BACKGROUND: Although clinical trials involving psychedelic-assisted psychotherapy have not observed short-term increases in the risk of death, limited data exist on mortality associated with hallucinogen use outside of controlled trial settings. We sought to determine whether people with an emergency department visit or hospital admission involving hallucinogen use were at increased risk of all-cause death compared with the general population and with people with acute care presentations involving other substances.
METHODS: We conducted a retrospective cohort study using linked health administrative data on all people aged 15 years and older living in Ontario, Canada, from 2006 to 2022. We compared overall and cause-specific mortality between members of the general population and people with incident acute care (an emergency department visit or hospital admission) involving hallucinogens and other substances.
RESULTS: We included 11 415 713 people; 7953 (0.07%) had incident acute care involving hallucinogens. In a matched analysis with 77 101 people with a median follow-up of 7 (interquartile range 3-11) years, acute care involving hallucinogens was associated with a 2.6-fold (hazard ratio [HR] 2.57, 95% confidence interval [CI] 2.09-3.15) increased all-cause mortality within 5 years (n = 482, absolute risk 6.1%) relative to the general population (n = 460, absolute risk 0.6%). Analyses excluding people with comorbid mental or substance use disorders showed similar elevations in mortality risk for acute care involving hallucinogens relative to the general population (HR 3.25, 95% CI 2.27-4.63). People with acute care involving hallucinogens were at a significantly elevated risk of death by unintentional drug poisoning (HR 2.03, 95% CI 1.02-4.05), suicide (HR 5.23, 95% CI 1.38-19.74), respiratory disease (HR 2.46, 95% CI 1.18-5.11), and cancer (HR 2.88, 95% CI 1.61-5.14) relative to the general population.
INTERPRETATION: Requiring hospital-based care for hallucinogen use was associated with increases in risk of death relative to the general population, particularly from suicide. These findings should be considered in clinical and policy decision-making, given the increasing use of hallucinogens and associated problematic use.
| Specialty Area | Score |
|---|---|
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Emergency Medicine |
This article is of limited use to emergency physicians as there are many social determinants of health apart from hallucinogen use that likely contribute to mortality in the patient group. I find it interesting (possibly inappropriate) that they try to apply increased mortality in ED patients seen for hallucinogen use to using hallucinogens in mental health, which is (hopefully) a more controlled setting.
This Canadian study of the risk of premature death in hallucinogen users looked at 11.4M charts and found that about 8K experience premature injury or death, likely related to substance use. The causes of death included suicide (HR=5), unintentional drug poisoning (HR=2), respiratory disease (HR=2.5), and cancer (HR=3). A slight artificiality was induced by classifying drugs by mechanism (serotonin) versus effect (disassociation). It is unknown whether there was a risk difference between these groups. Although the effect size was small (~2.5% increased risk for death in the next 5 years compared with the matched population), the fact that this is a modifiable risk must be entertained. This discussion belongs in the public square; harms and benefits must be discussed openly as they are for smoking.
Hallucinogens are definitely making a resurgence as a potential treatment for mental health issues, and experimental use is rising with it. This is a very helpful data set that details 2-time higher likelihood of death in people admitted for an acute intoxication of hallucinogen. The study was retrospective and could not detail drug levels or types. Comorbid mental illness very likely played a significant role. The higher rate of intentional self-harm may be a component of the drug use, the underlying psychiatric disease, or combination of both. I will use this information to try to connect patients and families to better mental health resources given these risks.
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