Psychedelic mushrooms in the USA: Knowledge, patterns of use and association with health outcomes

This survey study (n=7139) assessed the use of psychedelic mushrooms amongst adults in the US. The survey found that people generally self-medicate with psychedelic mushrooms for reasons related to mental health, with users reporting significantly higher levels of anxiety and depression. The study concludes with a call for a use-related harm reduction strategy for psychedelic mushrooms in the US.

Abstract

“Introduction: Popular media coverage, including of recent positive late stage clinical trials in depression and PTSD, and decriminalization initiatives, are transforming the public perception of psychedelics. However, little is known about levels of knowledge and personal use of psychedelic mushroom(s) (PM) among American adults.

Methods: We examined PM use and various measures of health status, quality of life and self-reported mental health outcome measures obtained through a national on-line, cross-sectional survey of adults with a demographic composition representative of the US adult population by region, gender, age, and race (weighted N = 251,297,495) from November 2020-March 2021.

Results: General mental health and well-being was a popular reason for PM use (63.6%). PM users were less likely to be overweight than non-users, but overall quality of life (VR-12) was lower for mental health (39.5 vs 45.5). PM users reported significantly higher levels of anxiety (GAD-7 scores of 9.6 vs 5.9) and depression (PHQ-9 scores of 11.2 vs 6.8). They were less likely to have health insurance [OR=0.50 (0.35-0.72)], but reported significantly more healthcare services utilization.

Discussion and Conclusions: There is a mismatch between our findings of an association between PM use and poor mental health outcomes, and current discourse on the positive health benefits of PM consumption. A significant number of Americans are already self medicating with PM and further research to understand the role of anecdotal knowledge and pseudoscientific information in PM uptake. There is an urgent need for a PM use-related national harm reduction strategy.”

Authors: Richard Matzopoulos, Robert Morlock, Amy Morlock, Bernard Lerer & Leonard B. Lerer

Summary

We examined PM use and health status, quality of life and self-reported mental health outcome measures in a national survey.

Results: General mental health and well-being was a popular reason for PM use. PM users reported higher levels of anxiety and depression, and less health insurance than non-users.

There is a mismatch between current discourse on the positive health benefits of PM consumption and our findings that PM use is associated with poor mental health outcomes.

Psychedelics are powerful and generally predictable psychoactive effects that influence perception, mood and cognition. There is growing evidence of the potential utility of psychedelics for a range of mental health conditions, pain and neurodegenerative disorders.

Biomedical research interest in psychedelics has been mirrored in a wave of positive public discourse, with the New York Times heralding a “psychedelic revolution” (11) and psychedelic content on streaming media such as The goop Lab (13) and Vice Media’s Hamilton’s Pharmacopeia (14) increasing in popularity.

Psychedelics have low addictive potential and benign toxicity profiles, and are perceived as safe by many users. They are also increasing in popularity, with LSD seeing a 60% increase in use and other unspecified hallucinogens seeing a 95% increase.

Psilocybin, the main psychoactive ingredient in more than 200 species of psychedelic mushrooms, has a particularly benign safety profile and possible positive health effects. It has been shown to be comparable to traditional selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors in treating major depressive disorder.

This study compared socio-demographic data of PM users and non-psychedelic users, and explored the associations between PM use and health status, health related quality of life and self-reported mental health outcome measures.

Data were collected through an on-line cross sectional survey of adults residing in the US, using a random stratified sampling framework. The survey targeted approximately 1,000-2,000 respondents per month, and multiple quality control processes were integrated throughout data collection.

Participants reported their demographic characteristics, educational attainment, health status, knowledge and use of psychedelics in the last 12 months, co-morbidities, health-related quality of life, anxiety, depression and knowledge of the positive uses of psilocybin.

Analysis was performed on data from a sample of participants who had taken psychedelics in the past 12 months. Psilocybin use was predicted by a multivariate logistic regression model.

Participants were 18 years old or older and received points for completing the survey. The actual amount of points awarded to each participant was determined by the research panel’s incentive policy.

Psychedelic use was confirmed by 526 participants, of which 134 had used PMs and other psychedelics and 122 had used PMs exclusively. PM users were significantly more likely to be male, younger, Hispanic/Latino and reside in the US’s Western Region.

PM users reported lower mental health scores, lower health utility and higher levels of anxiety and depression than non-users, and were also more likely to report healthcare resource utilization.

PM users held more favorable views of the positive potential for PM use for the treatment of a range of conditions than non-users, and were more likely to have heard more frequent positive reporting of the use of psychedelic drugs for mental health issues in the last six months than previously.

The multivariate logistic regression analysis explored the correlation between various factors and PM use. Those who reported worse health, were male, and were more likely to report PM use.

The present analysis confirms the popularity of psychedelics and PMs among US adult population. Estimated past-year psychedelic use was almost three times higher than recorded in the NSDUH, with PM use being significantly higher than all hallucinogens combined.

Psilocybin has a relatively benign reputation among psychedelics generally, and is widely considered to hold the greatest therapeutic potential among lifetime users. However, PM use was associated with negative mental health outcomes including anxiety, depression, comorbidities and medical treatment following use.

These findings were different from a recent study that found regular users of psychedelic drugs had less psychological stress compared to occasional users and nonusers, suggesting that people with certain traits were more prone to frequently use psychedelic drugs. However, more certainty is needed about dosage and treatment effect windows for PMs.

While use of PMs was expected to increase during COVID-19, the virus has thrown mental health disorders into sharp focus. The full impact on grieving families and communities will only become apparent in the future.

Classical serotonergic psychedelics do not cause neurotoxic effects, organ damage or long-term neuropsychological deficits. They may cause acute psychological effects, but these can be averted through supervised administration of perception-altering doses.

New psychedelics seem less benign and are associated with suicidal thinking and planning.

Across cultures, people use lay epidemiology to make sense of the world around them. Psychedelics have been shown to affect immune responses, promote structural and functional neural plasticity in key brain regions linked to psychological functioning, and promote neurological healing.

Population-based research could help to indicate receptivity for therapeutic application and provide real world evidence that can inform pragmatic trial designs.

We used an online data collection platform to collect information about recent psychedelic use, and made every effort to ensure the validity of information. However, we made no adjustments for statistical bias, and the timing of the study was unusual, which may have introduced some selection bias.

The present research clearly demonstrates the utility of population-based understanding of entheogen use, among which PMs remain particularly popular. However, the study shows a disturbing association with negative physiological and mental health outcomes.

Richard M was the primary author, Rob M and AM informed methodology, and AM conducted analyses. LL conceptualised the study, and BL contributed meaningful pharmacological expertise.