Psilocybin has potential to treat depression, anxiety despite legal ‘question mark’
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SAN DIEGO — Psilocybin has emerged as a potential treatment for depression and anxiety, including among patients with chronic rheumatic or autoimmune conditions, according to a speaker at the 2023 Congress of Clinical Rheumatology West.
“The first question is: How can we ensure access while preventing abuse?” Stephen J. Ziegler, PhD, JD, associate professor of public policy at Indiana University-Purdue University Fort Wayne, told attendees.
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Ziegler noted that he is not in favor of free access to psilocybin for everyone.
“There are good reasons to control drugs,” he said, adding that while antibiotics have cured many infections, stewardship is necessary to prevent resistance.
However, Ziegler stated he sees “enormous potential” in psilocybin. Still, several structural hurdles prevent widespread use of this drug in the rheumatology setting — not least of which is that it remains a schedule 1 substance according to federal law.
Although some states are expanding the current trend in relaxing cannabis laws and making certain exceptions for psilocybin, there is significant uncertainty with regard to how it may be used, according to Ziegler.
“States are all over the board in regard to psilocybin and cannabis,” he said. “There is a big question mark with regard to its legal status in the United States. It’s a mess.”
So far, just two states — Colorado and Oregon — have decriminalized psilocybin, while others have placed it on a “low priority list” for law enforcement. Meanwhile, Washington, D.C., as well as several cities in California, Michigan and Massachusetts have also decriminalized the drug. Rheumatologists interested in treating patients with psilocybin are encouraged to research the laws of the state where they practice.
Despite the current hurdles and legal patchwork, Ziegler noted that “legitimate research organizations,” including Johns Hopkins University, are currently studying the use of psilocybin to manage depression and end-of-life anxiety, among other indications.
“This is not a fly-by-night research organization,” he said.
These studies may soon provide verifiable data for patients in Oregon, for example.
According to Ziegler, psilocybin is currently being administered by the Oregon Health Authority, which stated that, “Psilocybin has shown efficacy, tolerability and safety in treating a variety of mental health conditions, including depression and anxiety disorders and end of life psychological distress.”
“This is really exciting potential,” he said.
Ziegler stressed that the medical use of psilocybin in Oregon is heavily guided by professionals, as opposed to cannabis, which can often be purchased, or prescribed and taken home, for self-dosing.
“There are no take-home bags for psilocybin,” he said. “The patient meets a licensed provider who has obtained it legally. During the next session, actual substance is provided.”
The mushroom “trip” can last 8 to 10 hours, according to Ziegler.
“The patient consumes the product in the presence of the facilitator in the clinic,” he said.
If the patient wishes, they may have a follow-up visit to discuss the experience.
“The interesting thing about psilocybin is that it might be one dose and that’s it,” Ziegler said.
Although psilocybin has not yet been tested in chronic pain or other chronic conditions, such studies may be coming sooner rather than later, according to Ziegler.
“The Food and Drug Administration has determined that preliminary clinical evidence may demonstrate substantial improvement over available therapies for treatment resistant depression,” Ziegler said. “They have also granted breakthrough therapy designation.”
Of course, there are risks, including migraines, Ziegler added.
“It is contraindicated in people with prior psychosis or preexisting mental illness,” he said. “The problem is that people with preexisting mental illness might actually benefit from psilocybin. The jury is out.”
As state and federal governments begin to sort out their policies regarding psilocybin in various indications, Ziegler sees a lost opportunity — brought on by more than 50 years of criminalization in the United States — that may finally be rectified.
“This particular drug and its potential has been kept from us because it has been in schedule 1,” he said. “That is quite tragic.”
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Ziegler S. No Prescription Required? The Growth of Humor Therapy, Psilocybin, and Cannabis as Alternative and Complementary Treatments for Pain and Palliative Care. Presented at The Congress of Clinical Rheumatology West; Sept. 7-10, 2023 (hybrid meeting).
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