🫠 Psychonaut POV

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Dr. Ben Malcolm assumed the alias, “Spirit Pharmacist,” because he was tired of pretending drugs couldn’t have spiritual effects. Now he’s living proof that yes, you can be rooted in academic rigor, scientific integrity, and a belief in something beyond measure.

We asked Ben about a big misconception around psychedelics he hears often, drug interactions and contraindications to be aware of, and considerations for anyone tapering off pharmaceuticals.

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What led you from clinical psychiatric pharmacy to becoming the Spirit Pharmacist? Was there a particular experience that launched you down this path?

My fascination with psychoactive drugs started when I was around 15 or 16, mainly through watching shows about addiction. I got really interested in MDMA and psilocybin after finding Erowid and reading different people's experiences. What struck me was how different the trajectory of these substances was compared to other drugs. Even when experiences weren't pleasant, people usually felt they learned something or felt better afterward.

The path wasn't straightforward though. Back in 2002-2004, there was very little psychedelic research happening. Roland Griffiths hadn't even published his seminal work on mystical experiences and psilocybin yet. So while psychedelics captured my attention, I couldn't see how this interest would lead anywhere career-wise. I ended up studying pharmacy and pharmacology simply because I was interested in it.

The turning point came during my first year of residency in a hospital setting. I was feeling burnt out when the psychiatric pharmacist handed me a flyer for a second-year residency in psychiatric pharmacy. Something just clicked. I realized that what had inspired my entire decade-long educational path had always been psychoactives.

By 2016, the psychedelic research scene had really heated up. Esketamine had received a breakthrough designation from the FDA, and MDMA and psilocybin would follow suit in subsequent years. There was finally enough solid data that someone with my background could stand on it and challenge people's perspectives around these substances in formal, data-backed ways.

The name "Spirit Pharmacist" came to me during a science and art conference focused on psychedelics in Los Angeles, aptly named Visionary Convergence. It captured some important things—first, an explicit recognition that drugs can have spiritual effects, which was never acknowledged in my pharmacy training. It also represented a different approach to psychiatry that doesn't pretend to know what will make another human being happy. Instead, I try to act as a knowledgeable sounding board for people exploring their own path to wellness.

What misconceptions do you encounter most in the public discourse about psychedelics?

One of the biggest misconceptions I encounter is around this idea of polarized experiences, such as the “bad trip” or a “full mystical experience.” People often think they're going to have either an entirely positive spiritual experience or a completely hellish, dysphoric one. But the most common psychedelic trajectory is actually experiencing a vast gamut of emotions—sometimes even paradoxical ones, like being so sad you could cry, but when the tears come, they're tears of joy.

So what should you expect? Well, there's usually a come-up phase that's inherently ego-threatening. You're riding the elevator up but don't know where the top floor is. This might involve some transient struggles with nausea, anxiety, or even physical pain if that's part of your history. Then there's a peak phase, which I see as working in a cathartic way. This is where you might have your big event of the day, whether it's a psychological realization that feels like an epiphany or remembering something you've forgotten. Classic themes here often involve forgiveness, gratitude, self-love, and self-acceptance.

After the peak is where I think you get a lot of the mystical gravy for the day. But here's the thing. Before you meet God, you usually have to meet yourself. If you've got a closet full of skeletons you haven't looked through for 20 years, it might take a while to get through that closet. But once you do, that's typically when the clouds part and the light comes through. That feeling of miraculous lightness often comes as a direct result of what you dealt with during the peak.

Can you share your perspective on microdosing and SSRI tapering? What should people understand about this process?

I really caution people against seeing microdosing and SSRIs as simple substitutes where you can trade one out for another rapidly. The backbone of success is usually going to be a longer, slower taper rate for the antidepressant rather than finding some magic pharmacological support. I generally have people focus on taking a step or two of the antidepressant taper first, because we want to isolate variables. If you're new to microdosing, that's one variable; decreasing your antidepressant dose is another.

When you start noticing some changes—hopefully in a tolerable way—those become your target symptoms for microdosing. What are you supposed to feel from microdosing? The jury's still out, but most people experience either a mood uplift or feel calmer. The beauty of psychedelics is that they're rapid-acting, so you shouldn't need to microdose for a month to figure out if it's helping.

I think microdosing cycles should be limited to three months maximum until we get more safety information about potential chronic toxicities associated with ongoing and regular psychedelic use. One concern is the possibility of developing valvular heart disease due to the chronic stimulation of the 5-HT2B receptor.

For individuals using psychedelics and SSRIs in parallel, the timing of microdosing cycles becomes important when considering how slow the person is tapering. For example, if they're on a six-month taper plan, they might need to build in 2-to-3-week mini-cycles of microdosing to cover acute withdrawal phases with each monthly dose reduction, while also giving themselves breaks between cycles to really understand where they're at without any additional support. Others tapering over a period of a couple months may be able to ‘cover’ their taper with a single microdosing cycle.

What are the most important drug-drug interactions people should be aware of when planning psychedelic experiences?

The two biggest concerns are MAO inhibitors and lithium. These are at the top of my list of what not to combine with psychedelics. MAOIs with certain psychedelics, particularly phenethylamines that release neurotransmitters or block their reuptake, can be dangerous and are strictly contraindicated in combination. Lithium seems to increase the chances of having either a very dysphoric experience or precipitating seizures when combined with psychedelics.

Most other interactions tend to blunt the effects of psychedelics rather than make them dangerous. Antidepressants, benzodiazepines, antipsychotics, and sleep medications like trazodone or mirtazapine can seemingly take the edge off the experience or even cause the psychedelic to dud. But there's still a lot we don't know about the extent of these interactions. Whether they reduce effects by 15% or 50% can make a huge difference in whether it's worth proceeding.

One often overlooked area is the impact of heavy alcohol or cannabis use. While cannabis might acutely enhance some psychedelic effects, heavy daily use tends to dull people's sensitivity over time. Sometimes there's such a myopic focus on prescription medications that we miss the bigger picture. If someone's drinking five glasses of wine a night and using cannabis heavily to sleep, that might be more important to address than their low-dose Prozac when preparing for psychedelic work.

Tell us about your pharmacology courses. Who are they designed for, and what gaps are they filling in psychedelic education?

Spirit Pharmacist offers both individual psychopharmacology consulting and psychedelic education. Coming from an academic background, I love creating educational resources, and I tend to write at a fairly technical level, similar to what you'd expect from graduate or pharmacy school. I get compliments from psychiatrists about the depth of information, but I also hear from psychedelic facilitators, therapists, and individuals on their own healing journeys who appreciate the detailed approach.

That said, I do create content for different audiences. For example, I recently released a free mini-course called Fungi Pharmacy that's designed for people who might want to use psilocybin in Oregon's legal framework. It's about an hour of education broken into short modules covering the basics. Even then, I don't skimp on detail. I believe people appreciate having access to thorough, academically-grounded information about psychedelics and their interactions.

It all comes back to what I've seen in practice: When people are forced to get educated about what they're doing, they engage with their own healing in a much more empowered way than when they're just following someone else's prescription plan. I see empowerment as integral to positive outcomes.

Want more from Ben?

Book a private consult or check out his courses to deepen your knowledge of psychedelics and psychopharmacology. Take 10% off with code TRICYCLE when you enroll by Jan 31.

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DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice. The use, possession, and distribution of psychedelic drugs are illegal in most countries and may result in criminal prosecution.