We Need To Have a Serious Talk

The fight against opioid addiction is a constant in modern society. I know personally, as they killed my little brother. In fact, his tragic loss is the reason I work in both cannabis and psychedelics.

Today, despite numerous conventional treatments being available, many patients still struggle to find an effective solution to overcome their dependency. What's more, thousands of them never succeed: in 2021, over 106,000 people died from overdoses caused by opioid abuse in the United States.

So, why does our society pose such resistance to the use of psychedelics that could provide a revolutionary option in the treatment of addictions?

This is the case with ibogaine, a substance extracted from the iboga plant. Studies, like this one from the NIH, show that it is effective in reducing cravings and withdrawal symptoms, being an important ally for patients to break the cycle of dependence. Due to the social harm that dependency represents, we cannot continue to turn a blind eye to treatments with such potential. That's why we need to talk about ibogaine.

Ibogaine To Treat Addiction

Researchers have studied the usefulness of ibogaine in treating addictions for more than 50 years. It all started in 1962 when Howard Lotsof accidentally discovered the anti-addictive effects of ibogaine. After taking it, he stopped using heroin without experiencing withdrawal symptoms. Of the six friends who took ibogaine with him that night, also dependent on heroin, only one relapsed.

It's not difficult to understand why Lotsof pursued a research career around the substance after that. His works include some case studies from the 1980s and 1990s, which reported most patients were detoxified after ibogaine therapy.

Individuals like Boaz Wachtel, who co-authored a paper with Lotsof, started treating addiction using ibogaine in the early '90s. "We've been using [Ibogaine] for the last 20 years to treat addiction," he said in a 2008 interview. "[Ibogaine] allows you to deal with the traumas in a very constructive way; it's like a psychiatric catharsis."

Various other studies have confirmed the anti-addictive effects of ibogaine. A 2017 study by John Hopkins'Alan Davis observed that 80% of patients treated with it succeeded in eradicating or drastically reducing withdrawal syndrome. Another report showed that most participants had no signs of withdrawal syndrome or cravings. Both effects are essential to get people out of the addiction cycle.

In 2020, ICEERS began a phase 2 clinical trial to explore the potential of ibogaine for the treatment of opioid addiction; completion is expected in 2023. The work in question addresses the risks of ibogaine ingestion and highlights the importance of doing the treatments within a legal framework, in hospital contexts and under the supervision of healthcare professionals. That recommendation helps us understand the resistance we see against ibogaine treatments, even between doctors.

Cause or Association? Risk or Recklessness?

Ibogaine ingestion can sometimes lead to changes in heart rhythm through QT interval prolongation — the time between heartbeats. Studies show that, depending on the dose, personal characteristics and combinations with other drugs, these alterations can be dangerous. In fact, there are some reports of deaths associated with ibogaine consumption.

This is why outlets like Time and Wired have published reports on ibogaine, treating it as both a promising drug and a kind of "death drug." These reports helped crystallize the idea that ibogaine carries a great risk of fatality.

However, their reports may miss part of the picture that science provides. In 2012, Kenneth Alper published a study where he looked into deaths associated with ibogaine. The work revealed that people who died had taken the substance with other drugs, like cocaine, alcohol and opioids — in some cases at the same time or on the same day. It is known that these substances also cause QT interval prolongation and therefore should never be mixed with ibogaine.

Additionally, Alper observed that none of the fatalities involved the use of ibogaine under medical supervision and in appropriate settings and that some of the people had comorbidities that represented objective contraindications for the use of the substance.

In other words, deaths commonly attributed to ibogaine were actually associated with the use of the substance, but not necessarily caused by it. The evidence indicates that these fatalities were actually caused by improper use.

The WHO estimates 1.3 million people die in traffic accidents yearly. Indeed, cars are potentially dangerous. To mitigate the risk, people need a driver's license and comply with traffic laws. But you don't really see people advocating to end the use of cars because of these fatalities.

Similarly, if ibogaine is used following protocols, with proper medical supervision in a hospital setting, there is a high likelihood for its use to be safe.

In November, I had the opportunity to meet one of the most experienced doctors in treating dependence with ibogaine, Dr. Bruno Rasmussen. Since 1994, he's performed more than 2,500 treatments with the substance and claims to have never had a serious incident. Nowadays, he leads Clínicas Beneva in Brazil, where laws allow ibogaine procedures.

"Ibogaine is a powerful tool for treating dependence, but it is not for everyone and must be used properly. First, an extensive clinical and psychiatric evaluation is necessary to identify possible comorbidities and contraindications," the doctor said on a podcast. "It is also essential to eliminate risky drug interactions. Stimulant users need to be clean at least 30 days before ibogaine therapy."

And he adds: "Any adverse effects that may arise are easily controlled when we have the patient monitored properly in the hospital." But of course, this is only possible because Brazil allows him to do that legally.

And here, I return to the main thesis: We need to talk about ibogaine and how to regulate it to fight against the opioid epidemic affecting the U.S. To some doctors, the research currently available provides enough to explore treatment regimens, and the option to utilize ibogaine as part of their treatment of opioid addiction can be part of confronting the issue across the U.S. I believe we must follow the example of what is being done in Colorado and Oregon regarding psychedelics. We cannot afford to ignore this alternative while thousands of Americans keep dying each year because of addiction.

Uncommon Knowledge

Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.

Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.

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