Patterns and consequences of recreational misuse of psilocybin and magic mushrooms
Psilocybin is a hallucinogenic tryptamine and the main indole alkaloid present in the commonly known 'magic mushrooms'. It is a prodrug, being extensively and rapidly metabolised into psilocin after ingestion. This metabolite is the ultimate responsible for the psychological and physiological effects of psilocybin, with its main binding target being the 5-hydroxytryptamine type 2A (5-HT2A) receptor. This work delivers a comprehensive compilation of psilocybin/magic mushrooms’ patterns of recreational use, legal status, abuse potential, adverse effects, and toxicity.
An extensive literature search was performed on PubMed database using the following terms: 'psilocybin', 'psilocin', 'magic mushrooms', or 'hallucinogenic mushrooms', in combination with 'toxicity', 'intoxication', 'forensic toxicology', 'recreational', or 'legal status'. Documents from regulatory agencies were also consulted to obtain additional information, especially on the prevalence and patterns of consumption and on cases of exposure. The retrieved articles and documents were lengthily explored to find additional bibliography pertinent to this review. In recreational settings, fresh/dried magic mushrooms are the consumed form of psilocybin, its use displaying a high prevalence amongst male adolescents and young adults, although being illegal in most worldwide countries. Adverse effects commonly reported include hallucinations, anxiety, agitation, euphoria, confusion, paranoia, nausea, vomiting, diarrhoea, headaches, mydriasis, tachycardia, and hypertension, being the treatment only supportive. There are also few reports on more rare severe effects, namely persistent psychosis, and myocardial infarction. Based on both pre-clinical and clinical studies, psilocybin/magic mushrooms have a low potential for addiction or dependence, and they are considered by scientific experts and consumers as drugs with low overall harmful profile.
In general, low toxicity and abuse potential are associated with psilocybin’s consumption. However, toxicity may result from the pharmacodynamic and pharmacokinetic interaction with other consumed psychotropic substances, and/or in individuals with self or family history of medical conditions.