By P.W. BARBER
Saturday, June 23, 2018
P.W. Barber is the author of Psychedelic Revolutionaries: LSD and the Birth of Hallucinogenic Research
Somewhere, a Cheshire Cat is smiling.
If you've been paying attention to the health news of late, you might think you've travelled back in time to the 1960s. It's not a bad acid trip. We are in the midst of a "renaissance" in psychedelic science, as the author Michael Pollan called it last month in the pages of The New York Times. Researchers are examining the potential of drugs like LSD and psilocybin ("magic mushrooms") - recreational drugs mostly associated with the 1960s counterculture - to act as psycho-therapeutic tools in the treatment of severe addictions, end-of-life anxiety, depression, and post-traumatic stress disorder. We're high on getting high.
Truth be told, many of the new findings are in fact old discoveries from the 1950s and 60s - dusted off and updated for the 21st century. Uncovering this revolutionary past has much to offer to the movement that is presently unfolding in Canada and abroad.
When classic psychedelics, particularly lysergic acid diethylamide (LSD), were legally banned, and restrictions against their use put in place, in the late 1960s and 70s, the widely held opinion in the psychiatric and scientific communities - and, at least among non-users, society at large - was that they were too dangerous. Psychedelics, many argued, had the potential for serious abuse. Furthermore, claims of their medical value were overinflated and lacking a firm evidence base. Not surprisingly, this resulted in a halt to scientific research in the area - although recreational use continued.
Psychedelic science's demise has become the subject of a growing body of historical analyses over the last decade, many of which point to, as contributing factors, a convoluted mixture of 1960s countercultural excesses (that is, psychedelic gurus and the LSD social movement), transformations in psychiatry (and how mental illnesses are understood, diagnosed and treated as well as what constitutes acceptable clinical research methodology), and even the covert experimentation of the U.S. Central Intelligence Agency (CIA). After several decades of being in cryogenic stasis, experimental research with psychedelics is back and attracting the attention of those in and outside of the scientific community.
Leading the charge is a new generation of researchers, based out of centres such as Johns Hopkins University, New York University and Britain's Imperial College in London, whose findings hold promise in treating mental illness.
Attitudes toward recreational drugs are shifting in North America, with legalization of recreational marijuana increasingly prevalent in the United States, and, come Oct. 17, across Canada.
Could magic mushrooms be next?
Perhaps no one definitive answer exists to answer the question of why we're in the midst of this socalled renaissance in psychedelic science. Certainly, many have alluded to mental health and addictions systems being in crisis.
Gauging by the staggering human and financial costs associated with mental health and addictions, plus the fact that demand for services and treatment appear to be outpacing the supply, it is easy to see why there is concern.
Roughly one in five people in Canada experience a mental illness in their lifetime. According to CAMH, Canada's premier research and treatment centre for mental health and addictions, 6.7 million Canadians suffer from mental illness, the cost of which is estimated to be $51-billion a year when factoring in healthcare costs, lost productivity and reductions in health-related quality of life.
In the United States, recent data indicate that more than 43 million Americans suffer from a mental-health disorder and close to half of that number have a cooccurring substance-abuse disorder. Approximately 9.6 million Americans have been found to experience suicidal ideation. In terms of economic costs, the U.S.
Substance Abuse and Mental Health Services Administration estimated the costs of mental illness to be a whopping US$467billion in 2012.
In one area alone - that of PTSD among returning U.S. veterans of the Iraq and Afghanistan wars - the costs are alarming, with one in five veterans (300,000) diagnosed with the disorder. As revealed by some PTSD figures from the same year, first-year treatment cost the government US$8,300 a person, for a total of more than US$2-billion.
To add to this, suicides among active-duty military personnel averaged one a day, 20 per cent of all suicides in the United States.
U.S. research has also revealed another troubling statistic: Americans with serious mental illnesses on average die 15 to 30 years earlier than those without, largely owing to the fact that the former have far higher rates of chronic diseases such as cancer, heart disease, stroke, diabetes and respiratory problems (interestingly, the study does not address what, if any, role the current medications used to treat severe mental illness may have had in contributing to these chronic diseases).
There's no question: We need to do more - and better.
Drugs, of course, have come to occupy an ever growing role in mental-health systems. From the early years of the psychopharmacological revolution in the 1950s onward, we have seen a proliferation in the number of drugs used to treat psychiatric disorders, with numerous variations of anxiolytics, antidepressants, anti-psychotics and other psychotropic medications. Whether these drugs, and the theories that go with them, have been a help or hindrance in the battle against mental illness continues to be a source of heated debate.
In an interview with The Canadian Press earlier this year, University of Saskatchewan medical historian Erika Dyck speculated the revival of scientific interest in these taboo drugs might have to do with people's desperation to find a therapy that works.
Most professionals working in the field will admit the standard medications being used to treat severe mental illnesses and addictions have their obvious benefits, but they also come with significant limitations; at best, the drugs have proven to be effective in the management of symptoms, and for some patients more than others. Unfortunately, the drugs have not been nearly as effective in treating the underlying illness.
In a recent episode of CBC Radio's White Coat, Black Art, Brian Goldman profiles the burgeoning use of these drugs and just how difficult it is for some people to stop taking them. Citing data from a New York Times article, Dr.
Goldman noted that from 2013 to 2014, 34.4 million adults were taking antidepressants, an increase of 250 per cent from a survey completed in 1999 to 2000. Canada also happens to be one of the largest consumers of antidepressants, ranking third on an Organization for Economic Co-operation and Development list of industrialized countries.
More problematic is the fact many of those taking antidepressants are long-term users who face the difficult challenge of withdrawal when attempting to discontinue the medications.
Along with psychopharmaceuticals such as anti-depressants, opioids are another burgeoning area of drug use - and abuse - in North America. Commonly used for pain management or to treat addictions, they are now associated primarily with a crisis that dominates today's news headlines. Psychedelics may have a hand to play here as well. In the 1990s, Russian researchers Krupitsky et al. employed the Saskatchewan psychedelic therapeutic model, using "high dose" ketamine to successfully treat heroin addiction. And today, there continues to be discussion around the potential of other psychedelics (such as ibogaine and ayahuasca) to achieve lasting abstinence from opioid addiction, with some addicts turning to psychedelic therapy as an alternative to opiate replacement drugs such as methadone and suboxone.
In Canada, opioid-related overdoses now account for more deaths than automobile accidents; this week, the Special Advisory Committee on the Epidemic of Opioid Overdoses released data revealing that almost 4,000 Canadians died as a result of opioids last year - with over 90 per cent of these deaths being ruled as accidental or unintentional - a staggering 34 per cent increase from 2016. (One of the more disconcerting stories to have appeared in recent years has been how some pharmaceutical companies intentionally underplayed the highly addictive nature of their drugs so as to not interfere with marketing efforts and profits.)
Given these scenarios, it begs the question of whether adding psychedelics, whose safety and medical value are still contested, to the mix is a good idea. Granted, the notion that powerful mindaltering substances such as psilocybin might in some way help to alleviate the mental-health and addictions crisis might strike some as ridiculous, unethical or just plain scientifically unsound.
Yet, we are once again at a point in time when these drugs are receiving serious scientific consideration.
New developments on the medical and recreational cannabis front have definitely helped to open the door to other possibilities in psychedelic science. In Canada and many parts of the United States, we have taken an almost 180-degree turn from the era of "reefer madness" to today, when marijuana is being touted for its medical and other benefits.
A group of Canadian psychologists that recently carried out a literature review on medicinal and recreational cannabis pointed to the effectiveness of the drug in treating various ailments, most notably the symptoms related to PTSD. Interestingly, the review also reported on findings from American states where a rise in cannabis, used legally for harm reduction, has correlated with a decrease in opioid overdoses. And just a couple of weeks ago, this newspaper reported on national research that indicated people suffering from PTSD but not medicating with cannabis are far more at risk for depression and suicidal ideation than those who do use cannabis; also referenced were the country's first randomized controlled trials to assess the usefulness of the drug in treating the disabling disorder.
In the foundational years of psychopharmacology, hallucinogenic drugs such as mescaline and LSD were an integral part of psychiatric research, initially for their ability to produce model psychoses in healthy subjects and then as adjuncts in the psychotherapeutic treatment of various mental ailments and substance-abuse disorders.
One of the more interesting, and one might argue revolutionary, case studies to emerge in the history of psychedelic science was that of Saskatchewan's research program, which lasted from 1951 until 1961.
During the 1950s, the province was on the cutting edge of mental-health research. Its work with psychedelic drugs in particular spawned numerous theories and novel approaches to psychiatric treatment, creating a situation that led psychopharmacologist David Healy to remark that "Weyburn and Regina were almost as important lights in the psychopharmacological firmament as Paris and Basel."
In the 1950s, Saskatchewan was one of the first places to conduct human experiments with LSD, assessing its physiological, biochemical and psychological effects and, in the process, mapping out the unknown territories
of the "other world." The Saskatchewan research, in fact, was responsible for the first, and perhaps only, Handbook on the Therapeutic Use of LSD; it fostered a radically innovative mental-hospital design based upon the drug experience; and yes, it will also go down in history for originating the term psychedelic ("mind manifesting"), which psychiatrist Humphry Osmond coined in 1956. Among the major highlights of the research, however, were the accomplishments in the areas of schizophrenia and alcoholism.
At a time when Freudian/psychoanalytical thought dominated psychiatry and theories surrounding schizophrenia, the Saskatchewan researchers, under the direction of the psychiatric duo of Dr. Osmond and Abram Hoffer, led the way in the turn toward biological psychiatry.
As with other researchers of hallucinogens in the 1950s, Saskatchewan's psychedelic scientists were initially preoccupied with the psychotomimetic ("madness mimicking") properties of the drugs and their ability to offer a glimpse into the worldview of patients with schizophrenia and other psychoses. But the province quickly separated itself from the rest of the pack in advancing the first specific biochemical theory for the disease (that is, the adrenalin metabolite hypothesis), which, in turn, led to a unique paradigm for understanding, diagnosing and treating the disease.
Based upon two key observations - that mescaline and adrenalin possessed uncanny structural similarities and that mescaline (and other hallucinogens) produced effects in healthy individuals nearly indistinguishable from symptoms associated with acute schizophrenia - Dr. Hoffer and Dr. Osmond launched a fullscale search for the "Mescalinelike Factor" in the human body, which they presumed to be a result of faulty adrenalin metabolism.
The researchers identified adrenochrome as one potential candidate, synthesizing the first pure samples of the chemical and proving it to possess psychotomimetic properties. Their next step was to begin experimenting with possible treatments that might prevent or cut down on the production of the hypothesized toxic substance.
(Dr. Hoffer and Dr. Osmond's use of massive doses of common vitamins such as niacin and ascorbic acid, and their claims of success in restoring wellness to many patients diagnosed with schizophrenia, became the subject of one of the, if not the biggest, controversies in post-Second World War psychiatry.)
Saskatchewan researchers were also among the first to use hallucinogens as therapeutics and as tools in understanding the human mind in general. With the assistance of psychologist Duncan Blewett, the team under Dr.
Hoffer and Dr. Osmond became known for their explorations into the psychedelic applications of the drugs. One of their most noteworthy forays was the co-creation of psychedelic-assisted therapy for the treatment of alcoholism, wherein the drug was administered to patients with the goal of achieving a mystical conversiontype experience.
At its peak, Saskatchewan was one of the only places in the world to incorporate this type of therapeutic option as a standard approach to dealing with alcoholism. The positive outcomes achieved with what were described as "hopeless cases" turned heads, the likes of which included Alcoholics Anonymous co-founder Bill W. and High Priest Timothy Leary.
But the hype surrounding Saskatchewan's psychedelic research was short-lived. By the time the research concluded in the early 1960s, it was embroiled in a series of controversies and would soon be faced with scientific findings from other research centres that failed to replicate its positive findings. At least this has been the standard narrative regarding this episode in psychedelic science history. A fuller reconstruction of the Saskatchewan story, however, makes for a much more complicated picture.
It also reveals a host of myths and misconceptions that have lasted to this day, for example, that the research was inseparable from, and even promoted, LSD's countercultural manifestations or that it was covertly sponsored by the CIA's MKUltra program.
By 1970, LSD and other psychedelics had become anathema to mainstream scientific and medical communities, their contributions to psychiatric and psychopharmacological history "flushed down the memory hole."
Despite psychedelics' illustrious history and their future promise, not everyone is on board. In a recent article in Harper's magazine, Nick Richardson takes issue with what he feels Michael Pollan and other surveyors of the renaissance to be saying, essentially that "the drugs are a net good and have been banned for nefarious reasons." Mr. Richardson expresses discomfort with the idea of psychedelic drugs resulting in mystical experiences and is "wary of placing too much trust in psychedelic revelations." Not only that, he finds psychedelic therapy "to be a little creepy." I am sure he is not the only one who feels this way.
But Mr. Richardson tends to view pro-psychedelic statements such as those of Mr. Pollan in the same vein as those of psychedelic pied piper Dr. Leary because of their "believing the dangers of psychedelics to be almost nonexistent." I cannot say with absolute certainty that Mr. Pollan denies the dangers inherent in the use of psychedelics; most of the researchers he interviewed would have stressed the dangers involved in psychedelic pursuits, but that these dangers could be controlled for provided the appropriate "set and setting."
The point here is that suggestions that psychedelics possess scientific and medical value should not be equated with a call for some psychedelic-fuelled utopia or with an appeal to the youth of the world to "turn on, tune in and drop out." We have hopefully moved beyond the black-andwhite portrayals of the drugs as either the panacea for all that ails humankind or the societal scourge they were made out to be at the height of the LSD mania in the 1960s.
Today's studies seem to indicate that there was validity to some of the earlier discredited research. Take psychedelic-assisted therapy for alcoholism as one example. In a 2012 meta-analysis of early randomized controlled experiments with LSD and alcoholism, Norwegian researchers Krebs and Johansen revealed that, in spite of methodological inconsistencies and weaknesses, "the effectiveness of a single dose of LSD compares well with the effectiveness of daily naltrexone, acamprosate or disulfiram," three standard medications used to manage alcohol dependence.
The psychedelic renaissance is still in its early days and many challenges lie on the road ahead.
Regulatory hurdles and funding still stand as the biggest barriers to present-day research, although government agencies responsible for the regulation and approval of drugs, such as the U.S. Food and Drug Administration and Health Canada, have displayed more openness to the possibility that psychedelics might afford a "breakthrough" with certain mental illnesses and addictions.
As it currently stands, most psychedelic drugs continue to be classed under the most restrictive drug schedules for controlled substances, a decision that was made for mostly political reasons.
It is doubtful the support of the pharmaceutical industry will be forthcoming any time soon, which is not surprising given the fact psychedelics pose a direct threat to its bottom line. In the case of psychedelic-assisted therapy, the drugs are a component, albeit a very important component, of a carefully structured therapeutic matrix that has the potential to achieve results in one to two sessions. (Researchers have shown how a single exposure to psychedelics has produced immediate and lasting improvements in symptoms for the patient that last long after the drug has been metabolized and gone from the body.) For this reason alone, psychedelics would not be very appealing to pharmaceutical companies, whose profits depend on clients taking their products on a daily basis for months and years on end.
Many of the successful studies to date have managed to get around these barriers through the dedication and generous funding of non-profit organizations such as the Multidisciplinary Association for Psychedelic Studies (MAPS). One of the most advanced areas of study at this time remains the Phase 3 clinical trials unfolding in Canada, the United States and Israel using MDMA ("ecstasy")-assisted therapy to treat cases of PTSD.
Further advancement in psychedelic science will depend on many things, but there is reason for optimism. If psychedelics are to find a place in mainstream medicine, progress must occur along a scientific path; it will not occur through some social or quasi-religious psychedelic movement, a fact best summed up in a statement by British psychiatrist Ben Sessa's statement that "doctors need randomized, double-blind, placebo controlled clinical studies, not anecdotal drug experiences, no matter how convincing they may seem to the users."
Time will tell if we are in store for a repeat performance of psychedelic science circa 1960s or if the field will advance sufficiently to the point where a new era is upon us.
ILLUSTRATION BY CHLOE SCHEFFE
ILLUSTRATION BY CHLOE SCHEFFE