The very term “drugs” as a catch-all way to describe certain substances is actually extremely deceptive. Some “drugs,” such as prescription opioid compounds like heroin, ketamine, and fentanyl, are dangerous and extremely addictive. The WHO reports, in fact, that 70% of drug use-related deaths are attributed to opioid misuse.
That’s 350,000 people that die from the addictive drugs each year. During the past year, opioid dependence around the world and the overdose deaths that come with it have spiked to a near-record high.
Other “drugs” like most psychedelics are not addictive in the least, a sentiment reflected by the FDA, and aren’t any more dangerous to most people than taking an antidepressant. In fact, psychedelics are a legitimately valuable tool for treating problematic substance addictions. Over the past few years, the practice of using psychedelics as an aid for psychotherapy has gained a significant amount of traction in the medical field.
In this article, we’ll discuss how psychedelics can be used to help eliminate opioid addiction by helping people approach their own issues in a new light. We’ll discuss what causes drug abuse (especially in the case of opioids), how psychedelics can address it through the lens of mental health, examine some past studies on psychedelic treatment for opioid addiction, and look to the future of psychedelics in the pharmacy.
What causes substance abuse addiction?
Before understanding why hallucinogens are so useful for treating opioid addiction, it’s important to understand how substance abuse disorder takes hold in the first place. This section will address what actually occurs in your brain to make you physically and mentally dependent on a substance.
General substance addiction
Most regulated substances, from nicotine to alcohol to sedatives, trick the brain into releasing an excess of a certain chemical when consumed. Different substances release different neural chemicals in different amounts, with the ones that release more generally being more highly addictive.
As the brain is flooded with the extra neural chemical after stimulant misuse, it literally rewires itself not to produce as much of that compound on its own. After all, it now has this external substance helping it produce more of the chemical, it can scale back on how much it’s producing by itself. Exactly how long it takes for the brain to make that transition depends on factors like the frequency of the substance being taken, the dosage, and the individual’s susceptibility to substance use disorders.
Once the brain stops producing as much of the chemical on its own, the extra amount of the chemical that was making the substance user feel extraordinary before becomes a “new normal.” The user no longer receives as much of a thrill from using the substance, and attempting to stop using it results in a chemical deficiency in the brain. The immense difficulty in dealing with that deficiency starts a vicious cycle in which the user continues abusing the substance and becomes more and more dependent on it over time, which significantly increases the chances of overdose deaths.
Substance use disorders nearly always have to do with a strong mental dependency in addition to the physical dependency. As the user abuses the substance more and more, they begin to see it as normal and do not stigmatize it, even if they did before. They usually also cannot or will not admit to themselves that they have an addiction. Some of the telltale addiction signs following stimulant misuse that they often disregard include:
- Feeling the urge to use the substance multiple times per day.
- Continuing to use the substance even though you know it’s interfering with work, social life, or other responsibilities.
- Displaying uncharacteristic behaviors or taking risks to obtain the substance.
- Spending a lot of time obtaining or recovering from use of the substance.
- Failing in your attempts to stop using the substance.
- Going through opioid withdrawal symptoms when you try to stop using.
Note that teens are usually even more susceptible to substance use disorders and overdose deaths than most people. This is because illegal substances often affect the prefrontal cortex, a part of the brain that is still developing during the teenage years.
Opioid use disorder
Opioids are incredibly addictive because they target the part of the brain responsible for controlling endorphin flow, the neural chemical most associated with pleasure. It was previously thought that dopamine was the brain’s most potent “pleasure chemical,” but scientists now suspect that dopamine is more tied to addiction than to pleasurable feelings themselves.
What’s more, the pleasurable experience caused by opioids is twofold; when opioids attach themselves to the brain’s opioid receptors, they not only produce more endorphins but also dull pain and other negative feelings.
The amplification of positive feelings and muffling of negative feelings caused by opioid use act as strong signals to the brain that it can stop working so hard to take care of itself. Some opioids, especially lab-produced ones like fentanyl, are tremendously powerful and will quickly decimate the brain’s natural production of certain chemicals after being used even a few times. Fentanyl can also lead to even more physically harmful addictions like cocaine use disorder.
What medications are used to treat opioid addiction?
Now that you understand why opioid addiction occurs, let’s look at how it’s treated.
The opioid epidemic has been ravaging many countries in the world for over a decade, and several traditional medications have become popular in treating opioid use disorder during that time. The three most commonly used ones are:
- Methadone. This medication comes in liquid form and can only be obtained in clinics specializing in drug addiction treatment. Methadone prevents most withdrawal symptoms, making it easier for recovering opioid users to abstain from the drugs. It is taken once per day.
- Buprenorphine is a powdered medication available in 3 forms: an edible tablet or a cheek swab, both of which must be administered daily, and an implant inserted under the skin that gradually dispenses the buprenorphine over 6 months. The medication blocks the effects of other narcotics.
- Naltrexone, which also blocks the effects of other narcotics. It is taken as a daily pill or as a monthly injection.
During the past few years, more scientific studies have been looking at psychedelics and their potential as medications to treat or even cure opioid use disorder. As a rule, psychedelics tend to be less invasive and more holistic than traditional medications used for addiction treatment.
The psychedelics most commonly used to fight opioid use disorder are:
- Lysergic acid diethylamide, also known as LSD.
- Psilocybin, the active ingredient in “magic mushrooms”
- Dimethyltryptamine (DMT), the most potent psychedelic.
- Mescaline, otherwise known as peyote, which is extremely potent and can have some nasty (though ultimately harmless) side effects
- Ibogaine, which is supposedly great at dealing with drug abuse but which needs further testing before it can be verified as safe to consume.
Pros and cons of traditional vs psychedelic medications for opioid addiction
What are the advantages of each? Spoiler alert: in recent years, more of the medical field has been discovering that psychedelic medications have a longer list of pros than traditional medications do.
Pros of traditional medications for opioid use disorder
- They’re easy to obtain for those who can admit they have an opioid addiction.
- The side effects are well-documented so you know what to expect.
Cons of traditional medications for opioid use disorder
- Often tedious and inconvenient administration methods.
- The medication only blocks the effects of the opioids or the withdrawal while it’s being taken, so it may be hard for the recipient to continue abstaining once off the medication.
- Moderate chance of causing mild to serious physical side effects such as: Restlessness General itchiness Persistent nausea Vomiting Slowed breathing Sexual dysfunction
Pros of psychedelic medications for opioid use disorder
- Only very occasionally (once every 2-6 weeks) needs to be administered. Even when administered, it just means ingesting a pill or tablet.
- Psychedelics attack the substance use disorder at the root, helping ensure the recipient will continue abstaining even once they are off the medication.
- In most people, psilocybin (magic mushrooms), LSD, and DMT do not cause any side effects apart from temporary nausea when taken. Some people are at risk for more serious side effects, so be sure to consult a qualified therapist before taking and practice naturalistic psychedelic use.
- Psychedelics are not habit-forming, so you don’t need to worry about developing a dependency like you might with traditional opioid use disorder medication.
- Psychedelics tend to have positive effects on the user’s long-term mental health.
Cons of psychedelic medications for opioid use disorder
- They’re often difficult to find since psychedelics are currently illegal in most places. That is changing, however, as we’ll discuss below.
- They can lead to negative experiences (colloquially known as “bad trips”) unless they’re used in a highly regulated setting like a psychedelic therapy session.
Past studies on using psychedelics to treat opioid use disorder
In this section, we’ll provide an overview of some of the most important studies and clinical trials looking at psychedelics used to deal with opioid use disorder.
Baltimore Prisons Study (LSD), 1973
In this experiment, 78 prisoners from Maryland correctional institutions, all of whom had been heroin abusers before being admitted, were divided into two groups. One group received psychedelic treatment for six weeks. The therapy consisted of five weeks of intense preparatory training, a single high-volume dose of LSD, and then a one-week assessment period. The therapy participants were also followed after the sessions to monitor progress The other group received traditional medication and therapy for six weeks. All the participants were then released back into society. Assessments were regularly administered among the participants over the next 12 months, and the treatment group (the ones who had been treated with psychedelics) showed significantly higher levels of abstinence.
Even back in 1973, researchers were interested in the power of psychedelics to eradicate opioid dependence. Although these older studies did manage to provide essential foundational evidence for future clinical trials, though, they did not receive enough funding. They were also too close to the hippie movement of the 60s, which had created lots of negative associations with psychedelics due to rampant overdosing and other instances of improper, unregulated use. For both those reasons, studies like this one were not taken very seriously and so did not gain much traction in the larger medical community even though the results were quite positive in favor of psychedelics’ ability to help opioid addicts recover and, at very least, avoid overdose deaths.
Frontiers Study (All psychedelics), 2020
In early 2020, researchers posted in-depth surveys on several sites focusing on psychedelic-based clinical trials, such as Erowid Center (erowid.org) and the Multidisciplinary Association for Psychedelic Studies (maps.org). The posts were in search of people who had (or had at one point had) opioid use disorder but had also used serotonin 2A psychedelics, which mainly include LSD, magic mushrooms, peyote, and DMT. In fact, 95.7% of participants met the official criteria for substance abuse disorder at one time and the remaining 4.3% still reported problematic use of opioids in the past.
444 people from around the world ended up completing the survey, which included lots of questions about demographics and drug use history to ensure only “serious” participants were included. The questions mainly addressed the qualities of the psychedelic experience itself, the after-effects, and the effects on the opioid use disorder.
The results were heavily in favor of psychedelics as a way to kick an opioid dependence, a result consistent with lots of existing research. Over 70% of participants reported that they had quit or severely lowered their use of the problematic substance after taking the psychedelic, which was most commonly either LSD or magic mushrooms. Most of the participants took the psychedelic drug at home and most had been looking for a “mystical experience” that would aid with their own psychological or spiritual exploration. However, most of them also reported walking away with more positive changes than they had bargained for.
81% of respondents reported no adverse side effects, About 18% reported mild side effects like tiredness or nausea, and only 5 participants (about 1%) reported severe side effects like developing a persistent generalized anxiety disorder or hearing voices for the next six months. It should be noted, however, that all five of the participants who developed those kinds of clearly alarming symptoms already had a history of mental health disorders like anxiety or depression before their psychedelic experience. This finding only further highlights the importance of making sure a qualified professional prescribes the psychedelics to you after considering your history with mental health. A professional will help ensure you practice naturalistic psychedelic use, which balances your natural tendencies with a healthy environment.
NSDUH Study (Psilocybin), 2022
By far the biggest study to look specifically at psychedelic use and its effects on opioid use disorder is also one of the most recent. In 2022, researchers looked at four years of data from The National Survey on Drug Use and Health and found that frequent opioid users who had taken magic mushrooms experienced a drastic or complete reduction in opioid use afterwards.
The study suggests that the psilocybin found in magic mushrooms may limit the brain’s production of serotonin and dopamine, two chemicals heavily involved with forming addictions. It also poses that the result could very well have something to do with the self-reflective “mystical experience” brought on by the psychedelic drug– more on that in the section below about “why are psychedelics so effective in treating opioid addiction?”
This is the highest-profile study on psychedelics and opioid use ever conducted, so its overwhelmingly positive results are a huge deal for the potential legalization of magic mushrooms for therapeutic use.
Ibogaine studies, 2017
In 2017, a company called Savant HWP researched and developed 18-MC, a compound meant to mimic the effects of a psychedelic called ibogaine without causing hallucinations. Ibogaine’s ability to help people kick addictions has been widely agreed-upon in underground circles for decades, although ibogaine in its natural and untreated form has been known to lead to extremely negative side effects like heart attacks, seizures, or even overdose deaths in a very small minority of its users.
In 2019, the formula for 18-MC was bought by Mind Medicine. In August 2022, though, Mind Med shelved 18-MC for unknown reasons.
The development and background research for 18-MC is interesting for the psychedelic therapy community because it suggests that legal psychedelics in the future may try to do away with the substance’s hallucinogenic qualities. This may make psychedelics less intimidating and more accessible for people who have never used them, which would obviously be a positive. It may also have a downside, though, as the mystical experience provided by the hallucinations has often been said to aid with creating a meaningful and long-lasting change in the user’s behavior.
Why are psychedelics so effective in treating opioid addiction?
Most people in the psychedelic therapy community agree that they are great at “unlocking” the ability to look at your own behaviors and beliefs from a critical and almost non-biased lens. In other words, they make productive self-reflection easier.
Many people who had practiced naturalistic psychedelic use said that the experience prompted them to take a step back from themselves, reevaluate their life, and refocus on the more important things. That may sound overreaching, but Steve Jobs himself summed up thousands of other published testimonies when he said:
An unhealthy habit like a drug addiction is very much one of the “unimportant” practices that addicts can examine from a new perspective during a psychedelic trip.
Psychedelics reportedly allow people to identify and dissect their issues AT THE ROOT instead of just covering them up with a Band-Aid like most traditional medications, which is why the therapeutic healing they seem to produce tends to be more reliable, more permanent, and more beneficial to mental health.
Is using psychedelics to address opioid use disorder legal?
Currently, psychedelics in any form are illegal in most locales. They are legal for supervised therapeutic use in a few places, such as Jamaica, the Netherlands, and the US states of Oregon and Colorado. Other countries and states are trying to do the same thing, and the recent propagation of studies with results that reflect positively on psychedelic therapy is a good sign that it will be legal in many more places soon, especially as future clinical trials using psychedelics to address opioid use disorder continue to pave the way.
Dustin Kemp · 12/29/2022