Old Drugs, New Tricks? Psychedelic drugs as therapeutic agents
For as long as we have recorded history, humans have been using chemicals to alter their perception of reality. Initial experimentation likely began with naturally occurring hallucinogens found in wild mushrooms and cactuses, but soon expanded to alcohol (fermented grains), opiates (poppy seeds), and stimulants (tobacco, coca leaves) with the advent of horticulture. The chemicals found in these plants could dull pain, create a euphoric state, reduce anxiety, increase arousal, and induce a sensation of connection with the universe. These plant-based drugs rapidly became important components of human social, religious, and medicinal practices.
As scientific discovery exploded in the 20th century, our ability to refine, manipulate, and synthesize new chemicals with even stronger psychoactive properties increased. Compounds like LSD and MDMA (ecstasy) were marketed as new treatments for disorders like alcoholism, depression, and anxiety. Psychiatrists would administer these compounds during therapy sessions to increase treatment efficacy. However, in response to the dangers of recreational use and their prevalence in the counter-cultural social movements of the 1960’s and 70’s, these drugs were quickly criminalized. Consequently, support for further clinical research into their potential medicinal benefits virtually disappeared.
Recently, privately funded organizations have helped to spur new life into these research efforts. Organizations like the Multidisciplinary Association for Psychedelic Studies have advocated for and funded clinical trials to investigate the effects of MDMA on improving therapy outcomes for patients suffering from treatment resistant Post-Traumatic Stress Disorder (PTSD). In one recent study, 10 of 12 patients who received MDMA in concert with psychotherapy had a decrease in PTSD symptoms, compared to only 2 of 8 patients who received placebo. Similarly, the Hefftner Research Institute recently reported that 12 of 15 (80%) patients who took doses of psilocybin (the active ingredient in hallucinogenic mushrooms) as part of a smoking cessation therapy remained abstinent at 6 months. This is impressive because most other smoking cessation therapies are, at most, 35% effective. Even the US government has begun to investigate controlled substances as mental health treatments. NIMH-funded clinical trials of ketamine (Special K) have demonstrated rapid (<2hr post-infusion) antidepressant efficacy that can last up to a week. In addition, NIMH is currently recruiting for a clinical trial to determine if ketamine can serve as a rapid-acting treatment for suicide ideation.
These studies beg the question: how are psychedelic drugs able to have such potentially dramatic effects in the clinic but not on the street?
The answer likely lies in the interplay between a class of neurotransmitters called monoamines (serotonin, dopamine, and norepinephrine) and the brain regions responsible for emotional memories. When recalled, memories can become moldable and subject to change. Monoamine neurotransmitters are an important part of emotional processing and help modulate and consolidate emotional memories. Importantly, most psychedelic drugs elevate monoamine stimulation far beyond levels achieved naturally. Therefore, drug-induced monoamine stimulation in a safe, clinical environment may allow the patient to ascribe new emotional context to a memory during guided therapy. Presumably, PTSD patients could employ this therapy to decrease fear and anxiety triggered by reminders of past events, or substance abusers could reduce cue-induced cravings.
Unfortunately, the stigma created by criminalization has impaired the ability of clinical researchers to fully investigate psychedelic drug therapies as potential adjuvant treatments. The present studies show impressive therapeutic effects but are hampered by small sample sizes and inadequate control groups. While there are legitimate concerns about the use of psychedelic drugs as therapies, without support for responsible research, it will be impossible to resolve those concerns. Perhaps now is the time to open regulation in a way that will provide the funding and access necessary to investigate these potentially life-changing therapies.
Image: "Garish (509162157)" by aussiegall
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