Psychedelics Are Promising, But Many Psychiatrists Don't Want to Use Them
I surveyed more than 300 psychiatrists on their knowledge and views of psychedelics.
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After a half-century away from the scrutiny of the public eye, psychedelics have reemerged. Once characterized as the dangerous poisons of “plain fools” by President Reagan, their reputation is in the midst of a dramatic renaissance.
Though the patient work of countless researchers has brought about this status change, the public face of this revival is an unlikely one—that of author Michael Pollan, whose new book, How to Change Your Mind, is giving psychedelics more media attention than they have received since the counterculture of the ‘60s.
This time, however, the discussion focuses not on their association with society’s fringes, but on the possibility that psychedelics could bring about a seismic shift in mainstream medicine’s treatment of mental illness and addiction.
Naturally occurring psychedelic compounds such as psilocybin and mescaline have been integral to the ritual practices of indigenous cultures for millennia. It wasn’t until LSD was synthesized and its psychoactive properties were discovered in the ‘40s, however, that psychedelics garnered attention for their potential medical uses.
In the ensuing decades, their treatment potential was explored in countless studies, and they were administered by physicians to thousands of patients. Due in part to the antics of Timothy Leary and his associates, psychedelics escaped the lab, and recreational use mushroomed. Society’s view, in turn, morphed from one of fascination to fear. Psychedelics were outlawed soon after, and most research on their treatment potential came to a halt as bureaucratic barriers multiplied and the medical establishment turned its back.
That might have spelled the end of psychedelic research were it not for a small group of dedicated individuals and organizations such as the Multidisciplinary Association for Psychedelic Studies, the Heffter Research Institute, and the Beckley Foundation, who faced the stigma and challenges associated with psychedelic research head on.
Organizations like these navigated the bureaucracy and amassed private funding for further scientific investigations. Through their efforts, studies rapidly accumulated, showing promising results in the treatment of conditions like obsessive compulsive disorder, anxiety, depression, and addictions. MDMA has now been granted “breakthrough therapy designation” by the Food and Drug Administration for the treatment of post-traumatic stress disorder in combination with psychotherapy and is moving into Phase 3 clinical trials.
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Discussion and reporting of findings from studies of LSD, psilocybin, and MDMA are occurring in some of the world’s most prominent psychiatric and general science journals, though many respected publications remain silent on the topic. Still, a little more than a decade ago, any mention of psychedelics as treatment in high-impact journals would have been unimaginable.
The medical community is now wondering how to most effectively incorporate psychedelics into existing research and treatment paradigms. One of the most practical questions is: If these compounds are legalized for treatment, who will prescribe them? Psychiatrists are the most likely candidates given their training in medicine and psychotherapy. But what do psychiatrists actually know and think about psychedelics? As a psychiatrist and researcher, this question intrigued me, so my colleagues and I decided to help answer it. In doing so, we surveyed more than 300 psychiatrists throughout the country on their knowledge and views of psychedelics.
Our findings, published this month in the Journal of Nervous and Mental Disease, gave us fascinating and surprising insights into the attitudes of our field. Research has demonstrated that there is no link between psychedelic use and subsequent mental illness or suicidal behavior. Instead, there is actually an association with decreased risk for mental health problems. Despite this, we found that most psychiatrists still believe the contrary. Nearly half of survey participants also thought that use of psychedelics increases the risk of long term cognitive problems, although there is evidence refuting this as well.
Despite these concerns about negative long-term effects, a little less than half of psychiatrists still felt that psychedelics show promise in the treatment of psychiatric disorders. However, less than a third believed that psychedelics could actually improve psychotherapy treatment outcomes. Still, a majority of participants agreed that psychedelics could be safely administered under medical supervision and more than 80 percent felt that further research on them is warranted.
Given the cultural legacy of the ‘60s and the role psychedelics played, we expected to find some generational differences in perceptions of psychedelics, and we did. Psychiatric trainees and younger psychiatrists were less concerned about potential risks of psychedelic use, more hopeful about their treatment potential, and more supportive of further research. Another factor at play in this difference of generational perspectives could be the media’s portrayal of psychedelics.
While news coverage of psychedelics tends to be positive today, the relationship between psychedelics and the media in the past was much more complicated. Decades ago, psychedelic coverage could be more negative and sensational, as detailed in Stephen Siff’s book Acid Hype: American News Media and the Psychedelic Experience. Though we can’t say with certainty, the impact of the media on our participants’ views is a notion worth considering.
Perhaps most striking, we found significant differences in survey responses based on gender. Female psychiatrists were less optimistic about the therapeutic potential of psychedelics, more concerned about the risks of using them, and less likely to agree with conducting further psychedelic research. The reason for this is unclear, though data from the National Survey on Drug Use and Health show that nearly twice as many men have used a psychedelic in their lifetime as women. We didn’t ask about personal use, but it’s possible that more male psychiatrists have used a psychedelic themselves, which could have made them less worried and much more open to using them as treatment.
Renewed interest in psychedelic treatment is coming at a challenging time in the history of modern psychiatry. Given rising rates of mental illnesses such as depression, escalating numbers of suicides, increasing levels of opioid addiction and staggering numbers of overdose deaths, we are now desperate for new, innovative treatments. Since the advent of SSRI antidepressants in the late 1980s, pharmaceutical companies have largely abandoned efforts to develop new medications for mental illness due to the difficulties of this work. Some medications have come along since then, but they have largely been “me-too” drugs that seem to be no more useful than the ones already available. Could psychedelics be the compounds that fill our innovation void?
Given the growing body of evidence supporting their usefulness in treatment, we psychiatrists must now ask ourselves a very important question: Did we get it wrong on psychedelics? If we are willing to entertain the possibility that we did, these compounds could be reintegrated into the mainstream scientific community for further objective assessment, and questions about them could be answered much more quickly.
If results continue to be positive, this could help with the push for psychedelics to be reclassified as a Schedule II controlled substances, which would recognize their medical uses and make further clinical and research efforts much easier. However, if stubborn, inaccurate, notions about them prevail, psychedelics may yet again be moved out of sight and into the shadows, and potentially powerful treatments for our patients might go unseen once more.
Brian Barnett is a post-doctoral fellow in the Partners Healthcare Addiction Psychiatry Fellowship and a clinical fellow in psychiatry at Harvard Medical School. Follow him on Twitter @BrianBarnettMD.
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