Can psychedelics prevent cocaine use?

Classic psychedelics (peyote, mescaline, psilocybin, LSD) may be associated with lowered odds of substance misuse and the development of Cocaine Use Disorder (CUD), according to the latest clinical psychology research from Harvard University’s Nock Laboratory (Boston, Ma).

Highlights from the study include:

  • Association of peyote use with the odds of CUD decreasing by over 50%.
  • All other classical psychedelics were either associated with no changes in the development of CUD or an increased risk of developing CUD.
  • Study results may help in developing treatment strategies for CUD involving psychedelics.

‘Classical’ psychedelics have been documented in medical literature dating back to the 1940s, though have been used by indigenous cultures for thousands of years in ceremonial, spiritual, and ritualistic settings. They include peyote, mescaline, psilocybin, and LSD, and act upon the brain by affecting the serotonin 2A receptor into eliciting the altered visual, auditory, and consciousness states that are associated with psychedelic experiences.

Previous research has linked the use of classic psychedelics to the improvement of substance use disorders including nicotine and alcohol addiction. More recently, associations have been drawn between psychedelic use to reductions in the abuse of other substances including cannabis, stimulants, and opioids. 

Research exploring the association of classical psychedelics to the relief or prevention of CUD is limited, however the potential utility of classical psychedelics for CUD has been suggested by other studies linking the use of ketamine, a non-classical psychedelic, to reduced cocaine use, cravings, relapse, and increased abstinence. Ketamine acts on the glutamate system of the brain rather than the serotonin system targeted by classical psychedelics. However, ketamine’s effects are similar to those induced by classical psychedelics. One such effect, the production of a ‘mystical experience,’ has been linked to improvements in CUD following ketamine use. Research has indicated that mystical experiences elicited by classical psychedelics may be largely responsible for their therapeutic potential

With this in mind, researchers at the Nock laboratory took to examining four years of data sourced from over 214,500 respondents who had taken The National Survey on Drug Use and Health (NSDUH), an annual survey focusing on substance use and health outcomes. Of all survey participants, 1,017 were identified as those having CUD (dependence or abuse) based upon diagnostic criteria from the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders). Researchers tested whether the use of each of the four classic psychedelics was associated with lowered odds of CUD. If a positive association between psychedelic use and decreased odds of CUD were noted, then further exploration was given to determine how many of the DSM-IV criteria for CUD were also given lower odds of occurring.

Of the four classical psychedelics, peyote was the only substance to confer lower odds of CUD occurring within the previous year, with odds of CUD reduced by greater than 50%. Lowered odds were found for 7 out of the 11 total CUD criteria outlined by the DSM-IV.

Peyote was associated with lowered odds of 4 out of 7 criteria for cocaine dependence in CUD including: spending a significant time acquiring and using cocaine, using more cocaine than intended, feeling decreased effects of the drug and/or needing more cocaine to achieve the same effect, and the inability to cut back on use. 

Peyote was also associated with lower odds of developing 3 out of 4 criteria for cocaine abuse in CUD including: significant work, home, or school problems as a result of drug abuse, use of cocaine in physically hazardous situations, and experiencing relationship issues as a result of cocaine abuse. 

As both risk factors and the factors which protect from the abuse and dependency associated with CUD are poorly known, the study results offer kindling to ignite further discussion in scientific and medical communities. Future studies that elicit greater understanding of why peyote is associated with decreased CUD may soon benefit certain types of patients who would otherwise have little recourse for their condition. Future studies may also draw out more information concerning the association of other classical psychedelics with increased chances of CUD, and reason(s) why mescaline, despite its similarities to peyote, is not associated with lowered odds of CUD.