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Decriminalization, legalization of psilocybin likely play roles in both increased exposure and poisoning.
Since 2019, calls to U.S. poison centers involving youth or young adults who took the psychedelic psilocybin have risen sharply, according to a study in the Journal of Adolescent Health. The timing is notable as 2019 was the start of a psilocybin decriminalization movement across numerous states and cities.
“Decriminalization most likely plays a role in the increase in psilocybin exposure calls reported to poison centers. Poison centers in the U.S. experienced similar increases related to cannabis when cannabis was decriminalized and legalized,” lead author Rita Farah, Pharm.D, Ph.D., M.P.H. told Psychiatric News. She is an epidemiologist in the Medical Toxicology Division at the University of Virginia (UVA) School of Medicine.
Farah and colleagues analyzed data from the National Poison Data System, which collects de-identified data from poison centers across the country. The researchers examined all cases of psilocybin exposure between 2013 and 2022 involving young people aged 13 to 25.
Psilocybin exposure in youth is alarming because the states that have decriminalized psilocybin do not allow people younger than 21 years to use it, said Rita Farah, Pharm.D., Ph.D., M.P.H.
Over the 10-year period, there were 4,055 calls for psilocybin exposure, of which about 66% involved psilocybin alone. The most commonly reported clinical effects were hallucinations or delusions, agitation, elevated heart rate, or confusion. While most of the exposures required professional medical attention, there were only two reported deaths, and both involved a secondary substance (fentanyl and amphetamine).
Between 2013 and 2018, the number of psilocybin calls per year remained steady among both adolescents aged 13 to 19 years and young adults aged 20 to 25 years. However, calls began to increase each year starting in 2019. Compared with calls in 2018, calls involving young adults more than doubled to approximately 300 calls in 2022. Over the same timeframe, calls involving adolescents more than tripled to approximately 450.
Farah said that the increase seen among teenagers is alarming, especially because states and cities that have decriminalized psilocybin still prohibit anyone younger than 21 from using it.
“The emerging question is: To what extent psilocybin decriminalization is responsible of the increase seen in our study? For that, we need to compare trends between states and [between] cities where psilocybin was decriminalized and states and cities where psilocybin remains illegal,” Farah said.
Psychiatrists should counsel their patients that psilocybin should not be used out of controlled clinical settings, said Christopher Holstege, M.D.
In the meantime, psychiatrists and other mental health professionals should counsel their patients about the risks of psilocybin, said study researcher Christopher Holstege, M.D. He is a professor of emergency medicine and pediatrics and Chief, Division of Medical Toxicology at the UVA School of Medicine as well as Director of UVA Health’s Blue Ridge Poison Control Center.
“To date, studies conducted to explore potential indications of psilocybin in treating major depressive disorders or alcohol use disorder have been done in a controlled setting and use a defined dose,” Holstege said. “Psychiatrists and mental health professionals should explain to their patients that the use of psilocybin is not without adverse events and should not be used outside clinical controlled settings and with unregulated products that do not have defined doses based on quality control measures.”
Holstege emphasized the need for action on curtailing the burgeoning trend of psilocybin poisonings.
“[P]racticing clinicians, public educators, and policy makers must assure that such products that contain psilocybin remain out of the reach of young children, are not sold to youth, and are not taken by individuals outside of evidence-based or emerging science,” he said. He added that vigilant quality control and a focus on labeling are critical. “Surveillance must occur to determine if there are adverse consequences to assure the safety of the population in a similar manner as other pharmaceutical products.”
The researchers reported no outside funding for this study. ■
“Psilocybin Exposures Reported to U.S. Poison Centers: National Trends Over a Decade”