A proposal to evaluate mechanistic efficacy of hallucinogens in addiction treatment

Current treatments for addiction are often ineffective. Hallucinogenic therapy shows promise for substance use disorders, with single doses producing significant, long-term beneficial effects and a safety profile of low toxicity and non-addictiveness. However, if the same psychological insights and decreased drug use could be achieved without drugs, pharmacological interventions may be unnecessary. No clinical comparisons of drug-induced versus non-drug-induced altered states for addiction treatment exist. A proposed clinical trial would evaluate abstinence in prescription opioid abusers after psilocybin, hyperventilation (Holotropic Breathwork), or an active placebo with niacin, aiming to distinguish hallucinogen-specific effects from those of altered states generally.

Study at a glance

Abstract

Current treatments for addiction are frequently ineffective. Hallucinogenic therapy has been indicated as helpful for a range of substance use disorders, yet this approach remains understudied and publicly unavailable. It is nonetheless a promising treatment, which has significant, long-term beneficial effects with single doses and a profile characterized by general safety, low toxicity, and non-addictiveness. However, pharmacological interventions, such as hallucinogens, should not be offered if the same effects (e.g. psychological insights/mystical experiences) and outcomes (e.g. decreased drug use) could be achieved absent pharmacological intervention. To date, there have been no clinical comparisons of drug-induced altered states with non-drug-induced states for addiction treatment. We propose and then outline a clinical trial to address this gap in knowledge. The proposed design would evaluate abstinence outcomes in a population of prescription opioid abusers after exposure to one of three conditions: a drug-induced altered state using psilocybin, a non-drug-induced altered state via hyperventilation (Holotropic Breathwork), and an active placebo with niacin. The outcomes of such a study would reveal important differences in therapeutic potential by discriminating hallucinogen-dependent effects from those psychological effects resulting from altered states.