Psilocybin—the psychedelic compound found in “magic mushrooms”—has exploded in popularity across the United States. Social media celebrates it. Wellness influencers promote microdosing. Decriminalization movements have swept through several cities. And early clinical trials showing benefits for depression and anxiety have only added to the excitement.

But here’s the uncomfortable truth: public enthusiasm is running far ahead of public health.
A new JAMA Psychiatry paper warns that what’s happening with psilocybin today closely resembles the early wave of cannabis legalization—rapid access, booming product diversity, rising potency, and a complete lack of regulation, safety testing, or education.

This is not about whether psilocybin “works” in clinical trials. This is about what happens when millions of people use unregulated products in the real world.

Let’s unpack what the article highlights—and what you should know before assuming mushrooms are “safe” just because headlines say they’re “natural.”

Psilocybin Use Is Rising Faster Than Ever

More than 7 million adults in the US reported using psilocybin in the past year—an enormous increase. The rise is especially strong among those aged 19 to 50. This isn’t happening in clinics, under supervision, or in controlled research environments.

It’s happening:

• in homes

• at music festivals

• in “guided journeys” run by non-clinicians

• in online microdosing communities

With increased use comes increased harm: poison control center calls related to psychedelics have jumped significantly.

This is the first major warning sign.

Wild Variability in Mushroom Potency

Unlike the psilocybin used in clinical trials—which is synthetic, pure, and dosed with milligram precision—real mushrooms vary enormously.

Chemical testing from decriminalized areas shows:

• 20-fold differences in psilocybin content between strains

• unpredictable levels of other tryptamines (like baeocystin and norbaeocystin)

• potency changing with how mushrooms are grown, dried, or stored

In simple terms:
people think they’re taking a “small dose,” but they may be taking 10 times more without realizing it.

This is how accidental “bad trips,” panic attacks, vomiting, confusion, and dangerous behavior happen.

Clinical Trial Results Do NOT Apply to Public Use

Many people assume that psilocybin is safe because clinical trials show positive outcomes for depression and end-of-life anxiety.

But public use is nothing like clinical trials.

In research settings:

• participants undergo psychological screening

• major mental illness, trauma, or substance use disorders are excluded

• dosing happens in a fully controlled environment

• two trained guides accompany the participant

• patients are prepared beforehand and supported afterward

Out in the real world?

• none of those safeguards exist

• people with active mental illness may use mushrooms alone

• doses are inconsistent

• purity is unknown

• set and setting are uncontrolled

This is the gap between science and street reality—and the risks are much higher outside the lab.

Co-Use With Cannabis Makes Risks Higher

One of the study’s most important findings:
Cannabis use commonly overlaps with psilocybin use—and this combination increases the chance of adverse events.

People report stronger hallucinations, more anxiety, higher heart rate, and more unpredictable reactions when the two are mixed.

As cannabis has become more potent, this interaction matters even more.

Young People Are More Vulnerable

Psilocybin use is growing among adolescents and young adults.

Why this matters:

• younger brains are more sensitive to psychedelics

• risk of panic, derealization, or trauma-like reactions is higher

• co-use with alcohol or cannabis is more common

• impulsive behaviors are more frequent in teens

The authors warn that age-specific safety research is urgently needed before we treat psilocybin like “another harmless wellness product.”

The Public Health Message: Slow Down, Don’t Rush

The paper’s core message is simple but vital:

The world needs to shift from focusing only on clinical trials to understanding real-world use.

That means investing in:

• public education

• accurate harm-reduction messaging

• chemical potency testing

• age-specific safety guidelines

• regulation that keeps pace with access

• monitoring co-use with other substances

Psilocybin may have real therapeutic potential.
But when millions are already using unregulated mushrooms, the priority must shift toward safety—not hype.

What You Should Take Away

Psilocybin is not inherently “bad,” nor is it a miracle cure. But the current pattern of widespread, unregulated use—without dosing standards, safety testing, or oversight—creates risks that people rarely talk about openly.

A few key reminders:

• natural does not mean predictable

• clinical trial results do not guarantee public safety

• potency varies dramatically

• mixing psilocybin with cannabis increases risks

• younger users are more vulnerable

• unregulated use requires careful harm-reduction

If psilocybin is to be used safely and responsibly, public health must catch up fast.

For Evidence-Based Psychiatric Guidance

Dr. Srinivas Rajkumar T, MD (AIIMS), DNB, MBA (BITS Pilani)
Consultant Psychiatrist & Neurofeedback Specialist
Mind & Memory Clinic, Apollo Clinic Velachery (Opp. Phoenix Mall)
✉ srinivasaiims@gmail.com 📞 +91-8595155808