Just Up the Dose?: Therapy Cults are Influencing Psychedelic Medicine Standards
It has become a problematic standard practice in the psychedelic therapy industry to increase drug dosages after patients display red flag symptoms. Psymposia discusses a recent Wall Street Journal article about these practices as they manifest in the ketamine industry; the psychedelic industry’s historic normalization of these practices; and recent attempts to convince lawmakers to protect psychedelic providers from liability for standard forms of medical malpractice. Together, these developments highlight why allowing a therapy cult to influence the norms of psychedelic medicine puts the public at risk.
Footnotes:
She Hoped Ketamine Would Rewire Her Brain. She Didn’t Live to See It Work. (WSJ):
Live link: https://www.wsj.com/health/wellness/ketamine-telehealth-dangers-4a7bc8da
Archive link: https://archive.is/qLxwO
The Psychedelic Syndicate (Psymposia):
https://www.psymposia.com/psychedelic-syndicate-executive-summary-silicon-valley-maps-lykos-mdma-fda-billionaires/
Hamilton’s Pharma Cope Series (Psymposia):
https://www.psymposia.com/hamiltons-pharma-cope/
Colorado has a chance to get ibogaine policy right (Colorado Newsline):
https://coloradonewsline.com/2026/02/17/colorado-get-ibogaine-policy-right/
Transcript
This transcript was generated automatically from YouTube's captions, then cleaned up by removing filler words, repeated words and background sounds. It may still contain errors.
[00:00] The general rule of thumb in the psychedelic therapy space is, oh, you're having these red flag effects. Let's give you some more. You can see that these allegations and dynamics are not met with many consequences within the industry because they're broadly shared across a lot of prominent groups and individuals in the space. The idea that prior to any kind of actual testing of this, we should be developing a slush fund to pay people that it kills is like mindboggling to me. Hey there, I'm Russell with the Psymposia podcast and today I'm here with my colleague Niche. We're here to discuss a recent Wall Street Journal article from March of this year, as well as how it relates to some broader themes in the psychedelic industry.
[00:51] We'll toss a bit of a content warning up front. There's some pretty disturbing material in this article. It discusses a number of vignettes that are kind of issues around ketamine therapy. And Nishay, you had some other thoughts on sort of those broader themes in the psychedelic industry as it relates to this article. Yeah, I thought it might be worth emphasizing that this does relate to our recent series on Hamilton Morris, Hamilton's Pharmarmacoupe, because some people, you know, have been curious about why we are talking about this. And I would say the main reason we're talking about this is that there are ongoing problems in the psychedelic industry that the industry has tried very hard to minimize and to cover up. And I think that this Wall Street Journal article really highlights how there are things going on that should not be happening and we can be doing more as a field to alert people to those issues so that things can be done more safely.
[01:43] So before we get into those broader themes, we can kind of explore some of the pieces that come up in this article itself. Specifically, the article which came out in March is titled, "She hoped ketamine would rewire her brain. She didn't leave live to see it work." Even the title is noteworthy because it mentions, you know, we've talked a lot about how these advertisements and like the talking points and metaphors are leading people to feel like this is going to fix them. You know, that this emphasis on expecting it to rewire her brain. This is a consequence of the way that the media is talking about these substances and leading people to think it's going to fix their problems and that people are pushing themselves to endure sometimes very challenging circumstances in order to get to that point.
[02:29] Yeah, absolutely. And one of the stories in this article really reflects that. The story of 32-year-old Traniel Harshman. I'm just going to read a little bit from the article here so we can give some context on what we're talking about here. So Jeffrey Gold, a psychiatric pharmacist in Colorado, said he sees patients who have gotten ketamine lozenes from other providers and take them when they feel they need it rather than a set schedule. Feels like they're becoming their own doctor, he said. When 32-year-old Traniel Harshman sought help in late 2024 for postpartum depression from Sage Psychiatric Services, a provider in Wyoming, a nurse practitioner named Christa Bluff met her in person, and prescribed ketamine lozenes for Harshman to take at home. Harshman suffered heart palpitations, had difficulty focusing, and felt disconnected from reality for days after taking the drug.
[03:19] Harshman was scared, but Bluff told her that these side effects were common at first, and increased her dose. According to Harshman's mother, Rhonda Copelan, she was given the understanding that oftentimes it gets worse before it gets better, Copelan recalled. I think she was so hopeful she really wanted to believe it would work for her, too. And I think before we get into the latter half of the story, just pausing there for a minute, that that's a very common understanding, misunderstanding the psychedelic therapy space. The idea that things are going to get worse before they get better and increasing this dosage. Yeah. Yeah, it's a vast oversimplification cuz it's like, you know, yes, for some people thinking to themselves, you know, trust the process and just go through it. And my initial anxiety or whatever is coming up is just transient.
[04:09] But it is it has become a dogma in the field where it is not appropriate to have that perspective in some cases where things are just genuinely not going well and you can't just expect to accelerate through it. But that is very widely commonly held by people that work in the space to the point that it was brought up I believe at South by Southwest by the then CEO of Lose Therapeutics as something that needed to be taught to the FDA. This idea that the system is not built to understand the process of how psychedelics work for people and that they may have things like suicidal ideiation along the way and these might not need to be considered adverse events or things like that.
[04:54] Is that the correct understanding of what then CEO Amy Emerson was saying? Absolutely. That things like, you know, suicidal ideiation, suicidality, it can is just like part of the process and how this played out. Just continuing with the reading here. On February 10th of last year, Harshman scheduled playdates for her four girls, ages 2 to 8, and put them down for a nap. Then she took her increased dose of ketamine. Soon afterward, in an eerily emotionless voice, Harshman called 911 and told the emergency responder that she had shot and killed her four daughters and was about to kill herself, too. According to a 911 recorder recording reviewed by the journal, she told the operator that someone had been trying to take her girls and it was easiest if everyone went at once. All five died.
[05:40] Harshman had no history of violence or suicidal thoughts, Copeland said. Harshman's toxicology report, which was reviewed by the journal, shows that the level of ketamine in her blood was more than four times the threshold reported in studies for mindaltering effects and physical impairment. Some medical reports suggest that patients could be prone to violent behavior under the drug's influence or coming off of it because they are dissociated from reality. And I think a lot of people are going to take issue with kind of that framing at the end there. I don't think a lot of people are going to like the line that people could become violent because of ketamine. But the reality is that someone was prescribed these as take-home medications to take for mental health related issues unsupervised and they did destabilize her or at least seemed to play some role in her destabilization.
[06:26] Yeah. the fact that she had had that prior difficult experience that did not resolve quickly and lasted over a series of days with the negative effects and just having this perspective that the process needs to be encouraged along with more ketamine. There were a lot of red flags there. There was reason to be cautious instead of just upping the dose and kind of blasting through the consequences. Yeah, there were red flags that should have been huge alerts that maybe more ketamine was not the answer and those were, like you said, just blown right through. That becomes a theme in other vignettes in this article. If we kind of pop down to this next bit here, there's another person in this article named Brian Robertson, who says he has spent years chasing the 1010 feeling he had when he first took ketamine.
[07:16] Now he takes lozenes about two to three times a week, prescribed by Dr. Adam Puit, a telealth doctor he met on Reddit, who often posts about ketamine, and in the process accumulates patients. Robertson said he's told the doctor that he's not doing well, suffers from fatigue and lack of sleep, and hasn't seen a ton of progress. He had his dose upped, and takes 500 milligrams each session at home alone. In the following line, he says he's developed a tolerance to the ketamine. rather than experiencing dissociation as he once did, he says the ketamine now makes him feel slightly drunk. And like another drug that's going to come up in some later things we're going to discuss, ibagane, which does have some serious health effects. Ketamine itself also does have long-term use effects on the bladder.
[08:02] It can have some serious and frequently irreversible damage to the urinary tract. So the idea that these doctors are just kind of consistently upping the dosage and regularity of these sessions that people are doing on their own with no supervision is is a real problem. Yeah. All the writing is on the wall here that this is like going to be in the history books as a another like what went wrong with the kind of pharmaceutical industry. Again, we're not saying that there's anything wrong with ketamine use per se. We're saying that there's a number of obvious red flags that come up consistently that should be taken seriously and maybe seen as a reason not to continue these therapies and instead the general rule of thumb in the psychedelic therapy space is oh you're having these red flag effects let's give you some more.
[08:52] Yeah. I mean like even with opioids like opioids are very important medicines that have a use case that also in history has been very significant over thousands of years and the fact that they were rolled out in such an irresponsible way that led to such mass suffering and unnecessary deaths now makes it harder for people who would benefit from them to actually have access to them. And that's where we're heading with a lot of the psychedelic industry because things are being pushed through with contempt for the people who are put in harm's way by the reckless approaches to, you know, prescribing and marketing these substances. We're risking undermining the entire field as people are like more skeptical of how this was allowed to happen.
[09:38] The dynamics described in the Wall Street Journal article here are reflected in previous cases in the psychedelic industry that were fairly high-profile. For instance, Vicky Duly and George Sarlo's case, which came up in our Hamilton's Pharmarmacoupe series reflects these dynamics almost to a tea, where Vicky Duly, who's a maps board member, eventually promoted to the treasurer of the organization, was providing psychedelic experiences to George Slo who was an elderly man me with memory issues who ended up donating a lot of money to maps, giving a lot of money to Vicki herself. In Olivia Goldhill's reporting on this situation in stat, she writes, "In a lawsuit filed by the courtappointed conservator of the Sarlo estate against Vicky Duly, it alleged that Duly used drugs including Iawaska and MDMA to heighten Sarlo's dependence on her.
[10:31] As Sarlo's health degenerated, she introduced him to ketamine and supervised an intensive dosing regimen." And that was even, you know, as Sarlo's mental capacities were deteriorating. there was an adding on of drugs into the mix which fits with this approach to just add more substances when things are getting worse. And as a result of this lawsuit, Vicky Duly had to return a number of things to the Sarlo estate including a Porsche that was allegedly purchased for her with the Sarlo money and she was kind of internally investigated by maps. Nothing came of it and she was promoted within their organization. So you can see that these allegations and dynamics are not met with many consequences within the industry because they're broadly shared across a lot of prominent groups and individuals in the space.
[11:20] Rick Doblin of MAPS the multi-disiplinary association for psychedelic studies has like regularly gone on stage at conferences and when people have said what if you know people are not getting better after two or three doses of MDMA and like the clinical trial context he said well you know this is just this limited version of the model that we're using to get through clinical trials but the actual full underground model that this is drawn from and what they hope to be able to continue once psychedelics become more available and accessible to use in a healing context is to move on to you know if one thing isn't working maybe the process is unfolding in a way that it it's not fully expressed and so shift to mushroom shift to 5 DMT and I was just thinking of one example that was in the micro dose from the March 12th 2025 edition from South by Southwest where they're talking about Dobin's comments on stage and he said the FDA has only
[12:21] Approved drugs for conditions in the DSM. Dopplin said so Leos would not be able to submit applications to use the drug for things like couples therapy which isn't in the DSM. And they said he also referenced Stannislav Grath, a Czech psychoanalyst whose ideas were fundamental to MAPS's MDMA therapy manual and who says quote the future of psychiatry is to take MDMA and then an hour later 5 MOD DMT underground therapists do are already combining MDMAs, psilocybin and LSD and treatments and quote are the real heroes of this whole movement and they are years ahead of what's happening in research. So clearly that that is the culture that a lot of the psychedelic advocacy is coming from of like there's this trauma in your body that is trying to come out and we have these different tools to kind of jiggle it and encourage it out and so bombarding people with different drugs higher doses like that's part of the entire culture that this is coming from.
[13:18] The problem with that culture is that because of groups like the psychedelic science funders collaborative that we have talked about in the psychedelic syndicate, so much of the infrastructure around psychedelic safety is getting built out by people that believe in this approach of bombarding people with different drugs at higher doses and seeing distress and challenging experiences as just part of the process. And what that means is that like in effect a lot of what I would describe as cultists are at the helm and establishing the standards of care by design based on the fact that the billionaires and millionaires funding this industry are also persuaded by the legitimacy of this pseudoscientific model.
[14:03] Yeah. and the fact that this mindset and these dynamics are being kind of mainstreamed and there's this idea that everyone's doing it this way in the underground and therefore that should be brought to the mainstream kind of reveals a chilling element of the Wall Street Journal story in the response from the sage psychiatry place that was prescribing the ketamine lozenes to the woman who killed her family. In their legal response, they specifically wrote that the provider's actions and treatments were common and not a deviation from any applicable standards of care. This dynamic of prescribing larger doses to take alone after red flags have already been shown is considered not a deviation from any applicable standard of care.
[14:49] When I read that, I was like, that's correct. I mean based on how the industry talks like what happened in this case is widely done by other practitioners which makes it very dangerous to create protections based on the fact that everyone else is doing it in the absence of actual evidence and safety rationale for that. Yeah. Which kind of leads us directly into I had mentioned earlier that we were going to have some discussions around Ibagane. There was a recent psychedelic alpha newsletter that came out that had a bit of a back and forth between someone who was promoting recommendations around standard of care for ibagane use as well as some a response to that. So I'll pop over to that. So it was written in psychedelic alpha was regarding Colorado's natural medicine program which was seeking to establish an ibeane research pilot program to treat substance use and mental health disorders.
[15:44] Alpha writes, "A closer look at the text of this bill as introduced shows that it also seeks to exempt natural medicine facilitators from liability for quote physical or psychological injury that a participant may experience as a result of the facilitator's performance or supervision unless the injury is the result of the facilitator's intentional misconduct, gross negligence, or a deviation from the recognized standard of care." They continue that a Florida State University law professor, Mason Marx, responded to this in a LinkedIn post that this element of the bill, if passed, would set a troubling precedent. Quote, "Concerns over scarcity don't justify stripping patients of wellestablished legal protections." Marks went on, referring to Fireside Project founder Joshua White's concerns that being subject to standard malpractice liability could discourage facilitators from working with the drug if it were permitted in the state.
[16:39] Yeah. I mean I think that you know when people use a phrase like standard of care a recognized standard of care usually that means there's this you know substantial evidence base behind it and you know peer-reviewed research clinical trials and in this case I mean there's a lot of as I was saying cultists in the psychedelic field who want to establish standards of care based on what cultists strongly believe is good for people and to create these loopholes is to totally unacceptable as I'm glad that Mason pointed out here. But just reading especially that longer oped from Joshua White, I mean so concerning the sorts of arguments that are being made to justify providing protections for people as long as they're doing what everyone else is doing without an evidence base to justify it.
[17:33] Yeah. And maybe we can take a look at that op-ed if we wanted to. It's a pretty short piece for the amount of disturbing content that's packed into it. And just before we jump in there to just to speak to some of the points we've been raising here, Colorado has specifically built in an accelerated program for lifting underground practitioners and their practices into the mainstream. a pipeline to bring underground practitioners into the above ground by specifically being licensed by the state to facilitate psychedelics for people who are desperate for healing and hearing all the media talking points about how psychedelics reset the brain and have all these like surefire benefits. Yeah.
[18:18] And here you can see some copy from Interrex accelerated path for lensure in Colorado discussing that in most cases the legacy path will include a one-day seminar near Boulder, Colorado and a 4-day practicum at Interrek Center for Psilocybin Services. And you qualify for this if you've been trained in any of these particular programs including CIS, Nuropa, UA maps and loose which all have these kind of roots in the underground. And specifically here it lists gather well training which is the legacy organization of Francois Borat's organization. Borat being someone who was very influential underground psychedelic trainer who was exposed for a number of abuses alongside her husband Aharan Grossbard.
[19:07] We wrote about this accelerated pipeline and inner track's role in developing this for Colorado in the psychedelic syndicate and we showed how Interot is connected to this syndicate of funders the psychedelic science funders collaborative many of whom are big fans of the borat growbard therapy cult that has continued on into gather and so all signs indicate the way that this natural medicine initiative was designed in Colorado was intended to serve as a laundering mainstreaming pipeline for these underground cult groups as is demonstrated by the list on the screen. I have written about the concerns with having five days of in-person training plus you know maybe some online modules and giving people this state lensure for a training philosophy that has been associated with driving specific patterns of abuse and I've been writing about that for a long time but as we were looking into this to
[20:07] Prepare for this conversation today I noticed that Gatherwell has been quietly removed from Inner Track's current list of approved training programs for this accelerated pipeline. I haven't heard anyone talk about that or any reason why they've been removed. I found it quite interesting because we have been writing about this for a long time now. Yeah, no statement on their removal or anything. With that said, let's circle back to Joshua White's op-ed in the Colorado newsine here. I'll pull it up on a screen share. So, the op-ed was called Colorado has a chance to get ibeain policy right. The psychoactive compound is not without danger, but for many patients it offers real hope. So yeah, this op-ed was written by Joshua White, who is the founder and executive director of Fireside Project, which is a kind of call-in service that you can call if you're having bad trips.
[20:59] Most notably, I think Fireside recently rolled out AI assisted psychedelic therapist training module called Lucy, which kind of congregated a lot of the recordings from Fireside of people's bad trips into a bot that can interface with psychedelic therapists or in training to give them an idea of what a bad trip might look like. But that's just a bit of a side note. this oped he goes into the ibeane therapy regulations in Colorado. So he says as Colorado considers how to regulate ibagane therapy it faces a difficult but familiar policy question how to responsibly expand access to a potentially life-saving treatment that carries real risk. In 2024 over 1300 Coloradoatans died by suicide at least 14% of them veterans.
[21:49] Over 1,600 died from drug overdoses. These deaths represent a public health emergency that has resisted conventional solutions. Ibeane, a naturally occurring psychoactive compound, has shown unusual promise in treating both opioid and cocaine addiction and severe psychological trauma, particularly among veterans. For many patients, a single treatment appears to interrupt addiction and suicidal ideiation in ways few other interventions can. Common story that psychedelic boosters like to toss out there. Do you know of kind of intensive research done on on ibeane or is it mostly anecdotal at this point? From what I was looking at, there haven't I don't think been like very rigorous blinded clinical trials with robust methodologies.
[22:34] There has been some research but just not to that standard and there's been a lot of anecdotal persuasive accounts of people saying that they really benefited from taking ibogga or ibagane and ibagane as the op-ed here says does have pretty significant cardiac risks associated with it more than many other psychedelic drugs which he notes here briefly but goes on to say if Colorado allows fear of rare but tragic outcomes to determine policy access to ibeane will remain scarce or driven underground where oversight is weakest and risks are greatest. A more responsible approach would acknowledge both the benefits and the risks and design a legal framework that allows patients to make informed choices with encouraging safe regulated care.
[23:20] Fortunately, the law already offers a workable model. Colorado need not invent new ethical framework to address IBA. It can adapt one that has long governed other high-risk highbenefit interventions. The first is vaccines. A tiny number of people suffer severe adverse events from vaccines and some die. Yet, we do not treat those deaths as proof that vaccines should be banned or that doctors should be exposed to unlimited civil liability. Instead, the federal government created the National Vaccine Injury Compensation Program, a no fault system that compensates those harmed. Workers compensation follows similar logic. Dangerous jobs sometimes result in injury or death even when employers follow the rules. Rather than forcing families to prove negligence in court, and rather than exposing employees to existential lawsuits, society struck a bargain.
[24:13] Injured workers receive guaranteed compensation. Employers receive predictable limited liability and essential work continues. Ibegan demands a comparable framework at least until the treatment has received full FDA review and approval when evidence-based risk evaluation and mitigation strategies and medical liability insurance will begin protecting conscientious providers. This blew my mind when I [laughter] was reading it when I was reading it yesterday. I mean just he's noting that it has not gone through like FDA review and so the fact that like we don't actually have that research in hand to know who is at risk and what the evidence base is in favor of this to just put the cart before the horse and try to create a state initiative that just blanket covers the risk of providers that are recklessly pushing this through by really overplaying the
[25:13] Potential for benefit and underemphasizing the potential for risk is so alarming to me. And this makes complete sense because, you know, Fireside is part of the MAPS PSFC kind of ecosystem. And so a lot of the people funding these groups and are, you know, behind this approach to the developing the industry are wanting Ibegan to be pushed forward and pressured forward and to get this out to the public and also make the public more receptive to having states like what happened in Texas getting invested in behind the ibeine industry. So this is such a classic example of industries that cause harm using an influence network to advance narratives that are in the interest of the industry and not in the interests of everyday people.
[26:05] It's kind of an astounding read there to think that like prior to FDA review and approval it should be treated this way. [laughter] I know bizarre. He continues, "The uncomfortable reality is that even when administered with rigorous screening, cardiac monitoring, and best practices, ibagane will occasionally result in deaths. That fact should not be minimized, but neither should it be allowed to eclipse the far larger truth. Not providing access to ibagane also kills people at vastly greater scale." I this is like rhetoric that bugs me throughout the psychedelic field is like this kind of strange false equivalency that not letting people use these drugs that haven't been proven to do the things they're saying they're doing is killing people.
[26:51] I [laughter] know I just I'm always sort of bothered and it's also this like black and white thinking where it's like there are things that we can do to better protect people. There are preventable deaths that don't need to happen. It's not just that there's this great thing that we know that works and unfortunately some of you will die. You know, that attitude is way too common and it just speaks to that the contempt for a genuine safety culture across the industry that at scale will disproportionately impact the most marginalized people in society. And not only that, these drugs, as he goes on to say, are not like other drugs. They should in fact get these special exceptions. If Colorado treats Ibagain like an ordinary medical intervention, subject to standard malpractice liability, it will all but guarantee scarcity.
[27:39] Clinics will not open. Insurance will be unobtainable. Only underground providers or offshore clinics will remain where oversight is weakest and risks are highest. The outcome would be morally indefensible. Colorado should instead create a statutory safe harbor for licensed Ivagane providers who meet clearly defined standards of care. Patients would give informed consent acknowledging the known risks, including death. In exchange, providers would be shielded from traditional tort liability for adverse outcomes absent gross negligence or fraud. I'll just wrap it up here. To protect patients and families, the state could establish an Ibeane injury compensation fund financed by modest per treatment fees and supplemented if necessary by public funds.
[28:25] When tragedies occur, and they will, families will receive swift, guaranteed compensation without years of litigation. While providers would not be punished for offering a treatment that society has deemed worth the risk, society has deemed worth the risk. This approach does not trivialize death. It takes the risks of Ibeain seriously enough to plan for it honestly. Most importantly, it respects the moral agency of those most affected. People who already face a high probability of dying without intervention should be allowed to choose a treatment that offers real hope even if it carries danger. The idea that prior to any kind of actual testing of this and like proof that it works the way he's saying, we should be developing a slush fund to pay people that it kills is like mindbogling to me.
[29:17] Very bizarre. And it speaks to the fact that this is the type of thought leader that the industry wants to get behind and promote as a leader in this space. It proves all of our points for us that this is the attitude that people have. And I think to his point and to maybe a final point here to end this on is that he is claiming that society is deeming this worth the risk that it's not these thought leaders in the space that are making these choices and influencing this. And as a counterpoint to that, Psychedelic Alpha recently reported on a poll done by Politico that noted that actually over half of people pled believe that the government should slow down the approach to new drugs to ensure that they are properly tested, even if it means delaying availability for those who need them urgently.
[30:06] So, it would seem that at least slightly over half of people pulled do not deem it worth the risk to just push these potentially dangerous things out before they're adequately tested. And that's going to wrap up our discussion for today. Thanks for watching. If you liked what we had to say, go ahead and like this video and subscribe to the channel. You can also find us on Patreon and at our website, Psymposia.com.
