#96 Drugs: medicine or poison?

There’s a lot of talk these days about psychedelics being “medicines.” I wouldn’t disagree with these claims. I think psychedelics can be medicinal for psychological and/or somatic disorders and diseases. Anyways, after scanning some social media and online journalistic pieces the last several months, and connected to a question I asked Dr. Kenneth L. Koch in episode 2.6 of my podcast was: How do we know whether a drug is a medicine or a poison? There’s a fine line between the two. In small doses, as is the case with psychedelics, anything could potentially be a medicine, and the same substance could be considered a toxic poison in larger doses. Even water can be harmful if one drinks too much of it in a short period of time.

Recently I recalled the work of the Swiss scientist-alchemist of the German Renaissance, Paracelsus. I had heard of Paracelsus before but delved a bit further into his work during a day-long workshop at the University of Antwerp on March 29, 2018, called Modern Science and the Demagification of the World. For some reason, I didn’t put 2 and 2 together that it was Paracelsus who said, “the dose makes the poison.” I want to read his biography one day to understand more about his philosophy and life’s work.

It irks me that something can be both a medicine and a poison. Where do we draw the line? Just as there is a fine line between genius and insanity, as the axiom goes, there appears to be a comparable threshold between a medicine and a poison. Does a psychedelic become a poison when it induces visionary states? Is that a sign that one took too much of a good thing? Microdosing psychedelics, for example, has been widely hailed as a therapeutic and cognitive enhancing tool; is a micro dose a medicine whereas a macro dose is a poison?

Another two-fold question I have is: Can a poison be medicinal, and can a medicine be poisonous. A recognized medicine can be poison if one is allergic or shows signs of resistance to said medicine. On the other hand, a substance customarily perceived as a toxic poison could be considered a medicine. For example, a substance such as iboga is cardiotoxic at the higher end of the dosage spectrum. But this might be exactly what the patient needs to kick an opioid habit. The cure might be contained in the higher dose and the altered/visionary state that ensues. One can only access the visionary/spiritual realm upon crossing a dosage threshold. Upon crossing such a threshold, visions of entities (berating the experiencer at times) and a life review of bad choices and missed opportunities show the experiencer how they’ve messed up and possibly what they can do to clean up their lives, usually, in the post-experience integration phase. The point is that one doesn’t get these insights on small doses. Are we supposed to “go big or go home” if we’re to get any value from these psychoactive compounds even though some of them are toxic at high doses?

This thought just popped into my mind: doctors deal medicine while assassins apply poison. On the one hand, one prescribes a lower dose to heal, and on the other hand, one administers a high dose to kill or maim. When it comes to psychedelics, can we not do both? One could start with lower doses to see how that helps, followed by higher doses to kill whatever toxic thoughts, behaviors, or diseases cling to the individual’s body or mind. And since many people take psychedelics in underground settings, people act as their own doctors and assassins. The point is not to kill oneself, to commit suicide, because you cannot work on yourself if you’re dead. I don’t think people take psychedelics as tools to end life. Most people who view psychedelics as medicines take them to heal, to get better, to improve, and to find answers to their questions.

In considering all of the above, I’m curious what we can learn from psychedelics by pushing the outer limits of what is considered safe usage. When Terence McKenna speaks of a “heroic dose,” e.g., 5 grams of dried mushrooms, is this safe usage? You wouldn’t die from taking such an amount but is it necessary? I wonder whether there is something more to learn by auto-intoxicating oneself with a medicine-turned-poison (or poison-turned-medicine?). Of course, I’m curious what lies at the limits of the known. But I wouldn’t put myself in harm’s way just to find out. I might consider pushing toward a particular substance’s limit if I had a medical team on standby with a defibrillator and other lifesaving means at the ready including that drug that doctors literally stab into your heart with a giant syringe to get your heart pumping again O_o I speak in extremes right now, I know this, but if some of us are going to push the limits, those people should know what they’re doing and have the proper medical know-how present. You’re probably wondering whether I would push the limits of a particular substance. Perhaps. It depends on what the median lethal dose rate is. I wouldn’t surpass such a dose, but would I get close to that threshold? Again, perhaps, IF I had medical professionals on standby to revive me. But once revived, you might never be the same again, mentally or physically.

To my knowledge, Kilindi Iyi was one of the first people to take double-digit-gram doses of dried magic mushrooms, for example, as high as 31 grams! He was well-under the median lethal dose in humans, but who would want to go to that headspace to find out what it is and what it’s like? Not me, never. But he lived to tell the tale and he seemed normal (even enlightened) in the YouTube videos I’ve watched of him at conferences.

I think Paracelsus is correct in saying that the dose makes the poison. Some circumstances demand medicine and others poison. I speak only for myself and am not making a normative statement for everyone, but I think pushing the limits of what is safe is where the most interesting action lies. Imagine a speedometer or propane tank dial with green, yellow, and red ranges. I believe most people experience the green and yellow ranges most of the time, whether on psychedelics or in other life activities in general, while the red range is risky according to currently known data. Once one approaches the border of the yellow and red zone, that’s where I think the most interesting experiences lie, namely, regarding visions and cognitive processes when it comes to psychoactive substances. I’m reminded of Chuck Yeager’s speed dial on the X-1 test jet when he broke the sound barrier in 1947 (Yeager & Janos, 1985). The dial read only to Mach 1 because scientists couldn’t imagine going faster. Many scientists at the time believed craft and pilot would disintegrate at such speeds. When Yeager officially broke the sound barrier, he broke the dial metaphorically speaking because it wasn’t designed to read past Mach 1 speed. My point is that many drugs have median lethal dose rates, that is, the dosage where 50% of the study subjects die. Ok, so one’s odds of success diminish once we know that 50% of subjects die at a particular dose. Regarding psychedelics, I would argue that the red range is the median lethal dose rate. That is not a threshold I would personally feel comfortable in crossing, unless, as stated above, I was accompanied by medical professionals.

Interestingly though, some subjects will not die at the median lethal dose; some subjects will endure high doses for some known and many unknown reasons. Undoubtedly, all subjects will die at a particular dose, in other words, no one can survive past a specific dose, it becomes too much for the body to handle, like putting too much sugar in your coffee: the coffee is so saturated with sugar that the excess, unabsorbed sugar drops to the cup’s bottom. However, there will always be outliers that can endure well past the median lethal dose. So even though a particular dosage kills 50% of the population, I’m curious what the outliers can experience at doses past the median lethal dose. I’m curious what visionary phenomena lie at these higher doses. Is there something we can do, some technology we can invent, that will be able to test whether someone is genetically fit to handle these higher doses? And once one’s genes are green-lit, they can probably be trained for these extraordinary experiences in addition to having proper medical professionals and equipment on standby. Essentially, what I’m proposing, or rather speculating, is akin to the plot of the film, Flatliners(1990). In the film, medical students devise a way to legally kill themselves, i.e., flatlined heart and brain signals, to explore the afterlife realm, and then are revived using modern medical equipment and expertise. Their methods are not guaranteed to work, but they are successful in the film. They also bring supernatural phenomena back into their everyday reality, so there’s that to consider as well.

In sum, I’m honestly curious about what psychedelic-induced visionary and cognitive phenomena lie at the border of medicine vs. poison, and further, safe poison and unsafe poison limits, all the while with the aim of staying alive. Such explorations will require advanced technology to test who is physically capable (e.g., outliers) to endure high doses of a particular psychedelic and medical supervision to intervene if things go sour.

Yeager, C., & Janos, L. (1985). Yeager: An Autobiography. Toronto: Bantam Books.

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