Records of all patients treated with opiate substitution treatment at Lisson Grove Health Centre dying between 1994 and 2025 and still registered at the time of their death were examined ( N = 46, over a period of >2000 patient-treatment-years). Additional information was gathered from the Coroner's offices involved, the local toxicology laboratories and the National Programme on Substance Use Mortality. Eight deaths (17%) were considered to be methadone-related by the coroner but after examining the clinical circumstances, in four out of eight the role of methadone was ambiguous.
Background Medicinal cannabis (MC) became legalised in Australia in 2016, yet relatively little is known about its longer-term effectiveness within the Australian context. Methods P2021 Australia was a prospective observational cohort study that collected data on patients prescribed MC (from as Product Formulary) for four conditions: chronic pain, anxiety, post-traumatic stress disorder (PTSD) and multiple sclerosis (MS) via validated questionnaires (baseline then 3-monthly for up to 12 months). Results At study end, a total of 522 patients had enrolled: 221 (42.3%) reported their primary complaint was chronic pain, 222 (42.5%) anxiety, 53 (10.2%) PTSD and 26 (5%) other conditions. Three-month data for chronic pain, anxiety and PTSD indicate MC is effective at reducing primary symptoms as well as improving quality of life (QoL), sleep, mood/depression and perceived overall health (insufficient data for MS). In chronic pain patients, effect sizes (Cohen's d ) at 3 months were 0.75 for pain severity and 0.8 for pain interference (BPI questionnaire), for anxiety patients, 1.34(GAD-7 questionnaire) and for PTSD patients 1.44 (PTSD Checklist-Civilian Version), and there were also significant improvements across other measures, including QoL, perceived overall health, mood/depression and sleep, with effect sizes ranging from 0.54 to 1.15. Twelve-month data for chronic pain and anxiety patients indicates that MC use is associated with improvements in primary symptoms, QoL, perceived overall health, mood/depression and sleep quality (insufficient data for PTSD and MS). Conclusion MC may be a useful treatment option for conditions, including chronic pain, anxiety and PTSD, where other treatments have not been successful.
We consider the validity and accuracy of information in medical science as it relates to legal liability. We argue that fundamental changes have occurred concerning knowledge dissemination to doctors (and patients) that have profound implications for the ethical and legal responsibility for accuracy. Such considerations are important for legal professionals at all stages of legal processes and tribunal proceedings.
Drawing on data gathered in the General Social Survey (GSS), this study examined the influence of political ideology, conceived as a measure of personal identity, and party affiliation, an indicator of group identity, on attitudes toward the legalization of marijuana in the United States. Earlier research found that while ideology showed significance as a determinant across a 30-year period, from 1986 to 2016, differences based on party affiliation did not become especially pronounced until 2004. At that point, in an increasingly partisan environment, individuals appeared to align themselves with perceived group stances. In the present study, with five demographic control variables in place, analyses showed that while ideology predicted legalization attitudes in each of three periods (2018, 2022, 2024), it lost significance as an explanatory measure in 2024 when regression equations included party affiliation. Findings appear consistent with recent studies addressing group identity, affective polarization, and negative partisanship.
In the past year, the medical regulation of psilocybin-assisted therapy has expanded across additional international jurisdictions, requiring an update to the original medico-legal synthesis. Newly established or clarified regulatory pathways in New Zealand, Germany, Switzerland, the Czech Republic, and at the United States federal level reflect continued evolution in therapeutic governance. Within the United States, Utah and New Mexico have now joined Oregon and Colorado in establishing lawful medical access pathways. These developments build upon earlier reforms in Alberta, Canada and Australia, where structured psychiatric prescribing frameworks were implemented.This update consolidates recent statutory amendments and regulatory decisions to provide a current comparative overview of jurisdictions permitting lawful medical use of psilocybin. By distinguishing comprehensive medical regulation from restricted or exceptional access schemes, this revised analysis maintains clarity within an increasingly dynamic global regulatory landscape.
Laws to control drugs have been progressively introduced since the early twentieth century to reduce non-medical use and drug-associated harm. Restrictions on what are now deemed ‘controlled drugs’ and, in New Zealand, ‘prohibited plants’ unjustly impact both medical care and research. The impact on research has frequently been cited in reference to the use of drugs in clinical research, such as the use of 3,4-methylenedioxymethamphetamine (MDMA) and psychedelic drugs (lysergic acid diethylamide (LSD), psilocybin, and n,n-dimethyltryptamine (DMT)). The complexities and legal requirements involved in their use, or simply the inability to legally access these drugs at all, has limited research for decades. While restrictions on research into the clinical applications of these drugs have been commonly reported, legal restrictions also inhibit or severely restrict other research areas. This short paper describes the impedance that drug law can have on research in non-clinical areas, with a discussion of the impact of the Misuse of Drugs Act 1975 on research of mushroom-forming fungi in New Zealand.
This qualitative study explored perspectives on recreational substance use and harm-reduction practices among festival workers at UK music festivals. Data were analysed using reflexive thematic analysis: researchers coded responses iteratively, identified patterns, and developed themes through consensus meetings. Drawing on qualitative responses from 21 professionals across medical, welfare, security, safeguarding, and emergency roles, the research reveals the complex realities of managing substance-related incidents in dynamic, high-pressure festival environments. Participants emphasised the pressing need for proactive drug education, on-site drug checking, and interventions tailored to the specific demographics and cultures of individual festivals. A recurring theme was the importance of safe, confidential spaces where attendees feel empowered to seek help without fear of judgement or legal consequences. However, respondents frequently identified visible police presence, environmental stressors, and fragmented interagency communication as significant barriers to effective service provision. Despite these challenges, workers described a strong sense of purpose and camaraderie, underscoring the emotional resilience required in these roles. The findings support the integration of collaborative, non-punitive harm reduction strategies into broader festival planning frameworks. By amplifying the voices of those on the front lines, this research offers practical insights into improving both attendee safety and staff wellbeing, and advocates for a shift towards welfare-first models that acknowledge the realities of drug use and prioritise informed, compassionate responses.
Introduction:The Five Dimensional Altered States of Consciousness (5D-ASC) Rating Scale is a self-report measure used to characterize changes in consciousness induced by pharmacological (e.g., psychedelics) and non-pharmacological methods (e.g., meditation), and predict clinical outcomes. Although it has been widely used with English-speaking participants, there is no version that has been adapted for Mandarin-speaking individuals. This study aimed to develop a high-quality Mandarin version of the 5D-ASC to increase language accessibility in psychedelic research. Methods:A Mandarin version of the 5D-ASC was developed adhering to the "Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation". The English version of the 5D-ASC was translated to Mandarin by two professional translators, reviewed by the study team (including a native Mandarin speaker), back-translated to English, and compared with the original version. Results:The Mandarin version of the 5D-ASC Rating Scale (5) includes 11 facets: experience of unity (), spiritual experience (), blissful state (), insightfulness () disembodiment (), impaired control and cognition (), anxiety (), complex imagery (), elementary imagery (), audio-visual synesthesia (), and changed meaning of percepts (). The survey can also be analyzed using its original 5-factor structure, yielding facets of oceanic boundlessness (), anxious ego dissolution (), visionary restructuralization (), auditory alterations (), and vigilance reduction (). The full translated survey is available in the appendix. Conclusion:Here, a Mandarin version of the 5D-ASC was developed by a team of highly qualified scientists and translators. Further research is needed to evaluate its reliability and validity in clinical and non-clinical Mandarin-speaking populations.
Background Whilst substance dependence is well-documented as a risk factor for suicide, less is understood about individuals who die by suicide following recreational polydrug use. Cocaethylene, a psychoactive metabolite produced by the co-ingestion of alcohol and cocaine, may be a cumulative risk factor for suicidality. This study examines the sociocultural, psychiatric and toxicological complexity of individuals whose deaths by suicide involved both alcohol and cocaine use. Methods Data were sourced from the National Programme on Substance Use Mortality (2007–2023), including coronial reports for 147 individuals where both cocaine and alcohol were present at post-mortem. Descriptive analyses examined sociodemographics, psychiatric diagnoses, prescribed medications, substance use, and method of suicide. Results The cohort was predominantly male (72.4%), aged 25–45, and overrepresented in the most deprived socio-economic deciles. Psychiatric morbidity was high: over half had documented mental health conditions, and 32.6% were in receipt of psychotropic medication at the time of death. Nearly one-third of medicated cases showed markers of pharmacological complexity, including treatment-resistant prescriptions and high-risk polypharmacy. Hanging was the most frequent method of suicide (72.1%), consistent with national trends in suicide. Conclusion Individuals who die by suicide following the co-use of alcohol and cocaine appear to represent a highly vulnerable and clinically complex group. Cocaethylene may serve as a marker for heightened psychiatric and behavioural risk. These findings underscore the need for integrated, cross-sector care models and routine suicide risk screening in substance use settings. Structural deprivation, psychiatric complexity and impulsivity are prominent factors in this population.
Aims: This article discusses how unintended side effects from the international regime of drug criminalization may serve to increase harmful drug use among some population segments and performs systematic scoping reviews of two putative underlying dynamics relating to violence victimization and the forbidden fruit or psychological reactance effect. If repetitive drug use is commonly a way of coping with psychological and physiological trauma, and such trauma commonly arise as a consequence of violent crime, then an increase in violence resulting from drug criminalization should be expected to entail an increase also in drug dependence. According to the logic of the forbidden fruit dynamic, moreover, the criminalization of certain behaviors may motivate people to engage in these behaviors. Design: Eligible studies were identified via the Pubmed database from its inception to 2023. The review included both qualitative and quantitative findings but was restricted to publications written in English. Results: From 291 records, 94 studies were included. The review found convincing evidence for a victimization dynamic and general support for a psychological tendency to be attracted to behaviors that might be deemed forbidden. Conclusions: While more research is needed, these findings allow for the preliminary conclusion that drug criminalization may increase drug use among some population segments.
Opioid-related deaths in Ontario remain persistently high, driven largely by an unstable and unregulated drug supply. In response, harm reduction services, such as supervised consumption sites/consumption and treatment services and safer supply programs, have been implemented to reduce the risks of overdose and connect people who use drugs with essential healthcare and social services. Unlike supervised consumption, safer supply programs offer prescribed alternatives to the unregulated toxic drug supply, reducing overdose deaths and improving client stability. Ontario hosts the largest number of safer supply programs in Canada, yet recent policy decisions threaten their existence. In December 2024, the Ontario Government passed Bill 223, prohibiting new safer supply programs and imposing restrictions that forced six federally funded programs to close on 31 March 2025. In their place, the government has implemented 27 Homelessness and Addiction Recovery Treatment (HART) Hubs, which exclude safer supply programs, supervised consumption services, and needle and syringe programs. This shift disregards the evidence supporting harm reduction's role, including safer supply programs, in reducing overdoses, stabilizing the drug supply, and engaging people in care. Safer supply programs have demonstrated significant benefits including increased access to health and social services, and reduction in overdose rates upon program enrollment. Removing these programs will force people who use drugs back to the unregulated toxic drug supply, jeopardize their connection to healthcare providers, and increase overdose risks. Ontario's decision to dismantle safer supply programs is a critical public health failure. Policymakers must prioritize evidence-based approaches to effectively address the opioid crisis and prevent unnecessary deaths.
Substance use at UK music festivals presents a significant public health challenge, with evolving patterns of drug use, associated risk behaviours, and harm reduction practices among attendees. A sample of UK festival attendees ( N = 773) completed a lengthy online survey detailing their typical substance use practices and related behaviours within music festival contexts. This study reports patterns in substance preferences and polysubstance use combinations, where younger individuals report the use of novel substances, while older attendees to use more historically popular drugs. Users of ketamine ( z = −10.58, P < .001), or novel psychoactive substances ( z = −4.23, P < .001) were significantly younger than non-users. The findings highlight the prevalence of alcohol use (92.8%, N = 718), and polysubstance use (60.7%, N = 476). Alcohol was particularly prevalent within the context of polysubstance use (71.6%, N = 341). Notably, polysubstance use involving the combined use of five substances (alcohol, cocaine, cannabis, ketamine, and MDMA) during the same period was concerningly common among those engaging in polysubstance use (25%, N = 119). The study identified a lack of engagement with critical harm reduction practices and provisions, such as accessing drug checking services ( N = 53, 6.7%) or onsite welfare provisions ( N = 82, 10.6%). The low reports of accessing formal onsite services suggests the need for improved educational outreach and the potential to enhance engagement through informal online platforms. This study highlights the importance of context-specific drug use patterns and targeted interventions, aiming to facilitate more effective public health responses. These findings indicate the necessity for adaptive and targeted interventions, particularly those addressing alcohol consumption, polysubstance use, and the promotion of early help-seeking.
Psychedelic-assisted therapy (PAT) is an emerging treatment approach that often combines pharmacotherapeutic dosing sessions with more traditional psychotherapy. Despite limited formal regulatory approval, treatment seekers can currently access PAT through a variety of avenues, including ketamine treatment centers and “supported adult use” psilocybin centers in the U.S., drug tourism, “underground” therapy, and participation in clinical trials, among other ways. This has created a heterogenous landscape of PAT access in which people self-report PAT utilization with a variety of psychedelic and hallucinogenic drugs. However, there is limited published data on patterns of PAT involvement across drugs among real-world patients.Therefore, the present study investigated patterns of PAT utilization by applying latent class analysis (LCA) to a purposive sample of 244 self-identified PAT patients. Participants were recruited from a variety of sources (e.g., ketamine clinics, social media groups, a large U.S. university) and asked to report lifetime PAT utilization involving six compounds: psilocybin, ketamine, mescaline, ayahuasca/N,N-Dimethyltryptamine (DMT), lysergic acid diethylamide (LSD), and 3,4-methylenedioxymethamphetamine (MDMA). Participants also completed sociodemographic and internalizing measures (e.g., Beck Depression Inventory II, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7), and responses were compared across classes.LCA yielded a three-class solution. In addition to High- (55.7% of the sample) and Medium-PAT classes (29.1%), a unique Psilocybin-Ketamine class (15.2%) was identified—membership in this class was characterized by universal involvement with psilocybin and notable involvement with ketamine PAT compared to other compounds. Between-class comparisons of mental-health assessments indicated that the High-PAT class reported elevated depression and anxiety.These findings suggest that high levels of lifetime involvement in a variety of PAT modalities may be associated with more severe self-reported psychiatric symptoms, raising questions about selection or iatrogenic effects within the current PAT landscape. The emergence of a Psilocybin-Ketamine class implies that these substances may serve as initial entry points into PAT.
The current mechanisms in the United States to research and develop novel reversal agents for substances that can lead to overdose are restricted by regulations placed on the pharmaceutical industry. While there are many forms of harm reduction critical to saving lives that require increased investment and research, it is proven that reversal agents, such as naloxone, help prevent overdose morbidity and mortality. In the setting of an evolving crisis of illicit substance use and related overdose with new, increasingly potent substances appearing in communities nationwide, it is essential to implement a structured approach to rapidly develop and deploy efficacious harm reduction tools to save lives. In this article, we review the history of US scheduled drug regulation which aims to mitigate substance use but also paradoxically hinders research into treatments for drug overdose. We also discuss the regulation of drug reversal agents in the context of changing patterns in illicit substance use as well as barriers to the rapid development of medical devices associated with drug reversal agents that address immense public health needs. The overdose epidemic is a national crisis that requires technological solutions in addition to sociopolitical reform. Even if a reversal agent or medication is approved for an emerging substance, the existing regulatory landscape for drug delivery devices discourages the development, access, and widespread adoption of potentially lifesaving treatments. A systematic approach to monitoring the evolution of illicit drugs and a more streamlined regulatory pathway is urgently needed to facilitate the development and deployment of effective harm reduction tools.
Emerging research suggests that prescribed cannabinoids may improve sleep quality both among people with formal diagnoses of insomnia and among those experiencing disturbed sleep in the context of other chronic health conditions. To document patterns of disturbed sleep among individuals seeking treatment with prescribed cannabis for chronic health conditions and to examine whether the use of prescribed cannabinoids ameliorates these problems. Data were derived from Project Twenty 21, an observational study of patients receiving medicinal cannabis from multiple clinics in the United Kingdom. Data at entry to treatment were available for 3998 individuals (34.4% female) seeking treatment for chronic conditions other than insomnia. Three-month follow-up data on patterns of sleep were available for 2017 patients, and three-monthly reports of sleep quality for up to 12 months were available for 929 individuals. Self-report ratings of sleep disturbance, quality of life, and condition-specific symptomatology were available at the time of entry to treatment and at three monthly intervals. Additional data included sociodemographic characteristics, primary reason for seeking treatment, use of prescribed sleep medications, and details of prescribed cannabis. 31% reported a secondary diagnosis of insomnia. Receipt of prescribed cannabinoids was associated with a large and clinically significant improvement in sleep quality, additional aspects of quality of life, and condition-specific symptomatology (all p < .001). A diagnosis of insomnia was associated with a significantly greater improvement in sleep quality ( p < .001). There was a 30% reduction in the proportion of people using sleep medications ( Z = 1.9, p < .05), and improvements in sleep quality observed at 3 months were maintained for up to 12 months, with these improvements being greater in people with insomnia. Sleep disturbances are common among individuals seeking medical cannabinoid treatment for other conditions. Prescribed cannabinoids are associated with a reduction in these disturbances and parallel improvements in other domains. Given the centrality of sleep to quality of life, practitioners treating a range of chronic illnesses should consider the potential benefits of prescribed cannabinoids both for targeting the primary condition and the potential ancillary benefits on sleep quality.
Psychedelics are undergoing a clinical research renaissance, with compounds such as psilocybin advancing to Phase 3 trials for treatment-resistant depression and receiving fast-track or breakthrough designations from regulatory agencies. Despite this progress, the field lacks standardized terminology to guide clinical development, dosing, safety monitoring, and regulatory classification. Here, we present a comprehensive framework for psychedelic nomenclature based on pharmacology, subjective effects, dosing, and therapeutic use. A pharmacological classification system is described, encompassing serotonergic, glutamatergic, kappaergic, GABAergic, and atypical psychedelics. Dose-dependent categories—microdose, minidose, mididose, and macrodose—are introduced to standardize the description of dosing levels and intended subjective effects. We also standardize vague terms like “short-acting” or “long-acting” with specific pharmacokinetic parameters, including route, onset, and duration of action. Safety considerations are also explored, particularly cardiovascular and psychological effects, and we discuss the need for risk mitigation protocols in higher-risk compounds like ibogaine. The evolving role of psychotherapy in psychedelic treatment is also examined, proposing terminology to distinguish between “psychedelic therapy” and varying levels of psychological support. A three-phase treatment model—preparation, dosing, and integration—is recommended as a minimum standard for safe and effective care. The lack of comparative research on psychotherapy modalities in psychedelic therapy is identified as a critical gap. Ultimately, a standardized lexicon and clinical framework will support clearer communication, improved trial design, and more equitable access as psychedelic therapies move toward widespread clinical use.
This pilot study assessed a video-based psychoeducational intervention designed to reduce substance-related harm among music festival attendees. Participants (N = 273) completed pre-intervention surveys, with 144 engaging in the intervention. Post-intervention, 80% of participants correctly recalled key information from the video. Analysis showed a significant reduction in self-reported substance-related harm post-intervention, suggesting potential efficacy in reducing harm. One-third of participants anticipated positive changes in behavior, and half reported a direct impact on their substance use practices. Additionally, many expressed improved perceptions of onsite services and an increased intention to adopt harm reduction strategies post-intervention. Evaluative participant feedback emphasized the need for modifications to improve engagement, such as incorporating real actors, shortening the video, and distribution methods like email and large screens at festival entrances. These suggestions highlight areas for refinement to enhance the intervention's reach and impact. The findings demonstrate the potential of online psychoeducational interventions as cost-effective tools for harm reduction in festival settings. However, large-scale trials are necessary to validate these results and address challenges related to participant retention and data reliability. Future research should focus on improving the intervention's design to strengthen its efficacy and sustainability in real-world settings.
Hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSDs) are heterogeneous disorders of the connective tissue associated with widespread chronic pain and co-occurring autonomic dysfunction. No disease-specific treatment has been identified. Unlicensed cannabis-based medicinal products (CBMPs) are increasingly prescribed for chronic mental and physical conditions. Project Twenty21 is a longitudinal, observational registry study producing real-world evidence on the safety and effectiveness of CBMPs prescribed by specialist consultants at UK-based private clinics. This study reports baseline characteristics and three-monthly follow-up patient-reported health outcomes assessed using clinically validated questionnaires for up to 12 months in 121 patients with hEDS/HSD enrolled in Project Twenty21. Co-morbidity was common, with participants reporting a mean of 6.16 ± 3.8 secondary conditions. Prescription opioid analgesic use was reported by 54 participants (45%), with a statistically significant reduction in mean morphine equivalent observed between baseline and three-month follow-up ( p < 0.001). Statistically significant improvements in mood/depression ( p = 0.010) and sleep quality ( p = 0.031) were observed between baseline and at each follow-up interval for the 12-month study duration with moderate effect sizes. Statistically significant improvements in quality-of-life ( p = 0.001), pain severity ( p < 0.001) and interference ( p < 0.001) were observed at each follow-up interval between baseline and nine-month follow-up with small–moderate effect sizes. Adverse events were reported by six participants (5%) and were predominantly assessed as mild. CBMP treatment is associated with improved symptomology, quality of life, and functionality in addition to reduced opioid requirement in hEDS/HSD patients. Future research should aim to improve clinical care, mechanistic understanding and refine effective CBMP formulations.
Although psychedelics have shown therapeutic potential in treating conditions such as depression, PTSD, and addiction, concerns remain regarding ethical practices, participant diversity, and the structural limitations of prevailing theoretical frameworks. This theoretical framework critically examines the dominant biopsychic model that underpins much of contemporary psychedelic research and introduces the medical sociological and social epidemiological psychedelics paradigm (MSSEPP) as a conceptual advancement. Rooted in medical sociology and social epidemiology and building on classic critiques of medicalization and biopolitics, MSSEPP emphasizes and appreciates the interconnected and simultaneous operation of social, cultural, structural, and economic conditions in shaping the relationship between psychosocial resources and health outcomes related to psychedelic use. By incorporating multidirectional processes—including indirect (mediating) and interacting (moderating) effects—MSSEPP accounts for complexities across the life-course that are often neglected in existing models. This article outlines a forward-looking agenda to integrate structural determinants, intersectional stigma, and community-based frameworks into psychedelic science. In doing so, MSSEPP provides a more holistic and ethically grounded orientation to guide future research, clinical design, and policy development.
