The Rise of Psilocybin Use in the United States: A Multisource Observational Study

Among adults who reported psilocybin use, prevalence was higher in those with mental health or chronic pain comorbidities. Using data from the NMURx survey, the investigators report past-year use among adults with moderate or severe anxiety symptoms at 5.3% compared with 1.7% in those with no or mild symptoms, and 5.2% for those with moderate or severe depression versus 1.6% for those without. Adults reporting chronic pain had a past-year prevalence of 3.4% versus 1.6% among those without chronic pain. Poison-centre data showed large relative increases in psilocybin exposures. Reports to U.S. poison centres rose 201% among adults (aged ≥18 years), 317% among adolescents (aged 12 to 17 years), and 723% among children (aged 0 to 11 years). In 2023 the extracted text lists 1 192 adult cases, 542 adolescent cases, and 288 paediatric cases; overall, 76.7% (1 550 of 2 022) of reported exposures involved a health care facility according to the poison-centre data. By contrast, routine health care encounter coding did not reflect comparable numbers. The National Hospital Ambulatory Medical Care Survey (NHAMCS) recorded only three cases of psilocybin poisoning in emergency departments and outpatient facilities over 2015–2021 (two in 2016, one in 2020). The extracted text does not provide further methodological detail about denominator populations, sampling frames, or analytic approaches for these reported figures in this section.

Rockhill and colleagues interpret these findings as evidence that both lifetime and past-year psilocybin use in the United States increased from 2019 to 2023 across age groups. They note that the NMURx estimate of 2023 past-year adult psilocybin use exceeded contemporaneous NSDUH estimates for several other illicit drugs, suggesting substantial recent uptake. The researchers highlight a discrepancy between poison-centre reports and health-care encounter coding: many exposures reported to poison centres involved health care, yet International Classification of Diseases, 10th Revision (ICD-10) codes in NHAMCS did not capture a similar burden. They propose that current ICD-10 coding may be insensitive for monitoring psilocybin-related health care impact, while acknowledging that coding practices could change as clinician awareness increases. The study team also emphasises the association between psilocybin use and comorbid mental or physical health conditions and raises the possibility that state-level legal and regulatory changes have encouraged attempts at self-treatment. From a policy and implementation perspective, they recommend rigorous education and enforcement of dose limits in regulated programmes, and the development of new passive and active surveillance tools to better characterise who is using psilocybin, why they use it, clinical outcomes, and public-health impacts within state-regulated settings. Finally, the authors identify the study's principal strength as the multisource characterisation of change across several data sets, and they acknowledge the primary limitation that the outcomes reported here are self-reported. They conclude that rising use of psilocybin warrants consideration by public-health and health-care professionals when developing policy and interventions.