Rethinking Psychedelics: A New Solution for Mental Health, Addiction and Therapy?
The psychedelic ‘60s are long gone but the drugs themselves are returning as new treatments for many conditions. Photo: Robert Altman/Michael Ochs Archives/Getty Images
The psychedelic ’60s are long gone, but the drugs themselves are returning in new and important ways, as effective therapeutics for many conditions and disorders, including smoking cessation, opioid addiction, depression, anxiety, PTDS and end-of-life care.
But psychedelics are also becoming increasingly acceptable and sought after as a way to “transcend time and space,” says psychiatrist Matthew Johnson, MD, one of the speakers at ideacity’s “The Psychedelic Summit: Health. Business. Legalization” on Feb. 25. (If you missed it, a replay is available starting on March 2. Go here for more information.)
If you don’t know much about ayahuasca, psilocybin (they’re magic mushrooms) or ashwaganda or any other psychedelic – or why and how they’re about to become mainstream and what they can do for you – read on.
What’s the Research?
Dr. Johnson, who was part of the summit’s opening session, helped pioneer the therapeutic use of psilocybin in his work with the Center for Psychedelic and Consciousness Research at Johns Hopkins University where he is a professor of psychiatry. Dr. Johnson participated in a Q&A with Zoomer earlier this week.
1. Not since the ’60s has there been so much interest in psychedelics, both therapeutic and recreational, with public corporations investing in cannabis, cannabis shops on every corner and the Canadian government allowing a few terminally ill patients to use psilocybin (more commonly known as magic mushrooms). Why now?
For psychedelics, the thing that really killed off research was the professional marginalization for conducting psychedelic science. A few decades had to pass for that to weaken. A generation that was opposed to it had to age out and pass on. The promising data from the last 20 years has attracted continually growing interest.
2. Is psilocybin an appropriate therapeutic for most terminally ill patients? What does it do for them? Should it be available to all of them?
This is a good idea to test, but we can’t get ahead of the data. What we know the most about is life-threatening cancer, but it is very likely that such results would extend to other seriously ill patients. It will have to pass Phase 3 trials to be fully approved. I think there is enough known to support legal “compassionate use” programs while that process is playing out, like what is happening now in Canada.
3. What about psychedelics, especially psilocybin for the rest of us? You’ve suggested in a National Public Radio interview that it should be considered as a first-line treatment for some disorders. Would that include chronic depression, addiction and anxiety? Who would these be appropriate for?
We have to follow the unfolding data, but I think so far, based on what is known, if psilocybin is shown effective for a disorder, there is a good bet that it would be an appropriate first-line treatment for that disorder – not for everybody but for many.
4. Can you tell me a bit about your current research? Where is this leading? Can you foresee a time when psychedelics are almost as common as antibiotics and, if so, when would that be?
I’m starting research examining LSD for chronic pain and psilocybin for opioid addiction and for PTSD. I’m planning on continuing the psilocybin smoking cessation work toward Phase 3 trials eventually. I think psychedelics will be more prevalent in psychological care and in medicine over the coming couple of decades.
5. Is psilocybin safe for everyone except those with high blood pressure? Does it work differently on people of different ages, and is it appropriate for people age 50 and up?
Nothing is completely “safe,” and there are many other factors that would be a problem, such as psychotic disorder and predisposition, and other severe medical issues like liver disease. We’ve run research participants with psilocybin up to 80 years old so long as they pass the medical criteria. Age doesn’t seem to cause a big difference in effects.
6. You’ve also said that using it can be like “opening a window, ” perhaps facing one’s greatest regrets and fears and shining a light on the dark corners of one’s life. There’s no way of knowing in advance what someone will experience or encounter. Isn’t it kind of like rolling the dice to see what comes up and therefore risky? Also, it seems like this could be extremely painful. You said it could feel like dying – obviously not a good feeling. So why do it? Is the possible catharsis worth the risk and pain?
Yes, there are risks, including having a painful and terrifying experience. This would not be [appropriate] for anybody who was not comfortable for that. With the right safeguards in a clinical context, there do not seem to be long-term harms from these difficult experiences so far. All medical and psychological procedures have risks. Life has risks. The relevant questions are what are those risks, what can we do to mitigate them and does the risk/benefit ratio with those mitigating strategies make it a reasonable option for an individual. I’ll also note that the most important and meaningful things in life involve pain and risk – growing up, recovery from injury, the birth process, loving others.
Is It Legal?
“The psychedelic renaissance is happening now,” says Ronan Levy, and the Toronto-based entrepreneur couldn’t be happier.
Levy, formerly a practising lawyer, is the co-founder and executive chairman of Field Trip Health Ltd., a publicly traded company listed on the Canadian Securities Exchange as of October 2020. The business offers “an integrated approach to using ketamine-enhanced psychotherapy to bring you back to life.”
Ketamine is a synthetic drug widely used as an anesthetic and sedative but has also become popular as a recreational drug for its ability to bring about a trance-like state.
It’s legally used off-label in the clinics.
With locations in Toronto, New York, Los Angeles, Amsterdam, Chicago and Atlanta and more opening soon, Field Trip is part of “a fast-growing, hyper-accelerated industry,” says Levy.
“There’s a lot of therapeutic interest, a lot of demand, a lot of investor interest.”
A number of different trends are coming together to propel psychedelics into the commercial mainstream.
“The pandemic has been making mental health more complex. Depression has tripled,” observes Levy. “Meanwhile, research around psychedelics has shown that they are a safe and effective treatment for depression and PTSD. They’re generally non-addictive, and it’s hard to overdose on them. The risk is low, and the reward is high. Fears are lessening, driven by science and data.”
As well, the stigma of drug use is disappearing, he says. “Cannabis is helping to change people’s minds about drugs.”
Appointments at Field Trip clinics begin with a physical and mental screening. The therapy may not be appropriate for people with uncontrolled high blood pressure or certain personality disorders.
If everything looks positive, each person’s program is individually designed in consultation with a physician, a team of therapists and a clinical psychologist.
Treatment of depression typically involves six ketamine exploratory sessions and three integration sessions. During each exploratory session, the drug is administered intramuscularly twice and leads to a 60- to 90-minute psychedelic experience. This is followed by a meeting with a therapist for classic cognitive behavioural therapy and to talk about what was experienced.
“It’s an opportunity to revisit the past, to explore emotions that were suppressed and to unpack the reasons for depression or other mental health conditions,” explains Levy. The ketamine experience enhances insights and “allows the brain to become more moldable in a positive way, to try to make changes to outlook, lifestyle, habits.
“It’s about driving change, not just taking a drug to feel better.”
Levy acknowledges that there’s a risk of a “bad” trip on the drug, but he prefers to call them hard trips.
“Even they can be therapeutic and cathartic,” he says. “We have staff who are well-equipped to help with challenging experiences, to control the situation and to try to make sure it’s a good experience in the first place.”
The cost for the series of six sessions ranges from $4,900 to $5,900.
“The future for psychedelics is incredible,” Levy insists. “People tend to be happier people when completing psychedelic therapies – with increased creativity and openness.”
He says he’s excited about how the conversation around mental health is changing.
And he envisions a time, not too far off, when going to a psychedelic clinic for to enhance mental and emotional fitness will be no different than going to a gym to work on physical fitness.
Making Psycho-Spiritual Connections
Cannabis shops are sprouting on practically every corner of Canada these days, as ubiquitous as banks and Starbucks.
Also ubiquitous in Canada is ayahuasca.
So says Summit participant Wade Davis, a man of many parts, the most intriguing of which may be his pioneering use of psychedelics.
Davis, the 67-year-old cover star of Zoomer magazine’s November/December issue, has impressive credentials. He’s a professor of anthropology at the University of British Columbia with a Harvard PhD in ethnobotany, National Geographic Society Explorer-in-Residence from 2000 to 2013 and author of 22 books including most recently Magdalena: River of Dreams, published in September.
But Davis doesn’t just explore the landscape of the known world. For decades, along with journeys to the farthest, highest, deepest least-explored corners of the planet, he has been venturing fearlessly into the deep, mysterious but alluring mindscape of the interior world, enabled by hallucinogenic and disassociative substances that separate mind from body.
He says he wouldn’t be who he is if he hadn’t experienced “serious psychedelics” in the 1970s: mushrooms, peyote, mescaline and LSD.
“I’m very proud and happy to say that I wouldn’t write the way I write, I wouldn’t think the way I think, I wouldn’t treat gay people the way I treat gay people, I wouldn’t treat women the way I treat women, I wouldn’t understand the power and resonance of biology – of nature itself – if I hadn’t taken psychedelics,” he says.
“Psychedelics were instrumental, cracking open the sky, flinging wide the windows of the mystic.”
The ubiquitous ayahuasca, Davis explains, is not a single drug but a brewed tea, a combination of a liana and a specific admixture plant that has that the hallucinogen dimethyltryptamine, or DMT.
“It’s the most powerful psychoactive preparation of the shaman’s repertoire in the Amazon,” says Davis.
He adds, “It’s fascinating how ayahuasca has gone from being a completely obscure thing – I could come back in 1974, tell someone I’d just taken ayahuasca, they wouldn’t have any idea what I was talking about – to now of course it’s become not just common knowledge but commonly used by people everywhere. That’s within a generation or two.”
It’s become so popular that ayahuasca tourism has become trendy: trips to the Amazon and the Andes to experience “the trip.”
Davis worries that it’s become too commercialized and predatory.
He also says that using psychedelics is not just about the individual narcissistic journey into self or even subverting the self to experience an epiphany.
“In the traditional reaches of the northwest Amazon, where the plant [the medicine] both originated but also where today it’s taken very much as a collective experience,” he says, “the ritual itself becomes a prayer for the continuity and the well-being of the people themselves – where you’d never even think of this in terms of ‘self’ or ‘I.’”
If taking ayahuasca is meant to be a sacred ceremony, it’s not necessarily a pleasant one.
“It’s not for the faint-hearted,” he says. “It’s a serious encounter.”
Davis is not a fan of marijuana, but he believes that the war on drugs is “the greatest public policy folly of our times.
“After more than 50 years, with an expenditure of $1 trillion in the U.S. alone, there are more people in more places using worse drugs than ever before.
He continues, “Decades ago, we were ruining the lives of young people caught with a single joint, and now we’re acting as if marijuana is perfectly benign and something to be dispensed at any corner store.
“This doesn’t inspire confidence that we’ve actually learned anything about the nature of human drug use.
Nevertheless, the legal and therapeutic status of drugs is slowly changing.
“There’s a resurgence of interest in the clinical applications of psychedelics which is long overdue,” Davis says, “These substances have immense potential, particularly in therapy.”
Now, here in Canada, with cannabis retail stores, with ketamine clinics and with psilocybin beginning to be prescribed for end-of-life care and permitted for religious rites in the Santo Daime church, drug use is being seen more and more in a positive light.
And enlightenment remains one of its attraction.
“Back in the day, our parents tried to warn us: ‘Don’t take these drugs, you’ll never come back the same,’”recalls Davis. “They of course didn’t understand that not coming back the same was the entire point of the exercise.”