Use Of Hallucinogens Research Articles

Treating Alcohol Use Disorder With Hallucinogens—Renewed Interest After a 50-Year Hiatus

This Viewpoint discusses the use of hallucinogens to treat alcohol use disorder.

Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder

Although classic psychedelic medications have shown promise in the treatment of alcohol use disorder (AUD), the efficacy of psilocybin remains unknown. To evaluate whether 2 administrations of high-dose psilocybin improve the percentage of heavy drinking days in patients with AUD undergoing psychotherapy relative to outcomes observed with active placebo medication and psychotherapy. In this double-blind randomized clinical trial, participants were offered 12 weeks of manualized psychotherapy and were randomly assigned to receive psilocybin vs diphenhydramine during 2 day-long medication sessions at weeks 4 and 8. Outcomes were assessed over the 32-week double-blind period following the first dose of study medication. The study was conducted at 2 academic centers in the US. Participants were recruited from the community between March 12, 2014, and March 19, 2020. Adults aged 25 to 65 years with a DSM-IV diagnosis of alcohol dependence and at least 4 heavy drinking days during the 30 days prior to screening were included. Exclusion criteria included major psychiatric and drug use disorders, hallucinogen use, medical conditions that contraindicated the study medications, use of exclusionary medications, and current treatment for AUD. Study medications were psilocybin, 25 mg/70 kg, vs diphenhydramine, 50 mg (first session), and psilocybin, 25-40 mg/70 kg, vs diphenhydramine, 50-100 mg (second session). Psychotherapy included motivational enhancement therapy and cognitive behavioral therapy. The primary outcome was percentage of heavy drinking days, assessed using a timeline followback interview, contrasted between groups over the 32-week period following the first administration of study medication using multivariate repeated-measures analysis of variance. A total of 95 participants (mean [SD] age, 46 [12] years; 42 [44.2%] female) were randomized (49 to psilocybin and 46 to diphenhydramine). One participant (1.1%) was American Indian/Alaska Native, 3 (3.2%) were Asian, 4 (4.2%) were Black, 14 (14.7%) were Hispanic, and 75 (78.9%) were non-Hispanic White. Of the 95 randomized participants, 93 received at least 1 dose of study medication and were included in the primary outcome analysis. Percentage of heavy drinking days during the 32-week double-blind period was 9.7% for the psilocybin group and 23.6% for the diphenhydramine group, a mean difference of 13.9%; (95% CI, 3.0-24.7; F1,86 = 6.43; P = .01). Mean daily alcohol consumption (number of standard drinks per day) was also lower in the psilocybin group. There were no serious adverse events among participants who received psilocybin. Psilocybin administered in combination with psychotherapy produced robust decreases in percentage of heavy drinking days over and above those produced by active placebo and psychotherapy. These results provide support for further study of psilocybin-assisted treatment for AUD. ClinicalTrials.gov Identifier: NCT02061293.

Use of psychoactive substances among nursing and medical students

Introduction: The use of psychoactive substances has been a worldwide problem that also affects university students. This study aimed to raise patterns of psychoactive substances used among Nursing and Medical students of a public institution of higher education. Materials and methods: Cross-sectional study of quantitative approach, conducted between September and November 2020 in the context of a public higher education institution in southern Bahia, Brazil. The sample consisted of 202 university students. Data were collected using an online questionnaire and the scale of screening for the use of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The descriptive statistical analysis was performed. Results: Most university students from nursing and medical courses (77.7%, n=156) have already used any of the PAS in lifetime. Among those who have used some substances, the highest frequency of use was alcoholic beverages (nursing 56%; medicine 43.4%), followed by marijuana (nursing 17.6%; medicine 23.6%) and tobacco (nursing 13.7%; medicine 10.4%). There was no use of hallucinogens and cocaine/crack by nursing students. Conclusion: The high incidence of PAS use (alcohol, tobacco, marijuana and hypnotics/sedatives) among students, in isolation or poly-use, represents risks that should be considered as a warning to the necessity of developing mental and academic health strategies regarding the use of PSA.

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

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. Cross-sectional. Data from the US National Survey on Drug Use and Health, 2002-19. Respondents aged ≥ 12 years (n = 1 006 051). 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. 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). 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.

Does cannabis testing in the military drive synthetic cannabinoid use? Self-reported use motivations among justice-involved veterans

Though synthetic cannabinoid receptor agonists (SCRAs) were controlled after being introduced as a 'legal high,' SCRAs likely remain appealing to individuals subject to routine drug screens as not all testing programs consistently include SCRAs. Military populations have been linked to SCRAs due to the unconfirmed supposition that testing protocols led many to substitute SCRAs for cannabis. This study aimed to explore SCRA use prevalence, correlates, and use motivations among veterans, with a particular focus on whether United States military personnel substituted SCRAs for cannabis to subvert testing protocols.All veterans appearing in one of eight civilian criminal courts in three U.S. states were invited to answer questionnaire items related to military service, court functionality, and substance use. Of the 579 veterans eligible, 54.9% chose to participate, yielding a cross-sectional sample of 318 veterans charged with a criminal offense by civilian authorities.Sixty-five (21.3%) justice-involved veterans reported lifetime SCRA use. Use while within the military was reported by 15.0% of veterans enlisting after 2008. Only eight (12.3%) reported SCRAs were used as a substitute for cannabis. Boredom (36.9%), experimentation (27.7%), and social aspects of SCRA use (32.3%) were more commonly reported motives. Logistic regression models indicated that use of cannabis (aPR=2.06, p<.05), hallucinogens (aPR=2.50, p<.01), and SCRAs (aPR=2.49, p<.05) while in the military were risk factors for SCRA use after leaving the military, whereas older age at time of military exist was a protective factor (aPR=.87, p<.01) CONCLUSIONS: Drug testing programs within the military do not appear to have the unintended consequence of routing individuals to more risky drugs; however, SCRAs appear to have been an underappreciated problem within the military. Further, use extends beyond the military with many only initiating use after discharge, suggesting SCRA use may jeopardize the health of veterans post-service.

MSR20 Challenges in the Development of Economic Evaluations for Psychedelics in Treatment of Depression

In recent years there have been significant advances in the use of psychedelic drugs (e.g., psilocybin) to treat depression, anxiety, addiction, and post-traumatic stress disorder. Interest in novel treatments for mental health conditions is fueled by the high added costs of these conditions, including direct medical costs and indirect costs such as productivity losses, as well as the relatively high “failure” rates of most standard treatments. In this presentation we discuss the main challenges faced when developing economic evaluations of psychedelics in the treatment of depression.

Psychopathological descriptive model of hallucinogenic/psychedelic drugs effect in the treatment of depression and addictions

IntroductionThere is a growing and renewed interest in the use of hallucinogenic drugs in the treatment of psychiatric disorders, especially since the FDA approval of ketamine treatment for resistant depression. The response to hallucinogenic psychedelic substances (ayahuasca, psilocybin, LSD, ketamine) in the treatment of depression and addictions calls for a theoretical explanatory model.ObjectivesProvide a descriptive / explanatory psychopathological model of the response to treatment with hallucinogenic drugs based on the descriptions of the subjects and the comparison with other extreme life experiences.MethodsRelevant published literature on subjective experiences in treatment with hallucinogenic drugs for depression and addictions is reviewed. It is compared with subjective experiences in life changing experiences.ResultsIntense emotional states, mystical-type experiences including feelings of oneness, transcendence, ineffability, and the complex emotion of awe seem to be consistently presented as psychic elements related to the efficacy of these treatments. The genetic and cultural (memetic) evolutionary value of these emotions in the cohesiveness of human groups and the genesis of affective symptoms, and in the recalibration of cognitions and emotions, is discussed.ConclusionsThe efficacy of hallucinogenic drugs used in the treatment of depression and addictions is accompanied by complex and varied emotions but with common psychopathological elements that could mediate their action.DisclosureNo significant relationships.

Psychedelics and Hallucinogens in Psychiatry: Finding New Pharmacological Targets

The therapeutic options for neurobehavioral disorders are still limited, and in many cases, they lack a satisfactory balance between efficacy and side effects. This work aims to review current evidence regarding the potential contribution of psychedelics and hallucinogens to the discovery of new drugs for treating different psychiatric disorders. Ayahuasca/N,N-dimethyltryptamine (DMT), lysergic acid diethylamide (LSD), and psilocybin have evidence supporting their use in depression, and psilocybin and ayahuasca have also shown good results in treatment-resistant depression. In randomized controlled trials (RCTs) conducted with anxious patients, there were symptomatic improvements with psilocybin and LSD. Psilocybin diminished Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores in a small obsessive- compulsive disorder (OCD) sample. The evidence is less robust regarding substance use disorders, but it suggests a possible role for LSD and psilocybin in alcohol use disorders and for psilocybin in tobacco addiction. In a clinical setting, these substances seem to be safe and well-tolerated. Their mechanisms of action are not fully elucidated, but there seems to be a preponderant role of 5-hydroxytryptamine (5HT) 2A agonism, as well as connectivity changes within the default mode network (DMN) and amygdala and some other molecular modifications. The studies underlying the conclusions have small samples and are heterogeneous in their methods. However, the results suggest that the use of psychedelics and hallucinogens could be considered in some disorders. More studies are needed to reinforce their evidence as potential new drugs.

Hallucinogenic Persisting Perception Disorder: A Case Series and Review of the Literature.

BackgroundHallucinogen persisting perception disorder (HPPD) is characterized by the re-emergence of perceptual symptoms experienced during acute hallucinogen intoxication following drug cessation. The underlying pathophysiology is poorly understood. We report the clinical characteristics and investigation findings of a series of HPPD cases with a literature review of previous case reports. We draw parallels between the features of HPPD and Visual Snow Syndrome (VSS).MethodsRetrospective case series of 13 patients referred from neuro-ophthalmologists. Literature review with 24 HPPD case reports were identified through database search using the terms “hallucinogenic persisting perception disorder” OR “hallucinogen persisting perception disorder.”ResultsLysergic acid diethylamide (LSD), 3,4-Methyl enedioxy methamphetamine (MDMA) and cannabinoid use was common. Cannabinoids and MDMA were mostly used in association with classical hallucinogens. The most frequent symptoms in our patients were visual snow, floaters, palinopsia, photophobia and nyctalopia. In the literature other symptoms included visual hallucinations altered motion perception, palinopsia, tracers and color enhancement. Ophthalmic and neurologic investigations were mostly normal. The majority of patients had ongoing symptoms. Two of our patients fully recovered—one after treatment with benzodiazepine and one without treatment. Twenty-five percent of cases from the literature fully recovered.ConclusionsHPPD presents with heterogeneous visual phenomena on a background of previous classic and non-classic hallucinogen use. Ophthalmic investigations are typically normal. The symptoms of HPPD in our case series overlap with the typical features of Visual Snow Syndrome (VSS). Patients presenting with VSS should be screened for past recreational drug use. The DSM-5 description of HPPD does not include visual snow, nyctalopia, photophobia or floaters. A revision of the diagnostic criteria to include these symptoms may better reflect the typical clinical phenotype. Increased awareness of HPPD as a secondary cause of VSS can avoid extensive investigations. Controlled trials comparing primary and secondary VSS patients are needed to understand the pathophysiology better and optimize treatment for HPPD.

A pilot psychedelic psychopharmacology elective

Background and purposeThere is renewed research attention on the use of psychedelic drugs to treat psychiatric illnesses. If psychedelic drugs are approved for medical use in the United States, patients, professionals, and policy makers will look to pharmacists as medication experts for advice on the safe, effective, and ethical use of these substances. To help prepare a future generation of pharmacists in this therapeutic area, a psychedelic psychopharmacology elective was developed and piloted. Educational activity and settingBroadly, the objectives of the course were to train students to (1) analyze scientific literature, (2) engage in ethical discussions, and (3) make evidence-based clinical recommendations about the use of psychedelics. The pilot elective course was delivered synchronously online to 12 second- and third-year pharmacy students during spring 2021. Activities included journal clubs, textbook reading assignments, reflective structured dialogues, a monograph, and a term paper. FindingsThe course was feasible for a single instructor and well-received by students. A mix of instructor-directed and self-directed learning approaches were utilized. SummaryThe pilot psychedelic psychopharmacology elective was a success, providing a framework for future courses.

Past-year hallucinogen use in relation to psychological distress, depression, and suicidality among US adults

BackgroundThere is renewed interest in the clinical application of hallucinogenic substances to treat a range of psychiatric conditions. However, there is mixed evidence regarding how use of such substances outside of medical settings relates to psychological distress, depression, and suicidality. MethodsWe examined data from a US representative sample of noninstitutionalized adults from the 2015–2020 National Survey on Drug Use and Health (N = 241,675). We evaluated whether past-year use of specific hallucinogens (i.e., LSD, DMT/AMT/Foxy, salvia divinorum, ecstasy [MDMA/Molly], ketamine) is associated with reporting past-year serious psychological distress (SPD), major depressive episode (MDE), and suicidality. Generalized linear models using Poisson and log link were used to estimate adjusted prevalence ratios (aPRs), controlling for sociodemographic characteristics and past-year use of various other illegal drugs. ResultsLSD use was associated with an increased likelihood of MDE (aPR = 1.23, 95% CI: 1.10–1.37) and suicidal thinking (aPR = 1.21, 95% CI: 1.09–1.34). Similar associations were observed between salvia divinorum use and suicidal thinking (aPR = 1.41, 95% CI: 1.00–1.97) and between DMT/AMT/Foxy use and suicidal planning (aPR = 1.81 95% CI: 1.17–2.81). On the other hand, ecstasy use was associated with a decreased likelihood of SPD (aPR = 0.83, 95% CI: 0.77–0.89), MDE (aPR = 0.91, 95% CI: 0.83–1.00), and suicidal thinking (aPR = 0.86, 95% CI: 0.75–0.99). ConclusionFindings suggest there are differences among specific hallucinogens with respect to depression and suicidality. More research is warranted to understand consequences of and risk factors for hallucinogen use outside of medical settings among adults experiencing depression or suicidality.

Agency-First Epistemology of Psychedelics

Letheby’s book is an engaging and crystal-clear exploration of the philosophical issues raised by the use of psychedelic drugs. In this paper, we focus on the epistemological issues Letheby examines in chapter 8 and argue that his analysis requires an agency-first approach to epistemic evaluation. On an agency-first approach, epistemic evaluation is about identifying the skills agents needs to acquire in order to pursue and fulfil their epistemic goals.

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

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

Psychedelic Cognition-The Unreached Frontier of Psychedelic Science.

Psychedelic compounds hold the promise of changing the face of neuroscience and psychiatry as we know it. There have been numerous proposals to use them to treat a range of neuropsychiatric conditions such as depression, anxiety, addiction and PTSD; and trials to date have delivered positive results in favor of the novel therapeutics. Further to the medical use, the wider healthy population is gaining interest in these compounds. We see a surge in personal use of psychedelic drugs for reasons not limited to spiritual enhancement, improved productivity, aiding the management of non-pathological anxiety and depression, and recreational interests. Notably, microdosing—the practice of taking subacute doses of psychedelic compounds—is on the rise. Our knowledge about the effects of psychedelic compounds, however, especially in naturalistic settings, is still fairly limited. In particular, one of the largest gaps concerns the acute effects on cognition caused by psychedelics. Studies carried out to date are riddled with limitations such as having disparate paradigms, small sample sizes, and insufficient breadth of testing on both unhealthy and healthy volunteers. Moreover, the studies are majoritarily limited to laboratory settings and do not assess the effects at multiple dosages within the same paradigm nor at various points throughout the psychedelic experience. This review aims to summarize the studies to date in relation to how psychedelics acutely affect different domains of cognition. In the pursuit of illuminating the current limitations and offering long-term, forward-thinking solutions, this review compares and contrasts findings related to how psychedelics impact memory, attention, reasoning, social cognition, and creativity.

Factores asociados con intento suicida en pacientes económicamente activos con diagnóstico de depresión mayor

IntroductionEvery 40seconds, one person in the world commits suicide. As such, suicide is considered a public health problem, and prior suicide attempt is one of the risk factors associated with completed suicide. Despite the strategies implemented and the studies carried out, in Colombia suicide figures are on the rise, more markedly in the economically active population. ObjectiveTo identify the sociodemographic, family, personal, economic and religious factors associated with suicide attempt in patients of productive age (18-62 years old) in a mental health institution in Bogota, Colombia. MethodsAn analytical prevalence study was conducted at the Nuestra Señora de la Paz mental health clinic in Bogota. To explore the relationship between the factors described and suicide attempt, a review of 350 medical records of the selected population was carried out. ResultsIn total, 37.7% of the sample presented a suicide attempt. Associations were found between the suicide attempt and higher education than primary school (PR=0.47 [0.23-0.97]), no economic income (PR=1.72 [1.13-2.61]), no partner (PR=2.10 [1.33-3.32]), alcohol consumption (p=0.045), hallucinogen use (PR=2.39 [0.97-3.43]) and the presence of personality disorder (PR=1.93 [1.11-3.34]). ConclusionsThe results of the study are similar to those previously described in other studies around the world. There is a need to recognise and address various factors associated with suicide attempt in depressed patients in order to implement promotion and prevention actions, early identification and specific interventions that have an impact on the numbers of completed suicide in the country.

Substance abuse among university students in Egypt: prevalence and correlates.

Drug abuse is a global challenge with harmful effects on health, wealth and wellbeing of nations. University students report more habitual use of marijuana, cocaine, hallucinogens and illicit drugs than noncollege students report. To identify the prevalence of tobacco use, alcohol and drug abuse and to identify some factors associated with drug abuse. A cross-sectional study recruiting 2552 students from all faculties hosted by Kafr El-Sheikh University during the academic year 2018-2019. Data were collected using a structured self-administered questionnaire. The prevalence of current drug abuse was 8.9% for cigarette smoking, followed by tranquilizers (4.3%), hashish (3.6%), alcohol (2.7%), bhang (1.4%) and tramadol (1.0%). Men reported significantly greater use of cigarettes, alcohol, tramadol, hashish and bhang than women. Students of practical colleges were found to smoke cigarettes and abuse hashish significantly more than their peers in other colleges. Risk factors associated with drug abuse were mainly related to gender and college type. There is a need to design and implement programmes to raise awareness and provide supportive services for prevention and management of drug abuse among university students tailored according to their needs.

Hallucinogens, alcohol and shifting leadership strategies in the ancient Peruvian Andes

In the pre-Columbian Andes, the use of hallucinogens during the Formative period (900–300 BC) often supported exclusionary political strategies, whereas, during the Late Horizon (AD 1450–1532), Inca leaders emphasised corporate strategies via the mass consumption of alcohol. Using data from Quilcapampa, the authors argue that a shift occurred during the Middle Horizon (AD 600–1000), when beer made fromSchinus mollewas combined with the hallucinogenAnadenanthera colubrina. The resulting psychotropic experience reinforced the power of the Wari state, and represents an intermediate step between exclusionary and corporate political strategies. This Andean example adds to the global catalogue documenting the close relationship between hallucinogens and social power.

Алкоголь в повседневной жизни советского Севера 1930-х годов

In the sometimes unbearable living conditions in the Arctic, the use of alcoholic beverages and hallucinogens is the only way to escape from the harsh reality. Alcohol can create the illusion of easily overcoming any obstacles and difficulties. Since the main enemy of man in the North is cold, the mythology of alcoholic “warming” is especially relevant for polar explorers. Within the framework of the Soviet Arctic utopia, it is important to take alcohol beyond commodity-money relations. In the North, the strangest transmutations of matter become reality. The Arctic is a kind of anti-world, where everything turns into its opposite. For example, the participants of the expedition “North Pole – 1” had to distill cognac into alcohol.

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High Prevalence and Early Onsets: Legal and Illegal Substance Use in an Urban Cohort of Young Adults in Switzerland

Introduction: Debates about the legalization of illegal substances (e.g., cannabis) continue around the globe. A key consideration in these debates is the adequate protection of young people, which could be informed by current prevalence and age-of-onset patterns. For Switzerland, such information is limited, which is particularly true for women, despite advanced political efforts to legalize cannabis. The objective of the current study was to investigate substance use prevalence rates and ages of onset in a community-representative sample of female and male young adults in Switzerland. Methods: Data came from the Zurich Project on the Social Development from Childhood to Adulthood (z-proso). In 2018, participants (N = 1,180, 50.8% females) were ∼20 years old. Lifetime and past-year use of alcohol, tobacco, cannabinoids, stimulants, hallucinogens, opioids, and benzodiazepines were assessed with an extensive substance use questionnaire. Additionally, ages of onsets of the respective substances were estimated by averaging participants’ self-reported ages of onsets from ages 13 to 20 (max. 4 assessments). Results: 57% of 20-year-olds had used cannabinoids, 16% stimulants, 15% opioids (mostly codeine), and 8% hallucinogens in the past year. Males had higher prevalence than females for most drugs; nevertheless, females’ prevalence rates were notably high. Legal substance use was typically initiated 1.3–2.7 years before legal selling age. Thus, almost half of the sample had consumed alcohol and tobacco by age 14. More than 40% of the total sample had smoked cannabis by age 16. Males initiated use of legal substances and cannabis earlier than females. Discussion: Our recent community-representative data suggested unexpectedly high levels and early onsets of substance use compared to a previous Swiss surveys and also the European average. Drug policy debates should consider urban substance use patterns when considering legalization efforts.