Psilocybin for Alcohol Use Disorder; Religious Use Update; Psychedelic Use at All-Time High

This week we’re looking at:

• The results and implications of the first controlled trial of psilocybin-assisted therapy for heavy drinking

• Recent findings that psychedelic use is on the rise and reached an all-time high among young adults in 2021

• Developments in the legal cover provided by religious freedom laws for the use of psychedelics

Before we jump in, next Wednesday, August 31st, at 8 pm CEST / 2 pm EST, I am moderating an panel discussion hosted by The Open Foundation and Blossom titled Overcoming Roadblocks: Making Psychedelic-Assisted Therapy a Reality

Psilocybin + Therapy Reduces Alcohol Consumption

The results of a study of Psilocybin Assisted Therapy (PAT) for Alcohol Use Disorder (AUD) from NYU were published this week in the Journal of the American Medical Association (JAMA) with promising effects.

The New York Times succinctly captured the results:

“A small study on the therapeutic effects of using psychedelics to treat alcohol use disorder found that just two doses of psilocybin magic mushrooms paired with psychotherapy led to an 83 percent decline in heavy drinking among the participants. Those given a placebo reduced their alcohol intake by 51 percent. By the end of the eight-month trial, nearly half of those who received psilocybin had stopped drinking entirely compared with about a quarter of those given the placebo, according to the researchers.”

There are a few interesting things to note about this trial:

1. As the first controlled trial of PAT for AUD, it is a milestone for the field.

2. Blinding in psychedelic trials continues to be an issue as more than 90% of study participants, and therapists correctly guessed treatment assignments.

3. The results did not mention the relationship between the intensity of Mystical Experience and outcomes, which previous research has shown to be a predictive factor.

4. The trial data has been licensed by the non-profit drug development company B.More, which will be launching a phase IIb trial of psilocybin for AUD early next year.

5. Finally, perhaps most relevant for the emergence of psychedelics as a therapeutic and cultural phenomenon, their use in the treatment of alcohol addiction specifically is a compelling case for changing long-held narratives and stereotypes, as evidenced by the type and extent of media coverage this trial received.

Alcohol Addiction is a Cultural Wedge for Psychedelics

The concept of psychedelics as a treatment for alcohol addiction is a particularly compelling narrative for mainstream audiences, as indicated by this five-minute feature on the Today Show featuring study participants and lead author Michael Bogenschutz.

Because alcohol is a culturally and legally acceptable drug, compared to illicit drugs of abuse (ironically, many still place psychedelics in this category), the problem of alcohol addiction is an acceptable topic of conversation and can be safely discussed on platforms such as the Today Show.

That a “dangerous and illegal drug” (psilocybin) may be a valuable treatment for addiction to a culturally and legally accepted drug (alcohol) is short-circuiting entrenched beliefs about good and bad drugs.

I’ve had more friends and family text and email about this study than any other psychedelic-related media mention. I think that this is telling.

Religious Use Update

There’s an oddity in this field.

While most mainstream media attention focuses on the “above ground” scientific developments, capital investments, and policy developments, the “underground” is also increasing, with perhaps even more significant implications.

One specific area of the “underground” I find entirely captivating is the intersection of psychedelics and religion, not necessarily for the potential to ask the “big questions” but as religion as a vehicle for creating a legal buffer for psychedelic use.

Psychedelic & entheogenic churches facilitate community gatherings, weekend retreats and even openly sell psychedelic products.

Two stories published this week highlight two approaches to sacramental psychedelic use and how law enforcement has so far responded.

A story in The Washington Post article tells the story of Zide Door, the entheogenic church in Oakland:

"The Zide Door church opened its doors in early 2019 as thephysical worship center for members of the Church of Ambrosia, “a nondenominational, interfaith religious organization that supports the use and safe access” of certain natural psychedelics, according to its website. In the lawsuit, it outlined what it calls the “sacramental use” of cannabis, mushrooms and other hallucinogenic substances as a way to connect with “a higher consciousness, their own eternal souls, spiritual beings and God,” although psychedelic mushroom consumption is not allowed on-site.

The church does not sell drugs, Hodges told the Chronicle. Instead, it charges a monthly $5 membership fee and then asks for donations in exchange for psychedelic products. As many as 200 people visit the church each day to get marijuana and mushrooms, Hodges told the Chronicle.  

“This is not just an excuse to sell drugs,” he told the Chronicle. “This is what we truly believe is the origin of all religion and really what religion should be.”

The Oakland Police raided Zide Door in 2020 but made no charges or arrests, although an estimated $200,000 worth of cannabis, mushroom, and cash were confiscated and never returned.

The second article, from Boston’s NPR News Station WBUR, chronicles a New Hampshire Ayahuasca Church, Pachamama Sanctuary:

"Januszewski, 46, with tattooed arms and a trimmed beard, is the pastor of Pachamama Sanctuary, a religious organization he founded off of a wooded road in Canterbury, New Hampshire, that serves ayahuasca to its guests several times each month. Since opening in 2019, Januszewski said he has welcomed close to 2,000 people to the three-bedroom house he rents for a weekend of psychedelic exploration...

Local law enforcement have responded to Pachamama Sanctuary, according to police logs, but Januszewski said there has been no legal action taken. He claims the federal Drug Enforcement Agency is also monitoring his facility, though the DEA didn’t respond to a request for comment.

I have to admit I find it surprising that law enforcement allows this to proceed unencumbered.

But perhaps I shouldn’t.

This excerpt from Chacruna’s Guide to RFRA and Best Practices for Psychedelic Plant Medicine Churches makes the case that there is a balancing act for both entheogenic churches as well as law enforcement:

"RFRA rights may be a claim or defense when burdened by the government and may become an affirmative legal right with an exemption from the Controlled Substances Act... While RFRA automatically provides protection for sincere religious exercise, not every church using psychedelic plant medicines will be exempt from criminal prosecution solely on the basis of religious use. There is a balancing test under RFRA that will be applied where the whole of a church’s religious beliefs and spiritual practices will be scrutinized – but scrutiny will be applied to the government’s interests in prohibiting this use, as well."

Looking Ahead

In addition to Zide Door’s case against the Oakland Police Department, there are at least two other developments we should expect soon:

1. Ben Gorelick, a rabbi in Denver, was charged with intent to distribute controlled substances and will hope RFRA protects him against the charges. The case is scheduled to resume next month.

2. This Fall, a paper documenting the “Religious Leaders” study—“a pilot study of the effects and possible utility of psilocybin-facilitated experiences for professional religious leaders” is expected to come out. Assuming these Religious Leaders had profound experiences, it will likely get mainstream attention and increase interest in psychedelics outside the clinical setting.

Given the importance of facilitation, Set & Setting, and the long duration of psychedelic experiences, the advantages of incorporating as a religious non-profit and RFRA may be a promising avenue for creating psychedelic affordable healing spaces. Therefore, we should expect more and more groups to go this route rather than waiting for laws to change.

Psychedelic Use at All-Time High Among Young Adults

From the New York Times:

“Marijuana and hallucinogen use among young adults reached an all-time record last year after having leveled off during the first year of the coronavirus pandemic, according to federal survey data…

The use of hallucinogens had been stable for decades, but in 2021, 8 percent of young adults reported using psychedelics compared with 3 percent in 2011, a record high since the category was first surveyed in 1988.

Over the past few years, researchers say, increasing media coverage and social media chatter about the potential therapeutic value of ketamine, psilocybin mushrooms and ecstasy have helped chip away at long-held taboos that were fostered during the nation’s failed war on drugs.

Further Reading

Bloomberg: Get Ready for the Magic Mushroom Pill

““The psychedelic treatment model is not well-suited to the medical infrastructure that we have,” Heifets says. Therapists are often in short supply in the US, and their care can be difficult if not impossible to receive reimbursement for from insurers. “Why do we have a mental health crisis?” he asks. “I don’t think it’s because we’re missing the right antidepressant drug.””

What does the Catholic Church say about psychedelics?

“The conversation about socially sanctioned use of psychedelics is happening, and we as Christians might have something to offer, whether by way of admonition or encouragement. And it’s hard to come away from How to Change Your Mind feeling that the inherited thinking on the subject equips us adequately for such a conversation, as a people committed to the truth, and to the care of each others’ souls.”

Time: Dying Patients Are Fighting for Access to Psychedelics

“The DEA is “thwarting operation of duly enacted federal law,” says Tucker. “If a physician deems their patient to have a life-threatening condition that could be addressed with one of the eligible investigational drugs, then that physician can seek [Right to Try] access, and should be granted it.” Advocates argue that the law has a particularly broad mandate. “The lack of an exclusion makes it clear that there is no exclusion” for Schedule 1 substances, Tucker says.”

Nature Outlook: Psychedelic drugs take on depression

“The NIH does fund some research on psychedelics. Its National Institute of Mental Health (NIMH), for example, spends about US$15 million annually on preclinical and clinical research, says Steven Zalcman, chief of the NIMH adult pathophysiology and biological interventions development branch. The vast majority of that is focused on ketamine or ketamine-like compounds. But the NIMH is not currently supporting any trials of psychedelics to treat depression. One of the challenges is that any trials it funds must focus on the mechanism underlying the therapy. But how psychedelics might relieve depression isn’t yet clear — making it difficult to formulate a hypothesis on which to base a trial.”

That’s it for this week - thanks for reading!

Zach