MDMA (ecstasy) became a popular recreational drug in the 1980s. As part of the Reagan administration’s “war on drugs” the head of the FDA (Food and Drug Administration) made MDMA a schedule 1 drug. Drugs get this designation when they have a high abuse potential and no accepted medical use. LSD and psilocybin preceded MDMA into this category which today includes marijuana, peyote, and methaqualone. Today we know that marijuana and LSD have therapeutic uses. Psilocybin and MDMA have breakthrough drug status and are both in FDA trials as adjunctive therapy for depression and PTSD. Considering that psychedelic medicines may change the face of psychiatric medicine, what are the recreational psychedelic risks?
Purity and Dosage Risks of Recreational Psychedelics
In the controlled studies of MDMA, psilocybin, LSD, ayahuasca, and other psychedelics, there have been virtually no reported serious adverse effects. On the other hand, there can be problems with recreational psychedelic use. The first reason is that the medicines used in research studies are pharmaceutical grade. They are pure and given in precise and correct doses and frequency. An issue with using psychedelics that are “street grade” is that you are not sure how much of the psychedelic you are getting.
Another issue is that street drugs commonly contain more than one ingredient. A person planning to use MDMA may also be getting a narcotic like heroin or fentanyl. While psychedelics do not cause habituation or physical addiction, other unexpected ingredients in street drugs can and will addict a person. While taking too much of a psychedelic can be disturbing, doing so does not have a lethal outcome. That is not the case with fentanyl, heroin and other drugs.
Positive Therapeutic Effects of Psychedelics Depend on the Setting
Over the centuries people have used ayahuasca in the Northwest Amazon River basin. This psychedelic medicine is used in a ceremonial setting. The same happens with peyote. The dramatic results seen with MDMA and psilocybin happen because these medicines are used as adjunctive therapy along with coaching or psychotherapy. The point is to use the medicines to reduce the negative reactions people have to recalling past traumatic and fear-inducing events. When psychedelics are used in this kind of setting, people find they are more open to others and the world, are able to put fearful and traumatic memories in perspective and move on to recovery.
Contrast this approach with taking street psychedelics of unknown dosage with unknown extra ingredients at a rock concert where the main performer is biting the heads off live birds and screaming obscenities. There are many variations on this theme but the point is that someone who lives in a chaotic, unhealthy setting and takes psychedelics of unknown strength along with unknown extra ingredients is not likely to get better and may even get worse.
Recreational Psychedelics and Effects on the Brain
Psychedelic medicines like psilocybin and LSD make serotonin receptors in the brain more active. This makes it easier for the brain to change from one activity state to another. The neurons in the brain grow more branches and create more connections as well. There is no reason to believe that a person needs to take these medicines in research settings in order for these effects to occur. As such, one would assume that there might be useful therapeutic effects that come out of recreational psychedelic use even without using the medicine in the right setting.
Long Term Effects of Recreational Psychedelic Use
When psychedelics are used without proper screening, correct dosage, or unwanted ingredients, there can be a number of serious side effects. These are mood disturbances, paranoia, disorganized thinking, visual disturbances, panic attacks, and recurrent flashbacks to the hallucinogenic experience. In general, these unwanted side effects are more common during periods of fatigue, stress, and other drug use as well as recurring use of psychedelics. An occasional long-term effect is an amotivational syndrome. In this case people are apathetic, passive, and with little interest in the things of life. In general, the negative long-term issues are caused in people who should not use the medicines in the first place and/or use psychedelics too often.
The flip side is that people who use psychedelics just once often report lifelong benefits like great social openness and empathy which often result in a happier and more satisfying life.
