Learning from reverse-engineering psychedelics, the murky future of ketamine telehealth, and who do psychonauts trust?
Plus: Mitigating the impacts of 280E, and Connecticut and Salem, MA relax psilocybin possession laws
Happy Friday, and welcome back to The Microdose, an independent journalism newsletter brought to you by the U.C. Berkeley Center for the Science of Psychedelics.
Learning from reverse-engineering psychedelics
In December 2022, two psychiatrists published an opinion piece in Molecular Psychiatry arguing for more targeted studies to help researchers understand the mechanisms underlying psychiatric disorders and their various pharmacological treatments. In the piece, the authors argue that the specific ways that psychedelics and ketamine work in the brain and body are not well understood; these researchers say the outcomes and targets of those drugs are “highly non-specific,” and therefore not the most promising for developing new and targeted treatments. In a response paper published this week in the same publication, two University of Texas at Houston researchers push back on that assertion, saying that reverse-engineering how psychedelics and ketamine work could, in fact, yield valuable knowledge.
As a comparison, the University of Texas at Houston researchers describe the development of anti-tumor cancer treatments, including immunotherapy medications and oncolytic viruses, or OVs, which are engineered viruses that attack tumor cells. Researchers also did not understand the exact mechanisms of these engineered viruses despite their apparent efficacy in targeting tumors. “Looking back, one could have portrayed the nonspecific effects of preliminary OVs in a manner not unlike the authors’ characterization of ketamine and psychedelics,” the psychiatrists write. The authors assert that these engineered oncolytic viruses “demonstrate effects in virtually every cancer/tissue type, agnostic to specific target, and modulate the tumor microenvironment in complex ways which continue to be incompletely understood.” Even so, researchers’ efforts to understand how OVs work have produced valuable science that has advanced the field. They make a case that researchers seeking new psychiatric pharmacological treatments should follow the cancer model, calling it “the ideal path forward for psychiatry: embracing what works and continuing to discover why it works, to ultimately facilitate targeted development.”
The future of ketamine telehealth remains murky
The federal government is sending some mixed messages about the future of ketamine telehealth. During COVID, the federal public health emergency declaration relaxed telehealth rules, allowing physicians to prescribe many drugs, including ketamine, after a telehealth consultation rather than an in-person appointment. After the Biden administration’s announcement that it would end the public health emergency declaration in May, the future of the industry was unclear.
In March, the Drug Enforcement Administration proposed a new rule that would allow practitioners to continue prescribing 30-day supplies of any Schedule III, IV, or V drug after a telehealth consultation, but refills would require an in-person evaluation. Last week, though, the DEA issued a temporary rule extending COVID telemedicine policies through November 2023. The new rule they’d proposed in March “resulted in 38,369 public comments,” the temporary rule summary said. While the agency reviews those comments, the DEA and Substance Abuse and Mental Health Services Administration (SAMHSA) are issuing the temporary rule “to avoid lapses in care for patients.”
On that same day, South Carolina physician Scott Smith was ordered by the DEA to stop prescribing mail-order ketamine to his patients, according to the Washington Post. Smith says he’s treated over 3,000 patients nationwide, many of whom told the Post that the medicine was a lifeline for them, and that they are now trying to find other ways to get the drug. The Microdose reached out to the DEA for confirmation that Smith was asked to stop prescribing ketamine to his patients, but did not receive a response by press time.
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Who do psychonauts trust?
How do psychedelics users get information about the drugs? A new study by researchers at the University of Michigan at Ann Arbor surveyed over 1,200 people about how they seek knowledge about psychedelics. Nearly 80 percent of respondents said they draw on their own experimentation with the drugs; a majority of respondents also said they relied on friends (61%), websites (61%), or internet discussion forums (57%) for information. They reported a high level of trust in peer-reviewed journal articles, psychedelics researchers, and psychedelics non-profits, and very low trust in pharmaceutical companies, government agencies, and the popular media. (In fact, respondents showed higher trust in people posting in online forums than they did in the media, government, or the pharmaceutical industry.)
Respondents were also polled on their beliefs about representations of psychedelics in popular media; a majority believed that media understates the benefits of psychedelics and overstates risks. Less than 5 percent of respondents said they sought out information from their primary care provider.
The respondents’ data indicates a gaping divide between psychedelics users and official institutions. “These results point to the need for further efforts in education, policy, research, and community building to align these two worlds, especially in relation to younger generations growing up in a rapidly developing psychedelic climate,” the authors write.
The Latest in Oregon: Mitigating the impacts of 280E
As Oregon creeps ever closer to having an operating psilocybin industry, psilocybin-related business owners are delving into the logistics of getting their companies off the ground. For years, the cannabis industry has been hamstrung by the Internal Revenue Service’s Section 280E, which prevents businesses “trafficking in controlled substances” from deducting business expenses on their taxes. This week, psychedelic non-profit Healing Advocacy Fund’s founder Sam Chapman moderated a panel with accountants and attorneys about what 280E means for business owners and how to mitigate its effects.
The panelists advised business owners to consider which costs were directly related to psilocybin production versus which are ancillary — the former type is not tax deductible, but the latter is, and could include things like social media and marketing, travel, and any portions of the physical location of the business not used for psilocybin purposes. Different types of psilocybin businesses also carry different liability for 280E; while manufacturers and service centers are clearly “trafficking” psilocybin, it’s ambiguous whether facilitators are. Panelists had different opinions about that, but if facilitators are independent contractors or employees of a service center and not directly involved with “trafficking” drugs, they may not have 280E liability at all. Panelists also outlined potential business models to help owners minimize trafficking-related costs (and hence, their tax burden). For instance, service center owners could sell other products unrelated to psilocybin, and instead of offering services directly, they could rent space to facilitators who work as independent contractors, or to non-psilocybin businesses.
The State of Psychedelics: Salem, Massachusetts and Connecticut relax psilocybin possession laws
The city council of Salem, Massachusetts has just voted to make the arrest of adults using psilocybin the lowest priority for local law enforcement. Advocacy group Bay Staters for Natural Medicine helped develop the deprioritization resolution; Salem joins five other Massachusetts towns that have passed similar measures.
Last week, Connecticut representatives passed House Bill 6734, which decreases penalties for possessing up to a half-ounce of psilocybin mushrooms. Previously, people charged with possession could be sentenced to a year in prison; now, the penalty for a first-time offender is a $150 fine. The bill now heads to the State Senate.
In a feature for Harper’s, journalist Sierra Crane Murdoch writes about her experience with the Oklevueha Earthwalks Native American Church and white appropriation of Native ceremony.
The shuttering of ketamine clinics from major companies like Field Trip and Ketamine Wellness Centers are “a warning of challenges that threaten to puncture the psychedelics bubble,” report Isabella Cueto and Olivia Goldhill in STAT.
Willamette Week polls Portlanders on how much they think a supervised one- to two-hour microdose psilocybin session would cost — and they are surprised to discover how wrong they are.
The Aspen Times reports that a Colorado man arrested for selling psilocybin mushrooms claims he was just gifting them and accepting donations in return.
“The Supreme Court v. Peyote,” the first episode of the new season of WNYC’s podcast More Perfect, tells the story of Al Smith. Smith was a Klamath Nation man fired from his job as a drug and alcohol counselor for participating in a peyote ceremony. He filed a lawsuit to seek eligibility for unemployment benefits, and his case was heard by the U.S. Supreme Court. In 1990, the court ruled against him and weakened the constitution’s First Amendment protections for religious ceremony in the process.
Cannabis dispensaries in Los Angeles are now selling ‘shrooms, too, reports the L.A. Times.
Utah TV station KSL reports that the local psychedelics community is grappling with last week’s murder-suicide inside Salt Lake City Psychedelic Therapy and Research.
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