Psychedelics Do No Harm, May Do Good

Pauline Anderson

March 12, 2015

Yet another study has failed to show a link between lysergic acid diethylamide (LSD) or other psychedelic drugs and depression, anxiety, and suicidal thoughts or behaviors. In fact, investigators found a link between psychedelics and a decrease in inpatient psychiatric treatment.

These findings are similar to those of other recent studies and add to a growing body of literature indicating that psychedelic drugs may not only be safe but actually therapeutic when it comes to mental health.

"The research suggests that psychiatrists shouldn't be prejudiced against psychedelic drugs and that if they have patients who use these drugs, it's not necessarily bad for them," study investigator Teri Suzanne Krebs, a PhD student and research fellow in the Department of Neuroscience, Norwegian University of Science and Technology, in Trondheim, told Medscape Medical News.

"Clinicians should know that it's possible to prescribe psychedelic drugs right now, today, although there could be some paperwork involved," she added.

This, she added, is spelled out in the United Nations 1971 Convention on Psychotropic Substances.

The new study was published online March 5 in the Journal of Psychopharmacology.

No Link to Mental Illness

For the study, Krebs worked with Pål-Ørjan Johansen, of EmmaSofia, a nonprofit company aiming to increase access to 3,4-methylenedioxy-methamphetamine (MDMA) and psychedelics.

The investigators used the annual National Survey on Drug Use and Health (NSDUH), which collects data on substance use and mental health from a random sample that is representative of the US civilian noninstitutionalized population. They pooled data from respondents aged 18 years and older from survey years 2008 to 2011.

The sample consisted of 135,095 respondents, of whom 19,299 (13.6% weighted) reported lifetime use of a psychedelic substance ― including LSD, psilocybin, mescaline, or peyote. These are all classic serotonergic psychedelics whose main mechanism of action is at the 5-HT2A receptor.

The researchers examined 11 self-reported indicators of past-year mental health problems, including depression, anxiety disorders, and suicide thoughts, plans, and attempts.

The study found that psychedelic users were more likely than nonusers to be younger, male, white, unmarried, to carry out risky activities, and to have used other drugs. They were also more likely to report a depressive episode before age 18 years. It is possible, said Krebs, that childhood depression prompts some people to try psychedelic drugs.

Lifetime psychedelic use was not associated with any of the indicators of mental health problems (adjusted odds ratio [aOR] range, 0.7 - 1.1), Instead, lifetime psychedelic use was associated with a lower likelihood of past-year inpatient mental health treatment (aOR, 0.8; 95% confidence interval, 0.6 - 0.9; P = .01).

The investigators also found lower levels of suicidal behaviors among psychedelic drug users, but this was not statistically significant, said Krebs.

Looking at individual psychedelic drugs, the study showed statistically significant associations between psilocybin use and lower likelihood of past-year serious psychological distress, inpatient mental health treatment, and psychiatric medication prescription (aOR, 0.9; P = .007).

Past-year use of LSD was associated with a lower likelihood of serious psychological distress (aOR, 0.8; P = .04).

However, mescaline or peyote use was associated with a greater likelihood of a major depressive episode in the past year.

"When you're using a lot of different statistical comparisons like this, you expect to find some things just by chance," explained Krebs. She noted that the statistical significance was very weak and that the effect size was small.

As well, she added, mescaline or peyote use was not associated with a physician diagnosis of depression.

Stratifying by age, sex, past-year illicit drug use, or childhood depressive episode did not substantially change the results of the analyses.

"Flashbacks" Debunked

The authors also discussed the concept of "flashbacks." In the 1960s, LSD users were reported to have recurring psychedelic experiences. But it turns out that patients allegedly suffering so- called flashbacks were diagnosed with schizophrenia and were already obsessing about their drug experience.

"Research doesn't support flashbacks; it's not a real phenomenon," said Krebs.

She also said that the concept of hallucinogen persisting perceptual disorder, in which visual symptoms are linked to taking psychedelics, was erroneous.

"If you look at this closely, it's actually ordinary optical phenomena that anyone could have," she said. "For example, if you stare at the sky or go from a dark room to a light room, there may be all kinds of visual effects. It has never been demonstrated that these symptoms are greater in people who use psychedelic drugs vs those who don't."

It is important, said Krebs, not to rely on anecdotes, case reports, and biased perspectives and to view data on psychedelic use from a statistical standpoint.

What is well documented, though, is that psychedelics elicit spiritual experiences and that users report achieving more understanding and acceptance of themselves.

The authors cited a recent randomized, controlled trial of psilocybin in which 67% of the participants regarded the experience as one of the most personally significant moments in their lives, and 64% reported improved well-being or life satisfaction.

Psychedelics likely not only do no harm, but they appear to be less risky than other drugs and behaviors. In the Netherlands, where psychedelic mushrooms are sold in stores to anyone older than 18 years, health authorities and police both report very few problems associated with this use, said Krebs.

"The experts there estimate that there is 1 hospitalization or serious injury per 100,000 servings of mushrooms consumed every year in the Netherlands," said Krebs.

Addiction Myth

Krebs stressed that psychedelics are not addictive and do not lead to compulsive use or dependence. "This is the most common public misunderstanding about psychedelics," she said. "People think that because they are controlled substances, they must be addictive, which is not true."

In the Unites States, psychedelic drugs fall under the Schedule 1 classification of the Drug Enforcement Administration (DEA). Such drugs are deemed to have no currently accepted medical use and a high potential for abuse.

But this potential for abuse is just one of the myths that continue to surround psychedelic drugs, said Krebs. She pointed out that "abuse" is not defined, and that according to the US National Institute of Drug Abuse, LSD is not considered an addictive drug because it does not produce compulsive drug-seeking behavior.

"And if you look at the text of the US 1970 Controlled Substances Act [CSA], it says nothing about addiction/dependence."

A clause in the CSA allows drugs to be placed in any schedule regardless of criteria. "This is what happened with MDMA/ecstasy. It was placed in Schedule I even though a DEA judge ruled MDMA should be Schedule III or unscheduled," she explained.

According to Krebs, physicians may not be aware that according to the UN 1971 Convention on Psychotropic Substances, use of Schedule 1 drugs is permitted not only for scientific purposes but also for "very limited medical purposes. "For example, a licensed clinic in Switzerland in the 1990s provided LSD to more than 100 patients, without running a formal clinical trial.

Another misconception is that psychedelic use is rare. It is estimated that in the United States, about 1 in 6 adults younger than 65 years have used a psychedelic drug, according to Krebs. Surveys suggest that just as many people take these drugs today as did in the 1960s, she said.

Yet another myth that has plagued the psychedelic drug field is the idea that there is a higher risk for suicide attempts and death or injury while on a psychedelic drug, said Krebs. "Based on other data, we know this is extremely rare."

There seems to be a renewed interest in the therapeutic use of psychedelic drugs. Krebs cited an open-label study in New Mexico that found that among nine alcohol-dependent patients who took two doses of psilocybin, alcohol consumption was cut in half after 6 months. These drugs are also being studied for their role in smoking cessation and cocaine dependence.

But some in the field are concerned about the lack of pharmaceutical support. Drug companies are not much interested in agents with patents that have long since expired and that are not administered on a daily basis.

That is perhaps why some researchers have turned to crowd funding to pay for psychedelic research. In the United Kingdom, this tactic is being used to raise money for an LSD brain imaging study. Kregs and her coinvestigator Johansen are also running a crowd-funding campaign to help fund their research.

Although the current study did not find a statistically significant association between psychedelic use and increased likelihood of past-year suicidal thoughts, plans, or attempts, another recent study did.

Both of these studies used data from the NSDUH and addressed very similar questions, but the earlier study (Hendricks PS et al. J Psychopharmacol. Published online Jan. 13, 2015) included about 60,000 more participants and an additional year of analysis.

"We found a statistically significant effect for reduced harm, and they didn't simply because we had more statistical power, but otherwise our odds ratios were similar and our results are consistent," commented the lead author of that earlier study, Peter Hendricks, PhD, assistant professor, Department of Health Behavior, University of Alabama at Birmingham.

Dr Henricks' study focused mostly on suicidality, whereas the Krebs study looked at 11 different outcomes.

Novel Research

Commenting on the study for Medscape Medical News, Dr Hendricks said it was "very well done" and "solid."

"It was a well-conducted study. This is a research team that has produced some very novel and rigorous research in the past."

Although he sees the spate of new research on psychedelics as a "rebirth," he believes there could well be an explosion of new research if funds were more readily available. However, he noted, that would mean removing psychedelic drugs from the DEA Schedule 1 classification.

The apparent recent rise in crowd funding for research on psychedelics reinforces the fact that obtaining research funding from "deep-pocketed agencies like the NIH" is still a challenge, said Dr Hendricks.

Much of the research that has been funded seems to point to the usefulness of psychedelic drugs in the field of addiction, said Dr Hendricks. He believes that although medications such as nicotine replacement therapies target specific mechanisms, psychedelics zero in on "higher-order" process.

"We are providing what we think is a meaningful spiritual experience that can provide a commitment to abstinence, a motivation to quit that could work irrespective of the specific substance of abuse."

Teri Suzanne Kregs is a board leader and Pål-Ørjan Johansen is a board member of EmmaSofia. Dr Hendricks reports no relevant financial relationships.

J Psychopharmacol. Published online March 5, 2015. Full text


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