Abstract
As psychedelic use increases and integrates with mainstream medicine, understanding the prevalence and nature of postpsychedelic adverse outcomes is critical. We investigated extended difficulties after psychedelic use via the Global Psychedelic Survey (GPS) 2025, which is a multilingual online survey of people who have used psychedelics. Data on the prevalence, characteristics, and associations of retrospectively reported extended difficulties was gained from N = 6,476 participants. The most common difficulties reported were existential struggle (36.6%), depression (34%), and derealization (29.4%). Existential struggle was rated as the most severe difficulty, but also the one contributing most to healing. Overall, 48.3% of participants reported one or more difficulties lasting 24 hours or more, and 9.9% experienced difficulties for over a year. Clinically relevant disruptive difficulties (defined as leasting at least a month that caused disruption to daily life) were reported by 8% of the sample and were associated with younger age at the time of survey and at first psychedelic use, lower income, lack of family support, lower emotional stability/conscientiousness/agreeableness, higher pre-existing anxiety/depression, and using psychedelics to treat mental health conditions. The results underscore the necessity for evidence-based education on the potential risks and benefits of psychedelics, robust safety guidelines in clinical psychedelic interventions, and additional services for those experiencing post-psychedelic extended difficulties.