As Australias first trial for psychedelic therapy for terminally ill patients gets under way, a growing movement says it could also help other conditions
In August 2016 I went to New York for the first time. On the second evening, as the sun slipped behind the building across the street, I was sitting on a long couch on the top floor of an old church. All around me instruments were scattered on the floor singing bowls, tuning forks, rainsticks, Tibetan bells. At the foot of a wall carpeted completely in moss, dripping like the jungle in the baking heat, was a large bronze gong.
On the table in front of me two small ceramic bowls contained a capsule of 125mg of pure MDMA and a chilli guacamole with three grams of powdered magic mushrooms stirred through it. I eyed them nervously. I was terrified that I was going to lose my mind but I was more scared that nothing would happen at all, that I was too broken for even this radical treatment.
Id left Australia to take psychedelics with a therapist. Almost a decade of regular talk therapies for depression had done little to explain why I still felt so numb, trapped and terrified. A few months earlier Id tracked down a guy online who said that, while it wasnt a magic bullet, he might have something that would help. I cant name him because its still completely illegal.
He was sitting across from me and after Id swallowed the contents of both bowls he handed me a padded eye mask and suggested I lie back on the couch. I heard him move across the room in the steamy darkness as I tried to relax and focus on my breathing. Moments later I heard the first strange notes from the gong.
2016 was a breakthrough year for psychedelic therapy, not just for me. In May, a study from the Beckley Foundation in partnership with Imperial College London found that two-thirds of their participants with treatment-resistant depression were in remission a week after a therapy session with psilocybin, the active chemical in magic mushrooms. One participant said: I found I felt more connected, to myself, other people, nature, life in general. I felt alive, rather than distant and isolated and cut off.
In November 2016 two US university studies jointly published their findings: 80% of the terminally ill patients who had similar psilocybin sessions experienced significant reductions in depression and anxiety.
The following week the US Food and Drug Administration announced that it was approving the final phase of trials of psychotherapy for post-traumatic stress disorder (PTSD) using MDMA.
Meanwhile, in Australia nothing. At the end of 2015 Psychedelic Research in Science and Medicine (Prism), a non-profit research association formed in 2011, had its second application for a study of MDMA-assisted psychotherapy knocked back by Deakin University. The email from the deputy vice chancellor for research said: The university will not engage in research that has the potential to damage its reputation as an ethical organisation.
Dr Martin Williams, president of Prism and a medicinal chemistry researcher at Monash University, got the message loud and clear. We realised then that it was going to be a hearts and minds operation on our behalf, that we were going to have to be an advocacy organisation and play the long game, he says.
The momentum has been building for decades overseas. In 1986 Rick Doblin, a trainee therapist with a PhD from the Harvard Kennedy school, founded the Multidisciplinary Association for Psychedelic Studies (Maps) to overturn the decision by the US Drug Enforcement Agency (DEA) to criminalise MDMA use. Initially a drug used in the 1970s by American therapists to enhance their clients feelings of trust and openness during sessions, MDMAs effects had become too popular to contain and, like LSD a couple of decades before, it broke through into wider culture leading to a blanket ban on recreation and research.
Doblin, a shambling sun-bear of a man with a perpetual smile, initially launched an appeal against the DEA decision through its own legal channels, and won. However, the DEA disregarded the ruling so Maps opted for medicalisation taking MDMA through several phases of clinical trials to establish its safety and therapeutic efficacy. I just knew from personal experience, from working with patients, that MDMA was so different from the way the government was trying to present it, so much better, that eventually the truth would come out, says Doblin. Did I think it would take 32 years? No.
It was only last year that the full results of six phase-two trials of MDMA-assisted psychotherapy were published, in Lancetand the Journal of Psychopharmacology. Of 107 patients with treatment-resistant PTSD who were administered the drug in two or three seven-hour sessions, with therapists, eye mask and music, 68% were in remission at the 12-month follow-up. Its about twice the success rate for the gold-standard treatment for PTSD: prolonged exposure therapy.
MDMAs therapeutic properties emerge from a combination of factors. Its most acute effect is to significantly dampen the activity of the amygdala, the part of our brain that regulates fear response. While it relieves anxiety and stress, MDMA also sharply increases the brains supply of serotonin and oxytocin, the neurotransmitters primarily responsible for mood regulation and social bonding.
A recent study in Nature suggested that MDMA can temporarily return the brain to an early development state of exuberant brain plasticity that fosters renewed social reward learning. The American psychiatrist Julie Holland says: You basically couldnt design a molecule that is better for therapy than MDMA.
A former firefighter, Ed Thompson, was overdosing nightly on a combination of booze and benzos when he entered a Maps trial in Charleston, South Carolina, in 2015. The trauma of losing nine colleagues as they fought a warehouse fire beside him, the worst firefighting loss in the US since 9/11, was compounded by a chronic illness afflicting his twin baby daughters.
My body felt like it was going to explode from the inside out … I was underwater and drowning, he told me last year. After three all-day MDMA sessions with two therapists beside him, he no longer met the criteria for PTSD. It was just an incredible time of healing.
In 2017 the US Food and Drug Administration declared MDMA a breakthrough therapy, and Doblin expects it to be a legal medicine in the US again by 2021. Phase-three trials have begun at 15 sites in the US, Canada and Israel and will roll out across Europe this year after agreement with the European Medicines Agency.
In Australia a proposal for an MDMA trial with just four participants is slowly moving through the approvals process, this time at Edith Cowan University in Perth. Stephen Bright, senior lecturer in addiction studies at the university and vice president of Prism, says it supports the trial, and the wider community is increasingly open to the idea. The public are generally receptive, he says. All the stuff Im talking about depression, trauma, addiction they have been touched by in some way. At the end of the day, the evidence says that psychedelic therapy is effective at treating a range of conditions.
Nigel Strauss, a Melbourne psychiatrist and trauma specialist who worked with Prism on its failed proposal, says the way psychedelic therapy works is a challenge to prevailing medical assumptions. Psychedelic drugs are a whole change of perspective, he says. These are meaning drugs, and the whole concept of meaning eludes people and they think its hocus-pocus. These are concepts that dont fit easily into medical science at the moment particularly in this country.
But something has shifted. In January St Vincents hospital in Melbourne announced that Australias first trial of psilocybin-assisted therapy for 30 people with terminal illnesses will start in coming months. It is believed the mind-expanding and mystical properties of the psychedelic experience might be especially effective at relieving the existential angst and hopelessness that often accompanies a terminal diagnosis. When youre working with psychedelics you can reliably expect these deeply embodied transformational moments, says Rosalind Watts, a clinical psychologist working on the Beckley/Imperial trial.
Williams, who is co-investigator on the St Vincents study, which Prism has helped organise, says what has been called the psychedelic renaissance overseas is more like the dawning of a new age in Australia, where there is no history of psychedelic research. Its definitely a major step forward because as long as we achieve positive results from the research, then we expect to move that into therapeutic practice in a period of time perhaps five to 10 years, he says.
Not everyone is so enthusiastic. Sandy McFarlane, the director of the centre for traumatic stress studies at the University of Adelaide, wonders if psychedelics researchers have been drinking the Kool-Aid: Adequate evidence from carefully controlled trials is yet to be published, particularly by individuals who are not advocates of the therapy. Let the data speak for itself as with any treatment.
Gillinder Bedi, a senior research fellow at the University of Melbourne who has previously run US studies of the pharmacology of MDMA, agrees that some advocates are a bit much: They are the true believers. Scientists are a little bit uncomfortable with the language that gets used. I dont think that [organisations like Maps] understand the effect of coming from the counterculture on the people outside it.
For Bedi their findings are almost too good to be true: The results Ive seen are unique the effects are really clear. Its just that theyve been in small studies and theyve been conducted by people who have massively vested interests in the whole thing Theres a part of me that goes, Why did your data end up so neat and nice? Im not sceptical about the rigour of the science, Im just confused more than anything.
But Bedi insists that contrary to its reputation MDMA is safe to use therapeutically: Its pretty clear now that we can administer it in a controlled environment with appropriate supervision pretty safely. Psychedelics studies exclude people with a history of psychosis or mania, as well as those with certain medical conditions that the drug effects could exacerbate. If its given to people who are well screened beforehand, those risks can be controlled.
The Prism team was cagey about the St Vincents study until the moment it was announced, but Williams has noticeably relaxed his attitude discussing psychedelics in the Australian context. I think theres been a broad shift in the public discourse, which has been this ongoing process, probably since the results of the clinical trials in the US and Europe were first communicated, he says. Its thanks to the great groundwork of Maps and others overseas that were at the point we are now at all.
A new non-profit called Mind Medicines Australia launches next month to coordinate training more therapists to meet the potential demand. Williams and Strauss are planning a study of psilocybin for treatment-resistant depression, modelled on UK research.
For more than a decade, the Beckley Foundation has developed groundbreaking psychedelic research in partnership with Imperial College London. They produced the first brain scans of the LSD and psilocybin experience which suggest that, rather than amplifying neural activity as expected, psychedelics appear to selectively inhibit the default mode network, which regulates executive brain function like a disciplinarian teacher. When psychedelics take it out of the picture for a period, a whole bunch of new connections and neural activity fires up like exuberant children, allowing a wider range of phenomena to reach conscious awareness. Brain scans of long-term meditators have shown the same pattern.
The novel neural connections facilitated in the psychedelic state can lead to lasting changes. A 2018 Beckley/Imperial study using data from their previous depression trial measured significant increases in the personality domain of openness three months after the single high dose of psilocybin.
It replicates similar findings from Johns Hopkins University in the US. Albert Garcia-Romeu, who is leading another Hopkins psilocybin study, told me that openness goes hand-in-hand with reductions in symptoms such as rigid negative thinking. [It] has shown association with overall happiness and quality of life, so in that regard I think it can be an important piece of the puzzle in terms of psychedelics therapeutic potentials, he says.
Ian Roullier, a participant in the Beckley study of treatment-resistant depression, described how he experienced it: Depression is a very narrow, restricted state and taking psilocybin really helps you to zoom out a lot more I felt a lightness within myself and more of a freedom. Like MDMA for PTSD, psilocybin has just been given breakthrough therapy status for treatment-resistant depression and large-scale trials are being rushed through across Europe.
For me, about an hour and a half after I lay down in New York, I took off the eye mask and sat up to a world transformed. For as long as I could remember there had been a wall of glass between the world and me, trapping me in a numb limbo that a litany of talk therapy and medications couldnt touch.
Like magic, the wall was gone. Everything I looked at had a new clarity and immediacy as I drank it in. It was as though an iron knot of tension in my forehead, which contracted my whole body in its clenching grip, had suddenly dissolved. I felt calm, confident and connected. I didnt feel like I was tripping I felt like myself for the first time in years. It was the purest relief Id ever known.
Almost three years later Im back living in Fremantle but its all changed. I had spent past Western Australian summers in bed, staring at the wall with the blinds down. This year Im up at five most mornings making the most of the rising sun: gym, swim, long walk on the beach, and in the studio by eight this morning to finish off my edits before uni. Id always wanted to write but the words wouldnt come, and while I still have to work bloody hard to keep the show on the road, its all flowing now.
Read more: https://www.theguardian.com/science/2019/apr/14/psychedelic-renaissance-could-mdma-help-with-ptsd-depression-and-anxiety
