Self-reported negative outcomes of psilocybin users: A quantitative textual analysis

This text-mining study (n=346) analyzed the semantic structure of negative experiences in response to using psilocybin reported on the Erowid database and found that states of paranoia, fear, and anxiety were typically associated with thought distortions. Bad trips were also more prevalent among female users, medical emergencies were linked with using high doses, and long-term negative outcomes were linked to concurrent use with other substances.

Abstract

“Introduction: Psilocybin, a substance mainly found in mushrooms of the genus psilocybe, has been historically used for ritualistic, recreational and, more recently, medicinal purposes. The scientific literature suggests low toxicity, low risk of addiction, overdose, or other causes of injury commonly caused by substances of abuse, with growing interest in the use of this substance for conditions such as treatment-resistant depression. However, the presence of negative outcomes linked to psilocybin use is not clear yet. The objective of this study is to investigate the negative effects of psilocybin consumption, according to the users’ own perception through self-reports extracted from an online platform.

Methods: 346 reports were analyzed with the assistance of the IRAMUTEQ textual analysis software, adopting the procedures of Descending Hierarchical Classification, Correspondence Factor Analysis and Specificities Analysis.

Results: The text segments were grouped in 4 main clusters, describing thinking distortions, emergencies, perceptual alterations and the administration of the substance. Bad trips were more frequent in female users, being associated with thinking distortions. The use of multiple doses of psilocybin in the same session or its combination with other substances was linked to the occurrence of long-term negative outcomes, while the use of mushrooms in single high doses was linked to medical emergencies.

Discussion: These results can be useful for a better understanding of the effects of psilocybin use, guiding harm-reduction initiatives.”

Authors: Bheatrix Bienemann, Nina Stamato Ruschel, Maria Luiza Campos, Marco Aurélio Negreiros & Daniel C. Mograbi

Summary

RESEARCH ARTICLE

Psilocybin, a substance found in mushrooms, has been used for ritualistic, recreational and, more recently, medicinal purposes. Self-reports from 346 users suggest that psilocybin use can have negative outcomes, such as thinking distortions and medical emergencies.

Introduction

According to epidemiological research, the use of psychedelic substances has been increasing in recent years, and the use of magic mushrooms has increased from 24.4% to 34.2% in lifetime use and from 10.4% to 14.8% in the last 12 months.

Psilocybin, the active ingredient in magic mushrooms, has been investigated in relation to its medicinal properties, in particular for conditions such as treatment-resistant depression (TRD). It has also shown potential clinical benefits for depression and anxiety in end-stage cancer, possibly with reductions in death anxiety underpinning its therapeutic effects.

There are divergences relative to the findings of previous studies regarding the use of psychedelics and mental health. In fact, some studies have demonstrated the potential for psilocybin to treat or alleviate symptoms present in different clinical conditions.

Users visit sites exclusively devoted to the storage and dissemination of information about psychoactive substances, and these sites provide an opportunity for real-time evaluation of emerging drug trends.

Psilocybin is capable of promoting intense perceptual changes, which may lead to risk of harmful use. In addition, healthy individuals may experience episodes of bad trips, which may involve mental confusion, agitation, extreme anxiety, fear and psychotic episodes.

This work investigated negative effects of psilocybin consumption according to the perception of users, and possible relationships between these effects and contextual details.

Extraction of data and construction of textual corpus

The textual data were obtained from reports manually extracted from the EROWID website, which is a database dedicated to reporting on psychoactive substances and documenting actual reports of users.

We selected 346 reports on the use of mushrooms in the category described as Mushrooms (Magic Mushrooms; Psilocybin-containing Fungi). The texts were transcribed manually and any grammar or typing errors were corrected.

The reports were categorized according to health problems, bad trips, train wrecks and trip disasters, presence of other substances besides mushrooms, dosage, route of administration, form of consumption and gender of user. Inter-rater reliability was calculated for all categories that have not previously been provided by the website.

Data analysis

We analyzed the participants’ answers qualitatively and quantitatively, using IRaMuTeQ 0.7 alpha 2 and R 3.1.2. We used the procedures of the Descending Hierarchical Analysis (DHA, Reinert Method); Specificities and Correspondence Factor Analysis (CFA), and visualized the co-occurrence between words and the communities in which they coalesce.

The words of interest were adjectives, nouns, pronouns, verbs, adverbs and forms not recognized by the IRaMuTeQ dictionary. The chi-square test values indicated how strongly words and categories are associated with their clusters.

Descending hierarchical analysis

The analysis by DHA retained 98.4% of the total corpus, and resulted in four clusters of words. These clusters were grouped into two distinct branches, one composed only of cluster 4 (28.1% of total forms classified) and the other composed of another branch with cluster 3 (20.1%) in one extremity.

Correspondence factor analysis

The CFA indicated that the clusters were divided mainly in three large areas, with cluster 1 and class 2 being strongly related to each other. Cluster 1 was significantly associated with bad trips, cluster 2 with train wrecks and trip disasters, and cluster 4 with health problems.

Discussion

This study analyzed reports of negative experiences with psychedelics, and found four main fields with different meanings in the participants’ reports.

The specific contents of cluster 1, which included 30.5% of TS, suggest that short term negative experiences are essentially linked to paranoia and fear/anxiety responses. This suggests that management of anxiety, either by pharmacological or contextual agents, is crucial in the administration of psilocybin.

Cluster 2, which accounted for 21.4% of TS, was associated with single high doses of psilocybin, and the presence of words such as ambulance, cop, police, hospital and the significant association of this cluster with the train wrecks and trip disasters subcategory indicate the occurrence of emergencies.

Cluster 1 and 2 are close to each other, suggesting that subjective experiences of bad trips are directly linked to emergencies. Cluster 3 is made up of words such as eye, color, pattern, light, visual, vision, stare, referring to visual distortions and sensory-perceptual changes in general.

Cluster 4 collected 28.05% of TS and agglutinated words that seem to refer to the context of psilocybin use, including preparation of mushrooms, dosage, use with other substances, and contextual details such as date. This cluster was also associated with the subcategory “health problems”.

Conclusion

This study aimed to analyze user self-reports of negative experiences with psilocybin, and found that distortions at the level of thought were the main cause for bad trips. Additionally, high doses and concurrent use with other substances were associated with longer-term health problems.

The current study has a number of limitations, including a large number of missing values, non-probability sampling, and self-selection. Nevertheless, given that psilocybin remains being consumed illegally, the current findings provide information valuable to understand use under current circumstances.