An NYU psilocybin depression study participant discovers an unforeseen application for psychedelics: the treatment of chronic pain. Part 1 of the series: Psychedelics and Chronic Pain.

Everything Worked, but Nothing Lasted

In the fall of 2020, I was living a pretty successful and happy life – on paper. I had co-founded a very popular, leading-edge CrossFit gym in NYC; one of the first in the world. I held multiple advanced certifications in applied neurophysiology through Z-Health, helping clients with challenging pain and performance issues. As an early adopter of kettlebell training, I became a nationally top-reviewed instructor and trained Team 6 Navy SEALs, astronauts, pro athletes, wounded veterans, and members of the FBI, NYPD, NYFD, and ROTC. I was featured in Men’s Fitness, the NY Times Sunday Routine, and USA Today. I had 30 years in the pain & performance field, training and teaching at a high level, and was becoming widely known for helping people with difficult mobility problems or chronic pain, using unique methods from the leading edge of neurological rehabilitation. On top of all of that, I was 17 years sober.

However, not all that glitters is gold. A now ex-business partner was committing a Ponzi scheme to the tune of millions, and his case followed him like a shadow, turning my life’s passion into an emotionally and financially toxic nightmare that economically devastated my family. My best friend, Kirk MacLeod, who I had completely rehabbed from chemo & cancer surgery, died six months after being declared in remission. My first son had developed undiagnosed GERD and couldn’t sleep more than an hour and half at a time, which meant my wife and I slept even less.

Unsurprisingly, my episodic depression returned after more than a decade and a half, and I was now increasingly treatment-resistant; unresponsive to psychiatric drugs that had previously worked. All my pain neuromodulation interventions that worked on my clients no longer worked for me, and I had developed chronic pain myself.

I share all my background here to demonstrate that I was not under-resourced in either knowledge, networks, or diversity of approaches, practice, or experiences. I poured over all my certification materials looking for anything I had missed, but had fallen into an increasingly deeper recovery hole; everything worked, but nothing lasted. I was hitting a new bottom in my life, deeply sinking into the midst of an increasingly treatment-resistant depression episode that had likely been ongoing for five years.

But then I became aware of ongoing studies on psilocybin for depression happening locally in NYC. I had experienced a few high-dose psychedelic sessions nearly a quarter century ago and had been an avid Terence McKenna fan (even speaking with him directly after a lecture in Seattle), but I had never taken psychedelics therapeutically, and my recreational interest had effectively vanished once I became sober from alcohol. Intrigued, I connected with the local clinical research coordinator, Leila Ghazhal, at the NYU for the clinical trial of Psilocybin for Major Depressive Disorder study (sponsored by the Usona Institute), and took all the online and over-the-phone assessments, passing them easily. The primary investigator (PI) on my study was Dr. Stephen Ross, who had been leading psychedelic research at NYU for more than a decade. Amazingly, I made it into the trial within a month and a half, learning that I’d actually beat out 8500 other applicants for just 100 spots nationwide.

Trying Not to Hope

When I first entered the trial, I was in a state of denial about how severe my depression was, but once I took the MADRS assessment, there was no avoiding that I had moderate to severe depression with suicidal ideation.

I remember a specific moment very well during this process, when I was finally cleared to enter the study and the study coordinator was speaking with me about the results of my assessment and my upcoming participation. I asked what would happen if I didn’t receive psilocybin during my session, and he reassured me that they would not just drop me off in the middle of the ocean to dog paddle – that there were other interventions and studies available and they would be sure to find me something, but there was a good chance I would receive psilocybin and hopefully get some good results. At this point, my mask cracked a little bit and some protective cynicism came out, and I quipped with a bit of a shrug: “Well, we’ll see.” I hadn’t meant it to be dismissive or sarcastic but it came out that way, and the conversational atmosphere rapidly shifted. He looked right at me and suddenly he wasn’t the primary investigator anymore, lost in the myriad details and logistics of a very involved study. Now he was the deeply experienced clinician and therapist, and, having heard something within the tone of my voice, dropped all the way in and asked softly: “What’s going on behind that, Court?” Suddenly, all the masking dropped and there was no more place to hide because I was so, so tired at this point, and had been waiting for this moment. In and out of therapy for years, dozens if not 100 self-help books, so many modalities, so many somatic systems, and here I was with a chance for something new to help me. When I realized why there was cynicism behind my statement, my voice cracked, I started crying, and I answered him: “Trying not to hope.”

The one glimmer of hope I did have was reading a 2018 paper by lead author Calvin Ly describing psychedelics’ neuroplastic activity in the prefrontal cortex. As someone who had studied the neurology of pain for years, this was revelatory. Many pain conditions are, in fact, nociplastic or noxious conditions arising out of the central nervous system (CNS); there’s no more injury or damage if there ever was, but your CNS is still continuing to put out a maladaptive alarm signal that is perceived as pain. So learning that psilocybin was creating actual structural change within my cortex – not “just” psychological change – was completely astonishing.

My dosing date was on March 5, 2020, and I remember looking down at the capsule sitting in the cup, saying to it: “I really hope that’s you.” I was terrified inwardly that I would receive the placebo, that I wouldn’t respond to the psilocybin, or that it would only work just a little bit, only for its effects to slowly fade. But within half an hour, there was no denying that I had received psilocybin, and I earnestly pursued all the procedures everyone on my care team at NYU had worked with me on for weeks in preparation for this day.

I was genuinely shocked at the sheer volume of psychological material from my childhood and early adulthood that came up. I had profound transpersonal experiences and healing, revisiting instances that were pivotal in my childhood. I had an encounter with the first woman I had ever loved, who had committed suicide three years after we had broken up. Her death had caused a profound grief in me that drove my drinking for a decade after. I thought I had released the majority of my grief around her once I got sober, but clearly, there was so much more to heal that had been deeply suppressed as I tried to move forward with my life.

Reset, Renewed, and Reborn

The biggest shock of all, though, was waiting for me at the end of the day when one of my facilitators casually pitched a seemingly routine question while closely watching me out of the corner of his eye: “So, how do you feel?” Without thinking, I reflexively replied, “Good,” but then, just as reflexively, scanned more deeply inward, and in a sudden rush, realized my depression was completely gone – not just better, but vanquished, exclaiming: “Good! That fast? Are you fucking kidding me, that fast? Is it gone already?”

It felt as if a huge mass had been surgically removed from me or as if an entire continent within my interior was now suddenly revealed. No matter how many times you read the word “remission” and the percentages behind it in scientific studies, very little will prepare you for the shocking reality of it. The contrast between before and after was profound. All of the iterative rumination was gone, and it took no effort for that to happen. And it only seemed to strengthen as the days passed. Miraculously, all suicidal thoughts ceased on that day and never returned.

Shockingly, only ten days after my dosing session, NYC went into a complete pandemic lockdown, my entire industry closed, and my two young boys were now at home with me 24/7, tele-learning. I cannot imagine what 2020 would have been like for me if I had received the placebo. It’s almost unimaginable.

But here is where the story takes an even more profound and impactful turn. During the session, my leg started intensely tremoring/spasming. I had been evaluated for musculoskeletal pain and dysfunction that I had acquired through a host of injuries over the years of my performance career, and in fact, had just been in the doctor’s office a few months earlier trying to determine if I had arthritis or something worse. But right there in the session room, I started having a neurological revision, with my muscles and nerves in my right inner thigh firing in an effort to recalibrate the sensory and motor inputs and outputs in that part of my kinetic chain. It was almost like a self-generated TENS unit (Transdermal Electromagnetic Nerve Stimulation, used to generate muscle contractions and neuromodulate pain signals with micro-electric pulses) getting my leg back online by creating intense motor activity in the muscles of my thigh.

I’ve since spoken with spinal injury survivor Jim Harris and read a case series from UC San Diego’s Psychedelics and Health Research Initiative (PHRI) published in PAIN Journal where the exact same thing occurred to them under the effect of psilocybin with the same positive results, but at the time, the facilitators were concerned enough to ask the primary investigator to come and evaluate me during the session. I had to explain to him, somewhat hilariously as I was going into my peak, that, in fact, the tremors felt intensely good. I’m grateful that he let them continue because it has made all the difference.

While I partially understood what had happened, I was understandably beyond eager to learn more, and to see where else this realization could take me: Why did this work so well? Has our understanding of chronic pain been wrong? And if psychedelics are the answer, what does treating chronic pain with psychedelics actually look like?

This is part 1 of a 2-part piece and part of a larger series on chronic pain and psychedelics. In part 2, I will dive into the research around remapping and mirror box therapy, and why my psychedelic experience seemed to be so effective.

Future articles will focus on: What is pain and what causes chronic pain, old assumptions vs. new science, the suspected mechanisms of action behind the interaction between psychedelics and pain, and best practices and safety concerns for working with psychedelics to alleviate chronic pain.

By Rebecca Martinez

How do you draw the line between a healthy escape and a dissociative disorder? And could dissociative psychedelics like ketamine play a part?

We live in a deeply interconnected world. From our ecosystems to our societies, the Earth is made up of living things held in dynamic relationships. We as humans are deeply woven into this fabric. But sometimes, all this connection can be too much to hold. Whether from acute trauma, overstimulation, or constant societal stress, our bodies have built-in intelligence that allows us to dissociate or disconnect from our current experience when we’ve reached our saturation point. 

On the heels of the COVID-19 pandemic, the question of how we cope with and heal from traumatic experiences has been front of mind. I spoke with somatic practitioner, Claudia Cuentas, MA, MFT, and Psy.D., psychologist, ketamine specialist and founder of KRIYA (Ketamine Research Institute), Raquel Bennett, to discuss the psychology of dissociation, what happens when it becomes a disorder, the healing power of escapism, and where psychedelics like ketamine fit into the conversation. 

It turns out, dissociation isn’t all bad.

A Term With Many Meanings: What Is Dissociation?

So, what exactly is dissociation? 

Raquel Bennett, who has been studying therapeutic ketamine since 2002 and who teaches the Masterclass on Ketamine in our Navigating Psychedelics for Clinicians and Therapists course, put it this way: “There are different kinds of dissociation or disconnection, including dissociation from your body or bodily sensations; dissociation from your thoughts or awareness; and dissociation from your biographical history, identity, or sense of self.”

Claudia Cuentas explained it another way. “Dissociation is a physiological self protective response, and it is activated when the body feels saturated or overwhelmed by an input or by too much information at once. That information can come from an internal or external stimulus.  Dissociation is our bodies’ ability to remove its attention from the present and take a break, pause and/or, hopefully, recalibrate back into presence. Children do it all the time. That gazing and daydreaming is self-regulating. It is an amazing regulatory system we have.”

While they may look the same from the outside, many experts say that dissociation is different from absent mindedness. Many of us can relate to driving home and not remembering the drive, or checking out during a meeting because we are distracted by something going on in our personal lives. Dissociation is a common experience, and not necessarily a cause for concern. The question is: Is dissociation or the dissociation patterns you have developed to cope with internal/external stressors interrupting your ability to enjoy life?

On top of this, the pressures of modern life can almost be too much to bear at times. We are inundated with unlimited newsfeeds and chaotic information overload in a way that no generation has ever been. What are embodied creatures like us meant to do with the realities of systemic injustice, climate catastrophe, and economic collapse, on top of personal concerns like relationships, mortgages, and health issues? 

In response to these pressures, we’ve normalized a culture of disconnection. Checking out of life may become a habitual way of coping with the strain of daily life: binge watching TV or scrolling on social media. Gaming out. Numbing with drugs or alcohol. Swiping on Tinder. These are activities that put us in passive roles and don’t require our engaged presence or participation. 

Dissociative Disorders

Tuning out itself isn’t necessarily problematic. When it comes as a response to overstimulation, it serves a purpose and then the person can return to present awareness naturally when they feel ready. However, this disconnection can sometimes happen involuntarily or becomes a default way of moving through life. Often, chronic dissociation comes as a result of acute or ongoing trauma.

For people living with dissociative states, this disconnection from one’s body, mind, emotions or identity can be distressing and have a major impact on relationships and quality of life. They may experience depersonalization (feeling as though they don’t control their body, thoughts or emotions) or derealization (a disruption in one’s perception of reality, as though the world is unreal, hazy or flat). 

Dissociation can show up in a lot of ways: tuning out during a difficult conversation, personality changes, forgetting major memories or stretches of time, difficulty staying present during sex, or feeling unaware of one’s own body. Sometimes these episodes begin in response to overstimulation or an event that triggers traumatic memory or association.

I asked Cuentas how these disorders happen, and how they might be addressed.

“At times, we may feel that life is not that safe or that the present is not that safe. This is especially true when there has not been an ability to heal, digest and process past trauma and understand why an experience was so frightening or difficult. People don’t want to feel present because if they do, they will be overwhelmed by sensations associated with pain, sadness, overwhelm. The body sends a signal to the brain through the nervous system, and the brain and/orr the body disconnect from the present reality. So the mind says, I am going to release attention from the whole system so that you are here… but not here. I am going to keep you safe.. This way, you don’t have to feel the pain you have gone through.”

“Dissociative diagnoses arise when we are using this way of coping as an unconscious default,” she adds. “Sometimes people struggle because they aren’t feeling like themselves. Maybe everything is numb. Or they feel like they are witnessing a facade of somebody else. Most of the time, dissociative diagnoses are connected to intense, deep, unaddressed trauma from very early on stages of life.”

This questionnaire is a useful tool for distinguishing between normal and problematic dissociative experiences. 

Could Somatic Practices & Dissociative Drugs Like Ketamine Be The Path Back?

According to Cuentas, the way to alleviate dissociative disorders is to increase one’s tolerance over time for sensations that may be uncomfortable or overwhelming, essentially moving through the trauma at a pace that’s comfortable and tolerable to the individual.

“We have to get beyond this self-protection mechanism that kicks in automatically. So how do we decode the experience to relieve the body from the automatic response in order to enjoy the present? If you keep unconsciously self protecting to not feel the pain, then you’re missing everything– joy, love, intimacy, all your senses. You turn off your ability to sense comfortable or uncomfortable experiences, like enjoying a sky full of colors, feeling the softness of your skin, hearing a song and go, ‘wow, I like that’. It’s numbing, and the person may not, at times, even realize.”

Finding pleasurable ways to exist in one’s body is an essential part of processing, healing, and moving through trauma. Many trauma therapists work with a particular focus on the body, known as “somatic” practices. This is essential because, although the mind can check in and out through dissociation, the body carries the load of a lifetime of experiences. Cuentas’ work focuses on the use of embodied approaches, like art, dance, music, drama and storytelling as healing modalities for families and communities.

Psychedelic substances may offer another path to doing this work. Part of the theory around why psychedelics help with trauma is related to capacity building. By promoting states of openness, they create opportunities for people to re-engage with painful or traumatic experiences and form new relationships to these memories.

Psilocybin and MDMA have received the most press in recent years, but ketamine has held a steady role as one of the only legal psychedelics clinicians can currently offer. It’s common to hear people speak about ketamine as a dissociative. I asked Bennett her thoughts on this classification. 

“When you take ketamine, you may be dissociated from your body; in other words, the signals from your sensory input organs may be temporarily muted,” she says. “However, when ketamine is utilized in a physically and psychologically safe setting, people tend to be keenly aware of or connected with their own thoughts and internal images.”

The dissociation felt with ketamine is more physiological than psychological. I asked Cuentas to expand upon this. She explained that, based on a somatic perspective, it seems like ketamine temporarily disconnects the body and the mind, whereas the coping mechanism of dissociation can often disconnect people from their own consciousness as well.

“Seems like Ketamine can turn the body off so the mind doesn’t have to negotiate how to to keep the body safe or what to do with the body’s intense signals of stress, which are common during or after traumatic experiences,” says Cuentas. “So for a period of time, it may not have to navigate the usual intensity and discomfort. If this happens, the mind is released from its usual concerns/stressors, and its attention can possibly concentrate on other sensations or realms of awareness.”

“As the body experiences numbness or dissociation, it is still tracking the experience, but not reacting. When a body is affected by an anesthetic like Ketamine for therapeutic uses, it will put the body in a highly suggestible state,” Cuentas adds. “From a somatic perspective, there is a window of time as a person is coming back to feeling their body again— that is the moment of doing a lot of processing. I believe this is possibly the most effective way to work with ketamine. Whatever happens in this window of reconnection between unconsciousness and consciousness or body awareness, will be recorded in the body. You would have to be intentional because whatever you introduce in that state can have a great impact on your psyche.”

Returning To Safety From Dissociative Disorders

Dissociation is the human body’s way of trying to achieve safety. As we are unlearning automatic responses that don’t serve us, the need for a sense of safety is still present. How do we develop a sense of safety within ourselves when we can’t guarantee it in our external environment? Therapists refer to resourcing—tools that help people develop a higher tolerance for discomfort. In this way, we can stay in the present moment longer without needing to dissociate.

Especially for people from marginalized communities, creating microcosms of safety, even temporary ones, can be essential practice for dealing with life. These pods of comfort can come from affinity spaces, keeping a close inner circle, getting immersed in something you love, and for some people, exploring altered states. 

In pursuit of safety, a natural response to triggering scenarios is to remove oneself from further harm. However, safety can’t necessarily be achieved in a societal context which is inherently unsafe for many people in our communities. Some people may feel they always have to be shut down or running to escape harm. For these folks, there is an even greater need for networks of support and practical tools that grow the ability to stay present. It can be empowering and freeing to stay present through a practice of pleasure, feeling the body’s sensations, and finding what feels positive and safe in the here and now. 

When Dissociation Can Be a Positive

For those of us not dealing with chronic dissociation, the question to ask is whether we are habitually checking out from the present moment and if so, what shifts in these habits might help us have a more fulfilling quality of life. Perhaps instead of relying on screens or substances to wind down, we could incorporate activities that invite pleasurable presence: music, dance, breath work, meditation, meals, or the company of a loved one. It helps to view this as something to practice, rather than something to be good or bad at.

On the other hand, escapism isn’t always a bad thing. There is agency in choosing when and how to turn off the outside world for a while. In order to absorb the benefits of this freedom, dissociating needs to be something that is consciously chosen, rather than an automatic stress based response. 

In some ways, escapism is a combination of dissociation and resourcing. Tuning out on purpose, or even altering one’s perception, can offer a healthy way to find rest and recovery from the concerns of daily life. It can also help us to remember what it is like to feel good and build capacity for pleasure. Feeling good is an essential part of our healing.

Grammy nominated singer Jhené Aiko often writes songs about the use of cannabis and psychedelics as medicine. As a mixed race woman of color, she poetically contrasts the peaceful haze of altered states and the harsh realities of the world outside. 

She says it well in her hit, “Tryna Smoke”:

Life’s no fairytale, I know all too well/ Gotta plant the seed sometimes /Then you let it grow

Inhale, exhale some more/ Heaven in Hell/ If you know, you know/ That sh*t is beautiful

You gotta just let it go/ Spark up a blunt and smoke

Similarly, in her song “Bed Peace”, featuring Childish Gambino, she sings:

Yeah, what I am trying to say is/ That love is ours to make so we should make it 

Everything else can wait/ The time is ours to take so we should take it 

We should stay right here/ We should lay right here’Cause everything is okay right here

Conclusion: Dissociation Is Complex

Dissociation is multifaceted. It can signal trauma, offer temporary respite from trauma, and potentially even a path to healing trauma.

Altered states of consciousness, whether from known dissociatives like ketamine, or other substances, give us an opportunity to choose when and how to leave our physical realms and return. They shift our awareness of our spirits, minds and bodies, and often create pleasurable sensations and new insights along the way. 

Cuentas closes our conversation by reminding me that the intentions we bring to these experiences are important. “You are recording information in your subconscious/psyche. So what do you want to put there?” she asks.

We can’t necessarily make the world safer today. So there is power in creating microcosms of the world we are dreaming forward. In creating a practice of pleasure and joy, we’re able to fill our spirits like a well to draw upon during difficult experiences. Perhaps eventually, as these micro-moments of safety and resourcing find their way into our embodied realities, they will spread like mycelium and we will create a world that is less traumatizing to begin with.

RESOURCES

Ketamine risk reduction information from Dance Safe

Firsthand accounts of dissociation

Claudia Cuentas

KRIYA Institute

This article was updated on July 19, 2021 to reflect changes by one of the sources.

Rebecca Martinez is a Xicana writer, parent and community organizer born and raised in Portland, Oregon. She is a co-founder of the Fruiting Bodies Collective, an advocacy group, podcast and multimedia platform addressing the intersections between healing justice and the psychedelics movement. Rebecca served as the Event & Volunteer Coordinator for the successful Measure 109 campaign, an unprecedented state initiative which creates a legal framework for psilocybin therapy in Oregon. She is also the author of Edge Play: Tales From a Quarter Life Crisis, a memoir about psychedelic healing after family trauma, spiritual abuse, and police violence. She serves on the Health Equity Subcommittee for Oregon’s Psilocybin Advisory Board as well as the Board of Advisors for the Plant Medicine Healing Alliance.

By Jeff Kronenfeld

Could 18-MC, a synthetic derivative of Ibogaine, make treatment safer without the psychedelic trip?

With COVID-19 still spreading, mutating, and killing, it’s easy to forget the other health crises ravaging the country. One of the most concerning of these is drug overdose deaths, with opioids representing a large share of such casualties. From 1999 through 2018, nearly 450,000 people fatally overdosed on opioids in the US. While slight decreases in 2018 buoyed hopes that we were past the peak, even then, overdose deaths were four times greater than in 1999. In 2019, such optimism was dashed as the number of opioid overdose deaths climbed to 50,042, an increase of nearly 7 percent over the previous year. But, are there viable treatment options that are overlooked by the medical community and general public?

In the psychedelic community, many would argue yes, and highlight the potential of ibogaine, a psychedelic compound found in the West African shrub, Tabernanthe iboga. But ibogaine comes with more possible health risks than other psychedelic plants and substances that we’ll explore below, and of course, there remains a lingering bias in some parts of the medical establishment against psychedelics. And so, a non-psychoactive alternative, 18-Methoxycoronaridine (18-MC) was developed in the 1990s and is now advancing through the FDA’s drug development process at a steady clip, while research into ibogaine remains virtually frozen. However, the question remains: are the concerns about ibogaine’s risks valid enough to explain the differing fates of these chemical cousins, or are other factors at play?

What is Ibogaine? 

Ibogaine is a plant-derived alkaloid with unique psychoactive properties distinct from those of classic psychedelics, such as LSD, psilocybin-producing mushrooms, or DMT. One of its effects is panoramic recall, often described by patients as watching a movie of their life playing in their head. Sometimes called a dissociative psychedelic, Geoff Noller, a medical anthropologist with a doctorate from the University of Otago’s Department of Psychological Medicine, prefers the term “oneiric” (pronounced ō-ˈnī-rik), which is defined as, “dream-inducing.”

This description of the ibogaine experience was seconded by Dr. Bruno Rasmussen, a physician and researcher based in Brazil who provides ibogaine therapy. “Ibogaine doesn’t make you hallucinate; Ibogaine makes you dream, but you are awake when you are dreaming,” Rasmussen said. “If you do an EKG during the effect of ibogaine, the lines will be like they are in a REM state, the rapid eye movements state, the dream state.”

How Does Ibogaine Work?

The unique, psychedelic qualities of ibogaine are not the only way it differs from more familiar hallucinogens. Psilocybin, LSD, and DMT all act in a more focused manner on the brain’s serotonin receptors. And while ibogaine does act on serotonin levels in the brain, it also acts on numerous other neural systems. Noller compares its relatively blunt mode of action to cannabis, which also acts on many different receptor sites, and contrasts it with more targeted designer medicines like Prozac. 

While the exact neural systems ibogaine engages are not fully understood yet, studies show it can reduce opioid withdrawal symptoms and help control cravings. This offers a window of opportunity for patients to make changes in their life that would otherwise be more difficult due to the pain, anhedonia, and other symptoms of withdrawal. Once they have weathered this storm, the reduction in cravings increases their likelihood of not relapsing. 

Furthermore, studies have shown that ibogaine reduces the amount of drugs, like cocaine, alcohol, and nicotine, that animals self-administer, despite the fact that each of these drugs has their own distinct way of influencing neural chemistry. This ultimately suggests that ibogaine acts on multiple regions of the brain. Studying this broad function could lead to new insights into the physiological underpinnings of addiction, which makes the relative dearth of research on ibogaine all the more curious — until you consider its potential hazards. 

Ibogaine Risks

The benefits of ibogaine must be weighed against its potential dangers. An article in the Journal of Forensic Science examined 19 deaths that occurred following ibogaine treatments given between 1990 and 2008. Post-mortem testing revealed that at least 11 of these patients had other drugs in their systems, such as benzodiazepines, cocaine, opiates, and methadone, all of which are known to be dangerous when mixed with ibogaine. 

Prior to treatment, however, a dozen of the patients who died also had one or more comorbidities known to pose risks when using ibogaine, such as obesity, brain neoplasm, and a range of diseases affecting the liver, heart, and other organs. 

Although ibogaine research in the US stalled in the late ‘90s, it continued abroad. Thomas Kingsley Brown, a California-based anthropologist, worked with the Multidisciplinary Association for Psychedelic Studies (MAPS) for a 2017 study in Mexico, where ibogaine treatment is not specifically outlawed. Thirty people with opioid dependence received ibogaine treatment and were evaluated over the following year. After one month, half of the research subjects stated they had not used opioids since their ibogaine session. Further follow-ups showed sustained anti-addictive effects.

“To address the first question of whether or not ibogaine can be used safely and effectively, my short answer is yes,” Brown said. “There are going to be risks with that, but you can also minimize the risk.”

In addition to screening patients for potentially dangerous comorbidities and identifying contraindications, such as the presence of drugs that could cause harmful interactions, Brown explained that genetic tests can determine how quickly people’s bodies break down ibogaine into noribogaine. This helps those administering the treatment determine whether it’s safe for a patient to move forward with ibogaine and how to calculate an optimal dosage.

Noller also worked with MAPS on an ibogaine study, though this one was based in New Zealand, where Medsafe (the country’s equivalent of the FDA) made such treatment legally available as a non-approved medication in 2010. According to Noller, this classification gives doctors the ability to write a prescription for a drug or treatment even if it hasn’t gone through a three-phase trial testing period. 

He points out that ibogaine’s mortality rate is comparable to methadone. A 2008 paper in the Journal of Ethnopharmacology reported 11 ibogaine-related deaths from 1990 to 2006 out of the 3,414 people estimated to have taken it — a mortality rate of 0.32 percent. A 2007 paper in the Drug and Alcohol Review found 283 methadone-related deaths in Australia between the years of 2000-2003 out of an estimated 102,615 episodes of treatment, which yields a mortality of 0.27 percent. 

But Rasmussen believes it can still be safer, attributing the majority of ibogaine-related deaths to preventable failures on the part of caregivers, such as not having qualified doctors present, forgoing the use of cardiac monitors, and passing on testing patients for drugs that could cause harmful interactions. His strongest piece of evidence for the ability to safely use ibogaine is that none of his roughly 2,000 patients have died due to or during treatment. In fact, he hasn’t even had a subject develop complications, like severe heart arrhythmia. In Brazil, doctors can legally prescribe ibogaine therapy in hospital settings, a model Rasmussen champions.    

“I think that the trick here is to face it as a little surgery,” Rasmussen explained. “We make some pre-surgical examinations, lab tests, blood tests, and EKGs. We do it in a big hospital with the emergency team aware that there is an ibogaine patient in the hospital. For anything we could need, we are backed up, but we never needed the emergency team because we do the lab tests, so we can usually prevent the complications.”

18-MC: The Non-Psychedelic Alternative to Ibogaine

Concerns about ibogaine’s psychoactive effects and potential risks led to the development of 18-MC in the 1990s. Dr. Kenneth Alper, a professor of psychiatry and neurology at New York University School of Medicine, explained that 18-MC is a structural analog of ibogaine, meaning they share a common molecular base, in this case the ibogamine ring system. At the microscopic level, even small variations can lead to big changes. 

The general consensus seems to be that 18-MC is not psychoactive or oneiric, though Alper speculated that it could potentially be hallucinogenic at higher doses. 18-MC also does not seem to carry the same cardiovascular risks. MindMed, a new Canadian pharmaceutical company focused on psychedelic and psychedelic-inspired medicines, obtained the patent for 18-MC in 2019 when it acquired the biopharma startup, Savant HWP, for an undisclosed sum. MindMed recently completed Phase I testing on 18-MC. The company declined to share information about their 18-MC trials or comment for this story. 

18-MC Patent and the Halting of Ibogaine Research

Karen Szumlinski, a neuropharmacologist, neuroscientist, and professor at the University of California Santa Barbara, worked on animal studies for both ibogaine and 18-MC from the mid to late ‘90s—long before Savant HWP or MindMed existed. 18-MC was first developed in 1996 by a group of scientists, one of which served as Szumlinski’s research mentor. Based on her observations, Szumlinski believes 18-MC is not psychoactive. But the bias against psychoactive compounds combined with 18-MC’s minimal cardiovascular risks are likely the reasons why ibogaine research in the US halted when it did.

Another reason ibogaine studies in the US stopped is due to profitability. Ibogaine is a natural product not eligible for a patent, according to Brown. Patenting molecules is how companies make big profits. Somewhat confusingly though, Howard Lotsof, the person credited with discovering ibogaine’s anti-addictive properties, was able to patent the use of ibogaine and related molecules in doses ranging from 1 mg/kg to 60 mg/kg given orally or rectally for treating poly-drug dependency in 1990. The patent covered addiction to one or more of the following: alcohol, heroin, methadone, cocaine, caffeine, amphetamine, desoxyephedrine, and nicotine. However, it’s the patents held by companies like MindMed that cause Rasmussen to express concerns.

“Big pharma, they like molecules that they can register as their intellectual property and make more money on,” Rasmussen said. “So, I think that’s the reason that there’s a lot of money for 18-MC and there’s no money for ibogaine research.”

Is the Ibogaine Experience a Crucial Part of the Treatment?

Ibogaine’s effectiveness for treating substance abuse disorders and addiction is established in human trials and supported by numerous first-person testimonials. We were unable to find data showing the same for 18-MC, likely because the results of clinical research don’t exist on the molecule yet. But when such information is available, it may offer additional insights into whether the consciousness-altering properties of ibogaine are essential to its effectiveness for treating various SUDs.

Alper suspects the new data will be consistent with what is shown in the existing research. “In terms of ibogaine and its effects on self-administration and withdrawal, the animal model and human experience appear to align pretty well,” Alper said. “Effects on reduced drug self-administration following treatment with ibogaine or 18-MC are not likely to be based on the processing of the content of psychoactive experience.”

In other words, Alper doesn’t think that the reduced consumption of addictive substances by lab animals is caused by psychedelic epiphanies. Rather, he believes it’s the physiologic processes induced by ibogaine. He suspects the same is true for humans, though he also accepts that the psychedelic experience could be a useful aid for patients undergoing psychotherapy.  

Other researchers were less optimistic about 18-MC’s relative prospects in human trials. “I think that at least in some cases—not the majority of them maybe, but in a significant number of situations—the psychedelic experience is a key to solving the problem,” Rasmussen explained. “It’s not that I think that 18-MC will not work, but I really don’t understand how it would work as well as ibogaine does without the psychedelic experience.”

Instead of viewing the question as a zero-sum game that promotes one treatment at the expense of the other, the true win-win scenario for patients would be that both medicines become safely available. After all, the need for more effective therapies is paramount. COVID-19 and the policies put in place to contain it have only exacerbated the risks posed by SUDs. The Lancet reports that as of July 2020, drug overdose deaths in the US increased by 13 percent, with rates in some states up by over 30 percent. 

If the end goal is to reduce harm and save lives over the long haul—and not pump up stock prices in the short term—then it’s up to those within the psychedelic movement to continue their decades-long struggle to end the criminalization of these potentially life-saving medicines. Otherwise, the fate of these powerful and potentially transformative substances will be decided by supporters of the failed policies of criminalization and the corporatization of psychedelics.

About the Author

Jeff Kronenfeld is an independent journalist and fiction writer based out of Phoenix, Arizona. His articles have been published in Vice, Overture Global Magazine, and other outlets. His fiction has been published by the Kurt Vonnegut Memorial Library, Four Chambers Press, and other presses.

For more info, go to www.jeff-k.com. 

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