Clinical Characteristics of Emergency Visits Related to Recreational Psychedelic Use

This study aimed to characterise the clinical features and outcomes of emergency department presentations associated with recreational psychedelic use and identify factors predicting more severe outcomes such as psychiatric hospitalisation.

This retrospective study reviewed emergency department presentations related to recreational psychedelic use found that most cases involved LSD, MDMA, or psilocybin, and were primarily driven by psychiatric symptoms such as agitation and anxiety rather than severe medical toxicity. The majority of patients were young adults, and most cases were managed in the emergency department without requiring admission, with only around 11% resulting in psychiatric hospitalisation.

Risk of hospitalisation was significantly higher in individuals with pre-existing psychiatric vulnerabilities, particularly a history of psychotic or bipolar disorders, and in those with concurrent cannabis use. These factors were the strongest predictors of more severe clinical courses, suggesting that underlying mental health conditions and polysubstance use play a key role in determining outcomes following acute psychedelic-related presentations.

Importantly, the study describes only emergency department cases and does not estimate the overall risk of psychedelic use in the general population. It reflects a clinically enriched sample of adverse or distressing experiences rather than typical use, and therefore cannot be used to infer how commonly psychedelics lead to emergency care or how they behave in controlled therapeutic settings.

Abstract

Recreational psychedelic use is increasing, yet data on adverse events remains limited. This study characterized emergency department (ED) visits associated with recreational psychedelic use at UC San Diego Medical Center. We conducted a retrospective chart review of ED encounters (2010–2023). Cases were identified using ICD-10 hallucinogen-related codes and confirmed through manual review. Multivariable logistic regression was employed to identify factors associated with psychiatric hospitalization. We identified 232 cases, primarily related to LSD (35.0%), MDMA (30.2%), and psilocybin (24.0%).

The cohort was predominantly young, white, and male. Common psychiatric symptoms included agitation (25.9%) and anxiety (24.6%). Common nonpsychiatric symptoms included nausea/vomiting (9.5%) and diaphoresis (5.2%). 11.2% of cases required psychiatric hospitalization. Factors associated with psychiatric hospitalization included concurrent cannabis use (OR = 10.9, 95% CI 3.37–39.64), history of bipolar disorder (OR = 12.67, 95% CI 2.35–70.43), and history of a primary psychotic disorder (OR = 17.10, 95% CI 2.01–187.49).

Psychedelic-associated emergency visits present with various clinical characteristics. While most recreational psychedelic presentations are effectively managed in the emergency department, specific factors predict severe outcomes.

Concurrent cannabis use and pre-existing psychotic or bipolar disorders are associated with increased odds of psychiatric hospitalization, underscoring the importance of targeted risk assessment in patients with these vulnerabilities.

Bhatt, K., Friedman, J., Benster, L. et al. Clinical Characteristics of Emergency Visits Related to Recreational Psychedelic Use. Community Ment Health J (2026). Read Paper

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