Story at a glance
- Many psychoactive drugs are classified as Schedule I under the 1970 Controlled Substances Act, meaning they have no medical use and pose a high abuse risk, despite recent studies indicating otherwise.
- To better understand psychiatrists’ views on scheduled substances, researchers at Ohio State University carried out an online survey among 181 professionals.
- Findings underscored expert opinions were incongruent with federal policy for some substances, suggesting updated scheduling may be warranted.
Reports have documented the increased popularity of marijuana and hallucinogenic drugs among Americans in recent years, while particular attention has been paid to potential therapeutic benefits of psilocybin, the active ingredient in magic mushrooms.
But under U.S. federal law, marijuana and many hallucinogenic drugs are classified as schedule 1, meaning they have “no currently accepted medical use and a high potential for abuse,” according to the U.S. Drug Enforcement Agency. This classification also hinders research on these substances, while use can lead to criminal consequences.
Now, new research from Ohio State University reveals many psychiatrists are taking issue with federal classification of psychoactive substances, particularly psilocybin and alprazolam (Schedule IV).
The online survey was completed by 181 U.S. psychiatrists, randomized to read one of four vignettes depicting a depressed patient who reported symptom relief after non-prescribed psychoactive drug use (methamphetamine [Schedule II], ketamine [Schedule III], psilocybin or alprazolam). Participants had been practicing psychiatry for an average of 16 years.
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“We wanted to choose two drugs for the vignettes that we felt were appropriately scheduled based on the scientific evidence, and then we chose two that we felt were not necessarily reflecting current evidence,” explained co-author Adam Levin, a third-year psychiatry and behavioral health resident in Ohio State’s College of Medicine, in a press release.
“Psilocybin may not be appropriately scheduled, and we felt risk might be underestimated for Xanax. Methamphetamine and ketamine, based on a review of the literature, are fairly consistent with their schedules. And then we wanted to see whether psychiatrists perceived any incongruities.”
Psychiatrists answered questions about the clinical scenario and rated the substance’s safety and therapeutic and abuse potentials.
Alprazolam (Xanax) is currently classified as a Schedule IV drug, meaning — in the eyes of the federal government — it has low potential for misuse and dependence and has strong therapeutic value.
But survey respondents rated alprazolam as having the highest misuse potential out of all four substances and found it has misuse potential on par with methamphetamine and alcohol. It also currently belongs to the third most commonly misused group of substances in the United States, benzodiazepines.
Behind ketamine, psilocybin was rated as having the second-highest therapeutic potential, while having the lowest potential for misuse. Studies have documented therapeutic benefits of ketamine and psilocybin for certain mental health conditions.
“The problem is that our drug schedules don’t match the scientific evidence of their actual harm and their actual therapeutic and abuse potential,” said co-author Alan Davis, assistant professor and director of the Center for Psychedelic Drug Research and Education in The Ohio State University College of Social Work in the release.
These substances were last classified in 1970 following the Controlled Substances Act. But since then, much more has been discovered about the drugs’ harms and potential uses. Notably, alcohol is not a scheduled substance, despite data showing it is the third leading cause of preventable death in the country.
“Methamphetamine, alcohol and Xanax were rated statistically equivalent in terms of their abuse potential,” Davis said. “And we showed a similar finding where methamphetamine, alcohol and Xanax were all found to be equivalent in terms of lower on the safety scale – more unsafe compared to psilocybin and ketamine.”
Overall, researchers stressed the importance of having policies congruent with scientific evidence and noted psychiatrists’ views were largely in line with those of other mental health professionals and drug addiction experts, along with drug users themselves.
“It’s important to call attention to this – we should have a flexible policy that can incorporate expert consensus,” Levin said.
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