Persisting Reductions in Cannabis, Opioid, and Stimulant Misuse After Naturalistic Psychedelic Use: An Online Survey

Abstract

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.

Psychedelics in Psychiatry: Neuroplastic, Immunomodulatory, and Neurotransmitter Mechanisms

“…Although ayahuasca has been shown to rapidly relieve depression symptoms in treatment-refractory depression in controlled clinical settings (Osório et al, 2015;Palhano-Fontes et al, 2019), the use of DMT and 5-MeO-DMT in naturalistic settings is receiving considerable attention given the rapid improvements elicited in several mental health domains accompanied by longlasting decreases in drug and alcohol use and abuse (Davis et al, 2019;Uthaug et al, 2019Uthaug et al, , 2020Garcia-Romeu et al, 2020). In vitro evidence supports the notion that 5-MeO-DMT might be beneficial for drug and alcohol addiction.…”

“…Aside from the improvement in depression, anxiety, and compulsion domains discussed so far, the enhancement of several behavioral, social, and cognitive domains have been reported after psychedelic exposure. These include reduced psychological distress (Hendricks et al, 2015), decreased opioid dependence (Pisano et al, 2017;Argento et al, 2019;Garcia-Romeu et al, 2020), decreased criminal behavior (Hendricks et al, 2018), enhanced creative divergent thinking and problem-solving skills (Kuypers et al, 2016;Sweat et al, 2016), proenvironmental behavior via increased nature relatedness (Forstmann and Sagioglou, 2017), and a decreased incidence of extreme political views (Nour et al, 2017;Lyons and Carhart-Harris, 2018).…”

“…A preclinical study found that ayahuasca consumption during pregnancy and lactation results in decreased anxiety and decreased the interest for social interactions in the offspring, suggesting potential neuromodulatory effects in the fetus (de Oliveira et al, 2011). Inhalation of 5-MeO-DMT has been reported to occasion mystical experiences associated with almost immediate improvements in depression and anxiety scores with enduring positive effects (Davis et al, 2019) and decreased drug use (Garcia-Romeu et al, 2020;Uthaug et al, 2020). Lastly, a study investigating platelet SERT found an upregulation in long-term ayahuasca drinkers, suggesting that long-term psychedelic use might induce plasticity mechanisms in the serotonergic system, potentially as a result of the long-term potentiation effect of ayahuasca over serotonergic neurotransmission, 5-HT levels, and SERT (Callaway et al, 1994).…”

Post-Psychedelic Reductions in Experiential Avoidance Are Associated With Decreases in Depression Severity and Suicidal Ideation

“…Given the wide range of mental health concerns for which psychedelic therapy has shown promise, it has been suggested that this treatment approach may target underlying transdiagnostic mechanisms (16)(17)(18)(19)(20)(21). Recent research has indicated that the intensity of "mystical-type" (4,6,7,9,22) or "peak" experiences engendered by psychedelics (23) is predictive of positive therapeutic outcomes; however, it remains unclear how (i.e., via what fundamental psychological and neurobiological mechanisms) psychedelic therapy brings about lasting therapeutic changes.…”

Psilocybin occasioned mystical‐type experiences

“…Mystical‐type and insight experiences as measured using validated questionnaires were found to be highly correlated with one another while only indirectly correlated with improved psychological well‐being. Regression analyses showed mystical‐type and insight experiences to be highly correlated with improved psychological flexibility and feelings of personal meaningfulness which in turn were highly correlated with improved psychological outlook (Davis, Barrett, & Griffiths, 2020; Garcia‐Romeu et al, 2019; Garcia‐Romeu et al, 2020). Therefore, these studies suggest that it is the improved psychological flexibility and personal meaningfulness associated with mystical‐type and insight experiences which enables depressed and anxious individuals and people with substance use disorders to reframe how they view their medical conditions, themselves, their lives and relationships with others (Belser et al, 2017; Davis et al, 2020; Garcia‐Romeu et al, 2019, 2020; Spiegel, 2016; Watts, Day, Krzanowski, Nutt, & Carhart‐Harris, 2017).…”