Why the controversy around microdosing in medicinal psychedelics?

The use of microdosing in medicinal psychedelics has stirred much controversy in recent years. While supporting research is now stacking up, the evidence base lacks maturity, leaving health providers and potential users unclear on its therapeutic prowess.

Intuitively, too, some have doubts about the efficacy of microdosing in the treatment of severe mental health conditions. Subperceptual by definition, opponents believe it may be too mild to instil the kind of radical mental rewiring many attest to in their experience with larger doses.

Associate Professor Dr Suresh Muthukumaraswamy , from The University of Auckland, believes some concern around microdosing is valid, given the research’s infancy. But he worries personal biases may be tainting perceptions of the literature.

“The research surrounding microdosing is yet to point to a definitive answer, so people are right to continue raising questions about it,” he said.

“However, my concern is that many people are drawn to this field because of their own personal experiences with psychedelics; and I wonder if some are letting these experiences overshadow their objectivity when it comes to drawing conclusions from the research base.”

In support of this view, Dr Muthukumaraswamy says the loudest opponents of microdosing tend to be those who support macrodosing – the latter of which is more challenging to falsify in a randomised control study.

“In macrodosing, the placebo is inherently flawed, because it will be very obvious to those in the placebo group if they haven’t been given the actual drug, which is hallucinogenic. In contrast, placebo trials for microdosing are more valid, as the experimental group’s experience is barely perceptual.

“So, if a strong macrodosing proponent is quick to undermine research on microdosing, it could hint that personal bias is at play,” he said.

A definitive answer may be years away

Despite this empirical advantage, microdosing research has been stunted by practical challenges. As such, it may be up to five years behind that of macrodosing.

“Microdosing trials can be difficult, because they involve sending people home with an explicit drug. Even though the dosage is very small and sub-hallucinogenic this does raise legal and ethical questions and is not permissible in some states,” Dr Muthukumaraswamy said.

Administering each dose in a laboratory could sidestep this issue, but would be practically unfeasible.

“It would involve participants coming in dozens of times, making the recruitment and retention almost impossible,” he added.

Increasing hope

Despite the challenges and lingering controversy around microdosing, Dr Muthukumaraswamy says the research is now stacking up in its favour.

Leading a team at the University of Auckland’s School of Pharmacy, Dr Muthukumaraswamy is currently gathering data around the therapeutic effects of LSD microdoses on mood, creativity, focus and cognition.

In his latest trial, Muthukumaraswamy and team gave volunteers 14 small doses of LSD (or a placebo), over a period of six weeks, and monitored their performance on a range of tasks.

Hi next trial will investigate whether LSD microdosing has an anti-depressive effect on participants with major depressive disorder.

“Our research is ongoing and we maintain that it is too early to say whether microdosing is safe and effective. But we are encouraged by what we have seen so far,” he said.

“I expect things will become much clearer five years from now, when we have caught up with the research on macrodosing. Until then, health authorities are right to use caution with this approach.”

Further insight

Sharing more details around his work with psychedelic microdosing, Dr Muthukumaraswamy is due to present at the upcoming Medicinal Psychedelics Conference, hosted by Informa Connect.

This year’s event will be held 25 July at the Crown Promenade Melbourne.

Learn more and register your place here.

About Dr Muthukumaraswamy

Suresh is an Associate Professor in psychopharmacology in the School of Pharmacy at The University of Auckland. His main research interests are understanding how therapies alter brain function and behaviour and in testing methodologies to measure these changes in both healthy individuals and patient groups.

Suresh began studying the psychedelics as postdoctoral fellow in 2011 with studies of psilocybin then later ketamine and LSD. He has received several Health Research Council of New Zealand research grants to support this work including grants to investigate the effects of microdoses of LSD. Suresh has published >130 papers, with his work receiving >10000 citations.