Pre-legalization psychedelic medicine is defined by an expanding of body of research that is matching the growing interest from the general population in this kind of healing. Join Dr. Emily Willow in an exploration of her career as a psychiatrist, researcher, and educator at this unique moment in the second psychedelic renaissance.
Getting to Know Dr. Emily Willow
Emily Willow, MD is a psychiatrist, researcher, and educator based in San Francisco, California. She is an ardent advocate for psychedelic medicine and has worked on multiple clinical trials investigating psychedelic-assisted psychotherapy – including both MDMA and psilocybin. She is a member of the clinical research team for the Multidisciplinary Association for Psychedelic Studies (MAPS) at the San Francisco Insight and Integration Center.
Additionally, Dr. Willow has a private practice in San Francisco, CA and is an attending psychiatrist at the University of California, San Francisco and Zuckerberg SF General Hospital in Psychiatric Emergency Services. She holds multiple mentorship and teaching roles, including at the California Institute of Integral Studies (CIIS) in the Center for Psychedelic Therapies and Research and the School of Consciousness and Transformation.
Mind Medicine in this Pre-Legalization Moment
Dr. Willow is a psychiatrist who has worked on the clinical trials for psychedelics and offers ketamine-assisted psychotherapy (KAP), which is the only psychedelic currently offered outside of clinical trials in the United States. In this pre-legalization time period, there has been “an explosion of popular media articles…blogs, podcasts, New York Times articles, and Today Show pieces on psychedelic medicine.
There’s a lot of interest in from the general population, and we don’t really have the ability to meet that need fully. Especially following Michael Pollan’s book, How to Change Your Mind, there was a lot of interest that came out because it targeted a different population of people than were previously interested in psychedelics. I’ve gotten a lot of new patient inquiries from people specifically who read Michael Pollan’s book and have been suffering with depression and PTSD or anxiety and haven’t felt met by the treatments that they are currently being offered.
I work with a lot of people on managing expectations, because we are pre-legalization, and psilocybin-assisted psychotherapy or MDMA-assisted psychotherapy is not something that I can offer, unfortunately.”
“The nice thing is that we do have ketamine-assisted psychotherapy (KAP) available now, pre-legalization. It’s very beneficial for a variety of mental health disorders, specifically depression as there’s been a lot more research into that, but also anxiety, trauma, PTSD, and overall deepening the psychotherapeutic process – helping to understand yourself.”
Meeting Patients Where They Are
When it comes to ketamine, how these treatments are presented can be important, for example as psychedelic journeys versus medical treatments. Language can invite patients in or perhaps push them away, depending on framing. Dr. Willow has encountered a wide range of people who are seeking psychedelic treatment and are therefore drawn to KAP therapy.
Given her experience in psychiatric emergency services, she’s become a bit more comfortable with the medicalization of the psychedelic experience. “That kind of speaks to where we are in this psychedelic movement and the [wide range] people who would benefit from it…having that medical container, decriminalization, or recreational use….
However, my general approach to working with patients is to meet them where they are, [especially since we are pre-legalization]. For people who are maybe more hesitant about psychedelics in general, and more comfortable with ketamine because it’s approved and has this long history of [medical] use, using language that is more in line with the Western medical model can be helpful. Because of my training and background, I also have the ability to talk about things on the other end of the spectrum, like transpersonal experiences and the archetypal, symbolic nature of these experiences, which is also very important. Yet the key is meeting the patient where they are and being flexible.”
Being more harm reduction-oriented, I think makes it easier to give the patients the treatment that they need.
Harm Reduction During Pre-Legalization
Harm reduction is a practice that helps to reduce the negative effects of substance use. When it comes to psychedelics, harm reduction takes into account biological and psychological factors. Dr. Willow uses a harm reduction approach in her work, informed by her early experiences with psychedelics working as a volunteer on the Zendo Project.
The Zendo Project is housed at the Multidisciplinary Association for Psychedelic Studies (MAPS) and provides a peer-led psychedelic harm reduction space at festivals like Burning Man. Dr. Willow supported people in altered states, and this helped her see how important harm reduction is as a licensed provider within this pre-legalization moment.
“Harm reduction is important, among other reasons, because I can’t legally recommend that someone use psychedelic medicines on their own, but I can use a harm reduction model that acknowledges that psychedelic use is a part of our society. Holding a non-judgmental container for that process is how I approach working with patients who are using psychedelics recreationally.”
“In psychiatry, we’re often training that psychedelic use is a substance use disorder, and while that can be true, I don’t necessarily agree with that as a blanket generalization for all psychedelic use. Holding a non-judgmental stance allows people to speak more freely about their use. I think a lot of patients don’t feel safe to share because of the legality of it. Being more harm reduction-oriented, I think makes it easier to give the patients the treatment that they need.“
Working on a Clinical Trial in Pre-Legalization
Dr. Willow currently works on the Phase 3 MDMA for PTSD trials, sponsored by MAPS. These trials are a key step in the process towards proving the efficacy of MDMA for PTSD and helping MDMA clear legal barriers to access. “This Phase 3 clinical trial is a real stepping stone into where we go next. This is the first Phase 3 clinical trial of psychedelic-assisted psychotherapy ever. If we do have FDA approval, we’ll be stepping into a brave new world of [legal] psychedelic medicine.”
“[Working on a clinical trial] feels like a dream. When I was in medical school a little over 10 years ago, I first learned about MAPS and happened to be going to medical school in the same city that one of the first Phase 2 MDMA-assisted psychotherapy clinical trials was being conducted by Michael and Annie Mithoefer and had the amazing opportunity to meet them at that time.
It was really fascinating to hold what I was learning in medical school and that kind of traditional Western medical model of treatment and contrast that with the healing I was witnessing [with MDMA in this trial]. That really shifted my personal trajectory, and I decided that I wanted to pursue being a psychiatrist, working with MAPS, and making a career from working with psychedelic medicines.
At that time, it was not as widely as accepted as it is now. It sometimes feels like a long road, but to be in this moment where they’re talking about psychedelic medicine on Fox News and on the Today Show and in the New York Times, it’s a really exciting moment to be a part of this movement that’s bringing real healing to people that are really suffering. It is so important to me and makes this work feel very meaningful, and I’m just honored to be a part of.”
It was fascinating to hold what I was learning in medical school and that kind of traditional Western medical model of treatment and contrast that with the healing I was witnessing [with MDMA in this trial].
MDMA for End-of-Life Anxiety
Dr. Willow also worked as an independent rater on the MAPS clinical trial focused on using MDMA to address end of life anxiety in people with a terminal diagnosis. “[An independent rater] is not associated with the research organization or the [research] team.
Independent raters aren’t aware of where a participant is at [in terms of treatment] in the study and they’re also blinded, so they don’t know if the patient got placebo or if they got medicine. They are as independent as possible. That particular study that I worked on, I happened to be the only independent rater, so I had the good fortune of meeting all of the participants at almost all of the time points, which was a unique experience for me to see that the kind of dramatic changes and…the really drastic improvements that a lot of the patients had – to watch them evolve and grow through having a course of MDMA therapy.
One of the things that really stands out to me is how these were people who had faced life-threatening illness, and by going through this process, renewed their vigor and zest for life. [After the trial], they did career changes or started a new business or were more able to connect with their families. That really stands out to me because these are people that had faced the possibility of death and, through their experience with MDMA-assisted psychotherapy, they were able to feel more connected to the lives that they had.”
Dr. Willow teaches a course on the history of psychedelic medicine for the philosophy graduate program at The California Institute of Integral Studies (CIIS). CIIS offers one of two certificate programs for licensed mental health practitioners that want to enter this field. (The other is the MAPS Therapy Training Program).
“My goal was to situate the psychedelic renaissance that we’re in at this current, [pre-legalization moment], in this really deep history and context of humans using psychedelics for thousands of years. We don’t have to reinvent everything – there’s a lot that we can learn from what has been done before, whether it be [thousands] of years of use by indigenous groups or the first psychedelic renaissance in the ‘50s and ‘60s. There’s an interconnectedness currently across different populations, but also interconnectedness with the past and into the future.
Connect with Dr. Emily Willow
Dr. Emily Willow invites you to connect! You can reach out through her website and through her Psychedelic Support Profile. She also has a public Instagram account @emilywillowmd where she shares a great deal of public health information about psychedelics.