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Saturday, January 29, 2022

What Is the Best Approach to Psychedelic Therapy? An Interview With Field Trip’s Ronan Levy

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The psychedelic boom has seen a huge rise in the number of classic and non-classical hallucinogens being tried due to mental health conditions. Almost all of these trials have not yet been completed, but anesthetic clinics are already open. In these clinics, licensed narcotic compounds such as ketamine, which has avoided regulation as a sedative compound, are administered to patients. Field Trip Health, a Toronto-based company, develops its own compounds, such as tryptamine-based FT-104, while also offering drug-paired trials of therapy with ketamine in its clinics. We spoke to Co-Founder and CEO, Ronan Levy, to learn more about Field Trip’s approach to psychedelic therapy and why 2021 was such an important year for psychiatric medication.

What are the biggest field trip developments in 2021?

RL
: 2021 was a big year for us. I think the biggest development was the listing on the Toronto Stock Exchange, then the listing on the Nasdaq, as well as the funding that we completed in March, where we raised $95 million. I think that was pivotal for a number of reasons, and I think the biggest reason, because we’ve heard from a number of friends and advisors that we will never be able to raise money from traditional pharmaceutical and biotech investors, given our integrated model. We’ve been able to prove them wrong with the largest fundraising funding in Canadian drug history, and one of the largest overall, and it’s a major vindication of our drug development strategy.

Beyond that, three things. Continuing implementation of our clinic; We are now in nine locations. The results we see in our clinics are just amazing. On average, most patients who come through our treatment programs see sustainable benefits in terms of their depression and anxiety scores for 120 days or more after treatment, making it, to my knowledge, the single most effective treatment option.

Currently, I’ve never heard of any other treatment programs that offer this kind of statistic, especially when compared to say, IV ketamine injection clinics, where benefits tend to return to average after about three weeks, I think. Therefore, our clinics have had tremendous success in helping people and building awareness of the field trip.

I think our efforts to develop drugs have been remarkable. We’ve made great progress. We have given a lot of instructions about the FT-104. It is a tryptamine very similar to psilocybin, but with about half the duration of the trial, it addresses one of the main limitations about psilocybin, which is the time and cost involved in the duration of the trial. This is very exciting. We launched the new pipeline program and the FT-200 series. We are continuing to evaluate other potential candidates to be pioneers in the FT-200 series, although the first one we have developed shows an incredible amount of promise in terms of maintaining the potency of the classic drug while treating [side effects] Associated with potentially painful 5-HT2B Serotonin receptors. This is really exciting too.

A: Why do you think the Field Trip approach has outperformed IV ketamine clinics?

RL:
IV ketamine clinics treat ketamine as an antidepressant. They provide IV on a slow drip, and maintain a very moderate level of ketamine for the duration of the experiment. We know that ketamine can cause synapse formation; It causes the brain to grow new synapses, which is very positive. But the intravenous infusion technique, I believe, is missing some of the essential elements of what makes narcotic-assisted therapies so powerful.

What you miss is twofold. One; We give intramuscular injections as opposed to intravenous injections, so it is a very quick start with a very high bioavailability. It leads to a psychedelic-like experience, not very different from a classic psychedelic, in which people are often able to go back and revisit past traumas, past experiences, and past memories and see them from a different perspective. I think that’s what people are trying to get at with traditional talk therapy or cognitive behavioral therapy. We’re just helping people get there, in a very fast state, with ketamine, and that’s because we’re giving the intramuscular injection that’s fast, whereas with IV ketamine it’s slow, so you don’t have a similar numbing experience with IV ketamine.

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Inside Toronto Fieldrip Clinic. credit: field trip

The second thing is that we pair our programs more closely with psychotherapy, we make more effective use of periods of neuroplasticity [induced by the drug], where people are able to make changes to the habits, mindsets, expectations and practices in their lives. Not only do they get a boost from ketamine and benefit from that emotional processing, in fact, they appear to be adopting new lifestyle considerations that support these mental health improvements.

We know that the way you eat and exercise affects mental health. And during these windows, people seem to be better able to adopt those different decisions that support a better view of emotional and mental health from their perspective. That’s why I think we’re seeing much better results. It is really a function of the treatment and the protocol that we use.

RM: Do you think that, after approval of drug-assisted therapy approaches, there could be a push toward purely pharmacological interventions from less effective pharmaceutical lobbyists? What do you think of the future of drug development?

RL:
I think if people benefit, that’s great. Just because they don’t benefit as much as possible doesn’t mean we have to be critical; It just means that we need to realize that there are different ways here and different desires.

I know there’s a lot of interest in some groups in finding treatable psychedelics like antidepressants, you know, the once-a-day pill, and they have big improvements. I think that’s great. There are some people who want to do this work. And then some people just don’t want to do that work. Some people want to climb mountains, others are content to sit at home and drink coffee at the kitchen table. I think the stronger options we have for people, the better. Personally, I like to base my experience on a drug. I think there is value in the work and the process. But this is me. And that’s not everyone. And if someone else says, “I’m not interested in that, I just want to feel better with a more conventional medical approach.” Brilliant. They should have options, too. I don’t see that as a struggle. Personally, I think at the end of the day, we’re all working toward the same thing. Then we take different approaches, as long as people are not harmed by it. I think it’s wonderful.

“Some people want to climb mountains, others are content to sit at home drinking coffee at the kitchen table.”

RM: You mentioned your drug development programs, which focus on compounds derived from classic psychedelics. Do you think the efficacy you will notice with these classic 5-HT2A receptor agonists will be significantly different from the efficacy you currently see with ketamine?

RL:
I think so. We see great results with ketamine. I’ll be honest, when I first started in the industry, I had this vision that ketamine would eventually be overtaken by the other drug because, at least on the surface, the potential effect of, say, psilocybin seems to be greater.

However, I have changed my point of view. I think ketamine will remain an essential part of drug-assisted therapies and clinics like ours will be able to offer a number of different treatment protocols, some off-label, but I think ketamine will be a part of it. What’s really nice about ketamine is that people don’t have to give up their traditional treatments, like [classical antidepressants] SSRIs or SNRIs to gain access to ketamine-assisted therapy. At least for now, the guidance with psilocybin and MDMA is that you want to get off the antidepressant before starting treatment. Ketamine is actually a very nice workout for people looking to explore medicine in this regard.

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Having said that, I expect that you will see better results with the classic anesthetic, and this is not based solely on my opinion. I think if you look at the data from a lot of studies, the potential effect of psilocybin and classic tryptamine tends to be higher than what we saw with ketamine.

But that’s just my guess, and the data will speak for itself. I think, however, that you will see the medical psychedelic industry starting to look like the underground psychedelic treatment industry right now. Yes, MDMA will be approved specifically for the treatment of PTSD and psilocybin will be approved specifically for major depressive disorder or treatment-resistant depression (TRD). And the FT-104 will be approved specifically for TRD and postpartum depression, which are indications we’re after, but I think people will start with ketamine as probably the first on board. They might use psilocybin to help treat their depression, but their psychiatrist might also say “We’ve used psilocybin for your depression and it’s very effective, but from our conversations, it seems like there’s a lot of trauma behind your depression. So even though you may not have a diagnosis of a disorder After the shock, MDMA may be a useful adjuvant therapy, “I think people will continue to work on this kind of thing. I really think we’re going to see a powerful mix of options for people. I think this will lead to the best results.

Ronan Levy was talking to Rory J. McKenzie, Senior Science Writer for Technology Networks

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