Dazen

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I currently live in Oregon and am curious as to what the impacts of legalizing therapeutic psilocybin use will be. I've educated myself in a basic way on the NYU/Johns Hopkins studies, but know that a lot will likely change based on further research and ironing out production/distribution details. Regardless, I think it presents some interesting questions about the implications of drug legalization and whether hallucinogens can provide valuable therapeutic support without creating undue harm. What do y'all think about the trajectory of drug legalization and therapeutic use?
 

WisNeuro

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The decriminalization aspect will be great. I haven't made up my mind about the medical and mental health uses, as the jury is still out. There is some promising research, but it's pretty far from the empirically supported stage. Unfortunately, these things tend to become a "miracle" cure, like how marijuana can cure everything under the sun, despite fairly limited evidence for most of its proposed uses.
 
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BuckeyeLove

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Hopeful that all of these new approaches get some more empirical backing. Can't tell you how many people in my 5 years licensed who have run the gambit of SSRI's and are effectively done due to the stupid side effects. And I don't blame them.
 
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R. Matey

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The decriminalization aspect will be great. I haven't made up my mind about the medical and mental health uses, as the jury is still out. There is some promising research, but it's pretty far from the empirically supported stage. Unfortunately, these things tend to become a "miracle" cure, like how marijuana can cure everything under the sun, despite fairly limited evidence for most of its proposed uses.

In OR, it's been touted as a cure. Even before this happened, there were clinics in Portland offering psilocybin assisted therapy. They are/were widely popular.
 
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WisNeuro

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In OR, it's been touted as a cure. Even before this happened, there were clinics in Portland offering psilocybin assisted therapy. They are/were widely popular.

Not surprised, it's pretty easy to capitalize on the placebo effect. There may be something to it, but we just don't have any rigorous, convincing data. In the meantime, teh opportunistic will do what they do best.
 
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psych.meout

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Not surprised, it's pretty easy to capitalize on the placebo effect. There may be something to it, but we just don't have any rigorous, convincing data. In the meantime, teh opportunistic will do what they do best.
Well, it's a placebo effect and a way for people to justify doing drugs, just like medicinal marijuana cards in California before it became recreationally legal.
 
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DynamicDidactic

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The question is whether psilocybin will be primarily therapeutic or recreational. Based on the current science, I see little reason to believe that it will be primarily therapeutic. Of course, even tobacco and alcohol have some therapeutic aspects but these are considered to be primarily recreational nowadays and barely therapeutic. Cannabis is touted as therapeutic but my view (though I am willing to be shown differently) is that it is primarily recreational and the therapeutic aspects are overblown in an effort to support its recreational legality.

As far as harm, psilocybin can be extremely dangerous in anything but small doses when it comes to accidental death (e.g., automobile accidents). However, I do not believe there is much concern regarding any other health concerns.

tl;dr probably wont be considered a major therapeutic agent but relatively safe.
 

DynamicDidactic

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I want to highlight that just b/c something is medical does not make it therapeutic and vice versa. I am not sure if the OP is more interested in whether the field of medicine will accept psilocybin as a treatment or whether we are interest in the larger view that psilocybin is therapeutic outside the bounds of medicine.
 
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psych.meout

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The question is whether psilocybin will be primarily therapeutic or recreational. Based on the current science, I see little reason to believe that it will be primarily therapeutic. Of course, even tobacco and alcohol have some therapeutic aspects but these are considered to be primarily recreational nowadays and barely therapeutic. Cannabis is touted as therapeutic but my view (though I am willing to be shown differently) is that it is primarily recreational and the therapeutic aspects are overblown in an effort to support its recreational legality.

As far as harm, psilocybin can be extremely dangerous in anything but small doses when it comes to accidental death (e.g., automobile accidents). However, I do not believe there is much concern regarding any other health concerns.

tl;dr probably wont be considered a major therapeutic agent but relatively safe.
And even if people are using psilocybin, cannabis, etc. therapeutically, I wonder if it's necessarily a good or helpful thing. If they're doing it to assist with other interventions (e.g., attenuate anxiety enough to do exposure), then I could see it being helpful, but just using these drugs whenever anxiety arises and not doing anything to actually change just sounds like another avoidance or safety behavior.
 
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foreverbull

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A former client who decided to use it impulsively had such a powerful spiritual experience on it that the client stopped using alcohol/drugs and went straight to AA meetings solidly for several months and it lifted any sense of depression for about the same duration. It was an “aha” moment/experiencefor them, as powerful hallucinogens can do when you think of them being used by shaman for thousands of years for ritualistic healing purposes and for visions.

In my region there is an organization that funds direct research on the therapeutic use of hallucinogens and conducts clinical trials, but as others have said, we need more research. That said, one can figure out quickly whether they got the real or fake mushrooms/pills if they’ve been told you may experience hallucinations but then don’t start to hallucinate, so there’s not really a way to double blind effectively at a full dose. They’re trying to research microdosing as well to prevent the sensory disturbance aspect.

It will be interesting to see this develop as more research is published. My interest comes from my anthropology background and our long history of ritual, religious/healing use of hallucinogens in tribal practice. I wonder about removing that sort of essential piece from other cultures and distilling the chemical composition only rather than the practice. That said, some folks in the psychology community are attempting to create/standardize a practice of therapeutic guidance during a hallucinogen experience, now trying to take on the role of shaman in Western Culture and trying to shape that experience to our own norms.

I’m interested to see how successful or unsuccessful this will be. It’s garnering increasing interest, but may just be a fad.
 
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foreverbull

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And even if people are using psilocybin, cannabis, etc. therapeutically, I wonder if it's necessarily a good or helpful thing. If they're doing it to assist with other interventions (e.g., attenuate anxiety enough to do exposure), then I could see it being helpful, but just using these drugs whenever anxiety arises and not doing anything to actually change just sounds like another avoidance or safety behavior.

That may apply microdosing research, but the idea behind the full dose studies is that a single dosage can alleviate symptoms for months—not regular dosing as needed. I’ll have to go back and look this up further, but If I recall, there had been research (limited, but out there) that supported alleviation of symptoms from just one dose administered under the care of trained clinicians.
 
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BuckeyeLove

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A former client who decided to use it impulsively had such a powerful spiritual experience on it that the client stopped using alcohol/drugs and went straight to AA meetings solidly for several months and it lifted any sense of depression for about the same duration. It was an “aha” moment/experiencefor them, as powerful hallucinogens can do when you think of them being used by shaman for thousands of years for ritualistic healing purposes and for visions.

Had a few people give me similar anecdotes. A legitimate cognitive epiphany is how a colleague of mine described it. Made huge changes in his life after having a controlled set of sessions (controlled meaning he was in a comfortable chair with someone there monitoring).
 
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Dazen

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I want to highlight that just b/c something is medical does not make it therapeutic and vice versa. I am not sure if the OP is more interested in whether the field of medicine will accept psilocybin as a treatment or whether we are interest in the larger view that psilocybin is therapeutic outside the bounds of medicine.
I'm personally more interested in whether is it therapeutic outside the bounds of medicine and, especially given the difficulties presented here around double blind trials with a hallucinogen, what research y'all would like to see as proof of its efficacy.
 
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Not surprised, it's pretty easy to capitalize on the placebo effect. There may be something to it, but we just don't have any rigorous, convincing data. In the meantime, teh opportunistic will do what they do best.

Really, what does the placebo effect even mean when you are talking about such a subjectively intense experience? The experience itself is the remedy, it's not that you could believe that you had one when you hadn't. The means by which the experience is induced is not so relevant, but it seems like it would be pretty difficult to create a psilocybin-level experience nonpharmacologically.
 
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erg923

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Did we forget about parsimony here? I'm confused?

Introducing substances that have not evaluated by the FDA for their therapeutic dosing seems irresponsible, silly, and not particularly needed to treat disorders for which we already have multiple evidence-based treatments treatment options and guidelines.

Beyond this. obviously, not all the problems of living are to be solved with clinical psychiatry and clinical psychology at this time. Does that mean we go all Tim Leary with our patients? No. I would prefer we work more on explanatory models, experimental psychopathology studies, and principles of psychological science and accept that some social influences and circumstances are beyond our reach/control.
 
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And even if people are using psilocybin, cannabis, etc. therapeutically, I wonder if it's necessarily a good or helpful thing. If they're doing it to assist with other interventions (e.g., attenuate anxiety enough to do exposure), then I could see it being helpful, but just using these drugs whenever anxiety arises and not doing anything to actually change just sounds like another avoidance or safety behavior.

Psilocybin is not used prn. It's a single (or a few) prolonged intense experiences that are supervised by a specialized therapist.
 
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Did we forget about parsimony here? I'm confused?

Introducing substances to treatment mental disorder that have not evaluated by the FDA for their therapeutic dosing seems irresponsible, silly, and not particularly needed to treat disorders for which we already have multiple evidence-based treatments treatment options and guidelines.

Beyond this. obviously, not all the problems of living are to be solved with clinical psychiatry and clinical psychology at this time. Does that mean we go all Tim Leary with our patients? No. I would prefer we work more on explanatory models, experimental psychopathology studies, and principles of psychological science and accept that some social influences and circumstances are beyond our reach/control.

The Hopkins trial of psilocybin was for despair associated with terminal illness. We don't have anything for that with anywhere near the efficacy apparent from that trial. Psychotherapy can help somewhat but the effect is nowhere near as rapid or powerful.
 
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WisNeuro

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Really, what does the placebo effect even mean when you are talking about such a subjectively intense experience? The experience itself is the remedy, it's not that you could believe that you had one when you hadn't. The means by which the experience is induced is not so relevant, but it seems like it would be pretty difficult to create a psilocybin-level experience nonpharmacologically.

Indeed, this would be much harder to study than say, a new SSRI-type agent. But, we know that the placebo effect exists whenever a participant feels that they have been given an active substance. This is where ingenuity comes in. For example, you could administer sedatives as an active control, and have both conditions engage in a lengthy VR experience. Obviously not perfect, as it was off the top of my head. But, just because something is difficulty to study, doesn't mean that we should abandon trying.
 
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R. Matey

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Really, what does the placebo effect even mean when you are talking about such a subjectively intense experience? The experience itself is the remedy, it's not that you could believe that you had one when you hadn't. The means by which the experience is induced is not so relevant, but it seems like it would be pretty difficult to create a psilocybin-level experience nonpharmacologically.

True, but I think the placebo effect would be the hope of the treatment working prior to receiving the dose. You could measure this pre and post treatment.
 
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PsyDr

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If hallucinogens fixed everything, we would have known by now.


I'm all for a good time. I've had a lot of self revelations in extreme experiences, but that doesn't mean they were good for me. Or that I liked what I learned.
 
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I currently live in Oregon and am curious as to what the impacts of legalizing therapeutic psilocybin use will be. I've educated myself in a basic way on the NYU/Johns Hopkins studies, but know that a lot will likely change based on further research and ironing out production/distribution details. Regardless, I think it presents some interesting questions about the implications of drug legalization and whether hallucinogens can provide valuable therapeutic support without creating undue harm. What do y'all think about the trajectory of drug legalization and therapeutic use?
Psychedelic assisted therapy services are already offered in Oregon for clients who use those substances on their own and would like to integrate their experiences post-use in therapy. Even though there's been some debate about this, since the therapist is not supplying the substance and can't stop the client from using a substance, it appears that this has been an ethical grey area. Since psilocybin is now legalized, I would assume it might be eventually used in a similar way that ketamine is used in clinics. From what I understand, psychedelic research is on the rise right now, (at least in my circles haha) so I'm interested in seeing what happens.
 

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Really, what does the placebo effect even mean when you are talking about such a subjectively intense experience? The experience itself is the remedy, it's not that you could believe that you had one when you hadn't. The means by which the experience is induced is not so relevant, but it seems like it would be pretty difficult to create a psilocybin-level experience nonpharmacologically.

Every time I go to a talk on psilocybin or MDMA or ketamine assisted therapies, my question is always "why do we think the improvement is due to any specific mechanism of action of the substance? Is it just that you're changing something very salient about the experiential frame and this facilitates engaging with whatever therapy differently? What if we use as a control something that will definitely make you feel like you obviously took something that we don't think is related to the putative MOA, say niacin? Do you expect that to have similar or different results?"

Never gotten a coherent answer from anyone.
 
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WisNeuro

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Not a lot of compelling evidence that hallucinogens lead to psychosis beyond the transient effects of the substance itself. All case studies and papers from the 50s and 60s with major flaws.
 

foreverbull

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Had a few people give me similar anecdotes. A legitimate cognitive epiphany is how a colleague of mine described it. Made huge changes in his life after having a controlled set of sessions (controlled meaning he was in a comfortable chair with someone there monitoring).

It's been awhile since I looked this up, but off the top of my head I thought that the reasoning behind this is the parts of the brain that are active in the right hemisphere during a hallucinogen experience that are not logic-based (some even go as far as to say more creative/spiritual/connected), and of course, sensory processing is affected as well. It reminds me of neuroanatomist Jill Bolte Taylor's (My Stroke of Insight author) experience when she had a stroke and her left hemisphere was shutting down and she felt a "oneness" with everything and at peace--she felt that it was a deeply profound experience to have that part of her right hemisphere more active.
 
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Every time I go to a talk on psilocybin or MDMA or ketamine assisted therapies, my question is always "why do we think the improvement is due to any specific mechanism of action of the substance? Is it just that you're changing something very salient about the experiential frame and this facilitates engaging with whatever therapy differently? What if we use as a control something that will definitely make you feel like you obviously took something that we don't think is related to the putative MOA, say niacin? Do you expect that to have similar or different results?"

Never gotten a coherent answer from anyone.

In 'How to Change Your Mind,' Michael Pollan reported that sensory experiences of rhythmic music and light patterns, without the actual drug, also induced something close to a psychedelic experience for him. I'm not sure how much I buy that, but the environment and expectations ('set and setting') do seem to be a really integral part of the experience, and may determine the difference between a spiritual revelation and a dorm-room experience of the 'Wow man, that was f-ed up!' variety. These things in principle should be separable for the purposes of study.
 
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A former client who decided to use it impulsively had such a powerful spiritual experience on it that the client stopped using alcohol/drugs and went straight to AA meetings solidly for several months and it lifted any sense of depression for about the same duration. It was an “aha” moment/experiencefor them, as powerful hallucinogens can do when you think of them being used by shaman for thousands of years for ritualistic healing purposes and for visions.

In my region there is an organization that funds direct research on the therapeutic use of hallucinogens and conducts clinical trials, but as others have said, we need more research. That said, one can figure out quickly whether they got the real or fake mushrooms/pills if they’ve been told you may experience hallucinations but then don’t start to hallucinate, so there’s not really a way to double blind effectively at a full dose. They’re trying to research microdosing as well to prevent the sensory disturbance aspect.

It will be interesting to see this develop as more research is published. My interest comes from my anthropology background and our long history of ritual, religious/healing use of hallucinogens in tribal practice. I wonder about removing that sort of essential piece from other cultures and distilling the chemical composition only rather than the practice. That said, some folks in the psychology community are attempting to create/standardize a practice of therapeutic guidance during a hallucinogen experience, now trying to take on the role of shaman in Western Culture and trying to shape that experience to our own norms.

I’m interested to see how successful or unsuccessful this will be. It’s garnering increasing interest, but may just be a fad.

MAPS?
 
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Did we forget about parsimony here? I'm confused?

Introducing substances that have not evaluated by the FDA for their therapeutic dosing seems irresponsible, silly, and not particularly needed to treat disorders for which we already have multiple evidence-based treatments treatment options and guidelines.

Beyond this. obviously, not all the problems of living are to be solved with clinical psychiatry and clinical psychology at this time. Does that mean we go all Tim Leary with our patients? No. I would prefer we work more on explanatory models, experimental psychopathology studies, and principles of psychological science and accept that some social influences and circumstances are beyond our reach/control.

I don’t see this as any different that “supplements” for mental illnesses that are already on the market and will likely never need FDA approval for not only dosing, but even for just being marketed for, and the claims that they improve, said illnesses.

There is a subset of patients who will be drawn to this because it is “natural” and/or because there is no “on going drug treatment.” It is literally supposed to be a “quick fix.” (Unless getting into microdosing.)

So placebo or not, I’m at least glad a “therapeutic guide“ will be present for their safety. I’d imagine most of these guides will have experience with the drug themselves, and/or have a similar amount of faith in it as their patients.

I certainly hope so anyways.
 

psych.meout

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I don’t see this as any different that “supplements” for mental illnesses that are already on the market and will likely never need FDA approval for not only dosing, but even for just being marketed for, and the claims that they improve, said illnesses.

There is a subset of patients who will be drawn to this because it is “natural” and/or because there is no “on going drug treatment.” It is literally supposed to be a “quick fix.” (Unless getting into microdosing.)

So placebo or not, I’m at least glad a “therapeutic guide“ will be present for their safety. I’d imagine most of these guides will have experience with the drug themselves, and/or have a similar amount of faith in it as their patients.

I certainly hope so anyways.
It's not that supplements didn't "need" approval. Supplements have skirted regulation for decades because Orrin Hatch and other senators were in the pocket of these big supplement producers.

There's not really a Big Psilocybin with which to contend.
 
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Ollie123

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Full Disclosure: I am close colleagues/friends with multiple people doing this type of work.

My Take: Keep studying it, because what the heck. We know incredibly little about the effects of schedule 1/2 drugs in humans because of the regulatory barriers to doing good experimental work. Is there something there? I'm far from convinced at this stage, but I'm certainly not prepared to rule out the possibility. That said, despite collaborating with these folks on other things there is a reason I haven't done so on these projects as I just haven't found it worth my time. The purported cognitive mechanisms are intriguing and at least in the addiction field do seem to fit with results from some qualitative work, but its all stuff we barely understand at this point.

TLDR - I'm skeptical, but keeping an open mind. We're a very very very long ways off from this being an EBP. That said, giving people 'shrooms before therapy is decidedly less ridiculous than many of the things being done in this field every day. So if the legal barriers are removed it is probably going to start happening whether it works or not.
 

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