Psychedelics for addiction recovery: 5 Questions for physician Peter Grinspoon
Grinspoon discusses recovery, addiction and whether psychedelics might have a role in addiction treatment.
When Peter Grinspoon was 13, his father Lester, then an associate professor of psychiatry at Harvard Medical School, wrote a book about psychedelics. The elder Grinspoon published Psychedelics Reconsidered in 1979, in which he called for the use of psychedelics in psychiatry. Eight years earlier, he’d written a book making a similar argument for marijuana (that book was called Marihuana Reconsidered). As a result of his views on drugs, Lester Grinspoon was shunned by many of his colleagues and never promoted to full professor. But the work was inspirational for the younger Grinspoon who grew up around his father’s famous, and weed-inclined friends including Carl Sagan and Alan Ginsberg.
After graduating from Swarthmore College, Grinspoon entered Boston University’s medical school — and along the way, he became addicted to opiates. Five years after becoming a primary care physician in Massachusetts, Grinspoon was charged with felonies for writing fraudulent scripts for opioids drugs, and stripped of his medical license. Now, more than 15 years later, Grinspoon is a primary care physician at Massachusetts General Hospital in Boston and an instructor at Harvard Medical School. In 2016, he published a memoir called Free Refills: A Doctor Confronts His Addiction. The Microdose spoke with him about recovery, addiction and whether psychedelics might have a role in addiction treatment.
Thanks for reading The Microdose! Subscribe for free to receive new posts and support my work.
What does addiction recovery typically look like in the U.S.?
Traditionally, recovery has been looked at as the absence of drugs. Recovery has been focused on an abstinence-only model, which we inherited from Alcoholics Anonymous. The Big Book — the organization’s foundational text — was written in 1939, and we didn’t know anything about addiction back then. We didn’t have MRIs, we didn’t have any medications to treat addiction; we didn’t have modern medicine then.
And traditionally, recovery treatment has been centered around things like Alcoholics Anonymous meetings, or rehab. Personally, I think rehab is one of the biggest scams — like sure, if you force people to be in an area where there are no drugs or alcohol for 90 days, they’re less likely to use drugs or alcohol, but if you put them back in their native environment, people are, if anything, more susceptible to overdose because they go back to using whatever opiates they were using before. But now they don’t have the same tolerance, so it’s easier to overdose. I would challenge anyone to show me good data showing that rehab actually helps people who are addicted. I think we need a huge paradigm shift.
What would that shift look like?
I think the way we treat addiction at Mass General is really effective. We have multidisciplinary teams — a primary care doctor who understands addiction and prescribes medications like Suboxone; an addiction psychiatrist; a recovery coach to provide individual peer support;, social workers to help people with housing, employment, and health insurance. We want to give people a pathway out of addiction. You can’t just stop using drugs; you’ve got to have a job, housing, and healthcare. Otherwise people are just going to be miserable and go back to using.
Subscribe for more great interviews and our weekly news roundup. (P.S. It’s free!)
What do we know about what is effective in treating addiction?
For Suboxone and Methadone, we have excellent results — there’s a 50 to 80 percent reduction in overdoses and deaths by overdose. I’ve also met thousands of people who have used cannabis to get themselves off of other drugs like alcohol and opiates, but there’s a lot more data for Suboxone and Methadone. With psychedelics, the research is growing every year; it’s not stone cold definitive yet, but we’re getting closer. One reason it’s not definitive is because it’s so hard to blind people. I don’t know about you, but I personally know when I’ve been given 100 micrograms of acid versus a sugar pill. I mean, if the walls are melting and everyone’s disintegrating — it’s not subtle. And because of that, there’s a big expectancy effect. If you take a pill that everyone tells you will make you happy, relaxed, and creative, you’re going to feel happy, relaxed, and creative.
This reminds me of a story about my dad: one time, we were on an airplane, and this woman started freaking out because she was afraid of flying. The flight attendants got on the intercom and asked if there was a doctor on board, so my dad got up and sat next to this woman and gave her a pill. He said, “Now, this is going to help you calm down and fall asleep.” She took the pill and calmed down, then fell asleep. The pilots were really grateful they didn’t have to divert the plane. It turns out he gave her a sugar pill. You absolutely aren’t allowed to do that these days but it worked like a charm. I mention this because half of what I do as a primary care doctor is placebo. I give patients something while we wait for the thing to get better, because it most likely will get better — and if it doesn’t, we figure something else out.
As psychedelic research has become more mainstream, there’s been discussion about whether ibogaine or psilocybin can treat alcohol use disorder or opioid addiction. How has the recovery community reacted to using psychedelics?
Your average addiction psychiatrist has been propagandized against many drugs, but especially cannabis; they tend to only read negative studies and don’t get exposed as much to the positive ones. Their support for legal access to medical cannabis trails behind public support. But something like 90 percent of psychiatrists are open to psychedelics and would consider using them in their practice.
In my most recent book, Seeing Through the Smoke, I talk about why psychiatrists are so pro-psychedelics but anti-cannabis. There are a lot of different theories why. For example, my neighbor, Jerry Rosenbaum, the director of Mass General’s Center for the Neuroscience of Psychedelics, said that cannabis was considered to be Valium-like — they help with symptoms — whereas psychedelics are potentially curative for things like treatment-resistant depression. Or it might be a “white drug, black drug” thing. Or it could be that cannabis paved the way for psychedelics. Or it could be that there’s more data and evidence for psychedelics in the format doctors are used to, compared to evidence for cannabis.
That evidence is still in its early stages, but do you have any thoughts on what it is about psychedelics that might support recovery?
On one level, recovery is just being happy enough so that the drugs don't have enough room to get in. It's about developing the tools to ask for help and connect with other people. Like for example, I just had surgery for my leg, but I didn't get addicted to the opiates because I'm in a much happier place, and I have all the tools.
You're never going to get help if you don't humble yourself and admit that you need help. It's all about connection, being mindful, living in the present, and not worrying about the past. It's about letting go of guilt and shame. And psychedelics really, really, really help people with these things. From what I know of recovery — what I've gone through personally and in working with hundreds of doctors and thousands of patients — there are benefits from working through those feelings, to be connected to other people, and to be connected to yourself. And I think that’s the case whether you do it in a hospital, with a therapist and a team, or if you're out in the woods with your friends. It just doesn't surprise me at all that this early data suggests psychedelics help with recovery. Some of the insights you get under psychedelics are exactly the insights you need to establish for recovery.
This interview has been edited and condensed for clarity and length.