With the rise in interest of various psychedelic drugs for a range of conditions (MDMA for PTSD, and ketamine and psilocybin mushrooms for treatment-resistant depression, to name a few), it seems only fair that we should pay serious attention to other substances in this family that might treat other conditions.
Introducing ibogaine. Well, not quite introducing. The fairly-obscure African plant, used traditionally in Gabon, was first patented in the United States for use in treating opioid addiction in 1985. Unlike common street drugs such as MDMA (“ecstasy,” “molly”), ibogaine does not have the reputation of being known as a club drug.
Like Years of Therapy in One Day
But Ibogaine is still relatively unknown, despite a guest appearance in an early episode of Homeland. When I have advocated for its use in combating our nation’s opioid crisis, most of the responses range from a confused “What?” to an inquisitive “Oh, yeah. I’ve heard of that.” It isn’t a cheap thrill, something folks are clamoring to ingest. People who have found relief with the African root-bark have compared it to receiving years of therapy in the course of one day. The induced vivid hallucinations and memories of childhood and formative experiences seem to facilitate the process of overcoming addictions, even if it isn’t an automatic or guaranteed cure.
However, that doesn’t mean it’s free of stigma. The federal government classifies it as schedule one – right up there with heroin, the addiction it is most well-known for treating, despite having “no medical use” according to the law. Statistics vary, with some rates as low as 20 percent. Other data shows 61% abstinence, eight months after treatment.
So, what’s the issue? If this plant boasts a higher success rate than Suboxone (8.6%, once Suboxone use is discontinued), why is it only available outside the U.S.? Why are we not allowing a treatment method that people with opioid use disorder have touted as the thing that saved their lives?
Why Is Ibogaine Illegal in the U.S.?
Some of the fault lies with the media. Much like with LSD, clinical studies are slow and evolution of public consciousness is slower. Most of what we see in the news is negative and exaggerated. As with anything, there are risks. Up to 30 deaths have been documented. When people with other health problems related to addiction are treated by those without medical training, death rates can be as high as three percent. In healthy folks, that same rate is around .3%.
But when much of what you see in the news and on television is people panicking, convulsing, or dying, it’s tough to form a well-rounded opinion. We are emotional creatures, and even with positive perspectives from people who swear by their experiences, we can’t get the negative images out of our minds for long enough to consider the benefits of ibogaine treatment.
Many of the risks involve heart issues. Most psychedelics function as stimulants, raising the heart rate, but ibogaine can be especially cardiotoxic. Ibogaine affects electricity in the heart and could potentially result in dangerous arrhythmias or bradycardia (low heart rate). Because of this and any other possible risks, legitimate clinics pre-screen patients and offer a small test dose to evaluate the effects. Based on the results, they decide if a full dose will be safely tolerated.
Like Other Hallucinogenics, Proven Benefits but Not a Panacea
The substance seems to work due to the uniqueness of the experience. I’ve read multiple accounts of people having vivid visions of the choices they made, and how they’ve arrived at this particular point in their life. This type of experience seems to be the key to its effectiveness in treating severe opioid and alcohol addictions, but experts don’t fully understand its mechanisms.
And yet, even with its proven benefits, it’s not a panacea. The person with the addiction cannot just visit a clinic, have an ibogaine experience, and expect to return home without changing anything. There is still a rate of relapse, because they haven’t worked on the external triggers. They must still tackle their disease in a proactive way, which may include altering their life and addressing what led to using in the first place.
Unlike commonly-used routes of getting off opioids – substitution medications such as methadone and Suboxone – ibogaine doesn’t require a patient to remain on another drug, taking it day in and day out to avoid experiencing cravings or going into withdrawal. Ibogaine seems to work by disrupting the receptors associated with addictive behaviors, as was witnessed in one 2015 study on its efficacy in opioid addiction.
Scientists found that the substance (which, I learned, doesn’t always produce the talked-about hallucinogenic effects that led to its illegal status) acts on receptors such as dopamine and serotonin, which are linked to addiction and the brain’s reward system. Other psychedelics that are currently being studied for their effects on mental illness and addiction – such as MDMA and psilocybin mushrooms – make use of these same receptors. What makes ibogaine unique is that, rather than attaching to receptors on the outside of a cell membrane, it attaches to the inside. This mechanism seems to be unique to ibogaine; it has not been observed in any other naturally occurring molecule.
Legal Status of Treatment Creates Financial Barrier and Increased Risk
A major barrier to receiving an ibogaine treatment is the prohibitive cost. A single week of treatment in Mexico costs $5,000, and that’s after the price of a plane ticket. In Canada, the price for a ten-day round is $8,000. As a result, it’s not an option that’s available to most people in need of addiction treatment.
We must legalize it here. International travel, necessary funds, time off from your job to recover – all these restrictions make it virtually impossible for the average person with treatment-resistant addiction to crack the barriers of that final, desperate chance at a life beyond drugs or alcohol.
There is a strong, tight-knit movement of psychedelic therapists, but due to the criminalized status of what should be viewed as medicine, those involved with administering these substances remain underground, increasing risks. Even though many of these practitioners are medical doctors, they work without the support of a hospital or facility. While their willingness to practice this medicine outside of the law is a testament to their belief in its efficacy, it also means they are less able to quickly and safely address problems that may come up.
Who knows what the genuine death toll of ibogaine is in the U.S.? It’s not likely that underground doctors are reporting these deaths to nurses and other hospital staff. If so, they’d be discovered, in turn ruining their careers and possibly derailing the entire growing movement. At least, that’s what instinct tells me. If nothing else, with the substance legalized, fewer deaths and injuries would occur due to more rigorous testing and administering – and consequently fewer accidents would happen as well.
Ibogaine has shown lasting benefits in treating addiction, as many people attest. One patient was quoted as saying: “It’s not just [that] it gets you off the heroin, it’s like, it hits the reset button — that’s the only way to really explain it. It’s like a new brain.” Shouldn’t we be listening to the voices of people who have actually been there, rather than tossing their words to the wind and sticking with what hasn’t worked?
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