Over the last few years, you have perhaps noticed this trend: The media is totally on the psychedelic drug bandwagon. Nearly everywhere you look, there are articles about the magical benefits of these drugs. What are these articles trumpeting? They’re great to treat alcoholism, miraculous to treat drug addiction and spectacular to treat mental ills that would not respond to any other treatment.

This is not the first time we’ve heard gushing claims that a controversial, dangerous class of drugs would solve all our problems. So is it time to trust these reports and rely on these drugs to cure human ills or is it time to take a closer, more discriminating look at the subject?

It takes no effort at all to find millions (literally) of online articles, studies and research supporting these declarations. Do an online search for “benefits of psychedelics for treating addiction” and you will find nearly four million search results. (Search for “benefits of psychedelics” and you will find nearly five million. As a side note, one wonders how many articles could have been found about the wonders of using opioids to treat all classes of pain before we dove head-first into the current opioid crisis.)

Mescaline, psilocybin and LSD. Images courtesy of the DEA.

Here are some examples of what you will find broadcast by government agencies and conventional media:

• Psilocybin (magic mushrooms) can cure alcoholism with just two doses. 
• LSD, peyote, ibogaine and ayahuasca may be useful as short-term interventions in treating drug dependency.
• Ketamine may be used to treat addiction to drugs or alcohol. 
• Psychedelics like psilocybin mushrooms, LSD, and mescaline (peyote) may be effective in treating addiction, depression, smoking and eating disorders. 
• Psilocybin can effectively treat alcoholism, drug addiction and smoking. 
• Ayahuasca can reduce the severity of drug addiction. 
• Ibogaine can reduce opioid use severity with just one use. 
• MDMA (Ecstasy) can be effective in treating drug and alcohol addiction. 

There are already millions of these search results and there are going to be millions more. However, before we throw our support wholeheartedly behind all these enthusiastic reports and a radical expansion in the use of powerful mind-altering drugs, it would be prudent to slow down and think about what we’re doing. In fact, it’s time to ask some pointed questions.

Questions We Should Be Asking

Some people are going to accept the idea of psychedelics as treatment at face value and become advocates for expanding their use in treating addiction just as some have tried in recent years to reduce opioid addiction treatment to a life-long dependence on prescribed opioids. But others of us will take a more critical view of all this pro-psychedelic media coverage. Questions that need to be answered include:

1. Is it possible that any psychedelic drug could truly cure something as pervasive and life-destroying as addiction to drugs or alcohol in just one or two doses? 
2. Are any of the claimed benefits real? 
3. Are they lasting?
4. What are the side effects, short-term and long-term? 
5. Are the adverse side effects being discussed and published along with the claimed benefits of the drugs?
6. Are researchers cataloging adverse effects or are they just looking for benefits?
7. Do these millions of search results prove that psychedelics are really safe and effective in eliminating or reducing the severity of addiction?
8. Does every person receiving this therapy in locations where it is legal receive a complete briefing on the possible effects before giving consent? 
9. Is it ever going to be the right thing to do to treat substance abuse and addiction with more drugs?
10. Do we know enough about these drugs to freely embrace them as yet another in a long line of drug-focused addiction treatments that unfortunately often either failed or had horrible unintended consequences?
11. And following question #9, what is the unvarnished history of treating substance abuse and addiction with drugs? 
12. Is there a possibility that treating an addicted person with psychedelics could cause them to become addicted to or dependent on a different drug? 

Before we sign on to treatment with psychedelics, let’s take a look back at history to determine if drug-based treatment of addiction has been successful in the past. 

Example #1: Heroin to Treat Morphine Addiction

Yes, at one time, heroin was used as a treatment for morphine abuse. In the second half of the 19th Century, the use and misuse of opium and morphine became widespread. Injuries during the Civil War demanded the use of opium or morphine as a painkiller and an unknown number of injured men (estimated in the hundreds of thousands) became addicted and stayed addicted for decades.

Laudanum was a liquid preparation of opium and was widely prescribed for “cough, diarrhea, rheumatism, ‘women’s troubles’, cardiac disease and even delirium tremens,” also in the second half of the century. Of course, all kinds of people of the time used or became addicted to laudanum including Elizabeth Barrett-Browning, Lord Byron, Charles Dickens and John Keats. Starting in the 1870s, Chinese operators were running opium dens in major cities and Western towns. By the end of the century, one out of every 200 Americans was addicted to one of these opioids.

Heroin succeeded morphine, becoming popular with medical doctors in the last decade of the century and the first decade of the new century. Those addicted to morphine began to be treated with this new drug which was said to have “only one-tenth of the toxic effects” of another opioid, codeine. Heroin was also used to treat diarrhea and coughs. 

A report published in the New England Journal of Medicine stated that heroin was “not a hypnotic” and carried no “danger of acquiring the habit.”

As we know now, rather than eliminating the opioid problem, heroin became the new opioid problem. It took time for doctors and hospitals to break their own habits of dispensing heroin freely. Early in the 20th Century, heroin became a significant problem in New York City, where “98 percent of all drug addicts were reported at the time to be heroin addicts.”

The treatment of morphine addiction with heroin created a far worse scourge than morphine did. Thus we might are right to be cautious about recommending the use of any drug to treat addiction lest we wind up in a worse situation from the effects of the new drug. 

Example #2: Modern Medication-Assisted Treatment

Following the treatment of morphine addiction with heroin, the Twentieth and Twenty-First Centuries brought us the treatment of heroin or prescription opioid addiction with methadone or buprenorphine. For decades, the administration of methadone was associated with seedy clinics in a shady part of town. Those taking methadone had to show up every day to get their dose which meant they could never stray far from home. Quite in addition to other problems, methadone clinics became a focal point for drug cartels to find and acquire new customers — a totally unanticipated consequence.

Buprenorphine took medication-assisted treatment uptown. Finally, a regular doctor in the suburbs could prescribe this medication. Multiple doses could be taken home. Medication-assisted treatment was quickly adopted as the Gold Standard supported by every federal agency. The Substance Abuse and Mental Health Services Administration and the National Institute on Drug Abuse fully backed the use of medication-assisted treatment over other, drug-free methods of recovery. 

NIDA’s website offers this information:

Effective Medications are Available

Medications, including buprenorphine (Suboxone®, Subutex®), methadone, and extended release naltrexone (Vivitrol®), are effective for the treatment of opioid use disorders.

• Buprenorphine and methadone are “essential medicines” according to the World Health Organization.3
• A NIDA study shows that once treatment is initiated, a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid use disorder…
• Medications should be combined with behavioral counseling for a “whole patient” approach, known as Medication Assisted Treatment (MAT).

The refrain was picked up by the National Institutes of Health: 

Medication-assisted treatment (MAT) remains the gold standard of biomedical care for opioid use disorder, and is effective in reducing the frequency of injecting among people who inject drugs.

And thus MAT became the order of the day, unfortunately often as a reductionist way to avoid dealing with the full scope of an individual’s addition. MAT has also had unintended consequences — such as MAT drugs themselves being diverted to illegal use. In a similar way, psychedelic drugs are on their way to being established as another medication-assisted treatment of addiction and mental disorders. 

In Part II of this extensive look at psychedelics (coming soon), we will look more closely at this new psychedelic phenomenon.