Beyond prohibition: A public health analysis of naturalistic psychedelic use

Despite recently resurrected scientific interest in classical psychedelics, few studies have focused on potential harms associated with abuse of these substances. In particular, the link between psychedelic use and psychotic symptoms has been debated while no conclusive evidence has been presented. Here, we studied an adult population (n = 1032) with a special focus on young (18–35 years) and healthy individuals (n = 701) to evaluate the association of psychedelic drug use with schizotypy and evidence integration impairment typically observed in psychosis-spectrum disorders. Experimental behavioural testing was performed in a subsample of the subjects (n = 39). We observed higher schizotypy scores in psychedelic users in the total sample. However, the effect size was notably small and only marginally significant when considering young and healthy subjects (Cohen’s d = 0.13). Controlling for concomitant drug use, none of our analyses found significant associations between psychedelic use and schizotypal traits. Results from experimental testing showed that total exposure to psychedelics (frequency and temporal proximity of use) was associated with better evidence integration (Cohen’s d = 0.13) and a higher sensitivity of fear responses (Cohen’s d = 1.05) to the effects instructed knowledge in a reversal aversive learning task modelled computationally with skin conductance response and pupillometry. This effect was present even when controlling for demographics and concomitant drug use. On a group level, however, only difference in sensitivity of fear responses to instructed knowledge reached statistical significance. Taken together, our findings suggest that psychedelic drug use is only weakly associated with psychosis-like symptoms, which, in turn, is to a large extent explained by psychiatric comorbidities and use of other psychoactive substances. Our results also suggest that psychedelics may have an effect on flexibility of evidence integration and aversive learning processes, that may be linked to recently suggested therapeutic effects of psychedelic drugs in non-psychotic psychiatric populations.

Background: One of the main public health strategies adopted at the beginning of the COVID-19 pandemic consisted of implementing strict lockdowns to stop the transmission of the virus. Despite being an effective measure, the confinement and the associated social isolation create a stressful, potentially lengthy situations that has been proven to have several psychological consequences. Given the potential benefits that certain psychedelic drugs have shown for the treatment of psychological disorders, this study aimed to assess the impact of lifetime psychedelic drug use on mental health in relation to the first strict lockdown adopted by various countries (April-July 2020).Methods: Subjects completed an online survey that inquired about sociodemographic factors, activities, and lifestyle factors during confinement, as well as health and mental health related factors. Subjects were asked about their lifetime use of psychedelic drugs (MDMA, ayahuasca, psilocybin-containing mushrooms, LSD, peyote, San Pedro, Bufo alvarius or 5-MeO-DMT, and others), being classified as regular users (more than once per 6 months), occasional users, or non-users. The survey included psychometric tests used to assess psychological distress, peritraumatic stress, social support, psychopathological symptoms, and personality. Linear regressions were performed with psychedelic drug users as the independent variable and psychometric factors as the outcomes, while correcting for age, gender, language, religion, spirituality, and use of non-psychedelic drugs.Results: The study included 2,974 English, Portuguese, and Spanish speakers (497 regular users of psychedelic drugs, 606 occasional users, and 1,968 non-users). On average, respondents were 36 years old and 70% were female. Psychedelic drug users, especially regular ones, reported less psychological distress, less peritraumatic stress, and more social support. Regarding personality measures, psychedelic drug users scored higher on the novelty-seeking and self-transcendence scales, and lower on cooperativeness.Conclusion: Our findings showed that regular users of psychedelic drugs had less psychological stress and some personality differences when compared to occasional users and non-users. This suggests that either the use of psychedelics might be a protective factor itself or people with certain previous traits are more prone to frequently using psychedelic drugs. Future prospective longitudinal research should investigate the underlying processes observed in this study to develop consistent hypotheses.

The need for publicly funded research on therapeutic use of psychedelic drugs.

Background: Substance use disorders (SUDs) are highly prevalent, affecting over 48.5 million Americans. Available treatments for SUD remain insufficient, and many patients do not respond to existing interventions despite adequate adherence to treatments. While novel therapies for SUD are urgently needed, the use of psychedelic drugs for the treatment of SUDs has shown promise. Objectives: This overview of systematic reviews summarizes existing evidence on hallucinogens—serotonergic psychedelics and ketamine—for the treatment of SUD. Methods: A comprehensive search of the literature was conducted to identify relevant evidence for using serotonergic and non-serotonergic psychedelics for the treatment of SUDs. After initial screening (n = 468 studies), 62 studies were retrieved and assessed for eligibility, and a total of 16 systematic reviews were included. Conclusions: Although preliminary, evidence suggests that the use of serotonergic and non-serotonergic psychedelics for the treatment of SUD may provide advantages over traditional therapeutics, and these compounds may eventually become part of the next generation of treatments for SUD under specific circumstances. Research with these drugs has faced significant challenges, though, and caution when interpreting results is warranted, given high risk of bias and several other methodological limitations from the studies to date. Furthermore, risks associated with these drugs are not negligible. For now, the use of psychedelic drugs for the treatment of SUDs remains experimental, and existing evidence is insufficient to support its use in clinical practice.

Background: Psychedelic-assisted psychotherapy has shown promising results for treating alcohol use disorder (AUD) and other mental health conditions. Although the precise mechanisms of psychedelic therapies remain unclear, many studies report increased feelings of connectedness following psychedelic experiences. Specifically, both nature relatedness (one’s subjective sense of being connected to nature) and social connectedness (feelings of comprehensive social closeness) have been shown to increase with psychedelic use, and greater connectedness in these domains has been associated with enhanced health and well-being. The current study examined whether a nature-themed video intervention presented to participants undergoing psilocybin-assisted psychotherapy would differentially affect nature relatedness compared with social connectedness in adults with AUD. Methods: A total of 20 participants were randomized to either the visual healing condition (viewing a 42-min nature video; N = 10) or the standard setting condition (guided body scan; music with eyeshades; N = 10). Nature relatedness and social connectedness were measured using the Nature Relatedness Scale (NRS-6) and the Social Connectedness Scale–Revised (SCS-R) at baseline and 2 weeks after the psilocybin session. Results: A significant between-group difference was observed in change in nature relatedness pre-to-postpsilocybin session [χ 2 (1) = 5.74, p = 0.02]. Nature relatedness significantly increased in the visual healing group [median change in NR-6 = 0.33, range = (−0.17, 0.67), p = 0.01], but not in the standard setting group [median change = 0.00; range = (−0.17, 0.33), p = 0.50]. No significant between-group differences were observed for change in social connectedness [χ 2 (1) = 0.89, p = 0.35], and no significant overall change in social connectedness was observed across groups [median change = −1.00, range = (−27, 20), p = 0.90]. Conclusions: Viewing a nature-themed video may enhance nature relatedness among individuals undergoing psilocybin-assisted psychotherapy for AUD. Future research should investigate the effects of real-life nature immersion and explore nature relatedness and other forms of connectedness as potential therapeutic targets in psychedelic-assisted and other psychotherapies NCT04410913.

Psychedelics Legislation Gains Momentum

(1) Background: There appears to be a growing disconnection between humans and their natural environments which has been linked to poor mental health and ecological destruction. Previous research suggests that individual levels of nature relatedness can be increased through the use of classical psychedelic compounds, although a causal link between psychedelic use and nature relatedness has not yet been established. (2) Methods: Using correlations and generalized linear mixed regression modelling, we investigated the association between psychedelic use and nature relatedness in a prospective online study. Individuals planning to use a psychedelic received questionnaires 1 week before (N = 654), plus one day, 2 weeks, 4 weeks, and 2 years after a psychedelic experience. (3) Results: The frequency of lifetime psychedelic use was positively correlated with nature relatedness at baseline. Nature relatedness was significantly increased 2 weeks, 4 weeks and 2 years after the psychedelic experience. This increase was positively correlated with concomitant increases in psychological well-being and was dependent on the extent of ego-dissolution and the perceived influence of natural surroundings during the acute psychedelic state. (4) Conclusions: The here presented evidence for a context- and state-dependent causal effect of psychedelic use on nature relatedness bears relevance for psychedelic treatment models in mental health and, in the face of the current ecological crisis, planetary health.

Preliminary studies show psychedelic compounds administered with psychotherapy are potentially effective and durable substance misuse interventions. However, little is known about the association between psychedelic use and substance misuse in the general population. This study investigated the association between psychedelic use and past year opioid use disorders within illicit opioid users. While controlling for socio-demographic covariates and the use of other substances, the relationship between classic psychedelic use and past year opioid use disorders was analyzed within 44,000 illicit opioid users who completed the National Survey on Drug Use and Health from 2008 to 2013. Among respondents with a history of illicit opioid use, psychedelic drug use is associated with 27% reduced risk of past year opioid dependence (weighted risk ratio = 0.73 (0.60-0.89) p = 0.002) and 40% reduced risk of past year opioid abuse (weighted risk ratio = 0.60 (0.41-0.86) p = 0.006). Other than marijuana use, which was associated with 55% reduced risk of past year opioid abuse (weighted risk ratio = 0.45 (0.30-0.66) p < 0.001), no other illicit drug was associated with reduced risk of past year opioid dependence or abuse. Experience with psychedelic drugs is associated with decreased risk of opioid abuse and dependence. Conversely, other illicit drug use history is largely associated with increased risk of opioid abuse and dependence. These findings suggest that psychedelics are associated with positive psychological characteristics and are consistent with prior reports suggesting efficacy in treatment of substance use disorders.

ABSTRACTAnthropologists have studied the use of psychedelic drugs across cultures for over a century; however, this literature has yet to be compiled. In providing a brief survey of ethnographic research produced in the Global North on the ‘classic psychedelics’, this article suggests that there not only exists a robust subfield that can be called the anthropology of psychedelics, but that the field also lacks diversity given that it predominately focuses on the Indigenous use of psychedelics or research at the intersection of Indigenous and Global North encounters. Accordingly, there exists a lacuna in the anthropology of psychedelics related to the widespread and variegated use of psychedelics in urban contexts across the Global North. As scientific research on the therapeutic aspects of psychedelics continues to gain momentum, the need for more cultural analyses on the extra‐pharmacological dimensions surrounding psychedelic drug experiences and their effects is in greater demand than ever.

BackgroundThere are few effective treatments for eating disorders (EDs), and new interventions are urgently needed. The MEDication and other drugs For Eating Disorders (“MED–FED”) survey investigated the lived experience of adults with EDs regarding their prescription and non-prescription drugs use. Psychedelic drugs were highly rated in this survey for their impact on ED symptoms and general mental health. Here, we provide a more granular analysis of a subset of the data pertaining to psychedelic drug use from this survey.MethodsThe MED–FED survey recruited adults who self-reported either a clinically diagnosed ED or disordered eating that was currently undiagnosed but causing significant distress. The demographics of recent and lifetime psychedelic users relative to non-users were examined, as well as their use of other prescription and non-prescription drugs, and co-morbid conditions. Qualitative analysis was used to examine themes emerging from open-ended comments around use of psychedelic drugs.ResultsOf the 5247 participants who completed the survey, 1699/5247 (32.4%) reported lifetime psychedelic use, with 1019/5247 (19.4%) having used in the last 12 months. Typical use involved infrequent consumption, once or twice per year, of psilocybin, LSD, 2-CB, or DMT. Those who reported recent psychedelic use were younger and less likely to currently use prescription drugs or to have been recently hospitalised for their ED. They were more likely to use other non-prescription drugs (e.g. cannabis, ketamine, stimulants) and to report co-morbid ADHD, PTSD, ASD, and substance misuse. Participants with a diagnosis of anorexia nervosa were less likely to report psychedelic use, while those with an undiagnosed ED were more likely. Qualitative analysis of responses (n = 200) revealed themes of profound transformation, increased connectedness, and new insights into illness following psychedelic experiences. A handful of respondents reported benefits from microdosing. A few respondents reported adverse outcomes in their open-ended comments, including “bad trips” (n = 15) and worsened ED symptoms (n = 8) after psychedelic use.ConclusionsThese findings provide a unique insight into psychedelic use among individuals with EDs. The results align with emerging evidence suggesting that psychedelics may be beneficial in this population, highlighting the need for further research, including clinical trials, to explore their efficacy and safety.

In recent years, the potential psychological benefits of psychedelic drugs have garnered increasing interest from academic and medical communities. We conducted a systematic review of literature examining the association between psychedelic drugs use and intimacy. The initial search yielded 5,902 studies, of which 19 met the inclusion criteria. Studies varied in methodology, including placebo-controlled experimental designs, quasi-experimental designs, and retrospective self-reports. Positive intimacy-related outcomes were reported in all nine laboratory setting studies, including relationship satisfaction, connectedness, emotional disclosure, empathy, and affiliation, as well as decreased social anxiety. Of the 10 studies that relied solely on retrospective self-report, six identified positive intimacy-related experiences including relationship quality, interconnection, empathy, and closeness. Four of these studies identified negative intimacy-related experiences, including disconnection, social anxiety, and relationship dissatisfaction and distrust. This systematic review demonstrates overwhelmingly positive effects of psychedelic drug use in research-controlled settings, but more research is needed to identify both the ideal settings for psychedelic drug use and the long-term impact of these drugs on intimacy.

A pilot psychedelic psychopharmacology elective

Background and aimsA mental health professional's background regarding psychedelics, including their attitudes, is important to the therapeutic effects of these drugs; however, no study has examined this in Asian populations. This study aims to evaluate the knowledge and attitudes of psychiatric professionals in Korea regarding the use of psychedelics in clinical practice.MethodsAn anonymous survey consisting of 15 questions was distributed to 200 participants at three academic psychiatric conferences in Korea. The survey assessed participants' knowledge of the history, mechanisms, and therapeutic potential of psychedelic drugs, as well as their attitudes towards their legalization and usage for psychiatric treatment.ResultsThe survey had a 96.5% response rate (193/200), with 44% (85/193) of respondents being psychiatry residents. Disparities in prior knowledge of psychedelics, especially in their mechanisms of action, were found between residents and psychiatrists. Despite this, for all participants, there was a notable interest in the potential therapeutic applications of psychedelics, particularly for conditions that are difficult to treat, such as depression and post-traumatic stress disorder. Additionally, positive attitudes toward psychedelics were lower among women, with most respondents expressing a cautious optimism about the future integration of psychedelics into psychiatric practice, contingent upon further research and regulatory approval.ConclusionsThe study underscores the need for enhanced education and training on psychedelic drugs within the Korean psychiatric community. Increasing awareness and understanding of these substances could help align Korean psychiatric practices with global trends in fields of psychedelics and potentially improve treatment outcomes for patients with severe and refractory psychiatric conditions.

This study examines how psychedelic drug users construct symbolic boundaries to differentiate themselves from other drug users. Drawing on 32 semi-structured interviews with people who have used psychedelic drugs, we explore how participants construct their psychedelic use as distinct from, and superior to, other forms of drug use. Participants differentiate themselves from “hard” drug users in two main ways. First, by emphasizing psychedelics’ perceived lack of addictive potential and reduced harm. Second, by focusing on the perceived legitimacy of their use, frequently citing mental health, therapeutic, and experiential benefits. Psychedelic users contrast their experiences with those of other drug users, in part, by valuing psychedelics as facilitating meaningful, introspective, and emotionally significant experiences rather than mere intoxication. These symbolic boundaries serve to sustain their use while shielding them from broader drug-related stigmas. The present study offers a novel example of boundary construction, a discussion of these findings conceptually, and elucidates least some of the reasons for persistent psychedelic use and how those who use psychedelics view themselves.

Increased psychological flexibility (PF) may underlie the lasting positive effects of psychedelic experiences on mental well-being. The associations between different components of PF, psychological inflexibility (PI), and well-being with psychedelic use are not well understood. We conducted a cross-sectional internet survey of participants (N = 629) with experience of classical psychedelics. Using network analysis, we examined how aspects of a single psychedelic experience (mystical-type features and psychological insights) and the frequency of past psychedelic use, were associated with current PF and PI components, as well as with mental well-being and ill-being. Mediation analyses explored whether PF mediated the relationship between past psychedelic use and well-being or ill-being. The network analysis linked psychological insight to the PF component Acceptance, with no association found between the frequency of past use and PF. Mediation analyses showed PF mediates the association between past psychedelic use and well-being and ill-being. These results suggest that the quality and depth of the psychedelic experience, rather than the frequency of use, are primarily linked to psychological flexibility, particularly Acceptance, and overall well-being. This underscores the importance of treating PF as a multidimensional construct to better understand the long-term mental health benefits of psychedelics.