Epidemiology of hallucinogen use in the U.S. results from the National epidemiologic survey on alcohol and related conditions III

Examining differences in the effects and contexts of naturalistic psilocybin use for White participants vs. Participants of Color: A longitudinal online survey study

BACKGROUND

Psilocybin (a psychoactive compound found in "magic mushrooms" or "shrooms") has been gaining increased attention in research and popular culture as a number of clinical and observational studies have demonstrated that it may have potential for improving mental wellbeing. Relatedly, there has been a substantial uptick in naturalistic (e.g., real-world, non-clinical) psilocybin use in the United States. While a number of longitudinal studies have demonstrated that naturalistic psilocybin use is linked to positive mental health outcomes on average, few studies have examined how the effects of psilocybin and contexts for psilocybin use may differ for White populations compared to Populations of Color.

OBJECTIVE

To examine differences in health outcomes, subjective effects, and contexts of naturalistic psilocybin use in White participants compared to Participants of Color.

METHODS

This study used data from a large, online longitudinal study of individuals who planned to engage in naturalistic psilocybin use (N = 2833). We used mixed-effects models to assess whether race/ethnicity (White vs. Participant of Color) moderated associations between time (Time 2 [initial assessment point for longitudinal measures], Time 5 [2-4 weeks post-psilocybin experience, and Time 6 [2-3 months post-experience]) and outcomes related to mental health (depression, anxiety, spiritual wellbeing, cognitive flexibility, emotion regulation [expressive suppression + cognitive reappraisal]). We also used exploratory chi-squared tests to examine differences in contexts for psilocybin use as well as differences in subjective effects related to the psilocybin experience.

RESULTS

Race/ethnicity moderated the associations between time for predicting spiritual wellbeing (beta = -1.8; 95 % CI [-3.4, -0.17]; p < 0.05), cognitive flexibility (beta = -1.5 [-2.7, -0.26]; p < 0.05), and emotion regulation - expressive suppression (beta = 0.25 [0.06, 0.44]; p < 0.05) at Time 6 (but not Time 5). Additionally, Participants of Color reported minor differences in subjective effects and context for use compared to White participants (e.g., more likely to have set an intention prior to use, report time speeding up during the experience, etc.). We found reductions in anxiety and depression for both Participants of Color and White participants, and our moderation tests for these outcomes were not significant.

CONCLUSION

Race/ethnicity impacts the associations between psilocybin use and various markers of mental wellbeing. Future longitudinal studies and experimental studies with larger samples of color can further elucidate the preliminary findings from this study.

Primum Non Nocere: The Onus to Characterize the Potential Harms of Psychedelic Treatment

The last few years have seen exponential growth in interest, investment, advocacy, and research into psychedelics as therapeutics. This reflects an optimism about the potential promise of psychedelics as therapeutics. As with all therapeutic interventions, research is needed not only into their benefits but also potential risks. Indeed, when substances with therapeutic potential are scrutinized over time, especially in broad populations with psychiatric and medical comorbidities typically excluded from clinical trials, and applied in less well-regulated or controlled settings, a greater understanding of the cautions emerges. Here, we review the literature on the known and potential harms, including enduring perceptual disturbances; triggering or enhancing the risk for onset of mania or psychosis; overuse, misuse, and dependence; challenging experiences or "bad trips"; risks associated with increased neuroplastic potential; and acute and cumulative cardiovascular effects. Each of these issues is addressed in this review, along with the call for continued research, including recommendations for further research and monitoring.

Associations between psychedelic use and cannabis use disorder in a nationally representative sample

BACKGROUND

Cannabis Use Disorder (CUD) is an increasingly prevalent disorder affecting millions of Americans each year. Psychedelic compounds have recently been investigated for their therapeutic potential in treating substance use disorders, yet no prior work has examined the relationship between naturalistic use of specific psychedelic compounds and rates of disordered cannabis use.

METHODS

Using a nationally representative sample of U.S adults from the National Survey on Drug Use and Health (2015 - 2019, 2021 - 2022), we used a series of survey-weighted multivariable logistic regressions to examine the association between past year disordered cannabis use and use of several classic psychedelics (i.e., LSD, psilocybin, mescaline, peyote, DMT) and non-classic psychedelics (i.e., ketamine, MDMA).

RESULTS

lifetime psilocybin use as well as past year LSD use were both associated with higher rates of past year DSM-5 CUD (adjusted risk ratio [aRR] range: 1.89 - 2.04), controlling for a variety of sociodemographic factors. These associations remained significant in the case of moderate-to-severe past year CUD (aRR range: 1.65 - 2.07). Past year LSD use also predicted three of eleven CUD symptoms among individuals with past year cannabis use (aRR range: 1.45 - 1.73).

DISCUSSION

Despite preliminary findings regarding the potential for psychedelic substances to help treat substance use disorders, our findings suggest a relationship between psychedelic use and disordered cannabis use, suggesting that certain psychedelic substances used in certain naturalistic settings are an indicator of greater risk of maladaptive cannabis use. Future directions to further disentangle these relationships are discussed.

ALSUntangled #77: Psilocybin

ALSUntangled reviews alternate and off-label treatments prompted by patient interest. Here, we review psilocybin, a chemical derived from mushrooms and belonging in the category of drugs known as psychedelics. Psilocybin has plausible mechanisms for slowing ALS progression because of its ability to cross the blood brain barrier and effect neurogenesis and inflammation. Currently, there are no pre-clinical ALS models, case reports, or trials for psilocybin and ALS in the context of disease modifying therapy. Depending on dosing, there can be a high risk of psychological side effects including hallucinations and physical harm. Based on the above information, we do not currently support the use of psilocybin as a means to slow ALS progression.

Beyond the first try: How many quit attempts are necessary to achieve substance use cessation?

Substance use disorder (SUD) is a chronically relapsing disorder; thus, individuals with SUD may require several attempts before achieving abstinence. The goal of the present study was to investigate what variables are associated with the number of quit attempts before successful abstinence was achieved. Data were collected from 421 International Quit & Recovery Registry participants. Participants answered several questions for each substance they reported being in recovery, including how many times they had attempted to quit that substance and whether they still used that substance. The results showed that the number of quit attempts was associated with the substance one was trying to quit, SUD severity (i.e., mild, moderate, severe SUD) for that substance, the number of years using that substance, and the age of use onset. Pairwise comparisons among substances indicated that pain medication and opioids had a significantly higher number of quit attempts than all other substances (ps < .001) but were not different from each other (p = 1.0). Pairwise comparisons across levels of SUD severity showed a significantly higher number of attempts for those with moderate than mild SUD (p < .001) and for those with severe than mild or moderate SUD (ps < .001). Overall, the results indicate that individuals who use opioids and pain medication, have more severe SUD, and more years of use need significantly more attempts before achieving successful abstinence. Thus, those might benefit from more targeted and effective interventions.

BACKGROUND AND AIMS

Substance use disorder (SUD) is a chronically relapsing disorder. Thus, individuals with SUD may need several attempts before achieving abstinence. The present study investigated the variables associated with the number of quit attempts before achieving successful abstinence.

METHODS

Data were collected from 421 International Quit & Recovery Registry participants. Participants answered several questions for each substance they reported being in recovery from, such as the age of first use, how many times they had attempted to quit that substance, and whether they still used that substance.

RESULTS

The number of quit attempts was associated with the substance one was trying to quit, SUD severity (i.e., mild, moderate, severe SUD) for that substance, the number of years using that substance, and the age of use onset. Pairwise comparisons among substances indicated that pain medication and opioids had a significantly higher number of quit attempts than all other substances (ps < .001) but were not different from each other (p = 1.0). Pairwise comparisons across levels of SUD severity showed a significantly higher number of attempts for those with moderate than mild SUD (p < .001) and for those with severe than mild or moderate SUD (ps < .001).

CONCLUSIONS

Opioids and pain medication require significantly more attempts than all other substances, according to our findings. Thus, such substances might need more targeted and effective interventions. Additionally, more severe SUD and more years of use were also associated with more quit attempts. Such findings suggest the need for more effective early interventions to decrease the number of attempts before successful abstinence.

Perioperative considerations for patients exposed to hallucinogens

Hallucinogen exposure in patients in the perioperative period presents challenges for anesthesiologists and other anesthesia providers. Acute and chronic exposure to these substances can cause physiological impacts that can affect the function of anesthetic and analgesic medications used during perioperative care. The objective of this narrative review is to educate readers on the wide array of hallucinogens and psychedelics that may influence the perioperative management of patients exposed to these substances. A narrative review of the literature surrounding hallucinogens and psychedelics was completed. Hallucinogens and psychedelics are quite varied in their mechanisms of action and therefore present a variety of perioperative implications and perioperative considerations. Many of these substances increase serotonin levels or act directly at serotonergic receptors. However, there are other relevant actions that may include varied mechanisms from N-methyl-D-aspartate receptor antagonism to stimulation of muscarinic receptors. With hallucinogen exposure rates on the rise, understanding the effects of hallucinogens is important for optimizing management and reducing risks perioperatively for patients with acute or chronic exposure.

Does the Perception of Risk Associated with Psychedelics Use Differ in Physicians According to Their Belief of Effectiveness?

The aim of this study was to explore the perception of psychedelics within the medical population. Participants were asked by questionnaire about the potential of abuse, the somatic and psychiatric complications, and the risks of self-harm and aggression associated with the use of psychedelics using Likert Scales. A total of 407 participants were included. In our sample, the following means were found: 3.05 for general risk (<.001), 2.68 for self-harm risk (<.001), 2.47 for aggression (<.001), 2.71 for addictive risk (< .001), 2.76 for psychiatric disorder risk (<.001), and 2.11 for somatic disorder(< .001). Physicians from the lower mean of age were significantly more supportive of therapeutic potential, while general practitioners were significantly less likely to consider psychedelics as a treatment than specialists (<.001). By the term therapeutic potential, we meant the therapeutic value attributable to psychedelics and the risks expressed the possibility of damage caused by the use of the drug. Clinicians who considered psychedelics as a potential treatment were less likely to associate these with risks than their counterparts (<.001). The results of this study show that the perception of the danger of psychedelic use was important in the medical community in France.

The Epidemiology of Psychedelic Use Among United States Military Veterans

We sought to identify patterns of psychedelic use among United States military veterans, compare demographic variables and perspectives of those who did and did not report use, and characterize benefits and adverse outcomes associated with use. Respondents (N = 426) were recruited to complete an online cross-sectional survey. Approximately one-half (51%) reported using psychedelics. Most did so for healing/treatment (70%) and/or spiritual purposes (48%), and most (85%) reported benefiting from use. Those who used psychedelics reported they would be more likely to use VA services (p < .001, d = 0.64) and to return to the VA for care (p < .001, d = 0.79) if psychedelic therapy was offered. Almost two-thirds (59%) reported adverse outcomes associated with use. Equivalent proportions rated their psychedelic experiences as beneficial among those who did (89%) and did not (81%) report adverse outcomes. Fewer adverse outcomes were associated with being older, using psilocybin, feeling prepared and confident in the reasons for use, being in a comfortable setting, and being able to "trust, let go, and be open" (Rc = 0.77; p < .001). Psychedelics may offer benefits but may also lead to adverse outcomes without proper preparation and support. Future research should examine the utility of psychedelic-based approaches for veteran mental health care.

[Psychedelic and dissociative agents in psychiatry: challenges in the treatment]

With the discovery of the antidepressive effects of ketamine and the increasing withdrawal of the pharmaceutical industry from the development of new psychotropic drugs, the psychiatric research into the clinical application of hallucinogens in psychiatry has literally blossomed in the last two decades. Promising results for various treatment approaches with psychedelic agents, such lysergic acid diethylamide (LSD) and psilocybin, and dissociative agents, such as ketamine and esketamine, have raised great hopes among researchers, clinicians and patients in recent years, so that there was already talk of a new era in psychiatry. As one of the first of these substances, in December 2019 intranasal esketamine was approved in the USA and the EU for the treatment of treatment-resistant depression and Switzerland followed in 2020. Recently, psilocybin was approved in Australia, Canada and Switzerland for compassionate use in exceptional cases for the treatment of depression, while large approval studies with various psychedelic agents are currently ongoing worldwide. The medical application of psychedelic agents and ketamine/esketamine is considered to be safe; however, as with all new forms of treatment it is of crucial importance that, in addition to the hopes, the specific challenges of these new treatment approaches must also be carefully considered and assessed. Excessive expectations and an insufficient risk-benefit estimation are detrimental to the patients and the reputation of the treating physician. Although a possible paradigm shift in the care of mental health is already being discussed, this review article consciously concentrates on the possible risks of treatment and the methodological weaknesses of the studies carried out so far.

Health Benefits and Positive Acute Effects of Psilocybin Consumption: A Quantitative Textual Analysis of User Self-Reported Data

There has been growth in the use of psychedelics by the global population in recent years. In addition to recreational and ritualistic use, recent research into psychedelics has brought advances for treating mental disorders. Understanding the specific circumstances in which psilocybin leads to positive outcomes may have important implications for the future of its clinical use and for harm reduction initiatives. This study aimed to investigate the positive effects from the consumption of psilocybin through public online self-reports. We sought to investigate health benefits promoted by the consumption of the substance, positive acute effects, and contextual details of these experiences. We analyzed 846 reports with the assistance of the IRaMuTeQ textual analysis software, adopting the procedures of Descending Hierarchical Classification, Correspondence Factor Analysis, and Specificities Analysis. The texts were grouped in 5 clusters, describing the content of mental experiences, cognitive processes, somatic experiences, perceptual alterations, and context of administration. The findings of this study reinforce central axes of the psychedelic experience, such as the presence of somatic and visual alterations, connectedness and feeling one with the world and effects of setting, as well as the beneficial character of mystical experiences this substance promotes, and the importance of the ego-dissolution phenomenon.

Substance Use among School-Going Adolescents and Young Adults in Rural Mpumalanga Province, South Africa

The ongoing public health crisis of substance use among school adolescents and young adults (AYAs) in South Africa is not new in research parlance, amidst the national policy of drug abuse management in schools. In view of no tangible progress to reduce substance use in high schools in the country, we conducted a cross-sectional quantitative study aimed at investigating substance use among adolescents and young adults in the four public high schools selected through multi-stage sampling in rural Mpumalanga province, South Africa. Data on substance use, demographics, household socio-demographics, and related factors were collected via a validated self-administered questionnaire. Hierarchical logistic regression was performed using STATA 18. The study included 402 AYAs aged between 14 and 23 years (18 ± 1 years), and 45% reported substance use in the last twelve months. Alcohol was the most used substance (74%), followed by cigarettes (12%) and cannabis (11%). AYAs used substances out of social influence, curiosity, to find joy, and to eliminate stress, especially in social events, on the streets, and at home, and reported negative physical health outcomes, mainly hallucinations, sleeping disorders, body weakness, and dry mouths. Hierarchical logistic regression showed that the likelihood of substance use was three times in a particular high school (S4) (AOR = 3.93, 95%CI: 1.72-8.99), twice among the grade 12s (AOR = 2.73, 95%CI: 1.46-5.11), over twenty times in the communities with substance availability (AOR = 22.45, 95%CI: 2.75-183.56), almost ten times among AYAs participating in recreational/sports activities (AOR = 9.74, 95%CI: 4.21-22.52), and twice likely to happen in larger households (AOR = 2.96, 95%CI: 1.57-5.58). Prevention and intervention efforts should consider these specific health concerns to develop targeted strategies for mitigating substance use and its adverse consequences in this vulnerable population towards achieving the United Nations' Sustainable Development Goal Target 3.5, which aims to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol.

Factors associated with the use of psychedelics, ketamine and MDMA among sexual and gender minority youths in Canada: a machine learning analysis

BACKGROUND

Substance use is increasing among sexual and gender minority youth (SGMY). This increase may be due to changes in social norms and socialisation, or due to SGMY exploring the potential therapeutic value of drugs such as psychedelics. We identified predictors of psychedelics, MDMA and ketamine use.

METHODS

Data were obtained from 1414 SGMY participants who completed the ongoing longitudinal 2SLGBTQ+ Tobacco Project in Canada between November 2020 to January 2021. We examined the association between 80 potential features (including sociodemographic factors, mental health-related factors and substance use-related factors) with the use of psychedelics, MDMA and ketamine in the past year. Random forest classifier was used to identify the predictors most associated with reported use of these drugs.

RESULTS

18.1% of participants have used psychedelics in the past year; 21.9% used at least one of the three drugs. Cannabis and cocaine use were the predictors most strongly associated with any of these drugs, while cannabis, but not cocaine use, was the one most associated with psychedelic use. Other mental health and 2SLGBTQ+ stigma-related factors were also associated with the use of these drugs.

CONCLUSION

The use of psychedelics, MDMA and ketamine among 2SLGBTQ+ individuals appeared to be largely driven by those who used them together with other drugs. Depression scores also appeared in the top 10 factors associated with these illicit drugs, suggesting that there were individuals who may benefit from the potential therapeutic value of these drugs. These characteristics should be further investigated in future studies.

[Ethics in the use of psychedelics: The definition of illicit drugs from the perspective of critical bioethics]

This essay, situated in the field of bioethics, examines the prohibition of psychedelic use, exploring arguments surrounding the growing evidence of their therapeutic potential and their millennia-long history of cultural and spiritual uses. It initially discusses the historical context of psychedelics and the various terms used to describe them. The essay problematizes the definition of "drugs," highlighting the lack of objective criteria for distinguishing between legal and illicit substances. Drawing on concepts and theoretical frameworks of critical bioethics, it analyzes how the prohibitionist moral discourse is sustained more by political and economic interests than by scientific justifications, leading to stigmatization and vulnerability. The essay advocates for the end of the prohibition of psychedelics based on ethical arguments, emphasizing their importance in reducing individual and collective suffering. The work contributes to a deeper reflection on this socially controversial topic, integrating interdisciplinary knowledge.

Use of Lysergic Acid Diethylamide by Major Depression Status

Importance

Renewed interest in the clinical potential of hallucinogens may lead people with depression to a generally more positive view of the use of lysergic acid diethylamide (LSD). Therefore, past-year LSD use among people with depression may be increasing in prevalence.

Objective

To assess time trends in the prevalence of past-year nonmedical LSD use by past-year major depression status and the variation in this association by sociodemographic characteristics.

Design, Setting, and Participants

This survey study used pooled publicly available data from 478 492 adults aged 18 years or older who were administered the National Survey on Drug Use and Health from 2008 through 2019. Statistical analysis was conducted from December 2022 to June 2023.

Main Outcome and Measures

Past-year major depression diagnoses per criteria from the DSM-IV were analyzed. Logistic regression models examined whether time trends in past-year nonmedical LSD use differed between adults with vs without past-year depression, adjusting for sociodemographic characteristics. Secondary analyses examined whether the trends in LSD use by depression status differed between sociodemographic subgroups.

Results

The analytic sample included 478 492 adults, of whom 51.8% were female, 56.1% were younger than 50 years, 11.7% were Black, 15.1% were Hispanic, 65.8% were White, and 7.5% were another race. Weighted interview response rates ranged from 64.9% to 75.6% during the study time frame. From 2008 to 2019, past-year use of LSD increased significantly more among adults with major depression (2008 prevalence, 0.5%; 2019 prevalence, 1.8%; prevalence difference [PD], 1.3% [95% CI, 1.0%-1.6%]) compared with adults without major depression (2008 prevalence, 0.2%; 2019 prevalence, 0.8%; PD, 0.6% [95% CI, 0.5%-0.7%]) (difference in difference, 0.8% [95% CI, 0.5%-1.1%]). This difference was particularly pronounced among young adults aged 34 years or younger (PD among those aged 18-25 years with depression, 3.3% [95% CI, 2.5%-4.2%]; PD among those aged 26-34 years with depression, 2.7% [95% CI, 1.6%-3.8%]) and individuals with incomes less than $75 000 per year (PD among those with income <$20 000, 1.9% [95% CI, 1.3%-2.6%]; PD among those with income $20 000-$49 999, 1.5% [95% CI, 1.0%-2.1%]; PD among those with income $50 000-$74 999, 1.3% [95% CI, 0.7%-2.0%]).

Conclusions and Relevance

This study suggests that, from 2008 to 2019, there was a disproportionate increase in the prevalence of past-year LSD use among US adults with past-year depression. Among those with depression, this increase was particularly strong among younger adults and those with lower household incomes. Among individuals with depression who also report LSD use, clinicians should discuss potential strategies for mitigating harm and maximizing benefits in medically unsupervised settings.

Substance Use Disorder and Suicidal Ideation in Rural Maryland

Background

Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges, chronic stress, and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explores risk factors to suicidal ideation, using emergency room discharge data from Maryland.

Methods

The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between ICD-10 coded opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable of suicidal ideation discharge. We controlled for income, race, age, and gender.

Results

Lifetime major depressive disorder diagnosis (odds ration [OR] = 79.30; 95% confidence interval [CI] 51.91-121.15), alcohol use disorder (OR = 6.87; 95% CI 4.97-9.51), opioid use disorder (OR = 5.39; 95% CI 3.63-7.99), and cannabis use disorder (OR = 2.67; 95% CI 1.37-5.18) were all positively associated with suicidal ideation.

Conclusions

The study highlights the strong link between prior substance use disorder, depression, and suicidal ideation visit to the emergency room, indicating the need for prevention and intervention, particularly among those in rural areas where the burden of suicidal ideation and chronic stress are high. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.

Hallucinogen use among young adults ages 19-30 in the United States: Changes from 2018 to 2021

BACKGROUND AND AIMS

Given the shifting landscape of hallucinogen use, particularly with increased therapeutic use, understanding current changes in use is a necessary part of examining the potential risk hallucinogens pose to vulnerable populations, such as young adults. This study aimed to measure hallucinogen use among young adults aged 19-30 years from 2018 to 2021.

DESIGN, SETTING AND PARTICIPANTS

This was a longitudinal cohort study among young adults aged 19-30 years from the US general population, interviewed between 2018 and 2021. Participants comprised 11 304 unique respondents, with an average number of follow-ups of 1.46 (standard deviation = 0.50). Of the observed data points, 51.9% were among females.

MEASUREMENTS

We examined past 12-month self-reported use of lysergic acid diethylamide (LSD), as well as hallucinogens besides LSD (e.g. psilocybin), monitoring any use as well as frequency, overall and by sex.

FINDINGS

From 2018 to 2021, past 12-month use of LSD among young adults in the US remained relatively unchanged, from 3.7% [95% confidence interval (CI) = 3.1-4.3] in 2018 to 4.2% in 2021 (95% CI = 3.4-5.0). Non-LSD hallucinogen [e.g. 'shrooms', psilocybin or PCP (phenylcyclohexyl piperidine)] use, however, increased in prevalence from 3.4% (95% CI = 2.8-4.1) to 6.6% from 2018 to 2021 (95% CI = 5.5-7.6). Across years, the odds of non-LSD use were higher for males [odds ratio (OR) = 1.86, 95% CI = 1.52-2.26] and lower for black than white participants (OR = 0.29, 95% CI = 0.19-0.47) and those without a college-educated parent (OR = 0.80, 95% CI = 0.64-0.99). Demographic disparities were similar for LSD use.

CONCLUSION

Prevalence of past-year use non-lysergic acid diethylamide (LSD) hallucinogen was twice as high in 2021 as in 2018 among US young adults. Correlates of non-LSD hallucinogen use included being male, white and from higher socio-economic status backgrounds.

Addiction specialists' attitudes toward psychedelics: A National Survey

BACKGROUND AND OBJECTIVES

In recent years, there has been accelerating scientific and public interest in the use of psychedelics to treat mental health disorders. Our study's objective was to assess the attitudes of addiction specialists regarding therapeutic psychedelics.

METHODS

Our study utilized an anonymous online survey to assess the opinions of 145 addiction specialists regarding the therapeutic promise, potential risks, and legalization of psychedelics in the treatment of psychiatric illness and substance use disorders. Psychedelics were defined in the survey as inclusive of nonserotonergic hallucinogens such as ketamine or MDMA in addition to "classic" serotonergic psychedelics.

RESULTS

Most respondents expressed positive attitudes to the therapeutic use of psychedelics, but a sizeable minority expressed concern for their addictive potential. Familiarity with psychedelic scientific literature was the strongest positive predictor of belief in the therapeutic potential of psychedelics, while concern for addictive potential was the strongest negative predictor.

DISCUSSION AND CONCLUSIONS

Participants overall expressed more positive attitudes to the therapeutic use of psychedelics than we had hypothesized. This may be attributable to the accelerating pace of psychedelics research in recent years. Given the strong influence of concern for addiction risk on attitudes, future study is warranted to explore the findings regarding these concerns. These findings may also represent an opportunity for improved education of physicians regarding the addictive potential, and relative risks/benefits of psychedelics.

SCIENTIFIC SIGNIFICANCE

Though there have been several prior studies assessing psychiatrist and psychologist attitudes toward psychedelics, we are unaware of any specifically examining the opinions of addiction specialists.

μ-opioid receptor agonists and psychedelics: pharmacological opportunities and challenges

Opioid misuse and opioid-involved overdose deaths are a massive public health problem involving the intertwined misuse of prescription opioids for pain management with the emergence of extremely potent fentanyl derivatives, sold as standalone products or adulterants in counterfeit prescription opioids or heroin. The incidence of repeated opioid overdose events indicates a problematic use pattern consistent with the development of the medical condition of opioid use disorder (OUD). Prescription and illicit opioids reduce pain perception by activating µ-opioid receptors (MOR) localized to the central nervous system (CNS). Dysregulation of meso-corticolimbic circuitry that subserves reward and adaptive behaviors is fundamentally involved in the progressive behavioral changes that promote and are consequent to OUD. Although opioid-induced analgesia and the rewarding effects of abused opioids are primarily mediated through MOR activation, serotonin (5-HT) is an important contributor to the pharmacology of opioid abused drugs (including heroin and prescription opioids) and OUD. There is a recent resurgence of interest into psychedelic compounds that act primarily through the 5-HT2A receptor (5-HT 2A R) as a new frontier in combatting such diseases (e.g., depression, anxiety, and substance use disorders). Emerging data suggest that the MOR and 5-HT2AR crosstalk at the cellular level and within key nodes of OUD circuitry, highlighting a major opportunity for novel pharmacological intervention for OUD. There is an important gap in the preclinical profiling of psychedelic 5-HT2AR agonists in OUD models. Further, as these molecules carry risks, additional analyses of the profiles of non-hallucinogenic 5-HT2AR agonists and/or 5-HT2AR positive allosteric modulators may provide a new pathway for 5-HT2AR therapeutics. In this review, we discuss the opportunities and challenges associated with utilizing 5-HT2AR agonists as therapeutics for OUD.

Perceived risk of LSD varies with age and race: evidence from 2019 United States cross-sectional data

PURPOSE

Psychedelics are being explored for their potential therapeutic benefits across a wide range of psychiatric diagnoses and may usher in a new age in psychiatric treatment. There is stigma associated with these currently illegal substances, and use varies by race and age. We hypothesized that minoritized racial and ethnic populations, relative to White respondents, would perceive psychedelic use as riskier.

METHODS

Using 2019 cross-sectional data from the National Survey of Drug Use and Health, we conducted a secondary analysis of 41,679 respondents. Perceived risk of heroin was used as a surrogate for overall risk of illegal substance use; heroin and lysergic acid diethylamide were the only substances queried this way in the sample.

RESULTS

A majority regarded lysergic acid diethylamide (66.7%) and heroin (87.3%) as a great risk if used once or twice. There were clear differences by race, with White respondents and those indicating more than one race having significantly lower perceived risk of lysergic acid diethylamide than respondents from other groups. Perceived risk of use also significantly increased with age.

CONCLUSION

Perceived risk of lysergic acid diethylamide is unevenly distributed across the population. Stigma and racial disparities in drug-related crimes likely contribute to this. As research into potential therapeutic indications for psychedelics continues, perceived risk of use may change.

How Important Is a Guide Who Has Taken Psilocybin in Psilocybin-Assisted Therapy for Depression?

Promising outcomes of Psilocybin-Assisted Therapy (PAT) for depression have generated concerted efforts to replicate, extend, and refine protocols to maximize efficacy. Psychotherapy research reveals that clients benefit most when important components of treatment align with their personal preferences. One open question related to PAT concerns the importance of the psilocybin experience of the guides (trained professionals present during acute effects). We sought to assess the importance of a guide who had used psilocybin to potential clients with depressive symptoms. Over 800 MTurk respondents with depressive symptoms rated the import of a guide who had used psilocybin relative to alternative characteristics in guides and cognitive behavioral (CBT) therapists. Importance ratings for guides who had used psilocybin significantly exceeded the "somewhat important" level (50 on a 0-100 scale), other guide-related qualities, and comparable ratings for a cognitive behavioral therapist who shared demographics, had experience with depression and received cognitive therapy personally. People of color (those who are not Caucasian) and those who had previous therapy gave significantly higher importance ratings for guides who had used psilocybin. Participants who chose to list other qualities important for guides listed very similar ones for CBT therapists, often emphasizing proper training and an empathic demeanor. Guides who have used psilocybin, who inform clients of the fact, might have advantages for facilitating PAT's antidepressant effects, as least in a subset of clients.

Hopelessness, Suicidality, and Co-Occurring Substance Use among Adolescent Hallucinogen Users-A National Survey Study

(1) Objectives: Hallucinogens are being explored as a potential treatment of psychiatric disorders. Micro dosing of illicitly purchased hallucinogen drugs is on the rise despite conclusive benefits. We aimed to evaluate the prevalence and odds of hopelessness, suicidality, and co-occurring substance use among adolescent hallucinogen users. (2) Methods: We performed a retrospective analysis of the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance System (YRBSS) 2001−2019 data that nationally represents school-going US adolescents. We identified hallucinogen use based on the survey questions, exploring the use of hallucinogens (LSD, PCP, mescaline, and mushrooms). (3) Results: Out of a total of 125,550 respondents, 8.4% reported using hallucinogens. Overall, the trend of hallucinogen use decreased from 13.3% (2001) to 7.0% (2019) (pTrend < 0.0001). Hallucinogen users were at high odds of feeling sad and hopeless (aOR: 1.40; 95%CI: 1.21−1.61; p < 0.0001), considering suicide (aOR: 1.36; 95%CI: 1.08−1.70; p = 0.009), and planning suicide (aOR: 1.49; 95%CI: 1.19−1.86; p = 0.001). Additionally, adolescent hallucinogen users had a higher prevalence of alcohol, cigarette, e-cigarette, marijuana, synthetic marijuana, inhalants, heroin, cocaine, methamphetamine, and ecstasy use. (4) Conclusions: The overall trend of hallucinogen use decreased among school-going American adolescents. We found a high prevalence of co-occurring substance use among hallucinogen users. We found that hallucinogen users were at high odds of feeling sad, hopeless, and considering and planning suicide. Further research is needed to explore the effects of recreational hallucinogen use among the adolescent population.

Comparing immediate- and delayed-onset posttraumatic stress disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)

Delayed-onset posttraumatic stress disorder (PTSD) is defined as a period of 6 months or more between trauma exposure and episode onset. Due to the limited research and lack of epidemiological studies on this form of the disorder, we investigated its prevalence, clinical features, and psychiatric comorbidities in a nationally representative sample of U.S. adults. Using National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) data collected from individuals who met the DSM-5 criteria for PTSD (N = 1,980), we compared delayed- and immediate-onset PTSD with regard to demographic and clinical variables, including comorbidity with psychiatric and substance use disorder (SUD) diagnoses. The overall prevalence of delayed-onset PTSD was 11.0%. Respondents with delayed-onset PTSD were more likely than those with immediate-onset PTSD to report active military combat exposure, more physical and emotional difficulties, and higher levels of pain; these individuals were also more likely to be divorced and less likely to meet the diagnostic criteria for select SUDs. After adjusting for confounding variables, we found a decreased risk of delayed-onset PTSD among individuals with hallucinogen use disorder, OR = 0.30; 95% CI [0.11, 0.87], d = 0.5. We found no significant associations between PTSD onset status and any other SUD, including alcohol use disorder, after adjusting for covariates. Further longitudinal research is required to investigate the temporal associations between PTSD onset and its clinical characteristics and comorbidities, as this could have implications on disorder progression and treatment approaches.

Adolescent and adult time trends in US hallucinogen use, 2002-19: any use, and use of ecstasy, LSD and PCP

BACKGROUND AND AIMS

Hallucinogen use is potentially harmful. Information on whether such use has increased in recent decades is lacking. This study assessed overall and age-specific time trends in the prevalence of 12-month hallucinogen use in the US general population.

DESIGN

Cross-sectional.

SETTING

Data from the US National Survey on Drug Use and Health, 2002-19.

PARTICIPANTS

Respondents aged ≥ 12 years (n = 1 006 051).

MEASUREMENTS

Predictors were continuous years. Outcome variables included any hallucinogen use and use of lysergic acid diethylamide (LSD), ecstasy and phencyclidine (PCP) in the past year. Socio-demographic variables (gender, age, race/ethnicity, educational level and family income) were covariates.

FINDINGS

Overall, hallucinogen use increased between 2015 and 2019 [prevalence difference (PD) = +0.44, P < 0.05]. Since 2002, hallucinogen use has increased in adults aged ≥ 26 years (PD, 2002-14 = +0.24, P < 0.05; PD, 2015-19 = +0.45, P < 0.001) and decreased in adolescents aged 12-17 years (PD, 2002-14 = -1.60, P < 0.0001; PD, 2015-19 = -0.73, P < 0.001). Ecstasy use has decreased in adolescents (PD, 2002-14 = -0.56, P < 0.001), adults aged 18-25 years (PD, 2015-19 = -0.96, P < 0.01) and ≥ 26 years (PD, 2015-19 = -0.13, P < 0.05). LSD use between 2002 and 2019 increased overall (PD = +0.71, P < 0.0001) and in all age groups (12-17: PD = +0.67, P < 0.001; 18-25: PD = +3.12, P < 0.0001; ≥ 26: PD = +0.36, P < 0.0001). Conversely, PCP use between 2002 and 2019 decreased overall (PD = -0.06, P < 0.001), in adolescents (PD = -0.24, P < 0.001) and young adults (PD = -0.32, P < 0.0001).

CONCLUSIONS

Since 2002, hallucinogen use in the United States has decreased among adolescents but increased in adults and is now estimated to affect more than 3 million adults aged 26+ years and more than 5.5 million adults aged 18+ years.

Use of plant-based hallucinogens and dissociative agents: U.S. Time Trends, 2002-2019

Aims

Information on time trends in use of different plant-based hallucinogens is lacking. The current study used nationally representative U.S. data to assess overall and age-specific time trends in the prevalence of lifetime and 12-month use of plant-based hallucinogens and dissociative agents.

Methods

Participants were respondents aged ≥ 12 years (N = 1,006,051) from the National Survey on Drug Use and Health, 2002-2019. Predictors were continuous years. Outcomes included illicit use of peyote, mescaline, psilocybin, ketamine, salvia, and tryptamine. Sociodemographic variables (gender; age; race/ethnicity; educational level; family income) were modeled as covariates. Trends were estimated overall and by age (12-17, 18-25, 26+). Prevalence differences [PDs] were obtained for each category, along with 95 % confidence intervals [CI].

Results

Increases in lifetime use were observed for psilocybin (2002-2019 PD=+1.61), tryptamine (2006-2014 PD=+0.55; 2015-2019 PD=+0.44), and ketamine (2006-2014 PD=+0.27; 2015-2019 PD=+0.21). Mescaline use decreased (PD = -0.89). While overall lifetime salvia use increased between 2006 and 2014 (PD=+1.81), prevalence did not change between 2015 and 2019. Twelve-month use of tryptamine and ketamine increased between 2006 and 2014 (PD=+0.14; +0.03, respectively). Twelve-month ketamine use also increased from 2015 to 2019 (PD=+0.03). By age, participants aged 12-17 and 18-25 showed decreases in use of most types of hallucinogens, but those age 26+ generally showed increases.

Conclusions

While use of plant-based hallucinogens and dissociative agents remains rare, lifetime use of ketamine, tryptamine, and psilocybin is increasing in adults. Considering these increases alongside concerns about unsupervised use of illicit products whose dose and composition is uncertain, clinicians and policymakers should remain mindful of the rising rates of illicit use in the general population.

The Psychedelic Integration Scales: Tools for Measuring Psychedelic Integration Behaviors and Experiences

In this study, we describe the development and initial validation of two psychometric scales for measuring psychedelic integration. Psychedelic integration refers to the post-acute period of time following psychedelic drug administration. We created the Integration Engagement Scale (IES) to capture positive behavioral engagement with integration and the Experienced Integration Scale (EIS) to capture internal aspects of feeling integrated. These scales were developed to measure post-acute psychedelic administration dynamics in order to inform the creation of enhanced integration support and to help refine a general conceptual understanding of the construct of psychedelic integration. The scales are brief and face valid instruments designed for practical use in applied and research settings. Scale items were generated and refined using the Iterative Process Model of scale development, with input from psychedelics experts and clinicians. Content validity, internal structure, and reliability were assessed via expert surveys, content validity analysis, cognitive interviewing, convergent validity analysis, exploratory factor analysis, and confirmatory factor analysis. The data indicates the scales are valid and reliable measurements of the behavioral and experiential forms of Psychedelic Integration.

Race, Ethnic, and Sex Differences in Prevalence of and Trends in Hallucinogen Consumption Among Lifetime Users in the United States Between 2015 and 2019

Background

The current study is one of the first to examine race, ethnic, and sex differences in the prevalence of and trends in hallucinogen use among lifetime users in the United States.

Methods

Data came from the 2015-2019 National Survey on Drug Use and Health and included respondent's reporting ever-using hallucinogens (n = 41,060; female = 40.4%). Descriptive and multinomial logistic regression analyses were conducted in Stata.

Results

Highest prevalence of past year hallucinogen use was among Asian females (35.06%), which was two-or-more times larger than prevalence of past year use among White males/females and Native American males. More than half of White males/females, Multiracial males, and Hispanic males reported had ever-used psilocybin or LSD, whereas less than one-quarter of Black males/females reported lifetime psilocybin use, and less than a third of Black females reported lifetime LSD use. Native American males had the lowest prevalence of lifetime MDMA use (17.62-33.30%) but had the highest lifetime prevalence of peyote use (40.37-53.24%). Pacific Islander males had the highest prevalence of lifetime mescaline use (28.27%), and lifetime DMT use was highest among Pacific Islander males/females (15.68-38.58%). Black, Asian, and Multiracial people had greater odds of past-year (ORs = 1.20-2.02; ps < 0.05) and past-month (ORs = 1.39-2.06; ps < 0.05) hallucinogen use compared to White people. Females had lower odds of past-year (OR = 0.79; ps < 0.05), past-month (OR = 0.78; ps < 0.05) hallucinogen use compared to males, except for lifetime use of MDMA (OR = 1.29; ps < 0.05).

Conclusions

These findings should inform public health initiatives regarding potential benefits and risks of hallucinogen use among racial/ethnic groups and women.

Adverse effects of psychedelics: From anecdotes and misinformation to systematic science

BACKGROUND

Despite an increasing body of research highlighting their efficacy to treat a broad range of medical conditions, psychedelic drugs remain a controversial issue among the public and politicians, tainted by previous stigmatisation and perceptions of risk and danger.

OBJECTIVE

This narrative review examines the evidence for potential harms of the classic psychedelics by separating anecdotes and misinformation from systematic research.

METHODS

Taking a high-level perspective, we address both psychological and psychiatric risks, such as abuse liability and potential for dependence, as well as medical harms, including toxicity and overdose. We explore the evidence base for these adverse effects to elucidate which of these harms are based largely on anecdotes versus those that stand up to current scientific scrutiny.

RESULTS

Our review shows that medical risks are often minimal, and that many - albeit not all - of the persistent negative perceptions of psychological risks are unsupported by the currently available scientific evidence, with the majority of reported adverse effects not being observed in a regulated and/or medical context.

CONCLUSIONS

This highlights the importance for clinicians and therapists to keep to the highest safety and ethical standards. It is imperative not to be overzealous and to ensure balanced media reporting to avoid future controversies, so that much needed research can continue.

Efficacy and safety of psilocybin-assisted treatment for major depressive disorder: Prospective 12-month follow-up

BACKGROUND

Preliminary data suggest that psilocybin-assisted treatment produces substantial and rapid antidepressant effects in patients with major depressive disorder (MDD), but little is known about long-term outcomes.

AIMS

This study sought to examine the efficacy and safety of psilocybin through 12 months in participants with moderate to severe MDD who received psilocybin.

METHODS

This randomized, waiting-list controlled study enrolled 27 patients aged 21-75 with moderate to severe unipolar depression (GRID-Hamilton Depression Rating Scale (GRID-HAMD) ⩾ 17). Participants were randomized to an immediate or delayed (8 weeks) treatment condition in which they received two doses of psilocybin with supportive psychotherapy. Twenty-four participants completed both psilocybin sessions and were followed through 12 months following their second dose.

RESULTS

All 24 participants attended all follow-up visits through the 12-month timepoint. Large decreases from baseline in GRID-HAMD scores were observed at 1-, 3-, 6-, and 12-month follow-up (Cohen d = 2.3, 2.0, 2.6, and 2.4, respectively). Treatment response (⩾50% reduction in GRID-HAMD score from baseline) and remission were 75% and 58%, respectively, at 12 months. There were no serious adverse events judged to be related to psilocybin in the long-term follow-up period, and no participants reported psilocybin use outside of the context of the study. Participant ratings of personal meaning, spiritual experience, and mystical experience after sessions predicted increased well-being at 12 months, but did not predict improvement in depression.

CONCLUSIONS

These findings demonstrate that the substantial antidepressant effects of psilocybin-assisted therapy may be durable at least through 12 months following acute intervention in some patients.

Toward a typology of hallucinogen users in the United States

BACKGROUND

Roughly one in ten American adults have used hallucinogens, and emerging evidence suggests that the prevalence of use is increasing. However, our understanding of the degree to which individuals "specialize" in the use of a particular hallucinogen or are poly-hallucinogen users remains incomplete.

METHODS

This study examined data from 6381 individuals reporting past-year hallucinogen use in the 2016-2018 National Survey on Drug Use and Health. Logistic regression examined the association between the number of distinct hallucinogens used and psychosocial/behavioral risks, and latent class analysis (LCA) characterized subgroups of hallucinogen users.

RESULTS

The vast majority of hallucinogen users, roughly 70%, are not "specialists" who use only one hallucinogen type; rather, lifetime poly-hallucinogen use is the norm. Critically, however, we also see that important differences exist within the population of hallucinogen users-half (51%) could be classified as LSD-Mushroom-Ecstasy users only (this group was disproportionally comprised of youth), nearly one third (30%) were Poly-Hallucinogen users (this group was disproportionately male and non-Hispanic White), and smaller proportions were limited primarily to use of LSD-Mushrooms (6%; these individuals were almost exclusively ages 35 and older) or Ecstasy Only (12%; these individuals were mostly younger adults ages 18-34).

CONCLUSIONS

Findings provide a fresh contribution to our understanding of poly-hallucinogen use in a time in which local and state governmental leaders, and people across the country, weigh the benefits and drawbacks of legalizing specific hallucinogenic drugs.

Hallucinogen Use and Misuse in Older Adults

Hallucinogens, or psychedelics, are substances/drugs that have been used for over a millennium. The most well known are LSD, psilocybin, mescaline, and PCP. These substances may induce hallucinations as well as cause somatic and psychological symptoms. Because of the Controlled Substances Act of 1970, there has been very little research done to determine the long-term consequences or perhaps potential benefit of misuse and abuse of hallucinogens. Typically, these drugs are not abused but more often misused. Recently, there has been a renewed interest in these compounds, which may lead to possible therapeutic options.

Driving while under the influence of hallucinogens: Prevalence, correlates, and risk profiles

BACKGROUND

Hallucinogen use is rising in the US, yet little is known regarding the prevalence and psychosocial/behavioral correlates of driving under the influence of these drugs.

METHODS

This study examined data from 4447 individuals ages 16-64 who reported past-year hallucinogen use in the 2016-2018 National Survey on Drug Use and Health. Prevalence estimates (with 95% confidence intervals [CIs]) were calculated for driving under the influence of hallucinogens (DUIH). Logistic regression examined psychosocial/behavioral correlates of DUIH, and latent class analysis (LCA) characterized subgroups of individuals reporting DUIH.

RESULTS

The prevalence of past-year hallucinogen use was 2.42% (CI = 2.30-2.54) and, in the general population, the prevalence of DUIH was 0.21%. Among past-year hallucinogen users, 8.94% (CI = 7.74-10.31) reported DUIH on at least one occasion over the previous 12 months. The probability of DUIH increased significantly with more frequent use. Compared to individuals who used hallucinogens and did not report DUIH, individuals reporting DUIH were significantly more likely to report mental health problems; use of other illicit drugs; selling drugs; a past-year arrest; or driving under the influence of alcohol, cannabis, or other illicit drugs. LCA identified three classes of individuals reporting DUIH, characterized by: use of and driving under the influence of cannabis; use of and driving under the influence of cannabis and other illicit drugs; and mental health concerns.

CONCLUSIONS

Nearly one in ten individuals who report using hallucinogens also report driving under the influence of hallucinogens-drugs that affect perception and risk-taking, with alarming implications for driving safety.

Understanding sexual and gender minority substance use through latent profiles of ecological systems

Background: Whereas the increased use of substances in sexual and gender minority (SGM) samples has been well documented, further person-centered analyses are necessary to better understand the unique profiles of SGM individuals and substance use. Methods: Utilizing a sample of 1,852 SGM emerging adults (M_age = 23.31) recruited via Prolific, a latent profile analysis was conducted to determine profiles of ecological systems using self-esteem, hope for the future, minority group connection, and a history of childhood adverse experiences. These profiles were then used to explore intergroup differences in the use of substances (alcohol, cannabis, prescription opioids, hallucinogens, heroin, tobacco, and amphetamines). Results: Four profiles were identified in this sample: (1) moderate with low self-esteem (47.8%), (2) connected with low adversity (30.9%), (3) moderate with high self-esteem (11.5%), and (4) disconnected with adversity (9.7%). Significant differences between profiles in the frequency of use were found in all substances except for cannabis and hallucinogens. Of note, participants in the connected with low adversity profile reported significantly more frequent alcohol use (M = 3.30) compared to the disconnected with adversity (M = 2.89) and the moderate with low self-esteem (M = 2.96) profiles. Additionally, the disconnected with adversity profile reported significantly more frequent tobacco use (M = 1.99) compared to all other profiles. Conclusion: With a majority of the sample fitting profiles marked by mental health concerns, the present study indicates the need to identify and address risk and protective factors for SGM emerging adults' substance use and highlights differences within the larger SGM community. Implications for improving mental health are described.

Racial/ethnic differences in prevalence of hallucinogen use by age cohort: Findings from the 2018 National Survey on Drug Use and Health

Background

Few studies have assessed the epidemiology of hallucinogenic substance use among racial and ethnic groups of varying age cohorts. Use of psychedelic substances may differ among people of color (POC), due to factors such as stigma and discriminatory drug enforcement practices against POC. The lack of inclusion of POC in psychedelic research further underscores the importance of identifying differences in use among racial/ethnic groups and age cohorts.

Methods

Data from the 2018 National Survey on Drug Use and Health (NSDUH) was used for this analysis (N = 56,313, unweighted), representative of the non-institutionalized U.S. population. Proportions of lifetime hallucinogen use by race/ethnicity were compared. Proportions of past year rates of use were compared to examine differences by race/ethnicity and age cohort.

Results

Approximately 15.9% of the U.S. population over 12 had used a hallucinogen at some point in their lifetime and 2.0% had used in the past year. Lifetime hallucinogen use was most prevalent among non-Hispanic White and multi-racial individuals, while Black/African Americans reported the lowest rates of use. White and multi-racial groups also reported the highest proportions of past year use among 12–34 year olds, and White individuals reported the highest proportions among 35–49 year olds. Hispanic individuals reported higher proportions of use among the 12–17 cohort, but lower proportions among the 26–49 year old cohorts. Black/African Americans reported the lowest rates of past year use among the 12–25 year old cohorts. 50+ and older cohorts reported the lowest rates of hallucinogen use in the past year.

Limitations

Data is cross-sectional and self-reported. “Race” is a social construction is subject to change over time, and NSDUH ethnoracial categories are limited. Institutionalized populations are not included in the study.

Conclusions

Significant differences in hallucinogen use among ethnoracial groups by substance and age cohorts were observed. Findings from this work may inform education, interventions, and therapeutic psychedelic research.

Psychedelic Knowledge and Opinions in Psychiatrists at Two Professional Conferences: An Exploratory Survey

Despite resurgent interest in psychedelic-assisted therapy, our insights into psychiatrists' knowledge and opinions about medicinal psychedelic applications are surprisingly narrow. Therefore, we anonymously surveyed psychiatrists attending psychedelic didactic presentations at two national meetings about these issues using a 26-item questionnaire. Response rate was 40.20% (106/264). Respondents were 41.73 ± 13.31 years old (range: 24-80) and 64.42% were male. They largely believed psychedelics show treatment promise and strongly supported federal funding for medicinal psychedelic research. The most common concerns were the lack of trained psychedelic-assisted therapy providers, the logistics of psychedelic-assisted therapy delivery, the administration of psychedelics for patients with contraindications, and diversion. The most desired psychedelic-related educational topics were potential benefits of psychedelic-assisted therapy, how to conduct psychedelic-assisted therapy, psychedelic pharmacology, and psychedelic side effects. Factors associated with increased belief in psychedelics' treatment potential included working primarily in research, scoring higher on a psychedelic knowledge test, and reporting less concern about psychedelics' addictive potential. Working primarily in research and consult-liaison psychiatry fellowship training were positively associated with support for medicinal psychedelic legalization, while increased concerns about addictive potential and attending psychiatrist status were negatively associated. Support for legalization of non-medicinal psychedelic use was negatively associated with age and positively associated with support for legalization of medicinal psychedelic use.

Pharmacologic Similarities and Differences Among Hallucinogens

Hallucinogens constitute a unique class of substances that cause changes in the user's thoughts, perceptions, and mood through various mechanisms of action. Although the serotonergic hallucinogens such as lysergic acid diethylamide, psilocybin, and N,N-dimethyltryptamine have been termed the classical hallucinogens, many hallucinogens elicit their actions through other mechanisms such as N-methyl-D-aspartate receptor antagonism, opioid receptor agonism, or inhibition of the reuptake of monoamines including serotonin, norepinephrine, and dopamine. The aim of this article is to compare the pharmacologic similarities and differences among substances within the hallucinogen class and their impact on physical and psychiatric effects. Potential toxicities, including life-threatening and long-term effects, will be reviewed.

Cannabis-induced oceanic boundlessness

BACKGROUND

Despite tetrahydrocannabinol (THC)'s reputation for creating dramatic effects at high doses, empirical work rarely addresses cannabis's impact on subjective responses common to the tryptamine psychedelics. We focused on these effects because they have preceded and covaried with the therapeutic impact of psilocybin in previous work.

AIMS

The current study examined if self-reported responses to cannabis products might parallel those found in clinical trials of psilocybin administration. We also investigated if measures of demographics and cannabis use might correlate with these responses.

METHODS

Participants reported the subjective effect of their highest THC experience using 27 items that assess oceanic boundlessness, a correlate of mystical experiences. They also answered infrequency items and questions on demographics and cannabis consumption.

RESULTS

In an effort to address concerns about replication, we divided respondents who passed infrequency items into two random samples. Self-reported "breakthrough" experiences were significantly greater than zero but significantly lower than those reported in randomized clinical trials of psilocybin (17-19% vs. 59%). Total scores covaried with perceived dosages of THC, but only in one sample. Heavier users of cannabis reported lower scores.

CONCLUSIONS

Self-report data suggest that high doses of cannabis can create subjective effects comparable to those identified in trials of psilocybin that precede relief from cancer-related distress, treatment-resistant depression, alcohol problems, and cigarette dependence. Given the disparate mechanisms of action, comparing THC-induced to psilocybin-induced effects might improve our understanding of the mechanisms underlying subjective experiences. This work might also support the development of a cannabis-assisted psychotherapy comparable to psilocybin-assisted psychotherapy.

LSD use in the United States: Trends, correlates, and a typology of us

BACKGROUND

Recent years have witnessed an increased interest in LSD. This study investigates current information on the trends and correlates of LSD use from years 2002-2018 and seeks to develop an initial typology of use and misuse.

METHODS

Data is taken from the NSDUH (National Survey on Drug Use and Health) collected between 2002 and 2018 and trends and correlates of LSD use were analyzed with a survey adjusted logistic regression.

RESULTS

Our findings indicate that LSD use has increased 200 % over the study period (.23 % 2002-2005 to .72 % 2015-2018, AOR = 1.10, 95 % CI = 1.08, 1.12). Our findings also indicate several correlates of LSD use including higher levels of education (college degrees: AOR = 1.62, 95 % CI = 1.23, 2.13), not being married (divorced or separated, AOR = 2.31, 95 % CI = 1.44, 3.73, and have never been married, AOR = 5.67, f 95 % CI = 4.09, 7.86), as well as higher levels of antisocial behavior (having been arrested AOR = 3.20, 95 % CI = 2.50, 4.09) and comorbid mental health and substance abuse disorders (serious psychological distress, AOR = 2.39, 95 % CI = 2.05, 2.80). Further, four distinct subclasses were also discovered within LSD users and two of these subtypes of LSD users contained comorbid mental health disturbances and heavy involvement in the criminal justice system.

CONCLUSION

LSD use has been on the rise within the last decades, particularly among those who are well educated. Two subclasses of LSD use (those with severe comorbid mental health disorders and those with criminal justice involvement) may require further interventions.

On the Relationship between Classic Psychedelics and Suicidality: A Systematic Review

Use of classic psychedelics (e.g., psilocybin, ayahuasca, and lysergic acid diethylamide) is increasing, and psychedelic therapy is receiving growing attention as a novel mental health intervention. Suicidality remains a potential safety concern associated with classic psychedelics and is, concurrently, a mental health concern that psychedelic therapy may show promise in targeting. Accordingly, further understanding of the relationship between classic psychedelics and suicidality is needed. Therefore, we conducted a systematic review of the relationship between classic psychedelics (both non-clinical psychedelic use and psychedelic therapy) and suicidality. We identified a total of 64 articles, including 41 articles on the association between non-clinical classic psychedelic use and suicidality and 23 articles on the effects of psychedelic therapy on suicidality. Findings on the association between lifetime classic psychedelic use and suicidality were mixed, with studies finding positive, negative, and no significant association. A small number of reports of suicide and decreased suicidality following non-clinical classic psychedelic use were identified. Several cases of suicide in early psychedelic therapy were identified; however, it was unclear whether this was due to psychedelic therapy itself. In recent psychedelic therapy clinical trials, we found no reports of increased suicidality and preliminary evidence for acute and sustained decreases in suicidality following treatment. We identify some remaining questions and provide suggestions for future research on the association between classic psychedelics and suicidality.

Culture and psychedelic psychotherapy: Ethnic and racial themes from three Black women therapists

Psychedelic medicine is an emerging field of research and practice that examines the psychotherapeutic effects of substances classified as hallucinogens on the human mind, body, and spirit. Current research explores the safety and efficacy of these substances for mental health disorders including anxiety, depression, and posttraumatic stress disorder (PTSD). Although current studies explore psychotherapeutic effects from a biomedical perspective, gaps in awareness around cultural issues in the therapeutic process are prominent. African Americans have been absent from psychedelic research as both participants and researchers, and little attention has been paid to the potential of psychedelics to address traumas caused by racialization. This paper examines cultural themes and clinical applications from the one-time use of 3,4-methylenedioxymethamphetamine (MDMA) as part of an US Food and Drug Administration (FDA)-approved clinical trial and training exercise for three African American female therapists. The primary themes that emerged across the varied experiences centered on strength, safety, connection, and managing oppression/racialization. The participants' experiences were found to be personally meaningful and instructive for how Western models of psychedelic-assisted psychotherapy could be more effective and accessible to the Black community. Included is a discussion of the importance of facilitator training to make best use of emerging material when it includes cultural, racial, and spiritual themes. A lack of knowledge and epistemic humility can create barriers to treatment for underserved populations. Implications for future research and practice for marginalized cultural groups are also discussed, including consideration of Functional Analytic Psychotherapy (FAP) as an adjunct to the psychedelic-therapy approaches currently advanced. As women of color are among the most stigmatized groups of people, it is essential to incorporate their perspectives into the literature to expand conversations about health equity.

People of color in North America report improvements in racial trauma and mental health symptoms following psychedelic experiences

This study examined how psychedelics reduced symptoms of racial trauma among black, indigenous, and people of color (BIPOC) subsequent to an experience of racism. A cross-sectional internet-based survey included questions about experiences with racism, mental health symptoms, and acute and enduring psychedelic effects. Changes in mental health were assessed by retrospective report of symptoms in the 30 days before and 30 days after an experience with psilocybin, Lysergic acid diethylamide (LSD), or 3,4-Methylenedioxymethamphetamine (MDMA). We recruited 313 diverse BIPOC in the US and Canada. Results revealed a significant (p < .001) and moderate (d = −.45) reduction in traumatic stress symptoms from before-to-after the psychedelic experience. Similarly, participants reported decreases in depression (p < .001; d = −.52), anxiety (p < .001; d = −.53), and stress (p < .001; d = −.32). There was also a significant relationship (R_c = 0.52, p < .001) between the dimension of acute psychedelic effects (mystical-type, insight, and challenging experiences) and decreases in a cluster of subsequent psychopathology (traumatic stress, depression, anxiety, and stress), while controlling for the frequency of prior discrimination and the time since the psychedelic experience. BIPOC have been underrepresented in psychedelic studies. Psychedelics may decrease the negative impact of racial trauma. Future studies should examine the efficacy of psychedelic-assisted therapy for individuals with a history of race-based trauma.

Who takes the trip? Personality and hallucinogen use among college students and adolescents

Research examining hallucinogen use has identified potential benefits, as well as potential harms, associated with use. The acute effects of hallucinogen use can be intense, disorienting, cognitively impairing, and may result in perceptual changes mimicking aspects of temporary psychosis. Hallucinogen use may also lead to the onset of more chronic issues, such as Hallucinogen Persisting Perception Disorder, which impairs daily functioning even when sober. However, research on factors that predict who will misuse hallucinogens is an understudied area. In particular, while sensation seeking, impulsivity, and emotion dysregulation have all been shown to be predictive of problematic substance misuse, there is almost no research on how these personality variables predict hallucinogen use. The present study assessed how these personality traits predicted hallucinogen use in a sample of college undergraduates (N = 10,251) and a sample of adolescents in an inpatient residential psychiatric hospital (N = 200). Results indicated that facets of sensation seeking, impulsivity, and emotion dysregulation positively predicted ever having used hallucinogens, earlier initiation of use, and lifetime use among college students. Findings also indicated that facets of sensation seeking, impulsivity, and emotion dysregulation positively predicted having ever used hallucinogens in the adolescent inpatient sample. Results highlight the need for more research on who is likely to misuse hallucinogens. If confirmed in future research, the findings presented herein indicate viable personality variables as predictors. This is especially important as there has been a recent explosion of research on the positive benefits of therapeutic hallucinogen use.

Men's health in the United States: a national health paradox

A health paradox exists in the United States. Men have worse health outcomes than women, but national offices exist for promoting women's but not men's health. Two factors that might contribute to this paradox are: underappreciation for the number of health issues that affect men more than women and unawareness that men's health receives less attention than women's health. Therefore, the aim of this article was to summarize the data related to these two factors. First, using mostly government data, an inventory of health issues that are more common in males than females was generated, with prevalence rates listed. Second, results from two new scientometric analyses are presented: (a) number of times "men's health" and "women's health" appeared in titles or abstracts of papers in PubMed from 1970 to 2018; and (b) number of journals currently indexed in MEDLINE that specialize in men's or women's health. The epidemiological data illustrate numerous health issues are more prevalent in men than women, and scientometric data reveal men's health has been given less attention as a distinct field of biomedical research than women's health. This information can help to educate legislators, health officials, journalists, and the general public about the current paradox surrounding men's health in the United States.

Self-reported negative outcomes of psilocybin users: A quantitative textual analysis

Psilocybin, a substance mainly found in mushrooms of the genus psilocybe, has been historically used for ritualistic, recreational and, more recently, medicinal purposes. The scientific literature suggests low toxicity, low risk of addiction, overdose, or other causes of injury commonly caused by substances of abuse, with growing interest in the use of this substance for conditions such as treatment-resistant depression. However, the presence of negative outcomes linked to psilocybin use is not clear yet. The objective of this study is to investigate the negative effects of psilocybin consumption, according to the users' own perception through self-reports extracted from an online platform. 346 reports were analyzed with the assistance of the IRAMUTEQ textual analysis software, adopting the procedures of Descending Hierarchical Classification, Correspondence Factor Analysis and Specificities Analysis. The text segments were grouped in 4 main clusters, describing thinking distortions, emergencies, perceptual alterations and the administration of the substance. Bad trips were more frequent in female users, being associated with thinking distortions. The use of multiple doses of psilocybin in the same session or its combination with other substances was linked to the occurrence of long-term negative outcomes, while the use of mushrooms in single high doses was linked to medical emergencies. These results can be useful for a better understanding of the effects of psilocybin use, guiding harm-reduction initiatives.

Hallucinogen Use is Associated with Mental Health and Addictive Problems and Impulsivity in University Students

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Among university students, lifetime use of hallucinogens was reported as 11.1%.

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Young adults who use hallucinogens have problems with a range of addictive substances and unhealthy behaviors.

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Elevated impulsivity is a common cognitive/personality feature underlying the problems associated with hallucinogen use.

Background

This study examined the prevalence of hallucinogen use in a large sample of university students and its associations with mental health issues.

Methods

9449 students received a 156-item anonymous online survey, which assessed the use of hallucinogens (ever or past year), alcohol and drug use, mental health issues, and impulsive and compulsive traits. Group differences were characterized using statistical tests (p values reported uncorrected, but only regarded as significant if surviving Bonferroni correction).

Results

3525 university students (57.7% female) responded to the survey. The prevalence of past 12-month hallucinogen use in the sample was 4.7%, with an additional 6.4% reporting having used more than 12 months ago. Hallucinogen use was associated with the use of multiple other drugs (e.g., alcohol, opiates) (each p < 0.001), mental health problems (p < 0.001), risky sexual behavior (p < 0.001), low self-esteem (p = 0.004), and impulsivity traits (p < 0.001) but not compulsivity. Effect sizes were small to medium.

Conclusion

Past use of hallucinogens was reported in 11.1%, and was associated with a variety of mental health and drug use problems. Clinicians should be aware that use of hallucinogens is common and mental health problems are more likely in those who use hallucinogens. This study indicates the need for longitudinal research into the negative effects of hallucinogen use on brain function and mental health, especially in young people. Such research should address the extent to which impulsive traits predispose to various substance use problems, versus the direct effects of hallucinogens (and other substances) on mental health.

Psychosocial Correlates and Early Substance Abuse Associated With Lifetime Hallucinogen Use Among Hispanic Young Adults

INTRODUCTION

The Hispanic population is among the most rapid growing populations in the United States. Continued research is needed regarding factors associated with substance abuse and Hispanic individuals. The present study examined psychosocial correlates to lifetime hallucinogen use among a national sample of Hispanic adults.

METHOD

A secondary analysis of the 2017 National Survey on Drug Use and Health was conducted. Questions assessing previous lifetime substance use, psychosocial factors, and demographics were completed by 2,866 Hispanic adults. Weighted logistic regression analyses were used to identify significant predictors of lifetime hallucinogen use.

RESULTS

Results indicated that greater than one in seven (15.1%) of Hispanic adults reported having ever used hallucinogens (lifetime use). Findings from the final multivariate regression revealed that those most likely to report lifetime hallucinogen use were male, used alcohol, marijuana, cigars, cigarettes, inhalants, and cocaine before the age of 21, and binge drank in the past 30 days.

DISCUSSION

Culturally competent prevention strategies aimed at addressing hallucinogen use among Hispanics are needed. Further research studies examining psychosocial reasons explaining the high prevalence of hallucinogen use among this population are warranted.

“Go ask Alice, when she’s 10-feet tall”: Psychosocial correlates to lifetime LSD use among a national sample of US adults

Introduction

Once thought a rarely used drug, LSD use is steadily increasing among US adults. A greater understanding of social factors and psychological determinants leading to lifetime LSD use can assist health educators and professionals in treating this growing problem. This study analyzed psychosocial factors related to LSD use among a national sample of adults.

Methods

A secondary data analysis of the 2017 National Survey on Drug Use and Health was performed.

Results

Results from the final multivariate logistic regression revealed that those who were male, African American or Hispanic, used alcohol, ecstasy, marijuana, inhalants, cocaine, and cigarettes before the age of 21 years, thought about suicide, got a kick out of doing things risky, and tested oneself to do risky things were more likely to use LSD.

Conclusions

This suggests that psychodynamic processes, for example, possible activation of emotional conflicts – can take place spontaneously – during ayahuasca intake in this particular setting. Some participants attributed symbolic meaning to the visionary content, which was more likely to take place in psychotherapeutically motivated clients. The specific setting influence as well as corresponding expectations of the participants in native wisdom could have considerable influence on experiences and interpretations, such as communication with entities as well as receiving personal teachings.