From Reason.com
Dr. David Nutt explains what the first brain imaging study of humans on LSD tells us about mental health and human consciousness.
Zach Weissmueller & Alex Manning|Jun. 1, 2017 4:45 pm
The study of psychedelics is "bringing psychotherapy and medicine together," says David Nutt, a neuropsychopharmacologist at Imperial College London and a co-author of the first imaging study looking at the effects of LSD on the human brain. "Drug-assisted psychotherapy is going to be the great advance in the [field in the] next 20 years."
In 2009, Nutt was fired from his job as a drug adviser to the British government after he made comments about ecstasy and other illegal drugs being less dangerous than alcohol and even horseback riding.
Reason's Zach Weissmueller sat down with Nutt at the Psychedelic Science 2017 conference in Oakland to talk about the results of his groundbreaking imaging study, what he learned about drug policy while working as a science adviser for the English government, and what he sees for the future of psychedelics and mental health treatment.
Produced by Zach Weissmueller
Camera by Alex Manning. Additional graphics by Meredith Bragg.
Music by Sergey Cheremisinov.
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This is a rush transcript—check all quotes against the audio for accuracy.
Zach: Hi I'm Zach Weissmueller for Reason. We're here at the Psychedelic Science 2017 conference in Oakland. I'm here with David Nutt. He is the Edmond J. Safra Professor of Neuropsychopharmacology at the Imperial College of London. Thank you very much for joining us Dr. Nutt.
Dr. Nutt: Good to be here.
Zach: You were the chief drug advisor in England. Something happened, could you just tell us that story?
Dr. Nutt: For nine years I was the head of the group that assessed drug harms for the government and over that time we did an enormous amount of research into the comparative harms of drugs. As a result of that I discovered, somewhat to my surprise, that alcohol was actually the most harmful drug in the UK. The drugs that politicians like to get hysterical about like cannabis and MDMA, Ecstasy, are comparably much less harmful. So then I started explaining that to the government saying, "Well, our drug laws are wrong. Actually putting people in prison for cannabis possession is not fair because alcohol is more dangerous." They did not want to hear that. They said, "Stop saying that."
Zach: They sacked you for looking at the data and giving your analysis. Isn't that your job as the Drug Advisor of the government?
Dr. Nutt: Well, I thought it was my job, yeah. I thought my job was to evaluate evidence and make recommendations, but they said, "Oh no, no, he's doing more than that. He's trying to change government policy." I said, "I thought that's what all scientists did." If the evidence suggests the policy's wrong then we want to change the policy, once you been sacked you've got no comeback. Although, of course, what did happen was that it brought the whole issue of drug harms and comparative harms in the public domain. There was an enormous outcry and a lot of scientists wrote petitions saying they should reinstate me. I became famous and the whole drug debate went viral. So for the first time we actually had a proper debate. The government shot itself in the head really because it went from drugs being something you didn't talk about to drugs being something everyone wanted to talk about.
Zach: Why was that such a taboo thing to say?
Dr. Nutt: There are some things which you can't have what you might call a balanced debate because everyone has a strong view. Drugs are bad, drugs are bad, War on Drugs, we've got to get rid of drugs. That was our policy the same way it's been American policy. Anyone challenging that was actually really cutting to the heart of the prejudices which underpin the British establishment. And it went right through government. It went certainly through both the right wing and the left wing parties.
Zach: It's my understanding that the US drug policy really drives a lot of policy in other countries. Could you speak to that as someone involved in the European drug policy?
Dr. Nutt: Absolutely. US policy on drugs was basically rolled out across the world through the United Nations. The US said "Jump", we said, "How high sir?" Every single drug policy in Britain was driven to comply with American policy. And I know that, I know there were drugs which were not controlled in Britain, like khat and I know that the US government pushed and pushed and pushed and pushed our government to eventually get khat bound. I managed to hold that back actually until I was sacked. We didn't make it illegal, but eventually they gave in.
Zach: Is the pressure coming through trade deals? Is it the UN? How does that work exactly?
Dr. Nutt: Yeah, well that's a good question because of course there's no pressure. There's nothing public. It's all behind the scenes. A few weeks later you'll hear from the Department of Health, "We don't like the policy on cannabis." "What's changed? Was it the fact that our Prime Minster was talking to George Bush?" It was those sorts of things. It's all off the record. It's just back story political pressure.
Zach: Your first and foremost a drug researcher. You've just completed some very interesting research in conjunction with the Beckley Foundation. It was a brain imaging study in relation to LSD. Could you tell me how that study was structured?
Dr. Nutt: LSD, a fascinating drug. In the 1950's and 60's it was going to solve the world's problems. The National Institute of Health in America funded 140 separate studies on LSD. A thousand papers were published, 40,000 patients, it was the revolutionary drug. Then as soon as it started being used recreationally, it suddenly became the evil drug and it got banned. Since then there's never been a single study of LSD in America and there's never been an imaging study of LSD. As a scientist, as a psychiatrist, a drug that has such profound opportunities to change the way, for instance, people are addicted, seemed to me we must study it. So having done studies with a sort of simpler, less threatening psychedelic, Psilocybin, mushroom juice, we decided it was time to bite the bullet and do the first brain imaging study of LSD.
Zach: So you were quite literally looking at, "This is your brain on drugs" and what is our brain on this particular drug?
Dr. Nutt: Well the good news is no one's brain got fried, but what we saw, we saw effects which were somewhat similar to what we'd seen with Psilocybin, but more profound, which you might expect because LSD has a very profound effect on many aspects of brain function. The key messages are that LSD breaks down the normal structure of brain integration. Our brains are trained over decades to do things exactly the same way as everyone else and exactly the same way everyday, every hour, every minute, every second. Those structures we thought were hardwired, but it turns out they're not hardwired. They can be disrupted by LSD. LSD basically makes the brain much more connected.
Parts of the brain which haven't been allowed to talk to each other for 30, 40 years can talk to each other again, huge amount of crosstalk. We call this the entropic brain or the much more flexible brain. We think that's what underlies the experiences that people have during the trip, even got good evidence for that, but also explains why afterwards people often feel different and better because they've been allowed to ... actually the brain's been allowed to work in a slightly different way for the first time, perhaps ever.
Zach: My understanding is that when people were closing their eyes the part of the brain that's associated with vision was actually still active. Could you tell me what you take away from that?
Dr. Nutt: Yeah, so what we showed was that the so-called ... the complex visual hallucinations that people say under psychedelics. They close their eyes and they say it's like films going on in front of their eyes even though their eyes are closed. We discovered why that is, it's because normally I close my eyes and there's very little activity in my visual cortex and there's not activity linking the visual cortex to the rest of my brain, but under LSD the visual cortex was connected to every part of the brain. So there was crosstalk and, of course, crosstalk for the visual system is visual talk so that's why you have these fascinating, complex, interesting images.
Zach: If one of the big takeaways from this is that on LSD different parts of the brain that don't usually work together are suddenly somehow connected, what does that mean in practicality, in application? Where does that take us? What questions should we now be asking that we have that information?
Dr. Nutt: Well, I think what's fascinating about it is it doesn't just explain the psychedelic state, but it also helps us make sense of why drugs like LSD can change the way people behave in the long term. There were six trials in American for LSD to be used to treat alcoholism. In fact, the founder of AA, Bill Wilson, he got his liberation from his alcoholism, the chains that held him to his drink were broken by a psychedelic experience. He became a profound enthusiast for LSD. He pioneered these six trials of using LSD for alcoholism. It works, people are much less likely to relapse back to drinking after they've had a psychedelic experience because they can see there's a world out there which isn't all about the bottle.
Zach: How difficult or easy was it to study this in the first place?
Dr. Nutt: Well, it wasn't easy, but because it was an experiment on normal volunteers it was a lot easier than doing it in patients. So the big challenge then, or now, is to go from these interesting studies in normal volunteers and take them into patients. That becomes a lot more complicated because an experiment is controlled by a different kind of ethics than a medicine.
Zach: At this conference we've heard researchers talk about some potentially promising results using psychedelics to treat things like PTSD, depression, anxiety. Do the brain scans that you did offer any clue as to why psychedelics seem to offer some relief to these kind of conditions?
Dr. Nutt: Psychiatric disorders, say like depression or PTSD, exist because people cannot disengage. They get locked into a form of thinking. Depressed people keep thinking negative thoughts. "I made a mistake. I was a bad mother." "I made a mistake. I was a bad person." They can't disengage those thoughts. PTSD, people can't disengage from the memory and over time those circuits in the brain become completely self-determining. They just go on and on and on, even if the person wants to stop them. And they can't. I think the disruption of circuits, the breaking down of these regimented silos of function of the brain by psychedelics is one explanation as to why people can escape from those underlying disorders.
Zach: Some critics might think why study psychedelics at all? We have pharmaceuticals that treat anxiety, depression, that are specifically designed to help with these disorders. Why open this can of worms and study psychedelics at all?
Dr. Nutt: Yeah, that's a really important question. And the people who are against psychedelics often say that, "We don't need it. We've got good treatments." Well, the truth is we don't have very good treatments. Half of all people who are treated with antidepressants don't respond to the first dose. To get 90% to respond you usually have two or three trials. So there are people who don't respond and never respond so there's an opportunity for them. Disorders like alcoholism response rates are like 10% not 80%. So there's a huge unmet need, that the first thing. Second thing is, these are fundamental states of ordered consciousness. I would argue the greatest goal for science is understanding the human brain. You can understand the human brain if you don't understand how the human brain is different when it's on a psychedelic. To me, this is one of the most fundamental questions.
Zach: Do you think psychedelics could offer a scientific glimpse into the phenomemon of consciousness itself?
Dr. Nutt: The conclusion I've come to from our work is there are at least two forms of consciousness. There's a consciousness which most people talk about when they talk about consciousness, which is whether you're awake or asleep, whether you actually know what you're doing, whether you can actually remember what you're saying, whether you've got self-awareness, that's one consciousness. We know what drives that. That's driven by neurotransmitters called glutamate and GABA. And there's another form of consciousness and this is what psychedelics, psychedelics change the nature consciousness. Not the amount of it, but the content. It's completely different access of brain function. That's driven by serotonin, the serotonin receptors that psychedelics work on. That is fascinating to me. I think that access is actually an access that scientists don't know about because that's not the scientific access. That's the access that artists, creative people work on, your poets, painters. Scientists think very linearly, but this is a nonlinear kind of experiential thinking. We've opened up, I think, the scientific study of things like creativity.
Zach: As you mentioned before, back in the 50s and 60s these were questions that started to be explored and then there was this long period that coincided with The War on Drugs where it was just not explored. Now people are starting to pick these questions back up and again and start asking them again. This conference we're attending right now has been around since 2010. Back then there were only a few scientists actually running studies, you were one of them. Now it seems like it's spread. There's more people, the studies are getting bigger and bigger. Could you give us just a lay of the land? Where is psychedelic science at this moment?
Dr. Nutt: It's entering the mainstream. It's like going to college. It's a freshman, jut getting there in the first term. People seeing it and saying "Well, it's not killing people, it's actually giving us interesting insights into the brain. It may be offering new treatments." The next stage is getting what you might call the mainstream, scientists say. We can progress our science more if we use these drugs. That's going to be the next big hike. Maybe in fours years time we'll see another big expansion. The science here compared with four years ago is it's five times more. Maybe in five years time it will 25 times more.
Zach: Are there any policy changes either here in the United States or in Europe that would enable us to proceed even more quickly?
Dr. Nutt: Oh yes, well, I mean it's still very difficult. We've got to change the regulations. These drugs are all stuck in what's called Schedule I under the UN Conventions under the USA law. We've got to get them out of Schedule I. We've got to get them in Schedule II or any other schedule with allows scientists to work with them without being treated as if they're criminals.
Zach: How would you envision these types of drugs being integrated into society or the medical establishment?
Dr. Nutt: These are the drugs which bring together psychiatry and psychology. These drugs are not drugs you take every day to hold at bay your depression or your anxiety. These are drugs which you use with a psychotherapist to change the way you deal with life and that way you get mastery over your anxiety or depression. So I see these drugs as being enormously powerful ways of bringing psychotherapy and medicine together. That, I think, is going to be a huge element of psychotherapy in the future. It's going to be drug-assisted psychotherapies. It's going to be the great advance in the next 20 years.
Zach: David Nutt, thank you very much for your time.
Dr. Nutt: Thank you.
Zach: For Reason, I'm Zach Weissmueller.
