Illicit Drugs and Therapeutic Potential

Paul Grobstein's picture

Welcome to the on-line forum associated with the 2008 senior seminar in Neural and Behavioral Sciences at Bryn Mawr and Haverford Colleges. Its a way to keep conversations going between course meetings, and to do so in a way that makes our conversations available to other who may in turn have interesting thoughts to contribute to them.

Thoughts this week about

and our conversation based on them ...
Darrell J Carroll's picture

"Are these drugs really much

"Are these drugs really much different than, say, morphine?" Pretty sure, the answer is no

JaymElaine's picture

Illegal Drugs for Therapeutic Use

 

So, I must say that I think I am going to have to agree with a little of everybody here! Marissa’s thoughts on drugs for therapeutic use are completely valid and I agree the most here. What is so wrong with these drugs? Such drugs as ecstasy, LSD, and magic mushrooms give you this high, this extreme euphoria. Now when I looked up the exact definition of euphoria, it was described as a feeling of intense happiness; what is wrong with feeling intense happiness? OK, so we do not generally feel intense happiness all the time, but what is wrong with wanting to? And for those who are generally, clinically depressed, what is wrong with helping them (through the use these drugs) bring themselves up to a level of happiness that is satisfactory, a level that we are usually at?

More research needs to be done with these drugs, of course, to prove efficacy, efficiency, safe dosage, etc., but with the research that we do have now, there are no long term or harsh short term effects seen with prolonged use of any of these substances.

Cigarettes are legal, alcohol is legal, and perhaps coming to a state near you, marijuana is also legal. Cannot these substances also be abused to some degree? Nicotine is highly addictive and has proven to be a direct link to various types of cancers. Alcohol abuse aids in the increasing numbers of accidents caused by D.U.I/D.W.I.’s. Marijuana is still illegal, but only if not used for medicinal use in some states such as California; but it took a lot of work for even marijuana’s positive medicinal/therapeutic use to be recognized. If we can allow strict access to marijuana for therapeutic use, then perhaps we can do the same for ecstacy, LSD, and magic mushrooms.

Finally, I leave with a question. Do you think that part of the reason why these drugs are not legal and will not be legal for a long time is because the government does not have control over their production and sales? Distribution of nicotine and alcohol is regulated, but such substances as marijuana, LSD or even ecstacy are not necessarily made in this country and thus their production is regulated elsewhere and our government is left with no control over it. Perhaps these drugs would be OK for therapeutic use if they were not already coming as illegal imports. I may be wrong, but it is just a thought. 

  

Jayme E. Hopkins, '08

ehinchcl's picture

A short summary...

So I wanted to post late (partially because of break and needing to re-collect my thoughts about the discussion, but partially for the more productive reason of hearing what you all had to say) and provide a little bit of a summary and my response to the above. First, I want to thank you all again for such insightful comments and provocative questions both in our class session and on the boards-- Liz, Elliot, and I really appreciate all your thoughts.

There a couple of topics which we seem to keep coming back to, one of which is this concept of recreational use and legalization. It seems that the general concensus here is that there should be research done using these drugs-- most of us justified this by stating that the possible benefits outweigh the currently understood consequences. I think both Stephanie and Jenna brought up the interesting point at the beginning of the talk about what happens for these patients (talking in a medical context alone for a second) are outside their controlled therapeutic environment. Most studies only look at the effects of these drugs with such controls in place (there is no study where a patient talks it out and trips in a safe place in one condition as compared to just handing someone drugs and saying go for it), so I think it is a very necessary thing to be worried about. We don't know if it might be the COMBINATION of the setting and drug which allow for benefits-- in fact all the drug literature do state that setting/atmosphere are the most likely predictors of the "goodness" of the trip/experience. But then the issue becomes how we go about controlling this, especially if we move outside of the medical context and talk about legalizing recreational use.

In terms of this, Emily A. brought up the idea that many of these studies say that patients would not use/abuse outside of the study (to clarify though: most patients state that they would use again, because of the positive effects, but that the drugs were illegal-- which is worrisome-- and that they liked the environment -- which is good.) Therefore, I still feel that overuse could be a problem, though hopefully if bad trips is what we are working against you would think that anyone who had one would not use recreationally, sort of a self-selecting anti-abuse mechanism. However, if bad trips are not that prevalent then you could see over-use/abuse... but if there aren't bad trips then what is the exact problem?

which brings us to the other topic that seemed to keep coming up in discussion: neurodiversity and drug-use. I really like the way Jenna put it when she said that it would be a "personal choice as to your state of mind." This really makes these drugs exactly like we would consider alcohol-- you can use if you so wish. I also like Kara's point about the "natural" state of things; when she brought up that perhaps drugs are simply allowing us to use our brains in a completely natural, if different, way. I like this idea because if you think about it (and especially as many of these compounds are natural, and those that aren't mimic what we consider to be natural effects) there are a lot of things we do everyday that change our brain chemistry... all of which we have a choice about. what we eat changes our body/brain chemistry. what we do-- i mean adrenaline pumping activities (be it working out or constant stress) have been shown to have significant effects on our brain chemistry. in fact, to put it into what is seemingly a ridiculous example, couldn't we say we should call stress somewhat of an illegal "drug" because it has been proven to have serious negative effects on longterm function? now i realize that homework and job stress are not likely to become schedule I anytime soon, but it makes the interesting point that our everyday actions are a choice. it is only cultural imposition of this negative stereotype that brings up such negative intuition, as Ian put it, about drugs.

now im not saying we should completely legalize all drugs here and now... because I think we do need more information about their safety and actual mechanism of action. It seems to me that these drugs allow our brains to heal themselves (as we talked about with CBT), and alex t put it nicely when he said they allow for "disinhibition and therefore self-reflection." But before i put them on the market I want to make sure we aren't mimicking something with drugs that we dont fully understand...

thanks again for all the interesting ideas!

Ian Morton's picture

the artifacts of drug culture

While I am very interested in the medical and research potentials of drugs, I would like to address Paul’s concern of why these drugs should be limited to medical use. A couple people (Amelia and K Smythe) used the term “counter culture,” which is the topic with about which I would like to think more. As K Smythe recognizes, counter cultures are typically conceptualized with some degree of negativity. However, in keeping with our conversations about mental diversity, I believe it would be beneficial to move away from these negative views – though how to do so is a difficult question, to which Rebecca offers some insight. Accordingly, perhaps we should even drop “counter” from the term counter culture, recognizing that drug cultures may just be “different” instead of pitted against the rest of society.
So what potential benefits could the drug culture offer society at large? While non-medicinal potentials of drug use may not be very pragmatic in a direct sense, as we have already pointed out, drugs offer the potential to allow for new ways of thinking, new states of mind. This opens the door to greater mental diversity: new creative potential, new perspectives, new cultures. Perhaps one of the greatest examples of the creative potential of drugs is the music industry. Jimi Hendrix, Pink Floyd, The Grateful Dead, and The Beatles stand out as bands that have completely driven the evolution of modern music, and all of these bands were highly influenced by drug use in their compositions. Even if one doesn’t like these bands, it seems short-sighted to disregard the contributions they have made for the world of music. Even without going into the potential cognitive benefits of music, isn’t it enough to say that these bands make millions of people happy? Sure this conversation requires discussions of the risks of drug use to oneself and others, but if observations suggest drugs like MDMA, marijuana, and LSD don’t pose a major risk to people’s lives and well-being, why not let Jimi Hendrix be while he’s rocking out with a headband soaked in acid? This was really one of Rebecca’s points in class: that we should recognize the potential benefits offered by the artifacts of drug culture. It seems to me that such artifacts are sufficient enough reason to consider the value of drug use. In no way am I here proposing that everyone do drugs, or that drugs should be unconditionally legalized. Rather, I only want to highlight the positives that often get thrown into the shadows of stigma.
Finally, as Rebecca points out, much of the stigma against drugs is driven by an internal feeling – an intuition. If we are to change the way society views drugs such as MDMA, these intuitions are what must be targeted. Targeting intuitions, is a complex process that involves changing unconscious cognition. For example, there are observations that suggest that while someone may consciously report not to be racist or biased, they may unconsciously respond to members of a different race in a negative manner. (A poor description. See Blink by Gladwell for a complete description of these observations.) The point is that while changing conscious beliefs about race or drug use is important, it is not enough to induce complete cognitive change. If we hope to create significant change, we must also try to target unconscious processes (e.g. emotions, feelings, or intuitions). Perhaps it would pay to consider how we could target these negative reactions/views, working with both conscious beliefs/values and unconscious intuitions.
tlogan's picture

Perhaps changing our

Perhaps changing our perspectives of culture/counterculture can be a push towards a greater acceptance of neurodiversity, and with which could be a push to drop the negative connotations associated with cultures that actively accept drugs deemed by certain elites as taboo.  I agree completely that we cannot discount the contributions made by "drug culture" and with this I am including not only the musical contributions but also the literary contributions of writers whose works have been accepted by the mainstream culture.  I'm sure Kerouac, Huxley, Carroll, and Coleridge would have been deemed counter-culture by our standards today, but we still accept their products as literary genius.  I'm not saying that every tenth grader trying to write a short story for class should go "dragon chasing" but am rather simply agreeing with Ian's point that these great works, products of illicit drug use, are immutably important to our culture.  We should shift our definitions of illicit, as well as automatically making any drug used recreationally illegal, though I suppose this doesn't happen if the drug is already being produced by company turning a profit (example: Robatussin).  I am also not saying that some drugs should not be considered illegal; (pcp should not be allowed for recreational use) however, the deliberation to decide which drugs should be illegal should be less knee-jerk and more deliberate.  Societies have valued mind altering substances for millennia, but why is alcohol the only drug that is acceptable currently?  How did this happen?

 I also think it should be much easier for researchers to conduct research on drugs, as some might not only hold insight into the drugs themselves but also into the brain itself.  It seems quite unreasonable that we can make something illegal to research before it has been thoroughly researched. 

kbrown's picture

Is taking drugs unnatural?

Hi everyone,

    Just like everyone else has said before, I really enjoyed our class discussion the tuesday before break, and I have been mulling over the topics and questions brought up during our class period since then.  Something that has recently been brought to my attention is that during our discussion I feel like I may have had an unfounded biased opinion against the widespread use of pychedelic drugs.  I completely agree with most who have previously posted that with the information that the assigned articles gave and that I have subsequently gained, that the research of, if not direct use of pyschedelic drugs in the treatment of disorders such as PTSD should be legal, and that preventing such drug research is unfounded and seemingly hypocritical, as many of the commonly used drugs today (SSRI's etc), have been shown to sometimes have deliterious consequences without absolute effectiveness.  However, although I do believe that the use of these drugs for medical treatment specifcally should be legal, during our discussion it was difficult for me to be fully convinced that legalization of psychedelic drugs would be a good choice (neglecting the fact that I think it would take a very long time for a government which has seen the non-conformist effects of drug culture in the 60's to ever allow legalization of those drugs in the U.S.) 

I felt discomforted in some way about the widespread use of psychedelic drugs, a thought which, being brought up by parents who fully enjoyed the benefits of a 60's hippie experience, was foreign.  But neglecting the government for a moment, when I think back to our discussion I think what made me most uncomfortable about the widespread use of these types of drugs is that it would somehow be unnatural or against our nature to use drugs which so obviously altered our mental state, in such a profound way, on a regular basis, that even if it were not proven harmful to our health, that it would in some way be going against a natural course of knowledge acquisition and thought pre-ordained by mother nature. 

Having thought about this more, I have changed my opinion about "naturalness" of these drugs, mostly because it began to occur to me that by taking these drugs we are simply tapping into a function or use of our own, evolutionarily gained brain that had we not used these drugs, we could not have known about, which definitely ties in to many people's points during class that these drugs can be used for creative purposes.  Thinking about it this way, it seems that taking these drugs is an incredible way of temporarily altering the mind to think in a completely different way.  When we spoke in the first or second session about the diseased brain, I think a lot of people brought up the notion that diseases such as autism are not in fact dysfunctions but instead allow some individuals to excel at very different things.  Perhaps drugs create the same type of mental diversity in a more transient setting, a fact that in the end seems simply taking advantage of a natural ability of humans to create a society which benefits from the diverse abilities of each individual brain (or at least to have this type of society be a future goal).

Mawrtyr2008's picture

Can we learn from cigarettes?

In keeping with Elliot's post, I think it's important to compare the standards we set for one class of drugs with the standards we set for other classes of drugs. Many people in the forum have addressed the perceived danger of these drugs, which I think ties in nicely with a previous line of discussion we had about culture and science. It seems to me that all objective data suggests that the psychedelics are far less dangerous than people actually think they are. This line of thinking is evidenced by the frequent use of the terms "scary" "hard drugs" etc. I have to admit that I feel similarly... something about these drugs feels dangerous. I think it's precisely that feeling that can be attributed to culture and also all mixed up with observations like what these drugs do, who uses them, why those people use them, etc.

After acknowldeging that this is a cultural thing, it seems important to me to address how this can be changed. For this, I think that the example of cigarettes and nicotine is a great one. In our parent's generation, cigarettes were considered to not have a long-term negative effect on the body, and in some advertising cases, were touted as able to improve health. In one generation, cigarette use went from status quo to stigmatized. It's important to note here that this change happened through research on all levels of organization. Reserach drove this cultural change, even in the face of corruption, concealment, and blatantly unethical decisions on the part of tabacco corportations. This all sounds so similar to the history of psychedelics!

 

I think that you three did a great job of letting the data speak for itself. Clearly, there is a role for further reserach in this field. If that is ever allowed, overcoming the public stigma associated with this drug class will be a very large challenge, but not an insurmountable one, as the case of cigarettes shows. It seems to me that the really important (maybe overly simplistic or optimistic?) message of this account is simply that scientific research has the ability to not only shape the scientific sphere, but the culture that it operates in.

aamen's picture

Legalizing Illicit Drugs

After our discussion last class period, I personally am in support of the idea of using illicit drugs to help people with disorders that are generally very difficult to treat.  I agree with Jenna that if there is scientific evidence that MDMA really has a positive effect on PTSD sufferers, I don’t see how ethically we can deprive them of that chance to get better.  I would extend that idea to any illicit drug that appears to treat a difficult to treat condition, provided that negative side effects do not eclipse the good that treating the condition would do, and as many people have noted, that becomes difficult because people react in different ways to these drugs – some people, for example, might in general be more prone to bad LSD trips. 

 

Thinking in general about illegal drugs, I feel like there are some “harder” drugs which should remain illegal, but at the same time some “softer” drugs that are currently illegal, but I can’t understand why.  The problem, of course, is that if the softer drugs were to be legalized and the harder drugs were to remain illegal, the line drawn between “soft” drugs and “hard” drugs would have to be totally arbitrary.  I think what’s frustrating to me now is that drugs like morphine are legal for the treatment of pain, but the use of medicinal marijuana is so controversial.  In my mind, how scary or dangerous a drug is has to do mostly with how addictive it is, and I believe that scientific evidence indicates that morphine can be physically addictive, while marijuana is not.  I don’t necessarily see a problem with the idea of drugs being available for people in general to use, but I do see a huge problem with growing percentages of the population becoming addicted to these drugs and not being able to function normally without them.  The problem is, coming from the whole DARE program background, I’ve had the idea that drugs like heroine are instantly addictive to everyone who takes them – I thought Professor Thomas’ point that the majority of people will not become addicted to such drugs was very interesting, and makes me more open to the idea of legalizing illegal drugs in general.

 

I also thought Felicia’s point regarding the role of the government in how we feel about drug use was very interesting.  Going back to morphine vs. marijuana as a pain killer, it seems that marijuana has a negative stigma that morphine definitely does not – but I can’t think of any logical reason why that would be other than simply that the government tells us that morphine is ok.  I know this whole post is confusing, but I keep getting confused when I try to think about why some drugs are medicinally legal and others (shown to potentially help medical conditions) are not.

K. Smythe's picture

Legalization issues

 

            I have always wondered why we have such strict laws against some drugs that people have never lethally overdosed on, or even very infrequently, when some things like alcohol and tobacco, with very clearly shown lethal effects, are not only legal but only loosely regulated.  I had never really thought about the idea that the type of people using drugs affects the legislature surrounding them.  “Counter-culture” drugs, drugs that hippies, or Goths or whoever little known subculture are associated with, seem to get intensely bad raps.  I do believe it is hard to legalize a drug that has been regulated for so long without people going a little crazy at first, but by legalizing, regulating and even taxing, it seems to me that the government could control these substances more effectively, and even make money off of them.  It also does seem strange when some of these drugs have a) never been overdosed on and b) have mainly positive side effects that they are “schedule 1” drugs.

 The idea of “self medication” through both legal (such as alcohol) and illegal drugs is an interesting one to think about.  Although clinical testing is just starting for many of these drugs, there are lots of people out there whose recreational drug use could probably be considered therapeutic.  Just like we talked about talking to a friend or taking a vacation as therapeutic, many people “self medicate” with alcohol (often with tragic results) and I assume this is true for many illegal drugs. It would be interesting to see, outside of clinical trials, the effects of these drugs on people and their use as a way to handle stress, anxiety, etc.

Although on some level I’m not sure that outlawing benign drugs that simply put one in a euphoric or happy state makes a ton of sense, there is still a part of me that would worry if these drugs were completely legalized.  Although I know it is unlikely, I can still imagine a world where people just pop a pill (or whatever intake method) and zone out; where we are dependent on drugs for happiness and functional lives.  It would scare me if the only way I could find happiness was through substance use. This is probably due to reading too much fiction, but I’m sure that some of these fears aid to the rationalizations behind banning these drugs.  Interestingly I suppose the exact same thing could be said of alcohol and alcoholism.

Overall I think that there is definitely potential in these now illicit drugs, although legalizing them seems like a huge step if it is done appropriately I think that they could in fact help at least some people.  We have yet to find medications for many anxiety and stress related disorders that help everyone who is afflicted.  It seems to me that trying to find ways to help more people is a good thing (though I do personally believe that we should “start with what we’ve already got” in terms of treatment), and that if these illicit but mostly harmless drugs can help some of these people, then let’s give it a shot.

 

Amelia's picture

I have to agree with Steph

I have to agree with Steph that I am still skeptical about the use of drugs (in particular ecstasy) for treatment of such disorders as PTSD. When suffering from PTSD some of the most overwhelming aspects is a lack of interest in anything, feeling as though you will never be happy again, and a feeling as though you don’t belong in society because you can’t understand the emotions of others. While I can see how being able to feel euphoria again would be a reason for the use of ecstasy (and be reminded what it feels like), I think the risk of sinking later in the week is too great a risk to take since suffers are already functioning at a very low level. Also, the case study we read really talked about how taking ecstasy helped this patient define what was causing her symptoms--- most people with PTSD are very sure of why they are feeling the way they are and what triggered it. Maybe this was a way for this lady to think differently about her experiences and how to change what she was doing, but I don’t think that the strategy would work for all suffers.

This doesn’t mean, however, that these drugs cannot be used as treatments for some disorders at some point. The argument that people would abuse these drugs if prescribed them seems absurd. The risk for abuse would probably comparable to abuse of people taking pain killers etc: basically none for those people that are taking these drugs for medical purposes. More research needs to be done, however as we talked about in class this is very difficult. It will also be difficult because we can never be sure how closely an animal model relates to humans (especially when we're looking at cognition). While making psychedelics allowed unrestrictedly would be inappropriate, they should be available to researchers to learn more about them and to investigate potential clinical uses for these drugs.

In responding to some questions that Elliot posted, I think it’s interesting to think of these drugs compared to morphine and alcohol. In terms of morphine, these drugs could be made to be under the same sort of restrictions and lead to a more effective use of the drugs. Technically the purpose of using these drugs would be very different than to why one might be prescribed morphine, but their restrictions could be the same. While people do become addicted to morphine, it is still mainly used as a drug under physician’s care. These other drugs could be made to be like this as well, and by making it restricted but available, may cut down on the rates of abuse (since it’s not seen as illegal/daring to use any more).

Alcohol is an interesting comparison. People can easily die from an overdose of alcohol, while like we discussed in class, you don’t overdose on ecstasy or LSD itself. Alcohol abuse is also very prevalent. Why is it then that alcohol is legal and the drugs are not? It returns us to the question of the hippie/techno backlash and I would suspect that alcohol was not outlawed (in recent times) because it has become such a part of our culture. Imagine if alcohol was outlawed tomorrow…Drugs, on the other hand, became part of this counter-culture and the dominant culture was able to quash them out. Also, their discovery and use is very new (unlike alcohol) to our culture, and cultures take time to adjust to new things. With more research, it will be interesting to see how drugs such as LSD may have a new job in the medical field.

Andrea G.'s picture

Legalization?

I agree with what most people have said already as far as legalizing the use of MDMA for medical research.  I also think that a lot of the concerns that have been raised (e.g. "mid-week blues", long-term effects of the drug) can only be addressed if this research is allowed.  If animal models of MDMA action in the brain are not accurate reflections of human MDMA use, as some of the research we talked about last class suggested that they aren't, then the only way we can answer these questions is with human research. 

Going further to the idea of legalizing drugs like MDMA for everyday use is where I, and most people, seem to become conflicted.  I understand and support Marissa's argument that it's possible that legalization and subsequent regulation of the production of these drugs will lead to "cleaner" or even "safer" products that may not have quite so large of a possibility for bad hallucinogenic experiences.  I definitely think, that given the qualifications for a schedule I drug (i.e. a high potential for abuse and no currently accepted medical use in treatment), that drugs like MDMA should be reclassified.  It makes no logical sense that MDMA should be more highly controlled than cocaine, methamphetamine, or other highly addictive drugs, given its seemingly much less addictive properties (you can find a list of drugs and their classifications here: http://www.usdoj.gov/dea/pubs/scheduling.html).  A big part of me, for whatever reason (maybe it's DARE and all of those "this is your brain on drugs" commercials when we were little) still isn't ok with the idea of just legalizing MDMA altogether.  My hesitation is definitely something I'll continue to think about; if there's no logical reason for my opinion, I'll have to do some reevaluation.

atuttle's picture

The human element

Reviewing the comments posted so far, a few people have pointed out the potential shortfalls of the widespread use of MDMA as a therapeutic tool. Stephanie raises the important point about “suicide Tuesdays,” while Jenna alludes to the possible harm that “bad trips” may create. As with other psychotropic drugs, it would appear that MDMA’s history, as well as its current form, are still relatively undeveloped. Even drugs that have been thoroughly researched and refined (such as antidepressants, which have evolved several times from tricyclics to SSRIs to a new generation of SNRIs) impact the brain in many ways and lead to a variety of side effects (like those listed in Rx commercials you may have seen). With further research, clinicians may be able to hone in on the correct dosage or chemical synthesis to alter MDMA enough to reduce these unwanted side effects.

As Natsu points out, however, the fine-tuning of these hallucinogenic drugs is at the expense of clinical populations who may be receiving a placebo or a (potentially) more dangerous iteration of the medication. While some data indicates that these drugs do not cause brain damage, I feel that both the mechanism (i.e., biological pathway) of the drug and longitudinal data must first be collected and interpreted before the drug is used in a therapeutic capacity. The percentage of bad trips reported in the trials we discussed last week are not insignificant. Furthermore, as Emila A. points out, it is difficult to screen for potential psychological factors that could lead to a bad drug reaction. These drugs may in some cases exacerbate suicidal tendencies or anxiety, even if there is little evidence for organic brain damage.

Finally, Elliot raises an interesting point by questioning whether alternative therapeutic practices could lead to similar results in PTSD cases. Hypnotherapy and meditation are often disregarded as effective forms of therapy by mainstream psychologists, yet they achieve the same goal as MDMA: Disinhibition of the patient in order to facilitate self-reflection and a new point of view in order to break the “vicious circle” of anxiety or depression, including pernicious anxiety disorders like PTSD. While these types of therapy may not work for everyone, they may be effective alternatives to a drug-based therapy. And while MDMA may ultimately prove to be an easy way to achieve the same alternate state-of-mind, these alternatives appear to be more attractive in the meantime, both for clinical populations as well as for groups who are looking for an alternative viewpoint in life.

~Alex Tuttle

Haverford '08

Marissa Patterson's picture

Illicit drugs

I hope everyone had a great break! It has been very interesting to read over the comments people have made. I have to agree with Jenna when she says that drugs with therapeutic effects should be made legal, at least for medical useage. However I wonder why only THOSE drugs should be made legal, as opposed to ones that at the moment do not appear to have any kind of medical benefit. What is so "dangerous" about allowing these types of things to be sold in the same way that cigarettes or alcohol are.

We spoke some in class about why these drugs have such a bad reception. I know we talked a little bit about the history of illicit drugs, but I wonder if some of it has to do with historical usage. Many of these drugs were isolated in the lab or used by native American populations, but at least in class it didnt seem like many of them had been used much in Europe, though alcohol and tobacco were. Perhaps it was some kind of us/other concept that remained until the drugs became more popular in the 60's. And then again it was another kind of dichotomy, the upstanding moral citizens verses "those crazy radical kids" which led to them becoming so "wrong" and bad.

One part of the deal here is that there is this major stereotype that drug use causes a person to not be a productive member of society. While I am sure that happens in some instances, I have met quite a few people at my internship at Prevention Point of Philadelphia, a syringe exchange program, and have met quite a few heroin users that definitely do not fit the stereotypical "drug user" role. They can hold jobs, they pay their taxes, etc, and use heroin too. Why is it not their choice to do so?

Another question is if these drugs were made legal, would they be more "clean" or "safe?" I don't know about how this has works in countries where pot is legal, if the drugs end up being mixed less with other drugs. How many of the bad effects from LSD etc come from their being cut with other drugs?

Also I was wondering if these drugs were able to be used for medical treatments, how should they be tested? How would we be able to ensure safety (should we?) when dealing with these types of pharmaceudicals?

Felicia's picture

  Jenna brings up an

 

Jenna brings up an interesting point - that we seem to be more skeptical of SSRI's than MDMA, and while I think Liz is right and part of it has to do with the fact that they are often treating different things, I also think research has something to do with it. The sheer volume of research we have on SSRI's, both positive and negative, allows us to draw more and different conclusions. There is much less research on the therapeutic potential of illicit drugs, and this, at least for me, leaves more room for hope. Naturally we want to help those suffering with PTSD, and if there's any way MDMA would benefit sufferers, I would like to explore it further. In other words, I can be more positive about MDMA because there isn't a whole lot of research telling me not to be. Maybe it's because the readings and discussion were fairly persuasive, but it seems absolutely unfair to deny MDMA as a *possible* treatment option. Of course it has negatives (suicidal tuesdays, other side effects), but you'd be hard pressed to find a current therapeutic drug without a laundry list of side effects. I also think Emily brings up a great point - it's about the combination of drugs and therapy - not drugs alone.

I don't want to make it sound like I'm all for psychadelics, but at this point I'm all for their research. The most important thing missing for me is a mechanism of action (which is also what makes me skeptical of any other drug). In order to better understand the mechanism, we need better methods of doing so; our current level of brain imaging studies aren't going to cut it. I think animal models are the best option at this point (which I'm sure we'll get into this week). As far as recreational usage goes, I think that is a question that should be tackled far after we get the green light to study them.

Professor Grobstein's mention of scientific integrity is especially important. While we're taught to be critical of the literature, we also expect scientists to uphold reliable practices. Without the ability to place faith in the literature, experimental science is absolutely useless. That said, mistakes are inevitable and likely accidental. Is it coincidental that ecstacy and LSD landed on the schedule I list shortly after damaging papers? No way. Were the research mistakes accidental? Debatable, but probably. The problem here is in governmental regulation, which I am at a complete loss to propose a solution. In my mind it raises a lot of ethical questions (both medical and political), and when politics and the government enter any field it becomes hairy. It's possible that the papers evoked a fear (what if that really could happen?) and the classifications come out of concern. But that doesn't change the reality that these drugs may at some point be useful for PTSD sufferers. At this point I think it's the stigma (brought on by who? the government?) attached to the drugs that is preventing people from advocating for their potential usefulness.

I know that that was messy toward the end, but I look forward to hearing what others think about the government's role in this.

Paul Grobstein's picture

DARE to ...

Thank all for rich conversation. Some notes for myself, and anyone else interested ....

Its interesting, indeed encouraging, to have this conversation with a D.A.R.E. generation. But its also interesting how much the inclination is to think about use of psychedelics only in the narrow context of "medical' conditions. I wonder why the restrictive perspective?

I would be very interested in having someone pick up on the issue of whether there really is a close parallel between the appearance of a subsequently withdrawn research paper on the hazards of ecstacy shortly before its classification on schedule I and the appearance of a subsequently withdrawn paper on LSD and chromosome breakage shortly before its classification on schedule 1. There are serious issues of scientific integrity here, both in the research and in the mechanisms of drug classification.

I'm intrigued as well by the question of why a single LSD exposure might have effects comparable to a number of sessions of cognitive behavioral therapy or psychotherapy. Could a common feature be the realization of a "split" between what one feels and who one is? Would an experience of this kind be valuable to everyone, regardless of their "health" state?

 

Mawrtyr2008's picture

Thoughts on the Hypotheticals...

It seems to me that your first question and your third question are really the same. I have quite a few responses to this entire topic that perhaps shed some light on why it seems more comfortable, safe, right to limit psychedelic drug use to "the narrow context of 'medical' conditions".

It's very interesting that descriptions of trips on these drugs are largely positive and emphasize interconnectedness, unity, and empathy. This line of reasoning really resonates with me that perhaps this kind of drug use should not be limited to the medical box. However... the unpredictability of trips, and the harm that could result from them, makes me wary of extending legalizing them to recreational use. Someone during our discussion brought up the example of a busdriver tripping on these drugs to highlight the possibility of unintentional harm being caused as a result of a bad (or even a good!) trip. This line of reasoning is very similar to utilitarian philosophy, as in "your right to swing your fist ends at my nose". A different phrasing that suits this example better might be that a busdriver's right to a positive and beneficial trip ends when my child's wellbeing is put in jeapordy. The problem with this reasoning is that, of course, since so much data regarding the unpredictability of trips is anecdotal, we really don't know the frequency of bad trips vs. good trips. Couldn't medical research help here? Couldn't medical reserach be seen as a stepping stone to gathering more data to assess whether further legalization is appropriate?

I think this strong reaction that I have to this possible, though perhaps unlikely scenario sheds light on a catch 22 many people have about psychopharmacology in general. There have been several international headlining news regarding unpredictable behavior as a result of drug use. I'm thinking here of mass shooting tragedies in the US attributed to the dramatic effects of taking drugs or rapidly coming off a drug regimine. Why am I so wary about the psychodelics and not as wary about SSRIs, if they can have equally devastating potential consequences? It seems to me that if we're criticizing the psychodelics, our criticism must extend to reevaluate the drugs currently in circulation...

This was all a very roundabout way of saying, I don't think that limiting a discussion about psychedelics to "the narrow context of 'medical' conditions" is necessarily a bad thing at all. I think, rather, it could prove to be a way of creating cultural change (ex: introducing the public to a previously stigmatized group of chemicals) and more importantly (!) making a more informed policy choices regarding the legalization of this class of drugs.

natsu's picture

Human subjects and informed consent

It seems like people have already brought up a lot of interesting questions and topics in the forum, and I’d like to comment on the issues concerning informed consent that have been mentioned by several people above.

I’m not sure how many of us are currently doing research with human subjects, but the significance of obtaining consent for participation, is something that I’ve personally had a lot of opportunities to think about during my project working with elderly patients who have Alzheimer’s. Like with any research, we have to obtain consent from all of our subjects- we give them a form and they sign it (if they still have the ability to write their name; otherwise this step is done verbally and we also obtain written consent from their caregiver). However, to be honest I am quite sure that some of our subjects who are in the severe stages of AD do not have any idea that they are in a study even though we have been working with some of them for over three months, and sometimes this makes me feel uncomfortable. Perhaps the thing that I dislike the most about research is that sometimes I feel like I am forcing people to do things. Most of our subjects seem to enjoy working with us and our computer exercises, but it is not at all rare for subjects to express feeling tired, bored or unhappy about what we are doing. Of course, most treatments have some unpleasant component to it; if we didn’t continue to stick to treatment just because it is a mildly unpleasant, we would probably not get to experience the positive effects. So I know that we can’t let people drop out simply because they complained about some part of the treatment being a little bit unpleasant- after all, people complain all the time and one of our most important roles as experimenters is actually to encourage people to continue and push people when they are in a complaining mood. While I understand this, I find this hard to justify sometimes, because I don’t feel as if I have obtained full consent from the subjects themselves in the first place.

While I do think that research on the possible use of psychedelic drugs is very important, I also think that conducting research on these drugs would be challenging because it could be difficult to monitor the side effects and participant consent. When we are testing substances that could potentially be so dangerous, it will probably be important to stop the administration of the drug whenever physicians see even the slight signs of adverse effects. Granted, most of the effects of the drugs aren’t supposed to be too bad (as Professor Grobstein noted in class) there also have been self-reports from people who have suffered severe dangerous effects after taking these drugs. But if we stopped people in this way, will we really be able to see the full positive effects? Also, what if an experimenter noticed signs of some negative effects and wanted to stop the administration of the drug, but the patient wanted to continue because he didn’t want to go back to suffering from the original disorder (like PTSD)? The informed consent must be composed REALLY carefully, because if the person had perceived that volunteering for the study means getting treatment in return, the subject would probably feel very unhappy that he did not get the full treatment that was promised to him. As Liz mentioned in class, in the end it really is about cost vs. gain. There may be some risks, but if the original condition is so debilitating you might want to take a risk, even if that might mean suffering from some negative effects. The assumption seems to be that these drugs will be used for people who are suffering from really severe forms of depression, fear and anxiety, but can we really depend on such individuals to make judgments about what psychological changes the drugs are promoting and make accurate cost vs. gain judgments? I know that the studies are performed under careful monitoring by professional experimenters, but who gets to choose whether the benefits are outweighing the costs during treatment, the subject or the experimenter?

Emily Alspector's picture

More thoughts

I thought this weeks discussion was really interesting. One thing Elliot brought up in his post above that I didn't think of was using these drugs on children. I don't think I could support that because of the obvious hallucinatory effects and the possible trauma that a child could encounter with the use of these drugs. Children who are depressed are difficult enough between the SSRIs being potential suicide-encouragers and their cognitive, emotion, and mental immaturity, that adding another factor like psychadelic drugs into the mix is just dangerous.

I am currently taking psych of trauma, and when dealing with veterans (and other trauma victims) with PTSD, their traumatic memories are almost inescapable. Thus, I think the hallucinatory effects of these drugs are similarly dangerous as in the case of small children. Also, the results of these drugs seem to be greatly dependent on the spirituality and openmindedness of the patient, and I think that with some people with PTSD, these are not going to be very prominent characteristics. Perhaps there can be some type of program designed to ease patients in to use of these drugs therapeutically (I think this was talked about briefly in class), and I'm wondering what exactly this would consist of. However, tor discussion on CBT two weeks ago really hit home to me; it's not about the drugs and it's not about the talking, it's about both simultaneously. In most psychiatry sessions, I think, the drugs and talk therapy go hand-in-hand, but with administration of these drugs, a good deal of preparation would need to take place. Is that enough? What might happen if a patient is given these drugs before he or she is ready? Drugs that induce a mind-altered state should obviously be treated with strict care, but is that enough? Are the effects worth risking for all the potential damages? More often than not, revisiting the trauma is more traumatic than the actual experience; having so little control over where the patients mind is actually roaming can have enormously dangerous consequences.

I was also very surprised that none of the prison inmates who were given the magic mushrooms wanted more after that. If it is such an overwhelming, eye-opening, spiritual experience, what about it makes people not want to revisit? Perhaps its the right about of intensity where people enjoy it but also know their limits. this seems to be a problem with alcohol consumption (also briefly mentioned in class). Because alcohol has been around for so long (and because it is much cheaper to buy), it would be near impossible to outlaw it. However, it seems to be much more dangerous than these psychadelic drugs. Questioning why the government was so set on outlawing LSD so quickly is beyond my scope of the issue. However, I would like to talk more on the topic of how government regulation of drugs is decided, what bases and what credentials are needed for a schedule one drug, etc.

 

Stephanie's picture

still skeptical...

I enjoyed our topic of discussion on Tuesday- Illicit drugs & their therapeutic potential.  I think our discussion raised many interesting and controversial issues.  Despite the recent evidence (studies we read about) supporting illicit drugs for therapy, I am still a little skeptical.

First, during the presentations, I remember Liz talking about the 'crashing' following using the drug- for example, Ecstasy users who use the drug on the weekends, experience "suicidal Tuesdays" and bad, serious "mid-week blues."   These effects occur days after taking the drug- so, when considering using these drugs for therapy, I think it is very important that we consider the effects the drug may have after being ingested, even a week later- not just the effects for the 8 hour therapy session where the drug's main effect is being experienced by the patient and supervised by a therapist- but what about a few days later when the patient is not with the therapist and is feeling these "suicidal Tuesdays"??  I think this could pose many problems especially for patients with PTSD and other disorders who may even have more intense feelings of "suicidal Tuesdays" and "mid-week blues" than the normal, healthy recreational Ecstasy user.  I think we need to think about the crashing or coming off of these drugs when we are considering them for potential treatments.  Would the effects during the eight hours of the therapy & drug session outweigh these after-effects of the drugs like "suicidal Tuesdays"?  I'm not too sure myself, but I think we must consider these things when investigating these drugs for therapeutic use. 

The potential harmful effects of these drugs need to also be investigated before we begin to use them- might these drugs have long-term effects on memory?  I think we need to do more studies investigating the effects of these drugs on the brain- and this most likely means using fMRI methods- which can be helpful, however, some of the smaller more micro changes occurring in the brain cannot be seen using brain imaging, so maybe in the future we will have better ways of investigating the effects of these drugs on the brain, cognition, and behavior.   Maybe the changes or damages these drugs are inflicting on the brain are too small for us to "see" right now with our current technology- I am still skeptical that using these drugs does not have any harmful or long-lasting side effects on your body or brain. 

Also, some people for example with the congenital heart defects have very bad reactions to some of these drugs, even death- so I think if we decide to use these drugs for therapeutic purposes a list of "exclusionary" criteria need to exist so people with these defects who may easily be harmed by the drug are excluded from taking it. 

ebitler's picture

MDMA Safety and MDMA vs SSRIs

Stephanie-

Most of the research into these drugs has aimed to address the issue of safety, especially when considering long-term use. This was of course made very difficult with the substance restrictions, but there's been a ton of research for the past 15 years or so (at least for MDMA, which is the only substance I'm talking about here).

The current trials are taking place because it seems at this point that there are no *extremely severe issues that arise from long term use. This is based on subjects that used MDMA, and these studies all have numerour problems (for example many of the subjects also used other drugs at some point, the studies aren't controlled experiments, etc.) The jury is still out on whether or not the physiological changes are "safe," especially when you're talking about long-term use. And to be honest I think it always will (the groups that want to find evidence that MDMA's physiological consequences are severe seem to find it, and vice versa for groups that expect moderate changes with effects that diminish over time).

Beyond the physiological consequences, the research that really made the strongest case for me was the article that examined consequences of MDMA use on cognitive functioning. They found deficits of verbal memory in heavy MDMA users compared to less-frequent users (<50 times!) and non-users. There were no significant differences in intelligence, attention, information processing speed, language, visual/spatial cognition, non-verbal memory, or execuitive functioning.  This suggests to me that while there is no consensus on the physiological changes, the cognitive changes are very minimal even with chronic use.

Back-Madruga, Boone, Chang, Grob, Lee, Nations, et al. (2003).  Neuropsychological effects of 3,4-methylenedioxymethamphetamine (MDMA or Ecstasy) in recreational users.  The Clinical Neuropsychologist.  17(4): 446-459.

I also think that it's very difficult to compare SSRIs to MDMA for PTSD treatment. Although SSRIs are prescribed to PTSD sufferes, they're not very effective. And more importantly, SSRIs are meant to be used daily for an indeterminable amount of time. MDMA however is only meant to be used a few times (maybe 2 or 3 times over the course of 1 year at most in a therapeutic setting). So although it does affect the seratonin system, the use would be incredibly infrequent. The idea with ecstasy is that its not any long-term physiological changes that are helping the patient over time (as with SSRIs), but rather the one or two instances changing the mental state that helps the patient get over major barriers they're facing so that they can deal with their issues better when they're in an un-altered mental state.

That said, I think your point of the mid-week withdrawal symptoms highlights another issue, as they may be more problematic in people suffering with disabling issues than the recreational population.

Danielle's picture

MDMA vs SSRIs

I think that the evidence shows that MDMA has treatment potential for people diagnosed with anxiety “disorders”. While I understand the value of pursuing further research for the treatment of different anxiety “disorders” with MDMA, I do not understand why we cannot make use of the prescription drugs we currently use to help people with these “disorders”. If MDMA works directly by mimicking serotonin and working through serotonin pathways, why cant we use SSRIs to treat anxiety related disorders? Also, I think research should focus on the similarities between SSRIs and MDMA, and specifically compare the effectiveness of both drugs in treating people with anxiety disorders. I think that in order to make people more accepting of MDMA as a treatment for anxiety, studies need to prove why MDMA treatment would be more effective than SSRIs or SSNRIs.

 

I wonder if MDMA would make a person diagnosed with anxiety more functional. I think that before these drugs can be used for treatment, the pathways by which they function and interact need to be further elucidated. People who have taken these drugs recreationally all report very different symptoms and react to situations very differently under the influence of these drugs. The action of these drugs within the brain and other bodily systems is still very unpredictable. In order to convince the public to accept these drugs as a treatment option they need to be completely understood. At this point I understand that research on the method of action of these drugs is limited, but if given a chance I think that some very interesting information could come out of these studies.

Jenna's picture

According to the promising

According to the promising results of the current preliminary research being done I don’t believe there is an ethical way to stop further research on using MDMA for PTSD.  Given the ineffectiveness of current treatments for PTSD and its debilitating nature I think it is important to pursue all promising treatments for this illness.  In general, I don’t think that drug policy should play a role in a drugs availability for research because just because a drug can be used recreationally doesn’t mean that it can’t have real therapeutic value.  

That being said, I think it is interesting that as a class we seemed more supportive of using MDMA for treatment than we were for using SSRIs for the treatment of depression even though there has been more research done on the use of SSRIs.  Although the SSRI research results are controversial there are many anecdotal cases where people say that SSRIs really made a difference in their lives.  Since most of the current research and enthusiasm for MDMA use in PTSD comes from anecdotal evidence I wonder why we are more positive about the quality, promise, and moral use of MDMA than SSRIs.  Last week we talked about how it may be better to try therapy alone first before turning to drugs for treatment.  Therefore, should MDMA also be used only in severe cases and as a last resort?

Along with this, while I believe if any drug has a therapeutic effect it should be legal, I have a harder time finding a similarly valid argument for whether drugs with no tested therapeutic purpose should be made legal for everyday use.  I see the similarity between MDMA and alcohol in that they both cause an altered state of mind and are used recreationally; however, I still have a harder time imagining going to the store and buying LSD for the weekend.  This is could be because I grew up in a “DARE” society which warned against the evils of “hard” drugs, but I think it equally warned against the danger of alcohol and I have much less trouble accepting alcohol than I do these other drugs.  Actually, I think there could be a good argument for making ecstasy legal.  However, I think that the hallucinations which can be caused by LSD make it a more “scary” drug and less safe to have in the general population.  I don’t know how real or common hallucinations are with LSD but if they could cause people to think they are a bird and jump off buildings or think another person is a witch and try to kill them I think it has more potential to be dangerous.    

Should we also make other psychoactive drugs (such as SSRIs, antipsychotics, ridalin, etc) legal for everyday use?  If we say that LSD and other hallucinogens should be legal for recreation than why can’t all prescription drugs be legal?  Perhaps it should be someone’s individual choice on what state of mind they want to have and all drugs should be legal as long as everyone is aware of the possible negative side effects.  It may be due to the culture I grew up in but I find this idea somewhat disturbing.  In this society people could take drugs to ease their pain anytime they wanted and since most people dislike pain I think this would be a common occurrence.  I’m sure not everyone would take it, but looking at today’s society it seems that many people are looking for a quick and easy cure for depression and other illnesses. However, we previously talked about how sometimes a depressed or anxious state of mind is a good and normal thing.  By changing society in this way would we be eliminating an important part of our human experience?

Elliot Rabinowitz's picture

Some more questions...

I would just like to reiterate Liz’s feelings – thanks for a fun and interesting discussion Tuesday night. Psychedelic drugs certainly provide enough controversy; they deal with everything such as their proposed medical benefits/harms, how they should be used, how they affect our bodies, how history has affected our ideas concerning these drugs, and much much more.

 

I also have some discussion topics that we touched on in class, but may be beneficial to further analyze through this forum. The first general idea concerns patient selection. Informed consent is an ethical standard considered extremely important in our medical environment. It is sometimes defined as “understanding, appreciating, reasoning, and expressing a choice.”

Can it truly be provided by patients suffering from psychiatric illnesses? How about from children or the elderly?

What if there are other options (such as holotropic breathing – basically induced hyperventilation) that could generate similar effects as these drugs? Should these psychedelics only be considered last resort options?

Should parents or family members be able to make decisions for others? Should the courts? Should doctors? If so, in what circumstances?

Phase trials are crucial for obtaining more research and learning how these drugs work in the human body. However, how should patients be selected and the trials be run, especially when we’re not sure how the drugs work and cannot necessarily predict their outcomes?

 

The second topic deals with the socio-cultural aspect of these drugs – parts of this topic were definitely discussed in class. Some more questions…

How much are our views today concerning these drugs affected by the hippie/techno backlash? Are we ready to change? Should we change? In what ways (e.g. make psychedelics generally legal or restrict them solely to medical settings)?

Are these drugs really much different than, say, morphine? What about as compared to alcohol?

What is the potential/risk for abuse? Is this likely?

How could their use be regulated safely and effectively?

Would allowing these drugs potentially promote other drug use that may not be so beneficial?

 

I know those are a lot more questions, but just find something that interests you and run with it! Excited to see what others have to say about this broad spectrum of ideas.

 

Thanks!

- Elliot

ebitler's picture

Thanks everyone for a fun

Thanks everyone for a fun (and thoughtful of course) night!  There were a lot of questions that came up tonight that we didn't even think of before, so there are also a lot of questions that we came up with that the class never got to.  I'll post the discussion questions that I had in mind here in case they spark any additional comments/discussion.  And here's what you really all want, the link to the party mouse page:

http://learn.genetics.utah.edu/units/addiction/drugs/mouse.cfm

So the first topic/set of discussion questions:

Based on an article about ecstasy for PTSD as relevant to veterans:

http://www.veteranstoday.com/modules.php?name=News&file=article&sid=2832

Currently there are over 25 million veterans and there are more overseas.  It's been projected that we can expect over 300,000 new cases of PTSD within the returning population of veterans, and the cost of treatment and lost revenue has been estimated for these PTSD cases to be $600 billion.  This information highlights Earl's question of how likely do you think is it that these drugs will be effective and used in the future therapeutically?  It seems that a drastic increase in the number of PTSD cases will highlight a need for treatment options.  Additionally, a quote from the veterans PTSD article brings into question the ethics of the policy preventing research: "It is inconsistent with traditional medical ethics or outright unethical to block treatment development and research based on drug policy."  This in light of the incidence of PTSD leads to a number of questions...

     Should we prioritize MDMA research due to the number of returning veterans?

     Should drug policy play a role in this potential research?

     Do you feel that it is unethical for the same institutions responsible for sending troops overseas are the same institutions preventing research into potential treatment options for these veterans?

     If shown to be effective, should MDMA therapy sessions be offered to all returning veterans?

     If you feel MDMA treatment options should be offered to veterans, do you feel that MDMA treatment options should be offered to civilians with PTSD?

     At what point should MDMA treatment options be offered to someone with PTSD?  Only after other (consistently ineffective) methods are tried extensively?  As the primary treatment option offered?

 

And the second topic/set of questions:

Other uses for these drugs...

     Given the mental changes that one experiences under the influence of the drugs that we talked about, what is the potential for use of these drugs in other settings?  For example, would a business corporation be more productive if they promoted "mental diversity" once a month by taking LSD together and thinking about the company and their work creatively?

     Do these drugs promote mental diversity?

     If so, to what extent should we promote use of these drugs beyond the therapeutic setting?  What other problems does this bring up (besides the obvious legal issues).

 

So those are just some questions to consider in addition to all the great questions that came up in class!

Thanks again!

-Liz

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