Self-reported negative outcomes of psilocybin users: A quantitative textual analysis

RESEARCH ARTICLE Self-reported negative outcomes of psilocybin users: A quantitative textual analysis Bheatrix Bienemann1, Nina Stamato Ruschel1, Maria Luiza Campos1, Marco Aurélio Negreiros1, Daniel C. Mograbi ID1,2* 1 Department of Psychology, Pontifı́cia Universidade Católica, São Paulo, Brazil, 2 Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, England, United Kingdom a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Bienemann B, Ruschel NS, Campos ML, Negreiros MA, Mograbi DC (2020) Self-reported negative outcomes of psilocybin users: A quantitative textual analysis. PLoS ONE 15(2): e0229067. https://doi.org/10.1371/journal. pone.0229067 Editor: Giuseppe Carrà, Universita degli Studi di Milano-Bicocca, ITALY Received: September 12, 2019 Accepted: January 28, 2020 Published: February 21, 2020 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0229067 Copyright: © 2020 Bienemann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The article analyses data already publicly available at www.erowid.org. Funding: D.C.M. acknowledges funding from the National Research Council (CNPq ref 312370) and * Abstract Psilocybin, a substance mainly found in mushrooms of the genus psilocybe, has been historically used for ritualistic, recreational and, more recently, medicinal purposes. The scientific literature suggests low toxicity, low risk of addiction, overdose, or other causes of injury commonly caused by substances of abuse, with growing interest in the use of this substance for conditions such as treatment-resistant depression. However, the presence of negative outcomes linked to psilocybin use is not clear yet. The objective of this study is to investigate the negative effects of psilocybin consumption, according to the users’ own perception through self-reports extracted from an online platform. 346 reports were analyzed with the assistance of the IRAMUTEQ textual analysis software, adopting the procedures of Descending Hierarchical Classification, Correspondence Factor Analysis and Specificities Analysis. The text segments were grouped in 4 main clusters, describing thinking distortions, emergencies, perceptual alterations and the administration of the substance. Bad trips were more frequent in female users, being associated with thinking distortions. The use of multiple doses of psilocybin in the same session or its combination with other substances was linked to the occurrence of long-term negative outcomes, while the use of mushrooms in single high doses was linked to medical emergencies. These results can be useful for a better understanding of the effects of psilocybin use, guiding harm-reduction initiatives. Introduction The growing use of psychedelic substances has been prominent in epidemiological research. According to the United Nations Office on Drugs and Crimes 2019 World Drug Report, there is an upward trend in recent years on quantities of hallucinogenic substances seized all over the world. This is in agreement with reported qualitative information on increasing use of this class of substances recently [1, but see 2]. Data from the 2019 Global Drug Survey indicates that among the 20 drugs used most prominently over the past year, 6 were psychedelic drugs [3]. From 2017 to 2019, “magic mushrooms” (mushrooms from the genus psilocybe) in particular had increases in lifetime use from 24.4% to 34.2% and use in the last 12 months from 10.4% to 14.8% [3, 4]. These increases are mirrored by the growth of the new psychoactive PLOS ONE | https://doi.org/10.1371/journal.pone.0229067 February 21, 2020 1 / 14 Self-reported negative outcomes of psilocybin users the Carlos Chagas Filho Research Support Foundation (FAPERJ ref 226501). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. substances (NPS) market in Europe in the last years [2], with some NPS attempting to mimic the effects of classic psychedelics. Psilocybin (4-phosphoryloxy-N,N-dimethyltryptamine), the active ingredient in “magic mushrooms”, has been investigated in relation to its medicinal properties, in particular for conditions such as treatment-resistant depression (TRD) [5], with suggestions that psychedelic research may lead to a paradigm shift in psychiatry [6, 7]. Psilocybin has also shown potential clinical benefits for depression and anxiety in end-stage cancer [8], possibly with reductions in death anxiety underpinning its therapeutic effects [9]. Although psilocybin is considered a toxicologically safe substance [10–12], there is no scientific consensus on the risks that the use of psilocybin may bring [13]. In a recent study by Carbonaro et al. [14], 10.7% of users reported that, under psilocybin, they placed themselves or others at risk of physical damage; 2.6% reported being violent or physically aggressive with themselves or others, and 2.7% reported having sought help in a hospital or emergency room. Regarding mental health outcomes, significant associations between the consumption of hallucinogens throughout life and mood, anxiety, personality, eating and substance abuse disorders were found in an epidemiological study [15]. This is in agreement with anecdotal evidence indicating persistent anxiety disorder after consumption of mushrooms containing psilocybin [16]. However, there are divergences relative to these findings. In a populational study by Krebs and Johansen [17], no negative mental health outcomes related to the use of classical psychedelics [LSD (lysergic acid diethylamide), psilocybin, mescaline or peyote (Lophophora williamsi)] were found. In fact, the authors reported findings indicated that the use of psychedelics was associated with decreased mental health problems. Similarly, another large epidemiological study found no relationship between psychedelic use and incidence of psychosis [18]. In addition, some recent studies have demonstrated the potential for psilocybin to treat or alleviate symptoms present in different clinical conditions [e.g. 6,19–21]. The analysis of self-reported user data is a method often neglected in the scientific literature. There are sites exclusively devoted to the storage and dissemination of information about psychoactive substances, with users visiting these sites to informally publish and share repor (...truncated)