PSILOCYBIN (Shrooms)

Why is psilocybin increasingly popular?

Mushrooms have been used for thousands of years in religious, spiritual and recreational settings across many cultures.^[8]Its use in special ceremonies is still common in several native communities in Mexico.^[9]

Clinical research into psilocybin treatment of various mental health and substance use problems started to gain steam in the 1990s.^[10] Promising early results led to the foundation in 2006 of the Center for Psychedelic and Consciousness research at Johns Hopkins University. Researchers have published thousands of scientific articles on the compound.^[11]

Patients who have taken psilocybin in clinical trials have reported:

• • Increased acceptance and processing of emotions
  • Connections to others
  • Forgiveness
  • Self-compassion
  • Insights into one’s self
  • Mystical experiences like connecting with God
  • Positive changes in the way they see the world
  • Increased motivation
  • Commitment to change^[12]
  • Being able to have empathy for others
  • Greater desire to be social

People in clinical trials also report what scientists define as “ego-dissolution” or a reduced sense of self. This can increase the feeling of being at one with the universe and be a rewarding experience. A pleasant experience is not always the case. Some people feel disoriented, experiencing anxiety and fear.^[13]

Is psilocybin legal or illegal?

Psychedelics, including psilocybin, have been illegal in the United States since 1970. They are considered to be Schedule 1 drugs. This means they are thought to have no medical value and are ripe for misuse. As a result, magic mushrooms are illegal under federal law.

However, due to promising results in early clinical trials and its relative safety, in 2018, the Food and Drug Administration named psilocybin as a “breakthrough therapy” for treating severe depression. In early trials, it resulted in a great deal of improvement over existing treatments.^[14]

Consequently, in June 2023, this agency published a first draft of guidelines for researchers to investigate the potential therapeutic value of these substances.^[15]

Due to the earlier positive initial results, in 2020, Oregon became the first state to legalize psilocybin. Voters approved the creation of a regulatory and licensing framework that will allow patients to take psilocybin under supervision in Oregon’s largest cities starting in 2023.^[16]

In November 2022, Colorado decriminalized possessing, cultivating and sharing psilocybin and other psychedelics such as ibogaine, mescaline and DMT for people 21 and older. Moreover, in June 2023, Colorado governor Jared Polis said he would issue pardons for all criminal convictions related to psychedelic drugs, similar to what he did for marijuana possession. He also said he wants insurance companies, including federal Medicare and Medicaid, to cover the cost of psychedelic treatments.^[17]

Other states are moving in a similar direction. In 2022, the Connecticut legislature started the process of legalizing centers in which veterans and first responders could take psilocybin. Texas, Utah, Maryland and Washington state have funded research on the medical use of psilocybin, while Arizona’s legislature introduced in 2023 a bill to allow clinical trials of psilocybin treatment for mental health conditions like depression and PTSD.^[18] In California, there is an initiative that would legalize psychedelics, including psilocybin, while in New Jersey, a bill aims to legalize the compound to treat certain disorders.

Cities including Washington, D.C.; Ann Arbor, Michigan; Seattle, Washington; and Oakland, San Francisco and Santa Cruz in California have passed measures that essentially decriminalize psilocybin mushrooms and sometimes other psychedelics found in nature. The cities make no distinction between medical and recreational uses.^[19]

What is psilocybin good for?

Psilocybin has been used in clinical trials to treat mental health problems such as depression, anxiety, post-traumatic stress disorder and obsessive-compulsive disorder. In addition, trials have focused on the treatment of nicotine (tobacco) and alcohol use disorders.

Even when given only a few times (1 to 3), these studies have shown that psilocybin is effective in treating mental health and substance use disorders compared to traditional treatments.^[20]

It must be stressed that studies involving psilocybin have been conducted with a small number of participants. Larger studies are needed to confirm their findings before routine medical use of psilocybin can be considered. Also, many of the participants were mainly young, non-Hispanic white individuals. So, whether diverse populations can benefit remains to be seen.

Here are some of the studies’ results:

Depression: Psilocybin treatment has also been proven effective for difficult cases of depression. These results have been especially encouraging given that depression is on the rise in the United States despite the widespread use of a broad set of medications and new treatments, like transcranial magnetic stimulation and ketamine therapy.

Some researchers believe that severe depression may be linked to neuronal atrophy or shrinkage in the brain. So, there has been growing interest in using psilocybin to treat depression as it can encourage brain network connectivity.^[21]

Clinical trials have found that psilocybin treatment relieves symptoms of major depressive disorder, treatment-resistant depression and end-of-life depression. It can also help reduce anxiety. The benefits occur very quickly compared to the weeks or months one has to wait for traditional medications to take effect. Positive results often last for months.^[22] Moreover, studies suggest that psilocybin has proved to be at least as effective as escitalopram e.g., Lexapro and Cipralex) in treating major depression. ^[23][24]

Despite some preliminary positive results, more studies are needed. In 2022, an evaluation of scientific trials using psilocybin for depression concluded that the trials had mixed results. Psilocybin may reduce or eliminate the severity of depression symptoms for some participants. However, the results were similar to a more traditional approach where people were given an antidepressant and therapy.^[25]

Alcohol: People that were given psilocybin engaged in heavy drinking less often and drank less when they did. It proved to have better results than people who took diphenhydramine (e.g., Benadryl), which can be used to counter withdrawal symptoms from heavy alcohol use. In some cases, psilocybin has also proved to be more helpful than talk therapy alone.^[26]

Other studies reported that participants often had spiritual insights, heavenly visions, and communion with the Divine. This suggests that psilocybin treatment for alcohol might include direct spiritual experiences and spiritual care as part of the recovery process.^[27]

Other studies linked these meaningful experiences with positive changes in drinking.^[28]

A 2022 evaluation of the trials concluded that psilocybin-assisted psychotherapy may reduce heavy drinking days. It may also help reduce the number of drinks per day among adults with alcohol use disorder.^[29]

Nicotine: In the case of heavy smokers, psilocybin has helped reduce the number of cigarettes smoked per day. In addition, it has proven to be significantly better for smoking cessation than traditional treatments such as varenicline (e.g. Chantix).^[30]

Other mental health disorders: Psilocybin has also been proven to treat obsessive-compulsive disorder and post-traumatic stress disorder (PTSD).^[31]

Considering these initial results, dozens of pharmaceutical companies are investing in psychedelics. They are working on changing the structure as well as designing similar compounds. In some cases, they are trying to get rid of the “trips,” which produce spiritual experiences and meaningful insights, even though they appear to be an essential part of the success of the clinical trials.^[32]

What about microdosing? What it is used for?

Some people are using psilocybin and other psychedelics in microdoses. This means taking the substance in amounts small enough to avoid impairment. People who do it claim that microdosing has helped them treat anxiety, depression, PTSD or to attain spiritual growth. ^[33]

Scientific evidence for microdosing, though, is scarce and has been mixed on if it works.  According to several recent studies conducted in Europe, people who microdosed reported improvement in their mood, creativity and thinking. It also reduced anxiety and increased energy and friendliness.

In one of these studies, researchers were able to measure increased changes in a blood marker related to neuroplasticity, which is the ability of the brain to rewire itself. These changes are often needed in order to effectively treat depression.^[34]

However, some researchers have found similar positive outcomes of microdosing with LSD in individuals who were given placebos. Placebos are substances that cause no effect on the body – like a sugar pill. These results have led some to claim that the positive effect of microdosing is only the belief that there will be improvement instead of the actual microdose. ^[35]

Although generally considered safe, microdosing can actually carry some risks. Psychopharmacologist Kelan Thomas says there also are other risks, such as the potential for developing valvular heart disease (VHD), a condition resulting from damage to heart valves.^[36]

In any case, experts agree that the promising early results warrant more research on microdosing.

What are the risks?

Although it does not cause physical dependence, psilocybin does carry some risks. A psilocybin experience can produce vastly different outcomes —from frightening to significant and positive, life-changing experiences.

A person’s response to psychedelics depends a great deal on how strong or potent the mushrooms are and the amount ingested. The experience also depends on set and setting. This means that it may vary widely according to the user’s state of mind and beliefs. In addition, the people with the person, and the music, art or spiritual imagery used can make a difference.^[37]

Physically, psilocybin can cause:

• • Nausea
  • Vomiting
  • Muscle weakness
  • Lack of coordination.
  • Increased pulse rate and blood pressure. A person with heart disease or a history of seizures should not use it. ^[38]
  • Headaches may be experienced the day after use. Usually, they are mild to moderate and respond to over-the-counter medications like Advil or Tylenol.

Psychologically, psilocybin also carries risks, particularly if a person ingests a high dose. It can cause: ^[39]

• • Hallucinations
  • Inability to tell fantasy from reality
  • A “bad trip,” which may consist of panic, fear, confusion and engaging in dangerous behavior. While rare, there have been instances where a person has fallen from a significant height or run into traffic.
  • Harm to people diagnosed with bipolar, schizophrenia and schizoaffective disorders as it can worsen their mental health. The psychological risks can also be greater in individuals with a family history of severe psychotic and psychiatric disorders.
  • “Flashbacks,” or hallucinogen-persisting perception disorder (HPPD), which are repeated hallucinations long after ingesting the drug. The causes of these effects, which in some people occur after a single experience, are not known.^[40]

In general, alcohol and other drugs may worsen the psychological and physical risks of psilocybin misuse. In most cases, a doctor will treat the negative effects with medication, such as benzodiazepines (e.g., Xanax, Ativan, Klonopin).^[31]

No serious, long-term adverse events have been reported that are directly tied to taking psilocybin.^[42]

What if you or your loved one decide to try psilocybin?

If you or a loved one decide to try psilocybin, consider enrolling in a clinical trial. You can use this database of privately and publicly funded clinical studies conducted worldwide to find a trial involving psilocybin.

Otherwise, you can wait until psilocybin therapies are available for the general public. For example, the use of psilocybin in facilities with trained specialists are scheduled to open by late 2023 in Oregon and in 2024 in Colorado.^[43][44]

Most likely, these sessions will not be covered by insurance, regardless of their potential benefits. It is also important to know that if you decide to try psilocybin in any of the cities across the United States where the compound has been decriminalized or legalized, a guide, professional or therapist who is not authorized to conduct psilocybin sessions will be legally liable if something happens to you.

In a clinical trial setting you will be screened for your personal and family history. If you are a good candidate for psilocybin treatment there are several steps in the process:

1. Preparation:
   1. There are several hours (e.g., 4-8 hours) of building a trusting relationship with the therapist or guides.
   2. The therapist should prepare the patient for a range of possibilities in terms of what you might experience. For example, some people have felt that they were being eaten alive by insects or that they were dying.
2. Session:
   1. In the session itself, you will likely be lying down, with headphones on for music and eyeshades.
   2. Two therapists should be on hand to ensure that at least one person is with you at all times. Their role is to check in and provide reassurance.
   3. You will experience images, sounds, voices, etc., created by your brain during the session.
3. Post Session:
   1. This phase is referred to as integration and may take several days. You will be asked to describe your experiences – what you saw, heard, and felt while the therapist actively listens.
   2. Psilocybin can provide life-changing moments. That said the professional guiding the session should not offer any interpretation of your experience. You get to decide what it means and its importance to you.

If you’d like to learn about others’ experiences and “trips” check out Shroomery, a website offering information about psilocybin mushrooms.

What if my child is using psilocybin recreationally?

You can detect if your child is using psilocybin by some signs common to psychedelics, which may include:

• • Increased breathing rate or body temperature.
  • Dilated pupils.
  • Changes in the sense of time and intensified sensory experiences such as seeing brighter colors.
  • Loss of appetite.
  • Dry mouth
  • Uncoordinated movements
  • Excessive sweating
  • Panic and paranoia.^[45]

It’s worth noting that only adults have participated in clinical trials of psilocybin treatment, so the research on the effects of the compound on teenagers’ brains is scant. However, teenagers should be discouraged from using psychedelics as the brain is not fully mature until the mid-to-late 20’s.^[46]

If you suspect that your child is using psilocybin or any other substance, talk with them. Here are some techniques to help you establish positive and fruitful communication.

Reducing the risks of using mushrooms recreationally

If you think that your loved one is using mushrooms, talk to them. Here are some useful ideas about how to approach the conversation.

The best course of action is not to use mushrooms. If your loved one insists on using it despite its downsides, consider sharing ways to reduce the risks. Remember that the most important thing is to keep them safe. Reducing the risks is not encouraging the use of substances. Instead, it recognizes that there are ways to minimize the consequences of mushrooms use.

Here are some risk reduction measures you may wish to share with your loved one. The recommendations are from a survey of people who use mushrooms and what they do to reduce risks:^[47]

• Know your substance: all substances’ effects are dose related. Usually, the more substances you take, the stronger and longer lasting the effects (and the greater the risk of harm). So, it’s a good idea to ‘test dose’ each new batch of mushrooms to see how strong it is. Start with a small amount of mushrooms and waiting for 90 to 120 before taking the planned dose.
• Avoid when depressed, anxious or paranoid: substances tend to worsen these states. Getting paranoid (e.g., being overly suspicious or fearful for no reason) when tripping is not uncommon.
• Avoid driving, biking or swimming: operating vehicles under the influence of any substance is always risky, the same as swimming.
• Watch friends who are tripping: check in on your friends if they are using mushrooms to make sure they are safe.
• Use mushrooms with people you trust: sometimes psychedelics can produce unpleasant experiences, so it is best to have someone you trust on your side.
• Use a reliable source: don’t get substances from people you don’t know or barely know.
• Plan your experience: plan in advance what you will do and where you will be when using mushrooms.
• Set a limit on the amount: use only what you planned to use before your session.
• Leave time between trips: leave enough time between trips (days, weeks, months) to understand and process your experience.
• Stay hydrated: Drinking plenty of water can help prevent dehydration and reduce the risk of overheating, which can be a side effect of mushrooms use.
• Avoid mixing with other substances: Mixing mushrooms with other drugs, including alcohol, can increase the risk of negative side effects, including seizures, paranoia, and heart problems.