What will 'psychedelic therapy' look like when it's legalized?

Psychedelic therapy will become legal in Oregon in 2023. That's thanks largely to a renaissance of psychedelic research that's changing attitudes on the substances' medical potential.

​Psilocybin mushrooms

Psilocybin mushrooms

Credit: contentdealer via Adobe Stock
  • In November, Oregon voted to legalize psilocybin therapy.
  • Psilocybin is already being used in clinical research settings, but it remains a controlled substance on the federal level.
  • At the 2020 Web Summit, two experts in the field of psychedelic research and therapy shed light on what the future of psilocybin therapy might look like.

For millennia, humans have been using psychedelic drugs for medicinal and spiritual purposes. But today, most nations have criminalized psychedelics, including the U.S., where psilocybin and LSD are classified as Schedule 1 drugs, defined as having "no currently accepted medical use and a high potential for abuse."

But attitudes on psychedelics are shifting. That's thanks largely to a renaissance of psychedelic research that's been gaining steam since the 2000s, producing startling studies showing how psilocybin (and other psychedelics) can help alleviate mental health problems like major depression, anxiety, and addiction disorders.

In November, Oregon made history by passing Measure 109, which legalized the use of psilocybin in therapeutic settings. That's a step beyond measures in other progressive American cities, like Denver and Oakland, which have decriminalized the substance but stopped short of allowing people to consume it.

What it means for Oregonians is that, starting as early as 2023, adults 21 and older will be able to go to a clinic and consume psilocybin under the supervision of a licensed therapist, who has to obtain the psilocybin from a licensed manufacturer.

So, what exactly will psychedelic therapy look like, and why would people seek it out?

Those questions were explored in a recent presentation at the 2020 Web Summit by Ekaterina Malievskaia, co-founder of the mental health company Compass Pathways, and Kelsey Ramsden, the COO of Mind Cure, which identifies, develops, and commercializes new mental health products.

What psychedelic therapy could look like

Ramsden said a psychedelic therapy session might look like this: You enter "a lovely place that looks much like your living room with some lovely people [licensed therapists] who are going to sit with you for the duration of your treatment," and then you're administered psilocybin. You might sit or lie down with a mask over your eyes, potentially listening to some music, while being supported by the professionals in the room until the experience winds down.

This session would be followed by an "integration period," which would take place in the days and weeks following the psilocybin experience. The Entheogenic Research Integration & Education (ERIE) defines integration as "the process by which the material accessed and insights gained in a [psychedelic] experience are incorporated over time into one's life in a way that benefits the individual and their community."

What kinds of insights might you gain? It's hard to say, as everyone's experience varies, and scientists are still working to understand exactly how psychedelics interact with the brain.

"Because these experiences are so unusual, it's very difficult to explain what to expect, what people are going to be experiencing," Malievskaia said. "I think only with advancement in neuroimaging, and advancement in different scientific techniques, that we started understanding how they actually work, and we can show how they work, and that sort of paradoxically demystifies these mystical experiences."

How psilocybin acts on the brain

Malievskaia noted that psilocybin works primarily on the brain's serotonin system, attaching to specific serotonin receptors that trigger a cascade of different neurological events. These serotonin receptors are densely expressed in a system of connections called the "default mode network" (DMN).

"The DMN is not an anatomical structure in the brain," Malievskaia explains. "It's a system of functional connections that forms throughout people's lives based on their life experience, life events, their learning, their environment. So essentially, it's a collection of patterns — cognitive, behavioral, emotional patterns — in response to environmental stimuli. And we associate these patterns, perhaps sometimes, with a sense of self, or sense of ego."

"So, when psilocybin binds to these [serotonin] receptors, it downregulates the DMN, and temporarily, people are lifted out of their ego. In these profound psychedelic experiences, they're able to look at their life situation — their conflicts, their personal narratives — from a different vantage point."

"And with skillful support, and in carefully controlled, supported environments, they're able to process traumatic events, memories, and generate more insights. With subsequent skillful integration, they're able to embody those insights, and that could lead, potentially, to changes in unhelpful behavioral patterns."

Neuroimaging studies suggest that the DMN is active during much of our experience, particularly when we're doing repetitive tasks, worrying, daydreaming, or going over memories. It's something like an "auto-pilot" mode that helps the brain save energy. But for people suffering from, say, depression or anxiety, this function can make it difficult to overcome a mental-health rut.

That's why psychedelics might function as something like a "reset button": By quieting activity in the DMN, psychedelics may help the brain break free of its usual patterns, allowing other regions of the brain to begin "talking" to each other, creating new connections. What's interesting is that studies suggest these beneficial effects persist long after the drug wears off — for months, in some cases.

Given popular misconceptions about psychedelics, Ramsden said it's important for researchers and psychedelic therapy advocates to be thoughtful in how they discuss emerging therapies, and she reiterated that the new wave of psychedelic research and therapy is grounded in real science.

"What we're not talking about is this idea of self-medicating, or going on these wild trips," she said. "This really is a practice with deep scientific rigor, with high-efficacy outcomes."


A landslide is imminent and so is its tsunami

An open letter predicts that a massive wall of rock is about to plunge into Barry Arm Fjord in Alaska.

Image source: Christian Zimmerman/USGS/Big Think
Surprising Science
  • A remote area visited by tourists and cruises, and home to fishing villages, is about to be visited by a devastating tsunami.
  • A wall of rock exposed by a receding glacier is about crash into the waters below.
  • Glaciers hold such areas together — and when they're gone, bad stuff can be left behind.

The Barry Glacier gives its name to Alaska's Barry Arm Fjord, and a new open letter forecasts trouble ahead.

Thanks to global warming, the glacier has been retreating, so far removing two-thirds of its support for a steep mile-long slope, or scarp, containing perhaps 500 million cubic meters of material. (Think the Hoover Dam times several hundred.) The slope has been moving slowly since 1957, but scientists say it's become an avalanche waiting to happen, maybe within the next year, and likely within 20. When it does come crashing down into the fjord, it could set in motion a frightening tsunami overwhelming the fjord's normally peaceful waters .

"It could happen anytime, but the risk just goes way up as this glacier recedes," says hydrologist Anna Liljedahl of Woods Hole, one of the signatories to the letter.

The Barry Arm Fjord

Camping on the fjord's Black Sand Beach

Image source: Matt Zimmerman

The Barry Arm Fjord is a stretch of water between the Harriman Fjord and the Port Wills Fjord, located at the northwest corner of the well-known Prince William Sound. It's a beautiful area, home to a few hundred people supporting the local fishing industry, and it's also a popular destination for tourists — its Black Sand Beach is one of Alaska's most scenic — and cruise ships.

Not Alaska’s first watery rodeo, but likely the biggest

Image source: whrc.org

There have been at least two similar events in the state's recent history, though not on such a massive scale. On July 9, 1958, an earthquake nearby caused 40 million cubic yards of rock to suddenly slide 2,000 feet down into Lituya Bay, producing a tsunami whose peak waves reportedly reached 1,720 feet in height. By the time the wall of water reached the mouth of the bay, it was still 75 feet high. At Taan Fjord in 2015, a landslide caused a tsunami that crested at 600 feet. Both of these events thankfully occurred in sparsely populated areas, so few fatalities occurred.

The Barry Arm event will be larger than either of these by far.

"This is an enormous slope — the mass that could fail weighs over a billion tonnes," said geologist Dave Petley, speaking to Earther. "The internal structure of that rock mass, which will determine whether it collapses, is very complex. At the moment we don't know enough about it to be able to forecast its future behavior."

Outside of Alaska, on the west coast of Greenland, a landslide-produced tsunami towered 300 feet high, obliterating a fishing village in its path.

What the letter predicts for Barry Arm Fjord

Moving slowly at first...

Image source: whrc.org

"The effects would be especially severe near where the landslide enters the water at the head of Barry Arm. Additionally, areas of shallow water, or low-lying land near the shore, would be in danger even further from the source. A minor failure may not produce significant impacts beyond the inner parts of the fiord, while a complete failure could be destructive throughout Barry Arm, Harriman Fiord, and parts of Port Wells. Our initial results show complex impacts further from the landslide than Barry Arm, with over 30 foot waves in some distant bays, including Whittier."

The discovery of the impeding landslide began with an observation by the sister of geologist Hig Higman of Ground Truth, an organization in Seldovia, Alaska. Artist Valisa Higman was vacationing in the area and sent her brother some photos of worrying fractures she noticed in the slope, taken while she was on a boat cruising the fjord.

Higman confirmed his sister's hunch via available satellite imagery and, digging deeper, found that between 2009 and 2015 the slope had moved 600 feet downhill, leaving a prominent scar.

Ohio State's Chunli Dai unearthed a connection between the movement and the receding of the Barry Glacier. Comparison of the Barry Arm slope with other similar areas, combined with computer modeling of the possible resulting tsunamis, led to the publication of the group's letter.

While the full group of signatories from 14 organizations and institutions has only been working on the situation for a month, the implications were immediately clear. The signers include experts from Ohio State University, the University of Southern California, and the Anchorage and Fairbanks campuses of the University of Alaska.

Once informed of the open letter's contents, the Alaska's Department of Natural Resources immediately released a warning that "an increasingly likely landslide could generate a wave with devastating effects on fishermen and recreationalists."

How do you prepare for something like this?

Image source: whrc.org

The obvious question is what can be done to prepare for the landslide and tsunami? For one thing, there's more to understand about the upcoming event, and the researchers lay out their plan in the letter:

"To inform and refine hazard mitigation efforts, we would like to pursue several lines of investigation: Detect changes in the slope that might forewarn of a landslide, better understand what could trigger a landslide, and refine tsunami model projections. By mapping the landslide and nearby terrain, both above and below sea level, we can more accurately determine the basic physical dimensions of the landslide. This can be paired with GPS and seismic measurements made over time to see how the slope responds to changes in the glacier and to events like rainstorms and earthquakes. Field and satellite data can support near-real time hazard monitoring, while computer models of landslide and tsunami scenarios can help identify specific places that are most at risk."

In the letter, the authors reached out to those living in and visiting the area, asking, "What specific questions are most important to you?" and "What could be done to reduce the danger to people who want to visit or work in Barry Arm?" They also invited locals to let them know about any changes, including even small rock-falls and landslides.

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The common cuttlefish

Credit: Hans Hillewaert via Wikicommons
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A scene from the 1996 Tim Burton film "Mars Attacks!"

Credit: "Mars Attacks!" / Warner Bros
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