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