Oregon Psilocybin Program Raises Safety Concerns as Use Expands Beyond Medical Indications, Johns Hopkins Study Finds
Key Insights
A Johns Hopkins University (search) study published in the International Journal of Drug Policy finds Oregon's psilocybin program has evolved beyond strictly medical uses, with many clients citing general wellness and expanded consciousness as reasons for participation.
Researchers report a low number of adverse reactions but warn of safety concerns when individuals seek psilocybin for serious medical or psychiatric conditions, noting possible underreporting of negative events.
Most program clients come from high-income backgrounds and reside outside Oregon, raising questions about equitable access and the program's broad eligibility criteria codified in state law.
Oregon's pioneering psilocybin access program has drawn scrutiny from researchers at Johns Hopkins University (search), who found that the state's "supported adult use" model has expanded well beyond strictly medical applications, raising several safety concerns about how the program operates in practice.
The study, published in mid-June in the International Journal of Drug Policy, analyzed 2025 data from the Oregon Health Authority (search) and represents one of the first systematic examinations of the nation's only state-regulated psilocybin access framework since voters approved the Oregon Psilocybin Services Act in November 2020.
A Program Shaped by Wellness, Not Medicine
Researchers found that a significant proportion of clients reported using psilocybin services for general health and wellness, rather than for treating specific medical or psychiatric conditions. The top three reasons for participation in 2025 were general health and wellness, change in perspective, and "expanded consciousness," according to state data cited in the study.
"Some people reported seeking out psychedelic services for general well-being while others reported seeking out services to treat medical or psychiatric conditions," said David Yaden, an associate professor of psychedelic research at Johns Hopkins University (search) School of Medicine. "There is some ambiguity about whether the services were designed to support these kinds of medical treatment related reasons, and this is an area for further discussion and consideration on the policy level."
The study also revealed that most patients in Oregon's program come from high-income backgrounds and from outside the state, raising questions about who is actually benefiting from the landmark policy.
Low Adverse Events, but Reporting Gaps Remain
Yaden noted that the program's "risk profile" was better than he expected, pointing to a low number of reported negative responses involving psilocybin. However, he cautioned that concerns may not be fully captured by current reporting mechanisms, leaving open the possibility that adverse events are being undercounted.
The researchers warned that the program raises "several safety concerns," particularly when individuals seek psilocybin for serious medical issues without the structured medical oversight that would accompany clinical trial settings.
Regulatory Framework and State Response
Oregon remains the only state to employ a "supported adult use" model, under which adults over 21 can access psilocybin for personal reasons as long as they are supervised by a licensed facilitator at a service center. Erica Heartquist, a spokesperson for the Oregon Health Authority (search), emphasized that the program's broad eligibility criteria are codified in state law and "not expanded by the agency."
She pointed to program requirements stipulating that "psilocybin products consumed must be cultivated or produced by a licensed psilocybin manufacturer, tested by a licensed laboratory, and may only be provided to a client by a licensed psilocybin service center during an administration session."
The findings arrive as Oregon implements a four-year plan from 2025 to 2029 aimed at destigmatizing psilocybin "as a culturally responsive option for healing and wellness." State health officials have referenced research on psilocybin's use for healing in Indigenous communities as well as its potential in addressing depression (search), alcohol and tobacco dependency, and trauma.
Pharmacology and Knowledge Gaps
Psilocybin, typically consumed in mushroom form, produces a chemical compound similar to serotonin, the neurotransmitter involved in regulating mood, appetite, cognition, and perception. Research has demonstrated that psilocybin can alter the brain's ability to both strengthen and weaken neural pathways. However, the study authors note that less information is available about the effects of numerous other compounds present in psilocybin mushrooms.
Ongoing Research Efforts
The Johns Hopkins study is not the only investigation into Oregon's program. A federally funded study announced in February by Oregon Health & Science University (OHSU) aims to examine the safety and effectiveness of psilocybin access in community settings rather than highly regulated laboratories.
Todd Korthuis, co-director of OHSU's Oregon Psilocybin Evaluation Nexus, said his group plans to release findings in July that detail how individuals respond to psilocybin up to 72 hours after treatment, extending beyond the current practice of monitoring only on the day of administration. This data will help researchers evaluate whether more negative reactions occur among individuals who turn to psilocybin for serious conditions such as trauma or depression (search).
"I am cautiously optimistic that expanding services through state regulated programs will be a good thing, but we won't know that for sure until we have long term data on people accessing these services," Korthuis said.