Can a Powerful Psychedelic Fight the Opioid Crisis?
46,802 Americans died from opioid overdoses in 2018, the latest year for which CDC data is available. This painful cost has been exacted regularly in recent years, the price of rampant opioid overprescription and profit-hungry pharmaceutical companies.
Preventing these deaths means finding an effective way to treat opioid addiction. Somewhere around two million Americans suffer from opioid-related substance use disorder. Treatments like buprenorphine and methadone calm the brain circuits affected by opioids, reducing cravings and withdrawal. In conjunction with counseling, these medications can gradually ferry addicted individuals back to normalcy. Unfortunately, medications are underutilized and states generally lack the resources to provide them to all afflicted individuals.
It is into this quagmire that some have suggested inserting a new, surprising treatment: a powerful psychedelic drug called ibogaine.
Derived from the root or bark of a West African shrub called Tabernanthe iboga, ibogaine has been used in the Bwiti spiritual discipline of the forest-dwelling Punu and Mitsogo peoples of Gabon for generations. Unforgettable to those who have taken it, a high dose of ibogaine induces an "oneirogenic" waking dream-like state for as long as 36 hours, with introspective effects that can last for months afterwards, supposedly permitting takers to conquer their fears and negative emotions.
A curious side effect, anecdotally recognized in the 1960s, is that ibogaine significantly reduces cravings for alcohol, cocaine, methamphetamine, opiates, and nicotine, so much in fact that some people claimed to be completely rid of their drug addictions after a single, mind-altering dose.
Half a century later, promising anecdotes still abound, but without any science-based evidence to back them, simply because no clinical trials in humans have been completed. This is for two reasons. One, ibogaine is illegal or controlled in much of the world, and two, it causes disconcerting side effects like dry mouth. nausea, and ataxia (difficulty in coordinating muscle movements) at commonly used doses. Most disturbingly, ibogaine can trigger an irregular heartbeat, leading to sudden cardiac arrest. The scientific literature is littered with case reports of this occurring, even in people with no underlying conditions.
Still, ibogaine shows considerable promise in animal models at resolving addictive behaviors, making human trials quite enticing even though the mechanism behind these effects still isn't completely understood. In 2016, researchers in New Zealand calculated that patients could be treated for their addictions with lower doses, around 0.87mg per kilogram of body weight, which is substantially lower than those presently being administered by gray market practitioners. Randomized, controlled trials are now underway to test their hypothesis.
Researchers are also turning their attention to a drug called 18-Methoxycoronaridine (18-MC), a derivative of ibogaine invented in 1996 by pharmacologist Stanley D. Glick from the Albany Medical College and the chemist Martin E. Kuehne from the University of Vermont. Early signs indicate that 18-MC preserves ibogaine's anti-addictive properties without the same cardiotoxicity.
The tragic toll of the opioid epidemic is forcing societies around the world to reckon with a reflective question: What truly constitutes a dangerous drug?. As we've learned, even drugs prescribed by ostensibly caring doctors can kill in great numbers, while drugs long banned for their reputed dangers could instead be more salubrious than we thought.