Prof. Jo Neill
The generalised public perception of psychedelic drugs is rooted in their legal categorisation as a Class A, Schedule 1 drug. Drugs in this category are considered to have the potential to harm an individual and society, and have ‘no medical use‘. The former point, regarding their safety, is one of the most prevalent myths surrounding psychedelic use.
Despite widespread acceptance within the general public that psychedelics carry significant risks, there’s no research to support this. While no drugs are absolutely and completely safe, the research strongly indicates that psychedelics are relatively low harms. In fact, in our multicriteria decision analysis, Prof. David Nutt and colleagues found that psychedelics were among the safest drugs. This is in contrast to alcohol — a common, legal and easily accessible drug — which was found to be especially dangerous.
A review by Prof. Jo Neill and her colleagues explored the risk profile of psychedelics, including:
- Harms to self/others
- Hallucinogen persistent perception disorder (HPPD)
Ultimately, they determined that the risks associated with psychedelic use are generally refuted or very rare — with the psychological risks heavily influenced by the set and setting of the experience. In unprepared people and unsafe settings, harm to self can occur — though, again, this is rare. Similarly, psychotic experiences are uncommon, and these are most often present in people with predisposing risk factors. Notably, what someone may consider a “bad” experience in the moment can lead to positive outcomes following the experience.
Regarding dependence risk, the research does not suggest that psychedelics lead to compulsive use — in fact, they may have therapeutic potential for treating addictions. Similarly, there was no evidence of neurotoxicity risk and there may be potential benefits for neuronal functioning and neuroplasticity.
However, there may be some degree of cardiovascular risk involved in psychedelic use. Because both psilocybin and DMT have serotonin-like actions, they induce temporary peripheral effects relevant to the heart, like increased blood pressure and heart rate. Interestingly, while serotonin itself is proinflammatory, psychedelics are anti-inflammatory.
Overdoses are extremely rare, only really occurring when combined with other drugs, or in needlessly intense doses. Occurrences of hallucinogen persistent perception disorder (HPPD) appear to be rare, with no cases being reported in recent trials. Still, more research is needed on this topic.
While the safety and risk profile of psychedelics should constantly be assessed, the harm-related stigma attached to psychedelics doesn’t match up with the actual risk profile.
Over the past few decades, drug policies in the U.S. have progressively become more and more harmful. Stricter drug laws and policies have led to a market filled with lower quality and misrepresented drugs. For many drugs, the dangers of being caught with them far exceeds any potential danger from actually using them (eg. psilocybin, LSD).
Many of the harms associated with drug use are dangers instigated by prohibition. For example, LSD is a non-toxic drug — but compounds that are created to mimic LSD (eg. 25I-nBOME) can be fatal. Similarly, many new and far less safe compounds are synthesised to imitate MDMA. These imitations are easily avoidable in a system that prioritizes safe drug use rather than pursuing the likely-impossible goal of eliminating drug-taking altogether.
There can be an overconfidence within the drug-using community about knowing what drug you are actually taking — particularly in the context of pressed pill forms. Pressing technologies are easily accessible, and they make it easier to misrepresent drugs and deceive markets. For example, cities may see a wave of true MDMA with a specific aesthetic (eg. blue circular pill), which is then followed by a wave of an identical form containing amphetamine — a much cheaper drug. This is intentional, as distributors use the initial wave to create a sense of confidence in a certain drug appearance.
Ultimately, there’s plenty of misinformation floating around the drug world in the form of anecdotes, stigmas, and profit-motivated deception. It’s important to navigate drug-use and with caution and approach information (especially anecdotes) with healthy scepticism.
Psychedelic experiences are often assumed to bring about positive changes, like increased prosocial motives, nature-relatedness, and unifying beliefs. While they are often hallmarks of the psychedelic experience, this isn’t always the case — and it’s not a definitive outcome. There are many factors that can influence the outcomes, with context playing a significant role.
While the immediate set and setting are well-known determinants, they expand beyond the acute period of the psychedelic journey. This idea is present within the concept of “conspirituality”, which refers to a demographic that self-identifies as spiritual and are more likely to believe in conspiracy theories. The overlap does make sense, as the approaches and values that lead someone to being open to spiritual concepts can also make them susceptible to conspiracies and more outlandish ideas.
Psychedelics put individuals in a vulnerable mindset. This vulnerable space is what gives psychedelics their incredible potential for growth and healing — but it also leaves the potential for harm. This reinforces the fundamental point that there are no perfect drugs or treatments. Psychedelics are not the panacea that they are often marketed to be, and the experience won’t be suitable for everyone.