There is an ongoing clinical trial of giving psilocybin (the active ingredient in ‘magic mushrooms’) to help people who are living with a methamphetamine (‘meth’ or ‘ice’) use disorder. Maureen Steele is a Peer Worker who helped to design the trial. She told Users News about the trial.
Treatments are lacking for “methamphetamine use disorder” (sometimes called “problematic meth use”, or “meth dependence”). Psychedelic-assisted psychotherapies are showing promise for treating a range of alcohol and other drug (AOD) use disorders and mental health disorders, so we want to see if they can help meth users.
We’ve heard many meth users tell us that illicit psychedelics have helped them to make positive life changes and get their meth use under control. There are many risks involved in using illicit psychedelics, so we’re researching psychedelic-assisted psychotherapy so we can see how it works, and how we might be able to make it a legal, safe, accessible and effective treatment for more people.
The people who we’re going to work with in this trial are those who are seeking treatment because of their concerns about their own methamphetamine use, and who have a goal to either reduce their meth use or stop entirely.
There’s a lot of interest in trained psychotherapists giving clients psychedelic drugs such as psilocybin (the active ingredient in magic mushrooms) to assist with psychotherapy.
Psychedelic-assisted psychotherapies
Psychedelics have been used throughout history, and in the mid-1900s there were quite a few scientific trials looking into the effectiveness of using psychedelic drugs to help with various mental health conditions.
Unfortunately, this research happened during the “hippy” era and a certain researcher who shall not be named, took the “expand your mind” aspect of psychotherapy a little too far when he suggested everyone “drop out” of society and take LSD instead. While I can sympathise with the sentiment, it scared the crap out of the government and made them intensify their War on Drugs!
So that killed research into psychedelics for about 30 years. But, the research has started to pick up again since the early 2000s, and there's been lots of research internationally.
The people considered ‘most in need’ of psychedelic-assisted psychotherapy seem to be getting trials first, for example, MDMA for people with chronic post-traumatic stress disorder (PTSD), such as our war veterans experience.
In Australia, there’s a trial in St Vincent’s hospital in Melbourne into psilocybin-assisted psychotherapy to treat anxiety and depression in people who are terminally ill and the results should be published soon.
The Australian government has recently put $15 million towards funding other trials and things are only just starting to heat up for research into psychedelics for treating mental illness and alcohol and drug use disorders.
Meth withdrawal
Currently, the most common way to stop using meth is called a ‘detox’ (detoxification) or ‘withdrawal.’
Basically, if you’re someone who is using more regularly — in other words, daily or for periods of several days — and you want to stop, you just taper down your use over a period of time or stop using in one go. It can be really challenging to withdraw, and it can be a barrier to people making other changes they want.
Generally, once you stop using, a detox takes about 14 days. You will “crash” for a day or 2 and feel pretty awful for about 10 days.
While lots of people withdraw from meth by themselves at home, there is help on offer from your local treatment service so I would advise people to take it. You might think that you can do it all yourself, but if you have been using for a while, your headspace could get pretty bad during withdrawal, so it can be good to know that you can call a detox worker if you need support, or things start getting crazy.
Anxiety and depression are the worst symptoms for many people going through meth withdrawals, rather than physical symptoms.
You can do a detox at an ‘In-patient’ withdrawal centre or at home. It is best to do it with the support of a GP or your local AOD service who can give you “medicated assistance” for easing the symptoms of withdrawal. Some people get stomach cramps and nausea, which you can take medications to help alleviate. To help with sleep and mood, they can give you a benzo if you’re lucky.
After the detox, any psychological issues should be addressed. This is where you need to learn how to be happy and confident without the support of meth. But after heavy, long-term meth use, it can take up to 9 months for your dopamine and norepinephrine levels to stabilize, so this is a confusing period when it comes to working out your feelings.
You can also go into an in-patient rehab for a few weeks (or months), or go to out-patient groups, such as SMART Recovery, or Narcotics Anonymous (NA) which can provide you with a therapeutic community. There are NA and SMART Recovery groups for meth users only.
There's also some evidence that treatment with cognitive behavioural therapy (CBT) can be associated with reductions in methamphetamine use.
The psylocibin trial
The project I’m involved with is a small pilot trial, of about 30 people at St Vincent’s Hospital, Sydney, and led by UNSW researcher, Dr Jonathan Brett.
We’re currently recruiting from drug and alcohol treatment centres in Sydney, because we need people to already be engaged with treatment. We also won’t start with really heavy users who use all day every day. Instead, we’ll be focusing on people who use over a long weekend or Fridays to Mondays. That is the safest place to start this research. If it’s safe and feasible in that population then we can expand it.
Anyone with a history of psychosis, schizophrenia or bipolar will be excluded. Unfortunately, we just don’t know enough about how psychedelics might impact people with those conditions, and we don’t want to make their condition any worse.
Unfortunately, the people who often need help the most — such as homeless people, very heavy users, and mentally ill people — can’t access these treatments yet as we are early in the trial phase, so these treatments are not yet available as standard treatments.
How the trial works is first up, you do a few preparation sessions with the 2 psychologists or counsellors who will be guiding you during your treatment session.
You get to know your therapists before you take psilocybin and you also talk about what to expect.
You also need to “Set your intentions” – what do you want to change in your life? What would you like to explore, or think about, during your psilocybin session?
Then you have the session when you take the psilocybin, which can last for 6 hours. You come into a nice room in a safe, private space, where you can lie down if you want to, and 2 therapists are there to support you the whole time. They won't talk much to you during the session, but they are there if you need anything.
Afterwards, you talk about how it went and what you learnt and they help you integrate it all into your life.
Peer worker involvement
I’ve given feedback on the study design and done my best to make sure the trial will set users up to succeed. Peers have known about the potential of psychedelics for a very long time, and it has taken science a long time to catch up.
Sometimes it feels as though researchers are very “risk adverse”, but the reality is that they have our safety in mind all the time and they are doing their best to protect people.
The medicalisation of psychedelics and stimulant drug use
I want to make it clear that although this trial is looking at how psilocybin can be used to reduce meth use, I don’t want to imply that all meth use is problematic. It is likely that psychedelics can help people by addressing the trauma that might be underlying their other drug use. But again, I don’t want to imply that all meth use is caused by trauma or that abstinence should be everyone’s goal.
Many people rely on illicit drugs in an attempt to self-medicate. Stimulants such as meth can make someone with undiagnosed ADHD feel better. The Catch-22 is that admitting you have a dependence on an illicit drug makes the prescriber unwilling to prescribe you dexamphetamine or lisdexamphetamine for ADHD!
Prescribers don’t expect people with ADHD to become abstinent from prescribed stimulants. On the contrary, a ‘healthy’ dependence is encouraged, even though there can be side effects.
I know some people prescribed dex and they use a small amount most days to help them focus at work, or socialise on weekends. And they also use psilocybin mushrooms regularly (about once every few months) to help them deeply reflect on how to live their best life (and to think of strategies to reduce their dependence on a stimulant). They generally don’t use dex on the day they use psilocybin. Having both those drugs in their toolkit is better than just relying on one.
Many people have profound and meaningful experiences taking psychedelics on their own. Psychedelics are probably safer and more therapeutic when given along with psychotherapy, but peer-led “integration” groups that help people make sense of their psychedelic experiences is something we’re also going to be doing some research into.
I also think it could be a good idea to do future studies of giving meth users prescribed dex or lisdex for daily use for a month or so to help them stabilize their use, and then on a weekend, lower their dex or lisdex dose and give them psilocybin for a day. Then let them continue to use as much dex or lisdex throughout the next few weeks as they want, and then give them another psilocybin weekend.
I think the medicalisation of stimulants is encouraging people to get diagnosed with ADHD. The ADHD label gives people a sense of relief, and it allows them to get medicated. But I do worry that it means they will see themselves as unnormal, and see medication as the main solution, rather than learning other coping strategies.
I think the world, and the system we live in is oppressive, and it makes us all feel like there's something wrong with us, but really, it's the system. And then when you’re told something is wrong with you, you will see medication as the answer, rather than changing the system and root causes.
We have medicalized our dependencies too much. Not everything that we are dependent on needs to be medicalised. Plenty of people rely on alcohol to live their best life—so why can’t we do the same with meth?
I know a few people who get home from work during the week and have a tiny puff on their meth pipe and have some relaxing fun, then get to sleep by midnight and get up normal. It helps them lots. It is recreational and therapeutic. Why is that not considered medical? Why don’t we make that easier for people to access? We should so that their drug is pure, and they have some medical support if they need it, and it is cheaper and stable dose, and healthier for them, and not so stigmatised and criminalised.
Lots of people that use meth actually want “speed” which used to mainly contain amphetamine, which is gentler and more similar to dexamphetamine. But getting diagnosed with ADHD is hard, and there's a long waitlist and no guarantee that you will get a prescription for a stimulant.
And then even when someone gets a prescription, they still have to fit inside a ‘medical box’. It means that on the weekend, if they want to triple their dose so they can have some fun, most doctors will say ‘no way’ but I think we need to make that acceptable. That’s what people want, and they shouldn’t have to lie to their doctor about it. All we should be asking is: is this use a problem for the person? Are they harming anyone else? If the answer is no, then leave them alone!
And even if someone is looking like they're struggling, don’t assume the drug is the problem. I’ve had times in my life where I looked like a bit of a mess, but if I wasn’t using drugs then I would feel suicidal — which believe me, is a lot worse!
I think psychedelics should be decriminalised because people should have the right to put whatever they want in their bodies, so long as it doesn’t hurt anyone else.
I also worry that while we wait for psychedelics to be made accessible through the medical system, people will face risks because of prohibition. They are at risk of the substance not being what they think it is, and not knowing the right dose. They might experience paranoia about being punished by law enforcement. Criminalisation means that it is harder to find a good psychedelic trip sitter. Psychedelics can make you very vulnerable, and some underground sitters do unethical things.
We also need to be careful about people thinking psychedelics are a magic bullet. They won't solve all your problems, and they can be really challenging and risky. A lot of support and education will be needed to make sure you get the best out of an experience.
Cost and access
I also think the medicalization of everything is frightening under the capitalist model of healthcare because the people who can't afford it will miss out on it. That’s what’s happening with ketamine therapy — the government has decided to not subsidise it on the Pharmaceutical Benefits Scheme (PBS) so now most people can’t afford it!
Another example is access medical cannabis. High-quality cannabis flower is about 15-20$ per gram, which is much more expensive than if you grew yourself or bought in bulk illicitly. Although some medical flower is starting to get closer in price to what you’d pay for bulk illicit flower.
Lots of people trying to get on medical cannabis are finding it hard because there's hoops to jump through. It is over-regulated. Most of the cannabis specialists who know how to do it easily will charge $300, although I’ve heard it is getting much easier and cheaper.
There are some people in the psychedelic underground who say selling psychedelics or facilitating psychedelic sessions for a price is immoral. I tend to agree. Ideally, I think you should be giving it for free or just charging a small amount to cover your costs. If you have ever taken psychedelic drugs you might know what I mean when I say that these drugs belong to everyone and no one individual has the right to take ownership of them, let alone make lots of money from them.
But I also know some underground psychedelic facilitators who say their time, energy and risk should be valued highly, and that more money means they can do a better job, and clients take the work more seriously. I’ve also heard of facilitators giving free or subsidized spots for people experiencing financial hardship.
I don’t want to see a capitalist commercial free-for-all like there is with some places in USA where cannabis is now legal! I would like the state to regulate these drugs as well as the facilitators so it doesn’t turn into a legal chaos. I hope our trial is a small step towards making that happen.
[Maureen Steele has been inducted into the NUAA Hall of Fame for her tireless and outstanding commitment to our community, and you can learn more about her in this Users News article ‘A lifetime of service’.]