Trends in first-time psychedelic and other hallucinogen use in the United States: Results from the National Survey on Drug Use and Health.

Psychedelic drug use is increasing due in part to local legislative reforms. Understanding the patterns of first-time psychedelic drug use is imperative for informing consumers, healthcare providers, and policy makers. The National Survey on Drug Use and Health (NSDUH) is a repeated cross-sectional nationally representative survey of civilians aged 12 and older. Use estimates are presented for 2002-2019 and 2021-2023; regression analyses did not span 2020 due to data incompatibility. Primary analysis variables were binary indicators for a) lifetime use of hallucinogens (LSD, psilocybin, and MDMA) and b) first-time use of hallucinogens in the past year. Among 1,005,421 respondents from 2002 to 2019 the prevalence of first-time use of any hallucinogen in the past year was 0.71 %; among 173,808 respondents from 2021 to 2023 0.79 % reported new hallucinogen use. From 2002-2019, an average of 0.39 % of participants used MDMA for the first time; 0.28 % used psilocybin for the first time; and 0.18 % used LSD for the first time each year. First-time use of any hallucinogen increased from 2002 to 2019 at an average odds ratio (OR) 1.009 (95 % confidence interval (CI) 1.001-1.016). New use varied by age group, with the age cohort x year interaction showing a decrease among the 12-17 age cohort (OR 0.96 (95 %CI 0.96-0.97)) and an increase among the 65 + cohorts (OR 1.56 (95 %CI and 1.02 (95 %CI 1.01-1.03), respectively). New LSD use increased (OR per additional year 1.08, 95 % CI 1.07-1.09). Similar increases were not observed for psilocybin, MDMA, or hallucinogens overall. For 2021-2023, there was no change in new use of hallucinogens (OR 0.97 [95 %CI 0.86-1.08]). First-time psychedelic and hallucinogen increased only slightly over the period from 2002 to 2019 though there were notable age-group and substance-specific trends: new use generally decreased among adolescents and increased in among those aged 65 and older. Trends from 2021 to 2023 likewise did not suggest changes in overall new use, but continue to show changing patterns of use across substances and age groups.