Open Letter to an Indiana Judge
By Erica Zelfand

What happened:

A woman in Indiana, USA was arrested for growing small amounts of psilocybin-containing mushrooms in her home. After trying a number of different pharmaceutical drugs to help her condition, she turned to microdosing for help with treatment-resistant depression. Microdosing helped her juggle the demands of her health, with being a mother, and with working full time as a nurse in the intensive care unit (ICU). 

In light of this arrest, this woman was facing 10 years in prison for the “federal offenses” of “dealing” a schedule I substance (despite only using the mushrooms for personal healing) and endangering a child (for growing the mushrooms in her home, where her children lived). 

 

How we helped:

 

We had several healthcare consultations with the woman to help her find other solutions for getting her mental health stable. Right to Heal’s CEO wrote a letter to the judge (shared below). We then connected her with our allies in the media to get her story the attention it deserved. This attention led to a crowd funding effort to cover her legal fees, as well as volunteer help from an attorney who specializes in drug cases like hers.

 

The outcome:

 

Our client dodged a decade-long prison sentence. In fact, she did no jail time at all. Unfortunately, she was sentenced to 90 days of house arrest, which therefore meant that she had to stop working as an ICU nurse. She also lost custody of her children

The letter:

 

Dear Judge _____;

 I hope this letter finds you well. I am an Oregon-licensed family doctor, writing to express my support for my client, Ms. ____ of _____.

As you likely know, mental illness afflicts approximately one in five Americans, and depression is the leading cause of disability worldwide. [1,2] Unfortunately, antidepressant medications (SSRIs and others) do not work as well as they once did – or as we once thought they did. [3,4] (That being said, I still do prescribe these medications sometimes.) About one-third of patients who try antidepressants do not respond to the therapy. [5,6]

Ms. ____ is one such a patient. Despite her diligence in following the advice and prescriptions of her other doctors, and despite her engagement in psychotherapy, Ms. ____ continues to suffer from this debilitating condition.

Fortunately, a wave of new research has shown that there is hope for individuals like Ms. ____: Psilocybin, a constituent found in over 200 different species of mushrooms,  has been shown to safely and effectively treat depression. [7-18] Psilocybin has also shown compelling outcomes in a head-to-head study against the SSRI medication escitalopram. [19]

These findings are so compelling, in fact, that I have worked to inform and educate the medical community and policy makers about the promise of this natural medicine that has been used by humans since at least 6,000 BCE. [20,21] I have also taken sabbaticals from my practice to travel to countries where psilocybin mushrooms are legal. There I have directly witnessed the profound healing potential of these humble fungi.

My efforts in this regard are not merely a curiosity or a pontification: the FDA has granted psilocybin breakthrough drug status twice – once in 2018 for the treatment of Treatment Resistant Depression (TRD), and again in 2019 for the treatment of Major Depressive Disorder (MDD). [22] In the fall of 2021, the United States government also granted funding to Johns Hopkins University to conduct research on the potential of psilocybin in smoking cessation. [23]

Unfortunately for Ms. ____ and countless of other individuals, however, psilocybin is currently a Schedule I substance in the United States. Considering that the U.S. government was conducting studies on psilocybin and LSD in the years preceding the 1970 Controlled Substances Act, it has been suggested that Nixon’s anti-psychedelics stance had less to do with a legitimate concern for public safety than with a disdain for the demographics that tended to use cannabis, psilocybin, and LSD – namely Blacks and anti-war hippies. [24,25]

But the laws are changing: The state of Oregon just legalized psilocybin services state-wide, and numerous other cities and jurisdictions in the United States have voted to decriminalize the medicine. [26,27] I suspect that within the span of our professional careers that you and I will see this medicine legalized at the Federal level. According to an analysis performed by researchers at Johns Hopkins, the data suggest rescheduling psilocybin no more restrictively than Schedule IV. [28]

Did Ms. ____ break the law by growing in her home an age-old, natural medicine that grows wild on every continent except Antarctica [29]? Yes. But is that law one that should even exist? In my medical opinion: absolutely not.

This is not only because of psilocybin’s profound healing capabilities, but also on account of its excellent safety profile. With respect to children, the risk of poisoning by psilocybin exists, though it is low. First of all, psilocybin-containing mushrooms both smell and taste like rotting dirt, making them unappetizing to even the experienced, adult “cosmonaut.” Furthermore, psilocybin has an overall gentle safety profile and no known lethal dose. [30] In certain at-risk populations (such as children and pets), a high dose of psilocybin may induce a seizure – a frightening, but thankfully typically self-limiting reaction. [31] Furthermore, psilocybin is not physiologically addictive. [32,33]

In comparison, alcohol toxicity is a growing cause of toxicity in children. Even small amounts of ethanol (alcohol) can induce hypoglycemia, coma, and hypothermia in a young child, and higher doses can kill. [34] We have also recently seen a rise in ethanol-induced injury to children from ingesting ethanol-containing hand sanitizer. [35]

An adult under the influence of ethanol is also much more likely to harm a child than an adult under the influence of psilocybin mushrooms. This risk of harm from a parent under the effect of psilocybin becomes even smaller – almost comically so – when we consider that Ms. ____ was taking psilocybin in micro-doses. A microdose is one-tenth to one-twentieth of a “psychedelic” dose, and exerts no psychoactive effect. [36]

A multicriteria decision analysis of drugs published in The Lancet further speaks to the matter of harm. [37] In this study, twenty substances were scored based on criteria related to: (1) the harm a drug produces in the individual who takes that drug, and (2) the harm that individual may pose to others (children, family members, the community, etc.).

While heroin, crack cocaine, and methamphetamine were found to be the most harmful drugs to individuals, alcohol was found to be the most harmful to others. Overall, alcohol was the most harmful drug (overall harm score of 72 out of 100 possible points). (Heroin and crack cocaine came in second and third places, respectively.) The least harmful drug was mushrooms: mushrooms were found to pose no risk to others (overall harm score of 6 out of 100 possible points). Here is a graph from the published study:

 

These findings support my conviction that a liquor cabinet in the home poses more direct and indirect threat of harm to a child than do psilocybin mushrooms. In short: the argument that Ms. ____ endangered a child by growing mushrooms in her home is not one backed by scientific evidence.

What we lose by punishing people like Ms. ____ is vast. Her community loses a nurse. Her children lose their mother. And Ms. ____ loses her rights to medical freedom and a life without depression.

What do we gain by locking her away? We gain proof of how misguided the laws are around these powerful medicines, and how misinformed and hypocritical our legal system is when it comes to drugs. We make Ms. ____ a kind of George Floyd. Ms. ____’s case will be used to fuel policy change and legalization efforts. She will be a martyr for the cause.

Personally, I do not think we need any more martyrs in this War. I hope that you will agree, and that you will see Ms. ____ for what she is: an empowered woman who refused to be destroyed by depression, and who finally found something that tremendously helped her care for herself, her children, and her patients while posing little to no harm to anybody.

Thank you kindly for your consideration.

Yours in Healing,

Dr. Erica Zelfand

References

1 Any Mood Disorder. National Institutes of Health (NIH). Accessed June 22, 2022. Available at: https://www.nimh.nih.gov/health/statistics/any-mood-disorder

2 Friedrich M. Depression Is the Leading Cause of Disability Around the World. JAMA. 2017;317(15):1517. doi:10.1001/jama.2017.3826

3 Kirsch I. Antidepressants and the Placebo Effect. Z Psychol. 2014; 222(3): 128–34. doi: 10.1027/2151- 2604/a000176.

4 Fava GA. May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance. Ther Adv. Pharmacol. November 2, 2020. doi: 10.1177/2045125320970325.

Simba Health, LLC | Tel: +1 971 317 0222 | Fax: +1 971 317 0223 | Hello@SimbaHealth.com 4

5 Al-Harbi KS. Treatment-resistant depression: therapeutic trends, challenges, and future directions. Patient Prefer Adherence. 2012;6:369-88. doi:10.2147/PPA.S29716.

6 Williams J, Nieuwsma J. Screening for depression in adults. UpToDate. Accessed June 22, 2022. Available at: https://www.uptodate.com/contents/screening-for-depression-in-adults

7 Davis AK, Barrett FS, May DG, Cosimano MP, Sepeda ND, Johnson MW, Finan PH, Griffiths RR. Effects of Psilocybin-Assisted Therapy on Major Depressive Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2020 Nov 4: e203285. doi: 10.1001/jamapsychiatry.2020.3285.

8 Ross S, Bossis A, Guss J, Agin-Liebes G, Malone T, Cohen B, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016 Dec; 30(12): 1165–80. doi: 10.1177/0269881116675512.

9 Daniel J, Haberman M. Clinical potential of psilocybin as a treatment for mental health conditions. Ment Health Clin. 2017 Jan; 7(1): 24–28. doi: 10.9740/mhc.2017.01.024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6007659/

10 Khan A, Faucett J, Lichtenberg P, Kirsch I, Brown WA. A systematic review of comparative efficacy of treatments and controls for depression. PLoS One. 2012; 7(7):e41778. doi: 10.1371/journal.pone.0041778.

11 Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: A meta-analysis of data submitted to the Food and Drug Administration. PLoS Medicine. 2008;5:e45. doi: 10.1371/journal.pmed.0050045

12 Roseman L, et al. Quality of Acute Psychedelic Experience Predicts Therapeutic Efficacy of Psilocybin for Treatment-Resistant Depression. Front Pharmacol. 2018; 8: 974. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5776504/

13 Carhart-Harris RL et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. The Lancet Psychiatry. 2016 Jul;3(7):619-27. doi: 10.1016/S2215- 0366(16)30065-7. https://pubmed.ncbi.nlm.nih.gov/27210031/

14 Carhart-Harris RL et al. Psilocybin with psychological support for treatment-resistant depression: six- month follow-up. Psychopharmacology (Berl). 2018 Feb;235(2):399-408. doi: 10.1007/s00213-017-4771- x. https://pubmed.ncbi.nlm.nih.gov/29119217/

15 Griffiths RR et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016 Dec; 30(12): 1181–97. doi: 10.1177/0269881116675513. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367557/

16 Carhart-Harris RL, Roseman L, Bolstridge M, et al. Psilocybin for treatment-resistant depression: fMRI- measured brain mechanisms. Sci Rep. 2017;7:13187. https://doi.org/10.1038/s41598-017-13282-7.

17 Roseman L, Demetriou L, Wall MB, Nutt DJ, Carhart-Harris RL. Increased amygdala responses to emotional faces after psilocybin for treatment-resistant depression. Neuropharmacol. 2018 Nov;142:263-269. doi: 10.1016/j.neuropharm.2017.12.041.

18 Stroud JB, Freeman TP, Leech R, Hindocha C, Lawn W, Nutt DJ, Curran HV, Carhart-Harris RL. Psilocybin with psychological support improves emotional face recognition in treatment-resistant depression. Psychopharmacology (Berl). 2018 Feb;235(2):459-466. doi: 10.1007/s00213-017-4754-y.

19 Carhart-Harris RL, et al. Trial of Psilocybin versus Escitalopram for Depression. N Engl J Med. 2021; 384:1402-11. doi: 10.1056/NEJMoa2032994

20 Samorini G. The oldest archeological data evidencing the relationship of Homo sapiens with psychoactive plants: A worldwide overview. J Psychedelic Studies. March 2019;3(2): 63-80. doi: 0.1556/2054.2019.008

21 Carod-Artal FJ. Hallucinogenic drugs in pre-Columbian Mesoamerican cultures. Neurologia. Jan-Feb 2015;30(1):42-9. doi: 10.1016/j.nrl.2011.07.003.

22 Brooks M. FDA Grants Psilocybin Second Breakthrough Therapy Designation for Resistant Depression. MedScape. November 25, 2019. Accessed June 22, 2022. Available at: https://www.medscape.com/viewarticle/921789

23 Johns Hopkins Medicine Receives First Federal Grant for Psychedelic Treatment Research in 50 years. Johns Hopkins Medicine. October 18, 2021. Accessed June 22, 2022. Available at: https://www.hopkinsmedicine.org/news/newsroom/news-releases/johns-hopkins-medicine-receives- first-federal-grant-for-psychedelic-treatment-research-in-50-years

24 Baum D. Legalize it all: how to win the war on drugs [Internet]. Harper’s Magazine. April 2016. Accessed August 4, 2021. Available at: https://harpers.org/archive/2016/04/legalize-it-all/

25 DiPaolo M. LSD and The Hippies: A Focused Analysis of Criminalization and Persecution in The Sixties. People, Ideas, and Things Journal. Cycle 9, 2018. Available at: http://pitjournal.unc.edu/content/lsd-and- hippies-focused-analysis-criminalization-and-persecution-sixties

26 Roberts C. Oregon Legalizes Psilocybin Mushrooms and Decriminalizes All Drugs. Forbes. November 4, 2020. Accessed June 22, 2022. Available at: https://www.forbes.com/sites/chrisroberts/2020/11/04/oregon-legalizes-psilocybin-mushrooms-and- decriminalizes-all-drugs

27 Georgiou A. Where Magic Mushrooms Are Decriminalized in the U.S. As Detroit Set to Vote. Newsweek. October 29. 2021. Accessed June 22, 2022. Available at: https://www.newsweek.com/magic-mushrooms-decriminalized-united-states-detroit-michigan-vote- 1643983

28 Johnson MW, Griffiths R, Hendricks S, Henningfield E. The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act. Neuropharmacol. November 2018; 142: 143-66. https://doi.org/10.1016/j.neuropharm.2018.05.012

29 Rodríguez Arce JM, Winkelman MJ. Psychedelics, Sociality, and Human Evolution. Front Psychol. September 29, 2021. doi: 10.3389/fpsyg.2021.729425

30 Nichols DE. Psychedelics. Pharmacological Reviews. 2016;68(2):264–355. https://doi.org/10.1124/pr.115.011478

31 Zhuk O, Jasicka-Misiak I, Poliwoda A, Kazakova A, Godovan VV, Halama M, Wieczorek PP. Research on acute toxicity and the behavioral effects of methanolic extract from psilocybin mushrooms and psilocin in mice. Toxins (Basel). 2015 Mar 27;7(4):1018-29. doi: 10.3390/toxins7041018.

32 Nichols DE. Psychedelics. Pharmacological Reviews. 2016;68(2):264–355. https://doi.org/10.1124/pr.115.011478

33 Johnson, Griffiths, et al. The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act. Neuropharmacol. 2018 Nov;142:143-66. doi: 10.1016/j.neuropharm.2018.05.012. https://pubmed.ncbi.nlm.nih.gov/29753748/

34 Baum, CR. Ethanol intoxication in children: Epidemiology, estimation of toxicity, and toxic effects. UpToDate. Accessed June 22, 2022. Available at: https://www.uptodate.com/contents/ethanol- intoxication-in-children-epidemiology-estimation-of-toxicity-and-toxic-effects

35 Pediatric Ethanol Toxicity. MedScape. Accessed June 22, 2022. Available at: https://emedicine.medscape.com/article/1010220-overview#a6

36 Fadiman J, Korb S. Might Microdosing Psychedelics Be Safe and Beneficial? An Initial Exploration. J Psychoactive Drugs. 2019:51(2):118–122. https://doi.org/10.1080/02791072.2019.1593561

37 Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010:376(9752), 0–1565. doi:10.1016/s0140-6736(10)61462-6. https://sci-hub.hkvisa.net/