Swiss trial: psilocybin halves cocaine cravings in 10 patients

A small trial suggests psilocybin, the psychoactive compound in “magic mushrooms,” may help people kick cocaine dependence by rewiring cravings and boosting psychological insight during therapy.

Researchers at the University Hospital of Basel in Switzerland gave two controlled doses of psilocybin—25 mg and 15 mg—seven days apart to 10 adults with severe cocaine use disorder while they underwent talk therapy. After five weeks, cravings among participants fell by about half on average, and seven of the 10 reported cocaine-free weeks. No serious adverse events were recorded, though some participants experienced temporary anxiety or nausea. Cocaine dependence has no FDA-approved medication, leaving clinicians with only behavioral therapies that work for a fraction of patients. The study, published in Nature Medicine, is the first clinical trial to test psilocybin specifically for cocaine disorder, building on earlier psychedelic research that showed promise for alcohol, tobacco, and opiate addictions.

Why this matters now is the surge in cocaine-related deaths over the past decade. U.S. overdose deaths involving cocaine rose from 7,000 in 2015 to more than 24,000 in 2022, according to CDC data, as fentanyl adulteration increased supply-chain risk. Behavioral treatments like cognitive behavioral therapy help only about one-third of patients and relapse is common. Psilocybin-assisted therapy could offer a one- or two-session path to disrupt entrenched reward circuits, similar to how it has shown preliminary benefit for nicotine addiction. The Basel team plans a larger, placebo-controlled study next year with 60 participants to confirm results and test different dosing schedules. If successful, the approach would likely face regulatory and cultural hurdles, but it would add a powerful new tool to an area with few options.

The science is still early. Past trials used LSD or psilocybin for alcoholism and tobacco, with some participants quitting for years. But cocaine studies have lagged behind, partly because the drug’s rapid high makes cravings intense and relapse risk high. The Basel trial used strict medical screening, a controlled setting, and integration therapy before and after dosing to minimize risks. Researchers caution that psilocybin is not a cure—it seems to “unstick” thought patterns so therapy can take hold—but it won’t replace ongoing support. If larger trials replicate these findings, it could shift treatment standards and push regulators to rethink psilocybin’s status as a Schedule I drug, reserved for substances with no accepted medical use.