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I’d been hesitant to speak openly about my quest because I’m old enough to remember the warnings about “bad trips” that boggle the brain. Imagine my surprise when my friend told me he had recently taken his first “journey” which he described as life-changing.
I asked him – a real estate developer living in Northern California who is married and has children – why he decided to try a psychedelic substance. “My work started to feel stale and meaningless,” he told me over a beer. “Despite a lot of thought and coaching on how to break the rut, I felt like I was still way off track.”
He and the others who have used these drugs spoke on condition of anonymity as most of these psychedelics are Schedule I substances, meaning they are illegal to manufacture, buy, possess or distribute.
When I confided in a few other friends about my interest in psychedelics, some said they had tried the drugs and experienced multiple benefits: from relieving anxiety to finding spiritual insight to fighting depression and, among some with cancer, helping reduce the fear of dying.
They are hardly outliers. According to a new YouGovAmerica study, “One in four Americans says they have tried at least one psychedelic drug,” which equates to approximately 72 million US adults. (The study included the previously mentioned drugs plus LSD, mescaline, and salvia.) Did I miss anything by not boarding?
When I asked my psychiatrist about taking part to improve my mental health, he supported me with two caveats: do it with a trained therapist or guide, and do your best to make sure the substance is what it says it is.
It’s hard these days not to see, hear, or read about the use of psychedelics, be it Michael Pollan’s bestselling (and accompanying Netflix documentary) How to Change Your Mind, online advertisements for psychedelic spa “trips” in the Underground therapists (aka “sitters” or “guides”) with websites promising mind-expanding journeys and a DIY online ketamine program — with a doctor connected via videoconference — you can do at home. (Ketamine was approved by the Food and Drug Administration as an anesthetic/analgesic in 1970, making prescription legal. It has been prescribed off-label for depression, anxiety, and other mental health problems for over 20 years. A derivative of ketamine called esketamine – sold as Spravato – FDA approved specifically for depression in 2019.)
In the biggest advance for depression in years, the FDA approves a novel treatment for the most severe cases
Recent clinical and headline-grabbing studies have demonstrated its effectiveness in treating a variety of conditions such as depression, addiction, obsessive-compulsive disorder, and post-traumatic stress disorder. And more and more studies are being done.
Fascinated but cautious, I wanted to know: How do I proceed wisely and safely? I started with an interview with Rick Doblin, the founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS). He reminded me that, aside from ketamine, none of these commonly illegal psychedelics are FDA approved, so he would only refer to them as “minimizing risk.”
“I don’t want people to think this is like a carnival ride,” he said. “There is always a risk.”
Matthew Johnson, a psychiatry professor at the Johns Hopkins Center for Psychedelic and Consciousness Research who has conducted numerous studies on psychedelics, also spoke about safety. Up to this point, Hopkins’ clinical trials filter out those with schizophrenia, bipolar disorder, or severe heart disease.
I mentioned that like millions of Americans, I take an antidepressant (an SSRI, or Selective Serotonin Reuptake Inhibitor), which he explained would likely dull the effects of psilocybin or MDMA. To start taking psychedelics, he told me I would want to taper off the SSRIs first, which is best done under medical supervision (which I’ve had trouble with in the past).
I wasn’t suicidal until I was sudden and frightening
I also have heart disease, so he advised me to talk to my cardiologist (who texted me that he doesn’t know anything about psychedelics use). In other words, these drugs are not for everyone.
Johnson reiterated that despite public testimonies about the beneficial therapeutic effects of psychedelics use, “there are dangers and it’s illegal.” Was he trying to discourage me? “I don’t encourage anyone to do this alone,” he said
Having researched this column, I am not interested in undertaking this journey alone. But assuming I had a guide or therapist, where would I start?
Doblin suggested that anyone with a “clinical indication” (like depression, PTSD, or anxiety) should go to ClinicalTrials.gov to find and potentially participate in nearby trials. When I recently searched the database for “psilocybin” studies in the United States, 67 studies came up. All are conducted at well-known academic medical centers, which means the studies are conducted using pure drugs that are FDA-approved and Drug Enforcement Administration-licensed, meaning the studies are regulatory-approved.
What about people without a clinical indication but who are on a spiritual quest? Here are the thoughts I gathered:
Kit and setting: I heard this phrase over and over again, which refers to finding a healthy mindset and relatively safe environment. For obvious reasons, Johnson called the roof of a tall building a bad idea, as was staying near cars or sharp objects. Robert Mitchell, who has practiced psychedelic therapy and administered herbal medicines for 30 years and has “treated hundreds of clients,” said, “The most important thing is that you feel safe and comfortable and not being disturbed.” He lives in Los Angeles and said , he often has clients renting a cabin in the Santa Monica mountains that serves as a “sacred space.”
Find an Experienced, Trusted Therapist: If you are looking for a psychedelic guide, word of mouth can be helpful. My real estate developer friend said, “For a beginner, I strongly advise others to find a guide, ideally recommended by someone you trust.” Johnson of Hopkins urges people not to take any of these psychedelic drugs alone ; Although there are still risks, it is less risky when someone is there who knows the identity of the substance and the dose. (He said this can be particularly critical for psilocybin mushrooms, which are known to have wide variation in potency.) New programs are available, such as the Psychedelic-Assisted Therapies and Research Certificate Program at the California Institute of Integral Studies to meet the growing need for qualified Psychedelic Therapists to meet demand.
Ask questions beforehand: Many therapists include a prep session before a journey or treatment begins. Questions to discuss in the preparation session include a discussion of the therapist’s background and expertise, your intent to take a psychedelic drug (and which one), your personal medical history, how he might deal with a problem that arises (eg (e.g. a medical side effect or a “bad” trip), the procurement of the medication and of course the fee. A Colorado woman gave me this advice: “I would definitely work with a therapist who has experience and a clear protocol for the use of psychedelics, including pre-trip interviews and post-trip integration appointments.”
Know what you are taking: Doblin said there is one DEA-licensed facility in the United States: Drug Detection Laboratories. It takes anonymous samples of illegal drugs, analyzes them and posts the results online. (You send it in with a specific code and pay a fee for analysis.) That being said, be sure to talk to potential leaders about the source of their substances. Mitchell told me he knows where his psilocybin mushrooms are grown and can vouch for their purity. In the end, a friend who had two psilocybin sessions said he “has to rely on the guide and the trust generated”. That will always be imperfect.
Do your homework: MAPS is a nonprofit educational group whose first Phase 3 study — on the effective use of psilocybin in severe cases of PTSD — was published last year in Nature Medicine, a leading peer-reviewed journal. The organization publishes information about the functions, uses, and legality of psychedelics. It offers an introductory course, Psychedelic Basics. Another resource is the MAPS Code of Ethics for Psychedelic Psychotherapy, which discusses psychological and physical risks.
So am I going to take a psychedelic journey?
I read everything I can get my hands on and talk to everyone I can reach about their experiences. I also remember the legal problems. Yes, Pollan and others are trying psychedelics and writing about their experiences—and not getting arrested or their careers derailing or seemingly suffering any ill effects—but that shouldn’t be taken as carte blanche to the rest of us.
I’ll be back here in a few months, so stay tuned.