Here & Now

Paul Hutson on Potential for Psychedelics in Mental Health

Frederica Freyberg:
An executive order from President Donald Trump calls for fast tracking research and access to psychedelic medicines for treatment of mental health disorders, with $50 million in funding going to state governments for the research into the treatments. The FDA pinpointed three companies, including Madison-based Usona Institute, for its new drug application for psilocybin in major depressive disorder. Usona says the designation is reserved for therapies addressing critical national health priorities and unmet medical needs. The work of UW-Madison researchers will be part of Usona’s application. The Center for Psychedelic Research has been looking at the promise of psilocybin and other psychedelics with human research subjects at its dosing lab on campus. We met with Professor Paul Hutson there to learn more.

Paul Hutson:
Psilocybin kind of works by itself. We’re here primarily to protect the subject, reassure them if they get anxious.

Frederica Freyberg:
So we are sitting in a room where patients or research subjects are administered psilocybin. What happens?

Paul Hutson:
When somebody is coming in for a psychedelic dosing session with psilocybin, for example, they come after about three to four hours of preparatory counseling and intention setting with the therapists that are going to be sitting with them. They’ll come in. They’ll lie down on the sofa after taking the capsule of psilocybin, and then the two therapists, which would be sitting in the chairs that we’re in facing the person on the sofa, would watch and attend them, reassure them if that was something that needed to happen with a hand on the shoulder, perhaps. And then after about six hours, they would be evaluated to make sure that they were safe to go home. They’d go home in the care of someone that they trusted that could make sure that they got home safely. And then we bring them back the next day, typically, and have a one- or two-hour debriefing and ideally bringing them back two or three more times. We think that that debriefing session, that ability to work with those people with whom they’ve got a therapeutic alliance is critically important to really maximize the effects of the psychedelic treatments. And one of the reasons why we don’t expect that recreational use of psychedelics is going to be anywhere near as therapeutically effective as the more controlled, somewhat more complex work with the therapists.

Frederica Freyberg:
What do they experience?

Paul Hutson:
That’s hard to describe, and it’s going to be different for every individual. And frankly, it’s probably different for every medication that we’re using. There’s a lot of hallucinogen effects like seeing sounds and abnormal visions of patterns in the carpet, patterns in the wall. But they also describe a noetic, all-knowing sense of knowledge that they’ve experienced something very profound. On the other hand, they typically describe it as being ineffable, very difficult to explain. Sometimes they feel like they’ve come into the presence of a deity, of God. Others feel very, very alone, like they’re in a canoe in the middle of the ocean on a very dark night and feel very isolated. But then on the other hand, they — that same person might then be visited by friends and deceased relatives, at least that’s what some would describe. And so it’s really hard to pin down a particular experience for any individual.

Frederica Freyberg:
What is the promise of treatment with psychedelics for things like depression or PTSD?

Paul Hutson:
It’s amazing, quite honestly, what the effects of one dose of psilocybin seem to have. We see some really remarkable results in individuals with depression, sometimes treatment resistant depression, and that can occur within 24 hours. And it seems to be durable in many individuals. Not all, not everybody responds like that, just like any medication. We also see in our own work with methamphetamine, but also other institutions looking at alcohol, tobacco, cocaine, some really remarkable rapid responses in terms of decreased uses of these drugs of abuse. I think that one of the things that really surprised me when I first got into this was that the psilocybin and LSD treatments are not addictive. I was part of the “this is your brain on drugs” generation. And so that was a surprise. But it’s really important to make it clear that we do screen the individuals that we bring into our studies. And I think it’s going to be important to screen the individuals that come to us after drug approval.

Frederica Freyberg:
What was your reaction when you learned of this executive order that kind of gives the FDA fast track?

Paul Hutson:
So the executive order does several things, but the thing that I think is going to have the greatest impact on our work and the psychedelic industry as a whole, is that it is going to accelerate the rate at which the FDA can evaluate drugs like this. And in particular, three companies got these national program vouchers that is going to accelerate even more the speed at which the FDA is reviewing their applications for approval. The concern that I have, quite honestly, is that the FDA will approve this sooner than we were expecting, and we don’t really have the capacity in terms of rooms, but especially the therapists that are going to attend these individuals to accommodate the demand that’s going to occur when that happens.

Frederica Freyberg:
And this would be happening presumably at research centers across the country?

Paul Hutson:
Once the drug is approved by the FDA, it does not have to be at a research center. I think that they are right now the ones that are best positioned to accommodate that. But frankly, it’s going to be both an academic and a private for profit enterprise as well. People will need to go to some of these clinics that will charge them out of pocket for the experience. The personnel demands to have the two therapists sitting in the room for eight hours is going to be one of the most critical things that we have to deal with. How are we going to — in a system where mental health professionals are hard enough to find — how are we going to expand that capacity to meet the demand from the psychedelic industry?

Frederica Freyberg:
And still, this is really exciting news, I imagine for someone like yourself.

Paul Hutson:
It is really exciting. Yes, we have participated in the development of psilocybin from about 12 years ago, and some of our work is actually going into the new drug application that Usona Institute is going to be working on. So we’re really excited that we can be part of that. But helping other companies but also looking at the mechanism of why this happens. We’ve got several studies that were just asking the foundational question, why does it work and how does it work and how can we perhaps make it better?