Are psychedelics actually medicine?: Clinical advocates

The terror that vanished

Dinah Bazer sat in a treatment room at NYU Langone, swallowed thirty milligrams of synthetic psilocybin, put on an eye mask, and lay back. She had ovarian cancer. The terror of dying had colonized the time she had left. Six hours later, she took off the mask. The terror was gone. Not managed. Gone. Five years later, in follow-up, still gone.

We watched this happen patient after patient. At Hopkins, NYU, Imperial College. People whose treatment-resistant depression had become their identity sat in a room, took a dose, and something shifted at a level conventional psychiatry cannot explain. Effect sizes 2.5 times larger than SSRIs. A single session.

The mystical predictor

Roland Griffiths was not a mystic. He was a psychopharmacologist whose publication record would survive any committee. When he reported that psilocybin occasioned experiences participants rated among the most meaningful of their lives, the mystical experience turned out to be the predictor of therapeutic outcome. The drug was doing something the biomedical model has no vocabulary for.

The prohibitionists invoke the opioid comparison. It is dishonest. Opioids are addictive. Psychedelics are anti-addictive — psilocybin is being studied for alcohol and nicotine dependence with results outperforming existing interventions. Comparing psilocybin to oxycodone is like comparing surgery to stabbing because both involve sharp objects.

The tradition holders raise the deepest challenge. The compound requires a container. They have been providing one for millennia. We built ours in a decade.

Where we concede ground: We overpromised. One trip cures depression distorts the data and we let it stand.

What would change our mind: Properly blinded trials showing effect sizes shrink to SSRI levels once expectancy is controlled.

Read the full synthesis: Are psychedelics actually medicine?