Self-medication with psychedelics: a scoping review and narrative synthesis of review-level evidence

Background: As public and scientific interest in psychedelics grows, unsupervised use for health purposes is increasing. In the U.S., past-year hallucinogen use nearly doubled from 2015 to 2023. Many individuals report self-treating physical or psychological symptoms without medical supervision using psychedelics-a practice termed self-medication. Despite this trend, review-level syntheses remain scarce. Aim: This scoping review aimed to map and synthesize review-level evidence on the self-medication of psychedelics, including which substances are used, for what health-related purposes, and what benefits and harms have been reported. Methods: We conducted a scoping review of review-level evidence on self-medication with psychedelics, following the PRISMA PRISMA-ScR (2018) checklist. Searches in PubMed, PsycINFO, and Google Scholar (October-November 2024) used the terms ("self-medication" OR "self-treatment") AND "psychedelics." Eligible reviews examined unsupervised use of classical or non-classical psychedelics for physical, mental, or behavioral conditions. Four reviewers independently screened all records. Data extraction was conducted using Elicit AI and was manually verified by reviewers. Methodological quality was assessed using AMSTAR criteria. Results: Three reviews met inclusion criteria (systematic, scoping, narrative). Psilocybin and LSD were most frequently reported, primarily for cluster headache and chronic pain. Outcomes included abortive relief, prophylactic relief, and prolonged remission, often from microdosed regimens. Approximately 40% achieved full remission; 70% reported preventive benefit. Adverse effects were rare and brief. Motivations for self-use centered on coping, desperation, and dissatisfaction with conventional care. Conclusions: Preliminary review-level evidence suggests that individuals self-medicating with psychedelics-particularly psilocybin and LSD-report symptom relief for conditions such as cluster headache, though findings remain limited by scarce and heterogeneous data. More rigorous research is needed to clarify effectiveness, safety, and real-world patterns of use.