A large survey shows patients view cannabis and psychedelics as more effective than prescription medications.
Cannabis and psychedelics have been rated the most effective treatments for eating disorders, according to a new study from The University of Sydney.
More than 5000 people participated in the Medications and Other Drugs for Eating Disorders (MED-FED) survey between 2022 and 2023. Australians made up 30% of the cohort, which spanned across 83 countries including the UK and the US.
For ED symptoms, psilocybin (magic mushrooms) and cannabis were the highest rated, followed by LSD.
For improving mental health, not ED symptoms, the best-rated drugs were prescription psychotropics. At the top was lisdexamfetamine, followed by methylphenidate, lamotrigine, bupropion and escitalopram.
Non-prescription drugs psilocybin, LSD and cannabis followed closely behind for mental health.
The survey asked about participants’ last 12 months of drug use, including prescription medications, caffeine, alcohol, tobacco and nicotine and non-prescription drugs.
Using a five-point scale, participants rated each drug for its effects on ED symptoms and mental health and the unpleasantness of side effects.
Nearly half of the respondents reported using cannabis daily and more than half were using prescription psychotropics.
Cannabis was the most popular drug overall for managing ED symptoms. However, fluoxetine was more strongly preferred among its users – while fewer people used fluoxetine than cannabis, a higher proportion of them chose it as their drug of choice for ED compared to cannabis users.
Natalie Spicer, Head of Clinical and Support Services at Butterfly Foundation told TMR that the use of non-prescribed drugs to cope with eating disorder symptoms is a known behaviour.
“The findings of this study, while groundbreaking in their scope, are not entirely surprising and do seem to accurately depict the landscape of mental health issues and drug use among people with eating disorders,” she said.
“With less than a third of people able to access the professional support they need to recover, it’s not surprising that people are turning to alternative approaches to deal with or cope with an eating disorder.”
She explained that long waitlists, a lack of available treatments and treatment approaches that might not be effective for an individual’s own circumstances and history are common barriers experienced by people with eating disorders.
“The fact that individuals are turning to cannabis and psychedelics to self-medicate suggests a desperation for relief from symptoms that are often resistant to conventional treatments.”
Ms Spicer encouraged healthcare professionals to access free training to upskill and better understand eating disorders, available via the National Eating Disorder Collaboration.
She said that one of the key things that stood out for her in the study was the different experiences of people with different diagnoses.
“For example, those with ARFID and Anorexia Nervosa reported cannabis as being beneficial in improving eating disorder symptoms, while in contrast, those with Binge Eating Disorder and Bulimia Nervosa poorly rated cannabis and suggest it could exacerbate eating disorder symptoms,” she said.
“This demonstrates that eating disorder treatment cannot take a ‘one size fits all’ approach – support must be person-centred and address an individual’s unique needs, preferences and history.”
For Professor Richard Newton, consultant psychiatrist, adjunct professor at Monash University and clinical director of Peninsula Health Mental Health Service, the study reinforced the need to be curious and nonjudgmental when discussing illicit drug use in people with easing disorders.
As a prescriber, he said it was great to see that fluoxetine and lisdexamfetamin were perceived positively by the people for whom they were most indicated, but that he was not surprised at the rate of people turning to illicit substances to help their symptoms.
“Doctors will prescribe things like olanzapine, quetiapine and/or benzodiazepines to try and help people with their anxiety around eating but often, it doesn’t help that much,” he told TMR.
Depression affected more than 65% of survey respondents and more than half reported anxiety disorders, but Professor Newton explained that antidepressants were far less effective in those that are very underweight or nutritionally compromised.
“I think it really reinforces the need for more research around the use of psychedelics and cannabis, particularly for people with restrictive eating disorders like anorexia nervosa,” he said.
Related
Ms Spicer said that the study’s conclusions provided a powerful justification for current research into psychedelics, ketamine and cannabidiol in eating disorder management.
“The fact that the individuals themselves are reporting positive effects from these substances validates the hypothesis behind the ongoing clinical trials,” she said.
Professor Newton was surprised that crystal meth was not focussed on in the study, given the predominance of Australian respondents and the prevalence of crystal meth here.
He also noted that the study was not an accurate representation of the Australian ED population.
More than 40% of diagnosed participants had anorexia nervosa, a fifth had bulimia nervosa, one in 10 had binge-eating disorder and 9% had avoidant/restrictive food intake disorder.
“The most common eating disorder in the population is binge eating disorder, then bulimia nervosa and anorexia nervosa coming last in terms of frequency. And yet, the respondents in this were anorexia first, then bulimia, then binge eating disorder,” Professor Newton said.
“Although it’s a wonderful study, it has limitations. The respondents are young people who are social media savvy and have very severe eating disorders.”
All participants were 18 years or older, and the cohort was 94% female and 82% white. More than a third of the cohort was undiagnosed but nominated disordered eating symptoms recognised by the DSM-5.
Unsurprisingly, undiagnosed respondents were less likely to be receiving psychological interventions or prescribed medications.
More than half the cohort reported having a problem with at least one substance. Despite being highly rated for ED symptoms and the drug of choice, many daily cannabis users reported dependence, overuse and/or side effects.
More than 15% of participants reported a comorbid drug dependence and around one in 10 reported alcohol dependence.
Alcohol was the rated as the worst drug for mental health, followed by cocaine, amphetamines and MDMA.
Lamotrigine, illicitly sourced diazepam, psilocybin and bupropion were the least likely drugs to have unpleasant adverse effects.
JAMA Network Open, 22 July 2025
For confidential & free support for eating disorders call the Butterfly National Helpline on 1800 ED HOPE (1800 33 4673) or visit www.butterfly.org.au to chat online or email.
