Issues in Psychedelic Research Introductory Comments:
Psychedelic Research Panel, 1996 ITA Conference

Rick Strassman, M.D.
rstrassm@islandnet.com

The first stage in the resumption of human research with psychedelics is complete. Training of those allowed to administer hallucinogens needs to be a priority, and the issue of self-experimentation made explicit.

The Manaus, Brazil ITA meeting provided much more time to discuss psychedelic plants and drugs than the previous ITA I attended, in Prague in 1992. This may be due to the setting, where religious use of DMT-containing ayahuasca is legally protected. It also may have to do with the gradually increasing attention being given to hallucinogens in our culture. I really enjoyed the meeting at the Hotel Tropical, and missed Rick Doblin. Without Sylvia Thyssen's and his organizing skills and MAPS support, the North American contingent would not have been as well-represented as it was. Sylvia did well in representing MAPS in Rick's absence. The open and frank presentation of information and opinions about current use of hallucinogenic plants using many different models was a highlight of the ITA meeting. Formal and informal groups brought together an enormous range of views: religious, policy, therapeutic, pharmaceutical, abductionist, anthropological, body-oriented, art, feminist, environmental, media, literary, educational and others. I am happy ITA and MAPS made such an opportunity possible. The following is a summary of my introductory comments on the last psychedelic research panel at conference.

The first stage in the resumption of human research with psychedelics is complete. This work, taking place in the United States, Europe and Russia, has established the safety of administering these highly restricted medications to humans. Mechanisms of action also are being clarified. The safety of hallucinogens used under medical supervision was accepted during the early phases of clinical research in the late 1950's and early 1960's. However, explicit in their placement into Schedule I of the Controlled Substances Act in 1970 is their lack of safety even under medical supervision. Since the late 1980's, reassuring clinical safety data have been obtained with acute administration of DMT, MDMA, ketamine, and ibogaine in the US; psilocybin, LSD, MDMA, mescaline, ketamine, and MDE in Western Europe; and ketamine in Russia. These studies have been primarily concerned with dose-response data, using a large number of biological measures, in addition to new psychological instruments. Confirmation and elaboration of recent hallucinogen-assisted psychotherapy studies will strengthen our ability to evaluate their efficacy.

Next stage

The next stage in resuming human work with hallucinogens will begin to see some expansion of the context placed upon it by the strictly psychopharmacological descriptive model that has supported the initiation of new research. Pharmacological studies, by characterizing how well-known hallucinogens work, could lead to the development of novel agents with a greater selectivity of effects, and fewer side effects. Brain imaging and physiology studies can locate where and how hallucinogen effects are mediated in the brain. The overlapping symptoms between hallucinogen intoxication and naturally-occurring psychoses may benefit from biological research. Drugs that blockade hallucinogen effects in normal volunteers might be effective for some of the symptoms of disorders such as schizophrenia and mania. This is particularly relevant considering the presence of naturally-occurring DMT in human body fluids. Both pharmacology and physiology studies rely heavily upon animal experimentation to both generate and validate hypotheses. However, those concerned with animal-based research consider how these data are produced to be problematic.

Endogenous DMT

The existence of endogenous DMT in humans raises the possibility not only of its role in psychiatric disorders. Particularly robust synthesis of DMT in the brain or pineal are theoretically possible during periods of extreme stress. Conditions like the near-death experience (NDE) and intensive meditation may also be pharmacologically characterized. In the field of psychotherapy, new studies will be most likely approved and/or funded if they suggest new treatments for conditions with a poor prognosis. Early research with alcoholism, heroin abuse, and terminal illness could be re- examined using current psychotherapy methodologies. Post-traumatic stress disorders, not well-defined during early psychotherapy studies, also may benefit from hallucinogen-assisted psychotherapy research.

Question of control

The nature of the appropriate placebo or control condition in psychotherapy studies continues to plague investigators. Data regarding the relative merits, and potential for combining, of "psychedelic" and "psycholytic" approaches need strengthening. Insights into normal and above-normal psychological processes might build upon previous ones showing enhancement of creativity.

Training of those allowed to administer hallucinogens needs to be a priority, and the issue of self-experimentation made explicit. Involvement in self-analytic and/or religious practice will help in making clear one's own motivations to administer these powerful drugs. Transference and counter-transference issues are greatly magnified, and can result in difficult sessions if not properly addressed. More subtle adverse effects of increasing denial and psychological rigidity might result from improper working through of material raised in psychedelic sessions. In addition, the nature of the setting for longer-acting drugs needs to be outside of the hospital environment, to reduce negative reactions.

If DMT or other psychoactive materials were found to be released at the time of death or near-death, a rationale would exist for administering such an agent in anticipation of death, and to study the near-death experience. It might be possible to provide a "dry-run" and practice for those with inordinate fear of dying. Those who have had a naturally-occurring NDE also could be administered DMT, and comparisons made, so as to understand better its biological underpinnings. The use of hallucinogens in this way borders on religious, and will be a controversial topic.

Researching religious use

Models for religious use are being re-formulated in attempts to operationally define "religious." Once some standardization occurs, research could be turned towards religious use, in ways that overlap with clinical research. For example, the nature and frequency of adverse effects in different settings (religious or clinical), as well as better indicators of who is prone to particularly intense or prolonged negative responses. Non-drug means of managing adverse effects might be better developed by comparing models of helping manage these effects. Religious use also could investigate issues not usually addressed by the mainstream medical tradition. For example, this could include the use of hallucinogens to enhance meditation practice, prayer, or other spiritual technologies. Such use has a long history in certain non-Western societies. Certain similarities exist between descriptions of high dose DMT states and those of individuals claiming to have been "abducted by aliens." Administering DMT to those individuals, and comparing the DMT- to the "abducted"- state might provide additional information regarding how this phenomenon takes place.