Old medicine
Ancient treatments once shunned by the medical community and embraced by the counterculture are going mainstream
Is American medicine about to get groovy? Paging Dr. Feel Good.
Psychedelics, a class of psychoactive substances that produce changes in perception, mood, and cognitive processes, may conjure up images of the counterculture of the 1960s—think Cheech and Chong. However, according to experts, psychedelics have the potential to transform mental health care, providing treatment options for a range of complex disorders, from treatment-resistant depression to substance use disorder and post-traumatic stress disorder (PTSD).
The first FDA-approved psychedelic drug, methylenedioxymethamphetamine, which is used in the treatment of post-traumatic stress disorders, is expected this year. It’s better known as MDMA. And if you’re asking yourself if this is the same drug that was popularized in the club scene of the 1990s and 2000s, the answer is yes.
At the same time, decriminalization efforts for other psychedelics have been underway for years and are taking hold across states like Oregon and Colorado. However, most of the successful efforts have happened in localities, including in my hometown of Washington, D.C., which decriminalized natural psychedelics, including psilocybin, ayahuasca, and mescaline, in 2020.
So, the emerging debate is less about whether psychedelics will become mainstream but about when they will become widely available and who will control their distribution. It’s similar in some ways to the debate about marijuana and THC.
, a senior lecturer at Johns Hopkins University, put it bluntly in her recent remarks at SXSW, noting, “Psychedelics are here, and they are here to stay.”A short history
Psychedelic treatments have been around for a long time, and their use in traditional indigenous medicine is long-standing.
Before the arrival of Europeans in the Americas, many indigenous cultures used natural psychedelics for spiritual, medicinal, and ritual purposes. These substances, derived from nature, were integral to their cosmologies, healing practices, and communal ceremonies.
Ayahuasca: Used in the Amazon Basin, ayahuasca is a brew made from the Banisteriopsis caapi vine and other plants. It was used for spiritual awakening, divination, and healing by indigenous peoples of the Amazon.
Peyote: Native to the southwestern United States and Mexico, peyote has been used by indigenous North American cultures, most notably the Huichol and the Navajo, for its psychoactive properties in healing rituals and spiritual journeys.
Psilocybin Mushrooms: Various Mesoamerican cultures, such as the Aztecs and Maya, used psilocybin mushrooms, referred to as "teonanácatl" (flesh of the gods), in religious and divinatory contexts.
San Pedro Cactus: Indigenous cultures in the Andes have used the San Pedro cactus for healing and shamanic purposes for over 3,000 years. The cactus contains mescaline, a powerful psychedelic.
Modern application
It’s only been in recent decades that the scientific and medical communities have begun to take notice of the transformative properties of psychedelics.
The arrival of Europeans brought suppression of many indigenous practices, including the use of natural psychedelics. However, over time, some of these substances were studied and integrated into Western medical and psychological practices, especially in the 20th century.
Research and Psychotherapy: In the mid-20th century, substances like LSD (synthesized from ergot alkaloids) and psilocybin began to be researched for their potential in psychotherapy, leading to a brief period of intense study and clinical application—the Central Intelligence Agency directed some of this. Although not a traditional psychedelic, LSD's discovery and subsequent research influenced the study of other natural psychedelics.
Suppression and Revival: The 1960s and 1970s saw a cultural and scientific interest in psychedelics, which was met with strict regulation and criminalization. However, the late 20th and early 21st centuries have seen a resurgence in interest and research, focusing on the therapeutic potential of psychedelics like psilocybin and ayahuasca for treating mental health issues.
Therapeutic Use: Recent studies have explored the use of psychedelics in treating depression, PTSD, addiction, and anxiety, especially in terminal illnesses, showing promising results. This has led to a reevaluation of their legal status and therapeutic potential in some countries.
In 2020, the scientific and medical community in the U.S. took notice when an influential study in the Journal of the American Medical Association of Psychiatry (JAMA Psychiatry) found that 71% of the patients with severe, previously treatment-resistant depression showed “clinically significant improvement” when using psilocybin that lasted at least four weeks and with “low potential” for addiction. More than half were considered in remission at four weeks.
This revelation sped up research and, in turn, may accelerate the widespread adoption of psychedelic therapies.
Big money versus ‘freedom’
Writing in JAMA Psychiatry in 2022, Dr. Joshua Siegel, James Daily, Demetrius Perry and Dr. Ginger Nicol predicted “that most states will have passed legislation legalizing psychedelics by 2033–2037,” which means that we’re about a decade or more from the widespread use and acceptance of such drugs. They also noted the possibility of rapid adoption, noting “higher apparent likelihood of FDA approval, the early shift towards bipartisan legislative support, early interest in reform at the federal level.”
But the question remains: who will control the future? Right now, there are two prevailing camps: those that believe in the decriminalized recreational model and those that believe in the FDA-approved medical model.
A handful of companies are sinking billions into the dream of creating safe, profitable drugs that get the FDA's approval, and they may have the edge. One of the biggest companies, Atai Life Sciences, is backed by PayPal billionaire Peter Thiel, who has contributed around $50 million to state and federal political candidates and campaigns since 2000. According to the non-profit OpenSecrets, he was either party's 10th largest individual donor in the 2022 midterm congressional elections.
But it’s more than just big money putting these big companies in the lead. According to Dr. Julie Howard, a psychiatrist, psychopharmacologist and author of New York Times bestsellers Moody Bitches and Weekends at Bellevue, it may boil down to safety. “Now we have an issue where a tablet of anything can kill you because we have a poisoned drug supply [due to fentanyl] in America. That is the biggest risk in the recreational model.”
No matter which side wins, the consensus is clear: psychedelics will move from counterculture to mainstream in just a few years. They are here to stay.