Pubdate: Sat, 01 Jun 2019
Source: San Francisco Chronicle (CA)
Copyright: 2019 Hearst Communications Inc.
Author: Erin Allday


UCSF psychiatrist Brian Anderson is studying an experimental therapy
to help long-term AIDS survivors - people who were infected with HIV
in the 1980s and never expected to live this long - who are feeling
sad and demoralized.

In a clinic outfitted with a comfortable couch, soft lighting, throw
pillows and blankets, the participants of his study are given
psilocybin, the hallucinogenic compound found in magic mushrooms. They
lie down for a few hours, a mask over their eyes and soothing music
playing in the background, and experience a psychedelic trip.

The next day, they talk to Anderson or one of his colleagues about the
trip. Then they start group therapy to talk about issues around
survival: long-held grief over the loss of friends or partners, deeply
rooted stigma of being gay and HIV-positive, their fear of dying. For
several of the 18 men in Anderson's initial study, it was their first
time talking about these hard issues.

"We know from other trials that people seem to talk more openly about
very challenging emotional material during the drug experience and
after the drug treatment," Anderson said. "Our participants told us
they started to really process some events from the distant past or
face things that they've been avoiding.

"Was it because they went through the drug experience? We don't know,"
he added. But the results were compelling enough that he's planning a
second study with female long-term survivors.

Anderson's work is part of a resurgence in psychedelic study that has
been brewing over the past decade - and that is now, at least to some
degree, fueling grassroots efforts around the country to decriminalize
use of certain psychedelic drugs.

The Oakland City Council is considering a decriminalization measure,
which if passed would make the East Bay city the second in the United
States to pass such policy; the first was Denver last month. Statewide
measures are being discussed in California and Oregon.

The decriminalization efforts are focused on natural psychedelics -
mushrooms, along with herbs, cacti and other plants from which
hallucinogenic compounds can be extracted. Whether the movements will
expand to include synthetic psychedelics such as LSD and MDMA - also
called ecstasy - or eventually lead to efforts to legalize the drugs,
remains to be seen.

The activity - both in politics and in medicine - represents a sort of
national psychedelic revival. Though several studies in the first half
of the 20th century had shown promise in using psychedelics for
treatment of mental health and neurological disorders, the drugs were
broadly maligned in the 1960s and '70s, largely because of public
concern over recreational use of LSD.

Antidrug campaigns that leaned on horror stories of bad trips and
tales of healthy people turned psychotic led to the outlawing of LSD
in 1966. Later, all psychedelics were placed under the government's
Schedule 1 category of drugs, officially designating them as having no
therapeutic use. Almost all formal study of psychedelics ended.

An underground community of psychedelic providers and users remained,
and actually thrived in places like the Bay Area, where counterculture
activities have always found support. MDMA was popular through the
1990s and 2000s in the Bay Area's club and rave scene. More recently,
microdosing - the practice taking small, carefully controlled amounts
of a psychedelic - has taken off among Silicon Valley techies and
university students who believe it boosts productivity and creativity.

All over the region are informal networks of people who will provide
psychedelics to those who are dealing with intractable mental health
issues, for whom approved pharmaceutical drugs and mainstream therapy
has fallen short. People grow hallucinogenic plants in community
gardens or their backyards, and they create safe spaces in their homes
for others who want to use the drugs.

But in the academic community, the resumption of medical research
really only started a few years ago. Now a new generation of
scientists is picking up where their predecessors left off.

"I came across the older era of psychedelic research in the late '90s,
when I was in college. I recognized it as this fascinating scientific
history for which these threads were left dangling," said Matthew
Johnson, an associate professor in psychiatry and behaviorial sciences
at Johns Hopkins University who has studied using psychedelics to
change behavior.

LSD is still largely ignored in medical research. But scientists
across several fields, mostly in mental health, are taking renewed
interest in the potential of other psychedelic drugs to treat
everything from addiction and social anxiety to chronic depression and
post-traumatic stress.

Most of the research has been focused on two synthetic drugs: MDMA and
a lab-made version of psilocybin that mimics the compound found in
hallucinogenic mushrooms. Some scientists are asking that psilocybin
be taken off the Schedule 1 list, which would ease access to federal
research funds and potentially make it easier to get approval for
medical applications. Almost all studies at the moment rely on private
donations for funding.

Even if studies prove that psychedelics are useful for treating
certain conditions, it would probably be years before they win federal
approval and - legally - reach consumers. The closest to getting there
seems to be MDMA, specifically as a treatment for post-traumatic
stress syndrome.

Two years ago, the Food and Drug Administration designated MDMA a
"breakthrough therapy" for PTSD, which could speed the approval
process. Early clinical trials have found that the drug is effective
for two-thirds of study participants. Phase 3 studies - the final
stretch before seeking approval - have started, with plans to enroll
at least 200 participants. Researchers have asked that the FDA allow
compassionate use for patients who suffer extreme symptoms of PTSD and
for whom no other treatments have worked.

"We're talking about a paradigm shift with mental health care," said
Ismail Lourido Ali, policy and advisory counsel for the
Multidisciplinary Association for Psychedelic Studies, which is
running the PTSD trial. "Our results are about twice as effective as
the next closest available treatment. We're in the process of studying
MDMA therapy for social anxiety in adults with autism, and MDMA for
eating disorders.

"The momentum is great, but at the same time, we're not talking about
silver bullets here," he added.

Studies are still limited, but they're happening at universities
around the country. There's Anderson's long-term survivors trial at
UCSF. At Johns Hopkins, Johnson and his colleagues reported about an
80% success rate in using psilocybin to help people quit smoking in
one small study. Research out of UCLA has found that psilocybin may
help cancer patients with depression and anxiety.

But it's far too soon to suggest that psychedelics are going to be a
panacea for a bundle of mental health and neurological conditions,
said Keith Humphreys, an addiction specialist at Stanford.

Psychedelics aren't addictive, he said, but they carry other risks,
including the potential for a small subset of people to suffer chronic
psychosis after using them. Some users can have psychedelic trips that
are terrifying or cause them to hurt themselves or others.

Mostly, though, Humphreys said he's not convinced that the drugs will
end up being all that useful. Most of the evidence so far is from
trials with just a handful of participants, or from observational or
anecdotal reports.

"It's very common in psychiatry to have a small clinical trial, and
everyone is so desperate for a new treatment and this looks like the
answer - and then we do bigger and better designed studies and the
bloom comes off the rose," Humphreys said. "It has nothing to do with
the history (of psychedelics) or that these drugs come from plants. I
could list a dozen medications we've seen it with. It's hype."

How psychedelics may help people with mental health issues isn't
clear. People who have had a psychedelic trip often say they were able
to evaluate parts of their lives - past trauma, relationships with
others, ongoing existential crises - from a detached point of view
while on the drugs. That gave them new perspective or allowed them to
place certain problems in a new context.

"People often report examining parts of their past memories or strong
emotions in ways that they weren't able to without help of the drug,"
Anderson said of the participants in his long-term survivors study.
"They create a new meaning about what happened to them."

Andre Humphrey, 38, said psychedelics helped him confront years of
abuse from his childhood that left him so traumatized that it affected
his ability to go to school, keep a job, maintain positive
relationships and even stay physically safe and healthy.

He was so moved by his psychedelic experiences that he eventually quit
a job in real estate and decided to open a clinic in Oakland to help
children from at-risk communities who have experienced trauma access
yoga, meditation and other "metaphysical healing" therapies - though
not psychedelics. He's calling his operation Inner City Bliss.

The most profound of his psychedelic trips came when he consumed
ayahuasca, a South American beverage made from several plant-based
ingredients. While he was under the influence, a child came to him
that he recognized as himself.

"I told him that I forgave him. It was life-changing," Humphrey said.
"It made me realize that I needed to love myself more, be easier on
the little child. It made me realize that inner child is real and I
need to handle him differently. I need to love him.

"After the ayahuasca," he said, "I cried for like two hours."
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MAP posted-by: Matt