What if all that stood between heroin addiction and sobriety was a trip to Baja California, Mexico, and a dose of a highly potent psychedelic drug?
With the stigma surrounding psychedelic drugs waning in the medical world, experts and researchers are giving another look at some of the most exotic substances in the world. One of those drugs — ibogaine — is now being used in some medical settings, particularly in Mexico and New Zealand, to treat opioid addiction.
And it appears to work: Although the studies are early and some of the anecdotes can sound more spiritual than scientific, there's a growing body of evidence that ibogaine is effective for treating certain forms of drug addiction.
It's not without risks, and it's not a cure-all. But as the nation deals with what lawmakers and public health officials have called a "heroin epidemic," unconventional treatments like ibogaine may merit more attention. They may, quite literally, save some people's lives.
Ibogaine causes an intense hallucinogenic experience
Ibogaine is a psychedelic compound found in the Tabernanthe iboga root, native to western Central Africa. According to the Multidisciplinary Association for Psychedelic Studies, it's not considered fit for recreational use, likely because the hallucinogenic experience is so intense and often scary and unpleasant. It's not addictive — but it has a relatively high mortality rate (about one in 300), typically caused by slowing of the heart, lethal combinations with other drugs, and liver problems.
Ibogaine is illegal in the US, with the federal government classifying it as a schedule 1 drug, a substance that has potential for abuse and no medical value. Critics say this classification is deeply flawed: Ibogaine doesn't appear to be good for recreational use ("abuse"), and it has potential medical value.
One example of its medical use: A large dose of ibogaine can prevent opioid withdrawal, eliminating cravings for drugs like prescription painkillers and heroin for up to months at a time — making it a potent tool for detox. And the psychedelic experience can cause what users describe as a profound shift in perspective, allowing them to see their life more clearly and make important adjustments for the better.
I spoke to two recovering opioid addicts — Steve and Kevin — who took ibogaine at a medical clinic in Baja California, where the drug is administered to treat drug abuse. They asked that I use only their first names to avoid publicly associating them with the stigma attached to drug use and addiction.
Steve's description of his hallucinogenic trip captures just how intense it can be, going from intense visions of terrifying, violent cartoons to out-of-body experiences in which he felt like he was traveling through the "infinite universe":
I felt like I was flying around outer space in my soul. I later realized that it was the infinite universe. I'm floating around in this place, hearing this buzzing noise in the background, but experiencing nothing but pure joy and happiness. It made me realize what our purpose is here — that we're all spiritual beings on a spiritual experience, the ride is what's important, and how to be a good person.
Kevin explained a similar intense phenomenon: "It corresponded with this intense visual experience in which I had my eyes closed, and my vision was just catapulted outside my mind into this abstract vision that looked like being in space. It was very, very exotic, and came on very strongly and powerfully, but none of it was scary. I felt very safe."
The closed eyes are an important detail: Unlike LSD and magic mushrooms, ibogaine doesn't tend to cause visual hallucinations in a person's surroundings. It invokes something closer to a dreamlike trance, which produces astonishing visuals when a user's eyes are shut — people describe anything from traveling through space, like Kevin, to seeing dead relatives who relay important wisdom.
The psychedelic trip can give people the perspective they need to improve their lives
To someone who hasn't gone through this type of experience before, it can sound ridiculous. But it may allow what researchers call "psychological growth."
Steve, for one, said using ibogaine helped him quit opioids — and led to other improvements in his life, like giving him the perspective and will to quit his unhappy job as a financial planner and start his own water testing and filtering business.
"The hallucination is really important," Steve said. "It lets you unplug, where there's no cellphones, no anxiety, money has no meaning, all possessions in your life have zero meaning. So you're sitting in a dark room, and you can sit there and talk to your inner self and figure out what's truly important in your life."
This is the typically described therapeutic effect of hallucinogens: When people take a potent dose of a psychedelic, they can experience spiritual, hallucinogenic trips that can make them feel like they're transcending their own bodies and even time and space. This, in turn, gives people a lot of perspective — if they can see themselves as a small part of a much broader universe, it's a lot easier for them to discard personal, relatively insignificant and inconsequential concerns about their own lives and death.
That may sound like pseudoscience. And the research on psychedelics is so early that scientists don't fully grasp how it works. But it's a concept that's been found in some medical trials, and something that many people who've tried hallucinogens can vouch for experiencing. It's one reason preliminary, small studies and research from the 1950s and '60s found hallucinogens can treat — and in some cases cure — addiction, anxiety, obsessive-compulsive disorder, and a crippling fear of death among people with terminal illnesses.
But ibogaine appears to go even further than the hallucinogenic effects — by actually stopping physical withdrawal symptoms such as sweating, muscle aches, and nausea.
The research shows ibogaine can help people quit opioids
The research is early, but the studies so far have found promising results for ibogaine's ability to treat drug, particularly opioid, addiction.
Thomas Brown, a researcher at University of California, San Diego, is working on a study that looks at the long-term effects of ibogaine on drug addiction, which Kevin and Steve both participated in. Previous studies — some on rats, others with humans — already found that ibogaine can reduce opioid and cocaine withdrawal. And much of this seems to be a real, physical effect: According to Brown's review of the research, ibogaine seems to have some sort of effect on the brain that eliminates physical withdrawal symptoms and then stops cravings for up to a few months.
But Brown wanted to find longer-term results by looking at patients in Baja California. Drug addicts have flocked to ibogaine clinics in this region, located in beach resort towns like Tijuana, usually spending a week or so before heading back home. (Advertisements and testimonials for the clinics come off as descriptions for getaway destinations — detailing luxurious, relaxing activities, stunning beach environments, and other qualities you'd expect to hear about a Club Med more than a rehab facility.)
Brown's latest study hasn't been published yet, but he said the findings were very promising. In the short term, he found a dramatic drop in withdrawal symptoms. In the long term, "we have 14 people who finished the final follow-up at 12 months," he said, acknowledging that it's a small sample size. "What we're showing is that their drug use dropped dramatically, that their relationships with family members and friends has improved dramatically, and that their legal problems, their problems with the law, have substantially dropped."
What's better, Brown said researchers conducting a study in New Zealand have reported similar results to him — and they've managed to look at a bigger pool of patients. With the backing of these findings, patient anecdotes, and the previous body of evidence, Brown seems fairly confident that he and other researchers are onto something big.
Ibogaine doesn't cure addiction, but it can help addicts put themselves in the right mindset and setting
There are limits to ibogaine, of course. For one, it doesn't cure opioid addiction. But the detox effect, coupled with the perspective attributed to the psychedelic trip, allowed patients to get their lives back in order — and more easily avoid drugs.
Kevin, for instance, said ibogaine allowed him to pursue traditional, abstinence-focused treatments he previously rejected. Those were, he said, crucial to getting clean, but he wasn't open to them before ibogaine.
"Ibogaine changed my relationship with addictive drugs," he said. "It opened the window for me to actually embrace life without drugs. I feel like it provided me with an opportunity to face my everyday living without feeling like I needed to be high."
This gets to one of the nuances of drug abuse: Addicts can't, in many situations, just quit drugs. They also often need to change the mentality and environment in which they were hooked — or risk falling into old, bad habits again.
Take, for example, the Rat Park experiments. As journalist Maia Szalavitz explained, some of the original experiments on cocaine and heroin addiction were conducted under animal testing settings in which rats were caged off and socially isolated, with drugs as their only real form of recreation. So Bruce Alexander, a Canadian researcher, decided to see what would happen if drugs were instead offered in a bigger cage in which rats had access to other rats. His results were striking: While rats in cramped, isolated cages preferred drug-laced water, the rats in social environments preferred plain water — even when the drug-laced water was made intensely sweet.
Ibogaine's detox effects and hallucinogenic experience make it easier for addicts to find that good environment: With fresh perspective and no cravings calling them back to heroin, addicts stand a much better chance of recovery.
It worked for Steve and Kevin: Both said they've mostly managed to avoid opioids since using ibogaine. (Steve had a brief relapse when he broke his back and doctors gave him morphine and painkillers, which eventually led to another round of ibogaine to detox.)
By no means is any of this conclusive proof that ibogaine can help everyone struggling with opioid addiction — Brown repeatedly cautioned that the findings so far are early, although promising. But faced with a growing nationwide opioid problem, it's certainly a promising, albeit unconventional, potential part of the solution.
Ibogaine could be an alternative treatment for a national problem
Since the late 1990s, the number of people dying from opioid painkiller overdoses has steadily risen, with more than 16,000 deaths reported in 2013. What's worse, one study in JAMA Psychiatry found opioid painkiller use has contributed to the rising use of heroin, an opioid that is deadlier and more addictive than painkillers. (A 2015 Centers for Disease Control and Prevention analysis, for example, found people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.)
Ibogaine could be a potent medicine for dealing with this problem, even among some of the worst addicts. That potential is reflected in Kevin and Steve's stories: They were opioid users for years, trying and failing to quit through traditional treatments before landing on ibogaine.
Kevin's story highlights the common descent from painkillers to heroin. "About a year after I started taking painkillers, I gradually increased my use — I went from swallowing pills to chewing pills and snorting pills," he said. "In 2010, I was dependent, but I decided to go cold turkey and just kick it without any kind of help. I thought I could beat it on my own. That only lasted about two weeks or so before I met a friend that I started spending a lot of time with who was into shooting up heroin. So after a year of taking pills, I progressed into intravenous heroin use."
Things deteriorated from that point forward. After a three-day binge of cocaine and heroin, Kevin was arrested for shoplifting. The legal trouble pushed him to — reluctantly — seek traditional abstinence treatment for an opioid addiction. After a month in the program, he started using heroin again. After nearly another year, he broke down to his mom, pleading for help and arguing that ibogaine, which he knew of from "curious internet research," could be a better fit than traditional rehab. So he and his family did some digging, eventually settling on a treatment center in Mexico.
Steve shared a similar story. After becoming dependent on prescription painkillers, he tried using Suboxone — an opioid that blocks withdrawal without causing the kind of intense high that heroin does, but requires regular use to sustain its effects. But he felt uncomfortable "substituting one opioid with another," as he described it. So he looked for alternatives, eventually deciding to try ibogaine.
Still, ibogaine won't be for everyone. But for patients like Kevin and Steve who tried traditional approaches without success, it could be a good way to jump-start the full healing process.
There's a push for more research into ibogaine and other psychedelics
Despite the promise, ibogaine treatments are still rare and relatively unknown. Kevin became familiar with the drug only through internet research. Steve learned about it from an episode of Law & Order: SVU, in which Dr. Huang risks his medical license by treating a patient with ibogaine. And research like Brown's is still rare, limited to a few studies and facilities in Latin America and New Zealand.
Like the other psychedelic drugs being considered for medical purposes, ibogaine isn't expected to be available for recreational use or even medical purchase in the US anytime soon. But it's something advocates hope to one day legally administer in controlled medical settings, where doctors and other trained professionals can evaluate patients for any medical risks, like heart problems, and watch over and guide them through the dosing and experience.
As researchers begin looking more seriously at psychedelic drugs and their potential benefits, it's an area of health care that's expected to grow. Ibogaine, then, could be one of the drugs that paves the way to a new field of medicine.