An unidentified man has survived a near-death experience after injecting himself with a self-made magic mushroom tea.
The case, published in the Journal of the Academy of Consultation-Liaison Psychiatry, is reporting that the man injected himself with the tea hoping to cure his bipolar disorder.
The man, reported to be 30 years old, was rushed to a local hospital after family members found him in a disoriented state. Emergency medical personnel found that in addition to incoherence, the patient was suffering from multiple organ failure.
Testing showed that he had growing Psilocybe cubensis in his bloodstream, the result of injecting a magic mushroom tea, he later told the doctors.
Prior research has suggested that some hallucinogenic compounds can help people with mental illnesses. Magic mushrooms (technically known as Psilocybin mushrooms) are but one example.
But researchers have stressed that these substances should only be administered under the guidance of a trained physician.
Research regarding magic mushrooms never involves injecting the fungus into the veins – instead, the active ingredient, psilocybin, is removed and administered.
Magic mushrooms are generally considered to be safe to use recreationally – they are typically boiled into a tea, eaten directly or are dried and crushed into a powder that can be put into other food, or even capsules.
Ingestion of mushroom products generally leads to hallucinations and sometimes feelings of euphoria or out-of-body experiences.
Magic mushroom ingestion can lead to bad trips, and sometimes people are harmed when they mistake poisonous mushrooms for the hallucinogenic kind. But otherwise, they are considered to be safe enough that several places in the U.S. have legalized their use.
In treating the man who injected himself with his own mushroom tea concoction, the doctors found that the fungus had begun growing in his veins and that was why it adversely impacted so many parts of his body.
In addition to treating the damaged organs, the doctors gave the man antibiotics and antifungal medicine to kill the infections.
The patient will reportedly have to continue taking both medications for some time to ensure the infections do not return.
In speaking with the press about the case, the man’s doctors suggested that the public needs to be better informed about the dangers of hallucinogenic drug use.
Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine) is an indoleamine or serotonin-like hallucinogen and the main psy- choactive principle of a group of hallucinogenic fungi of the genus Psilocybe, also often referred to as “magic mushrooms” (Hofmann, 1968).
Psilocybe mushrooms occur throughout the world and their human use in medical and religious rituals dates back for centuries, if not millennia (Stamets, 1996; Guzmán, Allen, & Gartz, 2000).
Modern psychopharmacological research with psilocybin begun with the discovery of the cultic use of Psilocybe mushrooms by Mesoamerican Mazatec Indians in 1955 (Wasson, 1958). Psilocybin and psilocin were identified at Sandoz Lab- oratories as the psychoactive compounds of Psilocybe mushrooms and synthesized by the renowned Swiss chemist Albert Hofmann (1958), who some 15 years earlier also discovered the chemically related ergoline hallucinogen LSD.
Soon after, synthetic psilocybin was marketed by Sandoz under the name Indocybin® for basic psychopharmacological and therapeutic clinical research (Hofmann, Heim, Brack, Kobel, et al., 1959; Passie, 1995; Passie, Seifert, Schneider, & Emrich, 2002).
Early clinical studies in the 1960s and 1970s demonstrated that psilocybin produces an altered state of consciousness (ASC) similar to LSD that is characterized by marked alterations in perception, mood, and thought, including changes in the experience of time, space, and self, that are rarely experienced otherwise except in dreams, religious exaltation, and acute psychoses (Isbell, 1959; Rümmele & Gnirss, 1961; Leuner, 1962; Wolbach, Miner, & Isbel, 1962; Fischer, 1971; Geyer & Vollenweider, 2008).
In these states, perceptual hypersensitivity, illusions, and pseudohallucinations (i.e., hallu- cinations with intact reality testing and insight) are common (Leuner, 1962; Hill, Fischer, & Warshay, 1969; Fischer, Hill, & Warshay, 1969; Fischer, Hill, Thatcher, & Scheib, 1970).
Intensification of affective responses, enhanced ability for introspection, regression to primitive and childlike thinking, and activation of vivid memory traces with pronounced emotional undertones can also occur (Leuner, 1971).
Psychophysiological and pharmacological studies revealed that psilocybin had a much shorter duration of action than LSD (4-6 h instead of 8-12 h; Cerletti, 1959). Although – apart from the duration of action – the effects of both drugs were found to be highly similar in a controlled study (Hollister & Hartman, 1962), clinical observations indicated that psilocybin tended to produce less anxiety, panic reactions, affective disturbances, and milder vegetative side-effects than LSD (Heimann, 1962; Nieto, 1962; A. E. David & J. M. David, 1961; Clark, 1968; Leuner, 1968; Passie, 1995). Hence, many hallucinogen re- searchers valued psilocybin as a useful substitute for the earlier discovered LSD to explore the neural basis of ASC in- cluding the basis of hallucinations, religious, spiritual, and psychotic dimension, while for others it was an attractive adjunct in psychodynamic-oriented psychotherapy to bring the unconscious into conscious (Leuner, 1971; Nichols, 2004; Nichols & Chemel, 2006).
Throughout the 1960s, LSD and related drugs became increasingly associated with cultural rebellion, were widely popularized as drugs of abuse, and depicted as dangerous. Consequently, around 1970, LSD and related drugs were scheduled in the most restrictive category in most countries.
Accordingly, human research on psychedelics became severely re- stricted, funding became difficult, and interests in therapeutic use of these drugs faded.
The 1990s witnessed a re-emergence of human hallucino- gen research in Europe, particularly with the development of new brain imaging techniques, sophisticated neuropsychological approaches, and neuropharmacological findings that have supported hallucinogens as models of at least some as- pects of natural occurring psychosis (for a review, see Geyer & Vollenweider, 2008). Many of these studies conducted in our and other laboratories used psilocybin as a tool to investigate the neural underpinnings of psychotic symptom formation including ego-disorders and hallucinations (Vollen- weider, 1992; Vollenweider, Leenders, et al., 1997; Vollen- weider, Vollenweider-Scherpenhuyzen, Bäbler, Vogel, & Hell, 1998; Gouzoulis-Mayfrank, Schreckenberger, et al., 1999; Gouzoulis-Mayfrank, Thelen, et al., 1999; Vollenweider & Geyer, 2001; Hasler, Grimberg, Benz, Huber, & Vollenwei- der, 2004) or to explore the effect of psilocybin on cognitive and visual processes (Spitzer et al., 1996; Umbricht, Koller, Vollenweider, & Schmid, 2002; Umbricht, Vollenweider, et al., 2003; Carter, Pettigrew, Burr, et al., 2004; Carter, Burr, et al., 2005; Carter, Pettigrew, Hasler, et al., 2005; Carter, Hasler, et al., 2007; Kometer, Cahn, Andel, Carter, & Vol- lenweider, 2011), time perception (Wackermann, Wittmann, Hasler, & Vollenweider, 2008; Wittmann et al., 2007), and on sensory gating and its relation to cognitive alterations (Gouzoulis-Mayfrank, Heekeren, et al., 1998; Vollenweider, Csomor, Knappe, Geyer, & Quednow, 2007).
Recent work has also explored the acute and long-term subjective effects of psilocybin in hallucinogen-naïve healthy subjects and found that 14 months after the experiments about two-third of participants still rated the experience as among the most personally meaningful and spiritually significant of their lives (Griffiths, Richards, McCann, & Jesse, 2006; Griffiths, Richards, Johnson, McCann, & Jesse, 2008).
In addition, several recent studies have re-investigated the tolerability and efficacy of psilocybin in the treatment of anxiety re- lated advanced-stage cancer (Grob et al., 2011) and obsessive- compulsive disorders (Moreno, Wiegand, Taitano, & Delgado, 2006). Other studies have focused on the pharmacokinetics (Hasler, Bourquin, Brenneisen, Bär, & Vollenweider, 1997), metabolism (Hasler, Bourquin, Brenneisen, & Vollenwei- der, 2002), dose-dependent effects (Hasler, Grimberg, et al., 2004), and receptor mechanism of psilocybin (Ametamey et al., 1998; Vollenweider, Vollenweider-Scherpenhuyzen, et al., 1998; Vollenweider, Vontobel, Hell, & Leenders, 1999; Vollenweider, Hasler, & Kometer, 2008; Hasler, Quednow, et al., 2009). For example, we have shown that the selective 5-HT2A receptor antagonist ketanserin blocks the hallucinogenic effects of psilocybin in human subjects (Vollenweider, Vollenweider-Scherpenhuyzen, et al., 1998), providing strong evidence for the link between 5-HT2A receptor activation and hallucinosis (Sanders-Bush, Burris, & Knoth, 1988).
Moreover, a recent animal study found a novel mechanism of func- tional interaction between 5-HT2A and mGluR2 receptors and suggests that specific mGluR2 agonists may block the effect of hallucinogens such as psilocybin in humans (González- Maeso, Weisstaub, et al., 2007; González-Maeso, Ang, et al., 2008; González-Maeso & Sealfon, 2009).
Although molecular and mechanistic studies in animal are pertinent, trans- lational research in human subjects and particularly the establishing of the links between the mechanism of action of hallucinogens and the subjective effects in humans is essential (Vollenweider, 2001).
Although serotonergic hallucinogens such as psilocybin are considered relatively safe physiologically and do not produce dependence (Leuner, 1981; Nichols, 2004; Johnson, Richards, & Griffiths, 2008), there is limited information on the acute tolerability and potential long-term psychological effects of psilocybin.
Moreover, given that many of the early human studies with psilocybin were poorly standardized and lacked adequate control groups or follow-up measures, or often had small and unrepresentative sample sizes, it is difficult to draw inferences with this work, e.g., on dose-response effects and the incidence of acute and subacute distress and side effects.
The purpose of this paper is to provide further information about the acute, subacute, and potential long-term subjective effects of psilocybin administration in healthy human subjects in a controlled experimental setting. The present analysis is based on data of 8 double-blind placebo-controlled psilocybin studies that were conducted in our laboratory during the past 10 years.
The data report on acute, subacute, and long- term effects of 227 individual psilocybin sessions obtained in 110 subjects using validated instruments to assess various aspects of consciousness, mood, psychological and physical side effects. Whereas parts of the data on the acute effects of psilocybin were previously published (see Table 1), the data on subacute and long-term effects/side-effects have not been presented elsewhere before.
Discussion
The present work analyzed acute, short-, and long-term effects of psilocybin in healthy human subjects by pooling raw data from a large body of well-controlled experimental studies.
Acute psychological effects
Consistent with other recent, smaller-scaled studies (Grif- fiths, Richards, McCann, et al., 2006; Moreno et al., 2006), the present analysis has shown that psilocybin dose-dependently induces an ASC, which is characterized by marked alterations in all mental functions, including perception, mood, volition, cognition, and self-experience.
The most prominent features of the psilocybin-induced ASC were alterations in visual perception (VRS), followed by positively (OBN) and negatively (DED) experienced alterations of self-awareness and loosening of ego-boundaries. The changes in visual perception ranged from increased visual imagery with closed eyes, optical illusions, elementary hallucinations, and synesthesiae to picture-like scenery hallucinations.
However, the experienced hallucinations were almost always recognized as unreal and therefore are more accurately described as pseudo- or nonpsychotic hallucinations. Drug effects accounting for the substantial increase in the OBN-scale, ranged from plea- surable experiences of depersonalization, derealization, and a changed sense of time to phenomena reminiscent of mystical- type experiences.
The modest increase in the DED-scale was primarily due to unpleasant disturbances of cognitive functions and somatesthesia, and much less so to suspiciousness or paranoid ideation. Reality testing usually remained intact, and most subjects sustained critical distance (“it is as if”) to their own subjective experience.
The auditory alterations (AUA) scale was only moderately affected by psilocybin, since true auditory hallucinations, such as hearing voices, rarely o curred, and auditory alterations mostly concerned occasional intensification of music and sounds or misperceptions of real auditory stimuli.
Psilocybin also dose-dependently increased the vigilance reduction (VIR) scale. This observation may come as a surprise, since lack of sedation and clouding of consciousness is usually considered as one of the most prominent characteristics of classical hallucinogens.
In fact, according to the classification scheme of Leuner (1981), hallucinogens of the first order (e.g., LSD, psilocybin, DMT, and mescaline) are differentiated from hallucinogens of the second order (e.g., ketamine, N2O, and scopolamine) by this very feature.
However, it should be noted that the effect of psilocybin on reduction of vigilance was relatively small and reflects the psilocybin-induced state of dreaminess, contemplativeness, and reduction of attentiveness, rather than true sedation or clouding of consciousness.
Cumulative distributions of the 5D-ASC major scales re- vealed widely varying individual responses. For instance, whereas one subject experienced strong effects on the low dose condition (63% of the possible maximum of the global scale), two subjects noticed almost no effects on the highest dose condition (below 5% of the possible maximum).
The high inter-subject and moderate inter-study variability of the pooled analysis supports the view that psilocybin effects are poorly predicted by drug dose alone and that other pharmacological variables, such as plasma levels of the active metabolite psilocin, as well as non-pharmacological variables notably expectations, personality structure, interpersonal support, and environment – likely play a very important role (Rinkel, DiMascio, Robey, & Atwell, 1961; Metzner, Litwin, & Weil, 1965; Dittrich, 1994; Johnson et al., 2008). The sig- nificance of such potential non-pharmacological predictors will be analyzed and presented in a separate publication.
Dose-response relationships for all major scales of the 5D- ASC were approximately linear. Since no ceiling effect has been observed within the administered dose range (45-315 µg/kg body weight), it is conceivable that psilocybin doses exceeding 315 µg/kg would have produced even stronger sub- jective drug effects.
This view is supported by a recent study of Griffiths, Richards, McCann, et al. (2006), in which sub- jective drug effects were measured by the APZ-questionnaire in 36 healthy volunteers who had received 429 µg/kg psilo- cybin. By estimating 5D-ASC from APZ scores through linear equations (Bodmer, 1999), we have found higher OBN and VRS scores in the study of Griffiths than in the highest dose condition of our studies.
Furthermore, in the study of Griffiths, 61% of subjects fulfilled Pahnke’s criteria for hav- ing a ‘complete’ mystical experience (Pahnke, 1969), which seems to be a considerably larger proportion than we have observed in the highest dose condition. Although we have used a different methodology and therefore cannot directly compare results, we have found that only 22% of subjects in the high-dose condition exceeded the cut-off value of the OBN scale suggestive of deep mystical or transcendent ex- periences.
However, it should it be noted that, in addition to the higher drug doses in the study of Griffiths, several other factors might have contributed to these differences. First, the investigation of transformative peak experiences has not been the primary goal of our research program.
Hence, our studies have not been designed in a way that the occurrence of such profound experiences is most likely. Whereas volunteers in the study of Griffiths were instructed to focus explicitly on the phenomenology of the drug experience and were left essentially undisturbed during their whole psilocybin session, subjects of our studies were engaged in performing tasks for a considerable amount of time.
Second, none of the subjects in Griffith’s study had previous experience with a hallucino- genic drug, whereas in our studies about 40% of subjects had previous experience with a classical hallucinogen (LSD, psilocybin, DMT, or mescaline) and almost 90% had smoked cannabis at least once in a lifetime.
Third, the subjects in Griffith’s study were middle-aged (46 years on average) and spiritually active, whereas our subjects were predominantly students, considerably younger (27 years on average), and not selected for being spiritual.
Despite extremely careful preparation, selection, and in- terpersonal support of subjects, there also seems to have oc- curred more acute adverse reactions in the study of Griffiths than in our studies.
Griffiths reports that 31% of subjects experienced significant fear and 17% had transient ideas of reference/paranoia, whereas in our studies only 7% of sub- jects in the highest dose condition fulfilled the criteria for strong dread of ego dissolution, which is suggestive of acute psychotic reactions.
Although these adverse reactions were confined to the acute phase and were readily managed by pro- viding interpersonal support without psychopharmacological intervention in all cases of both research groups, they provide a cautionary note on high-dose psilocybin studies. Clearly, careful selection of subjects and environment and thorough preparation and monitoring of subjects is extremely critical in high-dose psilocybin sessions.
The results of our analysis of the time-course of subjective effects measured by the AMRS indicate that the effects follow differential time courses, which are not necessarily paralleled by psilocybin plasma levels (Hasler, Bourquin, Brenneisen, Bär, et al., 1997). Whereas the effects of psilocybin on emo- tional excitation, sensitivity, heightened mood, and concen- tration reached their maximum in an early phase (60-180 min after drug intake), the effects on dreaminess, dazed state, inactivation, and introversion were more pronounced in a later phase (260-400 min).
The results are consistent with a study of Heimann (1961), in which expressive phenomena, such as changes in facial expression, voice, and posture, were ana- lyzed by use of video recording in 12 healthy volunteers who had received 0.06-0.19 µg/kg psilocybin on two experimen- tal days. Heimann observed that subjects were more active, emotional, vivid, extroverted, and cognitively impaired in the early phase of the psilocybin session relative to the later phase and that derealization and depersonalization phenom- ena began to dominate over visual alterations about 90-120 min after drug intake. During this later phase, subjects also increasingly turned inwards and appeared to be in a state of absent-mindedness with markedly reduced facial expression.
Short-term side effects
Our pooled analysis further revealed that the administra- tion of psilocybin caused only few subacute side-effects, as measured by the LC questionnaire 24 h after drug intake. Fur- thermore, those complaints that were reported significantly more often after psilocybin than after placebo concerned rela- tively mild conditions.
Except for headaches, all significantly affected items described symptoms of tiredness and exhaus- tion. Serious complications were not reported in any of the subjects. The reported after-effects of the LC questionnaire closely match the changes seen in the AMRS questionnaires 24 h after drug intake, namely, a moderate increase of tired- ness and reduction of activation.
The results of our analysis therefore suggest that psilocybin is usually well tolerated and that normal functioning is almost completely restored within 24 h after drug administration. These findings are in line with an investigation of Hollister (1961), which measured after effects of the administration of 36-205 µg/kg psilocybin to 17 subjects in 27 separate trials and also found occasional headaches and fatigue as being the most frequent complaints. Furthermore, our results are consistent with extensive tests in animals and humans, which found that psilocybin may be considered to be physiologically well tolerated (for a review, see Passie et al., 2002).
Long-term follow-up
Retrospective ratings of acute drug effects. At the time of the long-term follow-up 8-16 months after the last experi- mental session, the majority of subjects were still positively impressed by the psilocybin experience.
When subjects were asked to rate the acute psilocybin effects by six descriptive items, “enriching” was considered as most applicable. Over 60% of subjects rated the experience as very enriching and over 90% as enriching to at least a medium degree. Interestingly, several of our subjects rated the psilocybin experience as very enriching even though they had experienced signif- icant distress during the acute phase.
For instance, among the sixteen subjects who had an DED score of more than 50% of the maximum possible score, four subjects (25%) did not respond to the follow-up questionnaire, nine subjects (75% from those who responded) rated the experience as very enriching, two (17%) as medium enriching, and only one subject (8%) as not enriching.
The positive long-term resolution of acute distressful experiences by the majority the subjects might be partially explained by the strong support provided by our monitors, with whom subjects were able to talk freely about disturbing thoughts, feelings, and memories that had arisen during the session.
A significant number of our subjects reported not only enriching but also influential drug experiences. Our results are therefore in support of a recent follow-up study by Griffiths, Richards, Johnson, et al. (2008), in which psilocybin was found to facilitate experiences having enduring personal meaning and spiritual significance.
Changes in values and attitudes. Anecdotal reports and preliminary evidence from small-scaled experimental studies suggest that hallucinogenic drugs, when used under carefully controlled and supportive conditions, sometimes can lead to sustained positive changes in personality, attitudes, and values, particularly in those subjects who have experienced profound
personal insights and transcendent or mystical-type experiences. Among the most often reported subjective changes in attitude and personality are more self-understanding, more tolerance of others, less egocentricity, a less materialistic and aggressive orientation, and more appreciation of music, art, and nature (McGlothlin & Arnold, 1971).
Subjective changes in attitudes reported in the long-term follow-up ques- tionnaire of the present study are consistent with results of earlier follow-up studies (McGlothlin, Cohen, & McGlothlin, 1967; Doblin, 1991; Griffiths, Richards, Johnson, et al., 2008). We have found the highest percentages of subjects reporting positive changes in items measuring the attitude to ASC (56% of subjects), relations to the environment/nature (38%), and aesthetic experiencing (37%).
The observation that aesthetic experiencing (e.g., enhanced appreciation of art and music) was amongst the most often reported positive changes is par- ticularly interesting in light of an earlier placebo-controlled study by McGlothlin, Cohen, et al. (1967), which measured long-lasting effects of three high-dose LSD sessions in 24 healthy volunteers. In this study, greater appreciation of music (67% of subjects) and art (46%) were the most fre- quently reported subjective changes six months after the LSD experiments.
Furthermore, these subjective evaluations were supported by certain behavioral changes, such as increase in number of records bought, time spent in museums, and number of musical events attended.
Given the positive changes in attitudes and values reported by a relatively large proportion of subjects, it would be tempt- ing to conclude that hallucinogenic drugs hold a large and presently unused potential for increasing life-satisfaction and personal growth and for assisting psychotherapy.
However, our results should be considered as exploratory in nature be- cause possible changes have not been measured by validated questionnaires and no attempt has been made to correlate subjective changes with behavioral measures or information provided by close relatives and friends.
Therefore, we cannot rule out the possibility that the reported changes are biased towards preconceived opinions and expectations of subjects. Caution is especially warranted since it has been demonstrated that positive changes in personality, attitudes, and values are often attributed to the hallucinogen experience in subjects who have shown a previous interest in hallucinogenic drugs, but not in subjects whose hallucinogen intake was initiated by their psychotherapist (McGlothlin & Arnold, 1971).
Changes in drug consumption habits. Changes in drug use patterns that were reported in the follow-up question- naires of the present study were generally benign and well within expected ranges. Our results therefore indicate that a carefully-monitored administration of 1-4 doses of psilocybin to healthy volunteers within an experimental setting does not increase the risk for subsequent abuse of psilocybin or other illicit drugs.
Our results are consistent with the widely accepted view that classical hallucinogens have a very low abuse potential. Classical hallucinogens are not typically considered as drugs of addiction because they neither produce compulsive drug-seeking behavior nor physical withdrawal symptoms (O’Brian, 2005). They also cannot be considered as reinforcing substances because they fail to engender reliable self-administration behavior in laboratory animals (Deneau, Yanagita, & Seevers, 1969; Fantegrossi, Murnane, & Reissig, 2008).
The view that classical hallucinogens lack addictive qualities is further supported by epidemiological evidence. Recent general population survey data on lifetime prevalence of use of hallucinogenic mushrooms in 12 EU Member States indicate that among young people aged 15 to 24 years old, lifetime use of hallucinogenic mushrooms ranges from less than 1% to 8% (Hillebrand, Olszewski, & Sedefov, 2006).
Although psilocybin has, after cannabis, one of the highest lifetime prevalence rates of all illicit drugs, the proportion of recent (last 12 months) or current (last month) users is much lower for the use of psilocybin than it is for cannabis and ec- stasy. This observation suggests that the use of hallucinogenic mushrooms, like LSD, tends to be occasional, or discontinued after some time.
Regular use of classical hallucinogens is unlikely because tolerance to the effects rapidly develops after three to four daily doses (O’Brian, 2005). Furthermore, the intake of classical hallucinogens, especially in higher doses, is unattractive to many recreational drug users because it does not consistently produce any of the pleasurable effects of addictive drugs, such as escape, euphoria, anxiety relief, increase of self-esteem etc.
Although our experiments have shown that psilocybin can evoke highly-valued and in some cases even mystical-type experiences, subjects occasionally are also confronted with frightening and unpleasant thoughts, memories, and emotions. Moreover, as we have measured by the LC and AMRS questionnaires, most subjects describe the psilocybin effects as tiring.
This effect is further reflected by the observation that after 3-5 h the ‘coming-down’ from the psilocybin-effects, even if it has been a pleasant experience, is usually welcomed, and that most subjects are glad to regain their normal state of consciousness. Subjects often reported they were ‘saturated’ by new impressions and expressed the need to psychologically integrate their experience before they would consider repeating it.
Our findings are in line with a 10-year follow-up study by McGlothlin and Arnold (1971), which examined 247 subjects who had received LSD in either an experimental or therapeu- tic setting. As in our study, most subjects reported to have discontinued or reduced their frequency of hallucinogenic drug use.
The most often reported reasons for discontinuation were concerns about possible harm or illegality followed by a loss of interest. McGlothlin therefore speculated that in many subjects, hallucinogenic drugs lose their appeal over time simply because the uniqueness of the new modes of perception and thought that occur with them being often the primary incentive to take them in the first place is lost after repeated ingestion.
Spontaneous alterations of consciousness and flashbacks. Among the most often reported long-term sequelae of hallucinogenic drug use is a sudden and unexpected reoccurrence of all or certain aspects of the hallucinogenic effects, long after the drug should have worn off.
The phenomenon has been first described by (Sandison, 1954) and is often referred to as ‘flashback’. However, since its first description in the scien- tific literature (Horowitz, 1969), the term ‘flashback’ has been defined in so many ways that much confusion exists about its characteristics, prevalence, and aetiology (cf. Halpern & Pope, 2003). The present study avoided methodological in- consistencies of earlier follow-up studies and contributes to a better understanding of flashback phenomena after psilocybin administration by using operational criteria consistent with those of DSM-IV (‘Hallucinogen Persisting Perception Disor- der’ (HPPD), 292.89) and ICD-10 (‘Flashbacks’, F16.70).
Detailed questions about possible flashback phenomena and spontaneous ASC in the follow-up questionnaire of the present study indicated that none of our subjects fulfilled diag- nostic criteria for HPPD in DSM-IV or flashbacks in ICD-10. Furthermore, none of our subjects described visual phenom- ena reminiscent of the typical symptoms of HPPD mentioned under criterion A of HPPD in DSM-IV (292.89).
Our results support the view that HPPD and other troubling perceptual abnormalities rarely occur in a therapeutic or research context, where subjects are carefully screened and monitored and judi- cious doses of pharmaceutical quality drugs are given (Strass- man, 1984; Halpern & Pope, 2003).
The clinical relevance of flashback phenomena has been a matter of controversial debate for several decades. Whereas some researchers report virtually no such phenomena in series of hundreds or thou- sands of cases (Cohen, 1960; McGlothlin & Arnold, 1971), others report incidence rates as high 33% (Moskowitz, 1971) and 77% (Holsten, 1976) among individuals who have taken LSD. A recent review by Halpern and Pope (2003, pp. 116), which analyzed 20 quantitative studies reporting flashback phenomena, concludes that “the data do not permit us to estimate, even crudely, the prevalence of ‘strict’ HPPD”.
Halpern and Pope (2003) point out that most of these studies were published before operational diagnostic criteria for HPPD had been established and therefore used a wide variety of methodologies. They further criticize that confounding fac- tors such as recent drug intake, polydrug abuse, preexisting psychiatric disorders, and comorbidity often have been very poorly controlled in the studies.
It should also be noted that the scientific basis for the clas- sification of HPPD in DSM-IV appears to be formed almost exclusively by the research of Abraham and his colleagues (1982; 1983; 1988; 1996; 2001). Since the majority of Abra- ham’s work was focused solely on LSD use, we cannot safely infer that the diagnosis of HPPD has equal implications for all classical hallucinogenic drugs.
Interestingly, very few case reports have appeared on flashback-phenomena experienced by individuals who have used psilocybin, DMT, or mescaline exclusively. In fact, Hermle, Kovar, Hewer, and Ruchsow (2008) report in a recent review that there exists only one case report (Espiard, Lecardeur, Abadie, Halbecq, & Dollfus, 2005) where HPPD occurred after hallucinogenic mushroom use.
Prolonged adverse reactions. The present study supports the notion that prolonged adverse reactions, such as persisting psychosis or depression, are exceedingly rare when psilocybin is administered to well-adjusted subjects in a controlled ex- perimental setting (Strassman, 1984; Abraham and Aldridge, 1993; El-Mallakh, Halpern, and Abraham, 2008).
We have found no incidences of prolonged psychotic reactions or pre- cipitations of schizophrenia-spectrum disorders in the 110 subjects studied. However, one of our subjects experienced symptoms of emotional instability, anxiety, and depression, which lasted several weeks and were severe enough for him to seek professional help.
A few subjects described occasional mood swings, reactivation of old problems, excessive pensiveness and introversion, and memory and concentration problems in the first few weeks after the drug session. Although these adverse after-effects were generally benign and in all cases resolved after a few weeks, they underline the importance of careful debriefing and follow-up of subjects – especially in the first few days and weeks after drug administration.
reference link : DOI: 10.1177/0269881110382466
More information: A “trip” to the ICU: intravenous injection of psilocybin, Journal of the Academy of Consultation-Liaison Psychiatry. DOI: 10.1016/j.jaclp.2020.12.012
