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DoubleBlind: Image of woman with eyes closed. In this article, DoubleBlind explores using ibogaine to treat opioid addiction.
DoubleBlind: Image of woman with eyes closed. In this article, DoubleBlind explores using ibogaine to treat opioid addiction.
Photo by Robert Rieger

How Ibogaine Can Help with the Opioid Crisis

We're facing the most devastating overdose epidemic in American history. But can we overcome the "great disconnect" between science and stigma in order for ibogaine to become to help with the solution?

Adaam James Levin-Areddy // July 14, 2020

Not fitting in started early. Going to a private primary school in Florida, Juliana Mulligan— the daughter of two astrologers and someone who spent part of her childhood in India—never found a place among her “really conservative, wealthy” peers. Loneliness became alienation, then anxiety, then depression.

The first taste of relief came at age twenty, when her boyfriend at the time introduced her to opioids. “For the first time in my life, all my anxiety and depression were just gone,” she says. “It was liberating. It became the highlight of my week.”

It started with methadone, an opioid prescribed as a painkiller and treatment for dependence on other opioids, including heroin. Heroin soon followed. And oxycodone. And fentanyl. And anything she could get her hands on.

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It quickly turned into a habit, first taking away the pain, then taking up her time and money. Her inability to afford a consistent habit cast her into a perpetual state of withdrawal, always “semi-sick.” So she tried rehab.

At 22, she admitted herself into a dilapidated, albeit inexpensive, rehabilitation resort in the middle of a Belizean jungle (a. It was cheap; b. It wasn’t the US).

“It was really ramshackle. Run by this doctor from Texas who wasn’t even there,” she remembers. “It was basically round-the-clock, 12-step meetings. You’re supposed to get off drugs but they put you on four to five new ones. I went right back to using again afterwards. I think most of us did.”

On with the downward spiral: Back in Florida, Juliana was arrested for shoplifting and spent a night in jail. The night before her probation orientation she met up with a childhood friend who took her on “an insane drug tour of some really dark places in Miami.”

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“Needless to say, I did not report for my probation orientation the next day,” she says. “About a week later, my friend and I made it back from Miami-hell and my parents had told the police where I was out of fear for my safety.”

Police came knocking in the dead of night at her friend’s apartment, where she’d been sleeping. Her livid probation officer (“a Disney villain with bleached white hair with lots of blue eye- shadow and red lipstick”) demanded she take a drug test. She tested positive for “every drug but marijuana.”

A six-month sentence. Three if she committed to a prisoner rehab program.

Cold-turkey detox in prison, she recalls, was the “closest to hell on earth I have ever gotten.” Frail and in chronic agony, Juliana had to be moved to the medical observation block; the man in the neighboring cell had been convicted of murdering his pregnant girlfriend. Juliana felt tormented, but the officers dismissed her emotional display as psychosomatic–if not a performance.

“It’s all in your head,” she was told. “You’re in here until April so you better get it together.”

“This was actually the normal inhumane treatment I experienced at the hands of professionals throughout my opioid using time,” she says. “When I got towards the end of the withdrawal I had a kind of spiritual epiphany: I suddenly realized I was in jail doing social research. I tried to observe the dynamics of the jail, make it as fun as possible, make people laugh, and cause some mayhem where I could.”

Less beguiling was Project Recovery, the rehab program she had been required to attend, which amounted to not much more than another, more watchful 12-step program.

“I’m not a fan of the 12-step program. I don’t think that having people say they’re powerless, or that they have a disease, is helpful in any way, shape or form,” she says. “It always felt very disempowering. And there was no discussion of society or family structures that lead people to substance abuse. It’s all about the individual.”

Out of prison and not dependent on substances, Juliana started traveling the world again. But falling in love in Bogota (“a tricky place to move if you’re trying not to do drugs”) precipitated the next— and final—relapse. In a conspiracy of serendipity and irony, it was the bottomless availability and cheapness of drugs which convinced Juliana once and for all, as she put it: “opiates suck.”

“I needed to get to that point. I was able to do as much as I wanted. And I was done,” she says. And she knew the next step.

DoubleBlind: Image of Juliana Mulligan. In this article, DoubleBlind explores using ibogaine to treat opioid addiction.
Photo by Robert Rieger

Juliana’s fraternizing with “academically- inclined psychedelic users,” (her words) had put the work of the Multidisciplinary Association of Psychedelic Studies (MAPS), the psychedelic research nonprofit, on her radar from an early age. At 23, she had learned about ibogaine, a psychoactive alkaloid isolated from the roots of the Tabernanthe iboga shrub.

Ibogaine has been used as a sacrament in the Bwiti religion in West Africa for centuries, but since the 90s, medical clinics—largely in Mexico—have been popping up to administer it to people struggling with substance dependency. (Licensed professionals are also legally permitted to administer ibogaine in clinics in South Africa, Brazil and New Zealand.)

The average center charges between $5,000 and $10,000 for the treatment, sometimes more, which for Juliana, who regularly depleted her savings to sustain her dependency, was an inhibitive sum. But after her Bogota experience, and with the support of a close friend, she decided to turn to her mom, who at the time was unaware of the latest relapse. Her mom was “100 percent on board” and offered to cover the cost.

Among the drugs used in withdrawal treatments, ibogaine is unique. Most substances administered to patients in rehab are intended to temporarily allay withdrawal pains. The name of the practice, “substitution therapy,” already implies its flaws (ones with which Juliana was well acquainted). Ibogaine treatment, in contrast, goes after the addiction itself. It puts people into what’s often described as a “waking dream” state, with effects lasting for more than 10 hours.

“It’s not a hallucinogen like LSD. It’s not like you’re sitting there awake watching the trails on the wall,” describes Dana Beal, one of the world’s leading ibogaine activists who has experienced the effects of ibogaine firsthand. “You close your eyes and go into a waking dream. You’re paralyzed because you can’t summon the will to move. You just want to lie in a quiet room, left alone to review your lifetime of memories.”

In one small study, published in The American Journal of Drug and Alcohol Abuse in 2018, 50 percent of patients reported not using opioids in the previous 30 days at the three-month check-up following their ibogaine treatment. In comparison, says Ken Alper, associate professor of psychiatry and neurology at NYU School of Medicine, one-third to half of patients fail to even complete detoxification treatment using methadone, buprenorphine, and klonopin, today’s three most common drugs for opioid withdrawal symptoms. Among the people who do complete detoxification with these drugs, roughly half are still sober after four to five months.

“[Ibogaine] is the anti-drug,” says Beal, who along with researchers Howard Lotsof and Norma Alexander, studied ibogaine’s therapeutic effects. “You come out and you don’t want to do any more ibogaine, and you don’t want to do a lot of drugs after taking ibogaine.”

“[Ibogaine] is the anti-drug, You come out and you don’t want to do any more ibogaine, and you don’t want to do a lot of drugs after taking ibogaine.”

The marvels behind the workings of ibogaine have occupied researchers and activists, including Beal, since 1962, when Lotsof, a 19-year-old film student and dependent heroin user, took the then-legal psychedelic for recreation, only to find himself, to his incredulity, not experiencing withdrawal. Lotsof made the study of ibogaine his life’s work.

“With nothing more than an NYU film degree, he persuaded the National Institute on Drug Abuse to conduct a research program on ibogaine to the tune of $2 million in the early 90s,” says Alper.

Attempts since then to develop ibogaine into a legal medicine have largely stalled, however. Despite its promise for opioid addiction and other substance dependencies, there have been no double-blind, randomized clinical trials investigating it. (All the data that does exist is based on interviews and surveys with both subjects who have done ibogaine and the people who have administered it.)

Many people believe that this is due to ibogaine’s risk of fatality, but, according to Alper, the government-approved research in the 1990s merely ended in contractual and intellectual property disputes. In 2009, Alper sought to compile all available data about ibogaine-related deaths. He counted 19– out of an estimated almost 4,000 ibogaine treatments worldwide. Most of these deaths, he explains, were likely preventable and a result of improper medical supervision. The majority were caused by arrhythmias, a problem with the rate or rhythm of a person’s heartbeat which can occur when someone with a pre- existing heart condition, seizure disorder, or other condition, takes ibogaine.

Even still, ibogaine clinics have been sprouting up, many of them established by people who have had their lives changed by the drug. Almost everyone who ends up at one, says Alper, is someone who, like Juliana, failed to find success with currently available addiction treatments.

Juliana chose a clinic in Guatemala. Overseen by a man she describes as a “wild, mad- scientist cowboy of ibogaine with a good heart and a bad reputation,” it violated every possible safety check, including not waiting enough time for the opiates Juliana had taken to leave her system before giving her the ibogaine. She went into cardiac arrest, was rushed back and forth between four different hospitals and quite nearly became a statistic in Alper’s research.

But she didn’t. And when she woke up, she wasn’t in pain, she wasn’t going through withdrawal.

“It was miraculous. It was unbelievable,” she says, her voice still redolent of that initial disbelief. “In that moment it became clear to me that the years I spent struggling with drugs were really my training to do the work I was supposed to do. I felt so excited that I was going to embrace these experiences that make people feel ashamed, and use them to help other people.”

In the US, the phrase “opioid epidemic” has become tragically mundane. In 2017, the year President Donald Trump declared it to be a “national emergency,” over 70,000 people died of overdoses. That’s more than the number of Americans who died in the entirety of the Vietnam War.

Ibogaine advocates—like Juliana and Beal— have their work cut out for them. But if they’re right, the implications might extend past opioid addiction—to addiction itself.

“If you understand opioid addiction, you’re going to discover things that are helpful for other addictions, as well, because of the very fundamental nature of opioid addiction,” says Alper. “There is a lot of evidence in eating disorders or other compulsions that there’s an involvement of opioid signaling.”

Alcohol, sex, even screen-gazing, all have been related to opioid signaling in the brain. If ibogaine alleviates or reverses some of the changes in brain cells caused by addictive behavior, what might it reveal about why people become addicted in the first place?

“Ibogaine isn’t about finding one treatment for addiction: It’s about understanding the nature of all addiction,” Alper says. “Ibogaine is about understanding addiction itself, and based on that understanding there is a prospect for the development of fundamentally new treatments.”

“Ibogaine isn’t about finding one treatment for addiction: It’s about understanding the nature of all addiction…and based on that understanding there is a prospect for the development of fundamentally new treatments.”

Alper doesn’t think, however, that ibogaine is going to be it. As an alternative, he’s helping Canadian company Mind Medicine Inc. (“Mindmed”) research 18-methoxycoronaridine (18-mc), a synthetic derivative of ibogaine developed in the early 90s to avoid ibogaine’s risks and hallucinations. In September, the company announced they’re planning to investigate the drug for opioid use disorder.

A pharmaceutical company, Alper says, is unlikely to invest in ibogaine because it’s a naturally-occurring chemical and can’t be patented for profit. And even if they did, the FDA probably wouldn’t approve it because of its risks.

This, he says, speaks to a much larger bias in our society, something which former NIDA director Alan Leshner famously called “the great disconnect.” Stigma, says Leshner, has created a situation in America where substance dependence is treated as pathological rather than as a “chronic, relapsing, and treatable illness.”

For Alper, misgivings about ibogaine are the exemplar of the great disconnect.

“Yes, ibogaine has dangers, but what about the gravity of untreated dependence?” he says. “If you’re developing a cancer treatment like chemotherapy, you’re going to tolerate serious side effects. Addiction being a life threatening condition is not fully factored into our tolerance for risk.”

DoubleBlind: Image ibogaine molecular structure tattooed on arm. In this article, DoubleBlind explores using ibogaine to treat opioid addiction.
Photo by Robert Rieger

After her treatment, Juliana returned to the US. For the first time in her life, she was working and saving money, which she used to go back to school. She took an EMT course, and spent some time in South Africa, Costa Rica and Mexico training and working in ibogaine clinics. She finished her undergraduate degree at the New School in New York and got the ibogaine molecule tattooed on her left arm.

Ever the globe-trotter, she has returned to Brooklyn from living in Berlin, where she helps people prepare for and process their ibogaine sessions through her consulting business Inner Vision Ibogaine Coaching; provides over-the-phone counseling and support for people who seek to overcome their own substance use issues; and is the Psychedelic Program Coordinator for The Center or Optimal Living.

“I talk openly about the horrible shitty details of what I’ve been through, and do that as often as I can,” she says. “Bit by bit, it hopefully chips away at the stereotypes.”

At the suggestion that she’s in the business of helping people, Juliana balked. The only real sickness in need of curing, she reiterates, is the societal one.

“We live in a society that supports emotional suppression, teaching people that what they’re feeling isn’t legitimate. Productivity is the main priority. You have undealt with trauma leading to substance addiction, or to shopping addiction or sex addiction,” she says. “What people really need is community. They need love. They need to be heard and their stories to be valued. And typically that’s not what’s offered by our society.”

But Juliana is quick to distinguish that she’s “not rescuing” anybody. “All we do is help people help themselves,” she says. “Ibogaine is not a cure. It’s not a magic bullet. It’s a door opener into a new path and people still need to be responsible for doing the work themselves.”

Adaam James is a journalist and videographer currently working on Axios on HBO. He has previously worked at CNN and NBC News. He writes music under the name “Lost Amsterdam” and blogs about the end of the world at uncertain.substack.com.

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