CEO and co-founder of ATAI Life Sciences, Florian Brand explains why one psychedelic medicine might provide the key to fighting opioid addiction. 

No one wakes up one day and decides to become opioid dependent. You might have been warned against the risks – aware that there’s a chance of developing a tolerance or dependence on the drugs. At the start they block the pain and release that feel-good rush of dopamine in your brain, helping you function and go about daily life. But, after a while, that impulse – for a rush, for relief, for a shift in consciousness – can become all-consuming. What starts as a way to relieve stress and pain can become a full-blown dependency, or opioid use disorder (OUD).

Treatment options are limited. In 2018 alone, 2.1 million Americans met the diagnostic criteria for OUD. 47,600 people died from opioid overdoses.

Some may argue that this crisis is a result of big pharma’s overzealous marketing, but, whatever your view, there is little doubt that the industry has faltered in finding a solution. Until now, therapeutic approaches have focused on substituting opioid use for treatments that replace the drugs with milder substances. There’s a significant risk for adverse health effects, including long-term dependency, cognitive issues and drug interactions.

Results of treatments with currently available substitution therapies are variable, with relapse rates across substance use disorders estimated to be between 40 and 60%.

ATAI Life Sciences was formed to take a different approach. My fellow founders and I were inspired by our personal experiences of living with mental health disorders to create a company that leaves no stone unturned in our search for answers. We employ a decentralised, technology and data-driven platform model which includes eight companies working to responsibly accelerate the development of impactful and evidence-based therapies. Many of these companies use innovative technologies like artificial intelligence (AI) and computational biophysics to discover compounds that could hold therapeutic potential for people living with OUD as well as other disorders like treatment resistant depression and anxiety. ATAI’s focus is on patients who have already tried – and failed – to find relief with other therapeutics.

We aren’t alone in this thinking: Deborah Mash, CEO of one of ATAI’s close partners, DemeRx, has spent years investigating the therapeutic properties of the iboga plant in OUD. Together, we are now taking the next step for research by submitting Clinical Trial Applications for a Phase II study in opioid-dependent patients.

Ibogaine has been used in traditional ceremonies in West Africa as part of Bwiti religious practices since the late 1800s. It is known for its oneirophrenic and hallucinogenic properties and works by affecting a variety of neurotransmitter systems, including serotonin, opioid, and NMDA receptors. The exact mechanisms behind ibogaine’s dissociative psychedelic effects are unclear, but it has been speculated that the dream-like state induced in patients leads to a kind of “brain reset”. We want to see whether this reset might provide patients with a clean slate, empowering them to reframe their understanding of their behavioural patterns and play a more active role in reducing opioid use.

Uncontrolled data from hundreds of patients supports this theory. The largest study of ibogaine to date, found that a single low, oral dose significantly reduced opioid withdrawal scores, the severity of cravings and concurrent depression. Importantly, these effects persisted at a one-month follow up.

Research into ibogaine is difficult to carry out. Ibogaine is a Schedule I drug. According to the US government, Schedule I substances have no currently accepted medical use and a high potential for abuse. Consequently, clinical investigation of ibogaine remains limited, outside of a few highly regulated centres around the world. Dr Mash found a way to continue her research at a patient-funded treatment centre called Healing Visions that operates on the West Indies island of St. Kitts. There she was able to treat over 300 people from 1996-2003 in a holistically person-centred setting while collecting and publishing data about ibogaine addiction treatment.

Dr. Mash stated: “If ibogaine stays in the underground, backdoors, and back alleys outside of mainstream medical use, it’s never going to get out of Schedule 1 or be approved as a therapeutic drug, and we’ll never be able to get it to the millions of people who are desperate.”

We are working with Deborah to start a revolutionary shift in the way mental illness and addiction is studied, diagnosed and treated.

Our partnership with Deborah and her team doesn’t mean that we are a “psychedelics” company; it just means that existing treatments just aren’t working and opioid users and their families are still suffering from this devastating disorder due to a shortfall in mental health innovation. And, perhaps, that a pharmaceutical industry – used to being at the cutting edge of science – might yet have a thing or two to learn from ancient medicines like ibogaine when it comes to taking on OUD.