This review covers the story of shamans, political upheaval, life-changing and magical experiences, and the most mind-altering substances on earth. No, this is not a review of the latest magical-realism best-seller, but rather a sound scientific and well-researched book by an esteemed psychiatrist and academic, Professor David Nutt. In his latest book ‘Psychedelics: The revolutionary drugs that could change your life – a guide from the expert’, Professor Nutt attempts to make the science of psychedelics as compelling as their mystique and lore, and produces a highly readable and informative book.

The book offers a broad coverage of psychedelics; their effects, history, and potential, as well as an overview of psychedelic research, both his own and that of others. He does this in a clear and often humorous way, making it accessible to the general public as well as fellow doctors, who he specifically mentions as his target audience.

Professor Nutt is a man of many hats; arguably the psychedelic research King of England, a professor of psychopharmacology, and the former ‘Drug Czar’ of Britain when he acted as chairman of the Advisory Council on the Misuse of Drugs. He was notoriously fired from this role after publishing a paper showing the risk of dying from MDMA was dwarfed by that of Horse-Riding addiction (street-name ‘Equasy’).

Nutt was also hired by the British government to lead an evidence-based approach to drugs, which led to a paper purporting alcohol to be the most harmful drug to society (comfortably beating out crack cocaine, heroin, and methamphetamine based on its harm to others, rather than to the user). As he describes in this book, the government were rather less interested in this evidence than he might have hoped, and his frustration at this contributed to his publication on the dangers of ‘Equasy’.

Nutt’s first two book publications ‘Drugs Without the Hot Air: Minimising the Harms of Legal and Illegal Drugs’ and ‘Drink?: The New Science of Alcohol and Your Health’ presented to a lay audience the evidence and science behind his somewhat controversial beliefs. Nutt opines that governments, particularly that of his home country, prefer to make policy decisions based on political ideology and point-scoring than based on science. He says that he decided to enter the area of psychedelic science based on the clear beneficial evidence it produced, after prompting by a then PhD student, now academic juggernaut, Robin Carhart-Harris.

The history of psychedelics, both ancient and modern has been well covered by the best-selling ‘How to Change Your Mind’ by Michael Pollan. Nutt covers this history in a more truncated manner in this book. Big personalities come to the fore during this reciting; the Mexican healer Maria Sabina, whose accidental popularisation of ritual psychedelic mushroom use led to the destruction of her life; Alexander Shulgin, the chemist, who synthesised (and self-tested) thousands of psychoactive compounds; Friedrike Meckel Fischer, the underground psychedelic therapist, who was imprisoned after being informed upon by a jilted husband of an ex-client.

The book reads in the quintessential ‘Nutt style’, a welcome mixture of dry humour juxtaposed with hard neuroscience. Nutt’s own story and experiments are quite entertaining in their own right, not least his recounting of a first-time cannabis-user Jon Snow having a rather unpleasant time in an MRI scanner. Nutt’s recounting of his career in psychedelic research leaves plenty of room for criticism of the UK government, and their disinterest in an evidence-based and practical approach to psychedelics causing near-impassable red tape.

Nutt covers a gamut of psychedelics in depth, describing their history, pharmacology, and effects. He starts with ‘the classics’, i.e. LSD, psilocybin, and DMT, to the lesser known salvia and scopolamine. Later chapters delve deeper into the evidence of psychedelics in medicine, and provide interesting insights into how these experiments were formulated and conducted (including how raving Mormons were the perfect participants in a study assessing long-term harms of MDMA).

Sceptics of the medical use of psychedelics might be surprised to hear of Nutt’s optimism of psychedelics in treating cluster headache (which he gives a 10/10 certainty [perhaps should be 9.5 (Schindler et al. Reference Schindler, Sewell, Gottschalk, Luddy, Flynn, Zhu, Lindsey, Pittman, Cozzi and D’Souza2022)]) and anorexia nervosa, in addition to the more recognised impact on depression and PTSD. These hypotheses are again backed up by a combination of literature and personal recounting, and are a more approachable read than a systematic review of the topic.

Although Nutt’s concerns for the risks of psychedelics might be considered on the optimistic end of most psychiatrists, he does present the major risks associated with them. His main concern is that of an unregulated black-market leading to users consuming both unknown substances and dizzyingly (best-case scenario) high doses. With the average MDMA content of ecstasy pills tripling from 60 mg since the 90s (and often in excess of 250 mg) it is safe to say that the risks are climbing for consumers (perhaps even surpassing that of ‘Equasy’).

For the reader who is well immersed in psychedelic history and research, this book might not add much to your knowledge base. For every other psychiatrist who routinely treats patients, there is much to gain from reading this book and becoming acquainted with the science of psychedelics.