Abstract
Background:
Recent years have seen a resurgence in clinical interest in, and increased public acceptance of, psychedelic drugs in Canada. However, our understanding of how psychedelic drugs are currently used in Canada remains limited. We developed the Canadian Psychedelic Survey (CPS) to gather real-world evidence about psychedelic drug use in Canada. This study aimed to characterize CPS respondents; identify access sources; explore psychedelic-specific patterns, purposes, and contexts of use; and contextualize intense positive and challenging psychedelic experiences.
Methods:
The CPS was administered in January 2022. We used descriptive statistics to characterize the sample and understand access to psychedelic drugs and detailed patterns and contexts of use. We built separate logistic regression models to identify sociodemographic and psychedelic-related correlates of reporting an intense positive and challenging experience with psychedelic drugs.
Results:
We analyzed data from 2045 respondents (mean age = 38.4 years; 56% female). Psilocybin, 3,4-methylenedioxymethamphetamine (MDMA), and lysergic acid diethylamide (LSD) were the most used psychedelic drugs. Top motivations for psychedelic drug use were fun, self-exploration, general mental well-being, and personal growth. Lifetime intense positive and challenging psychedelic experiences were reported by 82% and 52%, respectively. Over half (56%) of those who had an intense challenging experience reported that “some good” came from the experience after-the-fact. In multivariable analysis, significant correlates of intense positive experiences included higher perceived psychedelic experience and fun and self-exploration as motivations for use (p < 0.05). Significant correlates of intense challenging experiences included higher perceived psychedelic experience and trauma management, fun, and boredom as motivations for use (p < 0.05).
Conclusion:
The CPS is the most comprehensive survey of psychedelic drug use to date. Detailing the range of therapeutic and nontherapeutic experiences of psychedelic drug consumers in Canada, these findings add important nuances that can inform evolving clinical research and policy discussions impacting safe access to and use of psychedelic drugs.
Keywords: psychedelics, survey, Canada, substance use
Background
Psychedelic substances are a classification of drugs broadly defined by their subjective effects involving altered states of consciousness and psychological, auditory, and visual sensory changes. Classic psychedelic drugs include substances such as psilocybin, lysergic acid diethylamide (LSD), and ayahuasca, characterized by their agonist effects at serotonin 2A (5-HT2a) receptors. Nonclassic psychedelic drugs such as empathogens (e.g., 3,4-methylenedioxymethamphetamine [MDMA]), dissociative anesthetic agents (e.g., ketamine), and atypical hallucinogens (e.g., salvia divinorum, ibogaine hydrochloride) have other mechanisms of action.
Although psychedelic drugs have a long history of use across cultural, religious, and spiritual contexts, clinical research involving psychedelic drugs has been limited since the mid 1960s due to legal restrictions1,2 and tight regulations on research involving pharmaceuticals.3
Interest in psychedelic drugs as potential treatment agents for various mental health conditions including depression, obsessive-compulsive disorder, substance use disorders, and post-traumatic stress disorder has recently proliferated alongside the resumption of clinical studies to investigate purported benefits.2,4 As of March 2021, there were 70 registered clinical trials aiming to investigate psychedelic drugs for the treatment of psychiatric disorders.5 In general, reviews of the existing clinical literature suggest both short- and long-term benefits with minimal safety concerns, but emphasize that additional rigorously controlled trials with larger sample sizes are warranted and ongoing.1,2,6,7
The renewed interest in, and research into, the therapeutic potential of psychedelic drugs can be viewed as part of a broader shift in the regulation of psychoactive drugs informed by public health and harm reduction rather than prohibition and criminal justice. In the United States, a number of cities have now passed regulations allowing for the personal possession and use of some psychedelic drugs, and recently Colorado and Oregon have moved to regulate both therapeutic and nontherapeutic use and access.8 In Canada, the province of British Columbia has received an exemption to the Controlled Drugs and Substances Act (CDSA) allowing adults to legally possess up to 2.5 g of certain otherwise unregulated substances, including MDMA.9
This change is accompanied by growing public acceptance of psychedelic drugs. For example, a 2021 Psychedelic Association of Canada (PAC) survey found that of 1051 respondents, 82% approve the use of psilocybin-assisted therapy for people suffering from an end-of-life illness, and 78% would support a government that legalized psilocybin-assisted therapy to improve the quality of life of end-of-life patients, as well as those receiving palliative care.10
The Canadian government classifies psychedelic drugs as controlled substances under the CDSA. Activities involving controlled substances are prohibited under the CDSA, except for specific instances allowed through regulations and/or when an exemption is issued, such as for clinical research purposes. However, in January 2022, Health Canada added psychedelic drugs to the list of treatments available under the Special Access Program, allowing physicians to request access to psychedelic drugs for patients with serious health conditions and limited conventional treatment options.11
In addition, ketamine—a dissociative anesthetic often used in emergency room or operating room settings—has demonstrated rapid antidepressant effects and is seeing increased off-label use in the treatment of pain, mental health, and substance use disorder, often as part of a psychedelic-assisted psychotherapy treatment model.12,13
Despite these developments, little is known about the real-world use of psychedelic drugs. The 2019 Canadian Alcohol and Drugs Survey suggests that about 2% of Canadians 15 years or older reported past-year psychedelic drug use, which has steadily increased since 2013, when 0.6% reported past-year use.14 However, beyond this cursory overview, detailed data on psychedelic drug use in Canada are lacking. We, therefore, designed and distributed the first comprehensive survey to explore patterns, access, and experiences of psychedelic drug use among people who use psychedelic drugs in Canada.
Materials and Methods
The Canadian Psychedelic Survey (CPS) is a comprehensive general population survey of Canadian psychedelic drug use. Informed by the principles of community-based research and harm reduction, a primary aim of the CPS is to incorporate the lived experience of the psychedelic community into the academic understanding of psychedelic drugs and associated public policy development. This 655-question survey was developed in collaboration with clinicians and academic researchers from Johns Hopkins, UCLA, University of Alabama, University of Michigan, Cleveland Clinic, McMaster, McGill, and UBC.
The survey focused on the use of 11 common psychedelic drugs: ayahuasca, N,N-dimethyltryptamine (DMT) or 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT), iboga or ibogaine, LSD or acid, 3,4-methylenedioxymethamphetamine (MDMA or MDA), mescaline, psilocybin, and salvia divinorum. In addition, novel and validated instruments were employed to gather data on who uses these substances; patterns of both personal and therapeutic use; psychedelic drugs and headaches/migraines; psychedelic drugs and mental health; the use of other substances before, during, and after psychedelic drug use; access to psychedelic drugs; the impacts of psychedelic drugs on the use of alcohol, tobacco, and other drugs; music and psychedelic drug use; and psychedelic drugs and mindfulness practices.
To participate in the study, respondents had to be 19 years or older, report past or current use of psychedelic drugs, have the capacity to consent for themselves, and be able to read, write, and speak English. Informed consent was gathered online, and all data were collected anonymously. However, participants could provide an email address to be entered into a draw to win 1 of 3 × $500 Amazon gift cards as compensation for taking the time to participate in the study, after which all email addresses gathered for the draw were immediately destroyed.
The survey received ethics approval from Advarra (Protocol No. Pro00059863), and was cosponsored by SABI Mind, the Multidisciplinary Association of Psychedelic Studies Public Benefits Corp. (MAPS PBC), and Psygen Industries. It was distributed from January 14 to 28, 2022, through NGOs such as MAPS Canada, the PAC, and the Canadian Drug Policy Coalition, as well as social media. Respondents completed the survey online on REDCap, a HIPAA- and PIPEDA-compliant electronic data capture system.
Study sample
We excluded all observations in which an invalid Canadian postal code was provided. We then used a combination of postal code, gender, age, relationship status, education, and income to remove probable duplicate entries. Finally, we removed respondents who did not endorse lifetime or past-year use of any of the 11 prespecified psychedelic drugs or a different psychedelic drug under the option for “other.”
Instruments and measures
The current analysis was focused on characterizing sample respondents, understanding patterns and contexts of general and specific psychedelic drug use, and exploring intense positive and challenging psychedelic experiences (i.e., “trips”).
Sociodemographic and general drug-related characteristics
We collected information on age, province of residence, self-identified racial background and gender, relationship and employment status, education, and annual income. We also inquired about lifetime and past-year nonpsychedelic drug use including benzodiazepines (prescription and nonprescription), cannabis, cocaine/crack, methamphetamines, opioids (prescription and nonprescription), and tobacco/nicotine.
General psychedelic drug use
Before exploring psychedelic drug-specific patterns of use, participants were asked several background questions about their general psychedelic drug use, including age of first use, and past-year frequency of use with categorical options (from once to daily; see Supplementary Files), and money spent on psychedelic drugs per month with categorical options (from $0 to >$500; see Supplementary Files). Participants were also asked to rank their level knowledge and experience with psychedelic drugs using a sliding scale from 1 to 100, with 1 being “no knowledge/experience at all” and 100 being “very knowledgeable/experienced.”
Motivation for use was assessed by inquiring about the primary overall reason(s) for psychedelic drug use (e.g., “for fun,” “to treat a medical condition”; all response options summarized in Supplementary Files). Finally, we also asked participants to indicate how they purchased/accessed psychedelic drugs over the past year, as well as what their preferred mode of access would be, assuming conditions permitted (e.g., “friend,” “health care professional”; all response options are summarized in the Supplementary Files). For all three questions, participants could select as many options from the list as they felt applied.
Specific psychedelic drug use
We then asked participants to identify whether they had either lifetime and/or past year experience with each of the 11 above-listed common psychedelic drugs, with the following options for each drug: “ever, microdose,” “ever, regular dose,” “past-year microdose,” and “past-year regular dose.” There was also an option to specify lifetime or past-year use of other psychedelic drugs in micro- or regular doses.
Participants who reported ever using a regular dose of any of the prespecified 11 psychedelic drugs (aside from “other”) were asked follow-up questions regarding use of that specific psychedelic including estimated total number of times used, frequency of use, most typical access source, primary motivation/intent of use, and most typical environmental and social setting of use. Please refer to the Supplementary Files for a description of the follow-up questions and response options. As these questions assessed a typical use scenario, respondents were asked to select a single item from the response list for each question.
Intense positive and challenging psychedelic experiences
Participants were asked whether they ever had an “intense but largely positive psychedelic experience” and whether they ever had a “challenging psychedelic experience (i.e., a bad trip).” For each question, those who responded affirmatively were asked a series of follow-up questions surrounding their most intense experience including which psychedelic drug was involved in the experience, who they were with during the experience (as above, described in Supplementary Files), and where they had the experience (as above, described in Supplementary Files). They also rated the intensity of their most intense experience on a scale from 1 to 100, with 1 being “worst experience of my life” and 100 being “best experience of my life.”
Those who endorsed having an intense positive experience were also asked to complete the Awe Experiences Scale (AWE-S)—a validated multifactorial measure of the experience of awe.15 In the context of contemporary psychedelic-assisted therapy, awe has been proposed as the psychological catalyst for positive change underlying mystical experiences induced by psychedelic drugs.16 Using a Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree), the instrument assesses 30 items that are further grouped into 6 factors: altered time perception, self-diminishment, connectedness, perceived vastness, physical sensations, and need for accommodation. We took the mean of each factor's five items to calculate factor-specific scores, and the mean of all factor scores to calculate the total awe score.
Those who endorsed an intense challenging experience were also asked to provide details about the psychological and physical symptoms experienced (e.g., “felt social paranoia,” “experienced mental or sensory overload”; all response options are summarized in the Supplementary Files). They were also asked to rate their level of agreement with the statement that “some good came out of your most challenging psychedelic experience” through a Likert scale. Those indicating moderate or strong agreement provided details about what type of good came from the experience (e.g., “resolved a challenging situation or emotion,” “overcame some of my personal fears”; all response options are summarized in the Supplementary Files).
Statistical analysis
Descriptive statistics were used to summarize all sociodemographic and substance use characteristics including all psychedelic-specific data for patterns of use, access, motivations, setting, and details of most intense positive and challenging psychedelic experiences.
We built bivariable and multivariable logistic models to examine sociodemographic psychedelic-related correlates of experiencing an intense positive trip (model series 1) and an intense challenging trip (model series 2). For each outcome, we considered age, gender, and education as potential sociodemographic correlates; we considered self-perceived psychedelic experience, past-year psychedelic drug use, motivation(s) for psychedelic drug use (each analytic category summarized in Supplementary Files; each motivation was dichotomized as yes vs. no), and the psychedelic drug most typically used (ketamine, LSD, MDMA, or other vs. psilocybin; see Supplementary Files for details of variable ascertainment) as potential psychedelic-related correlates.
In addition, for model series 1, we considered self-reported intense challenging psychedelic experience; for model series 2, we considered self-reported intense positive psychedelic experience. For each model series, variables associated with the outcome at p < 0.10 in bivariable analyses were entered into the final multivariable model. All analyses were conducted in R (version 4.2.1) using RStudio (version 2022.7.2.576).
Results
Sample characteristics and general psychedelic drug use
In total, there were 2869 survey responses, of which 2384 (83.1%) remained after removal of invalid and duplicate entries. Of these, 2045 (85.8%) respondents provided information about past or current use of a specific psychedelic drug and were included in the analysis. Women made up over half of the sample (56.2%), and the average age of respondents was 38.4 years (Table 1). The prevalence of lifetime and current (past-year) use of other substances was high in the sample, with a substantial majority reporting lifetime alcohol (99.4%) or cannabis use (98.1%), and >70% reporting past-year use of each. Self-rated psychedelic knowledge and experience were relatively high (>60 on a scale of 0–100).
Table 1.
Sociodemographic and Substance Use Characteristics of Canadian Psychedelic Survey Respondents (n = 2036)
| Characteristic | N (%) | |
|---|---|---|
| Age | ||
| Mean (SD) | 38.4 (12.8) | |
| Gender | ||
| Male | 785 (38.6) | |
| Female | 1144 (56.2) | |
| Nonbinary | 84 (4.1) | |
| Other or unknown | 24 (1.1) | |
| Geographic area | ||
| Atlantic | 68 (3.3) | |
| Quebec | 118 (5.8) | |
| Ontario | 445 (21.9) | |
| Prairies | 922 (45.3) | |
| British Columbia | 470 (23.1) | |
| Territories | 13 (0.6) | |
| Race/ethnicity | ||
| White | 1643 (80.7) | |
| Black | 13 (0.6) | |
| Indigenous | 49 (2.4) | |
| Asian | 104 (5.1) | |
| Other | 79 (3.9) | |
| Multiracial | 148 (7.3) | |
| Education | ||
| ≤High school | 345 (16.9) | |
| Undergraduate, college, technical degree | 441 (21.7) | |
| Graduate or professional degree | 1250 (61.4) | |
| Employment | ||
| Fulltime | 1263 (62.0%) | |
| Part-time | 350 (17.2) | |
| Retired | 124 (6.1) | |
| Unemployed | 299 (14.7) | |
| Use of nonpsychedelic substances | Lifetime | Past-year |
| Alcohol | 2023 (99.4) | 1633 (80.2) |
| Cannabis | 1997 (98.1) | 1487 (73.0) |
| Tobacco | 1656 (81.3) | 696 (34.2) |
| Opioids (nonpharmaceutical) | 227 (11.1) | 48 (2.4) |
| Opioids (pharmaceutical) | 974 (47.8) | 266 (13.1) |
| Cocaine | 1099 (54.0) | 330 (16.2) |
| Methamphetamine | 349 (17.1) | 73 (3.6) |
| Age of psychedelic drug initiation | ||
| Mean (SD) | 21.8 (9.3) | |
| Self-perceived psychedelic knowledgea | ||
| Mean (SD) | 67.3 (20.3) | |
| Self-perceived psychedelic experiencea | ||
| Mean (SD) | 60.1 (23.9) | |
| Type of dose usedb | ||
| Microdose only | 135 (6.6) | |
| Regular doses only | 887 (43.6) | |
| Both regular and microdose | 1014 (49.8) | |
| Past-year psychedelic drug use | ||
| Yes | 1525 (74.9) | |
| No | 511 (25.1) | |
| Past-year psychedelic drug use frequency (n = 1525) | ||
| <Monthly | 1032 (67.7) | |
| Monthly | 248 (16.2) | |
| ≥Weekly | 218 (14.3) | |
| Daily | 27 (1.8) | |
| Money spent per month on psychedelic drugs (n = 1525) | ||
| 0 | 381 (25.9) | |
| $1–99 | 689 (45.2) | |
| $100–249 | 128 (8.4) | |
| $250–499 | 35 (2.3) | |
| $500+ | 30 (2.0) | |
| Unknown | 262 (17.2) | |
Scale range = 0 (none) to 100 (very).
“Regular dose” was defined as a dose high enough to produce a psychedelic effect (i.e., a trip); “microdose” was defined as a small fraction of a regular dose, too low to produce a trip.
SD, standard deviation.
Over 90% of the sample had used a dose of psychedelic drugs high enough to produce a “trip,” whereas 6.6% reported only using psychedelic drugs in “microdoses.” Three-quarters (74.9%) of the sample endorsed psychedelic drug use in the past year, and most of them (67.7%) had used psychedelic drugs less than once per month in the past year.
Over half of respondents reported using psychedelic drugs for fun (76.5%), spiritual, psychological, or personal self-exploration (73.3%), general mental well-being (62.4%), and personal growth (60.5%). A smaller number of respondents endorsed using psychedelic drugs specifically to reduce the use of prescription (11.2%) or nonprescription (10.6%) substances. Additional motivations for using psychedelic drugs are displayed in Figure 1.
Fig. 1.
Self-reported motivations for using psychedelic drugs among Canadian Psychedelic Survey respondents (n = 2036). Eight (0.4%) respondents reported none of the above motivations for using psychedelic drugs. “Well-being” = to improve general mental well-being; “trauma” = to manage past trauma; “substitution” = to reduce the use of another substance; “medical” = to treat a specific medical condition; “growth” = personal growth; “exploration” = spiritual/psychological/personal exploration.
Respondents who used psychedelic drugs in the past year (n = 1525) were asked how they accessed psychedelic drugs during this time and where they would ideally access psychedelic drugs if conditions permitted. These responses are summarized in Figure 2. As shown, the majority of those with recent psychedelic drug use accessed these substances from a friend or acquaintance (62.8%); however, only 33.4% of respondents identified this as a preferred source under ideal conditions. Obtaining psychedelic drugs through a street dealer or the black market was less common, reported by 15.2%, and even fewer (3.3%) identified this as an ideal route of access, making it the least popular option.
Fig. 2.
Sources from which participants obtained psychedelic drugs in the past-year and would prefer to obtain psychedelic drugs if conditions permitted, n = 1525 respondents who reported past-year psychedelic drug use. Five (0.3%) and six (0.4%) respondents reported none of the above as current or ideal sources, respectively. “Friend” = friend or acquaintance; “retail store” = physical store; “clinic” = clinic or health care professional; “pharmacy” was not a response option for “access-actual” as psychedelic drugs are not currently available from pharmacies in Canada.
Almost half of respondents (48.1%) accessed psychedelic drugs online, and the majority (64.0%) wanted to obtain their psychedelic drugs online, making it the most favored access point if conditions permitted. The second and third most favored sources under ideal conditions were physical retail settings (56.5%) and clinics or health care professionals (50.6%)—both of which were less often reported as current sources of psychedelic drugs (8.7% and 5.2%, respectively), likely due to current legal or regulatory restrictions.
Specific psychedelic drug use
Prevalence of lifetime and past-year use of specific psychedelic drugs is displayed in Figure 3. Psilocybin was the most used psychedelic drug, with 92.3% reporting ever using it and 59.1% reporting past-year use. MDMA and LSD use was common, with >60% reporting lifetime use and about one-quarter reporting past-year use. Ibogaine was the least used psychedelic drug, reported by only 2.3% (and <1% in the past year). A small percentage of the sample also endorsed use of other psychedelic drugs that were not specified in the survey; these are summarized in Supplementary Table S1.
Fig. 3.
Prevalence of lifetime (green) and past-year (purple) use of different psychedelic drugs among Canadian Psychedelic Survey respondents (n = 2036). See Supplementary Table S1 for drugs classified as “other.”
Respondents who reported ever using a regular dose (i.e., not a microdose) of any of the prespecified psychedelic drugs (aside from “other”) shown in Figure 2 were asked follow-up questions regarding psychedelic drug-specific number of times used, frequency of use, and typical sources of access, intent of use, and environment and social settings surrounding use; these are summarized in Supplementary Table S2. Reasons for use varied between substances. Recreation was the most often reported motivation for 2C-B, ketamine, LSD, MDMA, nitrous oxide, psilocybin, and salvia use, whereas self-exploration/mind expansion was the top reported motivation for ayahuasca, DMT, ibogaine, and mescaline use.
There was also some variation in typical environmental and social settings of use by specific psychedelic drug used. A home (own or companion's) and outdoors were the top typical environmental settings for DMT, LSD, mescaline, psilocybin, and salvia, whereas in a home or at a large public gathering (e.g., party or rave) was the top typical settings for 2C-B, ketamine, MDMA, and nitrous oxide. Small gatherings (e.g., retreat) were also named as a common typical environmental setting for ibogaine use, along with in a home.
The majority (>50%) of respondents who used 2C-B, ketamine, LSD, MDMA, mescaline, nitrous oxide, psilocybin, and salvia reported preferentially using this drug with companions. Most of those who used DMT reported typically using either with companions (35.5%) or under the supervision of an abstaining companion (i.e., “trip-sitter”; 35.0%). Over 25% of those who used salvia also reported typically using with an abstaining friend. Ibogaine was most typically used with an unlicensed therapist, shaman, or trip guide (42.9%).
Intense positive experiences
Of those who responded to the survey question about intense but largely positive psychedelic experiences (n = 1724), 82.1% endorsed an intense positive experience. Mean AWE-S score associated with the most intense positive experience was 5.3 (standard deviation = 1.1), driven by high levels of agreement with the factors corresponding to altered time perception, connectedness, and perceived vastness (summary scores for all 30 subitems are provided in Supplementary Table S3).
The three most used psychedelic drugs (psilocybin, LSD, and MDMA) accounted for >80% of respondents' most intense positive experience. Despite being one of the least common psychedelic drugs used, ayahuasca accounted for 5% of intense positive experiences. Most experiences occurred within a home (45.6%) or outdoors (30.1%) and with companions (57.1%).
In a multivariable model, significant correlates of experiencing an intense positive psychedelic experience included older age (adjusted odds ratio [AOR] per 10-year increase = 1.32, 95% confidence interval [95% CI]: 1.15–1.51); higher self-perceived psychedelic experience (AOR per 10-point increase in rating = 1.50, 95% CI: 1.38–1.62); spiritual, psychological, or personal exploration (AOR = 2.62, 95% CI: 1.79–3.87) and fun (AOR = 1.42, 95% CI: 1.02–2.01) as a motivating use of psychedelic drugs; as well as reporting an intense challenging experience with psychedelic drugs (AOR = 2.43, 95% CI: 1.74–3.42).
Intense challenging experiences
Of those who responded to the survey question about intense and challenging psychedelic experiences (i.e., bad trip; n = 1708), 52.2% endorsed an intense challenging experience (Table 2). The most common symptoms reported during respondents' most intense experience were mental or sensory overload (61.1%) and social paranoia (51.7%). All other responses are summarized in Table 2. The three most used psychedelic drugs (psilocybin, LSD, and MDMA) accounted for >80% of respondents' most intense challenging experience, and ayahuasca was the fourth cited involved psychedelic drug (4%).
Table 2.
Contexts of Most Intense Positive (Left Column) and Challenging (Right Column) Psychedelic Experience Among Survey Respondents Who Endorsed Experiencing Intense and Challenging Psychedelic “Trips”
| Intense positive experience, N = 1416 (82.1%) | Challenging experience, N = 891 (52.2%) | |
|---|---|---|
| Intensity rankinga | ||
| Mean (SD) | 83.4 (14.8) | 40.6 (23.4) |
| Psychedelic used | ||
| 2C-B | 8 (0.6) | 4 (0.4) |
| Ayahuasca | 72 (5.1) | 36 (4.0) |
| DMT | 76 (5.4) | 21 (2.4) |
| Ibogaine | 6 (0.4) | 2 (0.2) |
| Ketamine | 43 (3.0) | 26 (2.9) |
| LSD | 372 (26.3) | 208 (23.3) |
| MDMA | 134 (9.5) | 54 (6.1) |
| Mescaline | 24 (1.7) | 7 (0.8) |
| Nitrous oxide | 5 (0.4) | 3 (0.3) |
| Psilocybin | 634 (44.8) | 480 (53.9) |
| Salvia | 8 (0.6) | 26 (2.9) |
| Other | 19 (1.3) | 24 (2.7) |
| Environmental setting | ||
| Home (own or companion) | 646 (45.6) | 491 (55.1) |
| Outdoors | 426 (30.1) | 161 (18.1) |
| Small gathering (e.g., retreat) | 149 (10.5) | 93 (10.4) |
| Large public gathering (e.g., party, rave) | 135 (9.5) | 117 (13.1) |
| Clinic or hospital | 22 (1.6) | 8 (0.9) |
| None of the above | 23 (1.6) | 21 (2.4) |
| Social setting | ||
| Alone | 250 (17.7) | 173 (19.4) |
| With companion(s) | 808 (57.1) | 488 (54.8) |
| With companion who abstains (trip-sitter) | 172 (12.1) | 141 (15.8) |
| With licensed therapist or health professional | 40 (2.8) | 11 (1.2) |
| With unlicensed therapist, shaman, or trip guide | 105 (7.4) | 36 (4.0) |
| None of the above | 26 (1.8) | 41 (4.6) |
| AWE-Sb,c | ||
| Altered time perception | 5.8 (1.2) | NA |
| Self-diminishment | 4.8 (1.6) | NA |
| Connectedness | 5.9 (1.3) | NA |
| Perceived vastness | 5.6 (1.4) | NA |
| Physical sensations | 4.5 (1.6) | NA |
| Need for accommodation | 4.9 (1.5) | NA |
| Overall score | 5.3 (1.1) | NA |
| Symptoms experienced | ||
| Confronted with challenging life issue (e.g., loss and trauma) | NA | 362 (40.6) |
| Experienced social paranoia | NA | 461 (51.7) |
| Experienced troubling visions | NA | 314 (35.2) |
| Experienced mental or sensory overload | NA | 544 (61.1) |
| Experienced “ego death”/dissolution of self | NA | 211 (23.7) |
| Worried about mental or physical health | NA | 378 (42.4) |
| Worried about never being the same after the trip | NA | 308 (34.6) |
| Worried about being arrested | NA | 98 (11.0) |
| Worried about being assaulted | NA | 60 (6.7) |
| Worried about being hospitalized | NA | 144 (16.2) |
| Worried about dying | NA | 234 (26.3) |
| None of the above | NA | 44 (4.9) |
| Reported experiencing “some good” from experience | ||
| Largely agree or strongly agree | NA | 498 (55.9) |
| Type of “good” that came from experience (n = 498) | ||
| Resolved a challenging situation or emotion | NA | 192 (38.6) |
| Gained insight into a difficult problem or life issue | NA | 297 (59.6) |
| Overcame personal fears | NA | 229 (46.0) |
| Addressed a long-standing physical or psychological trauma | NA | 144 (28.9) |
| Experienced “ego death”/dissolution of self | NA | 145 (29.1) |
| None of the above | NA | 57 (11.4) |
Scale range = 1 (“worst experience of my life”) to 100 (“best experience of my life”).
Each AWE-S factor score is the mean of 5 items with Likert scale for agreement (1 = strongly disagree; 4 = neutral; 7 = strongly agree).
N missing = 15.
AWE-S, Awe Experience Scale.
Like intense positive experiences, participants' most challenging experience tended to occur in a home (55.1%) and with companions (54.8%). Just over half of those who experienced an intense challenging experience (55.9%) reported that “at least some good” came from the challenging experience such as gaining insight into a difficult problem or life issue (59.6%), overcoming personal fears (46.0%), and resolving a challenging situation or emotion (38.6%; see Table 2 for full list).
In a multivariable model, significant correlates of experiencing an intense challenging psychedelic experience included higher self-perceived psychedelic experience (AOR per 10-point increase in rating = 1.19, 95% CI: 1.13–1.26) managing trauma (AOR: 1.41, 95% CI: 1.06–1.87), fun (AOR: 1.46, 95% CI: 1.10–1.92), boredom (AOR: 1.32, 95% CI: 1.01–1.73), and reducing the use of another substance (AOR: 1.39, 95% CI: 1.01–1.92) as motivating uses of psychedelic drugs; and reporting an intense positive experience (AOR = 2.39, 95% CI: 1.72–3.35). Past-year use of psychedelic drugs was negatively associated with an intense challenging experience (AOR = 0.68, 95% CI: 0.50–0.91) (Table 3).
Table 3.
Bivariable and Multivariable Correlates of Intense Positive Psychedelic Experiences (Left) and Challenging Psychedelic Experiences (Right) Among Canadian Psychedelic Survey Respondents
| |
Intense positive experience |
Challenging experience |
||
|---|---|---|---|---|
|
N
|
1724 |
1517a |
1708 |
1520b |
| Characteristic | OR (95% CI) | AOR (95% CI) | OR (95% CI) | Unadjusted OR (95% CI) |
| Age | ||||
| 10-Year increase | 1.18 (1.07–1.32)** | 1.32 (1.15–1.51)*** | 0.90 (0.84–0.98)* | 0.91 (0.83–1.00) |
| Gender | ||||
| Male (vs. female) | 1.86 (1.42–2.45)*** | 1.13 (0.79–1.60) | 1.25 (1.03–1.53)* | 1.03 (0.82–1.30) |
| Other (vs. female) | 1.19 (0.71–2.10) | 0.75 (0.39–1.51) | 2.12 (1.37–3.33)*** | 1.64 (1.00–2.75) |
| Education | ||||
| Undergraduate, college, technical degree (vs. ≤high school) | 0.90 (0.63–1.25) | NA | 0.87 (0.67–1.13) | NA |
| Graduate or professional degree (vs. ≤high school) | 1.31 (0.86–1.99) | NA | 0.81 (0.60–1.11) | NA |
| Self-perceived psychedelic experience | ||||
| 10-Point increase | 1.64 (1.54–1.75)*** | 1.50 (1.38–1.62)*** | 1.26 (1.21–1.32)*** | 1.19 (1.13–1.26)*** |
| Past-year psychedelic drug use | ||||
| Yes (vs. No) | 2.54 (1.94–3.29)*** | 0.88 (0.59–1.30) | 1.28 (1.03–1.61)* | 0.68 (0.50–0.91)** |
| Motivation for psychedelic drug use (vs. No) | ||||
| Spiritual/psychological/personal exploration | 4.22 (3.26–5.45)*** | 2.62 (1.79–3.87)*** | 1.90 (1.53–2.37)*** | 1.21 (0.89–1.65) |
| Treat specific medical condition | 1.84 (1.40–2.43)*** | 0.97 (0.63–1.51) | 1.41 (1.16–1.72)*** | 1.02 (0.76–1.35) |
| Improve general mental well-being | 2.87 (2.23–3.70)*** | 1.19 (0.78–1.80) | 1.57 (1.29–1.92)*** | 0.94 (0.71–1.26) |
| Personal growth | 3.79 (2.94–4.93)*** | 1.18 (0.77–1.80) | 1.73 (1.52–2.11)*** | 1.03 (0.76–1.38) |
| Manage past trauma | 2.64 (1.94–3.65)*** | 1.41 (0.90–2.23) | 1.65 (1.34–2.03)*** | 1.41 (1.06–1.87)* |
| Fun | 1.49 (1.13–1.95)** | 1.57 (1.06–2.32)* | 1.68 (1.34–2.11)*** | 1.46 (1.10–1.92)** |
| Boredom | 1.09 (0.81–1.47) | NA | 1.42 (1.13–1.79)** | 1.32 (1.01–1.73)* |
| Social/peer pressure | 0.72 (0.52–0.99)* | 0.98 (0.63–1.54) | 1.20 (0.92–1.57) | NA |
| Reduce the use of another substancec | 2.36 (1.60–3.60)*** | 0.95 (0.55–1.65) | 1.74 (1.35–2.25)*** | 1.39 (1.01–1.92)* |
| Psychedelic drug most typically used | ||||
| Ketamine (vs. psilocybin) | 3.46 (1.25–14.34)* | 2.85 (0.92–12.74) | 1.43 (0.82–2.57) | 1.14 (0.62–2.14) |
| LSD (vs. psilocybin) | 1.87 (1.14–3.23)* | 1.04 (0.58–1.95) | 1.64 (1.18–2.29)** | 1.14 (0.81–1.60) |
| MDMA (vs. psilocybin) | 0.76 (0.53–1.11) | 1.17 (0.73–1.89) | 1.09 (0.80–1.48) | 1.14 (0.81–1.60) |
| Otherd (vs. psilocybin) | 0.66 (0.45–0.99)* | 1.20 (0.74–1.99) | 0.95 (0.68–1.32) | 1.28 (0.89–1.86) |
| Challenging experience | ||||
| Yes versus no | 3.49 (2.67–4.60)*** | 2.43 (1.74–3.42)*** | NA | NA |
| Intensive positive experience | ||||
| Yes (vs. no) | NA | NA | 3.49 (2.67–4.60)*** | 2.39 (1.72–3.35)*** |
p < 0.05, **p < 0.01, ***p < 0.001.
Analytic n = 1517 due to missing responses for psychedelic drug most typically used (n = 191) and intense challenging psychedelic experience (n = 16).
Analytic n = 1520 due to missing responses for psychedelic drug most typically used (n = 188).
Includes prescribed and nonprescribed substances.
Includes 2C-B, ayahuasca, DMT, ibogaine, mescaline, nitrous oxide, salvia, and other (see Supplementary Table S1).
AOR, adjusted odds ratio; CI, confidence interval; LSD, lysergic acid diethylamide; MDMA, 3,4-methylenedioxymethamphetamine; OR, odds ratio.
Discussion
The CPS was developed to obtain a comprehensive picture of psychedelic drug use in Canada amid renewed scientific interest in psychedelic drug therapies and societal interest in legal access to psychedelic drugs. This study serves to characterize patterns of psychedelic drugs used (including type(s), motivations, and contexts of use), current and preferred sources of psychedelic drug access, and acute experiences induced by psychedelic drug use in a large sample of people who use them. Psilocybin was the most used psychedelic drug (both ever and in the past-year), but MDMA and LSD followed closely, and most respondents report typically using these drugs in familiar social and environmental settings (e.g., at home with friends).
However, as detailed through psychedelic-specific data reported throughout Supplementary Tables S1 and S2, relationships with psychedelic drugs represented within the survey are complex, individualistic, and extend into the use of unscheduled novel psychoactive substances, use for spiritual or religious purposes, and use in the context of retreats and with unlicensed guides.
Amid growing scientific focus on the clinical applications of psychedelic drugs—particularly for the treatment of specific mental health and substance use disorders,5 most respondents were still motivated by nonmedical reasons (i.e., for fun and personal exploration, and personal growth). Considering recent survey-based studies describing the self-guided use of classical psychedelic drugs to reduce or stop the use of other substances,17–20 naturalistic studies documenting prospective reductions in substance use among attendees of guided ceremonial ayahuasca retreats,21,22 and high-impact media coverage of the therapeutic potential of classical psychedelic drugs for substance use disorders,23 we included explicit categories for the use of psychedelic drugs to reduce or stop the use of prescription and nonprescription drugs.
About 1 in 10 respondents endorsed each of these “substitution” categories, together representing 18% of the sample. Future research is needed to elucidate a detailed contextual understanding about this type of use (e.g., type of psychedelic drugs used, intended substance for reduction, whether self guided or clinician guided, and metrics of effectiveness). However, our findings highlight an emerging patient and clinician need for guidance around this relatively common practice. A limited number of contemporary clinical trials show promise for psilocybin in reducing alcohol and tobacco use,24–26 but limitations of these studies necessitate further placebo-controlled research in this area.
Under the current prohibitive framework for psychedelic drugs, respondents reported a wide range of access points for obtaining psychedelic drugs, with friends or acquaintances providing the most common source, followed by online sales. Except for in-clinic prescription use of ketamine or therapeutic access from a health care provider through Health Canada's Special Access Program, current access channels are not legal or regulated. However, there appears to be strong interest in obtaining psychedelic drugs through safe, legal, and regulated sources.
This is evidenced by the very few (3%) respondents reporting dealers as a preferred access option under ideal conditions compared with the majority (>50%) favoring more traditional retail options such as online stores, retail stores, pharmacies, and clinics—all of which typically represent access options covered by a legal regulatory framework and associated quality controls.
About four in five (82%) respondents endorsed an intense positive psychedelic experience, rating their most intense experience relatively high on the AWE-S—and particularly on the “connectedness” subscale. Qualitative research points to enhanced feelings of connectedness as a key component of psychedelic-attributed positive effects on depression and addiction,27,28 and quantitative research demonstrates that increased feelings of connectedness partially mediate associations between psychedelic drug use and positive mood in general samples.29
In addition, over half (52%) of respondents endorsed an intense challenging psychedelic experience that included common characteristics such as confronting painful emotions or experiencing social paranoia or troubling hallucinations. Notably, 35% thought they would “never be the same,” and 26% worried they “might die,” so although psychedelic drugs are considered relatively safe compared with other common psychoactive substances such as alcohol and tobacco,30,31 these negative experiences nonetheless posed an existential threat to many participants.
However, 55% expressed agreed that “some good” emerged from their challenging experience including being able to resolve a challenging situation or emotion, gaining insight into a life issue, overcoming personal fears, addressing long-standing trauma, and experiencing “ego death.” Perceived benefit from challenging psychedelic experiences has been previously documented in a survey of psilocybin use32 and, in some cases (e.g., ayahuasca), acute adverse physical and psychological experiences are framed as integral to the therapeutic experience.33,34 The narrative practice of finding value in the challenging aspects of a psychedelic experience is thought to serve as a coping and integration mechanism.35
Although both intense positive and negative/challenging outcomes were significantly related to one-another, demonstrating substantial overlap, they did not share an identical set of independent correlates. Notably, the odds of each outcome increased significantly with self-ranked psychedelic experience. Although not a direct measure of number of times used, perceived experience is expected to increase with number of psychedelic experiences, likely contributing to this finding. Experienced users may also be more willing to explore psychedelic drugs more deeply by experimenting with higher doses or different substances.
In a naturalistic study prospectively documenting acute responses to classical psychedelic drugs, both acute mystical type and challenging experience were positively correlated with dose consumed and mystical-like—but not challenging—experiences were correlated with higher lifetime psychedelic drug use.36
The odds of each outcome also differed according to the typical motivations for psychedelic drug use. Whereas personal exploration (spiritual or psychological) was associated with intense positive experiences, managing trauma, reducing other substance use, and boredom were all associated with intense challenging experiences. The potential for psychedelic drugs to produce positive or challenging experiences is widely thought to be modified by one's mindset (e.g., expectations and psychopathology) and physical and social settings, collectively referred to as “set and setting.”37,38 Although typical motivations for use cannot directly capture personality traits or session-specific data on set and setting, some hypothesis-generating signals can be derived from the observed associations.
A recent systematic review examined relationships between individual baseline traits and acute psychedelic effects and found that, in general, personality traits indicative of one's openness to, and acceptance of, diverse cognitive experiences predicted with mystical and positive reactions, whereas traits indicative of apprehension or distress correlated with adverse reactions.39 Challenging experiences may be more likely when individuals are less clear about intentions for their psychedelic session.36
Boredom as a typical motivation for use may signify an indifferent mindset, possibly precluding any clear intention setting for the experience. Those using psychedelic drugs as a strategy to manage trauma or substance use disorders without clinical guidance may be more prone to distress upon entering the experience, increasing vulnerability to adverse reactions. Spiritual or psychological exploration may be more conducive to setting clear intentions and fostering feelings of openness and acceptance. Interestingly, “fun” as a general motivating factor for psychedelic drug use was associated with both intense positive and challenging experiences.
This category is open to broad interpretation and likely covers a range of mindsets (e.g., from nervousness to acceptance related to the experience) and intentions (from curiosity to connection with others or nature). Further dissecting this motivation will be important for future research seeking to understand the relationship of set and setting with psychedelic experiences.
Although this study benefits from the inclusion of detailed data collected from a large cohort of respondents, it is also subject to important limitations. This was a self-selected sample of people who use psychedelic drugs in Canada and may not be generalizable to the entire population of people living in Canada with past or current psychedelic drug use; in particular, as has been raised as an ongoing concern in psychedelic research,40 Black, Indigenous, and other people of color were under-represented.
In addition, since recruiting included organizations advocating for legal access to psychedelic drugs, respondents with positive experiences may be over-represented. Data were self-reported and vulnerable to recall inaccuracies and responding according to perceived social norms. In addition, due to the largely unregulated nature of psychedelic drugs, the identity, purity, or quality of substances reportedly used cannot be confirmed. The survey is cross-sectional and assessed typical or most intense experiences, preventing the possibility of investigating causal connections between variables.
As follow-up questions regarding frequency, access, and typical patterns of use for specific psychedelic drugs were triggered for lifetime use, we had missing responses (ranging from 6% to 45%, depending on the substance; see Supplementary Table S2) from respondents who indicated past-year use without indicating lifetime use. These data were used for descriptive purposes only and could not be combined for inclusion in the statistical analyses. Potentially important correlates of intense positive and/or challenging experiences that should be further explored in future research including total number of psychedelic drug uses (in this case, we were able to use self-perceived psychedelic experience as a proxy) and typical social and environmental setting of use.
Conclusions
This is the first survey to comprehensively document the use of psychedelic drugs in Canada. Respondents reported a wide range of access sources under the current legal framework and an interest in obtaining psychedelic drugs through more formal regulated channels. In general, most respondents used psychedelic drugs for fun, but some were more typically used for other purposes such as self-exploration. Intense positive and challenging psychedelic experiences were both common (>50%) and related to level of psychedelic experience and typical motivations for use.
This study's documentation of consumer characteristics, current patterns of access and use, and end-user experiences will help to inform evolving clinical, research, and policy discussions related to psychedelic drug access, education, and applications in Canada. However, considering the steady increase in psychedelic drug use for both therapeutic and nontherapeutic purposes in Canada and other jurisdictions, further observational and clinical research is warranted.
Acknowledgments
The authors would like to thank all of the respondents for sharing their experiences with psychedelic substances; your time expertise is deeply appreciated. Additionally, we'd like to thank the study sponsors for supporting this important research: SABI Mind, the Multidisciplinary Association of Psychedelic Studies Public Benefits Corp. (MAPS PBC), and Psygen Industries.
Authors' Contributions
S.L. contributed to conceptualization, methodology, formal analysis, investigation, data curation, writing—original draft, writing—review and editing, and visualization; P.L. contributed to conceptualization, methodology, investigation, resources, writing—original draft, writing—review, and funding acquisition.
Author Disclosure Statement
P.L. is the president of Sabi Mind, a cosponsor of this study. However, his compensation is not tied in any way to the outcomes of this study.
Funding Information
The Canadian Psychedelic Survey was co-sponsored by SABI Mind, the Multidisciplinary Association of Psychedelic Studies Public Benefits Corp. (MAPS PBC), and Psygen Industries.
Supplementary Material
References
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