Written by Ian Fignon ’13, alumnus of the University of Connecticut SSDP Chapter.
What if current drug laws prevented the use of a substance capable of significantly reducing opioid addiction with a single dose? Despite opioid overdose being the leading cause of death for Americans under 50 – with 91 Americans dying every day from opioid overdose [IF1] – overly strict drug laws and outdated addiction approaches have restricted the medical response to the current opioid epidemic. Traditional addiction treatment used throughout America remains largely ineffective; estimates place Alcoholics Anonymous’ success rate around 1 in 10. [IF2] The startling death toll and low success rate of current rehabilitation serve as a clear signal that new treatment options are needed. Ibogaine is one such option. Yet a proper understanding of ibogaine’s full potential in treating opioid use disorder remains unclear due to the drug’s prohibition as a Schedule-I substance. Research supporting ibogaine’s ability to help people with opioid use disorder endure withdrawals and cravings and remain abstinent first came out in the 1970s. In the past few years, a recent wave of studies has renewed medical interest in the drug’s addiction-fighting potential. A 12-month long, 2016 study done in New Zealand supported previous research and documented ibogaine’s clinical efficacy. Researchers concluded “ibogaine treatment reduced opioid withdrawal symptoms and achieved opioid cessation or sustained reduced use” at rates comparable to currently accepted treatments[IF3] . Those currently accepted treatments, however, require repeated administration. Ibogaine treatment only requires a single dose. Mounting evidence suggests ibogaine might actually be even more effective than existing treatment options. While ibogaine’s single dosing increases treatment flexibility, a 2016 study in Mexico showed ibogaine outperforms currently accepted treatments in keeping opioid users abstinent. 30 days after treatment, 50% of subjects treated with ibogaine reported no opioid use; buprenorphine and methadone detoxification figures after 30 days are usually around 18% and 26%. [IF4] Ibogaine treatment produced significantly higher abstinence rates, even among subjects previously treated for substance use disorders. Expanding possible treatments means increased options, more individualized medicine, and improved outcomes. Effectively combating opioid use disorder requires the further exploration of promising medicines like ibogaine. Previous research into ibogaine steered the medical community away due to concerns over drug effects. The most controversial element of ibogaine treatment is the drug’s psychedelic effects. Ibogaine consumption brings on visual and auditory hallucinations often described as a dream-like state. While ibogaine’s psychoactive effects raise pertinent abuse concerns, this is not a reason to outlaw its regulated medical use. Without need for repeated administration, ibogaine’s use can be restricted to the medical facilities where treatments occur – another advantage over other opioid use disorder medications. Another major concern with ibogaine treatment is drug safety. Based on recorded fatalities, ibogaine’s mortality rate is estimated to be near 1 in 400[IF5] – notable, but comparable to the mortality rate of accepted treatments like methadone[IF6]. New studies have concluded known deaths after ibogaine consumption were due to “torsades de points (TdP) arrhythmias” resulting from “advanced preexisting medical comorbidities, primarily cardiovascular.” [IF7] Though drug safety is paramount, drug safety must be considered alongside drug efficacy. Ibogaine treatment could easily include cardiac screenings to assess safety. Eliminating ibogaine as a treatment option does not make sense for an issue as deadly and pervasive as opioid addiction, where continued use may result in the use of diseased needles or a potential overdose. Drug safety concerns related to ibogaine have merit, but fail to outweigh the drug’s potential benefits in treating opioid use disorder. Under the Controlled Substances Act, ibogaine is classified as a Schedule-I controlled substance without currently accepted medical use. This legal framework prevents ibogaine’s use as a medicine despite its established efficacy in treating opioid use disorder. Though the CSA allows research to be conducted on Schedule-I substances, its lengthy and costly process – which requires DEA approval, upgraded security, and compliance with increased regulations – dissuades investigation. Drug laws like the CSA were not designed to stymie the exploration of new medicines and prevent medical progress. Though ibogaine has risks, research has proven the drug’s unique ability to reduce opioid withdrawals and cravings. Ibogaine is not some silver bullet for the opioid epidemic. Other undiscovered drugs could provide safer and more effective treatment, but right now such speculative options have a high daily death toll attached to them. Medical regulation is designed to protect patient safety; however, when medical regulation limits the exploration of more effective treatment options, as with ibogaine, it ends up harming patients. Ibogaine’s promising results warrant further study, and its medical potential should not be stymied by strict drug laws. In the face of the current opioid crisis, America needs medically sound drug policies that protect without hampering healthcare. [IF1]CDC
[IF3](Noller, Frampton, & Yazar-Klosinski, 2017)
[IF4](Brown & Alper, 2017)
[IF7](Noller, Frampton, & Yazar-Klosinski, 2017)