The psychedelic medicines MDMA and psilocybin are going through FDA trials on their way to being prescribed for treatment of depression and PTSD. They have also been found to be useful in the treatment of substance abuse disorders. All three of these are risk factors for suicide. Thus we expect to see psychedelic medicines reduce suicide risk as these medicines come into common use. In addition, there is strong evidence that recreational use of psychedelics also has the effect of lowering suicide risk over the years.
Recreational Use of Psychedelics and Suicide Risk
We know from recent and ongoing research that psychedelic medicines like psilocybin and MDMA effectively rewire the brain. This “rewiring” makes it easier for those suffering from conditions like PTSD to deal with their problem. Although research studies include professional guidance in the form of a coach or psychotherapist to help the person through their treatment, there is no reason to expect that a coach or therapist is necessary in order for the biochemical effects of the psychedelic to occur. One of the values of looking at people who have used psychedelics over the years is that we get a longer term view of the effects of these medicines than from research studies with follow up periods of a few years at most.
Psychedelic Drug Use in Marginalized Individuals
Researchers in Vancouver, Canada studied 800 women for four years. These women were sex workers. In this group of people the expected incidence of suicidal thoughts is high. The researchers asked if a woman had had suicidal thoughts within the prior year and if they used psychedelics. They found that women who had used psychedelics at least once in their lives were sixty percent less likely to report suicidal thoughts that those who had never used psychedelics. In contrast, women who had used crystal methamphetamine were more like than the average to have had suicidal thoughts. The same increased incidence applied to women who had been abused during childhood.
Long Term Benefits From One Use of Psychedelics
Something that stands out in the Vancouver study as well as in current psychedelic research is the need for only one or two treatments to obtain lasting results. It is of note that women in the Vancouver study did not need to have used a psychedelic medicine during the time when they would otherwise and felt suicidal in order to experience the protective effect. This is consistent with current psychedelic research subjects having improvement of depression and PTSD for as long as six years after a single round of therapy consisting of one or two doses of a psychedelic.
How About the Bad Effects of Psychedelics?
Much has been made about flashbacks and other unwelcome side effects with recreational use of psychedelics. There are two things to consider first of all in this case. Street drugs do not come in controlled doses, unlike pharmaceutical quality medications. Also, street drugs are rarely pure but rather a mixture of several drugs including the psychedelic that a person thinks they are taking. The side effect that is of the most concern is persistent hallucinogen perception disorder. This state occurs in about 4% of people who use psychedelics repeatedly for long periods of time. These folks get flashbacks when they are not taking the drug. These can occur months and even years after the last use.
The things that make a persistent hallucinogen perception disorder more likely include a “bad trip” when the person first uses the psychedelic, pre-existing conditions like depression, and routinely using other drugs along with psychedelics. There is no specific treatment for this condition and patients are coached in stress reduction techniques. Unlike many other street drugs, psychedelics are not habituating.
Does Long Term Effectiveness Change How Psychedelics Will Be Used?
Because psychedelics are used as adjunctive therapy along with coaching or psychotherapy in controlled settings people will not be given a bottle of pills and told to return to the doctor in a month. Rather, treatment will only be under the supervision of a professional and when treatment is not successful it is unlikely that the medicine will be tried again and again. What we can expect is that use of psychedelics in common treatment for depression and PTSD as well as substance abuse disorders is likely to cause a substantial reduction in the risk of suicide.