Prescribing Mushrooms for Anxiety

A New York University research team is using hallucinogenic experiences to help patients come to terms with their mortality.
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The room at the Bluestone Center for Clinical Research where patients take hallucinogens. (NYU)

“Some of the things I’m about to say might not make sense,” began O.M., a 22-year-old cancer survivor. He had the far-off look in his eyes that I recognized from so many of the other study participants. They sound like travelers, struggling to describe exotic foreign lands to the people left back home. That struggle is a sign that the treatment has worked. Ineffability is one of the primary criteria that define a mystical experience.

“I was outside of my body, looking at myself,” O.M. continued, “My body was lying on a stretcher in front of a hospital. I felt an incredible anxiety—the same anxiety I had felt every day since my diagnosis. Then, like a switch went on, I went from being anxious to analyzing my anxiety from the outside. I realized that nothing was actually happening to me objectively. It was real because I let it become real. And, right when I had that thought, I saw a cloud of black smoke come out of my body and float away.”

The encounter with the black smoke was just one of many experiences that O.M. had that day. As his mind, “like a rocket,” traversed vast expanses, his body never left the comfortable and well-worn couch at the Bluestone Center for Clinical Research in Midtown Manhattan. The athletic first-year medical student is one of 32 participants in a New York University study examining the hallucinogen psilocybin as a treatment for cancer-related anxiety.

For O.M., that anxiety had been crippling. Diagnosed with Hodgkin’s Lymphoma at the age of 21, the then-pre-med student at first refused to accept reality. “I’m pretty domineering,” he laughed. “I told the nurses, ‘I can’t have this right now.’ I thought I could negotiate with cancer.” That domineering spirit served O.M. well through six rounds of chemotherapy. He even looked forward, he insisted, to the debilitating side-effects of his cancer-killing infusions. Enduring them gave him a sense of agency. He could withstand the punishment; his cancer could not. Only when the treatments ended, with his cancer in remission, was O.M. consumed by a feeling of abject helplessness. The fight was over. From that day on, all he could do was wait to see whether the cancer would return.

“When I first met him, he had calluses all over his neck,” explained research manager Gabrielle Agin-Liebes. “He would constantly feel his lymph nodes as a habit, to see if they had grown. Even as he was talking to you, his hand would be up there feeling his neck. Ironically, that would make the lymph nodes swell up even more.”

“He had one of the highest ratings on the anxiety scale that we had seen: 21 out of 30,” Gabrielle continued. “To qualify for the study you only need an eight. The day after his first dosing session, he dropped to zero, and for seven months he’s stayed there. Zero anxiety.” The black cloud had carried it all away.

Psilocybin, found naturally in more than 200 species of mushrooms, has a long history of use by humans. Called “flesh of the gods” by the Aztecs, the mushrooms were widely consumed in religious ceremonies by pre-contact indigenous cultures throughout the Americas.  Cave paintings in Spain and Algeria suggest ritualized ingestion dating back as far as 9,000 years. Brutally suppressed by Christian authorities on both sides of the Atlantic, indigenous psilocybin use was nearly eradicated until the late 195o’s when Western psychiatry rediscovered it.

In the years after World War II, hallucinogen-aided therapy was a rapidly growing field. Conditions as diverse as alcoholism, drug addiction, post-traumatic stress disorder, and anxiety were treated. In the quarter century that followed, 40,000 patients were given psilocybin and other hallucinogens such as DMT, LSD, and mescaline. More than 1000 research papers were produced. The results were very promising, though as the NYU study’s principal investigator Dr. Stephen Ross explained, much of the research lacked proper oversight. “They didn’t understand set and setting in the beginning. Patients would be injected with LSD, put in restraints, and somebody would come back hours later. They were put in very drab clinical environments. Then you had people like Timothy Leary and his group over at Harvard who were using the drugs themselves, using them with famous people, and recklessly promoting psychedelics within American culture.”

The government soon took notice. As paranoia grew within the Nixon Administration over the rise of a drug-fueled counterculture, regulation became a priority. Creeping legislation culminated in the Controlled Substances Act of 1970. The law created five schedules of increasing severity under which drugs were to be classified. Psilocybin was rushed into the most restrictive Schedule I, alongside MDMA, marijuana, and heroin. The classification was reserved for drugs that, by definition, have a “high potential for abuse,” “no currently accepted medical use,” and a “lack of accepted safety.” The act signaled the end of psychedelics research in America for nearly 25 years.

Dr. Stephen Ross

The research made a slow comeback starting in the mid-90’s, but the stigma remains. “The only thing I learned about psychedelics in psychiatry training is that they were toxic,” Dr. Ross explained. “We were told that they cause psychosis. I’d also heard the old urban legends: that they cause chromosomal damage, and that if you take seven hits of LSD you go insane. But, I knew nothing about their history in psychology and in mental health, which had been considerable.”

The soft-spoken psychiatrist first came to NYU under a fellowship to do research on drug addiction. In his search for novel treatments for intractable conditions, Ross stumbled upon a decades-old study in which LSD had been used to successfully cure alcoholism. “I was shocked,” he admitted. “As a Schedule I drug, I assumed that LSD must be very addictive. But that simply wasn’t true. It does not behave like an addictive drug by any measure. I was even more shocked to find out that Bill Wilson, the founder of Alcoholics Anonymous, got sober from a psychedelics-induced mystical experience. He was so impressed that he actually wanted to introduce it into the bylaws of AA.” 

As for the toxicity Dr. Ross had been warned about in medical school, “There are simply no known long-term toxic effects from taking serotonergic hallucinogens,” he explained. “From a medical perspective, psilocybin is a remarkably safe compound.”

The Drug Enforcement Agency takes a different view. As a condition of Dr. Ross’s Schedule I license, the compound is stored in a restricted area inside a two ton safe. “It’s the only drug in the safe,” Dr. Ross elaborated, “and Monday through Friday, we take the drug out once a day and weigh it. Three people have to sign off on it.” That security is a stark reminder that distribution of psilocybin without a DEA license is a federal crime carrying penalties of up to 20 years in prison for a first offense.  

The intense scrutiny has produced a rigorous methodology. The NYU team screens every applicant for personal and family mental illness, health conditions, and substance abuse history. “We’ve had to be perfect,” Dr. Ross concluded. Additionally, each patient participates in months of intensive psychotherapy before and after treatment.  “They undergo an extensive review of their life,” Dr. Ross explained. “The goal is to try to construct a new narrative around cancer.”

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Roc Morin is a journalist based in New York and the author of And, a book of short stories.

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