BIRMINGHAM, ALABAMA — A single dose of psilocybin combined with therapist support improved cocaine abstinence compared with a placebo in a clinical trial conducted at the University of Alabama at Birmingham, according to a study published this month in JAMA Network Open. The trial assigned 19 participants to receive psilocybin and 17 to receive a placebo dose of diphenhydramine, with both groups working with a therapist to process their experiences.

Participants who received psilocybin were more likely to abstain from cocaine than those who received the placebo. There are no FDA-approved medications for addiction to cocaine or other stimulants such as methamphetamine, and cocaine-related deaths are rising globally, according to the latest UN global drug report, which also found that global cocaine production has reached an all-time high.

"We wanted to recruit people who were dependent on cocaine or had cocaine use disorder, and wanted to stop," said Dr Peter Hendricks, a behavioral health professor at the University of Alabama at Birmingham. Rather than advertising the trial as a psychedelic study, which can attract people already interested in psychedelic treatment, researchers advertised simply that they were seeking people trying to quit cocaine.

The majority of participants were low-income Black men, making the trial the first psychedelic clinical study to include a majority of Black participants. According to a systematic review, participants in U.S.-based psychedelic clinical trials tend to have higher socioeconomic status and are disproportionately white relative to the general population. A local Birmingham dataset showed that cocaine use was the strongest predictor of criminal justice involvement and recidivism. White people are more likely to report lifetime cocaine use than Black people, while Black people have higher arrest rates for cocaine-related crimes.

Psilocybin operates differently from typical pharmacological treatments for substance use. Medications for opioid use disorder act on the same receptors as opioids, and nicotine patches replace nicotine in tobacco in a safer form. "Psilocybin is different from most addiction medications that target the same neurochemical systems as the substance itself," said Gabrielle Agin-Liebes, a clinical psychologist at the Yale School of Medicine. "Psilocybin produces a profound altered state of consciousness, typically in a single session, within a structured psychotherapy context."

Neuroscience researcher Robin Carhart-Harris has said that psychedelics increase neuroplasticity and psychological plasticity. "People get stuck in ruts," Carhart-Harris said, referring to disorders such as addiction, depression, and anxiety.

Psilocybin is not a maintenance medication that people have to keep taking. The study excluded people with comorbid depression and anxiety, and a critical commentary said that the exclusion might limit the generalizability of the results. Common cocaine withdrawal symptoms include bad dreams, agitation, depression, and cravings.