Commonly known facts that statistics show are almost not worth repeating: The Centers for Disease Control and Prevention (CDC) reports that prescription opioids lead to 46 deaths a day, accounting for more than 35 percent of all opioid overdose deaths. The use of opioids may seem distasteful to some, but ignoring the fact that so many people suffer from chronic pain just isn’t an option when anywhere from 11 to 40 percent of Americans are afflicted. Yet, prescription opioids—which lack large, long-term use trials—don’t seem to offer a reliable lifelong solution for a condition that, for many, will never go away.
The opioid crisis and the medical industry’s seemingly inefficient treatment of chronic pain have driven the search for alternative, even homegrown, methods of pain management. Two anthropological researchers from Spain recently published a study suggesting an alternative to dependence on the $25.4 billion opioid industry: a psychedelic drug known as changa.
Changa is actually a varying mix of ayahuasca (not the drink, but rather the Banisteriopsis caapi vine that bears the same name) and several different types of plants containing N,N-Dimethyltryptamine (DMT). Unlike the ayahuasca-based drink, changa is smokable. Similar smoking blends have been traced back to pipes in Argentina dating from around 2000 B.C. The concoction eventually found its way to Australia, Julian Palmer reported in his book Articulations: On the Utilisation and Meaning of Psychedelics, after which point it was encountered by Erik Davis at a festival in Portugal.
Davis reports that smoking changa resulted in a strongly psychedelic experience: “The smoke was sweet, and the entrance into the vestibule of the tryptamine palace was smooth but strong, and I slid gently along DMT’s inside-outside Möbius strips of sentient energy with more clarity and with less anxiety than usual. My fingers folded into spontaneous mudras and the breath of fire sparked without will. Then the vibrating weave of nature’s alien mind fluttered and unfolded us and set us gently back on the scraggly hillside, where the crickets and their ambient chirp-track trumped the distant thump of machines. Boom!”
Most of the ingredients in the mixture, Davis says, were unlabeled, but changa researchers Genís Ona and Sebastián Troncoso—in what is apparently the first scientific study of the drug’s potential therapeutic effects—explain that DMT-containing plants are often combined with the ground seeds of Peganum harmala, a flowering desert bush. P. harmala has a long and storied history of being used in “mind-expanding rituals,” both on its own and in combination with ayahuasca, where it activates the DMT and helps in “accelerating and increasing [the drink’s] effects.” In addition to being a purported driver of ego death, P. harmala is also being eyed as “a freely available, cheap alternative to costly anxiolytics and antidepressants.”
In Ona and Troncoso’s study, “Long-lasting analgesic effect of the psychedelic drug changa: A case report,” the “analgesic undertreatment” that exists in light of the opioid crisis references numbers that point to a chronic pain-suffering population of 100 million in the U.S. and 95 million people in Europe. (Yes, even though Europe has nearly twice the population of the U.S., they reportedly have up to 5 million fewer chronic pain sufferers.)
The researchers explain that “the mechanisms of actions for these compounds [in changa] are quite similar to those found in the ayahuasca beverage, with possible differences in constituents if P. harmala is used instead of B. caapi.” They note that unlike ayahuasca drinks, however, the effects of a changa trip last only 15 to 30 minutes.
The evidence of long-term analgesic relief resulting from changa trips
The researchers present the case of JM, a 57-year-old Spanish doctor with fatigue and musculoskeletal pain in his limbs and elsewhere, whose “symptoms [that] slowly increased and became more extensive until they reached disabling levels” and would leave him with “almost one week” of pain following physical activity. In a story familiar to many people suffering from chronic pain, JM wakes up at night, disturbed by his own body. Even “ejaculation was painful,” with the pain in his arms leaving him unable to “caress his spouse.” The researchers explain that “after working a night shift in the hospital’s emergency services, [JM would] again [need] one week to recover physically and in terms of his sleep rhythm.”
After receiving a diagnosis of chronic fatigue and fibromyalgia, JM took a host of prescribed painkillers like ibuprofen and diclofenac, but saw “little or no improvement.” His symptoms alleviated a bit after completing a course of cognitive therapy designed for fibromyalgia patients, but this was a temporary solution and his fatigue returned after a couple of weeks. He juggled a number of other prescribed cures and medications but couldn’t settle on a permanent solution to his debilitating pain.
So, JM turned to something drastic. He’d tried ayahuasca once, five years before the publication of the study, and he decided to give alternative therapy another whirl with a therapist-guided changa session. The treatment, JM told researchers, involved 30 minutes of meditation followed by smoking “one previously prepared cigarette that [contained] freebase DMT and ground seeds of P. harmala.” This ended up being the first of five sessions with (except for the final session) 14 to 15 days between them. They ranged from a largely ineffective first go (“because he did not know how to smoke”) to sessions that would leave him almost pain-free “for a period of two weeks.” The doctor also reported an improvement in mood after the third session—reasonable, considering how inextricably tied chronic pain can be to depression.
JM noted that after that third changa session, his ability to see vivid colors (which had disappeared with the onset of his fibromyalgia) returned, another sign of lifting depression. The fourth session heralded “greater emotional stability, pain relief and a slight decrease in fatigue.” JM left a month between the fourth and fifth sessions, the last of which brought another two-week reprieve from the pain.
What could be driving changa’s pain-relieving properties?
The researchers suggest that the pain-relieving properties of changa can be traced at least in part to DMT’s ability to act on serotonin (5-HT) receptors. “The relationship between mood and pain is well known, so an elevation of mood produced by DMT could partially explain its analgesic effect,” the paper explains. “It has been observed that antidepressant drugs have an analgesic effect that is independent of their effect on mood.” Changa also interacts with sigma-1 receptors, which “play a role in several conditions such as addiction, depression, amnesia, cancer and pain” and even “modulate the activity of opioid… receptors.”
DMT on its own, the researchers say, has been found to reduce inflammation by acting on sigma-1 receptors and also to promote neural plasticity. P. harmala, for its part, has been shown to interact with mood-regulating neurotransmitters like dopamine and GABA and the enzyme MAO-A. Overall, a handful of different studies suggest that the ingredients in changa might, on their own, contribute to improving mood and even outlooks for chronic pain patients. But when it comes to looking at this holistic treatment, this one case study is basically all that exists.
The researchers admit that despite all of the pharmacological evidence, “It is [also] well-known that psychedelics can increase suggestibility in human subjects [and therefore] it is reasonable to think that the variables found in the ritualistic setting in which changa was provided, like expectancy or attentive and respectful listening by caregivers, together with the fact that there could be a real, short-term analgesic effect, probably exert a magnified placebo effect. [Plus,] the psychedelic experience itself… can modify the metacognitive interpretation of pain.”
When it comes down to it, the researchers say many more studies on DMT, P. harmala and any other constituents of changa—both separately and as a smoked mix—are required before anyone gets too excited about the practicality of using this as an alternative to traditional pain relievers. Hopefully, the short, limited work of these two Spanish researchers is a start.
Charlie Tetiyevsky is a writer and editor based in New York City. Find them on Twitter @tetiyevsky.