Many of these drugs have not been thoroughly studied for long-term effects when used off-label, leaving potential side effects and complications poorly understood. Misuse or overuse can lead to dependency, cardiovascular issues, sleep disturbances, and mental health problems such as anxiety or psychosis. Without proper medical supervision, users may also be unaware of harmful drug interactions or contraindications. These risks highlight the need for caution, regulation, and increased public awareness to prevent harm as PCE use becomes more widespread.