October 30, 2007
The Quest for the Ultimate Cure for Addiction
By: Alex Roslin
The Georgia Straight
Canada's largest urban weekly, The Georgia Straight, published a feature article about the MAPS-sponsored observational case study in British Columbia evaluating ibogaine treatment in subjects with opiate dependence. The article includes some interesting personal anecdotes and analysis from MAPS President Rick Doblin, PhD, as well as a discussion of MAPS' FDA Phase II research evaluating MDMA-, LSD-, and psyilocybin-assisted psychotherapy.
The quest for the ultimate cure for addiction
By Alex Roslin
Published on October 25, 2007
In the The Georgia Straight
Could the root of an African shrub hold the key to getting millions of addicts off heroin, coke, and crack – oh, yeah, and cure alcoholism in its spare time? Can a single dose of an extract from the mysterious shrub’s root bark be worth years on a therapist’s couch?
Some of the answers may soon be found in a three-bedroom house on the Sunshine Coast. Tucked away there on a hill, with a stunning view of the ocean and surrounded by tall trees, is the Iboga Therapy House.
Forty years after globetrotting backpackers introduced a substance called ibogaine into the U.S. drug culture, the extract from western Africa’s Tabernanthe iboga shrub has become an underground rage among drug-addled Hollywood celebs willing to plunk down between $3,500 and $10,000 for ibogaine treatment at any one of about a dozen unregulated clinics worldwide, including the one in B.C.
Because ibogaine is illegal in the U.S. – one of just three countries to ban the substance, along with Belgium and Switzerland – clients have to travel to clinics in countries such as Canada, Mexico, Costa Rica, and Slovenia for an “ibogaine experience”.
Advocates liken the miracle drug – which can unleash a reality-shattering trip so powerful it has been described as “dying and going to hell 1,000 times” – to the Holy Grail of addiction cures, comparable in importance to the discovery of penicillin. Although ibogaine’s alleged ability to quickly cure opiate addiction without withdrawal symptoms was discovered relatively recently, the substance has long been used in Gabon by hunters to stay alert and, in larger doses, in week-long sacred ceremonies in the Bwiti religion.
Yet despite the extraordinary claims about ibogaine’s powers, a B.C. study launched last February is the first time the drug’s therapeutic benefits for opiate addiction are being measured systematically in a public investigation. (Other clinics haven’t released data.)
Preliminary results from the Sunshine Coast clinic have justified much of the hype. “I’ve witnessed people’s lives being turned around,” said Leah Martin, one of the study leaders. Of 20 pre-study clients who took ibogaine at the facility in 2004, 13 were found to be abstaining when evaluated later, after an average interval of six months. The abstainers included six out of seven cocaine or crack addicts, three of eight opiate addicts and four of five people with other addictions, including to meth and multiple substances.
With an overall abstinence rate of 65 percent, ibogaine does way better than the 10-percent average of conventional drug-treatment programs, Martin said. What’s more, the clients at the B.C. facility are usually the hardest cases.
“People who contact the Iboga Therapy House have already done every type of program in their city and are scouring the Internet [for help]. They’ve been in detox multiple times and are highly resistant to other therapy. They say, ‘This is my last hope,’” she said.
Ibogaine works in two ways. It eliminates cravings for heroin and other drugs in many people, but it also often works at a deeper level, getting them to revisit life experiences–good and bad–and helping many find ways to heal and ensure cravings don’t come back. Scientists say it’s like hitting a reset button for your brain. Traces of the drug remain in the body for up to six months, continuing to ward off addictive urges in unknown ways. “It truly is its own category [of drug],” Martin said. “Right after, it’s common for people to say, ‘Whoa, what was that?’ But a month later, people might wake up and remember something and be able to move forward.”
Ibogaine appears to work on “every neurotransmitter system we know about”, Kenneth Alper, a psychiatry professor at New York University School of Medicine, told the Journal of the American Medical Association in a 2002 story on ibogaine. Alper, who is also a co-investigator in the B.C. study, has called the use of ibogaine “one of the biggest paradigm shifts regarding treatment for addiction in the span of my career”.
In a testimonial on the Iboga Therapy House’s Web site, one client says of the trip: “I pretty much died to my old self. I yelled, I kicked, I screamed (inside myself) but this new knowledge is too powerful to ignore.” Says another: “I believe Iboga brings you into and through the land of the dead, to the land of the Gods.”
The Georgia Straight connected with Martin early one morning near the end of her 8 p.m.-to-8 a.m. shift as a program worker at a Downtown Eastside residential detox centre run by the Portland Hotel Community Services Society. She spoke about her own ibogaine trip: “I felt as a facilitator I should know what it was like, to be able to relate.”
An ibogaine experience usually lasts 24 to 36 hours, most of which is, typically, spent on your back because of impaired muscle coordination and perception. The first four hours usually involve plenty of vomiting, coupled with hallucinations and strange physical sensations. This isn’t a drug for clubland.
Next is eight hours of what Martin called the “cognitive phase: the beginning stages of insights. You’re remembering things or events. It tells a very interesting story of yourself and your life.”
The intense visions are dreamlike, Martin said, but “if you find yourself in a vision you don’t like, you can just open your eyes. There is a lot of randomness along with insights. It truly was a reflection of my mind and the things I obsess about. I laughed at myself a lot, realizing how ridiculous people can be.”
This is the phase that can give people with addictions deep new insights into their troubles. “If you had trauma, people can relive that. After they’re traumatized, sometimes they shut themselves off from the pain, and that’s why they adopt certain habits. But to be able to see it in a healing way [with ibogaine] can be beneficial.”
Then comes another 12 to 24 hours of “residual stimulation” as the person keeps dreaming but slowly comes down, often falling asleep.
Advocates say the drug isn’t addictive itself partly because the trip is so hellacious. “It is not a recreational drug,” said Rick Doblin, president of the California-based Multidisciplinary Association of Psychedelic Studies, which is helping to fund the Iboga Therapy House study. Doblin is also the principal investigator.
The ibogaine work is just one of MAPS’s stable of groundbreaking research projects. The group is also funding the first-ever studies of therapy involving ecstasy, LSD, and magic mushrooms to deal with mental-health issues like posttraumatic stress, end-of-life anxiety, and obsessive-compulsive disorder. The U.S. studies all have an official okay from the U.S. Food and Drug Administration and even of the drug warriors at the Drug Enforcement Agency, and are attracting interest from the U.S. military for treating PTSD among Iraq vets.
Early results show ecstasy is not only safe for therapeutic purposes, but it can also help people who don’t respond to conventional therapy or treatment with the pharmaceutical drugs normally given for posttraumatic stress: Zoloft and Paxil. Doblin described the ecstasy results as “dramatic”–far better than those from the standard treatments.
The work has still met ferocious resistance from the DEA, however. MAPS is battling the agency in court to get permission for scientists to grow marijuana in order to study its use for pain relief, control of nausea, and other medical purposes. Last February, a judge ruled in MAPS’s favour, but the DEA has filed a series of objections, citing security concerns and likening Doblin to Colombian drug lord Pablo Escobar.
Speaking over the phone from his home in Boston, Doblin said he owes much of his doggedness and success to his own ibogaine trip in 1985, a year before he founded MAPS. “I feel it’s been a major contributor to what I’ve been able to accomplish,” he said, describing the experience as “lasting, powerful and very positive, although at the time it was horrendous”.
Back then, already active in drug-policy reform, he said he suffered from a neurosis common to many activists–“a certain arrogance, that we know the better world”. An underground therapist suggested ibogaine could help him grow personally and become a more effective activist.
Doblin took it one morning at the oceanfront house of a therapist, who stayed at his side. He lay in bed with his eyes closed all day, vomiting constantly, coughing and feeling like he was choking. The barf brought out complex emotions: “a line between self-criticism, self-perception, and self-hatred”. He started to blame his intense nausea on his inability to just chill out and unwind. “I thought this was all my doing–that I couldn’t relax. If only I was better, I could be a better tripper,” he said. Then came realization: here was a metaphor for his struggles with his arrogance. “I was crucified on the cross of my own self-perfectionism,” he said, laughing.
Twelve hours later, the stars came out, his guts relaxed, the upchucking stopped and everything got good. “I had one of the most blissful nights of my life. It felt like transcendence through exhaustion,” he said. “I’m forever grateful for that experience. I think about it often.”
The experience helped Doblin work out the arrogance thing; it also enabled him to develop the confidence to strike out and found MAPS. Yet he doesn’t believe it’s the easy wonder drug some suggest, and he supported the B.C. study partly because of the underground myths about ibogaine. “We’ve been deluded for a long time with the miracle-cure approach,” he said.
One problem is many ibogaine clinics that offer the expensive treatment are happy to let potential clients believe it will solve all their problems, Doblin said. The clinics have little incentive to follow-up with clients or study the treatment’s effectiveness, which, he said, is widely overestimated.
First off, he said ibogaine isn’t for everyone. It requires one to be “open to the self-reflection that ibogaine permits. It takes a certain courage to go through an ibogaine experience.” Even for these folks, he said, the trip has to be supported by aftercare and, possibly, a second dose.
There may also be safety concerns. About a dozen deaths have occurred during the 3,600 recorded ibogaine treatments that have taken place outside Africa since 1990. Advocates say pharmaceutical drugs also cause adverse reactions. Also, coroner reports in most of the cases placed the blame not on ibogaine, but on conditions like heart or liver disease and, in one case, a man choking on his vomit while eating a sandwich after the session had ended.
Just the same, the Iboga Therapy House screens potential clients for several medical conditions like ulcers, liver problems, blood clots, and heart trouble. Patients start with a small test dose and are observed for an hour for adverse reactions before the rest of the gram-sized full dose is given.
Gone, however, are the halcyon days when the clinic used to offer free ibogaine. In 2005, its founder, Vancouver pot entrepreneur Marc Emery, ran out of cash to fund the facility, so it had to close. Last February, the clinic reopened with money from MAPS. It now hopes to become self-sustaining by charging $4,700 for a five- to seven-day treatment session for dependence on heroin, methadone, and other opiates, cocaine, crack, or alcohol. (Shorter, cheaper sessions are also offered for spiritual or strictly therapeutic trips.)
Aside from the ibogaine, which the clinic buys for $700 a dose from a distributor in Spain, the sessions include therapy, massage, acupuncture, mild yoga, and elements of the traditional Bwiti ceremony to set the mood for the ibogaine session. Only one client or couple stays at the house at any time, and staff are on hand around the clock to monitor them.
Doblin said the B.C. ibogaine clinic is inexpensive when compared to hospital programs. Besides that, the cost doesn’t seem high compared to addiction’s drain on people and society. Almost 10 percent of the B.C. government’s budget is spent on substance abuse and problem gambling, according to a 2005 drug-policy report by the City of Vancouver. That report recommended alternative treatments for drug dependency, including the therapeutic use of psychedelic drugs like peyote and ayahuasca.
Although ibogaine wasn’t mentioned specifically, Zarina Mulla, a city drug-policy planner and report coauthor, spoke enthusiastically about it in a phone interview from her office.
“It helps users analyze some of the issues behind the drug abuse. Perhaps this is the most important thing because you can relapse and go back to the drug,” she commented.
Mulla said alternative approaches are vital at a time when the Harper government has announced a new Canadian drug policy modelled on the U.S. police-and-prisons approach, which she called “a failure…There’s such a large amount of money for enforcement [in the Harper policy] and none for harm reduction and only a little for prevention and treatment.”
Leah Martin, for her part, said she’s not holding out hope for any federal funds for the ibogaine clinic. It did apply once, but was rejected. “They were looking for teens that do [drug-education] tables at raves. We were a bit too obscure for them. People generally don’t know about [ibogaine].”
And in the current climate, that’s not all bad. “We’re lucky ibogaine is unscheduled [not banned] in Canada. We play our cards so we kind of stay off the radar.”
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