When Todd’s psychiatrist suggested he start taking psychedelics, he figured it was a joke.
It wasn’t. The former corporate executive from Colorado retired in 2006 after an MRI revealed his spine was riddled with a dozen tumors called hemangiomas, which later spread to his brain. Todd was told he would die before the end of 2008.
Somehow, Todd has survived—he credits medical marijuana, which he now uses daily—but he is still considered terminal. “It could be tomorrow. It could be five years from now,” he says in a call.
However, the 54-year-old spent the past decade plagued by a host of mental health problems, including PTSD and treatment-resistant depression. He was suicidal and tormented by violent night terrors. Nothing, not even massive doses of Xanax or Valium, could temper his panic attacks or end-of-life anxiety.
“My mental condition was deteriorating rapidly, and I was on [antidepressant] medication No. 14 and it wasn’t working,” Todd says. “My psychiatrist said, ‘I honestly think you're a big candidate for psychedelics.’”
That was about a year ago. Todd began taking homegrown psilocybin, the highly illegal alkaloid in so-called magic mushrooms. Known for prompting profound hallucinations, psilocybin was placed in the restrictive Schedule I category in 1970, meaning the US government recognizes no medical use for the drug and says that it carries a high risk of abuse.
Todd says there have been clear benefits from psilocybin with few side effects. He hasn’t had a single PTSD episode since he began taking it. His depression evaporated. The mushrooms even help ease the pain—agony that feels like being “shot in the back”—from the nerve-crushing tumors in his spine and skull.
“It’s knocked that out, it’s wiped that slate clean,” Todd says. The day before we talked, he’d eaten eight grams of fungus. A heavy dose is considered five grams , so this was no psychedelic snack—but Todd ingests this much about every week.
The experience is positively hypnagogic, allowing trippers to enter a dreamlike conscious state where time is distorted, color is amplified, and depth perception is warped. Euphoric, unbridled laughter is common, as are oddly introspective thoughts about existence and reality, and even synesthetic sensations, such as being able to “see” sounds. A trip can last four to six hours.
There can be negative effects as well, such as nausea, dizziness, paranoia, or panic attacks, but Todd doesn’t experience those. He still takes 10 milligrams of escitalopram, an antidepressant, and when the mushrooms wear off, 30 milligrams of the opioid oxycodone, but otherwise his prescription drug intake has drastically decreased.
Todd asked me not to use his real name, fearful that his health insurance provider could sever benefits because he uses illicit substances. But his doctors are aware and supportive of his psychedelic drug use, he says, which may legally exempt him under the federal Right To Try Act for terminally ill patients, signed by President Trump last May.
Indeed, magic mushrooms are having a therapeutic moment. In North America, at least four organizations, each with unique strategies, are working to expand access to psilocybin for anyone with mental health issues, dying or not. These groups hope to undo decades of psilocybin prohibition by removing criminal penalties for possession or cultivation, or by providing access to psilocybin in a therapist’s offices, or both.
They cite a small but growing body of research suggesting psychedelic drugs can, in fact, be medically beneficial with low potential for addiction or abuse. Some small studies suggest that psilocybin can alleviate obsessive-compulsive disorder , treatment-resistant depression , end-of-life anxiety , addiction , cluster headaches , and, yes, relieve pain . There’s also growing evidence that ingesting the drug can promote optimism and prosocial and mystical worldviews , and nurture well-being.
In just a few years, pockets of psilocybin-legal jurisdictions could appear, following the similar path that medical marijuana took to mainstream acceptance. The leaders of this movement include Compass Pathways, a UK startup developing psilocybin therapy for treatment-resistant depression in North America and Europe.
There are also two psilocybin grassroots movements, one in Oregon and another in Denver. If voters approve the Oregon Psilocybin Service Initiative in 2020, the state would develop a licensed psilocybin therapist industry and lower criminal penalties for growing or consuming mushrooms. Denver city voters may also get to decide whether to decriminalize personal possession and use of mushrooms—a voter initiative just gathered enough signatures to appear on the May ballot.
Finally, there’s TheraPsil, a group of seven Canadian health care professionals who formally announced their intent to challenge the illegality of psilocybin by petitioning Health Canada to allow access to mushrooms in a medical setting for terminal patients.
These little saprophytes—organisms that devour dead or decaying organic matter—are indeed enjoying a resurgence in popularity. But there are still numerous obstacles before psilocybin goes from black market hallucinogen to psychedelic medicine.
The Swiss chemical company Sandoz began in 1886 as a dye manufacturer, later pivoting to pharmaceuticals . But in 1947, with the help of one of their lead scientists, Albert Hofmann, the business began producing a psychiatric drug they called Delysid. Most people know it as LSD.
The psychedelic showed promise for treating mental health problems, but an LSD trip can last eight to 12 hours , so Sandoz sought a shorter-acting alternative. In 1958 Hofmann became the first to isolate psilocybin from mushrooms, subsequently developing a synthetic version called Indocybin. He first tried it on himself . Indocybin was safely marketed from 1961 until a rising cultural backlash against psychedelics led Sandoz to discontinue sales in 1966.
Now, more than 50 years later, a company is looking to pick up where Sandoz left off. Compass Pathways was founded in 2016 by George Goldsmith and Ekaterina Malievskaia, a married couple from London with little experience in the pharmaceutical industry. When their son developed treatment-resistant depression and OCD, they were desperate for help.
“The more they were treating him, the worse he was getting,” Malievskaia says in a call. So they took matters into their own hands. They began looking into scientific reports that psilocybin can rapidly reverse symptoms of depression for patients who have tried other approaches without results. And unlike Todd, these patients took only a single dose, not one per week.
Compass, which has reaped about $31.5 million in Series A investment, is conducting two studies to see how viable psilocybin is for psychotherapy. The first, due to finish in early 2019, is a double-blind placebo-controlled trial planned with 90 healthy volunteers to evaluate cognitive and emotional function. The study is also helping to train Compass’ therapists.
The Food and Drug Administration recently granted the company “ breakthrough ” therapy status for its second study, giving Compass priority review, following approval in August of a phase IIB clinical trial, designed to establish proper dosing.
The study is recruiting 216 participants across North America and Europe, making it the largest clinical psilocybin trial to date. Patients meet with a therapist to prepare, then are later given synthetic psilocybin, which can cost upward of $7,000 per gram , while being monitored for the duration of the trip. Afterward, the therapist helps patients process the experience. If successful, these trials could lead to psilocybin therapy becoming legal in the US by 2021.
Compass began as a nonprofit, but after realizing this research could cost an estimated $300 million, the company shifted to a for-profit model. That transition and other moves have drawn sharp criticism from some in the psychedelic community. A Quartz article published in November aired the concerns of numerous critics of Compass, who claimed that the company was backed by dubious investors and was attempting to monopolize magic mushrooms.
About a quarter of Compass is owned by Atai Life Sciences, a biopharmaceutical startup founded in 2018 by entrepreneur Christian Angermayer. One of Atai’s backers is PayPal cofounder and tech mogul Peter Thiel, who has come under fire for helping bankrupt Gawker via a lawsuit, donating money to President Trump, and selling surveillance tech to various governments for countering terrorism and policing migrants.
Malievskaia dismisses the criticism of Thiel. He has no say in Compass’ business operations, she says. “Peter is not one of the major investors. Personally, I think it's an excellent use of his money,” she says. “We don't screen investors based on their political convictions or what skeletons they have in their closets … It’s an equal-opportunity investment, and we are in charge of our mission, vision, execution.”
Because it occurs in nature, it’s not possible to patent psilocybin, but it is legal to patent a synthetic manufacturing process, which Compass has done . To manufacture psilocybin in large quantities, they solved about 60 different technical problems, a project that cost about $750,000, according to Malievskaia. Switching to a for-profit strategy was a “very logical development,” she says. But some have interpreted this as Compass trying to corner the psilocybin market or prevent others from researching it.
“It doesn't mean that we patented psilocybin as a molecule,” Malievskaia says. “Anyone can make it in many different ways: 3D printing, growing on yeast, genetic engineering … This is not blocking anyone. Investigators who want to use our product, we share it free of charge in exchange of providing safety data.”
While the US federal government has long held that psilocybin is dangerous, scientific evidence says otherwise. In the November issue of Neuropharmacology , a team of Johns Hopkins University School of Medicine researchers argued that under the Controlled Substances Act’s own criteria, psilocybin should not be Schedule I but the much less restrictive Schedule IV.
The grassroots movements in Oregon and Denver are citing this and other research in the hopes of removing local penalties for using or growing mushrooms.
The first to appear was the Oregon Psilocybin Society, founded by married therapist couple Tom and Sheri Eckert of Beaverton, who were inspired by—what else?—a personal mushroom experience. Their initiative would not only drastically reduce penalties for using or possessing psilocybin, it would create a state framework for therapists to become licensed psilocybin administrators, not too unlike Compass.
In other words, you wouldn’t be able to walk into an Oregon Circle K and get an eighth of shrooms. But if you believed that psilocybin, synthetic or from mushrooms, could help your mental health—or heck, even if you were just curious about what the experience is like—there’d be options. Getting insurance to cover it would be another issue entirely, of course.
The state attorney general recently approved OPS’s ballot title, so they now have until July 2020 to gather about 117,000 signatures. Then, during the next presidential election, Oregon voters will decide if this program is right for them. OPS hired a marketing research firm to test the waters and found that 47 percent of voters were in favor of their campaign with 46 percent opposed. That number rose to 64 percent when pollsters explained details about the initiative, with 54 percent in support of decriminalization.
So far, OPS has experienced no opposition, they say, but anticipate some backlash once the question is on the ballot.
“We suspect that Big Pharma is not gonna like this idea,” Sheri says in a call. “If you can treat an individual and it actually heals them and they no longer need to be daily dosing psych meds—that definitely impacts their budget.” She and others note that psilocybin could help ease the enormous financial cost of mental health disorders, which make up about 10 percent of the global burden of disease. (The market for depression medicine alone is expected to be worth $16.8 billion worldwide next year.)
The Eckerts are wary, but not completely distrustful, of bigger players like Compass. “We don't want to see it locked up in hospitals, costing impossible amounts of money,” Tom says. “The market has to play out in some way, but we are doing everything we can to make this a community-based framework.”
The ordinance proposed by Decriminalize Denver, the pro-psilocybin movement in Colorado, wouldn’t provide a system for public sales or psilocybin therapy, but for anyone 21 and over, personal use and possession of psilocybin would carry the lowest law-enforcement priority. The group’s ballot initiative, which has been endorsed by the local Libertarian and Green parties , would also prevent the city from spending any money to impose criminal penalties. (Despite living in Colorado, Todd, the psilocybin patient, would not be affected because the law would apply only to Denver.)
After the local elections division approved their ballot initiative in October , Decriminalize Denver gathered and submitted more than 9,438 signatures, almost double the required number. About 5,500 were accepted, meaning on May 7, 2019, city voters may decide whether to decriminalize personal possession and use of mushrooms.
The mile-high town is historically progressive on drug use: It was the first US city to legalize marijuana , in 2005, and in 2018 the city council voted in favor of overdose prevention sites for drug users to use narcotics like heroin under medical supervision. That law is pending state approval. Denver mayor Michael Hancock has walked back his support for supervised drug use and also does not support the psilocybin proposal.
Contrary to popular belief, Denver would not be the first North American locale to decriminalize mushrooms. In 2005, a New Mexico Court of Appeals ruled that growing mushrooms for personal use doesn’t technically count as drug manufacture, so even sprouting psilocybin in your dorm room isn’t illegal. Louisiana also exempts the cultivation of psychoactive plants and fungi “strictly for aesthetic, landscaping, or decorative purposes.” Nonetheless, Denver’s precedent on other drug issues has made folks like Kevin Matthews, the DD campaign director, optimistic that voters will reward his efforts.
“We talk to people all the time who say ‘Mushrooms have saved my life, mushrooms saved my marriage, mushrooms have broken me out of my depression, mushrooms are the only thing that works for my cluster headaches,’” Matthews says in a call. “I had a gentleman who signed the petition the other day who said it's the only thing that works for his wife's polycystic kidney disease. I had never even heard that one before.”
Meanwhile, in British Columbia, a team of seven health care professionals are gearing up for a legal fight in the hopes of legalizing psilocybin for terminal patients with end-of-life distress. About eight years ago, Bruce Tobin, a psychotherapist with 35 years of experience practicing in Victoria, British Columbia, was approached by one of his patients who desperately requested psilocybin therapy. She had survived cancer, but couldn’t shake the debilitating psychological suffering she had experienced with her diagnosis.
“She had tried everything: medicines, therapists, $1,000-per-day residential treatment programs. Nothing had worked,” Tobin says in an email. But what she was asking was still very illegal. Rather than break the law, Tobin decided to change it.
“I discovered,” Tobin explains, “I could apply for a so-called Section 56(1) exemption that would excuse me from the provisions of the Canadian Controlled Drugs and Substances Act, allowing me to legally use psilocybin in cases where it was ‘necessary for a medical purpose.’”
Thus, TheraPsil was born. The organization is petitioning the Canadian health authority to make psilocybin available medicinally, but only for people with dire need, similar to a trial planned in Melbourne, Australia this April. Tobin filed his application with Health Canada in January 2017, and it has been a slow road ever since, he says. Six other psychotherapists and medical professionals have since joined his efforts.
“If they decline to approve our application, our path forward is clear,” Tobin says. “Our legal counsel will file for a judicial review of Health Canada’s decision. If that is unsuccessful, we plan to go to the Federal Court of Appeals using the same arguments based on the Canadian Charter of Rights and Freedoms that were successful in compelling the government to change federal law to allow for patients’ access to medical cannabis. We are feeling confident.”
“There have been few, if any, real breakthroughs in the last quarter century in the development of psychiatric medicines,” Tobin adds. “Psilocybin promises to be a real game-changer.”
Indeed, it may not be long before psilocybin is legally available, one way or another, in various parts of the globe. As Robin Carhart-Harris , a leading psilocybin researcher, recently put it at the most recent World Economic Forum meeting, “The climate’s looking good.”
Like an underground hyphal knot, these efforts could form into fat, juicy mushrooms—the fungal fruits from decades of combined political, scientific, and social justice campaigns to bring psilocybin into the light.
Troy Farah is a reporter from the High Desert, California. His reporting has appeared in Ars Technica , Smithsonian, Discover Magazine, VICE, and others. He can be found on Twitter ( @filth_filler or at troyfarah.com
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