Can a psychedelic trip change the way people with life-threatening cancer face death? Results from two clinical trials suggest so.

Researchers have shown that a single dose of psilocybin – the active ingredient in magic mushrooms – combined with psychotherapy reduces depression and anxiety and increases feelings of wellbeing in people with cancer. What’s more, for most, these effects appeared to last for more than six months.

Psilocybin, along with other psychedelic drugs like LSD, was banned in the late 1960s. But an increased understanding of the drug’s physiological mechanisms has sparked a revival of research into its potential therapeutic benefits. Several small trials have shown its promise as a treatment for alcoholism, opiate addiction, depression and anxiety.

People with cancer often develop chronic symptoms of depression and anxiety, and antidepressants appear to be of little help. Some small studies have suggested that psilocybin could be an alternative.

To investigate, teams from Johns Hopkins University in Baltimore and NYU Langone Medical Centre in New York carried out two trials involving 80 people with cancer and symptoms of depression and anxiety.

In one trial, each volunteer participated in a psychotherapy session aided by either a single high dose of psilocybin or a low placebo-like dose of psilocybin. Five to seven weeks after this session, they took part in a second session with the other drug.

The second trial was run in a similar manner, except it used Vitamin B3 as a placebo.

Inner experience

During each session, the subjects laid on a couch, wore a blindfold and listened to music. They were accompanied by two researchers and were encouraged to focus their attention on their inner experiences.

To assess the volunteers’ responses, the trials used a variety of psychological and physiological measures, including blood pressure and heart rate, clinician-based tests and self-reported questionnaires. These assessments were carried out before each session and at either two or three points over the next six months. At the end of the trial, their families, friends and work colleagues were also interviewed to gauge their thoughts on the participant’s wellbeing.

Results across the two trials showed that psilocybin produced immediate and significant decreases in measures of depression, anxiety and mood disturbance, and increases in measures of quality of life, life meaning, death acceptance and optimism. These benefits were still present in 80 per cent of participants after six months.

The core feature of a psilocybin experience is a sense of unity; a feeling that everything is connected at some level, says Roland Griffiths, who led the Hopkins trial.

“After this kind of experience, people feel that they’ve learned something that’s of deep meaning and value to them,” he says. “They attribute changes in how they approach life, interact with people and to their value systems to that experience.”

There were no serious adverse effects in either trial, although there were some reports of nausea, headache and transient anxiety. The results together form the most extensive trial of psilocybin for treatment of depression and anxiety.

Alternative treatment

Stephen Ross, lead investigator on the NYU Langone trial, highlights the need for an alternative to the available care for people with cancer. “Anywhere from 40 to 50 per cent of cancer patients will have diagnosable anxiety or depression,” he says. “The [current] treatments, like antidepressants, really don’t work any better than placebo.”

In a commentary published alongside the trials, Richard Shelton and Peter Hendricks, both at the University of Alabama, at Birmingham, call into question the integrity of the placebo design in both trials, as none of the participants were asked which drug they thought they had received after each session.

This is normally carried out to ensure that the placebo arm of a trial is realistic enough. If people cannot accurately guess which drug they were given, it ensures that the results are down to the drug and not any other factor. However, they note that due to the hallucinogenic effects of the real drug, it may be unfeasible to create a placebo that is indistinguishable from the real thing, as is often the case with studies of psychoactive drugs.

Ross says the study now needs to be carried out on a larger sample of people. “Even though our two trials together replicated the same study and would lead one to think this is a real effect, it needs to be done in a larger, nationally representative cancer sample,” he says. “And if that trial shows what we showed then psilocybin potentially could be rescheduled to become a prescription medication for cancer related anxiety and depression.”

Journal references: Journal of Psychopharmacology, DOI: 10.1177/0269881116675512; DOI: 10.1177/0269881116675513

Psychiatrists in the 1960s certainly thought so. They carried out many studies looking at the effect of LSD and other psychedelics on people undergoing psychotherapy for , and alcoholism.

The idea was that the drug would mimic the effect of hypnotherapy, making people more suggestible and open to changing their thought patterns. The results were reportedly positive, but the experiments rarely included control groups and so don’t stand up to modern scrutiny.

The work ground to a halt when recreational use of LSD was banned in 1971 – even though using LSD for research purposes was exempt.

Several decades on and LSD research is less of a contentious issue. This has allowed a team of researchers to revisit LSD’s suggestive powers with more care.

The mind’s eye

A team at Imperial College London gave 10 healthy volunteers two injections a week apart, either a moderate dose of LSD or a placebo. The subjects acted as their own controls, and didn’t know which dose was which. Two hours after the injection, the volunteers lay down and listened to the researchers describe various scenarios often used in hypnotherapy. They were asked to “think along” with each one. These scenarios included tasting a delicious orange, re-experiencing a childhood memory, or relaxing on the shore of a lake.

“Sometimes the suggestions had a kind of irresistible quality” says team member . “In a suggestion which describes heavy dictionaries in the palm of your hand, one of the volunteers said that even though they knew that I was offering a suggestion and it wasn’t real, their arm really ached, and only by letting their arm drop a little bit did the ache go away.”

Once all the scenarios had been read out, the participants had to rate the vividness of the mental experiences they triggered on a standard scale.

The volunteers rated their experiences after taking LSD as 20 per cent more vivid than when they had been injected with the placebo.

Power of suggestion

Treating neuroses with psychotherapy requires the therapist to be able to influence the patient’s way of viewing themselves and their obsession. Co-author , also at Imperial College, says the work suggests that psychedelic-assisted psychotherapy may provide a unique opportunity for the brain to enter the plastic, or malleable, state required for this to happen.

Peter Gasser, a psychiatrist working in Solothurn, Switzerland, who recently , commended the study and emphasized the importance of suggestibility for therapy. “The mind on LSD is easily able to make connections between ideas and thoughts,” he says.

Now that the team has verified the historical findings, the path is laid for them to explore the mechanisms underpinning LSD’s effect on consciousness, and the legitimacy of its use in psychotherapy.

Journal reference: Psychopharmacology, DOI:

I HAVE been struggling with an addiction to opiates for the past three years. It started with prescription painkillers and progressed to full-blown heroin dependence.

In an attempt to kick the habit I signed up for a traditional 30-step inpatient treatment that involved individual and group counselling, and which cost about $30,000. That was a year ago, and it didn’t work. I felt unable to stay away from heroin.

Now I am at a small clinic in Baja California, Mexico, where I am taking part in the first trial to investigate the effectiveness of treating heroin addiction with a single dose of ibogaine – a psychoactive substance derived from the rainforest shrub Tabernanthe iboga.

“Ibogaine can take you many places, causing you to experience a range of emotions, memories and visions. If any of these images become too frightening, just open your eyes.” I am reassured by the words of the director of the clinic, Jeff Israel, but the drug’s history is not all rosy.

Several clinical trials have shown that low doses of ibogaine taken over the course of a few weeks can greatly reduce cravings for heroin and other drugs. There was extensive research on it in the 1990s, with good evidence of safety in animals and a handful of studies in humans. The US National Institute on Drug Abuse invested over $1 million, but then abandoned the project in 1995. A study had shown that at high doses, ibogaine caused some . Lower doses similar to those used in human addiction trials showed no such effect, however.

Ibogaine’s mind-altering effects mean that today, the US Drug Enforcement Agency defines it as having a high potential for abuse with no recognised medical use. It is classed as a schedule I drug, the most restrictive legal designation.

But anecdotal accounts suggest that a single treatment is just as effective as multiple low doses. The dose is much higher, although still nowhere near the levels found to cause harm in rats. A single treatment is less expensive than standard addiction therapies, and the intensity of the experience is not a recreational high that users seem to want to repeat.

So the Multidisciplinary Association for Psychedelic Studies (MAPS), a US non-profit research organisation, decided to investigate whether there was any scientific validity to the reports. Legal restrictions in the US severely limit funding for clinical trials of this kind, so the volunteers recruited – this is where I come in – were those who had sought treatment independently in Mexico, where there are fewer restrictions on ibogaine use.

“There have been claims by the government that there’s a high potential for abuse and no medical use, and claims from ibogaine advocates that one dose is a miracle cure. We’re trying to gather some scientific evidence to better evaluate it,” says Rick Doblin, executive director of MAPS. A similar study is also being carried out in New Zealand.

At the clinic, I and 29 other heroin addicts get our dose of ibogaine. The treatment costs between $2000 and $6500 depending on which clinic you go to. As it starts to take effect I feel an intense wave of energy emanating from the centre of my chest that permeates my entire body. This euphoric state also brings me instantaneous relief from the discomfort I was feeling after going without heroin for almost 24 hours.

“This euphoric state brought about an instant relief from the discomfort of going without heroin”

With my withdrawal symptoms completely gone, I am perplexed by the state of clarity I am in while seeing the most profound stream of visual phenomena. I am also filled with a sense of awe at the potential for a life free of heroin. Emotional memories force me to deal with some of the deep subconscious guilt I have repressed for years.

This powerful state persisted for over 12 hours. After remaining at the clinic for a week I was allowed to return home and over the next six months felt almost no cravings whatsoever.

Despite the earlier research, ibogaine’s mechanism of action is still not clear. And the lack of controlled human trials has prevented anyone finding out more. What is known is that the drug affects multiple receptors in the brain. Its ability to lessen cravings may be the result of its blocking of NMDA receptors. Drug-induced craving is linked to increased activity of these receptors and blocking them can inhibit cravings in animals. The long-term relief from withdrawal symptoms probably comes from the fact that ibogaine is sequestered in fat tissue and slowly released into the bloodstream for up to six months.

For the next year, principal investigator Thomas Brown of the University of California, San Diego, and his team kept track of all of us with telephone interviews and regular addiction severity tests, as well as quality-of-life assessments and drug tests. Brain scans were not taken since the dose was assumed safe based on prior human and animal studies.

Brown has not yet completed his analysis, but he says the results appear to show compelling preliminary evidence of ibogaine’s efficacy at a single dose. There has been a decrease in the severity of withdrawal symptoms in all 30 trial participants, he says.

When asked to rate the importance of their treatment on quality of life, both the subjects themselves and their partners stated that it had helped to greatly change their lives. “The main statistically significant improvements are in a consistent reduction in the severity of drug and alcohol use,” says Brown.

People working with addicts are interested. Steven Scanlan, a physician at Palm Beach Outpatient Detox in Boca Raton, Florida, says there are limitations to existing methods of treating addiction. He uses suboxone, a daily medication for opiate detoxification. With this therapy, though, people can often replace one addiction with another. “Every day people are calling asking me to detox them off suboxone, but it’s really the only weapon I have to detox people off opiates,” he says. “I’d be really excited to have something else to be able to use.”

Of the 29 others who took part in the trial, none are now reported as having problematic drug use. Two years after that one dose of ibogaine, I abstain from all drugs. Given the chance of relief from the physical and psychological dependence, I am free to make conscious choices again. We don’t yet know how effective this treatment would be in others, but the change in my life is startling.

“Given the chance of relief from the dependence, I am free to make conscious choices again”

This article appeared in print under the headline “Can a mind-altering drug cure heroin addiction?”