Therapeutic use of psilocybin: Practical considerations for dosing and administration
This review (2022) aims to provide healthcare professionals with an overview of practical considerations for psilocybin therapy, focusing on patient safety.
Authors
- MacCallum, C. A.
- Pistawka, C. A.
- Deol, J. K.
Published
Abstract
The interest in psilocybin as a therapeutic approach has grown exponentially in recent years. Despite increasing access, there remains a lack of practical guidance on the topic for health care professionals. This is particularly concerning given the medical complexity and vulnerable nature of patients for whom psilocybin-assisted psychotherapy may be considered. This article aims to provide health care professionals with an overview of practical considerations for psilocybin therapy, rooted in a patient safety focus. Within this piece we will review basic psilocybin pharmacology and pharmacokinetics, indications, practical therapeutic strategies (e.g., dosing, administration, monitoring) and safety considerations (e.g., contraindications, adverse events, and drug interactions). With this information, our goal is to increase the knowledge and comfort of health care professionals to discuss and counsel their patients on psilocybin therapy, ultimately improving patient care and safety.
Research Summary of 'Therapeutic use of psilocybin: Practical considerations for dosing and administration'
Introduction
Interest in psilocybin as a therapeutic agent has expanded rapidly in recent years after a long period of restricted research and access dating back to the 1960s. Psilocybin, the principal psychoactive compound in several Psilocybe mushroom species, has a long history of traditional use in Mesoamerican cultures and has re-emerged in Western medicine following encouraging results from clinical trials in areas such as cancer-related distress and treatment-resistant depression. Regulatory shifts — for example, the US Food and Drug Administration granting breakthrough therapy status for psilocybin in 2018–2019, and changes to access pathways in jurisdictions such as Oregon and Canada — have increased demand for practical clinical guidance for health care professionals (HCPs). Blest-Hopley and colleagues set out to provide HCPs with an accessible, safety‑focused overview of practical considerations for psilocybin-assisted psychotherapy (PAP). The paper reviews basic pharmacology and pharmacokinetics, summarizes current evidence for therapeutic indications, and offers practical recommendations on dosing, administration, monitoring, contraindications, drug–drug interactions, and adverse events. The authors emphasise the need for clinicians to be prepared to discuss psilocybin with patients as legal and decriminalisation landscapes evolve, and note that non‑medical models of access exist alongside medical pathways but are not the primary focus of this manuscript.
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MacCallum, C. A., Lo, L. A., Pistawka, C. A., & Deol, J. K. (2022). Therapeutic use of psilocybin: Practical considerations for dosing and administration. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.1040217
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Blest-Hopley, G., Pasculli, G., Ruffell, S. G. D. et al. · Frontiers in Psychiatry (2025)
Tylš, F., Páleníček, T., Klučková, T. et al. · Pharmacological Reports (2025)
Jacobs, E., Murphy-Beiner, A., Rouiller, I. et al. · Neuroethics (2023)
Haikazian, S., Chen-Li, D., Johnson, D. et al. · Psychiatry Research (2023)
Pereira, L. · European Neuropsychopharmacology (2023)
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