Primum Non Nocere: The Onus to Characterize the Potential Harms of Psychedelic Treatment.

As psychedelics gain popularity as potential therapeutics, understanding their risks becomes as important as studying their benefits. This review examines known and potential harms, including enduring perceptual disturbances, triggering or worsening mania or psychosis, overuse and dependence, challenging experiences ("bad trips"), risks from increased neuroplasticity, and acute and cumulative cardiovascular effects. The authors call for continued research and monitoring, especially as these substances move into broader, less controlled use.

Study at a glance

Abstract

The last few years have seen exponential growth in interest, investment, advocacy, and research into psychedelics as therapeutics. This reflects an optimism about the potential promise of psychedelics as therapeutics. As with all therapeutic interventions, research is needed not only into their benefits but also potential risks. Indeed, when substances with therapeutic potential are scrutinized over time, especially in broad populations with psychiatric and medical comorbidities typically excluded from clinical trials, and applied in less well-regulated or controlled settings, a greater understanding of the cautions emerges. Here, we review the literature on the known and potential harms, including enduring perceptual disturbances; triggering or enhancing the risk for onset of mania or psychosis; overuse, misuse, and dependence; challenging experiences or "bad trips"; risks associated with increased neuroplastic potential; and acute and cumulative cardiovascular effects. Each of these issues is addressed in this review, along with the call for continued research, including recommendations for further research and monitoring.