THE SCIENCE OF PSYCHEDELICS

The promise of magic mushrooms as a treatment for mood disorders and addictions

Could magic mushrooms be a long-term solution to crippling addictions and mood disorders like depression and PTSD? Clinical trials abroad have been showing that a few psychedelic trips may be able to ‘reboot’ the brain, changing set patterns of thinking. Science writer Leonie Joubert tells us why South Africa needs to make a mind shift about psychedelicassisted therapy.

Janeen Delaney looked at the capsule in her hand, she thought, ‘Boy, there’s so much promise. I am so ready for this.’ She was about to take a dose of psilocybin, the hallucinogenic compound found in magic mushrooms, as part of a 2008 study at Johns Hopkins University. Researchers were investigating whether a mystical experience brought on by the psychedelic would have a therapeutic effect on people with end-of-life anxiety. Janeen had been diagnosed with leukaemia three years previously.

‘I was living in fear,’ she says placidly, in a video interview. ‘My greatest fear was that I wouldn’t find that fullness, that place of contentment in my life before the process of dying.’ Janeen took the capsule,

‘ I started seeing how much legitimate, peerreviewed research was coming from leading medical schools that was showing significant advances in the medical use of psilocybin.

lay down and waited for the ‘magic’ to happen. ‘It was so overwhelmingly beautiful that tears were falling down my face.’ Samuel Barber’s ‘Adagio for Strings’ was playing through her headphones. ‘My breath was following this note up, and when the note stopped, I held my breath. I thought, “Ha, it’s okay not to breathe. How could it be that simple? Dear God, it is that simple! Remember that when you get [to the end of life]: it’s okay not to breathe any more.”’

Janeen emerged from the session feeling totally reassured. ‘I just knew everything was going to be okay,’ she says. ‘This study changed everything: I’m more patient, I take time to be present, I smile and say thank you – because I get to breathe another day. So I have a few years chopped off my life, but look at the quality that I’m able to experience now. If I got this for a week it would have been worth it – that I’ve had it for a year is astounding.’

Janeen died in 2015. In the end, she had it for seven years.

‘PSYCHOACTIVISM’

Deep-dose psychedelic ‘trips’ as a form of therapy, such as Janeen experienced, is the subject of award-winning local science writer Leonie Joubert’s fascinating podcast, The Psychonauts, in which she explores the science of psychedelics. For the past two years, she’s been keeping an eye on psilocybin trials abroad, and lobbying for the medical community in South Africa to start building a similar body of evidence-based research.

‘Psilocybin is one of many psychedelics that do something in the brain that result in a profound spiritual experience,’ Leonie told the audience at a talk held at Kalk Bay Books. ‘There are a number of medical teams abroad – including New York University, Imperial College London and Johns Hopkins University – that for several years have been doing state-licensed research where people are being put through therapeutic processes to treat various mood-related disorders and addictions: treatmentresistant depression, alcohol and nicotine dependence, and PTSD that hasn’t responded to other drugs or talk therapy,’ she explains. ‘Research is showing that the more mystical the experience, the more likely you are to treat your depression or break your dependency.’

Leonie has alot to say on the subject, yet she never rambles, cuts to the chase when she needs to, chooses her words carefully, and accesses anecdotal accounts and details of academic research with ease. Her fastidious approach is understandable if you consider that psilocybin is an illegal psychedelic that’s categorised as a Schedule 7 drug in SA and a Schedule 1 drug in the US and UK. This puts it in the same class as heroin and crystal meth – which is probably why, in many circles, the topic of psychedelic-assisted therapy is just too ‘radioactive’ to broach.

But change is afoot. Psilocybin is on track to being decriminalised and licensed for medical use in the US in less than five years, and in about five years in the UK and Australia. And yet, while the conversation has exploded abroad, there is palpable silence around the subject in South Africa.

‘Nothing is happening in the medical community here,’ says Leonie. She’s tried to get formal quotes from the SA Health Products Regulatory Authority (SAHPRA), the Registrar of Medicine, the Medical Research Council and academics in public mental health research, all to no avail. ‘I wanted to find out from SAHPRA if they were aware of the science and what the opportunities were,’ she told me. ‘I contacted them 20 times but had no joy. They’re just so overstretched. I also tried ’Stellenbosch;

to speak to people in the psychiatry departments at Wits, UCT and

only one head of department got back to me. I was told they have much bigger issues to deal with, which is strange.’

Strange indeed, when you consider the compelling findings emerging from trials, such as one conducted by Imperial College. ‘The results were remarkable,’ Leonie says. ‘Most participants saw an immediate and significant drop in the usual symptoms of depression, in some cases lasting for months after treatment.’

Interestingly, psilocybin as a treatment is nothing like antidepressants, which are taken daily in order for the drug to have an effect. ‘The effects of psilocybin are rooted in the subjective experience someone has during the dosing session, which brings about positive mood and behaviour changes that last for weeks, even months after the substance has left the body,’ she says. Participants in the Imperial College study described the substance as having reset, rebooted, even defragged their brain – this after just a single dose.

‘There are so many people who are suffering from mood disorders and substance dependence in South Africa, and we have this breakthrough medical

technology potentially available to us that is as natural as penicillin,’ says Leonie. She does, however, stress that she is calling for the substance to be administered in a controlled, monitored environment and that deepdose sessions should be supported by conventional psychotherapy methods.

‘I am talking about a strong body of evidence that shows the really appropriate ways of using psilocybin. I am not advocating irresponsible use.’

THE STIGMA OF PSYCHEDELICS

It was the case of traditional healer Monica Cromhout that initially piqued Leonie’s interest in the subject – ‘this grandmotherly type woman in an ordinary white picket-fence community’ who allegedly had been regularly facilitating mushroom ceremonies in Somerset West. These deep-dose sessions have been going for years in underground communities in SA. Participants take what is known as a ‘heroic dose’ of dried, powdered mushrooms (4-5g) mixed in with Rooibos tea, sit on a mat and proceed to have a four-to-six-hour experience that is overseen by ‘journey guides’.

In 2014, Monica was arrested and charged with possession of and dealing in a Schedule 7 substance, which can come with a minimum sentence of 15 years. ‘I thought I’d do a feature article on the court process that Monica was initiating to try to get psilocybin decriminalised,’ Leonie says. ‘Then I started seeing how much legitimate, peer-reviewed research was coming from leading medical schools that was showing significant advances in the medical use of psilocybin, and realised this story was too big.’ (The state has since decided not to pursue Monica’s criminal charge, and her High Court bid for decriminalisation is on hold.)

It was around this time that Leonie also discovered psilocybin and other psychedelics in a recreational context. ‘I realised how benign they are, relative to the myths surrounding them; that broke the coldness and anxiety of the cultural references I had around the substance.’

Those myths were essentially whipped up by former US president Richard Nixon. ‘Psychedelics have been used in traditional communities for thousands of years, and they made their way into the Western world through the medical labs in the ’30s, ’40s and ’50s when the psychiatric community was exploring the nature of the mind,’ Leonie explains. ‘They started seeing these incredible breakthroughs in treating depression and alcoholism.’

But the drugs escaped the lab, and were taken up by the anti-establishment movement which was undermining Nixon’s efforts to keep the war in Vietnam going. ‘So he bullied the UN into making psychedelics illegal and got them lumped in with the big boys,’ says Leonie. ‘Because they’re in the same class as heroin, the assumption is that they’re as harmful, yet they’re worlds apart.’ They’re not addictive and don’t have a toxic effect on the body.

The parallel to the decriminalisation of cannabis in SA is an obvious go-to. ‘Using evidence-based research, the cannabis case here showed clearly that the substance is much less harmful and addictive than alcohol and tobacco; on the basis of that, cannabis was decriminalised. Psilocybin is even less harmful,’ Leonie told the crowd at the bookshop. ‘The frustration is that until we have the legislation changed, we can’t do any evidence-based research.’

SCIENCE ASTRIDE THE SPIRITUAL

Perhaps what also makes the therapeutic use of psychedelics such a thorny issue is that it straddles the spiritual and the scientific: MRIs have shown the very real neurological effects of psilocybin; the experience of the trip, however, is firmly rooted in the mystical. ‘This visual explosion happens,’ Leonie says. ‘It’s like the inside of a mosque – [you see]

Psilocybin moderates the amygdala, so those monsters in the basement that you would usually shut the door on, you can now shine a light on and look at.

incredible mosaic work and colours, but it undulates; at the same time you have these incredible insights.’ Though this experience varies radically according to dosage: 0,1 to 0,2g is a microdose – ‘there aren’t any trials to support the evidence, but there are many anecdotal accounts of people experiencing increased productivity and a more stable mood’, says Leonie. A recreational dose (0,5 to 2g) will ‘make the rocks sparkle’ she adds, and about 4g is a deep dose.

‘Deep-dose trips are like the Tardis [from Dr Who]: on the outside it looks like a small box, but you open the door and it’s massive on the inside,’ Leonie says. ‘You go to one deep-dose session and come away feeling like you’ve had a decade’s worth of therapy.’

She is speaking from experience, having partaken in supervised ceremonies. Supervision is key, she stresses. Too high a dose of psilocybin, and you may have a potent psychological experience, where the disorientation could lead to you becoming distressed and hurting yourself. That’s why you should never do it alone: skilled guides must monitor the process to take care of you, and the environment needs to be controlled. The risk is in the care, says Leonie, not the substance, and that is easily managed. ‘With some drugs, like morphine, a tiny amount too much could have dangerous consequences, but psilocybin isn’t that dose sensitive. If you have 3g rather than 2g, the psychological experience may be more intense, but you won’t have a physiological, toxic response.’

While the medical community in SA is ‘way behind the zeitgeist’, as Leonie puts it, she is hopeful about how advances in psychedelic-assisted therapy abroad could impact us here. ‘Even if psilocybin is a Schedule 7 substance in SA, once it’s licensed in another country, you could apply through SAHPRA to use it as an unregistered orthodox medicine here. The model for how it would be used would need to be figured out – but it does mean that within five years, psilocybin could be a medicine here.’