When Tripping Becomes Treatment: Use of Psychedelics to Treat Mental Health & Addiction
Move over cannabis and CBD... There's a new medicinal powerhouse on the horizon.
I first discovered Michael Pollan while listening to Oprah's Supersoul Conversations Podcast. Pollan, like myself, is what I would call a mindful foodie. I listened intently to the podcast as he described the process of eating as a spiritual practice. Pollan is a journalist, has a master's degree from Colombia University, and has written five New York Times bestsellers. His book The Omnivore's Dilemma has (for good reason) changed the way people think about food. Pollan is also a Harvard professor, conscious eater, and nature writer. Additionally, he co-founded the UC Berkeley Center for the Science of Psychedelics and wrote the book How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence. Yes! You heard me right. The "food guy" is into psychedelics.
Recently, I've been reading a lot about the use of psychedelics as a cutting-edge therapy for behavioral health conditions like anxiety, depression, PTSD, and addiction. In fact, this topic has been trending for quite some time. When I first saw that Michael Pollan was being touted as a leading expert in this subject matter… I thought it must have been a different "Michael Pollan." I mean, what's the mindful food guru have to do with LSD?
Then, I watched Tim Ferris on an SXSW broadcast. And there… sitting across from Tim… was the same bald-headed, poetic, intellectual, and intriguing Michael Pollan. Only this time, instead of talking about his spiritual connection to food, he talked about tripping on LSD.
I knew that Pollan was extremely committed to his craft. This is a guy who bought a cow while studying the cattle industry, and true to form, he volunteered to take psychedelics to further his research on their therapeutic use. I found Pollan's personal investment totally intriguing. And although I rarely watch an entire broadcast (cuz I typically get bored and antsy), I watched this SXSW episode until the end.
Why is this topic so fascinating? For starters, there hasn't been an innovation in 40 years to treat addiction and mental health disorders, and current strategies have low efficacy and terrible side effects. So it seems logical that we should all take notes when renowned institutions, like NYU and John Hopkins, take an interest in research regarding new behavioral health treatments. And, as an addiction specialist, I was particularly fascinated by the discussion of how these therapies help people effectively rid patterns of destructive behavior long term— after only 1 or 2 treatments. Pollan really focused on how these innovative therapies may alleviate human suffering and he spoke specifically about how they've helped people rid the paralyzing fear that comes with a terminal diagnosis (for more information, read The Trip Treatment, by Michael Pollan).
What Are Psychedelics
Psychedelics are a loosely grouped class of illegal hallucinogenic drugs that act on sensory receptors in the brain and induce an experience often described as an altered state of consciousness. These quantum experiences are often referred to as "trips." Psychedelics include LSD, ecstasy, psilocybin, and ketamine. These drugs are classified as Schedule 1 drugs, which means they have a high potential for abuse and no medicinal value.
LSD (lysergic acid diethylamide), often called "acid," is an illegal street drug and potent hallucinogen. Its effects can be pleasurable or extremely unpleasant (AKA "a bad trip." LSD comes in various forms; pills, liquids, gelatin sheets/blotter paper (LSD is soaked onto paper and licked off or swallowed).
Psilocybin, the active ingredient in magic mushrooms, is similar to LSD and causes altered perceptions and hallucinations. Psilocybin is obtained from hallucinogenic mushrooms, which grow in tropical and sub-tropical climates.
Ecstasy (MDMA or Molly) is a synthetic drug that was initially popular in nightclubs/raves. MDMA primarily affects mood, triggers sexual arousal, and a desire for closeness with others.
Ketamine is used as an anesthetic in veterinary medicine and is often stolen from pet clinics and sold on the streets and in nightclubs for its euphoric and hallucinogenic effects.
The Back Story
On a spring day in 1943, 250 micrograms of LSD were swallowed by Albert Hofmann, their creator. This was the world's first acid trip and the effect on Hofmann was overwhelming— much like hundreds of other acid trips that followed.
After that fateful day and throughout the mid-sixties, medical research regarding psychedelics flourished. More than 100 government-funded studies explored using the drug to treat conditions like depression, alcoholism, schizophrenia, autism, and obsessive-compulsive disorder (Roos, 2018). Through the mid-1960s, psilocybin and LSD were legal and remarkably easy to obtain. Sandoz, the Swiss chemical company where, in 1938, Albert Hofmann first synthesized LSD, gave away large quantities of LSD to any researcher who requested it, in the hope that someone would discover a marketable application. Psychedelics were tested on alcoholics, people struggling with mental illness, terminal cancer patients, and convicts, as well as on perfectly healthy artists and scientists (to study creativity) and divinity students (to study spirituality). The results reported were frequently positive (Pollan, 2015). But when the hippie counterculture got hold of LSD, it garnered a bad reputation as a "party drug." It influenced movies, music, clothing, and the party scene. There were many tales of "bad trips" that resulted in permanent psychosis and disabilities.
Then, in 1970, the pervasive drug use of the '60s was met with a counterpunch when President Richard Nixon waged the war on drugs. He shut it all down (or tried to) by signing the Controlled Substances Act and creating the Drug Enforcement Agency (DEA).
Resurgence of Research
As I learned while watching the SXSW broadcast, research is again taking place with psychedelics and the results are promising. Researchers are reinvestigating how psychedelics can open up the subconscious and possibly cure difficult to treat conditions like depression, addiction, and PTSD.
Psilocybin research is taking place at several universities in the United States, including Johns Hopkins, NYU, Harbor-UCLA Medical Center, and the University of New Mexico. Dr. Roland Griffiths, neuropharmacologist and lead author of a groundbreaking Johns Hopkins study that examines the efficacy of psilocybin, says: "What is different about psilocybin, compared to other mood-altering drugs or pharmaceuticals, is the enduring meaning and belief changes that can occur. People feel 'reorganized' in a way they don't with other drugs. It's almost like reprograming the operating system of a computer" (Biotech Investor's Journal, 2021).
Another former "party drug," Ecstasy (MDMA), is showing positive results in clinical trials treating post-traumatic stress disorder (PTSD) and other mental health challenges. Post-traumatic stress disorder (PTSD) presents a major public health problem for which currently available treatments are only modestly effective. Clinical trials were conducted under a randomized, double-blind, placebo-controlled, multi-site structure, and the findings showed clinically significant improvement; 67% of the participants in the MDMA group no longer met the diagnostic criteria for PTSD after three sessions. "We conclude that MDMA-assisted therapy represents a potential breakthrough treatment that merits expedited clinical evaluation" (Mitchell, Bogenschutz, Doblin, 2021).
Efficacy & The Dosing Dilemma
Psychedelic compounds can have wildly differing results depending on the dose. For example, a large enough dose can trigger a full-on hallucinogenic experience. While a smaller dose can offer a number of helpful benefits-including lowering stress and anxiety without inducing any of the mind-altering effects.
That's why finding the "sweet spot" between the dose and the effect it induces in a patient's body is such a crucial part of drug research and development. Determining the efficacy and potency profiles help researchers find effective doses that trigger the intended outcome, while reducing undesirable side effects.
There are two distinct treatment approaches with psychedelics, both of which are proving successful in a variety of settings. That's why leading researchers in the field of psychedelics are creating novel drug compounds targeting both treatment approaches.
Macrodosing is designed to deliver a significant enough dose to produce substantial psychoactive effects. These doses are intended to work quickly, wear off quickly, and reduce the time a patient spends with their health provider.
As you may have guessed, the higher the dose, the more likely one is to experience a psychedelic experience. It's important to realize that it's this out of body (quantum experience) that is thought to bring about the desired change. During this out-of-body experience, the ego dissolves, insight develops, and the individuals feel harmony with others and the world around them. For this reason, this therapy is effective with conditions that are rooted in repetitive/destructive cycles of behavior that tend to create "disconnection". For example, addiction and depression both involve repetitive destructive behaviors that cause separation from loved ones and life in general. For these types of conditions, lasting improvement is often reported after only 1 or 2 sessions, which are always conducted in a controlled environment and led by a professional clinician. Macrodosing can be detrimental for a person without the proper controls and guidance in place.
Microdosing is when people consume very small amounts (micro amounts) of a psychedelics, usually every couple of days over the course of several weeks— to improve their mood, focus, creativity, motivation, or energy levels. The lower dosage provides therapeutic results without causing a hallucinogenic experience and there is little danger of a bad trip. Because these drugs have a longer duration, they benefit the patient throughout the day. Microdosing involves taking such a small dosage of the psychedelic in question that the user is generally able to continue with their daily life quite capably; neither they nor anyone they interact with would notice any major changes in behavior. Microdosing would be the preferred approach for treating, for example, ADHD in children where a hallucinogenic experience is undesirable. According to Rick Doblin, executive director of psychedelic research nonprofit MAPS, with microdosing "your cognitive processing is slightly enhanced in certain ways – more creative, more focused, a little bit of a mood elevation – but you're not in any way tripping. And you can drive. You can do all sorts of things that you wouldn't do if the dose were higher" (microdose-pro.com).
Microdosing is undergoing studies to gauge its therapeutic usefulness. A recent study by researchers from Maastricht University and the Beckley Foundation focused on non-hallucinogenic, low doses of LSD for pain management. The results, from an ingested amount of LSD 20 µg, were "significantly increased pain tolerance by about 20%, and decreased subjective levels of experienced painfulness and unpleasantness." (Microdose-pro.com, 2021)
Does The Government Support Psychedelic Research?
The federal government seems to have a split personality when it comes to supporting mental health research using psychedelics. Jerrold Rosenblum, the head of Massachusetts General Hospital's Center for the Neuroscience of Psychedelics, points out that "the FDA gave money to the Multidisciplinary Association for Psychedelic Studies (MAPS) which funds the study of MDMA and to Compass Pathways which is doing a Phase 2b psilocybin study, breakthrough status. In the meantime, the DEA [Drug Enforcement Administration] still has most psychedelics classified as Schedule 1 drugs.
"You may have a situation where the FDA eventually approves these treatments, and then the DEA will be compelled to reschedule them… I don't think it makes sense for psychedelics to continue in Schedule 1. When you talk about harm to self or harm to others, they're way down the list, below things you can buy in your pharmacy or that your doctor can prescribe. They're not addictive, though they do create an intense emotional experience that can be distressing if people are not prepared for it or if it's not done with the right mental set and in the right setting" (Powell, 2021).
Wall Street Takes Notice of Psychedelics
The excitement coming from the research front has been heard all the way to Wall Street where hungry investors are always looking for the next big money maker. Financial gurus are urging investors to take a closer look at companies that may soon be patenting psychedelic medications.
Kevin O'Leary, millionaire entrepreneur and co-host of TV's Shark Tank, is among the rich and famous scaling the market for mental health treatment innovations. He says the way investors should be looking at this opportunity is based on the fact that new medicines for mental health have not been approved for decades.
"The potential of psychedelics far exceeds the potential of cannabis," O'Leary said recently at CNBC's Healthy Returns Summit. "This is a brand-new area of medicine with such incredible potential," said O'Leary, who has personally invested in two major psychedelics companies that are conducting studies into how psychedelics could improve mental health. O'Leary said, "This could save lives, cure depression, help alcoholism, get people off opioids – why wouldn't I want to be invested?" (Staff writer, 2021).
That's a Wrap
So, suffice it to say that there is a rebirth occurring when it comes to the drugs of the '60s and '70s: Ecstasy, Psilocybin, and LSD. Although these drugs are still illegal, there is emerging evidence that these hallucinogenic substances could someday provide effective treatment for difficult to treat mental health conditions and addiction.
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