Research suggests psilocybin-assisted therapy may lead to decreases in alcohol consumption among those with alcohol use disorder (AUD). Psilocybin is the psychoactive chemical from magic mushrooms. Some preliminary studies indicate psilocybin may also have potential in treating cocaine use and opioid use, although larger studies are needed. There are promising clinical trials for using psychedelics to treat depression, anxiety, PTSD, and eating disorders. This research has piqued interest and led some people to try self-medication. But self-administration/self-medication isn’t the same as treatment under medical supervision.
While not like opioids, which have led to overdoses and deaths, risks remain with psychedelics. Researchers have found that people seeking emergency care subsequent to hallucinogenic use had a 2.6 times higher risk of death in five years compared with the general population, according to a recent study in CMAJ (Canadian Medical Association Journal). In another recent study, individuals needing emergency care after taking a hallucinogenic drug had a 21 times greater risk of developing schizophrenia in three years compared with the general population.
Young Adults
Academic groups have monitored nonmedical use of hallucinogens, highlighting young adults. Clear evidence shows that hallucinogenic use has increased. This appears related to news of psychedelics helping patients with depression, trauma, PTSD, and other issues. Among young adults aged 19 to 30 years, past‑year hallucinogen use was 8 percent in 2022, compared to 5 percent in 2017 and 3 percent in 2012. College students are also attracted to hallucinogenic substances. Experts worry that psychedelic research data is based on adult studies and assumes a mature brain, not an adolescent/young adult whose brain is still developing.
Psilocybin Safety
While many drugs of abuse cause overdose deaths, this rarely happens with hallucinogens. The lethal dose of psilocybin in humans is 1,000 times the effective dose. Humans usually can’t consume this quantity in a day. However, a massive overdose (gram-level dried mushrooms or milligram-level LSD) could cause prolonged delirium, hyperthermia, and secondary organ failure.
The National Institute on Drug Abuse (NIDA) says psilocybin does not typically lead to addiction, and there is no recognized physical withdrawal; however, the psychiatric manual, DSM-5, lists “other hallucinogen use disorder” as a category.
I remember in the ’60s when some psychedelic users did become dependent on the drug, preferring under-the-influence states to real life. With dependence on psychedelics, the person spent increasing periods obtaining, using/recovering from hallucinogens.
With magic mushrooms, users form a strong attachment to emotional/spiritual hallucinogenic experiences. A desire to reattain this state may lead to compulsive use despite minimal physical cravings.
Frequency of use is key. In therapeutic settings, psilocybin is administered in one to three sessions, a week or month apart, often with pre-preparation and integration therapy. In contrast, abuse involves using multiple times a week, suggesting attempts to avoid difficult emotions or reality itself.
Excessive users may take psilocybin to remain in a state of detachment. Another sign of unhealthy use is the lack of integration therapy or reflection after psychedelic experiences. Habitual users seek repeated experiences without behavioral change. Over time, regular use can resemble “psychedelic burnout,” with feelings of detachment from goals, relationships, and real life. Clinicians should be aware of signs that someone prefers the altered state over reality, leading to avoiding responsibilities, relationships, or therapeutic work outside of drugs. When psilocybin is the key means of evading reality, it is a problem.
LSD
Tolerance develops with behavioral effects of LSD after three to four daily doses, but no withdrawal syndrome has been observed. LSD is 100 times more potent than psilocybin. There are no known fatalities from direct pharmacologic toxicity in healthy adults at recreational doses. LSD does not cause respiratory depression (unlike opioids) or fatal arrhythmias.
Overdoses with psilocybin or LSD, causing life-threatening physiological effects, are rare. Serious outcomes (ICU admission, death) are also rare. When they have occurred, polysubstance use/environmental hazards were almost always involved.
Dangerous behavior during a “bad trip” may lead to self-harm, aggression, or accidental injury. Life-threatening emergencies may occur from impaired judgment, causing accidental trauma, falls, drowning, or darting into traffic. Severe panic attacks, agitation, or psychosis may occur. Rare physiological complications sometimes happen, like hyperthermia and dehydration—especially with LSD. Hypertensive crises with pre-existing cardiovascular disease have been reported.
Psychedelics Essential Reads
Anxiety, panic attacks, and acute disorientation are common reactions to hallucinogens and can be traumatic. Hallucinogen persisting perception disorder (HPPD)—persistent visual disturbances like flashbacks—is a long-term risk. Though rare, persistent visual distortions can be distressing, requiring careful management.
Back to the Past
At Woodstock in 1969 or Monterey in 1967, medical staff were available for bad trips and to talk people down or give them Valium. Doctor Dave, the founder of the Haight Ashbury Free Clinic, led physicians providing drug emergency care at major festivals. I recently asked Dr. Dave about psychedelics for treating addictions, and he said, “Clean and sober is the best path to true recovery.”
Two promising young psychologists at Harvard, Timothy Leary and Richard Alpert, began the Harvard psilocybin project, celebrating the drug’s potential for personal transformation and its ability to unlock deep insights and emotional releases. But, Leary and Alpert also acknowledged the psychological magnetism of these experiences and the dangers of using hallucinogens to avoid engaging. Hallucinogen use disorders appear as a combination of spending most waking hours thinking about, using, or getting over the effects of hallucinogens, and also using more often than intended. Use disorders also involve an inability to cut down or stop using, or continuing to use hallucinogens even though they are causing problems at work, home, or school. Alpert, in 1968, recounting relentless dosing at Harvard, wrote: “We took 400 µg of LSD every four hours… We were very high…and within a few days we came down!” Timothy Leary and Richard Alpert were fired from Harvard University in 1963. Both became icons of the psychedelic drug human potential movement. Leary became famous for the slogan “Turn On, Tune In, Drop Out,” which was part of his famous 1967 speech in San Francisco’s Golden Gate Park.
Summary
In research clinical trials or treatment in therapeutic or medical settings, psychedelics are used safely to treat various conditions (addiction, depression, PTSD) with rigorous prescreening, psychological support, and supervision. They are not approved by the FDA. Overall safety is generally good under supervision, but there are concerns about self-medication and adverse effects, including panic reactions, psychotic disorder, and long-lasting visual perceptual disturbances.
