This survey study (n=99) examined the attitude of mental health service users towards psilocybin therapy in Ireland and found that most respondents were supportive of research into psilocybin therapy, while support for therapy itself came mostly from respondents with non-religious beliefs and prior recreational experience with psychedelics.

Abstract

“Introduction: Despite the rapid advance of psychedelic science and possible translation of psychedelic therapy into the psychiatric clinic, very little is known about mental health service user attitudes.

Objectives: To explore mental health service user attitudes to psychedelics and psilocybin therapy.

Methods: A questionnaire capturing demographics, diagnoses, previous psychedelic and other drug use, and attitudes to psychedelics and psilocybin therapy was distributed to mental health service users.

Results: Ninety-nine participants completed the survey (52% female, mean age 42 years). The majority (72%) supported further research, with 59% supporting psilocybin as a medical treatment. A total of 27% previously used recreational psilocybin, with a male preponderance (p = 0.01). Younger age groups, those with previous psychedelic experience, and those with non-religious beliefs were more likely to have favourable attitudes towards psilocybin. A total of 55% of the total sample would accept as a treatment if doctor recommended, whereas 20% would not. Fewer people with depression/anxiety had used recreational psychedelics (p = 0.03) but were more likely to support government funded studies (p = 0.02). A minority (5%) of people with conditions (psychosis and bipolar disorder) that could be exacerbated by psilocybin thought it would be useful for them. One fifth of the total sample viewed psychedelics as addictive and unsafe even under medical supervision. Concerns included fear of adverse effects, lack of knowledge, insufficient research, illegality, and relapse if medications were discontinued.

Conclusions: The majority supported further research into psilocybin therapy. Younger people, those with previous recreational psychedelic experience, and those with non-religious beliefs were more likely to have favourable attitudes towards psilocybin therapy.”

Authors: Kate Corrigan, Maeve Haran, Conor McCandliss, Roisin McManus, Shannon Cleary, Rebecca Trant, Yazeed Kelly, Kathryn Ledden, Gavin Rush, Veronica O’Keane & John R. Kelly

Notes

When psychedelics become available as medicines, will the general public accept them? And more specifically, will patients accept them? If they don’t, then the whole enterprise of researching these compounds is mute. If they do, researchers and companies will know that there is a market to service. This survey study asked those who use mental health services about their attitudes regarding psychedelics as medicines.

The researchers sent participants a survey (via the post because of Covid) and got almost all of them to send it back. The participants in the study were suffering from depression, bipolar disorder, addiction, or personality disorders (e.g. OCD). Only a third of participants knew what psychedelics were, and that same percentage (but not per see the same respondents) thought it could be a good treatment option for them.

The researchers also found the following

72% supported further research
59% supported psilocybin as a medical treatment
55% would accept it as a treatment if a doctor recommended it

Among the 99 participants, those who were younger, less religious, or who had used psychedelics before responded more positively than the average. So case closed? Not so fast. Of those surveyed, 20% viewed psychedelics as addictive and unsafe, even when used under medical supervision. There is still a lot of educating to be done.

Introduction

The introduction of this paper makes a good distinction between recreational and academic/therapeutic use of psychedelics. Whereas in the first group 7.6% had sought treatment after a bad trip (in their lifetime), the second group reported less than 1% mild and transient adverse events.

Other studies that have polled attitudes find the following

Amongst American college students (n=124), 84% support further research into psychedelics (Wildberger et al., 2017)
American psychiatrists (n=324) are partially (42%) in agreement that psychedelics can help treat mental health disorders (Barnett et al., 2018)
- But 25% of them think they are unsafe, even under medical supervision
- Yet 80% of them do support further research
The Global Drug Survey finds that 59% of those who had used psychedelics before would accept them as treatment options (Winstock & Johnson, 2019)
- Which is much more than the 18% of those who hadn’t used psychedelics before

Methods

Those surveyed were ‘users of mental health services’ (or in other words, possibly the target audience for psychedelic therapies).

Their average age was 42, about 50/50 male/female, and most of them were Irish.

The participants were struggling with depression or anxiety (36%), bipolar disorder (12%), psychotic disorders (17%), personality disorders (14%), addiction (AUD/SUD, 19%), or eating disorders (1%).

A third (35%) was aware of psychedelics, and about a quarter (26%) knew about psilocybin (magic mushrooms).

Next to 55% being willing to accept it as a treatment, the same percentage would be willing to go of medications to do so.

More than half (52%) thought that the government should fund studies into the use of psilocybin as medicine.

Summary

A survey was distributed to mental health service users to capture demographics, diagnoses, previous psychedelic and other drug use, and attitudes to psychedelics and psilocybin therapy. The majority supported further research, with 59% supporting psilocybin as a medical treatment.

Introduction

Translational psychedelic science is evolving rapidly, with preliminary clinical evidence suggesting that psychedelic compounds may improve outcomes in major depressive disorder, treatment-resistant depression, addiction disorders, OCD, eating disorders, migraine suppression, and various types of headaches.

Psychedelic therapy involves activation of 5-HT2A receptors in the cortex, which promotes structural and functional neural plasticity, and induces changes in global brain connectivity, including default mode network integrity and amygdala reactivity. However, psychedelic compounds induce a wide range of complex subjective experiences with marked individual variation.

There are marked differences between recreational and therapeutic uses of psychedelics. Psilocybin therapy data from John Hopkins University reported no major psychological issues, while recreational psilocybin users reported seeking treatment for psychological symptoms.

A recent survey of 10,000 respondents from across Europe showed that 10% had used lysergic acid diethylamide (LSD) in the last 30 days, and that 1.6% of young adults had used magic mushrooms in the last 12 months.

The most recent Global Drugs Survey (GDS) of 26,000 people revealed some interesting trends, including increasing psychedelic use and self-reported microdosing. Furthermore, 4.2% of those using recreational psychedelics sought emergency medical treatment.

Approximately 80% of American college students agree that psychedelics can be a therapeutic tool for those with depression and 39% for anxiety, with a quarter thinking psychedelics are unsafe even under medical supervision.

Results from the previous GDS showed that 59% of people who previously used psychedelics would accept it as treatment for depression or PTSD.

Society’s relationship and attitude towards psychedelics is complex, but clear communication between researchers, clinicians, service users, and the public is required for a shared transparent scientific understanding of the risks and benefits of psychedelic therapy.

Survey design

A questionnaire was designed to capture attitudes of mental health service users to psychedelics and psilocybin with psychological support. A 5-point Likert scale was used to capture attitudes about psychedelics and psilocybin therapy.

Participant recruitment

Participants were recruited from Tallaght Community Mental Health Service and SPUH through outpatient department (OPD) clinics from September to December 2020. They were sent a participant pack via post to their residence and were contacted via telephone to complete the questionnaire.

Participants were recruited from open wards at SPUH from October to December 2020. Acute locked ward patients were excluded due to concerns that participation may exacerbate distress or confusion.

Data analysis

People who responded Agree strongly and Agree were summed and presented as net agree percentages. Two-tailed chi-square tests were used to determine statistical significance.

Results

Ninety-nine people participated in the survey, of which 56 were from the Tallaght community mental health service and 43 were inpatients in SPUH.

Attitudes to psilocybin therapy for various conditions

35% of the sample reported being knowledgeable about psychedelics and 26% about magic mushrooms. 30% believed psilocybin could be useful for their mental health problem.

Attitudes to safety and legality

Psilocybin was agreed upon by 72% of the respondents to be tested for medicinal value, and 59% agreed that the government should fund psilocybin studies.

35% of the sample reported lifetime psychedelic use, 27% had used magic mushrooms, 7% had used LSD in the last 12 months, 1% had used mescaline in the last month, and 2% had attended a psychedelic retreat.

Influence of previous psychedelic use

Participants who had previously used psychedelics were more knowledgeable about psychedelics and magic mushrooms, and were more likely to accept psilocybin if a doctor recommended it and to come off medications compared to those who had never used psychedelics.

Influence of gender

Males self-reported higher lifetime use of psychedelics and magic mushrooms compared to females, and reported being more knowledgeable about magic mushrooms.

Influence of age

Younger age groups reported higher levels of previous psychedelic use, more knowledge about psychedelics and magic mushrooms, and less agreement that psilocybin should be illegal.

Influence of religion

Participants without religious beliefs were more likely to agree that psilocybin is safe recreationally, could increase nature connection, increase connection to others, and benefit my mental health problem.

Influence of diagnosis

There were significant differences across diagnostic groups in previous psychedelic use, psilocybin for depression, psilocybin increases connection to nature, psilocybin should be tested for medicinal value, and government should fund psilocybin studies.

Possible indication vs contra‑indication

Participants with diagnoses of a possible therapeutic indication were more likely to agree that psilocybin may be useful for some mental health disorders, for depression, anxiety, for chronic pain, and for increasing connection to nature.

Concerns about discontinuing medication to accept psilocybin therapy

Many patients would not come off their medication to accept psilocybin therapy due to fear of adverse effects, lack of knowledge, insufficient research, and worries about relapse.

Discussion

This survey found that most participants approved of further research into psilocybin therapy, thought it should be approved as a medical treatment, and thought it might be useful for their own mental health problem.

Our survey identified a degree of therapeutic misalignment in that 15% of people agreed that psilocybin would be useful for psychotic disorders and BPAD, whereas 18% were neutral on the topic.

The rate of lifetime psychedelic use in our survey was high at 35%, and the rate of psilocybin use in the last year was higher in males than in females. The rate of psilocybin microdosing was considerably lower than the rate reported in the most recent GDS 2020 survey.

Clinical data indicates that higher doses of psilocybin may have a transdiagnostic antidepressant, anxiolytic, and anti-addictive action when administered in the context of psychological support.

The highest level of agreement for therapeutic indication in our survey was for chronic pain (34%), followed by 30% for depression, 24% for anxiety, and 20% for addiction disorders. Interestingly, male psychiatrists and early career stage trainees reported more favourable attitudes towards the potential therapeutic use of psychedelics.

A study indicated that religiosity tempered attitudes to psilocybin therapy. Participants without religious beliefs had more favourable attitudes to psilocybin therapy and were more likely to agree that psilocybin could increase people’s connection to nature and to other people.

One fifth of our sample deemed psychedelics unsafe even under medical supervision, and a similar proportion viewed psilocybin as addictive. They were also concerned with adverse effects, lack of information, insufficient research, illegality, and relapse if medications discontinued.

The concerns highlighted in our survey overlap with concerns from a previous GDS survey of 85,000 people, and participants who had previously used psychedelics had more favourable attitudes to psilocybin therapy for depression and anxiety disorders, but also psychotic disorders.

The level of support for further medical exploration and research of the therapeutic potential of psilocybin in our study was high at 72%, though only 52% agreed that the government should fund psilocybin studies, while 29% were neutral.

Almost 60% of participants agreed that psilocybin should be approved as a medical treatment. Psilocybin was granted breakthrough therapy designation for Treatment-Resistant Depression by the FDA in October 2018 and was decriminalized in Oregon in 2018.

Younger participants and those with previous psychedelic use had more liberal views on legalizing recreational psilocybin, and were more likely to have used psychedelics and to report themselves as knowledgeable about psychedelics.

Data from the GDS 2020 suggests that 40% of people did not undergo any preparatory or integration sessions before using psychedelics, and 4.2% sought emergency medical treatment.

The precise trajectory of psychedelic science and therapy is not yet clear, but a system-based precise-personalized therapy paradigm that incorporates high-quality therapeutic support is likely to optimize therapeutic outcomes.

Conclusions

Most people supported further research into the therapeutic potential of psilocybin, and clear public health messaging was necessary for the shared scientific understanding and optimal trajectory of psychedelic science and therapy.

Limitations

Due to non-response bias, our study may not be fully representative of total mental health service user population, and relied on self-reported drug history.