Casey Jones
Last week the National Institutes of Health hosted a two-day online event entitled Psychedelics as Therapeutics, Gaps, Challenges and Opportunities. The Institutes of Mental Health, Drug Abuse, and Alcohol Abuse and Alcoholism were cosponsors. This is following on the heels of the first federal grant for therapeutic psychedelic research in 50 years, a study at Johns Hopkins that will study psilocybin for tobacco use. This grant broke a long-standing federal moratorium on therapeutic research on schedule 1 substances.
Here is a description of the event:
The NIH Workshop on Psychedelics as Therapeutics is sponsored by NIMH, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism. Hallucinogens, psychedelics, and entactogens all appear to induce similar changes in neural network growth and function and so are sometimes grouped as “psychoplastogens”. Data suggest that psychoplastogens may facilitate changes in memory, behavior, and thought patterns, an effect that can be harnessed to therapeutic benefit. Therefore, the purpose of the workshop is to examine findings related to psychoplastogens in the treatment of depression, post-traumatic stress, and substance, and alcohol use disorders.
The workshop will cover mechanistic understanding of psychoplastogens, discuss what settings are needed for a therapeutic effect, and the necessity and nature of concomitant psychotherapies. Clinical study data will be presented to understand and overcome challenges in conducting psychedelic research and identifying knowledge gaps. The design of clinical trials will be discussed, including how they might be conducted in a manner that comply with drug regulatory agency requirements. In addition, presenters will discuss how to design psychedelic therapies that can realistically and ethically be implemented and reimbursed by medical insurers.
Wow. So, one of the hallmarks of psychedelic experiencing is a heightened sense of the the absurd. I mean, this is great. Really and truly cool. And OF COURSE the description will feature the driest, most academic, abstract jargon available, because, OF COURSE, these ARE the feds we are talking about here. This is serious business about plastic brains and neurons and stuff. No weird trippy shit to be found over here.
OK, OK, I know I'd better monitor my sarcasm meter. I just roasted the Happiest Company on Earth AND Star Wars last week, so I'm sure I must be on thin ice with some of you. And really, this doesn't make me feel cynical at all, just profoundly WEIRD. There has never been a bigger gap between the words used to describe psychedelics and the actual phenomenological effects of psychedelics. Psychedelics have been relegated to the fringes for so long it's extremely disorienting to find them at the absolute center of discussion of matters of human behavior and psychology.
Which is EXACTLY where they belong. Those of us who have enjoyed our little corner of freakville, with our own views, art, opinions, experiences and beliefs are gonna have to share. For many, psychedelics are so associated with counterculture, and mainstream American culture so associated with general cringeyness, that watching psychedelics emerge from the shadows is like watching someone eat a steak from a cow that you bred, grew, loved and then slaughtered. Your own experience is incredibly complicated and you really hope the eater enjoys the experience of eating, and holds the animal's sacrifice with the respect, even reverence, that it deserves. I recognize that this is a metaphor that has a pretty niche audience, but trust me, it fits.
Psychedelic science really has broken through. It seems likely, though there is no way to know for sure, that between the NIH workshop, the aforementioned tobacco grant, and the recent granting of “breakthrough therapy” by the FDA for psilocybin therapy for depression, the federal government will be loosening its considerable purse strings for researchers interested in studying psychedelics.
And researchers there are! Most recently, the University of Texas at Austin just announced the founding of The Center for Psychedelic Research and Therapy at the Dell Medical School. This is only the newest in a founding flush of recent major institutional psychedelic research centers.
In 2019, two pioneers of the current wave in psychedelic research started dedicated research centers, Imperial College in London founded the Imperial Centre for Psychedelic Research and Johns Hopkins Medical school launched the Center for Psychedelic Consciousness and Research.
UC Berkeley quickly joined in and founded the Center for the Science of Psychedelics in 2020.
In 2021, more universities got in on the action. In New York, two centers were founded, the Center for Psychedelic Psychotherapy and Trauma Research at Mount Sinai's Icahn School of Medicine and The Center for Psychedelic Medicine at the NYU Grossman School of Medicine. Also last year, the Transdisciplinary Center for Research into Psychoactive Substances was founded (in the midwest!!!) at the University of Wisconsin Madison School of Pharmacy.
These examples are limited to major universities who have founded dedicated research centers. It is hardly an exhaustive list of teams and labs who are doing psychedelic research. At Stanford university, where they do not have a dedicated research center, you can find a course page for a 200 level Psych course, Introduction to Psychedelic Medicine, with a much longer list of organizations and institutions getting in on the action.
Look, I have been beating this drum for years, but I'm not exaggerating when I say that many of the major players involved in psychiatry, psychology and mental health are going ALL IN on psychedelics. This is before even discussing the corporate angle and the multiple billions that have been raised in the private sector for everything from psychedelic pharmaceutical development to training companies to psychedelic software companies.
THIS. IS. HAPPENING.
If this is new to you, it would probably be a good idea to learn more (welcome to Tripping with Nate, keep coming back). If you've been keeping an eye on it but don't follow closely, it is now happening much faster than you think (keep reading). As someone who has followed this for my entire adult life, I find the pace to be nearly overwhelming.
No one can predict the future, but we must prepare for contingencies. It is not inconceivable that the field of mental health will look completely differently in 10 years than it does today, due to the seismic impact that psychedelic medicine may make. This may not happen, of course, but seems solidly in the range of outcomes.
In my opinion, the train has left the station and we are beyond debating if this is a good or a bad thing. We must transition to considering deeply HOW this frontier must be developed, and what values that we should insist be placed front and center. To that end, I would like to offer some suggestions for values that I think are vital to hold when approaching this work. This week I'll focus on only one, next week I'll add a couple more.
PRINCIPLE #1: Stop Caging People for Drugs
To lead any discussion of ethics and values in regards to psychedelic medicines, we must reckon with the inconvenient truth that psychedelic drugs are still against the law, and people are still going to jail for cultivating, possessing and using them. It's a very strange situation in which there are celebrated, borderline celebrity researchers, a fawning media, deep penetration into the cultural creative class, and yet people are still in cages for the exact same- as in- precisely the same- behavior. And yes, I'm sure many researchers are psychedelically naive, but c'mon. Wink, wink.
Criminal penalties for psychedelic drugs must end. There isn't room for foot dragging here. Anyone who is saying that "we need more research" or "we have to ensure that the culture is ready" or "we need containers for safe use" is actually saying "let's keep putting people in cages for now while I keep exploring this really cool thing I like a lot". Look, science is important. I'm emphatically for robust basic and clinical science in this area, it's incredibly exciting. But this is a fact: there is no evidence for a public benefit that warrants prohibition. Even without detailing the harms of prohibition (we don't have all day), there is no justification for infringing on the liberty of citizens without a compelling public interest. It's naive to say there are no challenges involved in decriminalization and legalization, but noticing only the challenges without accounting for the incredible destructiveness of the status quo is akin to blindness.
For those squeamish about potential problems arising from the removal of criminal penalties, there are other, non-cage options. Currently, if a kid wants to trip, he or she is going to (every, single day, in every corner of the country). They are going to get drugs of unknown quality from a dealer who may or may not be shady, and are almost certainly going to take them in a less than ideal situation. This happens all the time. This is the current reality under a repressive prohibitionist regime. THIS IS THE STATUS QUO. If you are concerned about this (and you should be, I don't want my kid in this situation), then robust drug education (actual education, not propaganda) and harm reduction are absolutely vital. My colleague Michael Pollan (hey, HE has a substack newsletter, I also have a substack newsletter- colleagues, right?) founded a cool newsletter The Microdose, and this week's edition features an interview with a mother whose son died during a trip that took a horrifying, tragic turn. It is worth reading her story and noting her measured, compassionate response to such a nightmarish situation.
It is vital that we establish, at a minimum, an agenda of removing criminal penalties on psychedelics (and all drugs, tbh) and investing in non-coercive means of improving safety, such as The Fireside Project, DanceSafe, the Zendo Project, or other programs built around a framework such as this document from the Heartland Alliance.
Remember, the status quo is positively diabolical: repressive, unsafe and for the benefit of only those agents who engage in the act of repression. Unless you are willing to say, without qualification, that users of psychedelic drugs should be jailed, and that such jailing is in the public interest, you are obligated to support, at minimum, decriminalization. It doesn't really matter if you are concerned about the second coming of Timothy Leary or any other justified qualification you can think of. The status quo is unjust. If you want to be involved in the business, research, clinical side of psychedelics, then you, yes YOU, are morally obligated to oppose prohibition, lest you be taken for someone profiteering from another's imprisonment.
After that, shall we say, strident statement, I don't imagine any of you who might disagree would be too willing to mention your differences in the comment section. But if you do disagree, I promise to engage in respectful discussion. I must acknowledge that the idea of changing drug laws IS kind of scary, for lots and lots of reasons. Additionally, maybe you have other suggestions for values or principles that we must consider when moving forward as a culture with psychedelics. What do you think?