A New Fungi in Town
Exploring the emergence of psychedelics as a tool in the medical world
—By Sofie Markle
Psychedelics are substances that have been used for thousands of years, providing cultures and people with profound personal insight and healing. Now imagine a medicine that could help patients reframe their struggles and reconnect with their inner selves. This is the potential that psychedelics have in the modern world, which are now emerging as powerful tools in the fields of medicine and therapy. These substances, long stigmatized and misunderstood, are gaining recognition for their potential to treat conditions such as mental health disorders, chronic pain, and addiction. Modern research is sparking new hope in therapeutic innovation while rising controversy in societal perceptions and traditional medical approaches.
The psychedelic renaissance
Psychedelics have an ancient history of being used by various cultures as medicine and tools for spiritual insight. However, it wasn’t until the mid-20th century that more research went into the exploration of psychedelics, particularly in Western medicine. LSD and psilocybin were explored for treating alcoholism, depression, anxiety, and even existential distress in terminally ill patients. A notable study by Dr. Humphry Osmond in the 1950s demonstrated significant success in helping alcoholics achieve sobriety using LSD-assisted therapy. It was reported that 40% to 45% of the alcoholics who were treated with LSD had not returned to drinking after a year.
In the late 1960s, it all came to an abrupt halt. Fear and political motivations during the War on Drugs increased to the point of criminalization of many substances, including psychedelics. In 1970, the United States classified LSD and psilocybin as Schedule I drugs under the Controlled Substances Act, claiming them to lack safety, with high risk for abuse or addiction and “no accepted medical use.” This effectively shut down research into their therapeutic potential. For decades, research into psychedelics remained dormant.
Revival and research
In recent years, research has slowly begun to make a comeback. Some researchers began to revisit the therapeutic potential of these substances, this time with more ethical and professional oversight. One of these researchers is Dr. Kevin Boehnke, an Assistant Professor in U-M’s Department of Anesthesiology and the Chronic Pain and Fatigue Research Center, studying the therapeutic applications of cannabis and psychedelics. “I know firsthand the limitations of many medication based treatments for chronic pain, and want to help develop better tools for people to effectively engage with their pain and heal.” He conducts a wide range of research from surveys of people who use psychedelics recreationally to pilot clinical trials of psilocybin assisted therapy for fibromyalgia, a chronic condition that causes pain and tenderness in the body. The rich medicinal history of psychedelics and cannabis is part of the reason he became interested in understanding their potential in the medical industry. “I wanted to help understand when and how they could be applied most successfully.”
Although much of the research is in its pilot stages, there are lots of positive signs being presented. At the neural level, a brain under the influence of psychedelics experiences “increased communication between rather than within brain networks,” says Dr. Jacob Aday, a Research Investigator and colleague of Boehnke in the Department of Anesthesiology, Chronic Pain and Fatigue Research Center (CPFRC) and the Michigan Psychedelic Center (M-PsyC). Dr. Aday is interested in the cognitive and social effects of psychedelics, striving to improve the research and safety associated with these drugs and look into potential avenues for psychedelics in therapy and chronic pain. This ability of the brain to make new connections is called plasticity. Psychedelics offer greater connections between different parts of the brain due to it being in a “heightened state of neuroplasticity,” says Aday. In the brain of someone who has depression these greater connections could rewire long-held patterns of rumination and excessive self-focus.
Dr. Aday explains that psychedelic therapy is “highly unique” from most pharmacological treatments in that, psychedelics need individuals to “put in the work” towards resolving their psychological issues, rather than just working in the background. Individuals can have “profound experiences of insight and sometimes reflect on issues [in] their life from an altered perspective that is conducive to healing.” Studies have demonstrated promising results in improving or alleviating symptoms in treating conditions like treatment-resistant depression, post-traumatic stress disorder (PTSD), and addiction. Psilocybin-assisted therapy has even been shown to produce rapid and sustained reductions in depressive symptoms, even in patients unresponsive to traditional antidepressants.
Destiny Dorozan-Dunkin is a therapist that doesn’t prescribe psychedelics to her patients, but provides an open space for sharing experiences. A psychotherapist in private practice, she deals with trauma, family history and helping people with various disorders. While getting her Masters in Clinical Psychology, the research of psychedelics had just begun to reopen. Since then, she says she’s been “keeping up on the research because [I know that] the toolkit is bare.” Although she doesn’t prescribe psychedelics to her patients, she has patients who are prescribed them in other clinical scenarios. She is excited about this resurge and potential new option for people who don’t take to traditional treatment. It’s estimated that only 30% of patients who take psychotropic medication, antidepressants such as SSRIs, take it as prescribed. This could be due to a number of reasons, including absences of noticeable therapeutic effects, sexual dysfunction, or other negative side effects, that may deter patients from taking the medication regularly, if at all. “It’s great for the people it works for, but we need something else for the people who don’t want to take it or it doesn’t work well or they have too many side effects.”
She compares the way psychedelics work on the brain to learning a language when you’re young. “Your brain is taking in all this new information, it’s recategorizing things, really quickly in a short period of time. And then at some point, your capacity for this critical period for learning language closes…. So what psychedelics do is re-open that critical period where your brain can recategorize information really quickly.”
Challenges
While the development of psychedelics in medicine is promising, there are many legal, scientific and ethical concerns, much of which stems from decades of anti-drug propaganda during the War on Drugs. Many people associate these substances with reckless recreational use, counterculture movements, and poor morals. This stigma affects not only public opinion but also the support of psychedelic research and treatment programs. Dr. Boehnke says the divide in the medical community is prominent: “For criminalization reasons, there’s been stigma, discomfort discussing this topic between patients and providers, and legal concerns to even bring up the topic in professional settings.”
One of the core concerns is the potential for psychedelics to be misused outside of controlled, therapeutic settings. However, criminalizing these substances causes there to be no quality control. There is a high risk of street drugs being contaminated or extremely potent, causing disease and sometimes even death. “Criminalization does very little to protect people from harms associated with these substances and in fact frequently harms people more than helping them,” says Dr. Boehnke.
Dr. Aday believes that there needs to be transparency in the discussion and characterizing the risks. “The primary risks related to psychedelic use are psychological.” Although recreational use of these substances can lead to unpredictable experiences, or what might be known as “bad-trips”, Dr. Aday remarks that such levels of distress are “transient and manageable” in a clinical setting. Such experiences may even be important to the therapeutic process. However, if not properly managed under professional guidance, could lead to placing individuals or others in harm.
Psychedelics stand out from other drugs in that our bodies build up a rapid tolerance to them. Individuals will experience very mild effects if time is not taken in between dosings. This “discourages patterns of use seen with other drugs that are abused.” While there is still need for caution, physically these substances are not inherently addictive. A greater concern would be who is more subject to the common physiological effects, such as increased heart rate, blood pressure and body temperature. Although these effects would resolve after dosing, Dr. Aday suggests that those with cardiac vulnerabilities would be at risk. This, along with patients who experience psychosis,such as those with schizophrenia, would be at high risk and discouraged from using psychedelics.
The importance of therapy
Therapeutic approaches will play a crucial role in integrating psychedelics into psychotherapy. Due to their strong effects on consciousness and cognition, psychedelic experiences can be “highly emotionally taxing and at times ontologically shaking,” says Dr. Aday. These effects can also be influenced by one’s mindset going into the experience and also the environment in which it takes place. There needs to be proper preparation and intention to facilitate a space of reflection. This is where a therapist comes in. “The therapist can provide really wonderful support, hold space for growth and healing, and help the client effectively work with themselves to enact some useful behavior change and making meaning of the experience,” says Dr. Boehnke. There must also be a distinction between the therapeutic aspects in a clinical setting versus working with a personal therapist. The clinical setting has its limitations.
Someone like Dorozan-Dunkin, who works with patients undergoing separate psychedelic-based therapies, is able to provide a relationship that the clinic might not. “They don’t have the long-term relationship.” Having known some patients for up to 8 years, Dorozan-Dunkin is able to provide deeper insights to her clients, knowing much more about who they are and their backgrounds.
To be continued
The research of psychedelics has been dormant for many years and much about how psychedelics work remains poorly understood. While research has shown that substances like psilocybin, LSD and MDMA can produce profound therapeutic effects, research of specific neurological effects need to be further investigated. This lack of understanding makes it difficult to predict outcomes or trial protocols. Many existing studies have small sample sizes and lack diversity, limiting having a more general view of their findings. Long-term effects of repeated psychedelic use, particularly in therapeutic contexts, are also unknown. More rigorous, large-scale clinical trials are needed before psychedelics can be safely and ethically integrated into mainstream healthcare. “We need more tools in the toolkit, the toolbox is pretty empty,” says Dorozan-Dunkin.
The renewed interest in psychedelics has generated significant excitement, leading critics to overstate their benefits or minimize their risks, some concerns being keeping proper blinding (withholding information about treatment assignments from participants, investigators, or assessors) in trials. This “hype” can create unrealistic expectations, both among the public and within the medical community. If early trials experience mixed or negative outcomes, it could trigger a backlash that undermines the progress made in destigmatizing these substances. Psychedelics have a lot of potential, but there is still much research to be done and we must pace ourselves along the way. As said by Dorozan-Dunkin, “We have an opportunity to really do this right and not mess it up.”
Feature Photo from UpSplash; Photo by Mari-Liis Link