Can recreational drugs be therapeutic?

Call it what you will – names include grass, ganja, hootch, loco weed, whacky tabacky, Mary Jane or her cousin, Alice B Toklas – cannabis has never been regarded by the mainstream as anything but a recreational drug… until now.

Suddenly in Australia marijuana (another of its names) has been moving into the therapeutic ‘space’, sanctioned by government as suitable for prescribing as an aid to alleviating, although not curing, a range of conditions, some of them paediatric.

While prescribing cannabis has so far been limited to, and taken up by, a relatively small number of practitioners, it is well and truly on the radar. In fact some patients, frustrated by legal delays, are buying their own supply, either on the street or online, even on the ‘Dark Web’.

So acceptable has the notion of medicinal cannabis become in the Northern Rivers, long considered the nation’s cannabis capital, that our National Party MPs, federal and state, are putting their weight and significant government funding behind a proposed cannabis facility.

As previously reported in GP Speak (Summer 2017-18 and Autumn 2018) this growing and processing facility, the beneficiary of a $2.5M federal grant, will be based not in notorious Nimbin but in conservative Casino where beef, not bud, has long been king.

Many analysts, not least a recent ABC ‘Four Corners’ program, suggest that the move to legalise medicinal cannabis is a Trojan horse masking the full legalisation of ‘dope’ throughout the land. Indeed, the company that aims to establish the Casino facility makes no bones about its longer-term aim.

“Assuming recreational cannabis becomes legal [as it has in various US states] it is suggested that the cannabis market in Australia could grow to $9B over the next 7 years.”

If that happens, the head-scratching by doctors asked to prescribe may be over: patients will be able to self-medicate at their corner pot shop.

So that’s cannabis, seen from the 1960s onwards as the mood-altering drug of choice for the ‘Woodstock generation’ of post-WW2 baby boomers. But what of the stronger psychedelics, the mescalins, LSDs, magic mushrooms et al that could take people out of themselves - or into, if you like - on ‘trips’ that lasted not a few hours but all night and into the next day.

Drug experiences that made you, like it or not, see melting walls, pink elephants, flashes back or forwards, experiences occurring nowhere except in your own mind…

In the words of cult icon Timothy Leary, ‘turning on’ with hallucinogens was the pathway to ‘tuning in’ and ‘dropping out’, this suggestion being the obvious fly in the ointment (Leary held a psychology PhD and taught at Harvard). Tuning in is what LSD is being increasingly valued for.

Not surprisingly, a drug that was being studied for its therapeutic effects on alcoholism, depression, and other conditions was quickly branded as ‘recreational’, apparently a bad thing, and banned.

However, the wheel has now turned, and rapidly, even though public discussion in Australia remains in its infancy. In the USA and UK, notably, the use, and usefulness, of mind and mood altering drugs is receiving close attention, with a thumbs-up consensus starting to emerge.

The New Yorker is one outlet giving considerable space to this work, notably the role of hallucinogenic drugs in helping terminally ill cancer patients cope with the fear of death.

Other articles have discussed the difference between a recreational psychedelic journey and a therapeutic one, one writer noting, “Whereas we don't typically trust the insights we have when we're drunk or dreaming, patients who take hallucinogens report having "a sturdy, authoritative experience."

The New York Times wrote that, “In the last few years, calls for marijuana to be researched as a medical therapy have increased. It may be time for us to consider the same for psychedelic drugs”

Back in 2015 the Independent (UK) reported two studies in the Journal of Psychopharmacology showing that a single dose of psilocybin – a powerful, naturally occurring psychedelic compound found in “magic mushrooms” – can radically improve the well-being and positivity of terminally ill cancer patients.

The research, completed at NYU and Johns Hopkins University, looked at participants diagnosed with advanced cancer who undertook ‘psychedelic assisted psychotherapy’, which entails a moderate to high dose of psilocybin in a controlled environment with psychological support from highly qualified guides.

Results demonstrated immediate and marked reductions in their levels of anxiety and depression that, remarkably, still persisted six months later in 80 per cent of the participants. Researchers compared and contrasted - favourably - this to other treatments such as anti-depressants and counselling, which can take a long time to show benefit for countering isolation, depression and anxiety, and sometimes not at all.

These patients are not dropping out, but dropping back in.

"In the States particularly but also in the UK there is more of a capacity and an understanding of why we would want to give drugs of abuse to humans in controlled settings. And so there have been no clinical trials approved in Australia yet." - Dr Gillinder Bedi

In the USA the potential therapeutic value of MDMA (‘ecstasy’) is being studied, with interest in the findings coming from, amongst other quarters, Australia, from where Dr Gillinder Bedi, head of Substance Use Research at Orygen, the National Centre of Excellence in Youth Mental Health in Melbourne, has contributed to JAMA Psychiatry a paper titled “Is Psychiatry Ready for MDMA the Medicine?”

In an interview on ABC Radio’s Health Report/Life Matters, Dr Bedi said there were two rationales for using MDMA as an adjunct to psychotherapy: “The broader rationale is that these kind of feelings [loving, playful, open] of reducing your defences interpersonally may act as a kind of fast-track for the therapeutic bond… in terms of PTSD… the rationale is around this reduction of fear.”

However, Dr Bedi stressed that, “I have seen no evidence that the drug alone does anything particularly beneficial. So I would not encourage people to rush out and give themselves MDMA to treat anything at all.”

While it seems unlikely that the corner pot-shops of the future will also be stocking LSD and MDMA, it is clear that substances once branded as recreational, and consequently outlawed, will increasingly be investigated for their therapeutic potential. To what extent this research will be compromised, or at best delayed, by associated stigma remains to be seen.

Clearly, Australia has been dragging the chain, largely, it may be argued, because of our lawmakers. As Dr Bedi noted, “In the States particularly but also in the UK there is more of a capacity and an understanding of why we would want to give drugs of abuse to humans in controlled settings. And so there have been no clinical trials approved in Australia yet.”

As evidenced by National Party MPs putting their weight behind a cannabis enterprise, the times are definitely a’changing. How clinicians, governments, Big Pharma and patients themselves react to the changes will be fascinating to observe.