Psychedelics, including mescaline, psilocybin, MDMA, and LSD, are being evaluated by researchers globally as potentially revolutionary treatments for mental health conditions including depression and post-traumatic stress disorder (PTSD).
But, this shift in attitude towards these long-prohibited drugs has understandably raised questions about the effectiveness and safety of these substances.
Ian Campbell, the CEO of mescaline-focused drug discovery firm Neural Therapeutics Inc., connected with Proactive to answer some of the more frequently asked questions about psychedelics and their therapeutic applications.
He was joined by Neural’s Scientific Advisory Board Member David Nutt, Edmond J. Safra Professor of neuropsychopharmacology at Imperial College London, who also shared his insights.
Proactive: Which psychedelics would you recommend we start with and which ones should we stay away from?
David Nutt (DN): What we know is that natural psychedelics, which have been used by Indigenous communities around the world for tens of thousands of years, are relatively safe. In those circumstances where we’ve got experienced shamans preparing them and making them available, their use has been very safe.
There are new psychedelics coming along that haven’t been tested in humans and until they are we won’t know if they are safe. Sticking with the tried and trusted ones is likely to be the best way forward.
What are the potential downsides of permitting the use of psychedelics?
DN: I don’t think there are any negative outputs from the use of psychedelics, certainly not for patients who need them.
But there will be people who will ask why they have been misled about these drugs for 55 years. There will be unpleasant, awkward questions to the regulators and to the scientists who have persisted with this myth of harm and persisted with the demand to keep them scheduled.
With all drugs, it’s a question of benefit/risk. We are going to find out, I’m certain, that the benefits so much outweigh the risks that we can be reassured that it’s worth changing the law to make psychedelics more available.
What are the long-term effects of psychedelics on bodily health?
Ian Campbell (IC): Any drug can have a side effect. However, these drugs have been used by Indigenous cultures for thousands of years. Mescaline, for example, a drug that Neural Therapeutics is developing, has been in use for more than 5,700 years in South America and more than 200 years in North America and continues to this day to be safely used.
These are real-world examples and we’re seeing these psychedelics also proving to be quite safe in clinical trials.
Mescaline is also one of those drugs where we are seeing mounting evidence through scientific publications of reduced cardiometabolic diseases, like type two diabetes.
Can psychedelics cause permanent psychological changes or disorders like psychosis?
DN: One of the big concerns about the use of psychedelics is that it can make people psychotic. In a way, a psychedelic experience is a bit like transient psychosis, and we use psychedelics in healthy people to mimic aspects of psychosis to develop new treatments for psychosis.
There is a genuine risk if you are using psychedelics in people who are psychotic that it can make psychosis worse. That is something we are very careful about. We exclude anyone who is psychotic, has been psychotic, or even people who have first-degree relatives – parents, brothers, sisters, children – because there is a risk you can trigger a psychotic episode.
Most clinical studies for psychedelics have used healthy volunteers. What side effects should we be concerned about if we permit studies including veterans who may benefit but likely have multiple issues such as drug or alcohol use disorders?
DN: Psychedelics, when used with comorbidity as many veterans have, can deal with addiction, depression, and trauma together because they disrupt the brain circuits underpinning them.
However, we have to be very conscious of the fact that traumatized people will relive the trauma during the treatment, so we need therapeutic programs that are consciously focused on preparing to get the best benefits from the trip. We need to make sure the therapists are skilled in preparing people for the trip and helping them deal with any negative consequences during the trip and then integrating the experiences, both the good and the bad ones, to overcome the illnesses that led that patient to need treatment.
The opioid crisis has touched every sector of society and shows no sign of stopping. How do we prevent more people from becoming addicted to substances, including psychedelics?
IC: This class of substances has been proven not to be addictive. We don’t see withdrawal in clinical trials. We see that through clinical trials and scientific work that’s ongoing today, we can treat people with substance use disorder with psychedelics. It’s not a concern when it comes to addiction.
Do we really need more types of drug therapy when we already have ketamine clinics/therapy?
DN: Ketamine has been a major breakthrough. It’s an anesthetic that’s been around for 40 years and it’s widely used in the third world as it’s the only anesthetic that doesn’t need an anesthetist to deal with respiration. It’s quite safe.
But it does have drawbacks. It can cause dependence. It’s much more likely to cause dependence than psychedelics and the effects are not as long-lasting. With psychedelics, you get an effect with a single dose. Whereas with ketamine, we normally have to give repeated doses over many weeks to get the intended effect. That’s much more expensive and a patient might build up a tolerance and that can affect how it is used.
We already have approved pharmaceuticals and therapies for the treatment of depression and PTSD, why do we need more?
DN: The reality is that the best antidepressants we have don’t really lift depression in about a third of people. The best treatments we have for PTSD don’t work in even half the people. Given that there are so many people with these conditions, depression will be the leading cause of disability in the Western world by the end of this decade and PTSD will not be far behind.
There has been no innovation in mental health treatments at the level of new pharmacological medicines for 50 years and that’s why psychedelics and ketamine are a real breakthrough because they work in a different way to traditional drugs and they can work where the other drugs have failed.
How do success rates compare between psychedelic treatments and traditional pharmaceuticals for PTSD?
IC: PTSD is a serious disorder. Fortunately, we’ve seen some good evidence of clinical breakthroughs using MDMA and psilocybin. We’ve seen organized groups taking veterans, for example, overseas to deal with their PTSD, with ayahuasca (DMT) administered by shamans. We hear anecdotally about them being able to deal with the root causes that led to their diagnosis.
Overall, the evidence is very strong both clinically and in the real world demonstrating that PTSD can be dealt with using psychedelic therapies.
How can psychedelic treatments be rolled out at scale if therapy is required alongside the psychedelic consultation?
IC: We’ve seen that telehealth is very effective. We now have wearable technologies, and I think this will play a bigger role in the future going forward with psychedelics. We want to ensure patient safety and doctors and therapists can scale out wearable technology in the community fast.
We also need to have a paradigm shift in how we think about therapy. If we take a lesson from Indigenous populations, we can treat people in group therapy. Group therapy is proving to be quite effective in many of these situations where people go off abroad together and build camaraderie and bonds and support each other. People seem to demonstrate great benefits from group therapy.
Psychedelic treatments can be scaled and will have to be scaled to deal with the enormous size of the mental health issues we have today.
Quotes have been edited for clarity and style