Transcriber: Bhavna Venkat Reviewer: Emma G
We live on the brink of a world
without either severe or chronic physical pain.
How so? Here’s a hint.
Psychedelics can be used to prevent some forms of extreme pain,
both directly and by helping other drugs to not lose effectiveness over time.
I believe that acting on this insight will be as powerful
for the alleviation of suffering as the advent of anesthesia was for surgery.
Hello, my name is Andrés and one of the co-founders
of the Quilliam Research Institute,
a non-profit that seeks to elucidate
the mathematical structure of consciousness.
Along the way, we identified neglected avenues for tackling extreme pain.
This is what this talk is about.
Today we take surgical anesthesia for granted,
but it actually took 50 years from the time it was noted
that nitrous oxide, ether and chloroform relieved pain
to when they were used for anesthesia.
Could there be anything today as significant as anesthesia was for surgery?
Perhaps already known by a tiny minority,
but widely neglected as a legitimate medical application?
I think the answer is yes.
You see, amputation is an extremely painful experience.
Imagine having to undergo it without anesthesia, it would be dreadful.
Well, according to the McGill pain scale,
which ranks painful experiences from 0 to 50,
amputation of a digit scores a 39.
But kidney stones already 42.
And the excruciating pain of a headache known as trigeminal neuralgia scores a 44.
And compared to traditional neuralgia,
a condition known as cluster headaches,
is similar in intensity, but much more long lasting.
The intensity of these experiences is not hard to imagine, it’s unimaginable.
One in a thousand people suffer from them
and they’re at a much greater risk of committing suicide.
Migraines are already a really significant pain.
But according to someone I interviewed who suffers from both.
If the disruption caused by the pain of a migraine
is like a little motorboat underwater,
a cluster headache is like a massive jet engine underwater.
Cluster headaches highlight that we really need
a logarithmic scale to make sense of how bad pain can be.
Meaning that with each increment on the scale,
you should multiply the pain by a constant rather than merely add a constant.
With this information, it becomes clear
that if we want to tackle the worst pains, we have to be strategic.
We have to have a good model of how they manifest and then a right.
Well, just as anesthesia was really good news,
I'm here to share that there is really good news for cluster headache patients.
The psychedelic drugs DMT, LSD and psilocybin
are capable of both aborting and preventing cluster headaches.
More so, in many cases, tiny doses is all you need,
meaning that hallucinating is not required.
To top it off, these drugs don't seem to stop working over time.
Unlike many current used treatments,
which in some cases make the headaches worse over time.
This takes us to the core point of this talk.
A new generation of drugs will allow us to hack
the physiological habituation mechanism that makes pain so difficult to treat.
Let me explain. Intuitively, for any given level of pain,
there is a corresponding dose of painkillers that will take care of it.
However, in practice, effectiveness usually fades.
So either a higher dose is tried
or you're forced to accept partial pain relief.
In other words, the nervous system is experiencing tolerance.
Now, tolerance is usually thought of as inevitable.
But as I just explained, psychedelics don't seem to exhibit chronic tolerance
when they’re further used to treat cluster headaches.
Even more impressively, the psychedelic drug known as Ibogaine
seems to be capable of reversing tolerance to opioid painkillers.
Ibogaine is currently being investigated as an addiction treatment.
Excitingly, case studies suggest that small doses of ibogaine
are capable of reversing mild forms of opiate tolerance.
This renews the degree of pain relief that a certain dose of opiate produces,
so that a suitable combination of a small dose opioid
and small dose ibogaine may potentially remain effective against chronic pain
for years without losing efficacy.
Research on the mechanism involved in these anti tolerance effect
will allow us to design new and improved drugs of potential enormous benefit.
And while, yes, treating addiction is a crucial application
that comes at a crisis point of the opioid epidemic,
I personally think that ibogaine as a research lead
for how to reverse tolerance will in the long run be enormously more impactful.
The phenomenon of tolerance is especially severe,
with benzodiazepines like Alprazolam, a.k.a. Xanax,
which are often prescribed for panic attacks and generalised anxiety.
Despite their acute effectiveness,
some people experience so much tolerance for these drugs
that they have never ending continuous withdrawal symptoms,
even when taking the same dose every day for years.
If they can, for a short while, and discontinued
the total number of panic attacks may nonetheless be higher,
when all is said and done.
The experimental antitolerance drug Flumazenil
which is often used as an antidote for benzodiazepine overdose,
shows a similar level of promise for reversing benzodiazepine tolerance,
as ibogaine does for reversing opioid tolerance.
Flumazenil is out of patent,
but it’s promising as a research lead to learn
the molecular mechanism involved in its antitolerance effects
so that new and improved drugs can be developed.
I envision a future where drug tolerance is a thing of the past,
where if you suffer from severe chronic pain
like 7.5% of the adult population today,
you will be prescribed drugs to which your body will never get used.
It’s hard to express how much of a game changer this is.
Okay, my final point.
These and other innovative methods, like the ones that I have exemplified,
will not enter common practice without policy changes
and more research to find out how to make them safe and effective.
So I invite you to join me in the quest to end extreme pain
with these and other innovative methods.
Smallpox was, for centuries, the cause of horrific human suffering.
It turns out that vaccines could prevent it.
Smallpox has now been eradicated.
Like smallpox or surgery without anesthesia,
it is up to us to ensure that we use the tools
we already have at our disposal to make sure that extreme pain
becomes a thing of the past.
Thank you so much. (Applause)