Inside the salt room, Scott Mickey flew above the bright expanse of his own consciousness. His eyes were closed. A weighted blanket pressed his body into a recliner. In his arm, an IV delivered a few dozen milligrams of ketamine to his bloodstream.
His mind was somewhere else.
"I ain't gonna lie, I was very skeptical," recalls Mickey, a 45-year-old business owner who runs a chain of head shops in rural Missouri. Before ketamine, the Rolla native had spent much of his life gripped by a deep social anxiety that made crowded indoor spaces, even a trip to the grocery store, intolerable to the point of breakdown.
He had gone to a psychiatrist. They prescribed him the antidepressant Xanax, but he says it felt like "wrapping your head in a blanket." So, one day this past October, he went to a different doctor, one located in a compact strip mall opposite the Saint Louis Galleria in St. Louis.
Ketamine is undergoing something of a renaissance. First synthesized in 1962, the substance has been used for decades as a surgical anesthetic, and not just because of its ability to safely render a person unconscious. For reasons scientists are still studying, the introduction of ketamine releases the mind to dissociate — that is, to be blissfully unaware, in all sensation and memory, of the physical trauma happening to their body.
However, with smaller amounts of ketamine, a person can experience that disassociation without the amnesia. That experience, as shown in the growing body of scientific research and widening availability of treatment options, acts as a profoundly effective antidepressant.
But it's not just ketamine that holds such promising possibilities for treatment. Currently, a combination of state and federal laws block patients from using an even more powerful line of psychedelics, substances that have long been used in indigenous rituals and which are well known to the crowd of self-experimenting "psychonauts" for their mind-expanding effects.
For Mickey, attending music festivals in his twenties had brought him into contact with hallucinogens like LSD and magic mushrooms, but it had been many years since he had taken a psychedelic trip. That day at the clinic in St. Louis, as the salt vapors flowed, he found himself settling into a comfortable chair and listening to the music coming from the wall speakers, the melody soft and meditative.
"I was sitting there, they started the IV, and I just got this little bit of a tiredness that came over me," he says now. "It was like, 'Oh, I could probably lay back and get comfortable.' When I laid my head against the pillow, it was like a light switch. It was, boom, there I was, flying. And there was no fear to it."
He remembers looking down at an endless landscape beneath him. He says, "I started thinking about my anxiety — why do I get uncomfortable in various situations? I flew close to the ground and saw this dark spot in the center of this snow-covered region. I instantly knew that it was either trauma or something that had happened in my life that created that inside of me."
As easy as thinking, Mickey flew down to the dark spot, and "exchanged energy." The spot turned light, and, he says, "as it happened, I would feel the release of this incredible weight."
Today, he describes it as one of the most powerful sensations of his life. He was sold.
"Once I had tried it once, I was like, 'Alright, I'll take the package.'"
After decades of legal restrictions and fear mongering, Americans are finally coming around to the notion that psychedelics are legitimate medicine. Even as the law and science lag behind, people in Missouri like Scott Mickey are already embracing ketamine; and these aren't hippies or followers of the sort of LSD utopia envisioned by Timothy Leary in the 1960s — these are simply people in pain.
During a recent visit to the Radiance Float + Wellness clinic in Richmond Heights, psychiatrist Dr. Zinia Thomas walks through a short hallway to the salt room, the same room in which Scott Mickey tuned in, dropped out and started flying through his mind. The back wall, built of rock salt bricks, is lit with cool blue lights. A flier on a table features a friendly message, "Enjoy your K-Cation," beneath a photo showing a line of multicolored cottages on a perfect beachfront.
Thomas founded the clinic in 2017, one year before then-President Donald Trump signed the federal Right to Try Act that made some classifications of drugs, including ketamine, open to therapeutic use if patients had exhausted FDA-approved treatment options.
At first, Thomas says she considered ketamine treatments as an option of last resort. But two key events shaped her current stance that ketamine is for everyone.
First came Missouri's legalization of medical cannabis. In 2020, Thomas began prescribing medical marijuana licenses to hundreds of patients across the state through virtual appointments. Quickly, she says, it became clear that people were seeking more substantial relief than even high-potency cannabis could offer.
"They wanted it to cure their depression, PTSD, their pain, migraines. They wanted it to cure everything," she says. "People put so much hope in it, but this is just a plant."
Thomas says she began suggesting ketamine as a possible treatment for her medical marijuana patients' more serious health needs. Around the same time, the pandemic hit — and with it, the crush of isolation, job stress and the ever-present tragedy of the rising death toll. She believes the pandemic inflamed a mental-health crisis that was already burning out of control.
"Even high-functioning people have suffered so much loss in the pandemic," she notes. "I just thought, 'Why should you have to fail other antidepressants before trying something like ketamine?'"
These days, Thomas' ketamine patients hail from across Missouri. Like her patient Scott Mickey, many travel to the St. Louis clinic, sit in a comfortable chair in the salt room and let reality melt away through six to eight sessions over the course of a month. Those sessions are followed by a "maintenance" of additional booster infusions. The treatments are not cheap: Single infusions run about $350, and the full "package" of shots and boosters can cost more than $2,000.
However, some patients never step foot in the clinic. With virtual doctor's appointments, Thomas can prescribe and mail "Trip Kits," which come with an eye mask, aromatherapy, a ketamine nasal spray and a one-month supply of KetaChew ketamine lozenges; the kit also comes with a journal divided into sections for patients to write down their emotions, insights and visions encountered during the psychedelic experience.
Although the antidepressive effect of the ketamine can feel instant and last weeks, Thomas says that those improvements aren't permanent. That's why she recommends patients undergo booster infusions or self-administer ketamine via the nasal spray or lozenges at home.
But Thomas argues that ketamine is just the beginning. She points to recent research on other psychedelics long demonized as "party drugs" showing breathtaking potential for treatment of PTSD and addiction, particularly when paired with psychotherapy. Recent clinical trials on MDMA — a.k.a. the rave drug Ecstasy — have put the substance on track for FDA approval for therapeutic use in 2023.
The treatment Thomas is most excited for, though, is psilocybin.
"Ketamine is a synthetic, and it has similar benefits to psilocybin, but it's short-lived. There's more maintenance required; it's a little bit more like any kind of pharmaceutical," she says. "Whereas you can do a one dose of psilocybin, and treatment-resistant depression can be eliminated."
Thomas isn't just shouting into a void. In 2019, the FDA granted two psilocybin clinical trials "breakthrough therapy" status, and one year later a ballot measure made Oregon the first state in the nation to legalize psilocybin for therapeutic purposes.
But in Missouri, medical professionals, patients and activists seeking to legitimize psychedelic treatment are struggling to overcome old legal barriers — and the legacy of the War on Drugs.
We know more about the therapeutic effects of psychedelics than ever before, but legally, they're stuck in the past. Despite research suggesting psilocybin can capably treat depression — an April study in the New England Journal of Medicine found "no significant difference" between groups of patients treated with a common antidepressant and psilocybin — the U.S. Drug Enforcement Administration still considers it a Schedule 1 illegal narcotic.
That designation means, by law, that psilocybin has "no currently accepted medical use" and carries a "high potential for abuse." These definitions were birthed in 1970 with the passing of the federal Controlled Substances Act, and it amounted to an early salvo in the generations-spanning crackdown on drug use in America.
Schedule 1 narcotics include a hodgepodge of different types of substances, from heroin and bath salts to cannabis and psychedelics. But even with the passage of the federal Right to Try Act in 2018, the DEA has fought physician attempts to prescribe Schedule I drugs like psilocybin outside of approved clinical trials. (Meanwhile, ketamine, a powerful psychedelic in its own right, is considered a Schedule 3 non-narcotic substance.)
In 2021, these decades-old schedule designations have little in common with current research. And the restrictions have sharply limited scientists' ability to uncover more evidence that these substances deserve to be reevaluated.
"It's an absurd catch-22," says Eapen Thampy, a lobbyist and legalization advocate in Missouri.
"At the end of the day, there are some drugs that are very dangerous and addictive and damaging," he argues. "Those are not psychedelics and marijuana."
Thampy has spent years trying to convince members of Missouri's conservative-majority legislature to warm to the notion of drug reform. (He's also found himself a target of drug laws himself, as he's currently awaiting sentencing after pleading guilty last year to federal charges involving marijuana trafficking. Thampy declined to discuss his criminal case for this story.)
While several drug legalization bills have been proposed in recent years — including a marijuana-focused Right to Try bill that failed to pass — it was a public vote via ballot initiative that ultimately legalized medical cannabis in 2018. But Thampy believes that mounting evidence produced by clinical trials, as well as vocal support from veterans, could make the difference for Missouri lawmakers on the issue of psychedelics.
One lawmaker, Kansas City-area Republican Representative Michael Davis, filed just such a bill this year, though it failed to pass out of committee. The bill sought to amend Missouri's state-level Right to Try bill by allowing eligible patients to seek out Schedule I drugs; the bill would also expand eligibility beyond just the terminally ill to include "debilitating" and "life-threatening" illnesses — seemingly encompassing conditions like depression and PTSD.
"My proposal protects the liberty interests of Missourians who believe these drugs offer valuable options in the treatment of numerous conditions," Davis said in a statement after introducing the bill.
While that version of the bill failed to gain momentum, Davis says he plans to refile it for the 2022 session. Appearing as a panelist during a November drug policy conference hosted by Thampy and the political action committee Crossing Paths, Davis pointed out that the Republican Party has already made the first move: "We had President Trump and congressional Republicans supporting a bill that would allow this at the federal level."
"Our bill," Davis continued, "would bring this down to the state level, to allow patients to have access to these psychedelics that can assist them with their pain."
The law of the state is one thing, but it's the law of nature that truly governs the field of psychedelics. Psilocybin grows out of the ground in mushrooms. The Amazonian sacrament of ayahuasca is brewed from vines. DMT — what some call the "god molecule" — can be distilled from wild plants, if you know where to look.
At a recent meeting of the Psychedelic Society of St. Louis, some three dozen members gather in a pinball and billiards hall connected to a pizza restaurant.
Several members of the society introduce themselves as "psychonauts," a term to describe their pursuit of mystical experiences through drugs; others say they've been self-treating various mental and physical ailments with psychedelics for years.
Their accounts of psychedelic experiences often seem to share metaphors, particularly around the notions of ego and death: During the meeting, several members describe journeys through mental spaces where egos are "dissolved" or "crushed." After leaving their bodies, they soared the cosmos, traversing what one society member calls "an infinite abyss of love." Others say they undergo the terror of death, only to be flung into a purely spiritual state as the trip fully kicks in.
"You feel your body as an outside entity," one man says, describing a DMT experience. "You feel yourself take your last breath and die."
Dan Conner, a self-described psychonaut and member of the society, says his personal journey into psychedelics began several years ago after taking twenty grams of dried psilocybin mushrooms — a hefty dose, he'd later realize, but one that exposed him to the potential of a "visionary experience" that went beyond just heightened sensations of color and music.
"There are no other drugs, outside of psychedelics, that make you become a better human being, more loving, more kind," he says.
Conner says he looks forward to the future legalization or decriminalization of psychedelics, but he's worried that attempts to treat these substances like pharmaceuticals could end up missing the point. He points to the trend of "microdosing" LSD, ostensibly allowing a user to remain functional while enjoying some visual effects and euphoria — but without the need to set aside six hours to journey across your mind's inner cosmos.
"But that's where the magic happens, that's where the work gets done," Conner emphasizes. "The experience is the healing, not the chemical."
Will Wisner, an Iraq War veteran who returned home with PTSD and survivor's guilt, is also wary of attempts to integrate psychedelics into the medical system that's failed so many veterans in the past. In recent years, Wisner has traveled outside the U.S. to undergo ayahuasca treatments, a physically draining psychedelic-ritual experience that involves a shaman and can take some sixteen hours per session.
Wisner is far from the only veteran to make the journey, but he stresses that the U.S. Department of Veterans Affairs has nothing to do with it.
"Right now, we are in a situation where we are a veteran space helping veterans, and we're going to do what the VA will not, or cannot, do," he says. "This is a spiritual thing. I wouldn't want to do ayahuasca with any doctor."
After a pause, he adds, "Unless it's a witch doctor."
Scientists are still grappling with what, exactly, a psychedelic experience represents. Is it something like a dream? A hallucination? The mind putting itself on the psychoanalyst's couch? Where does the mind go during an out-of-body experience? How can it observe itself?
For now, there are so many more questions than answers.
"What we do as humans is we make up a story about what we're perceiving," observes neuroscientist Dr. Joshua Siegel, who is part of a team of clinical researchers at Washington University currently studying the effects of psilocybin on the brain.
According to Siegel, the stories we tell ourselves contain real significance. While accounts of being separated from the ego or flying over your own consciousness might seem like nebulous hokum, Siegel notes that the number of people reporting similar themes during psychedelic experiences can't be waved off.
"Ego dissolution is fundamentally important from the therapeutic standpoint," he says. "A core feature of psychiatric illness is you're stuck in a maladaptive behavior, like depression, addiction, anxiety; the very experience of exiting your ego and your consciousness seems to help people to break the habit of behavior. No matter how they interpret it, experiencing your own death, flying like a bird, either way it can be useful."
But the mechanism for these experiences remains unclear. Dr. Ginger Nicol, a psychiatrist who leads Washington University's psychedelics research, points out that science still can't say whether the mystical experiences often described during psychedelic trips are required for the therapeutic effects to take hold, or something else entirely.
"As a psychiatrist, the human experience is really important, but mechanistically, and at the clinical level, can we measure that?" Nicol says. "If we can engineer it with a type of psychotherapy that targets a certain type of behavior — or if we could measure that experience — we could learn a lot about the human condition and what's it like to be alive and conscious."
The duo's latest work involves a brain mapping study using subjects in the midst of a psilocybin trip. While the study involves a relatively small number of test subjects, Siegel says each test produces "a very large amount of data on each subject, and on how brain networks are changing from before, to during, to after a large dose."
For Nicol, the ultimate goal is to use psychedelics as a "precision medicine," targeting specific conditions with the right drug for the job. But after decades of restrictions on research, science is still far from cornering the truth on what a psychedelic experience actually represents.
"We're trying to understand what's happening to the brain during something subjective," Nicol admits. Both she and Siegel acknowledge that, even with the use of FMRI brain imaging, it's possible that psychedelics are changing the brain's structures in ways researchers haven't yet taken into account. For the researchers, that possibility could be skewing their results.
It's a fair question. Even with cutting-edge technology and detailed neural mapping, do we actually know what a brain on drugs looks like?
"Is what we're visualizing in the data actually the whole story?" Nicol wonders. "It's the irony — is what we're seeing reality?"
Follow Danny Wicentowski on Twitter at @D_Towski. E-mail the author at [email protected]