2.05.2015

Do Psychedelics Prevent Suicide?

Pauline Anderson
February 05, 2015

Classic psychedelic drugs, including lysergic acid diethylamide (LSD) and mescaline, may help prevent suicide, new research shows.
Investigators at the University of Alabama at Birmingham found that any lifetime use of one of these drugs was associated with lower likelihood of psychological distress, suicidal thinking, suicidal planning, and suicide attempts.
The findings support the view that the restricted status of these drugs should be changed to facilitate research, lead author Peter Hendricks, PhD, assistant professor, Department of Health Behavior, University of Alabama at Birmingham, told Medscape Medical News.
"The risks of these drugs have been vastly overstated," said Dr Hendricks.
The study, the first to find a protective effect for psychedelic drug use in terms of suicidality, was published online January 13 in the Journal of Psychopharmacology.

Severe Restrictions
In addition to LSD, which is derived from the ergot fungus, and mescaline, which is the primary active constituent of peyote and other cacti, classic psychedelics include dimethyltryptamine (DMT) and psilocybin, which is the primary psychoactive constituent of Psilocybe and other mushroom genera. These substances primarily work as serotonin 2A agonists.
Illicit use of psychedelics during the 1960s led to severe legal restrictions that all but eliminated research into their therapeutic potential. In the United States, they are now Schedule 1 substances, a designation that denotes high abuse potential, the absence of currently accepted medical use, and a lack of accepted safety under medical supervision.
For this current study, researchers used the annual National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services. They pooled data on adult respondents to surveys from 2008 to 2012.
Survey respondents were asked whether they had ever used a classic psychedelic. They were also asked about psychological distress and whether they had ever thought about suicide, planned a suicide, or attempted suicide during the previous 12 months.
In addition, participants revealed information about lifetime use of cocaine, heroin, pain relievers, stimulants, sedatives, tranquilizers, and other drugs.
Of 191,382 respondents, 27,235 reported lifetime use of a classic psychedelic (13.6% weighted).
As well, 12,657 respondents reported psychological distress (4.8% weighted), 10,445 reported suicidal thinking (3.8% weighted), 3157 reported suicidal planning (1.1% weighted), and 1716 reported a suicide attempt (0.5% weighted).

Not Addictive
Lifetime classic psychedelic use was concentrated among 26- to 64-year-olds and was more common among men.
Such use was associated with a decreased likelihood of psychological distress (weighted odds ratio [OR], 0.8 [0.72 - 0.91]; P = .0002), suicidal thinking (weighted OR, 0.86 [0.78 - 0.94]; P = .001), suicidal planning (weighted OR, 0.71 [0.54 - 0.94]; P = 0.01), and suicide attempt (weighted OR, 0.64 [0.46 - 0.89]; P = .008).
Lifetime illicit use of other substances, on the other hand, was either not related with or associated with an increased odds of these outcomes, with ORs for most relationships exceeding 1.0.
This, said Dr Hendricks, "is consistent with the literature" showing that addictive substances are "very much associated with affective disturbances and suicide risk."
Cannabis, however, is "a bit trickier," in that its dependence potential appears to be low relative to cocaine, heroin, and alcohol.
But although these drugs are known to be addictive, psychedelic drugs are not, said Dr Hendricks.
"There is not a single human or animal model yet that has shown compulsive drug seeking behavior or withdrawal symptoms, which are typically a 'sine qua non' of addiction; without withdrawal, you don't have addiction."

Transformative Agents?
The survey only asked respondents whether they had ever used psychedelics, although information on when and how often they had used these drugs would have been helpful, said Dr Hendricks.
"It would have been great to have known when they had used, how frequently they had used, and the last time they had used, but we just didn't have that information."
However, he pointed out that psychedelic drugs can provide transformative mystical experiences after just one use.
"One does not need to be transformed more than once in one's lifetime."
There are numerous examples of such transformative experiences, both across the world's religions and in fiction. As described in the Bible, on the road to Damascus, Saul experienced "something fantastic, something deeply meaningful occurred, and it changed his perspective," said Dr Hendricks.
Fictional examples, he said, include Charles Dickens' character Ebenezer Scrooge in A Christmas Carol, who underwent an "amazing experience" that "completely changed who he was, his values, and his mood."

Relatively Harmless
When LSD first came on the scene, and was legal, there was tremendous enthusiasm for its therapeutic prospects. At the time, it was used recreationally and was linked with antiestablishment, antimaterialism, and anti–Vietnam War sentiments.
But the fallout from being tied to the "counterculture" revolution was "propaganda" that resulted in these drugs being severely restricted legally, said Dr Hendricks. There were erroneous reports, for example, that LSD could alter your genetic code or cause permanent damage to your brain, he said.
Indeed, there is now growing evidence suggesting that psychedelics are relatively harmless. According to one study cited by Dr Hendricks (Lancet. 2010;376:1558-1565), which ranked various drugs in terms of potential harm, LSD was third last overall on a list of 20 drugs. Alcohol was first, heroin second, and crack cocaine third.
Dr Hendricks believes it is time that access to psychedelic drugs be loosened to allow for uninhibited research.
"I'm a clinical psychologist, so I'm not a policy expert, but from my perspective, the data suggest they should be Schedule 4," he said.
Drugs under such a designation have a lower potential for abuse relative to drugs in other designations. They also have an accepted medical use, and their abuse may lead to limited physical dependence or psychological dependence.
Useful in Psychiatry?
However, not everyone agrees that a Schedule change for psychedelic drugs is warranted. According to John Halpern, MD, assistant professor, psychiatry, and director, Laboratory for Integrative Psychiatry, McLean Hospital, Belmont, Massachusetts, research on Schedule 1 drugs "is more difficult but not impossible," and to move psychedelics into a more accessible Schedule would require more evidence of their medicinal use.
"There are no double-blind, placebo-controlled trials to show that there's medical utility," he told Medscape Medical News.
However, Dr Halpern said psychedelics may in fact be useful in psychiatry. His own research showed that Native Americans who used peyote as part of their prayer service had overall better mental health, less anxiety, and more life satisfaction than either Native Americans who were former heavy alcohol users or Native Americans with minimal alcohol or drug use (Biological Psychiatry. 2005;58:624–631).
The current study "corroborates what I've already published, in a way," he said.
There were those who at one point wanted to develop LSD as an antidepressant, said Dr Halpern. According to anecdotal reports, there was even a drug company interested in combining low-dose LSD with an antiemetic, although the plan was scrapped owing to medical-legal concerns.
Dr Halpern also noted that LSD can be useful in pain conditions such as headache. In interviews with 53 cluster headache patients who had used psilocybin or LSD to treat their condition, Dr Halpern and colleagues described "dramatic results" in terms of "aborted attacks" and "cluster period termination" (Neurology. 2006;66:1920-1922).
But he cautioned that causality cannot be drawn from the current study and that its results could reflect a type of self-selection.
"It could be that people who are more emotionally stable to begin with may have more ability to consume hallucinogens more safely. We know that people who have issues around their sense of self and control do much worse when they ingest hallucinogens."
Dr Hendricks and Dr Halpern report no relevant financial relationships.
J Psychopharmacol. Published online January 13, 2015. Abstract


Medscape Medical News © 2015  WebMD, LLC