Risk is a sensitive and complex topic. The safest thing to do is to stay on the safe side, follow recommendations from the authorities and say that psychedelics can be very harmful. And then stop there. But for me personally, this is far too imprecise and I think it is possible to give a more nuanced picture if one dares to move a little out on the slippery ice. One could start by saying that research from the 60s and now the last ten years indicates that psychedelic drugs are not as harmful as has been commonly believed, at least. Politically driven anti-drug campaigns have gained a foothold, but the research is now starting to penetrate a little.
Measuring risk of death
When it comes to risks and side effects for substances that have not gone through all the clinical stages of approved drugs, we have worse numbers than clinicians would like. Phrases like “may cause increased blood pressure, psychosis, death, …” are often used, which always make me ask about statistics. Without a statistical context, such information is completely useless to me. So how big is the risk actually? Everything we do carries a certain risk of death, but also some benefit of some kind. But how do you assess the risk and benefit of something that you have not done before and that is difficult to define? There are a couple of expressions that I find useful. LD50 (short for lethal dose 50% ) can be used to assess the risk of so-called pharmacological overdose, as it is used to describe the dosage at which 50% of those who take it die. The term micromort , short for “micro mortality”, is a unit of measurement that corresponds to a one-in-a-million chance of dying, and can be used to calculate more general risk of death, including pharmacological overdose and other factors. This allows you to compare unknown activities with known activities, which has helped me a bit in my assessment. I will come back to micromort a little further down.
Test the cases
Test your stuff. The biggest risk with LSD, psilocybin, and MDMA is getting something other than what you want. All can be tested with test kits from sites like dancesafe.org and tripsafe.org and don't cost a fortune. You don't want to be unsure if you've ingested something deadly when your whole world changes.
LSD and psilocybin
Both LSD and psilocybin have extremely low toxicity. So low that it is currently unknown how much it takes for a person to die from a pharmacological overdose. Through experiments on mice, it is believed that it takes 82,000 times the user dose of LSD for them to die. Humans react differently than mice, but by converting from mice to humans, one would think that the LD50 for LSD and psilocybin is around 1,000 times the user dose. In comparison, a human would most likely die from either 3 packets of Paracetamol, 20 shots of vodka or 6 liters of water. So death due to overdose is not really something to worry about with LSD and psilocybin. Accidents under the influence of LSD or psilocybin have occurred, but this is very rare and has been greatly exaggerated in the media. It is difficult to find good figures on accidents related to LSD/psilocybin, but there is nothing to suggest that the risk of an LSD/psilocybin-related accident exceeds 1 micromort. For comparison, a day on the slalom slope, for example, corresponds to 0.7 micromort. Riding one mile on a motorcycle corresponds to 1 micromort.
Psychological damage
The psychological risk element with LSD and psilocybin is significantly greater than the physical one. Research from the 1960s to the present day has consistently shown that the risk here is also very low if you follow some guidelines ("set and setting", a sober person watching, etc.), but most people who try these substances often expect something different than what they get and do not follow these guidelines. This can lead to difficult experiences that are difficult to deal with afterwards. A difficult experience is not bad in itself, but without someone to talk to or tools to process the experience, it can end up as something traumatic that you would rather just forget. Psychological damage is difficult to define, but it has been common to believe that psychedelics cause chronic psychosis. It is known that psychedelics (and other psychoactive substances) can trigger psychosis, but no correlation has been seen between chronic psychosis and drug use . There are indications that psychedelics generally have a positive effect on the psyche over time, but there are exceptions. Flashbacks have occurred in some users. Not everyone thinks it's negative, but in some cases it's been difficult. For example, there's something called HPPD , which is a more persistent visual disorder. There's little research on this and a lot of uncertainty about its prevalence. Personally, I have great respect for "set and setting" after meeting several people who have been careless and believe afterwards that LSD/psilocybin has had a negative impact on their lives.
I would highly recommend TripSafe.org for more information on classic psychedelics.
MDMA
MDMA, also called Molly or ecstasy, is an abbreviation for 3,4-methylenedioxymethamphetamine and has become one of the most common party drugs in Norway in recent years. Until it was made illegal in 1985, it also had a clear therapeutic use, including in couples therapy and trauma treatment. The substance is chemically similar to mescaline and amphetamine and is a substance that stimulates the uptake of serotonin and oxytocin (the "cuddle substances") in the brain. David Nutt, a leading English researcher and psychopharmacologist, stated that a horseback ride has the same risk profile as a dose of ecstasy, somewhere between 0.5 and 1.5 micromorts. The LD50 for MDMA is estimated to be 10-20 mg/kg, so it is possible to overdose here if you are not careful. Some pills can contain up to 200-300 mg of MDMA, so if you take three of those you are clearly in the red risk zone. In crystal form (which is often what MDMA is sold in this country), it can also be difficult to calculate by eye. I think it is important to note that some situations can significantly increase the risk.
- Again, test the cases. There are several substances out there that have been sold as MDMA or ecstasy that are significantly more harmful, e.g. PMA/PMMA which has caused several deaths in Norway. In powder form you can also risk ingesting MDMC (methylone), which has a slightly different effect, and about which very little is known about mtp. toxicity. PsychonautWiki has a lot of good info about different substances.
- Don't overheat. MDMA increases your heart rate and blood pressure and makes you less sensitive to fatigue and overheating. This means you should be extra careful in hot places (dance floors, hot tubs, etc.) and make sure to take breaks. If you dance on a hot dance floor for several hours straight, the chance of getting heatstroke starts to become unnecessarily high.
- A weak heart does not handle MDMA well. If you have had heart problems or suspect you have one, you should refrain from taking it or consult a doctor beforehand.