The sweeping psychedelic microdosing movement especially popular with young people is new, it’s experimental, and it may do a lot of good. Microdosing on mushrooms or rather, their hallucinogenic chemical, psilocybin, and MDMA is gaining traction and millions in investment as a viable treatment for mental illness. A host of recent studies have shown promising results – although the placebo effect has called some into question. As more people seek magic, it’s worth asking what the unseen implications may be on insurance, for example.
Dr Blanche Andrews, Medical Advisor at Sanlam, says the short answer is that microdosing on psychedelics is ‘new’, but the underwriting process would be the same as for any other drug.
Some recent studies:
- MDMA combined with talk therapy has shown impressive results in treating those with post-traumatic stress disorder (PTSD)
- The Global Drug Survey of 6 753 people found microdosing on LSD or psilocybin can enhance mood, creativity, focus, and sociability, with minimal reported side effects
- Psilocybin was compared to escitalopram (a top-performing antidepressant) in one small study, and performed as well, with a faster onset and fewer side effects
More about microdosing
Microdosing means taking very small doses of a drug to benefit from its physiological action while reducing the risk of side effects. Psychedelic start-ups are currently making bank. Quartz reports psychedelic medicine start-ups have made about $329 million from January to April this year. And the global psychedelic drug market is forecast to be worth $10.75 billion by 2027. The long-stigmatised drugs are making a major comeback and are speculated to be effective for depression, eating disorders, addiction, and PTSD.
Why? Andrews says that in an Unherd article, Tom Chivers suggests that psychedelics disrupt Baye’s theorem. “We all have some level of confidence in prior beliefs – that’s how we make sense of the world. If our prior beliefs are strong, new information won’t change these. A depressed person often forms relentless, incorrect beliefs about their perceived worthlessness and the terrible state of the world. It’s difficult to shift these. But psychedelics do just that. They remove our familiarity with our surroundings.”
Quartz explains further: Psychedelics appear to bond with our brain receptors that attract serotonin – the ‘happy’ hormone. They also seem to restrict blood flow to the brain’s default mode network (DMN), which helps us make sense of the tide of information our senses send us. This gets ‘locked’ into ‘rigid, repetitive patterns of thought’. So, when we suppress it, we can break these ‘ruts’ and form new neural connections. Hence, a depressed person may be able to ‘break out’ of repetitive negative thoughts. Does this affect last when the drug wears off? The answer is not yet known and more research into the perceived vs. actual efficacy of microdosing is required.
The case for cannabis
MDMA and psilocybin remain illegal drugs in South Africa. But cannabis has been legal for private use since 2018. Microdosing on marijuana isn’t a new trend – in fact, Rolling Stone did an article on it in 2017, sharing some evidence that small, regular doses of THC (the psychoactive compound in marijuana) may be beneficial for moderating moods, boosting creativity, and more – without people becoming 'stoned, paranoid or lethargic'.
What does microdosing mean when it comes to insurance?
When it comes to any drug use, Andrews says insurers follow a set procedure for underwriting:
- First, we consider the mortality aspects. Could the use of the drug impact life expectancy?
- Then there’s the morbidity aspect. Could the use of the drug ramp up the risk of illness or disability? Could it mean a person risks leaving their occupation earlier?
- Is the use of the drug medical or recreational? If it’s medical, what’s the underlying condition it is being used to treat? For example, if one was microdosing for a mental health condition, the insurer would probably ‘rate’ for that condition, rather than (or perhaps as well as) the drug use.
- We then ‘risk stratify’ according to how often and how much is used, for example, an experimental user may have ‘dabbled’ once or twice, whereas a heavy user would be using X times a day.
- In the case of marijuana, we’d also need more detail about the product. Is it the THC compound (which causes the ‘euphoric high’) or Cannabidiol (CBD) that’s being used? Is it being ingested, smoked, or used topically as a cream? Smoking a high potency of THC (over 10%) has been linked with psychosis so would be an important consideration.
- What’s the likelihood of dependency, for example, THC is more addictive than CBD.
- Is there a risk that it’s a gateway substance? The gateway hypothesis is that substance use progresses sequentially, for example starting with alcohol and tobacco use, followed by cannabis and later the use of illicit drugs.
She adds, “Each insurance application is assessed on a case-by-case basis, taking into account the criteria mentioned and the overall risk profile of the client. An application may accordingly be accepted, accepted with ‘a loading’ or an exclusion(s), or rejected.
“The bottom-line is that it’s critical for individuals to disclose any substance or medication they’re taking to their insurer, to decrease the likelihood of any delays or rejection, should they claim. Honesty is always the best (for your) policy. Even something as seemingly common and innocuous as Ritalin should be disclosed, especially if taken regularly.”
Microdosing may be new, but insurers have an existing framework to follow.
Andrews concludes, “It demonstrates exciting potential but should be entered into with caution and consideration. Its impact on an insurance application must be one of the things to think about.”
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