(27) Perceptions of Psilocybin Assisted Therapy (PAT) for Substance Use Disorder

Background & Introduction: Psilocybin is a classic hallucinogen that has been used throughout human history in a variety of religious and spiritual contexts. Psilocybin assisted psychotherapy (PAT) has been gaining relevance as a promising treatment for various mental health and substance use disorders (SUD) (Ziff et al., 2022). Psychedelics, primarily psilocybin, have biological mechanisms that are directed toward serotonergic effects and promotions of neuroplasticity, which are key aspects in an alternate way of aiding mental health, substance use disorders, and even chronic pain (Weleff et al., 2024). Continuing the exploration of psilocybin treatment is beneficial in allowing relevant populations to have access to another form of substance use disorder treatment without increasing the fears of acquiring addiction to a new substance while experiencing the other benefits. This current study touches on the perceptions of opioid use disorder (OUD) patients in three aspects of potential relationships with PAT: race/ethnicity, previous psychedelic use, and history of incarceration.

Methods: A 15-minute survey was carried out for patients arriving at Cooper University Health Care Center for Healing offices. The survey was a shortened version of the instrument used from the University of Maryland School of Medicine’s study (Clifton et al., 2022) and pertains to topics of basic demographics, drug use and treatment history, then perceived risks of using psilocybin, and touching on likelihood of using psilocybin assisted therapy as a potential treatment option. Data will be analyzed using descriptive statistics and Fisher's exact tests for possible significance.

Results: Of the 53 participants who volunteered to conduct the survey the average age was 43.5 (SD ±9.96), 26 (49.05%) were men, 43 (81.13%) non-Hispanic white. Overall, 30 (56.6%) participants are on buprenorphine treatment, 12 (22.6%) extended-release buprenorphine, 10 (18.9%) methadone, and 1 (1.9%) reported none of the above treatment options. When asked of any arrest history, 42 (79.2%) reported yes and 29 (54.7%) when asked if longer term incarceration history.
When asked if participants would be interested in learning more about PAT, 44 (83.01%) reported yes, 7 (13.2%) no, and 2 (3.8%) were unsure. Willingness to try PAT if it were available had 37 (69.8%) participants reporting yes, 8 (15.1%) no, and 8 (15.1%) unsure. If PAT was an FDA (Federal Drug Administration) approved treatment option for OUD, 30 (56.6%) participants reported yes, they would be more likely to try PAT, whereas 13 (24.5%) reported no and 10 (18.9%) as still unsure. When asked if given the option to choose between receiving their current treatment for OUD or receiving PAT, 2 (3.8%) reported only PAT, 12 (22.6%) as continuing with their current treatment, 38 (71.7%) would be willing to try a combination of treatment options, and 1 (1.9%) reported none of the above.
Race and perceived risk of using psilocybin for SUD treatment held no significant difference after p-value correction. A Fisher’s exact test showed that willingness to try psychedelics differed by psychedelic use history (p = .017). Participants who had tried psychedelics were more likely to report willingness to try psilocybin assisted therapy (34/45 = 75.6%) than those who had not (3/8 = 37.5%), (OR = 4.96, 95% CI [0.82, 37.31], p = 0.045). A Fisher’s exact test indicated that preference for the combination of current treatment plus psilocybin assisted therapy differed by psychedelic use history (p = .02). Participants who had tried psychedelics were more likely to endorse the combination options (35/45= 77.8%) compared to participants who had not tried psychedelics (3/8 = 37.5%), corresponding to higher odds of selecting the combination treatment among the patients who have tried psychedelics (OR = 5.6, p = .03). Comparisons amongst previous arrest and incarceration history and hesitancy to try psilocybin assisted therapy were not significant.

Conclusion & Discussion: Overall, participants stated they would be interested in learning more about psilocybin assisted therapy before fully accepting it as a treatment option for themselves and not being comfortable having PAT be their only treatment pathway. More education about PAT has the potential to bring awareness to the community that there is another safe treatment option for OUD. Having non-significant results with law enforcement history and likelihood of trying PAT sheds some light that these factors may not play a role in hesitancy to try this form of treatment. Future studies may want to focus on having a larger and more diverse sample and talking within communities rather than targeting certain clinics. Stigma plays a large role in SUD treatment, and gaining community support for PAT may increase acceptability from patients, as well.

References: Clifton, J. M., Belcher, A. M., Greenblatt, A. D., Welsh, C. M., Cole, T. O., & Davis, A. K. (2022). Psilocybin use patterns and perception of risk among a cohort of Black individuals with Opioid Use Disorder. Journal of Psychedelic Studies, 6(2), 80-87. https://doi.org/10.1556/2054.2022.00214
Weleff J, Nunes JC, Costa GPA, Sofuoglu M, MacLean RR, De Aquino JP. From taboo to treatment: The emergence of psychedelics in the management of pain and opioid use disorder. Br J Clin Pharmacol. 2024; 90(12): 3036-3053. doi:10.1111/bcp.16045
Ziff S, Stern B, Lewis G, Majeed M, Gorantla VR. Analysis of Psilocybin-Assisted Therapy in Medicine: A Narrative Review. Cureus. 2022 Feb 5;14(2):e21944. doi: 10.7759/cureus.21944. PMID: 35273885; PMCID: PMC8901083.