By Amely Greeven
In April, the White House issued an executive order to accelerate research and expand patient access to psychedelic substances for treatment of severe mental health conditions. Behind the scenes, a movement comprising military veterans groups and figures like former Texas Gov. Rick Perry had advocated for sufferers of treatment-resistant PTSD, traumatic brain injury and opioid addiction to gain the right to try psychedelic drugs like MDMA, psilocybin and ibogaine before they received full FDA approval. Their reasoning was that there was no time to waste in pushing for well-studied therapies that can offer lasting recovery: Suicides in the veteran population are twice as common as for non-veterans, and drug overdose deaths nationwide during the pandemic exceeded 100,000 per year.
Mainstreaming psychedelics might seem taboo. But the therapeutic pathway being laid out recognizes that, when used as part of structured treatment overseen by specially trained psychotherapists, mind-altering substances can create profound opportunities for healing, sometimes in ways that no other treatments have been able to do.
MDMA, a synthetic compound that acts on serotonin and dopamine receptors in the brain, can help create an experience of self-acceptance, empathy for self and others, and trust that allows a person to process difficult experiences and go deeper in therapy, potentially rewiring their relationship to trauma. Studies show powerful results when used as part of treatment for complex PTSD cases as well as eating disorders and chronic pain. (Not technically a psychedelic, MDMA is considered an “empathogen” and was initially used for psychological healing before it infiltrated a recreational market as ecstasy in the ’80s, when its use was criminalized.) Ketamine, a dissociative anesthetic with psychedelic-like properties, is used for treatment-resistant depression, anxiety and pain. Psilocybin, a compound derived from mushrooms that is considered the “classic psychedelic” because of its action on serotonin receptors to create mystical experiences, is being extensively explored for the treatment of major depression as well as PTSD.
Less familiar to most is ibogaine, a psychoactive alkaloid derived from a plant native to west central Africa. Traditionally used ceremonially as a “bridge to the ancestors,” and inducing the longest, and often most intense or even harrowing, psychedelic journeys of any substance, it appears to interrupt addiction in powerful ways in some people by helping the brain “reset” cravings for drugs and quell withdrawal symptoms.
Yet working with these substances for healing requires guidance and experienced oversight. These medicines can potentiate transformation, but they require dedication, in the form of therapeutic sessions to integrate experiences. Ibogaine users, who must experience the medicine in a safe, monitored clinical setting due to its very real cardiotoxic risks, and currently have to go outside the country do so, may win a window of time to help their brain consolidate the changes—but they have to earn the results, by doing extensive inner work with support. MDMA itself is no silver bullet, proponents say, but with the right practitioner as an ally, it can make therapy more effective.
Advocates also caution that the push to improve access for complex cases should not be mistaken as a green light for people to experiment on their own. Not simply because of the illegality of using substances still classified as Schedule I drugs—though psychedelic mushrooms are now decriminalized in a few parts of the U.S.—but because of the real risks of harm from unregulated use, such as deadly contamination with fentanyl in street-sourced substances and potential psychotic breaks or interactions with medications.
There are plenty of reasons to watch the evolution of psychedelic medicine closely. Skeptics greeted the executive order with tough questions. Will the sacred contexts from which plant-derived medicines come, as well as the land and people from where they’re sourced, be forgotten and exploited in the rush to commercial use? Will pharmaceutical companies rush to benefit from the new pathway, profiting from molecularly similar medications they produce while the unpatented original substances remain criminalized?
Psychotherapist Shira Myrow, psychedelic integration facilitator and co-founder of I-Psychedelic Therapy, is cautiously optimistic. “The FDA should create a regulatory commission to ensure they truly understand this treatment before scaling. We need to learn from mistakes with the medicalization of marijuana, which led to dangerously potent strains. Yet, if stewarded with reverence, rigor and responsibility, the transformative potential of these medicine protocols is real, and possibly revelatory.”