The purpose of this study is to determine whether psilocybin is safe and well tolerated in people with SCI and whether psilocybin-assisted therapy reduces symptoms of depression. We will also evaluate the effects of psilocybin on pain, pain-related thoughts and behaviors, movement, sensation, autonomic functions such as blood pressure and heart rate regulation, and wellbeing and quality of life. These outcomes will be assessed through questionnaires, interviews, and standard evaluations, while monitoring any medical or psychological side effects throughout the study.

Thirty Veterans with chronic SCI will be enrolled: 15 people with paraplegia (T1 and below) and 15 with tetraplegia (C1-C8). Each participant will be randomly assigned to receive one dose of psilocybin: a low (5 mg), medium (10 mg), or high (25 mg). The study includes in-person and remote screening for both medical and mental health and once enrolled, 16 visits, consisting of a baseline evaluation, three preparatory and three integration therapy sessions, one psilocybin dosing session, and eight follow-up visits; three in-person visits at 1, 6, and 12 months after dosing and five remote visits.