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Safety in Psychedelics

There lingers a great fear around psychedelic drugs. Many people believe that when you take a psychedelic drug, you will 'lose your mind', become psychotic, or try to jump off a roof because you think you can fly. Many of these horror stories come from the propaganda war against drugs instigated by the American and English governments in the 1960's. Because these governments also banned research on these drugs for the next 4 decades, these horror stories could not be challenged by science, and many still survive in the minds of the public today. Popular health websites like www.verywellmind.com still post sensationalist warnings such as the one below.


Fortunately, the tide is now turning, and actual science is once again being carried out, thanks to the tireless work of researchers like Rick Strassman and Rick Doblin (MAPS) who spent decades petitioning for legal access to psychedelic drugs for research. Now psychedelic science is the hottest topic in mental health research, with hundreds of publications every year, and the evidence base for its therapeutic benefits is once again growing.



In 2015, Van Amsterdam compared the relative harm caused by a number of psychoactive substances. LSD, MDMA, and magic mushrooms scored the lowest of all substances. These results corroborated the 2010 findings of the Independent Scientific Committee on Drugs (ISCD)—an international organisation of drug experts independent of government interference.



In 2015, Hendricks & Griffith carried out a very large survey on Psilocybin, psychological distress, and suicidality. Of the 191,832 respondents, 7550 had used psilocybin and no other drugs. The results showed that people who had never taken any drugs whatsoever were 1.5 times more likely to suffer from psychological distress and twice more likely to attempt suicide than people who had taken psilocybin. Psilocybin is being shown to have a protective effect on psychological wellbeing at a population wide scale. This study suggests that you may be taking a risk with your mental health by not taking psilocybin.



Whenever a member of the public hears 'drug', they often think 'abuse' or 'addiction'. However, hallucinogens are not considered drugs of dependence in that they do not engender compulsive drug seeking (National Institute on Drug Abuse, 2001, 2006; O’Brien, 2006). They are not associated with a known withdrawal syndrome (O’Brien, 2006). Therefore, there is little risk that exposing human volunteers to hallucinogens will leave participants physically or psychologically dependent on these compounds. In fact, psychedelic drugs are used to help cure addiction and they are proving to be the most effective treatment we have ever had for this. They can help people quit smoking and quit alcohol.




Of course, as with any psychoactive substance, care must be taken with its use.


Many people worry about becoming psychotic after using a psychedelic drug. In a survey of investigators who had administered LSD or mescaline, Cohen (1960) reported that only a single case of a psychotic reaction lasting more than 48 h occurred in 1200 experimental (nonpatient) research participants. Notably, the individual was an identical twin of a schizophrenic patient. It is difficult to prove causation in such cases. It is unknown whether the precipitation of psychosis in such susceptible individuals represents a psychotic reaction that would have never occurred in the absence of hallucinogen use, or whether it represents an earlier onset of a psychotic break that would have inevitably occurred. Either way, a family history of psychosis is now an exclusion criterion for patients hoping to take psychedelic medicines.


There have been some reports of hallucinogen persisting perception disorder (HPPD) where a person may re-experience perceptual effects similar to those experienced under acute hallucinogen action causing distress and impaired functioning. The incidence of HPPD is unknown, although it is thought to be very uncommon given the relatively few cases reported out of the millions of hallucinogen doses consumed since the 1960s (Halpern and Pope, 2003). Although the term ‘flashback’ is sometimes used interchangeably with HPPD, the former term is often used to describe any brief perceptual effects reminiscent of acute hallucinogen effects but occurring beyond acute hallucinogen use, usually in the absence of clinical distress or impairment (Lerner, et al., 2002).



The most likely risk associated with hallucinogen administration is commonly known as a ‘bad trip’. As discussed in our previous blog posts, psychedelic medicines work by allowing repressed sensations, memories and emotions to surface into conscious awareness. In the intentional therapeutic setting, this is very beneficial as previously inaccessible subconscious material can then be processed by the patient leading to psychological relief. In cases where the individual did not intend to, nor was prepared to, deal with such repressed material, they may attempt to resist these experiences which will lead to anxiety, panic, or dysphoria. Fear and confusion may lead to erratic and potentially dangerous behaviours. It is for these reasons that psychedelic medicines must be taken in a mindful fashion with utmost care being taken to optimise the 'set and setting'.



Set and setting refers to the mindset of the patient going in to the therapy session and how well prepared they are, as well as the suitability and safety of the environment in which the therapy session takes place. When the patient is well prepped, they will have an idea of what to expect, feel confident that the drug is safe, and feel comfortable that their sitter will look after them. A recent randomised controlled trial from IDPAT member, Dr R Murphy, showed that patients have greater outcomes when they feel a good therapeutic relationship with their sitter. A recent meta analysis has found no significant adverse events in trials where psilocybin was administered over 800 times to 550 individuals.



The psychedelic session is usually embedded in a course of psychotherapy, where the patient has several preliminary sessions where they can share their issues with a therapist and learn about how psychedelic therapy works. If they are comfortable to continue, they are given a fixed dose of a controlled and regulated substance under the supervision of trained professionals. Afterwards, the patient will continue to see their therapist for integration sessions to help consolidate the healing and transformative effects they have experienced.



Although studies have shown psychological benefits with psychedelic use in the community, it is much safer to take psychedelics in a regulated therapeutic setting. Unfortunately, psychedelic medicines are currently not medically licensed in Ireland, which means people will continue to use these drugs in potentially unsafe environments and without proper preparation or integration, increasing their risk of psychologically distressing experiences. IDPAT would like to see psychedelic assisted therapy programmes being planned now so that these much needed treatments will be available in a safe and timely fashion when psychedelic medicines are licensed to help battle the rising mental health crisis. By not providing psychedelic assisted therapy, we are perpetuating the failures of our mental health services and leaving the health of our people in grave danger.




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