Research on psychoactive substances – drugs that alter brain function and affect mood, thoughts and behaviour – is receiving huge public attention right now.
Historically, clinical research involving controlled substances like cannabis, ketamine and psilocybin have been defined by stigma, legal restriction and scepticism, influences that have coloured media coverage as much as the research itself.
Public attention towards research on these substances was often directed predominantly towards substance abuse prevention and addiction recovery. Within clinical trials, this translated into large-scale interventions like school-based initiatives to prevent substance use, text-message aftercare in alcohol withdrawal, and creating support networks of friends and family in opiate users. Other studies pushed for wider societal change, replacing pub pint glasses with 2/3 pints or removing the largest wine glass size from menus.
But the conversation is changing. Substance use research extends far beyond addiction and prevention, and researchers are increasingly investigating the therapeutic potential of psychoactive substances. Meanwhile, even research into managing addiction increasingly takes a user-centric, anti-abstinence perspective, where reduced harms are prioritised over eliminating drug use.
The University of Exeter are exploring the use of ketamine, an often publicly misunderstood substance, in tandem with therapy to reduce the chances of alcoholic relapse. While perhaps best known as the horse tranquiliser-turned-recreational-drug (also available for badgers!), ketamine has long been used in anaesthesia and analgesia in humans too, and its dissociative properties create interesting routes for psychotherapy.
Psilocybin, better known as the active compound in magic mushrooms, is being harnessed by Imperial College London to help treat anorexia, investigating its potential improving wellbeing, reducing compulsive behaviours and aiding motivation towards recovery.
Meanwhile, researchers at the University of Edinburgh are using cannabis-based medicine to treat nerve pain commonly brought on by chemotherapy. Over the last decade, this has become an increasingly common intervention for varying sources of nerve pain. While older patients are often concerned about ‘getting high’ from this treatment, research at the University of Colorado in Boulder has found that those turning to it as a last resort after exhausing all other treatment options have found it effective and enjoyable, to the point that edible cannabis products tailored specifically towards the over 60s market would prove popular and viable.
Public interest in studies like these grows at pace, nudging perceptions of psychoactive substances from stigma and towards scientific curiosity and cautious optimism. This change is fuelled in part by profile piece journalism – news stories of real people like Andrea Wright, whose participation in a medical marijuana trial relieved her of the fibromyalgia and psoriatic arthritis symptoms that had left her unable to sleep for more than two hours at a time for a decade.
But amidst promising breakthroughs in the headlines, could public enthusiasm outpace published results? Could this hype around emerging treatments drive unprescribed and unsafe use of psychoactive substances in a well-intended act of self-help? And if expectations ultimately outstrip results, could disappointment reinforce the very stigma these studies are helping to challenge?
This is where clinical trial registries provide a lifeline. Trials supply a safe, transparent and ethical framework for investigating therapeutic uses for psychoactive substances. But complete trial findings can take years to surface as journal articles. When they do emerge, they’re often written in complex language, completely inaccessible to non-specialists, including medical staff who aren’t experts in psychiatry or psychoactive substances. This knowledge barrier, explored in a Journal of Cannabis Research collection, can mean that the clinical data never reaches users in order to inform their choices.
Prospective trial registration bridges that gap - registering before participants become involved means the planned body of work is made public from the outset. Records on registries like ISRCTN include a Plain English Summary which helps patients and their families understand why a study is being completed. These summaries explain the potential risks and benefits of using therapeutic psychoactive substances, building patients’ trust along the way.
And while those full published results might still take years to surface, we’ve had a huge push in the UK (and beyond) towards adding basic results and a lay summary to the registry within 12 months of data collection wrapping up. This means research reaches the people it is intended to help much sooner.
As interest in therapeutic psychoactive substances continues to grow, transparent clinical research will become more and more central to their existence. The journey from registration to research to results not only strengthens the evidence base, but also helps the public separate promise from proof. In doing so, it supports informed decisions, builds trust in research, and helps ensure that hope is guided by robust science rather than hype, contributing to the goal of improved global health and wellbeing.