On Saturday, April 18, President Trump issued an executive order that aimed to hasten and provide funding for research into the therapeutic effects of psychedelic compounds. Psychedelics are a group of compounds, ranging from psilocybin to MDMA, that have hallucinogenic effects and often induce an altered state of consciousness. Such compounds have been stigmatized for decades and made illegal even for medical use. Even before the order was issued, the use of psychedelics as a therapeutic has been a growing area of research in both academic and clinical circles. The measure itself will also provide $50 million in federal funding for ongoing research, speeding up the process in which psychedelic compounds like psilocybin can be used to treat neurological conditions. 

The executive order is an indication that psychedelic treatments are garnering more attention, and that FDA approval for certain compounds is imminent. “Psilocybin seems to be the closest for commercialization and FDA approval,” Dr. Nathan Sackett, an assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine, said. There isn’t a clear reason why psilocybin is the closest to commercialization, but Dr. Sackett cited its safe toxicology profile and the relatively large amount of data on its usage as possible reasons.

Psilocybin, and other psychedelic compounds, are powerful tools in psychiatry because they can stimulate neuroplasticity. Nirupa Shah, a former neurologist at the University of Washington School of Medicine, said, “Every condition where [neuroplasticity] can be a benefit is going to start having a trial, and the medical indications are going to expand past PTSD, severe depression, and anxiety.” Dr. Shah refers to neuroplasticity as brain circuitry altering in response to a new stimulus such as psychedelic compounds. Changes in circuitry can translate into changes in behavior, potentially combatting the symptoms of a variety of neurological disorders. “In my field, in epilepsy, the drugs are symptom modifying, [and] all the drugs that we use reduce frequency and severity of seizures,” Dr. Shah added. Compounds such as psilocybin will, instead of targeting symptoms, target the root cause of the disease by stimulating changes in neural circuitry.

Currently, “[psychiatric conditions] are ideally treated most often with a combination of medication to sort of attenuate the symptoms, and then some sort of psychological support,” Dr. Sackett said. Substance use disorders are treated with a mixture of therapy and medication., but psychedelics speed up the treatment process. “It accelerates the clinical effects of psychotherapy, and…what some people would say takes decades to complete in psychotherapy, it allows people to do it in weeks,” Dr. Sackett added. Additionally, psychedelics can cause changes in brain circuitry in ways similar to antidepressants but with lower drug exposure, reducing the risk of side effects. 

Despite their benefits, psychedelics aren’t a magic drug, and for some patients, the results might not be as satisfactory. Moreover, risks are still present as users are put “in an altered state where [they’re] very vulnerable,” Dr. Sackett said, adding that compounds will also have pharmacological risks that need to be considered. “The big question…is how do we identify the best patients for these compounds and what features do they have that we can generalize to other people.”