Are psychedelics addictive?

Psychedelics tend not to be overused and, for the most part, do not lead to addictive relationships with the substance. This is especially so with the classical psychedelics. Classic psychedelics (e.g., psilocybin, LSD, DMT, mescaline) show high safety margins in toxicology studies — meaning extremely high doses are required to produce life-threatening toxicity, far beyond typical human use. Several of the non-classical psychedelics, like Ketamine (as well as nitrous oxide and THC) DO carry varying degrees of potential for abuse.

Ketamine continues to be widely used in emergency medicine and trauma surgery and in veterinary surgery and in the treatment of pain. It has a history of safe and effective use in medicine for more than 50 years. Certainly, Ketamine appeals to some folks because it's short-acting and it can get you very high. It can lead to a profoundly altered state quickly and people recover fairly quickly. In a research study in Southeast Asia a few years back, young women who were interviewed said they love to use ketamine after school because they can get really high and still be home in time for dinner. In that sense, ketamine has powerful addictive potential because it's powerful and short-acting.

In talking about addiction, we have to parse out a couple of different issues:

Part of it is thinking about the mindset of the person who's taking the medicine and would they likely be having a substance use problem with something else if ketamine wasn't available?

Then, there's the question of the physical addictiveness, the addictive potential of something like ketamine.

Ketamine has been studied for a long time and it has very minimal physical addictive potential if it's used in a low-dose range, like what we use in a therapeutic application, and used infrequently or with space in between. That changes, though, if people use it in a high dose or frequently or when there is psychological addiction. Some people become accustomed, or some people find it desirable to stop feeling their feelings. They become addicted to the feeling of dissociation, the feeling of distance.

So, is ketamine inherently addictive? We don't think that it is. That said, there's tremendous potential for addiction and substance use disorder and problematic use that we need to be mindful of and that we are teaching the people we work with.

For researched safety profiles of psychedelics, we love to refer to Prof. David Nutt’s research. David Nutt is a British psychiatrist and neuropsychopharmacologist known for his work on drug harms, drug policy, and the neuroscience of psychoactive substances. He has led brain-imaging research on psychedelics such as psilocybin and LSD and authored multiple reviews and policy pieces on their safety and therapeutic potential.