How an illegal psychedelic drug could help treat opiate addiction
Pain and ibogaine
Kevin is in the fetal position on a warm bed in Mexico, in the throes of opiate withdrawal. Suddenly, a buzzing noise enters his ear, as if a wasp is building a nest in there. It’s the first sign the ibogaine he just consumed is taking effect, and things are about to get weird.
"This really intense energy slowly began to build in the center of my body and permeated throughout," Kevin tells The Verge, recalling that night. "It extended down to the tips of my toes and up to the crown of my head. While the physical sensation was building up, I had my eyes closed, and I started to feel this upward momentum within my mind." He felt he was being shot up into space. There was a consistent buzzing noise growing louder and louder with each passing moment, until all perception of his body’s location abruptly shattered. Then, he was captured in time and space like a photograph.
The ibogaine was part of his chance to free himself from addiction
Kevin was a 24-year-old with an intense opiate addiction — heroin and OxyContin were his drugs of choice — at the time, and the ibogaine was part of his chance to free himself from the addiction. He tried the standard treatments, like rehab and the prescription drug Suboxone, but they weren’t working for him. He then decided to enroll in a study evaluating the psychedelic substance ibogaine, for use in kicking an opiate addiction.
States across the US are facing opiate epidemics, which often start with prescription drugs, either legally prescribed or illegally bought. (Some people start taking opiates to treat legitimate pain and get addicted; some get pills from friends.) Over 2 million people in the US are addicted to opiates, and addiction is hard to treat. Data from the Centers for Disease Control (CDC) shows there were 16,235 deaths from overdosing on prescription opioids and 8,257 deaths from heroin in 2013.
There's motivation in the medical community to improve addiction treatment — even if it means something kind of far out
Treatment for addiction varies widely, and is not very effective. Addicts may have to go through a supervised detox from the drug, often lasting over a week. Sometimes they are then prescribed a drug, like methadone, to treat withdrawal — but sometimes they are simply put on an abstinence program in a rehab facility. Some facilities in the United States report treatment dropout rates as high as 75 percent; relapse rates for people who go through treatment can be as high as 90 percent. So there’s motivation for the medical community to try to improve addiction treatment, even if it means something kind of far out — like a psychedelic drug.
In fact, ibogaine, which is found in the root bark of some West African plants, isn’t the only psychedelic substance that’s being studied for addiction treatment. Psilocybin (perhaps better known as "magic mushrooms"), for instance, appears to help treat smoking addiction and alcoholism. In a study published last year from John Hopkins University, 12 of 15 longtime smokers were able to quit with the help of the substance. A 2014 study from researchers at the University of New Mexico focused on 10 participants and found drinking can be reduced by up to 50 percent with psilocybin treatment.
Ibogaine became a Schedule I substance in 1970, meaning it is said to have no "currently accepted medical use and a high potential for abuse," and it was batted about as an anti-abuse drug shortly before that. The possibility of using the drug for treating addiction became known a few years before, when a spry 19-year-old heroin addict named Howard Lotsof tried the drug in 1962. He was just looking for another way to get high, but it changed him. "The next thing I knew," he told The New York Times in 1994, "I was straight." He gave it to six other heroin addict friends, and five of them quit heroin immediately. Lotsof advocated for using ibogaine to treat opiate addiction for the rest of his life. He started the Dora Weiner Foundation to educate people on the drug and push for studies around the world, and he was successful at getting trials started in the Netherlands.
Ibogaine is illegal; that's slowed the research process
But ibogaine is illegal, and that’s slowed research progress. Certain underground trials that were done by various unaffiliated researchers in the US in the 1970s led to deaths. But Lotsof did get the National Institute on Drug Abuse to research ibogaine, and he received approval for an FDA clinical trial. Unfortunately for Lotsof, the study was never done, due to a lack of funding.
Actually, ibogaine research isn’t without encouragement in the mainstream. Mark Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD), believes there could be a place for ibogaine in opiate addiction treatment. Since opiate addictions are so difficult to treat, doctors are desperate for anything that might work. "It’s not a widely used medication, but the general view is that if it has some helpful approach for some people who don’t want to be using one of the three federally approved medications, that’s great," he tells The Verge. Kevin is one of those people.
Around 2009, while Kevin was finishing college, he started casually taking pills like Percocet, Roxycodones, and OxyContin. A year later, he was cutting up pills and snorting them. Kevin’s addiction became bad enough that he dropped out of his undergraduate program Northeastern University. (He returned to school and did eventually graduate, in 2013.) By June 2010, he was doing heroin. "I was just shooting speed balls and kind of entering a psychotic state," he said. He eventually ended up getting arrested while shoplifting. He decided to go to rehab for 30 days, followed by some 12-step meetings. He began using heroin again shortly after he was released.
For about a year, he didn’t have a job — he just did drugs. Eventually, his mother convinced him to look into experimental ibogaine treatments. So Kevin went to Southern California and met with Thomas Brown, the leader of the ibogaine study, in the summer of 2011.
Thirty people were enrolled in the study, and 12 made it to the end a year later, says Brown, who’s a research coordinator at the University of California–San Diego. That’s a high drop-out rate, in part because many patients lost contact with researchers once treatment was over. Preliminary data shows most people will relapse. Brown argues that may be because the treatment didn’t include any mandatory aftercare, like therapy or a halfway house. This kind of support is important for addicts, because it’s easy for them to fall back into old habits without direct support in the first few months after treatment. Most patients only stayed at the clinic about a week after the study treatment, and were clean for that time — and for at least a week after.
Preliminary data shows most people will relapse
"It does interrupt the addiction for people," Brown says. But Brown isn’t presenting ibogaine as a cure for addiction. (The results suggest that ibogaine alone isn't enough, anyway.) Rather, he thinks it gives patients a separation from toxic mental patterns and lessens withdrawal — which might allow conventional treatments to work better.
Kevin’s treatment began with an intake interview with Brown, followed by some EKGs and other tests. Around 10PM he received the ibogaine — three doses in a pill form, spaced a few minutes apart. The Multidisciplinary Association for Psychedelic Studies, which sponsored the trial did not provide the drugs; they are managed by the Pangea Biomedics ibogaine clinic in Baja California, Mexico.The researchers observed the treatment in the clinic.
Kevin was supposed to wait until he had hit the peak of his opiate withdrawal, an evaluation he was to make, to start the treatment, but he was too eager and started before that. "It didn’t entirely bring me through the withdrawal, but I don’t blame the medicine for that," he says. "I blame myself for rushing the treatment." After a long night on the drug, he went through a tough phase of the withdrawal the next day. But ibogaine let him put the withdrawal in context: he could change his life if he stayed off drugs. He followed his study treatment with a 12-step program and has been opiate-free ever since he was dosed, in 2011.
Because addiction is varied, it's hard to say what people will respond best to — for some, the best approach may be methodone, Suboxone, or just abstinence
Parrino, the AATOD president, says that because addiction is varied, it’s hard to say what people will respond best to — for some people, the best approach may be methadone, Suboxone, or abstinence. "There’s no single treatment that works for everybody," he says. Ibogaine could be added to this repertoire — but he wants to see more studies.
In addition to the US ibogaine study, an identical one, using the same procedure, was conducted in New Zealand. (It was also sponsored by MAPS.) That study included 14 patients, and three dropped out before it was finished. Both research groups will submit their results to scientific journals in the coming months. Dr. Geoff Noller, of the New Zealand study, says the preliminary results show the majority of their 11 patients stayed off opiates for a year after one ibogaine treatment. (There are some differences between the trials, most obviously in participants: 70 percent of Noller’s patients were addicted to methadone, which is an opiate that’s more commonly abused in New Zealand.)
At this point, it’s unlikely swaths of addicts will be flocking to places like Mexico to do psychotropic drugs like ibogaine, but ibogaine may hold potential. And what happens after the drug's administered may play a crucial role, the experts agree. Take Kevin: in addition to his 12-step program, he says he’s avoided situations where he would be around opiates, and he hasn’t had many urges to do them again. But he also describes the ibogaine treatment as crucial for his recovery. "Without it I don’t know how I ever would have stopped," he says.
Correction: This article originally stated that ibogaine was made a Schedule I substance in 1968. In fact, it was 1970. We regret the error.