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Berra Yazar-Klosinski, PhD, is the Chief Science Officer at the MAPS Public Benefit Corporation (MAPS PBC), a fully owned subsidiary of the non-profit Multidisciplinary Association for Psychedelic Studies (MAPS). Working for MAPS for over a decade, Berra has supported its clinical research program and regulatory affairs to grow to its current stage of maturity, developing strategy around how to bring MDMA-assisted psychotherapy to patients.
In this interview, Berra shares about her personal background and how she first became interested in psychedelics, reflecting on the challenges of reconciling her cultural background with her work in psychedelics. Further, Berra reflects upon the increasingly important theme of diversity, equity, and inclusion (DEI) in the psychedelic field, looking at the ways MAPS as an organization is trying to address this problem. She also shares her concerns in looking to a post-approval world in which MDMA and other psychedelic medicines are legal for medical use, offering her thoughts around how we could better prepare ourselves.
Jasmine Virdi: First of all, before we dive into your role and research at MAPS, I’d love to know more about you and your personal background. Where did your interest in psychedelics begin? Were psychedelics something you were always interested in?
Berra Yazar-Klosinski: I’m Turkish and I was born in South Carolina, actually around the corner from where the first clinical trials of MDMA-assisted therapy would later happen in Mount Pleasant in 2001. I lived in South Carolina until I turned nine, and then moved to Turkey where I lived in Istanbul for eight years. I went through elementary all the way through high school there, and then came to California to attend Stanford as an undergrad when I turned 17.
When I was in Turkey, I didn’t know anything about psychedelics, but I had an interest in things that were not necessarily part of the status quo. For example, I loved Salvador Dali and other types of “trippy” art. When I got into Stanford and came out to California, I was very socially anxious. I wasn’t really allowed to do “fun” stuff at the time as I was living at home with my parents who were quite conservative and felt certain activities were detrimental to my studies. It was only when I got away from my family environment that I started going to raves and discovered psychedelics, realizing that MDMA was surprisingly beneficial for my social anxiety.
Throughout my undergrad, I dabbled in psychedelics, and then once I graduated, I started working in biotech. I worked at two different biotech companies and subsequently got laid off around 9/11. Then I decided to go to grad school, pursuing a PhD in molecular cell and developmental biology at UC Santa Cruz for six-and-a-half years. Then I discovered that MAPS was located just down the road from my lab. I knew that psychedelics were powerful healing medicines, if used carefully, and they had long piqued my interest, but I hadn’t heard about MAPS before then. I started working at MAPS in 2009 while I was still trying to finish up my PhD, and I’ve since worked on all the MAPS-sponsored clinical trials.
JV: I’m also curious about you having a Turkish cultural background. What was it like for your parents when you started to work for MAPS? I would imagine that was a difficult pathway for you initially.
BYK: They were not fans and it was challenging for me. When I started working at MAPS they were very skeptical as they didn’t truly understand what it was all about. A large part of why I wanted to move to California, far away from my parents, was because I did not fully agree with them culturally. It made it a lot easier to have the freedom to not live close to them. In hindsight, I realized that I was actually escaping things by living far away. However, I’ve worked at MAPS for 12 years, and it has been a journey through which I’ve realized that I need to first resolve my internal conflicts with my parents before I can be truly free.
“We’re currently engaged in government interactions around health policy decisions and what evidence base they would want to see not only to approve MDMA as a medicine, but also to align the health system so that we can gain reimbursements and insurance coverage to ensure patient access. I think that’s the core challenge that we’re actively working on right now.”Berra Yazar-Klosinski
JV: I can imagine that it has been a challenging process to reconcile those two worlds. I’m also curious about what you see to be some of the main hurdles that lie in the way of legalizing MDMA-assisted therapies?
BYK: We’re currently engaged in government interactions around health policy decisions and what evidence base they would want to see not only to approve MDMA as a medicine, but also to align the health system so that we can gain reimbursements and insurance coverage to ensure patient access. I think that’s the core challenge that we’re actively working on right now. Namely, how to ensure that all patients will be able to access the drug, that it won’t be too expensive, and that there will be mechanisms to support them through patient assistance programs. The other challenge is ensuring diversity and inclusion in our workforce and among therapists as well as making sure the studies are not excluding marginalized groups, by the sheer function of how research is typically done.
JV: This leads me to a question that I had around the diversity and inclusion aspect. I’m curious about the studies that have happened so far and the main participant base of those studies. Also, looking to the future, are there any studies on the horizon that plan to look at a more targeted participant base? For example, a study looking at MDMA-assisted therapy for Indigenous veterans suffering from PTSD?
BYK: The studies that we have done so far are quite small compared to other medicines. The key interesting difference to me is that we have a large effect size on this treatment, meaning that it works for most people. As a result, the studies don’t have to be that big in terms of the number of participants in order to demonstrate a statistically significant effect. Having such a small participant pool limits the opportunity to try to have as many different racial groups represented as possible because the health system is sadly structured in a way that white Caucasian participants have better access to care and have better mobility and financial stability so that they can participate in a clinical trial. It is a really unfortunate bias that then leaves out important groups from being able to participate.
It used to be that we didn’t reimburse participants for their time and effort because we were still able to get people enrolled. But now we are reimbursing participants for their time and effort and doing a lot of targeted outreach into marginalized communities. The efforts have been helping, which is really encouraging, but it is obviously not as good as it needs to be. And that’s why we have a working group on DEI efforts that have been reviewing our study materials and giving us advice on how to make the studies more inclusive. It takes a lot of effort to overcome the systemic hurdles for access to healthcare and therapy that underserved communities face every day.
I had the privilege of participating in a publication with Terence Ching, who was a therapist on one of our phase two studies. He’s currently a postdoc at Yale, but he’s been doing some really interesting race- and ethnicity-based analyses, comparing the safety and efficacy results of participants of color to the white and Caucasian groups in our studies. We will have a lot more to say once those publications come out. But the results look encouraging in that we’re not seeing a big difference in terms of safety and efficacy between white and Caucasian participants, and participants of color. This is good news because we don’t want to cause harm inadvertently by not having the appropriate care and measures in place.
JV: Also, I believe that MAPS has a program in place through which it is providing scholarships to BIPOC therapists. Is that right?
BYK: That’s correct. I’m pretty excited about these developments actually. For me personally, I don’t actually consider myself to be white. Once you start getting into categorizing people it can become uncomfortable. For example, because I don’t consider myself to be white, I identify as Turkish and there is no category for me. I just get lumped into being white, even though I don’t personally identify that way. Sadly, it sometimes boils down to a reductionist approach of putting people in a box. For example, if I just go ahead and place myself in the “white box,” people don’t understand that I have such a different background, culture, and upbringing. What I’ve been finding among the MAPS-PBC staff is that my situation is not unique and that many of our staff are actually quite diverse. Many of them are first generation immigrants, like me, which is an interesting trend. I believe that we care a lot about diversity as an organization as it reflects who we are as individuals.
“I think in the mainstream there’s a lack of historical knowledge and orientation. That happens when you have new people becoming interested in something that’s new and alluring, seeming way too good to be true. They don’t necessarily do the work of reading about where the therapeutic methods originated or the ritual aspect of psychedelic medicine and the sacredness of it.”Berra Yazar-Klosinski
JV: Maybe this is a broader question, but I’d like to know what you see as some of the biggest challenges as psychedelics filter into the mainstream more generally, outside of MDMA-assisted therapy?
BYK: I think in the mainstream there’s a lack of historical knowledge and orientation. That happens when you have new people becoming interested in something that’s new and alluring, seeming way too good to be true. They don’t necessarily do the work of reading about where the therapeutic methods originated or the ritual aspect of psychedelic medicine and the sacredness of it. They just take it at face value, believing that it works better than anything else out there and that it is so much safer. Even though this is partially true, it is also an overgeneralization of very carefully controlled studies that we’ve been doing. It concerns me because there is the potential that if these substances are consumed incorrectly and without respect, they can harm people. That’s why we have therapeutic containers built into how these medicines are being shared with the mainstream, and that’s why they are being called, a new term that I really like, an “integrated multimodal therapy.” Healing comes as a synergistic effect; greater than the sum of its parts, greater than just providing the drug and therapy.
JV: In envisioning a post-approval world, what comes next? Do you think we are ready?
BYK: I don’t think we’re ready at all. This is the kind of stuff that I think about when I’m supposed to be sleeping. There has to be a paradigm shift in how people think about mental health and who is actually well positioned to go through these healing experiences. In the absence of having stable social support mechanisms, I don’t think that psychedelic-assisted therapy is a good idea. We’ve had a lot of desperate people who have applied to be in our studies, and we’ve had to turn them away because they were homeless; they didn’t have a social network or a home to go back to. There are so many life factors that are barriers to being ready to receive psychedelic-assisted therapy and reap the fullness of its healing benefits. It’s possible that the same limitations also apply to any sort of healing modality, including standard psychotherapy.
JV: As a society, collectively, do you think there are things that we could do to better prepare ourselves for a post-approval world?
BYK: Focusing on social support mechanisms is going to be critical. There’s a reason that loneliness, sadness, and isolation are drivers of mental health challenges. Most people completely lack support mechanisms, and as such they’re not well suited to engage in treatment, being forgotten by society on the wayside. I wish we could move toward rectifying social support systems that would help prevent these mental health challenges in the first place.
“Focusing on social support mechanisms is going to be critical. There’s a reason that loneliness, sadness, and isolation are drivers of mental health challenges.”Berra Yazar-Klosinski
JV: They’re just such big systemic issues that it is hard to think about how we can confront them… Beyond MDMA, I read that you had helped develop clinical strategies for LSD-assisted psychotherapy, cannabis, and ibogaine. When people think of MAPS, naturally they think of MDMA, but I’d love to know about these other substances in the context of MAPS.
BYK: When I first started at MAPS, I was working on monitoring the ongoing clinical trial for LSD-assisted psychotherapy as a treatment for anxiety due to a life-threatening illness. Those studies are not currently happening as our prime focus at present is MDMA. I also worked on two supporting observational studies with ibogaine to see if it might be a helpful treatment for opioid use disorder. We did long-term follow up interviews with participants who had already received ibogaine previously, following up on the factors that might have led to improvement or relapse. I also worked on the smoked cannabis study for treatment of post-traumatic stress disorder in veterans. So far, we’ve only worked on one study for which I got a grant from the state of Colorado Department of Public Health and Environment. However, we just got another grant from the state of Michigan to do a larger study focusing on the same thing. Thus, the cannabis study is currently under redevelopment, and we’re likely going to launch it in 2022.
JV: I always love to give those that I’m interviewing the opportunity to share about something that we didn’t touch upon in the interview that feels important for them to share.
BYK: One thing that I’d like to share is my appreciation for Chacruna. As an organization, I appreciate that Chacruna is willing to have the difficult conversations and continue facilitating dialogues where they are needed the most. I’m really supportive of those efforts and always listen to work that’s coming out of Chacruna to see if there’s anything we can improve on our side at MAPS.
Art by Fernanda Cervantes.
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