Psychedelic microdosing benefits and challenges: an empirical codebook

This survey study (n=278) aimed to develop a codebook of benefits and challenges associated with microdosing. The authors found, among other things, that many parallels exist between the effects reported as benefits and the effects reported as challenges.

Abstract

“Background: Microdosing psychedelics is the practice of consuming very low, sub-hallucinogenic doses of a psychedelic substance, such as lysergic acid diethylamide (LSD) or psilocybin-containing mushrooms. According to media reports, microdosing has grown in popularity, yet the scientific literature contains minimal research on this practice. There has been limited reporting on adverse events associated with microdosing, and the experiences of microdosers in community samples have not been categorized.

Methods: In the present study, we develop a codebook of microdosing benefits and challenges (MDBC) based on the qualitative reports of a real-world sample of 278 microdosers.

Results: We describe novel findings, both in terms of beneficial outcomes, such as improved mood (26.6%) and focus (14.8%), and in terms of challenging outcomes, such as physiological discomfort (18.0%) and increased anxiety (6.7%). We also show parallels between benefits and drawbacks and discuss the implications of these results. We probe for substance-dependent differences, finding that psilocybin-only users report the benefits of microdosing were more important than other users report.

Conclusions: These mixed-methods results help summarize and frame the experiences reported by an active microdosing community as high-potential avenues for future scientific research. The MDBC taxonomy reported here informs future research, leveraging participant reports to distil the highest-potential intervention targets so research funding can be efficiently allocated. Microdosing research complements the full-dose literature as clinical treatments are developed and neuropharmacological mechanisms are sought. This framework aims to inform researchers and clinicians as experimental microdosing research begins in earnest in the years to come.”

Authors: Thomas Anderson, Rotem Petranker, Adam Christopher, Daniel Rosenbaum, Cory Weissman, Le-Anh Dinh-Williams, Katrina Hui & Emma Hapke

Summary

Microdosing psychedelics has grown in popularity, but there is minimal research on the practice, and the experiences of microdosers in community samples have not been categorized.

Introduction

Microdosing psychedelic substances has recently grown in popularity, and scientific studies are just beginning to explore the effects of microdosing. This study aims to provide a data-driven taxonomy describing the positive and negative experiences reported by microdosers, summarizing high-potential avenues for focused experimental investigations.

The benefits of full-dose psychedelics

Early studies linked psychedelic use with beneficial effects, but prohibition halted research for 40 years. Modern research shows that psychedelics may be useful for treating alcohol and tobacco dependence, depression, end-of-life anxiety, and post-traumatic stress disorder.

Limiting microdosing research to topics that have been investigated in full-dose research may prematurely overlook unpredicted and potentially distinct microdosing outcomes. Instead, open-ended reports of benefits and challenges were solicited from microdosers who used LSD, psilocybin, or both.

The challenges of full-dose psychedelics

While psychedelics have considerable potential benefits and low physiological risks, full-dose experiences can put participants under considerable psychological risk. Delayed-onset headaches are another possible side-effect of full-dose psilocybin.

Johnson et al. [31] proposed safety guidelines for use with full-dose psychedelic substances, but anticipated that less frequent, less intense versions of full-dose challenges could be present even at the very low doses used in microdosing.

The present study

In this study, we explored the benefits and challenges experienced by microdosers and identified commonly-reported benefits and challenges. We also explored whether different substances were associated with different outcomes.

This study was part of a larger project that reported on the demographics, psychiatric comorbidities, and comorbid substance use of the sample.

Grounded theory method

The coding authors independently coded the benefits and challenges associated with microdosing using the principles of classic grounded theory, and the final codebook was iteratively discussed and refined over five refining passes.

Inter-rater agreement for benefits and challenges of microdosing was above 85% at every level (benefit code 85.1%, benefit sub-category 89.2%, benefit category 92.6%; challenge code 85.7%, challenge sub-category 86.9%, challenge category 88.5%).

Respondents

The sample analysed in the present study includes 278 respondents that answered the MDBC questions after indicating they had experience with microdosing LSD-only, psilocybin-only, or both LSD and psilocybin. These respondents were recruited primarily via the online forum “Reddit”.

This sample of microdosers is limited to modern Western populations, with a mean age of 27.8 (SD 8.9) and a non-normally distributed interquartile range of 21 – 31 years. Most participants were male, heterosexual, and white or European.

Design and questionnaires

Respondents completed a survey about their microdosing history, including substance, dose, and regimen. They were asked about benefits and challenges of microdosing, as well as health behaviours and substance-use changes.

Improved health behaviours and reduced consumption

Microdosing respondents indicated whether they had experienced improvements in mood, anxiety, meditative practice, exercise, eating habits, and sleep, and whether they had reduced their use of other substances.

Categories of benefit

The 11 categories of benefits were distiled from participant reports and are described in the full codebook.

Categories of challenges

The illegality of psychedelic microdosing substances is a major concern for many people, as is the social stigma surrounding the use of these substances.

There were 64 reports of other perceived challenges to microdosing, including the unknown risk-effect profile of microdosing itself, the need to prepare and remember to dose, and other miscellany.

Benefits and challenges by microdosing substance

Subjective importance ratings were non-normally distributed thus Wilcoxon signed rank tests were used to compare between substances. Psilocybin-only microdosers rated benefits as significantly more important than LSD-only microdosers; there were no differences found relative to respondents using both LSD and psilocybin.

Improvements and reductions

Participants reported improved mood, anxiety, meditative practice, exercise, eating habits, sleep, and reduced use of caffeine, alcohol, cannabis, tobacco, and illicit substances.

Discussion

Surveying extant communities of microdosers allowed for the creation of a qualitative taxonomy of MDBCs. These MDBCs can inform future microdosing research by leveraging participant reports for high-potential intervention targets.

The results of this study cannot be disentangled from expectation and placebo effects or recall biasses, but they point to potential therapeutic effects.

Emergent parallelism

Major parallels between benefits and challenges emerged among outcomes, suggesting that placebo effects and individual differences moderate reported effects.

The first hypothesis that could explain the parallelism between benefits and challenges is that the effects cancel out and nothing replicable is happening. However, the second hypothesis is that microdosing interacts with expectancy in some way, enhancing the effect of expectancy.

There are plausible pharmacological mechanisms of action for microdosing, and individual differences in genetically mediated substance metabolism, psychopathological diagnoses and personality, and momentary interpretations of interoceptive signals may affect how microdosing outcomes manifest.

Pathology may disrupt functional connectivity between the DMN and subgenual prefrontal cortex, whereas in a healthy brain, altered functional connectivity may produce undesirable activity rather than maintain healthy network coherence.

While parallelism emerged, not all categories of benefits were equally reported on both sides of the benefit/challenge divide. Mood, self-efficacy, and physiological response were the three largest differences in raw reporting rates.

Unique outcomes

Participants reported enhanced creativity and meta-creative processes after microdosing, and this finding accords with other findings that microdosers have higher creativity than non-microdosers and with full-dose research showing increased openness after full-dose psilocybin.

Illegality was the most commonly reported microdosing challenge, and is a socio-cultural circumstance, not an outcome of microdosing per se. This has resulted in unpredictable substance purity, dose accuracy, supply availability, and cost.

Improvements and reductions

Participants reported improving their mood and anxiety with microdosing, and decreasing their use of caffeine, alcohol, cannabis, and tobacco. These findings are consistent with research on full-dose psychedelics.

Limitations and future directions

The intent of the present study was to inform empirically-grounded data-collection initiatives by showcasing high-potential outcomes of microdosing, while also showcasing challenges that warrant measurement and suitable caution. We cannot claim that these perceived outcomes are causally related to microdosing.

We recruited participants from Reddit, and this convenience sample may have introduced demographic biasses. However, this data is still informative, and future intervention work should endeavour to recruit more inclusive and representative samples.

Qualitative research is biased by the research team and their coding decisions. The present taxonomy offers a foundation from which future focal research can be built, and suggests potential novel research avenues for psychedelic-based pharmacotherapeutic treatment of depression, anxiety, ADHD, smoking cessation, and substance use disorders.

Conclusion

Here we provide an initial taxonomy of benefits and challenges associated with psychedelic microdosing, which complements the other reports built from this larger microdosing research project. Experimental, hypothesis-driven studies are needed to test therapeutic safety and efficacy of microdosing psychedelics.