Background & Aims
Chronic pain affects more than 1.5 billion individuals and is the leading cause of disability and disease burden globally1. Substance use disorders are often co-morbid with chronic pain, complicating treatment2. Despite advances in the understanding of chronic pain and new pharmacotherapies, effective treatments are lacking3. Psychedelic drugs (e.g., psilocybin), which cause acute alterations in mood, cognition and affect, have shown potential for treating mood and substance use disorders, and chronic pain conditions4. Changing public narratives and decriminalization efforts have contributed to a steady increase in naturalistic psychedelic use across the globe5. However, little is known about how naturalistic psychedelic use affects substance use or health outcomes of individuals with chronic pain. The aim of this study was to assess changes in substance use and perceived effectiveness of psychedelics among a population around the world who use psychedelics and have chronic pain.
Methods
We administered an anonymous online global survey between May 19 and June 2, 2023 to gather data on perceptions and outcomes of psychedelics among English-speaking adults who reported past use of a psychedelic. In this analysis, we report on the subset of individuals (n=466/5,268) who reported using psychedelics to treat a chronic pain condition. We asked participants if their use of psychedelics affected their pain and resulted in changed use patterns of any of the following 9 non-psychedelic substances: alcohol, cannabis, tobacco, antidepressants, benzodiazepines, amphetamines, cocaine/crack, prescription opioids, or illicit opioids. We also assessed demographic characteristics, details about reported changed substance use patterns, perceived health outcomes, and predictive factors associated with either decreased or increased substance use via binary logistic regression.
Results
Among 466 participants (44.8% women), 78.8% indicated that psychedelics reduced pain, and 97.2% reported changed patterns of substance use as a result of using psychedelics. Of these, 86.3% reported ceasing or decreasing use of one or more substances following psychedelic use. The highest proportions of ceased/decreased use were with alcohol (71.1%), prescription opioids (64.1%), and anti-depressants (63.1%). The highest proportions of increased/initiated use were with illicit opioids (27.8%), cannabis (21.5%), and amphetamines (21.4%). Among those reporting ceased or decreased substance use, 21.2% indicated that the decrease lasted for >6 months. Common explanations for reduced substance use included feelings of connectedness toward self, others, spirit, and nature, and a reduction in anxious or depressive feelings. Finally, using psychedelics with a motivation to reduce substance use was positively associated with ceased or decreased substance use.
Conclusions
This work is among the most largest studies to date that have investigated outcomes of naturalistic psychedelic use among individuals with chronic pain. Although limited by cross-sectional study design, these results support future investigation into the potential of psychedelics to treat symptoms of chronic pain and associated substance use patterns. Additionally, by assessing naturalistic use, this work avoids some of the challenges associated with psychedelic clinical trial methodology, offering an ecologically relevant perspective of psychedelic use. Future observational and clinical studies are warranted to develop a more nuanced understanding of the safety, efficacy, and tolerability of psychedelics for individuals with chronic pain conditions.
References
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7. Griffiths, R. R. et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol 30, 1181–1197 (2016).
8. Raison, C. L. et al. Single-Dose Psilocybin Treatment for Major Depressive Disorder. JAMA 330, 843–853 (2023).
9. Bogenschutz, M. P. et al. Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder. Jama Psychiat 79, 953–962 (2022).
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Presenting Author
Nicolas G. Glynos
Poster Authors
Nicolas Glynos, PhD
PhD
University of Michigan
Lead Author
Anne Baker
PhD
University of Michigan
Lead Author
Jacob Aday
PhD
University of Michigan
Lead Author
Stephanie Lake
PhD
UCLA
Lead Author
Philippe Lucas
PhD
Sabi Mind
Lead Author
Kevin Boehnke
PhD
University of Michigan
Lead Author
Topics
- Treatment/Management: Complementary and Alternative therapies