Nicotine patches, chewing gum, cold turkey.
Giving up cigarettes can be tough, but there are
many strategies smokers can try. Matthew Johnson
wants to add another: he says he can help smokers
quit by giving them another drug – psilocybin –
that has been illegal for years in much of Europe
and North America. And yes, he realises that
sounds unconventional.
“The idea that this research sounds
counterintuitive, it makes sense to me,” he tells
me as we sit in his office at Johns Hopkins’
Behavioural Pharmacology Research Unit in
Baltimore.
It's been off limits for all the wrong reasons
– Matthew Johnson, pharmacologist
Johnson is a behavioural pharmacologist who has
been researching the relationship between drugs,
the brain, and human behaviour for more than 20
years. The last 10 of those have been spent here
at Johns Hopkins, where he and his team have
focused on psilocybin, a naturally occurring
psychedelic and the active ingredient in ‘magic
mushrooms’. Illegal it might be, but if psilocybin
is given to smokers a few times in a carefully
controlled way, it can be a remarkably effective
aid to help them kick the habit, he says.
“Most people will naturally assume that we're
looking at substitution therapy in the spirit of
methadone for heroin addiction or nicotine patch
or nicotine gum to replace smoking. [But] we're
not talking about putting someone on psilocybin or
mushrooms every day. It's not trading one
addiction for the other.”
This new research has been inspired by work done
in the 1950s and 60s that looked at using
psilocybin and LSD as treatments for addiction.
Although results back then were hugely promising,
the research hit a dead end as use of these
substances spread from labs and into the emerging
drug counter-culture. The drugs were criminalised,
and clinical research became impossible to
conduct.
“It's been off limits for all the wrong reasons,”
Johnson explains. “We know [these substances]
continue to be used, and because of not wanting to
encourage uncontrolled recreational use, we've
been so restrictive that we haven't allowed
research. We're really playing a catch-up game.
This stuff should've been done in the mid 70s…the
whole research agenda was just put in deep freeze
for multiple decades.”
In 2008 Johnson co-authored a paper entitled 'Human
hallucinogen research: guidelines for safety’,
which outlined how to responsibly conduct medical
trials with psilocybin and other hallucinogens. It
included recommendations on how to screen
potential volunteers, prepare them for the
experience, and how to conduct the drug-taking
sessions safely. The paper signalled a change in
attitude towards researching these compounds,
reflected by the fact that more than 460
psilocybin sessions have now been conducted at
Johns Hopkins alone, ranging from investigating
its use by cancer patients through to its effects
on meditation. But it’s the Smoking Cessation
programme, which has just finished its pilot
stage, that has attracted the most recent
attention.
It begins with a mantra...
The programme seems deceptively simple at first.
Fifteen volunteers, all long time smokers from the
Baltimore area who have tried and failed to quit
smoking multiple times, start with a course of cognitive
behavioural therapy. CBT is the standard
psychological approach to quitting smoking,
encouraging subjects to reflect on their
established thinking patterns.
A vital part of the Hopkins programme’s CBT
approach is the writing and reciting of a personal
mantra; a simple phrase that each volunteer
creates that encapsulates why they want to quit.
“This is really our mission statement. If you had
one sentence that you could remind yourself down
the road why you quit. We’ve had some people for
whom it’s about family: ‘I want to be there for my
granddaughter.’ For other people, it's more
philosophical, ‘The air that I breathe. I want it
to be free.’”
This mantra becomes even more central on the day
they take their first psilocybin. After four
sessions of CBT, the volunteers smoke what is
meant to be their last cigarette. For some this is
the night before, for others it’s literally just
before the session. “We've had people smoke in the
parking lot right before they come in here,”
Johnson tells me.
Then, it’s time for the drug. Albert
Garcia-Romeu, a post-doctoral fellow at Johns
Hopkins, who ‘guides’ the volunteers through the
CBT and the psilocybin sessions, describes how it
works: “We have them self-administer the capsule.
We take their cell phone. We take their shoes. We
give them some slippers. We want them to relax
into the day and feel almost like they're in a
spa. They don't have to go to work. They don't
have to do their normal day-to-day thing.”
“We practice before. Give them our hand so that
they have the support if they need it,” explains
Mary Cosimano, another of the guides who has been
working in the field for more than 15 years. “We
tell them, ‘We're here for you as much as you
like’.”
“Once the drug effect starts to kick in, we
encourage them just to lie down,” continues
Garcia-Romeu. “They put on headphones. They cover
their eyes. We have them just lay back and watch
and wait.”
We usually discourage them from getting too
chatty
From this point, the researchers step back. “What
we do here is psychedelic therapy,” explains
Garcia-Romeu. “That's high-dose. That's generally
not a talking therapy. We usually discourage them
from getting too chatty because it can be really
easy to get absorbed in the interesting sensory
things that are going on. We try to encourage them
to go inward and that's really where a lot of the
important work happens. I'm mostly just there as a
safety-monitor.”
The aim, the team explains to me, is to give the
volunteers a ‘profound’ or ‘mystical’ experience
that causes them to reassess their relationship
with smoking. That might sound like exactly the
kind of New Age drug talk that made people take
this kind of research less than seriously in the
past, but Garcia-Romeu explains it to me in a way
that sounds much more grounded.
“[Research shows there’s a] 71% success rate for
people who quit smoking just after they had a
heart attack,” he explains. A heart attack would
certainly qualify as a profound experience, but
it’s not something you can go around triggering in
people in order to stop them from smoking. Instead
the aim is to use a powerful psychedelic trip to
trigger a similar effect… an intense, abstract
experience that changes the patient’s perspective.
It’s this that the team refer to as a ‘mystical
experience’.”
This experience might range from images of God,
to powerful personal memories about their own life
or childhood, he explains.
The person is made to feel as safe as possible
The secret to triggering this kind of experience
is setting and context, Johnson explains. “Our
clinical impression is that those experiences are
most likely to happen under conditions where the
person is made to feel as safe as possible, that
they've developed a very strong rapport with the
people that they're with.” Also, the team has
found that making the act of taking the drug a
ritual seems to help.
“We ask them to bring pictures of themselves over
the years, family, people, places, and things.
We've had people who have filled the room with
pictures,” explains Cosimano. “Things that could
be important to them, objects. People have set up
altars. People bring stuffed animals or a blanket.
Things that can make them feel comfortable, safe,
cosy, meaningful.”
To enhance the feeling of ritual, the researchers
also put the capsule in a wooden goblet with
incense, and ask participants to repeat the mantra
they developed during the cognitive behaviour
therapy.
Garcia-Romeu and Cosimano show me the session
room, the place where these rituals take place.
It’s pretty much exactly as they’d described it to
me – a small, cosy room, softly lit with a
comfortable couch. They let me sit on it, and hand
me the wooden goblet used by their volunteers.
Books on Michelangelo and Van Gogh are scattered
around. There’s an undeniable feeling of safety
and comfort in the almost womb-like room, where
volunteers spend up to six hours until the drug’s
effects have worn off, after which they are taken
home by a member of their family.
Talking to the team is fascinating – they’re all
incredibly friendly, resolutely professional, and
clearly passionate about their work – but it’s
still hard for me not to shrug off the feeling
that the work seems counterintuitive. Perhaps it’s
my own prejudices about these drugs, but I remain
sceptical.
Still, the trial program – small though it is –
has produced tantalising results. Out of the 15
people, 12 were still smoke-free six months
following the trials, according to the
researchers. “We think and hope that there is
something new going on here,” says Johnson.
“We've had people in this study, a couple of
which claimed extraordinary things, like that they
don't feel nicotine withdrawal and they've been
smoking for pack a day for 40 years. Just seeing
that in one person is pretty profound.”
I push him a little more on why he thinks
psilocybin in particular might work in this way:
is it purely just a psychological effect, or does
he think the drug itself is affecting the brain’s
chemistry? “We can best understand it at this
point from a psychological perspective,” he
replies. “This isn't a drug that, in a simple way,
affects the brain’s nicotine receptors. Does this
drug under the right conditions eventually change
the way that the brain itself is interacting with
its own nicotine receptors? That's something that
very well could be happening. We don't know.”
Johnson is not the only person looking at
psychedelic therapies. Anthony Bossis is part of a
team at New York University conducting similar
trials into using psilocybin
to combat anxiety in cancer patients. He’s
impressed by Johnson’s preliminary results. “These
therapeutic approaches certainly warrant
additional and careful scientific study.”
And that’s what Johnson and his team are focused
on now, the next round of studies. The study
sample has been expanded to 80, and volunteers
will undergo MRI brain scans before and after the
sessions so the team can get a better idea of what
neurological effect the psilocybin is having on
smoking, if any. There are clearly still years of
work to be done, but Johnson is positive, and
believes it could be used to treat a variety of
psychological and behavioural conditions, not just
addictions.
There are many hurdles to overcome before
treatments become widespread
There are, of course, other hurdles that would
need to be passed before these treatments become
widespread. The main issue is working out who
would develop these compounds commercially, says
Thomas Insel, director of the US government’s
National Institute of Mental Health. The
pharmaceutical industry usually takes the lead in
that sort of work, he says, but they generally
have less interest in developing drugs for brain
disorders. “That said, a version of ketamine —
which also was a drug of abuse – is being
developed by Johnson and Johnson as an
antidepressant.”
And then there are legal questions too. “These
drugs are being used in the context of
psychotherapy, and we don’t have a clear
regulatory framework for [that yet],” says Insel.
These drugs are clearly a long way from becoming
widely available in medicine. “But that’s not a
reason to avoid [developing the therapies],” he
says.
Ultimately, the early success of these small
trials might not be repeated on larger scales. Yet
after decades where psychedelic therapy was never
investigated at all, scientists like Johnson and
his team are now at least trying to dig deeper
into the unexpected effects of this notorious
drug.