Chronic Microdosing: A Harm Reduction Perspective
The psychedelic renaissance has ushered in a wave of interest in substances like LSD and psilocybin, not just for full-blown "trips" but for subtle "microdoses" intended to enhance well-being without the intense visual and emotional experiences associated with higher doses. Microdosing, the practice of taking a very small, sub-hallucinogenic dose of a psychedelic, has been reported to improve mood, increase creativity, and even reduce the frequency of undesirable mental health symptoms. However, despite the surge in popularity and an abundance of anecdotal reports praising its benefits, the long-term effects, particularly the risks of chronic microdosing, remain largely under-researched and potentially misunderstood.
The Heart of the Matter: Unseen Risks of Chronic Microdosing
While microdosing can be a window to enhanced cognitive and emotional function, it could also, quite literally, end up breaking your heart. This isn't just a metaphor about disappointment; it's about the potential physical impact on your heart health, particularly concerning valvular heart disease (VHD).
Serotonin 2B Receptor Activation: The Hidden Culprit
Many are unaware that chronic activation of the serotonin 2B receptor (5HT2B) could lead to serious heart issues. Several medications that activated this receptor were withdrawn from the market due to their association with VHD — these include Fen-Phen and Redux in 1997, and Permax in 2007. These drugs led to heart valve thickening and murmurs, with roughly 25% of patients developing new onset VHD.
Why does this matter for microdosers? Both LSD and psilocin (the active metabolite of psilocybin) bind to the 5HT2B receptor. This means that the very receptor linked to these heart issues is activated by the substances commonly used in microdosing.
Low Dose, High Risk?
It's a common misconception that the low doses used in microdosing are too insignificant to cause any adverse effects. However, if microdosing yields perceptible benefits, it implies that there is enough receptor activation to trigger both desirable and potentially undesirable effects.
For instance, LSD and psilocin have strong affinities for both the 5-HT2A and 5-HT2B receptors, indicating that even at low doses, these substances could influence heart valve cells. This is particularly concerning given that psilocin has a relatively stronger affinity for 5HT2B than 5HT2A, potentially increasing the risk of VHD.
Counterarguments and Why They May Not Reassure
Some proponents of microdosing argue that historical use and anecdotal evidence suggest safety. For example, studies from the 1960s reported no observable damage from daily doses of LSD over months. However, these studies didn't focus on heart health or use modern, sensitive methods to detect heart damage.
Dr. Passie and Drs. Fadiman & Korb, prominent voices in the microdosing community, cite various studies and personal observations to argue against significant risks. Yet, their counterarguments often lack robust evidence or fail to directly address the potential for VHD.
Real-World Observations and What They Tell Us
An important point raised by Drs. Fadiman & Korb is the lack of reported heart valve trouble among thousands of microdosers. However, this absence of evidence isn't evidence of absence, especially considering the subtlety of VHD symptoms and the informal nature of most microdosing reports.
Interestingly, there have been observations of mood instability among chronic microdosers after extended periods, suggesting that not all effects are benign or even noticeable without careful, systematic study.
How to Mitigate the Risks: A Harm Reduction Approach
Given the potential risks, especially with chronic use, here are some harm reduction strategies to consider if you choose to microdose:
Shorter Duration, Longer Breaks: Opt for shorter microdosing cycles (a few weeks to a couple of months) followed by longer breaks. This can reduce the cumulative activation of the 5HT2B receptor and, potentially, the risk of VHD.
Monitor Your Heart Health: Be aware of VHD symptoms — chest pain, shortness of breath, and lightheadedness. Regular check-ups and, if possible, an echocardiogram can help detect any early signs of valve issues.
Educate Yourself and Stay Informed: As research evolves, stay updated with the latest findings. Being informed can help you make better decisions about your health and microdosing practices.
Seek Professional Guidance: If you're considering microdosing, especially if you have pre-existing health conditions, consult with a healthcare provider.
Balancing Curiosity with Caution
Microdosing, like any other intervention, carries both potential benefits and risks. The allure of enhanced mental and emotional functioning must be balanced against the understudied and potentially significant risk of heart disease. By adopting a harm reduction approach, microdosers can take steps to safeguard their health while exploring the potential benefits of psychedelics.
Remember, the journey to improved well-being should not lead to a broken heart — figuratively or literally. Stay safe, stay informed, and always consider the long-term implications of your health choices.
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