The Mainstreaming of Psychedelics

“What brings you to Canada?” the Border Patrol asked Dr. Michael Mithoefer in the spring of 2015. Mithoefer, a psychiatrist, and his wife Annie, a psychiatric nurse, are pioneers in MDMA-assisted psychotherapy.  Mithoefer had been invited to Toronto to address the largest gathering of psychiatrists in the world—the annual meeting of the American Psychiatric Association—on the results of their research into treating post-traumatic stress disorder (PTSD) using MDMA.

Needless to say, if there’s ever a time to avoid ruffling feathers with the mention of psychoactive substances, international border-crossing fits the bill. Mithoefer succinctly explained that he was presenting his PTSD research at the APA conference.

“PTSD? Did you know that researchers are using MDMA now to treat war veterans?” the border agent asked him incredulously.

Mithoefer recounts this story to me with delight after he arrives at the APA conference. It’s a sign of how much the times are changing: Not only is the famously old-fashioned APA hosting a panel on the use of psychedelics, but a recognition of their therapeutic value seems to be seeping into the public consciousness.

Minutes later, we notice that the tagline for this year’s conference embraces the concept of holistic medicine and sounds quite psychedelic: “Integrating body and mind, heart and soul.” The APA’s president. Dr. Paul Summergrad, even hosted a conversation with Ram Dass, the legendary spiritual teacher and psychedelic pioneer. Formerly Richard Alpert, Ram Dass conducted research with Timothy Leary at Harvard in the 1960s, which spurred him to embark on his lifelong spiritual journey. But in the decades since the backlash against Leary’s countercultural incitement to “turn on, tune in, drop out,” psychedelics have been shunned by mainstream psychiatry. So we were further amazed when, during his conversation with Ram Dass, Summergrad openly credited an early LSD trip with setting him on his life’s path in the field of psychiatry.

The mainstreaming of psychedelics, a goal often pronounced by Rick Doblin, PhD, founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS), seems to be well under way. MAPS is working toward that goal by developing medical, legal and cultural contexts for people to benefit from the careful use of psychedelics as well as cannabis.

Doblin founded MAPS 30 years ago, in 1986, right after MDMA was criminalized in the United States. Known at the time as “Adam,” MDMA was administered almost exclusively in therapeutic contexts when it first emerged in the 1970s. Thousands of therapists used Adam in their work; it was especially popular for couples therapy and treating phobias. In 1983, a distribution network in Dallas decided to rebrand the drug as “Ecstasy” and target the club scene. Not surprisingly, MDMA has become increasingly popular ever since.

At the time, the War on Drugs was just beginning to escalate, and its accompanying mentality of fear and criminalization loomed large. When the Drug Enforcement Administration saw the growing use of MDMA, it immediately launched a campaign to make it a Schedule I substance under the Controlled Substances Act, criminalizing its use and distribution. (A Schedule I substance is defined as one with a “high potential for abuse” and “no accepted medical use.” Other current Schedule I substances include cannabis, heroin, LSD, psilocybin and mescaline.)

The DEA’s campaign inspired a coalition of doctors, therapists and religious leaders to challenge the proposed scheduling, successfully forcing the agency to conduct a hearing. In May 1986, after almost two years of expert testimony, the DEA’s administrative-law judge ruled that MDMA should be placed in Schedule III, not I, because it had both a low potential for abuse and an accepted medical use. But in a final twist to the saga, the agency rejected its own judge’s ruling and placed MDMA in Schedule I, despite a clear lack of evidence regarding its dangers. In response, Doblin founded MAPS and began his 30-year campaign to demonstrate MDMA’s safety and efficacy as a medicine and return it to the mainstream.

Psychedelics at the UN

Tragically, the United States has exported its destructive Drug War to the rest of the world, with the DEA leading the charge for the restrictive scheduling of MDMA internationally. In 1986, the United Nations placed it under Schedule I of the UN Convention on Psychotropic Substances, even though the World Health Organization’s 22nd Report of the Expert Committee on Drug Dependence admitted that “no data are available concerning [MDMA’s] clinical abuse liability, nature, and magnitude of associated public health or social problems.” In the very same document, WHO recommended MDMA’s placement in Schedule I because of its alleged extreme liability for abuse. However, Dr. Paul Grof, the WHO committee’s chairman at the time, objected to the scheduling due to a lack of scientific evidence: The research cited in the report was on a different but related compound, MDA, which had been administered to rats in high and frequent doses.

Upon scheduling MDMA, the committee urged countries to pursue further research, as they were impressed by the anecdotal reports of MDMA’s therapeutic value. This encouragement by WHO is noteworthy, but since then, the organization has completely failed to promote such studies. In fact, only MAPS has sponsored medical research into the therapeutic potential and benefits of MDMA.

In April 2016, the UN General Assembly convened a special session to discuss the “world drug problem” for the first time in nearly two decades. Appropriately, these meetings took place on both Bicycle Day (April 19), the annual holiday celebrating the discovery of LSD, and the following day, 4/20. The weeklong summit certainly set an encouraging tone for the future of drug-policy reform; however, the so-called “outcome document”—which was ratified on the first day of the session, before any discussions had taken place—was a huge disappointment and didn’t reflect the drastic change of course so urgently needed in the War on Drugs.

Fortunately, a number of progressive-minded  countries, including Canada, Mexico, Jamaica, Colombia, Uruguay and the Czech Republic, were firm on the necessity of ending the Drug War, despite the difficulties faced by some of these nations in scaling back or ending their own prohibition policies at home. Alejandro Gaviria, Colombia’s health minister, memorably concluded his speech by likening the Drug War’s continuation to Einstein’s definition of insanity: doing the same thing over and over and expecting different results.

Although the outcome document represented at least some progress, it ultimately reaffirms the War on Drugs as a way to achieve the unrealistic goal of a drug-free world. But the coalition of progressive delegates and civil-society organizations that attended the UN summit are now empowered, better connected and ready to do the hard work of reform in their respective nations. In the end, the advances made in individual countries will be the ultimate driving force for progress at the UN—not the other way around.

Criminal Substances

The UN outcome document addresses psychedelics in three significant, if somewhat contradictory, ways: (1) by seeking to protect their “historic, indigenous” use; (2) by attempting to eliminate their recreational use through the continued criminalization of new psychoactive substances as well as all non-indigenous use; and (3) by recognizing the need to assess “the potential uses of new psychoactive substances for medical and scientific purposes.”

However, many member states do not accord protection to “historic, indigenous” use; only a few, including Jamaica and Bolivia, have implemented such measures. Similarly, although scientific and medical research is protected, very few member states facilitate research into these substances. The Czech Republic is a notable exception: The government recently appointed a working group dedicated to investigating the therapeutic benefits of psychedelics and is also funding psilocybin neuroimaging research.

Despite these small steps forward, the “menace” posed by so-called “new psychoactive substances” (NPS) was a favorite topic across the board. The tone of these discussions, which is unfortunately reflected in the outcome document, was eerily reminiscent of the Drug War’s hysteria-driven rhetoric.

The obsession of member states with the impossible goal of eliminating new psychoactive substances keeps them from recognizing that, in fact, prohibitionist drug policies have created a huge market for them. This is why following the prohibitionist model and banning NPS is a fool’s errand: As soon as one substance is scheduled and criminalized, another emerges to replace it. Worse, many currently legal NPS are ultimately far more dangerous than the original illegal substances that inspired them. For example, legal synthetic cannabis has enjoyed increasing popularity despite its potential lethality. Cannabis, on the other hand, doesn’t pose such dangers and is therefore undeniably safer than its synthetic substitute. And yet the continued illegality of cannabis in many parts of the world means that people are turning to its potentially deadly alternative.

The United Kingdom recently passed a blanket ban on all psychoactive substances unless they’re explicitly exempted, despite sharp criticism from advocates and researchers. (One notable exception is “poppers”—alkyl nitrite inhalants—thanks to a successful protest by the gay community.) Although the UK hosted events at the summit proudly proclaiming its new evidence-blind policy, the country’s law-enforcement agencies have delayed implementing the bill because, as they rightfully assert, the ban is unenforceable: If we can’t keep drugs out of prisons, how can we hope to eliminate them from the planet?

Disappointingly, the UN outcome document recommends continued plans for monitoring and criminalizing NPS, clearly prioritizing “the capacity of law enforcement agencies to detect and identify … new psychoactive substances [and to] prevent their abuse and diversion.”

Psychedelic Harm Reduction

MDMA provides a perfect example of the failure of prohibition policies. According to WHO, it is the third most commonly used illicit substance in the world (after cannabis and amphetamines), and its use has continued to climb despite its placement under Schedule I. Criminalization has clearly failed to serve as a deterrent and has only increased the dangers: MDMA users are forced to purchase the drug from black-market sources and, as a result, often unknowingly purchase MDMA mixed with other substances. A large number of the deaths associated with MDMA have actually been caused by dangerous adulterants.

Decriminalizing all psychoactive substances is necessary to reduce the market for new ones and to encourage practices such as drug education, sample testing, accurate dosage labeling and providing safe-support spaces without fear of prosecution—all of which have been shown to reduce the harms associated with drug use.

In the absence of such government action, a number of groups have stepped into the breach. DanceSafe sells drug-testing kits and distributes educational materials at events throughout the electronic-music community and online. The Drug Policy Alliance has launched a #SaferPartying campaign to inspire conversations about psychedelic harm reduction. MAPS has developed the Zendo Project, a safe space staffed with experienced mental-health workers at events like Burning Man. Safe spaces like these are essential for reducing the potential harms associated with psychedelics, as these drugs can often inspire intense emotional experiences. The Zendo Project’s mission also includes reducing the number of psychiatric hospitalizations and arrests, and demonstrating that safe, productive psychedelic experiences are possible without the need for law-enforcement-based prohibition policies.

MDMA and Mental Health

MAPS is now researching MDMA-assisted psychotherapy in three different areas: as a treatment for PTSD, social anxiety in autistic adults, and anxiety related to life-threatening illnesses. The group is also preparing a groundbreaking pilot study in MDMA-assisted psychotherapy for couples in which one partner suffers from PTSD. Both members of the couple will receive MDMA together, and they will also have neuroimaging performed before and after their MDMA-assisted psychotherapy sessions. Ironically, MAPS is able to fund these efforts as a nonprofit because governments around the world have spent an estimated $300 million trying to demonstrate the harms of MDMA. So, as Doblin explains, MAPS has been able to “aikido” this Drug War–fueled research to save the organization tremendous research costs.

MAPS projects that by 2021, MDMA will be approved for use by prescription as an adjunct to treatments for PTSD. For more than a decade, MAPS has sponsored a series of Phase 2 studies on such treatments both here and abroad. Thus far, the results have been incredibly promising: Phase 2 data from sites in Charleston, South Carolina; Boulder, Colorado; Vancouver, Canada; and Be’er Ya’akov, Israel, indicate that MDMA-assisted psychotherapy outperforms all current methods of treating PTSD. For example, the first completed pilot study in South Carolina saw 83 percent of its participants no longer exhibiting symptoms of PTSD after just two MDMA-assisted psychotherapy sessions. Currently, there are only two FDA-approved medications used to treat PTSD: Paxil and Zoloft, both of which are SSRIs (selective serotonin reuptake inhibitors). These substances can help to reduce PTSD symptoms, but they rarely succeed in eliminating them. The US Department of Veterans Affairs spends as much as $6 billion annually in disability payments to veterans for PTSD treatment.

PTSD is an adaptive coping response to traumatic experiences, which can be understood as events that cause an individual to feel profoundly endangered and deeply fearful for his or her physical safety. The sufferer re-experiences the original trauma and its related feelings repeatedly, which can make it difficult to engage with the outside world and even with family or friends. PTSD can therefore be especially hard for loved ones, both emotionally and financially. It is also highly related to depression, addiction and suicide. Some two dozen US veterans take their lives every day; more US veterans die by their own hand than die fighting wars.

But while PTSD is often misrepresented as solely a veterans’ issue, trauma is all too common throughout the United States. One study of a low-income black community in Atlanta found higher rates of PTSD than in returning war veterans. Research has shown that communities of color—specifically black, Latino, Native American, Pacific Islander and Southeast Asian refugees—experience elevated rates of trauma. There are also high rates of PTSD among the LGBT population, sexual-assault survivors, and people in prison or formerly incarcerated.

MDMA-assisted psychotherapy enables people suffering from PTSD to understand their trauma from a broader perspective and thereby process it in a healthier way. Most PTSD treatments target the symptoms, but MDMA-assisted psychotherapy directs participants to the source of their trauma. The process also encourages a more loving and understanding view of the self and the world, and thereby helps to release feelings of guilt, shame and fear. Neuroimaging of people under the influence of MDMA show reduced activity in the amygdala, the part of the brain that processes fear. Therapists suspect that this decrease in fearful feelings allows the participants to confront their trauma more directly.

I’ve had the privilege of watching many hours of video from these therapy sessions, and I’ve been inspired and moved by the healing and insight revealed in these tapes. Nicholas Blackston, a Marine Corps veteran who served in Iraq and is now a MAPS study participant, described his own experience with MDMA-assisted psychotherapy: “I had a profound moment—I guess it felt like a bird’s-eye view of how everything went down and why it happened. I was a machine-gunner; I was supposed to take anyone out before they take us out. So [our] getting hit was my responsibility, and my driver dying weighed a lot on me. I had that guilt for the longest time. [During MDMA therapy,] I saw my whole past completely differently. It no longer became something that was haunting me.”

These therapy sessions take place in cozy offices decorated with tranquil or indigenous art, perhaps a Buddha statue or two. The sofa is prepared as a bed, with extra pillows and blankets. The participant first meets with a team of two therapists for several preparatory sessions before he or she takes MDMA for three active-dose therapy sessions, which usually last about eight hours. The participant spends the night at the clinic after each active-dose session and has several follow-up meetings with the therapists, who are also available by telephone 24/7 in the weeks following the treatments.

MDMA psychotherapists employ “non-directive” therapy. The goal is to provide a safe environment for the participant to process his or her own traumatic experience, with the therapists on hand to offer any necessary support. They may encourage participants to “go inside” and trust their “inner healing intelligence” to guide the process. The participants often choose to lie down and spend a significant portion of their eight hours “going inside” with the assistance of headphones and eyeshades. The tapes of these sessions reveal much: The participants weep, laugh (sometimes uncontrollably), dance, reach out to hold the therapists’ hands and make beautiful observations out loud. Once the participants begin talking, they usually sit up, remove their headphones and eyeshades, and start working toward a new understanding of their trauma with the support of the therapists.

As Dr. Mithoefer explains: “When I worked in the ER, somebody came in with this big gash on their arm full of gravel. I don’t know how to heal that—my job is to create favorable conditions for the inner healing intelligence to be able to do it. So I get the gravel out, bring the sides [of the gash] closer together, irrigate it, and then the body always moves toward healing.

“What can happen is that things get in the way: infection, not enough blood supply, a foreign body left in there. So, in a way, our job in the ER is to remove the obstacles [to healing]. I think it’s very much the same with the psyche. I think there is this movement toward healing, and there’s a lot that can get in the way of that.”

MAPS has also seen promising results with its MDMA research at the Los Angeles Biomedical Research Institute on treating social anxiety in autistic adults. One participant is now able to make eye contact with other people; another has started dating for the first time—at the age of 40. In Marin County, California, therapists with the MAPS study on anxiety connected with life-threatening illness have reported similar results, with both the participants and their families detailing a dramatic shift for the better in their lives.

The Global Psychedelic Community

In addition to the MAPS studies, other exciting research is taking place across the United States and around the world. Usona, associated with the US-based Heffter Research Institute, focuses on psilocybin-guided sessions to treat end-of-life anxiety. Like MAPS, Usona seeks to develop psychedelics into prescription medicine through the FDA approval process. Heffter also sponsors other promising studies, including one demonstrating the efficacy of psilocybin sessions for quitting smoking. The Beckley Foundation, based in the UK, sponsors pioneering neuroscience research with psychedelics, most recently producing fMRI neuroimaging of individuals under the influence of psilocybin and LSD, under a team led by Dr. Robin Carhart-Harris.

There are also dozens of projects studying ayahuasca, ibogaine, Salvia divinorum, LSD, ketamine and other psychoactive substances. As the body of scientific research grows, it continues to help unite and empower the psychedelic community worldwide.   

Beyond these research organizations, there are over 50 psychedelic groups and societies spanning the globe, from Mexico City to London, St. Louis to Melbourne, and Atlanta to Prague. These are communities of people united by a common passion, hosting lectures or gatherings to promote education and advocacy around the use of psychedelics. Psymposia recently coordinated a coalition of dozens of psychedelic societies to launch the global #PsychedelicsBecause campaign. The International Center for Ethnobotanical Education, Research and Service (ICEERS) is doing important work developing the Ayahuasca Legal Defense Fund, to build unity and set precedents in courts around the world dealing with ayahuasca cases.

MAPS decided to celebrate its 30th anniversary by inviting its supporters to host Global Psychedelic Dinners in order to raise funds for the organization to purchase one kilogram of pharmaceutical-grade MDMA for its research. More than 70 of these inspiring community-led events have taken place in 17 different countries, in places as varied as Bali, Goa, Guadalajara, Moscow, Ottawa and Salt Lake City.

The growing unity of the global psychedelic community reflects the movement of psychedelics toward mainstream acceptance, although we clearly have some distance to travel. Recently, the Psychedelic Society of Ireland was forced to cancel its dinner at the last minute, after the venue refused to allow it. Fortunately, the society was able to reschedule its event at a different venue and include Rick Doblin via a video call. But it was an important reminder of the relative privilege that the psychedelic community possesses in its ability to speak openly about and advocate the use of these currently illicit substances. With such promising developments, both in research and in organizing, we can look forward to the day when the acceptance of psychedelic medicine grants millions of people the ability to achieve tremendous healing.

Natalie Lyla Ginsberg is the policy manager of the Multidisciplinary Association for Psychedelic Studies, or MAPS.