Research Watch
A single dose beat nicotine patches, and the caveats matter
At six months, 40.5% of the psilocybin group were verified as still not smoking, against 10.0% on patches. Both groups also had 13 weeks of therapy, the trial was unblinded, and 82 people is a pilot.
Nicotine is one of the hardest habits in medicine to break. Most cessation treatments produce modest long-term results, and the gap between wanting to stop and still not smoking a year later is where nearly everyone ends up. So a trial reporting that four in ten people were still off cigarettes six months later is worth looking at properly.
The trial
Researchers at Johns Hopkins randomised 82 adult smokers to one of two treatments on their quit date. One group received a single high dose of psilocybin, 30mg per 70kg of body weight. The other started eight to ten weeks of nicotine patches, the standard licensed treatment.
The detail that matters most: both groups also received a 13-week structured course of cognitive behavioural therapy. This was never psilocybin against nothing. It was psilocybin plus therapy against patches plus the same therapy.
Recruitment ran from January 2015 to May 2023. Eight years to enrol 82 people is a reminder of how slowly this research actually moves.
What they found
At six months, 17 of the psilocybin group, or 40.5%, had achieved prolonged abstinence. In the patch group it was 4 people, or 10.0%. The odds ratio was 6.12, with a confidence interval from 1.99 to 23.26.
On the looser measure of not having smoked in the previous seven days, it was 52.4% against 25.0%.
Crucially, abstinence was biochemically verified rather than self-reported. People were tested, not asked. In smoking research that distinction matters enormously, because self-reported quitting is notoriously optimistic.
The caveats, which are substantial
This is described by its own authors as a pilot trial, and the design has a significant weakness they state openly: participants and investigators were unblinded. Everyone knew who had received what.
For a treatment as unmistakable as a high dose of psilocybin, true blinding is close to impossible. But it means expectation is baked into the result. People who knew they had been given a powerful, much-discussed drug, and who had chosen to enrol in a psychedelic trial, may have expected more of it than people handed a patch.
The sample is also small, and 82 people randomised into two arms is not a basis for population-level claims. Participants were psychiatrically healthy and screened, which is not the general population of smokers.
No serious adverse events were attributed to either treatment.
What it might mean
The interesting hypothesis is not that psilocybin suppresses cravings the way nicotine replacement does. It is that a single strong experience may briefly loosen the pattern of behaviour itself, opening a window in which the CBT can do more work than it otherwise would.
That framing fits the wider picture in this field. The drug is not the treatment. The drug appears to make a period of psychological work more effective, which is why every serious trial wraps it in preparation, supervision and follow-up.
Where that leaves it
A 40.5% verified abstinence rate at six months is well above what standard treatments usually achieve, and the comparison group here was an approved treatment rather than a placebo. That is a genuinely encouraging signal.
It is also a small, unblinded pilot in screened volunteers, run alongside 13 weeks of therapy. It is a reason to fund a large blinded trial, not a reason to conclude anything about what mushrooms do to smokers in general.
Johnson MW, Naude GP, Hendricks PS, Garcia-Romeu A. Psilocybin or Nicotine Patch for Smoking Cessation: A Pilot Randomized Clinical Trial. JAMA Network Open, 2026. DOI: 10.1001/jamanetworkopen.2026.0972
Nothing here is medical advice. Psilocybin is a Class A drug in the UK, and these results come from a supervised clinical trial with screening and months of therapy attached, which is not the same as taking mushrooms.
