Psychedelic Therapy for Substance Use Disorders: Neurobiology, Evidence Base, Regulatory Considerations, and Unintended Consequences
Chairperson: Stephen Ross, MD, Professor of Psychiatry and Child & Adolescent Psychiatry, NYU Grossman School of Medicine
Presenters: Bertha Madras, PhD, Professor of Psychobiology, Harvard Medical School, based at McLean Hospital and cross-appointed at Massachusetts General Hospital; and Jack Henningfield, PhD, Vice President, Pinney Associates
Promising early-phase clinical research with classic or serotonergic psychedelics (e.g. 5HT2a agonists) was conducted from the late 1950s through the mid-1970s in the US and Europe on over 40,000 research participants, mostly with LSD and to a much lesser degree psilocybin, yielding over a thousand scientific papers. However, following the initial promise and then hype associated with psychedelic therapy, and in reaction to public health concerns about an increase in recreational use and associated harmful effects (i.e. psychosis, reckless behavior), the US began to restrict the use of psilocybin, LSD, and all serotonergic psychedelics by the general public starting in the mid-1960s. Further backlash occurred against psychedelics from organized psychiatry and government culminating in the enactment of the federal Controlled Substance Act in 1970 that classified all serotonergic psychedelics in the most restrictive category as DEA schedule I drugs, defined as high addictive liability and no known medical utility. Due to stigma and legal restrictions, federal funding ended for clinical research with psychedelics. Following this, clinical researchers working in this area had to abandon their programs of research. The research was halted before any definitive conclusions could be reached concerning the safety and clinical efficacy of psychedelic therapy for any psychiatric disorder. However, clinical research conducted in that era, in addition to establishing a favorable safety profile, suggested therapeutic signals of psychedelic-assisted psychotherapy with the most robust data in treating alcohol use disorder, followed by psychiatric and existential distress (and pain) associated with end-of-life cancer.
Learning Objectives
- Participants will be able to understand the current evidence base, regarding safety and efficacy, and gaps in the evidence base of psychedelic therapy for substance use disorders.
- Participants will be able to understand the basic neurobiology of action of the serotonergic psychedelics.
- Participants will be able to understand the regulatory pathway regarding drug development and implementation of psychedelic therapy for SUDs as well as unintended consequences for the general public of this approach.
Contingency Management: Implementation of a Highly Effective Intervention for the Treatment of Stimulant Use Disorder
Chairperson: Larissa Mooney, MD, Professor of Clinical Psychiatry and Director of the Addiction Psychiatry Division in the Department of Psychiatry and Biobehavioral Sciences at UCLA
Presenters: Richard Rawson, PhD, Research Professor, Vermont Center for Behavior and Health at the University of Vermont, Professor Emeritus, UCLA Department of Psychiatry; Larissa Mooney, MD, Professor of Clinical Psychiatry and Director of the Addiction Psychiatry Division in the Department of Psychiatry and Biobehavioral Sciences at UCLA; Thomas Freese, PhD, Director, UCLA Integrated Substance Abuse Programs (ISAP), Adjunct Professor, Department of Psychiatry, UCLA; and Michael McDonell, PhD, Professor, Department of Community and Behavioral Health in the Elson S. Floyd College of Medicine at Washington State University, Director, Promoting Research Initiatives in Substance Use and Mental Health (PRISM) Collaborative
Discussant: Richard Rawson, PhD, Research Professor, Vermont Center for Behavior and Health at the University of Vermont, Professor Emeritus, UCLA Department of Psychiatry
Moderator: Larissa Mooney, MD, Professor of Clinical Psychiatry and Director of the Addiction Psychiatry Division in the Department of Psychiatry and Biobehavioral Sciences at UCLA
Recent evidence indicates that methamphetamine and cocaine play a substantial and increasing role in the illicit drug crisis in the US—the 4th wave of the overdose crisis. The behavioral treatment known as contingency management (CM) has more than three decades of robust research supporting its efficacy for individuals with stimulant use disorder (StUD). Despite overwhelming evidence supporting CM, it has not been widely used in routine treatment outside the VA healthcare system. This situation is changing as states are arranging funding for CM and developing CM programming for individuals with StUD.
Learning Objectives
- Review the evidence for contingency management for stimulant use disorder and other substance use disorders, including as an adjunct to pharmacotherapy for SUD.
- Identify three barriers to widespread implementation of contingency management, and solutions to address these barriers.
- Identify policy implications from early implementation findings in California, Montana, and Washington that support continued expansion and reimbursement for contingency management.
Addressing the Emerging Drug Threat of Fentanyl Adulterated or Associated with Xylazine via Harm Reduction and Clinical
Chairperson: Adam Gordon, MD, MPH, Director, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Director, Vulnerable Veteran Innovative Patient-Aligned-Care-Team (VIP) Initiative
Presenters: Joseph Liberto, MD, National Mental Health Director, Substance Use Disorders, Department of Veterans Affairs; Adam Gordon, MD, MPH, Director, Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Director, Vulnerable Veteran Innovative Patient-Aligned-Care-Team (VIP) Initiative; Elizabeth Oliva, PhD, Senior Evaluator, VA Program Evaluation and Resource Center, Investigator, VA Center for Innovation to Implementation at the VA Palo Alto Health Care System; and Grant Baldwin, PhD, MPH, Director, Division of Overdose Prevention, CDC – National Center for Injury Prevention and Control
The US continues to be mired in an evolving opioid use disorder (OUD) and substance use disorder (SUD) epidemic. To confront the ongoing epidemic and emerging threats, the 2022 US National Drug Control Strategy (NDCS) was the first to include harm reduction interventions (e.g., naloxone distribution, drug test strips, syringe services programs). In 2023, the US declared illicit fentanyl, adulterated or associated with xylazine, as an emerging threat. Further, NDCS released a National Response Plan naming the Department of Veterans Affairs (VA) to address (1) evidence-based testing strategies; (2) evidence-based prevention, harm reduction, and treatment interventions; and (3) evaluation and research. The VA has responded to these calls by enhancing its harm reduction interventions by infusing them in not only SUD specialty care services but throughout its clinical environments (including outpatient mental health, primary care, and pain clinic settings). Further, it has adapted its treatment paradigms to confront illicit fentanyl and its adulterants (xylazine) in both SUD specialty care and non-SUD health care settings.
Learning Objectives
- At the end of this presentation, the audience will be able to describe epidemiological trends in fentanyl and xylazine in the United States, clinical considerations for addressing fentanyl and xylazine in clinical practice, and critical clinical and research gaps.
- At the end of the presentation, the audience will be able to discuss elements of harm reduction, the importance of incorporating harm reduction into their clinical practice, and resources to support harm reduction uptake.
- At the end of the presentation, the audience will be able to describe innovative and effective SUD prevention, harm reduction, and treatment within and outside of SUD specialty care clinical environments.
New Horizons in Addiction and the Law
Chairperson: Laurence Westreich, MD, Associate Professor of Clinical Psychiatry, Division of Alcoholism and Drug Abuse, Department of Psychiatry, New York University School of Medicine
Presenters: Elie Aoun, MD, Assistant Professor of Clinical Psychiatry, Columbia University; Debra Pinals, MD, Senior Medical and Forensic Advisor, National Association of State Mental Health Program Directors; and Laurence Westreich, MD, Associate Professor of Clinical Psychiatry, Division of Alcoholism and Drug Abuse, Department of Psychiatry, New York University School of Medicine
This submission is based on a book under contract to the American Psychiatric Association Publishing Company, tentatively titled “Addiction and the Law” This session will review important issues affecting persons with Substance Use Disorders (SUDs) in their interactions with the Legal System. Drs. Aoun, Pinals, and Westreich will address cutting edge matters relevant to the vast majority of persons with SUDs, and the clinicians who treat them. Over the past several years, the practice of addiction psychiatry and addiction medicine have received increased attention because of an improving awareness of the dual diagnoses of SUD and co-occurring mental illnesses, and because of the recent U.S. opioid crisis. Moreover, medical practices are, of necessity, expanding to incorporate substance use treatment as part of mainstream clinical care. Anyone who works with people with substance use disorders (SUDs) knows that there are innumerable interfaces between SUDs and the law. Individuals with SUDs may find themselves facing legal issues- whether through arrest, incarceration, DUIs, child custody disputes, employment issues, or court-ordered drug testing, administrative, regulatory and legal systems often have a critical role in how substance problems are addressed, and the result is often quite difficult given the awkward fit between current scientific and medical views and the black and white provisions of often outdated laws. Only by understanding the basics of both SUDs and governing laws can the practitioner navigate both systems in a manner that is both evidence-informed and relevant to the matter at hand.
Learning Objectives
- Attendees will understand the importance of both criminal and civil law to the lives of their patients diagnosed with Substance Use Disorders.
- Attendees will be able to discuss the legal system’s pervasive use of various and disparate rubrics for SUDS: brain disorder, moral failing, and iatrogenic affliction, amongst others.
- Attendees will appreciate the legal aspects of SUDs for pregnant women and families undergoing divorce proceedings.
Mini-Symposium: What’s Your Kryptonite: How to Boost Your Super Powers
The Mini-Symposium will last 60 minutes each and will be held in the Main Ballroom. This session is added to highlight more of the latest scientific evidence and innovations for substance use disorders treatment.
Chairperson: Kathryn Cates-Wessel, Chief Executive Officer, American Academy of Addiction Psychiatry
Presenters: Frances Levin, MD, Kennedy-Leavy Professor of Psychiatry at Columbia University and Chief of the Division on Substance Use Disorders at the New York State Psychiatric Institute; Kevin Sevarino, MD, PhD, Associate Clinical Professor, Yale University School of Medicine; and Ayana Jordan, MD, PhD, Associate Professor of Psychiatry, NYU Grossman School of Medicine
The American Academy of Addiction Psychiatry (AAAP) is the lead organization of three training cooperative agreements and grants funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). Initiatives include the Providers Clinical Support System for Opioid Use Disorder (PCSS-MOUD) with 23 partner organizations and steering committee members, the Opioid Response Network (ORN) has 46 partner organizations covering prevention, treatment, recovery and harm reduction, collectively representing over 2 million constituents and Racial and Ethnic Approaches to Community Health (REACH), which supports under-resourced and marginalized prescribers to become addiction specialists. PCSS-MOUD’s primary goal is to provide evidence-based practices to improve healthcare and outcomes in the prevention of those at risk and treatment for individuals with an opioid use disorder (OUD), as well as co-occurring stimulant use disorders. The ORN grant focuses on local implementation, providing training and education in evidence-based practices in the prevention, treatment, recovery and harm reduction of opioid and stimulant use disorders with local ORN consultants in every U.S. state and territories to meet locally identified needs. The REACH grant has an overall goal of enabling training of racial and ethnic minoritized addiction specialists in the Addiction Psychiatry and Addiction Medicine workforce, to increase the number of addiction specialists adequately trained to work with racial and ethnic minoritized patients with substance use disorders. These programs promote the education and training of health professionals leading to improved outcomes of those with substance use disorders. This session will focus on how to best utilize and participate in these initiatives.
Learning Objectives
- Gain an awareness of these resources and opportunities to get involved as an addiction psychiatrist nationwide and locally.
- Define repository of resources and support available to participants to support their clinical work and those they train..
- Identify ways to get involved as an addiction psychiatrist to help expand and diversify the workforce but support and extend primary care providers in your community. Opportunities for working collaboratively with other disciplines in the field and building collaboration.
