Psilocybin is 6-fold more effective than nicotine patches to stop smoking in pilot US study with CBT

7 April 2026. Related: Journal scan, Early access.

Simon Collins, HIV i-Base

The results of a small US randomised pilot study of medical psilocybin (the hallucinogen in magic mushrooms) in 82 HIV-negative smokers are notable for reporting a 6-fold higher response rate compared to standard of care with nicotine patches. [1]

Participants (60% male, 90% white) were required to want to quit and reported a median of six previous failed attempts.

The intervention arm involved a single high dose (30mg/70kg) of psilocybin compared to 8 to 10 weeks of FDA–approved nicotine patch treatments. Both groups received a 13-week CBT programme for smoking cessation which started five weeks before the intervention, with additional psychological support on hallucinogens for participants randomised to psilocybin.

At 6-month follow-up, prolonged abstinence was verified for 17 (40%) vs 4 (10%) participants in the psilocybin vs nicotine patch arms respectively [OR: 6.12 (95% CI: 1.99 to 23.26)], p=0.003. Seven-day abstinence was reported for 22 (52%) vs 10 (25%), respectively [OR: 3.30 (95% CI: 1.32 to 8.70)], p=0.01.

No serious adverse events were reported for either intervention.

For full details please see the open access paper published in JAMA Open.

comment

This study is reported for serious reasons.

Apart from using effective ART, stopping smoking is one of the most significant changes that people living with HIV can do to improve life expectancy. Yet currently approved anti-smoking products, including nicotine patches, report very low long-term response rates.

Importantly, CBT was an essential component of this study, with specific additional support for the psilocybin arm. The paper also reported an earlier open-label pilot study in 15 participants using CBT for smoking cessation and up to three lower psilocybin doses (20 to 30 mg/70 kg). In this study, biologically verified 7-day abstinence rates were 80%, 67% and 60% at 6, 12 and 30 months, respectively.

Also, although psilocybin-containing mushrooms are classified as Class A drugs in the UK under the Misuse of Drugs Act 1971, UK studies with psilocybin include using it as a potential treatment for depression, PTSD, opioid addiction and anorexia nervosa. [2, 3]

However, it is currently illegal to possess, consume, cultivate or supply these mushrooms, with potential penalties including up to seven years in prison or an unlimited fine. [4, 5]

A paper also published this week in Nature Medicine reported that although the chemical structures of five common psychedelic drugs (psilocybin, lysergic acid diethylamide, mescaline, N,N-dimethyltryptamine and ayahuasca) are very different, they produced similar areas of activity in the brain when tracked by MRI scans. [6]

References

1. Johnson MW et al. Psilocybin or nicotine patch for smoking cessation: A pilot randomized clinical trial. JAMA Netw Open. 2026;9(3):e260972. doi:10.1001/jamanetworkopen.2026.0972
   https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2846155
2. Imperial College. Centre for Psychedelic Research.
   https://www.imperial.ac.uk/psychedelic-research-centre
3. King’s College London. Psychoactive Trials Group.
   https://www.kcl.ac.uk/research/psychoactive-trials-group
4. Spore Supplies. Magic Mushroom Laws in the UK (2026): What’s Legal What’s Not and Why It Matters.
   https://sporesupplies.co.uk/blogs/how-to-guides/magic-mushroom-laws-in-the-uk-2025-what-s-legal-what-s-not-and-why-it-matters
5. gov.uk. Drug penalties.
   https://www.gov.uk/penalties-drug-possession-dealing
6. Girn M et al.  An international mega-analysis of psychedelic drug effects on brain circuit function. Nat Med, DOI: 10.1038/s41591-026-04287-9. (06 April 2026).
   https://www.nature.com/articles/s41591-026-04287-9