Trends in Psychedelic Related Emergency Department Visits During Oregon Drug Policy Reform

Use of psychedelic substances has increased in the United States as clinical research and state level reforms expand. Oregon implemented Measure 110, which decriminalized possession of controlled substances in February 2021, and Measure 109, which established a regulated psilocybin services program beginning in January 2023. The impact of these policies on Emergency Department (ED) utilization related to psychedelics is not well understood. The objective of this study was to evaluate associations between these policy changes and trends in psychedelic related ED visits.

We conducted an interrupted time series study using electronic health record data from multiple Oregon emergency departments from January 2016 through March 2025. ED encounters were included if they contained specific psychedelic-related International Classification of Diseases, Tenth Revision codes. Monthly visit counts and rates per ten thousand ED visits were analyzed using segmented regression adjusted for COVID-19 related changes in ED visits, and autocorrelation. Policy periods included pre-policy, post Measure 110 (decriminalization), and post Measure 109 (state regulation).

A total of 834 psychedelic related ED encounters met inclusion criteria. Approximately two thirds involved patients aged eighteen to thirty-four years, and seventy percent involved male patients. The rate of psychedelic related visits was 1.1 per ten thousand ED visits (95% CI 0.7 to 1.5) in January 2016 and increased to 2.9 per ten thousand immediately prior to Measure 110. After Measure 110, there was an immediate decrease of 0.8 visits per ten thousand (95% CI 0.2 to 1.5) with no subsequent trend change. Measure 109 was not associated with an immediate level change (95% CI −0.6 to 0.6) or slope change. Psychedelic related ED encounter rates remained low throughout the study period, ranging from approximately one to three visits per ten thousand ED encounters.

Psychedelic related ED visits increased before policy reform, decreased immediately after decriminalization, and remained stable following regulation, indicating that Oregon drug reforms were not associated with sustained increases in ED utilization related to psychedelics. Real world electronic health record data can inform evaluation of the public health impacts of psychedelic drug policy changes.