Persisting Reductions in Cannabis, Opioid, and Stimulant Misuse After Naturalistic psychedelic Use : An Online Survey
Albert Garcia-Romeu, Alan K. Davis, Earth Erowid, Fire Erowid, Roland R. Griffiths and Matthew W. Johnson
Frontiers in Psychiatry, 2020, Vol 10, Article 955.
Doi : 10.3389/fpsyt.2019.00955
Background : Observational data and preliminary studies suggest serotonin 2A agonist psychedelics may hold potential in treating a variety of substance use disorders (SUDs), including opioid use disorder (OUD).
Aims : The study aim was to describe and analyze self-reported cases in which naturalistic psychedelic use was followed by cessation or reduction in other substance use.
Methods : An anonymous online survey of individuals reporting cessation or reduction in cannabis, opioid, or stimulant use following psychedelic use in non-clinical settings.
Results : Four hundred forty-four respondents, mostly in the USA (67%) completed the survey. Participants reported 4.5 years of problematic substance use on average before the psychedelic experience to which they attributed a reduction in drug consumption, with 79% meeting retrospective criteria for severe SUD. Most reported taking a moderate or high dose of LSD (43%) or psilocybin-containing mushrooms (29%), followed by significant reduction in drug consumption. Before the psychedelic experience 96% met SUD criteria, whereas only 27% met SUD criteria afterward. Participants rated their psychedelic experience as highly meaningful and insightful, with 28% endorsing psychedelic-associated changes in life priorities or values as facilitating reduced substance misuse. Greater psychedelic dose, insight, mystical-type effects, and personal meaning of experiences were associated with greater reduction in drug consumption.
Conclusions : While these cross-sectional and self-report methods cannot determine whether psychedelics caused changes in drug use, results suggest the potential that psychedelics cause reductions in problematic substance use, and support additional clinical research on psychedelic-assisted treatment for SUD.
Keywords : psychedelics, hallucinogens, psilocybin, lysergic acid diethylamide (LSD), addiction, opioid, cannabis, stimulant
Substance misuse is a leading preventable cause of morbidity and mortality (1, 2), and contributed to over 63,000 drug overdose deaths in the US in 2016 (3). An estimated 23.3 million Americans have met Diagnostic and Statistical Manual of Mental Disorders 5th Ed. (DSM-5; 4) criteria for a substance
use disorder (SUD) regarding a drug besides alcohol or tobacco in their lifetime (5). Cannabis, opioids, and cocaine constitute the greatest proportion of these diagnoses (5). Recent trends have shown increased adult use of cannabis (6–8), opioids (9–11), and stimulant drugs (12, 13), and associated adverse public health outcomes (3).
Though cannabis use among those age 12–17 has largely decreased in recent years (6, 14), adults have shown greater use as more states have approved medical or recreational accessibility (8, 15). Concurrently, cannabis related emergency room visits (16) and prevalence of cannabis use disorder have risen (8). The United States has recently seen unprecedented levels of opioid misuse and overdose deaths, including a notable increase in prescription opioid misuse between 2001 and 2013 (17), and over
42,000 opioid-related deaths in 2016 (3). Additionally, recent increases in cocaine and other stimulant use (13, 18–20) have contributed to a substantial number of hospitalizations (21, 22) and deaths (3).
Available SUD treatments typically exhibit limited success with most patients not achieving long-term abstinence (23–26). Medications for opioid use disorder (OUD) include the agonist treatments methadone and buprenorphine, and the opioid antagonist naltrexone (27). However, many people who use opioids are unable or unwilling to access these treatments or do not adhere to them consistently enough to achieve long-term improvement (28–30) . There are no approved pharmacotherapies for cannabis (31) and stimulant use disorders (32), and with the exception of contingency management (33, 34), behavioral therapies generally have modest efficacy for treating SUDs (35, 36). Thus, the current public health landscape highlights an urgent need for novel, innovative strategies for treating SUDs.
Use of serotonin 2A (5-HT2A) agonist psychedelics such as lysergic acid diethylamide (LSD), psilocybin-containing mushrooms (hereafter referred to as psilocybin), peyote, and the dimethyltryptamine (DMT) containing admixture ayahuasca in both naturalistic and clinical settings have been implicated in decreased substance misuse (37–48). The strongest evidence is for LSD in the treatment of alcoholism, with six randomized studies showing an aggregated statistically significant effect for LSD improving outcomes in meta-analysis (49).
An early study in 74 male parolees with a history of chronic heroin use examined a 4- to 6-week residential treatment program involving roughly 5 weeks of preparatory therapy in conjunction with a single high-dose administration of LSD (300– 450 μg), compared with treatment as usual outpatient care involving weekly group therapy (46). The LSD treatment was well tolerated among this sample, which was largely African American (76%) and with relatively low education (mean of 8.6 years). Biologically verified continuous abstinence was significantly greater in the LSD than control conditions at 6 month (32% vs. 8%) and 12 month (25% vs 5%) follow-ups (46). Epidemiological data from the 2008–2013 National Survey on Drug Use and Health showed lifetime serotonin 2A agonist psychedelic use was associated with 27% reduced risk of past year opioid dependence and 40% reduced risk of past year opioid abuse when controlling for relevant covariates (43). Preliminary observational data have shown significant reductions in cocaine use in a small sample (n = 6) after participation in a ceremonial ayahuasca retreat geared toward addressing substance misuse (47). Pilot clinical research currently underway has also found promising early results of psilocybin-assisted treatment in people with cocaine use disorder (50, 51). In addition to these preliminary clinical findings, anecdotal reports further corroborate potential benefits of psychedelics in people with various substance use issues (e.g., 52).
We have previously published findings on individuals who self-reported reductions in tobacco (53), and alcohol misuse (40) attributed to naturalistic psychedelic use. However, instances in which people experienced a marked reduction in problematic cannabis, opioid, or stimulant use following ingestion of a psychedelic have not been systematically documented to date. Therefore, the current study sought to characterize instances in which individuals experienced a reduction in cannabis, opioid, or stimulant use after taking a psychedelic in a non-clinical setting. We hypothesized that greater improvements in substance misuse would be associated with greater mystical-type effects of the psychedelic experience consistent with preliminary clinical data (54, 55).