Psychedelics
Johanna Taylor Katroscik, PharmD
Psychedelics are making a comeback…but not in the way you might think. Recently, psychedelic therapeutics have made their way into mainstream media. News and journal articles, documentaries, and social media platforms are all exploring the possibilities that these mind-altering compounds could change the way we treat certain medical conditions.
So, what are psychedelics?
Psychedelics or psychedelic drugs are drugs that have mind-altering or hallucinogenic properties. There are numerous drugs and medications that have some sort of hallucinogenic property. Some of these include ketamine; dextromethorphan; phencyclidine (PCP); lysergic acid diethylamide (LSD); 3,4-methylenedioxymethamphetamine (MDMA, also known as ecstasy or molly); and psilocybin (the active ingredient in “magic mushrooms”).
Psychedelic drugs have been around for thousands of years and have been used therapeutically, recreationally, and as part of religious ceremonies. Until 1970, a number of these drugs were being used and studied for the treatment of different psychiatric conditions. However, in 1970 all research halted when LSD, psilocybin, and most other hallucinogenic drugs were classified as DEA Schedule I drugs. MDMA continued to be used and researched until, ultimately, it was also reclassified as a Schedule I drug in 1985.
Then, in 2000, researchers from Johns Hopkins University in Baltimore gained regulatory approval to resume research on psychedelic medications. Several years later, in 2004, the University of California, Los Angeles, began studying the potential benefits of psilocybin in patients with advanced-stage cancers. Since then, research has continued to gain momentum and is showing that there may be benefits to utilizing psychedelic therapy.
For example, a new study published in August 2022 in JAMA Psychiatry demonstrates that psilocybin could be a promising treatment for alcohol use disorder. Researchers found that study participants given psilocybin-assisted therapy reduced heavy drinking by 83%, compared with a 51% reduction among those who received a placebo.
Psilocybin and MDMA: Two top contenders in current research
Psilocybin is present in approximately 200 different species of fungi. It was first chemically isolated in 1958, and a chemical synthesis process for psilocybin was patented in 1963.
MDMA is a purely synthesized chemical compound that was developed in 1912 and was originally synthesized to be a parent compound in a reaction designed to synthesize other medications.
In the 1960s, both drugs gained popularity in clinical and recreational capacities.
One of the most recently published trials on MDMA was a phase 3 clinical trial that looked at the safety and efficacy of combining MDMA with psychotherapy for the treatment of PTSD. The trial enrolled 90 participants and looked at the primary endpoint of a change in baseline on a clinician-administered PTSD DSM-V scale. The preliminary data showed a good safety profile for MDMA as well as beneficial results in patients who received MDMA compared to placebo.
Researchers at Johns Hopkins University have published dozens of papers over the past 20 years and are continuing to conduct research into the different areas where psilocybin may be beneficial. Currently, they are enrolling patients for several studies including use of psilocybin for smoking cessation as an aid to help with depression for patients who have recently been diagnosed with Alzheimer’s disease, as a treatment for patients who have depression and alcoholism, and more. They have started the Johns Hopkins Center for Psychedelic & Consciousness Research and have resources for clinicians who want to learn more (hopkinspsychedelic.org).
What’s next?
At the time of publication, MDMA and psilocybin, along with most psychedelic and hallucinogenic drugs, are still classified as Schedule I drugs by FDA. Over the past 20 years, there has been a tremendous uptick in the research to understand if these drugs could be used both safely and effectively to treat different psychiatric and psychological disorders. ■