A Psychedelic Researcher: The Pitfalls and Pleasures Campaigning for Psychedelic Research in the British Medical Profession, the Media and the General Public
This article first appeared in the PsypressUK 2013: Anthology of Pharmacography. PsypressUK 2014 is out now and available here.
A brief Biography
I qualified in medicine from UCL, London, in 1997, specialised in mental health and now spend most of my time working as a child and adolescent psychiatrist in Bristol. But alongside my day job, for the last eight years, I have also been involved in psychedelic medical research. I began this unusual career interest in 2005 with an article in the British Journal of Psychiatry in which I described the emerging re-visiting of research into drugs like LSD, Psilocybin, MDMA, Ketamine and Ibogaine as adjuncts to psychotherapy for the treatment of unremitting anxiety disorders. At that time there were few others within UK medicine discussing this type of research – though plenty from the States, from other professions or from disparate tribes of recreational drug users.
Much to my surprise that first article was well received and it lead to a succession of invitations throughout the country to lecture at medical schools and hospitals, as well as other psychiatrists just interested to learn more about this peculiar subject. More published papers followed in medical journals and in 2007 I joined David Nutt at the Psychopharmacology Unit at Bristol University as a research associate. Whilst there I took part in the newly emerging psilocybin studies with Robin Carhart-Harris – becoming the first person in the UK to be legally given a psychedelic drug when Professor Nutt, as part of our pilot study, injected me with 1.5mg of intravenous psilocybin.
I subsequently contributed a paper, for David Nutt, in favour of MDMA research to the now infamous ACMD review of Ecstasy commissioned by the government, which lead to David’s unforgettable comments about horse riding and his eventual sacking from the government body he chaired. He left the department and moved to Imperial University London, where he now resides – and with ten times more scanners than they ever gave him to play with at Bristol University he is perfectly happy there.
How to be a Psychedelic Doctor in the NHS
Despite having such an idiosyncratic and poorly understood research interest I have found an overwhelming level of support from my non-psychedelic colleagues in the NHS. I am frequently awarded leave and funding to present on psychedelics nationally and internationally and am allowed a certain amount of free time within my NHS timetable to pursue this field of interest. I am deeply grateful for my colleagues and employers for such generosity – especially as they often don’t understand what it is I do with psychedelics. Nevertheless, perhaps they recognise that whilst I continue to get published in this field it is a worthwhile research trajectory – even though it is certainly on the fringe of mainstream medicine.
I have also had helpful and encouraging validation for this research topic coming from the Royal College of Psychiatrists and mainstream publications such as the Journal of Psychopharmacology and the Lancet. I have presented several symposia at College conferences – as well as fielding any relevant calls from the press that get directed towards the College. Unwittingly, it seems, I have become the psychiatric profession’s ‘voice of LSD and Ecstasy’.
Not that it has all be plain sailing. Along the way a number of less open-minded colleagues have not been so supportive. Some have told me my research is ‘career suicide’ and that the time and money could be better spent elsewhere. They have suggested I consider researching more wholesome topics such as antidepressants, antipsychotics or any of the other packaged products dished out to us psychiatrists by the pharmaceutical industry. However, I passionately disagree. Two-dozen peer-reviewed papers and annual international invitations to speak can hardly be seen as a waste of time. Furthermore, this year I published a text book – The Psychedelic Renaissance – for use by trainee doctors and the general public, bringing them up to date on the latest research in the field of psychedelic drugs. And by final way of validation I have just found out that the Royal College are commissioning me to write a teaching module on psychedelic research for their development and education service, which truly gives the stamp of approval that psychedelic medicine is a subject worthy of pursuit for career doctors.
So, in general, I feel the medical profession has accepted the growing re-emergence of psychedelic research with a reasonably warm attitude. Doctors are often rather conservative, cautious people, as well as being deeply concerned for their patients’ welfare; so they are on guard against anything that could be of harm. In this respect it is understandable that they approach the psychedelic drugs with trepidation. However, they are also people with a keen eye on emerging evidence, so they are able to see through the media scare tactics – on the whole – and accept robust scientific data when it is available.
And this is what the modern world of psychedelic research is all about; a strict avoidance of the pseudo-scientific hyperbole and a rigorous search for hard data about the safety and efficacy of these marvellous medicines. I wish the same approach could be said of the general public.
Convincing the herd that psychedelics will not be the destruction of Society and the dangers of ‘presenting a balance’
Unfortunately the UK media remain unhelpfully wedded to the seduction of eye-catching headlines more than to the assiduous gathering of balanced data. Alongside my efforts to convince the medical profession of the value and benefits of psychedelic therapies I have been keen to use my position to inform the popular media in the same topic. But on several occasions I have become unstuck. One main issue is that non-scientists (such as newspaper editors) have a tendency to not compare like with like. In particular they may counter a perfectly reasonable scientific argument with a less rational emotional line of reasoning.
An example of this occurred when, six years ago, I spoke to a journalist about the value of MDMA Therapy. I was careful to present, as usual, a balanced and cautious approach, using scientific data and clinical evidence to support my arguments in favour of the research. But the journalist then took my interview to his boss, the newspaper editor, who, in an effort to ‘create a balance’ went on to interview the parents of a teenager who tragically died after taking ten ecstasy tablets in a nightclub. The paper then used this as a counter argument to my interview, under the headline ‘British Doctor says Give Kids Ecstasy’ (or something similarly ridiculous). I was furious. I rang the editor and said ‘At what point did I ever recommend anyone taking ten ecstasy tablets in a night club?’ But I got nowhere. The emotional argument of grieving parents is a powerful force, and one that can trump any amount of scientific evidence – even if they are describing completely different issues. I learned an important lesson here about the difference between the sensitive journalist – who genuinely wants the facts – and the ruthless editor, who writes the headlines and is thinking only of ways to attract readers to the article.
‘Drugs Live’ on Channel Four
Recently I was asked to take part in Channel Four’s ‘Drugs Live’ programme about ecstasy. I was in communication with the show’s producers for some months in advance and was party to the development of the script as it took shape. I was due to be on the show to talk about the new ‘MDMA for PTSD’ project that David Nutt and I are planning.
The week of the live broadcast I took two days away from my patients. Channel Four kindly put me up in a swanky hotel in Chelsea and I sat in the audience, according to the script, diligently waiting for the microphone to come my way so I could share my thoughts on the safe and efficacious value of clinical MDMA research. At every advert break throughout the show I was told: “Stand by Dr Sessa! You are on next!” but Jon Snow never spoke me to about clinical MDMA.
Instead what I saw was the producers returning the presenters again and again back to repeated stories of ‘the dangers of ecstasy’, re-interviewing on multiple occasions a non-clinical professor of psychopharmacology and a collection of burned-out gurning ravers about their exploits in nightclubs taking recreational drugs.
Channel Four, who were anxious at appearing ‘soft on drugs’, had pulled my appearance at the last minute because of a top-down decision. In order to ‘present a balance’ they overly crowded the programme with negative reporting at the cost of dropping the far more realistic issue of the safe use of clinical MDMA. It seems that after all these years neither Channel Four nor their anti-MDMA professor could entangle the difference between recreational ecstasy use and clinical MDMA.
The day after the final programme I was staggered to see that the professor in question had written to The Telegraph complaining that he felt he was not given adequate airtime to express his opinions on the programme! I wrote to the paper in reply and my letter was published, with the counter argument that he was given far too much exposure for his minority views that are not representative of either the medical research community or the general public. And here is where the problem lies: a misunderstanding about how we manage risk in clinical medicine.
Clinical Risk Analysis and Psychedelic Research
It is systemically flawed to look at poly-drug recreational “ecstasy users” (whatever they are – the quality of tablet ecstasy being so poor these days as to be a virtually abstract concept) then describe minute, sub-clinical neurocognitive changes, and then compare this against the clinical use of MDMA in a controlled setting. I say sub-clinical because we know (those of us who work with patients and not just study participants in a lab) that despite 25 years of ecstasy use in the UK – with some 30 million doses of ecstasy taken recreationally every year – the levels of mortality and morbidity from this drug remains very low indeed. There have of course been some tragic high-profile deaths, which the media are always keen on reporting in stark contrast to the great many more everyday deaths from other drugs.
The truth is that deaths from ecstasy toxicity are very rare indeed – rarer than, as we know from Nutt, horse riding. And so too are non-fatal psychiatric disorders. I challenge any psychiatrists reading this to tell me they see their wards and clinics full of casualties of ecstasy use. Where is all this neurocognitive damage this Channel Four professor claims to have picked up with his microscope? In reality, after a quarter century of heavy ecstasy use in this country, the massive epidemic of casualties we were promised back in 1988 simply has not happened. Over ten years ago a department at Liverpool University that specialises in risk analysis was set up to look at the relative harms of ecstasy, but the project has since been shut down (they now explore gun crime instead), as it is now a well-known fact amongst scientists and politicians alike that Ecstasy is not, and never has been, a serious public health issue in the UK.
Perhaps the reason Channel Four failed to take into account the concept of risk-versus-benefit analysis is because it did not look at the problem from a clinical point of view? Everyday jobbing doctors know to weigh up the costs and benefits of the treatments we prescribe. We understand that no drug (or any other medical intervention) is 100% risk free. Whether considering something as invasive as cancer chemotherapy, or as benign as a sticking plaster, everything has a cost. In this context it is irrational to demonise the medicine MDMA just because the poorly controlled illegal use of ecstasy has some (very small) risks. This is a terrible example of medical practice and illustrates why non-clinical professors would not last a minute in a clinic setting if they are so rigidly expecting this fantastical ‘zero cost’ for their patients.
But the main reason why I, and the vast majority of the scientific and medical field object so strongly to Channel Four’s risk aversive approach is that RECREATIONAL ECSTASY DOES NOT EQUAL CLINICAL MDMA! (Forgive the capitals, I cannot shout this loud enough).
Endless studies on recreational ecstasy use are meaningless next to the proposed medical interventions myself and other colleagues are trying to introduce to the British public with our research on clinical MDMA. It is like reporting heroin abuse by junkies as justification for doctors not prescribing morphine in childbirth (though in fact much less so, as MDMA is no way near as toxic as the opiate drugs).
So what is next for UK Psychedelic Research?
I am a proud co-chair and organiser of Breaking Convention, a major UK-based psychedelic research conference that takes place every two years and invites international speakers to talk about the latest in psychedelic research. We are planning our July 2013 meeting now and it looks set to be as successful and vibrant as the 2011 meeting. I urge any readers of this article to get involved – assuming the world does not end on the winter solstice [editorial note: thankfully not!] – as ‘BC13’ will be a truly group effort and we want all hands on deck for the show.
The other bit of breaking news is that, in December 2012, our team at Cardiff University, consisting of myself, David Nutt, Jon Bisson, Robin Carhart-Harris and others from the neuroimaging and Trauma Stress Departments, submitted a funding request into the Medical Research Council. This is for the UK’s first clinical study looking at using MDMA-assisted psychotherapy to treat Post Traumatic Stress Disorder (PTSD). We believe that clinical MDMA, carefully prescribed under strictly controlled supervised conditions could have real potential to alter the course of the severely damaging and growing scourge of PTSD – a disorder with a high treatment-resistance that is desperately in need of novel and creative approaches.
Conclusion and Ethics
Perhaps I shouldn’t be too hard on Drugs Live. After all, a programme on this topic even five years ago would have been 99% ‘Killer Ecstasy’ and, if you were lucky, 1% clinical MDMA. So the fact that they shifted this balance a little is, I suppose, progress. But my complaint remains that Channel Four felt obliged to strive for that artificial 50/50 equilibrium – and in doing so they presented a clinically and scientifically unjustified argument that gave far too much airtime to the exaggerated risks of ecstasy and not nearly enough to the safe and efficacious research of clinical MDMA.
I doubt Channel Four’s programme did much to convince kids in clubs to lay off their pills and powders – as evidenced by the tweets coming in to Drug’s Live that night, which (so the presenters told me afterwards in the bar) showed that the general public were overwhelmingly in support of hearing the positive message about MDMA – not the silly antics of ravers and minority scare stories supporting a dated socio-politically motivated agenda.
So Channel Four certainly missed a trick that night in its attempt to debate this ethical issue. But we must not let the archaic irrationally biased argument against clinical MDMA continue to stand in the way of developing this medicine for the benefit of patients who may benefit from it. Like all psychedelic research – as I have discovered throughout my career with these fascinating compounds – the MDMA/Ecstasy debate has always been controversial and fraught with ethical dilemmas. The quest ahead of us now is to insist that media and science alike stay true to the concepts of a dispassionate and accurate evidence base with which to approach the true risks and benefits of psychedelic drugs. To do anything less than that really would be unethical.
Ben Sessa: Ben is one of the five co-founders of Breaking Convention, the UK’s only psychedelic conference, and the author of several novels and non-fiction books, including ‘The Psychedelic Renaissance’. He is a paediatric psychiatrist and is coordinating Britain’s first MDMA/PTSD study. He began publishing in medical journals on the subject of psychedelics as a trainee and since then has spoken nationally and internationally to doctors in a campaign to see these fascinating substances return to the mainstream pharmacopeia where their lives began. In 2008 he became a Research Associate under Prof. David Nutt at Bristol University, where he consulted for the ACMD on MDMA before working on the UK’s only human hallucinogen study in modern times – being the first person to be legally administered a classical psychedelic drug in this country for 33 years.