It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Study shows psychedelic drug psilocybin gives comparable long-term antidepressant effects to standard antidepressants, but may offer additional benefits
Psilocybin as good as SSRI for depression, but doesn’t lower sex drive, gives better sense of well-being and psychosocial functioning
European College of Neuropsychopharmacology
A direct comparison between the experimental psychedelic drug psilocybin and a standard SSRI antidepressant shows similar improvement of depressive symptoms, but that psilocybin offers additional longer-term benefits.
The comparison, between psilocybin (the active ingredient in “magic mushrooms”) and the SSRI escitalopram gave similar long-term improvements in depressive symptoms over a 6-month period, however patients taking psilocybin also reported better psychosocial functioning including experiencing a greater sense of meaning in life and psychological connectedness.
The work is presented for the first time at the ECNP Congress in Milan. A related paper will appear in the peer-reviewed journal Lancet eClinicalMedicine1 to coincide with the conference presentation (see details below). Lead researcher Mr Tommaso Barba (PhD candidate from Imperial College, London) said:
“This is the first work to compare the long-term effects of these two drugs in the context of overall well-being, not just freedom from depression. In previous work we had found that both treatments led to comparable improvements in alleviating symptoms of depression at the 6-week mark, such as sadness and negative emotions. However, this work shows that psilocybin outperformed escitalopram in several measures of well-being, meaning in life, work and social functioning. These results appeared to be maintained over a 6-month follow-up period. In addition, in previous work* we had found that psilocybin also improves sexual drive, in contrast to SSRIs which tend to lower libido in many patients. So overall it seems psilocybin might give additional positive mental health benefits.”
SSRI drugs (selective serotonin reuptake inhibitors), such as Prozac, Paxil and Zoloft, are one of the main types of drugs used to treat depression. However, around a third of patients don’t respond to SSRI treatment, so for them psilocybin may offer an alternative, although this was not studied in this trial.
Tommaso Barba continued:
“SSRIs work well, but not for everyone. They are also associated with some side effects. However this work implies that psilocybin generally seems to offer a real alternative, and perhaps additional benefits, to people who are worried about taking conventional antidepressants”.
The researchers, from Imperial College in London, undertook a 6-month study (phase 2, double-blind, randomised controlled trial) with 59 patients with moderate to severe depression. 30 were treated with a single dose of psilocybin, 29 patients were given a six-week course of escitalopram. Each group received similar psychological support of around 20 hours in total. Both groups showed significant improvement in depressive symptoms, even up to 6 months after treatment (the researchers stopped monitoring at 6 months). However those given psilocybin reported greater improvements in social functioning and psychological connectedness, with large effect sizes.
Co-first author Dr David Erritzoe, Clinical Director and Deputy Head of the Centre for Psychedelic Research, Imperial College, London, commented:
“This is important because improving connectedness and having greater meaning in life can significantly enhance a person's quality of life and long-term mental health. The study suggests that psilocybin therapy might be a more holistic treatment option for depression, addressing both the symptoms of depression and overall well-being. This could make a substantial difference in the overall happiness and daily activities of those suffering from depression, providing a more joined-up approach to mental health treatment”.
The researchers note that the patients were only treated for 6 weeks, and that many of the patients received additional treatments over the 6-month follow up.
Dr Erritzoe cautioned:
“Psilocybin is still an experimental drug; it has not yet been approved for general use. It is administered in highly controlled and protected environments: these precautions are not found in recreational psychedelic use, which is known for having unpredictable and potentially harmful effects, especially for vulnerable people struggling with mental health issues”.
Commenting, Johan Lundberg (Adjunct Professor of Psychiatry at the
Department of Clinical Neuroscience, Karolinska Institute, Stockholm) said:
“This report is an important attempt to compare the clinical value of psilocybin compared to a state-of-the-art treatment of major depressive disorder. The results come with several caveats, including the lack of a non-inferiority analysis and failure to report other interventions given during the follow-up period. That said, as a hypothesis generating piece it may benefit the field substantially. For now, we don’t know if psilocybin will be approved for the treatment of major depression, but if so, it won’t be for everyone. Some future patients might prefer psychedelic treatment over SSRI, but some patients may be intimidated by the dramatic alterations in perception and confrontations with challenging emotions that psychedelic drugs promote”.
This is an independent comment, Professor Lundberg was not involved in this work.
Notes:
Publication details: Effect of psilocybin versus escitalopram on depression symptom severity in patients with moderate-to-severe major depressive disorder: observational 6-month follow-up of a phase 2, double-blind, randomised, controlled trial. In press at Lancet eClinicalMedicine. Authors: David Erritzoe, Tommaso Barba, Kyle T. Greenway, Roberta Murphy, Jonny Martell, Bruna Giribaldi, Christopher Timmermann, Ashleigh Murphy-Beiner, Michelle Baker Jones, David Nutt, Brandon Weiss, and Robin Carhart-Harris. Paper reference 10.1016/j.eclinm.2024.102799
Mount Sinai Health System this week celebrated the opening of an expansion of its psychedelic psychotherapy research center into a new location and announced a foundational $5 million gift from The Bob & Renee Parsons Foundation. The center has been renamed The Parsons Research Center for Psychedelic Healing.
The new location is designed to support the Center's capacity to facilitate a growing number of rigorous clinical trials that focus on well-known compounds like MDMA, psilocybin, ketamine, and potentially others in the future. These chemical compounds have garnered significant attention in academic medicine for their potential to alleviate symptoms of post-traumatic stress disorder (PTSD), depression, anxiety, and other stress-related conditions.
The Foundation’s gift, which comes at a pivotal time for the field, will expand the Center's capacity for therapy, research, and therapist training, including a primary focus on veterans.
Located at 600 West 112th Street, on the southwest corner of Broadway, the new space will house six treatment rooms and a group therapy room, with features to enable therapy supervision, teaching, and research. Large floor-to-ceiling windows provide natural light and a view of the surrounding tree-lined streets.
“Since its initial launch in 2021, our psychedelic psychotherapy research center has made progress towards our understanding of the therapeutic potential for psychedelic-assisted psychotherapy,” said Rachel Yehuda, PhD, Director of The Parsons Research Center for Psychedelic Healing. “The recent decision by the Food and Drug Administration to withhold approval for MDMA-assisted therapy has cast some uncertainty as to how and when psychedelic therapy will be broadly available, but has also made clear that there is a critical need to advance rigorous psychedelic research. Our team remains steadfast in our commitment to this work and to ensure the incredible momentum that has been generated by academic researchers does not falter.”
Dr. Yehuda went on to say, “This is an existential moment for the field of psychedelic research in mental health, and rather than backing away from investment, as some are doing, The Bob & Renee Parsons Foundation is shining a light on what has become a darker path forward. Thanks to their vision and commitment and the continued generosity of our donors, we will meet the needs of the moment.”
“My own battle with PTSD lasted for decades after I returned from the Vietnam War. It was psychedelic-assisted therapy that finally brought me home after all those years,” said Bob Parsons, United States Marine Corps Vietnam war veteran and co-founder of The Bob & Renee Parsons Foundation. “Despite the FDA’s recent decision on MDMA, we’re digging in and funding more research because I have all the evidence I need—I know it works.”
The expansion of the Center reflects Mount Sinai’s commitment to providing institutional resources, strong scientific vision, and the established track record necessary to push forward with groundbreaking clinical trials. The gift from The Bob & Renee Parsons Foundation reflects an understanding by the Foundation that the moment demands serious and careful research and a deep commitment to uncovering effective treatments for veterans, who disproportionately experience conditions like PTSD that have been resistant to conventional therapies.
“The space was designed to embrace the importance of setting in therapeutic outcomes. From the moment our patients enter the beautifully designed Center, they will feel that they are in a place of safety and healing, which is paramount to maximizing the impact of the therapy sessions,” said Amy Lehrner, PhD, Clinical Director of The Parsons Research Center for Psychedelic Healing. “The views of nature, natural light, and complementary design will communicate serenity and warmth, setting a new standard for applying this nascent science. While solutions for traumatized people have been few and far between until now, with the advances we have made through this new space and the highly trained practitioners within, we now see renewed hope and healing.”
The Center is currently developing protocols for several studies, including pivotal group therapy studies, which required the creation of a large group space. The Center's expanded capacity allows for multiple simultaneous dosing sessions and group integration sessions, essential for advancing this critical work.
Mount Sinai investigators affiliated with the Center will also be conducting research on ketamine-assisted psychotherapy and psilocybin for patients with major depression and for the treatment of intergenerational trauma, as well as MDMA-assisted therapy for patients with eating disorders. Almost all trials will examine the mechanism of action of psychedelics using the latest developments in neuroimaging, molecular neuroscience, and natural language processing. These initiatives underscore the Center's role as a leader in developing innovative and effective treatments for mental health conditions. The Center also plans to continue to expand its focus on training and education of mental health clinicians in the use of psychedelic-assisted therapies. The Center has provided training and education free of charge to 250 clinicians thanks to a prior $5 million gift from The Bob & Renee Parsons Foundation in 2021.
“We are hopeful that the cutting-edge research and training being done at Mount Sinai will go on to transform the lives of veterans, and others, suffering from debilitating mental health conditions,” said Renee Parsons, co-founder of The Bob & Renee Parsons Foundation. “Bob and I know firsthand the detrimental impacts of PTSD—not only on the individual but their entire family. We remain committed to battling the stigma surrounding mental health and shining a light on promising treatments like psychedelic-assisted therapy.”
“New treatment options are desperately needed for the millions of people, both civilians and veterans, who suffer from mood and anxiety disorders like PTSD and major depression,” said Dennis S. Charney, the Anne and Joel Ehrenkranz Dean of Icahn Mount Sinai and President for Academic Affairs for the Mount Sinai Health System. “Mount Sinai researchers lead on the frontier of biomedicine, applying scientific rigor while also challenging clinical and scientific dogma to emerge as true innovators. Under Dr. Yehuda’s leadership and through the unwavering support of The Bob & Renee Parsons Foundation, this new space enables us to propel our efforts with the speed, safety, and quality that will have a meaningful impact on the field of psychedelic psychotherapy and the patients we serve.”
About the Mount Sinai Health System Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 600 research and clinical labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 9,000 primary and specialty care physicians and 11 free-standing joint-venture centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals, Best in State Hospitals, World Best Hospitals and Best Specialty Hospitals” and by U.S. News & World Report's® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report® “Best Hospitals” Honor Roll for 2024-2025. For more information, visithttps://www.mountsinai.org or find Mount Sinai onFacebook,Twitter andYouTube.
About The Bob & Renee Parsons Foundation The Bob & Renee Parsons Foundation offers support to nonprofit organizations successfully working to empower, educate, nurture and nourish people during what is often the darkest time of their lives. Founded in 2012 by philanthropists and business leaders Bob and Renee Parsons to provide hope and life-changing assistance to the country’s most vulnerable populations, The Bob & Renee Parsons Foundation offers critical funding at critical times to those in need. The Foundation’s giving is driven by the core belief that all people – regardless of race, religion, roots, economic status, sexual orientation or gender identity – deserve access to quality healthcare, education and a safe place to call home. Follow @WeDealInHope on social media or visit TBRPF.org, to learn more about partner organizations and the important work being done in the community.
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Entrance to The Parsons Research Center for Psychedelic Healing at Mount Sinai
Psychedelic-assisted psychotherapy treatment room within The Parsons Researh Center for Psychedelic Healing at Mount Sinai
Waiting Area within The Parsons Research Center for Psychedelic Healing at Mount Sinai
Interior of The Parsons Research Center for Psychedlic Healing at Mount Sinai
Credit
Mount Sinai Health System
Friday, September 20, 2024
Millions of depressed Americans could benefit from psychedelic therapy, study finds
New analysis reveals over half of patients treated for depression may be eligible for psilocybin-assisted therapy if FDA-approved
Genomic Press
Atlanta, Georgia - In the wake of mounting evidence for the efficacy of psychedelic-assisted therapies, the U.S. Food and Drug Administration (FDA) is considering approving psilocybin, the active ingredient in “magic mushrooms,” for treating depression in the near future. As this watershed moment approaches, a critical question arises: Just how many people might stand to benefit from this promising but still unproven therapy?
Shedding light on this high-stakes inquiry, a first-of-its-kind peer-reviewed study led by researchers at Emory University, the University of Wisconsin-Madison and UC Berkeley, and that will be published in Psychedelics (ISSN: 2997-2671, Genomic Press, New York) on 24 September 2024 has generated initial estimates of the potential demand for psilocybin-assisted therapy for depression in the United States. By analyzing national survey data on depression prevalence and treatment in conjunction with the eligibility criteria from recent landmark clinical trials, the researchers determined that between 56% and 62% of patients currently receiving treatment for depression—amounting to a staggering 5.1 to 5.6 million individuals—could qualify for psilocybin therapy if approved.
“Our findings suggest that if the FDA gives the green light, psilocybin-assisted therapy has the potential to help millions of Americans who suffer from depression” said Syed Fayzan Rab, an Emory MD candidate and the study's lead author. “This underscores the importance of understanding the practical realities of rolling out this novel treatment on a large scale.”
To arrive at their projections, the researchers first determined that of the nearly 15 million American adults with depression, about 9 million receive treatment in a given year. They then evaluated this population against various eligibility criteria used in recent clinical trials of psilocybin for depression. Their analysis generated a range of estimates: a “lower-bound” of 24% of patients eligible if the strict criteria of initial trials were applied, a “mid-range” of 56% based on criteria likely to be used in real-world medical settings, and an “upper-bound” of 62% after accounting for patients with multiple exclusionary conditions.
Notably, nearly a third of the lower-bound to mid-range jump resulted from the inclusion of patients with alcohol and substance use disorders, for whom growing evidence suggests psilocybin may actually be beneficial rather than contraindicated. However, even the 62% upper-bound estimate is likely conservative, as the analysis focused only on currently treated individuals and did not account for the potential influx of new patients drawn by the appeal of psychedelic medicine.
The researchers caution that these projections are highly contingent on the precise FDA approval parameters and subsequent real-world implementation factors. Insurance coverage decisions, availability of trained practitioners, and regional variations in access could all considerably constrain the ultimate uptake of psilocybin therapy. Additionally, if approval encompasses off-label use for conditions beyond depression, demand could further surge in unpredictable ways.
“While our analysis is a crucial first step, we've only scratched the surface in understanding the true public health impact psilocybin therapy may have,” said Dr. Charles Raison, a collaborator on the study and the lead investigator on one of the largest clinical trials looking at the efficacy of psilocybin therapy for depression. "Ultimately, the realizable potential of this treatment rests in the hands of regulatory bodies, policymakers, insurers, and the healthcare community at large. It's our hope that these findings spur productive discussions and proactive preparations to optimize the benefit to patients while minimizing unintended consequences."
As the psychedelic renaissance continues to gather momentum, this study provides a vital glimpse into the promise and challenges that may lie ahead. With millions of lives potentially in the balance, it underscores the urgency of further research to refine demand estimates and inform equitable, effective delivery of psilocybin therapy should it gain approval.
The peer-reviewed study, “An Estimate of the Number of People with Clinical Depression Eligible for Psilocybin-Assisted Therapy in the United States,” will be published on 24 September 2024 and will be freely available online at the website of Psychedelics (Genomic Press, New York): https://pp.genomicpress.com/aop/.
About Psychedelics – Psychedelics: The Journal of Psychedelic Pharmacology (ISSN: 2997-2671) is a peer-reviewed journal published by Genomic Press, New York. The journal is exclusively dedicated to the latest advancements in the realm of psychedelic substances and their potential therapeutic uses. Psychedelics embraces the full spectrum of research, from fundamental investigations to cutting-edge clinical studies and welcomes diverse perspectives and contributions, advancing the understanding of psychedelic compounds.
To obtain a confidential pre-print before the embargo date, contact: Fayzan Rab. Emory University School of Medicine: syed.f.rab@emory.edu
Method of Research
Data/statistical analysis
Subject of Research
People
Article Title
An Estimate of the Number of People with Clinical Depression Eligible for Psilocybin-Assisted Therapy in the United States
Article Publication Date
13-Sep-2024
COI Statement
Syed Fayzan Rab serves as a consultant at Sunstone Therapies. Elliot Marseille serves as adjunct faculty at UC Berkeley's Collaborative for the Economics of Psychedelics, which has received financial support from the Usona Institute. Charles Raison serves as a consultant to Usona Institute and Novartis.
Saturday, September 14, 2024
Study sheds light on potential demand for psilocybin-assisted therapy for depression in the U.S.
In the wake of mounting evidence for the efficacy of psychedelic-assisted therapies, the U.S. Food and Drug Administration (FDA) is considering approving psilocybin, the active ingredient in "magic mushrooms," for treating depression in the near future. As this watershed moment approaches, a critical question arises: Just how many people might stand to benefit from this promising but still unproven therapy?
Shedding light on this high-stakes inquiry, a first-of-its-kind peer-reviewed study led by researchers at Emory University, the University of Wisconsin-Madison and UC Berkeley, and that will be published in Psychedelics (ISSN: 2997-2671, Genomic Press, New York) on 24 September 2024 has generated initial estimates of the potential demand for psilocybin-assisted therapy for depression in the United States. By analyzing national survey data on depression prevalence and treatment in conjunction with the eligibility criteria from recent landmark clinical trials, the researchers determined that between 56% and 62% of patients currently receiving treatment for depression-;amounting to a staggering 5.1 to 5.6 million individuals-;could qualify for psilocybin therapy if approved.
Our findings suggest that if the FDA gives the green light, psilocybin-assisted therapy has the potential to help millions of Americans who suffer from depression. This underscores the importance of understanding the practical realities of rolling out this novel treatment on a large scale."
Syed Fayzan Rab, an Emory MD candidate and study's lead author
To arrive at their projections, the researchers first determined that of the nearly 15 million American adults with depression, about 9 million receive treatment in a given year. They then evaluated this population against various eligibility criteria used in recent clinical trials of psilocybin for depression. Their analysis generated a range of estimates: a "lower-bound" of 24% of patients eligible if the strict criteria of initial trials were applied, a "mid-range" of 56% based on criteria likely to be used in real-world medical settings, and an "upper-bound" of 62% after accounting for patients with multiple exclusionary conditions.
Notably, nearly a third of the lower-bound to mid-range jump resulted from the inclusion of patients with alcohol and substance use disorders, for whom growing evidence suggests psilocybin may actually be beneficial rather than contraindicated. However, even the 62% upper-bound estimate is likely conservative, as the analysis focused only on currently treated individuals and did not account for the potential influx of new patients drawn by the appeal of psychedelic medicine.
The researchers caution that these projections are highly contingent on the precise FDA approval parameters and subsequent real-world implementation factors. Insurance coverage decisions, availability of trained practitioners, and regional variations in access could all considerably constrain the ultimate uptake of psilocybin therapy. Additionally, if approval encompasses off-label use for conditions beyond depression, demand could further surge in unpredictable ways.
"While our analysis is a crucial first step, we've only scratched the surface in understanding the true public health impact psilocybin therapy may have," said Dr. Charles Raison, a collaborator on the study and the lead investigator on one of the largest clinical trials looking at the efficacy of psilocybin therapy for depression. "Ultimately, the realizable potential of this treatment rests in the hands of regulatory bodies, policymakers, insurers, and the healthcare community at large. It's our hope that these findings spur productive discussions and proactive preparations to optimize the benefit to patients while minimizing unintended consequences."
As the psychedelic renaissance continues to gather momentum, this study provides a vital glimpse into the promise and challenges that may lie ahead. With millions of lives potentially in the balance, it underscores the urgency of further research to refine demand estimates and inform equitable, effective delivery of psilocybin therapy should it gain approval.
Rab, S. F., et al. (2024) An estimate of the number of people with clinical depression eligible for psilocybin-assisted therapy in the United States. Psychedelics. https://doi.org/10.61373/pp024r.0025
Wednesday, September 04, 2024
Psychedelics show promise for treating PTSD by suppressing learned fear responses
New research reveals how psychedelic drugs like psilocybin acutely reduce fear by altering activity in the amygdala, a key brain region involved in processing fear and anxiety
Genomic Press
MILWAUKEE, WI - Ongoing research is revealing how psychedelic drugs like psilocybin (the active ingredient in "magic mushrooms") and LSD may help treat post-traumatic stress disorder (PTSD) by suppressing learned fear responses. In a new Bench to Bedside peer-reviewed article published in the journal Psychedelics (ISSN: 2997-2671, Genomic Press, New York), researchers from the Medical College of Wisconsin provide an in-depth look at the neural mechanisms underlying psychedelics' acute fear-reducing effects in rodent models of PTSD.
The amygdala, an almond-shaped structure deep within the brain, plays a central role in fear learning and expression. Excitatory neurons in the lateral amygdala are activated by fearful stimuli, leading to a cascade of activity that drives fear responses. The new research proposes that psychedelic drugs suppress this fear-related activity by enhancing inhibitory signaling from GABAergic interneurons onto the excitatory neurons.
"Our hypothesis is that psychedelics acutely suppress learned fear responses by activating serotonin 2A receptors on inhibitory neurons in the amygdala," said the lead author Thomas Kelly, an MD/PhD candidate. "This leads to increased release of the inhibitory neurotransmitter GABA, which quiets the activity of excitatory neurons that normally drive fearful behaviors."
The finding that psychedelics' acute effects on fear require activation of serotonin 2A receptors aligns with the receptor's established role in the drugs' hallucinogenic effects. However, the authors emphasize the importance of considering the broader pharmacological profile and duration of action of different psychedelic compounds.
For example, the drug MDMA, which has shown promise for treating PTSD in late-stage clinical trials, does not directly activate serotonin 2A receptors. Instead, MDMA increases the release of serotonin, which then activates various serotonin receptor subtypes. The research suggests that psychedelics with faster onset and shorter duration of acute effects may be advantageous for PTSD treatment compared to longer-acting drugs like LSD.
"The insights from preclinical studies can help guide the design of clinical trials and treatment protocols that optimize the therapeutic potential of psychedelics for PTSD," said senior author Dr. Qing-song Liu. "By understanding the mechanisms and time-course of psychedelics' effects on fear circuitry, we can better harness these compounds in a clinical setting."
Several clinical trials are currently investigating psilocybin-assisted therapy for PTSD, with some protocols incorporating drug administration in combination with exposure therapy to promote fear extinction learning. As this research progresses, the amygdala is emerging as a key locus of interest for understanding how psychedelics may extinguish fearful memories and provide a novel treatment approach for PTSD and other fear-related disorders.
The full article, titled “Exploring the therapeutic potential of psychedelics: Fear extinction mechanisms and amygdala modulation,” was published online on 09 August 2024 and is freely available online at the website of Psychedelics (Genomic Press, New York): https://pp.genomicpress.com/aop/
Contact: Thomas J. Kelly Medical College of Wisconsin tjkelly@mcw.edu 1-920-427-6177
Cannabis and hallucinogen use among adults remained at historic highs in 2023
Vaping among younger adults and binge drinking among mid-life adults also maintained historically high levels, NIH-supported study shows
NIH/National Institute on Drug Abuse
Past-year use of cannabis and hallucinogens stayed at historically high levels in 2023 among adults aged 19 to 30 and 35 to 50, according to the latest findings from the Monitoring the Future survey. In contrast, past-year use of cigarettes remained at historically low levels in both adult groups. Past-month and daily alcohol use continued a decade-long decline among those 19 to 30 years old, with binge drinking reaching all-time lows. However, among 35- to 50-year-olds, the prevalence of binge drinking in 2023 increased from five and 10 years ago. The Monitoring the Future study is conducted by scientists at the University of Michigan’s Institute for Social Research, Ann Arbor, and is funded by the National Institutes of Health.
Reports of vaping nicotine or vaping cannabis in the past year among adults 19 to 30 rose over five years, and both trends remained at record highs in 2023. Among adults 35 to 50, the prevalences of nicotine vaping and of cannabis vaping stayed steady from the year before, with long-term (five and 10 year) trends not yet observable in this age group as this question was added to the survey for this age group in 2019.
For the first time in 2023, 19- to 30-year-old female respondents reported a higher prevalence of past-year cannabis use than male respondents in the same age group, reflecting a reversal of the gap between sexes. Conversely, male respondents 35 to 50 years old maintained a higher prevalence of past-year cannabis use than female respondents of the same age group, consistent with what’s been observed for the past decade.
“We have seen that people at different stages of adulthood are trending toward use of drugs like cannabis and psychedelics and away from tobacco cigarettes,” said Nora D. Volkow, M.D., director of NIH’s National Institute on Drug Abuse (NIDA). “These findings underscore the urgent need for rigorous research on the potential risks and benefits of cannabis and hallucinogens – especially as new products continue to emerge.”
Since 1975, the Monitoring the Future study has annually surveyed substance use behaviors and attitudes among a nationally representative sample of teens. A longitudinal panel study component of Monitoring the Future conducts follow-up surveys on a subset of these participants (now totaling approximately 20,000 people per year), collecting data from individuals every other year from ages 19 to 30 and every five years after the participants turn 30 to track their drug use through adulthood. Participants self-report their drug use behaviors across various time periods, including lifetime, past year (12 months), past month (30 days), and other use frequencies depending on the substance type. Data for the 2023 panel study were collected via online and paper surveys from April 2023 through October 2023.
Full data summaries and data tables showing the trends below, including breakdowns by substance, are available in the report. Key findings include:
Cannabis use in the past year and past month remained at historically high levels for both adult age groups in 2023. Among adults 19 to 30 years old, approximately 42% reported cannabis use in the past year, 29% in the past month, and 10% daily use (use on 20 or more occasions in the past 30 days). Among adults 35 to 50, reports of use reached 29%, 19%, and 8%, respectively. While these 2023 estimates are not statistically different from those of 2022, they do reflect five- and 10-year increases for both age groups.
Cannabis vaping in the past year and past month was reported by 22% and 14% of adults 19 to 30, respectively, and by 9% and 6% of adults 35 to 50 in 2023. For the younger group, these numbers represent all-time study highs and an increase from five years ago.
Nicotine vaping among adults 19 to 30 maintained historic highs in 2023. Reports of past-year and past-month vaping of nicotine reached 25% and 19%, respectively. These percentages represent an increase from five years ago, but not from one year ago. For adults 35 to 50, the prevalence of vaping nicotine remained steady from the year before (2022), with 7% and 5% reporting past-year and past-month use.
Hallucinogen use in the past year continued a five-year steep incline for both adult groups, reaching 9% for adults 19 to 30 and 4% for adults 35 to 50 in 2023. Types of hallucinogens reported by participants included LSD, mescaline, peyote, shrooms or psilocybin, and PCP.
Alcohol remains the most used substance reported among adults in the study. Past-year alcohol use among adults 19 to 30 has showed a slight upward trend over the past five years, with 84% reporting use in 2023. However, past month drinking (65%), daily drinking (4%), and binge drinking (27%) all remained at study lows in 2023 among adults 19 to 30. These numbers have decreased from 10 years ago. Past-month drinking and binge drinking (having five or more drinks in a row in the past two week period) decreased significantly from the year before for this age group (down from 68% for past month and 31% for binge drinking reported in 2022).
Around 84% of adults 35 to 50 reported past-year alcohol use in 2023, which has not significantly changed from the year before or the past five or 10 years. Past-month alcohol use and binge drinking have slightly increased over the past 10 years for this age group; in 2023, past-month alcohol use was at 69% and binge drinking was at 27%. Daily drinking has decreased in this group over the past five years and was at its lowest level ever recorded in 2023 (8%).
Additional data: In 2023, past-month cigarette smoking, past-year nonmedical use of prescription drugs, and past-year use of opioid medications (surveyed as “narcotics other than heroin”) maintained five- and 10-year declines for both adult groups. Among adults 19 to 30 years old, past-year use of stimulants (surveyed as “amphetamines”) has decreased for the past decade, whereas for adults 35 to 50, past-year stimulant use has been modestly increasing over 10 years. Additional data include drug use reported by college/non-college young adults and among various demographic subgroups, including sex and gender and race and ethnicity.
The 2023 survey year was the first time a cohort from the Monitoring the Future study reached 65 years of age, therefore trends for the 55 to 65 year old age group are not yet available.
“The data from 2023 did not show us many significant changes from the year before, but the power of surveys such as Monitoring the Future is to see the ebb and flow of various substance use trends over the longer term,” said Megan Patrick, Ph.D., of the University of Michigan and principal investigator of the Monitoring the Future panel study. “As more and more of our original cohorts – first recruited as teens – now enter later adulthood, we will be able to examine the patterns and effects of drug use throughout the life course. In the coming years, this study will provide crucial data on substance use trends and health consequences among older populations, when people may be entering retirement and other new chapters of their lives.”
View more information on data collection methods for the Monitoring the Future panel study and how the survey adjusts for the effects of potential exclusions in the report. Results from the related 2023 Monitoring the Future study of substance use behaviors and related attitudes among teens in the United States were released in December 2023, and 2024 results are upcoming in December 2024.
If you or someone you know is struggling or in crisis, help is available. Call or text 988or chat at 988lifeline.org. To learn how to get support for mental health, drug or alcohol conditions visit FindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.govor call 800-662-HELP (4357).
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About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
About substance use disorders: Substance use disorders are chronic, treatable conditions from which people can recover. In 2023, nearly 49 million people in the United States had at least one substance use disorder. Substance use disorders are defined in part by continued use of substances despite negative consequences. They are also relapsing conditions, in which periods of abstinence (not using substances) can be followed by a return to use. Stigma can make individuals with substance use disorders less likely to seek treatment. Using preferred language can help accurately report on substance use and addiction. View NIDA’s online guide.
NIH…Turn
Plastic surgery patients who use marijuana also have elevated nicotine levels
Nicotine may be an unsuspected risk factor for complications, reports Plastic and Reconstructive Surgery®
"We found that patients who report marijuana use also have elevated urine nicotine and cotinine levels – even those who don't smoke or use other nicotine-containing products" comments ASPS Member Surgeon Joseph A. Ricci of Hofstra University School of Medicine, Great Neck, NY. "This raises concerns that unsuspected nicotine exposure might lead to an increased risk of postoperative complications."
First study to assess marijuana and nicotine use in plastic surgery patients
The rising prevalence of marijuana use raises questions about potential negative effects in patients undergoing surgery. Marijuana smoke contains carcinogens and irritants similar to those in tobacco smoke, with similarly harmful effects on pulmonary health.
Nicotine causes impaired wound healing, which is a special concern in patients undergoing plastic surgery. The rising popularity of marijuana, combined with newer nicotine delivery products such as vapes, "presents a clinical challenge for healthcare providers to identify patients who are exposed to nicotine, as patients themselves may be unaware," the researchers write.
Dr. Ricci and colleagues examined the possible link between marijuana use and nicotine exposure in 135 consecutive patients who consulted a surgeon to discuss cosmetic plastic surgery. Ninety-two percent of patients were women; the average age was 38 years. The patients were largely Hispanic, reflecting the demographics of the area served by the clinic.
High nicotine levels raise 'concern for unrecognized surgical risk'
In a survey, 19% of patients reported active nicotine use while 20% reported marijuana use: marijuana alone in 7% of patients and both nicotine and marijuana by 13%. Levels of nicotine and the nicotine metabolite cotinine were compared between groups.
The results showed elevated nicotine and cotinine levels among patients who said they used marijuana. The association was apparent not only in those who reported nicotine-containing products, but also in those who denied any type of nicotine use.
Although marijuana users had elevated nicotine, the levels weren't as high as typically found in patients who smoke or use other forms of nicotine. Most patients who reported marijuana and/or nicotine use on the study survey did not mention these substances during their discussion with the plastic surgeon. For this group, nicotine levels were comparable similar to those in active cigarette smokers.
"Patients may be hesitant to disclose their substance use history, possibly due to a lack of awareness about the perioperative risks associated with smoking and marijuana use," the researchers write. In 84 patients who went on to have plastic surgery, nicotine levels were lower compared to patients who did not undergo surgery.
Although the study did not find increased complication rates among marijuana users or those with elevated nicotine levels, the findings raise concern that such risks could occur. The researchers emphasize the need for definitive studies of the effects of marijuana on surgical outcomes. Meanwhile, Dr. Ricci and coauthors conclude: "In real clinical settings, under-reporting of nicotine-containing product use, including marijuana, remains a concern for unrecognized surgical risk and affects decision on offering elective procedures."
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