Study Title: Psilocybin to treat drug addictions

IRB Protocol Number: 22-001870
Principal Investigators: Ziva Cooper, PhD and Conor Murray PhD
Department: Department of Psychiatry and Biobehavioral Sciences
Email: conormurray@mednet.ucla.edu
Participation Duration: 30 minutes
Anticipated Number of Participants: 500

Research Purpose
This is a questionnaire study of the use of psilocybin as a therapy to treat drug addictions, such as for tobacco, alcohol, or cocaine use disorders. We are conducting a questionnaire study to help us understand how psilocybin impacts continued use of these drugs.

You are being invited to take part in this survey study if you have not taken this survey before and you meet the following eligibility criteria:
• You are at least 18 years old.
• You read, write, and speak English fluently.
• You have taken at least one dose of psilocybin mushrooms or psilocybin for the purpose of reducing the use of another substance.

Information on Research
The purpose of this form is to give you information to help you decide if you want to take part in a research study. This consent form includes information about:
• why the study is being done;
• the things that you will be asked to do if you are in the study;
• any known risks involved;
• any potential benefit;
• options that you have, other than taking part in this study.

If at any time you have questions about the study, please ask a member of the study team. Take all the time you need to decide whether you want to take part in this research study.

Procedures
If you agree to take part in this study, you will be asked to answer questions using Qualtrics. The health information that we may collect and use for this research includes medical information that may be considered sensitive, such as use of psilocybin. We will also ask questions about the experience you had when you took psilocybin, as well as history of drug use before and after psilocybin use. Your data, including de-identified data may be kept for use in future research.

Benefits
You will not receive any direct benefit from participating in this study. However, the information collected may help guide future projects and we believe that this study is scientifically important and may be personally worthwhile to you.

Risks
It is possible that you may feel uncomfortable answering study questions. Research participation is voluntary, and you may refuse to answer any question for any reason.

Confidentiality
We do not collect any identifying information such as your name, email address, or IP address. Your responses will not be used in this study if you do not complete the survey, so you will have the option to exclude your answers at the end of the survey.

Your anonymous responses will be seen and analyzed by research staff or representatives at the University of California, Los Angeles.

Alternatives to Participation
The alternative is not to participate.

Additional Costs
There are no costs to you for taking part in this study.

Compensation
There is no compensation for taking part in this study.

Voluntary Participation
Taking part in the study is your choice. You can decide not to participate or withdraw from the study at any time and for any reason.

Additional Information
If you have questions about your rights as a research subject, or you have concerns or suggestions and you want to talk to someone other than the researchers, you may contact the UCLA OHRPP by phone: (310) 206-2040; by email: participants@research.ucla.edu or by mail: Box 951406, Los Angeles, CA 90095-1406.

During the survey, please do not press the "back" button on your internet browser as it may erase your answers or prematurely terminate your session.

By clicking on the below “I AGREE” button, you confirm the following:
• An explanation of what is involved in the study has been provided and I agree to participate in the study.
• I fulfill the eligibility criteria
• A copy of this electronic information sheet will be available to me for download. By agreeing to participate, I have not given up any of the legal rights that I would have if I were not a participant in the study. Consent Document