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There is increasing interest in the idea that microdosing psychedelics – taking microscopic amounts of hallucinogenic drugs – could be a breakthrough in the treatment of mental illnesses. From its countercultural origins to legitimate study as a therapeutic aid, microdosing is hovering between being a cutting-edge practice or an unfounded pseudoscience.
The Verge writes that microdosing is everywhere; researchers have inked books, established news outlets have covered the topic, and social media groups have grown by thousands of users who are seeking information and advice. Low doses of psychedelic drugs for productivity and stimulation have made previously taboo and controversial substances like LSD “the drug fad du jour,” says The Verge, concluding that microdosing is not only being seriously discussed, it is “trendy.”1
Vice magazine explains that the practice of microdosing is the regular consumption of lysergic acid diethylamide (the LSD), between 1 and 10 micrograms (less than a tenth of a recreational dose), so users aren’t meant to feel any of the usual effects, such as:
Every user responds differently to LSD based on the dose amount, and individual physical and psychological characteristics. It is impossible to predict when a user will experience a bad trip (the negative effects).3
One of the biggest names in the theory of microdosing is James Fadiman, a researcher in the study of psychedelic drugs and their effects. Fadiman was working on LSD until it was federally banned in 1966, but continued his work in an unofficial capacity. Since 2010, Fadiman has been focusing on how regularly taking a tiny amount of a hallucinogenic drug can have significant medical effects. If done properly, there are no hallucinations or other physical and psychological effects that characterize normal LSD abuse and misuse. Fadiman’s investigations have found that the people who microdose correctly report better quality of life, experience a reduction in their anxiety, and “sometimes even conquer long-held mental hangups.”4
However, microdosing is not an exact science. Vice carries the story of how a podcaster took too much of a psychedelic during a microdose attempt, had a bad trip, and swore off the idea. Other people have told Fadiman that they didn’t enjoy the experience or struggled to maintain their positive outlook when they discontinued the microdosing. A few others took too much LSD and built up a tolerance for the drug, requiring greater and greater amounts until the effects were felt.
The point is made by Ralph Metzner, “the father of psychedelic culture,” who has touted LSD as “a totally amazing substance.” According to Metzner, the potency of LSD means that tiny amounts of the drug can make a notable difference if microdosed. But that potency is a double-edged sword because everyone will react to LSD in their own way based on their unique physical and psychological characteristics. Metzner compares it to using a microscope; the tool is the same, but everyone using it has to adjust the lens to their own satisfaction.
Because of its unpredictability, Matthew Johnson, a researcher at Johns Hopkins University admitted that “the scientific basis [for microdosing] is pretty shaky right now.” While there are believable and interesting benefits, the claims of how small doses of LSD induce good moods and psychological flow are not only found in other forms of self-help (like meditation and exercise), but as a natural part of daily life. If a person expects to have a particular kind of day, that person is more likely to have that kind of day regardless of unforeseen events that might have an impact.
For James Fadiman, this kind of skepticism is par for the course. His work has taken him to other scientists who agree that there is something legitimate behind the theory of microdosing, to the point where further inquiry is warranted, but note that the people who engage in microdosing could simply be having a placebo reaction.
For those who do take microdoses of LSD, Fadiman reports that they experience “a remarkable increase in feelings of determination, alertness, and energy,” along with a notable drop in feelings of depression. Curiously, Fadiman’s experiments in microdosing proved unhelpful for people who took LSD for the purpose of treating their anxiety; microdosing LSD had the apparent effect of increasing levels of anxiety in those people, but for those who joined the project as a way of treating both anxiety and depression (and not just anxiety), the treatment seemed to be effective in improving their feelings and general mental health.
The executive director of the Multidisciplinary Association for Psychedelic Studies points out that the use of hallucinogens as a mental health aid is not to make patients feel high or highly connected with the universe, but to help them go about their daily lives as normally as possible. Cognitive processing might be slightly augmented – people can feel mentally sharper, more focused, and creative – but if they experience a trip, then they are doing it wrong. A patient on a microdose should be able to safely and responsibly drive a car. Put simply, the effects should be so mild that they should be almost unnoticeable.
This is one reason why Fadiman calls his work “search” and not “research.” Fadiman openly admits that what he’s doing now will not meet the criteria for a clinical study, but he is optimistic that researchers in the future will find his data useful.
LSD has come a long way since its past as “the mascot for 1960s counterculture.” Widespread experimentation (recreational, but also scientific) was behind the passage of the Controlled Substances Act in 1970, which put psychedelics, cannabis, and heroin in Schedule I, placing those substances under the tightest federal restrictions. Not only would these substances be unavailable for public use, but their Schedule I designation of having no acceptable medical value meant that there could be no public health research conducted on them either.
This was a mistake, says Scientific American, which called for an end of the ban on the investigation of psychoactive drugs. With 14 million Americans who suffer from a variety of severe mental illnesses, the medical and scientific communities need innovative solutions and should not be shackled to the same ineffective antidepressants that were marketed in the 1950s.
5 To that point, a professor of neurobiology at the University of California, Berkeley, told Inverse that microdosing LSD is “absolutely” as safe as, or even safer than, taking regular antidepressants. David Presti said that the standard antidepressant regimen for depression is “awful”; microdosing, on the other hand, easily yields results that are much more positive.
Antidepressants, explains Presti, abound with known and unknown side effects, but are nonetheless exorbitantly expensive and aggressively marketed. Nonetheless, they have a generation’s worth of controlled, clinical trials that demonstrate their safety and effectiveness. Even so, the results they offer are mixed; selective serotonin reuptake inhibitors, for example, don’t work for a lot of people who have depression, but they are prescribed to 10 percent of Americans.6
On the other side of the equation, psychedelic drugs are comparably safer. There are no recorded or reported deaths as a direct result of LSD consumption. Even the bad trips (which can lead to people making risky, life-threatening decisions) stop when the drugs wear off. LSD appears to cause no long-term harm to the body or mind. Given that microdosing will expose users to only the smallest possible amount of the substance, Inverse suggests that “the risk of negative outcomes might be almost inconsequential.”7 Psychedelic mushrooms are “the safest recreational drug,” found the Global Drug Survey. Adam Winstock, the survey’s founder and a consultant addiction psychiatrist, said that the reduced threat “indicates a need for drug policy reform,” preferably one where psychedelics are not forced to share a controlled substances designation with heroin and GHB. Despite the Drug Enforcement Administration’s policy regarding psychedelics, there is little risk of abuse or psychological dependence on the substance, and they do not cause physical damage. “But,” clarified Winstock, “you need to know how to use them.”8
Psychedelic substances represent the “new thinking” that the mental health treatment community desperately needs, according to Scientific American, but draconian and outdated federal laws have stunted the work that pharmacologists can do. Researchers have to navigate a “daunting bureaucratic labyrinth” of approvals from regulators and hospital ethics committees, spending thousands of dollars in licensing fees, and tens of thousands of dollars to request drugs that are almost impossible to ethically and legally come by.
LSD appears to cause no long-term harm to the body or mind.
There is a precedent for using now-controversial drugs for scientific research; before the Controlled Substances Act, there were over a thousand publications that looked at how LSD could be a therapeutic aid for psychotherapists. MDMA, which is now thought of as a party drug and the main chemical ingredient in ecstasy, was touted as an accompaniment to talk therapy. Even marijuana, which has also been floated as a microdose drug to treat everything from depression to opioid use disorder, was historically used as a medication before it was lumped in with heroin when the Controlled Substances Act passed.
But thanks to the work by James Fadiman and others like him, there is renewed interest in whether LSD or psilocybin can help patients with cluster headaches or obsessive-compulsive disorder, or if MDMA can assist with post-traumatic stress disorder.
Psychologists and neuroscientists have suggested that certain receptors in the brain, which provide a landing zone for the chemical compounds in psychedelic drugs, might use the compounds to regulate conscious states that are imbalanced in patients who have depression or schizophrenia.
Given that there is still a danger of psychedelic drugs being abused, Scientific American argues that they should be moved down to Schedule II, with cocaine and methamphetamine. This will allow law enforcement to continue to track the movement of drugs that can cause serious problems, but will also give the scientific community the necessary access to determine whether or not such substances have any medicinal value at all. The alternative is the status quo, which has frozen any significant research on what could be a Pandora’s box of treatment for mental illness.
That idea has received support from people Ethan Nadelmann, the founder and executive director of the Drug Policy Alliance. Nadelmann has long campaigned for a reform of America’s drug laws, and he has been outspoken about the current status of psychedelics. Nadelmann posted that the time is coming when LSD is not merely decriminalized, but is made legally available to doctors and psychiatrists. He bases this on “the information that’s increasingly coming out about microdosing,” suggesting that the same kind of momentum that has made marijuana decriminalized and regulated in many states will soon come to psychedelics. The interest and coverage around LSD is giving the public a new perspective on what the drug actually is and what it can do; crucially, it is correcting many false assumptions that exist about the drug.
If the embargo on scientific studies is lifted, microdosing LSD could become like the normal prescription drug landscape. Some patients will find it useful, other patients will feel no significant effect. For some patients, microdoses of LSD will have to be temporary, and some other patients shouldn’t use it under any circumstances.
In 2017, psychedelic microdosing received two big boosts. Doctors in the United Kingdom received approval to use minute amounts of MDMA to treat alcohol addiction. The drug will be administered in conjunction with standard psychotherapy, and researchers will be looking closely at the experiment to see if MDMA will prove more effective at treating alcoholism than conventional treatments. Ben Sessa, the clinical psychiatrist on the trial told The Guardian that since MDMA has shown good results in helping people who have suffered trauma, he is optimistic that the drug will help alcoholics whose addiction is rooted in past trauma.9
The patients in the study are all heavy drinkers who relapsed into drinking after other forms of treatment proved ineffective at helping them stay clean. The plan is to put the patients through medical detoxification, then give them two standard therapy sessions without MDMA. Then, they will have an all-day session where they will be administered a capsule of MDMA. The session will also entail them talking to a therapist and time for meditation.
As an example of how difficult it was to set up the study, Sessa noted that he had originally budgeted £3,500 ($4,530) for 12g of MDMA, but the final cost was £62,000 ($80,123). Expensive as the drug is, the focus is on using the MDMA to “enhance the relationship between the therapist and the patient,” which will enable both to better identify the problems behind the long-term mental illness and the substance abuse that follows. The scientists conducting the trial, based at Imperial College London, will assess how safe the MDMA treatment is and deliver a preliminary indication as to whether the experiment has larger implications for mental health therapy.
Noting that other studies in the United Kingdom and the United States have yielded “remarkable” results in microdosing of psychedelics for patients with mental health illnesses, Sessa said the use of once-infamous drugs for therapeutic purposes was “careful, methodical [and] extremely rigorous science.” However, not everyone in Britain’s medical community is on board with the idea. A senior clinical lecturer at King’s College London’s National Addiction Center preferred that established, frontline addiction treatment services get attention and funding. While granting that “psychedelics are fascinating substances” with much to be learned about (and from) them, Ed Day stressed that the hype around microdosing may prove to be a distraction from the tangible problems facing the country’s substance abuse treatment services.
A month after Ben Sessa received clearance to begin his trials, the Food and Drug Administration in the United States granted “breakthrough therapy designation” to MDMA for the specific purposes of treating post-traumatic stress disorder. Limited clinical trials conducted over a number of years have shown that MDMA offers notable relief for PTSD patients, and after persistent lobbying by the Multidisciplinary Association for Psychedelic Studies, the FDA decided to open a door to more research.10
MAPS explained that the breakthrough therapy designation means that the FDA agrees that microdosing MDMA “may have a meaningful advantage […] over available medications for PTSD.” It also indicates that the FDA intends to give microdosing treatment greater priority than other therapies in the pipeline.
MDMA has proven useful in the treatment of post-traumatic stress disorder because of its empathogenic effects (how it prompts the increased release of serotonin, dopamine, and norepinephrine), which make users feel increasingly empathetic and prosocial to those around them.11 This is what makes MDMA popular in nightclubs and what contributes to the drug’s recreational abuse.12
From a therapeutic standpoint, the empathogenic properties of MDMA have been speculated to be of use in treatment for people who cannot feel appropriately connected to those around them, which is common in cases of schizophrenia, autism, or antisocial personality disorder. The release of the three neurotransmitters induced by MDMA causes strong feelings of happiness and comfort. When it comes to PTSD, this is not treatment in and of itself, but it does make it easier to recall and process traumatic memories in a therapist’s office. If patients who have endured a painful experience in their past feel are asked to talk about what happened to them, their neurons that archive the memory work in much the same way as they did when the memory first formed; in effect, a patient asked to talk about a traumatic experience will re-experience the trauma.
MDMA, says Popular Science, can rewire the memory. The warm and positive sensations prevent the patient from experiencing the same pain when they have to deal with a traumatic memory. This allows them to talk about their experience with their therapist without feeling like they are going through their nightmare all over again. The sessions are more productive, allowing the therapist to better guide the patient through the treatment process.13
The restricted clinical trials on the use of MDMA as a therapeutic agent for the treatment of post-traumatic stress disorder found that 61 percent of the 107 participants in a MAPS experiment did not meet the criteria for PTSD two months after they received three sessions of MDMA-assisted psychotherapy. One year later, it was 68 percent.
61 percent of the 107 participants in a MAPS experiment did not meet the criteria for PTSD two months after they received three sessions of MDMA-assisted psychotherapy
The final stage of clinical trials will assess the efficacy and safety of using MDMA in a psychotherapy setting, with participants in the United States, Canada, and Israel. Science magazine notes that if MAPS is able to raise the necessary $25 million to conduct the study, the “decisive trial” could be completed as early as 2021.14
Summing up the journey of how an illegal nightclub drug of abuse “could become a promising pharmaceutical” speaks to the persistence of the researchers who refused to believe that psychedelics have no medical value. But for some people, like a neuropsychopharmacologist at Imperial London, MDMA being on the cusp of proving itself “is not a big scientific step,” if only because that fact has been obvious to the medical community for a generation. Instead, “it’s a huge step in acceptance.”
For some, it’s a step in the wrong direction. Richard A. Friedman, a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Weill Cornell Medical College, wrote in The New York Times that LSD microdosing is a fad, and a worrisome fad. For all the perceived health benefits, lysergic acid diethylamide is still an unregulated and powerful drug, and patients cannot have any reasonable knowledge about what or how much they are actually taking. Past studies and experiments that have cleared LSD of long-term damage have either been short-sighted or self-reported; clinical experience, on the other hand, has shown that “psychedelics can be behaviorally toxic” in their own way, distinct from the infamy of alcohol or cocaine. People who have genetic risk factors for psychological disorders could be placed in harm’s way with even a microdose’s worth of exposure to a hallucinogen because it is too easy to take too much.15
Ultimately, says Friedman, because all the data we have about psychedelics comes from anecdotal self-reporting and limited trials, no one fully knows how safe or effective they are. He grants that hallucinogens being Schedule 1 drugs limits the amount of research that can be conducted on them, but notes that “there are many trials of Schedule I drugs like THC and cannabinol,” the active chemical compounds in cannabis.
LSD would not be the first time that a potentially dangerous drug has been acclaimed for its purported medicinal effects. Friedman notes that both cocaine and heroin were widely promoted for their analgesic properties, which is why cocaine is still a Schedule II drug, and prescription drugs share chemical similarities with heroin.16 The country weathered a cocaine epidemic in the 1970s and 1980s, and it is grappling with an opioid crisis of unprecedented proportions. Friedman clarifies that psychedelic drugs aren’t the next cocaine or heroin, “but we can’t assume they are perfectly safe” on the basis that serious harm has not yet been discovered.
The time might come when microdosing psychedelics to treat mental illnesses might be the next big thing in medicine, but that should happen only after large, robust, placebo-controlled trials. “We’re not there yet,” says Friedman, but he is optimistic that microdosing might shed light on some of the mysteries of brain functioning.
But for many doctors, the time is now. CBS News spoke with three doctors, all of whom conducted their own private microdosing experiments on willing patients, some of whom are in the advanced stages of cancer and struggling with resultant depression, stress, and anxiety. There were no bad trips, and all of the patients reported “miraculous” sensations of positivity and improved wellbeing. Such reporting may not assuage the concerns of people like Richard Friedman, but the results were good enough for NYU Langone Medical Center and Johns Hopkins University to conduct their own clinical trials.17
Big Think notes that with the opioid epidemic in full flow across the country, the “psychedelic renaissance” might be well-timed. With the lessons learned about overprescribing addictive prescription drugs, “microdosing psychedelics may be the future of mental health and addiction remediation.” For a long time, that future looked very far away; for a new mold of doctors and their patients, it’s coming closer.18Research Articles