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Psychedelic medicine: a re-emerging therapeutic paradigm

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CMAJ_Psychedelic_Cover_-_Oct_2015 In a recent article, Tupper et al. (2015) [1] investigate the new and re-emerging therapeutic paradigm involving psychedelic substances for treating mental health conditions. Recent studies with patient populations are reviewed and thoughts on how the paradigm may move forward are presented.

Unlike the research in the 60’s and 70’s, where non-randomised, non-blind methods, together with unethical procedures discredited the research, the new wave of studies is showing that research on psychedelics as therapeutic agents can abide by modern-day scientific, ethical and safety standards.

Research into the treatment of anxiety is looked at first, with a review of three recent studies involving patient populations struggling with end-of-life anxiety (LSD and psilocybin) and autism-related social anxiety (MDMA). The article then moves on to research on addiction, with studies using psilocybin (alcohol and tobacco) and ayahuasca-assisted therapy (various substances), the latter being investigated mainly by means of observational studies. Lastly, the review looks at research into PTSD with MDMA-assisted psychotherapy.

In sum, the studies reviewed indicate that research is going well and gaining more positive press, however attention is brought to the fact that this research needs to be extra careful and vigilant of potential hazard and harms. The precipitation of psychotic breaks in patients with mental disorders or a predisposition to these disorders can occur[2], as can Hallucinogen Persisting Perception Disorder (HPPD), which involves continual presence of sensory disturbances.[3] However, the incidence of these adverse effects in the general population is believed to be generally quite low, and when they do occur, this usually happens when the drugs are used in an uncontrolled setting. Due to these hazards, research involves careful screening of participants and typically excludes people with a family history of psychosis.

The authors go on to envision some of the benefits that could arise if science were allowed more freedom to investigate how psychedelic drugs work on a neurological level. For instance, the understanding of the relationship between the brain, mind and consciousness would be advanced, and the mechanisms of action of these agents could be unveiled, leading to optimal therapeutic protocols with certain psychedelics for specific disorders. Additionally, they point out the large health system costs worldwide for mental health conditions, arguing that research is economically warranted, with long-term prospects providing cheaper and shorter-term treatment compared to current treatments.

The review concludes with an outlook on how this paradigm may evolve, proposing that medical school programmes may need to be updated, with specialised clinical training for health professionals for such treatments. Overall, this new paradigm looks promising and it could serve to educate and correct previous misconceptions within the science community, influence legislation regarding drug law, and most importantly, treat and offer new ways to help treatment-resistant patients.

[1] Tupper, K. W., Wood, E., Yensen, R., & Johnson, M. W. (2015). Psychedelic medicine: a re-emerging therapeutic paradigm. Canadian Medical Association Journal, doi: 10.1503/cmaj.141124.

[2] Abraham, H. D., Aldridge, A. M., & Gogia, P. (1996). The psychopharmacology of hallucinogens. Neuropsychopharmacology, 14(4), 285-298.

[3] Halpern, J. H., & Pope, H. G. (2003). Hallucinogen persisting perception disorder: what do we know after 50 years? Drug and alcohol dependence, 69(2), 109-119.

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