San Diego Union-Tribune (Sunday)
Warning against ibogaine treatment
A Scripps nurse practitioner is urging people who are considering treatment in Baja California with ibogaine, a powerful psychedelic, to be informed about the medical risks, after a few patients have ended up in intensive care on the U.S. side of the border.
“I can speak to you with knowledge on this topic because I have taken care of patients who have undergone ibogaine therapy in Mexico and have ended up in an American ICU,” said Charlotte Thomas, an acute-care nurse practitioner and the chief of advanced practice for critical care at the intensive care unit at Scripps Mercy Hospital in Chula Vista.
The Union-tribune reported in September how ibogaine, a highly potent alkaloid traditionally extracted from the root of a plant native to Gabon in Africa, is being administered in underground clinics in Baja California to treat addiction, trauma and symptoms related to post-traumatic stress disorder. The powerful hallucinogen is illegal in the U.S., and doctors say there is very little scientific knowledge about its side effects.
There are no clinics licensed in Baja California to provide medical treatments with ibogaine, according to Marco Gámez, the director of the Comisión Estatal de Protección contra Riesgos Sanitarios, or COEPRIS, a state health agency. Nonetheless, Baja California has become one of the top locations for ibogaine administration in the world, according to practitioners in Mexico.
Very little data exists about ibogaine’s effectiveness as a treatment for addiction, trauma-related psychological issues and cognitive impairment. Because the drug is illegal in the U.S., it can’t be administered to study its effects.
Practitioners in Mexico claim it is extremely effective in temporarily eliminating opioid withdrawal symptoms, which can be painful and brutal, often preventing patients who want to get sober from doing so. Some mental health professionals who advocate for alternative treatment methods point to the low effectiveness of traditional rehabs and U.S. medical approaches to addressing addiction.
Thomas said going through alcohol withdrawal in a nonmedical setting can be life-threatening.
She added delirium tremens, or DT, is the most dangerous symptom of withdrawal from heavy alcohol use disorder. Delirium tremens symptoms include shaking, confusion, high blood pressure, fever and hallucinations.
“If someone comes into the hospital and goes into DT, even in the hospital, even in the ICU, even with the best medical therapy we can give them, there is a 15 percent mortality,” said Thomas. “And without medical treatment, it has a 35 to 50 percent mortality.”
Thomas pointed out that with ibogaine there have not been any randomized control trials, which is why the drug is not considered a treatment option in the United States. A randomized control trial is a type of scientific study in which the patients receiving the medication are chosen at random from the eligible population and a control group is used. Studies have been done on ibogaine that survey patients after they have used ibogaine, but those surveys may have inherent bias, she said.
“You need to go through rigorous, scientific evidence in order to gain approval” for use, she said. “In theory, it (ibogaine) might have implications in altering the reward pathways, but we practice evidence-based medicine in the United States, so you need a repeatable, reproducible, peer-reviewed randomized control trial to support that.”
Thomas added that ibogaine does not have any mechanism to treat the underlying changed function in an organ that is caused by withdrawal from alcohol or benzodiazepines, a class of drugs that acts as tranquilizers.
She urged people to start with their primary care physician or the SAMHSA (Substance Abuse and Mental Health Services Administration) website for considering options for detox treatments.