“This research has been in a deep freeze for decades”

Imran Khan talks to Tom Ireland about how psychedelic drugs can help us better understand mental health and consciousness – but only if the way we view and regulate these drugs changes.

12th December 2022

Pre-pandemic, Imran Khan was best known for his roles in UK science policy, having worked in senior roles at the Campaign For Science and Engineering, the British Science Association and Wellcome. Then, after a whirlwind intercontinental romance, and a hastily-organised wedding between lockdowns and travel bans, he found himself in the San Francisco Bay Area, California, looking for a new job. He has since become director of the UC Berkeley Centre for the Science of Psychedelics (BCSP), a new academic centre focused on research, training, and public education about psychedelic science.

Alongside the growing evidence that psychedelics can improve conditions like depression and PTSD when administered alongside therapy, Khan says that these mind-altering substances can also be a powerful tool for understanding how the brain creates consciousness. The problem is, in many parts of the world they are still illegal, and therefore difficult to study. The BCSP, alongside several similar new centres in the US and Europe, aims to not only study the science of psychedelics but also influence discussions about how we view these substances and how to use them safely.

Imran, how has it been moving from UK science policy to studying psychedelics in California? Did you have a prior interest in this topic?

It’s great, it feels like picking up a thread that's been there for a while. My undergraduate degree was in biology, and in my final year the topic that got me closest to thinking about a career in research was consciousness and what we know about the neural basis of it. In the end I decided to move into science communication and policy for a career, but I always retained that interest in brain science.

I was also working in Parliament when Professor David Nutt was fired as chair of the UK Government’s Advisory Council on the Misuse of Drugs. He was really dunked on by senior politicians for simply publishing research showing that substances like MDMA have far fewer social and personal harms than substances like alcohol. That got me engaged with the whole question of drug policy and how it's informed, or not informed, by science.

Alongside a personal curiosity about psychedelics, and all the coverage about how potentially valuable they are from a therapeutic perspective, I felt this was the next thing I wanted to devote myself to.

Can you tell us a little bit about the main strands of work the centre will be looking at?

We’re still fairly new, but we have outlined three or four major areas. One is the research: we really understand very little as a society about how these substances work. Much of our research is focused on fairly fundamental biological questions about psychedelics and the role they have in our brains, our bodies and our society.

The second is training psychedelic facilitators. Enthusiasm for psychedelic therapy is developing quickly, but in order for psychedelics to be therapeutically effective you need to be supported by a trained professional. Because these substances have been stigmatised for so long and are also still illegal, the supply of people who can do that work is limited. We're hoping to change that by having a training program that teaches professionals such as doctors, nurses, and spiritual care professionals how to do this in the context of their existing work. We just had our first cohort of around 25 trainees start a month ago, which is exciting.

The third element is public education. Although there's been this explosion of information and interest in psychedelics, it's still very nascent, and there is a public and social conversation that still needs to be had about the potential benefits, the risks, and the role they can play in medicine, therapy, in recreation and in abuse.

We want to underpin all that with a commitment to diversity equity and inclusion, and reciprocity to the indigenous communities that have safeguarded these substances.

Besides the legal context, what are some of the technical challenges of studying these powerful substances?

Clearly when you're studying something like consciousness or a transcendent experience, it's inherently subjective. It's really hard to make it objective, and if you do then you miss the point in some ways. But that's not a problem unique to psychedelics; any study of subjective experiences, such as people's mental health, runs into similar challenges.

Another problem is the use of placebo. With substances that can give people one of the most powerful experiences of their lives, it becomes very obvious very quickly to the subjects of the study and to the researchers who's on psychedelics and who's not. So blinding is a real issue and people are coming up with interesting ways around that, such as using the order effect, where you get both the placebo and the psychedelic, but in different orders and weeks apart.

A general challenge is the temptation to directly compare psychedelics to other therapeutic substances and drugs. What psychedelics tend to do in say, the context of treatment for PTSD, is to create the potential for change, by inducing neuroplasticity that you and a therapist can then work with. So you're really not studying the effect of the drug directly or on its own, you're studying the drug plus therapy.

That makes trying to distil out the unique intervention of the pharmacological substance really challenging. And the therapy is really hard to standardise because it's dependent on the interpersonal relationship between the practitioner and the client.

That’s what is so interesting about this field – you’re having to work out news ways of doing things that can help address really complex questions about our internal experiences.

Yes – and in some ways psychedelics create huge opportunities that doesn't exist in other parts of science, particularly for a topic like consciousness, which is so complex and hard to study. Psychedelics are a reliable, predictable, safe way to alter consciousness in a dramatic way.

That fits into an important scientific paradigm, where if you poke and prod a complex system and it responds in reliable ways, that can give you some important insight and intelligence about the deep underpinnings of that system. I think that's potentially one of the most exciting things about psychedelics –they give us a tool to produce reliable changes in the mind in a way that might allow us to figure out what the mind is and how it's working.

One of our researchers, Michael Silver, is a vision neuroscientist who has built a career looking at how the visual cortex turns the light that lands on your retina into visual precepts that we can actually experience. He's going to be doing some work where people are given low doses of psilocybin to see how that changes activity in the visual cortex. We know enough about how the visual cortex works to have some idea of what to look at: there are bits that we know influence things like edge recognition and movements for example.

We also know that those same things are altered when people are on psychedelics. People see edges differently, sometimes as waves rather than straight lines, and see trails of movement after objects pass by. Studying someone's visual cortex while they're on psychedelics could lead us to unpack how brain activity correlates with our conscious experience, and that feels to me like getting close to the holy grail of neuroscience. It’s tremendously exciting.

I was a little surprised to see that you are training psychedelic counsellors – this area of medicine is moving so quickly and we certainly aren’t at that stage in the UK. How do you balance your aim to help people access these substances safely with the potential risks, and the fact that the clinical evidence isn't conclusive or comprehensive yet?

It sometimes feels like we're swinging from a culture where these substances were demonised and seen as similar to really harmful substances like crack cocaine, to a culture where they're seen as a panacea and there's no risk at all with taking an acid trip. Clearly both extremes are flawed, and there needs to be a nuanced discussion about both the benefits and risks, like we would do for any medicine.

For now, in order to achieve the potential benefits, we need to be able to manage the risks. That management ideally would occur in a guided and facilitated session, but if not we can help people understand how to minimise the risk for themselves.

Because there's still a taboo around these substances, when people have a bad experience they're often not then in a position to seek either immediate or long term help; there's a fear around calling emergency services and there's a fear around admitting usage to mainstream medical practitioners. By mainstreaming and having those substances taken in the context of medical and regulatory frameworks, we can manage those risks better.

Ultimately, to fully understand the risks and the benefits of psychedelics, more research has to be done. That's really hard in a context where they are still taboo and still illegal. If you look at the regulations here in the US, things like psilocybin and LSD are currently in Schedule One, which is the equivalent of Class A in the UK, and in the US that’s defined as having no accepted medical use and a high potential for abuse.

As a result this research has been in what feels like a deep freeze for decades. Techniques like fMRI and CRISPR, techniques we take for granted now, were not available when research into psychedelics was last widespread and an accepted field of study. We know that there's an important link between psychedelics and neuroplasticity, but we don't know how these substances create neuroplasticity, how long it lasts or what the individual neurotrophic factors might be.

From what research has been done on psychedelics, we know that they have very low potential for abuse relative to other substances, and they clearly have some potentially huge benefits. I think the sooner we can move to a framework where we accept that at the very minimum, we need to study these substances more, the better position we will be in.

IK speaking copyUnder the directorship of Khan, the BCSP will explore the social, cultural and legal aspects of psychedelic substances, as well as neurobiology and their use in therapy. 

What is behind the sudden explosion of interest in this area now, after so many years in the deep freeze?

When I say deep freeze, I'm referring to an aboveground deep freeze. Although most researchers during the period from the 60's to the 00's would have told you that devoting your career to psychedelics would be career suicide, there were some researchers that nevertheless did do that. One of the most notable is Roland Griffiths at Johns Hopkins, who produced some really seminal work at a time when few others would have touched these substances with a bargepole.

There have been underground practitioners doing talking therapies with psychedelics for decades, and indigenous communities using these substances in a ritualistic and important cultural context for far longer.

As for why now? I think it could be that some of the oppressive forces that were keeping this all repressed have loosened a bit. I’d like to say that ultimately the science won out – although it was hard to do the research, the bits that were done have become hard to ignore. One of the big ones has been the work on MDMA for PTSD, a big clinical trial that MAPS (the Multidisciplinary Association for Psychedelic Studies) has been leading. The data from people who had severe PTSD has been remarkable.

If these substances are still Schedule One (Class A), can you tell me a bit more about the legal status of people being trained to administer these therapies?

In contrast to the UK, there's more of a patchwork and experimental approach to regulation in the US. At the national and federal level these substances are illegal, but in individual cities or states there can be more of a liberal framework. People here are watching Oregon state closely, which is in the process of legalising the use of psilocybin, the active ingredient in magic mushrooms. It’s establishing a statewide framework for legal, regulated psychedelic assisted therapy. So a number of the people that the BCSP is training are hoping to practice lawfully there. People are also setting up regulatory bodies, including the APPA (the American Psychedelic Practitioners Association) and the BPMT (the Board of Psychedelic Medicines and Therapies). In the city of Oakland in California, psychedelics are still technically illegal, but the police force have been instructed to treat crimes associated with psychedelics as the lowest priority. That allows a more underground and unregulated network.

As evidence for therapeutic use builds, and regulatory frameworks develop, is there commercial interest in this space developing as well?

Absolutely. Many of these compounds aren’t directly patentable, but that doesn't stop the private sector from innovating and creating new versions. For instance with MDMA (ecstasy), although there's huge therapeutic potential, there's also potential toxicity particularly for people with a history of cardiac problems. So a number of companies are trying to make safer versions of MDMA that still have the therapeutic benefits. Equally with something like psilocybin, people are trying to figure out ways to create a products that is easier to metabolise, reducing some of the unpleasant side effects some people experience such as nausea. There’s also networks of clinics appearing to provide the support and therapeutic settings.

I've heard people refer to it as a bit of a ‘wild west’, with companies springing up and then vanishing, and there's a lot of change and churn. Some people are excited about a potentially huge new area of medical industry, some feel like it is a bit of a money grab. I think we're all still seeing how that plays out.

Like the psychedelic research centre at Imperial in the UK, the vast majority of your funding comes from philanthropic private donors. Is this area of science still seen as off-limits by more conventional research funders?

Yes, we are funded by private funders, some of whom have chosen to be anonymous because these is still a cultural taboo around this subject. Many people who've taken psychedelics will tell you that some of those experiences can be the most transformative and most meaningful they've ever had in their entire life. Equally, some people who have really struggled with mental health have found that after years or decades of trying mainstream treatments, after a single encounter with psychedelics they're on a completely different trajectory. They want other people and society at large to be able to access those benefits.

The long term goal has to be that this is treated as a legitimate area of study, supported by public funding. Right now, it's hard because of the legal framework, but it's also hard because there just isn't as much published research on this. I hope that as more private funding appears that there will be stronger and bigger communities of research on this - and those research communities will then be in a better position to apply for public funding once the hand brake is taken off. But it feels like it's still going to be a long hard road ahead.

Managing risk in the psychedelic renaissance 
“There are known and documented risks associated with psychedelics and I would absolutely say that anyone who's considering exploring them or using them should really do their research on what those risks are. People can experience symptoms of psychosis or flashbacks after a trip, and there are rare but really sad cases where people whose faculties are impaired, and without a trained sober person sitting with them, have gotten themselves into situations where they've come to harm, sometimes fatally. The BCSP website is designed to be a public facing portal for people to understand what the risks might be and how to manage them, while the Zendo Project provides guidance and links."