An update on the state of science for psychedelics, and what all clinicians should know as they enter this uncharted territory.
Articles about psychedelic treatments for persistent depression, PTSD, and substance use disorder seem to be everywhere. Rarely a week goes by without a newly published study appearing in a peer-reviewed medical journal, usually followed by reports of the study in prominent news outlets.
Anyone born after 1970 may find themselves wondering, “What’s going on?” Until recently, psychedelics seemed to be artifacts of a bygone era of anti-war protests, hippies, Hair, and classic vinyl.
Here’s what you need to know.
1. These drugs have a long history.
Psychedelics actually have a long history. Archaeological evidence shows that early humans ingested specific plants and mushrooms, which produce chemicals with psychedelic properties. For millennia, indigenous people in Asia, Central and South America have used experiences induced by psychedelics as central components of sacred ceremonies. Western medicine’s examination of these drugs dates to the synthesis of LSD (lysergic acid diethylamide) in 1938 by Albert Hoffman, a Swiss chemist working for the Sandoz pharmaceutical company. Hofmann had been researching vasoactive compounds and initially set aside LSD. In 1943 he inadvertently absorbed some of the chemical transcutaneously and had the first LSD-induced psychedelic experience.
Recognizing its intense psychic properties, Sandoz offered LSD to psychiatrists who were interested in exploring its therapeutic potential. From 1950 through early 1970s, licensed physicians could administer or prescribe LSD to patients. Research flourished in the form of bench science, case studies and small, non-randomized trials. Before falling victim to the excesses and cultural-political tensions of the era, more than 1,000 articles about psychedelics were published in the medical literature. Then the Nixon administration reclassified psychedelics as Schedule I drugs, signifying high potential for abuse and no legitimate use. Research ceased.
But seeds had been planted in the minds of a handful of clinicians and investigators. Early in the present century the FDA granted permission to researchers at UCLA, NYU, and Johns Hopkins universities to conduct small, well-designed trials of psilocybin-assisted therapy. Consistent with previous findings, a large majority of patients with cancer and concomitant depression or anxiety demonstrated substantial improvements on standard scales. Notably, these benefits were often sustained through months of follow up. Publication of these studies ushered in the current renaissance of psychedelic-assisted therapies.
