LOS ANGELES — Melanie Senn’s father, long dead, appeared to her as she lay back in the dimly lit room at the Santa Monica clinic, a mask over her closed eyes, and the psychedelic trip began.
More precisely, it was his thumb. It was disembodied and huge, materializing in her mind to wipe away her own image. Just as a parent might lick a thumb, she said, and use it to clean the dirtied cheek of a child.
“It wasn’t like an aggressive move,” said Senn, 51, recounting the experience. Her father’s thumb had appeared right after the word “goodbye” stretched before her, like a banner in the sky.
“It was like, ‘Goodbye. We’re going somewhere else. And you cannot take this version of yourself,'” she recalled.
Her father had died decades earlier after struggling with alcohol use disorder and bouts of homelessness. She didn’t see herself as an alcoholic — it was a word that seemed out of place in her stable life as an educator, wife and mother — but she had begun to think about how much wine she was drinking at night, the sapped energy and headaches she endured by day.
Senn, who lives in San Luis Obispo, said she had signed up for the clinical trial, hours away in Santa Monica, to see whether therapy with psilocybin, the chemical compound in “magic mushrooms” that can cause hallucinations, might change her relationship to a much more familiar and socially sanctioned drug.
Genaro Molina/Los Angeles Times/TNS
A sign at the Pacific Neuroscience Institute in Santa Monica. (Genaro Molina/Los Angeles Times/TNS) A sign at the Pacific Neuroscience Institute in Santa Monica. (Genaro Molina/Los Angeles Times/TNS)
“If my dad had had access to psilocybin treatment,” she had wondered before her trip at the Pacific Neuroscience Institute, “could that have helped him?”
Psilocybin and many other psychedelics are broadly prohibited under federal law, categorized by the Drug Enforcement Administration as having “no currently accepted medical use.”
Yet U.S. researchers have been legally scrutinizing possible uses of psychedelics in scores of clinical trials approved by the government, addressing their effects on anorexia, migraines and a range of other maladies.
The Food and Drug Administration has deemed psilocybin a potential “breakthrough therapy” for treating depression, a designation that could fast-track the path to new pharmaceuticals.
Popular interest in psychedelics has been bolstered by the books of Michael Pollan, whose writing inspired Senn to look up psilocybin trials. And money, long the limiting factor in psychedelic research, is pouring into the field from corporate investors and intrigued philanthropists.
Addiction treatment has been one of the most keenly watched areas of psychedelics research in recent years, as studies explore whether they could help people shake off the need for other substances, both legal and illegal.
Early studies have shown promise with treating addiction to tobacco and alcohol. The question has gained urgency as the U.S. faces an overdose surge that is killing more than 100,000 people annually, the majority linked to opioids, and a spike in deaths tied directly to alcohol, which have hit their highest rate in decades.
Peter Hendricks, a public health professor at the University of Alabama Birmingham, said cocaine users have asked skeptically, “You’re going to help me stop getting high — by getting me high?” He is studying whether psychedelics paired with therapy could ease cocaine dependency.
Hendricks said he explains that psilocybin is not considered to be addictive. Some participants, he said, “will tell me, ‘Look, this sounds kind of crazy, but I’ve tried everything at this point, so I’m willing to give it a try.'”
Genaro Molina/Los Angeles Times/TNS
Dr. Keith Heinzerling holds a psilocybin capsule at the Pacific Neuroscience Institute.(Genaro Molina/Los Angeles Times/TNS) Dr. Keith Heinzerling holds a psilocybin capsule at the Pacific Neuroscience Institute.(Genaro Molina/Los Angeles Times/TNS)
At Johns Hopkins University, researchers examining whether psilocybin could help with tobacco cravings received a grant in 2021 from the National Institutes of Health — the first the agency has awarded in more than half a century to study therapeutic uses of a psychedelic drug.
Physicians in New York and New Mexico published a study this summer finding that patients treated with psilocybin and psychotherapy cut back more on heavy drinking than those who received psychotherapy and a placebo.
Hendricks is exploring possible benefits for cocaine users. Others have hoped to turn the powers of psychedelics toward easing opioid addiction.
The striking thing about psychedelics is that they have shown promise in treating addiction to a range of substances, said Matthew Johnson, a psychiatry professor at Johns Hopkins University.
“It’s not simply quelling the cravings. … It’s really allowing the person to wrestle with much deeper psychological questions at the heart of addiction.”
In addiction treatment, “we really are at a place where we need radical advances,” Johnson added. “As a field, we keep banging our heads against the wall.”
Experts say it’s unclear exactly why psychedelics seem to help some people with addiction.
Scientists have found that psilocybin acts on key areas of the brain that are important in addiction, said Dr. Lorenzo Leggio, a senior investigator with the National Institutes of Health whose research focuses on identifying new treatments.
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Roughly 40.3 million people in the U.S. had a substance use disorder, or SUD, in 2020. Yet, only 1.4% of those people received any treatment in the past year, and 1% received treatment at a specialty facility. The path to seeking treatment is riddled with obstacles—both systemic and inherent to addiction itself—which can make recovery difficult to access, and in some cases nearly impossible. Stigma surrounding substance use disorder and addiction has been a persistent barrier to seeking both help and understanding about living with the condition.
Substance use disorders are defined by the frequent use of alcohol, drugs, or both that cause “clinically significant impairment,” which includes health problems and the inability to complete responsibilities. Substances covered in the survey’s definition include cigarettes, alcohol, marijuana, hallucinogens, stimulants, inhalants, and opioids, among others. Treatment for substance use disorder varies and can include detoxification, medication, motivational interviewing, counseling (individually or in a group setting), and life skills training.
To investigate the most commonly cited reasons for not seeking treatment for substance use disorder, Zinnia Health reviewed data from the 2020 National Survey on Drug Use and Health, collected by the Substance Abuse and Mental Health Services Administration. The survey results cover people aged 12 and older who were classified as needing treatment for substance use disorder but did not receive any, despite feeling the need for it over the last year.
Released in October 2021, this data was collected in the first and fourth quarters of 2020, spanning 36,284 interviews. With surveys typically conducted in-person, SAMHSA was not able to compile results for the second and third quarters of 2020 due to the COVID-19 pandemic but was able to restart with web-based surveys for the fourth quarter of 2020. These are the most common barriers for people seeking treatment for substance use disorder.
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- Respondents citing this reason for not receiving substance use treatment: 1.7%
- Standard error: 0.93%
Studies have long shown that the longer the delay of getting a scheduled appointment at a treatment facility, the less likely someone struggling with substance use disorder will attend that appointment. While some people seeking treatment become discouraged and continue using when they’re put on a waitlist, others who stop using during the waiting period view this as evidence that they do not need treatment. Wait times and lack of program openings have become increasingly worse since the start of the COVID-19 pandemic, due to rehab programs needing to space patients out to prevent infection.
Whereas before the pandemic patients might live three to a room, social distancing requirements limited the number of patients who could safely participate in treatment. Making matters worse, the pandemic has exacerbated issues leading to increased substance use and overdoses, such as isolation and emotional and financial stress, causing more people to struggle with SUDs.
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- Respondents citing this reason for not receiving substance use treatment: 4.3%
- Standard error: 1.96%
SUDs and mental illness often appear together in the same patient, which can further complicate receiving treatment. Depression and other mental illnesses that increase feelings of hopelessness and isolation can make seeking treatment seem futile or impossible. Unfortunately, access to quality, evidence-based SUD treatment in the U.S. can be limited. Stories abound of those seeking treatment cycling in and out of endless programs and rehab centers, often without long-term recovery.
The 12-step model of treatment, inspired by Alcoholics Anonymous and similar support groups, is one of the prevailing programs, despite little evidence that such treatment is effective for those dealing with nonalcoholic addiction. Many may also find it hard to connect to the 12-step’s spiritual, quasi-religious messaging. Additionally, less than half of treatment centers offer programs that include medication-based treatment, which is shown to be highly effective for people struggling with drug use disorders, particularly when used in conjunction with counseling.
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fizkes // Shutterstock
- Respondents citing this reason for not receiving substance use treatment: 5.2%
- Standard error: 2.36%
Treatment programs vary dramatically in terms of the type of program (inpatient or outpatient), as well as the length of the program. Some are 30 days, while others are 90 days or even 12 months, in the case of methadone regimen maintenance. While evidence suggests that longer programs seem to yield better results in terms of sustained recovery, these programs—particularly residential ones—are often less financially accessible, and present a barrier in terms of time commitment.
For many people juggling jobs or child and family care responsibilities, going away for an extended period in order to undergo treatment does not seem possible. Often, leaving for treatment is contingent upon having a support system of family or friends willing to take on temporary child care duties, while at other times, courts may become involved in custody decisions. Not all treatment programs are residential, however—outpatient programs are part-time and allow for individuals receiving treatment to hold jobs or return home for part of the day.
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- Respondents citing this reason for not receiving substance use treatment: 5.6%
- Standard error: 1.83%
People suffering from SUDs often do not seek out treatment if they do not perceive themselves as being at “rock bottom,” or if they feel their problem isn’t “bad enough” to warrant treatment. The idea of needing to lose control of one’s life to justify seeking treatment is perpetuated by harmful media portrayals of SUDs. Media stereotypes that depict people experiencing substance use disorders as dangerous, insane, or manipulative, stigmatize addiction and make seeking treatment more difficult. They can also render milder or differently-presenting cases of SUD as invisible or easily dismissed, making it harder for those suffering from the disorder to recognize the need for treatment.
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- Respondents citing this reason for not receiving substance use treatment: 6.5%
- Standard error: 2.59%
Stigma around substance use impedes people from seeking treatment by creating a connotation of “moral weakness” and criminality. While many in the SUD field agree that the condition is a medical disorder and not a choice, there are still many cultural, religious, media, and even medical spaces that still perpetuate harmful notions about addiction as a personal failing. Even the language of “substance abusers” has been shown to perpetuate stigma, as “abusers” are perceived to be “deserving of punishment.”
Additionally, a study from Johns Hopkin University showed 43% of respondents were opposed to giving people with SUDs the same health insurance benefits as the general public. As a result, people suffering from SUDs are often denied medical care, cast out by their families or communities, or discriminated against in the workplace, incentivizing silence and secrecy over seeking help.
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fizkes // Shutterstock
- Respondents citing this reason for not receiving substance use treatment: 9.0%
- Standard error: 2.75%
The myth that kicking addiction is a matter of willpower is pervasive amongst people suffering from addiction and nondrug users alike. Similarly, there is a pervasive idea that handling substance use problems individually, without seeking treatment or support, is more honorable or commendable than attaining sobriety with assistance. Both of these myths are embedded in the American ideology that promotes individualism and the “bootstraps” mentality, which touts self-made success above community care or asking for help.
While most people experiencing SUDs believe they can quit on their own—and some do—research has shown that addiction changes the brain in a way that makes “deciding to quit” highly difficult, and staying sober long-term even harder. That’s why some combination of counseling, medication, and formulating a long-term recovery plan is helpful and often necessary to the recovery process.
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fizkes // Shutterstock
- Respondents citing this reason for not receiving substance use treatment: 11.9%
- Standard error: 3.46%
It’s no surprise that witnessing the public ridicule of celebrities struggling with drug use disorders—such as Charlie Sheen, Amanda Bynes, and Mary-Kate Olsen—has increased feelings of fear and shame in those experiencing addiction. Research shows that shame can hinder the ability to recover from addiction since addiction sometimes begins as a coping mechanism for already-existent feelings of shame.
Fear of community members or coworkers forming a negative opinion is not an irrational one: Ostracization has been shown to impact the part of the brain that registers physical pain and can be long-lasting. There are, however, federal protections under the Family and Medical Leave Act, as well as the Americans with Disabilities Act, which prevent people seeking treatment for SUDs from being fired or retaliated against.
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Photographee.eu // Shutterstock
- Respondents citing this reason for not receiving substance use treatment: 14.4%
- Standard error: 3.82%
Limited treatment options for SUDs is a particularly pressing issue in rural areas, often due to lack of resources, a problem which is exacerbated by limited transportation and often poor geographical access. The lack of treatment options in rural areas has only become more pronounced over the past several years, as the opioid epidemic, coupled with the COVID-19 pandemic, has continued to disproportionately impact rural communities. With the many approaches to SUD treatment available, one thing is widely agreed upon: Different types of treatment work for different people, and there is no single path to recovery. That’s why having a variety of treatment options is more than a matter of preference—it can be the difference between life and death.
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- Respondents citing this reason for not receiving substance use treatment: 19.1%
- Standard error: 4.60%
The staggeringly high cost of addiction treatment services is by far the largest barrier to seeking treatment for people struggling with SUDs. Over the past several years, investigative coverage on the for-profit rehab industry has illuminated one ubiquitous story: families and individuals facing financial ruin after seeking SUD treatment, or simply not seeking it out at all due to its prohibitively high cost. This is an issue that blocks low-income people from receiving treatment, resulting in an overdose death rate that is more than twice as high as that of affluent people.
Even middle-class people with health insurance are not fully protected, as many residential facilities charge between tens and hundreds of thousands of dollars for treatment, a number which would plunge the average American household into crippling debt. While financial assistance for treatment services is available, as are state-funded programs, access to information on these resources is limited, particularly for those without computer access.
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fizkes // Shutterstock
Other reasons cited that had low precision around the results:
- Had health care coverage but did not cover treatment or did not cover full cost
- No transportation/programs too far away/hours inconvenient
- Not ready to stop using
- Did not know where to go for treatment
- Might have negative effect on job
- Some other reason
Other barriers to seeking treatment for SUD include not being ready to stop using, a factor that often comes into play when the legal system becomes involved in substance-related cases. Court-ordered treatment, while sometimes helpful, has not been shown to lead to long-term recovery for people entering into treatment on an involuntary basis. In one report, opioid-related overdose deaths were more than twice as high for those who were forced into treatment than those who chose to go.
Additionally, many court-mandated treatment programs are not “medically-sound,” and “struggle to meet … human rights standards,” according to a report from Physicians for Human Rights. Research has shown that individuals who voluntarily enter into treatment for SUDs have more motivation to change behavior than those who were admitted involuntarily, though this is not necessarily an indicator of the recovery outcome.
This story originally appeared on Zinnia Health and was produced and distributed in partnership with Stacker Studio.
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Photographee.eu // Shutterstock
As opioids wreak havoc on thousands of lives, drug treatment facilities are becoming increasingly vital to communities. In 2021, drug overdose deaths breached more than 100,000, and the numbers keep climbing. According to the Center for Disease Control and Prevention, this was a 28.5% increase from the number of overdose deaths the year before.
Unfortunately, for some, treatment can be difficult to receive. Many Americans face racial disparities, particularly Black, Latino, and Native Americans. Other roadblocks include cost, insurance coverage, and the social stigma surrounding addiction.
For those that are struggling with addiction, there is a wide variety of types of treatment as well as types of facilities. For U.S. military veterans, you may enter into programs run by the Department of Veteran Affairs, and for Native Americans, tribal government and Indian Health Service facilities are available. There are also private nonprofit and for-profit organizations that offer treatment.
Each type of drug treatment center offers various types of care and programs for patients. This can range from inpatient hospitalization to regular outpatient care.
Citing data from the National Survey of Substance Abuse Treatment Services (SAMHSA), Zinnia Health broke down the 10 most common types of care in the United States’ substance use recovery centers.
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Guschenkova // Shutterstock
- Available at 658 facilities
--- 3.2% of private non-profit facilities (255)
--- 4.7% of private for-profit facilities (306)
--- 3.6% of local, county, or community govt. facilities (24)
--- 12.7% of federal government facilities (41)
--- 11.2% of state government facilities (32)
--- 0.0% of tribal government facilities (0)
--- 16.7% of Dept. of Veterans Affairs facilities (38)
--- 3.5% of Dept. of Defense facilities (2)
--- 0.0% of Indian Health Service facilities (0)
In 2020, out of the 16,066 facilities, hospital inpatient treatment was available at 658 facilities. Hospital inpatient treatment requires those with substance use disorders (SUD) or alcohol use disorder (AUD) reside at the care facility for a certain length of time depending on the program. Despite being one of the most effective forms of treatment at substance use recovery centers in the U.S., this was also the least available. In fact, this form of treatment is nonexistent at tribal government or Indian Health Service facilities, according to data from SAMHSA. This may be because this can be one of the most expensive forms of treatment. Inpatient treatment can cost $500 to $650 a day, and if you’re enrolled in a 30-day program, that treatment can cost you anywhere from $15,000 to $19,500.
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- Available at 784 facilities
--- 3.9% of private non-profit facilities (312)
--- 5.3% of private for-profit facilities (344)
--- 4.5% of local, county, or community govt. facilities (30)
--- 22.0% of federal government facilities (71)
--- 8.8% of state government facilities (25)
--- 0.8% of tribal government facilities (2)
--- 29.8% of Dept. of Veterans Affairs facilities (68)
--- 3.5% of Dept. of Defense facilities (2)
--- 0.0% of Indian Health Service facilities (0)
Similar to inpatient treatment, hospital detox care is both one of the least common and most expensive forms of treatment for addiction. This method of care is available at 784 facilities, mostly at private nonprofit or private for-profit facilities. No hospital detox care programs were available at Indian Health Services facilities. Hospital detox care is a program where patients go through detoxification from addictive substances and are overseen by hospital staff. On a daily basis, medical detox can cost between $500 to $650 which, like with hospital inpatient treatment, can be a difficult financial hurdle for many people to surpass. This type of care is especially in demand in the Northeast region of the U.S. in states such as New Jersey, where centers report addiction to be a growing issue as a result of the impact of the COVID-19 pandemic.
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Tyler Olson // Shutterstock
- Available at 784 facilities
--- 3.9% of private non-profit facilities (312)
--- 5.3% of private for-profit facilities (344)
--- 4.5% of local, county, or community govt. facilities (30)
--- 22.0% of federal government facilities (71)
--- 8.8% of state government facilities (25)
--- 0.8% of tribal government facilities (2)
--- 29.8% of Dept. of Veterans Affairs facilities (68)
--- 3.5% of Dept. of Defense facilities (2)
--- 0.0% of Indian Health Service facilities (0)
Residential detox care was found to be available at 1,412 facilities across the U.S. While this type of care is not offered in a hospital, it’s still a closely monitored detox program. Oftentimes, patients live at a home or facility where they can detox and attend therapy sessions. This type of program is usually for people who can’t be in or don’t need intensive inpatient care. These patients are treated in a hospital setting and still need structure. These types of programs seem to be the most common with the Department of Veterans Affairs as 15.4% of its facilities offer this.
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wutzkohphoto // Shutterstock
- Available at 1,869 facilities
--- 7.6% of private non-profit facilities (608)
--- 16.3% of private for-profit facilities (1,067)
--- 5.1% of local, county, or community govt. facilities (34)
--- 37.8% of federal government facilities (122)
--- 8.8% of state government facilities (25)
--- 5.2% of tribal government facilities (13)
--- 49.6% of Dept. of Veterans Affairs facilities (113)
--- 8.8% of Dept. of Defense facilities (5)
--- 6.9% of Indian Health Service facilities (2)
Outpatient detox care is most common at Department of Veterans Affairs and federal government facilities. This type of care can be found at 1,869 of the more than 16,000 facilities, so it’s not available at many institutions. Outpatient detox care is a treatment plan that allows patients to detoxify without having to be hospitalized or reside at a facility. Some patients may prefer this type of care if they are unable to live at a treatment center due to financial barriers. Other patients may have to opt for outpatient detox care because of personal or professional obligations and require flexibility.
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- Available at 2,277 facilities
--- 10.6% of private non-profit facilities (848)
--- 20.0% of private for-profit facilities (1,304)
--- 6.3% of local, county, or community govt. facilities (42)
--- 12.7% of federal government facilities (41)
--- 9.1% of state government facilities (26)
--- 6.4% of tribal government facilities (16)
--- 14.9% of Dept. of Veterans Affairs facilities (34)
--- 10.5% of Dept. of Defense facilities (6)
--- 0.0% of Indian Health Service facilities (0)
Day treatment for those with SUD or AUD is a type of partial hospitalization program. With this type of treatment, the patients might not require 24/7 care but still need consistent structure within a hospital setting. Like other forms of care, this treatment can be costly—around $350 to $450 per day, depending on where you live (as is often the case). Day treatment can be found at 2,277 drug treatment facilities across the U.S., particularly at private for-profit facilities. However, none were found at any Indian Health Service facilities.
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fizkes // Shutterstock
- Available at 2,427 facilities
--- 15.7% of private non-profit facilities (1,260)
--- 15.2% of private for-profit facilities (994)
--- 6.3% of local, county, or community govt. facilities (42)
--- 23.5% of federal government facilities (76)
--- 15.1% of state government facilities (43)
--- 4.8% of tribal government facilities (12)
--- 30.7% of Dept. of Veterans Affairs facilities (70)
--- 3.5% of Dept. of Defense facilities (2)
--- 13.8% of Indian Health Service facilities (4)
Short-term residential care is a form of drug treatment that requires patients to live at a non-hospital facility for a short period of time. These types of treatments typically require patients to remain at a facility for 28 to 30 days. Out of the more than 16,000 drug treatment centers surveyed, it’s only available at 2,427 facilities. While long-term programs tend to be more effective than shorter stints, short-term residential care can be an effective form of treatment for some people who struggle with SUD or AUD. This type of care was most commonly found at Department of Veterans Affairs and federal government facilities.
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Chinnapong / Shutterstock
- Available at 2,972 facilities
--- 24.2% of private non-profit facilities (1,936)
--- 12.7% of private for-profit facilities (829)
--- 7.5% of local, county, or community govt. facilities (50)
--- 22.3% of federal government facilities (72)
--- 20.0% of state government facilities (57)
--- 11.2% of tribal government facilities (28)
--- 28.1% of Dept. of Veterans Affairs facilities (64)
--- 1.8% of Dept. of Defense facilities (1)
--- 24.1% of Indian Health Service facilities (7)
Available at 2,972 facilities, this type of care was only slightly more common than short-term residential care programs. Other than the Department of Veterans Affairs, this form of care was most popular with private nonprofit facilities and Indian Health Service facilities. Long-term residential care is a program that offers 24/7 care for patients that reside at a drug treatment center for a longer period of time, sometimes months. Research has found long-term care tends to be the most effective means to recover from addiction. According to the National Institute of Drug Abuse, patients need to be in treatment for at least three months “to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment."
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Simone Hogan // Shutterstock
- Available at 5,829 facilities
--- 31.6% of private non-profit facilities (2,531)
--- 41.0% of private for-profit facilities (2,682)
--- 35.4% of local, county, or community govt. facilities (237)
--- 72.1% of federal government facilities (233)
--- 27.0% of state government facilities (77)
--- 27.7% of tribal government facilities (69)
--- 91.2% of Dept. of Veterans Affairs facilities (208)
--- 19.3% of Dept. of Defense facilities (11)
--- 27.6% of Indian Health Service facilities (8)
Methadone/buprenorphine maintenance, or naltrexone treatment, is an important form of care when it comes to substance addiction to opioids. These treatments can help curb the longing for opioids and assist those struggling with SUD to quit using. This type of care can be found at 5,829 facilities and is one of the most popular approaches to treatment. In particular, this treatment is especially popular with the Department of Veterans Affairs where more than 91% of facilities offer methadone/buprenorphine maintenance or naltrexone treatment. These numbers fall in line with the institute’s longtime efforts to increase access to these types of medications.
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fizkes // Shutterstock
- Available at 7,243 facilities
--- 43.7% of private non-profit facilities (3,498)
--- 46.9% of private for-profit facilities (3,068)
--- 44.0% of local, county, or community govt. facilities (295)
--- 52.0% of federal government facilities (168)
--- 33.7% of state government facilities (96)
--- 47.4% of tribal government facilities (118)
--- 61.8% of Dept. of Veterans Affairs facilities (141)
--- 28.1% of Dept. of Defense facilities (16)
--- 31.0% of Indian Health Service facilities (9)
Intensive outpatient care was the second-most popular form of treatment for those struggling with SUD or AUD. This type of treatment was found to be available at 7,243 facilities, or nearly half of all facilities. Intensive outpatient care is similar to regular outpatient care in that neither requires overnight hospitalization. However, intensive outpatient care may require closer supervision as well as more hours put into the program than standard outpatient treatment. Like regular outpatient care, this form of treatment may be more popular since it tends to be much less expensive than inpatient care, which requires residing at a facility.
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fizkes // Shutterstock
- Available at 12,249 facilities
--- 73.0% of private non-profit facilities (5,839)
--- 78.1% of private for-profit facilities (5,102)
--- 87.8% of local, county, or community govt. facilities (588)
--- 95.0% of federal government facilities (307)
--- 65.3% of state government facilities (186)
--- 91.2% of tribal government facilities (227)
--- 95.6% of Dept. of Veterans Affairs facilities (218)
--- 98.2% of Dept. of Defense facilities (56)
--- 89.7% of Indian Health Service facilities (26)
Regular outpatient care was by far the most commonly found form of treatment. According to the SAMHSA report, “outpatient treatment was offered by 82 percent of all facilities and was received by 94 percent of all clients in treatment.” Regular outpatient care typically involves a patient participating in regular meetings with a behavioral health counselor as well as participation in drug counseling. This treatment does not require hospitalization at a facility and can be for patients who have just gone through inpatient or residential treatment. Regular outpatient care may be more popular because it tends to cost significantly less than inpatient care and also provides flexibility to those who are unable to enter into a more demanding program. Outpatient care is especially common in states like Oregon; however, outpatient care isn’t for everyone as many people who struggle with drug use may need more intensive treatment.
This story originally appeared on Zinnia Health and was produced and distributed in partnership with Stacker Studio.
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The Substance Abuse and Mental Health Services Administration, or SAMHSA, reported that among the people who misused prescription pain relievers in 2020, nearly 65% stated that their primary reason for doing so was to relieve physical pain. The percentage of people reporting drug misuse as a reason to get high was 11.3%.
Misuse is defined as patients taking prescription medications in a way other than what has been recommended by their doctor. It might look like taking someone else’s prescription or taking one’s own at larger or more frequent doses, or for a longer period of time.
Citing data from SAMHSA, Zinnia Health identified the most commonly misused prescription drugs in the United States, all of which are opioid analgesics, or opioid pain relievers. This class of drugs acts on the central nervous system by blocking pain signals to the brain. In addition to pain relief, these drugs also intensely trigger the brain’s reward centers, releasing endorphins and creating positive feelings commonly referred to as euphoria. This is what makes prescription opioids—and all opioids, for that matter—so dangerously addictive.
Prolonged use of opioids can increase a patient's tolerance to a particular drug. With higher tolerance, the drug becomes less effective, and patients won't experience the same level of pain relief and feelings of euphoria, which often leads people to seek out opioids with higher potency. This could be why such a large percentage of people reported misusing prescription opioids to relieve pain. For example, a person who has misused and developed a tolerance to morphine may seek out something stronger like oxycodone or hydromorphone, the effects of which are felt more quickly and more intensely.
SAMHSA also found that nearly half of people who misused pain relievers (47.2%) reported getting these drugs from a friend or relative—by stealing, buying, or receiving them for free. Roughly 44% of people reported getting prescriptions from a healthcare provider. Drug diversion—or the disruption of a prescription drug along its legal and intended path from manufacturer to doctor to patient—is a contributing factor in drug misuse. Diversion happens through doctor shopping, theft, and forgery, among others.
The United States is in its third wave of an opioid crisis, but it is important to note this current wave is characterized by illicitly produced synthetic opioids. Overdose deaths from commonly prescribed opioids have been on the decline over the last several years. However, knowing the uses and risks associated with these drugs can be life-saving. Read on to learn the most commonly misused prescription drugs in the United States.
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MedStock Photos // Shutterstock
- Misuse over the past year (previous users): 8.9%
- Misuse over the past year (general population): 0.2%
Known by its brand names Avinza or Kadian, morphine is an opioid used to treat both acute and chronic pain. While morphine can be administered intravenously, it is most commonly taken via tablet or capsule. Morphine is closely related to other analgesics like hydrocodone and oxycodone. The potency of other opioids is often determined or compared relative to morphine’s potency.
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chatuphot // Shutterstock
- Misuse over the past year (previous users): 9.0%
- Misuse over the past year (general population): 0.5%
Tramadol, commonly referred to by its brand name Ultram, is a synthetic opioid used to treat moderate to severe pain, typically following a surgery. The drug is commonly prescribed as extended-release tablets to help with chronic severe pain from conditions like fibromyalgia. In 2019, an estimated 5.5 million people were prescribed Tramadol, totaling nearly 20 million prescriptions. It was the 35th most prescribed drug in the U.S.
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Joe Mamer // Shutterstock
- Misuse over the past year (previous users): 12.2%
- Misuse over the past year (general population): 0.9%
Codeine is an opioid used to treat mild to moderate pain and is most often prescribed as a cough suppressant. It can also be used to treat gastrointestinal problems like diarrhea. Because codeine is milder than other opioids, users with intentions of misuse increase dosages to achieve a greater high. Misuse of codeine can lead to the misuse of more intense opioids.
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Canva
- Misuse over the past year (previous users): 12.6%
- Misuse over the past year (general population): 1.7%
Hydrocodone is the most frequently prescribed opioid in the U.S. In 2020, 4.7 million people misused hydrocodone products, making them the most commonly misused type of prescription pain reliever that year. Hydrocodone, also known by its brand name Vicodin, is given to patients with moderate to severe pain usually following surgery or injury, or to alleviate pain associated with medical conditions such as cancer. In combination with homatropine, hydrocodone can also be used as a cough suppressant. Unlike other opioids, hydrocodone is not often illicitly manufactured and the vast majority of misused hydrocodone is pharmaceutical.
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PureRadiancePhoto // Shutterstock
- Misuse over the past year (previous users): 14.8%
- Misuse over the past year (general population): 0.1%
Pharmaceutical fentanyl, which this data refers to, can be up to 100 times more potent than morphine and is most often used to treat pain associated with advanced cancer. Legally produced fentanyl is typically administered through patches or lozenges. According to the Drug Enforcement Administration, misuse of these products can include ingesting the gel inside the patches or freezing the patches, cutting them into pieces, and placing them inside the cheek to absorb the contents. Because a percentage of fentanyl remains in used patches even after a three-day use, used patches are also targeted for misuse. Illegally manufactured, nonpharmaceutical fentanyl is at the heart of the third and current wave of America’s opioid epidemic.
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Canva
- Misuse over the past year (previous users): 16.6%
- Misuse over the past year (general population): 0.1%
Hydromorphone, commonly referred to by brand names Dilaudid or Exalgo, is an opioid prescribed to treat severe pain in patients who are resistant to less potent opioids. It is roughly eight times stronger than morphine, and the effects of a 1-2mg dose can be felt in as little as 15 minutes. Hydromorphone carries a high risk of addiction and is prescribed only in certain medical circumstances, like managing pain from cancer or cancer-related treatment. According to the Drug Enforcement Administration, hydromorphone used to be the most commonly misused or diverted drug, now supplanted by oxycodone and hydrocodone.
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PureRadiancePhoto // Shutterstock
- Misuse over the past year (previous users): 26.5%
- Misuse over the past year (general population): 0.2%
Buprenorphine is an opioid used in the medication-assisted treatment of opioid use disorder, or OUD, particularly to reduce intense withdrawal symptoms that can lead to relapse. It works by stimulating the brain in the same way as heroin or methadone, but to a lesser degree, creating a limit to its effects. It can produce euphoria without the risk of suppressing breathing, which is the actual cause of death in opioid overdoses. Since prolonged opioid use inhibits the brain’s ability to produce dopamine on its own, the right dosage of buprenorphine and a comprehensive treatment plan allows OUD patients to feel “normal” or at equilibrium.
This story originally appeared on Zinnia Health and was produced and distributed in partnership with Stacker Studio.
Psilocybin also indirectly stimulates a receptor for serotonin, a chemical in the brain that plays a role in addictive behavior, Leggio said, and some research suggests that psilocybin increases “plasticity,” so that “the brain becomes easier to adapt and to adjust.”
Some researchers say a psychedelic trip appears to free the brain to make new connections and eject itself from familiar ruts — a tool that could help patients break loose from destructive ways of thinking.
Hendricks said many people with substance use disorders devote a lot of time and energy to thinking about their urges and how to satisfy them, but during a psychedelic experience, “for many people, there is this intense experience of awe where they think outside of themselves in a very profound way.”
“It’s one thing for me to tell you, ‘Hey, your drinking is negatively affecting your relationship with your family members,'” he said. “It’s another thing to have a very visceral and vivid experience in which it is shown to you.”
Johnson, who has studied addiction to tobacco, said smokers, after tripping on psilocybin, have relayed realizations about the psychological reasons they use cigarettes. Many had “experiences that sort of opened them up to a different way of viewing the world,” seeing it as “this miraculous gift.”
If you suddenly see life as a miracle, “the question of whether or not you’re going to be smoking just seems trivial,” Johnson said.
Leggio, like many others, cautioned that research on psychedelics is in its early stages. It’s unclear whether the hallucinations tied to psilocybin are critical to any therapeutic effects or could be disentangled from them in a new medication. Psychedelic research has also struggled to find a placebo that participants cannot easily distinguish from a psychedelic trip.
“There is a lot of excitement — and I share that excitement,” Leggio said. But “we also need to make sure that we don’t overlook safety.”
Psychedelics have known risks, especially outside a clinical setting where patients are being monitored, experts have warned.
People undergoing psychedelic trips may see things that are disturbing, experience increases in heart rate or blood pressure, panic and put themselves in danger or be vulnerable to exploitation. In rare cases, users may suffer ongoing problems such as paranoia or hallucinatory flashbacks, according to the National Institute on Drug Abuse.
As scientists probe possible benefits in therapy, some local laws on psychedelics have been eased.
In Oregon, voters passed measures to create a regulatory framework for the use of psilocybin in supervised settings and eliminate criminal penalties for possessing limited amounts of controlled substances, including psilocybin and many other psychedelics. Colorado voters in November passed a measure to decriminalize the personal possession of psilocybin and other psychedelic plants.
In 2022, California lawmakers weighed a bill proposed by state Sen. Scott Wiener, D-San Francisco, that would have allowed the possession of psilocybin and several other hallucinogenic drugs for personal or facilitated use. Among those lobbying for the California bill were military veterans who say psychedelic treatment helped them with addiction and trauma.
“It’s not that it’s an overnight panacea or miracle, but it certainly was far more effective than anything we had tried to date,” said Amber Capone, who had been preparing to leave her husband, Marcus, before he underwent treatment in Mexico with the psychoactive substance ibogaine. The couple have founded a nonprofit, Veterans Exploring Treatment Solutions, that helps veterans get such therapies abroad.
Opponents of the California bill contended that therapeutic uses should not be conflated with decriminalizing such drugs more broadly. The group Crime Victims United of California argued that a possible therapeutic benefit “by no means justifies their wholesale legalization for the masses — who are not necessarily under the watchful eye of a licensed therapist.”
The bill was scaled back to a proposed study, then shelved in the fall. Wiener pledged to try again and recently introduced a revised version of the proposal.
Genaro Molina/Los Angeles Times/TNS
Dr. Keith Heinzerling speaks with Melanie Senn before a psilocybin session on Feb. 24 at the Pacific Neuroscience Institute. (Genaro Molina/Los Angeles Times/TNS) Dr. Keith Heinzerling speaks with Melanie Senn before a psilocybin session on Feb. 24 at the Pacific Neuroscience Institute. (Genaro Molina/Los Angeles Times/TNS)
In Santa Monica, Dr. Keith Heinzerling has long wondered about those crucial moments that people talk about in Alcoholics Anonymous.
“They talk about these epiphanies, where the switch flips and then they just feel different,” said Heinzerling, who was an addiction-medicine doctor and researcher at UCLA before joining the Pacific Neuroscience Institute. “Myself and some of the clinicians were always like, ‘How do you facilitate that?’ Because people would try, try, try — and it would happen at the least expected time.”
Psychedelics seem to him like one way to help patients get to those transformative moments — “a roller coaster that takes you on a tour of your inner self.” Heinzerling describes psychedelics as the most empowering model for therapy he has found.
“It’s not mind control,” he said. “It’s a door that you can choose to open.”
The Treatment & Research in Psychedelics program — better known as TRIP — has let patients, through federally regulated clinical trials, open that door in a softly lit room with a comfortable sofa and attentive therapists.
One of the latest studies, which recruited participants with alcohol use disorder, sought to gauge the safety and tolerability of playing a video — with classical music trickling over majestic scenes of butterfly wings, mountain ridges and waterfalls — to ease patients into the experience before they cover their eyes.
Heinzerling said the therapists reassure participants that “we’re going to keep your body safe here — and allow you to let your mind go.” After the psilocybin session, they meet again weekly through the course of the study to talk about the experience, with therapists helping patients process what they felt and saw.
Genaro Molina/Los Angeles Times/TNS
Psychotherapist Karina Sergi, left, talks with Melanie Senn, who prepares for a psilocybin session on Feb. 24 at the Pacific Neuroscience Institute in Santa Monica. (Genaro Molina/Los Angeles Times/TNS) Psychotherapist Karina Sergi, left, talks with Melanie Senn, who prepares for a psilocybin session on Feb. 24 at the Pacific Neuroscience Institute in Santa Monica. (Genaro Molina/Los Angeles Times/TNS)
Senn, one of a score of people participating in that pilot study, called it “hands-down the most profound experience of my life.” During her trip, she said, she experienced her father gently wiping away her image — “almost like he was erasing my ego” — then taking her to a celestial place that she strained to describe in words.
“I’m not a religious person,” she said, “but I truly think I have now been cured of my atheism.”
At one point, she saw her own children, connected to her with long, black umbilical cords; at another, she opened her mouth, and incandescent light poured out of her like a bulb as the message “No one is angry at you” resounded. She saw her mother, shrouded in a dark covering of wraiths, bones and melting faces, and felt her overwhelming grief.
“I felt completely wrung out afterward,” she said. “Kind of just raw, but also, like, soft and in awe.” A friend picked her up from the Santa Monica clinic and drew her a bath, where she soaked for hours.
Her husband joked on the phone, “Are you coming back a teetotaling vegan?” This was, after all, a study related to alcohol that required her to track how many drinks she had each day.
Senn said the depth of her psychedelic experience feels at odds with making simple declarations like “I’m not going to drink anymore.” But tripping through the cosmos with her long-deceased father did bring home to her that “you have all these connections. You have all this love. … You don’t have to hurt yourself.”
Months after taking psilocybin, she drank less, then not at all. Senn said her psychedelic trips were one part of a bigger journey that included changing her career, reading books on addiction, meditating, writing and practicing yoga. The transcendent beauty of her experience, she said, had made drinking seem dull and limiting.
“Seeing this sublime connection is making me feel so alive,” she said. “So much more alive than drinking myself to sleep.”
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