More on psychedelics

Further to my last post, when you go looking for studies on harm from hallucinogens/psychedelics, a hell of a lot of them start with something like "despite the rise in interest in psychedelics as potentially useful therapeutic tools in recent years, detailed and reliable studies about harmful effects have been lacking."    

Anyway, here are some of the more interesting things I have found, so far:

NMURx surveyed 267,268 adults representing 256,742,237 Americans (Table E1; available at http://www.annemergmed.com) over the study period. The prevalence of past year psychedelic use in nondecriminalized US states modestly increased from 2.4% (95% confidence interval [CI] 2.33% to 2.54%) in 2019 to 2020 to 2.84% (95% CI 2.74% to 2.95%) in 2021 to 2023. Oregon and Colorado rates have risen from 3.28% (95% CI 2.66% to 3.89%) in 2019 to 2020 to 5.44% (95% CI 4.63% to6.24%) in 2021 to 2023 

The background to that is that Oregon and Colorado " have already legalized and decriminalized the sale, possession, and growth of natural psychedelics for counseling, spiritual guidance, beneficial community-based use, and healing. As of August 2023, 22 states have active legislation on psychedelic medical use."  I don't know, but a state in which upwards of 5% having used a psychedelic in the last year sounds like a state with too many people using them.

 Going back to 2013, one open-access study found that regular users of psychedelics maybe had less mental health issues(!).   But the study itself acknowledges significant limitations.   And I see there is also perhaps a bit of the (many decades old) argument used regarding cannabis that if someone did get psychosis after doing the drug, maybe there were going to get schizophrenia anyway: 

There are very few case reports of prolonged psychiatric symptoms following psilocybin or mescaline [13], [52]. Almost all claims of psychiatric harm caused by peyote have been found on examination of medical records to be due to pre-existing schizophrenia or other causes [53], [54]. 

So, count me as suspicious of that study.

I see that the researchers in that study are quoted in a 2022 study which similarly seems determined to find that the risks are pretty low, and keeps emphasising that how they are used (you know, in a supportive, safe context, like a psych's office) makes it much safer.   Things like "how they are going to be used recreationally" don't get treated in much detail, for example:

 In unprepared individuals and/or in unsafe settings, effects of psychedelics may have the potential to escalate into dangerous behaviour (Johnson et al., 2008). Although very rare, there are reports of individuals jumping from buildings and ending their lives (e.g. Honyiglo et al., 2019; Keeler and Reifler, 1967). While these occurrences are uncommon compared with other psychoactive drugs – especially alcohol – they are widely reported in the media which contributes considerably to public perceptions of their risks.

And:

In Carbonaro et al.’s (2016) online survey about challenging experiences after consuming ‘mushrooms’, 11% of users reported putting themselves or others at risk of physical harm. This was often related to greater (estimated) dosage, difficulty of the experience and lack of physical comfort and social support – all of which can be controlled under clinical conditions. 

A study in Nature in 2023 is of limited use, given the small sample that it involved, but it's interesting that the abstract starts with the observation that a lot of studies seem to be biased towards the positive:

Recent controversies have arisen regarding claims of uncritical positive regard and hype surrounding psychedelic drugs and their therapeutic potential. Criticisms have included that study designs and reporting styles bias positive over negative outcomes. The present study was motivated by a desire to address this alleged bias by intentionally focusing exclusively on negative outcomes, defined as self-perceived ‘negative’ psychological responses lasting for at least 72 h after psychedelic use.  

Here's another questionable self selecting, self reporting, survey study, but it has this interesting part:

Taken as a whole, these studies provide convergent support for findings from clinical trials, including that psychedelic use (either lifetime or prospective) is associated with increased emotional well-being (19–26), reduced harmful substance use/misuse (i.e., illicit drugs/tobacco/alcohol) (27, 28), a tendency toward liberal political views and an enhanced sense of connection with nature (29, 30). These effects are reliably associated with the occurrence of various types of transformative mental states (e.g., mystical, emotional breakthrough, insight-type) during the acute psychedelic experience that have also predicted outcomes in clinical trials (6, 9, 11, 22, 31–33).  

 I can assure the reader that I did not become more Left leaning as I aged due to use of a drug!

 The study does turn up this figure for harms:

...not all participants reported unqualified benefit from psychedelic usage. Thirteen percent identified at least one harm, and these participants reported receiving significantly less mental health benefit from their psychedelic usage than participants not endorsing any harms. 

 OK, so a very recent study from Norway did some more survey stuff, and it's really hard to follow from the paper what they found!   It does have some interesting passages, though:

Adverse events as conceived in the context of clinical trials (e.g. any undesirable experience associated with the use of a medical product in a patient) overlap with the non-medical concept of ‘challenging experiences’ arising from self-experimentation with psychedelics. In clinical trials, the most common adverse events reported after ingestion of psychedelics are headaches, nausea and transient anxiety (Andersen et al., 2021). However, serious adverse events have been reported after the administration of psilocybin for treatment-resistant depression, such as severe suicidal (Goodwin et al., 2023) and cases of extreme anxiety induced by LSD requiring the use of benzodiazepines to contain the situation (Holze et al., 2023). In clinical trials, high anxiety during the psychedelic drug administration have been associated with worse clinical outcomes (Roseman et al., 2018). Anxiety following a high dose of psilocybin or LSD is also common among healthy subjects, as 30 % of participants in controlled studies experience fear and panic, and 17–34 % experience paranoid ideation (Griffiths et al., 2006, 2011; Schmid et al., 2015). Recently, there has been increased attention to possible negative effects resulting from both clinical and non-clinical use of psychedelics (Evans et al., 2023), and criticism of the field for not properly assessing and appreciating risks (van Elk and Fried, 2023). Challenging psychedelic experiences during acute effects are quite common, but to what extent and through which mechanisms they are implicated in prolonged negative effects needs more research. 

Well, that's a pity, because it's the more prolonged negative effect rate that I'm interested in! 

The next paragraph contains the now familiar refrain - more research needed:

The increased interest in psychedelics from researchers and the public merits translation of validated questionnaires for assessing the qualitative nature of subjective states and outcomes resulting from using these compounds. Epidemiological studies indicate that psychedelic drug use is increasing and that more people report difficulties during acute effects and seek help for post-psychedelic health complaints (Bouso et al., 2022; Miech et al., 2023; Simonsson et al., 2023; Tate et al., 2023). It is therefore paramount that researchers pay attention to negative and complex reactions to psychedelic drugs in the general population, as well as to their possible benefits. Measurements that capture these themes are also highly relevant in psychedelic-assisted psychotherapy, where processing difficult cognitive and emotional material is core to the treatment modality.

 Another paragraph talks about research that has looked at the adverse effects:

While not affecting most psychedelic users, there are indications that a significant proportion experience substantial distress and challenges with functioning after psychedelic experimentation (Simonsson et al., 2023). The types and precise causes of enduring negative effects after psychedelics are an ongoing area of research. At present there are studies and reports suggesting increases in anxiety, trauma-like symptoms, feelings of disconnection and dissociative experiences, depersonalization and derealization, existential confusion and loss in sense of purpose, and perceptual abnormalities such as Hallucinogen Persisting Perceptual Disorder (HPPD) (Bouso et al., 2022; Bremler et al., 2023; Evans et al., 2023; Kvam et al., 2023; Vis et al., 2021). In addition, there are credible reports of worsening and triggering of psychotic symptoms and manic or hypomanic states, induction of suicidal ideation, as well as negative impact on traits among people with personality disorders (Barber et al., 2022; Kramer et al., 2023; Marrocu et al., 2024; Morton et al., 2023). Having pre-existing psychiatric diagnoses is a risk factor for challenging psychedelic experiences in these studies, but not a prerequisite as it also occurs without known psychological risk factors and relates to variables such as higher dose, younger age, chaotic contexts, and absence of social support (Simonsson et al., 2023; Vizeli et al., 2024). These contextual factors appear to play a key role in the development of lasting negative effects and likely apply not only during the acute phase of a challenging psychedelic experience but also in the period afterward. In the future, we suggest that it is fruitful to study post-drug trajectories in combination with emphasis on the broad and varied range of mediating factors that interact with the psychedelic experience.  

Well, there's a hell of a lot of links there to go looking at, but I've spent enough time on this for now.  

Hallucinogens worry me

Sure, it's interesting that certain hallucinogens (most notably, DMT) produce similar types of peculiar results with most people (see machine elves), but after having the Algorithm send me to a bunch of YouTube videos from Comedy Central (of all places) in which "cool" people tell light hearted stories of their DMT trips, I am increasingly worried that cultural promotion of recreational tripping is going way too far.   (The videos seem to be 5 years old now, so I am late to notice them.)

In comments on any video about trips, there will be hundreds of people recommending how to do it right, so to speak.   There will be the occasional cautionary one, and there's a Joe Rogan clip of a guy who explains how it took 18 months to fully recover from his DMT experiences; but overall, it seems clear that there are too many people promoting it as an interesting or fun thing to do.

This just doesn't sit right with me.

People's mental health is something to be valued and treasured if it gets them through life on an even keel, so to speak.  To know a person with serious struggles with their mental health is to know how good it is to enjoy not having that problem.  Why risk it for mere recreational purposes?   

And it doesn't necessarily carry clear spiritual truths or lessons, as someone argued on Twitter recently:

Indeed, on that last point, why don't people just listen to what the members of the Beatles had to say about the empty promise of drug induced hallucinations?   

 

I have told the story before:  as a teenager I was impressed by Huxley's The Doors of Perception.   It's a cool idea to think that a drug lowers the brain filter to let you see a numinous world as it really is.  But it also becomes clear when you read more about the experiences of drug users that it is not really what is going on.

 

That said, I am not totally against the experiments in use of certain drugs by properly trained psychiatrists to see if they can help certain traumatised people.  (Although I am also already convinced that there is a great deal of hype around that topic,  too.)   

 

But I do have more and more sympathy as I age to taking the old Republican line on "this is your brain on drugs - just don't do it"  than the soft "do them, but just carefully, it will open your mind, man" experimental lines of the likes of Joe Rogan and whoever owns Comedy Central.

A new book on capitalism

A review here at the New York Times on the kind of book by an academic that sounds interesting, but which I can tell would take too much devotion to read in full:  "Capitalism: a Global History". 

A couple of extracts:

Previous histories have usually treated capitalism as a European invention, but Beckert, as ambitious as he is erudite, shows how capitalism arose as a global phenomenon, the peculiar behavior of a few merchants in places as far apart as Cairo and Changzhou.

By mapping the diverse origins of capitalism, Beckert reveals its protean and resilient character. Over hundreds of years, merchants created small enclaves of capital within port cities and elaborate networks of trust that stretched over long distances. Such connections, Beckert observes, helped them outflank and survive resistance from above, by landed aristocrats who thought “making money from money seemed closer to sin, sorcery or plain theft,” and from below, by “cultivators and craftspeople” who were loath to give up their local conceptions of prices set by “a shared sense of morality.” 

So far, sounds like it supports the generally conservative idea that capitalism is a more-or-less natural evolution arising out of how groups of people like to manage their lives.  But there are wrinkles, to put it mildly:

In these remote corners of the world European investors conducted a kind of civil experiment, extending the logic of the market to all aspects of life. Everything, especially human labor, was commodified and could be bought and sold for money.

And:

He offers an especially devastating critique of earlier mythologies of capitalism, showing how the “invisible hand” of the market does not peacefully guide world affairs, and how the development of capitalism was in no sense “natural.”

Like many books before it, “Capitalism” is not only a history but a moral indictment. The metaphor of monstrosity runs throughout Beckert’s pages. In his telling, the hand of capital is visible, cold, hard and vicious, and capitalism is a promiscuous creature, drawing on different kinds of labor, from enslaved to free and many in between, within various political frameworks, from democracy to dictatorship.

Two leading thinkers of the 18th century, the French philosopher Montesquieu and the Scottish political economist Adam Smith, argued that world trade promoted peace and harmony because it advanced mutual interest and interdependency.

What actually happened, and indeed was happening during the lifetimes of both men, was that trade was often militarized and violent. Armed fleets pointed their cannons at harbors to open markets for trade, and kings relied on bankers, when they weren’t trying to rein them in, to raise silver to outfit soldiers with guns and swords. Montesquieu was born in 1689. As Beckert points out, “between 1689 and 1815, Britain and France were at war for 64 years.” 

 

Goodbye to Tom Stoppard

I was always interested in Tom Stoppard, who seemed to be a clever, humane, and curious man.   (I am reminded in his obituaries that he supported Margaret Thatcher and called himself a "small c conservative" or "timid libertarian" - but this was back at the time before big C conservatives went all culture war nuts on science and immigration, so I don't hold it against him.  Besides, he had worked with Spielberg, so he can't have been a pain politically.)   

I actually saw his play Arcadia in Brisbane - one of the relatively few times in my life I have been to the theatre to see a drama instead of a musical.  I don't remember too much about it, to be honest, apart from recalling that I found it interesting and clever at the time.   (I do remember a discussion with my companion about how I thought it could have made one thing clearer, and she disagreed.)

Obituaries also note that he was married 3 times.   But people in the arts, you know?   If they have been married only once, they were probably an artist failure!

Anyway, I wish we had someone prominent like him now, in theatre, but I am not sure we do...