The idea that psychedelics could help people with substance use disorders has a long history.
At one time, Bill Wilson, the founder of Alcoholics Anonymous, hoped that LSD would become a catalyst for transformation within the 12-step organization until an internal backlash made him leave off the idea. Advocates and researchers have also touted the power of ibogaine, derived from the African tree Tabernanthe iboga, to interrupt and heal opioid use disorders since the 1960s.
Contemporary evidence that psychedelics could help people battling addictions is mounting. It includes clinical trials suggesting drugs such as psilocybin could help people quit smoking or drinking, and a recent longitudinal study in Canada that found psychedelics users used fewer opioid drugs.
Psilocybin vs opiods
In one of the most recent studies in this growing pile of evidence, a paper published in the journal Scientific Reports, researchers found the use of psilocybin, and interestingly only psilocybin, was associated with a lower incidence of opioid use disorders.
The research team at Harvard University used data taken from the National Survey on Drug Use and Health, an annual survey of 70,000 Americans aged 12 and older concerning their substance use. The study included the survey responses of 214,505 individuals taken from 2015 through 2019, assessing whether individuals had ever used mescaline, LSD or psilocybin at any point in their lives and whether they experienced signs of an opioid use disorder in the past year. For this study, opioid use disorder was defined as having abused or experienced dependence on prescription opioid painkillers or used heroin, or exhibited any of 11 of the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV criteria for an opioid use disorder. The DSM IV criteria include spending a lot of time over a month obtaining, using, or recovering from using opioids, and people finding themselves unable to stop using opioids even when they decide they want to.
The researchers found that the use of psilocybin at any point in a person’s life was associated with lower odds of having experienced signs of an opioid use disorder in the past year.
But perhaps most interesting was the exclusive nature of the finding. Of the psychedelics included in the study, psilocybin, peyote/mescaline, and LSD, only psilocybin was associated with lower odds of developing an opioid use disorder.
It’s all about demographics
Grant Jones, a Harvard PhD student in clinical psychology and lead author of the paper, is quick to point out that the study findings are associational, not causal; you cannot say, based on this study, that you are less likely to develop an opioid use disorder if you’ve taken psilocybin at some point in your life. It is also unclear whether there is something intrinsic to psilocybin that protects people from developing opioid use disorders, or if the social behaviors surrounding psilocybin use play a role.
“It might be driven by demographics,” Jones said, “the differences in individuals who use psilocybin versus those who don’t use psilocybin.”
Even if researchers could rule out social and demographic factors, the apparent special role of psilocybin found in this study could be a result of the limited amount of research conducted on other psychedelic substances to date rather than something unique to psilocybin’s pharmacology.
“There’s also a lot that we don’t know about the pharmacology of these substances,” he said. “Psilocybin has gotten a lion’s share of the attention at present, given that most studies have been utilizing psilocybin and constituent compounds for treating mental illness. So I think to be honest it’s just another truly open question.”
What this means for future research
To Jones, that’s the value of an associational study of this kind: It helps researchers challenge old assumptions, and develop the next set of questions to ask in more focused clinical trials.
“I think the benefit of studies like this is that it can set up a platform if you want to go to a government agency or private donors to help investigate these findings more deeply,” he said. “Let’s start to ask maybe some deeper, more rigorous questions about data like this.”
At some point, if the evidence leads there, Jones could see a clinical trial using psilocybin in the treatment of opioid use disorders.
But Jones said he also hopes the study will add more weight to those researchers, like himself, who hope to challenge stereotypes about people who use drugs, and about the drugs they use. Drug policies have at times been used as a hammer to oppress people and exacerbate inequalities, the result of drug policies often rooted in racism and other prejudices rather than science, according to Jones.
“Findings like this let us continue to complicate those narratives,” he said, “so that hopefully we can develop more nuanced and in-touch drug policy that lets us utilize any potential benefit of these substances, while also having accurate and well informed harm reduction related to the substances.”