Should I tell my doctor I'm using psilocybin? What to consider

The practical case for telling them: they can check for interactions with your current medications. This is genuinely important and is the strongest reason to tell your doctor at minimum. If you're not comfortable with full disclosure, ask hypothetically: 'A friend is considering psilocybin and takes X — are there concerns?'

The legal reality: your doctor has no obligation to report drug use to law enforcement. Confidentiality applies. The practical risk from telling your doctor is low in most situations. The risk from not knowing about an interaction with your medications can be higher.

The psychiatric context adds complexity. A psychiatrist might recommend against it based on your diagnosis or medications. That advice may be based on legitimate concerns or on outdated training. Either way, knowing their perspective helps you make a better-informed decision.