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Psychedelics Are Outgrowing Their Hippie History to Claim a Place in Medicine
But can rigorous research and licensure stay in front of venture capital and digital dispensing?
by Nolan Shah
The COVID-19 pandemic exacerbated an already pressing mental health crisis in the United States. More than 50% of the world’s population will be diagnosed with a mental illness at least once in their lives, with many more remaining undiagnosed due to inadequate mental health care. While traditional pharmacologic treatments such as Prozac are widely prescribed by psychiatrists, the research supporting the actual long-term efficacy of these drugs tells a different story.
The variability of patient outcomes after taking antidepressants establishes an urgent need to seek non-traditional approaches to mental health care. And no approach is perhaps less “traditional” than psychedelics.
While many believe psychedelics to be a new advent of the so-called “holistic health” movement, magic mushrooms have been used for more than 1,000 years in indigenous North America. Native Americans participated in vision quests in the hopes of interacting with a supernatural divine being/spirit. Psychoactive substances were even used in ancient medicinal practices and healing ceremonies.
Today, psychedelic drugs are synonymous with the counterculture movement of the 1960s because of one man, Timothy Leary: the “Father of Psychedelics” who told people to “Turn on, tune in, drop out.” Images of Leary and his followers depict a rebellious group of individuals who shared anti-establishment ideals. These people soon became the target of strict legislation such as The Convention on Psychotropic Substances, passed in 1971, which effectively ended the psychedelic movement for the rest of the 20th century. The legislation also halted clinical psychedelic research by defunding government-affiliated and higher education research institutes experimenting with the likes of LSD, MDMA, and Ketamine.
Holistic health and wellness trended astronomically during the pandemic era, with Americans spending over $450 billion on wellness products and services. For most, this comprised practices such as yoga, journaling, and nature retreats. However, some dove into the more extreme side of holistic health: psychedelics. From LSD to ecstasy, the recreational use of these hallucinogens gained enormous popularity, much like the boom in the 1960s.
The general criticism of holistic medicine is that there is a lack of scientific literature backing positive health claims. In the case of psychedelics, however, there is real evidence of a synergistic relationship between meditative practices and psychedelic usage. A study designed by Dr. Roland Griffiths looks at the effects of administering psilocybin to meditators and collected metrics such as heart rate and blood pressure before and after capsule administration. The study showed that ingesting psilocybin before meditation improves feelings of well-being and improves anxiety long term, as assessed by a 6-month follow-up questionnaire. Original effects of improved mood disposition were shown to last for months, in contrast to traditional antidepressants, whose effects subside only weeks after discontinuation.
A similar study by Dr. Franz Vollenweider demonstrated alterations in self-experience and connectivity which is a proxy for predicting long-lasting positive changes in mental health. For hardcore meditators, the purpose itself is blurry. Are they trying to reach an end goal? Are they seeking an omniscient truth? Psychedelics may help people get a glimpse of whatever they are trying to reach through meditation.
Psychedelics are not effective only when coupled with a meditation protocol. Dr. Charles Raison, a psychiatrist by training and the Director of Research on Spiritual Health for Emory Healthcare, has completed numerous studies showing the long-term efficacy of clinical psychedelic treatment on depression. Dr. Raison is also the Director of Clinical and Translational Research for the Usona Institute in Wisconsin, where he leads clinical trials testing the efficacy of psychoactive substances such as psilocybin and 5-MeO-DMT with the hopes of gaining FDA approval for these drugs.
According to Dr. Raison, current psychiatry seeks only to reverse symptoms of mental illness without identifying the root cause. Prescribing antidepressants is like putting a bandaid on a bullet wound. With the roar of the psychedelic movement, more and more states are legalizing psychedelics in the clinical setting through psychotherapy. Psychotherapy aims at actually figuring out why a patient is depressed, through a professionally guided “trip” session.
Currently, there are no psychedelics approved for commercial use by the Food and Drug Administration. However, the FDA has recently given psilocybin “breakthrough therapy status” which has led to the support of entities such as the Usona Institute. Additionally, a ketamine-adjacent therapy called S-ketamine was approved by the FDA specifically for patients with treatment-resistant depression. Further, ketamine itself is legal for at-home use for mental health treatment when prescribed by a licensed physician.
The biggest barrier to widespread access to psychotherapy is not pushback from the FDA. Raison says: “There just aren’t that many therapists, waiting times are long, and psychotherapy requires large amounts of money.” Yet he is hopeful for the future of psychedelics.
“Everyone seems bullish on the potential of psychoactive substances to improve mental health outcomes,” Raison says. The first state government that mandated funding for psychedelic research was surprisingly Texas. The trans-diagnostic effects [of psychedelics] that have already been demonstrated will prevent psilocybin or LSD or MDMA from becoming a flashpoint for culture wars.”
Looser legislation has given way to new psychedelic digital health platforms that ship ketamine to your doorstep. When asked about the future of these digital ketamine clinics, Dr. Raison says “I don’t know if that’s going to be a sustainable model. The FDA has recently started to come after these companies, so I think digital health will start to play a different role in the psychedelic space going forward.”
Individual investors and venture capital firms are optimistic that AI will take over the psychotherapy space and are putting their money behind that. A Business Insider analysis done in early January estimated that eleven VCs accounted for roughly $140 million in psychedelic startup investments. Companies such as MindState are developing products based on the design of MDMA by leveraging AI capabilities. The MDMA product will serve as a therapeutic for patients suffering from PTSD. Other companies in the psychedelic/AI market include Cybin Inc., Mind Cure Health Inc., and Novamind Inc. AI has been hypothesized to enhance the psychedelic industry by tracking symptoms and pairing it with health wearables to monitor disease states. Recently, a Chatbot was even used to guide a patient through a ketamine psychotherapy session.
Yet, while Dr. Raison is bullish on the idea that AI can take over the field of psychotherapy, Dr. Ingmar Gorman, CEO of Fluence, takes a different stance. Fluence is a psychedelic educational platform that equips mental health professionals with certifications for psychotherapy. “The science for how psychotherapy works are still very contentious,” Gorman says. “There are no clear signals regarding what about psychotherapy is beneficial to patient outcomes. There are so many variables and the most common and consistent variable that is predictive of how effective a psychotherapy session was is therapeutic alliance. The better the relationship between the provider and the patient, the better the outcome will be. In this sense, AI and subsequent Chatbots will not replace psychotherapists”.
Digital health is taking over the healthcare industry even in niche markets like psychedelic therapy. As new research continues to support the use of psychedelics for mental health treatment, companies will continue to emerge looking to connect patients to potential hallucinogenic therapies. It will be interesting to see how the FDA responds to more and more states following the lead of Oregon in approving psilocybin-assisted therapy.