Brain
Expert Pharmacologist
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- Jul 6, 2021
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For decades, the guide community has been quietly working in the shadows, delivering psychedelics to people across the country. And they're not so different from their «land-based» counterparts. Many have trained for years with traditional healers in Peru and Brazil, and follow a strict code of conduct designed to formalize practice and ensure safety.
This is certainly true of Kat (the guide from Part I), with whom I had the opportunity to speak. She has studied with a Peruvian mentor for eight years, has used ayahuasca over 900 times, and has performed hundreds of ceremonies in Europe and the United States.
She describes herself as a «tone setter», a person who controls the space. Mostly, she puts everyone at ease by demonstrating a calm and reassuring presence. «I track the pulse of the room, and when I need to approach someone, I try to be as grounded as the earth itself — that kind of calmness is infectious. The key is to be attuned to what's going on and what people are feeling and respond to it» — she said.
This is certainly true of Kat (the guide from Part I), with whom I had the opportunity to speak. She has studied with a Peruvian mentor for eight years, has used ayahuasca over 900 times, and has performed hundreds of ceremonies in Europe and the United States.
She describes herself as a «tone setter», a person who controls the space. Mostly, she puts everyone at ease by demonstrating a calm and reassuring presence. «I track the pulse of the room, and when I need to approach someone, I try to be as grounded as the earth itself — that kind of calmness is infectious. The key is to be attuned to what's going on and what people are feeling and respond to it» — she said.
Her role is walking a tightrope between letting people get through whatever they are going through and helping when they are too close to the precipice. If all is well, she's somewhere in the room singing healing songs and keeping a close eye on what's going on. If someone is panicking, Kat has to talk them out of it and do it in a way that doesn't stun everyone else in the room.
Just a few months ago, Kat said, a woman at one of her ceremonies was convinced demons had taken over her body. She became hysterical and threatened to call 911. These situations happen all the time, and the guide has to deal with them on the fly.
Unlike Hopkins physicians, Kat manages the travel of several people at once, sometimes dozens, and that comes with risks. I asked her why do it? Why risk someone reacting in ways they can't control, or risk going to jail?
Just a few months ago, Kat said, a woman at one of her ceremonies was convinced demons had taken over her body. She became hysterical and threatened to call 911. These situations happen all the time, and the guide has to deal with them on the fly.
Unlike Hopkins physicians, Kat manages the travel of several people at once, sometimes dozens, and that comes with risks. I asked her why do it? Why risk someone reacting in ways they can't control, or risk going to jail?
«Because it heals people. I see it every time I hold a circle, every time I lead a group of people through the experience. People come in with one point of view and leave with another. Sometimes it means they see the world with new eyes, and sometimes it means they realize that their flaws don't define them» — states Kat.
Kat, now 46 years old, has been through many battles. Before discovering ayahuasca 16 years ago on a trip to Peru, she suffered from alcoholism, bulimia and bipolar disorder — at one point she attempted suicide. «The medicine wasn't a panacea, but it set me on a different path, and basically, I've dedicated my whole life to this work» — she said.
Everyone who shows up at Kat ceremonies has their own reason for being there. Some are psychonauts — people seeking to explore altered states of consciousness through psychedelics. Others, like Laura, a 35-year-old woman from Philadelphia, use herbal medicine as a last-ditch effort to beat addiction.
In Laura's case, it was a 14-year addiction to heroin. «I was on the verge of death. I tried every traditional method you can think of — detox, counseling, rehab — and nothing helped» — Laura said. She eventually found ibogaine, a psychedelic compound derived from the roots of a West African shrub. «Ibogaine was like a street myth, this miracle drug that could reboot your brain and save you from the throes of addiction».
Ibogaine is not as well researched as psilocybin or LSD, and it is relatively dangerous, but it is one of the most powerful psychedelic drugs known, and there is preliminary research suggesting that it may be an effective treatment for opioid and cocaine addiction.
Another woman, Stephanie, 48, from Kansas, said she spent 15 years on Adderall, a stimulant prescribed for attention deficit hyperactivity disorder. «It consumed my whole life — every decision, every plan, pretty much every moment». She tried several times to quit smoking, but nothing worked. On a whim, she decided to take up psychedelics. A few weeks later, she was already attending the ceremony.
Her first ayahuasca intake was in September, nearly three months ago, and she hasn't touched Adderall since. «That experience was tough» — she said. «It was like seeing myself and my life through a mirror in an entertainment house, and I could see all the masks that I was wearing and how Adderall had become this crutch, this source of false energy that was propelling me through life. I feel like it recalibrated my whole being».
These stories are inspiring, but it is unclear how representative they are. Psychedelics are not magic elixirs, and taking them haphazardly carries physical and psychological risks, especially if you are taking medication or have been diagnosed with a psychiatric illness. But if used in the right setting and under the guidance of an experienced guide, they can have amazing therapeutic benefits.
Kat believes this work could have been more effective if she hadn't been forced to go underground. «If it was legal, I would spend more time with people before and after the experience. I'd want to build my team and do it out in the open like a regular business and take care of people from start to finish. Because we're in this legal gray area, people often come to the ceremony and then they're sent back out into the world, and that can be traumatic».
These stories are inspiring, but it is unclear how representative they are. Psychedelics are not magic elixirs, and taking them haphazardly carries physical and psychological risks, especially if you are taking medication or have been diagnosed with a psychiatric illness. But if used in the right setting and under the guidance of an experienced guide, they can have amazing therapeutic benefits.
Kat believes this work could have been more effective if she hadn't been forced to go underground. «If it was legal, I would spend more time with people before and after the experience. I'd want to build my team and do it out in the open like a regular business and take care of people from start to finish. Because we're in this legal gray area, people often come to the ceremony and then they're sent back out into the world, and that can be traumatic».
We asked Kat if she had noticed a change in the mix of people attending her ceremonies. «It used to be mostly psychonauts, but lately it's people, old and young, who want to 'come to terms with death' (if they are terminally ill) or deal with deep trauma» — said Kath. She works with a large number of veterans suffering from PTSD, many of whom tell her they have been unable to find help in traditional mental health care.
Still, she hesitated when we asked her about legalization. «They absolutely should be legal, but I'm not sure they'll be legal tomorrow. We need a solid foundation, a way to keep respect for these drugs. If we lose that, if psychedelics become another substance like marijuana, I'm afraid we're going to blow it up and burn it down like we did in the ‘60s» — she said.
Kat's concern, shared by many people in the field, is that the ceremonial aspects of psychedelics will be lost if they are legalized overnight. There is nothing wrong with recreational use, but those who regard psychedelics with a kind of sacred awe have a genuine fear that these substances will become trivialized if we don't make this transition sensibly.
How do we intelligently integrate psychedelics into the culture?
For better or worse, psychedelics, like all drugs, will be used outside the safer settings of research centers or private sessions with experienced guides. According to Jeff Batier, a psychologist at Adler University who works with severely traumatized patients, the question is this: «What harm reduction measures do we need to help protect people?»
Several people I spoke with pointed to the «harm reduction» model. Harm reduction aims to reduce the risks associated with drug use, as opposed to punitive models that aim to stop drug use altogether. It is a practical and humane approach that has worked well in countries such as Portugal, where all drugs for personal use have been decriminalized.
Still, she hesitated when we asked her about legalization. «They absolutely should be legal, but I'm not sure they'll be legal tomorrow. We need a solid foundation, a way to keep respect for these drugs. If we lose that, if psychedelics become another substance like marijuana, I'm afraid we're going to blow it up and burn it down like we did in the ‘60s» — she said.
Kat's concern, shared by many people in the field, is that the ceremonial aspects of psychedelics will be lost if they are legalized overnight. There is nothing wrong with recreational use, but those who regard psychedelics with a kind of sacred awe have a genuine fear that these substances will become trivialized if we don't make this transition sensibly.
How do we intelligently integrate psychedelics into the culture?
For better or worse, psychedelics, like all drugs, will be used outside the safer settings of research centers or private sessions with experienced guides. According to Jeff Batier, a psychologist at Adler University who works with severely traumatized patients, the question is this: «What harm reduction measures do we need to help protect people?»
Several people I spoke with pointed to the «harm reduction» model. Harm reduction aims to reduce the risks associated with drug use, as opposed to punitive models that aim to stop drug use altogether. It is a practical and humane approach that has worked well in countries such as Portugal, where all drugs for personal use have been decriminalized.
Although the harm reduction model is not usually associated with psychedelics, its principles still apply. There are already national harm reduction groups, such as the Zendo Project, sponsored by MAPS, that specialize in peer counseling for people experimenting with psychedelics.
For example, in Chicago, they started a harm reduction group called Psychedelic Safety Support and Integration. The goal is to provide safety and help people cope with their psychedelic experiences. This is a critical step that brings the community together, spreads awareness about the risks of psychedelic drug use, and creates a space for socializing.
At the moment, there is a disconnect between the harm reduction movement and the psychedelics research community. You come to a conference on psychedelics, and it's focused on the science and the therapeutic potential, and the general assumption is that if we just create good science, these drugs will be approved as drugs, and everything will just fall into place. That doesn't really make sense.
«If you go to a harm reduction conference — it's all about cultural change and how politicians don't care about the science. It's much more about organizing, who has the power, and how we can reduce risks and act safely» — says Jeff Batier.
This is partly why the harm reduction movement can be useful for psychedelics. Science may be critical to legalization, but public health programs will need to help integrate these drugs into the broader culture.
For example, in Chicago, they started a harm reduction group called Psychedelic Safety Support and Integration. The goal is to provide safety and help people cope with their psychedelic experiences. This is a critical step that brings the community together, spreads awareness about the risks of psychedelic drug use, and creates a space for socializing.
At the moment, there is a disconnect between the harm reduction movement and the psychedelics research community. You come to a conference on psychedelics, and it's focused on the science and the therapeutic potential, and the general assumption is that if we just create good science, these drugs will be approved as drugs, and everything will just fall into place. That doesn't really make sense.
«If you go to a harm reduction conference — it's all about cultural change and how politicians don't care about the science. It's much more about organizing, who has the power, and how we can reduce risks and act safely» — says Jeff Batier.
This is partly why the harm reduction movement can be useful for psychedelics. Science may be critical to legalization, but public health programs will need to help integrate these drugs into the broader culture.
Harm reduction groups like Bathje's and the Zendo Project are the best models of this kind of integration, and we will need to scale them up if psychedelics are to be legalized for medical use.
Could there be any problems with this integration?
After spending months thinking about these issues and talking to people at almost every level, I am convinced that a new culture of therapeutic psychedelics is rapidly developing. Just recently, a group of citizens in Denver gathered enough signatures to endorse a bill to decriminalize magic mushrooms.
The social and political environment today is very different from what it was in the 60s, and there is no reason to suspect such a backlash. Cultural containers and knowledge already exist and can increasingly be brought out of the shadows.
What that transition will look like on a larger scale and how long it will take is unclear. Advocates like Doblin seem reasonable if they continue to play the long game. Given the progress of the study, it is possible that psilocybin will be moved from a Schedule I drug (drugs with unknown medical value) to a Schedule IV drug (drugs with low abuse potential and known medical value) in the near future (2-3 years).
Could there be any problems with this integration?
After spending months thinking about these issues and talking to people at almost every level, I am convinced that a new culture of therapeutic psychedelics is rapidly developing. Just recently, a group of citizens in Denver gathered enough signatures to endorse a bill to decriminalize magic mushrooms.
The social and political environment today is very different from what it was in the 60s, and there is no reason to suspect such a backlash. Cultural containers and knowledge already exist and can increasingly be brought out of the shadows.
What that transition will look like on a larger scale and how long it will take is unclear. Advocates like Doblin seem reasonable if they continue to play the long game. Given the progress of the study, it is possible that psilocybin will be moved from a Schedule I drug (drugs with unknown medical value) to a Schedule IV drug (drugs with low abuse potential and known medical value) in the near future (2-3 years).
However, the process for changing the medication list is a bit convoluted. Under federal law, the U.S. attorney general can revise the drug schedule on his or her own, but before doing so, he or she must collect data and medical research from the Secretary of Health and Human Services. Congress can also pass laws to change the drug list and can override the attorney general's decision if it wants to.
We are unlikely to see much progress on this front under the current administration, but the political winds could change quickly, especially if research continues apace. That the Drug Enforcement Agency has already come to terms with the possibility of changing the list of psychedelics is a very positive sign.
We are unlikely to see much progress on this front under the current administration, but the political winds could change quickly, especially if research continues apace. That the Drug Enforcement Agency has already come to terms with the possibility of changing the list of psychedelics is a very positive sign.
«We are pleased to see research moving forward at institutions like Johns Hopkins. When the scientific and medical community comes to the DEA and says a substance should be a drug, it should be moved to list 4 or 5 instead of list 1; and then we will act accordingly»— said Rusty Payne, DEA spokesman, recently.
Support for psychedelics is also one of those rare issues that, in some cases, can cross traditional political lines. Rebecca Mercer, billionaire Republican financier and co-owner of Breitbart, donated $1 million to MAPS to fund research on veterans with PTSD. We may see more of this kind of bipartisan support as the research progresses.
There's one big question left that has to do with access. If you spend any time at all in the psychedelic subculture, you can't help but notice that it consists mostly of privileged white people. This largely depends on who owns the facilities, how much they cost (from $600 to over $1000 per session), where they are held, and the networks of people who support them. Another obstacle is that many people are simply unaware of the therapeutic potential of psychedelics.
Within the psychedelic community itself, there are concerns about commodification. Companies such as Compass Pathways are seeking to turn psilocybin into a pharmaceutical product (Compass' psilocybin research has received breakthrough therapy status from the FDA).
Compass began as a non-profit interested in creating a psychedelic hospice center, but has since shifted to a for-profit approach.
Thanks to big investors like Peter Thiel, Compass is able to dominate the supply chain of medical psychedelics from synthesis to therapy. It also hinders the research efforts of non-profit companies like Usona , which are developing their own psychedelic drugs.
If the market becomes monopolized, or if a few pharmaceutical companies control important patents, many people could be denied access.
There's one big question left that has to do with access. If you spend any time at all in the psychedelic subculture, you can't help but notice that it consists mostly of privileged white people. This largely depends on who owns the facilities, how much they cost (from $600 to over $1000 per session), where they are held, and the networks of people who support them. Another obstacle is that many people are simply unaware of the therapeutic potential of psychedelics.
Within the psychedelic community itself, there are concerns about commodification. Companies such as Compass Pathways are seeking to turn psilocybin into a pharmaceutical product (Compass' psilocybin research has received breakthrough therapy status from the FDA).
Compass began as a non-profit interested in creating a psychedelic hospice center, but has since shifted to a for-profit approach.
Thanks to big investors like Peter Thiel, Compass is able to dominate the supply chain of medical psychedelics from synthesis to therapy. It also hinders the research efforts of non-profit companies like Usona , which are developing their own psychedelic drugs.
If the market becomes monopolized, or if a few pharmaceutical companies control important patents, many people could be denied access.
Despite these concerns, we should welcome the development of psychedelic research. We need more research, and we need to involve more diverse populations to learn as much as we can about how these drugs work. As Richard Friedman, a clinical psychiatrist at Cornell University, said: «I'm all for optimism, but show me the data. I share the enthusiasm for the therapeutic potential of psychedelics..... but whether it's justified, the answer is data. And nothing but data».
So far the data is encouraging, but there is still much we don't understand. But we know enough to say that psychedelics are a powerful tool for reducing suffering, at least for some people. And we simply don't have enough of those tools to justify banning them.
So far the data is encouraging, but there is still much we don't understand. But we know enough to say that psychedelics are a powerful tool for reducing suffering, at least for some people. And we simply don't have enough of those tools to justify banning them.