The Relationship Between Naturalistic Psychedelic Use and Clinical Care in Canada

Glynos and colleagues situate their study in the context of rising public and clinical interest in psychedelic substances and psychedelic-assisted therapies, alongside growing naturalistic use in North America. The introduction notes promising clinical trial results for psilocybin and MDMA in conditions such as major depressive disorder, substance dependence and PTSD, while also describing rising population-level use of hallucinogens. The authors highlight parallels with cannabis, where rapid changes in legal status outpaced clinician preparedness, and they argue that Canada may face a similar mismatch between naturalistic psychedelic use and the readiness of healthcare systems and providers. The study set out to examine how Canadians who report past psychedelic use interact with conventional healthcare. Specifically, the investigators assessed whether people disclosed psychedelic use to primary healthcare providers (HCPs), reasons for disclosure or non-disclosure, perceived HCP knowledge about psychedelics, frequency of clinical or therapist-guided psychedelic use, awareness and use of substance testing services or kits, and self-reported therapeutic use and outcomes. Based on prior U.S. findings, the authors hypothesised that Canadian patterns would show limited integration with healthcare and low awareness and utilisation of substance testing. They also explored demographic and use-related factors associated with (1) disclosure to a primary HCP and (2) awareness of testing services.

The investigators conducted an anonymous, confidential online survey between 14–28 January 2022 using REDCap. Recruitment used social media and distributions via non-governmental organisations active in psychedelics and drug policy; participation was restricted to English-literate Canadian adults aged 19 or older who self-reported lifetime use of at least one of eleven specified substances (including psilocybin, LSD, MDMA/MDA, ketamine, DMT, ayahuasca, iboga/ibogaine, mescaline, nitrous oxide, 2C-B, and Salvia divinorum). After removing duplicates and responses with inappropriate or missing postal codes, the final analytic sample comprised 2,384 participants. The survey comprised 655 questions covering demographics, lifetime and past-year use patterns (micro- and macrodosing), motivations, set and setting, HCP interactions, therapeutic use, awareness and use of substance-testing services or at-home kits, and self-reported outcomes of using psychedelics to treat health conditions. Descriptive statistics characterised the sample and primary measures. The study used binary logistic regression to examine predictors of two outcomes: whether participants had discussed psychedelics with their primary HCP (yes/no) and whether they were aware of substance-testing services or kits (yes/no). Gender was modelled with dummy variables to compare female versus non-female and other gender identities versus male or female. The authors set significance at α = .05 and conducted analyses in SPSS version 27. The extracted text reports adjusted multivariate models based on subsamples (n = 716 for adjusted models), but does not detail the model selection strategy beyond reporting univariate and adjusted multivariate results. Study procedures received institutional review board approval, participation was voluntary, and completers were entered into a prize draw.

The cleaned sample included 2,384 participants who were predominantly White (87.2%), with a mean age of 38.8 ± 13.1 years. Gender distribution was 38.5% men, 56.3% women, and 4.1% identifying as non-binary or another gender. Most participants had college-level education, were employed, lived in urban areas, and the largest provincial representation was Alberta (43.1%), followed by British Columbia (22.6%), Ontario (21.3%) and Quebec (5.8%). Psilocybin (69.5%), MDMA/MDA (52.6%) and LSD (48.3%) were the most commonly reported substances. Psilocybin, LSD and MDMA/MDA were the most frequent choices for microdosing. Reported motivations for use were mainly recreational and personal development oriented: for fun (72.4%), spiritual exploration (67.8%) and personal growth (59.4%). Common settings were at home (32.6%) and outdoors (24.5%); only 3.6% reported using psychedelics in a clinic or hospital, and 4.4% had used psychedelics with a licensed therapist or HCP. Nitrous oxide and ketamine comprised the bulk of the small proportion who used psychedelics in clinical or HCP-guided contexts. Among the 104 participants who had used psychedelics under HCP or therapist guidance, 69.2% rated the presence of the HCP as "important" or "very important," and among those who had used psychedelics to self-treat a condition, 86.7% indicated they would be "likely" or "very likely" to use psychedelics under guided care if legally available. Regarding healthcare communication, 81.2% (n = 1,399/1,723 answering that item) reported never discussing psychedelics with their primary HCP. The most cited reasons were seeing no reason to tell (48.0%), concern about stigma (45.7%), preferring privacy (34.9%), and perceiving the HCP as inadequately knowledgeable about psychedelics (34.5%). Of those who had discussed use (18.8%, n = 324/1,723), 54.9% rated their HCP's knowledge as "fair" or "poor." Awareness and use of substance testing were limited: 44.8% (806/1,798) reported awareness of laboratory or at-home testing services; of those aware, 57.6% never used such services before consuming substances. At-home test kits were the most commonly used modality among users of testing (69.3%). Overall, 81.0% of respondents were either unaware of or never used testing services or kits. Half of a 1,722-person subsample (50.0%, n = 861) reported using psychedelics to self-treat a mental or physical health condition; 47.7% reported self-treatment for mental health and 10.2% for physical health (participants could select multiple categories). Depression (81.6%), anxiety (77.2%) and PTSD (39.3%) were the most commonly cited mental health targets, with chronic pain (49.1%) and headaches/migraines (37.1%) the most frequent physical conditions. Mean self-rated effectiveness on a 0–100 scale was 78.6 ± 17.6 for mental health and 71.3 ± 23.6 for physical health. Primary reasons for self-treatment included failure of traditional treatments (50.4%) and curiosity/interest (45.9%). Psilocybin was most often reported as the most effective substance for both mental (62.9%) and physical (47.4%) conditions. In regression analyses, univariate predictors of disclosing psychedelic use to a primary HCP included therapeutic motivation, likelihood of seeking therapist guidance, non-binary/other gender identity, older age, using a larger variety of psychedelics, and consuming both macro- and microdoses; female gender and consuming only macrodoses were associated with lower odds. In the adjusted multivariate model (n = 716), significant positive predictors of disclosure were therapeutic motivation (AOR = 2.10, 95% CI = 1.41–3.14, p < .001), greater likelihood of seeking therapist guidance (AOR = 1.44, 95% CI = 1.14–1.82, p = .002), and identifying as a gender other than man or woman (AOR = 4.04, 95% CI = 1.01–16.19, p = .049). For awareness of testing services, univariate predictors included larger variety of psychedelics used, younger age, therapeutic motivation, other gender identity, and consuming both micro- and macrodoses; female gender and consuming only microdoses were associated with lower odds. In the adjusted multivariate model (n = 716), larger variety of psychedelics used (AOR = 1.42, 95% CI = 1.31–1.54, p < .001), therapeutic motivation (AOR = 1.46, 95% CI = 1.04–2.05, p = .027) and female gender being associated with lower awareness (AOR = 0.63, 95% CI = 0.45–0.87, p = .006) were reported as significant. The extracted text also reports lower age (AOR = 0.97) and higher education (AOR = 1.10, 95% CI = 1.02–1.18) in this model, but the confidence interval and p-value information for age is internally inconsistent in the extraction and the p-value reported for education (p = .13) contradicts the confidence interval; the extracted text does not clearly resolve these inconsistencies.

Glynos and colleagues interpret their findings as demonstrating a substantial prevalence of therapeutic-motivated naturalistic psychedelic use in Canada coupled with limited integration into conventional healthcare. The discussion emphasises concordance with prior U.S. data: a small minority disclosed psychedelic use to primary HCPs (18.8% in Canada versus about 15.7% in the U.S.), low use of clinical or therapist-guided settings (< 5%), and low awareness and utilisation of substance-testing services. The authors note that many participants who self-treated reported substantial symptomatic improvements and that psilocybin was most commonly rated as effective, aligning with current clinical research trends. The investigators argue that the mismatch between clinical-trial environments and naturalistic use is important because clinical protocols typically include pre-screening, supervised administration of verified substances, therapeutic support during dosing and integration psychotherapy afterwards, all of which can reduce risks and potentially enhance benefits. They suggest policy-level responses such as rescheduling or decriminalisation to reduce criminal harms and clinical responses including expanded training, certification and educational outreach for healthcare providers and community members to improve safety and access to informed care. The discussion also highlights expanding access routes already emerging, including ketamine clinics, clinical trials and Special Access Programs in Canada. The authors acknowledge multiple limitations: convenience sampling that overrepresents White, educated and relatively affluent participants and recruitment strategies that targeted psychedelic-interested groups, which may bias toward favourable reports; reliance on self-report and retrospective recall without biological verification of substances; the cross-sectional survey design that cannot establish causality or longitudinal outcomes; and likely underrepresentation of adverse events. They call for future research to examine more detailed features of naturalistic experiences, adverse effects, validated longitudinal outcome measures, and better population-representative sampling. In sum, the authors conclude that their data replicate prior findings of a poorly integrated relationship between naturalistic psychedelic use and mainstream healthcare in Canada and argue for more visible substance-testing options and targeted HCP education to mitigate risks and support people using psychedelics for therapeutic purposes.