Psychedelics and the health risks of drugs, alcohol and tobacco

In the last decade or so, there has been a renaissance of interest in the therapeutic potential of psychedelics. While natural psychedelic substances have been used by humans for many thousands of years, psychedelics had a massive cultural impact on the West in the 1950s and 1960s. Albert Hoffman, a research scientist working for the Swiss pharmaceutical company Sandoz, accidentally invented LSD (lysergic acid diethylamide) in 1938 and discovered its psychedelic properties five years later. In 1955, a New York banker named Gordon Wasson sampled the psilocybe (magic) mushroom in Mexico and published an article on his experience in Life magazine.

Scientists discovered the role of neurotransmitters in the brain in the 1950s, and psychedelics inspired scientists to search for the neurochemical origins of mental disorders previously thought to be psychological. Psychedelics were also used in psychotherapy to treat various disorders, including alcoholism, anxiety and depression, with some promising results, although these studies generally did not reach modern standards of research design.

However, psychedelics were also embraced by the counterculture and became linked in the mind of authorities with youth counterculture and the anti-Vietnam war protests. By the end of the 1960s, most Western governments had outlawed and forced underground the psychedelic drugs which had been legal in most places previously, and also shut down all scientific research.

In the 1990s small groups of scientists managed to start conducting various trials of the therapeutic uses of psychedelics and this has led to the so-called psychedelic “renaissance” in which larger well-designed trials of psychedelic use for treating a range of mental disorders are being carried out by research groups at institutions such as Imperial College London, Johns Hopkins University and New York University. Just today, it was announced that the Australian government will be providing $15 million funding for clinical trials into the use of psilocybin and other psychedelics for the treatment of mental illnesses, including depression and PTSD. Michael Pollan’s book How to Change Your Mind gives an excellent account of the history of psychedelics, both above ground and underground, and the psychedelic renaissance, and was a best seller. See also this article by Michael Pollan on the “Psychedelic Renaissance”.

As part of my work on the global burden of disease for the World Health Organization (WHO), I carried out several assessments of the direct and indirect health impacts of the use of drugs, alcohol and tobacco. I recently did an approximate update to year 2019 for deaths directly due to drug use disorders (overdoses and directly toxic effects) and indirect deaths from road injury, suicide and infectious diseases attributable to drug use. A proportion of HIV, hepatitis B and hepatitis C deaths can be attributed to injecting drug use with contaminated needles. The great majority of direct and indirect deaths due to drug use are due to the use of opioids, both illicit and pharmaceutical opioids. Very few deaths are associated with psychedelic drug use, but I was curious to get a ballpark estimate for comparison with other drug deaths. I will present a brief summary of the broad estimates of drug-attributable deaths, then review evidence on the likely contribution of psychedelic drugs.

I have posted elsewhere a more detailed summary of my analysis of drug, alcohol and tobacco-attributable deaths. I estimate that there were around 186,000 deaths in 2019 globally due to drug use disorders (predominantly accidental drug overdose) of which 67% were attributable to opioid use. The second largest cause of drug-attributable deaths is hepatitis C, responsible for an estimated 156,000 deaths due to infection with contaminated injecting equipment. The following two figures and table show the contributions of the various causes for five main groups of drugs. The “other” category includes deaths due to misuse of pharmaceutical drugs other than opioids and amphetamines. Overall, a little over half a million deaths were attributable to drug use in 2019.

The following table and figure include recent WHO estimates for total deaths attributable to tobacco and alcohol use (around 8 million and 3 million respectively). When poor health is taken into account as well as mortality, the overall burden of disease becomes somewhat more prominent for alcohol and drug use . Unlike tobacco which kills most people at older ages with relatively limited periods of disability, alcohol and drug use are associated with significant loss of health at younger ages, and drug deaths in particular tend to occur at younger adult ages rather than older ages (see my other post for details).

Turning now to look at mortality associated with use of psychedelics, the literature is very consistent in finding that risks of mortality are extremely low or non-existent for LSD and psilocybin. Most countries do not include a separate category for reporting deaths associated with psychedelic drugs, and many countries lump them in with opioids and other hallucinogens in a single category. For example, Switzerland reports deaths for a single category “narcotics and psychodysleptics [hallucinogens]”. This is misleading.  It is rather like reporting deaths due to HIV infections and toxoplasmosis as a single category. That would likely lead the casual reader to assume that infection with toxo virus carries significant risk of death, and on public health and that on policy grounds these two infections can be treated as a single group. Many countries criminalize psychedelic use with penalties similar to those of non-medical opioid use.

The broader category “hallucinogens” includes not only the classical psychedelics (such as LSD, mescaline, psilocybin, MDMA etc) but also dissociatives (such as Nitrous oxide, ketamine, phencyclidine (PCP)) and deliriants (such as atropine, Benadryl and zolpidem (Ambien)).

The Office for National Statistics has published numbers of deaths from selected psychedelic substances from 1993 to 2014 for England and Wales here. This actually tabulates the numbers of deaths mentioning LSD or psilocybin on the death certificate, so its not necessarily the case that these deaths are causally attributable to the psychedelic use. A significant proportion of drug deaths are associated with multiple drug use, and studies have found that in many of these the primary factor was an opioid or alcohol. So how many deaths were there that mentioned LSD or psilocybin (with or without other drugs)?  In total for the 22 year period there 4 deaths in which LSD was mentioned and 1 death where LSD and psilocybin were mentioned, none with psilocybin only. That amounts to an average of 1 death per four years, although all the deaths were actually concentrated in the first decade 1993-2003.

An Australian study by Darke et al (2019) examined all hallucinogen-related deaths in Australia in the period 2000 to 2017. There were 82 deaths, with the majority associated with phenethylamines, a group that includes amphetamines, methamphetamine and MDMA (ecstasy). No mention is made of any deaths associated with psychedelics other than MDMA, and its unlikely there were any. Another paper on MDMA-related deaths in Australia by Roxburgh et al (International Journal of Drug Policy 2020)  identified 392 deaths between 2001 and 2018 in which MDMA was mentioned. Just under half of these were attributed to multiple drug toxicity, and only 34 resulted from MDMA toxicity alone. The remaining 38% were primarily due to motor vehicle accidents with MDMA listed as a contributory factor. MDMA is the only psychedelic for which small but significant numbers of deaths do occur. These are primarily associated with hyperthermia or over-heating. This relates not only to an apparent lack of knowledge among MDMA users about appropriate fluid consumption and the need to cool off when using MDMA, but also to the risk of overdosing due to the unknown concentration of MDMA in illicit tablets. Tablet testing and education are known to substantially reduce MDMA deaths, but many governments refuse to allow tablet testing.

LSD has been associated with deaths of people jumping out windows etc in the popular mind due to scare stories published in the media in the 1960s. Closer examination of most of these incidents has not found strong evidence for a causal association (see for example here or here), though there may have been a few deaths associated with risky behaviour during the heyday of unconstrained LSD use in the 1960s.

There is some evidence that psychedelic use may trigger psychotic episodes in people at risk of schizophrenia.  A review of cannabis use concluded that it may advance the onset of schizophrenia by a year or two on average in those who were going to get it in due course, but did not cause additional cases of schizophrenia. The evidence was not considered strong enough to include schizophrenia as an adverse outcome in the WHO assessment of the attributable burden of cannabis use several years ago.

Professor David Nutt and colleagues published a study in 2007 which developed a rational scale to assess the harm of drugs of potential misuse and concluded that, among other things, psychedelics are considerably less dangerous than alcohol and are misclassified with very harmful drugs in public policy. As a result, he was sacked from his position as the UK government’s chief drug advisor. See also this interview with him. Here are two graphs from his study which summarize the relative risks of dependency, fatal overdose and physical harms for various types of drug.

The following graph compares the study’s assessments of overall harm associated with various drugs with the public perceptions of harm. There is reasonable congruence of heroin and cocaine. However, the harm associated with alcohol is drastically underestimated and that for the psychedelics drastically overestimated. The tobacco and cannabis estimates by the study seem somewhat dubious to me, they seem to overstate the cannabis harm and understate the tobacco harm (both are in the 20’s on the overall harm score) whereas tobacco kills many orders of magnitude more people than cannabis. I will have to look more closely at their methodology.

Its clear that the psychedelics don’t even register on the harm scale associated with the tobacco, alcohol, opioids, cocaine or amphetamines. And in fact, that LSD and mushrooms are two of the safest drugs and it is bizarre to class them with the illicit opioids with similar criminal penalties. MDMA and ecstasy are responsible for small numbers of deaths, and these could be largely avoided if they were legalized and pill contents regulated, or even if pill testing was widely accessible. Cannabis is not quite as harmless as the psychedelics, and does have some risk of psychological addiction, unlike them. However, it also is much less harmful than other legal drugs such as tobacco and alcohol. And for many of these drugs, the harms associated with use are substantially lower than the harms associated with criminalization, which range from large scale incarceration and subsequent family destruction and impoverishment, to the corruption of police and public officials, and the subsidizing and encouragement of organized crime.

Revisiting The Hobbit movie (yes – as one movie not three)

Having recently re-read The Lord of the Rings trilogy (see my earlier post) and realizing that Peter Jackson had changed more in the movie versions than I had realized, I decided to rewatch the three Lord of the Rings (LOTR) movies for the third time, but this time in the Extended Edition, which I’ve never seen. I purchased a copy of that, which has just arrived. But I have been pondering whether to watch the Hobbit movies before watching LOTR.  I really disliked Peter Jackson’s padding out the story with made-up elements that were not in the book, and spinning it out to three overblown movies. There were some aspects I enjoyed, but I just could not bring myself to watch them again, let alone in the extended editions.

Then I stumbled across a “fan edit” of the Hobbit movies to make a single movie (of length just under 4 hours) which is reasonable faithful to the book, removes excess material and the more ridiculous action sequences. This fan edit, called “The Hobbit – The Cardinal Cut” is described here and can be downloaded or watched on Youtube.

Continue reading

How long ago were the events of The Lord of the Rings?

As I discussed in my previous post, Tolkien set out to create a mythology for the English in the Lord of the Rings (LOTR), the Silmarillion and related writings on Middle-earth. He presented himself not as the author of LOTR, but as the translator of various histories written by Bilbo, Frodo and others in the Third and Fourth Age of Middle-earth. This makes Tolkien quite unusual among modern writers of fantasy in presenting it as set in the real work but in an imagined prehistory. What happened in that period before the Earth’s actual recorded history is otherwise remembered down through the generations as folk myths and legends, especially among the Old English. Tolkien’s life work was an attempt to reconstruct our prehistory, and more specifically the prehistory of the English. Critics Lee and Solopova commented that “Only by understanding this can we fully realize the true scale of his project and comprehend how enormous his achievement was” [1].

Tolkien described the region in which the Hobbits lived as “the North-West of the Old World, east of the Sea” in LOTR, ie. essentially Europe (including Britain). However, as he noted in a letter [2], the geographies do not match, and he did not consciously make them match when he was writing. In another letter [3] he became much more specific, saying “If Hobbiton and Rivendell are taken (as intended) to be at about the latitude of Oxford, then Minas Tirith, 600 miles south, is at about the latitude of Florence. The Mouths of Anduin and the ancient city of Pelargir are at about the latitude of ancient Troy.” In the Prologue to LOTR, Tolkien also notes that “Those days, the Third Age of Middle-earth, are now long past, and the shape of all lands has been changed…”

Fascinated by the detailed chronologies and calendars set out in the Appendices to LOTR and elsewhere, I have naturally wondered how long ago from now the events of LOTR took place. About 15 years ago, I came across an article in the Journal of the Tolkien Society [4¡ which deduced that the Fourth Age began on Wednesday 18 March 3,102 BCE.  The events of LOTR took place during the preceding year.  Despite the bizarre exactness of this, I was quite impressed by the argument, which I summarize here briefly.

Continue reading

On re-reading the Lord of the Rings 50 years later

My first encounter with Middle Earth was when I came across The Hobbit in my first year of high school. The Hobbit gave me the same sense of the numinous and of “Northerness” as earlier had C.S. Lewis’s Chronicles of Narnia. I had borrowed it from the local library, did not remember the name of the author and only several years later as a teenager did I discover the Lord of the Rings (LOTR).  It was originally published in three volumes in 1954 and 1955, 18 years after the Hobbit was published in 1937. The Lord of the Rings became immensely popular in the 1960s with the publication of the Ballantine paperback editions, and in North America, the publication of the Ace pirated edition.  I first read it in 1969, when I purchased the 1968 first edition of the George Allen and Unwin one volume paperback with cover illustrations by Pauline Baynes:

Continue reading

Zen lineages and “transmission outside the scriptures”

I’ve mainly been doing shikantaza “just sitting” during the pandemic, but I recently started re-reading “Zen Koans: learning the language of dragons” by James Ishmael Ford. This is an excellent general introduction to Zen, the range of Zen methods of meditation, and particularly working with koans. Ford was given dharma transmission by my first Zen teacher, John Tarrant, who was the first Australian authorized to teach Zen.

Ford discusses the concept of Zen lineages in his book (pages 28-30) and this reminded me that I had collected information on the lineages of the teachers I have worked with, and inspired me to update it and turn it into a set of charts. These trace the transmission of Zen from India to China to Japan and then to my Western teachers. I’ve updated these and posted them below.

Continue reading

Why do people treat others with such inhumanity?

One of the key values of the Western Enlightenment that underlie the rise of science and our understanding of ourselves and the natural world is freedom of speech. Freedom of speech is under attack from the right and the left and from religious extremists. Last week, a French history teacher, Samuel Paty, was beheaded by an Islamic extremist after a lesson about free speech being a fundamental value of the French republic. And other extremists have attacked and killed people in France and Australia in the last week. Police forces and right-wing extremists in the USA have attacked Americans protesting against the extra-judicial murder of black Americans by police. And both the right and left are “cancelling” people whose views they disapprove of and in some cases making sure they lose their job or are boycotted.

Amara Green, a teenage girl who was hit in the face at close range by a deliberately aimed rubber bullet in Minneapolis, is facing months of reconstructive surgery

How can people treat others with such inhumanity?  And its not an insignificant proportionof the population. Despite horrifically cruel actions, such as separating babies and young children from their parents, locking them up, and not keeping any information that would allow the return of these children to their parents, a fairly stable 40% of Americans approve of these actions or simply don’t care all that much about them.  Evidence is now emerging of the extreme and unprovoked violence unleashed by police on peaceful protesters in the USA. There are now a number of documented cases of police vehicles being driven at speed into crowds. The same tactic that has been used with success by Islamic extremists in Europe. And clear evidence that so-called “non-lethal munitions” have been fired at point blank range at people, sometimes causing death, blindness or severe injury.

The same question has been examined in depth and debated at length regarding the role of the German people in the holocaust.  Why did ordinary Germans take part in large numbers in the rounding up and killing of Jews? This has been a question that I’ve thought a lot about, and found three books in particular to be very relevant.  I have been rereading these books over the last couple of months, as they examine these questions in depth and reach somewhat different conclusions from each other.

Continue reading

Anaximander – the first scientist

Recently I discovered Carlo Rovelli, an Italian physicist and best-selling popular science writer and noticed he had written a book on Anaximander, an early Greek philosopher who lived around 150 years before Socrates in the sixth century BC. Though I read some of the Greek philosophers when I was younger, I don’t recall coming across Anaximander. I thoroughly enjoyed reading his book and so here is a review.

Anaximander (c. 610 – c. 546 BC), lived in Miletus, a city of Ionia (in modern-day Turkey) and was a student of Thales. Nothing but a few quotations and descriptions of his work survive in the works of later philosophers, but from this sparse information, Rovelli mounts a persuasive argument that Anaximander was the first true scientist, the first to suggest that order in the world was due to natural forces, not supernatural ones.

Continue reading

Breathwork and sensed energy

In an earlier post, I described my experience with transformational breathwork and the Wim Hof method. I’ve continued to practice these, and to do some online sessions with the breathwork instructor from the retreat I attended late last year. In looking around for more information on breathwork, I came across a book by David Lee called “Life force: Sensed Energy in Breathwork, Psychedelia and Chaos Magic” (Norwich: The Universe Machine, 2018).

Lee gives an overview of and simple instructions for ten types of breathwork, as well as discussing their various purposes and effects, and the relationships between them. This is interesting enough, but his approach to understanding breathwork completely changed my experience of it. He describes the book as an exploration of “sensed energy” and schemes of belief that work best for experiencing, cultivating and manipulating these subtle sensations. In particular, he frames breathwork in terms of the arousal and relaxation of sensed energy.

Transformational breathing produces within minutes a tingling within the hands and feet and a sense of energy surging around the body. Lee advises to simply witness this energy as it circulates and coalesces into definite sensations and emotions. Layers of unresolved emotion may surface and the high level of sensed energy helps them to resolve. So breathwork may untangle pain and discomfort from the past. Lee describes how to modulate the intensity of the breathwork to hover in the space between suppression of this unresolved material and its too intense activation, allowing a process of resolution to occur, rather than repression or re-traumatizing. I certainly experience intense emotions at times during breathwork, and the periods of “tantrum” and application of pressure to particular points on the body enable you to intensify and experience or release these intense emotions.

Continue reading