As a child of the 1960s, I observed the ebb and flow of the counterculture and experimentation with recreational drugs, and the indelible effects these social movements left on American society. As a medical student in the 1970s, I became intimately acquainted with the promise and perils of the psychoactive agents in those drugs. During my psychiatric training in the 1980s, I cared for PCP-crazed patients, students having bad trips, youths strung-out on speed and coke-heads and pot heads in the emergency room, inpatient psychiatric units, state mental hospitals, on the streets and in homeless shelters.
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Through it all, despite their harmful and hedonistic effects, the aspiring researcher in me told me that these forbidden substances held great promise as probes that could reveal the neurobiology underlying the mental functions they so powerfully affected, and lead to new and potentially more effective treatments. Consequently, I was disheartened when laws were enacted that restricted the use of psychedelic substances for scientific and medical purposes — another casualty of the political controversy and turmoil at the time.
The term “psychedelic” derives from the ancient Greek and means “mind revealing.” It was coined by the British psychiatrist Humphrey Osmond, who was an early researcher, along with Aldous Huxley, of the medical uses of these compounds. Psychedelic substances alter cognition and perception through their effects on brain chemistry and induce altered states of consciousness that resemble trance, religious ecstatic, dream-like and near-death experiences. In this way, they are distinct from other psychoactive drugs, such as stimulants and opiates that induce other qualitative effects on the mind and behavior. In short, stimulants and opiates are a more about euphoria and pleasure, while psychedelics affect thought and perspective.
Prior to their national and international prohibition, psychedelic drugs had showed promise in the treatment of addictions, personality disorders, psychogenic sexual dysfunction and end-of- life care. However, it was their promiscuous recreational use and nefarious application in interrogation methods by government intelligence agencies that led to their ban.
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Now, almost 50 years later, there are increasing signs of the reemergence of psychedelic substances. I recently wrote an editorial for the Journal of Psychopharmacology on two studies that reported therapeutic psychological effects in cancer patients who were treated with psilocybin — a psychedelic substance found in peyote mushrooms — for terminal cancer. There have been similar such studies with LSD and mescaline.
Other agents that have been resurrected for medical use include 3,4-Methylenedioxymethamphetamine (“ecstasy” or MDMA) for the treatment of PTSD; ketamine (a pharmacologic cousin to PCP [“angel dust”] called “special K”) for treatment-resistant depression; and cannabis for a burgeoning number of medical indications including, first and foremost, pain and nausea.
While adventurous researchers at select universities, both in the U.S. and abroad, have conducted sporadic clinical studies with these notorious substances, these are superseded by use patterns and practices outside of the medical realm. Silicon Valley has adopted the practice of micro-dosing LSD to stimulate creativity in workers. Ayelet Waldman’s 2017 book, “A Really Good Day,” extols the virtues of this practice on a daily basis as life-changing.
Ayahuasca is a psychedelic substance derived from plants whose active ingredient is dimethyl tryptamine and has been used ritualistically by indigenous South American people for centuries. More recently, drinking a tea brewed with ayahuasca has been a popular underground activity of people seeking self-help or actualization. Shaman and practitioners operating outside of the medical and scientific communities conduct sessions for an increasing number of people seeking help or enlightenment.
While I clearly recognize the reasons that impel so many people to seek alternative remedies for various ailments that are inaccessible within the mainstream health care system, I cannot overstate the risks involved.
The legalization of cannabis is perhaps the largest of these phenomena. Today, 26 states and the District of Columbia currently have laws legalizing marijuana in some form. It’s hard to keep up with the various forms and potencies in which cannabis products are produced and marketed. And while it’s true that you cannot credibly say cannabis is more harmful than other recreational intoxicants like alcohol, tobacco and caffeine, we certainly don’t know the range of possible harmful effects that these products might produce in the diverse populations that will use them in the years to come. Consequently, we are conducting a great unplanned social experiment in the U.S. without knowing the potential consequences. This is akin to our past experiences with lead as a standard additive to gasoline and paint, asbestos to building insulation, cocaine to cola, alcohol and opiates to tonics and remedies.
[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]
Indeed, the same fate could await the resurgent use of recreational drugs for ostensibly therapeutic purposes. That is not to say that we should sustain their prohibition but that their prospective reprieve must be orchestrated in a careful and responsible way. That is, to truly determine the value that this previously outlawed class of substances holds for science, medicine and humanity, we must subject them to rigorous research. This will take time and require funding from the federal government through the National Institutes of Health, a willingness of the Food and Drug Administration to entertain their consideration as “new chemical entities” for development and possible approval, and the pharmaceutical industry to see their development as feasible and profitable.
If we do not heed this warning, we risk repeating the mistakes of the 1960s, and we will continue on using psychedelic substances with limited knowledge as to efficacy and safety, and at our own risk.
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Alternative Treatment to Treat Mental Health Issues? Heed These Cautions originally appeared on usnews.com
