calling for a psychedelic revolution. ALEX TROCHUT INSIDE THE...
Transcript of calling for a psychedelic revolution. ALEX TROCHUT INSIDE THE...
02.07.19 07:00 AM
INSIDE THE PUSH TO LEGALIZEMAGIC MUSHROOMS FORDEPRESSION AND PTSD
Activists, entrepreneurs, and doctors in the US and Canada are working to decriminalize psilocybin psychotherapy andcalling for a psychedelic revolution. ALEX TROCHUT
WHEN TODD’S PSYCHIATRIST suggested hestart taking psychedelics, he figured itwas a joke.
IT WASN’T. THE former corporate executive from Colorado retiredin 2006 after an MRI revealed his spine was riddled with a dozentumors called hemangiomas, which later spread to his brain.Todd was told he would die before the end of 2008.
Somehow, Todd has survived—he credits medical marijuana,which he now uses daily—but he is still considered terminal. “Itcould be tomorrow. It could be five years from now,” he says in acall.
However, the 54-year-old spent the past decade plagued by a hostof mental health problems, including PTSD and treatment-resistant depression. He was suicidal and tormented by violentnight terrors. Nothing, not even massive doses of Xanax orValium, could temper his panic attacks or end-of-life anxiety.
“My mental condition was deteriorating rapidly, and I was on[antidepressant] medication No. 14 and it wasn’t working,” Toddsays. “My psychiatrist said, ‘I honestly think you're a bigcandidate for psychedelics.’”
That was about a year ago. Todd began taking homegrownpsilocybin, the highly illegal alkaloid in so-called magicmushrooms. Known for prompting profound hallucinations,psilocybin was placed in the restrictive Schedule I category in1970, meaning the US government recognizes no medical use forthe drug and says that it carries a high risk of abuse.
Todd says there have been clear benefits from psilocybin withfew side effects. He hasn’t had a single PTSD episode since hebegan taking it. His depression evaporated. The mushrooms evenhelp ease the pain—agony that feels like being “shot in theback”—from the nerve-crushing tumors in his spine and skull.
“It’s knocked that out, it’s wiped that slate clean,” Todd says. Theday before we talked, he’d eaten eight grams of fungus. A heavydose is considered five grams, so this was no psychedelic snack—but Todd ingests this much about every week.
The experience is positively hypnagogic, allowing trippers toenter a dreamlike conscious state where time is distorted, color isamplified, and depth perception is warped. Euphoric, unbridledlaughter is common, as are oddly introspective thoughts aboutexistence and reality, and even synesthetic sensations, such asbeing able to “see” sounds. A trip can last four to six hours.
There can be negative effects as well, such as nausea, dizziness,paranoia, or panic attacks, but Todd doesn’t experience those. Hestill takes 10 milligrams of escitalopram, an antidepressant, andwhen the mushrooms wear off, 30 milligrams of the opioidoxycodone, but otherwise his prescription drug intake hasdrastically decreased.
Todd asked me not to use his real name, fearful that his healthinsurance provider could sever benefits because he uses illicitsubstances. But his doctors are aware and supportive of hispsychedelic drug use, he says, which may legally exempt himunder the federal Right To Try Act for terminally ill patients,signed by President Trump last May.
Indeed, magic mushrooms are having a therapeutic moment. InNorth America, at least four organizations, each with uniquestrategies, are working to expand access to psilocybin for anyonewith mental health issues, dying or not. These groups hope toundo decades of psilocybin prohibition by removing criminalpenalties for possession or cultivation, or by providing access topsilocybin in a therapist’s offices, or both.
They cite a small but growing body of research suggestingpsychedelic drugs can, in fact, be medically beneficial with lowpotential for addiction or abuse. Some small studies suggest thatpsilocybin can alleviate obsessive-compulsive disorder,treatment-resistant depression, end-of-life anxiety, addiction,cluster headaches, and, yes, relieve pain. There’s also growingevidence that ingesting the drug can promote optimism andprosocial and mystical worldviews, and nurture well-being.
In just a few years, pockets of psilocybin-legal jurisdictions couldappear, following the similar path that medical marijuana took tomainstream acceptance. The leaders of this movement includeCompass Pathways, a UK startup developing psilocybin therapyfor treatment-resistant depression in North America and Europe.
There are also two psilocybin grassroots movements, one inOregon and another in Denver. If voters approve the OregonPsilocybin Service Initiative in 2020, the state would develop alicensed psilocybin therapist industry and lower criminalpenalties for growing or consuming mushrooms. Denver cityvoters may also get to decide whether to decriminalize personalpossession and use of mushrooms—a voter initiative justgathered enough signatures to appear on the May ballot.
Finally, there’s TheraPsil, a group of seven Canadian health careprofessionals who formally announced their intent to challengethe illegality of psilocybin by petitioning Health Canada to allowaccess to mushrooms in a medical setting for terminal patients.
These little saprophytes—organisms that devour dead ordecaying organic matter—are indeed enjoying a resurgence inpopularity. But there are still numerous obstacles beforepsilocybin goes from black market hallucinogen to psychedelicmedicine.
THE SWISS CHEMICAL company Sandoz began in 1886 as a dyemanufacturer, later pivoting to pharmaceuticals. But in 1947,with the help of one of their lead scientists, Albert Hofmann, thebusiness began producing a psychiatric drug they called Delysid.Most people know it as LSD.
The psychedelic showed promise for treating mental healthproblems, but an LSD trip can last eight to 12 hours, so Sandozsought a shorter-acting alternative. In 1958 Hofmann became thefirst to isolate psilocybin from mushrooms, subsequentlydeveloping a synthetic version called Indocybin. He first tried iton himself. Indocybin was safely marketed from 1961 until a risingcultural backlash against psychedelics led Sandoz to discontinuesales in 1966.
Now, more than 50 years later, a company is looking to pick upwhere Sandoz left off. Compass Pathways was founded in 2016 byGeorge Goldsmith and Ekaterina Malievskaia, a married couplefrom London with little experience in the pharmaceuticalindustry. When their son developed treatment-resistantdepression and OCD, they were desperate for help.
“The more they were treating him, the worse he was getting,”Malievskaia says in a call. So they took matters into their ownhands. They began looking into scientific reports that psilocybincan rapidly reverse symptoms of depression for patients whohave tried other approaches without results. And unlike Todd,these patients took only a single dose, not one per week.
Compass, which has reaped about $31.5 million in Series Ainvestment, is conducting two studies to see how viablepsilocybin is for psychotherapy. The first, due to finish in early2019, is a double-blind placebo-controlled trial planned with 90healthy volunteers to evaluate cognitive and emotional function.The study is also helping to train Compass’ therapists.
The Food and Drug Administration recently granted the company“breakthrough” therapy status for its second study, givingCompass priority review, following approval in August of a phaseIIB clinical trial, designed to establish proper dosing.
The study is recruiting 216 participants across North America andEurope, making it the largest clinical psilocybin trial to date.Patients meet with a therapist to prepare, then are later givensynthetic psilocybin, which can cost upward of $7,000 per gram,while being monitored for the duration of the trip. Afterward, thetherapist helps patients process the experience. If successful,these trials could lead to psilocybin therapy becoming legal in theUS by 2021.
Compass began as a nonprofit, but after realizing this researchcould cost an estimated $300 million, the company shifted to afor-profit model. That transition and other moves have drawnsharp criticism from some in the psychedelic community. AQuartz article published in November aired the concerns ofnumerous critics of Compass, who claimed that the company wasbacked by dubious investors and was attempting to monopolizemagic mushrooms.
About a quarter of Compass is owned by Atai Life Sciences, abiopharmaceutical startup founded in 2018 by entrepreneurChristian Angermayer. One of Atai’s backers is PayPal cofounderand tech mogul Peter Thiel, who has come under fire for helpingbankrupt Gawker via a lawsuit, donating money to PresidentTrump, and selling surveillance tech to various governments forcountering terrorism and policing migrants.
Malievskaia dismisses the criticism of Thiel. He has no say inCompass’ business operations, she says. “Peter is not one of themajor investors. Personally, I think it's an excellent use of hismoney,” she says. “We don't screen investors based on theirpolitical convictions or what skeletons they have in their closets… It’s an equal-opportunity investment, and we are in charge ofour mission, vision, execution.”
Because it occurs in nature, it’s not possible to patent psilocybin,but it is legal to patent a synthetic manufacturing process, whichCompass has done. To manufacture psilocybin in large quantities,they solved about 60 different technical problems, a project thatcost about $750,000, according to Malievskaia. Switching to afor-profit strategy was a “very logical development,” she says.But some have interpreted this as Compass trying to corner thepsilocybin market or prevent others from researching it.
“It doesn't mean that we patented psilocybin as a molecule,”Malievskaia says. “Anyone can make it in many different ways: 3Dprinting, growing on yeast, genetic engineering … This is notblocking anyone. Investigators who want to use our product, weshare it free of charge in exchange of providing safety data.”
WHILE THE US federal government has long held that psilocybin isdangerous, scientific evidence says otherwise. In the Novemberissue of Neuropharmacology, a team of Johns Hopkins UniversitySchool of Medicine researchers argued that under the ControlledSubstances Act’s own criteria, psilocybin should not be Schedule Ibut the much less restrictive Schedule IV.
The grassroots movements in Oregon and Denver are citing thisand other research in the hopes of removing local penalties forusing or growing mushrooms.
The first to appear was the Oregon Psilocybin Society, founded bymarried therapist couple Tom and Sheri Eckert of Beaverton, whowere inspired by—what else?—a personal mushroom experience.Their initiative would not only drastically reduce penalties forusing or possessing psilocybin, it would create a state frameworkfor therapists to become licensed psilocybin administrators, nottoo unlike Compass.
In other words, you wouldn’t be able to walk into an OregonCircle K and get an eighth of shrooms. But if you believed thatpsilocybin, synthetic or from mushrooms, could help your mentalhealth—or heck, even if you were just curious about what theexperience is like—there’d be options. Getting insurance to coverit would be another issue entirely, of course.
The state attorney general recently approved OPS’s ballot title, sothey now have until July 2020 to gather about 117,000 signatures.Then, during the next presidential election, Oregon voters willdecide if this program is right for them. OPS hired a marketingresearch firm to test the waters and found that 47 percent ofvoters were in favor of their campaign with 46 percent opposed.That number rose to 64 percent when pollsters explained detailsabout the initiative, with 54 percent in support ofdecriminalization.
So far, OPS has experienced no opposition, they say, butanticipate some backlash once the question is on the ballot.
“We suspect that Big Pharma is not gonna like this idea,” Sherisays in a call. “If you can treat an individual and it actually healsthem and they no longer need to be daily dosing psych meds—that definitely impacts their budget.” She and others note thatpsilocybin could help ease the enormous financial cost of mentalhealth disorders, which make up about 10 percent of the globalburden of disease. (The market for depression medicine alone isexpected to be worth $16.8 billion worldwide next year.)
The Eckerts are wary, but not completely distrustful, of biggerplayers like Compass. “We don't want to see it locked up inhospitals, costing impossible amounts of money,” Tom says. “Themarket has to play out in some way, but we are doing everythingwe can to make this a community-based framework.”
The ordinance proposed by Decriminalize Denver, the pro-psilocybin movement in Colorado, wouldn’t provide a system forpublic sales or psilocybin therapy, but for anyone 21 and over,personal use and possession of psilocybin would carry the lowestlaw-enforcement priority. The group’s ballot initiative, which hasbeen endorsed by the local Libertarian and Green parties, wouldalso prevent the city from spending any money to imposecriminal penalties. (Despite living in Colorado, Todd, thepsilocybin patient, would not be affected because the law wouldapply only to Denver.)
After the local elections division approved their ballot initiativein October, Decriminalize Denver gathered and submitted morethan 8,500 signatures, almost double the required number. About5,500 were accepted, meaning on May 7, 2019, city voters maydecide whether to decriminalize personal possession and use ofmushrooms.
The mile-high town is historically progressive on drug use: It wasthe first US city to legalize marijuana, in 2005, and in 2018 thecity council voted in favor of overdose prevention sites for drugusers to use narcotics like heroin under medical supervision. Thatlaw is pending state approval. Denver mayor Michael Hancock haswalked back his support for supervised drug use and also doesnot support the psilocybin proposal.
Contrary to popular belief, Denver would not be the first NorthAmerican locale to decriminalize mushrooms. In 2005, a NewMexico Court of Appeals ruled that growing mushrooms forpersonal use doesn’t technically count as drug manufacture, soeven sprouting psilocybin in your dorm room isn’t illegal.Louisiana also exempts the cultivation of psychoactive plants andfungi “strictly for aesthetic, landscaping, or decorativepurposes.” Nonetheless, Denver’s precedent on other drug issueshas made folks like Kevin Matthews, the DD campaign director,optimistic that voters will reward his efforts.
“We talk to people all the time who say ‘Mushrooms have savedmy life, mushrooms saved my marriage, mushrooms have brokenme out of my depression, mushrooms are the only thing thatworks for my cluster headaches,’” Matthews says in a call. “I hada gentleman who signed the petition the other day who said it'sthe only thing that works for his wife's polycystic kidney disease.I had never even heard that one before.”
Meanwhile, in British Columbia, a team of seven health careprofessionals are gearing up for a legal fight in the hopes oflegalizing psilocybin for terminal patients with end-of-lifedistress. About eight years ago, Bruce Tobin, a psychotherapistwith 35 years of experience practicing in Victoria, BritishColumbia, was approached by one of his patients who desperatelyrequested psilocybin therapy. She had survived cancer, butcouldn’t shake the debilitating psychological suffering she hadexperienced with her diagnosis.
“She had tried everything: medicines, therapists, $1,000-per-dayresidential treatment programs. Nothing had worked,” Tobinsays in an email. But what she was asking was still very illegal.Rather than break the law, Tobin decided to change it.
“I discovered,” Tobin explains, “I could apply for a so-calledSection 56(1) exemption that would excuse me from theprovisions of the Canadian Controlled Drugs and Substances Act,allowing me to legally use psilocybin in cases where it was‘necessary for a medical purpose.’”
Thus, TheraPsil was born. The organization is petitioning theCanadian health authority to make psilocybin availablemedicinally, but only for people with dire need, similar to a trialplanned in Melbourne, Australia this April. Tobin filed hisapplication with Health Canada in January 2017, and it has been aslow road ever since, he says. Six other psychotherapists andmedical professionals have since joined his efforts.
“If they decline to approve our application, our path forward isclear,” Tobin says. “Our legal counsel will file for a judicial reviewof Health Canada’s decision. If that is unsuccessful, we plan to goto the Federal Court of Appeals using the same arguments basedon the Canadian Charter of Rights and Freedoms that weresuccessful in compelling the government to change federal law toallow for patients’ access to medical cannabis. We are feelingconfident.”
“There have been few, if any, real breakthroughs in the lastquarter century in the development of psychiatric medicines,”Tobin adds. “Psilocybin promises to be a real game-changer.”
Indeed, it may not be long before psilocybin is legally available,one way or another, in various parts of the globe. As RobinCarhart-Harris, a leading psilocybin researcher, recently put it atthe most recent World Economic Forum meeting, “The climate’slooking good.”
Like an underground hyphal knot, these efforts could form intofat, juicy mushrooms—the fungal fruits from decades ofcombined political, scientific, and social justice campaigns tobring psilocybin into the light.
Troy Farah is a reporter from the High Desert, California. His
reporting has appeared in Ars Technica, Smithsonian, DiscoverMagazine, VICE, and others. He can be found on Twitter
(@filth_filler or at troyfarah.com
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