Clinical Characteristics of Emergency Visits Related to Recreational Psychedelic Use

Recreational psychedelic use is increasing, yet data on adverse events remains limited. This study characterized emergency department (ED) visits associated with recreational psychedelic use at UC San Diego Medical Center. We conducted a retrospective chart review of ED encounters (2010–2023). Cases were identified using ICD-10 hallucinogen-related codes and confirmed through manual review. Multivariable logistic regression was employed to identify factors associated with psychiatric hospitalization. We identified 232 cases, primarily related to LSD (35.0%), MDMA (30.2%), and psilocybin (24.0%). The cohort was predominantly young, white, and male. Common psychiatric symptoms included agitation (25.9%) and anxiety (24.6%). Common nonpsychiatric symptoms included nausea/vomiting (9.5%) and diaphoresis (5.2%). 11.2% of cases required psychiatric hospitalization. Factors associated with psychiatric hospitalization included concurrent cannabis use (OR = 10.9, 95% CI 3.37–39.64), history of bipolar disorder (OR = 12.67, 95% CI 2.35–70.43), and history of a primary psychotic disorder (OR = 17.10, 95% CI 2.01–187.49). Psychedelic-associated emergency visits present with various clinical characteristics. While most recreational psychedelic presentations are effectively managed in the emergency department, specific factors predict severe outcomes. Concurrent cannabis use and pre-existing psychotic or bipolar disorders are associated with increased odds of psychiatric hospitalization, underscoring the importance of targeted risk assessment in patients with these vulnerabilities.