Psychedelics Show Potential to Improve SUD Treatment Outcomes

With more than 106,000 drug overdose deaths reported in the US in 2021 and more than 46 million people over the age of 12 having a past-year substance use disorder (SUD), there is a cause for concern and a need to identify new preventative and novel treatment options.

Psychedelics could be one avenue worth pursuing, Christopher Nicholas, PhD, assistant professor at University of Wisconsin School of Medicine and Public Health, told Sana Symposium attendees on October 26.

Dr Nicholas listed several psychosocial interventions with demonstrated efficacy in treating addiction, including motivational interviewing, harm reduction therapy, mindfulness, cognitive behavioral therapy, contingency management, and other therapies. Many models may also support a psychedelic-assisted therapy model, he said.

Addiction and trauma go hand-in-hand and are often co-occurring. Clinicians must have lens toward safety and trust, support systems, putting a premium on patient autonomy, and sensitivity related to cultural and historical issues, Dr Nicholas said.

Psychedelics as Emerging Treatments for SUD

Alcohol use disorder. Dr Nicholas shared a pair of studies examining the use of psychedelics to treat alcohol use disorder (AUD). Data from the first, a 2012 meta-analysis of using LSD to treat AUD, suggests there is a favorable probability of increased alcohol use upon administration of LSD in a controlled context.

More recently, a New York University study published in 2022 examined the efficacy of psilocybin as a treatment for adults with moderate-to-severe AUD. In this study, patients were given either 2 doses of psilocybin or placebo, along with 12 sessions of motivational enhancement and cognitive behavioral therapy. After 32 weeks, the number of heavy drinking days was substantially lower among the psilocybin patient population, although both groups saw a decrease.

“[These were] very encouraging results that warrant further trials,” Dr Nicholas said.

To that end, Dr Nicholas noted several active or upcoming AUD studies, including the following:

• Multi-center, double-blind, randomized, active placebo-controlled Phase 2 study of LSD;
• Psilocybin treatment of major depressive disorder (MDD) with co-occurring AUD;
• Psilocybin-assisted psychotherapy in adults with AUD; and
• Randomized, double-blind, placebo-controlled study of the effects of serotonin 2A/1A receptor stimulation by psilocybin on alcohol-addicted patients.

Tobacco use disorder. In a 2014 open-label trial of psilocybin for tobacco use disorder shared by Dr Nicholas, individuals with multiple prior quit attempts were provided with 12 sessions of CBT and up to 3 doses of psilocybin. Patients’ first day of psilocybin dosing also marked their tobacco quit day. The study found a strong correlation between the quality of patients’ experience and change in their cravings. The greater the degree of self-reported mystical experiences, the greater the decrease in craving for tobacco, Dr Nicholas said.

Dr Nicholas noted 2 other tobacco use disorder studies in progress. The first, for which data has been collected but not yet published, compares the efficacy of a single dose of psilocybin vs a nicotine patch, with both patient groups also receiving adjunct CBT. The second study, an upcoming multi-site, randomized control trial, will analyze the efficacy of 2 psilocybin sessions administered 1 week apart, along with adjunctive CBT.

Opioid use disorder. Ibogaine has been specifically applied to opioid use because of its ability to help mitigate withdrawal symptoms in OUD patients. In one open-label study of 27 individuals who sought 14-day inpatient detox and treatment for opioid and cocaine dependence, individuals were randomized to receive 1 dose of ibogaine at 500, 600, or 800 mg in a controlled, supportive setting. Rapid, long-lasting changes in mood were observed, with individuals in a moderate depression range prior to ibogaine falling below the depression diagnosis threshold following treatment. Heroin cravings and association between heroin use and positive outcomes were also reduced.

Dr Nicholas is also part of a group of University of Wisconsin researchers currently looking at the use of psilocybin with adjunctive buprenorphine for OUD. Other upcoming studies on the use of psilocybin to treat OUD include the following:

• An analysis of psilocybin-assisted psychotherapy for tapering opioid medication;
• Inpatient buprenorphine induction with psilocybin for OUD; and
• Psilocybin for OUD in patients on methadone maintenance with ongoing opioid use.

Stimulant use disorder. With stimulant use disorder, particularly involving methamphetamine, on the rise, Dr Nicholas and colleagues are running an open-label safety feasibility study of psilocybin for methamphetamine use disorder. The researchers are hoping to have data collected within the next 18 months.

Other current research includes a study looking at psilocybin-enhanced psychotherapy for methamphetamine use disorder and a pilot study of psilocybin-facilitated treatment for methamphetamine use disorder.

Meanwhile, researchers at the University of Alabama-Birmingham recently completed recruitment for a study of psilocybin for cocaine use disorder. A randomized population of 40 patients will receive 1 dose of psilocybin or placebo, along with CBT. Findings should be published within the next year.

Reference

Nicholas C. Psychedelic substances and their use in substance use disorder treatment. Presented at Sana Symposium; October 26-27, 2023; virtual.