I’d been hesitant to be open about my quest, because I’m old enough to remember the “bad trip” warnings that scramble your brain. Imagine my surprise when my friend told me that he had recently taken his first “trip”, which he described as life changing.
I asked him, a real estate developer living in Northern California, married with children, why he decided to try a psychedelic substance. “My work felt increasingly stale and pointless,” he explained to me over a beer. “Despite a lot of thought and training on how to break the routine, I felt like I was still off track.”
He and others who have used these drugs spoke on condition of anonymity because most of these psychedelics are Schedule I substances, meaning they are illegal to make, buy, possess or distribute.
When I confided in my interest in psychedelics to a few other friends, several said they had tried the drugs and experienced various benefits: from relieving anxiety to finding spiritual insights to combat depression and, among some with cancer, helping to reduce the fear of dying. .
They are hardly outliers. According to a new YouGovAmerica study, “one in four Americans say they have tried at least one psychedelic drug,” representing some 72 million American adults. (The study included the drugs mentioned above, plus LSD, mescaline, and salvia.) Was I missing a beat by not participating?
When I asked my psychiatrist about getting involved to help improve my mental health, he was supportive, with two caveats: Do it with a trained therapist or guide, and do everything you can to make sure the substance is what it says it is. .
These days, it’s hard not to see, hear, or read about the use of psychedelics, whether it’s Michael Pollan’s best-selling book (and accompanying Netflix documentary) “How to Change Your Mind,” online advertisements for “travel “of psychedelic spas, underground therapists (also known as “minders” or “guides”) with websites promising consciousness-expanding trips and a do-it-yourself online ketamine program, with a medical professional connected by videoconference, who can do at home. (Ketamine was approved by the Food and Drug Administration in 1970 as an anesthetic/pain reliever, making it legal to prescribe. For more than 20 years, it has been prescribed off-label for depression, anxiety, and other conditions.) A derivative of ketamine, called esketamine, sold as Spravato, was approved by the FDA in 2019 specifically for depression).
Recent headline-grabbing clinical trials and studies have shown its efficacy in treating a variety of conditions, including depression, addiction, obsessive-compulsive disorder, and post-traumatic stress disorder. And a growing number of studies are underway.
Intrigued but cautious, I wanted to know: How should I approach this in a smart and safe way? I began by interviewing Rick Doblin, founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS). He reminded me that aside from ketamine, none of these generally illegal psychedelics are FDA-approved, so he would only talk about “minimizing the risks.”
“I don’t want people to think this is like going to a carnival,” he said. “There is always a risk.”
Matthew Johnson, a professor of psychiatry at the Johns Hopkins Center for Psychedelic and Consciousness Research who has conducted numerous studies on psychedelics, also spoke on the subject of safety. Until then, Hopkins clinical trials rule out people with schizophrenia, bipolar disorder, or severe heart disease.
I mentioned that, like millions of Americans, I’m taking an antidepressant (an SSRI or selective serotonin reuptake inhibitor), which, he explained, would likely mute the effect of psilocybin or MDMA. To take psychedelics, he told me I’d like to taper off the SSRI first, which is best done with medical supervision (and which I’ve had trouble with in the past).
I also have heart disease, so he warned me to talk to my cardiologist (who texted me saying he knows nothing about using psychedelics). In other words, these drugs are not for everyone.
Johnson reiterated that despite public testimony about the positive therapeutic effects of psychedelic use, “there are dangers and it is illegal.” Was he trying to discourage me? “I don’t encourage anyone to do this on their own,” he said.
After researching this column, I am not interested in undertaking this journey on my own. But assuming you had a guide or a therapist, where would you start?
Doblin suggested that anyone with a “clinical indication” (such as depression, PTSD, or anxiety) should visit ClinicalTrials.gov to search for and possibly participate in nearby trials. Recently, when I checked the database of “psilocybin” studies in the United States, 67 trials came up. All are conducted at recognized academic medical centers, which means that the studies are conducted with pure drugs, approved by the FDA and authorized by the Drug Enforcement Administration, which means that the trials have regulatory approval.
What about people without a clinical indication, but who are on a spiritual quest? Here are the considerations I collected:
Set and setting: Over and over again I’ve heard this phrase, which refers to finding a healthy mindset and a relatively safe environment. For obvious reasons, Johnson called the rooftop of a tall building a bad idea, as is being near cars or sharp objects. Robert Mitchell, who has practiced psychedelic therapy and administered medicinal plants for 30 years and has treated “hundreds of clients,” said that “the most important thing is that you feel safe, comfortable and not disturbed.” Based in Los Angeles, he said he often has clients rent a cabin in the Santa Monica Mountains, which serves as a “sacred space.”
Find an experienced and trusted therapist: If you’re looking for a psychedelic guide, word of mouth can help. My friend, the real estate developer, said, “For a first timer, I feel strongly about advising others to find a guide, ideally recommended by someone you trust.” Hopkins’ Johnson urges people not to take just one of these psychedelic drugs; although there are still risks, it is less risky when there is someone who has knowledge of the identity of the substance and the dose. (He said this may be especially critical for psilocybin mushrooms, which are known to vary widely in potency.) New programs are available, such as the Psychedelic Assisted Therapies and Research Certificate Program at California Institute for Integral Studiesintended to meet the growing need for qualified psychedelic therapists to meet the demand.
Ask questions ahead of time: Many therapists include a preparation session before any trip or treatment begins. Questions to discuss in the preparation session include a discussion of the therapist’s background and experience, their intention to take a psychedelic medication (and which one), their personal health history, how they might handle a problem that comes up (such as a secondary medical or a “bad” trip), the supply of the medication and, of course, the fee. A woman from Colorado gave me this advice: “I would make sure to work with a therapist who has experience and a clear protocol for psychedelic use, including pre-trip discussions and post-trip integration appointments.”
Know what you are eating: Doblin said there is one DEA-licensed facility in the United States: the Drug Detection Laboratories. It accepts anonymous samples of illegal drugs and will test them and post the results online. (You send it with a specific code and pay a fee for analysis.) Barring that, you’ll want to talk to potential guides about the source of your substances. Mitchell told me that he knows where his psilocybin mushrooms are grown and can guarantee its purity. In the end, a friend who had two psilocybin sessions said that he “had to trust the guidance and the trust it generated.” That will always be imperfect.
Do your homework: MAPS is a nonprofit educational group whose first phase 3 study, on the effective use of psilocybin for severe cases of PTSD, was published last year in Nature Medicine, a leading peer-reviewed journal. The organization publishes information about the functions, uses, and legality of psychedelics. Offers an introductory course, Psychedelic Foundations. Another resource is the “MAPS Code of Ethics for Psychedelic Psychotherapy,” which discusses psychological and physical risks.
So am I going on a psychedelic trip?
I’m reading everything I can get my hands on and talking to everyone I can about their experiences. I am also remembering the legal issues. Yes, Pollan and others are trying psychedelics and writing about their experiences, and they haven’t been arrested or derailed in their careers or apparently suffering ill effects, but that shouldn’t be taken as carte blanche for the rest of us.
I’ll check back here in a few months, so stay tuned.
