What Psychiatrists Think Of Current US Psychedelics Policies

Psychiatrists differ considerably in their perceptions of certain psychedelic substances.

That's according to a new report from Ohio State University, in which 181 doctors took part in a survey about psychedelic safety and therapeutic value, as well as how they are categorized under U.S. policy.

These substances were originally classified in 1970, following the Controlled Substances Act. Yet since then, research and discovery on their dangers and potential uses has greatly advanced. It's worth noting that alcohol is currently not scheduled, despite it being the third leading cause of preventable death.

Many of the psychoactive drugs classified within the Schedule I group are believed to have no medical use and pose a high risk of abuse risk. Even though they have been consistently proving otherwise in recent studies, their current classification limits further advancement in research. 

On the other hand, the latest reports document the increased popularity of marijuana and hallucinogenic drugs among Americans. And psilocybin might be a perfect fit for treating several mental health conditions.

“The question became, are these schedules actually in alignment with the current state of evidence as measured through experts in the field of psychiatry?" Coauthor Alan Davis said. "That really was the whole point of this study.”

And what they found is that current scheduling ought to be updated, with “a flexible policy that can incorporate expert consensus.”

The Survey

Psychiatrists with an average 16-year-old practice participated in the online poll. They had to read one of four vignettes depicting a depressed patient who had found symptom relief after taking a non-prescribed psychoactive drug [methamphetamine (Schedule II), ketamine (Schedule III), psilocybin (Schedule I), or alprazolam (Schedule IV)].

Participants were also asked to rate their agreement level with hypothetical clinical decisions and future outcomes for each of the scenarios, and on the safety and therapeutic and abuse potential of the four listed drugs plus alcohol.

“We wanted to choose two drugs for the vignettes that we felt were appropriately scheduled based on the scientific evidence, and then we chose two that we felt were not necessarily reflecting current evidence," coauthor Adam Levin said.

“Psilocybin may not be appropriately scheduled, and we felt risk might be underestimated for Xanax. Methamphetamine and ketamine, based on a review of the literature, are fairly consistent with their schedules. And then we wanted to see whether psychiatrists perceived any incongruities,” he added said.

In the case of currently Schedule IV Alprazolam (Xanax), considered to behold low potential for misuse and dependence and a strong therapeutic value, psychiatrists rated it as presenting the highest misuse potential out of all four substances, together with methamphetamine and alcohol. 

In fact, Alprazolam (commercially known as Xanax) currently belongs to the third most commonly misused group of substances in the U.S., known as benzodiazepines. 

“Methamphetamine, alcohol and Xanax were rated statistically equivalent in terms of their abuse potential. And we showed a similar finding where methamphetamine, alcohol and Xanax were all found to be equivalent in terms of lower on the safety scale – more unsafe compared to psilocybin and ketamine,” explained coauthor Alan Davis.

On its behalf, psilocybin was rated as having the second-highest therapeutic potential behind ketamine, and as holding the lowest potential for misuse.  

“The problem is that our drug schedules don’t match the scientific evidence of their actual harm and their actual therapeutic and abuse potential,” Davis said. 

The researchers are calling on the need for policies to be concordant with scientific evidence, and noted psychiatrists’ views were largely in line with those of other mental health professionals and drug addiction experts, along with drug users themselves. “They’re just not in agreement with the current drug schedule.”

Coauthor Paul Nagib hopes the findings will influence other physicians to rethink their own attitudes towards these substances. “Whatever the evidence brings forward – that’s what we want to follow, rather than outdated policies. Let’s look to where the evidence guides us, even if it challenges what we’ve assumed to be true.”

Photo by National Cancer Institute on Unsplash