Psilocybin is a psychedelic compound produced by several species of mushrooms, which has been used for millennia across various cultures. It first gained broader awareness in the Western world during the 1960s and is now the subject of scientific inquiry due to renewed interest in the clinical applications of psychedelic medicines and psychedelic-assisted therapy.
Research into psilocybin and psilocybin-assisted therapy has found it to be effective in addressing a number of difficult-to-treat conditions, including alcohol use disorder, end-of-life anxiety, tobacco cessation, treatment-resistant depression, major depressive disorder, and cluster headache, among others.
In terms of physical safety, research suggests that psilocybin is generally well-tolerated. In animal models, the lethal dose for psilocybin was consistently found to be orders of magnitude above typical doses of the drug. Furthermore, similar to other serotonergic psychedelics, psilocybin does not lead to physical dependence or addiction. Researchers have therefore concluded that it has low potential for abuse.
While psilocybin is overall a very safe substance, it does have the potential to affect several physiological systems. For example, medications with strong serotonin 2B receptor binding affinity, like psilocin (the active metabolite of psilocybin), have been linked to valvular heart disease (VHD). Additionally, there are other medical conditions, such as uncontrolled hypertension, lithium use, or certain psychotic disorders, that may make psilocybin therapy medically risky for some patients.
In November 2020, Oregon voters passed Measure 109, which allows for the manufacture, delivery, and administration of psilocybin at supervised, licensed facilities. As of January 1, 2023, psilocybin provided by licensed growers is legal for consumption at licensed centers under the supervision of licensed facilitators for individuals aged 21 and older.
As research emerges on the medical benefits of psilocybin, and states like Oregon continue to approve the drug for medicinal uses, more patients are likely to seek out psilocybin-assisted therapy as a treatment option for various health conditions. However, health care professionals often lack the knowledge to discuss psilocybin therapy with patients and adequately assess whether it would be an appropriate and safe option for them.
To adequately respond to patients’ questions, it is crucial that clinicians have a basic understanding of psilocybin therapy, its indications based on promising clinical research, the pharmacology of psilocybin (including drug-drug interactions), and contraindications to psilocybin therapy.
“Licensed health care clinicians will be the backbone of safety as it relates to those with more complex medical histories who are going to be seeking services. We believe that educating clinicians is crucial to ensuring people are taking the right steps necessary prior to receiving services,” said Sam Chapman, campaign manager for Oregon Measure 109 and Executive Director of the Healing Advocacy Fund, a nonprofit dedicated to supporting the nation’s first regulated psilocybin therapy program.
Fortunately, courses have been created to help equip health care professionals with the tools they need to safely, effectively, and comfortably assess and discuss the relevant medical risks with their patients. The onus now falls on practitioners to educate themselves, especially primary care providers in states like Oregon. Psilocybin can be an extremely efficacious and safe medicine, but like with any medication, the risks and benefits must be weighed for each patient individually, which requires a knowledgeable clinician.
Lynn Marie Morski is a physician, attorney, and president, Psychedelic Medicine Association.
