NIDA Awards Up to $3.5 Million for Psilocybin Study on Cocaine Addiction in Virginia

Dr. Albert Arias, division chief of addiction and psychiatry at Carilion Clinic in Roanoke, Virginia, has secured a federal grant from the National Institute on Drug Abuse to launch one of the first U.S. pilot studies examining psilocybin-assisted therapy for cocaine use disorder. The initial award of $623,000 could expand to as much as $3.5 million if early safety and efficacy data justify continued investment, according to a Carilion press release.

Cocaine use disorder has long defied pharmacological treatment. While opioids and alcohol addiction each have multiple FDA-approved medications, no such option exists for cocaine dependence. Behavioral therapies help some patients, but relapse rates remain high, and researchers have spent decades searching for a compound that can interrupt the brain changes cocaine inflicts on reward circuitry.

How the study is designed

Arias and his team plan to recruit roughly 27 participants who currently meet diagnostic criteria for cocaine use disorder and have used the drug within the past month. The study is open to the broader community, not only existing Carilion patients, and local partners may refer candidates.

Participants will be divided into three groups. Two will receive a single dose of either 25 or 40 milligrams of psilocybin—the psychoactive compound in so-called magic mushrooms—while the third will receive a 5-milligram active placebo. All groups will then undergo six weeks of observation. The active placebo is meant to address a well-known challenge in psychedelic research: the drug's pronounced perceptual effects make it easy for participants to guess whether they received the real compound, which can bias self-reported outcomes.

The two-year pilot will primarily assess safety and tolerability. If the data show that participants reduced or stopped cocaine use, NIDA will release a second round of funding for a larger, follow-up trial.

Why psilocybin for stimulant addiction

Researchers have several theories about why psilocybin might help disrupt addiction. One centers on neuroplasticity—the brain's ability to form new neural connections. Chronic cocaine use appears to impair this flexibility, trapping users in rigid patterns of craving and compulsive use. Psychedelics, by contrast, have been shown in animal and human studies to promote dendritic growth and synaptic remodeling, essentially allowing the brain to "rewire" itself away from addictive loops.

Another hypothesis involves what Arias described as the drug's "mystical" effects. In prior studies of depression and alcohol use disorder, participants who reported profound, meaning-laden experiences during psilocybin sessions also showed the strongest clinical improvements. These experiences may shift self-perception, increase openness, and weaken the grip of habitual behaviors.

Cocaine is particularly difficult to treat pharmacologically because it disrupts multiple neurotransmitter systems simultaneously. It blocks dopamine reuptake, floods serotonin pathways, and alters gene transcription in neurons. "It really can affect the brain and the neurons on a profound level," Arias said. That molecular complexity has stymied drug-development efforts that targeted single mechanisms.

Federal context and state preparation

The grant arrives amid a significant federal push to accelerate psychedelic research. In April 2026, President Trump signed an executive order directing the Department of Health and Human Services to speed development of psilocybin, MDMA, and ibogaine as treatments for serious mental illness and addiction. NIDA subsequently issued a funding opportunity specifically calling for studies that could advance psilocybin as an addiction therapy.

At the state level, Virginia has already taken steps to prepare for potential FDA approval of psilocybin. Senate Bill 379, passed during the 2026 General Assembly session, creates a mechanism for the Virginia Board of Pharmacy to automatically reschedule psilocybin within 30 days if the FDA approves a medically administered formulation and the federal government moves the compound out of Schedule I. Oregon and Colorado have gone further, licensing psilocybin service centers for adult use, while several other states have formed preparatory work groups.

The larger landscape of psychedelic addiction research

The Carilion study joins a small but growing body of evidence on psychedelics for stimulant use disorders. A randomized trial at the University of Alabama at Birmingham, published in May 2026 in JAMA Network Open, found that a single dose of psilocybin combined with cognitive behavioral therapy produced higher abstinence rates than placebo among 40 adults with cocaine use disorder. Thirty percent of the psilocybin group achieved complete abstinence at six months, versus none in the placebo condition.

That study focused on a low-income, predominantly Black population—a demographic historically excluded from psychedelic research. The Carilion trial's broader community recruitment could help extend generalizability to rural and Appalachian populations, where cocaine use disorder has risen alongside opioid mortality but treatment infrastructure remains sparse.

People seeking help for substance use disorders can find medication-assisted treatment programs and behavioral therapy options nationwide. For those interested in clinical trial participation, the NIH maintains a searchable database of federally funded addiction studies at clinicaltrials.gov.