Summary: “What we’re talking about is a single session, six hours, that produces some kind of plastic change that can result in enduring positive changes in attitudes, moods, and behavior,” explains Dr. Griffiths in an article about the psilocybin-assisted therapy studies that are being conducted at the Center for Psychedelic and Consciousness Research at Johns Hopkins Medicine.
Originally appearing here.
The session rooms at the Center for Psychedelic and Consciousness Research at Johns Hopkins Medicine don’t look like typical doctor’s offices — there are plush couches, glowing Himalayan salt lamps and ceramic mushroom figurines.
“It’s like an upscale living room or posh yoga studio,” mused Dr. Matthew Johnson, an associate professor at the Department of Psychiatry and Behavioral Sciences and the associate director of the center.
Patients undergo treatment in a safe space that is unlikely to provoke a negative reaction to the drug.
Dr. Johnson said he realizes when people picture a lab researching psychedelic drugs — a particular image comes to mind.
“It’s not tie-dye lab coats,” he laughs.
Johns Hopkins Medicine announced the launch of this center in September after an injection of $17 million in funding from a group of private donors. It’s believed to be the first center of its kind in the United States and the largest in the world. The funding will support a team of six faculty neuroscientists, experimental psychologists and clinicians, along with five postdoctoral scientists and the cost of running new trials.
Psychedelic Drugs In Medicine
Although the center itself is new, its work will be a continuation of studies researchers have been conducting since 2000, when Johns Hopkins became the first research group to get regulatory approval in the U.S. to use psychedelics in research with volunteers.
Since then, the majority of its studies have focused on how psilocybin, the active hallucinogenic agent in so-called “magic mushrooms,” affects behavior and brain function. Johns Hopkins uses synthesized psilocybin in its research to keep the agent pure and the dosing precise.
Haven’t heard of psilocybin? You’re probably more familiar with its cousin, LSD.
“One of the decisions a couple of decades ago when researchers jumped back into this psychedelic field is that LSD did have most of the negative cultural connotations,” Dr. Johnson explains. “Politically, it was easier to move forward with psilocybin.”
Dr. Johnson and his team have already had success using psilocybin to treat certain types of addiction and depression. A pilot smoking cessation study in 2014 administered the drug to fifteen longtime smokers looking to quit.
“We had incredibly high success rates,” Dr. Johnson says. “80% of people were biologically confirmed as abstinent from smoking six months after the fact. And then at two and a half years on average, 60% of people were biologically confirmed as abstinent from smoking. That just completely dwarfs the best success rates that are out there.”
The studies at this center can be distilled into a two-part formula.
The first is behavioral cognitive therapy. Dr. Roland Griffiths, who heads the center, says the therapy is meant to psychologically prepare subjects before part two — taking a dose of psilocybin.
“They’ll observe their own behavior, assess their value system and what it is they want to do,” Griffiths says.
He says the therapy helps to solidify a subject’s intention, like quitting smoking, before taking the drug.
‘Go Into The Experience’
Next comes the session room. When it’s time for subjects to take a dose of psilocybin, they go to a session room and meet with their guide, who’s been with them during the preparatory therapy and will stay with them for the duration of their experience, or “trip.”
Mary Cosimano, director of guide services at the center, has worked at Johns Hopkins since 2000. As a guide, she’s involved with the therapy from the beginning,
“The experience [of taking the drug] can be disorienting and frightening,” Cosimano says. “Embarrassing things can come up. But we’ve talked about all that and in the preparation, they’ve shared their life and they’ve become very vulnerable and courageous. So they’re able to let go and go into the experience.”
She explains the role of the guide is to be there to support the subject, to remind them they’re safe. To be clear, there’s no hypnosis going on. She’s not prompting them with any behavioral changes. Cosimano stays with the subjects for the length of the trip — which lasts around six hours.
She has guided hundreds of sessions and says the experience is different for everyone.
“In 20 years, I’ve never gotten bored,” she says. “In fact, it’s just enhanced because every individual has their own unique experience.”
‘A Walk Around Your Mind’
One person Cosimano guided is Ellen Cox, who works at a tavern in Silver Spring, Marland. She smoked a pack of cigarettes a day for thirty years.
“I had tried everything from Chantix to lozenges to gum to cold turkey,” Cox says.
She saw a posting for a Johns Hopkins smoking cessation study online in 2018 and decided to give it a shot.
“We talked about my goals, what kinds of triggers made me smoke, how I thought I would feel when I would stop, stuff like that,” Cox says.
After four weeks of therapy, she went in to take the psilocybin.
“It wasn’t anything crazy where you think, ‘Oh my God, what is this,’” she smiles. “It was really interesting. It’s kind of like taking a little walk around your mind and diving down into rabbit holes and having a lot of memories pop up.”
Once the drug wore off, she did a ritual snuffing out of a final cigarette. The smell surprised her.
“I was so offended by the smell of the smoke,” she says. She says she’s never smoked again.
“I honestly didn’t think it would work,” she admits. “I went in there fully expecting to come out of there and go buy a pack of cigarettes.”
Cox concedes it wasn’t easy.
“There were a couple of days where I was white-knuckling it, but when it came down to it, I didn’t want to go out and get a pack of cigarettes,” she says. “I cannot tell you at what point that day that happened and made it fine. But it happened and I’m thrilled.”
Rewiring The Brain
Dr. Griffiths says they don’t know for certain yet why those kinds of lasting changes Cox experienced can happen. But he suspects it has to do with a kind of re-programming of the brain.
“Neuroimaging studies have shown … that at the time psilocybin is given, there’s a lot of neural connectivity among areas of the brain that usually don’t talk to one another,” he says. “And this occurs for the duration of time that the psilocybin is in the system. It’s led to a hypothesis that this may open a window of neuroplasticity in which there may be a rewiring going on.”
He cautions the tools to track those kinds of changes fall short of being able to prove this hypothesis definitively. He thinks of this psychedelic therapy more like a surgical intervention than other types of chronic treatment.
“What we’re talking about is a single session, six hours, that produces some kind of plastic change that can result in enduring positive changes in attitudes, moods and behavior,” Griffiths says. “So many interventions in psychiatry require either a number of sessions, like in psychotherapy or with a drug like an SSRI. It could be months or years of regular prescription of those kinds of compounds.”
He says studies thus far indicate people come out of their psilocybin session with a different sense of self-efficacy.
“They actually feel more empowered to rewrite the narrative of their lives,” he says.
Navigating Challenges
Since government funding of psychedelic research is almost nonexistent, acquiring enough money to conduct these studies has always been challenging. That’s one of the reasons why the center wasn’t able to launch until after significant private donations.
But there are other challenges as well.
One is regulatory control. Psychedelics are classified as Schedule I drugs (along with heroin and ecstasy). According to the Drug Enforcement Administration, that classification indicates drugs “with no currently accepted medical use and a high potential for abuse.”
The tight controls can restrict the availability of the substance for scientists to study, says Griffiths.
Another challenge is public perception. There’s a desire from researchers to recover from the bad publicity that LSD and other psychedelic drugs brought in the ’60s and make it easier for scientists to safely research the drugs. However, the drugs can be dangerous if people take them on their own without the screening and support that a research facility like Johns Hopkins provides.
At Johns Hopkins, for example, there’s an intense screening of potential subjects. Anyone with a family history or symptoms of schizophrenia or psychosis is not accepted into the studies. And there’s always a trained professional like Cosimano with the subject when they take the drug.
“When that occurs in a situation in which people are unprotected, like taking it with a group of friends at a concert, God forbid, it can lead to very serious consequences,” Dr. Griffiths says. “People might become frightened — run out into traffic. People do jump out of windows or engage in dangerous behavior. It’s very important to underscore that there are real risks associated with these compounds.”
Those risks are reduced to zero, he says, with the careful screening and preparation his team conducts.
The Future Of Psychedelics
Brad Burge, the director of strategic communication at the nonprofit Multidisciplinary Association for Psychedelic Studies, says he’s optimistic about the public becoming more accepting of psychedelics.
“There’s been a big cultural shift in how people look at the scheduling of drugs,” he says. “Medical marijuana is an example of that. We have, in most of the country, some kind of legal medical marijuana and the sky has not fallen.”
Burge says there’s also a real frustration within the public on the available approaches to mental health treatment.
“If there’s one thing that people are more suspicious of than psychedelics, it’s legal prescription drugs,” he says. “The whole medical psychiatric industry has let a lot of people down.”
The center at Johns Hopkins plans to test psilocybin in treating anorexia nervosa, PTSD and opioid addiction.