Back To LibraryLinks to the research papers mentioned in the video
Paper 1: https://www.tandfonline.com/doi/full/10.1080/00952990.2017.1320802
Paper 2: https://www.tandfonline.com/doi/full/10.1080/00952990.2017.1310218
Video Transcript:
[0:22] What if the best treatment for getting people off of opioids like heroin and oxycodone was discovered over fifty years ago by a 19-year-old heroin junkie in Brooklyn, but we're not using that treatment right now in this country because it's illegal here? Well, that'd be a tragedy given the devastating magnitude of the opioid crisis right now. In recent years, the death rates have been increasing, and those death rates are led by things like heroin and synthetic opioids like fentanyl.
[0:53] How are the treatments that we have right now? Well, clearly they’re not up to the task, because we have this opioid crisis on our hands. The standard treatment here in the United States is opioid replacement therapy or ORT. An ORT is where you take one opioid, typically something highly euphoric like heroin or oxycodone, and you replace it with something that doesn't give you that high, doesn't make you euphoric, and also is longer-lasting - something like methadone or buprenorphine. Now those are actually the two most common options here in this country for replacement.
[1:29] Now opioid replacement therapy, sometimes called opioid maintenance therapy because you have to maintain the treatment every day, is only effective if you keep using that replacement opioid - methadone or buprenorphine - every day for years, sometimes for the rest of your life.
[1:43] There are some major problems with this though. Dropout rates. So you have to take it everyday, and if you look at the numbers from the research, about five months into maintenance treatment on methadone, nearly 40% of people have already dropped out of the program. And if you look at buprenorphine, it's worse.
[2:03] So high dropout rates - those are people for whom that treatment is failing. Relapse rates are also high. If you drop out of the program, you're going to relapse, very likely you're going to go back to using the problem opioid. For methadone, the numbers are like this: about a month and a half after dropping out of the program, only one in four people is going to be abstinent from opioids. For buprenorphine again, it's worse - at only four weeks after dropping out of the program, only one in five people are abstinent from opioids.
[2:31] Fortunately though, there is a treatment that exists that only involves short durations of treatment and doesn't involve taking a drug every day for the rest of your life, and that is ibogaine treatment, which was discovered by accident serendipitously by this man Howard Lotsof when he was 19 years old and living in Brooklyn. He was given ibogaine by a friend of his who said “this stuff's derived from a West African shrub, it'll give you a 36-hour trip”.
[2:58] So Howard, who'd been a daily user of heroin at the time, took this on his own, and about 30 hours into that trip he'd taken a short nap and he woke up, walked outside of his apartment in Brooklyn, and he realized that even though he hadn't had any heroin for a day and a half, he wasn't going into withdrawal. He wasn't experiencing any cravings for heroin, and he also realized that his perception of heroin had completely changed. Whereas before he'd seen heroin as something that gave him comfort, now he viewed heroin as something that emulated death, and the very next thought in his head was "I prefer life over death."
[3:38] And he thought “this is remarkable”, and he actually gave it to a bunch of friends of his. They were in a group that were studying the psychotherapeutic effects of drugs and also just wanted to experiment with different things. Seven of those people were also regular heroin users, and five of them stopped using heroin for six months or more after they had had the ibogaine. This is quite remarkable, and Howard went on to make ibogaine treatment his life's work, and he went on to create a movement of ibogaine treatment around the world.
[4:09] So ibogaine, what is this stuff? It's a cousin of other psychedelic compounds like LSD and psilocybin from magic mushrooms. Here is a picture of the root bark - it's from this root called iboga. It's a shrub that's native to West Central Africa, and here you see a picture of that with some of the root bark scraped off. The ibogaine is concentrated in the root bark itself, and in West Central Africa this root bark powder and this root bark is used in initiatory rituals.
[4:39] It's considered a religious sacrament and it allows people to travel to the Land of the Dead to commune with ancestral spirits and to be reborn, and they often are given a new name when they are initiated. So in the rest of the world though, ibogaine has been used mostly to treat people for addiction, mostly opioid addiction.
[5:01] This is a picture of a treatment provider outside her apartment in Rotterdam in 1990. She's there with Howard Lotsof and his wife Norma, and this is actually one of the early treatment sites for ibogaine. So Howard had met people who were interested in providing this treatment for people, and it was a very small number of treatment providers. These were people in the Netherlands and maybe in New York City where it was underground because it was illegal because a decade after Howard made that discovery, ibogaine was made illegal in the United States and was put on Schedule One. Schedule One drugs are by definition those things that have a high potential for abuse and have no recognized therapeutic value.
[5:48] But Howard recognized the value of ibogaine and people started treating people for addiction in places like the Netherlands. And over the years or the next decade, more and more people were providing treatments, and by the end of the century around 900 people had been treated with ibogaine, and by 2006 that number had grown to about 3,500 people around the world had been treated with ibogaine.
[6:10] Now this map shows you treatment sites and you can see that there aren't any in the United States. There are three that are right there on the border with Canada and with Mexico, but they're on the other side of the border. They're not in the US because it's illegal in the US. It's not regulated in Canada or Mexico or any of the other countries that these treatment sites are appearing. There were 13 treatment sites at the time. And this ibogaine movement, which was started by Howard Lotsof and a few other people, was growing at this point.
[6:39] Fast forward to eight years later, we're in March of 2014. There are roughly three times as many treatment sites around the world and a lot of them are in Mexico. And you see the red pins here are sites in countries where the treatment was available eight years ago in 2006. The blue ones are in countries where treatment wasn't available eight years prior, and so you see that there are some other countries that now have treatment that didn't have it before. And the green ones, interestingly enough, are in countries where, by this time, ibogaine treatment had been made a legal prescription medication, and those three countries are Brazil, South Africa, and New Zealand, which actually started the trend in 2010. And you see there are some treatment sites there in those countries.
[7:22] So in places where it's not regulated and places where it's legal, we have ibogaine treatment sites. So with all these people receiving ibogaine treatment, probably over ten thousand people have received treatment by this point, we have to wonder: is it effective? And if you go on the internet you see stories of people who have been treated and they have these transformative experiences. They say it helped me, it interrupted my addiction, it allowed me to stop using heroin or oxycodone and it got me off of those things.
[7:52] But really until very recently, there has been almost no scientific evidence that ibogaine works. And why does this matter? Well, it matters because well you can tell someone a story about how something made a difference in your life and they might say, “well that clearly made a difference for you”, and they might even tell their friend “there's this great treatment for you that you might want to try out”, but it's no good for convincing the scientific and medical communities.
[8:15] Now for those communities you really need hard scientific data, which is why I started a study to look at how effective is ibogaine treatment for opioid addiction. And this is the publication that came out of it earlier this year with my colleague Ken Alper, and this is available online - you can look at the data in there in detail. But what I want to tell you about is the generalities.
[8:38] We studied outcomes for 30 people who were seeking treatment at clinics in Mexico, and we looked at before treatment and after treatment. We looked at two main things for people in this study. One was ‘is ibogaine effective in detox, and that is, does it reduce the withdrawal symptoms that you would get if you stopped taking heroin or other opiates’, and the other question is ‘is it effective in treatment - does it reduce the drug use, does it reduce opioid use, and does it help out with related problems like psychiatric status or social well-being or legal status, does it help with that as well’?
[9:16] So what we found was that yes indeed, ibogaine is effective for detox. Before treatment people are going into withdrawal, and then after treatment a few days later their withdrawal symptoms have basically disappeared and highly significant reductions where you'd expect the withdrawal symptoms would be increasing at this point a few days after they've stopped taking their opioids.
[9:36] And we also found reductions in opioid use that lasted for the entire 12 months. So we followed people for 12 months after treatment, and we found that their opioid use was greatly reduced at one month and stayed reduced the entire 12-month period. At one month we found out of the 30 people in the study, 15 people had not used the opioids at all, where they came into the study, when they came in for treatment they've been using opioids an average of 29 days over 30, and at 12 months we still had 30% of the people in the study who weren't using opioids on a daily basis.
[10:11] And the other major finding we had was that areas related to drug use were also improved, and the most important one, in my opinion, was that we found that after treatment, for the full 12 months following treatment, people's what we call social and family status was improved. And what that means is that their relationships with the people that matter most to them in their lives were improved - their family members, their close friends, their spouses.
[10:35] So from ibogaine treatment, a brief treatment period, and we get these fantastic results for 12 months following. And there was another study that was done in New Zealand where ibogaine treatment is now legal where they found similar results that were 12 months following treatment the opioid use was reduced greatly and they also have found that the withdrawal symptoms after treatment were greatly reduced.
[10:58] So we have this evidence that it works really well, right? So why isn't ibogaine treatment available here in the United States? Well, the main reason is that it is illegal and it's Schedule One as I mentioned before. And why is it Schedule One, why is it illegal? Well, in the late 60s ibogaine was placed on Schedule One and was made illegal along with a whole slew of other compounds that were psychoactive.
[10:22] It's a cousin of LSD and psilocybin. These drugs were associated with the counterculture, the hippie psychedelic counterculture of the late 60s, and all these drugs are placed on Schedule One and made illegal. So the main reason was that it's psychoactive. There are also some risks associated with ibogaine treatment, particularly if you have a pre-existing heart condition - it can cause arrhythmia, it causes a slowing of the heart rate. But I think the risks of this have to be counterbalanced by looking at the possible benefits of ibogaine treatment, and also they have to be looked at in the context of you know, compared to the risks of doing nothing, of just continuing as if it's status quo.
[12:03] Finally, pharmaceutical companies have very little incentive to look at ibogaine treatment. First of all, ibogaine is a natural product so it cannot be patented. Secondly, the treatment duration is very brief, on the order of days typically, and it's not something you take every day for the rest of your life, and so there isn't the same profit motive as there is for something like methadone which we're going to be taking for the rest of your life.
[12:30] So I want to go back to this idea about the psychoactivity, because that was why it was made illegal originally, and the stories that I've collected over the years of studying this tell me that for a lot of people they see the psychedelic effects as being really important in their healing process and their recovery.
[12:50] So I'm going to read you some of the things that they told me about their life before treatment, during treatment, and then after treatment. Going into treatment, people are often suicidal. They feel like the opiates are killing them. "If ibogaine doesn't work, I'm checking out." "It was a slow suicide." "I isolated myself more and more and I gave up all of my interests." "You don't feel joy, you don't feel pain, you don't feel love, you don't feel at all."
[13:17] Now in the experience itself, there are oftentimes very profound experiences, and one type of experience is something we could call a mystical experience. And here's an example from someone in the study: "I had a complete out-of-body experience where my soul left my body and went into the ‘other’ world that exists all around us all the time but that most cannot perceive... Soon after appeared a light being which I sensed was my guardian angel… It radiated goodness, joy and happiness. It made me understand that it has always been watching over me and always would be, but that the worst of my weight to bear was over."
[13:51] Also people sometimes find that they revisit traumas that they experienced or that they created for other people. They find a sense of remorse but they also find a sense of reconciliation with people who've wronged them or who they've wronged. This quote is from somebody who came into treatment having tried to kill himself five times. He came from a very abusive household and he says that he woke up shortly after treatment: "I woke up and I realized suddenly that all of my life experiences made me who I am today, and with that realization I totally forgave my mother and father. Before ibogaine I hated my father; now I'm thankful for all that I learned from him."
[14:29] And after treatment, what is the effect of this experience? People say things like "I have my life back! My personality is back. I want to be more social again." "Ibogaine treatment is like having your life handed back to you."
[14:43] So, what if we make ibogaine treatment legal and available here in the United States? Well, there are a couple things that would happen. Very importantly, it would make this treatment available for people who don't have the financial resources to get in an airplane, fly to Mexico or to Costa Rica or to the Bahamas and get ibogaine treatment. It would make treatment available to millions of people who don't currently have that treatment option available. And it would also allow for regulation in this country which would help to improve the safety of ibogaine treatment, and it would also help to improve the efficacy of ibogaine treatment because we could study it closely and we could integrate it with our current healthcare system.
[15:23] What if we don't make ibogaine treatment legal and available here in the United States? Well, you can see from the maps I showed that the ibogaine movement has been growing steadily and rapidly, and so it's going to continue to grow. The rest of the world is going to be moving forward with ibogaine treatment regardless of whether or not we join them. So it's going to happen with or without us.
[15:46] Thank you.