Roland Griffiths
Johns Hopkins
Roland R. Griffiths was a clinical pharmacologist at Johns Hopkins who conducted research on mood-altering compounds and established the institution's psilocybin research program. His published work focuses heavily on the therapeutic applications and clinical trials of psilocybin for conditions such as major depressive disorder and cancer-related psychiatric symptoms. Additionally, his research investigates the effects of psychedelics on episodic memory, mystical and challenging experiences, and changes in religious and spiritual beliefs.
31 claims checked on air: 25 supported 6 unverified
What they said on air - supported
11 citing their own research
Classic psychedelics including LSD, psilocybin, DMT, and mescaline are serotonergically-mediated hallucinogens.
"These are serotonergically-mediated classic hallucinogens, LSD, psilocybin in the magic mushroom, DMT, mescaline." (said at 0:01:52)
The classification of classic psychedelics—specifically lysergic acid diethylamide (LSD), psilocybin, N,N-dimethyltryptamine (DMT), and mescaline—as serotonergically mediated hallucinogens is firmly established in neuropharmacology. These compounds exert their characteristic psychoactive and hallucinogenic effects primarily through agonism at serotonin receptors, particularly the 5-HT2A receptor subtype.
- supports: Receptor interaction profiles of novel psychoactive tryptamines compared with classic hall… (European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology 2016) · cited 385x in the literature
"The present study investigated interactions between the novel psychoactive tryptamines DiPT, 4-OH-DiPT, 4-OH-MET, 5-MeO-AMT, and 5-MeO-MiPT at monoamine receptors and transporters compared with the classic hallucinogens lysergic acid diethylamide (LSD), psilocin, N,N-dimethyltryptamine (DMT), and mescaline. We investigated binding affinities at human monoamine receptors and determined functional serotonin (5-hydroxytryptamine [5-HT]) 5-HT2A and 5-HT2B receptor activation." (abstract, results, passage verified)
pubmedfull study (doi) - supports: Classical hallucinogens and neuroimaging: A systematic review of human studies: Hallucinog… (Neuroscience and biobehavioral reviews 2016) · cited 109x in the literature
"Serotonergic hallucinogens produce alterations of perceptions, mood, and cognition, and have anxiolytic, antidepressant, and antiaddictive properties. These drugs act as agonists of frontocortical 5-HT 2A receptors, but the neural basis of their effects are not well understood. Thus, we conducted a systematic review of neuroimaging studies analyzing the effects of serotonergic hallucinogens in man. Studies published in the PubMed, Lilacs, and SciELO databases until 12 April 2016 were included using the following keywords: "ayahuasca", "DMT", "psilocybin", "LSD", "mescaline" crossed one by one with the terms "mri", "fmri", "pet", "spect", "imaging" and "neuroimaging"." (abstract, results, passage verified)
pubmedfull study (doi)
Healthy volunteers who receive psilocybin under supportive conditions frequently rate the experience months later as among the top five most personally meaningful and spiritually significant of their lives.
"So, months later, people continue to reflect back on that experience and opine that it's among the most personally meaningful and spiritually significant of their lives. I mean, in the top five if not the single most, comparing these experiences to that of birth of a firstborn child or death of a parent." (said at 0:02:49)
In a double-blind randomized clinical trial evaluating the effects of psilocybin (30 mg/70 kg) versus methylphenidate in 36 hallucinogen-naïve healthy adults under supportive conditions, participants were evaluated at 2 months and 14 months post-session. At the 14-month follow-up, 58% rated the psilocybin session as among the top five most personally meaningful experiences of their lives, and 67% rated it among the top five most spiritually significant experiences. Certainty is moderate due to the relatively small sample size (n = 36).
A pilot study from UCLA evaluated a low dose of psilocybin in cancer patients.
"There had been one pilot study published a couple years ago with a low dose of psilocybin out of UCLA." (said at 0:14:38)
A double-blind, placebo-controlled pilot study conducted at Harbor-UCLA Medical Center (Grob et al., 2011) evaluated the safety and efficacy of psilocybin (0.2 mg/kg) in 12 patients with advanced-stage cancer and reactive anxiety. The study demonstrated the feasibility and safety of psilocybin administration along with significant reductions in trait anxiety at 1 and 3 months and improvement in depressive symptoms at 6 months.
A clinical trial at New York University (NYU) co-published alongside the Johns Hopkins study demonstrated that psilocybin produces significant reductions in anxiety and depression in cancer patients.
"A group at NYU ran a somewhat smaller study and we co-published just this last week, in fact, our results. And the results really were quite striking. They confirmed everything we had seen in the healthy volunteers that is these very vulnerable cancer patients who had very significant anxiety or depression experience the same types of...experiences" (said at 0:14:48)
A double-blind, placebo-controlled crossover trial conducted at New York University (NYU) in 29 cancer patients with psychiatric distress was co-published in December 2016 alongside a concurrent double-blind randomized trial conducted at Johns Hopkins University in 51 cancer patients. The NYU trial demonstrated that a single moderate dose of psilocybin paired with psychotherapy produced immediate, robust, and sustained reductions in anxiety and depression, with 60–80% of participants maintaining clinically significant improvements at 6.5 months follow-up.
- supports: Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depre… (Journal of psychopharmacology (Oxford, England) 2016) · cited 1731x in the literature
"In conjunction with psychotherapy, single moderate-dose psilocybin produced rapid, robust and enduring anxiolytic and anti-depressant effects in patients with cancer-related psychological distress." (abstract, conclusions, passage verified)
pubmedfull study (doi) - supports: Psilocybin produces substantial and sustained decreases in depression and anxiety in patie… (Journal of psychopharmacology (Oxford, England) 2016) · cited 2225x in the literature
"High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety." (abstract, results, passage verified)
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A randomized crossover study in cancer patients showed that psilocybin produced large, sustained reductions in anxiety and depression that persisted up to six months after a single active treatment.
"And interestingly, these people experience very large and sustained decreases in anxiety and depression, and the effects occurred really quite promptly after the administration of the drug. And although the design of the study was such, it was a crossover design so people were crossed over between essentially an inactive dose of psilocybin to an active dose or vice-versa. So the strongest conclusion we can make comparing our placebo condition and our active condition is this effect lasted out to five weeks, but in fact, we followed people out to six months and there was no evidence that there was any significant rate of relapse over that period of time." (said at 0:15:26)
A double-blind, randomized crossover trial of 51 patients with life-threatening cancer (Griffiths et al., 2016) found that high-dose psilocybin produced immediate, large, and statistically significant reductions in clinician-rated and self-rated measures of depression and anxiety compared to a low-dose control condition at the 5-week primary endpoint. At the 6-month follow-up, approximately 80% of participants continued to show sustained, clinically significant reductions in depressive and anxiety symptoms without significant relapse.
An uncontrolled pilot study in the UK involving 15 patients with treatment-resistant depression found that psilocybin produced large and sustained antidepressant effects lasting at least several months.
"A group from the UK published this summer an uncontrolled pilot study in, I think, it was 15 volunteers with treatment-resistant depression in which they gave psilocybin. And they showed large effects and sustained effects out to at least a couple of months." (said at 0:19:05)
The speaker accurately describes the 2016 open-label feasibility study led by researchers at Imperial College London (Carhart-Harris et al., The Lancet Psychiatry). In that trial, 12 patients (the speaker tentatively recalled 15) with moderate-to-severe treatment-resistant depression received two doses of psilocybin with psychological support. The study reported marked, statistically significant reductions in depressive symptoms that persisted through the 3-month follow-up period (Hedges' g = 2.0 at 3 months). Because this was an open-label, uncontrolled pilot trial with a very small sample size, the certainty of evidence for therapeutic efficacy from this study alone is very low.
- supports: Psilocybin with psychological support for treatment-resistant depression: an open-label fe… (The lancet. Psychiatry 2016) · cited 1566x in the literature
"In this open-label feasibility trial, 12 patients (six men, six women) with moderate-to-severe, unipolar, treatment-resistant major depression received two oral doses of psilocybin (10 mg and 25 mg, 7 days apart) in a supportive setting. There was no control group... Relative to baseline, depressive symptoms were markedly reduced 1 week (mean QIDS difference -11·8, 95% CI -9·15 to -14·35, p=0·002, Hedges' g=3·1) and 3 months (-9·2, 95% CI -5·69 to -12·71, p=0·003, Hedges' g=2) after high-dose treatment." (abstract, methods and results, passage verified)
pubmedfull study (doi)
Psilocybin and classic hallucinogens bind to serotonin 5-HT2A and 5-HT2C receptors, with primary behavioral effects mediated through the 5-HT2A receptor.
"In terms of mechanisms of action of these effects, psilocybin and the classic hallucinogens do bind serotonin 2A and 2C. The effects are believed from antagonism studies to be mediated primarily through 2A" (said at 0:22:22)
Classic serotonergic psychedelics (including psilocybin and its active metabolite psilocin) act as agonists at multiple serotonin receptor subtypes, including 5-HT2A and 5-HT2C. Double-blind, randomized human antagonism studies have consistently demonstrated that pretreatment with the 5-HT2A antagonist ketanserin completely or dose-dependently blocks the characteristic subjective, visual hallucinatory, neurophysiological, and mood-altering effects of psilocybin, confirming that its primary behavioral effects are mediated primarily via the 5-HT2A receptor.
The downstream neurochemical effects of classic hallucinogens like psilocybin are mediated through the glutamate system.
"it's very likely and I think our current hypotheses would suggest that the major effects that we see are downstream and probably are glutamate-mediated which links this whole thing about psilocybin and depression into this unfolding story about ketamine and depression." (said at 0:23:02)
Preclinical and mechanistic evidence supports the hypothesis that the downstream neurochemical and neuroplastic effects of classic hallucinogens (including psilocybin) in the prefrontal cortex are mediated by increased glutamatergic transmission, sharing convergent neurobiological pathways with ketamine. However, evidence for this mechanism relies primarily on animal models and neurochemical studies.
Ketamine demonstrates immediate and profound antidepressant effects in treatment-resistant depressed patients, but these effects are short-lived.
"ketamine, as I'm sure you know, has been shown to actually have very significant antidepressant effects in treatment-resistant depressed patients, at least a subtype of them. Those effects are immediate. They're pretty profound but they're very short-lived." (said at 0:23:39)
Meta-analyses and systematic reviews of randomized controlled trials demonstrate that ketamine produces rapid and significant antidepressant effects in patients with treatment-resistant depression (TRD), often peaking within 24 hours. However, after a single dose, these antidepressant benefits are short-lived, typically attenuating or disappearing within 3 to 7 days unless repeated administration or maintenance dosing is provided.
Acute administration of psilocybin decreases activity within the default mode network.
"And so work from the UK and additional work now is showing that at least acutely, psilocybin appears to decrease activity within the default mode network." (said at 0:26:50)
Human neuroimaging studies demonstrate that acute psilocybin administration decreases cerebral blood flow, BOLD activation, and functional connectivity within key hub regions of the default mode network (DMN), including the medial prefrontal cortex and posterior cingulate cortex. Pioneering work from UK researchers (Carhart-Harris et al., 2012) showed that acute psilocybin significantly reduced activity and positive coupling across DMN connector hubs, with subsequent precision-mapping studies confirming that acute network disruption and desynchronization are most pronounced within the default mode network.
- supports: Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. (Proceedings of the National Academy of Sciences of the United States of America 2012) · cited 1204x in the literature
"As predicted, profound changes in consciousness were observed after psilocybin, but surprisingly, only decreases in cerebral blood flow and BOLD signal were seen, and these were maximal in hub regions, such as the thalamus and anterior and posterior cingulate cortex (ACC and PCC). Decreased activity in the ACC/medial prefrontal cortex (mPFC) was a consistent finding and the magnitude of this decrease predicted the intensity of the subjective effects... Psilocybin caused a significant decrease in the positive coupling between the mPFC and PCC." (abstract, results, passage verified)
pubmedfull study (doi) - supports: Psilocybin desynchronizes the human brain. (Nature 2024) · cited 259x in the literature
"Psilocybin massively disrupted functional connectivity (FC) in cortex and subcortex, acutely causing more than threefold greater change than methylphenidate. These FC changes were driven by brain desynchronization across spatial scales (areal, global), which dissolved network distinctions by reducing correlations within and anticorrelations between networks. Psilocybin-driven FC changes were strongest in the default mode network" (abstract, results, passage verified)
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Activity in the default mode network is decreased in long-term meditators.
"and interestingly, activity in the default mode network is decreased in long-term meditators." (said at 0:28:18)
Functional neuroimaging studies comparing experienced or long-term meditators to meditation-naive controls demonstrate that core hubs of the default mode network (DMN), including the medial prefrontal cortex and posterior cingulate cortex, show significantly reduced activation during meditation and at baseline. Because these findings are derived from cross-sectional functional neuroimaging (fMRI) comparisons with modest sample sizes, the GRADE certainty is low.
Psilocybin-occasioned mystical experiences produce enduring increases in the personality domain of openness.
"after these mystical-type experiences, they are enduring changes in the personality dimension of openness." (said at 0:38:44)
Clinical trial evidence directly supports the claim. In a study evaluating healthy adults after high-dose psilocybin sessions, participants who underwent mystical-type experiences demonstrated statistically significant increases in the personality domain of Openness that remained elevated compared to baseline at follow-up more than one year later.
A pilot study combining psilocybin with cognitive behavioral therapy in 15 cigarette smokers achieved an 80% smoking abstinence rate at 6 months.
"we've done a pilot study in cigarette smokers, 15 smokers. We embedded the psilocybin manipulation in the context of a cognitive behavior therapy for smoking cessation. And remarkably, we had 80% abstinence rates at 6 months" (said at 0:39:38)
The speaker accurately describes the results of their 2014 open-label pilot study (Johnson et al.), which combined psilocybin sessions with a structured cognitive behavioral therapy (CBT) protocol in 15 treatment-seeking, nicotine-dependent smokers. At the 6-month follow-up, biologically verified 7-day point-prevalence abstinence was observed in 12 of the 15 participants (80%). The certainty of evidence for general efficacy is very low due to the small sample size and lack of a control group in the open-label pilot design.
- supports: Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. (Journal of psychopharmacology (Oxford, England) 2014) · cited 924x in the literature
"Participants were 15 psychiatrically healthy nicotine-dependent smokers (10 males; mean age of 51 years), with a mean of six previous lifetime quit attempts, and smoking a mean of 19 cigarettes per day for a mean of 31 years at intake. Biomarkers assessing smoking status, and self-report measures of smoking behavior demonstrated that 12 of 15 participants (80%) showed seven-day point prevalence abstinence at 6-month follow-up." (abstract, results, passage verified)
pubmedfull study (doi) - supports: Long-term follow-up of psilocybin-facilitated smoking cessation. (The American journal of drug and alcohol abuse 2017) · cited 709x in the literature
"A recent open-label pilot study (N = 15) found that two to three moderate to high doses (20 and 30 mg/70 kg) of the serotonin 2A receptor agonist, psilocybin, in combination with cognitive behavioral therapy (CBT) for smoking cessation, resulted in substantially higher 6-month smoking abstinence rates than are typically observed with other medications or CBT alone." (abstract, background, passage verified)
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Varenicline yields a 20% to 30% abstinence rate for smoking cessation.
"The varenicline which is probably our best treatment for smoking, 20% to 30%" (said at 0:40:23)
High-certainty evidence from randomized controlled trials and Cochrane systematic reviews confirms that varenicline is one of the most effective monotherapies for smoking cessation, achieving long-term continuous abstinence rates of approximately 20% to 30%. In a pooled meta-analysis of randomized controlled trials (PMID 25846123), continuous abstinence on varenicline was 22% at 52 weeks (and 49% at 9–12 weeks). Cochrane systematic reviews and network meta-analyses also confirm varenicline's superior efficacy compared to placebo, bupropion, and single-form nicotine replacement therapies.
- supports: Pharmacological interventions for smoking cessation: an overview and network meta-analysis… (The Cochrane database of systematic reviews 2013) · cited 1249x in the literature
"Varenicline increased the odds of quitting compared with placebo (OR 2.88; 95% CredI 2.40 to 3.47). Head-to-head comparisons between bupropion and NRT showed equal efficacy (OR 0.99; 95% CredI 0.86 to 1.13). Varenicline was superior to single forms of NRT (OR 1.57; 95% CredI 1.29 to 1.91), and to bupropion (OR 1.59; 95% CredI 1.29 to 1.96)." (abstract, results, passage verified)
pubmedfull study (doi) - supports: Abstinence and relapse among smokers who use varenicline in a quit attempt-a pooled analys… (Addiction (Abingdon, England) 2015) · cited 39x in the literature
"In varenicline-treated participants the relapse from weeks 9-12 to week 52 was 55%: 49% abstinent in weeks 9-12 (95% CI = 45-53%) versus 22% at week 52 (95% CI = 19-25%)." (abstract, results, passage verified)
pubmedfull study (doi) - supports: Nicotine receptor partial agonists for smoking cessation. (The Cochrane database of systematic reviews 2016)
"The pooled RR for continuous or sustained abstinence at six months or longer for varenicline at standard dosage versus placebo was 2.24 (95% CI 2.06 to 2.43; 27 trials, 12,625 people; high-quality evidence). Varenicline at lower or variable doses was also shown to be effective, with an RR of 2.08 (95% CI 1.56 to 2.78; 4 trials, 1266 people). The pooled RR for varenicline versus bupropion at six months was 1.39 (95% CI 1.25 to 1.54; 5 trials, 5877 people; high-quality evidence)." (abstract, results, passage verified)
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Clinical trials investigating psilocybin for substance use disorders include studies on alcohol use disorder at NYU and cocaine dependence at the University of Alabama.
"There's work going on at NYU in alcoholism. There's some work going on at University of Alabama on cocaine dependence." (said at 0:40:43)
The claim accurately reflects clinical trial programs evaluating psilocybin-assisted psychotherapy for substance use disorders. NYU Grossman School of Medicine researchers (led by Michael Bogenschutz) conducted a double-blind, randomized controlled trial investigating psilocybin for alcohol use disorder (NCT02061293), showing significant reductions in heavy drinking days. Concurrently, researchers at the University of Alabama at Birmingham (led by Peter Hendricks) conducted a randomized, placebo-controlled trial evaluating psilocybin for cocaine use disorder (NCT02037126).
In a survey of approximately 2,000 people about their worst psilocybin mushroom experience, approximately 10% reported putting themselves or others at risk of physical harm.
"we just, actually very recently, completed and published a large survey study of people who...this was about 2000 people, and we asked them, have you ever had a bad trip after taking psilocybin mushrooms? ... we have about 10% who say that they may have put themselves or others at risk of physical harm during the experience." (said at 0:45:24)
A 2016 survey study by Carbonaro and colleagues evaluated 1,993 individuals who reported on their single most psychologically difficult experience (worst "bad trip") following psilocybin mushroom ingestion. In that sample, exactly 11% reported having put themselves or others at risk of physical harm during the experience, directly supporting the speaker's claim.
In a survey of bad trips on psilocybin, a subset of respondents reported enduring psychological problems for which they sought psychiatric or psychological treatment within a year after the experience.
"And there's some percentage of people who say that they have enduring psychological problems for which they are seeking out psychological or psychiatric help with a year after the experience." (said at 0:46:20)
In a 2016 retrospective online survey by Carbonaro and colleagues investigating individuals' worst 'bad trip' after consuming psilocybin mushrooms (n = 1,993), 7.6% of respondents whose challenging experience had occurred more than one year prior reported seeking professional treatment for enduring psychological symptoms.
Approximately 30% of research volunteers in controlled psilocybin sessions report experiencing significant fear or anxiety for some duration of the session.
"we have about 30% of our volunteers who will describe, at least for some duration of time, experiences of significant fear or anxiety come up." (said at 0:50:26)
Double-blind, randomized controlled trials evaluating high-dose psilocybin in controlled laboratory settings document that roughly 30% to 39% of participants report transient episodes of strong fear, anxiety, or psychological struggle during the session, which are typically managed safely with preparation and interpersonal support.
The probability of experiencing very difficult or challenging reactions to psilocybin increases significantly between doses of 20 mg and 30 mg per 70 kg body weight.
"the probability of the very difficult experiences increase pretty significantly between 20 and 30 milligrams per 70 kilogram." (said at 0:52:44)
A double-blind, randomized crossover dose-effect study by Griffiths and colleagues (PMID: 21674151) evaluated oral psilocybin across five dose conditions (0, 5, 10, 20, and 30 mg/70 kg) in healthy adults. The trial found that while mystical-type positive effects plateaued between 20 mg/70 kg and 30 mg/70 kg, acute episodes of extreme anxiety, fear, and challenging psychological experiences increased substantially at the highest dose (30 mg/70 kg), with 39% of participants reporting extreme anxiety/fear during the high-dose sessions.
In the Johns Hopkins study investigating psilocybin for cancer-related distress, the primary high dose administered was 22 mg per 70 kg body weight.
"And with the cancer study, for instance, the dose that we used most often in that was 22 milligrams per 70 kilogram." (said at 0:53:17)
In the landmark Johns Hopkins randomized, double-blind crossover trial evaluating psilocybin for cancer-related depression and anxiety (Griffiths et al., 2016), psilocybin was administered using weight-adjusted dosing. The study compared a very low control dose (1 or 3 mg/70 kg) to a high therapeutic dose (22 or 30 mg/70 kg) administered with psychological support, confirming the use of 22 mg/70 kg as a primary high dose.
In the cancer-related distress trials involving 51 patients at Johns Hopkins and 29 at NYU, there was no indication that volunteers were psychologically harmed by psilocybin sessions.
"In the 51 volunteers we treated, and the 29 that were treated at NYU, we have no indication that people were harmed by these experiences" (said at 0:54:21)
Two seminal randomized, double-blind crossover trials published simultaneously in 2016 evaluated psilocybin-assisted psychotherapy in patients with life-threatening cancer and associated anxiety or depression: Griffiths et al. at Johns Hopkins University (51 participants) and Ross et al. at New York University (29 participants). Both studies observed rapid, substantial, and sustained improvements in anxiety, depression, and quality of life up to 6 months post-treatment, with no indications of lasting psychological harm or serious adverse psychiatric events resulting from the psilocybin sessions.
- supports: Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depre… (Journal of psychopharmacology (Oxford, England) 2016) · cited 1731x in the literature
"In this double-blind, placebo-controlled, crossover trial, 29 patients with cancer-related anxiety and depression were randomly assigned and received treatment with single-dose psilocybin (0.3 mg/kg) or niacin, both in conjunction with psychotherapy... Prior to the crossover, psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life." (abstract, results, passage verified)
pubmedfull study (doi) - supports: Psilocybin produces substantial and sustained decreases in depression and anxiety in patie… (Journal of psychopharmacology (Oxford, England) 2016) · cited 2225x in the literature
"The effects of psilocybin were studied in 51 cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety... High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety. At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety." (abstract, results)
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In the initial Johns Hopkins psilocybin study with hallucinogen-naive participants, high-dose methylphenidate was utilized as an active control, and participants were informed they could receive any of 11 different psychoactive compounds.
"Our first study, we actually gave a pretty high dose of methylphenidate or Ritalin as a control substance, and these were people who had never had a hallucinogen before. And furthermore, they were told that they could get 11 different kinds of psychoactive compounds." (said at 0:56:27)
The landmark 2006 Johns Hopkins study by Roland Griffiths and colleagues evaluated the acute and sustained effects of psilocybin in 36 hallucinogen-naive healthy adults. To control for expectancy and non-specific stimulant effects, the study used a high dose of methylphenidate (40 mg/70 kg) as an active control in a double-blind, counterbalanced crossover design. To further obscure the study design and reduce expectancy biases, participants were instructed that they could receive a drug from a broad list of different psychoactive compounds or placebo across their sessions.
Mescaline, the active compound found in peyote, is a serotonin 5-HT2A receptor agonist.
"Of course, we have peyote, which is mescaline, which is another serotonergic 2A agonist used by the American Indian." (said at 1:12:31)
Mescaline, a psychoactive protoalkaloid found in the peyote cactus (Lophophora williamsii), is well-established in pharmacological and neurobiological literature as a classic serotonergic psychedelic that exerts its primary hallucinogenic and perceptual effects via agonism at the serotonin 5-HT2A receptor.
- supports: Hallucinogens and Serotonin 5-HT 2A Receptor-Mediated Signaling Pathways. (Current topics in behavioral neurosciences 2018) · cited 309x in the literature
"Hallucinogens, which include naturally occurring chemicals such as mescaline and psilocybin, as well as synthetic compounds, such as lysergic acid diethylamide (LSD), induce profound alterations of human consciousness, emotion, and cognition... Although they bind other G protein-coupled receptor (GPCR) subtypes, studies indicate that several effects of hallucinogens involve agonist activity at the serotonin 5-HT 2A receptor." (abstract, introduction/background, passage verified)
pubmedfull study (doi) - supports: Effects of acute and repeated treatment with serotonin 5-HT2A receptor agonist hallucinoge… (Experimental and clinical psychopharmacology 2019) · cited 43x in the literature
"The prototype 5-HT2A receptor agonist hallucinogens LSD, mescaline, and psilocybin are classified as Schedule 1 drugs of abuse by the U.S. Drug Enforcement Administration." (abstract, introduction, passage verified)
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The subjective effects of inhaled Salvinorin A last less than 10 minutes, with individuals returning completely to baseline within 20 minutes.
"The effects of Salvinorin, this was inhaled Salvinorin, are very short-lived. Less than 10 minutes. So it's a very rapid onset and people are completely back to baseline within 20 minutes, but most of the effects have resolved much quicker than that." (said at 1:50:03)
Clinical pharmacodynamic studies of inhaled salvinorin A in healthy volunteers confirm that its subjective effects have a rapid onset, peak within 1 to 2 minutes, rapidly dissipate over the first several minutes, and return completely to baseline by approximately 20 minutes after administration.
- supports: Human psychopharmacology and dose-effects of salvinorin A, a kappa opioid agonist hallucin… (Drug and alcohol dependence 2011) · cited 137x in the literature
"Drug strength ratings peaked at 2 min (first time point) and definite subjective effects were no longer present at approximately 20 min after inhalation." (abstract, results, passage verified)
pubmedfull study (doi) - supports: Dose-related effects of salvinorin A in humans: dissociative, hallucinogenic, and memory e… (Psychopharmacology 2013) · cited 136x in the literature
"Orderly dose-related effects peaked at 2 min and then rapidly dissipated, replicating previous findings." (abstract, results, passage verified)
pubmedfull study (doi) - supports: Salvinorin A in humans: A systematic review of pharmacokinetics, pharmacodynamics, and saf… (Journal of psychopharmacology (Oxford, England) 2026)
"Pharmacokinetic profiles were characterized by rapid onset within seconds, peak effects at 1-2 minutes, and resolution within 30 minutes, consistent with fast absorption and clearance." (abstract, results, passage verified)
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Ayahuasca combines dimethyltryptamine (DMT) with a monoamine oxidase (MAO) inhibitor, which prevents rapid metabolism in the gut and prolongs its duration of action.
"DMT is also the active ingredient in ayahuasca, which is the brew that's consumed mostly in South America, and by some of these syncretic religions. And that's when the DMT is combined with an MAO inhibitor that slows down the metabolism in the gut. And so it changes the duration of action and makes it more like psilocybin" (said at 1:51:08)
The speaker's statement accurately describes the established pharmacological mechanism of ayahuasca. N,N-dimethyltryptamine (DMT) is rapidly degraded in the gastrointestinal tract and liver by monoamine oxidase A (MAO-A) during first-pass metabolism, rendering oral DMT largely inactive on its own. In ayahuasca preparations, DMT-containing plants (such as Psychotria viridis) are combined with plants containing β-carboline alkaloids (such as Banisteriopsis caapi, rich in harmine, harmaline, and tetrahydroharmine). These β-carbolines act as reversible MAO-A inhibitors, preventing peripheral enzymatic breakdown in the gut and liver, thereby conferring oral bioavailability and markedly extending its duration of psychoactive action to several hours, comparable to other classic oral psychedelics like psilocybin.
- supports: Metabolism and disposition of N,N-dimethyltryptamine and harmala alkaloids after oral admi… (Drug testing and analysis 2012) · cited 92x in the literature
"The β-carbolines reversibly inhibit monoamine-oxidase (MAO), effectively preventing oxidative deamination of the orally labile DMT and allowing its absorption and access to the central nervous system." (abstract, introduction, passage verified)
pubmedfull study (doi) - supports: Toxicokinetics and Toxicodynamics of Ayahuasca Alkaloids N , N -Dimethyltryptamine (DMT), … (Pharmaceuticals (Basel, Switzerland) 2020) · cited 113x in the literature
"Harmala alkaloids act as potent inhibitors of monoamine oxidase A (MAO-A), preventing extensive first-pass degradation of DMT into 3-indole-acetic acid (3-IAA), and enabling sufficient amounts of DMT to reach the brain." (abstract, results, passage verified)
pubmedfull study (doi) - supports: Neurobiological research on N,N-dimethyltryptamine (DMT) and its potentiation by monoamine… (Cellular and molecular life sciences : CMLS 2024) · cited 33x in the literature
"Due to rapid first pass metabolism, DMT is nearly inactive orally, but co-administration with β-carbolines or synthetic MAO-A inhibitors (MAOIs) greatly increase its bioavailability and duration of action." (abstract, background, passage verified)
pubmedfull study (doi)
Fact-checked episodes
Publications
- Sex Differences in Religious Beliefs Before and After an Entity Encounter During an Ayahuasca Experience.Journal of psychoactive drugs 2026 · CEBM Level 4
- Psychedelic Experiences Increase Mind Perception but do not Change Atheist-Believer Status: A Prospective Longitudinal Study.Journal of psychoactive drugs 2025 · CEBM Level 3
- A Field-Wide Review and Analysis of Study Materials Used in Psilocybin Trials: Assessment of Two Decades of Research.Psychedelic medicine (New Rochelle, N.Y.) 2025 · CEBM Level 4
- Effects of Psilocybin on Religious and Spiritual Attitudes and Behaviors in Clergy from Various Major World Religions.Psychedelic medicine (New Rochelle, N.Y.) 2025 · CEBM Level 2
- Translation and Initial Psychometric Evaluation of Spanish Versions of Three Psychedelic Acute Effects Measures: Mystical, Challenging, and Insight Experiences.Journal of psychoactive drugs 2024 · CEBM Level 4
- Unique effects of sedatives, dissociatives, psychedelics, stimulants, and cannabinoids on episodic memory: A review and reanalysis of acute drug effects on recollection, familiarity, and metamemory.Psychological review 2024 · CEBM Level 3
- The therapeutic alliance between study participants and intervention facilitators is associated with acute effects and clinical outcomes in a psilocybin-assisted therapy trial for major depressive disorder.PloS one 2024 · CEBM Level 3
- Impact of Psilocybin on Peripheral Cytokine Production.Psychedelic medicine (New Rochelle, N.Y.) 2024 · CEBM Level 3
- Psilocybin-assisted psychotherapy improves psychiatric symptoms across multiple dimensions in patients with cancer.Nature. Mental health 2024 · CEBM Level 2
- Belief changes associated with psychedelic use.Journal of psychopharmacology (Oxford, England) 2023 · CEBM Level 4
- Clinical Trial Design Challenges and Opportunities for Emerging Treatments for Opioid Use Disorder: A Review.JAMA psychiatry 2023 · CEBM Level 5
- Subtypes of the psychedelic experience have reproducible and predictable effects on depression and anxiety symptoms.Journal of affective disorders 2023 · CEBM Level 4
- Corrigendum to 'Psilocybin induces spatially constrained alterations in thalamic functional organizaton and connectivity': Neuroimage 2022 Oct 15;260:119434.NeuroImage 2023 · CEBM Level 5
- Attenuation of psilocybin mushroom effects during and after SSRI/SNRI antidepressant use.Journal of psychopharmacology (Oxford, England) 2023 · CEBM Level 4
- Assessing the risk of symptom worsening in psilocybin-assisted therapy for depression: A systematic review and individual participant data meta-analysis.Psychiatry research 2023 · CEBM Level 1
- Single-Dose Psilocybin Treatment for Major Depressive Disorder: A Randomized Clinical Trial.JAMA 2023 · CEBM Level 2
- Psychedelic Science, Contemplative Practices, and Indigenous and Other Traditional Knowledge Systems: Towards Integrative Community-Based Approaches in Global Health.Journal of psychoactive drugs 2023 · CEBM Level 5
- Naturalistic psilocybin use is associated with persisting improvements in mental health and wellbeing: results from a prospective, longitudinal survey.Frontiers in psychiatry 2023 · CEBM Level 3
- Double-Blind Comparison of the Two Hallucinogens Dextromethorphan and Psilocybin: Experience-Dependent and Enduring Psychological Effects in Healthy Volunteers.Psychedelic medicine (New Rochelle, N.Y.) 2023 · CEBM Level 2
- Past, Present, and Future of Psychedelics: A Psychedelic Medicine Roundtable Discussion.Psychedelic medicine (New Rochelle, N.Y.) 2023 · CEBM Level 5
- Models of psychedelic drug action: modulation of cortical-subcortical circuits.Brain : a journal of neurology 2022 · CEBM Level 5
- The Potential of Psychedelics for End of Life and Palliative Care.Current topics in behavioral neurosciences 2022 · CEBM Level 5
- Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: Prospective 12-month follow-up.Journal of psychopharmacology (Oxford, England) 2022 · CEBM Level 3
- A Single Belief-Changing Psychedelic Experience Is Associated With Increased Attribution of Consciousness to Living and Non-living Entities.Frontiers in psychology 2022 · CEBM Level 4
- Phenomenology and content of the inhaled N, N-dimethyltryptamine (N, N-DMT) experience.Scientific reports 2022 · CEBM Level 4
- Psilocybin induces spatially constrained alterations in thalamic functional organizaton and connectivity.NeuroImage 2022 · CEBM Level 4
- Psychedelic drug abuse potential assessment research for new drug applications and Controlled Substances Act scheduling.Neuropharmacology 2022 · CEBM Level 5
- Comparison of psychedelic and near-death or other non-ordinary experiences in changing attitudes about death and dying.PloS one 2022 · CEBM Level 4
- Preparing for the Bursting of the Psychedelic Hype Bubble.JAMA psychiatry 2022 · CEBM Level 5
- Psychedelic-Assisted Therapy for People with Eating Disorders.Current psychiatry reports 2022 · CEBM Level 5
- Ethical Issues Regarding Nonsubjective Psychedelics as Standard of Care.Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees 2022 · CEBM Level 5
- Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial.JAMA psychiatry 2021 · CEBM Level 2
- Psychedelics in Psychiatry-Keeping the Renaissance From Going Off the Rails.JAMA psychiatry 2021 · CEBM Level 5
- Development of the Psychological Insight Questionnaire among a sample of people who have consumed psilocybin or LSD.Journal of psychopharmacology (Oxford, England) 2021 · CEBM Level 4
- Trends in the Top-Cited Articles on Classic Psychedelics.Journal of psychoactive drugs 2021 · CEBM Level 4
- Errors in a Response Rate and in Effect Sizes in Study of Psilocybin-Assisted Therapy for Major Depressive Disorder.JAMA psychiatry 2021 · CEBM Level 5
- Optimal dosing for psilocybin pharmacotherapy: Considering weight-adjusted and fixed dosing approaches.Journal of psychopharmacology (Oxford, England) 2021 · CEBM Level 3
- The Subjective Effects of Psychedelics Are Necessary for Their Enduring Therapeutic Effects.ACS pharmacology & translational science 2021 · CEBM Level 5
- Psychedelics and Consciousness: Distinctions, Demarcations, and Opportunities.The international journal of neuropsychopharmacology 2021 · CEBM Level 5
- Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports.Pharmacopsychiatry 2021 · CEBM Level 4
- Psilocybin therapy increases cognitive and neural flexibility in patients with major depressive disorder.Translational psychiatry 2021 · CEBM Level 4
- Human Cortical Serotonin 2A Receptor Occupancy by Psilocybin Measured Using [ 11 C]MDL 100,907 Dynamic PET and a Resting-State fMRI-Based Brain Parcellation.Frontiers in neuroergonomics 2021 · CEBM Level 4
- Kratom (Mitragyna speciosa): User demographics, use patterns, and implications for the opioid epidemic.Drug and alcohol dependence 2020 · CEBM Level 4
- Emotions and brain function are altered up to one month after a single high dose of psilocybin.Scientific reports 2020 · CEBM Level 4
- Prevalence and Correlates of Caffeine Use Disorder Symptoms Among a United States Sample.Journal of caffeine and adenosine research 2020 · CEBM Level 4
- Survey of entity encounter experiences occasioned by inhaled N,N -dimethyltryptamine: Phenomenology, interpretation, and enduring effects.Journal of psychopharmacology (Oxford, England) 2020 · CEBM Level 4
- Psilocybin acutely alters the functional connectivity of the claustrum with brain networks that support perception, memory, and attention.NeuroImage 2020 · CEBM Level 2
- Subjective features of the psilocybin experience that may account for its self-administration by humans: a double-blind comparison of psilocybin and dextromethorphan.Psychopharmacology 2020 · CEBM Level 2
- Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety.Journal of contextual behavioral science 2020 · CEBM Level 4
- The Acute Effects of the Atypical Dissociative Hallucinogen Salvinorin A on Functional Connectivity in the Human Brain.Scientific reports 2020 · CEBM Level 2
- Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function.Pharmacology & therapeutics 2019 · CEBM Level 5
- A randomized controlled trial of a manual-only treatment for reduction and cessation of problematic caffeine use.Drug and alcohol dependence 2019 · CEBM Level 2
- 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) used in a naturalistic group setting is associated with unintended improvements in depression and anxiety.The American journal of drug and alcohol abuse 2019 · CEBM Level 4
- Survey of subjective "God encounter experiences": Comparisons among naturally occurring experiences and those occasioned by the classic psychedelics psilocybin, LSD, ayahuasca, or DMT.PloS one 2019 · CEBM Level 4
- Cessation and reduction in alcohol consumption and misuse after psychedelic use.Journal of psychopharmacology (Oxford, England) 2019 · CEBM Level 4
- Persisting Reductions in Cannabis, Opioid, and Stimulant Misuse After Naturalistic Psychedelic Use: An Online Survey.Frontiers in psychiatry 2019 · CEBM Level 4
- Classic Hallucinogens and Mystical Experiences: Phenomenology and Neural Correlates.Current topics in behavioral neurosciences 2018 · CEBM Level 5
- Psilocybin-occasioned mystical-type experience in combination with meditation and other spiritual practices produces enduring positive changes in psychological functioning and in trait measures of prosocial attitudes and behaviors.Journal of psychopharmacology (Oxford, England) 2018 · CEBM Level 2
- Double-blind comparison of the two hallucinogens psilocybin and dextromethorphan: similarities and differences in subjective experiences.Psychopharmacology 2018 · CEBM Level 2
- The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act.Neuropharmacology 2018 · CEBM Level 5
- Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts.Journal of psychopharmacology (Oxford, England) 2018 · CEBM Level 4
- Double-blind comparison of the two hallucinogens psilocybin and dextromethorphan: effects on cognition.Psychopharmacology 2018 · CEBM Level 2
- Intensity of Mystical Experiences Occasioned by 5-MeO-DMT and Comparison With a Prior Psilocybin Study.Frontiers in psychology 2018 · CEBM Level 4
- Long-term follow-up of psilocybin-facilitated smoking cessation.The American journal of drug and alcohol abuse 2017 · CEBM Level 4
- An online survey of tobacco smoking cessation associated with naturalistic psychedelic use.Journal of psychopharmacology (Oxford, England) 2017 · CEBM Level 4
- Effects of caffeine on alcohol reinforcement: beverage choice, self-administration, and subjective ratings.Psychopharmacology 2017 · CEBM Level 2
- The factor structure of the Mystical Experience Questionnaire (MEQ): Reply to Bouso et al., 2016.Human psychopharmacology 2017 · CEBM Level 5
- Potential Therapeutic Effects of Psilocybin.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics 2017 · CEBM Level 5
- Neuroticism is associated with challenging experiences with psilocybin mushrooms.Personality and individual differences 2017 · CEBM Level 4
- Qualitative and Quantitative Features of Music Reported to Support Peak Mystical Experiences during Psychedelic Therapy Sessions.Frontiers in psychology 2017 · CEBM Level 4
- A brief manualized treatment for problematic caffeine use: A randomized control trial.Journal of consulting and clinical psychology 2016 · CEBM Level 2
- Naltrexone but Not Ketanserin Antagonizes the Subjective, Cardiovascular, and Neuroendocrine Effects of Salvinorin-A in Humans.The international journal of neuropsychopharmacology 2016 · CEBM Level 2
- Time course of pharmacokinetic and hormonal effects of inhaled high-dose salvinorin A in humans.Journal of psychopharmacology (Oxford, England) 2016 · CEBM Level 4
- Weekly Energy Drink Use Is Positively Associated with Delay Discounting and Risk Behavior in a Nationwide Sample of Young Adults.Journal of caffeine research 2016 · CEBM Level 4
- Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences.Journal of psychopharmacology (Oxford, England) 2016 · CEBM Level 4
- The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms.Journal of psychopharmacology (Oxford, England) 2016 · CEBM Level 4
- Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial.Journal of psychopharmacology (Oxford, England) 2016 · CEBM Level 2
- Inhaled vs. oral alprazolam: subjective, behavioral and cognitive effects, and modestly increased abuse potential.Psychopharmacology 2015 · CEBM Level 2
- Nicotine reinforcement in never-smokers.Psychopharmacology 2015 · CEBM Level 2
- Psilocybin, psychological distress, and suicidality.Journal of psychopharmacology (Oxford, England) 2015 · CEBM Level 5
- Validation of the revised Mystical Experience Questionnaire in experimental sessions with psilocybin.Journal of psychopharmacology (Oxford, England) 2015 · CEBM Level 4
- Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction.Journal of psychopharmacology (Oxford, England) 2014 · CEBM Level 4
- Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction.Current drug abuse reviews 2014 · CEBM Level 4
- Acute cognitive effects of high doses of dextromethorphan relative to triazolam in humans.Drug and alcohol dependence 2013 · CEBM Level 2
- Cognitive effects of intramuscular ketamine and oral triazolam in healthy volunteers.Psychopharmacology 2013 · CEBM Level 2
- Dose-related effects of salvinorin A in humans: dissociative, hallucinogenic, and memory effects.Psychopharmacology 2013 · CEBM Level 2
- Comparative abuse liability of GHB and ethanol in humans.Experimental and clinical psychopharmacology 2013 · CEBM Level 2
- LC-MS/MS quantification of salvinorin A from biological fluids.Analytical methods : advancing methods and applications 2013 · CEBM Level 5
- Caffeine Withdrawal and Dependence: A Convenience Survey Among Addiction Professionals.Journal of caffeine research 2013 · CEBM Level 4
- Caffeine Use Disorder: A Comprehensive Review and Research Agenda.Journal of caffeine research 2013 · CEBM Level 5
- Acute effects of zolpidem extended-release on cognitive performance and sleep in healthy males after repeated nightly use.Experimental and clinical psychopharmacology 2012 · CEBM Level 2
- Psilocybin dose-dependently causes delayed, transient headaches in healthy volunteers.Drug and alcohol dependence 2012 · CEBM Level 2
- Characterization of individuals seeking treatment for caffeine dependence.Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors 2012 · CEBM Level 4
- High doses of dextromethorphan, an NMDA antagonist, produce effects similar to classic hallucinogens.Psychopharmacology 2012 · CEBM Level 2
- Factor Analysis of the Mystical Experience Questionnaire: A Study of Experiences Occasioned by the Hallucinogen Psilocybin.Journal for the scientific study of religion 2012 · CEBM Level 4
- Energy drink consumption and increased risk for alcohol dependence.Alcoholism, clinical and experimental research 2011 · CEBM Level 3
- Intravenous self-administration of γ-hydroxybutyrate (GHB) in baboons.Drug and alcohol dependence 2011 · CEBM Level 5
- Human psychopharmacology and dose-effects of salvinorin A, a kappa opioid agonist hallucinogen present in the plant Salvia divinorum.Drug and alcohol dependence 2011 · CEBM Level 2
- Caffeine choice prospectively predicts positive subjective effects of caffeine and d-amphetamine.Drug and alcohol dependence 2011 · CEBM Level 2
- Psilocybin occasioned mystical-type experiences: immediate and persisting dose-related effects.Psychopharmacology 2011 · CEBM Level 2
- Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness.Journal of psychopharmacology (Oxford, England) 2011 · CEBM Level 3
- Evaluating Dependence Criteria for Caffeine.Journal of caffeine research 2011 · CEBM Level 4
- Dose effects of triazolam and alcohol on cognitive performance in healthy volunteers.Experimental and clinical psychopharmacology 2010 · CEBM Level 2
- Dose effects of triazolam and scopolamine on metamemory.Experimental and clinical psychopharmacology 2010 · CEBM Level 2
- Effects of oral caffeine pretreatment on response to intravenous nicotine and cocaine.Experimental and clinical psychopharmacology 2010 · CEBM Level 2
- Increased alcohol consumption, nonmedical prescription drug use, and illicit drug use are associated with energy drink consumption among college students.Journal of addiction medicine 2010 · CEBM Level 3
- Caffeinated energy drinks--a growing problem.Drug and alcohol dependence 2009 · CEBM Level 5
- Caffeine withdrawal, acute effects, tolerance, and absence of net beneficial effects of chronic administration: cerebral blood flow velocity, quantitative EEG, and subjective effects.Psychopharmacology 2009 · CEBM Level 2
- Principles of laboratory assessment of drug abuse liability and implications for clinical development.Drug and alcohol dependence 2009 · CEBM Level 5
- Illicit gamma-hydroxybutyrate (GHB) and pharmaceutical sodium oxybate (Xyrem): differences in characteristics and misuse.Drug and alcohol dependence 2009 · CEBM Level 5
- Cognitive, psychomotor, and subjective effects of sodium oxybate and triazolam in healthy volunteers.Psychopharmacology 2009 · CEBM Level 2
- Attenuation of cocaine-seeking by GABA B receptor agonists baclofen and CGP44532 but not the GABA reuptake inhibitor tiagabine in baboons.Drug and alcohol dependence 2007 · CEBM Level 5
- A triazolam/amphetamine dose-effect interaction study: dissociation of effects on memory versus arousal.Psychopharmacology 2007 · CEBM Level 2
- Relative abuse liability of indiplon and triazolam in humans: a comparison of psychomotor, subjective, and cognitive effects.The Journal of pharmacology and experimental therapeutics 2007 · CEBM Level 2
- Differential effects of scopolamine and lorazepam on working memory maintenance versus manipulation processes.Cognitive, affective & behavioral neuroscience 2007 · CEBM Level 2
- Ramelteon: a novel hypnotic lacking abuse liability and sedative adverse effects.Archives of general psychiatry 2006 · CEBM Level 2
- Chronic intragastric administration of gamma-butyrolactone produces physical dependence in baboons.Psychopharmacology 2006 · CEBM Level 5
- Cognitive and subjective acute dose effects of intramuscular ketamine in healthy adults.Experimental and clinical psychopharmacology 2006 · CEBM Level 2