Turn on, tune in, be careful

May 24, 2018

I was born in 1953, which means I just turned 65. It also means that I bore witness to events in American life that are the stuff of history books to some readers. (Yes, at age 10, I watched the Ed Sullivan show the night the Beatles made their first appearance. Do you know what the Ed Sullivan show was? I hope you’ve heard of the Beatles….)

It also means I lived through the tumultuous time in the national narrative known as “the Sixties,” a time that has come to be associated with enormous cultural and social change. Two things about the Sixties: first, they really lasted from about 1966 through 1974, if you are referring to the period of cultural upheaval; the first half of the ‘60s was more like the ‘50s. Second, the country changed less, and less uniformly, than some cultural historians will have us believe. There were new ways of acting and thinking, but not for everyone, and not everywhere, and not necessarily for good (in both senses). Social change usually happens gradually, and I for one am enough of a conservative to think that is mostly a good thing.

One thing did truly change, though: middle-class American teens began to use marijuana and hallucinogens in much greater numbers than ever before. LSD guru Dr. Timothy Leary told a generation to “turn on, tune in, drop out,” and it listened to him. In the high-rise dorm where I lived when I was a college freshman, many kids used marijuana (and more) almost every night. It was part of their daily social life. Ten years earlier in the same place, that had not been the case.

What makes me think about that? The occasion for my mental meanderings is a story I read in the Wall Street Journal (WSJ) the other day (May 7). The story indicates that, with the stigma against the use of mairjuana and psychedelics fading, science is discovering that these drugs might have significant clinical utility.

The article, “The New Science of Psychedelics,” says that scientists at Johns Hopkins, UCLA, and other institutions are finding that psychedelic drugs, when administered in an appropriately controlled therapeutic setting, can be potent tools to treat mental illness. Psilocybin, a chemical cousin to LSD, has shown promise as a treatment for depression. It has also helped people who are addicted to alcohol and tobacco break the habit. In December 2016, the Journal of Psychopharmacology published two studies of phase 2 trials in which psilocybin was given to cancer patients suffering from depression and anxiety. In the studies, up to 80 percent of the subjects showed clinically significant improvements that lasted six months or more.

The WSJ story reveals that studies of the clinical efficacy of psychedelic substances, which are not physically addictive, are not new; some were conducted in the 1950s, and in some parts of Canada psychedelic therapy was an accepted treatment for alcoholism. What put a stop to such research was the bad reputation that developed around such drugs during “the Sixties.” It makes sense that, now that the medical use of marijuana in becoming increasingly accepted, and more and more people and places are at least entertaining the idea of the legalization of recreational marijuana, psychedelics are reemerging as a feasible subject for study.

The most important phrase in the WSJ article, however, is “when administered in a supportive therapeutic setting.” It is worrisome to think of individuals trying to self-medicate in this way. Those dorm rooms of my college days were not exactly therapeutic settings. Even more than most research, studies of the therapeutic effects of psychedelics must clear both scientific and ethical hurdles if they are to proceed.

What the direct implications of this for the clinical lab will be remains to be seen. It would seem, though, that new kinds of therapeutic drug monitoring will become part of your work. And, knowledge of patients’ prescription histories will be especially important in reporting results of drugs-of-abuse testing. That is an issue that could have legal ramifications. (See the “Clinical Issues” article on page 32.)