Hopeful signs for the psychedelic renaissance

Some positive indications from last week's ICPR conference

Welcome to all new subscribers. Here’s the Tuesday brief link round-up. First bit free, second bit just for paid subscribers.

Last week was one helluva week for the young psychedelic culture and industry. The FDA advisory committee almost unanimously rejected Lykos’ application for MDMA assisted therapy for PTSD. As I wrote on Friday, the extent of the committee’s criticisms was a shock for everyone in the field and has provoked something of an existential crisis.

I was at the ICPR conference last week and it sometimes felt like attending a mortgage bond conference circa 2008 (yes, I started my career writing about securitization!). It reminded me of the scene in the Big Short, when they’re at a conference and people’s phones start pinging about Bear Stearns collapsing.

This field can be kind of exhausting to work in, can’t it? I and a lot of friends of mine working in psychedelics sometimes feel burnout, disenchantment or fatigure, not because of the drugs but because of the constant drama, and also a sort of moral burnout from the gap between the inflated spiritual hopes of the field and the disappointing human behaviour one often encounters.

Nonetheless, I came back from Europe feeling cautiously optimistic for the field, because of how many presentations I saw specifically facing challenges for the field like adverse events.

A year ago, many of us attended MAPS’ mega-conference Psychedelic Science in Denver. There were 12,000 attendees, hundreds of panels and side events, and not a single panel or presentation on psychedelic harms. My project had a poster, and others mentioned harms in their presentation, but no panel or oral presentation specifically on harms. It felt like a big oversight amid all the euphoria of events like this recruitment event for the IPI therapist training course, which was called ‘Rapture’:

A year on, it’s a different story. We got to present our research in the biggest hall - thanks ICPR! - and there were several other presentations on psychedelic harms and post-psychedelic difficulties.

Before us, for example, Laura Kartner from the Central Institute of Mental Health presented a case study from the Episode trial in Germany, the first RCT of psilocybin for depression in Germany. The trial includes 144 patients, and one of them had a severe episode of derealization after her trip. According to Kartner’s abstract:

the patient developed a severe level of dissociation  in the weeks after (flashbacks). Pre-occupying questions regarding the validity of the experience remained and could not be resolved in the study context.

It’s an unfortunate case, but I really want to applaud Laura and colleagues for not minimizing or hiding the case but actually presenting about it at a conference so it can be discussed with colleagues.

There was also a talk by one participant, Maryam, whose difficulties during and after a psilocybin session in a Compass trial I wrote about here. ICPR invited Maryam to be a key-note speaker – props to her and to them for what many say was one of the most powerful sessions of the conference.

We heard from Marc Aixala about how to integrate challenging psychedelic experiences (I review his book here), and from Abigail Calder at the University of Fribourg, who presented a new scale to measure psychedelic side effects or adverse events (you can see her presenting at one of our Psychedelic Safety Seminars in our video archive).

We recently did a survey of 30 leading researchers who focus on psychedelic harms, and this quote from Abigail stood out:

I think we need to be extremely open with ourselves, patients, and the public about the fact that we are all still learning how best to administer psychedelics. This field is too young to exist without missteps, yet various incentives in the culture (and subculture) discourage talking about this. We need to actively create a constructive culture of error.

As one of the organizers from the Open Foundation put it, ‘we shouldn’t applaud the best results, we should applaud the best science.’

We heard a lot more about psychedelic ethics, with presentations on topics like informed consent and how to safeguard against misconduct from researchers including Dmitris Repantis, Nicolas Langlitz, Edward Jacobs and others. Also last week, this paper was published outlining a proposed ethics framework for the field.

And I met many people at the conference working on researching or supporting people with post-psychedelic difficulties. I met two people working on developing platforms to support integration after retreats. I met two different individuals looking to start up support groups for people after difficult psychedelic experiences. I met young researchers publishing theses on challenging psychedelic experiences.

And I met Dario Masah and Derin Marbin, two psychotherapists who run the Psychedelic Outpatient Clinic at the Universite de Charite in Berlin. Dario and Derin, supervised by the great Tomislav Majic, provide free online consultations for people dealing with post-psychedelic difficulties. They told me they are contacted by people around the world, who have often been misdiagnosed with psychosis or schizophrenia when it’s more likely they’re experiencing a post-psychedelic difficulty like derealization or Hallucination Persistent Perception Disorder. They would love to be connected to other post-psychedelic support clinics. Do any others exist?

These are encouraging signs. We’re in a new season of the psychedelic renaissance, after the euphoria, when the field has been forced to look challenges squarely in the face, and to take ethics and safety much more seriously.

There’s a lot to figure out. Can we reduce the risks of extended post-psychedelic difficulties, and improve the quality of post-psychedelic support to the point where these treatments could be considered ‘safe’ (or relatively safe) for the general public? And can the field put proper safeguards in place against the sorts of therapist / guide misconduct that derailed Lykos’ application?

After the paywall, some brief highlights and links from ICPR.