Inconsistencies between national drug policy and professional beliefs about psychoactive drugs among psychiatrists in the United States.
Adam W. Levin, Paul Nagib, Selina Deiparine, Thomas Gao, Justin Mitchell, Alan K. Davis
The International journal on drug policy October 2022 DOI: 10.1016/j.drugpo.2022.103816 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Quasi-experimental online survey Randomized Peer reviewed |
|---|---|
| Sample size | 181 |
| Population | American psychiatrists (mean age 48.7; 35% female) |
| Interventions | Psilocybin Methamphetamine Ketamine Alprazolam |
| Topics | Ketamine Psilocybin |
| Keywords | Alcohol Drug abuse Drug benefits Drug harms Drug policy |
| Key findings | American psychiatrists rated non-prescribed methamphetamine and alprazolam as less safe, less therapeutically promising, and more abuse-prone than psilocybin and ketamine, with methamphetamine and alprazolam rated similarly to alcohol. The authors argue these perceptions are inconsistent with the drugs' placement in the U.S. drug schedules and add to expert consensus that current drug policy is not scientifically coherent. |
Abstract
Evidence points to an incongruence between international drug policy and expert opinion about safety, abuse potential, and therapeutic potential of specific drugs. However, no prior studies have directly explored psychiatrists' attitudes about the current drug schedule. Therefore, we examined whether American psychiatrists' perceptions of four psychoactive drugs differed from those indicated by their schedules. A quasi-experimental online survey of a convenience sample of psychiatrists in the United States (N=181; Mean age=48.7; Female=35%). Participants were randomized to receive 1-of-4 vignettes, each depicting a depressed patient reporting relief from symptoms after non-prescribed psychoactive drug use (i.e., psilocybin [Schedule I], methamphetamine [SchedII], ketamine [SchedIII], or alprazolam [SchedIV]). Participants responded to questions related to this clinical scenario and then rated the safety, therapeutic, and abuse potentials of these four drugs and alcohol. There were significant differences by vignette condition in mean likelihood ratings of: warning against engaging in drug use again (p<.01), being concerned about developing a new psychiatric problem (p<.001), being concerned about increased suicide risk (p<.01) and being supportive of further use of this drug as part of the treatment plan (p<.001). Overall, non-prescribed use of methamphetamine and alprazolam was rated more concerning and less acceptable than non-prescribed use of psilocybin and ketamine. Compared to psilocybin and ketamine, participants rated methamphetamine and alprazolam as less safe (p<.001), having less therapeutic potential (p<.001), and having more abuse potential (p<.001). Mean ratings of safety and abuse/therapeutic potential of alprazolam and methamphetamine were equivalent to that of alcohol, and all three were rated more harmful than psilocybin and ketamine. American psychiatrists' perceptions about safety and abuse/therapeutic potentials associated with certain psychoactive drugs were inconsistent with those indicated by their placement in drug schedules. These findings add to a growing consensus amongst experts that the current drug policy is not scientifically coherent.