The Case for Prescribing Psychedelic Drugs

Originally appearing at A group of doctors who believe that psychedelic drugs can help patients with everything from Alzheimer’s to anxiety are meeting later this month Today’s psychiatrists are like 16th-century astronomers, gazing up at the stars without a telescope. And their understanding of the mind will remain limited until they are allowed to magnify it with psychedelic drugs. That’s the argument from a band of prominent international experts, many of whom are meeting in Canterbury next week for Breaking Convention, a medical conference on the use of drugs such as MDMA, LSD and psilocybin (magic mushrooms). This year marks the 40th anniversary of the UN Convention on Psychotropic Substances, which banned recreational and medical use of drugs such as Ecstasy and LSD. The product of a widespread backlash against recreational drug abuse in the 1960s, the convention is now being blamed for catching medical research in the crossfire of the war on drugs. But Dr David Luke, a senior lecturer in psychology at the University of Greenwich, says that the long hiatus of research is over; “the stigma is slowly falling away. Researchers continue to demonstrate that these drugs have beneficial effects in a medical environment. Some experts even argue that psychedelics are a human right.” The bad news for ageing hippies and teen ravers is that these experts are not advocating a rerun of the Summer of Love. The altogether sober message is that the drugs could help doctors to treat anxiety, depression and Alzheimer’s more quickly, cheaply and thoroughly. The consultant psychiatrist Ben Sessa, an organiser of the conference, feels sure that we’ll look back in 30 years’ time and wonder why we ever did psychotherapy without them. “Psychedelics are really useful tools that allow us to focus on things that are there that we can’t normally see,” he says. “They are our telescope.” Research in Post Traumatic Stress Disorder (PTSD) seems to be making the most progress in this field. When therapists treat PTSD, they encourage patients to recall and discuss their painful memories, helping them to wash out their emotional pain and move on. But the work is often hampered by a natural fear response; discussing a painful past, patients clam up or burst into tears. Researchers have found that Ecstasy can detach patients from the agony of their memories and help them to talk more freely. “If you ever come across a group of clubbers on Ecstasy,” says Dr Sessa, “you’ll find it very difficult to make them feel anxious. But unlike selective serotonin re-uptake inhibitors (or SSRIs, a group of drugs that includes brands such as Prozac), PTSD patients don’t need to take Ecstasy for months. They take it for three sessions at the most. It’s not used as an antidepressant.” The exact method of prescription is being trialled in the US and Switzerland, but this is generally how the therapy unfolds; after screening for physical or psychiatric complications, patients are given two to four sessions of non-drug psychotherapy to discuss the issues that are causing their anxiety. Patients learn what Ecstasy (MDMA) is, how it works and how a dose will make them feel. The first MDMA session starts in the morning and lasts all day. Patients take a dose (125mg, or the equivalent of two strong pills) in the presence of their therapist and wait to come up. The first few hours are spent relaxing with eyeshades and music. Once the rushing effects of the drug peak, the therapist begins to explore the issues covered in previous sessions. There follows an emotional outpouring of memories, often in minute detail. After six to eight hours the effects begin to fade, and the patient sleeps the drug off overnight. This cycle of four non-drug and one drug sessions is repeated over 12 weeks, in which time patients can make great progress, says Dr Sessa: “Some victims of rape or violent child abuse from years in the past have tried but never been able to explore their memories with a psychotherapist.But then they take MDMA, and for the first time in their lives, they find that they can talk in great detail about their abuse. And it’s so emancipating for them to shrug off the enormous weight that’s been resting on their shoulders for so long.” It’s not possible to obtain first-hand accounts of this treatment in the UK, because a licence to trial this treatment has never been granted. And this is the subtext to the conference; the battle to trial and roll out psychedelics in the face of overwhelming public and political opposition. There are no British health ministers willing to comment on this subject. When asked for a statement, the Department for Health insisted that the matter was for the Home Office. But research is building momentum. Dr Gavin Malloc, Programme Manager for Mental Health and Addiction at the Medical Research Council, says that psychedelic drugs are being widely used in empirical research in the UK. “MRC scientists at the universities of Oxford and Exeter are looking into ketamine as a temporary treatment to depression. Psilocybin is being used in terms of OCD. We have a major programme at Sussex that’s looking at the effects of psychoactive drugs. So as long as it’s good-quality science and all the regulatory requirements have been taken care of, we’re happy to consider MDMA therapy as a treatment.” The effect this research has on government policy is another matter. “We fund the best quality research and we try to help the Department of Health and the Home Office on policy,” says Dr Malloc, “but the bottom line is that decisions on law are taken by the people that we elect.” In a recent double-blind, placebo- controlled trial of MDMA in PTSD therapy in the States, 85 per cent of people given MDMA were cured of their symptoms, compared with 15 per cent of the placebo group. The best cure rate in trials of SSRI drugs is 65 per cent. Internationally, research is now reaching the stage at which licences are required to manufacture and trial the drugs on a wider scale; the result of legal battles in America and Europe that stretch back to the mid-1980s. The American Multidisiplinary Association for Psychedelic Studies says that MDMA could be a prescription medicine in 10-15 years, if it wasn’t a substance controlled by the UN convention. But that’s a very big “if”. Lady Amanda Fielding, the founder of the Beckley Foundation for psychoactive research, is organising an international policy meeting at the House of Lords to discuss amending the UN convention on drugs. “These substances can be extraordinarily useful for mental health, cognitive function, wellbeing, and increasing our understanding of consciousness. But the taboo has been almost total, and it’s reinforced by a UN Convention which prevents us from using them properly.” For Lady Fielding, this research is a route out of our “spiritual crisis”. “We’ve developed farther technologically in the past 2,000 years than we have advanced in our understanding of ourselves,” she says, “and the war on drugs has played a large part in that.” The challenge for academics at the convention next week seems to be how psychedelics can best be promoted to the mainstream medical profession — apparently an uphill struggle for Dr Ben Sessa. “When I turn up to give talks on this subject, people expect me in a kaftan and a big beard, and they’re surprised to see me wearing a grey suit. This is what we’re dealing with.” Breaking Convention takes place at the University of Kent on April 1, 2 and 3 Psychedelic psychiatry: a history 1940s Albert Hofmann discovers LSD by accident while testin
g derivatives of ergot as a drug for circulatory problems. Soon afterwards he began experimenting with LSD as a means of mimicking psychosis. Sandoz Laboratories begins producing LSD under the name Delysid. 1950s Researchers discover LSD’s potential to unlock repressed memories, giving birth to psychedelic therapy. Dr Ronald Sandison brings LSD to the UK and establishes the world’s first psychedelic therapy centre. MDMA is trialled, but largely ignored. 1960s Psychedelic research peaks, producing more than 1,000 scientific papers and a dozen international conferences.Celebrity patients Cary Grant and Sean Connery receive doses of LSD as part of their psychotherapy. Recreational use explodes and becomes associated with civil disobedience. The social backlash against LSD begins. 1970s UN Convention on Psychotropic Substances is passed, classing psychedelics alongside amphetamines as controlled substances. In Britain, the Misuse of Drugs Act follows. Medical use of LSD grinds to a halt but one American psychotherapist, Dr Leo Zeff, reintroduces MDMA as an alternative for psychedelic research. 1980s MDMA is banned in the UK following an amendment to the Misuse of Drugs Act, but the drug explodes in use recreationally. The Multidisciplinary Association for Psychedelic Studies is established and begins legal battles for research licenses. 1990s Rave culture propels MDMA into the headlines. Death of Leah Betts becomes the focal point for revived war on psychedelic drugs. Psychedelic research remains politically and socially non-viable. 2000s The Beckley Foundation is established in the UK. Effects of MDMA are proven to outstrip those of SSRIs. The British Journal of Psychiatry publishes its first paper on the medical uses of psychedelics for 40 years. The Times reports on “Breaking Convention: A Multidisciplinary Conference on Psychedelic Consciousness,” which will take place on April 2-3, 2011, at the University of Kent at Canterbury. The conference will feature four symposia; several tracks of seminars, debates, workshops, and presentations; film screenings; video presentations; and a track devoted to ayahuasca research. The article describes how psychedelics are making a huge comeback in science and medicine, and addresses the importance of MAPS’ current research into MDMA-assisted psychotherapy for PTSD. The article’s claim that MAPS’ research is hindered by the current legal status of MDMA, this is not actually the case: Because MDMA-assisted psychotherapy takes place in carefully controlled clinical contexts, our research has been able to move forward regardless of scheduling.