Medical and Psychiatric Consultation for Patients Considering State-Regulated Psilocybin Services: A Risk-Reduction Model and Two Illustrative Cases

Abstract Background State-regulated psilocybin services have expanded access outside research settings. Patients seeking these services may have medical and psychiatric complexity not represented in clinical trials, while guidance for clinicians advising them remains limited. We introduce the Psilocybin Education and Assessment Collaborative for Excellence (PEACE), a consultation model within a traditional healthcare system developed to support patients considering Oregon Psilocybin Services (OPS).

Methods: We describe the PEACE model’s structure and clinical approach, including individualized assessment, evidence appraisal, education, risk-reduction planning, and care coordination. We present two longitudinal cases illustrating clinical complexity and outcomes after accessing OPS.

Results: The first case involves a middle-aged man with alcohol use disorder who experienced early improvement after two OPS sessions and ultimately achieved abstinence through a nonlinear recovery process. During abstinence, he underwent a distressing high-dose unsupervised psilocybin experience, after which he received PEACE-supported integration care. The second case involves an older woman with major depressive disorder who completed supervised antidepressant tapers and underwent two supervised psilocybin experiences. Her depression worsened three months after the second experience, and she returned to PEACE for medication and integration support.

Conclusion: These cases illustrate the challenges of extrapolating psychedelic clinical trial findings to real-world settings and the importance of longitudinal follow-up, as early improvement may not reflect longer-term, nonlinear recovery trajectories. Consultation models such as PEACE may support informed decision-making, risk reduction, continuity of care, and integration of psilocybin-related care into existing healthcare systems.