Drugs: Education, Prevention and Policy

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Patterns of use, desired effects, and mental health

status of a sample of natural psychoactive drug
users

Marc Aixalá, Genís Ona, Òscar Parés & José Carlos Bouso

To cite this article: Marc Aixalá, Genís Ona, Òscar Parés & José Carlos Bouso (2019): Patterns
of use, desired effects, and mental health status of a sample of natural psychoactive drug users,
Drugs: Education, Prevention and Policy, DOI: 10.1080/09687637.2019.1611739

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DRUGS: EDUCATION, PREVENTION AND POLICY
https://doi.org/10.1080/09687637.2019.1611739

Patterns of use, desired effects, and mental health status of a sample of natural
psychoactive drug users

Marc Aixal
a, Gen
ıs Ona, Oscar Par
es and Jos
e Carlos Bouso
International Center for Ethnobotanical Education, Research & Services, Barcelona, Spain

ABSTRACT ARTICLE HISTORY

In recent years, the use of natural psychoactive drugs (NPDs) has grown rapidly. They are classified as Received 15 January 2019
new psychoactive substances (NPSs), despite the reality that they have been used for centuries. We are Revised 1 April 2019
lacking information regarding patterns of use or characteristics of users, but some evidence suggests Accepted 18 April 2019
that NPDs substantially differ from NPSs in terms of both their safety profile and patterns of use. The
KEYWORDS
aim of this study was to investigate patterns of use and user characteristics by collecting data from a Psychoactive; psychoactive
sample of NPD users. We designed an online questionnaire that was shared through social media. A plants; drugs; psychedelics;
sample of 564 NPD users was recruited from 52 different countries, with the United States being the mental health
most common (19%), followed by Spain (14.9%). The typical user in our sample is a well-educated
adult individual who uses NPDs sporadically. The most used substances were Psilocybe mushrooms
(88.5%) and ayahuasca (51%). Users reported that the use of NPDs positively influenced their lives, and
they showed a good mental health status. Stakeholders should consider these results particularly when
deciding on legal classifications for these substances, as the study findings suggest that NPDs should
not be in the same class as NPSs.

Introduction
Natural psychoactive drugs (NPDs) refer to animals, plants,
cacti, and fungi that have psychoactive effects and that have
been used in ritualistic contexts in different cultures around
the world. There are discrepancies and controversies about
appropriate terminology, with some authors including NPDs
in the category of new psychoactive substances (NPSs). We
propose instead to differentiate them by labeling them NPDs,
as most of them have a natural origin and have been histor-
ically used for various purposes, including healing practices,
initiation rites, and religious ceremonies (Halpern & Sewell,
2005). We can discern the essential role that NPDs played in
the strengthening of social cohesion (Andritzky, 1989).
Nevertheless, the effects of each NPD are unique and can
vary greatly, depending not only on their characteristic neu-
ropsychopharmacology (i.e. salvinorin-A interacts primarily
with Œ-opioid receptors (Maqueda et al., 2016) while mesca-
line binds to serotonin receptors (Glennon, Titeler, &
McKenney, 1984)), but also on their context of use (Carhart-
Harris et al., 2018).
In the last few decades, the consumption of NPDs such as
Salvia divinorum, Psilocybe fungi, or mixtures like ayahuasca
has increased dramatically (Andersson, Kristinsson, & Gry,
2009; Frecksa, Bokor, & Winkelman, 2016; Harvey & Wallis,
2015; Palamar & Le, 2018). Data from population studies
show that among people aged 21–34 years, between 15%
and 20% use psychedelic drugs (psilocybin mushrooms or
peyote). This means that there are
30 million psychedelic
drug users in the United States alone (Krebs &
Johansen, 2013).
Curiously, many NPDs are currently classified as NPSs. The
NPS category indiscriminately includes very different substan-
ces, and while some of them have a long history of a trad-
itional use, which entails a well-known safety profile and
specific contexts of use (in the case of NPDs), there is a lack
of information for others, more recently synthetized, regard-
ing their toxicity, and they also come with the implicit risk of
being impure or adulterated. We can find some survey-based
studies in which patterns of NPS use were analyzed in a rep-
resentative sample from the United States. Soussan and
Kjellgren (2016) found that not only hallucinogenic NPSs are
being used for self-exploration purposes or for the achieve-
ment of a mystical experience, but also there are opioid
derivatives mainly used for coping. Palamar, Martins, Su, and
Ompad (2015) noted that in their sample, the most com-
monly used NPS were hallucinogenic tryptamines (DMT), fol-
lowed by hallucinogenic phenethylamines (2-C series) and
synthetic cannabinoids. Similarly, Gonz
alez, Ventura,
Caudevilla, Torrens, and Farr
e (2013) showed that the most
commonly used NPS among Spanish people was hallucino-
genic phenethylamines.
Psychoactive plants and animals that have been tradition-
ally used for centuries or millennia, as noted above, are being
classified inaccurately as NPSs. This could be due to the
recent ‘discovery’ of these substances by Western users.

CONTACT Jos
e Carlos Bouso jcbouso@iceers.org International Center for Ethnobotanical Research, Education and Services, C/ Sep

ulveda, 65 Bajos 2,
08015 – Barcelona, Spain
ß 2019 Informa UK Limited, trading as Taylor & Francis Group
2
ET AL.
M. AIXALA
Table 1. Sociodemographic data of the sample.
Age <20 21–30
24 (4.2%) 160 (28.3%)
Gender Male Female
372 (66%) 184 (32.6%)
Educational level No completed studies High school Vocational education
12 (2.1%) 90 (16%)
Live with Alone With parents With partner/sons
137 (24.3%) 76 (13.5%)
Nationality United States of America Spain
107 (19%) 84 (14.9%)
Despite this growing interest in hallucinogenic NPSs espe-
cially, no studies have been conducted on this kind of NPSs,
their patterns of use, or their possible effects on the health
and well-being of the users.
This survey study aimed to gather data about users of
NPDs, people who could be classified not only as ‘NPS users’
but also as ‘e-psychonauts’, as they were recently named
(Orsolini et al., 2017). E-psychonauts are particularly inter-
ested in taking only ‘natural’ psychoactive drugs, such as
plants, animals, or fungi. But regardless of the name that
may attributed to them, they are using psychoactive drugs
that, in many cases, other cultures have used in the past and
some still use in the present. These modern uses usually dif-
fer from local and traditional ones (Heinrich, 2010), so we
must be aware of the current uses, as their potential benefits
and risks highly depend on the manner of use and the con-
text (Nutt, King, & Philips, 2010). This research was conducted
within the context of the European Commission-funded
Support to Transnational Projects in the Area of EU Drug
Policy Grant programme (Project No: HOME-2015-JDRU-AG-
DRUG-8860). The project hopes to positively contribute to
the EU Drugs Policy Action Plan 2013–2020 by improving
knowledge regarding patterns of NPD use and their eventual
impact on human health.
Method
Measures
We designed an online survey with closed-ended questions.
Participants were first provided with information about the
survey, including its purpose and an assurance of anonymity.
In the first section of the survey, the participants were asked
questions regarding sociodemographic information, including
age, gender, nationality, educational level, and the number
of people they live with. Participants were then asked about
their current use of alcohol, cannabis, and tobacco, reporting
their frequency of use on a five-point Likert scale (None,
Once a month or less, More than once a month, More than
once a week, or Every day). They were then asked if they had
used the following NPDs: ayahuasca (containing N, N-dime-
thyltryptamine or DMT), Iboga or ibogaine, Psilocybe mush-
rooms (containing psilocybin and psilocin), Salvia divinorum
or salivinorin-A, San Pedro and peyote (containing mescaline),
Amanita muscaria (containing ibotenic acid and muscimol),
khat (containing cathinones), Ipomoea or Argyreia (containing
ergine), kratom (containing alkaloids, such as mytragynine),
Datura species (containing atropine and scopolamine
31–40 41–50 51–60 >60
184 (32.6%) 118 (21%) 56 (10%) 22 (4%)
Other
8 (1.4%)
Certificate of higher education Graduate, bachelor Postgraduate or PhD
26 (4.6%) 149 (64.5) 223 (39.5%) 111 (19.7%)
Sharing a flat Other
210 (37.2%) 91 (16.1%) 50 (8.9%)
United Kingdom Canada Germany Italy
44 (7.8%) 27 (4.8%) 26 (4.6%) 26 (4.6%)
alkaloids), Bufo alvarius (containing bufotenine and 5-
methoxy-DMT), and rap
e (containing nicotine). For each one
of the NPDs that respondents reported using, they were
asked to answer questions about their use. These questions
concerned how many times they took the substance, when
they used it (Every day, In the last week, In the last month, In
the last year, or Sometime in lifetime), where they got it
from (Internet, Friends, Self-cultivation, Ceremony providers,
Smart-shops), in which context they used it (Traditional sha-
manic, Neoshamanic, With friends, Alone, Recreational con-
texts, among others), and how the consumption influenced
their lives (Very negatively, Negatively, It has not had an
influence, Positively, or Very positively).
At the end of the questionnaire, all respondents were
asked to complete the 12-item General Health Questionnaire
(GHQ-12; Goldberg, 1972) to indicate their general mental
health status. The GHQ-12 is recommended for the detection
of common mental disorders due to its strong psychometric
properties (0.82–0.86 Cronbach’s Alpha) (Goldberg et al.,
1997). Informed by other studies (Goldberg et al., 1997), we
selected a score of 4 as a cut-off point for considering men-
tal health disturbance.
Procedure
This survey was part of a larger project funded by the
European Union (see above) named Psych
eplants, consisting
of an educational programme for increasing knowledge and
offering harm-reduction information regarding NPDs. A web-
site was created where the survey was made available
(https://www.psycheplants.org). The survey was hosted by
the LimeSurvey platform (www.limesurvey.org) and shared
through the International Centre for Ethnobotanical
Education, Research & Service (ICEERS) social media accounts
on Facebook and Twitter. Different posts were published
inviting people who had experience with these kinds of
drugs to participate.
Data analysis
IBM SPSS Statistics v.20 was used to analyze the survey data.
Descriptive statistics were used. Additionally, linear regression
analyses were conducted to determine potential associations
between GHQ-12 score and other variables.
 DRUGS: EDUCATION, PREVENTION AND POLICY 3

Table 2. Frequency of use of alcohol, tobacco and cannabis, and ethnobotanicals used, number of times taken, and when used them.
More than More than Once a month
Every day once a week once a month or less Never
Alcohol 30 (5.3%) 134 (23.8%) 166 (29.4%) 164 (29.1%) 69 (12.3%)
Tobacco 174 (31%) 56 (10%) 38 (6.7%) 78 (13.8%) 218 (38.7%)
Cannabis 161 (28.5%) 119 (21.1%) 75 (13.3%) 132 (23.4%) 77 (13.7%)
In the last In the last In the last Sometimes
Yes No. times Every day week month year in lifetime
Ayahuasca 287 (51%) Mean ¼ 37
SD ¼ 109 – 6.7% 9.5% 40.5% 43.3%
Median ¼ 7
Iboga/ibogaine 47 (8.3%) Mean ¼ 7
SD ¼ 24 – 2.2% 9% 29% 60%
Median¼ 1
Psilocybe mushrooms 499 (88.5%) Mean ¼ 39
SD ¼ 111 – 4.7% 10.3% 36.8% 48.2%
Median ¼ 10
Salvia div/salvinorin-A 241 (42.7%) Mean ¼ 7
SD ¼ 29 – 0.4% 1.7% 14.3% 83.6%
Median ¼ 3
San Pedro 176 (31.2%) Mean ¼ 8
SD ¼ 25 – 2.3% 5.2% 29% 63.6%
Median ¼ 2
Peyote 119 (21.1%) Mean ¼ 5
SD ¼ 11 – 1% 1% 23% 75.2%
Median ¼ 1.5
Amanita muscaria 92 (16.3%) Mean ¼ 10
SD ¼ 37 – – 1% 12.2% 86.7%
Median ¼ 2
Khat 31 (5.5%) Mean ¼ 8
SD ¼ 13 – – – – 100%
Median ¼ 2
Ipomoea/Argyreia 58 (10.3%) Mean ¼ 8
SD ¼ 15 – – 3.5% 10.5% 86%
Median ¼ 3
Kratom 131 (23.2%) Mean ¼ 57
SD ¼ 172 4% 7.8% 5.4% 35.7% 47.3%
Median ¼ 4
Datura species 57 (10%) Mean ¼ 11
SD ¼ 41 – 1.8% 1.8% 14.5% 81.8%
Median ¼ 3
Bufo alvarius 51 (9%) Mean ¼ 5
SD ¼ 12 – 2.1% 10.6% 46.8% 40.4%
Median ¼ 1.5
Rape 208 (37%) Mean ¼ 62
SD ¼ 182 5% 11.7% 10.2% 46.3% 26.8%
Median ¼ 5
SD: standard deviation.

Ethics higher education or from a technical school, 16% went to a

The administered survey was anonymous and followed
Regulation (EU) 2016/679 of the European Parliament and of
the Council of 27 April 2016 on the protection of natural per-
sons with regards to the processing of personal data and the
free movement of such data.
Results
Sociodemographic data
A sample of 564 users (32.6% women) of NPDs was recruited.
Participants’ mean age was 35 years (SD ¼ 11.8). The sample
included 52 different nationalities, with respondents’ repre-
sentative of the United States of America (19%), followed by
Spain (14.9%), the United Kingdom (7.8%), Canada (4.8%),
Germany (4.6%), and Italy (4.6%). Regarding education level,
39.5% of the sample had graduated university, 19.7% had a
postgraduate degree or PhD, 18.1% had a certificate of
high school, 4.6% attended vocational education and train-
ing, and 2.1% had not completed high school (Table 1).
Alcohol, tobacco, and cannabis use
A total of 69 people (12.2%) were not consuming alcohol,
while 30 (5.3%) drank alcohol every day. Regarding tobacco
use, 218 people (38.7%) were nonsmokers and 174 (31%)
were daily smokers. Concerning cannabis use, the most
prevalent users were those who smoked cannabis daily
(28.5%), followed by those who only smoked cannabis once
a month or less (23.4%; Table 2).
Natural psychoactive drugs use
The most prevalent NPD used among our sample was the
Psilocybe mushrooms: 499 respondents (88.6%) had used
Psilocybe at least once in their lives. The second most-used
 4

Table 3. Where were obtained and contexts in which psychoactive ethnobotanicals were used.
Iboga/ Psilocybe Salvia San Amanita Ipomoea/ Datura
Ayahuasca ibogaine mushrooms divinorum Pedro Peyote muscaria Khat Argyreia Kratom species Bufo alvarius Rape
Where obtained
Internet 24 (4.3%) 10 (1.8%) 2 (0.4%) 68 (12.1%) 22 (4%) 7 (1.2%) 9 (1.6%) 6 (1.3%) 22 (4%) 59 (10.5%) 2 (0.4%) 4 (0.7%) 26 (4.6%)
Friends 35 (6.2%) 7 (1.2%) 293 (52%) 93 (16.5%) 57 (10%) 46 (8.2%) 23 (4.1%) 22 (4.7%) 12 (2.1%) 46 (8.2%) 14 (2.5%) 13 (2.3%) 100 (17.7%)
M. AIXALA

Self-cultivation 26 (4.6%) 2 (0.4%) 236 (41.8%) 26 (4.6%) 55 (9.8%) 13 (2.3%) 9 (1.6%) 6 (1.3%) 18 (3.2%) 5 (1%) 14 (2.5%) – –
Ceremony provider 235 (41.7%) 26 (4.6%) 55 (9.8%) 8 (1.4%) 78 (13.8%) 57 (10%) 7 (1.2%) 1 (0.2%) 1 (0.2%) 1 (0.2%) 9 (1.6%) 36 (6.4%) 125 (22.2%)

ET AL.

Smart-shop 8 (1.4%) 2 (0.4%) 79 (14%) 86 (15.2%) 8 (1.4%) 1 (0.2%) 7 (1.2%) 3 (0.5%) 16 (2.8%) 36 (6.4%) 55 (9.8%) 50 (9%) 6 (1.1%)
Harvesting 13 (2.3%) 24 (4.3%) 5 (1%)
Picking up 50 (9%)
Native groups 44 (7.8%)
Self-preparation 20 (3.5%)
Contexts of use
Shamanic/ traditional 126 (22.3%) 8 (1.4%) 2 (0.4%) – 35 (6.2%) 24 (4.3%) 3 (0.5%) – 1 (0.2% – 11 (2%) 58 (10.3%)
Neoshamanic 147 (26%) 14 (2.5%) 83 (14.7%) 13 (2.3%) 51 (9%) 32 (5.7%) 6 (1.1%) 31 (6.7%) 2 (0.4%) – 7 (1.2%) 25 (4.4%) 89 (15.8%)
With friends 64 (11.3%) 6 (1.1%) 337 (60%) 160 (28%) 78 (13.8%) 40 (7.1%) 52 (9.2%) 20 (4.3%) 32 (5.7%) – 28 (5%) 14 (2.5%) 103 (18.3%)
Alone 63 (11.2%) 14 (2.5%) 287 (51%) 101 (18%) 55 (9.8%) 28 (5%) 49 (8.7%) 6 (1.1%) 39 (7%) – 25 (4.4%) 9 (1.6%) 70 (12.4%)
Recreational 7 (1.2%) 3 (0.5%) 206 (36.5%) 50 (9%) 21 (3.7%) 15 (2.7%) 16 (2.8%) 13 (2.8%) 10 (1.8%) 76 (13.5%) 7 (1.2%) 50 (9%) 29 (5%)
Daime/UDV 61 (10.8%)
Ibogaine clinic 9 (1.6%)
Natives 10 (1.8%)
Daily stimulant 7 (1.2%) 41 (7.3%)
Substitute opiates 23 (4%)
Retreat with ayahuasca 7 (1.2%)
Combined with ayahuasca/Bufo alv. 83 (14.7%)
Influence on life
Very negatively – – – – – – 1 (1.1%) – 1 (1.8%) – 2 (3.6%) – –
Negatively – – 1 (0.2%) – – 1 (0.9%) 2 (2.2%) 3 (9.7%) 2 (3.5%) 4 (3%) 3 (5.5%) – 3 (1.5%)
It has not had an influence 9 (3.2%) 12 (26.7%) 43 (8.3%) 21 (7.8%) 40 (23%) 24 (20.7%) 39 (43%) 19 (61.3%) 22 (38.6%) 64 (49.6%) 19 (34.5%) 9 (18%) 64 (31.2%)
Positively 83 (29.2%) 15 (33.3%) 191 (36.8%) 83 (31%) 51 (30%) 46 (39.7%) 32 (36%) 5 (16%) 20 (35%) 36 (28%) 22 (40%) 11 (22%) 82 (40%)
Very positively 192 (67.6%) 18 (40%) 284 (54.7%) 164 (61%) 82 (47.4%) 45 (38.8%) 16 (18%) 4 (13%) 12 (21%) 25 (19.4%) 9 (16.4%) 30 (60%) 56 (27.3%)
GHQ-12
Mean 1.4
SD 2.2
Median 1
Mode 0
SD : standard deviation.
Bold: prevailing values.

NPD was ayahuasca (51%), followed by Salvia divinorum or
salvinorin-A (42.8%), rap
e (traditional snuff) (37%), or San
Pedro (31.2%; Table 2).
Number of times used
The NPD that respondents used the highest number of times
was also Psilocybe mushrooms (median ¼ 10 times).
Ayahuasca was the second most-used NPD (median ¼ 7
times). In descending order, we found rap
e (median ¼ 5
times), kratom (median ¼ 4 times), Salvia divinorum or salvi-
norin-A (median ¼ 4 times), Ipomoea/Argyreia (median ¼ 3
times), or Datura species (median ¼ 3 times; Table 2).
When natural psychoactive drugs were used
NPDs were used mostly ‘Sometimes in my lifetime’ (43%,
60%, 48%, and 83.6% in the cases of ayahuasca, Iboga or
ibogaine, Psilocybe mushrooms, and Salvia divinorum or salvi-
norin-A, respectively). ‘In the last year’ was the second most-
frequent answer (40.5%, 29%, 37%, and 14.3% in the cases of
ayahuasca, Iboga or ibogaine, Psilocybe mushrooms, and
Salvia divinorum or salvinorin-A, respectively). Kratom and
rap
e were the only NPDs for which daily users were found
(at 4% and 5%, respectively; Table 2).
Where natural psychoactive drugs were obtained
The general trend was to obtain NPDs through ceremony
providers (ayahuasca, Iboga or ibogaine, San Pedro, peyote,
and rap
e), but common ways to obtain some of them were
also through Internet websites (Ipomoea or Argyreia and kra-
tom), from friends (Psilocybe mushrooms, Salvia divinorum or
salvinorin-A, and khat), from smart-shops (Datura species and
Bufo alvarius), or from picking in a forest (Amanita muscaria;
Table 3).
Contexts in which natural psychoactive drugs were used
The context most shared among NPD users was being with
friends (in the case of Psilocybe mushrooms or San Pedro),
followed by Neoshamanic contexts (ayahuasca or khat), alone
(Iboga or Salvia divinorum), and in recreational contexts (kra-
tom and Bufo alvarius; Table 3).
Influence of natural psychoactive drugs use on life
Ayahuasca, Iboga or ibogaine, Psilocybe mushrooms, Salvia
divinorum or salvinorin-A, San Pedro, and Bufo alvarius users
reported that its use influenced them very positively. At the
same time, there were also participants who reported nega-
tive and very negative influences on their lives from Psilocybe
mushrooms, peyote, Amanita muscaria, khat, Ipomoea or
Argyreia, kratom, Datura species, and rap
e (Table 3).
DRUGS: EDUCATION, PREVENTION AND POLICY 5
GHQ-12 (mental health status)
The mean score of the sample was 1.4 (SD ¼ 2.2), and 90% of
the sample showed scores below 4, indicating a good state
of general mental health (Table 3). Regression analyses only
found tobacco use (Beta ¼ 0.35, p < .001) to be a predictor
variable for a lower health status.
Discussion
The main objective of this survey study was to increase
knowledge about current users of NPDs, including their
usage frequencies and related practices. First, we obtained
sociodemographic data, finding that the majority of the sam-
ple was adult (31–40 years) men (66%), with higher educa-
tion, living with their partner and/or sons. We gathered
participants from 52 different countries, with the United
States of America the most highly represented country (19%).
Concerning alcohol use, we found that only 5.3% of the
sample could be considered hazardous drinkers (those who
drink every day). Comparing the obtained data with norma-
tive data is difficult due to the different nature of the data
requested. In the case of alcohol use, we can compare the
percentage of people who use alcohol more than once a
month in our sample (30%), with the percentage of people
who used alcohol in the last 30 days in the USA (56%;
(NSDUH, 2015) or in Europe (62%; (EMCDDA, 2018)). Thus, it
seems that users of NPDs are less interested in alcohol
consumption.
The prevalence of daily tobacco users in our sample (31%)
was very similar to the number of users among the general
population in the USA (30%; (CDC, 2016)) or Europe (28%;
(WHO, 2018)). We found, however, a higher percentage of
daily cannabis users in our sample (28.5%) as compared to
the general population in the European Union (0.05–2.6%;
(EMCDDA, 2012)). However, among an American sample of
near 70,000 cannabis users, it was found that
33% were
daily users (GDS, 2017). As the majority of our respondents
were from the US, this could have certainly affected the num-
ber of daily cannabis users found in this research. Another
possible explanation is that people who use NPDs are more
likely to use cannabis, or vice versa, as both are naturally
occurring substances and may be viewed as posing little risk.
Further research should investigate polydrug use among
users of NPDs to gain clarification.
Psilocybe mushrooms were the most consumed NPD (by
nearly 90% of the sample). This is consistent with the
observed increase in their use since the 1970s (Orsolini et al.,
2017). Ayahuasca was also widely used (by 51% of the sam-
ple). The increasing number of ayahuasca users is a complex
phenomenon that some authors associate with health care
practices and therapeutic purposes (Apud & Roman
ı, 2017).
Salvinorin-A or Salvia divinorum was used by 42.7% of our
sample. There have been some reports about the increased
use of this plant or its extracts (Griffin, Miller, & Khey, 2008;
Wu, Woody, Yang, Li, & Blazer, 2011). Its use is associated
mostly with experimental purposes (Sumnall, Measham,
Brandt, & Cole, 2011). The less used NPDs were khat and
Iboga. Khat is a psychostimulant currently used by 20 million
6
ET AL.
M. AIXALA
people worldwide (Corkery et al., 2011), predominantly used
in East Africa and Ethiopia. The use of Iboga is less dissemi-
nated, maybe because of its potential physical risks, as well
as its preferred use as antiaddictive substance in cases of
dependence on opioids or other drugs (Alper, 2001).
We were interested also in the number of times our
respondents had taken each of the NPDs. The NPD used the
most is Psilocybe mushrooms. It is interesting to focus on the
NPDs that are commonly used once or few times, such as
Iboga or ibogaine and Bufo alvarius. Iboga or ibogaine produ-
ces an intense psychedelic experience that can last up to
20 h or more (Alper, Lotsof, Frenken, Luciano, & Bastiaans,
1999). Bufo alvarius is rich in 5-methoxy-N,N-dimethyltrypt-
amine (5-MeO-DMT), which is 4–10 times more potent than
N,N-dimethyltryptamine (DMT) (McKenna & Towers, 1984).
One recent epidemiological study found similar results, show-
ing that 5-MeO-DMT users only use it sporadically and they
consider its subjective effects to be more intense than those
of other psychedelic drugs. We can suggest, therefore, that
both Iboga or ibogaine and Bufo alvarius produce challeng-
ing experiences that consumers do not want to regularly
repeat. This is not to say that the induced experiences have
negative effects, as challenging experiences induced by psy-
chedelic drugs can have also positive effects (Carbonaro
et al., 2016). On the other hand, it may be also possible that
a single exposure to these substances is enough to perceive
that the expectations of users have been met.
The use of most of these NPDs appears to have been
sporadic in most cases. The majority were reportedly used ‘In
the last year’ or ‘Sometime in lifetime.’ This suggests a lack of
reinforcing properties, as already stated in the case of hallu-
cinogenic NPS (Soussan & Kjellgren, 2016). However, 4% and
5% of our sample use kratom and rap
e, respectively, every
day. This suggests that they have a minor dependence
potential due to their characteristic pharmacological mecha-
nisms, or they are adopted as lifestyle practices after individ-
uals are first ‘initiated’ into using these substances in
ritualistic settings.
The most common way to obtain NPDs was through cere-
mony providers. Despite growing concerns about how NPDs
can be easily accessed through Internet websites, there were
only two NPDs that were obtained in this way (kratom and
Ipomoea or Argyreia seeds). It was surprising to find that
users of Datura species or Bufo alvarius bought them primar-
ily in smart shops. Neither Datura plants nor Bufo alvarius are
on any list of controlled species, but 5-MeO-DMT is classified
in the USA as a Schedule I drug, so its sale, possession or use
is illegal. To deal with this regulation, smart shops usually
use stealthy techniques in selling their products, so these
shops offer a way to obtain these NPDs. It is surprising that
Bufo alvarius was reportedly obtained from smart shops, as
Internet research suggests that online NPD vendors do not
usually offer it. General knowledge based on the observation
of online trends suggests that Bufo alvarius is mainly
obtained through ceremony providers, but our data suggest
otherwise. It is also remarkable that the procurement of
Amanita muscaria remains traditional: picking it from
the forest.
Regarding context, 7 out of the 13 NPDs were predomin-
antly used ‘With friends’. Ayahuasca, Iboga, and khat were
the NPDs in which the ritualistic use was predominant. In
these kinds of ritualistic settings, a ‘directioning’ of the psy-
choactive effects is achieved. The context and the caregivers
present help to contain the experience and provide tools to
render it meaningful (Talin & Sanabria, 2017). Moreover, it
has been observed that adverse effects and overdoses are
less common among users who take NPDs in ceremonial set-
tings than among those who take them recreationally
(Halpern, Sherwood, Passie, Blackwell, & Ruttenber, 2008).
The recreational use of NPDs (represented in our survey only
by kratom and Bufo alvarius) seems to be uncommon. Davis,
Barsuglia, Lancelotta, Grant, and Renn (2018) found in their
survey study that the majority of consumers used 5-MeO-
DMT (the main active principle of Bufo alvarius) for spiritual
exploration. In addition, the general perception and opinion
of the e-psychonaut community is that Bufo alvarius is used
mostly in neo-shamanic contexts. This survey’s data suggest
otherwise, raising questions about lesser-known uses of Bufo
alvarius, or about the different intentions of those who offer
the Bufo alvarius ceremonies and those who participate
in them.
The influence of the consumption of some of the NPDs on
users’ lives has been evaluated in clinical trials (Griffiths et al.,
2011), showing that most subjects experienced mystical-type
experiences that had long-term positive effects. Population
surveys suggest that this happens also in naturalistic settings
(Hallok, Dean, Knecht, Spencer, & Taverna, 2013). Subjects
reported that the use of some NPDs influenced them posi-
tively, while Amanita muscaria, khat, Ipomoea or Argyreia, and
kratom had no influence, suggesting that these NPDs are less
able to induce profound and meaningful experiences. It can
also be argued that these NPDs that showed no positive
influence are those with the lower percentages of ceremonial
or structured use, thus making the context of use a variable
to consider regarding positive outcomes. There were also
participants who reported a negative influence from the use
of NPDs. There are case reports that confirm short-term, psy-
chological adverse effects (Riley & Blackman, 2008; van
Amsterdam, Opperhuizen, & van den Brink, 2011) or enduring
psychiatric disorders after the use of psilocybin mushrooms
(Nielen, van der Heijden, Tuinier, & Verhoeven, 2004) and
ayahuasca (dos Santos, Bouso, & Hallak, 2017). So, despite
more participants reporting positive effects, we should con-
sider this finding with caution because, first, these data were
collected through a single item asking participants to report
their subjective experience, and second, the sample was self-
selected so a degree of bias could affect their answers.
The mean GHQ-12 score obtained from our sample was
1.4, and mode was 0. Only 10% of participants scored >4.
Thus, we observed that users of NPDs generally have a good
state of mental health. Population studies generally indicate
that psychedelic drug users have a lower rate of mental
health problems (Krebs & Johansen, 2013). Observational
studies reported similar results when comparing psychedelic
drug users with nonusers (Bouso et al., 2012). But a recently
published study on the epidemiology of hallucinogenic

drugs use in US show opposite results (Shalit, Rehm, &
Lev-Ran, 2019).
Considering all of the information provided, and although
this is not the aim of the study, we must say that classifying
NPDs as NPSs seems highly nonsensical, so we suggest revi-
sing the current legislation and not putting such different
substances in the same category. NPSs are generally associ-
ated with deaths and central nervous system or liver toxicity
(Helander & B€ackberg, 2018). However, exposure to some of
the NPDs currently classified as NPSs has been associated
with reduced psychological distress and suicidality
(Hendricks, Thorne, Clark, Coombs, & Johnson, 2015) and sev-
eral potential benefits for healthy individuals (Elsey, 2017),
making it quite clear that we are dealing with very differ-
ent substances.
Although we must remember that the use of NPDs in
noncontrolled settings is not free of risks (Heise & Brooks,
2016), the prevalence of side reactions and even of fatalities
is considerably lower than other substances classified as NPSs
as well (Helander & B€ackberg, 2018). The results of this study
can be used by social workers, health practitioners, and law
and policy makers when considering the impact of the use of
NPDs on public health. These substances should be clearly
differentiated from general NPSs that have been recently syn-
thetized and which are associated with higher health risks.
The relevance of this distinction is based on the impact that
availability and legal status have on the harm potential of
drugs (Nutt et al., 2010). In this sense, the misclassification of
NPDs as NPS could have a negative impact on users due to
stigmatization and criminalization that is not in accordance
with the observed effects of these substances.
This survey study obtained detailed and relevant data on
a public health level. The survey showed that, in our sample,
the typical NPD user is a well-educated adult individual, not
keen on using alcohol, who uses NPDs sporadically in specific
contexts. However, due to the methodology used in this
study, this kind of user may not represent the general popu-
lation who use NPDs, as online survey studies cannot control
the representativeness of samples. While this can be con-
ceived of as only a partial look at NPD users, it is an import-
ant first step as epidemiological research is begun to collect
more data regarding the uses of NPDs and their potential
consequences.
It is also necessary to consider the characteristic ritualistic
uses of some of these NPDs, and how this context might pro-
tect users from any potential risks associated with the con-
sumption of psychoactive substances.
Disclosure statement
The authors report no conflict of interest
Funding
This work was supported by the European Commission under
Grant 59.360e.
DRUGS: EDUCATION, PREVENTION AND POLICY 7
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