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

2. 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

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

4. 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

5. - *

6. 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

7. 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

8. Ibogaine--Tabernantheiboga
Sacred plant of Gabon, West Africa

9. 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

10. 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

11. Ketamine Hydrochloride

12. 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

13. Ayahuasca-- Plant Combination

14. 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

15. 100 species of Psilocybegenus and other genera contain psilocybin*

16. 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

17. 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

18. 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

19. 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*

20. 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