Dale Johnson: I’m delighted this week to have with me Dr. Matt Rehrer. He’s an emergency medicine physician in the Bay Area. He graduated from Baylor College of Medicine in Texas and he moved to the Bay Area for residency in 2008, where he and his wife, Kara, have lived ever since.
Matt and Kara have been married for 21 years and they have three children. Matt serves on staff at North Creek Church in Walnut Creek, California. He’s the author of Redeeming Memory and contributed a chapter on dementia for The Christian Counselors Medical Desk Reference. Matt, it’s always good to talk to you, brother. Thanks for helping us think through this very unusual topic today.
Matt Rehrer: Yeah, thanks, Dale. Thanks for having me on.
Dale Johnson: Now, I’m seeing this concept of psychedelics everywhere and I’m going to build this up, Matt, and we’re going to ask you some questions that maybe we can’t ask a lot of people being a physician and seeing how psychedelics are used really within the medical sphere. In the counseling world, we’re seeing this in a lot of different ways. I’m seeing some people, as the concept of chemical imbalance theory sort of wanes, you’re seeing people now return to some idea of what has historically been called “romantic psychiatry,” and what they’re doing is they’re trying to seek anything that they think would be helpful.
You’re seeing this concept of using or utilizing psychedelics, and I’ve even heard one high-level psychiatrist at Tufts University and another actually who used to work with the FDA mention the concept of psychedelics as being something where a person can get inspiration and that’s what people are looking for in counseling with this whole concept of psychedelics.
As we start talking about this, some people, at least my age and older, would be thinking, man, are we really returning to Timothy Leary in the 1960s? What is happening here? What are we unleashing under medical appropriation here? We’re going to get into some of this, but I want to ask you first, what are psychedelics? How do we think about these things from your perspective as a physician?
Matt Rehrer: Yeah, you’re exactly right, Dale. There has been a return to psychedelics, particularly in the last few years, and for those who don’t even know what these are, maybe some of the listeners haven’t run into this, we’re talking about things like LSD, magic mushrooms, peyote, ayahuasca, stuff like that. They’re hallucinogens that give you an altered experience, and it does affect your perception, your mood, and your cognition of the world, so they’re using these things in a distorted way to affect the way they’re thinking. For some, that’s inspirational, it helps unlock their creativity, they feel like this is a spiritual journey.
But the difference between the 60s and now is they’re taking the same thing and using what are called microdoses, which are essentially 10 to 20% of what would have been considered a normal dose back in the 60s when you’re trying to get a trip or a high. So you’re just seeing a repackaging of the same thing but in a smaller dose, which is making people think, hey, this is safe and good, and this is going to be helpful.
Dale Johnson: Yeah, so you talked about microdosing. This is not me and you hanging out somewhere in the desert in the mountains of Arizona and we’re hitting peyote at whatever doses. There’s a concept behind this called microdosing, where it’s some sort of managed hallucinogenic.
Describe the concept- you mentioned a little bit microdosing. Describe a little bit more what microdosing actually is and how this is being used to treat people.
Matt Rehrer: Yeah, the concept is that you take a smaller dose and you get all these positive effects without necessarily getting the distressing ones. So you take maybe 10 to 20%, which would be equivalent to, we’re talking micrograms here, and you take this and essentially instead of getting this wild hallucinogenic experience, it helps instead just help your mood, help stabilize you, help your cognition, and everything’s kind of tamped down to what you’d expect.
And so the microdosing then being touted as a treatment option for things like depression, anxiety, PTSD, and then it’s expanding out to a whole lot of different uses now. We’re seeing it in substance abuse treatments and chronic pain and migraines. So it’s now kind of just exploding as far as what the options are and its use.
Dale Johnson: Now when you think about some of those uses, are they claiming, Matt, that these things are intended to be curative or it’s just to help reset in some way? What is the claim here with the microdosing?
Matt Rehrer: Well, if you talk to people that are doing the research, et cetera, they’re not claiming these are curative. They’re supposed to just be helpful in tempering or helping with different moods and affects and things like that. So it’s not considered a cure, but just a help as you work through your depression or work through your PTSD. But I think the general public doesn’t necessarily always see it that way. And it’s, I think, interpreted as this is essentially a cure.
But the treatment protocols would make it very clear it’s not because this is actually scheduled dosings you’re supposed to take. And there’s no like, hey, once you’re better, you’re off. Once you’re on, you’re on. And that’s part of the thing we’ll talk about that’s concerning about this.
Dale Johnson: Yeah, that is definitely quite concerning.
Now, as we think about any type of medical approach, and especially something that’s not curative, we always have to think about risk versus reward. And one of those discussions leads us in the direction of side effects. So talk a little bit about what people are describing and even what the literature says about some of the side effects of microdosing.
Matt Rehrer: As this is becoming more popular, the research obviously is expanding and is behind, honestly, trying to catch up. But the side effects that are being described in the literature, where these are protocols we’re actually trying to follow along patients with specific protocols, are seeing side effects like you’d expect headaches, nausea, dizziness, and tingling.
But then, interestingly, you have people having increased blood pressure, anxiety, agitation, panic, and these mini trips that they’re going on. So it’s being touted as like taking away some of these effects. But then when you get into the literature and look at the side effects, they start sounding a whole lot like somebody is just using psychedelics.
Dale Johnson: Now, that’s very interesting because, you know, if you think about the dosing down is something that now makes it legal. I’m assuming that this is legal. Describe a little bit about the legality of something like this, because if you’re riding down the street and you have peyote to whatever certain amounts, that would be considered illegal. Whereas, if you’re thinking about this concept of microdosing, does this make it now illegal?
Matt Rehrer: Yeah, it’s really interesting. This is a space that’s, I think, going to need to be expanded or at least better defined. Right now, surprisingly, it’s actually illegal under U.S. federal law, even microdosing, to have psychedelics.
However, now you get into the legislation that gets down to the state and city level, which is really fascinating. In the state level, two states, of course, have legalized psychedelics already. And you can guess which states those are, but it’s Oregon and Colorado that are leading the way on this.
And then it’s been what’s called deprioritized in certain U.S. cities. Essentially, what that means is they’re going to just turn a blind eye. It’s not worth their time. And so those cities, you can find a list of those cities around the country, one of which is in my backyard, which is Oakland.
So it’s interesting, because if the federal government were to be involved, it’s completely illegal. It doesn’t matter what state you’re in. But you have these conflicts between federal, state, and even city legislation now in microdosing, which makes it really gray for people and starts to sound a whole lot like marijuana legislation.
Dale Johnson: Well, that’s exactly what I was thinking of, is it seems to be following the same now well-beaten path that marijuana has taken on its trip to becoming legalized. I mean, that’s something certainly for us to keep in mind. But who’s recommending this? Who’s behind all of this in recommending this concept of microdosing?
Matt Rehrer: That’s what’s really interesting. There’s no major medical body currently that’s come out recommending it. However, if you’re in Oregon or Colorado as a licensed therapist, you can actually provide supervised microdosing therapy, meaning your therapist essentially is allowed to walk through with their client a strategy for microdosing. And there’s all sorts of different things online that you can find. And I’ll talk about that later because even by seeing the strategy of how to do this, you can see the problems because you can’t take it every day, which might be surprising to people because the tolerance levels are really high, but we can catch that maybe towards the end here. But you’re not going to see this recommended by any major body because the research doesn’t recommend it.
When you get into the body of research, there is big time mixed results. There’s definitely no standard response rate or dosing that seems to be capturing enough people to make a difference.
Dale Johnson: I’m glad to hear about the research because that was one of my questions that I wanted to get into. And that’s really important when we think about what is the research actually saying. And even one of the things that you mentioned I want to highlight because most people might not understand the difference between a psychologist and psychiatrist.
Well, a psychiatrist can write a script for medicine, right? They’re a medical doctor. Whereas psychologists, and this has been a debate historically, they cannot write a script. They’re not medical doctors. And what’s interesting is with microdosing, if what you said is true, they’re allowing now psychologists to create some sort of treatment plan utilizing microdosing.
That’s kind of an underhanded way for psychologists to start utilizing something that should be considered much more in the medical space. And I found that very interesting, especially when the research is sort of shoddy on that. Anytime we talk about research and what we see in the research, and I want you to elaborate on what we’re actually seeing in the research, you always have to consider placebo effect. Talk a little bit about sort of those concepts as it relates to microdosing.
Matt Rehrer: Yeah. There’s some pretty big holes right now in the research and acknowledged in every paper I looked at. Like, hey, there’s significant gaps. We need more research here. And part of the thing that most people have raised is there’s a challenge with lack of blinding, right? So you can’t blind somebody if they’re taken or not, because they will feel the effects.
And so what then enters into research is the placebo effect, which is very strong and consistent across quite a few different areas of research, particularly when you’re doing this type of research that involves feelings. My measurement for success is how somebody feels pre and post. So a lot of the surveys they’ll use to determine if this has been a success, like I’m using microdosing, it’s actually working for me, is survey-based. And they’ll go and give you a pre and post survey, of which usually is quite a few items. And then they have to determine what’s considered significant.
I have a 70-item survey. Well, if I rated something better three points on a 70 point survey, is that significant? And you’ll find in a lot of this literature, antidepressant literature as well, that that’s how they’re determining significance. And it’s so small and subtle, but they’ll say that’s significant. And with placebo effect, you get usually, if you look at literature, a 20 to 25% bump right off the bat for somebody in this space.
And it makes it really hard to tell. Are you actually effectively producing a change in a person? Or are you just getting the mind to think that there’s been a change? It’s very powerful. And this isn’t just in the psychiatry literature.
This actually is in medical literature, in general, the body and mind just are very tied together. So it’s just an interesting thing. And some people say, well, the placebo effect is worth it, because some people are having success. But it also allows them to latch on to something that might not be making an actual change in their life.
Dale Johnson: Yeah, it’s really interesting. I want to capitalize on some of the things that you said, because one of the things that I learned from your discussion here is, my understanding was that microdosing was intended to have a certain schedule. So it was intended to be a little bit shorter, as opposed to something that, you know, hey, you’re just going to be on this for quite some time, or at least until we see the reduction in symptomology or whatever.
That’s a huge question for me, as I think about long term. But if you have somebody on something long term, one of the things you have to start asking, particularly as it relates to any type of dosing in medicine, is tolerance. Is there a tolerance that’s built up?
So I want you to talk a little bit about some of those concepts, the long-term nature of the use, and then tolerance becoming an issue, which would inevitably, if you keep going down this path, you leave the land of microdosing, right? And you start saying, oh, we’ve got to up dosage, or we’ve got to do something different. So talk a little bit about some of those concepts.
Matt Rehrer: Yeah, this is definitely, I think, an area that needs to be highlighted, because the duration of the effect of the psychedelic, like one dose, it depends on what you’re taking, right? We listed a few different options.
One dose usually lasts anywhere between three and 12 hours, is the thought. But the protocols are very specific that you should only be taking one dose every two to three days. If you take it back to back days, even for a short period of time, you develop tolerance. We’re talking within a handful of days, you’ve already developed tolerance. And what happens then is if you are using it on consecutive days, as you imagine, you either need to increase your frequency of usage or raise your dosage.
And I think the concern here is, well, if you raise your dosage, even if the microdose was supposed to be the sweet spot, now you’re pushing higher and higher, you’re going to be in this spot where you might as well be taking the psychedelic like you were in the 60s. And I think that’s the thing that’s concerning here with this particular protocol, is are people actually going to hold to the schedule? Let’s even say if it’s working. But then over time, it seems to me as I’m reading about this, that that is going to be very hard for people to not then develop tolerance.
And like I mentioned earlier, this isn’t a cure. So meaning you are likely on this for quite some time. Now the idea would be like for PTSD, that you would eventually have a resolution of your symptoms or an improvement so you’d be able to get off. So I don’t want to make it sound like the idea is that people are just on this forever. But theoretically, this could be a long standing treatment plan that needs to be in place. And you can see why that could be a problem.
Dale Johnson: Now, as you as a medical doctor, you can you just simply been reporting and I want to give you a chance to offer a caveat. And I would say that, you know, what I’m about to say is not medical advice. I want to make sure people are clear on that. But all of this discussion makes me very uncomfortable when we’re talking about how we’re treating symptomology. And then, you know, what it is, the effects of the medicine itself, really, I think of Ephesians 5:18, do not be drunk with wine, but be filled with the Spirit.
We were designed by God to be filled with the Spirit, to be controlled by Him, not controlled by some sort of substance. So when we start walking down this path, this biblically is where I start to get a little bit nervous. And again, a refraining from, you know, medical advice, these types of things make me uncomfortable. As a physician, up to this point, you’ve been just simply reporting, you know, based on some of your expertise.
So I want to give you an opportunity to talk about this as a biblical counselor from the biblical counseling world. Give us your ideas here about how biblical counseling applies, or how we think about microdosing if we were to think biblically about this.
Matt Rehrer: I think when you step in the room and you’re going to counsel someone, first of all, you might just need to know that it’s potentially your counselee has tried this. So, first of all, this is starting to become to a point where you might have somebody in the church that has considered this, or maybe experimented and tried microdosing with psychedelics. So that’s helpful to be aware of, and I think it’s one reason we’re bringing this up on the podcast.
But second, microdosing is coming with a promise. It’s coming with a promise that is going to make you feel better, that it’s going to make you more creative, like all the things we’re talking about, for whatever reason, somebody’s grabbing this, they want to not be depressed anymore, they want to be happy in life, they want to get rid of their anxiety, they want to deal with their PTS, they’re the reason somebody has gone this direction.
And unfortunately, what that’s doing is shifting them away from dealing with, I think the heart level issues that we talk about constantly in biblical counseling, and addressing what actually has led them to pursue other treatment options outside of scripture. And I think what particularly happiness, it’s just the world’s search for happiness, is another just different way to feel better about life, and to deal with your problems. And we will look to God’s Word and say, this is just not the way to find happiness. In fact, God’s Word would say, don’t just treat your symptoms, let’s look for the cure.
And like we’ve been saying, this is not even supposed to be a cure, but the Bible says actually we do have a cure, Jeremiah 17:7-8 comes to mind, “blessed or happy is the man who trusts in the Lord, and whose trust is the Lord, for he will be like a tree planted by water that extends its roots by a stream and will not fear when the heat comes, but its leaves will be green, and it will not be anxious in a year of drought nor cease to yield fruit.” And you go, okay, that’s the anchor we’re looking for.
The happiness is built in God’s Word, and it’s built through Christ, not seeking after different temporizing things that are just going to numb you or make this kind of feel like it’s going away, that someone rooted and grounded in God’s Word can persevere through the trials in life and actually yield fruit, even in a drought. So I just get concerned when we start coming up with different alternative ways to get to what God says is the cure for your unsettledness, the cure for your sadness is actually through Christ and through His Word.
Dale Johnson: You know, Matt, it’s very helpful to help us to think through this.
We are seeing the popularity of something like this growing. Part of this has to do with some of the literature coming out about the chemical imbalance theory. People are looking for now a different way to try and manage some of the difficulties that we experience in life, depression, anxiety, and so on. And so, first of all, thanks for bringing this to our attention. Second, thanks for using some of your expertise as a physician.
And then third, I would say, thanks for finishing that up with looking at the data and helping us to think about it biblically. So brother, thanks for your time. I appreciate it.
Matt Rehrer: Yeah, thanks, Dale.
