Australia should be initiating a psychedelic research program : What are the barriers ?

Nigel Strauss, Stephen J Bright and Martin L Williams

Australian & New Zealand Journal of Psychiatry, 2016, Vol. 50, (11), 1036–1037

DOI: 10.1177/0004867416670520

 

A recent review in Pharmacological Reviews highlights that over the last decade, a renaissance has occurred in psychedelic drug research in North America and Europe as investigators at Johns Hopkins School of Medicine, University of California, Los Angeles (UCLA), New York University and Imperial College London have embarked on studies that could be paradigm-changing for psychiatry (Nichols, 2016). These developments overturn a 30-year embargo on psychedelic research that followed
political reactions to the 1960s counter- culture movement in the United States and elsewhere, as disgraced Harvard Professor Timothy Leary told the world to take psychedelics to ‘turn on, tune in and drop out’. Promising research was halted, not for lack of theoretical interest and clinical applications
but due to political pressure (Nutt et al., 2013).

Serotonin was discovered in the course of understanding the mechanism of action of lysergic acid diethylamide (LSD), while clinical research by psychiatrists showed the drug’s promise for treatment of depression, anxiety, psychosomatic disorders, autism, alcohol dependence, existential angst among the dying and in reducing criminal recidivism (Grinspoon and Bakalar, 1979).

The neologism ‘psychedelic’ was coined by psychiatrist Humphry Osmond in correspondence with Aldous Huxley. From its Greek roots, psychedelic means ‘mind-manifesting’, describing the profound, unique effects on human conscious experience elicited by these drugs. Naturally occurring psychedelics have been ingested safely by humans from premodern times for diverse medicinal, social and spiritual purposes (Nichols, 2016), some of which—notably ayahuasca in South America, peyote in North America and ibogaine in West Africa—have survived within their traditional contexts into contemporary times.

LSD, undoubtedly the most widely recognized psychedelic compound, was discovered by Albert Hofmann when he resurrected his research into the effects of ergot derivatives on uterine contractions and accidentally ingested a small dose. This soon led to his self-experimentation with the drug, experiences he described as extraordinary (Hofmann and Ott, 2013). In 1947, the first research paper was published on LSD in the Swiss Archives of Neurology and Psychiatry. Hofmann remained interested
in psychedelic research until his death; interviewed shortly before his 100th birthday in 2006, he called LSD ‘medicine for the soul’ and expressed his deep frustration at its prohibition, even demonization, worldwide (Hofmann and Ott, 2013).

The current renaissance in psychedelic research in North America and Europe demonstrates that science can come before politics. The methodological flaws oft-cited in critiques of the first wave of clinical research largely have been overcome (Nichols, 2016). Randomized controlled trials (RCTs) at Johns Hopkins, in which an active placebo (methylphenidate) was utilized in efforts to address issues of
double blinding, found that psilocybin can occasion spiritual and transcendental experiences that elicit longterm positive changes in personality. Multiple open-label and RCTs are now complete, with more in progress, that aim to study the capacity of psychedelic medicines such as psilocybin and LSD to reduce anxiety in patients suffering from advanced-stage cancer (Nichols, 2016). The results thus far have shown that the use of a psychedelic medicine on just one or two occasions within the context of a psychotherapeutic program of preparation and integration leads to a reduction in anxiety and depressive symptoms, sustained 6 months post intervention.

Research over many years has also indicated that psychedelics can be effective adjuncts in treating substance use disorders. Recently, an open-label trial of psilocybin-assisted psychotherapy for the treatment of tobacco addiction showed much higher rates of abstinence at 6 months follow-up than current treatments (Nichols, 2016). A proof-of-concept study found similar effects in treating alcohol dependence (Bogenschutz et al., 2015).

Finally, while not considered a classical psychedelic, 3,4-methylenedioxymethamphetamine (MDMA) shows promise for the treatment of posttraumatic stress disorder (PTSD). For people who are unable to discuss their trauma, a key component of most psychotherapies, MDMA reduces trauma-associated anxiety while allowing reprocessing of the trauma and subsequent healing. This is significant as while most medical treatments for PTSD provide symptomatic relief, they do not cure the disease. With several Phase II RCTs completed and more underway in the United States, Switzerland, Israel and Canada, the Multidisciplinary Association for Psychedelic Studies is approaching the US Food and Drug Administration (FDA) to proceed with Phase III multisite studies of MDMA-assisted psychotherapy for PTSD (for review, see Nichols, 2016).

For all the recent international progress, there is an anomalous absence of such research in Australia.
Efforts to follow up recently published investigations into the potential benefits of drugs such as MDMA and psilocybin for psychiatric illnesses such as PTSD and anxiety have been met with resistance. Universities have shown aversion to potential controversy, and ethics committees have been very
conservative in their responses despite demonstrated safety and promising results in clinical trials
overseas. Given our gold star rating in so many other aspects of biomedical research, we could well be leading the world in this re-emerging field.

For psychedelic research to take place in Australia, it must be recognized that psychedelic drugs are medical agents, notwithstanding their potential use outside the medical context. After all, these drugs were isolated or developed predominantly in laboratories, by and for the medical research community (Hofmann and Ott, 2013), long before the politically motivated War on Drugs.

Another potential barrier is that psychedelics are not like the drugs with which contemporary psychiatry
is familiar. In psychedelic psychotherapy, ‘set and setting’ are critical, and the patient is never prescribed the drug to take outside of the clinic. Rather, it is provided in the context of psychotherapy while the patient experiences its effects. Furthermore, an entire treatment involves the drug being provided on only two or three occasions within the context of preparatory and integrative psychotherapeutic sessions, a treatment model at odds with the current dominant paradigm of psychopharmacology.

If current resistance to psychedelic research continues, Australia risks being left behind progressive countries in the field such as the United States, Canada, Switzerland, Israel and New Zealand. While psychedelic psychotherapy is not a panacea, it has scope to be included in the contemporary psychiatric armory to be used where appropriate. However, the lack of current research leaves Australian psychiatrists and psychologists without opportunities to trial treatments that may benefit many Australians.  The burgeoning cost of mental healthcare also provides a significant incentive for alternative approaches to be explored.

There is no question that psychedelic research can be fraught with challenges. In practical terms, can a true double-blind ever be achieved for an intense psychedelic experience? Some studies have used an active placebo and others have used low doses of the psychedelic medicine itself. In economic terms, might philanthropy supplement public funding to underwrite expensive research on drugs that are already in the public domain? Encouragingly, cannabis research is about to lead the way. And finally, will the authorities, the media and the general public ever develop an informed, balanced attitude toward psychedelics? Only time will tell.

Psychedelic drugs raise arousal to enhance motivation for therapy. They increase feelings of closeness between the patient and therapist. They increase relaxation and reduce hypervigilance. They stimulate new ways of thinking and understanding to explore entrenched problems. And they reduce the fear of recalling traumatic memories.

Little wonder that new clinical trials investigating the therapeutic potential of the psychedelic drugs are
springing up all over the world. It may well be time for Australian psychiatry to come to the party.

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