Psilocybin Mushrooms and Truffles: Psilocybin, Psilocin and What Is Known

Urgent first. If someone has eaten a mushroom and is confused, very agitated, vomiting repeatedly, has chest pain, a seizure or trouble breathing, call 911 or US Poison Help at 1-800-222-1222. See poisoning: what to do first. Do not try to treat it at home.

Psilocybin and psilocin

Psilocybin comes from certain types of mushrooms found on nearly every continent. After it is taken, the body converts it to psilocin, which activates serotonin 5-HT2A receptors; researchers think this action accounts for much of the experience. [1] Psilocybin is classed with the classic psychedelics. See what natural psychedelics are. The mushrooms have a long history of use in traditional ceremonies. NIDA cites evidence that Indigenous people in Central America used them for healing and spiritual rituals as far back as 3000 B.C. [1]

Psilocybe species

Psilocybin and psilocin, along with related compounds such as baeocystin, typically occur in most species of the genus Psilocybe. A laboratory study of one species found the amounts varied a lot between individual mushrooms, which is one reason the strength of any mushroom is unpredictable. [2] This page does not help identify mushrooms. NIDA warns of the risk of mistaking a toxic mushroom for one containing psilocybin. [1] See plant and mushroom poisoning.

Fungal sclerotia ("magic truffles")

The sclerotia of some Psilocybe fungi are commonly called "magic truffles". A 2013 analysis noted they had become a source of psilocybin because sclerotia were not specifically named in laws that ban psilocybin mushrooms, and found psilocybin content varied nearly threefold across the samples tested. [3] That was a statement about laws as of that paper. We did not read any current national law on truffles, so their status in any country is not verified here.

What research shows

Evidence labels: approved medicine, promising but limited, mixed, insufficient evidence. Details of trial design are on psychedelic clinical trials and research limits.

• Approved medicine: we did not find an approved psilocybin medicine in the sources we read. NIDA says the FDA granted Breakthrough Therapy designation to some psilocybin formulations being studied for depression, which is a development status, not approval. [1] Check the FDA for the latest.
• Major depression: promising but limited. In a randomized 2023 trial of 104 adults, one dose of synthetic psilocybin with psychological support lowered depression scores more than a niacin placebo (average difference about 12 points on a 60-point scale at day 43), with no serious treatment-related adverse events but more overall and more severe adverse events than placebo. People with a history of psychosis or mania were excluded. [4] An earlier trial of 27 adults compared immediate with delayed treatment and found large effects. [5]
• Anxiety and depression in life-threatening illness: promising but limited. A Cochrane review found classic psychedelics may reduce anxiety and depression compared with active placebo, with low-certainty evidence from small trials. [6]
• Microdosing: insufficient evidence. NIDA says research has not established microdosing as safe or effective. [1] In a 191-person self-blinded study, microdose and placebo groups both improved and did not differ significantly. [7]
• Why caution is needed. People can often tell whether they received psilocybin, so blinding may fail. A review argues that effect sizes in psychedelic trials are likely overestimated because of unblinding and high expectations. [8] FDA guidance on trial design raises the same concern. [9]

Risks and adverse effects

• Common effects in trials. A meta-analysis of therapeutic-dose trials found more headache, nausea, anxiety, dizziness and raised blood pressure than with comparison treatments, resolving within 48 hours. [10]
• Serious events. A review of 214 studies found serious adverse events in about 4% of participants with preexisting neuropsychiatric disorders and none in healthy participants, while noting that adverse-event monitoring was uneven. [11]
• Outside clinical settings. NIDA says psilocybin raises blood pressure and heart rate, which may be dangerous for people with heart conditions, and can cause extreme fear, panic and risky behavior. It reports that poor mental health outcomes may be more likely outside clinical use. [1]
• Addiction. Research suggests psilocybin does not typically lead to addiction. [1]
• Pregnancy. NIDA says there is no data on psilocybin safety in pregnancy. [1] See pregnancy and breastfeeding.
• Mental health history. Clinical trials generally exclude people with psychosis or bipolar disorder as a precaution. [12]

Quality and labeling

NIDA notes some candies marketed as containing psilocybin have been found to contain toxic chemicals and caused severe illness. [1] In Portland, Oregon, a study of eight mushroom gummies found labeling "overall inaccurate", including a product labeled psilocybin-free that tested positive for psilocybin. [13]

Legal status

Not legal advice; laws change. Psilocybin and psilocyn are listed in Schedule I of the US federal Controlled Substances Act regulations. [14] Oregon runs a state-regulated program under Ballot Measure 109 that licenses psilocybin services, with service centers opening from summer 2023. [15] Other countries and states: not verified here. See legal status by country.