Are you tripping over how to underwrite microdosing?

As part of Swiss Re's Life & Health research and development team, my colleagues and I often field inquiries from clients looking for underwriting insights. Sometimes, this means navigating new territory. Recently, we got a question about "microdosing," the use of tiny amounts of psychedelic drugs that some have turned to address mental health issues. Studies show it is more common than you might think, and potentially something more insurers should have on their radar.  

A couple months ago, we received a request for assistance that highlighted a growing phenomenon: A client called seeking guidance after a prospective insured had disclosed they were microdosing psychedelics. This involves using small quantities of psychedelic substances –  LSD, short for lysergic acid diethylamide, magic mushrooms, or MDMA, also known as ecstasy -- in hopes of reaping benefits like improved mood or mental health.

As underwriters, we seek to make clear-eyed assessments of multiple risks when extending coverage to clients, in the process helping them make good decisions about healthy lifestyles.

That's why we want to understand the potential risks and benefits of microdosing as use extends to broader populations, not least because many people are experimenting on their own, without rigorous efficacy or safety evidence normally required for new therapies. Psychedelics, even tiny amounts, also remain illegal in most jurisdictions.

Some have turned to microdosing psychedelics for relief from conditions including depression, anxiety, obsessive-compulsive disorder, eating disorders, or Alzheimer's Disease – all elusive health challenges already affecting insurers. Microdosing, according to the theory behind it, may stimulate so-called neuroplasticity, reorganising the human nervous system's structure to produce positive cognitive outcomes.

Evidence microdosing works is mixed, with some studies concluding it didn't produce benefits. Many scientists believe more research is needed. To that end, several institutions including in the US and UK are investigating psychedelics and their potential health benefits. Already, however, the practice isn't uncommon, with studies even suggesting its use has risen since the COVID-19 pandemic began.

A 2020 survey of California college students indicated 17% were microdosing as they sought to improve mood or decrease anxiety. It's not just students, either: A 2021 study by life insurance broker LifeSearch indicated one in 10 UK adults was microdosing a range of drugs including MDMA, LSD and mushrooms as well as prescription medicines, a 43% increase in the practice since the start of the pandemic.

We've recently seen an uptick in clinical trials to investigate medical use of psychedelic substances, particularly psilocybin (from magic mushrooms) and LSD. Additionally, the US Food and Drug Administration is now developing guidance for clinical study of psychedelics, saying that while investigational substances show "initial promise as potential treatments for mood, anxiety and substance-use disorder," evaluating them poses unique challenges.

There's movement on the legal front, too.

Some governments are opening the door to microdosing psychedelics, following legalization of cannabis in US states. This year, Oregon became the first US state to begin licensing therapists to treat patients with psilocybin; Alberta, Canada, has made similar moves, as has Australia where psychiatrists can now prescribe MDMA and psilocybin for hard-to-treat depression and PTSD.

Swiss Re believes insurers should be guided by evidence-based decision-making and disciplined underwriting. Investigating microdosing's utility in addressing pressing health challenges makes sense, but it's very important these efforts are informed by sound clinical practice and good science, not hype.

With much to learn and regulations around psychedelic drugs evolving, we suggest underwriters consider applying individual consideration when they learn a potential client is microdosing, including discerning the presence of other risk factors and the legal status of microdosing in the location concerned.

Psychedelics have come a long way from their Flower Power heyday to their re-discovery as a potential but still unproven remedy, something that could become part of the next generation of therapeutic products. Such shifts create challenges and potential opportunities for insurers. To this end, Swiss Re's Life & Health Underwriting R&D team has produced "Is microdosing the next medical cannabis?" to help insurers on what could be their next underwriting trip.