Art courtesy of Adam Hale
How an Illegal Psychedelic Is Treating Opioid Addiction
In November, the United States Centers for Disease Control and Prevention reported that drug overdose deaths reached an all-time high in 2017, killing over 70,000 Americans. That figure includes almost 15,000 deaths from heroin and 28,000 from fentanyl (synthetic opioids) and related drugs (a 45 percent increase over the previous year). Natural and semisynthetic opioids, like oxycodone and hydrocodone, accounted for nearly 15,000 deaths. The opioid crisis was officially declared a national public health emergency in October 2017, but even with all hands on deck, conventional treatment options are limited and often unsuccessful. Most users relapse within a year of treatment. And complicating matters even more: The treatment that might have the highest potential for success is currently illegal in the US.
Ibogaine is a psychedelic compound derived from the bark of a shrub native to western central Africa. It seems to act as an addiction disruptor, blocking the acute symptoms of opioid withdrawal and giving patients a window of opportunity to rebuild a healthier life. (We first learned about ibogaine from a 2016 interview with researcher Dr. Deborah Mash.) Although current research suggests that ibogaine treatment for opioid addiction and withdrawal has a success rate up to 90 percent, ibogaine is listed as a Schedule I drug in the US, meaning it is considered illicit and has no formally accepted medical value. However, because it is unregulated in most other countries, people seeking treatment with ibogaine can find clinics across borders—often in Canada or Mexico.
Anthropologist Thomas Kingsley Brown, PhD, is a researcher with the Multidisciplinary Association for Psychedelic Studies (MAPS), a nonprofit psychedelic research and education group. Brown has been visiting these clinics since 2009, when he started interviewing patients who had undergone ibogaine treatment for opioid addiction. While other scientists focused on the numbers (success rates, number of opioid-free days), Brown recorded patient experiences: their addiction stories, their ibogaine trip, and their lives after treatment. These interviews bring to life not only the pain and despair of opioid addiction but also accounts of hope and second chances.
A Q&A with Thomas Kingsley Brown, PhD
There was a clear pattern, even within the small group of ten or twelve people I interviewed. I think it really was exemplified by the first person I interviewed. Her name was Sandi Hartman, and she passed away in 2014. But in 2009, when I first met her, she had just been treated about a month before at an ibogaine clinic.
Sandi bought the treatment as a present to herself for her sixtieth birthday. She had been living in Tennessee, where she had owned a farm that she sold in order to get treatment. She took her dog Yuppi, drove across the country, down through San Diego, and across the border into Mexico. Sandi had been addicted to opioids for about twelve years from the age of forty-eight, when she was in an auto accident and was prescribed opioids to manage her pain.
No one told Sandi that she could become addicted to these drugs, and no one followed up to see if she was able to stop using them when they were no longer needed. So she unwittingly became addicted to things like oxycodone and, for many years, suffered from really poor nutrition. She told me that she was eating nothing but gummy bears all day. She would prepare food for her dog, but she couldn’t take care of herself.
Sandi tried twice to stop on her own, but she couldn’t tolerate the withdrawal symptoms. So when she was sixty, she came out to Baja California and got these treatments. It completely turned her life around. She was able to stop using the opioids, and she told me that if I had seen her a few weeks before, I would have seen her in a much different state. Her health had been so poor that she could barely walk up a flight of stairs without totally exhausting herself.
But she was in much better shape by the time I saw her—even just a few weeks later. Sandi went to another place for aftercare where there were other people who had also received ibogaine treatment. And she recognized that it was really important for people to talk about their experiences with one another and to have support. She then went on to start her own aftercare center where, eventually, she also started treating people with ibogaine. Almost all the people I’ve talked to who run clinics got into it that way.
Sandi told me something I ended up hearing over and over, which was that she felt that the opioids were killing her. She described it as a slow suicide. I regularly heard things like “If this ibogaine treatment doesn’t work, I’m probably going to kill myself.” And then after treatment, people are completely different. They’re optimistic; they’re energetic; they’re looking forward to the next chapter in their life.
Most people who seek ibogaine treatment find out about it because they’re searching for something that will help. In the study that I did at two clinics in Mexico, patients had had an average of three other treatments before they came to the ibogaine clinic. Usually opioid replacement therapy, like methadone or suboxone, but also residential treatments or detox programs.
A lot of people stumble upon this online. Conventional treatments haven’t worked, they’re looking for something else, and they find this ibogaine thing they don’t know anything about. And there are online discussion groups and talk about treatment centers. People will immediately find all sorts of conflicting information, and they don’t know if they can trust it or not. It can be really hard to find something you can be sure about.
It’s very important to use a trustworthy clinic. Some people order ibogaine online out of desperation, but I don’t recommend that at all, because you really don’t know what you’re getting. And even more importantly, you need to have someone there to monitor you, and you should have an EKG and other medical tests done before you undergo any ibogaine treatment.
There are many good treatment centers, but there are also a lot of ones that don’t take the precautions that they should. False claims on their website, things like that. It pays to be careful here. I suggest people refer to the Global Ibogaine Therapy Alliance (GITA), where they have a manual called “Clinical Guidelines for Ibogaine-Assisted Detoxification.”
There are certainly similarities to other psychedelics, like psilocybin and LSD. But you would find a lot more similarity between the experiences on those substances—psilocybin and LSD—than you would comparing them with ibogaine. So even though ibogaine is in the same general category of a tryptamine psychedelic, it’s not a hallucinogen in the same way. Things in your visual field don’t morph. You close your eyes and have these dreamlike visions, but when you open your eyes, they stop. And it’s a lot longer-lasting. The experiences are twenty-four to twenty-six hours. It’s very difficult physically and emotionally. People will get to the end of it and they’ll just think, I don’t ever want to do this again. This is great, but that was it.
The pharmacology of ibogaine is pretty well known now—what receptors it hits, the effects in the brain. We have good knowledge of these things, and we may eventually understand ibogaine’s role in stopping withdrawal symptoms and reducing cravings. We know that. What’s more difficult to understand is the role of the psychedelic experience, which I believe has an important impact on long-term outcomes.
My main reason for thinking the trip is important is simply because that’s what patients tell me. If you look at the reports, where we asked people to write about their experiences with ibogaine, they say they have profound experiences that affect their relationships, their addiction, and other parts of their lives. They realize they have a lot of regrets, and they come out with a different understanding of their lives. That’s true across the board. It’s not just a epiphenomenon of the treatment.
Addiction treatment research with psilocybin, ketamine, and other psychedelics has shown that the psychological experience is important for treatment outcomes. It would logically bear out that the same would be true for ibogaine, but we’re still collecting evidence.
Ibogaine research now and in the near future is looking at the impact of what’s called aftercare, or integration. That means specifically working with psychotherapists or other experts to maintain and amplify the value of the psychedelic experience post-treatment. There’s a window of opportunity. Patients stop using the opioids for at least a couple of days because of the addiction interruption effect, and it’s important to use that time period carefully in order to extend the benefits of treatment and keep them off of the drugs.
Yes. In one study of thirty people, we used something called the Subjective Opioid Withdrawal Scale before and after ibogaine treatment. It measured the severity of patients’ withdrawal symptoms after they stopped using opioids. What the data showed was that for twenty-seven of the patients, withdrawal symptoms were reduced dramatically following treatment. But three of them actually got worse. They had the withdrawal symptoms you’d expect from people who just stopped taking opioids and didn’t have treatment at all. For some people, it doesn’t work. It might come down to differences in individual biology.
The other thing to look at, other than acute withdrawal symptoms, is whether patients actually stop using opioids, reduce their opioid use, or see other life improvements as a result of ibogaine treatment. Again, we have evidence that it makes a difference for most people, but not everybody.
I think that the numbers can be improved if there’s some concerted effort toward following up with people. In our study, for the most part, people were coming to a clinic in Mexico from the US, and they would be at the clinic for maybe a week. Possibly a couple of weeks. And then they would go back home. And there was no follow-up with them other than my doing this research study, and I was just calling them to see how they were doing.
Ideally, you’d have addiction counseling, maybe some group therapy—other things that would help people manage if they did have problems afterward. And most people are going to have some difficulties. Even if they stopped using opioids for weeks or months after treatment with ibogaine, they still might have to deal with the underlying root causes of their addiction. And that might be something that comes up a couple of months after treatment.
There are cases in which people have died shortly after their treatment. In 2012, Dr. Ken Alper wrote what is still the best article on the topic. At the time it was written, there had been nineteen fatalities following ibogaine treatment. Alper talks about the primary reasons why they occur, including preexisting heart conditions or opioid consumption during or right after treatment.
One of the dangerous things about ibogaine is that it acts as a “reset” for your brain, so if you were to use opioids for pain management after you’d had ibogaine, you would need to use a lot less than you had been using before ibogaine treatment. If you decide to take the same amount you were taking before treatment, whether it’s Oxycontin or heroin or something else, it could be fatal. You’re no longer habituated, and the lethal dose becomes a lot smaller.
That’s well-known at this point, but the risk of death has created a lot of caution against ibogaine within the medical community.
Phase 3 clinical trials are very, very expensive. MAPS, the non-profit organization doing phase 3 clinical trials for MDMA and PTSD, is spending $26.7 million for that project. Down the road, hopefully that’ll be the case for ibogaine as well.
Yeah, absolutely. People can contribute to research funding through MAPS. And if you are really interested in having those funds go to ibogaine research, then you can request that specifically.
RELATED READING AND RESOURCES
About the opioid crisis:
HEAL Initiative, National Institutes of Health
“Drug Overdose Deaths in the United States, 1999–2017” (National Center for Health Statistics, 2018)
“Short Answers to Hard Questions About the Opioid Crisis” by Josh Katz (New York Times, 2017)
“The Family that Built an Empire of Pain” by Patrick Radden Keefe (The New Yorker, 2017)
Dreamland: The True Tale of America’s Opiate Epidemic by Sam Quinones
“I’m Not a Doctor but I Play One at The Holiday Inn” by Trey Kay and Lu Olkowski (This American Life, 2006)
“A Psychedelic Can Cure Heroin Withdrawal” by Jessa Gamble (The Atlantic, 2016)
“Treating Addiction with Psychedelics” by Roni Jacobson (Scientific American, 2017)
“Ibogaine: One Man’s Journey to Mexico for Psychedelic Addiction Treatment” by Deborah Becker (WBUR, 2018)
Alper, K. R., Lotsof, H. S., & Kaplan, C. D. (2008). The ibogaine medical subculture. Journal of ethnopharmacology, 115(1), 9-24.
Brown, T. K. (2013). Ibogaine in the treatment of substance dependence. Current drug abuse reviews, 6(1), 3-16.
Brown, T. K., & Alper, K. (2018). Treatment of opioid use disorder with ibogaine: detoxification and drug use outcomes. The American journal of drug and alcohol abuse, 44(1), 24-36.
Glick, S. D., Rossman, K., Steindorf, S., Maisonneuve, I. M., & Carlson, J. N. (1991) Effects and aftereffects of ibogaine on morphine self-administration in rats. European Journal of Pharmacology, 195(3), 341-345.
Mash, D. C., Kovera, C. A., Pablo, J., Tyndale, R. F., Ervin, F. D., Williams, I. C., … & Mayor, M. (2000). Ibogaine: complex pharmacokinetics, concerns for safety, and preliminary efficacy measures. Annals of the New York Academy of Sciences, 914(1), 394-401.
Noller, G. E., Frampton, C. M., & Yazar-Klosinski, B. (2018). Ibogaine treatment outcomes for opioid dependence from a twelve-month follow-up observational study. The American journal of drug and alcohol abuse, 44(1), 37-46.
Thomas Kingsley Brown, PhD, is a researcher with the Multidisciplinary Association for Psychedelic Studies, primarily focused on ibogaine treatment for opioid use disorder. Brown holds an MS in chemistry from the California Institute of Technology as well as an MA and a PhD in anthropology from the University of California, San Diego. In addition to his work in ibogaine research, he is the coordinator for UCSD’s McNair Scholars Program for first-generation college students.
This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.