Psilocybin and Addiction

Hola!

Dr Lee here again with another topic I am happy to write about because it feels thoroughly relevant in Oregon in 2024. .

A lot of people have experienced the loving embrace of tobacco or alcohol overuse and I field a fair number of calls and emails about the topic of psychedelic treatment for addiction. We all have a person in our lives that has dealt with addiction.

There is existing clinical evidence that several types of psychedelics are promising for several types of addictions.

Psilocybin amongst the psychedelics has been used in recent trials to treat tobacco and alcohol use disorders with success. Psilocybin also appears to be the psychedelic with the largest effect on addiction.

Why do we care? Why Research Psychedelics for Addiction?

Addiction is incredibly common and the treatments we have for it aren’t very good.

At the moment the gold standard for addiction treatment is a concoction of social support, focused psychotherapy and, sometimes, pharmaceuticals. It’s really expensive and takes a lot of time.

The pharmaceutical drugs we have aren’t great. For instance, we give methadone for opiate addiction, which is just a synthetic weak opiate that sometimes seems more problematic than other opiates.

Probably more important than that, is that addiction treatment of all kinds requires a great deal of fierce introspection and self-investment that isn’t really possible or accessible for people just trying to get by. That’s part of the real magic of psychedelics. Psilocybin and the other traditional psychedelics help people see their situations in a new way.

Researchers have already observed a broad association between psychedelic use and opiate use reduction. Large scale data collected also suggests that psychedelic use can reduce addictive behavior. Several large surveys linked psychedelic use with reduced opiate usage compared to non-psychedelic users (1).

One study showed that psilocybin, amongst the psychedelics, is the only one that was able to reduce opiate usage in a large population (2).

The State of Addiction and Mental Health in Oregon

One of the specifically stated purposes of legalizing psilocybin in Oregon was to tackle the burden of mental illness in our state. This includes common mental health situations like anxiety, depression and PTSD, but also includes addiction.

Oregon is worst, or close to the worst, in the nation for several indices of illicit drug use and opiate drug use (3).

We in Oregon have a tangible and pervasive issue with opiates, especially fentanyl, that has intensified in the past two years. We are also in the Top 5 for most indices of mental health illness (4, 5, 6).

Legal psilocybin is a step to getting a special treatment to the people that need it in our great state.

The Research on Psilocybin and Substance Use Disorders

Psilocybin has been shown to have an impact on people with tobacco use disorder and alcohol use disorder.

One psilocybin research project followed participants for a year after their psilocybin therapy. This project showed that 12/15 test subjects were abstinent from tobacco at 6 months (7, 8).

Research on alcohol use disorder has shown similar preliminary results. Psilocybin was linked to ongoing alcohol abstinence at 36 weeks in one study (9, 10).

Dr Lee Note

I do want to point out that happens in research is more intense than what happens at a service center. Most research projects involve psilocybin administered twice, two weeks apart. There are two preparation sessions before and two therapy sessions after each psychedelic session.

For anyone seriously addressing addiction of any kind, psychedelics alone are not enough. What we do at Space cannot approximate what has gone on in these trials.

I do feel that a single well thought-out psychedelic experience can be incredibly motivating. The data is super promising!

But, a true plan utilizing psilocybin for addiction requires support from other health care professionals before and after the psychedelic session.

References

1. Pisano VD, Putnam NP, Kramer HM, Franciotti KJ, Halpern JH, Holden SC. The association of psychedelic use and opioid use disorders among illicit users in the United States. J Psychopharmacol. 2017 May;31(5):606-613. doi: 10.1177/0269881117691453. Epub 2017 Feb 14. PMID: 28196428.
2. Jones, G., Ricard, J.A., Lipson, J. et al. Associations between classic psychedelics and opioid use disorder in a nationally-representative U.S. adult sample. Sci Rep 12, 4099 (2022). https://doi.org/10.1038/s41598-022-08085-4
3. SAMHSA. “2021 National Survey of Drug Use and Health (NSDUH) Releases.” Www.samhsa.gov, 2021, www.samhsa.gov/data/release/2021-national-survey-drug-use-and-health-nsduh-releases.
4. https://www.kff.org/statedata/mental-health-and-substance-use-state-fact-sheets/oregon/#:~:text=The%20U.S.%20saw%20improvement%20in,overdose%20deaths%20in%20the%20state.
5. “Oregon Health Authority : Fentanyl Facts : Opioid Overdose and Misuse : State of Oregon.” Www.oregon.gov, www.oregon.gov/oha/PH/PREVENTIONWELLNESS/SUBSTANCEUSE/OPIOIDS/Pages/FentanylFacts.aspx
6. https://mhanational.org/issues/2022/ranking-states
7. Garcia-Romeu A, Griffiths RR, Johnson MW. Psilocybin-occasioned mystical experiences in the treatment of tobacco addiction. Curr Drug Abuse Rev. 2014;7(3):157-64. doi: 10.2174/1874473708666150107121331. PMID: 25563443; PMCID: PMC4342293.
8. Johnson MW, Garcia-Romeu A, Griffiths RR. Long-term follow-up of psilocybin-facilitated smoking cessation. Am J Drug Alcohol Abuse. 2017 Jan;43(1):55-60. doi: 10.3109/00952990.2016.1170135. Epub 2016 Jul 21. Erratum in: Am J Drug Alcohol Abuse. 2017 Jan;43(1):127. PMID: 27441452; PMCID: PMC5641975.
9. Bogenschutz MP, Forcehimes AA, Pommy JA, Wilcox CE, Barbosa PC, Strassman RJ. Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study. J Psychopharmacol. 2015 Mar;29(3):289-99. doi: 10.1177/0269881114565144. Epub 2015 Jan 13. PMID: 25586396.
10. Bogenschutz MP, Ross S, Bhatt S, Baron T, Forcehimes AA, Laska E, Mennenga SE, O’Donnell K, Owens LT, Podrebarac S, Rotrosen J, Tonigan JS, Worth L. Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2022 Oct 1;79(10):953-962. doi: 10.1001/jamapsychiatry.2022.2096. Erratum in: JAMA Psychiatry. 2022 Sep 14;: PMID: 36001306; PMCID: PMC9403854.