Professor David Nutt: To my mind, this is the big unknown. We can get people well. Of the people we get well, some stay well for a very long time, but the majority, the depression creeps back over three months, six months, particularly people who have been depressed for decades. And the real challenge now is how to keep those people well. And one option is, well, we just give them another trip every six months. But that is really, really difficult because of course the drugs are illegal.
Dr Rupy: Today, I'm absolutely thrilled to have Professor David Nutt on the podcast, an expert on drugs and how they work on the brain. He trained as a psychiatrist and for almost 50 years, his research has focused on new drug treatments for anxiety, depression, and addiction. Today, we're going to be diving into the world of psychedelics. We're talking LSD, psilocybin, and ketamine. We discuss the history of psychedelics and why they were banned in the first place, despite having a relatively good safety profile, how these drugs work and the mechanism on the brain, the default mode network, also known as DMN, and the latest research looking at its efficacy and role in a multitude of conditions. You can check out his latest book, Psychedelics, that I highly, highly recommend and try his revolutionary alternative to alcohol that we mentioned on the podcast called Sentia Spirits that you can find online. I'm really, really excited for you to hear this podcast. It's rare that Professor David Nutt has the time to dedicate a whole hour in his packed schedule, so to sit down with him and have a full-length conversation was an absolute pleasure. So please do enjoy my conversation with Professor Nutt today. You can watch this on the YouTube channel, just type in Doctor's Kitchen on YouTube. And remember, you can sign up to the Eat, Listen, Read newsletter where we also give you the seasonal Sundays newsletter on Sundays where we do a deep dive into an ingredient that's seasonal, how to cook it, what the history of it is, what the potential benefits are, as well as monthly curated content to help you have a healthier, happier week. On to my podcast with Professor David Nutt. Professor Nutt, we're going to start off with psychedelics. How can psychedelics help treat stress, anxiety, and depression?
Professor David Nutt: Well, if you'd asked me that 10 years ago, I would have said, I'm not sure they can. But since we've started using them to treat disorders like depression and OCD, a lot of people with PTSD have come up to me, the vets, and said, I've been to Spain or Holland or even the Amazon to get psychedelic treatment for my anxiety disorders, and they've done very well. So the last couple of years, I've been reframing what I think's going on in the brain in relation to this broader range of disorders. And I think we're coming up with an idea that all chronic mental illnesses have one thing in common, which is that people get thought loops which they struggle to break out of. So if it's PTSD, if it's trauma, they keep remembering the trauma. If it's depression, they keep, they have thought loops about how worthless and useless they are. If it's OCD, they keep having thought loops about cleanliness. And those thought loops occur at a very high level in the brain. And that's where psychedelics work. Psychedelics work in the cortex to disrupt those very high-level cortical processes. And they're very, in that sense, they're very different from traditional antidepressants, which work deeper in the brain, in the limbic system, the emotional centres. And I think the straight answer to your question is we can break down what we call maladaptive circuits of thinking with a psychedelic. And then that allows people to escape from what's been bugging them. But also, there's one other clever thing about psychedelics, is that they are also promote, they also promote neuroplasticity. So that when you get a new insight, for instance, you're a depressed person who suddenly under the psychedelic, you suddenly realise, I'm not a bad person. It's not my fault, it wasn't my fault that my parents divorced. You can reframe your perspective on yourself, and then you can use that neuroplasticity to lay down whole new ways of thinking about yourself and the future, and they can be very enduring.
Dr Rupy: And just on that subject of neuroplasticity whilst we're there, can you break down exactly what we mean by neuroplasticity? Because I think people have heard the terminology and they have a loose idea of rewiring the brain, but how do we actually sense that the these psychedelics are having an impact on it?
Professor David Nutt: Yes, so there are two complementary perspectives on this. So what we mean when we talk about neuroplasticity is that the brain changes. That's what it means. I mean, and of course, the brain changes all the time. The five-minute conversation we've just had has changed lots of parts of my brain in terms of even every memory that I've laid down of this conversation is due to neuroplasticity. So at a at a sort of molecular, cellular level, that is due to two things. That's due to synapses between neurons becoming either enhanced in strength or more of them developing. So when we people measure neuroplasticity in the brain, they're usually looking at the number of synapses in a particular circuit because we think that the more, the more synapses you have, the stronger the the circuit, all right? But the question is, how do you measure that in humans? You can't chop bits of the brain out and count synapses. One thing we are trying to do is use a particular imaging technique with a particular tracer. It's called positron emission tomography, and it uses a tracer which binds to one of the proteins that are in synapses. And and we've shown that in disorders where there's synaptic loss, like like dementia, there's less of this tracer binding. So we're now doing a study where we're seeing if we can increase the binding by giving a psychedelic. We're using both ketamine and then DMT. So that would be a sort of first proof in humans that you can actually get more synapses after a psychedelic trip. But the other thing we've done, and in some ways the most compelling, is that we have looked at the flexibility of the brain after psychedelics. And we've done this in patients and we've done it in healthy volunteers. And and you can very readily see in if you put a healthy person, a normal person in a scanner, give them a psychedelic, the brain becomes much more connected. And that I think is one of the crucial factors in why people get important insights when they take psychedelics. But that increased connectivity persists. Now with with our patient studies, and we've only really done this currently in in in depression, we're doing it in other disorders, but we've done two depression studies. And in the first one, we we scanned people's brains one day after the trip, because you couldn't really ethically put a depressed person in a scanner and hope to get a therapeutic benefit of the psychedelic. I mean, you might get the benefit, but we, you know, we couldn't justify that. So we scanned them a day after. And in the second study, we scanned them three weeks after. And then we looked at the ability of their brains to change their way of thinking, to to switch between different thinking states. And in both states, both the day after and three weeks after, the depressed brain was more flexible. And, and this is really remarkable, the more flexible it was, the better their outcome was at six months. So this is almost like a fingerprint or a measure of the changes in the brain which actually predict outcome in depression. That's very unusual.
Dr Rupy: How are you able to challenge their flexibility in that particular study? What what what measure did you use?
Professor David Nutt: The measure we use is we we look at the whole brain. Now in, let me just give you a little bit of the backstory. There are multiple networks in the brain, depending on how sophisticated your analysis is and how many measures you've got. But I mean, simply, there are some very obvious ones we can talk about. You know, there's there's the visual system, there's the hearing system, there's the speech system, there's the motor system, there's the feeling system, and there's the thinking system. And there are about three different thinking systems. There's a self-reflective system, there's a system which gets you out there doing things, you know, analysing things. And then there's another thinking system which is about the relevance of what's out there to you. So say let's say there are 10, 10 big networks in the brain. We can measure them and see how rapidly the brain moves between different ones. So obviously now I'm talking, my my auditory network is very active and my word production network is really, really active. And I and my visual network is very active because I'm looking at you and seeing if you're agreeing with me, which is great. And other networks aren't so active. So we can see how readily the brain flips between different networks. And after psychedelics, we can see they flip, it flips more readily. We see these transitions, there are more of the transitions basically. And that's really important because the the killer problem in depression is that people, one of the networks, which we call the default mode network, the network which encodes your sense of self, your value, your self-worth, that becomes overconnected to itself. And it doesn't connect to the rest of the world. So rather than evaluate your thoughts by seeing what other people are doing or saying or written about you, you get locked into this internal rumination, this loop of negative thought. We can break that out. We see that psychedelics break it down and it stays less tightly connected afterwards.
Dr Rupy: I want to go into the default mode network in a bit more detail, but perhaps before we do that, we can step back slightly and actually talk about what we mean by a psychedelic, what psychedelics we typically talk about from the research point of view, LSD and DMT, etc. and how those are different from other exogenous molecules that we might use. How does it differ from a nootropic, for example?
Professor David Nutt: Okay, so when we talk about psychedelics, most people are talking about what we call the serotonergic psychedelics. So these are drugs which like LSD, like DMT, like psilocybin, magic mushroom juice, DMT of course is in ayahuasca. They target a particular serotonin receptor in the brain called the serotonin 5-HT2A receptor. That receptor is really, it's probably the most interesting receptor in the brain in some ways because it's highly, for reasons we don't fully understand, it's massively expressed in the very highest parts of our brain, the parts of our brain which make us human. And that's of course is why psychedelics by perturbing those receptors change the very highest functions of our brain. So people think differently on psychedelics, but they can still move their arms and legs because it doesn't affect those, you know, those more longer evolved parts of the brain. But there are other kinds of psychedelics. And then there are ones like Salvia, which produce again, a rather similar disorganised state of brain function, but which is subjectively really quite different and often very unpleasant. And then there's Amanita muscaria, which is the the GABAergic psychedelic, which is we we believe is the is the mushroom that Alice took to get bigger and smaller because it it produces distortions of of size. And then of course there's ketamine. Now ketamine is pharmacologically very different from DMT or or psilocybin, but it produces again, perturbations of brain function which can liberate people from disorders like depression and addiction. And currently, of course, in the UK, it's the only psychedelic we can actually use because it's the only one that's a medicine. So so a lot of our clinical work is using ketamine at present, but but we're hoping in time that the regulations will change and we'll be able to get hold of psilocybin and maybe DMT.
Dr Rupy: And how do these differ from other molecules like nootropics that people talk about?
Professor David Nutt: Yes, so so nootropics, nootropics are drugs which promote brain metabolism and brain growth, but they do it in a general way, whereas psychedelics particularly target one receptor in that are localised on a very special set of cells. And let me just explain why these cells are really important. The human brain has more computing power than all the computers on earth put together. Why is that? Because your brain is made up of about 100 billion neurons and each neuron is a mini computer. And you think, you know, 100 billion times 100 billion is an awful lot of computing power. Now, what makes the those individual computers work as a whole are particular set of neurons which are located in the cortex, they're called the layer five pyramidal cells, and they pull it all together. So they make all the communications in your brain. And that is, you know, why we are so clever and you know, we've got the enormous capacities for everything that humans have. Psychedelics particularly target those those neurons. And we don't know why. We don't know why those neurons have got a lot of the 2A receptors. I think it's got something to do with the ability to think differently. I think they, those, we know that those receptors are involved in neuroplasticity. We know that those receptors mediate the psychedelic experience. We don't exactly know why they're there, but I think, you know, they they the fact that they're there means that even if if major things happen to you, even if you're not taking a psychedelic, like for instance, you know, you suddenly discover how to get make fire. I think the encoding of that experience, that that sort of light bulb moment, wow, I've done something fundamental. This is, they will be, it'll be encoded by a whole set of neurons which are controlled by those 5-HT2A receptors. And if you perturb them, then you change the way you think. And that's why you can break out of thinking patterns which are not necessarily very helpful and get into new ones.
Dr Rupy: Are there patterns of use across all these different types of psychedelics that we are seeing are more useful in different scenarios of the patient's diagnosis? So are there certain psychedelics that are more useful for treatment refractory depression, for example, or generalized anxiety disorder or PTSD?
Professor David Nutt: It's a bit too early to say. And the there are fundamental differences between the psychedelics, but they're more to do with the what we call the kinetics, the time course. So I was things like DMT, we have to either smoke or inject, it has a very transient effect, maybe 10, 12 minutes. For the clinical studies we're doing with DMT, we infuse it intravenously, lasts about 20 minutes. On the other end, you've got LSD, you know, the trip can last, you know, 15, 20 hours, which makes it quite hard actually to use clinically because you have to have people in hospital. So, but if you get the same level of interaction with the receptors in the brain at the same time with any of these drugs, you do get very similar effects. So at present, it's not clear whether a particular psychedelic would have particular utility for a particular disorder. It might turn out to be relevant, but it's going to take a lot more research. You know, we're very, we're only just starting this in present.
Dr Rupy: Because of the legality issues, is ketamine the most studied in terms of the psychedelics that we have research on today for all these different conditions? Or are we seeing actually that in terms of the weight of evidence for all the other ones, it's it's almost on par?
Professor David Nutt: So there's a paradox here. Ketamine is far and away the most used, but it it's the least studied. And the reason for that is I suppose because it's kind of less interesting because it's not, you know, we the questions that we're asking about ketamine now are being asked because we have done the psychedelic research. The ketamine researchers didn't really, they weren't, I mean, ketamine was developed as an anaesthetic, put, you know, knocks your brain out. People aren't really interested in what's going on in the brain when you're unconscious because you're unconscious. So it's only recently the ketamine's been used in a a sub-anaesthetic level in order to produce, for instance, an antidepressant effect. And those is sort of not been so intellectually interesting. The psychedelic research that has really driven the explosion of neuroscience studies in this field. And now we're desperately keen for the ketamine community to catch up. And in fact, we're beginning to do our own ketamine work because they don't seem to be doing it. So we're going to we're going to have to do it for them, I think.
Dr Rupy: Is there a bit of nervousness because ketamine, I guess, is one of those drugs where it can be abused? I mean, I remember seeing in the GUM clinic when I used to work in Brighton, we had ketamine users and they would come in with all different sorts of symptoms and bladder cystitis and quite, quite severe issues of a
Professor David Nutt: Oh yeah. Ketamine dependence is a is a serious problem, particularly as you pointed out in terms of the, you know, the chronic cystitis and requiring sometimes people to have their bladders removed, which is a horrible thing to have to do because it takes years off your life because you end up with kidney infections. But there's another side of that story as well, which is that heavy use of ketamine produces a kind of dementia. It produces a state of apathy and lack of energy and lack of foresight, which is almost either like dementia or a bit like some forms of schizophrenia. And that that is when ketamine is used recreationally repeatedly. The thing about ketamine is that you get tolerance to the effect quite rapidly, but you can what we call surmount that tolerance. You can overcome it by taking more. So people might start off taking a quarter of a gram of ketamine and after three or four months, they're taking three grams, you know, a night. And that then really does put the pressure on the brain and the bladder. Now, in clinical practice, ketamine is rarely used more than once or twice a week to start with, and then usually it's only it's limited to once a month for for maintenance therapy. So maybe over a year, you might get 15, 20 doses. That's probably not going to cause tolerance, it doesn't seem to cause tolerance, and it's probably not going to cause problems. But there are situations, particularly in the US, where there's not much control over who's getting ketamine, where you can doctor shop. You can, in theory, just keep, if you've got enough money, you can just go and see a doctor, a different doctor a day. And there are cases of ketamine dependence developing from the clinical use there. Now, psychedelics are fascinating because psychedelics also produce tolerance, but the tolerance is so powerful, you can't surmount it. And what's amazing, do you know who made that discovery?
Dr Rupy: No idea.
Professor David Nutt: That was made by the the US Army.
Dr Rupy: Oh, really?
Professor David Nutt: Yeah, because they were terrified in the 1950s that Russia was going to spray LSD over America and basically stop their American soldiers fighting. So the Americans did a lot of research on what's what's the antidote for LSD? They couldn't find an antidote, but they discovered if you treated your soldiers with LSD for three days, the third day it didn't work.
Dr Rupy: Huh.
Professor David Nutt: So that was the plan. If the war was going to break out, everyone would be tripping for two days and then they then the Russians could spray what they like. So we that that and that is a powerful safety measure. We we're very confident that psychedelics cannot, you know, most people don't want to use them more than once or twice anyway. And if you keep on using them, they just stop working.
Dr Rupy: That's so interesting because I was going to ask you about, if that happened in America, what happened in the in the UK with regards to the same?
Professor David Nutt: Well, normally if America says do something, we, it's America says jump, we say how high, sir? Every single component of our Misuse of Drugs Act, 1971 Misuse of Drugs Act, has been until 2016, the Psychoactive Substances Act, which we did on our own, up till that point, every single thing we have done has been at the behest of America. And I can tell you that because I can take categorically about particularly, well, it goes back to cannabis. Cannabis was a medicine in Britain until 1971. It was medicine. The rest of the world actually, America banned it, most of the rest of the world banned it in 1934, but we we held out. We said, why should, our doctors said, it's a medicine, we're going to use it. And then in 1971, America said, look guys, you know, you've, I don't know what the deal was, no one knows, no one, if they know they won't tell, but we decided to ban it as a medicine because America told us to. And then of course, 20 years later, it's all over America, but we it took us another 20 odd years to to to bring it back into medicine. So that was the first example. But more, an example I was party to when I was on the advisory council of the misuse of drugs, was was khat. You know, the chewable plant that comes from from, you know, from Ethiopia and so. Khat, perfectly legal in Britain. The Americans banned it because they like banning things. And we refused to ban it. And every, the advisory council once a year met with the foreign office. And the foreign office would come in each year and say, the Americans are telling us they really don't like the fact we haven't banned khat. It's causing big problems because they're importing it into America from Heathrow. And we would say, well, then unban it. They can import it directly. And they would get really angry. And eventually we conceded, eventually, I think in 2015, there was a, you know, a private member's motion to ban khat because essentially, you know, America wanted it banned.
Dr Rupy: Wow. So a lot of these political movements have influenced the research around these different substances, but also the, you know,
Professor David Nutt: Well, all the drug laws are political. It's obvious because alcohol is more harmful than most drugs that are banned. So that's clearly a political decision, not a health decision. But what people, what people don't realise is what you're intimating there. People think, well, it doesn't really matter, you ban a drug. Okay, so a few kids get locked up, you know, but it might deter some, so it might be have a beneficial side. What people completely overlook is the impediment to research that the ban produces, which means that medicines like psilocybin and LSD, before they were banned, there were 140 studies of LSD and psilocybin as medicines.
Dr Rupy: This is in 1960s?
Professor David Nutt: In the 50s and 60s. I mean, psilocybin, magic mushrooms, was a medicine, a licensed medicine from 57 to 68. It was a medicine. And then they, the America, then they said it wasn't a medicine because because people, as I say, it changed the way people voted. You look at that database, the database, there were 1,000, 1,000 clinical papers showing the utility. Some of the very top psychiatrists in the world were doing
Dr Rupy: 1,000?
Professor David Nutt: 1,000 papers, 40,000 patients. You know, the the safety database was overwhelming. It's very, very safe. And the outcomes were really, really well, they're good. And that was all denied in an attempt to, well, when they banned it, they just denied that. They just lied about it. They said it didn't have any clinical value, even though, you know, there's a thousand papers showing it does.
Dr Rupy: Wow. And looking at those 1,000 papers, if we still have access to those, what kind of efficacy were they demonstrating back then? And can you estimate, you know, if we did have those 50 years back of research on these substances, how many deaths, morbidity, you know, how how much
Professor David Nutt: It's the worst censorship of research in the and clinical practice in the history of the world. 55 years of denying proven medicines to the world. It is, it is, you know, I mean, it's a crime against humanity. So let's give you an example. A back of the envelope calculation. LSD for LSD for alcoholism. Maybe I'll give you a bit of the backstory here. Most people do not realise that Alcoholics Anonymous was founded as a result of a psychedelic trip. Bill Wilson, chronic inebriate, 1933, Yale graduate, was being detoxified for the last time before they were going to lock him up if he carried on drinking in a in a home for incurables. He had a, he was given a combination, it's in my book, of a mixture of scopolamine type drugs. It was called the Belladonna cure. He had a profound psychedelic experience when he said, I was on a mountain and a wind, not of air, but of spirit was blowing. And it came upon me that this was the God of the preachers, and I was a free man. And he, that's it. He ceased to be an alcoholic then. And he campaigned and very successfully, he set up Alcoholics Anonymous, and then he campaigned when LSD became available in the 50s, he campaigned for LSD to be used to treat people with alcoholism who couldn't see the bigger picture. They couldn't get in touch with the spiritual being, which is what Alcoholics, the 12-step program is about. It's about achieving that kind of spiritual awareness. And because he was so, such an important person and and he managed to persuade the US government to do six trials of LSD in alcoholism. And it was one or two doses as part of a psychotherapy package where you're trying to stop people drinking. Now, 10 years ago, two Norwegians went back and got the source data, did a proper meta-analysis, and they've shown that the effect size of LSD, one or just one or two trips in alcoholism is about three times that of the best subsequent treatment for alcoholism. Three times. Okay. So let's think, in those 55 years, on average, now it's about three and a half million people a year die prematurely of alcoholism. You go back back to the 60s and 70s, maybe two million. So let's just estimate maybe 100 million deaths, premature deaths from alcoholism over the last 55 years. How many would have been saved by LSD? Well, I mean, very conservatively, at least 10%. So let's say 10 million lives saved. How many lives have been saved by the LSD ban? Well, probably none. But let's be generous. Let's say it deterred a few people. Let's say maybe it deterred a thousand people who might have died. I mean, I'm not sure a thousand people have ever died of LSD in total. But anyway, well, maybe even, you know, it saved a million lives. The equation is so much in favour of the treatment. And that's why I'm, you know, why I've been protesting this for so long, because it's outrageous that a medicine should be denied to patients simply because people who were using it recreationally voted Democrat. I mean, it just doesn't make sense.
Dr Rupy: It is. It's incredibly sad when you frame it like that and you you think about the the number of lives and who are completely made upside down with the the effects of of alcohol, which is socially acceptable. And I guess it lends itself to the question of harms around LSD and how they were magnified. I've heard you talk, I think earlier about, you know, the sort of editorials around LSD and how it was sort of putting people in society against the idea of even allowing psychedelics for research. What what kind of harms are there associated with LSD as a specific psychedelic? And are they comparable to some of the other medications or they have they been exaggerated?
Professor David Nutt: Well, clearly there are harms. I mean, all drugs can harm, you know, but as I like to point out, more people in Britain every year die of water poisoning.
Dr Rupy: What's that?
Professor David Nutt: Water poisoning. If you drink five litres of water, you die. About seven people a year in Britain die of basically hyperhydration, drinking water, polydipsia, you know, about seven a year. And I mean, I don't know whether any a year die of, well, we know for psilocybin, one of the things we've been campaigning actively to make psilocybin rescheduled because we know from the government's own data, there might have been a death in the last 20 years.
Dr Rupy: 20 years.
Professor David Nutt: And it's a million people a year using it. So we know these drugs are extremely untoxic in overdose compared with say something like alcohol or tobacco or or even, you know, ketamine or benzos. So, so, but there are harms. I mean, you know, there are if if people have got a tendency to psychosis, then they can make psychosis worse. People can have bad trips and that can be dangerous. But even when you, even in the worst case scenario, when you look at the harms of psychedelics when used recreationally without any control, and compare them with the harms of other drugs, they still come out really low. And then if you then say, but if we only use them in a medical setting, they're going to come out even lower. You know, it is, it is, it makes no sense to keep them controlled as a schedule one drug, which means they're virtually impossible to work with. And it's not that my, my group have done that, a very famous paper, you've seen the graph of harms that was published in the Lancet in 2010. Just after that grant was published, a lot of people don't know this, the European Department of Justice said, we would like to give a grant to European experts to to see if they agree with you. And so we trained them in how to do the methodology, and then we let them go to it. And there were 30 experts from 20 countries, big differences, you know, some countries like Czech Republic, Norway, a lot of crystal meth use, other countries have different problems. They they changed every score that we had. They changed every waiting on every drug, and it came out with exactly the same, almost, only only two drugs changed place, GHB and ketamine changed place. It was almost identical to what we came up with. And then more recently, it's been done in Australia by Australian experts, and it's been done literally just last month and published by New Zealand experts. So where you where experts look at drug harms, alcohol is always number one because it's very commonly used. And psychedelics are always right down at the bottom.
Dr Rupy: I remember in the early 2000s, this is coming to me now, in Camden, which for the listeners who are not familiar with London, it's a place in North London, magic mushrooms seem to be on sale. And I don't know whether they were fake magic mushrooms. I never purchased them, obviously, but were they, was it legal at that point to actually have?
Professor David Nutt: This is another scandal. This is another example of how politics has driven policy. So until 2004, in Britain, magic mushrooms were legal.
Dr Rupy: They were, so they were genuine magic mushrooms.
Professor David Nutt: Because actually, two good things came out of the 1971 Misuse of Drugs Act. Two drugs were not, two things were not banned, probably because the Americans didn't know about them. We didn't ban cannabidiol because our scientists knew it wasn't psychoactive. And we didn't ban the magic mushroom. We banned psilocybin. So you weren't allowed to extract mushrooms, you know, the psilocybin from mushrooms, but the mushrooms were legal. Okay. No problems at all until, as you point out, a couple of head shops in Camden started selling freeze-dried mushrooms, cubensis mushrooms that came from Holland, where they were legal. And that incurred the wrath of the Daily Mail. And at that time, the Tories were in opposition. David Cameron, the man who was going to come to power and rationalize the drug laws and rationalize alcohol policy, who the day he was appointed, the day after he was appointed head of the Tory party, changed his mind completely, went from saying MDMA should be class B to be saying MDMA is, you know, devil's, you know, sweat or whatever. He changed his mind instantly. It was embarrassingly bad. But anyway, he decided that he could attack the current Labour party, because Blair was then in power at the time, on the mushrooms. So there were these Daily Mail, mushrooms are killing our kids, you know. And Tony Blair, being also rather, rather right-wing of inclination, instead of doing what he should have done, which was go to the ACMD, which we were on, and ask us to make a decision about magic mushrooms, he decided, I suppose he was, I can't remember, he was probably getting ready for the Iraq war then, I don't know. He decided to to bring together a group of experts to decide on how to deal with mushrooms. He didn't include any anyone who knew how to spell psilocybin. Basically, it was senior police, army, and him. Now, I wasn't in the, basically, we heard this, there aren't minutes of the meeting, but that apparently he called a, you know, his his special strike force on the mushrooms. And we heard a rumour, we heard a rumour that they were going, they were actually doing something about magic, they're going to actually try to change the law. So we wrote to them, we said, by the way, you know, you will know that you're not allowed to change the law without consulting us, because the law, the Misuse of Drugs Act says a government must consult with the ACMD. And we wrote to him, and then nothing happened. About two weeks later, they wrote back and said, okay, well, there's a debate in Parliament on Thursday. We want you to do a harm assessment by then. We said, well, it's Monday. And we can't do it. I mean, that's an insult. And they said, tough. But they complied with the law in that they they told, they consulted us. And they said it was our fault that we didn't come back with an instant reply. And then they banned it. And they so they took mushrooms, which were legal, and put them in class A. Why in class A? Well, because all psychedelics are in class A. Why are they in class A? For the same reasons that we've been going around already. It's historical enmity to to, I mean, completely. And then you had absurd things. You had police forces saying, right, we're going to crack down. We're going to spray the fields with chemicals to kill the mushrooms. You think, well, hang on, if you do that, you're going to affect the soil and the crops and the things you're going to spray don't kill mushrooms anyway. They just kill the grass. I mean, it was absolutely completely ridiculous.
Dr Rupy: Wow, what a scandal.
Professor David Nutt: Outrageous, outrageous. And it was all, well, we're tougher on drugs than the Tories. And that's happened, and that's still going on today. Why don't we have legal cannabis in this country? Because neither of, neither of the two main parties is quite sure how that's going to go with the the right-wing press in terms of the election. It would be really nice if they just said, look, guys, let's agree and take it out of the equation. I think drug laws should be taken out of the equation. I think the problem we have is that there aren't very many levers that governments have to get traction with voters. I mean, when you think about it, interest rates were taken out, you know, given to the Bank of England, you know, and fiscal policy has also got an independent group that actually oversees it. The only, the drugs are about the only sort of moral behaviour that can be controlled or used to to get political advantage. And so neither side is prepared to give up that possibility of of stepping out of line and then being vilified by the right-wing press. But if both sides agreed, then it could happen. And I think, you know, we should have an independent committee that used to be called the advisory council on the misuse of drugs that arbitrated on drug on drugs. And up till about 10 years ago, the government used to do what the ACMD said. But then, particularly under starting with with Blair, but also then with Brown and Cameron, they decided that they could use drugs to try to gain political advantage. We should, drug policy should be taken out of the Department of Health, it should and it should be given to an independent committee that sits with, sorry, it should be taken out of the Home Office where it is at present, because, you know, which is basically, as you know, the Home Office's role in life is to say no and to imprison people or send them to Rwanda. And then it should be given to the Department of Health with an independent committee that says, really, what the harms of drugs are and and, you know, basically have a have a misuse of drugs act which actually is honest to the relative harms. And that would serve an enormously important function because it means you could then, if you tell the truth to people, they might listen. Because everyone knows everyone's lying about drugs. So so harms emerge because no, you know, when occasionally the truth is told, no one believes it.
Dr Rupy: It's crying wolf, isn't it?
Professor David Nutt: It is.
Dr Rupy: There is a trend that I'm certainly privy to of people who are, quote unquote, healthy, i.e. they don't have a diagnosis of mental health disorders, whether it be anxiety or depression, taking psychedelics in various doses. Some people are microdosing, some people are taking larger doses or hero doses for the the sort of health optimization effects. Are there any benefits of people who don't have a diagnosis taking these substances for the benefit of their mood, their creativity, and other sort of spillover effects?
Professor David Nutt: So what what we can say is that there aren't any systematic studies because it's virtually impossible to do because these drugs are all illegal. I mean, for let me give you an example of the absurdity of the law. Six years ago, we got ethical permission to do a microdosing study with LSD at Imperial College. But the ethics committee said, the drug has to be given in hospital and they have to stay in hospital for 12 hours.
Dr Rupy: 12 hours.
Professor David Nutt: And we said, well, it's a microdose. And they said, yeah, but the half-life of LSD is eight hours, so you've got to stay for two half-lives. We said, but that's pointless because they're not having, you know, and they said, you have to do it. And we couldn't afford to do it. Because, you know, I mean, buying hospital space for 12 hours for every, so we just couldn't do it. I mean, again, a bonkers decision. Completely. I wouldn't mind administering in hospital so that they, you know, wouldn't have 100 tablets they take home, but but to, I mean, and that just, that just shows you why the research hasn't been done because the because the law, the scheduling really precludes it. But what we know is that a lot of people do microdose and they find it, you know, often they report that it's effective, it improves their mood, it improves their creativity. But we can't absolutely say that it does. We've tried to test that. In fact, we we did probably the closest you could do to a double blind study where we trained people to to blind themselves by giving them two, two kind of sort of colour-coded envelopes and and teaching them how to mix them up and then we we we knew what was in each. And we found there that you if you thought you were taking a microdose, it definitely improved your performance and your mood. But that's because you thought you were taking it. If it was placebo, you would just, you did just as well as if it was the active drug. But then if you thought you were taking placebo, you didn't do so well. So so there is an expectation effect. I don't think that actually disproves, I'm actually relatively sympathetic to the idea that that microdoses or mini or mini doses, doses that you just perceive, I think they might be therapeutic, they might be helpful in many ways. So I wouldn't say they don't work, but I just saying we can't prove they work. Then the other end, what about a macrodose? You know, a trip dose? Well, the first thing I would say is that there is absolutely zero evidence that megadoses work. So just as a clear harm reduction message, we now know from good scientific research, going above 25 milligrams of magic mushroom psilocybin or 150 micrograms of LSD just adds harm. It adds side effects. It doesn't give you any better psychological outcomes. So so megadosing, don't do. But a trip, what about a trip? Does a trip improve things? Well, one of the reasons we started doing work in depression was because we noticed in our healthy volunteers who were given psilocybin in a in a scanner, you got your head in a washing machine for 90 minutes, they come out and they say, wow, not that was not only interesting, but but I'm more in the world. Wow. I've got these wonderful descriptions from some of our our volunteers, you know, how they they could see colours differently and and they could they were much more in touch with other people. They were much more in touch with nature. And that is absolutely consistent finding. The people that volunteer for our studies and have a trip, they definitely do have well-being benefits which last for weeks or months afterwards, even though they're not, you know, they're just normal healthy people.
Dr Rupy: I was going to ask about that weeks and months afterwards. Do we have any indication of how long those well-being effects might persist for?
Professor David Nutt: Mostly they wear off over a few months. One of the really interesting things we've discovered, I mean, is is you can actually improve colour blindness with psychedelics.
Dr Rupy: Really?
Professor David Nutt: Yes. And and often that effect lasts quite a long time. And real scientists say, well, that's rubbish because colour blindness is in the retina. It's all to do with the cones and mutations of the cone genetics. And I say, the truth is, and this this this started from a someone just writing to me. He said, I thought, you know, you're working on psychedelics, would you be interested in this example of mine? And I said, what was it? He said, well, I'm, you know, I've got a particular kind of colour blindness, quite a rare one. He said, and my brother was is a great art fan. And he's dragging me around these galleries all the time and all I just see is just a sea of green and brown. And he said, then one day I took, he gave me some psilocybin. He said, and I suddenly saw this very famous picture by Monet, I think, of the Santa Maggiore in Venice. And he said, I suddenly, I suddenly saw it. I suddenly understood what he was talking about because I could see all the colours. He said, and I I just kind of cried for an hour because I understood. And people say, well, that can't be right. And of course it's right because he sees. So we did a, so as a result of him and someone else writing to me, we we put a questionnaire into the global drug survey that comes out every year, about four years ago, put a questionnaire, are you colour blind? Have you taken psychedelics? Have they helped your colour vision? And we got about 50 responses and about half of them said yes. And a few of them said it goes on for a very long time.
Dr Rupy: Interesting.
Professor David Nutt: And shall I tell you why I think it works?
Dr Rupy: Go for it.
Professor David Nutt: And I think it's part of this, it's an example of this efficiency of the brain. I think for most of us, unless we're artists and we work with colour, for most of us, colour is not central. You know, what, I mean, you know, we've been talking for an hour, right? But mostly your eyes are important, what you've said is important. Those are the two things. I mean, you know, the fact you're wearing a, you know, I probably won't even remember in an hour what colour shirt you're wearing because it's not important to me. And the brain downplays colour because in the modern world, colour isn't a big deal. You know, I mean, I think if you were, you know, living in the jungle and looking for different fruits, colour would be important. But we've kind of, we don't need colour in our life because it's more about facts and and language. And that suppression, we know that most of what your brain does actually is suppress things. It stops things happening in order to be very efficient for the things that are happening. And I think we suppress colour vision and that's liberated by psychedelics because we break down the suppression process in the same way as we break down the the processes which kind of drive negative thinking.
