• Psychedelic Treatment of Addiction: Coming to a Clinic near You?

    by Matthew Goldenberg, D.O.
    on Oct 5th, 2016
                                                       

With “Celebrities” like Scott Disick and Brooke Mueller making the news for allegedly entering addiction programs that utilize Hallucinogens as treatment of addiction, it came as no surprise to me that some of my readers had questions. Some of the questions included: “Are these safe?” “What drugs do they use?” “Is there really evidence that they work?” These are all great questions! This is an area I have less experience in, as Hallucinogens are not a common or FDA recommended tretment, therefore I did a literature search and reviewed the most up-to-date research studies. I want to use this post to answer your questions.  I think the best place to start is the beginning…

One of the most well-known hallucinogens, lysergic acid diethylamide, better known as LSD, was first synthesized in 1938. The short form "LSD" comes from its early code name LSD-25, which is an abbreviation for the German "Lysergsäure-diethylamid”. The lab that had discovered LSD was hoping to find a marketable clinic indication for use and so they made it “ [widely accessible to research labs] who tested it on alcoholics, people struggling with obsessive-compulsive disorder (OCD), [depression], [schizophrenia], Post Traumatic Stress Disorder (PTSD), as well as autistic children, terminal cancer patients, and convicts, as well as on perfectly healthy artists and scientists (to study creativity) and divinity students (to study spirituality)”. [1]

An early formulation of LSD to be used in hospitals.

According to one article, “Psilocybin and MDMA, better known as ecstasy, show 80 percent success rates years after treatment”. [2] Both of these drugs share many similarities to LSD and are in the same class of “hallucinogens”. Unfortunately, while the results reported were frequently positive [for many types of hallucinogens], many of the studies were, by modern standards, poorly designed and seldom well controlled, if at all. [1]

Psilocybin is a naturally occurring psychedelic compound produced by more than 200 species of mushrooms that can be eaten, grinded into a powder and put into capsules for use. 
MDMA popularly known as ecstasy or, more recently, as Molly, is a synthetic, psychoactive drug usually taken in capsules. 

The article went on to report that “between 1953 and 1973, the federal government spent four million dollars to 116 studies of LSD, involving more than seventeen hundred subjects…  [However], by the mid-nineteen-sixties, LSD use was widespread in the U.S. Subsequently, in 1970, Richard Nixon signed the Controlled Substances Act and put most psychedelics on Schedule 1, prohibiting their use for any purpose”. This caused the research to come to an abrupt halt. [1]

Illicit LSD is often sold in "tabs," which are dissolved on the tongue.

The article continues “[now, more than 40 years later, the government is gingerly allowing a small number of scientists to resume working with these [hallucinogenic drugs]…. Researchers are using or planning to use psilocybin not only to treat anxiety, addiction (to tobacco and alcohol), and depression but also to study the neurobiology of mystical experience, which the drug, at high doses, can reliably [cause]… Compared to psilocybin, LSD is stronger and longer-lasting in its effects, and is considered more likely to produce adverse reactions”. [1]


A brief history of Psychedelic Drugs. Photo credit: http://io9.com/


While these substances are still generally classified as Schedule I, I found a review article that looked at a large quantity of wide ranging data and concluded that there is “evidence indicating [hallucinogens] might be safe and effective tools for short term interventions in addictions treatment.  Evidence suggests that the psychedelics have a much greater safety profile than the major addictive drugs, having extremely low levels of mortality, and producing little if any physical dependence”. This paper reviews studies evaluating the use of LSD, peyote, ibogaine and ayahuasca in the treatment of dependencies and the possible mechanisms underlying the indications of effectiveness. They report that “evidence suggests that these substances help assist recovery from drug dependency through a variety of therapeutic mechanisms, including a notable “after-glow” effect that in part reflects their action on the serotonin neurotransmitter system”.  [3] This is the same neurotransmitter that common Selective Serotonin Reuptake Inhibitors (SSRI’s) including well-known brand name drugs like Prozac and Zoloft impact.

So the answers to the questions are:
1) “Are these safe?” Maybe. There is limited evidence out there because research has been limited. Some researchers feel they could be safer than some alternatives for short-term treatment of addiction and mental illness. However, long-term studies are lacking.

2)  “What drugs do they use?” The most common are: LSD, psilocybin, MDMA and Ibogaine among others.

3)  “Is there really evidence that they work?” There is some evidence of benefit, however, the studies have many limitations and newer, high quality research is pending…

After reviewing the limited data available, I would not recommend following in the footsteps of Scott Disick. However, I will be keeping an eye on the research as a possible alternative to current treatments as more research is published in the future!

Keep the Questions Coming!

Dr. Goldenberg

docgoldenberg@gmail.com
docgoldenberg.com
Twitter: @docgoldenberg

Author Matthew Goldenberg, D.O. Matthew Goldenberg D.O. is double Board Certified in Psychiatry and Addiction Psychiatry and is a certified Medical Review Officer (MRO). He is an expert in the evaluation and treatment of mental health disorders and is an addiction specialist for adults in his private practice in Santa Monica, California. Dr. Goldenberg also provides addiction psychiatry consultations to some of the nation’s top residential and outpatient treatment programs in the Los Angeles area and is experienced in the evaluation and treatment of professionals working in safety-sensitive positions. In addition to his clinical work, Dr. Goldenberg is an active author, researcher and invited speaker at local and national conferences. He also volunteers his time as a Clinical Instructor in the Department of Psychiatry at UCLA and is an Assistant Professor of Psychiatry at Cedars Sinai Medical Center.

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