Abstract
In October 2023 an off-duty pilot nearly took down an Alaska Airlines commercial jet mid-flight. 1 Riding standby in the cockpit jump seat, the man, whom colleagues described as a mild-mannered family man with an unblemished employment record, allegedly pulled the fire suppression handles in the cockpit, nearly turning the plane into a glider. The pilots wrestled him away from the handles, and flight attendants escorted him to the back of the plane, where he was handcuffed and detained until the plane landed safely.
When asked about his actions, the pilot acknowledged pulling the handles, saying he did so because he felt like he was trying to wake from a dream. He also indicated that he felt he was suffering a nervous breakdown, having taken psychedelic mushrooms 2 days earlier and then not sleeping for 40 hours.
He was later charged in State court with 83 counts of attempted murder, one for each person aboard the plane aside from himself. Experts and observers alike were left wondering why he did what he did—was it the mushrooms at fault or the man himself?
Turn on, Tune in, Drop out: A Checkered History
While people have used hallucinogenic substances like mushrooms and ayahuasca for religious, spiritual, and medicinal purposes since ancient times, scientific interest in the practice surged after lysergic acid diethylamide (LSD) and psilocybin were synthesized in the 1950s. 2 Some of the most promising studies in the 1950s and 1960s suggested that psychedelics could be effective for treating mental illnesses such as anxiety, depression, and alcoholism.
However, at the same time as psychedelics began to attract the attention of medical researchers, their recreational use boomed as part of the 1960s counterculture revolution. Soon, hallucinogenic substances were associated with revolt and mutiny against the establishment. This led to the 1970 Controlled Substances Act in the U.S., which made LSD, MDMA (ecstasy), cannabis, and psilocybin (the psychoactive substance in magic mushrooms) illegal and classified them as Schedule I drugs with high potential for abuse and no currently accepted medical use. 3 A year later, a United Nations treaty called the Convention on Psychotropic Substances of 1971 placed a global ban on all psychedelics, ending the production of medical-grade psychedelic compounds and with it, all related research funding and studies. 2
As a result, psychedelic use was driven underground for decades, and research on promising medical interventions languished. Yet, as the stigma surrounding these substances has eased with time, in the face of a global mental health crisis, researchers are again interested in investigating the promise of psychedelics for alleviating mental health conditions. In 2018, based on new clinical research, the Food and Drug Administration (FDA) took a step toward reversing course and gave psilocybin a “breakthrough therapy” designation for treating depression, allowing for the expedited development and review of related drugs. 2
While recreational use remains illegal at the federal level, as with cannabis, individual states have begun to take steps to legalize psilocybin within their own borders. On January 1st, 2023, Oregon became the first state in the nation to legalize its limited adult use. 4 In 2022, Colorado voters approved a ballot measure that removes criminal penalties for possessing certain psychedelics, and similar legislation has been introduced in New York, Washington, and other states. At the moment though, access to psychedelic substances is still highly limited and regulated.
Taking the Edge off: The Practice of Microdosing
Of course, that does not mean that psychedelics have disappeared. In fact, psychedelic use has its place in all tiers of society. Many Silicon Valley executives and A-list celebrities are open about consuming these substances, especially the practice of microdosing (consuming very small amounts of psychedelics to improve mental clarity and productivity, while avoiding the hallucinations and “high” of a full dose). Now that restrictions on psilocybin and ketamine have eased in some parts of the country, making psychedelic drugs easier to procure, even suburban moms now use them recreationally to treat anxiety and depression, optimize work life balance, and ease career pressures. 3
As is the case with many popular supplements, the few studies on microdosing psychedelics have found that it works no better than a placebo, yet many swear by the practice. Distributors are tapping into the microdosing trend, packaging the substances in medical-grade capsules or as innocuous candy, helping psychedelics find their place in medicine cabinets beside multivitamins and calcium gummies. Most microdosers liken the experience to having a glass of wine at a party or drinking a double espresso each morning. It gives them an edge or takes the edge off, boosting their mental health when they need it.
Taking the Measure of Psychedelics
Though recreational users and media outlets tout psychedelics as miracle cures, robust research on the potential psychological benefits of psychedelics is still in its infancy. Part of this is because official bodies still ban the substances, even for research purposes. In the U.S. in particular, until recently, psychedelics have had little success securing approval. However, in addition to the “breakthrough therapy” designation for psilocybin mentioned above, a ketamine derivative called esketamine won FDA approval in 2019 for use in patients with treatment-resistant depression, and MDMA may soon gain FDA approval owing to two Phase III clinical trials in which the substance was successfully used to treat patients with post-traumatic stress disorder. 2
Although the exact mechanism that helps these drugs treat mental health issues is still unclear, scientists believe that psychedelics like those above stimulate the release of reward chemicals such as dopamine and oxytocin and that these substances may also facilitate neural connectivity between brain regions. 2 In addition, psychedelic substances often help patients become emotionally vulnerable without self-criticism, allowing patients to confront and successfully address their emotional responses to events.
The question at hand remains: why use these illegal substances if other treatments are available for those same conditions? First, it is thought that psychedelics may be more effective and may work more quickly than traditional treatments. Psychedelics may act upon mechanisms within the brain that current medications do not, meaning that they may be more effective for treating certain people and some conditions. And unlike current antidepressants, which take weeks to reach an effective level in a patient’s body, psychedelics take effect immediately. Moreover, rather than requiring daily dosages, a single psychedelic experience can have effects that last for months, meaning that patients using psychedelics may require less medication and medical care than those on traditional treatments.
Of course, as with any medical intervention, there are potential drawbacks. Psychedelics at certain doses can cause a “high” that lasts several hours, requiring those who receive a psychedelic treatment to stay at a clinic overnight for each treatment. Many patients are unable or unwilling to make such a time-consuming and potentially expensive commitment. In addition, as with traditional medications, psychedelic use can come with physical side effects like a rise in blood pressure and in body temperature, which may exclude their use in patient populations with a history of cardiac and neurological issues.
The Potential of Cyberdelics
Because psychedelic substances remain largely illegal, people source them mainly through word of mouth, which these days means on social media. Though apps like Instagram are clear that they do not allow the sale or exchange of drugs on their site, distributors find ways to avoid being flagged, like using mushroom emojis instead of the words psilocybin or magic mushrooms. Because these “treatments” are not medically supervised, many users source their dosage and usage instructions online too, mostly using sites like Reddit and message boards to exchange anecdotes and advice. Unfortunately, this means that much of the information available to those who want to try psychedelics is incorrect and potentially harmful. In the future, regulation will be essential to making online spaces safe for psychedelic users.
The good news is there is the potential for technology to enhance psychedelic treatments in a supervised medical setting. Virtual reality (VR), digital therapeutics, and biofeedback have the potential to support treatment outcomes and offer a safe experience for patients. Psychedelic drugs and VR are alike in that both are used to disrupt the rigidity of sensory experience, as well as bolster outcomes of mental health treatments. 5 Even notable psychedelics pioneer Timothy Leary argued that cyberdelics, the fusion of psychedelic drugs and cyberculture, has the potential to reprogram the mind.
In both research and clinical settings, VR has been used to assist in treating several of the same conditions as psychedelics, including depression, anxiety, OCD, and substance abuse. 5 It is thought that VR provides therapeutic benefits by creating a benign, but vivid, setting in which patients can confront fears as well as promote memory reconsolidation. Ratings of “immersion” and “presence” in virtual environments also predict a number of positive outcomes, suggesting that transcending one’s typical mindset is a key factor in VR’s therapeutic efficacy. Overall, research supports that immersion in new environments can be an important feature of both psychedelic and VR experiences.
While the application of psychedelics in behavioral health care holds great promise, the current body of research is insufficient to conclusively assess its efficacy and safety. The hope is, with the easing of hallucinogenic stigma and increasing governmental approval of psychedelic use in medical research, scientists will soon be able to fully realize the immense potential of these substances in mental health care and will be given the tools to develop effective, safe, and multidisciplinary treatment protocols in the near future.