‘Good’ vs. ‘Bad’ Drugs: Psychedelic drugs for the treatment of psychiatric disorders
by Averil Bauer-Kong
In general, there is a perception of a distinct line between ‘good’ drugs and ‘bad’ drugs. ‘Good’ drugs are those that are used in a therapeutic sense that are used to treat diseases, whereas ‘bad’ drugs are those that are used recreationally and are associated with misuse and abuse. The narrative is changing however, where the observed benefits of psychedelics or cannabis psychoactives in treating pain, anxiety or other psychoses demonstrate that ‘good’ and ‘bad’ drugs are not mutually exclusive and the stigma around their use is gradually lightened. Psychedelics belong to the hallucinogenic class of drugs that affect the brain to induce behavioural changes. These drugs function via serotonin receptors to impact perception, mood, and cognition in the individual. The individual can experience a range of emotions from bliss to anxiety and panic. After investigation into the clinical benefits of psychedelics to treat anxiety, depression and addiction during the 1950s and 60s, there was a decline in research due to the categorisation of lysergic acid diethylamide (LSD) as a schedule one drug, indicating it had no regulated medical use and high potential for abuse. In recent years however, an interest in psychedelics as psychotherapies has re-emerged and promising results have been exhibited in patients with post-traumatic stress disorder (PTSD).
Siegel et al., 2021 summarizes the ongoing clinical studies of the psychotherapeutic potential of various psychedelic drugs. The authors performed a search and data extraction for completed, active and upcoming studies investigating the use of psychedelics as treatment for psychiatric disorders and selected studies using a set of inclusion criteria. 70 studies were included, each investigating a disorder including alcohol use disorder, anxiety, drug addiction and PTSD. Interestingly, this search and data extraction method has been adapted from oncology studies, where there are an abundance of clinical trials occurring.
From synthesis of all the included studies, MDMA was the psychedelic drug tested in the majority of studies. The studies were performed to determine the drug’s efficacy as an assistant to psychotherapy and its mode of action. The next most common studied drug was psilocybin for treatment against alcohol use disorder, anorexia, anxiety and depression. One study each was identified for ayahuasca, ibogaine hydrochloride, 5-MeO-DMT and DMT fumarate treatments for the treatment of depressive disorders. Overall, there is a substantial increase in clinical studies investigating psychedelic drugs as treatment for psychiatric disorders. Siegel et al.’s study exemplifies that when psychedelics are used in a controlled setting, the potential for abuse is greatly reduced, such that the therapeutic benefit outweighs the risk. The underlying theme of this paper is that the therapeutic use of ‘bad’ drugs should not be dismissed due to the surrounding stigma because when investigated in a rational and scientific way, they may yield valuable treatment for certain individuals.
Siegel, A N, Meshkat, S, Benitah, K et al. (2021). Registered clinical studies investigating psychedelic drugs for psychiatric disorders. Journal of Psychiatric Research. 139. pp: 71-81. doi: 10.1016/j.jpsychires.2021.05.019.