Psychoactive substances to treat depression and addiction have scientific backing, but while evidence suggests they work, questions remain, writes Russell Brown.
Tanea Paterson was tired of methadone. Like many dependent opiate users in New Zealand, she had been prescribed the long-acting opioid to help her stay off heroin and other injectable drugs. But it had been eight years on a high dose and she was stuck.
But in 2006, someone told her about ibogaine, a vision-inducing drug derived from a West African plant, which was said to help people kick addiction. She focused hard on learning what she could and eventually bought some via the internet. She put in capsules, packed them, boarded a plane ("Oh my God, what was I thinking?") and flew to Australia, where an acquaintance had agreed to sit with her.
There, in a hotel room, she downed the capsules. She briefly struggles for words now to describe what happened in the hours that followed.
"I felt like I was being broken down to nothing. There was a visual representation, I guess, of blackness. People talk about their childhood coming back to them in a dreamlike state, but I didn't really have that. I felt like I was being thrown out into the universe and then falling back down and rebuilding.
"I'd had experience with different psychedelics but the intensity of this was a whole other level."
She never needed, or used, methadone again.
Twelve years on, she still has occasional "moments" that take her back to the hotel room, "not exactly remembering things that happened then, but as if there's something that keeps working in the background. It's still allowing me to think more clearly and to be able to assess things more easily than I did before then."
This might sound like just another unprovable tale from the world of alternative therapies, a hallucination in itself. But three years after Paterson's life-changing trip, Medsafe's classification committee agreed, at its November 2009 meeting, to classify ibogaine as a prescription medicine that could be used in addiction therapy.
Part of the committee's reasoning was that although ibogaine treatment – a challenging experience at the best of times – had occasionally been fatal (there has been one death since in New Zealand), it had a lower mortality rate than the methadone the State was already prescribing.
In 2018, New Zealand is still one of only three countries, along with Brazil and South Africa, that allows ibogaine to be prescribed. LSD and psilocybin (magic mushrooms) are still listed in Class A of the Misuse of Drugs Act, their supply punishable by life imprisonment. And yet, the idea of administering these psychedelic drugs as a therapy for drug dependence, intractable depression and crippling grief is teetering on the edge of respectability.
No one has done more to reintroduce psychedelics to polite conversation than the American journalist Michael Pollan, whose book published this year, How to Change Your Mind: The New Science of Psychedelics, describes a wave of formal studies that seem to be showing a potentially powerful new approach to very difficult problems. Pollan himself has sat for interviews in which he describes guided experiences with LSD, psilocybin, DMT and ayahuasca, a traditional medicine from the South American rainforests as fulfilling and fascinating – even if he was treating no more than the middle-age blues.
One particular set of studies described by Pollan, marshalled by British researcher Robin Carhart-Harris, has led to a relatively new theory about why psychedelics work as they do. When subjects were given psychedelics and had their brain activity observed with a technique called magnetoencephalography (MEG), which measures electrical activity, it became apparent that a set of structures in the brain called the Default Mode Network was effectively taken offline.
The DMN is essentially how we get by day-to-day; it deploys a bundle of default assumptions about who we are, what we know and what our senses tell us, based on what they've told us in the past. It's bossy and efficient. But it's also implicated in undesirable repetitive behaviours like depression and addiction. When it was quieted in the subjects, the other parts of the brain lit up and began communicating with each other and neuroplasticity increased. People became unstuck.
"The thing that amazed me when I first looked at the data was just how massive the effects were," says Dr Suresh Muthukumaraswamy, a lecturer at the Auckland School of Medicine who did the brain imaging for Carhart-Harris' psilocybin and LSD studies. "I'd been playing around with giving people drugs and measuring brain signals for a few years at that point and I'd never seen data like this before. What the hell was happening to this person's brain?
"When we went into the study we weren't even sure it was going to do anything for us to record. But here were these gobsmackingly massive effects, a profound effect on brain function."
Measuring the brains of people on LSD isn't actually new. In the 1950s, years before possession of the drug became illegal, clinicians were studying their subjects with EEG. But as imaging tools have become more sophisticated, we've learned more.
The forgotten history of psychedelic research also includes the research at Weyburn Mental Hospital in Saskatchewan, Canada, where doctors gave LSD to more than 700 chronic alcoholics – half of whom duly became sober. (In 2012, Norwegian researchers analysed the historical results of half a dozen similar studies and concluded that "a single dose of LSD, in the context of various alcoholism treatment programmes, is associated with a decrease in alcohol misuse.")
The new therapeutic trend arrived in New Zealand too. Before we followed the prohibitive bidding of the US, which had been well and truly spooked by the anarchic antics of Dr Timothy Leary, LSD was frequently administered at Cherry Farm and other hospitals.
"There was a clinic on Remuera Rd that used to give patients LSD for various things," says Muthukumaraswamy. "The clinic's still running, but they don't want to be associated with that anymore."
Was what they were doing rigorous?
"None of it was rigorous."
Muthukumaraswamy has been contacted by people who received LSD in those settings. People find out he's the LSD guy and call him – even people on the other side of the line, where LSD is still a Class A illicit drug. It's the nature of the work that he maintains contact with the informal psychedelics community and he has a cordial relationship with "Amadeus", who maintains the Psychedelics New Zealand Facebook group.
Whatever your mental image of a psychedelics buff, Amadeus probably isn't it. He's in his late-20s, slim, serious and he works in financial forensics. The lounge of his home in Auckland's eastern suburbs is graced with an impressive array of bourbons and single malt whiskies, which calls to mind a shrine. A book on shamanism rests on one arm of the couch.
"My approach to psychedelics is twofold," he explains. "Personally, it's been really transformative in my life. Therapeutically as well as spiritually. Psychedelics have had a very big impact on that, but also that's not necessarily the way to help change the world.
"I've spent enough time on the subject to be sort of a lightning rod of information for people. So when people need to know about something I've usually already found out about it somehow."
He has seen a notable increase in the number of people asking him for advice since How to Change Your Mind was published.
"It seems to have really been something that's brought a lot of different people together for different reasons, to look at something from a somewhat objective standpoint. So I have had a lot of people who are maybe into dance music saying, 'I read this book, I now realise there's this whole other side to it'. Then I'll get people who are scientific-minded saying, hey I want to have a chat about how people do this when it's in a ritual setting."
His own story is one of having gone deep into his subject.
"Through a period of about two and half a years where I for various reasons didn't need to be working, I was able to immerse myself fully in the psychedelic community internationally. I went to a number of conferences, I became personal friends with a number of people. I've been involved with all sorts of different things in the communities: music, pill-testing, academic work, podcasts, conferences, documentary films. All sorts of things I've just soaked up like a sponge."
Remarkably, he says he personally hasn't tripped for nearly three years. His personal and working life haven't been "stable" enough to allow for the days required to prepare, have the experience and "integrate" it afterwards.
He says many of those who are using psychedelics source them online.
"Typically, someone's biting the bullet and ordering on the Dark Web, probably from Europe, on the understanding that friends will help distribute them."
He does fret sometimes about "teenagers who are taking drugs and having fun as it were. There are some harm parameters that need to be considered with that sort of usage."
According to the drug-checking organisation Know Your Stuff, the scene has become safer in the past couple of years. Until then, the potentially deadly synthetic hallucinogen 25i-NBOMe – "N-Bomb" – was commonly being sold as LSD. But real LSD – albeit of uncertain provenance and quality – is back, and popular.
But Muthukumaraswamy offers a firm note of caution, especially for those seeking to self-medicate for mental illness:
"I've had patients contact me who have suffered from severe depression and have self-medicated. When we do a study we screen everyone through psychiatric interviews, it's all very careful and about whether it's right for this person to do it. There have been situations where self-medicating hasn't worked out very well and people believe they've suffered severe complications from it.
"To self-medicate like that is really dangerous and it's important that people don't do that."
One fashionable psychedelic that has no role in the party world is ayahuasca, a brew of several plants – but typically containing the psychedelic DMT and harmala alkaloids – traditionally used by indigenous people in South America. Although it has been known of by Westerners for hundreds of years, it has emerged more recently as an "it" psychedelic.
It's typically taken with the oversight of an experienced overseer or shaman – and the type and quality of the oversight seems to have a significant influence on the experience. Last year 24-year-old New Zealander Matthew Dawson-Clarke never even got to fulfill his plan for an ayahuasca experience in Peru – he died after drinking a powerful tobacco tea meant to prepare him for the trip.
This year, former Waitakere mayor Bob Harvey wrote vividly about taking ayahuasca in Northland, under the guidance of a visiting South American shaman. He described a challenging experience – dominated by the vision of a giant serpent – that eventually gave way to an aftermath in which he felt "totally and absolutely alive", his possibilities "endless". He also vowed that he'd never do it again.
A key path to the West for ayahuasca has been Santo Daime, a syncretic religion founded on a blend of indigenous and Catholic worship in 1930s Brazil. There is a branch of the church in Auckland, which is said to have gained permission to import its sacrament under United Nations religious protections.
Santo Daime practice varies considerably from place to place. In Brazil, it's church-like, in Amsterdam, hippie-like. It was in the latter place that "Stefan", a New Zealand businessman in his 60s, found himself last year having an ayhuasca experience, having been persuaded by his girlfriend to attend a Santo Daime retreat.
"It was a real revelation, to me as an older guy," he says. "I'd never done anything like that before. I went in and felt a little bit uncomfortable because it was a bit of a hippie-fest. There was a lot of eye-gazing and stuff and I thought jeez, get me out of here."
He gradually settled in to a very different experience to that described by Harvey: a 45-minute "rocket ride" of beautiful visions, followed by hours of contemplation.
"I haven't had a lot of trauma to come out, so I could work on other things. Your personal self in terms of how you operate – what makes you happy? It increases your empathy, so as a businessman for 40-odd years, you can be regarded as somewhat distant and arrogant, because that's the way you do business. You have to be very judgemental, very quick – which doesn't always make you the nicest human being socially.
"This showed me a more empathetic thing, where you slowed right down and made eye contact with people, you were a bit more patient with what people were saying."
He thought a lot about his family.
"I saw the potential for family members who had committed suicide or had very bad depression or self-harm or addictions. My intuition straight afterwards was that if only my nephew had done this, he wouldn't have committed suicide. This could be a watershed therapy and I really believe it could work with troubled souls."
This year, he headed back for a repeat experience, taking his adult children with him.
Tanea Paterson kept thinking about Ibogaine. She went to international conferences and studied to become clinical practitioner in addiction. She discovered one uncomfortable truth about the psychedelic therapy world: it can be a dude zone.
"There's a few women globally, but it's quite hard-out – you deal with attitudes. I had a lot of shit handed to me during the time I was doing it. You've just got to get through it, but I think it is really off-putting for a lot of women."
Eventually, she was the legitimate treatment provider in an ibogaine study conducted by University of Otago anthropologist Geoff Noller.
The trial saw the entry of perhaps the key organisation in the psychedelic therapy revival: the Multidisciplinary Association for Psychedelic Studies (MAPS). Since it was founded in the US in 1986, MAPS has sponsored formal trials of MDMA and cannabis to treat PTSD and a remarkable set of studies in which LSD and psilocybin helped terminally ill patients transcend end-of-life anxiety.
MAPS funded the Otago ibogaine study – channelling money donated by former legal highs entrepreneur Matt Bowden – and provided a protocol developed for a similar one in Mexico. Noller says his study produced better results than the Mexican one: fully half the 14 subjects (another died of unrelated causes during treatment) were tracked for 12 months and remained opiate-free.
It was followed by a clinical trial under Otago psychopharmacologist Professor Paul Glue, who has also studied ketamine (both a paediatric anaesthetic and a club drug) as a potential treatment for intractable depression. As Noller sees it, he and Glue between them represent a key division in the field: is it the neurophysiological effect of drug that's important, or the subjective experience?
"Paul's interested in the brain, whereas I'm interested in the mind. They're two very distinct things. You can work with the brain and you can change this molecule and create a new drug and target these receptors – and that's what Paul's all about doing. But for me it's the mind, because of this powerful transformative phenomenon that is associated with so many of these substances. That's the fulcrum for this therapeutic value."
Muthukumaraswamy is reserving judgement.
"We don't know," he says. "If it is a clinical response, do they need to be having a psychedelic experience in order to get better, or is it just that the brain has been exposed to this particular serotonergic 2A partial agonist that causes particular signalling pathways to be active and maybe promotes neuroplasticity?
"Because if you have a rat, you can give a rat ketamine and make the rat undepressed. You can create chronically stressed rats and give them ketamine and they'll become essentially undepressed. But no one's really talking about rat experiences, right? The question is, how much is it relying on the experience, or how much is the experience along for the ride for a neurophysiological change? I'm not saying the experience isn't important, but we don't have any evidence either way."
One of the things that makes finding out hard is that it's difficult to design a control for experiments. If a subject receives the psychedelic rather than a placebo, everyone knows soon enough who's got what.
The study Muthukumaraswamy wants to do next may get around the problem. Not every psychedelic experience is a full-scale one: microdosing, the administration of a dose too low to produce psychedelic effects, has been claimed to enhance intellectual agility and creativity. Some Silicon Valley companies have gone so far as to ordain "microdosing Fridays" and a recent Dutch study found results "consistent with the idea that microdosing psychedelic substances improves both divergent and convergent thinking."
But that study did not use a control group and Muthukumaraswamy says "there are no scientific studies of microdosing at this point. Everything is hearsay. It could just be homeopathy."
But he believes the advantage of the small doses is that they can be mimicked to some extent with a stimulant such as caffeine, which can be used as a control.
"Because you don't have to worry about placebo responses, you can actually start to look at the physiological changes over a period of months. We want to examine some of the claims about microdosing and precognitive effects, changes in personality and attention, things like that.
"If you find microdosing can work and have pro-physiological affects, then clinically it would be a lot safer to give people microdoses. It's a lot less risky than giving someone a thwacking big dose and it's going to be a lot more palatable for health services."
Research may also offer insights into the mechanism of psychedelics which allow the clinical effect to be replicated without the drugs.
The only problem is money. Even to study conditions like depression, psychedelic therapy does not get public funding. He's wary of MAPS, regarding it as an advocate group, but is nonetheless dependent on philanthropy to do his work.
Noller believes strongly that "there are possibilities here" with psychedelic therapy "and we need to manage them appropriately. But on the other hand we need to be brave and we need to have open minds."
But we're left with a question that Michael Pollan grappled with and couldn't quite answer in How to Change Your Mind: if these drugs, carefully administered, are safe and life-changing for the afflicted, should they be legally allowed to relatively healthy people who simply want a new lease on life?
"That," says Muthukumaraswamy, "is an interesting question."