#182 - David Nutt: Psychedelics & Recreational Drugs

Nov 1, 2021 1h 38m 13 insights

David Nutt is a psychiatrist and a neuroscientist at Downing College, Cambridge. His research focuses on illicit drugs—their harm, classification, and potential for therapeutic use in psychiatry. In this episode, David discusses his framework for assessing the potential harm caused by common recreational drugs and explains how they are regulated, which is oftentimes misaligned with actual risk. He describes in detail the neurobiology, mechanisms of action, and addiction potential of alcohol, opiates, cocaine, and methamphetamine and contrasts those with psychedelics, which have been given a similar regulatory classification despite their relatively low risk of harm and their numerous potential therapeutic uses. Additionally, David explains the promise of psychedelics like ketamine, MDMA, and psilocybin for treating drug addiction and depression and discusses how political pressures have created roadblocks to future necessary research. We discuss: <ul> <li>David's early interest in the brain and experience in psychiatry [2:45]; </li> <li>David's brief work on government drug policy in the UK [10:15]; </li> <li>A scale for rating the relative harm of certain drugs [13:45]; </li> <li>The contrast in regulation between cannabis vs. alcohol and why research on potential benefits of cannabis is lacking [19:15]; </li> <li>The opiate crisis and rise of fentanyl: the cause and potential solution [25:00]; </li> <li>The science of addiction and the potential use of psychedelics for treating drug addiction [35:00]; </li> <li>Cocaine: mechanisms of action and risks [41:45]; </li> <li>Methamphetamine and crystal meth: mechanisms of action and neurotoxicity [48:15]; </li> <li>How psychedelics came to be classified as schedule I drugs despite their numerous therapeutic uses [52:45]; </li> <li>The history of MDMA and the bad science and political forces leading to its demonization [1:08:45]; </li> <li>History of ketamine, medical use of esketamine, and the waning effects of psychedelics with increasing usage [1:13:30]; </li> <li>Psilocybin for depression: David's promising research and the roadblocks to more robust experiments [1:20:15]; More.</li> </ul> <div>Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a> Show notes page for this episode: <a href="https://peterattiamd.com/davidnutt">https://peterattiamd.com/davidnutt</a> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a> Connect with Peter on Facebook | Twitter | Instagram.</div>

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Actionable Insights

1. Consider Psilocybin for Depression

Psilocybin, administered in a therapeutic setting, showed efficacy comparable to escitalopram (Lexapro) for depression, but with potentially fewer side effects, particularly regarding sexual dysfunction and emotional blunting, by disrupting negative thought patterns rather than broadly dampening the limbic system.

2. Test Black Market Drugs for Fentanyl

To combat the opioid crisis, allow individuals to test black market drugs for fentanyl to prevent accidental overdose, and advocate for safer treatments like medical cannabis for chronic pain.

3. Explore Ibogaine for Opioid Addiction

Ibogaine shows promise in treating opioid addiction by disrupting habit circuits, but it should be administered in a controlled medical setting with cardiac monitoring due to potential cardiac risks, and ideally not during acute withdrawal.

4. Evaluate Drugs by 16 Harms

Assess drugs using a multi-criteria decision analysis that considers 9 harms to the user (e.g., acute/chronic toxicity, dependence) and 7 harms to society (e.g., economic, family damage) to transparently and reliably rate their overall impact.

5. Assess Drugs: Risk vs. Trait Change

When considering drug use, evaluate two factors: the physical risk to the individual and whether the drug can alter a positive trait (improve life off the drug) or merely alter a temporary state.

6. Avoid Cocaine: High Risk, No Trait Benefit

Cocaine carries non-trivial physical risks, including cardiac toxicity and potential for dependence, and does not offer long-term trait alteration benefits, making its use generally ill-advised.

7. Ketamine for Depression: Mind Dosage

Ketamine can be effective for treatment-resistant depression, but recreational or daily use should be avoided due to risks of tachyphylaxis, severe cognitive impairment, and bladder damage; twice-weekly use appears safer in a clinical setting.

8. Space Out Psychedelic Doses

To avoid tachyphylaxis, which causes diminishing effects, allow at least one to two weeks between psychedelic doses, as repeated daily use quickly renders them ineffective.

9. MDMA for Empathy in Therapy

MDMA, an empathogen, can be useful in psychotherapy and couples counseling to foster clarity of thought, warmth, and empathy, potentially breaking down psychological resistance and improving relationships.

10. Implement Recreational Drug Harm Reduction

For recreational drug use in social settings, ensure access to free water and ‘chill out rooms’ to mitigate harms like dehydration and hypothermia, as demonstrated by historical ecstasy harm reduction policies.

Understand that social factors and coping with life stress are hugely important reasons why people use drugs and develop addiction, which can inform more empathetic and effective prevention and treatment approaches.

Listeners are encouraged to provide feedback on their thoughts and suggest topics for future episodes to help guide deeper discussions.

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