Inside the centre exploring the effect of psychedelic drugs on mental health

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Since childhood, Rachael Petersen had lived with an unexplainable sense of grief that no drug or talk therapy could entirely ease. So in 2017 she volunteered for a small clinical trial at Johns Hopkins University that was testing psilocybin, the active ingredient in magic mushrooms, for chronic depression.

“I was so depressed,” Petersen, 29, recalls. “I felt that the world had abandoned me, that I’d lost the right to exist on this planet. Really, it was like my thoughts were so stuck, I felt isolated.”

The prospect of tripping for hours on a heavy dose of psychedelics was scary, she says, but the reality was profoundly different: “I experienced this kind of unity, of resonant love, the sense that I’m not alone anymore, that there was this thing holding me that was bigger than my grief. I felt welcomed back to the world.”

Earlier this month, Johns Hopkins Medicine introduced the Centre for Psychedelic and Consciousness Research, to study compounds like LSD and psilocybin for mental health problems, including anorexia, addiction and depression. The centre is the first of its kind in the country, established with $17m (£13.6m) in commitments from wealthy private donors and a foundation. Imperial College London created what is thought to be the world’s first such centre in April, with some $3.5m from private sources.

“This is an exciting initiative that brings new focus to efforts to learn about mind, brain and psychiatric disorders by studying the effects of psychedelic drugs,” Dr John Krystal, chair of psychiatry at Yale University, says about the Johns Hopkins centre.

The centres at Johns Hopkins and Imperial College give “psychedelic medicine”, as some call it, a long-sought foothold in the scientific establishment. Since the early 2000s, several scientists have been exploring the potential of psychedelics and other recreational drugs for psychiatric problems, and their early reports have been tantalizing enough to generate a stream of positive headlines and at least two popular books. The emergence of depression treatment with the anaesthetic and club drug ketamine and related compounds, which cause out-of-body sensations, also has piqued interest in mind-altering agents as aids to therapy.

But the drugs’ history of abuse and the still-thin evidence base have kept the field largely on the fringes, and many experts are still wary. Psychedelic trials cannot be “blinded” in the same way most drug trials are: participants know when they have been dosed, and reports of improvement are not yet standardised.

“It raises the caution that the investigation of hallucinogens as treatments may be endangered by grandiose descriptions of their effects and unquestioning acceptance of their value,” Dr Guy Goodwin, a professor of psychiatry at Oxford, wrote in a recent commentary in the Journal of Psychopharmacology. “Timothy Leary was a research psychologist before he decided the whole world should ‘Turn on, tune in and drop out.’ It is best if some steps are not retraced.”

The scientists doing the work, at Hopkins, Imperial College and elsewhere, acknowledge as much and say the new funding will help clarify which drugs help which patients, and when the altered states are ineffectual or potentially dangerous.

“It’s been hand to mouth in this field, and now we have the core funding and infrastructure to really advance psychedelic science in a way that hasn’t been done before,” says Roland Griffiths, a neuroscientist at Johns Hopkins who will direct the new centre. Griffiths says the new funds would cover six full-time faculty members, five postdoctoral scientists and the costs of running trials. Among the first of those trials are a test of psilocybin for anorexia nervosa and of psilocybin for psychological distress and cognitive impairment in early Alzheimer’s disease.

“The one that’s crying out to be done is for opiate-use disorder, and we also plan to look at that,” Griffiths says.

Trials using psychedelics or other mind-altering drugs tend to have a similar structure. Participants, whether they have a diagnosis of PTSD, depression or substance abuse, do extensive preparation with a therapist, which includes a complete medical history and advice and information about the study drug. People with a history of psychosis are typically excluded, as psychedelics can exacerbate their condition. And those on psychiatric medications usually taper off beforehand.

On treatment day, the person comes into the clinic, takes the drug and sits or lies down, under continuous observation by a therapist, who provides support and occasional guidance as the drug’s effects become felt. In the Johns Hopkins trial that Petersen joined, participants wore eyeshades and headphones, lay down and listened to music.

“The first trip lasted 6½ hours, and I didn’t move,” she recalls. A week later, she returned for another dose; each dose was about twice what recreational users take. Therapy using psychedelics or other mind-altering compounds typically involves just one or two sessions on the drug.

“I would be lying if I said aspects of my experience weren’t deeply challenging and upsetting,” Petersen says. “The therapist would grab my hand – would save me in a moment – and encourage me to adopt a posture of welcoming everything, like a meditation.”

The literature so far, from trials like these, suggests that psilocybin is promising for chronic depression and addiction, and that MDMA, or ecstasy, can help people with post-traumatic stress. Cannabis and LSD also have been tried, for addiction and other problems, with mixed results.

One finding many drug studies share is that any positive effects are far more likely to last if the participant has an especially intense trip. The intensity is graded using a variety of measures, including what scientists call the MEQ, for “mystical experience, questionnaire,” although Griffiths allows that the term is misleading.

“That was a significant branding mistake because awe is not fun,” he says. “There’s something existentially shaking about these experiences.”

It is that existential reckoning, the theory goes, that prompts many people to rejigger their identities or priorities in a way that reduces habitual behaviours or lines of thinking that cause distress.

In a continuing trial, Matthew Johnson, an addiction specialist at Johns Hopkins and a member of the new psychedelic centre, is investigating how psilocybin treatment compares with use of a nicotine patch in helping people to quit smoking. So far, in the 39 people who have been in the study for at least six months, the abstinence rate in the psilocybin group is 50 per cent, compared with 32 per cent using the patch.

“The most compelling thing that makes psilocybin different from other addiction drugs is that it’s showing this cross-drug efficacy,” Johnson says. “It appears to have a similar effect, regardless of what drug the person is addicted to.”

That great potential, across many different diagnoses, is what attracted a small group of donors to Johns Hopkins, said Tim Ferriss, who brought in half the donated amount from investors, including more than $2m from himself. Ferriss, an investor and author, says that depression and addiction ran in his own family and that available treatments were often inadequate. His investment in the centre, he says, “was a chance to have a large output from a small input – a real Archimedes lever”. The Steven & Alexandra Cohen Foundation provided the balance of the commitments.

Petersen is convinced that her psilocybin trip made a lasting difference. She has had one relapse since the trial, she says, and continues on antidepressants. As a result of the trial, she also reordered her life, committing more time to things that are emotionally sustaining and letting go of those there weren’t.

“I think that trial was the single most effective thing I’ve done to manage my mental health, and I had tried almost everything,” she says. “And it leads me to believe that we need to radically change how we think about mental health.”

© New York Times