Psychedelics As Medicine

For the second time in a year, the U.S. Food and Drug Administration (FDA) has designated psilocybin therapy as “breakthrough therapy,” an action that is meant to accelerate the typically sluggish process of drug development and review.   This fresh look at psychedelics by the medical profession is not a completely new development.  In March 2019, the FDA approved a nasal spray depression treatment for treatment-resistant patients based on Esketamine, a substance related to ketamine — an anesthetic that has also been used as an illicit party drug and animal tranquilizer.

Pursuant to the federal Controlled Substances Act of 1970 and the laws of the States, both “Marijuana” and Tetrahydracannabinol (“THC”) are classified as “Hallucinogenic substances.”  Drugs, chemicals, and other substances intended for human consumption are classified by the Drug Enforcement Agency into five distinct schedules depending upon a variety of factors such as acceptable medical use and the drug’s abuse or dependency potential.   Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse.

Other drugs listed in the DEA’s Schedule I hallucinogenic substances include well-known illicit substances such as lysergic acid diethylamide (“LSD”), 3,4-methylenedioxymethamphetamine (“MDMA”), psilocybin, phencyclidine (“PCP”), and mescaline.  This category of drugs is commonly split into two smaller categories:   classic hallucinogens (such as LSD) and dissociative drugs (such as PCP).  Both types of hallucinogens can cause hallucinations, or sensations and images that seem real though they are not.  But does a drug that creates an alteration of perception necessarily mean that it is a psychedelic?

Both psychedelics and cannabis can produce mind-altering effects. But the effects produced by psychedelics and the effects produced by Cannabis are fundamentally different at the molecular level.  Drugs such as LSD, DMT (the active ingredient in ayahuasca), and psilocybin contain naturally occurring neurotransmitters that produce serotonin, a mood regulator, and dopamine, associated with the reward center in our brains.

On the other hand, THC, the psychoactive molecule in Cannabis that induces the mind-altering effect, also interacts with dopamine, which can lead to feelings of euphoria.  THC differs in that it interacts with the body’s own endocannabinoid system that helps to maintain the health and wellness balance (homeostasis).  Moreover, Cannabis is a genus of flowering plants that contain more than 100 organic molecules with a variety of psychoactive and non-psychoactive effects.  The full effect from the compounds in Cannabis are elicited from the large variety of molecules that occur within the bud of the plant.

There are two methods for determining whether a substance has psychedelic properties:  a binder test and an effects test.  The first method is based upon a molecular analysis of where in the human body the neurotransmitter binds and causes its effect on the brain and the body.

In the molecular analysis, scientists look at the neurotransmitter receptors and will classify a drug as psychedelic if it binds to serotonin 5-HT2A receptors as an agonist or partial agonist.  The possibility also exists that other serotonin receptors may be involved in the overall psychedelic experience of a user.

THC and other compounds in Cannabis create their effects by binding as agonists or partial agonists on the cannabinoid receptors CB1 and CB2.  Interestingly, scientists experimenting with THC recently have found evidence that THC can have a noticeable effect on the 5-HT2A receptors, further adding to the mounting evidence of cannabis being a psychedelic drug based on receptor binding.

In the practical effects analysis, scientists compare the practical effects of the drug on the person experiencing effects to what are classically considered psychedelic effects.   If a compound meets the criteria for either or both, then it may properly be termed psychedelic.

In 1964, psychedelic researcher and advocate Timothy Leary, along with colleagues Ralph Metzner and Richard Alpert, developed a scale for measuring the intensity of a psychedelic experience.  Based on its effects, they included Marijuana as a psychedelic in their analysis. The researchers said the effects of moderate to high doses of cannabis included synesthesia, enhanced perception of music, visual effects (including patterns) with the eyes closed, the emergence of unconscious emotions, and unrestrained creative and abstract thought patterns.

Now that the FDA has finally taken the first big step in normalizing the use of psychedelics as a means of improving the lives of Americans by approving the first large scale clinical trials, where can we go from here?  While current policies characterize any use of these substances as illicit abuse, approving such trials demonstrates that the FDA is capable of change.  Psychedelic medicine may prove to be the lever that moves drug policy away from the days of the Drug War in favor of more nuanced strategies that harness the benefits of psychotropic drugs while minimizing their risks.

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