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

This cross-sectional survey study (n=444) analyzed self-reported cases of reduced substance abuse disorder after using psychedelics and found that that the number of responders who fulfilled the criteria for their disorder dropped by 59% thereafter. Greater psychedelic dose, insight, mystical-type effects, and personal meaning of experiences were associated with a greater reduction in drug consumption, and most respondents claimed lasting improvements for over 1 year after using a psychedelic.

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.”

Authors: Albert Garcia-Romeu, Alan K. Davis, Earth Erowid, Fire Erowid, Roland R. Griffiths & Matthew W. Johnson

Summary

INTRODUCTION

Substance misuse is a leading preventable cause of morbidity and mortality in the United States, and has contributed to over 63,000 drug overdose deaths in 2016 (3). Recent trends have shown increased adult use of cannabis, opioids, and stimulant drugs, and associated adverse public health outcomes (3).

Available SUD treatments typically exhibit limited success with most patients not achieving long-term abstinence. There are no approved pharmacotherapies for cannabis or stimulant use disorders, and behavioral therapies generally have modest efficacy.

Psychedelics such as lysergic acid diethylamide (LSD), psilocybin-containing mushrooms, peyote, and the dimethyltryptamine containing admixture ayahuasca have been implicated in decreased substance misuse, with LSD showing the strongest evidence in the treatment of alcoholism.

Epidemiological data showed lifetime serotonin 2A agonist psychedelic use was associated with 27% reduced risk of past year opioid dependence and 40% reduced risk of past year opioid abuse. Preliminary observational data showed significant reductions in cocaine use in a small sample.

The current study sought to characterize instances in which people experienced a marked reduction in problematic cannabis, opioid, or stimulant use after taking a psychedelic in a non-clinical setting.

MATERIALS AND METHODS

This study was conducted as a cross-sectional, anonymous online survey hosted on SurveyMonkey between October 2015 and August 2017 to seek out people who had overcome alcohol or drug addiction after using psychedelics.

People who met the inclusion criteria, understood the study procedures, and were willing to voluntarily participate in the study were able to begin the survey. They were not financially compensated for completing the survey.

Measures

Information on participant demographics and drug use history was collected. The reference psychedelic experience was assessed retrospectively and included ratings of distress related to drug use prior to the reference psychedelic experience.

Participants were asked about the reference psychedelic experience, including the psychedelic used and approximate dose, type of setting where the experience occurred, intention for self-administering the psychedelic, and any adverse effects or other behavioral changes attributed to the reference psychedelic experience.

This survey was conducted concurrently for people reporting psychedelic-associated reductions in alcohol, cannabis, opioid, and stimulant use. It consisted of two iterations of a modified version of the Drug Use Disorders Identification Test-Consumption, the DSM-5 Substance Use Disorder Symptom Checklist, and the Alcohol Urge Questionnaire.

DUDIT-C

The DUDIT is an 11-item assessment that largely parallels the AUDIT, which is a 10-item assessment of alcohol misuse. The DUDIT-C provides an overall score of drug consumption.

DSM-5 Substance Use Disorder Symptom Checklist

This checklist was modified to assess symptoms of past and current cannabis, opioid, and stimulant use disorder. Participants endorsed whether each of the 11 diagnostic criteria for SUD were true or false.

Drug Urge Questionnaire (DUQ)

This instrument is a modified version of the Alcohol Urge Questionnaire (AUQ), which assesses craving for the specific drug of choice rather than alcohol.

Ratings of Persisting Effects

Participants rated the personal meaning, psychological challenge, psychological insight, spiritual significance, and change in well-being or life satisfaction attributed to the reference psychedelic experience on a scale from 1 to 8.

Data Analyses

To examine the effect of psychedelic experiences on substance use, variables were analyzed using chi-square and one-way analysis of variance tests. Pearson correlation coefficients were calculated to examine the degree to which DUDIT-C change scores were associated with primary study variables.

We conducted a path analysis to examine a model of substance use change associated with a psychedelic experience. This model included Pre-DUDIT-C, dose of the psychedelic, acute mystical and insight experiences, and personal meaning.

Respondent Characteristics

We recruited 3,987 people from October 2015 through August 2017 to fill out a survey regarding their use of cannabis, opioids, or stimulants. Of these, 2,556 met all inclusion criteria, provided informed consent, and initiated a response regarding one of these three classes of substances.

Substance Use, Mental Health, and Treatment History Prior to Psychedelic Experience

Participants with a history of substance use problems had a mean DUDIT-C score of 8.0, had been using their primary substance since the mean age of 17, and reported distress associated with their substance use between “a moderate amount” and “a lot”. Most participants had never used peyote, San Pedro, mescaline, ayahuasca, morning glory seeds, or DMT, and had received no treatment for their substance use prior to the reference psychedelic experience.

Reference Psychedelic Experience

Approximately three quarters of the sample reported using LSD or psilocybin in their reference psychedelic experience, and most reported having their experience in their home. They did not report an explicit intention to change their substance use through using the psychedelic substance.

Participants rated their reference psychedelic experience among the top 10 most personally meaningful, top 10 most psychologically challenging, and top 10 most psychologically insightful experiences of their lives. Two individuals reported strong negative change to well-being attributed to the reference psychedelic experience.

Adverse Effects

A majority of respondents reported no persisting adverse effects from their reference psychedelic experience, while 9% reported possible adverse effects and 10% reported definite adverse effects. Five individuals reported extremely severe adverse effects.

The five extremely severe adverse effects were described as, (1) being convinced I am heterosexual when actually I am bisexual; (2) having nightmares for 6 months; (3) experiencing tactile hallucinations and hearing voices; (4) having panic disorder and massive generalized anxiety for half a decade; (5) being depressed.

The survey found that some individuals reporting extreme adverse reactions had prior history of mental health conditions, but no causal attributions can be inferred from the present data.

Substance-Specific Differences in

Few differences were found between cannabis, opioid, and stimulant using groups on demographic variables, substance use and treatment history, and psychedelic-related variables. Cannabis users had lower mean ratings of substance-related distress, substance craving prior to the reference psychedelic experience, and DUDIT-C change scores compared to opioid and stimulant users.

Substance-Specific Withdrawal Symptoms

Two-thirds of the cannabis-using subsample reported experiencing withdrawal symptoms, including depression, craving, and insomnia, but most reported that these symptoms were less severe or much less severe after the reference psychedelic experience compared to prior quit attempts.

Approximately three quarters of opioid-using respondents reported experiencing withdrawal symptoms after the reference psychedelic experience, but rated these symptoms as “less severe” or “much less severe” compared to prior quit attempts.

Most stimulant-using respondents reported experiencing withdrawal symptoms after the reference psychedelic experience, but most reported that these symptoms were “less severe” or “much less severe” than prior quit attempts.

Substance Consumption Following the Psychedelic Experience

Over 70% of participants reported that they had greatly reduced or quit using their primary substance following their reference psychedelic experience. Most participants did not seek other treatment for substance use after their reference psychedelic experience.

Path Analysis

Table 7 shows Pearson correlations among variables. Greater decreases in consumption were significantly associated with greater age, ratings of the experience as personally meaningful and insightful, pre-DUDIT-C scores, and intensity of substance use distress.

Based on previously published survey data, a path analysis was conducted examining a proposed model to explain the effect of psychedelic consumption on problematic substance use reduction. Higher doses of the psychedelic substance, greater intensity of acute mystical and insight experiences, and higher ratings of personal meaning were all related to greater change in substance use.

DISCUSSION

444 individuals who self-reported taking a psychedelic drug in a non-clinical setting reported lasting reductions in cannabis, opioid, and stimulant misuse. Some reported negative impacts on overall life adjustment, including increased use of other drugs, though these effects were rare.

The present study used anonymous, retrospective self-report data collected from people who had used naturalistic psychedelics to assess changes in other substance use. The results cannot be generalized across all psychedelic users with other substance misuse issues, but provide valuable information for designing future treatments.

Participants reported less severe cravings and less anxiety and depression symptoms after the reference psychedelic experience compared with previous attempts to reduce or stop using their primary problematic substance. This finding is consistent with prior surveys and suggests a potential mechanism by which psychedelics may help reduce subsequent substance misuse.

Participants reported increased levels of personal meaning, psychological insight, and mystical-type effects, which were associated with higher psychedelic dose and greater reported change in drug consumption after the psychedelic experience.

Preclinical data suggest serotonergic psychedelics may have anti-addictive properties for alcohol and other drugs of abuse, and may hold considerable potential as novel therapeutics in treating various SUDs.

Although medications for opioid use disorder exist, the current overdose rates indicate the need for different treatment avenues. Psychedelic-assisted interventions may offer an attractive alternative to current treatment models, as they may result in lasting change in substance misuse after only one or a few psychedelic administration sessions.

AUTHOR CONTRIBUTIONS

AG-R, AD, EE, FE, RG, MJ, and AG made substantial contributions to the conception and design of the study, the acquisition and interpretation of the data, and the drafting of the manuscript. All authors approved the final version of the manuscript.