This Week in Psychedelics: New bills in Missouri and Rhode Island, drug interactions, and the trough of disillusionment
Happy Friday, and welcome back to The Microdose. Here’s the news of the week:
New bills in Missouri and Rhode Island. So far this year, The Microdose has reported on efforts in Washington, Utah, Virginia, Colorado, and Maine to introduce new psychedelics legislation.
This week, Utah House Bill 167 passed the legislature nearly unanimously and is expected to be signed into law by Governor Spencer Cox. HB 167 creates a task force to study psychedelics and specifically dictates that this task force must include experts from specific areas, including a licensed psychiatrist, a licensed pharmacist, a licensed psychologist, a neuroscience or mental health researcher, a hospital or healthcare expert, a trauma-focused therapist, and an attorney, among other roles. The task force must provide evidence-based recommendations in the form of a report by October 31, 2022.
In Missouri, Republican state representative Tony Lovasco introduced House Bill 2850, which would allow people diagnosed by a physician with treatment-resistant PTSD, depression, or a terminal illness to use “natural medicine” derived directly from a plant or fungus, which includes DMT, ibogaine, psilocybin, psilocin, and mescaline, but excludes peyote, which some Indigenous groups have requested be left out of decriminalization efforts for conservation reasons. The bill requires patients to receive this “natural medicine” through a caregiver, through hospice care, or at a healthcare facility, but it does not require any specific training or certification for those who administer treatment.
Rhode Island has also introduced two bills that would lower legal penalties for possession of psychedelics. While possession of prohibited drugs is a crime punishable by prison time or hefty fines up to $100,000, an exception has been made for the possession of marijuana: it’s been downgraded to a misdemeanor with a maximum prison sentence of two years or a fine of $500. House Bill 7715 would provide the same exceptions for psilocybin and the opioid buprenorphine. The other bill, HB 7896, largely repeals the state’s existing policies on drug possession. While manufacture or sale of scheduled drugs would remain a criminal act, possession of less than an ounce of any drug except fentanyl would be downgraded to a misdemeanor.
Drug interactions. A common claim among psychedelics advocates is that psychedelic-assisted therapy might be a more effective treatment than standard mental health therapies like antidepressants or mood stabilizers. But among scientists, there are lingering questions about the interaction between commonly prescribed drugs and psychedelic treatments. Do psychiatric medications change the efficacy of psychedelic treatment, and if so, in what way? In December, The Microdose reported on a clinical trial where researchers gave psilocybin to healthy volunteers who had been taking the antidepressant escitalopram for two weeks, and wrote that “escitalopram and psilocybin can be safely administered together.”
This week, a systematic review paper authored by researchers at the Oregon Health & Science University reviewed over three dozen studies to better understand how MDMA and psilocybin interact with other drugs, including antidepressants, beta blockers prescribed for high blood pressure, and other medications. Many clinical trials for MDMA- or psilocybin-assisted therapy exclude people taking certain drugs, including psychiatric medications. The researchers report that there is a particular lack of research on how psilocybin and psychiatric medications react. Because certain groups, like those with cardiovascular or liver disease, have usually been excluded from clinical trials of psychedelics, it could be a challenge to safely administer psychedelic therapy to those patients since the risks are not yet known.
There has never been a more exciting – or bewildering – time in the world of psychedelics. Don’t miss a beat.
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Into the weeds of Oregon’s new psilocybin regulations. As Oregon prepares to become the first state to legalize psychedelics, STAT’s Olivia Goldhill reports on lingering questions around what the state’s burgeoning psychedelics industry might look like, and what rules and regulations will govern the system.
Over the last year, the Oregon Health Authority’s Psychedelics Advisory Board has been drafting proposed rules and regulations, and in mid-February, they hosted a series of meetings to discuss what they’ve come up with. Stakeholders provided input on the drafted rules, and Zoom calls were open to the public. U.C. Berkeley Center for the Science of Psychedelics consultant Kelly Franger sat in on those discussions and reported back. Her detailed summaries show the granularity of these policy discussions and the difficult trade-offs and considerations OHA’s Oregon Psilocybin Services team must make in its recommendations. A couple of highlights:
The proposed rules attempt to prevent psychedelic therapy practitioners from engaging in bad behavior and unlicensed practices, but these discussions suggest that the rules alone might not prevent malpractice. For instance, draft rules define “scope of practice” as “professional boundaries related to psilocybin facilitation and avoiding the unlicensed practice of other disciplines such as medicine or psychotherapy” — but licensed practice could also go wrong, and a commenter in the meeting noted that professional licensing groups like the Oregon Medical Board have not yet publicly released standards about administering psilocybin therapy as a licensed physician. Additionally, in discussing standards for psilocybin therapy training programs, OHA has little authority in overseeing, assessing, modifying, or censuring guide training programs — it can only assess whether or not a program meets the requirements of its draft rules.
The draft rules also state that psilocybin products must be designed to be consumed orally only and explicitly prohibit “transdermal patches, inhalers, nasal sprays, suppositories, and injections.” In discussions around these rules, a hospice nurse pointed out that some clients might take medication through non-oral routes, like rectal administration. Another commenter suggested that perhaps exceptions could be made for qualified patients who have been permitted to use alternative psilocybin consumption methods after being evaluated by a medical professional. But, OHA said, that might violate Measure 109, which explicitly states that the OHA “may not require a client to be diagnosed with or have any particular medical condition as a condition to being provided psilocybin services.”
The trough of disillusionment. Zach Haigney, writer of psychedelics newsletter The Trip Report, writes that recent examinations of psychedelic therapy’s shortcomings is a sign we are at a low point in what he calls the “psychedelic hype cycle.” Haigney looks at the current moment through the lens of the Gartner Hype Cycle, a theory “which describes the narratives, waves of investment, and eventual adoption of new technologies.”
Haigney writes that, for the last two years, the psychedelics industry has been booming, culminating in what the Gartner Hype Cycle calls a “Peak of Inflated Expectations.” Dozens of companies have gone public, and states and cities across the country have passed psychedelics-related legislation. Now Haigney says we are in what’s called the “Trough of Disillusionment.” (After the trough comes the “Slope of Enlightenment” and, finally, the “Plateau of Productivity.”) “Clawing out of the trough of disillusionment means grappling with the hard questions and building the infrastructure and operational layer that will enable safe, responsible, and broad access to psychedelics,” Haigney writes.
The power and peril of touch. In recent months, former psychedelic therapy patients have come forward with accounts of alleged therapy abuse. This has spurred discussion in the field about ethics around consent and touch when patients are in an altered state, including a blog post published in the British Medical Journal’s Medical Ethics blog in December. This week, a group of researchers, former clinical trial participants, and other advocates penned a piece for Bill of Health, Harvard Law’s blog, in response to that BMJ blog post.
While the BMJ blog post argues that depriving a patient of touch “could retraumatize patients,” the authors of the Bill of Health post raise concerns about the lack of evidence to support that claim. Instead, they say, touch itself could retraumatize patients, so perhaps the best policy is to avoid it. “In the absence of evidence (for benefit of touch or harm of denied touch) alongside knowledge of potential threats (unwanted sexual/non-sexual touch and sequelae), a risk-averse approach should be taken,” they write.
Even more speed bumps. Researchers from the University of Auckland’s School of Pharmacy published a paper in Australian & New Zealand Journal of Psychiatry called “The challenges ahead for psychedelic ‘medicine.’” The authors discuss issues with research methods that can compromise results of clinical trials, like the difficulty in keeping patients from knowing which experimental condition they’re in. (Nearly 100% of participants in trials that tried to “blind” participants were able to correctly guess they’d been given a psychedelic drug.)
Other factors can also hurt research efforts. The scientists raise concerns that studies funded by grants from philanthropic organizations “often do not undergo the same type of rigorous peer review and scientific assessment that grants sent to a research council would.” They also point out stumbling blocks with the implementation of psychedelic therapy, like integration into healthcare systems and possible risks of self-medication. “With all the excitement around the potential of psychedelic medicine, it is important to remain objective and realistic about the difficult path that lies ahead given the pandemic it aims to treat,” the authors write.
Take a look at the first cohort of fellows for the Ferriss-UC Berkeley Psychedelic Journalism Fellowship. We’ll be following along as they publish and air their stories.
Chemical & Engineering News reports on pharmaceutical companies’ efforts to engineer psychedelic drugs without hallucinogenic effects.
The editorial board of the Harvard Crimson published an editorial encouraging Harvard and other universities to remove policies prohibiting psychedelics on campus. “We know that it’s tempting to view a college newspaper Editorial Board’s calling for psychedelic decriminalization as self-serving and disingenuous, but keep in mind: This is a deeply serious issue with implications far beyond our community,” they write.
Researchers at Yale, Johns Hopkins, and NYU have received a $1 million grant to develop a training curriculum for psychiatrists administering psychedelic-assisted therapies.
You’re all caught up! Have a great weekend. The Microdose is going on spring break, so we’ll see you when we return in two weeks. We’ll be back in your inbox with a new issue of 5 Questions on Monday, March 28.
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Thanks for another excellent post! There were some real interesting points in this one. I'm most intrigued by the chemistry of psychedelics, and my ears perked up at the section about concerns surrounding drug interactions. I'm not altogether surprised that few negative interactions have been found so far, simply because of the physiological strangeness of psychedelics. But this point made me think about the unexpected interactions between all sorts of different substances. For example, the fact that many (if not most??) medications interact pretty dramatically with grapefruit (which happens to be my favorite fruit) in either a depressive or stimulatory capacity depending on the mechanism of metabolism. I'm wondering if anyone is looking into the effects of grapefruit on psychedelics? Super cool stuff!