Ibogaine

Presents

Ibogaine in the treatment of drug dependence

Good morning to all of you

for those that do not know me, my name is Dartiu

The presenter today, this is a presentation of the PROAD group

is Eduardo Schenberg, he is doing a post-doc with me

in a research topic we have at PROAD

about psychodisleptics, or psychedelic substances

And actually, what he will present today is one of our works

that is unrelated to his post-doc

The post-doc deals with ayahuasca

electroencephalographic recordings of volunteers under effects of ayahuasca

it is in the last steps

But this is another study we did with ibogaine

But I won't say much in order to keep the surprise

Do you want to present yourself?

[audience] Tell a little about his carreer, he graduated in biomedicine here

You tell it... he forgot (laughs)

Good Morning, thank you all for being here

Thanks Dartiu for inviting me and giving me this opportunity

I did my undergrad here at UNIFESP, in biomedicine

then I took a Masters here in Psychobiology

working with memory and psychopharmacology on animal models

Then I thought it was time for fresh air and new contacts

and I went for a PhD at USP

And I did my PhD inside the network headed by Dr. Miguel Nicolelis

They had a laboratory at Sírio Libanês Hospital, I worked there for 5 years

with these electrodes they use, to record neurons in the rat

and my thesis was about the sleep-wake cycle of the rat

And when I finished my thesis, after the long and thorny process for a PhD

I again felt like needing fresh air

and I was inclined to something, lets say, closer to real life

something that was closer to real people and that I felt

like I was giving something back to society

Basic science is very important

but sometimes we end up being somehow distant

And I have a lot of interest in these substances

for which my prefered name is psychedelics

which include LSD, mescaline, psilocybin and DMT, mainly

And the plants which contain them, mainly ayahuasca

and today I will talk about iboga and ibogaine

I had a lot of interest in this kind of research

I think it's a research topic that has been forgotten

since drug prohibition in the late 60's

But this research is returning now, strongly, with very important articles

including in Nature Reviews Neuroscience

corroborating the idea that biomedicine, medicine, psychiatry and psychology

should look again at these substances, better understand what they do

and if they have therapeutic potentials, how to use this beneficially

Therefore we conducted this research on ibogaine

coordinated by Prof. Dartiu

conducted by me and Angélica

my colleague here, a psychologist

In partnership with Dr. Bruno Rasmussen Chaves

a physician, graduated here at UNIFESP also

and he is responsible for

drug dependence treatment

administering pharmaceutical ibogaine which he imports

with authorization from ANVISA

Thus, to avoid any kind of institutional misunderstanding

I would like to start stressing out that

the study was approved by the Ethics Comittee on Scientific Research

But this does not mean that they approved

any methodology from the treatment

The treatment had already been done, this is a retrospective study

We received clinical records from this doctor

and I consider very noble what he did

he opened his files

and we could access what happened to these patients

We could interview patients, both Angelica and me

and come up with data about relapse, recovery or not

what happened to these patients, what happens during ibogaine

how is this treatment, if it is safe and also if it is effective

and then there are two things I want to ask

for us to keep in the working memory, in our attention

These two questions

When we talk about a substance

a medicament or drug

there is the question of safety and the question of efficacy

But in the public debate these things are ill discriminated

and this creates a lot of confusion

Therefore this are two very important aspects

that we see in the results

one about the safety of using ibogaine therapeutically

and the other about efficacy, which we can discuss in the end

I guess all questions will be left to the end, right?

I've scheduled a 40 to 50 minutes talk

Thiago oriented me that it will be enough

So, before I start,

I would just like to ask how many of you are not from psychiatry?

or is not - I can do it, there too many clicks, I would annoy you too much - (laughs)

Who is not a psychiatry, please raise your hands

Is NOT, who is not a psychiatrist or is not

working in the department

Just to know that... I am also not a psychiatrist

therefore, from a certain perspective, I am talking as a layperson

I consider myself a neuroscientist

after I did a PhD i Neurosciences

But I think this is very interesting, because maybe I can bring

some new ideas that sometimes, when we come from a different field

from a different set of concepts, from outside a paradigm

sometimes can bring new ideas, that may be fertile, or not

I'll star with a very brief overview about the drug issue

Psychiatrists here know this much better than I do

I would like to talk a little about drug use

According to a recent study published by The Lancet in 2012

we currently have, in the world, approximately

300 million illicit drug USERS - prohibited substances

It is around 125 and 200 million cannabis, or marijuana, users

between 15 and 60 million amphetamine users

14 to 21 million cocaine users

and something between 11 and 21 useres of opiates

All of those being recreative users, users that do it despite these drugs being illegal

300 million seems a lot of people, but it's important to compare this

with the number of users of licit drugs: alcohol and tobacco

According to UN reports, published in 2010 and 2011

55% of the world population already drank in some moment in their lives

and around 25 to 33% smokes or smoked

And this gives us BILLIONS of people using drugs

But it is always very important for us to compare

drug USE with drug ABUSE and dependence

These are different things

that get mixed in the public debate

Abuse is an excessive use

without purpose, out of context and repeated

And if this starts to become very compulsive and excessively repeated

it can then be characterized as dependence

I brought here a list of criteria for dependence

the new DSM was recently published,

so maybe this is not the most up do date list

but it includes, in order to diagnose someone as dependent

drug use and even repeating it is not enough

It is necessary for the person to have intense desires to use the drug

with a lack of control over this use

also, that the person has an abstinence syndrome

that tolerance be present

Tolerance is the need to use more

quantity of the drug to get the same level of effects

Also, this people commonly spend much time

obtaining, using and recovering from the use

specially in drugs like alcohol, for which there is a considerable hangover

and finally, the continuous use

even after problems start to happen

and the use continues and the situation worsens over time

The risk for becoming dependent, for each drug

is not easy to estimate

but the current figures are 9% for cannabis

11% for amphetamines, 16% for cocaine and 23% for opioids

these the illicit drugs

And in the case of the licits, 10% for alcohol, somewhat close to cannabis,

And the most addictive of all are cigarettes

The risk to become dependent

for someone who starts smoking is 30%

Then, if we have a big problem in this country, and in the world

of drug abuse and dependence, the question that interests us

is what about the treatments, what do we have to offer these patients

And there are many available options being practiced

in Brazil and also abroad

We have the world famous 12-steps, originated from Alcoholic Anonimous

Psychotherapy, Churches, Self-help groups, Therapeutic communities

Harm Reduction Strategies

and even the compulsory or involuntary treatments

There is, then, considerable variability in the ways to address the problem

and how to deal with this patient and to offer treatment

Pharmacologically, there is not much to offer

There are just a few pharmacological treatments for drug dependence

a famous one is antabuse

a pill that should be taken before drinking alcohol

and if you drink alcohol after you would feel strong nauseas

But many patients simply do not take the pill and drink alcohol

then there is a problem of adherence

Specifically for psychostimulants, like cocaine and crack

there is almost nothing available, it is very incipient

Some initial attempts

There is the use of benzodiazepines, which are the tranquilizers

used for the abstinence syndrome

but specifically for cocaine dependence

there is a lack of pharmacological treatment

And there are the substitution therapies for opioid dependence

which is not common in Brazil, but is widespread in USA and Europe

including methadone, buprenorphine and naltrexone

And then there is a question which I consider very important for us to think of

What is a successful treatment for drug dependence?

Is it the total abstinence from the moment the patient is said to be recovered?

Or can the alcoholic patient go back to social drinking?

This is a complex question

I brought one example

an interesting report from Biological Psychiatry, from 2012

a small controlled clinical trial, with placebo

using amphetamine salts

in conjunction with topiramate, for cocaine dependence

And the results, celebrated by some peers,

were of 33% of the experimental group achieving 3 consecutive weeks abstinent

I will also ask you to keep these number, it's easy

3 weeks, 33% of patients

Interesting also that 16% of the placebo group achieved this same criterion

of 3 consecutive weeks abstinent

Which attests that, yes, it is possible, at leas for a subgroup

of these patients, to make treatment without pharmacology

But yet, 16 and 33% in not much

We are saying here that almost 70% of these patients, with this treatment

did not achieve more than 3 weeks

did not achieve even 3 weeks abstinent

And then there are the alternative therapies

In 2012 the use of LSD came back to the scientific literature

the diethylamide of lysergic acid

the most famous psychedelic drug, in the treatment of alcoholism

Which was done during the 50's, but these studies are generally criticized

in methodological basis

But in 2012 this very rigorous meta-analysis was published

and they conclude that indeed there are studies from the 50's with LSD

for alcoholism that were rigorously conducted, according to present criteria

that were being born at that time

And in this studies that were methodologically sound,

with ONE LSD session patients achieved 3 months of alcohol abstinence

It seems very significant, I think it is evidence

that in fact we should re-search these substances

with more parsimony and in serious investigations

And then, from LSD we get to ibogaine

I'll show you a rapid timeline

in order to contextualize what ibogaine is, where does it comes from, its history

to then talk about our study

The first published reports are from 1860

in which a specimen of the Tabernanthe iboga plant

was sent to France from Gabon

and some years later, the ceremonial use of iboga in Gabon was published

Iboga is a plant, which contains this molecule, ibogaine

and the plant is used in shamanic rituals, to contact spirits

ancestors, the deceased, for divination, and all these questions

which are a very rich and interesting field in anthropology

And early on in the history of pharmacology, in the beginning of the

20th century, ibogaine was isolated and cristalized from the root of the plant

Chemistry and neurochemistry were also very new disciplines at that time

In the 20th century, in the 50's, this researcher, Harris Isbell,

administered ibogaine to morphine dependent patients

that were already detoxified of morphine

But the results are hard to evaluate

because the studies happened inside a military program in USA

which used psychedelics for many purposes

including mind control in the war

and these data, a lot of it has been lost

and a little after this initial reports

of ibogaine use for dependent patients

came the chemical synthesis and definition of molecular structure

and only in the 60's that this guy, Howard Lotsof

rediscovered ibogaine's potential to treat drug dependence

he was a drug user, he had a group of friends at the age of 20

and they enjoyed using all types of psychoactives available

and with their dealers

they obtained ibogaine

they took ibogaine recreationally, to get high

and maybe they got as high and far as ever in their lives

the trip can last 10, 12, 15 hours. Some reports talk about 24 hours

and Howard Lotsof, in the following week, realized that for the first time

in many years, he had spent a few days without thinking in using opiates

Then he said: "there is something that happened in my ibogaine experience"

"that relieved me of the opiate cravings"

"and I use this everyday, I don't stop thinking about it"

He spent the rest of his life dedicated to ibogaine, he got to have patents

he was an activist, defended his cause

but he wasn't a scientist, he wasn't a doctor, nor a clinician

he faced a series of problems

and a little after he started his quest, em 1967, in USA

ibogaine was classified as "Schedule 1"

that is the most restricted category there, it is illegal

it is considered without medicinal potentials and very hard to do research

and in 1970 it was classified by the UN, but it is not illegal worldwide

it is not illegal, nor controlled in Brazil

Since the 70's a series of animal and human studies were done

I'll just give a brief overview of the animal literature, there are indexed papers

published with animal models of drug abuse and dependence

with results sometimes positive

the green arrow point down would be the positive results, of the rat diminishing

its consumption or search for the drug

in some models there are contradictory results

and in this last model, very important in the field of drug dependence

which is conditioned place preference, it did not have a positive effect

Then the literature in animals gives us a result, let's say

inconclusive, but there are some evidence there

and maybe until now, a lack of interest from the scientific community

and lack of financing to do new research with this substance

to help us better understand what is going on

In pharmacological terms, ibogaine is extremely complex

it doesn't fit the traditional paradigm of one drug, on target, one effect

and therefore one therapeutic property

Ibogaine, when ingested, is converted to noribogaine

and here I represented both these molecules

and all the known pharmacological targets

the size of each circle tell us how strong if the activation of these receptors

in orange the sites where they act antagonistically

in blue, agonistically

and in white those we don't know yet

therefore, they bind to many different targets, glutamatergic sites

in the 5HT2A receptor, which is very important

it's considered today the psychedelic receptor

because all these psychedelic molecules bind to this receptor

and there are very interesting studies i Europe

showing that the activation of these receptors is central

for the so-called psychedelic experience

which induces visions and reactivates memories

a recent finding is related to GDNF

the Glial-derived neurotrophic factor

ibogaine and noribogaine stimulates the release of GDNF

and this may be related to their therapeutic effect

and also the opioid receptors, both bind to opioid receptors

but it is extremely hard to characterize

if it has agonistic or antagonistic action

there is a recent study from NYU

looking at this point

and it is a very intriguing mystery which kind of action ibogaine has there

in the opioid receptors

And it's important to stress that they don't have direct action

at dopaminergic sites, the classic targets

the overstimulated receptors

mostly in psychostimulant dependence, like cocaine and crack

which are the main theme of hundreds of studies and millions of dollars

as being the therapeutic targets for drug dependece treatments

And this is very interesting, because if ibogaine really have,

and our study suggests it really has

interesting therapeutic properties for drug dependence

it may be pointing us new paths to think about

in terms of developing pharmacological treatments for drug dependence

then the question in humans

there is this article from 2008, published at Journal of Ethnopharmacology

about the ibogaine "medical subculture"

What happens is ibogaine is illegal in USA

and the evidences are mostly that it serves to treat opioid addiction

and this happens in the underground because of prohibition

and therefore they've given this name of medical subculture

According to this article, until february 2006

there were records for 3414 patients having submitted

to ibogaine sessions searching for treatment for drug dependence

and since the publication of this paper it has been increasing

apparently in exponential fashion

Ibogaine is getting famous, and a certain success

in many of the clinics, it is about ex-dependent people

trying to treat friends

with molecules or substance of unknown sources, sometimes extracts

and then, with the success comes the problems and failures, right?

and there are deaths related to ibogaine use

In a recent review, from 2012, the most recent available

and in the title they've put

"Fatalities temporally associated with the ingestion of ibogaine"

because many of this deaths

did not happen during the acute effects of this substance, but after

in some cases even after 72 hours of ibogaine ingestion

and then it becomes hard to attribute toxicity to ibogaine

that may have led to these deaths

in this long review, they talk about 19 deaths recorded between 1990 and 2008

If we compare this with those 3400 registered cases

we get approximately 0.6% of ibogaine use

with therapeutic purposes resulting in fatalities

From this 19 deaths, 15 were opiate dependents

2 used ibogaine or iboga extracts with spiritual purposes

and 2 dependent patients used for unknown reasons

the records did not say they were after treatment

because it is a medical subculture, many times crucial information is lacking

From this 19 cases, 5 did not involve the use of ibogaine hydrocloryde

which is the pharmaceutical substance

2 used alkaloid extracts, 2 cases involved ingestion of root bark

and in one case a brown powder of unknown origin

that we don't even known if is from the iboga plant or something else

12 cases had comorbidities, like liver disease, peptic ulcer,

brain neoplasm, cardiovascular or hypertensive disease

obesity, advanced heart disease and liver fibrosis

The author's conclusion, not mine,

Their conclusion is that

74% of cases with adequate post-mortem data

involve serious pre-existing comorbidities

mainly cardiovascular in nature

and/or simultaneous use of susbtances

There is this suspicion that there may be

pharmacological interactions between opioids and ibogaine

Therefore it would be important to detoxify the patient

for people to stay days or weeks

nobody knows how long, abstinent from opiates

before taking part in an ibogaine session

But then they conclude that these comorbidities

and maybe recent drug use

explain or contributed to the fatality

and that in most cases it is not possible to attribute it

to toxic effects of ibogaine

But there are published reports in the literature highlighting

that ibogaine can prolong the QT interval in the electrocardiogram

and that this may lead to fatalities

This is an area that needs more studies

and one of our future projects

is to record the electrocardiogram from patients that are taking ibogaine

before and after the effect of the substance

to better investigate this cardiac issue

and to help us understand the safety issue

Despite the fatalities, the therapeutic use of ibogaine continues

and a theoretical model has developed, explaining how it works

Ibogaine's effects are extremely long

the acute effects can last as long as 10 to 12 hours

that are split in two phases, the first lasts 4 to 8 hours, is commonly called

acute phase, which would be the so called psychedelic experience

after that, the patient enters and intermediary phase

lasting 10 to 20 hours

therefore these two phases amount a whole day

and then there is a last phase called residual stimulation

which is the next day, or 2 or 3 days following the ibogaine experience

In the acute phase the psychedelic visions predominate

this is an image you can find on the internet

it was made by someone who took ibogaine, and claims to have seen it

always in perpetual flux of movement, in high speed

but it is hard for us to understand how can color vision

and visions of other universes and alien like things

can help anybody recover from a problem like drug dependence

but many patients actually say that they do not get these kinds of visions

which is the effect that makes psychedelics most famous

but actually they go through an intense process in which they remember their lives

like in a movie

they remember traumatic memories from early childhood

from when they were babies, things they did not recall existed

and with very strong emotional content

Then I think this image represent quite nicely this question of hallucinating

a disorienting with a very strong emotional charge

and if this process is adequately conducted by the physician

supporting the patient, reaffirming he is safe, that there is no toxicity going on

that he is not in danger

And it is important to consider that all of this

is very hart to be achieved in the medical subculture

when you are administering ibogaine while hiding in a motel

worried if the police is going to find you and arrest everybody

it is then very hard to support the patient

and this is a very important question

But what can happen then is a very intense and deep emotional release

and there is where the therapeutic effects are

in this practice with ibogaine, according to some authors

and I'm included in this line of thought

The second phase then, is the one where the acute effects are almost over

including, in the acute effects, dizziness, difficulty in concentrating and vomiting

which occur reasonably frequently

and then the patient enters the intermediary phase

which is more adequate to psychotherapy approaches

because the acute phase is too intense, it is very hard to talk

very hard for them to pay attention i the external world

what is happening inside them, the memory recall is so intense

that they become totally immersed in this process

almost all the time with eyes closed

But this intermediary phase can be very beneficial to self-assessment

for the patient to look at himself

and although I don't have direct contact and experience with dependent patients

from what I read in the literature and from my conversations with my colleagues

I assume they are not very much accustomed

and habituated to the process of self-assessment

therefore, this can be a very beneficial period, very rich

that I think should be explored in future studies

what to do and what not to do during this intermediary phase

and after that the patient is then in a very open and broad process

I brought this map fro Jung

not because I consider the most adequate

but because it represents the range

of possibilities for explanation that we have here

But what I think is happening is that the patient can get out

he can take his attention exclusively from the outside world and come to the inside

and face the various difficulties and problems

he has or had during his life

And finally we get to this treatment in Brazil

which is a very interesting one

it is being conducted in a hospital, in the countryside of São Paulo

by a doctor, who gradutated here at UNIFESP

certified, legalized

pharmaceutical ibogaine imported from a Canadian company

with authorization of the brazilian government, with ANVISA endorsement

And this is very different from what happens in USA

This patients in Brazil, they go through clinic in Curitiba

as residential patients there

and they go through a series of psychotherapeutic processes

music therapy, physiotherapy, group therapy, individual therapy

and then they go to the countryside in São Paulo State,

where they receive ibogaine with this doctor in the hospital

after that they return to the clinic and stay there some more time

and as this is a retrospective study, we'll see it has a lot of variability

but it is a much safer and clinical environment

than what is happening abroad

Then in terms of drug abuse, these are the main substances

used or abused by these patients we studied

Alcohol, cannabis, cocaine and crack

64% reported use of alcohol

81% cannabis

83% cocaine

68% crack

interesting to note that the use of alcohol seems low

and most likely this is due to the way the doctor asks the question

because he simply asks "Which drugs do you use or used previously"

and they start answering about the illicit ones. They skip alcohol and cigarettes

it is very important, then, to have structured questionnaires

in order to know a little bit better about alcohol in these cases

a small fragility of the study, but that is common in retrospective studies like this

and 72% of the sample were polydrug users. They used 2, 3 or 4 substances

and they had experiences, but then in very small proportions

with other substances

A few patients mentioned use of LSD, and some pharmaceutical drugs

only one patient used amphetamines

and only one woman who used opiates, an italian

she came to Brazil specifically to take

this treatment with ibogaine

then among brazilians, no case of opioid use or abuse

in terms of the sample characteristics, the age of onset

men in blue, women in red

this is around 15 years old, 20 and 25 years old

alcohol with onset around 14, 15 years

cannabis a little bit later, around 16

cocaine later still and crack, on average, as the last drug

a small stair there, but not significant

important to note the minimum age to start using the drug,

which for alcohol is seven years old

and it also surprised me the use of cocaine at ten

and here I want to make a side comment, my personal oppinion, but if prohibition

cannot prevent a ten year old child to snore cocaine

the problem is very serious and we need to think in alternatives

And this is very important because the risk for dependence

that I mentioned in the beginning, is correlated to the age of onset

Start using drugs early in life

increases the risk of later problems

And also the issue of previous treatments, which is very important

here for men and women

the amount of people, and the number of previous treatmens

Then there is one woman who reported 39 previous internments

we do not believe much in that, but she claims so

and for men, a considerable number also

people with 10 previous treatments for drug dependence

the median being 4 previous treatments

very few patients involved in

this ibogaine treatment

this being their first attempt at a drug dependence treatment

then these are patients I think we can consider severe

started early, many failed attempts in previous treatments

and then they tried ibogaine

But the variability is an important question in this whole study

Therefore I built a map

of recovery trajectories

So we started with 75 patients

that we could personally reach

everytime it goes up in the map,

it means patients that did not relapse after one ibogaine sesssion

every arrow down points patients that did relapse after an ibogaine session

then we have one ibogaine session

a second session, a third, fourth, fifht

and then it goes, with patients stopping to take ibogaine

and therefore the number of patients decreases

and we can see here a series of possible trajectories

Then 75 patients participated in the first ibogaine session, 22 did not relapse

with 12 of those stopping at this point

and 10 deciding to take it again

then there are people that never relapse

but still wants to take it again, negotiating with the doctor

there is also the opposite, 53 patients that did relapse after the first session

29 stopped there, even having relapsed

and 24 decided to go on

Thus there are people that despite relapsing after the first session,

do not relapse after the second, and there is people that continue relapsing

including one patient that goes through 9 sessions

he used ibogaine 9 times, with intervals of approximately 3 months

between each session. And the doctor was very careful here

because he cut the dose in half in all this subsequent aplications

And then there are people that do not relapse, take again and then relapse,

there are many kinds of trajectories

and it is challenging to consider this as a group to do statistics

But we did and we found interesting results

Then in terms of abstinence and relapses

we could talk to 8 women and 67 men

It is somewhat common in the area of dependence

a male majority

All women were found abstinent

and they reported to be totally abstinent at the time we interviewed them

and this contact varies from a few week

to 3 or 4 years since the last ibogaine session

3 or 4 years before we, researchers, contacted them

And 72% of men declared themselves abstinent

but 10 or 11, I don't recall exactly now

reported that they were doing other treatments

after trying ibogaine

they went to participate in other treatments

If we discount those

we have 51% of men found abstinent

and this with patients found months

or even years after the last application of ibogaine

the is one patient that with one ibogaine session

reported complete abstinence for 3 years

and there are patients who report moderate use of substances

and one that claim to be able to drink socially at family events

About the number of ibogaine sessions

around half the sample did only one ibogaine session

around 30% did twice

and around 12% did 3 ibogaine sessions

it is very rare cases that took more than 3 times

very small slices that took 4, 5 times

and one guy that took it 9 times, always with half the initial dosage

The dosage is very important

and for women it was around 12 mg/kg

and there is variability there because of two factors

first, because ibogaine is imported, it takes long to arrive

and the patient changes weight while in the clinic

the other reason is that the doctor, according to his experience

sometimes give a booster dose after 40, 50 minutes or one hour

and this depends on his evaluation of the psychological status of each patient

then there is a small variability in the dose, but it is fairly small

for women, 12 +- 1.61 mg/kg in terms of standard deviation

and for men a lttle higher, almost 15 mg/kg

which is precisely what is considered therapeutic in the literature

the used dosage range, that is also below the toxicity levels

there are reports of toxicity in rats

with doses above 100 mg/kg

therefore he is way below the dose for which there are reports of toxicity

in terms of relapses, then, after the first ibogaine session

after two or three

the number of patients decreases

but we start with 75 patients, and aroun 70% relapse

therefore with one session he has an approximate success rate

if we consider abstinence, around 30%

with 2 sessions it increases to 40%

and with 3 sessions it gets to 60%

of patients reporting abstinence after the treatment

I will show you some histograms, not sure if you can see from the back

but I'll try to explain carefully

We have 3 histograms representing the same thing

but in different situations

The vertical axis is the number of patients

the larger the bar, more people

In the horizontal axis, the abstinence time achieved

Then at the start, before ibogaine, in red, we see that

the group is almost entirely concentrated here in the second bar

around the first, second and third, which is 2 months

and why two months of abstinence before ibogaine?

because this is required by the recovery clinic

Without the two months for detoxifying and therapy

it is not allowed to go to the ibogaine administration

and therefore this comes up in our results

and it shows that there is a following of the protocol

with some exceptions

After the first ibogaine session, what we observe here is a decrease here

that is, patients are more widespread in the graph

there is still a considerable amount of people with 1 or 2 months of abstinence

but ther is an increase in the bars at 3, 4, 5, 6 months

we are seeing here in these graphs until two years

and if we look to all the ibogaine sessions for each patient

independently of how many sessions each took

If we consider the interview as the end of the study

and there is people that took one, two, three or four

and if we look at everybody here, we see an even better increase

Therefore, in statistical figures, we start from a median of 2 months

to a median of 5 months with one session

5 months is above the 3 months from LSD

and way above the 3 weeks with topiramate

and with all the sessions each patient opted for

this median increases to 8 months

I think it is rather impressive

in just a few weeks it is hard

for a patient to restructure his life

but in 8 months, or more than that

because we are talking about the median

I think there is room enough for psychotherapy

for help, for family support

for patients to go back to study, to regain a job,

which are extra indicators of therapeutic success

and here, for those of you not accustomed to histograms,

I also plotted the means

it is not the best here, because these are not parametric data

but if we look to the averages before treatment, after one ibogaine

and after all ibogaines each patient took

and the days of abstinence, here we are around 60 days

here 5 months, 150, and then the 8 months

the average shows similar results than the median in this case

then we can see there is increase in the time abstinent

for people that decide to take more that one ibogaine session

reminding you that NEVER, in none of the cases

ibogaine sessions happened in consecutive days, or in the same week

The interval is always of many weeks

in most of the cases, more than one or two months

And at last, another part of the study

This retrospective part is already submitted for publication

we were evaluated by 4 reviewers. They asked 50 modifications in the text

but all of them were favorable to the publication

therefore we are expecting it to be published soon

and we are working, and this is mostly what Angélica does

her specialty, which is a very important part

for us to understand what is going on

which are the qualitative reports

What are these patients telling us

from the experiences they had while using drugs

and also during the ibogaine treatment

comparing it with other treatmens

thus I would like to show you some quotes, hope I am not

exceeding my time

Then regarding the treatment, this is always the patient's initial

gender, if male or female, and age

and one patient says that "ibogaine is a very large lever"

"It is like years of treatment, in 24 hours"

"Years, like 10 years in just... 24 hours"

"The good thing is you don't have cravings"

This is very important, this issue

this sensation of years of therapy with one psychedelic session

it appeared a lot in the 50's

in therapeutic sessions with LSD, this kind of report was very common

"Doctor, it seems I did one year of psychotherapy in an afternoon"

this comes back again

and this point about the lack of cravings is interesting

because there are no reports in the literature

regarding this effect for a sample which does not use opiates

Therefore it seems that the same type of effect that is already reported

happens also for psychostimulants

another patient, a woman, she says:

"Ibogaine helped me to center myself, ok?"

"To the point that I know what is right and what is wrong"

This reveals an insight, a gain of knowledge

about controlling herself and making decisions

which is a very important issue for these patients

who abuse drugs

Change in attitudes

"I've changed the way I face my problems. They will always exist"

"Then i get to the end of the day very grateful, very happy"

The patient realizing he can not scape his problems

but he can change his attitudes about the problems he has

Again, decision making. The patient says:

"It's a tool, a brake for consciousness, for all this"

"But it's not... it helps, ibogaine helps, it takes off the cravings, decreases it"

"but it's your choice, everything is choice, right? In life, it's all about choice"

Again, a report that seems to me a very beneficial insight

Maybe a little bit obvious from outside

but for dependent patients it's hard to get at this

another patient says:

"You must be willing to stop"

And we consider this a very important quote

We cannot expect ibogaine to solve the issue by itself

That you might administer ibogaine, the patient goes home,

nothing happens and the next day he doesn't want to use drugs anymore

It would be far too simplistic

and how do they get at these insights?

they take ibogaine and simply have these insights?

No. They go through all that arduous and sometimes painful process

that I mentioned in the theoretical model

and we see this also in the reports

Then about the effects, one patient said:

"I do not compare with any hallucinogen"

"Because it is not a pleasurable experience"

"It is a very strong experience that moves us a lot, ok?"

Another patient talks about death:

"Ibogaine made it crystal clear"

"that I would die if I kept using drugs"

The issue of death appears not only as an idea

This other patient says the following:

"If there is something hellish in this world, something you cannot imagine"

"is ibogaine"

"I am telling you, I used every drug possible in this life"

"but never something so strong"

"Then people ask me: can ibogaine be addictive?"

"No. Impossible to want to use it again" (laughs)

"You take it once and you'll never want to see it again in your life"

"Because the sensation if you're gonna die. You are going to die"

"I took it, and during the effects I thought I was going to die"

"I said I was going to die. I couldn't talk. I wanted to ask help"

"Ask to stop it. Like stop it or I will die"

Therefore the question is, can such a substance

that causes this sensation, have any therapeutic effect?

Or is this an unethical practice, a violence that is, let's say

maximizing the patient's suffering?

Then we need to look at this process in its totality

And it is not only about sensation of death

but when we look at the end, this patient comes back and says:

"But you get out of there different. You get out being another person"

"I tell you. I told this to my mother"

"Everybody should take ibogaine" (laughs)

"not only because of drug treatment. Treating drug is one thing"

"But the self-knowledge and... purification maybe"

"Everybody should take ibogaine because you become another person"

"You really change after taking ibogaine"

Thus this psychological process of death and rebirth

of ego fragmentation, of rediscovering oneself

was also very well known in the 50's

and there is a considerable literature about it

regarding psychedelics

and this kind of process is also apparent in studies abroad

with psilocybin

where patients go through this same kind of process

that is being called ego dissolution

where the person starts to disidentify

with the persona with which he commonly identifies

because all of us, we have many personas, many social masks

and then they think they've arrived at an essence

and when this process is complete

with support to interpret it

and to reevaluate oneself and to reconstruct life, there is much gain

The issue of death and rebirth again, a patient that said:

"I saw that I was ruining my life"

"I went back through my overdoses"

"and I saw that thanks to God I am alive"

It is probably very intense, deep and painful

for the person to have all these visions about all the emotional content

of all the overdoses she had in life

in a single experience of 10 or 12 hours in a hospital

Self-knowledge once again

I like a lot this saying from a woman

she said the following:

"I had this very bad thing inside of me"

"And only with ibogaine I could get rid of it"

"It was a very little sad girl, that lived inside of me"

"And I saw", and here she means during the ibogaine

"And I saw this little girl inside me, growing"

"Until it got to my real size and stuck to my body"

"It was myself, growing and maturing"

This is a very beautiful account of self-assesment

of remembering the problems they've gone during their lives

and how to overcome that

Happening from the insight. The patient has a very vivid sensation

that he realized it, or that ibogaine told him

Another patient says:

"For the first time in my life I saw myself without needing a mirror"

"I saw myself, I hugged and kissed myself"

Death appears not only regarding the individual himself

but also in relation to ancestors

Then this patient says:

"I saw my father dying, my mother crying"

Then in the sequence the experience shifts

"I saw my wedding. My father with me. Very beautiful"

"I remembered my baby blanket"

There she goes from a tragic vision of the father dying

to a nice vision of getting married

to a very old memory of being a baby

and then she has another memory:

"My brother being beaten up by my dad. Then I understood him"

Starts to realize family dynamics, older issues

that are not only about the patient as an individual

Another patient talks about ancestors:

"I saw my deceased ancestors"

"Who also had drug problems"

Then he starts realizing that the drug problem

is not only his, he did not invent this

How much of it was learned with the family

how much of this is a problem

a little larger than his own behavior only

And at last, the issue of spirituality, mentioned by some patients

not many, but some said things like this:

"Actually ibogaine is not only a medicament"

"Because it stir the spiritual side, you know?"

"It is like you said: WAKE UP"

"It's a force, something superior. You really believe, you really experience it"

And the last one, a patient that said:

"It was very spiritual. I still have a lot to work on"

"But that is what was missing"

"I wasn't paying attention to the spiritual side of my life"

And I want to close with this specific quote

because I like this point he mentions, a lot

that I still has a lot to work on, right?

It goes back to that question I brought

What is a successful treatment?

An open discussion I think, in the literature on this theme

Because drug dependence is a recurring condition

and there are patients that may stay years without using

and then they go back, relapse and star again with old patterns

and this person had the insight that he still has a lot to do

but that ibogaine gave him a considerable help

So thank you very much, hope we can have a time for questions

and a little conversation

Applause

[Jair Mari] Você quer conduzir? Vamos começar?

Perguntas?

Questionamentos, críticas... elogios?

Incômodos, curiosidades?

[Student] I would like to know about some study

with any report of an user

in an ibogaine retreat in the religious context i Africa

where it is most used. Is there any study with this information

if it can be harmful to the patient

to use it 9 consecutive times, or more, in case he decide to take more?

Well, these are two very distinct things, OK?

The cas of the patient that took it 9 times

once again emphasizing

that after the first session the dose was consideravly reduced

and he was asking for it, negotiating with his family and with the doctor

because he felt uncontrollable cravings, he thought that at each session

with the low dose, he could better control his cravings

and stay a little more time abstinent

This may recall the shamanic use

But it is VERY different of what happens in Africa

which is actually a very restricted use

Africa is not where we find most of the ibogaine use, it's in Mexico

In the border with USA

USA outlawed it, people are crossing the border and

clinics spread all over, some have doctors

others are completely run by ex-dependents

This is the place where some of the fatalities happened

But in the shamanic use, the estimated dose, because we don't have

the precision we can obtain in the lab

is this dose that would be equivalent to the half dose in our study

Instead of 15 mg

for opiates it goes as high as 20 mg/kg, the dose being used for treatment

and in the shamanic use it is estimated around 7 to 10 mg/kg

And all the context is very different

And then we would need to dive deep into anthropology

I'm fascinated by anthropology, but I'm not a professional, not an expert

But the contextual issue is paramount, I would show a video

But I though it was a little bit off-topic

But you can see it on youtube, there is this video of "iboga rite"

with "R-I-T-E""

it's a video of the Museum for Gabonese culture in France

a small sample around 3 minutes long in a ritual

Bwiti is the name of the religion

And these guys playing, painted, those cameras that capture in the dark

Black and white "night vision"

But the music they're playing during the ritual

and drumming and playing cords with the hands and mouth

Very impressive sounds, to make modern DJs jealous

A lot different, completely different from a patient in a hospital bed

Many patients report it is impossible to move

that moving is painful, that it's better to stay quiet with eyes closed

and the doctor also reports they asume fetal position

in the hospital bed

Then there is the dose issue, the context issue

and the behavior of people while using

and all those are very different

Probably also the psychological content is also very different

Here we are talking about patients with a recurring problem

of many years, some with more than 10 years

with a problematic history in drug use

Very different from another culture

another language, other worlview, in Africa

Dancing to contact spirits, right?

[Student] In Mexico it isn't ritualistic, it is therapeutic, clinic work?

In Mexico there are clinics. Some try to mix it

There are some dependent patients that paint themselves

some dependent patients that recovered with ibogaine

and now treat other patients. There is a movie also

I saw this documentary, there is a very polemic guy in USA

He is doing it and challenging the law

he was arrested a few times, liberated

he paints himself. After his treatment in these clinics he decided to go to Gabon

He went, he participated in the shamanic initiation there

And then he paints himself like the shamans while he is treating people

But this mixture is not what we are dealing with here

We are not studying

shamanic treatment for drug dependence

We are trying, what is being done, in my oppinion

is a pharmacological treatment

and we are looking at it from a biomedical perspective, psychiatric

[Prof. Jair Mari] Congratulations Eduardo,

a very good presentation

There is an enormous preparation there, a good student from our biomedicine

Welcome Home, welcome back to this school

Some comments I want to make. First, those who were in my class today

will remember the lesson. Can we adopt ibogaine in a treatment?

Is it's efficacy proved?

No, it's not, OK? We can only prove that through a good clinical trial

All this is just a beggining

This drug is fiery, it's very powerful, right?

I would like you to say a little about the neuroscience later on

But it is like if it opened the hippocampus

if it opened the memory structures

it would be very interesting to know it's action

So, from the point of view of efficacy, I'll tell a story from my clinic

There is a guy, you probably know him, he administers this vaccine for alcohol

In São José do Rio Preto I think, is this right?

I think everybody that works with dependence...

And then the patient came to me, I don't know if you've heard about this guy

But they come to me and ask, Dr. Jair, I want to take the vaccine

What do you think?

And i say wonderful, excellent. The vaccine is excellent

They go there, take the vaccine and stay 3, 6 months and some...

Why am I saying this?

Because there is an unspecific effect

that is important in the treatment. That's wy we need the clinical trial

I'm not saying that in this case it is unspecific effects

What I'm saying is that there is a proccess

to develop a treatment, OK?

And, for example,

to this vaccine, ther are patients that react really well

I am against the adoption of this treatment from a scientific perspective

But from the individual perspective, there is a ritual, to travel São José do Rio Preto

take the airplane and say "I will take a vaccine because I will stop drinking"

Isn't it? And this helps

But I am not against to the point of saying to the patient that there is no efficacy

The what I mean

is that many times the ritual also contributes to the treatment

which is exactly what the clinical trial is for, to remove this effect

from ritual and ceremony

Now this drug is very powerful, then it's very important

to make a clinical trial for us to be able to compare

to assess safety

Because it can have cardiac effects, there might be sudden deaths

There may be QT prolongation, and this can lead to heart failure

Then we need to study these effects

and to study and assess this with a good clinical trial

Definitely

And the other question is, is this an extract, various drugs together?

Or is it, like, marijuana has various drugs

And canabidiol, now there is this huge confusion

Oh, are they using marijuana for treatment?

Canabidiol is one of the drugs in cannabis

which is not THC, the drug that gives the high

Canabidiol is a calming drug, a tranquilizer

And this is what is being researched, at USP for example

People in Ribeirão Preto, right?

Crippa gas been doing it a lot, the effects of canabidiol

But marijuana, cannabis, it has 60 drugs, 50 to 60 drugs

This ibogaine, is it an extract, what is this?

Two questions, is it the molecule, does the extract contains only the molecule?

And what are the available evidences from neuroimaging, neuroscience, right?

Thank you

I'll start from the last

Ibogaine has around 12 alkaloids, the plant

And this is not well studied

In the case of this treatment we evaluated here in Brazil

That we are trying to publish, only ibogaine hydrochloride

Synthesized by a Canadian pharmaceutical company

Legally imported, 98-99% purity, medicinal quality drug

according to international standards

Which is different from what happens in other places, like Mexico for example

extracts, root pieces, brown powder

all of these are harm maximizing

I think one the very important result of our study

is the absence of fatalities

This attests to the importance

of not prohibiting the treatment

being done by physicians in hospitals

Because when you outlaw this condition

you generate the stimuli for the medical subculture

and then you are maximizing harms and risks

as we already saw in the literature

Regarding the neuroscientific perspective, we know absolutely nothing

No one has ever done neuroimaging, EEG, SPECT, MEG during ibogaine

We are proposing to this for the first time

We are writing this project to do a follow up study

Follow patients for 12 months

That is, to start even before they take ibogaine

and start following up before the treatment and after

and this is Angélica's specialty, she's a psychologist

and my part, with Dartiu as a coordinator, and my part

also including Dr. Luís Fernando Tófoli, from UNICAMP

my part is to do the EEG, before and during ibogaine's effects

at least during the first 4 hours

more that that is very hard, almost impossible, to keep a good EEG signal

And also collecting blood samples to evaluate metabolic parameters

It would be a very innovative research, very important

doing also the electrocardiogram

I think your hypothesis about the hippocampus is very interesting

I think there might be something there

The EEG unfortunately won't allow us to evaluate this, EEG is superficial

there are some techniques to estimate deep sources in EEG data

which we can try with the equipment we already have

from my FAPESP post-doc with ayahuasca

We could estimate something, but it is fragile

The ideal there would be neuroimaging

But for you to do ibogaine inside neuroimaging

maybe impossible, with patients, technically, methodologically

But it is seems very interesting to me

Briefly about the hippocampus, there is recent research

at Imperial College London

with psilocybin, in the last 5 or 6 years

neuroimaging and magnetoencephalogram (MEG)

and they had very unexpected results

that this consciousness expansion, it appears in neuroimaging

as reduction of activity in many different areas of the brain

and almost everybody expected the opposite, increases in brain activity

to generate more visions, more memories, or even hallucinations

the idea being that, for you to hallucinate, your brain is doing something extra,

and then you would perceive something that isn't in the external world

But the result showed the opposite

in EEG the same thing

reduction of amplitude of brain waves in may different frequencies

with exception of the hippocampus, in psilocybin

Which probably will be their next paper

It's not published yet,

but it has been shown in an international conference

Then I think you are right...

[Jair Mari] On target

Yes, on target, I think that's the way

[Professor] Two questions, the first is

You've said that before hospital admission

for ibogaine administration

they spend 2 months at a clinic, in a detoxifying process

but not only to detoxify, but therapies and so on

To these individuals who took ibogaine more than once

before every administration was there this 2 month reclusion?

This is the first question

The second is: You presented the article on fatalities

You've mentioned that there weren't fatalities in these 75 patients

who were submitted to this intervention

but I'd like to know about adverse effects

among these 75 patients

particularly about any case of psychotic break

of triggering psychotic episodes

but also about any adverse effects

I'd lease ask you to comment about that

OK. What was the first question?

If at every session the guy stays in the clinic... Oh, yes

No. Actually this is not clear in the data they provided

Actually, this was a developing protocol

They started working with ibogaine more than 10 years ago

in a very experimental sort of way, very empirical

This doctor, he met that patient, Howard Lotsof

in an international conference, and he was fascinated by the story

he started studying the literature, met other people in USA

and decided to give it a try. And this protocol was then developed over time

Then at the start they asked for a month long stay in the clinic

in the first years, but then this was changed

but they weren't precise

about when exactly did they adopt the two months

that's also why we see some variability there

older patients stayed less time in the clinic

When someone returns to a second or more sessions

Then it varies at each case

There are patients who create a very strong therapeutic bond with the clinic

so they go back there, but not necessarily for two months

but stays there some weeks, getting treatment

There are other patients that don't like the clinic

and then they negotiate with the doctor and search for therapy in other places

with other professional or other clinic

Therefore in subsequent sessions

the protocol is less structured than i the first time

[Professor] Then it is not guaranteed

that the patient was abstinent from drug use?

The doctor does a urine toxicological exam, in the morning before ibogaine

And he has sent patients back home because of that

patients that were positive in the urine test saturday morning

It's always administered saturday, and they stay the whole day in the experience

and they sleep in the hospital

and they leave only sunday morning or at night

depending on each case, on the clinical evaluation

About the adverse effects

I am not aware of psychotic episodes in any of these patients

that was documented. The sample is larger than these 75

They've given us a list of patients

But many we could not find

therefore we worked with these 75 we could directly reach

these data about relapses, lapses, age of onset, it was all obtained from us

We demanded this independence and rigor

that we might access the original source, which are the patients

We didn't found any fatalities

also among the patients in the list

About psychotic episodes, maybe Angélica can comment about

[Angélica Comis] Actually, in the interviewed sample

we had no reports

but we heard from other professionals, who worked with these patients

patients that were submitted to this procedure, and had some episode

but that it was short, than it may have been induced

and usually the patients who did develop some psychotic episode

were patients with preexisting conditions

such as bipolar disorder or some other disorder

[Prof. Jair Mari] What about bad-trips? No bad-trips? Because in LSD

we know well, don't we?

There are persons for whom the trip is wonderful

but some people have bad-trips

[Angélica Comis] We've seen i the reports some bad-trip, it's terrible

during it, because it's exactly when you get in touch

with your problems, difficulties and demons

And it is considered a bad-trip

But is common to get to this moment of redemption

It goes through the harder experience and comes back to redemption

And this, some say is an adverse effect, because it felt bad

But in the end they go back in a sense

yes, I'd like to go back, to comment a little bit more

about the adverse effects

we did not identify serious adverse effects

but this was one of the critiques of the reviewers on our paper

for us to elaborate more about this question, which we did and resubmitted

adverse effects like vomits and ataxia, mainly vomiting and ataxia

Nothing prolonged, no case of persistent ataxia, which might be

some indication of cerebelar toxicity

nothing like that, and also the dosage

that for cerebelar toxicity is above 100 mg/kg

more than 10, 8 or 9 times what is being administered here

The we get to question about what is an adverse effect

In terms of the patient's perception and in terms of the treatment purpose

We are talking about a psychiatric patient, with problematic history

and these people do not have problems just because of drugs

but they have a series of problems in their human relations

with their social circles

Then, is remembering this, reflecting about it, even though it's painful

is this adverse? it certainly isn't pleasurable

But it can be therapeutic

The psychotherapeutic process itself, without ibogaine, can be very painful

But we don't call this a "bad-trip"

The very idea and name for "bad-trips" was born after the clinical research

during recreational use. Then it makes sense

Those that want to have fun with a substance

when revisiting traumatic memories, they get scared

and then goes like "this is not what I wanted, I think I got an intoxicated drug"

"I took something else" and starts to create lots of explanations

to what's happening to her

But if they start with a therapeutic purpose, with clinical support

To look at these issues, to dive deep in this material

in order to try and understand why she's doing such a mess using drugs

and why everything is so hard, right?

Clinically I think it would be a mistake to call this as a "bad-trip"

And this was extensively discussed in recent conferences in California

In the last 3 years there were 3 consecutive conferences in California

Exclusively about psychedelic science

And the last one got a considerable proportion

with more people there than at FeSBE

which unites all experimental biological societies in Brazil

The the interest in growing, and this is a topic of concern

I wouldn't call it bad-trip

[Prof. Jair Mari] Good point, I think your explanation is very good

It's correct

I think it's hard, it's painful, suffered

they report as such, but many get to realize

what do they gain with it, in the end, if this process is completed

and one of our hopes is, in the follow-up study, to be able to identify

patients that do complete it

and patients that do not complete this process

and try to find out ways

to help those that can't, to take benefit

of this, let's say, hippocampal opening

that maybe comes up with some amigdala activation

And the Bum

[Prof. Jair Mari] Yes, it's probably a very strong emotional experience

may be close to panic, this feeling of death, right?

there is probably an adrenergic activation

The doctor is there all the time

he visits the patients every half an hour

he measures blood pressure, oxygen levels in the blood

and reaffirms them that they are safe

There is a psychiatrist around 84 years old, Stanislav Grof

he was, still is, the main expert about LSD clinical uses

he made more than 2000 therapeutic LSD sessions before prohibition

in Europe and USA

and he has this anecdote which I find very interesting

he tells about this patient who called him, at that time, whe he used

LSD in his therapy, and the patient said:

"Doctor, i want to kill myself, I need to kill myself, I must kill myself"

And he answered:

"I can help you with that, but let's leave the body out of it"

Then the question becomes a psychological death and rebirth

To help the other to deconstruct and reconstruct

so you get this feeling of death, but not at the physical level

not actual death, but metaphoric death, psychologically

[Angélica Comis] Only one thing I'd like to add, when the doctor

visits the patients every 30 minutes, when he notices this suffering

and many times the patient verbalizes, he measures cardiac frequency

and says "it's all right", because sometimes it's only the individual sensation

then the fact that someone is there

it calms people down and makes a lot of difference

[Professor] You mentioned a little

about the near death feeling, but there are some reports in the end

very powerful and strong, right? Then I would like to think a little bit

How can we correlate this with other situations where we find this feeling

patients that feel like almost dying, and then a sudden shift in behavior

For example, in ERs, sometimes patients stay there a long time

and they go through this sensation of almost dying

and they stay for a very long time in the hospital

but they get out with deep changes in attitude towards life

in purposes and things like that, which is another group which had

the process of near death and we see that they change

I'd like to know how can you put this things together

not from the pharmacological point of view

but from the angle of the experience of almost dying

I think this is a very interesting area for research

thanks for taking this question from a more broad perspective

It started to be a focus in neuroscience for the last years

it has an acronym already - NDE - Near Death Experience

there are some ideas of inducing it in the lab

or to study people that are going through it

people that got accidents

and there is a very interesting literature on the psychology of this

and it's very curious that there are some experiential parallels

there is this idea that people that go through processes

of almost dying, during cardiac ressucitation in hospitals

they report this kind of experience

of intense remembering their life stories

since they were born, even among lay people

this idea that when we die we see a movie, a short one about our life

in high speed, it seems to be a fact, there is psychological literature

coming from hospitals and there seems to be a parallel there

and there is this theory, very curious one, but still far

from being supported by scientific evidence

that DMT, one of the most famous psychedelics

would be, and by the way, this is a scientific fact

we have DMT inside our bodies

we can make it in our lungs mainly

but most likely also in the brain

but we have no idea why this endogenous DMT is for

when it is liberated,

and there is a series of methodological challenges to be overcome

but then comes this theory that maybe there is a role for DMT at the time of death

and there would be a link there with experiences during ibogaine

or during LSD with reports from people

that have gone through near death experiences

Now why is this so? Tremendous mystery, right?

Regarding the benefits, I guess for the patient, from a clinical perspective

we could elaborate on in various different manners

maybe Dartiu and Angélica can contribute more than I can here

but I think it's a central fact in our psyche

that we live the daily routine denying, excluding our mortality

We live like we were immortals

We don't stay there dealing with it all the time, it's very painful

it's very hard for us to talk about it all the time

[prof. Jair Mari] Fortunately, right Eduardo?

(Laughs)

It's good for us that we can put this away

and deal with it only sporadically

Or for many people, never

And then we see this benefit for the person, when they take this perspective

it enriches the everyday moment, every relation

every meal, every pleasure

like "man how good is it to be here"

I almost went away

now the salad, which is trivial, the guy looks at it as if it were his first time

and a very special salad

because he almost lost it

Then there is this relation in anything we attribute value to

according to what we have, according to the risk of loosing it

or is we lost it before we learn to appreciate what we had

when we loose, then I guess there is these psychological game

in the near death experience

To know more: www.plantandoconsciencia.org