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Recent psychedelic research: lessons from current personal experience - suggestions

 

    Sapere aude!  Dare to use your own intelligence!  This is the battle cry of the Enlightenment.  Immanuel Kant

I have recently described my experiences taking a couple of (legal) psilocybin trips in the Netherlands - see "Lessons from current personal experience - introductionand "Lessons from current personal experience - description".  A major reason for doing this was as a 'test run' for any psychotherapy clients (as well as colleagues and friends) who might be interested in the potential value of this approach both for forms of difficult-to-treat suffering and also for overall wellbeing.

weighing the pros & cons:  I neither recommend nor discourage people from taking psychedelics.  For anyone who is considering it, I would however strongly encourage a cautious & thoughtful weighing of the pros & cons.  These are potentially powerful substances.  I think they're much safer than the media & governments have portrayed, but anyone thinking of taking them is likely to be stupid if they haven't looked very carefully before they leap.  One place to look would be on this website, where clicking on psychedelics in the tag cloud opens up a series of posts including "Recent psychedelic research - an introduction", "Their use in psychotherapy", "Their use in the general populationand "Recent psychedelic research - what are the risks?".   

intentions/questions:  It makes sense to know why one is taking a psychedelic 'journey'.  Is it primarily out of curiosity, for personal exploration & growth, for spiritual & transpersonal reasons, for fun or to get high?  Multiple studies have shown that increases in wellbeing & other psychological benefits are more likely when taking psychedelics leads to mystical-type, peak experiences.  Early research results from the Global Psychedelic Survey show that "Having 'clear intentions' for the experience was conducive to mystical-type experiences" - a point that has also been underlined in the helpful book "The psychedelic explorer's guide".

preparation:  Before embarking on these trips, I learned more about psychedelics ... reading material available in books like the "The psychedelic explorer's guide"How to change your mind", in research papers and online.  The various blog posts on this website are now useful too as a resource.  I talked about it with my wife & friends.  I also spoke to a dear therapist who I have been seeing approximately monthly for some years now.  I arranged with her and with family & friends to check in with them online from the Netherlands (and once I was home again in Scotland) after my trips.

choosing guides/sitters/therapists:  This is a challenge.  Much of the good research has involved participants working with pairs of guides who they have had several hours of preparatory therapy/orientation with before embarking on the psychedelic trip itself.  The two guides have then stayed with the participant over the day of the trip, and then gone on to meet with them for a number of sessions afterwards to help them integrate their experiences.  I wanted to test run a system that could be used by therapists here in Scotland, where pre-trip preparation and post-trip integration/longer term follow-up could be done with known Scottish therapists while the trip itself was supervised by experienced trip-sitters in the Netherlands.  This latter can be done 1:1 or 1:2 or in one of the available small group psychedelic retreats.  Although much of the research has used a ratio of 1 trip-taker to 2 trip-sitters, we don't have studies on the pluses & minuses of this format.  My strong impression is that 1:1 support will often be as good, more economical of expense & therapist time, and easier to arrange.  There are some parallels with going for couple's therapy, where seeing just one therapist rather than a pair of therapists is likely to be just as helpful.  There are intriguing questions too about the potential advantages & disadvantages of taking a trip at some kind of group psychedelic retreat.  I can see potential pluses in reassurance from & connection with others going through the same journey.  There are advantages too in cost & facilitator time needed per participant.  The style and 'culture' of the group and its fit with the individual participant will, of course, contribute to its effectiveness/ineffectiveness as well.  I have a small query about safety if things go badly wrong for an individual participant in a group format ... facilitator quality & experience are very important here.  For more on these issues, see the blog post "Recent psychedelic research: further exploration".  Websites like Tripsafe.orgTripsitters and the Dutch UK Psychedelic Societies provide information & links for both individual & group psychedelic 'retreats'.

location:  There are a good few research trials enrolling participants around the world, but trying to get onto one of these trials is a pretty long shot.  In the UK, London Imperial College and COMPASS may be worth contacting, and in the States there are centres like the Heffter Institute and John Hopkins.  If one wants to take a psychedelic legally outside a formal research trial, the obvious option from the UK is to travel to the Netherlands to take psilocybin truffles.  Another possibility is to take ayahuasca - and here's a list of possible locations.  Other more far-flung options are also available (for example, in South America).  As I've already highlighted, a problem with travelling for therapeutic use of psychedelics is adequate preparation & subsequent integration.  Here a home-based therapist, ideally with knowledge of the overseas experience, is likely to be more appropriate (although tools like Skype could be useful here too). 

On a more micro scale there's the issue of whether to take a trip indoors or outside.  For controlled clinical research studies, there are many advantages to taking the trip indoors (typically using a fairly high dose, eye mask & musical playlist).  Albert Hofmann, the first person to synthesize both LSD & psilocybin, said being out in nature is the obvious place to take these substances.  I think he was making a very good point, maybe especially to deepen our connection with the environment and our sense of gratitude & wonder ... and that was my experience with the LSD trips I took as a student.  Note that in the recent paper "Predicting responses to psychedelics: a prospective study", the authors commented "According to this study's finding, being in a therapeutic environment did not seem to influence the nature of the psychedelic experience in any particular way.  This somewhat surprising finding might be interpreted as suggesting that it is not necessarily essential that the environment be carefully designed with therapeutic ends in mind, which would put fewer constraints on the requirements for designing the environment for psychedelic experiences.  However, what “being in a therapeutic setting” means to an individual is subjective and variable, and we did not pre-define what we meant by it."  So many interesting questions to explore here and, sadly, not a lot of money yet available to fund the relevant research.

dose:  What dose of psilocybin to take?  The way I currently see it is that there are at least three factors to keep an eye on when deciding dose.  The first is that if one takes the same weight of psilocybin truffles or mushrooms on a number of different occasions, it's very likely that there will be considerable variation in the amount of psilocybin one is ingesting each time.  So Pellegrini & colleagues, in their 2013 paper carefully analysing the psilocybin content of truffles, commented "The content of psilocybin was found to vary over a concentration range of 59.3 to 167.8 µg per 100 mg of fresh sclerotia."  This is equivalent to a large three-fold range from approximately 6 to 17mg of psilocybin in 10gm of truffle (average maybe 12mg/10gm).  Note that Roland Griffiths et al, from the research centre at John Hopkins, used a high dose of psilocybin in their 'mystical experiences' research - 30mg/70kg subject weight equating to an average of 25gm/70kg for truffles.  It's worth being aware as well that truffles & mushrooms may also contain other psychoactive substances like psilocin, baeocystin and norbaeocystin (in fact psilocybin acts on the body by being converted to psilocin). 

So there's likely to be considerable uncertainty over what dose one is actually taking.  Then a second factor to be aware of is that there's a large amount of further variation in how different people metabolise these substances.  Lindenblatt et al's early 1998 paper on plasma level variation in 7 physician volunteers, all of whom had ingested the same psilocybin dose per kg body weight, illustrates this well: 

Considering this variation in plasma psilocin concentration across time ... and linking it with other work ... for example see the diagram below from the recent 2018 paper by Geiger & colleagues on the metabolism & pharmacology of psilocybin:

This suggests that most people will have reached the 'high plateau' of their psilocybin trip within about 45 to 90 minutes of oral intake (with an average of possibly around 65 to 70 minutes).  The buccal route mentioned is when one holds a quid of truffle in one's cheek to encourage administration through the oral mucosa.  It's also worth noting that occasionally people may be particularly sensitive or insensitive to psilocybin, which is another reason to start on a fairly low dose (in case one is particularly sensitive) and be ready to top up a good deal (in case one is less sensitive).  So when wondering whether to add to one's initial psilocybin dose, it makes sense to do this at around 70 minutes after taking the first dose (this is maybe a little later than the standard advice to consider topping up at around 60 minutes if effects aren't as strong as one wants).  

This links with the third of the three factors I mentioned ... a person's subjective reaction to the changes psilocybin is producing in their body & brain.  Set and setting are important here.  How relaxed or anxious am I about this journey?  How easy is it for me to become deeply absorbed in experiences?  Do I have a clear intention for why I'm taking the trip?  How do I feel about the people I'm with and the environment I'm taking the trip in?  All these factors can ... and probably should ... affect my decision to take a higher or lower dose.  As a rule of thumb, if one is aiming for ‘mystical/peak experience’, which makes good sense to optimise the chances of beneficial longer term outcomes, it is reasonable to start with 10 to 15gm of truffles, wait about 70 minutes, and then take a further 7.5 to 15gm if one wants to (aiming for a final dose that produces about 30mg psilocybin/70kg body weight).  

route of administration:  I'm a fan of psilocybin tea, especially if one is taking higher doses of truffles.  As I wrote in the last post, psilocybin truffles contain lots of chitin - "a fibrous substance consisting of polysaccharides, which is the major constituent in the exoskeleton of arthropods and the cell walls of fungi".  This can be fairly upsetting for the gut.  One can get round this by using the truffles to make a tea, rather than eating them whole.  This is a widely used method (here are three recipes) and, for me, it's much more tolerable for my gut (especially when taking higher doses).  It's important to cut the truffles small, use hot (but not boiling) water, and both stir them regularly and try to squeeze the truffle fragments to encourage them to give out as much psilocybin as possible into the tea water.  Mixing truffles into foodstuffs is also an option. 

how many/frequent trips?  It makes good sense to leave plenty of time to integrate trip experiences, hence the widely respected suggestion to keep trips at least one (and quite probably several) months apart.  In fact for some people, a single trip experience is all they will want or need.  It's important though to realise that there aren't hard and fast rules, and I valued the two close-together trips I described in the last post.  More 'hard and fast' is the fact that when trips are very close together, the second trip is likely to be 'weaker'  because of the way that the body metabolises psychedelics.  So the recent 2018 paper by Geiger & colleagues on the metabolism & pharmacology of psilocybin comments " ... the rapid desensitization to a drug or toxin resulting in diminished physiologic effect, is a phenomenon seen with most hallucinogens. Tolerance begins to develop after the administration of a single dose. The mechanism behind this rapid desensitization is the physiologic response to 5-HT2A receptor overstimulation by quickly downregulating receptor sites.  In general, it is thought that these receptor sites return to fifty percent of their baseline within three to seven days of the initial dose and return to baseline within one to four weeks, depending on dose and duration of repeated use."  My personal experience taking trips three days apart (so a gap of two clear days before taking a second dose on the third day) was that there seemed to be a reduction in strength of about 20-25%, but this estimate was complicated by eating the truffles for the first dose, while using them as a tea for the second.  And it's important to note that trip intensity is dependent on other factors as well as on dose.

integration:  This is likely to be very important.  It seems only too easy to have a powerful psychedelic experience and then pack it away as 'an unusual trip memory' without really taking on board the rich potential learning.  Support from others is a big resource here, be they a therapist, partner, family member or friend ... or maybe a mix.  I strongly recommend recording important conversations and/or therapy sessions and then carefully relistening to what emerged.  Mind-maps, notes, poetry, journaling (maybe with the trip as an inner wisdom resource), pictures (see the last post) are all also well worth considering.  So too are techniques like focusing that delve down into emotions and body felt-sense.  There are good online resources too at, for example ERIE , Tripsitters and the Psychedelic integration list.  Whether we want to or not, as we go through our lives we change in many ways ... physically, psychologically, spiritually.  Deep experiences very much contribute to this evolution ... and we can consciously join with the experience to support changes that feel importantt & true for us.

For more posts on this website about these areas, click on psychedelics and other topics that interest you in the tag cloud.

 

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