Would you turn to psychedelic drugs to treat PTSD or a smoking addiction? Many people who struggle with a mental illness or substance use disorder may not know they have that option, or how clinicians have been successfully using psychedelics to address these illnesses.
On this episode of Menninger’s Mind Dive podcast, board-certified psychiatrist, physician-investigator for Segal Trials and assistant professor at The Johns Hopkins University School of Medicine, David Mathai, MD, joins us to discuss the importance of understanding the cultural and historical context of psychedelic drugs and why the first FDA-approved psychedelic drug therapy could come as soon as 2024.
Dr. Mathai simplifies the definition of psychedelics as "drugs, whose most prominent subjective effects often involve dramatic changes in thought, in mood and cognition." He says, that historically, these substances have been used in different cultural traditions across the globe for the purpose of healing and connection.
 Dr. Mathai notes that the earliest wave of research surrounding psychedelics was focused on LSD, which was discovered in the 1940s. “Realizing some of the therapeutic qualities such as LSD treatment for alcohol use disorder, anxiety and depression, related with end-of-life illness ... all of that was bubbling up,” said Dr. Mathai.
But the Vietnam War would serve as a gateway to dismantle that research.
For example, Dr. Mathai says there became a “complicated” social association between psychedelic drugs and counterculture, particularly with American protestors of the U.S. involvement with the war, who were often referred to as “hippies.” Dr. Mathai suggests this clash of cultures led to a growing animosity between proponents of psychedelic use, like American psychologist Timothy Leary, and politicians who were overseeing studies and held different views.
These opposing views, along with cases of reckless use of psychedelics, eventually led to the federal government's effort to combat illegal drug use in the 1970s, which Dr. Mathis credits with “shattering” psychedelic research for several decades until the early 2000s.
The resurgence of psychogenic research is often credited to a paper on psilocybin (a hallucinogen in certain types of mushrooms) written by Dr. Mathai’s mentor, the late American neuroscientist, Roland Griffiths. The research shows that users of psilocybin reported their experiences as among the most meaningful or spiritually significant experiences of their life.
Dr. Mathai was involved with trials of psilocybin at Johns Hopkins for people who want to quit smoking, which resulted in a 60% to 70% success rate of participants cutting down on tobacco use. Similar results were found in treating individuals with alcohol use disorder.
But it’s the optimism surrounding the drug MDMA that could mean big changes for psychedelic-informed therapies in America, specifically for individuals suffering from PTSD.
“In other words, 70% no longer carried a diagnosis of PTSD right after receiving MDMA-assisted therapy,” said Dr. Mathai.  The effectiveness for some lasted a year after treatment.
Once an application for MDMA therapy is submitted to the FDA, it could take six months to a year for a full review. While the process is much more complicated than a simple yes or no, medical experts are hopeful the treatment could be approved by 2024.
But it’s important to understand that one person’s experience taking the drug will likely be very different from the next person’s. Dr. Mathai believes researchers need to better understand the sensitivity level and potential for re-traumatization if psychedelic-informed therapies do become FDA approved.
As for the future of psychedelic research, Dr. Mathai believes welcoming more diverse fields into this space is one way to foster a healthy environment and ensure patients are properly cared for.
“More and more, we're starting to see different disciplines from psychologists, psychiatrists, neuroscientists, anthropologists and historians who are converging on some aspect of what psychedelics do and bringing that expertise and richness to this dialogue,” said Dr. Mathai.
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