Makhib Choudkhuri takes us on a deep dive into the science of psychedelic drugs.
The use of psychedelics in medical therapy has been headline news recently and this has created a very exciting buzz. Where did the (seemingly sudden) resurgence come from? Are they really something to get excited about, or are they simply too dangerous to be used as treatments?
Psychedelics (a.k.a. hallucinogens/party drugs) have been used for at least a few hundred, if not thousand, years. For example, in the original Hindu scriptures, the infamous Soma is thought to have contained the active component of the hallucinogenic fly agaric mushroom (amanita muscaria). The Ancient Greeks made drinks from wheat which was probably infused with the Ergot fungus, the active component of a chemical that very closely resembles LSD.
Some of the most commonly-used psychedelics in the UK are LSD (acid), psilocybin (magic mushrooms), and MDMA (ecstasy). They are especially prevalent at music festivals. People usually take these drugs to go on a psychological “trip” — the person’s fight or flight response is activated (an adrenaline rush), and the senses are heightened; they see a lot of bright lights and colours, and may have an out-of-body experience. The user usually experiences feelings of elation. A very accurate representation of a typical trip can be found in Netflix’s Bandersnatch, where the main character goes through an LSD trip.
However, a lot of negatives have been associated with psychedelics. Common beliefs include that they are addictive and can make you psychotic.
Many psychedelics are not physically addictive, although they can be mentally addictive. This is because, compared to other drugs (like heroin), LSD, psilocybin, and MDMA work in the serotonergic aspect of the brain. This means that they influence the production of serotonin. People have heard of dopamine as the happy hormone — serotonin is another one. The serotonergic pathway is not addictive. Proof of this is that most common anti-anxiety and antidepressant medications stop serotonin from being broken down on the postsynaptic nerve (rather than producing more of it), and none of them have addictive or dependent factors. In comparison to alcohol and cocaine, psychedelics are much safer to use.
However, the adverse effects are important to consider. Ketamine works on a different hormone pathway, and is significantly associated with addiction if abused long-term. Around 25% of people using psychedelics in the UK will experience a bad trip. This results in the person experiencing a range of emotions, from anxiety to very real terror, and the feeling of being trapped if hallucinations occur. This is not damaging to the person’s health in the long-term if they are reassured and taken away from any triggering stimuli, and in the case of a festival, if they are taken to a medical camp where supportive therapy can be given in order to decrease fear and anxiety.
In the longer-term, there have been some cases of people experiencing persistent psychosis, or hallucinogen persisting perception disorder. This can involve people seeing abnormal things and having flashbacks to a bad trip when they are sober. This can be a debilitating condition. The effects of long-term use have not been researched enough as of yet. There are no predictors for who is more likely to experience these conditions. There have, however, been some studies recently that have found no link between LSD and persistent psychosis.
The most dangerous effects of psychedelics are often not because of the stimulant itself, but because, as is often the case with street drugs, they are regularly taken along with multiple different psychedelics and with alcohol, which can cause problems due to overstimulation. They are also often very impure and are mixed with a variety of chemicals which can cause a variety of problems, including an increase in the likelihood of undergoing a bad trip.
Due to the much lower rates of adverse effects and non-dependence on psychedelics, there has been a flurry of research recently into the potential use of psychedelics for treatment of mental illnesses. A new research centre has opened in London, focussing on psychedelics. It is important to understand that modern-day drug development is extremely rigorous. Most drugs take 10 to 15 years to go through all the steps of a clinical trial before they can be administered to the general population. If at any point the drug is found to be harmful or dangerous, the trial is terminated and the drug usually never returns to the market. Only around one to eight percent of all drugs researched are safe enough to be prescribed. The few psychedelics that have been approved are in their purest form and have a much lower risk of adverse effects compared to the underground ones.
Ketamine has recently been approved in the USA for use in cases of treatment-resistant depression. This means that it’s one of the later steps to consider for a patient after at least two other antidepressants have been tried. This might seem worrying at first, due to the addictive properties of ketamine; however, it is administered in a very regulated manner, using the purest form of the drug with an experienced psychiatrist who can be there to guide the experience of the patient. People who are severely clinically depressed may not be able to leave the house or do any functional work. It can truly revolutionise their lives. They may be able to have a stable job, maintain healthy relationships with people, and be happier within themselves.
MDMA has nearly completed the clinical trials for use in treatment-resistant PTSD. It is administered during guided therapy, where the person will experience a trip, and with the guidance of a counsellor, psychologist or psychiatrist, past images or flashbacks can be tackled and faced. This has been shown to relieve people of traumatic experiences in their past. Some data has shown that one session using MDMA achieves as much as a 10-week course of normal therapy.
Psychedelics have been a part of society for a long time. The dangers are often hyperbolised. If someone is surrounded by supportive people, then these drugs are safer to take than almost all other substances. Psychedelics are also not just "party drugs" anymore. People with crippling mental health conditions can truly benefit from them, changing their lives for the better. The very real stories of people who have experienced a positive outcome are wonderful to see. The research looks promising and there are a lot of exciting things to come in the future.