In the Seattle lecture hall, where experts brainstorm the future of psychedelic research

The Mental Health Project is a Seattle Times initiative that focuses on treating mental and behavioral health problems. It is funded by Ballmer Group, a national organization that focuses on economic mobility for children and families. The Seattle Times retains editorial control over this team’s work.

About 65 scientists, doctors, advocacy groups and even a few farmers arrived at a glassy medical building in South Lake Union on a recent morning. They gathered in a lecture room, coffee in hand, to discuss the next frontier for the treatment of substance use disorders and addiction: psychedelics.

The meeting of minds came at the right time for several reasons. In less than nine months, Oregon’s nascent psilocybin industry can begin licensing the production, transportation, and sale of the psychedelics derived from certain mushrooms for use in supervised therapy. And in October, Seattle became the nation’s largest city to decriminalize psilocybin.

And there was an official reason for the meeting: The Washington Public University flagship is creating a new research center dedicated to the use of psychedelics to treat addiction. The South Lake Union meeting marked the center’s launch. Psychedelics are gaining ground as a therapy for treatment-resistant depression; in November, the largest-ever study on psilocybin and depression found the drug to be highly effective. But its potential use against substance use disorders is less well understood.

dr. Jürgen Unützer, chair of the department of psychiatry and behavioral sciences at the University of Washington School of Medicine, started the morning with a reflection on the importance of serious research into alternative remedies for substance use disorders — especially those refractory to standard treatment.

Why not try something different? Why not try something that could? to change your mind† Psychedelics have received “a lot of heat,” he said, but “not much light.”

dr. Nathan Sackett, an addiction psychiatrist and the main reason everyone had gathered, then took the stage. He joked about dressing up because he was wearing a suit—after all, he’s the one running UW’s new addiction research center—then threw himself into his pitch.

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The death rate from addiction exceeds all cancer deaths five times, he said — and think about the money spent on cancer research, treatments and prevention. What a contrast to the lack of resources targeting behaviors linked to cancer and death in general, he added, such as alcohol and tobacco use.

“Imagine if we had a health care system focused on prevention, early detection, aggressive treatments, and long-term monitoring of addiction in the same way we’re used to with cancer?”

A growing body of promising research suggests a way forward: Treatment that has historically been “driven to the fringe” — psychedelics, used in conjunction with psychotherapy — could be used as a drug against abuse of alcohol, tobacco and even opiates, Sackett continued.

“I will never forget the description of a very memorable patient, who described to me the first time he injected heroin as falling into a pool full of puppies,” he said. “For others, substance use is initially a seemingly rational choice; a means of urgently sought pleasure for a temporary relief from suffering, or a response to trauma or curiosity. And for most, the syndrome is characterized by a mixture of the two extremes.”

No matter how the path begins, he said, the end is often severe pain.

As a physician, Sackett increasingly felt that the available therapies and drugs were not sufficient to make changes at a pace that was beneficial to patients. His interest in psychedelics – a powerful way for people to experience new emotions and see their lives and purpose through a new lens – grew.

But starting a new center dedicated to using psychedelics as addiction treatment?

“I was told it was politically dangerous. It can backfire. It was too controversial… And trust me, for any reason you can give me as to why this could fail, I can give you five more,” he joked as the crowd, many kind to his argument, laughed.

“But I also believe that we are at a crucial crossroads,” he said. “Psychedelic-assisted psychotherapy is here to stay, and people are doing it whether we study it or not.”

Sacket is right. All over the Pacific Northwest and elsewhere, ketamine clinics are popping up as part of what’s commonly referred to as a “psychedelic revolution” in mental health. Last year, an article in The New York Times described psilocybin and MDMA as the “hottest new therapies since Prozac.” “Universities want in, and so does Wall Street,” the story read. And then a warning: “Some worry that a push to ease access could have unintended consequences.”

People who self-administer magic mushrooms or guide others in the use of psychedelics, do so largely underground. And there is limited data to support how psychedelics can or should be used to treat various substance use disorders.

In UW’s new research center, Sackett imagines, researchers will ask questions such as: Which psychedelics are best suited to which behavioral therapy and what type of patients might benefit from treatment? The first studies will use animals. Ultimately, Sackett hopes, the center will help launch clinical trials at multiple treatment sites.

For starters, he asked the crowd to help him brainstorm into smaller discussion groups — the new center needs help coming up with potential research projects.

In one room, about two dozen people sat in a semicircle to discuss how ketamine could be used to treat substance use disorders. Perhaps an observational study, someone suggests, based on the experiences of people already running ketamine clinics? A man who says he runs such a clinic likes the idea, but says all the red tape associated with research can be a burden to practitioners.

One of the group’s moderators, a clinical social worker named Ian Pocock, mentions a tension that becomes more apparent over the course of the morning.

“There is a huge knowledge gap between people with a research background and people with a clinical background. The language is different, the motives are different.”

In another session, however, a familiar face brings a sense of excitement into the conversation.

On a huge screen, Paul Stamets, a mycologist and celebrity in the psychedelics community who co-sponsored the event, appears on Zoom to talk with people personally about the path to legalization of various psychedelics, especially psilocybin. He is wary of the recent relaxation of the laws on psychedelics, suggesting that “we don’t close ourselves in on anything” that won’t allow for later modification, especially as the science of psychedelics is evolving rapidly. In particular, he criticized the new Oregon law, voicing concerns that it leaves no room for people to microdose.

“We have an extraordinary opportunity with probably multiple delivery platforms, and we shouldn’t be stifling innovation,” he added.

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