UW studies psychedelics’ effect

Natalie Eilbert

Milwaukee Journal Sentinel USA TODAY NETWORK – WISCONSIN

Approval to treat depression, addiction would require change to laws

Few things defined Day Host-Jablonky’s first psychedelic trip in 2014 more than having her blood drawn by nurses every 10 to 15 minutes in the dosing room.

There’s no verdant spring in the Northwoods, no Grateful Dead jam session. Instead, the setting was clinical. Two therapists accompanied Host-Jablonsky, helping to guide her experience as medical providers shuttled in and out, collecting data to better understand the effects of psilocybin, a drug known — either famously or notoriously — as “magic mushrooms” or “’shrooms.”

The setting wasn’t exactly what the general public associates with taking a hallucinogen. Perhaps even more surprising, the dosing is happening at the state’s flagship university.

The UW–Madison Transdisciplinary Center for Research in Psychoactive Substances supports research and education into psychedelic drugs and related compounds. The idea is to learn how these psychedelic substances may help mood or behavior in ways other forms of therapy can sometimes fall short.

For the last 10 years, the center at UW-Madison has been part of a psychedelic renaissance in the science community, one that comes after decades of negative media attention stymied re-

search and public perceptions.

Dr. Randy Brown, a professor of family medicine and community health at UW-Madison, said scientists, for the most part, have their sights set on clarifying the therapeutic value of psychedelics. Brown is a principal investigator who studies psychedelics in breaking addiction; others are studying the drugs in relation to treating depression, posttraumatic stress disorder, existential distress in terminal patients, and other behavioral health concerns.

The hope is that the drugs help people find answers within themselves, by creating a safe environment where they can explore the depths of their own minds. It is not, the scientists emphasized, a steppingstone for the legal recreational use of the drugs. Any use of the drug should be conducted in a clinical setting by medical providers, and only after rigorous vetting that it’s safe for the patient to take, they said.

In Host-Jablonsky’s case, she had no history of behavioral health challenges. But she agreed to participate in the study to help researchers better understand the best dosing for psilocybin and the relative safety of the drug. That, and she was curious.

“I heard about it through word of mouth, through people I really trusted,” Host-Jablonsky said. “And when I interviewed for it, I really liked what I heard about who the researchers were, and what angle they were coming from.”

She was there to help scientists build enough momentum to flip the script on society’s complicated relationships with psychedelics.

“It was very clear that we were participating in medical research and that we were giving to medical research in that way,” Host-Jablonsky said.

In many ways, Host-Jablonsky’s task was simple: lie down, slip on eye shades and noise-canceling headphones, and allow curated music to carry her thoughts to any and all corners of the mind. Researchers observed her on regular doses of psilocybin, and then recorded the effects when the dose was doubled.

Near the end of her trip, she recalled hearing the sparkling intro to The Beatles’ “Here Comes the Sun,” a familiar tune that broke her from her cognitive spell.

Her study ultimately supported the idea that people responded to simpler dosing of the drug. Administering a flat dose of the drug was more effective than determining dose based on body mass. Those findings are helping bring researchers closer to developing psilocybin for Food and Drug Administration approval, said Paul Hutson, the director of the center.

But FDA approval is not the same thing as legalization, emphasized Brown.

“What we’re moving toward is administering, monitoring and supervising the therapeutic value on the people who would benefit from it,” Brown said. “And that process won’t lead to legalization, per se.”

Hutson echoed Brown’s point, noting that the center “has not dabbled in the question” of decriminalization, at least not with the intensity of some states. Oregon was the first state to legalize hallucinogenic mushrooms; Colorado the second.

“We’re trying to understand how the drugs work, optimize their efficacy, how to make them more efficient, and which patients should be treated with them and which ones are not likely to be,” Hutson said.

Psychedelics may help with addiction and depression. How?

The center has already learned that psilocybin is a promising therapeutic intervention for drug addiction.

In one clinical study, psilocybin — which is not itself addictive — reduced methamphetamine use by 90% over the course of a month in people who had abused the drug on a regular basis. That’s especially significant, said Dr. Christopher Nicholas, an associate professor of family medicine and a co-investigator of the study, because no FDAapproved medications exist for people struggling with methamphetamine.

Psilocybin’s psychoactive effects can be especially powerful for people who struggle with addiction, Nicholas said. The hours-long trip can help people see, in clarifying ways, the damage their addiction has had on themselves and the people around them. It can help people understand the isolating nature of addiction.

“Participants are coming away from the experience wanting to reconnect to the important relationships in their lives,” Nicholas said.

But how? Researchers at the center have observed that the psychedelic experience creates profound meaning in the participants’ lives, a sense of purpose that had been missing or abandoned in the throes of addiction or psychic pain.

From that meaning, a window opens, one that researchers have described as a period of psychological flexibility.

Some of the most productive neurological research has looked at changes to what’s known as the default mode network of the brain before and after a trip, said Dr. Chantelle Thomas, a clinical psychologist who has conducted clinical research trials on psychedelics at UW-Madison since 2013.

The default mode network is the area of the brain activated when a person is daydreaming, resting or considering internal thoughts — and not stimulated by the outside world. The default mode network looks different for people with depression, Thomas said — a result, possibly, of stress breaking down certain links in the brain.

However, following a ketamine or psilocybin dose, the depressed brain’s default mode network becomes indistinguishable from a non-depressed brain’s network for a seven- to 10-day period. That shift in the default mode network has changed the relationship people have with their sense of self, Thomas said.

“The thing that feels most exciting about psychedelic work is the sense that who they are as person is allowed to evolve beyond the limitations of what their story has dictated. Some haven’t been able to get out of certain loops or behavioral patterns that tell them they don’t have worthiness or capacity,” Thomas said. “All of a sudden, they find themselves feeling completely connected to God or the universe or their grandmother who passed away decades ago.”

Follow-up care remains a concern

Researchers acknowledged their concern about what happens to patients after their experience with a psychedelic drug. If they emerge with a more open mind — that psychological flexibility — are they surrounded by positive influences?

“If you’ve got this period of suggestibility or adaptability, we want to make sure that the influences, the context that they go back into society with after the dose, is a positive one,” Hutson said. Hutson acknowledged that many people who struggle with addiction or depression aren’t necessarily going home to safe, positive environments. That can make outpatient work especially challenging at a time when new pathways in their brain have opened. And as of now, there just isn’t the infrastructure in the medical community to ensure someone who has had a clinical psychedelic experience gets the therapeutic care they need.

Without proper aftercare following a psychedelic experience, the clinical trials can start to feel a bit reckless, Thomas said.

Madison could lead the way in training more people

Thomas and a team of researchers at Usona Institute in Fitchburg, a neighboring city of Madison, are hoping to change that. Usona, a not-for-profit medical research organization, is one of the largest facilities in the country developing psilocybin, ketamine and other psychedelics for potential medical use.

Thomas is part of Usona’s educational immersive program, which aims to integrate psychedelic psychotherapy into training curriculums across the country. She wants to see more opportunities for students to learn about the field.

For now, psychedelic training isn’t part of graduate school programs, and Madison is particularly unusual in having both the university and Usona mere miles apart.

Some of those limitations could change, depending on the FDA. Three medical companies, including Usona, are in late clinical trials with the FDA to get psilocybin approved as a treatment for depression. Should the FDA approve psilocybin as a legitimate medical drug, that will trigger the DEA to de-schedule psilocybin as a Schedule I illicit substance.

Brown is hopeful that would shift the way we think about recovery, and the capacity for people to change themselves.

“There’s this idea that we can be our own agent of change and we have within us what is needed for that,” Brown said. “We just need to optimize the conditions to support that. Psychedelics would amplify and embolden the questions we’re sometimes too afraid to confront.”