Charles Grob, MD, Professor of Psychiatry and Pediatrics at the UCLA School of Medicine and the Director of the Division of Child and Adolescent Psychiatry at the Harbor-UCLA Medical Center in conversation with Thomas Strouse, MD, Professor of Clinical Psychiatry and the inaugural holder of the Maddie Katz Chair in Palliative Care Research and Education.
This Open Mind presentation will review the history, ethnobotany, pharmacology and potential clinical utility of psychedelics in treatment, particularly for conditions that are refractory to conventional therapeutic interventions.
The classic psychedelics are powerful and unique serotonergic agents that have been used in plant form for purposes of healing, divination and spirituality by indigenous cultures around the world since the dawn of mankind. Psychoactive plants that are of particular interest in this regard include Psilocybin cubensis, Lophophora williamsii, Tabernanthe iboga, Claviceps purpurea and Psychotria viridis. The active alkaloids of these plants that have been isolated, laboratory synthesized and, in some cases, utilized in clinical treatment studies are respectively psilocybin, mescaline, ibogaine, lysergic acid diethylamide (LSD) and dimethyltryptamine (DMT). During the 1950s and 1960s psychedelics, especially LSD, were investigated as potential treatments, particularly for psychiatric conditions that were often non-responsive to standard therapeutic interventions. While preliminary findings were encouraging, by the late 1960s and early 1970s virtually all clinical research with psychedelics was terminated because of the cultural and political turmoil of that era. Investigations examining the range of effects in human subjects did not resume until the 1990s.
One of the most promising areas of research from the 1960s to the early 1970s was the application of a psychedelic treatment model (primarily LSD) in patients with advanced-stage cancer suffering from high levels of existential anxiety and depression. Psychedelic research investigations of patients suffering from potentially fatal medical disease encountering severe psychospiritual demoralization has resumed by the early 2000s, with psilocybin treatment studies conducted at Harbor-UCLA, Johns Hopkins, NYU and UCSF. Plans for a new multi-site, double-blind, placebo-controlled study using a psilocybin treatment model with a patient population identified as having severe existential crisis and demoralization reactive to their potentially fatal medical condition will be reviewed. Other potential applications of the psychedelic treatment model include patients addicted to cigarettes, alcohol and cocaine, as well as other patients with refractory obsessive-compulsive disorder, eating disorders and chronic post-traumatic stress disorder. Potential future challenges to the field and the need to optimize safety and ethical parameters will be seriously considered, as will the potential risks and benefits of the emergence of commercial interests in this long-considered taboo field. An entirely new and novel treatment model may be emerging that has the potential to establish itself within mainstream psychiatry as well as other related specialties, including palliative medicine and addiction medicine. Future challenges and opportunities of the psychedelic treatment model viewed from the context of prior lessons learned will be carefully examined.
Charles S. Grob, MD, is Professor of Psychiatry and Pediatrics at the UCLA School of Medicine and the Director of the Division of Child and Adolescent Psychiatry at the Harbor-UCLA Medical Center. He previously held faculty positions at the Johns Hopkins School of Medicine and the University of California at Irvine. He has conducted approved clinical research with psychedelics since the early 1990s. From 2004-2008 he was the Principal Investigator of the first study in several decades to examine the use of a psilocybin treatment model for patients with advanced-cancer anxiety. He has also conducted research into the range of effects of MDMA, in both normal volunteers and in a selected subject population of adult autistics with severe social anxiety. And he has conducted a series of ayahuasca research studies in Brazil. Over the last thirty years Dr. Grob has published numerous articles and chapters on psychedelics in the medical and psychiatric literatures and he is the editor of Hallucinogens: A Reader (Putnam/Tarcher, 2002), co-editor (with Roger Walsh) of Higher Wisdom: Eminent Elders Explore the Continuing Impact of Psychedelics (SUNY Press, 2005) and co-editor (with Jim Grigsby) of the recently published Handbook of Medical Hallucinogens (Guilford Press, 2021). He is a founding board member of the Heffter Research Institute.
Dr. Thomas Strouse is Professor of Clinical Psychiatry and the inaugural holder of the Maddie Katz Chair in Palliative Care Research and Education. He is also Vice-Chair for Clinical Affairs in the Department of Psychiatry and Biobehavioral Sciences at the UCLA David Geffen School of Medicine. Dr. Strouse served as the Chief Medical Officer of the Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA from 2007 through 2021. Dr. Strouse has been a faculty member at UCLA since he completed his residency training there in 1991. Early in his career he was director of the UCLA Consultation/Liaison Psychiatry Service and worked closely with the UCLA Liver Transplant Program for more than a decade. He served from 1994-2007 as director of Cancer Pain Management and Supportive Oncology Services at the Outpatient Cancer Center at Cedars-Sinai Medical Center, where he developed additional interest and skills in palliative medicine. He has spent his career working with medically ill adults coping with psychiatric and physical aspects of catastrophic illness. Along with his current efforts to promote palliative care clinical research within the UCLA Health System, Dr. Strouse is a faculty member in the combined GLA/UCLA Palliative Medicine Fellowship, and is actively engaged with UCLA’s Operation Mend, a program for wounded US servicemen and women. Dr. Strouse is a Fellow of the American Academy of Hospice and Palliative Medicine, a Fellow of the Academy of Consultation/Liaison Psychiatry, and an American Psychiatric Association Distinguished Life Fellow. He is board certified in general psychiatry, consultation/liaison psychiatry, and hospice/palliative medicine. From 2007-2018 Dr. Strouse served on American Board of Internal Medicine Test Committee responsible for writing the certifying exam for all North American physician candidates for the ABMS subspecialty of Hospice and Palliative Medicine. He chaired the exam committee from 2014-2018 and continues to assist ABIM with exam development. Dr. Strouse has published many peer reviewed papers and book chapters and sits on the editorial boards of a number of important journals. In 2017 he became an Associate Editor for the Journal of Palliative Medicine. He lectures throughout the country on topics related to pain, palliative care, psycho-oncology, and psychiatric aspects of medical illness. He was educated at Pomona College and the Case Western Reserve University School of Medicine