Annika Loebig

"I was feeling really tense at the beginning of the pandemic and didn’t want to go on a big trip because I was afraid,” a member of the 160,000 strong microdosing subreddit tells me. “But I didn’t have work and had plenty of time for a few months, so I decided to experiment with microdosing." At a time when we’re stripped of many ways to look after our mental hygiene, it is unsurprising that some people resorted to alternative sources of support. The Global Drug Survey (GDS) published last year showed an increase in use of traditional psychedelics such as LSD, magic mushrooms, and DMT. However, the biggest increase was seen in the use of dissociative drugs such as the anaesthetic ketamine, colloquially known as ket or K. Although there are some obvious problems with people using untested drugs more liberally, particularly in an unregulated setting, the GDS in fact reported that out of 110 thousand respondents, 6,500 used recreational drugs as mental health self-treatment. But this is far from novel drug using behaviour. "I weaned off Effexor before starting, an antidepressant prescribed to me because living with pain makes you sad. It never worked,” one respondent tells me. “After a week of microdosing, the feeling of lingering sadness lifted along with feelings of anxiety, overwhelm, anger, impatience...I feel better than I have in years so I hope that it will help me get rid of migraines too." "After a week of microdosing, the feeling of lingering sadness lifted along with feelings of anxiety" A common takeaway was that people tried microdosing to alleviate mental and physical pain way before the pandemic. Psilocybin mushrooms, also known as magic mushrooms, were amongst the most popular plant medicines, with respondents self-reporting use of 0.03 mg to 0.27 grams on one or even four days, followed by two days off. Some also occasionally microdosed LSD in the same pattern. They reserved larger doses for times they wanted to 'go deeper' or feel the 'full healing effects', often in the company of friends and usually followed by longer breaks. "Sometimes a ‘macrodose’ is enlightening, other times frankly, it’s just a fun way to escape the monotony of everyday life, especially during quarantine days.” These testimonies are consistent with studies that showed one of the biggest benefits from microdosing includes an increase in overall wellbeing, and reductions in depressive symptoms. According to a paper published in 2019 on microdosing, 92.9% of respondents reported improved mood, and 59.2% said it helped their anxiety, while some (6.7%) experienced an increase in anxiety. It even helped reduce their use of other substances such as caffeine (44.2%), alcohol (42.3%), tobacco (21.0%), and psychiatric prescription medications (16.9%). Particularly for those who are resistant to antidepressants, psilocybin therapy has shown to be hugely beneficial for patients. As the aforementioned study shows that treatment-resistant depression affects 30% of patients with major depression, psilocybin holds great potential for the future of therapy. A member of a private Facebook group that discusses psychedelic use told me that he was interested in replacing his pharmaceutical medicines with plant medicines. After a few hit-and-misses with various substances, he gave psilocybin a try around four months ago - without planning on stopping anytime soon. “I've been struggling with depression, anxiety and PTSD for years now,” he tells me over a Facebook chat. “I read a news article about Oregon’s legalisation of psilocybin in therapeutic settings for those suffering from mental ailments. I thought I might try it since I have had great experiences in the past with psychedelics. I expressed this to a good friend and they immediately got some for me. If I can't get a hold of mushrooms again, I have ayahuasca waiting for me.” Although psilocybin came up a lot during my journey exploring the psychedelic universe, many extended the definition of plant medicines; CBD oils, adaptogenic plants and mushrooms like the Reishi mushroom, the stress relieving evergreen shrub Ashwagandha, passion flower and Valerian root tinctures all received notable mentions as cures to the ills of lockdown. One user emailed me to tell me about the benefits of cacao, a plant full of antioxidants that releases ‘feel-good’ hormones serotonin and dopamine, and anandamide - a neurotransmitter that helps bind together our cannabinoid receptors, perhaps better known as the receptors which the psychoactive compound THC in cannabis acts on. Lockdown might have made some of us feel as if drugs were in greater supply than flour and toilet paper, but even with the wide reach of the Global Drug Survey, it’s impossible to generalise experiences of psychedelic self-medication, as it involves a complicated set of different drug-using behaviours, Steve Rolles, policy analyst at Transform Drug Policy Foundation, tells me. “Some people used lockdown as an opportunity to cut down or stop using drugs, get healthier and make a change in their lives, which I hope is a good thing,” Steve tells me as we talk about the complexities of substance use during lockdown. “But some people may use drugs more because they are bored, so they get stoned to enhance playing video games for example. For others, if their relationships have suffered, if they are lonely or having other emotional or psychological problems, or if they have underlying mental health issues like depression, these problems are often made worse by lockdown. People with mental health problems generally have higher levels of alcohol and other drug use.” “In these scenarios, you might well see more substance use, often as a form of self-medication. Some people will use alcohol or benzodiazepines, opioids or ketamine as a form of escape. They're drugs of despair in some ways. They're used for people to relieve themselves of stress or sadness, or trauma, offering ways to escape from reality that you're finding difficult. Psychedelics are slightly different.” It’s difficult to place psychedelic use into the binary of medical and non-medical use, he tells me. Psychedelic’s grey area encapsulates a variety of practices and intentions, from spiritual uses for overall wellness, such as formal shamanic-guided experiences, to placebo-controlled trials in medicinal settings in which psilocybin (magic mushrooms) might be compared to the effects of classic antidepressants. In fact, a recent study published this April in the New England Journal of Medicine found that when assessing the effects of antidepressant escitalopram and psilocybin on patients with moderate to severe depression, the benefits of the active compound in magic mushrooms showed greater reductions in depression scores. Not only that, but they also occurred more quickly. Participants received daily placebo capsules for six weeks, the same length of the treatment with escitalopram, alongside therapy during and after their sessions. This meant that the researchers were able to compare the therapeutic effects of two doses of psilocybin to 43 daily doses of one of the leading SSRI (Selective Serotonin Reuptake Inhibitor) antidepressants. In addition to a greater magnitude in decreased depression scores, 57% of participants in the psilocybin group experienced a greater remission of symptoms, while only 28% did in the escitalopram group. Despite these promising research findings, the authors of the study do not condone self-medication and instead encourage its medicinal use in a clinical setting that offers therapeutic support. Reading this reminded me of Sophie Marsh, writer at Channel Void, a digital publication dedicated to discussions about holistic healing and art. In our interview, she tells me that she’s been ‘casually using psychedelics’ for the past four to five years after choosing not to go on antidepressants or antipsychotics to deal with elements of her PTSD. “I have always found mushrooms in particular to be something that gives me a sense of presence, and that restructures traumatic patterns,” Sophie tells me. “My biggest experience with plant medicine was actually ayahuasca, which was at the end of last year and that really shattered a visceral layer of grief, pain, unrest for me, that was kind of harboured within my body and my soul.” "My biggest experience with plant medicine was actually ayahuasca, which was at the end of last year and that really shattered a visceral layer of grief, pain, unrest for me, that was kind of harboured within my body and my soul." Psychedelics have enabled her to get to the root of her thoughts which impact her behaviour, so that she could better adapt her behavioural patterns in a way that’s more conducive to a healthy lifestyle, she tells me. She would usually use psychedelics about twice a month together with friends around nature, bringing food and music to ensure the setting is as supportive and safe as possible. “On that day, we really zoom out, in terms of what has been working, what cycles we've been stuck in, what patterns of behaviour or responses or reactions we have been relying on. I guess it's like a self-interventional strategy. It's been a process of self-trust, coming to govern your life like that and realising you're the one with the hands on the wheel, at any given time.” Sophie has tried traditional therapy since the age of around 15/16, but found that psychedelics have helped her speed up the process of healing. As helpful as it was to have a therapist assist her, she’s found that the self-authorship microdosing psychedelics or tripping together with friends offered her has been "a more effective and fruitful process". “I think we need to make a distinction between clinical medical use of psychedelics, and a space that we might define as more informal medical, or spiritual, or wellness, and then people just having fun,” Steve tells me. “Not all psychedelic use is motivated by medical or spiritual needs. A majority is more simply recreational. People taking magic mushrooms and going to parties, or taking LSD and going to a festival. It's more hedonistic, enhancing an experience.” “It's not going to be for everybody, some people will have a really challenging time on psychedelics. They'll revisit past traumas, and sometimes they'll be crying, and it can be really, really difficult. For many this will ultimately be positive and they come out of it feeling better, but there are no certainties.” "It's not going to be for everybody, some people will have a really challenging time on psychedelics. They'll revisit past traumas, and sometimes they'll be crying, and it can be really, really difficult." We’ve been aware of the positive effects of psychedelics on our mental wellbeing for a long time, way before Albert Hoffman synthesised LSD in 1938 or Aldous Huxley dissolved mescaline in a glass of water. Psilocybin is a psychedelic compound found in a variety of mushrooms in regions in South America, Mexico and the United States and has been used in shamanic rituals for centuries. But after a clampdown on the counterculture of the 60s and 70s, the War on Drugs announced by president Richard Nixon in 1971, and a subsequent 40-year pause on psychedelic research, drug use has been heavily stigmatised and made it virtually impossible to reap its benefits. But there is hope. Bristol has now opened its first ever psychedelic-assisted therapy clinic AWAKN Life Sciences Inc. led by Professor David Nutt, chairman of the non-profit organisation Drug Science, and psychiatrist Dr Ben Sessa. The clinic will be open for people with a variety of mental health issues from PTSD and depression to eating and alcohol use disorders (and those having £6000 lying around), in the hopes that this will eventually lead to a more accessible treatment option for the wider public. One has to wonder though what it says about the UK’s drug war when private institutions are able to open clinics before we offer for example overdose prevention centres or heroin-assisted treatment, two proposals that would arguably help more people harmed by the War on Drugs than those tripping with a therapist. “I welcome the emergence of these services,” Steve tells me. “But I do worry about corporate influence on psychedelics policy, particularly around medical provision. There's a lot of money being poured into psychedelic research at the moment. A lot of it is very speculative investor-based money. There's a lot of patenting going on, you know, attempts to patent very basic kinds of elements of psychedelic treatment, like lying on a sofa, listening to music.” He points out that while researchers rely on private investments to push research forward, he wished traditional government agencies like the National Institute for Health Research or the Economic and Social Research Council would contribute more to ensure research is conducted in the public good and is made freely available for all of society to benefit from. The fact that festival-goers can now test their drugs with the help of non-profit groups like The Loop is a welcome form of harm prevention, but it does expose the government’s priority to allow groundbreaking services to specific types of people in society before other apparently less worthy groups, like homeless people who inject heroin, who still don’t have access to supervised consumption facilities. What would decriminalisation of drugs look like in a way that protects public health and helps those most harmed by the War on Drugs? “Decriminalisation is what the World Health Organization refers to as a critical enabler of an effective public health response. So the idea being that you don't criminalise the population of people you are trying to reach and support. Criminalising adult risk behaviors just isn't a sensible public health approach. There are lots of behaviors which are risky, like unsafe sex or unhealthy eating, but we don't criminalise them - we try and manage them to minimise risks.” But changing the law is not enough. “Whether it's cannabis, MDMA, or anything else, we need to learn from the mistakes that we've made with alcohol and tobacco.” After seeing the social and health impact of heavy commercialisation, it’s become clear to Transform that ending the War on Drugs requires restrictions on profit-driven corporations who may seek to distort public health policy. “We're always trying to say: Look, yes, we want to legalise drugs, but we don't want to have cocaine brands sponsoring football teams. Or have MDMA brands sponsoring music festivals or whatever. You want to meet the demand for these things as they currently exist in the safest way possible, but you don't want to actively promote them.” Unfortunately, drugs and capitalism don’t mix well, he says. This is why Transform is advocating, amongst its many proposals, for a state monopoly on more risky drugs when they are legalised, which means that a government agency would control drug sales through state shops. The generated income could then fund communities impacted by the War on Drugs, as well as education, treatment, and harm reductions. Pharmaceutical packages containing MDMA might limit individual purchases to 5 x 30 mg in pill form, for example, or a gram of powder cocaine. Mockup of pharmaceutical MDMA package. Image courtesy of Transform Drug Policy Foundation. “The good thing about a regulated supply of any drug is it creates opportunities to transmit vital health information to the right people. So the package has information on it, and the person giving you the package is trained to tell you about risks and how to moderate them.” Although fatal overdoses with MDMA are rare, symptoms such as panic attacks, seizures and faintness can still occur, while cocaine fatalities more than doubled from 320 in 2015 to 708 in 2019, with poverty being the main driver behind this. Not only regulating the supply but also giving users potentially life-saving information through packaging can therefore play a part in mitigating the adverse health effects. Amongst all the logistical questions, and the need for a taxonomy and hierarchy of risks associated with drugs to inform how we would regulate them, it’s easy to get swept up in policy discussions while forgetting the real people who have been harmed by the War on Drugs. Transform’s campaign Anyone’s Child tries to remind us of that by telling people’s experiences with the harms of drug enforcement, and the consequences of laws that have criminalised, and sometimes even killed, their children. "I think it's useful to say that we're not decriminalising the drugs. We're decriminalising the people."

Annika Loebig

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