Thursday, July 13, 2006

Medicine: Magic Mushrooms more than just for stomping Koopas, saving Princesses

After four days of intense vomiting and, er, vomiting the other way, I can finally blog about the new Hopkins study about the possible uses of psilocybin and other hallucinogenic goodies as pharmacotherapy and as an adjunct for intense psychotherapy. But I think Syd Barrett can probably sum up anything intelligent I might have to say on the matter.

Psychiatry has always been interested in possible uses of the psychedelic medications to allow patients to explore parts of their brains that they might have difficulty calling up without a little help. Ecstasy was still legal for use as a psychiatric adjuvant up until 1985 (Merck filed patent on MDMA in 1912). Psychedelics enhanced communication, weakened defense mechanisms, and broke down barriers against introspection.

Most of these meds are serotonergic equivalent of a nuclear warhead, and years of amazingly effective ECT has taught psychiatrists that, for some reason, stimulating the hell out of the nervous system can sometimes lead to improvements against the negative symptoms of mood and thought disorders. Neuroscientists may have all of the "how's" and "why's" figured out in the next fifty years, but all psychiatry needs to worry about right now are the "what's": what could these medications help treat along with the therapies we already have available; what bad things could happen to people taking these medications inappropriately; and what do I need to do to get some of this junk in time for the weekend?

So the Hopkins study, or at least the way the media is covering it, since I can't get the pdf to come up from home, seems to just be looking at what the hell magic mushrooms do to people without prior mental illness in a controlled environment, with some nice research design with crossover and methylphenidate controls. Their results:

According to the Baltimore team, nearly two-thirds of the volunteers said they achieved a "mystical experience" with "substantial personal meaning." One-third rated the psilocybin experience as "the single most spiritually significant experience of his or her life," and another 38 percent placed the experience among their "top five" most spiritually significant moments.

Most also said they became better, gentler people in the following two months. "We don't think that's delusional, because we also interviewed family members and friends by telephone, and they confirmed these kinds of claims," Griffiths said.
My wife's initial response: "Dude, how did these people get to be in this trial? Sign me up." Basically, with results like that. But mysticism isn't exactly a primary end-point for a therapeutic trial, and I'm sure if there were safe recreational uses of medications like this, the free market would be more than happy enough to cover the expenses of the trials.

But of course, hitting shrooms is illegal for a reason: because the government doesn't want you to have any fun. Well, that, and the fact that they might be really dangerous. But that dangerousness is as least as unclear as potential therapeutic effects, and that's where the study leaves us with our proper cautionary tale:
Even though the candidates for the landmark study were carefully screened to reduce their vulnerability and closely monitored during the trial, "We still had 30 percent of them reporting periods of very significant fear or anxiety which could easily escalate into panic and dangerous behavior if this were given in any other kind of circumstances," Griffiths said.

"We simply don't know what causes a 'bad trip,' " he added, "and we can't forecast who'll have a difficult time and who won't."
Especially at a club, driving down the highway, or while operating heavy machinery.

The results of the study aren't surprising and its conclusions filled with the standard mantra of what needs to be studied further, i.e., everything. But the fact that this study was actually done, and that Bill Frist or Tom Cruise haven't been holding cats hostage or jumping on couches, says so much more. And (I absolutely speculate) it's Hopkins, so they can keep playing with Schedule 1 all they want. Not many politicians would have the nerve to fight with God's Hospital right across the Potomac, lest they wind up admitted there for a stubbed toe and leave straight from the ICU to the funeral home.

Of course, this means Hopkins jumps up a little higher on the residency match list, if only so my wife and I could be test subjects.

1 comment:

Josh said...

Interesting that you bring up Syd Barrett since, as I recall, you've never made a Syd Barrett reference. But now you do and now he'd dead. If you ever have to reference me, just refer to me as "that dude" or something, ok?