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Nov. 22, 2023 - Epoch Times
36:08
UCSF Doctor Using Psychedelics on Patients Explains Their Danger | Robin Carhart Harris
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Time Text
That classic image of someone thinking they can fly and jumping off a building isn't just alarmist propaganda.
These cases tragically have happened.
People are so severely altered under these drugs in the right hands in a way that could be positively transformative but without any support in a way that could kill them.
I think there is a place for opening up access to drugs like psilocybin, but we need to get it right.
And so with this massive scaling up, can we ensure the kind of safety and efficacy that we've seen in these small trials?
It's a really valid question.
Meet Professor Robin Carhart-Harris from UCSF as we explore decriminalizing psychedelic drugs in California.
Are these substances a way to healing or do they open a Pandora's box, unleashing consequences we are not ready for?
Robin, it's great to have you on.
Welcome.
Thank you.
It's great to be here.
We want to talk to you about a controversial law that is almost passing.
It's waiting for Governor Newsom to sign in California.
It's psychedelics.
We plan to decriminalize mushrooms, and there are people that are saying this is really good because it's good for treatment, PTSD, mental illness, and there are people that are saying This is not a good idea because it could create a lot of problems for society and it could have a lot of unintended consequences.
You are a professor that's been using psychedelics, you've been working with this.
Can you tell us what are the potential impacts of a law like this?
Of the law?
Well, it's hard to know.
In a sense, it's an experiment in itself, but policies are changing across the world.
There has been a policy change in Australia with doctors being allowed now to prescribe psychedelic therapy for psychiatric disorders like depression.
In the US, the state of Oregon approved a legalization bill based on a ballot initiative to legalize psilocybin therapy, not just for psychiatric disorders, but more generally even for apparently healthy people who want to have this experience.
Something similar has happened in Colorado with a bill getting through there to both decriminalize and legalize psychedelic therapy.
I hear Massachusetts is on the bill for 2024 and there's something happening in California as well, this Treat California initiative which could root state money, lots of money, billions of dollars to research on psychedelic therapy.
A lot's going on across the Western world in terms of liberalizing policy on psychedelic drugs.
What the impact of those policy changes will be, we don't know.
I could speculate.
I have done clinical trials with psychedelic drugs.
I've done Brain imaging experiments, trying to discover how they work in the brain.
And yes, these clinical trials as well, looking at things like psilocybin therapy.
When I say psilocybin, I'm referring to magic mushrooms.
So psilocybin therapy to treat depression.
I've designed three trials and led on two of those with psilocybin therapy and depression.
And also I've designed a psilocybin therapy for anorexia trial that's complete now, in the process of completing, and a further trial that's coming close to completion with psilocybin therapy for treating fibromyalgia syndrome, so a generalized chronic pain condition.
So I can speak to some of those findings, what we've been seeing.
It's not just me and my colleagues that have been doing this in isolation.
There are now a number of teams across the world and some quite big trials that have happened.
So there is a general picture of quite marked improvements in people's mental health outcomes with psychedelic therapy.
But these are trials.
These are very carefully controlled.
There's a screening process where we carefully assess someone's eligibility for the trial, that this is, in a sense, safe enough.
It's worth the risk.
All interventions carry some risk.
So is this worth the risk?
And we deem that it is, and then we proceed.
And so those conditions are quite different to what we might imagine with, say, an unregulated, very liberal legalization of psychedelic use.
Now, any kind of policy change like that I would be quite hesitant to support because we don't know what the safety profile of that would be.
What we do know is the safety profile based on the evidence that we've seen in our clinical trials.
We can look at the safety profile, the side effects, the risk, and we can look at the benefits.
So I can speak to that model And say that yes, the results look impressive.
This could treat potentially quite a broad range of different psychiatric disorders and have quite a positive impact.
Can you give us some examples of what you have seen?
So how do these psychedelics, how do those magic mushrooms work in helping people get treated?
Yeah, so across trials now, if I use the example of psilocybin therapy for general depression, something called major depressive disorder, then there have been three trials that have seen response rates, and we could define that as actually a halving of the severity of someone's depression when they come into the trial.
At the end of the trial, their depression's at least halved.
So that's how we define a response rate, and there we've seen 70% across three trials.
A further trial using stricter criteria has got something somewhat comparable, a little bit less in terms of response rate, but with stricter criteria.
But the general picture is that this looks very good.
In fact, we did a comparator trial where we compared how people did with six weeks of a conventional antidepressant drug that people took every day, which is what typically happens with antidepressant drugs.
Compare that to psilocybin therapy, we give two doses, just two doses three weeks apart.
The whole period.
Yeah.
So within a six-week period, two doses with psilocybin versus 43 it was with the conventional antidepressant.
At the end of the trial, we saw remission rates with psilocybin therapy that were twice as high than the conventional antidepressant drug.
And yes, we saw the response rates up at 70% versus I think it was close to 50% for the conventional antidepressant.
So that's promising.
And then we can look at how this is working and see that it's working quite differently to conventional treatments.
Most drug treatments seem to work by taking the edge off the negative emotions that people feel in depression, whether that's anxiety or the fears that Self-criticism that can characterize depression, the self-loathing and suicidal intent.
So these drugs, the conventional drugs, can work for, in a sense, helping people get through a stressful or distressing period, like incubating against stress, in a sense.
So you won't react to these drugs?
As much as dramatic, but you still will keep it, right?
You still have a level of...
It sort of levels people out, so it takes the edge off the negative, but the catch is it seems to take the edge off positive as well, so people do report.
Do have less emotions.
Yes, there's a kind of flattening of their emotional range with the conventional drugs, and that is a side effect.
You don't really want that, and that's the cost for reducing your symptoms severity with the drug treatment.
Psychedelic therapy is quite different.
It's almost an inversion of that rule of emotional blunting with the conventional drugs versus an emotional release or catharsis, a fancy word for an emotional breakthrough.
What does that look like?
Well, it actually looks like people crying a lot of the time.
Crying not necessarily tears of sadness, it could be, but it could be tears of joy.
It's just a strong release of pent-up emotion.
And when we measure that, which we do in these trials, we see that the magnitude of that emotional release is highly predictive of the magnitude of improvement that we see then downstream weeks or months afterwards.
And you see them completely changing.
So they come to you guys, they go to these trials, for the time being, they've been in trials, they come, you guys assess them, and then somebody that's depressed, that doesn't have good eye contact, that they are not feeling shy or all that, and then they go through these sessions, and then, or even one session, but they're supervised.
You guys are watching them for those few hours, right?
Is it a few hours?
It is, yes.
So the drug effects last for, they peak around hour two to three after ingesting the capsules and they'll last for about five hours or so.
We typically have people in for more like six, seven hours to look after their safety and be with them as they're coming down and making sense of things.
Yes, it's a long day.
That's part of the complexity of this treatment.
It's unusual that you would go and see a clinician and be with them for the whole day.
And so there are some challenges around that.
It's a wonderful thing, but it's also quite expensive to have staff time.
To be in a service for a full day is quite a luxurious type of treatment.
But then they don't have to take these antidepressant drugs afterwards, right?
Absolutely.
So, you know, the way the algorithm works out is it's cost-saving in the long run.
I mean, we're getting people well, and some of the time, not all of the time, but some of the time, they'll stay well.
And they'll get back to work.
Their social functioning improves.
This is something that we've seen in recent data, that social functioning improves after the psilocybin therapy to a significantly greater extent than any change with the conventional drug treatment.
Can you give us a specific example of somebody who came to you guys and you saw a big change?
Well I can.
I'm thinking of Kirk and I can say his name because he's, you know, talked to media and he did that after his treatment.
He was treated with psilocybin therapy for treatment resistant depression.
His depression had developed, linked in a sense, or at least worsened by the loss of his mother, his relationship and estrangement from his father, and so a sense of isolation and that sense of loss that went beyond typical mourning of someone into a significant depression that couldn't be treated.
So that's Kirk.
But Kirk's transformation was one of the most remarkable.
What sticks in my head isn't just that his depression went away.
And I remember once he either emailed or messaged me telling me that he'd been in a shopping mall and he had a funny feeling come over him.
And he thought, what is this feeling?
I swear I've had it before.
And then he realized it was optimism.
And he was like, I haven't had that for a long time, but that's what it is.
So he had that, yes, and his depression went away, and socially he seemed to be functioning very well.
But what sticks in my head is that he told me that he won an award at work for his performance.
And I thought, well, that's a solid thing.
It's not just him rating that he doesn't have depression anymore or Us projecting that on him in a wishful way, he's actually doing well in the real world.
So what was it like when he came to you?
Can you tell us about the moment when you met him and what was it like?
Yeah, well, he's a very sweet man, a Londoner, with a London accent.
But you just felt for him because he was tender and sweet.
Even in his depression, he could express that.
So he invited a kind of empathy.
And so he was quite a...
In a sense, there have been tougher cases to treat.
His was a kind of ideal case.
But he was lovely at the start and lovely at the end.
It's just that we got him well at the end as well.
So that was a particularly good experience.
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Now let's go back to the interview.
Now this law passing, so based on what you have experienced, so psychedelics do have a really positive impact so psychedelics do have a really positive impact in the treatment side of things.
But what are your thoughts on this law that is decriminalizing in California, the psychedelics in California?
Well, you know, a situation where you can have a criminal prosecution for someone using psychoactive mushrooms is a little questionable.
I mean, both of us are sat here With a drug in front of us, we've got a green tea, and it's psychoactive.
But we can do this quite freely.
So all drugs are different, but you assess the benefit and harm ratio.
I think there is a place for opening up access to drugs like psilocybin, but we need to get it right.
I think the system needs to have some regulation on how it's available to people because there are some risks, there are some potential harms.
That go beyond just caffeine in our green tea.
So what does that look like is the key question.
And as I understand it, I think this bill that could get through in California hasn't yet written in any kind of regulation.
So it's doing the decriminalization aspect.
People won't go to jail for personal possession of these mushrooms, magic mushrooms or psilocybin, the active ingredient.
But there's nothing that provides a structure around safe access.
And I just wonder whether there's a messaging with the bill that could encourage access but not provide any structure or regulation for safe access.
And I think that's a missing piece as I understand it.
What is a safe access?
Can you explain that?
Yes, so I think supervised use is important if not essential.
All people are vulnerable and these drugs make people especially vulnerable.
Like children in a sense, you know.
You wouldn't take your child to someone and just leave them.
You know that they require a certain quality of care and a watching over and a nurturing and so on.
And it's similar with psychedelics.
People are so vulnerable and tender and suggestible as well.
And so that has to be managed very carefully.
And so I think having supervised sessions in places that are certified, provided by people who are certified, trained in how to deliver this treatment, It's not rocket science.
The training will involve a lot of just good principles of good practice, of decency, with some nuance, but many mental health professionals already trained could provide this treatment very well, I believe.
But with the absence of that support, you have something entirely different in my mind to what we've been testing in the studies that we've been doing.
So yes, the different components I was describing, the psychological preparation, the supervision of the session, making sure people are physically safe as well as psychologically cared for.
And then providing psychological care after the experience, you know, with further contact with those who looked after you during the experience, is in my mind the basic model, not just for treating people with mental health problems, but also providing this in a way that can work at scale.
You know, these policy changes are a big deal.
Infrastructure changing like this is no small thing.
We don't know how it'll go.
It is an experiment, and so with this massive scaling up, can we ensure the kind of safety and efficacy that we've seen in these small trials?
It's a really valid question.
What if people use these things unsupervised?
What are your thoughts on that?
What are the challenges they can bring?
Yeah.
Well, in a sense, people can get away with it, but that's no solid principle because things can go wrong and they can go seriously wrong.
And there have been cases of things going seriously wrong.
People taking their own lives after a psychedelic experience.
Under a psychedelic as well, not realizing what they're doing.
That classic image of someone thinking they can fly and jumping off a building isn't just alarmist propaganda.
These cases tragically have happened.
People are so severely altered under these drugs.
In the right hands in a way that could be positively transformative, but without any support in a way that could kill them.
So, yes, speaking again to that special vulnerability, that's why I think people need to be looked over during the session, why they have to be assessed when they first come in, and also some degree of care afterwards as well.
Do you think this supervision part costs a lot and the state doesn't want to do it, so they just want to say, let's legalize it and have people just do it on their own?
Yeah.
So given the trajectory of the research, people are doing the math now and working out, you know, how much will this cost?
Okay, so it looks good in a lot of these trials, but is it a realistic treatment for your insurer to cover or a public health system?
Can we cover the cost of what sounds like quite a luxurious treatment with a full day?
In some of our trials, two full days.
In other trials, at least two full days, three.
Say with MDMA therapy, another drug, but a psychedelic-like drug in treating post-traumatic stress disorder.
Three dosing sessions there.
So that's a lot of care.
It's a lot of mental health professional time.
And so there's a lot of costs there.
And does the improvement justify that cost?
Can it ever be anything other than a private-payer model where those who can afford this have it and those who can't miss out?
And that's the question that we're trying to tackle at the moment with, in my mind, no obvious solution.
It's going to be a challenge.
There's a situation where the conventional drug treatments are the cheapest way to treat depression, and lo and behold, they dominate mental health care.
Is that because they work fantastically well and have no side effects?
I don't think it is.
I think it's because they're cost effective and they can work in a kind of industrial health care system.
Do you think we're gonna end up in a situation where we're gonna legalize these drugs and they're gonna become common and people that don't have mental health issues are gonna start taking them because they feel this is good for them?
Yes, I do actually.
I think that's the direction of travel that certainly in the West, policies are liberalizing.
If the trials that are currently ongoing get through, which really we're on the cusp of this, this could be even less than a year away with MDMA therapy for post-traumatic stress disorder.
Then this becomes, in a sense, legal through a medical model.
Doctors can prescribe.
You can legally access MDMA or ecstasy.
So this is coming, and trials with psilocybin therapy, they might be a few years further down the track, but they're happening right now.
The kind of trials that medicine regulators need to look at to determine whether they're going to approve this And then the system has to change to accommodate this medically approved treatment that then becomes no longer illegal, but legal in this medical delivery system.
So it's coming now.
What of people who don't meet diagnostic criteria for a psychiatric disorder?
They don't present to their doctor with a mental illness.
Well, certain policy changes are opening that up as well.
Oregon's opening that up, Colorado, maybe Massachusetts, and maybe California.
Now, how do we assess the benefit and harms there?
We've done some studies, some naturalistic studies, sampling quite large populations of people to see not just those with mental illness having these experiences, but those who don't.
And the results generally do look positive as well.
There are improvements there as well.
However, it's difficult to know, in a sense, those significant adverse events when people have their psychedelic experiences and are significantly negatively affected.
What is the prevalence of that?
It's quite hard to work out, actually, to kind of cut through.
Some of the alarmism generally about drugs that perhaps is filtered down for a few reasons, but maybe cultural reasons around, say, the drugs war in the West.
But to cut through that and actually get at some data and know what the prevalence is is actually very difficult.
And then the prevalence could change if you have a system that is too open, in a sense, too liberal, and you don't have some of the safeguards that I've been describing.
Do I worry about a situation like that?
Yes, I do, because I played a role in developing the science and collecting the evidence that has shown safety and efficacy with psychedelics, but in this carefully controlled treatment model.
But that's a different thing to a free-for-all.
People doing it in the middle of the street, in the middle of the day.
And that worries me.
And there's a misunderstanding of what we've done.
If you take the evidence from what we've done and then you think you could have that, people taking psychedelics in the streets, and that it'll go well, is a misunderstanding.
It's not an inference that you can make of that.
So you're an expert in this field.
You've developed some of the science that is leading to where we are.
Have the leaders talked to you guys?
Do you think there's much input from you guys into these laws that we're making?
Yes, there have been some consultation with scientists.
I haven't specifically spoken to the senator that's behind this current bill in California.
I'd be willing to.
But he has been talking with other scientists in California and I think elsewhere.
So I hope they're giving him good advice.
Yes, there's differing opinions, but I think this is a hot one, and we only have to go back a few decades in California to see how things were going wrong with psychedelics.
And actually, policy changes were first to come in the US, in the state of California, because of, you could say, unregulated psychedelic use in, for example, the city of San Francisco, and adverse events that were being seen there.
So, you know, we should learn from history, and history repeats, and we need to be very careful with this one, I think.
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Law enforcement members that we've interviewed, they've told us that they're very worried about this, the consequences of a law like this because they have to deal with it.
If somebody's having these problems in the street or they're trying these kind of things, these kind of drugs, then they are the ones that have to deal with it.
What are your thoughts on that?
Well, I hear that, but their worry might be a little misplaced because this bill doesn't legalise psychedelic access.
So it just deals with the decriminalisation and says that if you're found with, say, magic mushrooms on your possession, then police aren't going to prioritise that and pursue a prosecution.
Maybe they've got more serious issues.
Crimes and misdemeanours to worry about and focus resources on.
So I understand that, that principle.
And again, this isn't overtly an opening up of access to psychedelics.
Is it covertly or inadvertently going to open up access?
Well, it may well.
It may well.
And if it does, do we have a regulated system that is going to sufficiently look after people's well-being?
And I'm not sure we have that.
That's why I'm a little bit nervous about this particular decriminalization bill.
Because we're decriminalizing use of psychedelics, but we don't really have the infrastructure to do it right.
Yes, that's it.
And perhaps if we're more patient, we could develop something that is more thoroughly worked through where we do have the infrastructure for ensuring good safety and efficacy.
Now, do you have any advice for our lawmakers and our governor, which is about to sign this bill?
Yeah, I guess my advice would be how thoroughly have you really thought this through in terms of how it will impact on the impression of access, that there'll be a sort of, you know, a sort of implicit view that this is legal now, because it's not.
You know, the decriminalisation bill isn't a legalisation bill.
But people may well treat it like it is.
And are we ready for that?
Because we don't know how that will play out.
I don't know and I'm a scientist in this space.
So Robin, from what you're saying, we are decriminalizing the psychedelics as a drug.
You have been experimenting with this.
You think that this is a good direction for actually not considering this as a crime to have psychedelics, but you're very worried that this law will allow people to maybe Mass use in cases where they are not supervised and they may just not do it for the reasons that you were mentioning, that you have experimented.
Is that correct?
Partly, yes.
It gives the impression of an unregulated, fully legal system.
It isn't actually that.
This isn't a legalization bill, but it will give the public that impression.
And so people may then make that step and, you know, procure, get their hands on some psychedelics and take them without any kind of well-informed safeguarding around their use.
Could get in trouble, they could be harmed, they could even harm others, and that obviously wouldn't be a good thing.
So that's why there's some hesitancy, some ambivalence in me about this particular bill.
I've seen some fantastic transformations, people's lives saved with psychedelic therapy done in the right way, yet I've heard of cases of people losing their lives through psychedelic use done in the wrong way.
So, in a sense, it's a simple formula.
If we're going to do this, we have to do it right.
What kind of impact could it have for California and beyond if we do this right?
Well, I do think it could be positive.
We've covered the severity of mental illness that we see, especially in the major cities in California.
It affects us all, whether directly or indirectly.
And we don't want that.
We want people to be well.
So if this is a treatment that could improve wellness, not just on an individual level, But on a societal level, on a population level, then that's potentially something to embrace.
But I don't think this bill is going to achieve that.
Now, do you have any other thoughts for our audience?
Gosh, well, you know, all interventions carry some risk.
You know, even drinking water, you can drink too much.
And anything in excess can be harmful, just like that principle of the dose makes the poison, you know, an ancient principle in medicine.
And so I think we should see psychedelics as carrying no intrinsic good or bad.
They're just tools.
And what really matters is what you do with the tool.
And I think that's how we should look at psychedelics, that these are powerful tools.
Because of that power, they need to be respected.
And they need to be used in the most well-informed way in order to try and get the most benefit.
Robin Carhart-Harris, UCSF professor.
It was great to have you on California Insider.
Thank you.
I've enjoyed it.
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