Opinion – Psychedelic Turn: National psychedelic science reaches even palliative care

The flood of scientific articles on psychedelics — more than 3,000 papers published from 2016 to 2021 — has just been expanded with four items originating in Brazil, the third country in number of impact studies in this area. Good news for people with serious illnesses, the elderly, the depressed, the smokers and the anxious.

The main news came in the Journal of Pain and Symptom Management, a pioneering article on psychedelics in the journal dedicated to palliative care. This is a systematic review entitled “The Potential of Psychedelic-Assisted Therapies for Symptom Control in Patients Diagnosed with Serious Illnesses”.

The review arose from a partnership between Ana Cláudia Mesquita Garcia, a nurse and professor at the Federal University of Alfenas (MG), with Lucas Oliveira Maia, a biologist at Icaro (Interdisciplinary Cooperation for Ayahuasca Research and Outreach, something like Interdisciplinary Cooperation for Ayahuasca Research and Outreach). Ayahuasca Research and Diffusion), from Unicamp.

Systematic reviews exhaustively survey what has been published in established journals on a given topic. In this case, the use of psychedelics to alleviate physical and mental suffering of patients with serious illness.

From an initial sample of 65 articles, applied quality and uniformity filters reduced it to 20, encompassing a total of 640 participants in studies published from 1964 to 2021. Most (75%) people diagnosed with cancer.

More than half of the studies involved LSD and were done in the 1960s/70s, a trend aborted with the ban on the substance at the beginning of the War on Drugs (1971). A total of 347 people treated with LSD entered the survey, generally with good results in reducing symptoms such as anxiety and depression in the face of death.

This type of research on seriously ill patients was only resumed at the turn of the 20th to the 21st century, at Johns Hopkins University. In the new wave, the psychedelic investigated was psilocybin, which causes shorter “trips” (4-6h) than LSD (6-12h) and is less likely to trigger negative experiences, such as panic attacks.

Overall, these studies indicated the absence of serious adverse effects, physical or mental, all of mild or moderate intensity and transient.

“While our study confirms the therapeutic potential and extends it to physical symptoms (eg cancer pain) and other forms of psychiatric or psychological distress (eg anxiety, depression and adjustment disorders), it also underscores the importance conditions under which treatment is provided to ensure safety,” the authors write.

“Psychedelic-assisted therapies need to include careful considerations related to screening, preparation, dosing and appropriate integration sessions, according to evidence-based protocols.” That is, more studies are needed to detail such protocols, but the potential of psychedelics in palliative care is promising.

Lucas Maia, 34, is also a co-author in two other of the four studies on screen. One investigated LSD’s impacts on participants’ cognitive performance one day after ingestion. The other focused on people who attribute the ayahuasca effect to having given up smoking.

“This varied and multidisciplinary training is part of me”, says the researcher born in Goiás, who is now studying psychology to become a therapist. “I was accumulating knowledge in several areas: animal models, pharmacology, qualitative research, clinical experiments with psychedelics.”

Maia has a special predilection for the area of ​​palliative care. In 2020, she took a six-month course to train “death doulas”, professionals specialized in accompanying and supporting people at the end of life, as well as their families.

“We don’t talk and don’t think about death”, laments the researcher. He attributes his serene attitude in the face of the inevitable to his interest in yoga and Buddhism, “which have another way of looking at death and caring for it.”

LSD was going to be his doctoral topic, but it soon became evident that the scope of the project under the guidance of psychiatrist Luís Fernando Tófoli, from Unicamp, would not fit in the two years he still had to carry out the thesis defense. The project that I had begun to design was passed on to Isabel Wießner, from whom three articles on lysergic acid already commented on this blog (here, here and here, for example) came out.

The fourth and final one now appears in the European Neuropsychopharmacology journal under the title “LSD, afterglow and hangover: Increased Episodic Memory and Verbal Fluency, Decreased Cognitive Flexibility”. cognitive impairment), and brings Maia among the authors.

As described before in the blog, the study behind the four works applied several tests to 24 healthy volunteers in two sessions separated by two weeks, one with LSD and one with placebo. Participants didn’t know which day they took what (although it was easy for them to guess), nor did the researchers who administered the tests over the course of ten hours.

The next morning, new tests involved memory games, playing drawings, guessing logical sequences, and issuing a series of associated words at specified intervals of time. The idea was to verify whether LSD exerted any residual positive (“afterglow”) or negative (“hangover”) effects on different cognitive abilities.

Already out of the acute effect of LSD after a night’s sleep, participants produced mixed results. On the one hand, they did better in memory games and verbal series. On the other hand, they tended to insist more on guesswork errors in the post-LSD morning.

“The results are interesting for the clinic and the development of new treatments with these substances for several clinical conditions that have been neglected until now, such as in patients with dementia, stroke or simply regular cognitive losses during aging”, evaluates Wießner.

The results, says the German researcher, do not directly indicate that LSD is useful for these groups, since the sample investigated was healthy and relatively young (average of 35 years). What is important, for her, is that the article indicates possible improvements in several unrelated cognitive aspects, such as memory and verbal fluency, which depend on different brain areas and are still detectable 24 hours after a single, low dose.

Improved memory consolidation after psychedelics had previously been shown in rats, but the study by Wießner, Maia and colleagues was the first to show detectable improvements in humans. “The results suggest a therapeutic potential that may remain after acute use and point to a new avenue of investigation in clinical areas previously not associated with psychedelic treatments”, says the psychologist, as in the case of old age.

In addition, the group also detected a decrease in cognitive flexibility, a unique result in the literature, revealing that the loss during acute effects (shown in previous studies) remains until the next day. A problem for activities, the day after consumption of a psychedelic, that demand monitoring of one’s own performance and continuous adaptation to new conditions.

“It should be considered, for example, the recommendation of a day of rest after recreational use, or in therapy, without jobs that require high cognitive performance.” Don’t even think about taking acid one day and going to work as an air traffic controller the next, for example.

The third and final article of the recent series with the participation of Lucas Maia also has a relationship with the Icaro group, from Unicamp. “Ayahuasca and Interruption of Tobacco Use: Results of an Online Survey in Brazil”, published in the journal Psychopharmacology.

Maia was one of the supervisors of this research by student Carolina Marcolino Massarenti, carried out through the computer network with 441 people who had stopped smoking and attributed the feat to the use of ayahuasca.

More than 6 million patients die each year worldwide from smoking-related diseases. In Brazil, there are 150,000 deaths, which cost the health system more than R$ 60 million, according to the article.

The idea was to replicate a similar study from Johns Hopkins University, which used psilocybin, not ayahuasca. In the Brazilian case, it was found that the conditions most associated with success in quitting smoking were the intensity of mystical experiences under the influence of the substance and its frequent use (many participants were practitioners of ayahuasca religions such as Santo Daime, Barquinha and União do Vegetal).

On the other hand, those who reported positive mood during the psychedelic ayahuasca experience were among those who had the most relapses and the most difficulty quitting. “It is difficult to interpret this data, we need other studies”, says Maia.

A possible interpretation would be in line with the belief, among ayahuasqueiros, that stormy experiences under the influence of the substance (which they call “peia”, beating), as well as occasional vomiting or diarrhea, are an inseparable part of the self-knowledge provided by the “teacher plant” . That is, to get to the roots of problems, such as addiction, the journey is not usually easy.

Finally, the fourth Brazilian article of the recent harvest is the only one that has no relation with either Maia or Icaro. “Effects of Ayahuasca on the Endocannabinoid System in Healthy Volunteers and Volunteers with Social Anxiety Disorder: Results of Two Pilot, Proof-of-Concept, Randomized, Placebo-Controlled Trials,” which appeared in the journal Human Psychopharmacology.

In this case, the team is based in another center with extensive experience in the study of ayahuasca, that of psychiatrist Jaime Hallak at USP in Ribeirão Preto.

In focus were substances produced in the brain that are closely related to components of marijuana and are therefore called endocannabinoids. Levels of the endocannabinoid anandamide were measured in healthy volunteers and in patients with social anxiety disorder (SAD).

It was already known that serotonergic psychedelics, such as DMT from ayahuasca, which act on the receptors for the neurotransmitter serotonin (5HT2a), interact with the endocannabinoid system. By testing this interaction in healthy people and others with SAD, the group found that the latter had increased anandamide.

The first author is Rafael Guimarães dos Santos, who explained to the blog the relevance of the study: “There is preclinical evidence that 5HT2a agonists, including hallucinogens, modulate the endocannabinoid system, and this system is associated with the control of anxiety. possible human interaction had never been tested”.

Despite the regrets, Brazilian psychedelic science is moving – and moving forward.

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To learn more about the history and new developments of science in this area, including in Brazil, look for my book “Psiconautas – Travels with Brazilian Psychedelic Science”