Les psychédéliques : une nouvelle voie prometteuse dans le traitement des addictions

Paris, France – “It is important to develop new treatments in addiction medicine because addictions represent a significant cost for society,” emphasized Dr. Bruno Roméo, psychiatrist and addiction specialist at Paul Brousse Hospital (Villejuif), at the beginning of a session dedicated to the role of psychedelics in addiction treatment today, during the Neurosciences Psychiatry Neurology 2023 Conference. “Tobacco and alcohol are the top two preventable causes of mortality in France. However, pharmacological treatments for these addictions are rarely prescribed and have limited efficacy. We have high relapse rates, which is why there is a need to develop alternative therapies such as psychedelics,” he added. But what data do we have today regarding the effectiveness of psychedelics as a treatment for addiction? The results need to be replicated, but overall, psychedelics show great promise in alcohol use disorder and smoking addiction. Alcohol use disorder: limited studies In alcohol use disorder, there is limited data available, but a randomized controlled trial was published in JAMA in 2022 evaluating the effectiveness of psilocybin. In this study, the authors, Bogenschutz et al., included 95 patients, with 49 receiving psilocybin and 46 receiving diphenhydramine. A first session of psilocybin was conducted at 4 weeks, followed by a second session at 8 weeks at a higher dose. The researchers evaluated the number of consumption days, heavy consumption days, and number of drinks per consumption between 32 and 36 weeks. The researchers showed that after two sessions of psilocybin, there was a significant decrease in the number of heavy consumption days. In the control group, between 5 and 36 weeks, 20% of days were heavy consumption days, while in the psilocybin group, only 10% of days were heavy consumption days. Regarding the number of consumption days, a significant and rapid decrease was also observed, which was maintained over time. Between 5 and 36 weeks, the control group reported a little over 40% of consumption days, while the psilocybin group reported a little over 30% of consumption days. Similarly, the number of drinks per day decreased drastically after taking psilocybin, with a very rapid effectiveness. Consumption decreased from 6 drinks to less than 1 drink between weeks 5 and 8. Cumulatively, between weeks 5 and 36, the number of drinks consumed per day was over 2 in the placebo group and 1 in the psilocybin group. “We can see that psilocybin potentially has efficacy in the treatment of alcohol use disorder. However, these results need to be interpreted with caution due to the population included in this study, which is not representative of those who seek our addiction services. The patients included in the study had less than 60% of heavy consumption days at the start,” Dr. Roméo noted. For which patients? According to a retrospective survey conducted online at Paul Brousse Hospital, it appears that patients with severe alcohol use disorder who have had mystical psychedelic experiences are the ones who seem to respond best to psilocybin and therefore reduce their alcohol consumption. It also seems that patients who have decreased their tobacco consumption the most have lower psychological flexibility at the start of the study. “As if they had greater room for improvement and psychedelics helped them more,” explained the psychiatrist. Psychological flexibility is the ability to adapt to change, to experience the present moment (whether positive or negative) without resistance or the desire to escape the situation. What about psilocybin in smoking cessation? “There are even fewer studies on tobacco,” the speaker announced. In a pilot study with 15 patients, researchers Johnson et al. administered 2 or 3 doses of psilocybin, 20-30 mg, combined with cognitive-behavioral therapy (CBT), weekly interviews for 10 weeks. The patients were then evaluated three times, at 6, 12, and 30 months. The results showed a significant decrease in tobacco consumption from over 15 cigarettes per day to one or two cigarettes per day before increasing to 6 cigarettes. As for the abstinence rate, at 6 months, 12 out of 15 patients were smoke-free; at one year, 8 out of 15; and at 30 months, 7 out of 15. “We have rather interesting results, although they need to be interpreted cautiously due to the very small number of patients included in this study,” commented the expert. Similarly to alcohol use disorder, a retrospective survey conducted through a questionnaire at Paul Brousse Hospital showed that it seems to be the patients who smoked the most cigarettes and had the most mystical psychedelic experiences who appeared to respond better to psilocybin and, therefore, reduce their tobacco consumption. It also seemed that the patients who had the greatest decrease in tobacco consumption had lower psychological flexibility at the start of the study. What are the limitations of using psychedelics in addiction medicine? “Psychedelics show promise in addiction medicine, but there are various limitations to their use,” explained Dr. Roméo. One of them is societal. A questionnaire was sent to doctors by Dr. Laurence Bézo, an addiction specialist at Paul Brousse Hospital, to assess their opinions on psychedelics. To date, 407 doctors have responded, including 280 general practitioners, 50 addiction specialists, and 50 other specialists. The results show that 50% of the respondents believe that psychedelics have no therapeutic potential. Additionally, 3 out of 5 doctors believe that psychedelics are dangerous. More than half think that their use is associated with significant risks of self-harm and harm to others. Similarly, half of the doctors believe that the risk of addiction is very high and that there is a risk of developing psychiatric disorders. “Today, based on this sample, doctors consider psychedelics to be quite dangerous. There is a fairly negative perception of prescribing psychedelics in France,” commented Dr. Roméo. 50% of French doctors surveyed believe that psychedelics have no therapeutic potential. Participants even ranked psychedelics as one of the most dangerous drugs. On a scale of 0 to 7, participants ranked psychedelics alongside heroin and cocaine in terms of danger level. They are considered to be much more dangerous than alcohol, tobacco, or cannabis. “An IFOP survey conducted a few years ago in the general population found the exact same result. However, numerous studies have examined the dangers of psychedelics and have found that they are among the least dangerous drugs for oneself and others. Conversely, alcohol, heroin, crack, cocaine, methamphetamine, and tobacco are the most dangerous. Additionally, psychedelics have a very low risk of addiction and the lowest lethal risk. There is a complete dissociation between what the literature tells us today and the beliefs of society and some doctors,” commented the speaker. There is a complete dissociation between what the literature tells us today and the beliefs of society and some doctors Apart from these preconceptions, another limitation to the use of psychedelics is methodological. “Due to the effects of psychedelics, in studies, 9 out of 10 participants and doctors know what they have taken or given. This is a significant limitation. Currently, we are unable to conduct proper double-blind studies,” emphasized Dr. Roméo. In conclusion, according to the psychiatrist, psychedelics show promise in addiction medicine, but it is necessary to inform healthcare professionals, public authorities, and society in general in order to dispel misconceptions. “The results need to be replicated, but overall, psychedelics show great promise in alcohol use disorder and smoking addiction. They are generally well-tolerated, with few serious side effects. There is
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2023-08-01 08:42:29