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Psicodélicos y Salud Mental: Un Estudio de la Población
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Psychedelics and Mental Health: A Population Study Abstract Background The classical serotonergic psychedelics LSD, psilocybin, mescaline are not known to cause brain damage and are regarded as non-addictive. Clinical studies do not suggest that psychedelics cause long-term mental health problems. Psychedelics have been used in the Americas for...
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Psicodélicos y Salud Mental: Un Estudio de la Población

Teri S. Krebs, Plos One

Lunes 19 de agosto de 2013 (10/02/14)
Plos One ver en plosone.org

Psychedelics and Mental Health: A Population Study




Abstract

Background

The classical serotonergic psychedelics LSD, psilocybin, mescaline are not known to cause brain damage and are regarded as non-addictive. Clinical studies do not suggest that psychedelics cause long-term mental health problems. Psychedelics have been used in the Americas for thousands of years. Over 30 million people currently living in the US have used LSD, psilocybin, or mescaline.

Objective

To evaluate the association between the lifetime use of psychedelics and current mental health in the adult population.

Method

Data drawn from years 2001 to 2004 of the National Survey on Drug Use and Health consisted of 130,152 respondents, randomly selected to be representative of the adult population in the United States. Standardized screening measures for past year mental health included serious psychological distress (K6 scale), mental health treatment (inpatient, outpatient, medication, needed but did not receive), symptoms of eight psychiatric disorders (panic disorder, major depressive episode, mania, social phobia, general anxiety disorder, agoraphobia, posttraumatic stress disorder, and non-affective psychosis), and seven specific symptoms of non-affective psychosis. We calculated weighted odds ratios by multivariate logistic regression controlling for a range of sociodemographic variables, use of illicit drugs, risk taking behavior, and exposure to traumatic events.

Results

21,967 respondents (13.4% weighted) reported lifetime psychedelic use. There were no significant associations between lifetime use of any psychedelics, lifetime use of specific psychedelics (LSD, psilocybin, mescaline, peyote), or past year use of LSD and increased rate of any of the mental health outcomes. Rather, in several cases psychedelic use was associated with lower rate of mental health problems.

Conclusion

We did not find use of psychedelics to be an independent risk factor for mental health problems.

Introduction

Psychedelic plants have been used for celebratory, religious or healing purposes for thousands of years [1]–[3]. Use of psychedelics increased in the 1960s and has remained widespread in many parts of the world ever since. Over 30 million people living in the US have used lysergic acid diethylamide (LSD), psilocybin (magic mushrooms), and mescaline (peyote and other cacti) [4]. Common reasons for using psychedelics include mystical experiences, curiosity, and introspection [5]. The classical serotonergic psychedelics are not known to cause damage to the brain or other organs of the body, or cause withdrawal symptoms, elicit addiction or compulsive use [3], or cause birth defects or genetic damage [6]. Psychedelics often elicit deeply personally and spiritually meaningful experiences and sustained beneficial effects [7]–[12]. Psychedelics can often cause period of confusion and emotional turmoil during the immediate drug effects [13] and infrequently such adverse effects last for a few days after use. Psychedelics are not regarded to elicit violence [14] and dangerous behavior leading to suicide or accidental death under the influence of psychedelics is regarded as extremely rare [15]. LSD and psilocybin are consistently ranked in expert assessments as causing less harm to both individual users and society than alcohol, tobacco, and most other common recreational drugs [16]–[19]. Given that millions of doses of psychedelics have been consumed every year for over 40 years, well-documented case reports of long-term mental health problems following use of these substances are rare. Controlled studies have not suggested that use of psychedelics lead to long-term mental health problems [8], [9], [13], [20]. Here we evaluate the association between the use of psychedelics and mental health among US adults.

Materials and Methods

Ethics Statement

This study was exempt from review by our Regional Committee for Medical Research Ethics because all data are available in the public domain without any identification of personal information. The National Survey on Drug Use and Health (NSDUH) was approved by an institutional review board of the Research Triangle Institute.

Source, Population and Data

The annual NSDUH survey provides estimates of substance use and mental health indicators from a randomly-selected sample representative of the general US civilian non-institutionalized adult population. The Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services is responsible for the NSDUH study design and methods of assessment. Trained interviewers met the randomly-selected participants in their homes, and participants listened to recorded questions via headphones and then entered their answers directly into a computer, providing a highly confidential and standardized setting. We pooled data from NSDUH survey years 2001 to 2004 because in these years participants were asked about symptoms of a range of psychiatric disorders and about whether they have been exposed to an extremely stressful event. We excluded half of the participants from year 2004 because of changes in the survey questions. We restricted the samples to adults aged 18 years and older because younger participants were asked different mental health questions than adults. The response rate was 78%. In addition, approximately 10% of participants were excluded from the public use data file, either because of excessive missing data on drug use or because they were excluded at random in order to increase anonymity. Detailed information on the sampling and data collection methods, including interview instructions and questionnaires, confidentiality and informed consent are available at the NSDUH website (http://oas.samhsa.gov/nsduh.htm).

Use of Psychedelics

We counted participants as having any lifetime psychedelic use if they affirmed use of LSD, psilocybin, mescaline, or peyote. We also examined use of each of the substances separately. Mescaline and peyote was combined into one category “mescaline/peyote” because mescaline is the active substance in peyote cactus, but peyote was also examined separately. Information was also available on past year use of LSD, but not past year use of psilocybin or mescaline. LSD, psilocybin, and mescaline are all classical serotonergic psychedelics with main mechanism of action at the serotonin 2A receptor [3], [21].

Mental Health Indicators

Serious psychological distress.

The K6 scale provides a valid assessment of general psychological distress during the worst month of the past year, that are common to a broad range of psychiatric disorders, with strong accuracy in discriminating between people with and without one or more diagnoses from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV [22]) [23]. The K6 scale asks about frequency, using a 0 to 4 category scale, of six symptoms of psychological distress: feeling nervous, feeling hopeless, feeling restless or fidgety, feeling so sad or depressed that nothing could cheer you up, feeling everything was an effort, and feeling no good or worthless. A score of 13 or more on the K6 scale is the validated and recommended cut-point for serious psychological distress [23].

Mental health treatment.

Past year mental health treatment was divided into four outcome variables: inpatient mental health treatment, outpatient mental health treatment, psychiatric medication prescription, and felt a need but did not receive mental health treatment. Inpatient mental health treatment included overnight stays for alcohol or drug problems at hospitals or rehabilitation centers. Outpatient mental health treatment included treatment for alcohol or drug problems at rehabilitation centers, mental health centers, emergency rooms, doctors’ offices, prisons or jails, or self-help groups. Data was not available on medication prescription for alcohol or drug problems. Needed but did not receive mental health treatment included respondents who felt that they needed treatment for alcohol or drug problems but did not receive any such treatment.

Psychiatric symptom indicators.

Symptoms indicators for eight DSM-IV psychiatric disorders were evaluated using the short form of the World Health Organization Composite International Diagnostic Interview (CIDI-SF) [23]. The CIDI-SF consists of between three to eight questions per disorder and covers eight disorders: panic disorder, major depressive episode, mania, social phobia, general anxiety disorder, agoraphobia, posttraumatic stress disorder, and non-affective psychosis. We also examined each of the seven symptoms of non-affective psychosis individually (the cut-off for non-affective psychosis was two or more of the seven symptoms). The CIDI-SF appears to overestimate the rate of diagnoses, but most false-positive cases have some degree of the disorder even if they fail to meet full diagnostic criteria [23], [24]. We used the CIDI-SF to compare groups on symptom indicators, not to estimate prevalence of psychiatric diagnoses. We used standard scoring and cut-off points [25].

Control Variables

We selected control variables based on associations with mental health in previous research [26]. Control variables consisted of a variety of sociodemographic, psychological, and drug use variables: age at interview (11 categories), gender, race/ethnicity (7 categories: non-Hispanic white, non-Hispanic black, non-Hispanic Native American, non-Hispanic Native Hawaiian or Pacific Islander, non-Hispanic Asian, non-Hispanic more than one race, Hispanic), education (4 categories: did not graduate high school; high school graduate; some college; college graduate), household income (4 categories: less than $20,000; $20,000 to $49,999; $50,000 to $74,999; $75,000 or more), marital status (2 categories: single; married), likes to test self with risky behavior (“How often do you like to test yourself by doing something a little risky?”; 4 categories: never, seldom, sometimes, always), lifetime exposure to an extremely stressful event (“Such as being in combat, being involved in a life-threatening accident, being involved in a disaster, being physically beaten or sexually abused, or any other event which was extremely upsetting or stressful”), and lifetime non-medical use of each of ten types of drugs: cannabis (marijuana), opiates (heroin, opiate pain relievers), cocaine, tranquilizers/sedatives (benzodiazepines, barbiturates), stimulants (amphetamine, methamphetamine, methylphenidate), MDMA (ecstasy), inhaled anesthetics (nitrous oxide, ether), alkyl nitrites (poppers), other inhalants (solvents, volatile chemicals), and PCP (phencyclidine). Additionally, in the analyses of past year use of LSD we also included as control variables past year use of the other drugs listed above, but with only one variable for any past year inhalant use because data on specific inhalants was not available.

Data Analysis

We used multivariate logistic regression to calculate associations between the past year mental health indicators and use of psychedelics, including lifetime use of any psychedelics, lifetime use of LSD, psilocybin, mescaline/peyote, or peyote, and past year use of LSD. We also calculated the associations between the past year mental health indicators and lifetime use of any psychedelics in the presence or absence of other risk factors in stratified subgroups (sex, age, past year illicit drug use, lifetime exposure to an extremely stressful event). Participants with missing data on relevant mental health outcomes or past year illicit drug use were excluded.

The estimated associations between the use of psychedelics are presented as adjusted odds ratios (aOR), 95% confidence intervals (CI), and p-values. A statistically significant odds ratio greater than one indicates an association, and an odds ratio less than one indicates an inverse association. Because the mental health outcomes are all relatively uncommon, in this case, the odds ratio is a close approximation to the relative risk. For example, an adjusted odds ratio of 0.6 for a given outcome indicates that the rate of that outcome in psychedelic users is approximately 60% the rate in non-psychedelic users, after adjusting for control variables.

We used a standard alpha of 0.05; however any significant results should be considered in the context of the number of statistical analysis performed. It is typically recommended to have at least 10 events per predictor variable for multivariate logistic regression, although recent simulation studies suggest as few as 5 events per predictor variable is sufficient [27]. All the unstratified analyses had at least 10 events per predictor variable, with 21 to 379 events per predictor variable for mental health indicators besides the specific psychotic symptoms. In the stratified analyses of three of the more uncommon specific psychotic symptoms (“force inserting thoughts”, “force stealing thoughts”, “plot to harm you”) there were in some cases less than 10 and as few as 5 events per predictor variable. For all control variables the variance inflation factors were under 2.5, indicating little multi-collinearity. All calculations took into account the weighting variables and complex sample design variables of the NSDUH. For all calculations we used SPSS/PASW Statistics (version 18.0.3) with the Complex Samples Module.

Results

Characteristics of Psychedelic Users

The sample consisted of 130,152 respondents, of which 21,979 (13.4% weighted) reported lifetime use of any psychedelic. Tables 1 and 2 show the characteristics of the participants, according to lifetime use of any psychedelic. Compared to respondents with no lifetime use of any psychedelic, respondents with lifetime use of any psychedelic were more likely to be younger, male, white, Native American, or more than one race, have somewhat higher income and more education, not be married, like to test self by doing risky things, experienced an extremely stressful event, and to have used all classes of illicit drugs. For all the control variables, the differences between psychedelic users and non-users was statistically significant (Chi-square tests, for all p<0.001). Before adjusting for these confounding factors, psychedelic users had higher rates of all indicators of mental health problems.

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