What comes to mind for you when you read the words: ‘Magic Mushroom’?
More than likely, you’ve heard some mixed messages about this fungus. Some view them as a miracle drug and others think they are irredeemably dangerous to society. Currently there is a huge controversy over what is the best way to deal with the increase in interest around them, specifically for the medical treatment of some mental health conditions. A lot of the pressure comes from the demand for increased mental health care, with many Americans struggling to get accessible or adequate care. With decriminalization and legalization efforts already occurring at the state level, we are seeing accessibility for these psychedelic mushrooms more now than ever. In this essay I will explain the nuances to two potential perspectives, both centered around caring for the mental health crisis and doing what is best for the community.
To understand this debate, you must understand the history of the criminalization of psilocybin- the psychoactive compound found in the species of mushrooms classified as Magic Mushrooms. In the United States psilocybin is a Schedule 1 drug under the Controlled Substance Act (CSA), which makes them illegal on the federal level. In recent years, states like Oregon have taken steps to decriminalize psilocybin, as well as make it accessible to the public at clinics established for psychedelic-assisted therapy.
The legal status of psychedelic mushrooms is shifting, so how can we ensure psilocybin reform strategies are ethical, effective, and safe?
The Potential Harm for Community Health
One side of the argument stresses the dangers posed by increased access to psilocybin due to decriminalization and legalization efforts. We can explore this through perspectives of practicing psychiatrists like Gregory Barber et al., who wrote the article titled “A Case of Prolonged Mania, Psychosis, and Severe Depression after Psilocybin Use: Implications of Increased Psychedelic Drug Availability.” In this article we learn about the case of one of the author's patients who has experienced chronically impactful mental health challenges for eight months after ingesting psilocybin recreationally. The patient had a known history of anxiety and depression and was medicated for those conditions at the time of her experience with psychedelic mushrooms. What ensued was clinically severe mania and consequent depression, that seemed resistant to most psychiatric intervention she was offered during her recovery. Barber et al. also references the potential danger posed by the experience itself- citing a survey that found that 39% of respondents rated psychedelic use “among the top five most challenging experiences of his/her lifetime.” Barber et al. takes a stance against Oregon's reform efforts, citing how they do not currently have high enough standards of care and knowledge to mitigate the risks involved. They say that “when people have negative experiences on psilocybin—the unfortunate reality of any medical treatment—it will have been a preventable tragedy that they were not receiving care from trained professionals who can safely manage the situation” (Barber et al.)
Because of this increase in accessibility, as well as lack of clinical training on what to do best to help those who have been affected by psilocybin, it could be understood that reform efforts that increase availability poses possible risks to vulnerable groups.
The Potential for Improved Community Health
Another side of this argument focuses more on the potential benefits that psilocybin offers if it is more accessible and urges people to consider the negative effects of its current criminalization status, and the positive impacts of reform efforts. This perspective comes from experts like Dustin Marlan, an Assistant Professor of Law at the University of Massachusetts, who wrote “The Movement to Decriminalize Psilocybin, Explained.” Marlan references the importance of considering the clinical trials that have shown psilocybin's possible effectiveness against mental health conditions such as major depressive disorder and treatment resistant depression. This is important because as many as half of those who take psychiatric medicine do not get adequate relief from their symptoms (Marlan). Another point Marlan makes in support of current reform efforts is how they help fight the war on drugs. He says that “Prohibitionist policies and ideology led to harsh and excessive sentences for drug offenses that have devastated communities of color.” One statistic he shares to this point is that “Black Americans make up only about 15% of drug-users in the U.S., but account for around 37% of those arrested for drug offenses” (Marlan). Marlan praises the two-tiered reform efforts like that of Oregon, which decriminalized all controlled substances as well as regulated psilocybin assisted therapy. The program, DATRA, is “[E]xpected to lead to a 95 percent decline in racial disparities in drug arrests” (Marlan). Marlan argues that the current trends in reform efforts are a good thing, that they could help fight the mental health crisis as well as help dismantle oppressive structures in our country.
What Both Sides Agree On/Disagree On
While the community might be split on this issue, there are certain aspects that both these perspectives agree on. Both acknowledge the urgency of the current mental health crisis in the US and the existing deficit in care. Barber et al. contends that “the ever-worsening public mental health crisis demands urgent and creative solutions.” To the same point, Marlan references that “[e]xperts estimate that over 51 million American adults—roughly one in every five—suffer from mental illness, yet over half receive no treatment.” Both sources also agree that the current research surrounding psilocybin for improving mental health is promising, and that more research is needed to understand the full scope of benefits and risks. To be specific, clinical trials have shown psilocybin's possible effectiveness against mental health conditions such as major depressive disorder and treatment resistant depression (Marlan). Another aspect both perspectives acknowledge is that there must be structures in place to ensure that if psilocybin is meant to be used therapeutically, it should be accessible regardless of socioeconomic status or race. Marlan puts this as “there is a pressing need for regulations and social equity programs that prioritize equitable access to psychedelic medicines over profit.” Barber et al. agrees with that sentiment but argues for the need to resist the pace of these decriminalization efforts, to slow things down until science can catch up. The way they put it is “psychiatry should not compromise on its standards of care, nor its confidence in its treatments, to rush into a new treatment modality; we should not put the cart before the horse.”
This brings us to one of the biggest differences in these perspectives. This comes down to how the author feels about the current reform trends in the US. Marlan praises the reform strategy used by Oregon, stating that “Policymakers would do well to model future drug policy reforms on Oregon’s two-tiered approach in legalizing psilocybin and, at minimum, decriminalizing all other controlled substances.” In contrast, Barber et al. Sees the reform strategy of Oregon as “a highly dubious ethical position, imperiling the ability of patients to make informed clinical decisions and putting them at unnecessary risk for bad outcomes.” Barber et al. Argues the risk for harm is much too high to move forward with such brave reform efforts such as Oregon's, but Marlan’s perspective argues it is too risky not to make these changes.
Strengths and Weaknesses
Both articles have strong points, and both sides have a lot of validity. One weakness I found in Barber et al.’s argument was how much they based their argument on a single patient's experience, and a recreational experience at that. It is important to consider the potentially chronic and negative side effects psilocybin use might cause, but even Barber et al. admits it's a statistically rare occurrence for long term harm to occur. The author is relying on this information to scare you, and feeds into the idea that psilocybin is inherently too dangerous. This is misleading because current research supports the idea that psilocybin is relatively safe, ranking the least likely to be addictive or lethal, compared to 20 other drugs (Marlan).
One strength of Barber et al.'s argument was how most of the research that shows positive effects for therapeutic psilocybin use are in highly controlled situations that take a lot of care to ensure a safe experience for the patient (Barber et al.). In this way, it shows that a commitment by professionals to keep up a high standard of treatment is necessary to ensure there is less risk of harm. While I think Barber et al. has more inherent credibility on the medical aspects of this topic since they are psychiatrists, I think Marlan's argument showed more commitment to including information from other experts, which in turn strengthened his points. Another strong aspect to Marlan's argument is how the current legal status of psilocybin makes getting research on its effects more difficult. It is going to continue to be more difficult to find the right path forward without the ability to do research.
All in all, both bring a lot of important aspects we need to consider when it comes to drug reform and mental health.
The Path Forward
There is a middle ground within these two perspectives, that includes decriminalization with careful regulation to ensure ethical and safe therapeutic use for psilocybin to improve mental health in the US. I think true progress looks like addressing the concerns on both sides. We must consider how current anti-psilocybin structures have affected racial minorities in the US in the form of disproportionate incarceration rates, and I believe baseline decriminalization strategies are effective for that. I think it is unethical to wait for this first step until research proves it beneficial for therapeutic use. Harm is occurring now, and justice for that harm requires change.
As far as using psilocybin for improving mental health, there must be more research done to effectively mitigate the risks. But they must be allowed to conduct such research, which means we must change the policies that currently hinder research. It is also important that we prioritize a high quality of care based on what techniques are scientifically effective, and that we do not compromise on things such as equity and safety of care. The path forward for psilocybin reform looks like addressing the concerns over the risks, but proceeding with curiosity, science, and ethical practice.
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