Reposting: Set and Setting, a view from Joseph Campbell

Campbell provides a succinct example below which highlights the importance of preparing for and having the appropriate mindset prior to engaging in a psychedelic experience. Preparation and a supportive environment are key.

Set and Setting. Set refers to ones mindset. Why are you taking psilocybin? If it is just to get high, just for kicks, or to escape reality then forget it because "the magic is not going to work". If you are taking it to grow spiritually, to feel connected to those around you, to deal with an existential crisis or for an addiction problem
then you may be on the right path. Setting is the environment both social and physical that you will be in while the psilocybin is having its effect. Having a supportive environment that is familiar and relatively free of extraneous stressors with the presence of a spiritual guide or trained therapist is important.

Below is a conversation between journalist Bill Moyers and mythologist Joseph Campbell. Their enlightening discussions was made into a PBS series titled Joseph Campbell and the Power of Myth in 1988. A book, the Power of Myth followed.

In the course of their discussion, Joseph came to describe the peyote ritual found amongst Native Americans in north-western Mexico. Keep in mind that there are 3 main classes of psychedelics that work on the 5-HT2A receptors. The 3 classes are represented by psilocybin, peyote and LSD.

CAMPBELL: These missions are mystical journeys with all of the details of the typical mystical journey. First, there is disengagement from secular life. Everybody who is going to go on this expedition has to make a complete confession of all the faults of his or her recent living. And if they don't, the magic is not going to work. Then they start on the journey. They even speak a special language, a negative language. Instead of saying yes, for example, they say no, or instead of saying, "We are going," they say, "We are coming." They are in another world. Then they come to the threshold of the adventure. There are special shrines that represent stages of mental transformation on the way. And then comes the great business of collecting the peyote. The peyote is killed as though it were a deer. They sneak up on it, shoot a little arrow at it, and then perform the ritual of collecting the peyote. The whole thing is a complete duplication of the kind of experience that is associated with the inward journey, when you leave the outer world and come into the realm of spiritual beings. They identify each little stage as a spiritual transformation. They are in a sacred place all the way.

MOYERS: Why do they make such an intricate process out of it?

CAMPBELL: Well, it has to do with the peyote being not simply a biological, mechanical, chemical effect but one of spiritual transformation. If you undergo a spiritual transformation and have not had preparation for it, you do not know how to evaluate what has happened to you, and you get the terrible experiences of a bad trip, as they used to call it with LSD. If you know where you are going, you won't have a bad trip.

MOYERS: So this is why it is a psychological crisis if you are drowning in the water where --

CAMPBELL: -- where you ought to be able to swim, but you weren't prepared. That is true of the spiritual life, anyhow. It is a terrifying experience to have your consciousness transformed.

MOYERS: You talk a lot about consciousness.

CAMPBELL: Yes.

MOYERS: What do you mean by it?

CAMPBELL: It is a part of the Cartesian mode to think of consciousness as being something peculiar to the head, that the head is the organ originating consciousness. It isn't. The head is an organ that inflects consciousness in a certain direction, or to a certain set of purposes. But there is a consciousness here in the body. The whole living world is informed by consciousness. I have a feeling that consciousness and energy are the same thing somehow. Where you really see life energy, there's consciousness. Certainly the vegetable world is conscious. And when you live in the woods, as I did as a kid, you can see all these different consciousnesses relating to themselves. There is a plant consciousness and there is an animal consciousness, and we share both these things. You eat certain foods, and the bile knows whether there's something there for it to go to work on. The whole process is consciousness. Trying to interpret it in simply mechanistic terms won't work.

MOYERS: How do we transform our consciousness?

CAMPBELL: That's a matter of what you are disposed to think about. And that's what meditation is for. All of life is a meditation, most of it unintentional. A lot of people spend most of life in meditating on where their money is coming from and where it's going to go. If you have a family to bring up, you're concerned for the family. These are all very important concerns, but they have to do with physical conditions, mostly. But how are you going to communicate spiritual consciousness to the children if you don't have it yourself? How do you get that?  What the myths are for is to bring us into a level of consciousness that is spiritual.

Recent research/news keeps trickling in

Publication source: Journal of Psychopharmacology (August 2016)
Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences.  (PDF)
Basically concludes a 'bad trip' may not be so bad in the long run and may even be positive.  Still, be advised to only ingest for the right reason in a supportive environment.

Publication source: Journal of Toxicological Sciences (2015):
Ecstasy (MDMA) Alters Cardiac Gene Expression and DNA Methylation: Implications for Circadian Rhythm Dysfunction in the Heart.
Another reason why MDMA should NOT be used to treat PTSD.  Psilocybin does not have the high degree of toxicity that MDMS has.

Publication source: International Review of Neurobiology (2016)
Treating Addiction: Perspectives from EEG and Imaging Studies on Psychedelics:  (PDF)
This chapter outlines relevant EEG and brain imaging studies evaluating the effects of psychedelics on the brain. This chapter also reviews evidence of the use of psychedelics as adjunct therapy for a number of psychiatric and addictive disorders. In particular, psychedelics appear to have efficacy in treating depression and alcohol-use disorders.

Publication source: Psychopharmacology journal: (October 2016):
Alterations of consciousness and mystical-type experiences after acute LSD in humans (Full-text/PDF)
LSD not as effective in facilitating a mystical experience as psilocybin.

Publication source: Journal of Humanistic Psychology (October 2016):
A Comparison of Psychedelic and Nonpsychedelic Mystical Experiences
This study was authored by researchers from:

• University of Pennsylvania, Philadelphia, PA, USA
• University of North Carolina, Chapel Hill, NC, USA
• University of Melbourne, Parkville, Victoria, Australia
• New York University, New York, NY, USA
• Thomas Jefferson University, Philadelphia, PA, USA
• University of Tennessee at Chattanooga, Chattanooga, TN, USA

Experiences of profound existential or spiritual significance can be triggered reliably through psychopharmacological means using psychedelic substances. However, little is known about the benefits of religious, spiritual, or mystical experiences (RSMEs) prompted by psychedelic substances, as compared with those that occur through other means. In this study, 739 self-selected participants reported the psychological impact of their RSMEs and indicated whether they were induced by a psychedelic substance. Experiences induced by psychedelic substances were rated as more intensely mystical (d = .75, p < .001), resulted in a reduced fear of death (d = .21, p < .01), increased sense of purpose (d = .18, p < .05), and increased spirituality (d = .28, p < .001) as compared with nonpsychedelically triggered RSMEs. These results remained significant in an expanded model controlling for gender, education, socioeconomic status, and religious affiliation. These findings lend support to the growing consensus that RSMEs induced with psychedelic substances are genuinely mystical and generally positive in outcome. 

Publication source: Neuroimage: clinical (2016)
The mixed serotonin receptor agonist psilocybin reduces threat-induced modulation of amygdala connectivity (Full-text/PDF)
Highlights:

• We measured BOLD signals during a threat-inducing pictures task.
• Subjects were treated with psilocybin (a serotonergic hallucinogen) and placebo.
• We compared effective connectivity changes between psilocybin and placebo using DCM.
• We found that psilocybin decreased top-down connectivity from the amygdala to visual cortex.
• Results point at a neural mechanism underlying emotional shifts induced by psilocybin

Since the amygdala plays a key role in PTSD, this is another good reason for the DoD and/or Veterans Administration to conduct a Clinical Trial utilizing psilocybin to treat PTSD.

Publication source:  Therapeutic Advances in Psychopharmacology (June 2016):
Antidepressive, anxiolytic, and anti-addictive effects of ayahuasca, psilocybin and lysergic acid diethylamide (LSD): a systematic review of clinical trials published in the last 25 years (PDF)
In conclusion, ayahuasca, psilocybin and LSD may be useful pharmacological tools for the treatment of drug dependence, and anxiety and mood disorders, especially in treatment-resistant patients. These drugs may also be useful pharmacological tools to understand psychiatric disorders and to develop new therapeutic agents. However, all studies reviewed had small sample sizes, and half of them were open-label, proof-of-concept studies. Randomized, double-blind, placebo-controlled studies with more patients are needed to replicate these preliminary findings.

Publication source: The Baltimore Sun: (September 2016):
Growing research finds psychedelics effective in treating disease
Since Johns Hopkins is in Baltimore, this article mostly likely arose due to their proximity.

Research Update

There has been a paucity of recent, original research published on mindfulness and/or psilocybin for PTSD or other related mental health issues.  Two major articles from Johns Hopkins (Clinical Trial) and New York University (Clinical Trial) that utilized psilocybin to treat the existential distress frequently experienced by cancer patients are due to be published soon, but then I have been thinking that for the past 9 months. However, there has been a preliminary report in December 2015.

My hope it that both articles will both be published in the same issue of the same high profile journal such as the New England Journal of Medicine (NEJM - 2015 impact factor is 59.558,  the highest among general medical journals) or possibly the Journal of the American Medical Association (JAMA - 2015 impact factor is 37.684) since both articles in the same issue would increase public awareness of the profound usefulness and extremely low toxicity of psilocybin when used for the right reason in a supportive environment. It would also bring to light the very real possibility that those individuals with a limited time on this earth could avoid the use of mind numbing drugs like antidepressants, benzodiazepines, and high doses of narcotics though judicious use of psilocybin to ease their existential distress at this critical stage of life.

In May 2016 an article titled 'Changes in Mindfulness and Posttraumatic Stress Disorder Symptoms Among Veterans Enrolled in Mindfulness-Based Stress Reduction' was published in the Journal of Clinical Psychology.

Changes in Mindfulness and Posttraumatic Stress Disorder Symptoms Among Veterans Enrolled in Mindfulness-Based Stress Reduction
OBJECTIVES: The current study assessed associations between changes in 5 facets of mindfulness (Acting With Awareness, Observing, Describing, Non-Reactivity, and Nonjudgment) and changes in 4 posttraumatic stress disorder (PTSD) symptom clusters (Re-Experiencing, Avoidance, Emotional Numbing, and Hyperarousal symptoms) among veterans participating in mindfulness-based stress reduction (MBSR).
METHOD: Secondary analyses were performed with a combined data set consisting of 2 published and 2 unpublished trials of MBSR conducted at a large Veterans Affairs hospital. The combined sample included 113 veterans enrolled in MBSR who screened positive for PTSD and completed measures of mindfulness and PTSD symptoms before and after the 8-week intervention.
RESULTS: Increases in mindfulness were significantly associated with reduced PTSD symptoms. Increases in Acting With Awareness and Non-Reactivity were the facets of mindfulness most strongly and consistently associated with reduced PTSD symptoms. Increases in mindfulness were most strongly related to decreases in Hyperarousal and Emotional Numbing.
CONCLUSIONS: These results extend previous research, provide preliminary support for changes in mindfulness as a viable mechanism of treatment, and have a number of potential practical and theoretical implications.
Stephenson KR, Simpson TL, Martinez ME, Kearney DJ.
J Clin Psychol. 2016 May 6. doi: 10.1002/jclp.22323. [Epub ahead of print]
PMID: 27152480
Cited by (Google Scholar)
(PDF)

A long-term, >12 months, follow-up study titled 'Long-term follow-up of psilocybin-facilitated smoking cessation' has been published in the American Journal of Drug and Alcohol Abuse this month (July 2016).  I had discussed the original study in a previous post.

Long-term follow-up of psilocybin-facilitated smoking cessation.
BACKGROUND: A recent open-label pilot study (N = 15) found that two to three moderate to high doses (20 and 30 mg/70 kg) of the serotonin 2A receptor agonist, psilocybin, in combination with cognitive behavioral therapy (CBT) for smoking cessation, resulted in substantially higher 6-month smoking abstinence rates than are typically observed with other medications or CBT alone.
OBJECTIVES: To assess long-term effects of a psilocybin-facilitated smoking cessation program at ≥12 months after psilocybin administration.
METHODS: The present report describes biologically verified smoking abstinence outcomes of the previous pilot study at ≥12 months, and related data on subjective effects of psilocybin.
RESULTS: All 15 participants completed a 12-month follow-up, and 12 (80%) returned for a long-term (≥16 months) follow-up, with a mean interval of 30 months (range = 16-57 months) between target-quit date (i.e., first psilocybin session) and long-term follow-up. At 12-month follow-up, 10 participants (67%) were confirmed as smoking abstinent. At long-term follow-up, nine participants (60%) were confirmed as smoking abstinent. At 12-month follow-up 13 participants (86.7%) rated their psilocybin experiences among the five most personally meaningful and spiritually significant experiences of their lives.
CONCLUSION: These results suggest that in the context of a structured treatment program, psilocybin holds considerable promise in promoting long-term smoking abstinence. The present study adds to recent and historical evidence suggesting high success rates when using classic psychedelics in the treatment of addiction. Further research investigating psilocybin-facilitated treatment of substance use disorders is warranted.
Johnson MW, Garcia-Romeu A, Griffiths RR.
Am J Drug Alcohol Abuse. 2016 Jul 21:1-6. [Epub ahead of print]
PMID: 27441452

Results of the smoking cessation study above are quite impressive since prescription medications such as Chantix, the most potent aid for smoking cessation, have a success rate of about 35% at six months.

Finally, an article published in a Birmingham, Alabama newspaper (Weld, July 19, 2016) titled 'UAB professor wants to fight dependence with psychedelics', highlights an ongoing Clinical Trial by Peter Hendricks, associate professor at the UAB School of Public Health using psilocybin to treat cocaine addiction.

Some excerpts from the Weld article UAB professor wants to fight dependence with psychedelics:

• “Recreational use is completely different from very carefully controlled use in a therapeutic setting,” Hendricks said. “We know that there are individuals who use recreationally, and the effects in these contexts are completely different than what you might expect [from taking psilocybin] with a very specific intention and the assistance of a therapist.
• “In the appropriate setting and with the appropriate mindset and preparation, [psilocybin] can occasion a mystical-type experience sometimes called a ‘peak experience,’” Hendricks continued. “These would be mystical-type experiences that would qualitatively be indistinct from the sort of experiences reported by or experienced by the world’s great saints and sages… There’s often a sense of timelessness and spacelessness, there’s often a sense that all is one, and all people are one, that all of creation is one. There’s often an encounter with an unconditionally loving higher power, what most people would call God, and a sense of serenity or bliss.”
• “I think people are essentially having these types of experiences where they’re in a short amount of time confronted with what is most meaningful to them and how their behavior may stand in conflict with what they hold to be most sacred,” Hendricks said.  “So imagine if we were struggling with cocaine dependence or cocaine addiction, and often people who are addicted will — and they’re aware of this — they will prioritize the drug use over their relationships with people they love, over their careers, over their living situations and in some situations even over their basic living needs like food and shelter. And in this amount of time [of the peak experience], it’s as though people have a profound degree of insight and introspection that allows them to see the degree to which they prioritize that drug.”

Mental Health Nurses, Psilocybin and the 5-HT2A receptor

The Journal of Psychosocial Nursing and Mental Health Services is a monthly, peer-reviewed journal for mental health nurses in a variety of community and institutional settings. For more than 50 years, the Journal has provided the most up-to-date, practical information available for today’s psychosocial nurse, including short contributions about psychopharmacology, mental health care of older adults, and child/adolescent disorders and issues.

An article (below) just published in the Journal of Psychosocial Nursing and Mental Health Services was written by Dr. Robert H. Howland, an Associate Professor of Psychiatry at the University of Pittsburgh with clinical and research experience in psychopharmacology, psychotherapy, and novel and alternative therapies for mood and anxiety disorders. Dr. Howland has numerous publications in the field of Psychiatry.

Antidepressant, Antipsychotic, and Hallucinogen Drugs for the Treatment of Psychiatric Disorders: A Convergence at the Serotonin-2A Receptor.
Abstract
Antidepressant, atypical antipsychotic, and hallucinogen drugs mediate their actions in part by interactions with the serotonin-2A (5HT2A) receptor. Serotonergic hallucinogen drugs, such as psilocybin, bind most potently as agonists at the 5HT2A receptor, producing profound changes in perception, mood, and cognition. Some of these drugs have been or are currently being investigated in small Phase 2 studies for depression, alcoholism, smoking cessation, anxiety, and posttraumatic stress disorder. However, unlike the synergistic effects of combining antidepressant and atypical antipsychotic drugs, the potential therapeutic effects of hallucinogen drugs may be attenuated by the concurrent use of these medications because antidepressant and atypical antipsychotic drugs desensitize and/or down-regulate 5HT2A receptors. This finding has important implications for optimizing the potential therapeutic use of hallucinogen drugs in psychiatry.
Howland RH.
J Psychosoc Nurs Ment Health Serv. 2016 Jul 1;54(7):21-4. 
PMID: 27362381

The take-home message from this article is the potential therapeutic effects of hallucinogen drugs may be attenuated by the concurrent use of antidepressant and atypical antipsychotic drugs because they desensitize and/or down-regulate 5HT2A receptors.

Not many nurses currently have the opportunity to be involved with this promising avenue of treatment for depression, alcoholism, smoking cessation, anxiety, and posttraumatic stress disorder since their use is limited to a relatively few Clinical Trials. However, many individuals desperate for effective treatment of these disorders have been attempting to self-treat without professional guidance which is unfortunate and can only be changed by removing medicine such as psilocybin from Schedule I status.

St. Francis of Assisi, PTSD and psilocybin

Oldest known portrait
in existence of the saint,
dating back to St. Francis'
retreat to Subiaco (1223–1224)

Partly due to my admiration for Pope Francis who chose the name Francis as his papal name in honor of Saint Francis of Assisi (1181 - 1226 AD), and partly due to prior knowledge that St. Francis of Assisi had experienced PTSD as a result of his experience in battle and his experience as a POW, I purchased what appears to be the most recent and most authoritative book on St Francis.

The book is titled: Francis of Assisi: A New Biography (2012). The author, Dominican Friar Augustine Thompson, OP, professor of Medieval Church history, especially of Italy, appears to be highly qualified to  produce a very scholarly work.

Pope Francis's concern for the environment, the poor and his criticism's of the excesses of Capitalism coincides with his chosen papal name Francis.  St. Francis (will now be referred to as Francis), known as the patron saint of animals and ecology, spent his life as a cleric serving the poor and eschewing materialism.

It is fairly well known that Francis suffered from a profound case of PTSD following a brief local (Italian vs Italian) military campaign in which he saw many friends being killed and resulted in his year long captivity as a POW.

Following his release from captivity, he was noted to have changed from a gregarious young man from a middle class family with dreams of military glory to one who lost interest in money, social status, old friends and family.  He appeared to be full of self-loathing and guilt, what is currently referred to as moral injury. During this time he wandered aimlessly around the house, suffered frequent war-related flashbacks and nightmares and took no interest in the beauties of nature.

His acute psychological crisis lasted about 18 months, from late 1203 until the spring of 1205 after which he appeared to break out of his depression and began preparing for a new military adventure in Southern Italy in support of the papacy.  After a couple of feeble attempts to ride south to join the battle, he gave it up, sold his military equipment and horse and donned some cheap clothes and headed back towards Assisi.

Back at home, he refused his father's request to work in the family business and began practicing the prevailing remedy for expiating personal sin, works of almsgiving, prayer and bodily mortification.

Francis took to wandering the local forests with a friend "sometimes leaving him to stand outside near a cave near Assisi while the troubled young man spent long periods in isolation.  Francis was racked by demonic fears and perhaps hallucinations."

This above quote from the book by Fr. Thompson appears to be significant since hallucinations are not typically ascribed to PTSD and Psilocybe sp mushrooms do grow wild in Italy.

One characteristic experience individuals may have while taking psilocybin with the proper Set and Setting is ego dissolution which Francis most definitely acquired. Following a therapeutic session with psilocybin, the mind has an opportunity to reset itself in light of the new experience gained during the session.  This is a process that may take over an extended period of time as the psyche works through old traumas and grows spiritually through the newly gained insights.

Perhaps this is what happened to to Francis as on returning from his frequent visits to his forest refuge, he began spending more time at a local rural church, the church of San Damiano, repairing the church, caring for lepers and embracing a life free of material possessions. As his reputation grew over time he attracted followers to his simple life of labor, poverty, and caring for the sick.  Francis did not set out to create his own religious Order and resisted being placed in a position of leadership.  Some of the traits he is known for have similarities with those who have had profound spiritual experiences while taking psilocybin to include:

Oneness of all things
"Francis felt a deep union with living creatures, who, like the Lilies of the field and the birds of the air, lived the Gospel precept of complete reliance on God spontaneously and naturally.

In his love of God's creation, Francis encountered nature as a unified whole. Near his death, when he composed the "Canticle for Brother Sun and Sister Moon," he referred to the celestial bodies and the four classical elements (earth, air, fire, and water); he made no mention of any living creatures but no doubt saw them as part of the whole of creation.

Ego dissolution  
Francis referred to himself and his followers as the "Lesser Brothers". "That true spiritual authority came from putting one's self below others lies at the heart of Francis's insistence, first seen in this document that those in charge not be called "prior," which meant one "above" or "ahead" but rather all were to be "lesser brothers."

Non-judgemental
By refusing to pass judgement on others, an act that placed one above another, friars could find the inner peace necessary to use Francis's peace greeting with sincerity.

Mindfulness
Francis focused on living in the present moment.  "He found that the Brother cook was putting beans in water to soak the night before they were prepared, the usual culinary practice . Francis, noticing that this was "taking concern for the morrow," instructed him to wait until after Martins had sung the morning of the day they were to be used.  Given that beans needed  good 6 hours of soaking to be usable, this was cutting it short, but the cook obeyed Francis."

Compare Francis's worldview with that of cancer patients that have participated in a therapeutic psilocybin Clinical Trial to help them deal with their Existential Distress of not knowing if they will be alive even one year from now by reading the results of an article published in The Journal of the National Cancer Institute that details some of the patients in the Clinical Trial at New York University:

Opening doors of perception: psychedelic drugs and end-of-life care (PDF)
Macready N.
J Natl Cancer Inst. 2012 Nov 7;104(21):1619-20. Epub 2012 Oct 25. No abstract available.
PMID: 23104218
Cited by (Google Scholar)

Results of this ongoing study at New York University that has involved 12 patients given 0.3mg/kg of psilocybin.  Study goal is 32 patients.  Patients received 9 months of psychotherapy as well as psilocybin.

• all subjects experienced rapid clinical improvement (Psychiatric)
• there was significant reduction or resolution of death anxiety
• there was a decrease in depression/anxiety in general
• patients became more spiritual/philosophical and more connected with others
• they reported feeling interconnected with other forms of energy and that their consciousness was a part of a larger consciousness
• they felt connected to transcendental forces and a sense of sacredness

Dr. Anthony Bossis stated "Every patient I've worked with says the drug has allowed them to live more fully in the present, to be less concerned with yesterday and tomorrow and whether tomorrow will bring more suffering."

 "One patient, now deceased, said he realized that consciousness doesn't end, it doesn't die, it continuous and that his body is one aspect of life, that physical death is part of the life experience, but there is a broader continuum."

The Catholic Church appears to be open to the medical use of psilocybin and Pope Francis sampled coca leaves on a recent visit to Bolivia.  St. Francis curing his PTSD with magic mushrooms appears to be something the Church would be willing to consider as a realistic possibility.

If Pope Francis wishes to get a bit more adventurous, a trait he seems to have had at least since working as a bouncer in a nightclub prior to entering the Seminary, he could take part in one of two Clinical Trials looking for religious professionals to take psilocybin in order to help delineate the mystical experience.

There are times when a soldier in warfare can, after prolonged exposure to the exquisite horror of war, experience a transcendent reality of the oneness of all things. Such was the case with Pierre Teilhard de Chardin who served for four and one half years as a priest/soldier stretcher bearer on the front lines of World War I.

"Somewhere in the blood, sweat, and death of never-ending trench warfare, Teilhard glimpsed something that would haunt him: the vast inter-connectedness of living things. That realization changed his life."

The quote above comes from an adroit story in Motherboard titled 'The Jesuit Priest Who Believed in God and the Singularity' which is a must read.  Teilhard de Chardin can be referred to as the first to promote the concept of Singularity (termed the Omega Point by de Chardin) which is currently espoused by Ray Kurzweil. Kurzweil and de Chardin were written up in an article found in the medical journal Am J Neuroradiol (33:393–98 Mar 2012) titled The Omega Point and Beyond: The Singularity Event (PDF). Teilhard de Chardin, who was also an archaeologist, was whom William Peter Blatty based Father Merrin on in The Exorcist.

A series of quotes from the book "The Warriors: Reflections on Men in Battle" by J. Glenn Gray was presented by Jonathan Haidt in a thought provoking TED Talks Religion, evolution, and the ecstasy of self-transcendence.

Author J. Glen Gray entered the army as a private in May 1941, having been drafted on the same day he was informed of his doctorate in philosophy from Columbia University. He was discharged as a second lieutenant in October 1945, having been awarded a battlefield commission during fighting in France. Gray saw service in North Africa, Italy, France, and Germany in a counter-espionage unit.

Fourteen years after his discharge, Gray began to reread his war journals and letters in an attempt to find some meaning in his wartime experiences. The result is The Warriors, a philosophical meditation on what warfare does to us and an examination of the reasons soldiers act as they do.

Quotes from Gray's book as presented in Haidt's TED Talk reads as follows:

"Many veterans will admit that the experience of efforts in battle has been the high points of their lives. I passes insensibly into we.  My becomes our and individual fate losses its central importance."

"I believe that it is nothing less than the assurance of immortality that makes self sacrifice at these moments so relatively easy. I may fall but I do not die for that which is real in me goes forward and lives in my comrades for whom I gave my physical life."

There are approximately 22 Veterans across the U.S. who commit suicide every day, many of those are PTSD related. There exists a very real possibility that those who had not experienced such a transcendence during battle and have returned with PTSD may get there with the therapeutic use of psilocybin. Perhaps this is what happened to St. Francis of Assisi. Let us move in that direction.

"Gentlemen, we are being killed on the beaches. Let us go inland and be killed."
        Brigadier General Norman Cota - Omaha Beach 6 June 1944

With his troops pinned down and being slaughtered by the Germans and with a rising tide threatening them from the rear in the early minutes on Omaha Beach, General Norman 'Dutch' Cota's heroic efforts led the troops in a breakthrough off the beach to breach the German defensive position.

We are in need of some heroic researchers to lead the way forward with a Clinical Trial utilizing psilocybin to treat PTSD since there are currently no effective treatment available. We still have troops dying on the beaches, lets move forward.

The American public is becoming acutely aware of the vast potential psilocybin has for many mental health issues and its relative lack of serious adverse effects when given with professional supervision. The case for legalizing psychedelic drugs, published in The Business Insider on 11 June 2016, was originally published in a longer version in The Conversation titled Why do humans have an innate desire to get high? a few days earlier.

These are just a few recent examples of the rapidly changing societal views on the use of psychedelic substances that were undeservedly classified as Schedule I drugs as a political statement, not a medical or scientific one, during the Nixon Administration.  Psilocybin need to be removed from Schedule I status to free researchers to examine its safe and ethical use for humanity.

Psilocybin treatment for PTSD: a Clinical Trial protocol

There have been numerous studies published to date that provide an overwhelming rationale for conducting a Clinical Trial utilizing psilocybin to treat PTSD.  Below is a list of PTSD related issues and the recent research that has provided ample evidence to support such a trial and could function effectively as a key aspect in someone's protocol:

PTSD.  There has been a recent animal model study demonstrating the efficacy of low-dose psilocybin in treating PTSD as well as a 1968 case report on a long-standing chronic pain/depression/PTSD patient treated successfully with psilocybin. The animal model study also demonstrated psilocybin's ability to promote hippocampal neurogenesis.

Depression. A recent Lancet Psychiatry article has shown psilocybin to be highly effective for patients with treatment resistant depression.

No serious or unexpected adverse events occurred during the course of the study and all patients demonstrated a reduction in depression severity at 1 week that was sustained in the majority for 3 months. Eight (67%) of the 12 patients achieved complete remission at 1 week and seven patients (58%) continued to meet criteria for response at 3 months, with five of these (42%) still in complete remission. This is quite remarkable since the equivalent remission rate for SSRIs is around 20%. Unlike current anti-depression medications, psilocybin does not have to be given daily, perhaps only once or twice as in this study.

Social isolation/exclusion. Numerous studies have demonstrated improvement of social cognition deficits in various psychiatric disorders after psilocybin administration compared to placebo. Furthermore, emotional empathy was enhanced after treatment with psilocybin as well as a decrease in social exclusion and social stigmatization.

Addictions. A recent pilot study  involving 15 psychiatrically healthy nicotine-dependent smokers (10 males; mean age of 51 years), with a mean of six previous lifetime quit attempts, and smoking a mean of 19 cigarettes per day for a mean of 31 years at intake demonstrated an 80% abstinence at 6-month follow-up. The observed smoking cessation rate substantially exceeds rates commonly reported for other behavioral and/or pharmacological therapies (typically < 35%).

There are currently three Clinical Trials examining psilocybin's ability to help individuals with addiction related disorders.

Existential distress.  To me, this is key.  Existential distress is, in my opinion, what gives rise to PTSD in the first place. When a Warfighter heads out on patrol day after day not knowing if he will return, this creates a definite existential distress.  Why some develop PTSD as a result of this experience and others do not is not known but I suspect levels of pre-existing systemic inflammation may play a key role. A future study will examine psilocybin's ability to decrease inflammation in the brain.

Two recent studies. one performed at NYU, the other at Johns Hopkins that provided psilocybin to cancer patients with life-threatening in an attempt to mitigate their existential distress will soon be published. Preliminary results have been provided by NYU and by Johns Hopkins.  It is reasonable to infer that what is effective for these patients will be effective for those with PTSD as well.

Anger/violence. A recent study from the Journal of Psychopharmacology looked at 302 men ages 17-40 in the criminal justice system. Of the 56 percent of participants who reported using hallucinogens, only 27 percent were arrested for later IPV as opposed to 42 percent of the group who reported no hallucinogen use being arrested for IPV within seven years.

Dr. Peter Hendricks, one of the study authors, commented that "A body of evidence suggests that substances such as psilocybin may have a range of clinical indications," he said. "Although we're attempting to better understand how or why these substances may be beneficial, one explanation is that they can transform people's lives by providing profoundly meaningful spiritual experiences that highlight what matters most. Often, people are struck by the realization that behaving with compassion and kindness toward others is high on the list of what matters."

Suicidal ideations. Two previous studies have demonstrated psilocybin's potential effectiveness in preventing suicides.  A 2013 article in PLoS One used data from over 130,000 individuals drawn from years 2001 to 2004 of the National Survey on Drug Use and Health and demonstrated no significant associations between lifetime use of any psychedelics, lifetime use of specific psychedelics (LSD, psilocybin, mescaline, peyote), or past year use of LSD and increased rate of any of the mental health outcomes. Rather, in several cases psychedelic use was associated with lower rate of mental health problems to include suicide.

A 2015 article from the Journal of Psychopharmacology by researchers from the University of Alabama and Johns Hopkins demonstrated lifetime classic psychedelic use was associated with a significantly reduced odds of past month psychological distress (weighted odds ratio (OR)=0.81 (0.72-0.91)), past year suicidal thinking (weighted OR=0.86 (0.78-0.94)), past year suicidal planning (weighted OR=0.71 (0.54-0.94)), and past year suicide attempt (weighted OR=0.64 (0.46-0.89)), whereas lifetime illicit use of other drugs was largely associated with an increased likelihood of these outcomes.

Anxiety. Numerous studies have demonstrated a decrease in anxiety in those who have taken psilocybin with the proper Set and Setting. One specific 2011 study from UCLA titled Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer demonstrated a significant reduction in anxiety at 1 and 3 months after treatment as measured by the State-Trait Anxiety Inventory and the Beck Depression Inventory revealed an improvement of mood that reached significance at 6 months in 12 adults with advanced-stage cancer and anxiety.

In conclusion, with the possible exception of Ayahuasca, there exists no other known compound that has shown effectiveness with all the various issues manifested in those afflicted by PTSD.  It is less toxic than caffeine, not addicting and has to be given only once or twice. This is an excellent opportunity for the DoD and/or VA to conduct a Clinical Trial utilizing psilocybin to treat PTSD in an attempt to decrease suicides in active duty military and veterans, to take whatever steps necessary to find the best treatment for this debilitating condition.

Psilocybin shows great promise for those with treatment resistant depression

The World Health Organization describes depression as "the leading cause of disability worldwide" afflicting over 350 million people globally and costing the U.S. more than $200 billion annually which makes the promising research published 17 May 2016 in Lancet Psychiatry extremely timely and relevant. The news media has taken notice as well.

The Lancet Psychiatry article titled 'Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study'  (PDF) by researchers at the Imperial College London, ranked as a top 10 Univesity globally, was a pilot study which involved 12 patients, all whom had a failed response to standard medications and had suffered with major depression for an average of an astounding 17.8 years.

Patients received two doses of psilocybin (10 mg and 25 mg, orally, 7 days apart) in a supportive setting with psychological support provided before, during, and after each session if needed.  The psilocybin utilized in the study was synthetic, no actual mushrooms were consumed in order to provide a known amount of psilocybin for each patient. fMRI data was collected but will be detailed at a later date.

Since this was a feasibility trial, there was no control group.  However, since these patients had tried various other medications over time, this may be considered an 'N of 1' study with the patients serving as their own controls.

No serious or unexpected adverse events occurred during the course of the study and all patients showed some reduction in depression severity at 1 week that was sustained in the majority for 3 months. Eight (67%) of the 12 patients achieved complete remission at 1 week and seven patients (58%) continued to meet criteria for response at 3 months, with five of these (42%) still in complete remission. This is quite remarkable since the equivalent remission rate for SSRIs is around 20%. Unlike current anti-depression medications, psilocybin does not have to be given daily, perhaps only once or twice as in this study.

Marked and sustained improvements in anxiety and anhedonia were also noted. The researchers are now planning a larger randomized controlled trial as the next stage of this promising research. The inclusion of concurrent sessions of cognitive behavioral therapy or mindfulness meditation for some weeks or months during and following psilocybin administration may assist patient with the integration of what they learned during their 'trip treatment'.

Unfortunately the researchers ran into a ridiculous amount of legal red tape which took 32 months between having the grant awarded and treating the first patient since psilocybin is categorized as a Class A illegal drug in the United Kingdom (Schedule I in the United States). In a previous post, I have detailed the rationale for why psilocybin should not be classified as a Schedule I drug. As a brief refresher, the criteria for a compound being listed as Schedule I are:

1. The drug or other substance has a high potential for abuse. Comment: not true for psilocybin. It has shown promising in treating those with substance abuse issues.
2. The drug or other substance has no currently accepted medical use in treatment in the United States. Comment: not true for psilocybin. It is being used by many already but they have to take chances and go it alone without proper medical/spiritual supervision.
3. There is a lack of accepted safety for use of the drug or other substance under medical supervision. Comment: not true for psilocybin. There have been no serious adverse events in the hundreds of patients who have recently taken psilocybin in Clinical Trials.
4. (Unofficial) Because we said so!  Comment: this is the only reason psilocybin is listed as Schedule I as none of the 3 Official criteria are based on rational scientific thought. The reason psilocybin was made and remains Schedule I is purely political. While not a strong advocate of medical marijuana, I do applaud the DEA for currently reconsidering removing it from Schedule I status which will allow the needed research to proceed with less regulatory hurdles. Hopefully they will soon reconsider psilocybin as well. With the billions of dollars at stake, there will be an unprecedented amount of pressure on the DEA not to move psilocybin off of Schedule I status.

Senior author and Neuropsychopharmacologist Dr. David Nutt expressed reasonable displeasure over the 32 month bureaucratic delay stating “Every interaction — applying for licenses, waiting for licenses, receiving the licenses, applying for contracts for drug manufacture, on and on — involved a delay of up to two months. It was enormously frustrating, and most of it was unnecessary,” says Nutt. “The study result isn’t the remarkable part — it’s the fact that we did it at all.”

A thoughtful Commentary (PDF) in Lancet Psychiatry by Dr. Phil Cowen, a depression researcher with the University of Oxford, accompanies the research.

The VA and/or DoD has a primary responsibility towards their patients with PTSD and it is very disconcerting that they are not taking the lead in this very promising research.  Depression and PTSD go hand in hand as the statement below from the Veterans Administration points out:

Many symptoms of depression overlap with the symptoms of PTSD. For example, with both depression and PTSD, you may have trouble sleeping or keeping your mind focused. You may not feel pleasure or interest in things you used to enjoy. You may not want to be with other people as much. Both PTSD and depression may involve greater irritability. It is quite possible to have both depression and PTSD at the same time.

So, lets get going!

Magic mushrooms and blueberries: a recipe for treating PTSD

Individuals with PTSD frequently report experiencing social exclusion and social stigmatization. Social isolation will further compound their traumas, whether the nature of their trauma is mental, physical, moral or a combination. Such was especially the case with Veterans returning from the unpopular war in Vietnam.  Unlike the more recent excursion in the Middle East which had much support following the 9/11 atrocities, the Vietnam veterans were subject to significantly more indifference, rejection and criticism.

Now an exciting new study from the University Hospital of Psychiatry Zurich, authors of numerous psilocybin studies and the Institution that gave rise to Carl Jung, whose work had a profound influence on Joseph Campbell, have published an article titled Effects of serotonin 2A/1A receptor stimulation on social exclusion processing (PNAS April 2016).

In their study, the University of Zurich researchers demonstrated that psilocybin had a positive effect on brain regions to include the dorsal anterior cingulate cortex by stimulation of specific serotonin receptors. These findings may be relevant to the normalization of negative social interaction processing in psychiatric disorders characterized by increased rejection sensitivity. Plus this reduction of psychological pain and fear can be of great importance in facilitating the therapist-patient relationship and the psychotherapeutic treatment of formative negative social experiences.

Psilocybin has demonstrated an ability to increase subjective feelings of connection with the environment and other people, which may lead to stronger and more empathetic connections between people. This in turn may help reduce “egocentric bias” and “render negative experiences more bearable,” the authors of the study wrote.

In another recent article (FASEB April 2106) detailed in MedicalXpress and titled Eating blueberries could regulate genetic and biochemical drivers of depression and suicide the benefits of compound(s) in blueberries that help to ameliorate the depression and suicidal tendencies often associated with PTSD is described.  This is good news since available medical treatments offer only limited relief and a Clinical Trial utilizing psilocybin to treat PTSD, which offers the most promise of any known compound, has yet to be initiated.  Johns Hopkins, this is in your ballpark.  Time to hit a homerun.

The researchers from Louisiana State University (LSU), working with animal models, have found that eating blueberries could help to reduce the genetic and biochemical drivers behind depression and suicidal tendencies associated with the disorder. Specifically, eating blueberries increase the expression of the gene SKA2 which is found to be decreased in those with those who are depressed and may show suicidal tendencies. The rat's blueberry diet was equivalent to about two cups per day for a person which, with the present price of blueberries, would be quite expensive.

Previously the researchers found that rats with the PTSD-like experience fed a blueberry-enriched diet showed increased levels of the signaling chemical serotonin in the brain. Psilocybin has a positive effect on the serotonergic system as well so there may be a good synergy here.

It was LSU researchers who were the first to isolate DMT (dimethyltryptamine) from the mammalian pineal gland which I have written about previously.

Of course eating 2 cups of blueberries a day will probably not cure anyone of PTSD but it does help to highlight the importance of diet, along with exercise and stress reduction towards mitigating the effects of PTSD.  But then again, if I ever have the opportunity to be part of a therapeutic session of psilocybin for PTSD, I'll be sure to follow it up with a big bowl of juicy, organic blueberries!

“There are moments when one feels free from one’s own identification with human limitations and inadequacies ... Life and death flow into one, and there is neither evolution nor destiny; only being.” — Albert Einstein

Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA

The article titled Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA was published in The Lancet Psychiatry on 5 April 2016. The article reviews the encouraging use of psilocybin and MDMA (I am personally opposed to the use of MDMA to treat PTSD as discussed below) for various psychiatric disorders and was written by Psychiatrists from UCLA and the University of South Carolina.

Below is the Summary from the 5 April 2016 article in The Lancet Psychiatry:

4-phosphorloxy-N,N-dimethyltryptamine (psilocybin) and methylenedioxymethamfetamine (MDMA), best known for their illegal use as psychedelic drugs, are showing promise as therapeutics in a resurgence of clinical research during the past 10 years. Psilocybin is being tested for alcoholism, smoking cessation, and in patients with advanced cancer with anxiety. MDMA is showing encouraging results as a treatment for refractory post-traumatic stress disorder, social anxiety in autistic adults, and anxiety associated with a life-threatening illness. Both drugs are studied as adjuncts or catalysts to psychotherapy, rather than as stand-alone drug treatments. This model of drug-assisted psychotherapy is a possible alternative to existing pharmacological and psychological treatments in psychiatry. Further research is needed to fully assess the potential of these compounds in the management of these common disorders that are difficult to treat with existing methods.

In a previous post, I mentioned that Jeffrey A. Lieberman, MD, currently chairman of psychiatry at the Columbia University College of Physicians and Surgeons and director of the New York State Psychiatric Institute and former president of the American Psychiatric Association, has endorsed research on psychedelic compounds in a Medscape post (free registration) stating they "need to be studied in an intensive and extensive way". Some passages from Dr. Lieberman's post for those without Medscape access:

• We have had a nearly 50-year hiatus in any serious investigation, except for some heroic investigators at a few universities, primarily in Europe but also in the United States.
• These psychedelic drugs clearly are pharmacologically active, have profound effects, could be useful for therapeutic purposes, and need to be studied in an intensive and extensive way before an informed determination can be made. 
• I believe that the scientific investigation of mind-altering psychedelic drugs in the 1960s and '70s was a truncated but promising avenue of research, and that these medications, these drugs, could have significant value for a variety of indications if studied adequately.

It is obvious that Psychiatry is showing increasing support for the use of psychedelics as therapeutic tools to treat various mental health issues.

The Lancet series of journals has a history dating back to 1823 with The Lancet being ranked second among general medical journals, (with an impact factor of 45), after The New England Journal of Medicine (impact factor of 56) according to the 2014 Journal Citation Reports. Johns Hopkins, which dates back to 1876, has been ranked among the top 10 in US News' Best National Universities Rankings and among the top 20 in a number of international rankings.

I mention both of theses highly regarded institutions due to the newly published Johns Hopkins-Lancet Commission on Public Health and International Drug Policy article and its call for non-violent minor drug offenses including use, possession, and petty sale, to be decriminalized internationally due to the serious detrimental effects on the health, wellbeing and human rights of drug users and the wider public. The article is titled 'Public health and international drug policy' and was published on 2 April 2016 in The Lancet. Authors of this study are from institutions to include Yale University, Columbia University, the UN, Johns Hopkins, UCSF, UCSD, and many prominent international Universities.

The article summary in MedicalXpress concludes:

• A number of countries, mostly in Europe, have decriminalized minor drug offenses with good results, including more ability to reach people with health and social services and better capacity of the police to focus their efforts on high-level trafficking offenses. Drug use, low-level possession and petty sale of drugs should not be subjected to criminal penalties, including prison sentences, and health and social services for drug users should be improved.
• People who use drugs have been shown in many countries to be keen to take advantage of prevention and treatment services, but they are often systematically excluded on the grounds of being thought unworthy or unreliable as patients. Governments should invest in comprehensive HIV, TB and hepatitis C services for people who use drugs. While sexually transmitted HIV is on the decline globally, HIV transmission linked to drug use is increasing. Comprehensive HIV, hepatitis C and TB services should be scaled up in prisons as well as in the community.
• Overdose deaths can be greatly reduced by ensuring that people who use opioids have good access to medication-assisted treatment and by ensuring that people who use drugs or are likely to witness overdoses have access to and are trained in delivering naloxone, a medicine that reverses overdose.
• Increasing numbers of national governments and sub-national jurisdictions (such as US states) are introducing legally regulated markets of cannabis. Governments and research bodies should see these as opportunities for rigorous scientific research and evaluation so best practices for public health and safety can be identified and emulated.
• Over-zealous drug control policies are limiting access to pain medications for legitimate clinical use in too many countries. Governments must find balanced policies for ensuring that people have access to controlled medicines such as opioids for the relief of pain while still impeding non-medical use of these substances.

While the focus of the Lancet article is on narcotics, this drug policy review details the futilities of the current approach to curtailing illicit drug use. Psilocybin is currently classified as a Schedule I drug by the DEA and the FDA based on the following criteria:

1. The drug or other substance has a high potential for abuse.
2. The drug or other substance has no currently accepted medical use in treatment in the United States.
3. There is a lack of accepted safety for use of the drug or other substance under medical supervision

As for the abuse potential, #1 on the list, notice the graph below which clearly shows psilocybin to be relatively free of dependency and toxicity issues.  Also notice how MDMA has a much higher dependency and toxicity potential than psilocybin.  So, let's scratch #1 off the list.  It just should not be there.

Data source is Gable, R. S. (2006). Acute toxicity of drugs versus regulatory status. In J. M. Fish (Ed.), Drugs and Society: U.S. Public Policy, pp.149-162, Lanham, MD: Rowman & Littlefield Publishers

Psilocybin, besides being less toxic than caffeine and lacking in dependency potential, has shown profound potential in treating addiction problems.  A small pilot study at Johns Hopkins enabled 12 of 15 (80%) subjects to remain tobacco free for 6 months.  Prescription medications such as Chantix, the most potent aid for smoking cessation, have a success rate of about 35% at six months. There are currently 2 other Clinical Trials utilizing psilocybin to treat addiction disorders: one for alcohol dependence and one for cocaine addiction.

As stated in the Lancet Psychiatry study that led off this post, psilocybin has shown encouraging potential for treating various mental health issues.  One of the most profound potentials of psilocybin is in treating the existential distress experienced by cancer patients or anyone with a life threatening diagnosis or having faced life threatening experiences (PTSD). So let's scratch #2 of the list as well.

As for #3, lack of accepted safety for use under medical supervision, all of the recent well-controlled, ethical Clinical Trials completed and ongoing have not shown any serious adverse effects.  So, lets take #3 off the list as well.  Where does that leave us now?

In my opinion, there should be a class-action lawsuit against the DEA and FDA forcing them to take hallucinogens off the Schedule 1 status to enable more ethical research to proceed for psilocybin.  

In an interview with John Ehrlichman, advisor to US President Richard Nixon, Ehrlichman explains that the War on Drugs was not to protect the American public but was ‘really about’ hurting ‘the antiwar Left, and black people’, and openly admits, ‘Did we know we were lying about the drugs? Of course we did’ (Baum, 2012).  We can now see how this policy was not to protect the American Public and in fact has hurt us. A recent (5-13-2016) article in Medical Daily titled 'The War on Drugs May Have Misrepresented Psychedelics; Here's Why That Matters' by Stephanie Kossman does an excellent job addressing this issue.

My objection above to the use of MDMA is first of a philosophical nature.  MDMA is synthetic. Psilocybin is natural and has a history of use for spiritual growth going back thousands of years. Second, MDMA displays an unacceptable degree of toxicity that psilocybin does not have.

My review of the research literature shows there are at least as many reasons not to use MDMA for PTSD as there are for its use.  By running a trial for PTSD using MDMA instead of psilocybin researchers are settling for use of an inferior compound with high levels of toxicity and dependence issues over psilocybin. I'm certain many researchers in the field share the same sentiments but are unwilling to speak up.

A case in point is the April 2016 publication of two articles, one involving psilocybin, the other MDMA.

In the article titled Meta-analysis of molecular imaging of serotonin transporters in ecstasy/polydrug users, researchers found that ecstasy users demonstrated significant reductions serotonin in the brain. which can impact appropriate emotional reactions to situations. They also noted that the effects on the serotonin system may underlie the cognitive deficits observed in ecstasy users.  MDMA is a drug that should be given a second look before using it in any Clinical Trials due to its neurotoxicity.

One the other hand, the April 2016 psilocybin study, Effects of serotonin 2A/1A receptor stimulation on social exclusion processing, has been given positive reviews by the media and demonstrates a keen applicability for treating PTSD.  It appears as though researchers have bet on the wrong horse so far in that there is are Clinical Trials using MDMA in the treatment of PTSD but none for psilocybin.

It is possible the MDMA researcher's goal leans more towards finding a use for MDMA than in finding the best treatment for PTSD which is unfortunate.

Prominent institutions such as Johns Hopkins have discussed using psilocybin in a Clinical Trial to treat PTSD but have yet to act on this idea.  In my opinion, the reason for this inaction is twofold. First, they realize MDMA is already involved in a Clinical Trial to treat PTSD and they do not want to step on those researcher's toes or to have two controversial trials treating PTSD.

The second reason is that, to my knowledge, none of the primary players in psilocybin research are military veterans.  I could be mistaken about this but have seen no mentions in the many CVs I've perused online to indicate such an association. If they had military experience, it would serve as an impetus to head in that direction. They should keep in mind that their right to perform their current research depends on the freedom we are currently enjoying in our society, a freedom many have died for.

If we are not careful, the current path of overpopulation and environmental destruction (Nature 6 April 2016) we are on could very soon put great stress on our way of life. Psilocybin may help us navigate our way out of this mess by contributing to a society with more openness and is less egocentric.

The American Chemical society now supports research into psilocybin and other hallucinogens

The American Chemical society has been around since 1876 and does not tend to support controversial topics.  On March 28, 2016, Chemical & Engineering News a weekly magazine published by the American Chemical Society, came out with a cover story titled 'Psychedelic compounds like ecstasy may be good for more than just a high'.

The article has separate essays on  ibogaine, MDMA, cannabis, ketamine, and psilocybin.  The psilocybin essay contains a quote from Dr. Roland Griffiths, a prominent researcher from Johns Hopkins stating:

“It was unlike anything I’ve seen in psychopharmacology before,” says Roland R. Griffiths, a professor of psychiatry and behavioral sciences at Johns Hopkins University, of his first trial examining the safety of psilocybin in healthy volunteers.

Those volunteers had positive effects that could last for years. “People had increased satisfaction and quality of life,” Griffiths says. “They felt more generous, centered, optimistic, and caring toward other people in their lives.” Patients’ friends, family members, and work colleagues confirmed the differences. 

We are moving in a positive direction.

Chronic pain, PTSD, mindfulness and psilocybin

Individuals with PTSD frequently experience chronic pain as well.  According to the Veterans Administration website on chronic pain and PTSD, approximately 15% to 35% of patients with chronic pain also have PTSD. Only 2% of people who do not have chronic pain have PTSD. One study found that 51% of patients with chronic low back pain had PTSD symptoms.

Just for the record, I am not a fan of the Veterans Administration when it comes to providing quality medical care for Veterans.  Although there are some notable exceptions, Veterans are provided with inferior medical care when compared with health care provided in the civilian sector. There is a culture at the VA where a significant percent of the employees have an attitude that the VA exists for them and having to deal with those Veterans is a pain in the ass. Plus they know it is almost impossible to get fired from the VA. I speak from experience having worked at 4 VA hospitals and having been a patient in 3 of them. It is time to shut it down and provide Veterans with the quality of care they deserve while saving taxpayers the expense of propping up a broken, outdated system.

Veterans should be allowed to receive local healthcare with a provider of their choice. What the Veterans Administration should focus on is research, in close collaboration with the Department of Defense, to improve medical treatment for issues that are unique to this population. I am not alone in criticism of the current care our Veterans are receiving. See New Commission on Care Report: VA Too Broken to Fix from the Federal Practitioner (6 April 2106).

Unfortunately many PTSD/chronic pain patients have been treated with opioids which are great for acute pain but very destructive for those with chronic pain.  Recent statistics provide an estimate of 40 deaths per day in the U.S. from the current epidemic of opioid prescription overdoses. In an attempt to address this issue the CDC has recently published new guidelines for prescribing opioids for chronic pain. CDC Director Tom Frieden, MD, MPH, stated in a news teleconference on 15 March 2016 just prior to the new guidelines. "For the vast majority of patients, the known, serious and all too often fatal risks far outweigh the unproven and transient benefits, and there are safer alternatives."

So what are some of the safer alternatives and why do individuals with PTSD tend to experience more chronic pain than those without PTSD?  This essay will attempt to clarify these issues.

On 22 March 2016, the Journal of the American Medical Association (JAMA) published a very timely article regarding research that attempts to find a nonpharmacologic approach to treating low back pain (LBP).  The article is titled "Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial" and is freely available online.

Results of this breakthrough study concluded "among adults with chronic low back pain, treatment with mindfulness-based stress reduction (MBSR) or cognitive behavioral therapy (CBT), compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain."

It should be noted that while the researcher in this study were primarily from the University of Washington, Seattle, the mindfulness-based stress reduction (MBSR) program they utilized was developed at the University of Massachusetts Medical Center in the 1970s led by Jon Kabat-Zinn.  Becoming trained as a provider in MBSR involves much more than getting a certificate for having taken a weekend course.  To be effective, you must be a practitioner of MBSR yourself which takes much dedication and training. Therefor finding  therapist trained in MBSR can be rather difficult but still much easier than finding a therapist trained to lead you through a therapeutic psilocybin session.

Just 5 days prior to the release of the JAMA study, the National Institutes of Health (NIH) commented on a newly released study published in the Journal of Neuroscience titled "Mindfulness-meditation-based pain relief is not mediated by endogenous opioids" that was partially funded by the NIH. The authors of the study concluded "results demonstrate that meditation-based pain relief does not require endogenous opioids. Therefore, the treatment of chronic pain may be more effective with meditation due to a lack of cross-tolerance with opiate-based medications." This study is important because opioid and non-opioid mechanisms of pain relief can interact synergistically to increase the effectiveness of pain control.

Although the Journal of Neuroscience study does not indicate what the non-opioid pathway may be, there is a plethora of evidence to suggest that it may involve the default mode network (DMN).  Hyperconnectivity of the default network has been linked to rumination in depression and chronic pain. Mindfulness meditation and therapeutic use of psilocybin both have shown similar functions in reducing activity of the DMN.

A key structure within the default mode network is the posterior cingulate cortex which is activated during self-referential thinking and deactivated during meditation and psilocybin intake. It is possible that decreasing self-referential processing distracts the individual from ruminating over their life condition and allows them to have the experience of being connected to the world outside themselves and to live a more contented, productive life with a significant decrease in pain. Individuals who have taken psilocybin as part of a Clinical Trial for cancer patients have made statements indicating that after taking psilocybin they just do not pay that much attention to their pain anymore.

After all these years, it is very satisfying to have the CDC, NIH, and JAMA all joining me in an attempt to treat conditions like chronic pain and PTSD in a nonpharmacologic manner such as mindfulness.  If medication is needed, lets stick with the natural non-addictive variety such as psilocybin. Besides being non-addicting, psilocybin has shown profound medical benefits and need only be taken a once or twice - a pharmaceutical company's nightmare.

Psilocybin use implicated in a reduction of intimate partner violence

The recent study by Peter S. Hendricks, Ph.D., University of Alabama Birmingham (UAB), Department of Health Behavior, had been placed on the University of Alabama News website a few weeks ago but is now no longer available.  The reason for this in not known.  Also, the journal this research will be published in is also not yet known.

Still, the information that was once on the website has been preserved by other websites such as MedicalXpress.  MedicalXpress (a great source of the most recent medical news) gives UAB as the source of its information.  Here is a link to the article from MedicalXpress titled Hallucinogens use could protect against intimate partner violence.

The study looked at 302 men ages 17-40 in the criminal justice system. Of the 56 percent of participants who reported using hallucinogens, only 27 percent were arrested for later IPV as opposed to 42 percent of the group who reported no hallucinogen use being arrested for IPV within seven years.

Dr. Hendricks commented that "A body of evidence suggests that substances such as psilocybin may have a range of clinical indications," he said. "Although we're attempting to better understand how or why these substances may be beneficial, one explanation is that they can transform people's lives by providing profoundly meaningful spiritual experiences that highlight what matters most. Often, people are struck by the realization that behaving with compassion and kindness toward others is high on the list of what matters."

I'll keep you posted regarding the publication of this study and hopefully an explanation as to why the information was removed from the UAB website.

From Dr. Hendricks' CV, it is noted that he has shown a lifetime dedication to assisting those with substance abuse issues.  I sincerely hope his recent interest in the use of psychedelics towards this end will not have a negative impact on his career.  This has happened in the past but hopefully the current renaissance in psychedelic research will be allowed to continue as long as the researchers follow their current rigorous scientific standards and ethical behavior.  The science is there to support this research and there is no room in science or medicine for bias.

Twenty years ago, Dr. Henricks most likely would have been fired for promoting research on psychedelics. Now there are groups sprouting up all over the world encouraging like-minded individuals to share their support and experience with these sacred, entheogenic substances (synthetics such as MDMA not included).  A search for entheogens in Meetups highlight this global support.

Update (04/25/2016): Dr. Hendricks article has now been published in the Journal of Psychopharmacology and is titled Hallucinogen use and intimate partner violence: Prospective evidence consistent with protective effects among men with histories of problematic substance use

A recent article in Aggression and Violent Behavior (March/April 2016) by researchers from The University of Western Ontario titled Recreational drug use and human aggressive behavior: A comprehensive review since 2003  backs up Dr. Hendrick's research with the following conclusions:

• Alcohol causes aggression.
• Cannabis is correlated with aggression, and personality mediates this association.
• The research on methamphetamines, opiates, and stimulants and aggression is complex.
• Hallucinogens such as psilocybin reduce aggressive behavior.
• Psilocybin is associated with positive spiritual and mystical experiences.
• Psilocybin significantly alleviates symptoms of obsessive–compulsive disorder.
• Low doses of psilocybin extinguished the conditioned fear response to an adverse stimulus in an animal model of PTSD.
• Psilocybin positively impacts hippocampal neurogenesis.
• Psilocybin was proposed as a potential treatment for Posttraumatic Stress Disorder.

PTSD is associated with an increase in intimate partner violence. A large epidemiological study of Vietnam and Vietnam-era Veterans that was conducted in the mid-1980s examined intimate partner violence (ranging from slapping and pushing to using a knife or gun), and found that 33.0% of Veterans with PTSD compared to 13.5% of those without PTSD reported intimate partner violence in the past year (1). Considering all of the many positive properties of the therapeutic use of psilocybin, a reduction in intimate partner violence is another benefit to add to the list.  PTSD is not seen just in the military and in Veterans. Soon, due to the coming global climate catastrophe, the majority of the earths population will have PTSD so we best start investigating psilocybin as a treatment ASAP.

For some health care providers, the lack of effective treatments for conditions such as PTSD, addictions, suicidal thoughts, depression, and fear of death leads them, out of compassion and empathy, to assist those suffering by guiding them through psychedelic therapy in violation of the law.  To me, these brave souls are true 'Heroes of the Universe'.  They are heroes as they are giving their live's for a cause great than themselves.  The goals is to provide those suffering with a sense of unity, a shared universal consciousness, which reveals all of our interconnectedness.

I sincerely hope the laws change soon so these compassionate beings do not have to suffer the consequences of unfair and misguided laws.  Psychedelics should be removed from Schedule I classification as they are neither addicting nor lacking in medical benefit.  A recent article in The Atlantic questions whether current psychedelic drug laws violate our basic human rights?

1. Jordan, K. B., Marmar, C. R., Fairbank, J. A., Schlenger, W. E., Kulka, R. A., Hough, R. L., & Weiss,       D. S. (1992). Problems in families of male Vietnam Veterans with posttraumatic stress disorder. Journal       of Consulting and Clinical Psychology, 60, 916-926. doi: 10.1037//0022-006X.60.6.916 (PDF)