why it’s so hard to study psychedelics for mental health treatment
Since time immemorial humans used psychedelics to induce visions and open their minds to the spiritual and supernatural. Shamanic visions and rites of passage often included heavy doses of plants that would play with one’s senses and create surreal visions. While our ancestors imbued these often sacred substances, the last thing they probably thought we’d ever do with them is to microdose mind-altering chemicals to make us more focused staring at a screen and typing. To the counterculture pioneers of the 1960s and 70s, this would seem like a sacrilege. Yet here we are, using tiny doses of psychoactive drugs to improve focus.
Or at least that’s what some people, especially Silicon Valley techies, are claiming is happening. As far as science is concerned, the studies are rather mixed and due to the often illegal nature of the chemicals involved, rely largely on self reporting. This sets up a problem very similar to studying the medicinal properties of marijuana. We have strong evidence that it has benefits as a mild opiate and can help treat certain mental disorders, but due to the inconsistent nature of the research, just how effective and safe it is still remains to be seen. The same issue applies to research into the potential benefits of drugs like ketamine, magic mushrooms, and LSD for a cause our ancestors would find more to their sensibilities: treating mental illness.
why is it so hard to study medical psychedelics?
We know that ketamine could be used to treat depression and psilocybin, the active ingredient in psychedelic mushrooms can be helpful for patients with PTSD and anxiety disorders. But in the United States, psilocybin, like marijuana, is a Schedule I drug according to the government, so as far as bureaucrats are concerned, it has no legitimate medical uses. This makes studying its effects very difficult, especially since there are no medical psilocybin laws at state level to act as a workaround for a calcified political stance. LSD, another psychedelic thought to make its users more creative and alleviate anxiety, falls into the same trap, and for the same reason.
How drugs are classified in the United States is set by the Controlled Substances Act of 1970, signed with great enthusiasm by Richard Nixon. Its goal wasn’t necessarily to codify scientific understanding of various substances and base their regulation on how they affect us. It was a political exercise which saw the demonization of drugs enjoyed by people despised by Nixon and his allies. Counterculture “hippies” and African Americans enjoyed marijuana? It went on Schedule I despite evidence that it better fit the definition of Schedule III delivered to his desk. The hippies are taking LSD and magic mushrooms? Well, he did call Timothy Leary the most dangerous man in America for his pro-psychedelic stance, so Schedule I those things.
It’s still possible to study the substances and their effects, but it takes money and dedication. To establish a good case for researching their medical benefits, you need to collect evidence that they might actually have some, hence the self reporting of users who claim small doses lower their anxiety or help pull them out of depressive episodes or PTSD flashbacks. But, of course, the question is whether we’re seeing something genuine or just a placebo effect, and how to control and establish the right dosage, making sure the results are as consistent as possible. If we’re going to use psychedelics in medicine, we can’t just give patients a bag of whatever it is we think will work and wish them the best of luck. In fact, we know that would be harmful.
why we might not have prescriptions for psychedelics
Just like we saw with studies into the side-effects of mindfulness and meditation, journeying too deep inside your mind can end very badly. Obviously, the same problem applies to a drug trip without medical supervision, which is why researchers who study their effects on patients who already have a mental illness aren’t advocating for a prescription containing pills with psilocybin or LSD for patients to take two and call their doctor in the morning. Instead, they envision a very controlled experience with a therapist who has experienced taking psychedelics and can talk the patient through the trip, as well as handle any potential meltdowns and freakouts. It would be an intense but firmly guided experience over the course of six months to a year.
Microdosing on them to stay focused at work or be more creative during a brainstorming session, however, would require a very different approach. One could say that because the dose is so small, the substances should come in pill form. But if they’re sold over the counter, there’s potential for abuse as a recreational drug rather than a stimulant for a professional setting, and if you make it prescription only, what criteria should doctors use to determine if you need a prescription for LSD? This is why accurate research is so important. It might not provide foolproof, definitive answers to these questions, but it can at least give us some guidelines to follow and formulate sound policy and treatment plans.
how do we get better science about these drugs?
To know exactly how beneficial ketamine, psilocybin, and LSD are in the real world, the only way to go is a series of double-blind peer-reviewed studies. One such effort to study the efficacy of microdoses of LSD is currently underway. Participants will randomly take either a placebo or a tiny amount of LSD in identical capsules without knowing which is which, then be tested on the kinds of creative and cognitive skills the substance is supposed to improve. The hitch is that the drug is illegal so subjects will have to blind themselves by mixing up their stash with placebos, then let the researchers figure out which was which with Smart QR codes, and plot their test results alongside their use.
While this sounds like a promising experiment, there will always be the question of just how well the subjects mixed up the drugs and placebos themselves because the study isn’t really double blinded, more like one eye opened. For this research to lead us into bigger and better studies, the results would have to be overwhelming, the signal clearly standing out from the noise, which means a heavy incentive to make sure it succeeds and a major red flag to give the submitted paper extra scrutiny during review. This is not to say that researchers would maliciously submit false data, they far more than likely wouldn’t. But we know there are subconscious decisions in how to interpret data that could make a desired result more likely.
Just consider that subjects may not have mixed up the control and drug properly, or mislabeled the envelopes, or remembered which capsule was which more times than they should have and exhibited a placebo response. This is why true double-blind studies are a necessity and there needs to be a system that allows us to accurately study the therapeutic properties of an illegal substance freely, and have a vehicle for changing drug laws based on scientific merit instead of the opinions of lawmakers with axes to grind or still stuck in the anti-counterculture Red Scare mentality of the middle of the last century. And this is especially important when researchers are saying their work can help people for whom conventional therapy is failing.