Are Drugs Bad, The Future Cannabinoids as a Medicine 3.0 ft. Dr. Matthew Moore

Are Drugs Bad, The Future Cannabinoids as a Medicine 3.0 ft. Dr. Matthew Moore

Dr. Matthew Moore: I suspect that there will be enough data that someone will have gone through clinical trials for several of these mainstream cannabinoids. [Intro music] Bryan Fields: What's up guys, welcome back to another episode of The Dime. I'm Bryan Fields, and with me as always is Kellen Finney. This week we've got a very, very special guest, Dr. Matthew Moore. Matt, thanks for taking the time, how are you doing today? Dr. Matthew Moore: I'm great, thanks for having me. Kellen Finney: How are you doing, Matt? I'm doing really well, super excited to talk to you — the topics are going to be exciting, and I'm excited to have our first three-time guest back on. How are you doing today, Bryan? Bryan Fields: I'm excited. Matt, that is an incredible accomplishment in the history of The Dime — we've never had a two-time returning guest, let alone a three-time returning guest, and I can only wonder if you're going to bring the intensity since our two other episodes with you are two of our highest-performing episodes. We had a lot of requests from some specific individuals we will not name to bring back the doctor for a third time. So Matt, just to clarify a little East Coast/West Coast — I know with your wife you might have origins on the East Coast — but do you have any loyalty East or West? Dr. Matthew Moore: That was a good angle, Bryan, thank you. I have to give you the Third Coast option, because I'm from Texas, so I can't be beholden to East Coast versus West Coast. Texas is its own thing, so I'll take the Texas coast. Bryan Fields: As disgusting as it is, I love it — their own coast, Texas. Kellen Finney: Yeah, rightfully so, rightfully so. Bryan Fields: So today we're going to do things a little different than we normally do — hit a variety of topics. The one I was excited to get your opinion on was the off-duty pilot accused of potentially taking down an Alaska Airlines plane, or attempting to. He said he had taken magic mushrooms 48 hours earlier, which he claimed altered his perspective. Matt, I want your take — when you saw the headline, and what you thought of that statement. Dr. Matthew Moore: The first thing I'd say is these drugs are not something that should be trifled with. I don't think it's appropriate for a pilot to take any psychedelics that close to proximity before doing his job, or a bus driver— Bryan Fields: He wasn't flying, he was off duty, so he was just a passenger on the plane. Dr. Matthew Moore: Oh, broadly expand that to say you shouldn't be in the cabin of a plane, or the cockpit, doing things like that. 48 hours after a magic mushroom trip is kind of — there are drugs that will last that long, and there's probably an amount of psilocybin that could get you there, but I struggle to believe it 48 hours later unless he's a real anomaly. I'm also of the opinion that these aren't toys — they're used recreationally, but people use explosives recreationally too, that's what fireworks shows are, and every year hundreds to thousands of people lose hands and fingers to something used recreationally. Just because it's recreation doesn't mean it's safe — mountain climbing is recreation, paragliding is recreation. Bryan Fields: Do you think it was fearmongering at all? Do you think they used his statement to push into the headlines, maybe for clickbait? Kellen, I want you in here too — conceivably, in 48 hours, a variety of things could have happened that led to this. Kellen Finney: I mean, there's no way — maybe if he took a pound of mushrooms he'd still be under the influence. I think he used it as a scapegoat, and I do think it's fearmongering — these headlines become obstacles to the continued advancement of getting psychedelic treatments to people who need them. Recreational versus medicinal use is very different, but when someone sees this kind of headline and then goes to the ballot to vote on something like this, it's going to influence their opinion. Bryan Fields: What do you think — if it was Ambien, would it make the same kind of noise? Kellen Finney: They can't, because Ambien is a pharmaceutical drug that went through serious FDA clinical trials, and they know the side effects. Correct me if I'm wrong, Matt. Dr. Matthew Moore: With any narcotic like that, you get the sticker that says "do not drive or operate heavy machinery" — meaning don't be in a position to make life-changing decisions while on it. If it had been Ambien, I'd be curious about the car-accident statistics for people on it. My mom took Ambien for a long time — you take it and go straight to bed, and if you don't, it gets pretty weird, and waking up early on it gets weird too, in a way that's not quite like most dissociative or psychedelic drugs I've seen people on. It's erratic, chaotic, a total lack of coherent connections. Whenever someone's on mushrooms and makes an outlandish claim, you can trace the trippy logic behind it. Ambien is more like trying to make sense of the actions of a person with dementia — very simplistic, A plus B equals C. So I'd be surprised if psilocybin caused this guy's actions. I think it's a cop-out for the pilot. There's been a lot of reporting on pilot mental health lately, and how pilots are effectively encouraged to hide mental health issues to maintain their required flight hours each year — if they take time off for treatment, they risk losing their license. So there's a huge motivation not to address mental health, and saying "it's not a mental health issue, I was on drugs" seems better to some people. But the real question is, why were you doing drugs before riding in the cockpit of a plane? Bryan Fields: I think he was a passenger, and I think he'd taken the drugs for — I can't remember exactly, maybe depression or mental health — but on the plane he decided he wasn't having a good time and freaked out. He thought he was saving everyone, broke in to turn the engines off, believing someone else was trying to crash the plane and was out to get him. Clearly a mental break. Kellen Finney: There are cases where heavy psychedelics, even cannabis, can push people with a family history of schizophrenia to have those conditions become more prevalent through use. Maybe the psilocybin triggered his schizophrenia or something similar — that's consistent with him saying he was "saving everyone" when he was really just trying to turn off the engines. Dr. Matthew Moore: That's an important conversation — the effects these drugs can have on people who aren't a baseline average person. But we're talking about a statistically irrelevant number here, one guy, and we're trying to derive reasons for one person's horrible decisions, which isn't fair to the drugs. I think it comes back to grabbing headlines — and yes, it's an important conversation about what these drugs do to people with a history of psychosis or family mental health issues. We've seen with cannabis that people predisposed to schizophrenia gravitate toward consuming it — does that mean cannabis causes psychosis, or is there a concomitant factor driving the desire for it? It's important to remember the context: thousands of people take mushrooms and don't try to crash planes or hurt anyone, and successfully address their own mental health or just have a good time. Bryan Fields: Those statistical outliers are exactly the challenge — media grabs the one case and blows it up to seem commonplace, whether for clicks or to reduce momentum behind the drug. But Matt, what happens if you don't know your family history — are you still susceptible to those kinds of breaks? And is there a way to take these safely without putting yourself or others at risk? Dr. Matthew Moore: As far as I know, there aren't genetic markers identified for that, though I could be mistaken. The general rule for any psychedelic is start low and go slow. Even doctor-prescribed drugs start at a low dose to find the minimum effective amount — that's how everyone should approach most drugs, even something as nontoxic as CBD; why take 500 milligrams a day if 150 works? There's a gradient between safe, harm-reduction choices and "all drugs are bad" — which is effectively what society has decided, unless it's gone through a clinical trial, or unless Big Pharma is behind it. Bryan Fields: That's interesting — I read an article today from The Economist about who the winners in the American healthcare system are, and the largest profit margins actually come from pharmaceutical brokerage companies, not manufacturers or clinical companies. Dr. Matthew Moore: Right — drugs made in Germany, for example, aren't made by nonprofits, but they still sell for an eighth to a tenth of the U.S. price. The cost of a therapeutic usually isn't in the capsule — especially with psychedelic-assisted therapies, where the therapy itself, four to eight hours of a therapist's time, is the expensive part. Regular talk therapy runs at least $800 a session, and ketamine sessions run $2,200–$2,300 without insurance for three doses, when the ketamine itself costs about $70. A lawyer once told me the real test of Schedule One status is whether there's an economic advantage to carrying a drug through clinical trials. Most Schedule One molecules are easy to make with abundant starting materials, which makes them less profitable to develop because it's easy for someone to undercut you — you can grow psilocybin mushrooms anywhere. That's not a great investment if you're spending hundreds of millions on approval and someone else can dodge your indication. So this rush of money into psilocybin, MDMA, and LSD is really an interesting IP play, because the money isn't in the molecule — it's in owning the clinics. Kellen Finney: There's a clear line between prescribed drugs for an illness and the recreational world where people take the same drugs without a doctor. With psilocybin, maybe there's eventually a prescribed pill, but people will still eat magic mushrooms recreationally. Will there ever be a clinical trial for the recreational mushroom experience, given it's different from a purified product? Is recreational use just going to be a permanent free-for-all, and the only way we learn about side effects? Dr. Matthew Moore: You'll run into the same polypharmacy issues as cannabis — mushrooms contain more than just psilocybin, and different mushroom types produce different effects, from laughing to feeling at one with nature. Those other compounds affect the experience the same way cannabis's polypharmacy does. Since biologically active molecules interact together, you get a different picture from plant to plant, further shaped by individual genetics and receptor types. That makes it incredibly hard to get through clinical trials, which is why a purified, single-entity psilocybin or psilocin powder will likely have the cleanest data — the FDA prefers single-entity drugs because it's easier to prove causation instead of untangling combinations of three, four, six, or eight active compounds. Kellen Finney: How far are we from a personalized-medicine approach to clinical trials? Dr. Matthew Moore: Researchers are working on that every day, but I don't think it's the cost-effective approach for our current healthcare system, which is why companies like Merck or Pfizer aren't pursuing it aggressively. Kellen Finney: Cost-effective for whom? Wouldn't I want medicine tailored to my own body? Dr. Matthew Moore: Unfortunately, our healthcare system isn't focused on cost-effectiveness for the consumer — it's focused on cost-effectiveness for shareholders. Kellen Finney: What if I became a shareholder — could I help facilitate that shift? Dr. Matthew Moore: You'd need billions — you and a hundred million of your closest friends buying up 51% of every major pharmaceutical company. Kellen Finney: Okay, that's all I need. Let me write this down. Bryan Fields: What about a billionaire like Brian Johnson, who's trying to reverse his own aging? Kellen Finney: He is the Blueprint. Bryan Fields: He is — I'm a big fan. He's focused on diet, and there's tools like InsideTracker, where you get quarterly blood tests to see biomarkers and how diet affects them. Brian Johnson, author of The Blueprint and a former tech founder, spends about $2 million a year reversing aging and has successfully reduced his biological age as measured by DNA methylation. Kellen Finney: Isn't that personalized medicine? Dr. Matthew Moore: That's personalized anti-aging, sort of medicine — and a growing number of people believe aging itself is a disease, so that could be a personalized way to treat it. Bryan Fields: Matt, do you agree with that? Dr. Matthew Moore: If you have the money, you can move mountains. There are cases like AIDS, where three or four patients have been cured through specific gene therapies — but it's not generalizable; each therapy has to be tailored to the individual's existing genetic markers. Personalized medicine requires an understanding of the human body, anatomy, and psyche that we don't currently possess. Do you know Michael Levin? He was a software engineer who moved into developmental biology and talks about cellular intelligence. Drugs rarely bind to just one receptor — LSD is one of the most selective, targeting mainly the 5-HT2A receptor, but most drugs hit many receptor sites because they resemble molecules the body already uses. You're essentially doing chemical warfare on your body, sending a blunt message instead of the specific, complex signals your body naturally uses — which is why we get side effects from off-target binding. Biologics and mRNA vaccines are steps toward speaking the body's actual language more precisely, rather than a drug like Viagra that's "for your heart" but does other things too. Bryan Fields: What would that "something else" be? Dr. Matthew Moore: I don't know, but we could make money off it — one of the best industries to be in. Bryan Fields: Sex and death. Kellen Finney: It made the internet a thing. Bryan Fields: Matt, are you familiar with Medicine 3.0? Dr. Matthew Moore: Not as a term, no. Bryan Fields: Peter Attia coined the phrase — proactively preventing disease rather than reacting to it. He says we're currently in Medicine 2.0, where you get diagnosed and then treated with a pharmaceutical to stabilize the condition. Being proactive instead of reactive could make a massive difference for society. Kellen, you want to jump in? Kellen Finney: I completely agree — there's a growing body of people supporting that concept. Matt, are you going to start this kind of testing and tailor your diet to your own biomarkers? Dr. Matthew Moore: It comes back to cost-effectiveness — sounds great, but also sounds pretty costly. Bryan Fields: What if money wasn't a factor? Dr. Matthew Moore: Then yes, preventative medicine is the way to go. I'm not waiting for symptoms — chasing pain is the big no-no, like never letting a hospital patient skip a dose while still hooked to a machine. Staying ahead of things matters, but as a species we don't yet have the understanding needed to personalize medicine for all eight billion people, even if there may only be one or two meaningful differences between each of us. Kellen Finney: Maybe AI or ChatGPT can accelerate that from an informational standpoint. Dr. Matthew Moore: That's really the only way — no human could track that level of detail across billions of people, but an AI storing all of human knowledge could. That's where we're headed, but as long as our healthcare system is profit-driven, we'll keep chasing treatments instead of cures, keeping the same patient on the books for 40 years so shareholders keep getting revenue. Bryan Fields: I want to give you credit and switch gears — about a year and a half ago you told Kellen and me that cannabis wouldn't be descheduled but would be rescheduled to Schedule Three. A lot of people have gone back and forth on that, but I want to give you your props. Here's a quote I read today: "Rescheduling rather than descheduling has led to some voices in the cannabis industry claiming the process is a Trojan horse meant to gift marijuana to big pharmaceutical interests." Dr. Matthew Moore: I still disagree, because the polypharmacy problem makes it very hard to get whole-plant cannabis through the clinic. I think naturally derived THC extract will become the most cost-efficient way to make medical THC once cannabis reaches Schedule Three. It's not a gift — it's a really expensive endeavor to get FDA approval and insurance reimbursement. The best path to real access is probably Congress setting something up like the veterans' research bill on smoking flower, sidestepping the standard FDA clinical pathway, since agencies must follow whatever Congress mandates. Pure compounds are easier to get approved. Schedule Three might let aggressive companies set up state-specific medical cannabis operations — say, a big pharma company running a California-only medical cannabis business, gathering data toward eventually pursuing full clinical trials. Ideally, by then it's fully descheduled. I'm hoping cannabis won't stay at Schedule Three long enough to matter much, since clinical trials still take years. Bryan Fields: So it would just be the molecule that moves to Schedule Three? Dr. Matthew Moore: That's where bifurcated scheduling comes in. Bryan Fields: Hold on, explain bifurcated scheduling for our audience first. Dr. Matthew Moore: Bifurcated scheduling is when a controlled substance and the actual drug product — the consumer or patient form — can have different schedules. Epidiolex, for example, is fully descheduled as a formulation, even though CBD the molecule has its own status. THC is Schedule One, Syndros is Schedule Two, and Marinol is Schedule Three — three different schedules for essentially the same molecule. MDMA is Schedule One, but once approved in capsule form for clinical use, that specific drug product gets descheduled because it can't remain Schedule One with an approved medical use — though it likely becomes at least Schedule Two, like an amphetamine. If cannabis flower becomes Schedule Three, it wouldn't necessarily force THC itself to move, since THC as a molecule doesn't automatically follow the flower's scheduling — you could still see arbitrary caps like 0.3%, 1%, or 3% THC. So it's not simply a giveaway to pharma; nothing about DEA or FDA processes is ever that simple. It's largely pay-to-play — enough regulatory advisors can get you through the system, but they're not cheap; those are the barriers to entry. Bryan Fields: What does the industry look like in 10 years, Matt, with pharma and rec cannabis? Dr. Matthew Moore: By 2034 we'll have Matt back on. I think there will be a large number of approved cannabinoid-derived drugs — mostly single-entity, or simple combinations like CBN with melatonin — and I suspect several mainstream cannabinoids will have gone through full clinical trials. Bryan Fields: Can they protect those trials with patents? Dr. Matthew Moore: Protection comes through the drug product — you can't patent CBD the molecule, but you can patent a specific formulation and concentration with excipients, and there's also indication exclusivity, giving seven years before a generic competitor can pursue the same indication. Sativex, which is 50% CBD/50% THC, is still incredibly expensive to get through clinical trials because combining molecules multiplies the complexity — does the combination work, does it work better than each alone, or just additively? As you add more molecules, the complexity multiplies further. You'll likely see a market shaped by more states allowing naturally derived drugs — cocaine, psilocybin, and LSD are all naturally derived or close to it, and MDMA is only two steps from a natural product — so the real debate becomes what actually counts as a "derivative," a definition Congress hasn't clearly settled. Bryan Fields: That's because they don't know. Dr. Matthew Moore: I think it's because the people paying them haven't told them exactly what it should mean. Bryan Fields: Based on what you're saying, Matt, you should be living in Denver with Kellen. Kellen Finney: What's that supposed to mean? People in Denver seem pretty favorable toward derivatives and how many steps away from natural they are. Bryan Fields: We all took calculus, congratulations. Dr. Matthew Moore: Back to the original question on Schedule Three for cannabis — I think it's unlikely we won't have recreational cannabis 10 years from now. Bryan Fields: People in Colorado said that 10 years ago, and it's almost been 10 years of legalization there come January. Colorado has the third-largest population of any legal state, and prosecution effort there is minimal — the states around it are legal too, so nobody cares. Kellen Finney: I believe in democracy — since most people believe it should be legal, it will be legal. Bryan Fields: Two years ago you flagged Delta-8, and it swept the country; last year, Delta-10, not as big but still made headwinds. Any compounds on the radar now that people aren't talking about yet that you think will matter a year from now? Dr. Matthew Moore: Setting aside Delta-9 and Delta-8, look at something like THCP — the C7 side-chain THC — it's significantly more potent, which isn't necessarily good since you don't want to blast off unexpectedly. But for functional beverages, needing far less material to hit the same effect is cheaper for manufacturers, even if the consumer doesn't notice a difference. Potency isn't the end game for consumers, but it will be for manufacturers looking to cut costs and reduce bitterness or off-flavors. Consumers look for an effect, not a molecule — psychonauts chase novelty, but most people settle on their steady favorites, like "eggs and bacon," and stick with them. Bryan Fields: I love it. Kellen Finney: THCP still kind of scares me — it's way too potent. Bryan Fields: You were scared of Delta-10 too, and you left us pretty concerned. Dr. Matthew Moore: Fair — I stand by where I was on Delta-10 a year ago. Have you ever looked at a chromatogram from Delta-10 products on the market? Bryan Fields: No, and I don't want to. Dr. Matthew Moore: I just wanted to put THCP on the board so we can revisit it in a year. There's an important interplay between people chasing novelty, who help discover new things, and the broader market, which wants: THCV for weight loss, CBN for sleep, THC to get high. Once you know what you like, you don't experiment much further, and eventually the market hits inertia around a set of steady, trusted products, phasing out the constant chemical tweaking done just to make a quick buck for a few months. Kellen Finney: Do you think it ends up like the alcohol industry — gin versus whiskey versus wine, different "drunks" for different categories, and people just pick their preferred style? Dr. Matthew Moore: Yeah, similar to resin versus rosin versus flower — people who only smoke don't do edibles, people who eat edibles stick with edibles, vape users stick with vapes. Preferences form and people don't discriminate against their category of choice. Bryan Fields: I feel so seen right now. Dr. Matthew Moore: The market has matured a lot, especially with CBD, and CBN feels like an underdog molecule that's everywhere but doesn't get enough credit for how much is sold — it's one of the most popular non-THC cannabinoids among people I talk to. The market finding its groove with legitimate players should help pave the way for further decriminalization, though there are still a lot of players just trying to make a quick buck, which holds back full legalization. Regardless, the cat's out of the bag — you're not going to arrest 50 million Americans or shut down every hemp farm. Bryan Fields: It could be done — slow and expensive, but we love slow and expensive things here. Kellen Finney: Speaking the government's favorite words. Bryan Fields: So, ethics and money aside, Matt, what experiment or research would you undertake? Dr. Matthew Moore: If I had unlimited money and no ethical constraints, I'd fund research into cellular intelligence, inspired by Michael Levin's work — things like how a cell "knows" what kind of cell it is, despite all cells running the same basic machinery, and how a skin cell can be reprogrammed directly into a nerve cell without returning to a stem cell state first. If we ignore these kinds of intelligence, we're missing forms of intelligence throughout the universe — even plants communicate via root signals, releasing distress chemicals when cut, which is the smell of fresh-cut grass. If you trace back far enough, there's no clear starting point where consciousness begins — it may be a continuum starting from a single fertilized cell. I'd focus funding on what Levin calls somatic cell therapy: convincing the body's own cells to do things they already know how to do, like regrowing an entire limb correctly, the way some animals can. Rather than blasting the whole body with chemical "warfare," like most treatments do, the goal would be precise cellular messaging — similar to cancer prodrug therapies activated only by targeted light at a tumor site, sparing the rest of the body. Bryan Fields: That's perfectly said, Matt, and I think that's where we should leave the conversation — we've taken it to a whole other universe. For our listeners who want to get in touch, learn more, and fund your experiments, where can they find you? Dr. Matthew Moore: You can reach me by email, find me on LinkedIn, or through The Dime — go there and look me up. Bryan Fields: Looking forward to seeing you next year. Dr. Matthew Moore: Yeah, hopefully the playing field will be a little friendlier by then. Bryan Fields: Hopefully. Thanks for taking the time, man, this was fun.