Opioids are prescription medications or street drugs derived from the opium poppy plant. Opioid use disorder (OUD) is a mental disorder that involves the harmful use of opioids or dependence on them. Symptoms may include a strong desire or difficulty in controlling use, persistent use despite harmful consequences, or physical withdrawal states.
Opioid use in North America has become so rampant that the media has called it an “opioid epidemic.” The rate of paramedic-attended overdose events in BC has increased six-fold since the declaration of the toxic drug emergency, from eight events per 100,000 people in January 2015 to over 50 events per 100,000 people in July 2021. Mortality from accidental illicit drug toxicity is extremely high, particularly in men 40 to 59 years old and those 19 to 39 years old. In Canada, 9.7% (roughly 351,000) of people who used opioid pain relievers engaged in problematic use.
The COVID-19 pandemic has contributed to the already deadly and ongoing national public health overdose emergency, wherein opioid-related poisonings and deaths continue to rise. During the first year of the pandemic, there was a 95% increase in opioid toxicity deaths (over 7000 deaths) from April 2020 to March 2021, compared to the year before. Factors include the increasingly toxic drug supply, increased feelings of isolation, stress and anxiety, and changes in the availability or accessibility of services for people who use drugs (PWUD).
The crisis disproportionately affects specific regions and populations, such as people with low income or males working in certain industries, such as construction.
In 2020, we shared an article on our support of the expanded opioid therapy program in British Columbia (BC). Just a few weeks ago, the federal Minister of Mental Health and Addictions and Associate Minister of Health announced the granting of a three-year exemption under the Controlled Drugs and Substances Act (CDSA) to remove criminal penalties for people in BC who possess a small amount of certain illicit substances for personal use. This exemption will be in effect from Jan. 31, 2023, to Jan. 31, 2026.
Although medications for OUD exist, current opioid overdose rates show the need for alternative treatments. In this article, we’ll discuss the psychedelic research involved in treating OUD.
Psychedelic research on opioid use disorder
It’s no secret that psychedelics were studied for their potential to treat various mental disorders. Recently, researchers have looked into their potential for OUD.
From 2008 to 2013, researchers analyzed the relationship between classic psychedelic use and past year OUDs within 44,000 illicit opioid users who completed the National Survey on Drug Use and Health (NSDUH). Among respondents with a history of illicit opioid use, psychedelic drug use was associated with 27% reduced risk of past year opioid dependence and 40% reduced risk of past year opioid abuse. Researchers did not associate any other illicit drug with reduced risk of past year opioid dependence or abuse, and concluded psychedelic drugs were associated with decreased risk of opioid abuse and dependence. Positive psychological characteristics are consistent with prior reports that suggested efficacy in the treatment of substance use disorders.
A subsequent 2020 study published in the journal Psychiatry involved adults at least 18 years of age who self-identified as having had problematic cannabis, opioid, or stimulant use and had used a psychedelic (LSD, psilocybin, peyote, or Ayahuasca) outside of a research or medical setting. Out of the 630 individuals who completed the online survey regarding their psychedelic use, 155 individuals reported a change in opioid use following a psychedelic experience. A larger proportion of opioid users sought treatment following the reduction or elimination of drug use.
Earlier this year, researchers investigated the relationship between recent naturalistic psychedelic use and subsequent daily illicit opioid use among people who use drugs. They drew data collected from 2006 to 2018 from three cohorts of community-recruited PWUD in Vancouver, Canada. Researchers estimated the association between psychedelic use and subsequent daily illicit opioid use. Results showed psychedelic use remained independently associated, with significantly reduced odds of subsequent daily opioid use. While confirmation in other settings is required, the findings align with growing evidence that psychedelic use is associated with reductions in subsequent substance use, including illicit opioid use.
A study published in April of this year assessed whether classic psychedelics lowered the odds of OUD using data from the NSDUH from 2015 to 2019. Psilocybin was the only substance associated with lowered odds of OUD, while all other substances examined shared no association with OUD, including increased odds of OUD. The study represents a step towards a greater understanding of factors that may prevent or alleviate OUD.
Future clinical trials are required to test whether the association between psilocybin and OUD is causal, identify which mediators underlie the association, and assess whether there’s a causal link between psilocybin and OUD. More studies can also provide foundational evidence for the link and maximize the likelihood of ethical and safe clinical trials to assess psilocybin’s treatment potential.
A current trial administered by Johns Hopkins University is investigating whether 2 doses of psilocybin administered under supportive conditions can reduce illicit opioid use and improve quality of life as measured by World Health Organization Quality of Life (WHOQOL-BREF) in individuals with OUD in Methadone Maintenance Treatment (MMT) who are concurrently using other opioids illicitly.
With more awareness about this tragic disease and developments in psychedelic research, we hope OUD may become a thing of the past.