Naturalistic Psychedelic Use: A World Apart from Clinical Care

This survey (n=1,435) among psychedelic users finds that most (75%) don’t discuss psychedelics with their doctor. Almost none (3-4%) had taken psychedelics in a medical setting, though most (78%) were likely to do if legally available. Though a majority (63%) were aware of testing kits, almost half (43%) had never used these services.

Abstract

“Interest in and availability of psychedelics for therapeutic purposes has increased in recent decades. In a large, anonymous, online survey, we investigated patterns of communication with healthcare providers and awareness and utilization of substance testing kits or services among people using psychedelics naturalistically. The sample population included attendees of a psychedelic activism event and users of psychedelic social media forums. Among 1,435 participants, 72.5% never discussed psychedelic use with their primary care provider (PCP). Only 4.4% reported using psychedelics with a therapist and 3% in clinical settings, although 77.8% were very or extremely likely to take psychedelics with a therapist if one were legally available. While 62.6% of participants were aware of substance testing services, 42.6% of these indicated never using them. Regression analyses identified several variables associated with disclosure to PCP and utilization of substance testing services including age, gender, frequency and number of psychedelics used, and likelihood of consuming psychedelics under the guidance of a therapist if one were legally available. Further research is necessary to investigate these findings among other groups. Our findings suggest that relevant training and education for healthcare providers is needed, along with more visible options for substance identity testing.”

Authors: Nicholas G Glynos, Christopher W. Fields, Julie Barron, Moss Herberholz, Daniel J. Kruger & Kevin F. Boehnke

Summary

In a survey of 1,435 people using psychedelics naturalistically, 72.5% never discussed psychedelic use with their primary care provider, and 42.6% indicated never using substance testing services. Further research is necessary to investigate these findings among other groups.

Introduction

Psychedelic-assisted therapy is a treatment approach that combines a psychedelic drug (e.g., psilocybin) with tailored psychotherapy. It has shown promising results for treating major depressive disorder, post-traumatic stress disorder, end of life anxiety, and substance use disorders.

In the U.S., reported naturalistic use of psychedelics has steadily increased over the past decade. However, the relationship between these experiences and the healthcare system remains largely unknown, and thoughtful input from healthcare providers before and after naturalistic psychedelic use may help reduce negative outcomes of psychedelic use.

Many healthcare providers feel unprepared to support patients who have used psychedelics, and 64.9% of respondents reported unclear understanding of psychedelic assisted treatment.

In the context of limited training, the presence of adulterants in psychedelic substances may further impede appropriate clinical response, posing additional risks for people using psychedelics naturalistically. Drug testing kits and services can reduce these risks.

In the current study, people reporting naturalistic psychedelic use were asked about disclosure to health-care providers, reasons for disclosure or non-disclosure, and use of testing services to confirm substance identity.

Participant recruitment and eligibility

Participants were recruited through posted advertisements at a psychedelic activism event, e-mail listservs, and posts in psychedelic interest groups on social media platforms.

Survey development

The survey was designed with input from stakeholders, students, and advocacy groups, and academics experienced in survey design. It assessed details about participants’ past clinical diagnoses, as well as their reported use of psychedelics and perceived outcomes.

Measures

Demographic information was collected, including age, gender, race, household income, education, and ZIP Code of primary residence. Participants rated how their past use of psychedelics interacted with their past diagnoses.

Past psychedelic use was assessed with a checklist of the most commonly used serotonergic and non-serotonergic psychedelics. Participants were asked whether they had ever discussed psychedelics with their primary healthcare provider and rated their PCP’s knowledge of psychedelics.

Statistical analysis

The study population was characterized using descriptive statistics, and between group differences in continuous variables were assessed using independent sample t-tests. Binary logistic regression analyses were used to determine the effects of demographics on outcome variables.

Results

1,930 participants started the survey, 1,435 completed it, and after applying exclusion criteria, 1,435 eligible responses were used for subsequent analyses.

The sample population was mostly White, had a mean age of 35.2 years, and was composed of 52.9% men, 40.8% women, and 6.1% individuals who identified as transgender.

Attrition analyses

After applying exclusion criteria, 251 respondents started the survey, but did not complete it. The attrition group was less likely to consume psychedelics under therapeutic support.

Psychedelic use patterns: frequency, set, and setting

Most participants (55.8%) reported using psychedelics every 2 – 5 months or more, and most used psilocybin mushrooms (92.1%), LSD (76.8%), and MDMA (55.5%). The most frequently reported reasons for using psychedelics were spiritual/psychological/personal exploration, personal growth, and to improve general mental health.

Healthcare provider attitudes and safety

Most participants reported never discussing psychedelics with their PCP, typically because of stigma, a preference to keep psychedelic use private, legal concerns, or believing that their PCP is not adequately knowledgeable about psychedelics.

Substance testing

Nearly two-thirds of respondents were aware of the availability of laboratory services or at home test kits to confirm the identity of psychedelic substances.

Logistic regression: PCP communication and testing services

Multiple predictors were significantly associated with the outcome variable “Have you discussed psychedelics with your primary health-care provider?” These included higher age, higher frequency of psychedelic use, and higher total number of psychedelics used.

Psychedelics and health

Perceived outcomes of psychedelic use were positive, with 93.2% of participants reporting improved overall psychological, emotional, mental, and/or physical well-being, and decreased use of alcohol, tobacco/nicotine, and opioid prescription drugs.

Discussion

Most participants in this survey reported never discussing psychedelics with their primary healthcare provider, and most wanted access to therapist support for their psychedelic experience. The most prevalent mental illnesses self-treated with psychedelics were depression, anxiety, PTSD, and addiction.

Generally, perceived changes in health and well-being and clinical outcomes were largely positive, and many participants reported decreasing their use of alcohol, tobacco, and opioid prescription medications after using psychedelics. However, a small portion of participants reported worsened symptoms, most notably among those using psychedelics for sleeping disorder and bipolar.

Except for ketamine, the most frequently used substances are currently designated Schedule I under the Controlled Substances Act. This designation unnecessarily harms patients in several ways, including being arrested or incarcerated, lack of medical oversight, and not disclosing use to health-care professionals.

Psychedelics may interact with common psychiatric medications, have possible contraindications, and may cause negative psychological consequences. However, access to professionally guided psychedelic therapy may mitigate these consequences.

As the legal landscape for naturalistic psychedelic use grows increasingly permissive, it is vital to thoughtfully consider the risks associated with psychedelic use to ensure safety and promote effective harm reduction.

Our study has several limitations, including a convenience sample recruitment strategy that over-enriched for psychedelic enthusiasts and a cross-sectional design that renders self-reported symptom changes subject to recall bias. Additionally, we were unable to verify that participants had diagnoses of their reported conditions.

This study highlights significant knowledge and therapeutic gaps regarding naturalistic psychedelic use with healthcare providers and is the first to assess communication between men and women using psychedelics.

Conclusions

Psychedelic therapies are rapidly emerging as novel options for the treatment of a variety of mental and physical conditions. However, conventional healthcare systems are not currently considering naturalistic psychedelic use, and there is a need for increased education and training among healthcare providers.