Comparing Substance Use Consequences between Serotonergic Psychedelics, MDMA, and other Drugs of Abuse Among United States Adults with History of Psychiatric Illness

Psychedelic-assisted therapy could transform treating psychiatric illness, but harms from exacerbating substance use disorder (SUD) among adults with psychiatric illness using psychedelics have not been studied. A cross-sectional survey in the US was used to test whether Drug Abuse Screening Test scores (DAST-10, validated instrument predicting SUD) were more severe when psychiatric illnesses (anxiety disorder, major depressive disorder [MDD], post-traumatic stress disorder [PTSD], and bipolar disorder) and serotonergic psychedelic or MDMA use were combined. Any psychedelic use among adults with psychiatric illness history (anxiety: 5.1% [95% CI: 4.7, 5.6]; MDD: 5.1% [4.3, 5.8]; PTSD: 6.9% [5.9, 7.9]; bipolar: 9.2% [8.0, 10.5]) was more prevalent than the general population (2.6% [2.5, 2.8]). Significant increases in scores were associated with psychedelic use independent of other concurrent drug use, but increases were smaller than for opioids or stimulants. Approaches to managing SUD risks with psychedelics should differ from past approaches for other drugs.