Over the
last few months, I have received many questions about psilocybin, also known as
“magic mushrooms,” a drug that seems to be constantly in the news. It turns out
that much of the current research on psilocybin is conducted by my colleagues
at the Behavioral Pharmacology Research Unit at Johns Hopkins, led by an
excellent researcher named Dr. Roland Griffiths. This group has already
established a Center for Psychedelic and Consciousness Research.
What is psilocybin? Psilocybin is a hallucinogen or
psychedelic drug. This means that it can alter a person’s mood, thoughts, and
perceptions. Other examples of psychedelic drugs are LSD and mescaline. People
who take psychedelics often report a profound mystical experience that
transforms the way they think about their life and values. Psychedelic drugs
are distinguished from what are called “dissociative” drugs like ketamine or
PCP, which make people feel disconnected from their body or environment. The drug
MDMA (known as “Ecstasy”) seems to have both psychedelic and dissociative
properties.
What does psilocybin
look like? Psilocybin
is found in certain strains of mushrooms that grow across many regions of the
U.S. This is why the drug goes by the name “shrooms. These mushrooms can be
eaten fresh or in a dried state. Psilocybin can also be found in powdered form
(to mix in liquids or sprinkle on food) or in capsules. Like cannabis, there is
also a market for psilocybin gummies and other “edibles.”
How does psilocybin
impact the brain? We
do not have perfect answers to this question. We know that psilocybin impacts
receptors that are activated by the neurotransmitter serotonin. The drug
appears to exert effects in the prefrontal cortex and hippocampus of the brain.
In addition to direct effects, psilocybin appears to disrupt neural
communication across brain regions, in some ways increasing communication and
in other ways disrupting communication. Scientists are still trying to make
sense of this chaos.
Is psilocybin legal? While not yet legal, some cities,
including Washington D.C., have decriminalized psilocybin. This means that
people will not face penalties for possessing or using this drug, though it
cannot yet be sold. As with cannabis, there is a trend to overvalue the
potential positive aspects of the drug and devalue the unintended but very real
adverse effects.
How many people use
psilocybin? We
have seen an increase in its use over the past few years. The NIH reports that
about 4 to 5% of high school students have tried it at least once, while about
8% of young adults (19 to 30) have used it.
What are its short-term
effects? One of
the difficulties in studying and even classifying this drug is that its effects
are unreliable, which means that different people will experience different
consequences. For some people, one dose of psilocybin leads to a reduction in
self-focus and increased connectedness to others, a kind of spiritual awakening
that feels meaningful and even life changing. People also report feeling much
happier, even days and weeks after taking the dose.
Others
experience severe agitation and fear, the type of bad reaction that can land a
person in the emergency room. Because perceptions and judgment are distorted,
people who use psychedelics outside of a controlled setting can put themselves
in dangerous situations and sustain injuries. We think that many factors might
influence the drug experience: biology, emotional state, expectations, and even
the setting where it is consumed. Because of the variety of responses, people
who take psilocybin in experimental studies are routinely guided through the
experience by a trained therapist.
What are its long-term
effects? The
serious study of psilocybin is a relatively recent endeavor, and there are few
studies that have investigated its long-term effects. We know that many of the
positive effects of the drug extend considerably longer than the presence of
the drug in the body. Some users report that they re-experience perceptual
changes in the weeks or months following use, an experience that has
traditionally been called a “flashback.” We simply don’t know how many people
experience this type of effect. My guess is that people with pre-existing
vulnerabilities to psychotic thinking would be most sensitive to flashbacks.
Is psilocybin
addictive? At this
point, there seems to be agreement that frequent use can cause tolerance, which
means that higher doses are needed to get the same effect. It seems to me that,
for those who find the experience rewarding, psilocybin has strong potential to
be very addicting, as are most things that people find pleasurable.
Can psilocybin help
people with psychiatric conditions? Because
psilocybin impacts serotonin receptors and has antidepressant effects, there is
hope in the field of psychiatry that it will be helpful for the treatment of
depression and other disorders that are associated with low levels of
serotonin. This hope extends to the treatment of people who have serious forms
of mental illness that have not responded well to traditional medicines or
psychotherapy.
A
national study, led by Dr. Griffiths, compared a single dose of psilocybin
(with psychological support) to a placebo to treat people suffering from
depression. The results were just published in the Journal of the American Medical Association and show that those
receiving psilocybin were more likely to show improvement in depression
symptoms than those receiving the placebo, though psilocybin was also associated
with more adverse effects, like headaches and nausea. I am certain that trials
comparing psilocybin to established medications are underway.
Another
area to watch is the use of psilocybin to reduce anxiety and pain in people
with cancer and other life-threatening diseases. Sadly, the principal
investigator of many of these studies, Roland Griffiths, was recently diagnosed
with Stage 4 cancer. In many interviews, he reported that his personal use of
psilocybin was very helpful in accepting his terrible condition.
When asked about drug legalization, he was much more cautious, knowing that the
possible therapeutic benefits must be weighed against the worry of misuse by
adolescents and adults.
Overall,
this is an exciting area of study, though scientists have been careful to
emphasize the need for more research. The media, of course, have been less
discerning. We have already lived through many “wonder drugs,” like Xanax and
Oxycodone that also have high abuse potential. Prozac was once considered a
miracle drug for depression, and suboxone a miracle drug for opioid addiction. Each
of these drugs can be very helpful but are far from miraculous; people are
simply too complicated. The study of psilocybin is off to a strong start, and
it will not be long until we understand its therapeutic benefits and adverse
impacts.
In
the meantime, it is best to stay away. There is a good reason why the studies
are all conducted with on-site psychological support while the person is
experiencing drug effects: The drug response can be quite unpredictable and
scary, and its long-term impact unknown.
