VIE 28 DE ENERO DE 2022 - 03:00hs.
Column by journalist Marcelo Leite in Folha de S. Paulo

Science bets on psychedelic anesthetic ketamine against gambling compulsion

Journalist and doctor in social sciences Marcelo Leite writes a column in Folha de S. Paulo about news in neuroscience about the treatment of mental problems with ayahuasca, ecstasy, LSD and other drugs that transform consciousness. This week, he brought science's bet on experimental psychedelic treatments against gambling addiction. According to Leite, 10 million people suffer from ludopathty in the United States.

In continuing to broaden the range of potential psychiatric applications, psychedelic drugs run the risk of having their image discredited as a Brás Cubas plaster, a dubious panacea. Now even the gambling compulsion has entered the crosshairs of research into experimental psychedelic treatments.

The list of therapies under investigation continues to grow: depression, anxiety, post-traumatic stress, OCD, some disorders of the autistic spectrum, anorexia, chemical dependency… it is proposed that even diseases seen as purely physiological, such as migraine and brain damage in boxers, can be mitigated with consciousness alters.

The Canadian company Awakn is responsible for the use of a psychedelic against the compulsive propensity to gamble and bet. It is recruiting participants for a study in the United Kingdom, under the direction of Celia Morgan of the University of Exeter, which aims to scrutinize the effect of ketamine on the reward systems at work in this compulsion and on the superstitious thinking that underpins it.

Ketamine is a dissociative anesthetic rarely covered in news coverage of psychedelic rebirth (it doesn't appear in my book “Psychonauts,” for example). A legalized drug of wide medical use, it is also successful in the night scene as a “key” and has been used by psychiatrists to treat depression for at least 15 years, as an injection.

More recently, a variant of the compound called sketamine has gained a nasal formulation for use as an antidepressant. One advantage of these substances is their shorter effect, compatible with outpatient use, compared to psychedelics such as ayahuasca and psilocybin, which have also been studied for depression.

It is estimated that in the United States alone there are 10 million people addicted to gambling (2.5% of the population). Awakn is looking to expand its therapeutic market with other forms of binge potentially treatable with ketamine, such as alcohol dependence, against which it also plans to use MDMA (the base of ecstasy).

Broadening the range of various forms of addiction, including for example sex, the share of the US population affected can reach 27%. Worldwide, chemical dependency would be 15-20%.

It's a master market, and also a hugely US government-funded research niche. Drug research czar Nora Volkow's HEAL (acronym for Helping End Addiction in the Long Term) initiative alone has earmarked more than US$1.5 billion in three years (triple of the MCTI budget) for 500 projects.

Volkow is criticized by American neuroscientist Carl Hart, with whom he was once close. He accuses her in the book “Drugs for Adults” (Zahar) of fomenting hysteria around opioid abuse in the US. In any case, in 2020, there were 93,000 overdose deaths in that country (three quarters after opioid use), 29% more than in the previous year.

Awakn's option to investigate ketamine and MDMA for addition is curious. There are five decades of experience with another psychedelic derived from African plants, ibogaine, in alternative treatments for chemical dependency, including in Brazil, but with the disadvantage that its effect takes many hours and requires cardiac monitoring.

Marcelo Leite
The columnist for Folha is a journalist and a doctor in social sciences from Unicamp. He was a Nieman Fellow at Harvard University and a Knight-Wallace Fellow at the University of Michigan.