Are psychedelics addictive? Side effects and risks

People can make a tea called ayahuasca, which is also known as hoasca, aya, or yagé, from the natural plant version. Some psychedelics come from plants or mushrooms (often referred to alcohol use disorder and depressive disorders alcohol research as “magic mushrooms”), while others are synthetic and manufactured by humans. Psychedelics are a group of psychoactive drugs that can induce hallucinations and feelings of euphoria.

1. Griffiths et al. (1979) concluded that the reinforcing effects of PCP are most likely unrelated to its hallucinogenic properties, and that the lack of self-administration in animals agrees with the finding that people use psychedelics at a very low level and that most discontinue use spontaneously.
2. However, some people misuse DXM to achieve the feelings of euphoria it creates when taken in doses of 250–1,500 mg — much higher than the therapeutic range.
3. Assessing the risks of psychedelic use is challenging, as there are many different substances, applications, environments and population groups in this rapidly developing field.

These surveys use the terms “hallucinogen” and “hallucinogen use disorder” and data from those surveys are reported below. Regulatory and legal hurdles of getting psychedelic medicines proven as mainstream medicines are still substantial, so overcoming historic misperceptions is vital. The past decade has seen an increasing focus on research on the therapeutic applications of psychedelics – a direct benefit for the public, which is positively represented in current media (Aday et al., 2019). A recent YouGov study (2017) indicates that public perceptions in the United States becoming more positive, with the majority (63%) being open to medical treatment with psychedelics if faced with a pertinent medical condition, and a UK YouGov survey (2021) corroborates these results. The DSM-V (American Psychiatric Association (APA), 2013) reports a prevalence rate for HPPD as 4.2% in hallucinogen users (Baggott et al., 2011) based on a single online questionnaire.

Are psychedelics addictive?

In most cases, these side effects are mild and diminish in duration, intensity and frequency with time (Strassman, 1984). Since the Millennium, however, psychedelic agents have been gathering the interest of researchers. Starting with Johns Hopkins, several American universities and research organizations have obtained approval from the Food and Drug Administration to study the focus on: alcohol and the immune system pmc medical use of hallucinogenic drugs, largely for the treatment of disorders that have resisted treatment. The drugs are administered in moderate to large doses in a specially soothing setting in the presence of a trained psychotherapist who also delivers psychotherapy. But starting the 1990s, at first quietly, then openly, medical interest in psychedelics has been resurgent.

Johansen and Krebs (2015) propose that modern anti-psychedelic legislation began over 100 years ago when rival religious groups campaigned against Native American peyote use, calling peyote ‘addictive’ as well as an ‘insidious evil’ (Newberne and Burke, 1922). Although evidence and human rights arguments led to exemptions for specific indigenous groups, the laws and biases against peyote remained in place and were then extended to other psychedelics. Research from 2016 assessed the use of psilocybin in helping 15 individuals quit smoking. An analysis of the data indicated that the drug might hold promise in fostering long-term smoking abstinence. However, at least one psychedelic, lysergic acid diethylamide (LSD), can cause tolerance. Tolerance means that a person may need to take higher dosages to achieve the same effect.

While researchers debate how to describe and classify psychedelic and dissociative drugs and other drugs with similar properties, they generally group these drugs according to how they work in the brain.3 Some people use the term “hallucinogens” to refer to all or some psychedelic and dissociative drugs. Within the clinical environment, set and setting, as well as the overall care experienced, can be largely controlled (Rucker et al., 2018). Rapport between patient and therapist is vital as the patient is undergoing a potentially life-changing experience (for many, with a substance they have no previous experience with) especially as co-creating truly informed consent between providers and patient can be challenging (Andersen et al., 2021). Training and experience of the therapists (both during the dosing sessions and for the all-important integration sessions) is also essential (Tai et al., 2021). Psychedelics can induce a vulnerable state, not just during but also after use (Andersen et al., 2021).

A 2015 clinical trial evaluated the value of psilocybin in 10 participants with alcohol dependence. The results suggested that the drug reduced cravings for alcohol and increased abstinence. Some serotonergic hallucinogens are present in nature, including psilocybin, a compound in mushrooms of the genus Psilocybe, or N,N-dimethyltryptamine, a compound in the botanical beverage ayahuasca. It is currently under study as a treatment for alcoholism, anxiety disorders, Alzheimer’s disease, and other dementias. Also, psychedelics increase disorder in the way brain cells operate, which has the effect of prioritizing incoming sensory input over existing beliefs, encouraging novel responses to incoming information.

Information provided by NIDA is not a substitute for professional medical care or legal consultation. Among people aged 12 or older in 2021, 2.6% (or about 7.4 million people) reported using hallucinogens in the past 12 months. First synthesised by Albert Hofmann in 1938, LSD is a semi-synthetic tryptamine derived from the naturally occurring ergot alkaloid ergotamine (Nichols, 2004).

Yet, while Gable (2006) suggests that the dependence potential of oral DMT and the risk of sustained psychological disturbance are minimal, Winstock et al. (2013) argue that the very desirable effect profile of smoked DMT indicates a high abuse liability which may be offset by a low urge to use more. Similarly, administration of LSD results in high acute drug liking ratings but no craving (Holze et al., 2021; Schmid et al., 2015). Assessing the risks of psychedelic use is challenging, as there are many different substances, applications, environments and population groups in this rapidly developing field. This article looks at the potential adverse effects of psychedelics, using the current science to outline risks as well as anecdotes surrounding harms.

FIND TREATMENT:

Psychedelics have certain effects, such as mystical experiences, that make them attractive for recreational use. Limited research suggests that they may also have medical uses, such as reducing depression and anxiety, as well as promoting abstinence from smoking and alcohol. All current legal administration of psychedelic drugs is conducted under the direct supervision of specially certified therapists. Importantly, researchers contend that it is the psychotherapy that transforms MDMA, psilocybin, and other hallucinogens from a novelty into a medicine.

Other studies have documented much lower prevalence rates of the disorder, some as low as 1/50,000 (Grinspoon and Bakalar, 1979). In addition to producing visual hallucinations, euphoria, and mystical experiences, psychedelics have other effects that underlie their recreational use. According to one clinical trial, these include derealization, which is when a person feels detached from their surroundings, and depersonalization, which is when they feel detached from their body or mind. Keep reading to learn more about the recreational and medical use of psychedelics, including the side effects and risks of these drugs.

Researchers are also investigating other drugs sometimes classified as psychedelic and dissociative drugs, such as MDMA, and the way they work in the brain. In summary, although there have been isolated case reports of abuse (e.g. Modak et al., 2019), the characterisation of psychedelics as addictive is based on misinformation and misunderstanding. In fact, today these compounds are more often discussed in terms of their anti-addictive properties (e.g. Bogenschutz et al., 2015; Johnson et al., 2017).

MDMA is also being tested for use as a treatment for depression, anxiety, and substance use. The resurgence of interest can be attributed to the ability of the substances to induce lasting benefits with a remarkably short course of treatment—two or three doses. This time around, however, it is recognized that the presence of a trained and supportive therapist in a safe and comfortable environment is essential for obtaining the benefits of psychedelic agents. The U.S. Food and Drug Administration has indicated that, pending the outcome of ongoing clinical trials, it is willing to approve the use of psychedelic-assisted psychotherapy. Psychedelic-assisted psychotherapy promises a brightened outlook for an array of psychiatric afflictions and drug treatment delivered with compassion. A common perception linked to psychedelics is that they induce ‘flashbacks’ of the drug experience long after its acute effects have subsided.

Cardiovascular pathology in human studies

Collectively, these changes in public perception and regulation suggest that the stigma surrounding psychedelics may be beginning to dissipate, and that society is moving away from previous negative narratives to a more scientific, evidence-based approach to risks and benefits of psychedelics as medicine. But today’s scientific-technological approaches have advanced considerably since the early research. For an example of current techniques applied to enable our understanding of how psychedelics new life house produce their effects, please see Singleton et al. (2021). Most earlier shortcomings are being addressed in recent trials, that is, in randomised placebo double-blind studies (Carhart-Harris et al., 2021; Mitchell et al., 2021). Long-term ritual consumption of ayahuasca is not toxic or harmful to adults (Dos Santos, 2013) or in adolescents (Doering-Silveira et al., 2005). Doering-Silveira et al. (2005) also found no foetal deaths or abnormalities in mothers who used ayahuasca during pregnancy.

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. Another long-term effect is a phenomenon called hallucinogen persisting perception disorder (HPPD). This involves flashbacks of a prior drug experience that can happen without warning and cause significant distress or impairment. In clinical studies using standardized treatment protocols, drug effects may last for three to six hours, during which time a therapist is always present.

In Anthony et al.’s (1994) classic study on problematic drug use, based on representative data from the US National Comorbidity Survey, psychedelics had the lowest rate of abuse from all drugs analysed of users who qualified for a dependence diagnosis (4.9%). According to other studies using DSM-IV criteria, a far lower proportion of users develop hallucinogen dependence. For example, Kendler et al. (1999) provide a 0.2% estimate of hallucinogen dependence among hallucinogen-using female twins. 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. Wide-scale medical interest in psychedelics first arose in the 1950s and ’60s, and the agents were found to be notably safe, non-addictive, and of potential value for treating a wide range of psychiatric disorders.

Unfortunately, this did not generate the same media attention as the original work (Strassman, 1984), meaning that earlier studies played a major role in shaping media representations of psychedelics, ultimately shaping public opinion. Psychedelic use does not conform to the profile of clinical features representing other types of dependencies, for example, opioids (Morgenstern et al., 1994). Very few hallucinogen users experience an inability to cut down or control use, a key indicator of dependence.