LSD faces an acid test as a pain killer

The Weekend Australian

Picture yourself in a boat on a river,
With tangerine trees and
marmalade skies
Somebody calls you, you answer
quite slowly,
A girl with kaleidoscope eyes.
Lucy in the Sky with Diamonds,
The Beatles

PSYCHEDELIA sent a creative tsunami through the rock bands of the 1960s, but government concern over the recreational abuse of drugs such as LSD led to bans that killed off exploration of any legitimate medical uses.

But there is something of a resurgence of interest among researchers in the medical uses for LSD, psilocybin and MDMA. Clinical trials have shown promising results for relieving crippling "cluster" and other vascular headaches, as well as pain, suffering and anxiety in terminally-ill cancer patients.

The results of several studies into the use of psychedelic drugs for medical and therapeutic use were announced at a recent international symposium on LSD in Basel, Switzerland. The event, called "LSD: Problem Child and Wonder Drug", honoured the 100th birthday of Dr Albert Hofmann, the Swiss chemist who discovered the mind-altering effects of LSD in 1943 while researching derivatives of ergot rye. Controversy still surrounds the medical use of lysergic acid diethylamide, known as LSD or "acid", and related substances like psilocybin, a psychedelic alkaloid the active hallucinogenic ingredient in so-called "magic mushrooms".

LSD was banned in America (with the rest of the world quickly following suit) in October 1966 at the height of the hippy era, after widespread recreational use and abuse overshadowed potential applications as a psychotherapy tool.

By the middle of the 1960s over 1000 peer-reviewed papers had been published detailing the successful treatment with LSD of more than 40,000 patients for schizophrenia, depression, alcoholism and other disorders. Some of the most startling results came from Dr Timothy Leary, who conducted his own psychotherapy experiments at Harvard with LSD and psilocybin to treat alcoholism over 40 years ago.

Now a new generation of psychedelic researchers are cautiously guiding Hofmann's "problem child" back to where it started – as a medication for migraine relief, eliminating anxiety and as a palliative for the dying.

Rick Doblin is the founder of the Multidisciplinary Association for Psychedelic Studies, a registered non-profit organisation in Sarasota, Florida, that assists researchers in facilitating government approval for psychedelic research in humans. MAPS has been instrumental in assisting many current psychedelic researchers to navigate the maze of regulations worldwide and allow researchers to study these compounds.

"These substances and these states of mind don't inherently make people drop out of society, or want to start a counter-culture – we can weave them into our culture as it is," Doblin said last year. "After several generations the culture is better able to accept and integrate these states of mind and the ways we're trying to help people with them."

John Halpern is the associate director of substance abuse research at Harvard University's McLean Hospital and has been sponsored by MAPS in his psychedelic research. He has previously received approval from the US Food and Drug Administration to give MDMA – better known as Ecstasy – to terminally-ill cancer patients to relieve their pain and fear of dying.

With his colleague Andrew Sewell, a research fellow in psychiatry, Halpern and the Harvard team are pressing for a renewal of clinical trials with LSD and psilocybin for migraine relief, specifically cluster headaches.

A cluster headache, also known as "trigeminal autonomic cephalgia", is a severe migraine which can completely debilitate a victim, causing blood vessels in the brain to expand. The pain can be extreme.

Professor James Lance, one of the founding members of the Brain Foundation and Headache Australia, has been promoting the understanding and treatment of migraine and other headaches since 1965. He treats many cluster headache sufferers and one patient has told him that he takes psilocybin to ease his symptoms – carefully measuring a small dose that will ease pain without hallucinations.

Cluster headaches are rare, affecting about one patient for every 100 migraine sufferers, and Professor Lance points out that people shouldn't take the researchers' interest in psychedelic drugs as a carte blanche to try out illegal drugs.

"(Cluster headaches) commonly wake sufferers from sleep around 2am and seem to be connected to an internal clock that regulates attacks," Lance says.

"Where psilocybin comes into the picture nobody knows, but it could be a pointer to the mechanism of cluster headaches and it is well worth pursuing."

Current medical science can make the pain of cluster headaches more bearable, but cannot cure the condition itself. Traditional medicines can have severe side effects and are difficult to apply when sufferers are gripped with a crippling attack. Medications like Cafergot have proven moderately successful in aborting a single cluster headache attack, and other drugs like verapamil and lithium can prevent an attack from occurring as long as the levels of the drugs in a patient's system remain high. According to some reports, LSD and psilocybin, however, appear to terminate the entire cluster headache cycle for an extended period of time, even after trace elements have left the body.

Chronic sufferers have reported relief from cluster attacks for up to two weeks using the hallucinogens, and episodic sufferers report a single dose of LSD can cure cluster headaches for as long as a year.

Of course, without proper controlled trials, where patients are randomly allocated to receive different treatments, no one can be sure that these improvements are caused by the LSD or psilocybin – or even that the improvements are in fact as significant as the patients later seem to recall.

Much of the anecdotal evidence so far has been gathered by Clusterbusters, a grassroots public education and support network for cluster headache sufferers. Lobbying by Clusterbusters has helped spur legitimate research like that now being pursued at Harvard. Facilitating FDA-approved trials may offer a way forward for helping cluster headache sufferers, often frustrated by existing options.

Sewell has collated anecdotal reports suggesting that in 93 cases of patients who used psilocybin, almost 40 per cent found it completely effective in relieving a cluster headache or breaking the cycle that causes them.

A smaller test batch of subjects used LSD to treat their migraines and reported similar results, with 90 per cent expressing complete relief from cluster pain and 10 per cent saying they felt an improvement of more than 75 per cent. Almost half of these patients achieved therapeutic success with both chemicals at sub-psychedelic doses that did not trigger hallucinogenic effects. However, results can vary according to the bodyweight and physiology of the patient, and the source and potency of the psilocybin or LSD. Psilocybin and LSD are illegal in Australia, despite "a resurgence in the illicit market with younger people", according to Paul Dillon, information manager for the National Drug and Alcohol Research Centre in Sydney. About 8 per cent of Australians have used hallucinogens, according to NDARC research. While hallucinogens are not drugs of dependence, Dillon says as with all drug use there are "still risks involved" with LSD and psilocybin.

Some legal drugs patients take to alleviate the pain have also been known to interfere with LSD, notably selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and other antidepressants. These same drugs do not, however, interfere with psilocybin and its effects in reducing cluster headache pain.

Sewell and his colleagues are awaiting publication of this research in medical journals and once the Harvard MDMA study headed by Halpern is complete, the next step will be the renewal of controlled clinical trials with psilocybin and LSD, last done in the 1960s.

Studies continue at other research centres in America and worldwide, including Israel, Spain, Switzerland and Germany.