Psychoactives, Volume 5, Issue 2 (June 2026) – 10 articles

The label content on consumer products is important for communicating health-related information and promoting safety, which is especially important for psychoactive products such as legal cannabis. New York State (NYS) legalized cannabis for adult use in 2021 and implemented packaging and labeling requirements, including requiring NYS symbols and a Certificate of Analysis (COA). We conducted an online survey exploring consumer recognition of the required NYS symbols and the comprehension and utilization of information provided in COAs. Participants (N = 195) had low recognition of required NYS symbols, most frequently selecting a symbol required in California as being required in NYS. Most participants did not know what proportion of the products that they used had a required NYS symbol on them. Half of the participants did not know how often they viewed COAs, and those who did viewed them less than half of the time they purchased products on average. Participants’ perceptions of the clarity of COAs and the impact of a COA on product safety were mixed. Additionally, 14.9% of respondents reported not using a product because of the information contained in the COA, and 13.8% reported not using a cannabis product because it did not have a COA. These results demonstrate the need for consumer education regarding cannabis product labeling and safety. Full article

Post-traumatic stress disorder (PTSD) remains inadequately treated by existing pharmacological and psychological interventions, prompting growing interest in psychedelic-assisted psychotherapy. Although randomised controlled trials have evaluated several psychedelic agents for PTSD, to our knowledge, no prior PTSD-specific synthesis has quantitatively examined multiple agent classes within a single review framework. This systematic review and meta-analysis searched PsycINFO, CINAHL, Embase, MEDLINE, and clinical trial registries to identify RCTs of psychedelic-assisted psychotherapy for PTSD. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and random-effects meta-analyses were conducted for efficacy outcomes; safety and therapeutic protocols were synthesised narratively. Eleven RCTs involving 358 participants met inclusion criteria, evaluating MDMA, ketamine, and cannabidiol, of which eight contributed to meta-analyses. MDMA-assisted psychotherapy demonstrated a significant moderate-to-large reduction in PTSD symptom severity with negligible heterogeneity, and participants were significantly more likely to achieve clinical response and loss of PTSD diagnosis. The pooled effect for ketamine was small and non-significant, and a single cannabidiol trial showed no clear benefit. All agents were generally well tolerated. MDMA-assisted psychotherapy showed a promising efficacy signal for PTSD symptom reduction, although safety data were heterogenous and remain insufficient for strong comparative conclusions. Evidence for ketamine and cannabidiol remains too limited to support clinical implementation and it is noted that the current evidence base is dominated by MDMA trials. Further adequately powered trials with standardised outcomes and direct comparative studies across agents are needed. Full article

Acute pain is the most common presentation in the emergency department (ED), accounting for approximately 78% of visits and highlighting the need for rapid and effective pain management. Ketamine is a well-established analgesic that can serve as an alternative when opioids are contraindicated. Recently, low-dose ketamine (LDK), also known as sub-dissociative or subanesthetic ketamine, has emerged as a potential option for acute pain control in ED settings; however, evidence regarding its efficacy and safety remains inconsistent. This systematic review aimed to evaluate the effectiveness and safety of LDK for acute pain management in the emergency department. A comprehensive search of SCOPUS, PubMed, and Web of Science was conducted using predefined keywords related to ketamine, acute pain, and emergency care. Peer-reviewed randomized controlled trials (RCTs) published in English between 2015 and 2025 involving adults aged ≥ 18 years were included, and the risk of bias was assessed using the Cochrane Risk of Bias 2 (ROB-2) tool. Sixteen RCTs including 1908 adult patients met the inclusion criteria. The findings were heterogeneous: several studies demonstrated that LDK provided effective pain reduction within 30 min compared with commonly used analgesics such as morphine, ketorolac, and fentanyl, whereas others found no significant superiority, including one placebo-controlled trial. The analgesic effect appeared dose- and administration-dependent, with short intravenous infusions showing better tolerability than bolus dosing. Transient neuropsychiatric adverse effects were reported, but no serious adverse events were identified. Larger multicenter studies are needed to further clarify optimal dosing strategies and confirm the safety profile of LDK in ED pain management. Full article

While prior research links psychedelic use to improved psychological outcomes, less is known about whether psychedelic exposure relates to engagement with formal mental health care when treatment is recognized as needed. Using publicly available, de-identified pooled data from the National Survey on Drug Use and Health (2008–2019), this study examines whether lifetime psychedelic use is associated with missed needed mental health treatment and whether psychedelic exposure moderates the relationship between psychological distress and unmet care, with attention to gender differences. Regression analyses indicate that psychedelic use is not independently associated with lower odds of missing needed treatment once psychological distress is accounted for. However, psychedelic exposure is associated with a weaker relationship between distress and missed care: as psychological distress increases, individuals with prior psychedelic use—particularly men—exhibit a smaller increase in missed needed treatment compared to non-users. Gender-stratified analyses show that this buffering pattern is evident for men across multiple substances, whereas among women, only MDMA demonstrates a comparable moderating effect. These findings suggest that psychedelic use does not uniformly increase engagement with mental health care but is associated with gendered differences in how psychological distress translates into disengagement. Situated within the Medical Sociological and Social Epidemiological Psychedelics Paradigm, the results highlight how structural inequality shapes the behavioral translation of psychedelic experiences, producing diminished returns for women despite comparable levels of distress. Full article

This observational study examined the association between binge drinking and a binary measure of participation in physical activity (PPA) in veterans and nonveterans using pooled 2021–2023 Behavioral Risk Factor Surveillance System data (n = 107,498). Multivariable survey-weighted logistic regression models were stratified by veteran status and adjusted for sociodemographic and health characteristics. Veterans were older than nonveterans (mean age: 60.8 vs. 51.4 years) and slightly less likely to report PPA (80.8% vs. 83.4%). Among veterans, binge drinking days were inversely associated with PPA (aOR = 0.98, p = 0.01), indicating lower odds of physical activity with increasing binge drinking days. A similar but stronger association was observed among nonveterans (aOR = 0.98, p < 0.001). These findings suggest that binge drinking is associated with reduced PPA among veterans and nonveterans. Full article

Prolonged grief disorder (PGD) affects approximately 10% of bereaved individuals and is now formally recognized in both the DSM-5-TR and ICD-11. Despite its prevalence, PGD often responds poorly to traditional therapeutic approaches. This manuscript outlines the protocol for an early-stage open-label feasibility trial investigating the use of psilocybin, a psychedelic compound, in treating PGD in adults, with a focus on young adults. The study will involve 20 participants diagnosed with PGD. Each participant will undergo a structured therapeutic process that includes a preparatory session, a single 25 mg dose of psilocybin, and post-session integration. Throughout the study, participants will be monitored via symptom assessments, including qualitative and quantitative data, with the main aims related to safety, feasibility and acceptability. Functional MRIs will be obtained pre- and post-dosing and collected during a standardized grief-elicitation methodology. Key outcome measures include changes in the severity of PGD and trauma symptoms, cognitive flexibility, openness to experience, meaning in life and subjective experiences during the psilocybin session. Neural activity will also be evaluated through fMRI to better understand the neurobiological effects of the treatment. This research represents one of the first clinical protocols specifically focused on the potential of psilocybin for treating PGD. The goal is to assess feasibility and safety while laying the groundwork for future randomized controlled trials. Full article

Increasing rates of cannabis use among young adult college students is concerning, as research suggests that there may be a negative relationship between cannabis use and academic performance. The present study was conducted to investigate the relationships between cannabis use, harm reduction strategies, and college students’ grade point average (GPA). Participants (N = 125) completed an online survey that included a measure of Cannabis Use Frequency, Protective Behavioral Strategies (PBS) for Cannabis, and the New General Self-Efficacy scale. Hierarchical regressions were used to examine whether Cannabis Use Frequency or PBS for Cannabis were associated with GPA after controlling for covariates. Mediation analysis was conducted to determine whether Cannabis Use Frequency explained the relationship between PBS for Cannabis and GPA. Additionally, general self-efficacy was investigated as a potential moderator of the relationship between PBS for Cannabis and GPA. The results did not show a significant relationship between Cannabis Use Frequency or PBS for Cannabis and GPA after controlling for covariates. General self-efficacy did not significantly moderate the relationship between PBS for Cannabis and GPA. While PBS for Cannabis was indirectly related to Cumulative GPA via Cannabis Use Frequency, and its direct effect was associated with Cumulative GPA, the total effect was not significant, suggesting a suppressor effect. To our knowledge, this was the first study to investigate the relationship between PBS for Cannabis and academic performance with official GPA records. Future longitudinal studies are needed to identify strategies that may help students who engage in cannabis use succeed academically. Full article

Introduction: Chronic non-cancer pain represents a major global health challenge because of its high prevalence, functional impact, and limited response to conventional therapies, highlighting the need for alternative approaches. In this context, subanesthetic-dose ketamine has emerged as a promising therapeutic option because of its ability to modulate central sensitization and enhance analgesia through NMDA receptor antagonism. However, current evidence regarding its long-term efficacy and safety remains limited and heterogeneous. Objective: To evaluate the efficacy and safety of subanesthetic ketamine for the management of chronic non-cancer pain in adults, based on randomized controlled trials published between 2005 and 2025. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Randomized controlled trials involving adults with chronic non-cancer pain were included, comparing ketamine with placebo or other active agents. The databases searched were PubMed, ScienceDirect, and the Cochrane Library. Risk of bias was assessed using the Cochrane RoB-2 tool, and the certainty of evidence was evaluated using GRADE. Results: Five trials met the inclusion criteria. All included studies evaluated intravenous ketamine at doses ranging from 0.3 to 0.5 mg/kg. Overall, ketamine demonstrated significant short-term pain relief (p < 0.05), particularly in neuropathic conditions; however, the magnitude of this effect decreased progressively after the infusion ended. Reported adverse effects were mild and transient, with no evidence of severe toxicity. Heterogeneity in dosing protocols, pain phenotypes, comparator strategies, and follow-up duration limited cross-study comparability. Conclusions: Current evidence supports the short-term efficacy and safety of subanesthetic-dose ketamine as an analgesic option for chronic non-cancer pain, especially in neuropathic syndromes. However, the transient nature of its effects and the heterogeneity among studies underscore the need for standardized protocols and longer follow-up periods. Despite its generally favorable short-term safety profile, subanesthetic ketamine should be used with caution under strict clinical supervision, as the potential for long-term neurocognitive, urological, and hepatic adverse effects remains insufficiently defined. Full article

Synthetic cannabinoids are widely available in the United States, yet contemporary national data on who uses these products, and disparities in use, are limited. To assess disparities in lifetime and past-year synthetic cannabis use (each yes/no), we used 2022–2024 National Survey on Drug Use and Health data from adults aged ≥18 years (n = 139,532) and fit two multivariable logistic regression models adjusted for survey year and sociodemographic and policy characteristics. We also calculated proportions of lifetime and past-year use by various plant-based cannabis use modalities. The proportions of adults with lifetime and past-year synthetic cannabis use were 2.7% and 0.3%, respectively. Younger age, male sex, lower education and household income, and non-metropolitan residence were linked to both lifetime and past-year synthetic cannabis use. For example, past-year synthetic cannabis use was associated with living in non-metropolitan (vs. large metropolitan) areas (AOR = 1.54; 95% CI: 1.03–2.30). Past-year use was also linked to residence in states without medical cannabis law coverage (AOR = 1.45; 95% CI: 1.09–1.94). Finally, past-year synthetic cannabis use was most prevalent among adults who smoked (67.3%) or vaped (52.5%) plant-based cannabis. Synthetic cannabis use was uncommon overall but exhibited clear disparities, underscoring the need for continued surveillance amid evolving cannabinoid policies and markets. Full article