Other Psychedelics of Note – PSYCH: The Psychedelics As Medicine Report 3rd Edition

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While psilocybin, LSD, MDMA, ketamine, ibogaine and ayahuasca currently dominate the development of psychedelics as medicines, a number of other compounds are emerging as credible candidates in their own right. In particular, mescaline has re-entered academic research agendas, and early studies are beginning to explore the potential of 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) for conditions such as PTSD.



Salvia divinorum



Salvia divinorum is regarded as the most psychoactive naturally occurring compound known, with potency comparable to LSD at extremely small doses. The principal active compound, salvinorin A, can produce psychoactive effects at doses as low as 200 micrograms.



Salvia belongs to the Lamiaceae family, which also includes mint. Despite its potency, very little is known about its toxicology, safety profile or adverse effects, as minimal clinical research has been conducted to date. Psychoactive effects may occur when salvia is chewed, smoked, or consumed as a tea.



Unlike most classical psychedelics, salvinorin A does not act on serotonin receptors. Instead, it is a potent kappa-opioid receptor agonist, giving it a distinct pharmacological profile. Revixia Life Sciences, part of atai Life Sciences, is currently developing a proprietary formulation of salvinorin A (RLS-01) for the treatment of treatment-resistant depression.



Mescaline



Mescaline can be derived from cacti such as peyote and San Pedro, or synthesised chemically. Humans have used mescaline for thousands of years for purposes ranging from pain relief and anti-inflammatory effects to spiritual and ritual practices.



Despite its long history of use, mescaline is classified as a Schedule I substance, meaning it is officially considered to have no recognised medical benefit and a high potential for abuse. However, peyote and San Pedro remain legal for ceremonial use in certain regions of the Americas, particularly among Indigenous communities with established traditions.



There are anecdotal reports of mescaline being used for analgesia and headache relief, but robust clinical evidence is currently lacking. Only three clinical trials list mescaline as an intervention. One trial is investigating mescaline for alcohol use disorder, while the others compare mescaline’s effects against other psychedelics across a range of psychometric outcomes rather than targeting specific conditions.



DMT



N,N-Dimethyltryptamine (DMT) is a powerful but short-acting hallucinogenic compound found naturally in many plants and animals. It occurs in high concentrations in plants such as Mimosa tenuiflora and Banisteriopsis caapi, the latter forming one half of the ayahuasca brew.



DMT produces intense visual and hallucinogenic experiences of much shorter duration than psilocybin or LSD. It is classified as a Schedule I substance under the 1971 UN Convention on Controlled Substances.



Chemically, DMT shares similarities with the anti-migraine medication sumatriptan and acts as a non-selective partial agonist across multiple serotonin receptors, particularly the 5-HT2A receptor. There is anecdotal evidence suggesting DMT may alleviate chronic migraines, but modern clinical data on pure DMT for medical use is virtually absent.



Low doses of DMT are typically defined as 0.05–0.1 mg per kilogram of body weight, with the psychedelic threshold estimated at around 0.2 mg/kg. Research into DMT’s mechanisms of action is ongoing, notably at Imperial College London.



5-MeO-DMT



5-MeO-DMT is a naturally occurring tryptamine alkaloid found in various plant species and in high concentrations in the parotid gland secretions of the Colorado River and Sonoran Desert toads. Its effects are fast-acting and short-lived, similar to DMT, though subjectively distinct.



The legal status of 5-MeO-DMT largely mirrors that of DMT, with the exception of a historical period between 1971 and the late 1980s when it was used as a sacrament by the Church of the Tree of Life. Beckley Psytech, a UK-based company, is currently investigating 5-MeO-DMT as a treatment for a range of neuropsychiatric disorders, including depression and substance misuse.



Kratom



Kratom (Mitragyna speciosa) is a tree native to Southeast Asia and parts of Africa. At low doses, kratom acts as a stimulant, while higher doses produce analgesic effects. It is not considered a classic psychedelic, and its interaction with serotonin 5-HT2A receptors remains unclear.



The effects of kratom are thought to arise from activity across multiple receptor systems, which may explain reported benefits for opioid withdrawal symptoms, anxiety and depression. More than a dozen countries have classified kratom as a controlled substance, restricting its sale, use, and production.



As of July 2021, neither the UN nor the United States has scheduled kratom, although US authorities are considering doing so. The FDA banned kratom imports in 2014, after it had previously been marketed as a dietary supplement.



2C-X Compounds



The term 2C-X refers to a family of synthetic compounds first developed by Alexander Shulgin in the 1970s and 1980s. Not all 2C compounds are psychedelic, though notable examples include 2C-B, 2C-E and 2C-I.



Some therapists explored 2C-X compounds as potential therapeutic tools, as they were perceived to offer a middle ground between the empathogenic effects of MDMA and the psychedelic intensity of LSD. Today, most 2C-X compounds are controlled substances, with 2C-B classified as a Schedule I drug in the US since 1995.



Nitrous Oxide



Nitrous oxide, commonly known as laughing gas, has long been used for anaesthesia and pain management and, like ketamine, appears on the World Health Organization’s List of Essential Medicines.



When inhaled, nitrous oxide can induce dissociative effects through its interaction with GABA-A and NMDA receptors. A small number of clinical trials have reported reductions in depressive symptoms following nitrous oxide administration. A recent phase II study found that a 25% nitrous oxide mixture produced therapeutic effects comparable to a 50% mixture, with fewer side effects.



Novel Compounds



Over the course of his career, Alexander Shulgin synthesised nearly 200 psychedelic compounds. Today, a new generation of researchers is continuing this work by developing novel and second-generation psychedelics.



Many of these compounds are created by making small structural changes to existing psychedelics to improve efficacy, shorten duration, or create patentable molecules. Examples include 18-MC and tabernanthalog, both derived from ibogaine.



Numerous second-generation variants of psilocybin, MDMA and LSD are currently in development. While many of these compounds must still undergo extensive safety testing, advances such as the open-sourcing of Google DeepMind’s protein-folding database are accelerating discovery and expanding the potential for innovation in psychedelic medicine.








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