from the world's big
Can psychedelics help treat pain?
Forthcoming Phase II trials with ibogaine aim to find out.
- Pharmacology professor Richard J. Miller is hopeful for the resurgence in clinical studies of psychedelics.
- Ibogaine, used in France for decades, is making a comeback in potentially helping curb addiction and treat pain.
- Psychedelics were deemed illegal for political and not medical reasons, an error we are reinvestigating.
With all the hype regarding the potential for psychedelics to help treat anxiety and depression, with the potential to replace or coexist with SSRIs, there are yet more realms hallucinogenic substances could aid in. Whereas psilocybin and MDMA are showing positive results in sufferers of mental pain, a formerly sanctioned drug, ibogaine, is making a comeback in pain management and addiction circles.
As with other psychedelics, ibogaine was swept up in Richard Nixon's crusade against minority and freethinking populations in the late sixties and deemed a Schedule 1 drug in 1971. Yet from 1939 to 1970, ibogaine was used in French psychotherapy under the trade name Lambarene, writes Northwestern University's Feinberg School of Medicine pharmacology professor Richard J. Miller.
As with the entire class of substances, the scheduling of ibogaine was a political, not medical, decision. As Miller recently told me from his office in Chicago,
"The drugs, at the federal level, are Schedule 1 drugs, which means that they have absolutely no medical utility whatsoever and are incredibly dangerous. People think that the reason that they're in that schedule is based on some kind of reasonable science or other understanding of what they do rather than just some complete bullshit, which is what it is."
I reached out to Miller after reading his excellent history on pharmacology, Drugged: The Science and Culture Behind Psychotropic Drugs (the full transcript is here). While he's spent decades clinically studying drugs, the narrative shines when Miller discusses the cultural stories about how and why we seek to alter our consciousness, be it through caffeine or magic mushrooms.
There is no greater substance for the treatment of pain—Miller's clinical speciality—than opiates. Drugs like morphine reduce the amount of the neurotransmitter acetylcholine, causing smaller muscle contractions. The inhibition of these neurotransmitters, combined with opiate receptors in our midbrain implicated in our reward center, help to make us feel better—and get us addicted.
Which is the rub: the greatest pain reliever yet discovered is highly addictive. The novelist Amitav Ghosh wrote an entire trilogy about the political and cultural effects of the opium trade; Thomas de Quincy famously defined a genre when penning a book about his addiction to laudanum. Today, in America, we have our own opium war in the form of fentanyl. The side effects are, as we are collectively experiencing, disastrous.
Just as the mental health industry needs a better solution than SSRIs, which are remarkably effective in the short-term but also deadly over the span of years and decades, physical pain management needs a revolution. The hallucinogenic shrub, Tabernanthe iboga, might provide relief.
Though the cradle of civilization, Africa is relatively void of hallucinogens. One of the strongest utilized comes via the main alkaloid in T. iboga, ibogaine. Iboga communities exist in Gabon, Cameroon, and Zaire, where adherents either eat or drink the yellow root to experience visions in order to, as the Bwiti phrase it, "break open the head."
Iboga made its way to France in 1864, first appearing in the scientific literature two decades later. Ibogaine was extracted in 1901. Howard Lotsof, a heroin addict in New York City, discovered ibogaine in the sixties and self-experimented to curb his addiction. It worked. He persuaded a pharmacologist in Albany to test the substance in morphine-dependent rats, which also "appeared to work," according to Miller. The researchers also noticed positive results getting the rats off of cocaine, alcohol, and nicotine.
The Albany team then worked with a team at the University of Vermont in an attempt to synthesize an ibogaine analog. Even the ceremonial users in Africa knew that the root is toxic; swallow too much and death ensues. The team, searching for a less toxic substance, synthesized 18-methoxycoronaridine (18-MC). Ibogaine has been used in addiction treatment for decades even as it has been predominantly illegal.
After Phase 1 trials, the funding was exhausted. A new organization, MindMed, is currently planning Phase II trials this year. So far, 18-MC does not appear to have the hallucinogenic effects of ibogaine, which might prove important if it is ever developed for widespread addiction treatment or pain management. Ibogaine notably causes cardiovascular problems in some users; 18-MC might also skirt that issue.
This also solves the patent problem. Given the money required in R&D of a new drug—over $1 billion, in some cases—it's challenging for pharmaceutical companies to profit from new drugs. At the same time, as Miller assures me, "they are definitely making money." That much is obvious given the billions of dollars that the Sacklers profited from helping create the opioid epidemic, the very reason we so desperately need a better solution now.
Yet it also begs the question: why are we in so much pain? The reasons are varied: sedentary lifestyles; dramatic income gaps; social media's role promoting the constant yearning for youth; intensely laborious jobs; being overworked and underpaid. If the revolution in pharmacology last century taught us one thing, it's that humans will seek pills to cure problems instead of addressing the root cause. As Miller and I discussed, the distance between physical and emotional pain isn't necessarily as far as believed.
"When you use the word pain, which you just used in a certain way, pain could mean things like somebody's emotional pain to a clinician. However, it's usually much more involved in actual physical pain. That's the kind of thing that people are usually talking about when they're talking about trying to replace opiates for treatment of those kinds of things. On the other hand, there is emotional pain. On the third hand, there is actually a connection between physical pain and emotional pain. We know about how different parts of the brain connect with each other. So there are a lot of levels that you can attack pain."
While it's hard to find a bright side to the opioid epidemic, Miller says one positive is that governmental agencies are taking pain management more seriously. That covers mental and physical pain—there's a reason the FDA has labelled both psilocybin and MDMA as breakthrough therapies. Regardless of the type of pain, and knowing there is a meeting point between the two, psychedelics are showing efficacy in many aspects of treatment. This is a field of research whose time has come.
- Why psychedelics should be over-the-counter medicine - Big Think ›
- A potential cure for chronic pain has been discovered - Big Think ›
Ready to see the future? Nanotronics CEO Matthew Putman talks innovation and the solutions that are right under our noses.
Innovation in manufacturing has crawled since the 1950s. That's about to speed up.
Evolution doesn't clean up after itself very well.
- An evolutionary biologist got people swapping ideas about our lingering vestigia.
- Basically, this is the stuff that served some evolutionary purpose at some point, but now is kind of, well, extra.
- Here are the six traits that inaugurated the fun.
The plica semilunaris<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NjgwMS9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYxMTgyMzg1NX0.ZY8qmhtoZfbRMAqrNnmbgyk7GLabglx_9lBq3PKcy7g/img.png?width=980" id="99882" class="rm-shortcode" data-rm-shortcode-id="68e8758894b0359c6ef61b2c158832b2" data-rm-shortcode-name="rebelmouse-image" />
The human eye in alarming detail. Image source: Henry Gray / Wikimedia commons<p>At the inner corner of our eyes, closest to the nasal ridge, is that little pink thing, which is probably what most of us call it, called the caruncula. Next to it is the plica semilunairs, and it's what's left of a third eyelid that used to — ready for this? — blink horizontally. It's supposed to have offered protection for our eyes, and some birds, reptiles, and fish have such a thing.</p>
Palmaris longus<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NjgwNy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMzQ1NjUwMn0.dVor41tO_NeLkGY9Tx46SwqhSVaA8HZQmQAp532xLxA/img.jpg?width=980" id="879be" class="rm-shortcode" data-rm-shortcode-id="970e9c15f3c3d846dde05e2b2c6ebf12" data-rm-shortcode-name="rebelmouse-image" />
Palmaris longus muscle. Image source: Wikimedia commons<p> We don't have much need these days, at least most of us, to navigate from tree branch to tree branch. Still, about 86 percent of us still have the wrist muscle that used to help us do it. To see if you have it, place the back of you hand on a flat surface and touch your thumb to your pinkie. If you have a muscle that becomes visible in your wrist, that's the palmaris longus. If you don't, consider yourself more evolved (just joking).</p>
Darwin's tubercle<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NjgxMi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0ODUyNjA1MX0.8RuU-OSRf92wQpaPPJtvFreOVvicEwn39_jnbegiUOk/img.jpg?width=980" id="687a0" class="rm-shortcode" data-rm-shortcode-id="b38a957408940673ccc744f0f6828d18" data-rm-shortcode-name="rebelmouse-image" />
Darwin's tubercle. Image source: Wikimedia commons<p> Yes, maybe the shell of you ear does feel like a dried apricot. Maybe not. But there's a ridge in that swirly structure that's a muscle which allowed us, at one point, to move our ears in the direction of interesting sounds. These days, we just turn our heads, but there it is.</p>
Goosebumps<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NzMxNC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyNzEyNTc2Nn0.aVMa5fsKgiabW5vkr7BOvm2pmNKbLJF_50bwvd4aRo4/img.jpg?width=980" id="d8420" class="rm-shortcode" data-rm-shortcode-id="f735418322b34382dcd882299c9ccc48" data-rm-shortcode-name="rebelmouse-image" />
Goosebumps. Photo credit: Tyler Olson via Shutterstock<p>It's not entirely clear what purpose made goosebumps worth retaining evolutionarily, but there are two circumstances in which they appear: fear and cold. For fear, they may have been a way of making body hair stand up so we'd appear larger to predators, much the way a cat's tail puffs up — numerous creatures exaggerate their size when threatened. In the cold, they may have trapped additional heat for warmth.</p>
Tailbone<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NzMxNi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMDMzMDc3N30.p9BEtkf3-PV3EtDSQMUGUeopsimiCHUagx97P4f8IBw/img.jpg?width=980" id="e8ab8" class="rm-shortcode" data-rm-shortcode-id="0063ce99bdd22fbebe1279244b87935c" data-rm-shortcode-name="rebelmouse-image" />
Coccyx. Image source: decade3d-anatomy online via Shutterstock<p>Way back, we had tails that probably helped us balance upright, and was useful moving through trees. We still have the stump of one when we're embryos, from 4–6 weeks, and then the body mostly dissolves it during Weeks 6–8. What's left is the coccyx.</p>
The palmar grasp reflex<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTA5NzMyMC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzNjY0MDY5NX0.OSwReKLmNZkbAS12-AvRaxgCM7zyukjQUaG4vmhxTtM/img.jpg?width=980" id="8804c" class="rm-shortcode" data-rm-shortcode-id="45469ca5ee5f43433a782f7d4ac0a440" data-rm-shortcode-name="rebelmouse-image" />
Palmar reflex activated! Photo credit: Raul Luna on Flickr<p> You've probably seen how non-human primate babies grab onto their parents' hands to be carried around. We used to do this, too. So still, if you touch your finger to a baby's palm, or if you touch the sole of their foot, the palmar grasp reflex will cause the hand or foot to try and close around your finger.</p>
Other people's suggestions<p>Amir's followers dove right in, offering both cool and questionable additions to her list. </p>
Fangs?<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">Lower mouth plate behind your teeth. Some have protruding bone under the skin which is a throw back to large fangs. Almost like an upsidedown Sabre Tooth.</p>— neil crud (@neilcrud66) <a href="https://twitter.com/neilcrud66/status/1085606005000601600?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
Hiccups<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">Sure: <a href="https://t.co/DjMZB1XidG">https://t.co/DjMZB1XidG</a></p>— Stephen Roughley (@SteBobRoughley) <a href="https://twitter.com/SteBobRoughley/status/1085529239556968448?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
Hypnic jerk as you fall asleep<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">What about when you “jump” just as you’re drifting off to sleep, I heard that was a reflex to prevent falling from heights.</p>— Bann face (@thebanns) <a href="https://twitter.com/thebanns/status/1085554171879788545?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script> <p> This thing, often called the "alpha jerk" as you drop into alpha sleep, is properly called the hypnic jerk,. It may actually be a carryover from our arboreal days. The <a href="https://www.livescience.com/39225-why-people-twitch-falling-asleep.html" target="_blank" data-vivaldi-spatnav-clickable="1">hypothesis</a> is that you suddenly jerk awake to avoid falling out of your tree.</p>
Nails screeching on a blackboard response?<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">Everyone hate the sound of fingernails on a blackboard. It's _speculated_ that this is a vestigial wiring in our head, because the sound is similar to the shrill warning call of a chimp. <a href="https://t.co/ReyZBy6XNN">https://t.co/ReyZBy6XNN</a></p>— Pet Rock (@eclogiter) <a href="https://twitter.com/eclogiter/status/1085587006258888706?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
Ear hair<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">Ok what is Hair in the ears for? I think cuz as we get older it filters out the BS.</p>— Sarah21 (@mimix3) <a href="https://twitter.com/mimix3/status/1085684393593561088?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
Nervous laughter<blockquote class="twitter-tweet" data-lang="en"><p lang="en" dir="ltr">You may be onto something. Tooth-bearing with the jaw clenched is generally recognized as a signal of submission or non-threatening in primates. Involuntary smiling or laughing in tense situations might have signaled that you weren’t a threat.</p>— Jager Tusk (@JagerTusk) <a href="https://twitter.com/JagerTusk/status/1085316201104912384?ref_src=twsrc%5Etfw">January 15, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
Um, yipes.<blockquote class="twitter-tweet" data-conversation="none" data-lang="en"><p lang="en" dir="ltr">Sometimes it feels like my big toe should be on the side of my foot, was that ever a thing?</p>— B033? K@($ (@whimbrel17) <a href="https://twitter.com/whimbrel17/status/1085559016011563009?ref_src=twsrc%5Etfw">January 16, 2019</a></blockquote> <script async src="https://platform.twitter.com/widgets.js" charset="utf-8"></script>
President Vladimir Putin announces approval of Russia's coronavirus vaccine but scientists warn it may be unsafe.
A new coronavirus vaccine on display at the Nikolai Gamaleya National Center of Epidemiology and Microbiology in Moscow, Russia.
Credit: Alexander Zemlianichenko Jr/ Russian Direct Investment Fund via AP
Medical workers draw blood from volunteers participating in a trial of a coronavirus vaccine at the Budenko Main Military Hospital outside Moscow, Russia.
Credit: Russian Defense Ministry Press Service via AP
A report from the New York Times raises questions over how the teletherapy startup Talkspace handles user data.
- In the report, several former employees said that "individual users' anonymized conversations were routinely reviewed and mined for insights."
- Talkspace denied using user data for marketing purposes, though it acknowledged that it looks at client transcripts to improve its services.
- It's still unclear whether teletherapy is as effective as traditional therapy.
Talkspace.com<p>Former employees also questioned the legitimacy of certain interventions by the company into client-therapist interactions. For example, after one therapist sent a client a link to an online anxiety worksheet, a company representative instructed her to try to keep clients inside the app.</p><p style="margin-left: 20px;">"I was like, 'How do you know I did that?'" Karissa Brennan, a therapist who worked with Talkspace from 2015 to 2017, told the Times. "They said it was private, but it wasn't."</p><p>Other former employees said the company would pay special attention to its "enterprise partner" clients, who worked at companies like Google. One therapist said Talkspace contacted her for taking too long to respond to Google clients.</p><p>Talkspace responded to the Times with a Medium <a href="https://medium.com/@founders_22883/talkspace-founders-respond-to-a-new-york-times-article-78d6f5c45c59" target="_blank">post</a>, which claimed the Times report contained false and "uninformed assertions."</p><p style="margin-left: 20px;">"Talkspace is a HIPAA/HITECH and SOC2 approved platform, audited annually by external vendors, and has deployed additional technologies to keep its data safe, exceeding all existing regulatory requirements," the post states.</p>