BHE Podcast, Episode 016 – Ronan Levy, Field Trip Health Executive Chairman

Ronan Levy, co-founder and executive chairman of Field Trip Health, joins the BHE Podcast to discuss transitioning from practicing law to entrepreneurship endeavors that challenge the status quo, surging interest in the therapeutic potential of psychedelics, the future of psychedelics in the United States, how Field Trip is expanding its operations across multiple countries, and the organization’s decision to begin trading on the Canadian Securities Exchange.

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Tom Valentino: Welcome to the "Behavioral Healthcare Executive Podcast." I'm BHE Senior Editor, Tom Valentino. Today I am joined by Ronan Levy, the executive chairman and co founder of Field Trip Health, a psychedelic therapy development and delivery firm. Ronan, welcome to the show.

Ronan Levy: Thanks for having me.

Tom: Both you and your Field Trip co founders have an interesting backstory. Before the entrepreneurship phase of your career, I believe you were practicing law. What motivated you to transition into the kind of work that you're doing now? Ronan: I like to say that I used to be a lawyer, but I'm feeling much better now.

[laughter]

Ronan: To be quite honest, my transition from law was something that was always in the cards. I realized very early, in terms of starting law school, my practice, and my career, in that respect, that I wasn't well cut out for that kind of stuff.

I prefer challenging the status quo and challenging conventions, as opposed to adhering to them and enforcing them. Just a very different mindset. Even though I started my practice or my career as a practicing lawyer, I was always on a path of getting out. It was just a question of what was the right time and place to do so.

It actually happened, initially in 2011, just over 10 years ago. I haven't noted it in my calendar. It's my personal day of growth because that was the day I quit my last job.

It was also the same day, five years later that we signed the letter of intent to sell one of the businesses that myself and the other co founders in Field Trip started. I'd say, It's been a pretty auspicious day for us and for me.

In the practice, I progressively worked from being a private practice lawyer to being an in house lawyer, transitioning then into more business roles. Then, eventually left in 2011 to start my first business, and just carved out a niche, doing things that most people wouldn't expect.

Our first business was a cash for gold business, which is not a business that has a very positive reputation. We went into it with a view of trying to bring legitimacy, authenticity, and transparency to that business, and we were quite successful in doing so.

Just taking a different look on it, putting a different spin on it. It's always been in my head and in my space to look at opportunities that other people would blush over. After that, we started that, we'd launched it and it was operating.

I never had ambitions of being an executive running a gold business in my life. I went back into the private practice of law, working with tech startups. It was the heart of the tech boom. That's how I met the co founders in our last business, which was in that Canadian medical cannabis industry.

We were exploring a number of ideas, including one in cannabis, but they were reticent to get into the cannabis industry because they thought it was too sketchy. I was like, "Listen, guys, this is now legal. You don't get an opportunity where a massive black market opportunity overnight becomes legal.

"It would be a real miss not to take advantage of this opportunity and having more comfort, bringing that lens of 'If you don't like it, don't avoid it. Bring authenticity and transparency to it.'"

I controlled those guys long enough that they've finally agreed to look at it. We got excited about it, and then our last business was born, and that set the footprint for this business.

Tom: What made you want to move into the area of psychedelics?

Ronan: With Canadian cannabis clinics or businesses in the cannabis industry, all of us got into that industry being fairly agnostic to the therapeutic potential of cannabis. Open minded, but far from persuaded, philosophically, we all agreed that the war on drugs made no sense.

If we could do our part to avoid putting more people in jail for something that reasonably innocuous, that was good enough for us, but what we saw was how profoundly transformative cannabis medicine was.

We had over 150,000 patients through our network of clinics across Canada. Almost everybody reported significant improvements in their health and wellbeing, even though it wasn't necessarily a double blind clinical trial or anything along those lines, the objective anecdotal observational data. This is profound in all of our doctors.

Again, many of who came in quite skeptical to cannabis medicine, almost uniformly reported that it was the single most effective medicine that they had ever prescribed in their career. It opened our minds to one stigmatized medicines and perspectives around health and wellbeing that have been generally closed off to conventional/allopathic medicine.

After we sold that business and spent a couple of years helping build Aurora Cannabis, the company that acquired it, we left to do something new. The time was right to part ways, and so we started exploring a number of opportunities.

We just so happened that one of the first meetings we had after we left, was with a woman named Judy Blumstock, who was looking to raise capital for a drug development company, looking at different formulations of psilocybin. She alerted us to all the things that were happening in psychedelics, and two things happened.

First was we realized that we had a unique skill set. Having scaled at the clinical network in the stigmatized medicine area with Canadian cannabis clinics, operating it very efficiently, doing it very well, and helping a lot of people, as well as helping scale the broader cannabis industry.

We were uniquely qualified to bring that experience to bear on this emerging opportunity in psychedelics.

Secondly, personally, I've done a lot of work with meditation, metaphysics, coaching, therapy, and self reflection. I know just how profoundly it has positively affected my life.

When Judy in that meeting described a single psilocybin assisted therapy session as 10 years of therapy in an afternoon, even though I knew that to be a significant exaggeration, even if there's any truth to that whatsoever, I was of the view that psychedelics are something that the world needs. That this is a really important opportunity to pursue, and it needs to happen.

We spent a lot of time trying to understand where opportunities in the space may be, and out of that, Field Trip was born Tom: Yeah, psychedelics, in general, has emerged as a hot button topic in the last year or two. It certainly seemed like you and your colleagues jumped in at a great time. Why do you think interest in the use of psychedelics to treat addiction and other mental health conditions has heated up so much over these past couple of years?

Ronan: It's a convergence of factors, all coming together at the right place in time. First of all, cannabis has done a lot of the legwork to challenge one stigmatized or strongly held viewpoints about certain drugs and attitudes towards them. We had a more comfortable playing field to have the conversation around psychedelics.

I think the research has been profound. Psychedelic research, by and large, stopped around 1970, but about 10 or 15 years ago, some very enterprising academics at Johns Hopkins, NYU, Imperial College, and the folks at the Beckley Foundation started to pick up the research, which starts to show profound results.

You have an open minded atmosphere. You have incredibly persuasive scientific data supporting this. Then you have this massive mental health crisis that we're all experiencing right now with conventional treatments not working.

People increasingly looking to alternative modalities to help them both with their physical and their mental health. In part triggered as a backlash to the opioid crisis, a loss of faith, and the big pharmaceutical model that has been driving healthcare for the last 30, 40, 50 years. All of these came together in a relatively small moment of time, and that's why we're seeing this interest. People are excited about it because people need it, and the evidence and the safety profile is quite persuasive.

Tom: One of the things that's interesting when it comes to psychedelic assisted psychotherapy, is it's different from how other treatments that involve the use of medications are provided. It's not like you can give a patient [laughs] a form of psychedelic substance and just send them on their way.

Can you talk about the differences in implementing that into psychotherapy and treatment for patients?

Ronan: Yeah, that's a very good point. It's one we should emphasize if people aren't familiar with what's going on, but the emergence of psychedelics as a therapeutic modality is in the context of psychedelic assisted psychotherapy.

We're not using the psychedelic drug as an antidepressant or a mental health treatment in and of itself. It's being used as a catalyst to enhance the efficacy of the therapy around it.

Now, there are certainly some neural biological effects that enhance the therapeutic outcomes, but the evidence seems to suggest that it is being used as a catalyst for the therapy and the opening it provides for the emotional processing, more so than changing the serotonin levels in the brain or anything along those lines.

It's what I like about psychedelics. It's one of the things that I found I liked quite significantly about the cannabis industry, is that conventional/allopathic medicine, by and large, the person receiving treatment is a passive participant in it.

You go, you see the doctor, the doctor prescribes something, you take the pill, hopefully, the pill does the work or not, and that's it. Whereas with cannabis, and certainly with psychedelics, because it's not a single pill, because it's very active, you need to triage. You need to understand what works for you. You need to do the work.

It becomes a much active experiential medical experience, which gives a lot of agency and autonomy back to people and makes them an active participants in their healthcare. That's important. It makes people feel relevant and involved in their own lives.

That's probably one of the failings of conventional approaches to, let's say, psychiatry, in particular, is that it was very passive just trying to use a drug to solve a problem when we know, at least I believe, the human experience is a lot more than just our neurochemistry.

There's a lot more going on, and we need to get into the emotions and our feelings, and all of that as part of the process.

What's so exciting about psychedelic assisted therapies, and for people who aren't aware of what typically is involved when a person participates in psychedelic assisted therapies, is that there's a lot of preparatory work with a therapist or team of therapists.

The range of issues and experiences to be explored, and potentially processed, are established. Then, there's a session with the drug, which is, typically just a person puts on eyeshades music, comfortable chair, and then just go inward to experience, whatever comes up.

Afterward, there's a very active integration process, where we take more Conventional Cognitive Behavioral Therapy techniques. Take advantage of the period of neuroplasticity that seems to happen after a psychedelic experience to enable people, not only to do the emotional processing, but to make the lifestyle, outlook, and habit change that will sustain the improved moods, because the one thing that happens is that most psychedelics are natural, fast acting antidepressants, so people feel better.

It's really about taking that feeling better and making it into something that's sustainable.

Tom: Field Trip's got a lot of things going on among them. You recently opened a facility for studying plant based psychedelics in Jamaica. What can you tell us about that?

Ronan: When we were getting started with psychedelics, we looked out and tried to do our best to predict the future. We realized that there was going to be two paths to access psychedelic therapies.

One was going to be the conventional FDA clinical trial, synthetic, single molecule approach that we're used to from a medical pharmaceutical perspective. The other one was going to look a lot like what we saw with cannabis, where it's driven by a lot more grassroots political activism.

As we looked further and further out, or as we tried to think further and further out, we quickly realized that there'd probably be a convergence at some point that these two paths would operate in parallel very harmoniously, I think.

Eventually, they would start to overlap when people start to look to psychedelic, even in the medical context as being not just relevant to treating depression, anxiety, or any other DSM indicated mental health conditions, but realize that it enhances their quality of life much like conventional therapy does, but on, I would say a very accelerated much more intense basis.

Not realizing which path would get across the line first, but wanting to be positioned to participate in either or both, we wanted to do the work that we saw was relevant to establishing the cannabis industry in terms of cultivation protocols.

As SOP is making sure that when you are using plant based psychedelics, you are giving good, clean, pure unadulterated, toxin free, mold free, bacteria free products so you don't create any unnecessary risks in terms of these therapies. That's the work we're doing in Jamaica. It's a cultivation and research facility, looking at developing the best protocols for cultivation anticipating. We'll see other states like it happened in Oregon, create legal markets for plant based psychedelic therapies, as opposed to synthetic molecule based psychedelic therapies, which is the more conventional way.

As well as trying to identify new tryptamines and new molecules because one of the things we did see also in psychedelics is that while everyone still talks about THC and CBD as the relevant molecules, there's a hundred known minor cannabinoids, each of which have incredible therapeutic potential.

We believe that the same would hold true with psilocybin producing mushrooms. We wanted to invest in the understanding of the basic research and science of psilocybin producing mushrooms as, as well as the cultivation practice.

Tom: Has your work been impacted by the COVID 19 pandemic over the past year? Have you guys had to adjust your priorities, delay any projects? How has your work changed as a result of what's been going on in the world?

Ronan: I'm a big believer in not finding silver bullets, but always finding silver linings, and so that happened with us. By and large, we haven't been impacted too negatively. It's really hard to parse out what impact the pandemic has had because our first clinic opened in the midst of the pandemic.

It's hard to say if people are avoiding us, or more interested in the therapies that we're offering because this is the only context in which we've operated. Pandemic did cause some construction delays, for sure, in LA, New York, and in Amsterdam. Not significant, not material, but pushed us back a bit.

What it did, it opened up was an opportunity to explore some projects that we always thought were relevant, but not core to what we were doing and build out our digital technology platforms. We have two digital tools that are part of the Field Trip ecosystem portal, which is designed to support the in clinic patient's experience.

It's a great tool that therapists use to set the framework for what people are going through, embark on in terms of the therapy, provide meditations readings, videos so that everyone's prepared and understanding while they're going through.

It provides mood monitoring, all sorts of tools that make the therapeutic process much more manageable, because one of the challenges with therapy generally is that it seems like an unending road. You don't know what the milestones are.

You start and you never know where you're going to end, whereas chunking it up and breaking it, and so like a step by step process. It makes it much more approachable for a lot of people. It also enables us to collect a lot of data so we can see what's working, what's effective, what people are responding to. That's portal.

Then we launched an app called Trip, which was inspired by the recognition that as various cities started to decriminalize psychedelics, like we saw in Denver, Oakland, and now Cambridge and Ann Arbor.

There's going to be a lot of people who are out exploring with consciousness expansion, self discovery, and a variety of manners without any tools or understanding of best practices.

We realized that we could take what we've developed for our in clinic experience, simplify it and synthesize it and put it out to the world so people could start...If they're going to do this kind of work, they're doing it with a strong basis to start from instead of taking mushrooms, doing breathwork, or anything along those lines by themselves without any guidance.

That was what Trip is designed to support from a harm reduction perspective, to make sure that if people are doing anything with consciousness expansion, they're doing it from a good starting place with the right inference.

Tom: What's your outlook on the use of psychedelics in the United States moving forward?

I know you guys have got things going on in Canada. You've got the facility down in Jamaica. You're over in Amsterdam. You do have some facilities here in the US. Do you see this becoming more widespread? I know you mentioned what's going on in Oregon and Denver. Where overall are we heading here?

Ronan: In the US, we're operating. We have four facilities operating, providing ketamine assisted therapies. So there is one currently legal form of psychedelic assisted therapy even though ketamine is not conventionally considered a psychedelic.

It works in many of the same ways. People have experiences very similar to the classic psychedelics. It is already mainstream and broadly accessible and available, at least from a legal medical perspective, through the off label use of ketamine.

But no, certainly, I anticipate you're going to see legal access to psychedelic therapy is using the classics like MTMA, psilocybin, and potentially others. As soon as two years from now in Canada and the US because MAPS, which is the Multidisciplinary Association for Psychedelic Studies, are in the second part of their phase 3 trial, looking at MTMA assisted therapy for the treatment of PTSD.

The first phase 3 showed incredible results. Their phase 2 showed People don't like using this term, but it's the simplest way to describe it an almost effective cure for PTSD, when they found that 70 percent of the participants in their Phase 2 who had chronic severe PTSD on average for 17 years, following two or three treatments, I can't remember exactly, no longer met the DSM criteria as having PTSD.

Now, we don't know how long those benefits are sustained for, but it is pretty significant and pretty impactful that people no longer qualify as having PTSD after completing one of these treatments. It does start to look like a potential cure for the people that it does work for. It's not everybody, but 70 percent is a significant part of the population.

We're seeing amazing clinical trials with MTMA. Those should be finished and presumably approved sometime in the next year or two, so by 2023 we'll see MTMA.

2025 or 2026, we anticipate the clinical trials for synthetic psilocybin, which has been granted breakthrough therapy status by the FDA, along with the MTMA trials, to be completed and approved.

You'll see federal legal medical access to psychedelic therapies by 2025, 2026 for Psilocybin, MTMA, and potentially others, but those the two drugs that are leading the charge right now.

Then there's going to be the state by state stuff like Oregon. Oregon will have a legal market for psilocybin therapies by next year if all goes according to plan. You'll see a number of other states like Florida, Hawaii, and California have all introduced legislation to create similar type programs to Oregon. Those could even come faster, but 2025, 2026, it'll be on sale.

Tom: A lot to look forward to. One more thing I wanted to ask you about before I let you go. Field Trip, went public on the Canadian Securities Exchange last year. Could you tell us a little bit about what went into that decision, how it's impacted your business, and where Field Trip is headed overall?

Ronan: Sure. One of the things that we realized very early on in our conversations with the key leaders in the early days of the modern psychedelic renaissance, people like Rick Doblin, Michael Paulin, and the folks at the Beckley Institute in the UK, was that a whole new set of infrastructure is going to be needed in order to enable people to access these therapies at scale.

This is not something that can be done in a conventional doctor's office because psilocybin experience's anywhere from four to six hours, and it requires a whole bunch of staffing that most doctor's offices don't provide.

As we realized that the expense of building out this new clinical infrastructure, as well as developing new drugs and taking them through clinical trials, is going to be a capital intensive effort to build out the functioning aspects of this industry.

Access to capital has always been top of mind for us. Even though we didn't anticipate going public as early as we did, there was something called the COVID 19 pandemic that really [laughs] roiled the financial markets.

Even though there's a lot of excitement around Field Trip and what we were doing, a lot of investor interest, the consistent feedback from all of the investors was, "I love what you're doing. Want to be part of the story. Want to invest, but with such an uncertain outlook.

"I can't have my money tied up in a private company. We would need access to liquidity in order to make an investment decision." We heard that enough times that we decided to accelerate our path to being public, and so we listed on the Canadian Securities Exchange in October, which is great. It's helped build a platform to further advance the discussion around psychedelics.

Having been in the early days of the Canadian cannabis industry and watching a company, then called Tweed, now called Canopy, go public, it helped amplify the conversation around cannabis.

We are certainly using the fact that we're obliged to provide a lot of information as a public company as a tool and a method to help create awareness for the science and research around psychedelic therapies as well.

Tom: Ronan Levy, best of luck to you and your team at Field Trip. A lot of interesting stuff going on. We look forward to seeing what happens here to come. Thanks a lot for joining us today.

Ronan: Thank you so much for having me. It's been a real pleasure.

Tom: As a reminder, you could subscribe to the "BHE Podcast" on Apple Podcasts, the TuneIn app, and other podcast listening platforms. Past episodes are also available on our website, behavioral.net.

Our thanks again to Ronan Levy of Field Trip Health for joining us. I'm Tom Valentino, and this has been the Behavioral Healthcare Executive Podcast.