psychedelics for addiction

“The first major impact of a psychedelic experience in the 20th century in relation to addiction was that of Bill Wilson, the founder of Alcoholics Anonymous. He had an atropine-induced revelatory experience that he described as follows: “Suddenly the room lit up with a great white light. I was caught up in an ecstasy which there are no words to describe. It seemed to me in my mind's eye, that I was on a mountain and that a wind not of air but of spirit was blowing. And then it burst upon me that I was a free man.” Bill's psychedelic spiritual experience changed his life—through it he felt he was able to escape from the shackles of alcohol dependence, becoming permanently abstinent (for more details on the history of psychedelics, see Nutt, 2023).”

A Perspective on Psychedelics as Treatments for Addictions by Nutt et al in the Journal of Studies on Alcohol and Drugs, March 2024
https://www.jsad.com/doi/full/10.15288/jsad.23-00032

Psychedelics, including more broadly, MDMA and ketamine, along with the classical psychedelics like LSD and psilocybin/psilocin, are being studied more and more as treatments for substance use disorders (ie, addictions). More studies means more data in support of their use, and already we are seeing such clinical trials demonstrating hopeful effects of ketamine on treatmnet of alcohol use disorder, opioid use disorder, cocaine use disorder, and cannabis use disorder. Use in these indications are still being studied, and it’s unclear how ketamine would be marketed given it’s a generic drug and being used off label. The limited data we have on the FDA approved ketamine product (esketamine nasal spray, AKA Spravato), suggests it is less effective than generic racemic ketamine, at least for treatment of depression. It is certainly much more expensive ($600-900 instead of $2-3). It is possible that a company will try to gain FDA approval for one of these indications, but then they would risk clinicians simply using generic ketamine off label, bypassing their formulation, and decreasing their profit potential. It makes me wonder if any company will actually invest in the work to carry out FDA trials for this.