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Psychiatry & the psychedelic drugs. Past, present & future

This review article (2018) looks at the pre- and post-prohibition clinical studies on psychedelics and offers strategic advice on the legal and regulatory hurdles.

Authors

  • James Rucker
  • David Nutt

Published

Neuropharmacology
meta Study

Abstract

The classical psychedelic drugs, including psilocybin, lysergic acid diethylamide and mescaline, were used extensively in psychiatry before they were placed in Schedule I of the UN Convention on Drugs in 1967. Experimentation and clinical trials undertaken prior to legal sanction suggest that they are not helpful for those with established psychotic disorders and should be avoided in those liable to develop them. However, those with so-called 'psychoneurotic' disorders sometimes benefited considerably from their tendency to 'loosen' otherwise fixed, maladaptive patterns of cognition and behaviour, particularly when given in a supportive, therapeutic setting. Pre-prohibition studies in this area were sub-optimal, although a recent systematic review in unipolar mood disorder and a meta-analysis in alcoholism have both suggested efficacy. The incidence of serious adverse events appears to be low. Since 2006, there have been several pilot trials and randomised controlled trials using psychedelics (mostly psilocybin) in various non-psychotic psychiatric disorders. These have provided encouraging results that provide initial evidence of safety and efficacy, however the regulatory and legal hurdles to licensing psychedelics as medicines are formidable. This paper summarises clinical trials using psychedelics pre and post prohibition, discusses the methodological challenges of performing good quality trials in this area and considers a strategic approach to the legal and regulatory barriers to licensing psychedelics as a treatment in mainstream psychiatry.

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Research Summary of 'Psychiatry & the psychedelic drugs. Past, present & future'

Introduction

The paper reviews the history, contemporary evidence and future prospects for the classical psychedelic drugs (mescaline, psilocybin, DMT and LSD) in psychiatry. It situates these compounds in a long ethnobotanical and pharmacological context, describes their early 20th century clinical use and the mid-century proliferation of psychiatric research, and summarises how widespread recreational use and political reactions led to international scheduling and the near cessation of medical research after 1967. Rucker and colleagues set out to provide a synopsis of selected clinical studies carried out before 1970 and to review all major clinical studies since the turn of the millennium. The paper also discusses methodological challenges in designing modern clinical trials with psychedelics and examines the legal, regulatory and commercial pathways and barriers to licensing psychedelics as medicines in mainstream psychiatry.

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Study Details

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