When Peter Loeb co-founded Lionrock Recovery in 2010, the business of treating substance use disorders (SUDs) was very different.
SUDs were stigmatized as taboo addictions, drug laws were stricter and models like Lion Rock charging clients for telehealth visits had not started. At the same time, there were fewer acute problems around SUDs – the number of annual fatal overdoses in the U.S. has soared over 300% since 2010, largely due to opioid misuse, according to the CDC.
Additionally, more than 46 million Americans 12 or older meet the applicable criteria for having an SUD, according to the U.S. Department of Health and Human Services.
The destigmatizing of some treatment practices combined with increased alarm over SUDs have ushered in a new era “where the discussion of treatments is different,” Loeb told Addiction Treatment Business. Once “radical” approaches, like prescribing patients psychedelics, are now in use.
But these approaches are still firmly in a preliminary stage for behavioral health providers. Familiar hurdles of federal approval and acceptance by health insurance companies and pharmacies remain. There’s also reputational damage if treatments currently at the edge of conventional behavioral health prove unreliable.
Below, ATB reviews the current state of play regarding new ways to treat SUDs.
Psychedelics gaining ground
A chemical compound primarily used as an anesthetic, the Food and Drug Administration approved ketamine in 2019 for treatment of depression in tandem with psychiatric therapy, and there is growing evidence it may also treat SUDs.
Lionrock, for example, conducted trials in 2023 in which patients were administered ketamine on a staggered schedule lasting 11 weeks along with psychotherapy, compared to a control group that just received therapy.
“What we saw is a significant improvement compared to the control group when it came to anxiety and depression,” Loeb said.
Ketamine may specifically be helpful in combating opioids as it can “amplify the effects of buprenorphine,” according to Sherry Reis, who is the cofounder of Ethnea, a company that began in 2022 with a business model of psychedelic-assisted therapy. Buprenorphine is a commonly prescribed drug to treat opioid use disorder.
Like ketamine, there is evidence psilocybin can address SUD by enhancing neuroplasticity, or the recircuiting in the brain of decision-making processes. For instance, a Journal of the American Medical Association study from 2022 demonstrated that participants who took psilocybin had fewer heavy drinking days, as their mind no longer viewed alcohol as a necessity or solution.
At the start of 2024, the American Medical Association plans to release a set of codes for psychedelic therapy treatment, a process where AMA tracks emerging health care practices. It often leads to a treatment plan gaining traction to compel reimbursement from private insurance, Medicaid or Medicare.
Still, “individual insurers will still hold decision-making power” on covering psychedelic treatment, Reis said, and may see the move as controversial.
“People are sometimes confused by the paradoxical nature of using drugs to treat drug abuse,” she said.
That may particularly be the case with psilocybin, which is best known as the active ingredient in magic mushrooms and federally classified as an illegal drug.
“We are not at a stage where we can offer psychedelics commercially,” Loeb said.
Weight loss and diabetes drugs
As celebrities like Elon Musk tout the power of drugs like Ozempic and Wegovy to lose weight, health care providers are looking into such drugs’ ability to combat SUD.
The drugs and their generic equivalents contain semaglutide, which mimics the hormone glucagon-like peptide-1, or GLP-1, which is supposed to reduce blood sugar levels and let the body know it’s had enough to eat.
GLP-1 triggering drugs could also reduce cravings for tobacco, alcohol, cocaine and opioids, said Patricia Sue Grigson, professor of neuroscience at Penn State University.
Grigson cites a handful of early clinical trials plus a study she completed with the Caron Treatment Center in Wernersville, Pennsylvania, that shows the GLP-1 liraglutide reduces opioid craving compared to placebo treated controls.
That study has not yet been submitted for publication, though Grigson called it “statistically significant and very promising.”
Caron and other health care providers are not ready to prescribe on a wide basis GLP-1s, which is still mostly prescribed for people with Type 2 diabetes, according to Dr. Adam Scioli, chief medical officer at Caron.
Stimulating the brain
One set of experimental treatments at Caron is sending noninvasive electrodes to brain cells in order to stimulate desired brain states. These methods include neurofeedback, neuromapping and hyperbaric oxygen treatment, which posits that stimulating brain cells with pure oxygen can enable cells damaged by SUD to heal more quickly.
Studies are not yet published about the effectiveness of these treatments, which Scioli of Caron said are conducted on patients while “working in combination with established treatments we know are effective” including therapy. Meanwhile, Nassama Ait-Daoud Tiouririne, a University of Virginia professor of psychiatry and neurobehavior sciences is in the midst of a pilot study to see if low-intensity focused ultrasound can rewire the brain in patients with cocaine use disorder.
While these new ways of treating SUDs are in a preliminary stage, Loeb expressed faith the more reliable treatments will become commercially viable, “If they can show their value to patients and, at the end of the day, that value is significant.”
