The psychedelic industry needs to learn how to deal with bad trips – and bad publicity
Compass published good trial results last week, but over-sensitive public relations spoiled the party
Last week was a big week for psychedelics. First, the good news. Compass Pathways published the findings of its Phase 2 trial of psilocybin therapy for treatment-resistant depression. It found a statistically significant and clinically meaningful reduction in depression symptoms in the groups who took a 25 MG dose and a 10 MG dose of psilocybin (the drug in magic mushrooms) compared to a control group. This is great news, and will give hope and encouragement to the roughly 350 million people worldwide who suffer from treatment-resistant depression.
It's another small step forward on the long road towards the re-normalization of psychedelics in western society, after two millennia of demonization. But there’s still a long way to go. Compass’ share price is down around 75% over the last 12 months, as are other psychedelic stocks. They have been mauled by the bear market, and some analysts and investors are sceptical that psychedelic therapy will ever be a profitable market, because of issues around patenting a naturally-occurring product, and continued challenges around the public and regulatory perception of psychedelics.
The more sobering part of Compass’ results concerned ‘treatment-emergent adverse experiences’ (TEAEs). 9% of the participants who took a 25 MG dose had an adverse experience lasting from two days to three weeks after the trip itself. Around a third of participants had suicidal ideation when they arrived for the trial, but for 14% of the 25 MG group and 17% of the 10 MG group, that suicidal ideation was worse three weeks after the trial.
Compass assured its investors in an investor call:
Case-by-case analysis of safety data found no evidence to suggest a causal relationship between these TEAEs and administration of COMP360 psilocybin.
But that’s not what they said in their published article. In the journal article, they said:
In view of the participants who showed worsening of suicidal state, suicidality demands clinical vigilance in future trials of psilocybin for depression
We don’t know what the adverse experiences were or why they occurred – this is why it’s useful to have some qualitative data on adverse experiences (ie interviews). It may be that suicidal ideation got worse because the treatment didn’t work as hoped – you can understand that, if your life is hell, and you are holding on for a cure, it would be fairly crushing if that cure didn’t work.
The further psychedelics get down the road towards normalization, the more we will learn about adverse experiences and how to manage them. Every medicine has risks and side effects. Anti-depressants were launched amid great fanfare and quasi-cultic enthusiasm, and it took around 30 years for regulators and the pharma industry to take seriously people’s reports of side effects such as dependency, loss of libido, weight gain and so on.
Hopefully the psychedelic industry will react with greater maturity and less denialism than the anti-depressant industry, and start investigating these effects properly now (that’s what our study is trying to do).
It may be that psychedelic side effects are less serious, less long-lasting, and easier to manage. I hope so. But let’s learn more about them, to give people the most confidence going into trips, and the best support afterwards.
However, there are still some signs that psychedelic therapy is being treated like a religion, with any criticism seen as heresy.
Compass published its results to coincide with one of the largest psychedelic conferences – Wonderland in Miami. It drew some of the biggest names in psychedelic business, like Christian Angermayer and Robin Carhart-Harris – the latter gave a talk which touched on adverse experiences and put forward some hypotheses on why they might occur. These are just hypotheses, by the way – I haven’t yet seen evidence that poor socioeconomic status makes a bad trip more likely. I guess it makes an adverse environmental setting more likely.
But what should have been a good week for psychedelics went a little sour when it emerged that Wonderland had banned various journalists and activists from the event, including Nese Devenot and Brian Pace, who have written on ‘right-wing psychedelia’; and Lily Kay Ross, who presented the Cover Story podcast which criticized MAPS for failing to protect participants adequately in its trial of MDMA for PTSD.
One of the banned activists – Sasha Sisko – does see it as their mission to pop up at every major psychedelic event to challenge psychedelic leaders about ethical abuses. I imagine that gets quite annoying. But still, it’s not a great look to be banning critical journalists from psychedelic events. Instead, have a press conference and let them ask critical questions.
Even worse was a presentation by Hamilton Morris, famous psychedelic TV presenter who now works for Compass as a consultant. According to audience reports, his presentation laid into various journalists for being over-critical of the psychedelic industry. He criticized Brian Pace and Nese Devenot, again, for their piece on ‘right-wing psychedelia’, calling it ‘insane’, and he also criticized Vice’s Shayla Love for her reporting.
This was a bad idea.
First of all, if you ban some journalists from your event, don’t then take to the stage to criticize their work. This is giving their work tonnes of free publicity. Secondly, Pace and Devenot’s contention that psychedelic culture has often skewed to the right, and does so still today, is factually accurate (I’ve explored the same topic, as has Nicolas Langlitz). The smart response would not be ‘that’s insane’, it would be ‘so what?’ If psychedelics are ever going to be normalized in western cultures, they need political support from the right as well as the left. The fact some people on the far right were or are into psychedelics does not mean psychedelics are essentially fascist - they’re not essentially anything, other than context-amplifiers.
Thirdly, Shayla Love is widely respected as one of the best, if not the best, reporters on psychedelics. Her pieces are long, thoughtful and balanced analyses of the complexities around psychedelics. In fact, she won an award at Wonderland for her reporting last year, and Vice won an award for best reporting on psychedelics this year.
Yes, some of her articles have raised concerns around the psychedelic market, such as patent issues and adverse experiences. That’s how free speech and a free market works. Investors want to know about precisely these issues.
The psychedelic industry has enjoyed a bull run in good publicity for over a decade. It has got high on its own hype, and now sees any criticism as heresy. It needs to grow up and wise up fast, because much more vicious and prejudiced criticism is coming down the road. If you think Shayla Love is unfair reporting, you are woefully unprepared for what is coming.
In other news:
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