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Journal of Psychoactive Drugs
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/ujpd20
The Relationship Between Naturalistic Psychedelic
Use and Clinical Care in Canada
Nicolas G. Glynos, Daniel J. Kruger, Nicholas Kolbman, Kevin Boehnke &
Philippe Lucas
To cite this article: Nicolas G. Glynos, Daniel J. Kruger, Nicholas Kolbman, Kevin Boehnke &
Philippe Lucas (2023): The Relationship Between Naturalistic Psychedelic Use and Clinical Care
in Canada, Journal of Psychoactive Drugs, DOI: 10.1080/02791072.2023.2242353
To link to this article: https://doi.org/10.1080/02791072.2023.2242353
Published online: 29 Jul 2023.
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The Relationship Between Naturalistic Psychedelic Use and Clinical Care in
Canada
Nicolas G. Glynos PhD
a,b,c
, Daniel J. Kruger PhD
b,c,d
, Nicholas Kolbman MS
b,c,e
, Kevin Boehnke PhD
b,c
*,
and Philippe Lucas PhD
f
*
a
Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA;
b
Department of Anesthesiology, University of
Michigan Medical School, Ann Arbor, MI, USA;
c
Center for Psychedelic Science, University of Michigan, Ann Arbor, MI, USA;
d
Population Studies
Center, University of Michigan, Ann Arbor, MI, USA;
e
Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA;
f
SABI Mind,
Calgary, Alberta, Canada
ABSTRACT
Naturalistic psychedelic use among Canadians is common. However, interactions about psyche-
delic use between patients and clinicians in Canada remain unclear. Via an anonymous survey, we
assessed health outcomes and integration of psychedelic use with health care providers (HCP)
among Canadian adults reporting past use of a psychedelic. The survey included 2,384 participants,
and most (81.2%) never discussed psychedelic use with their HCP. While 33.7% used psychedelics
to self-treat a health condition, only 4.4% used psychedelics with a therapist and 3.6% in a clinical
setting. Overall, 44.8% (n = 806) of participants were aware of substance testing services, but only
42.4% ever used them. Multivariate regressions revealed that therapeutic motivation, higher like-
lihood of seeking therapist guidance, and non-binary gender identication were signicantly
associated with higher odds of discussing psychedelics with one’s primary HCP. Having used
a greater number of psychedelics, lower age, non-female gender, higher education, and
a therapeutic motivation were signicantly associated with higher odds of awareness of substance
testing. We conclude that naturalistic psychedelic use in Canada often includes therapeutic goals
but is poorly connected to conventional healthcare, and substance testing is uncommon. Relevant
training and education for HCPs is needed, along with more visible options for substance testing.
ARTICLE HISTORY
Received 10 February 2023
Accepted 11 July 2023
KEYWORDS
Psychedelics; survey; Canada;
substance testing; healthcare
Introduction
The last decade has brought increasing interest and
public attention toward psychedelic substances in con-
junction with psychedelic-assisted psychotherapy as
possible treatments for neuropsychiatric conditions
and substance-use disorders. Indeed, psilocybin-
assisted therapy shows potential for treating major
depressive disorder (Carhart-Harris et al. 2021; Davis
et al. 2021; Goodwin et al. 2022), as well as alcohol
(Bogenschutz et al. 2015, 2022) and tobacco dependence
(Johnson et al. 2014; Johnson, Garcia-Romeu, and
Griffiths 2016). Similarly, MDMA (3,4-methylenediox-
ymethamphetamine) assisted therapy is currently in
phase III clinical trials following several years of promis-
ing results in treating post-traumatic stress disorder
(PTSD) (Jerome et al. 2020; Mitchell et al. 2021).
Concurrent with renewed clinical interest and
research on psychedelics and related therapies, psyche-
delic use among adults in North America continues to
increase (Ofir et al. 2022). The Monitoring the Future
survey reported that the use of hallucinogens (including
psychedelics) by young adults in the U.S. has reached an
all-time high in 2021, with significant increases over the
past 5 and 10 years (National Institutes of Health (NIH)
2022). Similarly, in Canada, 2.0% of adults reported
past-year hallucinogen use, which has steadily increased
since 2013, when 0.6% reported past-year use (Canadian
Alcohol and Drugs Survey (CADS) 2019). These trends
mirror the increasing levels of cannabis use among
Canadians, which was legalized medically in 2001 and
recreationally in 2018 in Canada and continues to be the
most used drug apart from alcohol and tobacco (Fischer
et al. 2016). Despite this, Canadian physicians are cur-
rently not adequately prepared to advise patients on
medical cannabis use due to a lack of sufficient training
in this field (Ng et al. 2022). This presents a potential
warning for psychedelics if they are to follow similar
paths of medicalization or legalization in Canada
(Rochester et al. 2021).
These increases in use are in tandem with loosening
drug policies, which have restricted psychedelic use in
CONTACT Kevin Boehnke kboehnke@med.umich.edu Department of Anesthesiology, University of Michigan Medical School, 24 Frank Lloyd Wright
Drive, Ann Arbor, MI 48106
*These authors contributed equally to this work.
JOURNAL OF PSYCHOACTIVE DRUGS
https://doi.org/10.1080/02791072.2023.2242353
© 2023 Taylor & Francis Group, LLC
both countries since the U.S. Controlled Substances Act
of 1970, and via Bill S-60 in Canada in 1967. Two states
(Oregon and Colorado), and several municipalities in
the U.S. recently decriminalized psychedelic substances,
with additional proposals under consideration
(Psychedelics Legalization & Decriminalization
Tracker, 2022). Similarly in Canada, British Columbia
decriminalized personal possession of several illicit sub-
stances (including psychedelics) as of January 2023, and
additional municipalities are considering similar decri-
minalization proposals. Additionally, Canada recently
enabled certain medical professionals to possess and
administer psilocybin and MDMA under a Special
Access Program (SAP) authorization on a case-by-case
basis, and the province of Alberta recently became the
first Canadian province to regulate the use of psyche-
delics for therapeutic purposes.
However, the medical system is likely unprepared for
widespread psychedelic access, as demonstrated by the
analogous cannabis landscape (Boehnke, Davis, and
McAfee 2022) and the observed disconnect between
naturalistic and medical use of psychedelics. In
a recent online survey of 1,435 individuals reporting
psychedelic use in the U.S (Glynos et al. 2022), over
70% of participants never discussed their psychedelic
use with their primary healthcare professional (HCP),
only 4.4% reported ever using psychedelics with
a therapist or HCP, and awareness and use of testing
kits to verify the identity of psychedelic substances was
low. These findings demonstrated that there is little
communication or medical oversight from HCPs for
those who use psychedelics naturalistically, which may
increase potential risks and harms among individuals
with preexisting conditions such as psychotic disorders,
or those who do not have access to adequate therapeutic
or medical support (Johnson, Richards, and Griffiths
2008). However, whether these findings apply to
Canada is uncertain, and little is known about the rela-
tionship between naturalistic psychedelic use and con-
ventional healthcare among Canadian adults.
We investigated, in the current report, these same
trends among Canadian residents who reported natur-
alistic psychedelic use. We assessed disclosure of psy-
chedelic use to healthcare providers, reasons for
disclosure or non-disclosure, ranking of HCP knowl-
edge of psychedelics, use of psychedelics in clinical set-
tings or under therapeutic guidance, and whether
testing services were used to confirm substance identity.
Given similar policy and use trends between the
U.S. and Canada, we hypothesized that the current
results would align with our previous study, including
a lack of integration between naturalistic psychedelic
use and conventional care, as well as low awareness
and utilization of substance identity testing. We also
explored demographic and use factors associated
with: 1) disclosure of psychedelic use to a primary
HCP and 2) use of testing kits for psychedelic
substances.
Methods
Participant recruitment and eligibility
Participants were invited to take part in an anonymous,
confidential online survey managed via REDCap survey
development software (Vanderbilt University) from
January 14–28, 2022. In addition to advertisements on
social media, the survey was distributed online through
various non-government organizations including
MAPS (Multidisciplinary Association for Psychedelic
Studies) Canada, the Psychedelic Association of
Canada, and The Canadian Drug Policy Coalition.
Study participants were limited to English literate
Canadian adults (≥19 years of age) who self-reported
past use of at least one of eleven psychedelic substances
(2C-B [4-bromo-2,5-dimethoxyphenethylamine]), aya-
huasca, DMT/5-Methoxy-DMT, iboga/ibogaine, keta-
mine, LSD, MDMA/MDA
[3,4-methylenedioxyamphetamine], mescaline, nitrous
oxide, psilocybin, or Salvia divinorum). To arrive at
the final sample size, data were further cleaned by
excluding duplicate observations as well as those with
inappropriate or missing postal codes. As a result of skip
logic designed into the survey or attrition from the
study, certain questions were not presented to the entire
sample. Therefore, to handle missing data, percentages
are presented as a proportion of the population that
answered each question.
Survey measures
This 655 question survey was part of a comprehensive
general population survey of psychedelic use by
Canadian adults. In addition to other domains this
survey included questions asked in our previous inves-
tigation (Glynos et al. 2022), which are described below.
The survey questions are available upon request from
the corresponding author.
Demographic information included participants’ age,
gender, race, annual household income, highest level of
education achieved, relationship and employment sta-
tus, as well as Canadian Province or Territory of
residence.
The survey used a matrix to identify micro and
macro lifetime and past year use of 11 common psyche-
delics, with the following assessments subsequently
2N. G. GLYNOS ET AL.
presented for each identified substance: the motivation
to use, frequency of use over the past year, set and social
setting of use. This was followed by questions specific to
HCP interactions, and self-reported therapeutic use,
including use under the supervision of a health care
provider, the importance of HCP presence, and like-
lihood of using psychedelics under guidance of
a healthcare professional if those services were legal
and available. The latter question was only presented
to those who reported using psychedelics to self-treat
a mental or physical health condition.
Participants indicated whether they had ever dis-
cussed psychedelics with their primary HCP and their
level of comfort in, and reasons for or against, disclosing
psychedelic use to their HCP. Those who disclosed
psychedelic use to their HCP were asked to rate their
primary HCP’s knowledge of psychedelics on a scale
from “poor” to “excellent.” We also asked participants
about their awareness of laboratory services or at-home
test kits to confirm the identity of psychedelic sub-
stances, how often they use these services or products
before consuming psychedelics, and the types of services
they use.
Self-reported health outcomes resulting from psy-
chedelic use were assessed by asking participants
whether they had used psychedelics to treat either
a mental or physical health condition, the condition
that they attempted to treat, and the reason for using
psychedelics to treat that condition. For those who
reported using psychedelics to treat a health condition,
participants rated the effectiveness of naturalistic psy-
chedelic use on a scale from 0 (not at all effective) to
100 (completely effective). Additionally, we asked if the
use of psychedelics resulted in the discontinuation of
traditional treatments, the duration of symptom
improvement resulting from psychedelic use, and the
most effective psychedelic substance in treating their
condition.
Statistical analysis
Data were coded and cleaned by Broadstreet Health
Economics and Outcome Research. We characterized
study population demographics, use patterns, and
interactions with healthcare providers using descrip-
tive statistics. Ratios are provided in the text when
sample sizes differed from the expected overall sample.
We then used binary logistic regression analyses to
investigate the effects of demographic and psychedelic
use characteristics on the outcome variables “Have you
discussed psychedelics with your primary healthcare
provider?” (yes/no) and “Are you aware of the avail-
ability of substance testing services or products?” (yes/
no). For gender, we used dummy variables to com-
pare 1) female vs. non-female (male or other gender
identity), and 2) other gender identity vs. non-other
(male or female). Significance was set at α = .05.All
analyses were conducted using SPSS version 27 (IBM
Corp. 2020).
Study procedures were approved by Advarra
Institutional Review Board services. Participation was
voluntary, and participants could withdraw at any time.
Participants who completed the survey were entered
into a drawing for 1 of 3 Amazon gift certificates valued
at $500.
Results
Sociodemographic characteristics
The raw dataset consisted of 2,869 observations, and
after applying exclusion criteria and cleaning data,
2,384 participants were included in the analyses. The
sample was mostly White (87.2%), 38.8 ± 13.1 years old,
and consisted of 38.5% men, 56.3% women, and 4.1%
individuals who identified as non-binary and other self-
described gender (Table 1). The majority were college
educated, employed either full- or part-time, either mar-
ried or in a domestic partnership or civil union, and
currently lived in urban areas. The highest proportion of
participants resided in Alberta (43.1%), British
Columbia (22.6%), Ontario (21.3%), and
Quebec (5.8%).
Psychedelic use patterns: frequency, set and setting
For the overall sample (N = 2,384), the most widely used
psychedelics were psilocybin (69.5%), MDMA/MDA
(52.6%), and LSD (48.3%, Table 2), with psilocybin
(39.3%), LSD (14.1%,), and MDMA/MDA (8.3%) most
commonly used for microdosing. The most frequently
reported reasons for use were for fun (72.4%), spiritual
exploration (67.8%), and for personal growth (59.4%).
The most common setting for use was at home (32.6%),
or outdoors in a naturalistic environment (24.5%), with
only 3.6% using psychedelics in a clinic or hospital.
Most participants reported using psychedelics with
a companion using the same or similar substance
(39.8%), vs. only 4.4% with a licensed therapist or HCP.
Nitrous oxide accounted for 80.5% (n = 70/87) of
clinical setting psychedelic use and 59.6% (n = 62/
104) of use under therapeutic or HCP guidance;
ketamine accounted for 18.4% (n = 16/87) and
19.2% (n = 20/104) of use under those settings,
respectively. Of those who had used psychedelics
under the guidance of a therapist or HCP, 69.2%
JOURNAL OF PSYCHOACTIVE DRUGS 3
(n = 72/104) said that the presence of the HCP was
“important” or “very important” to the success of
their psychedelic experience, and over 97% (n =
101/104) assign at least some importance. Finally,
among the participants who reported using psyche-
delics to self-treat a mental or physical health con-
dition (n = 861), 86.7% (n = 621/716) reported being
“likely” or “very likely” to use psychedelics under the
guidance of a trained HCP if those services were
legal and available.
Healthcare provider communication
Most participants (81.2%, n = 1,399/1,723) reported
never discussing psychedelics with their primary HCP,
because they saw no reason to do so (48.0%, n = 672/
1,399), were concerned about stigma (45.7%, n = 639/
1,399), preferred to keep their use private (34.9%, n =
488/1,399), or did not believe that their primary HCP
was adequately knowledgeable about psychedelics
(34.5%, n = 482/1,399; Table 3). Of the 18.8% (n = 324/
Table 1. Sociodemographic characteristics.
Overall
N2,384
Age, mean (SD) 38.8 (13.1)
Gender n = 2,393
Male 38.5%
Female 56.3%
Non-binary 4.1%
Prefer to self-describe 0.6%
Prefer not to say 0.5%
Race n = 2,384
White 87.2%
Hispanic 2.3%
Asian 4.6%
South Asian 2.6%
Black 1.4%
Aboriginal/First Nation 3.2%
Métis 3.2%
Other 3.7%
Annual household income n = 2,384
Less than $40,000 21.8%
$40,000–$99,999 41.1%
More than $100,000 37%
Highest education n = 2,384
High school or less 17.8%
Technical or non-university degree 27.3%
Bachelors, Masters or Advanced Degree (MD, PhD, etc.) 54.9%
Relationship status n = 2,384
Married 28.3%
Widowed, divorced or separated 11.5%
In a domestic partnership or civil union 22.5%
Single, but cohabiting with a significant other 10.4%
Single, never married 27.3%
Employment status n = 2,384
Employed, working full-time 61.7%
Employed, working part-time 16.8%
Not employed, looking for work 6.0%
Not employed, NOT looking for work 4.6%
Retired 6.8%
Disabled, not able to work 4.2%
Province or Territory of residence n = 2,384
Alberta 43.1%
British Columbia 22.6%
Manitoba 2.0%
New Brunswick 0.8%
Newfoundland and Labrador 0.5%
Northwest Territories 0.1%
Nova Scotia 2.1%
Nunavut (Territory) 0.1%
Ontario 21.3%
Prince Edward Island 0.1%
Quebec 5.8%
Saskatchewan 1.1%
Yukon (Territory) 0.4%
Currently live in n = 2,384
Rural or remote area 13.7%
Suburban area 29.5%
Urban area 56.8%
4N. G. GLYNOS ET AL.
Table 2. Psychedelic use, set and setting.
Regular
dose Micro dose
Never
used
Psychedelic substances: n = 2,384 n = 2,384 n = 2,384
2C-B 8.5% 0.8% 90.8%
Ayahuasca 8.7% 1.2% 90.4%
DMT/5-MeO-DMT 15.0% 4.2% 82.5%
Iboga/Ibogaine 1.4% 0.7% 98.0%
Ketamine (K) 23.0% 5.0% 74.2%
LSD/Acid 48.3% 14.1% 47.0%
MDMA/MDA (Ecstasy/Molly) 52.6% 8.3% 42.8%
Mescaline (San Pedro, Peyote, etc.) 11.6% 2.2% 86.8%
Nitrous Oxide (whippets, laughing gas) 23.3% 3.1% 74.3%
Psilocybin (mushrooms or synthetic) 69.5% 39.3% 21.1%
Salvia divinorum 16.3% 1.9% 82.3%
Other 3.9% 1.0% 95.6%
Motivation to use psychedelics:
#
n = 2,384
Treat a medical condition 33.7%
Improve mental well being 57.9%
Spiritual exploration 67.8%
Personal growth 59.4%
Manage past trauma 29.7%
For fun 72.4%
Social/peer pressure 15.4%
Boredom 21.8%
Reduce prescription use 11.1%
Reduce other substance use 10.1%
None of the above 0.3%
How frequently have you used psychedelics in the past year? n = 1,645
Once 15.5%
Once every 6 months 20.4%
Once every 2–5 months 31.6%
Once every month 16.4%
Once every week 6.7%
2–3 times per week 7.6%
Daily 1.7%
Typical settings for consuming regular doses
#
n = 2,384
Inside my home 32.6%
Inside a companion’s home 16.5%
In a clinic or hospital 3.6%
At a small gathering/retreat 12.6%
At a large public gathering/party/rave/event 23.3%
Outdoors in an urban environment 3.6%
Outdoors in a naturalistic environment 24.5%
How have you used psychedelics?
#
n = 2,384
Alone 13.2%
With a companion not using psychedelics 16.4%
With a companion using same/similar substance 39.8%
With a licensed therapist or health professional 4.4%
With an unlicensed therapist, shaman, or trip guide 3.5%
With a group of 2 or more companions 24.9%
With a group of strangers 0.8%
Have you ever used psychedelics under the care and guidance of a therapist or healthcare
professional?
n = 820
Yes 12.7%
No 87.3%
How important was the presence of the healthcare provider to the success of your psychedelic
experience?
n = 104
Very important 50.0%
Important 19.2%
Moderately important 22.1%
A little important 5.8%
Not important 2.9%
How likely is it that you would use psychedelics under the guidance of a trained healthcare
professional if these services were legal and available to you?
n = 716
Very likely 67.6%
Likely 19.1%
Neutral 7.0%
Unlikely 3.1%
Very unlikely 3.2%
#
Participants could select all that apply.
JOURNAL OF PSYCHOACTIVE DRUGS 5
1,723) who had discussed psychedelics with their pri-
mary HCP, over half (54.9%, n = 178/324) rated their
primary HCP’s knowledge of psychedelics as “fair” or
“poor.”
Substance testing
Nearly half (44.8%, n = 806/1,798) of participants were
aware of the availability of laboratory services or at-
home test kits to confirm the identity of psychedelic
substances. Of these, a majority (57.6%, n = 464/806)
indicated that they never use those services or products
to confirm the identity of psychedelic substances before
consuming. Of those who did report using these services
or products, at-home test kits (69.3%, n = 237/342) were
the most frequently used. Overall, 81.0% (n = 1,456/
1,798) of the sample were either unaware of or never
used laboratory services or at-home test kits.
Psychedelics and health
Among a pool of 1,722 participants, 50.0% (n = 861)
reported using psychedelics to self-treat a mental or
physical health condition with 47.7% (n = 821) doing
so to treat a mental health condition and 10.2% (n =
175) to treat a physical health condition (Table 4). This
result aligns closely with the observation that n = 803
participants (33.7%) indicated that treating a medical
condition was a motivating factor for their psychedelic
use (Table 2). The mental health conditions most often
self-treated with psychedelics were depression (81.6%, n
= 670/821), anxiety (77.2%, n = 634/821), and PTSD
(39.3%, n = 323/821), and when asked to rate the effec-
tiveness of psychedelics in relieving mental health
symptoms on a scale of 0–100, the mean was 78.6 ±
17.6. The physical health conditions most often self-
treated with psychedelics were chronic pain (49.1%, n
= 86/175), and headaches/migraines (37.1%, n = 65/
Table 3. Healthcare provider attitudes and substance testing.
Have you ever discussed psychedelics with your primary healthcare provider? n = 1,723
Yes 18.8%
No 81.2%
How comfortable are you sharing details about the consequences of your psychedelic use (i.e. changes in symptoms, changes in
medication) with your primary healthcare provider?
n = 324
Very comfortable 46.3%
Somewhat comfortable 31.2%
Neither comfortable nor uncomfortable 5.9%
Somewhat uncomfortable 10.2%
Very uncomfortable 6.5%
Why haven’t you discussed psychedelics with your primary healthcare provider? n = 1,399
Concern about stigma 45.7%
I prefer to keep private 34.9%
Legal concerns 25.8%
To avoid contradicting advice 9.5%
I do not trust 13.2%
Not adequately knowledgeable about psychedelics 34.5%
Won’t be able to integrate psychedelic use into treatment 30.6%
No reason to discuss 48.0%
None of the above 9.5%
How would you rate your primary healthcare provider’s knowledge of psychedelics? n = 324
Excellent 4.0%
Very good 9.0%
Good 13.3%
Fair 18.2%
Poor 36.7%
Are you aware of the availability of laboratory services or at home test kits to confirm the identity of psychedelic substances? n = 1,798
Yes 44.8%
No 55.2%
How often do you use laboratory services and/or at home test kits to confirm the identity of a psychedelic substance before
consuming?
n = 806
Never 57.6%
Rarely 14.3%
Sometimes 13.3%
Often 6.9%
Always 7.9%
What type of testing service do you use?
#
n = 342
At home test kit 69.3%
Testing service at an event 34.5%
My dealer, therapist or shaman tests for me 21.9%
Laboratory-based service 23.1%
Other 3.2%
#
Participants could select all that apply.
6N. G. GLYNOS ET AL.
175), and the mean effectiveness rating for treating
physical conditions was 71.3 ± 23.6. The primary rea-
sons for using psychedelics to self-treat a health condi-
tion were that traditional treatments had failed (50.4%,
n = 434/861), and that psychedelics would be interesting
to try (45.9%, n = 395/861). Psilocybin, which was the
most used substance among this population, was cited
as the most effective substance to treat both mental
(62.9%, n = 516/821) and physical (47.4%, n = 83/175)
health conditions.
Table 4. Health outcomes.
Have you self-treated with psychedelics? n = 1,722
Yes, to treat a physical health condition 10.2%
Yes, to treat a mental health condition 47.7%
No, never to treat a condition 49.9%
Reason for self-treatment with psychedelics
#
n = 861
Traditional treatments had failed 50.4%
I didn’t like the idea of traditional treatments 29.0%
I thought it would be interesting to try 45.9%
It fits in with my beliefs or cultural practices 35.3%
It was recommended by friends 25.2%
None of the above 3.1%
Which physical health condition have you treated with psychedelics?
#
n = 175
Autism 7.4%
Cancer 6.9%
Cardiovascular 3.4%
Chronic pain 49.1%
Covid 6.9%
Diabetes 2.9%
Gastrointestinal disorder 13.1%
Headache/migraines 37.1%
Neurological disorder 8.0%
Sleeping disorder 26.9%
Other 30.3%
Which mental health condition have you treated with psychedelics?
#
n = 821
Addiction 19.2%
Anxiety 77.2%
ADHD 24.7%
Bipolar 5.6%
Depression 81.6%
Eating disorder 9.6%
OCD 8.3%
Personality disorder 9.0%
PTSD 39.3%
Psychotic disorder 1.5%
Other 4.4%
Effectiveness on improving physical health (mean, SD)
δ
71.3 (23.6)
Effectiveness on improving mental health (mean, SD)
δ
78.6 (17.6)
Length of benefits Physical health Mental health
n = 175 n = 820
1 week 30.9% 17.4%
Several weeks but less than a month 17.7% 22.1%
1 month 10.9% 11.2%
Several months but less than a year 15.4% 23.4%
A year or two 2.3% 3.3%
Continuously 22.9% 22.6%
Most effective substance for self-treatment
n = 175 n = 821
2C-B 2.3% 0.4%
Ayahuasca 10.3% 4.4%
DMT/5-MeO-DMT 5.7% 1.6%
Iboga/Ibogaine 0.0% 0.4%
Ketamine 8.6% 4.1%
LSD/Acid 8.0% 12.9%
MDMA/MDA 4.6% 8.3%
Mescaline 0.0% 0.9%
Nitrous Oxide 1.1% 0.4%
Psilocybin 47.4% 62.9%
Salvia divinorum 1.1% 0.2%
None were effective 10.9% 3.7%
#
Participants could select all that apply.
δ
Effectiveness was rated on a scale of 0–100 with 0 = not at all effective, and 100 = completely effective.
JOURNAL OF PSYCHOACTIVE DRUGS 7
Logistic regression: HCP communication and testing
services
In univariate analyses, having a therapeutic motivation
to treat a physical or mental health condition, likelihood
of seeking therapist guidance, a gender other than man
or woman, higher age, larger variety of psychedelics
used, and consuming both macro and microdoses
were all significantly associated with higher odds of
disclosure of psychedelic use to one’s primary HCP
(Table 5). Consuming only macrodoses, and female
gender were significantly associated with lower odds of
disclosure. However, in the adjusted multivariate model
(n = 716), only having a therapeutic motivation to treat
a physical or mental health condition (Adjusted Odds
Ratio [AOR] = 2.1, 95% Confidence Interval [CI]
= 1.41–3.14, p < .001), likelihood of seeking therapist
guidance (AOR = 1.44, CI = 1.14–1.82, p = .002), and
gender other than man or woman (AOR = 4.04, CI
= 1.01–16.19, p = .049) were significantly associated
with higher odds of discussing psychedelics with one’s
primary HCP. In univariate analyses assessing aware-
ness of substance testing kits or services, larger variety of
psychedelics used, lower age, having a therapeutic moti-
vation to treat a physical or mental health condition,
other gender, and consuming both microdoses and
macrodoses were significantly associated with higher
odds of awareness. Female gender and consuming only
microdoses were significantly associated with lower
odds of awareness. In the adjusted multivariate model
(n = 716), larger variety of psychedelics used (AOR =
1.42, CI = 1.31–1.54, p < .001), lower age (AOR = 0.97,
CI = 0.97–0.96, p = .001), higher education (AOR = 1.1,
CI = 1.02–1.18, p = .13), and having a therapeutic moti-
vation to treat a physical or mental health condition
(AOR = 1.46, CI = 1.04–2.05, p = .027) were significantly
associated with higher odds of awareness of substance
testing kits or services, and female gender (AOR = 0.63,
CI = 0.45–0.87, p = .006) was associated with lower odds
of awareness.
Discussion
This large survey of Canadian residents demonstrates
a high self-reported use of psychedelics for therapeutic
purposes in conjunction with a disconnected relation-
ship between naturalistic psychedelic use and main-
stream medical care. Consistent with our hypotheses,
most participants did not disclose their psychedelic use
to their primary HCP, used psychedelics without clinical
or therapeutic support, and the majority were either
unaware or did not use substance testing services (either
Table 5. Regression analyses of discussing psychedelics with primary HCP and awareness of substance testing kits or
services.
Univariate predictions Multivariate predictions
Predictor Exp(B) (95% CI) pExp(B) (95% CI) p
Have you ever discussed psychedelics with your primary healthcare provider?
Therapeutic motivation 4.00 (3.11–5.15) <.001 2.10 (1.41–3.14) <.001
Likelihood of therapist guidance 1.46 (1.16–1.84) .001 1.44 (1.14–1.82) .002
Other gender
#,δ
3.75 (1.25–11.24) .018 4.04 (1.01–16.19) .049
Age 1.01 (1.00–1.02) .010 1.02 (1.00–1.03) .053
Number of psychedelics used 1.17 (1.11–1.23) <.001 1.07 (0.99–1.16) .107
Macrodose only 0.55 (0.43–0.71) <.001 0.24 (0.04–1.58) .136
Female gender
#
0.69 (0.54–0.88) .002 0.76 (0.52–1.09) .137
Microdose only 0.79 (0.47–1.33) .372 0.32 (0.05–2.27) .256
Both microdose and macrodose 1.90 (1.48–2.42) <.001 0.36 (0.06–2.31) .280
Education 1.02 (0.97–1.07) .457 1.03 (0.95–1.12) .448
White 1.08 (0.75–1.56) .697 1.17 (0.67–2.07) .581
Household income 0.95 (0.87–1.03) .177 0.97 (0.85–1.10) .627
Are you aware of the availability of substance testing services?
Number of psychedelics used 1.40 (1.33–1.47) <.001 1.42 (1.31–1.54) <.001
Age 0.99 (0.98–0.99) <.001 0.97 (0.97–0.96) .001
Female gender
#
0.66 (0.54–0.79) <.001 0.63 (0.45–0.87) .006
Education 1.03 (0.99–1.07) .103 1.10 (1.02–1.18) .013
Therapeutic motivation 1.53 (1.26–1.86) <.001 1.46 (1.04–2.05) .027
Other gender
#,δ
4.14 (1.14–15.10) .031 3.12 (0.47–20.76) .240
Microdose only 0.25 (0.16–0.40) <.001 0.44 (0.04–4.56) .487
Likelihood of therapist guidance 0.97 (0.83–1.12) .661 0.97 (0.82–1.14) .683
White 1.15 (0.87–1.52) .335 1.08 (0.66–1.75) .758
Both microdose and macrodose 1.59 (1.32–1.92) <.001 0.71 (0.07–6.88) .769
Household income 0.95 (0.87–1.01) .126 0.99 (0.88–1.11) .864
Macrodose only 0.90 (0.74–1.08) .262 1.07 (0.11–10.46) .953
#
: In full model regression analyses, a dummy variable was used to compare female vs. non-female genders.
δ: A dummy variable was used to compare other gender identities vs. male or female. Other gender included self-descriptions such as “non-
binary,” “trans man,” and “androgynous.”
8N. G. GLYNOS ET AL.
at-home kits or laboratory services) to verify the identity
of their psychedelic substance. Of note, most partici-
pants using psychedelics for mental or physical health
conditions reported substantial improvements in their
symptoms.
These findings complement and expand upon results
from our previous study among U.S. residents using
psychedelics naturalistically (Glynos et al. 2022). Our
findings on disclosure of psychedelic use to primary
HCP are remarkably concordant (18.8% in Canada vs.
15.7% in U.S.), with similar reasons for non-disclosure
of use: stigma, privacy, no reason to discuss, and HCP is
not adequately knowledgeable about psychedelics.
Generally, a lower proportion of Canadian residents in
the current study were aware of at-home or laboratory
testing services for psychedelic substances (44.8% vs.
62.6%) although a comparable proportion never used
these services (57.6% in Canada, 64.1% in U.S.). As with
our study in the U.S., most participants in the current
study (54.9%) described their primary HCP’s knowledge
of psychedelics as “fair” or “poor,” a result that aligns
with recent findings about the lack of knowledge and
preparedness surrounding psychedelic therapies among
psychologists and psychiatrists (Barnett, Siu, and Pope
2018; Davis et al. 2021). When considering the current
trends in North America toward increased naturalistic
psychedelic use among adults, in tandem with the
relaxation of drug policies associated with widespread
decriminalization and legalization efforts, these findings
highlight a critical need for additional infrastructure to
support individuals choosing to use psychedelics
naturalistically.
We found that a large portion of the sample (57.9%)
attempted to self-treat a mental or physical health con-
dition with psychedelics. The mental and physical
health conditions that were most frequently treated
with psychedelics were depression (81.6%), anxiety
(77.2%), PTSD (39.3%), chronic pain (49.1%) and head-
aches/migraines (37.1%), all of which have been, or are
currently being investigated in clinical trials with psy-
chedelics (David and Hellerstein 2022; Schindler 2022).
As reported by survey participants. the most effective
substance was psilocybin for both physical (47.4%) and
mental (62.9%) health conditions, a finding that aligns
with current research trends. These results suggest that
findings from modern psychedelic clinical research may
be in part interacting with trends for self-treatment with
psychedelics naturalistically.
Although participants reported positive effects of
self-treatment with psychedelics, the set and setting of
this self-treatment emphasizes the mismatch between
clinical trial research and naturalistic use of psychede-
lics. Less than 5% of respondents reported using
psychedelics either in a clinical setting or under the
guidance of a therapist or HCP. Among those using
psychedelics under the guidance of a trained HCP (n
= 104), the majority (69.2%) indicated that the presence
of the HCP was “important” or “very important” to the
success of their experience, and over 85% would be
likely or very likely to avail themselves of the services
of a healthcare professional if that option was legally
available. With the expansion of ketamine clinics in
Canada and the U.S., along with increased access via
clinical trials and federally sanctioned Special Access
Programs, legal use overseen by HCPs is becoming
increasingly accessible (Zach et al. 2021). In contrast to
the < 5% who had HCP support during naturalistic use,
modern clinical trials with psychedelics typically employ
a therapeutic support team to be present before, during,
and/or after psychedelic dosing sessions (Watts and
Luoma 2019). These support teams reduce potential
risks and may promote therapeutic benefit in several
ways. First, pre-screening of past diagnoses and current
medications are important to ensure that psychedelics
can be taken safely and to avoid potential contraindica-
tions or side effects (Johnson, Richards, and Griffiths
2008). Second, consuming psychedelics under clinical
or therapeutic care can ensure that a pure and unadult-
erated substance of known dose is being consumed,
mitigating risks associated with the potential presence
of toxic substances which can often be present in illicit
drugs, including psychedelics (McCrae et al. 2019).
Third, it is becoming increasingly well established that
the presence of a HCP during dosing sessions and con-
comitant psychotherapy following dosing are both
important factors in promoting safety by allowing for
psychological and medical support, as well as maximiz-
ing the potential efficacy of treatment (Carhart-Harris
et al. 2018; Haijen et al. 2018; Leor, Nutt, and Carhart-
Harris 2018; Roseman et al. 2019). Fourth, psychological
support in the weeks following dosing sessions not only
helps patients to integrate and process the experience(s)
to promote meaningful change, but also allows for the
building of therapeutic alliance and promotes patient-
centered care, both of which are recognized as key
components of effective clinical care (Epstein and
Street 2011; Murphy et al. 2022).
Combined with the results of our recent U.S. survey,
the findings in the current report highlight an important
challenge to modern drug policy and clinical care: indi-
viduals are consuming illicit substances and reporting
beneficial health outcomes, yet a lack of clinical infra-
structure and safe, legal access increases potential risks
and harms, and impedes the provision of the necessary
therapeutic care to support people using these sub-
stances. From a policy perspective, some of these risks
JOURNAL OF PSYCHOACTIVE DRUGS 9
could be mitigated by rescheduling or decriminalizing
psychedelic substances to align with modern research
findings of therapeutic potential and known risk factors,
and to remove criminal charges associated with drug
possession or use (Johnson et al. 2018). From a clinical
perspective, additional certification opportunities, educa-
tional outreach, and training programs could be lever-
aged for both healthcare providers and individual
community members to improve standard of care and
widen accessibility of psychedelic-associated support
(Boehnke, Davis, and McAfee 2022). Such certification
and training programs are currently offered by a growing
number of organizations and academic institutions
across the US and Canada, but additional opportunities
will be needed to meet the needs of larger clinical trials
and demands of legal and clinically available psychedelics
(Tai et al. 2021). Future studies might focus more closely
on details about specific naturalistic psychedelic experi-
ences, the effects on past diagnoses, or the occurrence of
adverse effects or negative experiences, including long-
itudinal tracking of self-reported therapeutic benefits
using validated assessment measures.
Given our convenience sampling method, our study
sample overrepresented white, wealthy, and educated
individuals, which may not generalize to the Canadian
population. In addition to the limitations associated
with recall bias of past experiences and outcomes in
our cross-sectional survey, our study did not include
biological measures to confirm substance use. Thus,
we are unable to confirm that the substances con-
sumed by participants were pure and unadulterated,
especially considering the fact that most substances
are illicit and many participants reported not using
testing kits or services to confirm substance identities.
Finally, as our recruitment strategies predominantly
targeted psychedelic and decriminalization interest
groups, our results likely overrepresent beneficial out-
comes associated with naturalistic psychedelic use,
while underrepresenting negative or harmful out-
comes. In context of these limitations, this study repli-
cates our initial U.S. findings around the disconnected
relationship between mainstream healthcare and psy-
chedelic use in Canada. The current study was well
powered with a large sample size and, unlike other
studies of psychedelic use that often oversample men,
our sample included a relatively high percentage of
women and individuals who identify as non-binary.
Our current findings highlight how poorly naturalistic
psychedelic use is integrated into conventional health-
care systems. These results demonstrate the need for
additional resources and infrastructure to help ensure
safe and responsible naturalistic psychedelic use for ther-
apeutic purposes. These could include the
implementation of additional training or education pro-
grams for current and future healthcare providers or
community members, along with more accessibility and
availability of substance testing services. As naturalistic
psychedelic use continues to increase and liberalization
policies expand, it will be essential to ensure that con-
ventional healthcare systems are prepared to provide
support and care related to these substances to maximize
therapeutic efficacy and reduce unnecessary risks and
harms.
Acknowledgments
We are very grateful to the many participants who completed
this survey.
Disclosure statement
Philippe Lucas, PhD., is a co-investigator in this study, as well
as President of SABI Mind, a clinic group that co-sponsored
the Canadian Psychedelic Survey. Kevin Boehnke, PhD., has
received protocol development funding from Tryp
Therapeutics and sits on a data safety and monitoring com-
mittee for Vireo Health (unpaid). Dr. Boehnke’s effort on this
publication was partially supported by the National Institute
on Drug Abuse of the National Institutes of Health under
Award Number K01DA049219 (KFB). The content is solely
the responsibility of the authors and does not necessarily
represent the official views of the National Institutes of Health.
Funding
This study was partially funded by SABI Mind, MAPS Public
Benefit Corps, and Psygen.
ORCID
Nicolas G. Glynos PhD http://orcid.org/0000-0002-6952-
131X
Daniel J. Kruger PhD http://orcid.org/0000-0002-2757-
7016
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