The relationships of classic psychedelic use with criminal behavior in the United States adult population

Exploring serotonergic psychedelics as a treatment for personality disorders

Both psychotherapeutic interventions and pharmacological agents have demonstrated limited efficacy in the treatment of personality disorders (PDs). Emerging evidence suggests that psychedelic therapy, already showing promise in treating various psychiatric conditions commonly comorbid with PDs, may exert therapeutic effects by promoting adaptive changes in personality. Thus, psychedelic therapy could hold potential for addressing core features of PDs through shared mechanisms of personality modulation. Although historical literature and observational studies suggest the potential clinical utility of psychedelics in treating PDs, rigorous research is lacking, and individuals with PDs are often excluded from modern psychedelic therapy trials. In the present review, we first discuss research on the effects of psychedelics in individuals with a PD through the conventional lens of the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR) categorical model. Next, using the dimensional DSM Alternative Model of Personality Disorders (DSM-AMPD) as a framework, we examine how psychedelics may affect self-functioning, interpersonal functioning, and pathological personality traits. We conclude by discussing the clinical relevance of psychedelic therapy as a treatment for personality pathology, including safety considerations, gaps and limitations, and recommendations for approaching psychedelic therapy within these more complex clinical populations.

Hemispheric annealing and lateralization under psychedelics (HEALS): A novel hypothesis of psychedelic action in the brain

Current models of psychedelic action in the brain propose changes along the dorsal-ventral and anterior-posterior axes but neglect to address the lateral axis. This article proposes a novel model of psychedelic action called HEALS (Hemispheric Annealing and Lateralization Under Psychedelics) which involves the reversal of the typical hierarchical relationship between the two hemispheres of the brain. In typical modes of consciousness, the hemispheres act in parallel process with the left predominating. Under psychedelics, as well as in other altered states of consciousness (ASCs), this hierarchy is reversed, with the right hemisphere released from inhibition by the left. In support of this model, the available neuroimaging evidence for lateralization under psychedelics is reviewed. Then, various cognitive and emotional changes observed under psychedelics are contrasted with those same functions in each hemisphere. These include attention; social and emotional intelligence; creativity and insight; and language. The article concludes with a review of laterality in other ASCs, such as meditative and trance states, and suggests that many phenomena associated with psychedelics, and other ASCs, might be explained by an atypical annealing between the hemispheres toward right hemisphere predominance.

An Occupational Perspective on Psychedelic Therapy: A Scoping Review

Background. Interest in the use of psychedelics for mental health therapy is burgeoning. Qualitative research methods are increasingly used to understand patient's experiences; however, there is a lack of literature that explores psychedelic use from an occupational perspective. Purpose. To conduct a scoping review of qualitative literature on the experiences of psychedelic use for the purpose of mental health therapy, through an occupational lens. Key Issues. Wilcock's occupational perspective of health was employed to analyze the use of psychedelics in mental health from an occupational perspective. Despite heterogeneous therapy contexts and substances used, patients reported comparable benefits regarding occupational engagement, such as increased mindfulness and autonomy in doing, a renewed sense of being, greater motivation to grow and become, and an improved sense of connection and belonging. Implications. This review demonstrates how psychedelic use in the context of mental health support can be experienced as a meaningful occupation and may contribute to overall health. In turn, this review highlights the utility of an occupational perspective for "non-sanctioned" or stigmatized occupations like psychedelic use, as well as the need for more research on psychedelic use from an occupational perspective. Using an occupational perspective of health can help to de-stigmatize psychedelic use as a meaningful occupation, rather than a deviant one, and shed light on how psychedelics may also positively impact one's participation in everyday life and overall health.

Religion, Psychedelics, Risky Behavior, and Violence

Research has found that psychedelic use is associated with positive behavioral changes, however research has yet to explore the relationship between socio-cultural conditions on this relationship. This paper intends to fill this gap by testing the effects of religious participation and beliefs on the relationship between psychedelic use and behaviors. This study examines the relationship between Lifetime Classic Psychedelic Use (LCPU), different aspects of religion (such as salience and attendance), and the likelihood of committing a violent assault. The analysis uses pooled data from the National Survey of Drug Use and Health (NSDUH) from 2015 to 2019, with a sample size of 282,768. Binary logistic regression models conducted in Stata 17 reveal that LCPU and religion (salience and influence) are independently associated with reduced violence. Additionally, two-way interactions indicate that the association between risky behavior and violence is smaller among individuals with high levels of religious salience. Furthermore, a three-way interaction suggests that the association between risky behavior and violence is smaller for those who have used psychedelics, with the largest effect observed among individuals with high religious salience. These results show that religious factors can influence the relationship between psychedelic use and behaviors, with both attendance and salience operating simultaneously.

Diminished psychedelic returns on distress: Marital status and household size

Although the use of psychedelics to impact health has seen growth, little research has tested the effects of culture conditions on the relationship. More specifically, how does marital status and family size affect the relationship between psychedelics and health? This study tests the relationship between Lifetime Classic Psychedelic Use (LCPU), marital status, and household size (number of people living in a household) on levels of psychological distress in the past 30 days. This project uses pooled data from the National Survey of Drug Use and Health (NSDUH) (2010 to 2018) (N = 674,521). The Final sample size is determined by the dependent variable, psychological distress in the past month (n = 158,633). The analysis includes a series of nested logistic regression models conducted in Stata 17. Results indicate that LCPU is independently associated with better health, but the association between LCPU and health varies across levels of household size. Larger households are associated with higher levels of distress, which are then exacerbated among psychedelics users. Furthermore, three-way interactions reveal that the negative association between household size and distress gets larger among psychedelic users who are married, divorced, and widowed. Overall, results suggest that household size negatively impacts the association between LCPU and health, with those who are married, divorced, and widowed experiencing the worst outcomes.

Psychedelic Microdosing among Young Adults from Southern California

Despite common depictions in the media, there is little scientific evidence on microdosing psychedelic drugs. We assessed awareness, prevalence, and dosing practices of microdosing psychedelic drugs among young adults 18-22 years old from Southern California (2018-2019). We examined whether sociodemographic factors, personality traits, mental health, or other substance use behaviors were correlated with having ever microdosed. Among 2,396 participants, 293 (12%) had heard of microdosing and 74 (3%) ever microdosed. Among those who had heard of microdosing, 79% correctly defined microdosing as taking an amount of a psychedelic much lower than a standard dose, whereas 15% misperceived microdosing as a standard psychedelic dose. Psilocybin was the most common drug ever microdosed (70%), followed by lysergic acid diethylamide (LSD, 57%). Among those who ever microdosed, ~18% reported using psychoactive doses far higher than would be generally considered a microdose. White race, male/masculine gender identity, bisexual identity, past 6-month other drug use, greater attention deficit/hyperactivity disorder symptoms, mindfulness, and sensation-seeking were positively associated with having ever microdosed in multivariable models. Young adult microdosing merits further attention from scientific and public health professionals to help prevent misperceptions and potential adverse consequences as well as explore its potential therapeutic applications.

Aggressive behaviours associated with MDMA and psychedelics: a narrative review

OBJECTIVE

Monoamine neurotransmitters play a role in aggression, especially when altered by illicit substances. However, some literature suggests that not all illicit substances may lead to aggression, notably psychedelics. This narrative review investigates the associations between serotonergic psychedelics and MDMA on aggressive behaviour.

METHODS

PubMed and PsycINFO were searched for original, peer-reviewed articles evaluating the effects of serotonergic psychedelics and 3,4-methyl enedioxy methamphetamine (MDMA) on violent and aggressive behaviour using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

After removing duplicates, a total of 555 articles were screened, with 16 meeting the inclusion criteria. One additional article was obtained through reference screening bringing the total to 17 articles. Of these 17 articles, 14 studies focused on MDMA and three on serotonergic psychedelics. Findings were mixed, with some results demonstrating increased aggression following psychedelics and others suggesting protective effects. Limitations in the current literature include varied definitions of psychedelics, lack of standardised objective outcome measures and failure to control for confounding.

CONCLUSION

As psychedelic research continues to expand, further assessment on the effects of serotonergic psychedelics and MDMA on aggressive behaviour is required.

Epidemiology of classic psychedelic substances: results from a Norwegian internet convenience sample

Objective

In recent years, there has been a renewed interest in investigating the use of classic psychedelics such as psilocybin and lysergic acid diethylamide (LSD) in the treatment of mental disorders and substance use disorders. However, knowledge about the epidemiology of classic psychedelics in the Nordic countries is limited.

Methods

We recruited adult, Norwegian participants who have had a memorable experience after taking a classic psychedelic substance. They filled in an anonymous internet survey with 119 items covering matters related to recreational use of psychedelics using a secure, web-based application. Data are presented by using descriptive statistics (frequencies, means, and standard deviations).

Results

We recruited 841 participants, 770 (72% male; 88% 45 years or younger) of which were included in the data analysis. The intentions behind taking the psychedelic substance were mainly recreational (46.1%) or therapeutic (42.3%). Most participants reported that their most memorable experience was with psilocybin. As in modern era clinical trials, most participants were well-prepared before, did processing during, and did integration work after the experience, whereas only a minority were supported by a therapist. Self-perceived symptoms of various mental disorders and substance use disorders were prevalent in the sample. Most subjects reported improvements in their condition. Although adverse reactions were usually mild and short-lived, 4.2% lasted for 1 year or more. Persisting flashbacks were present for a year or more among 2.9% of the participants.

Conclusion

In this cross-sectional sample of Norwegian, self-selecting adults, we shed light on what characterizes the most memorable experience with a classic psychedelic substance, including short- and long-term risks and benefits. For the most part, the psychedelic experience led to improvements in self-perceived symptoms of mental disorders and substance use disorders. However, a small subset experienced persisting adverse reactions.

Longitudinal and transcultural assessment of the relationship between hallucinogens, well-being, and post-traumatic growth during the COVID-19 pandemic

The COVID-19 pandemic has had a devastating impact on the health and wellbeing of the global population. This paper presents the results of a longitudinal transcultural study that was begun at the peak of the pandemic (in April, 2020). An online survey was used to collect data from English-, Spanish-, and Portuguese-speaking participants. The survey collected information about sociodemographics, lifestyle activities, COVID-19-related circumstances, and drug use (with an emphasis on hallucinogenic drugs), as well as involving psychometric questionnaires. Users of hallucinogenic drugs had higher psychological well-being and lower scores on psychopathology scales, both at baseline and during follow-ups. This difference was larger when users were distinguished by frequency of use, as regular users scored higher on psychological well-being and lower on psychopathology scales. Subjects with more psychological distress had lower scores for all scales of post-traumatic growth, but if they were regular hallucinogens users, they had higher scores for post-traumatic growth. When comparing the results between cultural contexts, heterogeneous results were obtained. There were more English-speaking regular users of hallucinogenic drugs. Further research should analyse the potential role of hallucinogens in large-scale catastrophes, with a special focus on post-traumatic growth.

Race and ethnicity moderate the associations between lifetime psilocybin use and crime arrests

Introduction

Psilocybin use has been linked to lowered odds of crime-related outcomes across a host of observational studies. No studies have investigated how these associations may differ among those of different races and ethnicities.

Methods

Using a nationally-representative sample of 734,061 adults from the National Survey on Drug Use and Health (2002-2020), we investigated whether race and ethnicity moderate the associations between lifetime psilocybin use and four measures of crime arrests (property crime, assault, serious violence, and miscellaneous crimes).

Results

First, we replicated prior findings and demonstrated that psilocybin confers lowered odds of crime arrests for all four outcomes in question. Second, we demonstrated that race and ethnicity moderate the associations between lifetime psilocybin use and crime arrests for three of our four outcomes. Third, we examined the associations between psilocybin and crime arrests across different races and ethnicities (White, Black, Indigenous, Asian, Multiracial, and Hispanic participants). Psilocybin conferred lowered odds of at least one crime arrest outcome for all racial and ethnic groups except for Black and Hispanic participants.

Discussion

Future investigations should take an intersectional approach to studying the interrelationship of sociodemographic factors, psychedelic use, and crime, examine the structural factors (i.e., systemic racism) that may underlie these results, and investigate whether psychedelics can alleviate mental health disorders that contribute to cycles of recriminalization for communities of color.

Psychedelics and workplace harm

This study aims to understand the relationship between Lifetime Classic Psychedelic Use (LCPU), employment status, and weekly work hours on levels of psychological distress. The data used for this analysis is pooled from the National Survey of Drug Use and Health (NSDUH) from 2008-2019 and includes a sample size of 484,732 individuals. The findings suggest that LCPU and being employed are independently associated with better health. Additionally, the results indicate that psychedelic use is associated with lower distress for those who are employed, volunteer, retired, or permanently disabled. However, those who are unemployed, full-time students, or homemakers may experience higher levels of distress with psychedelic use. Interestingly, the analysis also suggests that those who use psychedelics are working longer hours per week before experiencing an increase in stress. Overall, the study suggests that psychedelics are not likely to have a negative impact on employment outcomes.

Hallucinations and Hallucinogens: Psychopathology or Wisdom?

Hallucinations are currently associated almost exclusively with psychopathological states. While it is evident that hallucinations can indicate psychopathology or neurological disorders, we should remember that hallucinations also commonly occur in people without any signs of psychopathology. A similar case occurs in the case of hallucinogenic drugs, which have been long associated with psychopathology and insanity. However, during the last decades a huge body of research has shown that certain kinds of hallucinations, exerted by hallucinogenic drugs, may serve to improve mental health. We propose that, in light of historical, epidemiological, and scientific research, hallucinations can be better characterized as a common phenomenon associated sometimes with psychopathology but also with functional and even beneficial outcomes. In the last sections of the manuscript, we extend our argument, suggesting that hallucinations can offer a via regia to knowledge of the mind and the world. This radical shift in the cultural interpretation of hallucinations could have several implications for fields such as drug policy, civil law, and psychiatry, as well as for the stigma associated with mental disorders.

Race and ethnicity moderate the associations between lifetime psychedelic use (MDMA/ecstasy and psilocybin) and major depressive episodes

BACKGROUND

Psychedelics are receiving renewed attention within Western medicine as they represent potential treatments for many difficult-to-treat mental health disorders. However, psychedelic science is limited in its focus and inclusion of racial and ethnic minorities. Hence, this study examines whether race and ethnicity moderate the associations that naturalistic 3,4-methylenedioxymethamphetamine (MDMA)/ecstasy use and psilocybin use share with major depressive episodes (MDEs).

METHOD

Data for this project are from The National Survey on Drug Use and Health (2005-2019). Participants were adults aged 18 years and older (unweighted N = 596,187). This study used multivariable logistic regression to test the interaction between race and ethnicity and MDMA/ecstasy use and psilocybin use for predicting lifetime, past year, and past year severe MDEs.

RESULTS

Race and ethnicity significantly moderated the associations between MDMA/ecstasy use and psilocybin use and MDEs. For White participants, MDMA/ecstasy use and psilocybin use each were associated with lowered odds of all three MDE outcomes (adjusted odds ratio (aOR) range: 0.82-0.92). For Hispanic participants, MDMA/ecstasy use and psilocybin use each conferred lowered odds of only a past year MDE (MDMA/ecstasy aOR: 0.82; psilocybin aOR: 0.79). For Non-Hispanic Racial Minority participants, MDMA/ecstasy and psilocybin use did not confer lowered odds of any MDE outcomes.

CONCLUSION

Race and ethnicity have an impact on the associations that psychedelics share with mental health outcomes. Future research should explore the impact of identity and discrimination on the effects of psychedelics and should explore whether these substances can serve as effective treatments for minorities when used in culturally informed contexts.

Ancient Roots of Today's Emerging Renaissance in Psychedelic Medicine

An international ban on psychedelics initiated by the United Nations' Convention on Psychotropic Substances in 1971 restricted the clinical use of these ancient psychoactive substances. Yet, in an era marked by rising mental health concerns and a growing "Deaths of Despair" epidemic (i.e., excess mortality and morbidity from suicide, drug overdose, and alcoholism), the structured psychedelic use that has long been a part of ritual healing experiences for human societies is slowly regaining credibility in Western medicine for its potential to treat various mental health conditions. We use a historical lens to examine the use of psychedelic therapies over time, translate ancient lessons to contemporary clinical and research practice, and interrogate the practical and ethical questions researchers must grapple with before they can enter mainstream medicine. Given the COVID-19 pandemic and its contributions to the global mental health burden, we also reflect on how psychedelic therapy might serve as a tool for medicine in the aftermath of collective trauma. Ultimately, it is argued that a "psychedelic renaissance" anchored in the lessons of antiquity can potentially help shift healthcare systems-and perhaps the broader society-towards practices that are more humane, attentive to underlying causes of distress, and supportive of human flourishing.

Psychedelics and Desistance From Crime: Lessons From the Concord Prison Experiment

Recent investigations of naturalistic psychedelic use purport that psychedelic therapies may be useful in criminal justice contexts for reducing recidivism. The present study applies interactionist theories of desistance to critically explore how psychedelic therapies could facilitate agentic self-transformation to support desistance from crime. Psychedelic experience reports written by inmates as part of the “Concord Prison Experiment” (CPE) were collected from the New York Public Library. Reports from 29 participants were then analyzed using a qualitative content analysis that employed both conventional and directed approaches. Participants frequently reported on changes in emotion and sense perception, interactions with other participants, and self-knowledge. Reports of self-knowledge often emerged from cognitive shifts that led to reflexive thought and novel insights regarding crime and criminality. These findings demonstrate how psychedelics can facilitate cognitive shifts in meaning conducive to inspiring desistance from crime. However, shortcomings of the CPE indicate that the social environment can hinder integration, by constraining the potential to enact changes in one’s life or realize meaningful insights through prosocial relationships. The combination of potentially harmful prison environments and the vulnerable states of consciousness generated by psychedelics should preclude investigations among actively incarcerated participants. Without addressing common social and structural barriers to successful reentry such as housing and employment, the efficacy of psychedelic-assisted therapy as a recidivism reducing intervention will be limited. Alternative approaches might explore how psychedelic therapy can address the psychological impacts of incarceration.

Race and ethnicity moderate the associations between lifetime psychedelic use (MDMA and psilocybin) and psychological distress and suicidality

Psychedelic compounds have been linked to salutary mental health outcomes in both naturalistic and clinical settings; however, current research on psychedelics suffers from a lack of inclusion and focus on racial and ethnic minorities. Thus, the goal of our study was to assess whether race and ethnicity moderate the associations that naturalistic lifetime MDMA (3,4-Methylenedioxymethamphetamine) use and psilocybin use share with past month psychological distress and past year suicidality (ideation and planning). Using data from the National Survey on Drug Use and Health (NSDUH) (2008-2019) (N = 484,732), we conducted survey-weighted multivariable logistic regression to conduct interaction tests and to assess the associations that MDMA use and psilocybin use share with the aforementioned outcomes for each racial and ethnic group. Race and ethnicity significantly moderated the associations between MDMA and psilocybin use and psychological distress and suicidality. For White participants, MDMA and psilocybin use conferred lowered odds of all distress and suicidality outcomes. For racial and ethnic minority participants, the associations between psychedelic use and suicidality were far fewer. These findings invite further research into the impact of race, ethnicity, and other identity factors (e.g., socioeconomic status, sexual/gender minority status) on the effects of psychedelic substances.

Self-Entropic Broadening Theory: Toward a New Understanding of Self and Behavior Change Informed by Psychedelics and Psychosis

The extremes of human experiences, such as those occasioned by classic psychedelics and psychosis, provide a rich contrast for understanding how components of these experiences impact well-being. In recent years, research has suggested that classic psychedelics display the potential to promote positive enduring psychologic and behavioral changes in clinical and nonclinical populations. Paradoxically, classic psychedelics have been described as psychotomimetics. This review offers a putative solution to this paradox by providing a theory of how classic psychedelics often facilitate persistent increases in well-being, whereas psychosis leads down a "darker" path. This will be done by providing an overview of the overlap between the states (i.e., entropic processing) and their core differences (i.e., self-focus). In brief, entropic processing can be defined as an enhanced overall attentional scope and decreased predictability in processing stimuli facilitating a hyperassociative style of thinking. However, the outcomes of entropic states vary depending on level of self-focus, or the degree to which the associations and information being processed are evaluated in a self-referential manner. We also describe potential points of overlap with less extreme experiences, such as creative thinking and positive emotion-induction. Self-entropic broadening theory offers a heuristically valuable perspective on classic psychedelics and their lasting effects and relation to other states by creating a novel synthesis of contemporary theories in psychology. SIGNIFICANCE STATEMENT: Self-entropic broadening theory provides a novel theory examining the psychedelic-psychotomimetic paradox, or how classic psychedelics can be therapeutic, yet mimic symptoms of psychosis. It also posits a framework for understanding the transdiagnostic applicability of classic psychedelics. We hope this model invigorates the field to provide more rigorous comparisons between classic psychedelic-induced states and psychosis and further examinations of how classic psychedelics facilitate long-term change. As a more psychedelic future of psychiatry appears imminent, a model that addresses these long-standing questions is crucial.

Associations between MDMA/ecstasy use and physical health in a U.S. population-based survey sample

INTRODUCTION

3,4-Methylenedioxymethamphetamine (MDMA/"ecstasy") is an empathogen that can give rise to increased pleasure and empathy and may effectively treat post-traumatic stress disorder. Although prior research has demonstrated associations between ecstasy use and favorable mental health outcomes, the associations between ecstasy and physical health have largely been unexplored. Thus, the goal of this study was to examine the associations between ecstasy use and physical health in a population-based survey sample.

METHOD

This study utilized data from the National Survey on Drug Use and Health (2005-2018), a yearly survey that collects information on substance use and health outcomes in a nationally representative sample of U.S. adults. We used multinomial, ordered, and logistic regression models to test the associations between lifetime ecstasy use and various markers of physical health (self-reported body mass index, overall health, past year heart condition and/or cancer, past year heart disease, past year hypertension, and past year diabetes), controlling for a range of potential confounders.

RESULTS

Lifetime ecstasy use was associated with significantly lower risk of self-reported overweightness and obesity (adjusted relative risk ratio range: 0.55-0.88) and lower odds of self-reported past year heart condition and/or cancer (adjusted odds ratio (aOR): 0.67), hypertension (aOR: 0.85), and diabetes (aOR: 0.58). Ecstasy use was also associated with significantly higher odds of better self-reported overall health (aOR: 1.18).

CONCLUSION

Ecstasy shares protective associations with various physical health markers. Future longitudinal studies and clinical trials are needed to more rigorously test these associations.

Macrodosing to microdosing with psychedelics: Clinical, social, and cultural perspectives

To date, the clinical and scientific literature has best documented the effects of classical psychedelics, such as lysergic acid diethylamide (LSD), psilocybin, and dimethyltryptamine (DMT), in typical quantities most often associated with macrodosing. More recently, however, microdosing with psychedelics has emerged as a social trend and nascent therapeutic intervention. This variation in psychedelic practice refers to repeat, intermittent ingestion of less-than-macrodose amounts that do not cause the effects associated with full-blown "trips". Microdosing paves the road to incorporating psychedelic drugs into a daily routine while maintaining, or even improving, cognitive and mental function. Unlike macrodosing with psychedelics, the influence of microdosing remains mostly unexplored. And yet, despite the paucity of formal studies, many informal accounts propose that microdosing plays an important role as both a therapeutic intervention (e.g., in mental disorders) and enhancement tool (e.g., recreationally-to boost creativity, improve cognition, and drive personal growth). In response to this relatively new practice, we provide an integrative synthesis of the clinical, social, and cultural dimensions of microdosing. We describe some of the overarching context that explains why this practice is increasingly in vogue, unpack potential benefits and risks, and comment on sociocultural implications. In addition, this article considers the effects that macro- and microdoses have on behavior and psychopathology in light of their dosage characteristics and contexts of use.

Association between Lifetime Classic Psychedelic Use and Sick Leave in a Population-Based Sample

OBJECTIVES

Absenteeism from work due to illness, and related costs, has increased steadily during the past decades. In recent years, there has been a reemergence of research on the therapeutic effects of classic psychedelics showing associations with both physical and mental health. However, the association between classic psychedelics and sick leave remains unknown. The aim of this study is to investigate the association between lifetime classic psychedelic use and sick leave in the past 30 days among adults in the United States (N = 407,717), using data from the National Survey on Drug Use and Health (2005-2019), weighted to be representative of the US adult population.

METHODS

The primary analysis was conducted using multiple linear regression, controlling for sociodemographic characteristics, risky behavior, and use of other substances.

RESULTS

There was a significant and negative association between lifetime classic psychedelic use and sick leave in the past 30 days (B = -0.09, p < 0.01) when adjusting for all control variables.

CONCLUSION

These findings suggest that classic psychedelics could potentially lead to reduced sick leave and associated costs in the general population, but more research is needed to investigate potential causal pathways of classic psychedelics on sick leave and evaluate possible mechanisms.

Psychedelic drug abuse potential assessment research for new drug applications and Controlled Substances Act scheduling

New medicines containing classic hallucinogenic and entactogenic psychedelic substance are under development for various psychiatric and neurological disorders. Many of these, including psilocybin, lysergic acid diethylamide (LSD), and 3,4-methylenedioxymethamphetamine (MDMA) are Schedule I controlled substances of the United States Controlled Substances Act (US CSA), and similarly controlled globally. The implications of the CSA for research and medicines development, the path to approval of medicines, and their subsequent removal from Schedule I in the US are discussed. This entire process occurs within the framework of the CSA in the US and its counterparts internationally in accordance with international drug control treaties. Abuse potential related research in the US informs the eight factors of the CSA which provide the basis for rescheduling actions that must occur upon approval of a drug that contains a Schedule I substance. Abuse-related research also informs drug product labeling and the risk evaluation and mitigation strategies (REMS) will likely be required for approved medicines. Human abuse potential studies typically employed in CNS drug development may be problematic for substances with strong hallucinogenic effects such as psilocybin, and alternative strategies are discussed. Implications for research, medicinal development, and controlled substance scheduling are presented in the context of the US CSA and FDA requirements with implications for global regulation. We also discuss how abuse-related research can contribute to understanding mechanisms of action and therapeutic effects as well as the totality of the effects of the drugs on the brain, behavior, mood, and the constructs of spirituality and consciousness.

Psychedelics in the treatment of unipolar and bipolar depression

This is a narrative review about the role of classic and two atypical psychedelics in the treatment of unipolar and bipolar depression. Since the 1990s, psychedelics experience a renaissance in biomedical research. The so-called classic psychedelics include lysergic acid diethylamide (LSD), psilocybin, mescaline and ayahuasca. Characteristic effects like alterations in sensory perception, as well as emotion- and self-processing are induced by stimulation of serotonin 2A receptors in cortical areas. The new paradigm of psychedelic-assisted psychotherapy suggests a therapeutic framework in which a safely conducted psychedelic experience is integrated into a continuous psychotherapeutic process. First randomized, controlled trials with psilocybin show promising efficacy, tolerability, and adherence in the treatment of unipolar depression. On the other hand, classic psychedelics seem to be associated with the induction of mania, which is an important issue to consider for the design of research and clinical protocols. So called atypical psychedelics are a heterogeneous group with overlapping subjective effects but different neurobiological mechanisms. Two examples of therapeutic value in psychiatry are 3,4-methyl​enedioxy​methamphetamine (MDMA) and ketamine. Since 2020 the ketamine enantiomer esketamine has been granted international approval for treatment-resistant unipolar depression, and also first evidence exists for the therapeutic efficacy of ketamine in bipolar depression. Whether psychedelics will fulfil current expectations and find their way into broader clinical use will depend on future rigorous clinical trials with larger sample sizes. A well-considered therapeutic and legal framework will be crucial for these substances to create new treatment settings and a potential paradigm shift.

Exploring protective associations between the use of classic psychedelics and cocaine use disorder: a population-based survey study

Cocaine Use Disorder (CUD) is a significant public health problem associated with elevated morbidity and mortality within the United States. Current behavioral treatments have limited efficacy and there are currently no FDA approved pharmacological treatments for CUD. Classic psychedelics might be associated with lowered odds of substance misuse and may effectively treat various forms of addiction. Thus, the goal of this study is to assess protective associations that lifetime use of classic psychedelics may share with CUD within a nationally representative sample of the U.S. We used data from The National Survey on Drug Use and Health (NSDUH) (2015–2019) and conducted survey-weighted multivariable logistic regression to test whether each of four classic psychedelics (peyote, mescaline, psilocybin, LSD) conferred lowered odds of CUD and its related 11 sub-criteria. Participants were 214,505 adults in the NSDUH (2015–2019) aged 18 and older. Peyote conferred lowered odds of CUD, reducing the odds of CUD by over 50% (aOR: 0.47). All other substances (including other classic psychedelics) either shared no association to CUD or conferred increased odds of CUD. Furthermore, sensitivity analyses revealed peyote to confer sharply lowered odds of the majority (seven of 11) of CUD criteria as well (aOR range: 0.26–0.47). Peyote use is associated with lowered odds of CUD. Future inquiries into third variable factors (i.e., demographic/personality profiles of individuals who use peyote, motivational/contextual factors surrounding peyote use) that may underlie our observed associations may reveal protective factors that can inform treatment development for CUD. Additionally, future longitudinal studies can shed further light on whether there is a temporal link between peyote use and lowered odds of CUD.

Lifetime use of MDMA/ecstasy and psilocybin is associated with reduced odds of major depressive episodes

BACKGROUND

Depression is a major mental health issue worldwide, with high rates of chronicity and non-recovery associated with the condition. Existing treatments such as antidepressant medication and psychological treatments have modest effectiveness, suggesting the need for alternative interventions.

AIM

The aim of this study was to examine the relationships between MDMA (3,4-methylenedioxymethamphetamine)/ecstasy and psilocybin use and major depressive episodes (MDEs).

METHODS

This observational study used data from a large (N = 213,437) nationally representative sample of US adults to test the association of lifetime use of MDMA/ecstasy, psilocybin and other classic psychedelics (lysergic acid diethylamide (LSD), peyote, mescaline), other illegal substances (e.g. cocaine, phencyclidine (PCP)), and legal/medicinal substances of misuse (e.g. pain relievers, tranquilizers) with lifetime, past year, and past year severe MDEs.

RESULTS

Results revealed that lifetime MDMA/ecstasy use was associated with significantly lowered odds of a lifetime MDE (adjusted odds ratio (aOR) = 0.84; p < 0.001), past year MDE (aOR = 0.84; p < 0.001), and past year severe MDE (aOR = 0.82; p < 0.001). Psilocybin was associated with significantly lowered odds of a past year MDE (aOR = 0.90; p < 0.05) and past year severe MDE (aOR = 0.87; p < 0.05). All other substances either shared no relationship with a MDE or conferred increased odds of an MDE.

CONCLUSIONS

These results suggest that MDMA/ecstasy and psilocybin use is associated with lower risk of depression. Experimental studies are needed to test whether there is a causal association between use of these compounds and the alleviation of depressive symptoms.

The economics of psychedelic-assisted therapies: A research agenda

After a long hiatus, psychiatry is undergoing a resurgence of interest in psychedelic drugs as therapy for a wide range of mental health disorders Accumulating clinical evidence suggests substantial potential for psychedelics used in a therapeutic context, as treatment for, among other disorders, depression, post-traumatic stress disorder (PTSD), and addictions to tobacco, opioids and alcohol. As soon as 2024, powerful new therapeutic modalities could become available for individuals with mental health problems refractory to traditional therapies. Yet research has lagged on economic considerations, such as costs and cost-effectiveness, the economic effects of widespread implementation, pricing, and economic appraisal's methodological considerations relevant to psychedelic therapies. These issues are critical if psychedelic therapies are to become widely accessible. We describe six types of economic analyses and their rationale for decisions and planning including the needs of health care payers. We also outline desirable features of this research, including scientific rigor, long horizons, equity, and a global view.

MDMA/ecstasy use and psilocybin use are associated with lowered odds of psychological distress and suicidal thoughts in a sample of US adults

BACKGROUND

Suicide is one of the leading causes of death worldwide and rates within the United States have risen over the past two decades. Hence, there is a critical need for novel tools to treat suicidal ideation and related mental health conditions. 3,4-Methylenedioxymethamphetamine (MDMA)/ecstasy and classic psychedelics may be two such tools.

AIMS

The aim of this study was to assess non-causal associations between MDMA/ecstasy and classic psychedelic use and psychological distress and suicide risk.

METHODS

In this study, we examined the aforementioned associations among 484,732 adult participants in the National Survey on Drug Use and Health (2008-2019).

RESULTS

Lifetime MDMA/ecstasy use was associated with reduced odds of past year suicidal thinking (10% reduced odds; odds ratio (OR) = 0.90; 95% confidence interval, CI = (0.84-0.97); p < 0.01) and past year suicidal planning (OR = 0.88; 95% CI = (0.78-0.99); p < 0.05). Furthermore, lifetime psilocybin use was associated with reduced odds of past month psychological distress (OR = 0.78; 95% CI = (0.73-0.84); p < 0.001) and past year suicidal thinking (OR = 0.90; 95% CI = (0.83-0.96); p < 0.01). Finally, lysergic acid diethylamide (LSD) was associated with increased odds of past year suicidal thinking (OR = 1.07; 95% CI = (1.00-1.15); p < 0.05).

CONCLUSION

MDMA/ecstasy and psilocybin use are associated with reduced odds of suicidal thinking and related outcomes-though experimental studies are needed to determine whether these associations are causal. These findings call for more research into the efficacy of MDMA/ecstasy and classic psychedelics for treating psychological distress and suicidal thoughts and behaviors, and for updated drug legislation that allows for further investigation into these substances.

Psilocybin use is associated with lowered odds of crime arrests in US adults: A replication and extension

BACKGROUND

The United States boasts the largest prison population in the world, conferring significant direct and indirect costs (e.g. lost wages for the incarcerated, increased morbidity/mortality, etc.) to society. Recidivism rates are high for the imprisoned and most interventions to reduce criminality are minimally effective. Thus, in addition to the need for criminal justice reform, there is a need to better understand factors linked to lowered criminal behavior.

AIM

The aim of this study was to assess the relationships between the use of classic psychedelic substances (psilocybin, LSD, peyote, and mescaline) and past year arrests for various crimes (i.e. property, violence, alcohol and substance use, miscellaneous crimes).

METHODS

This study used nationally representative data from The National Survey on Drug Use and Health (NSDUH) (2015-2019) (N = 211,549) to test the aforementioned associations.

RESULTS

Lifetime psilocybin use was associated with lowered odds of seven of 11 past year arrest variables (adjusted odds ratio (aOR) range = 0.30-0.73). Peyote was associated with reduced odds of motor vehicle theft (aOR = 0.30) and driving under the influence (aOR = 0.52), and mescaline was associated with reduced odds of drug possession/sale (aOR = 0.51). Virtually all other substances either shared no relationship to our outcomes or conferred higher odds of arrest.

CONCLUSION

This study suggests that use of classic psychedelic substances is associated with lowered odds of crime arrests. Future research should explore whether causal factors and/or third variable factors (e.g. personality, political orientation) underlie the relationship between classic psychedelic use and reduced criminal behavior.

New Insights Into the Clinical and Nonclinical Effects of Psychedelic Substances

Abstract. After decades of stagnation, research on psychedelic substances (such as lysergic acid diethylamide [LSD], psilocybin, or N,N-dimethyltryptamine [DMT]) has experienced a renaissance over the last 10 years, with various major research programs being conducted across Europe and the United States. This research primarily investigates the potential of psychedelics in the treatment of mental health disorders, their short- and long-term effects on recreational users, and the neurological and cognitive processes responsible for their effects. The present review provides a concise summary of the most recent insights gained from this research. We briefly outline the history of psychedelic research, the objective and subjective effects caused by these substances, the prevalence and socio-psychological correlates of their use, as well as their potential for harm. Subsequently, we review empirical research on the beneficial effects of psychedelics in clinical samples, focusing on their efficacy in the treatment of major depression, anxiety, and substance use disorders, and discuss research on the proposed neural and cognitive mechanisms behind these effects. We then review research on their effects on healthy subjects, focusing on psychological well-being as well as changes in personality, nature-relatedness, and creativity. Finally, we review empirical evidence regarding the long-term effects of single experiences with psychedelics and conclude with a summary and outlook.

Associations between lifetime classic psychedelic use and cardiometabolic diseases

The objective of the current study was to investigate the associations between lifetime classic psychedelic use and cardiometabolic diseases. Using data from the National Survey on Drug Use and Health (2005-2014), the present study examined the associations between lifetime classic psychedelic use and two types of cardiometabolic disease: heart disease and diabetes. Respondents who reported having tried a classic psychedelic at least once in their lifetime had lower odds of heart disease in the past year (adjusted odds ratio (aOR) = 0.77 (0.65-0.92), p = .006) and lower odds of diabetes in the past year (adjusted odds ratio (aOR) = 0.88 (0.78-0.99), p = .036). Classic psychedelic use might be beneficial for cardiometabolic health, but more research is needed to investigate potential causal pathways of classic psychedelics on cardiometabolic diseases.

LSD use in the United States: Trends, correlates, and a typology of us

BACKGROUND

Recent years have witnessed an increased interest in LSD. This study investigates current information on the trends and correlates of LSD use from years 2002-2018 and seeks to develop an initial typology of use and misuse.

METHODS

Data is taken from the NSDUH (National Survey on Drug Use and Health) collected between 2002 and 2018 and trends and correlates of LSD use were analyzed with a survey adjusted logistic regression.

RESULTS

Our findings indicate that LSD use has increased 200 % over the study period (.23 % 2002-2005 to .72 % 2015-2018, AOR = 1.10, 95 % CI = 1.08, 1.12). Our findings also indicate several correlates of LSD use including higher levels of education (college degrees: AOR = 1.62, 95 % CI = 1.23, 2.13), not being married (divorced or separated, AOR = 2.31, 95 % CI = 1.44, 3.73, and have never been married, AOR = 5.67, f 95 % CI = 4.09, 7.86), as well as higher levels of antisocial behavior (having been arrested AOR = 3.20, 95 % CI = 2.50, 4.09) and comorbid mental health and substance abuse disorders (serious psychological distress, AOR = 2.39, 95 % CI = 2.05, 2.80). Further, four distinct subclasses were also discovered within LSD users and two of these subtypes of LSD users contained comorbid mental health disturbances and heavy involvement in the criminal justice system.

CONCLUSION

LSD use has been on the rise within the last decades, particularly among those who are well educated. Two subclasses of LSD use (those with severe comorbid mental health disorders and those with criminal justice involvement) may require further interventions.

The Therapeutic Potential of Psilocybin

The psychedelic effects of some plants and fungi have been known and deliberately exploited by humans for thousands of years. Fungi, particularly mushrooms, are the principal source of naturally occurring psychedelics. The mushroom extract, psilocybin has historically been used as a psychedelic agent for religious and spiritual ceremonies, as well as a therapeutic option for neuropsychiatric conditions. Psychedelic use was largely associated with the "hippie" counterculture movement, which, in turn, resulted in a growing, and still lingering, negative stigmatization for psychedelics. As a result, in 1970, the U.S. government rescheduled psychedelics as Schedule 1 drugs, ultimately ending scientific research on psychedelics. This prohibition on psychedelic drug research significantly delayed advances in medical knowledge on the therapeutic uses of agents such as psilocybin. A 2004 pilot study from the University of California, Los Angeles, exploring the potential of psilocybin treatment in patients with advanced-stage cancer managed to reignite interest and significantly renewed efforts in psilocybin research, heralding a new age in exploration for psychedelic therapy. Since then, significant advances have been made in characterizing the chemical properties of psilocybin as well as its therapeutic uses. This review will explore the potential of psilocybin in the treatment of neuropsychiatry-related conditions, examining recent advances as well as current research. This is not a systematic review.

Associations between lifetime classic psychedelic use and markers of physical health

BACKGROUND

In recent years, there has been significant research on the mental health effects of classic psychedelic use, but there is very little evidence on how classic psychedelics might influence physical health.

AIMS

The purpose of the present study was to investigate the associations between lifetime classic psychedelic use and markers of physical health.

METHODS

Using data from the National Survey on Drug Use and Health (2015-2018) with 171,766 (unweighted) adults aged 18 or above in the United States, the current study examined the associations between lifetime classic psychedelic use and three markers of physical health (self-reported overall health, body mass index, and heart condition and/or cancer in the past 12 months) while controlling for a range of covariates.

RESULTS

Respondents who reported having tried a classic psychedelic at least once in their lifetime had significantly higher odds of greater self-reported overall health and significantly lower odds of being overweight or obese versus having a normal weight. The association between lifetime classic psychedelic use and having a heart condition and/or cancer in the past 12 months approached conventional levels of significance, with lower odds of having a heart condition and/or cancer in the past 12 months for respondents who had tried a classic psychedelic at least once.

CONCLUSION

The results of the present study suggest that classic psychedelics may be beneficial to physical health. Future research should investigate the causal effects of classic psychedelics on physical health and evaluate possible mechanisms.

Association Between Lifetime Classic Psychedelic Use and Hypertension in the Past Year

[Figure: see text].

Violence and mental disorders: a structured review of associations by individual diagnoses, risk factors, and risk assessment

In this Review, we summarise evidence on the association between different mental disorders and violence, with emphasis on high quality designs and replicated findings. Relative risks are typically increased for all violent outcomes in most diagnosed psychiatric disorders compared with people without psychiatric disorders, with increased odds in the range of 2-4 after adjustment for familial and other sources of confounding. Absolute rates of violent crime over 5-10 years are typically below 5% in people with mental illness (excluding personality disorders, schizophrenia, and substance misuse), which increases to 6-10% in personality disorders and schizophrenia spectrum disorders, and to more than 10% in substance misuse. Past criminality and comorbid substance misuse are strongly predictive of future violence in many individual disorders. We reviewed national clinical practice guidelines, which vary in content and require updating to reflect the present epidemiological evidence. Standardised and clinically feasible approaches to the assessment and management of violence risk in general psychiatric settings need to be developed.

Psilocybin occasioned mystical-type experiences

OBJECTIVE

Research into psychedelic therapy models has shown promise for the treatment of specific psychiatric conditions. Mystical-type experiences occasioned by psilocybin have been correlated with therapeutic benefits and long-term improvements in positive mental outlook and attitudes. This article aims to provide an overview of the topic, highlight strengths and weaknesses in current research, generate novel perspectives and discussion, and consider future avenues for research.

DESIGN

This narrative review was designed to summarise and assess the state of research on psilocybin occasioned mystical-type experiences and applications for the treatment of specific psychiatric conditions.

RESULTS

Contemporary methods on the quantification of mystical-type experiences and their acute subjective effects are discussed. Recent studies provide some understanding of the pharmacological actions of psychedelics although the neurological similarities and differences between spontaneous and psychedelic mystical-type experiences are not well described. Applicability to modern clinical settings is assessed. Potential novel therapeutic applications include use in positive psychology interventions in healthy individuals.

CONCLUSIONS

Since 2006 significant advancements in understanding the therapeutic potential of psilocybin-assisted psychotherapy have been made; however, more work is required to understand the neuromechanistic processes and applicability in modern clinical settings. Despite promising results in recent studies, funding issues for clinical trials, legal concerns and socio-cultural resistance provide a counterpoint to experimental evidence.

Risk factors for recidivism in individuals receiving community sentences: a systematic review and meta-analysis

OBJECTIVE

We aimed to systematically review risk factors for criminal recidivism in individuals given community sentences.

METHODS

We searched seven bibliographic databases and additionally conducted targeted searches for studies that investigated risk factors for any repeat offending in individuals who had received community (non-custodial) sentences. We included investigations that reported data on at least one risk factor and allowed calculations of odds ratios (ORs). If a similar risk factor was reported in three or more primary studies, they were grouped into domains, and pooled ORs were calculated.

RESULTS

We identified 15 studies from 5 countries, which reported data on 14 independent samples and 246,608 individuals. We found that several dynamic (modifiable) risk factors were associated with criminal recidivism in community-sentenced populations, including mental health needs (OR = 1.4, 95% confidence interval (CI): 1.2-1.6), substance misuse (OR = 2.3, 95% CI: 1.1-4.9), association with antisocial peers (OR = 2.2, 95% CI: 1.3-3.7), employment problems (OR = 1.8, 95% CI: 1.3-2.5), marital status (OR = 1.6, 95%: 1.4-1.8), and low income (OR = 2.0, 95% CI: 1.1-3.4). The strength of these associations was comparable to that of static (non-modifiable) risk factors, such as age, gender, and criminal history.

CONCLUSION

Assessing dynamic (modifiable) risk factors should be considered in all individuals given community sentences. The further integration of mental health, substance misuse, and criminal justice services may reduce reoffending risk in community-sentenced populations.

Transformative experience and social connectedness mediate the mood-enhancing effects of psychedelic use in naturalistic settings

Past research suggests that use of psychedelic substances such as LSD or psilocybin may have positive effects on mood and feelings of social connectedness. These psychological effects are thought to be highly sensitive to context, but robust and direct evidence for them in a naturalistic setting is scarce. In a series of field studies involving over 1,200 participants across six multiday mass gatherings in the United States and the United Kingdom, we investigated the effects of psychedelic substance use on transformative experience, social connectedness, and positive mood. This approach allowed us to test preregistered hypotheses with high ecological validity and statistical precision. Controlling for a host of demographic variables and the use of other psychoactive substances, we found that psychedelic substance use was significantly associated with positive mood-an effect sequentially mediated by self-reported transformative experience and increased social connectedness. These effects were particularly pronounced for those who had taken psychedelic substances within the last 24 h (compared to the last week). Overall, this research provides robust evidence for positive affective and social consequences of psychedelic substance use in naturalistic settings.

Psychedelics and potential benefits in “healthy normals”: A review of the literature

We are in the midst of a psychedelic research renaissance. With research examining the efficacy of psychedelics as a treatment for a range of mental health indications still in its early stages, there is an increasing body of research to show that careful use of psychedelics can yield a variety of benefits in “healthy normals” and so lead to “the betterment of well people.” Psychedelics have been found to modulate neuroplasticity, and usage in a supportive setting can result in enduring increases in traits such as well-being, life satisfaction, life meaning, mindfulness, and a variety of measures associated with prosocial behaviors and healthy psychological functioning. The effect of psychedelic experience on measures of personality trait openness and is potential implications is examined, and the potential role of awe as a mediator of the benefits of the psychedelic experience is discussed. Special attention is given to the capacity of psychedelics to increase measures of nature relatedness in an enduring sense, which is being correlated with a broad range of measures of psychological well-being as well as a key predictor of pro-environmental awareness and behavior. The effects of particular classical psychedelic compounds on healthy people are discussed, with special attention given to the mystical-type experiences occasioned by high doses of psychedelics, which appear to be an important mediator of long-term benefits and psychotherapeutic gains. Research looking at the potential benefits of psychedelic microdosing is discussed. Potential future research avenues are explored, focusing on the potential development of psychedelics as agents of ecotherapy.

Using the pharmacy retail model to examine perceptions and biases of a UK population sample towards regulation of specific psychoactive drugs

Background:

Contemporary research indicates that the legal classifications of cannabis (Schedule 2, Class B), 3,4-methylenedioxymethamphetamine (MDMA) (Schedule 1, Class A) and psilocybin (Schedule 1, Class A) in the United Kingdom are not entirely based on considerations of harm and therapeutic utility. The legal classifications of the substances discussed are typically determined by legislators such as Parliament and, therefore, may be a reflection of the views or perceived views of the general public.

Objective:

The aim of the study was to provide an indication of the underlying psychology regarding the legislated sale of alcohol, tobacco, cannabis, MDMA and psilocybin in pharmacies according to a UK general population sample.

Methods:

A sample of 105 UK nationals was selected for the survey. Participants were asked questions on perceived relative harm of the five substances. After viewing contemporary information on reported relative harm and therapeutic applications, the participants were asked questions related to using the pharmacy retail model for the sale of the substances discussed. Participants who opposed the substances being sold primarily in pharmacies were asked to explain their rationale according to a predetermined list of options for each of the five drugs. Participants were also asked whether they consider it a human right to be legally permitted to consume the substances.

Results:

The participants' perceptions of relative harm (tobacco > MDMA > psilocybin > alcohol > cannabis) were not in agreement with the relative harm reported in the literature (alcohol > tobacco > cannabis > MDMA > psilocybin). Principal objections to the currently illicit substances being legally available in pharmacies include it sending the wrong message; it feels wrong; it is too dangerous; disliking the smell of cannabis; disapproval of the people; and not liking the idea of people using psychoactive drugs for entertainment or to have mystical/religious experiences. Overall, the participants determined that being legally permitted to consume the substances discussed is an issue of relevance to human rights. A majority of the male participants concluded that being legally permitted to consume alcohol, tobacco, cannabis and Psilocybe mushrooms is a human right in contrast to the majority of female participants who solely considered alcohol consumption to be a human right.

Conclusions:

The data suggest that the legal classifications may not simply be based on considerations of harm. Misperceptions of the dangers, biases and non-health-related aversions likely contribute to the continuation of policies that do not reflect the state of scientific research.

Prevalence and epidemiological associates of novel psychedelic use in the United States adult population

BACKGROUND

Novel psychedelics approximate classic psychedelics, but unlike classic psychedelics, novel psychedelics have been used by humans for a shorter period of time, with fewer data available on these substances.

AIMS

The purpose of this study was to determine the prevalence of novel psychedelic use and the associations of novel psychedelic use with mental health outcomes.

METHODS

We estimated the prevalence of self-reported, write-in lifetime novel psychedelic use and evaluated the associations of novel psychedelic use with psychosocial characteristics, past month psychological distress, and past year suicidality among adult respondents pooled from years 2008-2016 of the National Survey on Drug Use and Health (weighted n=234,914,788).

RESULTS

A fraction (weighted n=273,720; 0.12%) reported lifetime novel psychedelic use. This cohort tended to be younger, male, and White, have greater educational attainment but less income, be more likely to have never been married, engage in self-reported risky behavior, and report lifetime illicit use of other drugs, particularly classic psychedelics (96.9%). (2-(4-Bromo-2,5-dimethoxyphenyl)ethanamine) (2C-B) (30.01%), (2,5-dimethoxy-4-iodophenethylamine) (2C-I) (23.9%), and (1-(2,5-dimethoxy-4-ethylphenyl)-2-aminoethane) (2C-E) (14.8%) accounted for the majority of lifetime novel psychedelic use. Although lifetime novel psychedelic use was not associated with psychological distress or suicidality compared to no lifetime novel psychedelic use or classic psychedelic use, relative to lifetime use of classic psychedelics but not novel psychedelics, lifetime novel psychedelic use was associated with a greater likelihood of past year suicidal thinking (adjusted Odds Ratio (aOR)=1.4 (1.1-1.9)) and past year suicidal planning (aOR=1.6 (1.1-2.4)).

CONCLUSION

Novel psychedelics may differ from classic psychedelics in meaningful ways, though additional, directed research is needed.

Population Survey Data Informing the Therapeutic Potential of Classic and Novel Phenethylamine, Tryptamine, and Lysergamide Psychedelics

INTRODUCTION

The majority of contemporary psychedelic research has focused on ayahuasca, lysergic acid diethylamide, and psilocybin, though there are hundreds of novel psychedelic compounds that may have clinical utility. The purpose of the present study was to evaluate the therapeutic potential of classic and novel phenethylamine, tryptamine, and lysergamide psychedelics via a large, nationally representative population-based survey.

METHODS

We tested the unique associations of lifetime classic and novel phenethylamine, tryptamine, and lysergamide psychedelics with past month psychological distress and past year suicidality among respondents pooled from years 2008-2017 of the National Survey on Drug Use and Health (weighted N = 260,964,827).

RESULTS

Lifetime classic tryptamine use was associated with a decreased odds of past month psychological distress [aOR = 0.76; (0.69-0.83)] and past year suicidal thinking [aOR = 0.79; (0.72-0.87)]. Lifetime novel phenethylamine use, on the other hand, was associated with an increased odds of past year suicidal thinking [aOR = 1.44; (1.06-1.95)] and past year suicidal planning [aOR = 1.60; (1.06-2.41)]. No other significant associations were found.

DISCUSSION AND CONCLUSIONS

These findings, which may be driven by differences in pharmacodynamics, suggest that classic tryptamines may hold the greatest therapeutic potential of the psychedelics, whereas novel phenethylamines may pose risk for harm. The present findings thus support continued research on the clinical application of classic tryptamines. Though the current results caution against the clinical utility of novel phenethylamines, further study of these and other novel psychedelic substances is nonetheless warranted to better understand their potential application.

Predicting Responses to Psychedelics: A Prospective Study

Responses to psychedelics are notoriously difficult to predict, yet significant work is currently underway to assess their therapeutic potential and the level of interest in psychedelics among the general public appears to be increasing. We aimed to collect prospective data in order to improve our ability to predict acute- and longer-term responses to psychedelics. Individuals who planned to take a psychedelic through their own initiative participated in an online survey (www.psychedelicsurvey.com). Traits and variables relating to set, setting and the acute psychedelic experience were measured at five different time points before and after the experience. Principle component and regression methods were used to analyse the data. Sample sizes for the five time points were N = 654, N = 535, N = 379, N = 315, and N = 212 respectively. Psychological well-being was increased 2 weeks after a psychedelic experience and remained at this level after 4 weeks. Higher ratings of a “mystical-type experience” had a positive effect on the change in well-being after a psychedelic experience, whereas the other acute psychedelic experience measures, i.e., “challenging experience” and “visual effects”, did not influence the change in well-being after the psychedelic experience. Having “clear intentions” for the experience was conducive to mystical-type experiences. Having a positive “set” as well as having the experience with intentions related to “recreation” were both found to decrease the likelihood of having a challenging experience. The baseline trait “absorption” and higher drug doses promoted all aspects of the acute experience, i.e., mystical-type and challenging experiences, as well as visual effects. When comparing the relative contribution of different types of variables in explaining the variance in the change in well-being, it seemed that baseline trait variables had the strongest effect on the change in well-being after a psychedelic experience. These results confirm the importance of extra-pharmacological factors in determining responses to a psychedelic. We view this study as an early step towards the development of empirical guidelines that can evolve and improve iteratively with the ultimate purpose of guiding crucial clinical decisions about whether, when, where and how to dose with a psychedelic, thus helping to mitigate risks while maximizing potential benefits in an evidence-based manner.

The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act

This review assesses the abuse potential of medically-administered psilocybin, following the structure of the 8 factors of the US Controlled Substances Act (CSA). Research suggests the potential safety and efficacy of psilocybin in treating cancer-related psychiatric distress and substance use disorders, setting the occasion for this review. A more extensive assessment of abuse potential according to an 8-factor analysis would eventually be required to guide appropriate schedule placement. Psilocybin, like other 5-HT2A agonist classic psychedelics, has limited reinforcing effects, supporting marginal, transient non-human self-administration. Nonetheless, mushrooms with variable psilocybin content are used illicitly, with a few lifetime use occasions being normative among users. Potential harms include dangerous behavior in unprepared, unsupervised users, and exacerbation of mental illness in those with or predisposed to psychotic disorders. However, scope of use and associated harms are low compared to prototypical abused drugs, and the medical model addresses these concerns with dose control, patient screening, preparation and follow-up, and session supervision in a medical facility. CONCLUSIONS: (1) psilocybin has an abuse potential appropriate for CSA scheduling if approved as medicine; (2) psilocybin can provide therapeutic benefits that may support the development of an approvable New Drug Application (NDA) but further studies are required which this review describes; (3) adverse effects of medical psilocybin are manageable when administered according to risk management approaches; and (4) although further study is required, this review suggests that placement in Schedule IV may be appropriate if a psilocybin-containing medicine is approved. This article is part of the Special Issue entitled 'Psychedelics: New Doors, Altered Perceptions'.

Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy

A psychological model of classic psychedelic-assisted psychotherapy informed by contemporary scientific data is presented in this paper. It is suggested that classic psychedelic-occasioned mystical experience is characterized by profound awe, a discrete emotion experienced in the presence of a vast stimulus requiring accommodation of mental structures. Awe, in turn, promotes the small self, a construct that, in the extreme, is analogous to those of unitive experience and ego dissolution. The small self is conceptualized as key to understanding the downstream effects of mystical experience occasioned in the context of classic psychedelic-assisted psychotherapy. With this novel theoretical framework in mind, a number of clinical implications and recommendations are provided so as to advance this incipient field of study.

Current perspectives on psychedelic therapy: use of serotonergic hallucinogens in clinical interventions

Humans have used serotonergic hallucinogens (i.e. psychedelics) for spiritual, ceremonial, and recreational purposes for thousands of years, but their administration as part of a structured therapeutic intervention is still a relatively novel practice within Western medical and psychological frameworks. In the mid-20^th century, considerable advances were made in developing therapeutic approaches integrating administration of low (psycholytic) and high (psychedelic) doses of serotonergic hallucinogens for treatment of a variety of conditions, often incorporating psychoanalytic concepts prevalent at that time. This work contributed seminal insights regarding how these substances may be employed with efficacy and safety in targeted therapeutic interventions, including the importance of optimizing set (frame of mind) and setting (therapeutic environment). More recently, clinical and pharmacological research has revisited the effects and therapeutic potential of psychedelics utilizing a variety of approaches. The current article provides an overview of past and present models of psychedelic therapy, and discusses important considerations for future interventions incorporating the use of psychedelics in research and clinical practice.