Most Addiction Specialists Support Legalized Therapeutic Psychedelics

Pauline Anderson

December 16, 2021

UPDATED December 28, 2021 // Editor's note: This article has been updated with comments from an expert in the field.

The majority of addiction specialists, including psychiatrists, believe psychedelics are promising for the treatment of substance use disorders (SUDs) and psychiatric illnesses and, with some caveats, support legalization of the substances for these indications, results of a new survey show.

This strong positive attitude is "a surprise" given previous wariness of addiction specialists regarding legalization of marijuana, study investigator Amanda Kim, MD, JD, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, noted.

"We had hypothesized that addiction specialists would express more skepticism about psychedelics compared to non-addiction specialists," Kim said.

Instead, addiction experts who participated in the survey were very much in favor of psychedelics being legalized for therapeutic use, but only in a controlled setting.

The findings were presented at the American Academy of Addiction Psychiatry (AAAP) 32nd Annual Meeting.

Growing Interest

In recent years, there has been increased interest in the scientific community and the general public in the therapeutic potential of psychedelics, said Kim. Previous research has shown growing positivity about psychedelics and support for their legalization among psychiatrists, she added.

Psychedelics have been decriminalized and/or legalized in several jurisdictions. The US Food and Drug Administration has granted breakthrough therapy designation for 3,4-methyl​enedioxy​methamphetamine (MDMA) in the treatment of posttraumatic stress disorder (PTSD) and has granted the same designation to psilocybin in the treatment of major depressive disorder.

"Despite psychedelics increasingly entering the mainstream, we are unaware of any studies specifically assessing the current attitudes of physicians specializing in addictions regarding psychedelics," Kim said.

For the study, investigators identified prospective survey participants from the AAAP directory. They also reached out to program directors of addiction medicine and addiction psychiatry fellowships.

In the anonymous online survey, respondents were asked to rate their level of agreement with 30 statements.

The analysis included 145 respondents (59% men; mean age, 46.2 years). Psychiatrists made up about two thirds of the sample. The remainder specialized in internal and family medicine.

Most respondents had some clinical exposure to psychedelics. Almost 85% reported discussing a psychedelic experience with at least one patient.

Positive Attitudes, Concerns

Overall, participants expressed very positive attitudes regarding the therapeutic use of psychedelics. About 64% strongly agreed or agreed psychedelics show promise in treating SUDs, and 82% agreed they show promise in treating psychiatric disorders.

However, more than one third of respondents (37.9%) expressed concern about the addictive potential of psychedelics. This is more than in previous research polling psychiatrists, possibly because the study's "broad" definition of psychedelics included "non-classic, non-serotonergic hallucinogens," such as ketamine and MDMA, Kim noted.

Because ketamine and MDMA are both lumped into the hallucinogen category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), "and both are known to have addictive potential, this may have obscured participant responses," she added.

Some 28% of participants expressed concern about psychedelic use increasing the risk for subsequent psychiatric disorders and long-term cognitive impairment.

Almost three quarters (74.5%) believe the therapeutic use of psychedelics should be legalized. However, most wanted legal therapeutic psychedelics to be highly regulated and only administered in controlled settings with specially trained providers.

Interestingly, almost half of the sample believed therapeutic psychedelics should be legal in a variety of different contexts and by non-Western providers, in accordance with indigenous and/or spiritual traditions.

One surprising finding was that most respondents believed patients would be keen on using psychedelics to treat SUDs, said Kim.

"This may reflect evolving attitudes of both providers and patients about psychedelics, and it will be interesting to further study attitudes of patients toward the use of psychedelics to treat SUD in the future," she added.

Attitudes toward psychedelics were generally similar for psychiatrists and nonpsychiatrists; but psychiatrists expressed greater comfort in discussing them with patients and were more likely to have observed complications of psychedelics use in their practice.

Kim noted the study's limitations included the small sample size and possible selection bias, as those with more favorable views of psychedelics may have been more likely to respond.

More Education Needed

Commenting for Medscape Medical News, Brian Barnett, MD, an addiction specialist and assistant professor of psychiatry at Cleveland Clinic, Ohio, said the study "contributes important findings" to the growing literature on clinician views of psychedelics.

"Importantly, this study shows that participants who are familiar with the scientific literature on the therapeutic use of psychedelics are more likely to hold the belief that psychedelics show promise in treating psychiatric conditions," said Barnett, who was not involved with the research.

He noted that addiction to classical psychedelics such as psilocybin and LSD is "so rare that most non-addiction specialists will never see more than a handful of cases in their career."

However, the study suggests worries about the addictive potential of psychedelics "may be strongly influencing concerns about legalization of psychedelics for medical use," Barnett said.

"It's clear there's still important education to be done within medicine about the addictive and therapeutic potentials of psychedelics, so that clinicians can accurately weigh the potential risks and benefits of these intriguing compounds for their patients struggling with mental health conditions and addictions, should they come to market," he said.

Barnett also noted that interpretation of the study findings is limited due to a lack of information about how nonresponders to the survey differed from responders.

The study was supported by the Source Research Foundation. Barnett is on the advisory board of CB Therapeutics, a company working to develop psychedelic-based treatments.

American Academy of Addiction Psychiatry (AAAP) 32nd Annual Meeting: Poster F70.

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