Are you or someone you know using GLP-1s? Are you or that person planning to sit with a psychedelic such as mushrooms, ayahuasca, or MDMA this summer?

There's some things that might want to be considered beforehand.

I personally don't use GLP-1s, but more and more people show up to my office that do. I'm not a medical doctor, and if you know me, I take safety and harm reduction as serious as I can, and with 1 out 8 people taking GLP-1s this is a topic that is becoming more and more important.

What we'll cover:

• What GLP-1 medications (Ozempic, Wegovy, Zepbound, Mounjaro, and others) actually do in the body

• Why delayed gastric emptying matters for anyone taking an oral psychedelic

• What's established science vs. what's still speculative

• Practical screening questions and risk-management strategies

• Real-world scenarios walking through how this plays out
  

Who this is for: anyone on a GLP-1 curious about psychedelics, facilitators and sitters who screen clients, therapists and clinicians, and anyone whose friend or partner is on one of these medications. Educational, not prescriptive.

Content for this talk draws substantially on the clinical research and workshop of Dr. Ben Malcolm, PharmD, MPH ("The Spirit Pharmacist". For a deeper clinical dive, his full workshop is available at spiritpharmacist.com.

This talk is for educational purposes only and does not constitute medical, psychological, or legal advice.

Josh Jupiter is a psychedelic integration coach, certified facilitator, and founder of Brooklyn Balance LLC

Transcription:

okay welcome everybody i'm excited to have you all here we'll be talking about glp1s and psychedelics at this time so why this matters now well in 2023 roughly eight percent of american adults reported using a classic psychedelic in the past year roughly double from the rate a decade earlier psilocybin use alone has tripled since since 2019 so that's not a fringe movement it's a mainstream shift that we're seeing and it's happening often without adequate infrastructure to support it so more and more people are entering altered states and sometimes people go in a little too quick and they might get they might get traumatized or have some developmental trauma and glp1s are everywhere one l one in eight americans have tried one so that's not a niche group that's your neighbor your client and maybe you so a quick disclaimer i'm not a medical doctor this talk is educational it's not medical advice nothing here replaces a conversation with your prescribing provider i'm not telling anyone to take or not take anything this is just about making an informed choice and knowing what questions to ask if you would like to speak with a medical professional check out dr ben malcolm also known as the spirit pharmacist and he specializes in psychedelic drug interactions so there's also a deep clinical grade version of this material on his website as well there'll be a link to that at the end so a little bit about me uh i'm josh jupiter i founded brooklyn balance in 2022 i work full-time as a psychedelic integration coach and facilitator i've been trained with tam integration i've done various trainings with maps psychedelic support um various shamanic trainings and through my own work as well as working with clients and learning every day as i go forward i've personally never taken a glp one but i'm coming across more and more people who are on them a little background on me is my background is a little unconventional for this field i spent about 15 years in film production i was a producer in 2008 when i graduated from college i had debilitating panic attacks i had tremendous anxiety i was prescribed ssris i was on them for about eight years where when i started to wean off with medical support after that i began to explore psychedelics carefully with a facilitator and trusted community in 2020 in 2020 i got burned out from film production and i made a choice to pursue this work full-time i mention all this because my own path to this field wasn't through academia it was through my own nervous system so today since 2022 i've been working full-time in psychedelic integration coaching focusing on preparation post-experience integration facilitating and educating in 2023 i completed training with tam integration 12-month certification program i also did various trainings with maps that year i speak each semester at myu in the alternative psychology class and i work one-on-one and i also support groups what i offer today is the synthesis of the training in my experience and working with clients to present a little bit here and my view on things so who's this talk for so it's for anyone on a glp1 who's maybe curious about psychedelics it's for facilitators sitters who screen clients before a session maybe you're a therapist a clinician working at this intersection and anyone whose friend or partner is on one of these medications or may in the future be on one of these medications so in plain english a glp1 is a hormone your gut already makes after you eat it tells your pancreas release some insulin and it tells your brain you're full stop eating glp1 medications are lab-made copies of that hormone but they're turned up much stronger and made to last longer than the natural version that's already inside your body so that's why they're called incorrect in mimetics incorrect in is just the category name for the gut hormones that triggered the insulin release after a meal and mimetic means to mimic or copy that hormone glp1 drugs copy your body's own fullness signal and dial it way up so brands you may have heard of ozempic wagovi zip bound magiorno etc and what do they do they increase insulin release reduce appetite and food noise that constant mental chatter about food they slow down how fast your stomach empties and that's the key detail and that's the real reason why i created this talk so why are they significant well about one in eight americans have tried a glp1 that mean that's a meaningful slice of the people sitting in your ceremony maybe your therapy room or your retreat having this in their system whether they think to mention it or not they're increasingly prescribed off-label beyond diabetes and weight loss including research and there's some early research about uh addiction treatment with them alcohol abuse alcohol use disorder so the population taking these is only growing and getting more varied this is a genuinely new interaction because 10 years ago this conversation didn't exist the medications are new the popularity is new and the research on how they interact with psychedelics is still catching up in real world reports for glp1s like anything there are risks and maybe adverse effects so some common ones nausea vomiting diarrhea constipation fatigue less common pancreatitis gastroparesis gallstones bowel obstruction and rare rare but severe maybe severe vomiting severe pain fever yellowing skin in that case seek out immediate medical attention so it's also worth note noting because these drugs suppress appetite so effectively some people on them for a while develop nutrient gaps or lose muscle faster than expected relevant context for anyone about to put their body through something demanding like a ceremony so early research suggests glp1s may help with alcohol use disorder and other addictive behaviors both glp1s and psychedelics act on the same brain reward circuitry which is part of why researchers are curious about them together some people report reduced food noise less obsessive rumination about food that's a real documented effect not just an anecdote one noted one notable negative finding worth mentioning i wouldn't actually say this is negative i just say it's worth noting is that there was some thought that glp1s could help with depression and there has not been any from what i'm seeing there's not true evidence that they indicate that they can help with depression so there's no evidence of them being a proven antidepressant antidepressant and that's worth saying out loud so it doesn't over promise one thing worth noting is researchers are testing an ayahuasca compound alongside glp1s for pancreas cell regeneration it's an early animal stage work and it's an interesting two-way collision of these two worlds so why psychedelics might attract someone on glp1s so my framing on that is this is that if someone's starting a glp1 they might be in the mindset of i'm doing something to take care of myself i'm doing something to improve my quality of life that same impulse the drive toward health and change is often what draws people to psychedelics too both are in their own way an effort to feel better and take control of your health it makes sense these two populations overlap it's not a coincidence it's the same instinct showing up twice so some questions worth asking before a session if you're doing intake with somebody are you currently taking a glp1 medication which one how long have you been on it and are you still titrating increasing your dose when was your last dose any nausea vomiting stomach pain in the last few days any history of gastroparesis or other gi conditions how's your hydration and appetite been lately have you talked to your prescriber about this some red flags use caution active gi symptoms near a session vomiting abdominal pain if they've recently increased increased their dose signs of poor hydration or nutrition there's no prescriber to consult with a history of disordered eating layered on top of appetite suppressing medications so if there's any flags present there's no harm in waiting give it some time so the the pharmacology is pretty interesting and i've i've tried to put it here in plain english um and keeping it simple so glp1s slow down your stomach on purpose that's part of how they make you feel full longer the side effect nobody thinks about anything you swallow has to sit in that slower stomach before your body can absorb it so food pills mushrooms all of it so there's the pharmacokinetics and there's the pharmacodynamics pk and pk and pd right so the two terms can sound intimidating but simply put pk is what your body does to the drug think of it as the drug's road trip how it gets absorbed travels through your bloodstream and eventually leaves your body for the pd what the drug does to your body once it arrives the actual effect you feel so a glp1 changes the pk the road trip gets longer and slower which changes the pd when and how strongly you feel anything and so you know what this looks like with a psychedelic is say with mushrooms mushrooms normally someone the average person might start to feel the effects 30 to 45 minutes in maybe sooner maybe later right with a glp1 people have reported onset anywhere from two to six hours later the effects can feel much weaker than expected or in some cases nothing noticeable at all even with mushrooms that tested strong so the unpredictability itself is in is the risk it can look like weak mushrooms when actually it's just a slow stomach mdma right orally ingested same digestive slowdown applies effects can be delayed or blunted on top of that mdma and glp1s are overlapping side effects both can cause nausea and both can stress your body's hydration and electrolyte balance that overlap is worth planning around not just the timing issue and i'll note i do know people who are on glp1s and do take mdma and mushrooms and they're fine but they've slowly eased into it and they've really gotten more familiar with how what works for them specifically with ayahuasca the same absorption delay applies here too but ayahuasca can add on a more unpredictable wrinkle to it because the brew already reliably can cause nausea and vomiting as part of the purge so that can genuinely make it hard to tell is this the ayahuasca or is this the glp1 so ayahuasca and glp1s are the least studied or known about talked about at the moment and so it likely deserves a large amount of caution so the single most important harm reduction point don't chase the high so if someone takes mushrooms if someone takes mdma and they don't feel anything in the normal window the instinct to assume that the the dose is weak or that the person should take more with a g with a glp1 on board it's a bit backwards the first dose may still be coming and stacking a second or third dose on top of that creates a risk of unpredictable delayed hit stronger later less controlled experience than intended so more patients not more medicine is the safer move so facilitators clinicians working with this combination the working with this combination generally follow a simple sequence find out what someone's taking and where they are in their dosing schedule speak with their prescriber when possible set honest expectations that onset may be delayed or unpredictable build in more time than usual and agree ahead of time that redosing isn't the plan if nothing seems to be happening really setting expectations i i really always like to say something might happen and nothing might happen so uh you know and if if you're looking for a deeper dive in this i'll mention dr ben malcolm's full course walks through detailed real world case examples of exactly this kind of decision making if you want the deeper dive um that's where to look there'll be a link to that in the end so you know what to do if someone is taking a glp1 and wants to do psychedelics check with the prescriber they check with their prescriber double checking right safety first harm reduction tell them what the you know talk with them and tell them what they're considering doing and don't make the decision a vacuum getting outside opinion and help can be really beneficial know your timeline when was the last dose are you still titrating up early titration tends to carry the strongest most unpredictable gi effects expect the unexpected onset onset might be slower weaker or different than you're used to that's the medication and it might not mean it's a bad batch or a bad set and setting don't redose to chase a feeling this is the one thing to really drill into people give it time before assuming nothing is happening again hydrate deliberately before and during sessions and work with someone who knows about this interaction a facilitators or a sitter who's aware of this or do a personal consult with a specialist it's worth the investment and when in doubt more time beats more medicine every time so you know we're seeing these two trends collide quietly more people using glp1s more people taking receiving psychedelics and with just a little more awareness with things like this we can see them a little more clearly uh here's a link to access the deep dive with dr ben malcolm on glp1 psychedelics pharmacokinetics uh the talk itself is about 75 minutes or an hour and a half so it's quite it's quite interesting quite fascinating um the next thing i'm doing if you're interested in learning more about me or seeing what i'm up to is i have a workshop called psychedelic consent our next one will be august 4th uh in dumbo brooklyn new york it's a really great space for a journeyer a facilitator a therapist to deepen their consent language skills capabilities learn more about oneself so that we can learn to trust surrender and receive the medicine better and thank you all for being here um i can be reached at josh at brooklynbalance.org instagram is brooklynbalanceintegration and uh my website is brooklynbalance.org and here's a qr code um thank you all for being here i'm gonna stop sharing my screen and if you have any questions um pop them into the chat we can do a little q a if there's anything yeah i see people have their hands up i actually disabled i'm gonna stop recording you