(89) Perceived Risks of Psychedelics in Individuals with Substance Use and Psychiatric Disorders

Background & Introduction: Psychedelics have arisen as a potential treatment for substance use disorders (SUD) and other psychiatric disorders (PD). Studies suggest that psychedelics may work by increasing neuroplasticity, increasing mental flexibility, or by decreasing craving and alcohol consumption by improving interpersonal relationships and self-acceptance.

Psilocybin, a psychedelic with a positive safety profile and low risk of addiction, may be a promising, emerging treatment for SUD. A recently published randomized controlled trial showed promising results for psilocybin when combined with psychotherapy for individuals with AUD. While prior studies of clinicians demonstrate broad support for the therapeutic use of psychedelics, research is limited on the assessing the acceptability by individuals with SUD and PD. Patients themselves may harbor concerns for safety including risk for addiction. Knowledge about the beliefs and perceptions of individuals with alcohol use disorder (AUD), opioid use disorder (OUD), and PD towards psychedelics may help inform implementation efforts as patients with concerns may be less likely to initiate or adhere to psychedelic treatments that could be beneficial.

The aims of this study are to assess in patients with AUD, OUD, or PD: the use of psychedelics for recreational and therapeutic reasons and perceptions of risk and treatment acceptability of psychedelics.

Methods: Patients diagnosed with alcohol use disorder, opioid use disorder, or psychiatric disorder were invited to participate in a 15 to 20-minute survey that was administered using REDCap.

The survey collected information regarding respondent demographics (age, sex, gender, ethnicity and race, education, living situation, income, political affiliation), substance use treatment and substance use history, awareness of psychedelics as substances and treatments, perceived risks/harms and acceptability of psychedelics, AA/NA attendance, and spirituality.

Eligible participants were invited from a psychiatric clinic of a tertiary hospital or an online patient portal to complete an anonymous online survey on their own or over the phone with a research assistant. All participants who completed the survey were compensated with a $10 gift card for their time.

Data was analyzed using SPSS. Responses were stratified to those who did and did not believe utilizing psychedelics were helpful in the treatment of SUD and PD. Bivariate analyses compared those who do and do not support psychedelics to identify any differences in their demographics or other characteristics using chi-square for categorical variables, t-test for continuous variables, and non-parametric tests as appropriate.

Results: A total of 191 adults with a mean age of 45.1 years [SD = 14.3] participated in the study and 63% were female. Of all participants, 31% were diagnosed with AUD, 15% had OUD, 40% had any SUD, 85% had a psychiatric disorder, and 60% had a PD without a SUD. Participants were mostly White (83%), 9% Black, 7% Hispanic/Latino. For highest grade in school completed, 27% of participants reported a graduate degree, 41% reported a college degree, 20% reported some college, 10% reported a GED/high school, 2% had not completed high school.

Eighty-one percent had heard of psychedelic treatment. Sixty-three percent of participants had used a psychedelic at least once; specifically, 51% tried magic mushrooms, 33% tried LSD, 30% tried MDMA, 14% tried mescaline, 6% tried DMT, 10% tried salvia, 12% tried ketamine. Twelve percent were currently using a psychedelic, including 8% using magic mushrooms, 3% ketamine, 2% LSD, 1% mescaline, 1% MDMA, 1% DMT.

Overall, 71% thought psychedelic treatment could help people with SUD or psychiatric disorder, and 69% would personally try psychedelic treatment. Participants were more likely to think psychedelic treatment could help SUD or PD if they had heard of psychedelics (p= <.001) or psychedelic treatment before (p= <.001). Participants believed psychedelics were not more harmful than alcohol (60%), tobacco (65%), or opioids (79%). Half (49%) of participants would be more likely to use psilocybin if it were legal and 72% of participants were interested in learning more about psychedelic treatment.

Participants who thought psychedelic treatment could help were more likely to have ever used cigarettes (p=.025), marijuana (p=.011), cocaine/crack (p=.018), heroin (p=.033), other opioids (p=.031), stimulants (p=.001), ketamine (p=.043), and benzodiazepines (p=.008). Participants who thought psychedelic treatment could help SUD or PD were more likely to currently use marijuana (p=.002) and/or psilocybin (p=.041).

Of participants who did not think or were unsure that psychedelic treatment could help, 30% would be more likely to try psilocybin if it were FDA approved for SUD, AUD, or PD and 33% were unsure, 39% wanted to learn more about psychedelics and 24% would try psychedelics as treatment. Participants who were unsure or did not think psychedelics could help were more likely to have never tried a psychedelic before (p= <.001) and believed that psychedelics could cause depression (p= <.001), addiction (p= <.001), brain damage (p= <.001), harmful interactions with other drugs (p= <.001), physical pain (p= <.001), heart damage (p= <.001), overdosing (p=.003), insanity (p= <.001), and death (p= <.001).

Conclusion & Discussion: Psychedelics appear to be acceptable as treatment to most individuals with SUD or other PD. Participants were more likely to support psychedelic treatment if they had heard of or used psychedelics/psychedelic treatment previously. Participants who didn’t think psychedelics could help were more likely to think they caused addiction/dependence, brain damage, harmful interactions with other drugs, overdosing, and death. Some participants who did not think psychedelics could help were interested in learning more and were willing to try them as treatment. The sampled participants consisted of mostly middle-aged adults, and most participants had tried a psychedelic earlier in their lives, however, did not currently use psychedelics.
Limitations of the study could be attributed to participant recall biases. While only participants who met the eligibility criteria were contacted, participants were asked to participate in a study of psychedelics and could have self-selected based on knowledge of psychedelics. The study was conducted in one hospital clinic and may not be generalizable to other settings and populations.
Future efforts could focus on exploring adverse events related to psychedelics, educating patients on the safety of psychedelics, and exploring concerns with patients. Additional research could further explore use of psychedelics on AUD, OUD, and psychiatric conditions.

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