Illegal Drugs and their Potential for Therapeutic Use

    MDMA (Ecstasy), LSD, and Psilocybin (“Magic Mushrooms”) are three psychedelic Schedule 1 drugs that have been outlawed for decades in the United States.  A Schedule 1 drug has reportedly “high potential for abuse” and “no currently accepted medical use in treatment” (1).  I agree that our current society is biased to believe that these drugs serve no potential medicinal purposes.  I mean, who would think otherwise, right?  The D.A.R.E. program has taught school-children since the fourth grade that horrible drugs like these are bad and should never be used, no matter what.  But what if this is not the whole truth?  What if these drugs could prove incredibly useful in specific therapeutic environments?  What if people who are currently suffering could be effectively treated with such “horrible” drugs?  After some basic research, I argue that these proposals are not only “what ifs,” but rather a reality in our world today.

    Before delving into the social and cultural interpretations of these drugs, it is first important to review how they work biologically and what effects they have on the body/mind in the short and long term.  Ecstasy acts as a stimulant by increasing serotonin release in the synapse (2, 3).  LSD most likely acts on subtype 2A serotonin receptors in the cortex; it is proposed to change the number of these receptors and/or change the perception of pain and anxiety (4, 5, 6).  Psilocin, the body’s processed form of psilocybin, acts by mimicking serotonin and acts as a partial agonist at the serotonin receptor (7, 8).  All of these drugs can generate quite varied physiological and psychological effects.  However, some general common effects do arise: euphoria, empathy, connection to others, confusion, inner-peace, enhanced senses, mental clarity, and a sense of experiencing an altered reality.  Some other, more negative effects can include short-term panic attacks, bad trips, and even flashbacks (at least for LSD).

    What must be kept in mind is that all of the information presented above concerning how these drugs work biologically is primarily hypothetical – little data has been found to confirm how these drugs work, even though they all seem to point to serotonin- related processes.  Furthermore, the effects experienced by any two individuals can vary greatly, depending on individual genetic factors, the mind state, and the surrounding environment.  Therefore, little is actually known about how these drugs generate their drastic effects.

    One of the most marked and common effects of these drugs is to help individuals think in new ways.  They enable individuals to overcome personal and social barriers in order to reach an altered, but natural mental state – similar to the goals of Cognitive Behavioral Therapy.  Obviously, this result could serve incredibly useful for many patients suffering from psychiatric diseases.  However, to really support their use in such therapeutic environments, many people (including those in our class) expressed a need for further research.  Most of the class was overwhelmingly supportive for promoting their use in research settings and/or for medical treatment.

    One problem our class seemed to get stuck on during the discussion and on the boards was whether we should use these drugs medically to obtain further data, or first conduct non-human-based-clinical research to learn more about how these drugs generate their effects.  This definitely has circular qualities – should medical practice or research come first, as learning more about each can support or reject the other?  I would argue that we should approach the situation from both directions, in order to maximize our ability to learn the most about these drugs.  The easiest way to explain this reasoning is through an example, such as using MDMA for treatment of Post-Traumatic Stress Disorder (PTSD).

    Many people around the world are currently suffering from PTSD, including 25 million U.S. veterans (9, 10).  Though several pharmacological and psychotherapeutic treatments exist, none have been shown to be consistently successful.  The use of MDMA as part of a treatment plan was begun in a 2004 trail funded by the Multidisciplinary Association for Psychedelic Studies (MAPS) and the initial findings appear to be quite positive (9, 10, 11).  Yet, many people, including those in our class, expressed numerous concerns.  Can people who are suffering from psychological “diseases” truly provide informed consent?  Is prescribing a drug with such unpredictable trips really safe when patients may have severe depressive symptoms?  Should serious potential side-effects, such as intense depressive thoughts days later (suicide Tuesdays), sway doctors from administering this dangerous drug and researchers from studying it?

    While these concerns are certainly valid, there are plenty of arguments to support the use of psychedelics in not only such trials, but in research and further clinical settings.  These drugs can be used in highly controlled clinical settings, where the patient is made to become familiar with the environment and doctor numerous times before the drug is administered.  The patient could be required to stay in the treatment facility for some extended amount of time in order to be continually monitored, just in case any bad side-effects do set in even days later.  This focuses on the “set and setting” – a person adequately prepared for the experience is much less likely to have a bad trip, and more likely to gain valuable insight from the effects of the drug (12).  Furthermore, it is a combination of the drug and talk therapy that will produce the most beneficial effects –trained doctors by no means just hand over prescriptions for the drugs and tell patients to come back in a year.  Also, almost all drugs have a slew of side-effects, which can often be fairly dangerous.  For example, Accutane is currently used to treat acne, even though it can generate serious birth defects and correlates to increased suicidal thoughts in a subset of patients (13).  Therefore, these psychedelics could be administered in a similar way as Accutane – they could be used, at least initially, as a last resort option and exclusionary criteria could eliminate patients who would be likely to have dangerous complications.  However, simple bench research can only help us learn about these complications to a limited extent – mimicking PTSD in an animal model is going to be difficult.  Finally, though informed consent could potentially be a challenge, there have got to be at least some situations in which there are not any outstanding complications and adequate informed consent can be provided.  In such cases, only the law is then inhibiting this therapy.  This seems rather unethical to not help suffering patients who have shown failed responses to other treatments.  Such actions ignore patient autonomy and violate the beneficent roles our society expects of medical practitioners (14).

    Therefore, why should the law limit the use of these drugs?  Where does this Schedule 1 classification come from?  Much of it is the lingering effects of a cultural backlash against the hippie-era of the 1960’s.  Originally, these drugs were used in many therapeutic scenes, titled wonder drugs.  However, their recreational use and growing social stigma surrounding them in the 60’s and 70’s generated fear and their illegal status was implemented.  Funding for research of these drugs was cut off, and throughout the years they have assumed the sense of feeling dangerous, as Rebecca W. described nicely in her board post.  Research suggesting serious side-effects of these drugs was often published right around the time their illegal status was accepted, only later to be proven false or even retracted by the original authors (11).  Therefore, the limited research that does exist appears to oppose this highly restricted classification.

    A useful endeavor throughout our class discussion was the comparison of these drugs to other more socially acceptable ones, such as alcohol, morphine, and SSRIs.  Alcohol can be highly addictive and cause death if taken in excess.  None of these drugs, by themselves, can cause such drastic results, yet anyone 21-years old is legally allowed to go down the street and buy alcohol.  Morphine is highly addictive, but used regularly as a prescription for pain relief.  SSRIs are by no means well understood and their effects are highly controversial, yet they are popularly prescribed anti-depressants.  Are the potential for bad trips really so bad with these psychedelic drugs that they should not be allowed in similar settings?  Furthermore, are they so horrible that they deserve the Schedule 1 classification?  After some limited comparative analysis, this classification seems somewhat absurd from a more objective mindset.

    If this is the case, how can these negative perceptions be changed?  In order to cause change, it must take place at multiple levels in our society.  It must be addressed at the level of the government, where people in power can produce legal changes in drug classifications and types of research funding allocation.  Drug education must change – the D.A.R.E. program with which many children grow up should not be so misleading and instead aim to more accurately portray how these psychedelics are not so different from current drugs on the market.  Supporting an accurate cultural awareness to change societal stigma against these drugs will in turn support research – people may feel more motivated to try them or have family members take them, generating support for their research funding.  Increased research can then provide more information as to how these drugs work, helping medical practitioners learn the best ways to use, and not use, these drugs.

    Many people in our class expressed further interest in the idea of making such psychedelics legal for everyday use, not only medicinal purposes.  If they can be so beneficial in enhancing creativity and altered states of mind, why should they be limited to medical environments?  Our class seemed much more tentative about this general legalization proposal.  Admittedly, many individuals suggested this may be due to the cultural pressures against these psychedelics that have been engrained in their minds since early childhood.  However, most people still just felt uncomfortable with the idea.  Some suggested that such a policy change may be alright, but only after in depth research further elucidates the biological mechanisms behind their effects.

    I personally also feel this hesitancy.  I think there is a reason some drugs are prescribed and administered in only control settings, even if the research does not always support such consistent classification systems.  Otherwise, why not make all drugs available to everyone?  In an ideal society, I think that may work well.  However, I think our society is anything but ideal, and elected government officials do end up making decisions to help protect individuals from themselves.  Also, if the mental state and surrounding environment are so important during the trips of these drugs, then I would be somewhat concerned for individuals self-administering them without such careful consideration; the potential negative side-effects are serious, and should be treated as such.  Maybe our society will eventually become one in which self-administration of all types of drugs will be acceptable, but I think we are a ways away.  Until then, I think focusing on making these drugs more acceptable in the public eye, specifically for research and therapeutic purposes, will provide enough of challenge.  And only after society accepts these drugs for these limited purposes will it even be possible to generate significant support for their general legalization.

    MDMA, LSD, and Psilocybin are powerful drugs that can generate serious effects in the body and mind.  However, unlike many are led to believe, these effects are not all bad and can generally be productive if used in a familiar and controlled setting.  Therefore, the current data concerning these psychedelics, though limited, seems to speak for itself.  This leaves much to hope for in the future.  We as an informed society should work to re-evaluate current legal and illegal drugs, scrutinizing the research behind them in order to keep legal and ethical decisions consistent concerning drug classification.  Increased research uncovering the potential these drugs can serve at least in medical settings should be supported.  If that means running therapeutic trials, then so be it.  More and more trials are being supported each year as individuals, organizations, and countries around the world begin to recognize the important uses these drugs may serve.  We can only hope that our country catches on and people begin to learn more about the facts of these drugs rather than make somewhat irrational decisions based on pre-conceived, misinformed, socio-cultural biases.  Then who knows – maybe some of our friends and families will be taking these drugs sooner than we can believe.

References:

1. Drug Schedules, from http://www.addictions.org/schedules.html.
2. MDMA (Ecstasy), Aug. 2006, drug information from DEA, http://www.usdoj.gov/dea/concern/mdma.html.
3. Methylenedioxymethamphetamine, 2 May 2008,  http://en.wikipedia.org/wiki/MDMA.
4. LSD, Aug. 2006, drug information from DEA, http://www.usdoj.gov/dea/concern/lsd.html.
5. Lysergic acid diethylamide (LSD), 1 May 2008, http://en.wikipedia.org/wiki/Lsd.
6. Brown, David Jay, “Psychedelic Healing?  Hallucinogenic drugs, which blew minds in the 1960s, soon may be used to treat mental ailments,” Scientific American Mind, 28 Dec. 2007, http://www.sciam.com/article.cfm?id=psychedelic-healing&print=true.
7. Psilocybin & Psilocyn and other Tryptamines, drug information from DEA, http://www.usdoj.gov/dea/concern/p.html.
8. Psilocybin, 28 April 2008,  http://en.wikipedia.org/wiki/Psilocybin.
9. Thrill, Scott, “Breaking the Drug Taboo: Group of Traumatized Veterans Get Ecstasy Treatment,” Alternet, 11 Feb. 2008, http://www.alternet.org/drugreporter/76576/.
10. Shroder, Tom, “The Peace Drug,” Washington Post, 25 Nov. 2007, http://www.washingtonpost.com/wp-dyn/content/article/2007/11/20/AR2007112001777.html?sid=ST2007112300636.
11. Check, Erika, “Psychedelic drugs:  The ups and downs of ecstasy,” Nature, 429, 126-128, 13 May 2004, http://www.nature.com/nature/journal/v429/n6988/full/429126a.html.
12. Hickman, Katy, “The trip of a lifetime,” BBC News, 5 April 2006, http://news.bbc.co.uk/1/hi/magazine/4877462.stm.
13. Meadows, Michelle, “The Power of Accutane:  The Benefits and Risks of a Breakthrough Acne Drug,” FDA Consumer, March-April 2001, http://www.fda.gov/fdac/features/2001/201_acne.html.
14. Psychopharmacology, D.P. Folsom, J. Sable, D.V. Jeste  Encyclopedia of Bioethics, 3rd Ed. Pages 2190-2192.