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Barnett BS, Koons CJ, Van den Eynde V, Gillman PK, Bodkin JA. Hypertensive Emergency Secondary to Combining Psilocybin Mushrooms, Extended Release Dextroamphetamine-Amphetamine, and Tranylcypromine. J Psychoactive Drugs 2024:1-7. [PMID: 38903003 DOI: 10.1080/02791072.2024.2368617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/09/2024] [Indexed: 06/22/2024]
Abstract
Data on medication interactions with psychedelics are limited. Here we present what may be the first published report of a hypertensive emergency following the combination of psilocybin mushrooms with a monoamine oxidase inhibitor (MAOI). A 42-year-old man with treatment-resistant major depressive disorder took 1 g of Psilocybe cubensis mushrooms, while prescribed tranylcypromine, extended-release dextroamphetamine-amphetamine, and other medications. Approximately half an hour later, he developed severe hypertension with chest pain, palpitations, and headache. Upon hospital presentation, the electrocardiogram demonstrated ST-elevation. The patient was diagnosed with a myocardial infarction and treated with lorazepam, nitroglycerin, and aspirin. He subsequently underwent emergency cardiac catheterization, which revealed no significant cardiac abnormalities. Following overnight hospitalization, he was discharged home with no lasting physical sequelae. Though data are few, past studies suggest that classic serotonergic psychedelics (5HT-2A receptor agonists) such as dimethyltryptamine (DMT), lysergic acid (LSD), and synthetic psilocybin should not produce hypertensive emergency when combined with MAOIs. We suspect phenylethylamine, found in Psilocybe cubensis and other species of psilocybin mushrooms, interacted with tranylcypromine and dextroamphetamine-amphetamine to produce this hypertensive emergency. Patients prescribed MAOIs should be warned of the potential for hypertensive emergency when consuming psilocybin mushrooms, particularly when also prescribed norepinephrine releasers such as dextroamphetamine-amphetamine.
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Affiliation(s)
- Brian S Barnett
- Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Curtis J Koons
- Department of Anesthesia, Pikeville Medical Center, Pikeville, KY, USA
| | - Vincent Van den Eynde
- PsychoTropical Research, Bucasia, QLD, Australia
- Department of Psychiatry, RadboudUMC, Nijmegen, The Netherlands
| | | | - J Alexander Bodkin
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Stanger MK, Soffer HO, Bryan AD, Skrzynski CJ. Comparing Cannabis Use Motivations and Dependence Across Regular Cannabis Users Who Have or Have Not Recently Used Psilocybin. Cannabis Cannabinoid Res 2024. [PMID: 38885938 DOI: 10.1089/can.2024.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
Introduction: In Colorado, both cannabis and psilocybin are legal and becoming more commonly used. However, there is almost no research detailing the public health concerns regarding negative outcomes (e.g., dependence) of cannabis and psilocybin co-use and motives that may perpetuate these negative outcomes (e.g., coping, boredom). Methods: Using data from a larger observational study on cannabis and metabolic processes, regular cannabis users (use ≥7 times/month; n = 97, 35.1% female, 89.7% WHITE) who used psilocybin in the past 3 months (n = 34) were compared with those who had not used psilocybin in the past 3 months (n = 63) on cannabis dependence as measured by the Marijuana Dependence Scale and endorsement of 12 cannabis motives from the Comprehensive Marijuana Motives Questionnaire. Correlations between motives and dependence were also examined and compared across groups. Results: Findings revealed that individuals who had recently used psilocybin had greater cannabis dependence scores than those who had not used recently [F (1, 95) = 5.53, p = 0.02], and more strongly endorsed that their cannabis use was motivated by enjoyment [F (1, 91) = 4.31, p = 0.04], boredom [F (1, 91) = 9.10, p < 0.01], and availability [F (1, 91) = 9.46, p < 0.01]. Correlations between dependence scores and coping and boredom motives were also significantly positive for both groups (all p values <0.05) whereas positive correlations with experimentation, celebration, and availability motives were only significant for recent psilocybin users (all p values <0.05). Discussion: These results suggest there are motivational differences for cannabis use among those who co-use cannabis and psilocybin, and there may be a greater risk for harm for these individuals.
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Affiliation(s)
- Madeline K Stanger
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Harmony O Soffer
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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Glynos NG, Aday JS, Kruger D, Boehnke KF, Lake S, Lucas P. Psychedelic substitution: altered substance use patterns following psychedelic use in a global survey. Front Psychiatry 2024; 15:1349565. [PMID: 38455520 PMCID: PMC10917882 DOI: 10.3389/fpsyt.2024.1349565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Recent research suggests that psychedelics may have potential for the treatment of various substance use disorders. However, most studies to date have been limited by small sample sizes and neglecting to include non-North American and European populations. Methods We conducted a global, cross-sectional online survey of adults (n = 5,268, 47.2% women) self-reporting past or current psychedelic use and investigated whether psychedelic use was associated with changes in use of other substances. Results Nearly three-quarters (70.9%; n = 3,737/5,268) reported ceasing or decreasing use of one or more non-psychedelic substances after naturalistic psychedelic use. Among those with previous use, 60.6% (n = 2,634/4,344) decreased alcohol use, 55.7% (n = 1,223/2,197) decreased antidepressant use, and 54.2% (n = 767/1,415) decreased use of cocaine/crack. Over a quarter of the sample indicated that their decrease in substance use persisted for 26 weeks or more following use of a psychedelic. Factors associated with decreased use included a motivation to either decrease one's substance use or self-treat a medical condition. Importantly, 19.8% of respondents also reported increased or initiated use of one or more other substances after psychedelic use, with illicit opioids (14.7%; n = 86/584) and cannabis (13.3%; n = 540/4,064) having the highest proportions. Factors associated with increased substance use included having a higher income and residing in Canada or the US. Discussion Although limited by cross-sectional study design, this large observational study will help inform future studies aiming to investigate the relationship between substance use patterns and psychedelic use.
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Affiliation(s)
- Nicolas G. Glynos
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Abor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Jacob S. Aday
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Abor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Kruger
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Kevin F. Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Abor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Stephanie Lake
- University of California Los Angeles (UCLA) Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Orłowski P, Hobot J, Ruban A, Szczypiński J, Bola M. The relation between naturalistic use of psychedelics and perception of emotional stimuli: An event-related potential study comparing non-users and experienced users of classic psychedelics. J Psychopharmacol 2024; 38:68-79. [PMID: 38069478 DOI: 10.1177/02698811231216322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Previous research has suggested that controlled administration of psychedelic substances can modulate emotional reactivity, enhancing positive and diminishing negative emotions. However, it is unclear whether similar effects are associated with using psychedelics in less-controlled naturalistic environments. AIMS This cross-sectional study investigated the neural markers associated with the perception of emotional stimuli in individuals with extensive experience of naturalistic psychedelic use (15 or more lifetime experiences), comparing them to non-users. METHODS Electroencephalography (EEG) signals were recorded from two groups: experienced psychedelics users (N = 56) and non-users (N = 55). Participants were presented with facial images depicting neutral or emotional expressions (anger, sadness, and happiness). Event-related potential (ERP) components were analyzed as indices of emotional reactivity. RESULTS Psychedelic users were characterized by significantly lower amplitudes of the N200 component in response to fearful faces, in comparison to non-users. In addition, interaction effects between Group and Emotional expression were observed on N170 and N200 amplitudes, indicating group differences in the processing of fearful faces. However, no significant between-group differences emerged in the analysis of later ERP components associated with attention and cognitive processes (P200 and P300). CONCLUSIONS The results suggest that naturalistic use of psychedelics may be linked to reduced reactivity to emotionally negative stimuli at the early and automatic processing stages. Our study contributes to a better understanding of the effects related to using psychedelics in naturalistic contexts.
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Affiliation(s)
- Paweł Orłowski
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Poland
| | - Justyna Hobot
- Consciousness Lab, Psychology Institute, Jagiellonian University, Kraków, Poland
| | - Anastasia Ruban
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Jan Szczypiński
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Poland
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Michał Bola
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology of Polish Academy of Sciences, Poland
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Ragnhildstveit A, Khan R, Seli P, Bass LC, August RJ, Kaiyo M, Barr N, Jackson LK, Gaffrey MS, Barsuglia JP, Averill LA. 5-MeO-DMT for post-traumatic stress disorder: a real-world longitudinal case study. Front Psychiatry 2023; 14:1271152. [PMID: 38076677 PMCID: PMC10710141 DOI: 10.3389/fpsyt.2023.1271152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/03/2023] [Indexed: 02/12/2024] Open
Abstract
Psychedelic therapy is, arguably, the next frontier in psychiatry. It offers a radical alternative to longstanding, mainstays of treatment, while exciting a paradigm shift in translational science and drug discovery. There is particular interest in 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT)-a serotonergic psychedelic-as a novel, fast-acting therapeutic. Yet, few studies have directly examined 5-MeO-DMT for trauma- or stress-related psychopathology, including post-traumatic stress disorder (PTSD). Herein, we present the first longitudinal case study on 5-MeO-DMT for chronic refractory PTSD, in a 23-year-old female. A single dose of vaporized bufotoxin of the Sonoran Desert Toad (Incilius alvarius), containing an estimated 10-15 mg of 5-MeO-DMT, led to clinically significant improvements in PTSD, with next-day effects. This was accompanied by marked reductions in hopelessness and related suicide risk. Improvements, across all constructs, were sustained at 1-, 3-, 6-, and 12-months follow-up, as monitored by a supporting clinician. The subject further endorsed a complete mystical experience, hypothesized to underly 5-MeO-DMT's therapeutic activity. No drug-related, serious adverse events occurred. Together, results showed that 5-MeO-DMT was generally tolerable, safe to administer, and effective for PTSD; however, this was not without risk. The subject reported acute nausea, overwhelming subjective effects, and late onset of night terrors. Further research is warranted to replicate and extend these findings, which are inherently limited, non-generalizable, and rely on methods not clinically accepted.
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Affiliation(s)
- Anya Ragnhildstveit
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Ryan Khan
- Integrated Research Literacy Group, Draper, UT, United States
| | - Paul Seli
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Lisa Claire Bass
- Integrated Research Literacy Group, Draper, UT, United States
- Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - River Jude August
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | - Miriam Kaiyo
- Integrated Research Literacy Group, Draper, UT, United States
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, United States
| | - Nathaniel Barr
- School of Humanities and Creativity, Sheridan College, Oakville, ON, Canada
| | | | - Michael Santo Gaffrey
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
- Department of Pediatrics, Division of Pediatric Psychology and Developmental Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
- Children’s Wisconsin, Milwaukee, WI, United States
| | | | - Lynnette Astrid Averill
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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Kruger DJ, Barron J, Herberholz M, Boehnke KF. Preferences and Support for Psychedelic Policies and Practices Among Those Using Psychedelics. J Psychoactive Drugs 2023; 55:650-659. [PMID: 37353935 DOI: 10.1080/02791072.2023.2228784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/11/2023] [Accepted: 05/26/2023] [Indexed: 06/25/2023]
Abstract
Legal, scientific, and social landscapes for psychedelics are changing rapidly. Differences of opinion exist among key stakeholders regarding regulatory control, models of provisioning psychedelic therapy, and medicalization, decriminalization, and/or legalization policies. We assessed the policy preferences of people using psychedelics naturalistically (N = 1221) to understand how they aligned and differed with institutional entities and existing psychedelic policies. Three quarters of participants would support decriminalization and legalization. On average, participants strongly supported individuals being legally able to grow and possess psychedelic plants and/or fungi for personal consumption. Trends included more support for natural over synthetic substances, self-production and consumption over gifting, gifting over sales, and administration of psychedelics with therapeutic support than without therapeutic support. Participants were concerned about pharmaceutical-like policy models, including patents of natural and synthetic psychedelic compounds. Participants were mostly from the State of Michigan, though geographical differences were minor. Those who identified as a psychedelic guide, educator, or therapist had small yet extensive differences from those who did not. As psychedelic liberalization continues to advance, it is critical for policymakers to consider these preferences to ensure laws provide safe and equitable access to these substances and appropriate medical support for their use.
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Affiliation(s)
- Daniel J Kruger
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Anesthesiology Department and Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julie Barron
- Blue Sage Health Consulting, Ann Arbor, MI, USA
- Michigan Psychedelic Society, Ann Arbor, MI, USA
- Decriminalize Nature, Michigan, Ann Arbor, MI, USA
| | - Moss Herberholz
- Michigan Psychedelic Society, Ann Arbor, MI, USA
- The Radical Well-Being Center, Southfield, MI, USA
| | - Kevin F Boehnke
- Anesthesiology Department and Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
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Glynos NG, Kruger DJ, Kolbman N, Boehnke K, Lucas P. The Relationship Between Naturalistic Psychedelic Use and Clinical Care in Canada. J Psychoactive Drugs 2023; 55:660-671. [PMID: 37516904 DOI: 10.1080/02791072.2023.2242353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/11/2023] [Indexed: 07/31/2023]
Abstract
Naturalistic psychedelic use among Canadians is common. However, interactions about psychedelic use between patients and clinicians in Canada remain unclear. Via an anonymous survey, we assessed health outcomes and integration of psychedelic use with health care providers (HCP) among Canadian adults reporting past use of a psychedelic. The survey included 2,384 participants, and most (81.2%) never discussed psychedelic use with their HCP. While 33.7% used psychedelics to self-treat a health condition, only 4.4% used psychedelics with a therapist and 3.6% in a clinical setting. Overall, 44.8% (n = 806) of participants were aware of substance testing services, but only 42.4% ever used them. Multivariate regressions revealed that therapeutic motivation, higher likelihood of seeking therapist guidance, and non-binary gender identification were significantly associated with higher odds of discussing psychedelics with one's primary HCP. Having used a greater number of psychedelics, lower age, non-female gender, higher education, and a therapeutic motivation were significantly associated with higher odds of awareness of substance testing. We conclude that naturalistic psychedelic use in Canada often includes therapeutic goals but is poorly connected to conventional healthcare, and substance testing is uncommon. Relevant training and education for HCPs is needed, along with more visible options for substance testing.
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Affiliation(s)
- Nicolas G Glynos
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Psychedelic Science, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Kruger
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Psychedelic Science, University of Michigan, Ann Arbor, MI, USA
- Population Studies Center, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas Kolbman
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Psychedelic Science, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Boehnke
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Psychedelic Science, University of Michigan, Ann Arbor, MI, USA
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Mallaroni P, Mason NL, Kloft L, Reckweg JT, van Oorsouw K, Ramaekers JG. Cortical structural differences following repeated ayahuasca use hold molecular signatures. Front Neurosci 2023; 17:1217079. [PMID: 37869513 PMCID: PMC10585114 DOI: 10.3389/fnins.2023.1217079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Serotonergic psychedelics such as ayahuasca are reported to promote both structural and functional neural plasticity via partial 5-HT2A agonism. However, little is known about how these molecular mechanisms may extend to repeated psychedelic administration in humans, let alone neuroanatomy. While early evidence suggests localised changes to cortical thickness in long-term ayahuasca users, it is unknown how such findings may be reflected by large-scale anatomical brain networks comprising cytoarchitecturally complex regions. Methods Here, we examined the relationship between cortical gene expression markers of psychedelic action and brain morphometric change following repeated ayahuasca usage, using high-field 7 Tesla neuroimaging data derived from 24 members of an ayahuasca-using church (Santo Daime) and case-matched controls. Results Using a morphometric similarity network (MSN) analysis, repeated ayahuasca use was associated with a spatially distributed cortical patterning of both structural differentiation in sensorimotor areas and de-differentiation in transmodal areas. Cortical MSN remodelling was found to be spatially correlated with dysregulation of 5-HT2A gene expression as well as a broader set of genes encoding target receptors pertinent to ayahuasca's effects. Furthermore, these associations were similarly interrelated with altered gene expression of specific transcriptional factors and immediate early genes previously identified in preclinical assays as relevant to psychedelic-induced neuroplasticity. Conclusion Taken together, these findings provide preliminary evidence that the molecular mechanisms of psychedelic action may scale up to a macroscale level of brain organisation in vivo. Closer attention to the role of cortical transcriptomics in structural-functional coupling may help account for the behavioural differences observed in experienced psychedelic users.
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Affiliation(s)
- Pablo Mallaroni
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Natasha L. Mason
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Lilian Kloft
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Johannes T. Reckweg
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Kim van Oorsouw
- Department of Forensic Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Johannes G. Ramaekers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Kruger DJ, Glynos NG, Fields CW, Herberholz M, Boehnke KF. An Assessment of Psychedelic Knowledge Among People Using Psychedelics Naturalistically. J Psychoactive Drugs 2023; 55:420-424. [PMID: 36328419 DOI: 10.1080/02791072.2022.2142709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022]
Abstract
Identifying gaps and strengths in psychedelic-related knowledge is key to developing effective, evidence-based education to inform appropriate use of and harm reduction practices for psychedelics in the naturalistic use landscape. The current study piloted an assessment instrument with questions on legal status, therapeutic potential, and side effects of psychedelics among people reporting current psychedelic use. We recruited participants (N = 1435) at a psychedelic advocacy event and through psychedelic interest groups on social media. Respondents completed a brief survey of psychedelic use and psychedelic knowledge. Items assessed basic knowledge of various topics surrounding psychedelics, such as legal status, active compounds, and known therapeutic efficacy based on the clinical trial literature. Respondents who had used greater numbers of different psychedelics, with higher levels of education, lower age, greater frequency of psychedelic use, identifying as male, used high doses (vs. microdosing only), identifying as Caucasian/White, and with greater annual household income answered more questions correctly. Most respondents exhibited high knowledge of psychedelics, though there is also a demonstrated need for education and outreach, especially in under-represented communities.
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Affiliation(s)
- Daniel J Kruger
- Population Studies Center, University of Michigan, Ann Arbor, MI, USA
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nicolas G Glynos
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
- Center for Consciousness Science, University of Michigan, Ann Arbor, MI, USA
| | - Christopher W Fields
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Moss Herberholz
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kevin F Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA
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Boehnke KF, Cox K, Weston C, Herberholz M, Glynos N, Kolbman N, Fields CW, Barron J, Kruger DJ. Slouching towards engagement: interactions between people using psychedelics naturalistically and their healthcare providers. Front Psychiatry 2023; 14:1224551. [PMID: 37599880 PMCID: PMC10436225 DOI: 10.3389/fpsyt.2023.1224551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction There is substantial public interest in psychedelics as potential treatments for psychiatric conditions. However, most psychedelics are criminalized under federal law in the USA, so it is unclear whether use occurs with clinical support. Our objective was to assess whether naturalistic psychedelic use occurs with clinical support, interactions between those using psychedelics and healthcare providers (psychiatrist, therapist, or primary physicians), and use characteristics. Methods We conducted an online, anonymous, confidential, cross-sectional survey of adults reporting psychedelic use (N = 1221) through a psychedelics advocacy event and social media between 9/18/2022 and 11/5/2022. We assessed participant disclosure of psychedelic use with their psychiatric care provider (PsyCP) and/or primary care provider (PCP), desire for provider support, access to support, and rate of taking prescribed psychoactive medications alongside psychedelics. Results Among participants with such care providers, 22% disclosed psychedelic use to their PCP vs. 58% to their PsyCP. Participants were less confident in PCP vs. PsyCP ability to integrate psychedelics into treatment. Common reasons for nondisclosure included stigma, inadequate provider knowledge, and legal concerns. 23% reported taking psychedelics on the same day as potentially interacting psychiatric medications (e.g., anxiolytics, antidepressants). Despite 81% of participants desiring therapist support during psychedelic experiences, only 15% had received such support. Discussion Our results show that psychedelic use is generally disconnected from primary and psychiatric clinical care. This disconnection may result in safety issues, including inadequate screening for contraindicated conditions, lack of support during emergent adverse events, and drug interactions. Enhanced clinical education and orienting drug policy towards known harms and benefits of psychedelics is needed.
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Affiliation(s)
- Kevin F. Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Arbor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Kasey Cox
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Cody Weston
- Psychiatry Department, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Moss Herberholz
- The Radical Well-Being Center, Southfield, MI, United States
| | - Nicolas Glynos
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas Kolbman
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Christopher W. Fields
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Julie Barron
- Blue Sage Health Consulting, Ann Arbor, MI, United States
- Michigan Psychedelic Society, Ann Arbor, MI, United States
- Decriminalize Nature Ann Arbor, Ann Arbor, MI, United States
| | - Daniel J. Kruger
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
- Population Studies Center, University of Michigan, Ann Arbor, MI, United States
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Spriggs MJ, Murphy-Beiner A, Murphy R, Bornemann J, Thurgur H, Schlag AK. ARC: a framework for access, reciprocity and conduct in psychedelic therapies. Front Psychol 2023; 14:1119115. [PMID: 37251069 PMCID: PMC10211333 DOI: 10.3389/fpsyg.2023.1119115] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/31/2023] [Indexed: 05/31/2023] Open
Abstract
The field of psychedelic assisted therapy (PAT) is growing at an unprecedented pace. The immense pressures this places on those working in this burgeoning field have already begun to raise important questions about risk and responsibility. It is imperative that the development of an ethical and equitable infrastructure for psychedelic care is prioritized to support this rapid expansion of PAT in research and clinical settings. Here we present Access, Reciprocity and Conduct (ARC); a framework for a culturally informed ethical infrastructure for ARC in psychedelic therapies. These three parallel yet interdependent pillars of ARC provide the bedrock for a sustainable psychedelic infrastructure which prioritized equal access to PAT for those in need of mental health treatment (Access), promotes the safety of those delivering and receiving PAT in clinical contexts (Conduct), and respects the traditional and spiritual uses of psychedelic medicines which often precede their clinical use (Reciprocity). In the development of ARC, we are taking a novel dual-phase co-design approach. The first phase involves co-development of an ethics statement for each arm with stakeholders from research, industry, therapy, community, and indigenous settings. A second phase will further disseminate the statements for collaborative review to a wider audience from these different stakeholder communities within the psychedelic therapy field to invite feedback and further refinement. By presenting ARC at this early stage, we hope to draw upon the collective wisdom of the wider psychedelic community and inspire the open dialogue and collaboration upon which the process of co-design depends. We aim to offer a framework through which psychedelic researchers, therapists and other stakeholders, may begin tackling the complex ethical questions arising within their own organizations and individual practice of PAT.
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Affiliation(s)
- Meg J. Spriggs
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- Drug Science, London, United Kingdom
| | - Ashleigh Murphy-Beiner
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- Department of Psychology, Royal Holloway University of London, London, United Kingdom
| | - Roberta Murphy
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- South West London and St George’s Mental Health NHS Trust, London, United Kingdom
| | - Julia Bornemann
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- Drug Science, London, United Kingdom
| | | | - Anne K. Schlag
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
- Drug Science, London, United Kingdom
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Kopra EI, Ferris JA, Winstock AR, Kuypers KP, Young AH, Rucker JJ. Investigation of self-treatment with lysergic acid diethylamide and psilocybin mushrooms: Findings from the Global Drug Survey 2020. J Psychopharmacol 2023:2698811231158245. [PMID: 36876583 DOI: 10.1177/02698811231158245] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Growing numbers of people are using psychedelics for personal psychotherapy outside clinical settings, but research on such use is scarce. AIMS This study investigated the patterns of use, self-reported outcomes and outcome predictors of psychedelic 'self-treatment' of mental health conditions or specific worries/concerns in life. METHODS We use data from the Global Drug Survey 2020, a large online survey on drug use collected between November 2019 and February 2020. In all, 3364 respondents reported their self-treatment experiences with lysergic acid diethylamide (N = 1996) or psilocybin mushrooms (N = 1368). The primary outcome of interest was the 17-item self-treatment outcome scale, items reflecting aspects of well-being, psychiatric symptoms, social-emotional skills, and health behaviours. RESULTS Positive changes were observed across all 17 outcome items, with the strongest benefits on items related to insight and mood. Negative effects were reported by 22.5% of respondents. High intensity of psychedelic experience, seeking advice before treatment, treating with psilocybin mushrooms and treating post-traumatic stress disorder were associated with higher scores on the self-treatment outcome scale after averaging values across all 17 items. Younger age, high intensity of experience and treating with LSD were associated with increased number of negative outcomes. CONCLUSIONS This study brings important insights into self-treatment practices with psychedelics in a large international sample. Outcomes were generally favourable, but negative effects appeared more frequent than in clinical settings. Our findings can help inform safe practices of psychedelic use in the community, and inspire clinical research. Future research can be improved with utilisation of prospective designs and additional predictive variables.
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Affiliation(s)
- Emma I Kopra
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jason A Ferris
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Adam R Winstock
- Institute of Epidemiology and Health Care, University College London, London, UK.,Global Drug Survey Ltd, London, UK
| | - Kim Pc Kuypers
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - James J Rucker
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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