The Truth About Tripping: How Psychedelics Made A Comeback

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01_0142Photographed by Stephanie Gonot.
Back in 1957, British psychiatrist Humphry Osmond summed up LSD’s effects in a pithy couplet, which he sent to the writer Aldous Huxley: “To fathom hell or soar angelic,” Osmond wrote, “Take a pinch of psychedelic.”

Many psychiatrists and researchers of the era, including Harvard psychologist-turned-counterculture-LSD-guru Timothy Leary, ended up getting carried away with the idea of “soaring angelic.” Osmond, who studied how LSD could treat alcoholism, wasn’t among them. But, questionable research practices and increased recreational use soon tainted psychedelics’ reputation and squelched legitimate scientific inquiry on potential therapeutic use. The Controlled Substances Act of 1970 classified LSD and psilocybin — the active compound in magic mushrooms — as substances with a high potential for abuse and no medical benefits.

Now, a small but growing group of researchers have returned to Osmund’s approach, testing how psychedelics might be used to treat psychiatric disorders. These scientists are exploring how to harness the drugs’ consciousness-expanding effects to promote psychological healing. “Enough time has elapsed since all the turmoil in the ‘60s,” says Charles Grob, chief of child and adolescent psychiatry at UCLA and a longtime leading psychedelics researcher. “Those ghosts can be put to rest, and we can take a fresh and objective look at these compounds when administered under optimal conditions."

Existing studies are small and still need to be replicated in larger patient groups to see if findings hold up. But, they have generated interest as promising potential treatments for people who don’t get relief from existing therapies — patients who need fast-acting relief from severe symptoms, don’t respond to traditional treatments, and/or have notoriously tough-to-treat conditions such as PTSD.

And, whereas current psychiatric drugs have to be taken as maintenance medications, studies have found that psychedelics can continue to relieve symptoms for days, weeks or even months after they are administered. Here’s a look at what scientists have found.

LSD And Psilocybin
Both LSD and psilocybin are considered “classical hallucinogens” that interfere with the brain’s ability to interpret outside sensory input, often shifting people’s focus inward and producing spiritual revelations and a sense of transcendence. Scientists are testing whether they can combine the drugs with short-term therapy and counseling to bring about a new outlook in people with with several hard-to-treat psychiatric conditions.

One such group includes dying people with severe anxiety and depression. In March, researchers in Switzerland published the results of a small study of 12 terminally ill patients — the first controlled trial in 40 years to look at LSD-aided psychotherapy. Investigators randomly assigned participants to receive either a single, high dose of LSD, or a low, subtherapeutic dosage as an active placebo. All went through eight therapy sessions. Two months later, the high-dose group had substantially larger reductions in their anxiety scores compared to the active placebo group.

Other researchers are looking to see whether psilocybin is similarly effective for terminally ill cancer patients. In 2011, Dr. Grob and colleagues published a small, placebo-controlled study showing lasting reductions in stress and anxiety levels after treatment. Researchers at NYU and Johns Hopkins are now conducting similar studies. Though unclear on how psilocybin might change the brain to cause long-term shifts in outlook, the Hopkins team and a few other groups are testing whether taking advantage of this effect could successfully treat addiction.

Treating addiction with a recreational drug such as psilocybin might sound counterintuitive, but the compound has not demonstrated addictive properties itself. Addiction is notoriously hard to treat and overcome, but the people who do succeed often describe having some kind of spiritual or psychology epiphany, or altered life perspective.

Indeed, some case reports and other preliminary studies have suggested that hallucinogens such as psilocybin help treat alcoholism. Encouraged by these findings, researchers at the University of New Mexico are conducting more rigorous trials of psilocybin-assisted therapy for alcohol dependence, while a group at the University of Alabama-Birmingham is starting to test whether psilocybin helps treat cocaine addiction.

And, some of the same Hopkins researchers studying psilocybin as a treatment for end-of-life anxiety are also examining whether they can combine it with a structured smoking-cessation program to help long-term smokers quit. The Hopkins study results are still unpublished, but they show promise, with 80% of the smokers still abstaining six months after finishing the program.
02_0143Photographed by Stephanie Gonot.
Ketamine
Ketamine, a powerful sedative that also has hallucinogenic properties, was first developed in 1962 and later approved for use as an anesthetic for both human and animal patients. The drug has powerful dissociative effects; it causes users to feel that their minds are disconnected from their bodies. Clubbers began taking ketamine, or “Special K,” in the ‘70s and ‘80s for these out-of-body sensations. Recently, the drug has surged in popularity, especially in the U.K. and China.

While ketamine rises in popularity as a party drug, a slew of studies have demonstrated its potency as an antidepressant. Antidepressants already on the market take weeks to kick in, but ketamine works within a couple of hours. That fast-acting quality is especially crucial for people who need immediate, emergency relief from severe depression or suicidal thinking. Benefits can persist for up to one or two weeks.

This year, two review studies concluded that the drug, when administered intravenously, provides dramatic, fast-acting treatment for depression, bipolar disorder, and suicidal thinking. Ketamine also shows promise as a nasal spray, and a pharmaceutical company has begun testing a drug, currently dubbed GLYX-13, that partially blocks the same brain receptors ketamine does. Preliminary evidence suggests that the drug avoids the most dramatic, psychotic-like side effects of taking ketamine, but still relieves depression.

More recently, Columbia researchers have found that low-dose ketamine reduces OCD symptoms for up to a week in some subjects. A companion study looking at whether exposure therapy could extend ketamine’s benefits also produced promising results: At least one patient reported continuing relief several months later.

This fall, the Columbia team is beginning a study testing the GLYX-13 compound as well as whether intranasal ketamine can provide even more relief of OCD symptoms. “One of the things that’s really exciting about ketamine is that it has these rapid effects,” says lead researcher Carolyn I. Rodriguez, MD, PhD, a psychiatry professor and OCD expert at Columbia. A ketamine-based nasal spray, she hopes, could help patients when their compulsions paralyze them; it could “rescue them in that moment,” she says.
03_0144Photographed by Stephanie Gonot.
MDMA
MDMA, which combines stimulant effects of amphetamine with psychedelic effects, was invented back in 1912. It didn’t capture public attention until the ‘80s and ‘90s, when it gained notoriety as a “love drug” that heightened sexual experiences — and as a club drug that fueled raves. But, before that, some therapists in California were using the compound to get people to open up.

These therapists found the drug to be a potent “empathogen,” especially effective at dissolving the fear and distrust that tormented people with PTSD and often prevented them from achieving significant gains in therapy. The federal government, though, was not convinced of the benefits. Recreational use of Ecstasy or Molly — street versions of MDMA that are often adulterated with other drugs — was soaring in the 1980s, and no studies had been conducted to test MDMA’s therapeutic effects. In 1985, the DEA classified MDMA as a Schedule 1 substance: an illegal drug with no legitimate medical use.

It took almost a decade before any researchers secured permission to conduct structured MDMA studies on human subjects. Eventually, studies showed that MDMA increases blood levels of the hormone oxytocin, which spurs social bonding, and prolactin, which promotes relaxation and emotional openness — exactly the qualities that many therapists believe facilitate effective psychotherapy for PTSD. More recent studies have shown that one or two sessions of MDMA, combined with therapy, improves the severity of PTSD symptoms by as much as much as two-thirds and seems especially effective for the 40% of people who don’t respond to other treatments.

“If there were such a thing as a perfect drug for PTSD, MDMA might be it,” says Brad Burge, spokesperson for the Multidisciplinary Association for Psychedelic Studies, one of a few major groups funding psychedelic research. MAPS is coordinating multiple trials of MDMA-assisted therapy for veterans, firefighters, and others suffering from the disorder in hopes of winning FDA approval by 2021.

Just this spring (20 years after he received the first FDA approval to conduct the first human study of MDMA), Dr. Grob of UCLA got the government go-ahead to conduct the first controlled study testing whether MDMA — which is known to promote openness and bonding — can effectively reduce social anxiety in autistic adults.
04_0145Photographed by Stephanie Gonot.
Marijuana
When the federal government classified marijuana as a Schedule I drug back in 1970, the drug was included in a category with other psychedelics, though it has both stimulant and depressant effects and doesn’t typically cause the same kind of profound hallucinations.

The drug has been studied extensively, but almost no studies have examined whether it works to treat psychological problems. That’s surprising, given the rapidly growing list of states that allow medical marijuana, including as a PTSD treatment.

This lack of research, says MAPS spokesman Burge, stems in large part from an obscure federal regulation that adds more red tape for marijuana research — above and beyond the requirements in place for other Schedule I drugs like MDMA. MAPS, along with psychiatrist Sue Sisley, until recently a professor at the University of Arizona, spent three years trying to get permission to purchase research-designated pot from the federal government. And, that was after the FDA had already approved Sisley’s study testing marijuana as a treatment for veterans suffering from PTSD.

Sisley is the currently the only researcher in the country with government approval to study marijuana. But, her work is on hold since the University of Arizona abruptly fired her in June — a dismissal Sisley has said was triggered by her political activism in favor of medical marijuana. A huge number of veterans have rallied to her side. But, for now, without a home for the study, this important research remains in limbo.