Comparing Substance Use Consequences between Serotonergic Psychedelics, MDMA, and other Drugs of Abuse Among United States Adults with History of Psychiatric Illness

Among US adults with a history of anxiety, major depression, PTSD, or bipolar disorder, past use of serotonergic psychedelics or MDMA is more common than in the general population—for example, 9.2% of those with bipolar disorder report such use versus 2.6% overall. Using a validated screening tool, psychedelic use was linked to higher scores indicating more severe substance use disorder risk, even after accounting for other drug use. However, the increase in risk was smaller than that associated with opioids or stimulants. The authors suggest that managing substance use disorder risks in psychedelic-assisted therapy may require different approaches than those used for other drugs.

Study at a glance

Abstract

Psychedelic-assisted therapy could transform treating psychiatric illness, but harms from exacerbating substance use disorder (SUD) among adults with psychiatric illness using psychedelics have not been studied. A cross-sectional survey in the US was used to test whether Drug Abuse Screening Test scores (DAST-10, validated instrument predicting SUD) were more severe when psychiatric illnesses (anxiety disorder, major depressive disorder [MDD], post-traumatic stress disorder [PTSD], and bipolar disorder) and serotonergic psychedelic or MDMA use were combined. Any psychedelic use among adults with psychiatric illness history (anxiety: 5.1% [95% CI: 4.7, 5.6]; MDD: 5.1% [4.3, 5.8]; PTSD: 6.9% [5.9, 7.9]; bipolar: 9.2% [8.0, 10.5]) was more prevalent than the general population (2.6% [2.5, 2.8]). Significant increases in scores were associated with psychedelic use independent of other concurrent drug use, but increases were smaller than for opioids or stimulants. Approaches to managing SUD risks with psychedelics should differ from past approaches for other drugs.