Hallucinogen use in the United States, 2021–2023: Diverging trends and subgroup patterns

TL;DR

Hallucinogen use in the U.S. remained stable overall from 2021 to 2023, but specific substances like LSD and ketamine showed opposite trends, with implications for targeted public health strategies.

Contribution

The study reveals diverging trends in specific hallucinogens, emphasizing the need for substance-specific monitoring and policy responses.

Findings

LSD use declined significantly from 2021 to 2023.

Ketamine use increased, particularly among males and uninsured individuals.

Education level remains a strong correlate of hallucinogen use.

Abstract

While interest in the therapeutic and recreational use of hallucinogens has increased, national surveillance often reports use in aggregate, potentially masking shifting trends among pharmacologically distinct substances. This study assessed trends in specific hallucinogens from 2021 to 2023 and identified correlates of use, with particular attention to subgroup patterns in populations commonly prioritized for prevention and access-focused interventions.

Using nationally representative NSDUH data (2021–2023; ages ≥12), we estimated annual past-year prevalence of LSD, PCP, ecstasy (MDMA), ketamine, Salvia divinorum, and tryptamines (including DMT). We fit survey-weighted logistic regression models with year (continuous) to assess trends and pooled multivariable models to examine demographic correlates.

Although overall past-year hallucinogen use was stable (2.83 % [95 % CI: 2.52–3.14] in 2021; 2.82 % [2.52–3.12] in 2023), substance-specific trends diverged. LSD declined (aOR per year=0.83, 95 % CI: 0.75–0.93), from 0.88 % (0.72–1.04) in 2021–0.58 % (0.47–0.68) in 2023. Ketamine increased (aOR=1.11, 95 % CI: 1.02–1.21), from 1.61 % (1.42–1.80) to 1.91 % (1.67–2.16). Ecstasy/MDMA and tryptamines were stable, and PCP and Salvia remained rare. Use concentrated among young adults and males; adjusted models indicated higher odds among uninsured respondents and those below the federal poverty level.

Despite stable overall hallucinogen prevalence, significant increases were observed for ketamine alongside declines for LSD, suggesting a shifting landscape of hallucinogen use. Substance-specific monitoring may better inform screening, prevention, and harm-reduction efforts than aggregate hallucinogen indicators, especially as ketamine’s medical availability expands and disparities in access to mental health treatment persist.

•LSD use declined annually 2021–2023 in U.S. NSDUH data.•Ketamine use rose, notably among males and uninsured adults.•Divergent trends suggest substance-specific policy responses.•Education remains strongly associated with hallucinogen use.•Findings inform targeted harm-reduction and surveillance.

LSD use declined annually 2021–2023 in U.S. NSDUH data.

Ketamine use rose, notably among males and uninsured adults.

Divergent trends suggest substance-specific policy responses.

Education remains strongly associated with hallucinogen use.

Findings inform targeted harm-reduction and surveillance.