Which Drug Epidemic Is Next: Meth, Psychedelics, Mushrooms?

In the United States, there is a distinct tendency for opioid epidemics to be followed by stimulant epidemics. David Musto, M.D., renowned Yale historian of medicine and expert on drug policy, first observed such a pattern of substance use in the U..S and, based on historical analysis, articulated his cyclical theory of drug use in the 1970s, providing a compelling lens for understanding drug trends.

Data show that many people now are “speedballing,” smoking or injecting combined depressants like opioids (e.g., fentanyl) with stimulants such as cocaine or methamphetamine. Another possible emerging epidemic is psychedelics or psychedelic mushrooms, “shrooms.”

Historical Changes in Illegal Drug Preferences

Drug preferences often reflect cultural and psychological shifts, Musto observed. After an opioid epidemic, with symptoms marked by sedation, withdrawal, and lethargy, increasing numbers of drug-abusing people may turn to stimulants for energy, euphoria, and feeling empowered. Drug policy crackdowns on one substance often leave a vacuum filled by another. As heroin became less available in the 1970s, cocaine surged.

After the U.S. opium crisis of the late 19th century, cocaine use increased, especially with its inclusion in patent medicines and beverages like the original version of Coca-Cola. (Cocaine hasn’t been present in Coke products for 100-plus years.) Following the heroin epidemic of the late 1960s and early 1970s, cocaine use spiked, peaking in the 1980s as crack cocaine became prevalent.

In the current opioid epidemic, signs indicate increased stimulant use. Methamphetamine and cocaine use have risen sharply in recent years, sometimes co-occurring with opioid use. Cocaine, methamphetamine, and speedball deaths have increased, as has prescription misuse of Adderall and Vyvanse (prescription psychostimulants) for energy and work performance enhancement.

Saturday Night Live Performers and Drug Changes

Celebrity endorsements of drugs significantly impact public perception of their safety and use. The history of Saturday Night Live (SNL) is intertwined with the addiction struggles of some cast members and SNL alumni. Millions of Americans learned about cocaine, speedballing, and their consequences by way of watching the travails of prominent individuals from SNL. Some performers died or faced significant addiction-related issues with considerable publicity.

We also learned about treatment and recovery from SNL stars. John Belushi was the most famous SNL cast member with addiction. He died on March 5, 1982, at age 33, from speedballing heroin and cocaine. Belushi’s larger-than-life persona and on-/off-screen lifestyle were fueled by substance use. His death was a defining moment in public awareness of Hollywood’s drug problems.

Chris Farley died December 18, 1997, age 33, of a speedball drug intoxication (cocaine and morphine). Farley’s death was eerily similar to Belushi’s. Phil Hartman died at 49 on May 28, 1998, murdered by his wife, who, under the influence of cocaine and alcohol, allegedly believed he was an imposter.

Chevy Chase had multiple issues with painkillers and alcohol and was public about entering rehab in 1986 and 2016. Fellow SNL comedian Garrett Morris was addicted to cocaine and alcohol and spoke out about the drug culture during his time at SNL (and about his treatment). Robert Downey, Jr. had widely-publicized drug crises fueled by cocaine, heroin, marijuana, and alcohol. His multiple treatments, slips, and relapses were resolved with successful recovery and resurgence in his career.

Looking Back at Other Celebrity Abuse

Robin Williams quit cocaine in the early 1980s after the death of his close friend John Belushi and the birth of his first child. Williams described cocaine as “God’s way of telling you you are making too much money.” This is a brilliant analysis, as animals will self-administer cocaine to death if given unlimited access. River Phoenix died October 31, 1993, age 23, of a speedball combining cocaine and heroin. Whitney Houston died on February 11, 2012, by accidental drowning in a bathtub. Her death was exacerbated by cocaine use and heart disease.

Addiction Essential Reads

A Global Glut in Cocaine Shocks the World

AA and NA Were Right: Spirituality Decreases Addictions

Now vs Then

Current drug use trends share similarities with those of the late 1970s and early 1980s when an opioid epidemic gave way to rising stimulant abuse, including cocaine and methamphetamine. Today, while the opioid crisis remains severe (with synthetic opioids like fentanyl dominating), there is a plateau in opioid use and a re-emergence of polysubstance abuse, with methamphetamine and cocaine used together with fentanyl and alone. Cocaine production is at record levels, and lucrative as 1 kg of cocaine is worth $2,000 in Colombia but > $25,000 if it reaches the USA or Europe.

Past-year hallucinogen use has reached a historically high prevalence among adults 35 to 50 years old: 4% in 2022. Prevalence substantially increased from 2% in 2021 to less than 1% in 2017 and 2012. Use of LSD, psilocybin, and other hallucinogens is increasing among teens and adults.

What’s Next: Psychedelics or Continued Acceleration of Psychostimulants?

In considering whether psychedelics or methamphetamine will pose the next big drug crisis, it's important to look at history and celebrity influencers.

Medical and scientific studies are reporting a variety of benefits of psychedelic treatment—LSD for general anxiety disorder, psilocybin for depression, MDMA for PTSD. Psychedelics have also been gaining endorsements and pre-FDA-approval adopters.

Elon Musk has reportedly expressed support for psychedelics, especially for treating PTSD and depression. The world’s richest man, Musk, has also reportedly used MDMA and psychedelics. He told Don Lemon on CNN that he has a prescription for ketamine from “an actual, real doctor” and uses “a small amount once every other week or something like that” for depression.

Silicon Valley has a history of fascination with psychedelics. Its tech leaders not only celebrate their participation in the psychedelic-fueled Burning Man Festival but also use psychedelics as a driver of the work culture of Silicon Valley. Apple co-founder Steve Jobs talked publicly about their experience with psychedelics, as does OpenAI's Sam Altman. Google's Sergey Brin has reportedly used shrooms and has helped fund a start-up for psychedelic treatments.

Other entrepreneurs and executives are following such trendsetters in turning to psychedelics like LSD, ayahuasca, MDMA, and shrooms to inspire them in their professional lives. However, while well-suited for use at festivals or supervised office or destination retreats, a psychedelic drug like LSD or psilocybin loses its psychoactive effects due to the development of tolerance.

There are always substantial risks to consider in taking a psychedelic, and even those who have had a "good trip" do not necessarily rush to do it again. Psychedelics are not generally thought to be addictive, but hallucinogen use disorder can develop after repeated hallucinogen use.

Psychostimulants are highly addictive. Nevertheless, venture capitalists, private equity, and others in high finance are reportedly taking psychostimulants to become more engaged and work harder and longer. With drugs such as Adderal, Vyvance, cocaine, and methamphetamine, use stimulates and reinforces the next use.

“Psychostimulants over psychedelics, for sure," says David T. Courtwright, Ph.D., Presidential Professor Emeritus at the University of North Florida and author of The Age of Addiction: How Bad Habits Became Big Business.. "Psychostimulants ‘work with’ opioids and other CNS depressants in ways psychedelics do not. Fentanyl users have reasons for adding meth to the mix. Also, the effects of psychostimulants are more regular and predictable than those of psychedelics. Historically, regular and predictable effects are keys to a drug's mass-market success. Most people start the day with coffee, not psilocybin."

In the West, he notes, "outside their original indigenous contexts, psychedelics have been more of a boutique-market phenomenon. New psychedelics and new means of promoting them could change the equation, but for now, my money is on Musto's prediction over Musk's."

Conclusion

Musto’s observation of cyclical drug trends remains relevant for understanding substance use patterns. However, polysubstance use and the rise of synthetic drugs challenge the idea that opioid epidemics always lead to stimulant epidemics. The re-emergence of psychedelics and new synthetic drugs, such as fentanyl, ketamine, and synthetic cannabinoids like K2, complicates the traditional cycle. The availability of all these substances may create overlapping epidemics rather than distinct cycles.

Psychedelic use is also becoming popular. However, it is a false dichotomy to believe there must be either a methamphetamine or psychedelic use epidemic. It can be both, as there are separate populations of drug users.

Methamphetamine, cocaine, and opioid users often develop addictions. In contrast, psychedelics are primarily used selectively, on a retreat or at a festival, or as self-treatment by people who have had a psychiatric problem or trauma. Psychedelics, unlike psychostimulants, are not used continuously and to death. Users might attend festivals like Burning Man and devote the necessary time to use and recover from psilocybin, ayahuasca, or LSD. Psychedelic poisonings are rare, and recent psilocybin research has shown that subjects, even those with eye-opening insights or effects, are often unsure they would ever take shrooms again.