Billions of dollars have poured into potential drug treatments for cocaine addiction – mostly unsuccessful – as abuse of the drug climbs worldwide, but now researchers suggest psychedelics could be the answer, showing promise for treating post-traumatic stress disorder, depression, anxiety, alcohol use disorder, smoking and more, reports Science.
The results of a pioneering randomised trial, more than a decade in the making, reveal that a single dose of psilocybin, the psychedelic component of magic mushrooms, brought significant relief for people addicted to cocaine. The study of 40 people, described in JAMA Network Open, showed that 180 days after treatment, 30% of the psilocybin group was completely abstaining from cocaine, versus none of the placebo group – and those who continued using the drug did so less frequently.
“This is significantly better than any medication ever tested to treat cocaine use disorder,” said Stephen Ross, a Professor of Psychiatry at New York University who was not involved in the work. He called the results “remarkable,” and the magnitude of the effects “highly substantial”.
The study, funded by the University of Alabama at Birmingham (UAB) and the non-profit Heffter Research Institute, was also notable for its participant pool.
Of the 40 people who took part, more than 80% were black and 65% earned less than $20 000 a year.
“Although the study was small, one strength is that most participants had lower than average income and education, which are associated with barriers to addiction treatment,” said Nora Volkow, director of the National Institute on Drug Abuse, who was not involved in the trial.
More research will be needed to replicate the findings, she said, but the study provides evidence “that psilocybin has promise for treating addiction to cocaine and potentially other illicit stimulants”.
When UAB clinical psychologist Peter Hendricks launched the trial in 2015, he aimed to recruit a representative sample of people addicted to cocaine. People from lower income communities “bear the brunt of the mental health crisis”, he said, yet they are often left out of research on psychedelics.
A review he conducted of 98 psychedelic trial articles found that 93% of US participants were college educated, and most earned incomes well above the national median. “What happens when a psilocybin intervention is provided to someone who has a demanding, difficult and chaotic life?” he asks.
The answer was slow in coming because of scarce funding and the disruption of the Covid-19 pandemic.
Finding participants who met the study criteria was also a challenge.
The researchers had to exclude many of the 910 people they screened because they did not live in the area, did not qualify as having cocaine use disorder, were dependent on other drugs besides cocaine, had medical issues, or did not show up for their first appointment.
The 40 people who enrolled reported using cocaine, on average, every other day. All received four or five sessions of cognitive behavioural therapy, a recommended non-drug treatment for cocaine use disorder.
Before any participants took psilocybin, all were instructed on what to expect from the trip and how to deal with challenging moments.
Half then received the hallucinogen and half received an active placebo, diphenhydramine, an antihistamine that at high doses has some mind-altering effects, including sedation and cognitive slowing.
Most in the psilocybin group were able to correctly guess what they received, and there were no serious adverse events. All participants also had five additional psychotherapy sessions to help translate any insights from their experience into behaviour changes.
The researchers followed up with participants 90 and 180 days after treatment. At the 180-day mark, six people reported having given up cocaine entirely and had no traces of the drug in their urine; all had received psilocybin.
On average, those in the psilocybin group reported using cocaine 1.5 times a month compared with 12 times a month in the placebo group. “Even if we’re not considering complete abstinence, we’re still seeing far less use,” Hendricks said.
“These very promising preliminary results should be replicated in larger, multisite trials,” said Kathleen Brady, a psychiatrist at the Medical University of South Carolina who was not involved in the trial.
Hendricks said he was applying for funding and searching for an industry partner to begin that work.
Study details
Psilocybin in the treatment of cocaine use disorder: a randomised clinical trial
Peter Hendricks, Sara Lappan, Richard Shelton et al.
Published in JAMA Network on 7 May 2026
Abstract
Importance
Cocaine use disorder is a serious public health problem and no medications have been proven effective for its treatment.
Objective
To evaluate psilocybin in the treatment of cocaine use disorder. It was hypothesised that psilocybin, compared with placebo, would yield a higher percentage of cocaine abstinent days, a greater likelihood of complete abstinence from cocaine, and a greater latency to first cocaine lapse through 180 days after end of treatment.
Design, Setting, and Participants
Randomised, quadruple-blind, placebo-controlled clinical trial at a major medical research centre in the Deep South of the US. Participants were individuals with cocaine use disorder who were motivated to quit and without significant comorbidities, recruited between May 2015 and August 2023 with data collection completed in May 2024.
Interventions
Participants were randomised (1:1) to receive a single oral dose of psilocybin (25 mg per 70 kg of body weight) or active placebo (100 mg diphenhydramine). All participants received manualised psychotherapy that incorporated cognitive-behavioural treatment approximately 1 month before and 1 month after an all-day investigational drug treatment session.
Main Outcomes and Measures
Percentage of cocaine abstinent days, rates of complete cocaine abstinence, and time to first cocaine lapse through 180 days after end of treatment, assessed by timeline follow-back interview and confirmed with urinalysis. Hypotheses were formulated before data collection and analyses followed intention-to-treat principles.
Results
Of the 40 participants, 33 (82.5%) were men, the median (IQR) age was 50.0 (43.8-56.0) years, 33 (82.5%) were black, and 7 (17.5%) were White. Most participants had lower socioeconomic status, with 26 participants (65%) having an annual income of $20 000 or less. Four participants were lost to follow-up, resulting in 36 participants who completed assessments through 180 days after end of treatment. Psilocybin recipients had a higher percentage of cocaine abstinent days (β = 28.95; 95% CI, 18.22-39.67; P < .001), greater likelihood of complete cocaine abstinence (odds ratio, 18.37; 95% CI, 1.92-2468.17; P = .007), and a reduced risk of cocaine lapse over time (hazard ratio, 0.28; 95% CI, 0.13-0.60; P = .001) than active placebo recipients. No serious adverse events occurred.
Conclusions and Relevance
In this randomised clinical trial, psilocybin appeared to be safe and efficacious for treating cocaine use disorder among individuals from under represented and vulnerable populations. Further research is warranted to replicate and expand these findings.
JAMA Network article – Psilocybin in the Treatment of Cocaine Use Disorder (Open access)
Science article – Magic mushroom compound shows promise against cocaine addiction (Open access)
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Alcohol addiction cut by 83% after psilocybin therapy – NYU study
Research probes ‘magic’ mushrooms to treat depression, addiction and PTSD