A prescription for magic mushrooms

“THEY call it the sacred geometry: a kaleidoscope of fractal patterns that fill your vision. They bloom and swirl upwards like the vaulted ceiling of the Taj Mahal in iridescent gold, or silver, or turquoise, with edges of quicksilver. Your vision is filled with a movie of swirling shape-shifting auroras, except there's nothing ethereal about the colours; they are vibrant, metallic-edged, primary; they are thick and solid but move like fluid."

That is how Leonie Joubert, writer and journalist, describes the experience of taking about one gram of psilocybin mushrooms — with eyes closed — in the introduction of her podcast The Psychonauts.

The mushrooms — also called magic mushrooms or shrooms — are part of a family of substances, or drugs, that led The Beatles to Revolver (LSD). They're how Sting found himself in conversation with grass on a farm (mescaline), and what Hunter S Thompson allegedly took with his “attorney" during a notorious visit to Las Vegas (both of the aforementioned, and more).

Although these drugs are associated with a lifestyle — unkempt hair and peace; revolution and Richard Nixon — research, especially over the past decade, has yielded promising results about the medical value of some psychedelic substances. The latest study, published by Johns Hopkins University in the US, found that psilocybin — the psychedelic compound in magic mushrooms — had “sustained antidepressant effects" on patients with clinical depression.

The study

A total of 24 adults (aged 21-75) took part in the study. They took the substance only twice during sessions lasting about 11 hours each, which also included psychotherapy. The psilocybin was administered in the form of gelatin capsules at a dose of 20mg per 70kg of body weight for the first session, and 30mg per 70kg for the second session. The subjects were then instructed to lie on a couch in a living room-type environment wearing sleep masks and headphones. Music by artists such as Vivaldi, Bach and Mozart was played to “enhance inner reflection". At this level, Joubert explains, the sense of your physical being dissolves almost entirely, and the music connects all the patterns, colours and emotions that you experience rather than perceive.

Up to four weeks after the last session, the depression of 17 participants had improved by at least 50%, and 13 met the criteria for remission. (Levels of depression were determined using the GRID-Hamilton questionnaire.)

This form of treatment is now part of a growing body of research suggesting alternative forms of mental health care, potentially with less risk and better results.

It's not limited to depression either. Similar results have recently been observed for addiction to cigarettes or alcohol, trauma, as well as anxiety. One study observed lower levels of anxiety and depression in at least 60% of cancer patients who took part, even more than six months after they took the psilocybin.

‘Effective, safe, and affordable’

Dr Mike West, a psychiatrist in Cape Town, says the research, which originally began in the 1940s but resumed only in the new millennium, indicates that various psychedelic substances are “effective, safe and affordable, and with more and more research, it's becoming increasingly difficult to deny these facts".

The reason for the nearly 40-year gap is due to the United Nations Convention on Psychotropic Substances in 1971, which declared psychedelic substances dangerous and illegal. The conference is said to have been convened under pressure from the US, where the government had already launched a serious campaign against the substances, primarily LSD, possibly more for political than scientific reasons.

Rumours that the drugs are deadly, can turn a person's brain into an egg, or make them try to fly off buildings, quickly took hold and spread.

But Nicholas Stubbs, one of the founders of the Psychedelic Society SA, an awareness organisation, says each new study chips away at the stigma that has influenced perceptions worldwide until today.

Some governments have since reconsidered their opinions thanks to the research. Canada has approved 13 exemptions for terminal cancer patients to take psilocybin for anxiety, although magic mushrooms are still illegal. Psilocybin, however, is legal in several other countries or certain states in the US.

This is not yet the case in South Africa.

15 years in prison for possession or use

The use or possession of psilocybin can result in as much as 15 years behind bars, the same as for heroin. Trafficking carries a maximum sentence of 25 years. The South African Health Products Regulatory Authority (Sahpra) also classifies psilocybin as a Schedule 7 substance with other hallucinogens such as mescaline and lysergic acid diethylamide (LSD), as well as heroin and methamphetamine (tik).

According to Sahpra, Schedule 7 substances have “no recognised medical use and an extremely high potential for abuse or dependence". However, this is not the opinion of numerous researchers, including those at Johns Hopkins University, who have determined that psilocybin potentially has very effective medical uses.

While there are cases of abuse, other researchers from the same university wrote in 2018 that “the actual risk of dependence and harm associated with psilocybin is estimated to be among the lowest of all major substances of abuse and dependence". And Professor Robert Gable, a psychologist in California, concluded in 1993 that caffeine poses a greater risk of dependence.

There are risks, though. According to Sahpra's Yuven Gounden, psilocybin can lead to, among other things, psychotic episodes, anxiety, panic, nausea and, although uncommon, hallucinogen persisting perception disorder — flashbacks of a previous hallucinogenic experience that can sometimes last for years.

“If taken without adequate preparation, instruction, guidance, supervision, support, whatever it may be, the risks increase," says West. “But this applies to any medication." However, he adds, if the necessary steps are taken, the likelihood is “negligible". The user's state of mind and environment are especially important. This is the reason for the living room atmosphere and music used in the study.

Side effects and risks

Compare that with the side effects of the more common form of antidepressants, selective serotonin reuptake inhibitors (SSRIs), which include insomnia, nausea and diarrhoea. According to Harvard University, other risks of SSRIs may include internal bleeding, complications for pregnancy and breastfeeding, as well as suicidal thoughts among young people.

West, however, saysthere is still not enough research to compare psilocybin with traditional medications such as SSRIs. Magic mushrooms do offer promising results in treatment-resistant patients — those who do not respond to regular antidepressants.

During the Johns Hopkins study, the most severe incident was a case of high blood pressure that resolved without medical intervention. Otherwise, participants experienced emotionally challenging feelings, such as anxiety, panic, and feeling “dead or dying", as well as headaches.

But Professor David Nichols, an American pharmacologist who has been studying the field since the late 1960s, generally describes psychedelic substances as “physiologically safe". And in 2010, a study in the UK estimated magic mushrooms were less harmful than tobacco, alcohol and cannabis — three substances that can be legally consumed in South Africa today.

With a 15-year sentence, mere possession might be one of the most dangerous consequences associated with magic mushrooms. “There is no scientific justification for this (criminalisation), and there is no public health benefit to continuing to classify it this way," says West.

Criminalisation ‘unconstitutional’

Paul-Michael Keichel, a partner at Schindlers Attorneys in Johannesburg (now with Cullinan & Associates in Cape Town), believes that rather than the substance itself, it's the laws that criminalise it that are unconstitutional. Keichel, with his client Monica Cromhout, a retired nurse and grandmother who was arrested in 2014 after authorities found 2kg of magic mushrooms in her home, is attempting to legalise psilocybin through the justice system.

According to Keichel, who was also involved in the case about the private use of cannabis, the legislation on magic mushrooms contradicts several constitutional rights, including the rights to affordable healthcare, bodily integrity and privacy.

“There are several rights in the constitution that, if correctly interpreted, tell us that as a free citizen you can decide to consume what you want, do what you want, as long as you don't violate the rights of other people," says Keichel.

After the Constitutional Court ruled in 2018 that the private use and possession of cannabis are legal, Schindlers submitted commentary to parliament on the new cannabis bill. According to the firm's legal opinion, the criminal prohibition of cannabis is contradictory to more than 10 constitutional rights. Keichel explains that the case is almost identical when it comes to psychedelic substances.

The “rights to freedom of conscience, religion, thought, belief and opinion" are central to the case. By criminalising psychedelic substances, the state limits to some extent which parts of a person's mind may be explored, says Keichel.

‘Psychologically insightful’

Users can sometimes pick up their memories like objects, navigate thoughts like corridors, or simply experience a clarity, says Joubert. Almost 90% of those who took part in the Johns Hopkins study, for instance, described the sessions as one of the top five most “personally meaningful and psychologically insightful" experiences of their lives. About 80% found the experience ineffable.

“If one isn't allowed to control one's own human experience," Keichel asks, “and that's something that the government may trample upon, well, can you really say that we are free as individuals?"

He warns that if the cannabis case is any indication, the state is likely to oppose any attempts to legalise psychedelic substances.

There are also no signs that the government is eager to change the legislation itself. While Gounden referred to “numerous journal articles and world reports", including the 1971 convention, on the risks of the substances, Sahpra could not comment on any of the studies on therapeutic uses because the government has not received any applications for a medication containing psilocybin.

And asked whether the government has considered changing the scheduling of any psychedelic substance, the answer was straightforward: “Sahpra continually monitors and reviews the scheduling status of substances in terms of safety and efficacy."

Joubert says that although the medical community has an opportunity and responsibility to promote research, South Africa is still far behind. When she began inquiring six years ago, Joubert got the impression that psychedelic substances were not a priority.

Priorities

Depression, however, is. So is addiction. As well as anxiety and trauma. Between July and September of 2020, 5,107 murders, more than 70,000 cases of assault, 8,922 rapes and 4,803 carjackings were reported to the police.

While only around 30% of adults in South Africa drink alcohol, those who do consume almost 35 litres of pure alcohol annually, as reported by the Department of Trade & Industry. The ban on alcohol sales during the Covid-19 lockdown reportedly saved as many as 21 lives a day.

The South African Depression and Anxiety Group (Sadag) says that as many as one in five South Africans will experience a form of depression in their lifetime. However, only one in every 10 South Africans has had access to mental health care, with less than R100 spent per person each year.

The University of Cape Town found in 2016/2017 that the Department of Health spent less than 5% of its budget on mental health care. They also found that amitriptyline, used for adults with depression, is one of the most frequently stocked medications.

And with an official unemployment rate above 30%, magic mushrooms are more affordable and accessible because they can be taken in their natural form without the need for processing or manufacturing, and also do not need to be taken daily.

Magic mushrooms, despite the name, are not a miracle solution that will solve all mental disorders in South Africa overnight. There is still much that scientists do not understand about psilocybin. However, ignoring the potential benefits of the substance, says West, “is scientifically, morally and ethically indefensible".

♦ VWB ♦

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