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Psychedelic! How Hallucinogens May Soon Go Mainstream as Medicine

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In the 1960s, Harvard psychologist Dr. Timothy Leary and his partner Dr. Richard Alpert began experimenting with hallucinogenic drugs such as LSD and psilocybin (the ingredient in “magic mushrooms”) to learn about the drugs’ effects on the mind. Leary may be known now for “turn on, tune in, and drop out” (his and Alpert’s lab was shut down over safety concerns), but he may have been onto something, and current researchers have taken up his mantle (if not his penchant for taking the mind-altering drugs themselves).

New studies show that there actually might be benefits for mental health from a number of hallucinogens, including psilocybin, ketamine (a “rave” drug known as Special K), MDMA (known as Ecstasy or Molly) and LSD. These experts see hallucinogens’ possibilities for the treatment of a host of issues…

Hallucinogens, also known as psychedelics, have so far been studied in small doses taken  in carefully supervised environments and rigorously coupled with psychotherapy—so you’re not about to get a prescription for one this weekend. But the research is real—and promising.

A LONG, STRANGE TRIP: WHERE IT ALL BEGAN

Studying psychedelics’ potential to treat mental health conditions isn’t new. Research was conducted worldwide between 1950 and 1970. The US government alone spent millions on studies that involved thousands of participants—in some cases, without their consent or even knowledge. But increased recreational use by counter-culture hippies and resulting fears about dangers—many of which were overblown or untrue—shut it all down. The Controlled Substances Act, which classified psychedelic drugs as Schedule I, meaning they were highly likely to be abused and of no medical use, became law in 1970.

DRUG RESEARCH CHALLENGES

In recent years there’s been a resurgence of interest in studying medical uses for hallucinogens at major academic medical centers, but researchers still need to clear significant hurdles to do so, both with the Food and Drug Administration and the Drug Enforcement Agency.

Funding is yet another problem. Most pharmaceutical research in the US is funded by the National Institutes of Health (NIH) or drug manufacturers, but the NIH and big pharma remain reluctant to get involved in hallucinogen studies, so financing has to be secured through private donors and philanthropic institutions. That effort received a big shot in the arm this spring with the establishment of Fundamental, a crowdfunding campaign conceived by cancer survivor and New York City real estate developer Rodrigo Niño, CEO of the commercial real estate crowdfunding platform Prodigy. Fundamental’s goal is to raise millions of dollars to fund rigorous medical studies.

HOW HALLUCINOGENS WORK

Psychedelic drugs are thought to activate serotonin 2A receptors in the brain, which profoundly alters consciousness. When this happens, stimuli that the brain might have ignored suddenly become highlighted, and the mind is opened to new experiences. From the user’s perspective, there can also be a mystical or spiritual component. MDMA, according to a leading hypothesis, promotes attachment and bonding, so recounting a traumatic event to a psychotherapist in a safe environment while under its influence may remove the fear and anxiety associated with the memory and replace it with a more positive memory.

One thing these drugs don’t do is trigger addiction. Psilocybin and LSD do not possess addictive properties in any ways that we measure addiction in animal and human models. In fact, they may have anti-addictive properties—studies from the 1950s to 1970s, and several studies conducted in recent years, have found that a single low dose of LSD can be effective in treating alcoholism (more on the alcoholism research below).

Hallucinogens can exacerbate psychosis, however, and should never be given to psychotic patients such as schizophrenics. As the experiences in the ’60s and ’70s demonstrated, there are well-known adverse psychological effects from uncontrolled recreational use of psychedelics. The most serious are psychosis in people with a known psychotic illness or who are at risk for psychotic illness…dangerous behavior such as violence and suicide…and severe anxiety and panic.

But once that susceptible population is screened out, psychedelics are very safe when used in controlled environments and administered by skilled clinicians. In the modern era of research with psychedelics over the last 20 years, there have been more than 2,000 doses of psilocybin administered—and zero serious adverse events.

TREATING ALCOHOLISM WITH A SPIRITUAL AWAKENING

One of the most promising areas of the earlier research, before the Controlled Substances Act, was in using psychedelics to treat alcoholism. Today, preliminary results of an ongoing NYU study suggest a very positive outcome. Instead of LSD, researchers are trying psilocybin, the “magic mushroom” compound, which acts in the body in a similar way. Following the first psilocybin session, the number of drinking days, as well as heavy drinking days, dropped significantly among participants. At Johns Hopkins Medical Center, another early-stage study has reported that psilocybin is effective against tobacco addiction. Other researchers are studying its use for treating cocaine addiction.

How psychedelics work against addictions isn’t understood exactly. There are certainly biological explanations, in terms of rewiring the brain and changes at the gene level. But a leading hypothesis in the NYU psilocybin trial to treat alcoholism is that a spiritual transformation—the result of a drug-induced personally meaningful mystical experience—is key. In that trial, 70% of participants reported that being on the drug was one of the top five most significant experiences of their lives. If that has an effect on curing addiction, it wouldn’t be surprising. As far back as the early 1800s, William James, the father of American psychology, suggested that spiritual/mystical experiences could help addicts, and a spiritual awakening is one of the guiding principles of Alcoholics Anonymous.

INVESTIGATIONS TO TREAT DEPRESSION, AUTISM, PTSD AND MORE

Here are a few more ways that psychedelic drugs are being studied for therapeutic purposes…

  • Cancer patients: In a phase 2 study at NYU Langone Medical Center and Johns Hopkins University, a majority of people suffering cancer-related anxiety or depression experienced rapid, substantial and sustained relief for as long as eight months from a single dose of psilocybin administered in conjunction with psychotherapy.
  • Depression: In a small British study, patients who had been clinically depressed for an average of 18 years and who had not responded to standard medications showed an improvement in symptoms one week after two doses of psilocybin. Five of the 12 participants were in complete remission three months later. Several other small studies have found that ketamine provides rapid antidepressant effects for severe and even suicidal depression, and new clinical trials sponsored by the US Department of Veterans Affairs, as well as the National Institutes of Health, are underway.
  • Autism: Researchers at UCLA are studying how MDMA might ameliorate the social anxiety and resulting isolation of adults with Asperger’s syndrome, a high-functioning form of autism spectrum disorder.
  • PTSD: MDMA-assisted psychotherapy has shown promising results in treating post-traumatic stress disorder. Prior medications and psychotherapy had not worked for the patients in the study, yet one year after treatment, 68% of them were demonstrating long-term improvement, and some no longer met the criteria for having PTSD.
  • Cognition: The Beckley/ Imperial Research Programme in the UK is undertaking the first controlled scientific investigation into whether LSD microdosing—taking such a small dose you don’t even know you’re on it—enhances cognition, increases productivity, improves mood and/or boosts creativity. Their findings could result in therapeutic use for people with ADD and depression, among other conditions.

THE FUTURE OF HALLUCINOGENS

Given how much interest this research is getting, the hope is that the next phases will enjoy a faster approval process and increased funding. Early clinical trials have moved into the second and third phases, so it’s possible we will see these treatments become available to patients in three to five years. If it happens, it’ll be under restrictive conditions—drugs administered by certain doctors in certain hospitals and clinics with appropriate supervision. So “tune in”—we’ll follow this closely!

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Source: Stephen Ross, MD, director of addiction psychiatry at New York University (NYU) Langone Medical Center, associate professor of psychiatry and child and adolescent psychiatry at NYU School of Medicine, director of the division of alcoholism and drug abuse at Bellevue Hospital, principal investigator of the NYU psilocybin cancer anxiety study, and co-lead investigator of the NYU psilocybin-assisted treatment of alcohol dependence study. Date: September 12, 2017 Publication: Bottom Line Health
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