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Psychedelic drugs should be legally reclassified so that researchers can investigate their therapeutic potential



Trials of physiologically safe and non-addictive drugs such as LSD are almost impossible, writes James J H Rucker , calling on the authorities to downgrade their unnecessarily restrictive class A, schedule 1 classification Psychedelic drugs, especially lysergic acid diethylamide (LSD) and psilocybin, which is found in the Psilocybe genus of “magic” mushrooms that grow throughout the United Kingdom, were extensively used and researched in clinical psychiatry before their prohibition in 1967. Hundreds of papers, involving tens of thousands of patients, presented evidence for their use as psychotherapeutic catalysts of mentally beneficial change in many psychiatric disorders, problems of personality development, recidivistic behaviour, and existential anxiety.1 This research abruptly ended after 1967, when psychedelics were legally classified as schedule 1 drugs under the UK Misuse of Drugs Regulations and as class A drugs under the UK Misuse of Drugs Act 1971. Schedule 1 in the UK broadly mirrors schedule I of the 1971 United Nations Convention on Psychotropic Substances, adoption of which is a requirement of UN membership.2 This classification denoted psychedelic drugs as having no accepted medical use and the greatest potential for harm, despite the existence of research evidence to the contrary. Indeed, in 1992 John Ehrlichman, …
Psychedelic drugs should be legally reclassified so
that researchers can investigate their therapeutic
Trials of physiologically safe and non-addictive drugs such as LSD are almost impossible, writes
James J H Rucker, calling on the authorities to downgrade their unnecessarily restrictive class A,
schedule 1 classification
James J H Rucker specialist registrar in adult psychiatry and honorary clinical lecturer, MRC Social,
Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience,
King’s College, London, SE5 8AF
Psychedelic drugs, especially lysergic acid diethylamide (LSD)
and psilocybin, which is found in the Psilocybe genus of “magic”
mushrooms that grow throughout the United Kingdom, were
extensively used and researched in clinical psychiatry before
their prohibition in 1967. Hundreds of papers, involving tens
of thousands of patients, presented evidence for their use as
psychotherapeutic catalysts of mentally beneficial change in
many psychiatric disorders, problems of personality
development, recidivistic behaviour, and existential anxiety.1
This research abruptly ended after 1967, when psychedelics
were legally classified as schedule 1 drugs under the UK Misuse
of Drugs Regulations and as class A drugs under the UK Misuse
of Drugs Act 1971. Schedule 1 in the UK broadly mirrors
schedule I of the 1971 United Nations Convention on
Psychotropic Substances, adoption of which is a requirement
of UN membership.2This classification denoted psychedelic
drugs as having no accepted medical use and the greatest
potential for harm, despite the existence of research evidence
to the contrary.
Indeed, in 1992 John Ehrlichman, former assistant to Richard
Nixon—the US president who intensified the “war on drugs”
in the 1970s—notoriously admitted that the administration had
lied about the harmful effects of drugs and had manipulated
media coverage of them for political advantage.3Nearly 50 years
later psychedelic drugs remain more legally restricted than
heroin and cocaine, which are schedule 2, class A in the UK.
But no evidence shows that psychedelic drugs are habit forming;
little evidence shows that they are harmful in controlled settings;
and much historical evidence has shown that they could have
use in common psychiatric disorders. A growing number of
organisations, most recently in Norway, are questioning the
need for such draconian restrictions.4
Where’s the harm?
Psychedelic drugs do not induce dependence.5A 1984 review
of adverse reactions to psychedelics found little evidence of
harm in controlled settings.6Furthermore, in 2010, an analysis
of harms caused to recreational users and to society by a range
of psychotropic substances ranked LSD and psilocybin among
the safest of all those studied.7The therapeutic index (toxic dose
as a ratio of standard dose) for LSD and psilocybin is about
1000; for cocaine it is 15, for heroin it is 6, and for alcohol it is
10.8The belief that psychedelics induce homicidal or suicidal
behaviour was inculcated by the politically driven and media
led condemnation of LSD in the 1960s.9
In a population study of 130 152 respondents to the US National
Survey on Drug Use and Health (NSDUH) from 2001 to 2004,
a history of reported psychedelic use was associated with lower
reported levels of serious psychological distress, the need for
mental health treatment, and psychiatric medicine.10 Researchers
found no association with psychosis. Using data from the
2008-12 NSDUH (n=191 382) Hendricks et al found that ever
having used psychedelics was associated with a significantly
reduced risk of suicide.11 These results have been broadly
replicated in another sample of 135 095 randomly selected US
Evidence for medical use
Many of the clinical trials of psychedelics published in the 1950s
and ’60s, before prohibition, fell short of modern standards;
however, several good quality, controlled trials were performed.
Using data from six such trials in alcoholism, a recent
meta-analysis that compared treatment with LSD against
controls in 536 people found that LSD treatment was favoured
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in terms of objectively measured improvements in alcohol
misuse, with an odds ratio of 1.96 (95% confidence interval
1.36 to 2.84).13 Recent pilot studies performed outside the UK
have shown clinical efficacy in anxiety associated with advanced
cancer,14 obsessive compulsive disorder,15 tobacco addiction,16
alcohol addiction,17 and cluster headaches.18
However, larger clinical studies are almost impossible
throughout the Western world because of the practical, financial,
and bureaucratic obstacles imposed by schedule 1 classification
or its equivalent.19 For example, because of the burden of
compliance with the UN’s schedule I, only one manufacturer
in the world produces psilocybin at sufficient quality, quoting
our group a prohibitive £100 000 for 1 g (50 doses).
In the UK, to hold a schedule 1 drug, institutions require a
licence costing about £5000. Only four hospitals currently hold
such licences, which come with regular police inspections and
onerous rules on storage and transport. Prescribers of a schedule
1 substance also must hold a licence, which costs £3000.
These restrictions, and the accompanying bureaucracy, mean
that the cost of clinical research using psychedelics is 5-10 times
that of research into less restricted (but more harmful) drugs
such as heroin—with no prospect that the benefits can be
translated into wider medical practice. The self reinforcing cycle
of stigma generated by schedule I classification means that
almost all grant funders are uncomfortable funding research
into psychedelics, and similar problems are encountered with
ethics committees.
Legal prohibition of some psychotropic substances continues
to be a condition of UN membership, stigmatising a facet of
behaviour and arguably causing more harm than it prevents.20
The UN schedule I creates its own circular argument for
psychedelics to remain stringently restricted, even though the
original reasons for classifying them as such were largely
Because psychedelics are not harmful in relation to other
controlled substances and are not habit forming, and because
evidence suggests medical use, we call on the UK Advisory
Council on the Misuse of Drugs and the 2016 UN General
Assembly Special Session on Drugs to recommend that
psychedelics be reclassified as schedule 2 compounds to enable
a comprehensive, evidence based assessment of their therapeutic
Competing interests: I have read and understood the BMJ policy on
declaration of interests and have no relevant interests to declare.
I thank Robin L Carhart-Harris and David J Nutt, Centre for
Neuropsychopharmacology, Division of Brain Sciences, Imperial College
London, W12 0NN.
Provenance and peer review: Not commissioned; not externally peer
1 Grinspoon L, Bakalar J. The psychedelic drug therapies. Curr Psychiatr Ther
2 United Nations. Convention on psychotropic substances, 1971.
3 Baum D. Truth, lies, and audiotape. In: Smith L, ed. The moment: wild, poignant, life
changing stories from 125 writers and artists. Harper Perennial, 2012.
4 Higgins A. Odd push in drug averse Norway: LSD is OK. 4 May 2015. http:
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6 Strassman RJ. Adverse reactions to psychedelic drugs: a review of the literature. J Nerv
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7 Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis.
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8 Gable RS. Comparison of acute lethal toxicity of commonly abused psychoactive
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9Grinspoon L, Bakalar J. Psychedelic drugs reconsidered. 1st ed. Lindesmith Center, 1997.
10 Krebs TS, Johansen PØ. Psychedelics and mental health: a population study. PLoS One
11 Hendricks PS, Thorne CB, Clark CB, et al. Classic psychedelic use is associated with
reduced psychological distress and suicidality in the United States adult population. J
Psychopharmacol 2015;29:280-8.
12 Johansen PØ, Krebs TS. Psychedelics not linked to mental health problems or suicidal
behavior: a population study. J Psychopharmacol 2015;29:270-9.
13 Krebs TS, Johansen PØ. Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis
of randomized controlled trials. J Psychopharmacol 2012;26:994-1002.
14 Grob CS, Danforth AL, Chopra GS, et al. Pilot study of psilocybin treatment for anxiety
in patients with advanced stage cancer. Arch Gen Psychiatry 2011;68:71-8.
15 Moreno FA, Wiegand CB, Taitano EK, Delgado PL. Safety, tolerability, and efficacy of
psilocybin in 9 patients with obsessive-compulsive disorder. J Clin Psychiatry
16 Johnson MW, Garcia-Romeu A, Cosimano MP, Griffiths RR. Pilot study of the 5-HT2AR
agonist psilocybin in the treatment of tobacco addiction. J Psychopharmacol
17 Bogenschutz M, Forcehimes A, Pommy J, et al. Psilocybin-assisted treatment for alcohol
dependence: a proof-of-concept study. J Psychopharmacol 2015;29:289-99.
18 Sewell RA, Halpern JH, Pope HG. Response of cluster headache to psilocybin and LSD.
Neurology 2006;66:1920-2.
19 Nutt DJ, King LA, Nichols DE. Effects of schedule I drug laws on neuroscience research
and treatment innovation. Nat Rev Neurosci 2013;14:577-85.
20 Hari J. Chasing the scream. 1st ed. Bloomsbury Publishing, 2015.
Cite this as: BMJ 2015;350:h2902
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... For instance, psilocybinonly produced by one licenced pharmaceutical company in the UK, COMPASS Pathways PLCis priced at £100,000 per 1 g (Johnson, Garcia-Romeu, Cosimano, & Griffiths, 2014). Fourthly, given the social stigma surrounding the topic, most research depends on private sources of funding, which are a very unreliable and unstable source of income (Rucker, 2015). These hurdles increase the financial burden and consume valuable research time, becoming increasingly challenging the more restrictive the category. ...
... For instance, literature on LSD and psilocybin shows growth with periods of decay (Figures 2b and 4b). Research on these substances was on the rise during the 50s and 60s, but underwent an important recess in the 1970s (Figures 2b and d, 4a and b) after a series of sociopolitical events (Figure 1) (Lawrence et al., 2021;Rucker, 2015). Additionally, the literature on MDMA also exhibits growth with periods of decay. ...
... In the UK, the brewing industry sponsored anti-MDMA campaigns due to the negative impact it was having on their business (Carey, 1997). Given the instability and shortage of funding sources to study Schedule I compounds, the ban together with the unfavourable propaganda against MDMA impacted its research (Rucker, 2015). These limitations seem to explain the pattern of growth of the number of papers on MDMA per year, which increased through the 1980s and early 1990s, but stagnated and dropped after 1995 (Figures 2 and 4). ...
Although intended to avoid illicit drug use, national laws and international conventions have limited research on psychoactive drugs. To characterise the evolution of the literature on psychoactive drugs, a bibliometric study of 15 psychoactive drugs from 1960 to 2018 was conducted in which 956,703 academic publications were obtained from Web of Science. Growth patterns were analysed per drug type, legal status and country. Our results show the existence of heterogeneous patterns of growth for the publications of different psychoactive drugs. Strikingly, the literature on legal substances and depressants represented between 60% and 80% throughout the years. We found unexpected regional differences in the scientific output about the selected drugs, which might be explained by cultural and political phenomena. Governments and funding bodies should consider these results when allocating resources to research on psychoactive drugs to optimise the therapeutic applications of these compounds and our understanding of the nervous system.
... Considerable evidence shows that the MDR (2001) are not based on the scientific evidence of the risks of these drugs (Nutt et al., 2010;Rucker, 2015). For example, an extensive and detailed Multi-Criteria Decision Analysis (MCDA) of 20-legal and illegal-drugs found that those in S1, such as LSD and psilocybin, were the least harmful to both users and society (Nutt et al., 2010) Counter-intuitively, S2 drugs, most notably heroin, cocaine and amphetamines, scored significantly higher on all 16 harm criteria. ...
... As a result, more methodologically sound research is needed for definitive conclusions to be drawn. However, due to the MDR (2001), there are many practical, financial and bureaucratic barriers to conducting this research (Rucker, 2015). In a survey of members of the UK's leading psychopharmacology organisation, the British Association for Psychopharmacology (BAP), the most reported barriers to research were found to be the cost of S1 CD licenses, storage and security requirements, transportation difficulties, and penalties for not adhering to the guidelines (Freeman et al., 2018). ...
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There is increasing research to suggest that certain Schedule 1 drugs, most notably psychedelics, can be effective in treating a range of mental health disorders. However, due to several practical, financial, and bureaucratic barriers, there is a lack of large-scale trials into their efficacy. This study aimed to explore the barriers, and any facilitators, to undertaking Schedule 1 research through examining the different positions Schedule 1 and other controlled drug researchers place themselves in, and the impact this has on their experiences.
... Recently, voters in Oregon in the USA decriminalized psilocybin and granted it treatment status for therapeutic use in licensed medical facilities, under the supervision of trained professionals. Indeed, legal reclassification would expedite the clinical research programme needed to integrate high-quality psychedelic therapy into public psychiatry for the benefit of those with non-psychotic mental health disorders [90,91]. ...
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Introduction Despite the rapid advance of psychedelic science and possible translation of psychedelic therapy into the psychiatric clinic, very little is known about mental health service user attitudes. Objectives To explore mental health service user attitudes to psychedelics and psilocybin therapy. Methods A questionnaire capturing demographics, diagnoses, previous psychedelic and other drug use, and attitudes to psychedelics and psilocybin therapy was distributed to mental health service users. Results Ninety-nine participants completed the survey (52% female, mean age 42 years). The majority (72%) supported further research, with 59% supporting psilocybin as a medical treatment. A total of 27% previously used recreational psilocybin, with a male preponderance (p = 0.01). Younger age groups, those with previous psychedelic experience, and those with non-religious beliefs were more likely to have favourable attitudes towards psilocybin. A total of 55% of the total sample would accept as a treatment if doctor recommended, whereas 20% would not. Fewer people with depression/anxiety had used recreational psychedelics (p = 0.03) but were more likely to support government funded studies (p = 0.02). A minority (5%) of people with conditions (psychosis and bipolar disorder) that could be exacerbated by psilocybin thought it would be useful for them. One fifth of the total sample viewed psychedelics as addictive and unsafe even under medical supervision. Concerns included fear of adverse effects, lack of knowledge, insufficient research, illegality, and relapse if medications were discontinued. Conclusions The majority supported further research into psilocybin therapy. Younger people, those with previous recreational psychedelic experience, and those with non-religious beliefs were more likely to have favourable attitudes towards psilocybin therapy.
... Since 1970, the law has not changed, despite our pleas (Nutt et al., 2013;Rucker, 2015). So, why is this resurgence of interest happening now (and is it wise)? ...
... Despite its striking clinical effect in a number of indications, as a naturally occurring compound, psilocybin presents a challenging intellectual property space which may temper the enthusiasm of industry for investment of the significant resources required to bring a treatment to market. The stigma associated with psilocybin's restrictive legal classification deters both grant funders and ethics committees from supporting research (Rucker, 2015), while these restrictions hinder the pace of scientific investigation by introducing significant bureaucratic and financial hurdles, meaning only the best-resourced and most determined scientists are able to pursue research. Many of these hurdles are in place whether a lab requires 8 mg of psilocybin for an animal study or 800 mg for a clinical trial. ...
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The recent revivification of interest in the therapeutic use of psychedelics has had a particular focus on mood disorders and addiction, although there is reason to think these drugs may be effective more widely. After outlining pertinent aspects of psilocybin and obsessive-compulsive disorder (OCD), the current review summarizes the evidence indicating that there may be a role for psilocybin in the treatment of OCD, as well as highlighting a range of potential therapeutic mechanisms that reflect the action of psilocybin on brain function. Although the current evidence is limited, that multiple signals point in directions consistent with treatment potential, alongside the psychological and physiological safety of clinically administered psilocybin, support the expansion of research, both in animal models and in further randomized controlled trials, to properly investigate this potential.
... In this scenario, some researchers suggested that these drugs should be reclassified so that their therapeutic potentials can be fully investigated like any other drug with therapeutic potentials. 75,76 But although re-schedule would be desirable, the Convention already established that scheduled substances are only allowed precisely for scientific and medical purposes. Thus, these substances should be re-scheduled not only because their risk do not correspond with the specific schedule list where they are located but because the Convention already guarantees its medical and scientific uses. ...
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Psychedelics or serotonergic hallucinogens are a group of substances that share the agonism of serotonergic 5-HT 2A receptors as their main mechanism of action. Its main effects include changes in perception, cognitive process, and mood. Despite being used for centuries by different cultures in ritual contexts, these substances have currently aroused the interest of science and industry for their promising antidepressant, anxiolytic, and anti-addictive effects. Considering this evidence, this article aims to explore some of the possible health policy challenges to integrate these therapeutic tools into broad and heterogeneous health systems. As a main benefit, these substances produce rapid and enduring effects with the administration of single or few doses, which could lead to new treatment possibilities for patients with severe mental disorders resistant to the usual medications. The main challenge is associated with the fact that these substances remain scheduled in most countries and are associated with social stigma related to their recreational use (especially LSD and psilocy-bin). This situation makes it exceedingly difficult to conduct clinical trials, although international conventions allow such research. Ethically, this could be interpreted as a violation of human rights since thousands of people are prevented from having access to possible benefits. Interestingly, ritual ayahuasca use is more acceptable to the public than the use of psilocybin-containing mushrooms or LSD. The controlled, clinical use of LSD and psilocy-bin seems to be less criticized and is being explored by the industry. Rigorous scientific evidence coupled with industrial interests (LSD and psilocybin), together with respect for traditional uses (ayahuasca) and international conventions, seems to be the best way for these drugs to be integrated into health systems in the next years. Which highlights the need for an urgent dialogue between science, health system, society, and politics.
... Classical psychedelics such as psilocybin are currently designated as Schedule 1 drugs in the UK and USA, imposing onerous and highly restrictive regulations around their use in a research and therapeutic context (Aday et al., 2020; Nutt et al., 2013), with clinicians calling on such restrictions to be revised to more fairly reflect their relative harm and potential benefit and to facilitate greater access for research and potential medical development Nutt et al., 2020;Rucker, 2015). Presently, most human psilocybin studies occur in monitored hospital or research settings, despite psilocybin in its naturally occurring fungalform having an ancient history of human usage (Nichols, 2020). ...
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Therapeutic psychedelic administration and contact with nature have been associated with the same psychological mechanisms: decreased rumination and negative affect, enhanced psychological connectedness and mindfulness-related capacities, and heightened states of awe and transcendent experiences, all processes linked to improvements in mental health amongst clinical and healthy populations. Nature-based settings can have inherently psychologically soothing properties which may complement all stages of psychedelic therapy (mainly preparation and integration) whilst potentiating increases in nature relatedness, with associated psychological benefits. Maximising enhancement of nature relatedness through therapeutic psychedelic administration may constitute an independent and complementary pathway towards improvements in mental health that can be elicited by psychedelics.
... It is still included in Schedule I of the United Nations classification of drugs, restricting its use in research and making it difficult to potentially use it as a therapeutic tool in medicine. This classification has recently been questioned by various authors (8,43). A few decades ago, anecdotal reports of suicidal acts in recreational users were published, and intensely emphasized by the media (44,45). ...
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Lysergic acid diethylamide (LSD) was studied from the 1950s to the 1970s to evaluate behavioral and personality changes, as well as remission of psychiatric symptoms in various disorders. LSD was used in the treatment of anxiety, depression, psychosomatic diseases and addiction. However, most of the studies were not performed under contemporary standards, and it has taken several decades for a resurgence of interest in LSD research and its therapeutic potential for psychiatry. The aim of this review is to identify controlled and randomized clinical trials that assess the potential use of LSD in psychiatry. PRISMA guidelines for systematic review were followed. A literature search of PubMed and Psychedelic bibliography from Multidisciplinary Association for Psychedelic Studies (MAPS) databases was performed as well as a manual search of references from evaluated studies. Only randomized-controlled clinical trials were included. Study quality was systematically calculated by using the Cochrane Collaboration Tool for assessing risk of bias. A final selection of 11 articles was made after considering inclusion and exclusion criteria. LSD was administered to 567 patients in a dose ranging from 20 to 800 mcg. Despite the design heterogeneity of clinical trials, positive results were observed, thus revealing the therapeutic potential of LSD to reduce psychiatric symptomatology, mainly in alcoholism. The vast majority of authors describe significant and positive short-term changes in patients, despite the fact that in some studies an important homogenization was observed between the LSD treatment group and control group at long-term follow-up. Multiple variables regarding LSD treatment therapeutic approach and quality of experience were revealed and related to therapeutic outcomes. LSD is revealed as a potential therapeutic agent in psychiatry; the evidence to date is strongest for the use of LSD in the treatment of alcoholism. Despite the difficulty of designing proper double blind clinical trials with this substance, new studies that conform to modern standards are necessary in order to strengthen our knowledge on its use and open new doors in the future.
Psychedelic-assisted psychotherapy is an emerging psychiatric treatment that is attracting significant scientific, medical, and public attention. Whilst preliminary results from empirical studies are promising, the medical use of these compounds is highly controversial. Surprisingly, and despite the current controversies caused by the re-medicalisation of psychedelics, bioethicists have remained mysteriously silent. This paper aims to stimulate further bioethical reflection regarding the re-medicalisation of psychedelics. The current paper aims to do this by applying a normative phenomenological lens of analysis. Namely, this paper applies Martin Heidegger's critique of modern technology, and Fredrik Svenaeus' extension of this critique, to the re-medicalisation of psychedelics. I argue that when this critique of modern technology is applied several normative issues become apparent. Specifically, it becomes apparent that the re-medicalisation of psychedelics risks turning the ecological sources, cultural contexts, and experiences induced by psychedelics into resources to be exploited for human goals; all of which risks endangering ecosystems, appropriating traditional knowledge, and reducing the therapeutic effects of psychedelic-assisted psychotherapy. Furthermore, I suggest that preserving non-reductionist, non-instrumentalising traditional ways of understanding psychedelic compounds is essential in mitigating these consequences. More discussion by bioethicists is necessary as these consequences represent important global challenges for the psychedelic renaissance that require immediate addressing.
5-Methoxy-N,N-dimethyltryptamine (acronymized as 5-MeO-DMT) is sui generis among the numerous naturally occurring psychoactive substances due to its unparalleled ego-dissolving effects which can culminate in a state of nondual consciousness that is phenomenologically similar to transformative peak experiences described in various ancient contemplative traditions (e.g., Advaita Vedānta, Mahāyāna Buddhism, inter alia). The enigmatic molecule is endogenous to the human brain and has profound psychological effects which are hitherto only very poorly understood due to the absence of scientifically controlled human experimental trials. Its exact neuronal receptor binding profile is a matter of ongoing research; however, empirical evidence indicates that its remarkable psychoactivity is partially mediated via agonism of the 5-HT1A/2A (serotonin) receptor subtypes. Anthropological/ethnopharmacological evidence indicates that various cultures utilized 5-MeO-DMT containing plants for medicinal, psychological, and spiritual purposes for millennia. We propose that this naturally occurring serotonergic compound could be fruitfully utilized as a neurochemical research tool with the potential to significantly advance our understanding of the psychological and neuronal processes which underpin cognition and creativity (e.g., downregulation of the default mode network, increased global functional connectivity, neuroplasticity, σ1 receptor interactions, etc.). An eclectic interdisciplinary perspective is adopted, and we present converging evidence from a plurality of sources in support of our conjecture. Specifically, we argue that 5-MeO-DMT has significant neuropsychopharmacological potential due to its incommensurable capacity to completely disintegrate self-referential cognitive/neuronal processes (viz., ego death). The importance of unbiased systematic scientific research on naturally occurring endogenous psychoactive compounds is discussed from a Jamesian radical empiricism perspective, and potential scenarios of abuse are addressed, particularly in the context of neuroethics, cybernetic manipulation, and military research on torture.
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Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK. Method Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. Findings MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. Interpretation These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm.
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A recent large population study of 130,000 adults in the United States failed to find evidence for a link between psychedelic use (lysergic acid diethylamide, psilocybin or mescaline) and mental health problems. Using a new data set consisting of 135,095 randomly selected United States adults, including 19,299 psychedelic users, we examine the associations between psychedelic use and mental health. After adjusting for sociodemographics, other drug use and childhood depression, we found no significant associations between lifetime use of psychedelics and increased likelihood of past year serious psychological distress, mental health treatment, suicidal thoughts, suicidal plans and suicide attempt, depression and anxiety. We failed to find evidence that psychedelic use is an independent risk factor for mental health problems. Psychedelics are not known to harm the brain or other body organs or to cause addiction or compulsive use; serious adverse events involving psychedelics are extremely rare. Overall, it is difficult to see how prohibition of psychedelics can be justified as a public health measure. © The Author(s) 2015.
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Several lines of evidence suggest that classic (5HT2A agonist) hallucinogens have clinically relevant effects in alcohol and drug addiction. Although recent studies have investigated the effects of psilocybin in various populations, there have been no studies on the efficacy of psilocybin for alcohol dependence. We conducted a single-group proof-of-concept study to quantify acute effects of psilocybin in alcohol-dependent participants and to provide preliminary outcome and safety data. Ten volunteers with DSM-IV alcohol dependence received orally administered psilocybin in one or two supervised sessions in addition to Motivational Enhancement Therapy and therapy sessions devoted to preparation for and debriefing from the psilocybin sessions. Participants' responses to psilocybin were qualitatively similar to those described in other populations. Abstinence did not increase significantly in the first 4 weeks of treatment (when participants had not yet received psilocybin), but increased significantly following psilocybin administration (p < 0.05). Gains were largely maintained at follow-up to 36 weeks. The intensity of effects in the first psilocybin session (at week 4) strongly predicted change in drinking during weeks 5-8 (r = 0.76 to r = 0.89) and also predicted decreases in craving and increases in abstinence self-efficacy during week 5. There were no significant treatment-related adverse events. These preliminary findings provide a strong rationale for controlled trials with larger samples to investigate efficacy and mechanisms. NCT02061293. © The Author(s) 2015.
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Mental health problems are endemic across the globe, and suicide, a strong corollary of poor mental health, is a leading cause of death. Classic psychedelic use may occasion lasting improvements in mental health, but the effects of classic psychedelic use on suicidality are unknown. We evaluated the relationships of classic psychedelic use with psychological distress and suicidality among over 190,000 USA adult respondents pooled from the last five available years of the National Survey on Drug Use and Health (2008-2012) while controlling for a range of covariates. Lifetime classic psychedelic use was associated with a significantly reduced odds of past month psychological distress (weighted odds ratio (OR)=0.81 (0.72-0.91)), past year suicidal thinking (weighted OR=0.86 (0.78-0.94)), past year suicidal planning (weighted OR=0.71 (0.54-0.94)), and past year suicide attempt (weighted OR=0.64 (0.46-0.89)), whereas lifetime illicit use of other drugs was largely associated with an increased likelihood of these outcomes. These findings indicate that classic psychedelics may hold promise in the prevention of suicide, supporting the view that classic psychedelics' most highly restricted legal status should be reconsidered to facilitate scientific study, and suggesting that more extensive clinical research with classic psychedelics is warranted. © The Author(s) 2015.
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Despite suggestive early findings on the therapeutic use of hallucinogens in the treatment of substance use disorders, rigorous follow-up has not been conducted. To determine the safety and feasibility of psilocybin as an adjunct to tobacco smoking cessation treatment we conducted an open-label pilot study administering moderate (20 mg/70 kg) and high (30 mg/70 kg) doses of psilocybin within a structured 15-week smoking cessation treatment protocol. Participants were 15 psychiatrically healthy nicotine-dependent smokers (10 males; mean age of 51 years), with a mean of six previous lifetime quit attempts, and smoking a mean of 19 cigarettes per day for a mean of 31 years at intake. Biomarkers assessing smoking status, and self-report measures of smoking behavior demonstrated that 12 of 15 participants (80%) showed seven-day point prevalence abstinence at 6-month follow-up. The observed smoking cessation rate substantially exceeds rates commonly reported for other behavioral and/or pharmacological therapies (typically <35%). Although the open-label design does not allow for definitive conclusions regarding the efficacy of psilocybin, these findings suggest psilocybin may be a potentially efficacious adjunct to current smoking cessation treatment models. The present study illustrates a framework for future research on the efficacy and mechanisms of hallucinogen-facilitated treatment of addiction.
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The classical serotonergic psychedelics LSD, psilocybin, mescaline are not known to cause brain damage and are regarded as non-addictive. Clinical studies do not suggest that psychedelics cause long-term mental health problems. Psychedelics have been used in the Americas for thousands of years. Over 30 million people currently living in the US have used LSD, psilocybin, or mescaline. To evaluate the association between the lifetime use of psychedelics and current mental health in the adult population. Data drawn from years 2001 to 2004 of the National Survey on Drug Use and Health consisted of 130,152 respondents, randomly selected to be representative of the adult population in the United States. Standardized screening measures for past year mental health included serious psychological distress (K6 scale), mental health treatment (inpatient, outpatient, medication, needed but did not receive), symptoms of eight psychiatric disorders (panic disorder, major depressive episode, mania, social phobia, general anxiety disorder, agoraphobia, posttraumatic stress disorder, and non-affective psychosis), and seven specific symptoms of non-affective psychosis. We calculated weighted odds ratios by multivariate logistic regression controlling for a range of sociodemographic variables, use of illicit drugs, risk taking behavior, and exposure to traumatic events. 21,967 respondents (13.4% weighted) reported lifetime psychedelic use. There were no significant associations between lifetime use of any psychedelics, lifetime use of specific psychedelics (LSD, psilocybin, mescaline, peyote), or past year use of LSD and increased rate of any of the mental health outcomes. Rather, in several cases psychedelic use was associated with lower rate of mental health problems. We did not find use of psychedelics to be an independent risk factor for mental health problems.
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Many psychoactive drugs are used recreationally, particularly by young people. This use and its perceived dangers have led to many different classes of drugs being banned under national laws and international conventions. Indeed, the possession of cannabis, 3,4-methylenedioxy-N-methylamphetamine (MDMA; also known as ecstasy) and psychedelics is stringently regulated. An important and unfortunate outcome of the controls placed on these and other psychoactive drugs is that they make research into their mechanisms of action and potential therapeutic uses - for example, in depression and post-traumatic stress disorder - difficult and in many cases almost impossible.
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Assessments of lysergic acid diethylamide (LSD) in the treatment of alcoholism have not been based on quantitative meta-analysis. Hence, we performed a meta-analysis of randomized controlled trials in order to evaluate the clinical efficacy of LSD in the treatment of alcoholism. Two reviewers independently extracted the data, pooling the effects using odds ratios (ORs) by a generic inverse variance, random effects model. We identified six eligible trials, including 536 participants. There was evidence for a beneficial effect of LSD on alcohol misuse (OR, 1.96; 95% CI, 1.36-2.84; p = 0.0003). Between-trial heterogeneity for the treatment effects was negligible (I² = 0%). Secondary outcomes, risk of bias and limitations are discussed. A single dose of LSD, in the context of various alcoholism treatment programs, is associated with a decrease in alcohol misuse.