Pot, Psychedelics, and the Controlled Substances Act

By Maximillian (Max) H. Matthies posted 12-03-2019 08:18


Richard Nixon signed the Controlled Substances Act (CSA) into law in 1970 and in 1971 declared the War on Drugs, ostensibly to curb recreational drug use, although some say that advocates had less than idealistic motives. Under the CSA, cannabis, peyote, LSD, heroin, methaqualone (Quaaludes), and many others are Schedule I drugs because they have "no currently accepted medical use" in the United States, there is a lack of accepted safety for use under medical supervision, and they have a high potential for abuse. Schedule II drugs include Dilaudid®, methadone, Demerol®, OxyContin®, Percocet®, and fentanyl and can only be issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. As we all are aware, the opioid crisis has been fueled in part by the overprescription of these superaddictive Schedule II substances.

Humans have been using cannabis and peyote medicinally for thousands of years. From the 1950s to the early 1970s, more than 40,000 cases of treatment using psychedelics such as LSD and MDMA (Ecstacy) were discussed in 1,000 different medical papers. The studies covered everything from addiction and depression, to PTSD and obsessive-compulsive disorder, to antisocial disorders and autism with some level of success. (However, many of these studies had no controls.) Placing these and other psychedelics in Schedule I shut the door on any further research on their therapeutic potential.

Today, anxiety affects 40 million adults in the United States. Depression affects 16.1 million American adults. Roughly 15 percent of veterans suffer from PTSD (it varies by conflict). Clinicians are increasingly dealing with treatment-resistant depression, anxiety, and the ineffective use of antidepressants and prolonged exposure therapy for PTSD. Fourteen million adults have alcohol use disorder. And to bring it closer to home, lawyers are not immune to these mental health issues.

Forty years later, psychedelics and other Schedule I substances are back in the news, but for very different reasons. MDMA may offer significant relief for sufferers of PTSD in clinical use trials and was granted breakthrough therapy designation in 2017. There is evidence that LSD may successfully treat alcoholism and anxiety. Psilocybin has shown to be effective in treating depression, even for cases in which other treatments have failed. Cannabis as cannabidiol (CBD) binds to the same serotonin receptor as LSD but does not cause hallucinations, and it may provide relief for people with schizophrenia. While ketamine (a party drug also known as "Special K") is a Schedule III drug, the FDA has approved a depression treatment based on ketamine, which works for patients considered treatment resistant.

Some of the same substances targeted by the War on Drugs may provide relief to millions of Americans. While the research results appear hopeful, especially for those who have not responded to other forms of treatment, a lot of work remains to create safe treatment modalities that can be used consistently.