High hopes? Precision psychedelic addiction medicine

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Current addiction neuroscience research and neuroimaging investments have yielded poor clinical outcomes.
• A significant gap exists between mechanistic understanding of addiction and its clinical utility, with only 1.8% of individuals receiving effective treatment.
• A paradigm shift is needed to move from a diagnostic focus to a theragnostic framework utilizing biomarkers.

Purpose of the Study:

• To advocate for a reorientation of addiction neuroscience towards a theragnostic framework.
• To highlight the potential of integrating translational neuroimaging biomarkers (fMRI, EEG, PET) with psychedelic research to improve addiction treatment.
• To propose a roadmap for embedding biomarkers in clinical trials for addiction.

Main Methods:

• Reviewing neuroimaging paradigms (acute and pre-post) to index pharmacodynamic effects and treatment response to psychedelics.
• Co-developing multimodal biomarkers with clinical trials for gambling and opioid use disorders.
• Leveraging ongoing studies at the Centre for Psychedelic Research, Imperial College London.

Main Results:

• Psychedelic compounds like psilocybin engage key neurobiological networks central to addiction.
• Multimodal biomarkers can identify biotype-specific responses to psychedelic therapies.
• Validated biomarkers could serve as regulatory-grade tools for theragnostic co-development.

Conclusions:

• Psychedelic therapy, combined with a theragnostic approach and biomarker integration, offers a transformative potential for addiction medicine.
• This shift can enable personalized and precision-guided care, moving beyond symptomatic relief.
• Realizing this vision requires robust multi-stakeholder collaboration and investment in a scalable theragnostic infrastructure.