Are psychedelics having ‘a moment’?

What with high-profile endorsements from individuals like Prince Harry and John Oliver, landmark legal changes making them more accessible, and an ever-increasing number of studies revealing how potent and effective they are at treating numerous mental health conditions, you could certainly say that psychedelics are having 'a bit of a moment'.

This was made abundantly clear to me when, in November 2022, I attended Wonderland, 'the world's leading psychedelic event', put together by Microdose.

While I was surprised to be invited, I readily accepted, because if, as many believe, psychedelics are set to revolutionise mental health treatment, it would be good to know how this might happen, and what the consequences of it may be.

However, while a new generation of effective antidepressants would certainly be worth celebrating, psychedelics have significantly more to offer beyond that. Or so a great many people believe. So much so, that they're willing to invest considerable amounts of time and money into them, confident that they'll be reaping the dividends of doing so very soon.

Whether they're right about this is a whole other question. But the enthusiasm for psychedelics is certainly there, and in various fields. If what I learned in Miami is any indication, psychedelics could potentially change the world, and relatively soon. Whether they will, or whether that change will be for the better? That remains to be seen. But it's certainly something we be prepared for.

Breaking down boundaries

The mechanisms via which psychedelics work, the effects they have on the brain, are both variable and incredibly complex (for a helpful overview of matter, read 'Shaking the kaleidoscope of the mind', by Dr Matt Wall, published in this very magazine in March 2023.

But to put it as simply as possible, psychedelics (temporarily) cause a dramatic increase in connection and communication between typically disparate brain regions and processes. As a result, our senses and emotions merge together, our memories and perceptions overlap, and so on. And so, we experience the psychedelic 'trip'.

This helps explain why the potent therapeutic potential of psychedelics; by making the brain's internal systems more malleable, more flexible, and introducing signals from new and unfamiliar regions, the unhelpful neural circuits that have developed which underlie mental disorders, can be more readily changed, even reversed. This is, in essence, the ultimate goal of all modern mental health interventions, be they pharmacological or psychological. But it's usually a slow, painstaking process. According to the available evidence, psychedelics speed this up considerably.

Basically, psychedelics work by suppressing barriers in the brain. What's intriguing is that, if the Wonderland event is anything to go by, they're having a similar effect in the wider world too.

As well as individuals from the fields of science, medicine, pharmaceuticals, and mental healthcare, the event featured prominent types from the worlds of finance and investment, art, spirituality, traditional cultures, technology, history, movies, music, and more. Because psychedelics are impacting on all these things, to some extent.

Stepping back, it's important to acknowledge that this isn't necessarily a reflection of the inherent qualities of psychedelics. It could be more due to the nature of our complex, interconnected, multifaceted society. Sure, psychedelics are having an effect on filmmaking, commerce, culture etc, but you could legitimately say that about shoes. Or cheese.

However, the difference is that those things are commonplace. Psychedelics aren't. But it looks like they could be, and relatively soon. If this comes to pass, it could have many significant outcomes for all of us.

The economics of psychedelics

If the number of multi-multi-millionaire investors present at the Wonderland is anything to go by, psychedelics have the potential to have a substantial economic impact. Kevin Harrington, star of Shark Tank and inventor of the infomercial, was one such individual present. He confidently predicted that legalised psychedelics could become a trillion-dollar industry.

While this may sound like a hyperbolic exaggeration, that's not necessarily the case. After all, if there was a drug that was naturally occurring, non-addictive, with renowned recreational properties with comparatively few side effects, that improved mental health, and this was made readily available in modern society… why wouldn't such a thing be obscenely profitable? That's the stance of an increasingly large number of people, many of whom clearly have much experience with making eye-watering amounts of money. And undeniably, the creation of new trillion-dollar industry would have tangible knock-on effects for us all.

The many businesses, products and services touting their wares an event dedicated to them further emphasises the financial potential of psychedelics. Things like functional mushroom-infused coffee, cryotherapy booths (see photo), intravenous vitamin infusions, and more. However, this could be viewed as a source of concern. After all, none of those businesses or services mentioned involved actual psychedelics in any way.

At best, they, along with psychedelics, can all be said to fall under the (admittedly ever-popular) category of 'Things that change your body to make you feel better'. However, while popular with many, the evidence base that backs up the claimed benefits of these 'psychedelic adjacent' offerings is, to put it diplomatically, often somewhat limited.

While there's no obvious harm being caused by this sort of thing at present, it still suggests that, even at these early stages, evidence and logic are taking second place to 'opportunity for profit'. You might say this is nothing unusual, and you'd have a point. But when we're talking about the therapeutic potential and potency of psychedelics, it's warrants attention even so.

While it's impossible to deny that the USA is far ahead of the UK and other developed nations in their increasingly progressive attitudes towards psychedelics, it's also impossible to deny that, in the USA, commerce and medicine are considerably more intertwined than elsewhere. And it's this insidious mix of healthcare, medication, capitalism, and profit motive gave us, among other things, the ongoing, and deadly, US opioid crisis. Should such forces gain control of psychedelic medications, it could lead to many possible outcomes. It's hard to imagine any of them would be good.

Ultimately, psychedelics could have a considerable economic impact. Perhaps too considerable. Thankfully, that's not the only factor at work.

Psychedelics: the best medicine?

As you'd expect (or hope) from an international event dedicated to what psychedelics have to offer, the medical science community were very well represented.

One concern, raised by Dr Matt Wall in his aforementioned article, regarding the increasing enthusiasm around the therapeutic potential of psychedelics, is the relative lack of large scale studies that support it. While what studies exist certainly do strongly suggest that psychedelics could be genuine game changers, for a wide range of mental health problems, there aren't that many of these studies, and the ones we have are relatively small, incorporating relative handfuls of subjects, rather than the much greater numbers you'd hope for if you want to apply your findings to whole populations.

There are valid reasons for this. One is that the regressive War on Drugs led to an effective halt on all psychedelic research for many decades, and scientists are only now starting to make up for that lost time. Another is that the potency of psychedelics, as well as their largely-unfair-but-still-salient reputation for harm, means that they must be handled with care, as does the selection of subjects/patients who receive them in the name of research. Nobody wants another MKUltra.  

However, Wonderland revealed that, in this area, positive changes are well underway. The Multidisciplinary Association for Psychedelic Studies (MAPS), an organisation for coordinating psychedelic research and education about psychedelics, with founder Rick Doblin, was a prominent presence throughout, flagging up coordinated and collaborative research efforts into therapeutic psychedelics. Other national, and multinational, organisations and companies are also becoming more prominent and running larger scale research, like MindBio Therapeutics and their expansive microdosing LSD studies.

A potential wild card here is the growing enthusiasm for psychedelics from the US military. Military veterans are currently among the most enthusiastic lobbyists for more psychedelic research and investment. Their motivations may not be the most noble (e.g. medications that can quickly and easily deal with a soldier's trauma mean they remain a viable combat asset for longer), but if the US military gets behind something, it's increasingly that it'll remain 'small scale'.

There are also more unexpected approaches being explored, like the experiments into the therapeutic application of combined psychedelics and virtual reality. Psychedelics could also, via the link between MDMA and sex/love chemicals, address how there are far fewer medications for sexual disfunction in women than there are for men. 

And if one substance is likely to be the "breakout star" of psychedelic therapies, it's ketamine. Ketamine works differently to typical psychedelics, but has similar, albeit milder, effects. Accordingly, ketamine is often the go-to for psychedelic therapies. It's an effective, fast-acting antidepressant, superior to SSRIs. It's being trialled as a treatment for numerous conditions, from PTSD to eating disorders. Ketamine clinics are increasingly common in the US.

I even got involved in the ketamine revolution myself by moderating a panel by Seelos Therapeutics, all about their Ketamine therapy which, their studies suggest, rapidly alleviates severe suicidal ideation. At present, there are no medications for this, so this ketamine treatment could be genuinely groundbreaking.

However, you might assume that those attending a conference dedicated to the potential of psychedelics would be loath to criticise them. This assumption would be wrong. The scientific contingent, at least, are constantly urging caution, or raising warnings, regarding psychedelics becoming widely available.  

One phrase that I heard repeatedly was "We don't want legal psychedelics to be the next legal marijuana", because despite (or maybe thanks to) it's commercial success, the legalisation of marijuana in the US (and elsewhere) has totally scrambled its medical application. When someone's medication is cheaply available on every shop corner, it's a lot harder to get them to stick to a proscribed schedule. The rollout of legalised marijuana was often touted as a perfect example of what not to do.

The practical impacts of legalised psychedelic therapies were also highlighted. For instance, if psychedelic therapy were to become mainstream, where would we find and train the tens of thousands of trained medical personnel necessary for implementing it? Psychedelic therapy requires a very detailed combination of medication and therapeutic guidance: it's not a case of "take two a day and come back in a month".

Ultimately, even if psychedelics are as therapeutic as many believe, and they do become widespread and accepted, that will still lead to numerous issues and problems. Change is invariably disruptive, even if it's for the better.

The law on drugs

Let's address the elephant in the room: how can there be an international conference dedicated to the opportunities presented by legal psychedelics… when they're still illegal? It's a good question. So much so that Wonderland regularly explored the legal situation regarding psychedelics. The reality is, as ever, complicated.

Why are psychedelics so proscribed in the first place? Seemingly due to a combination of bad luck,  scandal-inducing professors, and being an early and prominent casualty of the War on Drugs.

Unsurprisingly, people who pay to attend a psychedelics event aren't fans of the War on Drugs. It was regularly described as a wholesale disaster, and literally planet-endangering.

One particularly insightful individual regarding this issue is Neil Woods, former UK undercover drug operative, and ambassador for Law Enforcement Action Partnership (LEAP). He outlined the changes in attitudes towards psychedelics, like their increasing legalisation (in certain contexts) in Oregon, Colorado, California, Florida, and elsewhere. Australia also recently officially recognised psychedelics as medicines.

Neil highlighted how these changes are driven from the bottom up; it's the general population changing their minds about psychedelics, and politicians/decision makers are reacting accordingly, rather than leading the way.

What caused this (seemingly rapid) shift in attitudes to psychedelics? Journalist and author Amanda Siebert researched this matter at length for her book Psyched: 7 Cutting-Edge Psychedelics Changing The World. She explained that there are several factors behind it. There's the ever-increasing evidence of their potent therapeutic effects (albeit derived from mostly small studies). There's the Covid-19 pandemic, which caused a huge increase in global mental health problems, and thus enthusiasm for new and effective mental health treatments, an area where psychedelics are front and centre.

Then there's the legalisation of cannabis. Despite the concerns and criticisms of the results of this from many quarters (as outlined earlier), when decriminalising a previously stigmatised drug rapidly creates a multibillion-dollar industry, people will want to repeat this phenomenon. Accordingly, many are expecting the same thing to happen with psychedelics. As we've seen, some are literally banking on it.  Which brings us full circle to the economic factors pushing psychedelics ever closer to the mainstream.

But even if the scientific community is advising restraint regarding the profit-making potential of psychedelics, it doesn't mean they're completely unified on this matter.

As stated, many psychedelics are naturally occurring. They're found in mushrooms, cacti, leaves, the skin of toads, and more. And while the recent law changes in the US that make psychedelics more accessible are significant, they tend to focus on naturally occurring psychedelics. Which has led to an increasingly heated debate in the scientific arena, one that shows up often in the wider world: whether 'synthetic' or 'natural' is better.

This often stems from a persistent 'natural = better and safer' assumption by the wider population, which would obviously lead to political decisions being shaped by it. But there are many reasons why this assumption isn't true (e.g. an artificial insulin pump is synthetic, cyanide is natural). But in the realm of psychedelics science, it's a bit more nuanced.

Many scientists favour the synthetic approach, for logical reasons: isolating and refining the active psychedelic molecule from a natural source means you can both mass produce it, and control the specific dosage of it, which is typically an essential aspect of modern pharmacological medical interventions.

But there are still those, such as Paul Stamets, the de facto Paul Macartney of magic mushrooms,  who maintain that natural psychedelics are better, invoking the entourage effect, whereby the various molecules in a naturally occurring psychedelic substance work together to enhance the effect, not hinder it. There are theories which argue that this is how the human brain evolved.

But ultimately, this debate, while important, distracts from the wider point, which is that psychedelics, if the expectations of many come to pass, will soon be a part of everyday life. And if this does happen, the outcomes will be far reaching, and substantial.

Come what may, psychedelics are increasingly likely to disrupt the current status quo regarding psychiatric medication, drugs, economics, and more, increasingly untenable. The consequences of this would affect us all, so its in all our interests to work to make them good ones.

• Dr Dean Burnett explores more about how our brain interprets and reacts to the world in his latest book, Emotional Ignorance
• Find more from Dean in our archive.