Kentucky eyes ibogaine, a psychedelic, to treat opioid addiction

BRYAN HUBBARD heard the same story so often as a lawyer in Kentucky. It would come from the same type of person (a middle-aged woman from the Appalachian mountains) who had worked hard her whole life in the same kind of occupation (a low-wage, low-skill job). She would have a work accident (a slip-and-fall or a lifting injury) that sparked debilitating pain, with no observable source for that pain. A doctor would then prescribe the woman opioids, and then she would spiral into addiction.

These women were truly experiencing pain, says Mr Hubbard with a thick southern drawl, “but the nature of their pain was emotional and spiritual”. They had become “completely hopeless about their ability to live a life with autonomy and dignity”, and this workplace accident was “the straw that broke the camel’s back”. Any successful treatment must tackle that specific type of pain—and he says that ibogaine, a little-known psychedelic, is the answer.

Now Mr Hubbard is the executive director of the Kentucky Opioid Abatement Advisory Commission, a group formed to supervise the $842m settlement Kentucky received from opioid companies as compensation for the crisis, but he will not be for much longer. The state’s incoming attorney-general, Russell Coleman, has appointed a former Drug Enforcement Agency (DEA) agent to the role, starting in January. Mr Hubbard has spent the past few months working to convince one of the country’s most conservative states, which only legalised marijuana this year, to spend $42m of that settlement money on ibogaine research. That mission could be in trouble in 2024, especially with a former DEA agent at the helm.

Ibogaine is not your college dorm-room type of psychedelic. The drug comes from the iboga plant, a Central African shrub, and it has been used in tribal coming-of-age rituals. It causes trips so unpleasant that even the most adventurous drug-users shy away from a second dose. Along with mystical experiences and feelings of spiritual transformation, ibogaine can cause pain, anxiety, sweating, nausea and irregular heart rhythms. Some have died from cardiac events. The experience can last up to two days, with several days of rest needed after. It can be an extremely difficult experience, says Andrew Tatarsky, a psychologist at the Freedom Institute, an outpatient treatment centre in New York City. “It’s not something you want to take for fun or party with.”

The Western story of using ibogaine to treat addiction seems to start with one man, Harry Lotsof, who ingested the drug in 1962 and says he woke up free from his heroin addiction. This might sound too good to be true, but ibogaine is known as an “addiction interrupter”, says Dr Tatarsky. People, including some of his patients and a close family member, claim that it resets their nervous system so that they no longer crave the drug they are addicted to. For decades people have claimed to have been cured of their drug addictions—cocaine, opioids and more—after one dose.

While learning about the more commonly known psychedelics—LSD, psilocybin, ayahuasca—as a treatment for substance abuse, Mr Hubbard says he stumbled upon ibogaine. He became intrigued by the claims, but felt constrained. “There are people in my office who would be ready to chop my head off if they knew that I was working within the world of psychedelics,” he says.

People who use ibogaine have an “introspective experience” that “affirms for them the reality of their divinity as a human”, Mr Hubbard says. “That spiritual restoration is going to help fuel and support long-term recovery.”

Not everyone is persuaded. Patricia Freeman, a pharmacy professor at the University of Kentucky and a member of the commission, called a special meeting to discuss the FDA approval process. Experts testified that approval would face challenges, due to ibogaine’s side-effects and its current status as a Schedule I drug with no medical use. Although a few government-supported clinical trials on ibogaine as a treatment for substance abuse are underway, FDA approval could take years if it happens at all. Kentucky should use the settlement money to get patients access to proven and effective treatments for opioid addiction now, says Judy Griffin, a doctor and an addiction specialist at the REACH Project, a substance-abuse clinic in New York state.

Others worry that ibogaine research will not help regular Kentuckians in the future. Dimitri Mugianis treated patients illegally with ibogaine for years—he was even arrested for it. He says that ibogaine treatment involves several days in a facility while being monitored by medical professionals. Who is going to be able to afford a boutique treatment like that? Certainly not the Kentuckians who are currently suffering in one of the poorest states in the union, he says.

Mr Hubbard admits that the research is far from a sure thing. The new executive director could scrap his proposal. Still, Mr Hubbard is confident that ibogaine research for opioid-use disorder will not die on the vine. “There are other states that are interested,” he says enthusiastically. “So keep your eyes open to how that plays out.” ■