The Beatles fantasized about “Lucy in the Sky with Diamonds,” Eminem rapped about mushrooms, A$AP Rocky celebrated “L$D.” In an interview with Rolling Stone, Harry Styles credits magic mushrooms for his creativity in producing his chart-topping album Fine Line.

Psychedelics play a role in music and pop culture, but they are also increasingly relevant in scientific and psychiatric research. Psilocybin, commonly known as magic mushrooms, has recently made national news because of its possible benefits in treatment for certain mental illnesses.

In November, Oregon legalized psilocybin, the first ruling anywhere across the globe to declare plans for regulating the drug’s therapeutic use. Ann Arbor has decriminalized magic mushrooms and other psychedelic plants, along with other cities such as Denver, Colo.; Oakland, Calif. and Santa Cruz, Calif.

This past January, the Advanced Integrative Medical Science Institute addressed the federal Drug Enforcement Administration requesting that psilocybin be allowed in the therapeutic treatment of “terminally ill cancer patients suffering from anxiety and/or depression.” The DEA responded, denying therapeutic use due to the current Controlled Substances Act regulations. On Monday, March 8, Dr. Sunil Aggarwal of AIMS filed a petition for review with the United States Ninth Circuit Court of Appeals for medical treatment of cancer patients with mental health concerns. 

These updates may initially seem shocking, as psilocybin is still technically a prohibited Schedule 1 Drug, which is categorized along with marijuana as having “no currently accepted medical use.” The U.S. Food and Drug Administration, however, recognizes Compass Pathways’ research on psilocybin in that it shows potential for substantially improving patient outcomes with certain cases of depression.

Psilocybin is currently undergoing Phase 2 and 3 clinical trials for treatment-resistant depression, and it has been studied as a possible treatment for specific terminal illness-related depression and anxiety, as well as substance abuse disorders. In addition, John Hopkins School of Medicine’s research found that psilocybin had a significant effect on depression and anxiety symptoms after five weeks and persisting after six months. 

With the administration of psilocybin, one study noted significant reductions in smoking rates, while a proof-of-concept study reported increases in sobriety rates for individuals with alcohol dependence. Psilocybin has also been studied in relation to obsessive-compulsive disorder, and ongoing clinical trials are studying the use of the drug in treating post-traumatic stress disorder, cocaine and opioid use disorders, anorexia nervosa and depression in patients with Alzheimer's disease. 

Why should we research psychedelics in treating psychiatric disorders instead of further studying antidepressants and other medications that are already commonly prescribed? Many individuals are more interested in psilocybin because the current medications on the market have not worked well for them. Others like the idea of psilocybin because the treatment has quick and long-lasting effects and lacks various negative side effects such as weight changes and decreased sex drive that may come with antidepressants.

How do psychedelics act as therapeutic agents from a biological standpoint? Its neurophysiology comes down to changes in metabolism and blood flow in the brain. Such changes activate regions of the brain that do not usually interact with one another. As a result, there is less activity in structures called the default mode network, which is thought to contribute to the therapeutic effects that psychedelics can have in treating mental illness.

You may wonder why psilocybin is classified as a high-risk, Schedule 1 drug if it supposedly can treat psychiatric disorders. The stigma surrounding psilocybin and other psychedelics largely exists due to President Nixon’s War on Drugs. During the 1950s, however, psychedelics were found to have positive effects and usage spread to mental health professionals clinically and in research. Nixon’s signing of the Controlled Substances Act in 1970 criminalized psychedelics and terminated any research in the works on the matter. 

If psychedelics such as psilocybin are approved to treat psychiatric conditions, they will be highly regulated by psychiatrists. These drugs would not be readily available for just anyone to try. However, it is important to note that psilocybin has been used in some indigenous cultures for millennia and still is used for such practices in some areas of the United States today.

What about the horror stories of bad trips? The concept of “set and setting” refers to the combination of an individual’s environment during a psychedelic session and their mindset beforehand. The psychiatrists who would be providing the psychedelic-assisted therapy would be expected to evaluate and facilitate a safe set and setting to optimize their patients’ experiences.

Yes, there are risks associated with the usage of psilocybin, as there are with any drug. According to Neurotherapeutics, a scientific journal, the main risk of psilocybin and psychedelics is potential anxiety and confusion, as these sentiments could lead to harmful choices when unsupervised. Additionally, individuals who have current psychosis, are at risk for psychotic disorders or are predisposed to cardiovascular problems are excluded from psilocybin studies due to the increased chance of a negative reaction.

I am not, by any means, encouraging individuals with mental health concerns to experiment with psychedelics on their own. But drugs such as psilocybin seem to have a lot of potential for assisting certain individuals with their mental health troubles. Rick Doblin, the founder and executive director of the Multidisciplinary Association for Psychedelic Studies, explains that his organization’s long-term goal is “mass mental health.”

Doblin has a point. If society wishes to achieve “mass mental health,” we must approach treatment for mental illnesses from all angles. There is no “one box fits all” in medicine; every patient is going to require a slightly different treatment plan, as we all have our personal preferences and individual differences in drug responses.

So sure, pop culture’s obsession with psychedelics may not be solely rooted in medicinal purposes. There may be a lot of promise in psychedelic-assisted therapy, though. And maybe, one day, there will be orange pill jars lining the shelves at CVS Pharmacy that read “psilocybin” in printed lettering. 

Marina Wagner can be reached at mwagnerr@umich.edu.

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