Treatment with hallucinogenic mushroom drug shows promise for patients with deep anxiety
It was mid-morning when Carol Vincent, the owner of a small marketing firm in Victoria, British Columbia, sat down and swallowed a capsule full of pure, synthesized psilocybin. Many people are familiar with the “natural” version, found in so-called magic mushrooms, which have effects similar to LSD and are banned under federal law. Vincent, though, was part of a formal scientific experiment, run by a team from Johns Hopkins University, to see if the drug might relieve psychological distress in patients fighting cancer.
Six years earlier, she’d been diagnosed with follicular non-Hodgkins lymphoma, a slow-growing form of blood cancer that is considered treatable but not curable. “After a few years, my health was okay, but I just felt like I was walking around with an anvil over my head,” Vincent recalls. “I was in this permanent state of low-grade anxiety and depression. It just felt like life is never going to be fun anymore.”
That morning in Baltimore was Vincent’s first psychedelic experience. As two experienced guides sat across from her, she pulled down her eyeshades, put on headphones and lay down to await whatever came next.
According to Roland Griffiths, the neuropharmacologist who heads the Hopkins research team, as many as 40 percent of cancer patients suffer from a mood disorder, like anxiety or depression. Two studies published Thursday in the Journal of Psychopharmacology suggest that psilocybin may offer a dramatic helping hand. Vincent was the last of 51 cancer patients taking part in the trial at Hopkins. Six months after a single dosing session, the study found, more than 80 percent maintained “clinically significant” improvement in their mood and anxiety levels.
A similar study at New York University included 29 volunteers; at follow-up, between 60 and 80 percent showed meaningful improvement on various measures of psychological well-being.
To Griffiths, “What makes the studies so unique is that this represents a single intervention: a period of four to six hours that produces rapid and enduring changes.”
While the papers are written in the meticulous language of academic science, testimonies from patients offer a bracing view of what the treatment is like, and a hint of the challenge the approach poses to the usual methods of psychiatry.
A day before her drug session, Vincent had met with Mary Cosimano and Taylor Marcus, the Johns Hopkins researchers who would sit with her during the trip. “They coached me, and said that sometimes people experience scary things,” Vincent recalls. “They said, ‘If you have that happen, don’t run away – just walk right in. Do you think you can do that?’ And I said, ‘I skydived for ten years, and I was scared, but I could still jump out.’”
As the drug took hold, Vincent says, “It was very much like a deep-space experience… Not the kind of starry, starry night, but black, deep space… very awe-inspiring, but very dark, impersonal… Then I started getting technicolor everything, then things on Earth, like this incredible crystal turquoise… Half the time I was laughing, half the time I was crying, but it was all so beautiful.”
Patrick Mettes, a volunteer in the NYU study, also made careful notes about his experience. “More than once, I felt as if my journey and the overall experience of psilocybin contained the elements of a classic story arc (exposition, climax, resolution),” he wrote. “I could feel my physical body trying to vibrate in unity with the cosmos… I was being told (without words) to not worry about the cancer. It’s minor in the scheme of things. Simply an imperfection of your humanity, and that the more important matter, the real work to be done, is before you.”
In many ways, the studies harken back to an earlier era: not the tune-in, turn-on world of the sixties counterculture, but a period of medical research that was nearly buried forever. Between Albert Hofmann’s 1943 discovery of LSD and the early 1970s, more than a thousand research papers were published on potential uses of LSD, psilocybin and similar drugs.
Dr. Stephen Ross, the psychiatrist who led the NYU study, says he knew nothing of that history until a colleague, Dr. Jeffrey Guss, brought it up just a few years ago. “When I took a closer look, it astounded me,” says Ross. “It involved some of the best psychiatric minds of the day, and it was a complete new paradigm of care, with the idea of mystical states at its core.”
While the notion of a “mystical state” sounds fuzzy, researchers have developed a scale, the Mystical Experience Questionnaire, or MEQ30, to try and quantify it.On the MEQ30, participants are asked questions such as whether they’ve had “experience of unity with the ultimate reality,” or “awareness of the life or living presence in all things.” In the recent studies, a higher score on the MEQ30 – more mystical, as it were – correlated strongly to improvement.
In an earlier study at Hopkins, a majority of healthy volunteers who took psilocybin rated the occasion among the five most meaningful experiences of their life. These people were simply spending the afternoon in a room at a medical clinic, accompanied by two near-strangers. And yet, the sense of deep meaning comes up again and again.
“I scored it right up there,” says Vincent. “First, birth of my son. Then both my marriages. And honestly, this [the dosing session] would be next.”
The NYU and Hopkins projects were both supported financially by the Heffter Research Institute, a non-profit that vets and funds research involving psychedelics. George Greer, Heffter’s Medical Director, says they were largely inspired by the work of Dr. Stanislav Grof, a Czech émigré and psychelic pioneer who conducted more than 4,000 LSD therapy sessions and reported that LSD could relieve anxiety and despair in (terminal cancer patients.)
The next step, says Greer, is to try and repeat the findings in a larger study. He said another group, the Wisconsin-based Usona Institute, is working to design the next round of psilocybin trials, but Malynn Utzinger, Usona’s CEO, said plans are still in the early stages.
A parallel effort is underway in Europe, where COMPASS, a UK-based medical research organization, has met with regulators from the European Medicines Agency to discuss the feasibility of clinical trials to enable patient access to psilocybin therapy, “in areas of significant unmet medical need.” A number of European academic institutions are planning their own studies with the drug.
The effort behind psilocybin is part of a broader flowering of what’s sometimes called “psychedelic medicine.” The FDA is already working out details of a Phase 3 study to test MDMA – better known as Ecstasy – as part of a treatment for post-traumatic stress disorder. Smaller studies have been conducted or are underway testing psilocybin against depression, obsessive-compulsive disorder, anxiety in adults with autism and against alcohol, cocaine and tobacco addictions. A handful of studies in Europe are testing LSD and other psychedelics for similar uses.
Beyond the strangeness quotient, psychedelic studies present certain unique challenges. In medical research, a drug’s effects are typically compared against those of a placebo. In a “blinded” study, neither the subject nor the researcher is aware of whether the subject has received the placebo or the study drug. When the study drug can produce potent mystical experiences and mind-bending hallucinations, maintaining the “blind” can be difficult to the point of absurdity.
NYU and Johns Hopkins took two different approaches to the problem. At NYU, participants received a dose of Niacin, a vitamin that produces a modest jolt of alertness and a slight tingling sensation. At Johns Hopkins, researchers used a low dose of psilocybin, with barely perceptible effects. Griffiths said his team tried hard to maintain the illusion, proceeding as if every session was using the higher dose. In one intriguing finding, 24 percent of patients getting not the active drug, but the placebo – the miniscule dose of psilocybin – rated that among the most meaningful events of their lives. That result suggests that the sense of ritual, not just the drug alone, is a vital part of the experience.
With regard to safety, most experts see little danger in taking the drug in a controlled setting. “You can’t overdose, and you can’t get addicted,” says Dr. Jeffrey Lieberman, chair of the psychiatry department at Columbia University and a past president of American Psychiatric Association, who is not associated with the studies but who wrote a commentary that accompanied their publication. Even for recreational users, he says, “The only risk is that someone intoxicated will do something stupid, and that a very small number will have a more sustained adverse reaction to taking [psychedelics].”
Psilocybin does tend to raise blood pressure during the trip, and patients with heart conditions were excluded from the NYU and Hopkins studies, as were those with any history of mental problems, even in their extended families. Griffiths calls the latter decision, “probably an overabundance of caution.”
Carol Vincent says that the day she knew her improvement would last occurred a couple of months after flying home to British Columbia. “I was driving to a meeting on a beautiful sunny day, music in my car, singing along, and I suddenly thought – oh my God, I’m happy. I hadn’t had that.”
Patrick Mettes, the NYU volunteer who wrote about vibrating with the cosmos, had been dealt a tough hand. He’d felt perfectly healthy when his wife, Lisa Callaghan, spotted a yellowish tinge in his eyes. He lived just a block from an ER, so after a leisurely stop at Starbucks he strolled over to find out what was wrong. He learned that his bile ducts – small tubes inside the liver – were full of cancer. Before finding the study, he battled the disease for four years, slowly losing ground.
Callaghan says he was searching for a sense of meaning behind illness. In the notes he wrote after his session, it sounds like he found one: “My life has changed in ways I may never fully comprehend. But I now have an understanding… An awareness that goes beyond intellect… that my life, that every life, and all that is the universe, equals one thing… love. And it is good!”
Thirteen months later, Mettes suffered a massive heart attack. He lived another two months, barely eating, before he died. His wife says he was at peace. “He knew he was going somewhere, even if he didn’t know where it was,” she recalls. “He just said, ‘I wish you could come with me.’
She says the experience changed her, as well. “As far as death goes, I have no fear of it now. None.”