Susan SzuchSpringfield News-Leader
Long associated with Grateful Dead shows, raves and youth counter-culture, discussions about psilocybin — hallucinogenic "magic mushrooms" — are sprouting up in unexpected places.
Classified as a Schedule I drug under the Controlled Substances Act, psilocybin increasingly has been touted as more than a tool for getting high — it's being explored as a way to treat depression and anxiety, with prominent supporters far removed from the tie-dye-wearing hippies depicted in pop culture and D.A.R.E. program presentations.
Recently, Republicans in Missouri's legislature have been leading the charge to partially legalize the psychedelic substance. Committees in the state's House and Senate have both advanced proposals that would allow military veterans to enroll in studies exploring the use of psilocybin to treat mental health conditions such as post-traumatic stress disorder and depression without criminal repercussions. The bill also makes arrangements for $3 million in grants "for research on the use and efficacy of psilocybin."
The Senate bill, SB 768, is sponsored by Sen. Holly Thompson Rehder, a southern Missouri Republican and candidate for lieutenant governor who said the legislation was aimed at helping veterans experiencing PTSD.
“There should be no limits for them when it comes to access to mental health treatment, including non-pharmacological treatments,” Thompson Rehder told the Missouri Independent in January.
Her bill received approval from the Senate Emerging Issues Committee in late February. March 5, similar legislation sponsored by Republican state Rep. Aaron McMullen was passed out of the House Veterans Committee.
It remains to be seen how far the proposals will go before the end of the legislative session in May — last year, McMullen's proposal won initial approval in the House but was lost in the logjam in the Senate. But support among conservative lawmakers and the scientific community appears to be growing. Here's what to know.
How does psilocybin work?
While research is still being done to figure out exactly how psilocybin and other psychedelic substances affect the body, the current theory is that they "activate a cascade of cellular processes that cause growth and connection, particularly among neurons in the central nervous system," said Dr. Ginger Nichol, an associate professor in child psychiatry at Washington University in St. Louis. The psychedelics are sometimes called "rapid-onset anti-depressants."
She and her colleague Dr. Josh Siegel conducted a study that used high-quality scans of a person's brain over time to see what happens before, during and after treatment with psilocybin. What they found was that psilocybin disrupts the way the brain works. In a Washington University School of Medicine in St. Louis podcast, Siegel explained psilocybin as a "snowstorm."
"Most treatments kind of slowly nudge the brain in a better direction, but psychedelics are a snowstorm," he said. "... You have these well-trodden tracks in the snow, and then a blizzard comes along and shakes everything up and allows for new connections, new pathways, and it does that quickly."
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Why is psilocybin useful for treating conditions like depression or PTSD?
Many people use medication and psychotherapy to treat conditions like depression. Psychotherapy can help people work to identify negative behaviors and beliefs and replace them with healthy ones as well as develop better ways to cope with difficulties in life. However, it can be a long road, with the American Psychological Association reporting that on average, adults with depression receive 20 to 24 weekly sessions, or five to six months, of therapy.
In Siegel's snowstorm analogy, patterns of thoughts or behaviors could be considered tracks in the snow, which are ingrained in someone's brain as a result of life experiences or trauma. While psychedelics like psilocybin are the snowstorm, therapy or guidance create the new tracks that allow the brain to function differently.
"It’s helping you harness, intentionally, that rapid opening up of learning and plasticity and establishing new connections," Nichol said. "Thinking about a traumatic experience, for example, as something that you mastered rather than something that victimized you (can cause) a shift or reframe in the way you think about things."
What research into psilocybin still needs to be done?
There are still a lot of questions about psilocybin, which is listed by the U.S. Drug Enforcement Agency as a Schedule I substance. Schedule I substances are defined as drugs that currently have no accepted medical use and a high potential for abuse.
The American Psychiatric Association currently does not endorse the use of psychedelics on a wide scale, but "supports continued research and therapeutic discovery into psychedelic agents with the same scientific integrity and regulatory standards applied to other promising therapies in medicine," according to its 2022 position statement.
Nichol acknowledges that there is still much work to be done, as well.
"For most people, these are chronic conditions," Nichol said. "We don’t really know for sure whether psychedelics are a cure or a treatment that may need to be continued over the long term."
Additionally, there are administrative concerns, which Siegel wrote about in a 2022 article for the Journal of the American Medical Association: How will we educate and license prescribers and therapists? What standards and regulations should there be for the drugs? How will clinicians and insurers bill treatments?
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Who has psilocybin been shown to work for?
There's still research needed to determine who psilocybin works best for, but it could be "based on diagnosis, or based on age, life history and how many times you’ve had an episode of depression," Nichol said.
She's heartened by the fact that lawmakers are focusing on decriminalization as well as research, especially for populations with "a grave need" for treatments, like veterans.
“It’s an interesting time to be doing this research because there are other populations you could see as being important kind of like veterans are: first responders, people in medical professions," Nichol said. "It is good to see that lawmakers are really thinking about their constituents in a way they haven’t before."
Like many medications, there are certain situations where psilocybin shouldn't be used. For example, since psychedelics can cause perceptual disturbances like illusions and hallucinations, those with psychosis, perceptual dysfunction or a family history of disorders like schizophrenia should not use them until "we understand better what it does in your brain mechanistically."
In addition, psychedelics impact the cardiovascular system "in a way that makes them less safe to use regularly," often increasing heart rate and blood pressure. Nichol thinks that cardiovascular monitoring will be necessary for people who are going to be prescribed psychedelics.
What other states have legalized psilocybin?
Only Oregon and Colorado have decriminalized psilocybin so far, though bills similar to Missouri's are being proposed in statehouses across the nation.
Oregon decriminalized psilocybin in 2020 and legal psilocybin use began in 2023, but it's far different than the dispensary model seen in states that legalize recreational cannabis. Instead, the Oregon Health Authority has licensed over 20 service centers to administer the drug and 200 facilitators to assist clients. Clients older than 21 don't need referrals or diagnoses to use the centers, though according to NPR, facilitators said the majority of their clients "are seeking to increase self-knowledge and/or address mental health concerns — rather than just use the drugs recreationally."
In Oregon, a treatment session consists of three parts: Preparation, where the client meets with a facilitator; administration, where the client consumes the psilocybin at the treatment center under the facilitator's observation; and integration, where the client can take part in an optional session with the facilitator. Psilocybin products are cultivated or processed by a licensed manufacturer, tested by a licensed testing laboratory and then sold or transferred to a licensed service center, according to the Oregon Health Authority.
In 2022, Colorado's voters approved a proposition to legalize several psychedelics, including psilocybin. Currently, people can give away or share psilocybin with others who are 21 years old or older, but are prohibited from selling it. The state is also planning on having licensed facilities like in Oregon, that isn't anticipated to start until 2025, according to Colorado Public Radio reporting.
Susan Szuch reports on health and food for the SpringfieldNews-Leader. Follow her onX, formerly known as Twitter, at @szuchsm. Story idea? Email her at sszuch@gannett.com.
