Reason: Psychedelic Science

In the 1950s and ’60s, psychedelic drug research seemed to offer promising paths for treating schizophrenia, obsessive-compulsive disorder, alcoholism, and other disorders. The Controlled Substances Act of 1970 interrupted legitimate scientific inquiry, but there was a brief renaissance in the late ’70s and early ’80s, when psychiatrists embraced MDMA as a tool to catalyze the therapeutic process. By 1985, however, MDMA was better known as the street drug “ecstasy” and was added to the list of chemicals that the government defined as having a high potential for abuse and no accepted medical use.

In the early 1990s the tide turned again, as a new wave of research made a serious case that psychedelics should have a role in psychiatry. “This research is no longer seen as uncomfortably fringe,” says Rick Doblin, “but is now being accepted more widely as promising and important and opening up a long-blocked avenue of research in psychiatry.”

Doblin, executive director of the Multidisciplinary Association of Psychedelic Studies (MAPS), has been at the forefront of this wave. His tale is one of the focal narratives in former Washington Post reporter Tom Shroder’s Acid Test, a book that weaves intimate biographies of key players in psychedelic research with the stories of the patients they aim to help.

Another important figure in the book is Michael Mithoefer, a psychiatrist with a private practice in Charleston, South Carolina. Mithoefer’s research team completed the first major study investigating MDMA as an aid to treating posttraumatic stress disorder (PTSD). The study, which was funded by MAPS, revealed its 83 percent success rate in the Journal of Psychopharmacology in 2010. A follow-up study published two years later emphasized that the results from the initial MDMA-assisted psychotherapy sessions were sustained for nearly all of the volunteers. Their symptoms were relieved, on average, for just under four years, though two of the subjects experienced a relapse. This is especially noteworthy because only a handful of psychotherapy sessions involved MDMA, compared to a dismal success rate of treatment with a daily regimen of antidepressants, mood stabilizers, and in some cases even antipsychotics and tranquilizers.

 

These are still, to be sure, preliminary results. The study was conducted as a “proof of principle” trial, meaning that it focused on a small sample (just 20 volunteers) to show that the experiment could be conducted safely, that the credibility of the therapist training manual could be tested, and that MDMA-assisted psychotherapy could produce favorable results. With successful outcomes for all three objectives, the study provides a strong argument for further research. And indeed, a similar study was completed two years ago in Switzerland. Its outcome was not as dramatic—a third of the subjects experienced a reduction of PTSD symptoms from severe to mild—but it was still deemed a successful trial. Additional trials are still ongoing in the U.S., Canada, Australia, and Israel; if they go well, researchers plan to petition the U.S. Food and Drug Administration to approve phase III protocols, the final step toward making MDMA an approved treatment.

 

When researchers investigate treatments for PTSD, their chief tool for measuring their results is the Clinician-Administered PTSD Scale (CAPS), a structured clinical interview that measures the severity of the sufferer’s symptoms on a scale of 0 to 130. To meet the criteria for enrollment in Mithoefer’s study, a CAPS score of at least 50 had to persist for at least three months while volunteers received antidepressant treatment and at least six months of psychotherapy. Before the MDMA sessions, the volunteers in Mithoefer’s study averaged a CAPS score of 80. That dropped to below 30 just two months after their final MDMA session, less than half the average score of the placebo control groups. The dramatic reduction in CAPS score meant that the volunteers no longer met the minimum criteria for PTSD. In other words, they were essentially cured.

While these subjects are left anonymous in the scientific literature, Shroder puts names and life stories to the people behind the numbers: veterans, victims of sexual abuse, terminally ill cancer patients, and others desperate for relief. Nicholas Blackston, for example, served two tours with the Marines in the second Iraq war; he participated in Mithoefer’s second MDMA study, which aimed to treat subjects whose PTSD stemmed from war-related trauma. Shroder devotes about half of Acid Test to Nick’s story.

“PTSD was like a file folder sitting on a desk not knowing where to be stored, therefore piling up other file folders behind it, creating stress,” Blackston tells me. “The MDMA-assisted psychotherapy helped my mind properly file it away, allowing for peace of mind.” Blackston still has occasional issues with anxiety, but he says these are easy to manage and are not related to his PTSD. “I experienced some pretty horrific things in war, and those images can never be erased,” he says. “Although they’re still within my mind, I’m no longer haunted nor debilitated by those traumas. The therapy has allowed my mind to process trauma as information to learn from.”

MAPS is not the only organization working to bring psychedelic drugs back into the medical community. The Heffter Research Institute has been funding research with psilocybin—the active compound in so-called magic mushrooms—at UCLA, New York University, Johns Hopkins, and the University of New Mexico. The focus so far has been on psilocybin’s ability to trigger a mystical experience, which may be useful in various applications of psychotherapy, from easing end-of-life anxiety to quitting smoking. The U.K.-based Beckley Foundation is partnering with researchers at Imperial College London to examine the effects of psilocybin and LSD on the brain. Additional research with ayahuasca, an Amazonian brew containing the psychedelic drug DMT, and ibogaine, an addiction interrupter from the African iboga plant, are ongoing in Europe, Latin America, and New Zealand.

Earlier this year, The Journal of Nervous and Mental Disease published the first clinical trial in more than 40 years that used LSD for psychotherapy. Peter Gasser, a Swiss psychiatrist, conducted a double-blind placebo-controlled experiment in 12 people with debilitating anxiety associated with a life-threatening disease. All 12 subjects experienced significant reductions in their anxiety following only two LSD-assisted psychotherapy sessions, with their relief lasting at least 12 months through ongoing monitoring of symptoms.

Acid
Test is a crucial addition to the story of science’s psychedelic renaissance. By showing what researchers have accomplished, it makes a strong case against letting regulators close the door on their work again.

Kevin Franciotti (franciotti.k@gmail.com) is a freelance journalist based in Boston.