LAUSR

Editor’s Note The Journal of Psychoactive Drugs published a case study reporting reduction of obsessive-compulsive disorder (OCD) symptoms after consumption of psilocybin-containing mushrooms (Lugo-Radillo and CortesLopez 2021). We subsequently received a letter suggesting that psychedelic research has progressed beyond case studies, and recommending that journals focus on publication of clinical trials rather than case reports. I found the both the letter and the reviewer comments thoughtful and informative concerning current issues in psychedelic research, and invited all authors to publish their comments in this section. Joseph Guydish, PhD Editor, Journal of Psychoactive Drugs Letter to the Editor: Prioritize Well-Controlled Randomized Trials in Psychedelic Medicine I read with interest the case report entitled “Longterm Amelioration of OCD Symptoms in a Patient with Chronic Consumption of Psilocybin containing Mushrooms,” published in Journal of Psychoactive Drugs (Lugo-Radillo and Cortes-Lopez 2021). While the topic is relevant and provides insights, this study underscores the need for well-controlled clinical trials when evaluating the potential therapeutic efficacy of psychedelics such as psilocybin and lysergic acid diethylamide (LSD). Psychedelic medicine is undergoing a renaissance, after many decades of limited research as a consequence of political forces. Despite being generally considered physically safe and non-addictive, these psychoactive substances significantly alter cognitive, mood, and perceptual processes (Nichols 2016). In this past decade, emerging clinical research has revealed positive effects of psychedelic-assisted psychotherapy on anxiety, addictive and depressive symptoms. Most noteworthy, London’s Center for Psychedelic Research demonstrated antidepressant effects of psilocybin equal to escitalopram in phase 2, double-blind, randomized controlled trial. Positive treatment outcomes favored psilocybin involving these patients with major depressive disorder (Carhart-Harris et al. 2021). What the psychedelic community needs are welldesigned clinical trials, not more case reports. James Allen Wilcox reported in this journal’s 2014 issue that psilocybin relieved core symptoms of OCD in one patient, but there was a future “need for further, legitimate research into the value of psilocybin in the treatment of anxiety disorders” (Wilcox 2014). That time for legitimate research is now, as jurisdictions loosen laws and there are 176 “recruiting and not yet recruiting studies” registered on ClinicalTrials.gov (2021). This plethora of ongoing psychedelic-based interventions is in stark contrast to other previously published cases (Leonard and Rapoport 1987; Moreno and Delgado 1997; Wilcox 2014), when funding and ethical approvals were hard to come by for researchers. The medical community does not need more cases reporting preventative or therapeutic interventions in small sample sizes, e.g. n = 1, as these require stronger evidence. Lugo-Radillo & Cortes-Lopez detailed a patient “who reported a significant decrease in his OCD symptoms after the consumption of psilocybincontaining mushrooms” (2021). This positive case may act as a guide for vulnerable patients wishing to re-create this outcome, and the variant and source of mushrooms are even identified here. The inclusion of such information may exert more harm than good, as the field awaits news of trustworthy and possible guideline-changing clinical trial data. Psilocybin has been once safely used in patients with OCD in a clinically controlled environment (Moreno et al. 2006), but nothing can be inferred to non-clinically controlled environments. Meanwhile, it is widely known