🫠 Psychonaut POV

Welcome to Tricycle Day. We’re no psychiatry clinic, but we’ve got a prescription for you. Medication: our newsletter. Frequency: read twice weekly. Dosage: 5 mins. Precautions: content is highly addictive. 📝

Reid Robison, known today as Chief Clinical Officer of Numinus, began his career as a classic pill-slingin' psychiatrist. But a series of eye-opening experiences permanently shifted his view on mental health, and now he’s on a mission to help folks heal from the inside out.

We spoke to Reid about his windy path into psychedelic medicine, the ongoing crusade to make psychedelic therapy accessible, and some drug-free tools he uses to overcome hopelessness and despair.

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You've been involved in humanitarian efforts for a long time, from medical missions to free clinics. How has your exposure to different cultural environments shaped your perspective on mental health?

Starting out as an eager young psychiatrist at the University of Utah, I was fueled by a sense of purpose. I had just completed my training when a devastating earthquake hit Haiti. That disaster sparked my interest in humanitarian work, especially in alleviating mental suffering worldwide. Armed with a bag of the most cutting-edge psychiatric medicines from top pharmaceutical companies, I set off on a mission to make a meaningful impact.

Upon arriving in Haiti, reality hit me hard. My arsenal of pills often proved inadequate. They felt more like temporary fixes, offering a few hours of relief but falling short of addressing the underlying issues. The experience left me feeling powerless and questioning the true progress we were making.

Determined to find more effective treatments for conditions like depression, PTSD, and eating disorders, I dove into the world of clinical trials. It wasn't until I was invited to participate in a ketamine study that I glimpsed a ray of hope. A single dose of this medicine provided rapid relief for the majority of people. Yet, what truly fascinated me was the profound psychedelic experience it occasioned.

Fast forward a few years, and I found myself in the heart of the jungle, at an ayahuasca ceremony. The stories of miraculous healing had beckoned me there. When I showed up with my medical supplies, I was met with a smile from the shaman, who assured me they wouldn't be necessary. What unfolded was beyond extraordinary—a fusion of ancient plant medicine and modern therapy, resulting in profound healing and transformation. That whole experience and chain of events continues to influence my own inner work and approach to serving others to this day.

Your work has focused on making quality mental health care accessible to all. What steps are you taking at Numinus toward that goal, and what challenges have you encountered along the way?

Navigating through the many challenges to date has been exhilarating to say the least. Several years back, I started a clinic in a relatively small town about an hour outside of Salt Lake City, Utah. We offered a range of services, from traditional psychiatry to psychotherapy, with a special expertise in ketamine therapy. The demand was immediate and the response overwhelmingly positive. This prompted us to expand, establishing more clinics in Utah. Eventually, we merged with Numinus and extended our reach to clinics in Canada. Together, we built on that foundation of accessibility, intention, and meeting challenges head-on.

In Utah alone, where we now operate five clinics, we're on track for approximately 80,000 client visits this year. While only a minority—about 25%—are ketamine and esketamine sessions, that still translates to tens of thousands of ketamine therapy sessions since we began. One of our primary challenges was delivering high-quality, evidence-based therapies at a large scale, while maintaining the utmost respect and reverence for set and setting, as well as the sacred traditions associated with some of these medicines (such as psilocybin, which we’re offering through research studies in the US and through compassionate use exemptions in Canada).

We've refined our model to a point where it continues to expand. Currently, we're grappling with insurance battles; it’s an ongoing crusade for us as we fight for accessibility on behalf of our clients. Our pricing for ketamine services was intentionally set at an accessible rate of $225 per dosing session, a fraction of what many others charged. However, even this price was out of reach for some, necessitating a two-pronged approach: pursuing insurance coverage for ketamine and introducing Spravato (or esketamine), which had been FDA approved and therefore covered by most payors. We've administered this treatment over 20,000 times, each one covered by insurance, and leveraged patient assistance programs to help bring copays down. Looking ahead, we're focused on optimizing delivery methods—group, individual, and family-based—and preparing for forthcoming medicines like MDMA and psilocybin.

In addition to clinical work, we conduct our own research and collaborate with others. Just yesterday, a paper was released from Usona on the psilocybin for depression study, in which we played a crucial role as a site and I co-authored the paper. We really take a multifaceted approach within our clinics, offering the best possible evidence-based treatment approaches to the communities we serve.

You went deep into genetics research at one point in your career and even founded a genomics company. Do you see a future where genetics and personalized medicine intersect with psychedelic therapy?

This is a fun question, and to be honest, my thoughts on the intersections of these fields are still evolving. I began my academic journey conducting gene-finding research in autism and other neurodevelopmental conditions, which yielded some success. However, when I tried to apply these techniques to more complex conditions like depression and ADHD, things got much more difficult. Predicting treatment response and developing biologically based diagnostic tools is a big deal, almost like the Holy Grail of personalized medicine.

But in the context of psychedelic therapy, I don't believe genomics will provide the answers. This skepticism is coming from someone deeply passionate about genetics, with a history of exploring the human genome. It's similar to pharmacogenetic testing in psychiatry, which provides data based on common genetic polymorphisms (often found in genes encoding things like serotonin transporters, for example) to assess how likely someone is to respond to or tolerate a specific medication. However, this doesn't offer a crystal-clear prediction; it's more of a statistical likelihood that can be useful for selecting a medication and sometimes adjusting dosing.

Practically speaking, sometimes people can figure out the right dose before they even get their genetic test results back. That said, considering the time it's taken for pharmacogenetics to evolve—it's been a decades-long process just to reach a point where you can order it and have it covered by insurance—similar markers for predicting responses to psychedelics will likely take time to develop. Given that these substances are often used for common mental health conditions like depression and PTSD, it's improbable that genetics will become an everyday healthcare tool for determining the right psychedelic medicine and dosage anytime soon. Don’t get me wrong—I certainly feel that this pursuit is worthwhile, but it could take a decade or longer before it reaches clinical utility.

Have you faced much resistance, either from patients or peers, while merging ancient practices like meditation and yoga with modern mental health care?

As a psychiatrist, I've prescribed pills to hundreds of people. I'm the first to acknowledge that, in our modern society with its pervasive mental health struggles, psychiatric medications can be genuinely life-saving. Yet, it's undeniable that we often rely on them excessively. For mild to moderate cases of depression and anxiety, there are probably better first-line therapies than a pill. Consider how much of our anxiety and trouble sleeping stem from our inability to rein in our unruly minds from rehashing the past or overthinking tomorrow.

Discovering yoga was a turning point for me. While I'd been teaching meditation and using it in my clinical practice, I'd become increasingly frustrated with my ability to truly engage my patients in regular meditation practice. Yoga, however, offered not only a more compelling incentive to enter that meditative state but also introduced a critical missing element—an embodiment approach.

Since then, yoga has evolved into a way of life for me, as well as a system to augment the clinical and psychedelic therapy practices I offer. Yoga, to me, offers a structured path to waking up from the trance of distraction, unworthiness, and overthinking, bringing stillness to the mind and enabling a profound presence in one's life. It fosters empathy and compassion, both for oneself and others. The practice extends beyond personal healing, becoming a catalyst for helping others and elevating global consciousness. When we engage in this inner work, we not only enhance our own well-being but also contribute to a positive shift in the world, creating a ripple effect that extends to our care for the planet.

My intention in spreading this work has been to integrate the principles of yoga and brain science to craft a blueprint for healing and personal growth. I genuinely believe in the potential of uniting a practice that has withstood millennia with our evolving understanding of mental health. I draw on science to enhance my yoga practice and vice versa, using yoga to enrich my life.

What advice do you have for individuals who might be struggling to find hope or healing on their mental health journey?

You're not walking this path alone, even if it feels that way. There's always a thread of hope somewhere, even when it’s hard to find. Hopelessness, as I see it, is made up of two ingredients: the belief that things will never improve and the fear that nobody truly comprehends the depth of your struggle. It's a tough space to inhabit, especially because our culture tends to shy away from confronting discomfort. This isolation can intensify the weight of it all. What you need are allies who aren't afraid of delving into the darkness with you, who can empathize and stand with you as you do this brave work.

The second thing that comes to mind is creating a sanctuary to embrace your emotions. It might seem paradoxical—why endure discomfort to eventually feel better? But when you start viewing emotions as signals, evolutionary tools brimming with invaluable insights on how to navigate life, it begins to make sense. They're like those warning lights on your car's dashboard, urging you to pay attention before things overheat. Ignoring them is like driving blind, while issues fester in the shadows. When we truly listen, we realize emotions have a physical sensation and a call to action, directing us towards what we truly need.

For instance, when sadness washes over us, it might manifest as a lump in our stomach or a heavy heart. Recognizing and allowing these sensations illuminates our need for comfort. Traditionally, our culture has told us to tune out these feelings, but doing so leaves us navigating the world at a severe disadvantage. By making space for our emotions, we empower ourselves to forge a clearer path forward.

Want more from Reid? Peep his creative side, and catch him co-hosting the Psychedelic Therapy Frontiers podcast from Numinus.

That’s all for today. Before you head off, don’t forget to share, rate, and review Tricycle Day below. Catch ya next time, Cyclists! ✌️

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.