Control and monitoring of recreational DMT use is difficult because of its widespread natural availability. Approximately one­quarter of DMT users report personally extracting the substance from plant material (Cakic et al., 2010), which may also contain toxic hydrogen cyanide. Instructions for DMT extraction are readily available on Internet forums and include use of harmful chemicals, with a high risk of contamination. DMT’s easy accessibility for recreational use, hazardous extraction process, co­occurrence with toxic plant chemicals and links to psychotic illness warrant significant medical concern. DMT is not detected in routine drug screens and its use is likely under­recognized by psychiatrists. An increased awareness of the existence of DMT abuse and comprehensive research into the chemical’s actions in the brain are encouraged.