The Perils of Viewing Psilocybin Strictly As a Psychiatric Medication

The Scottsdale Research Institute (SRI) grows psilocybin mushrooms in Arizona with permission from the Drug Enforcement Administration. Late last month, the organization announced that it will use those mushrooms in a state-funded study testing their effectiveness in treating post-traumatic stress disorder (PTSD).

That project, which the Food and Drug Administration (FDA) has greenlit, exemplifies a renaissance of research investigating the psychotherapeutic potential of a drug that has been federally prohibited since 1968. But this route to pharmacological redemption, which focuses on turning psilocybin into an officially approved medicine, does not address the injustice of criminalizing people who use psychedelics for reasons the government refuses to recognize as legitimate.

The SRI study, which will include 24 veterans, firefighters, and police officers diagnosed with PTSD, is the first to use whole mushrooms rather than synthetic psilocybin. SRI President Sue Sisley says she aims to explore the possibility that other components of psilocybin mushrooms contribute to their effects.

In 2018, the FDA recognized psilocybin as a “breakthrough therapy” for “treatment-resistant depression,” a designation that was supposed to facilitate regulatory approval. Subsequent studies have reinforced the case for psilocybin-assisted psychotherapy as a treatment for depression and cancer-related anxiety, and it also looks promising as a PTSD treatment.

The process for obtaining FDA approval is expensive and time-consuming, and it has not yet resulted in any new options for people with psychological problems that might be relieved by psilocybin sessions. Five years ago, Oregon voters took a different approach, approving a ballot initiative that authorized state-licensed “psilocybin service centers” where adults 21 or older can use the drug under the supervision of a “facilitator” after completing a “preparation session.”

Notably, that initiative did not require any particular medical or psychiatric diagnosis. Colorado voters went further two years later, passing an initiative that not only authorized “healing centers” but decriminalized the noncommercial production, possession, and transfer of psilocybin and four other naturally occurring psychedelics.

While the campaigns for both of those initiatives emphasized psychotherapeutic applications, the resulting legislation left room for other uses. The same is true of various local measures, beginning with a Denver ballot initiative in 2019, that discouraged the arrest and prosecution of psychedelic users.

Those measures often described psilocybin and other natural psychedelics as “entheogens,” which refers to substances that generate “the god within.” That term suggests the inadequacy of viewing these drugs strictly as psychiatric medications.

In a 2023 RAND Corporation survey of people who had used psilocybin in the last year, 49 percent described their goal as “improved mental health,” a category that includes but extends beyond individuals who would qualify for a psychiatric diagnosis. Other common responses included “personal development” (45 percent), “curiosity” (43 percent), “spiritual growth” (41 percent), and “cognitive development” (41 percent).

Needless to say, these goals do not easily fit within any application that the FDA is likely to bless. Nor does the most frequently reported motivation: Fifty-nine percent of respondents said they used psilocybin for “fun,” e.g., “for a sense of joy, pleasure, or play, including at a party or other social gathering.”

Except for Colorado, no state is willing to tolerate these wide-ranging uses of psilocybin, notwithstanding scientific assessments that suggest the drug has far less potential for harm than alcohol. In Texas, where I live, possessing less than a gram of the wrong fungus is punishable by up to two years in jail, while one to four grams can get you up to 20 years.

Under federal law, simple possession of psilocybin is punishable by up to a year in jail and a minimum fine of $1,000. Possession with intent to distribute carries a penalty of up to 20 years in prison.

These laws raise questions that go far beyond the real or purported benefits of psilocybin. While the most common uses of “magic mushrooms” might strike politicians or regulators as frivolous, that judgment is not enough to justify treating those personal choices as crimes.

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