PSA Profile: Examining the Future of Psychedelic Pharmacology with Dr. Emily Kulpa
Co-founder of the Psychedelic Pharmacists' Association
Dr. Emily Kulpa has been working at the cutting edge of psychedelic science for a half-decade and counting. Early in her career as a licensed pharmacist, Dr. Kulpa grappled with the shortcomings of modern pharmaceutical mental health care on both a professional and deeply personal level.
Perturbed by her experiences within the modern American healthcare system, her journey through the crossroads of pharmacology and plant medicine led her to the front lines of psychedelic science itself - firstly north of the border and across the pond, but now back at home as co-founder of the Psychedelic Pharmacists’ Association and as a licensed provider of psilocybin-assisted therapy through her private practice in Portland, Oregon.
In this remarkably candid interview, Dr. Kulpa dives deep into the murky waters of psychedelic pharmacology - speaking with not only scientific expertise gained directly from her work in the field, but also with an earnest vulnerability that serves as an essential-to-read example of the forward-thinking courage that it takes for medical professionals like Dr. Kulpa and her colleagues at the PPA to fight for the integration of psychedelic pharmacology into western hemispheric healthcare from inside the pharmaceutical industry itself.
Gorsline: When and why did you first become interested in psychedelics?
Kulpa: I have faced the challenges of depression and anxiety for a considerable portion of my life, beginning in my teenage years. Throughout my journey, both before and during pharmacy school, I tried numerous antidepressants and anti-anxiety medications, none of which proved effective for me. My first role as a clinical pharmacist was with a managed care organization, where I noticed a recurring theme among my patients with mental health conditions: like me, many had tried and failed to find relief through conventional antidepressants.
Even after completing pharmacy school, I continued to struggle with depression, at times grappling with severe suicidal thoughts. I distinctly remember being at work, thinking “I can’t accept that the medications I had tried and failed were the only pharmaceutical treatments available.” My quest for alternatives led me to discover recent studies conducted at institutions like Imperial College and Johns Hopkins, exploring the use of psychedelic substances over the past decade. The research revealed that these substances, when used responsibly in a controlled setting with proper preparation, were generally safe and posed minimal risks, showing promise particularly for individuals with treatment-resistant mental health conditions.
Motivated by this revelation, I became involved with the Canadian Centre for Psychedelic Science, contributing to their pioneering research on microdosing. This experience, combined with my in-depth review of the research, solidified my interest in exploring these substances both for personal healing and to assist others facing similar struggles. In 2019, my journey led me to Berlin to attend a conference on psychedelics hosted by the Mind Foundation, where I had the opportunity to meet the CEO of Compass Pathways at the time and a Director at the Synthesis Institute.
Subsequently, I traveled to the Netherlands to legally purchase psilocybin truffles, marking the beginning of an indescribably profound experience unlike any I had previously encountered. Following this experience, I was convinced of the significant potential these substances hold and became determined to involve myself further in this field.
What’s the origin story behind the Psychedelic Pharmacists Association?
Soon after my trip to Berlin, my desire to immerse myself in the psychedelic field led me to join the Synthesis Institute, a legal psilocybin retreat center in the Netherlands, as an independent contractor. In my role as the Health and Safety Screening Director, I collaborated closely with psychologists, therapists, and psychiatry residents to meticulously screen applicants for the retreats, ensuring their psychological and physical safety. This task was both exhilarating and daunting, given the novelty of the research and my ongoing education about these substances. During my experience, the complexity of applicants' medication regimens, often involving multiple psychotropic drugs, stood out. With limited knowledge on drug interactions at the time, we had to turn away a considerable number of applicants. However, we gradually gained more insight into the potential interactions between antidepressants and psychedelic substances.
I noticed the scarcity of pharmacists in this emerging field, despite the presence of therapists, psychiatrists, doctors, and nurses. Given the psychedelic-assisted therapy involves drug-assisted interventions, I believed pharmacists could play a crucial role, offering unique insights into drug interactions, aiding in medication tapering, and providing harm reduction education.
Motivated to make a difference, I boldly showcased my psychedelic work and interests on my LinkedIn profile, seeking to connect with other researchers and advocates in the field. I reached out to a few pharmacists already involved, such as Ben Malcolm, Paul Hutson, and Kelan Thomas. My actions sparked interest among other pharmacists and pharmacy students, leading to numerous conversations about my work and career trajectory. Before long, a group of seven of us, sharing a passion for the potential of psychedelics, began meeting regularly. I thrive on visionary thinking and creative problem-solving, relishing the opportunity to lead projects and bring ideas to life. Encouraged by a co-founder, Sa’ed Al-Olimat, I took decisive steps to formalize our collective endeavor: filing our articles of incorporation, registering our domain name, and using my address for the official record. With consensus from the group, I became the inaugural president of the newly formed Psychedelic Pharmacists Association.
As a co-founder of the aforementioned Psychedelic Pharmacists Association, what role(s) do you see yourself and the PPA playing in shaping the future of psychedelic medicine and pharmacology in the United States?
I envision myself in diverse roles. On one hand, I am an advocate for the utilization of psychedelic-assisted therapies and the furtherance of mental healthcare and consciousness studies. On the other hand, I champion the expansion of pharmacists' roles within primary and mental healthcare, advocating for an enlarged scope of practice that includes prescribing rights among other responsibilities. As a licensed facilitator in Oregon, I am actively accepting new clients for legally guided psilocybin administration sessions. Additionally, I serve as a consultant and harm reduction educator within the psychedelic medicine field and am in the process of developing support programs for clients tapering off antidepressants.
Ultimately, I see my role extending beyond individual healing to include fostering recovery within collective, organizational, and global contexts. I see the Psychedelic Pharmacists Association (PPA) as a pivotal resource for pharmacists, healthcare professionals, and other significant stakeholders in the psychedelic medicine arena. Our goal is to aid in state and federal legislative endeavors, offer comprehensive education and insights into pharmacokinetics/pharmacology and medication interactions, and foster multidisciplinary collaborations to ensure a seamless continuum of care.
In your expert opinion, how can Oregon’s psilocybin legalization process serve as a model (or cautionary tale) for other states (like Massachusetts) considering similar legislation?
While I commend Oregon for being the pioneering state to legalize psilocybin, there are notable criticisms of the framework it has adopted. One concern is that early legislative proposals seemed to be influenced by entities operating retreat models, like the Synthesis Institute. This close influence geared the legislation toward a retreat-based model and larger center-type models, which, despite the benefits, inadvertently disadvantages small independent practitioners. This goes against the core intentions behind Oregon's Measure 109, which aimed at broader accessibility and use. The legislation restricts usage to licensed service centers, excluding home or small office settings, and introduces significant financial and operational barriers. Renting a space in these centers as an independent contractor can cost about $500, with a single dose of psilocybin priced at $150-200 from licensed growers. This is compounded by the costs of engaging a licensed facilitator, who themselves may have invested approximately $15,000 in qualifying training on top of a $2,000 annual licensing fee, thus significantly inflating the cost for clients. Moreover, the legislation imposes stringent requirements on opening a licensed center and maintaining licensure, further diminishing access. Each facilitator is also tasked with devising an equity plan to make services accessible and affordable, yet the cost remains uniformly high regardless of a client's income, raising questions about the actual equity achieved and sustainability.
In envisioning the legalization of psychedelic medicines elsewhere, I advocate for a more inclusive model. One approach could allow healthcare providers to prescribe or administer these treatments, considering that five substances have already received breakthrough therapy designation from the FDA. Not everyone may require a licensed facilitator for a meaningful experience; some individuals might benefit from the guidance of an experienced harm reduction educator and the support of a knowledgeable friend.
Drawing inspiration from the Netherlands, where psilocybin truffles are dispensed in designated Smart Shops with educated staff members, I could imagine psilocybin mushrooms being kept behind the pharmacy counter with a comprehensive 60-minute screening and harm reduction education by pharmacists, presenting a viable alternative. Such a model could significantly enhance accessibility while reducing costs, without compromising safety for the right candidates. Data shows that fatalities from psychedelic mushrooms are exceedingly rare, especially when compared to over-the-counter medications like NSAIDs, which are responsible for thousands of deaths annually in the U.S.
This discrepancy raises a critical question about our current drug classification and accessibility standards: Why aren't psychedelic mushrooms more accessible, while common pain relievers, with higher associated mortality rates, remain over-the-counter? This is a question worth contemplating.
Based on your prior experience working in both Netherlands’ and Canada’s healthcare systems, what do you think American legislators and medical practitioners alike can learn from the strengths and shortcomings of the Dutch and Canadian models, respectively?
In the Netherlands, psilocybin truffles are legally available, whereas psilocybin mushrooms were prohibited in 2008. Truffles, which are the sclerotia or underground growths of the mushroom, still contain the psychoactive compound psilocybin. The sale and distribution of psilocybin truffles are regulated and confined to specialized stores known as "smart shops." Individuals who are 18 years of age or older can purchase these truffles from smart shops, provided they show valid identification. Smart shops in the Netherlands have a reputation for encouraging safe consumption practices. They offer guidance on dosages, describe the effects, outline potential risks, and advise on how to mitigate adverse reactions. This proactive approach is designed to minimize harm and educate consumers on responsible usage. Incidents of death or serious harm resulting exclusively from psilocybin truffles are exceptionally rare.
Psilocybin, the active ingredient in both truffles and mushrooms, is recognized for its low toxicity and minimal risk of overdose. Studies and anecdotal evidence suggest that the main hazards linked to psilocybin usage stem not from the drug's pharmacological properties but from the behavioral changes induced by its psychoactive effects. These may lead to accidents or engagement in hazardous activities, particularly in unsupervised or unfamiliar settings. Nonetheless, such incidents that result in serious injury or fatality are rare.
Regarding the Canadian Healthcare model, my insights are limited as my involvement was confined to consulting on a research study without direct engagement with the healthcare system itself.
One of the biggest concerns surrounding psilocybin-assisted therapy is the high cost of treatment sessions. How do you think this issue can be addressed - be it legislatively, commercially, or otherwise - to make psychedelic medicine more accessible to a wider range of patients?
As I’ve mentioned before, one potential model involves keeping psilocybin mushrooms behind the pharmacy counter, where pharmacists could conduct a thorough 60-minute screening and provide comprehensive harm reduction education. This approach could significantly improve accessibility and affordability without sacrificing safety. For those who prefer the presence of a guide or facilitator, services could be offered through facilitation centers or via home visits. Individuals at a higher risk of adverse reactions should receive administration in a clinical setting. Moreover, I advocate for the potential of group sessions to not only reduce costs but also facilitate healing, provided the client is suitable for such a setting. While there are undoubtedly many feasible solutions, a major obstacle remains our culture's prioritization of profits, materialism, and egoic factors over more compassionate values such as mutual healing and collective success. Shifting these cultural values could make the implementation of such solutions far more attainable.
Another challenge facing potential psychedelic therapy providers in Oregon and Colorado is the high cost of certification and licensing for clinicians who want to provide psilocybin-assisted therapy. What are your thoughts on how to address this barrier and encourage more mental health professionals to enter this field?
Answering these questions is challenging for me because I firmly believe that what we need goes beyond reform to a revolution in healthcare and education. The predominant therapeutic approaches currently endorsed and covered by insurance are Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT), reflecting the training focus of therapists obtaining their master's degrees. Research indicates that CBT and DBT are more beneficial than no therapy at all. Nevertheless, there are more profound issues and behavioral patterns that these methods may not fully address. It's interesting to note that therapists themselves might prefer different therapeutic modalities than CBT or DBT for their personal therapy.
In my view, there are several therapeutic approaches that could synergize more effectively with psychedelic substances, such as Internal Family Systems (IFS), NeuroAffective Relational Model (NARM), and Somatic Experiencing (SE). My personal journey includes leaving a DBT program that I found unhelpful and pursuing therapy with IFS and, more recently, a NARM-trained therapist. Based on my experiences, a bad therapist can indeed cause harm, while a great therapist can facilitate profound transformation.
What I believe constitutes an exceptional therapist or psychedelic facilitator includes innate integrity, firm boundaries, self-awareness of one's strengths and limitations, trust in one's intuition, dedication to personal growth, empathy, non-judgment, attentiveness, openness, and genuine curiosity. The current training programs might not fully nurture these qualities. It has taken me extensive personal work over the last five years to feel prepared to responsibly guide clients through psychedelic therapy. My training program in psychedelic facilitation has supplemented my journey with valuable skills and practical experience.
Furthermore, the lack of recognition for developmental trauma or complex PTSD (cPTSD) in the DSM-5—contrary to its acknowledgment in Europe—highlights a significant oversight in the United States. I am convinced that trauma, whether developmental, collective, or generational, underlies many instances of depression and anxiety. If we don’t even know what the root problem is, how can we solve it cost-effectively?
As psychedelic medicine continues to gain traction around the world, what do you see as the best-case and worst-case scenarios for its future in the United States?
In an ideal scenario, we would see the legalization of all drugs under a harm reduction model integrated into a national healthcare system, ensuring that these treatments are both accessible and affordable for everyone. This would coincide with a cultural shift towards valuing healing, restoration, creativity, cooperation, minimalism, and the pursuit of reaching our full human potential.
On the other hand, the worst-case scenario could involve a regression in legislation, increased barriers to access through exorbitant costs, and people not receiving the necessary level of care for true healing and recovery. This issue extends beyond healthcare, reflecting broader societal values and priorities. Currently, our healthcare system is more focused on profits than on healing patients or promoting well-being and longevity. Our culture fails to value rest, healing, and recovery — elements crucial for individuals to truly improve and flourish. They require space and time. As we begin to integrate these substances into our existing systems, the outcome remains to be seen, but it's clear that significant changes are necessary for a healthier future.
What would you say to parents, families, and individuals who might be against or still on the fence about the use, decriminalization, and/or legalization of psychedelics?
I care about the pursuit of truth, analyzing data, and evaluating the benefits versus risks. When you dive into the research data, you might be astonished to find that several psychedelic substances are, for the most part, well-tolerated with minimal adverse effects if used in a controlled environment with intentions and purpose. From our current understanding, these substances are comparatively less harmful than many legal and commonly used substances, including nicotine and alcohol. The justification for rendering these substances illegal initially lacks any scientific or evidence-based foundation. They have been inappropriately classified as Schedule I drugs, alongside heroin and cocaine, despite having entirely different mechanisms of action, side effect profiles, and outcomes.
Every decision carries its own set of risks. Opting to drive to work entails the risk of an accident, injury, or even death. Conversely, the decision to avoid driving due to the fear of accidents could result in job loss if you fail to meet work expectations. Growing up with the DARE program instilled in me a deep-seated fear of using these substances because of the risk of brain damage, insanity, or self-injury. Now I have a doctorate in pharmacy and a bachelor's in biology. I honed my skills in analyzing research papers, learning about human physiology and the interaction of organic and pharmaceutical compounds. Despite my initial trepidation, my extensive research and personal experimentation with various substances have led me to recognize the potential benefits of psychedelic medicines in alleviating symptoms of depression or anxiety, outweighing the potential risks. I firmly believe that in the right setting, with the correct dosage and intention, psychedelic substances can serve as a therapeutic tool for healing.