Don’t Try This at Home, Kids: The Real Risks of Psychedelic Use for Young People and HPPD

The Alluring World of Psychedelics and a Word of Caution

The resurgence of interest in psychedelic substances like psilocybin, LSD, and DMT for their potential therapeutic benefits in adults is undeniable. Clinical trials are exploring their use for conditions ranging from depression and PTSD to anxiety and addiction, often with promising results when administered in controlled, therapeutic settings. This renewed scientific focus, coupled with increasing media attention and a shift in public perception, can sometimes create an impression that these substances are universally safe or even beneficial. However, this narrative often overlooks a critical demographic: adolescents and young adults. It also sometimes downplays or fails to adequately address potential long-term risks, one of the most concerning of which is Hallucinogen Persisting Perception Disorder, or HPPD. For young people, whose brains are still undergoing significant development, the use of powerful psychoactive substances outside of medical supervision carries unique and often amplified risks. The allure of mind-altering experiences, peer pressure, or the search for self-discovery can lead adolescents to experiment with psychedelics without a full understanding of the potential consequences. While the conversation around adult therapeutic use is evolving, it is crucial to have a separate, clear, and cautionary discussion about psychedelic use among younger individuals. This article aims to do just that, focusing specifically on the risks, including the development of HPPD, and why the message "don’t try this at home, kids" is more pertinent than ever. This piece is written for an audience interested in psychedelic psychotherapy but perhaps uncertain about the risks, especially for younger populations, and will maintain a professional yet approachable tone suitable for an eighth-grade reading level.

What is Hallucinogen Persisting Perception Disorder (HPPD)?

Hallucinogen Persisting Perception Disorder (HPPD) is a rare but serious condition recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is characterized by the re-experiencing of perceptual distortions that were first encountered during a previous hallucinogenic drug intoxication, long after the acute effects of the drug have worn off. These are not typical "flashbacks" which are usually brief and episodic re-experiences of past drug effects. Instead, HPPD involves persistent or frequently recurring visual disturbances that can last for weeks, months, or even years, causing significant distress and impairment in daily functioning. A comprehensive review by Martinotti et al. (2018) published in Brain Sciences provides a detailed overview of HPPD. The authors note that while the prevalence is considered low, the condition is often under-recognized. The visual disturbances in HPPD can take many forms, including:

• Geometric hallucinations: Seeing patterns, shapes, or grids superimposed on surfaces.
• Trailing phenomena: Seeing trails or afterimages following moving objects.
• Halos or auras around objects: Bright lights or colored rings appearing around things.
• Intensified colors: Colors appearing much brighter or more vibrant than usual.
• Visual snow: Seeing tiny, flickering dots across the visual field, similar to television static.
• Illusions of movement in the peripheral visual fields: Seeing things move out of the corner of the eye when nothing is there.
• Difficulty reading: Text may appear to move, shimmer, or be difficult to focus on.
• Macropsia or micropsia: Objects appearing larger or smaller than they actually are.

It is important to distinguish between two proposed subtypes of HPPD, as discussed by Martinotti et al. (2018). HPPD Type I is often described as benign, short-term, and reversible, sometimes referred to as "flashbacks." Individuals with HPPD Type I may not find these experiences overly distressing and might even consider them "free trips." In contrast, HPPD Type II is characterized by long-term, often irreversible or slowly reversible, and pervasive visual disturbances that cause significant distress and impairment. This is the form that aligns more closely with the DSM-5 criteria for HPPD. While LSD is the substance most classically associated with HPPD, Martinotti et al. (2018) list a wide range of substances that have been linked to the condition, including psilocybin (magic mushrooms), mescaline (from peyote and San Pedro cactus), MDMA (ecstasy), ketamine, dextromethorphan, and even cannabis and synthetic cannabinoids in some cases. This underscores that the risk is not limited to just one type of hallucinogen.

Why Are Young People Particularly Vulnerable?

The adolescent brain is a work in progress. Key areas involved in decision-making, impulse control, and emotional regulation, such as the prefrontal cortex, are not fully mature until the mid-twenties. This period of development is characterized by heightened neuroplasticity, meaning the brain is more adaptable and susceptible to being shaped by experiences – both positive and negative. Introducing potent psychoactive substances during this critical window can have profound and potentially long-lasting effects on brain structure and function. Several factors contribute to the increased vulnerability of adolescents to the adverse effects of psychedelics, including HPPD:

1. Ongoing Brain Development: As mentioned, the brain is still developing. Psychedelics exert their effects by interacting with neurotransmitter systems, particularly the serotonin system. Disrupting these systems during a sensitive developmental period could lead to more persistent alterations than in a fully mature brain. The very plasticity that allows for learning and adaptation in adolescence might also make the brain more susceptible to embedding the aberrant perceptual changes seen in HPPD.
2. Higher Propensity for Risk-Taking and Experimentation: Adolescence is often a time of increased experimentation and risk-taking behavior. This can lead to using substances in unsafe contexts, without knowledge of dosage or purity, or mixing substances, all of which can increase the risk of adverse outcomes.
3. Psychological Vulnerabilities: Adolescence is also a period when many mental health conditions first emerge. Pre-existing psychological vulnerabilities, even if undiagnosed, can be exacerbated by psychedelic use. A study by Bremler et al. (2023) published in Scientific Reports, which focused on long-term negative psychological responses to psychedelics (though not exclusively HPPD or adolescents), found that prior psychological vulnerabilities were a potential causal factor for negative outcomes. While their sample was not exclusively adolescent (mean age 31, but 53% of initial questionnaire completers were <25), the findings highlight the role of pre-existing conditions.
4. Lack of Developed Coping Mechanisms: Adolescents may not have fully developed the emotional resilience and coping mechanisms to navigate challenging psychedelic experiences or to manage the anxiety and distress that can accompany persistent perceptual disturbances like HPPD.
5. Influence of Set and Setting: The principles of "set" (mindset, expectations, psychological state) and "setting" (physical and social environment) are crucial for psychedelic experiences. Young people experimenting recreationally are often in uncontrolled, unpredictable, or even unsafe settings, which can significantly increase the likelihood of negative experiences and potentially lasting harm. The Bremler et al. (2023) study also identified unsafe or complex environments and high or unknown drug quantities as potential causal factors for negative responses.

The Link Between Adolescent Use and HPPD

While HPPD can occur in individuals of any age after hallucinogen use, there is concern that adolescents might be at particular risk, or that the consequences could be more severe or impactful given their developmental stage. The research specifically focusing on HPPD in adolescents is still somewhat limited, but the general understanding of adolescent brain development and vulnerability to drug effects supports this concern. The review by Martinotti et al. (2018) notes that HPPD can arise even after a single exposure to a triggering drug. For an adolescent experimenting for the first time, this means the risk is present from the outset. The paper also mentions that the condition is more often diagnosed in individuals with a history of previous psychological issues or substance misuse – patterns that can sometimes begin or escalate during adolescence. One of the key findings from the Bremler et al. (2023) study on negative psychedelic experiences was that young age was identified as a potential causal factor. In their initial questionnaire data, 53% of those reporting negative experiences lasting over 72 hours were under the age of 25. This suggests that younger individuals might indeed be more susceptible to enduring negative psychological consequences, which could include HPPD or conditions that co-occur with it, like anxiety and depersonalization/derealization, which are frequently reported by those with HPPD.

Beyond HPPD: Other Risks for Young Psychedelic Users

While HPPD is a specific and concerning risk, it's not the only potential negative outcome for adolescents using psychedelics. Other risks include:

• Acute Psychological Distress: "Bad trips" characterized by intense anxiety, paranoia, fear, or confusion can be traumatic, especially for a young person. While often temporary, these experiences can sometimes trigger longer-lasting psychological issues.
• Exacerbation or Precipitation of Mental Illness: For individuals predisposed to conditions like schizophrenia, bipolar disorder, or other psychotic disorders, psychedelic use can potentially trigger the onset of these illnesses or worsen existing symptoms. This risk is particularly relevant during adolescence and early adulthood when these conditions often first manifest.
• Impaired Cognitive Development: While research is ongoing, there are concerns that regular use of psychoactive substances during adolescence could interfere with cognitive development, affecting learning, memory, and executive functions.
• Risky Behaviors: Being under the influence of psychedelics can impair judgment and lead to risky behaviors, increasing the chance of accidents or other harm.
• Development of Substance Use Disorders: While classic psychedelics are generally not considered to have high addictive potential in the same way as substances like opioids or stimulants, early initiation of any drug use can be a risk factor for developing substance use disorders later in life.

What Needs to Be Done? A Call for Caution and Education

The growing interest in the therapeutic potential of psychedelics in adults should not overshadow the very real risks they pose to young, developing minds. A clear distinction must be made between controlled, clinical use in adults under medical supervision and recreational, unsupervised use by adolescents. Education is Key: Honest, evidence-based education about the risks of psychedelic use, including HPPD, is crucial for young people, parents, educators, and healthcare providers. This education should not rely on scare tactics but should provide factual information about how these substances affect the developing brain and the potential for long-term consequences. Open Dialogue: Parents and caregivers should foster an environment where young people feel comfortable discussing substance use without fear of judgment, allowing for open conversations about risks and harm reduction. Early Intervention and Support: For young people who do develop HPPD or other negative consequences from psychedelic use, access to knowledgeable and supportive healthcare professionals is vital. Unfortunately, due to the rarity of HPPD, many clinicians may not be familiar with it, making diagnosis and treatment challenging. Increased awareness and training for medical and mental health providers are needed. Responsible Media Portrayal: Media and public discourse around psychedelics should be nuanced and responsible, clearly distinguishing between therapeutic research in adults and the risks of recreational use, especially for vulnerable populations like adolescents.

Conclusion: Protecting Young Minds

The psychedelic renaissance offers exciting possibilities for mental health treatment in adults. However, this enthusiasm must be tempered with a strong dose of caution when it comes to adolescents and young adults. The developing brain is uniquely vulnerable, and the use of potent psychoactive substances like psychedelics can carry significant risks, including the distressing and potentially long-lasting condition of HPPD. While research continues to explore both the benefits and risks of these compounds, the message for young people should be clear: experimenting with psychedelics is not a game and can have serious, enduring consequences. The allure of a mind-expanding journey should not overshadow the potential for a journey into lasting perceptual disturbances or other psychological difficulties. Protecting young minds requires awareness, education, and a cautious approach to these powerful substances. "Don’t try this at home, kids" isn't just a catchphrase; it's essential advice when it comes to psychedelic use in adolescence.

Disclaimer: Psychedelic Assisted Psychotherapy has not been approved by any regulatory agencies in the United States, and the safety and efficacy are still not formally established at the time of this writing.

References

Bremler, R., Katati, N., Shergill, P., Erritzoe, D., & Carhart-Harris, R. L. (2023). Case analysis of long-term negative psychological responses to psychedelics. Scientific Reports, 13(1), 15998. https://doi.org/10.1038/s41598-023-41145-x

Martinotti, G., Santacroce, R., Pettorruso, M., Montemitro, C., Spano, M. C., Lorusso, M., di Giannantonio, M., & Lerner, A. G. (2018). Hallucinogen Persisting Perception Disorder: Etiology, Clinical Features, and Therapeutic Perspectives. Brain Sciences, 8(3), 47. https://doi.org/10.3390/brainsci8030047