Effects of psychedelics on opioid use disorder: a scoping review of preclinical studies.

The opioid crisis has driven a search for new treatments for opioid use disorder (OUD). A systematic review of 40 preclinical animal studies found that the psychedelic compounds 18-methoxycoronaridine (18-MC), ibogaine, noribogaine, and ketamine generally reduced opioid self-administration, eased withdrawal symptoms, and altered conditioned place preference. However, seven studies showed no improvement over controls. Most research has focused on iboga derivatives, which appear effective but carry higher cardiovascular risk than other psychedelics. The review calls for more translational and clinical studies that test a broader range of psychedelic agents and explore mechanisms, safety, dosing, and treatment frequency.

Study at a glance

Abstract

The current opioid crisis has had an unprecedented public health impact. Approved medications for opioid use disorder (OUD) exist, yet their limitations indicate a need for innovative treatments. Limited preliminary clinical studies suggest specific psychedelics might aid OUD treatment, though most clinical evidence remains observational, with few controlled trials. This review aims to bridge the gap between preclinical findings and potential clinical applications, following PRISMA-ScR guidelines. Searches included MEDLINE, Embase, Scopus, and Web of Science, focusing on preclinical in vivo studies involving opioids and psychedelics in animals, excluding pain studies and those lacking control groups. Forty studies met criteria, covering both classic and non-classic psychedelics. Most studies showed that 18-methoxycoronaridine (18-MC), ibogaine, noribogaine, and ketamine could reduce opioid self-administration, alleviate withdrawal symptoms, and change conditioned place preference. However, seven studies (two on 2,5-dimethoxy-4-methylamphetamine (DOM), three on ibogaine, one on 18-MC, and one on ketamine) showed no improvement over controls. A methodological quality assessment rated most of the studies as having unclear quality. Interestingly, most preclinical studies are limited to iboga derivatives, which were effective, but these agents may have higher cardiovascular risk than other psychedelics under-explored to date. This review strengthens support for translational studies testing psychedelics as potential innovative targets for OUD. It also suggests clinical studies need to include a broader range of agents beyond iboga derivatives but can also explore several ongoing questions in the field, such as the mechanism of action behind the potential therapeutic effect, safety profiles, doses, and frequency of administrations needed.