Psychedelics in the USA
Return to clinical practice?
Sergey Syrov, Denis Yatsutko, XX2 century
In the USA, psychedelics are being studied again. The time when the prohibition of psychoactive substances also concerned scientific institutions has passed. Everything is legal and respectable. On the business card website The New York Center for Psychedelic Medicine (New York University Langone Center for Psychedelic Medicine) gathers volunteers to participate in regular research. In September 2022, this is a test of the effect of cannabidiol (which does not possess any psychoactive properties of a cannabinoid) on the condition of people in need of strong anesthesia, and prohibited by the convention The effect of methylenedioxymethamphetamine (MDMA, aka ecstasy) on people with post-traumatic stress disorder.
The Center for Psychedelic Medicine was recently opened — it is part of the Department of Psychiatry at NYU Langone Health, funded by donations, a significant part of which ($ 5 million) was made by the pharmaceutical company MindMed founded in 2019 (full official name — Mind Medicine Inc., based in Canada). MindMed is developing (so far unsuccessfully) a drug addiction remedy based on microdoses of the hallucinogen LSD and the non-hallucinogenic 18-methoxycoronaridine.
It seems that the medical business is inspired by the history of cannabis decriminalization in some US states and other countries. The use of marijuana has not only become legal in some territories — in some places studies are already being published in which it is a priori declared a "type of healthy behavior", while the trade in "grass" is extremely profitable. According to Global Market Insights, the medical marijuana market alone was estimated at US$ 59 billion in 2021.
What kind of ideas are prompting American society to curtail the "fight against drugs" in the form in which it has been conducted since 1970? A good example is a 2015 article in the New Yorker singing an ode to psilocybin. The emotional core of the article is the story of a TV presenter dying of cancer Patrick Mettes and his family. In short: Patrick participated in a clinical trial of psilocybin, experienced strong psychedelic sensations, received a mystical insight, enjoyed the last months of his life (as much as possible), gifted others with participation and love, after which he refused chemotherapy and died.
In the article you will find a brief history of the work of scientists and enthusiasts with psychoactive substances and assurances that the medical use of psychedelics controlled by specialists is safe and there are practically no "bad trips" in patients — states of acute psychosis, sometimes entailing extremely sad consequences. The benefit is obvious — helping those who can no longer be cured.
The New Yorker quotes the words Rick Doblin (Rick Doblin), director of the Multidisciplinary Association for Psychedelic Research, answering the question of whether society is ready for the legal use of psychedelics:
"It was a completely different time (we are talking about the 60s, before the prohibition of many substances). Back then, people didn't even talk about cancer or death. Women were given tranquilizers before giving birth; men were not allowed to enter the maternity ward. Yoga and meditation were completely wild activities. Now mindfulness is mainstream, and everyone does yoga, and there are maternity hospitals and hospices everywhere. We have integrated all these things into our culture. And now I think we are ready to integrate psychedelics as well."
In Russia, psilocybin is included in the List I of narcotic drugs, the turnover of which is prohibited in the Russian Federation in accordance with the legislation of the Russian Federation and international treaties of the Russian Federation.
So, the integration process has started. In 2018-19, the FDA awarded psilocybin the status of a "breakthrough therapy" for the treatment of depression in humans and lifted the ban on research on the use of psilocybin in the treatment of mental disorders. The assignment of the status of "breakthrough therapy" may mean that in the very near future the possibility of legal use of the substance for the treatment of mental disorders will open. Who will be prescribed psilocybin?
For example, alcoholics — in combination with psychotherapy. An article has been published with materials from a double-blind study showing that a kind word (psychotherapy) in combination with psilocybin works twice as well as a kind word in combination with a placebo. However, for some reason, researchers used diphenhydramine as a placebo, an antihistamine with a lot of side effects: from relaxation of smooth muscles to drowsiness, increased depressive effects of alcohol and even delusional states.
Is it worth saying that it is impossible to achieve full-fledged "blinding" in the study of the effects of large doses of a psychoactive substance? We keep this in mind — however, honest authors do not bypass this point and recognize the presence of a problem, as well as others: a small sample of subjects (slightly less than a hundred people, "covid is to blame"), evaluation of the results according to questionnaires (analyses were taken to control the answers, but in about half of the cases).
The researchers note that the subjects well tolerated the administration of two full doses of the drug, and severe side effects were observed only in patients who received a placebo (but we remember that, in fact, it was, to put it mildly, not quite a placebo).
In general, the periodic return of scientists to previously studied substances is understandable: armed with newer, more advanced knowledge, they can discover something that their predecessors missed. However, whenever it comes to studying a particular psychoactive drug, it seems that at least some of the people involved in this just really want to get such drugs out of the ban. And it is this desire that their public rhetoric and even the design of research follow. However, this is only a subjective impression, we do not insist on it.
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