• Psychedelic Medicine

Drug Addiction | +70 articles


Psychedelics: Treating addiction, depression and anxiety, with Dr. Roland Griffiths​


Psychedelics were the subject of serious medical research in the 1940s to the 1960s, when many scientists believed some of the mind-bending compounds held tremendous therapeutic promise for treating a number of conditions including severe mental health problems and alcohol addiction. By the mid-60s, research into psychedelics was shut down for decades.

After the blackout ended, the doctor we have on the podcast today was among the first to initiate a new series of studies on psilocybin—the psychoactive compound in “magic” mushrooms.

On today’s Broken Brain Podcast, our host, Dhru, talks to Dr. Roland Griffiths, a Professor in the Departments of Psychiatry and Neurosciences at Johns Hopkins University School of Medicine. He has conducted extensive research with sedative-hypnotics, caffeine, and novel mood-altering drugs. In 1999, he initiated a research program at Johns Hopkins investigating the effects of the classic hallucinogen psilocybin that includes studies of psilocybin-occasioned mystical-type experiences in healthy volunteers, psilocybin-facilitated treatment of psychological distress in cancer patients, psilocybin-facilitated treatment of cigarette smoking cessation, psilocybin effects in beginning and long-term meditators, and psilocybin effects in religious leaders. In this episode, Dhru and Dr. Griffiths talk about his extensive research with psilocybin in the treatment of psychological distress in cancer patients and cigarette smoking cessation. They discuss the connection between psilocybin, spirituality, and consciousness. They also talk about psychedelics and their potential for treating conditions ranging from drug and alcohol dependence to depression and post-traumatic stress disorder.

In this episode, we dive into:
- The connection between psychedelics, spirituality, and consciousness (7:48)
- The history of psychedelic research (8:28)
- The reintroduction of psychedelic research by Dr. Roland Griffiths and others (12:27)
- Why research participants rated their psychedelic experience as one of their most meaningful (16:36)
- What is happening in the brain when using psychedelics (23:39)
- How psychedelics can help us understand altered states of consciousness (29:09)
- The therapeutic benefits of psilocybin for the treatment of addiction (40:16)
- How a single dose of psilocybin substantially diminished depression and anxiety in cancer patients (44:52)
- The future of psychedelics (48:07)
- The downside and risks of psychedelics (56:14)
- Learn more about Dr. Roland Griffiths and his work (1:00:24)

For more on Dr. Roland Griffiths and his research on psychedelics check out his website https://hopkinspsychedelic.org.​
 
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Ibogaine inhibits hERG channels: A cardiac arrhythmia risk!*

Xaver Koenig, Michael Kovar, Stefan Boehm, Walter Sandtner, Karlheinz Hilber

Ibogaine, an alkaloid derived from the African shrub Tabernanthe iboga, has shown promising anti-addictive properties in animals. Anecdotal evidence suggests that ibogaine is also anti-addictive in humans. Although not licensed as therapeutic drug, and despite evidence that ibogaine may disturb the rhythm of the heart, ibogaine is currently used as an anti-addiction drug in alternative medicine. Here we report that therapeutic concentrations of ibogaine reduce currents through human ERG potassium channels. Thereby, we provide a mechanism by which ibogaine may generate life-threatening cardiac arrhythmias.

In preclinical studies on animals, ibogaine, an indole alkaloid derived from the root bark of the African shrub Tabernanthe iboga, has shown promising anti-addictive properties: ibogaine attenuates opioid withdrawal signs and reduces the self-administration of a variety of drugs including opioids, cocaine, nicotine, and alcohol. The inhibition of dopamine release in the nucleus accumbens as essential part of the brain’s reward systems offers an explanation for ibogaine’s anti-addictive actions. The underlying molecular mechanisms may involve interactions with neurotransmitter transporters as well as opioid and glutamate receptors, effects that have been observed at ibogaine concentrations between 0.1 and 30 uM.

Since ibogaine interacts with numerous different cellular and molecular targets, its potential to generate adverse effects is significant. Besides the expected neurotoxic actions, ibogaine also affects the cardiovascular system. In both animals and humans, high doses of ibogaine decrease the heart rate. Alarming are several reported cases of sudden deaths with unclear cause after ibogaine use, which have been hypothesised to be related to cardiac arrhythmias. In accordance with this hypothesis, a severely prolonged QT interval of the electrocardiogram (ECG), associated with ventricular tachyarrhythmias, was observed in a 31-year-old woman after she had taken a single dose of ibogaine.

Here, we provide the first experimental evidence on the mechanism by which ibogaine may generate life-threatening cardiac arrhythmias: inhibition of human ERG (hERG) potassium channels in the heart. Conducting the rapid component of the delayed rectifier potassium current IKr, hERG channels are crucial for the re-polarisation phase of cardiac action potentials. hERG current reduction, either due to genetic defects or blockade by drugs, delays cardiac repolarisation resulting in QT interval prolongation and in an increased risk for Torsade de Pointes arrhythmias and sudden cardiac death. Consequently, hERG channel blockade has become a common reason for drug failure in pre-clinical safety trials.

*From the article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888945/
 
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Journey Colab believes it has the formula for addiction treatment

by Nicolle Hodges | The Dales Report | 8 Feb 2022

Journey Colab is focused on unlocking the science of psychedelics to build a whole new model of addiction care combining the potential of neuroplasticity promoting therapeutics like mescaline with psychotherapy and community support. Their lead program is mescaline – one of the naturally-occurring classical psychedelics – for the treatment of Alcohol Use Disorder (AUD) for patients in desperate need of durable remission. Their focus this year is building on the first modern natural data set on mescaline and are currently conducting the first industry-sponsored human trials.

Further, their Journey Reciprocity Trust is setting the industry standard for the “healing economy.” The Trust holds ten percent of the company’s founding equity for the future benefit of groups working to ensure equitable access to mental health treatment, those working on the conservation of naturally occurring psychedelics, and Indigenous communities that have traditionally used psychedelics.

What makes mescaline particularly effective in the treatment of AUD?

Founder and CEO, Jeeshan Chowdhury: “Mescaline is very interesting in that it’s the only phenethylamine in the classic psychedelic. It’s closer to MDMA than psilocybin, which is a tryptamine. When we look at both the traditional use of mescaline, what we’re seeing now with the rigorous scientific understanding of the mechanism of action, and the clinical studies, these long-acting psychedelics offer a unique advantage.”

Psychedelic Medicine + Therapy + Community Support?

“We know that traditional communities in traditional settings have used mescaline-containing plants for hundreds of years to deal with addiction. In communities that have been disproportionately affected by addiction in response to individual and systemic trauma, the use of mescaline-containing plants combined with therapy and community support shows to be one of the only effective treatments for alcohol use in their communities.”

Psychedelics open a period of relearning

“When people think about relearning periods, you can think about when a child is able to learn a language very easily, versus us trying to learn as adults. We know psychedelics can open critical windows of learning. It’s very clear now from scientific evidence that longer-acting psychedelics, like mescaline, open this period for not hours like ketamine, but weeks. We’re seeing a longer period of neuroplasticity, which lends itself to a chronic condition like Alcohol-Use Disorder where we’re trying to achieve behaviour change. When psychedelic medicine is combined with therapy and community support, we see the strongest effects.”

Reciprocity built into the business model

“I would be negligent in trying to create any product or service and not include or learn from the only people who have done this at-scale, who have done it safely and effectively. It’s a business decision for us to create a space of dialogue with those communities to learn from each other. It’s not a charity, it’s not window-dressing. It makes us a better company and helps us make better decisions. We were able to learn the potential around mescaline because we set up Journey as a stakeholder model, created a space of dialogue, and understood the unique potential of mescaline that everyone else had overlooked.”

 
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How magic mushrooms might help cure addiction*

Giving psilocybin to alcohol-dependent rodents may have revealed a way to repair the neurological mechanism that is damaged by long-term alcohol use and fuels addiction.

by Luke Taylor | Discover Magazine | Feb 23, 2022 1:55 PM

Alcohol consumption causes 5.3 percent of all deaths worldwide and is a factor in more than 200 disease and injury conditions, ranging from behavioural disorders to traffic accidents. Like other addictive substances, regular use can be difficult for users to give up — even when causing severe and obvious harm.

Once long-term alcoholism takes hold, it changes the brain at a cellular and anatomical level, reducing a person’s ability to resist alcohol cravings and fosters dependence. In severe cases, it can cause brain damage and dementia.

“Alcohol essentially removes the executive-function brakes on the brain, leading to cravings, excessive use and tolerance,” says Pamela Walters, a consultant in forensic and addiction psychiatry and director of Forward Trust, a substance misuse and mental health charity in the U.K.

Breaking consumption habits early on before they become ingrained is the most effective treatment, Walters says.

But a series of studies of psychedelics suggest that taking a trip could give addicts a neurological reset that makes it easier for them to ditch harmful substances. Psilocybin — the active ingredient in magic mushrooms — may reverse the long-term neurological damage caused by alcoholism, says Marcus Meinhardt, a researcher at the Central Institute of Mental Health in Mannheim, Germany.

A November study in Science on psilocybin, co-authored by Meinhardt and colleagues in France and Germany, may have revealed a key mechanism driving alcoholism. Targeting this neuro-mechanism could restore the brain’s executive function and an alcohol-user’s ability to better weigh the long-term damage caused by alcohol versus the short-term reward, the authors concluded. They also recommended patient trials as important follow-up measures to vet their findings.

The study, which was limited to alcohol-dependent rats, found that the animals were less likely to return to alcohol after they were given psilocybin. The response suggests that it somehow reduced the rodents’ cravings.

More importantly, says Meinhardt, their levels of mGluR2 — an essential protein for healthy brain function — dropped when they consumed alcohol. That mGluR2 increased after they were given psilocybin. The study’s authors theorise that the resurgence in the rats’ mGluR2 levels restored their ability to execute self-control and made them less likely to discount the rewards of abstinence.

“Like in rodents, MGluR2 is also missing in human brains, thus we now provide mechanistic insights on how to repair it,” Meinhardt says.

Glutamate is essential for regular brain function. When alcohol is consumed, the mGluR2 receptor behaves differently, however. Glutamate production also decreases, altering decision-making. Dysregulation of mGluR2 has been observed in those who are dependent on other addictive substances like cocaine, so targeting the neurotransmitter could help treat the abuse of other substances, Meinhardt says.

Early studies of psychedelics suggest that they could make it easier for people to give up addictive substances, either by the user gaining perspective and experience from a so-called trip, or from effects at a biological level. A small study of psilocybin and cognitive behavioural therapy for smokers in 2014 found that 67 percent were still tobacco-free 12 months after giving it up — a success rate twice as high as traditional treatments.

Humphrey Osmond, a pioneer of psychedelic treatment in the 1950s and 60s, claimed that 40 to 45 percent of the alcoholics to whom he prescribed LSD — which acts on the same brain receptors as psilocybin — were sober one year later.

Most trials of psychedelics were halted when the substances were banned in 1968. But the field is undergoing a renaissance. Researchers say the issues treatable by hallucinogens could span from anxiety and depression to addiction and PTSD. For Meinhardt’s thesis, however, the leap from a rodent brain to a human one is a big one.

Some of his prior studies of psilocybin and LSD for alcohol addiction were effective, but only short-term. It's unclear whether the effects waned due to psychological differences between rodents and humans or incorrect time or dosages, he says. His team is collaborating with researchers in Zurich to see if humans will exhibit the same response as rodents and expects to publish results in the summer of 2023.

“We want to further understand how exactly this restoration [of mGluR2] works, so we can fully understand the molecular mechanisms of psilocybin and try to initiate clinical trials,” Meinhardt says.

*From the article here :
 
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Psychedelic therapy and the opioid crisis*

by Matthew Dunehoo | Psychedelic Spotlight | 4 Mar 2022

I first met Brittany eight years ago, when she was waiting tables at a revered Kansas City diner chain. Her eloquence, her generosity of spirit, her work ethic and natural beauty all caught my attention. She wins people over effortlessly. It’s a gift. I had no way of knowing at that time that Brittany was already struggling with substance use disorder, to a degree that would continue to grow beyond her control.

At 26 years old, Brittany represents one human amidst a surging statistical reality. According to health policy research center SHADAC, the annual number of drug overdose deaths has nearly quadrupled from 17,500 in the year 2000 to 67,400 in 2018. The organization states, “Most of these deaths involved opioids, including heroin, prescription painkillers, and synthetic opioids such as fentanyl.”

Anyone on this list of opioid crisis casualties could be your sister, your daughter, your friend.

Brittany was prescribed opioids by her doctor for ovarian cysts at 16. At the time, she was already living on her own. Both her father and mother were struggling addicts, and Brittany grew up within the omnipresently bleak reality of her family’s poverty. Opioids turned out to provide just the escape she had dreamed of, and treatment immediately mutated into vice.

A number of companies working with psychedelic medicines are developing therapeutics to treat addiction and opioid withdrawal symptoms, with a focus on ibogaine. This naturally occurring psychoactive substance, and indole alkaloid, is found in a perennial rainforest shrub native to Central Africa called Tabernanthe iboga. Ibogaine hydrochloride can be extracted from the plant and has been shown to have a powerful effect on a variety of brain receptors, which can be altered to help with the elements of addiction.

Mindcure, a Canadian company has completed the first stage of manufacturing pharmaceutical grade ibogaine, which it is utilizing in further clinical trials. The idea is that these powerful psychedelics can, once more fully understood, be institutionally administered as a game-changing treatment for addiction, which can take root at an early age in at-risk individuals, and plague them through their perilous lives.

“I had had a troubled life. I was already vulnerable to things like substance use,” Brittany says. “I was marginalized, my parents were addicts. I was prescribed oxycodone for my ovarian cysts. I remember just being a kid and taking them, and thinking, this is what I’ve been looking for my whole life, this feeling. I think about the origin of [my opioid addiction] and it really just traces back to that moment. It’s something I’ve chased ever since.”

Treatment with psychedelic medicine like ibogaine or ketamine cannot continue to be accessible only to the wealthy. It’s clear that collectively we recognize the severity of the opioid crisis in North America. Shows like Hulu drama Dopesick and HBO’s Euphoria inform and entertain, while there are no shortage of books, news, and diatribes like this abound. It’s no longer a secret. Yet our national recognition and reaction in terms of taking the evasive action necessary to create policies to truly attempt to fix the situation are bafflingly inept.

At the time of our interview in December, Brittany was “living” for the most part, unhoused, on the streets, bouncing between heroin houses and rehab centers, if and when she could find a bed. Currently she resides in the Jackson County jail awaiting trial for a disturbingly long list of recent offenses that include theft, possession and evading arrest. She is now looking at significant prison time. This is a woman who has all of the tools necessary to make a lasting and positive impact in this world. A recent diagnosis of borderline personality disorder, coupled with substance use disorder and the relentless stranglehold cycle of poverty are conspiring against her in the most insipid fashion imaginable.

As her friend, I will do what I can by listening when she calls. And I’ll learn more about science and industry working for solutions, helping advocate responsibly as I’m able. But the helpless feeling experienced by those with loved ones in the throes of addiction, is withering. Testimonials of those who have found relief from substance use disorder and an array of other deep-seated illnesses through psychedelic medicine, evoke visions of the miraculous.

Miracles cannot exist for the privileged alone.

Matthew Dunehoo is the producer, director, and co-host of our flagship series “Spotlight in Focus,” which offers in-depth analysis and candid interviews with luminaries throughout the field of medicinal psychedelics. Two episodes are now available to watch on ALTRD.TV.

*From the article here :
 
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The next big addiction treatment

Several psychedelic drugs are touted as effective treatments for drug and alcohol abuse. But psilocybin combined with therapy is emerging as the most effective.

by Brendan Borrell | New York Times | 11 Apr 2022

In recent years there has been a spate of research suggesting psychedelic drugs can help people manage mental health conditions like depression, anxiety, chronic pain or even eating disorders. But a growing body of data points to one as the leading contender to treat the intractable disease of substance abuse. Psilocybin, the active ingredient in psychedelic mushrooms, has shown promise in limited early studies, not only in alcohol and harder drugs, but also nicotine — all of which resist long term treatment.

“The old rule of thumb is that one-third of people get better, one-third stay the same, and one-third continue to get worse,” said Dr. Michael Bogenschutz, a psychiatrist at New York University’s Grossman School of Medicine studying psilocybin-assisted therapy as a treatment for alcohol abuse. “What’s fascinating to me about this whole process is how many different kinds of experiences people can have, which ultimately help them make these profound changes in their behavior.”

Take Aimée Jamison, who several years ago wanted to kick her cigarette habit before her 50th birthday. Statistically speaking, Ms. Jamison’s chance of success wasn’t great. According to the Centers for Disease Control and Prevention, 55 percent of adult smokers tried to quit in 2018, but only 8 percent were successful.

Ms. Jamison, an investor who lives part-time in Boston, had heard about psychedelic therapies, but the drug is largely illegal for personal use. So, in the fall of 2018, she flew to Baltimore to participate in a clinical trial at the Johns Hopkins Center for Psychedelic & Consciousness Research. When she had to abstain from nicotine for a day before a brain scan, she could barely sleep and called it “the most hellish 24 hours I’ve experienced.”

After three talk therapy sessions at the Hopkins clinic, she was given a single pill containing 30 milligrams of psilocybin, a relatively high dose. After swallowing the pill, she put on an eye-mask, lay on a couch and went on a psychedelic trip with two therapists nearby for the next five hours.

When her trip ended, she sat up and looked at the therapists. “Now, I understand why I smoked,” she said, “and I don’t need to do that anymore.”

Over the next couple months Ms. Jamison attended several more therapy sessions, but took no additional psilocybin. She hasn’t touched a cigarette in the years since. An early version of that study (in which participants had two or three psilocybin sessions), published in 2014, reported an 80 percent success rate in 15 smokers, compared with 35 percent typically observed in patients taking the leading conventional antismoking drug Chantix.

Buoyed by such positive outcomes, the Hopkins study has expanded to include more participants, and, last year, the team received a $4 million grant from the National Institutes of Health.

It’s still uncertain how effective using psilocybin to treat addiction is in the long-term and whether some individuals are more likely to benefit than others. Some study participants have had troubling experiences during their trips, and experts say that people should not be taking the drug outside of legitimate research studies or without medical supervision.

The five-hour duration of the experience will also make it costly in a health care setting, which could limit its use in lower-income communities disproportionately affected by drug and alcohol abuse. Still, many experts hungry for new addiction therapies say that psilocybin represents a new and potentially exciting treatment for people suffering from a disease that is difficult to address.

Treating more than a chemical dependency

One of the reasons addictions are so hard to treat is that most are more than chemical dependency. Long after the short-term withdrawals have waned, people suffering from addiction often face living without the stress release valve that their habit gave them. Those wishing to quit may persevere for a few weeks or months, but when stressed or upset, their brains often divert them back to the familiar territory of their addiction.

Some experts say psilocybin addresses that psychological need. Along with LSD and mescaline, it is known as a “classic psychedelic,” which activates switches in the brain’s visual cortex, the serotonin 5-HT2a receptors, producing hallucinations. Back in the psychedelic heyday of the 1950s and 1960s, such drugs were evaluated for treating depression and addiction with mixed results.

But that work was put on ice in the 1970s with the passage of the Controlled Substances Act, which placed LSD and psilocybin in the most restrictive legal category, known as Schedule 1.

Thirty years later, in 2000, Roland Griffiths, a psychopharmacologist at Johns Hopkins, received the green light from the Food and Drug Administration to study the psychological effects of psilocybin on 30 volunteers. In a survey given to participants two months after their session, more than half ranked it as among the most meaningful experiences of their lives.

Psychedelic research has blossomed since then. A British study published earlier this year found that people with severe alcohol abuse disorder who received ketamine-assisted therapy abstained from drinking 10 percent more over six months than those who received just a placebo along with therapy or education.

Some studies on ketamine and addiction, however, suggest that its antidepressant effect wears off over time, and participants may need repeated infusions. This is a potential problem because the drug itself has the potential to become a drug of abuse and overdoses can, in rare cases, be fatal.

Researchers who are enthusiastic about psilocybin say its longer, more intense psychedelic experience make it a more long-lasting therapeutic. It generally requires just a single session or sometimes several sessions to be effective, provided it’s integrated with psychotherapy or some other form of counseling.

“People have greater mental flexibility following psilocybin,” said Matthew Johnson, a psychologist at Johns Hopkins who leads the smoking trial. “That increase in openness might be a permanent change that can help in overcoming addiction.”

An uncertain future

Although psilocybin remains illegal under federal drug laws, some cities, including Denver, and Santa Cruz, Calif., have decriminalized it. Oregon, in November 2020, voted to become the first state to legalize it for medical use.

Psilocybin is considered safer than ketamine and is not habit-forming, but it does have its downsides. The greatest risks may come from a person who uses the drug alone and wanders into traffic or other dangerous situations while high. Even in the supervised setting of a research laboratory, users often experience side effects, such as vomiting or loss of coordination, and the trip itself can produce anxiety, pain or even a psychotic break.

“One of the big challenges of these treatments is that the effects are somewhat unpredictable,” Dr. Bogenschutz said.

The California Institute of Integral Studies is one of the best known organizations offering a certificate program to train future therapists working with psychedelics, but since psilocybin-assisted therapy remains illegal, an underground treatment market has popped up around the country.

Jon Kostakopoulos, a former alcoholic who founded the Apollo Pact, a nonprofit that advocates for increased federal funding of psilocybin research, said that the psychedelic landscape can be tough for people to navigate. He said he has spoken to several people who became suicidal after their psychedelic guides told them to quit taking their conventional antidepressant medications in preparation for their psilocybin trip. Mr. Kostakopoulos tries to direct people to legitimate clinical trials, like the pilot study he took part in at N.Y.U. and which he believes helped him to give up alcohol.

“I think you need to do this with properly trained professionals,” he said. “There are some shady actors.”

Some also some worry that psilocybin is not being evaluated in the poorer communities where addiction has its greatest toll. “We need to develop treatments to help everyone,” said Peter Hendricks, a psychologist who studies psilocybin and addiction at the University of Alabama in Birmingham.

He is nearing the conclusion of a clinical trial that has stretched on for more than five years, which aims to evaluate the potential of psilocybin as a treatment for cocaine abuse. He focused on recruiting users from low income communities around Birmingham, including among the homeless, where addiction is rampant.

On its own, psychotherapy is not generally an effective treatment for cocaine use disorder. In Dr. Hendricks’s trial, however, a preliminary analysis of the first 10 participants showed that those who received psilocybin along with therapy used cocaine on fewer days over the next six months than those who received a placebo alongside therapy. They also reported that it was significantly easier to abstain from cocaine and reported higher life satisfaction.

Dr. Hendricks, however, warns that people shouldn’t get their hopes up too high. “The existing treatments are very ineffective,” he said. “I’m hoping to go from pretty darn ineffective to not bad or decent.”

 
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Michael Barajas, right, and his fiancée, Lindsay Garcia, stand outside their Aberdeen home.

Easier access to Buprenorphine is helping people with opioid use disorder turn their lives around*

by Sandi Doughton | Seattle Times | 13 Mar 2022

MICHAEL BARAJAS TOOK his first vacation this year, at the age of 33.

For most of his life, the Aberdeen native had no interest in leaving town — unless it was to pick up or deliver drugs.

“Nothing else mattered but getting high,” he says, “so why would I go anywhere?”

The backstory Doctors who believe in bupe are bringing the opioid-addiction treatment to people where they are

Since he’s been sober for nearly three years, Barajas’ world has broadened in ways that seemed inconceivable when he was camping in abandoned houses, focused only on “getting well” with another bump of OxyContin, heroin or whatever he could get his hands on.

He’s now working full-time for a company that manages rental properties in Ocean Shores. He’s engaged and shares a house with his fiancée. On their trip to California in January, they visited her family, checked out the scene at Venice Beach and strolled the Santa Barbara pier.

Barajas credits his recovery to a medication called buprenorphine, or bupe, and a new type of clinic that’s part of a statewide push to make the treatment more accessible.

Also known by the brand name Suboxone, bupe is a synthetic opioid similar to methadone but much safer and less powerful. In former drug users like Barajas, it doesn’t cause euphoria and it actually prevents them from getting high if they take other opiates. The medication blocks withdrawal symptoms and calms the jangling brain circuits that trigger cravings and the temptation to relapse.

“It’s opened up a whole lot of doors for me,” Barajas says during a recent, monthly visit to the MAT (medication assisted treatment) Clinic at Summit Pacific Medical Center in the tiny town of Elma. “Instead of being locked in that mental state where my brain is constantly telling me I want that feeling of being high, I can now do things and experience life and grow as a person.”

The clinic’s lead nurse, Beth Hindbaugh, beams.

“I’m super proud of you,” she says.

ENCOURAGEMENT AND COMPASSION are integral to the clinic’s philosophy. So is upending the traditional — often punitive — approach to addiction treatment.

Behavioral therapy, detox and 12-step programs long have dominated recovery paradigms, but evidence increasingly shows that medication, especially buprenorphine, is far more effective.

Patients taking bupe or methadone are half as likely to relapse or overdose as those who get only counseling. In fact, adding talk therapy to buprenorphine-based treatment doesn’t significantly improve success rates, according to several studies. Medication for addiction is linked with a drop in arrests and fewer emergency room and hospital visits, which reduces the economic toll.

“Getting on Suboxone results in a more complete and longer sobriety than anything else we do,” says Dr. Shawn Andrews, founder and medical director of the Elma clinic. Though it doesn’t work for everyone, the medication can be life-changing for many.

“People get their lives back. They get their kids back. They go to school; they get better jobs and contribute to society,” she says.

But fewer than 1 in 5 Americans with opioid addiction receives any type of medication, with the highest gaps among people of color. Widespread use of buprenorphine, which was approved by the FDA in 2002, has been hampered by medical bureaucracy, restrictive regulation, doctors’ reluctance to treat drug users and the stubborn misconception that medication is a crutch, not a true path to recovery.

“There’s a pervasive attitude that people who struggle with substance use disorders are just weak, that they could quit if they wanted to,” says Dr. Charissa Fotinos, acting state Medicaid director at the Washington State Health Care Authority. “But we know from the brain science that they can’t. This is not a willful act. This is not a moral failing.”

An estimated 2 million people in the United States suffer from what medical experts refer to as opioid use disorder, a term that acknowledges the disease-like impact on the brain and body. Overdose deaths reached an all-time high of 100,000 during the second year of the coronavirus pandemic, driven in large part by a flood of fentanyl, which is much deadlier than heroin.

In the face of the ongoing crisis, Washington is among several states shifting to a strategy described as medication-first and low-barrier. The goal is to dismantle obstacles and make it easier to get buprenorphine to those who need it most.

Over the past several years, the state has received more than $130 million in federal opioid response grants, and some of that money has gone to create 25 new treatment sites, like the one in Elma. Most are low-barrier, and many are located in places frequented by people with addiction: needle exchanges, emergency rooms, shelters and jails. Local governments and organizations are also adding low-barrier options; King County now has 33.

“We’ve recognized that there’s a group of folks who aren’t comfortable or don’t feel safe in the regular health care system because they’ve been judged or stigmatized,” Fotinos says. “So let’s just be where they are, and if they’re ready and willing and interested in treatment, let’s provide it for them right there.”

THE ELMA CLINIC, 30 miles west of Olympia, demonstrates many of the elements for success — even in rural Grays Harbor County, which has the state’s highest rate of overdose deaths and few doctors willing to prescribe buprenorphine. Patients don’t need appointments. If they meet the criteria, they can walk out the same day with medication instead of having to wait weeks for their first dose. That’s an important change, because delays can plunge people into withdrawal and send them scrambling for drugs to stop the misery. State regulators recently lifted limits on the amount and duration of bupe treatment, removed some insurance barriers and raised payments to doctors. They did away with a long-standing requirement that patients also enroll in talk therapy.

In low-barrier programs, no one is booted out for relapsing. If someone wants to cut down on heroin use but continue using other drugs, such as meth, that’s OK, too. The idea is to help all patients reduce their risk of overdose and improve their lives and health — even if it’s just baby steps at first.

Addiction experts compare it to treating patients with high blood pressure or diabetes. Doctors don’t kick them out if they smoke or sneak a piece of birthday cake, but that’s the way people with substance use disorder are often treated.

“Recovery is an incremental process for most people,” Andrews says. Even the most motivated patients usually stumble before it sticks. For people who lack stable housing, it’s even more challenging.

“It’s very hard to stay sober if you’re sleeping in a tent and rats are nibbling at your feet,” Andrews says.

BARAJAS FOLLOWED A typically twisting path.

Growing up with a mother addicted to meth, he assumed drug use was the norm.

“Since I was probably 12 years old, I’ve always been on something, whether it was booze or pills or cocaine,” he says. He occasionally stole, but mostly sold drugs to make money, chalking up a string of arrests and jail time.

His first attempts to get clean were through cold-turkey therapy programs. He didn’t find the counseling helpful but did OK for a while until a series of calamities pushed him over the edge. An injury cost him his livelihood as a logger. His house burned, his grandmother was diagnosed with cancer and he got hit by a car.

Smoking opioids ruined his marriage and his relationship with his daughter, but it eased the suffering.

“It just numbs you from life, and your body doesn’t hurt until you’re out of drugs.”

Barajas’ first stint at the Elma clinic ended in relapse. Then his girlfriend at the time died of an asthma attack because she was too high to find her inhaler.

“That was the big push I needed for myself,” Barajas recalls. “I thought, ‘What if my daughter were to find me like that, laying on the ground?’ ”

He was so ashamed of his relapse, he almost didn’t return to the clinic. “I’m thankful they didn’t say, ‘Your chance is over. You failed,’ ” he says. “They want you to come back and keep trying.”

WASHINGTON’S LOW-BARRIER sites are still too new to measure their impact, and disruptions from the pandemic haven’t helped, Fotinos says. At least 24,000 people have received treatment through the new programs since 2018, but retention rates aren’t clear, and the number of Washington residents with opioid addiction is also increasing.

Caleb Banta-Green, of the University of Washington’s Addictions, Drugs and Alcohol Institute, conducted the state’s first low-barrier pilot project at Seattle’s downtown needle exchange in 2017 and found that even among a largely homeless population, buprenorphine slashed overdose deaths and reduced opioid use. Nearly 80% of drug users surveyed said they wanted to quit, with medication by far the preferred method. But another analysis found most people don’t initially stay on the medication for the recommended minimum of six months.

To evaluate the method on a larger scale, Banta-Green and his colleagues are collecting data on overdoses, deaths, relapse rates, hospitalizations and arrests from six clinics across the state.

The link between drugs and crime also makes prisons and jails important players in expanding buprenorphine treatment. At the South Correctional Entity (SCORE) jail in Des Moines, for example, eight in 10 people booked are on some kind of intoxicant, says Lt. Jeffrey Gepner.

Those on opioids used to be left to endure withdrawal with no medical intervention, which can sometimes be deadly. In most cases, guards would mop up the vomit and diarrhea, move prisoners to another cell, then repeat the process, says Gepner, who now leads the jail’s medication assisted treatment program.

Buprenorphine is provided to inmates sick from withdrawal and to those who want to continue or start a treatment program. Many jails and prisons have similar programs, and more are adding them after a lawsuit in Whatcom County that argued it was illegal for correctional facilities to deny addiction treatment.

“The goal here is to say: ‘We’ll get you stabilized. We’ll hook you up with someone on the outside to help you with treatment. We’ll even give you a ride to your first appointment,’ ” Gepner says. Continuity of treatment is crucial because former inmates face an extremely high risk of overdose death after release.

But Gepner acknowledges there’s only so much he and his team can do during a brief window of incarceration. In most cases, it doesn’t come close to addressing the complex tangle of circumstances that contribute to addiction, from trauma and mental illness to poverty and homelessness.

Some experts worry the pendulum is swinging too far toward medication as a quick fix and away from more holistic treatment, including counseling.

Dr. Kenneth Stoller, who directs the Johns Hopkins Broadway Center for Addiction in Baltimore, says treatment narrowly focused on medication could sell patients short. In his program, buprenorphine and other meds are part of a comprehensive package that includes helping patients find housing, connect with psychiatric care and work on skills such as parenting.

The program’s therapists provide individualized care and aren’t afraid to “push and pull” patients past obstacles to help them achieve their goals, he says — something medication-first clinics shy away from.

“I worry that the system will eventually see treatment as equivalent to providing medication,” he says. “And that the result will be that patients get fewer resources than they deserve, and that their outcomes will be suboptimal and that providers and society will in turn blame the patient.”

EVEN AT LOW-BARRIER clinics, patients aren’t just given a prescription and left to fend for themselves. Nurse-managers provide moral support and talk through issues from the medication itself to other aspects of their clients’ lives. Staff members help patients explore housing options and connect with social services and more intensive counseling. At the STEP clinic (Support, Treatment, Engagement, and Pride), in Seattle’s Central District, some staff members are themselves in recovery, which helps them empathize and understand what clients need, says medical director Dr. Eliza Hutchinson, of Country Doctor Community Health Centers.

The clinic is tucked in a corner of the Hepatitis Education Project’s syringe service, where people can pick up clean needles, toothbrushes, socks — and now, if they qualify, a Suboxone prescription.

Hutchinson started the program primarily to reach those who aren’t able to navigate the maze of conventional medicine because their lives are upended by drug use and other complications, from lack of housing to mental illness.

“We tend to see folks with a lot going on that makes it challenging to stabilize them,” she says.

Randy Gaspard, who is living in an apartment after several years being unsheltered, drops in often. Through his years of addiction, Gaspard, 56, was arrested repeatedly for burglary. He tried getting sober with methadone, which is more tightly regulated than bupe and requires daily clinic visits. He’d schlep across town and wait in line, only to encounter some problem that meant he had to start over.

With buprenorphine, patients get prescriptions for several days, a week or even a month, depending on their circumstances. The medication costs between $80 and $200 a month, which is covered by Medicaid, Medicare and most private insurance. Regular urine tests help ensure patients are taking their bupe, not selling it.

“I’m not saying it’s peaches and cream,” Gaspard says of the treatment. “But it’s a hell of a lot better. I’m not dope-sick all the time, and I’m not running around out there trying to find it.”

AS GASPARD WRAPS UP his visit, Alicia Burden sweeps into the clinic with cheery greetings and a stack of pizzas to share. She works as assistant manager and sometime-delivery driver at a Domino’s in the area.

Burden started using drugs as a teenager, and her addiction led her into prostitution, theft and — eventually — violence. She fatally stabbed a man who she said was attacking her, and she was sentenced to 11½ years in prison.

As her release date approached, Burden started Suboxone treatment because she feared she might relapse.

“I didn’t trust myself,” she says. “Being an addict is not just a one-time thing. It’s a forever thing.”

Nearly two years into her treatment, things are going great, she tells Hutchinson. “I’m not having any cravings. I don’t even dream about it anymore.”

Work is good, she’s in a relationship, and she and her boyfriend are talking about having a baby. While many people continue taking buprenorphine for the rest of their lives, Burden tells Hutchinson she wants to start tapering off with the goal of quitting completely.

“I just don’t want to be on anything anymore,” she says.

After the appointment, Burden, 35, stops to gather socks, syringes, lip balm, lotion and packages of the overdose prevention drug Narcan. She’ll pass them out to people who are homeless and using drugs in her University District neighborhood. She understands what they’re going through, and tries to serve as a model to show that change is possible.

“I’m always excited about everything,” she says, “because I just wake up glad to not be dead or in a coma on the streets.” She hopes some of the people she helps eventually will find their own way to recovery.

“Some people aren’t strong enough,” she says. “They’ll do it when they’re ready.”

*From the article here :
 
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New study links psilocybin to lower risk of opioid addiction*

by Greg Gilman | Psychedelic Spotlight | 11 Apr 2022

A study published in Nature today provides more evidence that psychedelics could serve as a major tool in the fight against opioid addiction, with psilocybin users, in particular, being up to 34 percent less likely to have opioid use disorder (OUD).

“Psilocybin was the sole classic psychedelic substance associated with lowered odds of past year OUD in a large, nationally-representative sample of the U.S. population,” write study authors Grant Jones, Jocelyn A. Ricard, Joshua Lipson and Matthew Nock. “These findings accord with other population-based survey research indicating that classic psychedelics share differing relationships to mental health outcomes in naturalistic contexts.”

In other words, different psychedelics — LSD, ayahuasca, MDMA, mescaline, peyote — may be uniquely suited to treat certain mental health conditions, and this study correlates psilocybin, specifically, to reducing opioid abuse and dependence.

One recent ketamine trial for alcohol use disorder delivered very promising results, as well, and that’s just the tip of the iceberg of potential applications of psychedelics, in general.

This latest psychedelics study drew on 2015-2019 data from The National Survey on Drug Use and Health, an annual survey that examines substance use and health outcomes within a nationally-representative sample of the US citizens. It was modeled after a 2017 study, which was the first to conclude, “Experience with psychedelic drugs is associated with decreased risk of opioid abuse and dependence.”

That study found classic psychedelic use conferred 27 percent reduced risk of past-year opioid dependence and 40 percent reduced risk of past-year opioid abuse, and current study authors felt it was “crucial to examine whether such findings replicate.” Of the 214,505 respondents in this second attempt, those who used psilocybin were found to be 17 to 34 percent less likely to develop symptoms of opioid dependence.

Most interesting is that psilocybin was the only substance associated with lowered odds of OUD. “Other classic psychedelics shared no association with OUD or were associated with increased odds of OUD,” the study states.

“These results are cross-sectional and correlational and so cannot be used to make causal inferences,” study authors note. “However, this study offers an important contribution to the research literature by demonstrating the replication of [the] original finding that lifetime use of psychedelics conferred lowered odds of opioid dependence and abuse.”

They add, “Furthermore, our findings suggest it is worth investigating the protective effects of psilocybin for all related diagnostic criteria for OUD, including overuse and tolerance, opioid-related emotional distress, and opioid-related social and work problems.”

*From the article here :
 
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Psilocybin could be a therapeutic breakthrough for addiction

by Tara Law | TIME | 19 Apr 2022

To the uninitiated, psilocybin—the substance that gives ‘magic mushrooms’ their psychedelic qualities—could be dismissed as a recreational drug. Like many other psychedelics, it is banned by the U.S. government as a Schedule 1 substance, meaning it supposedly has high potential for abuse and no currently accepted medical use in treatment. However, to many medical science researchers, psilocybin is much more: a promising treatment for a range of health issues. In particular, experts increasingly see the chemical as a potentially effective, low-risk tool to help patients break their dependencies on other substances. Given that more than 100,000 people died after overdosing on opioids and other drugs in the U.S. last year, it’s an understatement to say it’s urgent to find new, effective treatments for substance use disorder.

The research supporting psilocybin’s use in this context has been growing for a while now. One of the most recent such studies, published in Scientific Reports on April 7, looked at data from 214,505 U.S. adults in the National Survey on Drug Use and Health (NSDUH) from 2015 to 2019, and found an association between past use of psilocybin—at any time in their lives—and a reduced risk of opioid use disorder. The researchers looked at 11 criteria that scientists use to diagnose opioid use disorder (for instance, spending a significant amount of time getting and using drugs), and found that past psilocybin use was significantly correlated with lowered odds of seven of items on the list, and with marginally lowered odds of two others.

There’s a major caveat with this study: because it was looking at correlations, it didn’t find any definitive proof that psilocybin use in-and-of-itself reduces the risk of opioid use disorder. "While the researchers controlled for things like educational attainment, annual household income, and age, there may be social or personal characteristics that make psilocybin users different from people who didn’t decide to use the drug," says Grant Jones, a graduate researcher at Harvard University who co-authored the study. “Maybe there’s different psychological profiles that make [some people] more immune to developing substance use disorders; we don’t know,” says Jones.

Nevertheless, the study adds to growing evidence that psilocybin is worth investigating as a treatment for substance use disorder. For example, a 2017 Johns Hopkins University pilot study, co-authored by Albert Garcia-Romeu, found that the majority of 15 participants were able to quit smoking for at least 16 months after receiving two to three moderate to high-level doses of psilocybin. A similar proof-of-concept study into alcohol use disorder in 2015, led by Michael Bogenschutz, a professor of psychiatry at New York University Grossman School of Medicine, found that abstinence among addicts increased significantly following the use of psilocybin. Observational studies, including Jones’ report and additional research from Garcia-Romeu, have also found that psilocybin is associated with a reduced risk of using substances like cocaine, marijuana, and opioids.

Additional research has shown another potential therapeutic use of psilocybin: to assuage depression. For instance, a small randomized clinical trial published in JAMA Psychiatry in 2020 found that psilocybin-assisted therapy caused a rapid reduction in the symptoms of major depression symptoms, and that the effects remained statistically significant at least four weeks later. Another study, published this year in the Journal of Psychopharmacology, found that among a small group of participants with depression who received two doses of psilocybin with supportive therapy, 75% still had some response to the treatment, and that 58% were in complete remission from depression. In another study co-authored by Jones, published earlier this year in the Journal of Psychopharmacology, he and colleague Matthew K. Nock reviewed NSDUH data, and found that psilocybin use was associated with a reduced risk of major depressive episodes.

Despite all that, Jones acknowledges that there’s still a lot to learn about psychedelics. “The thing that always strikes me about psychedelic research is that even though there’s an immense amount of excitement, and a lot of attention, and a lot of a lot of financial support that’s flowing into the space, the actual body of literature is still very sparse,” Jones said. “I think we’re exploring the boundaries of the benefits of well-being.”

Why might psilocybin help treat addiction?

Several clinical trials focused on mental illnesses like depression have shown that psilocybin appears to boost patients’ moods, even weeks after taking the drug. Exactly how remains uncertain, but researchers have a few ideas. For example, psilocybin appears to increase the brain’s neuroplasticity—the ability for neural networks to shift and rewire. In a study published April 11 in Nature Medicine, for example, researchers found that psilocybin helped to broadly build more connections between different parts of the brain, while simultaneously reducing interactions between brain areas connected with depression—and, in terms of outcomes, psilocybin use seemed to reduce patients’ depressive symptoms. In research in both people and animals, psilocybin appears to make it easier to break out of habits and become more adaptive, says Bogenschutz. “It increases the capacity of the brain to change, and therefore for thinking and behavior to change.”

In addition, evidence from animal trials suggests psilocybin’s effect on mental wellbeing may be connected, in part, to its ability to reduce inflammation—an immune response in the body’s tissues to dangers ranging from stress to physical injuries, which researchers have found is associated with psychiatric disorders like depression.

Biological mechanisms aren’t the only reason scientists are excited about psilocybin and other psychedelics—there’s also the psychological experience of taking the drugs. “The types of experiences that people often have with these drugs can be highly meaningful, insightful, and also sometimes spiritual in nature,” says Garcia-Romeu. “When you ask them, those experiences are the reason that they’re making these better choices, and they’re making these behavioral changes.”

The unique advantages of psilocybin

Researchers point to two characteristics that make psilocybin an especially attractive potential treatment for mental health conditions. First, while it can trigger some dangerous side effects if not used in a controlled environment, it tends not to be addictive. Second, psilocybin can have long-lasting effects, which means people would only have to take it intermittently, putting them at a reduced risk from any side effects. “That’s a huge advantage in terms of safety…compared to taking a pill every day, and having that side effect profile follow you for months, possibly years, depending on how long you take it,” says Matthew Johnson, a professor in psychedelics and consciousness at Johns Hopkins University.

In many ways, research on psilocybin’s potential is still just beginning. Almost all psychedelic research in the U.S. came to an abrupt halt after the U.S. stepped up regulation of pharmaceutical research in the 1960s and criminalized the manufacturing and possession of psilocybin and other psychedelics. Scientists are still “reopening the books” on psychedelics to make up for decades of stalled research, says Garcia-Romeu. At this point, only a relatively few clinical trials have been published on psilocybin as a treatment for any type of substance use disorder, and many of those trials have involved a very small number of participants.

But the resulting evidence has been accumulating, and is generating an increasing amount of scientific attention on the possibilities of the drug—including, last fall, the first federal grant for studying a psychedelic treatment in 50 years, for a double-blind randomized trial looking into psilocybin as a smoking cessation tool. In Bogenschutz’s words, "science has reached a first tipping point where there’s now enough evidence [that] it’s really hard not to take the potential of psychedelics seriously.”

Scientists who study addiction science are anxiously awaiting the results of this, and other burgeoning research into the potential of psychedelics in their field. Substance use disorders are chronically undertreated, and few have highly effective treatment options. For example, only a minority of Americans with alcohol use disorder—the most common substance use disorder in the U.S.receive treatment; a nationwide study conducted by the Washington University School of Medicine in St. Louis put the share of alcoholics getting the care they needed from 2015-2019 at only about 6%.

In Bogenschutz’s opinion, the psychology and physiology underlying addiction to any given substance has a lot in common with that driving addiction to other such dependencies. And that, he believes, is what makes psychedelics so promising a therapeutic for substance abuse—it seems, he says, to be a sort of panacea for addiction. “Something about psychedelic treatment of addiction that is exciting, is that the ways the mechanisms we hope it will work, are not really specific to any particular addiction,” he says. “These drugs could represent a therapeutic breakthrough for alcohol use disorder, other addictions, mood and anxiety disorders—a whole host of conditions.”

 
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Can Ketamine be used to treat addictions?

Results from several recent clinical trials indicate promise.

by Claire Wilcox M.D. and Vanessa Lancaster | Psychology Today | 24 Mar 2022​
  • In a handful of randomized clinical trials, ketamine reduces substance use, and effects are long-lasting.​
  • On the other hand, the studies are small, safety is not established, and results need replication before widespread use.​
  • Ketamine may become a viable treatment option in the near future, especially for treatment-refractory individuals.​
In the last couple of decades, there has been an explosion of research on ketamine, an anesthetic that can induce a hallucinogenic trance-like state, to treat various mental health problems.

Many studies indicate possible benefits. In fact, in 2019, an intranasal form of a molecularly-similar compound (esketamine) was given FDA approval for depression treatment.

Unlike esketamine, ketamine [taken orally, through intramuscular (IM) injection or intravenously (IV)] is only FDA-approved for use as an anesthetic. This is because it alters the level of consciousness.

However, studies show it can reduce depression, improve chronic pain symptoms and even reduce pain medication use after surgery if given intraoperatively. Therefore, there is increasing use of ketamine off-label for major depressive disorder and pain.

Pain and depression can fuel more substance use in people with or at risk for substance use disorder (SUD), the clinical term for what is more colloquially referred to as addiction.

Fueled by this knowledge and results from preclinical studies indicating that ketamine and similar compounds improve withdrawal symptoms, craving, and drug use, several important, albeit small, clinical trials have recently been run in people with SUD to probe for effects in this population.

Findings from key studies

Alcohol

In a 2020 article, researchers reported some exciting results from a trial in forty people with alcohol use disorder. All participants received motivational enhancement therapy, but half were randomized to a single IV ketamine session, and the others to midazolam.

Midazolam, a benzodiazepine, was chosen for the control group because it can also change the level of consciousness. Those in the ketamine group experienced more abstinence and less heavy drinking, and the effects persisted at six months follow-up.

In a still more recent study, ninety-six people with alcohol use disorder were randomized to one of four groups: 1.) three weekly ketamine infusions (IV) plus mindfulness therapy, 2.) three saline infusions plus mindfulness therapy, 3.) three ketamine infusions plus alcohol education, or 4.) three saline infusions plus alcohol education.

In this study, saline was used as the placebo control, so it was likely easy for participants to identify whether they had been assigned to the active or the placebo group. Ketamine resulted in more days abstinent at six-month follow-up than placebo, with the greatest reduction in the ketamine plus therapy group.

Stimulants

Another recent randomized-controlled clinical trial in people with cocaine use disorder indicates ketamine might benefit people with problems with stimulants, too. In this study, 55 participants received either a single IV ketamine or midazolam session, and all had several mindfulness-based relapse prevention therapy sessions.

At fourteen days, 48 percent of participants in the ketamine group remained abstinent compared with 11 percent in the midazolam group. Craving scores were lower in the ketamine group, and, at the six-month follow-up, 44 percent of the ketamine group reported cocaine abstinence, whereas none in the midazolam group were abstinent.

Heroin

The same research group has performed two randomized clinical trials in people with heroin use disorders. Unlike in the alcohol and cocaine studies, in these, ketamine was given IM, and therapy was done during the ketamine sessions rather than a day or so afterward.

The first trial measured the differences in clinical outcomes between a higher and lower dose of ketamine in seventy detoxified heroin-dependent individuals, the lower dose acting as a control group. The higher dose had a larger beneficial effect on craving and drug use, and benefits lasted until at least 24 weeks.

In their second study, three sessions were compared to one session in 53 heroin-dependent patients. Three sessions were more effective, with higher abstinence rates (50 percent compared with 22 percent) at the one-year follow-up.

Studies have also shown that ketamine may be useful for withdrawal management.

Pitfalls, limitations, and unanswered questions

Although these trial results are encouraging, there are limitations to the work that has been done so far and unanswered questions about potential problems with using ketamine for SUD treatment. Following are some important considerations.​
  • Placebo effects can influence results. Clinical trials are most informative if participants are assigned to either active treatment or placebo treatment randomly and if they don’t know which group they are assigned to.​
Placebos are used in clinical trials because everyone tends to improve in a clinical trial regardless of treatment group assignment. To accurately isolate and measure the effect of the active treatment, outcomes need to be compared between groups to obtain valid information about the therapeutic potential of a treatment.

It is particularly challenging to blind participants to treatment group assignment in a study of a mind-altering substance, like ketamine, because people know they are getting a placebo if they don’t feel a change.

This could especially have been the case in one of the alcohol studies, where saline was used as the control (Grabski et al., 2022), which might have made ketamine look more effective than it actually was.​
  • Ketamine has psychoactive effects and therefore has abuse potential. Experts have raised concerns that it could just become someone’s new addiction. Although this has not been reported in the literature thus far in the setting of using it for SUD treatment, the jury is still out on this question.​
  • Ketamine may not be effective when people are on medication-assisted treatment (MAT) for opioid use disorder. Ketamine may bind to opioid receptors and activate them, and this may be one of the mechanisms by which it reduces depression symptoms (although this finding has not been seen in all studies).​
Whether ketamine will still be effective as a treatment for SUD when opioid agonists (buprenorphine) or antagonists (naltrexone) are in the system is unknown.​
  • Research into ketamine for SUD is in its nascent phases, and much more needs to be done. The studies have been small, and whether these findings will be replicated in other settings needs to be determined. Work is also needed to identify the ideal dose, route of administration, number of sessions, and most effective psychotherapy add-on. Whether esketamine has the potential to reduce substance use and craving is also not yet known.​
  • There are risks and side effects associated with ketamine infusions. In addition to some minor transient, uncomfortable side effects (nausea, dizziness, drowsiness, etc.) that dissipate after one to two hours, high blood pressure and changes in heart rate have been observed. People can also experience dysphoria, anxiety, and even increased suicidal thoughts during and just after a session. In rare instances, adverse psychiatric symptoms last days.​
In conclusion

In summary, studies show that ketamine infusions may reduce craving and promote recovery for people with alcohol, stimulant, and opioid use disorders. That the effects of ketamine on craving and substance last months across studies are especially exciting. For depression treatment, by contrast, effects usually only last a few weeks.

That said, research into using ketamine for SUD treatment is still in its early phase, and more work needs to be done before it can be recommended for widespread use. Evidence-based approaches for SUD treatment should be tried first, including medications to reduce craving (especially for alcohol and opioid use disorder) and numerous well-studied group, individual, and family-based behavioral interventions.

On the other hand, for disorders for which we have few pharmacologic treatments, such as cocaine use disorder, or for people who have failed standard treatments, we may see off-label use of ketamine for relapse prevention grow increasingly common in the not-so-distant future.

 
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Treating Addiction with LSD

by Amelia Walsh & Dr. Lynn Marie Morski, MD, Esq | Psychable

LSD is most well known for its popularity during the 1960s, but it has since re-emerged as the subject of continued speculation for its potential uses as a therapeutic tool.

While some critics of psychedelics claim otherwise, LSD is a drug with a low potential for abuse. In fact, researchers are beginning to consider the possibility of its efficacy in the treatment of addiction. Even the Alcoholics Anonymous founder Bill Wilson believed that LSD could offer hope to those struggling with certain substance use issues.

Is there any evidence to support the theory that LSD can help treat addiction? In this article, we will unpack what is known and has yet to be determined, as well as what the future might hold for research efforts.​

What is LSD?

LSD is a semi-synthetic psychedelic substance derived from a fungus called Claviceps purpura, a type of ergot. LSD can cause intense examination of emotions and events in the past or present, speculation for the future, perception of additional dimensions, and profound awareness of that which was previously unrealized. Of course, every substance affects each individual somewhat differently, but these are some of the most common experiences.

LSD works on the brain by altering the communication between the regions that are believed to limit a person’s intake of sensory information and create the subjective experience of the ego, or our narrative sense of “I.” These brain regions are referred to as the default mode network (DMN), which may be responsible for repressing consciousness. LSD appears to temporarily dampen the activity of the DMN, leading to greater communication between other brain regions. The dampened activity of the DMN has been shown to correlate with the subject experience of “ego-death” or “ego-dissolution.” Although experiencing ego-death can be scary, it often culminates in feelings of connectivity to something greater than oneself. It is just one example of the kinds of mystical experiences that psilocybin might induce that are thought to have therapeutic benefits.

There are several ways to ingest LSD. It is most commonly ingested orally as a portion of blotter paper or dissolved in liquid, however, LSD can also be administered topically, nasally, or through other forms of inhalation. It should be noted that currently, it is not legal for personal use or possession outside of a federally-approved clinical research setting.

Any substance or medicine used in or outside of a clinical setting may cause side effects that are sometimes serious and may be dangerous for those with existing mental and physical health conditions. The effects of a full dose can include hallucinations and dissociation accompanied by a distorted or enhanced relationship to reality and interpretation of sensations. For more information about LSD and its potential side effects and risks, read Psychable’s Beginner’s Guide to LSD.​

Treating addiction with LSD: Does it work?

From the 1950s to the 1970s, LSD was studied for its potential benefit in treating conditions like mood and personality disorders, anxiety, depression, as well as substance use disorders. Recent efforts have reopened certain inquiries (such as how LSD might help alleviate anxiety in adults dealing with a life-threatening illness), but there is still so much more to know before LSD can be considered as a possible treatment for additional mental health issues.

Even so, its early role in addiction recovery treatments from the 1950s to 70s had shown promising results. In an analysis of clinical studies conducted at inpatient alcohol recovery centers between 1966 and 1970, 58 percent of participants who were given one dose of LSD during a single therapy session reduced or eliminated their alcohol intake, as opposed to 38 percent of the subjects who were not given doses of LSD. Those treated with LSD were also 15 percent more likely to remain sober six months after the completion of inpatient treatment.

While studies from the 1960s and 70s do not satisfy the requirements of a modern clinical trial, they certainly suggest that deeper investigation into the possibility of using LSD in the treatment of addiction is warranted.

Researchers are exploring the possibility of studying the temporary state of disruption in the DMN during an experience with LSD that might be able to increase neural plasticity and change habitual thought patterns. If studies demonstrate this to be a reality, it might open doors for testing how the substance can reset behavioral patterns that influence addiction.

When LSD is administered, the limitations imposed by the DMN are temporarily removed and there is greater cognitive fluidity. LSD binds to both serotonin 2A and dopamine receptors in the brain and initiates a subsequent biological response, which may explain the common effects of emotional openness, peace, and connectedness to something that feels meaningful (like the universe as a whole or the divine). Such a mental state, though temporary, could offer a long-term solution to some of the underlying problems of addiction such as feelings of worthlessness, inability to cope with trauma, or disconnectedness to greater meaning (should the ultimate results prove to be lasting).

Recent evidence for the efficacy of treating addiction with LSD largely consists of personal, anecdotal accounts, though organizations like MAPS are proposing new studies for its use in other areas of mental health. If trials show promising results, it is possible that modern studies directly related to LSD for addiction may be initiated.

Though evidence in the 1960s and 70s suggested that LSD might be effective in treating addictive behavior related to alcohol, it is possible that further research could indicate similar applications in cases of other substance use disorders in the future.​

Closing thoughts and resources

LSD is currently a Schedule I drug in the United States and is illegal for use outside of clinical settings or to formulate for personal use. Beyond this, LSD obtained illegally is sometimes adulterated with other substances and may be dangerous.

If you or someone you know is struggling with addiction, do not wait to find help. Substance use can be a serious problem and pose risks to your overall health and well-being. Severe situations might be life-threatening, so it is crucial to seek treatment immediately.

If you need help or more information about options for treatment, the Substance Abuse and Mental Health Administration (SAMHSA) offers a toll-free helpline at 1-800-662-HELP (4357). Resources are also available at https://www.findtreatment.gov.

If you have had an independent experience with LSD and would like to process it with a knowledgeable practitioner who specializes in integration, there are listings available here on Psychable or on the MAPS website.

 
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