MHM Magazine

Issue 5 | 2022 | MENTAL HEALTH MATTERS | 37 MHM increase the likelihood of challenging experiences when using psychedelics. The likelihood of adverse effects can be reduced through careful screening, adjustment of medication to prevent drug- interactions, preparation, session monitoring, psychological support, and post-session psychotherapeutic integration support. Predicting response to psychedelic substances in a non- clinical environment is challenging, as previous recreational experience with psychedelics does not necessarily predict the occurrence of adverse events in patients seeking relief of psychiatric symptoms. There are a number of useful internet websites that provide information about adverse effects and medication interactions, e.g. www.thethirdwave.co Medication interactions with psychedelic substances can increase the risk of potential side effects but can also reduce the effect of the psychedelic drug, thereby preventing the psycho- active effects of psychedelics. In patients that are using prescribed psychotropic medications for psychiatric symptoms, this can create challenges for the patient and treating clinician, e.g., gradually weaning off medications while monitoring for relapse and withdrawal symptoms, and planning for recommencement of medication post-psychedelic substance use. In general, medications with potential serotonergic effects should be avoided. Avoid stimulants, benzodiazepines, and alcohol on the day of administration of the psychedelic substance. Specific recommendations for psychedelic substances should be followed, e.g. diet and food recommendations (Ayahuasca), and safety protocols regarding administration and monitoring (Ketamine, Ibogaine). The psycho-active effects of psychedelics make patients physically and psychologically vulnerable, suggestible, and highly dependent on the persons they ask to support them. In the absence of a clear legal path toward the therapeutic use of psychedelics, many patients and clinicians are using unregulated “psychedelic underground therapists” to address the set, setting, and skill required for harm reduction and integration therapy. The dilemma is that a referral or recommendation by a health professional to an “underground therapist” implies the existence of an established healthcare treatment or service, and clinicians are responsible for knowing and staying within the boundaries of their scope of practice. There is an urgent need for professional codes of conduct and regulation to allow referral and recommendations to qualified professionals that can offer harm reduction and integration therapy, without facing criminalisation or prosecution by professional licensing authorities. South African drug policy reform and public mental health initiatives should be evidence- based and the increasing amount of evidence indicating the benefits of psychedelic-assisted psychotherapy will hopefully fuel public and professional pressure on government to decriminalise and legalise psychedelic substances. Potential adverse effects of classic psychedelic substances Acute physical effects Varies according to specific substances but includes: Acute, transient elevated vital signs, jaw clenching, perspiration, lack of appetite, headaches, nausea, fatigue, feeling cold, thirst, dizziness, perspiration, restlessness. Serotonin Syndrome Altered mental state, altered neuromuscular excitability, autonomic instability (Hunter Criteria). Typically manifests within 24 hours of exposure to offending agent in patients who have used a serotonergic agent within the preceding 5 weeks. Late physical effects Fatigue, lack of appetite, low mood, insomnia, need for more sleep, increased irritability, headache, difficulty concentrating, and anxiety. Rarely suicidal ideation and behaviour. Acute psychological effects Anxiety, panic, dysphoria, paranoia, and/or dangerous behaviours, experiences of emotional and/or physical suffering, feelings of grief, and feelings of isolation. Benign psychedelic “flashbacks” and very rarely Hallucinogen Persisting Perceptual Disorder. Ontological “shock” with alteration in metaphysical beliefs towards a non-materialist worldview. Enduring psychological and psychiatric symptoms Non-adherence and discontinuation of treatment.  Psychiatric treatment interference Unresolved and non-integrated difficult experiences may lead to persisting negative outcomes.