johns hopkins, behavioral pharmacology research unit ... · psychedelics in addiction treatment...
TRANSCRIPT
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Psychedelics
in Addiction Treatment
Chris Stauffer, MDUCSF & SFVAMC, Dept of Psychiatry
Matthew Johnson, PhDJohns Hopkins, Dept of Psychiatry & Behavioral Sciences
Mary Cosimano, MSWJohns Hopkins, Behavioral Pharmacology Research Unit
Boston | November 8, 2019
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Disclosure
• No classic psychedelic (e.g., psilocybin, LSD, mescaline) nor MDMA have a current FDA-approved indication for medical use
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What is a ”PSYCHEDELIC”?
• Classic Psychedelics (5HT2A agonists)• Psilocybin • LSD (lysergic acid diethylamide)• Mescaline • DMT (N,N-Dimethyltryptamine)
• Empathogen-Entactogen• MDMA• MDA
• Dissociatives• Ketamine
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Why PSILOCYBIN?
PsilocybinPsilocybe cubensis(+ >200 other species
of mushroom) Caffeine
Coffee
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Maria Sabina, Mazatec curandera
Robert Gordon WassonPsilocybe mexicana
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Pharmaceutical Psilocybin
1959: Isolated from P. Mexicana
1960s: Produced by Sandoz, 100’s of legal administrations worldwide
Brown RT, et al. Clin Pharmacokinet. 2017;56(12):1543-1554. Passie T, et al. Addict Biol. 2002;7(4):357-364.
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1970: Controlled Substances Act Psilocybin - DEA Schedule 1 substance
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1980’s: animal work
1990’s: FDA approves human dose-response study (UNM)
2001: First modern-day psilocybin clinical trial (OCD, UArizona)
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Relative Harm of Drugs of Potential Misuse
Nutt D, et. al. The Lancet 2007, 369:1047-1053
van Amsterdam J, et. al. Eur Addict Res 2010;16:202–207
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National Survey on Drug Use & HealthThe Substance Abuse & Mental Health Services Administration (SAMHSA)
• Pooled 2008-2012, n > 191,832 (7,550 lifetime psilocybin use)
• Respondents ≥18yo
Lifetime Hx Psilocybin Use vs No Hx Psychedelic Use
weighted odds ratios (95% confidence intervals), *p<.05, **p<.01, ***p<.0001
Psychological distress
Suicidal thinking
Suicidal planning
Suicide attempt
past month past year past year past year
.70 (.60-.81)*** .76 (.64-.90)** .54 (.36-.82)** .58 (.35-.94)*
Hendricks, Johnson, & Griffiths. J Psychopharmacol. 2015; 29(9):1041-1043.
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Petri G, Expert P, Turkheimer F, Carhart-Harris R, Nutt D, Hellyer J, & Vaccarino F. (2014) Homological scaffolds of brain functional networks. J. R. Soc. Interface. 11:20140873.
Placebo Psilocybin
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•Major Depressive Disorder•Cancer-related anxiety•Migraine/Cluster Headache•OCD•Anorexia•Substance Use Disorders (Nicotine, Alcohol, Cocaine)
PSILOCYBIN –Current Clinical Trials (33)
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Psychedelics in Addiction Treatment
Matthew W. Johnson, Ph.D.Associate ProfessorBehavioral Pharmacology Research UnitDepartment of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine
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• Psilocybin in >100 mushroom species
• “Classic psychedelic”– Psilocybin
– LSD
– Mescaline (peyote)
– DMT (ayahuasca)
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1940s – 1970s
• Psychedelics were intensely investigated as research tools and therapeutics
• Promising findings for:
– Cancer-related distress
– Alcoholism
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The Dark Ages
• Despite promising preliminary findings, human research with psychedelics became largely dormant
• Dormancy largely a reaction to the association of LSD with the 1960s counterculture
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Abuse liability & Risks 2018
• Can cause harm in people with psychosis or predisposition
• For anybody, can cause fear, panic, confusion and potentially dangerous behavior
• Moderate elevations in pulse & blood pressure
• Headaches in day following use
• Persisting perceptual changes
• No addiction
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Safety Guidelines 2008• Assisted in the approval of
psychedelic studies by new scientists and universities
• Screening, preparation, monitoring, follow-up
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Mystical Experiences & Lasting Benefit 2006 & 2008• Safe in this structured setting• Among the 5 most meaningful life
experiences for majority of people• Improvements in mood and quality
of life >1 year after sessions
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Psilocybin Dose Effects 2011• Increasing psilocybin dose has an
orderly effect on mystical experience, challenging experience, and long term positive attribution
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Mystical Experience
• About 60% of participants in both studies met criteria for a “complete” mystical experience
• Unity• Noetic quality• Sacredness• Sense of transcending time and space• Positive mood• Ineffability
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Psilocybin Increases Openness 2011
• First experimental study to change a personality dimension
• Driven by mystical experience
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Driven by Mystical Experience
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Addiction Treatment• Classic psychedelics can be misused but are not addictive
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Krebs & Johansen (2012)Across studies, LSD nearly doubled the odds that
alcoholic patients would be improved at the 1st follow up (N=536)
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Smoking Cessation Pilot 2014
• Feasibility and safety
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Pilot Study Timeline
• 15 week protocol with weekly meetings• Cognitive behavioral therapy• 3 psilocybin sessions over 8 weeks (20-30 mg/70 kg)• 1st Psilocybin session on target quit date
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Success Rates Substantially Higher than Typical
(Hughes et., 2003; Jorenby et al., 2006; Sykes & Marks, 2001)
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Mystical Experience in Smoking Cessation 2015• Greater success in those who
had mystical experience• Mystical experience associated
with craving reduction
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Alcohol Dependence Pilot
• 10 alcohol-dependent participants
• Motivational Enhancement Therapy
• 2 sessions of .3 mg/kg and .4 mg/kg psilocybin
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Survey Study of Alcohol Cessation
• 343 people claiming to have quit or reduced smoking as the result of a psychedelic experience
• 83% no longer qualified as having a alcohol use disorder
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Randomized Comparative Efficacy Trial
• 80 treatment-resistant smokers• Randomized to psilocybin or nicotine patch• Same cognitive behavior therapy• 1 psilocybin session
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“Matt Johnson believes that psychedelics can be used to change all sorts of behaviors, not just addiction. The key, in his view, is their power to occasion a sufficiently dramatic experience to ‘dope-slap people out of their story...’ Psychedelics open a window of mental flexibility in which people can let go of the mental models we use to organize reality.’”
The Dope Slap Effect
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AcknowledgmentsRoland Griffiths, Ph.D.
Bill Richards, Ph.D.
Mary Cosimano, M.S.W.
Albert Garcia-Romeu, Ph.D.
Brian Richards, Psy.D.
Frederick Barrett, Ph.D.
Maggie Klinedinst
Robert Jesse
Annie Umbricht, M.D
Chad Reissig, Ph.D.
Peter Hendricks, Ph.D.
Katherine MacLean, Ph.D.
Haley Sweet
Samantha Gebhart
Toni White
Fred Reinholdt, M.A.
Leticia Nanda, N.P.
Eric Richter
Grant Glatfelter
Janna Bonesteel
Crystal Barnhouser
Theresa Carbonaro, Ph.D.
Patrick Johnson, Ph.D.
Jenna Cohen
Marylyn Clark
Daniel Emory
Eric Jackson
Heather Cronin
Una McCann, M.D.
Debbie Allan
Kim Nelson
T. Cody Swift, M.A.
Lilian Salinas
Laura Doyle
Nathan Sepeda
John Clifton
Nora Belblidia
Dan Evatt, Ph.D.
David Nichols, Ph.D.
Charles Nichols, Ph.D.
Tehseen Noorani, Ph.D.
FundingHeffter Research Institute
Beckley Foundation
Counsel on Spiritual Practices
Betsy Gordon Foundation
William Harrison
National Institute on Drug Abuse
https://hopkinspsychedelic.orgEmail: [email protected]
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Psychedelics in Addiction Treatment
Mary Cosimano, MSWBehavioral Pharmacology Research UnitDepartment of Psychiatry and Behavioral SciencesJohns Hopkins University School of Medicine
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Johns Hopkins Center for Psychedelic & Consciousness Research
Conducting Psychedelic-Assisted Treatment
Mary Cosimano, MSW Director of Clinical Services
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Are Psychedelic Drugs a Panacea?
• Smoking cessation, end-of-life, depression, beginner and long-term meditators
• Tom Insel former director of NIMH• Different symptoms - Same mental formations • Excess rigidity in brain• Destructive narratives• Psychedelics work on locked-in conditions
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The Role of the Guide
• Similar for all studies• Each participant assigned 2 guides• Preparation meetings• Psilocybin sessions • Integration meetings
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Preparatory Meetings
• 6 to 8 hours - few days to weeks• Developing trust and rapport • Session logistics• Managing high-dose psilocybin sessions• Set: participant’s internal mental state• Setting: external environment
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Volunteer on Value of Preparation
“Had it not been for the two experienced researchers in the room, I probably would have had a full- blown panic attack and lost the larger experience.”
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Psilocybin Session
⚫ 8 hour day – Lying on sofa – eyeshades - headphones
⚫ Relax and Let go - Expansion of Consciousness⚫ The onset of revelatory experiences seems to
correspond to my success in remaining relaxed.”⚫ Majority have Mystical Experience -
Interconnectedness⚫ Difficult experiences not uncommon⚫ Important and meaningful
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Integration Meetings
• Incorporate experiences into daily life• Key Component of Studies• Easy to dismiss• “Integration is weaving the mystical into the practical.”
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My Perspective as Guide
• Who am I? What is meaning of my life?• Our Connections – to everything – to life• Love is connection - relationships• Love: true nature, authentic self• Guide – exploration with participant• Each a unique exploration – same method
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Personal Belief
• I believe this exploration in combination with the psilocybin sessions and integration, is what leads to reconnection to our true, authentic self— and that helps to find meaning to our lives-
• THAT appears to me to be one of the main outcomes of our psilocybin studies.
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Volunteer Quote
• “My single strongest memory will be from the first session when I found myself chasing something that had been eluding me. When I caught it, I discovered that it was me. The subsequent embrace and rejoining seems to me to be the single most powerful event in my life. I feel whole for the first time and able to cope with anything. Apart, “I” was weak and directionless. Listless, really. But together, I’m strong, capable of anything, and just happier.”
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Tom “Comfortable and Cozy”
• 59 year old male
• Professional artist
• 41 years smoking a pack a day
• Multiple quit attempts
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Tom’s Reasons to Quit
• More energy• More money• More oxygen in his body• Sleep better• Procrastinate less – more productive
• Be healthier
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Tom’s Mantra
• “I am confident and content and free to be who I am.”
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Tom’s Reasons to Continue Smoking
• Great with coffee• Helped him get away from it all• Helped him focus. • Social aspects important, “It was a way of really bonding with
others – a communion with others.” • An integral part in Tom’s life.
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Tom’s First Session
“This is like being present where anything feels possible. I am comfortable to wait and see. I want to share this feeling of being held here, coddled and cozy, just simply being is so unique. It holds me without effort. I am so grateful to be here.”
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Tom’s Second Session
“It was one of exultation, fun, joy, and it was child-like. I was taken care of so I was able to expand and see with new eyes.”
“I was made comfortable and cozy, safe and secure.”
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Tom’s Third Session
“I felt comfortable and cozy physically, and confident and content mentally. To have both together is a sense of the eternal.”
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• Registered a “zero” on Cotinine and CO• who am I going to be in the next 30-40 years• So many possibilities as non-smoker
6 and 12 month follow –up and Beyond…
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Another Smoking Volunteer
• Felt hopeless she could quit smoking.• Felt trapped and unhappy in many areas of life.• Successfully quit smoking• Made major changes in her life• Realized smoking masked her depression
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6 month follow up report
• “I do feel like the study helped me remember who I was outside of what my life had become. I believe I was depressed, and that is the reason I went back to smoking in the first place. The study allowed me to look at the feelings of depression and process them instead of distracting myself from them by using nicotine.”
• She felt she had gotten her “old” (true) self” back.
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Johns Hopkins Session Room
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Study Team Funders
⚫ Roland R. Griffiths, Ph.D ⚫ Matthew W. Johnson, Ph.D⚫ Fred Barrett, Ph.D⚫ William A. Richards, Ph.D.⚫ Albert Garcia-Romeu, Ph.D.⚫ Natalie Gukasyan, M.D.⚫ Alan Davis Ph.D⚫ Annie Umbricht, M.D.⚫ Manoj Dos, Ph.D.⚫ Nathan Sepeda⚫ Nora Belblidia⚫ Ian Geithner⚫ Anna Stern⚫ Jessica Lombardi⚫ Brian Winston⚫ BPRU Faculty and Staff
Heffter Research InstituteCouncil on Spiritual PracticesRiverstyx FoundationBetsy Gordon FoundationBeckley FoundationFetzer InstiituteMcCormick FamilyTim FerrissMatt MullenwegCraig Nerenberg,Blake MycosjieStephen and Alexandra Cohen
FoundationNIDA