The use of psychedelics such as ibogaine represents one of the most compelling developments in opioid addiction treatment.
The opioid crisis has been a well-documented struggle throughout North America. According to the World Health Organization, approximately 500,000 people die each year due to illicit drug use. In 2019 alone, the United States saw 70,630 drug overdose deaths — 70 percent of which were directly attributable to opioids. The pandemic has only exacerbated the ongoing crisis; from 2019 to 2020 alone, opioid overdose deaths increased by nearly 30 percent to more than 93,000.
This epidemic carries with it a heavy financial toll — one that represents a burden for more than just healthcare. Social welfare and public health are also heavily impacted, as are law enforcement officials, care workers and each victim's loved ones. Accounting for these factors, the CDC estimates that prescription opioid abuse in the United States creates an "economic burden" of approximately US$78.5 billion a year.
The opioid crisis cannot be solved through law enforcement alone. To effectively manage opioid abuse, one must address the root cause — addiction. In that regard, the use of psychedelics such as ibogaine represents one of the most compelling recent developments in treatment.
What are opioids?
Opioids are a family of drugs closely related to the opium poppy, and consist of two distinct classifications.
The first, opiates, derive from naturally occurring compounds in the plant. Opium is the first and oldest opiate, with the first known use dating back to approximately 2100 BC. The prescription drug morphine is technically a concentrated and purified form of opium, and also the base from which other opiates, such as codeine and thebaine, are derived.
Synthetic opioids have a similar chemical structure to opiates, but are not naturally occurring. Heroin is one of the first known synthetic opioids, originally marketed in the early 20th century as a more effective, less addictive alternative to morphine. Other synthetic opioids include fentanyl, hydromorphone, methadone and buprenorphine.
By binding with chemical receptors located throughout the body, opioids are known to produce a range of clinical effects. They are powerful analgesics, relieving pain without causing a loss of sensation or consciousness. Side effects of opioid use include euphoria, mood changes, drowsiness, brain fog, constipation, nausea, itching and vomiting.
How are opioids typically used?
Opioids are almost unilaterally prescribed for pain relief. Post-surgical patients, for instance, are typically given morphine once surgical anesthetics wear off. Patients may also be prescribed opioids for broken bones and chronic pain.
Starting in the late 1990s, prescription opioids saw a sharp increase in usage, as pharmaceutical companies erroneously informed the medical community that they were non-addictive. This over-prescription is widely regarded as the root cause of the epidemic.
Why are opioids dangerous?
When used for short-term pain relief, opioids are generally safe. Long-term use of any opioid medication can cause a patient to develop a dependency on the drug. This, in turn, can result in severe, life-threatening withdrawal symptoms if the patient stops taking opioids.
Patients may also develop opioid tolerance, requiring progressively larger doses of the drug to stave off withdrawal. This can lead to an overdose simply from excessive ingestion or injection. Loss of tolerance due to detoxification is also a significant risk factor.
Opioids sold on the street are even more dangerous, as it's impossible to tell how concentrated they are. Fentanyl, which is 50 to 100 times more potent than morphine, is an especially notable example. Cocaine, heroin and counterfeit prescription drugs cut with fentanyl are also becoming increasingly more common.
What is being done to combat the opioid epidemic?
Because the opioid crisis is a complex issue, it requires a multi-pronged solution. Organizations such as the CDC and Canada's Public Health Agency are working closely with governments at the municipal, regional and federal level. In addition to greater public awareness, they seek to improve treatment, prevention and recovery programs, whilst simultaneously pushing to decriminalize and destigmatize substance abuse.
The province of Ontario, for instance, recently invested C$32.7 million in addictions services and supports. In 2020, the Biden government announced plans to invest US$125 billion into treatment, prevention, and recovery programs over the coming decade. And programs such as Prevention Point Pittsburgh work to provide both supervised consumption sites and more widespread access to treatment.
Yet even this level of investment and involvement is only part of the solution. Traditional methods such as detoxification are insufficient for treating opioid addiction, with a staggering 91 percent of patients experiencing a relapse. Alternative treatments are necessary, which is where the private sector has its part to play.
According to a 2021 Crunchbase survey, venture-backed companies working on addiction treatments and service offerings have raised over US$1 billion in funding to date. Much of this investment capital has been directed towards startups that champion the clinical use of psychedelics.
Why psychedelics represent a new path for addiction treatment
In 2017, Dr. Alan Davis, PhD, surveyed 88 opioid-dependent individuals after their visit to an ibogaine clinic in Mexico between 2012 and 2015. Of those surveyed, 80 percent indicated that their withdrawal symptoms were either significantly reduced or entirely absent. Another 50 percent reported reduced cravings, and 30 percent said that after just one treatment, they never used opioids again.
Dr. Davis's study joins a growing body of research into the efficacy of psychedelics in treating opioid addiction. Although researchers are still unclear on the precise mechanics of how drugs such as ibogaine assist in recovery, many suspect it may have to do with how they interact with the brain's reward pathways. Many of the same neurotransmitters associated with addiction are also directly affected by psychedelic drugs, and one 2016 study even found ibogaine to have an inhibiting effect on cocaine molecules.
It is important to note that the same research described above also indicates that ibogaine and similar drugs are not a "magic bullet" for treating addiction — as with other drugs used to treat mental health conditions, psychedelics are most effective when combined with therapy.
How investors can help in the fight against opioid addiction
Where psychedelic-focused startups are concerned, the market for investors is both rich and incredibly fast-growing.
Last year, New York based Mind Medicine (NASDAQ:MNMD) became the first psychedelic pharmaceutical company to go public. This was followed by a multitude of others in short order, including Atai Life Sciences (NASDAQ:ATAI) and Compass Pathways (NASDAQ:CMPS). It's worth noting as well that addiction is just one prong of what these businesses aim to address.
While companies such as Universal Ibogaine (TSXV:IBO) focus primarily on addiction recovery, others, such as NeonMind Biosciences (CSE:NEON,OTCQB:NMDBF) believe psychedelics could be used to treat obesity. Although research into the matter is still in its infancy, the market for investors is an extremely promising one. Many have even gone so far as to call psychedelics the next frontier in not only addictions counseling, but healthcare as a whole.
Universal Ibogaine recently engaged contract research organization partners to enable the company’s planned clinical trial in Canada to be conducted upon approval from Health Canada. UI is currently working with its CRO partners to finalize the study design in advance of an anticipated clinical trial application to treat opioid dependent individuals with ibogaine.
A new, formative market is emerging thanks to the increased focus on companies looking to treat the opioid crisis using innovative therapies like those being created by psychedelic startups. This presents investors with an investment opportunity that could be both profitable and rooted in improving the overall wellbeing of those struggling with addiction.
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