An analysis of a large international drug survey suggests that psilocybin is a relatively safe drug, with only 0.2% of magic mushroom users having sought emergency medical care after use. The findings, published in the Journal of Psychopharmacology, further suggest that such adverse incidents are most often psychological in nature and resolved within 24 hours.
Psilocybin, a psychedelic compound found in certain mushrooms, induces a mind-altering state when ingested. While the substance is considered to be quite safe compared to other psychoactive drugs, possible adverse reactions include anxiety, paranoia, and panic attacks, and some users have reported lingering effects on mental health. There is also concern that panic reactions can impair judgment long enough to provoke dangerous behavior or accidents.
Scientific studies have emerged suggesting positive mental health benefits to these ‘magic mushrooms’, resulting in generally positive press about the drug. But researchers have pointed out that ongoing study is crucial for guiding public policy and identifying safety precautions regarding psychedelics.
“Psychedelic use in the general public is increasing, amidst increasing research and public interest on their therapeutic potential,” said study author Emma Kopra, a PhD student at King’s College London. “Gathering balanced information on their safety profile is particularly important given the rather polarized perspectives between recent positive media reports on psychedelics’ mental health benefits, in contrast to the legacy of ‘War on Drugs’, specifically the dissemination of misinformation of psychedelics’ dangers and public policy focused on criminalization of users instead of harm reduction.”
“Previous evidence suggests psilocybin-containing mushrooms are relatively safe especially regarding physiological toxicity, but overall there is little academic research on the occurrence and nature of adverse reactions.”
The researchers conducted a study to investigate the prevalence of adverse experiences that result in the seeking of emergency medical treatment (EMT) after psilocybin use. The study authors also hoped to uncover predictors of these adverse incidents. Kopra and her colleagues analyzed survey responses from the 2017 Global Drug Survey, a large international survey of drug users, while specifically focusing on respondents who reported having used magic mushrooms in the past year.
Respondents who had used magic mushrooms in the past year were asked whether they had ever sought EMT after use. Of the 9,233 respondents who answered this question about emergency medical treatment, 19 of them (0.2%) had sought such treatment. Younger age was a significant predictor of having sought EMT, while neither first-time use nor frequency of use in the past year were significant predictors.
The most commonly cited symptoms by EMT seekers were psychological. Anxiety/panic (68%), paranoia/suspiciousness (68%), and seeing/hearing things (42%) were the top three reported symptoms. Still, some troubling physical reactions occurred, with 37% reporting passing out/unconsciousness, 32% reporting difficulty breathing, and 26% reporting seizures. Eight of the respondents who reported seeking EMT were admitted to hospital, and all of them except one said they had returned to normal within 24 hours.
The majority of EMT seekers said they had consumed other substances within the same session as the magic mushrooms, with 37% reporting cannabis use and 32% reporting alcohol use. When asked why they felt the adverse experience had occurred, the most commonly cited reasons were being in the wrong mind-set (47%), being in the wrong place (37%), and substance mixing (37%).
“No drug is entirely risk free, but relative to most recreationally used drugs, psilocybin mushrooms demonstrate a good safety profile based on the rate of emergency medical treatment seeking in this sample,” Kopra told PsyPost. “We found that most adverse reactions were psychological in nature and, importantly, were reported to be short-lasting. Based on perceived reasons for these experiences, risk of adverse reactions can be reduced by certain safety precautions such as ensuring one is in the right state of mind (‘set’) and physical environment (‘setting’), as well as avoiding mixing substances. Regardless, perhaps owing to their complex and profound psychological effects, responses to psychedelics are difficult to predict with high certainty and sometimes adverse reactions occur even with careful use.”
There were a few notable limitations to the study. For one, respondents had volunteered for the study, which may have led to a biased sample. Additionally, since there were so few EMT seeking incidents, there was limited data to establish predictors. However, since adverse reactions are rare, more data would require a massive sample.
“Our sample is not population-representative; the survey advertising may only reach and attract certain demographics or types of respondents,” Kopra explained. “Further, self-reported answers may be affected by biases in memory or attempts to influence survey results. The small number of emergency medical treatment seekers, as well as some unmeasured variables such as current psychiatric medications, limited our ability to establish potential predictors of adverse experiences. More research is needed to study these predictors and the detailed circumstances of adverse reactions, to improve advice on safety precautions and harm reduction strategies.”
Overall, the study authors suggest that severe, adverse reactions to magic mushrooms are very rare and tend to be short-lived. For respondents who did experience concerning physical reactions, such as passing out or seizures, it is unclear why. Notably, more than a third of those who reported EMT seeking felt that mixing substances was to blame for the experience. The researchers note that “pre-existing conditions, interactions with other substances or medications as well as consumption of poisonous mushrooms” may have been factors.
“Psilocybin is currently being investigated in clinical trials for mental health conditions across the world, including in our department,” Kopra said. “It is important to draw a distinction between the use of psilocybin in clinical or research settings and recreational magic mushroom use, with partly overlapping yet distinct safety considerations and risk profiles.”
The study, “Adverse experiences resulting in emergency medical treatment seeking following the use of magic mushrooms“, was authored by Emma I. Kopra, Jason A. Ferris, Adam R. Winstock, Allan H. Young, and James J. Rucker.
