ImportanceInterest in and use of hallucinogens has been increasing rapidly. While a frequently raised concern is that hallucinogens may be associated with an increased risk of psychosis, there are limited data on this association.ObjectivesTo examine whether individuals with an emergency department (ED) visit involving hallucinogen use have an increased risk of developing a schizophrenia spectrum disorder (SSD).Design, Settings, and ParticipantsThis population-based, retrospective cohort study (January 2008 to December 2021) included all individuals aged 14 to 65 years in Ontario, Canada, with no history of psychosis (SSD or substance induced). Data were analyzed from May to August 2024.ExposureAn incident ED visit involving hallucinogen use.Main Outcomes and MeasuresDiagnosis of SSD using a medical record–validated algorithm. Associations between ED visits involving hallucinogens and SSD were estimated using cause-specific adjusted hazard models. Individuals with an incident ED visit involving hallucinogens were compared with members of the general population (primary analysis) or individuals with ED visits involving alcohol or cannabis (secondary analysis).ResultsThe study included 9 244 292 individuals (mean [SD] age, 40.4 [14.7] years; 50.2% female) without a history of psychosis, with a median follow-up of 5.1 years (IQR, 2.3-8.6 years); 5217 (0.1%) had an incident ED visit involving hallucinogen use. Annual rates of incident ED visits involving hallucinogens were stable between 2008 and 2012 and then increased by 86.4% between 2013 and 2021 (3.4 vs 6.4 per 100 000 individuals). Individuals with ED visits involving hallucinogens had a greater risk of being diagnosed with an SSD within 3 years compared with the general population (age- and sex-adjusted hazard ratio [HR], 21.32 [95% CI, 18.58-24.47]; absolute proportion with SSD at 3 years, 208 of 5217 with hallucinogen use [3.99%] vs 13 639 of 9 239 075 in the general population [0.15%]). After adjustment for comorbid substance use and mental health conditions, individuals with hallucinogen ED visits had a greater risk of SSD compared with the general population (HR, 3.53; 95% CI, 3.05-4.09). Emergency department visits involving hallucinogens were associated with an increased risk of SSD within 3 years compared with ED visits involving alcohol (HR, 4.66; 95% CI, 3.82-5.68) and cannabis (HR, 1.47; 95% CI, 1.21-1.80) in the fully adjusted model.Conclusions and RelevanceIn this cohort study, individuals with an ED visit involving hallucinogen use had a greater risk of developing an SSD compared with both the general population and with individuals with ED visits for other types of substances. These findings have important clinical and policy implications given the increasing use of hallucinogens and associated ED visits.

中文翻译：

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涉及致幻剂使用和精神分裂症谱系障碍风险的急诊科就诊


重要性对致幻剂的兴趣和使用一直在迅速增加。虽然一个经常被提出的担忧是致幻剂可能与精神病风险增加有关，但关于这种关联的数据有限。目的检查急诊科 （ED） 就诊涉及致幻剂使用的个体患精神分裂症谱系障碍 （SSD） 的风险是否增加。设计、设置和参与者这项基于人群的回顾性队列研究（2008 年 1 月至 2021 年 12 月）包括加拿大安大略省所有年龄在 14 至 65 岁之间且无精神病病史（SSD 或物质诱发）的个体。数据分析时间为 2024 年 5 月至 8 月。暴露涉及使用致幻剂的急诊科就诊事件。主要结局和措施使用病历验证算法诊断 SSD。使用特定原因调整的危险模型估计涉及致幻剂和 SSD 的急诊就诊之间的关联。将涉及致幻剂的急诊就诊个体与普通人群（初级分析）或涉及酒精或大麻的急诊就诊个体（二级分析）进行比较。结果该研究包括 9 244 292 例无精神病史的个体 （平均 [SD] 年龄，40.4 [14.7] 岁;50.2% 为女性），中位随访时间为 5.1 年 （IQR，2.3-8.6 年）;5217 例 （0.1%） 有一次涉及使用致幻剂的急诊就诊。2008 年至 2012 年期间，涉及致幻剂的急诊科年就诊率保持稳定，然后在 2013 年至 2021 年期间增加了 86.4%（每 100 000 人 3.4 次对 6.4 次）。 与一般人群相比，涉及致幻剂的急诊就诊个体在 3 年内被诊断为 SSD 的风险更大（年龄和性别调整后的风险比 [HR]，21.32 [95% CI，18.58-24.47];3 年时 SSD 的绝对比例，5217 人中有 208 人使用致幻剂 [3.99%] vs 普通人群中 9 239 075 人中的 13 639 人 [0.15%]）。在调整共病物质使用和心理健康状况后，与一般人群相比，接受致幻剂 ED 就诊的个体患 SSD 的风险更高 （HR，3.53;95% CI，3.05-4.09）。在完全调整的模型中，与涉及酒精 （HR， 4.66;95% CI， 3.82-5.68） 和大麻 （HR， 1.47;95% CI， 1.21-1.80） 的急诊就诊相比，涉及致幻剂的急诊科就诊与 3 年内 SSD 风险增加相关。结论和相关性在这项队列研究中，与普通人群和因其他类型物质进行 ED 就诊的个体相比，涉及使用致幻剂的 ED 就诊的个体患 SSD 的风险更大。鉴于致幻剂的使用和相关的急诊就诊的增加，这些发现具有重要的临床和政策意义。