Trial PaperTobacco/Nicotine Use Disorder (TUD)Substance Use Disorders (SUD)Healthy VolunteersPublic Health, Prevention & Behaviour ChangePsilocybin

Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction

In an open-label 15-week pilot with 15 nicotine-dependent smokers, moderate and high doses of the 5-HT2A agonist psilocybin administered alongside structured cessation support yielded an 80% biochemically-confirmed seven-day point-prevalence abstinence rate at six months, substantially higher than typical rates (<35%). While the uncontrolled design prevents definitive efficacy claims, the study suggests psilocybin may be a promising adjunct to smoking cessation treatment and provides a framework for future controlled research.

Authors

  • Albert Garcia-Romeu
  • Roland Griffiths
  • Matthew Johnson

Published

Journal of Psychopharmacology
individual Study

Abstract

Despite suggestive early findings on the therapeutic use of hallucinogens in the treatment of substance use disorders, rigorous follow-up has not been conducted. To determine the safety and feasibility of psilocybin as an adjunct to tobacco smoking cessation treatment we conducted an open-label pilot study administering moderate (20 mg/70 kg) and high (30 mg/70 kg) doses of psilocybin within a structured 15-week smoking cessation treatment protocol. Participants were 15 psychiatrically healthy nicotine-dependent smokers (10 males; mean age of 51 years), with a mean of six previous lifetime quit attempts, and smoking a mean of 19 cigarettes per day for a mean of 31 years at intake. Biomarkers assessing smoking status, and self-report measures of smoking behavior demonstrated that 12 of 15 participants (80%) showed seven-day point prevalence abstinence at 6-month follow-up. The observed smoking cessation rate substantially exceeds rates commonly reported for other behavioral and/or pharmacological therapies (typically <35%). Although the open-label design does not allow for definitive conclusions regarding the efficacy of psilocybin, these findings suggest psilocybin may be a potentially efficacious adjunct to current smoking cessation treatment models. The present study illustrates a framework for future research on the efficacy and mechanisms of hallucinogen-facilitated treatment of addiction.

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Research Summary of 'Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction'

Introduction

Earlier research from the 1950s–1970s suggested therapeutic potential for 5-HT2AR agonist hallucinogens in treating substance use disorders, but many of those studies lacked modern methodological rigour and the field was largely abandoned amid controversy and regulatory restrictions. More recent experimental work with psilocybin in healthy volunteers and in patients with advanced cancer has reported mystical-type experiences and enduring positive behaviour change well beyond the acute drug effect, suggesting a possible mechanism relevant to addiction treatment given associations between increased spirituality and recovery outcomes. Johnson and colleagues therefore conducted an open-label pilot study to assess the safety and feasibility of psilocybin as an adjunct to a structured smoking cessation intervention. The study aimed to establish whether a psilocybin-facilitated protocol could be delivered safely, and whether preliminary cessation rates would justify proceeding to a randomized controlled trial; no control condition was included in this first-step evaluation.

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Study Details

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Jefsen, O., Højgaard, K., Christiansen, S. L. et al. · Acta Neuropsychiatrica (2019)

60 cited
Cessation and reduction in alcohol consumption and misuse after psychedelic use

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211 cited
Classic psychedelics: An integrative review of epidemiology, therapeutics, mystical experience, and brain network function

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Psychedelic effects of psilocybin correlate with serotonin 2A receptor occupancy and plasma psilocin levels

Madsen, M. K., Fisher, P. M., Burmester, D. et al. · Neuropsychopharmacology (2019)

Trait Openness and serotonin 2A receptors in healthy volunteers: A positron emission tomography study

Stenbæk, D. S., Kristiansen, S., Burmester, D. et al. · Human Brain Mapping (2019)

9 cited
Microdosing psychedelics: personality, mental health, and creativity differences in microdosers

Anderson, T., Petranker, R., Rosenbaum, D. et al. · Psychopharmacology (2019)

142 cited
How do psychedelics work?

Carhart-Harris, R. L. · Current Opinion in Psychiatry (2019)

Psychiatry might need some psychedelic therapy

Johnson, M. W. · International Review of Psychiatry (2018)

Current perspectives on psychedelic therapy: use of serotonergic hallucinogens in clinical interventions

Richards, W. A., Garcia-Romeu, A. · International Review of Psychiatry (2018)

Ketamine for the treatment of addiction: Evidence and potential mechanisms

Ezquerra-Romano, I. I., Lawn, W., Krupitsky, E. M. et al. · Neuropharmacology (2018)

Exploring the effect of microdosing psychedelics on creativity in an open-label natural setting

Prochazkova, L., Lippelt, D. P., Colzato, L. S. et al. · Psychopharmacology (2018)

143 cited
Psychedelics and music: neuroscience and therapeutic implications

Barrett, F. S., Preller, K. H., Kaelen, M. · International Review of Psychiatry (2018)

DMT models the near-death experience

Timmermann, C., Roseman, L., Williams, L. et al. · Frontiers in Psychology (2018)

A Gratuitous Grace: The Influence of Religious Set and Intent on the Psychedelic Experience

Neitzke-Spruill, L., Glasser, C. · Journal of Psychoactive Drugs (2018)

DARK Classics in Chemical Neuroscience: Psilocybin

Geiger, H. A., Wurst, M. G., Daniels, R. N. · ACS Chemical Neuroscience (2018)

High dose psilocybin is associated with positive subjective effects in healthy volunteers

Nicholas, C. R., Henriquez, K. M., Gassman, M. C. et al. · Journal of Psychopharmacology (2018)

61 cited
Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts

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Effects of psilocybin therapy on personality structure

Erritzoe, D., Roseman, L., Nour, M. R. et al. · Acta Psychiatrica Scandinavica (2018)

219 cited
The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act

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Mental health of a self-selected sample of psychedelic users and self-medication practices with psychedelics

Mason, N. L., Kuypers, K. P. C. · Journal of Psychedelic Studies (2018)

Unifying theories of psychedelic drug effects

Swanson, L. R. · Frontiers in Pharmacology (2018)

Clinical interpretations of patient experience in a trial of psilocybin-assisted psychotherapy for alcohol use disorder

Bogenschutz, M. P., Podrebarac, S. K., Duane, J. H. et al. · Frontiers in Pharmacology (2018)

Powerful substances in tiny amounts An interview study of psychedelic microdosing

Johnstad, P. G. · Nordic Studies on Alcohol and Drugs (2018)

121 cited
Serotonergic hallucinogens in the treatment of anxiety and depression in patients suffering from a life-threatening disease: A systematic review

Reiche, S., Hermle, L., Gutwinski, S. et al. · Progress in Neuro-Psychopharmacology and Biological Psychiatry (2018)

The hidden therapist: evidence for a central role of music in psychedelic therapy

Kaelen, M., Giribaldi, B., Raine, J. et al. · Psychopharmacology (2018)

213 cited
Psychiatry & the psychedelic drugs. Past, present & future

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Psilocybin for treatment-resistant depression: fMRI-measured brain mechanisms

Carhart-Harris, R. L., Roseman, L., Bolstridge, M. et al. · Scientific Reports (2017)

Neuroticism is associated with challenging experiences with psilocybin mushrooms

Barrett, F. S., Johnson, M. W., Griffiths, R. R. · Personality and Individual Differences (2017)

78 cited
Psychedelic Drugs in Biomedicine

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Shannon entropy of brain functional complex networks under the influence of the psychedelic Ayahuasca

Viol, A., Palhano-Fontes, F., Onias, H. et al. · Scientific Reports (2017)

Effects of LSD on music-evoked brain activity

Kaelen, M., Lorenz, R., Barrett, F. S. et al. · Biorxiv (2017)

Potential Therapeutic Effects of Psilocybin

Johnson, M. W., Griffiths, R. R. · Neurotherapeutics (2017)

Ayahuasca’s entwined efficacy: an ethnographic study of ritual healing from ‘addiction’

Talin, P., Sanabria, E. · International Journal of Drug Policy (2017)

93 cited
Psilocybin-Assisted Therapy: A Review of a Novel Treatment for Psychiatric Disorders

Thomas, K., Malcolm, B., Lastra, D. · Journal of Psychoactive Drugs (2017)

Modern clinical research on LSD

Liechti, M. E. · Neuropsychopharmacology (2017)

Psychedelics, personality and political perspectives

Nour, M. R., Evans, J., Carhart-Harris, R. L. · Journal of Psychoactive Drugs (2017)

164 cited
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Acute effects of LSD on amygdala activity during processing of fearful stimuli in healthy subjects

Mueller, F., Lenz, C., Dolder, P. C. et al. · Translational Psychiatry (2017)

The association of psychedelic use and opioid use disorders among illicit users in the United States

Pisano, V. D., Putnam, N. P., Kramer, H. M. et al. · Journal of Psychopharmacology (2017)

5-HT2A Agonists: A Novel Therapy for Functional Neurological Disorders?

Bryson, A., Carter, O., Norman, T. et al. · International Journal of Neuropsychopharmacology (2017)

18 cited
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The fibrinolytic system: A new target for treatment of depression with psychedelics

Idell, R. D., Florova, G., Komissarov, A. A. et al. · Medical Hypotheses (2017)

An online survey of tobacco smoking cessation associated with naturalistic psychedelic use

Johnson, M. W., Garcia-Romeu, A., Johnson, P. S. et al. · Journal of Psychopharmacology (2017)

117 cited
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Martin, D. A., Nichols, C. D., Nichols, Á. C. D. · Current Topics in Behavioral Neurosciences (2017)

Phenomenology, Structure, and Dynamic of Psychedelic States

Preller, K. H., Vollenweider, F. X. · Behavioral Neurobiology of Psychedelic Drugs (2016)

Treating drug dependence with the aid of ibogaine: a qualitative study

Schenberg, E. E., de Castro Comis, M. A., Alexandre, J. F. M. et al. · Journal of Psychedelic Studies (2016)

The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms

Barrett, F. S., Bradstreet, M. P., Leoutsakos, J. M. S. et al. · Journal of Psychopharmacology (2016)

Psychedelics in the treatment of unipolar mood disorders: a systematic review

Rucker, J., Young, A. H., Jelen, L. A. et al. · Journal of Psychopharmacology (2016)

The serotonin 5-HT2C receptor and the non-addictive nature of classic hallucinogens

Canal, C. E., Murnane, K. S. · Journal of Psychopharmacology (2016)

Psychedelics as Medicines: An Emerging New Paradigm

Nichols, C. D., Nichols, D. E., Johnson, M. W. · Clinical Pharmacology and Therapeutics (2016)

Development of a Psychotherapeutic Model for Psilocybin-Assisted Treatment of Alcoholism

Bogenschutz, M. P., Forcehimes, A. A. · Journal of Humanistic Psychology (2016)

The Associations of Naturalistic Classic Psychedelic Use, Mystical Experience, and Creative Problem Solving

Sweat, N. W., Bates, L. W., Hendricks, P. S. · Journal of Psychoactive Drugs (2016)

Alterations of consciousness and mystical-type experiences after acute LSD in humans

Liechti, M. E., Dolder, P. C., Schmid, Y. · Psychopharmacology (2016)

190 cited
Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences

Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S. et al. · Journal of Psychopharmacology (2016)

Psilocybin for treating substance use disorders?

de Veen, B. T. H., Schellekens, A., Verheij, M. M. et al. · Expert Review of Neurotherapeutics (2016)

Clinical Applications of Hallucinogens: A Review

Garcia-Romeu, A., Kersgaard, B., Addy, P. H. · Experimental and Clinical Psychopharmacology (2016)

174 cited
Treating Addiction: Perspectives from EEG and Imaging Studies on Psychedelics

Tófoli, L. F., De Araujo, D. B. · International Review of Neurobiology (2016)

Long-term follow-up of psilocybin-facilitated smoking cessation

Johnson, M. W., Garcia-Romeu, A., Griffiths, R. R. · The American Journal of Drug and Alcohol Abuse (2016)

562 cited
A Public-Health-Based Vision for the Management and Regulation of Psychedelics

Haden, M., Emerson, B., Tupper, K. W. · Journal of Psychoactive Drugs (2016)

28 cited
LSD modulates music-induced imagery via changes in parahippocampal connectivity

Kaelen, M., Roseman, L., Kahan, J. et al. · European Neuropsychopharmacology (2016)

Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study

Carhart-Harris, R. L., Bolstridge, M., Rucker, J. et al. · Lancet Psychiatry (2016)

1174 cited
Ego-dissolution and psychedelics: validation of the ego-dissolution inventory (EDI)

Nour, M. R., Evans, J., Nutt, D. J. et al. · Frontiers in Human Neuroscience (2016)

Effects of Ayahuasca and its Alkaloids on Drug Dependence: A Systematic Literature Review of Quantitative Studies in Animals and Humans

Nunes, A. A., Dos Santos, R. G., Osório, F. L. et al. · Journal of Psychoactive Drugs (2016)

80 cited
LSD-induced entropic brain activity predicts subsequent personality change

Lebedev, A. V., Kaelen, M., L€ Ovd En, M. et al. · Human Brain Mapping (2016)

292 cited
Neural correlates of the LSD experience revealed by multimodal neuroimaging

Carhart-Harris, R. L., Muthukumaraswamy, S., Roseman, L. et al. · PNAS (2016)

Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA

Grob, C. S., Mithoefer, M. C., Brewerton, T. D. · Lancet Psychiatry (2016)

Psychedelics

Nichols, D. E. · Pharmacological Reviews (2016)

Lysergic acid diethylamide: a drug of ‘use’?

Das, S., Barnwal, P., Ramasamy, A. et al. · Therapeutic Advances in Psychopharmacology (2016)

New World Tryptamine Hallucinogens and the Neuroscience of Ayahuasca

McKenna, D., Riba, J. · Current Topics in Behavioral Neurosciences (2016)

Serotonergic Hallucinogen-Induced Visual Perceptual Alterations

Kometer, M., Vollenweider, F. X. · Behavioral Neurobiology of Psychedelic Drugs (2016)

Validation of the revised Mystical Experience Questionnaire in experimental sessions with psilocybin

Barrett, F. S., Johnson, M. W., Griffiths, R. R. · Journal of Psychopharmacology (2015)

Psilocybin, psychological distress, and suicidality

Hendricks, P. S., Johnson, M. W., Griffiths, R. R. · Journal of Psychopharmacology (2015)

84 cited
LSD enhances the emotional response to music

Kaelen, M., Barrett, F. S., Roseman, L. et al. · Psychopharmacology (2015)

Classic psychedelic use is associated with reduced psychological distress and suicidality in the United States adult population

Hendricks, P. S., Thorne, C. B., Clark, B. et al. · Journal of Psychopharmacology (2015)

345 cited
Psilocybin-assisted treatment for alcohol dependence: a proof-of-concept study

Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A. et al. · Journal of Psychopharmacology (2015)

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