Psychedelic Medicine: Will The High Always Be Part Of The Therapy?

As psychedelic drug R&D progresses, an internal debate is heating up, among both scientific researchers and the industry as a whole. Is the (often) hallucinogenic “trip” produced by many psychedelic drugs integral to their medicinal effect?

It’s a question that has major ramifications for the industry on several different levels.
 
  1. Adoption rates
  2. Insurance coverage
  3. Efficiency/profitability
  4. Drug normalization/legalization

No trip = faster growth, more profits

It is the hallucinogenic trip produced by psychedelic drugs that motivated most governments around the world to (short-sightedly) criminalize these substances, heavily.

These psychoactive effects will deter some (many?) people from seeking out such therapies. It will make health insurers more hesitant to provide coverage of approved drugs.

Adoption rates

As Psychedelic Stock Watch has observed previously, psychedelic drugs appear increasingly likely to emerge as the “miracle drugs” of the 21st century.

They are potent medicines that are producing spectacular success rates in clinical settings, while drug R&D continues to rapidly expand on the number of potential treatment markets. But these Miracle Drugs will deliver limited benefits if many people are frightened away by the “experiential” therapy.

Non-hallucinogenic derivatives of these substances would/will obviously generate dramatically higher adoption rates among both physicians and patients.

For patients, psychedelic drugs become ‘just another pill’. For physicians, there are reduced concerns of adverse reactions/side effects. For both, it bypasses anti-drug phobias produced from decades of anti-drug propaganda.

Insurance coverage

Producing non-hallucinogenic psychedelic drug therapies will also dramatically boost insurance coverage as psychedelic drugs are licensed and approved.

To begin with, such therapies would be much cheaper, since they won’t require the (very-expensive) multi-hour supervision that comes with experiential therapies. Reduced side effects and adverse reactions would also make them more attractive to insurers.

Similar to patients and physicians, non-hallucinogenic versions of these therapies would also prevent anti-drug phobias from impacting coverage decisions.

Efficiency/profitability

As just noted above, non-hallucinogenic versions of these therapies would be much cheaper and more efficient since they would not require expensive and extended sessions staffed by medical professionals.

What happens with any medical treatment where you can simultaneously (and dramatically) increase efficiency and adoption rates? Much greater profit margins.

The psychedelic drug industry has an enormous profit incentive to aggressively explore the potential of non-hallucinogenic versions of these drugs. This is why we are seeing an increasing percentage of new R&D initiatives targeting non-hallucinogenic molecules. Expect this trend to continue.

Faster and more certain path to normalization/legalization of psychedelics

It is the hallucinogenic trip that led to the criminalization of psychedelics. Obviously, eliminating the psychoactive effects from these drug therapies would greatly encourage both politicians and regulators to remove the legal/regulatory barriers that currently block most of these substances from commercialization.

Getting non-hallucinogenic versions of these substances legalized/approved would also seem to be a stepping stone along the road to the broader legalization of these substances for medicinal use.

To trip, or not to trip? The debate heats up

Two recent articles, both appearing on Forbes, add fuel to the psychedelic drug industry’s Great Debate. The first article focused specifically on “a new compound derived from a naturally-growing hallucinogen [that] may revolutionize psychiatry”.

Here, a non-hallucinogenic derivative of ibogaine (which comes from the iboga plant) is showing potential to “repair stress-damaged neurons and brain circuitry”.

Research is at the pre-clinical level, meaning testing on mice. But if it can be repeated at the clinical level, this would be an important breakthrough. As one of the more powerful psychedelics, the ibogaine trip is especially intense – and more prone to side effects and adverse reactions.

It was the second Forbes article that waded into the broader debate.
 
The first opinion sought out by Forbes’ writer was from a research scientist working on a $27 million grant from Defense Advanced Research Projects Agency (DARPA), the U.S. military’s research branch.

A strange choice? Actually, no.

The U.S. military is experiencing its own Mental Health Crisis: an increasing percentage of U.S. veterans grappling with PTSD, which has led to an “epidemic” of suicides among military personnel (an average of 22 per day).

Psychedelic drug-based research is showing exciting potential to dramatically improve the standard of care for Post-Traumatic Stress Disorder – and address the suicide epidemic. This has led to the U.S. Defense Department becoming the largest individual donor for psychedelic drug research.

The quest for non-hallucinogenic Miracle Drugs

Bryan Roth is one of the research scientists at work for DARPA at the University of North Carolina. Roth’s mission is simple. “The goal is to find compounds that are therapeutic and not psychedelic.”
 
…Roth is on a moonshot mission to find the next perfect drug: one that is effective at treating depression and post-traumatic stress disorder quickly like clinical trials suggest psilocybin and MDMA, which is more commonly known as the party drug molly or ecstasy, can, but without the hallucinogenic ride.

“It would be marvelous, it would be groundbreaking,” Roth says, laughing, “if we could have a drug, you take it at night, you wake up and you’re not depressed. It would be the end of Prozac.”

Roth’s position is unambiguous. Getting rid of the trip is highly desirable.

Forbes also sought the opinion of Tania Gonsalves, a healthcare analyst at Canaccord Genuity Group – a Canadian investment bank deeply involved with the psychedelics industry. Gonsalves sides with Roth.

“In my opinion, for the industry to really take off you need to find an at-home way of administering this,” says Gonsalves. “If that means removing the hallucinogenic properties to make it more accessible to the broader population, that’s your blue sky.”

The economics behind Gonsalves’ viewpoint has been explained above. But is this a debate that can (and should) be decided strictly on the basis of dollars-and-cents?

The argument to keep the trip

Lining up on the other side of the fence are two of the psychedelic drug industry’s most-respected voices in drug research: MAPS Founder, Rick Doblin and Dr. Robin Carhart-Harris of London’s Imperial College.

Doblin views the DARPA research as a potential threat to the psychedelic drug industry reaching its full potential.
 
“The tragedy that I see is that DARPA could have a winner right now with MDMA for PTSD,” says Doblin. “But DARPA is trying to say screw the psychedelic experience and let’s invest in non-psychedelic psychedelics while 20 vets a day are killing themselves.”

Dr. Carhart-Harris is also firmly in the camp of those who believe that the psychedelic trip (and accompanying therapy) is integral.
 
While it still needs to be proven, he believes the fundamental therapeutic benefit comes from the combination of drugs and therapy. “You can’t break these components down and have one without the other,” says Carhart-Harris.

As with so many of the socio-economic debates around us today, the debate is being framed by the media in binary terms: either you need the trip, or you don’t need the trip.

A middle ground in psychedelic drug therapy?

What if the position that is ultimately demonstrated by the science is much more nuanced? In other words, what if both camps can – and should – get what they want here?

What may very well emerge as clinical testing on these substances continues (on both hallucinogenic and non-hallucinogenic molecules) is that a certain percentage of patients must receive a fully-experiential therapy.

This could be necessary for patients with the most severe mental health disorders. Alternately, it could simply be essential for any/all especially “treatment resistant” sufferers of mental health disorders.

Thus, drug R&D on trip-based psychedelic therapies would need to continue, and these therapies would need to be licensed and approved. This would placate the concerns of Doblin and Dr. Carhart-Harris.

Parallel to this, a growing body of research is emerging that either non-hallucinogenic versions of these substances or non-psychoactive “microdoses” do provide medicinal benefits.

There is clearly enough evidence to justify continuing R&D along this branch of the psychedelic drug industry. Non-hallucinogenic psychedelic therapies that do work would benefit everyone – including those in need of more intensive therapies.

If many patients (with less advanced or less-resistant symptoms) can be successfully treated with non-hallucinogenic therapies, this will free up more mental healthcare dollars for the patients who need more intensive – and much more expensive – treatment.

Win/win.

The bottom line for investors


Today, the science on psychedelics is not yet able to resolve the Great Debate within this industry. This means that more astute investors will likely spread their dollars around among companies pursuing both avenues of drug research.

There is a strong probability (if you believe the experts) that at the end of the day, at least some experiential psychedelic therapies will remain essential in providing mental health care.

At a minimum, designing truly effective non-hallucinogenic alternatives will likely be further down the road in R&D. Enough time for experiential versions of these drugs to be approved and commercialized.

Twenty-two veteran suicides per day.

The Department of Defense (and U.S. veterans on the brink) can’t want extra years for more politically palatable, non-hallucinogenic therapies to emerge.

MAPS’ MDMA-based clinical trial for treating PTSD is now in Phase III – and reporting significant results for over 90% of veterans in the study. Conversely, two-thirds of veterans receiving conventional therapies from the VA express dissatisfaction with their treatment.

The future of psychedelic medicine may be non-hallucinogenic. But for the present, the “trip” remains indispensable.
 
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