Psilocybin 'Bad Trips' Underscore Need for Research Safeguards

Megan Brooks

January 06, 2017

In a survey of persons who used psilocybin recreationally by ingesting the drug in so-called magic mushrooms, about 1 in 10 reported that their worst "bad trip" put themselves or others in harm's way.

A substantial majority called their most distressing bad trip one of the top 10 biggest challenges of their lives. Yet, most still rated the negative experience as "meaningful" or "worthwhile," with half of these people claiming it as one of the topmost valuable experiences in their life.

The results were published in the December issue of the Journal of Psychopharmacology.

Bad Trip Risk Factors

"Considering both the negative effects and the positive outcomes that respondents sometimes reported, the survey results confirm our view that neither users nor researchers can be cavalier about the risks associated with psilocybin," Roland Griffiths, PhD, psychopharmacologist and professor of psychiatry, behavioral sciences, and neurosciences at Johns Hopkins University School of Medicine in Baltimore, Maryland, said in a news release.

Dr Roland Griffiths

Dr Griffiths has spent more than a decade studying psilocybin's capacity to produce profound, mystical experiences, treat anxiety and depression, and aid in smoking cessation. The goal of the current research was to shed light on the impact of negative experiences with psilocybin.

Through advertisements on social media and email invitations, the researchers recruited individuals who reported a psychologically difficult or challenging experience while using magic mushrooms. A total of 1993 individuals completed an online survey that focused on their single worst "bad trip."

On average, respondents were 30 years old at the time of the survey and were 23 years old at the time of their worst bad trip; 93% reported they had used psilocybin more than twice. Most respondents were white men, and roughly half had college or graduate degrees.

Close to 11% of respondents reported that they had put themselves or others at risk for physical harm during their bad trip; 2.6% reported that they behaved in a physically aggressive or violent manner toward themselves or others; and 2.7% reported getting help at a hospital or emergency department during the bad trip. Of those whose bad trip occurred more than a year in the past, 7.6% sought treatment for enduring psychological symptoms.

Factors increasing the likelihood of risk behavior during the bad trip included higher psilocybin dose and longer duration and difficulty of the experience, as well as the absence of physical comfort or social support during the experience.

Five respondents with preexisting anxiety, depression, or suicidal thoughts attempted suicide during their worst bad trip. Six individuals reported that their suicidal thoughts vanished following the bad trip, which is consistent with findings of a recent study by Dr Griffiths and colleagues suggesting that psilocybin had antidepressive effects in cancer patients.

As reported by Medscape Medical News, in that study, a single, high dose of psilocybin administered in a controlled setting produced rapid, clinically significant, and lasting effects on mood and anxiety in late-stage cancer patients.

About two thirds (62%) of respondents rated the bad trip as among the top 10 most difficult experiences in their lifetime, 39% listed it in their top 5 most difficult experiences, and 11% listed it as their single most difficult experience.

Despite these difficulties, it is "notable," the authors state, that 84% of respondents reported benefiting from the experience, with 76% reporting increased well-being or life satisfaction attributed to the experience. Interestingly, more than a third (34%) of respondents reported that their bad trip was among the top 5 most meaningful experiences of their lives, and 31% ranked it in the top 5 most spiritually significant experiences of their lives.

"The counterintuitive finding that extremely difficult experiences can sometimes also be very meaningful experiences is consistent with what we see in our studies with psilocybin – that resolution of a difficult experience, sometimes described as catharsis, often results in positive personal meaning or spiritual significance," said Dr Griffiths.

Powerful Drug

George Greer, MD, psychiatrist and medical director of the Heffter Research Institute, which partially funded the survey, told Medscape Medical News that outside of psilocybin research, difficult life experiences often result in personal benefit.

"Examples of this 'no pain, no gain' concept include hard work, athletic training, and education. This survey appears to confirm that learning from difficulty applies to intense inner experience as well as to the more common difficulties in everyday life," he said.

Dr Griffiths and colleagues note that the survey findings "affirm concerns about taking psilocybin in uncontrolled environments." According to the Substance Abuse and Mental Health Services Administration's 2014 National Survey on Drug Use and Health, about 22.9 million people, or 8.7% of Americans, reported prior use of psilocybin.

In terms of psilocybin research, the findings "do reaffirm the need to place safety first," said Dr Greer.

"Psilocybin is a powerful medicine, and it is Heffter's position that the positive effects found in research to date are most reliably achieved when psilocybin is administered by a doctor with special training and used in a therapeutic setting. Safety has not been demonstrated for psilocybin when used outside of a clinical or laboratory setting, and we caution against recreational use of psilocybin because of potential adverse psychological reactions," he added.

The Heffter Research Institute is supporting research into the use of psilocybin in several areas, including cancer and addiction.

"The medical research setting provides crucial protections from harm that the recreational setting does not," Dr Greer noted. "These include a psychiatric evaluation to exclude subjects with a history of a serious mental disorder that could recur, the presence of specially trained psychotherapists to support subjects through distressing and confusing experiences, and hours of both presession preparation and postsession integration psychotherapy to help subjects maximize the benefits from the session."

Dr Greer added that "less than 1% of medical research subjects in psilocybin trials experience enduring psychological symptoms, so the implications for ongoing research are to continue to carefully screen, prepare, and support patients during and after psilocybin sessions."

Acceptable Risk?

In an interview with Medscape Medical News, Gerald Valentine, MD, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, said the "best quality scientific research into psilocybin is being sponsored by Heffter. They are very thoughtful and careful."

It is also worth considering the "relative risk" with psilocybin vs other treatments, said Dr Valentine, who was not involved in the survey or in Heffter-funded research.

"There are many treatments that are known toxins, like chemotherapeutic agents for cancer. There is risk involved with these agents and risks involved in doing research with these agents. But if the outcome is lifesaving or in significantly increasing functional capacity, especially at the end of life, or quality of life or the quality of death – that may be an acceptable level of risk," said Dr Valentine.

"With psilocybin, difficult or challenging experiences fall in the psychological or spiritual realm, not physical, typically. This is a different type of risk profile that I would say the medical profession is not accustomed to.

"To put it into a relative scale in terms of actual physical harm, psilocybin is extremely safe, yet we tolerate many experimental medications that have known risks, including death, because it is an acceptable risk to try to come up with better treatments," he added.

The study was funded by grants from the National Institute on Drug Abuse, the Council on Spiritual Practices, and the Heffter Research Institute. Dr Griffiths is a member of the board of directors of the Heffter Research Institute. Dr Valentine has disclosed no relevant financial relationships.

J Psychopharmacol. 2016;30:1268-1278. Full text

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