There’s a lot of good work being done on this important question. Several new training programs have been started, but there is also research to see if there are other, more efficient models of therapy besides the traditional two facilitator model—group therapy is one; designing treatment suites where one therapist can guide several patients at once, etc. But the Psychedelic Science Funding Collaborative estimates that 100,000 facilitators will be needed in the next decade, so this is a potential bottleneck to scaling psychedelic therapy. It’s also an opportunity for philanthropy.
Michael Pollan
I was nervous about this. But the reactions I get are more curious than judgmental, even from my mother and son. In general I expect much more pushback—both personal and professional—than I actually received. I’ve come to the conclusion this is one of those issues—like gay rights—where it is vitally important for people to come out of the closet, discuss their experiences in an unsensational way, and when they do the public will listen and shift its views. This is how anything gets normalized—by ordinary people telling their true stories.
I share Hamilton’s concerns that psychedelic therapy can be over-hyped. Many of the researchers are sounding a more cautious note, but there’s so much capital chasing so few good ideas right now, and the media is so positively disposed to psychedelics that a correct is bound to happen, and should. Some of these over-valued new companies will crash; there will be adverse events in the drug trials: if you trial hundreds of depressed patients, some of them are likely to commit suicide, and because the pre-existing narratives about psychedelics, this will be a big media story, even though suicides happen getting on and off SSRI’s all the time.
But in the end, it is the research that will determine whether psychedelic therapy earns a place in mental health treatment or not. I don’t think we’ll see a disabling backlash as we did in the 1960s. The need for new therapeutic tools is so desperate that the mental health establishment will embrace psychedelic therapy if the phase II trials are anywhere near as good as the phase II.
I can’t overestimate the value of public education as a way to inoculate the public against the inevitable negative stories—business collapses, sexual abuse in the treatment room, suicides, scandal. The press, having treated psychedelics so positively in the last few years, will eventually turn, as the press always does sooner or later. But the more solid information and true stories in the information ecosystem, the less of an effect this will have.
I’m a bit of worrywart. Some of these retreat centers are well-run and legit, but others are sketchy, and when people start having bad experiences it will have consequences. The public is just learning about psychedelics, and negative stories are bound to shape their perceptions.
We haven’t seen rigorous well-controlled trials of microdosing of psychedelic vs a placebo. One recent study, in which citizen scientists blinded themselves, strongly suggest a placebo effect. There is so much “magic” associated with psychedelics that that taking a tiny dose is likely to have an unusually strong placebo effect. But more research needs to be done.
It’s important to understand that ALL the research done on psychedelics—research that has already produced potentially revolutionary treatments for PTSD, depression, existential distress and addiction—has been privately funded by philanthropists. This area is still too controversial for government funding. I can’t think of another case where philanthropy has achieved so much in twenty years.
The distinctions between legal and illegal drugs are largely arbitrary. Alcohol and tobacco do much more damage to society and individual than most illicit drugs. A genuine risk/benefit analysis would lead to a complete overhaul of the federal schedule of illegal drugs, which cannot be justified on public health or scientific grounds. Politics and history have played a much bigger role than science.
I’d be curious to know what Matt Johnson thinks, but don’t think it’s necessary for the researchers to have the experience. However I do think it’s useful and informative, and especially useful for the facilitators. This is one of the limitations of most current training programs—the trainees can’t legally have the experience they are administering. The Berkeley Center for the Science of Psychedelics (full discloser: I am a co-founder) has an opportunity to offer the psilocybin experience to its trainees, since the Center will be working with “healthy normals” rather than volunteers with a clinical diagnosis. MAPS has gotten permission to do give MDMA to a limited number of trainees.
Psychiatry is a long road, but we certainly will need more psychiatrist interested in psychedelic therapy. It’s a good vantage from which to advance the field.
As mentioned earlier, training up facilitators is key. I also think we need more basic science to understand the brain mechanisms involved. Most research is focused on treating new disorders, which is important, but there’s not much on HOW psychedelics work—neuroplasticity, neurogenesis, anti-inflammatory effects, potential to re-open critical periods of development, etc. This work will lead to new treatment for new indications eventually. It will also shed light on what consciousness is. There is a young generation of neuroscientists eager to do this work, but as yet, traditional funding sources are not available to study psychedelics, which is why private philanthropy can have an outsized effect here.
Scaling psychedelic therapy is an enormous challenge—it’s so different from either the current models of pharmaceutical therapy—a pill a day forever—or talking psychotherapy—a weekly session more or less forever or until the insurance runs out—that it will take some genuine innovation to fit this square beg into these round holes. Yes, psychedelic therapy takes intensive preparation and integrations but only over a short period and with a small number of sessions. It actually cures many problems, so shouldn’t need to be repeated constantly . But when people say it’s potentially revolutionary, they’re thinking of these existing models. It needs to be said, however, that these existing models don’t work very well for many, if not most, patients. If psychedelic therapy is proven to be superior, corporations and national health agencies (and potentially some public benefit corps like MAPS’) will figure out the necessary new models. The success of the research is the key.
Great questions. There are two ways to think about this. If you have a specific concern or focus, you can find an institution that shares it. Carey Turnbull has formed an inititive to deal with the patent issues, for instance (I don’t recall the name of it). If you’re interest in delivering and scaling MDMA therapy for trauma, MAPS is the place to donate. If interested in the treatment of other indications check out Hopkins, NYU, Yale or Mass General—they’re all working on different ones and they al do great work. If basic neuroscience or public education around psychedelics is important to you, consider the Berkeley Center (with which I’m affiliated).
The second approach to find an institution whose values accord with your own and make an unrestricted gift, allowing the institution to allocate funds as they see fit. This is incredibly valuable to an institution, as it allows them to cover vital but unglamorous things like overhead.
Psychedelics can have great value for people who are not clinically mentally ill and I look forward to a time when they will be available to such people in the same way we make psychotherapy available to people who don’t have a DSM diagnosis of mental illness. People seek therapy who are sad or anxious, who have relationship problems, career questions, etc etc. We’re all on a spectrum at the far end of which is clinical depression or anxiety or obsession or addiction, so we stand to benefit from medicines that alleviate these symptoms. Watch the experiment on Oregon, which has legalized psilocybin therapy for any adult who wants it, beginning in two years or so.
I think we need more research on these questions. There is some preliminary indications that a single psilocybin experience increase measures of “nature connectedness” and decreases tolerance for authoritarianism. But I wonder about the samples—people positively inclined in these directions already. We need to test the drugs on anti-environmentalists and authoritarians to see if they have a reall effect or just strengthen predispositions.
I would love to see a trial of healthy normals to see if it increases altruistic behavior—how about a trial of two groups of philanthropists, one gets high dose psilocybin and the other not, and which group increases its giving over the following year? do I have any volunteers?
I do think we will find a way to fold these powerful substances into our society. Do I think they could help change consciousness at scale? In my hopeful moments, yes—they do seem to nudge people in the direction of altruism, ego-lessness, connection to nature, and to valuing nature, interconnectedness and love. Is this inevitable? Probably not—some people emerge from their experiences of ego death with a worrying ego inflation. There is also the question of how do you administer a drug to a whole society? You can’t put psychedelics in the water like flouride. We have no other precedents, so we’re really in uncharted territory here. But good research could help us decide if our hopes and aspirations for psychedelics are grounded in reality or dreams.
This is important work that remains to be done. The Oregon initiative represents one good-faith effort to design a regime under which people (in Oregon) will have regulated access to psilocybin therapy. There are surely other experiments that will be tried. But the FDA drug approval process is only one path. There will also be a religious/spiritual path, in which new churches that use psychedelics as sacraments will seek, and probably win, constitutional protection, as the Native American Church and two ayahuasca churches already have. This is an exciting time for policy and legal innovation in this area.
I teach journalism, and specifically teach science journalists how to read a scientific paper, which many of them are not equipped to do. I stress the importance of fact-checking and why journalists should not be afraid of ambiguous information, ie, no need to be all positive or all negative. It comes down to personal integrity and journalistic ethics, and is no different in psychedelic coverage than coverage of any other issue.
There are movements in many places to decriminalize plant medicines and to legalize drugs. Check out Decriminalize Nature and also Drug Policy Action—both highly respectable campaigns. Philanthropic monies are flowing into policy work—Dr Bronner’s, for example, contributed quite a bit to the recent Oregon ballot initiative.
MDMA is farthest along and will probably be approved first, followed by psilocybin,. LSD< DMT, etc are many years away.
I think the potential for using MDMA to solve conflicts is a rich area of exploration. I know Rick Doblin at MAPS has a longstanding interest in this. (In the 1980s he sent hundreds of doses of MDMA to the Russian leadership, hoping to advance arms negotiations!) I believe there are some projects along these lines underway or planned in Israel.