Psilocybin Shows Promise for Cocaine Use Disorder: JAMA
USA: A randomized clinical trial has found that psilocybin appeared to be safe and effective in treating cocaine use disorder, including among individuals from underrepresented and vulnerable populations. These findings highlight psilocybin’s potential as a novel therapeutic option, although larger studies are needed to confirm and expand upon these results.
The findings were published in JAMA Psychiatry by Peter S. Hendricks and colleagues, who evaluated whether psilocybin combined with psychotherapy could help individuals achieve and maintain abstinence from cocaine use.
Cocaine use disorder remains a major public health challenge, and currently, there are no approved medications with proven effectiveness for its treatment. To address this gap, researchers conducted a randomized, quadruple-blind, placebo-controlled clinical trial at a major medical research center in the southern United States.
The trial enrolled 40 adults with cocaine use disorder who were motivated to quit and had no major medical or psychiatric comorbidities. Participants were randomly assigned to receive either a single dose of psilocybin (25 mg/70 kg body weight) or an active placebo (diphenhydramine), alongside a structured psychotherapy program incorporating cognitive behavioral therapy. Treatment outcomes were assessed over 180 days using measures of cocaine-abstinent days, complete abstinence, and time to first relapse, with self-reported cocaine use confirmed through urine testing.
The median participant age was 50 years, more than 80% were Black, and nearly two-thirds had annual incomes of $20,000 or less. Overall, 36 of the 40 participants completed the six-month follow-up period.
Key findings from the study included:
- Participants receiving psilocybin achieved a significantly higher percentage of cocaine-abstinent days compared with those receiving an active placebo.
- Psilocybin treatment was associated with a substantially greater likelihood of complete abstinence from cocaine during the follow-up period.
- Individuals in the psilocybin group experienced a lower risk of cocaine relapse and remained abstinent for longer before a first lapse occurred.
- No serious adverse events were reported during the trial.
The researchers acknowledged several limitations, including the possibility that psilocybin's noticeable psychoactive effects may have compromised blinding. Outcomes also relied partly on self-reported cocaine use, despite confirmation through urine testing. Additionally, the small sample size, limited assessment of psychotherapy fidelity, and potential lack of generalizability to routine clinical populations warrant cautious interpretation of the findings.
The researchers concluded that psilocybin shows promise as a potential treatment for cocaine use disorder. However, larger studies involving more diverse populations are needed to confirm these preliminary results and identify the most effective treatment approach.
Reference:
Hendricks PS, Lappan SN, Shelton RC, et al. Psilocybin in the Treatment of Cocaine Use Disorder: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(5):e2611029. doi:10.1001/jamanetworkopen.2026.11029
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