Psychedelic drugs should be legally reclassified so that researchers can investigate their therapeutic potential

Decades before the junior doctor describing LSD as ‘safe’ [1] entered psychiatric training I studied the actions of hallucinogens both in the laboratory and the community. From a public health point of view, both recreational and therapeutic drugs go in and out of fashion [2] and some patient populations may be more, or less, vulnerable to psychedelic substance use: there is 90 years’ scientific literature on the effects of mescaline, for example. Sometimes cumulative toxicity becomes apparent for hallucinogenic substances. Dissociative anaesthetics are invaluable in tranquilliser darts for animals and for human surgery where no other agent in practical, but in the community repeated use of ‘Angel Dust’ or ‘Special K’ by some individuals seems to become proconvulsant or psychotomimetic. Unlike our present Conventions on drugs, a good system of legislation and regulation would balance risks and benefits and comprehend some individual variation among patients.

So, back to LSD. It has been known for a long time that this does not cause the Dependence Syndrome – rather, users become sensitised to repeated doses, progressing to disturbances of perception that are spontaneous, uncontrollable and potentially distressing.[3] With a period of abstinence short-term users generally return to their premorbid state, but alas long-term users are likely to have a complex history of polysubstance use, and no one really understands all the interactions of hallucinogens (for example their role in one suicide that I remember vividly). The author is right that in the 1960s and 70s politicians manipulated public perceptions of many drugs ‘for political advantage’,[1] but he is too young to remember the Vietnam era when the US Air Force had a genuine problem over the use of LSD. You would not want, say, UK drivers of heavy goods vehicles to take LSD - or medical trainees, which I can recall. When I was training family practitioners (GPs) about drugs in the 1980s, their most common drug-related call out was not about heroin or cocaine but about young family members having a Bad Trip.

Understanding hallucinogens requires a completely different perspective to understanding the risks and benefits of addictive drugs like heroin. In conclusion, the law may sometimes be an ass [4] but I never call LSD ‘safe’.

[1] Rucker JJH. Psychedelic drugs should be legally reclassified so that researchers can investigate their therapeutic potential. BMJ 2015;350:h2902

[2] Caan W. Deeply designed drugs. European Journal of Neuroscience 1991;3 Suppl 4: 322.

[3] Caan W. Adolescent drug use and health: problems other than dependence. In: Caan W, de Belleroche J, editors. Drink, Drugs and Dependence: from science to clinical practice. London: Routledge; 2002. P.145-170.

[4] Dickens C. The Adventures of Oliver Twist. London: Bradbury and Evans 1846.