August 3, 2014
The Case for Medical LSD, Mushrooms, and Ecstasy
By: German Lopez
Vox reports on the resurgence of research into the medical potential of psychedelic-assisted psychotherapy, highlighting clinical studies investigating the therapeutic use of MDMA, LSD, and psilocybin for the treatment of anxiety, alcoholism, obsessive compulsive disorder, and addiction. The article notes how early psychedelic research has served as the inspiration and foundation for current psychedelic research, details the progress of current research, features a comprehensive interview with psychedelic researcher Dr. Charles Grob about past, present, and future psychedelic research. “It’s great to see that momentum is moving forward,” explains Grob. “I think we are going to be able to accomplish the goals that the earlier generations were not able to, by and large because the world we live in today is far more ready to handle the implication of research with psychedelic drugs.”
the world increasingly embraces medical marijuana, some researchers are beginning to look at how other, more taboo drugs might be used to treat health issues. Hallucinogens aren’t often at the center of conversations about US drug policy. But these drugs — LSD, mushrooms, and ecstasy, to name a few — are categorized by the federal government as schedule 1 substances, with high risk of abuse and no medical value.
Researchers are now investigating whether that classification is warranted. Inspired by the work of researchers from the 1950s and 1960s, experts like UCLA psychiatrist Charles Grob are tapping into the hallucinogens for their potential to treat all sorts of psychological conditions: alcoholism, anxiety, obsessive compulsive disorder, and even nicotine addiction.
Grob bases his belief off early results from his own research and other ongoing studies, as well as research from the 1950s through 1970s that found massive medical potential in the hallucinogens. It might be hard to understand now, but there was a moment in those early years when many doctors strongly believed hallucinogens would revolutionize psychiatric care.
The concept of medical hallucinogens first surfaced in the 1950s
From the 1950s through the early 1970s, the psychiatric world took the idea of medical hallucinogens very seriously. “At that time, they were considered to be really the cutting-edge of psychiatric research,” Grob says. “They only collapsed because of all of the cultural and political turmoil of that era.”
Two leading reviews of the research from that time, with a focus on the highly popular LSD, found the drugs could produce solid medical results in controlled settings. A 1960 study by UCLA psychiatrist Sidney Cohen found hallucinogens could pose some risks to patients, but those risks were mitigated in better regulated environments. Under conditions in which a patient was carefully guided through the hallucinogen experience and treated through psychotherapy before and after, the results were promising. A 1984 follow-up study by University New Mexico psychiatrist Rick Strassman had similar findings.
The promise of hallucinogens, Grob explains, is that they could produce a psychological effect in one or two doses that would take months or even years to reproduce with other drugs.
“When you’re talking about psychiatry, the medications we use that I prescribe all the time usually have to be utilized on a daily basis — for weeks, for months, sometimes for years,” Grob says. “When you’re talking about a hallucinogen treatment model, the drug itself might only need to be applied on one occasion or perhaps a couple of occasions spread out by many weeks or many months — all within the context of ongoing psychotherapy.”
The idea is these drugs create a hallucinogenic experience of such magnitude that they can essentially reorient a person’s worldview away from anxiety, depression, or even addiction. If that reorientation is guided properly, the experience can have a long-lasting positive effect on certain patients.
Grob and other researchers aren’t only relying on studies from half a century ago. With the help of organizations like the Heffter Research Institute and MAPS, research in this field is getting a new shot. Currently, there are ongoing studies for alcoholism, anxiety among cancer patients, and autism.
Grob in 2011 conducted his own study on the effects of psilocybin, the psychoactive compound in mushrooms, with late-stage cancer patients struggling with anxiety. Although the dose and sample size were admittedly quite low, Grob says the results were promising and the lessons learned from the study will help spur future research.
“The reports I got back from the subjects, from their partners, from their families, were very positive — that the experience was a great value and it helped them regain a sense of purpose, a sense of meaning to their life,” Grob explains. “The quality of their lives notably improved.”
A recent study of LSD as a treatment for anxiety in patients with life-threatening diseases produced similarly promising results. The study also looked at a small sample size of 12 patients, but the reductions in anxiety seemed to last even a year after the treatment.
So far, the research has drawn little opposition — perhaps because it’s been conducted quietly with little fanfare. It’s likely anti-drug groups, such as those who currently oppose the legalization of medical marijuana, will try to put up more hurdles to the studies if the research becomes more mainstream.
These studies also aren’t definitive, given the small sample sizes and low doses. But, for Grob and other interested parties, they show that researchers should at least pick up where their colleagues left off decades ago.
The drugs aren’t for everyone
Grob emphasizes that hallucinogens should only be tried with willing patients after conventional treatments fail. When they are used, he says the drugs should only be deployed in a controlled environment further guided by psychotherapy both before and after the treatment.
“You’re not going to write a prescription, give it to someone, and say, ‘Take one of these, tell me what happens,’” Grob explains. “Nothing like that.”
For the doctor facilitating the treatment, Grob argues there should be a long list of expectations: the facilitators should be trained to prepare the patient for what could happen in the treatment, actively guide the patient through the experience, and, after the treatment, help patients integrate what they went through into their lives.
Based on previous research, Grob argues the drugs work better when a patient is predisposed to what could be interpreted as a spiritual experience. Since the idea is to help someone tear themselves away from self-imprisoning thoughts, the treatment might be more effective if someone is ready to accept a hallucinogen experience as evidence of something greater than one’s self.
As researchers dig deeper into these drugs, they’ll find out whether the decades-old findings stick. It’s certainly possible that the drugs could be useful for a wider audience — or they might turn out to have much less medical value than people like Grob hope. At least for now, though, it seems like the field is being taken more seriously.
Charles Grob is a professor of psychiatry and biobehavioral sciences at UCLA who is highly active in a burgeoning field of psychiatric research: medical hallucinogens. Grob has conducted research into the drugs as a potential treatment for anxiety in late-stage cancer patients, and he co-wrote an article in the Scientific American on the topic in 2010. I spoke with Grob earlier this week about the potential of medical hallucinogens. This interview has been edited for length and clarity.
German Lopez: What’s the case for using medical hallucinogens?
Charles Grob: Keep in mind that some of these drugs were explored during the 1950s and 1960s as possible treatment models. At that time, they were considered to be really the cutting-edge of psychiatric research. They only collapsed because of all of the cultural and political turmoil of that era.
Here we are, many decades later, and it seems more feasible again. We’re able now to conduct these studies in the way they ought to be conducted — without a lot of fanfare, quietly, often under the radar, using very strong research methodologies, and going through all the approval processes of the government regulating agencies.
This model has particular merit with patient populations that do not respond well to conventional treatments. That’s the case with alcohol abusers, that’s the case with chronic post-traumatic stress disorder patients, that’s the case with people with advanced cancer who have overwhelming anxiety, depression, and demoralization. It’s kind of a reactive, catastrophic existential experience they’re going through, and conventional treatment doesn’t get them very far with these kinds of situations.
But the hallucinogen model when conducted under optimal conditions has been shown to have a remarkable potential.
One thing that’s different about this treatment compared to conventional drug treatment models is the frequency of use. When you’re talking about psychiatry, the medications we use that I prescribe all the time usually have to be utilized on a daily basis — for weeks, for months, sometimes for years. When you’re talking about a hallucinogen treatment model, the drug itself might only need to be applied on one occasion or perhaps a couple of occasions spread out by many weeks or many months — all within the context of ongoing psychotherapy.
It’s not a treatment model where you write a prescription and say, “Here, have this filled, take it when you have the chance, and tell me next week what it does.” It’s nothing at all like that. We have people come in — they’re seen in one of the research facilities at our hospital — and we sit with them for the full six to eight hours, however long the experience is. We interact, and it’s very much a controlled environment.
German Lopez: Is the idea with these drugs that they have such a massive effect on a person’s mind that they can produce an experience strong enough to reorient their brain and self-perception?
Charles Grob: I would say it’s a reequilibration of one’s sense of self: how they perceive their history and their past, how they perceive themselves in the present, and how they perceive themselves moving forward into the future. It can allow for a dramatic kind of reequilibration and, under some conditions, a rather dramatic transformation.
German Lopez: You’ve worked with cancer patients. What was the response you saw from those patients?
Charles Grob: It was a pilot study, a preliminary investigation. Based on our primary article, you can see that, despite the relatively small sample size, we got very positive results.
We established good safety parameters. Nobody had an adverse medical reaction, nobody had an adverse psychological reaction, nobody had a bad trip, nobody had any flooding anxiety, paranoia, or anything in those regards.
We also established feasibility — that we could get all the regulatory approvals. That took a couple of years. So we established feasibility and safety. Those were actually our two biggest goals.
On top of that, the bonus was in terms of how patients did. People responded very positively. Their anxiety lessened, their moods improved — often to a significant degree. It was surprising given that we only had 12 subjects, and each subject acted as their own control.
That’s just from our quantitative data. But I also spent plenty of time with these people and their close family and spoke with them in great detail as to the impact of the treatment experience and how it played out over the following weeks, months, and sometimes the next year or two. The reports I got back from the subjects, from their partners, from their families, were very positive — that the experience was a great value and it helped them regain a sense of purpose, a sense of meaning to their life. The quality of their lives notably improved.
Here’s an example: this one woman, who was quite ill and was shutting herself off from friends and family, was becoming increasingly isolated, and conventional treatments hadn’t helped her. She had a very profound experience during the treatment. Afterward, she and her husband started to become more social. They reached out again to some of their old friends, they started going to concerts, they even went up to San Francisco to see the opera, which they really loved. To the degree that her medical illness allowed, she normalized her life again.
German Lopez: That’s a dramatic change, especially given that it was a low dose of psilocybin.
Charles Grob: Yes, it was a modest dose. The Johns Hopkins University study and New York University study were initiated after our study. Since we had already established good safety parameters, they were able to get approval for a higher dose, which I believe may be better.
German Lopez: How do you see those studies going?
Charles Grob: They’re just finishing studying their final subjects, and now they have to wait for six months to elapse after the last treatment of the last subject. Then they’re going to do the quantitative analysis. So we don’t know for sure until we get their analysis back, which will be in some months.
But just talking to the investigators, they were very moved by many of their subjects and the reports they provided. By all appearances, their subjects seemed to do as well or perhaps even better than ours — given that they were using a slightly higher dose.
German Lopez: With hallucinogens, there’s been a multi-decade gap of no research since the early 1970s. Back then, our research protocols weren’t as rigorous. Is that something that makes looking back at the old research harder?
Charles Grob: Not necessarily. You start off understanding that they just had different models of investigation. They would provide far more detail on the single case of an individual, but they collected far less quantitative data. They didn’t have the rigorous control models that we use. Nevertheless, their reports are very, very encouraging and really should point us to take another look at the kind of work they did.
Today, we can utilize state-of-the-art research methodologies conducted under optimal conditions, go through all the regulatory agencies, and then we can see whether its value is as promising as the early investigators strongly believed it was.
“Remember, these are not treatments for everyone. Someone needs to almost be called to it, or the individual may decide that what they hear about it resonates with them.”
German Lopez: So how do you see these drugs being deployed?
Charles Grob: Remember, these are not treatments for everyone. Someone needs to almost be called to it, or the individual may decide that what they hear about it resonates with them.
Again, it’s not for everyone. But in cases involving advanced cancer, if they are experiencing very high levels of anxiety focused on their impending passing, and if they feel a loss of sense of purpose or loss of meaning, those might be indications that this treatment is worth considering.
But at the end of the day, the subject on their own needs to come to their own decision of whether this is a treatment they want to pursue. I would not want patients to be pressured into undergoing this kind of treatment.
German Lopez: I’m sure some people might not be open to what others consider a spiritual experience. Is that part of the issue too?
Charles Grob: Right. One thing that’s quite unique about these compounds, when you structure the conditions just right, is that they appear to have a rather unique potential of facilitating very powerful psychospiritual experiences.
Early investigators from the 1960s and 1950s observed some interesting results in this regard by looking at patient populations with chronic alcoholism or terminal cancer and anxiety. They found some subjects who went through what was often only one session of treatment within the context of psychotherapy had a powerful mystical experience. That experience appeared to be predictive of a better therapeutic outcome down the line. Meaning, the ones in the alcoholic group who had that powerful, mystical experience were more likely to establish and sustain sobriety over longer periods. In the case of the patient with advanced cancer and anxiety, that’s the patient who was more likely during evaluations in the weeks and months following to have reported more marked improvement in their anxiety and mood regulation.
German Lopez: You mentioned this isn’t for everyone. How would doctors actually get this to patients? Would they recommend it?
Charles Grob: Oh, no. I’m sure a lot of people might disagree with me on this, but I think there needs to be a special certification process for health providers who are facilitators of this experience.
I don’t think just any doctor or health provider could be a facilitator. I think there needs to be an individual with special qualifications. There needs to be some kind of process providing training, oversight, supervision, and proper vetting of future facilitators.
It’s similar to what you observe in the field of surgery, in which you have some procedures that not just any surgeon can conduct. You need to go through a special course of training, you need to observe more experienced surgeons conduct that procedure, you need to conduct the procedure under direct supervision, and much later on you may perhaps end up supervising someone as he or she learns the procedure.
German Lopez: With these kind of drugs, there’s always going to be concerns about the possible health effects. How do you respond to those concerns?
Charles Grob: First and foremost, you optimize safety. You need very knowledgeable, well-trained, and ethical facilitators. It takes tremendous trust to be able to conduct this work.
You also need optimal conditions for psychedelic psychotherapy. Set and setting — that’s what the early investigators realized would determine outcomes. The set is the psychological disposition and underlying vulnerabilities of the person receiving the drug, as well as their intentions, their expectations, and what they hope to get out of it. Then the setting is where you have the experience, how safe and secure it is, who is overseeing the session, who is making sure the safety parameters are very well set in place, how good is the therapeutic structure in which someone is working. So set and setting are very important for predicting therapeutic outcomes and ensuring safety.
If you go back at the prior era of psychiatric research with hallucinogens in the 1950s and 1960s, you had about a thousand published papers discussing upwards to 50,000 subjects who had been treated. On two occasions, very comprehensive assessments were conducted evaluating all of these published studies, looking at safety and outcomes.
One study was done in 1960 by a UCLA psychiatrist named Sidney Cohen, who looked at all the work published on the psychedelics in the 1950s. He found that very strong safety parameters were maintained in well-structured studies.
A follow-up was done in 1984 by another psychiatrist at the University New Mexico named Rick Strassman. He looked at all the work after the Cohen assessment, so he looked at the 1960s to the early 1970s. Again, he found very strong safety parameters in studies where optimal attention to set and setting features were provided.
German Lopez: Almost as much as the drug itself, it seems like one of your big focuses is getting the patient in the right environment. It’s not like, say, obtaining a medical marijuana card, picking up pot at a dispensary, and getting high at home.
“You’re not going to write a prescription, give it to someone, and say, ‘Take one of these, tell me what happens.’ Nothing like that.”
Charles Grob: Exactly. You’re not going to write a prescription, give it to someone, and say, “Take one of these, tell me what happens.” Nothing like that. It has to be under direct supervision in an optimally structured setting with facilitators who know what they’re doing, have good ethical integrity, and who are adept in monitoring these situations.
Then, very importantly, facilitators should be able to help patients integrate their experiences after they happen. That’s why it’s important to have preparatory psychotherapy prior to treatment and also integrative psychotherapy in the days, weeks, and months after the session — to help subjects put into context what they experienced.
German Lopez: How is it seeing this research start moving forward a little more quickly after years of work?
Charles Grob: The pace of progress is picking up. Years and years ago, we were a couple of lone voices in the wilderness. At this point, there are more studies, more proposals for more studies, more investigators expressing strong interest, and more understanding that this is an important field that could potentially help a lot of people.
There’s also a couple of organizations that have really helped facilitate progress. One is the Heffter Research Institute. I’m on the board of Heffter, and they helped with funding for my psilocybin cancer-anxiety study, as well as the two studies at NYU and Johns Hopkins. Another organization is called MAPS. They’ve been involved in MDMA treatment studies, including providing start-up funding for my current study on autism and social anxiety.
German Lopez: Given that progress, do you feel optimistic about your work?
Charles Grob: I think it’s been a neglected topic, but it’s great to see that momentum is moving forward. I think we are going to be able to accomplish the goals that the earlier generations were not able to, by and large because the world we live in today is far more ready to handle the implication of research with psychedelic drugs.
We can now do this in a safe, responsible manner — as opposed to what happened in the 1960s, when we had a relatively immature culture that was not ready to understand the full range of effects of these compounds nor did they adequately understand the importance of structures designed to maintain safety for human research conducted with psychedelic drugs.
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