As interest in psychedelic drugs grows across therapy rooms and festival fields, questions about their real world safety are becoming harder to ignore. New global research suggests that while serious physical harms remain uncommon, reports linked to substance misuse are more frequent for some widely used psychedelics. The findings were published in Psychiatry Research.
The study examined safety reports submitted to the World Health Organization’s international drug monitoring system, which collects information from healthcare professionals and the public across more than 180 countries. Researchers focused on classic psychedelics such as LSD, psilocybin, DMT, and mescaline, alongside MDMA, often known as ecstasy.
MDMA and LSD accounted for the vast majority of reports, with more than 1,500 linked to MDMA and nearly 400 linked to LSD. Reports involving psilocybin, DMT, and mescaline were far fewer, reflecting either lower use, lower reporting, or reluctance to disclose use of illegal substances.
Across all drugs examined, the most commonly reported problems were psychiatric in nature. These included concerns related to substance misuse, dependence, and broader mental health difficulties. Compared with a widely used painkiller with low abuse potential, reports linked to MDMA and LSD were far more likely to involve substance use disorder and alcohol misuse.
When researchers compared these drugs with a strong opioid known for high addiction risk, MDMA and LSD still showed higher reporting of several substance misuse related outcomes, although opioid use remained more closely linked to drug dependence itself. This distinction highlights differences between prescription drugs and substances more commonly used in recreational settings.
Importantly, reports of overdose were rare, accounting for roughly 1% to 2% of all cases linked to MDMA and LSD. Serious physical complications affecting the heart, digestive system, or nervous system were also uncommon. Pregnancy related and congenital complications were reported only rarely across all substances.
Most reports came from adults aged 18 to 44, and the majority involved men. Europe accounted for the largest share of reports overall, although cases involving psilocybin and mescaline were more often reported from the Americas.
The findings do not mean that psychedelics directly cause substance misuse. The database cannot confirm whether reported problems were caused by a single drug, multiple substances taken together, or pre existing vulnerabilities. Previous surveys suggest that many people who use psychedelics also consume alcohol or cannabis, which may partly explain the higher rates of misuse related reports.
Experts also caution that voluntary reporting systems tend to under capture milder side effects and may miss many cases entirely. At the same time, fear of legal consequences may discourage people from reporting harms linked to illicit drug use, meaning the true scale remains uncertain.
Even so, the research provides one of the clearest pictures yet of how psychedelics and MDMA appear in global safety monitoring outside controlled clinical trials. As psychedelic assisted therapies continue to attract public and medical interest, the study highlights the importance of careful screening, education, and realistic expectations about risks alongside potential mental health benefits.