Welcome to Impact Factor, your weekly microdose of commentary on a new medical study. I'm Dr F. Perry Wilson.
In 2006, 36 research subjects were given the psychedelic agent psilocybin under carefully controlled lab conditions. The majority reported having a mystical experience, with 21 of 36 rating it one of the top five most personally meaningful experiences of their lives.
Lab-controlled experiments of the effects of psychedelics have repeatedly shown that the agents can induce so-called "transformative experiences"powerful, nearly religious experiences that may even lead to a reevaluation of central values. Lab studies also suggest that they can cause a dissolution of the ego, leading to certain universal "oneness" and lasting positive effects. But let's be honestthe vast majority of people who use psychedelics aren't using them in laboratories.
So where do you go to find people using psychedelics in the real world?
Yup. Burning Man.
You've probably heard of Burning Man, Coachella, Lollapalooza. And if you were a part of Dr Molly Crockett's Yale team of psychology researchers, you could actually gofor science!
Results of the in-the-wild study appear in this week's Proceedings of the National Academy of Sciences. The team attended six multiday mass gatherings in the United States and United Kingdom and set up a booth to interview participants about their experiences with various substances.
Credit to clever survey design here. They maintained anonymity by creating a unique identifier for each individual. And to make sure that people weren't actively under the influence, they included a few sobriety checks in the questionnaire. Here's one:
Did you catch that?
To ensure that participants would be comfortable being honest about their exposures, they mixed legal sources of exposure into the survey examples. So instead of asking if the participant had been smoking marijuana, they asked whether he or she had used cannabis products (eg, weed, THC, CBD, hemp oil).
The numbers indicate... well, about what you'd expect.
Eighty percent of individuals surveyed had used alcohol at the event, 51% had used cannabis products, and just over a quarter had used psychedelics. About 1 in 8 reported using no substances at all.
The big question was whether those mystical effects seen in the lab would translate to the real world. And, indeed, they seemed to.
Those who had taken psychedelics were more likely to report a transformative experience, more likely to have a positive mood, and more likely to feel socially connected. This was independent of the effect of other agents.
Now, you might think that people predisposed to take psychedelics are also more likely to claim transformative experiences. The researchers tried to disentangle that by asking the participants about their desire and expectation to have a transformative experience. The effect of psychedelic exposure was just as robust even after accounting for that desire.
The transformative experiences themselves were different when psychedelics were involved compared with other drugs. They were more positive and more likely to lead to shifts in one's moral values.
Now, a major caveat is that the survey wasn't really designed to pick up adverse drug effects, so take the Pollyanna-ish results here with a grain of lysergic acid. But still, overall, the drugs seem to do in real life what they do in the lab. And broadly, the effects are positive.
But why are we talking about this? Three reasons.
First, it's a fun study to remind us that science is cool and doesn't have to be done in a petri dish.
Second, it's a study to remind us that some of our patients use drugs that don't come from us. It is part of good medical practice to ask about them and to understand their effects in context.
But most of all, I think we need to start paying more attention to this space. Softening social attitudes toward certain drugs like cannabis and psychedelics have opened the door to more robust research about their effects. And though it's early days, there seems to be some promise here.
Depression is an epidemic in this country. Current therapies are okay but fail in too many patients. I am encouraged that certain previously verboten drugs, like ketamine, are seeing a rebirth as potentially game-changing antidepressants. We should proceed slowly and cautiously in evaluating any substance that has the capability to alter the sensorium so profoundly (and even change our moral values), but we'd be remiss to dismiss them out of hand. So pay attention. And stay groovy.
F. Perry Wilson, MD, MSCE, is an associate professor of medicine and director of Yale's Program of Applied Translational Research. His science communication work can be found in the Huffington Post, on NPR, and here on Medscape. He tweets @methodsmanmd and hosts a repository of his communication work at http://www.methodsman.com.
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