In the historical context of public health, harm reduction has focussed on reducing the negative consequences of drug use, as opposed to promoting abstinence or eliminating use 24. Harm reduction support services align with the Australian Government’s Federal Drug strategy, which includes harm reduction as the third pillar in their overall harm minimisation approach to drug use in Australia for the period of 2017–2026 25. Within a clinical framework, harm reduction approaches extend to respecting the individual’s autonomy and values, whilst helping them to engage in conscious and informed decision making 26. Specifically, harm reduction for users of psychedelics may include education about both the risks and potential benefits of psychedelic use, involving specific strategies designed to maximise the benefit of the psychedelic experience, making benefit enhancement a component of psychedelic harm reduction 27. In clinical practise, there are ethical and legal considerations which guide harm reduction practises 27. However, understanding what harm reduction practises are currently employed by users of psychedelic drugs in naturalistic settings, what influences use of these strategies, and the outcome of any interventions which have been undertaken may inform future harm reduction efforts in both clinical and public health settings.
Factors that influence harm reduction strategies
Given the unique psychological risk profile of psychedelics, and the rapid increase of users in Australia, the application and evaluation of specific harm reduction interventions for this population is urgently needed to reduce the risk of potential psychological harms. Differing motivations and intentions for psychedelic use were identified, which appeared to interact with the social setting of drug ingestion and potential harm minimisation strategies identified. For example, one study found that those who had intentions for self-treatment were more likely to report having the psychedelic experience in a solo setting either with or without a sober guide 54.
- Current therapeutics for depression are slow-acting, taking several weeks before demonstrating efficacy, and approximately 1/3 of patients will not respond to them (Rush et al. 2006).
- For instance, the use of cognition enhancing substances to pass exams or to get a promotion at work can be seen as cheating (Savulich et al., 2017; Colzato, 2018) and may not be fair to those who choose not to use it.
- All data analysed in the current study are included in this published article (and its supplementary information files).
Microdoses of a Psychedelic
With regard to rodent models of PTSD, using psychedelics in combination with or fear extinction training could possibly strengthen these specific circuits to mitigate fear responses. A) Percentage of respondents who stopped using at least 1 psychedelic substance in a regular dose (white bar) or a microdose (black bar) depicted per reason. (B) Percentage of respondents who experienced negative side effects and currently microdose (light grey bar) or who experience negative side effects and stopped microdosing (dark grey bar) depicted per type effect. (C) Percentage of respondents who experienced negative side effects and currently microdose (light grey bar) or who experienced negative side effects and stopped microdosing (dark grey bar) depicted per effect onset. An online questionnaire was advertised to psychedelic users on several psychedelic websites and fora between March and July 2018.
Shutdown leaves gaps in states’ health data as respiratory illness season begins
Thus far, there has only been one placebo-controlled trial studying the effects of psychedelic microdosing (Yanakieva et al. 2018). This study focused on time-perception, but did not assess the effects of psychedelic microdosing on emotionality. We conducted an anonymous online survey of 2347 people to 1) document the prevalence of psychedelic microdosing, 2) determine the perceived effects of this practice on depression, anxiety, memory, attention, and sociability and 3) establish the common motives for discontinuing the practice. In addition to microdosing psychedelics alone, growing interest has focused on a practice referred to colloquially as stacking which involves combining microdoses of psychedelics—primarily psilocybin-containing mushrooms—with other substances that are proposed to accentuate salutary effects.
Data Availability
In general, our findings highlight the diversity of practices gathered under the umbrella of microdosing. Indeed, although the present examination provides the most detailed account to date of the practice of stacking, our conclusions are nonetheless limited by a need for more fine grained detail regarding stacking practices. As such, disambiguating the form of Lion’s Mane consumed by participants is an important distinction for future studies in order to minimize potentially contradictory effects. Further, the literature on stacking substances independent of psychedelic substances is itself limited, particularly with respect to clinical trials with human subjects53,54. In light of the limitations inherent in generalizing from animal to human models, proposals regarding the mechanisms underlying stacking remain speculative and warrant cautious interpretation. Thus, a promising avenue for future microdosing studies would be to distinguish the independent effects and synergies of psychedelic and stacked substances.
- Taken together, a recreational, full dose can prove costly and impractical for certain disorders, requiring individuals to be supervised in a controlled, clinical environment.
- In addition, the sample was too small in order to make a comparison between microdosing and the different kind of offered treatments, such as medication or therapy sessions.
- However, the first modern placebo controlled study reported no significant changes in subjective levels of mental focus when comparing the acute effects of 3 different single microdoses of LSD with a placebo (Yanakieva et al., 2018).
- These findings suggest that differing intentions for use may inform different harm reduction or benefit enhancing strategies.
Prevalence of psychedelic microdosing
To compare the effectiveness of self-medication with psychedelic microdoses with conventional treatment, and regular psychedelic doses, binary logistic regressions were conducted for the mental (total) and physiological (total) diagnoses for each of the three effectiveness questions. In case of significant results, separate binary logic regressions were conducted for each category within the mental or physiological diagnosed group in order to examine whether this effect was disorder-specific. It has not been established that the hallucinations produced by psychedelic compounds are necessary for their positive effects on mood and anxiety. First, psychedelics of the entactogen class, such as MDMA, do not reliably produce hallucinations, yet MDMA has demonstrated efficacy for treating PTSD in phase II clinical trials (Dunlap, Andrews, and Olson 2018). This promising therapeutic recently received breakthrough therapy designation by the Food and Drug Administration (FDA), and phase III clinical trials are already recruiting subjects. Additionally, anecdotal reports have suggested that low, sub-hallucinogenic doses of psychedelic compounds might also possess therapeutic value.
Several online psychedelic community forums were identified which facilitated information and experience sharing between peers 39, 60. Users reported being more likely to seek information from their own experiences, online forums, their peers and peer reviewed journal articles over other sources such as health practitioners or government sources. Harm reduction is currently included in the Australian Governments National Drug Strategy to 2027, so formal harm reduction interventions for users of psychedelic drugs are likely to be driven by government bodies or healthcare workers 25. This is a challenge which may need to be considered in the development of harm minimisation campaign strategies, as our review suggests that harm reduction efforts may be more readily received if they are peer led or come from academic sources. Users of psychedelic drugs in naturalistic settings seek knowledge about the substance they are taking, including dosage recommendations, safe usage practises and suitable settings for ingestion 37, 43, 46, 51, 53.
However, some findings suggest that, like psychedelic users more broadly, microdosers are disproportionately male and lower in education and income relative to non-microdosers9,30. Interestingly, microdosers report higher levels of past year substance use but lower levels of substance use disorders, anxiety disorders, and negative emotionality3,15. An extensive range of harm reduction or benefit enhancing strategies are reported by people who take psychedelic drugs in naturalistic settings 51, 53.
Participants who were informed through their knowledge seeking of what to expect from the psychedelic experience, felt more capable of navigating through a challenging experience 43, whilst users with little prior knowledge were more likely to report adverse outcomes 20, 40. Microdosing with psychedelics, the practice of taking a low dose of a psychedelic every couple of days, seems to be an increasing trend among science, technology, engineering, and mathematics professionals. Multiple anecdotal reports suggest performance enhancing effects; however, these positive reports may overshadow potential negative experiences. Only one-fifth experienced negative effects of which most occurred acutely after consumption of the substance. Negative effects were not a reason to stop microdosing whereas absence of self-rated efficacy was. The most frequently reported motives and effects of microdosing are stimulating productivity, for example, increasing focus, energy levels, and creativity and inducing positive mood (Johnstad, 2018; Prochazkova et al., 2018; Winstock et al., 2018; Polito and Stevenson, 2019).
Rand estimates that 8 million people in the U.S. used psilocybin in 2023 and half of them reported microdosing the last time they used it. Use of music during the psychedelic experience to reduce distress was reported in four out of the 27 studies 43, 47, 51, 53. Some users reported approaches such as preparing a specific playlist before the experience, and others found that changing the music during an experience could be a helpful de- escalation strategy to reduce strong uncomfortable emotions, due to its ability to amplify or shift emotional states 43. Motivation to microdose was assessed by summing the total amount of responses for each of the 5 main motivation categories.
Nevertheless, specifying the exact dose is difficult for respondents (Johnstad, 2018), which might be due to not knowing its purity and/or not having the right equipment to adequately dose when motives and side-effects of microdosing with psychedelics among users pmc using such small amounts (thethirdwave, 2018). With regard to microdosing motives, the majority of the respondents (37%) indicated they microdosed for performance enhancement, such as to increase energy, creativity, and concentration. Accordingly, the majority of the microdosers did so at the workplace, of which computer/office work and studying was their main daily occupation.
Common Drugs Used for Microdosing
Furthermore, as a dose-specific difference in SRE of neurodevelopmental and physiological disorders was not seen, it could be hypothesized that such an experience is not necessary for these disorders, suggesting a different mode of therapeutic action. However, future clinical studies need to properly assess this, as well as further explore whether effects are specific and not due to other currently unmeasured components of psychedelic therapy (28), and investigate the neurobiological mechanisms underlying the acute quality of the experience. The present study aimed to investigate, by means of an online questionnaire, the self-rated effectiveness (SRE) of self-medication with psychedelic microdoses for diagnosed mental and physiological disorders, compared to conventional treatments and regular doses of psychedelics. Overall, findings showed that SRE of MDP on all three effectiveness questions (“Did it work?”, “Did symptoms disappear?”, “Did your quality of life improve?”) was higher compared to that of conventional treatments for both mental and physiological diagnoses. In contrast, SRE of microdoses was lower compared to that of regular psychedelic doses for mental disorders, while for physiological disorders no difference was shown. Specifically, compared to conventional treatments, further analysis demonstrated that MDP was only rated more beneficial on all three effectiveness questions for neurodevelopmental and anxiety disorders, ad hoc analyses revealed that only ADHD/ADD accounted for the results for neurodevelopmental disorders.