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Matthew Johnson, PhD, a Professor of Psychiatry and Behavioral Science at Johns Hopkins University School of Medicine in Baltimore, has a PhD as an experimental psychologist and has a longstanding interest in a variety of psychoactive drugs.

But it is his track record that has made him known among his colleagues. Dr. Johnson was one of the main attractions at the INSIGHT ‘23 meeting held recently in Berlin, Germany.

“I’ve really focused on what you’d call drugs of abuse, but also ones with therapeutic applications,” said Dr. Johnson, who was fascinated with the topic years before joining the faculty of Johns Hopkins in 2004. Since then, he has used psychedelics and therapy to help smokers quit their habit and cancer patients to see decreases in depression and anxiety.

Patient Selection and Psychedelic-Assisted Therapy Are Paramount

However, Dr. Johnson warns that it can be dangerous to “play guru” with patients.

“[People using] psychedelics can make people highly suggestible. These experiences are sometimes so big that some researchers think the normal rules don’t apply, but that is exactly the wrong approach” he said. While he says that counterculture icon and Harvard Psychologist Timothy Leary, PhD conducted some great research on lysergic acid diethylamide (LSD) and psilocybin more than half a century ago, Dr. Leary unfortunately thought the normal rules do not apply to psychedelics. Dr. Johnson says we need to do the opposite, and be concerned about clinical ethics especially when dealing with psychedelics.

“But [Dr. Leary] did some things we may not want to repeat. We’re going too far when we say this work is literally going to save the human species. I think that’s failing to learn the lessons of the ‘60s. This lack of humility justifies anything. So, my advice is to cling to boring old ethics.”

Indeed, engaging in psychedelic-assisted treatment is a bit like running a marathon, said Peter Hendricks, PhD, a Professor in the Department of Health Behavior at the University of Alabama at Birmingham.

“It could be great for your health. It could be life-changing. But first, you’d need to see if you’re healthy enough to participate,” he explained. “Do you have any heart issues, for example? Do you have the right shoes, the right clothing? Do you know how to best train for a marathon? How best to optimize your nutrition? How to hydrate on the day of the marathon, and how to recover after? Obviously, you wouldn’t want to do this without lots of thought and planning. Otherwise, you could really get hurt.”

Furthermore, said Dr. Hendricks, there’s some concern that psychedelics may not be safe for people with bipolar disorder (BPD) or schizophrenia.

“Psychedelics may not be safe for those with BPD or schizophrenia, and the experiences can be intense and overwhelming—for anyone, whether or not there is a history of BPD or schizophrenia,” he said. “During the acute effects of psychedelics, people appear to be more suggestible, and obviously more vulnerable. Psychedelics seem to sometimes dredge up some really difficult psychological material—memories, thoughts, and feelings we may have gone to great lengths to avoid—and confronting this material can sometimes be disruptive.”

For this reason, said Dr. Hendricks, “it’s critical to have the guidance of mental health professionals to prepare for the unparalleled effects of psychedelics.” And he said, “it’s critical that clinicians involved in psychedelic-assisted treatment should adhere to the highest possible ethical standards—and they should be answerable to a licensing board.”

Thinking Outside the Box

Despite the risks, Dr. Johnson feels the potential is immense. He added that people are often surprised to hear that the FDA is encouraging clinical trials among teenagers once a given drug is approved for adults. “Post-traumatic stress disorder is also a problem in adolescents, and people with PTSD commit suicide. It would be unethical not to cautiously explore that because there’s a lot of suffering in young people with depression.”

Within 2 years, he said, the FDA will likely approve psilocybin for TRD, followed close behind by psychedelics to treat alcohol and tobacco dependency. He said some critics believe that psychedelic therapy for addiction might simply be replacing one addiction with another but said the practice is different when it comes to psychedelics.

“This is not a substitution therapy. People might be familiar with methadone, for example, to treat opioid dependence, such as heroin, or even nicotine patches and nicotine gum for tobacco addiction,” he said. “For those, you take the medication every day to curb your withdrawal. This is about taking the substance, depending on the study, only once, twice, or three times under medical supervision, with outcomes that appear to last for months—even a year or more later.”

New research, he said, suggests that for TRD, the effects of psilocybin fade after a few months. That may lead to a situation where, he said, “depending on the results, the patient may need a booster, an additional session every 3 to 6 months or a year. We’ll let the research guide us.”

https://www.endocannabinoidmedicine.com/psychedelic-researchers-emphasize-patient-selection-psychedelic-assisted-therapy/