A patient arrives at the Johns Hopkins Center for Psychedelic and Consciousness Research in Baltimore, ready for a full day of treatment. For the next eight hours, she’ll recline on a large couch with an eye mask and headphones playing classical music. Two facilitators are nearby, ready to help if needed.
After vitals like blood pressure are checked and the patient feels comfortable, a physician will administer a dose of psilocybin, the active ingredient in “magic mushrooms.” The journey has begun.
Certain types of mushrooms — known as “magic mushrooms” or “medical mushrooms” — produce psilocybin, a compound that can alter activity in certain regions of the brain, which can lead to changes in perception, emotion and cognition, commonly called “tripping.”
At Johns Hopkins and a growing number of research institutions across the country, healthcare professionals and scientists are investigating the potential benefits of psychedelic drugs like magic mushrooms in psychiatric treatment for people with depression, anxiety, post-traumatic stress disorder (PTSD) and other mental health conditions.
“People will describe really powerful emotional experiences that leave them with different insights afterwards,” said Mary “Bit” Yaden, M.D., a physician and psychiatrist at the Hopkins center. “A lot of folks are able to make pretty powerful changes after these experiences. It’s a different model for psychiatry, which I think is exciting.”
From a neuroscience perspective, the medicine helps us rewire and reroute our neural pathways, according to Charlotte James, founder of Psychedelic Liberation Training and other organizations that provide psychedelic training and education centered on people of color. “It can also work at a cellular level in helping identify where in your body different illnesses and trauma are occurring or originating. If we think about trauma being stored in the body — both trauma in our lifetime and intergenerational trauma — and how that’s impacting our health outcomes, the medicine allows us to do some work in the body to release our trauma.”
Psychedelic research is still in its earliest stages after being halted for decades because of government policy. Studies flourished in the 1950s and early 1960s after researchers found promising benefits for mental health conditions and substance abuse dependence, but research was banned for at least two decades because of concerns about psychedelic abuse by “counterculture” participants in the mid-1960s.
The research group at Johns Hopkins received regulatory approval in 2000 to restart research with psychedelics in healthy volunteers. Since then, their studies have focused on psilocybin’s potential benefits for treatment-resistant depression, PTSD and the mental health of people with terminal cancer as they work to manage emotional distress and anxiety. Studies on substance use disorders showed reductions in heavy drinking and smoking.
New studies around the world continue to emerge, including one focusing on psilocybin as a treatment for anorexia.
Those who work with psychedelics are clear about the power of the medicines. But you also have to put in the work.
“You’re not going to show up, take [mushrooms], and then, hours later, wake up and be ‘fixed,’” said James. “A good practitioner … will require pre-work, and there will be integration support coming out of the ceremony so you can think about how you’re taking the lessons from the medicine, embodying them and using them to enhance your life.”
In the Johns Hopkins studies, participants must first complete three to four psychotherapy sessions with a physician and facilitators before having one or two treatments.
“We’re creating a condition for the participant to feel they can trust you,” Yaden said. “Because psilocybin can be scary — to have a change in your conscious state is intimidating for some folks.”
The ultimate goal is to help patients unlock past trauma or issues so they can deal with them more clearly on their own or with the help of a mental health professional. After the psilocybin session, participants are encouraged to talk to the facilitator about the feelings and experiences that emerged so they have a plan of action for their mental health team. Patients might have one more psilocybin administration as part of the study, but the treatment is not designed to be ongoing.
“So far, the only way we’ve explored this is as a one-and-done treatment,” Yaden said. “For many, the long-term follow-up data is very encouraging.”
Getting access to psilocybin for treatment can be difficult. To participate in legally regulated methods, people have to enroll in a study, and access is even more restricted for people of color since they’re underrepresented in psychedelic studies like they are in most studies. Another alternative is to find a locality where medicinal use is legal — and there aren’t that many of those. Right now, Oregon and Colorado and a handful of U.S. cities are the only places that have legalized psilocybin.
Some people are choosing to have psychedelic experiences outside clinical spaces, visiting psychedelic societies with practitioners who provide education about psychedelic use and who lead traditional, ancestral healing practices with legal psychedelic plants.
But, James cautioned, anyone expecting to simply obtain magic mushrooms for a “trip” should think again. Participants are expected to build trust, community and relationships with others in the group with the understanding that the medicines are powerful and should be used with respect. Nevertheless, these types of experiences are a way to increase access for those who can’t get into a study or who don’t feel comfortable experiencing a “trip” inside a clinician’s office and would rather do so with trusted community members.
James said she understands why a clinical setting might not feel safe for some people, such as women from marginalized backgrounds, and they might decide a collective is a better choice.
“For example, I don’t want to be in a doctor’s office tripping,” she said. “As a Black woman, especially, it might not be the setting where I’m going to have the most trust.”
Research-based psilocybin use doesn’t focus on “microdosing,” or using the drug in small amounts on a semi-regular basis. There’s little research about long-term micro use of psychedelics, as most studies examine the effects of larger doses given to a person in a controlled environment just once or twice.
“With microdosing, you are in some ways replicating that antidepressant model where you’re taking very low doses that aren’t necessarily meant to impact your subjective experience,” Yaden said. “I think one thing that gives me caution is that the psilocybin itself affects a receptor that is involved in the heart and there haven’t been long-term studies of microdosing.”
People who microdose magic mushrooms might speak on a more general level about how the medicine has improved their lives, but Yaden said those benefits haven’t yet been reflected in the research.
She supports the research study model over microdosing or taking psilocybin on your own because of the studies’ highly controlled settings that screen patients for mental and physical health conditions to see if they’re the right fit, and work to build safety, trust and openness between professionals and patients.
“In most of the country, these are still considered like schedule one drugs,” she said. “The last thing we want is for anybody to do something that could potentially put them in harm’s way. If science has taught me anything, it’s a deep humility and understanding that there’s so much we don’t know. The most important thing as a practitioner is to keep people safe and to appreciate that these medicines have enormous potential for the future.”