Sacred Plants as Medicines for Substance Abuse Rehabilitation Dr. Michael Winkelman, M.P.H., Ph.D Arizona State University (Retired)

Overview Medical Discovery of Psychedelic Addictions Treatment Peyote, LSD, Ibogaine, Ketamine, Ayahuasca and Psilocybin Mechanisms of Therapeutic Effectiveness Scientific Evaluation of Therapeutic Efficacy The Rationale for Immediate Applications

Peyote and Native American Church Hybrid Native American-Christian Religion Formed in early 20th century Sacramental use of Lophophorawilliamsii

Lophophorawilliamsii Active ingredient is mescaline Processed in ways similar to 5HT2a psychedelics Produces visionary experiences revealing future as an addict/alcoholic Re-connection with spiritual world New Identity in community relations Management of acculturation loss Considered only effective treatment for Native American alcoholics

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LSD Addictions Treatment Discovery of spontaneous remission of alcoholism in high dose studies Mystical experiences associated with remission Evidence of “after-glow effect” and short-term remission Meta-analyses of best early studies (Abuzzahab and Anderson, Krebs and Johnson) Significant evidence of short and medium term effects Decline in effectiveness of single dose by 1 year

Alcohol Treatment Effects of LSD Effectiveness from high dose psychedelic rather than psycholytic (low dose) treatments Life transforming mystical and cosmic experiences as key to therapeutic effects Review of life experiences that reveal source of problems Relive contributory traumatic experiences Analogous to “hitting the bottom” Shift in consciousness Once supported by Alcoholics Anonymous founder Bill Wilson

Ibogaine--Tabernantheiboga Sacred plant of Gabon, West Africa

Ibogause for addictions treatment Discovered by addict community Used for effects as addiction interrupter/withdrawal cessation Significant element of narcotic self-help groups Mostly evaluated with informal research But significant clinical studies of toxicity Significant concerns about potential fatalities Need for patient screening

Treatment Dynamics Characterized as “oneiric”- dream like Provokes autobiographical review of life Evocation of repressed memories Insight into origins of drug abuse May reveal insight into psychological blocks contributing to addictive behaviors Facilitates a re-enactment of past and re-scripting Selective interference with prior learned patterns, especially as related to dependence

Ketamine Hydrochloride

Ketamine An approved medication used in human and veterinary anesthetic Has dissociative, anesthetic, analgesic properties Also has psychedelic properties Effective treatment for a range of opioid, alcohol and stimulant addictions Mystical experiences predicts successful outcomes Also has other significant effects Persistent reductions in depression Substantial reduction in PTSD symptom severity

Ayahuasca-- Plant Combination

Evaluations of Ayahuasca Studies with Brazilian syncretic religions Uniao de Vegetal Evaluations of young church members provide evidence regarding toxicology and safety Case controls with neuropsychiatric assessments Adults report dramatic reduction in all drug use Including alcohol and nicotine Shamanistic treatment centers provide case study evidence of effectiveness Notable success with treatment resistant cases

100 species of Psilocybegenus and other genera contain psilocybin *

Medicinal Uses of Psilocybin Established effectiveness in treatment of OCD, cluster headaches/”suicide headaches” Clinical studies of end-of-life transition Relatively recent applications to addiction medicine Exploratory research in nicotine addiction treatment Likely applicability for all addictions

Mechanisms of Therapeutic Efficacy Serotonin Enhancement Psychointegration Alteration of Consciousness Unity Experiences and Ego Suspension Internal Focus of Attention Access to Repressed Memories Suggestibility and Emotional Enhancement Behavioral Dishabituation Psychological Integration Ritual as Social Reintegration

Phases of Evaluation of New Drugs Phase 1– Evaluate safety (toxicity), side effects, dosage ranges Phase 2– Evaluate safety, effectiveness, ideal dose and outcomes in patient populations Phase 3– Randomized clinical trials Phase 4– Extended clinical trials for comparison of relative benefits

Evaluation of Psychedelic Treatments Drug Phase 1 Phase 2 Phase 3 Peyote yes yes yes LSD yes yes + (meta-analysis) Ibogaine yes yes Ketamine yes yes Off-label Ayahuasca yes limited Psilocybin yes yes*

The Rationale for Immediate Use Lack of Addictive Properties and Low Risk Evidence from Phase I and Phase II studies The Ineffectiveness of Current Treatments Widespread evidence of potential to interrupt addiction, craving and withdrawal Objectively produce mystical experiences thought to be central to addiction remission The Existence of a Health Epidemic Justifications from Compassionate Perspectives