6.2.1 Addictive and “abuse potential”
Concerns about the addictive potential (development of hallucinogen use
disorder [HUD]) or “abuse potential” of psychedelics have been
raised as a common argument against the investigation of psychedelics
for SUDs, since their historic scheduling as a Schedule I controlled
substances (i.e., high potential for abuse and no currently accepted
medical use). Still, the evidence to support the addictive potential of
psychedelics is scant. Current FDA guidance for psychedelic trials
outlines guidance for the assessment of this risk.117National Survey on Drug Use and Health (NSDUH) data reports the rates of
HUD criteria by DSM-IV criteria very low amongst respondents that have
used a hallucinogen (less than <1% for both meeting criteria
for “abuse” and dependence). Other data from the NSDUH concerning
serotonergic psychedelics specifically, commonly reports that past use
of these compounds is associated with lower rates of certain SUDs
(specifically meeting OUD criteria in some studies),94as do other studies of naturalistic psychedelic use reporting a decrease
in the use of multiple substances including opioids.93In addition, some of the recent trials investigating psilocybin for MDD
that have included longer term follow-up have noted no reported
additional psilocybin use up to 12 months after the trial amongst
participants.141 Overall, only more data in study
participants with co-occurring SUDs and/or chronic pain conditions and
further, more specific FDA guidance around psychedelic studies will
determine best practices for study design and risk assessment around the
serotonergic psychedelics. Detailed discussions and considerations
around assessing the abuse potential of psychedelics and their current
drug scheduling have been reviewed in detail here.142