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Rebroadcast: Psychedelics and who should be able to use them

WASHINGTON, DC - FEBRUARY 5:
A DC resident has an operation growing psilocybin mushrooms, including these Galindoi variation of Psilocybe mexicana mushrooms, two middle, and Psilocybe cubensis mushrooms, left and right, in Washington, DC, on Monday, February 5, 2020.  With the legalization of marijuana, advocates are now pushing for other legalizations, like psilocybin mushrooms.  Activists in Colorado, Oregon and California have pushed for approval of psilocybin mushrooms and now folks in the District are starting.  Many claim medicinal uses - depression, PTSD and other disorders - as is the case in some European countries.
(Photo by Jahi Chikwendiu/The Washington Post via Getty Images)
WASHINGTON, DC - FEBRUARY 5: A DC resident has an operation growing psilocybin mushrooms, including these Galindoi variation of Psilocybe mexicana mushrooms, two middle, and Psilocybe cubensis mushrooms, left and right, in Washington, DC, on Monday, February 5, 2020. With the legalization of marijuana, advocates are now pushing for other legalizations, like psilocybin mushrooms. Activists in Colorado, Oregon and California have pushed for approval of psilocybin mushrooms and now folks in the District are starting. Many claim medicinal uses - depression, PTSD and other disorders - as is the case in some European countries. (Photo by Jahi Chikwendiu/The Washington Post via Getty Images)

Sign up for the On Point newsletter here.  This rebroadcast originally aired on Jan. 6, 2023.

In the 1960s, tensions rose over who should have access to psychedelics.

There were advocates who thought everyone should be able to use psychedelics. There were also researchers who thought psychedelics should stay in the lab.

But when psychedelic drugs were banned by federal law in 1970, it ended the debate over who should have access to them.

Now, psychedelics are back. They’re growing in popularity, and the tensions around access, money and research are back, too.

Today, On Point: Psychedelics and who should be able to use them.

Guests

Amy Lynn McGuire, professor of biomedical ethics. Director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine.

Also Featured

Sandor Iron Rope, board member of the Indigenous Peyote Conservation Initiative, president of the Native American Church of South Dakota.

Brom Rector, founder of Empath Ventures, a venture capital fund that invests in psychedelics.

Brian Pilecki, clinical psychologist based in Oregon, psilocybin facilitator in-training.

Melissa Lavasani, CEO of Psychedelic Medicine Coalition, chairwoman of Decriminalize Nature D.C.

Transcript

Part I

TIMOTHY LEARY [Tape]: Turn on. Tune in. Drop out.

MEGHNA CHAKRABARTI: By the time Timothy Leary uttered those famous words in San Francisco in 1967, the former Harvard psychology professor was already well known as the “high priest” of the psychedelics movement.

Leary, and the rapid expansion in the popularity of psychedelic drugs, had captured the world’s attention by the mid 1960s.

In this moment from a British documentary series called “World Tomorrow,” Leary describes an LSD trip. He’s seated, cross legged on the floor, as a child wearing beads toddles by.

LEARY [Tape]: There’s a sense of being in communion with powers greater than yourself and intelligence, which far outstrips the human mind and energies which are very ancient. You have a sense of a veil is pulled away, and for the first time you see how things really are. 

CHAKRABARTI: Not everyone was along for the ride. The movement to bring psychedelic drugs to all was met with great resistance from the federal government, of course, which had first secretly, and illegally, experimented with psychedelics in projects such as the CIA’s MKUltra program.

The federal government later pivoted to viewing psychedelics as a threat as their public use spread.

Researchers also expressed serious reservations. Scientists, such as Dr. Stanley Krippner at Maimonides Medical Center in New York believed psychedelics showed strong promise as a treatment for a wide range of conditions — but only under controlled circumstances. He was featured in that 1967 British Documentary “World Tomorrow.”

STANLEY KRIPPNER [Tape]: LSD could be integrated into the general fabric of American society, but we will need additional research to indicate how best this should be done. We want to have research to indicate how it affects the educational process, whether or not it should be used in schools, universities and colleges. We will need research to indicate what types of mental illness it’s most effective for. 

But the controlled, meticulous roll out of psychedelics research was not what Leary and others had in mind when they envisioned integrating the drugs into American life. In 1966, Leary appeared on the Merv Griffin show. He told Griffin he’d already taken LSD 311 times – and predicted one day, you would too.

LEARY [Tape]: And I’ll say to your viewers, within ten or 15 years, psycho chemicals which expand consciousness and accelerate the mind and open up the wisdom that’s inside will be just as common as books are today. When your kid comes home from school, you won’t say to him, What book did you read today?

You’ll say, Which molecule did you use to open up? Which Smithsonian Institute or which Library of Congress existence as your mind? I know that sounds far out, but everything, every new advance in science just seems impossibly. How can you use drugs to open up your mind as an educational tool?  

CHAKRABARTI: Enter, President Richard Nixon.

PRES. NIXON [Tape]: America’s public enemy number one in the United States is drug abuse. 

CHAKRABARTI: June 17, 1971, Nixon announced the federal government’s hundred-million-dollar war on drugs abroad … and at home. His administration passed the Controlled Substances Act, which included making all psychedelics a schedule one drug – making them both illegal, and effectively banning all research using the drugs.

And that would be it. For almost 50 years. Scientists who wanted psychedelics to stay in the lab, and Timothy Leary, who wanted the drugs out in the world … both shut down to the enforcement power of the federal government.

Well, a half century later, the times, they are a changin’.

NEWSCAST: When it comes to psilocybin in Oregon you could call us trailblazers, or guinea pigs or maybe both. The beaver state has the nation’s first regulatory framework for legal psilocybin services. And that’s thanks to Measure 109 that was passed by voters back in 2020 with 55% of the vote.

CHAKRABARTI: The movement to decriminalize psilocybin, or magic mushrooms, began in the last decades and several cities have decriminalized its use. And on January 1st of this year, Oregon became the first state to allow adult use of psilocybin. And those psychedelics remain Schedule 1 drugs. In 2014, a group at Johns Hopkins University was the first in the country to obtain regulatory approval to conduct psychedelic research on healthy volunteers.

And since then, other research groups have also received federal approval. So that brings back to mind those tensions from the 1960s. The divide between people who want psychedelics for all, and scientists who believe in restrained use only in the lab. Will we relive those tensions? Or could things get even more complex? Because in the 21st century, when legalization is on the horizon, big money investors aren’t far behind.

How could they influence the renewed use and slow spread of psychedelic drugs? That’s what we’re going to be talking about today. And we’re joined by Amy Lynn McGuire. She’s a professor of biomedical ethics and director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine.

She joins us from Houston, Texas. Professor McGuire, welcome to On Point.

AMY LYNN McGUIRE: Hi, thank you so much for having me.

CHAKRABARTI: I first wonder if you might describe what precipitated this resurgence in both the public and scientific interest in psychedelics about a decade or so ago.

McGUIRE: Yeah. So as you mentioned, the research use of psychedelics and study of psychedelics really began again in the 1990s. And there have been a couple of groups that have really spent quite a bit of time researching the therapeutic potential of different psychedelics, primarily largely in psilocybin, but other psychedelics as well to treat mental health disorders. pain, cancer, end of life care, things like that.

And in 2017 and 2019, respectively, the FDA actually named both psilocybin and MDMA breakthrough therapies for treatment of both post-traumatic stress disorder and treatment resistant depression.

CHAKRABARTI: So those were, that’s a really major change then from the federal government’s viewpoint, isn’t it?

McGUIRE: It is, I think it’s following the early data, the early evidence suggesting that these substances, when used therapeutically, could have really profound impacts on people’s lives, people who have been suffering for a very long time with mental health disorders.

CHAKRABARTI: Yeah. We’re going to talk about public interest in psychedelic drugs in just a second. But tell me a little bit more about that period in the late ’90s, early 2000s, because from my understanding, after psychedelics were made Schedule I drugs, almost all, if not all scientific research into the drugs stopped for decades, right?

But was there a connection between the kind of research that had been done in the ’50s and ’60s? And the kind of research that was renewed in the late ’90s? Was there a connection between those two?

McGUIRE: I think there were still some scientists who were really very committed to trying to study the therapeutic potential. Because remember in the ’50s and ’60s, the research that was being done, the legitimate research that was being done was really quite promising. And tens of thousands of patients received psychedelics through clinical trials.

There was a lot of research that was done both in the United States and Canada on the treatment of alcoholism and other substance use disorders that showed great promise for the potential of this to really transform people’s lives. So they’re, it didn’t, the interest in that and the enthusiasm about it from a scientific perspective didn’t die when these laws passed and there were some committed researchers who were really continuing to try to do the research.

And in the 1990s, the Drug Enforcement Agency loosened its hold and allowed some research to begin. Because they’re still Schedule I substances though it’s quite difficult to conduct research. And so you have to have certain special licenses and access to the substances.

That has slowed down the progress of research quite a bit. And if the DEA were to loosen its or reschedule these substances, I think it would open up the research field in important ways.

CHAKRABARTI: Reschedule, meaning making it a different level of controlled substance.

McGUIRE: Yeah. So Schedule 1 means that it has a high potential for abuse and no therapeutic potential whatsoever. So the more that the research happens and that there’s a building evidence base that there could be some therapeutic potential, I think the harder it becomes to continue to justify these substances being scheduled as Schedule 1 substances. And so they would, the DEA would need to reschedule them as schedule 2, which means that they’re more easily accessible for research purposes.

CHAKRABARTI: Do you think that could happen? Because it seems to me to be surprising the rapidity with which both public interest and even public activism, and then research interest in psychedelics has grown in the past 10, 15 years, 20 years maybe.

McGUIRE: Yeah. So there is quite a bit of interest in it. There’s a confluence of things that are happening now that I think that make rescheduling these substances much more likely in the near future. So on the one hand, there is a lot of speculation including by the Biden administration that the FDA will approve the first psychedelics for therapeutic use in the coming two years.

Part II

CHAKRABARTI: Professor McGuire, you were saying about how there’s speculation that in the next two years, the Biden administration may approve the first legal medication of psychedelic drugs.

Tell me more about that.

McGUIRE: So it wouldn’t be the Biden administration approving it, but the Biden administration has come out and speculated that the FDA may approve the first psychedelic drugs within the next couple years. And so they’re starting to prepare for that. There’s been talk about establishing.

I don’t know if it’s been established yet, but a federal task force to think through what would be the implications if FDA were to approve a psychedelic for therapeutic use. You were talking about the tensions between the personal nonmedical use of psychedelics and the research or medical use or, research into the medical use of psychedelics that we saw in the 1960s.

And I do think that there’s similar parallels that we’re seeing now. It’s a really complex sort of legal and social environment going on right now.

CHAKRABARTI: Yeah, and that’s, there’s all different, there’s a bunch of different threads within that complex set that I want to explore with you. But before we leave what’s happening inside the lab, I just want to check something. Because I’ve been reading some reactions and papers from the early research again, as you mentioned, into various psychiatric disorders to mental health issues, alcohol use disorder. I believe even there are potential research projects in oncology. So a lot of different areas of interest here, but some folks are saying that the early results are, they’re not saying it’s miraculous, but they’re describing it as ultra promising.

What do you make of that? Is that just like the excitement of being able to do this research again, or is this really could be groundbreaking efforts here?

McGUIRE: So I think there are some really promising early studies, but most of them are early, right? So they’re small sample sizes.

They’re potentially not super generalizable. We don’t know long term effects, those sorts of things. So there has been a lot of discussion of are we over hyping this as we tend to do with new, exciting innovations or is this excitement really justified, and I think it’s probably a little bit of both.

I think that the media has become interested in this and as you get media attention related to things, you get big headlines and there tends to be a little bit of overhype of the potential findings that we have right now. But on the other hand, I do think that there are some promising early studies that should really encourage us to continue this research and to make sure that we’re building a solid evidence base to really understand how, and when and under what circumstances these substances can be most useful.

So let’s switch over to another sort of quadrant of this new world of psychedelics in the United States.

As we mentioned, on January 1st, Oregon became the first state to allow the legal use of psilocybin. So we spoke to Brian Pilecki. He’s a clinical psychologist based in Portland, Oregon, and he’s training to be a psilocybin facilitator. And he says, psychedelics really blow up the traditional medical model.

And it’s important to be intentional when using them for mental health treatment.

BRIAN PILECKI: They don’t quite fit in therapy. They don’t quite fit in medication or psychiatry. There’s a spiritual aspect to them. Psychedelic experiences are very dependent on the set and setting, what you do to prepare a person in the days and weeks leading up to an experience, that matters. How you construct the environment and show up as another person in the room, that matters. How you encourage a client to respond to their experience, whether some challenges came up or something really positive came up. That matters, too.

CHAKRABARTI: Professor McGuire, first of all, what did you think when Oregon voters, actually I should make that clear, it’s Oregon voters who first voted to allow legal adult use of psilocybin. What did you think about a statewide change like that?

McGUIRE: Yeah, so I don’t think it’s very surprising, given our current sort of political environment and what we’ve seen happen with other controlled substances like cannabis.

And I think this is, psychedelics are the next generation from a legal perspective of what we’re seeing with regard to the legalization or decriminalization of cannabis.

CHAKRABARTI: But it still seems cannabis and marijuana advocates had to fight a long and hard road.

Is that a similar battle that’s happened for advocates of psychedelics?

McGUIRE: Maybe not quite as openly. I think that things have been happening behind the scenes, but I also think that cannabis laid the foundation that made it easier and more acceptable for psychedelics to go this, go on this path.

CHAKRABARTI: I just wonder what you think of the fact that what states like Oregon, the state, and other local jurisdictions when they have effectively decriminalized psilocybin, what they’re saying is that adults can just casually use it. Does that evince an appropriate understanding of what these drugs actually are and what they can do to a person?

McGUIRE: You’ve uncovered quite a few tensions, right? So there is this tension between sort of the federal government and the gatekeeping role that they have over these sorts of substances. And the states and their desire to act independently in terms of whether they criminalize or decriminalize.

Then there’s the tension also between the medical use and the non-medical use. And so Colorado has now also passed an initiative to decriminalize psilocybin. And both Oregon and Colorado are playing with this medical, non medical boundary of, is it going to be acceptable?

And again, this is following in the lead of cannabis where we saw initially medical marijuana laws being passed, where you could use it for medicinal purposes. And then it got expanded to personal use and you have dispensaries that are not for medicinal purposes that people can access through.

So I think we’re seeing the same tension playing out, and it raises some concerns primarily from the perspective of people who think they’re using this recreationally, but they’re really, or claim to be using it recreationally or obtaining it recreationally.

But then using it for medicinal purposes or they’re self-diagnosing and self-treating and I think that can, potentially have some safety concerns associated with it if there’s not appropriate oversight by a medical professional or somebody else.

CHAKRABARTI: Yeah, you know what’s so fascinating to me Professor McGuire is in preparing for today’s conversation, I watched that entire 1967 documentary I referenced at the top of the show, “World Tomorrow,” where they featured conversations with Allen Ginsberg, Timothy Leary, other researchers and researchers from the ’60s.

There’s also a totally wild scene in the middle of it. Of a Colorado, speaking of Colorado, of a Colorado mom in 1967 with three children who like was regularly taking LSD every two weeks, in fact, she and her husband. And it was really helping them deal with not only the tensions of their current life, but unresolved things from their past.

But I point this out because she also mentions that her youngest child had gotten ahold of the equivalent of six adult doses of LSD and took it. And was this tiny kid on a trip for half a day. And she seemed okay with it. But it got me thinking, we’re seeing, in 2023, there were just a bunch of reports that came out about the rise in children being admitted to hospitals for having taken edibles of cannabis when they shouldn’t have.

Do you have thoughts about when these things become more accessible, that it’s not just the adults, but we have to also think about other people who might get their hands on it.

McGUIRE: Yeah. So absolutely. That’s very concerning. I do think we need to have protections in place and obviously that’s true with all pharmacologics, right?

You don’t want children getting their hands on any type of substance. And taking a bunch of pills or something like that. But it’s interesting that you mentioned that. Because there’s actually been a couple of news articles that have come out over the last year or so that have talked about these more mainstream uses of psychedelics even now.

So there was one article that talked about how young mothers are micro-dosing to try to deal with the stressors of having little kids and then there was an article talking about how Silicon Valley companies may be encouraging psilocybin retreats for their employees in order to expand creativity or enhance creativity.

And there’s a lot, of course, issues associated with that in terms of the workplace and things like that. But so I think there is some enthusiasm for using these in a more mainstream way. Using these substances to deal with everyday stressors and it does harken back to those stories from the 1960s and raises some similar concerns.

CHAKRABARTI: So microdosing moms and Silicon Valley bros, we’re going to come back to that thought a little bit later, a little earlier, you said that there’s enthusiasm and hope behind the research potential, the renewed research potential of psychedelics, especially if some of them make their way to actually being FDA approved drugs.

And I would say that part of that enthusiasm also comes from the investment potential of a whole new class of drugs that could be developed. So I’m thinking that they’re, just like with cannabis and the supposed green wave of investment, that followed it, will we see, or are we at the beginning of seeing something similar with Psychedelics, Professor McGuire?

McGUIRE: Absolutely. Yeah. There’s been some estimates that the U.S. market for psychedelics will reach almost $11 billion by 2027. So there’s a ton of potential for companies to invest and make money, and I think people are recognizing that and they’re trying to be very creative in the ways in which they can start to position themselves to be leaders in that sector.

CHAKRABARTI: $11 billion in the next four years.

McGUIRE: That’s one of the estimates that I’ve seen in print, so yeah.

CHAKRABARTI: Okay, wow. So that’s what makes this sort of 2023 version of those 1960s tension even more interesting to me, right? Because now we have investment dollars, venture capital and a lot of people who see this as a way to make money as part of the picture. And we spoke to one of those folks, Brom Rector. He runs an investment fund called Empath Ventures. He founded it in 2021. And Empath Ventures invests only in businesses related to psychedelics. Their goal is to raise $10 million, and Rector says they’re halfway there. And they’ve invested in 12 companies so far.

BROM RECTOR: Some of those are basically what you might characterize as pharmaceutical companies that happen to be working with psychedelics. These are companies that are trying to get psychedelics that we all know and love approved by the FDA as treatments for things like depression and anxiety and PTSD.

Some of these companies are trying to invent new psychedelic drugs. We invested in a clinic down in Mexico that is using psychedelic therapy to help people break their opiate addiction. We invested in a company that makes music to accompany psychedelic therapy and ketamine therapy. Obviously, we expect to make some kind of positive return.

CHAKRABARTI: And Brom Rector also told us that he believes psychedelics offer way more investment potential than even cannabis.

RECTOR: The world of psychedelic molecules is massive. Rather than betting on the success of a single plant, it’s almost like using the investing analogy.

It’s almost like psychedelics is a portfolio of different molecules. If it turns out that one of these drugs ends up not being popular, there are still hundreds of other ones that have a chance at becoming adopted broadly.

CHAKRABARTI: So that’s Brom Rector who runs an investment fund called Empath Ventures.

Professor McGuire, what impact do you think investors could have on the research and development of the use of psychedelics?

McGUIRE: Huge impact, right? Commercial interest always has a large impact on the way that things evolve because there’s a lot of power and there’s a lot of motivation when you’re dealing with money.

I think it’s interesting because there’s two potential ways that this could go forward. And this harkens back to that tension between state regulation and legalization, and widespread sort of social distribution of these substances and more controlled clinical trials for therapeutic use.

So the tension there is that the more widely available these substances become, the more difficult it becomes to conduct these controlled clinical trials to better understand their therapeutic potential. Because it’s difficult to enroll people into randomized clinical trials, for example, if they can just go to their local dispensary and get access to a drug, as we said earlier.

And that sort of compromises our ability to build a solid evidence base. So the two sort of areas of commercial potential deal with FDA approved drugs and pharmaceuticals, which is a huge market, right? So if you have FDA approved drugs for treatment of mental health disorders, which one in five Americans suffer from now, then that’s a huge potential from a therapeutic perspective.

There’s also commercial potential associated with more mainstream widespread access through local dispensaries that’s nonmedicinal. And it’ll be difficult for both of those sectors to develop at the same time for the reasons that I stated before, but I think there’s investment in both sides.

CHKRABARTI: Yeah, you were just saying what I was about to add, that there’s big money on both sides pushing equally on the research side. We just got 30 seconds before our next break. Those investors don’t have a ton of tolerance for super long timelines for new drug development. Do you think that could have an impact on the kind of research or the pressures that the researchers feel who are reentering the world of psychedelics?

McGUIRE: Yeah. It’s really expensive to bring a new drug to market, right? And it does typically take quite a long time. So there’s a lot of pressure to move things quickly and to make sure you’re picking the right targets.

This article was originally published on WBUR.org.

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