Opinion – Normalitas: Spain advances in the therapeutic study of psychedelics

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Opinion – Normalitas: Spain advances in the therapeutic study of psychedelics

A few years ago it would have sounded like a spin off of Fear and Loathing in Las Vegas, a creizidelic saga directed by the genius Terry Gilliam.

But since August 2022, the Spanish Society of Psychedelic Medicine (SEMPsi) is a reality — and a clear sign that the revolution, or “psychedelic renaissance,” as it’s been called, is at hand.

Currently, in Europe, only the Netherlands and Austria allow the controlled use of psychoactive substances in a clinical context.

Neighboring countries such as Spain, however, begin to consistently advance in related studies from 2023 onwards.

This year, several hospitals and scientific centers in the country will start or expand phase 3 clinical trials, the last phase before the commercial approval of a new medicine.

These are randomized studies, generally multicentric (that is, taking place simultaneously in several institutions), and involve a substantial number of patients.

Most investigations focus on psilocybin and 5-Meo-DMT for cases of severe depression (resistant to conventional treatments) and MDMA (aka ecstasy) for post-traumatic stress, as has already been happening in the USA, a pioneer in the subject.

As the psychiatrist Óscar Soto Angona, president of SEMPsi, explained to La Vanguardia, “the objective [da recém-criada entidade] is to disseminate truthful information, based on scientific evidence, about the therapeutic use of psychedelics, and to establish clinical guidelines, codes of ethics and good practices for the application of these treatments in the health area”.

Angona knows what he’s talking about. A member of the resistant depression program and an investigator at the Vall d’Hebron model hospital in Barcelona, ​​she has participated in several related clinical trials.

“By 2028 or sooner,” he estimates, “we could see the approval of MDMA and psilocybin along with assisted therapy.”

The star of the new psychedelics administered in microdoses is undoubtedly psilocybin, extracted from fungi of the genus psilocybe.

First isolated by the mythical Swiss chemist Albert Hofmann in the late 1950s, this alkaloid has experienced a clinical-scientific revival since at least the 2000s.

THE frisson around the substance goes far beyond loka trips with “magic mushrooms” harvested from cow dung in intergalactic mountains.

In addition to promising results in cases of resistant depression, psilocybin has been studied in different countries as an auxiliary protocol in anorexia, OCD, anxiety and even addictions such as smoking or alcoholism.

At the same time, non-profit initiatives such as ICEERS, with branches in Spain and the Netherlands, have been studying the potential therapeutic benefits of other psychoactive substances such as iboga (an African bush from which ibogaine is extracted, used, for example, in cases of detoxification from methadone) and ahayuasca.

“Lysergic acid (LSD) is also being studied, but there are few ongoing trials because its mechanism of action is very similar to that of psilocybin and is more complex. Even so, there are very preliminary studies of LSD for fibromyalgia, Alzheimer’s or pain chronicle,” observes Soto.

The specialist, like other referents in the area, stresses that the results are encouraging and that “these substances are not additive in the clinical or therapeutic scope”, but that it is necessary to carry out an educational work so that the general public and patients understand risks and benefits in each case.

“These are substances (…) that require an adequate environment and controlled psychotherapeutic follow-up”, warns another of Soto’s colleagues, Santiago Madero, a psychiatrist at the Hospital Clinic in Barcelona. Furthermore, not everyone would be ideal candidates: microdoses are, in principle, contraindicated in patients with psychotic and bipolar disorders, for example.

If approved, MDMA and psilocybin will not be the first psychedelics to be used therapeutically in Spain: since November 2022, for example, hospitals can prescribe esketamine, an anesthetic for nasal application derived from ketamine (also known as ketamine), already legalized in the United States since 2019 as a complementary protocol in severe depressive disorders.

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Around the world, the therapeutic use of psychedelics is nothing new — even 6,000-year-old cave paintings attest to the presence of fungi psilocybe in the Iberian Peninsula –, but the gradual return of its acceptance in the scientific/research and clinical environment after the great boom of the 1950s and 60s and consequent ostracism in the following decades, yes.

Since then, in recent years, renowned clinical research centers such as John Hopkins, in the United States, and Imperial College, in London, have presented studies that, today, are references in the area.

There is a long way to go, however, that transcends the issue of scientific validation, and that is related to a paradigm shift — social and clinical — around psychedelic therapies.

“I believe that Spanish psychiatrists in general are not prepared to prescribe this type of therapy, considering it outlawed or ‘alternative’, as there are many prejudices in this regard. underground psychedelic therapies are carried out in our country”, says Helen Dolengevich, psychiatrist at the Henares hospital in Madrid, and author of the book New Psychoactive Drugs.

Studies, dialogue and information are, without a doubt, essential to dispel myths and prevent the inappropriate use of active principles that, as much as curatives, can have negative effects if used without guidance or out of context.

It is also necessary to regulate the market to minimize the risk that certain psychoactive substances are commercially exploited with false promises of miracles.

On my social media feed, for example, for some time now, advertisements have popped up here and there from companies selling “packs” of microdoses as if they were “chuches” (candy, in Spanish), that is, with the same ease with which I could buy panties on sale online.

As Marcelo Leite always points out in his column Virada Psychedélica, in Folha, it is important to remember that the therapeutic use of psychedelics is still under study and must be adopted under medical decision and supervision.

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