Review of Psychedelic Medicine by Richard Miller

/ Uncategorized / By

This review can also be found on Blossom Analysis’ website.

Psychedelic Medicine: The Healing Powers of LSD, MDMA, Psilocybin, and Ayahuasca by Richard Miller describes the history of research into psychedelics. He does this by interviewing many of the luminaries in the field and with a focus on LSD, MDMA, ayahuasca, and psilocybin. The book provides a good, albeit high-level, overview of where the research stands up to 2017.

Overall, this book would be a good introduction to psychedelics as medicine for people. Those who are familiar with the people Miller talks with in the book likely will already know the main talking points that are brought up. It is fairly basic and gives a broad overview of the four drugs that are discussed: LSD, MDMA, psilocybin, and ayahuasca.

Introduction

Psychedelic Medicine takes the form of a series of discussions between the author, Dr. Richard Louis Miller, and various other scientists and notable figures in the world of psychedelic research.

In the introduction, Miller mentions that a Danish couple he talked to suggested that something bad was happening in the United States. He connects it to the long-term suppression of scientific information.

A specific example Miller points to is how in 1930 Harry J. Anslinger was appointed to be commissioner of the Federal Bureau of Narcotics. His ideology and racism got in the way of science. He prosecuted people of colour for their drug usage and used his national influence to make certain substances illegal, including alcohol. Nixon and Reagan followed in his footsteps declaring war on drugs, including psychedelics.

Part One – LSD

The Biochemistry of Changes in Consciousness with David Nichols

  • LSD was a precursor for the discovery of serotonin.
  • Research is driving by mechanisms of funding and Nichols work was funded for the National Institute on Drug Abuse (NIDA) for much of his career. Higher scheduled drugs require more money to pay for the registration fees and jump through the logistical hoops required to study them.
  • All of the psychedelics interact or activate the serotonin 5-HT2A receptors, one of the ancient and foundational neurotransmitters in the brain.
  • Serotonin isn’t sending different messages each having different effects, it is modulating or governing other neurotransmitters.

LSD Brain-Imaging Studies with Amanda Feilding

  • Feilding set up the Beckley Foundation in 1998 which led to  the Beckley-Imperial Research Programme with David Nutt in 2009.
  • After doing LSD in 1965 Feilding met Bart Huges who had a hypothesis about how LSD changed the cerebral circulation and increased the volume of blood in the brain capillaries. This could allow you to control the LSD experience.
  • A secondary hypothesis was that the “ego” was a reflex mechanism that is controlled through conditioning. It directs the blood where it is most needed, but because we are upright normally, the brain has less blood in it. So, when LSD increases the blood supply to the brain, connectivity within the brain is increased (something that Feilding is seeing in their brain-imaging studies).
  • Feilding suggests that the reason the United Kingdom banned these substances was to please America.
  • Despite the UN allowing research it is so expensive and damaging to careers that most scientists don’t want to touch the topic.
  • LSD removes one’s filters and rigid tracks of behaviors to allow someone to become more open.
  • A core feature of trauma is a repressed area where blood circulation is not allowed to freely circulate. These substances can help assist blood flow to these areas.

Observations from 4000 LSD Sessions with Stanislav Grof

  • Consciousness is a fundamental aspect of our experience, one that the spiritual philosophies of the East focus on exploring and the West lacks.
  • Grof began doing psycholytic therapy, medium doses, to do “onion peeling of the unconscious”.
  • LSD is like a knife. It can be used for amazing medical interventions, prepare food, and commit heinous crimes.
  • LSD promotes an understanding of our ecological interconnectedness. Nothing should be more important than protecting life and creating optimal conditions for survival on the planet–something we are not doing. Transformational changes, such as those experienced with LSD can help open us to our fundamental interconnectedness.

The Condensed Psychedelic Explorer’s Guide with James Fadiman

  • There are six major variables that can make a healthy, safe, and meaningful psychedelic session.
    • The mental set – what your mindset is before the session
    • The physical setting – preferably somewhere safe with people you trust.
    • The sitter – a guide who can help you if you get into frightening places is essential
    • The substance and dosage – what type of drug you take heavily influences the experience you will have.
    • The session itself – how the actual session runs and what you do during that time
    • What kind of a life group you come back into – Do you come back to people who support your expanded awareness? Or do these people think you have just done something evil or dangerous?

Part 2 – MDMA: Heart Medicine

Drawing a Map from “X” to Rx with Rick Doblin

  • MDMA is a semisynthetic drug that opens up your emotional capabilities. It reduces your fear and anxiety and promotes self-acceptance and peace.
  • Doblin experienced LSD just as these things were being banned.
  • Just prior to the DEA banning MDMA in 1984 Doblin had helped conduct a safety study in 32 people that they kept quiet.
  • They took the results to the DEA and argued that it shouldn’t be banned for therapeutic use. They won the lawsuit but the administrator of the DEA rejected it.
  • In 1986 he started MAPS as a nonprofit pharmaceutical company to develop psychedelics into FDA-approved prescription medications.
  • Doblin mentions the tremendous need for end-of-life-care, treatments for PTSD, and addiction. MDMA provides a tool that can treat all three of those.

Pioneering Government-Approved Research with Charles Grob

  • Grob conducted the first government-approved psychological research study of MDMA.
  • They found few major side effects and the worst reaction in the study was by someone who had been given a placebo.
  • Grob cites a lack of government funding and a suppression of doctors’ personal experiences as factors that are inhibiting the study of MDMA.

Demonstrating MDMA’s Safety and Efficacy in Treating End-of-Life Anxiety with Phil Wolfson

  • Wolfson was (at the time of the interview) recently given FDA approval to use MDMA in his psychotherapy practice.
  • MDMA got a bad reputation because of a fellow, George Ricaurte, in 1984 who published a study saying that MDMA causes neurotoxicity. It turned out that his group was “mistakenly” (Wolfson uses quotes) using methamphetamine in their studies. After this was revealed, the damage had already been done.
  • Wolfson recommends DanceSafe, a place that does drug analyses to make sure people know what they are taking (DanceSafe is still an incredible resource!)

MDMA for Post-traumatic Stress Disorder with Michael and Annie Mithoefer

  • Michael and Annie seem to agree with other interviewees that the ban on these substances was political and not scientific and that research on these substances has been supressed.
  • MDMA is different than a psychedelic. Some call it an entactogen or an empathogen.
  • It is a molecule that looks a bit like methamphetamine and something like mescaline. It largely boils down to a lot of monoamine release (serotonin, dopamine, and norepinephrine in addition to hormones like prolactin and oxytocin).
  • From their studies with PTSD they have had very encouraging results. 83% had a strong clinical response compared to 25% in the placebo group.
  • Annie mentions that the patients report a changed relationship with their emotions in a beneficial manner.

Part 3 – Psilocybin

Spiritual Psychopharmacology with Roland Griffiths and Katherine MacLean

  • The first study done on psilocybin in recent times, conducted by Griffiths, began in 1999 and was published in 2006. They compared psilocybin with an active control (Ritalin).
  • There was a lot of scrutiny and reluctance to approve the trial (it was even sent out for external review by the IRB, which was unprecedented).
  • Griffiths has been scientifically observing the mystical experience. The majority of participants (over 70%) endorse the main feature of the experience being a sense of interconnectedness of everything. All is one.
  • These experiences promote a lasting positive change even at a year out.
  • MacLean has been measuring increases in openness in those who use psilocybin. Openness consists of both imagination, intellectual curiosity, aesthetics, and feelings.
  • Fear can lead to transcendence. It can function as a doorway to open up the experience to something more beautiful and transcendent.
  • MacLean offers the analogy that psychedelic medicines are like going in for psychological surgery.

Seeking Solace for the Terminally Ill with Charles Grob

  • Grob ran a double-blind placebo controlled study using psilocybin to treat those with advanced-stage cancer. There were no adverse effects in the study.
  • They used a synthetic compound to minimize variability and because the FDA are more comfortable dealing with synthetic compounds rather than whole plant products.

Psilocybin and Depression with Amanda Feilding

  • As of 2016 they had recently done a study using psilocybin for chronic depression. 67% of participants who had been depressed for on average 18 years, and had been unresponsive to other treatment, showed significant improvements in their depression.
  • She worked with Griffiths on a study of psilocybin for nicotine addiction that had an 80% success rate.
  • Psilocybin offers a medicine that people might only have to take 2 or 4 times a year rather than the standard antidepressants that people have to take 365 times a year.

Part 4 – Ayahuasca

Hard Science in the Amazon with Charles Grob

  • Ayahuasca is a decoction of two plants. Nothing happens with either plant when taken in isolation, but together they produce a powerful altered state.
  • Grob with Dennis McKenna conducted a study using participants from the Uniao do Vegetal (Union of the Plants) conducting diagnostic and life-story interviews while measuring their basic physiological parameters. They also did neuropsychological and personality tests on these individuals who had been in the church for at least 10 years while comparing them to a control group who had never done ayahuasca.
  • The subjects were all very high-functioning. They had history of significant psychopathology, severe addiction, and mood disturbance prior to joining the UDV which had all gone away since partaking of the ayahuasca ceremonies.

Plants Meet People with Dennis McKenna

  • McKenna initiated the Hoasca Study of individuals within one of the Brazilian churches. It’s one of the most extensive studies on ayahuasca to date. Nearly all participants were in a bad place before joining the church. After joining the church and partaking of ayahuasca (which they give most of the credit to) they turned their lives around and healed themselves.
  • Ayahuasca is both a mind and body drug. It’s good for your mind but it also is good for your body, especially your immune system.

The Science of the Sacred with Rick Doblin

  • Jordi Riba has been conducting Phase I studies on ayahuasca in Spain, assessing the safety, the mechanism of action, and how the drug works.
  • One of the reasons Doblin says for the popularity of ayahuasca is that it has been spread by two different churches: the UDV (mentioned above) and Santo Daime. Both defended a religious right to use it in the US.
  • Doblin suggests that a fundamental question that we need to address is whether this is a sacred substance and should only be used in religious contexts or if it is a more neutral substance (one that has a religious framework put over it).

Part 5 – Psychiatric Prescription Drugs: Tired Soldiers

Questioning the Psychiatric Paradigm with Robert Whitaker

  • Whitaker wrote an article for the Boston Globe in 1998 on the mentally ill being given chemical agents that heightened their psychosis. Researchers would also withdraw antipsychotic medication from patients diagnosed with schizophrenia.
  • He reported on two studies that suggested that living in a developed country such as the US is a strong predictor that you won’t have a good outcome if you are diagnosed with schizophrenia.
  • In the poorer countries patients were only on antipsychotics for a short time, rather than an extended period of usage.
  • Whitaker traces the history of the treatment of mentally ill in his book Mad in America. He provides an example in 1751 Pennsylvania where the mentally ill were put in cells with straw in them, just like stalls for animals. The public could pay a few cents to look at the crazy people in their cells like zoo animals.
  • During this time, “the age of reason”, medical doctors assumed that because they lost their reason, these people descended to a lower level of being and were some sort of animal.
  • In 1812, the reform movement out of York, England by Quakers viewed these people as human beings, not animals and built a retreat in the countryside because nature was healing. They treated them like people.
  • The Quakers found a few things. They found the resistance of patients and the propensity for violence vanished. They also found that people with this treatment got well again after just one year. 50% of those people never needed treatment again (which is unheard of in modern times).
  • Galtonian Eugenics led to the US in 1896 passing policies to keep “the mad” people from breeding. They locked people up through their “breeding” years and they sterilize other patients. This was deemed constitutional in the US Supreme Court in 1927.
  • In 1940, the prefrontal lobotomy is treated as a miracle. And in 1955 you start seeing a lobotomy in a pill.
  • 1987 is the arrival of Prozac, the first SSRI and the first of the second generation psychiatric drugs.

Living Naturally with Julie Holland

  • Big Pharma and ad campaigns target women and as a result you find women are overmedicated.
  • The biggest takeaway from her book Moody Bitches, Holland says, is that women are naturally cyclical and dynamic in their moods.
  • There is need of a controlled withdrawal. People assume that as they decrease their meds, because they feel poorly, there is a chemical imbalance that the drug fixes, when they are actually just in withdrawal.
  • It is easier to come off heroin or cocaine than it is to come off of most prescription psychiatric medications.
  • Abilify is a good medicine for schizophrenia, but you don’t make much money off of the 1% of the population that is schizophrenic, so they marketed it as an add-on to treat depression.
  • Zoloft is the most popular antidepressant prescribed by nonpsychiatrists. In 2010, Zoloft sold more units than Tide detergent.
  • There was a Duke study comparing Zoloft with exercise. One group got Zoloft, one group got exercise, one group got both. The people with exercise did the best, only Zoloft was second, with the group that got both doing the worst. Why? Because Zoloft counters the effect of exercise.

Epilogue – FDA Approval by 2021?

  • This section is a bit outdated. I’m writing this in October of 2021 and we are still in Phase III of trials using MDMA for PTSD. The FDA forecasts it will be approved in 2023. We’ll see if that number holds up.