Psychoactive Harm Reduction

If drug users can't buy drugs from informed sellers, they'll get them from uninformed sellers and remain uninformed too. Drug use and sale should require permits which can be retracted if risk has been caused to others, but most drugs would almost never be used if the users were informed of all the risks, except in cases where those risks can be managed when informed how. However, there are three classes of drugs with particular therapeutic potential, and whether their potential is worth the risk depends on the severity of the disorder being treated:

 PSILOCYBIN:
TREATMENT

anxiety 1
RISK (LOW) MANAGEMENT
anxiety 1  low dosage 1

 KETAMINE:
TREATMENT

depression 2
RISK (MEDIUM)MANAGEMENT
brain damage 3psychedelics 3 (before)

MDMA:
TREATMENT

trauma 4
RISK (VERY HIGH)MANAGEMENT
blood brain barrier dysruption 10doxycyclin 11 (after) *
caffeine 24 (after) **
neuroinflammation 15doxycyclin 11 (after)
hyperthermia 5memantine 6 (before)
neurotoxicity 7memantine 7 (before)
cerebral edema 20ginkgo 23
reduced cerebral blood flow 21ginkgo 22
neural vasospasm 16ginkgo 17
oxidative stress 14 vitamin C 14 (before)
serotonin depletion 18vitamin C 18 (before)
hyponatremia 8low water input 9
migraines 12tryptophan 13 (after)
disseminated intravenous coagulation 19

* contraindicated with increased intracranial / intraocular pressure
** contraindicated with vasospasm

Sources:
Catlow BJ: Effects of psilocybin on hippocampal neurogenesis and extinction of trace fear conditioning.
2 Cambridge University: A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes
Nature, Nuri Farber et al.: Serotonergic Agents That Activate 5HT2A Receptors [such as LSD] Prevent NMDA Antagonist Neurotoxicity
4 Journal of Psychoactive Drugs: A Clinical Plan for MDMA (Ecstasy) in the Treatment of Posttraumatic Stress Disorder (PTSD): Partnering with the FDA
5 Medical News Today: Moderate doses of MDMA 'fatal in warm environments'
6 University of Valencia: Involvement of NMDA glutamate receptors in the acquisition and reinstatement of the conditioned place preference induced by MDMA
8 Garland A. Campbell et al.: The Agony of Ecstasy
9 Brvar M. et al: Polydipsia as another mechanism of hyponatremia after 'ecstasy' (3,4 methyldioxymethamphetamine) ingestion.
10 Rubio-Araiz A: (MDMA, ecstasy) disrupts blood-brain barrier integrity through a mechanism involving P2X7 receptors.
11 Jonathan S Alexander et al.: Venous endothelial injury in central nervous system diseases
12 Linda Changa: Effect of ecstasy [3,4-methylenedioxymethamphetamine (MDMA)] on cerebral blood flow: a co-registered SPECT and MRI study
13 Federigo Sicuteri: The ingestion of serotonin precursors (L-5-hydroxytryptophan and L-tryptophan improves migraine headaches)
14 Mahalakshmi Shankaran et al: Ascorbic acid prevents 3,4-methylenedioxymethamphetamine (MDMA)-induced hydroxyl radical formation and the behavioral and neurochemical consequences of the depletion of brain 5-HT
17 Ameneh Mashayekh et al.: Effects of Ginkgo biloba on cerebral blood flow assessed by quantitative MR perfusion imaging: a pilot study
18 Mahalakshmi Shankaran et al.: Ascorbic acid prevents 3,4-methylenedioxymethamphetamine (MDMA)-induced hydroxyl radical formation and the behavioral and neurochemical consequences of the depletion of brain 5-HT
19 J.A. Henry et al.: Toxicity and deaths from 3,4-methylenedioxymethamphetamine ("ecstasy")
20 Sharma et Ali: Acute administration of 3,4-methylenedioxymethamphetamine induces profound hyperthermia, blood-brain barrier disruption, brain edema formation, and cell injury
21 Linda Changa et al.: Effect of ecstasy [3,4-methylenedioxymethamphetamine (MDMA)] on cerebral blood flow: a co-registered SPECT and MRI study
22 Sun BL et al.: Effects of extract of ginkgo biloba on intracranial pressure, cerebral perfusion pressure, and cerebral blood flow in a rat model of subarachnoid haemorrhage.
23 M. Otani: Effect of an extract of Ginkgo biloba on triethyltin-induced cerebral edema
24 Chen et al.: Caffeine protects against disruptions of the blood-brain barrier in animal models of Alzheimer’s and Parkinson’s disease

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