FDA approval of psychedelics could drive an underground boom, requiring public health measures for risks and adverse events

FDA approval of psychedelic treatments is likely to increase use outside regulated medical channels, making public health preparation essential. Evidence from Oregon suggests that supervised psilocybin services have generally positive outcomes, but they represent only a small share of total use: an estimated 90,000 additional people used psilocybin annually after legalization, while about 5,000 used the state program in 2025. Survey data found limited emergency care and overall benefit, but also extended difficulties such as worsening anxiety, depression and headaches. The author argues that high prices, waiting times and limited access will push many people toward underground providers, dispensaries, churches and illicit markets. Government and industry messaging should therefore explain risks in both medical and non-medical settings, include extended post-psychedelic difficulties in provider training and informed consent, and create support systems for severe adverse reactions. The central danger is not adverse events themselves, but concealing them.