Over 5 million people could benefit from taking psychedelics — but there’s one catch

ATLANTA — As psychedelic medicine inches closer to mainstream acceptance, researchers have tackled a crucial question: How many Americans with mental health issues would benefit from psilocybin-assisted therapy? According to a new study published in Psychedelics, the answer ranges from 2.2 to 5.6 million people currently being treated for major depression. However, there’s one major catch — psychedelics are still awaiting FDA approval for medical use.

Psilocybin, the active compound found in “magic mushrooms,” has shown promising results in treating depression, particularly in cases where traditional antidepressants have failed. The FDA has already designated it as a “breakthrough therapy,” fast-tracking its path toward potential approval.

However, not everyone with depression will be eligible for this innovative treatment. The study, led by researchers from Emory University, the University of Wisconsin-Madison, and UC Berkeley, analyzed various medical conditions that might make psilocybin therapy unsafe for certain patients.

“This information is significant because much of the current focus on psychedelic therapies is about its efficacy within clinical trials, and very few people are studying what would be the broader implications of implementing these novel therapeutics,” says Fayzan Rab, lead author of the study and M.D. candidate at Emory University’s School of Medicine, in a media release. “Our study is one of the first to look at the bigger public health and economic consequences of a world where psilocybin therapy is made more available to Americans.”

The researchers found that depending on how strictly medical providers apply safety criteria, between 24% and 62% of patients currently receiving depression treatment could qualify for psilocybin therapy. For those with treatment-resistant depression—defined as failing to respond to at least two different antidepressant medications—the numbers range from 600,000 to 1.7 million eligible patients.

Several medical conditions could disqualify someone from receiving psilocybin therapy. These include psychotic disorders, recent suicide attempts, uncontrolled diabetes, recent heart attacks, stroke history, epilepsy, and certain personality disorders. The researchers found that when applying the strictest clinical trial criteria, about 76% of depression patients would be excluded from treatment.

However, in real-world settings, some exclusion criteria used in clinical trials might not apply. For instance, while current trials typically exclude patients with alcohol or substance use disorders, evidence suggests psilocybin therapy might actually benefit these individuals. When researchers adjusted their estimates to reflect more realistic clinical scenarios, the percentage of eligible patients more than doubled.

“Coming to the aid of people who are suffering is very important, and psilocybin-assisted therapy could help people arrive to a place of satisfaction within themselves so that their lives achieve optimal meaning and purpose,” says George Grant, MDiv, PhD, and co-director of Emory University’s Center for Psychedelics and Spirituality. “Psychedelic medicines have promise because the intervention is so fast acting, whereas right now, insurance providers and payers often need to fund the use of antidepressants throughout their lives.”

The study’s findings have significant implications for healthcare planning and resource allocation. If psilocybin therapy receives FDA approval, healthcare systems will need to prepare for potentially millions of patients seeking this treatment option. This includes training therapists, establishing treatment facilities, and creating clear guidelines for patient screening.

The accessibility of psilocybin therapy will likely vary significantly by region. States like Oregon and Colorado, which have already legalized psychedelic therapies, may see higher initial demand while other states work to establish their regulatory frameworks. Urban areas may have better access to trained professionals and treatment facilities compared to rural regions.

Insurance coverage will play a crucial role in determining who can actually access these treatments. Medicaid, as the largest healthcare payer in the United States, could significantly influence access through its coverage decisions. With 18-20% of Medicaid beneficiaries experiencing clinical depression, their coverage policies could dramatically impact the treatment’s availability to lower-income Americans.