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MAPS Bulletin Winter 2013: 2013 Annual Report
 
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December 4, 2013

10 Best Answers to Questions About Using Psychedelics

By: April M. Short

AlterNet

AlterNet highlights 10 of the best questions and answers from the AMA (Ask Me Anything) hosted by MAPS Founder Rick Doblin and MAPS staff on reddit. MAPS staff answered more than 75 out of over 2,000 questions asked by the reddit community. “This is one of the most exciting and inspiring parts of what we do,” says Brad Burge of MAPS. “Interacting with people who are actively trying to broaden their perspective about the risks and therapeutic benefits of psychedelics and marijuana.“


Originally appearing here.

Rick Doblin—founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS), appeared on Reddit’s AMA feature (Ask Me Anything) to openly answer questions along with a team of 10 from MAPS on December 3.

For those who are unfamiliar, AMA is like the town hall meeting of the digital age, providing a chance for anyone to ask about anything and, if the comment is promoted by other users to the top of the pile, they will receive a response. When President Obama made a surprise AMA appearance as part of his 2012 campaign efforts, he was bombarded with so many questions the flood of traffic momentarily took down the site.

In Doblin’s introduction to the AMA session he described MAPS as a 501(c)(3) non-profit research and educational organization that develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana. Then, he noted that the staff could answer any questions about:

•  Scientific research into MDMA, LSD, psilocybin, ayahuasca, ibogaine, and marijuana;

•  The role of psychedelics and marijuana in science, medicine, therapy, spirituality, culture, and policy;

•  Reducing the risks associated with the non-medical use of various drugs by providing education and harm reduction services;

•  How to effectively communicate about psychedelics at your dinner table;

•  and anything else!

Doblin also noted that currently the most promising research at MAPS focuses on treating post-traumatic stress disorder (PTSD) with MDMA-assisted psychotherapy.

The MAPS team was inundated with more than 2,000 questions and had responded to more than 75 by publishing time (2:30pm, December 4).

According to Brad Burge, director of communications and marketing for MAPS, the team will continue to answer questions through the end of the week as long as there is interest—and they may even decide to continue answering questions indefinitely.

“Educating the public honestly about psychedelics and marijuana is a core part of our mission,” he said. “This is one of the most exciting and inspiring parts of what we do: interacting with people who are actively trying to broaden their perspective about the risks and therapeutic benefits of psychedelics and marijuana.“

Here are ten of the most fascinating questions and answers to come out of the AMA:

1. Question from luttnugs:

Is it possible for people to have completely different reactions/symptoms from the same psychedelic? Say hypothetically I eat mushrooms and my friend eats the same amount of said mushrooms. Should we experience similar symptoms or is it possible that genetics could lead to completely different reactions?

Answer from Rick Doblin:

Yes. The beauty of psychedelics is that we don’t have psychedelic experiences; we have experiences of ourselves catalyzed by psychedelics. Stan Grof has said that LSD is a “non-specific amplifier of the unconscious,” so that what we experience depends on who we are.

LSD is like dreaming—it’s not uniform content, it’s a way of processing content.

2. Question from SkittleSkitzo:

How bad is marijuana for the lungs? Also, is it actually possible to “re-trip” (where you hallucinate years later because its in your spinal fluid) on acid?

Answer from Rick Doblin:

Marijuana does not cause lung cancer, nor does it cause chronic obstructive pulmonary disease (COPD). The cannabinoids in marijuana have anti-tumor properties; however, people who smoke marijuana can sometimes get colds and respiratory infections. I think unbiased risk/benefit analysis by the FDA could result in marijuana in smoked form becoming an approved prescription medicine.

LSD is not stored in the spinal fluid and it is not possible to “re-trip” years later. That is entirely a drug war fabrication.

3. Question from Quasarstoquarks:

Do you believe that spiritual drug experiences (such as shamanistic rituals involved with ayahuasca) will ever have a place in modern medicine?

Answer from Rick Doblin:

MAPS recently sponsored a study of ayahuasca in the treatment of addiction in British Columbia. Bill W., the founder of Alcoholics Anonymous, took LSD in the 1950s and felt it could play a major role in the treatment of addiction. The spiritual experiences help people to accept themselves, and give people strength. So spiritual experiences will have a place in modern medicine, such as research into LSD for people with anxiety associated with the end of life. Earlier LSD research in the 1960s for cancer patients showed that spiritual experiences were correlated with therapeutic outcomes. Spiritual experiences can occur in a hospital setting as well as in a shamanistic ritual. I think modern psychiatric medicine will increasingly combine psychotherapeutic and spiritual experiences.

4. Question from MDMA_Throw_Away:

My wife and I tried MDMA for the first and only time (so far…) earlier this year. It was the best experience I’ve ever had on any drug. We expected to be sexing like rabbits but much to my surprise we had a late night of chatting, laughing, and even airing grievances with eachother in a way that we both could just accept and talk through. We cried together over things that we routinely did that were hurtful to the other. We had a whole night of connecting with each other like we never had before.

It was downright therapeutic.

I think this would be such an incredible drug for couples that need refocused on each other. What kind of work is being done to make MDMA legal for responsible adults?

Answer from Berra Yazar-Klosinski, Ph.D., lead clinical research associate:

Couples therapy was actually the most common therapeutic use for MDMA before it was placed on Schedule 1 in 1985. However, at present the most effective way to study the risks and benefits of MDMA is to study it as a treatment for a clinically diagnosable psychiatric disorder. After medical use becomes more accepted, it may become possible for additional uses of the medication to be studied.

Here is a related article from a 2011 issue of Elle magazine that you might find interesting.

Answer from Rick Doblin:

We were recently contacted by a group of European researchers who want to start a study of couples therapy. They are seeking a government grant to complete the study. If accepted, this will be a remarkable study.

As Berra said, we are focused on turning psychedelics into medicine. Relationships aren’t diseases. We definitely hope to see this research expand.

Medicine will increasingly combine psychotherapeutic and spiritual experiences.

5. Question fromOceanMan7:

I know from experience that a bad trip on psychedelics can be extremely scary and traumatizing. How do you guarantee that your patients have a positive experience?

Answer from Ben Shechet, clinical study assistant:

There is no guarantee that a psychedelic experience will be ‘positive’—in fact, since most of our research subjects are dealing with significant psychological issues in their lives, their experiences can be quite difficult. We make sure that our subjects feel safe and well cared-for within the therapeutic space, and focus on building a strong working alliance between the therapists and subjects. But we also view difficult experiences as moments that carry great potential for healing and growth, and encourage our subjects to enter into those experiences willingly, as they are often the very things that need to be experienced fully in order for the individual to move forward in their life.

6. Question from dennisb230980:

What is your opinion about [T]im [L]eary in terms of psycedelic scientific research[?]

Answer from Rick Doblin:

Tim Leary, when he was at Harvard, did incredibly valuable scientific research. The Good Friday Experiment for which he was a faculty sponsor was the first study of psychedelics in spiritual experiences ever conducted. My undergraduate thesis was a 25-year follow-up study to Leary’s study. It was a key to my understanding of the 1960s. The people I interviewed who participated in the original Good Friday Experiment told me that the mystical experience of oneness had important political implications in their lives in that it inspired them to see our commonality more so than our differences, and motivated them to work for social change. When I look back on the 1960s, the backlash from society was more about psychedelics going right and motivating people to challenge the status quo than it was about psychedelic experiences going wrong, though that happened as well. The Good Friday Experiment has motivated almost all of the current psychedelic researchers.

Leary’s Concord Prison Experiment was exceptionally idealistic in trying to show that psychedelic mystical experiences could produce measurable reductions in recidivism. Where I’m not comfortable with Tim Leary is that once he left Harvard he exaggerated the results of the Concord Prison Experiment and ended up sharing false information.

I believe there’s something holy and spiritual about science, and that the results of research need to be shared with the greatest of integrity. I admire Tim, but also feel that he became what he was objecting to: Propaganda against psychedelics in his mind justified propaganda for psychedelics. MAPS is trying to be a leader in research into both the benefits and the risks of psychedelics, and reporting them honestly.

7. Question from Rack3m:

What do you see as the next big hurdle for publicly funded research grants?

Answer from Rick Doblin:

NIMH has not funded psychedelic research since the mid-1960s, but we hope that will change over the next few years. We are currently developing a research grant proposal to send to the NIMH in order to move forward with our PTSD research.

We are also in discussion with the VA and DOD about the concept of treating veterans suffering from PTSD with MDMA-assisted psychotherapy. It may take several more years before we engage in a collaborative study and receive government funding.

Currently, all of our research is funded through donations.

8. Question from musicisbelieving85:

With the current MDMA research, once that is finished is the expected result to get FDA to approve MDMA psychotherapy or is the plan to do even more research? What’s the current expected timetable for making this available for basically anyone that needs help in this way?

Answer from Amy Emerson, director of clinical research:

We are currently in Phase 2 of our clinical trials, this phase gathers preliminary information on the safety and efficacy of the drug to treat the condition under investigation in populations of 12 to 200 subjects. Phase 3 trials gather conclusive evidence regarding efficacy and safety in larger populations of 250 to 2000 subjects. At least two Phase 3 studies are typically required to prove safety and efficacy before permission for prescription use can be approved.

While we are working to complete the Phase 2 studies, Phase 3 planning will start including work to identify a GMP (good manufacturing process) manufacturer of MDMA as well as large scale training of Phase 3 investigators. We anticipate completing the primary end points in our Phase 2 studies in late 2015. We plan to have our End of Phase 2 meeting with FDA in early 2016 and apply for programs to accelerate development. By the end of phase 2 we will know if we have been accepted to any accelerated development programs and will finalize our Phase 3 strategy with FDA.

We estimate we will need to do 2 Phase 3 studies with 200-250 subjects per study across multiple sites, the studies will be conducted in a staggered fashion from 2016-2020. In parallel with this, MAPS will request FDA permission to conduct Expanded Access (Compassionate Use) studies with cost recovery for people who do not qualify for the Phase 3 program. If a drug proves to be safe and efficacious in two Phase 3 studies, the sponsor of the studies submits a New Drug Application (NDA) to the FDA and/or the European Medicines Agency (EMEA), which review the application for possible approval as a prescription medicine. We anticipate the decision regarding MDMA as a prescription medication would occur in 2021.

9. Question from Pipken:

A very recent study by Taurah et al. indicates that MDMA use results in widespread behavioral deficits when compared to other drug users, and that alarmingly, these deficits did not go away even after a prolonged period of abstinence. When taken together with evidence in animal models that any substantial MDMA usage causes irreparable damage of serotonergic neurons, it appears that MDMA use can result in the selective yet permanent death of these neurons even in humans.

What methods have you utilized to minimize the damage and maximize the benefits of these psychedelics in your research trials?

Answer from Ilsa Jerome, Ph.D., clinical research and information specialist:

We have examined the literature on MDMA toxicity over time; there are sections on the matter in our Investigator’s Brochure, which is periodically updated.

The recent study features a large sample but is still retrospective (meaning people are measured after they start taking ecstasy) and compares between groups. This makes it similar to 99% of most studies of ecstasy users, and the problem with this is that the method makes it hard to eliminate the other potential points of causation; it’s essentially a fancy correlational study with multiple groups. Drug use is poorly matched in this sample.

MAPS studies involve a couple of administration of known MDMA in a therapeutic setting, and so are different from unsupervised use of “ecstasy” in various settings.

We examined cognitive function in our first study of MDMA-assisted psychotherapy in people with PTSD, and we did not find any indicate that receiving MDMA as compared with inactive placebo reduced performance on these tests.

The animal models have long been in question since they are based on interspecies scaling, and this model is not suitable for compounds with nonlinear pharmacokinetics (meaning, a higher dose has a greater effect than expected), and MDMA has nonlinear pharmacokinetics. Hence most rodent and monkey toxicity studies use inappropriately high doses.

We still inform people of the potential risks of toxicity before they take part in MDMA studies, and we leave three to five weeks between each dose.

10. Question from entropico:

What is the single most challenging anti-psychedelic argument used and how do you deal with it?

Answer from Brad Burge:

The single most challenging rational argument against psychedelic research is the claim that by investigating the beneficial potential of these drugs and engaging in public education about the results of that research, we are also encouraging the irresponsible use of the drugs by leading people to believe that they are safe.

There are two simple responses to this question that we have found to be useful: (1) We do not claim that psychedelics, or any drugs, are safe, only that in defined situations their benefits can outweigh their risks; and (2) ultimately, we do encourage the responsible use of psychedelics, though we acknowledge that current prohibitionist and anti-harm reduction policies make those responsible uses more difficult to engage in.

The main resistance encountered by psychedelic research, however, is not rational, but deeply emotional. Decades of cultural paranoia surrounding the use of psychedelics, combined with the suppression of scientific research into their benefits until recently, have traumatized our culture and conditioned many people to fear them. As a result, our main challenge as we work to increase public awareness about the risks and benefits of psychedelics is to find a way through these fears. When you talk to others about psychedelic research or what they can do, remember that they might be afraid. When it comes to communicating about psychedelics, compassion is key.


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