Counterculture drugs and modern medicine
Why psychedelics might be the answer to the mental health crisis
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Letâs talk about magic mushroomsâŠ
đ€·ââïž Problem
Poor mental health is a growing public health concern:
Depression is the second leading cause of disability worldwide
Antidepressant medication prescriptions are increasing
Rising demand has led to medication shortages
Existing treatments are not always effective and have a lot of side effects
đĄ Solution
Combine psychedelics with psychotherapy to create a new structured treatment approach to treating mental health conditions.
Increase research and funding into psychoactive drugs that have previously shown promise in treating multiple mental health conditions.
Allow rigorous research and effective research communication to help overcome governmental and societal apprehension related to psychedelics.
đ Terms
Mental health conditions can be treated using a combination of pharmacological and talking therapies.
Selective serotonin uptake inhibitors (SSRIs). A popular medication used to treat mental health disorders like depression. They work by blocking the re-uptake of the hormone serotonin in the brain and probably have the greatest effect in more severe forms of depression.
Psychotherapy. Also known as âtalking therapyâ. Usually administered in person with a trained professional. Loads of different techniques. Some have a better evidence base than others.
Psychedelics. A class of psychoactive drugs. Create altered states of consciousness through effects on serotonin receptors in the brain. Also thought to help the brain make new connections (increased plasticity). Main types include:
LSD (acid)
Psilocybin (magic mushrooms)
DMT (long history of use in South America, found in Ayahuasca)
MDMA (ecstasy)
Ibogaine (naturally occurring substance derived from the root of Tabernanthe iboga )
đ History
Humans have a long history with psychedelics. Hereâs the tl;dr:
Prehistoric - Psychedelics derived from bark, roots, plants and fungi have been used as medicines and spiritual tools for 1000s of years. But they didnât enter the world of Western medicine until the 1940s/50s.
1938 - Swiss chemist and low key genius Albert Hofmann is the first to synthesise LSD whilst working for Sandoz Laboratories (now a subsidiary of Novartis). However he doesnât discover its psychoactive properties until 1943 (he had his first âtripâ whilst riding a bike!)
1950s - Sandoz distributes LSD to researchers allowing scientists to carry out extensive research into its therapeutic potential. By the mid 1960s, 1000s of papers have been published detailing the use of psychedelics in around 40,000 patients.
1958 - Hofmann continues his study of psychoactive substances and successfully isolates and determines the structure of psilocybin.
1960s - Increased use of psychedelics amongst the general public and the counterculture (i.e. hippies â), causes a moral panic. Sandoz ceases production and many countries ban LSD. Some suggest that pharmaceutical and government interests had a role in sabotaging psychedelic researchâŠ
1970s - The US pass the Controlled Substances Act, placing psychedelics in the Schedule I (most restrictive) category. Many countries join the UN Convention on Psychotropic Substances Treaty intended to control psychedelic drugs.
1990s - The non-profit Multidisciplinary Association for Psychedelic Studies (MAPS), is founded to help scientists design, fund and obtain regulatory approval for research involving controlled drugs.
2000s - The psychedelic research hiatus ends when Roland Griffiths, a Professor in Psychiatry and Neurosciences at Johns Hopkins School of Medicine in the USA, manages to convince the US government to let him use healthy volunteers to study psilocybin.
2017 - The FDA grants âBreakthrough Therapy Designationâ to MDMA for assisted psychotherapy in individuals with PTSD.
đ„Â Players
People
Professor Roland Griffiths - Director of the Johns Hopkins Center for Psychedelic and Consciousness Research.
Dr Robin Carhart-Harris - A protege of Griffiths and head of the Centre for Psychedelic Research at Imperial College London.
Professor David Nutt - Deputy head at the Imperial centre (see below). Has lobbied for schedule 1 restrictions on psychedelics to change.
Institutions
Imperial College London Centre for Psychedelic Research - first Centre in the world to investigate the brain effects of LSD using modern brain imaging and the first to study psilocybin for treating severe depression.
Johns Hopkins Center for Psychedelic and Consciousness Research - first Centre to obtain regulatory approval in the United States to reinitiate research with psychedelics in healthy, psychedelic-naive volunteers.
Advocacy groups
Beckley Foundation - collaborates with scientific and political institutions to support research and develop policy around psychoactive substances.
Multidisciplinary Association for Psychedelic Studies (MAPS) - works to create safe, legal, and beneficial opportunities for psychedelics in medicine and society.
Pharma Companies
ATAI Life Sciences - biotech company focussing on psychedelics for mental health. Has several portfolio companies including Compass.
Compass Pathways - carrying out late stage clinical trials on psilocybin for treatment resistant depression using a synthesised formulation âCOMP360â.
Field Trip Psychedelics - provide an end-to-end ketamine based psychotherapy solution from initial consultation through to supervised sessions with the drug.
Champignon Brands - Canadian based company focussing on the discovery and development of psychedelics for mental health applications.
Eleusis - life sciences company testing psychedelics in a range of conditions including mental health, Alzheimers and inflammation.
MindMed - Currently in phase 1/2 trials for a range of compounds including LSD for anxiety, an ibogaine derivative for opioid withdrawal and LSD micro-dosing for adult ADHD.
đŒ Use cases
Depression:
Psilocybin is currently being compared to a common SSRI for treating major depression in a randomised double-blind trial
UK regulators have signed off on a clinical trial using DMT to treat depression
Evidence shows psilocybin reducing depression and anxiety in cancer patients
Eating disorders. Psychedelics might have a role in treating conditions like anorexia nervosa.
Post traumatic stress disorder. MDMA with psychotherapy has been shown to be beneficial for PTSD in a phase II clinical trial.
Addiction. Ibogaine has evidence to suggest it can help with opioid addiction.
đź Predictions
Rogue treatments. Thereâs a long journey ahead to achieve regulatory approval for psychedelic treatments. Individuals or organisations in less regulated countries might provide unauthorised access to psychedelics before the evidence base is firmly established.
Difficult public relations. Several generations have been raised believing psychedelics are dangerous, illicit substances that might be a gateway to harder stuff. Some serious PR is probably required to improve their image.
Approval within 5 years. Several promising compounds and preparations are in mid to late stage clinical trials. Regulatory authorisation is probably only a few years away (assuming results remain promising).
Psychedelics + psychotherapy. âGuidedâ treatments will be the de facto way psychedelics are administered. Controlled environments with trained personnel are necessary to ensure patient safety.
Experience based medicine. Psychedelics bring a new paradigm to medicine. Supplementing âtalking therapiesâ with hallucinogenic experiences is a completely novel approach in Western medicine.
Personnel shortage. Psychedelic treatments require trained professionals to be present for long periods over several sessions. This will be a limiting factor for scaling up access.
Lifestyle medicine. Much like the current trend in glucose monitoring for athletic performance - companies will arise that focus on offering psychedelic micro-dosing for improved productivity, good habit formation etc.
Increased investment. Life sciences and pharma companies focusing on psychedelics will see increased interest and investment. The UK already has a dedicated fund for psychedelic healthcare companies.
đ Opportunities
Learning from weed. Cannabis has also seen a recent research resurgence for multiple indications including chronic pain. Those looking to seek approval for psychedelics should learn the mistakes of medical cannabis and seek regulatory approval at national rather than state level.
A dispassionate scientific approach. Hype around psychedelics could lead to over-promising and under-delivering. The role of psychedelics in mental health will be established through rigorous study and comparisons with existing treatment.
Alternatives to randomised trials. Psychoactive substances make randomised trials difficult (you can tell if youâre not getting the real thing). Alternative approaches might be required to demonstrate effectiveness other than the current double blind randomised trial gold standard.
Beyond mental health. Researchers are already looking to see if psychedelics have a role in the treatment of inflammatory conditions. Their therapeutic potential may stretch beyond just mental health. Eleusis are trialling psychedelics for diabetic retinopathy and micro dosing LSD for Alzheimers.
đ Links
This Guardian article by Robin Carhart-Harris - head of the Centre for Psychedelic Research at Imperial College London
This article describing âBicycle Dayâ - the first LSD trip taken by chemist Albert Hofmann