Understanding the Opioid Crisis: Mechanisms and Consequences

David Nutt is a psychiatrist and a neuroscientist at Downing College, Cambridge.  His research focuses on illicit drugs—their harm, classification, and potential for therapeutic use in psychiatry. In this episode, David discusses his framework for assessing the potential harm caused by common recreational drugs and explains how they are regulated, which is oftentimes misaligned with actual risk. He describes in detail the neurobiology, mechanisms of action, and addiction potential of alcohol, opiates, cocaine, and methamphetamine and contrasts those with psychedelics, which have been given a similar regulatory classification despite their relatively low risk of harm and their numerous potential therapeutic uses. Additionally, David explains the promise of psychedelics like ketamine, MDMA, and psilocybin for treating drug addiction and depression and discusses how political pressures have created roadblocks to future necessary research. We discuss:

• David’s early interest in the brain and experience in psychiatry [2:45];
• David’s brief work on government drug policy in the UK [10:15];
• A scale for rating the relative harm of certain drugs [13:45];
• The contrast in regulation between cannabis vs. alcohol and why research on potential benefits of cannabis is lacking [19:15];
• The opiate crisis and rise of fentanyl: the cause and potential solution [25:00];
• The science of addiction and the potential use of psychedelics for treating drug addiction [35:00];
• Cocaine: mechanisms of action and risks [41:45];
• Methamphetamine and crystal meth: mechanisms of action and neurotoxicity [48:15];
• How psychedelics came to be classified as schedule I drugs despite their numerous therapeutic uses [52:45];
• The history of MDMA and the bad science and political forces leading to its demonization [1:08:45];
• History of ketamine, medical use of esketamine, and the waning effects of psychedelics with increasing usage [1:13:30];
• Psilocybin for depression: David’s promising research and the roadblocks to more robust experiments [1:20:15];More.

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