Self Portrait by Louise Bourgois, 1990

Q&A With Dr. Lindsay Mackay, MD, CCFP - Physician & Psychedelic Medicine Researcher 

Can you tell us about yourself (and the work you are doing with psilocybin)? 

I work as a doctor in Vancouver’s Downtown Eastside providing addictions and primary care. I work a lot with people struggling with opioid use (like heroin and fentanyl) as well as with people who suffer from past trauma. I am a researcher in psychedelic medicine and Principle Investigator for an upcoming study that will use psilocybin to treat alcohol, stimulant and opioid addictions.

Can you explain what is meant by the “Psychedelic Renaissance”?

Research on the use of psychedelic therapy including psilocybin thrived from the 1950s to the early 1970s. During that time a number of studies showed there could be benefit for certain mental health conditions and addictions. Unfortunately, in the 1970s psychedelic substances were classified as “drugs of abuse” with no recognized medical value. Over the past few decades, research has resumed to examine how psychedelics work using modern brain imaging and to study their therapeutic potential in treating various conditions. It’s important to note that naturally occurring psychedelics such as psilocybin have been, and continue to be used in other cultures as part of traditional practices for centuries.

How does Psilocybin work?

Psilocybin works on a type of serotonin receptor in the brain. Initial studies using imaging like functional MRI which measures brain activity after people have taken psilocybin suggest that psilocybin disrupts the “default mode network”, which is a connected area of the brain involved with narrative thought, memory and ego identity. These changes to brain activity are thought to result in unconstrained thought, which could help create mystical-type experiences, ego-dissolution and could change how someone relates to their past memories.  The theory is that these significant experiences may have lasting impacts on thoughts, behaviours and self-perception. 

What are the potential benefits of psilocybin?

Preliminary studies with small groups of people show that psilocybin could be useful for treatment of certain mental health conditions such as treatment resistant depression and anxiety, end of life distress as well as problematic substance use like alcohol and smoking.  I think research is just starting to scratch the surface of the potential benefits of psilocybin and it’s an exciting road ahead!

Can you give an overview of the current research that has been done with Psilocybin?

At Johns Hopkins, psilocybin-assisted therapy using 2 or 3 doses of treatment to help people who were heavy, long term smokers quit or reduce their smoking showed 80% quit rates at six months and almost 70% at 1 year after treatment. For alcohol use, early research showed that one or two psilocybin-assisted therapy sessions increased alcohol quit rates and reduced alcohol cravings. An Imperial College London preliminary study showed that psilocybin assisted psychotherapy reduced depressive symptoms in patients with treatment-resistant depression. Another Johns Hopkins study showed that psilocybin assisted psychotherapy reduces end of life distress among patients with advanced stage cancer. Further research is currently underway to assess the therapeutic potential of psilocybin for other substance use disorders such as cocaine use disorder. Although much of the research is early and uses small numbers of people, the results are promising and are also consistent with much of the previous research done in the 50s and 60s.

What does psilocybin assisted therapy look like?

There is variation but typically it starts with multiple preparation sessions where people set their intentions and prepare for the experience with a therapist trained in psychedelic assisted therapy. Preparation is followed by a treatment session where a lower dose of psilocybin is given with the therapist present in the room for the entire duration of the effects of the psilocybin, usually about 6 hours. The treatment occurs in a room that is designed and decorated to be relaxing and calming. Music is played and the person is lying down with an eye shade on, to help encourage them to go inward. After treatment, there are integration sessions which help people reflect and find meaning in their experience. This cycle of preparation, treatment and integration can be repeated and usually is in the research.

Can you tell us more about the importance of set & setting?

These terms were first used in the 50s & 60s during the beginning of psychedelic therapy. Set refers to someone’s mindset going into the experience and setting means the environment someone is in when taking a psychedelic like psilocybin. Set and setting are important in influencing someone’s experience with psychedelics; having a fearful mindset in a stressful or chaotic environment could result in a negative experience while having a calm and open mindset in a supportive, safe environment helps to create a positive one. 

There is a lot of talk about microdosing, can you explain what this means and the potential benefits?

There is actually no formal agreed upon scientific definition of what defines a microdose. Microdosing as it relates to psilocybin or other psychedelics, usually involves taking a very small dose, approximately one-tenth to one-twentieth of a regular dose, that does not impair normal functioning over multiple days with the goal of improving and enhancing wellbeing and cognition. There are many claims on forums and data collection apps which speak to people’s experience with microdosing however more formal research is lacking where various doses of psilocybin would be compared to a placebo to determine the effect. I think there will be a lot to learn in the area of microdosing in the future.

Is there a risk of addiction with psilocybin?

Research has shown that psilocybin, when used in a therapeutic setting is low risk for addiction, physical and psychological harm. It should be noted that certain medications can interact negatively with psilocybin, especially those used to treat depression or anxiety. People with a personal or family history of a psychotic disorder such as schizophrenia should avoid psychedelics, and some chronic diseases could be exacerbated by taking psychedelic drugs. 

What is meant by a “bad trip” and can you avoid one?

A bad trip refers to a negative or frightening intense experience after taking a psychedelic such as psilocybin. Starting with a low dose and having the support of someone who is experienced with psychedelics and challenging experiences is important, especially for those who may be struggling with mental health concerns such as PTSD, as psychedelic use could bring up past traumatic experiences and intensify emotions. One interesting finding from the research was that in a guided setting, more intense experiences can result in more long-lasting change. For example, in the studies on psilocybin therapy treatment for smoking and alcohol use, people who reported more intense mystical-type experiences had significant reductions in their smoking and alcohol use.

What excites you the most about the future potential for psilocybin?

Every day I treat the symptoms of so many people’s underlying trauma – their addiction, which claims the lives of tens of thousands of Canadians every year. Psilocybin has the potential to address the underlying trauma that leads to addiction in the first place and has the potential to reduce suffering and save lives. 

Answers by Dr. Lindsay Mackay

Questions by Yawn