Zachary Herrmann

Mental health problems including depression, anxiety, suicide, and burnout are common among health care providers. Resilience and well-being are factors thought to protect against these incidents. Clinical trials and naturalistic studies of psychedelic compounds have shown decreases in depression, anxiety, and suicidality while suggesting improvements in well-being. This secondary analysis of a large cross-sectional online survey consisting of participants with at least one lifetime psychedelic use sought to examine how use affects health care providers who treat psychiatric disorders with medications. In total, 228 respondents retrospectively completed measures of depression, anxiety, and well-being before and after psychedelic exposure. They also reported lifetime use, harms attributed to use, and preferred psychedelic agent. Psychedelic use was associated with improvements in depression, anxiety, and well-being. Reported suicidality decreased and resilience increased. A factor analysis suggested that a cluster of mystical, interpersonal, and personal items predicted improvement in depression, anxiety, well-being, suicidality, and resilience. Preferred psychedelic agent did not affect outcomes. Frequency of use was not associated with outcomes although differences in effect sizes were seen. Harm reported was consistent with the general population, with 13.2% ( n = 30) reporting at least one harm. Pre-exposure alcohol use, aggressive impulses, and desire to die by suicide improved most often while marijuana use most often worsened or did not change. These results are consistent with clinical trials and naturalistic studies examining psychedelic use in the general population and suggest that health care providers who treat psychiatric disorders with medications may benefit from psychedelic use, although some harm was reported. Given the current mental health crisis among health care providers, further research is warranted to examine whether interventions utilizing psychedelics could improve well-being and effectiveness of health care providers while decreasing adverse mental health outcomes associated with working in health care. ClinicalTrials.gov (ID: NCT04040582).

Subjective responses to psychoactive drugs have served as intriguing windows into consciousness as well as useful predictors. Subjective reactions to psychedelic molecules are particularly interesting given how they covary with subsequent improvements associated with psychedelic-assisted treatments. Although links between subjective reactions and decreases in treatment-resistant clinical depression, end-of-life anxiety, and maladaptive consumption of alcohol and nicotine appear in the empirical literature, the measurement of these subjective responses has proven difficult. Several scales developed over many decades show reasonable internal consistency. Studies suggest that many have a replicable factor structure and other good psychometric properties, but samples are often small and self-selected. We review the psychometric properties of some of the most widely used scales and detail their links to improvement in response to psychedelic-assisted treatments. Generally, assessments of mystical experiences or oceanic boundlessness correlate with improvements. Challenging subjective experiences, psychological insight, and emotional breakthroughs also show considerable promise, though replication would strengthen conclusions. We suggest a collaborative approach where investigators can focus on key responses to ensure that the field will eventually have data from many participants who report their subjective reactions to psychedelic molecules in a therapeutic setting. This may aid in predicting improvement amongst targeted conditions and wellbeing.

Heroin-induced toxic leukoencephalopathy (TLE) is an uncommon condition that presents with nonspecific and variable neuropsychiatric findings. It may result in satisfactory recovery or death. Traditionally referred to as “chasing the dragon” syndrome and associated with inhalation of pyrolyzed heroin, recent publications have reported forms of the syndrome associated with noninhaled heroin. We report 2 cases of heroin-induced TLE associated with noninhaled routes of administration and a well-documented history of opioid use disorder. The patient in the first case presented with moderate to severe symptoms. Magnetic resonance imaging of the brain revealed increased T2 and fluid-attenuated inversion recovery signals bilaterally throughout subcortical and periventricular white matter. She survived with significant cognitive issues at discharge from which she adequately recovered by 11-month follow up. The patient in the second case presented with severe symptoms. Magnetic resonance imaging of the brain showed diffuse abnormal increased T2 and fluid-attenuated inversion recovery signals in the white matter of the centrum semiovale and corona radiata. The patient died within 3 weeks of presentation. Both cases illustrate the underrecognition of the form of TLE associated with noninhaled heroin and the difficulties involved in confirming recent heroin use that likely delayed the diagnosis. Further, noninhaled heroin-induced TLE can present with specific signs and symptoms that may help clinicians delineate it from the inhaled form. Given the ongoing opioid epidemic, early and accurate recognition of this condition is of paramount importance.