Microdosing as a Therapeutic Alternative for Mental Health Issues
Review of: Toby Lea et al., “Microdosing psychedelics: Motivations, subjective effects and harm reduction,” International Journal of Drug Policy (2020).
In recent years, the practice of “microdosing” or regularly consuming very small doses of psychedelic drugs has gained popularity as a form of self-administered treatment for a range of mental health disorders. Although the medical and psychiatric communities have increased research into the use of psychedelics (including psilocybin, LSD, ayahuasca and more) in the treatment of issues such as depression, substance misuse and anxiety, scientific understanding and consensus about the benefits, risks and proper therapeutic dosing remain limited. Accordingly, to fill the gaps in this small but growing body of knowledge, a recent study conducted by Toby Lea and colleagues examined the “motivations, dosing practices, short-term perceived benefits and unwanted effects, and harm reduction practices of people microdosing psychedelics.”
Published in the International Journal of Drug Policy, the study drew on data from the Psychedelic Experiences Survey, an international online survey. More than 2,500 participants were recruited, 525 of whom were microdosing at the time of the survey, and these are the individuals upon which Lea et al. focused. Participants were asked which substances they microdosed and why; the quantity and frequency of dosing; how they obtained and prepared the drugs; what they considered benefits and drawbacks of such use; and what steps they took to minimize harms.
Although study participants hailed from all over the world, nearly half (48.2 percent) reported living in the United States. The average participant was 34.5 years old and had started microdosing at 31, although most (65 percent) had been microdosing for six months or less. Roughly three-fourths (73.5 percent) were male, and 78.3 percent identified as heterosexual. More than half of the participants had a university degree (52.8 percent) and a majority were employed (49.3 percent worked full time; 15.4 percent worked part time; and 17.3 percent were students).
Nearly two-thirds of the participants (65 percent) reported having ever taken a full dose of psychedelics for what they considered to be therapeutic purposes, and 67 percent reported having ever taken a full dose of psychedelics for recreational purposes. In both cases, roughly half of participants reported having done so in the past year. The majority of participants (55 percent) microdosed with psilocybin (commonly referred to as “shrooms”) or LSD (48.2 percent), and most took their dose in the morning (72 percent). Beyond that, schedules varied, but almost one-third followed a cycle that included one day “on” followed by two days “off.” Just over 25 percent reported microdosing before work or school.
As to their motivations, participants reported a variety of reasons that included personal and spiritual development (31.2 percent) and enhanced cognitive performance (18.1 percent), though these responses varied slightly according to the preferred substance. The most common reason for microdosing was to cope with mental health and substance-use problems (40.4 percent), either as an alternative to or in conjunction with so-called “conventional treatments.” In fact, almost half (49.3 percent) of study participants reported having seen a mental health professional, 43 percent had been diagnosed with a mental disorder, 34.3 percent had been prescribed psychiatric medication and 10.5 percent had been treated for misuse of alcohol or other drugs. And, in fact, these motivations aligned with participants’ reported experiences of improved mood, reduced anxiety, enhanced performance, and improved connection to people and the environment. While most participants did report some unwanted psychedelic, anxiety or physical effects from microdosing, this was only common for a handful.
The most common harm reduction practices reported by the participants included skipping microdoses when feeling unwell (31 percent) or in an unfamiliar environment (22.9 percent); and avoiding alcohol (30.8 percent), caffeine (23.8 percent) and driving (20.3 percent) on microdose days. However, Lea et al. note that because roughly 22 percent of participants said microdosing caused them to experience euphoria, dosing might be an issue and warrants additional study.
Overall, Lea et al.’s findings are largely consistent with other studies that describe “improved psychological wellbeing among people microdosing,” which suggests the need for clinical trials to further evaluate the safety and efficacy of the practice as a therapeutic tool. That said, the study does have some limitations. For example, participants were recruited via convenience sampling—such as email lists and online discussion forums for psychedelic communities—rather than random sampling, and most had taken standard recreational doses of psychedelics in the past year. All of this indicates that the sample may be biased toward having a positive perspective on microdosing. In addition, because this study was survey-based, the authors were unable to confirm findings through behavioral observation or dig deeper into their significance with qualitative follow-ups. These limitations do not invalidate the findings, but even further highlight the need for future studies that seek to inform decisions about whether and to what extent microdosing represents a therapeutic alternative for those struggling with mental health issues.