Psychedelics and chronic pain: self-reported outcomes on changed substance use patterns and health following naturalistic psychedelic use

Abstract

Psychedelic substances have shown preliminary efficacy for several neuropsychiatric disorders and are currently being investigated for chronic pain conditions. However, few studies have investigated outcomes of naturalistic psychedelic use among individuals with chronic pain, and none have assessed psychedelic-related changes in substance use patterns in this population. In a cross-sectional survey of adults who reported using psychedelics to self-treat a chronic pain condition (n = 466; 46.1% women), we investigated changed substance use patterns and self-reported outcomes on physical and mental health following use of a psychedelic. Most (86.3%; n = 391/453) indicated that they ceased or decreased use of one or more non-psychedelic substances “as a result of” psychedelic use, and 21.2% (n = 83/391) indicated that the decrease in use persisted for more than 26 weeks after psychedelic use. Alcohol (71.1%; n = 226/318) and prescription opioids (64.1%; n = 100/156) had the highest proportions for ceased/decreased use. Illicit opioids (27.8%; n = 22/79) and cannabis (21.5%; n = 78/362) had the highest proportions for increased/initiated use. In multivariate regression modeling, having a motivation to reduce one’s substance use was positively associated with ceasing/decreasing substance use (p < .001). Perceptions of health outcomes following psychedelic use were broadly positive, and psilocybin was reported to be the most effective substance for both physical and mental health symptoms. Although limited by a cross-sectional study design, findings from this large sample merit future investigation into the benefits and risks of naturalistic psychedelic use among individuals with chronic pain.

Introduction

Over the past two decades, psychedelics and psychedelic-assisted therapies have shown remarkable promise for the treatment of a variety of neuropsychiatric disorders. ¹ Although the therapeutic mechanisms of psychedelic treatments are not completely understood, leading hypotheses suggest synergistic effects among neurobiological mechanisms such as serotonin 2A receptor activation, enhanced neuroplasticity, and altered functional connectivity^2,3 and psychological mechanisms such as the acute effects of the subjective experience,^4,5 increased acceptance,^6–8 increased cognitive flexibility, and enhanced feelings of connection to self, others, and nature.^9,10

There is growing interest in the potential of psychedelics for treating physical health conditions such as those involving chronic pain.^11–13 Chronic pain, which may affect up to 30% of the global population, presents a substantial economic burden and is among the leading causes of seeking medical care. ¹⁴ The biopsychosocial model, which is a prominent framework for the etiology of chronic pain, postulates that dynamic interactions among biological, psychological, and social factors contribute in a multidimensional manner to the presentation and occurrence of physical pain symptoms. ¹⁵ The transdiagnostic potential of psychedelic-assisted therapies, therefore, has provided impetus for the next wave of clinical research of psychedelics for the treatment of chronic pain conditions. ¹⁶ Indeed, clinical trials are currently underway to assess psilocybin-assisted therapies for a range of chronic pain conditions including fibromyalgia (NCT05128162), low back pain (NCT05351541), phantom limb pain (NCT05224336), migraine and cluster headache (NCT04218539; NCT02981173), and cancer-related pain (NCT06001749).

Investigation of naturalistic psychedelic use among individuals with chronic pain has been limited. In a recent survey of individuals with fibromyalgia (N = 354), approximately one-third of participants reported past use of a psychedelic, and less than 3% reported negative effects on overall health or pain symptoms. ¹⁷ Another observational study (N = 250) of individuals with varying chronic pain conditions found that macro doses of psychedelics were perceived to provide significantly more pain relief than over the counter medications, opioids, or cannabis. In addition, relative to micro (i.e., sub-perceptual) doses, macro doses provided significantly improved reductions in pain intensity and pain acceptance. ¹⁸

Together, these studies support potential health benefits related to naturalistic psychedelic use in patients with chronic pain. However, there is an absence of research on other relevant patient outcomes, such as changes in non-psychedelic substance use patterns and resulting changes in mental health, both of which may be important factors in assessing chronic pain treatment outcomes in the context of the biopsychosocial model of pain. In the current study, we surveyed an adult population of individuals who reported using psychedelics to self-treat a chronic pain condition. Perceived mental and physical health outcomes were assessed along with resulting changes in substance use patterns and predictors of those changes. Consistent with other investigations of naturalistic psychedelic use,^17–20 we hypothesized that participants would report improved chronic pain symptoms as well as reductions in use of other substances following psychedelic use.

Methods

The data presented here were collected from the Global Psychedelic Survey, a large cross-sectional survey distributed online between May 19 and June 2, 2023 via online psychedelic organizations including the Multidisciplinary Association for Psychedelic Studies (MAPS) and MAPS Canada, The Psychedelic Association of Canada, OPEN Foundation, Mind Medicine Australia, International Center for Ethnobotanical Education, Research and Service (ICEERS), and social media. This survey gathered data on psychedelic use trends among English-speaking adults 21 years of age or older across the globe. The survey targeted 11 substances with psychedelic-like properties including the “classic” psychedelics ayahuasca, DMT/5-MeO-DMT (N,N-dimethyltryptamine/5-methoxy-N,N-dimethyltryptamine), LSD/acid, mescaline, and psilocybin, as well as several “atypical” psychedelics including 2C-B (4-Bromo-2,5-dimethoxyphenethylamine), iboga/ibogaine, ketamine, MDMA/MDA (3,4-methylenedioxymethamphetamine/3,4-methylenedioxyamphetamine), nitrous oxide, and Salvia divinorum. The study was reviewed by Advarra (protocol # Pro00071490) to help ensure that the rights and welfare of research participants were protected and that the research study was carried out in an ethical manner. However, the IRB only oversaw Canadian subjects, determining that this international study was otherwise exempt from IRB oversight in other jurisdictions under the Department of Health and Human Services regulation 45 CFR 46.104(d)(2).

Sample and data cleaning

All participants were English literate adults (≥21 years) who self-reported past or current use of one or more of the 11 psychedelics included in the survey. Informed consent to participate was gathered online as a part of the survey, and all responses were collected anonymously. Upon survey completion, participants were given the option to provide their email address to be entered into a drawing for one of three $500 Amazon gift cards. All email addresses were stored separately from the study data and were deleted prior to data analysis to ensure confidentiality and anonymity of participants. Data gathering was conducted via the Quantified Citizen website and app, which are both Personal Information Protection and Electronic Documents Act (PIPEDA) and Health Insurance Portability and Accountability Act (HIPAA) compliant.

Prior to analysis, data were cleaned and prepared by Precision Analytics. In addition to removing duplicate responses, data were excluded if the participant’s reported age was either missing or less than 21 years, or if they did not report naturalistic use of one of the 11 psychedelic substances in their lifetime. This resulted in a dataset of 6379 valid responses for the Global Psychedelic Survey. The current report focuses only on those who indicated that they have attempted to self-treat a chronic pain condition with psychedelics. The final analytic sample includes data from 466 respondents, which are included in the subsequent analyses.

Measures

A complete list of the questions in the survey is provided as a supplementary material. In addition to addressing demographic characteristics such as gender, country of residence, age, education, and income, the survey also included questions about various aspects of psychedelic use such as number (i.e. variety) of psychedelics used, typical dosages consumed (microdoses only, macrodoses only, both micro and macro doses), and motivations for using psychedelics with possible responses including: to treat a medical condition, to reduce use of another substance, general well-being, personal growth/self-exploration, religious/spiritual development, recreational, or none of the above. In addition, we assessed lifetime use of non-psychedelic substances and medications, including alcohol, cannabis, nicotine/tobacco, antidepressants, benzodiazepines (e.g., Valium and Ativan), prescription or non-prescription amphetamines (e.g., Ritalin, Adderall, speed, and crystal meth), cocaine/crack, prescription opioids (e.g., Fentanyl, Oxycodone, and Hydromorphone), and illicit opioids (e.g., heroin, Fentanyl, Oxycodone, and Hydromorphone).

Changes in substance use

We asked participants if their use of any non-psychedelic substances changed “as a result” of their psychedelic use via nine questions (one for each non-psychedelic substance of interest listed above). Respondents who endorsed lifetime use of a non-psychedelic substance at the survey outset were presented with the corresponding change in use question for each endorsed substance later in the survey. The exception was antidepressants, for which the changes in use question was presented to all respondents, as lifetime use was not assessed with the other substances as the survey outset. For each of the nine categories of non-psychedelic substances, participants indicated whether their use of psychedelics resulted in ceased use, decreased use, no change in use, initiation of use, increased use, or an option for not having used that substance. We included the latter category due to the inclusion of antidepressants (asked to all participants) and as we expected some respondents with lifetime use of a substance to not identify with any other listed response option (e.g., cases of one-time use many years before survey completion). Participants who reported ceasing or decreasing substance use “as a result of” naturalistic psychedelic use then identified the psychedelic substance that was particularly impactful for ceasing or decreasing the use of other substances. We also asked these participants how psychedelics helped them cease or decrease use of other substances in a “select all that apply” format with possible options including: they made me feel more connected to myself, they changed my relationship with/or perspective on other substances, they made me less anxious or depressed, they helped me resolve past trauma, they made me feel more connected with nature, they made me feel more connected with others, they made me feel more connected with spirit, they reduced cravings/urges, or they reduced withdrawal. Finally, we asked participants who reported ceased or decreased use how long the decrease in substance use typically persisted after using psychedelics, with response options including: Less than 1 week, 1–4 weeks, 5–11 weeks, 12–26 weeks, more than 26 weeks, or no set pattern.

Health outcomes

For both physical and mental health conditions, we asked participants to select all health conditions that they have attempted to treat with psychedelics, whether they found psychedelics to be effective (yes vs no), the effectiveness rating of each psychedelic used for both mental and physical health conditions (0–100; 0 = not at all effective, 100 = very effective), the duration of beneficial effects (ranging from less than 1 week to more than 1 year), the reasons for trying psychedelics, and the substance that has been the most effective in treating symptoms of their condition(s). We also asked participants to report whether they had pursued a range of conventional treatments prior to using psychedelics to self-treat a mental health condition, or at the current time. Possible responses included counseling, physical activity, mindfulness, meditation/yoga, medications, combination therapy and medications, herbal remedies, or cognitive-behavioral therapy.

Statistical analysis

We first characterized the sample via descriptive statistics. We then sub-grouped participants by whether they reported ceased/decreased use of any substance (ceased/decreased use vs no ceased/decreased use). We compared associations between these two sub-groupings and socio-demographic characteristics using chi-square tests and the Cramer V statistic for categorical variables, and independent sample t-tests and the Cohen d statistic for continuous variables. To identify potential predictors of changed substance use, we conducted binary logistic regression analyses for those who reported ceased or decreased substance use. Predictors in the model included: age, gender identity (female, other gender [gender fluid, transgender, a different gender] vs male), education level (scored continuously from: less than high school, high school degree or equivalent, technical or non-university degree, university degree [Bachelor’s or equivalent], graduate degree [MA, MSc, etc.], doctorate or professional degree [JD, MD, PhD, etc.]), income (scored continuously from: very low income/well below average, low income/below average, middle income/about average, high income/above average, very high income/well above average), race/ethnicity (White/Caucasian vs other), number of psychedelics used (up to 12), type of psychedelic dose(s) consumed (both macro and micro doses, only micro doses, vs only macro doses), motivations for psychedelic use (medical, recreational, to reduce other substance use; all yes vs no). Pairwise McNemar’s tests were used to compare pursuit of conventional treatments prior to using psychedelics for mental health versus at the time of survey completion. Possible treatments included talk therapy/counseling, cognitive-behavioral therapy (CBT), mindfulness, medications (e.g., antidepressants, antianxiety, mood stabilizers, antipsychotics, and sedatives), combination therapy and medications, herbal remedies (e.g., St John’s Wort, Kava Kava, Chamomile Extract, and Valeria), meditation/yoga/Tai Chi/Qigong, and physical activity. Significance was set at α = 0.05 (two-sided) for all tests, and all analyses were conducted using SPSS version 29.

Results

The sample included 466 adults (46.1% women) with an average age of 42.6 ± 12.1 years. Among those who reported previously using non-psychedelic substances (n = 453), 86.3% (n = 391/453) indicated that they ceased or decreased use of one or more non-psychedelic substances “as a result of” psychedelic use, and 13.3% (n = 62/453) did not cease or decrease use of any substances (Table 1). A significantly higher proportion of those who ceased or decreased use of other substances were younger, had used a larger variety of psychedelics, and consumed both micro and macro doses (all p values <.01).

Table 1.

Demographics.

Descriptive	Ceased or decreased use (n = 391)	No ceased or decreased use (n = 62)	t or χ2	p Value
Gender			3.2	.53
Women	44.8% (175)	53.2% (33)
Men	51.2% (200)	40.3% (25)
Non-binary	3.1% (12)	4.8% (3)
Other	0.8% (3)	1.6% (1)
Prefer not to say	0.3% (1)	0% (0)
Region of residence			8.6	0.04
Asia pacific	11.3% (44)	3.2% (2)
Europe	4.3% (17)	1.6% (1)
Latin America	1.3% (5)	4.8% (3)
North America	83.1% (325)	90.3% (56)
Age in years (M, SD, range)	41.7, 11.4, 21 - 76	47.0, 14.0, 25 - 80	3.3	<.001
21–24	1.5% (6)	0% (0)
25–34	33.0% (129)	22.6% (14)
35–44	30.2% (130)	27.4% (17)
45–54	16.1% (63)	22.6% (14)
55–64	11.3% (44)	11.3% (7)
>65	4.9% (19)	16.1% (10)
Number of psychedelics used (M, SD, range)	5.5, 2.4, 1 - 12	4.6, 2.5, 1 - 12	−2.8	<.01
Dosage used			273.616	<.001
Microdose only	1.8% (7)	6.5% (4)
Macrodose only	9.0% (35)	12.9% (8)
Both micro and macro doses	89.3% (349)	80.6% (50)
Education			6.2	0.28
Less than high school	4.1% (16)	1.6% (1)
High school or equivalent	16.1% (63)	11.3% (7)
Technical degree	17.1% (67)	12.9% (8)
Bachelors degree or equivalent	28,4% (111)	24.2% (15)
Graduate degree	23.5% (92)	33.9% (21)
Doctoral /professional degree	10.7% (42)	16.1% (10)
Income			3.01	0.56
Very low	7.7% (30)	6.5% (4)
Low	21.2% (83)	19.4% (12)
Middle	34.5% (135)	45.2% (28)
High	26.1% (102)	22.6% (14)
Very high	10.5% (41)	6.5% (4)

Among those with previous use, greater than half of participants reported ceasing or decreasing use of all non-psychedelic substances, excepting cannabis, as a result of psychedelic use (Figure 1). The highest proportions of ceased or decreased use were with alcohol (71.1%; n = 226/318), prescription opioids (64.1%; n = 100/156), antidepressants (63.1%; n = 185/283), and illicit opioids (60.7%; n = 48/79). Cannabis had the lowest proportion of ceased or decreased use (39.0%; n = 141/362) among all substance classes. Reports of increased or initiated use of substances following psychedelic use were lower (39.1%; n = 177/453) among those who endorsed previously using one or more substances. The highest proportions of increased or initiated use were with illicit opioids (27.8%; n = 22/79), cannabis (21.5%; n = 78/362), and amphetamines (21.4%; n = 39/182). Alcohol had the lowest proportion of increased or initiated use (9.7%; n = 31/318).

Figure 1.

Self-reported changes in substance use following psychedelic use. The number of participants who reported past or current use of a substance is listed below each substance. Proportions for each category are shown in their respective locations. BDZs: benzodiazepines, AMPs: amphetamines.

Among those who reported ceasing or decreasing use of at least one non-psychedelic substance, psilocybin was most often endorsed (29.9%; n = 117/391) as the most impactful psychedelic that contributed to that change, followed by ketamine (12.5%; n = 49/391) and ayahuasca (11.8%; n = 46/391) (Table 2). Of the sub-group who reported psilocybin as most effective, most (88.0%; 103/117) had used more than one psychedelic in their lifetime. Psilocybin was also reported as the most effective substance for those who reported ceasing or decreasing use of both prescription opioids (33.3%; n = 33/100) and illicit opioids (18.8%; n = 9/48) following psychedelic use. Approximately one-third (35.0%; n = 137/391) reported that their decrease in substance use did not follow a set pattern of time or that it depends on the substance and circumstance, whereas 21.2% (n = 83/391) indicated that their decrease in substance use typically lasts for more than 26 weeks. Reported reasons for how psychedelics contributed to decreased substance use patterns centered on feelings of connection, with participants reported increased feelings of connection to self (62.7%; n = 245/391), others (52.2%; n = 204/391), spirit (51.7%; n = 202/391), and nature (50.4%; n = 197/391). A majority also indicated that psychedelics made them feel less anxious or depressed (51.2%; n = 200/391), and that they changed their relationship with/or perspective on other substances (50.1%; n = 196/391).

Table 2.

Details about changed substance use patterns.

	n = 391	% of total
Which of the following psychedelics did you find particularly impactful in ceasing or decreasing your use of other substances?
Psilocybin	117	29.9
Ketamine	49	12.5
Ayahuasca	46	11.8
DMT/5-MeO-DMT	27	6.9
LSD	24	6.1
MDMA	23	5.9
Iboga/Ibogaine	22	5.6
Mescaline	15	3.8
Nitrous oxide	14	3.6
2C-B	9	2.3
Salvia divinorum	8	2.0
None of the above	37	9.5
How long does the decrease in substance use typically persist after using psychedelics?
Less than 1 week	30	7.7
1–4 weeks	58	14.8
5–11 weeks	47	12.0
12–26 weeks	36	9.2
More than 26 weeks	83	21.2
No set pattern	137	35.0
How have psychedelics helped you to cease or decrease the use of other substances?
They made me feel more connected to myself	245	62.7
They made me feel more connected with others	204	52.2
They made me feel more connected with spirit	202	51.7
They made me less anxious or depressed	200	51.2
They made me feel more connected with nature	197	50.4
They changed my relationship with/or perspective on other substances	196	50.1
They helped me resolve past trauma	184	47.1
They reduced cravings/urges	157	40.2
They reduced withdrawal	93	23.8
None of the above	19	4.9

A multivariate regression model was developed to determine potential predictors of ceased or decreased substance use. We found that using psychedelics with a motivation to reduce one’s substance use was positively associated with ceased or decreased use (p < .001), and age was negatively associated with ceased or decreased use (p = .049) (Table 3).

Table 3.

Univariate and multivariate predictions of factors associated with ceasing or decreasing use of other substances.

Predictor	Univariate predictions			Multivariate predictions
	Exp(B)	95% CI	p	Exp(B)	95% CI	p
Reduced substance use motivation	5.91	2.09 - 16.67	<.001	6.48	2.22 - 18.89	<.001
Age	0.97	0.95 - 0.99	<.01	0.98	0.95 - 0.99	0.049
Education level	0.77	0.62 - 0.96	0.020	0.80	0.62 - 1.02	0.076
Has used only micro doses	0.24	0.07 - 0.84	0.025	0.28	0.05 - 1.38	0.118
Number of psychedelics used	1.18	1.04 - 1.33	0.010	1.12	0.97 - 1.28	0.125
Other gender	0.71	0.20 - 2.52	0.590	0.47	0.10 - 2.09	0.322
Medical motivation	0.66	0.35 - 1.23	0.187	0.72	0.35 - 1.42	0.342
Has used micro and macro doses	0.55	0.26 - 1.18	0.125	1.27	0.47 - 3.39	0.637
White/Caucasian	0.77	0.33 - 1.79	0.547	0.83	0.33 - 2.00	0.673
Recreational motivation	1.22	0.69 - 2.16	0.486	1.09	0.58 - 2.04	0.784
Income level	1.01	0.78 - 1.32	0.919	1.03	0.76 - 1.39	0.825
Female gender	0.75	0.43 - 1.32	0.324	0.93	0.50 - 1.74	0.832

The most highly cited reasons for trying psychedelics to treat mental or physical health conditions were because the participant did not like the idea of traditional treatments (41.2%; n = 192/466), and that traditional treatments were ineffective (29.8%; n = 139/466) (Table 4). In addition to chronic pain, which all participants reported treating with psychedelics, headache/migraines (34.3%; n = 160/466), and sleeping disorders (31.8%; n = 148/466) were the most highly cited physical conditions that were treated with psychedelics. A majority (78.8%; n = 367/466) indicated that psychedelics were effective in treating their physical health conditions, and 18.4% (n = 63/343) reported that the benefits of psychedelics on physical health symptoms typically last for more than 1 year. The mental health conditions that were most often treated with psychedelics among this population were depression (84.6%; n = 230/272), anxiety (76.1%; n = 207/272), and PTSD (63.2%; n = 172/272). Nearly all (99.3%; n = 270/272) indicated that psychedelics were effective in treating their mental health conditions, and 28.1% (n = 75/267) reported that the benefits of psychedelics on mental health symptoms typically last for more than 1 year. Psilocybin was reported as the most effective psychedelic in treating both physical (29.4%; n = 137/466), and mental (48.9%; n = 133/270) health conditions. Participants were asked to rate the effectiveness (0-100) of the substance that they deemed to be most effective for both physical and mental health conditions. Ketamine, endorsed by 70 participants as the most effective substance for treating physical health symptoms, had the highest effectiveness rating for physical health conditions (mean ± standard error of mean = 73.5 ± 2.6), and DMT, endorsed by 11 participants as the most effective substance for treating mental health symptoms, had the highest effectiveness rating for mental health conditions (92.6 ± 3.4) (Figure 2).

Table 4.

Health outcomes.

	n = 466	% of total
What led you to trying psychedelics to treat your physical or mental health symptoms?
I did not like the idea of traditional treatments	192	41.2
Traditional treatments were ineffective	139	29.8
It fits with my beliefs or cultural practices	99	21.2
I saw positive media coverage	89	19.1
It was recommended by friends	86	18.5
Other	139	29.8
None of the above	11	2.4
Which physical health conditions have you attempted to treat with psychedelics?
Chronic pain	466	100.0
Headache/migraines	160	34.3
Sleeping disorder	148	31.8
Neurological disorder	86	18.5
Gastrointestinal disorder	83	17.8
Autism spectrum disorder	78	16.7
Traumatic brain injury	74	15.9
Cancer	58	12.4
COVID-19	53	11.4
Diabetes	48	10.3
Other	65	13.9
Have you found psychedelics to be effective in treating your physical health conditions?
Yes	367	78.8
No	99	21.2
How long do the benefits of psychedelic on your physical health condition typically last? (n = 343)
1 week or less	108	31.5
Between 1 week and 1 month	83	24.2
Between 1 month and 1 year	89	25.9
More than 1 year	63	18.4
Which psychedelic has been the most effective in treating your physical health condition?
Psilocybin	137	29.4
Ketamine	70	15.0
Ayahuasca	34	7.3
LSD	25	5.4
MDMA	24	5.2
DMT/5-MeO-DMT	16	3.4
Mescaline	15	3.2
Iboga/Ibogaine	10	2.1
Salvia divinorum	7	1.5
Nitrous oxide	5	1.1
2C-B	4	0.9
None of the above	19	4.1
Which mental health conditions have you attempted to treat with psychedelics?(n = 272)
Depression	230	84.6
Anxiety	207	76.1
PTSD	172	63.2
Substance use disorder	85	31.3
ADHD	73	26.8
OCD	39	14.3
Bipolar disorder	31	11.4
Eating disorder	29	10.7
Personality disorder	28	10.3
Other	21	7.7
Have you found psychedelics to be effective in treating your mental health conditions?
Yes	270	99.3
No	2	0.7
How long do the benefits of psychedelics on your mental health condition typically last? (n = 267)
1 week or less	48	18.0
Between 1 week and 1 month	73	27.3
Between 1 month and 1 year	71	26.6
More than 1 year	75	28.1
Which psychedelic has been the most effective in treating your physical health condition?(n = 270)
Psilocybin	133	48.9
Ketamine	37	13.6
MDMA	28	10.3
Ayahuasca	26	9.6
LSD	23	8.5
DMT/5-MeO-DMT	11	4.0
Iboga/Ibogaine	4	1.5
Mescaline	3	1.1
Salvia divinorum	2	0.7
None of the above	3	1.1
Missing	2	0.7

Figure 2.

Effectiveness ratings of psychedelics for mental and physical health Participants were asked to indicate which psychedelic substance was most effective for self-treatment of their mental (a) or physical (b) health condition(s), and “n” denotes the number of participants who endorsed each substance as most effective. Plots show mean effectiveness ratings (0 - 100; 0 = not at all effective, 100 = very effective), with error bars showing ± standard error of mean.

Participants retrospectively reported whether they had pursued conventional treatments for their mental health prior to using psychedelics, and at the time of survey completion (Figure 3). At the time of survey completion, significantly fewer participants indicated that they pursued counseling (36.1% vs 20.2%; p < .001), medications (27.9% vs 10.3%; p < .001), combination therapy and medications (22.3% vs 7.1%; p < .001), herbal remedies (22.1% vs 12.0%; p < .001), and CBT (20.8% vs 5.8%; p < .001).

Figure 3.

Changes in conventional treatments before and after psychedelic use Participants were asked to retrospectively report which conventional treatment(s) they pursued prior to using psychedelics as a mental health treatment, and in a follow-up question, which conventional treatment(s) they currently (at the time of survey completion) pursue. N = 466 for all groups. CBT: cognitive-behavioral therapy. McNemar’s test was used to compare proportions between “prior” and “currently” groups. *p < .001.

Discussion

Among this large sample of adults who reported self-treating a chronic pain condition with naturalistic use of psychedelics, we found that many participants reported decreased substance use patterns, improved symptoms of physical and mental health conditions, and reductions in many conventional mental health treatments following psychedelic use. These findings contribute to a growing body of literature suggesting potential health benefits of psychedelics in naturalistic settings and provide new insights into the potential of psychedelics for individuals with chronic pain conditions. However, nearly 40% of the population also reported increased or initiated use of substances following psychedelic use, so we remain cautious about potential effects of psychedelics on changed substance use patterns.

Most of the sample (86.3%; n = 391/453) indicated that they ceased or decreased use of one or more non-psychedelic substances as a result of psychedelic use. This is an important finding in consideration of the known overlap between problematic substance use and chronic pain conditions. Alcohol dependence and prevalence of alcohol use disorder is increased in those with chronic pain conditions,^21,22 and it has been reported that over 60% of chronic pain patients may present with a comorbid opiate use disorder.^23,24 Treating chronic pain patients with comorbid substance use disorders is particularly challenging, given the habit-forming potential of many analgesic drugs, ²⁵ and exacerbation of chronic pain symptoms that can result from drug dependence and drug seeking behavior. ²⁶ Novel strategies are needed to support this large patient population, and the results here suggest that psychedelic treatments may have clinical potential for these comorbid indications.

Alcohol was the substance most often reported as ceased or decreased (70.1%; n = 226/318), followed by prescription opioids (64.1%; n = 100/156). Illicit opioids showed the highest proportion in the ceased category, with 46.8% (n = 37/79) indicating that they stopped using illicit opioids as a result of their psychedelic use. Importantly, among those who reported ceasing or decreasing use of any substance (n = 391), nearly a quarter (21.2%; n = 83/391) said that the decrease in substance use typically persists for more than 6 months after using psychedelics. Given the ongoing crises resulting from the prevalence of highly toxic opioids circulating in unregulated drug supply, and the known harms of opioid addiction, these results shed light on a potential future direction of clinical psychedelic research. Apart from a small technical report, ²⁷ there are no published trials on the treatment of opiate use disorder or opiate withdrawal symptoms with classical psychedelics. A handful of studies, however, have shown promising preliminary results with ibogaine ²⁸ and ketamine. ²⁹ Research in this field is still nascent, and caution must be exercised, especially with ibogaine, which may have neuro- and cardiotoxicity properties that may be of particular risk to those with pre-existing cardiovascular conditions. ³⁰

Consistent with previous findings, ²⁰ we found that within this chronic pain population, having a motivation to reduce one’s substance use was positively associated with ceased/decreased use. This aligns with an increasing body of work, suggesting the importance of intention setting for beneficial therapeutic outcomes with psychedelics.^31,32 Although intention setting is an inherent component of clinical research, these findings suggest that naturalistic psychedelic use outcomes are improved by purposeful intention setting. We also found that age was negatively associated with decreasing or ceasing substance use, which aligns with a growing body of literature suggesting blunting effects of psychedelics with increased age.^33,34

In addition to changed substance use patterns, we also assessed self-reported outcomes on physical and mental health. We observed that over a third of the population reported using psychedelics to self-treat headache/migraines, conditions which have received increasing attention in clinical and observational research with classical psychedelics. ³⁵ Similarly, the mental health conditions most often self-treated within this population include those that have been investigated most heavily in academic research settings (i.e., depression, anxiety, and PTSD). This finding, which has been repeatedly observed in observational studies,^36–39 suggests that motivations for naturalistic psychedelic may be informed by trends and outcomes of clinical research conducted under controlled conditions. With the challenges of scalability that loom for the likely future of commercialized psychedelic medicine (i.e., the intense time and staffing burden required for preparation, dosing, and integration sessions), these results suggest that naturalistic psychedelic use could have comparable efficacy relative to clinical settings, and alternative approaches could be explored as psychedelics are deployed into mainstream care. ⁴⁰ This is supported by the findings that for physical health conditions, nearly 80% found psychedelics to be effective, and nearly 20% experienced benefits for more than 1 year, and for mental health conditions, 99% found psychedelics to be effective with nearly 30% experiencing benefits for over 1 year. On the other hand, these findings may be the result of a so-called “psychedelic hype bubble,” that has caused an inflation of perceived effectiveness or value of psychedelic treatments among the general population. ⁴¹ Further, naturalistic psychedelics use may have increased risks relative to clinical settings, especially for individuals with pre-existing conditions. Therefore, we remain cautious in interpreting these observational results and look forward to additional work that can advance our understanding of the relationships between naturalistic psychedelic use and health outcomes in individuals with chronic pain conditions.

Limitations and strengths

There are several limitations to the current study. We are unable to confirm either the identity or quantity of psychedelic and non-psychedelic substances consumed as reported by participants, and all self-report items are subject to recall bias and/or confirmation biases. The study design did not allow for the confirmation of self-reported diagnoses, and we did not collect detailed data on chronic pain conditions. Further, we cannot confirm the extent to which changes in substance use were correctly attributed to psychedelic use as a causal factor. Longitudinal investigations including a control group that did not take psychedelics could help address this concern. And although the survey was distributed globally and received responses from 85 countries, our convenience sampling recruitment strategy yielded predominantly North American participants, and the survey was presented only in English, further limiting the participant pool. Lastly, our recruitment strategies depended largely on psychedelic interest, research, or educational groups, which may have created a positive bias toward psychedelic use in this sample.

Despite these limitations, this study is among the largest to investigate naturalistic psychedelic use among a population with chronic pain, and it includes a substantial proportion of participants outside of North America. Our inclusion of items related to changed substance patterns in addition to mental and physical health outcomes provides a broadly informative perspective on outcomes of naturalistic psychedelic use within this population.

Summary and conclusions

In this survey of adults with a self-reported chronic pain condition, 86.3% indicated that they ceased or decreased use of one or more non-psychedelic substances (e.g., alcohol, cannabis, tobacco/nicotine, antidepressants, amphetamines, cocaine/crack, prescription opioids, or illicit opioids) as a result of naturalistic psychedelic use. Alcohol (71.1%) and prescription opioids (64.1%) had the highest proportions of ceased/decreased use. Nearly a quarter of the sample reported that the decreases in substance use typically persist for 26 weeks or more following psychedelic use. 39.1% reported increasing or initiating use of one or more substances following use of a psychedelic, with illicit opioids (27.8%) and cannabis (21.5%) having the highest proportions. Regression modeling revealed that having a motivation to reduce one’s substance use was positively associated with ceasing/decreasing substance use. Psilocybin was reported as the most effective substance for reducing one’s substance use, as well as for self-treatment of both physical and mental health symptoms. Perceived effectiveness of psychedelics for physical and mental health were positive and long lasting, and significant reductions in conventional treatments following psychedelic use were observed in retrospective reports. These findings provide important contributions to the study of psychedelics for chronic pain conditions and should motivate future investigation in this area. Future investigations should explore both observational and clinical trial approaches to assessing the potential safety and efficacy of psychedelics in individuals with chronic pain conditions.

Ethical statement

Ethical approval

The study was reviewed by Advarra (protocol # Pro00071490) to help ensure that the rights and welfare of research participants were protected and that the research study was carried out in an ethical manner.

Informed consent

Informed consent to participate was gathered online as part of the survey, and all responses were collected anonymously. Informed consent to publish anonymized results was gathered online as a part of the survey.

ORCID iDs

Nicolas G Glynos https://orcid.org/0000-0002-6952-131X

Philippe Lucas https://orcid.org/0000-0003-1948-3842