N. Adam Brown is a practicing emergency physician, entrepreneur, and healthcare executive. He is the founder of ABIG Health, a healthcare growth strategy firm, and a professor at the University of North Carolina’s Kenan-Flagler Business School. Follow
Looking for an election-year healthcare issue that could bring the two major political parties together? Think there is no such thing?
Think again. A public opinion survey conducted last summer by the University of California, Berkeley, found 61% of U.S. voters support legalizing regulated therapeutic access to psychedelics. Breaking it down by party, liberal voter support for legalized therapeutic access to psychedelics was 80%, compared to moderates at 66%, and conservatives at 45%.
To be clear: Use of psychedelics, such as psilocybin, for recreation is quite different than therapeutic interventions that are paired with intensive psychotherapy. Psilocybin can cause intense psychological experiences, which, if not handled correctly, could lead to adverse outcomes, particularly in individuals with a predisposition to psychosis-associated mental health issues. However, the promise of psilocybin to treat anxiety, depression, and post-traumatic stress disorder (PTSD) is real.
The country must expand research into physician-assisted psilocybin treatment.
Psilocybin Research, Treatment Is Not a New Phenomenon
The use of mushrooms containing psilocybin, a naturally occurring psychedelic compound, has a history that stretches back millennia. Indigenous cultures have utilized these mushrooms for spiritual and medicinal purposes, treating everything from toothaches to rheumatism.
Notably, use by these cultures always included a leader or guide. As a 2022 paper by researchers at Oregon State University explained, “While practices vary between indigenous groups, in general ceremonies are always done with care at night in a quiet place guided by an elder or shaman…”
During the earlier half of the 20th century, academic and scientific research on the potential benefits of psilocybin was being conducted across the U.S., in colleges and universities — and even by the federal government. As Senator Brian Schatz (D-Hawaii) has explained, “Study of hallucinogens was commonplace in the 1950s and 60s, but after drugs such as marijuana and LSD became associated with the counterculture movement, the U.S. government’s so-called war on drugs all but put an end to the scientific inquiry.”
In other words, research was halted not because of concerns about the safety, but because of disdain for hippie, anti-Vietnam War culture.
The Therapeutic Potential of Psilocybin Today
Research has picked up again over the last decade and studies conducted by institutions like Johns Hopkins University (JHU) and Imperial College London have shown promising results, indicating psilocybin can promote profound changes in mood, perception, and cognition, which may lead to long-lasting improvements in mental health.
The mechanism by which psilocybin exerts its effects involves the serotonin 2A receptor, leading to altered brain connectivity and increased emotional responsiveness. Unlike traditional medications, which require regular administration, psilocybin has been shown to have lasting effects after just a few supervised sessions. This unique aspect of psilocybin therapy could revolutionize the treatment for a host of mental health conditions, offering a potentially more effective and sustainable option. One study suggested even a single dose could help relieve major depressive disorder.
Safety is paramount, however, since taking the drug could lead to dangerous or even violent behavior or prolonged psychoses. JHU has made safety a cornerstone of its efforts. Its researchers recommend other safeguards, including the exclusion of volunteers with personal or family history of psychotic disorders or other severe psychiatric disorders, and more.
Mental Health Challenges Have Huge Costs
The burden of conventional treatments for depression, anxiety, and PTSD is staggering.
The economic burden of major depressive disorder (MDD) among U.S. adults, for example, was an estimated $236 billion in 2018, a 35% increase since 2010. And that is just one of a host of mental health challenges. For people whose anxiety or depression is treatment-resistant, the costs are even more burdensome. Individuals with treatment-resistant depression spend nearly $1,300 a year on out-of-pocket medical and drug costs, and are more likely to be taking a host of medications.
Why, then, has it taken so long for research to take off? One reason is lobbying by pharmaceutical firms. Big Pharma wields considerable influence over drug policy and research funding. A naturally occurring substance like psilocybin, which cannot be patented in its natural form and even if altered would likely face patenting controversy, poses a threat to the profitability of pharmaceutical companies. As a result, there is little incentive for these companies to support research into psilocybin, which could undermine their market share for synthetic drugs.
But our current mental health medications are far from perfect; they’re not long-lasting and some may actually harm patients. A study recently published in BMC Medicine suggested benzodiazepines, commonly prescribed medications for anxiety and sleep disorders in older adults, may have long-term negative effects on brain health, specifically on memory and mood regulation. Shouldn’t we continue searching for alternative, better options?
While the Promise Is Great, Regulation Is Necessary
While psilocybin holds considerable promise, policymakers and the medical community face risks associated with legalization. Without proper study, management, and regulation, the potential for harm increases. As physicians, policymakers, parents, and others talk about these treatments, we must emphasize that their promise does not exist through experimentation in a teenager’s bedroom or at frat parties.
Government authorities are embracing the potential of psychedelics. The Oregon Psilocybin Services Act is the first U.S. law to establish a regulatory framework for receiving psilocybin. Last summer, FDA released its first guidance on clinical trials for psychedelic drugs.
To mitigate the risk of harm, stakeholders must establish a framework for the regulated use of psilocybin. These rules should include stringent guidelines for clinical use, proper training for healthcare providers, and comprehensive patient and community education. By learning from the experiences of other countries where psilocybin use is more advanced, such as in Canada and the Netherlands, we can develop best practices for safe and effective implementation.
The historical use of psilocybin, coupled with modern scientific evidence, suggests that this natural compound holds promise. To realize its full potential, we must navigate the challenges posed by existing drug policies, the pharmaceutical lobby, and the need for effective regulation. It is the only way to usher in a new era of mental health treatment.
Source : MedPageToday