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Psychedelic drugs should be legally reclassified so that researchers can investigate their therapeutic potential

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James Rucker at King's College London
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Abstract

Trials of physiologically safe and non-addictive drugs such as LSD are almost impossible, writes James J H Rucker , calling on the authorities to downgrade their unnecessarily restrictive class A, schedule 1 classification Psychedelic drugs, especially lysergic acid diethylamide (LSD) and psilocybin, which is found in the Psilocybe genus of “magic” mushrooms that grow throughout the United Kingdom, were extensively used and researched in clinical psychiatry before their prohibition in 1967. Hundreds of papers, involving tens of thousands of patients, presented evidence for their use as psychotherapeutic catalysts of mentally beneficial change in many psychiatric disorders, problems of personality development, recidivistic behaviour, and existential anxiety.1 This research abruptly ended after 1967, when psychedelics were legally classified as schedule 1 drugs under the UK Misuse of Drugs Regulations and as class A drugs under the UK Misuse of Drugs Act 1971. Schedule 1 in the UK broadly mirrors schedule I of the 1971 United Nations Convention on Psychotropic Substances, adoption of which is a requirement of UN membership.2 This classification denoted psychedelic drugs as having no accepted medical use and the greatest potential for harm, despite the existence of research evidence to the contrary. Indeed, in 1992 John Ehrlichman, …
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PERSONAL VIEW
Psychedelic drugs should be legally reclassified so
that researchers can investigate their therapeutic
potential
Trials of physiologically safe and non-addictive drugs such as LSD are almost impossible, writes
James J H Rucker, calling on the authorities to downgrade their unnecessarily restrictive class A,
schedule 1 classification
James J H Rucker specialist registrar in adult psychiatry and honorary clinical lecturer, MRC Social,
Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience,
King’s College, London, SE5 8AF
Psychedelic drugs, especially lysergic acid diethylamide (LSD)
and psilocybin, which is found in the Psilocybe genus of “magic”
mushrooms that grow throughout the United Kingdom, were
extensively used and researched in clinical psychiatry before
their prohibition in 1967. Hundreds of papers, involving tens
of thousands of patients, presented evidence for their use as
psychotherapeutic catalysts of mentally beneficial change in
many psychiatric disorders, problems of personality
development, recidivistic behaviour, and existential anxiety.1
This research abruptly ended after 1967, when psychedelics
were legally classified as schedule 1 drugs under the UK Misuse
of Drugs Regulations and as class A drugs under the UK Misuse
of Drugs Act 1971. Schedule 1 in the UK broadly mirrors
schedule I of the 1971 United Nations Convention on
Psychotropic Substances, adoption of which is a requirement
of UN membership.2This classification denoted psychedelic
drugs as having no accepted medical use and the greatest
potential for harm, despite the existence of research evidence
to the contrary.
Indeed, in 1992 John Ehrlichman, former assistant to Richard
Nixon—the US president who intensified the “war on drugs”
in the 1970s—notoriously admitted that the administration had
lied about the harmful effects of drugs and had manipulated
media coverage of them for political advantage.3Nearly 50 years
later psychedelic drugs remain more legally restricted than
heroin and cocaine, which are schedule 2, class A in the UK.
But no evidence shows that psychedelic drugs are habit forming;
little evidence shows that they are harmful in controlled settings;
and much historical evidence has shown that they could have
use in common psychiatric disorders. A growing number of
organisations, most recently in Norway, are questioning the
need for such draconian restrictions.4
Where’s the harm?
Psychedelic drugs do not induce dependence.5A 1984 review
of adverse reactions to psychedelics found little evidence of
harm in controlled settings.6Furthermore, in 2010, an analysis
of harms caused to recreational users and to society by a range
of psychotropic substances ranked LSD and psilocybin among
the safest of all those studied.7The therapeutic index (toxic dose
as a ratio of standard dose) for LSD and psilocybin is about
1000; for cocaine it is 15, for heroin it is 6, and for alcohol it is
10.8The belief that psychedelics induce homicidal or suicidal
behaviour was inculcated by the politically driven and media
led condemnation of LSD in the 1960s.9
In a population study of 130 152 respondents to the US National
Survey on Drug Use and Health (NSDUH) from 2001 to 2004,
a history of reported psychedelic use was associated with lower
reported levels of serious psychological distress, the need for
mental health treatment, and psychiatric medicine.10 Researchers
found no association with psychosis. Using data from the
2008-12 NSDUH (n=191 382) Hendricks et al found that ever
having used psychedelics was associated with a significantly
reduced risk of suicide.11 These results have been broadly
replicated in another sample of 135 095 randomly selected US
adults.12
Evidence for medical use
Many of the clinical trials of psychedelics published in the 1950s
and ’60s, before prohibition, fell short of modern standards;
however, several good quality, controlled trials were performed.
Using data from six such trials in alcoholism, a recent
meta-analysis that compared treatment with LSD against
controls in 536 people found that LSD treatment was favoured
james.rucker@kcl.ac.uk
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BMJ 2015;350:h2902 doi: 10.1136/bmj.h2902 (Published 26 May 2015) Page 1 of 2
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VIEWS & REVIEWS
in terms of objectively measured improvements in alcohol
misuse, with an odds ratio of 1.96 (95% confidence interval
1.36 to 2.84).13 Recent pilot studies performed outside the UK
have shown clinical efficacy in anxiety associated with advanced
cancer,14 obsessive compulsive disorder,15 tobacco addiction,16
alcohol addiction,17 and cluster headaches.18
However, larger clinical studies are almost impossible
throughout the Western world because of the practical, financial,
and bureaucratic obstacles imposed by schedule 1 classification
or its equivalent.19 For example, because of the burden of
compliance with the UN’s schedule I, only one manufacturer
in the world produces psilocybin at sufficient quality, quoting
our group a prohibitive £100 000 for 1 g (50 doses).
In the UK, to hold a schedule 1 drug, institutions require a
licence costing about £5000. Only four hospitals currently hold
such licences, which come with regular police inspections and
onerous rules on storage and transport. Prescribers of a schedule
1 substance also must hold a licence, which costs £3000.
These restrictions, and the accompanying bureaucracy, mean
that the cost of clinical research using psychedelics is 5-10 times
that of research into less restricted (but more harmful) drugs
such as heroin—with no prospect that the benefits can be
translated into wider medical practice. The self reinforcing cycle
of stigma generated by schedule I classification means that
almost all grant funders are uncomfortable funding research
into psychedelics, and similar problems are encountered with
ethics committees.
Legal prohibition of some psychotropic substances continues
to be a condition of UN membership, stigmatising a facet of
behaviour and arguably causing more harm than it prevents.20
The UN schedule I creates its own circular argument for
psychedelics to remain stringently restricted, even though the
original reasons for classifying them as such were largely
fallacious.
Because psychedelics are not harmful in relation to other
controlled substances and are not habit forming, and because
evidence suggests medical use, we call on the UK Advisory
Council on the Misuse of Drugs and the 2016 UN General
Assembly Special Session on Drugs to recommend that
psychedelics be reclassified as schedule 2 compounds to enable
a comprehensive, evidence based assessment of their therapeutic
potential.
Competing interests: I have read and understood the BMJ policy on
declaration of interests and have no relevant interests to declare.
I thank Robin L Carhart-Harris and David J Nutt, Centre for
Neuropsychopharmacology, Division of Brain Sciences, Imperial College
London, W12 0NN.
Provenance and peer review: Not commissioned; not externally peer
reviewed.
1 Grinspoon L, Bakalar J. The psychedelic drug therapies. Curr Psychiatr Ther
1981;20:275-83.
2 United Nations. Convention on psychotropic substances, 1971. www.unodc.org/pdf/
convention_1971_en.pdf.
3 Baum D. Truth, lies, and audiotape. In: Smith L, ed. The moment: wild, poignant, life
changing stories from 125 writers and artists. Harper Perennial, 2012.
4 Higgins A. Odd push in drug averse Norway: LSD is OK. nytimes.com 4 May 2015. http:
//bit.ly/1FntGeK.
5 Brunton L, Chabner B, Knollman B. The pharmacological basis of therapeutics. 12th ed.
McGraw Hill Professional, 2011.
6 Strassman RJ. Adverse reactions to psychedelic drugs: a review of the literature. J Nerv
Ment Dis 1984;172:577-95.
7 Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis.
Lancet 2010;376:1558-65.
8 Gable RS. Comparison of acute lethal toxicity of commonly abused psychoactive
substances. Addiction 2004;99:686-96.
9Grinspoon L, Bakalar J. Psychedelic drugs reconsidered. 1st ed. Lindesmith Center, 1997.
10 Krebs TS, Johansen PØ. Psychedelics and mental health: a population study. PLoS One
2013;8:e63972.
11 Hendricks PS, Thorne CB, Clark CB, et al. Classic psychedelic use is associated with
reduced psychological distress and suicidality in the United States adult population. J
Psychopharmacol 2015;29:280-8.
12 Johansen PØ, Krebs TS. Psychedelics not linked to mental health problems or suicidal
behavior: a population study. J Psychopharmacol 2015;29:270-9.
13 Krebs TS, Johansen PØ. Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis
of randomized controlled trials. J Psychopharmacol 2012;26:994-1002.
14 Grob CS, Danforth AL, Chopra GS, et al. Pilot study of psilocybin treatment for anxiety
in patients with advanced stage cancer. Arch Gen Psychiatry 2011;68:71-8.
15 Moreno FA, Wiegand CB, Taitano EK, Delgado PL. Safety, tolerability, and efficacy of
psilocybin in 9 patients with obsessive-compulsive disorder. J Clin Psychiatry
2006;67:1735-40.
16 Johnson MW, Garcia-Romeu A, Cosimano MP, Griffiths RR. Pilot study of the 5-HT2AR
agonist psilocybin in the treatment of tobacco addiction. J Psychopharmacol
2014;28:983-92.
17 Bogenschutz M, Forcehimes A, Pommy J, et al. Psilocybin-assisted treatment for alcohol
dependence: a proof-of-concept study. J Psychopharmacol 2015;29:289-99.
18 Sewell RA, Halpern JH, Pope HG. Response of cluster headache to psilocybin and LSD.
Neurology 2006;66:1920-2.
19 Nutt DJ, King LA, Nichols DE. Effects of schedule I drug laws on neuroscience research
and treatment innovation. Nat Rev Neurosci 2013;14:577-85.
20 Hari J. Chasing the scream. 1st ed. Bloomsbury Publishing, 2015.
Cite this as: BMJ 2015;350:h2902
© BMJ Publishing Group Ltd 2015
For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h2902 doi: 10.1136/bmj.h2902 (Published 26 May 2015) Page 2 of 2
VIEWS & REVIEWS
... There have been several narrative, scoping and systematic reviews examining the therapeutic value of psychedelic substances in ameliorating substance use disorders. Some comprehensive reviews include substance use disorders in the context of mental disorders more generally (e.g., Belouin & Henningfield, 2018;Reiff et al., 2020;Rucker, 2015;Tupper et al., 2015), while others noted below are quite targeted. The most comprehensive reviews cover epidemiological studies, mechanisms, safety considerations, treatment efficacy and regulatory challenges (see Johnson et al., 2019 for an excellent example). ...
... Despite the therapeutic promise and growing investment in the field, there are widely acknowledged and significant barriers to scientific and clinical progress. Chief among these is that psychedelics are illegal in most jurisdictions as highly restricted Schedule I substances, thereby making it extremely difficult for the required clinical studies to be approved and funded, and to source and administer the psychedelic compounds at a reasonable cost for research (Belouin & Henningfield, 2018;Marks & Cohen, 2021;Nutt et al., 2013;Rucker, 2015). Barriers with respect to potential safety and adverse consequences appear to be grounded in the somewhat illogical argument that an evidence-based therapeutic tool of medicine should be banned because it may be used for other harmful purposes, an argument that has rarely been invoked in other types of health care including pharmacologic agents, particularly prescription opioids (Dakwar, 2016). ...
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... The traditional practices of indigenous communities like the Shipibo are only just starting to be investigated using scientific methods, yet knowledge and appeal of their techniques appear to be spreading quickly through the Western media space (Yaden et al., 2021). Emphasis must be placed on preventing history from repeating itself, whereby psychedelics are not naively glamorised as they were in the 1960s, which resulted in the complete restriction of scientific testing on potentially useful compounds and the birth of the War on Drugs (Rucker, 2015). ...
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Ayahuasca is a psychedelic plant brew originating from the Amazon Rainforest. It is formed from two basic components, the Banisteriopsis caapi vine, and a plant containing the potent psychedelic dimethyltryptamine (DMT), usually Psychotria viridis. There has been a dramatic increase in interest surrounding ayahuasca since the turn of the millennium. Increasing numbers of tourists are travelling to the Amazon rainforest to drink the brew, with various media outlets, celebrities, and researchers describing benefit from its consumption. Ayahuasca is now present in every continent and retreat centres offering plant medicine experiences in the Amazon rainforest has become a thriving business. Anecdotal evidence varies significantly, ranging from evangelical accounts to horror stories involving physical and psychological harm. This thesis comprises five studies investigating Amazonian ayahuasca use. Initially, the pharmacology of the brew is explored in the form of a systematic review, concluding complex synergistic mechanisms may be present, although further research is needed. The remaining studies utilise observational methodology, investigating the impact of ayahuasca retreats following a traditional Shipibo lineage adapted for ayahuasca tourists in the Peruvian Amazon. The effects of the brew on personality, mental health outcomes, epigenetics, and nature relatedness are documented. Further, a phenomenological analysis of the ayahuasca experience is included. The research in this thesis is amongst the first to investigate Shipibo-style ayahuasca retreats in the Peruvian Amazon. Various ethical issues surrounding the increasing popularity of the brew and potential medicalisation are also discussed. It is hoped that this research will add to the growing body of knowledge surrounding the potential therapeutic effects of ayahuasca, whilst considering risks, ethics, and wider applications.
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... This categorization precipitated limitations on both its clinical utilization and research prospects. In the year 2015, a treatise featured in the British Medical Journal articulated the imperative for a legal reclassification of psychedelic substances, positing a compelling argument for researchers to delve into their therapeutic potential (Rucker, 2015). ...
Psilocybin for the treatment of Alzheimer’s disease
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  • Jul 2024
Alzheimer’s disease (AD) stands as a formidable neurodegenerative ailment and a prominent contributor to dementia. The scarcity of available therapies for AD accentuates the exigency for innovative treatment modalities. Psilocybin, a psychoactive alkaloid intrinsic to hallucinogenic mushrooms, has garnered attention within the neuropsychiatric realm due to its established safety and efficacy in treating depression. Nonetheless, its potential as a therapeutic avenue for AD remains largely uncharted. This comprehensive review endeavors to encapsulate the pharmacological effects of psilocybin while elucidating the existing evidence concerning its potential mechanisms contributing to a positive impact on AD. Specifically, the active metabolite of psilocybin, psilocin, elicits its effects through the modulation of the 5-hydroxytryptamine 2A receptor (5-HT2A receptor). This modulation causes heightened neural plasticity, diminished inflammation, and improvements in cognitive functions such as creativity, cognitive flexibility, and emotional facial recognition. Noteworthy is psilocybin’s promising role in mitigating anxiety and depression symptoms in AD patients. Acknowledging the attendant adverse reactions, we proffer strategies aimed at tempering or mitigating its hallucinogenic effects. Moreover, we broach the ethical and legal dimensions inherent in psilocybin’s exploration for AD treatment. By traversing these avenues, We propose therapeutic potential of psilocybin in the nuanced management of Alzheimer’s disease.
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... Studies on PAP to date have generally been small and with limited follow-up. The scale of these studies may be limited by the classification of psilocybin as a schedule 1 drug and the associated costs of handling such substances (Howard, Neill, Schlag, & Lennox, 2021;Rucker, 2015). ...
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... Indeed research, and even public access to psilocybin, is increasingly becoming legal in some countries (Phelps et al. 2022). As psilocybin is legally reclassified to enable researchers to investigate its therapeutic potential, it would make a significant impact on treatments available to psychiatric medicine (Rucker 2015;Kargbo 2020;Nichols 2020). It would be important for researchers and industry to collaborate closely, to ensure that what becomes available to health practitioners, patients and the public will be based on solid results and clinical testing, whereas industry could provide funding and unique research questions (Phelps et al. 2022). ...
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Humans have collected and used hallucinogenic mushrooms for ethnic medicinal, recreational, and religious purposes since before recorded history. Currently, the use of these mushrooms is illegal in most countries, but where their use is legal they are applied as self medication. Psilocybin and psilocin, two psychoactive alkaloids, are naturally synthesized by hallucinogenic mushrooms. The chemical structure of these compounds are similar to the neurotransmitter serotonin. Activation of this system by psilocybin and psilocin may produce temporary changes in the brain that induce hallucinations and feelings of euphoria. Adjustment of the serotonin system in this way can moderate symptoms of related mental disorders. This review summarizes relevant and current information regarding the discovery of hallucinogenic mushrooms and their contained psychoactive compounds, the events that lead to their criminalization and decriminilization, and the state of knowledge of psilocybin, psilocin, and derivatives. Last, research on the psychoactive properties of these mushrooms is placed in perspective to possible applications for human dysfunctions.
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... Consequently, following the Controlled Substances legislation of the United States, psilocybin and other psychedelics were classified as schedule I drugs by the United Nations Convention on Psychotropic Substances in 1971 (Nutt et al., 2013). Schedule I substances are considered to have high abuse potential, poor safety, and no therapeutic indication (Rucker, 2015). Criminalization of psychedelic drugs effectively prevented further research into their potential experimental and therapeutic uses for several decades. ...
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Background: Recent research indicates that psychedelic-assisted therapy (PAT) may be a safe and effective treatment for several psychiatric disorders, including those experienced by people with serious physical illness. Understanding health care workers' (HCWs') attitudes and knowledge about the clinical application of psychedelics for patients with serious illness is important in progressing research and identifying factors to consider in potential future implementation of PAT. Aim: The aim of this systematic review was to synthesize quantitative, qualitative, and mixed methods studies that explored HCWs' attitudes and knowledge about the role of psychedelics in treating psychological distress in patients with serious illness. Design: MEDLINE, PsycInfo, and CINAHL were searched for quantitative, qualitative, or mixed methods primary empirical studies, published in English from 2006 onward. Two reviewers independently screened articles for inclusion. The Joanna Briggs Institute (JBI) convergent approach to mixed methods systematic reviews guided synthesis of the findings of included studies. One reviewer extracted data from included studies which was checked for accuracy by another reviewer. Two reviewers independently critically appraised included studies using JBI critical appraisal tools. Results: The review included nine studies (seven qualitative, two quantitative) conducted in four countries. Five themes were developed: Polarized views about PAT for patients with serious illness; attitudes often informed by PAT research knowledge and heuristic methods; stronger evidence base needed to increase HCWs' confidence and support implementation of PAT; barriers may hinder PAT's potential integration into existing care models; and team-based approach and clinical education are essential to facilitate PAT. Conclusion: Although support for PAT varied, most HCWs perceived potential benefits in treating refractory distress, desired education about PAT, and called for further research to develop a stronger evidence base. Limitations of the review and included studies are discussed, along with implications of the findings and recommendations for future research.
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Ayahuasca is a psychedelic plant brew originating from the Amazon rainforest. It is formed from two basic components, the Banisteriopsis caapi vine and a plant containing the potent psychedelic dimethyltryptamine (DMT), usually Psychotria viridis. Here we review the history of ayahuasca and describe recent work on its pharmacology, phenomenological responses, and clinical applications. There has been a significant increase in interest in ayahuasca since the turn of the millennium. Anecdotal evidence varies significantly, ranging from evangelical accounts to horror stories involving physical and psychological harm. The effects of the brew on personality and mental health outcomes are discussed in this review. Furthermore, phenomenological analyses of the ayahuasca experience are explored. Ayahuasca is a promising psychedelic agent that warrants greater empirical attention regarding its basic neurochemical mechanisms of action and potential therapeutic application.
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Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK. Method Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. Findings MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. Interpretation These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm.
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Psychedelics not linked to mental health problems or suicidal behavior: A population study
Article
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  • Mar 2015
  • J PSYCHOPHARMACOL
A recent large population study of 130,000 adults in the United States failed to find evidence for a link between psychedelic use (lysergic acid diethylamide, psilocybin or mescaline) and mental health problems. Using a new data set consisting of 135,095 randomly selected United States adults, including 19,299 psychedelic users, we examine the associations between psychedelic use and mental health. After adjusting for sociodemographics, other drug use and childhood depression, we found no significant associations between lifetime use of psychedelics and increased likelihood of past year serious psychological distress, mental health treatment, suicidal thoughts, suicidal plans and suicide attempt, depression and anxiety. We failed to find evidence that psychedelic use is an independent risk factor for mental health problems. Psychedelics are not known to harm the brain or other body organs or to cause addiction or compulsive use; serious adverse events involving psychedelics are extremely rare. Overall, it is difficult to see how prohibition of psychedelics can be justified as a public health measure. © The Author(s) 2015.
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Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study
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Several lines of evidence suggest that classic (5HT2A agonist) hallucinogens have clinically relevant effects in alcohol and drug addiction. Although recent studies have investigated the effects of psilocybin in various populations, there have been no studies on the efficacy of psilocybin for alcohol dependence. We conducted a single-group proof-of-concept study to quantify acute effects of psilocybin in alcohol-dependent participants and to provide preliminary outcome and safety data. Ten volunteers with DSM-IV alcohol dependence received orally administered psilocybin in one or two supervised sessions in addition to Motivational Enhancement Therapy and therapy sessions devoted to preparation for and debriefing from the psilocybin sessions. Participants' responses to psilocybin were qualitatively similar to those described in other populations. Abstinence did not increase significantly in the first 4 weeks of treatment (when participants had not yet received psilocybin), but increased significantly following psilocybin administration (p < 0.05). Gains were largely maintained at follow-up to 36 weeks. The intensity of effects in the first psilocybin session (at week 4) strongly predicted change in drinking during weeks 5-8 (r = 0.76 to r = 0.89) and also predicted decreases in craving and increases in abstinence self-efficacy during week 5. There were no significant treatment-related adverse events. These preliminary findings provide a strong rationale for controlled trials with larger samples to investigate efficacy and mechanisms. NCT02061293. © The Author(s) 2015.
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Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population
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Mental health problems are endemic across the globe, and suicide, a strong corollary of poor mental health, is a leading cause of death. Classic psychedelic use may occasion lasting improvements in mental health, but the effects of classic psychedelic use on suicidality are unknown. We evaluated the relationships of classic psychedelic use with psychological distress and suicidality among over 190,000 USA adult respondents pooled from the last five available years of the National Survey on Drug Use and Health (2008-2012) while controlling for a range of covariates. Lifetime classic psychedelic use was associated with a significantly reduced odds of past month psychological distress (weighted odds ratio (OR)=0.81 (0.72-0.91)), past year suicidal thinking (weighted OR=0.86 (0.78-0.94)), past year suicidal planning (weighted OR=0.71 (0.54-0.94)), and past year suicide attempt (weighted OR=0.64 (0.46-0.89)), whereas lifetime illicit use of other drugs was largely associated with an increased likelihood of these outcomes. These findings indicate that classic psychedelics may hold promise in the prevention of suicide, supporting the view that classic psychedelics' most highly restricted legal status should be reconsidered to facilitate scientific study, and suggesting that more extensive clinical research with classic psychedelics is warranted. © The Author(s) 2015.
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Pilot Study of the 5-HT2AR Agonist Psilocybin in the Treatment of Tobacco Addiction
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Despite suggestive early findings on the therapeutic use of hallucinogens in the treatment of substance use disorders, rigorous follow-up has not been conducted. To determine the safety and feasibility of psilocybin as an adjunct to tobacco smoking cessation treatment we conducted an open-label pilot study administering moderate (20 mg/70 kg) and high (30 mg/70 kg) doses of psilocybin within a structured 15-week smoking cessation treatment protocol. Participants were 15 psychiatrically healthy nicotine-dependent smokers (10 males; mean age of 51 years), with a mean of six previous lifetime quit attempts, and smoking a mean of 19 cigarettes per day for a mean of 31 years at intake. Biomarkers assessing smoking status, and self-report measures of smoking behavior demonstrated that 12 of 15 participants (80%) showed seven-day point prevalence abstinence at 6-month follow-up. The observed smoking cessation rate substantially exceeds rates commonly reported for other behavioral and/or pharmacological therapies (typically <35%). Although the open-label design does not allow for definitive conclusions regarding the efficacy of psilocybin, these findings suggest psilocybin may be a potentially efficacious adjunct to current smoking cessation treatment models. The present study illustrates a framework for future research on the efficacy and mechanisms of hallucinogen-facilitated treatment of addiction.
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Psychedelics and Mental Health: A Population Study
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The classical serotonergic psychedelics LSD, psilocybin, mescaline are not known to cause brain damage and are regarded as non-addictive. Clinical studies do not suggest that psychedelics cause long-term mental health problems. Psychedelics have been used in the Americas for thousands of years. Over 30 million people currently living in the US have used LSD, psilocybin, or mescaline. To evaluate the association between the lifetime use of psychedelics and current mental health in the adult population. Data drawn from years 2001 to 2004 of the National Survey on Drug Use and Health consisted of 130,152 respondents, randomly selected to be representative of the adult population in the United States. Standardized screening measures for past year mental health included serious psychological distress (K6 scale), mental health treatment (inpatient, outpatient, medication, needed but did not receive), symptoms of eight psychiatric disorders (panic disorder, major depressive episode, mania, social phobia, general anxiety disorder, agoraphobia, posttraumatic stress disorder, and non-affective psychosis), and seven specific symptoms of non-affective psychosis. We calculated weighted odds ratios by multivariate logistic regression controlling for a range of sociodemographic variables, use of illicit drugs, risk taking behavior, and exposure to traumatic events. 21,967 respondents (13.4% weighted) reported lifetime psychedelic use. There were no significant associations between lifetime use of any psychedelics, lifetime use of specific psychedelics (LSD, psilocybin, mescaline, peyote), or past year use of LSD and increased rate of any of the mental health outcomes. Rather, in several cases psychedelic use was associated with lower rate of mental health problems. We did not find use of psychedelics to be an independent risk factor for mental health problems.
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Nutt DJ, King LA, Nichols DE. Effects of Schedule I drug laws on neuroscience research and treatment innovation. Nat Rev Neurosci 14: 577-585
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Many psychoactive drugs are used recreationally, particularly by young people. This use and its perceived dangers have led to many different classes of drugs being banned under national laws and international conventions. Indeed, the possession of cannabis, 3,4-methylenedioxy-N-methylamphetamine (MDMA; also known as ecstasy) and psychedelics is stringently regulated. An important and unfortunate outcome of the controls placed on these and other psychoactive drugs is that they make research into their mechanisms of action and potential therapeutic uses - for example, in depression and post-traumatic stress disorder - difficult and in many cases almost impossible.
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Lysergic Acid Diethylamide (LSD) for Alcoholism: Meta-Analysis of Randomized Controlled Trials
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