Feb 1, 2014

Discovery of new psychiatric medication, whether for the treatment of
depression, autism or schizophrenia, is at a virtual standstill. As just one
example, the antidepressants on the market today are no more effective at
reversing the mood disorder than those that first became available in the
1950s.

New thinking is desperately needed to aid the estimated 14 million American
adults who suffer from severe mental illness. Innovation would likely
accelerate if pharmacologists did not have to confront an antiquated legal
framework that, in effect, declares off-limits a set of familiar compounds
that could potentially serve as the chemical basis for entire new classes of
drugs.

LSD, ecstasy (MDMA), psilocybin and marijuana have, for decades, been
designated as drugs of abuse. But they had their origins in the medical
pharmacopeia. Through the mid-1960s, more than 1,000 scientific publications
chronicled the ways that LSD could be used as an aid to make psychotherapy
more effective. Similarly, MDMA began to be used as a complement to talk
therapy in the 1970s. Marijuana has logged thousands of years as a
medicament for diseases and conditions ranging from malaria to rheumatism.

National laws and international conventions put a stop to all that. The
Controlled Substances Act of 1970 declared that these drugs have “no
currently accepted medical use” and classified them in the most stringently
regulated category of controlled substances: Schedule I. The resulting
restrictions create a de facto ban on their use in both laboratories and
clinical trials, setting up a catch-22: these drugs are banned because they
have no accepted medical use, but researchers cannot explore their
therapeutic potential because they are banned. Three United Nations treaties
extend similar restrictions to much of the rest of the world.

The decades-long research hiatus has taken its toll. Psychologists would
like to know whether MDMA can help with intractable post-traumatic stress
disorder, whether LSD or psilocybin can provide relief for cluster headaches
or obsessive-compulsive disorder, and whether the particular docking
receptors on brain cells that many psychedelics latch onto are critical
sites for regulating conscious states that go awry in schizophrenia and
depression.

In many states, doctors can now recommend medical marijuana, but researchers
cannot study its effects. The uneasy status quo leaves unanswered the
question of whether the drug might help treat attention-deficit
hyperactivity disorder, nausea, sleep apnea, multiple sclerosis and a host
of other conditions.

A few privately funded studies of these compounds have yielded tantalizing
hints that some of these ideas merit consideration. Yet doing this research
through standard channels, as psychopharmacologist David J. Nutt of Imperial
College London and his co-authors noted in a recent article in Nature
Reviews Neuroscience, requires traversing a daunting bureaucratic labyrinth
that can dissuade even the most committed investigator. (Scientific American
is part of Nature Publishing Group.) It can take years to receive approval
for a clinical trial from both regulators and hospital ethics committees,
even while tallying thousands of dollars in licensing fees and tens of
thousands to obtain drugs that are, of course, unavailable from a chemical
supply catalogue.

The endless obstructions have resulted in an almost complete halt in
research on Schedule I drugs. This is a shame. The U.S. government should
move these drugs to the less strict Schedule II classification. Such a move
would not lead to decriminalization of these potentially dangerous
drugs-Schedule II also includes cocaine, opium and methamphetamine, after
all-but it would make it much easier for clinical researchers to study their
effects.

If some of the obstacles to research can be overcome, it may be possible to
finally detach research on psychoactive chemicals from the hyperbolic
rhetoric that is a legacy of the war on drugs. Only then will it be possible
to judge whether LSD, ecstasy, marijuana and other highly regulated
compounds-subjected to the gauntlet of clinical testing for safety and
efficacy-can actually yield effective new treatments for devastating
psychiatric illnesses.

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