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- Sep 28, 2017
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I have a patient who is a young adult white female, and she has a history of cannabis and alcohol use disorders; she currently denies cannabis use for the past six months but still drinks alcohol about once a week; she says she drinks socially but about half of these times she ends up getting drunk. She and a friend of hers also recently began participating in Native American religious ceremonies about once a month, in which psilocybin is used, and she reports this helps her to feel happier and it helps her to have interesting thoughts about herself and it makes the world more colorful for a few hours. She denied other substance use to me but from a recent PCP note I read, it appears she also disclosed use of acid and Molly. Of course, her participation in the Native American rituals as a purely religious experience is suspect, given her substance use history and the fact that she is not Native American.
During the recent visit to her PCP, it was recommended she talk with her psychiatrist about getting a medication specifically for her anxiety, because she has been having elevated heart rates, which the PCP also considered was due to the illicit substances, but which the patient said she wasn't willing to give up. She said her PCP recommended a medication that "started with C and ended with pam... I think it's pronounced clonpam, or clonzepam, or clonziapam, or something like that." While it may be true that the PCP suggested clonazepam and the patient just didn't know how to pronounce it, this reminded me of classic drug seeking behavior.
I did not end up prescribing her any controlled meds at this time, but this got me thinking about psilocybin and whether its use in a religious practice without any evidence of a substance use disorder should preclude the use of any controlled substances as medications. Let's say this patient had zero substance abuse history and was only using psychedelics in religious ceremonies. Are there any drug interactions or safety concerns I would need to be aware of, before starting a patient on any medication?
During the recent visit to her PCP, it was recommended she talk with her psychiatrist about getting a medication specifically for her anxiety, because she has been having elevated heart rates, which the PCP also considered was due to the illicit substances, but which the patient said she wasn't willing to give up. She said her PCP recommended a medication that "started with C and ended with pam... I think it's pronounced clonpam, or clonzepam, or clonziapam, or something like that." While it may be true that the PCP suggested clonazepam and the patient just didn't know how to pronounce it, this reminded me of classic drug seeking behavior.
I did not end up prescribing her any controlled meds at this time, but this got me thinking about psilocybin and whether its use in a religious practice without any evidence of a substance use disorder should preclude the use of any controlled substances as medications. Let's say this patient had zero substance abuse history and was only using psychedelics in religious ceremonies. Are there any drug interactions or safety concerns I would need to be aware of, before starting a patient on any medication?