Adverse experiences resulting in emergency medical treatment seeking following the use of magic mushrooms

This survey study (n=9,233) assessed the prevalence and nature of magic mushroom-related adverse reactions resulting in emergency medical treatment seeking in a global sample of people reporting magic mushroom use. 0.2% of respondents sought emergency medical treatment the most common symptoms being anxiety/panic and paranoia/suspiciousness. Poor ‘mindset’, poor ‘setting’ and mixing of substances were the most reported reasons for incidents. Young age was the only predictor associated with a higher risk of emergency medical presentations.

Abstract

“Background: Psilocybin-containing mushrooms are used for recreational, spiritual, self-development and therapeutic purposes. However, physiologically relatively nontoxic, adverse reactions are occasionally reported.

Aims: This study investigated the 12-month prevalence and nature of magic mushroom-related adverse reactions resulting in emergency medical treatment seeking in a global sample of people reporting magic mushroom use.

Methods: We use data from the 2017 Global Drug Survey – a large anonymous online survey on patterns of drug use conducted between November 2016 and January 2017.

Results: Out of 9233 past year magic mushroom users, 19 (0.2%) reported having sought emergency medical treatment, with a per-event risk estimate of 0.06%. Young age was the only predictor associated with a higher risk of emergency medical presentations. The most common symptoms were psychological, namely anxiety/panic and paranoia/suspiciousness. Poor ‘mindset’, poor ‘setting’ and mixing of substances were the most reported reasons for incidents. All but one respondent returned back to normality within 24 h.

Conclusions: The results confirm psilocybin mushrooms are a relatively safe drug, with serious incidents rare and short-lasting. Providing harm-reduction information likely plays a key role in preventing adverse effects. More research is needed to examine the detailed circumstances and predictors of adverse reactions including rarer physiological reactions.”

Authors: Emma I. Kopra, Jason A. Ferris, Adam R. Winstock, Allan H. Young & James J. Rucker

Summary

Introduction

Psilocybin-containing mushrooms have been used in some ancient cultures from prehistoric times, but more widespread use started in the 1970s. The psychedelic may help with mental health conditions and addictions, as well as increase well-being and trait openness in healthy individuals.

Psilocybin is a physiologically safe substance with no evidence of neurophysiological deficits, organ damage or addiction potential. It induces slight increases in breathing frequency, heart rate and blood pressure, and has additionally been associated with nausea, dizziness, shivering and abdominal pain.

Psilocybin-containing mushrooms are used for recreational, spiritual, self-development and therapeutic purposes.

There have been only three known deaths attributed to magic mushroom toxicity. However, estimating dosage can be difficult, hence increasing the risk of noncritical overdoses and challenging experiences.

Psilocybin can induce adverse reactions such as anxiety, disorientation, fear, grief, paranoia and panic attacks. These effects may last long-term and may contribute to dangerous behaviour, accidents, self-harming and even suicidality.

The promising research on psilocybin’s healing potential has given the substance positive visibility in the media in recent years. However, positive recovery stories might encourage psychedelic use and overshadow information on safety precautions with potentially detrimental consequences.

This study explores the potential of demographic variables, mental health conditions, use patterns and previous magic mushroom experience as predictors of emergency medical treatment seeking following magic mushroom use.

Design

The GDS is an annual, anonymous and encrypted online survey on substance use that is advertised in social networking sites.

The GDS 2017 survey was launched in November 2016 and was available until January 2017 in 10 languages. Participants were not remunerated.

Measures

At the start of the survey, participants were asked about their demographics and when they last used specific drugs. Those who indicated history of use were then asked about their use of magic mushrooms in the last year.

Respondents were asked about the psychological and physiological symptoms they presented with, the number of magic mushrooms they had consumed, what other substances they had taken, and whether they had required hospitalization.

Participants were asked about their mental health and well-being at the end of the survey.

Data analysis

The risk of seeking emergency medical treatment increased with the number of times a person used magic mushrooms in the past year.

The researchers used non-parametric statistics to explore the experiences and symptom profiles of EMT seekers, and used Pearson’s Chi-square (2) and Fisher’s exact tests to investigate associations between treatment-seeking status and gender, previous magic mushroom experience status, and presence of mental health diagnosis.

Frequency and risk of EMT incidents

The GDS 2017 received 119,108 responses, of which 24.5% reported lifetime use of magic mushrooms. Of these, 43.0% reported having used magic mushrooms within the past year, and 0.2% indicated they had sought EMT following magic mushroom use in the past year.

The response rate to the EMT question was 98% among past-year users who completed the whole survey, indicating that a large majority of missing responses have likely occurred due to dropouts.

Predictors of EMT seeking

A comparison of the characteristics of EMT-seeking groups revealed a significantly lower median age among EMT seekers compared to non-seekers, and no difference in the prevalence of EMT seeking between men and women.

There was no significant difference in the prevalence of EMT seeking, the number of commonly consumed mushrooms, or the past-year frequency of use of magic mushrooms between EMT seekers and non-seekers.

Symptom profile and nature of EMT incidents

Eight EMT seekers were admitted to hospital, and all recovered within 24 h. The median number of magic mushrooms consumed was 10.0, and 37% of participants reported having used cannabis during the session while alcohol consumption was reported by 32%.

The most common reasons for participants thinking the incident had happened were wrong mind-set and mixing with other substances.

Discussion

This article examined the prevalence and nature of adverse experiences leading to EMT seeking following the use of magic mushrooms. The results were consistent with expectations and replicate previous literature supporting magic mushrooms’ safety.

The most prevalent symptoms of psilocybin use were anxiety/panic and paranoia/suspiciousness, but a number of concerning physiological symptoms also occurred, including passing out, difficulty breathing and seizures. The aetiology behind these symptoms is less clear. A number of seizures have been reported following magic mushroom consumption, with the exact causes being largely unascertained. Lithium may have been a contributing factor in some cases.

In this study as well as in a previous study on LSD-related EMT experiences, majority of respondents consumed other substances prior to seeking EMT, most commonly cannabis and alcohol. Over one-third of respondents reported mixing substances as a reason for their adverse experience.

In a survey of participants who had taken magic mushrooms, 26% reported having used cannabis and 19% alcohol during or immediately before their experience. However, several participants reported cannabis having significantly exacerbated their difficult experience.

Mixing substances, being in the wrong mood/mindset and place/setting were among the most commonly reported reasons for incidents. However, a significant proportion indicated uncertainty regarding the reason of the incident, two times higher than in our investigation on LSD.

In this study, younger age was the only predictor of EMT incidents. Previous experience with psychedelics did not predict risk of incidents, but people with more experience should remain mindful of the risks brought by experimenting with challenging environments, increasing dosages and mixing substances.

The present study found no indication for a higher risk of EMT seeking in people with lifetime mental health diagnoses. However, previous research has suggested associations between serious adverse reactions to psychedelics and presence of mental health conditions, however, the present finding conflicts with this finding.

Psilocybin had a low rate of emergency presentations, in line with expert analyses and assessments of people using substances, and was associated with a lower risk of major incidents and hospital admissions compared to LSD.

The low incidence of EMT incidents is a positive finding, but predictors of incidents are difficult to establish and nature of experiences can only be analysed from 19 participants. Further investigation is required into the causes of more rare emergencies such as seizures.

Although most people reporting challenging psychedelic experiences cite resulting therapeutic value and benefits to their well-being, some also report experiencing psychological distress. Training mental health professionals is important for encouraging people to come forward and seek help when this is needed.

Several limitations need to be considered when appraising this study, including sampling, participation bias and response bias. Furthermore, retrospective self-reports are often affected by recall and response biases, and the question and the limited options may be leading the respondents’ answers.

Our survey cannot confirm the purity or potency of magic mushrooms, or the amount of other substances used. It can also not establish the circumstances surrounding the incidents or the determining factors leading to EMT seeking in each case.

The world’s largest survey on drug use has provided valuable insights into magic mushroom – related serious adverse experiences. Most adverse reactions are short-lived, and can be minimized with certain safety precautions.