Boehnke, K.F., Cox, K., Weston, C., Herberholz, M., Glynos, N., Kolbman, N., Fields, C., Barron, J., & Kruger, D.J. (in press). Slouching towards engagement: Interactions between people using psychedelics naturalistically and their healthcare providers. Frontiers in Psychiatry.
There is substantial public interest in psychedelics as potential treatments for psychiatric conditions. However, most psychedelics are criminalized under federal law in the USA, so it is unclear whether use occurs with clinical support. Our objective was to assess whether naturalistic psychedelic use occurs with clinical support, interactions between those using psychedelics and healthcare providers (psychiatrist, therapist, or primary physicians), and use characteristics. We conducted an online, anonymous, confidential, cross-sectional survey of adults reporting psychedelic use (N=1221) through a psychedelics advocacy event and social media between 9/18/2022 and 11/5/2022. We assessed participant disclosure of psychedelic use with their psychiatric care provider (PsyCP) and/or primary care provider (PCP), desire for provider support, access to support, and rate of taking prescribed psychoactive medications alongside psychedelics. Among participants with such care providers, 22% disclosed psychedelic use to their PCP vs. 58% to their PsyCP. Participants were less confident in PCP vs. PsyCP ability to integrate psychedelics into treatment. Common reasons for nondisclosure included stigma, inadequate provider knowledge, and legal concerns. 23% reported taking psychedelics on the same day as potentially interacting psychiatric medications (e.g., anxiolytics, antidepressants). Despite 81% of participants desiring therapist support during psychedelic experiences, only 15% had received such support. Our results show that psychedelic use is generally disconnected from primary and psychiatric clinical care. This disconnection may result in safety issues, including inadequate screening for contraindicated conditions, lack of support during emergent adverse events, and drug interactions. Enhanced clinical education and orienting drug policy towards known harms and benefits of psychedelics is needed.
Legal, scientific, and social landscapes for psychedelics are changing rapidly. Differences of opinion exist among key stakeholders regarding regulatory control, models of provisioning psychedelic therapy, and medicalization, decriminalization, and/or legalization policies. We assessed the policy preferences of people using psychedelics naturalistically (N = 1221) to understand how they aligned and differed with institutional entities and existing psychedelic policies. Three quarters of participants would support decriminalization and legalization. On average, participants completely supported individuals being legally able to grow and possess psychedelic plants and/or fungi for personal consumption. Trends included more support for natural over synthetic substances, self-production and consumption over gifting, gifting over sales, and administration of psychedelics with therapeutic support than without therapeutic support. Participants were concerned about pharmaceutical-like policy models, including patents of natural and synthetic psychedelic compounds. Participants were mostly from the State of Michigan, though geographical differences were minor. Those who identified as a psychedelic guide, educator, or therapist had small yet extensive differences from those who did not. As psychedelic liberalization continues to advance, it is critical for policymakers to consider these preferences to ensure laws provide safe and equitable access to these substances and appropriate medical support for their use.
Glynos, N.G., Kruger, D.J., Kolbman, N., Boehnke, K.F., & Lucas, P. (in press). The relationship between naturalistic psychedelic use and clinical care in Canada. Journal of Psychoactive Drugs.
Naturalistic psychedelic use among Canadians is common. However, interactions about psychedelic use between patients and clinicians in Canada remain unclear. Via an anonymous survey, we assessed health outcomes and integration of psychedelic use with health care providers (HCP) among Canadian adults reporting past use of a psychedelic. The survey included 2,384 participants, and most (81.2%) never discussed psychedelic use with their HCP. While 33.7% used psychedelics to self-treat a health condition, only 4.4% used psychedelics with a therapist and 3.6% in a clinical setting. Overall, 44.8% (n = 806) of participants were aware of substance testing services, but only 42.4% ever used them. Multivariate regressions revealed that therapeutic motivation, higher likelihood of seeking therapist guidance, and non-binary gender identification were significantly associated with higher odds of discussing psychedelics with one’s primary HCP. Having used a greater number of psychedelics, lower age, non-female gender, higher education, and a therapeutic motivation were significantly associated with higher odds of awareness of substance testing. We conclude that naturalistic psychedelic use in Canada often includes therapeutic goals but is poorly connected to conventional healthcare, and substance testing is uncommon. Relevant training and education for HCPs is needed, along with more visible options for substance testing.
Boehnke, K.F., Kruger, D.J., & Lucas, C. (in press). Changed substance use after psychedelic experiences among individuals in Canada. International Journal of Mental Health and Addiction.
The Canadian Psychedelic Survey was a cross-sectional online survey of adults (n = 2393, mean age = 3 8.8 +/- 13.1, 56.3% women) who self-reported past or current psychedelic use. We investigated whether psychedelic use was associated with self-reported changes in the use of other substances. Participants reported substantial changes, with 43.8% (n = 651) decreasing or ceasing alcohol use, 42.5% (n = 272) ceasing or decreasing antidepressant use, and 42.4% (n = 200) decreasing or ceasing cocaine use. The highest rates of increased use (10.9%; n=151) and initiation (3.5%, n = 7) were for cannabis and amphetamines, respectively. The most common reasons for psychedelic substitution were feeling more connected with self (72.4%, n = 653), others (54.4%, n = 491), and nature (54%, n = 487), as well as feeling less anxious or depressed (59.5%, n = 537). Factors associated with reduction in any substance use included motivation to treat a medical condition, number of psychedelics used, and younger age. This real-world evidence should be rigorously investigated in future studies.
There is a remarkable surge of interest in psychedelics, including new stakeholders and greater media attention. There is a need to examine the information-seeking behavior of people using psychedelics naturalistically, given the importance of preparation and harm-reduction. We examined sources of information for people using psychedelics naturalistically, and the degree to which they are trusted in a large, anonymous, online survey (N = 1221). The most common source of participants’ information on psychedelics was their own experimentation and experiences (79.52%). Most also sought information from Internet websites (61.67%), friends (61.02%), Internet discussion forums (57.08%), books (57.00%), and articles in peer-reviewed scientific journals (54.55%). Few sought information from their primary health care provider (4.83%). Articles published in scientific journals, psychedelic non-profits, and researchers based in colleges or universities were the most trusted sources of psychedelic information. Government agencies and pharmaceutical companies were the least trusted. Few participants thought that the popular media accurately stated the benefits and risks of psychedelics and most thought that the popular media failed to distinguish between different types of psychedelics. Our results indicate a high level of information seeking among psychedelic users, with a diverse array of information sources typically outside of mainstream health and medical care systems.
Identifying gaps and strengths in psychedelic-related knowledge is key to developing effective, evidence-based education to inform appropriate use of and harm reduction practices for psychedelics in the naturalistic use landscape. The current study piloted an assessment instrument with questions on legal status, therapeutic potential, and side effects of psychedelics among people reporting current psychedelic use. We recruited participants (N = 1435) at a psychedelic advocacy event and through psychedelic interest groups on social media. Respondents completed a brief survey of psychedelic use and psychedelic knowledge. Items assessed basic knowledge of various topics surrounding psychedelics, such as legal status, active compounds, and known therapeutic efficacy based on the clinical trial literature. Respondents who had used greater numbers of different psychedelics, with higher levels of education, lower age, greater frequency of psychedelic use, identifying as male, used high doses (vs. microdosing only), identifying as Caucasian/White, and with greater annual household income answered more questions correctly. Most respondents exhibited high knowledge of psychedelics, though there is also a demonstrated need for education and outreach, especially in under-represented communities.
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.