Eight million Americans used psilocybin last year, and they don’t resemble the patients in the trials
STUDY: Yang KH et al, American Journal of Psychiatry 2026
STUDY TYPE: Cross-sectional survey, with accompanying editorial
FUNDING: National Institute on Drug Abuse
Background
Psilocybin may soon win FDA approval for depression, and several states have loosened its legal status. This study from the 2024 National Survey on Drug Use and Health tells us how its use has grown.
The Study
- 58,633 US residents aged 12 and older, weighted to represent the nation.
- Past-year users were compared with nonusers.
Results
About 1 in 35 (2.8%) people used psilocybin in the past year. Use was highest among young adults, men, white people, and the college-educated. Other studies report 1 in 8 US adults have tried psilocybin in their lifetime.
Users often took other substances:
- 87% used cannabis
- 31% had alcohol use disorder
- 12% used LSD, and 12% used MDMA
A past-year major depressive episode raised the odds of psilocybin use by 37%. The authors suspect some are self-treating.
In an accompanying editorial, Dr. Mark Olfson notes that psilocybin’s trials excluded bipolar disorder, psychosis, suicide risk, and substance use disorders. For community use, nearly 60% were 34 or younger, the peak age for onset of bipolar and psychotic disorders. Those populations are more represented in the reports of psilocybin psychosis, as are other risk factors more common with community use: high dosing, or pairing it with cannabis or other drugs.
Practice Implications
Ask your young, depressed patients about psilocybin routinely and without judgment, including why they use it. When a patient discloses use:
- Screen for cannabis and other substance use.
- Ask about personal and family history of bipolar disorder and psychosis.
- Review serotonergic medications, since SSRIs may blunt psilocybin’s effects.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
