Why Chronic Psychedelic Microdosing May Not Be Appropriate

July 14, 2020 14:47:17

Clinical trials of macro dosage of psychedelics have revealed positive results. However, the same can’t be said of chronic microdosing. Users need to be aware of possible risks involved with continuous heavy use of psychedelics as researchers are working on determining the balance between the risks and benefits of psychedelic treatment.

One of the key things that are coming up is the risk of heart diseases, specifically Valvular Heart Disease (“VHD”). Psychedelics work by activating the serotonin 2B receptor and some scientists report changes in heart valves and murmurs as a result of this activation.

VHD symptoms include shortness of breath, chest pain, and lightheadedness. Most studies focus on identifying if serotonin 2B activation is responsible for these conditions in microdosing patients or if the patients already had it before medication.

Previous medication that had 2B receptor activation was removed from U.S. pharmaceuticals because of the supposed risk of VHD. Examples include dexfenfluramine, pergolide, and fenfluramine/phentermine. Medical reports showed that about 25% of patients who took these medications daily developed VHD.

This statistic calls for lots of research to be done about psychedelics as a number of them may need to be taken by patients over a long period of time during their treatment

The main issue that arises is how much dosage can cause these adverse effects. If the drug has shown promising results, then it affirms serotonin activation. It turns out these effects can be both positive and negative. It only becomes problematic when taken daily for a long time, maybe over a year.

All these assertions were brought to light in a microdosing article published by Kuypers et al. (2019) in which they cite why fenfluramine/phentermine was banned. 5 out of 24 patients that had been induced with the medicine underwent heart surgery.

A few psychiatrists, Drs. Fadiman & Korb dismiss these allegations and gave their counterarguments regarding this issue in a site about microdosing. They argue that drug dose isn’t the main factor that determines the effects of these drugs, but some pharmacologic factors do. Secondly, they state that none of the patients under chronic microdosing have reported heart valve problems whilst microdosing.

Another doctor, Dr. Passie, also gave commentaries on microdosing opposing the allegations that these drugs had anything to do with VHD. Dr. Passie cited a 1968 study that involved a daily dosage of LCD for over 35 months without any notable damage. The test was carried out on 7 children that were suffering from schizophrenia.

However, there are some limitations to the report by Bender and Sankar who fail to mention if they used any parameters to measure heart changes. Dr. Passie also argues that any cases of valvulopathy in a patient would disappear after the medication stops.

A contrary report by Graham (1967) states otherwise. In a trial where 12 patients with methysergide-induced VHD had murmurs, only 5 of them showed improvement while the condition remained the same for 7. 2 other cases required heart surgery out of which only one survived.

Besides, questions of frequency and duration come up for those who state that chronic microdosing does not affect VHD. Were these doses being administered daily, consecutively, or periodically? Would a patient know if they had VHD? What can be done to reduce risk?

All this evidence shows that microdosing for shorter periods with a break in between reduces the risk of developing VHD. Researchers and psychedelics companies like Compass Pathways are likely to provide some answers to these questions. In the meantime, these substances should only be administered in a clinical setting to limit any possible risks.

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