Where to with psychedelic research? by Rick J. Strassman, M.D.

'How to modify the research setting so as return to the roots of my original interest in them? That is, to minimize adverse effects, and maximize potential benefits?'

Rick J. Strassman, M.D.
Port Townsend, Washington, 98368 USA
e-mail: rstrassm@olypen.com

Psychedelic, or hallucinogenic, drugs are a unique family of chemicals. They modify perception, thinking, emotions, and body sensation in various combinations and to different degrees. The particular syndrome they produce is unlike that caused by any other drugs. Psychedelics are found in nature: many plants and fungi, and occasional animals, contain large enough quantities to produce noticeable effects. Others are laboratory modifications of naturally found compounds. Humans produce very small amounts of DMT and closely related psychedelics. Duration of effects can range from minutes, for DMT, to nearly a day, for ibogaine. Psilocybin, LSD, and mescaline last for 6-12 hours.

Psychedelics produce their effects by altering brain chemistry, primarily of serotonin, an important neurotransmitter. The gap between brain chemistry and subjective experience, however, remains enormous for psychedelics--this also is true for all mind-altering drugs, including medications like Prozac.
Psychedelics have been used by non-literate societies from prehistoric times until now. The extraordinary states of mind brought on by these drugs reserve them a singular social role in personal and cultural maintenance and development.

In the 1940's and 1950's psychedelics were important in the development of "biological psychiatry" or "psychopharmacology." This allowed psychiatry to return to the fold of medicine, a victory for psychiatrists disillusioned with the monopoly exerted by Freudian psychoanalysis.

Psychiatric researchers have used psychedelics to study mind-brain mechanisms, as well as mimic certain features of naturally-occurring psychoses. They also used psychedelics to improve psychotherapy for difficult-to-treat conditions--ranging from neurosis to terminal illness. In treating death-related issues, psychiatry ventured into pastoral realms.

Outside of psychiatric research, contemporary Western use is mostly recreational. Few take psychedelics in a psychotherapeutic or religious setting. Relatively new Latin American churches consume a beverage, ayahuasca, containing psychedelic doses of DMT.

One of the main reasons I trained as a psychiatrist, in fact, even went to medical school, was to learn more about psychedelic drugs. I hoped I might learn enough to be able to give them in human research.

I was exposed to both science fiction, and science, by my father, an electrical engineer by training. He was hard-working and modest, but also drank excessively and was prone to depression and violent outbursts. The altered state caused by alcohol held a strong hold on him.

My own drug use in college, primarily marijuana and psychedelics, sealed my interest in drug-induced alterations of consciousness. I felt, thought, and saw things, and in ways, I never imagined possible. I learned to meditate, and worked in a tissue culture laboratory, publishing on the developing central nervous system. I took classes on dreams and hypnosis, physiological psychology, and early Buddhism. Somehow the pineal gland seemed involved in the production of naturally occurring psychedelic states--perhaps in produced DMT during non-drug induced altered states of consciousness.

I became involved with a Buddhist organization for support and guidance. Many of the monks' first sense of a religious dimension to their lives came while undergoing a psychedelic experience. This was an important shared context for my association with this community.

I found out about DMT in the late 1980's. This short-acting, naturally occurring psychedelic seemed ideal for resuming human research with psychedelics. I proposed to give various doses of DMT, to carefully characterize biological and psychological effects. This is called a dose-response study. I suggested we enroll normal volunteers, who had previous psychedelic drug experience.

I wanted to give DMT for several reasons. Some were quite conscious, some were less conscious, and others took years later to see more clearly. However, the thread that ran through the entire tapestry of this research was the following question: Are psychedelics, in and of themselves, beneficial?

Was Tim Leary right, when he promoted widespread unsupervised use, in which the inherent nature of the drug steers the experience toward a positive outcome? Or was Aldous Huxley more correct, suggesting that a carefully selected, even elite, group of individuals take psychedelics only rarely, and then only in carefully supervised settings?

Resuming human psychedelic research after a nearly 20 year lapse in the field was a huge challenge. My professional friends and colleagues in the psychedelic field were not optimistic. At this time, MDMA, or Ecstasy, was just getting to be known. Psychotherapists were using it in their practices. When looking for a way to give MDMA with government approval, the current drug laws looked impenetrable. Requests to the US Food and Drug Administration for permission to administer MDMA to humans were delayed indefinitely while scientists tried to understand its neurotoxic potential. My request to administer DMT might end in the same interminable review process.

While gaining permission to give DMT at the University of New Mexico took nearly two years, I actually found local, state, and federal agencies consistently helpful. Lack of protocol was more the problem than were political or moral objections to my proposal.
We obtained federal and private foundation financial support for this first and subsequent studies. From 1990 to 1995, we gave 60 volunteers over 400 doses of DMT. We also performed preliminary studies with psilocybin. We had permission and drug to begin an LSD study, but did not start by the time I left the University.

Pure DMT is usually smoked, but this was impractical on a hospital research unit. Injection into the shoulder muscle was not as fast as the smoked route, so we chose to give DMT intravenously (IV). Onset of effects was usually within 2-3 heartbeats after the injection ended. The peak of the experience occurred within 90-120 seconds after that. Volunteers felt essentially normal by 20-30 minutes. Studies occurred in the hospital, which turned out to be a significant source of support for volunteers, especially those who believed they were dead or dying as the rush of DMT effects swept over them.

Our style of supervising sessions was supportive, but not therapeutic. We did not talk very much, and rarely offered interpretations of people's experiences, preferring instead to let the volunteer work on things with only our prompting. We provided an accepting, loving, concerned, but rather ascetic atmosphere. It was almost a hybrid of my understanding of Buddhist and psychoanalytic principles and practices.

DMT was physically safe, even in doses that produced temporary unconsciousness. People varied in their sensitivity to DMT. The majority had never been as affected by a psychedelic drug, including those with previous DMT experience, as they were by their high dose DMT sessions. A smaller number thought it was similarly or a little less intense than previous high dose psychedelic experiences. A handful, maybe 2-3, had minimal psychological and physical responses.

Many volunteers were deeply moved by high doses of DMT. It was difficult not to be anxious while drug effects started, but if a volunteer was able to "let go" during the first five or ten seconds, the session would be extraordinarily enjoyable. Beautiful abstract geometric patterns might metamorphose into well-defined images and visions. This eyes closed visual display included animals, people, landscapes, and non-human but somehow "conscious entities."

Many volunteers likened a high dose of IV DMT to what they imagined death must be like. The loss of bodily awareness, the separation of consciousness from the body, seemed like the movement of the soul, spirit, or mind into non-material, and perhaps spiritual, worlds. Those with this sort of experience often remarked that they now were much less, if at all, afraid of death.

While our volunteers were not suffering from major mental illnesses, they, like all of us, had personal problems. Most volunteers did at least some, and sometimes a great deal of, psychological "work" on themselves. A high dose of DMT seems to me to be essentially "traumatic;" that is, marked by an unexpected, sudden onset, and overwhelming loss of control and integrity of self-identity. This may be why those who had unresolved feelings about their own past traumatic experiences were able to process those memories, if they were so inclined, in new and deeper ways.

A surprisingly large number of people had contact with "entities." Not infrequently there was a sense of communication between them and the volunteer. Sometimes there would be references to the time and space the entities inhabited. Themes of experimentation, such as "implants" and "adjustments," by the beings on our volunteers reminded me of alien abduction stories. Their "nearness" started me thinking about dark matter, which comprises about 95% of the universe's mass.

A number of volunteers had what I believe were mystical, or religious, experiences. They felt, saw, and understood the basic underlying nature of reality. They found indescribable support and love within that experience. There was a certainty that there is an unborn, undying, unchanging, and uncreated wellspring of existence. Occasional visits to, and correspondence with senior clergy from, the Buddhist center helped focus my goals and thinking about these phenomena.

What we were seeing at this stage was all I had hoped for, and more. People were reaching the most altered states of consciousness they ever had experienced. Even more gratifying was what seemed to be positive outcomes to those altered states in the vast majority of cases. People were happier, more relaxed, had gained insights into troubling circumstances, and accepted their lives in new ways.

Further into the project, some difficulties developed, clinically and conceptually. All but two of the original group of 13 volunteers were people I had known for a number of years in different circles. Additional studies recruited people I did not know. The implicit trust and familiarity that existed in the first, dose-response, study was missing for subsequent ones. This made it more difficult for volunteers to let go as readily into the DMT experience, and made me less certain about their and my ability to manage their highly regressed condition.

In addition, I began to feel the constraints of the biomedical model that we used to place our initial project. I believe this model was the only one that could have succeeded in obtaining approval and funding. The initial project asked, "What does DMT do?", and involved giving only DMT to volunteers.
To continue within that model, however, we needed to ask, "How does DMT work?" To answer this, other drugs were combined with DMT so as to increase, reduce, or otherwise modify its effects. In addition, more intrusive scanning and imaging protocols were developed. It was difficult to recruit people for these studies: they were not especially interested in having a modified DMT experience, nor being so intruded upon by high technology. I also didn't like feeling as if I needed to "sell" these projects to less than fully willing and interested potential volunteers.

I was concerned that treating people like large laboratory rats might lead to them feeling like ones. I drew the line at a study that would have injected volunteers with radioactivity. The gap between ethics and science was too great.

IV DMT is best given in the hospital. Its effects on heart rate and blood pressure are so great that I needed the reassurance provided by instantly available resuscitation teams. However, our preliminary psilocybin work convinced me that for the full experience to occur with this longer-acting drug, a non-hospital setting was necessary. The local hospital ethics committee was concerned about safety. The case of a volunteer who signed out of the hospital against medical advice, just as psilocybin effects were beginning, made it even less likely we could give this drug outside of the hospital. This also sharply reduced the number of potential volunteers.

Adding to these issues, I was getting the answer to my question about the intrinsically beneficial effects of psychedelics, and it was "No." As I followed our volunteers over time, it was clear that there were not many profound or lasting effects of the high dose DMT experience, in the absence of ongoing psychological or spiritual work in their everyday lives. Of the triad: drug, set, and setting, I was concluding that the most dispensable of the three in one's personal growth was drug.

Personally, I began this research with great anticipation and enthusiasm. However, as high dose DMT session after high dose DMT session followed one after another over the months and years, I noticed a certain psychological, emotional, and spiritual exhaustion setting in. The reasons for this are complex, but a major factor was the lack of a richer and more supportive context within which this work could be conceptualized. I was giving drugs; neither more, nor less.

If the drugs themselves, in our neutral clinical environment, had little long-term benefit on our volunteers, what about the risks? I thought I was exceptionally well-trained and prepared to do this sort of work. Despite this, we had many short-term difficult situations with DMT. And hospital-based psilocybin sessions seemed a set-up for problems, especially paranoid reactions.

How to modify the research setting so as return to the roots of my original interest in them? That is, to minimize adverse effects, and maximize potential benefits. I saw a conflict between the best setting, and the requirements for research. This conflict is over the need for data. We wanted something from our volunteers while they were in a psychedelic state.

I also saw longer-range implications of resuming psychiatric research with psychedelics. What if there were to be a wave of similar biomedical psychiatric research with them? These studies would refer to mine as precedent, and would likely be performed by scientists less familiar with, and supportive of, the complex and unusual states brought on by these drugs. I felt as if I had opened a Pandora's box, and I wondered if I could close it.
The issues raised by this research contributed to an over twenty-year relationship with my Buddhist community straining and rupturing. An article I wrote on DMT and "enlightenment," DMT's role in death and dying, and a suggestion to combine meditation and psychedelics in religious training, spurred a hasty withdrawal of support. Senior priests who now had positions of authority within the religious order could no longer acknowledge their indebtedness to the psychedelic experience. Holiness superseded the truth.

The pressures showed themselves in yet another form. My wife fell ill and required emergency surgery.

Things seemed to be dangerously accelerating. The momentum of the work was too great to modify it mid-stream. I decided to stop.

Over three years have passed since I gave anyone DMT or psilocybin. The drugs are stored in a secure site in North Carolina. I send in annual reports to the government, requesting that the files for the drugs be kept on hold, but not closed.

I do not plan to return to this work any time soon. I think the psychiatric research setting is not an especially safe nor effective way to give these drugs. I do not know the best setting.

I am impressed with the little I know about culturally sanctioned and constrained ritual using long-acting psychedelic plants. However, there are no contemporary Western models for this kind of use.

I think the dominant Western religions should take a very serious interest in developing such rituals. I also believe that any institutionalized religion runs the risk of dogmatizing experience and abusing power. I think clinical psychiatry can join forces with an established religious tradition in this endeavor. The partnership could provide a more egalitarian and "peer-reviewed" view of reality and relationships. And perhaps the best of both disciplines could be brought to bear on the pressing issue of how to best utilize these powerful and potentially beneficial drugs.