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Discussion => Newbie discussion => Topic started by: Dutch Pride on September 01, 2013, 09:31 pm
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Perspectives on DMT Research
From DMT: The Spirit Molecule, a book in progress
by Rick Strassman
In this chapter from his book in progress, Strassman discusses the historical, pharmacological and clinical contexts within which future DMT research questions can be formulated.
Prelude: The First Sessions
IN NOVEMBER, 1990, we gave Philip the very first dose of DMT in our research project. In this case, we were going to administer it by the intramuscular (IM) route. This is in contrast to how we later gave DMT. As you'll see, the effects of IM DMT were too slow and we changed to the IV (intravenous) route after this, Philip's first session.
Philip was 45 years old when he began the DMT project. Bespectacled, bearded, and of medium height and build, he was an internationally-known clinical psychologist, psychotherapist, and workshop leader.
Philip had smoked DMT before and I was glad he had. He and Nils, our second volunteer, had taken it in Philip's house about a year before. This was the day after a Peruvian shaman, or folk healer, had conducted a religious ceremony using plants that contain DMT. This psychedelic plant brew is called ayahuasca or yage, the famous "vine of the soul," or "vine of the dead." The two men were enthusiastic about this orally active form of DMT, and were eager to smoke it that next day, when some members of the workshop made it available. They wanted to feel its effects in a much more immediate and intense manner.
Philip's and Nils' experiences on smoked DMT were typical of many people's. Incredibly rapid onset of effects, a kaleidoscopic display of visual hallucinations, and separation of consciousness from the physical body. And, most curiously, there was a feeling of "the other" somewhere within the hallucinatory world to which DMT allowed them entrance.
While I could not encourage psychedelic drug abuse, only experienced psychedelic drug users were potential candidates for our research. This is partly for reasons of informed consent. Can someone really know what they are getting into with this type of research without having had their own experiences beforehand?
It was hard to believe we were actually now able to give DMT. The two-year process of obtaining permission and funding, which I felt would never end, was finally behind me. Attaining the goal never seemed as likely as a continual struggle to do so. While it was an historic day, the fact that we were going to be giving Philip DMT by the intramuscular, or IM, route had me already thinking ahead. I thought the IM method might be too slow and mild compared to the smoked drug. What I had read about IM DMT suggested it took up to a minute to start working, much longer than the smoked method, where effects are felt while holding the breath from the first inhalation. But, since all but one previously published research paper on DMT used the IM method, I was obliged to begin this way. I thought 1 milligram per kilogram (mg/kg), or about 75 mg, would be a moderately high dose based upon the older medical literature.
It was at least five years since I gave anyone an IM injection of anything, and I was nervous about giving our first dose of DMT this way. What if I missed? Probably the last IM injection I gave was the anti-psychotic drug, haloperidol, to an agitated patient with psychosis. These patients often had arms and legs restrained involuntarily by psychiatric orderlies or the police beforehand, to make sure the patient's disorganized and frightened state didn't end in violence. This also kept the patient's arm in a relatively stable position for me to inject them.
While it was some years ago, I did remember the confidence with which I used to give IM shots, having given hundreds over a nearly 10-year span. I liked giving shots. The secret was to think of the syringe as a dart. We were taught in medical school to pretend you were throwing a dart into the rounded shoulder muscle of the patient's arm, or else the gluteus maximus muscle, which makes up most of the bulk of our buttocks. A single, fluid motion, letting go just as the needle pierced the muscle through the skin, usually gave excellent results. We had practiced on grapefruits.
Philip, however, was neither a grapefruit, nor an acutely psychotic patient delivered up to me for involuntary tranquilization. He was a professional colleague, friend, and research volunteer with equal footing to us in many ways. Philip was to be the scout. Cynthia, our research nurse, and I were to remain at "base camp," to hear about where he went after he returned.
I practiced my technique in the air, walking down the hall, before entering Philip's room. I explained what we were about to do: "I'll wipe your shoulder with some alcohol. Take as much time as you need to collect yourself. Then, I'll inject the needle into your arm, draw back to make sure I'm not in a blood vessel, and then squeeze the plunger on the syringe. It might sting, or it might not. You ought to feel something in a minute or less. And, I'm not sure what that something will be."
His eyes were closed, already preparing to venture into unknown territory, a territory only he would perceive, leaving us behind to look after his life functions. He opened his eyes widely to look at us once more.
He needed little time to calm and prepare himself. He closed his eyes again and said, "I'm ready." The injection went without a hitch.
After about 60-90 seconds, Philip opened his eyes and began breathing more deeply and looking "altered." His pupils were large, he began groaning, and the lines of his face smoothed. He closed his eyes while Robin, his new girlfriend, held his hand. He looked up at her at about 25 minutes.
His first words were "I could have done more."
We all breathed a collective sigh of relief.
Forty minutes after the injection, he started speaking slowly, and haltingly, in his soothing voice.
"I stayed in my body," he said, meaning he stayed aware of his "physical self" throughout the session.
He continued, "Compared to smoked DMT, the visuals were less intense, the colors were not as deep, and the geometric patterns did not move as fast."
He sought my hand for comfort. My hands were damp from nervousness, and he laughed good-naturedly at my anxiety, which was clearly greater than his!
When he arose to go the bathroom, he was quite shaky. He returned and drank grape juice and ate some yogurt, while filling out our rating scale. He felt "spaced-out" while we walked back and forth to another building where I had to do some errands. I wanted to accompany him and see how he was for the next hour or two. He seemed well enough three hours after his DMT. We said good-bye in the parking lot, and I told him I'd call him later that night.
When we spoke that night, Philip said Robin and he went to eat lunch after leaving the hospital. He immediately felt more alert and focused. While Robin drove them the 40 miles to her home, in the mountains outside of Albuquerque, he was euphoric and colors seemed brighter. He sounded quite happy on the phone.
Philip sent me a written report a few days later. Most important was his last comment: "I expected to jump to a higher level, to leave the body and ego consciousness, the jump into cosmic space. But this did not happen."
Philip did not believe the effects broke through the "threshold" he expected. This threshold, what we have called the "psychedelic threshold" for full DMT effects, is crossed when there is a separation of the mind from the body, and the complete replacement of the mind's contents with the effects of the drug. There was a sense of wonder, awe, and a feeling of undeniable certainty in the reality of the experience. This level of effect was not found in Philip's experience with IM DMT.
I was glad to have someone like Philip in the role of "human guinea pig." He was psychologically mature and stable, familiar with the effects of these drugs, and could make clear, understandable comparisons among different drugs' effects. I felt reassured in the correctness of enrolling only experienced psychedelic users for this research.
Philip's report left no doubt that IM DMT effects lagged behind those of smoked. We could have given a higher dose of intramuscular DMT, but I didn't think the IM route would ever give the "rush" that is one of the hallmarks of smoked DMT. This rush refers to the first 15-30 seconds of DMT's effects, when the entire shift from normal to psychedelic reality takes place with breathtaking speed. Perhaps the fact that there is so little time to prepare for the rush makes the effects of DMT so unusual. There was not much someone could do, except hold on, and watch, and remember. There was no working up to it.
Because our work focused on the effects of psychedelics as normally experienced by typical users, we believed it important to reproduce as closely as possible effects of smoked DMT, the way it is normally used "on the street." In addition, I also thought that since DMT is produced naturally in the human body, the best way to determine its effects and possible role in our mental lives is to get it into the brain as fast as possible. A more rapid way of getting it into the system was clearly needed.
Smoking DMT on the Research Unit was impossible. Besides the terrible smell of burning DMT, likened to that of burning cellophane, we didn't know what potentially harmful by- products of burning DMT were produced and might get into the lungs. Nor were we certain that all the DMT would be absorbed by smoking. DMT smokers typically describe needing to take 3-4 long "tokes," or inhalations, to get the full effect. I knew that as DMT is smoked, the room seems to be shattering into millions of crystalline pieces, and your body with it. Deciding whether you were inhaling or exhaling was complicated enough, let alone making sure you got enough DMT vapor into the lungs.
I spoke with my colleague who had made the DMT, Professor David Nichols at Purdue University, an international authority on psychoactive drugs. He thought a switch to the intravenous route was necessary, but he was glad he wasn't going to be the one giving it! I then called the physician at the FDA who was overseeing this research. He said five words that surprised, reassured, and frightened me, all at the same time: "You're the expert. You decide." This was true, but the implications of his remark were great. The re-opening of American psychedelic research with humans had begun with this project, by my conceiving of and shepherding through the protocol through two gruelling years. Now I was doing it. With this responsibility came some uncertainty, too. Was I really up to this, despite the many years of training? The challenges and risks seemed almost too great. And now, after our first dose of DMT, I was faced with having to decide to do something with DMT never done before: giving it directly into the bloodstream of a normal volunteer by the IV route.
The only previously published information on IV DMT was from one report published in the 1950's. And, that project studied severely disabled patients with schizophrenia, most of whom were not able to give clear reports of their experiences. In fact, one unfortunate schizophrenic woman's pulse was not detectable for a short while after her dose of IV DMT. I was glad we had made certain all our volunteers had healthy hearts.
The FDA physician continued, "Try about one-fifth the IM dose when you switch to the IV route. That will probably give you lower maximum blood and brain levels of DMT than you produced by giving it IM, and you should have some room to maneuver."
Philip and Nils both eagerly volunteered for this new and uncharted phase of the research, finding a satisfactory IV dose of DMT in normal volunteers. Since both had smoked DMT, we could compare directly the effects of IV to smoked drug. And, in Philip's case, we could compare IV to IM routes.
Nils, who lived in Arizona, moved in with some friends in New Mexico for a month so he could start the DMT study. He was 36 years old when he began participating in our research. Nils supported himself for the last 15 years by dealing drugs: marijuana, LSD, and psilocybin- containing "magic" mushrooms. He had also written popular underground pamphlets, under a pseudonym, about smoking the psychedelic venom of the Sonoran desert toad, which contained high levels of a compound closely related to DMT, 5-methoxy-DMT. Nils was a long and lanky fellow, charming, and fun to be with. He was keenly interested in psychedelics, and always was looking for a neglected plant or animal product that might produce a psychedelic effect. He was a store-house of obscure plant and chemical information. He had taken LSD many times, having "lost track after the 150th dose." Nils was no stranger to psychedelic drugs and their effects.
Nils was powerfully moved by his first and only use of smoked DMT, taken at Philip's the year before. He said, "It made strong telepathic impressions causing mental bonds with the people around me. This was confusing and overwhelming. I became very excited, as an inner voice spoke to me. This was my intuition directly relating to me. It was the most intense experience of my life. I want to go back. I saw a different space with bright bands of color. I couldn't raise my hands, I tripped so hard. It is a mental Mecca, an excellent reference point for all other psychedelics. Those around me looked like alien space insects. I realized they were all part of it, too."
Nils received 0.2 mg/kg intravenous DMT about a week after Philip's first IM dose, in November, 1990. Similar to Philip's first ever dose of DMT, while the actual administration was a landmark, I also felt it was just a dry-run, a rehearsal for the real thing, as I believed we would certainly go beyond 0.2 mg/kg. Such is the method of medical research: slow, baby steps to ensure no harm is caused. Unfortunately, it is sometimes hard to listen to one's own advice, as will be seen soon enough.
The actual quantity of DMT solution was small when it arrived on 5E of the University of New Mexico Hospital, the site of the Research Center, no more than a cc (cubic centimeter), one- sixteenth of a tablespoon. So that I could control the rate of giving the drug, without squirting it all in at once, I added an additional 4 cc of sterile salt water. While this would dilute the DMT in the blood stream only an insignificant amount, I now could slowly and smoothly give the drug in one continuous "push" over a minute or so.
Cynthia, our research nurse, and I sat on either side of Nils, who was inside his familiar regulation Army sleeping bag. He took this bag with him when he travelled, both literally and figuratively: when he would travel on the road, or when he would take a psychedelic drug "trip." As the injection was half-way complete, he said, "Yes, I taste it." Nils turned out to be one of the few volunteers who could taste the DMT as the drug-rich blood rushed passed through his mouth and tongue on the way to his brain. A metallic, slightly bitter, taste.
Upon finishing the injection, I noted and was impressed with how quickly the DMT solution had made its way upward. I thought, "This seems to be fast enough." I finished the injection by flushing his IV line with a small amount of additional sterile salt water, to ensure that any DMT sticking to the sides of the tubing was washed free and delivered entirely to his bloodstream. My notes are sketchy as to the effects of 0.2 mg/kg IV DMT on Nils. This may have been because he is a taciturn man by nature, or because I was not impressed with the intensity of the experience either. But, he did say he thought this dose of DMT was "maybe one- third to one- fourth" a full one, relative to his smoked DMT experience.
Perhaps feeling a little puffed up with confidence by the ease with which these first two sessions, Philip's IM and Nils' IV, had gone, I decided to proceed immediately to three times Nils' IV dose: to 0.6 mg/kg. In retrospect, a more cautious move to 0.4 mg/kg, the aforementioned "baby step" forward, was definitely in order. My confidence was premature. Thankfully, I didn't jump to 0.8 mg/kg, which I would have done if I had followed up Nils' comment that 0.2 mg/kg was one- fourth a full dose.
One cold windy Albuquerque morning in December, 1990, I entered Nils' room. He was lying under his Army sleeping bag, awaiting the first 0.6 mg/kg dose. Cynthia had placed a small needle into a forearm vein, for injecting the DMT solution. She was sitting on his right side, while I was on his left, where the tubing from the intravenous line was dangling off his arm. Philip also was here, as he was scheduled to receive this same dose later in the morning, if things went well with Nils. Philip sat at the foot of the bed, curious as to what Nils was about to experience, and to provide moral support for all of us. Little did we suspect we'd need him to give us physical support, too.
I infused the solution of DMT somewhat more quickly than I did for his previous 0.2 mg/kg dose, over 30 seconds, rather than 45. I thought a faster injection might produce less dilution of the DMT in the bloodstream, and thus produce higher peak blood, and therefore brain, levels. After the infusion of drug and saline flush were complete, he said, "I can taste it... Here it is!" Immediately after saying this, he started tossing and turning under his sleeping bag. He then sat up with a start, "I'm going to vomit."
He looked at us, dazed and uncertain. Cynthia and I looked at each other at the same time, and realized we had nothing for him to throw up into. We never thought people would vomit. He mumbled, "But, I didn't have any breakfast... so there's nothing to throw up." Nils was becoming agitated, pulling the pillow and sleeping bag over his face. He curled into the fetal position, away from us and the blood pressure machine, kinking the tubing connecting the cuff to the machine. We could not get an adequate blood pressure reading at either 2 or 5 minutes, when we expected it to be at its peak, and potentially dangerous, level. He "tried" climbing out of the bed, but this seemed to be more a purposeless flailing of his arms and legs, a substantial volume of limbs in someone 6'4". His hands were cold and clammy as all three of us maneuvered him back into the now- too-small-seeming bed. He retched at 6 minutes into a basin we found in the closet. Because he had to sit up to do so, we got a chance to reposition him in a way that would let us see him more clearly, and to get a blood pressure and heart rate recording.
He then reached out to Cynthia for some contact, touching her arm and sweater. He looked as if he were about to stroke her hair, but quickly seemed to forgot what he was going to do. He began staring at me, saying, "I need to look at you now, not Philip or Cynthia." I did my best to look calm, answering his gaze with my own; praying quietly he would be all right. By 10 minutes, when we finally got a satisfactory reading, his pulse and blood pressure were surprisingly normal. At 19 minutes, he sat up on his elbows and laughed. He looked very "stoned:" large pupils, lopsided grin, mumbling incoherently.