Daily Archives: January 29, 2020

Medicare said this month that it would cover acupuncture for people with chronic low back pain, seeking to give patients alternatives to potentially addictive narcotic pain relievers.On January 21, the Centers for Medicare and Medicaid Services (CMS) announced a national coverage determination for this treatment. For coverage purposes, people must have had chronic low back pain that has persisted for at least 12 weeks or more, the agency said. This pain should not have an identifiable cause, such as infections, diseases, surgery and pregnancy.

Under these circumstances, CMS will cover up to 12 visits in 90 days. The agency said it will cover eight additional sessions for those patients who demonstrate improvement. There is a limit of 20 acupuncture treatments covered per year. Treatment should be discontinued if patients show no improvement, CMS said."We are taking advantage of important lessons learned from the private sector in this critical aspect of patient care," Kimberly Brandt, Chief Deputy Administrator of Operations and Policies at CMS said in the announcement. "Excessive dependence on opioids for people with chronic pain is one of the factors that led to the crisis, so it is vital that we offer a variety of treatment options for our beneficiaries."

In the decision memorandum, CMS said insurers, including Aetna, several Blue Cross Blue Shield, Cigna, Kaiser Permanente and United Healthcare plans provide some acupuncture coverage. The agency said the relative safety of acupuncture and the serious consequences of the opioid crisis in the United States provided "sufficient reasons to provide this non-drug treatment" to people enrolled in Medicare who have chronic low back pain.

"While a small number of adults 65 years or older have enrolled in published acupuncture studies, patients with chronic low back pain in these studies showed improvements in function and pain," CMS said.Round Trip ProblemIn the decision memorandum, CMS said it had reflected and then, in 1980, rejected the idea of covering acupuncture. In 2004, CMS considered acupuncture for fibromyalgia but found no convincing evidence of this benefit. In that same year, CMS also reached the same conclusion about the use of acupuncture to relieve pain in patients with osteoarthritis.

CMS also noted in the memo that many groups and individuals had written to the agency in support of Medicare acupuncture coverage, and patients often included personal pain relief reports.But some commenters told CMS that acupuncture was a "pseudoscience," with positive results described in some report probably due to the placebo effect.Among the critics of the proposal was Steven L. Salzberg, PhD, director of the Center for Computational Biology at the Johns Hopkins University School of Medicine. He told CMS that he was concerned about the use of taxpayers' money to cover acupuncture."No well-designed study has shown that it has any benefit beyond a placebo effect, and scientifically there is no serious debate about its effectiveness," Salzberg said in his comment sent to CMS in January 2019. "Simply put, I don't work , and patients who believe in acupuncture are being deceived. Testimonies such as those in the comments here do not include evidence. "

Salzberg confirmed to Medscape Medical News on Tuesday that it remains his point of view.

For more news, follow Medscape on Facebook, Twitter, Instagram and YouTube.

. (tagsToTranslate) acupuncture (t) traditional Chinese medicine (t) alternative medicine / complementary medicine (t) alternative treatment (t) medicine (alternative / complementary) (t) pain (t) chronic back pain (t) back pain ( chronic) (t) chronic pain (back) (t) chronic pain (t) elderly / elderly concerns (t) geriatrics (elderly care) (t) opioids (t) pain (pain management) (t) management from pain

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Medicare chooses to cover acupuncture for pain in the midst of an opioid crisis - NewsDio

On a Saturday afternoon last year, I sat in a 100-year-old renovated church in Zandvoort, a coastal town in The Netherlands, and ate about 30 milligrams of psilocybin, the active ingredient in magic mushrooms.

This was out of character. I haven't taken drugs since my early 20s. I relish the feeling of being in absolute control, and recoil at uncertainty. Handing over my brain and sense of reality to a fungus was terrifying. And yet I had come to a legal psilocybin retreat to do just that.

For the past year or so, Ive been reporting on the resurgence of psychedelic research. People with treatment-resistant depression, addiction, and terminal illness-related anxiety have been finding what sounds like incredible relief from these drugs. As someone with anxiety and OCD, I was curious if mushrooms could release me from maladaptive habits, and the ruminating thoughts that seem to stay with me no matter how many years of therapy I do.

I was not alone in my intention; the 14 others at the retreat didnt travel from all over the world to take shrooms recreationally. During our introductions, many talked about wanting an improved mental quality of life, accessing higher levels of spirituality, or finding ways to address a feeling that something was missing. About half had never taken psychedelics, and had no interest in doing so until reading about the resurgence of psychedelic medicine in outlets like The New Yorker or The Economist. Nearly everyone mentioned being influenced by journalist Michael Pollans recent book, How to Change Your Mind, a best-seller that chronicles the recent spike in research.

Psychedelics may be infiltrating the educated elites reading lists, but taking these drugs in a formal setting with doctors administering them is still difficult. The trials in the U.K. have thousands of people on their waiting lists, including people who already participated and want to do it again, said Rosalind Watts, a psychologist at Imperial College London's psilocybin depression study. At the end of every lecture I give, there is a line of people saying, I really need to try this. Where can I go? Watts told me.

In the face of this demand, psychedelic retreats are stepping in to fill the gap. They are scattered around the world, usually in places with legal loopholes. In the Netherlands, for example, trufflesthe base of the mushroomare legal, and thats what we consumed.

I went to a retreat called Synthesis. It cost $2,000 for three days (they waived my fee, and VICE paid only for the transportation to and from Amsterdam). It provided impeccably designed, modern accommodationswith a sauna, vegetarian chef, and an ever-flowing supply of herbal teas. The retreat consisted of one day of preparation, one day when we took the truffles, and a day dedicated to integration, or processing our experience. There were four facilitators to guide 15 clients, and two of them were licensed mental health clinicians. There was a medic present on the day of our trip.

The Lighthouse interior. Courtesy of Synthesis.

Retreats are advertised as places for mental transformation and growth. But the experience at a retreat can be very different from a clinical trial. There is no precedent for what a psychedelic retreat is "supposed" to be, or what kind of support its required to provide. Synthesis is on the responsible and safe end of the spectrum; there are other retreats with no trained psychologists or doctors, where facilitators take mushrooms with their attendees. Some completely lack sufficient screening for more serious mental health disorders.

As psychedelics continue to shed their dated, Nixon-era reputation, a new generation of interested users will seek these drugs out. They are people like me: nervous about taking psychedelics illegally or unsupervised, not necessarily interested in the recreational effects, but excited about the medical promise. Within this group will also be people (like me) with varying levels of mental health disorders, who have come across ongoing psychedelic research and cant or won't wait for regulatory approval.

As such, retreats risk becoming a testing ground for unresolved questions around these drugs as treatment: How much support does a person need during a trip intended for mental healing? Should that support come from psychologists and psychiatristsor shamans? Is it better to take these drugs in groups, or alone? Whats the right dose? What about microdosing? Is a medical trip different from a recreational one? Is there a way to predict who will have a difficult trip?

I went to Synthesis not only to see what mushrooms could do for my life, but to ask what the looming psychedelic wellness movement will look likenot just in a clinical context, but as a burgeoning form of medical tourism and DIY mental healthcare.

Over the three days, I did observe others having the kind of transcendent moments I had read so much about. But what I went through was something different. My trip was not fun. It was highly emotional, painful, and at moments, approached being deeply therapeuticbut perhaps not as much as it could have.

Im far too anxious to have ever considered going to a different kind of retreatsay, an ayahuasca retreat in the Brazilian jungle somewhere. That kind of retreat is centuries old, and steeped in cultural meaning, but also includes vomiting, sleeping outside, and eating unfamiliar foods. Synthesis was different: It had amenities. Showers. A bed. Fruit-infused water. A Dutch chef named Lotta, who brought in bushels of organic produce each morning.

Synthesis is the first wave of a new kind of psychedelic retreat. It aligns its mission with burgeoning science and research projects, not just the mystical. Synthesis copies many of the practices at Imperial College Londonone of the worlds best medical centers working on psychedelicswhen administering psilocybin, and collaborates with researchers there, providing data on the experiences of people who take psychedelics in group settings. But this creates a somewhat confusing hybrid. Is it a spa? A vacation? A research study? A doctors appointment? A therapy session?

This new breed of retreat is still substantially different from an actual research trial. At Imperial, for example, participants go through an extensive screening process, where they discuss their mental health, and also their childhoods and past trauma, which starts to build trust with the therapists, Watts told me. There are about five hours of one-on-one preparation with a therapist. Subjects take psilocybin twice, with two guides assigned to each person, usually a psychologist and psychiatrist. There are two hours of integration following each dose, and three follow-up Skype calls, each an hour long.

Watts acknowledged that not everyone needs that. The retreat setting is in a group, with less prep time and individualized attention,which could be fine for most people. "But some people might need more," Watts said. "Certainly for people that have a history of lifelong depression, then they for sure would need a lot more than that.

I met Gemma, a 31-year-old designer who lives in Portland, in the car that brought us from the train station in Amsterdam to Zandvoort. She later told me that she has had depression since she was a teenager. From 18 to 28 she was on and off a variety of antidepressants.

Many of the newer psychedelic retreats don't recommend that those with serious mental health issues attend. At Synthesis, every participant has to complete a health screener ahead of time. Myles Katz, co-founder of Synthesis, told me they turn away about half of the people who apply.

Synthesis's medical screener asked Gemma about depression, and when she was open about her history, they asked her some follow up questions about her mental health. But I dont really know where I am mentally, to be honest, she said. I go to work every day. I go out and socialize. Im not in bed every day and I have not been institutionalized. However, I have lived feeling this way for so long that I am in this space where I get used to the way I am.

Though retreats are technically for so-called "healthy normals," on every psilocybin retreat website I looked at, including Synthesis, they advertise themselves as places of mental healing. (Along with a due-diligence caveat saying that they are not providing official medical care.) Your body and mind knows how to heal itself; psilocybin allows us to trust ourselves again, Truffles Therapy in Mexico wrote. The only requirement is your willingness to surrender your ideas and let nature do what she does best.

Buena Vida retreat, also in Mexico:

"Do you find that your regimen of mental health, therapy & SSRI medication is just helping you 'get by' but not truly BREAK THROUGH?Have you suffered from depression, anxiety or PTSD for so longyou cant even remember feeling good?Those looking to heal chronic depression, anxiety, low self-esteem, lack of creativity, PTSD or even simply a lack of purpose in their lives are sure to benefit from a safe session with psilocybin mushrooms.

This framing can end up attracting people who have mental illness histories. As Gemma approached 30, she started to explore natural and alternative medicines, seeing naturopaths and getting into yoga and supplements. Her naturopath asked if she had heard of microdosing, and she started to read about psychedelics, right around the time Michael Pollans book came out. One Friday night, home alone, she came across the Synthesis website.

I was like, Oh my god, this is amazing. You read about all this stuff, but heres a place I can go and I can do this, she said. People say it was almost like this cure for depression. I know it doesnt specifically say that on the website, but you read so many positive things and it starts to make sense. I was like, I have to do this. I remember feeling a real sense of like, Wow, my future could be so much different.

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We were welcomed to The Lighthouse, as the renovated church is called, by our guides, Adam, Valerie, James, and Odin. They were dressed, as one might have expected, in flowy clothes, and had peaceful, earthy vibes.

Adam, an American yoga instructor and certified Reiki Master who lives in Berlin, was our lead facilitator. Valerie, a regal brunette from Oakland, is an LMFT from the California Institute of Integral Studies (CIIS), a psychedelic-assisted psychotherapy certification program; CIIS trainees go to retreats for hands-on experience as part of their curriculum. Valerie and James, a British man with a low ponytail and a gentle voice, were the only licensed therapists at the retreat.

Shortly after arriving, I milled around the cavernous kitchen and living space, saying awkward, earnest hellos to the other guests. (For their privacy, and so as not to interfere with the effects of the program, I am only including testimonies of those who consented to interviews two weeks after the retreat itself.)

On our day of "preparation," time stretched out long in front of me, and I itched from anticipation. We talked as a group about our intentions, and the following days plans, or as Adam called it, our Flight Instructions.

There was a lot of emphasis on leaning in to anything that we might experience. Adam said to trust, let go, and be open. If we were looking for a mantra, he suggested that we breathe in to Let, and exhale to go. He assured us there was no such thing as a bad tripanything that happened would teach us something.

The next day, we enacted a kind of tea ceremony, crushing truffles with a mortar and pestle along with lemon and ginger. We went to the "ceremony room," a large white room with a skylight and heated floors. There were mattresses for us to lie on, blankets, and eye shadesto encourage an internal, introspective journey (this is what most research protocols call for as well). My hands were shaking as I drank the mushroom tea and spooned the mashed up truffles from the bottom of the teapot into my mouth. I lay back, and put my eye shade on.

The ceremony room. Courtesy of Synthesis.

The first hour was completely physically overwhelming. It was as if I was in a kaleidoscope that someone was shaking rapidly. I felt dizzy and panicked. At one point, I opened my eyes and saw Adam sitting next to me. It must have been obvious that I was distressed because he put his hands over menot touching me, but doing Reiki. It felt hot, painful, and I didn't like it. I tried to push his hands away, and he told me to breathe and lean into it. This had the opposite effect of being calming: I became frantic, and it was suddenly urgent for me that someone else sit with me instead of him.

The day before, Valerie had told me that if I started to feel overwhelmed, I could look for her. I asked Adam if he could get her, and he told me that she had gone to lunch.

I couldnt understand how that was possible. For a moment, I thought I had hallucinated it, which terrified me. I was no longer sure of what was going on around me. I couldn't figure out where I was, or how long it had beenand it was all rooted in a confusion around Valerie leaving to go out to eat. (I found out later that all the guides were taking quick 20-minute lunch breaks.) I thought that my brain was hiding her from me, that it was my own fault that I couldnt see the one person who could help me. I existed inside this despair, self-hatred, and confusion for what felt like hours.

Eventually, Valerie did return from her break, and when she sat down next to me, I started to cry. I wanted her to hold my hand or touch me so that I could know, even with my eyes closed, that she was there, but couldn't figure out how to ask for that.

After some undetermined amount of time, I managed to request if we could leave the ceremony room for a break from the music playing over the speakers, which I found to be overpowering. We went into the living and dining room, where Lotta, the chef, was chopping food.

Listening to a woman preparing food, and feeling reunited with Valerie, my mind started to dwell on my mother, my grandmother, and my great-grandmotherthe matriarchal line of women in my family. My mom is Chinese and grew up during the Cultural Revolution. I had spent time in therapy before talking about the trauma she went through and my relationship to it. But on shrooms, I started to experience this in a tangible way that I never have before.

I felt literally connected to all of my female relatives, and started to think about the stories that I had heard about their childhoods and lives. Snippets came and wentmy great grandmother running her dumpling shop, and then being forced to become a maid for her husbands family. My grandmother running away from home at 12 and living alone in the attic of a library. My grandmother in the labor camps during the Cultural Revolution. My mother's nanny stealing food during the Great Starvation.

With my brain going in and out of Communist China, I told Valerie about my great-grandmother, my grandmother, and my mother. I felt the searing loneliness of their neglect, and the starkness of them having to push aside everything except their survival.

But while I was experiencing all of this, I also had some level of understanding that I was not supposed to be out of the ceremony room. Valerie was not supposed to be only sitting with me. She was one of four people there to take care of 15. I was taking her away from the group who also needed to be taken care of.

In a moment of lucidity, I looked through the window at the backyard and saw Gemma, sitting and cryingshe looked distraught. I felt horribly guilty for taking away one of the people there to help her. That knowledge made my journey harderand even more so since I was grappling with the themes of care, and my often-suppressed desire for others to take care of me. Here I was asking for care, but knowing deep down that I was asking for too much given the context that I was in.

While I spent most of the day crying, Christopher, a 50-year-old from Monterey, California, spent it laughing. He said the mushrooms told him he had spent too much of his life crying and now it was time to laugh, and not feel guilty. In his journal he wrote, Im just going to laugh the whole time. I fucking deserve it.

Even within that pleasure, family history came up for him. I realized very vividly that my mother is living inside me, and not only is she living inside me, but the people that live inside of her are in me as well," he saida sentiment that reminded me of my own journey. Another line from his journal read: I wonder what a fun childhood is like.

Two weeks after our trip, Christopher noticed some subtle changes in his life. He used to react intensely to adverse circumstances, but now finds himself pausing before he responds. He said he felt a greater sense of connection to peopleeven those he doesnt know. He was not the kind of person to marvel at the interconnectedness of all things before, but said that now, the instinct to do so came easily. Im not talking about a massive transformation that has occurred and Im changed forever, Christopher said. Its a slight shift. Its opened up new ways of looking at things and ways of behaving and ways of responding.

Ed was 72 when at Synthesis, and is 73 now. Hes a lawyer in Manhattan who had tried to get into meditation, but there was always some block that he couldnt get over. I thought that this was an enabler to get me over that, he said. All of the answers in the material world werent enough. I thought, there has to be more, but I hadnt found the more yet.

Ed also left Synthesis with a great sense of connection. I had a sense of knowing, surety, and a sense of peace and great comfort that there is a unity between me, other people, nature, and the world, he said. There was an overwhelming sense of gratitude for just being alive in this place. Gratitude for others, and love.

During his trip, he told me he went to the Ganges with a guru, and conducted a symphony, hallucinations he experienced in a dream-like fashion.There was so much joy during the course of the journey, he said. "It was this happiness and joyfulness that had been buried for so many years inside of me. And it was all coming out. There was this big smile on my face, and the experience of ecstatic joy it was overwhelming.

The ceremony room. Courtesy of Synthesis.

Gemma's experience was more like mine. She saw some visuals at the beginning, swirling nature-like things, that made her smile. But after awhile, she wasnt completely sure where she was, and was feeling physically very uncomfortable. You know that kind of feeling before you get a bug," she said. "You wake up in the middle of the night and youre like, somethings wrong with my body. Im going to be ill.

At the start of the ceremony, Gemma tried to let go. But it wasnt clicking. I kept saying to myself, 'Your body will only give you what you can handle.' And, 'What are you trying to teach me?' I wasnt getting any of those answers," she said. "Did I have a bad trip? I didnt see myself dying. I wasnt terrified or having horrible visions. I was just quite fearful and anxious.

Out of our group, only Gemma and I had trips that I would define as "difficult." Is it because we both had pre-existing mental health issues? From Watts qualitative work, shes found that there is a difference between groups of people that do psychedelics who have psychiatric or traumatic history. It makes sense that you have to go through those layers first, she said.

People take psychedelics every day and dont have licensed therapists with them. We dont require that everyone at Burning Man bring their therapist when they take a tab of LSD. But these retreats are not just another place for recreational use. They are intentionally set up for people to have deep and healing experiences, and by doing so, could be attracting people with mental health concerns that they want to heal. And in that setting, shouldn't there be someone present who is an expert at dealing with that?

A retreat in Jamaica, Mycomeditations, says on its website that while it confers with clinical psychologists and therapists before and after retreats, there is not always a therapist present. Also, about half of the facilitators take mushrooms with the guests. They have identified as their [sic] 'sweet spot,' as they are able to empathize and assist with guests who are in the mushroom space more effectively, the site reads. Synthesis does not allow their facilitators to take psilocybin, and is against the practice. What's considered acceptable from retreat to retreat can vary widely.

Psychedelics Today, which interviewed the owners of Mycomeditations multiple times on its podcast, recently released a statement withdrawing its support of the retreat, saying that The team seems to have great intentions, but there are some missing pieces around safety that have made us not willing to endorse the company any further.

An embittered discussion ensued on Psychedelics Today's Facebook page from people who had gone to the retreat and had different experiences. Some felt that the retreat was accepting people who were too vulnerable and werent able to provide the proper support, and others had incredible and healing experiences.

Katherine MacLean, a research scientist at Johns Hopkins who volunteered as a facilitator on a Mycomeditations retreat, said that she witnessed one to two potential medical emergencies on each of the two retreats she went to, including several hours of severe vomiting and diarrheabeyond what she said is normally seen with mushroomsand one person who lost consciousness and fell, hitting their head on concrete.

Also, the retreats accept people who are at significant risk of harm, including people with physical and psychological conditions that would almost always be excluded from other remote psychedelic or meditation retreats, and certainly screened out of clinical trials. She became uncomfortable offering prep and integration support for people with extreme depression, anxiety, suicidality, substance dependence ... and voiced my concerns about taking on such serious and vulnerable cases.

A founder of Psychedelics Today, Kyle Buller, said that when he went to Mycomeditations, people took the mushrooms out in an open field. "Everybody was invited to bring their own music and you know, sometimes it just felt really loose," he said. Some of the facilitators were great even though they were under the influence. They did a really great job holding space, but sometimes I would wonder, whose experience is this? Is this the facilitator's trip or is this the participant's trip?

Matthew Johnson, a psychiatrist and the associate director of the Johns Hopkins Center on Psychedelic and Consciousness Research, said that though he believes deeply in the promise of psychedelic therapy, he cannot recommend any retreat in good conscience because of the wide amount of variability and lack of professional oversight. He said that these drugs are generally pretty safe, but there are still risks. In a clinical setting theyre best equipped to handle those risksbe they physical or mental.

Further, he worries about what impacts a rise in retreats might have on ongoing research. If no one is guiding what they're doing, bad outcomes or experiences could color the reputation of the science that's taking place.

You dont have to go far back into the history of psychedelics to find examples of dosing gone wrong, he said. Im pretty obsessed with the lessons from the past in this area, and Im doing my best to shape the field so that we continue to absorb those lessons, Johnson told me. There were so many dimensions where boundaries become blurred surrounding psychedelics. Were concerned about it. Like, if the law passes in Oregon and some life coach is overseeing a session and someone runs out and gets hurt, people will say, oh that psychedelic research is not so safe.

I asked Johnson if a potential solution would be to separate out people like Gemma and meprovide different levels of supportso that I could have had a personor twowith me the whole time. He's not sure. He said that even if we could create a delineation between healthy and unhealthy people, theres still a certain amount of unpredictability.

"Youve got to be driven by the higher need for care, Johnson said. Thats why in the clinical setting there are psychologists and psychiatrists who have built relationships with their patients, and are experienced with trauma, depression, and anxiety.

He recalled a psilocybin study he conducted with participants who were experienced meditators; people with tens of thousands of hours of meditation under their belts. Youd think this person has all of their ducks in a row, you know?" he said. "Like, theyve sorted out their childhood issues and whatnot. Well, guess again. This stuff comes up with any human being, even without an explicit history of trauma. Were complex and I personally think that every human being has some level of unresolved trauma, whether its diagnosable or not. I don't think theres a person alive where you could say, 'Yeah, theyre going to have a high dose of a psychedelic and no deep issues are going to come up. I dont think that person exists.' Humans are very deep.

Right after my weekend at Synthesis, I went to Berlin for a conference on psychedelic medicine hosted by the MIND European Foundation for Psychedelic Science. One panel discussion was titled: Therapists versus Healers: Requirements for Training and Personality of Psychedelic Therapists. Predictably, the clinicians on the panel felt that some kind of official training was important to guide a person on a trip, while "healers," like an experienced mediator, felt it was notthat a deep understanding of these drugs was more important.

Johnson said that he doesn't think there is going to be a clinical benefit for someone who spends the whole time feeling like they don't know what they got themselves into, or that they can't trust the people around them. Youre probably not going to completely surrender psychologically into the experience, which is what you really need to do to reap the benefits," he said. "You cant surrender when you have second thoughts, like What is going on here?

A difficult trip at a retreat could still be healing, but it could also be re-traumatizing, especially if someone has issues of abandonment, said Gita Vaid, a ketamine-assisted psychotherapist, who also took truffles at Synthesis with me. If someone is not available in those critical moments, its not only a lost opportunity, it could be triggering.

Elizabeth Nielson, a psychologist and psychedelic researcher who focuses on integration, said that she often gets calls from people who went on retreats, and are struggling afterwards. They havent always had a bad trip but sometimes what they experienced is hard to grapple with when they return to daily life.

Nielson has heard stories of people walking away with life-changing experiences too, she said. But she likened it to going to a farmers market and buying a homemade herbal remedy for something. It may or may not work, but its unregulated. [Retreats] may not be doing anything illegal, theyre also not working within the structures of the existing mental healthcare system, which is very different, Nielson said. I think that a lot of people dont really understand that.

A lot of clinicians are getting approached by their patients with questions, Nielson said. Theyre being looked to as authorities on this topic because its mental healthcare, she said. But there isn't a lot of formal training or continuing education training for them to look for. To that end, she recently helped develop a program for clinicians to learn about harm reduction and integration in clinical practice in relation to psychedelics.

One issue is cost. If every retreat staffed licensed clinicians it would cost like 10,000 pounds, or something," Watts said. "We are all going to have to, at some point, think about: Whats the minimum safe and effective framework for people? Another is that just because someone is a trained therapist doesn't mean they have experience knowing how to help someone go through, or cope with, a psychedelic trip.

Vaid had attended Synthesis to see what other frameworks for psychedelic care were out there. She told me that she was impressed by our three days, even though it was very different from her own practiceshe works with much lower doses of ketamine that are personalized for each patient.

Her setting is much more like a therapy session. Synthesis was more spiritual, including components like meditation, breathwork, and body work. Having a mystical experience, research shows, is a predictor of a positive outcome from the drug, but it's not known how much that should come from the setting itself. I am personally not a spiritual person, at least in the traditional sense. I find rich meaning in human emotions, psychology, art, music, chemistry, biology, and nature. But things like crystals, energy, deities, and spirits dont move me, and so when Adam held his hands over me, in an attempt to soothe me with Reiki, it felt not neutral, but hostilelike an affront to my personal beliefs.

My experience was so focused on the women in my family that I found I couldn't sit with anybody but a woman. Valerie was the only female facilitator there during my weekend at Synthesis. Johnson said most of the research trials include a man and a woman for each subject because they're learning how important diversity is in being able to support people reliving different kinds of trauma.

Katz, the Synthesis cofounder, and I had a conversation about my experience, and I shared some of these thoughts. He was receptive, and said he's aware that retreats are still a work in progress. He said they're now trying out individually-geared doses, and offering women-only retreat weekends. And they usually do try to have a gender balance otherwiseon my weekend, the group was supposed to be led by a woman named Nataja who got sick. As their customer base continues to grow, theyve encountered a bottle-neck with facilitators, Katz said. At the moment, theyve paused the number of customers they are accepting to hire and train more. That was an example of where we werent equipped to be flexible when someone cancelled last second," he told me.

Synthesis just had their 500th customer, which is hundreds more than some of the clinical trials. At the same time, Katz said, Its only 500 people. The research isnt able to readably predict what makes a trip go one direction for one person, and a completely different one for someone else.

Were just one organization working with one particular method of using psilocybin, Katz said. And we're doing the best we can to uphold the medical safety and best practices that we believe can help data-driven decisions about what will make things better."

In November, Synthesis announced that Robin Carhart-Harris, the Head of the Centre for Psychedelic Research at Imperial College London, would be joining their advisory board. It's a continuation of a collaboration that already exists between the two groupsSynthesis provides data to Imperial College's Ceremony Study, which tracks ceremonial use of psychedelics. But Katz hopes that Carhart-Harris's presence will help them further advance their screening process, how they support their guests, and perhaps even using data to try and predict what kind of experiences a person might have and have the right kinds of support ready. "Being able to legally operate with customers and psilocybin is a unique advantage of Synthesis, and we believe there is a lot more potential than simply the retreat business we have started," Katz said.

I asked him if he thought that, through their alliance with Imperial College and their dedication to following best practices, they might specifically attract the very kinds of people that need more support, like mepeople who theyre not necessarily equipped to help.

Katz said it's possible, and it's a tough position to be in. He knows that when Synthesis rejects someone, they go to another retreat. Thats not a great scenario, because were basically saying its not safe, and theyre like, I dont care, if this other person will accept me, he said.

Theres truly so much more that we dont know than we do know, Katz said. It sounds a bit harsh, but its essentially trial and error, and growing. Saying, okay that doesnt work. Shift.

I was interested in taking shrooms because it seemed like it could "reset" your brain. Watts said that now-infamous notion comes from a quote from an interview that she did with a participant, which was picked up by the media. While it rang true for that person, she said people can get too excited about the metaphor. In their screenings, many people reference that sentiment, telling Watts that they want a brain reboot. People with that expectation can resist going into difficult emotions during their trips because they thought it was just going to be a "reset"effortless.

What's often missing from the psychedelic health stories that we read is that psychedelics are a tool. They can facilitate psychological work, but it's still workwork that isn't always easy or fun, and can be very painful.

This is an intense therapeutic process, Watts said. "This is a journey into the deepest parts of yourself and potentially might be very challenging. I think the messaging around psychedelics, it would be helpful if that changes a bit.

Perhaps for some it is like a reset. But I bet that there will be others, like me and like Gemma, for whom it is not as simple as ripping a bandaid off.

I want my time to be explained to me a bit more, Gemma said. "I know you shouldnt compare to anybody elses journey, but Im like: has anybody had a situation like this? Am I the only person to go through this retreat and do this, or is it common? You really question yourself when you leave it. Everybody says this is the most amazing thing in their life. And youre like, Oh god. Is there something really wrong with me now? Johnson said that actually, it's common: people blame themselves and thinking theyve screwed it up, and squandered their experience.

I dont think we can blame individuals for not having a good experience, or point to them "not letting go," or "surrendering" as the only thing that went awry. From my experience as a psychiatrist and psychoanalyst, its really difficult to change your character and change your mind even when youre motivated and have intention to do so, Vaid said. Psychedelics are not the magic bullet for that. Its a process and you can gain insight. But most of us know that when you have insights and a big 'A-ha' moment, how much that actually translates to real change is limited.

Vaid thinks the relationship part of psychedelic therapy is not talked about enough. Much of the advertising for the retreats focuses on how taking these drugs is an opportunity to change your mind, including sciencey terms like "deactivation of the default mode network" or "neuroplasticity." But the relationship and therapy piece is no less significant than the medicine itself, Vaid said.

I wonder what my experience would have been like if I had had a dedicated person to sit with me, like in a medical study. Watts considers having a hand to hold a bare minimum for psychedelic work. What if I hadnt had to worry whether Valerie had to be somewhere else to take care of other people?

"To need the support of someone and for it not to be there can be like a kind of repetition of primary wounds in childhood, Watts said. Thats another reason why we love having a male and a female therapist, because its a reparative situation for people who havent had a loving mom and loving dad dote on them all their childhoods. We all crave it. In a way, its almost like a mini-reparenting exercise.

The dining table at meal time. Courtesy of Synthesis.

Looking back, what I did experience was profound. I've talked about my mother and her history in therapy before, but not with the depth of feeling that occurred during my psilocybin trip. I was, without judgment, able to dive into those emotions in a way that I never had. There were times I was hysterically crying and gasping for air, and I don't cry in front of other people. I'm very careful to control my behavior around others, and here I was, in front of a stranger, really letting go.

I'm unsure if I had any lasting effects from my trip. I've since dwelled on the themes that came up for me, especially around care and abandonment, more than I would have otherwise. But not in ways that feel necessarily productive or healingit's more like a wound was reopened.

I did not feel blissful, I did not walk away from my trip with a deep connection to the universe. If I were to summarize my takeaway in one sentence, it would be that that life is full of suffering, and that we are forced to sacrifice our softness to have the strength to face that suffering. I am curious if my takeaway would have been different with more support.

I don't know if I'll do psychedelics again. I wouldn't rule it out. I did learn a lot about what kind of support I might need if I did it again in a therapeutic context, and about parts of myself, my family, and my past that could be deeper wells of pain than I previously thought.

As psychedelic retreats increase in number, its going to be key for them to recognize the experiences that dont involve beautiful visuals and the love-is-universal revelations. People with mental health conditions and people with trauma may have different journeys on psychedelics. If only the good experiences get talked about, there's less room for the idea that difficult experiences can be transformative too, with the proper support and integration. The clinical framework seems to allow for that, and expect it. It's almost a given that people will experience difficult things. The question is whether non-clinicians will figure out how to make them worthwhile.

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I Went to a High-End Psychedelic Retreat to Address My Anxiety - VICE

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Newswise It sizzles on the grill. But does it fizzle in terms of nutrition? Thats the question when it comes to the new plant-based burgers that are flying off grocery store shelves and restaurant tables.

Consumer choices include the Beyond Burger, the Impossible Burger and even Impossible sausage crumbles, which a major pizza chain is testing in select nationwide markets. These plant-based meat substitutes promise the flavor, aroma and taste of beef without the associated health risks. But whats inside these new patties, and do the potential health benefits outweigh the risk of eating these processed foods?

To be clear, registered dietitians at Penn State Health favor eating whole foods over processed foods. But these newer meat substitutes can be a great transition food for someone looking to eat a more plant-based diet, said Andrea Thompson, a registered dietitian at Penn State Health St. Joseph.

Todays trendiest plant-based burgers differ from past offerings. Traditional processed veggie, soy or black bean burgers, which debuted in the 1970s, contain processed vegetables (mushrooms, carrots, peppers among them), protein (soy or black beans), rice, oats and corn oil. Many remain on the market today.

The new plant-based burgers combine protein (soy, pea, bean or brown rice), oils (coconut, sunflower or canola), and methylcellulose and food starch as binders, depending on the brand. Impossible also uses heme a molecule naturally occurring in plants to give its burger added flavor. Beyond Meat uses beet juice extract, apple extract and natural flavors to achieve the same goal.

Overall, plant-based burgers tend to have fewer calories than burgers made with animal-based meat, Thompson said.

All plant-based meat substitutes offer an alternative to animal-based meat, which carries some health risks. Literature shows that people who eat more saturated fat which is found in red meat are at higher risk for cardiovascular disease and some types of cancer, said Susan Veldheer, assistant professor and registered dietitian in the Department of Family and Community Medicine at Penn State College of Medicine. However, plant-based meats contain some fiber which could be considered a benefit that red meat doesnt offer. When we look at groups of people who eat diets that are high in fiber they tend to have lower risks of cardiovascular disease, cancer and diabetes, she said.

In addition, red meat production brings environmental concerns. Many environmental agencies have concluded that animal agriculture for human consumption is one of the top, if not the number one contributor to human-caused climate change, Thompson said.

But plant-based meat substitutes also raise eyebrows among dietitians. For one, theyre ultra-processed, Veldheer said. That means they go through a lot of manufacturing and processing before they reach your plate and often contain ingredients that are not commonly found in the average kitchen. Ultra-processed foods tend to contain more sodium than their whole plant or animal-based counterparts.

They also may carry similar amounts of saturated fat. In fact, recent studies suggest that the coconut oil found in plant-based burgers have a similar impact on blood cholesterol levels as oils from animal-based products like butter, Thompson said.

The newer plant-based burgers do contain small amounts of Genetically Modified Organisms (GMOs). These products are developed to withstand herbicides such as glyphosate, which is linked to certain types of cancer. We dont know the full health implications of GMOs because they are relatively new to our food supply, and its very difficult to research GMOs and their impact on health, Veldheer said.

People with soy or coconut allergies should avoid the newer plant-based burgers, since they often contain one or both ingredients. Some may also contain gluten. Some may also contain eggs or dairy, which means they are not vegan. Always read the nutrition label, Thompson said.

And while plant-based burgers are the new kid on the nutritional block, the healthiest food choice remains eating more whole foods, including fruits, vegetables and whole grains. The diets proven to prevent disease such as the Mediterranean diet or the DASH eating plan stress whole foods, Veldheer said. The research in this area is pretty clear. The more you choose whole foods over processed foods, the healthier your diet will be, which can lead to better health overall.

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TheMedical Minuteis a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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The Medical Minute: Is impossible meat too good to be true? - Newswise