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The utilization of psychoactive substances in a clinical setting is once again receiving recognition among healthcare professionals. In addition to the surpassed psychiatric hurdles that we had the opportunity to witness and document throughout the production of A New Understanding, studies conducted by respected institutions and medical facilities are continuing to roll out at an increasingly rapid rate. These substances, most notably psilocybin, are proving themselves effective in aiding terminally-ill individuals whose severe depression and anxiety may have been considered clinically-untreatable a mere quarter-century ago.
As a method of furthering awareness, professor David Nutt of Imperial College London issued an editorial, published in the Journal of Psychopharmacology, that looks to “the most rigorous controlled trials to date using the psychedelic drug psilocybin (Griffiths et al., 2016; Ross et al., 2016).” To help subside the fears that many people have carried with them from the ‘drugs fry your brain’ era, predominent figures in relevant fields of research were asked to give commentaries on two of the most boundary-pushing clinical studies of the past 50 years. The sheer amount of willingness from everyone that was approached, despite short notice, is a display in itself of the amount of interest that these studies and others like them have sparked.
Among the list of commentators are two past-presidents of the American Psychiatric Association (Jeffrey Lieberman and Paul Summergrad), the past-president of the European College of Neuropsychopharmacology (Guy Goodwin), previous deputy director of the Office of USA National Drug Control Policy (Herbert Kleber) and previous head of the UK Medicines and Healthcare Regulatory Authority (Sir Alasdair Breckenridge). The responses offered by the commentators were overwhelmingly positive with the unanimous consensus being, “It’s time to take psychedelic treatments in psychiatry and oncology seriously, as we did in the 1950s and 1960s, which means we need to go back to the future,” according to the editorial by David Nutt.
At the time of Albert Hoffman’s discovery of LSD in 1943, there was no connotation attached to these substances whatsoever. It was not difficult for Hoffman to convince his employers at the pharmaceutical company Sandoz that this substance has the potential to aid in the understanding of mental illness, and may even present a novel approach to the treatment of such conditions. During the 50s and 60s Sandoz supplied the LSD used in hundreds of trials involving thousands of patients with over 130 of the research grants funded by the US government. The findings of these pioneer studies were generally reported as positive and encouraging regarding the alleviation of debilitating anxiety, depression and even addiction.
With the seemingly positive reception of LSD in the world of psychiatrics, Hoffman continued to conduct research on other psychoactive substances derived from plant matter, which brought him to DMT, the psychoactive ingredient of ayahuasca, and psilocybin, the primary psychoactive constituent of ‘magic’ mushrooms. This is where psilocybin gained its initial foothold in the world of healthcare, as its quick 30-50 minute onset and four-five hour duration made it the most ideal of the substances to administer and study in a controlled environment. Psilocybin also demonstrated a clear dose-effect relationship and, given the proper setting, rarely resulted in a ‘bad’ trip among research participants. Deemed the most clinically-ideal of the psychedelic substances, Sandoz believed they could revolutionize the field with their trials. unaware of the imminent resistance that would put this research on hold for decades.
Image by Peter DeJong/AP
It was at the time of the Vietnam War protests and the Haight-Ashbury social revolution that LSD began receiving backlash from the United States government, which led to its ban on the basis of dubious so-called research findings of harm. Unfortunately, psilocybin and all other known psychedelic substances were grouped into this gross misjudgement and thus, received the same fate of criminalization despite a lack evidence that suggests potential dangers.
After a four-decade barrage of slander and fear incision, psychedelic substances are now being slowly resurrected in the world of medicine and psychiatric healthcare with the help of the field’s top minds. Since the beginning of the 21st century, a series of psychological, imaging and small pilot clinical studies have re-laid the groundwork set forth all those years ago. These studies have provided the intellectual foundation underpinning the two most recent clinical psychedelic investigations; the most rigorous double-blind placebo-controlled trials of a psychedelic drug in the past 50 years.
The first of the two studies acknowledged in Nutt’s editorial was led by Roland R. Griffiths, Ph.D. of Johns Hopkins University School of Medicine and published in the Journal of Psychopharmacology last November. In the trial, 51 individuals with a life-threatening diagnosis and clinically-significant symptoms of anxiety and/or depression were given very low (placebo-like) doses (1 or 3 mg/70 kg) and high doses (22 or 30 mg/70 kg) of psilocybin. The doses were administered using a counterbalanced sequence with 5 weeks between sessions, followed by a 6-month follow-up session.
The high-dose of psilocybin administered during the trial seemed to have a definitive correlation with a decrease in both clinician- and self-rated measures of depression and anxiety, and increases in overall quality of life, life meaning and optimism. At the time of the 6-month follow-up, 80% of the participants continued to display clinically significant decreases in depressed-outlook and anxiety. Participants also attributed improvements they experienced in life/self, relationships, mood and spirituality to their high-dose experience.
The second clinical study, also published last November in the Journal of Psychopharmacology, was led by Stephen Ross, MD of the New York University School of Medicine. In this double-blind, placebo-controlled, crossover trial, the researchers randomly assigned 29 patients with cancer-related depression and anxiety to receive a single-dose of niacin or psilocybin (0.3 mg/kg), both in conjunction with psychotherapy. Changes in anxiety and depression were assessed between the two groups prior to the crossover at 7 weeks.
Prior to the crossover, those who received the dose of psilocybin demonstrated an immediate, substantial and sustained improvement in anxiety and depression as well as a decrease in their cancer-related demoralization and hopelessness, improved spiritual wellbeing and increased quality of life. At the time of the 6.5-month follow-up, the enduring anxiolytic and anti-depressant effects of psilocybin were still apparent, as approximately 60-80% of the trial participants demonstrated a sustained reduction in depression and anxiety, benefits in existential distress and, most importantly, an improved attitude towards death.
It is crucial to note that these studies are highly controlled and carefully conducted by medical researchers within a suitable clinical setting. Of course, there is more research to be done, and although the results are remarkably positive, healthcare professionals believe that this type of treatment will always need to be conducted in a clinical setting and not administered to patients for use at their discretion. The findings of these and similar studies, however, are nothing short of ground-breaking and are exactly what is necessary to incite the much-needed psychedelic revolution in the field of psychiatric healthcare.
“Hopefully, the positive findings that they report will act to spur on other researchers in the field of psychopharmacology, particularly in relation to depression, anxiety and addiction,” Nutt stated.
Nutt, David. "Psilocybin for Anxiety and Depression in Cancer Care? Lessons from the past and Prospects for the Future." Sage Pub. Journal of Psychopharmacology, n.d. Web.
Griffiths, R., M. Johnson, M. Carducci, A. Umbricht, W. Richards, B. Richards, M. Cosimano, and M. Klinedinst. "Psilocybin Produces Substantial and Sustained Decreases in Depression and Anxiety in Patients with Life-threatening Cancer: A Randomized Double-blind Trial." Sage Journals. Journal of Psychopharmacology, n.d. Web. 06 Jan. 2017.
Ross, S., A. Bossis, J. Guss, G. Agin-Liebes, T. Malone, B. Cohen, S. Mennenga, A. Belser, K. Kalliontzi, J. Babb, Z. Su, P. Corby, and B. Schmidt. "Rapid and Sustained Symptom Reduction following Psilocybin Treatment for Anxiety and Depression in Patients with Life-threatening Cancer: A Randomized Controlled Trial" Sage Journals. Journal of Psychopharmacology, n.d. Web. 06 Jan. 2017.