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Lake S, Lucas P. The Global Psychedelic Survey: Consumer characteristics, patterns of use, and access in primarily anglophone regions around the world. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104507. [PMID: 38936219 DOI: 10.1016/j.drugpo.2024.104507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/24/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Despite advancements in policies governing psychedelic substances globally, our understanding of real-world psychedelic use and its variations across international jurisdictions remains limited. We implemented the Global Psychedelic Survey (GPS) to capture information about psychedelic consumer characteristics, access, and usage patterns around the world. METHODS The GPS was administered online in Spring 2023 to English-speaking adults (≥21 years) who use(d) psychedelics. We categorized survey responses into major catchment regions (Canada/US, Europe/UK, Australia/NZ, All Other). We used descriptive and bivariable statistics to characterize consumers' socio-demographic characteristics, psychedelic access sources, and usage patterns. We examined regional differences in psychedelic use patterns using multinomial logistic regression. RESULTS We analyzed 6379 responses from 85 countries including Canada/US (n = 4434), Europe/UK (n = 771), Australia/NZ (n = 864), and Other (n = 310). Psilocybin, LSD, and MDMA were the most used psychedelics and personal growth was the most common use motive across all catchments. There were significant regional differences in psychedelic use patterns, including types of psychedelics used (e.g., less ibogaine use in Europe/UK and Australia/NZ relative to Canada/US), frequency of use (e.g., lower frequency use in Australia/NZ relative to Canada/US), motivations for use (e.g., less therapeutic use in Europe/UK and Other relative to Canada/US), and types of dosing regimens (e.g., more "micro"-dosing in Canada/US). DISCUSSION In this large sample of adult psychedelic consumers from regions around the world, infrequent psychedelic use centered around life enhancement was common. Respondents indicated preference for legal access via quality-controlled sources. Jurisdictional differences in access and usage patterns likely reflect region-specific regulations and traditional practices. Further research should explore opportunities to increase representation of non-White respondents in psychedelic research via translation of studies into several languages and incorporation of culturally reflective, community-based study development.
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Affiliation(s)
- Stephanie Lake
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Suite 38-418, Los Angeles, CA 90095, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Philippe Lucas
- SABI Mind, 1615 10 Ave SW suite 202, Calgary, AB T3C 0J7, USA
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2
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Nutt D, Crome I, Young AH. Is it now time to prepare psychiatry for a psychedelic future? Br J Psychiatry 2024:1-3. [PMID: 38764044 DOI: 10.1192/bjp.2024.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Australia has just rescheduled two drugs controlled under the United Nations Psychotropic Drug Conventions, psilocybin and MDMA, as treatments for treatment-resistant depression and post-traumatic stress disorder respectively. This feature explores the reasons for these developments, the opportunities and challenges they provide to psychiatry communities and how along with health systems these communities might respond to these developments.
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Affiliation(s)
- David Nutt
- Division of Psychiatry, Imperial College London, UK; and Drug Science, London, UK
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Copa D, Erritzoe D, Giribaldi B, Nutt D, Carhart-Harris R, Tagliazucchi E. Predicting the outcome of psilocybin treatment for depression from baseline fMRI functional connectivity. J Affect Disord 2024; 353:60-69. [PMID: 38423367 DOI: 10.1016/j.jad.2024.02.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Psilocybin is a serotonergic psychedelic drug under assessment as a potential therapy for treatment-resistant and major depression. Heterogeneous treatment responses raise interest in predicting the outcome from baseline data. METHODS A machine learning pipeline was implemented to investigate baseline resting-state functional connectivity measured with functional magnetic resonance imaging (fMRI) as a predictor of symptom severity in psilocybin monotherapy for treatment-resistant depression (16 patients administered two 5 mg capsules followed by 25 mg, separated by one week). Generalizability was tested in a sample of 22 patients who participated in a psilocybin vs. escitalopram trial for moderate-to-severe major depression (two separate doses of 25 mg of psilocybin 3 weeks apart plus 6 weeks of daily placebo vs. two separate doses of 1 mg of psilocybin 3 weeks apart plus 6 weeks of daily oral escitalopram). The analysis was repeated using both samples combined. RESULTS Functional connectivity of visual, default mode and executive networks predicted early symptom improvement, while the salience network predicted responders up to 24 weeks after treatment (accuracy≈0.9). Generalization performance was borderline significant. Consistent results were obtained from the combined sample analysis. Fronto-occipital and fronto-temporal coupling predicted early and late symptom reduction, respectively. LIMITATIONS The number of participants and differences between the two datasets limit the generalizability of the findings, while the lack of a placebo arm limits their specificity. CONCLUSIONS Baseline neurophysiological measurements can predict the outcome of psilocybin treatment for depression. Future research based on larger datasets should strive to assess the generalizability of these predictions.
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Affiliation(s)
- Débora Copa
- Universidad de Buenos Aires, Facultad de Ingeniería, Instituto de Bioingeniería, Buenos Aires, Argentina.
| | - David Erritzoe
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom
| | - Bruna Giribaldi
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom
| | - David Nutt
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom
| | - Robin Carhart-Harris
- Centre for Psychedelic Research, Division of Academic Psychiatry, Imperial College London, London, United Kingdom; Psychedelics Division, Neuroscape, Department of Neurology, University of California, San Francisco, USA
| | - Enzo Tagliazucchi
- Universidad de Buenos Aires, Facultad de Ciencias Exactas y Naturales, Departamento de Física, Ciudad Universitaria, Buenos Aires, Argentina; CONICET - Universidad de Buenos Aires, Instituto de Física Interdisciplinaria y Aplicada (INFINA), Ciudad Universitaria, Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile
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Atiq MA, Baker MR, Voort JLV, Vargas MV, Choi DS. Disentangling the acute subjective effects of classic psychedelics from their enduring therapeutic properties. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06599-5. [PMID: 38743110 DOI: 10.1007/s00213-024-06599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
Recent research with classic psychedelics suggests significant therapeutic potential, particularly for neuropsychiatric disorders. A mediating influence behind symptom resolution is thought to be the personal insight - at times, bordering on the mystical - one acquires during the acute phase of a psychedelic session. Indeed, current clinical trials have found strong correlations between the acute subjective effects (ASE) under the influence of psychedelics and their enduring therapeutic properties. However, with potential barriers to widespread clinical implementation, including the healthcare resource-intensive nature of psychedelic sessions and the exclusion of certain at-risk patient groups, there is an active search to determine whether ASE elimination can be accompanied by the retention of persisting therapeutic benefits of these class of compounds. Recognizing the aberrant underlying neural circuitry that characterizes a range of neuropsychiatric disorders, and that classic psychedelics promote neuroplastic changes that may correct abnormal circuitry, investigators are rushing to design and discover compounds with psychoplastogenic, but not hallucinogenic (i.e., ASE), therapeutic potential. These efforts have paved the discovery of 'non-psychedelic/subjective psychedelics', or compounds that lack hallucinogenic activity but with therapeutic efficacy in preclinical models. This review aims to distill the current evidence - both clinical and preclinical - surrounding the question: can the ASE of classic psychedelics be dissociated from their sustained therapeutic properties? Several plausible clinical scenarios are then proposed to offer clarity on and potentially answer this question.
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Affiliation(s)
- Mazen A Atiq
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Matthew R Baker
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Maxemiliano V Vargas
- Institute for Psychedelics and Neurotherapeutics, University of California, Davis, Davis, CA, USA
| | - Doo-Sup Choi
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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5
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Baldo BA. The entactogen 3,4-methylenedioxymethamphetamine (MDMA; ecstasy) as a treatment aid in psychotherapy and its safety concerns. Arch Toxicol 2024:10.1007/s00204-024-03765-8. [PMID: 38743292 DOI: 10.1007/s00204-024-03765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
The phenylethylamine, 3,4-methylenedioxymethamphetamine (MDMA, 'ecstasy'), is the prototypical example of an entactogen. Its original placement in highly restrictive drug usage categories in the US and UK, led to an inevitable restriction on MDMA neuroscience research and treatment. The dominant pharmacological effects of MDMA are its properties of release and inhibition of reuptake of amine neurotransmitter transporters for dopamine, norepinephrine, and serotonin. MDMA is an agonist of a wide range of receptors; its mood-altering effects are mediated via 5-HT2A receptors; this receptor may also mediate its effects on body temperature, analgesia, and anxiolytic properties. The mechanisms underlying MDMA's entactogenic properties of sociability and interpersonal closeness are not known but release and involvement of oxytocin, a peptide thought by some to be involved in social bonding, has been suggested. Adverse effects of MDMA are mostly transient; acute multiorgan adverse effects occurring during raves or crowded dance gatherings include dehydration, hyperthermia, seizures, rhabdomyolysis, disseminated intravascular coagulation, and acute renal failure. Deaths following MDMA taken by itself are rare compared to fatalities following coadministration with other drugs. A recent FDA-approved phase 3 clinical trial of MDMA for post-traumatic stress disorder (PTSD) led to the conclusion that MDMA-assisted therapy represents a potential breakthrough treatment meriting expedited clinical evaluation. Despite the ongoing deliberations by the FDA and EMA for approval of MDMA treatment of PTSD, the Australian Therapeutic Goods Administration (TGA) recently announced that after an evaluation of the therapeutic value, benefits, and risks of MDMA, it will permit its prescribing for the treatment of PTSD. Further examples of regulatory relaxation toward MDMA-assisted psychotherapy are underway. These include the FDA's recently approved clinical trial to assess MDMA's efficacy in the treatment of "asociality" in patients with schizophrenia and an open trial of MDMA treatment for alcohol-use disorder which showed decreased alcohol consumption. There are also ongoing studies on the little understood startle response, anxiety associated with life-threatening illness, and social anxiety in autistic adults.
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Affiliation(s)
- Brian A Baldo
- Kolling Institute of Medical Research, Royal North Shore Hospital of Sydney, Sydney, NSW, 2065, Australia.
- Department of Medicine, University of Sydney, Sydney, NSW, 2000, Australia.
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Geyer MA. A Brief Historical Overview of Psychedelic Research. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:464-471. [PMID: 38000715 DOI: 10.1016/j.bpsc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
Classical serotonergic psychedelics such as lysergic acid diethylamide or the naturally occurring compounds psilocybin and mescaline produce profound changes in mood, thought, intuition, sensory perception, the experience of time and space, and even the experience of self. Research examining psychedelic compounds has had a complex and turbulent evolution. Many cultures throughout the world have used psychedelic plants not only for mystical, ritualistic, or divinatory purposes but also for curing illnesses. Much of the genesis and progress of modern investigations into the effects and underlying mechanisms of action of psychedelics have been intertwined with studies of the neurotransmitter serotonin. Early hypotheses that serotonergic systems mediate psychedelic effects were supported initially by preclinical animal studies and subsequently confirmed by pharmacological studies in healthy humans. The use of psychedelic compounds as putative psychotomimetics that reproduce some features of naturally occurring psychotic disorders met with some limited success. More recent studies are exploring psychedelics as potential psychotherapeutic agents. Recent indications that even 1 or 2 psychedelic treatments produce robust and sustained reductions in clinical symptoms in a variety of psychiatric disorders have prompted an enormous resurgence of interest in the nature and mechanisms contributing to their effects.
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Affiliation(s)
- Mark A Geyer
- UC San Diego Center for Psychedelic Research, Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California.
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Sinha JK, Trisal A, Ghosh S, Gupta S, Singh KK, Han SS, Mahapatra M, Abomughaid MM, Abomughayedh AM, Almutary AG, Iqbal D, Bhaskar R, Mishra PC, Jha SK, Jha NK, Singh AK. Psychedelics for alzheimer's disease-related dementia: Unveiling therapeutic possibilities and pathways. Ageing Res Rev 2024; 96:102211. [PMID: 38307424 DOI: 10.1016/j.arr.2024.102211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/04/2024]
Abstract
Psychedelics have traditionally been used for spiritual and recreational purposes, but recent developments in psychotherapy have highlighted their potential as therapeutic agents. These compounds, which act as potent 5-hydroxytryptamine (5HT) agonists, have been recognized for their ability to enhance neural plasticity through the activation of the serotoninergic and glutamatergic systems. However, the implications of these findings for the treatment of neurodegenerative disorders, particularly dementia, have not been fully explored. In recent years, studies have revealed the modulatory and beneficial effects of psychedelics in the context of dementia, specifically Alzheimer's disease (AD)-related dementia, which lacks a definitive cure. Psychedelics such as N,N-dimethyltryptamine (DMT), lysergic acid diethylamide (LSD), and Psilocybin have shown potential in mitigating the effects of this debilitating disease. These compounds not only target neurotransmitter imbalances but also act at the molecular level to modulate signalling pathways in AD, including the brain-derived neurotrophic factor signalling pathway and the subsequent activation of mammalian target of rapamycin and other autophagy regulators. Therefore, the controlled and dose-dependent administration of psychedelics represents a novel therapeutic intervention worth exploring and considering for the development of drugs for the treatment of AD-related dementia. In this article, we critically examined the literature that sheds light on the therapeutic possibilities and pathways of psychedelics for AD-related dementia. While this emerging field of research holds great promise, further studies are necessary to elucidate the long-term safety, efficacy, and optimal treatment protocols. Ultimately, the integration of psychedelics into the current treatment paradigm may provide a transformative approach for addressing the unmet needs of individuals living with AD-related dementia and their caregivers.
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Affiliation(s)
| | - Anchal Trisal
- Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Shampa Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
| | - Saurabh Gupta
- Department of Biotechnology, GLA University, Mathura, Uttar Pradesh, India
| | - Krishna Kumar Singh
- Symbiosis Centre for Information Technology (SCIT), Rajiv Gandhi InfoTech Park, Hinjawadi, Pune, Maharashtra 411057, India
| | - Sung Soo Han
- School of Chemical Engineering, Yeungnam University, Gyeonsang 38541, the Republic of Korea; Research Institute of Cell Culture, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, the Republic of Korea
| | | | - Mosleh Mohammad Abomughaid
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, University of Bisha, Bisha 61922, Saudi Arabia
| | - Ali M Abomughayedh
- Pharmacy Department, Aseer Central Hospital, Ministry of Health, Saudi Arabia
| | - Abdulmajeed G Almutary
- Department of Biomedical Sciences, College of Health Sciences, Abu Dhabi University, Abu Dhabi P.O. Box 59911, United Arab Emirates
| | - Danish Iqbal
- Department of Health Information Management, College of Applied Medical Sciences, Buraydah Private Colleges, Buraydah 51418, Saudi Arabia
| | - Rakesh Bhaskar
- School of Chemical Engineering, Yeungnam University, Gyeonsang 38541, the Republic of Korea; Research Institute of Cell Culture, Yeungnam University, 280 Daehak-Ro, Gyeongsan 38541, the Republic of Korea.
| | - Prabhu Chandra Mishra
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, India
| | - Saurabh Kumar Jha
- Department of Zoology, Kalindi College, University of Delhi, 110008, India.
| | - Niraj Kumar Jha
- Centre for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Centre of Research Impact and Outcome, Chitkara University, Rajpura 140401, Punjab, India; School of Bioengineering & Biosciences, Lovely Professional University, Phagwara 144411, India; Department of Biotechnology Engineering and Food Technology, Chandigarh University, Mohali, India.
| | - Abhishek Kumar Singh
- Manipal Centre for Biotherapeutics Research, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India.
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8
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Hayden Griffin O, Leban L, Singh D, Webb M, Narayanan S. Deconstructing Differential Drug Coverage within a Malaysian Media Source. J Psychoactive Drugs 2024; 56:272-278. [PMID: 36864012 DOI: 10.1080/02791072.2023.2186287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/04/2023] [Accepted: 02/13/2023] [Indexed: 03/04/2023]
Abstract
Many researchers have noted that media coverage of drugs can be sensationalized and/or have questionable accuracy. Additionally, it has been alleged that the media often treats all drugs as harmful and can fail to differentiate between different types of drugs. Within this context, the researchers sought to deconstruct how media coverage was similar and/or different according to drug type within a national media outlet in Malaysia. Our sample comprised 487 news articles published over a two-year period. Articles were coded to reflect thematic differences in drug framing. We focus on five drugs widely used in Malaysia (amphetamines, opiates, cannabis, cocaine, and kratom) and assess the most frequent themes, crimes, and locations mentioned in reference to each drug. All drugs were primarily covered in a criminal justice context, and articles highlighted concern about the spread of these drugs and their abuse. Drug coverage varied, particularly in association with violent crimes, specific regions, and discussion of legality. We find evidence of both similarities and differences in how drugs were covered. Variation in coverage demonstrated that certain drugs were deemed a heightened threat, as well as reflected broader social/political processes shaping ongoing debates over treatment approaches and legality.
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Affiliation(s)
- O Hayden Griffin
- Department of Criminal Justice, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lindsay Leban
- Department of Criminal Justice, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Darshan Singh
- Centre for Drug Research, Universiti Sains Malaysia, Minden, Penang, Malaysia
| | - Megan Webb
- Department of Sociology, University of California, Riverside, CA, USA
| | - Suresh Narayanan
- School of Social Sciences, Universiti Sains Malaysia, Minden, Penang, Malaysia
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Vohryzek J, Cabral J, Lord LD, Fernandes HM, Roseman L, Nutt DJ, Carhart-Harris RL, Deco G, Kringelbach ML. Brain dynamics predictive of response to psilocybin for treatment-resistant depression. Brain Commun 2024; 6:fcae049. [PMID: 38515439 PMCID: PMC10957168 DOI: 10.1093/braincomms/fcae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/16/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
Psilocybin therapy for depression has started to show promise, yet the underlying causal mechanisms are not currently known. Here, we leveraged the differential outcome in responders and non-responders to psilocybin (10 and 25 mg, 7 days apart) therapy for depression-to gain new insights into regions and networks implicated in the restoration of healthy brain dynamics. We used large-scale brain modelling to fit the spatiotemporal brain dynamics at rest in both responders and non-responders before treatment. Dynamic sensitivity analysis of systematic perturbation of these models enabled us to identify specific brain regions implicated in a transition from a depressive brain state to a healthy one. Binarizing the sample into treatment responders (>50% reduction in depressive symptoms) versus non-responders enabled us to identify a subset of regions implicated in this change. Interestingly, these regions correlate with in vivo density maps of serotonin receptors 5-hydroxytryptamine 2a and 5-hydroxytryptamine 1a, which psilocin, the active metabolite of psilocybin, has an appreciable affinity for, and where it acts as a full-to-partial agonist. Serotonergic transmission has long been associated with depression, and our findings provide causal mechanistic evidence for the role of brain regions in the recovery from depression via psilocybin.
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Affiliation(s)
- Jakub Vohryzek
- Department of Psychiatry, University of Oxford, Oxford, UK
- Center for Music in the Brain, Aarhus University, Aarhus, Denmark
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Joana Cabral
- Department of Psychiatry, University of Oxford, Oxford, UK
- Center for Music in the Brain, Aarhus University, Aarhus, Denmark
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, University of Minho, Portugal
| | - Louis-David Lord
- Department of Psychiatry, University of Oxford, Oxford, UK
- Center for Music in the Brain, Aarhus University, Aarhus, Denmark
| | - Henrique M Fernandes
- Department of Psychiatry, University of Oxford, Oxford, UK
- Center for Music in the Brain, Aarhus University, Aarhus, Denmark
| | - Leor Roseman
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, UK
| | - David J Nutt
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, UK
| | - Robin L Carhart-Harris
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de la Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Morten L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, UK
- Center for Music in the Brain, Aarhus University, Aarhus, Denmark
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
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10
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Borissova A, Rucker JJ. The development of psilocybin therapy for treatment-resistant depression: an update. BJPsych Bull 2024; 48:38-44. [PMID: 37357767 PMCID: PMC10801413 DOI: 10.1192/bjb.2023.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/14/2023] [Accepted: 04/02/2023] [Indexed: 06/27/2023] Open
Abstract
Psilocybin is a classic psychedelic drug that has attracted increasing research interest over the past 10 years as a possible treatment for mood, anxiety and related conditions. Initial phase 2 clinical trials of psilocybin given alongside psychological support for major depression and treatment-resistant depression (TRD) demonstrated encouraging signs of basic safety, further confirmed by a large study in groups of healthy volunteers. The first international multi-centre randomised controlled trial was published in 2022, with signs of efficacy for the 25 mg dose condition in people with TRD when compared with an active placebo. Phase 3 trials in TRD are scheduled to start in 2023. Early evidence suggests that single doses of psilocybin given with psychological support induce rapid improvement in depressive symptoms that endure for some weeks. We therefore provide a timely update to psychiatrists on what psilocybin therapy is, what it is not, and the current state of the evidence-base.
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Affiliation(s)
- Anya Borissova
- Centre for Neuroimaging Sciences, King's College London, UK
| | - James J. Rucker
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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11
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Mitchell JM, Anderson BT. Psychedelic therapies reconsidered: compounds, clinical indications, and cautious optimism. Neuropsychopharmacology 2024; 49:96-103. [PMID: 37479859 PMCID: PMC10700471 DOI: 10.1038/s41386-023-01656-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 07/23/2023]
Abstract
The clinical investigation of psychedelic medicines has blossomed over the last 5 years. Data from a Phase 3 industry trial and a multicenter Phase 2 industry trial, in addition to multiple early phase investigator-initiated and industry trials, have now been published in peer-reviewed journals. This narrative review summarizes both the recent data and the current clinical trials that are being conducted with various classes of "psyche-manifesting" substances, which may prove beneficial in the treatment of a broad range of conditions. Methodological considerations, unique challenges, and next steps for research are discussed in keeping with the uniquely "experiential" nature of these therapies.
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Affiliation(s)
- Jennifer M Mitchell
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA.
- Department of Veterans Affairs, Research Service, San Francisco VA Medical Center, San Francisco, CA, USA.
- Berkeley Center for the Science of Psychedelics, University of California Berkeley, Berkeley, CA, USA.
| | - Brian T Anderson
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
- Berkeley Center for the Science of Psychedelics, University of California Berkeley, Berkeley, CA, USA
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12
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Nutt DJ, Peill JM, Weiss B, Godfrey K, Carhart-Harris RL, Erritzoe D. Psilocybin and Other Classic Psychedelics in Depression. Curr Top Behav Neurosci 2023. [PMID: 37955822 DOI: 10.1007/7854_2023_451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Psychedelic drugs such as psilocybin and ketamine are returning to clinical research and intervention across several disorders including the treatment of depression. This chapter focusses on psychedelics that specifically target the 5-HT2A receptor such as psilocybin and DMT. These produce plasma-concentration related psychological effects such as hallucinations and out of body experiences, insightful and emotional breakthroughs as well as mystical-type experiences. When coupled with psychological support, effects can produce a rapid improvement in mood among people with depression that can last for months. In this chapter, we summarise the scientific studies to date that explore the use of psychedelics in depressed individuals, highlighting key clinical, psychological and neuroimaging features of psychedelics that may account for their therapeutic effects. These include alterations in brain entropy that disrupt fixed negative ruminations, a period of post-treatment increased cognitive flexibility, and changes in self-referential psychological processes. Finally, we propose that the brain mechanisms underlying the therapeutic effect of serotonergic psychedelics might be distinct from those underlying classical serotonin reuptake-blocking antidepressants.
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Affiliation(s)
- D J Nutt
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK.
| | - J M Peill
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - B Weiss
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - K Godfrey
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - R L Carhart-Harris
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
- Psychedelics Division, Neuroscape, University of California San Francisco, San Francisco, CA, USA
| | - D Erritzoe
- Centres for Neuropsychopharmacology & Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
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13
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Sharma R, Batchelor R, Sin J. Psychedelic Treatments for Substance Use Disorder and Substance Misuse: A Mixed Methods Systematic Review. J Psychoactive Drugs 2023; 55:612-630. [PMID: 36933948 DOI: 10.1080/02791072.2023.2190319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 03/20/2023]
Abstract
Renewed interest in psychedelic substances in the 21st century has seen the exploration of psychedelic treatments for various psychiatric disorders including substance use disorder (SUD). This review aimed to assess the effectiveness of psychedelic treatments for people with SUD and those falling below diagnostic thresholds (i.e. substance misuse). We systematically searched 11 databases, trial registries, and psychedelic organization websites for empirical studies examining adults undergoing psychedelic treatment for SUD or substance misuse, published in the English language, between 2000 and 2021. Seven studies investigating treatment using psilocybin, ibogaine, and ayahuasca, alone or adjunct with psychotherapy reported across 10 papers were included. Measures of abstinence, substance use, psychological and psychosocial outcomes, craving, and withdrawal reported positive results, however, this data was scarce among studies examining a wide range of addictions including opioid, nicotine, alcohol, cocaine and unspecified substance. The qualitative synthesis from three studies described subjective experience of psychedelic-assisted treatments enhanced self-awareness, insight, and confidence. At present, there is no sufficient research evidence to suggest effectiveness of any of the psychedelics on any specific substance use disorder or substance misuse. Further research using rigorous effectiveness evaluation methods with larger sample sizes and longer-term follow-up is required.
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Affiliation(s)
| | - Rachel Batchelor
- School of Health and Psychological Sciences, City, University of London, England, London, UK
| | - Jacqueline Sin
- School of Health and Psychological Sciences, City, University of London, England, London, UK
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14
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Velásquez MM, Lattig MC, Chitiva LC, Costa GM, Sutachan JJ, Albarracin SL. Dendritogenic Potential of the Ethanol Extract from Lippia alba Leaves in Rat Cortical Neurons. Molecules 2023; 28:6666. [PMID: 37764442 PMCID: PMC10537230 DOI: 10.3390/molecules28186666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
A reduced dendritic complexity, especially in regions such as the hippocampus and the prefrontal cortex, has been linked to the pathophysiology of some neuropsychiatric disorders, in which synaptic plasticity and functions such as emotional and cognitive processing are compromised. For this reason, the identification of new therapeutic strategies would be enriched by the search for metabolites that promote structural plasticity. The present study evaluated the dendritogenic potential of the ethanol extract of Lippia alba, an aromatic plant rich in flavonoids and terpenes, which has been widely used in traditional medicine for its presumed analgesic, anxiolytic, and antidepressant potential. An in vitro model of rat cortical neurons was used to determine the kinetics of the plant's effect at different time intervals. Changes in morphological parameters of the neurons were determined, as well as the dendritic complexity, by Sholl analysis. The extract promotes the outgrowth of dendritic branching in a rapid and sustained fashion, without being cytotoxic to the cells. We found that this effect could be mediated by the phosphatidylinositol 3-kinase pathway, which is involved in mechanisms of neuronal plasticity, differentiation, and survival. The evidence presented in this study provides a basis for further research that, through in vivo models, can delve into the plant's therapeutic potential.
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Affiliation(s)
- María Marcela Velásquez
- Instituto de Genética Humana, Facultad de Medicina, Pontifica Universidad Javeriana, Bogotá 110911, Colombia
| | | | - Luis Carlos Chitiva
- Departamento de Química, Pontificia Universidad Javeriana, Bogotá 110911, Colombia
| | - Geison M. Costa
- Departamento de Química, Pontificia Universidad Javeriana, Bogotá 110911, Colombia
| | - Jhon Jairo Sutachan
- Departamento de Nutrición y Bioquímica, Pontificia Universidad Javeriana, Bogotá 110911, Colombia
| | - Sonia Luz Albarracin
- Departamento de Nutrición y Bioquímica, Pontificia Universidad Javeriana, Bogotá 110911, Colombia
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15
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Wall MB, Harding R, Zafar R, Rabiner EA, Nutt DJ, Erritzoe D. Neuroimaging in psychedelic drug development: past, present, and future. Mol Psychiatry 2023; 28:3573-3580. [PMID: 37759038 PMCID: PMC10730398 DOI: 10.1038/s41380-023-02271-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Psychedelic therapy (PT) is an emerging paradigm with great transdiagnostic potential for treating psychiatric disorders, including depression, addiction, post-traumatic stress disorder, and potentially others. 'Classic' serotonergic psychedelics, such as psilocybin and lysergic acid diethylamide (LSD), which have a key locus of action at the 5-HT2A receptor, form the main focus of this movement, but substances including ketamine, 3,4-Methylenedioxymethamphetamine (MDMA) and ibogaine also hold promise. The modern phase of development of these treatment modalities in the early 21st century has occurred concurrently with the wider use of advanced human neuroscientific research methods; principally neuroimaging. This can potentially enable assessment of drug and therapy brain effects with greater precision and quantification than any previous novel development in psychiatric pharmacology. We outline the major trends in existing data and suggest the modern development of PT has benefitted greatly from the use of neuroimaging. Important gaps in existing knowledge are identified, namely: the relationship between acute drug effects and longer-term (clinically-relevant) effects, the precise characterisation of effects at the 5-HT2A receptor and relationships with functional/clinical effects, and the possible impact of these compounds on neuroplasticity. A road-map for future research is laid out, outlining clinical studies which will directly address these three questions, principally using combined Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) methods, plus other adjunct techniques. Multimodal (PET/MRI) studies using modern PET techniques such as the 5-HT2A-selective ligand [11 C]Cimbi-36 (and other ligands sensitive to neuroplasticity changes) alongside MRI measures of brain function would provide a 'molecular-functional-clinical bridge' in understanding. Such results would help to resolve some of these questions and provide a firmer foundation for the ongoing development of PT.
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Affiliation(s)
- Matthew B Wall
- Invicro, London, UK.
- Faculty of Medicine, Imperial College London, London, UK.
- Centre for Psychedelic research and Neuropsychopharmacology, Imperial College London, London, UK.
| | - Rebecca Harding
- Clinical Psychopharmacology Unit, Faculty of Brain Sciences, University College London, London, UK
| | - Rayyan Zafar
- Faculty of Medicine, Imperial College London, London, UK
- Centre for Psychedelic research and Neuropsychopharmacology, Imperial College London, London, UK
| | | | - David J Nutt
- Faculty of Medicine, Imperial College London, London, UK
- Centre for Psychedelic research and Neuropsychopharmacology, Imperial College London, London, UK
| | - David Erritzoe
- Faculty of Medicine, Imperial College London, London, UK
- Centre for Psychedelic research and Neuropsychopharmacology, Imperial College London, London, UK
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16
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Jaster AM, González-Maeso J. Mechanisms and molecular targets surrounding the potential therapeutic effects of psychedelics. Mol Psychiatry 2023; 28:3595-3612. [PMID: 37759040 DOI: 10.1038/s41380-023-02274-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Psychedelics, also known as classical hallucinogens, have been investigated for decades due to their potential therapeutic effects in the treatment of neuropsychiatric and substance use disorders. The results from clinical trials have shown promise for the use of psychedelics to alleviate symptoms of depression and anxiety, as well as to promote substantial decreases in the use of nicotine and alcohol. While these studies provide compelling evidence for the powerful subjective experience and prolonged therapeutic adaptations, the underlying molecular reasons for these robust and clinically meaningful improvements are still poorly understood. Preclinical studies assessing the targets and circuitry of the post-acute effects of classical psychedelics are ongoing. Current literature is split between a serotonin 5-HT2A receptor (5-HT2AR)-dependent or -independent signaling pathway, as researchers are attempting to harness the mechanisms behind the sustained post-acute therapeutically relevant effects. A combination of molecular, behavioral, and genetic techniques in neuropharmacology has begun to show promise for elucidating these mechanisms. As the field progresses, increasing evidence points towards the importance of the subjective experience induced by psychedelic-assisted therapy, but without further cross validation between clinical and preclinical research, the why behind the experience and its translational validity may be lost.
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Affiliation(s)
- Alaina M Jaster
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA
| | - Javier González-Maeso
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA.
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17
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Buot A, Pallares C, Oganesyan A, Dauré C, Bonnelle V, Burguière E, Dos Santos JFA, N'Diaye K, Ljuslin M, Smith P, Verroust V, Wyplosz B, Morgiève M, Mallet L. Improvement in OCD symptoms associated with serotoninergic psychedelics: a retrospective online survey. Sci Rep 2023; 13:13378. [PMID: 37591906 PMCID: PMC10435518 DOI: 10.1038/s41598-023-39812-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023] Open
Abstract
A renewed interest in the use of psychedelics for treating obsessive compulsive disorder (OCD) has emerged in the last 20 years. But pre-clinical and clinical evidence remain scarce, and little is known about the factor determining the magnitude and persistence of the therapeutic effect. We therefore designed a retrospective online survey to explore, in the general population using psychoactive drugs, their impact on OCD symptoms. We also assessed the attitude of the participants towards the substance in term of frequency of intakes. In a sample of 174 participants, classic psychedelics were reported as the only substances effective at reducing OCD symptoms. In classic psychedelics users, symptoms reduction was associated with the intensity of acute effects, itself correlated to the dose. Reports on the persistence of the therapeutic effect varied from weeks to months, but we could not find any predicting factor. Finally, the occurrence and frequency of subsequent intakes, which seemed to be limited in our sample, were predicted by the magnitude and persistence of the therapeutic effect, respectively. Our observations support the hypothesis of classic psychedelics efficacy in reducing OCD symptoms but a careful evaluation of the persistence of this effect is still needed.
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Affiliation(s)
- Anne Buot
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France.
| | - Cecile Pallares
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | | | - Charles Dauré
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | | | - Eric Burguière
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | | | - Karim N'Diaye
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Michael Ljuslin
- Service de Médecine Palliative, Département de Réadaptation Et Gériatrie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pauline Smith
- Environmental Justice Program, Georgetown University, Washington, D.C, USA
| | - Vincent Verroust
- RESPADD, Paris, France
- UR PSYCOMADD- CHU Paul Brousse, Villejuif, France
- Université de Picardie-Jules Vernes, Amiens, France
| | - Benjamin Wyplosz
- Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Margot Morgiève
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
- Université Paris Cité, CNRS, Inserm, Cermes3, Paris, France
| | - Luc Mallet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
- Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland
- Univ Paris-Est Créteil, DMU IMPACT, Département Médical-Universitaire de Psychiatrie Et d'Addictologie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
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18
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van Amsterdam J, Burgess N, van den Brink W. Legal Approaches to New Psychoactive Substances: First Empirical Findings. Eur Addict Res 2023; 29:363-372. [PMID: 37557091 DOI: 10.1159/000531503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/08/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Generic drug legislation, i.e., simultaneously banning groups of drugs, has been introduced worldwide to counteract the trade and use of emerging "new psychoactive substances" (NPSs) more effectively. SUMMARY The potential and de facto positive and negative effects of generic drug legislation have been described using an analysis based on documented evaluations of the experiences in the UK and Germany, supplemented with data from other publicly available sources. In particular, the effects of generic drug legislation on availability, use, sales, and overall health harms of NPS, and switches from NPS to traditional (classical) drugs are addressed. The results show that the introduction of generic drug legislation in the UK and Germany has enabled stricter regulation of NPS but has also led to some major harms within the domain of public health. Depending on the population considered, the rate of NPS use remained stable, slightly declined, or increased following the banning of NPS. Once banned, NPSs were more often purchased on the black market, often together with other (more harmful) drugs. Moreover, NPS-related harms did not reduce following the ban, and in some cases even increased. Finally, when harmful NPS, like potent synthetic opioids and cannabinoids, become substantially used and endanger public health, legislators already have the legal means to ban the problem drug, thus overruling the need for a generic ban. KEY MESSAGES Generic drug legislation may facilitate drug law enforcement, but it is not (very) effective in counteracting NPS use and it may increase NPS-related public health problems. It is concluded that, overall, the advantages of generic drug legislation are overshadowed by its serious disadvantages.
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Affiliation(s)
- Jan van Amsterdam
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, Amsterdam, The Netherlands
| | - Nicholas Burgess
- School of Law, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, Amsterdam, The Netherlands
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19
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Lear MK, Smith SM, Pilecki B, Stauffer CS, Luoma JB. Social anxiety and MDMA-assisted therapy investigation: a novel clinical trial protocol. Front Psychiatry 2023; 14:1083354. [PMID: 37520237 PMCID: PMC10379654 DOI: 10.3389/fpsyt.2023.1083354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background Social anxiety disorder (SAD) is a serious and prevalent psychiatric condition that heavily impacts social functioning and quality of life. Though efficacious treatments exist for SAD, remission rates remain elevated and a significant portion of those affected do not access effective treatment, suggesting the need for additional evidence-based treatment options. This paper presents a protocol for an open-label pilot study of MDMA-assisted therapy (MDMA-AT) for social anxiety disorder. The study aims to assess preliminary treatment outcomes, feasibility and safety, and psychological and physiological processes of change in the treatment of SAD with MDMA-AT. A secondary aim includes the development of a treatment manual for MDMA-AT for SAD. Method The outlined protocol is a randomized, open-label delayed treatment study. We will recruit 20 participants who meet criteria with moderate-to-severe social anxiety disorder (SAD) of the generalized subtype. Participants will be randomly assigned to an immediate treatment (n = 10) or delayed treatment condition (n = 10). Those in the immediate treatment condition will proceed immediately to active MDMA-AT consisting of three preparation sessions, two medicine sessions in which they receive oral doses of MDMA, and six integration sessions over approximately a 16-week period. The delayed treatment condition will receive the same intervention after a 16-week delay. Our primary outcome is SAD symptom reduction as measured by the Liebowitz Social Anxiety Scale administered by blinded raters at post-treatment and 6 month follow up. Secondary outcomes include changes in functional impairment, feasibility and safety measures, and novel therapeutic processes of change including shame and shame-related coping, belongingness, self-concealment, and self-compassion at post-treatment. Exploratory outcomes are also discussed. Discussion The results of this pilot trial advance the field's understanding of the acceptability and potential effectiveness of MDMA-AT for social anxiety disorder and provide an overview of relevant therapeutic mechanisms unique to SAD. We hope findings from this protocol will inform the design of subsequent larger-scale randomized controlled trials (RCT) examining the efficacy of MDMA-AT for SAD. Clinical trial registration https://clinicaltrials.gov/, NCT05138068.
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Affiliation(s)
- M. Kati Lear
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
| | - Sarah M. Smith
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
| | - Brian Pilecki
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
| | - Chris S. Stauffer
- Department of Psychiatry, Oregon Health and Science University, Portland, OR, United States
| | - Jason B. Luoma
- Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, United States
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20
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Al-Imam A, Motyka MA, Hoffmann B, Magowska A, Michalak M. Infoveillance and Critical Analysis of the Systematically Reviewed Literature on Dimethyltryptamine and the "God Molecule". Pharmaceuticals (Basel) 2023; 16:831. [PMID: 37375778 DOI: 10.3390/ph16060831] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Aboriginals of Latin America have used DMT (N,N-dimethyltryptamine) in ritualistic ceremonies for centuries. Nevertheless, there are limited data on web users' interest concerning DMT. We aim to review the literature and explore the spatial-temporal mapping of online search behavior concerning DMT, 5-MeO-DMT, and the Colorado River toad via Google Trends over the past 10 years (2012-2022) while using 5 search terms: "N,N-dimethyltryptamine", "5-methoxy-N,N-dimethyltryptamine", "5-MeO-DMT", "Colorado River toad", and "Sonoran Desert toad". Literature analysis conveyed novel information concerning DMT's past shamanic and present-day illicit uses, showcased experimental trials on DMT uses for neurotic disorders, and highlighted potential uses in modern medicine. DMT's geographic mapping signals originated mainly from Eastern Europe, the Middle East, and Far East Asia. In contrast, 5-MeO-DMT signals prevailed in Western Europe, Indo-China, and Australasia. Signals concerning the toad originated from the Americas, Australia, India, the Philippines, and Europe. Web users searched the most for "N,N-dimethyltryptamine" and "5-MeO-DMT". Three terms exhibited significant upgoing linear temporal trends: "5-MeO-DMT" (β = 0.37, p < 0.001), "Sonoran Desert toad" (β = 0.23, p < 0.001), and "Colorado River toad" (β = 0.17, p < 0.001). The literature and Infoedemiology data provided crucial information concerning DMT's legal status, risks and benefits, and potential for abuse. Nonetheless, we opine that in the upcoming decades, physicians might use DMT to manage neurotic disorders pending a change in its legal status.
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Affiliation(s)
- Ahmed Al-Imam
- Department of Computer Science and Statistics, Doctoral School, Poznan University of Medical Sciences, 61-806 Poznan, Poland
- Department of Anatomy and Cellular Biology, College of Medicine, University of Baghdad, Baghdad 10047, Iraq
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
| | - Marek A Motyka
- Institute of Sociological Sciences, University of Rzeszow, 35-959 Rzeszów, Poland
| | - Beata Hoffmann
- Institute of Applied Social Sciences, University of Warsaw, 00-927 Warsaw, Poland
| | - Anita Magowska
- Department of History and Philosophy of Medical Sciences, Poznan University of Medical Sciences, 61-806 Poznan, Poland
| | - Michal Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 61-806 Poznan, Poland
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21
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Montgomery BW, Allen J. Cannabis Policy in the 21st Century: Mandating an Equitable Future and Shedding the Racist Past. Clin Ther 2023; 45:541-550. [PMID: 37414505 DOI: 10.1016/j.clinthera.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/27/2023] [Accepted: 05/01/2023] [Indexed: 07/08/2023]
Abstract
The cannabis legalization movement in the United States has experienced unprecedented success in the past decade due to a wave of grassroots reforms in states across the country. The current legalization movement began in 2012, when Colorado and Washington became the first two states to legalize the use and sale of cannabis for adults aged ≥ 21 years. Since then, the use of cannabis has been legalized in 21 states, Guam, the Northern Mariana Islands, and Washington, DC. Many of these states have explicitly framed the law change as a rejection of the War on Drugs and its harms, felt disproportionately in Black and Brown communities. However, racial inequities in cannabis arrests have increased in states that have legalized cannabis for adult use. Moreover, states working to implement social equity and community reinvestment programs have made little progress toward their goals. This commentary describes how US drug policy, racist in intention, gave way to drug policy that perpetuates racism, even when its ostensible or stated goal is equity. As the United States prepares for national legalization of cannabis, it is critical that we break away from past legislation and mandate equity in cannabis policy. Developing meaningful mandates will require us to acknowledge our history of using drug policy for the racist goals of social control and extortion, study the experience of states that are trying to implement social equity programs, listen to Black leaders and other leaders of color who have developed guidance for equity-focused cannabis policy, and commit to a new paradigm. If we are willing to do these things, we may be able to legalize cannabis in an anti-racist way that will stop causing harm and enable us to effectively implement reparative practices.
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Affiliation(s)
| | - Jane Allen
- RTI International, Waltham, Massachusetts
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22
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King LA, Nutt DJ, Nichols DE. Remove barriers to clinical research for schedule 1 drugs with therapeutic potential. BMJ 2023; 381:981. [PMID: 37130596 DOI: 10.1136/bmj.p981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
| | - David J Nutt
- Centre for Psychedelic Research Division of Psychiatry, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - David E Nichols
- Department of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
- Purdue University School of Pharmacy, West Lafayette, IN, USA
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23
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Meir P, Taylor L, Soares JC, Meyer TD. Psychotherapists' openness to engage their patients in Psilocybin-Assisted Therapy for mental health treatment. J Affect Disord 2023; 323:748-754. [PMID: 36535547 DOI: 10.1016/j.jad.2022.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/04/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Despite psychedelic research initially ceasing in the 1970-80s, the findings documented encouraged researchers to re-examine the safety and efficacy of treating mental health with psychedelics. Of particular focus, psilocybin has shown to have therapeutic potential for a variety of mental health problems and was granted breakthrough therapy status by the FDA. Should psilocybin eventually become legally licensed, the success of Psilocybin-Assisted Therapy (PAT) may largely rely on clinicians' openness to engage their eligible patients with PAT. We therefore assessed 119 psychologists' openness to recommend PAT, perceived barriers/facilitators to informing patients about PAT, and factors affecting their openness to involve patients with PAT if FDA approved. While 77.4 % of psychologists agreed they would inform eligible patients about PAT, 91.6 % stated they would still recommend psychotherapies that do not involve psilocybin first. 76.5 % endorsed that knowledge on psilocybin would increase their likelihood to inform patients about PAT. More positive attitudes and beliefs about psilocybin, greater self-reported knowledge of psilocybin, personal history of psychedelic usage, and more positive attitudes towards medical cannabis (MC) was associated with greater openness to engage patients with PAT. Our regression analysis revealed that attitudes towards MC and beliefs about psilocybin were the only significant predictors of psychotherapists' openness towards PAT. These findings provide relevant information to institutions planning educational programs for mental health professionals about psilocybin and Psychedelic-Assisted Therapies.
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Affiliation(s)
- Priel Meir
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, Houston, TX, United States
| | - Leslie Taylor
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, Houston, TX, United States
| | - Jair C Soares
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, Houston, TX, United States
| | - Thomas D Meyer
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, UTHealth Science Center at Houston, Houston, TX, United States.
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24
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Nutt D, Spriggs M, Erritzoe D. Psychedelics therapeutics: What we know, what we think, and what we need to research. Neuropharmacology 2023; 223:109257. [PMID: 36179919 DOI: 10.1016/j.neuropharm.2022.109257] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/07/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022]
Abstract
Psychedelic therapy is perhaps the most exciting new development in psychiatry. Not only does it offer a radical new approach to treatment where mainstream approaches have proven ineffective, but the growing evidence for transdiagnostic efficacy is eliciting a re-think of current diagnostic and symptom-specific approaches to psychiatry. This excitement has led to a massive investment in this field with many tens of new pharmaceutical companies being set up to research the effects of known psychedelics and develop new patentable molecules. Whilst this enthusiasm is to be welcomed, it is important that new research is properly grounded in established facts and reflects current knowledge. In this commentary we lay out the knowledge framework that should be taken into account by all innovative researchers in this field.
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Affiliation(s)
- David Nutt
- Centres for Neuropsychopharmacology and Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Meg Spriggs
- Centres for Neuropsychopharmacology and Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - David Erritzoe
- Centres for Neuropsychopharmacology and Psychedelic Research, Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK.
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Erridge S, Olsson F, Sodergren MH. Patient priorities for research: A focus group study of UK medical cannabis patients. Complement Ther Clin Pract 2023; 50:101693. [PMID: 36399996 DOI: 10.1016/j.ctcp.2022.101693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/06/2022] [Accepted: 11/06/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION There has yet to be an evaluation of medical cannabis patient preferences with respect to future research. As such, prioritisation of research agendas has been largely driven by academia and industry. The primary aim of this study was to elicit priorities for research from medical cannabis patients in the United Kingdom (UK). METHODS Patients undergoing active treatment for health conditions with medical cannabis in the UK were invited to take part in focus groups from December 2021 to February 2022. An inductive thematic analysis of responses was performed. Participants also completed a ranking exercise whereby they assigned ten counters (each equivalent to £1 million GBP) to competing research priorities. RESULTS 30 medical cannabis patients participated across 3 focus groups. The following themes were identified as research priorities: adverse events, comparison between cannabis-based medicinal products, health conditions, pharmacology of cannabis, types of study, healthcare professionals' attitudes, social environment, agriculture and manufacturing, and the cannabis plant. Participants assigned the highest proportion of research funding to 'assessment of effect on specific symptoms' (26 counters; 8.7%). CONCLUSIONS This study highlighted specific themes within which to focus future research on medical cannabis. Clinically, there was a directive towards ensuring that research is condition- or symptom-specific. Participants also emphasised themes on the social impact of medical cannabis, such as knowledge of medical cannabis among healthcare professionals, stigma, and effects on driving and in the workplace. These findings can guide both research funders and researchers into effectively conducting research which fits within a more patient-centric model.
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Affiliation(s)
- Simon Erridge
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK; Sapphire Medical Clinics, London, UK
| | - Fabian Olsson
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mikael H Sodergren
- Imperial College Medical Cannabis Research Group, Department of Surgery and Cancer, Imperial College London, London, UK; Sapphire Medical Clinics, London, UK.
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The Safety and Efficacy of Psychedelic-Assisted Therapies for Older Adults: Knowns and Unknowns. Am J Geriatr Psychiatry 2023; 31:44-53. [PMID: 36184377 DOI: 10.1016/j.jagp.2022.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/12/2022] [Accepted: 08/31/2022] [Indexed: 01/25/2023]
Abstract
Psychedelics and related compounds have shown efficacy for the treatment of a variety of conditions that are prevalent among older adults, including mood disorders, the psychological distress associated with a serious medical illness, post-traumatic stress disorder (PTSD), and prolonged grief disorder. Psychedelics also have properties that could help provide therapeutic benefits for patients with dementing disorders, as well as promoting personal growth among healthy older adults. This article focuses on psilocybin, a classic psychedelic, and MDMA, a substituted amphetamine with properties similar to classic psychedelics. Both act on the 5HT2A receptor. Psychedelics can be safely administered to healthy adults in controlled conditions. However, both psilocybin and MDMA can increase blood pressure and heart rate, which could be a concern if used in older adults with cardiovascular disease. Very few older adults or patients with serious comorbidities have been included in clinical trials of psychedelics to date, raising the question of how generalizable study results are for the patients that most geropsychiatrists will be treating. Research on the neurophysiologic and mechanistic effects of psychedelics in older adults could also provide insights into the aging brain that could have clinical applications in the future. Given the potential of psychedelic compounds to benefit older adults, more research is needed to establish safety and efficacy among older adults, particularly those with multi-morbidity.
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Associations between MDMA/ecstasy, classic psychedelics, and suicidal thoughts and behaviors in a sample of U.S. adolescents. Sci Rep 2022; 12:21927. [PMID: 36535992 PMCID: PMC9763256 DOI: 10.1038/s41598-022-25658-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Suicide is one of the leading causes of death amongst adolescents and decades of research have failed to curb suicide rates within this population. There is thus a need to better understand factors that correlate with adolescent suicidal thoughts and behaviors (STBs). MDMA/ecstasy and classic psychedelics represent two areas for exploration, as use of these substances has been associated with both increased and lowered odds of STBs. Thus, the goal of this study was to test the associations between MDMA/ecstasy and classic psychedelics (psilocybin, peyote, mescaline, LSD) and STBs in a nationally representative sample of U.S. adolescents. We tested these associations in a sample of adolescents aged 12-17 years old from the National Survey on Drug Use and Health (2004-2019) (N = 262,617) using survey-weighted multivariable logistic regression models. Lifetime psilocybin use was associated with lowered odds of lifetime suicidal thinking, planning, and attempts (aOR range 0.77-0.85). Conversely, LSD was associated with increased odds of these same outcomes (aOR range 1.20-1.35). MDMA/ecstasy, peyote, and mescaline did not share associations with STBs. Our study demonstrates that individual classic psychedelics share varying relationships to STBs among adolescents. Future cross-sectional and longitudinal studies are needed to further elucidate the link between classic psychedelic use and STBs in youth.
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George DR, Hanson R, Wilkinson D, Garcia-Romeu A. Ancient Roots of Today's Emerging Renaissance in Psychedelic Medicine. Cult Med Psychiatry 2022; 46:890-903. [PMID: 34476719 PMCID: PMC8412860 DOI: 10.1007/s11013-021-09749-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 01/30/2023]
Abstract
An international ban on psychedelics initiated by the United Nations' Convention on Psychotropic Substances in 1971 restricted the clinical use of these ancient psychoactive substances. Yet, in an era marked by rising mental health concerns and a growing "Deaths of Despair" epidemic (i.e., excess mortality and morbidity from suicide, drug overdose, and alcoholism), the structured psychedelic use that has long been a part of ritual healing experiences for human societies is slowly regaining credibility in Western medicine for its potential to treat various mental health conditions. We use a historical lens to examine the use of psychedelic therapies over time, translate ancient lessons to contemporary clinical and research practice, and interrogate the practical and ethical questions researchers must grapple with before they can enter mainstream medicine. Given the COVID-19 pandemic and its contributions to the global mental health burden, we also reflect on how psychedelic therapy might serve as a tool for medicine in the aftermath of collective trauma. Ultimately, it is argued that a "psychedelic renaissance" anchored in the lessons of antiquity can potentially help shift healthcare systems-and perhaps the broader society-towards practices that are more humane, attentive to underlying causes of distress, and supportive of human flourishing.
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Affiliation(s)
- Daniel R George
- Department of Humanities, Penn State Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA, 17033, USA.
| | - Ryan Hanson
- Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Albert Garcia-Romeu
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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29
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Wright DJ, Colagiuri B, Glozier N. Evaluating the attitudes of mental health professionals towards trials of MDMA: a randomised vignette trial. BMJ Open 2022; 12:e060360. [PMID: 36428011 PMCID: PMC9703308 DOI: 10.1136/bmjopen-2021-060360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To compare attitudes of mental health (MH) professionals towards trials of methylenedioxymethamphetamine-assisted psychotherapy (MDMA-AP), with a neutrally labelled pharmacotherapy trial. DESIGN A randomised controlled vignette study design, with experimenters blinded to group condition. SETTING Participants were recruited online via professional societies. PARTICIPANTS Psychiatrists, psychologists and MH researchers from across Australia. INTERVENTIONS Participants were randomly allocated to read a vignette about a trial of either MDMA-AP or a neutrally labelled pharmacotherapy. OUTCOMES Comparison of the difference in four attitudes towards MDMA-AP and control: How likely they were to (1) recommend participating, or (2) object to participating in the trial; (3) their predicted efficacy; and (4) concerns about the safety of the trial. RESULTS There were no overall differences between professional's attitudes towards MDMA-AP (n=51) and the control pharmacotherapy (n=43) trial vignettes. Psychiatrists were less likely to recommend participation in the MDMA-AP than the control trial (d=0.72, p=0.02), but did not differ in other attitudes. Psychologists and researchers did not differ in any attitudes. The correlation between professional experience and both: (1) concern about, and (2) strength of objection to, the trial, was higher for MDMA-AP, than control (d=0.60, p=0.01 and d=0.40, p=0.03, respectively). CONCLUSIONS Psychiatrists, but not psychologists or researchers showed more hesitancy in recommending trials of MDMA-AP versus an unknown pharmacotherapy. Experienced MH professionals were more likely to have negative views about MDMA-AP trials than less experienced MH professionals. This may reflect the experience of prior unfulfilled pharmacotherapy innovation or exuberance associated with fewer years of practice. Research into, and implementation of, MDMA-AP may face barriers with certain MH professionals, which will need be addressed if MDMA-AP continues to show promise as an efficacious treatment. TRIAL REGISTRATION NUMBER The study design was registered with the ANZCTR (ACTRN12620001068954).
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Affiliation(s)
- Dean J Wright
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben Colagiuri
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Nick Glozier
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
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30
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Belouin SJ, Averill LA, Henningfield JE, Xenakis SN, Donato I, Grob CS, Berger A, Magar V, Danforth AL, Anderson BT. Policy considerations that support equitable access to responsible, accountable, safe, and ethical uses of psychedelic medicines. Neuropharmacology 2022; 219:109214. [PMID: 35973601 PMCID: PMC9536012 DOI: 10.1016/j.neuropharm.2022.109214] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/24/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022]
Abstract
There is mounting evidence suggesting psychedelic and entactogen medicines (namely psilocybin and 3,4-methylenedioxymethamphetamine [MDMA]), in conjunction with proper psychosocial support, hold the potential to provide safe, rapid acting, and robust clinical improvements with durable effects. In the US, both psilocybin and MDMA have been granted Breakthrough Therapy designations by the US Food and Drug Administration and may potentially receive full FDA approval with similar regulatory considerations occurring in multiple countries. At the same time, regulatory changes are poised to increase access to legal or decriminalized psychedelic use in various non-medical settings. This review provides a brief discussion on the historical use of psychedelic medicines, the status of the empirical evidence, and numerous significant policy considerations that must be thoughtfully addressed regarding standards-of-practice, consumer protection, engagement of communities, safeguarding access for all, and developing data standards, which supports the responsible, accountable, safe, and ethical uses of these medicines in clinical, faith-based, and other contexts. We provide suggestions for how public health and harm reduction can be supported through a public-private partnership that engages a community of stakeholders from various disciplines in the co-creation and dissemination of best practices and public policies.
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Affiliation(s)
- Sean J Belouin
- United States Public Health Service, Germantown, MD, USA; Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, MD, USA; Pain and Palliative Care, NIH Clinical Research Center, Bethesda, MD, USA.
| | - Lynnette A Averill
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; US Department of Veterans Affairs, Michael E. DeBakey Veterans Administration Medical Center, Houston, TX, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; US Department of Veterans Affairs, National Center for PTSD - Clinical Neurosciences Division, Orange, CT, USA; Reason for Hope, New York, NY, USA
| | - Jack E Henningfield
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Research, Health Policy and Abuse Liability, Pinney Associates, Bethesda, MD, USA
| | - Stephen N Xenakis
- Reason for Hope, New York, NY, USA; United States Army, Hallandale Beach, FL, USA; Uniformed Services University of the Health Sciences (UHSUS), Bethesda, MD, USA
| | - Ingrid Donato
- Office of Prevention Innovation, Center for Substance Abuse Prevention, SAMHSA, Rockville, MD, USA
| | - Charles S Grob
- David Geffen School of Medicine at University of California (UCLA), Los Angeles, CA, USA; Division of Child and Adolescent Psychiatry, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ann Berger
- Pain and Palliative Care, NIH Clinical Research Center, Bethesda, MD, USA
| | - Veronica Magar
- Gender, Equity and Human Rights, World Health Organization (WHO), Geneva, Switzerland
| | - Alicia L Danforth
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Brian T Anderson
- University of California San Francisco (UCSF) Department of Psychiatry & Behavioral Sciences, San Francisco, CA, USA; University of California Berkeley Center for the Science of Psychedelics, Berkeley, CA, USA
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31
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Glatfelter GC, Pottie E, Partilla JS, Sherwood AM, Kaylo K, Pham DNK, Naeem M, Sammeta VR, DeBoer S, Golen JA, Hulley EB, Stove CP, Chadeayne AR, Manke DR, Baumann MH. Structure-Activity Relationships for Psilocybin, Baeocystin, Aeruginascin, and Related Analogues to Produce Pharmacological Effects in Mice. ACS Pharmacol Transl Sci 2022; 5:1181-1196. [PMID: 36407948 PMCID: PMC9667540 DOI: 10.1021/acsptsci.2c00177] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Indexed: 11/06/2022]
Abstract
4-Phosphoryloxy-N,N-dimethyltryptamine (psilocybin) is a naturally occurring tertiary amine found in many mushroom species. Psilocybin is a prodrug for 4-hydroxy-N,N-dimethyltryptamine (psilocin), which induces psychedelic effects via agonist activity at the serotonin (5-HT) 2A receptor (5-HT2A). Several other 4-position ring-substituted tryptamines are present in psilocybin-containing mushrooms, including the secondary amine 4-phosphoryloxy-N-methyltryptamine (baeocystin) and the quaternary ammonium 4-phosphoryloxy-N,N,N-trimethyltryptamine (aeruginascin), but these compounds are not well studied. Here, we investigated the structure-activity relationships for psilocybin, baeocystin, and aeruginascin, as compared to their 4-acetoxy and 4-hydroxy analogues, using in vitro and in vivo methods. Broad receptor screening using radioligand binding assays in transfected cells revealed that secondary and tertiary tryptamines with either 4-acetoxy or 4-hydroxy substitutions display nanomolar affinity for most human 5-HT receptor subtypes tested, including the 5-HT2A and the serotonin 1A receptor (5-HT1A). The same compounds displayed affinity for 5-HT2A and 5-HT1A in mouse brain tissue in vitro and exhibited agonist efficacy in assays examining 5-HT2A-mediated calcium mobilization and β-arrestin 2 recruitment. In mouse experiments, only the tertiary amines psilocin, psilocybin, and 4-acetoxy-N,N-dimethyltryptamine (psilacetin) induced head twitch responses (ED50 0.11-0.29 mg/kg) indicative of psychedelic-like activity. Head twitches were blocked by 5-HT2A antagonist pretreatment, supporting 5-HT2A involvement. Both secondary and tertiary amines decreased body temperature and locomotor activity at higher doses, the effects of which were blocked by 5-HT1A antagonist pretreatment. Across all assays, the pharmacological effects of 4-acetoxy and 4-hydroxy compounds were similar, and these compounds were more potent than their 4-phosphoryloxy counterparts. Importantly, psilacetin appears to be a prodrug for psilocin that displays substantial serotonin receptor activities of its own.
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Affiliation(s)
- Grant C. Glatfelter
- Designer
Drug Research Unit, National Institute on
Drug Abuse Intramural Research Program, Baltimore, Maryland 21224, United States
| | - Eline Pottie
- Laboratory
of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical
Sciences, Ghent University, Campus Heymans, Ottergemsesteenweg
460, 9000 Ghent, Belgium
| | - John S. Partilla
- Designer
Drug Research Unit, National Institute on
Drug Abuse Intramural Research Program, Baltimore, Maryland 21224, United States
| | | | - Kristi Kaylo
- Usona
Institute, Madison, Wisconsin 53711, United States
| | - Duyen N. K. Pham
- Department
of Chemistry & Biochemistry, University
of Massachusetts Dartmouth, North Dartmouth, Massachusetts 02747, United States
| | - Marilyn Naeem
- Department
of Chemistry & Biochemistry, University
of Massachusetts Dartmouth, North Dartmouth, Massachusetts 02747, United States
| | - Vamshikrishna Reddy Sammeta
- Department
of Chemistry & Biochemistry, University
of Massachusetts Dartmouth, North Dartmouth, Massachusetts 02747, United States
| | - Stacie DeBoer
- Department
of Chemistry, University of Wyoming, Laramie, Wyoming 82071, United States
| | - James A. Golen
- Department
of Chemistry & Biochemistry, University
of Massachusetts Dartmouth, North Dartmouth, Massachusetts 02747, United States
| | - Elliott B. Hulley
- Department
of Chemistry, University of Wyoming, Laramie, Wyoming 82071, United States
| | - Christophe P. Stove
- Laboratory
of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical
Sciences, Ghent University, Campus Heymans, Ottergemsesteenweg
460, 9000 Ghent, Belgium
| | | | - David R. Manke
- Department
of Chemistry & Biochemistry, University
of Massachusetts Dartmouth, North Dartmouth, Massachusetts 02747, United States
| | - Michael H. Baumann
- Designer
Drug Research Unit, National Institute on
Drug Abuse Intramural Research Program, Baltimore, Maryland 21224, United States
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Reynolds LM, Barnett B, Weleff J, Morunga E, Wells A, Stack A, Akroyd A, Hoeh N, Sundram F, Muthukumaraswamy S, Lawrence N, Evans WJ. The perceptions of cancer health-care practitioners in New Zealand and the USA toward psychedelic-assisted therapy with cancer patients: A cross-sectional survey. Palliat Support Care 2022:1-10. [PMID: 36325995 DOI: 10.1017/s1478951522001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES A resurgence of research investigating the administration of psychedelic compounds alongside psychotherapy suggests that this treatment is a promising intervention for anxiety, depression, and existential distress in people with cancer. However, psychedelic treatment that induces a mind-altering experience potentially poses barriers to vulnerable cancer patients, and health-care practitioners may have concerns about referring their patients to trials investigating this approach. The aim of the current study was to investigate the perceptions of cancer health-care practitioners based in New Zealand and the USA related to psychedelic-assisted therapy. METHODS This study utilized a cross-sectional survey of cancer health-care practitioners in New Zealand and the USA via convenience sampling to identify their perceptions about the concept of conducting psychedelic-assisted therapy with cancer patients. RESULTS Participants perceived that (1) psychedelic-assisted therapy has the potential to provide benefit for cancer patients, (2) research in this area across a variety of domains is important, (3) work should consider spiritual and indigenous perspectives of health, and (4) there was willingness to refer patients to trials in this area, especially patients with advanced disease who were no longer going through curative treatment. Participants in the USA had greater awareness of psychedelics than the New Zealand sample; however, New Zealand participants more strongly believed that spiritual/indigenous factors should be considered in psychedelic-assisted therapy. SIGNIFICANCE OF RESULTS Cancer health-care practitioners in our sample considered research investigating the potential for psychedelic-assisted therapies to be important and may be more open to studies that start in palliative and end-of-life contexts.
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Affiliation(s)
- Lisa M Reynolds
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | - Brian Barnett
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Jeremy Weleff
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Eva Morunga
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
- Cancer and Blood Service, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Alesha Wells
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | - Aideen Stack
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | - Amelia Akroyd
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | - Nicholas Hoeh
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, The University of Auckland, Grafton, Auckland, New Zealand
| | | | - Nicola Lawrence
- Cancer and Blood Service, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
- The Department of Oncology, The University of Auckland, Auckland, New Zealand
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Abstract
With the extensive public, commercial and scientific interest from what has been widely termed the psychedelic renaissance, it is important that the scientific practices and results obtained from its implementation into medicine are put under a critical microscope. While there are numerous works on the potential benefits and applications of psychedelics as medicines, relatively little has been written about the challenges this field will face when incorporated into modern medical practice. Indeed, as a new or at least revived area of investigation, psychedelic medicine has a particular set of challenges which need to be addressed. In this viewpoint, we identify a number of these challenges. First, challenges related to the design of individual research studies are discussed, particularly focusing on current practices surrounding blinding, expectancy, the use of therapy and sources of bias. Second, the broader context of the research environment is considered, including how medical science typically establishes evidence, funding bodies and the impact of psychedelics being scheduled at odds with their risk profile. Finally, we describe challenges relating to the implementation of psychedelic therapies into modern medicine, considering the social and economic context. Alongside, we provide suggestions for what could be included into current research protocols to mitigate these challenges.
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Affiliation(s)
| | - Anna Forsyth
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Rachael L Sumner
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
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34
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Kaypak AC, Raz A. Macrodosing to microdosing with psychedelics: Clinical, social, and cultural perspectives. Transcult Psychiatry 2022; 59:665-674. [PMID: 36031848 DOI: 10.1177/13634615221119386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
To date, the clinical and scientific literature has best documented the effects of classical psychedelics, such as lysergic acid diethylamide (LSD), psilocybin, and dimethyltryptamine (DMT), in typical quantities most often associated with macrodosing. More recently, however, microdosing with psychedelics has emerged as a social trend and nascent therapeutic intervention. This variation in psychedelic practice refers to repeat, intermittent ingestion of less-than-macrodose amounts that do not cause the effects associated with full-blown "trips". Microdosing paves the road to incorporating psychedelic drugs into a daily routine while maintaining, or even improving, cognitive and mental function. Unlike macrodosing with psychedelics, the influence of microdosing remains mostly unexplored. And yet, despite the paucity of formal studies, many informal accounts propose that microdosing plays an important role as both a therapeutic intervention (e.g., in mental disorders) and enhancement tool (e.g., recreationally-to boost creativity, improve cognition, and drive personal growth). In response to this relatively new practice, we provide an integrative synthesis of the clinical, social, and cultural dimensions of microdosing. We describe some of the overarching context that explains why this practice is increasingly in vogue, unpack potential benefits and risks, and comment on sociocultural implications. In addition, this article considers the effects that macro- and microdoses have on behavior and psychopathology in light of their dosage characteristics and contexts of use.
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Affiliation(s)
- Ayse Ceren Kaypak
- Lady Davis Institute for Medical Research, 293290Institute for Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada.,Department of Psychiatry, 64050Marmara University School of Medicine, Istanbul, Turkey
| | - Amir Raz
- Lady Davis Institute for Medical Research, 293290Institute for Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada.,Departments of Psychiatry, Psychology, and Neurology & Neurosurgery, 5620McGill University, Montreal, QC, Canada.,Montreal Neurological Institute, 5620McGill University, Montreal, QC, Canada.,Institute for Interdisciplinary Brain and Behavioral Sciences, 6226Chapman University, Irvine, CA, USA
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35
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Kurtz JS, Patel NA, Gendreau JL, Yang C, Brown N, Bui N, Picton B, Harris M, Hatter M, Beyer R, Sahyouni R, Diaz-Aguilar LD, Castellano J, Schuster N, Abraham ME. The Use of Psychedelics in the Treatment of Medical Conditions: An Analysis of Currently Registered Psychedelics Studies in the American Drug Trial Registry. Cureus 2022; 14:e29167. [PMID: 36259015 PMCID: PMC9567237 DOI: 10.7759/cureus.29167] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 12/03/2022] Open
Abstract
Although early therapeutic research on psychedelics dates back to the 1940s, this field of investigation was met with many cultural and legal challenges in the 1970s. Over the past two decades, clinical trials using psychedelics have resumed. Therefore, the goal of this study was to (1) better characterize the recent uptrend in psychedelics in clinical trials and (2) identify areas where potentially new clinical trials could be initiated to help in the treatment of widely prevalent medical disorders. A systematic search was conducted on the clinicaltrials.gov database for all registered clinical trials examining the use of psychedelic drugs and was both qualitatively and quantitatively assessed. Analysis of recent studies registered in clinicaltrials.gov was performed using Pearson’s correlation coefficient testing. Statistical analysis and visualization were performed using R software. In totality, 105 clinical trials met this study’s inclusion criteria. The recent uptrend in registered clinical trials studying psychedelics (p = 0.002) was similar to the uptrend in total registered clinical trials in the registry (p < 0.001). All trials took place from 2007 to 2020, with 77.1% of studies starting in 2017 or later. A majority of clinical trials were in phase 1 (53.3%) or phase 2 (25.7%). Common disorders treated include substance addiction, post-traumatic stress disorder, and major depressive disorder. Potential research gaps include studying psychedelics as a potential option for symptomatic treatment during opioid tapering. There appears to be a recent uptrend in registered clinical trials studying psychedelics, which is similar to the recent increase in overall trials registered. Potentially, more studies could be performed to evaluate the potential of psychedelics for symptomatic treatment during opioid tapering and depression refractory to selective serotonin reuptake inhibitors.
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Henningfield JE, Coe MA, Griffiths RR, Belouin SJ, Berger A, Coker AR, Comer SD, Heal DJ, Hendricks PS, Nichols CD, Sapienza F, Vocci FJ, Zia FZ. Psychedelic drug abuse potential assessment research for new drug applications and Controlled Substances Act scheduling. Neuropharmacology 2022; 218:109220. [PMID: 35987353 DOI: 10.1016/j.neuropharm.2022.109220] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/05/2022] [Accepted: 08/09/2022] [Indexed: 10/31/2022]
Abstract
New medicines containing classic hallucinogenic and entactogenic psychedelic substance are under development for various psychiatric and neurological disorders. Many of these, including psilocybin, lysergic acid diethylamide (LSD), and 3,4-methylenedioxymethamphetamine (MDMA) are Schedule I controlled substances of the United States Controlled Substances Act (US CSA), and similarly controlled globally. The implications of the CSA for research and medicines development, the path to approval of medicines, and their subsequent removal from Schedule I in the US are discussed. This entire process occurs within the framework of the CSA in the US and its counterparts internationally in accordance with international drug control treaties. Abuse potential related research in the US informs the eight factors of the CSA which provide the basis for rescheduling actions that must occur upon approval of a drug that contains a Schedule I substance. Abuse-related research also informs drug product labeling and the risk evaluation and mitigation strategies (REMS) will likely be required for approved medicines. Human abuse potential studies typically employed in CNS drug development may be problematic for substances with strong hallucinogenic effects such as psilocybin, and alternative strategies are discussed. Implications for research, medicinal development, and controlled substance scheduling are presented in the context of the US CSA and FDA requirements with implications for global regulation. We also discuss how abuse-related research can contribute to understanding mechanisms of action and therapeutic effects as well as the totality of the effects of the drugs on the brain, behavior, mood, and the constructs of spirituality and consciousness.
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Affiliation(s)
- Jack E Henningfield
- PinneyAssociates, Inc, 4800 Montgomery Lane, Suite 400, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Marion A Coe
- PinneyAssociates, Inc, 4800 Montgomery Lane, Suite 400, Bethesda, MD, USA
| | - Roland R Griffiths
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sean J Belouin
- Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
| | - Ann Berger
- Chief of Pain and Palliative Care, Senior Research Clinician (Full Professor). National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Allison R Coker
- MAPS Public Benefit Corporation (MAPS PBC), San Jose, CA, USA; Department of Neurology, University of California, San Francisco, CA, USA
| | - Sandra D Comer
- Columbia University, Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - David J Heal
- DevelRx Ltd. BioCity, Nottingham, And Department of Pharmacy and Pharmacology University of Bath, Bath, UK
| | - Peter S Hendricks
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, USA
| | - Charles D Nichols
- Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center, USA
| | - Frank Sapienza
- Partner, The Drug and Chemical Advisory Group, LLC, Fairfax, VA, USA
| | | | - Farah Z Zia
- Department of Health & Human Services National Institutes of Health, National Cancer Institute Division of Cancer Treatment & Diagnosis, Washington, DC, USA
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Orozco M, Harris S. Psilocybin and the Meaning Response: Exploring the Healing Process in a Retreat Setting in Jamaica. ANTHROPOLOGY OF CONSCIOUSNESS 2022. [DOI: 10.1111/anoc.12162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Levin A, Nagib PB, Deiparine S, Gao T, Mitchell J, Davis AK. Inconsistencies between national drug policy and professional beliefs about psychoactive drugs among psychiatrists in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 108:103816. [PMID: 35964449 DOI: 10.1016/j.drugpo.2022.103816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence points to an incongruence between international drug policy and expert opinion about safety, abuse potential, and therapeutic potential of specific drugs. However, no prior studies have directly explored psychiatrists' attitudes about the current drug schedule. Therefore, we examined whether American psychiatrists' perceptions of four psychoactive drugs differed from those indicated by their schedules. METHODS A quasi-experimental online survey of a convenience sample of psychiatrists in the United States (N=181; Mean age=48.7; Female=35%). Participants were randomized to receive 1-of-4 vignettes, each depicting a depressed patient reporting relief from symptoms after non-prescribed psychoactive drug use (i.e., psilocybin [Schedule I], methamphetamine [SchedII], ketamine [SchedIII], or alprazolam [SchedIV]). Participants responded to questions related to this clinical scenario and then rated the safety, therapeutic, and abuse potentials of these four drugs and alcohol. RESULTS There were significant differences by vignette condition in mean likelihood ratings of: warning against engaging in drug use again (p<.01), being concerned about developing a new psychiatric problem (p<.001), being concerned about increased suicide risk (p<.01) and being supportive of further use of this drug as part of the treatment plan (p<.001). Overall, non-prescribed use of methamphetamine and alprazolam was rated more concerning and less acceptable than non-prescribed use of psilocybin and ketamine. Compared to psilocybin and ketamine, participants rated methamphetamine and alprazolam as less safe (p<.001), having less therapeutic potential (p<.001), and having more abuse potential (p<.001). Mean ratings of safety and abuse/therapeutic potential of alprazolam and methamphetamine were equivalent to that of alcohol, and all three were rated more harmful than psilocybin and ketamine. CONCLUSION American psychiatrists' perceptions about safety and abuse/therapeutic potentials associated with certain psychoactive drugs were inconsistent with those indicated by their placement in drug schedules. These findings add to a growing consensus amongst experts that the current drug policy is not scientifically coherent.
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Affiliation(s)
- Adam Levin
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States; Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH 43210, United States
| | - Paul B Nagib
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States; Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH 43210, United States
| | - Selina Deiparine
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Thomas Gao
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Justin Mitchell
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Alan K Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH 43210, United States; Center for Psychedelic and Consciousness Research, Johns Hopkins University, Baltimore, MD 21224, United States; College of Medicine, The Ohio State University, Columbus, OH 43210, United States.
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Psychedelic drugs for psychiatric disorders. J Neurol Sci 2022; 440:120332. [DOI: 10.1016/j.jns.2022.120332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 11/19/2022]
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Smith WR, Appelbaum PS. Novel ethical and policy issues in psychiatric uses of psychedelic substances. Neuropharmacology 2022; 216:109165. [PMID: 35718006 DOI: 10.1016/j.neuropharm.2022.109165] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/02/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
Classic psychedelics and related substances have shown promising initial research results. However, they raise a number of relatively novel ethical and policy challenges in light of their psychoactive properties, their emergence from the unregulated "underground" settings in which they have been used, their rapid commercialization, and the means and speed with which they are moving from a Schedule 1 drug to legalized use. All of these issues are affected by the current limits to the evidence base on use of psychedelics. Here we survey these novel challenges, illustrating the issues raised regarding each, and offering suggestions for how to address them. Emerging findings on psychedelic therapies suggest promise in treating psychiatric disorders, including major depressive disorder with psilocybin (Carhart-Harris et al., 2021; Compass pathways, 2021; Davis et al., 2021) and post-traumatic stress disorder (PTSD) with 3,4-methylenedioxymethamphetamine (MDMA) (Mitchell et al., 2021). Additional research is underway on other conditions (Reiff et al., 2020). At this early stage in the research process, the published evidence supporting psychedelic use is limited by relatively small sample sizes (as compared to Phase 3 trials for conventional anti-depressants), highly selected and perhaps atypical participants, and the need for replication (Smith and Appelbaum, 2021b). Nevertheless, the promise of these findings and the emerging efforts at legalization and/or decriminalization in several parts of the country, utilizing a diversity of mechanisms, raise important ethical and policy questions that have received little systematic exploration. To help address this deficit, this commentary surveys four domains in which ethical and policy questions arise. We focus chiefly on psilocybin, the most promising of the psychedelics now being investigated, though our conclusions may generalize to other classic psychedelics or related agents, like MDMA. Of note, we focus here on questions that are relatively novel or particularly important for psychedelics. Many other ethical issues regarding psychedelics in both research and clinical contexts will be similar to those for other treatment modalities. As with other modalities, when used in clinical practice there will be ethical challenges regarding patient confidentiality, informed consent, balancing the risks and benefits of treatment, and provision of equitable access. Clinical research on psychedelic compounds is not unusual in raising concerns about the adequacy of understanding of randomization and possibility of allocation to the control arm of the trial, therapeutic misconception, and exclusion or exploitation of marginalized or otherwise disadvantaged groups (Emanuel et al., 2000). Regarding disadvantaged groups, like many other areas of medical research, early psychedelic research had a significant history of exploitation of vulnerable populations including imprisoned persons and people of color (Strauss et al., 2021). Although we acknowledge the importance of issues that are very similar to those for other treatment modalities, we do not discuss them in detail.
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Affiliation(s)
- William R Smith
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA; Scattergood Program for Applied Ethics of Behavioral Health Care, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, USA.
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, USA; Center for Law, Ethics & Psychiatry, New York State Psychiatric Institute, USA
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Maia LO, Beaussant Y, Garcia ACM. The Therapeutic Potential of Psychedelic-assisted Therapies for Symptom Control in Patients Diagnosed With Serious Illness: A Systematic Review. J Pain Symptom Manage 2022; 63:e725-e738. [PMID: 35157985 DOI: 10.1016/j.jpainsymman.2022.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/20/2022]
Abstract
CONTEXT People affected by serious illness usually experience suffering in its various dimensions, not only in the physical but also in the psychosocial and spiritual aspects. The interest in psychedelic-assisted therapies as a potential new therapeutic modality has increased since evidence suggests a significant impact of their use on the outcomes of patients with serious illness. OBJECTIVES To systematically review the available evidence on the effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness. METHODS The protocol of this systematic review has been prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. This review included randomized and non-randomized controlled trials published in peer-reviewed scientific journals. A comprehensive search for studies was carried out in the main scientific databases, including Web of Science, Scopus, Cochrane Library, PsycINFO, PubMed, CINAHL, and EMBASE. There were no limitations regarding the year or language of publication. RESULTS The sample was composed of 20 studies. The results suggest positive effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness, with considerable safety of use. Most studies have been conducted with lysergic acid diethylamide, psilocybin, and N,N-dipropyltryptamine in cancer patients. The adverse effects reported were of physical and/or psychological nature and of mild to moderate intensity, transient, and self-resolutive. CONCLUSION The evaluated evidence suggests positive effects of psychedelic-assisted therapies for symptom control in patients diagnosed with serious illness, especially regarding symptoms of psychological and spiritual nature.
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Affiliation(s)
- Lucas Oliveira Maia
- Interdisciplinary Center for Studies in Palliative Care (L.O.M., A.C.M.G.), School of Nursing, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil; Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO) (L.O.M.), School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative Care (Y.B.), Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ana Cláudia Mesquita Garcia
- Interdisciplinary Center for Studies in Palliative Care (L.O.M., A.C.M.G.), School of Nursing, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil.
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Girn M, Roseman L, Bernhardt B, Smallwood J, Carhart-Harris R, Nathan Spreng R. Serotonergic psychedelic drugs LSD and psilocybin reduce the hierarchical differentiation of unimodal and transmodal cortex. Neuroimage 2022; 256:119220. [PMID: 35483649 DOI: 10.1016/j.neuroimage.2022.119220] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/03/2022] [Accepted: 04/15/2022] [Indexed: 12/20/2022] Open
Abstract
Lysergic acid diethylamide (LSD) and psilocybin are serotonergic psychedelic compounds with potential in the treatment of mental health disorders. Past neuroimaging investigations have revealed that both compounds can elicit significant changes to whole-brain functional organization and dynamics. A recent proposal linked past findings into a unified model and hypothesized reduced whole-brain hierarchical organization as a key mechanism underlying the psychedelic state, but this has yet to be directly tested. We applied a non-linear dimensionality reduction technique previously used to map hierarchical connectivity gradients to assess cortical organization in the LSD and psilocybin state from two previously published pharmacological resting-state fMRI datasets (N = 15 and 9, respectively). Results supported our primary hypothesis: The principal gradient of cortical connectivity, describing a hierarchy from unimodal to transmodal cortex, was significantly flattened under both drugs relative to their respective placebo conditions. Between-condition contrasts revealed that this was driven by a reduction of functional differentiation at both hierarchical extremes - default and frontoparietal networks at the upper end, and somatomotor at the lower. Gradient-based connectivity mapping indicated that this was underpinned by a disruption of modular unimodal connectivity and increased unimodal-transmodal crosstalk. Results involving the second and third gradient, which, respectively represent axes of sensory and executive differentiation, also showed significant alterations across both drugs. These findings provide support for a recent mechanistic model of the psychedelic state relevant to therapeutic applications of psychedelics. More fundamentally, we provide the first evidence that macroscale connectivity gradients are sensitive to an acute pharmacological manipulation, supporting a role for psychedelics as scientific tools to perturb cortical functional organization.
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Affiliation(s)
- Manesh Girn
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 Rue Université, Montreal, QC H3A 2B4, Canada.
| | - Leor Roseman
- Centre for Psychedelic Research, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Boris Bernhardt
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 Rue Université, Montreal, QC H3A 2B4, Canada
| | | | - Robin Carhart-Harris
- Neuroscape Psychedelics Division, Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - R Nathan Spreng
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 Rue Université, Montreal, QC H3A 2B4, Canada; Departments of Psychiatry and Psychology, McGill University, Montreal, QC, Canada; Douglas Mental Health University Institute, Verdun, QC, Canada; McConnell Brain Imaging Centre, McGill University, Montreal, QC, Canada
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Schlag AK, Aday J, Salam I, Neill JC, Nutt DJ. Adverse effects of psychedelics: From anecdotes and misinformation to systematic science. J Psychopharmacol 2022; 36:258-272. [PMID: 35107059 PMCID: PMC8905125 DOI: 10.1177/02698811211069100] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Despite an increasing body of research highlighting their efficacy to treat a broad range of medical conditions, psychedelic drugs remain a controversial issue among the public and politicians, tainted by previous stigmatisation and perceptions of risk and danger. OBJECTIVE This narrative review examines the evidence for potential harms of the classic psychedelics by separating anecdotes and misinformation from systematic research. METHODS Taking a high-level perspective, we address both psychological and psychiatric risks, such as abuse liability and potential for dependence, as well as medical harms, including toxicity and overdose. We explore the evidence base for these adverse effects to elucidate which of these harms are based largely on anecdotes versus those that stand up to current scientific scrutiny. RESULTS Our review shows that medical risks are often minimal, and that many - albeit not all - of the persistent negative perceptions of psychological risks are unsupported by the currently available scientific evidence, with the majority of reported adverse effects not being observed in a regulated and/or medical context. CONCLUSIONS This highlights the importance for clinicians and therapists to keep to the highest safety and ethical standards. It is imperative not to be overzealous and to ensure balanced media reporting to avoid future controversies, so that much needed research can continue.
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Affiliation(s)
- Anne K Schlag
- Drug Science, London, UK,Department of Brain Sciences, Imperial College London, London, UK,Department of Geography, King’s College London, London, UK
| | - Jacob Aday
- Drug Science, London, UK,Department of Psychology, Central Michigan University, Mount Pleasant, MI, USA,Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, USA
| | | | - Jo C Neill
- Drug Science, London, UK,Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - David J Nutt
- Drug Science, London, UK,Department of Brain Sciences, Imperial College London, London, UK,David J Nutt, Department of Brain Sciences, Imperial College London, Burlington Danes Building, The Hammersmith Hospital, London W12 0NN, UK.
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Hendricks PS, Copes H, Family N, Williams LT, Luke D, Raz S. Perceptions of safety, subjective effects, and beliefs about the clinical utility of lysergic acid diethylamide in healthy participants within a novel intervention paradigm: Qualitative results from a proof-of-concept study. J Psychopharmacol 2022; 36:337-347. [PMID: 35253517 DOI: 10.1177/02698811211055855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Classic psychedelics show promise in the treatment of mental health conditions; however, more scalable intervention protocols are needed to maximize access to these novel therapeutics. In this proof-of-concept study, perceptions of safety, subjective effects, and beliefs about the clinical utility of lysergic acid diethylamide (LSD) were evaluated among healthy participants (N = 31) administered 50 to 100 µg LSD in a treatment paradigm conceptualized as more scalable than traditional approaches to administering classic psychedelics. METHODS Semi-structured interviews assessed participants' expectations, experience, and thoughts on the safety and efficacy of the study design. These interviews were transcribed for thematic analysis relating to perceptions of safety, subjective effects, and beliefs about the clinical utility of LSD. RESULTS Most participants felt safe throughout the study, with a minority reporting concerns related to having a challenging experience that diminished over time. Participants attributed their feelings of safety to the study structure and support of their attendants, which allowed them to "let go" and immerse themselves in the experience without pre-occupation. Furthermore, participants reported transcendent, mystical-type experiences characteristic of classic psychedelics, with almost half highlighting the prominent role played by music during the acute period of drug action. Finally, participants endorsed support for the clinical utility of LSD in controlled environments, expressing the belief that LSD is safe and has the potential to help others. CONCLUSION Findings provide preliminary support for the feasibility of this scalable interventional paradigm and set the stage for future critical research with clinical populations.
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Affiliation(s)
| | - Heith Copes
- The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - David Luke
- Centre for Mental Health, School of Human Sciences, Old Royal Naval College, University of Greenwich, Greenwich, UK
| | - Shlomi Raz
- Eleusis Health Solutions US, New York, NY, USA
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van Amsterdam J, van den Brink W. The therapeutic potential of psilocybin: a systematic review. Expert Opin Drug Saf 2022; 21:833-840. [DOI: 10.1080/14740338.2022.2047929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jan van Amsterdam
- Department of Psychiatry, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
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Lebrero-Tatay J, Sebag A, Ezquerra-Romano I. Asymmetry in Psychoactive Research: A Bibliometric Study on 15 Psychoactive Drugs. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426211068439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although intended to avoid illicit drug use, national laws and international conventions have limited research on psychoactive drugs. To characterise the evolution of the literature on psychoactive drugs, a bibliometric study of 15 psychoactive drugs from 1960 to 2018 was conducted in which 956,703 academic publications were obtained from Web of Science. Growth patterns were analysed per drug type, legal status and country. Our results show the existence of heterogeneous patterns of growth for the publications of different psychoactive drugs. Strikingly, the literature on legal substances and depressants represented between 60% and 80% throughout the years. We found unexpected regional differences in the scientific output about the selected drugs, which might be explained by cultural and political phenomena. Governments and funding bodies should consider these results when allocating resources to research on psychoactive drugs to optimise the therapeutic applications of these compounds and our understanding of the nervous system.
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Affiliation(s)
- Julia Lebrero-Tatay
- Division of Neuroscience and Experimental Psychology Manchester, The University of Manchester, Manchester, UK
- Drugs and Me, London, UK
| | - Arthur Sebag
- Drugs and Me, London, UK
- Institute of Cognitive Neuroscience, University College London, London, UK
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Nair JB, Hakes L, Yazar-Klosinski B, Paisner K. Fully Validated, Multi-Kilogram cGMP Synthesis of MDMA. ACS OMEGA 2022; 7:900-907. [PMID: 35036754 PMCID: PMC8756783 DOI: 10.1021/acsomega.1c05520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
MDMA is increasingly used in clinical research, but no cGMP process has yet been reported. We describe here the first fully validated cGMP synthesis of up to 5 kg (≈30 000 patient doses) of MDMA in a four-step process beginning with a noncontrolled starting material. The overall yield was acceptable (41-53%, over four steps), and the chemical purity of the final product was excellent, exceeding 99.9% of the peak area by HPLC in each of the four validation trials. The availability of cGMP-compliant MDMA will facilitate ongoing clinical trials and provide for future therapeutic use, if encouraging results lead to FDA approval.
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Affiliation(s)
- Jay B. Nair
- MAPS
Public Benefit Corporation (MAPS PBC), 3141 Stevens Creek Blvd #40547, San Jose, California 95117, United States
| | - Linda Hakes
- Independent
Consultant for MAPS Public Benefit Corporation, 3141 Stevens Creek Blvd #40547, San Jose, California 95117, United States
| | - Berra Yazar-Klosinski
- Multidisciplinary
Association for Psychedelic Studies (MAPS), 3141 Stevens Creek Blvd #40563, San Jose, California 95117, United States
| | - Kathryn Paisner
- KP2
LLC, 2510 14th Ave., Oakland, California 94606, United States
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Jones GM, Nock MK. MDMA/ecstasy use and psilocybin use are associated with lowered odds of psychological distress and suicidal thoughts in a sample of US adults. J Psychopharmacol 2022; 36:46-56. [PMID: 34983249 DOI: 10.1177/02698811211058923] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Suicide is one of the leading causes of death worldwide and rates within the United States have risen over the past two decades. Hence, there is a critical need for novel tools to treat suicidal ideation and related mental health conditions. 3,4-Methylenedioxymethamphetamine (MDMA)/ecstasy and classic psychedelics may be two such tools. AIMS The aim of this study was to assess non-causal associations between MDMA/ecstasy and classic psychedelic use and psychological distress and suicide risk. METHODS In this study, we examined the aforementioned associations among 484,732 adult participants in the National Survey on Drug Use and Health (2008-2019). RESULTS Lifetime MDMA/ecstasy use was associated with reduced odds of past year suicidal thinking (10% reduced odds; odds ratio (OR) = 0.90; 95% confidence interval, CI = (0.84-0.97); p < 0.01) and past year suicidal planning (OR = 0.88; 95% CI = (0.78-0.99); p < 0.05). Furthermore, lifetime psilocybin use was associated with reduced odds of past month psychological distress (OR = 0.78; 95% CI = (0.73-0.84); p < 0.001) and past year suicidal thinking (OR = 0.90; 95% CI = (0.83-0.96); p < 0.01). Finally, lysergic acid diethylamide (LSD) was associated with increased odds of past year suicidal thinking (OR = 1.07; 95% CI = (1.00-1.15); p < 0.05). CONCLUSION MDMA/ecstasy and psilocybin use are associated with reduced odds of suicidal thinking and related outcomes-though experimental studies are needed to determine whether these associations are causal. These findings call for more research into the efficacy of MDMA/ecstasy and classic psychedelics for treating psychological distress and suicidal thoughts and behaviors, and for updated drug legislation that allows for further investigation into these substances.
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Affiliation(s)
- Grant M Jones
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Buonomano LS, Mitnick MM, McCalmont TR, Syracuse P, Dugosh KL, Festinger DS, Lent MR. Clinical Characteristics and Quality of Life in Adults Initiating Medical Marijuana Treatment. Med Cannabis Cannabinoids 2022; 5:95-101. [PMID: 35950051 PMCID: PMC9247440 DOI: 10.1159/000524831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/25/2022] [Indexed: 12/13/2023] Open
Abstract
INTRODUCTION Despite the rising availability and use of medical marijuana (MM) in the USA, little is known about the demographics, clinical characteristics, or quality of life of MM patients. This study describes the demographic characteristics and health-related quality of life (HRQoL) of MM patients who are initiating treatment in Pennsylvania. METHODS Two-hundred adults naive to MM and referred for any of the 23 state-approved qualifying conditions were recruited at three MM dispensaries in Pennsylvania between September 2020 and March 2021. All participants consented to the study; completed semi-structured interviews that included demographic questionnaires, the Short Form-36 (SF-36), and Generalized Anxiety Disorder-7 (GAD-7); provided height and weight measurements; and allowed access their dispensary medical records. RESULTS Participants had a mean age of 48.5 ± 15.6 years, predominantly identified as female (67.5%), and were most commonly referred for chronic pain (63.5%) and/or anxiety (58.5%). Additionally, 46.0% were living with obesity as determined by BMI. Relative to a normative sample, participants reported diminished HRQoL in several domains, most notably in role limitations due to physical health (M = 46.0 ± 42.0), role limitations due to emotional problems (M = 52.5 ± 42.3), energy and fatigue (M = 39.8 ± 20.2), and pain (M = 49.4 ± 26.0). DISCUSSION/CONCLUSION Patients initiating MM treatment experienced low HRQoL in multiple domains. Future studies could evaluate the relationship between HRQoL and patients' decisions to pursue MM treatment, as well as changes in HRQoL with MM use over time.
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Affiliation(s)
- Lydia S. Buonomano
- School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Matthew M. Mitnick
- School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Thomas R. McCalmont
- School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Paulina Syracuse
- School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Karen L. Dugosh
- Public Health Management Corporation, Research and Evaluation Group, Philadelphia, Pennsylvania, USA
| | - David S. Festinger
- School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Michelle R. Lent
- School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
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Beating Pain with Psychedelics: Matter over Mind? Neurosci Biobehav Rev 2021; 134:104482. [PMID: 34922987 DOI: 10.1016/j.neubiorev.2021.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 02/08/2023]
Abstract
Basic pain research has shed light on key cellular and molecular mechanisms underlying nociceptive and phenomenological aspects of pain. Despite these advances, [[we still yearn for] the discovery of novel therapeutic strategies to address the unmet needs of about 70% of chronic neuropathic pain patients whose pain fails to respond to opioids as well as to other conventional analgesic agents. Importantly, a substantial body of clinical observations over the past decade cumulatively suggests that the psychedelic class of drugs may possess heuristic value for understanding and treating chronic pain conditions. The present review presents a theoretical framework for hitherto insufficiently understood neuroscience-based mechanisms of psychedelics' potential analgesic effects. To that end, searches of PubMed-indexed journals were performed using the following Medical Subject Headings' terms: pain, analgesia, inflammatory, brain connectivity, ketamine, psilocybin, functional imaging, and dendrites. Recursive sets of scientific and clinical evidence extracted from this literature review were summarized within the following key areas: (1) studies employing psychedelics for alleviation of physical and emotional pain; (2) potential neuro-restorative effects of psychedelics to remediate the impaired connectivity underlying the dissociation between pain-related conscious states/cognitions and the subcortical activity/function leading to the eventual chronicity through immediate and long-term effects on dentritic plasticity; (3) anti-neuroinflammatory and pro-immunomodulatory actions of psychedelics as the may pertain to the role of these factors in the pathogenesis of neuropathic pain; (4) safety, legal, and ethical consideration inherent in psychedelics' pharmacotherapy. In addition to direct beneficial effects in terms of reduction of pain and suffering, psychedelics' inclusion in the analgesic armamentarium will contribute to deeper and more sophisticated insights not only into pain syndromes but also into frequently comorbid psychiatric condition associated with emotional pain, e.g., depressive and anxiety disorders. Further inquiry is clearly warranted into the above areas that have potential to evolve into further elucidate the mechanisms of chronic pain and affective disorders, and lead to the development of innovative, safe, and more efficacious neurobiologically-based therapeutic approaches.
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