Elsevier

Neuropharmacology

Volume 142, November 2018, Pages 143-166
Neuropharmacology

Invited review
The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act

https://doi.org/10.1016/j.neuropharm.2018.05.012Get rights and content
Under a Creative Commons license
open access

Highlights

  • Psilocybin mushrooms have been used for millennia for spiritual and medical purposes.

  • Animal and human studies indicate low abuse and no physical dependence potential.

  • Major national surveys indicate low rates of abuse, treatment-seeking and harm.

  • Psilocybin may provide therapeutic benefits supporting its development as a new drug.

  • Analysis supports the scheduling of psilocybin no more restrictively than Schedule IV.

Abstract

This review assesses the abuse potential of medically-administered psilocybin, following the structure of the 8 factors of the US Controlled Substances Act (CSA). Research suggests the potential safety and efficacy of psilocybin in treating cancer-related psychiatric distress and substance use disorders, setting the occasion for this review. A more extensive assessment of abuse potential according to an 8-factor analysis would eventually be required to guide appropriate schedule placement.

Psilocybin, like other 5-HT2A agonist classic psychedelics, has limited reinforcing effects, supporting marginal, transient non-human self-administration. Nonetheless, mushrooms with variable psilocybin content are used illicitly, with a few lifetime use occasions being normative among users. Potential harms include dangerous behavior in unprepared, unsupervised users, and exacerbation of mental illness in those with or predisposed to psychotic disorders. However, scope of use and associated harms are low compared to prototypical abused drugs, and the medical model addresses these concerns with dose control, patient screening, preparation and follow-up, and session supervision in a medical facility.

Conclusions

(1) psilocybin has an abuse potential appropriate for CSA scheduling if approved as medicine; (2) psilocybin can provide therapeutic benefits that may support the development of an approvable New Drug Application (NDA) but further studies are required which this review describes; (3) adverse effects of medical psilocybin are manageable when administered according to risk management approaches; and (4) although further study is required, this review suggests that placement in Schedule IV may be appropriate if a psilocybin-containing medicine is approved.

This article is part of the Special Issue entitled ‘Psychedelics: New Doors, Altered Perceptions’.

Keywords

Psilocybin
Abuse potential
Controlled Substances Act
Depression
Anxiety
Addiction

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