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5 Jul, 2019 07:56

I’ve never tested psychedelic drugs on myself, I probably should – psychedelics researcher

Hijacked by the 60s summers of love, music and flower power – psychedelics don’t exactly have a great reputation. But is that all about to change? We talked to Robin Carhart-Harris, head of Psychedelic Research at Imperial College London, who says the drugs could prove revolutionary for treating mental illness.

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Sophie Shevardnadze: Dr. Robin Carhart-Harris, head of the Centre for Psychedelic Research at Imperial College London, welcome to the show. It's really great to have you with us.  

Robin Carhart-Harris: Thank you, it's nice to be here.  

SS: So, Robin, we know that in the days of early experiments with cocaine, researchers, like Freud, they were quite happy to test the substances on themselves. Have you tested psychedelics on yourself? I mean, have you arranged some sort of Bicycle Day for yourself? And how would you describe your experience? 

RCH: Yes. Well, I haven't. No. I mean there are places where people can have psychedelic experiences legally. At the moment, Amsterdam is being one. And then there's a long history of plant-based psychedelic use in the Amazon but sadly I've missed out. Maybe I need to do something about that. But no, bicycle Day - that was Albert Hoffman, but I guess he did it before there was any notion of these compounds being substances that should be controlled. 

SS:So, you are testing psilocybin and other psychedelics for treating depression. But we already have drugs that treat depression and that do not entice any hallucinations or hours of tripping; naturally for people hearing that you want to use mushrooms to cure depression sounds like curing depression with vodka, you know what I mean? It just doesn’t sound too serious to me - “i feel bad, so I’ll take some acid and it’ll help”... 

RCH: It's a world away from the sloppiness, and social ills, and alcohol. What it does to families in terms of its addiction - potential, dangerous drug. Drug scientists tend to rank it up among the most dangerous of all drugs. So, when they've done these assessments of relative harms, magic mushrooms, which have a long history of uses, plant based medicines by certain cultures, are right down the bottom, quite reliably. So it would be wrong to in any way associate them with alcohol which is a much more dangerous drug. It should be said that magic mushrooms used out of context, used in the wrong way carry potential harms like any psychoactive substance. But used in the right way, they seem to have quite a profound therapeutic potential and quite a good safety profile as well, and then a really important consideration here is to compare it with what's presently available. And the main options for people suffering with a dangerous disorder, like depression, associated so much with suicide, for example. Is that they take drugs every day? Every day they're popping pills. And the model with psilocybin therapy is rather to have one or two isolated experiences rather than popping drugs every day. 

SS:So, we know that even marijuana, which is considered by many countries light enough of a drug to be legalised, can provoke mental disorders in fragile minds if you use it too much. What are the risks that a strong psychedelic substance like LSD can tilt the balance of the mind towards insanity, not away from it? (I mean, I’ve seen people on festivals with their minds kind of burned with acid…) 

RCH: Burned with us, right. It's difficult to know what people do on these festivals. There's a lot of alcohol being consumed and other drugs as well. And if psychedelics are being used at festivals, typically they're being used out of context. So, when we study psychedelics, we're doing so in a controlled way. And if we're giving them to people with psychological vulnerabilities, then there's some careful screening and a lot of therapeutic support, that’s something very different kind of recklessness or general recreational use of a lot of drugs. The danger is of inducing a worsening of psychological state. Yes, you hear some anecdotes. Really this is more in the space of anecdote than scientific data. The, what we call, meta-analysis of large data pools from controlled research, also population surveys of people who've taken psychedelics tend to associate use of these compounds with better mental health outcomes. That's probably quite a surprise to your viewers because of a lot of the sensationalism and stigma. That's going to go on together with these compounds from the 1960s and cultural happenings, then, for example, tend to think these are drugs that can very easily trigger psychotic disorders, insanity. But while the experience itself may mimic aspects of what we call psychosis or madness, to use a general term, the longer-term effects seem to be in the other direction, so there's interesting, very interesting paradox there, where the experience itself can be challenging but in the longer term. After the drug effects are worn off, people describe a kind of lightening of mood, a clarity of vision, they often report being freer of some of the biases and focus on self and ego after these experiences. So, there is an interesting paradox, but I can't emphasise enough the importance of context when psychedelics are used. And when they are used with an intention for self discovery, self realisation and therapeutic intentions, the outcomes are very different from what you see when people take any drugs in any kind of irresponsible recklessness. 

SS:So, I want to ask you about the South American psychedelics like Ayahuasca . There's so much talk around it lately. And they provoke a near-death experience in users. And I read that researchers like you and actually the users too consider it beneficial. How is it beneficial? I mean dying experience, it makes me really even scared to think about it. 

RCH: Yeah, I guess this is speaking to that paradox again that when you look at near-death experiences themselves, whether they're from illness or injury, people often report a kind of renewed appreciation of life after they've come so close to literal death in the case of actual near-death experiences. And then come back. So, it's suggesting that if you model or mimic this experience, your body isn't dying. In fact these compounds physiologically are very well tolerated, so there isn't any actual literal physical risk of dying. But what's being suggested is that something's going on in people's brains, that's mimicking perhaps what happens in the brain when people are dying. And then there is this curious paradoxical change after the experience, where people report that somehow the experience that they've had is being transformative, and they feel particularly good afterwards. They might report that they’re perspective on themselves and on their loved ones, and their life has changed and they're much more appreciative and grateful for having life, and aren't taking it for granted so much... 

SS: So, Ayahuasca and different cactus-derived substances,DMT-based drugs are considered mental medicine in South American tradition. What do you think about those traditions? Do you think a shaman-led ceremony is just a ritual or can actually have some real healing powers? 

RCH: I think it has to be done in a certain way. And really that's such a key message for people interested in learning about these compounds. I like to describe them as a hybrid therapeutic model. They're not just a drug and neither are they just psychotherapy. Something is between the two where there's this special synergistic component to things, when you put the drug, and what it does to the mind and the brain together with a nurturing supportive inquiring context. It seems to have these interesting therapeutic outcomes. But in emphasising that as well, these experiences - when people are in the throes of an Ayahuasca experience or a magic mushroom experience - they're often very challenging, they're often actually quite frightening. And so again, that speaks to the importance of having a therapeutic context, I would say, with the ritualistic use of ayahuasca because of the old traditions and cultures. There can be a lot of sort of magic and animism tied up with the model. And whether or not that's useful is an interesting question as for scientist. I tend to think that what's going on is perhaps better understood from a naturalistic perspective, understanding the biology and the deep psychology of the experiences, rather than invoking notions of magic. But equally, it's important, I think, perhaps not to be too arrogant from a Western scientific perspective and entirely do away with this cultural aspects of things that might actually be in some ways part of the therapeutic process for some...  

SS: So, when that experience happens in South America with Ayahuasca, a shaman serve as a guide, so to say. He makes sure that a person who goes through the experience is OK. When you conduct an experiment, can you or your staff really control the effects of the substance on their patients? I mean, if the patient starts to drift away somewhere they don’t want to be, can you bring them back to the real world, so to say?  

RCH: Well, the interesting thing is that we don't always necessarily strive to bring them back as such. We have this approach of trusting where the mind is taking them, trusting the natural flow of the experience. There seems to be something very curious about these experiences, that the mind tends to gravitate within these experiences towards psychologically important material, therapeutically important material. And our philosophy, I suppose, is that it's right that they go there, even if it's challenging, even if it's a post-trauma, for example. If we've set things up in the right nurturing supportive way, then we can hold people's hands during these experiences, encourage them to literally look the demons in the eye. And what we see when people do this with some degree of confidence, then they experience a kind of breakthrough. Often experiences of insight, and revelation, and a shift. Shift in their perspective, that they report is being very cathartic or releasing in emotional way and so unburdening.  

SS: So, Robin,  you said that on psilocybin, the brain sort of begins routing the signals differently. In a normal state, this part mostly talks to that regions, and that’s it, but on drugs, almost all regions communicate with pretty much everyone else. That sounds to me like, I don’t know, walking into a room where everyone is shouting at each other. Doesn’t that just mess you up instead of opening new horizons? 

RCH: Well, that's one way to spin it, but another way to look at it is that you could think of a party or a social context where ordinarily you might have systems or networks, where the components that make up those systems only talk to each other, and there's a kind of insular sort of cliquish quality to the conversations. But imagine a more open conversation, where people are exchanging different ideas, and there's more creativity and potential insight occurring. So that's another way of spinning it. But perhaps, if we do away with spin entirely and just think about what the mind in the brain is like, as we develop what we're seeing on the psychedelics and not drugs generally, it's wrong to lump psychedelics in just as drugs, this way is too simplistic. Alcohol is a drug ,caffeine is a drug, but under psychedelics there's more globally interconnected brain state, which is actually quite similar to what you see in a very young brain. And there are good and bad aspects to the quality of mind in a very young person, for example, in an infant. 

SS:So, as far as I understand, the human body develops a tolerance for psilocybin pretty fast. Does that mean that for curing depression you'll have to crank up the dosage all the time? 

RCH: Well, thankfully not. One of the issues with drugs of potential misuse is that if they induce tolerance, there's a kind of seeking, searching quality to the way people take the drugs, that if they're rewarding which most drugs are - alcohol, heroin and such like cocaine - then people, if there's some tolerance, then they start drinking more or taking more heroin to overcome that tolerance. What you see with psychedelics is that they're not naturally rewarding drugs. People under these compounds don't often like it. It could be psychologically confronting, it can be scary. And so typically after a psychedelic experience, even though in the days, and weeks, and months afterwards, they can report a profound positive transformation. They're not so eager to go back there and have that scary experience again. 

SS:Depression often goes hand in hand with drug abuse, and drugs can lead to cross-tolerance, in other words, tolerance across whole families of substances. Have you already tried your treatment on patients with a history of drug abuse? I mean, can there be any trouble on that front?  

RCH: Yes, there's some evidence that psilocybin therapy can be effective in the treatment of alcohol dependence, smoking addiction. There're also some reports of sort of sister compounds to psilocybin being effective in the treatment of cocaine addiction and opiate addiction as well, so these compounds used in the right way, used in a therapeutic way, whether about psychological insight and emotional release seem to actually be anti-addictive rather than addictive themselves, and no evidence of any switching over from a truly addictive drug to psilocybin or another psychedelic.

SS: I read you say that it’s hard for you to get grants for research because grant judges think you’re just a hippie and not a serious scientist. How do you convince them otherwise? 

RCH: Well, I think you have to be dispassionate and objective and lay out a compelling argument. And when done in that way, I do feel confident that some of the stigma, and the spin, and the projection, and the politicisation around these compounds should hopefully fall away, and people can listen and be led by the data. And if it's compelling, then, I just think, there'll be a tipping point where to be in some way. Blocking this kind of research is just going to be counterproductive. And I also think public opinion will change when we're hitting these impasses with such high prevalence rates of mental illness that people will be disillusioned with the current treatments. The drug treatments and psychotherapy is that you can be locked in for years without any real major breakthrough, and they'll want a more human and holistic solution to the problem. So I am quite optimistic that things will change now, and actually they are changing. 

SS: But here's the thing.In the world of psychedelic drug research, I imagine there’s a lot of scientists who are actually hippies, who produce poorly backed research, are not careful with evidence and results.  I mean, you only need to go to the internet and type in “marijuana” and you will find a million websites claiming that it is a cure for everything from cancer to world hunger; how do you tell serious scientists in your field from those who are just on a trip? 

RCH: You know, you go on the Internet and search, and there's no quality control. Within the scientific community, we have a peer reviewed process. I would actually say in this day and age, the scientists who are working with psychedelics are doing so in a much more responsible and mature way than perhaps was done in the 1960s, for example, and major mistakes were made then around a kind of overzealous romanticisation of these compounds, so I would say that the good scientists in this field, which make up the majority, really do carry out their research in quite a methodical and proper way. And thankfully, there's a very self-correcting quality to science where via trial and error you come up with a prediction, you test your prediction and then you go by the results that you see, and so the process continues. And I do think the scientists in this area are really adhering to that, to that classic model. 

SS:Robin, during the Cold War, both the Soviets and the CIA experimented with various drugs in search of the mythical truth serum as well as weapons of psychological war. More recently, it looks like the CIA briefly considered looking into drug-assisted interrogations after the 9/11. It probably sounds like something from a thriller movie, but did special services ever try tapping into your knowledge? Do you know that? 

RCH: Well, if they were effective I wouldn't know it. So, overtly I've never seen that. It's curious that some militaries have looked into these compounds. I suppose it speaks to their power as agents to profoundly alter the mind. But it's such a kind of perversion of the way these compounds should be rightly used, ethically used. Where it's about an openness to building a trusting relationship and about insight, and self-awareness, and self discovery. To think that they were used in a manipulative way is, of course, very sad, and we hope that, as we go on into the future, that approach isn't attempted again. 

SS:OK, now real talk. Amphetamine was widely issued to soldiers during World War II, as far as I know, Vietnam saw marihuana smoked across the board and steroids issued to Special Forces, and I heard drugs are issued to servicemen even now - for instance, Air Force issues Dexedrine to pilots on long missions. If the military is so keen on researching stimulants, why isn’t it also the main customer for R&D in psychedelics?  

RCH: Yeah, I guess drugs can be very different to each other, so stimulants are going to give people energy, they might help in terms of fatigue. But they're addictive, and there's a crash with the energised high that comes with a stimulant. So, there's often these downsides. And I think with psychedelics... They're not so easy to control in a sense, when people are under the influence of a psychedelic, perhaps, it isn't so easy to direct the mind in a manipulative way. And part of the view on their use in a military context was that this is why they may have been dropped as mind control agents in the sense that instead of people putting people into this highly manipulative state, instead there was something going on, that was more about self realisation and such-like. So, I just don't think that’s the right kind of drugs for military purposes necessarily. 

SS:So,micro-dosing of psychedelics is apparently a thing now - a signature practice of Silicon Valley whiz kids, as I heard. At Davos, you said there’s no hard science on it yet, and this could in fact be overhyped, and you keep saying that psychedelics are not party drugs. From your perspective, should things like these remain in the medical domain, or is it ok for the public to just sip diluted drugs like coffee?   

RCH: Well, the micro dosing phenomenon, it is true. We're yet to see any really rigorous studies carried out on it, so going by the principle that you should be led by the evidence... the evidence isn't really there. So, should we listen to the anecdote, we could, in terms of designing studies, to test this. I would say a kind of theoretical sort rational concern I have about microdosing is that it's not controlled. So, the model that I'm talking about in terms of the therapeutic application of psychedelics is very controlled. The clinician led people wouldn't be given the compound and then invited to go home and take it. They would be taking it under the supervision of mental health professionals who know what they're doing, can prepare the individuals for the experience, guide them through it, and then look after them afterwards as well. With micro dosing that doesn't happen. Typically it's more about taking these very small doses and then going about your usual day. It's difficult to determine at this stage how easy it is to dose with a micro dose, how easy is it for a microdose, a very small dose, to become a too high dose. And if people are meant, according to the idea, go about their everyday activities, they get in their car and go, and actually they're feeling the effects of a reasonable dose of LSD, it doesn't feel like a realistic and safe model for rolling out. So, I can't really see it happening. People might just do it anyway, but that's no reason to advocate it in any way, so it doesn't really have my support at this stage.

SS: Well, Robin, thanks a lot for this interesting chat and good luck with everything.  

RCH: Thank you.