The study reinforces the need for greater awareness and vigilance regarding the use of hallucinogens. Despite their potential for some therapeutic applications, such as in the treatment of mental disorders, the risk of developing psychotic disorders among vulnerable users must be carefully assessed. In addition, the increasing demand for medical care related to these substances suggests the urgency of preventive and educational strategies that balance their benefits and risks.
In recent years, interest in and use of hallucinogenic substances has grown rapidly, raising concerns about possible associated risks, such as the development of psychotic disorders.
Despite their frequent discussion, there is still little scientific data to assess the real connection between the use of hallucinogens and the risk of disorders such as schizophrenia.
The main objective of this study, conducted at the University of Ottawa, was to investigate whether people who sought care in an emergency department (ED) due to hallucinogen use were more likely to develop a schizophrenia spectrum disorder (SSD) in the future.
This research used data from Ontario, Canada, covering the period from January 2008 to December 2021, with analyses conducted between May and August 2024.
The researchers analyzed a large health database, covering more than 9 million individuals aged 14 to 65, all with no prior history of psychotic disorders. Among these, they identified those who had ED visits related to hallucinogen use.
These individuals were compared with two groups: the general population and individuals who sought care because of alcohol or cannabis use.
The primary outcome measure was subsequent diagnosis of a schizophrenia spectrum disorder (SSD), assessed by a validated algorithm in medical records. The average follow-up of participants was just over 5 years.
The study revealed striking trends related to hallucinogen use and the risk of psychotic disorders, highlighting a significant increase in the frequency of emergency department (ED) visits for these substances and a clear link with the development of schizophrenia spectrum disorders (SSD).
Emergency department visits related to hallucinogen use have increased significantly, especially since 2013. Between 2008 and 2021, the number of cases increased by 86.4%. In absolute terms, the annual rate increased from 3.4 visits per 100,000 people in 2008 to 6.4 visits per 100,000 in 2021. This increase highlights a worrying trend in the use of these substances and its association with health complications.
The data indicated that people who sought emergency care due to hallucinogen use had a significantly higher risk of developing a schizophrenia spectrum disorder in the following three years.
Among hallucinogen users who visited the ED, 3.99% were diagnosed with TEE, compared with only 0.15% of the general population. This difference reflects a substantially increased risk for those exposed to these substances. Even after adjusting for factors such as age, sex, and mental health conditions, hallucinogen users remained at elevated risk of developing TEE.
Specifically, these individuals were 3.5 times more likely to be diagnosed compared with individuals in the general population with no history of hallucinogen use.
When compared with individuals who visited the ED for alcohol use, the risk of TEE was 4.6 times higher for hallucinogen users. For cannabis users, the risk was 1.5 times higher.
These figures highlight that hallucinogen use is more strongly associated with the development of psychotic disorders than other substances, such as alcohol and cannabis.
These results suggest that hallucinogen use, especially at levels that lead to a medical emergency, is associated with a substantially increased risk of psychotic disorders. This has important implications for public health and regulatory policy, given the increasing interest in and use of hallucinogens, both recreationally and in therapeutic settings.
The study reinforces the need for greater awareness and vigilance regarding hallucinogen use. Despite their potential in some therapeutic applications, such as in the treatment of mental disorders, the risk of developing psychotic disorders among vulnerable users must be carefully assessed.
In addition, the increasing medical care-seeking related to these substances suggests the urgency of preventive and educational strategies that balance their benefits and risks.
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Emergency Department Visits Involving Hallucinogen Use and Risk of Schizophrenia Spectrum Disorder
Daniel T. Myran, Michael Pugliese, Jennifer Xiao, Tyler S. Kaster, M. Ishrat Husain, Kelly K. Anderson, Nicholas Fabiano, Stanley Wong, Jess G. Fiedorowicz, Colleen Webber, Peter Tanuseputro, and Marco Solmi
JAMA Psychiatry. Published online November 13, 2024.
doi:10.1001/jamapsychiatry.2024.3532
Abstract:
Interest in and use of hallucinogens has been increasing rapidly. While a frequently raised concern is that hallucinogens may be associated with an increased risk of psychosis, there are limited data on this association. To examine whether individuals with an emergency department (ED) visit involving hallucinogen use have an increased risk of developing a schizophrenia spectrum disorder (SSD). This population-based, retrospective cohort study (January 2008 to December 2021) included all individuals aged 14 to 65 years in Ontario, Canada, with no history of psychosis (SSD or substance induced). Data were analyzed from May to August 2024. An incident ED visit involving hallucinogen use. Diagnosis of SSD using a medical record–validated algorithm. Associations between ED visits involving hallucinogens and SSD were estimated using cause-specific adjusted hazard models. Individuals with an incident ED visit involving hallucinogens were compared with members of the general population (primary analysis) or individuals with ED visits involving alcohol or cannabis (secondary analysis). The study included 9 244 292 individuals (mean [SD] age, 40.4 [14.7] years; 50.2% female) without a history of psychosis, with a median follow-up of 5.1 years (IQR, 2.3-8.6 years); 5217 (0.1%) had an incident ED visit involving hallucinogen use. Annual rates of incident ED visits involving hallucinogens were stable between 2008 and 2012 and then increased by 86.4% between 2013 and 2021 (3.4 vs 6.4 per 100 000 individuals). Individuals with ED visits involving hallucinogens had a greater risk of being diagnosed with an SSD within 3 years compared with the general population (age- and sex-adjusted hazard ratio [HR], 21.32 [95% CI, 18.58-24.47]; absolute proportion with SSD at 3 years, 208 of 5217 with hallucinogen use [3.99%] vs 13 639 of 9 239 075 in the general population [0.15%]). After adjustment for comorbid substance use and mental health conditions, individuals with hallucinogen ED visits had a greater risk of SSD compared with the general population (HR, 3.53; 95% CI, 3.05-4.09). Emergency department visits involving hallucinogens were associated with an increased risk of SSD within 3 years compared with ED visits involving alcohol (HR, 4.66; 95% CI, 3.82-5.68) and cannabis (HR, 1.47; 95% CI, 1.21-1.80) in the fully adjusted model. In this cohort study, individuals with an ED visit involving hallucinogen use had a greater risk of developing an SSD compared with both the general population and with individuals with ED visits for other types of substances. These findings have important clinical and policy implications given the increasing use of hallucinogens and associated ED visits.
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