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The Year of the Psychedelics2026-01-18

“Consciousness is a tricky thing.”

—A.D. Aliwat

Psychedelics have the potential to be transformative drugs in psychiatry, if administered appropriately. 2026 will be their year of wider adoption. The dose (and the duration, and the domain) make the poison. But that is true for every drug in psychiatry, and indeed in medicine in general. In the right patient, for a limited amount of time, at a minimal dose, for the right reasons they have the potential to be quasi curative and allow people to move on with their lives. In the wrong patient (with an underappreciated underlying genomic risk), used for too long, at too high a dose, for the wrong reasons (i.e. recreational), they can have devastating psychotic side-effects. In order not to lose these wonderful drugs again to scandal and controversy, like occurred five decades ago, we need to test patients comprehensively with blood biomarkers to see if they would benefit1,2,3 and if they have underlying risks4.

Marijuana as well has become legal in various jurisdictions. It is not the marijuana from five decades ago, the THC content is very high, and in the wrong individuals can have devastating consequences. The rate of psychosis in young people tied to marijuana use has skyrocketed in recent years, destroying bright futures and tearing apart families. The fact that genes for schizophrenia are involved in the body in cannabinoid signaling is not new, we have reported that over a decade ago5. Biomarker testing before deciding to use, and biomarker testing when problems appear, can prevent issues, or in the latter case guide precise treatments, to mitigate and reverse the damage.

What is old is new again. However, we are wiser and more technologically advanced now, so benefits can be maximized and risks can be minimized https://mindxsciences.com/bloodtests/.

Footnotes

  1. Le-Niculescu H, Roseberry K, Levey DF, Rogers J, Kosary K, Prabha S, Jones T, Judd S, McCormick MA, Wessel AR, Williams A, Phalen PL, Mamdani F, Sequeira A, Kurian SM, Niculescu AB. Towards precision medicine for stress disorders: diagnostic biomarkers and targeted drugs. Mol Psychiatry. 2020 May;25(5):918-938. doi: 10.1038/s41380-019-0370-z. Epub 2019 Mar 12. PMID: 30862937 ↩

  2. Le-Niculescu H, Roseberry K, Gill SS, Levey DF, Phalen PL, Mullen J, Williams A, Bhairo S, Voegtline T, Davis H, Shekhar A, Kurian SM, Niculescu AB. Precision medicine for mood disorders: objective assessment, risk prediction, pharmacogenomics, and repurposed drugs. Mol Psychiatry. 2021 Jul;26(7):2776-2804. doi: 10.1038/s41380-021-01061-w. Epub 2021 Apr 8. PMID: 33828235 ↩

  3. Bhagar R, Gill SS, Le-Niculescu H, Yin C, Roseberry K, Mullen J, Schmitz M, Paul E, Cooke J, Tracy C, Tracy Z, Gettelfinger AS, Battles D, Yard M, Sandusky G, Shekhar A, Kurian SM, Bogdan P, Niculescu AB. Next-generation precision medicine for suicidality prevention. Transl Psychiatry. 2024 Sep 6;14(1):362. doi: 10.1038/s41398-024-03071-y. PMID: 39242534 ↩

  4. Hill MD, Gill SS, Le-Niculescu H, MacKie O, Bhagar R, Roseberry K, Murray OK, Dainton HD, Wolf SK, Shekhar A, Kurian SM, Niculescu AB. Precision medicine for psychotic disorders: objective assessment, risk prediction, and pharmacogenomics. Mol Psychiatry. 2024 May;29(5):1528-1549. doi: 10.1038/s41380-024-02433-8. Epub 2024 Feb 8. PMID: 38326562 ↩

  5. Ayalew M, Le-Niculescu H, Levey DF, Jain N, Changala B, Patel SD, Winiger E, Breier A, Shekhar A, Amdur R, Koller D, Nurnberger JI, Corvin A, Geyer M, Tsuang MT, Salomon D, Schork NJ, Fanous AH, O'Donovan MC, Niculescu AB. Convergent functional genomics of schizophrenia: from comprehensive understanding to genetic risk prediction. Mol Psychiatry. 2012 Sep;17(9):887-905. doi: 10.1038/mp.2012.37. Epub 2012 May 15. PMID: 22584867 ↩