Will Increased Psychedelic Use Lead to More Hospitalizations and ER Visits?

It is no surprise that in recent years the use of psychedelics has been on the rise, as some 20 cities and states have decriminalized once-prohibited plants and fungi, and the FDA moves toward approving psychedelic-assisted therapies. But has that increase had any implications for public health?

A new report suggests that there are public health consequences. The study, which was funded by the Health Services Research Administration Stanford Addiction Medicine Fellowship program, looked at “Trends in hallucinogen-associated emergency department visits and hospitalizations in California, USA from 2016 to 2022.”

The study authors reviewed publicly available data for emergency department visits and hospitalizations in California. They found that psychedelic-associated ED visits increased by 54% between 2016 and 2022, and hospitalizations increased by 55% during the same period.

In absolute terms the numbers were small, noted Nicolas Garel of the Stanford University School of Medicine Department of Psychiatry and Behavioral Sciences, and lead author of the study. There were 3,476 psychedelic-associated ED visits in 2022, compared to 262,729 alcohol-associated ED visits and 139,479 cannabis-associated ED visits in the same year. The hospitalization numbers are similar.

Garel says that the study serves to “remind people that you can have a very difficult trip. It can end up with adverse experiences. I’m not a prohibitionist. But we see overly simplistic media coverage that leads to a message that people can try these substances and forget they might have a bad reaction.”

One important takeaway for Garel is how the system that categorizes “hallucinogens” within the medical field – the International Classification of Diseases – aggregates a wide range of mind-manifesting compounds into a single group. He asks, “How can it be possible, in terms of public health monitoring, to cluster all those very different substances together? Psilocybin, MDMA, ketamine are so different in terms of safety, tolerability, even purpose of use.” This clustering makes it impossible to get an accurate sense of their specific harms, he added.

Are ED visits and hospitalizations rising in parallel with the increase in psychedelic use? Because there are no studies of psychedelic use by state, or estimates for recent years, Garel says that “it’s all speculation.” But he suggests that there is reason to think psychedelic consumption has grown more than 55% in California since 2016.

“People know that set and setting are important,” he says, “and they are more cautious. So despite the increase in use, there are less harms. But it’s impossible really to know.”

Another factor that might contribute to ED visits and hospitalizations, Garel suggests, could be the rise in psychedelic use by young people suffering from depression. According to a recent survey of data from the National Survey on Drug Use and Health, “the proportion of adults who reported past-year LSD use increased more among those with depression than those without depression. Disproportionate increases in past-year LSD use were more pronounced among young adults with depression than their older counterparts.”

It’s reasonable to assume that media coverage of research supporting the practice of psychedelic-assisted therapy to treat depression has led more people with depression to explore psychedelic use, Gorel says. Which, in turn, could increase ED visits and hospitalizations.

But Greg Ferenstein of Frederick Research, a consultancy for the psychedelics industry, feels that the California study misses an important conclusion that can be drawn from the data they present. A close look at the numbers shows that the adverse effects peak in 2020 and 2021, and decrease in 2022 following the decriminalization of psychedelic plants and fungi in Oakland, Santa Cruz, and other cities. 

“It appears that hospitalizations decrease in a state around when some of its major cities began decriminalization,” says Ferenstein. He adds that he has seen similar statistics for Colorado, as the state implements decriminalization policies for psilocybin.

“People have access to better product and more professional advice because there’s decrim and a robust market. California is much closer to a legal market in reality and it shows why that (likely) makes psychedelics safer. In general, prohibition may hurt public health when it comes to psychedelics,” he says.

The study notes that to “avoid double counting, poisoning or overdose codes associated with hallucinogens, cannabis or alcohol” these incidents are not included in the counts “as there was potential for an individual visit to have both a use disorder code and overdose code for one visit.” 

This raises questions about the potential for more studies that could look at ED visits associated with overdose, misidentification, or inadvertent ingestion of contaminants such as fentanyl, the use of which is causing a record number of deaths in California cities. Researchers might examine whether decriminalization of psychedelics, and the concurrent increase in risk reduction education, are mitigating the number of medical events associated with psychedelics even as their use becomes more widespread.