Special Report: Psychedelics in Medicine Part 3: Psychedelics for substance use disorders

Section 3: Psychedelics for substance use disorders

Psychedelics are viewed by some as the perpetuation of drug misuse and abuse. However, literature tends to suggest that these treatments can reduce use of other drugs, such as opioids, cannabis, and stimulants.[1] Both animal and human studies suggest that there is no potential for physical dependence on psilocybin, along with very low abuse risk.[2] Further, treatment with psilocybin has resulted in increased insight into cigarette smoking, resulting in reduced use of nicotine.[3,4] Lysergic acid diethylamide (LSD) has also demonstrated similar effects, with 38% of a 358-participant study quitting cigarette use. Of these, 74% maintained abstinence for at least two years.[5] Opioid use is a significant problem, such that the ability of psychedelic drugs to reduce risk of future opioid abuse and dependence is an important clinical consideration.[6,7] Alcohol use has also been studied with psilocybin treatment, suggesting that subjective experiences have resulted in greater insight into the addiction. This novel insight is purported to play a therapeutic role in subsequent reductions in alcohol use that may also involve psychedelic-induced serotonergic alterations and changes in mood.[8] Both LSD and psilocybin have been shown to decrease alcohol consumption, with up to 83% of participants no longer meeting diagnostic criteria for Alcohol Use Disorder following treatment. Insight continued to be a major factor associated with the magnitude of decline in use.[9] The synthetic 2,5-dimethoxy-4-iodoamphetamine (DOI), a psychedelic associated with significant mood improvements, also demonstrates effectiveness in reducing alcohol consumption via 5-HT2A alterations. Further, the effects of DOI were associated with alcohol-preferring participants compared to controls.[10] The culmination of this literature, although incomplete, appears to suggest that psychedelic drugs not only have a low potential for dependence when appropriately used, but can also be used to treat substance use disorders across the spectrum.

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