The contribution of psychotherapy in potential therapeutic effects of psychedelics for treatment of opioid use disorder.

A review of trials on psychedelics for opioid use disorder (OUD) found no studies directly comparing different types of psychotherapy or testing psychedelics with versus without concurrent psychotherapy. Most research on alleviating opioid withdrawal symptoms did not include psychotherapy. The few studies on ketamine and LSD for opioid use and abstinence used a psychedelic-assisted therapy model. There is insufficient high-quality evidence to determine whether concurrent psychotherapy is necessary in psychedelic trials for OUD. Future trials should explore the interplay between psychedelic treatment and psychotherapy.

Study at a glance

Abstract

Despite national efforts to curb the opioid crisis, the clinical and societal challenges continue to grow. FDA-approved medications for opioid use disorder (OUD) are effective but are associated with high rates of treatment discontinuation and relapse. A collection of agents with acute effects on consciousness, collectively (if variably) categorized as 'psychedelics', have emerged as potential treatments for substance use disorders, including OUD. Psychedelics are typically administered alongside psychotherapy, though the role and necessity of concurrent psychotherapy remains a topic of debate. This review examines trials involving both classical and non-classical psychedelics for OUD treatment, aiming to evaluate the evidence for the importance of psychotherapy and identify the most effective therapeutic approaches, if any. No studies were identified that directly compared different psychotherapy modalities or assessed the effects of psychedelics with versus without concurrent psychotherapy. Most research examining the impact of psychedelics on alleviating opioid withdrawal symptoms did not incorporate a psychotherapy component. However, the few studies that investigated the effects of psychedelics (ketamine and LSD) on opioid use and abstinence adopted a psychedelic-assisted therapy model. There is insufficient high-quality evidence to support or oppose the necessity of concurrent psychotherapy in psychedelic trials for OUD. Future clinical trials should be structured to explore the interplay between psychedelic treatment and psychotherapy.