What’s the new trend currently taking the dinner party by storm? The answer is microdosing, where you take a small amount of a substance instead of the full dose. Everyone is talking about it, and everyone seems to be doing it.
It’s from LA, of course. Right after the pandemic, I visited a friend there and saw how wildly popular it was.
Now the British are trying it more and more often.
At a dinner party before Christmas, two of the ten guests confessed that they had done this with psychedelic drugs.
They weren’t hippies or artists; one was a lawyer and the other a TV producer.
When people talk about microdosing, they usually mean a psychedelic drug such as LSD or psilocybin (the active substance in ‘magic mushrooms’).
The idea is that taking a smaller dose means you get the mental health benefits claimed for the drug – increased self-confidence, focus, creativity, improved mood and empathy – without the hallucinogenic effect.
The doses are often around five to ten percent of the dose needed to make someone ‘high’.
When people talk about microdosing they usually mean a psychedelic drug such as psilocybin, the active substance in ‘magic mushrooms’ (stock image)
The problem, of course, is that psychedelic drugs – apart from the fact that they are illegal – do not involve a ‘treatment dose’.
A substance like LSD is often delivered as a colorless liquid soaked on paper.
It is not manufactured in a pharmaceutical laboratory and it is impossible to measure purity levels at any dose, micro or otherwise.
The potency of mushrooms varies greatly.
More than 200 species contain psilocybin, and there is no way to know which mushroom you are using or how much psilocybin you are consuming. When I asked my friends about this at the dinner party, both admitted that they had occasionally taken more than they intended and started hallucinating.
Taking too large a dose can lead to a frightening and even traumatizing experience.
Additionally, there is no clear evidence of real mental health benefits associated with microdosing LSD or psilocybin, and there are clear risks, so it’s not something I would ever recommend.
However, the concept of microdosing is interesting.
It is not well known that doctors do this all the time: not taking LSD, of course, but prescribing drugs in microdoses to their patients.
Many medications have unwanted effects at high doses, or simply more side effects, so we go lower.
I microdose myself with a prescription drug. I take Roaccutane, a drug used to treat acne.
Roaccutane is normally given in a course of four to six months at a dose of 0.5 to 1 mg per kg body weight per day.
I first took it 12 years ago at a dose of 80 mg per day for nine months. But after I stopped, the acne came back.
So my dermatologist prescribed another six-month treatment. This second bout cleared my skin perfectly – and when the treatment ended, my dermatologist suggested I continue it indefinitely to avoid relapse. But this time at ‘microdose’ level.
I now take 20mg per week to control acne – a fraction of the 560mg per week I was taking at the full dose.
My doctor has many patients who follow this microdosing regimen.
Roaccutane can have unpleasant side effects, including very dry, flaky skin, itchy eyes, problems seeing at night and sensitivity to the sun, all of which I suffered from, plus more serious problems with the liver, kidneys and pancreas, mood swings , and joint pain, which fortunately I did not experience.
But a microdose is just enough to keep the skin clear without these side effects.
There are of course even more examples of microdosing.
For example, taking small doses of Ozempic is becoming increasingly popular.
People take enough to dampen the appetite – or to suppress the desire to drink alcohol – but not so much that they start to lose weight. And on several occasions in my clinic I have prescribed medications this way.
Many of my patients who have had psychosis have been taking high doses of antipsychotics to treat their symptoms for a year or so.
These are strong medications with sometimes unpleasant side effects and people often want to try a break from them for a while.
In some patients, I have reduced the dose gradually over a few months, and if they do not develop psychosis again, I have maintained them at about one-tenth of their full dose.
This way they usually don’t get the side effects, but they do gain some antipsychotic properties.
It also means that they are more likely to actually take the medication.
However, doctors should be careful when considering prescribing much lower doses of medications.
The drug may not be approved for use at a lower dose, and we don’t always know if something taken at a low dose is still effective, or if the benefits are just due to placebo.
On the skin, the benefits are obviously very visible, and I’m grateful that my microdosing regimen works so well.
Richard Hammond with his wife Mindy in October 2023 at the premiere of The Bikeriders
Richard’s divorce after 28 years
Richard Hammond and his wife Mindy are reportedly divorcing after 28 years. That’s a very long time to be married.
Divorce can be a terrible shock, regardless of the length of a marriage, but after all these years it will take time for both of them to adjust.
I have seen patients who divorce after decades of marriage and never seem to fully get over it. Their world has collapsed and they must now rebuild without the one person they relied on for support.
The longer you are together, the more you have experienced as a couple. And no matter how much a partner desires it, it’s never easy to separate yourself from all that shared history.
It takes a minute to sign the divorce papers, but it could take years to feel like yourself again.
Smokers and obese patients risk being pushed to the back of the queue for operations under plans to cut NHS waiting lists.
This makes me very uncomfortable and is a dangerous slippery slope. We shouldn’t do it.
Is it time to consider very radical reforms to the NHS?
A survey by think tank Policy Exchange last week found that access to GPs and good treatment for life-threatening diseases were seen by the public as more important priorities than free care across all services.
I have always been a passionate supporter of the principle of free NHS care at the point of delivery, but frankly the healthcare system in its current form is hardly fit for purpose. For the first time since I started working in the NHS at the age of 16, I would now seriously consider the idea of some form of payment or insurance.
DR MAX PRESCRIBES… Call a friend
A study has found that loneliness can kill people because it increases the amount of proteins that clog the arteries and can cause early death. There have been so many advances in medicine in recent decades, but it seems shocking to me that something as simple to address as loneliness still seems like such a problem. You don’t have to be a doctor to handle this. We can all do our part by simply calling a friend.