Psilocybin Safety: A Look at Psychological Risks

‍Overview: Psilocybin, the active compound in magic mushrooms, has a generally safe neurophysiological profile, but there are psychological risks to consider. Challenging experiences, known as “bad trips,” can occur, potentially leading to temporary distress. Additionally, there's a risk of triggering or worsening psychotic disorders, especially in predisposed individuals. Clinical settings have stringent safety protocols, but recreational users should be aware of personal risk factors. While research suggests lower emergency care rates compared to other drugs, precautions are still necessary, including understanding family and personal mental health histories and consulting professionals before use.

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Psychological Risks Associated with Psilocybin Use

Psilocybin — the psychedelic compound in magic mushrooms — boasts a well-established safety profile. There is no evidence of long-term neurophysiological deficits, organ damage, or addiction potential associated with its use, though physiological effects, slight increases in heart rate, and blood pressure are important to consider for those with underlying cardiac conditions. 

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But what about the psychological safety profile of psilocybin? While many individuals have positive and transformative experiences, it’s important to acknowledge that there are potential psychological risks to consider.

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For example, users should be aware that challenging experiences, commonly referred to as ‘bad trips,’ can occur, which may lead to temporary psychological distress. Additionally, there is a risk of initiating psychotic reactions or exacerbating psychotic disorders, particularly in individuals predisposed to or with a history of psychotic disorders. 

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It’s important to approach psilocybin use with awareness of these psychological aspects to ensure a safe and informed journey.

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Challenging Experiences with Psilocybin

One of the primary psychological risks associated with psilocybin use is the potential for having a challenging psychedelic experience, commonly referred to as a “bad trip.”

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A bad trip is usually characterized by intense emotions and distressing psychological experiences, which can include anxiety, paranoia, confusion, or feelings of impending doom. During a challenging experience, users may also find themselves grappling with thoughts that challenge or unsettle their understanding of themselves or the world.

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These negative emotions and perceptions can lead to a highly uncomfortable and psychologically challenging experience. While research suggests that some individuals retrospectively view their challenging psychedelic experience as a crucially important step in their healing, personal growth, or otherwise, bad trips can also have destabilizing and traumatic effects.

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Navigating Psilocybin Journeys: Importance of Set and Setting

Of course, it is important to acknowledge that the vast majority of users report having positive experiences with psilocybin, with a significant number of psilocybin study participants reporting their experiences to be some of the most meaningful, spiritually significant, and psychologically insightful of their entire lives.

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However, the risk of a bad trip underscores the importance of the principles of set and setting — using psilocybin with a prepared, relaxed, open, and curious mindset and in a controlled and supportive environment, ideally with a trusted and experienced trip sitter, guide, or therapist. Trip sitters can help mitigate the risk of a challenging experience and provide reassurance and guidance if difficult moments do arise.

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Set and setting plays a crucial role in shaping the nature of the psilocybin experience. By adhering to it, users can exert a degree of influence over their experience. For example, maintaining a positive mindset and ensuring a safe, comfortable, and supportive environment can significantly reduce the likelihood of a bad trip and promote more positive outcomes from the psilocybin journey.

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While there are no foolproof measures to eliminate the possibility of a challenging experience entirely, acknowledging the significance of set and setting can empower individuals to approach psilocybin experiences with a greater sense of mindfulness and responsibility, thereby potentially reducing the likelihood of negative experiences and promoting safer, more constructive experiences. 

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Psilocybin and the Risk of Psychosis 

There is also concern that psilocybin use might trigger psychotic reactions or worsen psychotic disorders, particularly in individuals who are already predisposed to or diagnosed with psychotic disorders.

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While there is concern regarding the potential for psilocybin use to trigger or exacerbate psychotic reactions, particularly in individuals predisposed to or diagnosed with psychotic disorders, it's important to note that such occurrences are rare. This is especially true in clinical settings where stringent safety protocols are in place.

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The current literature indicates that psychedelic-assisted psychotherapy in research settings is generally safe. There have been no reports of long-term psychosis among patients participating in clinical trials.

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In clinical trials, safety measures are implemented to prevent such reactions from occurring. For example, patients with a personal or family history of psychotic or manic illness are excluded from participation to minimize the risk of inducing such episodes.

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The setting of psychedelic sessions is rigorously controlled, and patients receive therapeutic support before, during, and after the psilocybin experience. Psychedelic research protocols are designed with safety as the primary concern

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Moreover, the patients selected for clinical trials undergo thorough screening and selection processes. Screening allows healthcare professionals to identify individuals at higher risk of adverse reactions, such as those with a history of psychotic disorders or a family history of such conditions.

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By conducting comprehensive assessments, clinicians can help mitigate the potential for harm and ensure the safe and effective administration of psychedelic-assisted therapies. However, severe reactions are possible, and the mental health consequences for these patients can be significant.

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Psychedelic Safety: Legislation, Personal Risk Factors, and Risk Mitigation

Data suggest that psilocybin users require lower rates of emergency medical care compared to users of other recreational drugs, and long-term severe consequences are rare. Research has even suggested that psilocybin — and LSD and MDMA — may be less harmful than alcohol.

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Although rare, psychedelics have been known to induce psychotic episodes outside of clinical settings, especially in individuals with a predisposition. This predisposition may be linked to personal or familial histories of psychotic disorders.

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As psychedelics gain popularity outside of clinical settings, driven in part by increasing evidence of their therapeutic potential for mental health treatments, certain jurisdictions have passed legislation to decriminalize psilocybin for recreational use. Moreover, in 2019, Oregon became the first state to legalize psilocybin for therapeutic purposes.

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With the increasing availability of psilocybin, there may be a rise in the rates of bad trips and adverse effects. In recreational settings, safety measures may not always be in place as they are in clinical settings. Therefore, it’s crucial for recreational users to educate themselves about personal risk factors. 

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Recreational users can take several steps to educate themselves about their predisposition to potential adverse reactions to psychedelics:

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• Family History: Start by examining family history for any instances of psychotic disorders, bipolar disorder, or other mental health conditions. A family history of such disorders may indicate a higher risk for adverse reactions.

• Personal Mental Health History: Reflecting on personal mental health history is essential. Have you experienced episodes of psychosis, mania, or severe anxiety in the past? Have you ever been diagnosed with a mental health disorder? Understanding one’s own mental health background can provide valuable insights into potential risks.

• Consultation with Mental Health Professionals: Seeking guidance from mental health professionals, such as psychologists or psychiatrists, can offer personalized assessments and recommendations. These professionals can help individuals evaluate their risk factors and make informed decisions about psychedelic use.

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By taking these steps, recreational users can gain a better understanding of their predisposition to potential adverse reactions to psychedelics and make more informed decisions about their use.