Drug and Alcohol Review
September 5, 2019
Elena Argento, Rielle Capler, Gerald Thomas et al.
98 citations
Ayahuasca-assisted therapy helped Indigenous community members in Canada reduce substance use and cravings, with eight of eleven participants completely stopping at least one substance by six months after retreats. The therapy differed from conventional treatments by helping participants identify negative thought patterns and barriers related to addiction. Increased connectedness with self, others, and nature or spirit was described as a key element associated with reduced substance use and cravings. These qualitative findings expand on prior quantitative results and suggest that ayahuasca-assisted therapy may offer benefits for addressing problematic substance use where conventional treatments have limited efficacy.
Drug and Alcohol Review
May 21, 2012
Janine V. Olthuis, Christine Darredeau, Sean P. Barrett
79 citations
Among 226 cannabis users, most first-time use of harder illicit drugs—including cocaine, amphetamines, MDMA, heroin, and hallucinogens—involved simultaneous use of other substances, with at least 75% of participants reporting co-administration. Alcohol, tobacco, or cannabis were the substances most often used alongside the new drug. First-time use of alcohol, tobacco, and cannabis itself showed less simultaneous polysubstance use. The findings suggest that episodes involving alcohol, tobacco, or cannabis may directly facilitate the initiation of new substance use, pointing to potential risk factors for substance use progression.
Drug and Alcohol Review
January 1, 2007
Kelly J. Clemens, Iain S. Mcgregor, Glenn E. Hunt et al.
55 citations
The substituted amphetamines MDMA (Ecstasy) and methamphetamine (METH, ice, speed) are increasingly popular among party-drug users. Human studies of their acute and long-term adverse effects are often ambiguous due to confounding factors. Animal models show that intravenous METH is a potent reinforcer, while MDMA enhances social behavior. Brief exposure to either drug can cause long-term reductions in dopamine, serotonin, and noradrenaline in the brain and alter receptor and transporter proteins, though whether this reflects neurotoxicity remains unclear, especially for MDMA. Lasting changes in social behavior, anxiety, depressive symptoms, and memory have been observed in rats, matching some human findings. MDMA/METH combinations may produce greater adverse effects than either drug alone, a concern given that party drug users may frequently encounter this combination.
Drug and Alcohol Review
July 25, 2021
Daniel Perkins, Emérita Sátiro Opaleye, Hana Šimonová et al.
54 citations
People who consumed ayahuasca in naturalistic settings reported lower current use of alcohol and other drugs, including risky drinking, compared to those who used it less often. The more times ayahuasca was consumed, the stronger the association with never or rarely drinking alcohol and not using a range of drugs in the past month. These effects were greater for individuals with a prior substance use disorder. The strength of subjective spiritual experience, number of personal insights gained, and drinking ayahuasca with an ayahuasca church were also linked to lower substance use in some analyses. The associations remained after adjusting for religious or social group effects.
Drug and Alcohol Review
September 1, 2022
Lukas A Basedow, Sören Kuitunen-Paul
42 citations
People most often use serotonergic psychedelics (hallucinogens) to expand their awareness, such as to increase self-knowledge, promote spiritual development, or satisfy curiosity. This motive appeared in 78% of the 37 studies reviewed, followed by coping (67%) and enhancement (57%). The pattern held across different types of psychedelics, different cultural backgrounds, and both quantitative and qualitative research, with no significant changes from 1967 to 2020. To reduce potential harms, harm-reduction services might offer non-drug ways to fulfill the desire for expanded awareness. Future research should examine motives for specific psychedelics.
Drug and Alcohol Review
May 1, 2006
Michael Lyvers
41 citations
The evidence for MDMA-induced serotonergic neurotoxicity in human recreational ecstasy users remains inconclusive. Inconsistent findings on persistent cognitive and serotonergic deficits, lack of clear links between brain imaging changes and functional impairments, and confounding effects of cannabis or other drug use complicate the picture. Methodological issues, including poor sample matching, questionable relevance of animal models, and potential pre-existing deficits in impulse control or serotonin systems that might predispose to drug use, further undermine conclusions. Because nearly all studies are retrospective, the controversy over whether MDMA causes neurotoxicity or cognitive harm in humans is unlikely to be resolved soon.
Drug and Alcohol Review
July 1, 2005
Joachim D. Uys, Raymond J.m. Niesink
35 citations
Club drug use, particularly the combination of ecstasy (MDMA) and gammahydroxybutyrate (GHB), is increasing. This review describes the subjective effects of the MDMA/GHB combination and reviews the individual actions of MDMA on serotonin, dopamine, and noradrenaline systems, as well as GHB's actions on these systems. It is postulated that GHB attenuates the unpleasant or dysphoric effects of MDMA by its effect on the central dopaminergic system. Studies investigating combinations of psychoactive substances are limited, and awareness of this phenomenon and the pharmacology of these drugs is important for effective prevention.
Drug and Alcohol Review
July 1, 2022
Monica J Barratt, Alexia Maddox, Naomi Smith et al.
19 citations
About 5.3% of respondents in a large international survey reported using binaural beats to experience altered states, with higher rates in the United States, Mexico, Brazil, Poland, Romania, and the United Kingdom. Younger age and non-male gender predicted use, as did recent use of cannabis, psychedelics, and novel drugs. Most users listened to relax or fall asleep (72.2%) or change their mood (34.7%), while 11.7% sought effects similar to those of other drugs—a motivation more common among classic psychedelic users (16.5% vs. 7.9%). Users primarily accessed binaural beats via video streaming sites on mobile phones.
Drug and Alcohol Review
February 1, 2023
Borja J Rodríguez-cano, Maja Kohek, Genís Ona et al.
17 citations
Ibogaine, a psychoactive alkaloid from the Tabernanthe iboga plant traditionally used in Bwiti culture, has been used experimentally to treat substance use disorders (SUD) since 1962. Interviews with 13 people who self-treated their SUD with ibogaine revealed that the drug's therapeutic benefits arise not only from its pharmacology but also from the subjective experience it induces. Participants reported that ibogaine evoked interpersonal and transpersonal experiences, autobiographical memories, and personal insights. These effects, along with preparation, integration, and motivation for lifestyle change, appear to help individuals cope with their SUD, particularly given limited alternative treatment options.
Drug and Alcohol Review
November 5, 2024
Jordan J. Negrine, Cheneal Puljević, Jason Ferris et al.
8 citations
Australian psychologists generally hold positive attitudes toward psychedelic-assisted therapy (PAT) following the 2023 regulatory changes that permitted psilocybin and MDMA in clinical services. Most view PAT as promising for chronic mental health conditions like depression, but express concerns about limited evidence on efficacy, potential adverse experiences, and the complexity of individualized treatment protocols. Many psychologists lack detailed knowledge about the interventions. The findings emphasize the need for comprehensive education and training programs, including exposure to psychedelic experiences and credible higher education institutions, to ensure competent administration of PAT.
Drug and Alcohol Review
September 1, 2024
Jessamine Soderstrom, Jodie Grigg, Owen Mcwilliam et al.
5 citations
Chronic nitrous oxide use inactivates vitamin B12, causing neurological and psychiatric damage. A case series from an Australian emergency department between 2019 and 2021 identified 22 patients, mostly young males (median age 22.4 years), who inhaled a median of 150 bulbs daily for 9 months. Common symptoms included ataxia, numbness, falls, urinary retention, and psychosis; 12 of 14 patients who underwent MRI had spinal cord degeneration. All received vitamin B12 injections, and many also oral methionine. Hospital stays lasted a median of 4 days, costing about $2,061 per day. The data prompted public health measures such as warning labels, purchase limits, and legal restrictions on sales intended for abuse.
Drug and Alcohol Review
May 1, 2024
Nicole D. Fitzgerald, Joseph J Palamar
5 citations
Among adults entering randomly selected electronic dance music events in New York City, the proportion who had tested their ecstasy with a drug testing kit in the past year rose from 23.1% in 2017 to 43.1% in 2022, an 86.6% increase. Among those who tested, the share who always tested their drug rose from 31.2% to 60.6%. The proportion who found out or suspected their ecstasy was adulterated fell from 59.6% to 18.4%, with suspected methamphetamine adulteration dropping from 21.9% to 3.6%. The findings indicate growing use of drug testing kits and decreasing suspected adulteration, supporting the need for formal drug checking services.
Drug and Alcohol Review
September 1, 2023
Joseph J Palamar
5 citations
Among people who attend electronic dance music parties in New York City, experiencing a harmful or very unpleasant effect after using cocaine or ecstasy in the past month was associated with a lower willingness to use the same drug again in the next month. For cocaine, the adjusted prevalence ratio was 0.58, and for ecstasy, 0.45. Adverse effects from LSD or ketamine did not show a statistically significant association with willingness to use again after adjusting for other factors. The findings suggest that personally experienced adverse effects can deter future use of some party drugs in this high-risk population, and interventions may benefit from highlighting such effects.
Drug and Alcohol Review
April 10, 2017
Stephen Bright, M.l. Williams, David Caldicott
5 citations
Psychedelic-assisted psychotherapies, using psilocybin, LSD, or MDMA, show promise for treating depression, anxiety, PTSD, and substance use disorders, with recent randomized controlled trials reporting significant improvements. For example, psilocybin-assisted therapy helped 80% of participants quit smoking at 6 months, and MDMA-assisted therapy led to 86% of participants no longer meeting PTSD criteria. Despite a renaissance in research elsewhere, Australia has conducted no such studies, facing barriers like institutional vetoes. The authors argue addiction researchers should follow these developments, as psychedelics may enhance psychotherapy for trauma-related substance use disorders, potentially paradigm-changing.
Drug and Alcohol Review
November 1, 2024
Rebekka Syrjanen, Martin Dutch, Shaun L. Greene et al.
3 citations
At three Australian music festivals in 2022/2023, blood samples from 24 critically ill patrons revealed that unreported illicit drugs or new psychoactive substances were detected in 18 patients. Among these, methylamphetamine was found in 10 patients, cathinones in 7, and benzodiazepine-type new psychoactive substances in 6. The most frequently reported and detected drugs were MDMA, ketamine, and cocaine. The toxicosurveillance network provides additional intelligence for harm reduction, aiming to identify high-risk drug use patterns and inform evidence-based messaging.
Drug and Alcohol Review
January 1, 2025
Rachit Gupta, Greta Moon, Yvonne Bonomo et al.
2 citations
GHB withdrawal can be far more prolonged than the typical 5-7 days, sometimes recurring over 56 days despite initial stabilization and toxicological evidence of abstinence. A male patient in his 30s with a 15-year history of daily high-dose GHB use experienced three hospital admissions over 8 weeks, each requiring intravenous sedation and intubation for agitated delirium. His withdrawal delirium was successfully treated with a slow, six-month taper of benzodiazepines and baclofen, preventing further re-emergence of the debilitating delirium. This case demonstrates that severe GHB withdrawal may require extended support and slow medication tapering, with benzodiazepines and GABA-B agonists as effective treatments.
Drug and Alcohol Review
May 1, 2025
Joel Keygan, Breanna Willoughby, Raimondo Bruno et al.
1 citation
Receiving a high-dose MDMA drug alert was associated with intentions to reduce or avoid the drug in a hypothetical scenario. In an online survey of Australians who had used MDMA pills or capsules in the past year, 45.4% of those shown an alert said they would not use the drug, compared to 20.7% of the control group. Among alert recipients, 46.7% said they would use and reduce their initial dose, versus 69.0% in the control group. Those who received an alert were about three times more likely to report intending not to use rather than taking a smaller dose, compared to the control group. Different phrasings of the alert did not significantly change intended behavior.
Drug and Alcohol Review
March 1, 2026
Jack Freestone, Harriet MacDonald, Stassi Kypri et al.
Drug alerts in Australia are triggered when MDMA pills contain at least 150 mg of free-base MDMA, a threshold experts consider reasonable despite its limitations. Nineteen such alerts were issued in 2024, raising concerns about diminishing impact. Fifteen experts who design and disseminate drug alerts completed a survey, and seven participated in a focus group. Most agreed 150 mg is a reasonable threshold because it enables rapid communication and addresses potential harm, though thresholds cannot account for evolving manufacturing or consumption trends. Limited capacity to monitor community perceptions means there is little evidence to justify changing the threshold. Notifying communities about high-dose MDMA remains a harm-reduction priority; improving monitoring and establishing a dosage database could enhance future risk communication.
Drug and Alcohol Review
February 26, 2026
Katherine M Keyes, Yvonne Terry-Mcelrath, Megan E. Patrick
About 1 in 15 young adults in the United States reported microdosing hallucinogens in the past year, with 73% of those who used hallucinogens engaging in microdosing. Microdosing was strongly linked to other substance use: among microdosers, 72% reported 10 or more occasions of past-year alcohol use and 86% reported 3 or more occasions of past-year cannabis use. Odds ratios for other substance use among microdosers ranged from 2.53 for past-month cigarette use to 37.73 for heavy cannabis use. Few demographic differences emerged, though Black respondents were less likely to microdose than White respondents.
Drug and Alcohol Review
November 1, 2025
Jodie Grigg, Simon Lenton, Amy Peacock et al.
From 2021 to 2023, Australians who regularly used ecstasy or other stimulants and also used nitrous oxide showed a rise in use of large cylinders (from 6% to 26%) and a rise in reported neurological symptoms (from 5% to 14%). Most respondents knew about brain or nerve damage risks, but only one in five identified vitamin B12 depletion as a risk, and 17% were unaware of any risks. One-third took no precautions. Sourcing from convenience stores and 24/7 delivery services was common and linked to heavier use. Fewer than five people received treatment for symptoms. The authors call for balanced regulation and education of retailers, clinicians, and consumers.
Drug and Alcohol Review
November 1, 2025
Adams L Sibley, Madigan L Bedard, Samuel Tobias et al.
Medetomidine, a veterinary tranquilizer more potent than xylazine, has emerged as an adulterant in the U.S. illicit fentanyl supply. Analysis of 11,363 drug samples from a national mail-based drug checking program between December 2022 and April 2025 found medetomidine in 2.4% of samples, with growth beginning June 2024. It commonly appeared with fentanyl (58.8%) and xylazine (55.9%). Samples where medetomidine was the primary ingredient were nearly 12 times more likely to be associated with reported hallucinations (17.6%) compared to all other samples (1.2%). These unexpected hallucinations may serve as a signal for medetomidine's presence in local drug markets, contradicting its clinical use for preventing delirium.
Drug and Alcohol Review
January 1, 2024
Jai Whelan, Geoffrey E Noller, Ryan D Ward
Most TikTok videos about MDMA portray the drug neutrally (40.6%) or positively (34.9%), with intoxication presumed in 40.2% of videos. Humor was the most common theme (80.5%). Only nine out of 498 videos contained harm reduction content, which together were viewed nearly one million times. The findings suggest that unrestricted access to MDMA-related content on TikTok may shape perceptions of the drug, and better monitoring or promotion of harm reduction material could help offset potential harms.
Drug and Alcohol Review
February 1, 2022
Matthew J A O'Reilly, Christine A Harvey, Robin Auld et al.
Across 19 music festivals in New South Wales between October 2019 and March 2020, 302 substances suspected by police to contain MDMA were analyzed. 95% contained MDMA; the rest contained other drugs or no drug. Capsules were the most common form, followed by tablets, crystal, and powder. Median MDMA base-purity of non-tablet forms ranged from 73.5% to 75.0%. Median dose per tablet (116 mg) was higher than per capsule (68 mg), with wide variation: capsules ranged 14-146 mg, tablets 24-201 mg. Only 3.5% of tablets or capsules contained a high dose (130 mg or greater). Adulterants were found in 14.1% of MDMA substances, but only 1.6% contained a psychoactive adulterant, and none were dangerous.
Drug and Alcohol Review
December 1, 1998
W Hall
This review examines two hypotheses linking cannabis use to psychosis. The first posits that heavy cannabis use may cause a rare 'cannabis psychosis' that remits after abstinence, requiring very high THC doses, prolonged use of potent cannabis, or a pre-existing vulnerability. The second suggests cannabis may precipitate or exacerbate schizophrenia. A large prospective study found a linear relationship between cannabis use frequency by age 18 and schizophrenia risk over 15 years, though causality remains unclear due to possible confounding by other drug use or self-medication. Stronger evidence supports that cannabis exacerbates schizophrenia symptoms. Mental health services should identify and advise patients with schizophrenia to reduce or abstain from cannabis and other drugs.
Drug and Alcohol Review
June 1, 1996
J M White, C F Ryan
Ketamine, a dissociative anesthetic similar to phencyclidine, produces analgesia, dissociation, hallucinations, and anesthesia while also stimulating cardiovascular and respiratory systems. Uncontrolled use risks psychosis, violence, accidents, and cognitive impairment. Tolerance and physical dependence are possible but require further study. Ketamine primarily acts as an antagonist at the PCP site of the NMDA receptor and enhances catecholamine, especially dopamine, activity. Opioid receptor involvement is weak and unclear. Despite known clinical effects, little is understood about ketamine as a recreational drug or drug of dependence.