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More news is below. But first: what you wanted to know about psychedelics.
A dose of something newPsychedelic drugs have won over some surprising converts. Scientists say they can treat a range of psychological ailments. Tech titans swear by them. Hollywood stars praise microdosing. Rick Perry — a onetime Texas governor and Trump official — is now an unlikely champion. In a recent newsletter, we asked for your questions about psychedelic drugs. You wondered about ailments they can treat, the dangers of using them and where you can get some. Today, The Times’s expert beat reporters answer. (Got a question for us? Submit it here.) Science and healthAndrew Jacobs, who covers psychedelic medicine for the Science desk, answers these questions. I’ve read about so many compounds — psilocybin, LSD, ayahuasca, ketamine, MDMA, ibogaine. Which ones are used in psychedelic therapy, and why? Laura Wilcox, Arlington, Mass. Many mind-altering drugs have shown promise for conditions like depression, anorexia and post-traumatic stress disorder. Some, like the anesthetic ketamine, are not considered classic psychedelics but are often lumped together with other drugs that shape perceptions of reality. Here’s a quick primer:
Are psychedelics a possible cure for dementia or cognitive decline? Ginger Gillison Schlather, Washington, D.C. The research is in its infancy. Investigators are especially interested in the drugs’ effects on neuroplasticity, mood and neuroinflammation — a key driver of Alzheimer’s disease. One study is looking at whether psilocybin can reduce depression and improve the quality of life for people with early-stage Alzheimer’s. What can these drugs treat? Do they have a different effect on people with mental health disorders? Vee Crichton-Hill, St. Paul, Minn. There are scores of psychedelic studies underway on end-of-life anxiety, depression, traumatic brain injury, obsessive compulsive disorder and others. Only ketamine can be legally used “off label” for treatment-resistant depression. MDMA may win approval to treat PTSD, and a psilocybin-like compound may win approval for severe depression. People with personality disorders have generally been excluded from trials because researchers worry they could react badly.
What are the risks? Jay Cantwell, Providence, Utah Most psychedelics have a low risk profile when taken at standard doses in supervised settings. But there are short-term psychological risks, including anxiety, paranoia and confusion, that can be brought on by an especially intense experience. (Read below for more on “bad trips.”) There is less data on the long-term risks, but there have been rare cases of long-lasting paranoia, mood disturbances and hallucinations — symptoms that mirror schizophrenia. To what extent are large pharmaceutical companies investing in this treatment? Emily Miller, Traverse City, Mich. Today, most compounds are made by start-ups and small, independent players. As the government signs off on more uses, though, the big drugmakers will likely muscle in; a $3 billion marketplace now is expected to be worth $8 billion by 2032. But there are limitations: Many drugs can’t be patented because, like psilocybin mushrooms, they occur naturally. Others, like LSD, are old and have exceeded patent protection. Pharmaceutical companies may try to qualify for new patents by tweaking an existing drug’s molecular makeup or delivery method. Law and cultureErnesto Londoño covers drug use and policy for The Times and wrote “Trippy: The Peril and Promise of Medicinal Psychedelics,” which came out last year. He answers these questions. Do we know how many Americans use psychedelics and what age groups they belong to? Helen Young, Massachusetts It’s rising, especially among young adults. Last year, nearly 10 percent of people between the ages of 19 and 30 reported having used psychedelics in the past year, an all-time high. (Pun kind of intended.) More than 5 percent of older people said the same, a fivefold increase from 2019. I recall hearing stories in my youth about people who became “stuck” on trips, sometimes taking a single dose and winding up committed to an institution. Does this actually happen, and how often? Jeff Feiler, Florence, N.J. “Bad trips” take many forms. On rare occasions, people can experience distorted perception and struggle to perform certain tasks for days or even months. This phenomenon is called hallucinogen persisting perception disorder, and scientists don’t understand what causes it. (One example: An off-duty Alaska Airlines pilot had a breakdown during a flight in 2023 after taking mushrooms and is accused of trying to crash the plane.) More common bad trips involve revisiting traumatic memories, feeling deep grief or experiencing fear similar to a nightmare. Is there a way to avoid a bad trip? Laura Knispel, Des Moines There are steps people can take to make these experiences safer and less likely to induce panic. For starters, having someone sit with you — an experienced, ethical guide — can make a huge difference. Unfortunately, hucksters abound. Also, be mindful about dosing: Start small, particularly if you’re prone to anxiety. You can buy testing kits online to ensure you haven’t been sold a counterfeit. But there’s no guarantee of avoiding a bad trip, I’m afraid. Where are psychedelics legal for mental health treatment, and how are the different states regulating them? Jane Tippet, Manhattan, Kan. Ketamine psychotherapy is the most accessible. Clinicians in the United States offer it aboveboard, but there are risks for addiction and bladder damage. Oregon and Colorado allow the use of psilocybin mushrooms in a controlled setting, under the care of a licensed sitter. New Mexico is launching a similar program soon, and lawmakers elsewhere are watching. But under federal law, producing, selling or using compounds like psychoactive mushrooms, ayahuasca, LSD and peyote remains a serious crime. How do you gain access to these spiritual/medical interventions without leaving the country or running afoul of the law? Alex Carswell, Pasadena, Calif. The Drug Enforcement Administration grants a handful of groups permission to import and administer psychedelics under religious freedom laws. The Native American Church got special dispensation in the 1980s for its religious use of peyote. Eventually, the Drug Enforcement Administration granted exemptions to churches in Oregon, Arizona and Washington state that consider ayahuasca — a potent Amazonian brew that contains DMT — a sacrament. In recent years, many psychedelic enthusiasts who had operated underground have begun offering retreats and ceremonies after registering as churches. The legality of these groups is murky.
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