Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century.
By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound). Ketamine and MDMA are sometimes categorized as “quasi-psychedelics” due to shared features in their subjective effects, although these synthetic molecules possess important differences.
Growing Body of Research
Psychedelic therapy is now being heralded as a potential game-changer in mental health and wellness by researchers and clinicians at a variety of top institutions, including Harvard, Yale, Johns Hopkins, Stanford, UC Berkeley, UCSF, and others. This excitement is based on the promising findings of a growing number of studies which have consistently demonstrated rapid, potent, and sustained symptom reductions for patients with depression, anxiety, PTSD and substance use disorders after only 1-3 dosing sessions.1
These studies, mostly conducted with psilocybin – which is naturally found in over 200 species of mushrooms worldwide – have found sustained symptom reductions at six months,2 one year3 and, at the longest, 2.5 years in certain cases.4
Clinical trials are also ongoing and near completion for a variety of additional indications, including chronic pain (neuropathic, cancer-related, and fibromyalgia), cluster headaches, and functional neurological disorders. This work is also motivated by the wide-ranging effects of psychedelics beyond their psychological effects, including their role as potent anti-inflammatory5 and pro-neuroplasticity agents.6
A Far Cry From Drugs
A major source of the excitement regarding psychedelic therapy is its fundamentally different approach compared to conventional pharmaceutical treatments.7 Psychedelic therapy is explicitly conducted within a bio-psycho-social-spiritual model that seeks to heal the underlying causes of mental dysfunction, as opposed to simply masking symptoms.
It is regarded as a curative approach that seeks to catalyze and leverage the brain and body’s innate healing capacity in order to create true lasting change and healing. This is a far cry from standard pharmaceutical drugs, which often facilitate chronic dependence and simply mask symptoms.
Understandably, these claims might raise some eyebrows and evoke some skepticism. Indeed, for many, the word psychedelic immediately brings up images of hippies and the countercultural movement of the 1960s, as well as concerns and horror stories regarding the safety or lack thereof of this class of compounds.
How could psychedelics – once vilified for their dangerous and potentially harmful effects – now be viewed as a paradigm-shifting breakthrough treatment by a growing number of doctors and scientists?
In the remainder of this article, we highlight the large body of research indicating they can be used safely in clinical contexts for the majority of individuals, while also acknowledging the need to exercise caution and sensitive care when working with these substances.
Psilocybin for Depression
Currently, the largest evidence base supporting psychedelics exists for psilocybin therapy in the treatment of depression. Randomized, controlled trials (RCTs) have consistently revealed rapid reductions in depressive symptoms, with significant improvements occurring within one day after psilocybin administration.8 This contrasts starkly with the slower onset of traditional antidepressants, which may take weeks to show similar effects.
What is truly remarkable is the strength and durability of the impact with psilocybin and the other classic psychedelics. One study found that 75% of patients exhibited a 50% or more reduction in depression symptoms, with 58% maintaining remission, at a 12-month follow-up after only two psilocybin sessions.3
Other studies have similarly found potent and sustained reductions, with minimal adverse events. As a result of the promising results, the FDA granted “breakthrough status” for psilocybin therapy in the treatment of treatment-resistant and major depression, in 2018 and 2019, respectively. This status helps streamline the route to potential FDA acceptance as a legal, regulated treatment. Estimates based on the current pace of research suggest possible FDA acceptance for psilocybin as early as 2027.
Other Research-Based Potential for Psilocybin
RCTs investigating psilocybin therapy have also found similarly potent and enduring results for end-of-life distress, alcoholism, and tobacco addiction. As a striking example, a study of individuals with tobacco addiction found that 80% remained abstinent six months after psilocybin-assisted therapy,9 and that, even after 2.5 years, 75% were still abstinent.4 These rates far surpass those seen with traditional therapies, which typically feature an abstinence rate of less than 35%.10
Addressing Safety Concerns
The safety of psychedelics is a reasonable concern given some of the alarming claims that emerged in the mid-20th century. Psychedelic therapy is a far cry from the uncontrolled recreational use that had given rise to the horror stories within the public imagination.
Extensive research involving both animals and humans demonstrates that psychedelics are safe when administered in controlled clinical or scientific settings.11 To underscore this point, the rate of adverse events in psychedelic-assisted psychotherapy studies is comparable to standard psychotherapy.12
It is important to highlight that there is no evidence of neurotoxicity,13 even at doses far beyond those administered for psychedelic therapy. Nevertheless, it is crucial to emphasize that considerable care is taken to psychologically prepare individuals for psychedelic administration, and to create a safe, secure, and trusting therapeutic container.
Individuals can experience a “bad trip” – characterized by acute episodes of anxiety, confusion, and dysphoria; but these have been found to resolve organically in clinical contexts and can be safely managed under skilled supervision.14 In fact, challenging experiences on psychedelics can often lead to therapeutic breakthroughs when they are worked through and resolved in a clinical setting.15
It’s important to note that the risk of prolonged psychosis is limited to those with pre-existing vulnerabilities,16 and screening for such susceptibilities greatly minimizes risk.
Finally, it’s important to note that research in animals and humans indicates that psychedelics have minimal addictive potential17 and, in fact, there is increasing evidence that they may have anti-addictive properties and efficacy in helping treat substance-use disorders.18
Relevance to Chiropractic and Wellness Care
Ultimately, we see psychedelics as akin to a chiropractic adjustment for the mind and brain. Research suggests that by breaking up old, unhelpful patterns of thought and behavior, and enabling the processing of repressed emotions and memories, psychedelics may allow the brain’s innate intelligence to reorganize and recalibrate itself.
Moreover, research points toward the holistic benefits of psychedelics, including their potent anti-inflammatory effects, pain sensitivity-modulating effects,19 and ability to positively influence the gut microbiome.20
This holistic approach reflects the comprehensive care model in chiropractic practice, highlighting the importance of incorporating psychedelic insight into holistic health disciplines to improve overall well-being.
Final Thoughts
As laws regarding psychedelics are poised to change in the coming years, with MDMA anticipated for FDA approval by mid-2024 and psilocybin potentially following suit in 2027, wellness practitioners may want to prepare for an influx of patient inquiries about these substances. Practitioners will want to address patient questions and concerns with confidence and provide accurate guidance, ensuring patient safety and optimizing care.
Moreover, understanding psychedelics aligns with a holistic approach to wellness, offering practitioners additional tools to promote mental, physical, and spiritual health. By integrating knowledge of psychedelics into their practices, practitioners can consider a more comprehensive range of therapeutic options, meeting the diverse needs of their patients and fostering any even deeper understanding of holistic wellness.
Editor’s Note: Drs. Girn and Pincus specialize in educating health care practitioners on the emerging clinical and scientific research on psychedelics. They offer educational resources at Psyclinical.life.
References
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
