COMMENTARY

Psychedelic Drugs Redux: Don't Leapfrog the Research

Jeffrey A. Lieberman, MD

Disclosures

July 17, 2015

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Hello. This is Dr Jeffrey Lieberman of Columbia University in New York City, speaking to you today for Medscape. I am calling my comments "Psychedelic Drugs Redux" because we are experiencing appeals for the use—for therapeutic purposes—of drugs that previously were considered recreational hallucinogens. To some degree, this resonates with an earlier blog on ketamine, which could have been titled "When Practice Leaps Ahead of Research." In the case of ketamine, I was highlighting the growing use of ketamine based on very solid research indicating that it was effective as an antidepressant agent, particularly in patients with treatment-refractory disease. My point was that the increasing use of ketamine for these purposes and other psychiatric indications had leapfrogged the research that would systematically determine the safety and benefits of ketamine usage for these purposes.

In the case of psychedelic drugs, we have something that is similar but with some important differences. During recent months and years, there have been calls in the media (and to some degree in the professional literature) for the use of various psychedelic agents for psychotherapeutic purposes. Specifically, these appeals referred to lysergic acid diethylamide (LSD), psilocybin, ayahuasca—which is used for religious rituals in some South American and Central American indigenous populations—and finally MDMA (methylenedioxy-methamphetamine) or ecstasy. These have been proposed to be useful for various disorders, including post-traumatic stress disorder, addiction, depression, and various types of personality disorders.

These pleas are occurring in an environment with no framework or context for how the drugs should be studied and on what basis they could be used safely. As most people know, psychedelic drugs were developed and began to be studied for medical purposes in the 1950s. In the 1960s, these drugs were ensnared by the social and cultural turmoil of the counterculture and because of their widespread recreational use. They were made illegal and then were banned from medical research.

At that time, there was promising evidence for their useful application to treat mental disorders, but this really was never fully developed to a degree that the data could be reviewed by the FDA to determine whether they were safe and effective for clinical practice. We have had a nearly 50-year hiatus in any serious investigation, except for some heroic investigators at a few universities, primarily in Europe but also in the United States.

We Need to Study These Drugs

We are now seeing increasing calls for using (or at least studying) these drugs from people within the medical profession and outside the medical profession, in the general public of informed observers of literature on this topic. My point is not to say that these drugs should be discounted and relegated to the criticism and dismissal similar to that of clearly unfounded new-age, nutraceutical, or naturopathic treatments, for which we have no basis for claims of therapeutic efficacy. These psychedelic drugs clearly are pharmacologically active, have profound effects, could be useful for therapeutic purposes, and need to be studied in an intensive and extensive way before an informed determination can be made. If not, we will find ourselves in a situation that may resemble what we are seeing with marijuana, with its increasing legalization despite having an inadequate knowledge base, because of social and political pressure.

I believe that the scientific investigation of mind-altering psychedelic drugs in the 1960s and '70s was a truncated but promising avenue of research, and that these medications, these drugs, could have significant value for a variety of indications if studied adequately. Until we have studied them, however, it is not prudent for any proposals for these to be used on an ad hoc experimental basis. They need to be studied, and we need to determine for what purposes they should be used and what risks and benefits are associated with these treatments.

I am calling for more serious, prudent, thoughtful, and informed opinions to be expressed on this topic before it catches on in the lay public and the medical community does not pay sufficient attention and respond to them accordingly. We need to know how to react to a growing body of opinion, which calls for treatments that are not necessarily ready for primetime.

Thank you for listening. This is Dr Jeffrey Lieberman from Columbia University, speaking to you today for Medscape.

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