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Saturday, September 24, 2022

One Man’s Psychedelic Journey to Confront His Cancer

Can psychedelics help people? Growing evidence says yes, especially for PTSD, addiction, and depression — with strict medical supervision as part of psychotherapy. These are not treatments you can give yourself. More research is needed to determine who will benefit most from these treatments. Initially, doctors will likely try other treatments first before they try one of the new psychedelic-assisted psychotherapies.

Are psychedelics legal? No. The FDA hasn’t approved psilocybin or MDMA for medical uses outside of clinical trials. They are Schedule I illegal substances under the federal Controlled Substances Act. Simple possession of them is a violation of federal law as well as laws in many states.

How much would these treatments cost? The cost could run into the hundreds or thousands of dollars, according to scientists involved in the research. MAPS, a nonprofit research organization that is working to bring MDMA-assisted psychotherapy to market, estimates their treatment cost at $14,000 per case for PTSD, no matter the seriousness. But estimates for some other treatments are lower. That’s compared to an annual cost for conventional PTSD treatments that ranges between $5,000 and $24,000, depending on the seriousness of the case. MAPS estimates that insurers would almost certainly save money on most cases 3 years into treatment.

Those costs might come down in protocols like the latest cancer and depression research, which uses group therapy instead of one-on-one therapy before and after the dosing sessions.

But it’s not yet clear if insurance would cover these treatments. Then again, other treatments for mental health conditions have their own costs and insurance issues. Ketamine, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and even a typical round of talk therapy can cost thousands of dollars. And insurance coverage can be uncertain even with these approved treatments.

Who would have access to these treatments? “It may be that the people most in need of these treatments are those least likely to have access, especially at first,” says Steven Huang, a psychedelic diversity equity and inclusion consultant who works with MAPS and other companies involved in psychedelic research.

The complexity of mental health issues in underserved communities like people of color, LGBT, and the financially disadvantaged are the very things that could bar some members from the current round of clinical trials. Careful screening, Huang says, has led to a homogenous group that is overwhelmingly upper middle class, middle-aged, and white.

To include a wider variety of people going forward, scientists and study sponsors will have to look for better recruitment and screening strategies, he says. Not only will this serve a more diverse population, says Huang, it will also provide a more varied, and so more accurate, set of data to help shape psychedelic treatments.

Another problem is cost. A likely cost of several thousand dollars could bar many underserved communities that may lack financial resources. That’s why, says Huang, in the absence of widespread insurance provider coverage, pharmaceutical companies and mental health providers have an obligation to make sure that successful psychedelic-assisted therapies, once approved, are made available to underserved communities and those most in need.

What is microdosing and does it work? It’s when you take regular tiny doses (about 1/10th of a standard dose) to improve mood or creativity. Though some people swear by it, the evidence is so far lacking. The results reported by researchers come from full dosing in carefully controlled settings with guidance from trained professionals.

Are psychedelics the “new medicinal marijuana”? Not really. Marijuana currently treats pain and nausea in limited cases. Psychedelics, if approved by the FDA, would be part of treatment for serious mental health issues and require extensive supervision and therapeutic support.

What are the risks and side effects? The physical risks are few as long as you take them in the right dose and in a safe, medically controlled setting. But they can be unsafe for people with serious heart issues. They tend to raise heart rate and blood pressure though usually not much more than vigorous exercise or sexual activity.

Other possible side effects commonly reported in trials on psilocybin and MDMA include mild to moderate headache, nausea, fatigue, loss of appetite, and insomnia. But these don’t typically last much longer than the effects of the drugs themselves.

The psychological risks are low as well, but they are more complex. Some reports suggest that “classic psychedelics” like psilocybin (and to a lesser extent MDMA) could trigger psychosis and even schizophrenia in certain people. So trials try to screen out anyone who’s ever had a psychotic episode or schizophrenia in their family.

Some clinical studies on psilocybin also try to screen for people who’ve had bipolar disorder and even some personality disorders, though these are harder to find during screening.

Further studies may uncover other, more serious risks and side effects and home in on those who are most likely to get them.

How do I find a clinical trial? Go to ClinicalTrials.gov to find out more about drug-assisted psychotherapy trials for MDMA, psilocybin, LSD, DMT, and other psychedelic medications.

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