New Scientist Originally appearing here.
I have been struggling with an addiction to opiates for the past three years. It started with prescription painkillers and progressed to full-blown heroin dependence.
In an attempt to kick the habit I signed up for a traditional 30-step inpatient treatment that involved individual and group counselling, and which cost about $30,000. That was a year ago, and it didn’t work. I felt unable to stay away from heroin.
Now I am at a small clinic in Baja California, Mexico, where I am taking part in the first trial to investigate the effectiveness of treating heroin addiction with a single dose of ibogaine ” a psychoactive substance derived from the rainforest shrub Tabernanthe iboga.
“Ibogaine can take you many places, causing you to experience a range of emotions, memories and visions. If any of these images become too frightening, just open your eyes.” I am reassured by the words of the director of the clinic, Jeff Israel, but the drug’s history is not all rosy.
Several clinical trials have shown that low doses of ibogaine taken over the course of a few weeks can greatly reduce cravings for heroin and other drugs. There was extensive research on it in the 1990s, with good evidence of safety in animals and a handful of studies in humans. The US National Institute on Drug Abuse invested over $1 million, but then abandoned the project in 1995. A study had shown that at high doses, ibogaine caused some brain cell degeneration in rats. Lower doses similar to those used in human addiction trials showed no such effect, however.
Ibogaine’s mind-altering effects mean that today, the US Drug Enforcement Agency defines it as having a high potential for abuse with no recognised medical use. It is classed as a schedule I drug, the most restrictive legal designation.
But anecdotal accounts suggest that a single treatment is just as effective as multiple low doses. The dose is much higher, although still nowhere near the levels found to cause harm in rats. A single treatment is less expensive than standard addiction therapies, and the intensity of the experience is not a recreational high that users seem to want to repeat.
So the Multidisciplinary Association for Psychedelic Studies (MAPS), a US non-profit research organisation, decided to investigate whether there was any scientific validity to the reports. Legal restrictions in the US severely limit funding for clinical trials of this kind, so the volunteers recruited ” this is where I come in ” were those who had sought treatment independently in Mexico, where there are fewer restrictions on ibogaine use.
“There have been claims by the government that there’s a high potential for abuse and no medical use, and claims from ibogaine advocates that one dose is a miracle cure. We’re trying to gather some scientific evidence to better evaluate it,” says Rick Doblin, executive director of MAPS. A similar study is also being carried out in New Zealand.
At the clinic, I and 29 other heroin addicts get our dose of ibogaine. The treatment costs between $2000 and $6500 depending on which clinic you go to. As it starts to take effect I feel an intense wave of energy emanating from the centre of my chest that permeates my entire body. This euphoric state also brings me instantaneous relief from the discomfort I was feeling after going without heroin for almost 24 hours.
With my withdrawal symptoms completely gone, I am perplexed by the state of clarity I am in while seeing the most profound stream of visual phenomena. I am also filled with a sense of awe at the potential for a life free of heroin. Emotional memories force me to deal with some of the deep subconscious guilt I have repressed for years.
This powerful state persisted for over 12 hours. After remaining at the clinic for a week I was allowed to return home and over the next six months felt almost no cravings whatsoever.
Despite the earlier research, ibogaine’s mechanism of action is still not clear. And the lack of controlled human trials has prevented anyone finding out more. What is known is that the drug affects multiple receptors in the brain. Its ability to lessen cravings may be the result of its blocking of NMDA receptors. Drug-induced craving is linked to increased activity of these receptors and blocking them can inhibit cravings in animals. The long-term relief from withdrawal symptoms probably comes from the fact that ibogaine is sequestered in fat tissue and slowly released into the bloodstream for up to six months.
For the next year, principal investigator Thomas Brown of the University of California, San Diego, and his team kept track of all of us with telephone interviews and regular addiction severity tests, as well as quality-of-life assessments and drug tests. Brain scans were not taken since the dose was assumed safe based on prior human and animal studies.
Brown has not yet completed his analysis, but he says the results appear to show compelling preliminary evidence of ibogaine’s efficacy at a single dose. There has been a decrease in the severity of withdrawal symptoms in all 30 trial participants, he says.
When asked to rate the importance of their treatment on quality of life, both the subjects themselves and their partners stated that it had helped to greatly change their lives. “The main statistically significant improvements are in a consistent reduction in the severity of drug and alcohol use,” says Brown.
People working with addicts are interested. Steven Scanlan, a physician at Palm Beach Outpatient Detox in Boca Raton, Florida, says there are limitations to existing methods of treating addiction. He uses suboxone, a daily medication for opiate detoxification. With this therapy, though, people can often replace one addiction with another. “Every day people are calling asking me to detox them off suboxone, but it’s really the only weapon I have to detox people off opiates,” he says. “I’d be really excited to have something else to be able to use.”
Of the 29 others who took part in the trial, none are now reported as having problematic drug use. Two years after that one dose of ibogaine, I abstain from all drugs. Given the chance of relief from the physical and psychological dependence, I am free to make conscious choices again. We don’t yet know how effective this treatment would be in others, but the change in my life is startling.
New Scientist publishes a detailed report of a participant’s experience in MAPS’ study of ibogaine-assisted therapy as a treatment for addiction. MAPS Founder Rick Doblin elaborates on the purpose of ibogaine research, explaining, “There have been claims by the government that there’s a high potential for abuse and no medical use, and claims from ibogaine advocates that one dose is a miracle cure. We’re trying to gather some scientific evidence to better evaluate it.”