Psychedelics: From Criminalized Taboo to Psychiatry's Next Horizon

Image By: University of Michigan Medical School

Since the Controlled Substances Act was signed into law by Richard Nixon in 1970, drugs have been classified into different schedules that are determined based on an assessment of medical value and abuse potential. Schedule One, the most severe, meant that a drug both had a high potential for abuse while also lacking any meaningful medical value. Therefore, it is not be available for consumption, possession, or distribution. It is in this group that virtually all well-known psychedelic drugs were placed into, along with cannabis. Notably, this is the same category as heroin and actually a rung higher than cocaine and methamphetamine.

Part of the reason for this discrepancy stems from the political conditions at the time, with two of the main communities of political dissidence, the African-American community and the countercultural movement, favoring the use of cannabis and psychedelics. This, along with the corresponding demonization of these substances by the government, allowed lawmakers to brush science aside in determining their classifications. Criminalizing these drugs aided the federal government in destabilizing these groups through arrests and harassment, both of which were mainly targeted towards African-Americans.

Legalization movements have since made strides. In 2020, the UN revised its classification of cannabis and in 2022, at the direction of President Biden, the Department of Health and Human Services recommended cannabis be lowered to Schedule 3. Globally, the drug enjoys significant legality within the Western world. Psychedelics have made less, but still impressive, progress. In 2020, Oregon became the first state to legalize supervised adult use of psilocybin, and last November, Colorado became the second. Multiple universities across the country now offer accredited courses in administering psychedelic-assisted treatment. Generally, more studies are being conducted and reviewed that demonstrate the medical value of psychedelics, revealing their ability to treat a host of mental illnesses such as PTSD, depression, anxiety, and even addiction. The frequency of mental illness has continued to rise and there is a dire lack of effective solutions and treatment; psychedelics may offer a much needed reprieve. 

One in eleven Americans will be diagnosed with PTSD during their lifetime and roughly thirteen million experience PTSD in a given year.. Currently, exposure based therapy is the gold standard in PTSD treatment. On average, 53% of patients no longer meet the criteria for diagnosis after treatment; there is no no suggestion that it should cease to be the go-to treatment option. However, PTSD remains a pervasive condition with a high rate of comorbidity, making additional treatment options urgent. Data indicates that after using certain drugs, particularly MDMA and Ketamine, patients experienced incredibly high rates of remission. A study in which participants with PTSD were given two doses of MDMA found that more than 83% no longer met the criteria for diagnosis. In comparison, EBS entails about a dozen sessions over the course of months. In a study of veterans with PTSD and treatment-resistant depression, patients received six ketamine injections over the course of twelve days. Remarkably, 80% experienced PTSD remission.

This has not gone without notice. The Pentagon recently approved ten million dollars in funding for research to study psychedelic assisted therapy for the treatment of PTSD and traumatic brain injuries. As much as this indicates the progress the movement has made, further steps still must be taken. In an interview on NPR, organizers expressed disappointment at the scale of the funding, lamenting that the vast majority of veterans who want access will still need to be turned away. As high as thirty percent of veterans of the Iraqi and Afghanistan wars experience PTSD.

In addition to PTSD, addiction is a problem that has always loomed, though now it appears more extreme than ever as the opioid crisis continues to develop. Overdose has killed more than a million Americans since 1999. Unfortunately, there is virtually no medical treatment for addiction, making recovery a long and difficult road that requires ample determination and support that many are not afforded. Psychedelics have long been used to treat addiction (LSD, for example, was originally marketed as a treatment for alcoholism and heavily promoted by the founder of Alcoholics Anonymous) and recent research has emerged that gives this notion scientific support. In particular, Psilocybin has been found to have high addiction-treating potential. Among those with alcohol use disorder, studies have found that after a session of psilocybin-assisted therapy, the number of heavy drinking days significantly decreased. In one study, 32% of participants abstained completely from alcohol consumption. Similarly, a study of tobacco users found a 67% rate of abstinence after a 52-week follow up. Specifically, Ibogaine, a powerful psychedelic drug, has been found to be helpful in treating opioid addiction. Though research is scarce, in one study of opioid addicts who received Ibogaine-assisted therapy, the majority of participants reported abstinence after twelve months and generally reduced drug use, while 36% also reported reduced alcohol use. 

Another testament to its potential is the frequency of so-called “drug tourism”; thousands of people have traveled outside the US to countries like Mexico to visit ibogaine clinics, where the drug is unregulated. Similar clinics with other drugs are also popular for treating PTSD and other mental conditions. 

Importantly, even common mental health problems can be treated by psychedelics. Depression, now being experienced at all time highs, is not well understood on a neurological level, making much of the available treatment inconsistent and ridden with side-effects. Short of addressing root causes, psychedelics may offer one of the most promising avenues for improvement. Johns Hopkins found that psilocybin can be effective in treating depression. Measuring adults with a long history of depression, scores on the GRID-Hamilton Depression Rating Scale, a standard depression assessment tool in which scores of above 24 indicate severe depression and scores below 7 no depression, decreased from 22.8 pretreatment to just 7 six months later. Following up after twelve months, researchers found a 58% rate of remission. The FDA has even granted two “breakthrough treatment” designations for psilocybin in addressing treatment-resistant depression.

In some cases, psychedelics can offer completely novel treatment. For cluster headaches, which cause short but incredibly severe bursts of daily pain for month-long stretches, LSD and psilocybin are the only known medications that can provide relief. LSD is effective even in its non-psychoactive form, making it an especially attractive option. Existing research broadly indicates that psychedelics have the capacity to treat a large breadth of mental, emotional, and even physical conditions. Substances such as DMT, psilocybin, MDMA, and LSD have all been found to have effects ranging from relieving pain and anxiety to treating disorders such as OCD and making weight loss easier.

Overall, psychedelic drugs offer groundbreaking treatment options for a wide range of serious conditions, many of which have become particularly urgent and widespread problems. Even in fields where treatment does already exist, psychedelics can offer more attractive alternatives, especially given their negligible physical impact and lack of side-effects relative to many existing psychotropic medications, which have a wide range of negative side effects and can alter neurochemistry and brain function in dangerous ways. The biggest obstacle to the integration of psychedelics into mainstream psychiatric and medical treatment is the lack of investment in new research that is necessary to speed up legal progress. Psychedelics have the potential to usher in a new era of psychiatry, providing a class of incredibly versatile drugs with the capacity to heal the mental anguish imposed on humans in the twenty-first century.