When paired with psychotherapy, a single dose of psilocybin helped patients with cocaine use disorder (CUD) significantly reduce the number of days they used cocaine compared with patients who only received psychotherapy, according to a
study published yesterday in
JAMA Network Open.
Why It’s Relevant
Even as global cocaine use reached record highs in 2023, CUD has remained difficult to treat, with no approved pharmacotherapies and only one behavioral intervention associated with reduced use among patients. No trials have previously evaluated the potential of psychedelics to address CUD.
By the Numbers
- Researchers randomized 40 participants (83% male, median age of 50, 83% Black) to receive psilocybin (25mg per 70 kg of body weight) or 100mg diphenhydramine (an active placebo). All participants received weekly psychotherapy one month before and one month after their all-day psilocybin treatment session.
- Both groups reported increased cocaine-abstinent days between their initial psychotherapy session and psilocybin treatment, but only the psilocybin group continued that trend after treatment.
- Overall, the psilocybin group was 18 times more likely to report complete cocaine abstinence than the placebo group 180 days after treatment. The psilocybin group also had a 72% lower risk of cocaine lapse during follow-up.
What’s More
While most psychedelic trials have included participants with higher socioeconomic status than the general population, 65% of the participants in this study had an annual income of $20,000 or less.
The Other Side
Like other psychedelic trials, blinding presented a challenge, with 90% of the psilocybin participants and 47% of the placebo participants correctly guessing which group they were randomized to. Further, the lead study author was also the primary psychotherapist, which may have introduced bias—though the therapy was manualized.
Takeaway Message
The author of an
accompanying commentary cautioned against early enthusiasm for psychedelics as a treatment for substance use disorders: “[I]f the current results are framed prematurely as broadly efficacious, without emphasis on the full treatment regimen (i.e., intensive psychotherapy) and safety protocols, there may be a rise in consumption and associated adverse events among a vulnerable population seeking relief.”
Related Article
Source
Peter S. Hendricks, et al. Psilocybin in the treatment of cocaine use disorder: a randomized clinical trial. JAMA Network Open. Published online May 7, 2026. doi:10.1001/jamanetworkopen.2026.11029
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