A new clinical trial indicates that a single dose of psilocybin may effectively treat cocaine addiction, with participants showing higher abstinence rates compared to those receiving a placebo. This research highlights the urgent need for effective treatments for cocaine use disorder, especially as stimulant overdoses rise.
Key points
Single dose of psilocybin shows potential for cocaine addiction treatment
Participants receiving psilocybin had higher abstinence rates than placebo group
Urgent need for cocaine use disorder treatments due to rising overdose deaths
No FDA-approved medications exist for cocaine or stimulant addiction
Cocaine production is at an all-time high globally
Mentioned in this story
Dr Peter HendricksUniversity of Alabama at BirminghamJama Network Open
psilocybincocaine
Results from a new clinical trial show that a single dose of psilocybin could be an effective treatment for cocaine addiction.
The study, published in Jama Network Open this month, showed that 19 participants who received a single dose of psilocybin were more likely to abstain from cocaine than 17 participants who received a placebo of diphenhydramine, a common antihistamine.
Participants in both groups worked with a therapist to process their experiences.
Dr Peter Hendricks, a behavioral health professor at the University of Alabama at Birmingham and lead author of the study, said finding a treatment for cocaine use disorder is especially urgent for a number of reasons. As of now, there are no FDA-approved medications for addiction to cocaine or other stimulants, like methamphetamine.
Over a decade ago, Hendricks was looking for ways that psilocybin could help keep people out of jail. A large, local Birmingham dataset showed “that cocaine use was the single strongest predictor of criminal justice involvement and recidivism”, Hendricks said. This is particularly true for low-income Black men, who made up the majority of participants in the study. While white people are more likely to report lifetime cocaine use than Black people, Black people are more likely to be arrested for cocaine-related crimes.
The mechanism that probably makes psilocybin work for cocaine might also work for many classes of addictive substances, some experts say. Robin Carhart-Harris, a neuroscience researcher who has studied how psychedelics work in the brain, believes psychedelics increase neuroplasticity and psychological plasticity – or the ability to change thinking and behavior. He says addictions inherently involve a resistance to change rigid, impulsive behaviors.
Gabrielle Agin-Liebes, a clinical psychologist at the Yale School of Medicine, notes that “psilocybin is different” from most addiction medications that “target the same neurochemical systems as the substance itself”. Medications for opioid use disorder act on the same receptors as opioids; nicotine patches replace the nicotine in tobacco in a safer form.
Q&A
What did the clinical trial on psilocybin for cocaine addiction find?
The trial found that participants who received psilocybin were more likely to abstain from cocaine compared to those who received a placebo.
How many participants were involved in the psilocybin study for cocaine addiction?
The study involved 36 participants, with 19 receiving psilocybin and 17 receiving a placebo.
Why is finding a treatment for cocaine addiction urgent?
There are currently no FDA-approved medications for cocaine addiction, and stimulant overdoses are increasingly causing fatalities in the U.S.
What are the implications of rising cocaine deaths globally?
The rise in cocaine deaths, alongside increased production, underscores the critical need for effective addiction treatments and public health interventions.
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Psilocybin, on the other hand, “produces a profound altered state of consciousness, typically in a single session, within a structured psychotherapy context”, Agin-Liebes explained, noting that psilocybin was not a maintenance medication that people have to keep taking.
“It’s more like a catalyst within a therapeutic process,” Agin-Liebes added.
The idea is that, with the help of a therapist, a single dose can facilitate shifts in perspective and self-compassion that help people change their behavior. It might be especially effective for cocaine because withdrawal symptoms are more psychological and less physically painful than for substances like opioids or alcohol, Agin-Liebes said. Common cocaine withdrawal symptoms include bad dreams, agitation, depression and cravings.
A critical commentary published alongside the study pointed out that the results might not be generally applicable, because the study excluded people with comorbid depression and anxiety. But Carhart-Harris pointed out that psilocybin shows promise for both those conditions.
Like addictions, depression and anxiety are disorders where “people get stuck in ruts”, Carhart-Harris said. Psilocybin might help people out of those ruts and Agin-Liebes and Hendricks agree; the success of a study is a clear sign that psilocybin for cocaine use disorder is a promising treatment that should proceed to larger-scale clinical trials.
The study is also notable because it is the first psychedelic clinical trial to include a majority of Black participants. While many spiritual rituals involving psychedelics originated in Indigenous societies in Latin America and Africa, US psychedelic culture today is often associated with Silicon Valley as well as elite, white personalities like Michael Pollan.
Agin-Liebes pointed out that a recent systematic review “found that participants in US-based psychedelic clinical trials tend to have higher socioeconomic status and are disproportionately white relative to the general population”.
There are “several layers to this”, Agin-Liebes said. Social media ads, university listservs and word-of-mouth recruitment for clinical trials might be more likely to reach affluent, white populations. Hendricks noted that when he was recruiting for the trial, “we wanted to recruit people who were dependent on cocaine or had cocaine use disorder, and wanted to stop”.
Ads recruiting for psychedelic trials often refer explicitly to psychedelics, which makes them more likely to attract people who were already interested in receiving psychedelic treatment. But for this trial, researchers instead just advertised that they were looking for people trying to quit cocaine.
“The sample that was recruited is representative of the population of people with cocaine use disorder and want to stop in Birmingham, Alabama,” Hendricks said.
That the trial wasn’t designed to attract psychedelic enthusiasts might also mean it was less susceptible to the “expectation effect”, which can raise suspicions around psychedelic trial results. People might volunteer because they already believe in psychedelics, and then they are usually able to guess if they received a placebo or not because psychedelics have such distinct effects.
