Psilocybin Shows Promise in Cocaine Addiction Treatment
Recent findings from a clinical trial indicate that a single dose of psilocybin may effectively help treat cocaine addiction.
The study, which appeared in Jama Network Open this month, involved 19 individuals who received psilocybin and found them to have a higher likelihood of abstaining from cocaine compared to 17 participants who were given a placebo, diphenhydramine, an antihistamine.
Both groups engaged in therapeutic sessions to process their experiences.
Dr. Peter Hendricks, a behavioral health expert at the University of Alabama at Birmingham and the study’s lead author, emphasized the urgent need for treatment options for cocaine use disorder. Currently, there are no FDA-approved medications available for cocaine addiction or other stimulants like methamphetamine.
Stimulant-related overdoses are unfortunately becoming more common in the U.S. According to a recent UN global drug report, deaths linked to cocaine are increasing worldwide as production levels soar.
Over a decade ago, Hendricks sought ways to utilize psilocybin to prevent incarceration. A substantial dataset from Birmingham indicated that cocaine use strongly correlated with criminal justice involvement and recidivism, particularly among low-income Black men, who made up most of the study’s participants. While white individuals report higher lifetime cocaine use, Black individuals face a greater likelihood of arrest related to cocaine-related offenses.
Some experts believe that the mechanisms by which psilocybin operates might be applicable to various addictive substances. Robin Carhart-Harris, a researcher focusing on the neuroscience of psychedelics, noted that they may enhance neuroplasticity and psychological adaptability—key factors in overcoming addiction.
Gabrielle Agin-Liebes, a clinical psychologist at the Yale School of Medicine, pointed out that psilocybin operates differently from typical addiction medications. Many of these target the same neurochemical systems as the addictive substance itself. For example, medications for opioid use disorder affect the same receptors as opioids, while nicotine patches simply replace nicotine.
In contrast, psilocybin leads to a deep altered consciousness, usually achieved in one session within a structured therapeutic setting. It isn’t intended for ongoing use like traditional medications but serves as a catalyst for therapeutic progress.
The aim is to leverage a single dose, in conjunction with therapy, to inspire significant shifts in perspective and self-compassion—crucial factors in behavior modification. Agin-Liebes noted that this could be particularly beneficial for cocaine addiction due to its primarily psychological withdrawal symptoms, which tend to be less physically distressing compared to other substances like alcohol or opioids. Common symptoms of cocaine withdrawal include agitation, cravings, and depression.
A critical commentary accompanying the study raised concerns about its generalizability, citing the exclusion of participants with comorbid anxiety and depression. However, Carhart-Harris mentioned that psilocybin has shown promise for individuals with those conditions as well.
Both Carhart-Harris and the others pointed out that depression and anxiety often trap individuals in a cycle, similar to addiction. They agree that the study’s promising results warrant further large-scale clinical trials focused on psilocybin for cocaine use disorder.
This trial is especially noteworthy for being the first psychedelic study to include a majority of Black participants. While many psychedelic practices began in Indigenous cultures in places like Latin America and Africa, current U.S. psychedelic discourse often centers around elite groups.
Agin-Liebes mentioned a recent systematic review indicating that participants in U.S.-based psychedelic trials tend to be disproportionately white and have higher socioeconomic statuses than the general population.
Agin-Liebes elaborated that various factors—including social media campaigns, university outreach, and word-of-mouth—may predominantly attract affluent, white individuals to these studies. Hendricks stressed that during recruitment for the trial, they specifically aimed to attract individuals struggling with cocaine addiction who genuinely wished to quit.
Interestingly, the trial’s recruitment strategy did not emphasize psychedelics but instead appealed to those wanting to overcome cocaine dependence. Hendricks remarked that this approach resulted in a sample representative of cocaine use disorder individuals in Birmingham, Alabama.
By not targeting individuals already interested in psychedelics, the trial may have mitigated expectations that could otherwise skew results. Participants in psychedelic trials may sometimes already have preconceived notions about the effects, which could influence their perceptions of whether they received the active substance or a placebo.
