Somewhat buried among the more obvious Election Day news about races too close to call was that of drug-related ballot measures — with New Jersey, South Dakota, Montana and Arizona voting to legalize recreational marijuana (and Mississippi’s votes on the matter still being tallied), and Oregon becoming the first state to decriminalize small amounts of other drugs, including cocaine, heroin and methamphetamine.
Separately, Oregon voters approved Measure 109, legalizing psilocybin — the main chemical property of psychedelic mushrooms — for therapeutic use in a supervised setting, with the aim of treating depression and other mental health conditions.
“With Measure 109, we have planted the psychedelic flag, respecting the ancient traditions while blazing a trail into the future,” noted Tom and Sheri Eckert, the husband-and-wife therapist couple behind the long push for psilocybin legalization, in a Wednesday Facebook message to supporters on their Oregon Psilocybin Society page.
The post from the duo, who could not be reached by Yahoo Life for comment, continued, “While bringing deep healing to Oregon, Measure 109’s passage ends the most persistent taboo — the taboo surrounding ourselves, our inner realms, our freedom to safely explore our own consciousness. … Psilocybin therapy is not a singular panacea for what ails us or our world. But there is a unique significance. Oregon has done something important here.”
Indeed, one of the foremost leaders in the field of therapeutic psychedelics research, David Nutt, the Edmond J. Safra Professor of Neuropsychopharmacology at Imperial College London, tells Yahoo Life he is “delighted” to hear the news from Oregon, which brings with it an “immense” potential to help people struggling with depression and other issues.
Michael Pollan, author of the bestselling How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence, weighed in on Twitter, calling Oregon’s news “a big deal.”
A big deal. Psilocybin initiative passed too. Congratulations https://t.co/h16X795nvQ
— Michael Pollan (@michaelpollan) November 4, 2020
The measure’s passage has come at the same time as the results of a breakthrough clinical trial on the drug’s effectiveness in adults with major depressive disorder, published Nov. 4 in JAMA Psychiatry. In the results of the study — the first such randomized trial — researchers note that two doses of lab-synthesized psilocybin capsules, given in tandem with supportive psychotherapy, produced “rapid and large reductions in depressive symptoms,” with most participants showing improvement and half of the study participants achieving what appeared to be remission after four weeks. (In 2016, Johns Hopkins researchers first reported that supportive psilocybin treatment significantly relieved a more “reactive” form of anxiety and depression in people with a cancer diagnosis.)
Although the U.S. Food and Drug Administration has not approved psilocybin, it has twice now given it the designation of “breakthrough therapy” — a process designed to expedite the development and review of drugs meant to treat a serious condition where there is preliminary clinical evidence indicating “that the drug may demonstrate substantial improvement over available therapy,” according to the FDA.
That’s sure to help with approval, but how the new law will play out in Oregon — particularly regarding how treatments will be regulated and overseen — remains to be seen, Matthew Johnson, associate director of the John Hopkins Center for Psychedelic and Consciousness Research, tells Yahoo Life. “The initiative itself is really about the initiation of a process,” he says. “There’s a whole lot to be figured out.”
He adds that the new Johns Hopkins findings are “very encouraging,” and, in the meantime, other clinical trials of the drug for depression are ongoing at research centers across the country (with ClinicalTrials.gov showing 18 currently happening). Johnson is working on funding a similar trial for the drug’s effects on posttraumatic stress disorder (PTSD). The U.K.-based Compass Pathways is also in the midst of a large-scale clinical study. Here’s what we know so far about the benefits — and risks — of therapeutic psilocybin.
It’s not addictive
“There is a common misconception that these drugs are addictive,” Nutt tells Yahoo Life about psilocybin and other psychedelics. “They are not. In fact, they are anti-addictive. They are not dangerous.”
Johnson concurs, noting that psilocybin “doesn’t appear to be addictive in any sense.”
Still, he says, there are two main risks: “There is the potential for people with psychotic disorders or other severe disorders [such as possibly bipolar disorder] to be worsened,” he says, adding that “a psychedelic experience could exacerbate and even precipitate those illnesses in those with the disposition.” (So, the “urban legends” people have been hearing since the 1960s of “people going on a trip and never coming back” could have been individuals who had such a predisposition, as has been theorized about Syd Barrett of Pink Floyd.)
Another big risk of psilocybin therapy? “The bad trip,” Johnson notes, adding that “what’s truly bad is when people panic and do something and get themselves hurt.” There’s also “the cardiovascular possibility,” as the drug has the potential to raise one’s blood pressure or heart rate, but that it’s not so different from the severely vulnerable seeing a heightened blood pressure from things like “walking upstairs, shoveling snow or having sex.”
It’s why there are strict safeguard measures in place for clinical research trials — and why of potential concern for him in Oregon is whether or not therapists there will follow the same protocol. “If there are adverse outcomes,” he says, “then John and Jane Public could look at that and say, ‘Oh, I thought I read all this promising stuff with these research trials. I guess not.’”
The drug yields effects quickly, lasts longer
Compared with pharmaceutical antidepressants — SSRIs like Prozac and Zoloft — it is “much faster acting … takes immediate effect rather than taking several weeks to work,” says Nutt. Plus, the effects seem to last longer, for weeks or even months, he says, noting that “they work [against depression] with just a single dose and no need to be taken daily. Indeed, if they are used daily, their effects wear off.” That could also minimize side effects as compared with those of antidepressants.
It works in a completely different way than antidepressants
In his 2017 study “Serotonin and brain function: a tale of two receptors,” published in the Journal of Psychopharmacology, Nutt proposed that the neurotransmission of serotonin — a brain chemical considered a natural mood stabilizer — enhances two distinct reactions to adversity, as mediated by two separate brain receptors: One, when targeted by traditional antidepressants (SSRIs), enhances the brain’s ability for “passive coping,” while the second, when targeted with psychedelics, enhances “active coping,” or “actively addressing a source of stress.”
The idea of two receptors, the study notes, “purports to explain how different drugs (SSRIs and psychedelics) that modulate the serotonergic system in different ways, can achieve complementary adaptive and potentially therapeutic outcomes.”
Put more plainly, Johnson explains, “We’re still figuring out how it works. But the million-dollar question that we don’t have a definitive answer to yet is how is their brain potentially different — along with the psychological change — long-term” after psilocybin treatment?
One thing that is known, he says, is that when a patient is on the drug, “one of the most relevant effects is that brain areas that don’t usually communicate with each other are communicating more,” he says. “There are massive shifts in the way the brain communicates, and likely that has something to do with [positive effects on depression] — like increased personality openness and increased flexibility, which likely relate to the long-term benefits.”
In fact, Johnson likens the therapeutic effects of the drug as being “more like psychotherapy than traditional medicines,” in that the patient “is learning something from their experience. … It’s temporary medication, but what it’s probably doing is instilling the changes you more likely see from therapy — broadening perspective, openness — in the right, supportive context.”
As Pollan reported in How to Change Your Mind, those who had found relief from depression with psilocybin told him, “It was like a holiday away from the prison of my brain. I felt free, carefree, reenergized,” and, “It was like the light switch being turned on in a dark house.”
Bottom line, Johnson says, “There’s something there — though we don’t want to get ahead of the data — that’s definitely worthy. It’s very promising.”
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