This multi-dataset observational study (n=5 nationally representative surveys) quantifies changes in psilocybin use and healthcare utilisation in the United States between 2014 and 2023. It finds that adult lifetime use increased from 10.0% (25 million) in 2019 to 12.1% (31.3 million) in 2023, while adolescent use rose modestly from 1.1% to 1.3% during the same period.
Background
Psilocybin is being studied as a potential treatment of mental health and substance use disorders. As the first hallucinogenic substance decriminalized in some states within the United States, patterns of psilocybin use have likely changed.
Objective
To quantify change in prevalence and health care utilization of psilocybin users between 2014 and 2023.
Methods
We included 5 nationally representative data sets: the National Survey on Drug Use and Health (NSDUH), the Survey of Non-Medical Use of Prescription Drugs (NMURx), Monitoring the Future (MTF), the National Poison Data System (NPDS), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) (Table) (1-5). Psilocybin use prevalence estimates were calculated annually and plotted using the appropriate design-based adjustments. The relative change and 95% CI in estimates between 2019 and 2023 were calculated; 2019 was selected as the reference for change over time because this was the first year that psilocybin legalization policy changed anywhere within the United States.
Findings
Psilocybin use across data sets was relatively stable before 2019. Lifetime use among adults (aged ≥18 years) increased from 10.0% (95% CI, 9.7% to 10.3%) in 2019 to 12.1% (CI, 11.6% to 12.6%) in 2023, from 25 to 31.3 million (NSDUH). Lifetime use among adolescents (aged 12 to 17 years) increased from 1.1% (CI, 0.9% to 1.3%) in 2019 to 1.3% (CI, 1.0% to 1.6%) in 2023, from 285 000 to 344 000 (NSDUH).
Papers in Blossom that reference this study
Simon, G., Tadmor, N., Evans, J. et al. · Research Square (2026)
Gregorio, G. D., Basset, S., Manmohan, H. et al. · Research Square (2026)
Simonsson, O., Hendricks, P. S., Swords, C. M. et al. · Journal of Affective Disorders (2025)
Among adults who reported psilocybin use, prevalence was higher in those with mental health or chronic pain comorbidities. Using data from the NMURx survey, the investigators report past-year use among adults with moderate or severe anxiety symptoms at 5.3% compared with 1.7% in those with no or mild symptoms, and 5.2% for those with moderate or severe depression versus 1.6% for those without. Adults reporting chronic pain had a past-year prevalence of 3.4% versus 1.6% among those without chronic pain. Poison-centre data showed large relative increases in psilocybin exposures. Reports to U.S. poison centres rose 201% among adults (aged ≥18 years), 317% among adolescents (aged 12 to 17 years), and 723% among children (aged 0 to 11 years). In 2023 the extracted text lists 1 192 adult cases, 542 adolescent cases, and 288 paediatric cases; overall, 76.7% (1 550 of 2 022) of reported exposures involved a health care facility according to the poison-centre data. By contrast, routine health care encounter coding did not reflect comparable numbers. The National Hospital Ambulatory Medical Care Survey (NHAMCS) recorded only three cases of psilocybin poisoning in emergency departments and outpatient facilities over 2015–2021 (two in 2016, one in 2020). The extracted text does not provide further methodological detail about denominator populations, sampling frames, or analytic approaches for these reported figures in this section.
Rockhill and colleagues interpret these findings as evidence that both lifetime and past-year psilocybin use in the United States increased from 2019 to 2023 across age groups. They note that the NMURx estimate of 2023 past-year adult psilocybin use exceeded contemporaneous NSDUH estimates for several other illicit drugs, suggesting substantial recent uptake. The researchers highlight a discrepancy between poison-centre reports and health-care encounter coding: many exposures reported to poison centres involved health care, yet International Classification of Diseases, 10th Revision (ICD-10) codes in NHAMCS did not capture a similar burden. They propose that current ICD-10 coding may be insensitive for monitoring psilocybin-related health care impact, while acknowledging that coding practices could change as clinician awareness increases. The study team also emphasises the association between psilocybin use and comorbid mental or physical health conditions and raises the possibility that state-level legal and regulatory changes have encouraged attempts at self-treatment. From a policy and implementation perspective, they recommend rigorous education and enforcement of dose limits in regulated programmes, and the development of new passive and active surveillance tools to better characterise who is using psilocybin, why they use it, clinical outcomes, and public-health impacts within state-regulated settings. Finally, the authors identify the study's principal strength as the multisource characterisation of change across several data sets, and they acknowledge the primary limitation that the outcomes reported here are self-reported. They conclude that rising use of psilocybin warrants consideration by public-health and health-care professionals when developing policy and interventions.