Psychiatrists disagree with US policy on mind-altering drugs

A new national survey reveals dramatic differences between psychiatrists’ perceptions of the safety and therapeutic value of some psychoactive drugs and how these the same drugs are classified in US policy.

For example, anti-anxiety medications Xanax is a Schedule IV drug under the Controlled Substances Act, which means that it is considered to have a low potential for abuse and dependence and a high therapeutic value. But the psychiatrists surveyed rated the drug, known generically as alprazolam, as having the highest abuse potential of any drug they were surveyed about – equivalent to abuse potential ratings of methamphetamine and alcohol.

The group also assessed the psychedelic compound psilocybin as having the lowest abuse potential and the second highest therapeutic potential behind ketamine. And yet, as a Schedule I drug, psilocybin currently has no accepted medical use and is considered to be at high risk of abuse.

“The problem is that our treatment regimens do not match the scientific evidence of their actual harm and their actual therapeutic and abuse potential,” the lead author said. Alan DavisAssistant Professor and Director of Psychedelic Drug Research and Education Center at Ohio State University College of Social Work.

The authors noted how the evidence has changed since the substances were placed on the schedule of the Controlled Substances Act (CSA) in 1970: Studies have suggested that psilocybin, MDMA (ecstasy) and cannabis, all Schedule I drugs, have therapeutic potential and a relatively low risk of abuse or physical harm. Meanwhile, benzodiazepines, the family of drugs to which Xanax belongs, are the third most misused substances — among banned drugs and prescription drugs — in the United States.

“The question has become, do these schedules actually align with the current state of evidence as measured by experts in the field of psychiatry?” Davis said. “That was really the whole point of this study.”

The research was recently published online in the International Journal of Drug Policy.

The research team recruited 181 psychiatrists from across the United States for the survey. The average age of the participants was 49 and they had been practicing for an average of 16 years.

Adam Levin

Participants were presented with one of four scenarios representing a patient who had found relief from his severe depressive symptoms with an off-prescription drug and is now asking to be incorporated into his treatment: either psilocybin, methamphetamine (a Schedule II drug), ketamine (Schedule III) or Xanax. Researchers asked participants to rate their level of agreement with hypothetical clinical decisions and future outcomes for each vignette. All participants also answered questions about the safety, therapeutic potential, and abuse potential of the four vignette drugs plus alcohol.

“We wanted to pick two drugs for the vignettes that we thought were appropriately timed based on the scientific evidence, and then we picked two that we didn’t think necessarily reflected the current evidence,” the first said. author. Adam Levina third year intern in psychiatry and behavioral health in the state of Ohio medical college. “Psilocybin may not be timed appropriately, and we felt the risk might be underestimated for Xanax. Methamphetamine and ketamine, based on a review of the literature, are fairly consistent with their And then we wanted to see if the psychiatrists perceived any incongruities.

Statistical analyzes showed that surveyed psychiatrists’ perceptions of the drugs’ acceptability, safety, abuse, and therapeutic potentials were generally in conflict with those defined by their current Controlled Substances Act schedule.

Psychiatrists tended to consider psilocybin and ketamine to be safer, less likely to be abused, and more potentially therapeutic than alprazolam, methamphetamine and alcohol – a substance that is not listed by the CSA.

“Methamphetamine, alcohol and Xanax were found to be statistically equivalent in terms of abuse potential,” said Davis, who also holds a professorship in psychiatry and behavioral health. “And we showed a similar finding where meth, alcohol and Xanax were all found to be equivalent in terms of being lower on the safety scale – more dangerous than psilocybin and ketamine.”

The authors noted that the restrictions associated with Schedule I drugs in particular limit the ability of scientists to study these compounds – for their beneficial and harmful qualities, all of which must be determined – and carry criminal consequences for users who may not finding symptomatic relief from any medication. legally available drugs.

“You might ask, why is it important that the medication schedule doesn’t reflect the evidence? Well, that’s important,” Levin said. “We want our policies to be consistent with scientific evidence.

Paul Nagib

“Another interesting finding was that psychiatrists’ opinions on these drugs were broadly in agreement with other mental health professionals, addiction experts, including in other countries, and with drug addicts themselves. They just don’t agree with the current drug schedule,” he said. “It’s important to draw attention to this – we should have a flexible policy that can incorporate expert consensus .”

Co-author Paul Nagiba third-year medical student at Ohio State, said the findings may inspire other physicians to rethink their own attitudes toward substances that have historically been stigmatized.

“Whatever the evidence is, that’s what we want to follow, rather than outdated policies,” he said. “Let’s look at where the evidence leads us, even if it challenges what we have assumed to be true.”

This work was supported by the Drug Enforcement and Policy Center at Moritz College of Law at Ohio State, the Steven & Alexandra Cohen Foundation, the Center for Psychedelic Drug Research and Education (CPDRE), and private donors.

Davis is affiliated with Johns Hopkins University Center for Psychedelics and Consciousness Research. Levin and Nagib are affiliated with the CPDRE. Additional co-writers included Selina Deiparine, Thomas Gao, and Justin Mitchell, all from Ohio State.

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Alvin J. Chase