The work also benefits from recent research into the use of hallucinogens in treating mental illness, which has promoted broader acceptance of these substances. “There was long a feeling that drugs made you sick and addicted,” says José Capriles, an archaeologist at Pennsylvania State University (Penn State) who excavates in Bolivia. “Today, there is a new openness,” he adds, which is freeing grant money and attracting graduate students.
I'm really happy to hear things like this. The potential benefits (and drawbacks, of course) been evident to lots of us psychonauts for a long time, and finally the sentiment seems to have turned enough so some money can actually get into the research to see if these things can help us today via treatments. A real joy to see after so many decades of the failed war on drugs that influenced policies across the globe.
The problem with psychoactive drugs, as I understand it, is not the lack of positive results. There are plenty of well recognized cases.
The problem is the the unpredictability, because there are plenty of catastrophic results too, and we don't really know why. We can't tell "in your case you should take this dose, the risks are quantified and acceptable, and this is what we should do if things go wrong". And it is not for the lack of trying.
People tend to forget that LSD is a product of "big pharma" and they definitely tried to make a safe and effective treatment out of it, so that they could make money out of their patent.
The "war on drugs" certainly didn't help, but research never really stopped, but we are struggling to turn these drugs into treatments that up to modern standards. And by the way, many controlled substances are used in mainstream medicine: heroin, fentanyl, amphetamines (incl. meth), cocaine, ketamine,...
The "war on drugs" certainly didn't help, but research never really stopped.
This is false. The scheduling of psychedelics such as psilocybin and LSD was catastrophic for medical research in the United States (as well as in many other countries) from the early 1970s until the mid-2000's. Even today, research on psychedelics is challenging.
but we are struggling to turn these drugs into treatments that up to modern standards
The elephant in the room is that psychedelics don't really fit into our existing framework around development of psychiatric drugs. For example, you can't really run a RCT, because it's completely obvious to the patient whether they've received the drug or a placebo. The concepts of set and settings, and the importance of "guides" in trials, prove challenging as they introduce highly subjective elements. I would frame this as more of a mismatch than a case of "modern standards being better" - the jury is still out on whether psychedelics will prove effective, and we're still trying to figure out how to "prove" that.
The problem with psychoactive drugs, as I understand it, is not the lack of positive results. There are plenty of well recognized cases.
There is a long way to go toward solid research on this topic. The studies that exist have small sample sizes and usually very limited monitoring periods after the dose, which makes them extremely prone to placebo effects. There’s no real blinding in a study with powerful psychedelics, so long-term comparisons against active comparators (therapy, other antidepressants) are needed.
There is a lot of reporting that would make the studies seem like slam-dunk, case closed results, but every study I’ve read so far has felt very weak compared to traditional antidepressant studies. That’s expected for early stage research, but it’s going to take a lot more to quantify the treatment effects.
The problem is the the unpredictability, because there are plenty of catastrophic results too, and we don't really know why.
The studies go to great lengths to have controlled circumstances like therapists monitoring and guiding the situation for hours, including integration sessions afterward in a lot of the studies.
This helps control the situation for those studies, but it’s hard to translate that to real world practices. If the current proliferation of poorly-run ketamine clinics by cash grabbing providers is a clue, it would be really hard to ensure the level of trained therapist oversight that happens in these studies if this every becomes mainstream.
There’s also the big problem of occasional majorly negative outcomes, as you noted. There are a lot of reports around the internet of even seasoned psychonauts who eventually had a trip that left them depressed or dissociated for months. For the longest time these anecdotes were dismissed as having triggered an underlying mental health disorder as a way to avoid blaming the drug. The advice was always that people with mental health problems shouldn’t take the drugs. Well now that we’re talking about using these as antidepressants (maybe) then it would be exclusively people with severe mental health conditions taking them.
I don’t think it would take very many severely negative public cases to shut it down or at least severely restrict it.
We have pretty strong indications of when and why things go wrong. Openness vs rigid thinking are an axis that are very strong correlative factors. A lot more nuance but there is a lot we do know about risk factors so it isn’t a complete question mark.
The way I think of them is as a mulligan in a trading card game like Magic.
Sometimes you have a hand you can't keep, and it's better to draw a new hand with one fewer card. Don't want to do that too many times, or you will almost certainly have a losing hand.
but we are struggling to turn these drugs into treatments that up to modern standards.
We are struggling to pay for the research that would result in these being effective treatments (not subscription medicines) that would start out as generic drugs.
ketamine
Great example, SPRAVATO, is a brand name patent protected version of this drug (enantiomer) that as a dose cost over 500 bucks.
Meanwhile my at home treatment used Braun 250mg lozenges, which probably cost ~ $4 a pop (wholesale) and for many 2-3 are enough for a treatment session.
It's not like it's a novel drug -- the gatekeeping is ridiculous. Fuck the DEA.
i don't dispute that the "War on Drugs" was (is?) pretty much just a glorified jobs program for law enforcement but nevertheless some drugs are very bad. ironically enough alcohol, despite being the most readily available drug after caffeine, is probably the worst drug of all in terms of societal destruction.
is probably the worst drug of all in terms of societal destruction.
We are yet to observe a society where the overwhelming majority of the population regularly uses fentanyl, crack cocaine or meth-amphetamine. I bet that if we try comparing apples to oranges alcohol would end up being relatively harmless.
If Crack was legal today would you light up a pipe ?
Maybe right after filing your taxes ?
The most dangerous part of any illegal substance is the illegal economy existing to support it. Drug dealers generally can’t sue each other so they resolve disputes via other means.
Law Enforcement has the right to suspend all your so called rights because someone you may or may not know might have an unauthorized substance.
Set the legal drug age to whatever the enlistment age is. I’d argue 21 for both.
If Crack was legal today would you light up a pipe ?
I wouldn’t but I don’t drink either, while many ppl drink themselves to incapacitation.
The difference between crack and a bottle o’ Jack though is that consequence of a crack-filled weekend isn’t just a hangover.
Maybe a society with all drugs legal would eventually figure out tolerable dosages for heavy recreational crack use (I really did write this ha), but do you want to live through the couple of decades of that discovery phase?
I wouldn't celebrate the end of the war on drugs just yet. Even if psychedelic medicines are approved, bifurcated scheduling means that rich white people using psychedelics in clinics would be respectable medical users, but the same exact molecule used on the street by poor brown people would still be schedule 1 and used to justify continued persecution. Tails they win, heads we lose.
Context does matter though? There are plenty of substances which are legal for certified professionals to use in controlled settings that would be illegal for untrained amateurs to use for recreational purposes. Plutonium, for example.
Comments
I'm really happy to hear things like this. The potential benefits (and drawbacks, of course) been evident to lots of us psychonauts for a long time, and finally the sentiment seems to have turned enough so some money can actually get into the research to see if these things can help us today via treatments. A real joy to see after so many decades of the failed war on drugs that influenced policies across the globe.
The problem with psychoactive drugs, as I understand it, is not the lack of positive results. There are plenty of well recognized cases.
The problem is the the unpredictability, because there are plenty of catastrophic results too, and we don't really know why. We can't tell "in your case you should take this dose, the risks are quantified and acceptable, and this is what we should do if things go wrong". And it is not for the lack of trying.
People tend to forget that LSD is a product of "big pharma" and they definitely tried to make a safe and effective treatment out of it, so that they could make money out of their patent.
The "war on drugs" certainly didn't help, but research never really stopped, but we are struggling to turn these drugs into treatments that up to modern standards. And by the way, many controlled substances are used in mainstream medicine: heroin, fentanyl, amphetamines (incl. meth), cocaine, ketamine,...
This is false. The scheduling of psychedelics such as psilocybin and LSD was catastrophic for medical research in the United States (as well as in many other countries) from the early 1970s until the mid-2000's. Even today, research on psychedelics is challenging.
The elephant in the room is that psychedelics don't really fit into our existing framework around development of psychiatric drugs. For example, you can't really run a RCT, because it's completely obvious to the patient whether they've received the drug or a placebo. The concepts of set and settings, and the importance of "guides" in trials, prove challenging as they introduce highly subjective elements. I would frame this as more of a mismatch than a case of "modern standards being better" - the jury is still out on whether psychedelics will prove effective, and we're still trying to figure out how to "prove" that.
That's really wrong though: it's really hard to not feel effects of fentanyl, opioids, ketamine either.
But we only use those as sedative. Or how ?
Except ketamine therapies are being done right now with low doses where the effects are lighter than psychedelics
There is a long way to go toward solid research on this topic. The studies that exist have small sample sizes and usually very limited monitoring periods after the dose, which makes them extremely prone to placebo effects. There’s no real blinding in a study with powerful psychedelics, so long-term comparisons against active comparators (therapy, other antidepressants) are needed.
There is a lot of reporting that would make the studies seem like slam-dunk, case closed results, but every study I’ve read so far has felt very weak compared to traditional antidepressant studies. That’s expected for early stage research, but it’s going to take a lot more to quantify the treatment effects.
The studies go to great lengths to have controlled circumstances like therapists monitoring and guiding the situation for hours, including integration sessions afterward in a lot of the studies.
This helps control the situation for those studies, but it’s hard to translate that to real world practices. If the current proliferation of poorly-run ketamine clinics by cash grabbing providers is a clue, it would be really hard to ensure the level of trained therapist oversight that happens in these studies if this every becomes mainstream.
There’s also the big problem of occasional majorly negative outcomes, as you noted. There are a lot of reports around the internet of even seasoned psychonauts who eventually had a trip that left them depressed or dissociated for months. For the longest time these anecdotes were dismissed as having triggered an underlying mental health disorder as a way to avoid blaming the drug. The advice was always that people with mental health problems shouldn’t take the drugs. Well now that we’re talking about using these as antidepressants (maybe) then it would be exclusively people with severe mental health conditions taking them.
I don’t think it would take very many severely negative public cases to shut it down or at least severely restrict it.
We have pretty strong indications of when and why things go wrong. Openness vs rigid thinking are an axis that are very strong correlative factors. A lot more nuance but there is a lot we do know about risk factors so it isn’t a complete question mark.
The way I think of them is as a mulligan in a trading card game like Magic.
Sometimes you have a hand you can't keep, and it's better to draw a new hand with one fewer card. Don't want to do that too many times, or you will almost certainly have a losing hand.
We are struggling to pay for the research that would result in these being effective treatments (not subscription medicines) that would start out as generic drugs.
Great example, SPRAVATO, is a brand name patent protected version of this drug (enantiomer) that as a dose cost over 500 bucks.
Meanwhile my at home treatment used Braun 250mg lozenges, which probably cost ~ $4 a pop (wholesale) and for many 2-3 are enough for a treatment session.
It's not like it's a novel drug -- the gatekeeping is ridiculous. Fuck the DEA.
The War on Drugs only serves to give law enforcement unlimited extra constitutional powers.
Even the bizarre murder of Central American fishermen is justified by someone somewhere having a dime bag or something.
Who needs trials , or evidence. Drugs are bad.
Government good.
Drugs bad.
i don't dispute that the "War on Drugs" was (is?) pretty much just a glorified jobs program for law enforcement but nevertheless some drugs are very bad. ironically enough alcohol, despite being the most readily available drug after caffeine, is probably the worst drug of all in terms of societal destruction.
We are yet to observe a society where the overwhelming majority of the population regularly uses fentanyl, crack cocaine or meth-amphetamine. I bet that if we try comparing apples to oranges alcohol would end up being relatively harmless.
If Crack was legal today would you light up a pipe ?
Maybe right after filing your taxes ?
The most dangerous part of any illegal substance is the illegal economy existing to support it. Drug dealers generally can’t sue each other so they resolve disputes via other means.
Law Enforcement has the right to suspend all your so called rights because someone you may or may not know might have an unauthorized substance.
Set the legal drug age to whatever the enlistment age is. I’d argue 21 for both.
I wouldn’t but I don’t drink either, while many ppl drink themselves to incapacitation.
The difference between crack and a bottle o’ Jack though is that consequence of a crack-filled weekend isn’t just a hangover.
Maybe a society with all drugs legal would eventually figure out tolerable dosages for heavy recreational crack use (I really did write this ha), but do you want to live through the couple of decades of that discovery phase?
Not fentanyl, but it used to be normal to get methamphetamine as a cough treatment from any pharmacy, and it worked out okay.
Heroine and cocaine too, coke was full of... coke at the beginning
Pretty sure we have a a couple examples of what happens when a huge swath of the people in charge are using prescription amphetamines.
Berlin in 1939 and Silicon Valley jn 2026 come to mind.
i can think of a way to find out :)
we'll have to take it in stages https://en.wikipedia.org/wiki/Clinical_trial
I wouldn't celebrate the end of the war on drugs just yet. Even if psychedelic medicines are approved, bifurcated scheduling means that rich white people using psychedelics in clinics would be respectable medical users, but the same exact molecule used on the street by poor brown people would still be schedule 1 and used to justify continued persecution. Tails they win, heads we lose.
Context does matter though? There are plenty of substances which are legal for certified professionals to use in controlled settings that would be illegal for untrained amateurs to use for recreational purposes. Plutonium, for example.