Psychedelics' Potential to Address Spinal Cord Injury with Joel Castellanos, MD and Jim Harris

In this episode of the Psychedelic Medicine Podcast, Dr. Joel Castellanos and Jim Harris join to discuss the possibilities of addressing spinal cord injuries using psychedelic medicine. Dr. Castellanos is a board certified physical medicine and rehabilitation and pain management physician and an associate professor in the department of anesthesiology at University of California, San Diego School of Medicine. Jim Harris is a National Geographic photographer who suffered a spinal cord injury during one of his adventures who became notable in the psychedelic space with the article in Outside "Jim Harris Was Paralyzed. Then He Ate Magic Mushrooms."

Jim starts off by sharing his own backstory of how he broke nine vertebrae in his spine during a 2014 ski expedition in Patagonia, Chile, leading to significant loss of motion and sensation. After some promising success in traditional rehabilitation and physical therapy settings, Jim details his surprising experience of healing with psilocybin.

In this vein, Dr. Castellanos discusses the importance of neuroplasticity in healing for spinal cord injury patients. He talks about how forming new neural pathways can help a patient regain function and sensation in a part of the body that had previously been paralyzed, and leveraging this neuroplasticity using psychedelics and other tools may be a promising way to improve outcomes among these traditionally underserved patients.

Considering the unique needs of spinal cord injury patients, Jim wonders whether lower doses of psychedelics may be more beneficial for this population, as it would allow them to maintain a greater degree of sobriety and groundedness to pursue physical therapy and rehabilitation activities while under the influence of the substance.

Dr. Castellanos expresses excitement about the possibilities of psychedelic therapies for these patients, as not only does early anecdotal evidence such as Jim's story suggest that these substances may be effective in helping to facilitate regain of function and sensation, but also because of the mental changes brought on by a psychedelic experience. Patients may feel more optimistic and eager to apply themselves following a psychedelic experience, which will facilitate healing beyond just what occurs as a result of the effects of the substance itself. He is also encouraged by current research into different forms of neuroplasticity which have different mechanisms. Dr. Castellanos suggests employing these in combination, such as using psychedelic therapy alongside vagus nerve stimulation, may offer more effective treatment options for spinal cord injury patients.

At the end of this conversation, Jim poses Dr. Castellanos a fascinating question: whether there may be any downsides to over-encouraging neuroplasticity. Dr. Castellanos responds that there could be certain risks of increasing pain in patients, as neuroplasticity encourages new connections to be formed in the brain, but it matters what specifically becomes more interconnected. As such, there is reason to proceed with caution even as neuroplasticity offers significant benefits.

In closing, Jim shares some hard reduction tips for other spinal cord injury patients interested in exploring psychedelic healing. Both he and Dr. Castellanos are optimistic at the possibilities of psychedelic therapies used in conjunction with other treatments for patients like Jim.

In this episode:

• Leveraging neuroplasticity using psychedelics and other tools to help physical medicine and rehabilitation patients regain function
• Anecdotes of other spine injury patients who've regained function or sensation following a psychedelic experience
• The connection between spasticity and psychedelics
• How the response to psychedelics has changed over time for Jim
• Connecting physical therapy and psychedelic therapy to improve efficacy of rehabilitation
• How different mechanisms of neuroplasticity may be used in concert to promote recovery
• Harm reduction tips

Quotes:

Jim: "[when I first took psilocybin] all of a sudden I had an ability to contract my hamstring and… lift my heel off the ground, like up toward my butt, and I hadn't been able to do that up until that time." [9:12]

Joel: "My primary focus is on neuroplasticity and ways that we can creatively modulate the nervous system to optimize recovery and optimize quality of life, whether that's from a pain perspective or a regaining motor strength perspective." [13:34]

Joel: "If we can demonstrate that through psychedelics we can optimize and improve and make recovery more efficient, it is something that will be a huge deal for a great number of patients, and make my job as a rehab physician easier." [14:37]

Jim: "The reason I've become interested in psychedelics as medicine has been trying to figure out… what are all the ways that I can have some sort of personal efficacy in my own recovery." [19:22]

Jim: "I do know of other anecdotes kinda similar to mine, of people—maybe especially it seems like with a first psychedelic experience—suddenly regaining sensory or motor functions." [22:41]

Jim: "It seems there's maybe some reason to suspect that some of the nerve plasticity that psychedelics can allow may reopen the critical period of this pivotal mental state where, say having a psychedelic and doing physical therapy in that state and maybe even the days afterwards, might result in a bigger functional change than just doing the therapy alone." [24:28]

Jim: "My hypothesis would be that a useful physical therapy dose [of psychedelics] might be a lot less than what Johns Hopkins and other institutions are dosing as a therapeutic dose. It seems to me that maybe a really high dose psychedelic experience is going to make it harder to stay connected to your body, connected to doing a task." [29:17]

Joel: "If I can identify three or four different ways to open up neuroplasticity that each have different mechanisms, it allows me to leverage those to give robust functional recovery and that's what I'm interested in." [33:56]

Joel: "If psychedelics can reframe someone's cognition and reframe their situation where that gives them a little bit of hope, along with having a supportive therapy team, along with it working on descending inhibition and activating muscles that were previously paralyzed, that's multiple different levels of approaching someone that just had the worst thing in their whole life happen to them… It builds resilience and then it's also working on the neuromuscular pathway to improve functional recovery." [37:30]

Joel: "I don't think just taking a psychedelic or other medication on its own is always going to be efficacious in solving that maladaptive pattern. But, when combined with specific and guided therapy, whether that's physical therapy, or psychotherapy, or cognitive therapy, I think that's where you can guide those neurons to a healthier connection through neuroplasticity." [50:17]

Links:

"Outside article: Jim Harris Was Paralyzed. Then He Ate Magic Mushrooms."

Psychedelics and Health Research Initiative at University of California San Diego

Dr. Castellanos on Twitter

Jim on Instagram

Previous episode: Psychedelic Therapies for Pain with Joel Castellanos, MD

Fireside Project website

Psychedelic Medicine Association

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