Psilocybin: Considering Therapeutic Potential for Decriminalization
The following was written for an general, scholarly audience with limited knowledge of psychedelics. It is intended to briefly introduce psilocybin as a therapeutic psychedelic and describe the current sociocultural and health context with regard to its potential decriminalization. Further investigation of interests spurred by this reading is highly recommended.
Inspiring an entire subculture of art and vilified in the War on Drugs, psychedelics have remained an active realm of controversial intrigue and may resurface as a topic of mainstream discussion in times to come. The term “psychedelic” refers to the substance itself, the more commonly known including psilocybin, MDMA, LSD, or DMT. It can also describe the mental state attributed to psychedelic use, characterized by altered cognition and sensory perception, perhaps accompanied with euphoria, extreme despair, or hallucination. Such altered states of consciousness may appear seemingly undesirable and even dangerous, however, proponents of the benefits of psychedelics argue otherwise. Hearkening traditional, shamanistic ritual, research of psychedelic usage uncovers their reimagined therapeutic potential, particularly in mental health, serving as a “spirit medicine” to human consciousness. Examining psilocybin as a representative example, recent findings build upon indigenous knowledge, testify to the valuable use of psychedelics in medicine, and incite considerations for decriminalization.
One of the earliest introduced to American culture, psilocybin is the psychoactive molecule derived from specific strains of mushrooms, commonly known as “magic mushrooms” or “shrooms,” creating the controversial effects characteristic of psychedelics. Studies show it has extremely low toxicity, a lethal dose far exceeding the amount producing profound alterations in consciousness.(1) When orally administered, the effect of psilocybin can be felt within 10-60 minutes, peaks by two hours and subsides by eight hours, though numbers can vary with dosage. Physiologically measurable effects include increased pupillary diameter, elevated blood pressure, and increased heart rate with slight activation of the sympathetic system. Effects of the drug “high” include altered time and space, dreaminess, depersonalization, extreme shifts in mood, altered ability to concentrate, and unusual body sensations and thoughts. Additionally, cultural beliefs, current life challenges, underlying mental state, and expectations influence the felt experience. A chief adverse effect is psychological distress in the form of extreme anxiety or panic.(2) Such variability in subjective effects and adverse effects complicates the understanding of psilocybin and its impact on human psychology.
To assess the effects of psilocybin, its use must be contextualized along with user mental state and the immediate environment. Known as “set” and “setting,”(3) these factors were controlled in a double-blind study of psilocybin with a placebo and follow-up session at Johns Hopkins University. All participants’ sets were screened to be medically and psychologically healthy, and the sessions were conducted in a living room-like environment. 24 volunteers rated the experience at the 14-month follow-up as among the top five spiritual experiences of their lives, their comments reflecting a shared experience characterized by an “expanded consciousness,” “unity,” “loss,” and “transcendence.”(4) Positive, long-lasting outcomes following psilocybin administration in a supportive environment suggest that identifying and structuring the malleable variables of set and setting can distinguish a psychedelic experience to be deeply spiritual in meaning, possibly conducive to medical applications, a strong counter-example to the presumption of psychoactive drugs as catalysts of psychological distress. Indeed, numerous other studies find positive correlations between controlled psilocybin administration in psychotherapy and relief from mental afflictions including obsessive compulsive disorder, cancer anxiety, alcohol dependence, and tobacco cigarette addiction.(5) As mental health continues to demonstrate an urgent need for a wider range of treatment, the availability of a psychedelic-induced therapy provides a potentially effective option of care for these sensitive and difficult-to-treat disorders.
Outside the purviews of therapy, recreational use of psilocybin in uncontrolled settings poses a challenge to the mitigation of adverse anxiety or panic response. Although these reactions can resolve spontaneously and in most cases do not require hospitalization,(1) supportive care can make a critical difference for those who suffer from a mental disorder and those who poorly tolerate psychedelic shifts of perception. Recreational users could be seeking healing and divination, as were original contexts of psilocybin use in many cultures of South and Central America,(3,5) using time-tested ceremonial safeguards to minimize adverse effects, but modern contexts generally present a loss of indigenous knowledge and lack of guides whose role of facilitation creates a carefully structured, safe space for exploration of consciousness. Often, recreational users opt to undertake psychedelic experiences at music and art festivals saturated with unfamiliar people and situations. Without prior mental preparation, this setting can significantly alter their experience for the worse, leading to a “bad high.” In response to this problem, the Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit organization that funds many of the psychedelic clinical studies, offers a manual of guidelines on harm reduction principles and strategies.(6) A closer look at this manual, specifically its emphasis on harm reduction, provides a means to address the challenge of drug safety.
MAPS’ Zendo Project Psychedelic Harm Reduction manual supplies a clear, organized, and comprehensive example of how to optimally respond to those experiencing adverse psychedelic effects. Designed for volunteers to aid users at gatherings, it notably imports the idea that difficult psychedelic experiences need not necessarily be defined as “bad highs,” but rather can be approached as opportunities for transformation.(7) Given that cognitive or spiritual exploration is among the intentions of recreational and medicinal use, a perspective that abstains from pathologizing variation and extremes in mental condition can help create a calm environment more apt to help users through the duration of their psychedelic experience. The language of the manual reflects a sense of compassionate care. Suggestions highlight how to listen actively and encourage users to communicate and connect with their experience, a process reminiscent of psychotherapy. Most importantly, the manual embodies a positive outlook on psychedelic exploration without skirting how to identify when additional attention is needed, as is the case when serious mental illness is suspected or when violent behavior becomes a threat to safety. This example, among MAPS’ numerous resources, builds upon decades of research and, without discounting the possible dangers of psychedelic use, promotes a compassionate harm reduction model of care for future developments in psychedelics.
While organizations attempt to ensure continual research and education of psychedelic benefits and risks, legal and cultural barriers prevent greater understanding of the positive functions and potential role of psychedelics in medicine. The Drug Enforcement Agency currently places psilocybin as Schedule I, described as a drug that has no medical use and possessing high abuse liability, despite well-formulated clinical studies and incalculable experiences demonstrating otherwise.(1) This designation not only restricts legal access to the drug, limiting the amount of substances available for research and requiring researchers to obtain special permissions, but generates additional harm as illegal markets persist in distribution of substances without quality control for potency.(3) Users thus suffer from unpredictable toxic effects and the larger public is barred from the potential of greater choice in therapeutic care. If the primary concern is drug safety, decriminalization of psychedelics is a solution that would recognize problems of potential drug abuse as a public health issue rather than one of penal punishment.(8) Money funneled into law enforcement against psychedelic usage better serves the masses when redistributed into research, drug regulation, and health programs for addiction or mental illness - the exact ailments with which psychedelic therapy show promising results.
With successful models to emulate and infrastructural proposals available, the decriminalization of psychedelics is a reality that is within our society’s grasp. As a leading example, Portugal’s decriminalization of heroine in 2001, along with a redirection of government funds to needle-exchange programs, education, and recovery clinics, resulted in decreased rates of problematic drug use and incarceration.(8) Utilizing the body of knowledge already obtained through research, proper management and regulation of psychedelics can yield even greater benefits when considered in conjunction with public health principles. Filling demand, the Health Officers Council of British Columbia proposes a post-prohibition regulatory model that addresses governance and regulation. A Psychoactive Substance Committee would cooperate with cultural groups for cultivation and collection used in specific traditions, oversee production and distribution, and regulate trade. In addition, a College of Psychedelic Supervisors would establish, monitor, and enforce practice standards for the training of qualified supervisors, including indigenous, spiritual, and medicinal practitioners.(3) Guided by research and anthropological regard, these suggestions directly answer the questions of how to control the quality of psychedelic substances to health standards and how to ensure a supportive environment for optimal psychedelic therapeutic effect.
Taking account of the risks and benefits of psychedelics, evidence heavily demonstrates the feasibility of decriminalization to revolutionize treatment of mental illness and the potential of such changes to indicate greater shifts in cultural consciousness. From the time of early exposure of indigenous sacraments to Western culture, individual experiences spurred organizational efforts to disperse knowledge and access to psychedelics, whether in traditional form or derivative of those used in sacred ritual. Our generation may witness legislative reform on psychedelics, beginning at the state level, to enact post-prohibition regulatory measures on psilocybin mirroring that of alcohol and marijuana. Considering clinical evidence and experiential testimony in the magnitude of sanctioned therapeutic use and illegal recreational use, it is difficult to deny the historical and ongoing interest in this unique class of substances. Perhaps the interest in exploration of consciousness and the draw of transcendental unity bespeaks of a need to reconsider the medical paradigm of mental health, embracing the conceptualization of wellness and health as a balance of mind, body, and spirit. While once barely conceivable, evidence-based proposals now lay the groundwork for decriminalization, regulation, and management, rendering the implementation of psychedelics as physiological and spirit medicine within reach.
1. L. Jerome. Investigator’s Brochure. Multidisciplinary Association for Psychedelic Studies. http://www.maps.org/research-archive/psilo/psilo_ib.pdf. Published March-April 2007. Accessed December 2017.
2. Peden NR, Pringle SD. Hallucinogenic Fungi. Lancet. 1982; 1:396-7
3. Haden M, Emerson B, Tupper KW. A Public-Health-Based Vision for the Management and Regulation of Psychedelics. Journal of Psychoactive Drugs. 2016;8(4):243-252
4. Griffiths RR, Richards WA, McCann U, Jesse R. Mystical- type Experiences Occasioned by Psilocybin Mediate the Attribution of Personal Meaning and Spiritual Significance 14 Months Later. Journal of Psychopharmacology. 2008; 22(6):621–632
5. Mithoefer MC, Grob CS, Brewerton TD. Novel Psychopharmacological Therapies for Psychiatric Disorders: Psilocybin and MDMA. https://s3-us-west-1.amazonaws.com/
mapscontent/research-archive/published/Mithoefer_Grob_Brewerton_2016.pdf. Published April 2016. Accessed December 2017.
6. Zelfand E. Psychedelic Science: Spirituality as Medicine. Naturopathic Doctor News & Review. 2017;13(3):1-4
7. The Zendo Project Training Manual. Multidisciplinary Association for Psychedelic Studies. https://www.maps.org/images/pdf/Psychedelic-Harm-Reduction-2015.pdf. Accessed December 2017.
8. Why Decriminalization Is the Harm Reduction Tactic We Need to Treat Society’s Drug Problem. Psychedelic Times. https://psychedelictimes.com/harm-reduction/why-
decriminalization-is-the-harm-reduction-tactic-we-need-to-treat-societys-drug-problem/. Published April 2017. Accessed December 2017.