The future of psychedelic medicine [PART I]

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Psychedelics are experiencing a boom of sorts. Last year, the documentary series «How to Change Your Mind» was released on Netflix, which introduced viewers to the idea of using psychoactive substances to restore impaired brain function. Numerous startups on Instagram are actively promoting home ketamine therapy. Additionally, in 2020, Oregon became the first state to legalize psilocin for therapeutic purposes.

Scientific research is actively ongoing. Clinical trials with MDMA in the treatment of post-traumatic stress disorder have shown promising results —perhaps the FDA will approve its use in the next year or two in all states in its entirety.

A study published in the Journal of Affective Disorders found that using ketamine before a C-section may help reduce the risk of postpartum depression. In August 2022, a small study was presented in JAMA Psychiatry in which two sessions of psilocybin combined with therapy significantly reduced the number of days of alcohol abuse among participants.

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While scientific understanding of how this works is still emerging, we are beginning to realize that tryptophan compounds seem to affect the response of those areas of the brain responsible for mood, cognition, and perception to the neurotransmitter serotonin. Initial research suggests that this may increase neuroplasticity — the brain's ability to learn and adapt to new environments.

Although clinical understanding of psychedelics is just beginning to develop, their use in therapy is deeply rooted in history. For thousands of years, mushrooms have been used in the spiritual rituals of the Masatec people in present-day Oaxaca, Mexico. Ibogaine, now advertised as an addiction treatment, is derived from a plant used by hunters in West Africa to increase concentration while hunting.

Peyote has been used in North America as a spiritual and medicinal tool since 1000 BC. MDMA, on the other hand, is derived from the safrole in sassafras oil, and its recorded use by Native Americans dates back to at least the 16th century.
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Many indigenous peoples continue the tradition of using plant medicines, while others seek to restore lost practices that have been hindered or lost as a result of colonization and other factors.

Federal drug policies since the 1970s, which many public health experts consider misguided, have had dire consequences for BIPOC members and have slowed research into the therapeutic properties of compounds such as
LSD, mescaline, and psilocybin. Although decriminalization laws like those passed in Oregon go against the war on drugs, some experts note problems with the new wave of enthusiasm.

They caution that the resurgence of psychedelic medicine, fueled by media attention and venture capital investment, may make these substances less accessible to those who could benefit most from them. These groups include indigenous peoples and other marginalized communities with high rates of trauma and co-morbidities who often lack access to quality treatment, let alone expensive clinics or resorts.

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The future of equitable drug use in the U.S. remains uncertain and requires multiple perspectives. Nevertheless, experts (therapists, activists, educators, researchers, and entrepreneurs) — are observing, learning, and changing views on this topic.

Preserving the roots of history
Dawn D. Davis, who comes from the Shoshone-Bannock Tribe and hails from Fort Hall, Idaho, has many facets united by a single purpose. As a researcher, educator, mother, farmer and goat herder, and peyote user, her lifelong commitment to the interconnectedness of the natural resources that give us life.

In her postdoctoral work in the Energy Systems Division at Idaho National Laboratory, Davis studies resource management with a focus on water access and energy sustainability in marginalized and rural communities. She is also laying the groundwork for research on the cactus Lophophora williamsii, known as peyote, which requires careful handling among indigenous peoples and beyond.

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The plant has caught the attention of psychedelic followers because of its mescaline content, a hallucinogenic compound that research suggests may help treat problems such as addiction and post-traumatic stress disorder.

Still, Davis' ancestors and many Native North Americans have used peyote in spiritual ceremonies and for medicinal purposes, such as relieving toothaches or treating wounds, for thousands of years.
«It’s always been a part of my life» — she states.

Over time, however, Davis has noticed that available plants are becoming increasingly rare and the cacti are shrinking in size. P. williamsii grows slowly, sometimes taking more than a decade to mature, and most are on private land. She and her family, like many traditional peyote users, access the plant through the ceremonies of the Native American Church, a small religious group.

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With a degree in museum studies and Native American cultural studies, Davis began pursuing a doctorate in natural and water resources at the University of Idaho in 2013 to understand the scope of the current problem. During that time, she collected data on peyote's growth locations and its preferred vegetation and soils.

Davis hopes that her findings on the current distribution of peyote, which she defended in 2021, will help landowners and native users better understand the conditions that allow the plant to thrive.


Although she is still working to confirm and publish her data, preliminary findings indicate that the slow-growing cactus' potential habitat in Texas and Mexico is extensive enough to suggest that it can persist in its natural environment.

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An important factor, she believes, is the need to integrate traditional knowledge into conservation efforts. During her field research, Davis communicated with land owners and interacted with nature in a genuine way, sharing her intentions and obtaining permission from all involved.

She emphasizes that Western science must pay attention to such approaches to prevent further declines in plant populations.

Preservation measures may become especially urgent as some psychedelic enthusiasts advocate for broad decriminalization of peyote. Groups including the Native American Church of North America, where Davis is a member of the Legislative Committee, and the National Congress of American Indians, where she serves as co-chair of the Peyote Task Force, believe such an initiative could endanger already rare wild peyote colonies and insist that peyote not be included in such decriminalization bills.

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Some members of these and other advocacy organizations point to the availability of faster-growing cacti, such as San Pedro, that also contain mescaline and could be used in place of peyote. Although less effective, the tall San Pedro cactus can grow in various regions of the world. In the U.S., it is often found in arid front lawns where it is allowed, but the use of mescaline is illegal.

As for Davis, she favors removing mescaline from decriminalization bills altogether, fearing it could lead to an increase in peyote harvesting.

Davis stresses that she represents only one tribe, making it crucial to include multiple Native voices in discussions to protect the plant and honor the traditions that guide the use of a particular flora.

«I may be the only Native American peyote researcher. I don't know of any others. But it's a complicated situation because I don't consider myself a psychedelic researcher. I research medicine and I see it from a completely different perspective» — she says.

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Sacred therapy
Danielle Herrera's ketamine patients at Sage Integrative Health don't face traditional clinical approaches. The Bay Area psychotherapist gets people to explore the world in an altered state of consciousness by offering them sensory objects like feathers and bowls of water and singing with them. «This is common in ayahuasca practices. Singing together can be a very powerful experience» — she notes, referring to rituals involving the psychoactive South American drink.

Although Herrera, who considers herself indigenous and part Filipino, says her therapeutic work is based on traditional rituals, she doesn't design each session under ketamine as a ceremony like those in the Amazon.

She advocates two principles that run counter to traditional medical views: first, that every recreational drug can be beneficial with the right therapeutic approach and research, and second, that the process should be individualized for each patient and therapist.

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She began her career working with children, but did not seek to utilize her childhood trauma, stemming from her parents' drug problems, in her professional life.

That changed after she went to the Harm Reduction Therapy Center in San Francisco. The mobile clinics where Herrera worked provided people under the influence of various substances with the help they needed. They may have been hungry or had injuries that required bandaging, and Herrera also provided psychological support.

While working, she began training in ketamine therapy at the Sage Institute clinic.
«I noticed that at the intersection of harm reduction and psychedelic therapy approaches, there were new opportunities to engage with families» — she shares.

Her mother, now sober, struggled with methamphetamine addiction for a long time and recounted her first experience with the substance, which was positive and spiritual. «Even the addiction counselors shamed her. She confided in me that if there had been just one person she could have discussed her spiritual awakening with, maybe she wouldn't have slipped into erratic use and depression» — says Herrera.

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Herrera now promotes integration — a thoughtful reflection on the experience of being under the influence of substances — using «any drug you can think of».


She argues that each session can be profound and unique. She resists common stereotypes about psychedelic experiences, believing that such perceptions can mislead patients into expecting relief from internal conflicts.

Most of her patients, especially those who have been subjected to racial aggression throughout their lives, become more conscious of their inner rage.

An important aspect of Herrera's work is her complete self-constancy.


«During my training, I actively resisted the colonial attitudes deeply embedded in modern psychiatric systems. I was a true master of overturning the foundations» — she shares.
 

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