Tuesday, February 5, 2013

psychedelics as pharmacotherapy


Two articles in my Google Reader caught my eye this morning:
Ecstasy, the Marriage Counsellor of Tomorrow
Can Magic Mushrooms Help Cancer Patients?
The first reports on a study that argues we're not evolutionarily built to survive romantic relationships because we simply live too long, so why not consider "love drugs" as an aid to make it together to the end. (as an aside: drugs alone are never the answer! although they can be a terriffic adjunct to long-term behavioural therapy.) The second reports on a book/study exploring the use of psilocybin to alleviate the distress associated with cancer diagnosis.

In both cases, the authors surely raise eyebrows by suggesting that currently illegal drugs with "no accepted medical use" and "high abuse potential" may actually have value when used in therapeutic settings. The notion is neither new nor radical to me, but to a public used to a 'Schedule I = bad' mantra, probably pretty racey. But from a neurobio perspective, I don't see a whole lot wrong with it. Neither article advocates using the drug more than a handful of times, and no addiction has ever arisen from a handful of times. Addiction is an acquired disorder that develops with repeated use and eventually turns compulsive -- not likely to happen when used on an irregular, occasional basis. Even the studies of "seasoned" ecstasy or psilocybin users I've seen tend to report patterns of moderate, weekend use, rather than the kinds of compulsive binges you see with other psychostimulants. And nevermind that hallucinogens such as psilocybin have not been shown to have a dopaminergic reward/reinforcement component, so are not likely to result in addiction altogether. With ecstasy, sure, there are cardiovascular risks or the potential for overheating, it's an amphetamine after all; but again, with the doses implied for these purposes, not likely. And brain damage? If you're picturing studies that pit a drug-using against a healthy brain, consider that the drug-using subjects are selected for heightened use duration or severity, and that the healthy comparison subjects in many cases are allowed a handful of occasions of use in their lifetime -- so the marriage-ecstasy/cancer-mushroom brains are going to look more like the controls than the users.

Of course I'm sure the policy implications are tricky (it's probably hard to allow medical use without unleashing a reckless free-for-all), but can we at least ease up on the "no medical value" mantra so we can see if maybe we've been wrong all along? I don't see the harm in at least finding out.

In any case, I wonder if it's a coincidence that both articles appeared on the same day, or if it's a sign of a turning tide.

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