Intended for healthcare professionals


Psilocybin: a revolution in psychedelic medicines in the US?

BMJ 2022; 379 doi: (Published 06 October 2022) Cite this as: BMJ 2022;379:o2178
  1. Joanne Silberner, freelance journalist
  1. Seattle
  1. Follow on Twitter @jsilberner

As a flurry of US states approve psilocybin for medicinal use, Joanne Silberner asks whether the most carefully studied of psychedelic drugs will revolutionise treatment of depression and other psychiatric ailments

Six decades ago, hallucinogenic drugs such as psilocybin and LSD were having a heyday in the US. Medical researchers were testing their value for psychotherapy, Western anthropologists were studying their use in indigenous communities around the world, and casual users were being excitedly implored by a high profile Harvard researcher to “turn on, tune in, and drop out.”

Then things changed. The Harvard researcher and a colleague were fired for zealous promotion of untested drugs. The US Army and Central Intelligence Agency were caught testing psychedelics as interrogation agents on civilians who didn’t know or consent. In both research trials and casual use, little if any consideration was being given to users’ baseline mental health, and the media were full of stories of trips gone bad.

Decades later, psychedelics—with psilocybin, the active ingredient in magic mushrooms, in the lead—are making a medical comeback in the US. Careful, methodical experiments have established a small but solid research base. A recent call for 30 health worker volunteers for a study of psilocybin for covid burnout drew 3000 applications. A 2019 TED talk by the founder of a non-profit company developing psychedelics as prescription medicines has been viewed more than four million times. And a book on the subject, How to Change your Mind, became a national bestseller.

One reason things are different now is the easing up of the regulatory environment. The usually conservative Food and Drug Administration (FDA) has actively cleared the path towards approval of psilocybin and similar compounds. The state of Oregon will allow use of psilocybin on 1 January 2023, so long as users follow safety …

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