Are underground guides being left out of psilocybin’s future?

Welcome back to The Drop In, DoubleBlind’s newsletter serving up news, culture, and independent journalism about psychedelics straight to your inbox. 

Today’s freshly reported stories dive into a new study on underground psilocybin facilitators who worry that the rise of “corporadelics” is stripping the soul from psychedelic therapy. We’ve also got an update on an ongoing study investigating how LSD might help with generalized anxiety.

If you’re not doing anything on Saturday, February 22, you should come to our Sex and Psychedelics workshop hosted by the esteemed Dr. Brinkley! You can find out more here.

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Mary Carreón
Senior Editor

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Are the Underground Guides Who Shaped Psilocybin Therapy Being Left Behind?

As psychedelic regulations push for models of standardization, underground practitioners are wary of the corporate future of psychedelics.

While psychedelic mushrooms have been studied, decriminalized, and commercialized, far less attention has been given to the underground facilitators who laid the groundwork for what’s become the foundation of psilocybin therapy. Now, a new study published in the Journal of Psychedelic Studies offers a look into the practices and priorities of psilocybin mushroom facilitators. Their insights, collected through in-depth interviews, offer a crucial counterpoint to the push for clinical standardization, raising fundamental questions about who should steward psilocybin’s future.

The study, conducted in an undisclosed Western U.S. state, found that most underground practitioners were women, white, and aged 31 to 50. Unlike the therapists now entering the field through state-licensed programs, these guides largely came from alternative backgrounds — herbalism, somatic therapy, Buddhist studies, and energy work. The study points out that while their respective trainings were rigorous, they were informal and built through mentorships, personal experience, and years of self-directed study. 

A key takeaway from the study is the practitioners’ concern over who should receive mushroom therapy. They warn against fast-tracking clients into high-dose experiences, particularly those with severe trauma or unstable mental health. Without adequate groundwork, the experience can be destabilizing rather than healing, which challenges the dominant narrative of high-dose psychedelic therapy. Facilitators mostly find patients or clients through word-of-mouth networks rather than advertising and often reject those seeking a “quick fix.” This is determined by a screening system. 

A growing anxiety among facilitators, according to the study, is the corporatization of psychedelics (or what’s often referred to as the rise of “corporadelics.”) Many worry that big-money interests, such as Big Pharma, will strip away the spiritual and relational aspects of the work, reducing psilocybin therapy to a sterile, for-profit model — one that’s only accessible to the wealthy. 

They argue that no single profession — whether therapists, doctors, or shamans — should “own” this space. Instead, they advocate for decentralized learning communities and mentorship-based training, rather than relying on a single governing body or standardized training process.

The study also dives head-first into the ongoing debate over whether facilitators should have firsthand experience with the medicine (in this case, psilocybin mushrooms) they administer. Underground practitioners overwhelmingly argue that personal experience is not just beneficial but essential — allowing facilitators to build a deep relationship with the medicine, understand its effects, and hold space more effectively for others. Many modern psychedelic researchers and practitioners disagree with this view, arguing that having a personal relationship with the medicines they facilitate is irrelevant to achieving optimal clinical outcomes. Instead, they emphasize emotional maturity, compassion, and formal therapeutic training as the key factors in providing effective care.

While the clinical world debates dosage and safety protocols, underground practitioners insist that the real key to psilocybin healing lies in something far harder to measure — relationship, humility, and the wisdom of the mushroom itself.

Final Clinical Trials Begin for LSD Anxiety Treatment

MindMed’s Phase 3 trial tests MM120, an LSD drug, for anxiety across multiple doses, aiming to prove its efficacy and push acid into mainstream medicine.

The psychedelic pharmaceutical company MindMed has dosed its first patient in Panorama, the second Phase 3 clinical trial testing MM120 — its proprietary formulation of LSD — as a treatment for generalized anxiety disorder (GAD). With this move, the company continues its push to bring psychedelic therapy into mainstream medicine, staking its leadership in an increasingly competitive race to commercialize psychedelics for mental health.

MM120 is being investigated for its potential to deliver rapid and lasting anxiety relief. The first Phase 3 trial, Voyage, launched in late 2024 and focused solely in the U.S., administering a single 100-microgram dose of MM120 against a placebo. Now, Panorama expands the scope by incorporating U.S. and European trial sites and introducing an additional dosing group receiving 50 micrograms, alongside the original 100-microgram and placebo groups. The introduction of this intermediary dose aims to control for expectancy effects, a persistent challenge in psychedelic research, and further distinguish MM120’s effects from those of placebo.

Dr. Daniel R. Karlin, MindMed’s chief medical officer, highlighted the importance of this methodology. “A lot of conversation has been had in this space about the role of functional blinding,” Karlin writes in the Psychiatric Times, referring to the difficulty in ensuring that patients — who often have vivid, unmistakable experiences on psychedelics — don’t inadvertently bias trial results by knowing which group they fall into. By testing MM120 at different doses, MindMed aims to prove its effectiveness isn’t just a placebo effect driven by expectation.

Unlike traditional mental health treatments, such as SSRIs and benzodiazepines — which often take weeks to work and come with side effects ranging from emotional blunting to dependency — MM120 has shown in previous trials that a single dose can reduce anxiety symptoms within 24 hours; it also has a window of efficacy lasting up to 12 weeks. If Phase 3 results hold up, MindMed could secure FDA approval for MM120, ushering in a new era of anxiety treatment — one that’s less about daily maintenance and more about deep, paradigm-shifting experiences.

If successful, MindMed’s trials could not only reshape the mental health landscape but also cement LSD’s long-awaited return to mainstream medicine.

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