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Powerful psychedelic gets renewed attention as treatment for opioid addiction

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Pharmaceutical company Atai Life Sciences is spending millions to research the compound, and congressional lawmakers from both parties have pushed the government to promote ibogaine research to combat drug addiction, post-traumatic stress disorder and other mental health problems.

For Dr. Deborah Mash, a professor of neurology at the University of Miami who began studying ibogaine in the early 1990s, this growing interest confirms her belief that the compound could help alleviate the opioid crisis. “Ibogaine is not a silver bullet, and it won’t work for everyone, but it is the most powerful addiction switch I have ever seen,” she said.

Researchers have also studied ibogaine’s ability to treat other difficult mental health conditions. A small study published earlier this year in the journal Nature Medicine found that veterans with traumatic brain injuries who underwent a single session of ibogaine therapy had marked improvements in their disability, psychiatric symptoms and cognition.

No adverse side effects were reported among the 30 study participants, who were followed for one month. There was no control group.

Dr. Nolan Williams, the study’s lead author, said the results were particularly notable given the lack of treatment options for head injuries.

“These are the most dramatic effects of a drug that I have ever seen in an observational study,” said Dr. Williams, director of the Brain Stimulation Laboratory at Stanford University.

He and other researchers are quick to recognize the limitations of existing science on ibogaine therapy. “Without the green light from the FDA to conduct studies, you simply cannot do the type of randomized trials that are the gold standard for clinical studies,” Dr. Williams said.

Ibogaine is known to induce arrhythmia or irregular heartbeat which, in severe cases, can lead to fatal cardiac arrest.

Other researchers are more skeptical of its potential as a widely accessible anti-addiction therapy. William Stoops, a professor of behavioral sciences at the University of Kentucky who specializes in substance use disorders, said ibogaine’s cardiac risks make it a poor candidate for regulatory review.

Even if ibogaine were to receive approval from the Food and Drug Administration, the worsening health of many long-term opioid users, many of whom have cardiovascular problems, would make them ineligible for treatment, Dr. Stoops said. And the high cost of providing ibogaine in a medically supervised setting would further reduce the number of potential patients, he added. “Access would be so restricted that how many people would benefit? He asked.

The National Institute on Drug Abuse, part of the National Institutes of Health, has already begun funding studies (which are not human trials) of ibogaine analogs, chemically related compounds that may provide therapeutic benefits without health risks. The agency’s director, Dr. Nora Volkow, said she had long been intrigued by ibogaine’s anti-addiction potential and was wary of its heart risks.

But existing treatments for opioid use disorder, like methadone and buprenorphine, are imperfect, she noted, and half of all patients stop taking them after six months.

“In addition to existing effective medications, there is a need for different treatment options than we currently have,” said Dr. Volkow. “We need to change the way we do things and explore what science shows us. »

The FDA said it could not say whether it would support ibogaine studies in the future, noting that federal law prohibits the agency from commenting on prospective applications for investigational drugs.

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