Real-world psychedelics data: 5 Questions for public health researcher Kari Rockhill

Rockhill discusses Rocky Mountain Poison Control and Drug Safety’s research and how it might inform future psychedelic regulations and policy.

Rocky Mountain Poison Control and Drug Safety (RMPDS) was founded in 1956 as a poison control center and the organization still serves that purpose. If you live in Colorado, Montana, Idaho, Hawaii, or southern Nevada and call poison control, you’ll get RMPDS on the line. RMPDS also conducts drug and public health research, and has even begun developing poison antidotes to venomous snakebites and exposures to radioactive materials.

A decade ago, when biostatistician Kari Rockhill joined RMPDS’s research department, the organization was largely focused on opioid addiction. That shifted towards stimulants such as ADHD drugs Adderall and Ritalin as they became more popular. More recently, the organization has been ramping up its research on psychedelic use, conducting a nationally-representative survey about Americans’ use of the drugs. The Microdose spoke with Rockhill about RMPDS’s research and how it might inform future psychedelic regulations and policy.

RMPDS is collecting data on psychedelic use through its National Survey Investigating Hallucinogenic Trends (NSIHT). I know there are other research groups studying psychedelic use as well; what methods do you all use that differ from existing research?

With NSIHT, we work with commercial panel companies to recruit participants. These are people who are recruited to take all kinds of surveys, from politics to “do you like your toothpaste?” Unlike some other surveys, they’re not recruited because of their drug use, so we truly believe that when we sample from these panels, we can capture the whole spectrum of use, from enthusiasts to critics, from people who use psychedelics often to people who have used psychedelics once and never touched them again.

Why is it important to have this real-world data, and how might that be used?

If you ask three different people, you’re going to get three different answers. I’m a public health professional, an epidemiologist by training, so I have strong opinions about addressing public health concerns at the population level. Clinical trials are important because we do need to understand whether these medicines are effective, but we need to look at the population-level and understand what the risks are to the average Joe who happens to come across this substance and use it. Driving under the influence is a great example of why this matters. We’re finding in our data that using multiple substances is very common; I don’t mean just mixing multiple psychedelics, but mixing psilocybin with cannabis or with alcohol. That informs how we educate people and help them figure out the best way to safely use these substances, and what other things we need to have in place to ensure safety.

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What should we have in place to ensure safety?

We need peer support services like The Fireside Project, where people are trained to address situations where someone might be having a difficult psychedelic experience. Poison centers and suicide hotlines will be important too, in case people need those. And it’d be great to have more first responders trained on how to handle challenging experiences; it took quite awhile for first responders to get fentanyl and opioid trainings.

We should also have substance specific messaging around safe use. To use a Colorado example: if you’re going to a show at Red Rocks, which substances should you steer clear from mixing? If you are going to take drugs, what intentions do you want to set before you go into, and who will you be surrounded by? Public education and resources to help people understand what they’re getting into is really beneficial, and population-level data about drug use can inform what to prioritize in that messaging. In the age of social media, there’s a lot of information, so it’s extra important to establish reputable sources.

RMPDS is working with Colorado's Natural Medicine Program to collect data. What does that collaboration look like?

We had an existing relationship with the Colorado Department of Public Health and Environment; we work with them on other topics beyond psychedelics, but we’re working with them to gather data about the Natural Medicine Program. We work with other agencies, too, like the Department of Revenue and Department of Transportation.

But our primary goal is research at the national level; we’re funded through the Substance Abuse and Mental Health Services Administration, which is an agency within the Department of Health and Human Services. So while we’re monitoring drug use in Colorado, we’re really trying to track general use patterns to understand how that is changing over time. For example, can we track how much increase there’s been in ibogaine use? Is that happening in ceremonial settings, or in retreats? Or are people doing it recreationally? We take a risk-benefit approach; there are going to be people who really benefit from these substances, and we want to capture that, but then there will also be people who experience risks when taking these substances. That’s true for any medication, and having this data helps us quantify the risk-benefit profile of all these substances. We’re trying to be very intentional about giving each molecule its own time and space in our research. What we find with psilocybin might not be true for LSD.

Colorado just rolled out its Natural Medicine Program this year, and New Mexico will be doing so soon as well. And, of course, there are several psychedelics that could be put in front of the Food and Drug Administration for approval in the coming years. How might your research capture how these changes at the state and federal level influence the behavior of people?

Our NSIHT survey already has Colorado- and Oregon-specific questions, and we plan to continue that; when New Mexico rolls out its program, we’d add that too. When it comes to evaluating specific things within state programs, we have different collection techniques that we’re working on. We’re actually currently collecting some patient-level data within Colorado from ketamine clinics.

As for the FDA space, we have a lot of experience collecting data to monitor drugs that have REMS — Risk Evaluation Mitigation Strategies, which require companies to report back to the FDA about how safe their product is and how it’s being used in the real world. Any product that has abuse potential tends to have REMS. For the last 15 years, we’ve collected data on FDA-approved opioids and stimulants to help fulfill some of those requirements; it’s been our bread and butter. For example, if a company had an opioid on the market, we serve as an independent third party data collection system collecting data describing their products. And we also work directly with the FDA with some population-level statistics. We collaborate on both sides, and that’s kind of the beauty of RMPDS: we’re completely independent.

Right now it’s unclear what kind of REMS the FDA might require of psychedelic products. We actually wrote a position paper last year about how you need customized data about these drugs; some should be monitored in ways that are similar to opioids and stimulants, but there are special considerations for understanding the therapeutic component of psychedelic use, and the providers of therapy. There’s a lot of new data to be collected to lay out a framework for that.

This interview has been edited and condensed for clarity and length.