Army Sgt. Jonathan Lubecky returned from serving in the war in Iraq with debilitating post-traumatic stress disorder. Fourth of July fireworks in his neighborhood triggered terror so profound, he locked himself in a closet, dressed in full body armor.
Gripped by suicidal thoughts and desperate for help, in 2014, Lubecky enrolled in a clinical trial: supervised doses of MDMA, also known as ecstasy or Molly, which produces a range of euphoric feelings. He went through three sessions, in which a medical provider guided him through an MDMA experience. Lubecky’s suicidal thoughts abated for the first time in eight years.
He shares his story in a new Netflix documentary, How to Change Your Mind. It’s based on a book by journalist Michael Pollan which spotlights psychedelics in medical and mental health treatment. Certain plant-derived substances have attracted renewed interest in recent years and shown promise in alleviating symptoms of PTSD, depression, anxiety, addiction and other mental health disorders.
For decades, psychedelics — including psilocybin (“magic mushrooms”), LSD, MDMA, ketamine, mescaline and others — were classified as Schedule I illegal drugs with no accepted medical use. But in 2019, the Food and Drug Administration approved a ketamine-based depression medication; it may soon do the same for other psychedelic treatments. In 2020, a ballot measure in Oregon legalized psilocybin for therapeutic use.
This shift has many people curious about psychedelics and their medical uses. Below, we dive into what to expect from the field of psychedelic therapy over the coming years.
An ancient tradition with new scientific implications
Humans have used consciousness-altering plants for spiritual and medicinal reasons for thousands of years. Some North and Central American indigenous peoples use peyote-derived mescaline in religious ceremonies dating back 8,000 years, while numerous Siberian tribes have ingested the psychedelic mushroom fly agaric for sacred purposes for millennia.
In the early 20th century, Western scientists began researching psychedelics’ effect on the human mind, studying both naturally occurring substances like mescaline and lab-created drugs like LSD (lysergic acid diethylamide). Early studies by psychiatrists showed that such mind-altering drugs had enormous potential for treating disorders such as addiction, depression and anxiety.
But during the social and political upheaval of the 1960s, psychedelics “escaped the lab,” as Pollan puts it. Young people especially experimented with them recreationally, which caused a backlash of public concern about the drugs’ potential dangers. As the “Swinging ‘60s” gave way to the “law and order” 1970s, the US government classified all psychedelics as Schedule I illegal drugs, part of the larger “war on drugs.”
Only recently have clinical trials revisited the promising findings of earlier decades. New studies found that when administered in a clinical setting with psychotherapeutic support, psychedelics can produce rapid and long-lasting improvement for patients with serious depression, anxiety, obsessive-compulsive disorder, PTSD, alcohol addiction and smoking. Psilocybin has also been found to alleviate anxiety and depression in patients with life-threatening cancer.
The University of California, Berkeley, is one of several institutions worldwide that share research, best practices and training tools for use of psychedelics in spiritual and healthcare settings.
“At this moment, psychedelics are expanding into many different aspects of our culture and our healthcare system,” explains Rev. Moana Meadow, a healthcare chaplain and a member of the Psychedelic Facilitation Certificate Program at Berkeley’s Center for the Science of Psychedelics.
The center trains healthcare providers and religious and spiritual care professionals in facilitating psychedelic experiences for spiritual and psychotherapeutic care safely and effectively.
Given the promising results of clinical trials, government agencies like the FDA are considering legalizing more psychedelics for medical purposes.
The current landscape
At the moment, ketamine is the only FDA-approved psychedelic, used off-label to treat depression and suicidal thoughts as a nasal spray called Spravato. But MDMA could be close behind: After encouraging results, clinical trials moved to Phase 3 in 2021, and this summer, the Biden administration released a letter saying it expects the FDA to approve MDMA for PTSD treatment as soon as 2023.
Meanwhile, dozens of clinical trials across the US are studying therapeutic uses for LSD, psilocybin and other psychedelics. In Oregon, the first state to legalize psilocybin for therapeutic use, agencies will roll out treatment services next year. Researchers and regulators nationwide will be watching closely to see how such a framework might work elsewhere.
For now, patients interested in these treatments must enroll in clinical trials, which provide a safe, supervised psychedelic therapy experience. Trial volunteers are carefully screened; they must meet the criteria of the study, which could mean being a certain age, having a certain health diagnosis or a specific life history.
There are also a few health risks that exclude certain populations from psychedelic clinical trials, explains Matthew Johnson, a professor of psychiatry and behavioral science at Johns Hopkins University School of Medicine.
Taking psychedelics can raise blood pressure and heart rate, and in rare cases can induce psychotic symptoms in people with a predisposition for psychotic illnesses like schizophrenia. Therefore, says Johnson, “it is important to exclude folks with severe heart disease and folks who are suffering from psychotic disorders or those who show a predisposition to such disorders.”
Extensive research has found that in clinical settings where participants are carefully screened and supervised by professionals, psychedelic therapy is very safe.
Future of psychedelic therapy
If the FDA approves more psychedelics for use in medical care, more people will be eligible for this kind of treatment. Yet psychedelics aren’t your typical pharmaceutical, which means we probably won’t see doctors simply write a script for an acid trip.
Rather, mental health providers and medical professionals will work with patients to determine whether a specific psychedelic therapy treatment is right for them, and that treatment will be delivered in a supervised setting. It could be a one-time experience or an ongoing treatment; some clinical trials are studying the potential benefits of microdosing (taking very low levels of a drug at regular intervals) psilocybin or LSD for patients with depression.
Oregon’s forthcoming psilocybin service is managed by the Oregon Health Authority, and will be available in licensed facilities, under trained supervision, to adults over age 21. Other states are considering legalizing psilocybin, including California, Colorado and New Jersey. If such measures pass, each state may adopt its own framework for legal use of psychedelics.
Safety protocols for providers and facilitators will also be critical, something that’s already built into clinical trials, says Johnson. “It would be a specialty treatment, not something a clinician would do on the side,” he says. “It requires specialized training on how to conduct this treatment.”
Proper facilitation includes patient screening, preparation, supervision and follow-up care — “not ‘Take two and call me in the morning,’” Johnson adds.
There is still a lot to learn about psychedelic treatment in therapeutic settings, but researchers hope this field can provide real and lasting benefits. After his transformational experience with clinically supervised doses of ecstasy, Sgt. Lubecky became an advocate for treating PTSD in veterans with MDMA. He’s spoken at police conventions and submitted testimony for congressional hearings on drug law reform.
“My story is the same story as millions of veterans,” Lubecky says in the Netflix documentary. “Where my story becomes unique is the fact that I took MDMA three times. It saved my life.”