Dr Rakesh Jetly | Chief Medical Officer, Mydecine

Dr. Jetly currently serves as Academic Chair of Military Mental Health at The Royal's Institute of Mental Health Research, and as an associate professor of psychiatry at Dalhousie University (Halifax), and the University of Ottawa. In 2015, he was appointed, “The Canadian Forces Brigadier Jonathan C. Meakins, CBE, RCAMC Chair in Military Mental Health.” He has published numerous articles in professional journals and presents nationally and internationally on such topics as post-traumatic stress disorder and operational psychiatry. Dr. Jetly has previously held various professional positions as a psychiatrist, including: Director of the “Operational Trauma and Stress Support Centre,” Atlantic Region (2000-2008); Chief Resident in Psychiatry, S͘t Michael’s Hospital (1999-2000); and Senior Medical Officer for the “Canadian Contingent United Nations Middle East” in Israel (1993-1994).

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What made you personally want to get involved in psychedelic research?

I've spent over 30 years as a medical officer and psychiatrist in the Canadian Armed Forces. I have personally deployed to such locations as Rwanda around the time of a massacre and immense humanitarian crisis. I've also deployed to the Middle East, a place where trials of historic proportions exist. In 2006 and 2007 I deployed to Kandahar, Afghanistan at a time when being a Canadian soldier in Afghanistan was the most dangerous soldiering in the world.

With this military career I have seen friends succumb to the traumatic stress that they were exposed to as well as too many patients to count. The so-called operational stress injuries that recall them in Canada that include conditions such as PTSD, depression and substance use disorders can be crippling and impact individuals and their families. Over the years I was involved in the creation of military clinics focused on PTSD. There are a number of evidence-based treatments for PTSD that will and should remain as the first-line approaches. Sadly, many soldiers and veterans do not respond well to these treatments and the search is on for novel, safe and effective treatments.

I have been intrigued throughout most of my career by the psychedelics and the role they could play in enhancing people's response to psychotherapy. One has to really sit with people suffering from conditions such as PTSD to understand how fixed their thinking can be which perpetuates the negative feelings associated with PTSD and depression. It appeared to me when reading about past work in the 60s and 70s that somehow psychedelics may open the mind to the concepts that they were otherwise closed to. Over the years particularly as the Chief of Psychiatry of the Canadian Armed Forces, I was asked quite often to comment on research taking place with MDMA, ketamine etc.  I've tracked this research with interest knowing full well we would be years away from being able to study such things with an active-duty serviceman, but I did see the promise. As I transition from the military back to civilian life this seems a natural area for me to explore. Myself and many colleagues that are like-minded are excited by the prospect of helping veterans afflicted with this very serious illness of PTSD.

Which achievements are you most proud of at Mydecine to date?

Ultimately, I am thrilled that Mydecine Innovations Group (MIG) has committed to focusing clinical trials on veterans suffering from PTSD. It may not be the largest subgroup of people suffering in society, however I feel there is a moral imperative for countries to address the clinical needs of the men and women that have sacrificed so much for our nations and to protect our values. The unwavering support for these clinical trials has led me to MIG and has allowed me to attract a very talented group of investigators and advisors.

What do you believe is the most important thing for people to understand about the future of psychedelics as medicine?

For me as a clinician scientist, I believe that we will establish a place for psychedelics alongside all other treatments. We will conduct ethical research in university centres to establish the safety and efficacy of these treatments. There will be no shortcuts. It is also very, very important to understand that as we work with psychedelics these are not "drug trials" as we used to conduct for antidepressants and antipsychotics. Psychedelics whether it's for depression, PTSD or addiction are being used not as standalone agents but in the context of "psychedelic assisted psychotherapy". It appears that the psychedelic medication prepares the mind for psychotherapy.

How do you think psychedelics will affect the future Psychiatry??

This certainly could be a game changer. I'm excited by the fact that it is going back to the roots of psychiatry that understands that the mind/brain duality is a myth. This approach will ensure that we don't singly focus on medication or psychotherapy,  we must consider both. It is also compelling because one or 2 doses of medication with psychotherapy suggests definitive treatment. This is a radical departure from taking medication every day for months, years or life.

When you were the chief psychiatrist for the Canadian Armed Forces, you had a long career working with survivors of trauma, How do you hope to see Psychedelics used in the treatment of PTSD for soldiers? ?

I believe that I've answered as above. Ultimately the responsible thing to do is to start this treatment in veterans and so-called "treatment resistant" PTSD. If active-duty soldiers respond to the first-line evidence-based treatments, they will often remain in uniform and continue their careers; it is typically when treatment fails that they are "medically released" or discharged from the military. These veterans who have devoted their entire lives to military service are now left with chronic illness with severe exacerbations that impact all spheres of life. If we can start with improving the condition for these veterans it will be a fantastic beginning. In time with more research psychedelic assisted psychotherapy, it may indeed become a first-line treatment with established safety and efficacy, as well as, recognition by regulatory bodies such as the FDA and health Canada.

What is the biggest misconception that people have about the treatment of PTSD?

There are many misconceptions. First, the treatment is incredibly difficult and typically requires exposure to the traumatic events that cause the illness in the first place. This incredibly difficult requirement to confront the past in order to obtain desensitization and habituation from the traumatic memories leads to an incredible number of dropouts from treatment. The misconception really is that treatment is an "end" and once people overcome stigma and seek care they get better. Unfortunately, a significant proportion of those in care did not get better.

Which current studies are you most excited about and why?

Our series of studies looking at psychedelic assisted psychotherapy on PTSD in veterans is extremely exciting. These small studies will allow us to use variable doses and timing of the psychedelic starting with psilocybin and also vary the timing and psychotherapeutic approaches. These will give us a very good idea of what the larger studies should look like. I'm also excited by the talented group of PIs and Scientific Advisory Board that will be informing our decisions.

What trend do you think is emerging in the world of psychedelics and what impact do you see that having in the next decade?

The biggest thing that I notice is that we are moving psychedelics from the fringe into the mainstream. These are no longer studies being done in farmhouses or ranches. Major universities such as Johns Hopkins, Imperial College in London, Maastricht University etc. are all involved. To have a lasting impact we need to have a deliberate and scientific approach led in university centres. Physicians and medical organizations will not accept psychedelics unless they have undergone the same rigour that other treatments have. This will require patience but will pay off in the long run. Otherwise the many positive stories regarding psilocybin use that have been around for years can just be dismissed as anecdotes or placebo effects.

What obstacle do psychedelic-focused companies need to overcome in the near future to be medically accessible and be able to help patients?

The obstacles as above are demonstrating safety and efficacy to the regulatory bodies such as the FDA and Health Canada in North America. This requires preclinical studies, then small studies that are replicated, followed by larger phase 3 trials to achieve "an indication"in the medical world. The obvious obstacle is the many years of psychedelic use in a recreational sense, but of course this can be overcome with irrefutable trials. The companies, in my opinion, should learn from the errors of the cannabis industry and focus singularly on the medical use and benefit of psychedelics without confusing their mission with recreational use. Recreational use of substances be they alcohol, opiates, cannabis or psychedelics must be clearly separated from the medicinal use.

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