Mar 24, 2021
Brian Holoyda, MD, MPH, MBA, conducts a Masterclass on the
history of psychedelic research and how the renaissance of this
drug class could affect psychiatric patients.
Dr. Holoyda, a
forensic psychiatrist, practices in the San Francisco Bay Area. He
also provides psychiatric consultations across the country. Dr.
Holoyda has no disclosures.
Take-home points
- The effects of psychedelics are dose dependent and difficult to
predict. The impact of psychedelic treatment on violent behaviors
was studied since the 1960s with varying results. More recent
studies suggest that psychedelic use (excluding phencyclidine, or
PCP) is associated with less violent crime.
- Dr. Holoyda recommends that, before psychiatrists treat
patients with psychedelic-assisted psychotherapy, patients should
be screened for history of violence or aggression while using
psychedelics (and in general) and a history of serious mental
illness. Patients require informed consent about the risk of
violence and interventions used to control aggressive
behaviors.
Summary
- In 1960, the Harvard Psilocybin Project included a study in the
Concord (Mass.) Prison in which researchers hypothesized that using
psychedelic-assisted psychotherapy in prisoners would reduce risk
of violent recidivism. The original authors, including Timothy
Leary, PhD, published varying results of the study – including
that psychedelic use reduced recidivism. However, some argue the
overly positive results from the first analysis were attributable
to a halo effect. A recent reanalysis showed that the base rate for
recidivism in the intervention group was 34%, and not significantly
different from that of the control group.
- Psychiatrists have continued to use psychedelic-assisted
therapy for patients with psychopathology and treatment-resistant
sexual offenders to investigate whether the transcendent
experiences can change their personalities, including the
development of insight and empathy.
- Dr. Holoyda published a review of all published cases in
medical literature discussing psychedelic use and violent behavior.
Most of the cases were published in the 1960s-1970s, when
psychedelics were viewed negatively as a product of the
counterculture era.
- More recent observational studies identified that psychedelics
use is associated with a greater likelihood of carrying a firearm
as well as intimate partner violence, but these newer studies are
fraught, because PCP is sometimes classified as a psychedelic.
Other epidemiological studies have identified reductions in violent
behaviors associated with psychedelics use, compared with other
illicit substances. Those reductions in violent behaviors include a
lower probability of supervision failure, and a lower risk of
intimate partner violence and drug distribution.
-
Peter S. Hendricks, PhD, and associates analyzed data from 225
million individuals who took the National Survey on Drug Use and
Health from 2002 to 2014 with a focus on psychedelics use,
excluding PCP. They
found that a lifetime history of psychedelic use decreased the
odds of theft, assault, and arrest for property and violent crime.
Studies such as this suggest that individuals who favor
psychedelics may be less prone to violent crime rather than a
direct effect of psychedelics on decreasing violent crime.
- As psychedelics enter the clinical sphere, clinicians must keep
in mind that experiences on these agents are unpredictable. In a
study of unmonitored psychedelic use, individuals report putting
themselves or others at risk. Others reported behaving aggressively
or violently, and others sought help at a hospital.
- Before using psychedelics in a therapeutic environment,
clinicians should assess patients’ past use and experience on
psychedelics. They also should screen for history of “bad trips,”
leading to aggression, agitation, paranoia, and risky behaviors. In
clinical trials with psychedelics, individuals with history of
bipolar and psychotic disorders have been excluded to reduce the
risk of triggering an episode. For medicolegal protection,
psychiatrists should engage in a thorough informed consent process
before using psychedelic-assisted therapy.
References
Holoyda B.
Psychiatric Serv. 2020;71(12): 1297-99.
Holoyda B. J Am Acad
Psychiatry Law. 2020 Mar;48(1):87-97.
Hendricks PS et al. J Psychopharmacol. 2017 Oct 17.
doi: 10.1177/0269881117735685.
Carbonaro TM et al. J
Psychopharmacol. 2016;30(12):1268-78.
Metzner R. Reflections on the Concord prison project and the
follow-up study. Bulletin of
the Multidisciplinary Association for Psychedelic Studies/MAPS.
Winter 1999/2000. 9(4).
Arendsen-Hein GW. LSD in the treatment of criminal psychopaths,
in "Hallucinogenic
Drugs and Their Psychotherapeutic Use." (London: H. K. Lewis & Co,
1963).
Leary T. Psyched Rev. 1969;
10:20-44.
Leary T and Metzner R. Brit J Soc Psychiatry. 1968;2:27-51.
Leary T et al.
Psychother. 1965;2:61-72.
Doblin R. J
Psychoactive Drugs. 1998; 30:419-26.
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Show notes by Jacqueline Posada, MD, associate producer of the
Psychcast; assistant clinical professor in the department of
psychiatry and behavioral sciences at George Washington University,
Washington; and staff physician at George Washington Medical
Faculty Associates, also in Washington. Dr. Posada has no conflicts
of interest.
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