Trends in hallucinogen-related emergency department and hospital admissions, 2016 to 2023

This interesting JAMA paper is reassuring when considering possible increasing adverse effects as psychedelics become used more widely. The authors report: “Introduction Hallucinogen use in the United States has increased in recent years, particularly among young adults, amid shifting cultural attitudes and medicalization.  US Food and Drug Administration (FDA) breakthrough therapy designations for psilocybin and methylenedioxy-methylamphetamine (MDMA), along with widespread media coverage of their therapeutic potential, coincide with evolving policy landscapes (eg, municipal and state-level decriminalization and legalization). Together, these developments may be shaping national trends in ways that extend beyond localized policies. Additionally, growing cross-jurisdictional travel to areas with more permissive psychedelic policies raises questions about whether local reforms may have national implications. It remains unclear whether these evolving cultural, medical, and policy contexts in the United States are reflected in detectable changes in hallucinogen-related emergency department and inpatient admissions at the population level. Methods We conducted this retrospective cohort study using the Merative MarketScan Commercial and Multi-State Medicaid databases (2016-2023), including individuals aged 16 to 64 years. Monthly rates of hallucinogen-related emergency or hospital admissions (ICD-10 code F16xx) were calculated as a proportion of all substance-related admissions (ICD-10 codes F10xx to F19xx, excluding nicotine). Temporal trends were estimated using bayesian multiple change-point (MCP) models (eMethods in Supplement 1). Analyses used SAS version 9.4 (SAS Institute) and R version 4.5.1 (R Project for Statistcal Computing), with the mcp package. The study followed RECORD-PE guidelines and was exempt from human participant review by the Washington University human research protection office. Results Among 1 355 161 individuals with substance-related admissions from 2016 to 2023, 21 700 (1.6%; median [IQR] age, 28 [21-39] years) had at least 1 hallucinogen-related admission. Of these individuals, 13 079 (60.3%) had Medicaid coverage, and among those with race and ethnicity data (Medicaid enrollees), 487 (4.2%) were Hispanic; 5412 (47.1%) non-Hispanic Black; and 5064 (44.1%) non-Hispanic White. Across individuals with hallucinogen-related admissions with at least 6 months of continuous enrollment preadmission (15 420 individuals), 6-month preadmission comorbidities included mood disorders (5394 [35.0%]), anxiety disorders (4500 [29.2%]), schizophrenia-spectrum disorders (2262 [14.7%]), and non-nicotine substance–related disorders (2913 [18.9%], including opioids [n = 894], alcohol [n = 1048], cannabis [n = 1487], stimulants [n = 905], and sedatives [n = 182]). As shown in Figure 1, the monthly share of hallucinogen-related admissions ranged from 0.59% in January 2016 to 1.18% in January 2021 of substance-related admissions throughout the 7-year period. By contrast, alcohol- and opioid-related encounters accounted for the overwhelming majority of admissions throughout the study period (Figure 1). As illustrated in Figure 2, MCP models identified rising hallucinogen-related admissions until early 2020, followed by a decline through 2023.”

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