In a study published online yesterday in Archives of General Psychiatry, investigators at UCLA published the results of a pilot study using psilocybin (the active ingredient in “magic mushrooms”) to treat anxiety in cancer patients. This was a small study, with 12 patients who acted as their own controls (each had two sessions, one using the active drug and the other using a niacin placebo). These patients were fairly ill with advanced cancer, in fact only two of the patients were alive at the time of publication. Aside from legion anecdotal reports that using ‘shrooms makes people feel better, which has been accumulating since prior to Woodstock, we know that psilocybin and its active metabolite, psilocin, are potent serotonin agonists like LSD and presumably other psychedelics as well. Not that mushrooms and Paxil are strictly comparable, but we also know that generally upregulating the serotonin system is good for mood and anxiety, so there is a decent pharmacological rationale to think that this treatment might work.
It seems that the purpose of the study was twofold. First, as a proof-of-concept and model for further studies with psychedelic drugs, and second to actually test the efficacy of psilocybin on anxiety. The study does seem to have demonstrated that these drugs can be given in a safe manner and be fairly benign: no adverse reactions (or bad trips) were reported. The authors describe using a fairly low dose of psilocybin compared to the studies done with this drug 40 years ago. It’s not clear to me how this dose actually compares with the recreational doses used by your average illicit consumer, but it was apparently enough to get some typical psychedelic effects.
I’m not familiar with the “5-Dimension Altered States of Consciousness profile,” but it’s apparently a method to assess quality and intensity of experiences, and a good way to scientifically rate and characterize mushroom trips (and presumably other drug experiences as well). The patients described their psilocybin experiences as generally positive, with higher scores in “Positive Derealization” and “Positive Depersonalization,” compared to the low scores in “Anxious Derealization” and “Fear of Loss of Thought Control,” to name a few of the subscales. It’s not clear whether the “Manialike Experience” item would be considered pleasant or unpleasant, but this one scored high as well.
If there are any criticisms of the study, they would be the small size and the lack of a true placebo (I think the strongest niacin flush in the world would be easily distinguishable from a mushroom trip, and the patients in the study in fact said so). Given that the patients were their own controls in a cross-over design, the long-term results of the drug use isn’t interpretable compared to the placebo anyway, and that wasn’t really the aim of the investigators. So is psilocybin effective for anxiety in cancer patients? Probably. Should we go ahead and recommend it? Probably not.
For the patient experienced with psychedelic use and with access to his or her own supply, I think it would be fair to suggest a trial. But if this study concerned a “regular” prescription drug, we would still be quite a ways off from FDA approval and evidence-based recommendation. Given the complicated legal and social history of psilocybin, we are still incredibly far from mainstream acceptance of this drug as a treatment, even in critically ill patients.
But the big news lately is that after a 40-year hiatus, relegated to touring with the Grateful Dead, Phish, and annual appearances at Burning Man, etc., psychedelic drugs are officially re-entering the world of science. As the baby boomers gain control of research budgets, and the generations of academics who feared illicit drug use continue to retire, medicine is perhaps getting over its hang-ups related to these drugs. In the brave new world of “medicinal” marijuana, it’s important to allow researchers to evaluate the potential of these drugs the same way we investigate the drugs produced by Big Pharma. Why should global corporations be the only ones allowed to tinker with your serotonin system?