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Vamvakopoulou IA, Nutt DJ. Psychedelics: From Cave Art to 21st-Century Medicine for Addiction. Eur Addict Res 2024:1-19. [PMID: 39321788 DOI: 10.1159/000540062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/25/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Psychedelic substance use in ritualistic and ceremonial settings dates back as early as 8,500 BCE. Only in recent years, from the mid-20th century, we have seen the re-emergence of psychedelics in a therapeutic setting and more specifically for the treatment of addiction. This article aims to review research over the past 40 years using classic (psilocybin, lysergic acid diethylamide [LSD], dimethyltryptamine [DMT], mescaline) and atypical (ketamine, ibogaine, 5-MeO-DMT, 3,4-methylenedioxymethamphetamine) psychedelics for the treatment of addiction. SUMMARY We will start with an overview of the pharmacology and physiological and psychological properties of psychedelic substances from pre-clinical and clinical research. We will then provide an overview of evidence gathered by studies conducted in controlled research environments and naturalistic and ceremonial settings, while we identify the proposed therapeutic mechanisms of each psychedelic substance. KEY MESSAGES Classic and atypical psychedelics show promise as therapeutic alternatives for the treatment of addiction, through the improvement of psychological and physiological symptoms of dependence. A more comprehensive understanding of the ancient and present-day knowledge of the therapeutic potential of psychedelics can facilitate hope for psychedelic therapeutics in the treatment of addiction, especially for individuals who have failed other conventional treatment methods.
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Affiliation(s)
- Ioanna A Vamvakopoulou
- Division of Brain Sciences, Centre for Psychiatry, Imperial College London, Commonwealth Building, Hammersmith Campus, London, UK,
| | - David J Nutt
- Division of Brain Sciences, Centre for Psychiatry, Imperial College London, Commonwealth Building, Hammersmith Campus, London, UK
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2
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Havel V, Kruegel AC, Bechand B, McIntosh S, Stallings L, Hodges A, Wulf MG, Nelson M, Hunkele A, Ansonoff M, Pintar JE, Hwu C, Ople RS, Abi-Gerges N, Zaidi SA, Katritch V, Yang M, Javitch JA, Majumdar S, Hemby SE, Sames D. Oxa-Iboga alkaloids lack cardiac risk and disrupt opioid use in animal models. Nat Commun 2024; 15:8118. [PMID: 39304653 DOI: 10.1038/s41467-024-51856-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 08/16/2024] [Indexed: 09/22/2024] Open
Abstract
Ibogaine and its main metabolite noribogaine provide important molecular prototypes for markedly different treatment of substance use disorders and co-morbid mental health illnesses. However, these compounds present a cardiac safety risk and a highly complex molecular mechanism. We introduce a class of iboga alkaloids - termed oxa-iboga - defined as benzofuran-containing iboga analogs and created via structural editing of the iboga skeleton. The oxa-iboga compounds lack the proarrhythmic adverse effects of ibogaine and noribogaine in primary human cardiomyocytes and show superior efficacy in animal models of opioid use disorder in male rats. They act as potent kappa opioid receptor agonists in vitro and in vivo, but exhibit atypical behavioral features compared to standard kappa opioid agonists. Oxa-noribogaine induces long-lasting suppression of morphine, heroin, and fentanyl intake after a single dose or a short treatment regimen, reversal of persistent opioid-induced hyperalgesia, and suppression of opioid drug seeking in rodent relapse models. As such, oxa-iboga compounds represent mechanistically distinct iboga analogs with therapeutic potential.
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MESH Headings
- Animals
- Humans
- Male
- Ibogaine/analogs & derivatives
- Ibogaine/pharmacology
- Ibogaine/therapeutic use
- Rats
- Myocytes, Cardiac/drug effects
- Myocytes, Cardiac/metabolism
- Opioid-Related Disorders/drug therapy
- Analgesics, Opioid/adverse effects
- Analgesics, Opioid/pharmacology
- Rats, Sprague-Dawley
- Disease Models, Animal
- Receptors, Opioid, kappa/metabolism
- Receptors, Opioid, kappa/agonists
- Receptors, Opioid, kappa/genetics
- Alkaloids/pharmacology
- Hyperalgesia/chemically induced
- Hyperalgesia/drug therapy
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Affiliation(s)
- Václav Havel
- Department of Chemistry, Columbia University, New York, NY, 10027, USA
| | - Andrew C Kruegel
- Department of Chemistry, Columbia University, New York, NY, 10027, USA
| | - Benjamin Bechand
- Department of Chemistry, Columbia University, New York, NY, 10027, USA
| | - Scot McIntosh
- Department of Basic Pharmaceutical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, NC, 27268, USA
| | - Leia Stallings
- Department of Basic Pharmaceutical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, NC, 27268, USA
| | - Alana Hodges
- Department of Basic Pharmaceutical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, NC, 27268, USA
| | - Madalee G Wulf
- Department of Chemistry, Columbia University, New York, NY, 10027, USA
| | - Mel Nelson
- Department of Molecular Pharmacology and Therapeutics, Columbia University, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Therapeutics, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Amanda Hunkele
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Center for Clinical Pharmacology, University of Health Sciences & Pharmacy at St Louis and Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Michael Ansonoff
- Department of Neuroscience and Cell Biology, Rutgers University, Piscataway, NJ, 08854, USA
| | - John E Pintar
- Department of Neuroscience and Cell Biology, Rutgers University, Piscataway, NJ, 08854, USA
- Rutgers Addiction Research Center, Brain Health Institute, Rutgers University, Piscataway, NJ, 08854, USA
| | - Christopher Hwu
- Department of Chemistry, Columbia University, New York, NY, 10027, USA
| | - Rohini S Ople
- Center for Clinical Pharmacology, University of Health Sciences & Pharmacy at St Louis and Washington University School of Medicine, St Louis, MO, 63110, USA
- Washington University Pain Center and Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Najah Abi-Gerges
- AnaBios Corporation, 1155 Island Ave, Suite 200, San Diego, CA, 92101, USA
| | - Saheem A Zaidi
- Department of Quantitative and Computational Biology, University of Southern California, Los Angeles, CA, 90089, USA
- Department of Chemistry, Bridge Institute, Michelson Center for Convergent Sciences, University of Southern California, Los Angeles, CA, 90089, USA
| | - Vsevolod Katritch
- Department of Quantitative and Computational Biology, University of Southern California, Los Angeles, CA, 90089, USA
- Department of Chemistry, Bridge Institute, Michelson Center for Convergent Sciences, University of Southern California, Los Angeles, CA, 90089, USA
| | - Mu Yang
- Mouse Neurobehavioral Core facility, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jonathan A Javitch
- Department of Molecular Pharmacology and Therapeutics, Columbia University, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
- Division of Molecular Therapeutics, New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Susruta Majumdar
- Department of Neurology and Molecular Pharmacology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Center for Clinical Pharmacology, University of Health Sciences & Pharmacy at St Louis and Washington University School of Medicine, St Louis, MO, 63110, USA
- Washington University Pain Center and Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Scott E Hemby
- Department of Basic Pharmaceutical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, NC, 27268, USA
| | - Dalibor Sames
- Department of Chemistry, Columbia University, New York, NY, 10027, USA.
- The Zuckerman Mind Brain Behavior Institute at Columbia University, New York, NY, USA.
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Wong S, Yu AY, Fabiano N, Finkelstein O, Pasricha A, Jones BDM, Rosenblat JD, Blumberger DM, Mulsant BH, Husain MI. Beyond Psilocybin: Reviewing the Therapeutic Potential of Other Serotonergic Psychedelics in Mental and Substance Use Disorders. J Psychoactive Drugs 2024; 56:513-529. [PMID: 37615379 DOI: 10.1080/02791072.2023.2251133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/25/2023]
Abstract
There has been a resurgence of interest in the use of psychedelic therapies for several mental and substance use disorders. Psilocybin, a "classic" serotonergic psychedelic, has emerged as one of the primary compounds of interest in clinical research. While research on psilocybin's potential mental health benefits has grown, data on the safety and efficacy of other serotonergic psychedelics remain limited. A comprehensive scoping review on the use of mescaline, ibogaine, ayahuasca, N,N-dimethyltryptamine (DMT), and lysergic acid diethylamide (LSD) in the treatment of mental and substance disorders was conducted. Independent reviewers screened titles, abstracts, and full texts and conducted data extraction. Seventy-seven studies met the inclusion criteria. There were 43 studies of LSD, 24 studies of ayahuasca, 5 studies of DMT, 5 studies of ibogaine, and 5 studies of mescaline. Commonly reported benefits included improved mood and anxiety symptoms, improved insight, reduced substance use, improved relationships, and decreased vegetative symptoms. Commonly reported adverse effects were psychological, neurological, physical, and gastrointestinal in nature. Serious adverse events (homicide and suicide) were reported in published studies of LSD. In conclusion, there is only low-level evidence to support the safety and efficacy of non-psilocybin serotonergic psychedelics in individuals with mental and substance use disorders.
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Affiliation(s)
- Stanley Wong
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - An Yi Yu
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Fabiano
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Ofer Finkelstein
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Aryan Pasricha
- Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Brett D M Jones
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joshua D Rosenblat
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Mood Disorder Psychopharmacology Unit, Unity Health Network, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - M Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Hughes ME, Garcia-Romeu A. Ethnoracial inclusion in clinical trials of psychedelics: a systematic review. EClinicalMedicine 2024; 74:102711. [PMID: 39050106 PMCID: PMC11268117 DOI: 10.1016/j.eclinm.2024.102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
Background Prior data indicate limited ethnoracial diversity in studies testing psychedelic-assisted treatments. Regulatory approval for psychedelic treatments may be imminent given growing evidence for safety and efficacy in a variety of psychiatric conditions. Data on racial and ethnic inclusion rates in clinical psychedelic studies since 2018 have not been systematically reported to date. With the publication of multiple new studies in the field, an update to existing ethnoracial inclusion data is needed to inform the state of the science and future directions for research. Methods Systematic review of Pubmed/MEDLINE, EMBASE, and Web of Science for studies of any design testing a psychedelic treatment for a psychiatric or substance use disorder published between January 1, 1994 and May 24, 2024. Search terms related to serotonergic psychedelics and MDMA, psychedelic therapies, psychiatric disorders, and substance use disorders were used. References of reviewed studies were screened for inclusion. Studies were rated for quality on a five-point scale ranging from 1 (most rigorous, i.e., properly powered randomized clinical trial) to 5 (least rigorous, e.g., case reports). Separate analyses were performed for two groups of studies, one involving all included studies meeting search criteria, and the other involving only studies from the USA. Rates of inclusion of different ethnoracial groups were calculated between studies published before and after December 31, 2017. Additionally, the proportion of White vs. non-White participants was compared between studies published before and after December 31, 2017. Finally, a nonparametric Mann-Whitney U test was used to compare the relative quality ratings of studies published before and after December 31, 2017. Findings 787 studies were screened, and 39 studies were included. This included 16 studies (n = 282) from a prior review published in 2018 with an additional 23 studies (n = 1111) that were published after 2017, consisting of 14 randomized controlled studies, 8 open-label studies, and 1 placebo-controlled, within-subject, fixed-order study. In all included studies published after 2017, 85.6% of participants identified as non-Hispanic White, 3.1% as Black, 6.8% as Latinx/Hispanic, 3.6% as Asian, 1.2% as Indigenous, 3.5% as mixed race, 1.4% as other, Pooled data from all included studies (n = 1393) found 85.0% of participants identified as non-Hispanic White, 2.9% as Black, 5.9% as Latinx/Hispanic, 3.2% as Asian, 1.9% as Indigenous, 3.7% as mixed race, 1.4% as other. In studies conducted in the USA (n = 1074), 908 (84.5%) of participants identified as White, 36 (3.4%) as Black, 80 (7.4%) as Latinx/Hispanic, 43 (4.0%) as Asian, 15 (1.4%) as Indigenous, 40 (3.7%) as Mixed, and 9 (0.8%) as Other. Differences in inclusion rates were found when comparing studies published before and after December 31, 2017 for all included studies and all studies conducted in the USA. The proportion of White to non-White participants was found to have decreased in studies conducted in the USA over the same period, but not for all included studies. Interpretation Underrepresentation of ethnoracial minoritized populations persists in studies examining psychedelic therapies, despite growing calls for diversity. Non-Hispanic White participants remain an over-represented majority by a large margin, though, there were greater proportions of ethnic minoritized populations included in studies since 2018, particularly in studies conducted in the USA. This indicates progress towards equity in psychedelic research, though much work is needed to inform the safety and efficacy of psychedelic treatments in the general population. Funding There was no funding source for this study.
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Affiliation(s)
- Marcus E. Hughes
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Interventional Psychiatry Service, Yale Psychiatric Hospital, New Haven, CT, USA
| | - Albert Garcia-Romeu
- Center for Psychedelic and Consciousness Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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5
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Castro-Nin JP, Serantes D, Rodriguez P, Gonzalez B, Carrera I, Torterolo P, González J. Noribogaine acute administration in rats promotes wakefulness and suppresses REM sleep. Psychopharmacology (Berl) 2024; 241:1417-1426. [PMID: 38467891 DOI: 10.1007/s00213-024-06572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
Ibogaine is a potent atypical psychedelic that has gained considerable attention due to its antiaddictive and antidepressant properties in preclinical and clinical studies. Previous research from our group showed that ibogaine suppresses sleep and produces an altered wakefulness state, which resembles natural REM sleep. However, after systemic administration, ibogaine is rapidly metabolized to noribogaine, which also shows antiaddictive effects but with a distinct pharmacological profile, making this drug a promising therapeutic candidate. Therefore, we still ignore whether the sleep/wake alterations depend on ibogaine or its principal metabolite noribogaine. To answer this question, we conducted polysomnographic recordings in rats following the administration of pure noribogaine. Our results show that noribogaine promotes wakefulness while reducing slow-wave sleep and blocking REM sleep, similar to our previous results reported for ibogaine administration. Thus, we shed new evidence on the mechanisms by which iboga alkaloids work in the brain.
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Affiliation(s)
- Juan Pedro Castro-Nin
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, 11800, Uruguay
| | - Diego Serantes
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, 11800, Uruguay
| | - Paola Rodriguez
- Laboratorio de Síntesis Orgánica, Departamento de Química Orgánica, Facultad de Química, Universidad de la República, Montevideo, 11800, Uruguay
| | - Bruno Gonzalez
- Laboratorio de Síntesis Orgánica, Departamento de Química Orgánica, Facultad de Química, Universidad de la República, Montevideo, 11800, Uruguay
| | - Ignacio Carrera
- Laboratorio de Síntesis Orgánica, Departamento de Química Orgánica, Facultad de Química, Universidad de la República, Montevideo, 11800, Uruguay
| | - Pablo Torterolo
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, 11800, Uruguay.
| | - Joaquín González
- Departamento de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, 11800, Uruguay.
- Brain Institute, Federal University of Rio Grande do Norte, Natal, RN, 59078, Brazil.
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Arenson A, Campbell CI, Remler I. Psychoactive plant derivatives (ayahuasca, ibogaine, kratom) and their application in opioid withdrawal and use disorder - a narrative review. J Addict Dis 2024; 42:253-263. [PMID: 37199191 DOI: 10.1080/10550887.2023.2195777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The opioid epidemic and limited access to treatment for opioid withdrawal (OW) and opioid use disorder (OUD) has led individuals to seek alternative treatments. This narrative review aims to educate clinicians on the mechanisms of action, toxicity, and applications of psychoactive plant-based substances patients may be using to self-treat OUD and OW. We specifically discuss ayahuasca, ibogaine, and kratom as they have the most evidence for applications in OUD and OW from the last decade (2012-2022). Evidence suggests these substances may have efficacy in treating OW and OUD through several therapeutic mechanisms including their unique pharmacodynamic effects, rituals performed around ingestion, and increased neuroplasticity. The current evidence for their therapeutic application in OUD and OW is primarily based on small observational studies or animal studies. High-quality, longitudinal studies are needed to clarify safety and efficacy of these substances in treatment of OW and OUD.
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Affiliation(s)
- Alexandra Arenson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Cynthia I Campbell
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Ilan Remler
- Addiction Medicine and Recovery Services, Kaiser Permanente San Leandro Medical Center, San Leandro, CA, USA
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Mestre D, Paula A, Gil FP, Vaz J. Multiple Episodes of Cardiac Arrest Induced by Treatment With Ibogaine: A Case Report. Cureus 2024; 16:e63487. [PMID: 39081435 PMCID: PMC11287021 DOI: 10.7759/cureus.63487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2024] [Indexed: 08/02/2024] Open
Abstract
Opioid dependence is a common problem, and therapeutic alternatives are scarce and ineffective. Ibogaine, illegal in several countries, has been reported as a possible therapy in alternative clinics and it is also used as a recreational drug, despite its cardiotoxic potential, including QT prolongation. We report a case of long QT leading to multiple episodes of cardiac arrest after a single dose of ibogaine (200mg, 2.6mg/Kg) in a patient without structural heart disease. This case highlights the fact that even low doses of ibogaine can be lethal and warns us about the consequences of its use.
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Affiliation(s)
- David Mestre
- Intensive Care Unit, Hospital José Joaquim Fernandes, Beja, PRT
| | - Alexandra Paula
- Intensive Care Unit, Hospital José Joaquim Fernandes, Beja, PRT
| | - Francisco P Gil
- Intensive Care Unit, Hospital José Joaquim Fernandes, Beja, PRT
| | - José Vaz
- Intensive Care Unit, Hospital José Joaquim Fernandes, Beja, PRT
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8
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Trimzi A, Campbell M. Can Past Psychedelic Use Mitigate the Severity of Opioid Use Disorder?: Case Report of a Musician. Dela J Public Health 2024; 10:50-52. [PMID: 38966344 PMCID: PMC11221875 DOI: 10.32481/djph.2024.06.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
Little is known about the association between psychedelic use and substance abuse in the general population. We present a case of an award winning musician with an extensive history of hallucinogen use during his early life and how this impacted his overall wellbeing and opioid experience.
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Atiq MA, Baker MR, Voort JLV, Vargas MV, Choi DS. Disentangling the acute subjective effects of classic psychedelics from their enduring therapeutic properties. Psychopharmacology (Berl) 2024:10.1007/s00213-024-06599-5. [PMID: 38743110 DOI: 10.1007/s00213-024-06599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
Recent research with classic psychedelics suggests significant therapeutic potential, particularly for neuropsychiatric disorders. A mediating influence behind symptom resolution is thought to be the personal insight - at times, bordering on the mystical - one acquires during the acute phase of a psychedelic session. Indeed, current clinical trials have found strong correlations between the acute subjective effects (ASE) under the influence of psychedelics and their enduring therapeutic properties. However, with potential barriers to widespread clinical implementation, including the healthcare resource-intensive nature of psychedelic sessions and the exclusion of certain at-risk patient groups, there is an active search to determine whether ASE elimination can be accompanied by the retention of persisting therapeutic benefits of these class of compounds. Recognizing the aberrant underlying neural circuitry that characterizes a range of neuropsychiatric disorders, and that classic psychedelics promote neuroplastic changes that may correct abnormal circuitry, investigators are rushing to design and discover compounds with psychoplastogenic, but not hallucinogenic (i.e., ASE), therapeutic potential. These efforts have paved the discovery of 'non-psychedelic/subjective psychedelics', or compounds that lack hallucinogenic activity but with therapeutic efficacy in preclinical models. This review aims to distill the current evidence - both clinical and preclinical - surrounding the question: can the ASE of classic psychedelics be dissociated from their sustained therapeutic properties? Several plausible clinical scenarios are then proposed to offer clarity on and potentially answer this question.
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Affiliation(s)
- Mazen A Atiq
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Matthew R Baker
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Jennifer L Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Maxemiliano V Vargas
- Institute for Psychedelics and Neurotherapeutics, University of California, Davis, Davis, CA, USA
| | - Doo-Sup Choi
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Yuan S, Jiang SC, Zhang ZW, Li ZL, Hu J. Substance Addiction Rehabilitation Drugs. Pharmaceuticals (Basel) 2024; 17:615. [PMID: 38794185 PMCID: PMC11124501 DOI: 10.3390/ph17050615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
The relapse rate of substance abusers is high, and addiction rehabilitation adjunct drugs need to be developed urgently. There have been numerous reports on blocking the formation of substance addiction, but studies on drugs that can alleviate withdrawal symptoms are very limited. Both the dopamine transporter (DAT) hypothesis and D3 dopamine receptor (D3R) hypothesis are proposed. DAT activators reduce the extracellular dopamine level, and D3R antagonists reduce the neuron's sensitivity to dopamine, both of which may exacerbate the withdrawal symptoms subsequently. The D3R partial agonist SK608 has biased signaling properties via the G-protein-dependent pathway but did not induce D3R desensitization and, thus, may be a promising drug for the withdrawal symptoms. Drugs for serotoninergic neurons or GABAergic neurons and anti-inflammatory drugs may have auxiliary effects to addiction treatments. Drugs that promote structural synaptic plasticity are also discussed.
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Affiliation(s)
- Shu Yuan
- College of Resources, Sichuan Agricultural University, Chengdu 611130, China;
| | - Si-Cong Jiang
- Haisco Pharmaceutical Group Comp. Ltd., Chengdu 611138, China;
| | - Zhong-Wei Zhang
- College of Resources, Sichuan Agricultural University, Chengdu 611130, China;
| | - Zi-Lin Li
- Department of Cardiovascular Surgery, Xijing Hospital, Medical University of the Air Force, Xi’an 710032, China;
| | - Jing Hu
- School of Medicine, Northwest University, Xi’an 710069, China;
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de Wit L, Hendriks H, van Engelen J, Heusinkveld H, Kienhuis A, Rorije E, Woutersen M, van der Zee M, Jeurissen S. New Approach Methodologies (NAMs) for ad hoc human health risk assessment of food and non-food products - Proceedings of a workshop. Regul Toxicol Pharmacol 2024; 149:105615. [PMID: 38555098 DOI: 10.1016/j.yrtph.2024.105615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/18/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
RIVM convened a workshop on the use of New Approach Methodologies (NAMs) for the ad hoc human health risk assessment of food and non-food products. Central to the workshop were two case studies of marketed products with a potential health concern: the botanical Tabernanthe iboga which is used to facilitate mental or spiritual insight or to (illegally) treat drug addiction and is associated with cardiotoxicity, and dermal creams containing female sex hormones, intended for use by perimenopausal women to reduce menopause symptoms without medical supervision. The workshop participants recognized that data from NAM approaches added valuable information for the ad hoc risk assessment of these products, although the available approaches were inadequate to derive health-based guidance values. Recommendations were provided on how to further enhance and implement NAM approaches in regulatory risk assessment, specifying both scientific and technical aspects as well as stakeholder engagement aspects.
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Affiliation(s)
- Lianne de Wit
- RIVM, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands
| | - Hester Hendriks
- RIVM, Centre for Safety of Substances and Products, Bilthoven, the Netherlands.
| | | | | | - Anne Kienhuis
- RIVM, Centre for Health Protection, Bilthoven, the Netherlands
| | - Emiel Rorije
- RIVM, Centre for Safety of Substances and Products, Bilthoven, the Netherlands
| | - Marjolijn Woutersen
- RIVM, Centre for Safety of Substances and Products, Bilthoven, the Netherlands
| | | | - Suzanne Jeurissen
- RIVM, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands
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Knuijver T, ter Heine R, Schellekens AFA, Heydari P, Lucas L, Westra S, Belgers M, van Oosteren T, Verkes RJ, Kramers C. The pharmacokinetics and pharmacodynamics of ibogaine in opioid use disorder patients. J Psychopharmacol 2024; 38:481-488. [PMID: 38519421 PMCID: PMC11102648 DOI: 10.1177/02698811241237873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Ibogaine is a hallucinogenic drug that may be used to treat opioid use disorder (OUD). The relationships between pharmacokinetics (PKs) of ibogaine and its metabolites and their clinical effects on side effects and opioid withdrawal severity are unknown. We aimed to study these relationships in patients with OUD undergoing detoxification supported by ibogaine. METHODS The study was performed in 14 subjects with OUD. They received a single dose of 10mg/kg ibogaine hydrochloride. Plasma PKs of ibogaine, noribogaine, and noribogaine glucuronide were obtained during 24 h. Cytochrome P450 isoenzyme 2D6 (CYP2D6) genotyping was performed. The PKs were analyzed by means of nonlinear mixed effects modeling and related with corrected QT interval (QTc) prolongation, cerebellar ataxia, and opioid withdrawal severity. RESULTS The PK of ibogaine were highly variable and significantly correlated to CYP2D6 genotype (p < 0.001). The basic clearance of ibogaine (at a CYP2D6 activity score (AS) of 0) was 0.82 L/h. This increased with 30.7 L/h for every point of AS. The relation between ibogaine plasma concentrations and QTc was best described by a sigmoid Emax model. Spearman correlations were significant (p < 0.03) for ibogaine but not noribogaine with QTc (p = 0.109) and cerebellar effects (p = 0.668); neither correlated with the severity of opioid withdrawal symptoms. CONCLUSIONS The clearance of ibogaine is strongly related to CYPD2D6 genotype. Ibogaine cardiac side effects (QTc time) and cerebellar effects are most likely more driven by ibogaine rather than noribogaine. Future studies should aim at exploring lower doses and/or applying individualized dosing based on CYP2D6 genotype.
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Affiliation(s)
- Thomas Knuijver
- IrisZorg, Nijmegen, The Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands
| | - Rob ter Heine
- Department of Pharmacy, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
| | - Arnt F. A. Schellekens
- Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands
- Department of Psychiatry, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
| | - Paniz Heydari
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Luc Lucas
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sjoerd Westra
- Department of Cardiology, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
| | - Maarten Belgers
- IrisZorg, Nijmegen, The Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands
| | | | - Robbert Jan Verkes
- Department of Psychiatry, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
- Pompestichting, Nijmegen, The Netherlands
| | - Cornelis Kramers
- Department of Pharmacy, Research Institute for Medical Innovation, Radboudumc, Nijmegen, The Netherlands
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Hilal FF, Jeanblanc J, Deschamps C, Naassila M, Pierrefiche O, Ben Hamida S. Epigenetic drugs and psychedelics as emerging therapies for alcohol use disorder: insights from preclinical studies. J Neural Transm (Vienna) 2024; 131:525-561. [PMID: 38554193 DOI: 10.1007/s00702-024-02757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/22/2024] [Indexed: 04/01/2024]
Abstract
Alcohol use disorder (AUD) is a public health issue that affects millions of people worldwide leading to physical, mental and socio-economic consequences. While current treatments for AUD have provided relief to individuals, their effectiveness on the long term is often limited, leaving a number of affected individuals without sustainable solutions. In this review, we aim to explore two emerging approaches for AUD: psychedelics and epigenetic drugs (i.e., epidrugs). By examining preclinical studies, different animal species and procedures, we delve into the potential benefits of each of these treatments in terms of addictive behaviors (alcohol drinking and seeking, motivation to drink alcohol and prevention of relapse). Because psychedelics and epidrugs may share common and complementary mechanisms of action, there is an exciting opportunity for exploring synergies between these approaches and their parallel effectiveness in treating AUD and the diverse associated psychiatric conditions.
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Affiliation(s)
- Fahd François Hilal
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France
| | - Jerome Jeanblanc
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France
| | - Chloé Deschamps
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France
| | - Mickael Naassila
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France.
| | - Olivier Pierrefiche
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France
| | - Sami Ben Hamida
- INSERM UMR 1247-Research Group on Alcohol and Pharmacodependences (GRAP), Université de Picardie Jules Verne, Chemin du Thil - Centre Universitaire de Recherche en Santé, 80025, Amiens, France.
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14
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Cherian K, Shinozuka K, Tabaac BJ, Arenas A, Beutler BD, Evans VD, Fasano C, Muir OS. Psychedelic Therapy: A Primer for Primary Care Clinicians-Ibogaine. Am J Ther 2024; 31:e133-e140. [PMID: 38518270 DOI: 10.1097/mjt.0000000000001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Ibogaine is a plant-derived alkaloid that has been used for thousands of years in rites of passage and spiritual ceremonies in West-Central Africa. In the West, it has primarily been used and studied for its anti-addictive properties and more recently for other neuropsychiatric indications, including post-traumatic stress disorder, depression, anxiety, and traumatic brain injury. AREAS OF UNCERTAINTY Ibogaine requires careful patient screening and monitoring because of significant safety issues. There is potential for cardiotoxicity (prolonged QT interval); without rigorous screening, fatal arrhythmias may occur. However, preliminary research suggests that co-administration of ibogaine with magnesium may mitigate cardiotoxicity. Additionally, ibogaine may have dangerous interactions with opiates, so patients who receive ibogaine treatment for opioid use disorder must withdraw from long-acting opioids. Other potential concerning effects of ibogaine include rare incidences of mania or psychosis. Anticipated transient effects during ibogaine treatment can include ataxia, tremors, and gastrointestinal symptoms. THERAPEUTIC ADVANCES Robust effects after a single treatment with ibogaine have been reported. In open-label and randomized controlled trials (RCTs), ibogaine reduces heroin and opioid cravings by upwards of 50%, up to 24 weeks after the treatment. An observational study of 30 Special Operations Forces veterans with mild traumatic brain injury reported that 86% were in remission from post-traumatic stress disorder, 83% from depression, and 83% from anxiety, one month after a single-dose ibogaine treatment. LIMITATIONS Although there are several observational and open-label studies, there is only a single double-blind, placebo-controlled RCT on ibogaine. More RCTs with large sample sizes must be conducted to support ibogaine's safety and efficacy. CONCLUSIONS Given the promising preliminary findings, ibogaine could potentially fill a much-needed gap in treatments for challenging conditions, including opioid dependence. Ibogaine's remarkable effects in traditionally treatment-resistant, combat-exposed individuals hints at its potential in broader populations with physical and psychological trauma.
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Affiliation(s)
- Kirsten Cherian
- Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Kenneth Shinozuka
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Burton J Tabaac
- University of Nevada, Reno School of Medicine, Reno, NV
- Department of Neurology, Carson Tahoe Health, Carson City, NV
| | - Alejandro Arenas
- Department of Anesthesiology, University of Washington School of Medicine, Seattle, WA
| | - Bryce D Beutler
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Viviana D Evans
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Owen S Muir
- Fermata Health, Brooklyn, NY; and
- Acacia Clinics, Sunnyvale, CA
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15
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Glynos NG, Aday JS, Kruger D, Boehnke KF, Lake S, Lucas P. Psychedelic substitution: altered substance use patterns following psychedelic use in a global survey. Front Psychiatry 2024; 15:1349565. [PMID: 38455520 PMCID: PMC10917882 DOI: 10.3389/fpsyt.2024.1349565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Recent research suggests that psychedelics may have potential for the treatment of various substance use disorders. However, most studies to date have been limited by small sample sizes and neglecting to include non-North American and European populations. Methods We conducted a global, cross-sectional online survey of adults (n = 5,268, 47.2% women) self-reporting past or current psychedelic use and investigated whether psychedelic use was associated with changes in use of other substances. Results Nearly three-quarters (70.9%; n = 3,737/5,268) reported ceasing or decreasing use of one or more non-psychedelic substances after naturalistic psychedelic use. Among those with previous use, 60.6% (n = 2,634/4,344) decreased alcohol use, 55.7% (n = 1,223/2,197) decreased antidepressant use, and 54.2% (n = 767/1,415) decreased use of cocaine/crack. Over a quarter of the sample indicated that their decrease in substance use persisted for 26 weeks or more following use of a psychedelic. Factors associated with decreased use included a motivation to either decrease one's substance use or self-treat a medical condition. Importantly, 19.8% of respondents also reported increased or initiated use of one or more other substances after psychedelic use, with illicit opioids (14.7%; n = 86/584) and cannabis (13.3%; n = 540/4,064) having the highest proportions. Factors associated with increased substance use included having a higher income and residing in Canada or the US. Discussion Although limited by cross-sectional study design, this large observational study will help inform future studies aiming to investigate the relationship between substance use patterns and psychedelic use.
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Affiliation(s)
- Nicolas G. Glynos
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Abor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Jacob S. Aday
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Abor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Kruger
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
| | - Kevin F. Boehnke
- Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, United States
- Chronic Pain and Fatigue Research Center, University of Michigan Medical School, Ann Abor, MI, United States
- Michigan Psychedelic Center, University of Michigan, Ann Arbor, MI, United States
| | - Stephanie Lake
- University of California Los Angeles (UCLA) Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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16
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Cherian KN, Keynan JN, Anker L, Faerman A, Brown RE, Shamma A, Keynan O, Coetzee JP, Batail JM, Phillips A, Bassano NJ, Sahlem GL, Inzunza J, Millar T, Dickinson J, Rolle CE, Keller J, Adamson M, Kratter IH, Williams NR. Magnesium-ibogaine therapy in veterans with traumatic brain injuries. Nat Med 2024; 30:373-381. [PMID: 38182784 PMCID: PMC10878970 DOI: 10.1038/s41591-023-02705-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/10/2023] [Indexed: 01/07/2024]
Abstract
Traumatic brain injury (TBI) is a leading cause of disability. Sequelae can include functional impairments and psychiatric syndromes such as post-traumatic stress disorder (PTSD), depression and anxiety. Special Operations Forces (SOF) veterans (SOVs) may be at an elevated risk for these complications, leading some to seek underexplored treatment alternatives such as the oneirogen ibogaine, a plant-derived compound known to interact with multiple neurotransmitter systems that has been studied primarily as a treatment for substance use disorders. Ibogaine has been associated with instances of fatal cardiac arrhythmia, but coadministration of magnesium may mitigate this concern. In the present study, we report a prospective observational study of the Magnesium-Ibogaine: the Stanford Traumatic Injury to the CNS protocol (MISTIC), provided together with complementary treatment modalities, in 30 male SOVs with predominantly mild TBI. We assessed changes in the World Health Organization Disability Assessment Schedule from baseline to immediately (primary outcome) and 1 month (secondary outcome) after treatment. Additional secondary outcomes included changes in PTSD (Clinician-Administered PTSD Scale for DSM-5), depression (Montgomery-Åsberg Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale). MISTIC resulted in significant improvements in functioning both immediately (Pcorrected < 0.001, Cohen's d = 0.74) and 1 month (Pcorrected < 0.001, d = 2.20) after treatment and in PTSD (Pcorrected < 0.001, d = 2.54), depression (Pcorrected < 0.001, d = 2.80) and anxiety (Pcorrected < 0.001, d = 2.13) at 1 month after treatment. There were no unexpected or serious adverse events. Controlled clinical trials to assess safety and efficacy are needed to validate these initial open-label findings. ClinicalTrials.gov registration: NCT04313712 .
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Affiliation(s)
- Kirsten N Cherian
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Jackob N Keynan
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Lauren Anker
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Afik Faerman
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | | | - Ahmed Shamma
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Or Keynan
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - John P Coetzee
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
- Polytrauma Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jean-Marie Batail
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Angela Phillips
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Nicholas J Bassano
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Gregory L Sahlem
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Jose Inzunza
- Ambio Life Sciences, Vancouver, British Columbia, Canada
| | - Trevor Millar
- Ambio Life Sciences, Vancouver, British Columbia, Canada
| | | | - C E Rolle
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Jennifer Keller
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Maheen Adamson
- WRIISC-WOMEN & Department of Rehabilitation, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, USA
| | - Ian H Kratter
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Nolan R Williams
- Brain Stimulation Lab, Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA.
- Department of Radiology, Stanford School of Medicine, Stanford, CA, USA.
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17
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Ona G, Reverte I, Rossi GN, Dos Santos RG, Hallak JE, Colomina MT, Bouso JC. Main targets of ibogaine and noribogaine associated with its putative anti-addictive effects: A mechanistic overview. J Psychopharmacol 2023; 37:1190-1200. [PMID: 37937505 DOI: 10.1177/02698811231200882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND There is a growing interest in studying ibogaine (IBO) as a potential treatment for substance use disorders (SUDs). However, its clinical use has been hindered for mainly two reasons: First, the lack of randomized, controlled studies informing about its safety and efficacy. And second, IBO's mechanisms of action remain obscure. It has been challenging to elucidate a predominant mechanism of action responsible for its anti-addictive effects. OBJECTIVE To describe the main targets of IBO and its main metabolite, noribogaine (NOR), in relation to their putative anti-addictive effects, reviewing the updated literature available. METHODS A comprehensive search involving MEDLINE and Google Scholar was undertaken, selecting papers published until July 2022. The inclusion criteria were both theoretical and experimental studies about the pharmacology of IBO. Additional publications were identified in the references of the initial papers. RESULTS IBO and its main metabolite, NOR, can modulate several targets associated with SUDs. Instead of identifying key targets, the action of IBO should be understood as a complex modulation of multiple receptor systems, leading to potential synergies. The elucidation of IBO's pharmacology could be enhanced through the application of methodologies rooted in the polypharmacology paradigm. Such approaches possess the capability to describe multifaceted patterns within multi-target drugs. CONCLUSION IBO displays complex effects through multiple targets. The information detailed here should guide future research on both mechanistic and therapeutic studies.
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Affiliation(s)
- Genís Ona
- International Center for Ethnobotanical Education, Research, and Service (ICEERS), Barcelona, Spain
- Department of Psychology and Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Tarragona, Spain
- Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, Spain
| | - Ingrid Reverte
- Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
- Santa Lucia Foundation (IRCCS Fondazione Santa Lucia), Rome, Italy
| | - Giordano N Rossi
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rafael G Dos Santos
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute for Translational Medicine (INCT-TM), CNPq, Ribeirão Preto (SP), Brazil
| | - Jaime Ec Hallak
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute for Translational Medicine (INCT-TM), CNPq, Ribeirão Preto (SP), Brazil
| | - Maria Teresa Colomina
- Department of Psychology and Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Tarragona, Spain
| | - José Carlos Bouso
- International Center for Ethnobotanical Education, Research, and Service (ICEERS), Barcelona, Spain
- Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, Spain
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Cameron LP, Benetatos J, Lewis V, Bonniwell EM, Jaster AM, Moliner R, Castrén E, McCorvy JD, Palner M, Aguilar-Valles A. Beyond the 5-HT 2A Receptor: Classic and Nonclassic Targets in Psychedelic Drug Action. J Neurosci 2023; 43:7472-7482. [PMID: 37940583 PMCID: PMC10634557 DOI: 10.1523/jneurosci.1384-23.2023] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/13/2023] [Accepted: 08/18/2023] [Indexed: 11/10/2023] Open
Abstract
Serotonergic psychedelics, such as psilocybin and LSD, have garnered significant attention in recent years for their potential therapeutic effects and unique mechanisms of action. These compounds exert their primary effects through activating serotonin 5-HT2A receptors, found predominantly in cortical regions. By interacting with these receptors, serotonergic psychedelics induce alterations in perception, cognition, and emotions, leading to the characteristic psychedelic experience. One of the most crucial aspects of serotonergic psychedelics is their ability to promote neuroplasticity, the formation of new neural connections, and rewire neuronal networks. This neuroplasticity is believed to underlie their therapeutic potential for various mental health conditions, including depression, anxiety, and substance use disorders. In this mini-review, we will discuss how the 5-HT2A receptor activation is just one facet of the complex mechanisms of action of serotonergic psychedelics. They also interact with other serotonin receptor subtypes, such as 5-HT1A and 5-HT2C receptors, and with neurotrophin receptors (e.g., tropomyosin receptor kinase B). These interactions contribute to the complexity of their effects on perception, mood, and cognition. Moreover, as psychedelic research advances, there is an increasing interest in developing nonhallucinogenic derivatives of these drugs to create safer and more targeted medications for psychiatric disorders by removing the hallucinogenic properties while retaining the potential therapeutic benefits. These nonhallucinogenic derivatives would offer patients therapeutic advantages without the intense psychedelic experience, potentially reducing the risks of adverse reactions. Finally, we discuss the potential of psychedelics as substrates for post-translational modification of proteins as part of their mechanism of action.
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Affiliation(s)
- Lindsay P Cameron
- Department of Psychiatry, Stanford University, Palo Alto 94305, California
| | - Joseph Benetatos
- Department of Neurosciences, University of California-San Diego, La Jolla 92093, California
| | - Vern Lewis
- Department of Neuroscience, Carleton University, Ottawa K1S 5B6, Ontario Canada
| | - Emma M Bonniwell
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee 53226, Wisconsin
| | - Alaina M Jaster
- Pharmacology and Toxicology, Physiology and Biophysics, Virginia Commonwealth University, Richmond 23298, Virginia
| | - Rafael Moliner
- Neuroscience Center, HiLIFE and Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | - Eero Castrén
- Neuroscience Center, HiLIFE and Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki 00014, Finland
| | - John D McCorvy
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee 53226, Wisconsin
| | - Mikael Palner
- Clinical Physiology and Nuclear Medicine, Department Clinical Research, University of Southern Denmark, Odense DK-2100, Denmark
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Fernandes-Nascimento MH, Negrão AB, Viana-Ferreira K, Chaves BDR, Wang YP. Three Decades of Research on the Development of Ibogaine Treatment of Substance Use Disorders: A Scientometric Analysis. J Psychoactive Drugs 2023:1-11. [PMID: 37927218 DOI: 10.1080/02791072.2023.2276230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
Ibogaine is a natural psychoactive drug that has been investigated for its potential role in the treatment of substance use disorders since the mid-1960s. To evaluate the interest in ibogaine's use as a therapeutic agent, we performed a scientometric analysis covering the last three decades (1993-2002, 2003-2012, and 2013-2022). A complementary analysis was performed to select and describe published clinical trials and meta-analyses. A total of 1523 references were found. Linear growth of publications in the first and third decades were identified, and the average number of publications from 1993 to 2002 was lower than that in the other two decades. Researchers from five continents were identified. Globally, academic research centers in the United States and Canada were the most productive. Cocaine, tobacco, morphine, and alcohol prevailed as major keywords in the first two decades and opioids and psychedelics were included in the third decade. A few key authors were the most co-referenced. One preclinical meta-analysis and no meta-analysis in humans were found. Research trends for ibogaine are widespread, growing, and consonant with current attentiveness in drug abuse. Our findings support the pressing need for rigorous clinical research on ibogaine to evaluate its efficacy and safety.
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Affiliation(s)
- Maria Helha Fernandes-Nascimento
- Programa de Pós-Graduação, Fisiopatologia Experimental, Departamento de Patologia, Faculdade Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - André Brooking Negrão
- Instituto Perdizes, Hospital das Clínicas (HCFMUSP), Faculdade Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karine Viana-Ferreira
- Programa de Pós-Graduação, Fisiopatologia Experimental, Departamento de Patologia, Faculdade Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Yuan-Pang Wang
- Instituto de Psiquiatria (LIM-23), Hospital das Clínicas (HCFMUSP), Faculdade Medicina, Universidade de São Paulo, São Paulo, Brazil
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20
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Salinsky LM, Merritt CR, Zamora JC, Giacomini JL, Anastasio NC, Cunningham KA. μ-opioid receptor agonists and psychedelics: pharmacological opportunities and challenges. Front Pharmacol 2023; 14:1239159. [PMID: 37886127 PMCID: PMC10598667 DOI: 10.3389/fphar.2023.1239159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
Opioid misuse and opioid-involved overdose deaths are a massive public health problem involving the intertwined misuse of prescription opioids for pain management with the emergence of extremely potent fentanyl derivatives, sold as standalone products or adulterants in counterfeit prescription opioids or heroin. The incidence of repeated opioid overdose events indicates a problematic use pattern consistent with the development of the medical condition of opioid use disorder (OUD). Prescription and illicit opioids reduce pain perception by activating µ-opioid receptors (MOR) localized to the central nervous system (CNS). Dysregulation of meso-corticolimbic circuitry that subserves reward and adaptive behaviors is fundamentally involved in the progressive behavioral changes that promote and are consequent to OUD. Although opioid-induced analgesia and the rewarding effects of abused opioids are primarily mediated through MOR activation, serotonin (5-HT) is an important contributor to the pharmacology of opioid abused drugs (including heroin and prescription opioids) and OUD. There is a recent resurgence of interest into psychedelic compounds that act primarily through the 5-HT2A receptor (5-HT 2A R) as a new frontier in combatting such diseases (e.g., depression, anxiety, and substance use disorders). Emerging data suggest that the MOR and 5-HT2AR crosstalk at the cellular level and within key nodes of OUD circuitry, highlighting a major opportunity for novel pharmacological intervention for OUD. There is an important gap in the preclinical profiling of psychedelic 5-HT2AR agonists in OUD models. Further, as these molecules carry risks, additional analyses of the profiles of non-hallucinogenic 5-HT2AR agonists and/or 5-HT2AR positive allosteric modulators may provide a new pathway for 5-HT2AR therapeutics. In this review, we discuss the opportunities and challenges associated with utilizing 5-HT2AR agonists as therapeutics for OUD.
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Affiliation(s)
| | | | | | | | - Noelle C. Anastasio
- Center for Addiction Sciences and Therapeutics and Department of Pharmacology and Toxicology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Kathryn A. Cunningham
- Center for Addiction Sciences and Therapeutics and Department of Pharmacology and Toxicology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, United States
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21
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Hornick MG, Stefanski A. Hallucinogenic potential: a review of psychoplastogens for the treatment of opioid use disorder. Front Pharmacol 2023; 14:1221719. [PMID: 37675046 PMCID: PMC10477608 DOI: 10.3389/fphar.2023.1221719] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
The United States is entering its fourth decade of the opioid epidemic with no clear end in sight. At the center of the epidemic is an increase in opioid use disorder (OUD), a complex condition encompassing physical addiction, psychological comorbidities, and socioeconomic and legal travails associated with the misuse and abuse of opioids. Existing behavioral and medication-assisted therapies show limited efficacy as they are hampered by lack of access, strict regimens, and failure to fully address the non-pharmacological aspects of the disease. A growing body of research has indicated the potential of hallucinogens to efficaciously and expeditiously treat addictions, including OUD, by a novel combination of pharmacology, neuroplasticity, and psychological mechanisms. Nonetheless, research into these compounds has been hindered due to legal, social, and safety concerns. This review will examine the preclinical and clinical evidence that psychoplastogens, such as ibogaine, ketamine, and classic psychedelics, may offer a unique, holistic alternative for the treatment of OUD while acknowledging that further research is needed to establish long-term efficacy along with proper safety and ethical guidelines.
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Affiliation(s)
- Mary G. Hornick
- College of Science, Health and Pharmacy, Roosevelt University, Schaumburg, IL, United States
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22
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Oliveira D, Fontenele R, Weleff J, Sofuoglu M, De Aquino JP. Developing non-opioid therapeutics to alleviate pain among persons with opioid use disorder: a review of the human evidence. Int Rev Psychiatry 2023; 35:377-396. [PMID: 38299655 PMCID: PMC10835074 DOI: 10.1080/09540261.2023.2229430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/20/2023] [Indexed: 02/02/2024]
Abstract
The opioid crisis remains a major public health concern, causing significant morbidity and mortality worldwide. Pain is frequently observed among individuals with opioid use disorder (OUD), and the current opioid agonist therapies (OAT) have limited efficacy in addressing the pain needs of this population. We reviewed the most promising non-opioid analgesic therapies for opioid-dependent individuals synthesising data from randomised controlled trials in the Medline database from December 2022 to March 2023. Ketamine, gabapentin, serotoninergic antidepressants, and GABAergic drugs were found to be the most extensively studied non-opioid analgesics with positive results. Additionally, we explored the potential of cannabinoids, glial activation inhibitors, psychedelics, cholecystokinin antagonists, alpha-2 adrenergic agonists, and cholinergic drugs. Methodological improvements are required to advance the development of novel analgesic strategies and establish their safety profile for opioid-dependent populations. We highlight the need for greater integration of experimental pain methods and abuse liability assessments, more granular assessments of prior opioid exposure, greater uniformity of pain types within study samples, and a particular focus on individuals with OUD receiving OAT. Finally, future research should investigate pharmacokinetic interactions between OAT and various non-opioid analgesics and perform reverse translation basic experiments, particularly with methadone and buprenorphine, which remain the standard OUD treatment.
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Affiliation(s)
- Debora Oliveira
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
| | - Rodrigo Fontenele
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - Jeremy Weleff
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, 1950 E 89th St U Bldg, Cleveland, OH 44195, USA
| | - Mehmet Sofuoglu
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
| | - Joao P. De Aquino
- Yale University School of Medicine, Department of Psychiatry, 300 George Street, New Haven, CT 06511, USA
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, 34 Park Street, 3 Floor, New Haven, CT 06519, USA
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23
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Zafar R, Siegel M, Harding R, Barba T, Agnorelli C, Suseelan S, Roseman L, Wall M, Nutt DJ, Erritzoe D. Psychedelic therapy in the treatment of addiction: the past, present and future. Front Psychiatry 2023; 14:1183740. [PMID: 37377473 PMCID: PMC10291338 DOI: 10.3389/fpsyt.2023.1183740] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
Psychedelic therapy has witnessed a resurgence in interest in the last decade from the scientific and medical communities with evidence now building for its safety and efficacy in treating a range of psychiatric disorders including addiction. In this review we will chart the research investigating the role of these interventions in individuals with addiction beginning with an overview of the current socioeconomic impact of addiction, treatment options, and outcomes. We will start by examining historical studies from the first psychedelic research era of the mid-late 1900s, followed by an overview of the available real-world evidence gathered from naturalistic, observational, and survey-based studies. We will then cover modern-day clinical trials of psychedelic therapies in addiction from first-in-human to phase II clinical trials. Finally, we will provide an overview of the different translational human neuropsychopharmacology techniques, including functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), that can be applied to foster a mechanistic understanding of therapeutic mechanisms. A more granular understanding of the treatment effects of psychedelics will facilitate the optimisation of the psychedelic therapy drug development landscape, and ultimately improve patient outcomes.
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Affiliation(s)
- Rayyan Zafar
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Neuropsychopharmacology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Maxim Siegel
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Neuropsychopharmacology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Rebecca Harding
- Clinical Psychopharmacology Unit, University College London, London, United Kingdom
| | - Tommaso Barba
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Neuropsychopharmacology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Claudio Agnorelli
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Neuropsychopharmacology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Shayam Suseelan
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Neuropsychopharmacology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Leor Roseman
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Neuropsychopharmacology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Matthew Wall
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Neuropsychopharmacology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Invicro, London, United Kingdom
| | - David John Nutt
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Neuropsychopharmacology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - David Erritzoe
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Neuropsychopharmacology Unit, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
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24
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Nardou R, Sawyer E, Song YJ, Wilkinson M, Padovan-Hernandez Y, de Deus JL, Wright N, Lama C, Faltin S, Goff LA, Stein-O'Brien GL, Dölen G. Psychedelics reopen the social reward learning critical period. Nature 2023; 618:790-798. [PMID: 37316665 PMCID: PMC10284704 DOI: 10.1038/s41586-023-06204-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/11/2023] [Indexed: 06/16/2023]
Abstract
Psychedelics are a broad class of drugs defined by their ability to induce an altered state of consciousness1,2. These drugs have been used for millennia in both spiritual and medicinal contexts, and a number of recent clinical successes have spurred a renewed interest in developing psychedelic therapies3-9. Nevertheless, a unifying mechanism that can account for these shared phenomenological and therapeutic properties remains unknown. Here we demonstrate in mice that the ability to reopen the social reward learning critical period is a shared property across psychedelic drugs. Notably, the time course of critical period reopening is proportional to the duration of acute subjective effects reported in humans. Furthermore, the ability to reinstate social reward learning in adulthood is paralleled by metaplastic restoration of oxytocin-mediated long-term depression in the nucleus accumbens. Finally, identification of differentially expressed genes in the 'open state' versus the 'closed state' provides evidence that reorganization of the extracellular matrix is a common downstream mechanism underlying psychedelic drug-mediated critical period reopening. Together these results have important implications for the implementation of psychedelics in clinical practice, as well as the design of novel compounds for the treatment of neuropsychiatric disease.
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Affiliation(s)
- Romain Nardou
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Brain Science Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Edward Sawyer
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Brain Science Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Young Jun Song
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Brain Science Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Makenzie Wilkinson
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Brain Science Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Yasmin Padovan-Hernandez
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Júnia Lara de Deus
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Brain Science Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Noelle Wright
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Brain Science Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Carine Lama
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Brain Science Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Sehr Faltin
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Brain Science Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Loyal A Goff
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Oncology, Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Genevieve L Stein-O'Brien
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Brain Science Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- The Kavli Neuroscience Discovery Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Gül Dölen
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
- The Brain Science Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
- The Kavli Neuroscience Discovery Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
- The Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
- The Center for Psychedelics and Consciousness Research, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
- The Wendy Klag Institute for Autism and Developmental Disabilities, Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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25
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Johnston JN, Kadriu B, Allen J, Gilbert JR, Henter ID, Zarate CA. Ketamine and serotonergic psychedelics: An update on the mechanisms and biosignatures underlying rapid-acting antidepressant treatment. Neuropharmacology 2023; 226:109422. [PMID: 36646310 PMCID: PMC9983360 DOI: 10.1016/j.neuropharm.2023.109422] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
The discovery of ketamine as a rapid-acting antidepressant spurred significant research to understand its underlying mechanisms of action and to identify other novel compounds that may act similarly. Serotonergic psychedelics (SPs) have shown initial promise in treating depression, though the challenge of conducting randomized controlled trials with SPs and the necessity of long-term clinical observation are important limitations. This review summarizes the similarities and differences between the psychoactive effects associated with both ketamine and SPs and the mechanisms of action of these compounds, with a focus on the monoaminergic, glutamatergic, gamma-aminobutyric acid (GABA)-ergic, opioid, and inflammatory systems. Both molecular and neuroimaging aspects are considered. While their main mechanisms of action differ-SPs increase serotonergic signaling while ketamine is a glutamatergic modulator-evidence suggests that the downstream mechanisms of action of both ketamine and SPs include mechanistic target of rapamycin complex 1 (mTORC1) signaling and downstream GABAA receptor activity. The similarities in downstream mechanisms may explain why ketamine, and potentially SPs, exert rapid-acting antidepressant effects. However, research on SPs is still in its infancy compared to the ongoing research that has been conducted with ketamine. For both therapeutics, issues with regulation and proper controls should be addressed before more widespread implementation. This article is part of the Special Issue on "Ketamine and its Metabolites".
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Affiliation(s)
- Jenessa N Johnston
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Bashkim Kadriu
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Josh Allen
- The Alfred Centre, Department of Neuroscience, Monash University, Melbourne, Victoria, Australia.
| | - Jessica R Gilbert
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Ioline D Henter
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
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26
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Mash DC. IUPHAR - invited review - Ibogaine - A legacy within the current renaissance of psychedelic therapy. Pharmacol Res 2023; 190:106620. [PMID: 36907284 DOI: 10.1016/j.phrs.2022.106620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 03/13/2023]
Abstract
Ibogaine is a powerful psychoactive substance that not only alters perception, mood and affect, but also stops addictive behaviors. Ibogaine has a very long history of ethnobotanical use in low doses to combat fatigue, hunger and thirst and, in high doses as a sacrament in African ritual contexts. In the 1960's, American and European self-help groups provided public testimonials that a single dose of ibogaine alleviated drug craving, opioid withdrawal symptoms, and prevented relapse for weeks, months and sometimes years. Ibogaine is rapidly demethylated by first-pass metabolism to a long-acting metabolite noribogaine. Ibogaine and its metabolite interact with two or more CNS targets simultaneously and both drugs have demonstrated predictive validity in animal models of addiction. Online forums endorse the benefits of ibogaine as an "addiction interrupter" and present-day estimates suggest that more than ten thousand people have sought treatment in countries where the drug is unregulated. Open label pilot studies of ibogaine-assisted drug detoxification have shown positive benefit in treating addiction. Ibogaine, granted regulatory approval for human testing in a Phase 1/2a clinical trial, joins the current landscape of psychedelic medicines in clinical development.
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Affiliation(s)
- Deborah C Mash
- Professor Emerita University of Miami Miller School of Medicine, Depts. Neurology and Molecular and Cellular Pharmacology.
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27
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Dickinson J. Transpersonal Intersubjectivity in Ibogaine Experiences: Three cases. ANTHROPOLOGY OF CONSCIOUSNESS 2023. [DOI: 10.1111/anoc.12172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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28
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Rodríguez-Cano BJ, Kohek M, Ona G, Alcázar-Córcoles MÁ, Dos Santos RG, Hallak JEC, Bouso JC. Underground ibogaine use for the treatment of substance use disorders: A qualitative analysis of subjective experiences. Drug Alcohol Rev 2023; 42:401-414. [PMID: 36456173 DOI: 10.1111/dar.13587] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/16/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Ibogaine is one of the alkaloids naturally found in plants such as Tabernanthe iboga, which has been traditionally used by members of the Bwiti culture. Since the discovery of its anti-addictive properties by Howard S. Lotsof in 1962, ibogaine has been used experimentally to treat substance use disorders (SUD), especially those involving opioids. We aim to provide a detailed understanding of the underlying psychological aspects of underground ibogaine use for the treatment of SUD. METHODS Semi-structured interviews were carried out with 13 participants with SUD, which motivated their self-treatment with ibogaine. The data were analysed using the grounded theory approach and considered the context of the treatment, and the nature of the occurring hallucinogenic and cognitive phenomena during the treatment experience. RESULTS We identified several psychological effects that the study respondents experienced, which seem to play a substantial role in the therapeutic process concerning SUD. The evoking of interpersonal and transpersonal experiences, autobiographical memories, and preparation, integration and motivation for a lifestyle change are important components that participants reported during and after ibogaine intake. DISCUSSION AND CONCLUSION Ibogaine is increasingly being used for the treatment of SUD, due in part to the limited treatment options currently available. Its beneficial effects seem to be related not only to its complex pharmacology but also to the subjective experience that ibogaine induces. The main aspects of this experience are related to autobiographical memories and valuable personal insights, which together appear to help individuals cope with their SUD.
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Affiliation(s)
- Borja J Rodríguez-Cano
- International Center for Ethnobotanical Education, Research and Service, Barcelona, Spain
| | - Maja Kohek
- International Center for Ethnobotanical Education, Research and Service, Barcelona, Spain
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | - Genís Ona
- International Center for Ethnobotanical Education, Research and Service, Barcelona, Spain
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Rafael G Dos Santos
- International Center for Ethnobotanical Education, Research and Service, Barcelona, Spain
- Department of Neurosciences and Behavior, University of São Paulo, São Paulo, Brazil
- National Institute for Translational Medicine, Brazil
| | - Jaime E C Hallak
- Department of Neurosciences and Behavior, University of São Paulo, São Paulo, Brazil
- National Institute for Translational Medicine, Brazil
| | - José Carlos Bouso
- International Center for Ethnobotanical Education, Research and Service, Barcelona, Spain
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
- Department of Neurosciences and Behavior, University of São Paulo, São Paulo, Brazil
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29
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The Bright Side of Psychedelics: Latest Advances and Challenges in Neuropharmacology. Int J Mol Sci 2023; 24:ijms24021329. [PMID: 36674849 PMCID: PMC9865175 DOI: 10.3390/ijms24021329] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/31/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
The need to identify effective therapies for the treatment of psychiatric disorders is a particularly important issue in modern societies. In addition, difficulties in finding new drugs have led pharmacologists to review and re-evaluate some past molecules, including psychedelics. For several years there has been growing interest among psychotherapists in psilocybin or lysergic acid diethylamide for the treatment of obsessive-compulsive disorder, of depression, or of post-traumatic stress disorder, although results are not always clear and definitive. In fact, the mechanisms of action of psychedelics are not yet fully understood and some molecular aspects have yet to be well defined. Thus, this review aims to summarize the ethnobotanical uses of the best-known psychedelic plants and the pharmacological mechanisms of the main active ingredients they contain. Furthermore, an up-to-date overview of structural and computational studies performed to evaluate the affinity and binding modes to biologically relevant receptors of ibogaine, mescaline, N,N-dimethyltryptamine, psilocin, and lysergic acid diethylamide is presented. Finally, the most recent clinical studies evaluating the efficacy of psychedelic molecules in some psychiatric disorders are discussed and compared with drugs already used in therapy.
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30
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Mosca A, Chiappini S, Miuli A, Mancusi G, Santovito MC, Di Carlo F, Pettorruso M, Corkery JM, Canessa C, Martinotti G, Di Giannantonio M. Ibogaine/Noribogaine in the Treatment of Substance Use Disorders: A Systematic Review of the Current Literature. Curr Neuropharmacol 2023; 21:2178-2194. [PMID: 36263479 PMCID: PMC10556383 DOI: 10.2174/1570159x21666221017085612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ibogaine and noribogaine are psychedelic substances with dissociative properties naturally occurring in plants of the Apocynaceae family. Research has shown their efficacy in treating substance use disorders (SUD), particularly in opiate detoxification, but their efficacy and toxicity are still unclear. OBJECTIVE This review aims to assess the anti-addictive role of ibogaine and evaluate its side effects. METHODS A systematic literature review was conducted on the 29th of November 2021 using PubMed, Scopus and Web of Science databases through the following search strategy: ("Ibogaine" OR "Noribogaine") AND ("SUD" OR "substance use disorder" OR "craving" OR "abstinence" OR "withdrawal" OR "addiction" OR "detoxification") NOT animal NOT review NOT "vitro." The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed for data gathering purposes. Research methods were registered on PROSPERO (CRD42021287034). RESULTS Thirty-one articles were selected for the systematic revision, and two were considered for analysis. The results were organised according to the type of study: case reports/case series, randomised- controlled trials (RCTs), open-label, survey and observational studies. The main outcomes were related to the anti-addictive effect of ibogaine and its cardiac toxicity. A meta-analysis of side effects was conducted using RevMan 5.4 software, showing a significant risk of developing headaches after ibogaine/noribogaine treatment. CONCLUSION The results show some efficacy of ibogaine in the treatment of SUDs, but its cardiotoxicity and mortality are worrying. Further studies are needed to assess its therapeutic efficacy and actual safety.
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Affiliation(s)
- Alessio Mosca
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - Stefania Chiappini
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, AL10 9AB, UK
| | - Andrea Miuli
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - Gianluca Mancusi
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - Maria Chiara Santovito
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - Francesco Di Carlo
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - John M. Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, AL10 9AB, UK
| | | | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, AL10 9AB, UK
| | - Massimo Di Giannantonio
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
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Gomes BR, Tofoli LF. A sacred plant of neuronal effect: the use of ibogaine in addiction treatments in Brazil. ANTHROPOLOGY OF CONSCIOUSNESS 2022. [DOI: 10.1111/anoc.12157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bruno Ramos Gomes
- School of Medical Sciences – Unicamp Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz. CEP 13083‐887 Campinas SP Brazil
| | - Luis Fernando Tofoli
- School of Medical Sciences – Unicamp Rua Tessália Vieira de Camargo, 126. Cidade Universitária Zeferino Vaz. CEP 13083‐887 Campinas SP Brazil
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Vorobyeva N, Kozlova AA. Three Naturally-Occurring Psychedelics and Their Significance in the Treatment of Mental Health Disorders. Front Pharmacol 2022; 13:927984. [PMID: 35837277 PMCID: PMC9274002 DOI: 10.3389/fphar.2022.927984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/06/2022] [Indexed: 12/20/2022] Open
Abstract
Classical psychedelics represent a family of psychoactive substances with structural similarities to serotonin and affinity for serotonin receptors. A growing number of studies have found that psychedelics can be effective in treating various psychiatric conditions, including post-traumatic stress disorder, major depressive disorder, anxiety, and substance use disorders. Mental health disorders are extremely prevalent in the general population constituting a major problem for the public health. There are a wide variety of interventions for mental health disorders, including pharmacological therapies and psychotherapies, however, treatment resistance still remains a particular challenge in this field, and relapse rates are also quite high. In recent years, psychedelics have become one of the promising new tools for the treatment of mental health disorders. In this review, we will discuss the three classic serotonergic naturally occurring psychedelics, psilocybin, ibogaine, and N, N-dimethyltryptamine, focusing on their pharmacological properties and clinical potential. The purpose of this article is to provide a focused review of the most relevant research into the therapeutic potential of these substances and their possible integration as alternative or adjuvant options to existing pharmacological and psychological therapies.
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Affiliation(s)
- Nataliya Vorobyeva
- Hive Bio Life Sciences Ltd., London, United Kingdom
- *Correspondence: Nataliya Vorobyeva,
| | - Alena A. Kozlova
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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F. Martins ML, Heydari P, Li W, Martínez-Chávez A, Venekamp N, Lebre MC, Lucas L, Beijnen JH, Schinkel AH. Drug Transporters ABCB1 (P-gp) and OATP, but not Drug-Metabolizing Enzyme CYP3A4, Affect the Pharmacokinetics of the Psychoactive Alkaloid Ibogaine and its Metabolites. Front Pharmacol 2022; 13:855000. [PMID: 35308219 PMCID: PMC8931498 DOI: 10.3389/fphar.2022.855000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
The psychedelic alkaloid ibogaine is increasingly used as an oral treatment for substance use disorders, despite being unlicensed in most countries and having reported adverse events. Using wild-type and genetically modified mice, we investigated the impact of mouse (m)Abcb1a/1b and Abcg2 drug efflux transporters, human and mouse OATP drug uptake transporters, and the CYP3A drug-metabolizing complex on the pharmacokinetics of ibogaine and its main metabolites. Following oral ibogaine administration (10 mg/kg) to mice, we observed a rapid and extensive conversion of ibogaine to noribogaine (active metabolite) and noribogaine glucuronide. Mouse Abcb1a/1b, in combination with mAbcg2, modestly restricted the systemic exposure (plasma AUC) and peak plasma concentration (Cmax) of ibogaine. Accordingly, we found a ∼2-fold decrease in the relative recovery of ibogaine in the small intestine with fecal content in the absence of both transporters compared to the wild-type situation. Ibogaine presented good intrinsic brain penetration even in wild-type mice (brain-to-plasma ratio of 3.4). However, this was further increased by 1.5-fold in Abcb1a/1b;Abcg2−/− mice, but not in Abcg2−/− mice, revealing a stronger effect of mAbcb1a/1b in restricting ibogaine brain penetration. The studied human OATP transporters showed no major impact on ibogaine plasma and tissue disposition, but the mOatp1a/1b proteins modestly affected the plasma exposure of ibogaine metabolites and the tissue disposition of noribogaine glucuronide. No considerable role of mouse Cyp3a knockout or transgenic human CYP3A4 overexpression was observed in the pharmacokinetics of ibogaine and its metabolites. In summary, ABCB1, in combination with ABCG2, limits the oral availability of ibogaine, possibly by mediating its hepatobiliary and/or direct intestinal excretion. Moreover, ABCB1 restricts ibogaine brain penetration. Variation in ABCB1/ABCG2 activity due to genetic variation and/or pharmacologic inhibition might therefore affect ibogaine exposure in patients, but only to a limited extent. The insignificant impact of human CYP3A4 and OATP1B1/1B3 transporters may be clinically advantageous for ibogaine and noribogaine use, as it decreases the risks of undesirable drug interactions or interindividual variation related to CYP3A4 and/or OATP activity.
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Affiliation(s)
| | - Paniz Heydari
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Wenlong Li
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Alejandra Martínez-Chávez
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Nikkie Venekamp
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maria C. Lebre
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Luc Lucas
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Jos H. Beijnen
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Alfred H. Schinkel
- Division of Pharmacology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- *Correspondence: Alfred H. Schinkel,
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Knuijver T, Schellekens A, Belgers M, Donders R, van Oosteren T, Kramers K, Verkes R. Safety of ibogaine administration in detoxification of opioid-dependent individuals: a descriptive open-label observational study. Addiction 2022; 117:118-128. [PMID: 33620733 PMCID: PMC9292417 DOI: 10.1111/add.15448] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/15/2020] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS Ibogaine is an indole alkaloid used in rituals of the African Bwiti tribe. It is also used in non-medical settings to treat addiction. However, ibogaine has been linked to several deaths, mainly due to cardiac events called torsades des pointes preceded by QTc prolongation as well as other safety concerns. This study aimed to evaluate the cardiac, cerebellar and psychomimetic safety of ibogaine in patients with opioid use disorder. DESIGN A descriptive open-label observational study. SETTING Department of psychiatry in a university medical center, the Netherlands. PARTICIPANTS Patients with opioid use disorder (n = 14) on opioid maintenance treatment with a lasting wish for abstinence, who failed to reach abstinence with standard care. INTERVENTION AND MEASUREMENTS After conversion to morphine-sulphate, a single dose of ibogaine-HCl 10 mg/kg was administered and patients were monitored at regular intervals for at least 24 hours assessing QTc, blood pressure and heart rate, scale for the assessment and rating of ataxia (SARA) to assess cerebellar side effects and the delirium observation scale (DOS) to assess psychomimetic effects. FINDINGS The maximum QTc (Fridericia) prolongation was on average 95ms (range 29-146ms). Fifty percent of subjects reached a QTc of over 500ms during the observation period. In six out 14 subjects prolongation above 450ms lasted beyond 24 hours after ingestion of ibogaine. No torsades des pointes were observed. Severe transient ataxia with inability to walk without support was seen in all patients. Withdrawal and psychomimetic effects were mostly well-tolerated and manageable (11/14 did not return to morphine within 24 hours, DOS scores remained below threshold). CONCLUSIONS This open-label observational study found that ibogaine treatment of patients with opioid use disorder can induce a clinically relevant but reversible QTc prolongation, bradycardia, and severe ataxia.
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Affiliation(s)
- Thomas Knuijver
- IrisZorg verslavingszorgArnhemthe Netherlands
- Nijmegen Institute for Science Practitioners in Addiction (NISPA)Nijmegenthe Netherlands
- Department of Pharmacology–ToxicologyRadboud UMC NijmegenNijmegenthe Netherlands
| | - Arnt Schellekens
- Nijmegen Institute for Science Practitioners in Addiction (NISPA)Nijmegenthe Netherlands
- Department of PsychiatryRadboud UMCNijmegenthe Netherlands
| | - Maarten Belgers
- IrisZorg verslavingszorgArnhemthe Netherlands
- Nijmegen Institute for Science Practitioners in Addiction (NISPA)Nijmegenthe Netherlands
| | - Rogier Donders
- Department for Health EvidenceRadboud UMC NijmegenNijmegenthe Netherlands
| | | | - Kees Kramers
- Department of Pharmacology–ToxicologyRadboud UMC NijmegenNijmegenthe Netherlands
| | - Robbert Verkes
- Department of PsychiatryRadboud UMCNijmegenthe Netherlands
- Centre of Forensic PsychiatryPompe KliniekNijmegenthe Netherlands
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Marseille E, Bertozzi S, Kahn JG. The economics of psychedelic-assisted therapies: A research agenda. Front Psychiatry 2022; 13:1025726. [PMID: 36545038 PMCID: PMC9760680 DOI: 10.3389/fpsyt.2022.1025726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022] Open
Abstract
After a long hiatus, psychiatry is undergoing a resurgence of interest in psychedelic drugs as therapy for a wide range of mental health disorders Accumulating clinical evidence suggests substantial potential for psychedelics used in a therapeutic context, as treatment for, among other disorders, depression, post-traumatic stress disorder (PTSD), and addictions to tobacco, opioids and alcohol. As soon as 2024, powerful new therapeutic modalities could become available for individuals with mental health problems refractory to traditional therapies. Yet research has lagged on economic considerations, such as costs and cost-effectiveness, the economic effects of widespread implementation, pricing, and economic appraisal's methodological considerations relevant to psychedelic therapies. These issues are critical if psychedelic therapies are to become widely accessible. We describe six types of economic analyses and their rationale for decisions and planning including the needs of health care payers. We also outline desirable features of this research, including scientific rigor, long horizons, equity, and a global view.
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Affiliation(s)
- Elliot Marseille
- Global Initiative for Psychedelic Science Economics (GIPSE), University of California, Berkeley, Berkeley, CA, United States.,Center for Global Health Delivery Diplomacy and Economics, University of California, San Francisco, San Francisco, CA, United States
| | - Stefano Bertozzi
- Global Initiative for Psychedelic Science Economics (GIPSE), University of California, Berkeley, Berkeley, CA, United States.,Center for Global Health Delivery Diplomacy and Economics, University of California, San Francisco, San Francisco, CA, United States.,School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - James G Kahn
- Global Initiative for Psychedelic Science Economics (GIPSE), University of California, Berkeley, Berkeley, CA, United States.,Center for Global Health Delivery Diplomacy and Economics, University of California, San Francisco, San Francisco, CA, United States.,School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
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Köck P, Froelich K, Walter M, Lang U, Dürsteler KM. A systematic literature review of clinical trials and therapeutic applications of ibogaine. J Subst Abuse Treat 2021; 138:108717. [PMID: 35012793 DOI: 10.1016/j.jsat.2021.108717] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Iboga and its primary alkaloids, ibogaine and noribogaine, have been of interest to researchers and practitioners, mainly due to their putative efficacy in treating substance use disorders (SUDs). For many SUDs, still no effective pharmacotherapies exist. Distinct psychoactive and somatic effects of the iboga alkaloids set them apart from classic hallucinogens like LSD, mescaline, and psilocybin. AIMS The study team performed this systematic review focusing on clinical data and therapeutic interventions involving ibogaine and noribogaine. METHODS The team conducted a search for all publications up to December 7, 2020, using PubMed and Embase following PRISMA guidelines. RESULTS In total, we identified 743 records. In this review, we consider 24 studies, which included 705 individuals receiving ibogaine or noribogaine. This review includes two randomized, double-blind, controlled clinical trials, one double-blind controlled clinical trial, 17 open-label studies or case series (including observational or retrospective studies), three case reports, and one retrospective survey. The published data suggest that ibogaine is an effective therapeutic intervention within the context of SUDs, reducing withdrawal symptoms and craving. Data also point toward a beneficial impact on depressive and trauma-related psychological symptoms. However, studies have reported severe medical complications and deaths, which seem to be associated with neuro- and cardiotoxic effects of ibogaine. Two of these fatalities were described in the 24 studies included in this review. CONCLUSION Treatment of SUDs and persisting comorbidities requires innovative treatment approaches. Rapid-onset therapies such as the application of ibogaine may offer novel treatment opportunities for specific individuals. Rigorous study designs within medical settings are necessary to warrant safe application, monitoring, and, possibly, medical intervention.
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Affiliation(s)
- Patrick Köck
- University of Basel Psychiatric Clinics, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
| | - Katharina Froelich
- University of Basel Psychiatric Clinics, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Marc Walter
- University of Basel Psychiatric Clinics, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Undine Lang
- University of Basel Psychiatric Clinics, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Kenneth M Dürsteler
- University of Basel Psychiatric Clinics, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland; Department for Psychiatry, Psychotherapy and Psychosomatic, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Wallace B, Rea K. Enhancing equity-oriented care in psychedelic medicine: Utilizing the EQUIP framework. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103429. [PMID: 34461409 DOI: 10.1016/j.drugpo.2021.103429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
Psychedelic-assisted therapies are experiencing a re-emergence in mainstream medicine and mental health contexts. A wide variety of psychedelic-assisted therapy modalities are being utilized to address mental health issues such as substance use disorders, end of life anxiety, treatment-resistant depression, suicidality, PTSD and other conditions. The novel and inchoate acceptance of psychedelic-assisted therapies into mainstream medical and therapeutic realms raises questions of equity. Concerns have been raised that individuals and communities facing structural inequities are perhaps least able to access these treatments including Black, Indigenous and people of colour (BIPOC) as well as people who use drugs. Psychedelic-assisted therapies may exemplify the inverse law of care whereby services are most inaccessible to communities with the most need, especially if these therapies are regulated into the private sector. As legalization and wider implementation of these therapies appears to be imminent, now is a critical time to consider how health equity may be promoted within psychedelic medicine. This paper examines how the EQUIP Health Care approach (https://equiphealthcare.ca) may inform the development and provision of equity-oriented psychedelic-assisted therapies. The EQUIP approach seeks to reduce the effects of structural inequities on people's health, the impacts of discrimination and stigma, and the mismatches between usual approaches to care and the needs of people most affected by health and social inequities. Key dimensions of the EQUIP intervention include cultural safety, harm reduction, trauma and violence-informed care, and contextual tailoring.
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Affiliation(s)
- Bruce Wallace
- UVIC School of Social Work, Scientist, Canadian Institute for Substance Use Research (CISUR), University of Victoria, School of Social Work, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Kerri Rea
- University of Victoria, School of Social Work, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada
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38
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Waters K. Pharmacologic Similarities and Differences Among Hallucinogens. J Clin Pharmacol 2021; 61 Suppl 2:S100-S113. [PMID: 34396556 DOI: 10.1002/jcph.1917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/22/2021] [Indexed: 12/27/2022]
Abstract
Hallucinogens constitute a unique class of substances that cause changes in the user's thoughts, perceptions, and mood through various mechanisms of action. Although the serotonergic hallucinogens such as lysergic acid diethylamide, psilocybin, and N,N-dimethyltryptamine have been termed the classical hallucinogens, many hallucinogens elicit their actions through other mechanisms such as N-methyl-D-aspartate receptor antagonism, opioid receptor agonism, or inhibition of the reuptake of monoamines including serotonin, norepinephrine, and dopamine. The aim of this article is to compare the pharmacologic similarities and differences among substances within the hallucinogen class and their impact on physical and psychiatric effects. Potential toxicities, including life-threatening and long-term effects, will be reviewed.
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Affiliation(s)
- Kristin Waters
- School of Pharmacy, University of Connecticut, Storrs, Connecticut, USA
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39
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Luz M, Mash DC. Evaluating the toxicity and therapeutic potential of ibogaine in the treatment of chronic opioid abuse. Expert Opin Drug Metab Toxicol 2021; 17:1019-1022. [PMID: 34139922 DOI: 10.1080/17425255.2021.1944099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - Deborah C Mash
- University of Miami School of Medicine, Neurology & Pharmacology, University of Miami Life Science Bldg., Florida, USA
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40
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Underwood MS, Bright SJ, Les Lancaster B. A narrative review of the pharmacological, cultural and psychological literature on ibogaine. JOURNAL OF PSYCHEDELIC STUDIES 2021. [DOI: 10.1556/2054.2021.00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AbstractIbogaine is a psychoactive alkaloid contained in the West African plant Tabernanthe iboga. Although preliminary, evidence suggests that ibogaine could be effective in the treatment of certain substance use disorders, specifically opioid use disorder. This narrative review concentrated on the pharmacological, cultural and psychological aspects of ibogaine that contribute to its reputed effectiveness with a specific focus on the ibogaine state of consciousness. Although the exact pharmacological mechanisms for ibogaine are still speculative, the literature highlighted its role as an NMDA antagonist in the effective treatment of substance use disorders. The cultural aspects associated with the use of ibogaine pose questions around the worldview of participants as experienced in the traditional and western contexts, which future research should clarify. From a psychological perspective, the theory that the ibogaine state of consciousness resembles REM sleep is questionable due to evidence that indicated ibogaine supressed REM sleep, and contradictory evidence in relation to learning and memory. The suggested classification of the ibogaine experience as oneirophrenic also seems inadequate as it only describes the first phase of the ibogaine experience. The ibogaine experience does however present characteristics consistent with holotropic states of consciousness, and future research could focus on exploring and potentially classifying the state of consciousness induced by ibogaine as holotropic.
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Affiliation(s)
- Martie S. Underwood
- 1Professional Development Foundation and Canterbury Christ Church University, 58 Bass Coves, The Coves, R512 Provincial Road, Broederstroom, Hartbeespoort, 0240, South Africa
| | - Stephen J. Bright
- 2School of Medical and Health Sciences, Edith Cowan University, 270 Joondlaup Drive, Joondalup, WA 6027, Australia
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González J, Cavelli M, Castro-Zaballa S, Mondino A, Tort ABL, Rubido N, Carrera I, Torterolo P. EEG Gamma Band Alterations and REM-like Traits Underpin the Acute Effect of the Atypical Psychedelic Ibogaine in the Rat. ACS Pharmacol Transl Sci 2021; 4:517-525. [PMID: 33860181 PMCID: PMC8033602 DOI: 10.1021/acsptsci.0c00164] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Indexed: 02/07/2023]
Abstract
Ibogaine is a psychedelic alkaloid that has attracted large scientific interest because of its antiaddictive properties in observational studies in humans as well as in animal models. Its subjective effect has been described as intense, vivid dream-like experiences occurring while awake; hence, ibogaine is often referred to as an oneirogenic psychedelic. While this unique dream-like profile has been hypothesized to aid the antiaddictive effects, the electrophysiological signatures of this psychedelic state remain unknown. We previously showed in rats that ibogaine promotes a waking state with abnormal motor behavior along with a decrease in NREM and REM sleep. Here, we performed an in-depth analysis of the intracranial electroencephalogram during "ibogaine wakefulness". We found that ibogaine induces gamma oscillations that, despite having larger power than control levels, are less coherent and less complex. Further analysis revealed that this profile of gamma activity compares to that of natural REM sleep. Thus, our results provide novel biological evidence for the association between the psychedelic state and REM sleep, contributing to the understanding of the brain mechanisms associated with the oneirogenic psychedelic effect of ibogaine.
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Affiliation(s)
- Joaquín González
- Departamento
de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, 11200, Uruguay
| | - Matias Cavelli
- Departamento
de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, 11200, Uruguay
- Department
of Psychiatry, University of Wisconsin, Madison, Wisconsin 53558, United States
| | - Santiago Castro-Zaballa
- Departamento
de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, 11200, Uruguay
| | - Alejandra Mondino
- Departamento
de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, 11200, Uruguay
- Department
of Anesthesiology, University of Michigan, Ann Arbor, Michigan 48103, United States
| | - Adriano B. L. Tort
- Brain
Institute, Federal University of Rio Grande
do Norte, Natal, Rio Grande do Norte 59056, Brazil
| | - Nicolás Rubido
- Aberdeen
Biomedical Imaging Centre, University of
Aberdeen, Aberdeen AB25 2ZG, United Kingdom
- Instituto
de Física de Facultad de Ciencias, Universidad de la República, Montevideo, 11400, Uruguay
| | - Ignacio Carrera
- Departamento
de Química Orgánica, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Pablo Torterolo
- Departamento
de Fisiología, Facultad de Medicina, Universidad de la República, Montevideo, 11200, Uruguay
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Bhat S, Guthrie DA, Kasture A, El-Kasaby A, Cao J, Bonifazi A, Ku T, Giancola JB, Hummel T, Freissmuth M, Newman AH. Tropane-Based Ibogaine Analog Rescues Folding-Deficient Serotonin and Dopamine Transporters. ACS Pharmacol Transl Sci 2021; 4:503-516. [PMID: 33860180 PMCID: PMC8033614 DOI: 10.1021/acsptsci.0c00102] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 02/05/2023]
Abstract
![]()
Missense
mutations that give rise to protein misfolding are rare,
but collectively, defective protein folding diseases are consequential.
Folding deficiencies are amenable to pharmacological correction (pharmacochaperoning),
but the underlying mechanisms remain enigmatic. Ibogaine and its active
metabolite noribogaine correct folding defects in the dopamine transporter
(DAT), but they rescue only a very limited number of folding-deficient
DAT mutant proteins, which give rise to infantile Parkinsonism and
dystonia. Herein, a series of analogs was generated by reconfiguring
the complex ibogaine ring system and exploring the structural requirements
for binding to wild-type transporters, as well as for rescuing two
equivalent synthetic folding-deficient mutants, SERT-PG601,602AA and DAT-PG584,585AA. The most active tropane-based
analog (9b) was also an effective pharmacochaperone in vivo in Drosophila harboring the DAT-PG584,585AA mutation and rescued 6 out of 13 disease-associated
human DAT mutant proteins in vitro. Hence, a novel
lead pharmacochaperone has been identified that demonstrates medication
development potential for patients harboring DAT mutations.
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Affiliation(s)
- Shreyas Bhat
- Institute of Pharmacology and the Gaston H. Glock Research Laboratories for Exploratory Drug Development, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Waehringerstrasse 13a, Vienna 1090, Austria
| | - Daryl A Guthrie
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, Maryland 21224, United States
| | - Ameya Kasture
- Department of Neurobiology, University of Vienna, Vienna 1090, Austria
| | - Ali El-Kasaby
- Institute of Pharmacology and the Gaston H. Glock Research Laboratories for Exploratory Drug Development, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Waehringerstrasse 13a, Vienna 1090, Austria
| | - Jianjing Cao
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, Maryland 21224, United States
| | - Alessandro Bonifazi
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, Maryland 21224, United States
| | - Therese Ku
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, Maryland 21224, United States
| | - JoLynn B Giancola
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, Maryland 21224, United States
| | - Thomas Hummel
- Department of Neurobiology, University of Vienna, Vienna 1090, Austria
| | - Michael Freissmuth
- Institute of Pharmacology and the Gaston H. Glock Research Laboratories for Exploratory Drug Development, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna, Waehringerstrasse 13a, Vienna 1090, Austria
| | - Amy Hauck Newman
- Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, Maryland 21224, United States
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Wilson C, Millar T, Matieschyn Z. Novel treatment of opioid use disorder using ibogaine and iboga in two adults. JOURNAL OF PSYCHEDELIC STUDIES 2021. [DOI: 10.1556/2054.2020.00133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AbstractIbogaine is a naturally occurring psychedelic medicine with anti-addictive properties. While research on ibogaine is limited, several observational studies have shown ibogaine can mitigate opioid withdrawal, as seen with reductions in clinical and subjective opioid withdrawal scores and reduced drug use severity (Noller, Frampton, & Yazar-Klosinski, 2018; Brown & Alper 2018). Furthermore, the psychoactive experience may help individuals to realign their values, purpose and sense of connection, as seen with post treatment reductions in depression scores (Noller et al., 2018; Mash et al., 2000).Case seriesThis case series describes two cases of individuals accessing ibogaine through private unregulated clinics in the Vancouver area to treat their opioid use disorder.ConclusionsIn case 1, the client achieved total abstinence from all opioids within 5–6 days of starting ibogaine treatment, did not experience any opioid withdrawal symptoms after ibogaine treatment and maintained abstinence from opioids for 3 years. In case 2, the patient took ibogaine/iboga in multiple treatments over a short period of time (<4 months). The patient stopped all non-medical opioids after the first iboga treatment and then used ibogaine to aid with further dose reductions of her opioid agonist therapy (OAT) and has maintained abstinence from opioids for 2 years. Ibogaine offers a unique and novel therapeutic approach to treating opioid use disorder. Further studies are needed to establish the safety, risks and potential role for ibogaine as a mainstream, evidence-based addiction treatment.
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Affiliation(s)
- Claire Wilson
- Interior Health, #36-450 Landowne St., Kamloops, BC, V2C1Y3, Canada
| | - Trevor Millar
- Interior Health, #36-450 Landowne St., Kamloops, BC, V2C1Y3, Canada
| | - Zak Matieschyn
- Interior Health, #36-450 Landowne St., Kamloops, BC, V2C1Y3, Canada
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Iyer RN, Favela D, Zhang G, Olson DE. The iboga enigma: the chemistry and neuropharmacology of iboga alkaloids and related analogs. Nat Prod Rep 2021; 38:307-329. [PMID: 32794540 DOI: 10.1039/d0np00033g] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Covering: 2000 up to 2020 Few classes of natural products have inspired as many chemists and biologists as have the iboga alkaloids. This family of monoterpenoid indole alkaloids includes the anti-addictive compound ibogaine as well as catharanthine, a precursor to the chemotherapeutic vinblastine. Despite being known for over 120 years, these small molecules continue to challenge our assumptions about biosynthetic pathways, catalyze our creativity for constructing complex architectures, and embolden new approaches for treating mental illness. This review will cover recent advances in both the biosynthesis and chemical synthesis of iboga alkaloids as well as their use as next-generation neurotherapeutics. Whenever appropriate, we provide historical context for the discoveries of the past decade and indicate areas that have yet to be resolved. While significant progress regarding their chemistry and pharmacology has been made since the 1960s, it is clear that the iboga alkaloids will continue to stoke scientific innovation for years to come.
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Affiliation(s)
- Rishab N Iyer
- Department of Chemistry, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - David Favela
- Department of Chemistry, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - Guoliang Zhang
- Department of Chemistry, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA.
| | - David E Olson
- Department of Chemistry, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA. and Department of Biochemistry & Molecular Medicine, School of Medicine, University of California, Davis, 2700 Stockton Blvd, Suite 2102, Sacramento, CA 95817, USA and Center for Neuroscience, University of California, Davis, 1544 Newton Ct, Davis, CA 95618, USA
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Manzano-Nieves G, Liston C. Psychedelics re-engineered for potential use in the clinic. Nature 2020; 589:358-359. [PMID: 33299163 DOI: 10.1038/d41586-020-03404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cameron LP, Tombari RJ, Lu J, Pell AJ, Hurley ZQ, Ehinger Y, Vargas MV, McCarroll MN, Taylor JC, Myers-Turnbull D, Liu T, Yaghoobi B, Laskowski LJ, Anderson EI, Zhang G, Viswanathan J, Brown BM, Tjia M, Dunlap LE, Rabow ZT, Fiehn O, Wulff H, McCorvy JD, Lein PJ, Kokel D, Ron D, Peters J, Zuo Y, Olson DE. A non-hallucinogenic psychedelic analogue with therapeutic potential. Nature 2020; 589:474-479. [PMID: 33299186 PMCID: PMC7874389 DOI: 10.1038/s41586-020-3008-z] [Citation(s) in RCA: 221] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 10/30/2020] [Indexed: 12/19/2022]
Abstract
The psychedelic alkaloid ibogaine has anti-addictive properties in both humans and animals.1 Unlike most substance use disorder (SUD) medications, anecdotal reports suggest that ibogaine possesses the potential to treat patients addicted to a variety of substances including opiates, alcohol, and psychostimulants. Like other psychedelic compounds, its therapeutic effects are long-lasting,2 which has been attributed to its ability to modify addiction-related neural circuitry through activation of neurotrophic factor signaling.3,4 However, several safety concerns have hindered the clinical development of ibogaine including its toxicity, hallucinogenic potential, and proclivity for inducing cardiac arrhythmias. Here, we apply the principles of function-oriented synthesis (FOS) to identify the key structural elements of its potential therapeutic pharmacophore, enabling us to engineer tabernanthalog (TBG)—a water soluble, non-hallucinogenic, non-toxic analog of ibogaine that can be prepared in a single step. TBG promoted structural neural plasticity, reduced alcohol- and heroin-seeking behavior, and produced antidepressant-like effects in rodents. This work demonstrates that through careful chemical design, it is possible to modify a psychedelic compound to produce a safer, non-hallucinogenic variant with therapeutic potential.
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Affiliation(s)
- Lindsay P Cameron
- Neuroscience Graduate Program, University of California, Davis, Davis, CA, USA
| | - Robert J Tombari
- Department of Chemistry, University of California, Davis, Davis, CA, USA
| | - Ju Lu
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Alexander J Pell
- Department of Chemistry, University of California, Davis, Davis, CA, USA
| | - Zefan Q Hurley
- Department of Chemistry, University of California, Davis, Davis, CA, USA
| | - Yann Ehinger
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Matthew N McCarroll
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Jack C Taylor
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA
| | - Douglas Myers-Turnbull
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA.,Quantitative Biosciences Consortium, University of California, San Francisco, San Francisco, CA, USA
| | - Taohui Liu
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Bianca Yaghoobi
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Lauren J Laskowski
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Emilie I Anderson
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Guoliang Zhang
- Department of Chemistry, University of California, Davis, Davis, CA, USA
| | | | - Brandon M Brown
- Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, USA
| | - Michelle Tjia
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - Lee E Dunlap
- Department of Chemistry, University of California, Davis, Davis, CA, USA
| | - Zachary T Rabow
- West Coast Metabolomics Center, University of California, Davis, Davis, CA, USA
| | - Oliver Fiehn
- West Coast Metabolomics Center, University of California, Davis, Davis, CA, USA
| | - Heike Wulff
- Department of Pharmacology, School of Medicine, University of California, Davis, Davis, CA, USA
| | - John D McCorvy
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pamela J Lein
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - David Kokel
- Institute for Neurodegenerative Diseases, University of California, San Francisco, San Francisco, CA, USA.,Department of Physiology, University of California, San Francisco, San Francisco, CA, USA
| | - Dorit Ron
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jamie Peters
- Department of Anesthesiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.,Department of Pharmacology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Yi Zuo
- Department of Molecular, Cell and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | - David E Olson
- Department of Chemistry, University of California, Davis, Davis, CA, USA. .,Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, Sacramento, CA, USA. .,Center for Neuroscience, University of California, Davis, Davis, CA, USA. .,Delix Therapeutics, Inc., Palo Alto, CA, USA.
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Doss MK, May DG, Johnson MW, Clifton JM, Hedrick SL, Prisinzano TE, Griffiths RR, Barrett FS. The Acute Effects of the Atypical Dissociative Hallucinogen Salvinorin A on Functional Connectivity in the Human Brain. Sci Rep 2020; 10:16392. [PMID: 33009457 PMCID: PMC7532139 DOI: 10.1038/s41598-020-73216-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022] Open
Abstract
Salvinorin A (SA) is a κ-opioid receptor agonist and atypical dissociative hallucinogen found in Salvia divinorum. Despite the resurgence of hallucinogen studies, the effects of κ-opioid agonists on human brain function are not well-understood. This placebo-controlled, within-subject study used functional magnetic resonance imaging for the first time to explore the effects of inhaled SA on strength, variability, and entropy of functional connectivity (static, dynamic, and entropic functional connectivity, respectively, or sFC, dFC, and eFC). SA tended to decrease within-network sFC but increase between-network sFC, with the most prominent effect being attenuation of the default mode network (DMN) during the first half of a 20-min scan (i.e., during peak effects). SA reduced brainwide dFC but increased brainwide eFC, though only the former effect survived multiple comparison corrections. Finally, using connectome-based classification, most models trained on dFC network interactions could accurately classify the first half of SA scans. In contrast, few models trained on within- or between-network sFC and eFC performed above chance. Notably, models trained on within-DMN sFC and eFC performed better than models trained on other network interactions. This pattern of SA effects on human brain function is strikingly similar to that of other hallucinogens, necessitating studies of direct comparisons.
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Affiliation(s)
- Manoj K Doss
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA.
| | - Darrick G May
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Matthew W Johnson
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - John M Clifton
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
| | - Sidnee L Hedrick
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, USA
| | - Thomas E Prisinzano
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, USA
| | - Roland R Griffiths
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Frederick S Barrett
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD, 21224, USA
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Breeksema JJ, Niemeijer AR, Krediet E, Vermetten E, Schoevers RA. Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies. CNS Drugs 2020; 34:925-946. [PMID: 32803732 PMCID: PMC7447679 DOI: 10.1007/s40263-020-00748-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Interest in the use of psychedelic substances for the treatment of mental disorders is increasing. Processes that may affect therapeutic change are not yet fully understood. Qualitative research methods are increasingly used to examine patient accounts; however, currently, no systematic review exists that synthesizes these findings in relation to the use of psychedelics for the treatment of mental disorders. OBJECTIVE To provide an overview of salient themes in patient experiences of psychedelic treatments for mental disorders, presenting both common and diverging elements in patients' accounts, and elucidating how these affect the treatment process. METHODS We systematically searched the PubMed, MEDLINE, PsycINFO, and Embase databases for English-language qualitative literature without time limitations. Inclusion criteria were qualitative research design; peer-reviewed studies; based on verbalized patient utterances; and a level of abstraction or analysis of the results. Thematic synthesis was used to analyze and synthesize results across studies. A critical appraisal of study quality and methodological rigor was conducted using the Critical Appraisal Skills Programme (CASP). RESULTS Fifteen research articles, comprising 178 patient experiences, were included. Studies exhibited a broad heterogeneity in terms of substance, mental disorder, treatment context, and qualitative methodology. Substances included psilocybin, lysergic acid diethylamide (LSD), ibogaine, ayahuasca, ketamine and 3,4-methylenedioxymethamphetamine (MDMA). Disorders included anxiety, depression, eating disorders, post-traumatic stress disorder, and substance use disorders. While the included compounds were heterogeneous in pharmacology and treatment contexts, patients reported largely comparable experiences across disorders, which included phenomenological analogous effects, perspectives on the intervention, therapeutic processes and treatment outcomes. Comparable therapeutic processes included insights, altered self-perception, increased connectedness, transcendental experiences, and an expanded emotional spectrum, which patients reported contributed to clinically and personally relevant responses. CONCLUSIONS This review demonstrates how qualitative research of psychedelic treatments can contribute to distinguishing specific features of specific substances, and carry otherwise undiscovered implications for the treatment of specific psychiatric disorders.
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Affiliation(s)
- Joost J Breeksema
- University Center of Psychiatry, University Medical Center Groningen, Postbus 30.001, 9700 RB, Groningen, The Netherlands.
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | | | - Erwin Krediet
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Military Mental Health Care, Utrecht, The Netherlands
- ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Robert A Schoevers
- University Center of Psychiatry, University Medical Center Groningen, Postbus 30.001, 9700 RB, Groningen, The Netherlands
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Barber M, Gardner J, Savic M, Carter A. Ibogaine therapy for addiction: Consumer views from online fora. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 83:102857. [PMID: 32693321 DOI: 10.1016/j.drugpo.2020.102857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
Background Ibogaine is a psychedelic drug used by for-profit clinics and lay-people to treat addiction, despite some reported fatalities and a lack of rigorous clinical research. Little is known about ibogaine therapy from a consumer perspective. Online discussions generate and disseminate information about ibogaine therapy and provide a window into how people understand ibogaine's risks and uses. We examined views expressed in online fora in order to describe a consumer perspective of ibogaine therapy for addiction, and to elucidate the role of online fora in mediating people's understanding of, and engagement with ibogaine. Methods We thematically analysed 40 threads comprising posts from 101 individual contributors from two popular online fora; Reddit (n = 20) and Drugs Forum (n = 20). Results Our analysis identified three primary themes: (1) online fora as a resource for do-it-yourself research; (2) the therapeutic interaction in ibogaine therapy, and; (3) therapeutic mechanisms of ibogaine. Online fora were a key resource for information about ibogaine therapy, where personal experiences and evidence-based information were valued. Treatment arrangements, risks, and harm reduction were discussed at length by forum participants. Discussions of therapeutic effects focused on pharmacological mechanisms but positive psychological changes resulting from the psychedelic experience were also reported. Clinic-based treatment was preferred by many forum participants due to safety concerns, but money and time and treatment intent sometimes necessitated lay-administration of ibogaine. Microdosing of ibogaine was also frequently discussed. Conclusion: Online fora appear to have facilitated a sense of community where individuals are held to account for the success of ibogaine therapy. Fora discussions illustrate that neuroscientific explanations of addiction and behaviour have explanatory salience for people involved in ibogaine therapy. Online fora could be used as a platform for clinician and peer-led support and harm-reduction interventions, and for further research monitoring treatment practices and long-term outcomes.
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Affiliation(s)
- Michaela Barber
- Turner Institute for Brain and Mental Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - John Gardner
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, Australia
| | - Michael Savic
- Eastern Health Clinical School, Monash University; and Turning Point, Eastern Health, Melbourne, Australia
| | - Adrian Carter
- Turner Institute for Brain and Mental Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Srivastava AB, Mariani JJ, Levin FR. New directions in the treatment of opioid withdrawal. Lancet 2020; 395:1938-1948. [PMID: 32563380 PMCID: PMC7385662 DOI: 10.1016/s0140-6736(20)30852-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/10/2020] [Accepted: 04/06/2020] [Indexed: 12/16/2022]
Abstract
The treatment of opioid withdrawal is an important area of clinical concern when treating patients with chronic, non-cancer pain, patients with active opioid use disorder, and patients receiving medication for opioid use disorder. Current standards of care for medically supervised withdrawal include treatment with μ-opioid receptor agonists, (eg, methadone), partial agonists (eg, buprenorphine), and α2-adrenergic receptor agonists (eg, clonidine and lofexidine). Newer agents likewise exploit these pharmacological mechanisms, including tramadol (μ-opioid receptor agonism) and tizanidine (α2 agonism). Areas for future research include managing withdrawal in the context of stabilising patients with opioid use disorder to extended-release naltrexone, transitioning patients with opioid use disorder from methadone to buprenorphine, and tapering opioids in patients with chronic, non-cancer pain.
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Affiliation(s)
- A Benjamin Srivastava
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA.
| | - John J Mariani
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - Frances R Levin
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
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