thing, far removed, and in the hands of pharmaceutical companies. It’s here that Dr. Greer’s long view, and assertion of the need for trained therapists and clinics for them to practice in, takes on its greatest importance. Laws and attitudes can change, but it’s doubtful, to me at least, whether or not this psychedelic renaissance, and it’s new model for mental healthcare, can work without fostering that human connection to set and setting.
