It's a steep climb to get to your legal high. Bristol's first psychedelic clinic sits on the end of an elegant (probably Edwardian) shopping row at the top of a precipitous hill at the edge of the suburb of Clifton. In a compact but airy split-level office, formerly a Thai café, a company called Awakn has been trying to help people by dosing them with the drug ketamine.
This may come as a shock to listeners of The Archers. Twenty years ago one of the radio soap's main characters, Jazzer McCreary, was rendered nearly comatose by taking too much of the drug, described by the programme's website as "a powerful horse tranquilliser which is abused for recreational purposes". Jazzer spent a week in intensive care, was discharged with memory problems and was barred from the local pub for months. And that was as much as I knew about ketamine until a few weeks ago.
Dr Ben Sessa, the chief medical officer for Awakn, whose career has been devoted to researching the properties and uses of "mind-altering" drugs, is bewildered by the association. "Can I say something about this horse tranquilliser business?" he asks me when we meet in the treatment room in the Awakn basement. Then, without pausing, "I do not understand it. We don't say, 'Penicillin, that dog antibiotic' – we use penicillin in dogs all the time. We don't say, 'Morphine, that cat analgesic' – my cat got prescribed morphine after a broken leg. Ketamine is not a veterinary medicine; it's a human medicine. Today, in Bristol hospitals, we'll be giving it to a dozen children as an anaesthetic."
More of the eloquent Sessa later. Though he professes surprise at the way this drug has been misdescribed, in fact neither of us is astonished. From the late Sixties onwards a moral panic about drug taking and substance abuse swept the world and became the half-century-long "war on drugs". In that battle "psychedelics" – drugs that have hallucinatory or perception-altering properties – were lumped in with substances whose highs very often came at the cost of addiction. LSD went on the proscribed list alongside heroin; psilocybin (or magic mushrooms) was banned alongside crack cocaine; MDMA went down the same road as crystal meth.
When the Essex teenager Leah Betts died after taking Ecstasy at her 18th-birthday party in 1995 and her heartbroken parents released a Polaroid picture of her comatose in hospital, the seemingly inevitable response was to try to prevent the taking of such a drug. That attempt at persuasion required its demonisation. By the late Nineties, ketamine, a widely used anaesthetic that had become a dance-party drug, was consigned to the same hall of infamy.
I'd date the beginning of the fightback in this country to the Nutt affair of 2009. Professor David Nutt, a psychopharmacologist (ie an expert on the effects of chemicals in the brain) was the last Labour government's "drugs tsar" – chairman of the Advisory Council on the Misuse of Drugs. By no means a flower child, Nutt was a hard-headed assessor of risk. If there were a harm index, he wrote, alcohol would come in fifth, behind heroin, cocaine and barbiturates, and tobacco would be ninth. Cannabis, Ecstasy and LSD wouldn't even make it to the top ten.
When I talk to Nutt (he's now paid to provide oversight to Awakn's work), he recalls an interview on the Today programme when he was asked whether he was "seriously telling us that LSD is less harmful than alcohol" and he replied, "Yes." He was then sacked by the home secretary, Alan Johnson. What he'd said might be true, but it didn't help the anti-drug effort. Nutt's sacking, though, caused a reaction in the scientific community, which led to a widespread questioning of anti-drug tropes.
Meanwhile, younger researchers were already questioning the established wisdoms. Not least because, unlike their elders, they either knew plenty of people who took recreational drugs or had taken them themselves, and were far more aware of their day-to-day effects.
One of the people I have come to meet in Bristol is Celia Morgan, professor of psychopharmacology at the University of Exeter. She's also head of the first controlled study into the use of ketamine to treat alcohol abuse – which is what they're doing here in Clifton – and head of Awakn's programme for helping treat addiction using ketamine alongside psychotherapy. (Readers may need Awakning after that list, but it had to be got through.)
As a psychology student at University College London needing to find a subject for a third-year project, she chose to look at ketamine simply because quite a few of her contemporaries used it at parties and described its strange properties. That took her to the literature of attempts in the Fifties and Sixties – before the war on drugs closed down the research avenues – to study the therapeutic use of psychedelics.
In particular, she was struck by the work of Humphry Osmond, a British psychiatrist living in the US. Osmond, the man who famously "turned on" the writer Aldous Huxley to mescaline, began giving ketamine to alcoholics because he had observed that those who suffered delirium tremens hallucinations when they were coming off the booze were more likely to stay off it. He thought it might have worked as a kind of aversion therapy, but however it worked, he found that withdrawing alcoholics given LSD were more successful at kicking the habit.
Morgan wondered whether it wasn't other aspects of the psychedelic at work – its mind-altering rather than its aversive properties. "There was this fascinating change in consciousness and in time – all the ineffable things, the mystical experiences, the sense of coming close to some kind of meaning. Seeing yourself from outside your body."
She was working as a psychologist for a substance-abuse service in London as she continued to read up on this history. "It was pretty severe, and there wasn't a lot of treatment. And having several members of my family who struggled with alcohol abuse, I was looking at this stuff on psychedelics." And thinking: we should be researching this. Despite constant discouragement from going down the route of studying therapeutic psychedelics, Morgan stuck with it. In 2006 at Yale, where she was attached for a while, the first research was published by a group of which she was a part showing that ketamine was also an antidepressant. "Initially, people didn't believe it. But the evidence mounted. Very depressed patients who couldn't get out of bed would suddenly get up and enjoy life. It was like that film Awakenings."
Fifteen years on, in January this year, Morgan and her team were able to publish the results of a UK trial in The American Journal of Psychiatry. It showed that patients given doses of ketamine in tandem with sessions of psychotherapy were significantly more able to reduce or altogether stop their use of alcohol. Compared with a pre-trial abstinence rate of 2 per cent at six months, patients now achieved abstinence 87 per cent of the time. And that, as Morgan points out, given the premature death rate among alcohol abusers, is a lot of lives saved. The trial has greenlit the possibility of widespread use in the UK of ketamine plus therapy to treat alcoholism. And, as we will see, it opens the door for the use of psychedelics in an incredible range of therapeutic situations, from depression to, well, almost anything.
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Alex was part of it. His treatment took place in London but he's travelled to Bristol for our meeting. He's in his early forties, middle class, short beard, heavily tattooed, with a soft Scottish accent. He uses words carefully and avoids all extreme expressions. He was a photographer for most of his career but is now in training to become a clinical psychologist.
The story he tells is one of a low-level desperation that has its roots in something utterly everyday. "I started drinking in parks when I was 16 or so because there was very little to do in the town I was living in," he says. "I would hang out in parks and alcohol kind of came with that, and I never really stopped, to be honest."
It carried on into adulthood. He wasn't a binger who'd wake up having soiled his pants, he says. Just a steady three strong beers a night and maybe a liquid lunch, and every now and again he'd drive when he shouldn't have. Nothing anyone called him out on. "It was an insidious, creeping problem, and there wasn't ever a point where I thought I've got to do something about this. I was a boyfriend, a friend. I was managing all my responsibilities."
But then he and his girlfriend had their first child and Alex decided that he would be a better father if he drank a bit less. And discovered that he simply couldn't. He would always find a reason to drink. He'd offer to go down to the supermarket to get some shopping and find himself coming back with more than food. He'd just be too edgy and agitated if he denied himself some booze.
And, as he describes it, the failure then made him depressed. "I'd say, OK, I'm not going to drink for a weekend, and then not be able to keep to that and become miserable." And then, he says, he heard about the ketamine trial, which he joined in January 2019.
In some ways Alex may not sound like the ideal character for a piece like this. It would be more dramatic if he had a history of blacking out, being sacked, of violence or serious health problems. But that's what makes Alex's story in some ways more useful. Like so many others, he was a functioning low-level alcoholic and he needed help.
Over the course of four weeks Alex received seven psychotherapy sessions, three of them preceded by an intravenous infusion of ketamine. Of course, this being a blind trial Alex didn't know for sure whether he was in the group being given the drug or not. He hoped he was and, after the first infusion, felt pretty sure he was. The psychotherapy, he says, was very directed to the process he was going through. Very much about boozing and not a lot about his mother.
So what was taking this smallish dose of ketamine like? Alex had shades on and some music coming through headphones. After about five seconds he "started getting some kind of lights in my vision, flashes of colour, and I notice they're particularly bright and then I'm kind of sucked into them. It wasn't like 'boom' in your face; it was a slow coming into the experience, definitely a very new, peculiar feeling."
Then on a different day the infusion led to him hallucinating that he was part of an endlessly recurring experiment in a Matrix-style study. And then he thought he might be dead and outside his physical body. Instead of it creating anxiety, however, he just found that it didn't really matter. His feeling was one of acceptance. Then he returned to his body. "What then?" I ask. "Tea and biscuits," he replies. "Very British."
I know from researching an article about psilocybins in 2018 that what Alex experienced is a mild version of a common set of psychedelic sensations. Morgan tells me that she took a dozen people who'd had ketamine "and that sense of the dissolving, losing a sense of self, was very common. We call it dissociative, because you're less obsessed with yourself. But actually you feel more connected to everything else around you, to the universe. You're less self-absorbed. You can feel like you're melting into the sofa…" I must look alarmed. "In a good way," she says with a laugh.
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Here we come to the absolutely fascinating part. How does taking a psychedelic drug so affect the brain that it can "cure" someone suffering from a destructive compulsion or depression? That it works in this instance is evidenced by the results of the trial. But why?
Certain conditions, like depression, are accompanied by a dying off of neurons in the prefrontal cortex of the brain – this can be observed. We also know psychedelics work by blocking certain receptors in the brain, though the receptors ketamine affects are different from those of the other common psychedelics. In effect, they stop transmission between neural pathways in the brain.
In Nutt's words certain negative behaviours, like addiction, are in essence a constant repetition of the use of certain neural pathways and the atrophy of others. As we become depressed, become alcoholics, become convinced we are worthless, we get locked into what Nutt calls "thought loops". After a while the alternative pathways become disused.
Sessa, who has a background in child and adolescent psychology, sees many mental health problems as the consequence of childhood trauma. Not necessarily what we usually call child abuse, but all the various ways in which a child is taught to believe she is worthless or unloveable. "The more you use a neuron pathway," he says, "the more connections it gets, the faster it becomes and the more it becomes your go-to pathway." And the more it does, the greater the likelihood of problems from addiction to compulsion to depression. It's like worrying away at a wound until it bleeds.
But by blocking the use of existing neural pathways, ketamine encourages the growth of others. Sessa uses the analogy of ketamine as a fall of snow on an overused piste. "Imagine you've got a ski slope and if you go down the mountain in the same way every day, you always let the skis drop into the same path. And that's the path that's been there since you were a child. Ketamine is an overnight fall of snow, so the next day there are no ski tracks and you don't have to go down that way. You can take a new one."
And that is where the psychotherapy comes in. It plays the role of the ski guide suggesting new and better paths to ski down. One closes down the bad ways, the other opens good ones. It's a fabulously satisfying explanation. And it's not just a hypothesis, says Sessa. Studies of brain tissue have shown neural regrowth associated with ketamine. It causes (my new favourite word) neuroplasticity.
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I forget to ask Alex what he thought of the explanation why his brain allowed him to kick his drink habit. Perhaps today I am suffering from a neuroplasticity deficit. But something certainly worked for him, though it took time.
"I would say probably a year into the trial, I started to feel like I might have this licked. I think there is a drive to succeed that I didn't have before. There was a belief I could overcome it and that I wasn't going to fail, and that was driven by my experiences in the trial."
Alex, as I said, is not given to exaggeration, so the next thing he says is quite moving. "It's like I am a different person. I'm a better husband, a better father, a better student, a better son, a better brother. I hope my family would agree it's really turned my life around."
For Sessa, it's not just a success, it's a vindication. He's been working for this for most of his career. And for a lot of that time he has felt like the ignored scientist who has spotted the asteroid on its way to Earth.
"I had the experience as a student of none of my teachers knowing anything about this and of being told things I knew simply were not true. I would say, 'No, actually this was really big in the late Fifties. It was the next big thing in psychiatry and it wasn't controversial.' "
His phone rings. "Lucy in the Sky with Diamonds? Really?" I say. "Been my ringtone for 15 years," he says happily. "This is the pinnacle of my life's work. For the past 15 to 20 years I've said, 'One day I'm going to open the UK's first medical psychedelic clinic.' And here we are. It's a tremendous validation for me against those cynics."
But he's right. After ketamine will come trials with MDMA, psilocybin, maybe LSD. And not just for alcoholism. Awakn is opening a new London clinic to add to the other planned centres where patients can now have the treatment at a cost of £6000 (NZ$11,850). I take a look at it on my return from Bristol. It's located just by Euston station. It's very light, with Scandi wood, lots of plants and reindeer moss as wallpaper. There are six treatment rooms and Awakn is very proud of it.
You won't even need a GP's reference. The Awakn people hope that their results will spur the NHS to make their therapy an approved treatment and provide it to patients free. It's a common argument that you can save money spent on people in appalling condition if you treat them earlier. I cannot think why that would not be true in the case of alcoholism or depression. As Nutt reminds me, the consequence of addiction currently costs the NHS as much as treating cancer.
But will the research for new uses happen here? In the US, investing in the area of therapeutic psychedelic research is now a multibillion-dollar affair. The money from patients is more easily forthcoming and there's less regulation. Over there, ketamine clinics often don't offer psychotherapy. They let the snow fall and the skier go where they may. Here, where the NHS could guarantee a less risky set of therapies, there is, of course, no money for research. We are resolutely still behind the curve, at a time in our history when we badly need to be more enlightened and open. Nutt tells me the depressing news that the leading psychedelics research scientist in Britain, Robin Carhart-Harris, who has been turned down seven times for a research grant, has now upped sticks and gone to San Francisco. Dominic Cummings, says Nutt, was very interested when he was at No 10, but right now there's little sign of things changing.
The lack of funds won't stop Awakn. Right now the Bristol clinic has a waiting list of 400 people who want to pay for treatment. Barring disasters, success will breed success. But if the treatment is as effective as the trial suggests, and if other psychedelics offer variations on that therapeutic theme, and if the scientific explanation is the one I was given, the implications are incredible. "The use of psychedelics," says Nutt, "is the biggest breakthrough in mental health innovation since the Sixties – the biggest revolution in decades. Within 10 years psychedelic clinics will be present in all psychiatric establishments." Goodbye, ECT.
But let's think bigger. Because what negative and damaging mental state might not be treatable with psychedelics? If alcohol abuse and depression, why not OCD and even obesity? Weight watchers on acid. Imagine that. Now you can.
What if the drugs do work after all?
Several recreational drugs known for mind-altering trips could help alleviate PTSD, depression and other disorders, research shows. So will our doctors soon be prescribing us MDMA or LSD?
Magic mushrooms
The hottest treatment for depression since Prozac? It could be growing in a field nearby. Patients who were given psilocybin, the psychedelic compound found in "magic mushrooms", showed a reduction in depressive symptoms of more than 50 per cent after their treatment in a 2020 study by Johns Hopkins University.
MDMA (Ecstasy)
It's best known as a party drug taken in clubs, but MDMA could help trauma survivors cope with painful memories. Two thirds of people no longer qualified for a PTSD diagnosis after treatment with it in a trial by an American charity last year. The drug appears to work by calming the amygdala – the part of the brain that tells the body to prepare for danger. Last month, it was legalised in Canada for medical use to treat mental health issues.
LSD
A wave of Silicon Valley technology moguls have insisted that taking tiny hits of psychedelics makes them perform better at work, feel more focused and creative. "Microdosing" LSD can aid the thought processes involved in problem solving, reported a 2020 review in Therapeutic Advances in Psychopharmacology.
Ketamine
The drug nicknamed "Special K" by clubbers became a popular party drug because of its dissociative effects. Currently, it is licensed to be used by doctors and vets as an anaesthetic, but researchers are building a compelling case for its wider use in humans. In December, research by the University of Exeter found ketamine can ease depression and soothe suicidal thoughts in the short term, with some patients' suicidal thoughts reduced for up to a week
Historical highs
Concord State Prison Experiment, 1961
Would felons be inspired to leave a life of crime behind if they took psychedelics? That was the question posed by a group of Harvard University lecturers when they gave psilocybin, the active ingredient in magic mushrooms, to 32 inmates of a maximum security prison. They would have usually expected 64 per cent of inmates to return to prison within 6 months, but only 25 per cent of the group given the hallucinogenic re-offended.
The Total Encounter Capsule, 1968
Far from viewing psychopaths as incurable, psychiatrist Dr Elliott Barker decided that what they needed was LSD-fuelled naked sessions. He gave LSD to a group of psychopaths from Oak Ridge psychiatric , stripped them nude, and put them in a small room for up to 11 days. To eat, the group had to take turns to suck liquid out of straws in the wall. The plan was to shock them into feeling empathy, but it had limited success.
Good Friday Experiment, 1962
Can drugs give you a religious experience? To find out, psychiatrist and minister Walter Pahnke gave a capsule of white powder to 20 divinity students just before a Good Friday service on the Boston University campus. Ten contained the hallucinogenic psilocybin, 10 contained a placebo. The students on the placebo sat quietly in their pews, while those given the drug lay down or wandered around the chapel saying, "God is everywhere." They reported profound religious experiences including a "cosmic homecoming".
Written by: David Aaronovitch
© The Times of London
