Background: Recreational drug use is a major cause of disease, injury, physical and mental impairment and death in developed countries such as the United Kingdom and the United States. Alcohol, tobacco, cannabis, 3,4-methylenedioxymethamphetamine (MDMA) and psilocybe mushrooms are recreational drugs with capacity to cause harm. Cannabis, MDMA and psilocybin have reported therapeutic applications. Objectives: The primary purpose of this study was to determine which of the three types of vendor (pharmacy, shop and the black market) are perceived to be the most suitable for selling the substances discussed according to a general population sample. Methods: A sample of 105 UK nationals was selected for the survey. Participants were presented information regarding reported relative dangers of alcohol, tobacco, cannabis, MDMA and psilocybin and potential therapeutic applications. Participants were then asked to review harm reduction strategies. Results: It was found that participants concluded that pharmacists with available NHS support from GPs and mental health workers are the most suitable vendors of cannabis, MDMA and psilocybin as opposed to regulated shops or the black market (p < 0.001). There was a high level of support for selling cannabis in pharmacies both for therapeutic use and for harm reduction purposes with a mean score of 7.0 out of 10. Participants (60) with a university education were found to be more in favour of the substances being sold primarily in pharmacies (alcohol 5.6, tobacco 6.7, cannabis 7.6, MDMA 6.5 and psilocybin 6.5) than participants (45) with no university qualification (alcohol 5.0, tobacco 4.8, cannabis 6.3, MDMA 5.0 and psilocybin 5.1). Conclusions: The data suggest that the university-educated participants are supportive of treating recreational drug use as a health issue with GPs, mental health workers and pharmacists taking on roles.

Objective Research into psychedelic therapy models has shown promise for the treatment of specific psychiatric conditions. Mystical‐type experiences occasioned by psilocybin have been correlated with therapeutic benefits and long‐term improvements in positive mental outlook and attitudes. This article aims to provide an overview of the topic, highlight strengths and weaknesses in current research, generate novel perspectives and discussion, and consider future avenues for research. Design This narrative review was designed to summarise and assess the state of research on psilocybin occasioned mystical‐type experiences and applications for the treatment of specific psychiatric conditions. Results Contemporary methods on the quantification of mystical‐type experiences and their acute subjective effects are discussed. Recent studies provide some understanding of the pharmacological actions of psychedelics although the neurological similarities and differences between spontaneous and psychedelic mystical‐type experiences are not well described. Applicability to modern clinical settings is assessed. Potential novel therapeutic applications include use in positive psychology interventions in healthy individuals. Conclusions Since 2006 significant advancements in understanding the therapeutic potential of psilocybin‐assisted psychotherapy have been made; however, more work is required to understand the neuromechanistic processes and applicability in modern clinical settings. Despite promising results in recent studies, funding issues for clinical trials, legal concerns and socio‐cultural resistance provide a counterpoint to experimental evidence.

Objective Reports have indicated possible uses of ayahuasca for the treatment of conditions including depression, addictions, post‐traumatic stress disorder, anxiety and specific psychoneuroendocrine immune system pathologies. The article assesses potential ayahuasca and N,N‐dimethyltryptamine (DMT) integration with contemporary healthcare. The review also seeks to provide a summary of selected literature regarding the mechanisms of action of DMT and ayahuasca; and assess to what extent the state of research can explain reports of unusual phenomenology. Design A narrative review. Results Compounds in ayahuasca have been found to bind to serotonergic receptors, glutaminergic receptors, sigma‐1 receptors, trace amine‐associated receptors, and modulate BDNF expression and the dopaminergic system. Subjective effects are associated with increased delta and theta oscillations in amygdala and hippocampal regions, decreased alpha wave activity in the default mode network, and stimulations of vision‐related brain regions particularly in the visual association cortex. Both biological processes and field of consciousness models have been proposed to explain subjective effects of DMT and ayahuasca, however, the evidence supporting the proposed models is not sufficient to make confident conclusions. Ayahuasca plant medicine and DMT represent potentially novel treatment modalities. Conclusions Further research is required to clarify the mechanisms of action and develop treatments which can be made available to the general public. Integration between healthcare research institutions and reputable practitioners in the Amazon is recommended.

Background: Contemporary research indicates that the legal classifications of cannabis (Schedule 2, Class B), 3,4-methylenedioxymethamphetamine (MDMA) (Schedule 1, Class A) and psilocybin (Schedule 1, Class A) in the United Kingdom are not entirely based on considerations of harm and therapeutic utility. The legal classifications of the substances discussed are typically determined by legislators such as Parliament and, therefore, may be a reflection of the views or perceived views of the general public. Objective: The aim of the study was to provide an indication of the underlying psychology regarding the legislated sale of alcohol, tobacco, cannabis, MDMA and psilocybin in pharmacies according to a UK general population sample. Methods: A sample of 105 UK nationals was selected for the survey. Participants were asked questions on perceived relative harm of the five substances. After viewing contemporary information on reported relative harm and therapeutic applications, the participants were asked questions related to using the pharmacy retail model for the sale of the substances discussed. Participants who opposed the substances being sold primarily in pharmacies were asked to explain their rationale according to a predetermined list of options for each of the five drugs. Participants were also asked whether they consider it a human right to be legally permitted to consume the substances. Results: The participants' perceptions of relative harm (tobacco > MDMA > psilocybin > alcohol > cannabis) were not in agreement with the relative harm reported in the literature (alcohol > tobacco > cannabis > MDMA > psilocybin). Principal objections to the currently illicit substances being legally available in pharmacies include it sending the wrong message; it feels wrong; it is too dangerous; disliking the smell of cannabis; disapproval of the people; and not liking the idea of people using psychoactive drugs for entertainment or to have mystical/religious experiences. Overall, the participants determined that being legally permitted to consume the substances discussed is an issue of relevance to human rights. A majority of the male participants concluded that being legally permitted to consume alcohol, tobacco, cannabis and Psilocybe mushrooms is a human right in contrast to the majority of female participants who solely considered alcohol consumption to be a human right. Conclusions: The data suggest that the legal classifications may not simply be based on considerations of harm. Misperceptions of the dangers, biases and non-health-related aversions likely contribute to the continuation of policies that do not reflect the state of scientific research.

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