By: Maximilian Magun, PharmD Candidate c/o 2016
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While the harm in smoking is well known, quitting is easier said than done. Prescription and over-the counter nicotine replacement therapies (e.g. nicotine patch, gum, inhaler, nasal spray, lozenge), as well as oral tablets (e.g. Zyban™, Chantix®) have mediated success for some. In fact, when used correctly, these products can increase the rate of quitting by 50 to 70%.1 However, with the long-term consequences of smoking continuously surfacing, increased efforts are being made to help more smokers reach their goals. Psilocybin, the active chemical in “magic mushrooms,” has been studied in the context of smoking cessation, and has shown promising results.
Psilocybin is a psychoactive alkaloid that is present in more than 180 species of mushrooms. In the body, psilocybin is dephosphorylated to psilocin, a nonselective serotonin (5-HT) agonist with high affinity towards the 5-HT2A receptor.2 As a result, psilocin induces alterations in mood and thinking, and may cause hallucinations, delusions, and paranoid ideations. Medium doses of about 12-20 mg show a controllable altered state of consciousness that lasts three to six hours.2 However, psilocybin is classified as a Schedule I drug, which means that it has a high abuse potential, no current medical use, and cannot be prescribed even under medical supervision.3
Researchers at the Johns Hopkins Department of Psychiatry and Behavioral Sciences conducted a study on the effects of psilocybin and its potential as a smoking cessation aid. Psilocybin was administered as part of the comprehensive cognitive behavioral therapy smoking cessation program. This program involved weekly counseling sessions that addressed quitting techniques, such as keeping a diary of when cravings occur. Patients included in the study were ages 21 to 65 and had no demonstrated history of psychiatric disorders or recent history of alcohol or drug abuse.4 This fifteen week pilot study consisted of 15 individuals (ten males) with an average age of 51, average cigarette intake of 19 per day, average smoking years of 31 years, and an average of six previous failed quitting attempts. A moderate (20 mg) dose of psilocybin was administered to study subjects in the form of an oral capsule on the day that each participant wanted to quit smoking, followed by two subsequent higher (30 mg) doses two weeks and eight weeks from that first date.5 Subjects were observed for six hours post-dose and given eyeshades and headphones to help them relax from the psychogenic effects of the drug. After a six-month follow up of the study, 12 of the 15 subjects showed abstinence from smoking.6
Due to the modest sample size, further trials are needed to prove the effectiveness of psilocybin therapy in smoking cessation. The usefulness of this approach may be limited by drug schedule, side effects, and time requirements (e.g. multiple hours at administration sites); however, with multiple failures of other therapies, novel therapies encourage the use of risk vs. benefit analysis to identify the next possible treatment option in smoking cessation.
SOURCES:
- Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2012;11:CD000146.
- Passie T, Seifert J, Schneider U, Emrich H. Pharmacology of psilocybin. Addiction Biology. 2002;7:357–64.
- Psilocybin. PubChem. 2015. Available at: http://pubchem.ncbi.nlm.nih.gov/compound/Psilocybin#section=Top. Accessed February 8, 2015.
- Smoking. Johns Hopkins Bayview Medical Center. Available at: http://www.hopkinsmedicine.org/johns_hopkins_bayview/research_clinical_trials /clinical_trials/smoking.html. Accessed February 8, 2015.
- Johnson M, Garcia-Romeu A, Cosimano M, Griffiths R. Pilot study of the HT2AR agonist psilocybin in the treatment of tobacco addiction. J Psychopharmacol. Sept 2014;28(11):983-92.
- Magic mushrooms could help smokers quit. 2015. Available at: http://www.cbsnews.com/news/magic-mushrooms-could-help-smokers-quit-the-habit/. Accessed February 8, 2015.
[pubmed_related keyword1=”nicotine” keyword2=”psilocybin” keyword3=”smoking”]
