1.1 Executive summary
The use of hallucinogenic mushrooms (paddo's) poses such a low risk for the
health of the individual and for society that prohibiting their use would appear to
be a disproportionately grave measure in relation to the nuisance and damage
caused by their current use. This is the conclusion reached by the Co-ordination
Centre for Assessment and Monitoring of new drugs (CAM) in an assessment
commissioned by the the Dutch Ministry of Health, Welfare and Sport (VWS).

The CAM performed this risk assessment according to established procedures with
the support of the Committee for risk assessment of new drugs for the mushrooms
containing the active substances, psilocin and psilocybin, the so-called ‘magic
mushrooms’ (paddo’s).

Physical or psychological dependence has not been reported, and acute toxicity is
mainly confined to possible attacks of panic or anxiety, which only seldom have
fatal consequences. With regard to chronic toxicity, only the occurrence of
flashbacks can be mentioned. Thus, on balance, the use of magic mushrooms is
not considered to pose a risk to an individual’s health. For only one of the criteria
in this risk category, namely, acute toxicity, was a small risk estimated. Although
scientific data are not available, the use of magic mushrooms in combination with
other psychoactive products, including alcohol, appears to constitute an additional
risk.

The increase in the number of sales outlets (including internet) has made magic
mushrooms more easily available since the year 2000; the number of available
species has also increased. There is hardly any adequate user information
available. The quality of the product is unpredictable due to the variation in
concentration of the psychoactive substances in the magic mushrooms, while
those selling the product have little awareness of the quality. The prevalence of
use, the vulnerability of the user and the number of reports of accidents is limited.
The prevalence of use by tourists has increased considerably since the year 2000,
partly due to a substantial growth of tourism. Contrary to the Dutch users, poorly
prepared tourists, especially those in Amsterdam, are considered a vulnerable
group; several serious accidents have been reported within this group the last few
years. In general, the risk for public health is considered to be small.

Magic mushrooms reduce the user’s ability to react (e.g. decrease in driving skills),
but do not reduce the user’s threshold of violence. As use usually takes place at
home or in the countryside, there is no public nuisance. Therefore, the risk of
disturbing the public order is considered to be small. Contrary to the general
population, tourists use magic mushrooms in hotels and public places, which may
cause more public nuisance.

Involvement of organized crime has not been reported. Some individuals from the
smartshop scene have ties with cannabis growers. Legally grown fresh magic
mushrooms may serve as raw material for the illegal trade and export of dried
mushrooms or products containing processed mushrooms. Therefore, the risk for
criminal involvement is considered to be small.

Both the recommendation of the Committee from the year 2000 to impose
requirements on the quality of magic mushrooms (standardization, purity and
labeling) and the trade in magic mushrooms (including a sound information supply
that are conducive to a limited availability of magic mushrooms) have barely been
put into practice the past few years.

The committee points out that most of the magic mushroom use occurs without
problems. Compared to other substances for which CAM has performed a risk
assessment (i.e. MBDB, MTA, PMMA, ketamine and GHB), magic mushrooms
score relatively low on the risk scale. As the weighted risk assessment in 2007
does not deviate from the assessment in 2000, the committee does not consider a
fundamental revision of magic mushroom policy to be warranted. Prohibiting
hallucinogenic mushrooms (for the satisfied consumer too) would appear to be a
disproportionate grave measure in relation to the nuisance and damage caused by
their current use. Enforcement of such a ban also requires financial resources.
Alternative substances could be used, causing more damage to public health and
being possibly more attractive from a criminal perspective, leading to more public
nuisance. The committee considers the risks highest for those unfamiliar with the
effects of use (foreign tourists) and those using magic mushrooms in an unfamiliar
environment. The most important risks noted by the committee are the varying
composition and quality of the products, the sales containers, which are too large,
the poor consumer information and the readily availability of the magic
mushrooms.

According to the committee, most can be gained by the development of highquality
standard consumer information ( including material for foreign tourists in
their native language); this information should be made available in sales outlets
and tourist information depots/centres. The lack of high-quality standard consumer
information appears to be more common in sales outlets other than smartshops.
Further conditional regulation of the trade in magic mushrooms should be
considered if required by modification of food and consumer goods legislation. To
prevent unintended overdoses, the dose should be reduced to a maximum of 10-
15 grams of fresh magic mushrooms per sales container.

Summary
The “CAM risk assessment magic mushrooms (paddo’s). Information report 2007”
shows no evidence that the state of the art of, and opinions and views on magic
mushrooms have largely changed since the year 2000. Few new data have
appeared in scientific (and gray) literature about physical or mental dependence,
acute and chronic toxicity, risk for public health and criminal aspects related to the
consumption of magic mushrooms.
The prevalence of magic mushroom use in the Dutch population is still declining,
considering its decrease in last year prevalence amongst young visitors to cafés in
Amsterdam from 6.3% in 2000 to 2.9% in 2005.
Though previously acknowledged before, two issues appear to be of increasing
importance:
1. combinatory use of mushrooms and alcohol (or other drugs; poly-drug use);
2. the setting in which the magic mushrooms are consumed.
The 2007 report of the Amsterdam Municipal Health Service (GGD) and the review
of EMCDDA suggest that the fatal outcome of magic mushroom consumption may
be related to prior or simultaneous use of alcohol. Over two years GGD gave
assistance and ambulance support in about 70 magic mushroom related incidents.
In 63 of those foreign tourists (92%) were involved. Obviously, the absolute
number of medical supports given to tourists is much higher as compared to those
given to Dutch paddo users. However, considering the several hundreds of
thousands of young tourists which visit Amsterdam yearly and use paddo’s, this
number of supports is not alarming. That less support seems to be given to Dutch
users, highlights the importance of a quiet setting for magic mushrooms use (i.e.
users should not use on street corners, crowded hotel rooms, and should avoid
confusing noisy and bright lighted settings). Various stakeholders advocate
amongst others to inform the consumers better by flyers and leaflets which warn
the consumer in different languages not to combine magic mushrooms use with
alcohol consumption, to take care of a quiet setting, and to have surveillance by a
non-user.