Psychedelics and veterans with chronic pain
Many veterans suffer from dual epidemics of chronic pain and opioid dependence. Can psychedelics help vets curb addiction and fight chronic pain?
Marine corporal Craig Schroeder served in Iraq in the “Triangle of Death.” One day, a makeshift bomb left him with traumatic brain injury, a broken foot and ankle, and a herniated disc. In addition to hearing and memory loss, he is one of many veterans with chronic pain.
Veterans are the tip of the spear regarding chronic pain, opioid dependence, and overdose deaths. But they’re also at the forefront of new research showing psychedelics may treat chronic pain more effectively than opioids, without the risk of dependence or overdose.
Combat and chronic pain
Nearly half of veterans who see combat come back with chronic pain. In one survey, nearly half of veterans with chronic pain had suffered for at least a year, and more than half were in pain constantly or daily. By contrast, 26% of the general population suffers from chronic pain. More than half of these veterans rated their chronic pain as moderate or severe.
Over the past ten years of the most recent psychedelic renaissance, VA hospitals have been epicentres of randomised, controlled trials on using psychedelics to treat conditions like PTSD, anxiety, and depression. First, veterans are more likely to suffer from these conditions. Second, VA hospitals provide controlled environments which are in many ways ideally suited to running these types of trials.
Thanks to these studies, we have fairly robust preliminary data on the effectiveness and safety of using psychedelics to treat psychiatric problems such as PTSD, anxiety, depression, alcohol dependence, and more. When it comes to chronic pain, the evidence is thinner and more preliminary. Researchers are still very much in the early stages. But the evidence that’s coming out is promising. And with so many studies in the pipeline, we should know a lot more before long.
The research on psychedelics and chronic pain
At UC San Diego, Mark Geyer, Distinguished Professor of Psychiatry and Neurosciences Emeritus and founding member of the PHRI, has studied the behavioural and neurobiological effects of psychedelics such as LSD, DMT, mescaline and psilocybin, for the past 40 years. He helped launch the Heffter Research Institute in 1993, which is dedicated to renewing research into the beneficial uses of psychedelics. Researchers in Japan also studied using LSD for phantom-limb sufferers in the 1970s with “small but suggestive” results.
In 2020 researchers at the Netherlands’ Maastricht University and their colleagues published one of the few double-blind, randomized, placebo-controlled studies on psychedelics and physical pain in the Journal of Psychopharmacology. They found people on LSD, even at a low dose, kept their hands submerged in almost-freezing water nearly as long as people who’d taken opioids oxycodone and morphine in previous studies. The authors concluded: “Low doses of LSD might constitute a novel pharmacological therapy.”
A 2021 study showed people with chronic pain reported substantially improved pain scores during and after psychedelic experiences. A 2021 study on migraine sufferers found patients who took even a single dose of psilocybin reported a “significant” reduction in their migraine during the test period compared with those who took a placebo.
Yale University announced a trial using psilocybin to treat cluster headaches in 2021. In August 2021, Beckley Psytech raised $80 million for psychedelic research to fund, among other things, a phase 1b safety trial looking into using low-dose psilocybin to treat short-lasting unilateral neuralgiform headache attacks, a rare kind of headache. In May 2021 multimillion-dollar psychedelic start-up Mind Medicine (MindMed) announced a study series, Project Angie, on whether LSD and an undisclosed drug can treat chronic pain.
The drawbacks to conventional treatments
A lot of what makes potentially using psychedelics to effectively treat chronic pain so exciting is that opioids are currently the most effective and commonly used legal treatments available for chronic pain.
While opioids are extremely safe when used as prescribed, they carry significant risks of dependence and overdose. In 2020 opioids caused or contributed to 68,630 overdose deaths in the US, according to the CDC.
The vast majority of instances of opioid addiction and overdose deaths result directly or indirectly from the War on Drugs. The DEA currently severely limits access to well-studied, effective treatments for opioid dependence. And it contributes significantly to an epidemic of undertreatment for chronic pain, which leads sufferers to turn to black-market alternatives like heroin and fentanyl.
Veterans are hardly exempt from undertreatment for chronic pain. Chronic pain sufferers who can’t get their medication experience withdrawal symptoms that “feel like a panic attack and the flu at the same time,” according to the Washington Post. Thanks to the DEA, men and women who lost limbs serving in Iraq and Afghanistan are needlessly entering withdrawal.
The potential benefits of psychedelics
Unlike opioids, psychedelics aren’t addictive and are extremely difficult to fatally overdose on.
“Psychedelic substances have a generally favourable safety profile, especially when compared with opioid analgesics,” reads a review paper in a 2020 British Medical Journal publication. Psilocybin may pose cardiovascular risks, but so far only in cases of chronic, heavy use.
The other problem with conventional treatments for chronic pain is that they’re not always effective. “Neuropathic pain conditions such as phantom limb pain are often difficult to treat,” says UC San Diego PHRI member Timothy Furnish, associate clinical professor of anesthesiology and pain medicine. “The possibility that psychedelics could reorganize pain pathways in the brain holds out the promise of a much more long-lasting treatment than current medication can offer.”
Preliminary findings from the PHRI indicate that psychedelics can significantly, meaningfully, and perhaps even permanently reduce chronic pain caused by conditions like cluster headaches, complex regional pain disorder, phantomlimb pain, tinnitus, and more.
“As a non-addictive alternative to opioids, psychedelics represent a revolutionary and much-needed new approach to the treatment of pain,” according to the PHRI at UC San Diego .
Chronic pain is a huge and growing problem in the United States. Unfortunately, the legal treatments currently available to sufferers are not only often inadequate but carry significant risks of dependence. The Drug War has created an opioid epidemic, caused by an undertreatment epidemic which pushes people suffering from chronic pain toward dangerous street drugs or even worse solutions.
Research indicates psychedelics may actually work better than conventional treatments, without as many risks. It’s incumbent on the federal government to remove the barriers to research and treatment so that we can help ensure no one has to suffer needlessly or take unnecessary risks