Beyond prohibition: A public health analysis of naturalistic psychedelic use

Abstract

Abstract Psychedelic drug use is experiencing a global resurgence, both in clinical research and community settings. This paper presents a comprehensive public health analysis of the naturalistic use of psychedelics—defined as use outside clinical or research environments. Drawing on a review of 104 peer-reviewed articles, this analysis evaluates the mental, physical, and social outcomes associated with substances such as psilocybin, LSD, MDMA, mescaline, and 5-MeO-DMT. Findings indicate that naturalistic psychedelic use is associated with reductions in depression, anxiety, PTSD, substance use disorders, interpersonal violence, and suicidality, while enhancing emotional well-being, social connectedness, spirituality, nature relatedness, psychological flexibility and physical health. These benefits are observed across diverse populations in many countries, including individuals with trauma, addictions, and chronic pain, as well as in older adults and marginalized groups. Importantly, while adverse effects can occur, they are typically short-lived and often associated with identifiable risk factors such as youth, high doses, psychological vulnerability, and poor set and setting. Drawing on harm reduction principles and Indigenous cultural models, the paper outlines how public education and safe use guidelines—emphasizing mindset, environment, and dosage—can mitigate risks. The data suggest that current prohibitionist drug policies are both outdated and harmful and that a shift toward legalization, regulated access, and evidence-informed education is not only justified but urgently needed. A public health approach to psychedelics, one grounded in safety, inclusion, and scientific evidence, offers the most rational path forward.