psilocybin (magic mushrooms)

Introduction

psilocybin “magic mushrooms” are often used as psychedelic hallucinogens with relatively short duration of effects although these can cause severe serious psychological adverse effects, and rarely respiratory paralysis
experienced users generally employ harm reduction or benefit enhancing strategies and these can be categorised into three themes¹⁾:
- before psychedelic use
  - mental preparation “set”
    - “embrace the experience and whatever you encounter on your journey”
    - “learn about psychedelic experiences/substance you are taking”
    - “clear time before and after for preparation and recovery”
    - “prepare for anxiety/challenge, whatever you are feeling will go away”
  - environment “setting”:
    - “be with people you love/trust”
    - “have a guide/sitter/facilitator”
    - “be in a safe, familiar, and comfortable location ”
    - “music that will facilitate trip”
  - “start small (low doses)”
- during psychedelic experience
  - “have water on hand and hydrate often”
- after the experience (integration)
small numbers of treatments with psychedelic-assisted psychotherapy can potentially offer significant and sustained alleviation to symptoms of multiple psychiatric conditions

the National Drug Strategy Household Survey from 2022–23 saw the percentage of Australians who used a psychedelic drug rise from 1.6 per cent in 2019 to 2.4 per cent three years later taking the number of people who use these drugs annually up to about 500,000 people and 12.2% of those over aged 14 stated that they had used them at least once, up from 7.6^ in 2001. ²⁾

although the risks and harms of psychedelics from a physical perspective are low, psychedelic drugs carry a unique psychological risk profile which is increased in uncontrolled settings.³⁾
adverse experiences including feelings of loneliness, nightmares, anxiety, uncontrollable worrying, panic, despair, hallucinations, disorientation, derealization, suicidality, psychotic disorder, manic symptoms, cardiovascular events, and hallucinogen persisting perception disorder have been documented. Adverse experiences such as anxiety and fear, existential struggle, social disconnection, depersonalization, and derealization can persist after psychedelic experiences, sometimes for over a year ⁴⁾
vomiting was the most frequent reported adverse physical effect, with some respondents experiencing headaches, abdominal pain, and breathing difficulties;
serotonin syndrome may occur when certain psychedelics are taken by those using specific antidepressant classes

see Wood-lover paralysis
“wood lovers paralysis”
- a rare toxidrome, which has often been associated with the consumption of the psilocybin native Australian hallucinogenic fungi Psilocybe subaeruginosa (aka subs or gold tops) ⁵⁾⁶⁾
- may cause leg weakness, difficulty swallowing and respiratory muscle paralysis and possibly death from respiratory failure
- severe cases may require intubation
- symptoms appearing most commonly within four hours of ingestion and generally improves after 24hrs

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