The unsanctioned use of an obscure drug to treat addiction has exploded recently, a new report finds.
A subculture of advocates who say the hallucinogen ibogaine alleviates addiction to opiates has welled up from New York City and spread to small clinics and informal treatment networks across the globe.
“On the basis of word of mouth, the ibogaine scene has quadrupled in the last 5 years,” says Ken Alper, a psychiatrist at the New York University School of Medicine in New York City. Alper and two colleagues published their report in the January Journal of Ethnopharmacology.
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Alper delved into the ibogaine culture by scanning an e-mail list and making contact with key proponents. In 2001, he reported that 857 people had taken ibogaine. In the new paper, Alper and colleagues report that by 2006, at least 3,414 individuals—and perhaps as many as 4,900—had taken ibogaine. Of these, 68 percent explicitly took it to treat addiction, mostly to heroin and other opiates, including prescription drugs such as OxyContin (oxycodone).
About 1,200 of the users obtained ibogaine from what Alper calls “lay providers/guides.” Usually former addicts themselves, these providers have no formal medical training but often follow a treatment manual written by ibogaine advocates.
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Ibogaine is illegal in the United States but legal in most of the rest of the world, including in Mexico and Canada, which together house at least three small ibogaine clinics.
Derived from the root bark of a West African shrub, ibogaine transports many users on an often unpleasant 24- to 36-hour “trip” in which they see visions or relive past events. Practitioners of the West African Bwiti religion ritually eat the root bark as a spiritual aid.
In 1962, a young heroin addict from Staten Island, Howard Lotsof, took ibogaine on a lark. After his trip, he no longer craved heroin. Convinced of the drug’s effectiveness against addiction, Lotsof, who worked on the new report with Alper, began trying to develop ibogaine into a legitimate medicine, a goal he continues to pursue despite numerous setbacks.
The National Institute on Drug Abuse (NIDA) in Bethesda, Md., invested several million dollars in laboratory and animal studies in the early 1990s before abandoning ibogaine.
In 1993, a physician from the University of Miami, Deborah Mash, won Food and Drug Administration approval for a human safety study of ibogaine. Mash never finished that study, but in 1996 she opened a clinic on the Caribbean island of St. Kitt’s, where she has treated some 400 patients. In 2001, Mash published data on 32 of those patients, finding that ibogaine banished withdrawal symptoms.
One ongoing study, funded by the private Multidisciplinary Association for Psychedelic Studies in Ben Lomond, Calif., is tracking 20 patients treated at a Vancouver clinic. But a large, rigorous trial of ibogaine’s long-term effectiveness seems unlikely.
“The idea of trying to push this into pharmaceutical development is a tough nut,” says Frank Vocci, director of anti-addiction drug development at NIDA.
Vocci cites safety concerns as one reason for such reluctance. The new study reports that since 1990, 11 people have died within 72 hours of taking ibogaine. Ibogaine providers recommend that people with certain heart conditions avoid the drug, as it can exacerbate those problems.
Still, Alper says that studying ibogaine could provide basic insights into addiction. “Ibogaine has its limitations, and it may or may not be something that’s practically useful, but the mechanism of action of ibogaine and why it’s working is a really, really interesting scientific question.”