Psilocybin for Treatment of Alcohol Use Disorder: a Feasibility Study

Study Overview
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Brief Summary
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The purpose of this project is to assess the feasibility and safety of administering a single dose of psilocybin to patients diagnosed with alcohol use disorder (AUD). In addition the investigators will establish the pharmacokinetic properties of the active metabolite psilocin. This is the first step in a research project that has the overall aim to evaluate the efficacy of a single administration of psilocybin as an intervention for treatment of AUD.

Detailed Description
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The investigators will evaluate the feasibility and safety of administering psilocybin to 10 patients diagnosed with AUD. Following informed consent, patients will be screened for eligibility as per in- and exclusion criteria and baseline values will be recorded as per outcome measures. All patients will receive a single administration of 25 mg of psilocybin. As per safety guidelines patients will be monitored the entire dosing session by study staff familiar with the psychedelic effects of psilocybin. In addition, the patients will meet before and after the dosing session with a psychologist connected to the study for preparation and post-session debriefing, respectively. During dosing session, the investigators will collect blood plasma psilocin levels in order to establish pharmacokinetics and an estimated brain 5-HT2AR occupancy. When the effects of psilocybin subside, the investigators will ask the patients to fill out questionnaires encapsulating the psychedelic experience. One week after drug administration the patients are required to meet for an end-of-study assessment of outcome measures including adverse events.

Official Title
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Psilocybin for Treatment of Alcohol Use Disorder: a Feasibility Study

Conditions
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Alcohol Use Disorder (AUD)

Intervention / Treatment
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* Drug: Psilocybin


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age of 20-70 years (both included). Body weight of 60-95 kg (both included). Diagnosed with AUD according to DSM-5 criteria and alcohol dependence according to ICD-10. Alcohol Use Disorder Identification Test (AUDIT) ≥ 15. ≥ 5 heavy drinking days. Exclusion Criteria: Personal or first-degree relatives with current or previous diagnosis within psychotic spectrum disorders or bipolar disorder. History of delirium tremens or alcohol withdrawal seizures. History of suicide attempt or present suicidal ideation. Withdrawal symptoms at inclusion, defined as a score higher than 9 on the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar). Present or former severe neurological disease including head trauma with loss of consciousness > 30 min. Impaired hepatic function (liver transaminases > 3 times upper normal limit). Cardiac problems defined as decompensated heart failure (NYHA class III or IV), unstable angina pectoris and/or myocardial infarction within the last 12 months. Abnormal electrocardiogram Impaired renal function (eGFR < 50 ml/min). Uncontrolled hypertension (systolic blood pressure >165 mmHg, diastolic blood pressure >95 mmHg). Pharmacotherapy against AUD including disulfiram, naltrexone, acamprosate and nalmefene or treatment with any of these compounds within 28 days prior to inclusion. Treatment with any serotonergic medication or any use of serotonergic psychedelics within 1 month prior to inclusion. Any other active substance use defined as a Drug Use Disorder Identification Test score > 6/2 (m/w) and substance use disorder based on investigator's clinical evaluation, except for nicotine. Women of childbearing potential who are pregnant, breastfeeding or have intention of becoming pregnant or are not using adequate contraceptive measures considered highly effective61. Hypersensitivity to the active substance or to any of the excipients. Unable to speak and/or understand Danish. Any condition that the investigator feels would interfere with trial participation.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Open label study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Psilocybin<br>10 patients will receive a single administration of psilocybin | Drug: Psilocybin<br>* A single administration psilocybin (25mg, opaque capsule for oral ingestion). The psilocybin is synthetically manufactured under current Good Manufacturing Practices (cGMP)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Safety: Adverse events associated with administration of psilocybin in patients diagnosed with alcohol use disorder | Assessment of the incidence and severity of expected and unexpected adverse events | 1 week after drug administration | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility: Proportion of participants who complete | Proportion of included patients who complete the planned procedures | 1 week after drug administration | 
| Pharmacokinetic parameter of psilocin: Cmax | Cmax: maximum concentration of plasma psilocin determined from concentrations-versus-time data. Blood samples will be drawn with intervals of 20 minutes | From drug administration and 300 minutes after. | 
| Pharmacokinetic parameter of psilocin: Tmax | Tmax: Time to reach maximum concentration of plasma psilocin determined from concentrations-versus-time data. Blood samples will be drawn with intervals of 20 minutes | From drug administration to 300 minutes after. | 
| Pharmacokinetic parameter of psilocin: AUC | AUC: Area under the plasma concentrations-versus-time curve determined using the linear trapezoidal rule. | From drug administration to 300 minutes after. | 
| Subjective effects of psilocybin: Intensity | Intensity of the drug effect will be assessed with intervals of 20 minutes asking the patients How intense is the experience right now on a 0-10 Likert scale where 0 = not intense at all, 10 = very intense. | From drug administration to 8 hours after | 
| Subjective effects of psilocybin: Mystical Experience | Experiential aspects of psilocybin measured by The Mystical Experience Questionnaire (MEQ). The patients are asked to rate the items on a 6-point scale going from 0= none; not at all to 5=extreme; more than ever before in my life and stronger than 4. | 8 hours after drug administration | 
| Subjective effects of psilocybin: Altered States of Consciousness | Experiential aspects of psilocybin measured by the 11-Dimensional Altered State of Consciousness scale (11-DASC). The patients are asked to rate the items by placing marks on a horizontal visual analogue scale (100 millimeters in length) going from no, not more than usual (on the left) to yes, very much more than usual (on the right). | 8 hours after drug administration | 
| Subjective effects of psilocybin: Awe Experience | Experiential aspects of psilocybin measured by the Awe Experience Scale. The patients are asked to rate the items on a 7-point scale going from 1= Strongly Disagree to 7= Strongly Agree. | 8 hours after drug administration | 
| Subjective effects of psilocybin: Ego Dissolution | Experiential aspects of psilocybin measured by the Ego Dissolution Inventory. The patients are asked to rate the items by placing marks on a horizontal visual analogue scale (100 millimeters in length) going from no, not more than usual (on the left) to yes, very much more than usual (on the right). | 8 hours after drug administration | 
| Change in craving | Change in self-reported craving measured by the Penn Alcohol Craving Scale (PACS). The patients are asked to rate the items on a 7-point scale going from 0= Never to 6= Nearly all of the time. | Baseline and 1 week after drug administration | 
| Change in self-efficacy | Change in self-reported self-efficacy measured by the Alcohol Abstinence Self-efficacy (AASE). The patients are asked to rate the items on a 5-point scale going from 1= not at all to 5= extremely. | Baseline and 1 week after drug administration | 
| Change in mindfulness | Change in self-reported mindfulness measured by the Mindful Attention Awareness Scale (MAAS). The patients are asked to rate the items on a 6-point scale going from 1= Almost always to 6= Almost never. | Baseline and 1 week after drug administration | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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psilocybin, alcohol use disorder, psychedelics, addiction, pharmacokinetics, psilocin, feasibility