KPE researchers have published a case report on the use of psilocybin to treat concussions, the first time this has been documented in a peer-reviewed journal.
The case, published this week in the journal Psychoactives, involves a 22-year-old intercollegiate athlete with persistent concussion symptoms resulting from a sports injury. The athlete was being treated at the David L. MacIntosh Clinic, the University of Toronto’s world-renowned sports medicine clinic.
When his symptoms did not respond to conventional therapies, the athlete self-administered psilocybin, a psychedelic derived from Psilyocybe cubensis mushrooms. It is illegal to produce, sell or possess psilocybin in Canada.
Influenced by his previous use of the substance, known as “magic mushrooms,” and anecdotal reports suggesting its potential for promoting neuroplasticity, the athlete administered three doses on days 42, 45 and 46 post-injury at a dose level known to produce minimal perceptual effects.
After the first dose, the athlete reported an immediate reduction in headaches and light sensitivity lasting for 24 hours. Encouraged by this response, he proceeded with two additional doses, achieving an almost complete resolution of his symptoms within a few weeks.
“At this point, it’s too early to conclude that we can attribute his improvement to the psilocybin,” says Dr. David Lawrence, medical director of the David L. MacIntosh Clinic and lead author of the study. “A placebo or expectancy effect may have been at work. But he made some pretty rapid improvements in symptoms shortly after taking it. And importantly, there was no harm—he didn’t get worse.”
Concussion symptoms generally improve with time, explains Lawrence. However, rapid symptom changes are rarely seen past the point where a concussion is labelled “persistent.”
“Before drawing strong conclusions, we need larger, randomized and controlled trials,” he says. “But what we saw was an interesting association. In theory, there may be a role for using psychedelics in the management of persistent symptoms after concussion.”
According to Lawrence, there is a theoretical basis for psilocybin to have neuroprotective properties. Concussions can disrupt autonomic nervous system balance and mitochondrial function, leading to metabolic and cognitive impairments. Psilocybin interacts with the sigma-1 receptor, which plays a role in mitochondrial function. Mitochondria can optimize energy metabolism and reduce reactive oxygen species and calcium homeostasis.
The case offers valuable insights that should be considered in the treatment of concussions. Lawrence says clinicians should be aware that patients may be self-administering substances like psilocybin in an attempt to manage their symptoms and should be prepared to discuss this in an informed and non-judgmental way. Patients should feel comfortable sharing any additional treatments they’ve tried so that clinicians can help them be supported and safe.
For most people with concussions, symptoms resolve within weeks to months. However, in about 10-15% of people, symptoms linger. Current treatment options include a multidisciplinary, rehabilitative approach that targets the symptoms to improve function. This approach is effective in many people, but persistent concussions are complex enough that it does not work for everyone.
Inspired by the need for more and better treatments, researchers at KPE will continue to explore psilocybin’s potential therapeutic effects on persisting symptoms of concussion. Although the drug is not legal in Canada, researchers can apply for special access permission to conduct their studies.
An important area of future research will be dose and frequency of administration, says Lawrence. The 250 mg dose taken by the athlete in the published case report is above the threshold for “microdosing”—where there would be no perceptual effects—but well under the amount that would be considered a macro dose.
“It will be interesting to see where this research leads,” concludes Lawrence.