Who Is Reached by Supervised Psilocybin Services? Oregon Services Versus National Psilocybin Use

Supervised psilocybin services are expanding across the United States, yet how individuals accessing these programs compare with those using psilocybin in the general population is unknown. We conducted a cross-sectional descriptive comparison of Oregon Psilocybin Services (OPS) data from licensed service centers in 2025 (5,935 encounters) and the 2024 National Survey on Drug Use and Health (NSDUH) public-use file (1,822 of 47,299 adults reporting past-year psilocybin use), examining demographics, reasons for use, self-reported disability, and past-year psychiatric conditions and treatment. OPS clients were predominantly female (58.2%) and aged 35 or older (82.1%), whereas adults reporting psilocybin use nationally were predominantly male (64.0%) and younger than 35 (56.7%). Racial and ethnic minority representation was narrower in Oregon (0.9% Black, 2.5% Hispanic vs. 5.4% and 14.3% nationally). OPS clients reported higher incomes (58.5% earning >$95,000) and primarily cited wellness; self-reported disability was uncommon. Adults using psilocybin nationally had high past-year rates of major depressive episode (22.7%), serious psychological distress (36.8%), substance use disorder (61.7%), and mental health treatment receipt (42.9%). Oregon's open-access model selects higher-income, clinically stable, wellness-oriented adults, while millions with psychiatric and substance-use burden use psilocybin outside supervised channels; its safety and utilization data should not be generalized.