With the increasing recognition of psychedelics as therapeutics, many substance use recovery providers are questioning if and when they should incorporate psychedelic therapy into clinical practice.
As with most aspects of behavioral health treatment, there is no one-size-fits-all answer to this question. But in reviewing the current research on psychedelic therapy for cocaine and opioid addiction treatment, one compound shows incredible promise—psychoactive alkaloids.
Like many other “plant medicines,” psychoactive alkaloids have a long history of use in traditional cultures. However, they have only relatively recently gained the attention of western researchers. To help you decide where they might fit into your practice, we’ll cover all the important information you need to know about this exciting new treatment, starting with an overview of what psychoactive alkaloids are.
What Are Psychoactive Alkaloids?
Psychoactive alkaloids are a group of compounds found in the roots of a mid-sized shrub from West Africa. Members of the Bwiti religion in Gabon, Zaire, and Cameroon have used preparations of these roots for centuries, for a variety of ceremonial and medicinal practices.
While psychoactive alkaloids appear to impact several physical and neurological systems in the body, their main effect is inducing a hallucinogenic state that’s described by many treatment participants as “lucid dreaming”. After consuming psychoactive alkaloids, people often report lengthy and vividly realistic replays of early childhood experiences and important life events.
While the experience itself is rarely described as pleasant, a surprisingly large proportion of people who undertake therapy with psychoactive alkaloids find the treatment very effective for cocaine and opioid addiction. Interestingly, the compounds seem to be beneficial for addiction on several different physical and psychological levels, leading to it being labeled an “anti-addictive drug” by addiction researchers.
How Can They Help with Cocaine and Opioid Addiction?
While the effects of psychoactive alkaloids are still being studied, a collection of survey reports and open-label clinical trials suggests they can benefit cocaine and opioid addiction in a variety of ways. We’ll cover the main findings from the research below.
Shortens Withdrawal Period
A 2018 paper on psychoactive alkaloid-assisted detoxification found that a single-dose treatment significantly decreased opioid withdrawal symptoms in test subjects (191 volunteers). Withdrawal symptoms were measured in study participants at 2 hours before psychoactive alkaloid treatment to establish a baseline, then at regular intervals over the following 72 hours.
Researchers noted that psychoactive alkaloids “brings about a rapid detoxification from heroin and methadone”. Physician-measured withdrawal symptom scores in patients were substantially lower at 36 hours post-treatment than at the 2-hour baseline period, with sustained improvements still noticeable at 72 hours. For reference, opioid withdrawal usually peaks in intensity at 24-48 hours, with acute symptoms lasting for 7-10 days.
Through bypassing the acute withdrawal stage, patients administered psychoactive alkaloids can avoid this incredibly unpleasant and high-risk withdrawal period in detoxification, which so often results in relapse or failed treatment.
A 12-month observational study from 2017 followed 15 people as they received psychoactive alkaloid treatment for opioid addiction in New Zealand. In addition to noting a similar reduction in withdrawal symptoms to the aforementioned study, most participants also reported a “sustained reduction in drug craving/use and cessation of use in some cases.”
Induces Desire to Stop Using
Many patients who receive addiction therapy using psychoactive alkaloids report a strong and sudden desire to stop using opioids completely. This appears to be partly tied up in the “transformative states,” or “mystical experiences” participants have while in a hallucinogenic state. Some report a “perspective shift,” where they more clearly see and understand their drug use, but it is likely the markedly reduced withdrawal symptoms and cravings also play a role.
Whatever the cause, the desire to stop using drugs is common in patients treated with psychoactive alkaloids. Out of 88 patients addicted to opioids who were surveyed after treatment:
- 30% never used opioids again following treatment
- 54% abstained for at least one year
- 31% were abstinent for at least two years
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Rewires Addiction Brain Circuitry
Addiction leads to substantial changes in neurological reward pathways among people using opioids and cocaine. And while extended periods of abstinence can gradually reset these disruptions to a more normal state, many people relapse before full recovery can occur.
While the exact mechanisms are still being studied, psychoactive alkaloids are thought to positively impact addiction receptor sites and transporter proteins in the brain. Research suggests that psychoactive alkaloids “cause a rapid reset of mu opioid expressing neurons in the reward-aversion centers of the brain.”
Helps to Process Trauma
Military personnel are at especially high risk of experiencing PTSD and trauma-related mental health concerns. With several experts expressing concern about a “crisis” in the availability of effective therapies for those suffering from PTSD, attention has turned to psychoactive alkaloids as a potential solution.
A 2020 research paper that surveyed 51 U.S. veterans who had undertaken psychoactive alkaloid treatment, noted significant reductions in almost all domains measured related to PTSD symptoms and other related mental health concerns. These improvements were found to be long-lasting, with over 80% of participants reporting that psychoactive alkaloid treatment was one of the most personally meaningful, spiritually significant, and psychologically insightful experiences of their lives.
Relieves Depression and Anxiety Symptoms
Post-acute withdrawal syndrome, also known as PAWS, is a set of impairments that can persist for weeks or months after a person is abstinent from opioid and cocaine use. It is characterized by symptoms of depression and anxiety, which can often be severe. Many people in substance use recovery find PAWS incredibly challenging to manage and it is often associated with relapse.
All the studies mentioned thus far found statistically significant improvements in depression and anxiety symptoms among study participants. Researchers hypothesize that this relief of the troubling symptoms that so often drive drug use may be part of the key to the efficacy of psychoactive alkaloids in treating addiction.
Safety Concerns of Psychoactive Alkaloids
Despite its many potential benefits, substance use recovery treatment with psychoactive alkaloids carries significant risks. The most pressing concern is cardiotoxicity, which has been fatal among several test subjects.
To mitigate the risks, pharmaceutical companies are ardently working to isolate certain compounds from the roots used in psychoactive alkaloid treatment. The hope is that in time, people struggling with addiction will have access to a standardized treatment that still offers the same clinical benefits as addiction treatment, without the substantial safety risks.
Psychoactive alkaloids are currently classified as Schedule 1 controlled substances under federal law in the United States. This means it is not legally approved for any addiction treatment or other therapeutic use.
In light of its legal status, most people who access psychoactive alkaloid treatment travel overseas to a country where it can be legally administered under medical supervision.
Several psychoactive alkaloid clinical trials are currently underway in the United States and abroad, but it’s likely to still be some time before an FDA-approved treatment is available.
Which Clients Might Benefit from Treatment
Most patients that decide to try psychoactive alkaloid treatment do so after exhausting all available conventional treatments for addiction with no success. In light of the safety risks and legal implications, this seems like a wise choice.
Should you have a patient expressing interest in psychoactive alkaloid treatment, you may wish to educate them about the potential risks. If they remain adamant about obtaining treatment, it could be prudent to recommend they consider a reputable facility where treatment is provided under full medical supervision.
Like all medication-assisted substance use treatment, aftercare is a key component of psychoactive alkaloid treatment. Even if your patient travels overseas for therapy, they will still benefit from your ongoing care and management according to traditional evidence-based substance use recovery guidelines.
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