- Alcohol use disorder (AUD) has increased during the Covid-19 pandemic
- Conventional therapies for AUD have limited effectiveness in ensuring long-term remission and harm reduction
- Journey Colab will test mescaline, a long-acting psychedelic found in peyote, as an adjuvant to conventional treatments for AUD
- Journey Colab gives co-founder equity to the Indigenous communities that inspire its work
Pushed to the periphery of public awareness during Covid-19 pandemic, the disease of substance addiction continues to ravage humanity. Substance abuse deaths are often “deaths of despair,” as addiction is a brain disease that is often coincident with other mental illnesses, such as anxiety and depression. The need for new ways to treat substance use disorder has never been greater, yet medicine possesses few pharmacological tools with which to combat this pernicious disease. In addition to the burgeoning opioid epidemic, addiction to alcohol has been increasing, driven in part by the stresses of pandemic life and by the economic disparities made worse in the wake of Covid-19.
The treatment of alcohol use disorder (AUD), in particular, has limited pharmaceutical options with which to augment non-pharmacological therapies. Among the few drugs approved in the US for treatment of AUD, disulfiram, green-lit by the FDA in 1949, causes patients to experience swift and powerful hangover symptoms if they consume alcohol, thereby acting as a deterrent. More recently-approved naltrexone blunts the pleasure derived from alcohol consumption, while acamprosate helps to protect against the neurotoxicity that can occur during alcohol withdrawal. While these pharmaceuticals can be used to treat AUD, each has limitations and drawbacks. There is therefore a high unmet medical need for additional FDA-approved therapeutics targeting this disease.
After decades of neglect by the scientific community, a renaissance is occurring in the study of entheogens in the treatment of mental health disorders, with the goal of developing approved therapeutics. An entheogen is a psychoactive substance that has been historically used in spiritual contexts. For millennia, societies have used entheogens to improve their members’ well-being. Since many effective therapeutics, including the heart drug digoxin and the anti-malarial artemisinin, have been derived from traditional medicines, there is interest in exploring entheogens to treat mental illnesses. Among the sources of these psychoactive substances is peyote, which has been used by Native Americans for thousands of years. Apache, Huichol, Utes, Comanche, and Navajo peoples are among the current heirs of peyote’s ancient discoverers and stewards of its spiritual and medicinal uses.
Journey Colab, a California biopharma startup, leads the effort to develop an FDA-approved form of mescaline, a psychoactive molecule that occurs naturally in peyote, as a therapeutic to assist with the treatment of AUD. Cognizant of the traditional discoverers of this potential therapeutic, this company, in an arrangement that is to my knowledge unique among biopharma startups, set aside a 10% equity stake to benefit traditional peyote stewards and the AUD treatment communities. I spoke with Journey Colab’s founder and CEO, Jeeshan Chowdhury, its acting COO and CLO, Rebecca Lee, indigenous rights activist, impact advisor and trustee Sutton King, and addiction expert and recently-appointed scientific advisor Kelly J. Clark about the company’s goals, genesis, and unique structure.
Louis Metzger: Why is Journey Colab developing mescaline for AUD?
Jeeshan Chowdhury: Mescaline is very interesting relative to other psychedelics because it has a relatively long duration (10-12 hours). The extended experience allows people to navigate core traumas in a way that other psychedelics don’t. Mescaline may give people more of an opportunity for extended neuroplasticity, which allows them to make the most of talk therapy and community support as part of holistic therapy for AUD. Despite the medical world’s best efforts, conventional therapies for AUD have yielded abysmal rates of durable remission and harm reduction. We have very clear observations that mescaline, when combined with therapy and community support, is incredibly powerful at alleviating suffering from this disease.
Metzger: Kelly, you’ve recently joined Journey’s scientific advisory board. What drew you to Journey Colab’s approach?
Kelly J. Clark: I was pleased to see that Journey Colab is approaching the development of mescaline for AUD treatment in a way that’s evidence-based, with appropriately designed clinical trials. AUD is an underserved disease and has suffered from addiction treatment being largely segregated from the rest of medicine. I see mescaline as having the potential to assist psychotherapy by enabling acute episodes of care within a chronic care paradigm. The medical community and regulators are moving toward measuring addiction treatment outcomes in terms of harm reduction and functioning, rather than utter abstinence. Journey’s work is part of that paradigm shift.
Metzger: Jeeshan, what inspired you to found Journey Colab and to create its unusual ownership structure?
Chowdhury: I never thought that I would start a psychedelic drug company. I’m very much a product of two things: First, coming from a conservative Muslim family, where there’s a very strict conservative view on substances; and second, being a child of the 1980’s from Canada with its “war on drugs.” I grew up thinking that psychedelics would fry your brain.
I founded this company through my own mental health journey. From the outside, my life looked great. I became a physician and was subsequently a Rhodes Scholar at Oxford, where I earned MS and Ph.D. degrees in health informatics. Later, much to the grief of my immigrant parents, I dropped out of medical residency to come to San Francisco to participate in a startup incubator program called Y Combinator. My first company was ListRunner, a digital health startup that was acquired by Commure through its expansion.
Everything looked great from the outside, but I always felt like I was drowning in my mental health problems. I sought out care, the best that we had available at the time – antidepressants and talk therapy. These helped, but to a limited extent. It was like having a life preserver to keep my head above water, but these therapies didn’t get me out of my immersion in depression.
I came to psychedelic medicine out of desperation for something that would work after trying so many things that didn’t improve my mental wellness in a transformative way. Psychedelic therapy enabled me to see maladaptive patterns that had formed since childhood, and in combination with talk therapy, enabled me to change them. It also helped to catalyze my understanding of how these patterns arose. Psychedelic therapy completely saved my life.
I have been on both ends of the stethoscope and have seen that there are people suffering from mental illnesses, including AUD, far more intensely than I had. I realized that we don’t have adequate tools with which to help many of them. I took the California Institute of Integral Studies course on psychedelic training and research. On this learning journey, I met Sam Altman (board member of Journey Colab). Together we realized that not only do we need to advance psychedelic therapy, particularly around addictions, but we need to do it in the right way. If we take psychedelic medicine and just put it into an existing system that does not serve us well, we will not get transformational results. That’s why we set up Journey Colab as a stakeholder model, where 10% of the founding equity is set aside in reciprocity to give back to the communities where psychedelic use originated and to help the therapist and community partners with whom we’re working.
Metzger: How is Journey Colab learning from these traditional users of mescaline?
Chowdhury: We are creating a space of trust and dialogue in our consultation process to apply what we learn from traditional mescaline users to clinical and scientific methods. We aim to create a clinical protocol that is accessible to people where they are. We are making something new that fits into a clinical environment, and we are ensuring that we share the value that is created from this dialogue with these communities.
Metzger: Can you tell me more about how this sharing of equity is structured?
Rebecca Lee: We created a perpetual purpose trust that holds 10% of our founding equity. It’s different from more familiar forms of trust because instead of naming a particular person or entity as the beneficiary, the beneficiary is a defined “purpose” – in this case, the purpose of the Journey Reciprocity Trust is to share the value created by the company with Indigenous communities that have traditionally used psychedelic medicine, with groups that are working on the conservation of the organisms producing naturally occurring psychedelics (because so many of theses are threatened due to environmental degradation and over-harvesting), with the therapists who will be delivering this care, with other nonprofit psychedelic partners in the space, and with communities that are under-served by mental healthcare. We wanted to share this sort of co-founder ownership of Journey Colab with our stakeholder community. The trust will be led by an independent stewardship committee of five members, who will each represent the beneficiary communities. One of the seats will be filled by Sutton King, a powerful advocate for Native Americans, a descendant of Wisconsin’s Menominee and Oneida Nations, and Journey Colab’s founding Head of Impact. Sutton has spent her whole life advocating for underserved communities.
Metzger: Sutton, as impact advisor and trustee at Journey Colab, in what ways do you envision the trust impacting indigenous communities? What is the type of impact you would like to see?
Sutton King: The Journey Reciprocity Trust represents a principle that is central to my identity as an Afro-Indigenous woman: the Seventh-Generation Principle. This Haudenosaunee philosophy inherited from my people holds that our decisions today should result in a sustainable world seven generations into the future. The Journey Reciprocity Trust embodies this principle by sharing the success of Journey Colab with stakeholders far into the future, supporting equitable access to mental health services, and ensuring the protection of sacred plant medicines. Indigenous-led, the trust emphasizes the importance and validity of Indigenous voices and their autonomy to make decisions. Such voices are oftentimes excluded and alienated. We cannot use the medicines that Indigenous cultures have protected without valuing Indigenous ways of being and thinking. The trust has the ability to support Indigenous communities with the economic investment necessary to continue strengthening sovereignty and the preservation of culture and land. Through centering access and benefit-sharing, the trust has an opportunity to redistribute wealth in a way that respects the plight of Indigenous peoples and begins using money as a tool for restorative healing.
The conversation has been edited and condensed for clarity.