Over the past few years, the United States has seen a growing acceptance of psychedelic mushrooms. Since 2019, two states and a variety of cities and towns across the country have moved to decriminalize psilocybin, the psychoactive compound found in the mushrooms. In Massachusetts, six communities have joined the movement, with Salem being the most recent, after the City Council approved a measure to decriminalize psilocybin containing fungi last month. Lawmakers on Beacon Hill are even contemplating decriminalizing the substance at a statewide level, with bills to do so introduced into the Massachusetts House and Senate this past January. Many supporters of the effort say the mushrooms have a therapeutic effect that could be used in a variety of ways to treat mental illnesses such as anxiety, depression and addiction. To help us get to the bottom of how psychedelic mushrooms affect us, GBH's All Things Considered host Arun Rath spoke with Dr. Peter Grinspoon, a psychedelics educator, cannabis specialist and instructor in medicine at Harvard Medical School.

Arun Rath: So, studies on using psychedelics therapeutically have taken off in recent years, and we hear some pretty dramatic testimonials, anecdotally. Can you first give us a sketch of what we now know about the therapeutic potential of psilocybin mushrooms?

Dr. Peter Grinspoon: Well, the mushrooms, of course, have been used therapeutically for thousands of years by many indigenous cultures, and there was quite a bit of research in this country until the war on drugs got in the way. We've had about a 50 year hiatus in the research, but recently, over the last 10 years, there's been an explosion of interest in studying the therapeutic potential of psychedelic mushrooms or psilocybin, and also MDMA, ketamine, other psychedelic substances. The studies have been remarkable and I don't think anything's definitive yet. We're still in the process of learning about this, but for example, treatment resistant depression is one of the cruelest conditions that someone could be afflicted with. It means you've been resistant to at least three different antidepressants with no benefit. The mushrooms and other psychedelics seem to have potential for exactly these types of extremely difficult to treat conditions. So, the psychiatric community is on fire, the activist community is on fire. Everybody's very, very excited to get these medications, not just legal, but legal, accessible and affordable.

Rath: Could you talk also about the risks if, say, someone were to ingest psilocybin outside of a formal therapeutic context? I think we know there can be bad outcomes, right?

Dr. Grinspoon: Yeah, there certainly could be bad outcomes even within a therapeutic context. It's hotly debated if mushrooms should be legal to do with a psychiatrist or if it should be for people walking around in the woods with their friends, doing it responsibly with a trip sitter, someone who's not using the mushrooms. It's hotly debated whether they even need to be strictly in a therapeutic context. The advantage of a therapeutic context, of course, is that there's medical professionals and personnel in case there is a bad outcome. Those outcomes mostly have to do with anxiety. The most important thing with many of these psychedelics is set and setting, making sure you're in a peaceful, relaxed state of mind and nobody's asking you to be responsible for anything stressful. You [need to] pay attention to set and setting, and if also be reasonable about the dosage, you don't want to take what's called a heroic dose of mushrooms. That can be very disorienting. The main adverse effects can be anxiety and rarely, psychedelics can trigger psychosis, but generally that's extremely rare. The main concern is anxiety attacks and panic attack. Certainly no one would question the utility of being in a therapeutic venue because then you could have a safety backup. But again, many people believe that these things are not that dangerous. In the big picture, people can learn to use them safely and they shouldn't strictly be restricted to medical context.

Rath: With the current legal classification, outside of participating in one of these sanctioned studies, are qualified therapists or others able to obtain or prescribe psilocybin for their patients?

Dr. Grinspoon: Obtain yes, in the gray market. Prescribed? No, because psilocybin is still astoundingly just like cannabis, a schedule one controlled substance. That means it has a high abuse liability. Except psilocybin does not have a high abuse liability. It's not even addictive. It may have low potential abuse liability. The other qualification for schedule one is no medical utility. Now, as I mentioned before, we've known about their medical utility for hundreds, if not thousands of years and with all these new studies coming out, it's beyond a shadow of a doubt that for some people, they are incredibly effective. So, they need to be taken out of schedule one immediately. Yesterday. Because that just interferes with the research in it. It provides criminal penalties for people who are just trying to help themselves and heal themselves. There's no reason to get law enforcement involved with any of this. It is right now impossible to prescribe, again because it's schedule one, though many people think that within the next year or two, they're going to approve it, at least for emergency use. That should no longer keep it stuck in schedule one, and it'll be a lot easier for people to access and to study and to use these substances.

Rath: Is it safe to say that you support the move towards legalization at the local level and beyond?

Dr. Grinspoon: Absolutely. I've actually helped with the local legalization initiatives. I think it's great they don't just legalize the mushrooms. They educate people. For example, they educate police to help the person, not arrest them if they're having a bad trip. That is a huge harm reduction, and if there's less of a climate of fear because these things aren't illegal, people are more likely to get help and people are less anxious about using them in general. You're less likely to have these bad outcomes, which are usually anxiety related in the first place. So, I'm a huge proponent.

Now, I can see both sides of the argument about the benefit of doing it in a medicalized context with a psychiatrist who knows about it, a therapist or two who can help you integrate it. All that's great, assuming you can get someone to pay for it. We need the insurance companies to step up. But I also see the utility of people being allowed to use these ancient substances that humans have been using for thousands of years without needing to be able to afford it. I work in an inner city clinic. None of my patients are going to be able to afford this psychedelic therapy. That doesn't mean it should be off limits to them. It shouldn't be illegal. I'm a big advocate of having people able to make their own choices, and I do think they should be legal. However, I don't think they should be legal in the same way that cannabis is per se. You don't want a dispensary, you don't want the equivalent of like a bud tender, I guess a shroom tender upselling you. People will take really high doses. You don't want that at all. I envision it more like a state run store where they're legal and there are no criminal penalties, but it's not like the sort of free for all you can get at an alcohol store or a cannabis store.

Rath: That was actually my next question, were there lessons to be taken from the legalization of cannabis, a ways to, or how not to legalize psychedelics?

Dr. Grinspoon: Well, the main lesson from the legalization of cannabis is that the legalization of cannabis has been a profound historical success. Now, 38 states have medical marijuana and 23 have full adult legalization. [A 2017 poll showed] 94% of Americans support legalization of medical marijuana and there's not a single state that's saying "We made a mistake, let's illegalize cannabis." So, getting law enforcement out of it and using the money for taxes to help society is a much better thing.

I think that cannabis really paves the way in that we have a green light for legalizing the mushrooms. The only difference is mushrooms are stronger and as you alluded to before, you could have a bad trip. Certainly the legalization has to have some guardrails or controls. I mean, some people have suggested that you need a training course, like a very short certification. Understand about dose, set and settings, so they're not going to have an awful experience. I think you could legalize them sensibly, helpfully, in a way that maximizes benefit and minimizes harm without having law enforcement involved at all. But at the same time, not necessarily having it be an open free for all.

Rath: Dr. Grinspoon, this has been fascinating. Thank you so much.

Dr. Grinspoon: Thank you so much for having me.