CANADA The dangerous hype around psychedelics as a treatment CANADA
The dangerous hype around psychedelics as a treatment for mental illness
One of the things Prince Harry reveals in his tell-all memoir Spare is that he has sometimes turned to psychedelic drugs to ease his mind.
Along with getting therapy for his mental distress, he tried nibbling magic mushrooms and quaffing ayahuasca. Discussing the book with Anderson Cooper on 60 Minutes, he said that though he does not endorse the recreational use of psychedelics and they must be taken with the “right people,” if “you are suffering from a huge amount of loss, grief or trauma, then these things have a way of working as a medicine.”
The Prince is just the latest celebrity to say he derived some good from psychedelics, the family of drugs that are being hailed as a promising treatment for mental illness and addictions. But do they actually work? As the psychedelics boom rolls on, skeptical scientists and doctors are starting to say: hold on.
Research into the therapeutic value of the drugs is still in its infancy. Many of the claims about them – that they rewire the brain, that they help people conquer their inner demons – remain unproven. Most psychedelics are still not approved for medical use, though Health Canada can grant special permission for research, therapy and end-of-life care. Years of painstaking trials lie ahead before they are cleared or, like cannabis, legalized, if they ever are.
“The evidence for the efficacy of psychedelics is minuscule compared to the hype,” says Tyler Black, a professor in the University of British Columbia’s department of psychiatry.
That hype is everywhere these days. Clinics offering therapy using ketamine – a drug, sometimes known as K or Special K, that can produce an out-of-body experience – are popping up in Canadian cities. Some Vancouver dispensaries now sell magic mushrooms openly, ignoring the fact they are prohibited by the Controlled Drugs and Substances Act. A host of online outlets sell them, too, delivering neatly packaged shrooms promptly to the consumer’s doorstep.
Universities all over the world are investigating the potential of psychedelics. In Canada, UBC, Queen’s and the University of Toronto are among the institutions that have jumped on the bandwagon.
A flood of documentaries covers every aspect of “the shroom boom.” In Fantastic Fungi, mushrooms are portrayed as a miracle organism with the power to cure our bodies and minds. On an episode of the Gwyneth Paltrow Netflix series The Goop Lab, the wellness magnate and her team explore psychedelics as “a healing modality.”
Private companies with names such as Havn and Numinus are getting into the game, hoping for a bonanza like the legalization of cannabis. There are even psychedelic resorts for those struggling to get sober.
Proponents claim that once-taboo substances such as MDMA, psilocybin, ayahuasca and ibogaine could help free countless sufferers from the agonies of mental illness and addiction. MDMA, the party drug known as ecstasy or E, is said to help with therapy for post-traumatic stress disorder; psilocybin, the compound present in magic mushrooms, for bipolar disorder and treatment-resistant depression. Ayahuasca, a hallucinogenic drink brewed by Indigenous peoples in South America, is supposed to aid in the recovery of those struggling with a dependence on alcohol or drugs. Ibogaine, a compound extracted from the bark of an African shrub, is touted for alcohol and drug detoxification.
It is no mystery why these novel treatments hold such appeal. Many Canadians struggled to maintain their mental and emotional health during the COVID-19 crisis. Drug overdose deaths soared. “There is enough pain out there that we’re looking for alternatives and this is a promising one,” says Jim Parker, a successful natural gas trader who got interested in psychedelics when a niece with mental-health challenges found relief with ketamine. He founded Calgary’s Bloom Psychedelic Therapy and Research Centre, which offers carefully administered ketamine-assisted therapy under the guidance of trained therapists and doctors.
“By their definition, psychedelics uncover the deeper parts of our mind, where limiting beliefs and repetitive patterns reside,” the Bloom website says.
The danger is that all of this raises the hopes of the afflicted, only to let them down with a thump.
Jonathan Stea, a clinical psychologist at Calgary’s Foothills Medical Centre, says that though psychedelics research is fascinating and the potential worth investigating, so far, “the science is not great.”
He says that some of those who get psychedelics-assisted psychotherapy may show improvement simply because they get a lot of therapy, not because the drug unlocks their trauma or changes their brains.
Any benefits of psychedelics, he said in an e-mail response, must be weighed against “the reality of potential harm and unintended consequences, such as side effects and the promotion of self-medicating,” at the expense of “more established, evidence-based treatments.”
Vincent Lam, a Toronto addictions doctor who is also an award-winning novelist, says psychedelics might one day prove to be effective for treating substance-use disorders, “but the emphasis really has to be on the ‘might’ at this point.”
“It really is going to require a lot more research and also well-designed research, in order to determine, first of all, whether it can be useful and, secondly, in specifically what ways,” he says.
Some of his patients have tried psychedelics treatment, but continue to suffer from substance-use disorder. “Whether or not it actually helps to treat the kinds of addictions that I am treating, clinically, is far from clear.”
Some studies, he says, don’t follow the research subjects for long enough to show whether the effects of psychedelics are lasting. In the case of ketamine for depression, he says, the effects would seem to last only for a week or two.
Other studies suffer from a different defect. To tell whether a drug really works, researchers usually give some study participants a placebo such as a simple sugar pill, then compare the effects they report against the effects reported by those who took the genuine drug. That’s hard to do with psychedelics; it’s pretty obvious to participants whether they are having a psychedelic trip or not.
Matthew Burke, a cognitive neurologist at Sunnybrook Health Sciences Centre and the University of Toronto, pointed to the issue in a 2021 article in the journal Nature Medicine, titled Caution at Psychiatry’s Psychedelic Frontier. In an interview, he called it a “huge, huge problem” with psychedelics research, evident in recent studies on psilocybin and MDMA. “If you look at any other field in medicine, that would be a complete violation of the principles of the clinical trial,” he said.
At the Centre for Addiction and Mental Health in Toronto, researchers are keeping a close eye on the psychedelics boom. CAMH just got a federal grant to study whether psilocybin can ease depression.
“We think it’s very important not only to assess whether these drugs work but also to understand how they work and for who,” says clinical scientist Ishrat Husain. “These are all unanswered questions.”
He says “rigorous” research is needed before doctors and therapists start using psychedelics to treat patients on a regular basis. He is troubled that clinics offering ketamine-assisted therapy have started popping up in Canadian cities “without much in the way of robust evidence from clinical trials.”
Some skeptics say that psychedelics are just riding the wave of the wellness movement, which values all things natural and organic and puts less stock in dull old science. “There is this idea that they are somehow exotic and ancient and that this makes them a more credible treatment,” says Timothy Caulfield, a University of Alberta professor who specializes in debunking health misinformation.
That they have been banned for so long just adds to their cachet. “The feeling is: They were suppressed by The Man. Now they’re available, so let’s start using them,” Prof. Caulfield says.
Other skeptics say the commercialization of psychedelics is fuelling the inflated hopes. Companies that are setting up clinics or hoping to market future psychedelic therapies and compounds are likely to oversell their potential and overinterpret the research, they argue. Prof. Black of UBC says that there is a gold-rush atmosphere around psychedelics, much as there was when cannabis was legalized. Though the field has a counterculture, anti-corporate vibe, much of the interest is being driven by a hunger for profit. “The big driver here is not scientific interest but money,” he says. “It’s a huge industry and it’s growing fast and this is just rife for people being exploited for their dollars.”
His UBC colleague Nickie Mathew, a specialist in addiction psychiatry, says that, before long, there is bound to be a backlash. “Pretty soon we are going to be hit by some sobering results and then we are going to have a more realistic view of these drugs,” he said. “We should really do the painstaking studies and figure out what the actual upsides and downsides are and not assume we know before those studies have happened.”
The most arresting note of skepticism about the psychedelics boom comes from the Johns Hopkins University School of Medicine. Researchers at the school’s Center for Psychedelic and Consciousness Research pioneered the study of psychedelic drugs to treat addiction, mental illness and other conditions. But in August, a trio of Johns Hopkins scholars warned that the recent surge in interest in the therapeutic uses of the drugs was getting out of control.
“Psychedelic research currently appears to be trapped in a hype bubble driven largely by media and industry interests,” said a paper by David Yaden, James Potash and Roland Griffiths in JAMA Psychiatry, a journal of the American Medical Association. Though they say they still believe that the substances have great promise, they caution that “in the past few years, a disturbingly large number of articles have touted psychedelics as a cure or miracle drug. … The potential for blowback is real.”
Prof. Yaden said in an interview that though several studies have suggested psychedelics hold promise as a mental-health tool, one recent paper on the use of psilocybin for depression showed only marginally better results than a traditional anti-depressant medicine. There is a lot of “loose talk” about how psychedelics can change the brain, he said. Much more study is needed, with large samples and control groups.
Views on psychedelics tend to be polarized, Prof. Yaden said. “After decades of extreme alarmism and over-the-top negativity, now we’ve had a few years of over-the-top positive statements.” He said he and his co-authors feel “cautious optimism” about the drugs, “with the understanding that there are real risks, and these are not panaceas or cures.”
The risks are real enough. Heavy ketamine use can lead to bladder damage. Ibogaine can cause irregular or slowed heart rates. Psychedelics users can sometimes have bad trips that cause them more of the very mental trauma they are trying to escape, especially if they use the drugs at home, at a party or through an underground outfit without a therapist on hand to monitor them. A recent University of Melbourne study showed that about two-thirds of a sample group that used ayahuasca experienced adverse physical effects such as vomiting and about half mental-health effects, though the researchers said neither was usually severe.
Jim Parker of Calgary’s Bloom clinic is undeterred. Though he is quick to say that he is not a doctor, that psychedelics are no magic bullet and that much more study is needed, “the data suggests this will help a lot of people.” What he has read and seen tells him that, unlike traditional pharmaceuticals, which appear to numb the pain associated with mental illness and addiction for some, psychedelics can help sufferers gain insights into the root causes. They also appear to help the brain develop “new connections,” which can be seen with neuro-imaging technology.
But the researcher associated with his outfit is not so confident. Leah Mayo holds a chair in psychedelics and mental health at the University of Calgary, a position created with a $3-million gift to the university from Mr. Parker. She calls herself the “resident skeptic.” An American who worked in Sweden on cannabinoid research before she came to Calgary, she worries that, like cannabis, touted as a treatment for everything from glaucoma to insomnia, psychedelics are being seen as a cure-all.
She sees potential and is keen to explore it further, but says research is still in its early days and evidence that they work, though growing, is still minimal.
Like Prof. Yaden, she has doubts about whether psychedelics can “rewire” the brain, a concept she calls little more than a “cool tagline” until solid studies prove it. She also wonders whether some people say they are getting better on psychedelics simply because everything they hear tells them they should get better – the expectancy effect, which researchers often see with treatments for mental health.
“Right now, you know, everyone and their mother thinks psychedelics are going to be the next big thing,” she says.
In a way, they already are. Prince Harry’s book is a bestseller. His remarks about the value of psychedelics for mental health made headlines. Under way for a few years, and gaining momentum with every passing month, the psychedelics renaissance shows every sign of continuing.
Whether it can truly help those who suffer the agonies of mental illness and addiction remains to be seen.
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