Treatment (STDW)

Psychedelics Are Showing Real Promise for Treating Mental Disorders

Wed, 08/15/2018 - 21:50

Research presented at the American Psychological Association's annual meeting in San Francisco last weekend is illuminating the rapid advance of psychedelic science. New findings are adding to a growing mountain of evidence that psychedelics could be effective at treating a range of psychological problems, including post-traumatic stress disorder (PTSD), depression, and social anxiety.

[image:1 align:left]The research could be laying the groundwork for legal prescribing of psychedelics including MMDA (ecstasy), ayahuasca, LSD, and psilocybin (magic mushrooms). But that's a way down the road: All of these drugs are currently illegal, classified as Schedule I under the Controlled Substances Act. (The two plants that combine to make ayahuasca are not illegal, but DMT, the mind-altering ingredient in ayahuasca, is.)

Researchers began studying psychedelics for their potential healing benefits after the discovery of LSD in 1943, but that research came to a screaming halt in the 1960s, when psychedelics were criminalized in the wake of their widespread adoption by the counterculture. Recent years, however, have seen an efflorescence of interest in the therapeutic benefits of the substances -- and it's starting to pay off.

"Combined with psychotherapy, some psychedelic drugs like MDMA, psilocybin, and ayahuasca may improve symptoms of anxiety, depression and post-traumatic stress disorder," said Cristina L. Magalhaes, Ph.D., of Alliant International University Los Angeles, and co-chair of a symposium on psychedelics and psychotherapy. "More research and discussion are needed to understand the possible benefits of these drugs, and psychologists can help navigate the clinical, ethical and cultural issues related to their use."

In one study, researchers questioned 159 participants about their spirituality, their relationship with their own emotion, and their use of hallucinogens. Laurentian University's Adele Lafrance, Ph.D., reported that psychedelic use correlated with higher levels of spirituality, which were associated with fewer symptoms of anxiety and depression and improved emotional stability.

"This study reinforces the need for the psychological field to consider a larger role for spirituality in the context of mainstream treatment because spiritual growth and a connection to something greater than the self can be fostered," said Lafrance.

An ayahuasca study found similar results. That study suggested the drug could help relieve addiction and depression, as well as helping people cope with trauma.

"We found that ayahuasca also fostered an increase in generosity, spiritual connection, and altruism," said Clancy Cavnar, Ph.D., with the Núcleo de Estudos Interdisciplinares sobre Psicoativos (Nucleus of Interdisciplinary Psychoactive Studies).

Another study, led by Alicia Danforth, Ph.D., of the Los Angeles Biomedical Research Institute at the Harbor-UCLA Medical Center, found that a combination of psychotherapy and MMDA could treat social anxiety in adults on the autism spectrum. In that study, 12 participants with moderate to severe social anxiety twice given doses of MMDA and treated with psychotherapy, and they showed significant, long-lasting reductions in anxiety.

"Social anxiety is prevalent in autistic adults and few treatment options have been shown to be effective," said Danforth. "The positive effects of using MDMA and therapy lasted months, or even years, for most of the research volunteers."

Yet another study examined the use of psilocybin in reducing stress and anxiety in people suffering from terminal cancer. In that study, 13 subjects were given psilocybin in conjunction with psychotherapy. Researchers found that the experience helped subjects grapple with their feelings about death and develop new understandings of dying.

"Participants made spiritual or religious interpretations of their experience and the psilocybin treatment helped facilitate a reconnection to life, greater mindfulness and presence and gave them more confidence when faced with cancer recurrence," said Gabby Agin-Liebes, a doctoral candidate in psychology at Palo Alto University, who conducted the research.

After a decades-long lacuna, psychedelic science is back. How long that will take to translate into psychedelics becoming legally available by prescription remains to be seen, but the groundwork is being laid right now.

Categories: Treatment

Saying Goodbye to Mr. Methadone: Dr. Bob Newman Dead at Age 80

Wed, 08/15/2018 - 21:29

Dr. Robert Newman died earlier this month after being struck by an automobile earlier this summer. He was 80 years old.

[image:1 align:left caption:true]If any one man can be credited with carving out a space for the use of methadone as a treatment for heroin addiction, he is that man. Working as a New York City public health doctor in the 1960s, he was given the task of ensuring that heroin addicts who wanted treatment could get treatment with methadone. His boss, city health department head Gordon Chase, told him he would be known as "Mr. Methadone."

While he did not achieve the goal of providing treatment to everyone who wanted it, Newman oversaw the rapid expansion of the city's fledgling methadone program in the early 1970s. The number of patients on methadone went from a handful to more than 10,000 in two years, and 35,000 by 1975.

And he stood up for those patients. When the NYPD wanted Newman to turn over patients' methadone records, he refused. Instead, he took to the courts to defend his patients' right to privacy -- and he won.

After that, he devoted his career to advocating for evidence-based treatment, traveling the country and the world and picking up a second moniker, "the methadone pope," as he advanced harm reduction ideas decades before they became popularized.

He faced opposition from abstinence and 12-step proponents, as well as from elected officials like New York City Mayor Rudy Giuliani, who in 1998 tried to shut down the city's methadone program on the moralistic grounds that it merely substituted one addiction for another. The diplomatic Newman didn't challenge Giuliani head on but instead used interviews to make his case that methadone treatment allowed addicts to lead productive lives.

Newman also advocated for a humane approach toward addicted mothers and pregnant women, supporting groups such as National Advocates for Pregnant Women in their fight against the demonization and criminalization of those women. He was a drug policy reformer who served for decades on the board of the Drug Policy Foundation and then its successor the Drug Policy Alliance.

As this century's opioid epidemic deepened, Newman was cautiously optimistic that the work he had begun decades earlier would help further destigmatize addiction. "I'm hoping that pragmatism will win out," he said. "As more and more Congresspeople, people in the general community and physicians have children who develop a problem with prescription drug use and can't get treatment for it, I think it will make people more receptive to opening doors to treatment."

Newman was not only an influential physician in addiction issues, he was a giant in the hospital world as a whole. He served as President of Beth Israel Medical Center in New York, and then of the entity that acquired Beth Israel along with other facilities -- and then of the entity that acquired that entity. But one could still talk him at a drug policy conference, or send him an email, and you'd get an email back.

Dr. Robert Newman's contribution to an enlightened approach to addiction cannot be overstated. He will be missed, but his legacy lives on.

(Read Bob Newman's 1998 interview with this newsletter here.)

Categories: Treatment

Chronicle AM: PA Gov Says State Not Ready for Legal Pot, New FDA Guidelines on MATS, More... (8/9/18)

Thu, 08/09/2018 - 19:37

The FDA has issued new draft guidance aimed at expanding the use of medication-assisted treatments (MATs) for opioid addiction, Pennsylvania's governor says the state isn't ready for legal weed, the Oklahoma medical marijuana fight isn't over yet, and more.

[image:1 align:left caption:true]Marijuana Policy

Pennsylvania Governor Says State Not Ready for Marijuana Legalization. Gov. Tom Wolf (D) said during a radio interview on Tuesday that he doesn't think the state is ready to legalize marijuana. "There are, what, six states that have legalized recreational marijuana in the United States," Wolf said. (The actual number is nine.). "I don't think the citizens of Pennsylvania are ready for it, and so the answer I would say is no… I don't think Pennsylvania's actually ready for recreational marijuana." The position puts Wolf at odds with two neighboring Democratic governors, Phil Murphy of New Jersey, who is strongly pushing legalization, and Andrew Cuomo of New York, who just signed off on the notion.

Los Angeles Won't Vote on Raising Pot Tax in November. The city council has reversed a decision to place a 1% marijuana tax increase on the November ballot. The city estimated it would raise approximately $30 million per year from the tax increase, but faced immediate blowback from industry groups who said pot taxes were already too high and are driving consumers to the black market.

Medical Marijuana

Oklahoma Agencies Still Have "Concerns" Over Legal Medical Marijuana. Interim health commissioner Tom Bates told lawmakers Wednesday that the Health Board still has concerns about how medical marijuana will be implemented and that a special session of the legislature may be needed to see the program properly implemented. The board wants lawmakers to amend the law so that, among other changes, commercial grows are indoor only, patient home grows are prohibited or require a special license, smokable marijuana is prohibited, THC levels are limited to 12% or less, a pharmacist is required on-site at dispensaries, and that a list of qualifying conditions for patients be created. Some of the changes are among those recommended in the Health Board's first try at setting interim rules, which were retracted in the face of loud public opposition. Any effort to re-adopt them is certain to lead to renewed clamor.

Heroin and Prescription Opioids

FDA Seeks to Expand Use of Medication-Assisted Therapies for Addiction. The Food & Drug Administration (FDA) on Monday released new draft guidance aimed at promoting the creation and more widespread use of medication-assisted therapies (MATs) for opioid use disorder. The guidance adjusts how FDA evaluates new treatments for opioid addiction. Instead of only determining whether a treatment lowers opioid use, the agency will now assess whether the medication could help lower overdose rates and limit the spread of infectious disease. "We must consider new ways to gauge success beyond simply whether a patient in recovery has stopped using opioids, such as reducing relapse overdoses and infectious disease transmission," said Scott Gottlieb, FDA commissioner.

Categories: Treatment

Does Microdosing Psychedelics Really Improve Your Life?

Mon, 08/06/2018 - 21:12

Microdosing psychedelics has been a thing for awhile now. It is the practice of ingesting drugs such as LSD or psilocybin (the stuff that puts the magic in magic mushrooms) in amounts too small to create a psychedelic experience in a bid to improve focus and creativity, boost mood, or quell anxiety.

[image:1 align:left caption:true]Microdosing has developed a laudatory literature -- see Ayelet Waldman's 2017 A Really Good Day: How Microdosing Made a Mega Difference in My Mood, My Marriage, and My Life and Michael Pollan's 2018 How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence -- but next to no serious scientific study.

Until now. In findings first presented at the June Beyond Psychedelics conference in Prague (and to be published as three separate research papers later this year), University of Toronto researchers offered fascinating insights into the how, why, and results of using small amounts of psychedelics for therapeutic effects.

In a research announcement, cognitive neuroscientist and study coauthor Thomas Anderson said his interest in the topic was sparked when reviewed the scientific literature and found plenty of anecdotal reports but a lack of scientific research on the practice.

"There's currently a renaissance going on in psychedelic research with pilot trials and promising studies of full-dose MDMA (ecstasy) use for post-traumatic stress disorder and of psilocybin use within healthy populations or to treat depression and end-of-life anxiety," said Anderson. "There hasn't been the same research focus on microdosing. We didn't have answers to the most basic epidemiological questions -- who is doing this and what are they doing?"

Anderson and a team of researchers decided to do something no one had done before: ask the users themselves about their experiences. The researchers identified microdosing communities on Reddit and other social media forums and sent them an anonymous online survey asking about the quantity and frequency of their psychedelic use, reasons for microdosing, effect on mood, focus and creativity, and the benefits and drawbacks of the practice. The survey generated 1.390 initial responses, with 909 respondents answering all questions. Two-thirds of the respondents were either current or past microdosers.

"We wanted to ensure the results produced a good basis for future psychedelic science," Anderson said.

What they found was that microdosers reported positive effects, including improved focus and productivity, better connection with others, and reductions in migraines. Quantitatively, microdosers scored lower than non-microdosers on scales measuring negative emotionality and dysfunctional attitude.

Microdosers did report some drawbacks to the practice, but those were related more to the illegal status of psychedelics than to the practice itself.

"The most prevalently reported drawback was not an outcome of microdosing, but instead dealt with illegality, stigma and substance unreliability," says Anderson. "Users engage in black market criminalized activities to obtain psychedelics. If you're buying what your dealer says is LSD, it could very well be something else."

The survey did help clarify the frequency of microdosing -- most respondents reported using every three days, while a smaller group did it once a week -- and just what constituted a microdose.

"Typical doses aren't well established," said Anderson. "We think it's about 10 mcg or one-tenth of an LSD tab, or 0.2 grams of dried mushrooms. Those amounts are close to what participants reported in our data."

But accurate dosing was another problem area: "With microdoses, there should be no 'trip' and no hallucinations. The idea is to enhance something about one's daily activities, but it can be very difficult to divide a ½-cm square of LSD blotting paper into 10 equal doses. The LSD might not be evenly distributed on the square and a microdoser could accidentally 'trip' by taking too much or not taking enough," Anderson said.

"The goal of the study was to create a foundation that could support future work in this area, so I'm really excited about what these results can offer future research," he explained. "The benefits and drawbacks data will help ensure we can ask meaningful questions about what participants are reporting. Our future research will involve running lab-based, randomized-control trials where psychedelics are administered in controlled environments. This will help us to better characterize the therapeutic and cognitive-enhancing effects of psychedelics in very small doses."

Eventually, the science will catch up to the practice. In the meantime, microdosers are going to microdose. Anderson has a scholarly caution for them: "We wouldn't suggest that people microdose, but if they are going to, they should use Erlich reagent (a drug testing solution) to ensure they are not getting something other than LSD."

This article was produced by Drug Reporter, a project of the Independent Media Institute.

Categories: Treatment

How to Prevent Opioid Overdoses? Provide Hard-Core Addicts Free Pharmaceutical Heroin

Thu, 07/19/2018 - 15:22

With Ohio beset by a massive public health crisis around opioid use and overdoses -- more than 4,000 Ohioans died of opioid overdoses in 2016 -- the Cleveland Plain Dealer sent travel editor Susan Glaser to Amsterdam in search of innovative approaches to the problem. While there, she rediscovered Holland's longstanding, radical, and highly-effective response to heroin addiction and properly asked whether it might be applied to good effect here.

[image:1 align:left]The difference in drug-related death rates between the two countries is staggering. In the US, the drug overdose death rate is 245 per million, nearly twice the rate of its nearest competitor, Sweden, which came in second with 124 per million. But in Holland, the number is a vanishingly small 11 per million. In other words, Americans are more than 20 times more likely to die of drug overdoses than Dutch.

For Plain Dealer readers, the figures that really hit home are the number of state overdose deaths compared to Holland. Ohio, with just under 12 million people, saw 4,050 drug overdose deaths in 2016; the Netherlands, with 17 million people, saw only 235.

What's the difference? The Dutch government provides free heroin to several score hardcore heroin addicts and has been doing so for the past 20 years. Public health experts there say that in addition to lowering crime rates and improving the quality of life for users, the program is one reason overdose death rates there are so low. And the model could be applied here, said Amsterdam heroin clinic operator Ellen van den Hoogen.

"It's been an enormous success. I think it would work elsewhere," she told Glaser.

It already has. The Dutch program was modeled on a similar effort in Switzerland, which has also proven successful. Germany and Canada are among the several other countries with similar programs.

The Dutch approach is an example of the country's policy of gedogen (pragmatic tolerance), the same principle that led the Dutch to pioneer quasi-legal access to marijuana in the 1980s. It is also rooted in the notion that, for some, drug addiction is a chronic disorder, not a condition to be "cured," and one that can be treated with supervised drug use under clinical supervision. And the complete cessation of drug use need not be the ultimate goal; rather, the Dutch look for reductions in criminal activity and increases in the health and well-being of the drug users.

"It's not a program that is meant to help you stop," acknowledged van den Hoogen. "It keeps you addicted."

That's not a sentiment sits well with American moralizers, such as George W. Bush's drug czar, John Walters, whom Glaser consulted for the story. He suggested that providing addicts with drugs was immoral and not "real treatment," but he also resorted to lies about what the Dutch are doing.

He claimed the Dutch are "keeping people addicted for the purpose of controlling them" and that the Dutch have created "a colony of state-supported, locked-up addicts."

Actually, the Dutch are dealing with older, hardcore addicts who have repeatedly failed to quit after repeated stints in treatment, including methadone maintenance therapy, and they are neither "controlling them" or locking them up. Instead, the people in the program show up at the clinic twice a day, get their fix, then go about their business. This heroin-assisted treatment (HAT) allows those hardcore users to live less chaotic and more productive lives.

And heroin-assisted treatment is "real treatment," said Peter Blanken, a senior researcher with the Parnassia Addiction Research Centre in Rotterdam. He pointed out that one-quarter of program participants make a "complete recovery," including better health and quitting illegal drugs and excessive drinking. Many others continue to use heroin, but do so with better outcomes, he said.

There is also a real safety benefit to using state-supplied pharmaceutical heroin. It's potent, but it's a known quantity. Users face no risk of adulteration with more dangerous drugs, such as fentanyl, which is deeply implicated in the current US overdose crisis.

In the current political atmosphere in the United States, providing heroin to hardcore addicts is a hard sell indeed. Other, lesser, harm reduction interventions, such as needle exchanges remain controversial, and the country has yet to see its first officially sanctioned safe injection site. And drug decriminalization, which has led to a dramatic reduction in heroin addiction and overdose deaths in Portugal, remains off the table here, too. But with an annual drug overdose death toll of more than 50,000 people a year, it may time to start asking how many more Americans we are willing to sacrifice on the altar of moralistic drug prohibition.

Categories: Treatment

Advocates Claim "Overdose Prevention" Bill Would Drive People Out of Treatment and Increase Overdoses [FEATURE]

Wed, 07/11/2018 - 20:35

A bill ostensibly aimed at reducing opioid overdoses passed the House last month, but rather than cheering it on, drug treatment and recovery advocates are lining up to block it in the Senate. That's because instead of being aimed at reducing overdoses, the bill is actually a means of removing patient privacy protections from some of the most vulnerable people with opioid problems, including people using methadone-assisted therapy to control their addictions.

[image:1 align:left caption:true]And that, advocates say, is likely to increase -- not decrease -- opioid overdoses by pushing users away from drug treatment out of fear the information they reveal could be used against them. The fear is real: Unlike other medical conditions, drug addiction leaves patients open to criminal prosecution, as well as stigmatization and other negative social consequences if their status as drug treatment or maintenance patients is revealed.

This bill, H.R. 6082, the Overdose Prevention and Patient Safety Act, would remove drug treatment patients' ability to control the disclosure of information to health plans, health care providers, and other entities, leaving them with only the lesser privacy protections afforded to all patients under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

"The confidentiality law is often the only shield between an individual in recovery and the many forms of discrimination that could irreparably damage their lives and future," said Paul Samuels, President/Director of the Legal Action Center. "Unfortunately, there is a very real danger of serious negative consequences for people whose history of substance use disorder is disclosed without their explicit consent."

The Legal Action Center is spearheading the effort to block this bill with the Campaign to Protect Patients' Privacy Rights, which counts more than a hundred organizations, including the American Association for the Treatment of Opioid Dependence, AIDS United, Community Catalyst, Faces and Voices of Recovery, Facing Addiction, Harm Reduction Coalition, National Advocates for Pregnant Women, National Alliance for Medication Assisted Recovery and the, National Council on Alcoholism and Drug Dependence.

The current patient privacy protections, known as 42 C.F.R. Part 2 ("Part 2"), were established more than 40 years ago to ensure that people with a substance use disorder are not made more vulnerable to discriminatory practices and legal consequences as a result of seeking treatment. The rules prevent treatment providers from disclosing information about a patient's substance use treatment without patient consent in most circumstances. The bill's plan to replace Part 2's confidentiality requirements with HIPAA's more relaxed standards would not sufficiently protect people seeking and receiving SUD treatment and could expose patients to great harm, the advocates charge.

"They should call this the Taking Away Protections Act," said Jocelyn Woods, head of the National Alliance for Medication-Assisted Recovery. "People will be afraid to go into treatment. I'm getting emails from people who want to leave treatment before this happens. If I were going into a program and they can't tell me my information will be safe, I would think about turning around and walking out," she said.

"Many of us would not have gone to treatment or accepted services if we thought that our information would have been shared with other entities without our permission. We would not have put our careers, reputation or families at risk of stigma and discrimination if we were not assured that information about our substance use disorder was safe and would only be shared with our consent," added Patty McCarthy Metcalf, executive director of Faces and Voices of Recovery.

The push for the bill is being led by health information software companies and behavioral health providers, such as Hazelden and the Betty Ford Center, and it prioritizes convenience over patient privacy.

[image:2 align:right]"This is because the behavioral health people see complying with the privacy requirements as a pain in the ass," said Woods. "They're going to have to fix their computer systems to block out any treatment program licensed by the federal government -- not just methadone programs -- and they don't want to do that. One of the software companies, Netsmart, complained that they don't want to mess with their programming," she said.

"We need Part 2," Woods continued. "It keeps police out of the program. Without it, police can walk right in. They already sit outside methadone clinics and bust people for DUI on the way out. If this passes, they will walk right in. If the police see anyone they think has a warrant or committed a crime, they're gone."

While the bill has made its way through the House, advocates are hopeful it will stall in the Senate.

"The House pushed this through because they wanted to look like they were doing something and because the behavioral health people were pushing for it," Woods said, "but my sense is that it's moving slowly in the Senate. We have this crazy president, and there's immigration, and the congressional break, and then campaign season. My hope is we can push this past the elections and a blue wave in November will give us a fighting chance."

But the campaign isn't taking any chances and is mobilized to fight on the Hill in the next few months to block the bill. As Mark Parrino, President of the American Association for the Treatment of Opioid Dependence warned: "In the midst of the worst opioid epidemic in our nation's history, we cannot afford to have patients fearful of seeking treatment because they do not have faith that their confidentiality will be protected."

Categories: Treatment

Can Magic Mushrooms Treat Cocaine Dependency?

Fri, 07/06/2018 - 03:27

The hunt for a pharmacological agent to help people strung out on cocaine get off the marching powder has been a long one, and non-traditional types of treatments are among the possibilities being studied. Ibogaine is one pharmacological therapy being studied. Another is href="https://www.uab.edu/news/research/item/9565-study-can-taking-a-hallucinogen-curb-cocaine-use" target=_blank_>psilocybin, the chemical that puts the magic in magic mushrooms.

[image:1 align:left]Scientists at the University of Alabama-Birmingham's (UAB) School of Public Health are now conducting a clinical trial to see whether psilocybin can help break cocaine addiction.

The trial currently has almost 20 people enrolled, but researchers are looking for more subjects -- people who are currently using cocaine and have a strong desire to quit.

"Our goal is to create a tool or drug that provides significantly better outcomes for individuals addicted to cocaine than those that currently exist," said Sara Lappan, Ph.D., a postdoctoral scholar in the Department of Health Behavior

In the trial, participants receive a dose of psilocybin and are monitored for six hours, about the duration of the experience. Then, the researchers track his or her cocaine use.

"Our idea is that six hours of being under the effects of psilocybin may be as productive as 10 years of traditional therapy," Lappan said.

The researchers theorize that psilocybin works on three levels: the biochemical, the psychological, and the spiritual. In terms of biochemistry, psilocybin disrupts brain receptors thought to reinforce addictive behaviors. Psychologically, the drug is believed to reduce cravings, increase motivation, and increase one's sense of self-efficacy. Spiritually -- or transcendentally -- psilocybin (along with other psychedelics) is thought to increase both a person's sense of purpose and his or her sense of universal connectedness or oneness.

"If our hypotheses are supported, this has the potential to revolutionize the fields of psychology and psychiatry in terms of how we treat addiction," Lappan said.

But don't run out and start gobbling down magic mushrooms to quit cocaine just yet, the researchers cautioned.

"We aren't advocating for everyone to go out and do it," said Peter Hendricks, Ph.D., associate professor of health behavior in the School of Public Health at UAB. "What we are saying is that this drug, like every other drug, could have appropriate use in a medical setting. We want to see whether it helps treat cocaine use disorder."

They're not the only ones looking into the secrets of psilocybin. UAB is one of a half-dozen universities studying its potential medicinal benefits. The others are Johns Hopkins University, Imperial College London, New York University, University of California-San Francisco and Yale.

This article was produced by Drug Reporter, a project of the Independent Media Institute.

Categories: Treatment