“There may be lots of promise here,” Insel said, “but it’s really easy to
forget about issues related to safety, issues related to rigor, issues related
to reputational risks.” He suggested that psychedelics would probably
need to be rebranded in the public mind and that it would be essential to
steer clear of anything that smacked of “recreational use.” He and
Summergrad both warned that a single sloppy researcher, or a patient
with a disastrous experience, could poison the well for everybody.
Nobody needed to mention the name Timothy Leary.
• • •
HOW CLOSE ARE WE to a world in which psychedelic therapy is sanctioned
and routine, and what would such a world look like? Bob Jesse was in the
audience when the former head of NIMH took his swipe against
“recreational use,” and though I didn’t see it, I can picture his grimace.
And what exactly is wrong with re-creating ourselves? Bob Jesse
worries that the “medicalization” of psychedelics these men were
advocating as the one true path would be a mistake.
Not that medicalization will be easy. Several steep regulatory hurdles
will first need to be overcome. Phase 3 trials involve multiple sites and
hundreds of volunteers; they can cost tens of millions of dollars.
Normally Big Pharma foots the bill for such trials, but thus far the
pharmaceutical companies have shown scant interest in psychedelics. For
one thing, this class of drugs offers them little if any intellectual property:
psilocybin is a product of nature, and the patent on LSD expired decades
ago. For another, Big Pharma mostly invests in drugs for chronic
conditions, the pills you have to take every day. Why would it invest in a
pill patients might only need to take once in a lifetime?
Psychiatry faces a similar dilemma: it too is wedded to interminable
therapies, whether that means the daily antidepressant or the weekly
psychotherapy session. It is true that a psychedelic session lasts several
hours and usually requires two therapists be present for the duration, but
if the therapy works as it’s supposed to, there won’t be a lot of repeat
business. It’s not at all clear what the business model might be. Yet.
Several of the researchers and therapists I’ve interviewed nevertheless
look forward to a time, not far off, when psychedelic therapy is routine