Psychedelics as treatment for cocaine addiction? A Roanoke doctor won a federal grant to study the possibilities.

Could there be magic in some mushrooms? Carilion Clinic researchers are studying whether psilocybin — the psychoactive ingredient in “magic mushrooms” — could help people with addiction. 

Dr. Albert Arias, division chief of addiction and psychiatry at Roanoke-based Carilion, recently received a federal grant to launch a pilot study examining how psilocybin, combined with psychotherapy, might affect cocaine addiction. 

“Psychedelics have been enjoying a renaissance of interest in the scientific world as a treatment for psychiatric disorders,” Arias said in a phone interview.

There has been a growing interest in studying psilocybin as a treatment for a number of diseases. The National Library of Medicine shows over 300 studies examining whether psilocybin could be medicine. 

One recently published study found that psilocybin could prevent chemotherapy pain. Another is looking at the mental effects caused by Lyme disease. Health and Human Services Secretary Robert F. Kennedy Jr. and Department of Veterans Affairs Secretary Doug Collins signed a memorandum of understanding to explore psychedelic-assisted therapy research for veterans suffering from PTSD.

Arias’ research will focus on whether psilocybin treatment can reduce cocaine use, cravings and behaviors associated with addiction. 

Researchers have theories about how psilocybin might affect neurotransmitters — chemical messengers that carry signals from one nerve cell to another — but they do not yet know exactly how the drug works in treating addiction, Arias said. The two-part study will also examine some popular theories, such as the hypothesis that psychedelics help the brain’s neuroplasticity — its ability to change and form new connections — which is disrupted in addiction, depression and anxiety. 

If psilocybin does affect neuroplasticity, Arias said, that could help people unlearn some of the behaviors associated with addiction. His team will also examine whether the drug’s “mystical” effects change how people think about themselves and their place in the world

There are medication-assisted treatments for other substance use disorders, such as those involving opioids and alcohol. But there is no federally approved medication specifically for treating cocaine addiction, Arias said. 

It’s not for a lack of effort, he said. Like some other drugs, cocaine directly disrupts dopamine in the brain’s reward system. But it also affects serotonin and alters levels of neurotransmitters in the brain. This causes dopamine to remain in the synapse longer and accumulate, which increases signaling to dopamine receptors and contributes to cocaine’s euphoric and stimulating effects.

“They [the effects of cocaine] really go to the molecular level in terms of affecting things like transcription — what genes are turned on, which ones are turned off. So it really can affect the brain and the neurons on a profound level,” Arias said. 

Those effects make cocaine and methamphetamine addiction particularly difficult to treat, Arias said.

The initial $623,000 award will mostly assess the drug’s safety and how well participants tolerate it. 

The data will need to indicate that participants stopped using cocaine as a result of the treatment before a second allocation of funding is released from the National Institute on Drug Abuse at the National Institutes of Health. The award could grow to $3.5 million, according to a press release from Carilion. 

[Disclosure: Carilion Clinic is one of our donors, but donors have no say in news decisions; see our policy.]

Federal changes push for psilocybin research, FDA approval

Carilion’s study comes as federal agencies increase their focus on psychedelic research, including research into potential treatments for addiction.

President Donald Trump signed an executive order in April directing the Department of Health and Human Services to accelerate research and drug development involving psychedelic drugs for serious mental illness.

The National Institute on Drug Abuse also issued a research opportunity specifically seeking studies that could speed the development of psilocybin as a treatment for addiction. 

Arias was working on research related to opioid and cocaine use when an NIH officer suggested he consider applying for funding for psychedelic research. He has not researched psychedelics before, but it’s not uncommon for researchers to receive grant awards in adjacent fields, he said.

“They wanted it to be inclusive of scientists that were established, that were not necessarily only dedicated to psychedelic research,” Arias said. Relying on researchers with backgrounds beyond psychedelic research could bring different perspectives to the field and help avoid simply replicating existing findings, he said.

The federal order also directs agencies to look at ways to expand access to psychedelic treatments through existing avenues, including the Food and Drug Administration’s Right to Try program, a 2018 law that lets eligible patients with life-threatening illnesses try unapproved experimental drugs without FDA oversight. The order also calls for certain psychedelic drugs to receive priority consideration through the FDA’s review process.

Virginia has also taken steps to prepare for the possibility that the federal government could approve psilocybin treatments. Senate Bill 379, sponsored during the 2026 General Assembly session by state Sen. Jennifer Boysko and co-sponsored by Sen. Scott Surovell, both D-Fairfax County, creates a mechanism for Virginia to automatically adjust how it classifies psilocybin if the federal government eventually approves a psilocybin drug for medical use.

Federally, psilocybin remains a Schedule I controlled substance. Schedule I drugs have a high potential for abuse and serve no established medical purpose in the United States, according to the U.S. Department of Justice. 

Some states have decriminalized it. Oregon and Colorado, for example, have passed legislation to allow psilocybin to be used for mental health treatments at licensed facilities, and possession of small amounts is decriminalized. Several other states have created work groups to prepare for medicalization.

The new Virginia law directs the state Board of Pharmacy to reschedule psilocybin to match the federal government’s scheduling within 30 days after two things happen: The FDA approves a formulation of psilocybin designed to be administered by a healthcare professional in a healthcare setting and the federal government changes psilocybin’s controlled-substance schedule in connection with that approval, according to the bill. 

Carilion will recruit participants from the community

The Carilion study will recruit participants from the broader community, not just people who are already Carilion patients.

Researchers are looking for people who currently meet the criteria for cocaine use disorder and who have used cocaine within the past month. Arias said local partners may refer patients to the study, while people in the community who are interested may also seek treatment through Carilion.

Recent cocaine use matters more than how much treatment someone has already received, Arias said. Someone who is already being treated could still participate if they continue to meet the criteria for cocaine use disorder and are still struggling with it. Conversely, someone who has been in treatment and is doing well enough that they no longer meet the criteria would not qualify.

The pilot will divide about 27 participants among three groups. Participants will receive a single dose of either 25 milligrams or 40 milligrams of psilocybin, or a 5-milligram dose that serves as an active placebo, followed by six weeks of observation. 

The active placebo is intended to help researchers address one of the challenges of studying psychedelics: Participants may be able to tell whether they received a psychedelic dose because of the drug’s noticeable effects.

The pilot is expected to last about two years and will help researchers determine whether the treatment shows enough of a signal to move forward with a larger study, Arias said. 

A larger study could follow

If the pilot produces promising enough results and NIH provides additional funding, the second part of the project would enroll a substantially larger group: about 90 participants total, divided into three groups. The researchers would use the results from the first phase to select the psilocybin dose for the larger trial.

Participants would receive two doses rather than one. Arias said the larger trial would run for about 10 weeks, with one dose near the beginning and a second dose about a month later. This is closer to what researchers would expect from a study examining a potential clinical treatment, rather than the smaller pilot’s goal of simply detecting an initial signal. 

Arias also hopes to add brain imaging during the second phase. Researchers plan to obtain neuroimaging from as many participants as possible to investigate whether there are signals associated with a better treatment response.

The second phase would last about three years. But there could be a gap between the two phases while NIH reviews the results of the pilot and determines whether to fund the next stage.