Psychedelic Drug Targets Addiction
LOUISVILLE, Kentucky — Ibogaine, a formidable psychedelic made from the root of a shrub native to Central Africa, unleashes a harrowing trip that can last more than 24 hours, and it can cause sudden cardiac arrest and death.
But according to a number of small studies, between a third and two-thirds of the people who were addicted to opioids or crack cocaine and were treated with the compound in a therapeutic setting were effectively cured of their habits, many after just a single session.
Ibogaine appears to quell the agony of opioid withdrawal and cravings, then give patients a born-again-style zeal for sobriety. Now, after decades in the shadows, and with opioid overdose deaths exceeding 100,000 a year in the United States, it is drawing a surge of interest from researchers who believe it could treat opioid use disorder.
“It’s not an exaggeration to say that ibogaine saved my life, allowed me to make amends with the people I hurt and helped me learn to love myself again,” said Jessica Blackburn, 37, who is recovering from heroin addiction and has been sober for eight years. “My biggest frustration is that more people don’t have access to it,” she added.
That is because ibogaine is illegal in the United States. Patients have to go abroad for ibogaine therapy, often at unregulated clinics that provide little medical oversight.
Kentucky and Ohio are considering proposals to spend millions of dollars of opioid settlement money on clinical trials for ibogaine therapy. Federal drug researchers have signaled a willingness to allow the drug to be studied again — more than 40 years after regulators ceased research over concerns about the drug’s cardiac risks. And the drug company Atai Life Sciences is spending millions to research the compound.
“Ibogaine is not a silver bullet, and it won’t work for everybody, but it’s the most powerful addiction interrupter I’ve ever seen,” said Dr. Deborah Mash, a professor of neurology at the University of Miami who began studying ibogaine in the early 1990s.
Ibogaine can induce arrhythmia, which in severe cases can lead to fatal cardiac arrest. William Stoops, a professor of behavioral science at the University of Kentucky who specializes in substance use disorders, said these risks made ibogaine a poor candidate for regulatory consideration.
Even if ibogaine were to receive approval from the U.S. Food and Drug Administration, the tattered health of many long-term opioid users, many of whom have cardiovascular problems, would make them ineligible for treatment, he said. And the high cost of providing ibogaine in a medically supervised setting would further reduce the pool of potential patients, he added.
The U.S. National Institute on Drug Abuse has begun funding studies (that are not trials involving humans) on ibogaine analogues, chemically related compounds that might provide the therapeutic benefits without the health risks.
Some doctors and addiction experts who work with ibogaine say its heart risks can be mitigated. In addition to pre-treatment screening and cardiac monitoring, providers have found that administering magnesium before and during ibogaine treatments effectively addressed the risks.
Dr. Martín Polanco, the medical director of The Mission Within, a clinical program in Mexico that helps veterans with traumatic brain injury, post-traumatic stress and addiction issues, said he had administered ibogaine to more than 1,000 veterans without adverse reactions.
In Brazil, an ibogaine program that largely treats crack addiction has not reported any deaths among patients since it began operating in 1994, said Dr. Bruno Rasmussen, the program’s chief medical officer.
The clinic, in São Paulo state, has treated more than 2,500 people, and Dr. Rasmussen
Cardiac risks beleaguer a promising therapy.
said 72 percent maintained their sobriety years after their initial sessions.
In 2011, Juliana Mulligan, a psychotherapist and former opioid user from New York, suffered a series of cardiac arrests after undergoing treatment at an ibogaine clinic in Guatemala. The clinic, she later found out, had inadvertently given her double the standard dose, which is typically determined by a patient’s body weight.
“When I came to in the hospital, I didn’t care about the near-death experiences because I felt so great and wasn’t in withdrawal,” Ms. Mulligan said. “In fact, one of my first thoughts was, ‘Wow, this is the future of opioid treatment.’ ”
She has not had a craving since. She went on to get a social work degree and has become a consultant for ibogaine-related projects.
Jason Rogers, 44, an electrician in Kentucky, said he had been using heroin for 20 years. He had been on and off methadone for years, but the fear of withdrawal had thwarted any meaningful recovery. Ibogaine, he had heard on the street, would help him through detox, but he does not have the $5,000 that clinics in Mexico charge for the therapy.
“I’d do anything to get clean,” he said. “At this point, I need a miracle.”