This study explores hallucinogen use, comparing adults with and without a recent history of justice involvement. While past research finds that justice-involved adults are more prone to health problems and substance use behaviors, less attention has been paid to hallucinogen use. Using data from 2021 to 2024 National Survey on Drug Use and Health, we assessed the association between past-year justice involvement and hallucinogen use among U.S. adults. Logistic regression models include demographic characteristics, health-related measures, and other types of substance use. Results indicate that hallucinogen use continues to increase, particularly among adults with recent justice involvement. While both poor health and substance use behaviors were significantly associated with hallucinogen use, once other types of substance use were included in the analysis there was no longer a significant difference in hallucinogen use based on justice involvement. Lastly, we identified several differences in correlates of hallucinogen use among adults with and without justice involvement. Research on hallucinogens is important as some states have moved to decriminalize use and prevalence has increased in recent years. Given the increased risk for poor health and substance use among adults with criminal justice contact, research in this area is important.
Kratom is a psychoactive herbal substance derived from a tree indigenous to Southeast Asia that provides both stimulant and analgesic (opioid agonist) effects. It is currently available in most areas of the United States and has potential for misuse/abuse. The proper treatment of kratom use disorder is not widely defined, but prior case reports and case series purport that sublingual buprenorphine/naloxone is an effective treatment. Pain management clinical pharmacist practitioners (CPPs) are uniquely equipped to work as independent providers and implement the treatment of many disease states including kratom use disorder. We present a case report of a patient who was referred to the CPP-run pain pharmacotherapy clinic for management of chronic lower back pain and shoulder pain in the setting of long-term kratom use. While collaborating with the patient's primary care provider, it was determined that buprenorphine/naloxone would be started to treat his chronic pain and kratom use disorder/dependence. The pain CPP led, planned, and performed the induction of buprenorphine/naloxone and frequently followed up with the patient to reassess his symptoms. The buprenorphine/naloxone, along with other pharmacologic and nonpharmacologic treatments, successfully managed his pain and other symptoms without significant withdrawal or return of cravings.
Few studies have examined perceptions of psilocybin for use in a mental health context. In two studies involving independent samples (total N = 1,102), we examined the intentions to use psilocybin in a mental health context in relation to psychotherapy, psychiatric medication, and natural versus synthetic options. We also examined potential predictors of the intentions to use psilocybin. In Study 1, we found that participants had significantly lower intentions to use psilocybin in a mental health context versus psychotherapy and traditional psychiatric medications. We also found that males reported being more open to using psilocybin as compared to females whereas females reported being more open than males to using psychotherapy. Finally, psilocybin use intentions were negatively associated with age, and positively associated with mindfulness, narcissism, and current self-reported depression. In Study 2, we found that participants had stronger intentions to use a natural version of psilocybin isolated from mushrooms as compared to an identical synthetic version or a synthetic psilocybin analog that elicits the same biological effects (i.e. the three types of psilocybin or psilocybin-like compounds currently of interest). Overall, these studies provide novel insights into the factors that might influence psilocybin use in a mental health context if FDA-approved.
There is still inconsistency in psychedelic research across the United States. There are gaps in our understanding of the psychedelic community's perception of topics including reasons for use and set/setting. The goal is to utilize these findings to produce better quantitative research, to ask the right questions of the right communities. This qualitative study organized focus groups from people who use psychedelics for: 1) recreational/spiritual and 2) mental health reasons. We conducted 10 focus groups with 29 people. The data were analyzed using Grounded Theory. A primary coder (JJ) inductively coded the transcribed audio recordings, and a secondary coder (CJ) deductively coded the data using JJ's codebook. Four themes emerged. We learned that people who use for recreational reasons often still use with purposive intent. Secondly, there is evidence of preparation and integration with their use. In those that use for mental health reasons, it was not uncommon to have a history of prior psychedelic use, and those individuals also had concerns about access to psychedelics for others who needed mental health treatment. These themes provide useful information for researchers to develop data collection tools for harm reduction and therapy techniques that are grounded in community perspectives and supportive literature.
The therapeutic effects of psychedelic-assisted treatments covary with acute mystical experiences as well as enhancements in psychological flexibility. Psychological flexibility, a key construct in acceptance and commitment therapy (ACT), has broad benefits for adaptive functioning and well-being, making it a vital focus of psychedelic-assisted therapy. More than 200 participants (54.9% female, 70% Caucasian, 72% with a college degree) completed the Mystical Experiences Questionnaire (MEQ-30) addressing their most profound mystical experience as well as the Multidimensional Psychological Flexibility Index (MPFI) and their psychedelic use. Analyses revealed that psychedelic use had an indirect effect on psychological flexibility through mystical experiences, underscoring the potential role of mystical experiences in fostering psychological growth. Participants who had used a psychedelic reported significantly higher scores on the MEQ-30 and MPFI compared to those with only non-drug mystical experiences. The flipped model did not achieve statistical significance. These findings suggest that mystical experiences might act as a catalyst for increases in psychological flexibility, and they underscore the need for further research on the mechanisms linking mystical experiences and psychological flexibility, particularly in clinical contexts. Psychedelic-assisted therapy, informed by frameworks like ACT, shows promise for enhancing psychological flexibility and fostering long-term mental health improvements. Preparatory and integration sessions that emphasize flexibility may improve treatment outcomes.
Opioid use disorder (OUD) is a debilitating condition that impacts multiple domains of life, including social attachment systems, which makes recovery and relapse prevention challenging. The Brain Opioid Theory of Social Attachment suggests opioids hijack mechanisms involved in love and bonding. Previous studies show that social interaction can help reduce opioid use in both animals and humans, but little is known about whether prosocial emotions like love and empathy can protect against opioid use among people treated with medications for OUD. In this cross-sectional study, data were analyzed from 189 adults receiving methadone treatment for OUD at community-based programs in New Jersey and Utah. Surveys measured opioid use, empathy, love, along with covariates including pain, anxiety, depression, social support, and stigma. Participants reported lower levels of love and empathy compared to normative samples. In zero-inflated Poisson, higher love and empathy scores were significantly associated with fewer episodes of opioid use, even after adjusting for covariates. Anxiety, pain, and social support were significant predictors, with social support unexpectedly linked to greater opioid use. Findings suggest that love and empathy can buffer against opioid use, consistent with theories that support the use of prosocial emotions that target the same pathways as opioids.
3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy has emerged as a potential strategy to treat posttraumatic stress disorder (PTSD). We conducted a national serial cross-sectional study of U.S. Veterans with PTSD from January 1, 2018, to December 31, 2023, to quantify the prevalence of potential contraindications, risk factors, and drug-drug interactions relevant to MDMA-assisted therapy. Participants were required to have at least two diagnostic codes for PTSD within a calendar year. Each year, 303,451 to 326,315 participants received care for PTSD. The annual proportion of individuals with at least one contraindication for MDMA-assisted therapy ranged from 15.3% to 17.3%, and the annual proportion with at least one conditional or modifiable risk factor ranged from 55.2% to 58.2%. Each year, 85.7% to 87.5% of participants filled at least one prescription for another medication that potentially interacts with MDMA. Many individuals with PTSD have contraindications or conditional risk factors that may require additional evaluation prior to receiving MDMA-assisted therapy, but many may be eligible with careful management of modifiable conditions and potential drug-drug interactions. Our results have important implications for policymakers and clinicians as studies examining the safety and efficacy of MDMA-assisted therapy continue to evolve toward potential implementation.
This paper aims to evaluate the perceived value of the drug prevention activities in Malaysia's high-risk areas. The drug prevention activities involved are counseling, outreach, workshop, and program. A quantitative method is employed in this study to investigate the participants' perception on the programs. A cross-sectional survey of 332 participants across seven selected high-risk regions in Peninsular Malaysia were selected for their proximity to international borders and high drug-related crime statistics. The results revealed compelling insights, showing that emotional and social values were strongly correlated with program effectiveness, while functional value showed only marginal influence. These findings challenge conventional policy approaches by demonstrating that community-based interventions fostering emotional support networks and social cohesion yield substantially greater impact than traditional information-driven or enforcement-focused strategies. The study also has theoretical contributions by validating the applicability of perceived value theory in substance abuse prevention contexts, while offering practical recommendations for policymakers to redesign interventions with greater emphasis on psychosocial support mechanisms. Limitations include the cross-sectional design and regional focus, suggesting opportunities for future longitudinal studies across broader geographical areas to assess program sustainability and cultural adaptability.
This case study explores the potential role of mystical-type experiences in ketamine-assisted psychotherapy (KAP). A patient with generalized anxiety disorder and migraines underwent four intramuscular KAP sessions (0.5-0.9 mg/kg). Outcomes were assessed using the Outcome Questionnaire-45 (OQ-45), the Hood Mysticism Scale (HMS), and interviews. Greater therapeutic gains followed sessions with higher HMS scores. The patient attributed improvements to the psychological and spiritual impact of the experiences, emphasizing the therapeutic relationship and integration process. In this case, these experiences appeared to play a meaningful role in therapeutic change, contributing to the discussion on the role of subjective effects in KAP.
Cannabis use has been associated with persistent perceptual disturbances, but systematic clinical characterization remains limited, particularly regarding multimodal sensory involvement. To characterize persistent perceptual disturbances following cannabis use, focusing on symptom profiles, temporal patterns, and clinical features. This exploratory observational study was conducted across the Valle d'Aosta and Piemonte regions of Italy between 2020 and 2025. We characterized 13 patients with persistent visual/auditory symptoms following cannabis exposure through comprehensive clinical assessment, neurological examination, neuroimaging, and standardized questionnaires. Given the small sample size, analysis focused on clinical characterization rather than statistical inference. Thirteen patients (10 males, mean age 24.3 ± 4.1 years) had used natural cannabis (69.2%) or synthetic cannabinoids (30.8%). Visual snow was universal (100%), with high rates of trailing phenomena (92.3%), halos (84.6%), and color changes (76.9%). A novel finding was the presence of auditory hypersensitivity in 61.5% of patients. Symptoms emerged at a mean of 3.2 ± 2.4 weeks following cannabis cessation. All neurological investigations were normal. Comorbid anxiety disorders were present in 84.6% of patients; functional impairment was severe in 30.8%, moderate in 46.2%, and mild in 23.1%. This exploratory study describes persistent multimodal sensory disturbances in patients after cannabis exposure. Consistent visual snow, frequent auditory hypersensitivity, and normal neurological investigations suggest a distinct phenotype warranting systematic investigation. While preliminary and requiring validation in larger samples, these findings highlight a potentially underrecognized cannabis complication meriting clinical attention.
Gabapentinoids are increasingly implicated in drug-related deaths, and little is known about the harms of dependence or detoxification outcomes. Abrupt cessation is associated with adverse events, such as seizures, yet no standardized withdrawal scales or treatment regimens exist. This study describes the clinical and demographic characteristics of people undergoing specialist inpatient gabapentinoid detoxification in a large, regional unit in Manchester, United Kingdom, and explores predictors of treatment outcome. The sample included all patients (n = 38) admitted for gabapentinoid detoxification between years 2017-2022. Clinical data were analyzed using a retrospective observational cohort design to explore associations between baseline characteristics and outcomes. We hypothesized that people undergoing multiple detoxifications and/or detoxification for illicit gabapentinoid use would be more likely to have negative outcomes. This is the largest cohort undergoing inpatient detoxification from gabapentinoids studied till date. The majority were male, White British, unemployed, straight, with a mean age of 38.9 (SD = 8.9), and required detoxification from multiple substances (n = 35). The majority completed detoxification successfully. Relapse (p < .001), complications (p = .001), personality disorders (p = .034), a concurrent benzodiazepine (p = .011) or opioid detoxification (p = .025) were significantly associated with an incomplete detoxification. Illicit use of pregabalin, and multiple concurrent detoxifications were not related to outcomes. Further research is needed to optimize treatment.
Earlier studies have documented psychoactive substance use and nicotine exposure among commercial drivers in Ghana. However, those studies relied solely on self-reported questionnaires, which are prone to recall and response bias. This study aimed to provide a more accurate estimate by using a chromatographic immunoassay urine drug test. This exploratory cross-sectional study was conducted between January and August 2024 in the Tamale metropolitan area of Ghana. The study included 70 consenting commercial drivers aged from 26 to 78 years. Sociodemographic, anthropometric and occupational factors were collected using a semi-structured questionnaire. Urine samples were then obtained from the participants and tested for Amphetamine (AMP), Barbiturates (BAR), Benzodiazepines (BZO), Cocaine (COC), Tetrahydrocannabinol (THC), Morphine (MOP), Opiates (OPI), nicotine exposure using Cotinine (COT), Tramadol (TML), and Tricyclic Antidepressants (TCA) using the 10-panel Multi-Drug One Step chromatographic immunoassay test kit. The total urine prevalence of psychoactive substances and nicotine exposure was 61.4%, consisting of COT (37.1%), THC (24.3%), BZO (11.4%), Tramadol (5.7%) and AMP (2.9%). While the self-reported smoking prevalence was 10%, the urine cotinine prevalence was 37.1%. In addition, 14(20%) of the urine samples tested positive for two substances. Contrary to expectations, commercial drivers with no history of accident were more likely to test positive for TML [AOR = 8.667(95%CI: 1.025-73.249)], or two substances [AOR = 5.000(95%CI: 1.051-23.789)]. The urine samples of commercial drivers tested positive for psychoactive substances and nicotine exposure. However, positivity for a psychoactive substance or nicotine exposure may not be associated with a history of road traffic accidents. Further studies are recommended.
Peers have been found to be an important influence on adolescent behavior. However, there remains limited research examining childhood peer behaviors as predictors of later substance use. Examinations have not included full behavior profiles comprising both antisocial and prosocial peer behaviors. This study sought to identify latent clusters of peer behaviors during childhood and their relevance for understanding substance use. The Adolescent Brain Cognitive Development (ABCD) dataset was analyzed. These data are composed of the full ABCD sample of 11,880 United States children aged 9-10 years at baseline and surveyed annually, with data collection beginning in 2017. A multistage cluster sampling methodology was used to collect data from catchment areas surrounding the 21 study sites. Latent class analysis was used to identify peer behavior clusters. Logistic regression was used to examine the relevance of childhood latent peer class assignment for predicting substance use in early adolescence. A three-class solution was identified (neutral, prosocial and antisocial peers, prosocial peers). Assignment to the prosocial and pntisocial peers peer class predicted increased substance use risk. Findings indicate that youth with peers involved in both prosocial and antisocial behaviors in childhood present the highest risk for substance use in early adolescence.
Psychedelic-assisted therapy (PAT) is increasingly recognized as a potential novel treatment for substance use disorder (SUD). As evidence continues to grow, the successful implementation of this modality into clinical practice will depend significantly on the perceptions and attitudes of mental healthcare professionals. Accordingly, a systematic review was conducted to provide a comprehensive overview of the scientific literature on how professionals view the use of psychedelics for the treatment of SUD. A systematic search was performed across six databases, including PubMed, MEDLINE, PsycINFO, Academic Search Premier, CINAHL, and SocIndex. A total of six studies were identified with a total of 966 participants. Findings revealed that the majority of mental healthcare professionals hold a cautiously optimistic attitude toward PAT. Moreover, a minority expressed hesitancy and critical perspectives, citing concerns about safety, efficacy, and the practical challenges of integrating PAT into existing clinical frameworks. Finally, the results indicate that knowledge and familiarity with PAT were key predictors of a more positive outlook. Given the current limited level of knowledge among professionals, these findings underscore a significant need for targeted education and training. Addressing these barriers is essential to facilitate the effective and responsible integration of PAT into standard clinical care for SUD.
Substance and alcohol use are often used in sexual contexts among sexual minority men (SMM) and may be associated with condomless anal sex (CAS), a proximal exposure relevant to HIV risk. This study examined the association between alcohol and substance use during sex and the frequency of insertive (ICAS) and receptive (RCAS) condomless anal sex. A secondary analysis of cross-sectional data from a respondent-driven sample (RDS) of 252 SMM in San Francisco in 2020 was conducted, and 135 participants who reported at least one CAS event with their last three sexual partners in the past six months were included in the analysis. A zero-truncated negative binomial regression model was used to estimate the rate ratio (ERR) of ICAS and RCAS. Results indicated that being drunk before or during sex was associated with a 2.6-fold increase in the number of ICAS events and a 7.2-fold increase in the number of RCAS events. Methamphetamine showed inverse associations with ICAS (ERR = 0.5) and RCAS (ERR = 0.3), while poppers were positively associated with ICAS (ERR = 2.5) and RCAS (ERR = 3). Overall, alcohol intoxication and popper use in sexual contexts were associated with higher CAS counts among SMM, supporting stigma-free harm-reduction screening and PrEP/STI prevention, while inverse associations with methamphetamine warrant cautious interpretation and event-level study in future work.
Ketamine-assisted psychotherapy (KAP) is an emerging treatment approach that may enhance ketamine's antidepressant effects through neuroplastic synergism or transformative psychological experience. Despite growing clinical use, real-world KAP practices remain understudied. This cross-sectional survey examined the practices of fifty licensed KAP providers treating depression, recruited from a U.S.-based online provider network. Participants represented a professionally diverse sample, including physicians, clinical psychologists, social workers, and other practitioners. Ketamine was most commonly administered intramuscularly (42%) or sublingually (40%), often at psychedelic-dose ranges. Most practitioners (74%) conducted psychotherapy before, during, and after ketamine administration. The most frequently used psychotherapy modalities were Internal Family Systems (74%), humanistic/existential (62%), and supportive (58%), with most practitioners employing an eclectic approach blending three to four different modalities on average. The most commonly endorsed overall treatment goals were fostering inner healing intelligence, leveraging neuroplastic effects of ketamine, and facilitating a transformative experience. No significant association was found between psychotherapy modalities and treatment goals, revealing unclear logic for how therapeutic approaches are matched to desired outcomes. Findings reveal broad variability in real-world KAP practices, underscoring the need for comparative clinical trials to establish evidence-based standards. These insights may inform the development of protocols for emerging psychedelic-assisted psychotherapies more broadly.
Ecstasy-type drugs are the most frequently seized synthetic drugs in Brazil, usually containing a mixture of MDMA and its analog MDA. In recent years, an increasing number of samples have been found to contain only MDA, possibly reflecting shifts in the synthetic routes of ecstasy-type substances during the COVID-19 pandemic. However, the exclusive use of MDA remains poorly characterized, and its toxicological profile is still not fully understood. Data from chemical analyses of drug seizures in Rio Grande do Sul, Southern Brazil, were reviewed. In addition, blood and urine samples collected from clinical and forensic cases involving ecstasy use were analyzed by LC-MS/MS. MDA was detected in 31.1% of seized drug samples, surpassing MDMA, which accounted for 25.6%. A marked rise in MDA detections was observed after 2020, peaking at 52.6% of seizures in 2023. In addition, sixteen clinical and four postmortem cases involving MDMA and/or MDA were documented, with MDA predominating from 2021 onwards. The study identified a higher prevalence of MDA compared to MDMA, indicating a shift in ecstasy use patterns in Brazil. This finding underscores the need for robust analytical approaches and sustained toxicological monitoring to support drug surveillance and public health policies.
U.S. military veterans face an elevated suicide risk compared to the general population. Both the use and misuse of tranquilizers (i.e. several classes of medications that treat anxiety and muscle spasms via central nervous system action, including benzodiazepines) have been associated with suicidal thoughts and behaviors among veterans. However, it remains unclear whether risk varies across different patterns of tranquilizer use. Participants included 12,584 U.S. military veterans (13.0% female; 78.1% non-Hispanic White; 49.3% age 65 and older), from the 2015-2019 National Survey on Drug Use and Health (NSDUH). Tranquilizer use without misuse was associated with greater odds of suicidal ideation and planning, relative to nonuse (p's < 0.01). Tranquilizer misuse was associated with greater odds of suicide ideation, planning, and attempts compared to nonuse (p's < 0.01). Relative to use without misuse, tranquilizer misuse was associated with greater odds of suicide ideation, planning, and attempts (p's < 0.01). These results support a graded association between tranquilizer use/misuse and suicidal thoughts and behaviors, suggesting that risk for suicide-related outcomes may increase from no use, to use without misuse, to misuse. Future research should explore the clinical utility of addressing tranquilizer use/misuse as part of targeted suicide prevention strategies among veterans.
Limited research suggests that distinct intentions covary with acute experiences and subsequent outcomes. Nevertheless, data on the types of intentions set by users remain scarce, and their effects lack clarity. This study uses a retrospective, mixed-methods, cross-sectional approach to investigate intention-setting among psychedelic users. We establish a taxonomy of intentions in naturalistic use and examine how domain-specific intentions correlate with acute effects and changes in well-being. Additionally, we test qualities for effective intention-setting. The most common intentions focus on self-discovery and personal growth, as well as healing and mental health. Participants reported that intention-setting provided direction and cognitive focus, as well as positive emotional anchoring. Intentions related to mental health, self-expansion, and physical health were associated with greater subjective effects, including mystical experiences, emotional breakthroughs, and challenging experiences, as well as improved well-being and reductions in dysfunctional attitudes. In contrast, recreational intentions were unrelated to reductions in dysfunctional attitudes and correlated negatively with changes in well-being. Finally, intentions that were specific, relevant, and integrated after the psychedelic experience correlated with improvements in well-being. Unexpectedly, flexible intentions covaried with worse outcomes. These data suggest that specific, relevant, integrated intentions focused on self-discovery and mental health might offer the most benefits.
Opioid dependence is a public health concern in New Zealand, with limited treatment options beyond opioid substitution therapy (OST). Ibogaine, a psychoactive alkaloid with reported anti-withdrawal and anti-craving effects for opioid dependence, is legally available by prescription in New Zealand, offering a context for exploring user experiences. A qualitative collective case study design was used to examine the experiences and motivations of 10 opioid-dependent individuals who used ibogaine for opioid detoxification. Participants were recruited through ibogaine networks, OST services, and snowball sampling. Semi-structured interviews were conducted and analyzed using an inductive thematic analysis approach, informed by an interpretive, experiential framework. Analysis focused on how participants understood their motivations, treatment processes, safety practices, and post-treatment outcomes. Seven themes were identified: "Desperation to be opioid free," "motivations for using ibogaine," "safety conscious and support seeking," "improving ibogaine practices," "effects of treatment on depression and anxiety," "effects of treatment on dependence," and "the spiritual effect." Participants associated ibogaine treatment with rapid detoxification, improved mood, reduced anxiety, and periods of sustained abstinence, though relapse occurred in some cases. Preparation, medical screening, and post-treatment psychosocial support were critical to positive outcomes. This study adds to the literature by documenting experiences of ibogaine use, with implications for clinical practice, policy, and future research.
