5 Questions for Lynnette Averill

Lynnette Averill’s father, a Marine Corps veteran who served in Vietnam, struggled with post-traumatic stress disorder (PTSD) for years, and died by suicide in the early 1980s, when she was three years old. She was too young to remember him, but she grew up acutely aware of the effects of stress, trauma, and war on individuals, their families and communities. 

Averill’s parents both grew up in rural Montana, but didn’t get to know each other until they were living in San Francisco in the late 1960s. Averill often heard her parents’ friends discussing their experiences with what they called “psychedelic medicine.” The way they thought about these substances seemed at odds with what she saw in her teenage classmates. For her mom’s friends, it wasn’t about going to parties and getting high; instead, they talked about healing, connection, and seeking meaning and purpose. 

Averill went on to earn a psychology PhD at the University of Utah, and completed a fellowship at the Yale School of Medicine where she studied PTSD and suicidality. All the while, psychedelics and trauma were in the back of her mind. When the opportunity arose to combine the two as part of her research she was thrilled. First, her work focused on ketamine, a popular topic among other Yale researchers. (“​​There's an unwritten rule that you have to participate in ketamine trials if you are an investigator at Yale,” she jokes.) A colleague began planning an MDMA trial, so Averill read as much current research as she could. Now, Averill has a joint appointment at Yale and the Baylor College of Medicine in Houston, and has served as an expert consultant in Texas’s House Bill 1802, which established a commission to study the efficacy of psychedelic treatment in treating PTSD in veterans. The Microdose spoke with Averill about how she got involved with psychedelic policy work, and the types of research and logistical issues she thinks that policymakers should consider.

Your earliest work investigated psychological treatments for PTSD and suicidality in veterans. What led you to study ketamine and psychedelic therapies?

In working with veterans with PTSD and other chronic stress issues for years, I saw that the number of patients who had a phenomenal response to talk therapy or selective serotonin reuptake inhibitors (SSRIs) were relatively few and far between. SSRIs  are our gold standard — the best option we have — but you still have a 50-50 shot, at best, of it working. Imagine if you’re struggling significantly, and somebody says, “I've got something you can try, but you're going to need to take it every day for at least four weeks, maybe eight to twelve weeks, and you may or may not feel any better during that time. In fact, you might feel worse. And you'll also potentially lose or gain 20 to 30 pounds, experience cognitive impairment, and you might not be able to perform sexually. But don't fret! If you get to the end of that three month period and it hasn’t worked, you will start over at ground zero and try the same treatment over again.” That’s what SSRIs are, and that's unacceptable, but that is the reality for many people. 

In psychiatry and mental health, medications and talk therapy often do a good enough job at supporting people to not die, but in many cases, we do not do a good job in supporting people to build lives that they truly want to live. Those are wildly different things. In talking with so many veterans who have engaged in psychedelic treatment — sometimes out of the country, or sometimes in the underground in the States — people say they feel like they're more able to do that work, to pursue a life that has meaning and purpose. I have never heard of, nor treated, anyone who told me that taking Prozac was one of the most meaningful experiences of their life, or that they felt so much more connected to themselves or to their community, or to the divine. 

You’ve recently gotten involved with policy work. How did that opportunity come about?

When I moved to Texas in 2020, I came with the intent of starting a research program specifically looking at psychedelic medicine for chronic stress-related concerns. As I started setting up my lab and applying for grants, I serendipitously stumbled upon a post from Alex Dominguez, who is a Democratic state representative here, who wanted to put in a bill to support psychedelic medicine for veterans with PTSD. And I thought, “Well, that's amazing — that’s what I want to be doing!” I reached out to him to say kudos, and also to find out who he was working with as his advisors, because there really wasn't much of a psychedelics footprint in Texas.

So I ended up serving as the subject matter expert for Texas House Bill 1802. I haven't ever really been involved much in politics at all, certainly not in policy, but in the last two years, I have been involved in all sorts of policy and advocacy work, which has mostly become a second full-time job.

There has never been a more exciting – or bewildering – time in the world of psychedelics. Don’t miss a beat.

What’s the status of House Bill 1802, and how have you been involved with it? 

It funds a clinical trial of psilocybin for veterans with PTSD, and an exhaustive literature review of psychedelics with a focus on veterans. To my knowledge, Texas was the first state that passed a bill specifically funding psychedelic research. To be evaluating psilocybin for PTSD is really exciting because it hasn't happened yet. We can guess what those results will look like. But from a scientific evidence perspective, it's not something that’s been tried yet. 

Two weeks ago, we had our first meeting with Texas’s Health and Human Services, who will oversee the study and the budget, so that is very exciting. In tandem with that, we've been working on ironing out study details as much as we could while waiting for final details about budgets. I've also had some conversations about leveraging state funding and expanding the trial to include an MDMA arm, where we’d be able to compare MDMA to psilocybin treatment, which hasn’t been done yet. I'm hoping by the last quarter of this year we would be able to actually enroll participants. I would like it to be sooner, but I'm also trying to be very realistic that setting up trials rarely goes quickly. 

I am really delighted to have been part of the Texas bill because a lot of places are looking to it as a model. Texas is very conservative, and I think many people thought, Wait, what? If conservative Texas is doing this, then everybody else needs to get on board. 

Do you think states will continue to drive policy change, or do you see federal policy changes on the horizon as well?

So many states have taken their own route and said, We can't wait for the federal government; we've got to be moving on this on our own for the benefit of our own citizens. 

Federally, I can see concerns about ending up with a situation where you’re herding cats — relatively unruly cats. That’s what has happened with medical marijuana and there’s zero consistency of what policy looks like state to state, how it's regulated, and who can access it. If states do completely different things with psychedelics policy, I can't fathom what that patchwork would look like. I imagine that it may be harmful to not have at least some sort of oversight from the federal government. At the very least, the federal government could guide insurers, saying they need to consider how to fund this kind of therapy, or getting cooperation from Medicare and Medicaid.

Still, there's a lot of movement and the landscape is rapidly evolving even at places like the Drug Enforcement Agency and Food and Drug Administration. I think we're probably a year out from MDMA having FDA approval — right now it has the breakthrough therapy designation, and they’re far enough along with their phase 3 clinical trial that I don’t think anyone is expecting wild adverse effects. If that goes through, it will require DEA rescheduling of MDMA. Generally, when the FDA approves a drug, that’s basically the FDA saying there are medical benefits to the drug. At that point, the DEA could no longer say there is no medical benefit there, which is how they’ve classified MDMA and other psychedelics for the last few decades.

After you got involved with the Texas bill, you’ve done other policy consulting work through your non-profit, Reason For Hope. Who have you been talking with, and what issues do you advise them on?

The intent of Reason For Hope is to consider the policy and advocacy around rolling out psychedelic treatment in a way that is reasonable, responsible, ethical, and equitable. Co-founder Brett Waters is an attorney, and Martin Steele is a retired Lieutenant General — each of us had involvement in different aspects of policy or advocacy and found ourselves with a full dance card of state representatives who are interested in what sort of legislation would make sense to put forward, or people at various federal organizations who are similarly interested in learning about the topic. 

The consequences of being unprepared are monumental. They can’t be overstated. For instance, the roll out of esketamine approval in many ways serves as the poster child of everything that we need not to allow to happen in psychedelic medicine. [Editor’s note: Ketamine has long been legally available as an anesthesia, but esketamine — a molecule found in generic ketamine, and behaves in the body in much the same way — was approved by the FDA in 2019 to treat depression; since esketamine has been patented, it can cost hundreds of times as much as generic ketamine.) It’s now very much an intervention only for the top one percent —  insurance does not provide coverage for it in most cases, and most people can’t afford even the clinics that provide the most reasonable rates. 

Also, psychedelic treatments would be a big paradigm shift in the way the FDA puts forth policy. The FDA does not regulate the practice of medicine, or the therapy component of mental health care. But in the case of psychedelic therapy, the FDA would need to consider those components — what does that look like? And we also need to ask how we would integrate psychedelic therapy into our healthcare system. With psychedelic therapy, you’d need to tell psychologists, psychiatrists, social workers, and other practitioners: instead of seeing one patient every hour for eight hours, we're going to take you off the grid for a whole day to see one patient for eight hours. That's a huge ask from an infrastructure perspective, and economic perspective. 

This interview has been edited and condensed for clarity and length.