Psilocybin mushrooms are the most commonly used psychedelic substance in the US, surpassing other psychedelic drugs such as MDMA (known as ecstasy) in popularity, according to a new RAND report.
Based on a new national survey, researchers found that about 12 percent of respondents reported using psilocybin at some point in their lives, and 3.1 percent reported using the substance in the past year. An estimated 8 million American adults used psilocybin in 2023.
Psychedelic substances such as psilocybin mushrooms and MDMA have long been touted as promising for the treatment of various mental health conditions, with enthusiasm for the substances being developed over the past decade. Although clinical research continues to grow, less attention has been focused on the changing political landscape for some psychedelics.
The report, which takes a broad look at emerging issues surrounding the non-clinical use and supply of psychedelics, suggests that as state and local officials ease regulations on the substances, federal policymakers must decide whether they want psychedelics to follow in the footsteps of the profit model of cannabis or take another path.
The state of psychedelics today reminds me of where we were with cannabis policy 12 years ago. Now is the time for federal policymakers to decide whether they want to shape these policy changes or stand on the sidelines.”
Beau Kilmer, lead author of the report and senior policy researcher at RAND
Researchers warn there is concern that if efforts to expand the non-clinical supply of psychedelics go wrong, it could cause a backlash that could have a chilling effect on research and potential therapeutic uses.
“Based on what happened with clinical research on psychedelics after the 1960s, this is not an idle concern,” said Kilmer, co-director of the RAND Drug Policy Research Center.
The RAND report is based on several sources of information, including a December 2023 survey of a representative sample of 3,791 American adults who were asked about the use of a variety of substances, including psychedelics. The survey included several questions specific to the use of psilocybin and how to take it. The researchers also analyzed data from the National Survey on Drug Use and Health and the National Incident Reporting System.
The researchers interviewed lawyers, policy advocates, regulators, clinical researchers, mental health providers, and representatives from organizations working in the emerging psychedelic industry for the US and abroad. The work also involved discussions with members of indigenous communities about their spiritual medicines.
“Policy changes may affect Indigenous peoples who have long-standing traditions with certain spiritual medicines commonly referred to as psychedelics,” said Michelle Priest, co-author of the report and assistant policy researcher at RAND. “Respectful engagement with Indigenous community members who are empowered to speak on these issues can help create policies that benefit from generations of wisdom while protecting Indigenous rights.”
Despite a federal ban on supply and possession outside of approved clinical research and some religious exemptions, some state and local governments are relaxing their approaches to psychedelics, including approaches that legalize some forms of supply to adults for any reason.
For states considering alternatives to banning the supply of psychedelics, the report highlights how there are many options other than the for-profit approach. For example, states could allow people to forage or grow their own food, or allow them to join non-profit collectives or cooperatives. There is also the supervised use model operating in Oregon for psilocybin and expected to be operational in Colorado in 2025.
One difference from cannabis policy debates, the researchers note, is the role of oversight in policy discussions surrounding psychedelics. Even in places that do not adopt the supervision model implemented in Oregon and Colorado, policymakers will likely face many decisions about regulating intermediaries and supervision arrangements.
The RAND report found that unlike people who use cannabis and many other drugs, those who use psychedelics typically do so infrequently. The RAND survey found that 0.9% of respondents reported using psilocybin in the past month, compared to 20% of respondents who reported using cannabis in the past month.
The researchers estimate that among all American adults, the total number of days of cannabis use in the past month was on the order of 650 million, while the comparable number for hallucinogens was closer to 7 million.
Among those who reported past-year use of psilocybin in the RAND survey, 47% reported microdosing the last time they used it. Microdosing involves using small amounts of psilocybin or other psychedelics — often 1/10 to 1/20 of the typical dose.
The researchers say one takeaway from the analysis is the extent to which infrequent users drive the market for psychedelics. For cannabis, the market for infrequent users is negligible, accounting for about 5% of total days of use last month. For psychedelics, this figure is closer to 60%.
“While price is an important policy driver when considering the regulation of cannabis and alcohol, it will likely play a much smaller role for psychedelics, as infrequent users currently drive the market and tend to spend relatively little on these substances,” said Rajeev Ramchand. co-author of the report and co-director of the RAND Epstein Family Veterans Policy Research Institute.
The researchers found that while writing the report, it became clear how little has been published about the markets and patterns of use of many psychedelics — particularly psilocybin. They offer ideas for improving existing surveys, such as the National Survey on Drug Use and Health, and recommend conducting qualitative research (ideally longitudinally) with those who use psychedelics and those who produce and distribute these substances in legal or illegal settings.
Support for the study was provided by a gift to RAND from the Sergey Brin Family Foundation and RAND internal support.
Other authors of the study are Rhianna C. Rogers, Ben Senator and Keytin Palmer.
RAND’s Social and Economic Well-being division seeks to actively improve the health and social and economic well-being of populations and communities around the world.
RAND Health Care promotes healthier societies by improving health care systems in the United States and other countries.
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Journal Reference:
KilmerB., et al. (2024) Examining alternatives to the prohibition of psychedelic drugs. RAND Corporation. doi.org/10.7249/RRA2825-1.
