Psilocybin’s Potential: For Better or Worse?

Due to breakthrough scientific research and growing public interest, the United States is entering a psychedelic revolution. Various districts are pushing to loosen their laws in order to explore the possible benefits of decriminalization and therapeutic application. Psilocybin is a cornerstone psychedelic and a natural classic hallucinogen, which can be used to treat dependence on other substances such as alcohol and tobacco, treatment-resistant depression, and a host of anxiety disorders.  As a result, various organizations are making haste to implement psilocybin into the pharmaceutical industry. As the rush to pharmaceuticalize psilocybin has paralleled legalization efforts, numerous concerns have risen that pharmaceutical development is outpacing the emerging clinical science.  

Psilocybin is typically considered a serotonin agonist, meaning that it facilitates the activation and transmission of serotonin, the “feel good” neurotransmitter. However, recent findings suggest there are peripheral effects on glutamate and dopamine neurotransmitter systems. Psilocybin use has also been shown to increase neuroplasticity in the cerebral cortex, which is what may enable the user to explore new thought patterns and consider different perspectives. For these reasons, if a dose is taken in optimal settings, users often report mystical and existentially meaningful experiences. Psilocybin not only produces perceptual hallucinations, but also alterations in one’s thoughts and moods. Included among these experiences is loss of ego boundaries, or a dissolution of the envelope that contains one’s ‘self.’

Since classic psychedelics like Psilocybin accentuate perceptual experiences, it is important to acknowledge that anxiety is a common response to the drug, even in the most well-controlled clinical studies. The loss of ego boundaries can cause negative affect and confusion, which is colloquially known as a dysphoric 'bad trip.'  For this reason, psilocybin use for the treatment of anxiety and mood disorders should occur under the supervision of trained professional treatment providers. Although serious adverse reactions to psilocybin are rare, negative physiological outcomes can include headaches, nausea, and vomiting, the latter of which is usually triggered by orally administered high doses.

Across the United States, psilocybin drug-policy reform crosses typical political boundaries. Denver, Colorado was the first city to decriminalize psilocybin in May of 2019, with Oakland, California following suit later in June. Oregon clinically legalized psilocybin in November of 2020, the only state to do so. Texas, Florida, and Virginia are now conducting clinical research to assess their best options for reform. Liberal-leaning districts typically enact reform aiming to make psilocybin law enforcement's lowest priority, intending to reduce overall incarceration rates. Supporters of this rationale include figures such as Alexandria Ocasio Cortez of New York and Scott Wiener of California. More conservatively-run states tend to emphasize psilocybin’s therapeutic potential to treat PTSD in veterans, with influential political voices such as Dan Crenshaw, Matt Gaetz, and former Texas Governor Rick Perry using such logic to appeal to other lawmakers.

However, widespread reform is not always logistically perfect. The Oregon initiative does not allow for expungement of prior charges related to psilocybin, and as of now psilocybin remains recreationally illegal. There are also questions concerning the motivation to decriminalize psilocybin for law enforcement purposes, as psilocybin and other hallucinogens make up a small portion of all drug related charges. Furthermore, there are variations in the logistics of psilocybin reform in differing parts of the country. For instance, Oakland’s initiative involves a much wider legalization of hallucinogens other than psilocybin. However, there are concerns over such initiatives involving ambiguity of legal possession limits and methods of cultivation and sharing. Furthermore, Native American communities have voiced their concerns about the “gentrification” of psychedelic substances like psilocybin that have been used ceremonially in indigenous cultures throughout history.

If the potential therapeutic usage of psilocybin is central to the argument of legalization, psychologist and psychiatrist communities should weigh in on the debate regarding policy reform. A 2018 survey including over 300 American Psychiatric Association members reported that 80% of respondents thought psilocybin needed more research done before widespread legalization occurred, with almost 65% reporting they believe it could increase rates of psychiatric disorders. Conversely, 42.5% believed psilocybin could help alleviate psychiatric disorders, and many stated that an appropriate clinical setting would be essential to its effective use. Overall, findings from this survey indicate that many mental-health professionals are still on the fence regarding psilocybin’s therapeutic efficacy, with a consensus that more research is necessary.

Along with Native Americans’ concerns of cultural gentrification, medical historians are skeptical about whether the future of psilocybin therapy will include availability to all who can benefit from it, rather than just catering to the wealthy. In Manhattan for instance, a clinic called Field Trip Health, offers four starting sessions of psychedelic-assisted psychotherapy with ketamine at a price of $4,100.  If this remains the trend, then psychedelic-treatment will be exclusive to the elite.

The FDA has also granted “breakthrough therapy” designation to psychedelics, which has prompted profit-oriented companies to hasten clinical trials.  The Center of Mental Health Pathways and Support for Self-directed Care, now known as COMPASS Pathways, received this designation from the FDA in 2018.

COMPASS has also found itself at odds with the professional academic psychedelic community.  One individual who opposes organizations such as COMPASS is psychedelic expert Bill Jesse, founder of the Council on Spiritual Practices, an organization that partners with various religious scholars, biomedical professionals, and spiritual guides in order to safely bring spiritual experiences more directly to those who seek it for the betterment of the individual and their community. Organizations such as Jesse’s are important to psilocybin reform because they ideally serve as a checks and balances systems to form the most safe and effective treatment programs possible. In 2017, Jesse published his “Statement on Open Science and Open Praxis with Psilocybin, MDMA, and Similar Substances.” This statement is an open call for advocacy concerning free flow of psychedelic research information, so that psychedelics can be best understood rather than used for profit-driven advancements. Jesse has obtained nearly 150 signatures from various well-reputed scientists, scholars, researchers, and treatment providers. Some of the biggest names include famous psilocybin enthusiast Paul Stamets, Dennis McKenna, Roland Griffiths, William Richards, and Rick Doblin (founder of MAPS, a non-profit psychedelic research company).  

The backlash against COMPASS may have been triggered by reportedly shady business practices and strategies. COMPASS is set to be the first widespread legal provider of therapeutic psilocybin products, and even has pending international patents for their own crystalized version. COMPASS is also Nasdaq approved, has raised over $240 million, and is conducting over 20 clinical psilocybin trials in ten countries. One of these trials includes 216 subjects in over a dozen cities in North America and Europe. Historically, big pharma has been known to use patent laws at the expense of clinical integrity in order to eliminate competition and raise profits.

COMPASS started as a non-profit organization that relied on donations for its growth, its founders are George Goldsmith and Ekaterina Malievskaia. As they gained traction, the founders reached out to high profile psychologists and psilocybin researchers to serve as business advocates. These professionals would often become “informal advisors,” adding their reputation to the board of consultants. For instance, Katherine Maclean who researched psilocybin at Johns Hopkins for five years, became director of the Psychedelic Education and Continuing Care Program in New York, and helped create COMPASS’s research protocol system shared this experience. Maclean eventually lost contact with the founders of COMPASS, only to hear from them when she expressed a desire to present some of her collaborative research with COMPASS at an upcoming TED Talk. COMPASS denied her ability to talk about her work and claimed that the nature of the work was intellectual property owned by COMPASS. The main concern with instances like this is that COMPASS appears to use the intellectual-property agreements to control any clinical advancements related to psilocybin.

The monetization of psilocybin treatment comes with the potential to inflate positive and minimize negative clinical-trial research findings. As Roland Griffiths, founding director of the Center for Psychedelic Consciousness Research at Johns Hopkins once said, “We have to be careful not to overpromise, but these are fantastically interesting compounds with numerous possible uses,” while also mentioning on JAMA that society’s expectations may be outstretching the body of scientific data. Researchers such as Griffiths agree that psilocybin has great potential to not only be a pharmaceutical phenomenon, but a world changing one as well. Griffiths should know, as he and Katherine Maclean both helped conduct a 2011 study that analyzed the acute effects of psilocybin on 52 “hallucinogen-naive” subjects, specifically in terms of changes in Big Five personality traits. Of the five personality traits, Openness was the only one that produced significant increases. Of the six descriptive factors for Openness, “action” was the only demographic that was not significantly increased over a year after dosing sessions. Hypothetically, without safeguards in place to assure that the clinician is acting with the utmost ethical practice, the potential exists for treatment to result in damage. Thus, if psilocybin substantially increases traits of Openness, then clients undergoing psychedelic assisted therapy would be much more receptive to adopting new ideas. If the suggestibility of the treatment provider is misguided, then harm can be done to the client.

Concerns over therapeutic misuse of psilocybin are not far off from what has happened in the past, such as advertisements for the use of LSD as an everyday pick-me-up in the 1950s. During this decade, there were reports of therapists taking LSD with their clients, and in some instances, psychosis resulting from extreme overapplication of LSD. Similar events have occurred in underground psilocybin therapy clinics operating during the years since, and this may become a greater threat if psilocybin is legalized and advertised as a one-size-fits-all mental mediator. However, people such as the Oregon Psilocybin Society’s co-founder Tom Eckert have advocated for treatment- provider accountability, which includes strong training standards, and transparent communication about the negative aspects of dosing psilocybin.

Society must tread lightly towards psychedelic expansion, as false promises of a mental cure-all could lead to massive mishaps in populations who are already struggling with mental illness. Many modern studies on psilocybin have shown that it can increase personal meaningfulness, life satisfaction, connectedness to nature, and prosocial attitudes. Considering the feelings of unity that come with dosing psilocybin, it is understandable that some believe more widespread use can make the world a better place. Historically, the psychedelic utopianism that was popularized by Timothy Leary and Terence McKenna promoted this basic idea that psychedelic use could prevent the world from being destroyed by nuclearization. Naturally, it would be unrealistic to think that psychedelic use can save the world from humanity’s threats, but it may help those who are struggling with various forms of mental distress, alleviate substance dependence, and bring greater meaning to those who seek it. Looming questions remain regarding how therapeutic psilocybin can remain a safe and viable option for those other than the elite. Going forward, we must hope that those in positions of influence work to ensure an honest, safe, and efficacious path towards realizing psylocibin’s full therapeutic potential.