Help With Heroin

Jesse Singal reviews a new study supporting the view that treating heroin addiction with heroin is more effective than methadone:

The [North American Opiate Medication Initiative] numbers are striking: A year after the start of the study, nearly 90% of those given heroin remained in treatment, while just over half in the methadone group did. … HAT, also known as heroin maintenance, is based on the premise that while methadone treatment is effective by many standards, most methadone users end up back on heroin or other opiates eventually—either with or without methadone supplementing their habit. Since the search for heroin is, in many ways, more harmful to society than the use of it, methadone may have important limitations as a means of mitigating the damage done by heroin addiction.

“It’s not controversial in either [Switzerland or the Netherlands],” said Peter Reuter, a policy analyst at the University of Maryland’s School of Public Policy, “and in Switzerland it’s been there for so long that people have forgotten that it was once controversial.”

The Village Voice covered a far more controversial approach to heroin addiction:

Taken in sufficient quantity, [root bark from the tabernanthe iboga plant] triggers a psychedelic experience that users say is more intense than LSD or psilocybin mushrooms.

Practitioners of the Bwiti religion in the West African nation of Gabon use iboga root bark as a sacrament to induce visions in tribal ceremonies, similar to the way natives of South and Central America use ayahuasca and peyote. [Claire] Wilkins is one of a few dozen therapists worldwide who specialize in the use of iboga (more specifically, a potent extract called ibogaine) to treat drug addiction. …

Ibogaine and iboga root bark are illegal in the United States but unregulated in many countries, including Canada and Mexico. Wilkins, though, is hardly alone in her belief that iboga-based substances can be used as a legitimate treatment for drug addiction. Researchers at respected institutions have conducted experiments and ended up with hard evidence that the compound works—as long as you don’t mind the mindfuck.

A Dish reader talked about his mindfuck here. More ibogaine testimonials and resources here. Caption for the above clip:

Short sequence from my BBC broadcast documentary Detox or Die. This was for BBC’s “ONE Life” strand. A documentary biopic of my junk addiction that culminates in my attempt to detox with ibogaine. This African visionary drug has, however, been linked to several fatalities and has some rather unpleasant side effects. Heavy stuff but ultimately redeeming.

(Video hat tip: IBO-Radio)

Chemical Counseling

Brian Earp defends the idea that some couples should take neurochemical "love drugs" to prevent divorce:

In the case of marriages generally, the individuals involved have voluntarily placed themselves under a mutual oath to stick together "for better or worse" and "until death do us part." The relevant duty is simply to honor that marital commitment, by every reasonable effort, instead of abandoning it too easily when things go "worse." As love drugs become safely and cheaply available, and if side-effects or other complications could be minimized, then using them might, in some cases, fall into the bubble of "every reasonable effort."

Ecstasy (MDMA) was used in part for marital therapy almost as soon as it was discovered. Some studies have shown clear benefits for the depressed, and those suffering from PTSD. I favor its decriminalization and intensified research on its possible medical benefits. But the pursuit of happiness in America does not seem that high on either party's agenda, does it?

Taking Shrooms Seriously

A new study sheds light on what happens to your brain on psilocybin, the key compound in magic mushrooms:

"Psychedelics are thought of as ‘mind-expanding’ drugs, so it has commonly been assumed that they work by increasing brain activity,” says [David Nutt, a neuropsychopharmacologist]. "Surprisingly, we found that psilocybin actually caused activity to decrease in areas that have the densest connections with other areas."

Maia Szalavitz elaborates:

Under the influence of mushrooms, overall brain activity drops, particularly in certain regions that are densely connected to sensory areas of the brain. When functioning normally, these connective "hubs" appear to help constrain the way we see, hear and experience the world, grounding us in reality. They are also the key nodes of a brain network linked to self-consciousness and depression. Psilocybin cuts activity in these nodes and severs their connection to other brain areas, allowing the senses to run free.

The findings bode well for the the therapeutic potential of psilocybin:

Two regions that showed the greatest decline in activity were the medial prefrontal cortex (mPFC) and the posterior cingulate cortex (PCC). The mPFC is an area that, when dysfunctional, is linked with rumination and obsessive thinking. "Probably the most reliable finding in depression is that the mPFC is overactive," says Carhart-Harris. … "[Psilocybin] shuts off this ruminating area and allows the mind to work more freely," he says. “That’s a strong indication of the potential of psilocybin as a treatment for depression."

Aldous Huxley remains, I think, the most powerful exponent of what this is about. It is about, in his words, the revelation that "the universe is All Right".

And all shall be well and
All manner of thing shall be well
By the purification of the motive
In the ground of our beseeching.

If you believe, as I do, that we are at root children of God, trapped, as Pascal put it, between being angels and beasts, then there will be moments in our lives when we are closer to being angels and closer to being beasts. In my view, our beastliness, as it were, is a function of our contingency as evolving primates, having to tackle a terrifying world of death, disease, war, hatred, and fear with intelligence and self-control and self-defense. This is the world of the first half of Hobbes' Leviathan.

But we are also more than that, as Jesus taught us. We are children of God. Our alienation is because something deep within us yearns to come home, a home we do not remember, but we know exists. What psilocybin seems to do is remove the veil from seeing and accepting this wondrous, difficult truth. It does not add something to our consciousness that isn't already there. It simply calms the noise around it so we can hear what is already within us. Hence the parallels between brains in deep meditation and brains on psilocybin.

Of course, we need the veil to survive in our physical, practical lives. As Huxley notes above, we couldn't walk across the street without it. If we were always aware of the staggering beauty of Creation and the overwhelming force of God's love for us, we would be like Jesus – homeless, jobless, possession-less, beyond family or tribe. And that is where the saints are and where we are lucky occasionally, by grace, to find ourselves. Mystics have sometimes strained against their physical limits to see the truth. Jesus starved and meditated for 40 days in the desert. Others, like Julian of Norwich or St Teresa of Avila, had experiences of such intensity they live on in our consciousness even now.

To glimpse this even once – by chemical ingestion – opens up the truth as to who and what we are. It is not a substitute for living that truth, or searching for it every day, or prayer, or the sacraments, or caritas. But it is a sacramental glimpse. And however far into the darkening forest you walk, you never forget the mountaintop.

Or the view, which is eternity. Now.

Psilocybin At The End Of Life

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Dr. Stephen Ross's research uses "psilocybin-assisted psychotherapy to treat end-of-life distress in people with cancer." The results:

In my fifteen years as a psychiatrist, I’ve seen some profound things. Here I’ve seen decreased death anxiety, decreased depression, greater integration back into daily life, improved family function, and increased spiritual states. Half of our patients had classic mystical experiences, and the other half probably had near-mystical experiences. … I think psilocybin is a safe treatment modality that can potentially be a paradigm change within psychiatry and very helpful to dying patients.

If only we can transcend the fear.

(Photo of Psilocybe Cubensis by Flickr user afgooey74)

Can MDMA Treat PTSD?

by Zoë Pollock

Brian Anderson covers the push to get MDMA, or ecstasy, approved as a prescription medicine.

MDMA’s effects typically manifest themselves 30-45 minutes after ingestion, so it doesn’t take long for rhythms to develop in Charleston. Sessions at the clinic oscillate between stretches of silent, inward focus, where the patient is left alone to process his trauma, and unfiltered dialogue with the co-therapists. “It’s a very non-directed approach,” Michael Mithoefer told me. This allows subjects to help steer the flow of their trip. They are as much the pilots of this therapy as their overseers. “Once they get the hang of it,” Mithoefer explained, “sometimes people will talk to us for a while and then say, ‘OK, time to go back inside. I’ll come report when I’m ready.’”

Vaughan Bell sees a historical parallel:

‘Narcoanalysis’ was used widely in mid-20th Century where a range of drugs, from ether to sodium pentathal, were applied to patients with ‘war neurosis’ for exactly this purpose. Unfortunately, it was unsuccessful and abandoned. So this is why the MDMA treatment is a gamble. All known effective psychological treatments for PTSD involve not only confronting the memories of what happened to make sense of them, but also re-experiencing the associated anxiety. A treatment with a drug that removes anxiety will, by current predictions, have limited effectiveness.

But he maintains hope for the new study.

The Other Side Of Psychedelics

by Chris Bodenner

Sam Harris, who detests the War on Drugs and wants his daughter to try psilocybin or LSD at least once in her life, describes a bad trip:

On my first trip to Nepal, I took a rowboat out on Phewa Lake in Pokhara, which  offers a stunning view of the Annapurna range. It was early morning, and I was alone. Bad-tripAs the sun rose over the water, I ingested 400 micrograms of LSD. I was 20 years old and had taken the drug at least ten times previously. What could go wrong?

Everything, as it turns out. Well, not everything—I didn’t drown. And I have a vague memory of drifting ashore and of being surrounded by a group of Nepali soldiers. After watching me for a while, as I ogled them over the gunwale like a lunatic, they seemed on the verge of deciding what to do with me. Some polite words of Esperanto, and a few, mad oar strokes, and I was off shore and into oblivion. So I suppose that could have ended differently.

But soon there was no lake or mountains or boat—and if I had fallen into the water I am pretty sure there would have been no one to swim. For the next several hours my mind became the perfect instrument of self-torture. All that remained was a continuous shattering and terror for which I have no words.

These encounters take something out of you. Even if drugs like LSD are biologically safe, the potential for extremely unpleasant and destabilizing experiences presents its own risks. I believe I was positively affected for weeks and months by my good trips, and negatively affected by the bad ones. Given these roulette-like odds, one can only recommend these experiences with caution.

(Photo by Matt Bodenner)