Psychedelic therapy: The medicine and the research
Psychedelic therapy is a therapeutic practice that uses psychedelic substances like psilocybin (commonly known as magic mushrooms), LSD, MDMA (commonly known as ecstasy or molly) and ketamine, amongst others. There has been a resurgence in interest in these therapeutics and types of treatment in recent years as on-going research is showing that these compounds hold immensely promising therapeutic potential.
While some of these substances were being used in research in the 1950s and early 1960s — which showed impressive results when treating various mental illnesses — they were eventually outlawed in the U.S. and Canada, around the time the hippy counterculture rose to prominence.
“There exists molecules that have been perhaps misused in the past, and criminalized, and now there’s a resurgence of interest because they show a potential for treating a variety of mental health conditions,” explains Rotem Petranker, one of the directors at the Canadian Centre of Psychedelic Science. “There was a bit of an interruption when these substances were criminalized, but work continued, albeit, limited.”
That is now changing. As Petranker explains, traditional psychiatry appears to be lacking options when it comes to treating challenging mental health issues.
“There’s a mental health crisis and conventional psychiatry hasn’t caught up yet,” he says. “So initially it started because people wanted to take more risks.”
The use of these psychedelic drugs in the context of therapy is currently seeing a surge in interest, research and practice. An increasing number of clinics that offer psychedelic therapy — which use ketamine therapy, psilocybin therapy or MDMA therapy — are opening up in major cities around North America.
Since these substances are scheduled under the Controlled Drug and Substance Act in Canada, they can only be acquired legally through an exemption to Section 56. In the U.S., these substances are scheduled under the Controlled Substances Act. However, these drugs are often sold and taken illegally.
There are other types of therapeutic psychedelic practices that take place underground, without regulations, which use substances like ayahuasca and ibogaine, largely to treat addiction-related mental health conditions. However, Health Canada has granted several exemptions to various religious groups in Toronto, Montreal and Winnipeg to import ayahuasca for use in ceremonies.
Types of psychedelic drugs used in psychedelic therapy and their effects
Just because certain drugs are classified as psychedelic, doesn’t mean they will have the same effect and impact.
“Most psychedelic substances are very different,” explains Petranker. “It’s like comparing alcohol, Advil and cheese. Psilocybin and LSD is one category, ketamine is another and MDMA is a third totally unrelated category. They work on different parts of the brain and in different ways.”
Psilocybin is a hallucinogen found in certain species of mushrooms. It activates the serotonin receptors, mostly in the prefrontal cortex of the brain, which is the area known to impact mood, perception and cognition.
“The primary experience is one of spirituality, reflection on self and a sense of awe and mystery and the portal effect, which is a sense of accomplishment and transitions,” explains Mark Haden, director of clinical research at Psygen. “It’s a similar feeling to when you climb Mount Everest or graduate university. All of those feelings are present during psilocybin.”
Magic mushrooms can be ingested straight, though they’re sometimes brewed in teas or hidden in chocolate. The effects are usually felt after about 30 minutes if ingested orally, or quicker if drunk, and generally last between four and six hours. As with all psychedelic medicine, set and setting have a huge impact on the experience. Psychedelics, including magic mushrooms, can inspire “bad trips”, which are known as transient anxiety. If it’s managed well, the challenging thoughts, feelings and emotions that arise during the experience are often where therapeutic breakthroughs occur.
“It’s challenging during the effect but that’s where people learn the most from that period of the experience,” says Haden. “Therapy is rarely a pleasant experience. It’s challenging and that’s what’s healing.”
Ketamine is classified as a dissociative anesthetic but can inspire a psychedelic experience at a different dosage. It’s primarily used as an anesthetic in surgery to induce a dissociative state. Clinical settings use ketamine off-label to treat certain mental conditions like treatment-resistant depression. During psychedelic therapy, a dose of ketamine lower than an anesthetic dose is administered either as a shot in the muscle or through an IV, which leads to a sense of disconnection from the body.
This feeling is unique to ketamine. “Given the right dosage, you have no sense you’re a human being with a body, you’re out there in visually fantastic spaces,” explains Haden. “The amount of reflectivity of your sense of self is relatively low. The otherworldliness can be spiritual.”
The acute phase of this experience lasts about an hour and any side effects dissipate quickly.
MDMA stands for 3,4-methylenedioxymethamphetamine. It is an empathogen, which, in higher doses, has a similar chemical makeup and effect as an amphetamine (a stimulant) and to mescaline (a hallucinogen). It inspires the feeling of oneness and emotional openness, which is why it’s increasingly being studied for its potential in psychedelic-assisted psychotherapy. When taken in higher doses, MDMA is a serotonin agonist, which means it mimics serotonin. It is typically taken in a pill or capsule form and kicks in after about an hour, with the effects lasting between four and six hours.
“It has a high sense of reflection on self and it reduces fear,” says Haden. “It’s a calming experience.”
LSD stands for lysergic acid diethylamide, and under pharmacological classification its known as a classical hallucinogen or psychedelic. Chemically, it has a similar makeup to psilocybin, though it is produced in a lab, rather than grown as a mushroom. LSD is often taken on a tab of paper when used illegally. In the context of therapeutic research and psychedelic therapy, it is administered as a pill or a capsule. The effects experienced with LSD are intense: it inspires an altered sense of reality and dramatically impacts the senses. It can also bring about a strong spiritual connection and reflection of self, along with the portal effect.
Ongoing research suggests that LSD therapy can have an impact on anxiety, anxiety associated with severe illness, depression or addiction.
Ayahuasca is a brew that’s chemically derived from Amazonian plant matter to induce a psychedelic state. It is ingested orally as a liquid, usually in traditional ceremonies as a way to gain spiritual insight and overcome challenges, including emotional trauma and physical dependencies like addiction. It takes between 20 and 60 minutes to kick in, with the effects lasting up to six hours. Its main active ingredient is dimethyltryptamine (DMT), which is considered a classical psychedelic — and one that naturally occurs in the body. It can induce feelings ranging from fear and paranoia to euphoria, along with auditory and visual hallucinations. A proper ayahuasca ceremony is led by an experienced shaman, and the experience on the substance typically induces nausea that leads to “purging,” through vomiting or diarrhea.
While DMT is an active ingredient in ayahuasca, it can also be consumed on its own. It’s usually smoked in a powder form, leading to immediate and intense feelings of otherworldliness, although the effects only last under an hour. It increases the production of serotonin, and inspires feelings of euphoria and alternative perspectives of reality. However, it doesn’t bring about deeper meaningful feelings.
“Unlike other psychedelics, it is not particularly connective or connecting,” says Haden.
The first clinical trial that examines DMT’s use for depression is currently underway in the UK.
Ibogaine is similar to ayahuasca in that it’s a naturally occurring psychoactive substance found in plant matter, However, it comes from a different region (Western Africa), a different plant, a different tradition, is made up of different chemicals and is used for different purposes. While both ayahuasca and ibogaine are taken in ceremonies, the latter is used specifically for the treatment of opioid addiction. The bark of the plant is broken down into a powder and ingested in a capsule or on a spoon. The experience is felt in different stages — dreamlike, reflective, and residual stimulation, and can last up to 24 hours.
Ongoing research suggests that it can have an impact on opioid addiction.
Relevant studies and the future of psychedelic therapy
Some psychedelics have been used in non-Western societies for thousands of years in the context of sacred ceremonies.
It wasn’t until the 1940s that the psychedelic effects of LSD were discovered by Swiss chemist Dr Albert Hofmann. By the 1950s, LSD was being used as part of practices to help treat mental disorders and alcoholism. By the early 1960s, this type of treatment was lauded as the next big thing, with an estimated 40,000 patients being treated with it for conditions ranging from psychopathy to neurosis.
In the U.S. the introduction of new drug regulations passed by Congress along with new designations by the Food and Drug Administration that classified LSD as experimental restricted further study of the substance. As LSD became nearly synonymous with hippy counterculture, the drug became vilified and the research of it came to a halt.
It wasn’t until the 1990s that the study of psychedelics began to pick up again, leading to a number of significant findings.
Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance
Over the course of two months, 36 healthy volunteers who had never taken psychedelics received psilocybin or Ritalin in three sessions, and were asked afterwards about their experiences. Those who received psilocybin reported “acute perceptual changes” and “increased measures of mystical experience.” Volunteers rated the experience with the drug as having significant personal and spiritual meaning and considered and noticed long-term positive changes in how they thought and felt.
Magic mushrooms can help smokers break the habit
A Johns Hopkins study looked at 15 study participants who took psilocybin over the course of six months. It found that 80 percent had quit by the end of the study, compared to an approximate 35 percent success rate for patients taking the drug varenicline, which is considered to be the most effective medicine for tobacco use disorder.
MDMA-assisted therapy for severe PTSD
In this study, patients with severe PTSD were treated with MDMA, along with therapy sessions. The results found that the MDMA-assisted therapy helped with treatment, even in severe cases of PTSD. It concluded that this type of therapy “has the potential to dramatically transform treatment for PTSD and should be expeditiously evaluated for clinical use.”
Further research into psychedelic therapy is still required
While a lot of the research into psychedelic drugs is producing positive results, Petranker stresses it’s important to remain skeptical.
“A lot of the research is very enthusiastic that shows it works. There’s some good research out there but a lot of it is just cheerleading,” he says. “A lot of people have been using [psychedelics] and mostly nothing terrible has happened so far. But I’m saying I wouldn’t trust the research and I’d be hesitant to trust the press releases from companies who stand to gain if psychedelics are used.”
Haden suspects that if psychedelics become more accessible, the positive stories will increase, along with the negative.
“The more you treat a wide range of people, the more people who are doing it, the more unskilled therapists will come to the plate who don’t provide people with the support during and after the experience,” he says. “So more and more bad things will happen. When I talk to therapists who want to get involved in this field, they’ve heard all the good stuff. They haven’t heard the challenges.”
However, he predicts that in the future, psychedelic drugs in the context of psychedelic therapy will continue to be examined for their potential.
“I think that as more substances are proven to be effective with a wide range of indications, slowly psychedelics will be used off-label,” Haden says. “They will be used with psychiatrists and psychologists and other therapists for a wide range of indications. And they may be very common for the use of psychiatry, psychology, clinical social work and clinical nursing practices.”
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