October 2020 · Mind Medicine Australia
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On the Need for a Bioethics of Psychedelic Psychotherapy: A Few Preliminary Challenges By Eddie Jacobs

Psychotherapy assisted by psilocybin, a naturally occurring compound in ‘magic mushrooms’, has recently received ‘Breakthrough Therapy’ status from the FDA, in recognition of the substantial benefits witnessed in clinical trials investigating treatment-resistant depression. A number of trials of psilocybin-assisted therapy are also underway for major depressive disorder, one of the most significant causes of disability worldwide (1), and the modality has the potential to support the long-term cessation of tobacco- addiction to which kills some 5,000,000 people per year – more effectively than any other available treatment (2). As such, it seems certain that therapy assisted by psilocybin and other psychedelics will receive significant interest from the biotechnology sector, psychiatry research and public health policy over the coming years.

However, for all its apparent promise, psychedelic-assisted psychotherapy remains extremely under-researched from a bioethical perspective. This is a serious shortcoming, and with licensing around the corner, it is now also an urgent problem. Against the backdrop of regular healthcare, the experience of psychedelic-assisted psychotherapy, its mechanisms of action, and its downstream consequences, are all pretty unusual. So perhaps unsurprisingly, pre-existing bioethical accounts of mental health treatments are challenged by this new treatment along a number of directions.

A full account of potential ethical challenges embedded in psychedelic-assisted psychotherapy, and a clear articulation of the clinical and policy choices that can defuse these challenges, will be a vital component in establishing psychedelic-assisted psychotherapy within the mainstream of healthcare.  The clinical promise of psychedelics is only part of the story – the success of a technology or treatment depends not just on its efficacy, but also on a slew of social facets of the culture it is embedded in. Not only do we want to have our ethical house in order before there is widespread uptake of psychedelic psychotherapy, but getting the ethics right will also facilitate widespread uptake.

Suppose we forge ahead without deep, critical ethical engagement, and we overlook something that we could have fixed, that leaves patients feeling let down, violated, or otherwise not properly considered. Not only would that amount to a failure of a physician’s duty of care, it would cost the psychedelic psychotherapy movement itself: maybe the loss of the public goodwill that has been so hard to build, maybe a series of litigation actions that make treatment providers, insurers, and decision-makers in other jurisdictions considerably less enthusiastic about facilitating psychedelic psychotherapy, ultimately meaning that many other people who could benefit would miss out. By seeking out potential problems now, and thinking about how to manage or accommodate them, we thereby minimise these risks.

A useful prism through which to understand some of these bioethical challenges is the tranche of unusual, non-clinical ‘side-effects’ of psychedelic experiences. Alongside the target clinical effect, psychedelic experiences can increase prosocial disposition, affect attitudes towards death, enhance aesthetic appreciation and improve patients’ sense of personal well-being and life satisfaction (3,4,5,6). Perhaps most interestingly, they can induce mystical experiences of long-lasting spiritual significance (7), and produce robust changes to religious belief (8) and personality (9,10). Such experiences appear to be a feature, rather than a bug, of psychedelic psychotherapy, with the intensity of the mystical experience correlating with the extent of clinical benefit. Of potentially wider significance, they might cause long-term changes to political values and, perhaps, behaviours (3, 11).

The focus on the therapeutic potential of psilocybin-assisted therapy has meant that the significance of these non-clinical outcomes has been underestimated. But their importance could hardly be overstated: even where psilocybin-assisted psychotherapy proves an effective treatment, participants can report this clinical success as one of the least important effects of the experience, when compared to the other changes (6). Given the unique power that this treatment has to influence facets of a patient’s character that cut to the very core of their identity, it is imperative that the breadth of its potential impact is carefully and critically examined. With the knowledge of these changes, clinicians who conduct psychedelic-assisted psychotherapy are knowingly changing people in a fundamental sense, far beyond the bounds that are usually seen within medicine.

The reflexive response to such ‘side-effects’ from some strains of medical ethics would be to square them away by appeal to the dominance of autonomously given, informed consent: so long as a patient is adequately briefed of the possible consequences of a treatment, their decision to continue with a treatment is conclusive. But the intuitive understanding of informed consent faces a number of challenges with psychedelic-assisted psychotherapy. The superficial challenge is that the very nature of the mystical experience induced by psychedelics runs contrary to the mainstream understanding of informed consent. A core characteristic of mystical experiences is that they are ineffable – inexpressible or incomprehensible in linguistic terms. Insofar as patient briefing takes place linguistically, securing informed consent will not be straightforward.The deeper problem with understanding informed consent in the context of psychedelic medicines, is to find a secure standpoint from which to make judgments of autonomy.  Commonplace advice to people considering whether to undertake a medical intervention, is to choose whichever option leads to a better quality of life, all things considered. But judgments about quality of life are necessarily dependent on a system of values, and values themselves can be changed by psychedelic-assisted psychotherapy. If you know your perspective on life may radically change following psilocybin, how do you adjudicate between your current evaluation of prospective quality of life after psilocybin, and your likely post-psilocybin evaluation of quality of life after treatment? (12) This is not a mere philosophical puzzle. How might we counsel a prospective patient considering psilocybin-assisted therapy who has debilitating depression and is a fervently proud, card-carrying materialist atheist. From this patient’s perspective, coming out of treatment believing in God or some sense of Ultimate Reality may be more horrendous to consider than continued clinical suffering. But, were this patient to proceed with treatment and have a religion-inducing ‘God-encounter experience’ (8), they would not have nearly as negative an evaluation of this newfound belief, after the fact.

With the non-clinical changes following psilocybin administration come questions of authenticity, self-conception, and self-development. Psychedelics are far from the first treatment to challenge these notions in psychiatry. The expansion of SSRI prescription in the 1990s led to worries about ‘cosmetic psychopharmacology’ and patients ‘losing themselves’ to Prozac (13,14) . The personality characteristics and outlooks that develop in users of SSRIs do not truly belong to them, it is argued, given their lack of connection to the patient’s overall narrative arc and  environment (14). Prima facie, some drivers of change seem more authentic than others. Changes that come about from slower-acting, experiential factors (a period of missionary work, the raising of a child) seem intuitively more plausibly ‘authentic’ than those that come about by faster acting, exogenous, artificial factors clearly linked to neurological disruption (a railroad spike through the left frontal lobe, a six week course of SSRIs). But psychedelic-assisted psychotherapy refuses categorisation under this schema. Although the changes are detectable rapidly, and come about following the administration of a drug with a dramatic acute and post-acute effect on brain function (15,16), psychedelic experiences are, nonetheless, experiences. Indeed, they are experiences that tend to be ranked among the most meaningful in a patient’s life (3), making them more credible candidates for authentically cohering with, or indeed shaping, the narrative arc of a patient’s life. Further exploration and elaboration of these ideas, as well as being philosophically interesting, can usefully feed into public narratives about the meaning and significance of clinically administered psychedelic experiences: it is a strange medical treatment indeed that returns patients to their loved ones not only freed from their tobacco addiction, but also with a perceptibly different personality, a penchant for spending time in nature and art galleries, and a newfound spirituality (2, 6). A clear articulation of the authenticity of these changes, if they can be understood as a natural and comprehensible expression of continuity, rather than an exogenously-imposed transfiguration, could serve to assuage suspicion or mistrust of psychedelic medicine among patients’ loved ones, and the wider public.

These are just a few of the surprising ethical quandaries that lurk within psychedelic medicine. While some of the challenges may seem theoretical or philosophical, the sharp end of each of them is to be found in the clinic, requiring sincere and critical reflection on the part of the psychedelic research community, and perhaps ultimately incorporated into the soon-to-be-expanding training programmes for therapists.

 

By Eddie Jacobs

 

References

1.     https://www.who.int/news-room/fact-sheets/detail/depression

2.     Johnson, M. W., Garcia-Romeu, A., & Griffiths, R. R. (2017). Long-term follow-up of psilocybin-facilitated smoking cessation. The American journal of drug and alcohol abuse, 43(1), 55-60.

3.     Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., …& Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of psychopharmacology, 30(12), 1181-1197.

4.     Ross, S., Bossis, A., Guss, J., Agin-Liebes, G., Malone, T., Cohen, B., … & Su, Z. (2016). Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. Journal of psychopharmacology, 30(12), 1165-1180.

5.     Garcia-Romeu, A., R Griffiths, R., & W Johnson, M. (2014). Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction. Current drug abuse reviews, 7(3), 157-164.

6.     Noorani, T., Garcia-Romeu, A., Swift, T. C., Griffiths, R. R., & Johnson, M. W. (2018). Psychedelic therapy for smoking cessation: qualitative analysis of participant accounts. Journal of Psychopharmacology, 32(7), 756-769.

7.     Doblin, R. (1991). Pahnke’s “Good Friday experiment”: A long-term follow-up and methodological critique. Journal of Transpersonal Psychology, 23(1), 1-28.

8.     Griffiths, R., Hurwitz, E. S., Davis, A. K., Johnson, M. W., & Jesse, R. (2019). Survey of  subjective” God encounter experiences”: Comparisons among naturally occurring experiences and those occasioned by the classic psychedelics psilocybin, LSD, ayahuasca, or DMT. PloS one, 14(4), e0214377.

9.     MacLean, K., Johnson, M., & Griffiths, R. (2011). Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness. Journal of Psychopharmacology, 25(11), 1453-1461.

10.  Erritzoe, D., Roseman, L., Nour, M. M., MacLean, K., Kaelen, M., Nutt, D. J., & Carhart‐Harris, R.L. (2018). Effects of psilocybin therapy on personality structure. Acta Psychiatrica Scandinavica,138(5), 368-378.

11.  Lyons, T., & Carhart-Harris, R. L. (2018). Increased nature relatedness and decreased authoritarian political views after psilocybin for treatment-resistant depression. Journal of Psychopharmacology, 32(7), 811-819.

12.  Schick, F. (1997). Making choices: A recasting of decision theory. Cambridge University Press.

13.  Kramer, P. D., & Kramer, P. D. (1994). Listening to prozac. London: Fourth Estate.

14.  Elliott, C. (1998). The tyranny of happiness: Ethics and cosmetic psychopharmacology. Enhancing human traits: Ethical and social implications, 177-188.

15.  Carhart-Harris, R. L., Erritzoe, D., Williams, T., Stone, J. M., Reed, L. J., Colasanti, A., … & Hobden, P. (2012). Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. Proceedings of the National Academy of Sciences, 109(6), 2138-2143.

16.  Carhart-Harris, R. L., Roseman, L., Bolstridge, M., Demetriou, L., Pannekoek, J. N., Wall, M. B., … & Leech, R. (2017). Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms. Scientific reports, 7(1), 13187.

 

Common Views and Attitudes Towards Psychedelic Medicines and Therapies by Candice Folkard

 


Psychedelics have a rich history, from use amongst indigenous people, guided by ancient knowledge passed on through centuries of traditional practices, to their discovery by modern science leading into a hampering period of criminalisation and finally through to a resurgence of research into uses in modern psychological treatment. A brief insight into the research, past and present, shines a light on the profound potential of psychedelics. Many studies have perfected the formula for safe therapeutic use, right dose and setting with skilled facilitators. This combination, with few treatment sessions, has provided sufferers of treatment resistant major depressive disorder, depression and anxiety associated with diagnosis of terminal illness, severe posttraumatic stress disorder (PTSD) and substance use disorder, with exceptional enduring therapeutic benefits (Bright & Williams, 2018; Carhart-Harris et al., 2018; Daniel & Haberman, 2017).

The state of mental health is at a tipping point, on the verge of further decline with exacerbation from an imminent economic depression and the increased psychological distress experienced due to the COVID-19 situation. A new approach to mental health treatment is an impending necessity, to help curb future burdens associated with increasing levels of mental distress. Psychedelic research has provided promising results, making psychedelic medicine an obvious candidate for the progression into a new paradigm for treating mental illness. Given the significant benefits of psychedelic medicines, relaying this information to the general public effectively is an important step towards the acceptance and integration of psychedelic-assisted therapies.

This exceptional period of rapid change that we currently find ourselves in has exposed a deep divide in understandings, views and opinions amongst individuals, communities, governments and within institutions. The COVID-19 situation, which is both symbolic and symptomatic of this complex time, has on the one hand produced an enormous amount of conflicting information coming from multiple sources, while on the other hand has not produced a single authoritative position, making it hard for most to differentiate fact from opinion and science from politics. These tensions are not unfamiliar to researchers in the area of psychedelic medicines; however, the scale of the current crisis changes the way we see the problem and directs us to new ways of responding. The COVID-19 situation has shown that when deciphering information, there is an obvious disparity between and within, science, medicine, politics and industry.

Information from highly influential sources leading to impulsive decision-making, has the capacity to produce unforeseen undesirable implications. We have seen an example of this recently with the initial predicted COVID-19 death rate — later found to be highly inaccurate — resulting in the instantaneous introduction of new policies worldwide. With the implementation of these policies, we are now witnessing a rise in mental illness, substance abuse and suicide risk (Wesley Mission & Suicide Prevention Australia, 2020). In hindsight the inadequacies and long-term implications of these policies are becoming visible, highlighted by new and upcoming research (Atkeson et al., 2020; Kaplan et al., 2020; Madhi, et al., 2020; Miles et al., 2020).

The complexity and tensions inherent within the COVID-19 situation present a unique opportunity for reflective research in that it surfaces, in a very explicit way, the challenges associated with the delivery and receipt of information. Learning from the COVID-19 situation, more focus can be placed on the fundamentals of the spread of information within the area of psychedelic medicines and how information flows impact on consensus and associated behaviour and attitudes.

The public perception of psychedelic medicines, relates back to the criminalisation of psychedelics in the 1960’s. The residual effects of this classification, including stigmatisation, rejection and fear, is central to the continuous spread of confusing and incorrect information within the public domain (Belouin & Henningfield, 2018; Bright & Williams, 2018; Sessa, 2016). The spread of this information has both created serious limitations for scientific research, and the uptake of the medicines and therapies themselves (Belouin & Henningfield, 2018; Bright & Williams, 2018; Sessa, 2016).

The way in which information is delivered can either be, a shortcoming for the distribution of correct information, or a catapult for the distribution of incorrect information, leading to a myriad of challenges for policymakers and public health. The dissemination of information in the COVID-19 environment has brought into focus the associated challenges, highlighting how advancements in the use of psychedelic assisted therapy may be curtailed. It is an important consideration when making informed decisions regarding the delivery of information, to examine and understand the sources, intended purposes behind, and the interpretation.

Misinformation can be described as information that originates from an absence or lack of supporting empirical or factual evidence. History tells us that the current scheduling of psychedelics follows on from the criminalisation of LSD in 1966 (Belouin & Henningfield, 2018; Sessa, 2016). LSD was completely banned for any use, including research purposes, on the basis that it posed a danger to the public, despite thousands of studies on the therapeutic use of LSD during the 1950’s and 1960’s deeming LSD, when used in controlled settings, to be “overwhelmingly safe and effective” (Sessa, 2016, p. 8). Based on this, the criminalisation and stringent scheduling of psychedelics is not supported by empirical evidence and based on misinformation.

In understanding the roots and propagation of misinformation, it is important to examine the sources. A study by McCright and Dunlap (2017) discusses the origins and spread of political misinformation and outlines that it is; often based on ideological agendas, deeply ingrained and mutually reinforced by the public, and cohesively promoted through collaborative relationships with industries and media outlets. This study highlights the disregard for accuracy in the delivery of highly influential information and also the difficulties in rectification at this level.

Research suggests that information is often selectively chosen, skewed or sensationalised for entertainment purposes (Klin & Lemish, 2008). With the media driven stigma of a ‘dangerous party drug’, ecstasy is an unregulated drug found to often not contain MDMA at all (Rickwood et al., 2005). MDMA, the psychedelic component in what’s been classified as breakthrough treatment for PTSD (Doblin et al., 2019) is often misleadingly referred to as ecstasy. This demonstrates the potential for incorrect terminology to exacebate misconceptions. However, becoming aware of misleading terminology allows for intervention to expose and correct it, helping to conteract misconceptions.

Aside from understanding and acknowledging the origins of information and misinformation, it is equally important, to recognise and understand how it is received and absorbed. Deciphering whether information is correct or incorrect involves not only the way it is delivered but also how it is interpreted, transferred into knowledge and beliefs, and interacts with prior knowledge and beliefs. Amongst the general population there are many misconceptions associated with psychedelics as a result of misinformation, such as, they are dangerous, toxic and addictive physically, psychologically and/or socially (Belouin & Henningfield, 2018; Byock, 2018). These misconceptions have been refuted by the large amount of research that has taken place since psychedelic medicines were discovered by scientists in the 1890’s (Bright & Williams, 2018; Nichols, 2016; Sessa, 2016), but the obvious dilemma is that such research is not readily available to, or accessed by the general public.

Misconceptions and misinformation are difficult to counteract, as they become imbedded in beliefs and attitudes. The “war on drugs” campaign, led by politics and propagated by mass media has left an unfortunate legacy. The campaign established psychedelics position as an enemy and threat to society. In establishing this position, knowledge was tactfully directed, shifting and cementing the general public opinion of psychedelics. In a study reviewing literature on cognitive biases that influence social perceptions, Marks and Miller (1987) found that values and beliefs held by individuals are often influenced by social groups and the selective exposure to biased samples of information that agrees with and maintains a desired or already held position.

It has been proposed that individuals generally only seek new knowledge when it is necessary or vitally important to do so (Thon & Jucks, 2017), and when it comes to acknowledging new information — whether it is evidence based or not — an individual’s prior knowledge and beliefs are often defended and upheld (Pennycook, 2020). Clearly, prior knowledge and beliefs play a significant role in the adoption of new information, exemplifying the difficulties in shifting firmly held beliefs and gaining trust and acceptance.

The “war on drugs” has been described as, a war on “sovereignty over consciousness” (Hancock, 2015, p. 3). In the current media climate we are witnessing an increase in censorship and a polarisation of information, which similarly to the “war on drugs” can be described as a war on sovereignty over knowledge. Ideally there should be accountability for ingenuousness within sources of information, but it is instead, left to the individual to firstly identify misinformation and secondly rationally and logically question it. Awareness leads to change and begins with acknowledgement and acceptance. Acknowledging and accepting the dilemmas within the delivery and uptake of information, will therefore bring about awareness necessary for change.

Misinformation is somewhat complicated and incorporates many variables from all parties including the sources of information and the intended audience, and many aspects that influence the interpretation and accommodation of information. Misinformation has effectively sustained misconceptions and stigmatisation surrounding psychedelics. It is therefore relevant to investigate and understand in order to move forward and create a model for initiating and establishing positive views and attitudes towards psychedelic medicines and therapies. Further research is needed to explore the barriers surrounding misinformation, to aid successful advocation for psychedelic medicines and promote their place in therapeutic, psychological and clinical practice.

By Candice Folkard

 

References

Atkeson, A., Kopecky, K., & Zha, T. (2020). Four stylized facts about COVID-19. NBER Working Paper №27719. https://doi.org/10.3386/w27719

Belouin, S. J., & Henningfield, J. E. (2018). Psychedelics: Where we are now, why we got here, what we must do. Neuropharmacology, 142, 7–19. http://doi.org/1016/j.neuropharm.2018.02.018

Bright, S., & Williams, M. L. (2018). Should Australian psychology consider enhancing psychotherapeutic interventions with psychedelic drugs? A call for research. Australian Psychologist. https://doi.org/10.1111/ap.12345

Byock, I. (2018). Taking psychedelics seriously. Journal of Palliative Medicine, 21(4), 417–421. https://doi.org/10.1089/jpm.2017.0684

Carhart-Harris, R.L., Bolstridge, M., Day, C.M.J. et al. (2018). Psilocybin with psychological support for treatment-resistant depression: six-month follow-up. Psychopharmacology, 235, 399–408. https://doi.org/10.1007/s00213-017-4771-x

Daniel, J., & Haberman, M. (2017). Clinical potential of psilocybin as a treatment for mental health conditions. Mental Health Clinician, 7(1), 24–28. https://doi.org/10.9740/mhc.2017.01.024

Doblin, R. E., Christiansen, M., Jerome, L., & Burge, B. (2019). The past and future of psychedelic science: an introduction to this issue. Journal of Psychoactive Drugs, 51(2), 93–97. https://doi.org/10.1080/02791072.2019.1606472

Hancock, G. (2015). The devine spark, psychedelics, consciousness and the birth of civilization. London: Hay House UK Ltd.

Kaplan, G., Moll, B., & Violante, G. L. (2020). The great lockdown and the big stimulus: tracing the pandemic possibility frontier for the U.S. NBER Working Paper №27794. 1–53. https://doi.org/10.3386/w27794

Klin, A., & Lemish, D. (2008). Mental disorders stigma in the media: review of studies on production, content, and influence. Journal or Health Communication, 13, 434–449. https://doi.org/10.1080/10810730802198813

Madhi, S. A., Gray, G. E., Ismail, N., Izu, A., Mendelson, M., Cassim, N., Venter, F. (2020). COVID-19 lockdowns in low- and middle-income countries: success against COVID-19 at the price of greater costs. South African Medical Journal, 110(8), 724–726. https://doi.org/10.7196/SAMJ.2020.v110i8.15055

Marks, G., & Miller, N. (1987). Ten years of research on the false-consensus effect: an empirical and theoretical review. Psychological Bulletin, 102(1), 72–90.

McCright, A. M., & Dunlap, R. E. (2017). Combatting misinformation requires recognizing its types and the factors that facilitate its spread and resonance. Journal of Applied Research in Memory and Cognition, 6, 389–396.

Miles, D. K., Stedman, M., & Heald, A. H. (2020). “Stay at home, protect the national health service, save lives”: A cost benefit analysis of the lockdown in the United Kingdom. The International Journal of Clinical Practice, 1–14. https://doi.org/10.1111/ijcp.13674

Nichols, D. E. (2016). Psychedelics. Pharmacological Reviews, 68(2), 264–355. https://doi.org/10.1124/pr.115.011478

Pennycook, G. (2020). Belief bias and its significance for modern social science. Psychological Inquiry: An International Journal for the Advancement of Psychological Theory, 31(1), 57–60. https://doi.org/10.1080/1047840X.2020.1722577

Rickwood, D., Crowley, M., Dyer, K., Magor-Blatch, L., Melrose, J., Mentha, H., & Ryder, D. (2005). Perspectives in psychology: substance use. Melbourne: The Australian Psychological Society Ltd.

Sessa, B. (2016). The history of psychedelics in medicine. In M. V. Heyden, H. Jungaberle, & T. Majić, Handbuch Psychoaktive Substanzen (pp. 1–26). Berlin: Springer, Berlin, Heidelberg. https://doi.org/10.10.1007/978-3-642-55214-4_96-1

Thon, F. M., & Jucks, R. (2017). Believing in expertise: how authors’ credentials and language use influences the credibility of online health information. Health Communication, 32(7), 828–836. http://dx.doi.org/10.1080/10410236:2016.1172296

Wesley Mission & Suicide Prevention Australia. (2020, June). Policy and Advocacy. Suicide Prevention Australia: https://www.suicidepreventionaust.org/policy-advocacy

Psychedelic-Assisted therapies For Criminal Offenders — A New Paradigm For Rehabilitation? By David Heilpern

I have a lifelong interest in decreasing violent crime and imprisonments rates. For 21 years I was a proudly activist judicial officer seeking to reduce both — definitively a barbed-wire fence proposition.

I have a more recent interest in the treatment of mental health issues by the use of psychedelic assisted therapy. At first glance, it may appear that these two interests are disconnected. The purpose of this short blog is to explain that they are intricately linked, and thus my excitement at being on the advisory panel for Mind Medicine Australia.

I have personal experience of vicarious trauma detailed in my Tristan Jepson Memorial Foundation lecture[1], and am happy to disclose that I have been flirting with the idea of psychedelic assisted therapy for myself.

So, let’s play ‘what if’ for a while.

1. What if psychedelic assisted therapy could make a real dent in the numbers of those suffering from substance abuse disorder, PTSD and depression/anxiety?

2. What if a substantial proportion of those who commit crimes and are imprisoned are suffering from those conditions?

3. What if there was broad availability of these treatments for violent offenders?

4. What if there was broad outspoken support from the criminal justice sector?

As to the first ‘what if’, having read the research, I am comfortably satisfied that psychedelic assisted therapy including psilocybin and MDMA has great results in treating conditions such as substance abuse disorder, PTSD and depression/anxiety. The phase three trials will undoubtedly cement psychedelic assisted therapy as a key treatment to these ailments. However, I notice that much of the recent research has been on those perceived to be worthy — those dying of terminal illness, Vietnam veterans, AIDS survivors, anorexia patients and the like. There are some studies of those with substance abuse disorders, but having read that research it is notable that violent offenders are not the target tested group.

Yet, and this answers the second ‘what if’, those suffering abuse disorder, PTSD and depression/anxiety are responsible for much of the violent crime in Australia.

I know it’s academically sound to start with the empirical evidence-based studies, however sometimes anecdotal evidence has more punch. As a children’s court magistrate, I noticed something very quickly — there were no repeat violent offenders who had not witnessed or been the victim of violence in the home. None, zero. Every sentencing report detailed PTSD from living in fear as a child. Every single one. All of these kids I had to lock up had experienced seeing their mum beaten up, or been abused themselves.

And with violent women offenders, it soon became apparent that the vast majority had been victims of sexual abuse and suffered from PTSD or substance abuse disorder as a result. For men, the picture was more complex with a range of diagnoses — until the Royal Commission. Suddenly, it became acceptable for men to admit to the abuse they had suffered and a PTSD diagnosis became more and more common. For most violent male criminals, alcohol abuse disorder was a regular feature.

This anecdotal evidence is, unsurprisingly, supported by the research. For women prisoners, two thirds had a mental health condition, and one third for men. A third of women had a history of self-harm. A quarter of all entrant prisoners were taking medication for a mental health condition[2]. This is a world-wide phenomenon — for example, the prevalence of psychosis in a London prison population was found to be more than 20 times that of the general community, and almost 70% of people in prison had more than one mental health disorder[3].

The figures don’t distinguish between violent and other offenders, and nor do they inform of the type of mental illness. I plan to dig deeper on these issues, however my hypothesis is that the research will conform with my observations –the vast majority of violent offenders have mental health issues that lend themselves to psychedelic treatment. There are two important caveats to this hypothesis worth keeping in mind — firstly, the vast majority of those who have mental health conditions are not violent. Secondly, those with mental health conditions are much more likely to be victims of violent crime.

And to the third ‘what if’ — imagine if there was broad availability of psychedelic assisted treatment of these violent offenders. I’m not suggesting we lace prison water with LSD a la Timothy Leary, however surely psychedelic therapy holds more likelihood of rehabilitation than the rigid discipline of time behind bars and a lifetime of psychiatric medication. I opine that violent offenders ought to be the first for whom this treatment is available — because there is a sure and clear test of effectiveness. They either re-offend or they don’t.

And finally, to the fourth ‘what if”. There certainly are some barriers to getting criminal justice support for psychedelic therapy — there are deeply entrenched views that mimic those of Mr Mackey in South Park — all drugs are bad. Of course, the logical flaws in that approach are obvious but should not be discounted as it is the dominant hegemony. Such views are shared by the majority of police, judges and lawmakers in the country. Medicinal cannabis has faced decades of prohibition until very recent times in this country, and still the barriers are significant. Legitimising psychedelics is a hurdle that may take some time and effort.

The other hurdle is that psychedelic treatment will not of itself impact on the sociological causes of crime for which treatment of individuals is but a small part. Chronic inequality, institutionalised racism, toxic masculinity and a lack of rehabilitation services all contribute to rising crime. There are no magic bullets for these. However, if the focus is on violent crime — particularly domestic and family violence — then criminal justice system support may be easier to garner.

So, if we are serious about decreasing the prison population and reducing violent crime the criminal justice system ought support psychedelic therapy availability. The current law and order ‘solutions’ to violent crime — more police, longer sentences, tougher prisons — demonstrably are not working. It is time to try a more scientific approach.

By David Heilpern

References
[1] https://www.judicialcollege.vic.edu.au/sites/default/files/2019-07/Helipern%20%282017%29%20TJMF%20Lecture%20-%20Lifting%20the%20Judicial%20Veil.pdf

[2] https://www.aihw.gov.au/getmedia/2e92f007-453d-48a1-9c6b-4c9531cf0371/aihw-phe-246.pdf.aspx?inline=true

[3] Bebbington P, Jakobowitz S, McKenzie N, Killaspy H, Iveson R, Duffield G & Kerr M 2017. Assessing needs for psychiatric treatment in prisoners: 1. Prevalence of disorder. Social Psychiatry and Psychiatric Epidemiology 52(2):221–9. doi: 10.1007/s00127–016–1311–7

How Psilocybin-Assisted Therapy Changed My Life by Tania de Jong AM

From Singing to Psilocybin

I don’t drink or smoke. I’ve never taken any drugs till four years ago. Yet today, my life revolves around psychedelic medicines — heavily stigmatized substances still illegal in this country and most others across the world.

How did this happen?

Singing has always been my super wonder drug! Neuroscience shows that singing fires up the right temporal lobe of our brain, releasing endorphins and makes us happier, healthier, smarter and more creative. Our neurotransmitters connect in new and different ways, improving our memory, language and concentration.

When we sing with other people this effect is amplified. What was not understood until recently is that singing in groups triggers the communal release of serotonin and oxytocin, the bonding hormone, and even synchronizes our heartbeats. Group singing can produce satisfying and therapeutic sensations even when the sound produced by the vocal instrument is not of high quality. Everyone singing in a group is lifted up, no matter their singing ability.

That’s why belonging to a choir is a great way to address isolation, boredom, anxiety, PTSD, depression and even dementia.

Twelve years ago I created the charity Creativity Australia and the social inclusion program With One Voice. My hope was to bring people from different backgrounds, generations, faiths and cultures, haves and have-nots together through the experience of singing in choirs. We are changing the world, one voice at a time and alleviating loneliness, depression and social isolation.

My ultimate mission in life is to help people find their voice, unleash creative potential and bring light into our shadows. I’ve witnessed how song can be a powerful tool in achieving this end.

I also believe psychedelics have a monumental role in helping achieve this. In fact, I know they will allow me to scale this mission in a way I’d never dreamed possible.

Over the past two decades, I’ve founded seven companies and three charities. I’m a Member of the Order of Australia, a sought-after global speaker, and an international soprano, performing both as a soloist and as part of a group. I’ve released 12 albums.  Throughout my life I’ve always had a niggling feeling that I’m not experiencing the full picture in spite of all my achievements.

I hope this article provides a deeper understanding of why I co-founded Mind Medicine Australia (MMA).

Taking an illegal substance had never occurred to me until stumbling across Michael Pollan’s article in The New Yorker magazine titled “The Trip Treatment” via a blog I received from Tim Ferriss. Reading it not only made me aware for the first time of the current resurgence in psychedelic research, but also helped me to understand how these ancient plant medicines were assisting people to heal from depression and trauma and come to terms with end-of-life anxiety. Something about this resonated so strongly with me.

From that point on, my interest in trying these hallucinogenic plants for myself began to grow and I realised that many people expose themselves to these altered states on a regular basis. I wondered if I was missing out on perhaps an essential experience of what it means to be human and further exploring my psyche. What could psychedelics teach me about who I am or who I could be? What unknown parts of myself and our cosmos could they grant me access to? What healing might be available for my mind, body and spirit?

So, I recruited the support of Peter, my partner at the time and now husband, and we set out on a quest to have a therapeutic experience with psilocybin mushrooms. Having lost his father to suicide in his early teens, Peter was also interested in dealing with past traumas in a way he’d never thought available to him.

However, being able to do this in a safe and legal setting proved difficult. This was important to us. After first trying, and failing, to get into multiple trials happening globally at the time, we were eventually referred to a private therapist in the Netherlands, where the use of psychoactive truffles is legal. Our search over, we flew overseas, met him, and ingested a large dose of psilohuasca — a combination of psilocin-containing fungi and Syrian Rue, a MAO inhibitor used to enhance and prolong the effects of a trip.

Inner Journeying

Describing what it was like for me to take one of these substances is difficult. My first time was so far removed from anything I’d encountered before.

Heading into this, I was incredibly nervous. Having never lost control before, combined with everything I’d heard about psychedelics and drug use in general, I thought that the medicine was going to obliterate or destroy my brain. That turned out to be as far as possible from reality.

What happened for Peter and me was one of the most meaningful experiences of both our lives. The medicine completely shot us into space. What initially overwhelmed me was this incredible sense that everything is in me and I’m in everything…we are ONE. These realizations were profound for me, but it’s the deeper insights Peter and I gained that have left a lasting impression. What we learned from this one session was so profound and powerful, we didn’t feel compelled to have another for a whole year.

Far more important than the psychedelic encounter itself is the integration of the experience. That takes time.

This work continues to touch multiple areas of my life. For example, being born Jewish as the daughter and granddaughter of Holocaust survivors, the majority of our relatives were murdered. I’ve lived with transgenerational trauma for as long as I can remember. Whether I wanted to or not, I’ve confronted a lot of this during my medicine trips and undergone significant healing as a result.

My creativity has also increased massively. I’m able to access more moments of flow and purity in my singing, public speaking, curation of immersive events and writing. I’ve also noticed real lifts in my energy and consciousness. I feel more intelligent. Overall, it feels as if a number of neural pathways have reconnected for me and a whole lot of new ones have been formed. It’s as if all these missing parts of myself have been found.

Creating a Movement, Making a Real Difference

Fast forward three years, Peter and I now seek out a session every four to six months. We call it our regular reset/reboot experience. It’s a bit like defragging the hard drive! Every single time we work with these medicines, the experience is different. We get new insights, clean up physical and mental baggage and heal a little more.

Not only have we woven psychedelic use into our lives, but the immense value we’ve gained from taking these medicines  is what inspired Peter and me to establish our fifth charity, Mind Medicine Australia, in early 2019. If this medicine has had such positive and healing benefits for us, we thought it could help the millions of people suffering with mental illness.

Mental Health in Australia

Mind Medicine Australia exists to help alleviate the suffering caused by mental illness in Australia through expanding the treatment options available to medical practitioners and their patients.

We seek to reduce Australia’s terrible mental health statistics, which are worsening as a result of the current and ongoing COVID-19 pandemic. Of particular concern are the high levels of mental illness, addiction and suicide amongst the veteran, first responder and other marginalised population groups.

Pre-COVID, 1 in 5 Australians were experiencing a mental illness and existing treatments are failing for the majority of patients. Pre-COVID, 1 in 8 Australians were estimated to be on antidepressants (including 1 in 4 older adults and children as young as five) and their use across Australia has risen by a massive 95% over the past 15 years. Yet our mental health statistics continue to worsen, resulting in one of the highest rates of mental illness in the world.

Numerous mental health experts in Australia recently announced that the COVID-19 crisis could lead to a 25% jump in the suicide rate if unemployment reaches 11%, which is highly likely. It also goes without saying that mental illness in the community is at an all-time high. The incidence of trauma, anxiety, depression and substance abuse are all accelerating as this pandemic and the fall-out from it continues.

These statistics cannot do justice to the heartache, suffering and community damage that mental illness is currently having on our society.

Depression treatment methods haven’t substantially changed for decades. Reversion rates are high following antidepressant medication, and side effects and withdrawal symptoms are significant.

Psychedelic-Assisted Therapies

MDMA and psilocybin-assisted therapies have been found to be low in toxicity. They have not been shown to produce organ damage or neuropsychological side effects that are risks with some psychiatric medications. Furthermore, they are not typically considered drugs of dependence.

Research on the effectiveness of e therapies is being conducted at prestigious universities, including Johns Hopkins, Yale, UCLA, Harvard, Cambridge and Imperial College, London.

The FDA has granted a “breakthrough therapy designation” for psilocybin-assisted therapy for depression and MDMA-assisted therapy for PTSD, a designation that will help speed clinical trials of these two psychedelics. In the United States, MDMA is in Phase 3 trials as a treatment for PTSD.

In addition to the current late-phase FDA trials, there are also trials underway of psychedelic therapies for the treatment of end-of-life depression and anxiety, alcohol and drug addiction, dementia, anorexia and other eating disorders, cluster headaches and chronic pain. A summary of psychedelic medical research can be found here.

Access to these therapies is now legally available in a number of countries via Expanded or Special Access Schemes in USA, Switzerland and Israel. A number of Australian psychiatrists have also recently received approvals through our Special Access Scheme for use of MDMA and psilocybin-assisted therapy for treatment-resistant patients.

Theories of Why Psychedelics May Work

A number of theories have been put forward to account for the possible therapeutic effects of psychedelics. One thought is that classical psychedelics may help with issues like depressive, addictive and obsessive disorders by allowing the mind to “break out” of repetitive and rigid styles of thinking, feeling and behaving. Psychedelics temporarily alter activity and increase connectivity between novel neural networks within the brain, breaking patients out of pathological patterns of thought and habit. This helps to develop a form of “active coping” and creates a fertile ground for change, restoring patient agency.

Psilocybin primarily activates the 5HT2a receptor in the brain. Recent research suggests that this receptor aids adaptivity through enhancing sensitivity to context, learning and unlearning, cognitive flexibility and synaptogenesis (new neuronal connections).

In a therapeutic setting, psychedelics may produce profound personal or existential insights, feelings of empathy and self-compassion, and a sense of connection or unity with other people, things and the world in general. Research shows that these characteristics are correlated to therapeutic outcomes and that patients regard these experiences among the most meaningful of their lives.

Mind Medicine Australia

Our goal at MMA is to ensure that these therapies become an integral part of our mental health system, that they are accessible and affordable to all Australians in need and that they achieve high remission rates leading to a substantial improvement in our mental health statistics.

To achieve this, we need practitioners who are trained to provide psychedelic-assisted therapies in medically controlled environments. Aspiring professionals need to learn the different therapy modalities that will inform their work with “non-ordinary states of consciousness.” They also need to be very capable of “holding space” for a period of hours, which is unlike the normal one to two-hour sessions usually delivered.

Another important area to be well versed in professionally before working with psychedelics is trauma. It’s critical to be experienced in somatic practices, as well as understanding and being comfortable with transference and projection. This level of comfort comes from both training in the subject matter and doing your own inner work. Processing one’s own non-ordinary states of consciousness can help others do the same.

Our Certificate in Psychedelic-Assisted Therapies course is being developed by Renee Harvey (a senior Clinical Psychologist from the UK who was part of the Imperial College Therapist Team for these modalities). This is the first professional development program in the Southern Hemisphere, compares favourably with existing ones in the United States and the United Kingdom, and is being designed in collaboration with the world’s leading programs.

We also hope to provide an opportunity for clinicians to receive their own MDMA-assisted therapy session and participate in transpersonal breathwork to assist in altering consciousness.

We are also working to ensure that therapeutic treatment for patients takes place in medically supervised environments, without losing the essence of the transcendental which underpin their healing potential.

Mind Medicine Australia is in the process of establishing an Asia-Pacific Centre for Emerging Mental Health Therapies. Its main mission is to expand the mental illness treatment paradigm in Australia and boldly position Australia as a global leader in mental health innovation, with partnerships encompassing University, philanthropic, private industry and government sectors.

MMA is also partly-funding the nation’s first psychedelic clinical trial. Currently underway at Melbourne’s St Vincent’s Hospital, the study is looking at the potential of psilocybin to treat end-of-life depression and anxiety.

Other key aspects of our strategy involve educational events, webinars and awareness building, funding for relevant and novel clinical trials, the development of an appropriate legal and ethical structure for discussion with regulators, rescheduling applications for psilocybin and MDMA, the development of reliable sources of pharmaceutical grade psilocybin and MDMA in Australia and maintenance and expansion of international information flows and rollout strategies so that all Australians who need these therapies can access them through the medical system. We are also planning a major international summit for 2021.

We’ve recruited a Board and Advisory Panel that includes leaders in researching these therapies, such as Roland Griffiths from Johns Hopkins University, Professor David Nutt, Head of Neuropsychopharmacology and Robin Carhart-Harris from Imperial College London, and Rick Doblin from MAPS.

Mental illness keeps a person separate and alone. Rigid thought structures, feelings of despair and the belief that things aren’t going to work out for them… that feeling of not being loved and whole. These are the kinds of struggles people everywhere are dealing with. I know, because every day we get emails and letters and calls from those who’ve tried every other type of medication and therapy and are at the end of the road. It breaks my heart how much suffering and loneliness there is.

At Mind Medicine Australia, we’ll continue to work to establish safe and effective psychedelic-assisted treatments, with the ultimate hope we can alleviate the unnecessary suffering that millions of Australians face every day.

Please watch this 2-minute animation to find out why psychedelic-assisted psychotherapy needs to be available to those who are suffering.

The views and opinions expressed in this article are wholly Tania de Jong AM’s and do not represent those of the charities and businesses which they are affiliated with.

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