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The use of psilocybin—the active compound in so-called “magic mushrooms”—has increased significantly in the United States since 2019, according to a new study published in the Annals of Internal Medicine. Drawing on data from five national sources, researchers found sharp increases in both lifetime and recent use, especially among adults with symptoms of anxiety, depression, and chronic pain.
Psilocybin is a naturally occurring hallucinogen found in certain species of mushrooms. It has attracted growing scientific and public attention due to promising early studies suggesting it may help treat depression, post-traumatic stress disorder, and substance use disorders. Although not currently approved by the U.S. Food and Drug Administration, psilocybin has entered clinical trials and has been decriminalized or legalized in parts of Oregon, Colorado, and several municipalities. This shifting legal landscape has raised questions about whether broader public use is increasing—and what the public health consequences might be.
“With efforts to legalize psilocybin mushrooms in Colorado, Oregon, and elsewhere ongoing, we wanted to determine whether there were more people using psilocybin mushrooms now than when legalization first passed here in Denver in 2019,” said Joshua Black, the co-lead author and senior scientist at Rocky Mountain Poison and Drug Safety, a division of Denver Health.
To investigate these trends, the researchers analyzed five major U.S. data sources to examine psilocybin use from 2014 to 2023: the National Survey on Drug Use and Health, the Survey of Non-Medical Use of Prescription Drugs, Monitoring the Future, the National Poison Data System, and the National Hospital Ambulatory Medical Care Survey. By comparing responses across these sources, the team aimed to track changes in who is using psilocybin, how often, and whether they’re showing up in healthcare settings as a result.
The researchers chose 2019 as a key benchmark, since that year marked the first legal policy changes regarding psilocybin in the United States. Until then, use patterns were relatively stable. But after 2019, things began to shift. According to the National Survey on Drug Use and Health, lifetime use of psilocybin among adults rose from 10 percent (around 25 million people) in 2019 to 12.1 percent (over 31 million people) in 2023. Among adolescents aged 12 to 17, lifetime use rose more modestly, from 1.1 percent to 1.3 percent.
The increases were even more dramatic when looking at recent use. Among adults aged 18 to 29, past-year use rose 44 percent from 2019 to 2023. Among adults 30 and older, it jumped 188 percent. By 2023, 2.1 percent of adults reported using psilocybin in the past year—more than the number who reported using cocaine, LSD, methamphetamine, or illegal opioids.
“A lot more people are using psilocybin mushrooms,” Black told PsyPost. “And we observed increases across many different age groups. Psilocybin mushrooms are now the 2nd most frequently used substance in the country, behind only cannabis.”
The Monitoring the Future study, which focuses on adolescents, also found that past-year use among 12th graders rose by 53 percent during the same period, reaching 2.5 percent in 2023. Most users were younger and more likely to be male compared to the general population, according to the Survey of Non-Medical Use of Prescription Drugs.
“We were surprised at how consistent the information was across data sources. Use in communities and the number of healthcare interactions were both higher in 2023 than in 2019.”
Mental and physical health appeared to be major drivers of use. People with moderate to severe symptoms of anxiety or depression were about three times more likely to have used psilocybin in the past year compared to those with milder symptoms. A similar pattern was observed among those experiencing chronic pain. These findings suggest that a substantial number of people may be turning to psilocybin in an attempt to manage ongoing health issues—perhaps influenced by growing media attention to its therapeutic potential.
While the study found little evidence that psilocybin users were flooding emergency rooms, it did reveal a sharp rise in calls to poison control centers. Between 2019 and 2023, such calls increased by 201 percent for adults, 317 percent for adolescents, and 723 percent for children aged 11 and younger. In 2023 alone, U.S. poison centers received over 1,100 calls related to adult psilocybin exposures, over 500 involving adolescents, and nearly 300 involving children. Notably, the vast majority of these cases led to some form of health care contact.
In contrast, official hospital data showed only three emergency department cases involving psilocybin between 2015 and 2021. This discrepancy highlights a problem with how medical systems currently track psychedelic-related health incidents. The researchers suggest that existing diagnostic codes—used in hospital records—may be failing to capture psilocybin cases accurately.
The researchers emphasized that the increasing use of psilocybin, particularly for self-treatment, creates a need for better education, surveillance, and policy responses. “Public views on psilocybin are shifting,” said Black. “However, that means we also need to make sure people understand the risks, know how to use it safely if they choose to, and that health care systems are prepared.”
Co-lead author Karilynn Rockhill added that the speed of change surprised the research team. “What really surprised us was how quickly these numbers changed and how many people using psilocybin had conditions like depression, anxiety, or chronic pain,” she said.
The study had some limitations. All the data came from self-reported surveys, which are subject to inaccuracies such as underreporting or exaggeration. Also, while the study examined national trends, it did not explore state-by-state differences, which could be important given the local nature of drug policy in the United States. Still, by drawing on multiple large-scale datasets, the study offers one of the most comprehensive views to date of how psilocybin use is evolving.
“We’d like to study how safe and effective it is to use psilocybin mushrooms in community settings,” Black said. “With legalization likely to increase availability and decrease stigma, we want to ensure both the public and policymakers have the information they need to make evidence-based decisions.”
“A main message we have for the public is plan before you trip,” he added. “Find a safe place to use and find someone who you trust to be present. We don’t recommend using alone, especially for the first time.”
The study, “The Rise of Psilocybin Use in the United States: A Multisource Observational Study,” was authored by Karilynn M. Rockhill, Joshua C. Black, Michael S. Ladka, Kanku B. Sumbundu, Heather A. Olsen, Jennifer S. Jewell, Joshua Hunt, R. Cameron Wolf, Karuna Nerurkar, Richard C. Dart, and Andrew A. Monte.
