The Use of Hallucinogens in the United States: Prevalence, Correlates, and a Typology of Use

Background and Purpose: Hallucinogens are increasingly prominent in drug legalization debates, and recent evidence suggests that rates of hallucinogen use are rising in the United States (US). This is noteworthy, particularly in light of potential short- and longer-term health and social consequences related to hallucinogen use. Moreover, prior research makes clear that individuals who misuse one psychoactive substance are more likely to misuse other substances as well—and emerging evidence suggests that individuals who use one type of hallucinogen are often likely to use other hallucinogens. However, at present, our understanding of the characteristics of hallucinogen users and the prevalence and manifestations of poly-hallucinogen use remain limited. Cognizant of this gap, we use a person-centered approach to develop a typology of hallucinogen users and, in turn, identify specific psychosocial correlates of poly-hallucinogen use in the US.

Methods: The present study used a sample of 6,381 individuals from the 2016-2018 National Survey on Drug Use and Health reporting past-year hallucinogen use. The psychosocial correlates examined were past year: depressive episode, other illicit drug use, and criminal justice system involvement. Logistic regression was used to examine the association between the number of hallucinogens used and key psychosocial correlates, and latent class analysis (LCA) was used to model hallucinogen user subgroups.

Results: Most hallucinogen users reported poly-hallucinogen use: indeed, a majority (70.1%) of the sample reported using at least two types of hallucinogens and half (49.35%) reported using 3+ types. The distinct number of hallucinogens used was positively associated with the likelihood of past-year depression (AOR = 1.10, 95% CI = 1.03-1.18), other illicit drug use (AOR = 1.38, 95% CI = 1.32-1.45), and criminal justice system contact (AOR = 1.16, 95% CI = 1.06-1.27). The best-fitting modeling of the data revealed four specific subgroups of hallucinogen users: an LSD, mushrooms, and ecstasy group (51.4% of sample, mostly ages 12-25), a poly-hallucinogen group that used virtually all types of hallucinogens at much higher rates than the mean for the sample (30.3%, mostly male and non-Hispanic White), an ecstasy-only group (13.3%, highest proportion of female and respondents of color), and an LSD or mushrooms group (5.9%, mostly older adults).

Conclusions and Implications: Findings from the present study shed new light on our understanding of the characteristics and behaviors of hallucinogen users in the US. We see compelling evidence that the overwhelming majority of current hallucinogen users, roughly 70%, are not “specialists” who use only one hallucinogen type, but rather that lifetime poly-hallucinogen use is the norm. This point is driven home by the finding that half of current hallucinogen users reported having used at least three distinct hallucinogen types in their lifetime. Critically, however, we also see that important differences exist within the population of hallucinogen users. Study findings can be used to inform clinical service delivery of as well as policy considerations. In particular, findings highlight the need to assess for a full range of hallucinogens when providing substance misuse treatment and underscore the need for broad-based substance misuse prevention efforts.