Antipsychotic prescribing trends in schizophrenia between 2011 and 2021: real-world data from a US electronic health record database

Background: Psilocybin-containing mushrooms have attracted increasing research and public interest in recent years due to promising early evidence on psilocybin's therapeutic potential.Although physiologically relatively nontoxic, adverse reactions are however occasionally reported.Scientific study of such reactions outside clinical contexts has remained scarce yet is of high importance amidst evidence of increasing use in the community.Aims: The present study investigated the 12-month prevalence, predictors and nature of magic mushroom-related adverse reactions resulting in emergency medical treatment seeking (EMT) in two international samples of people reporting magic mushroom use.Methods: We use data from the Global Drug Survey (GDS), a large annually conducted anonymous online survey on patterns of drug use, reporting findings from survey years 2017 and 2020.Prevalence of EMT seeking was calculated for both surveys, in addition to per-event risk estimate from 2020 data where information on number of EMT incidents was available.A multivariable logistic regression analysis was conducted to investigate predictors of EMT seeking from combined data of both years, with predictor variables age, gender, lifetime diagnosis of mental health condition, and past-year frequency of use.In addition, separate multivariable logistic regressions were conducted for each survey year focusing on additional predictor variables relating to amount of mushrooms consumed whose measurement differed between survey years, as well as presence of previous experience with magic mushrooms included in GDS2017.Finally, we examined the nature of incidents, including symptom profile and perceived reasons of adverse reactions, from a specialist section included in GDS2017.Results: Out of 9,233 past year magic mushroom users in GDS2017, 19 (0.2%) reported having sought emergency medical treatment.Out of 11,933 magic mushroom users in GDS2020, 66 (0.6%) had sought EMT, with a per-event risk estimate of 0.3%.Younger age (p¼.002), higher frequency of use, and survey year 2020 (p's<.001)were associated with increased risk of EMT seeking, in addition to higher number of mushrooms consumed on a day of use in GDS2017 (p<.001).Results from the GDS2017 specialist section revealed most common symptoms were psychological, namely anxiety/panic and paranoia/suspiciousness. Poor 'mindset', poor 'setting', and mixing substances were most reported reasons for incidents.58% had consumed other substances in the lead-up to the incident, most frequently cannabis (37%) and alcohol (32%).All but one of the 19 respondents returned to 'normality' within 24 hours.Conclusions: The results confirm psilocybin mushrooms are a relatively safe drug, with serious incidents rare and short lasting.The observed threefold increase in the prevalence of incidents from 2017 to 2020 raises concerns of the possible impact of sometimes overwhelmingly positive portrayal of psilocybin mushrooms in recent media.Providing harm reduction information of safety precautions, such as of the importance of 'set' and 'setting', is increasingly important and likely plays a key role in preventing adverse effects.More research is needed to examine the detailed circumstances and predictors of adverse reactions including rarer physiological reactions.Conflict of interest Disclosure statement: