The need to shift the focus of the psychedelic research in Albuquerque was clear. Risks were real, and long-term benefits vague. I began looking for a way to improve the benefit-to-risk ratio. This required a more concerted effort to develop a therapy study, one that would involve working with patients instead of normal volunteers. It also called for using a longer-acting drug that would allow time to perform psychological work during the acute intoxication.
In the next two chapters, I will describe how the cessation of my work began with research involving the longer-acting drug psilocybin and with plans to treat patients. Events from both within and outside of the research environment combined to exert tremendous personal and professional pressure. At a certain point I felt I had less to lose, and more to gain, by discontinuing the psychedelic research.
19
Winding Down
A wide range of difficulties began affecting our psychedelic drug studies. Their cumulative effect led to my leaving New Mexico and stopping the research. I will begin describing those events in this chapter.
Some difficulties were built into the study from its very inception, and it was only a matter of time before they began causing problems. The biomedical model was the most obvious of these concerns.
Others resulted from a series of unfortunate events. Such was the case of the university’s Human Research Ethics Committee not allowing us to take the psilocybin project out of the hospital into a more pleasant environment.
Many of the stumbling blocks were ones I dimly saw but chose to minimize, hoping they might “take care of themselves”: There should have been little surprise that a critical mass of collaborators at the University of New Mexico failed to materialize as promised. I suspected, but needed to see for myself, that there would be few sustained beneficial effects on our volunteers from isolated high-dose DMT sessions. I kept on the research team an especially troubled and troubling graduate student. I chose to disregard reports I had heard about contact with beings on DMT and was unprepared for dealing with their frequency in our work. I ought to have predicted what would be my Buddhist community’s response to publicly linking psychedelics with Buddhist practice.
Certain developments truly were completely unexpected, but in retrospect they appear related to the strain of performing the research, and its effects on those around me. My former wife’s sudden development of cancer falls into this category.
The repercussions of working with spirit molecules are so complex, so widespread and far-reaching, that no one who was not there from the very beginning could really understand what this research was like. However, the purpose of this book is to tell the entire story. Part of every story is its end. For those who are now working, or wish to work, with psychedelic drugs, it’s important to convey these details, in a spirit of “informed consent.” You’d better know what you’re getting yourself into.
There were several threads running through these projects, and early on they all lined up rather neatly. I wanted to give a lot of DMT, see what various doses did, and then give more. The first two projects, the dose-response and the tolerance studies, felt like the appetizer and the main course. Single high doses of the spirit molecule were incredibly psychedelic, and repeated dosing made it possible to assimilate and work more effectively with the access it provided to profound altered states. However, the model that allowed me to begin also negatively constrained subsequent research projects with DMT.
The biomedical model’s explicit task is to dissect, dig deeper, and explain-by-describing the biological phenomenon under examination. Since this model holds sway in psychiatric research, I learned it thoroughly and presented the DMT studies in those terms.
In the dose-response and tolerance studies, the biological measurements were less personally compelling than were the psychological effects of DMT. We drew blood and measured vital signs and temperature, and with these data we could mathematically demonstrate that something really was going on. The rating-scale data also nicely straddled the clinical and objective realities; that is, the questionnaire provided objective validation of subjective effects. Nevertheless, the most fascinating and rewarding data were obtained by listening to and watching our volunteers in Room 531.
However, once we began the required mechanism-of-action research, the biomedical model was going to exert greater restrictions upon the types of studies we would be allowed to perform. In chapter 8, “Getting DMT,” I described these follow-up DMT studies, which examined the effects of pindolol, cyproheptadine, and naltrexone. We combined these receptor-blocking drugs with DMT and compared responses to this combination with those of DMT alone. We thus could infer the role of the relevant receptor in mediating specific effects of the spirit molecule.
These types of studies no longer placed the subjective effects of DMT at the forefront of our inquiry. The mechanisms were now more important than the experience. The explicit setting had shifted in a titanic manner. These protocols now approached our subjects less as individuals undergoing a psychedelic experience and more as biological systems with which we could define drug mechanisms more precisely.
It wasn’t easy to be as enthusiastic about these studies as the earlier ones. In fact, volunteers did as much to encourage me to perform them as I did to request their participation. Adding to this discomfort was my sense that I had learned something deep and basic about the workings of the spirit molecule. In the last chapter, I describe this conclusion—that is, that lasting or substantial benefit from high-dose DMT sessions in our setting was difficult to see. Combined with the gradually growing incidence of adverse effects, I saw the risk-to-benefit ratio turning less favorable. I needed to change the model to one in which people might benefit from participating in the studies.
The two frameworks that might contain projects where people “got better” were the psychotherapeutic and the spiritual. A spirituality-based project was unlikely in a clinical research environment. So I began work on a psychotherapeutic project, a psilocybin-assisted psychotherapy study with the terminally ill.
It was at this point I felt most acutely the lack of a larger psychedelic research community at the university. While the Research Center and Department of Psychiatry were consistently and unquestionably supportive of my studies, there were no local psychiatric colleagues familiar with psychedelic drug research.
A large part of why I began our work with a strictly biomedical model related to promises by other psychedelic research scientists, especially psychotherapeutically oriented ones, to join forces with me once the New Mexico research started. I was willing to take the set and setting risks inherent in the biomedical model in anticipation of colleagues later helping me shift to more treatment-based activities.
There’s a widespread and far-flung network of scientists and clinicians interested in psychedelic drugs throughout the United States, many of whom have close affiliations with the academic and the private sectors. I met nearly all of them at various meetings before the DMT research began. This psychedelic research network seemed more altruistic and cooperative than the larger biomedical research community. Perhaps scientists who believed in psychedelics’ power could join forces, rather than compete.
At these meetings was a unanimous complaint that “the government won’t let us study these drugs.” If only somewhere someone could begin, that place would become the center of a psychedelic research renaissance. As it became apparent that I would receive permission to give DMT and would obtain some funding for the study, it seemed that the University of New Mexico would become just that center of psychedelic research.
I was willing to accept the short-term drawbacks associated with the animal-biology-based model as the price for initiating studies. However, I hoped that after establishing safe use of psychedelics under medical supervision, more therapeutic studies would begin with my colleagues’ assistance. It would be a smooth transition from our dose-response and tolerance work to psychedelic therapy projects.
Topping off this amb
itious clinical research framework was the development of new psychedelic drugs with unique properties. With the full range of clinical facilities available, it would be easy to assess the effects of new medications in normal volunteers and in specific patient populations.
It sounded good. The University of New Mexico is the premier university in the state and has dozens of undergraduate and graduate departments, professional schools, and a highly ranked medical school. I believed that once research began in Albuquerque, the half dozen or so carefully positioned colleagues throughout the country would quickly join me. They said they would.
After the Food and Drug Administration approved the DMT study and we began work in late 1990, I asked my colleagues to come on board. The opportunity for which we all had been waiting had arrived.
Here is how they answered:
“My wife thinks Albuquerque’s too small. There aren’t enough malls. My daughter doesn’t want to leave her friends.”
“We have to wait until our son graduates from high school in seven years.”
“The University of New Mexico is second-rate. I’d never take my research there.”
“We’ve already moved enough. I can’t commit to another move unless I know it’s the last one I’ll ever make.”
“I have to wait until I get my Ph.D. I don’t know when that will be.”
“I don’t want to work that hard. I like my part-time job at a mental health clinic. I get to take a lot of vacations and go on meditation retreats.”
In retrospect, I had succumbed to my own wishful thinking. It was easier to talk about the transformative value of the psychedelic experience than it was to put into practice some of its contents. My colleagues may have had inspiring experiences, but they were not committed to goals that required work and sacrifice.
There were, of course, other less explicit reasons for everyone’s sudden change of heart about the importance of joining forces to generate a critical mass of psychedelic researchers. One of these undoubtedly was the normal and reasonable, although difficult to admit, anxiety about really doing this sort of work. Anyone who knows anything about administering psychedelics gets nervous just thinking about it.
Another issue concerned political motives. That is, who was going to lead the way in psychedelic research? Rather than combining our efforts, some colleagues saw the breakthrough occurring in Albuquerque as an opportunity to establish their own research foundations, putting themselves at the head of such organizations.
While the lack of support by psychedelic colleagues was an emotional loss, I could deal with that. More problematic was being left holding the ball. I now was committed to a course of research out of which I had planned to transition as soon as I could with the aid of those collaborators.
As the dose-response study neared completion, I needed to decide how to design subsequent grant applications and study designs. It seemed reckless to begin proposing full-fledged psychotherapy protocols. I had no training in that field of research and knew that any such proposals would fail to attract funding. There was momentum to continue biomedically based studies. We had the data and Research Center support, and it was my area of expertise. These mechanism-of-action follow-up studies would not be controversial, and there would be support for funding them.
I could delay this process by performing dose-response and perhaps tolerance studies with other drugs, such as psilocybin and LSD. However, the brain-science projects would increasingly take precedence. Any psychotherapeutic studies would be minor, informal, and peripheral to the main thrust of my work. I designed several mechanism-of-action experiments and received approval and a generous grant to perform them. At the same time, I also received approval and funding to perform a dose-response study with psilocybin.
Psilocybin, the active ingredient in magic mushrooms, is closely chemically related to DMT. It’s orally active and much longer-acting. It also is significantly more popular than DMT, so learning about its effects has greater relevance to public health issues of drug abuse.
Psilocybin’s six- to eight-hour duration was attractive in many ways. We’d be able to study its effects in a more leisurely manner than with DMT. Volunteers could participate in experiments while intoxicated with psilocybin in ways that were impossible in the case of DMT’s debilitating and brief peak effects.
However, the setting of the Research Center was an obstacle to designing and thinking about psilocybin protocols. Many of our DMT volunteers would have leaped at the opportunity to participate in a psilocybin project if it were not for the prospect of spending an entire day in an altered state of consciousness in the hospital.
The short duration of DMT’s effects usually allowed us to find a window of tranquility at the Research Center. Even so, there were many times when the sounds of jet planes, laughing and debating medical personnel, crashing carts, groaning and screaming patients, the overhead duct fan, and roaring compactors had a major negative impact on people’s DMT sessions. The smells of burning food, medication, and powerful disinfectants were especially grim. And the rare but regular occurrence of hospital service personnel walking into Room 531 was a constant source of anxiety. They all would combine to make a full-day psilocybin session an exercise in tension.
The university owned several small houses within a city block of the hospital. There was a relatively steady turnover of clinical, administrative, and teaching personnel in them. Several had little courtyards and gardens, and they seemed perfect for taking the psilocybin research “off-site.”
I approached the Research Center nursing and administrative staff, the University Hospital legal counsel and risk-management office, and the Department of Psychiatry about moving the psilocybin research out of the hospital. They all considered my request reasonable, prudent, and within the realm of possibility
However, the Human Research Ethics Committee, many of whose current members were not familiar with our research, was not comfortable with the safety issues off-site studies might raise. They wanted to make sure that security guards were close at hand to manage any volunteers who might act dangerously, and they wanted us to keep studies in the more contained hospital setting. As is so often the case, their fears led to exactly the outcome they hoped to avoid.
Several brave DMT volunteers agreed to come in for some psilocybin pilot work in which we would determine what were “low,” “medium,” and “high” doses of the drug. A few people dropped out after low-dose experiences, finding the hospital room and setting too restrictive. There were no significant problems with these research subjects other than that they felt cramped and bored. Then we had a serious incident.
One of these volunteers was Francine, a physical therapist I had met while working in the hospital as a consulting psychiatrist. She was thirty-five years old when she volunteered for the DMT-pindolol study. She had taken a lot of psychedelics in college, but stopped using them upon entering graduate school, after which she got married and raised a large, successful family.
I was concerned by her tales of driving long distances, swimming in lakes, and undertaking other tasks requiring focus and attention while under the influence of psychedelics. Perhaps she was trying to fend off the effects of the drugs with her hyperactivity. She was physically rather robust, but it didn’t seem as if her physique was the only thing contributing to the sense she exuded of being tightly wound, bunched up, and restricted. Nevertheless, careful questioning on my part failed to turn up any sign that she could not manage situations that came up while she was under the influence.
Francine tolerated the low screening dose of DMT without difficulty, but she kept the head of the bed maximally elevated, at an almost ninetydegree angle. She looked terribly uncomfortable, but denied feeling any awkwardness. She talked throughout the entire session, from the time I began giving the drug until all effects were gone. I gave her fair warning about the next day’s high dose of DMT.
I doubt it will be that big. After all, I’ve taken a lot of LSD with little effect
in the past.
We asked her to put on the eyeshades and lie down before we began with the following morning’s high dose. If she were less distracted by her desire to provide us with ongoing commentary about her experience, she might be able to let go into the effects more easily. She reluctantly agreed to put them on her forehead so that she could flip them down over her eyes later, “if I see the need.” She again kept the back of the bed upright.
Francine’s high dose was unpleasant and reminded her of how much time had elapsed between her college tripping days and now. She had a busy and full life, with a lot of responsibilities, and wasn’t sure about the psychic high risk involved in taking big doses of drugs anymore. As with the low dose, she kept her eyes open and talked throughout the session. One of her comments neatly summarized Francine’s attitude towards the spirit molecule:
The DMT said, “Come with me, come with me,” and I wasn’t sure I could really afford to go.
Despite her misgivings, Francine followed through with the pindolol study without difficulty and eagerly volunteered for the psilocybin pilot work. She believed the slower progression of its effects would be more to her liking than the “nuclear cannon” of DMT.
Francine had an enormously gratifying peak experience in response to an early dose of psilocybin. She was much more cooperative with the structure of the setting that day and laughed, giggled, and exclaimed joyfully for most of the session. As the day came to a close, she summarized it for us:
It was the most unbelievable thing. I’ve never been that high in my life. It made 0.4 DMT look small by comparison. It was the ultimate trip. I may never want to trip again. Why would I? What would be the point? Certainly no higher dose of psilocybin would be necessary.
DMT: The Spirit Molecule: A Doctor's Revolutionary Research into the Biology of Near-Death and Mystical Experiences Page 30