The Power of Psychedelics

Research continues to reinforce the capacity of psychedelics to revolutionize psychiatric care—as well as the importance of understanding the safety and ethical concerns that come with this type of therapy.  

“Based on the evidence we have so far, it seems likely that a good portion of people whose needs have been unmet thus far can be helped with psychedelics,” says Matthew Johnson, PhD, who joined the Center of Excellence for Psilocybin Research and Treatment at Sheppard Pratt’s Institute for Advanced Diagnostics and Therapeutics earlier this year. 

Dr. Johnson, an accomplished researcher on the human effects of psychedelics, is dedicated to building on that evidence. For the past 15 years, he’s been studying the use of psilocybin to treat tobacco addiction. This work led to the first federal grant in the U.S. for therapeutic administration of a psychedelic in a research project, of which Sheppard Pratt is one of four research sites. 

Tackling the roots of addiction 

Another recent study conducted by Dr. Johnson showed very high rates of smoking abstinence in patients treated with psilocybin compared to nicotine patches in a head-to-head comparison. “Typically, those patients have been struggling for many years, some for decades, and often have tried many other treatments that have proven unsuccessful. So it’s very exciting to see people make changes with such high success rates,” he says. 

This type of treatment is significantly different from other medications used for the treatment of tobacco addiction. Unlike nicotine replacement therapy, psychedelics aim to get to the  psychological roots of addiction. 

“Knowing this sets the stage for expanded work with psychedelics for addiction. Everything we know about how psychedelics are exerting those effects suggests that there may be potential to treat a wide variety of addictions,” explains Dr. Johnson, who believes psychedelics could be  used to treat other substance use disorders and  addictions. 

Safety and ethical issues 

With the increasing likelihood that psychedelics will become an FDA-approved treatment for various disorders—such as MDMA for PTSD—questions about risks, safety, and ethics need to be addressed, cautions Dr. Johnson. 

One consideration is that psychedelics can be challenging to administer because of the magnitude of people’s experiences. “This is a serious specialty that someone needs to thoroughly understand before conducting the therapy, especially to minimize adverse experiences or so-called ‘bad trips,’” he says. 

Dr. Johnson also has concerns about inappropriate therapist-patient relationships, or therapists “going down the guru track,” as he puts it. 

“I think there’s a strong potential for therapists to go in the direction of religious leaders in helping people fill in the blanks about the nature of these transcendental experiences,” warns Dr. Johnson.  

Instead, the role of the clinician in psychedelic treatment should be to support people through their experience and allow whatever meaning they take from it. According to Dr. Johnson, the field needs to establish the norms for appropriate research and clinical practice. “It’s not obvious how you help support these experiences. How do you handle a treatment where a sizable portion of  people say it was the most spiritually meaningful event of their life? How do you appropriately leverage that toward therapeutic good and support patients, without being corrupted by the attraction of everything that can come with that?” 

Dr. Johnson has published risk and safety guidelines about the various dangers, how to avoid them, and how to address those risks in the research process. He’s calling on researchers and clinicians, state boards of medicine, professional societies, and the FDA to continue this work and develop models for appropriate use, guidelines, and training to ensure that these therapies are delivered safely, ethically, and effectively. 

The future of psychedelic research 

Dr. Johnson is preparing to work on a new research project looking at using LSD to treat chronic pain in people who are misusing prescription opioids. “It will address people who don’t have a full-blown substance use disorder but are showing the signs of potentially falling prey to the  full manifestations of addiction,” he  says.   

That’s just one example of the continuing research he and the team at Sheppard Pratt are conducting as they build on their previous work examining the use of psychedelics to treat depression, bipolar II disorder, and suicidality.  

“There will be an increasing number of disorders for which we show evidence that psychedelics can be helpful. Any disorder that needs behavior change is a ripe area for investigation with a lot of  promise,” he says.