National and regional trends in seizures of shrooms (psilocybin) in the United States, 2017–2022

Abstract

Background:

Psilocybin, the principle psychoactive component in “shrooms”, is regaining acceptance in therapeutic settings, leading to media coverage of medical benefits associated with use. Possession is also becoming increasingly decriminalized throughout the United States. There is a lack of data on prevalence of shroom use, but trends in law enforcement seizure data can provide one indicator of shroom availability in US communities. We determined whether seizures of shrooms have shifted between 2017 and 2022.

Methods:

This study examined national and regional trends in counts and total weight of shroom seizures reported to High Intensity Drug Trafficking Areas in the US between 2017 and 2022 (N=4526).

Results:

There were 402 seizures in 2017 compared to 1396 in 2022 with the plurality occurring in the Midwest (36.0%), followed by the West (33.5%). Between 2017 Quarter 1 (Q1) and 2022 Quarter 4 (Q4), the number of seizures increased by 368.9% (AQPC=7.0; 95 CI: 5.9–8.1) and there were significant increases in all four regions. In terms of weight, 226.0 kg was seized in 2017 vs. 844.0 kg in 2022, and the greatest total weight in seizures was in the West (1864.2 kg, 42.6%), followed by the South (1831.9 kg, 41.8%). Between 2017 Q1 and 2022 Q4, the total weight seized in the US increased by 2749.7% (AQPC=6.2, 95% CI: 0.3–12.4) and there were significant increases in all four regions.

Conclusions:

Seizures of shrooms have increased, suggesting that availability may be escalating; thus, increases in prevention efforts and harm reduction education are warranted.

1. Introduction

Psilocybin, the principle psychoactive component in “magic mushrooms” or “shrooms”, is the most prevalent plant-based hallucinogen used in the United States, with an estimated 9.2% of individuals aged ≥12 reporting having ever used by late 2019 (Walsh et al., 2022). Estimates from national surveys suggest that use was most prevalent by the mid-1970 s and that use thereafter declined (Miech et al., 2023), but evidence suggests that self-reported use of shrooms has been increasing. Specifically, between 2002 and 2019, lifetime reported use of shrooms increased among individuals age ≥12 in the US, with increases appearing to be driven by adults age ≥26 (Walsh et al., 2022). Recent increases in the past-year use of hallucinogens other than LSD have also been reported in a national panel study of adults aged 19–30, which estimated an increase from 3.4% in 2019 to 6.6% in 2021 (Keyes and Patrick, 2023). Although the use of shrooms is less likely to lead to serious adverse effects or use disorder like some other common illegal drugs (Gable, 2004; Nutt et al., 2010), adverse effects such as “bad trips” (fueled by thinking distortions and perceptual alterations) do occur (Bienemann et al., 2020). Among people responding to an online survey about their worst “bad trip”, 39% rated it among the top five most challenging experiences in their lifetime (Carbonaro et al., 2016). In 2021, there were 439 exposures reported to Poison Control in the US, 30.1% of which involved exposure among children age ≤5 (Gummin et al., 2022). One study estimated that over a fifth (21.4%) of adults attending nightclubs and dance festivals in New York City used shrooms in the past 12 months and 10.9% reported experiencing a harmful or very unpleasant effect in which they were worried about their immediate safety (Palamar et al., 2019). A more recent study focusing on this population found that 8.3% of attendees who used in the past month reported experiencing such an adverse effect (Palamar and Le, 2023).

Recent increases in use of hallucinogens, more broadly, may be associated with increased coverage of their perceived therapeutic benefits, based on a recent increase in clinical trials testing psilocybin, specifically, in treating psychiatric conditions. Major trials suggest psilocybin’s efficacy in treating conditions such as major depressive disorder in particular (Davis et al., 2020; Goodwin et al., 2022; Tullis, 2021), but also in treating conditions such as anxiety, posttraumatic stress disorder, and substance use disorders (Bird et al., 2021; Bogenschutz et al., 2022; Hendricks et al., 2015; Ross et al., 2016). Such findings have been widely covered by the media, and research has found that media coverage of the medical benefits of use of drugs like ketamine and MDMA appear to be linked to increased willingness of some people to use nonmedically (Palamar and Le, 2022), which may also be applicable in the case of psychedelics such as shrooms. Increased popularity of microdosing psychedelics (Polito and Stevenson, 2019) may be contributing to increasing prevalence of use, but another factor driving recent increases in use of shrooms may involve increasing availability. Psychedelics are becoming more legally accessible in the US as a result of psychedelic reform bills, which increased from 5 in 2019 to 36 in 2022 (Siegel et al., 2023). Most of these bills (58%) have proposed decriminalization and the vast majority (90%) have focused on psilocybin (shrooms) (Siegel et al., 2023). Despite psilocybin being a Schedule I controlled substance at the federal level, various cities and states in the US, particularly in the West, have begun to enact more liberal policies regarding possession. Denver, Colorado was the first city to decriminalize use (in 2019), followed by select cities in California and Oregon in 2020. In fact, Oregon not only became the first state to decriminalize use, but it also became the first state to legalize therapeutic use (Siegel et al., 2023). These trends are likely to continue, as it has been projected that most states will have passed legalization measures by 2034–2037 (Siegel et al., 2023).

Given indications of increasing use based on national survey data, the potential for adverse effects associated with use, and potential increases in accessibility, it is important to monitor trends in use of shrooms to inform prevention and harm reduction efforts. However, data measuring self-reported use of shrooms are limited. Among three main national surveys on drug use, one only queries lifetime (but not more recent) use of shrooms, and the others only assesses use indirectly by asking about the use of hallucinogens (e.g., other than LSD) (Centers for Disease Control and Prevention, 2022; Schulenberg et al., 2022; Walsh et al., 2022). Results of such surveys are also lagged. In this study, we focus on shroom seizures as an indicator of shroom availability or supply. Drug seizures are commonly used as an indicator of drug availability (Jones et al., 2020; US Drug Enforcement Administration (DEA), 2021). In addition, studies have determined that trends in seizures of fentanyl and its analogs, heroin, cocaine, and methamphetamine are correlated with trends in nonfatal and fatal overdose (Degenhardt et al., 2005; Jalal and Burke, 2021; Man et al., 2021; Zibbell et al., 2019, 2022). In this analysis, we reviewed national seizure data from 2017 through 2022 to examine trends in shroom seizures, as a proxy for shifts in drug availability or supply. We also focused on trends within US regions given that rapidly shifting laws may be affecting both illicit availability and use.

2. Methods

2.1. Procedure

Congress created the High Intensity Drug Trafficking Areas (HIDTA) program to assist federal, state, local, and tribal law enforcement agencies within critical drug trafficking regions in the US. There are 33 HIDTAs within 50 states and the District of Columbia (HIDTA, 2022). HIDTAs collect data on drug seizures made by participating law enforcement agencies (3299 in 2022). Quarterly data are collected through the HIDTA Performance Management Process. This analysis was conducted in collaboration between HIDTA officials and the NIDA-funded National Drug Early Warning System (NDEWS) (Cottler et al., 2020). We analyzed data on reported seizures of mushrooms/psilocybin (“shrooms”) from January 2017 through December 2022.

2.2. Variables

We created variables indicating the total count of shroom seizures and the total aggregated weight of seized product for each year and quarter within each year ranging from 2017 through 2022. While 94.7% (n=4285) of seizures were recorded in weight (kg), 5.3% (n=239) were recorded in dosing units and 2 were reported in liters. Given that HIDTAs that record shroom seizures in terms of dosing units equate these to about 2 g (Rocky Mountain HIDTA Investigative Support Center Strategic Intelligence Unit, 2019), shrooms recorded as such were recoded accordingly into 2 g per reported unit. The two cases recorded in liters were omitted from weight counts.

2.3. Statistical analyses

We calculated counts for the full US and also for each of the 50 states (plus the District of Columbia) and region. Aggregate counts were plotted in choropleth maps and then Joinpoint Regression version 5.0.1 was used to estimate trends (National Cancer Institute, 2023). This program fits weighted least-square regression models to counts on a log-transformed scale. Separate analyses were conducted for counts and total weight of seizures first for the US overall and then stratified by region. Poisson models were specified under the assumption of heterogeneity across time. A maximum of four joinpoints was specified and the number of joinpoints was determined using weighted BIC criteria. For each trend, we calculated the adjusted quarterly percentage change [AQPC]. We also calculated the absolute and relative percentage change between 2022 Q4 and 2017 Q1 for each trend. Estimates (fitted values) of trends by region were plotted for comparison.

We also conducted a set of supplemental analyses. First, we conducted a set of analyses to determine whether there were shifts in HIDTA-related law enforcement and the overall number of drug seizures between 2017 and 2022 to inform interpretation regarding shifts in shroom seizure prevalence related to possible shifts in enforcement activity. Specifically, we examined trends in the overall number of drug seizures made by participating HIDTAs and in the percentage of seizures consisting of shrooms. We also determined whether there were shifts in HIDTA-related law enforcement across years based on the number of participating agencies, the number of drug initiatives, and the total number of participants (e.g., officers) in the program. In addition, we conducted sensitivity tests in which we examined trends of psilocybin/psilocin reports (submissions) to DEA National Forensic Laboratory Information System (NFLIS) labs within the US and by region between 2017 and 2022 based on data from published reports (US DEA, 2018, 2019, 2020, 2021b, 2022, 2023). While there is overlap between HIDTA and NFLIS, NFLIS collects data from forensic laboratories (currently 284 within 50 states) that voluntarily report their results (which does not reflect all seizures). NFLIS reports reflect drugs that have been analyzed and reported to the DEA (Pitts et al., 2023) and only count data for number of submissions is published. This secondary data analysis did not involve human subjects and was exempt from review by the NYU Langone Medical Center Institutional Review Board.

3. Results

There were 4526 seizures between 2017 and 2022 with 402 in 2017, 443 in 2018, 539 in 2019, 673 in 2020, 1073 in 2021, and 1396 in 2022. Between 2017 Quarter 1 (Q1) and 2022 Quarter 4 (Q4), the number of seizures increased in the US by 368.9% (AQPC=7.0; 95% confidence interval [CI]: 5.9, 8.1) (Fig. 1 and Table 1).

Fig. 1.

Trends in the Number of Shroom Seizures in the United States and by Region, 2017–2022.

Table 1.

Quarterly Trends in the Number of Shroom Seizures in the United States, 2017–2022.

	Count		Change From 2017 Q1 to 2022 Q4		Trend
	2017 Q1	2022 Q4	Absolute Change (n)	Relative Change (%)	AQPC (95% CI)
United States	74	347	273	368.9	7.0 (5.9, 8.1)b
Midwest	31	112	81	261.3	6.7 (5.2, 8.1)b
Northeasta	1	8	7	700.0	6.0 (2.3, 9.9)b
South	19	105	86	452.6	8.3 (6.6, 10.0)b
West	24	122	98	408.3	6.1 (5.0, 7.2)b

Abbreviation: Q1, Quarter 1; Q4, Quarter 4; AQPC, adjusted quarterly percentage change; CI, confidence interval.

^aSince there were no seizures in the Northeast in 2017 Q1, we present the number seized in 2017 Q2.

^bIndicates that the AAQC was significantly different from zero at the alpha = 0.05 level.

The plurality of seizures (2017–2022) occurred in the Midwest (n=1630, 36.0%), followed by the West (1516, 33.5%), the South (1249, 27.6%), and the Northeast (131, 2.9%). Table S1 presents the total number of seizures and total weight of seizures for each state. The states with the greatest number of seizures were Ohio (n=395), Florida (n=327), Michigan (n=272), Texas (n=265), and Colorado (n=221). Table S2 presents annual counts of seizures within each state. The largest (absolute) increases between 2017 and 2022 were in Ohio (n=82), Florida (n=80), Utah (n=69), Texas (n=66), and Michigan (n=51). There were quarterly increases across all regions (Fig. 1 and Table 1 continued): in the Midwest (by 261.3%; AQPC=6.7, 95% CI: 5.2, 8.1), the Northeast (by 700.0%; AQPC=6.0; 95% CI: 2.3, 9.9), the South (by 452.6%; AQPC=8.3; 95% CI: 6.6, 10.0), and in the West (by 408.3%; AQPC=6.1; 95% CI: 5.0, 7.2).

With respect to total weight of shrooms seized, a total of 4380.0 kg was seized between 2017 and 2022 with 226.0 kg seized in 2017, 364.7 kg seized in 2018, 116.8 kg seized in 2019, 1286.1 kg seized in 2020, 1542.3 kg seized in 2021, and 844.0 kg seized in 2022. Between 2017 Q1 and 2022 Q4, the total weight seized in the US increased by 2749.7% (AQPC=6.2, 95% CI: 0.3–12.4) (Fig. 2 and Table 2).

Fig. 2.

Trends in the Total Weight (kg) of Shroom Seizures in the United States and by Region, 2017–2022.

Table 2.

Quarterly Trends in the Total Weight (kg) of Shroom Seizures in the United States, 2017–2022.

	Weight (kg)		Change From 2017 Q1 to 2022 Q4		Overall Trend
	2017 Q1	2022 Q4	Absolute Change (kg)	Relative Change (%)	AQPC (95% CI)
United States	11.6	330.6	319.0	2749.7	6.2 (0.3, 12.4)c
Midwest	4.3	97.5	93.2	2179.8	13.7 (10.1, 17.4)c
Northeasta	0.4	2.0	1.6	385.5	14.6 (7.0, 22.6)c
South	0.7	127.5	126.8	17074.3	2.9 (−5.4, 12.0)
West	6.6	103.6	97.0	1473.4	1.3 (−5.5, 8.5)

Abbreviation: Q1, Quarter 1; Q4, Quarter 4; AQPC, adjusted quarterly percentage change; CI, confidence interval.

^aSince there were no seizures in the Northeast in 2017 Q1, we present the total weight seized in 2017 Q2.

^bThe year category presented in each trend represents year/quarter groupings as determined by joinpoint regression.

^cIndicates that the AQPC was significantly different from zero at the alpha = 0.05 level.

The greatest total weight in seizures (2017–2022) was in the West (1864.2 kg, 42.6%), followed by the South (1831.9 kg, 41.8%), the Midwest (516.5 kg, 11.8%), and the Northeast (167.4 kg, 3.8%). The greatest weight of seizures was in Nevada (708.7 kg), followed by Florida (577.0 kg), Texas (571.2 kg), California (484.2 kg), and Louisiana (309.1 kg). Table S3 presents the annual total weight of seizures within each state. The largest (absolute) increases between 2017 and 2022 were in Oregon (90.3 kg), California (56.3 kg), Kentucky (54.8 kg), Illinois (53.4 kg), and Texas (49.2 kg). With regard to regional trends, there were quarterly increases from 2017 Q1 through 2022 Q4 in the Midwest (by 2179.8%; AQPC=13.7; 95% CI: 10.1–17.4) and in the Northeast (by 385.5%; AQPC=14.6; 95% CI: 7.0–22.6) with no joinpoints detected (Fig. 2 and Table 2 continued). Increases in weight from 2017 Q1 through 2022 Q4 were not significant in the South or in the West. Choropleth maps depicting shifts in the number of seizures and total weight of seizures by state between 2017, 2020, and 2022 are presented in Figure S1.

Table 3 presents a breakdown of aggregate number of total weight as well as the average individual weight of shrooms seized by region. While the West had the greatest total weight seized (1864.2 kg; 42.6%), the weight of individual seizures, on average, was higher in the South (Mean = 1.51 ± 15.0), driven in part by relatively large single seizures in Texas (386.1 kg in 2020) and in Florida (247.0 kg in 2021).

Table 3.

Aggregate Number of Total Weight and Average Individual Weight of Shrooms Seized by Region, 2017–2022 (N=4526).

	Total Count and Weight Seized
	Count n (%)	Total Weight Seized kg (%)
South	1249 (27.6)	1831.9 (41.8)
West	1516 (33.5)	1864.2 (42.6)
Northeast	131 (2.9)	167.4 (3.8)
Midwest	1630 (36.0)	516.5 (11.8)
	Average and Spread of Weight of Individual Seizures (in kg)
	Mean ± SD	Median (Range)
South	1.51 ± 15.00	0.03 (0.0001–386.1)
West	0.96 ± 6.31	0.03 (0.0002–139.8)
Northeast	0.94 ± 2.96	0.07 (0.0001–20.0)
Midwest	0.32 ± 1.64	0.02 (0.0003–26.7)

With respect to supplemental analyses, trends in the total number of drugs seized by HIDTAs and the percentage of these seizures consisting of shrooms are presented in Table S4. The overall number of drug seizures increased from 74,663 in 2017 to 106,409 in 2022, a 42.5% increase (adjusted annual percentage change [AAPC]=6.0, 95% CI: 1.0–11.5). The percentage of shroom seizures within this increasing total also increased from 0.54% to 1.31%, a 142.6% increase, with a particular increase from 2019 through 2021 (annual percentage change [APC]=33.7, 95% CI: 21.1–28.4). As shown in Table S5, the number of HIDTA-affiliated agencies increased from 2884 in 2017 through 3299 in 2022 (a 14.4% increase; AAPC=3.2, 95% CI: 1.6–4.8) as did the number of HIDTA initiatives (from 904 to 946, a 4.6% increase; AAPC=1.2, 95% CI: 0.6–1.8), although the number of HIDTA participants did not significantly change across years. With regard to annual analysis of NFLIS trends, the number of psilocybin/psilocin reports in the US increased from 4107 in 2017 to 9932 in 2022, a 141.8% increase. Overall, the percentage of reports (2017–2022) was similar between the South (30.2%), the Midwest (31.0%), and the West (28.3%), with only 10.4% occurring in the Northeast. However, with respect to trends in reports, the steepest increase was in the Northeast (a 174.4% increase), followed by the South (168.2%), the Midwest (142.6%), and the West (98.9%) (all of which increased significantly).

4. Discussion

This study examined trends in shroom seizures from 2017 to 2022 through the use of national seizure data. We used seizure data as an indicator of potential availability of illicit shrooms. Our separate analyses based on seizure counts and total weight present a nuanced picture of illicit shroom availability in the US. Overall, most individual seizures occurred in the Midwest followed by the West and the South, and this order remained despite large increases through 2022. The greatest weight of shrooms was seized in the West (and followed closely by the South). The individual weight of seizures, on average, was also greatest in the South. With respect to trends in total weight seized, however, although there was a general increase through 2022, the total weight seized peaked in 2021. This appears to be driven by peaks in the West and South in late 2020 and early 2021, respectively, followed by decreases throughout 2022. This suggests that while the number of individual seizures has increased through 2022, the recent peak in total weight was in 2021. As such, it appears that shroom seizures increased even after the onset of the COVID pandemic—unlike cannabis and methamphetamine seizures which decreased after the onset of COVID and then rebounded (Palamar et al., 2021).

Overall increases in the counts and total weight of shroom seizures from 2017 to 2022 suggest possible increases in shroom availability in the US. Seizures of illicit drugs are commonly used as an indicator of drug supply or availability, which is in turn assumed to reflect potential for future use. For example, fewer seizures have been shown to reflect disruptions to drug supply chains (European Monitoring Centre for Drugs and Drug Addiction, 2020; Mounteney et al., 2010; Palamar et al., 2021). In the case of shrooms, increases in seizures appear to be associated with increases in use, which may be related to increased legal accessibility in some areas of the US as well as rising awareness of the potential therapeutic benefits of shrooms. There has recently been an increase in trials testing psilocybin, specifically, for treating psychiatric conditions (Tullis, 2021). Research has found that media coverage of the medical benefits of use of drugs like ketamine and MDMA appear to be linked to increased willingness of some people to use nonmedically (Palamar and Le, 2022), which may also be applicable in the case of psychedelics such as shrooms.

The greatest weight of shrooms seized in the West may be related to recent enactment of laws decriminalizing the use and possession of shrooms following the passage of a city ordinance in May 2019. Referred to as the Denver Psilocybin Mushroom Initiative (Chavez and Prior, 2019), the ordinance decriminalized psilocybin by prohibiting the city from spending resources on imposing criminal penalties for personal use or possession of psilocybin-producing mushrooms (Denver, 2019). Shortly thereafter, the cities of Oakland and Santa Cruz (both in California) passed resolutions making the enforcement of laws related to the personal use and possession of entheogenic plants, including psilocybin-producing mushrooms, the lowest law enforcement priority (Kaur, 2020; Kennedy, 2019; Oakland City Council, 2019). In 2020, Oregon not only became the first state to decriminalize use, but it also became the first state to legalize therapeutic use (Siegel et al., 2023). Indeed, Oregon, followed by California, were the states with the largest absolute increases in shrooms seized by weight between 2017 and 2022. Further, California, Oregon, and Colorado have the fourth, sixth, and seventh-greatest total weight of seizures, respectively, with nearby Nevada having the greatest weight (with a current bill to decriminalize possession awaiting review by Nevada’s state senate). The possession and use of entheogenic plants, including psilocybin mushrooms was also decriminalized in Detroit, Michigan in 2021 (O’Kane, 2021), with Michigan having the third-highest number of seizures.

While decriminalization tends to reflect more liberal views toward use, enactment can lead to laxed enforcement and decreases in arrests (Plunk et al., 2019), although this can also lead law enforcement to increase with respect to dismantling shops that openly sell such product (such as what happened in Oregon) (Jacobs, 2023). This situation can be informed by research focusing on medical and recreational cannabis legalization, which has also been found to be associated with increases in seizures of cannabis (Rocky Mountain HIDTA, 2021; Worrall et al., 2022). In fact, in Colorado, where an amendment allowing recreational cannabis use passed in 2012, cannabis seizures have continued to increase, with 5.5 tons of illegal cannabis seized in 2020, along with the dismantling of large black-market operations including 168 felony arrests (Rocky Mountain HIDTA, 2021). While shrooms can grow in various areas of the US, including the Southeast and Gulf Coast, natural shroom growth appears to be most abundant in the Pacific Northwest, with growth in areas such as cow pastures in Oregon (Nicholas and Ogamé, 2006; Oregon-Idaho HIDTA, 2019). Illegal commercial indoor shroom grow sites have also been commonly detected and raided in Oregon in particular, and such sites appear to be major cultivation sites for interstate shipping (Oregon-Idaho HIDTA, 2015, 2019). Given that shrooms grow naturally in the US, unlike many other drugs which are typically synthesized and/or smuggled into the US (US DEA, 2021a), such availability may continue to present challenges with respect to control and regulated possession and use.

4.1. Limitations

First and foremost, while we view seizures as a possible indicator of illicit availability, seizures do not indicate prevalence of use. States and regions of seizures reported were the seizures occurred; however, this does not mean that the state or region that the shrooms were seized in was the product’s final destination (Oregon-Idaho HIDTA, 2015). Given that the destination was not known, we focused on raw seizure counts and weights as opposed to population-level rates. Law enforcement efforts could have also differed across areas, with more seizures potentially reflecting greater vigilance by law enforcement. Indeed, our supplemental analyses determined that HIDTA-related law enforcement efforts increased over time as well as the total number of drug seizures, but a large portion this increase involved fentanyl seizures (Palamar et al., 2022), and we also found that despite this increase, the percentage of seizures involving shrooms still increased at a faster rate. Relatedly, similar to the shifting cannabis situation in the US (Freisthler and Gruenewald, 2014; Paschall and Grube, 2020; Pedersen et al., 2021), shifting city- and state-level policies regarding psilocybin and other psychedelics could affect availability, use, and law enforcement efforts. We were unable to conduct state-level trends because many states had too few seizures to model estimates with confidence.

HIDTA seizures do not represent all drug seizures in the US, but we did observe similar increases overall and by region based on published NFLIS data. Although, similar to our aggregated HIDTA data, counts of seizures based on NFLIS data similarly indicate that the plurality of seizures has occurred in the Midwest with the fewest occurring in the Northeast. Large individual seizures, particularly in the South (in 2020–2021), influenced the total weight seized. NFLIS received a far greater number of reports of psilocybin seizures, so it is unknown how many large seizures were unrecorded by HIDTA systems. For example, news sources reported that an investigation of a growing operation in Colorado in 2021 led to a seizure of nearly 3000 lbs. of shrooms (Byars, 2021). Such large seizures have the potential to affect future trends in weight as well given that $8.5 million worth of shrooms was seized from a growing operation in Connecticut in late 2023 (Collins, 2023)—within the Northeast region which currently has the lowest number of seizures. Finally, given that it is unknown to what extent shrooms were seized in “wet” or “dry” form (with dry, ready-to-consume product typically only weighing a tenth of wet product) (Nicholas and Ogamé, 2006), weight could not be translated into possible doses. Relatedly, chocolate bars are now more commonly produced containing shrooms (Oregon-Idaho HIDTA, 2019), with at least one seizure (e.g., in Louisiana in 2021) of chocolate bars containing shrooms. As such, we must keep in mind that form of the drug product seized can influence the recorded weight.

4.2. Conclusions

In conclusion, seizures of shrooms have increased in the US, suggesting that availability or supply may be escalating; thus, increases in prevention efforts and harm reduction education are warranted. Given a rapidly shifting legal landscape (Siegel et al., 2023) coupled with increasing media coverage and potential for expanded commercialism in an area in which the drug is becoming legal (Smith and Appelbaum, 2021), it is important to monitor psilocybin availability, use, and adverse effects linked to use, to understand the commonality of exposure, and to inform both prevention and harm reduction efforts.