President Donald Trump’s new pick for surgeon general wrote in a recent book that people should consider using unproven psychedelic drugs as therapy and in a newsletter suggested her use of mushrooms helped her find a romantic partner.
Dr. Casey Means’ recommendation to consider guided psilocybin-assisted therapy is notable because psilocybin is illegal under federal law. It’s listed as a Schedule 1 drug, defined as a substance “with no currently accepted medical use and a high potential for abuse.” Oregon and Colorado have legalized psychedelic therapy, though several cities in Oregon have since banned it.
The surgeon general’s job is to provide Americans with the best scientific information available on how to improve their health and reduce their risk of illness and injury. Past surgeons general have used their position to educate Americans about health problems like AIDS and suicide prevention. The surgeon general’s warning in 1964 about the dangers of smoking helped change the course of America’s health.
Some, like Dr. C. Everett Koop, surgeon general under President Ronald Reagan, became widely known with substantial impact on policy, and others slipped easily from memory.
Means’ nomination follows a pattern from Trump to select people known for their public personas more than their policy positions. In the case of Means, the Republican president said he chose her solely on the recommendation of Health Secretary Robert F. Kennedy Jr. “Bobby thought she was fantastic,” Trump said, adding that he did not know her.
Means, who received her undergraduate and medical degrees from Stanford University, began a medical residency in Oregon but did not complete it. Her medical license is listed as inactive. Contacted by phone, Means declined to comment on the record.
She made the recommendation about psychedelics in her 2024 book, “Good Energy,” which she wrote with her brother, Calley Means, an entrepreneur who now works in the Trump administration as a health adviser and who has said he invested in biopharmaceutical companies that specialize in psychedelics.
Much of the book focuses on metabolic health, what Casey Means calls “good energy.” She suggests a number of strategies to help people “manage and heal the stressors, traumas, and thought patterns that limit us and contribute to our poor metabolic health and thriving.”
One such strategy is to “consider psilocybin-assisted therapy,” referring to the compound found in psychedelic mushrooms. She details her thinking on the subject in a 750-word passage.
“If you feel called, I also encourage you to explore intentional, guided psilocybin therapy,” she wrote. “Strong scientific evidence suggests that this psychedelic therapy can be one of the most meaningful experiences of life for some people, as they have been for me.”
Though there have been some studies suggesting benefits from psychedelics, it has not been shown that benefits outweigh the risks. Psilocybin can cause hours of hallucinations that can be pleasant or terrifying. When paired with talk therapy, it has been studied as a treatment for psychiatric conditions and alcoholism, but very little research has been done in healthy people. Side effects can include increased heart rate, nausea and headaches. Taking it unsupervised can be dangerous. Hallucinations could cause a user to walk into traffic or take other risks.
Means wrote that psilocybin and other psychedelics have been stigmatized. She touted the benefits of MDMA, also known as ecstasy or molly, for helping people with post-traumatic stress disorder, or PTSD. The Food and Drug Administration last year declined to approve the use of MDMA as a therapy for PTSD after a panel of advisers found the research was flawed and there were significant risks in using it.
Means refers to psychedelics in her book as “plant medicine.” She describes how she took mushrooms for the first time around Jan. 1, 2021, after she was inspired by “an internal voice that whispered: it’s time to prepare.”
“I felt myself as part of an infinite and unbroken series of cosmic nesting dolls of millions of mothers and babies before me from the beginning of life,” she wrote, adding that in her experience “psilocybin can be a doorway to a different reality that is free from the limiting beliefs of my ego, feelings, and personal history.”
In a newsletter she published in October, Means said she had also used psychedelics to help her make “space to find love at 35.” She wrote that she “did plant medicine experiences with trusted guides” to become ready for partnership, punctuating the line with a mushroom emoji. She noted she was not necessarily making recommendations that others do the same.
In a post this month about her White House health policy wish list, Means said she wanted more nutritious food served in schools, suggested putting warning labels on ultra-processed foods, called for investigations into vaccine safety and said she wanted to remove conflicts of interest. She did not specifically mention psychedelics but said that researchers have little incentive to study “generic, natural, and non-patentable drugs and therapies” and that a portion of research budgets should be devoted to alternative approaches to health.
Calley Means has also advocated for the use of psychedelic drugs, writing in a 2021 blog post that he first tried psilocybin during a challenging time in his life and “it was the single most meaningful experience of my life — personally, professionally, and spiritually.” He said in 2022 that he had “sold all of my 401k” and bought stocks in two companies that are developing and researching psychedelics. He did not respond to messages seeking comment.
Casey Means’ confirmation hearing has not been scheduled. Trump chose Means after questions were raised about the resume of his first pick for surgeon general, former Fox News medical contributor Janette Nesheiwat, and he withdrew her nomination.
Associated Press Medical Writer Carla K. Johnson in Washington state and AP writer Ali Swenson in New York contributed to this report.