Tuesday 23 July 2019

Microdosing: 'It gives me the strength to say, I can do this!'

People in Ireland and across the world are experimenting with microdosing - ingesting tiny amounts of psychedelic drugs to boost their mood. The problem is that it's illegal. Katie Byrne reports

Boost: A growing cohort are taking microdoses of pyschedelic substances
Boost: A growing cohort are taking microdoses of pyschedelic substances
Doctor John Kelly who is participating in a global trial for the treatment of depression. Picture: Gerry Mooney
Ayelet Waldman recounted her experience of microdosing in her candid memoir A Really Good Day
Open your mind: Dr James Fadiman believes 'sub-perceptual' doses of LSD can have anti-depressant benefits
Ayelet Waldman's 'A Really Good Day'.
Ivor Browne.
Katie Byrne

Katie Byrne

Twice a week, *Sarah Conway starts her day with a strong cup of coffee, a bowl of buckwheat porridge and approximately 10-15 micrograms of lysergic acid diethylamide (LSD).

It's known as a "microdose" and according to Sarah, it's "enough to make a difference to how you feel but not nearly enough to make you feel like you're tripping".

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Sarah, who is in her early thirties and lives in Dublin, is among a growing cohort of people who are taking microdoses of psychedelic substances to improve their overall mood and performance.

It's an emerging phenomenon, especially among young Silicon Valley professionals who believe that small doses of LSD can increase their productivity and give them a competitive edge.

Ayelet Waldman recounted her experience of microdosing in her candid memoir A Really Good Day
Ayelet Waldman recounted her experience of microdosing in her candid memoir A Really Good Day

Yet for Sarah, microdosing is no productivity hack. While she says it helps her feel more focussed and in control of the day ahead, she isn't taking LSD to 'get shit done'. She's taking it to get out of bed in the morning.

Sarah, who works as a freelance graphic designer, suffers from chronic intractable pain and depression and, after years of trying every imaginable medication, she has turned to psychedelics as a last-ditch effort to overcome her illness.

"My disease rips my life apart every few days and then I have to pick myself up and start from scratch," she says. "And that can be hard doing that over and over again, waking up every day knowing you're not in for a good day.

"Getting up in the morning means having to bear through the first few hours of unbearable pain," she says, "but microdosing is giving me the strength to think, 'I can do this!' It's giving me confidence in my own body. I'm more connected to my body when I microdose and I'm not giving out to myself about my disease anymore."

Anti-depressant benefits

Sarah has used LSD as a recreational drug in the past but she hadn't heard of microdosing until she was introduced to the work of James Fadiman, an American psychologist who believes that "sub-perceptual" doses of substances like LSD and psilocybin mushrooms can have anti-depressant benefits.

At first she planned to microdose with psilocybin mushrooms - it seemed like the more natural route - but a trip to the Dublin mountains didn't prove as fruitful as she hoped.

Ivor Browne.
Ivor Browne.

She had a similar problem sourcing LSD in Dublin. Microdosing might have made the headlines in recent years, but LSD isn't a commonly available street drug in Ireland.

Eventually she contacted a friend in Berlin who agreed to post her a half-sheet of LSD containing 50x200 microgram doses. The envelope arrived a week later.

While Baby Boomers might remember microdots - tiny LSD pills - and lysergic acid-laced sugar cubes, a sheet of acid is blotter paper that has been dipped in LSD, dried and perforated into squares, with each square containing a set dose.

Sarah takes one of these squares, which measures about 1/4 inch wide, and cuts it into four. Then she cuts each smaller square into four teeny-tiny triangles.

One triangle is approximately 1/10 of a recreational dose of LSD - which generally ranges from 100-200 micrograms - and Sarah takes one of these every three days with a break at the end of each month-long cycle.

Broadly speaking, a microdose of LSD won't trigger mind-bending hallucinations. However, according to Sarah, it's enough to significantly alter one's outlook.

Open your mind: Dr James Fadiman believes 'sub-perceptual' doses of LSD can have anti-depressant benefits
Open your mind: Dr James Fadiman believes 'sub-perceptual' doses of LSD can have anti-depressant benefits

"Things that would have stressed me don't get to me anymore," she says. "It kind of resets everything and makes you think of things differently.

"I'm just super grateful for things when I take it," she adds. "I remember one day I burst out laughing at myself. I was filling up the kettle to make a cup of tea and, in my head, I was like, 'We are so lucky that we have a fresh water source'. And then I thought, get a grip, Sarah, for f*** sake!'"

Fadiman first touched on the idea of microdosing in his book, The Psychedelic Explorer's Guide, originally published in 2011. Yet his work remained relatively under the radar until it began to gather pace in Silicon Valley's bio-hacking community.

Biohackers are interested in "hacking" their body's biology to increase physical and cognitive performance and, to quote some of its more ambitious proponents, become 'superhuman'.

The biohacking movement promotes self-experimentation, whether it's through intermittent fasting, polyphasic sleeping or DNA sequencing. And in their perpetual quest for peak productivity, they stumbled upon the idea of microdosing as a way to boost focus, harness innovation and maybe even pay their respects to tech god Steve Jobs, who famously described LSD as one of the "two or three most important things" he ever did in his life.

A 2015 Rolling Stone article lifted the lid on the growing number of tech professionals who were microdosing LSD as a creativity enhancer. A couple of years later, Ayelet Waldman recounted her experience of microdosing in the unflinchingly candid memoir, A Really Good Day.

The writer, who was diagnosed with bipolar II in her early thirties, says a month-long programme of LSD microdosing helped to regulate her moods, save her marriage and, as the book title suggests, turn even the most mundane days into "really good" ones.

The success of Waldman's book - coupled with increasing media attention - helped to move microdosing from an underground practice to a watercooler conversation.


Cultural zeitgeist

It has captured the cultural zeitgeist and, in the words of Fadiman, who recently took to Twitter to remark on its popularisation, "All we need now is a cookbook, an exercise video, and a line of clothing".

After collecting over 1,000 self-reports from participants in 59 countries - most of whom microdosed once every three days for a month - Fadiman has established a link between microdosing psychedelics and "improvements in negative moods, especially depression".

These findings appeared in the Journal of Psychoactive Drugs but this is far from a randomised, double-blind, placebo-controlled study, as Fadiman himself pointed out.

And while the psychological benefits of LSD microdosing have been widely publicised through anecdotal accounts, the first ever placebo-controlled trial only started in September of last year, with published results expected in late 2020.

Dr John Kelly, a lecturer in clinical psychiatry at Trinity College, is looking forward to reading the results but right now he's unconvinced.

"There is only one rigorous study of LSD microdosing, and this showed that participants that received the LSD microdose had a slightly altered perception of time. They did not investigate health or well-being measures.

"The rest of the studies investigating LSD microdosing are of very poor quality," he points out.

Instead he points to a groundbreaking study from Imperial College London, which showed that psilocybin mushrooms significantly reduced depression symptoms in 67pc of participants with treatment-resistant depression (patients who have failed to respond to two or more trials of anti-depressant medication) at one week. Forty per cent of participants showed a sustained response at three months post-dose.

"Although open-label, with a small sample size of 12 people, it showed marked clinical improvements, rarely seen in the field of psychiatry," he says.

A world-wide, double-blind randomised control trial has been launched and Kelly's team, which is headed up by Professor Veronica O'Keane, was the first in the world to assist a participant through a "psilocybin experience", designed as part of this trial, in Tallaght Hospital, Dublin.

Given the psychedelic nature of the experience, participants are closely monitored by two psychiatrists (Veronica and John), two therapists and a study co-ordinator.

Nonetheless, it's a long and - one would imagine - emotional day, with participants receiving the capsule at 9am and spending between 6-8 hours in a room specially equipped with ambient music (think Nils Frahm, Ólafur Arnalds and David Helpling) and eye masks to "fully immerse themselves in the experience".

Kelly and his associates are still actively recruiting for participants in Ireland (psilocybin@crp.healthcare) but there are of course strict exclusion criteria.

People with psychotic disorders, borderline personality disorder, active substance addiction, and some medical disorders (cardiac problems, uncontrolled diabetes, seizure disorders) are excluded.

In addition, participants have to come off all antidepressants for a minimum of three weeks - again, they are meticulously monitored during this period and throughout the 12-week period after dosing.

But what about LSD microdosing? Does the same exclusion criteria apply? "Clearly, people with psychotic disorders, bipolar disorder, certain personality disorders - particularly Borderline Personality Disorder - should not microdose," says Kelly.

LSD microdosing could also exacerbate anxiety, he adds, and he advises people with certain cardiac problems to steer clear too.

Caution is warranted, agrees consultant psychiatrist at the Hermitage Medical Clinic, Dr Mike Scully, but the commonly held idea that LSD stays in a person's system and leads to disturbing flashbacks throughout their life may need to be re-evaluated.

"I think the reputation that psychedelics have as these really terrible drugs that create very significant, severe and enduring mental disorders is misplaced," he says.

"Potentially, they are a lot safer than a lot of other drugs that people use. And when you consider microdosing, that is possibly the safest way to use them if you're going to use any of them."

'Psychedelic experience'

Of course, that's assuming that you get the dosage right. Fadiman says people who feel like they are "on the edge of a psychedelic experience" have taken too much, but how much is too much when you're dealing with micrograms and tiny shreds of blotter paper?

"As LSD is illegal and unregulated, and considering most people do not have access to laboratory facilities," says Kelly, "it is very difficult for people to know the precise dose they are taking."

It's also worth noting that the positive effects that people describe are not dissimilar to the benefits that others attribute to holistic modalities like yoga, meditation and other forms of bodywork. It begs the question: is microdosing a chemical shortcut to peace of mind in an instant gratification era?

This is the point Ivor Browne makes when I visit him in his home in Ranelagh, Dublin. The former Chief Psychiatrist of the Eastern Health Board was something of a maverick when he used substances like LSD and ketamine as an adjunct to therapy in the 1970s, but a regular meditation practice has since led him to conclude that you don't necessarily need any substance to reach altered states.

Browne, who recently turned 90, has plenty of stories to share, from the Ancient Egypt theme of his first ever LSD trip (an Egyptian-looking back-scratcher perched at the side of his bathtub "set him off"), to the last time he used LSD as part of a group therapy session in a church beside the former St Brendan's psychiatric hospital in Grangegorman.

However, while he still appreciates the therapeutic benefits of LSD, he's wary of people self-administering a substance that he believes should be taken under guidance.

"Psychedelics are certainly useful from the point of view of opening up experience," he says. "However, a person could go into a psychotic state so it should be used responsibly, under supervision."

Kelly agrees. "'Set and setting' are pivotal for the optimisation of the psychedelic experience," he explains, quoting the term coined by 1960s LSD advocate Timothy O'Leary.

"In contrast to recreational use, therapeutic applications are conducted in a safe, controlled, supportive environment, with trained therapists," he adds.

And this, let's not forget, is exactly how LSD was administered before it was discovered by 1960s counterculturalists and, subsequently, outlawed as a Schedule 1, Class A drug with "no medical use".

'Citizen scientists'

With this in mind, it's easy to understand why psychiatrists - or at least the psychiatrists I spoke to - aren't especially interested in reports about 'citizen scientists' microdosing LSD. They are, however, excited about the comeback of legitimate psychedelic research.

Contingent on results from the current trial, Dr Kelly says he is "cautiously optimistic" that psilocybin-assisted psychotherapy will be a treatment option for certain types of depressed patients in Ireland in the next five years.

Dr Scully, meanwhile, is thinking five steps ahead. He says it will be a "significant step forward" if clinical trials can establish that psychedelic drugs have therapeutic potential.

However, the real challenge, he says, would be gaining support from politicians and healthcare systems. Psychedelic therapy would rely on the legal reclassification of certain drugs and that, adds Dr Scully, is another conversation entirely.

Some names have been changed

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