This perspective paper (2021) advocates the need for public funding of independent evaluations of the efficacy of psychedelic drugs, given that current research efforts spurred by private philanthropic interests may propel a widespread use of psychedelics and demands to implement them as a first-line treatment, ahead of the evidence on their safety, efficacy, and long-term effects.
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Author: Wayne Hall
The need for publicly funded research on therapeutic use of psychedelic drugs
The classic psychedelics include mescaline, psilocybin, LSD, dimethyltryptamine (DMT), and plant-based substances such as ibogaine and ayahuasca.
Over the past two decades, there has been a revival of clinical research on the therapeutic use of psilocybin and MDMA. These drugs have produced substantial benefits in patients with treatment-resistant depression and post-traumatic stress disorder, and the FDA has encouraged this research.
A major challenge in conducting randomized placebo-controlled trials of psychedelics is that patients and therapists are aware of who has been given a psychedelic drug.
Psilocybin has a low abuse potential because it does not produce euphoria or self-administration in animals, and users rapidly develop tolerance to its effects.
Psilocybin caused minor short-term adverse effects in 110 participants in laboratory studies followed up for 8-16 months. One participant reported persistent emotional instability, anxiety and depressive feelings that recovered after receiving psychotherapy.
Psilocybin has been described as a “disruptive” treatment because it produces an immediate clinical response and is sustained for six months.
The major limitations of the current evidence for psychedelic drugs are interconnected. Limited support from philanthropic sources has funded the research, and small samples of patients have been studied.
If psychedelic drugs are introduced in clinical practice, they may be used to treat anxiety and depression disorders and unhappiness, in the same way that “medical cannabis” has done.
The evidence may be used to argue for compassionate access to other psychedelic drugs, such as LSD, mescaline and DMT, as well as for the legalization of adult use of psychedelic plants for any purpose.
Public funding of independent evaluations of psychedelic drugs is needed. These evaluations should include longer-term follow-up evaluations of favorable outcomes.
Rationale for and usefulness of the inclusion of gaming disorder in the ICD-11
Video games are popular as an interactive recreational activity and as a passive entertainment, with portable consoles and smart devices making them easily accessible almost anywhere.
Gaming can produce numerous benefits for many players, including the fulfilment of psychological needs. However, problematic gaming can also cause mental and physical symptoms as well as functional impairment.
Gaming disorder is now included in the ICD-11 as a disorder due to addictive behaviours. It is characterized by impaired control, increased priority given to gaming over other life interests and daily activities, and a continued involvement in gaming despite negative consequences for the individual and his/her acquaintances.
Several features are key to emphasize in order to differentiate between people with gaming disorder and those who engage in intense or persistent patterns of gaming without experiencing associated negative consequences.
Gaming disorder was introduced in the ICD-11 based on epidemiological, clinical and neurobiological studies, as well as data obtained from treatment providers.
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Equity and Ethics