What’s the new fashion trend currently sweeping dinner parties? The answer is microdosing, in which you take a small amount of a substance instead of the full dose. Everyone talks about it and everyone seems to be doing it.
It comes from Los Angeles, of course. Just after the pandemic I visited a friend there and saw how hugely popular it was.
Now, increasingly, the British are trying it too.
At a dinner before Christmas, two out of ten guests confessed to using psychedelic drugs.
They were neither hippies nor artists: one was a lawyer and the other a television producer.
When people talk about microdosing, they’re usually referring to a psychedelic drug like LSD or psilocybin (the active ingredient in “magic mushrooms”).
The idea is that taking a smaller dose means getting the drug’s claimed mental health benefits (increased confidence, focus, creativity, improved mood, and empathy) without the hallucinogenic effect.
Doses are usually around five to ten percent of the dose needed to get someone high.
When people talk about microdosing, they are usually referring to a psychedelic drug such as psilocybin, the active ingredient in “magic mushrooms” (file image)
The problem, of course, is that with psychedelic drugs – aside from the fact that they are illegal – there is no “treatment dose.”
A substance like LSD usually appears 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 dosage, micro or not.
Meanwhile, the potency of mushrooms varies greatly.
More than 200 types contain psilocybin and there is no way to know which mushroom you are taking or how much psilocybin you are consuming. When I asked my dinner friends about this, they both admitted that at times they had taken more than they intended and had started hallucinating.
Taking too large a dose can cause a frightening and even traumatic experience.
On top of that, there is no clear evidence of any 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; They don’t take LSD, of course, but instead prescribe medications to their patients in microdoses.
Many medications have undesirable effects, or simply more side effects, at high doses, so we lower the doses.
I microdose a prescription medication. I take Roaccutane, a medication used to treat acne.
Roaccutane is usually administered in a cycle lasting four to six months at 0.5 to 1 mg per kg of 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 it, the acne came back.
Then my dermatologist prescribed another six-month treatment. This second session cleared my skin perfectly and when the treatment was finished, my dermatologist suggested that I continue with it indefinitely to avoid relapses. But this time, at the ‘microdose’ level.
I now take 20 mg per week to keep acne at bay, a fraction of the 560 mg per week I took at the full dose.
My doctor has many patients on this microdose regimen.
Roaccutane can have unpleasant side effects, including very dry, scaly skin, itchy eyes, trouble seeing at night, and sensitivity to the sun, all of which I suffered, as well as more serious problems with the liver, kidneys, and pancreas. mood swings, and joint pain, which fortunately I didn’t experience.
But one microdose is enough to keep your skin clear and without any of these side effects.
Of course, there are other examples of microdosing.
For example, it is increasingly common to take small doses of Ozempic.
People drink enough to quell their appetite (or quell the desire to drink alcohol), but not enough to start losing weight. And on several occasions I have been prescribed medications this way in my clinic.
Many of my patients who have had an episode of psychosis have been taking high doses of antipsychotics for about a year to treat their symptoms.
These are strong medications with occasionally unpleasant side effects and people often want to try a period without them.
With some patients I have gradually reduced the dose over a few months and, if they do not develop psychosis again, I have kept them on about a tenth of their full dose.
In this way, they tend not to suffer the side effects, but do suffer some of the antipsychotic properties.
It also means they are more likely to 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 lower doses, and we don’t always know if something taken at low doses is still effective or if the benefits are just a result of the placebo.
In the case of skin, of course, the benefits are very visible and I am 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 separation after 28 years
Richard Hammond and his wife Mindy are reportedly divorcing after 28 years. That’s a long time to be married.
Divorce can be a terrible shock, regardless of the length of the marriage, but after all those years, both of you will need time to adjust.
I have seen patients who divorce after decades of marriage and never seem to get over it. Their world has collapsed and now they have to rebuild it without the only person they trusted for support.
The more time they are together, the more they have spent as a couple. And no matter how much one partner wants it, disentangling all that shared history is never easy.
It takes a minute to sign the divorce papers, but it can take years to feel like yourself again.
Smokers and obese patients face being ordered to the back of the queue for operations under plans to reduce 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 last week by the Policy Exchange think tank found that the public considered access to GPs and good treatment for life-threatening illnesses to be more important priorities than free care for all services.
I have always been a passionate believer in the principle of free NHS care at the point of delivery, but frankly the health service in its current form is barely fit for purpose. For the first time since I started working in the NHS, aged 16, I would seriously consider the idea of some form of payment or insurance.
DR MAX RECIPES… Call a friend
A study has found that loneliness can kill people because it increases the proteins that line the arteries and can lead to premature death. There have been so many advances in medicine over the past few decades, but it surprises me that something as simple to address as loneliness still seems like such a big problem. You don’t have to be a doctor to help address this. We can all do our bit by simply calling a friend.