Original Article: Innovative Strategies for Addressing Substance Use Disorders: The Classic Hallucinogens
By Michael P. Bogenschutz, Psychiatric Times, April 20, 2017,
Dr. Bogenshultz describes this study: Residential psychedelic (LSD) therapy for the narcotic addict. Savage C, McCabe OL. A controlled study. Arch Gen Psychiatry. 1973 Jun;28(6):808-14.
Bogenshultz is taking the value of the results too far without looking at the design of this trial: Unblinded LSD drug given to persons who agree to be in the study. Low N of 39 persons in each comparator group.
He states it was a controlled trial of LSD-assisted treatment of heroin addiction, N=78 with heroin addiction randomized to abstinence based group therapy and urine monitoring vs. 4-5 wks of residential treatment , including a single high-dose LSD session, followed up usual care. Results showed that an “impressive” 25% in the LSD group were continuously abstinent during the 12 months follow up compared to 5% in the control group. 10/39 were abstinent in the LSD arm, and 2/39 abstinent in the control group.
Looking at it the other way, 29 persons (75%) who, in spite of AGREEING to and KNEW they were in the LSD group were not abstinent, and we don’t know how long abstinence lasted after the study ended. The LSD group is clearly not blind and these persons could have some strong placebo effect bias of hope and expectation of being in the active LSD group, and those in the control group knew they did not get LSD, in spite of having some interest in getting it because they knew it was an LSD study when they signed up for it, thus they may have had some disappointment. The researchers were also not-blind-you cant have one time high-dose LSD session and not know what is going on. The non-abstinent rates of 95% of controls and 75% in the active groups do not seem not all that different in the face of an unblinded treatment.
So here, in relatively low numbers studied, we have a fairly large percent of persons NOT maintaining abstinence despite being in an open LSD study. This was a methodologically troubled study: open label for LSD group, persons having an expectation if receiving LSD in both groups with a modest 20% more abstainers in the open LSD group. Open label drug and filtering out of patients who agree to get open label drug is not a controlled study.
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