A hallucinogen-related hospital admission is followed by psychosis far more often than other substance admissions — 16.4% vs 6.6%. But once baseline psychiatric burden is accounted for, the link all but vanishes.
In 273,466 adults with substance-related admissions, the hallucinogen group walked in with a much heavier baseline psychiatric burden: prior psychotic disorder 19.2% vs 6.3%, more mood/anxiety and co-occurring substance use, and a younger median age (24 vs 34). After adjusting for baseline psychiatric history and demographics, the association was gone (adjusted HR 0.97, 95% CI 0.95–1.00). Baseline psychotic disorders — not hallucinogen exposure — predicted who went on to develop psychosis.
Two implications: screen outpatient psychiatric history, not just hospitalizations, when assessing hallucinogen exposure or candidates for psychedelic therapy; and read population-level "drug → psychosis" associations cautiously when baseline comorbidity is poorly measured.
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