It’s a Tuesday in the middle of March when 17-year-old Olivia Israel walks into the Center for Transformational Psychotherapy for her appointment. Big plump cushions, fluffy white blankets, candles, and Buddhist artwork are dispersed throughout the space. It’s not your typical doctor’s office or your typical doctor’s appointment. Israel is there for her third ketamine session. She suffers from debilitating anxiety and after traditional routes like talk therapy and anti-anxiety medication provided little benefit to her, she decided, with her mother’s guidance, to give ketamine therapy a try.
“I kind of had this realization that I was like, ‘I don’t want to keep living this way. I think that we just needed to try something new,’” Israel said.
Psychedelics have been used globally for many centuries in healing practices, but following misuse and poorly conducted clinical trials, they were disregarded in Western medical practices. Richard Nixon created the Schedule I classification as part of his War on Drugs in 1971. Schedule I drugs are classified as those without an accepted medical use and a high potential for abuse. That list includes heroin, LSD, cannabis, ecstasy or MDMA, and peyote.
After psychedelics escaped the lab and became co-opted by the hippie and rock and roll subculture of the 60s and 70s, it set the U.S. on a path of criminalizing substance use. It shut down all research on psychedelic therapeutic effects. Now as mental illness wreaks havoc on our society, with more than 50% of the U.S. population being diagnosed with a mental illness according to the CDC, there is a resurgence of psychedelics in clinical settings as people are rethinking how we treat and look at mental illness.
While ketamine has been used to manage treatment-resistant depression since 2019, other psychedelics thus far have remained outside legal use and heavily criminalized. Ketamine therapy is currently practiced in Colorado, but psilocybin treatment is yet to come. as of the Nov. 8, 2022, Colorado general election, psilocybin therapy is now legal. In late January, Gov. Jared Polis appointed 15 people to the newly formed Natural Medicine Advisory Board to develop regulations, licensing rules and training programs. The board will make its first recommendations by Sept. 30. State-regulated clinics could start offering the substance as early as late 2024. Clinics in Colorado have been working for years on developing internal guidelines as well to ensure they’re ready to hit the ground running.
“There’s this idea of the brain having a default mode network,” said Sara Lewis, director of training and research for Naropa University’s Center for Psychedelic Therapies. “People can have a wider experience of themselves in the world without that thinking, analyzing mind going nonstop. The way that thinking happens is there’s patterns [that] become deeply embedded in a particular groove or a way of seeing the world. With depression or with anxiety, it’s like we can’t get loose of thinking in the same way, seeing the world in ways that are actually very troubling to us. When those parts of the brain are quiet, it’s not like they’re deleted, but when they’re quieted down, people are able to have greater access and see things in a different way.”
Israel’s first ketamine session, which was held in California, was unlike anything she had ever experienced. Sitting down on a big reclining couch, she talked with her therapist and medical doctor, preparing herself for the session and telling them about how her anxiety has been for the last few weeks. After 45 minutes, it was time for her to get the intramuscular ketamine shot into her arm. She laid back with her mom by her side as the medical doctor injected the ketamine and the therapist put an eyeshade, a blanket and headphones on her. Now the journey begins.
“I actually had no idea that I was even on any substance,” Israel said. “I didn’t know what was going on. I didn’t remember that I was on ketamine. I didn’t remember that I was in this office. I was in a fur factory, and I was being transported around on this conveyor belt. I came out of it just a little unsettled, I think, because I was trying to make too much of it. I was trying to understand it too much.”
She said her second experience was more positive because she didn’t try to control or make sense of her visions.
“I felt much more of a release,” Israel said. After the session, an integration session is necessary to really learn from the trip. That looks like a typical talk therapy session, but you are applying what you just experienced during the trip to real life.
Lewis said depression and other mental illnesses at one point were thought of as spiritual or moral issues. These diagnoses were often a vehicle for gendered social control. In the 1800s, doctors used the term “hysteria” to describe mostly women who had symptoms of depression or anxiety. Lewis said, that scientific thinking has shifted.
“There was this period of time where people really thought depression was like a chemical imbalance,” Lewis said. “And that theory isn’t totally holding up today. I think people are seeing that it’s more complicated than that. Things like SSRI pharmaceuticals can be really beneficial and helpful for people. But they’re not really treating anything. It’s just kind of helping people with their symptoms. I’ve just seen with my own clients that they just have limited value. And so I think that there’s some promise with psychedelics, and they do not work for everyone. But I think there’s some promise of a deeper kind of healing in terms of root causes.”
Part of Lewis’ job involves training therapists in graduate school already licensed and working in their field and who want additional advanced and specialized training in psychedelic therapy. She also works as a medical and psychological anthropologist. For several years, she’s been particularly interested in ayahuasca and other hallucinogens. She focuses not only on the positive experiences that people are having but also looks into cases when people have had not-so-positive reactions and how they can work with that in a therapeutic setting.
“MDMA and ketamine are very natural fits in a clinical setting,” Lewis said. “They’re synthetic, they’re made in a lab. To me, they kind of flow very easily in the clinical space. Psilocybin, I’m less sure of. I actually don’t know if I’m going to [provide psilocybin therapy] in my own clinical practice.”
Andre Ricciardi, a 55-year-old cancer patient, also treated in California, started psilocybin therapy a few weeks ago as part of a clinical trial.
“I have stage four colon cancer,” Ricciardi said. “I’ve had colon cancer now for two years. The life expectancy with stage four colon cancer isn’t much more than three years. Fifty percent of people with my diagnosis don’t even make it to two years.”
Ricciardi saw the news about psilocybin therapy reducing end-of-life anxiety, which he’s currently grappling with.
“I’m certainly not suffering from depression, but there’s definitely anxiety,” he said.
Psychedelics have been a part of Ricciardi’s life illegally and recreationally but not medicinally since he was a young adolescent. Going into his first clinical psilocybin session, he had some fears, expectations, and intentions.
“I guess my intentions were, how do I deal with chronic pain? I had some radiation a few months ago that I’m still feeling, but I know it’s going to get worse,” he said. “I know that I’m going to be dwelling in that space. I’m afraid of the process of dying. How do I have the best possible death? I want to experience every moment of it, and that doesn’t mean I’m going to reject opiates if I need them when I’m in pain. But how do I immerse myself in it and have a conscious death?”
Instead of numbing the anxiety with pharmaceuticals, Ricciardi wanted to get to the root of his anxiety about dying with psychedelics. Up until this point, he’s always been able to tell himself he’s not dying when he feels his heart start to race and the voice in his head.
“I couldn’t say that to myself in this instance because I am going to die,” he said. “I don’t know what the cancer that’s metastasized to my liver, being exposed to a high dose of mushrooms, I don’t fucking know if that’s going to kill me. But when I was really at the heaviest part of the trip, I remember thinking to myself the anxiety I felt about going into this psychedelic experience proved to be unnecessary. And while I was in the experience, everything felt perfectly natural and perfectly comfortable and death is going to be the same way. I’m going to be extremely anxious going into it, but once it starts happening, it’s going to feel perfectly natural. And I’m just going to go.” Riccardi added, “I was expecting death and doom and gloom and worms and soil. And I got this overwhelming love that I’ve never experienced on psychedelics before.”
Allison McQueen is a licensed professional counselor, board-certified art therapist, psychedelic specialist and the clinical director of the Center for Medicinal Mindfulness in Boulder, Colorado, one of the first legal psychedelic therapy clinics in North America.
“Psychedelic medicines bring out an intelligence within us, so they can in certain contexts help us be our best selves and come up with our best ideas to heal from very difficult traumas. They can help us solve impossible problems,” McQueen said. “We see this on a personal basis every day.”
McQueen said she’d seen patients with treatment-resistant depression or complex PTSD—“someone who shouldn’t have gotten better because there was so much destabilization in the system”—be healed for years after a psychedelic therapy session. “I feel like culturally, people are really getting it like, ‘Okay, we’ve done the western medicine thing. We’ve done the talk therapy thing.’ [There’s] nothing inherently bad about those, but they don’t unlock what psychedelics can unlock. So it’s a great time to be doing this work [and] to be doing it in Colorado of all places is awesome,” says McQueen.
Going forward, both Israel and Ricciardi plan to do a couple more sessions. Both Lewis and McQueen stress that psychedelic therapy is not just about taking these drugs and having a weird trip, but it is really about integrating what you learn from the trip into your everyday life.