Contributor: Jorge Chalit-Hernandez, OMS3
Educational Pearls:

Psychedelics are being studied for their therapeutic effects in mental illnesses, including major depressive disorder, post-traumatic stress disorder, anxiety, and many others
Classic psychedelics include compounds like psilocybin, LSD, and ayahuasca
- MDMA and ketamine are often included in psychedelic research, but have a different mechanism of action than the others
- Their mechanism of action involves agonism of the 5HT2A receptor, among others
- Given their resurgence, there is an increase in recreational use of these substances
A recent study assessed the risks of recreational users developing subsequent psychotic disorders
- Individuals who visited the ED for hallucinogen use had a greater risk of being diagnosed with a schizophrenia spectrum disorder in the following 3 years
- Hazard ratio (HR) of 21.32
- After adjustment for comorbid substance use and other mental illness, the hazard ratio was 3.53 - still a significant increase compared with the general population
- They also found an elevated risk for psychedelics when compared to alcohol (HR 4.66) and cannabis (HR 1.47)
The study did not assess whether patients received antipsychotics or other treatments in the ED

References

Lieberman JA. Back to the Future - The Therapeutic Potential of Psychedelic Drugs. N Engl J Med. 2021;384(15):1460-1461. doi:10.1056/NEJMe2102835
Livne O, Shmulewitz D, Walsh C, Hasin DS. Adolescent and adult time trends in US hallucinogen use, 2002-19: any use, and use of ecstasy, LSD and PCP. Addiction. 2022;117(12):3099-3109. doi:10.1111/add.15987
Myran DT, Pugliese M, Xiao J, et al. Emergency Department Visits Involving Hallucinogen Use and Risk of Schizophrenia Spectrum Disorder. JAMA Psychiatry. 2025;82(2):142-150. doi:10.1001/jamapsychiatry.2024.3532

Summarized & Edited by Jorge Chalit, OMS3
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Episode 956: Psychedelics and Risk of Schizophrenia

Emergency Medical Minute