Acute hallucinogen use demonstrates increased in-hospital mortality

1. People receiving acute hospital care for hallucinogen use had an increased risk of mortality compared with the general population.

Evidence Rating Level: 2 (Good)

The global use of hallucinogens has rapidly increased since the mid-2010s. While many clinical trials support the therapeutic use of hallucinogens in mental and substance use disorders, concerns remain regarding the increased risk of serious adverse events, including suicidality and death, especially outside of supervised clinical settings. Furthermore, research on the link between hallucinogen use and mortality risk remains limited. This study thus examined whether people with an emergency department visit or hospital admission involving hallucinogen use were at increased risk of all-cause death compared with the general population. This retrospective cohort study used linked administrative data on individuals aged 15 years and older living in Ontario, Canada, from January 2006 to December 2021, with mortality follow-up until December 2022. In the primary analysis, people with acute care involving hallucinogens were matched to the general population on age, sex, and index date. Of the 11,415, 713 people included in the study, 7,953 (0.07%) had incident acute care involving hallucinogens (mean age, 27.8; 5587 male [70.3%]). The matched analysis included 77,101 people (mean age, 27.7; 54, 233 male [70.3%]) with a median follow-up of 7 (interquartile range 3–11) years. Acute care involving hallucinogens was associated with a 2.6-fold increased all-cause mortality within 5 years (hazard ratio [HR] 2.57, 95% confidence interval [CI] 2.09–3.15), with absolute risk of 6.1% (n = 482) compared to 0.6% in the general population (n = 460). Similar results were found after excluding people with comorbid mental or substance use disorders (HR 3.25, 95% CI 2.27–4.63). Furthermore, relative to the general population, people with acute care involving hallucinogens had a higher risk of death by unintentional drug poisoning (HR 2.03, 95% CI 1.02–4.05), suicide (HR 5.23, 95% CI 1.38–19.74), respiratory disease (HR 2.46, 95% CI 1.18–5.11), and cancer (HR 2.88, 95% CI 1.61–5.14). Overall, this study found that people receiving acute hospital care for hallucinogen use had an increased risk of mortality compared with the general population. Considering the growing use of hallucinogens outside of clinical settings, these findings may be important in clinical and policy decision-making. 

Click to read the study in CMAJ

Image: PD

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