Powerful psychedelic gains renewed attention as a treatment for opioid addiction
LOUISVILLE, Ky. — Ibogaine, a formidable hallucinogen made from the root of a shrub native to Central Africa, is not for the timid. It unleashes a harrowing psychedelic trip that can last more than 24 hours, and the drug can cause sudden cardiac arrest and death.
But scientists who have studied ibogaine have reported startling findings. According to a number of small studies, nearly two-thirds of the people who were addicted to opioids and 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 provide two seemingly distinct benefits. It quells the agony of opioid withdrawal and cravings, and then gives patients a born-again-style zeal for sobriety.
Now, after decades in the shadows, and with opioid overdose deaths exceeding 100,000 a year, ibogaine is drawing a surge of fresh interest from researchers who believe it has the potential to 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.”
That’s 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. And federal health officials have signaled a willingness to allow the drug to be studied again — more than 40 years after they pulled the plug on research over concerns about the drug’s cardiac risks.
Drug company Atai Life Sciences is spending millions of dollars to research the compound, and congressional lawmakers from both parties have been pushing the government to promote ibogaine research for substance use, post-traumatic stress disorder and other mental health problems.
For Dr. Deborah Mash, a professor of neurology at the University of Miami who began studying ibogaine in the early 1990s, the soaring interest is a vindication of her belief that the compound could help ameliorate the opioid crisis.
“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,” she said.
Researchers have also been studying ibogaine’s ability to treat other difficult mental health problems. A small study published this year in the journal Nature Medicine found that military veterans with traumatic brain injuries who underwent a single ibogaine therapy session experienced marked improvements in disability, psychiatric symptoms and cognition.
No adverse side effects were reported among the study’s 30 participants, who were followed for a month. There was no control group.
Dr. Nolan Williams, the study’s lead author, said the results were especially notable given the lack of therapeutic options for traumatic brain injuries.
“These are the most dramatic drug effects I’ve ever captured in an observational study,” said Williams, director of the Brain Stimulation Lab at Stanford University.
He and other researchers are quick to acknowledge the limitations of existing science on ibogaine therapy.
“Without a greenlight to conduct studies from the FDA, you just can’t do the kind of randomized trials that are the gold standard for clinical studies,” Williams said, referring to the Food and Drug Administration.
Ibogaine is known to induce arrhythmia — an irregular heartbeat — which in severe cases can lead to fatal cardiac arrest.
Other researchers are more skeptical of its potential as a broadly accessible anti-addiction therapy. William Stoops, a professor of behavioral science at the University of Kentucky who specializes in substance use disorders, said ibogaine’s cardiac risks made it a poor candidate for regulatory consideration.
The National Institute on Drug Abuse, part of the National Institutes of Health, has already begun funding studies on ibogaine analogues, chemically related compounds that might provide the therapeutic benefits without the health risks. The agency’s director, Dr. Nora Volkow, said she had long been intrigued by ibogaine’s anti-addiction potential — and wary of its cardiac risks.
But existing treatments for opioid use disorder, such as methadone and buprenorphine, are imperfect, she noted, and half of all patients stop taking them after six months.
One of the main obstacles to studying ibogaine is its classification as a Schedule 1 drug — a compound with “no currently accepted medical use and a high potential for abuse,” according to the Drug Enforcement Administration.
Many researchers say that categorization is flawed.
“People are not taking it to go to raves or to end up in cuddle puddles,” said Dr. Gul Dolen, a neuroscientist at the Berkeley Center for the Science of Psychedelics at the University of California, Berkeley, who has been studying ibogaine’s effects on the brain. “Most people who do it say they never want to take it again.”
The drug, made from the root bark of Tabernanthe iboga, has long been an integral part of healing and rite-of-passage rituals in Gabon. The renewed interest in ibogaine as a treatment for opioid-use disorder mirrors the trajectory of other psychedelic compounds whose therapeutic promise was embraced by researchers in the 1960s, only to be dashed during President Richard Nixon’s war on drugs.
But in the early 1990s, Mash and other researchers wondered if ibogaine could help address the crack epidemic that was convulsing American cities. The National Institute of Drug Abuse began funding animal studies, and the early results on drug-addicted rodents were so encouraging that the FDA approved human trials.
Mash’s interest in ibogaine’s anti-addictive potential was piqued during a 1993 visit to the Netherlands, where she observed a group of heroin addicts undergoing ibogaine treatment at a hotel. The next morning, three patients gathered for breakfast, which was surprising given that most people in the throes of opioid withdrawal have no interest in eating or socializing. The three men remarked on how well they felt — and said that they had no desire to get high.
“That was the most exciting part,” Mash said. “You could see that ibogaine was allowing them to contemplate life without drugs.”
Throughout that decade, she continued working with ibogaine at a clinic on the Caribbean island of St. Kitts that largely served Americans. But in 1995, when NIDA discontinued ibogaine funding over its heart dangers, Mash was crestfallen. None of the nearly 300 patients treated on St. Kitts had experienced heart problems, she said, in large part because the clinic screened out patients with existing cardiovascular issues and employed electrocardiograms during the treatments.
Other doctors and addiction experts who work with ibogaine say the drug’s heart risks can be effectively mitigated. In addition to pretreatment screening and cardiac monitoring, providers have found that administering magnesium before and during ibogaine treatments effectively addressed the risks.
Dr. Martín Polanco, a psychedelic researcher and the medical director of the Mission Within, a clinical program that helps veterans with traumatic brain injury, PTSD and addiction issues, said he had administered ibogaine to more than 1,000 Special Operations 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, according to Dr. Bruno Rasmussen, the program’s chief medical officer.
The clinic, which operates out of a hospital in Sao Paulo state, has treated more than 2,500 people, and Rasmussen said 72% of all patients maintained their sobriety years after their initial sessions.
Juliana Mulligan, a recovering opioid user from New York, keenly understands ibogaine’s risks. In 2011, she suffered a series of near-fatal arrhythmias 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 the hospital, I didn’t care about the near-death experiences because I felt so great and wasn’t in withdrawal,” Mulligan said. “In fact, one of my first thoughts was, ‘Wow, this is the future of opioid treatment.’ ”
Mulligan went on to get a social work degree and has since become a consultant for those seeking ibogaine therapy.
There are dozens of ibogaine clinics around the world, the majority of them in Mexico, but Mulligan recommends only a handful to clients.
“There are a lot of problematic characters out there, which is why ibogaine needs to be studied, regulated and administered in a medical setting here in the U.S.,” she said.
Those who have taken ibogaine liken the experience to a vivid waking dream, one that leads you on a seemingly methodical review of unpleasant life events, especially traumatic ones.
Blackburn, the recovering addict from Kentucky, recalled watching a disembodied hand yank snippets of unsettling memory from filing cabinets. At one point, she experienced her own funeral through the eyes of her mother.
“It felt like I was battling for my life,” she said.
Scientists are not entirely sure how ibogaine works on the brain. Advanced neuroimaging and other studies suggest it stimulates the growth of new neurons and promotes neuroplasticity, a rewiring of the brain that is a hallmark of psychedelic medicine.
Such growth typically appears in the so-called critical period, when the brain most readily absorbs new information and experiences, peaks during childhood and steadily declines in adulthood.
Dolen said that psychedelics appeared to spur the onset of a new critical period and that the longer the psychedelic experience, the longer the critical period remained open. She said that most likely explained why ibogaine, which prompts the longest psychedelic trip known to researchers, could have such a profound effect on patients with seemingly intractable mental health problems.
Practitioners warn that ibogaine therapy is not for everyone. Rasmussen’s clinic, for example, requires extensive preparation, including abstaining from drugs at least two weeks before the treatment and several weeks of counseling both before and after.
“It’s hard work, and you have to be motivated; otherwise, you won’t experience the benefits,” he said.
In the United States, the renewed interest in ibogaine has largely been fueled by the thousands of Americans who have sought treatment abroad and returned home with tales about overcoming addiction after a single session. The fact that many of them are military veterans has helped ease some of the long-standing institutional resistance to psychedelic medicine.
Since last year, a state commission in Kentucky, created and overseen by the state’s Republican attorney general, has been considering whether to spend $42 million of $800 million in opioid settlement funds on ibogaine research.
On the outskirts of downtown Louisville, Ky., where officials have been grappling with a surge of overdose deaths, there is widespread interest in ibogaine therapy, even if legally sanctioned treatment is years away.
“We’ve got to try something, because we’re desperate,” Henry Lucas, chief operating officer of the Kentucky Harm Reduction Coalition, who is in long-term recovery from opiate dependence, said one recent morning as he drove to a mobile health unit in West Louisville. When he arrived, a half-dozen people had already begun gathering for the protein bars, fentanyl test strips and warm clothing that are distributed for free.
Jason Rogers, 44, an electrician, stood in line, shivering and rail thin. His limbs bore the scars of a 20-year heroin habit that began when he sampled the Lortab painkillers in his grandfather’s medicine chest.
“I started out getting high, but I’m just stuck in this cycle where I’m just chasing my tail,” he said.
Rogers said 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 doesn’t 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.”