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> The "war on drugs" certainly didn't help, but research never really stopped. This is false. The scheduling of psychedelics such as psilocybin and LSD was cat

by whakim 23d ago

> The "war on drugs" certainly didn't help, but research never really stopped. This is false. The scheduling of psychedelics such as psilocybin and LSD was catastrophic for medical research in the United States (as well as in many other countries) from the early 1970s until the mid-2000's. Even today, research on psychedelics is challenging. > but we are struggling to turn these drugs into treatments that up to modern standards The elephant in the room is that psychedelics don't really fit into our existing framework around development of psychiatric drugs. For example, you can't really run a RCT, because it's completely obvious to the patient whether they've received the drug or a placebo. The concepts of set and settings, and the importance of "guides" in trials, prove challenging as they introduce highly subjective elements. I would frame this as more of a mismatch than a case of "modern standards being better" - the jury is still out on whether psychedelics will prove effective, and we're still trying to figure out how to "prove" that.

heavenlyblue 23d ago
That's really wrong though: it's really hard to not feel effects of fentanyl, opioids, ketamine either.
- ttoinou 23d ago
  But we only use those as sedative. Or how ? Except ketamine therapies are being done right now with low doses where the effects are lighter than psychedelics
- whakim 23d ago
  Sure; total blinding is an issue with many drugs (however active placebos which can make you feel dizzy/sedated/whatever can help); opiods/fentanyl/etc sometimes have to make do with imperfect blinding. The fact remains that the psychedelic state is so distinct from normal consciousness that the challenge is qualitatively different.
vikramkr 22d ago
There are plenty of other cases (e.g. ultra rare diseases) where we don't do RCTs for various practical reasons. So it's not really a problem of the existing framework - there's a ton of room for "we can't do an rct because like, duh they know they're tripping." But as other comments pointed out were really hampered by the lack of understanding of how and why these do or don't work - why some people get positive outcomes and why some get negative (preferably we'd like to know before prescribing broadly!) a ton of this basic research/mechanistic understanding etc has not been possible because of the war on drugs. If research had been possible we would be in a much better place of understanding how they could be regulated and used today - even with the more limited technology available a couple decades ago more openness around this could have at least enabled e.g. more and larger observational studies that could elucidate things today but we're stuck with a very fragmented and incomplete picture

by whakim 23d ago

heavenlyblue 23d ago

That's really wrong though: it's really hard to not feel effects of fentanyl, opioids, ketamine either.

ttoinou 23d ago
But we only use those as sedative. Or how ? Except ketamine therapies are being done right now with low doses where the effects are lighter than psychedelics
whakim 23d ago
Sure; total blinding is an issue with many drugs (however active placebos which can make you feel dizzy/sedated/whatever can help); opiods/fentanyl/etc sometimes have to make do with imperfect blinding. The fact remains that the psychedelic state is so distinct from normal consciousness that the challenge is qualitatively different.

vikramkr 22d ago

There are plenty of other cases (e.g. ultra rare diseases) where we don't do RCTs for various practical reasons. So it's not really a problem of the existing framework - there's a ton of room for "we can't do an rct because like, duh they know they're tripping." But as other comments pointed out were really hampered by the lack of understanding of how and why these do or don't work - why some people get positive outcomes and why some get negative (preferably we'd like to know before prescribing broadly!) a ton of this basic research/mechanistic understanding etc has not been possible because of the war on drugs. If research had been possible we would be in a much better place of understanding how they could be regulated and used today - even with the more limited technology available a couple decades ago more openness around this could have at least enabled e.g. more and larger observational studies that could elucidate things today but we're stuck with a very fragmented and incomplete picture