Sounds Good to Me

When you read the heart-wrenching stories of how people with epilepsy, migraines, and other debilitating illnesses receive comfort and relief from cannabis, you wonder how our governor, our legislature and our church can be against it.

Medical marijuana

DJ Schanz, director of the Utah Patients Coalition, estimated that his group gathered nearly 200,000 signatures to put legalizing medical marijuana on the ballot.

Support found by signature gatherers “parallels the support shown in the polls: about 75 percent support us, and 25 percent do not.”

Since then, the Utah Medical Association opposed the initiative and The Church of Jesus Christ of Latter-day Saints praised the UMA’s stance without quite directly opposing the initiative itself. Herbert also has come out against the initiative.

Schanz said in response Monday that the UMA “doesn’t represent the majority of Utah doctors much less the LDS Church” members, and added “we are moving full steam ahead.”

The Legislature sought to offer a compromise to stop the initiative. It passed laws allowing terminally ill patients to try medical marijuana and for the state to arrange growing it for them. Supporters said that is far too little to satisfy them, and leaves out many people whose pain and suffering could be eased by using cannabis.

A panel started writing the rules for a new medical marijuana law by listening to suggestions from people like Mark Newman, who travels to Nevada every few months and spends up to $1,000 to buy marijuana that he uses to treat his migraines.

“I was sick and tired of taking opioids,” Newman said Thursday. “You just keep taking them and taking them and taking them. Then all the sudden you forget how many you’ve taken.”

Where’s our empathy?

Then I listened to a podcast with Doug Fabrizio and Michael Pollan, author, journalist, professor (incidently, his sister, Tracy, is married to Michael J. Fox). He’s also a gardener and writes about the benefits of living close to the soil—human engagement with the natural world.  About three years ago, he got interested in psychedelic drugs to relieve depression, fear, and anxiety in terminal cancer patients.  It’s still about plants. Psilocybin comes from mushrooms. Controlled tests show that patients were happier, more content, less depressed and fearful of death after participating in the study. It gives me immense comfort.  So much better than being drugged to death as you approach death.

The Trip Treatment

Research into psychedelics, shut down for decades, is now yielding exciting results.

By  Michael Pollan (Excerpts from an article in The New Yorker, February 9, 2015.)

Psilocybin may be useful in treating anxiety, addiction, and depression, and in studying the neurobiology of mystical experience.

Illustration by Stephen Doyle

On an April Monday in 2010, Patrick Mettes, a fifty-four-year-old television news director being treated for a cancer of the bile ducts, read an article on the front page of the Times that would change his death. His diagnosis had come three years earlier, shortly after his wife, Lisa, noticed that the whites of his eyes had turned yellow. By 2010, the cancer had spread to Patrick’s lungs and he was buckling under the weight of a debilitating chemotherapy regimen and the growing fear that he might not survive. The article, headlined “hallucinogens have doctors tuning in again,” mentioned clinical trials at several universities, including N.Y.U., in which psilocybin—the active ingredient in so-called magic mushrooms—was being administered to cancer patients in an effort to relieve their anxiety and “existential distress.” One of the researchers was quoted as saying that, under the influence of the hallucinogen, “individuals transcend their primary identification with their bodies and experience ego-free states . . . and return with a new perspective and profound acceptance.” Patrick had never taken a psychedelic drug, but he immediately wanted to volunteer. Lisa was against the idea. “I didn’t want there to be an easy way out,” she recently told me. “I wanted him to fight.”

Patrick made the call anyway and, after filling out some forms and answering a long list of questions, was accepted into the trial. Since hallucinogens can sometimes bring to the surface latent psychological problems, researchers try to weed out volunteers at high risk by asking questions about drug use and whether there is a family history of schizophrenia or bipolar disorder. After the screening, Mettes was assigned to a therapist named Anthony Bossis, a bearded, bearish psychologist in his mid-fifties, with a specialty in palliative care.

After four meetings with Bossis, Mettes was scheduled for two dosings—one of them an “active” placebo (in this case, a high dose of niacin, which can produce a tingling sensation), and the other a pill containing the psilocybin. Both sessions, Mettes was told, would take place in a room decorated to look more like a living room than like a medical office, with a comfortable couch, landscape paintings on the wall, and, on the shelves, books of art and mythology, along with various aboriginal and spiritual tchotchkes, including a Buddha and a glazed ceramic mushroom. During each session, which would last the better part of a day, Mettes would lie on the couch wearing an eye mask and listening through headphones to a carefully curated playlist—Brian Eno, Philip Glass, Pat Metheny, Ravi Shankar. Bossis and a second therapist would be there throughout, saying little but being available to help should he run into any trouble.

The effects of psilocybin resemble those of LSD, but, as one researcher explained, “it carries none of the political and cultural baggage of those three letters.” LSD is also stronger and longer-lasting in its effects, and is considered more likely to produce adverse reactions. Researchers are using or planning to use psilocybin not only to treat anxiety, addiction (to smoking and alcohol), and depression but also to study the neurobiology of mystical experience, which the drug, at high doses, can reliably occasion.

As I chatted with Tony Bossis and Stephen Ross in the treatment room at N.Y.U., their excitement about the results was evident. According to Ross, cancer patients receiving just a single dose of psilocybin experienced immediate and dramatic reductions in anxiety and depression, improvements that were sustained for at least six months.

 “I thought the first ten or twenty people were plants—that they must be faking it,” Ross told me. “They were saying things like ‘I understand love is the most powerful force on the planet,’ or ‘I had an encounter with my cancer, this black cloud of smoke.’ People who had been palpably scared of death—they lost their fear. The fact that a drug given once can have such an effect for so long is an unprecedented finding. We have never had anything like it in the psychiatric field.”

Many researchers I spoke with described their findings with excitement, some using words like “mind-blowing.” Bossis said, “People don’t realize how few tools we have in psychiatry to address existential distress. Xanax isn’t the answer. So how can we not explore this, if it can recalibrate how we die?”

The idea of giving a psychedelic drug to the dying was conceived by a novelist: Aldous Huxley. In 1953, Humphry Osmond, an English psychiatrist, introduced Huxley to mescaline, an experience he chronicled in “The Doors of Perception,” in 1954. (Osmond coined the word “psychedelic,” which means “mind-manifesting,” in a 1957 letter to Huxley.) Huxley proposed a research project involving the “administration of LSD to terminal cancer cases, in the hope that it would make dying a more spiritual, less strictly physiological process.” Huxley had his wife inject him with the drug on his deathbed; he died at sixty-nine, of laryngeal cancer, on November 22, 1963.

The recreational use of psychedelics is famously associated with instances of psychosis, flashback, and suicide. But these adverse effects have not surfaced in the trials of drugs at N.Y.U. and Johns Hopkins. After nearly five hundred administrations of psilocybin, the researchers have reported no serious negative effects. This is perhaps less surprising than it sounds, since volunteers are self-selected, carefully screened and prepared for the experience, and are then guided through it by therapists well trained to manage the episodes of fear and anxiety that many volunteers do report. Apart from the molecules involved, a psychedelic therapy session and a recreational psychedelic experience have very little in common.

 “Ineffability” is a hallmark of the mystical experience. Many struggle to describe the bizarre events going on in their minds during a guided psychedelic journey without sounding like either a New Age guru or a lunatic. The available vocabulary isn’t always up to the task of recounting an experience that seemingly can take someone out of body, across vast stretches of time and space, and include face-to-face encounters with divinities and demons and previews of their own death.

Volunteers in the N.Y.U. psilocybin trial were required to write a narrative of their experience soon after the treatment, and Patrick Mettes, having worked in journalism, took the assignment seriously. His wife, Lisa, said that, after his Friday session, he worked all weekend to make sense of the experience and write it down.

When Mettes arrived at the treatment room, at First Avenue and Twenty-fifth Street, Tony Bossis and Krystallia Kalliontzi, his guides, greeted him, reviewed the day’s plan, and, at 9 a.m., presented him with a small chalice containing the pill. None of them knew whether it contained psilocybin or the placebo. Asked to state his intention, Mettes said that he wanted to learn to cope better with the anxiety and the fear that he felt about his cancer. As the researchers had suggested, he’d brought a few photographs along—of Lisa and him on their wedding day, and of their dog, Arlo—and placed them around the room.

At nine-thirty, Mettes lay down on the couch, put on the headphones and eye mask, and fell silent. In his account, he likened the start of the journey to the launch of a space shuttle, “a physically violent and rather clunky liftoff which eventually gave way to the blissful serenity of weightlessness.”

The “same force that takes you deep within will, of its own impetus, return you safely to the everyday world,” the manual offers at one point. Guides are instructed to remind subjects that they’ll never be left alone and not to worry about their bodies while journeying, since the guides will keep an eye on them. If you feel like you’re “dying, melting, dissolving, exploding, going crazy etc.—go ahead,” embrace it: “Climb staircases, open doors, explore paths, fly over landscapes.” And if you confront anything frightening, “look the monster in the eye and move towards it. . . . Dig in your heels; ask, ‘What are you doing in my mind?’ Or, ‘What can I learn from you?’ Look for the darkest corner in the basement, and shine your light there.” This training may help explain why the darker experiences that sometimes accompany the recreational use of psychedelics have not surfaced in the N.Y.U. and Hopkins trials.

Early on, Mettes encountered his brother’s wife, Ruth, who died of cancer more than twenty years earlier, at forty-three. Ruth “acted as my tour guide,” he wrote, and “didn’t seem surprised to see me. She ‘wore’ her translucent body so I would know her.” Michelle Obama made an appearance. “The considerable feminine energy all around me made clear the idea that a mother, any mother, regardless of her shortcomings . . . could never not love her offspring. This was very powerful. I know I was crying.” He felt as if he were coming out of the womb, “being birthed again.”

Bossis noted that Mettes was crying and breathing heavily. Mettes said, “Birth and death is a lot of work,” and appeared to be convulsing. Then he reached out and clutched Kalliontzi’s hand while pulling his knees up and pushing, as if he were delivering a baby.

“Oh God,” he said, “it all makes sense now, so simple and beautiful.”

Around noon, Mettes asked to take a break. “It was getting too intense,” he wrote. They helped him to the bathroom. “Even the germs were beautiful, as was everything in our world and universe.” Afterward, he was reluctant to “go back in.” He wrote, “The work was considerable but I loved the sense of adventure.” He put on his eye mask and headphones and lay back down.

“From here on, love was the only consideration. It was and is the only purpose. Love seemed to emanate from a single point of light. And it vibrated.” He wrote that “no sensation, no image of beauty, nothing during my time on earth has felt as pure and joyful and glorious as the height of this journey.”

Then, at twelve-ten, he said something that Bossis jotted down: “O.K., we can all punch out now. I get it.”

He went on to take a tour of his lungs, where he “saw two spots.” They were “no big deal.” Mettes recalled, “I was being told (without words) not to worry about the cancer . . . it’s minor in the scheme of things . . . simply an imperfection of your humanity.”

Then he experienced what he called “a brief death.”

“I approached what appeared to be a very sharp, pointed piece of stainless steel. It had a razor blade quality to it. I continued up to the apex of this shiny metal object and as I arrived, I had a choice, to look or not look, over the edge and into the infinite abyss.” He stared into “the vastness of the universe,” hesitant but not frightened. “I wanted to go all in but felt that if I did, I would possibly leave my body permanently,” he wrote. But he “knew there was much more for me here.” Telling his guides about his choice, he explained that he was “not ready to jump off and leave Lisa.”

Around 3 p.m., it was over. “The transition from a state where I had no sense of time or space to the relative dullness of now, happened quickly. I had a headache.”

When Lisa arrived to take him home, Patrick “looked like he had run a race,” she recalled. “The color in his face was not good, he looked tired and sweaty, but he was fired up.” He told her he had touched the face of God.

Every guided psychedelic journey is different, but a few themes seem to recur. Several of the cancer patients I interviewed at N.Y.U. and Hopkins described an experience of either giving birth or being born. Many also described an encounter with their cancer that had the effect of diminishing its power over them. Dinah Bazer, a shy woman in her sixties who had been given a diagnosis of ovarian cancer in 2010, screamed at the black mass of fear she encountered while peering into her rib cage: “Fuck you, I won’t be eaten alive!” Since her session, she says, she has stopped worrying about a recurrence—one of the objectives of the trial.

Great secrets of the universe often become clear during the journey, such as “We are all one” or “Love is all that matters.” The usual ratio of wonder to banality in the adult mind is overturned, and such ideas acquire the force of revealed truth. The result is a kind of conversion experience, and the researchers believe that this is what is responsible for the therapeutic effect.

I was struck by how the descriptions of psychedelic journeys differed from the typical accounts of dreams. For one thing, most people’s recall of their journey is not just vivid but comprehensive, the narratives they reconstruct seamless and fully accessible, even years later. They don’t regard these narratives as “just a dream,” the evanescent products of fantasy or wish fulfillment, but, rather, as genuine and sturdy experiences. This is the “noetic” quality that students of mysticism often describe: the unmistakable sense that whatever has been learned or witnessed has the authority and the durability of objective truth. “You don’t get that on other drugs,” as Roland Griffiths points out; after the fact, we’re fully aware of, and often embarrassed by, the inauthenticity of the drug experience.

This might help explain why so many cancer patients in the trials reported that their fear of death had lifted or at least abated: they had stared directly at death and come to know something about it, in a kind of dress rehearsal. “A high-dose psychedelic experience is death practice,” Katherine MacLean, the former Hopkins psychologist, said. “You’re losing everything you know to be real, letting go of your ego and your body, and that process can feel like dying.” And yet you don’t die; in fact, some volunteers become convinced by the experience that consciousness may somehow survive the death of their bodies.

In follow-up discussions with Bossis, Patrick Mettes spoke of his body and his cancer as a “type of illusion” and how there might be “something beyond this physical body.” It also became clear that, psychologically, at least, Mettes was doing remarkably well: he was meditating regularly, felt he had become better able to live in the present, and described loving his wife “even more.” In a session in March, two months after his journey, Bossis noted that Mettes “reports feeling the happiest in his life.”

“We still had our arguments,” Lisa recalled. “And we had a very trying summer,” as they endured a calamitous apartment renovation. But Patrick “had a sense of patience he had never had before, and with me he had real joy about things,” she said. “It was as if he had been relieved of the duty of caring about the details of life. Now it was about being with people, enjoying his sandwich and the walk on the promenade. It was as if we lived a lifetime in a year.”

Mettes’s equanimity exerted a powerful influence on everyone around him, Lisa said, and his room in the palliative-care unit at Mt. Sinai became a center of gravity. “Everyone, the nurses and the doctors, wanted to hang out in our room—they just didn’t want to leave. Patrick would talk and talk. He put out so much love.” When Tony Bossis visited Mettes the week before he died, he was struck by Mettes’s serenity. “He was consoling me. He said his biggest sadness was leaving his wife. But he was not afraid.”

 “We are all terminal,” Griffiths said. “We’re all dealing with death. This will be far too valuable to limit to sick people.” ♦