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Denver, the biggest city in the first state to legalize recreational marijuana back in 2012, has narrowly passed an ordinance to essentially decriminalize psilocybin, the hallucinatory substance found in over 100 varieties of mushrooms. After the results are officially certified later this month, enforcement will be given the lowest priority, and a panel will be established to try to assess the impact of “magic mushrooms” on public safety, finances and public health.
From a purely medical perspective, this seems to be a good thing, to allow treatment for a drug problem rather than locking people up. But there is also legitimate concern that the new ordinance could lead to more unregulated recreational use, which has many associated dangers.
Indeed, magic mushrooms can cause accidental injury, panic, confusion and fear of losing your mind. And Colorado already has a problem with recreational marijuana. With high content-THC pot appearing in everything from food to cosmetics to coffee, there have been thousands of unanticipated side effects flooding emergency rooms. Paranoia, psychosis, uncontrollable vomiting (relieved by hours of hot showering) — all have required emergency treatment. Long-term impact includes impaired judgement, loss of motivation and memory problems. No free lunch here.
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The same or worse could be true for “shrooms,” especially if they start to appear in your food or coffee. Unfortunately, decriminalizing is just a short step away from widespread recreational use, which would be a disaster.
Medically, psilocybin shows promise and might be a usable treatment in the near future. Fairly recent small studies in the prestigious journals The Lancet and Nature have showed a very positive response to psilocybin among patients with resistant depression, meaning that they had failed other, more conventional medications and therapies.
Recreational use is risky
According to Dr. Michael Bogenschutz, a New York University School of Medicine psychiatry professor studying the effects of psilocybin, “Clinical trials are currently under way evaluating the effects of psilocybin for psychiatric conditions including addiction (alcohol use disorder, cocaine use disorder, opioid use disorder and nicotine use disorder), depression and headache.”
It is too soon to draw any definite conclusions, Bogenschutz told me in an email, but added that “psilocybin has an excellent safety record when administered to carefully screened volunteers under supportive controlled conditions. If it does prove to be safe and effective in robust clinical trials, psilocybin-assisted treatment could have a great impact on psychiatry.”
Small studies at NYU and elsewhere have shown therapeutic effects persisting for months following one or two doses of medication. Bogenschutz emphasizes that there is a big difference between “medical use of psilocybin in the context of clinical trials (or future clinical use) and unsupervised use. The risks of the latter are considerably greater.”
A magic mushroom pill?
A few years from, now there could be a psilocybin pill that a carefully trained psychiatrist can offer to his or her patients. It will make sense at that point to downgrade psilocybin from a Schedule 1 controlled substance, meaning that it has “no currently accepted medical use.”
The Food and Drug Administration is considering whether cannabis should be downgraded to the less restricted categories, and I think it should be.
More research is needed before psilocybin could be seen in the same way as medical marijuana. In the meantime, politicians will continue to use both as political footballs. And big business will continue to enter the playing field as soon as laws are relaxed or removed. Unfortunately, the victims of a failed or hasty policy will continue to show up in the ER.
Threading the needle between proper use and overuse, between potentially real medicinal value and reckless recreational risks, is far from easy. Unfortunately, politicians (and the business interests that finance their campaigns) are the ones with their hands on the switch, rather than the scientists who should be making these decisions.
Marc Siegel, a member of USA TODAY's Board of Contributors and a Fox News medical correspondent, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. Follow him on Twitter: @DrMarcSiegel
This article originally appeared on USA TODAY: Threading Denver's magic mushrooms needle: Promising as medicine, risky as recreation
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