Psychedelics: Treatment or Terror?

Over the past couple of decades, the line between inherently perilous substances and therapeutics has been slowly fading, especially when it comes to psychedelics. Psychedelics are a type of hallucinogenic that act on serotonin levels in the brain to alter mood, perception, and many other processes. These drugs work by acting as agonists on 2A serotonin receptors, especially those expressed on apical dendrites of neocortical pyramidal cells in layer V of the brain (Nicholas, 2016, p.1). With this mechanism of action, they increase serotonin levels, which many scientists hypothesize to be a useful trait of the drug class and why, despite the stigma surrounding the drug, psychedelics have potential as a treatment.

Psychedelics have historically been used in therapeutic treatments before modern medicine took an interest in them. In fact, there are murals of mushrooms and people wearing those mushrooms in Saharan regions and Spain. Later, there was evidence of peyote, which contains a potent psychedelic, being used for medicine around 3700 BC (Woolfe 1). Over decades, the practice of ingesting natural psychedelics traveled around the world, showing up in journals and conversations, before reaching the Western world. Many scientists tried the substances they presumed to be psychedelics in the late 1800s to verify that what their peers said about the experience was true and accepting its use as a therapeutic, even recommending the drugs to patients for particular issues. In 1943, Albert Hofmann discovered the first synthesized hallucinogenic, lysergic acid diethylamide (LSD), using it for therapeutics and starting the everlasting controversy about this class of drugs (Carhart-Harris 3). It’s important to understand the variations between the types of psychedelics, with six in total, (there are six in total) to truly comprehend why the scientific community began doubting the effectiveness of the substances. One key factor to all psychedelics is that they are all hallucinogenic substances.

The first is the most commonly known: lysergic acid diethylamide, also known as LSD or “acid.” LSD is made from ergot, a fungus that grows on rye grain. It became illegal in the ‘60s because of its severely harmful effects and was listed as a Schedule I drug, which is considered the most restricted and harmful level of substances. When Hofmann discovered the substance, he began using it as a potential medical treatment until he realized that it was hallucinogenic. Hofmann chose to take around 25 micrograms of the substance and noticed that he had extreme visual hallucinations. Scientists continued using the substance until they realized that there was no real benefit to the drug, at which point it had spread to the general public globally and had created a counterculture of drug use (“The history of LSD - acid,” p. 2). Eventually, powers like the military realized that the substance could be weaponized because of how much it could muddle judgment in whole armies, and was in the process of being more used as a military weapon until it was banned altogether in 1967 (“The history of LSD - acid” 4).

Next up, there’s dimethyltryptamine (DMT), which is found in plants from Central and South America. This drug was commonly used for short-lived experiences, which is why it’s referred to as a “businessman’s trip.” Then, we have mescaline, which is found in the peyote cactus. This is the same substance used commonly in ancient civilizations and is still used by some Native American tribes for rituals. Next, there is ololiuqui, which is found in the morning glory flower’s seeds in Central/South America. This was also used during rituals in some indigenous civilizations. The main difference between this substance and mescaline is that it isn’t a controlled substance, so it’s more widely used and widely available. Another common type of psychedelic is psilocybin or magic mushrooms. This compound is found in many wild mushrooms that grow around the world, but is highly toxic,even lethal, The next type of psychedelic is ketamine, which is still used as an anesthetic even though it can become a hallucinogenic in low concentrations. Finally, there is ecstasy or MDMA, which is less of a hallucinogenic and more of a stimulant. In high quantities, though, it can also cause the delusions of other hallucinogenics. This drug is particularly risky because of the negative health effects it has such as dehydration and hyperthermia.

While psychedelic therapy is still uncommon, there are some medical exemptions to its Schedule I classification. Ironically enough, some psychedelics are used to treat other substance use disorders, especially alcohol dependence. For example, ketamine psychedelic therapy is still widely used for this reason, particularly because ketamine is one of the only psychedelics with a proven medical use. In a study done to test the effectiveness of KPT on alcohol dependence, it was noticed that >50% more of the patients who received KPT had complete abstinence from alcohol after one year (Krupitsky 1). Psilocybin is also being used to treat alcohol addiction, with results showing that those with the drug had “self-reported mean percent drinking days and percent heavy drinking days [that] were reduced by more than half of what had been reported at baseline” (Tupper 5). Psilocybin may also be used to help with tobacco addiction, although this is still a pilot test. Other conditions that may be helped with psychedelics, specifically MDMA and psilocybin, include posttraumatic stress disorder (PTSD) and social anxiety because of their serotonergic impacts.

However, like all controversial agents, there is a significant amount of backlash when psychedelics were first introduced to the scientific community as a possibly beneficial drug, and there are many steps that need to be taken to resolve this dilemma. The main reason for this is that therapists and other medical professionals who may prescribe psychedelics for medical use have an ethical duty to reduce harm to patients, and giving these substances may do the opposite, conflicting with their vow to do no harm. Even so, in some countries, therapists can provide psychotherapy surrounding when a client has their own psychedelic experience (Pilecki, 2021, p.6). While there are risks involved with using psychotherapy, there are some benefits too. If a patient wants the treatment, prescribing it allows patient autonomy and supports their choice to maximize their benefits while reducing overall risks. Additionally, educating patients about the benefits and risks of psychedelics fulfills informed consent, further helping a patient take precautions against currently-existing misinformation about psychedelics As for reducing societal stigma about the drugs, changing strict policies,which also diminish the importance of mental health as psychedelics are commonly used to treat mental health disorders, is a huge step that can be taken. Specifically, psychedelics should be reduced from a category 9 to a category 8 (controlled substance) drug, which will increase their availability (Andrews 11). If research isn’t as restricted as it currently is and the media can make informed assumptions about psychedelics rather than relying on stigma, the future of psychedelic-supported therapy is bright.

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