Magic mushrooms to soothe the dying

In 2015, Ian Roullier tripped on a high dose of magic mushrooms while lying in a hospital bed in London’s Imperial College. Ian had been depressed his entire adult life — as a kid, he and his sister had been repeatedly abused by their father, and the effects of that trauma left him in a hole of anxiety, self-loathing and numbness.

For years he’d tried to find catharsis through therapy and medications, but relief only came after he spent a day in that darkened room, headphones on, listening to an Eno playlist, with a pair of therapists by the bed for reassurance, while he dived inside his own mind.

The trip wasn’t easy. At one point he envisioned coming face to face with his father, and shortly afterwards with a towering, ferocious military horse. Rather than avoiding him or running, he looked him dead in the eye and ended up laughing hysterically at the bizarre image. “I thought that if I ever engaged with those thoughts it would be the end of me but, once you actually look them in the eye, they don’t have that effect,” he told me last year.

For months after that session, Ian was finally released from his father’s grip. “I felt more comfortable being myself than ever before. I found I felt more connected to myself, other people, nature, life in general. I felt alive, rather than distant and isolated and cut off … Depression is a very narrow, restricted state, and taking psilocybin really helps you to zoom out a lot more.”

Australian patients are finally about to get the chance to experience a little of that magic over here. After years of quiet lobbying, a new study has recently been announced at St Vincent’s Hospital in Melbourne. Starting in April, 30 people will receive a dose of 25mg of psilocybin, the psychoactive extract in magic mushrooms, alongside therapeutic support before, during and after their trip.

Unlike the London study, which targeted treatment-resistant depression, the Melbourne trial will focus on people with a terminal illness. No one is claiming it’s going to cure the disease, of course; rather, it’s hoped that therapeutic tripping can help patients deal with the existential depression and anxiety that naturally accompany a pressing sense of mortality.

Martin Williams, a neuropharmacology researcher at Monash University and co-investigator on the new trial, says it’s a novel and necessary innovation. “A significant minority of patients are simply unable to face death with any degree of calmness and so their quality of remaining life diminishes dramatically. Psychedelic psychotherapy can really change people’s minds — literally — and offer them a relief from their symptoms which they’re really not achieving at the moment.”

The new approach is based on the results of earlier trials in the US, at Johns Hopkins and New York University. In 2016, the Journal of Psychopharmacology published the two institutions’ findings: 80% of the people with life-threatening illnesses they treated experienced significant reductions in anxiety and depression.

Over the past 15 years, hundreds of people have been given psilocybin in clinical studies in the US and UK — another Johns Hopkins study found 80% of smokers had quit six months after a couple of high-dose sessions. More than half of the patients who were treated alongside Ian at Imperial College found clinical remission from the symptoms of hitherto treatment-resistant depression. In the first study of the modern era, two-thirds of healthy volunteers rated their clinical trip as one of the most significant events of their life.

The results have been so striking that late last year the US Food & Drugs Administration gave psilocybin “breakthrough therapy” status, which speeds up their new drug approval process and makes it likely it will be a legal medicine within a few years. In response, there’s already a ballot measure in Oregon seeking to decriminalise and regulate the therapeutic use of magic mushrooms at the 2020 election.

Mushrooms aren’t the only psychedelic drug coming in from the cold. Trials of therapy with MDMA, primarily to treat post-traumatic stress disorder, have been ramping up over the same period. The latest round of research found that 68% of participants were still in remission a year after three all-day sessions, which run roughly the same as with psilocybin: lying down in a comfortable room, eye mask, headphones, two therapists on hand at all times, and therapy sessions before and afterwards. MDMA also has breakthrough therapy status, and is likely to be regulated even sooner than psilocybin.

For almost a decade, a small advocacy group has been trying to establish an Australian arm of psychedelic research. When I first spoke to the members of Psychedelic Research In Science and Medicine (PRISM) in 2016, they were fairly morose about their prospects, having just been rejected by a university for the second time, on the personal intervention of a deputy vice-chancellor.

Recently, though, their reception has notably improved. There is currently another proposal for a small trial of MDMA therapy working its way through the approvals process at Edith Cowan University in Perth. “Australia has a history of following the American lead in terms of any pharmaceutical and medical intervention,” Martin Williams, who is PRISM’s president, told me.

Along with Dr Marg Ross from St Vincent’s, Martin has been working for over a year to get the necessary approvals for the trial. “It’s certainly a significant step forward. I think it’s really going to break the ground for further work, and we’re already looking at other potential trials.”

A new organisation called Mind Medicines Australia has been established to train more therapists to meet the demand, and Williams reckons that psychedelics could be available as a regulated therapeutic treatment “within five to ten years”.

Nigel Strauss, a Melbourne psychiatrist who collaborated on earlier applications with PRISM, cautions that conservative Australian institutions are still resistant. “It’s to do with the belief, I guess, rightly or wrongly, that psychedelic drugs change people’s worldview … And the academic world, particularly in this country, doesn’t quite understand what that means and is a bit fearful of it. These are drugs that do help people come to terms with the meaning of their existence.”

That’s the idea behind the psilocybin study. At higher doses, it can more or less reliably induce what’s come to be known as a “classical mystical experience”, drawing on a taxonomy that goes back to William James’ classic study of religious experiences. In previous research, a more powerful sense of universal oneness and ego loss has correlated with greater therapeutic impact.

Psychiatrist Stephen Bright, vice-president of PRISM, explains what happens. “They’re able to come to terms with what’s happening for them. They end up afterwards with a sense of comfort that everything’s going to be OK. Consequently, the data shows a decrease in anxiety, depression, increased quality of life and connection with significant others.”

Albert Garcia-Romeu, currently leading a psilocybin study at Johns Hopkins, calls it “inverse PTSD”.

“When people have these very profoundly moving experiences with psilocybin it causes brain changes and personality changes that are long-lasting, similar to the way that a serious trauma can have the same kinds of negative effects,” Garcia-Romeu said.

In London, neuroimaging by the Imperial College researchers has shown that psychedelic drugs seriously inhibit the activity of a brain network called the default mode network, which is associated with self-reference, rumination and acts as a sort of executive director of higher level cognitive processes. At a high dose of psilocybin, it shuts down — in its stead, a stack of new neural connections and networks form.

The same pattern has been shown in long-term meditators — it’s a bit like psychedelics can offer the royal road to the subconscious and ego loss, at least for a few hours. The new scans vindicate Aldous Huxley’s old line about the brain operating as a reducing valve on consciousness — knock it out temporarily and watch those doors expand.

Of course, we’ve been here before. Through the ’50s and ’60s, many thousands of patients were given therapy with psychedelics by enthusiastic doctors. The results were good, if a little amateur. Then came the counterculture, the backlash, Nixon, the war on drugs, etc. The true believers never lost their faith, though — a small community of therapists and researchers, based mainly in the US, kept working away underground. Now they’re going mainstream again.

Robin Carhart-Harris, the head of the Imperial College team that gave Ian Roullier his therapeutic trip, is presenting the team’s findings at Davos this week. A Peter Thiel-funded start-up has swept in recently and rushed through much larger trials of psilocybin for depression in the UK. Michael Pollan’s book about his own experiences with therapy with mushrooms and other drugs was an Amazon bestseller, and he spruiked it on Colbert and the morning shows.

Williams has noted a big shift recently. “There’s been a broad shift in the public discourse which we were always trying to contribute to quietly, but it’s really gathered a lot of momentum.” Since 2016, when the US and UK research groups all published their major findings, media attention has been lavish.

“The more people are familiar and comfortable with the concepts, the easier it becomes to broach the subject.” Just last week, even the FT in London was running an enthusiastic feature about non-clinical psilocybin “group therapy” — in response, a retiree from Cornwall wrote in to detail her own recent psilocybin experience, crediting Pollan’s book with including people like her in the “mushrooming mental health zeitgeist”.

About a decade late as usual, it looks like Australia is finally starting to get with the times.