Psilocybin Shows Growing Potential for Smoking Cessation

Quitting smoking is hard, and anything that might help should be thoroughly explored, particularly when we know different options work for different people. Psilocybin, the naturally occurring psychedelic compound found in over 200 species of “magic mushrooms,” firmly belongs on the list, having shown promise for various substance use disorders. 

A single psilocybin dose combined with cognitive behavioral therapy (CBT) was more effective for quitting than the nicotine patch paired with CBT, found a recent study by researchers at Johns Hopkins University School of Medicine and the University of Alabama at Birmingham.

Psilocybin acts on serotonin receptors and can alter perception, mood and thought. What exactly is behind its demonstrated potential for smoking cessation? 

“We don’t know for sure, and it is not likely one mechanism,” Dr. Matthew Johnson, one of the study authors, told Filter. “It most likely is an increase in mental flexibility and learning, combined with a perspective-shifting subjective experience.” 

At six-month follow-up, 40.5 percent in the psilocybin cohort were abstinent compared with just 10 percent in the nicotine patch cohort.

The 82 study participants, aged 21 to 80, were people who smoked daily and had more than one previous unsuccessful quit attempt. All received 13 weeks of CBT that included keeping a daily smoking diary, listing reasons for quitting versus continuing to smoke, exploring health and financial drawbacks of smoking, and developing strategies to manage cravings and withdrawal. 

The trial randomized participants to additionally receive either one 30 mg dose of psilocybin or a nicotine patch. The participants in the psilocybin group received education regarding the effects of the drug, and the protocol for its administration involved laying on a couch wearing eyeshades while listening to music through headphones. 

On the day after the target quit date, 38 psilocybin participants (90.5 percent) and 32 nicotine patch participants (80 percent) self-reported achieving 24 hours of abstinence from smoking. At six-month follow-up, 17 participants (40.5 percent) in the psilocybin cohort were abstinent compared with just four participants (10 percent) in the nicotine patch cohort. No serious adverse events were reported in either group.  

The researchers wrote, “The results of this study add to the increasing evidence that psychedelic treatment may have general anti-addiction efficacy across various addictive drugs,” the researchers wrote, “[… and] suggest that psilocybin holds potential in the treatment of tobacco use disorder and, along with other psychedelics, should be investigated further for tobacco and other substance use disorders.”

There were significant limitations to the study, including a glaring lack of racial diversity among participants: Just 3.7 percent were Black and none were Indigenous, while 89 percent were white. Study participants had to be “psychiatrically healthy,” so people with schizophrenia, depression or bipolar disorder were excluded. People with a recent substance use disorder or a positive drug screen were also ineligible.  

Black and Indigenous people, people with mental health diagnoses and people who use (other) drugs are all among those most vulnerable to smoking-related harms! It is vital—especially when the study concludes that various psychedelics should be further investigated for substance use disorder—that future research is designed to represent these populations and allow diverse cohorts to benefit from trials. Failure to do so would be research malpractice.

And why use nicotine patches in the study, when decades of research has demonstrated low rates of efficacy? “There are more studies for the patch, it is FDA-approved for smoking cessation, and there is no variability across products,” Johnson said.  

Perhaps a better comparator would have been vapes; a growing number are FDA-authorized, and vapes in general have proved more effective than Nicotine Replacement Therapy.

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