By Danielle Gerhard
[quote]When the light turns green, you go. When the light turns red, you stop. But what do you do when the light turns blue with orange and lavender spots?[/quote]
– Shel Silverstein, A Light in the Attic
Research and development of drug therapies for treating mental illnesses burgeoned in the early to mid-20th century, coinciding with a more permissive public sentiment on the origins of psychological disorders. Gradually, psychopharmacological discoveries shifted from serendipitous findings to rational drug design to target specific chemical systems in the brain. However, many treatments, such as selective serotonin reuptake inhibitors (SSRIs) for depression or atypical antipsychotics for schizophrenia and bipolar disorder, can take weeks to months to be effective and require chronic treatment. This often results in undesirable, and sometimes permanent, side effects as a result of the drug’s unintended off-target effects. Therefore, many researchers have directed their studies towards rapid-acting, acute treatments, particularly psychedelics.
Psychedelics entered the experimental world due to subjective reports of not only sensory hallucinations but importantly the expansion of consciousness experienced following use. Popular psychedelics include MDMA, LSD, ketamine, peyote, psilocybin (magic mushrooms) and marijuana. Like many drugs used to treat mood disorders, psychedelics also increase neural levels of the neurotransmitter serotonin. The general American public stance on legalization of illicit drugs has become more lax since the days of prohibition and “reefer madness.”
One example of societal shifts can be seen with the most popular illicit drug in the US: marijuana. Marijuana legalization has attracted a lot of attention lately, so much so that it has entered daily political rhetoric. The Gallup Poll on Illegal Drugs found that the percentage of individuals in favor of legalizing marijuana has risen from 12% in 1969 to 51% in 2014. The percent of individuals who report having tried marijuana has surged from 4% in 1969 to 38% in 2013. While only 38% of those polled have tried marijuana, 70% approved of the drugs use to alleviate pain and suffering.
Given increasing public support for the legalization of marijuana, why is it still considered illegal at the federal level and furthermore, why is it still classified as a Schedule I drug under the Controlled Substances Act that was enacted in 1970? Schedule I drugs are characterized as having a high potential for abuse, no medical use, and a lack of accepted safety. Other drugs in this category include heroin and methaqualone but also other psychedelics like MDMA, LSD, and psilocybin. Advocates of marijuana legalization and individuals urging for a revised categorization of psychedelics are calling on Congress to revise the CSA classification of these drugs to correspond with their science-based scheduling process.
There has been a lot of stigma and misconceptions circulating about the effects of psychedelics, which largely stem from conservative backlash to Vietnam-era rebellion in the youth who were reported to be using psychedelics. Three main concerns raised by the opposition regarding psychedelics include: safety, addiction and the long-term effects on mental health. While drug safety should be a concern regardless of its legal state, two legal drugs in particular, alcohol and tobacco, have been shown to be more harmful and dangerous to the brain and body than psychedelics. Recent reports by government agencies concerned with drug safety reported that only 0.005% of hospitalizations in 2013 were related to LSD or psilocybin, significantly lower than alcohol or non-medical abuse of prescription pills. Furthermore, psychedelics have very low levels of abuse when compared to alcohol and tobacco. The National Institute for on Drug Abuse (NIDA), a government funded research agency, describes LSD as a non-addictive agent.
While there is a growing push to grant doctors the ability to prescribed marijuana for the purposes of treating the symptoms accompanying chronic and painful diseases like cancer or multiple sclerosis, there have been fewer studies investigating the use of other psychedelics to treat another chronic disease: mental illness. This is largely due to the third concern mentioned above. Many individuals who are opposed to loosening the restrictions on psychedelics worry that drugs like LSD, which transiently mimic aspects of schizophrenia, could independently instigate the onset of a mental illness.
A group from Norway has recently published a paper in the Journal of Psychopharmacology presenting data from a large-scale US population study to examine the relationship between psychedelic use and mental illness or suicidality within the year following use. Lead authors Johansen and Krebs randomly surveyed data from 139, 095 individuals, approximately 20,000 of which were psychedelic users. After controlling for potentially confounding factors like childhood mental illness, demographics and other drug use, they failed to find any link between mental illness and psychedelic use. There is a need for more studies like this to further benefit research, policy and the scheduling of psychedelic drugs.
A few interesting and promising clinical studies are currently underway to investigate the therapeutic potential of difference psychedelics for individuals who have failed to respond to mainstream treatments. The non-profit organization Multidisciplinary Association for Psychedelic Studies (MAPS) recently gained attention for a study that has successfully crowd-sourced funding to investigate the additive effects of MDMA-assisted psychotherapy in treating posttraumatic stress disorder (PTSD). Other large ongoing studies through MAPS include LSD-assisted psychotherapy for anxiety, ibogaine (from the West African shrub iboga) therapy for drug addiction, and a handful of studies using psilocybin in cancer patients or individuals diagnosed with obsessive-compulsive disorder.
The purpose of this article is not to advocate for the widespread use of psychedelics but to discuss key empirical findings that support a reclassification of these drugs to make it easier for scientists to more effectively study their potential benefits in treatment resistant patients. While the study by Johansen and Krebs found no link between psychedelic use and mental health or suicide risk, many researchers are interested in focusing on their potential to treat mental illnesses. It is important to remember that there are still potential risks of taking psychedelics that should be taken into consideration.
As with all prescribed or non-prescribed drugs, there are individual differences in the pharmacokinetics and pharmacodynamics, or how our body affects the drug and how the drug affects our body. While many users may experience an expansion of consciousness and feel as if they have benefited from taking these drugs, others may have a very negative subjective experience that can have lasting negative effects. Another risk to consider is that because these drugs are illegal and therefore unregulated, they can be laced with harmful or more addictive drugs. For the most part, the studies discussed in this article are investigating the use of these drugs not in healthy individuals but rather in patients who are suffering from a mental illness and have failed to respond to any other commercially available treatments.