Psychedelic Medicine Podcast with Dr. Lynn Marie Morski

In this episode Amy Della Rocca, PMHNP joins to discuss Spravato, the FDA-approved prescription esketamine nasal spray, and its place in the field of psychedelic medicine. Amy is a psychiatric nurse practitioner and the Clinical Director of Marpa, a Spravato treatment center in New York.
In this conversation, Amy offers a grounded and practical look at Spravato as one of the most accessible forms of psychedelic medicine currently available, especially for patients with treatment-resistant depression who may be priced out of intravenous or intramuscular ketamine treatments. She explains how insurance coverage, prior authorizations, and the 2025 shift allowing Spravato to be used as monotherapy have expanded access, while also walking through what treatment actually looks like in practice - from REMS monitoring and nasal spray administration to maintenance schedules and the importance of outside therapeutic support. Throughout, Amy emphasizes that Spravato can produce a wide spectrum of psychedelic effects, that it should not be dismissed as a "lesser" medicine because it is FDA-approved or pharmaceutical, and that the most effective treatment happens in a relational container that balances medical safety, emotional support, and realistic expectations about what the medicine can and cannot do.
 
In this episode, you'll hear:
What Spravato is and how it differs from other forms of ketamine treatment
How insurance coverage, Medicaid, and copay assistance can make psychedelic care more financially accessible
Which two diagnoses Spravato is approved to treat
Why the 2025 approval of Spravato as a monotherapy meaningfully changed patient eligibility
What a typical Spravato session looks like, including dosing, REMS monitoring, and maintenance treatment
Why therapy, integration support, and external community can strongly influence treatment outcomes
How patients' experiences can range from subtle relaxation to deeply psychedelic states
Why stigma within psychedelic spaces can invalidate ketamine experiences - and why Amy argues that needs to change
What makes a patient a good candidate for Spravato treatment
How clinicians can carefully work with complex cases, including suicidality, trauma histories, and bipolar depression
 
Quotes:
"Generally we have Medicaid covering [Spravato treatments]. We have no co-pays on that or maybe it's a five-dollar co-pay. With some insurances, if there's a big deductible, they will have to pay the deductible like other treatments." [6:38]
"In 2025, the FDA changed that requirement [to be on an antidepressant to receive Spravato treatments]. And now Spravato is… approved for monotherapy. So, as you know, so many of the people that are coming to us are not taking daily antidepressants because they've had terrible side effects. Or… they've felt worse, it increased their [suicidal ideation] or, you know, whatever it was. And so to have them still have to take one just felt like the wrong thing to do." [8:34]
"I would say 30% of the patients continue [regular Spravato treatments] on some level—40% maybe of maintenance. And that can be every two weeks; it can be every week. There are plenty of folks that find that the glutamate activity of this medicine helps them more than anything they've ever taken and so they end up tapering off of other meds and continue to get weekly sessions with us." [14:28]
"This treatment feels, in a way, like a half-treatment without outside therapy" [15:25]
 
Links:
Amy on LinkedIn
Marpa Minds website
Journey Clinical website
Psychedelic Medicine Association Course: Managing Medical Risk in Patients Seeking Psilocybin Therapy
Previous episode: Ending Pill Shaming: How Psychedelics and Pharmaceuticals Can Both Support Healing with Erica Zelfand, ND
Previous episode: Ketamine Therapy Explained: The Science Behind Mental Health Treatment with Dr. Jason Wallach
Psychedelic Medicine Association
Porangui

In this episode, Michelle Weiner, DO, MPH returns to share her expertise on low-dose ketamine for chronic pain. Dr. Weiner is double board-certified in Interventional Pain Medicine, Physical Medicine, and Rehabilitation. She is founder of Neuropain Health delivering personalized integrative care treating the root cause of pain and suffering, both physical and emotional, using a multidisciplinary biopsychosocial approach with many years of clinical experience with ketamine-assisted therapy.
In this conversation, Dr. Weiner reframes chronic pain as more than a symptom of tissue damage, describing it instead as a complex sensory and emotional experience shaped by the brain, nervous system, and a person's broader life context. She explains how chronic pain can become entrenched through maladaptive neural network patterns, fear, stress, and identity-level beliefs, and argues that effective treatment must move beyond symptom suppression toward a biopsychosocial model that addresses suffering, function, and quality of life. Drawing on her clinical work, Dr. Weiner discusses how low-dose ketamine, when paired with preparation, integration, pain reprocessing therapy, somatic work, and functional movement, may help create a window of neuroplasticity that allows patients to interrupt rigid pain patterns and reconnect with their own capacity for healing.
 
In this episode, you'll hear:
How Dr. Weiner understands chronic pain
The "triple network model" of neuropsychiatric conditions and how Dr. Weiner applies this to thinking about chronic pain
Why imaging, injections, and medications often fall short once pain has become chronic and centrally mediated
The gate control theory of pain and how this relates to possible mechanisms of ketamine treatments of pain
How ketamine may support chronic pain treatment by creating a temporary window of neuroplasticity that can be used for deeper therapeutic change
What pain reprocessing therapy is and why Dr. Weiner sees it as a first-line intervention for many chronic pain conditions
Patient stories from Dr. Weiner's practice where belief change was a key component of healing pain
 
Quotes:
"Over time, when [pain] becomes chronic, it's no longer trying to alter the physical body, it's actually trying to reprocess what's happening in the brain." [3:47]
"Ketamine for me started to become more interesting because I realized that this wind-up phenomenon that is so responsible for a lot of people's chronic pain can actually start to be reversed when we start using medications [like ketamine] that can change the balance of glutamate and GABA [neurotransmitters]." [14:26]
"So I just started to think, how can we use the lowest dose of ketamine to create neuroplasticity, guide them in a way that they're able to move and shift the story, and then that's how you can create long term change.  [18:51] 
"The key is to understand that we are our own healers. If we're not involved in actively participating in our treatment, then we're relying on someone else outside of us and that's not really a long term plan." [29:20]
"More with ketamine is definitely not better. When people feel so disconnected and so separate from themselves, they can experience more fear. And I think that's important to have that sweet spot where they're able to get that time out. They're not really feeling their pain, they're not in their ordinary mind and their conscious thoughts and they're able to have the brain connect in a different way and experience things differently, which then creates hope and allows them to really wake up and say, 'oh, there there are other options out here for me.'" [30:11]
 
Links:
Dr. Weiner's recent article "Treating chronic pain with low dose ketamine and adjunct therapies within a biopsychosocial approach: a case series"
Dr. Weiner's website: Neuropain Health
Dr. Weiner on Instagram
Dr. Weiner on LinkedIn
Previous episode: Ketamine-Assisted Psychotherapy for Chronic Pain with Michelle Weiner, DO, MPH
Psychedelic Medicine Association
Porangui

In this episode Dr. Simon Ruffell joins to discuss the research on ayahuasca for PTSD. Dr. Ruffell is a psychiatrist, researcher, and student of curanderismo (Amazonian shamanism) working at the intersection of Western psychiatry, traditional plant medicine, and Indigenous knowledge systems. He is Executive Director of Onaya, Lecturer in Psychology and Psychedelics at the University of Exeter, and Chief Medical Officer of MINDS, with a focus on integrative and relational approaches to healing and consciousness.
In this conversation, Dr. Ruffell explores the emerging research on ayahuasca as a treatment for PTSD, drawing on both Western scientific models and Indigenous Shipibo knowledge systems. He outlines how ayahuasca may work through mechanisms such as increased neuroplasticity, disruption of rigid predictive models, and potential epigenetic shifts related to stress and trauma, while emphasizing that these biological explanations exist alongside Indigenous understandings of "cleaning ancestral lines." Sharing preliminary findings from his ongoing research with military veterans in collaboration with Heroic Hearts Project, Dr. Ruffell discusses significant reductions in PTSD symptoms at six-month follow-up, the powerful role of community and ceremony, and the ethical complexities of studying sacred practices through Western scientific tools. He closes with a moving story of a veteran whose healing journey illustrates both the promise and the limits of psychedelic medicine when embedded in relational and cultural context.
 
In this episode, you'll hear:
Western scientific theories for how ayahuasca may alleviate PTSD
How trauma-related epigenetic changes may be transmitted across generations
Preliminary results from Dr. Ruffell's study of ayahuasca for veterans diagnosed with PTSD
The role of community bonding and peer support among veterans in maintaining therapeutic gains
Why ayahuasca research in the Amazon includes a broader plant-based healing system—not just the brew itself
How Indigenous healers interpret epigenetic findings as confirmation of longstanding ancestral frameworks
The ethical considerations of bringing Western measurement tools (like EEG) into sacred ceremonial contexts
 
Quotes:
"This is what I find most interesting about our research—that it is cutting edge science but at the same time, when we conduct it with indigenous healers, we get a whole new perspective on what could be happening when it comes to interpreting the results and also making decisions of what to research as well." [14:09]
"According to measures of PTSD on the scales that we're looking at, over 80% of the participants that were scoring for PTSD before their ayahuasca retreats and no longer scoring for PTSD at that six month follow up. So it's not just immediately after the ayahuasca retreats. It's six months later. And that's super, super encouraging." [15:52]
"When we take things to the lab, one of the reasons that we might see the effect size diminishing is because we no longer have shamanism, basically, which is exerting a huge effect." [16:55]
"Traditionally what would happen is that the curandero would drink ayahuasca and the participants would just be there and the curandero would use the visions that they had with ayahuasca to look into the participants and to diagnose them. And then the healing would come through them singing their medicinal chants, which are the icaros. And then afterwards they would give them a prescription of plants or whatever it is that they needed. And sometimes the prescription would be to drink ayahuasca, but most of the time it wouldn't be. [27:18]
"You can't separate like DMT, in my eyes, from the rest of the compounds in ayahuasca, from the ceremony, from the jungle. That, in my opinion, is what makes up Shipibo. Otherwise you just have a bunch of chemicals." [28:20]
 
Links:
Dr. Ruffell's website
Dr. Ruffell on LinkedIn
Dr. Ruffell on Instagram
Onaya website
Onaya Science website
Onaya on LinkedIn
Onaya on Instagram
Previous episode: Can Ayahuasca Heal PTSD? with Former Army Ranger Jesse Gould
Psychedelic Medicine Association
Porangui

In this episode, Dr. Sean M. Viña joins to discuss the ways that social inequality can impact psychedelic healing. Dr. Viña is a sociologist with a PhD from Indiana University whose research focuses on psychedelics and mental health, and social inequality.
In this conversation, Dr. Viña explains that while psychedelics are often framed as transformative treatments, their benefits appear unevenly distributed and frequently constrained by structural factors such as income inequality, education, stigma, caregiving burden, segregation, and social isolation. The discussion highlights how women—particularly single mothers—may experience diminished gains due to caregiving demands and stigmatization of mental illness, while Black and Latino populations show little measurable benefit once socioeconomic inequality is accounted for. Throughout, Dr. Viña emphasizes that outcomes are shaped less by the substances themselves than by the sociocultural environments people return to after treatment, underscoring the importance of community integration and structural supports alongside clinical care.
 
In this episode, you'll hear:
What inspired Dr. Viña to research social inequality and psychedelics
How caregiving burden, education, and stigma modulate women's mental health outcomes following psychedelic use
Why socioeconomic inequality appears to eliminate measurable benefits for many Black and Latino participants
The role of segregation, policing environments, and chronic stress in shaping treatment outcomes
Why American Indian populations respond better to psychedelic treatments in rural areas with greater access to nature and their culture
How having access to private versus public health insurance can impact psychedelic healing
Why focusing only on therapist–patient interactions may miss key determinants of success
Implications for designing more equitable psychedelic treatments and research
 
Quotes:
"Women who are highly educated actually seem to be getting about as much benefit [from psychedelic treatments] as men who are highly educated, but [lack of] education doesn't seem to negatively affect men the same way it affects women. Again, that's the pattern we see in all kinds of other health resources." [9:36]
"One of the studies that we did showed that if it wasn't for education and income differences, there would be a slight benefit [from psychedelics] for black participants in these surveys. But as soon as you accounted for education inequality and income inequality, it was wiped out." [21:40]
"I love the concept of the psychedelic renaissance, but when we start thinking about the statistics of who this is helping, this is a renaissance of less than 1% of people, right? This is a very small group of people who are getting benefits, just like many of the other resources that have come out in the past. … all these resources are probably valuable. They're all helpful. But there needs to be more than just the drug. There needs to be a bigger conversation about this society and the community that people are living in." [36:31]
 
Dr. Viña's academic articles:
"Medical Sociological and Epidemiological Psychedelics Paradigm", Drug Science Policy and Law, 2025
"A Community Centered Approach to Psychedelics", Discover Mental Health, 2025
"Unequal Healing: Gender, Psychedelics, and the Burden of Care", Women and Therapy, 2026
"Psychedelics and Mental Health Treatment Seeking Among Asians and Hawaiians", Psychoactives, 2025
"American Indian areas and psychedelics: A test of the minorities' diminished psychedelic returns", Journal of Rural Mental Health, 2025
"Religious Social Integration, Psychedelics, and Psychological Distress", Journal of Psychoactive Drugs, 2024
"Stigma, Psychedelic Use, and the Risk of Reduced Formal Mental Health Care", Stigma and Health, 2024
With Amanda L. Stephens: "Minorities' Diminished Psychedelic Returns." Drug Science, Policy and Law, 2023


Links:
Dr. Viña on LinkedIn
Dr. Viña on Researchgate
Previous episode: Psychedelics and Religion with Hunt Priest, MDiv
Psychedelic Medicine Association
Porangui

In this episode, Hunt Priest joins to discuss the intersection of psychedelic experiences and religion. Hunt is the founder of Ligare: A Christian Psychedelic Society and was a participant in the Johns Hopkins/NYU Psilocybin Study for Religious Leaders in 2016. The epiphanies he had at Hopkins forever changed the trajectory of his work and led him to start Ligare in 2021.
In this conversation, Hunt Priest reflects on how participating in the Johns Hopkins study reshaped his understanding of Christianity, embodiment, and spiritual experience. Drawing on his background as an Episcopal priest, he explores the deep resonance between psychedelic experiences and Christianity, arguing that non-ordinary states of consciousness have always been central to religious life, even if institutional churches have often marginalized them. The discussion ranges from spiritual emergence and theological disruption to healing, discernment, and the role clergy can play in preparation and integration. Hunt also shares his own profound embodied experience during the study where he encountered Vedic and Upanishadic concepts firsthand. He explains how it ultimately led him to found Ligare, a Christian psychedelic society aimed at bridging psychedelics, healing, and the Christian mystical tradition.
 
In this episode, you'll hear:
Hunt's ideas of how psychedelic experiences connect with Christian sacraments and liturgical practices
How psychedelics connect with understandings of religious pluralism and the diversity of spiritual experiences
Resources for working through ideas that psychedelic experiences could be sinful or demonic
Hunt's thoughts on navigating theological disruption, spiritual emergence, and expanded images of God
Why embodiment and bodily wisdom are central to spiritual insight and healing
The vital opportunity institutional religion risks missing in the current psychedelic renaissance
 
Quotes:
"I think there's a lot of us [clergy] out there that understand that the spiritual issues that come up with psychedelics are important and need to be tended to in a sensitive way—in an open minded way, an open hearted way." [14:36]
"The Church has, over time, taught people to not trust their minds or their bodies. And that's a huge mistake because our bodies keep the score and they also are one of the places we hold wisdom—which was the biggest lesson I got from the first experience I had at Hopkins." [17:39]
"That's why the spiritual care professionals could be so important: when these issues, these spirit big spiritual questions or even a collapse of your own theological framework happens, you need help to put it back together. And just like therapy helps us put our emotional life back together, I think a good spiritual director or spiritual advisor—one-on-one or small group work—can help us put our theology back together." [21:47]
 
Links:
Ligare website
Ligare on Instagram
Hunt on Instagram
Hunt on LinkedIn
Center for Action and Contemplation website
Previous episode: Avoiding the Pitfalls of Psychedelic Medicine with Matthew Johnson, PhD
Psychedelic Medicine Association
Porangui