Heroin Addiction

Dying to get clear: is ibogaine the reply to heroin addiction? – The Guardian

A At the age of 12, Jay smoked cigarettes and weed; at 16 he snorted coke; Two years later, he took heroin and crack – but when he left college, he was a "functional drug addict" who could get up in the morning, put on a suit, and travel from his parents' home in north London to work in the city as a banker.

Then his marriage broke down; his health deteriorated; he was addicted to the powerful pain reliever tramadol after an unrelated surgery on his stomach; and when the doctors stopped that dose, he replaced it with heroin.

Jay checked into a £ 10,000 weekly rehabilitation center in Thailand in 2016 that kept him clean for a while, but then started using it again. A friend had told him about Ibogain, a drug from an obscure African plant that would allow him to drop heroin without the lengthy, painful withdrawal – and stay away. It would help him understand why he was addicted, his friend insisted that he "talk to God".

Curiously Jay started searching the internet for ibogaine, but when he dived into a rabbit hole he found horror stories: he read that it slowed the heart to dangerously low levels; that it was unregulated and was issued by unscrupulous providers, most of them former addicts; There were stories of people with heart attacks. Then there were the deaths.

The use of ibogaine was restricted in the UK last summer when the Psychoactive Substances Act came into force – comprehensive legislation to combat public panic over synthetic marijuana, or so-called legal highs. But the rehab hadn't worked for Jay and he refused to try methadone ("a terrible drug. I saw what she does to people and I didn't want to replace one addiction with another"), so he booked a flight Durban, South Africa, for treatment at an ibogaine clinic that he thought was real.

Bitter medicine: Dr. Anwar Jeewa with Howard Lotsof at an Ibogaine conference in Washington DC

One day before his flight, he stopped taking drugs as directed by the clinic and began to experience withdrawal symptoms at the airport. "It's like the worst flu you've ever had," he said. "Your bones hurt inside. You shiver and you are cold, then you are hot, you sweat, you cannot eat, you vomit – from both sides. "

Ibogaine, Jay believed, was his only hope.

The Tabernanthe iboga plant grows in the Gabon rainforest. It's a green leaf shrub with fruits that look no different than fat, orange jalapeño peppers, but it's the bark of the root from which you extract ibogaine. It has been used for centuries to evoke visions in the participants of the Bwiti ceremony, a traditional ritual of growing up as a tribe, in which hallucinogenic visions are understood as death and rebirth. They believe that Iboga enables them to communicate with their ancestors (bwiti is roughly translated as ancestor).

According to the Global Ibogaine Therapy Alliance, which publishes research and information on ibogaine, this ancestral worship of Gabonese tribes says that by learning the language of the spirits of things, it is possible to communicate with God.

Stopping heroin is like the worst flu you've ever had. Your bones hurt inside

Jay

Researchers brought a specimen back to France in the mid-19th century, and 60 years later, ibogain was marketed there under the name Lambarène for use as a stimulant. In 1985, a man named Howard Lotsof was granted the first US patent for the treatment of opioid addiction – two decades earlier, Lotsof had been addicted to trying ibogaine for the first time. "The next thing I knew," he told the New York Times in 1994, "I was straight." But it remained banned in the United States, although it was advertised on the internet as a miracle cure for opioid addicts in the late 1990s.

In September of this year, 20 experts – some with a medical background, other providers or activists – gathered at an Ibogaine conference in Vienna to raise awareness of the drug and promote more research in Europe. But is it the miracle cure that some claim? Or is ibogaine restricted in the UK and banned in America for a reason – a dangerous drug administered by charlatans with little or no medical knowledge?

I met Jay one afternoon in a cafe near his home in north London. He initially found a clinic in Mexico online and skyped it with the owner, but was quickly discouraged. He showed me an email correspondence with the facility. The cost of the seven-day addiction program was "typically $ 8,000 [£5,900] but I could credit $ 1,000 for your flight," an email said. “I would need a $ 500 refundable deposit for a credit card. The remaining $ 6,500 can be paid by bank transfer or bank check. "The man added that his nurse could do the health screening via Skype or email.

"I just didn't feel comfortable," said Jay. "There are many retreats in Costa Rica and elsewhere, but it seems they are trying to make money quickly, be it from a hippie trying to make a life experience or from an addict."

Root of the problem: a Gabonese man with an iboga bush from which ibogaine is harvested. Photo: Laurent Sazy

Finally, Jay found someone he could trust – a man named Dr. Anwar Jeewa, who ran a clinic in South Africa. Jeewa, "a mid-50s boy with a white beard," was waiting for Jay at Durban airport when he arrived, and immediately gave him a dose of morphine for his withdrawals. "He was very relaxed. He had clearly done this a couple of times, "said Jay.

On Monday morning, Jeewa Jay gave a test dose of ibogaine – a brown plastic capsule to swallow with a glass of water. An hour later, Jay felt that his retreats had disappeared. The next 12 to 18 hours were a blur, but he remembered a nurse giving more pills – eight in total. "I lay there and couldn't move, almost paralyzed. And every time I closed my eyes, I started to think and dream. "He particularly remembers a vivid dream:" I could see a woman, almost like Mother Maria, who shook a finger at me. She offered to take me everywhere and I said, "No, no, no."

Jay now believes it was a sign: “I have a co-dependent relationship with my mother. We love each other down to the last detail, but I need your confirmation and I don't get it, so I make it to other people or I'm annoyed. "That, he told me, was one of the reasons why he kept turning to drugs.

In the 24 hours after treatment, those who took ibogaine talk about what they call "gray days". "You feel sluggish and shitty and your legs don't really work," said Jay. But a day later “experience pure exhilaration. You find that you are no longer dependent on anything. Even a cup of tea with sugar tastes terrible. "

We have had ibogaine deaths, but that's because people only treat themselves at home.

Dr. Anwar Jeewa

Jay flew home and in the 10 months since he had no relapse. "I was recently at a bachelor party and all my friends were taking cocaine and I didn't. I couldn't have said no earlier. I developed a new feeling of trust. I have a new job, a new friend. I feel like an actually functioning member of society. "

Jay has become an Ibogaine evangelist, but there is a limitation. His heart throbbed shortly before his flight home, and when he was back in England he was hospitalized and diagnosed with a congenital heart problem – something he said could be worsened by taking ibogaine.

A review of the medical reports published in 2015 on heart problems related to ibogaine found that "alarming reports of life-threatening complications and sudden deaths" have accumulated related to ibogaine. The review found that it not only lowers the heart rate, but also interacts with the heart's electrical signals – which probably explains the "potentially life-threatening cardiotoxicity of ibogaine [damage to the heart muscle]".

It is estimated that one in 400 people die from taking ibogaine because they already have heart problems, seizures due to acute withdrawal from alcohol or other drugs that are not recommended for treatment with ibogaine, or from taking opioids during treatment influence of ibogaine.

Jay told me that prior to his treatment, he had not had an EKG to check for heart problems and that Jeewa "skipped something that he shouldn't have". An EKG could have uncovered his heart defect, and if it had, he probably wouldn't have gone through it.

"I saw faces from the past": Jeremy Weate, who participated in an eight-day Bwiti ritual in Gabon.
Photo: Courtesty of Jeremy Weate

From his clinic in South Africa, Jeewa told me that what happened to Jay “only happens in 1% of our cases. That's why I don't let myself be burdened. I always think if you have a heart or liver problem you will know before you come to me. "

Jeewa, who insisted that his protocol be safe, said that he usually asks patients to come to his clinic a day earlier, and that he now has a family doctor in the clinic and installs ECG monitors in each room . He said he was concerned about non-medically trained ibogaine providers. "Ex-addicts take ibogaine and then they have to save the world and help people," he told me. "Here are the problems. These guys have no medical background."

Jeewa, who trained as a dentist and is a former addict himself, said that in his experience, mainstream doctors are skeptical about ibogain and fear that if they prescribe it to patients, they will lose their medical approval: "We have ibogain Deaths, however, are due to charlatans and the fact that people treat themselves at home with ibogaine, which they buy online. "

I have seen it for 20 years. How many official clinics are there? None. Ask yourself why

Edward Conn

Currently, people without medical qualifications make up the lion's share of ibogaine suppliers. I spoke to another man who, like Jay, researched ibogaine treatment online before deciding to go for one in Europe. Aden, who lives in Luton, paid € 5,000 to send his brother to an ibogaine detoxification center on the continent, but he says his sibling has almost died. His brother, in his early 30s, flew there with his mother. When he got to the clinic, he got a cup of magnesium and said it would clean his stomach. "They asked Mama to go and locked him in his room," said Aden. "He was left there to feces all night and urinate on himself."

The next morning, Aden said that his brother had a stomachache and informed the staff at the center that the ibogaine was not working and that he was still suffering from withdrawal.

"The next evening it was the same – he didn't respond and had really bad hallucinations. In his mind he kept seeing our uncle who had committed suicide and it frightened him. So they gave him THC oil [the active ingredient in cannabis that produces a high] It was a really unprofessional place. "

Aden said his brother had received more and more ibogaine because they could not find out why he was still retiring. On the fourth day, his mother told the clinic that she had to take Aden's brother to a hospital. "When they got there, the doctors were angry with mom," he said. “They knew the clinic because their patients were hospitalized all the time. They gave my brother charcoal to free him of all the garbage they had put in him and immediately started using methadone again. "

Aden said his brother, who had difficulty breathing, was diagnosed with chronic obstructive pulmonary disease (COPD or lung disease) and a gastric ulcer on the edge of the perforation. If his brother had previously had a proper medical exam and had been treated by a healthcare professional, this would not have happened. The Ibogaine Clinic returned half of the money before the people who ran it stopped responding to Aden's emails.

"I think Ibogaine can only be successful if many factors are met," said Aden. "But I now understand why it is so licensed and banned in some countries."

Ibogaine works for some. It is most effective for people who have abandoned their drug-consuming lifestyle

Edward Conn

Anwar Jeewa, the Darwin-based provider, told me that Ibogaine works with short-acting opiates like heroin, morphine and opium, but not with synthetic opiates like methadone or buprenorphine. He said the quality of ibogaine was also different and he had even seen fake iboga bark being sold. "There is no quality control, no consistency," he said.

Jeewa insisted that ibogaine would not have worsened Aden's brother's COPD or stomach ulcer, but since he was a drug user before taking ibogaine, his body was impaired. "Consuming heroin puts a strain on your body – and some people get stomach ulcers because of opiate damage."

He said opiates are essentially pain relievers, so you may not feel the symptoms of these stomach ulcers (or other conditions), but as soon as you stop taking them – and then take ibogaine to treat the addiction – these ulcers can flare up.

In the United States, ibogaine is a List 1 substance that, like heroin, is described as a drug "without currently accepted medical use and with a high potential for abuse". The situation is similar in some other countries, but in most cases it is not regulated – neither illegal nor officially sanctioned. The situation is more complicated in the UK. According to the Interior Ministry, a supplier (with a maximum sentence of seven years) can be prosecuted under the Psychoactive Substances Act of 2016 if ibogaine is administered for its psychoactive effects. However, the law contains exceptions for recognized scientific research "and for health professionals who act within their obligations".

The General Medical Council, which sets standards for physicians in the UK, recommends that they be satisfied that there is sufficient evidence of their safety when prescribing unlicensed medicines. Professor Colin Drummond, chair of the addiction faculty at the Royal College of Psychiatrists, said that although it is technically possible to prescribe an unlicensed drug like Ibogain: "It is an experimental drug and is therefore not recommended as a treatment."

Jeremy Weate, a British development consultant whose own experience led him to help organize the recent Ibogain conference in Vienna, believes that hysteria over the war on drugs in the United States has resulted in a blanket ban, while in the UK the Psychoactive Substance Act has failed addicts who could benefit from it.

Weate, who is not addicted but interested in the healing properties of plants, wanted to experience Ibogain himself, but through the Bwiti ritual in Gabon. Last year, he paid € 3,000 to fly to Libreville and attend an eight-day ceremony. It consisted of ritual bathing, inhaling the smoke from burning herbs for several hours and eating ibogarinde ("It tasted worse than sawdust"). Afterwards he said that he was in a dreamlike state for more than a day and saw faces of "photographic quality" that seemed to be from the past, talking to a higher female spirit who seemed to know everything about me. "

"Ibogaine carries risks," he said, "and you have to take it very seriously, but it's the most successful opioid addiction drug – methadone or heroin. The ban doesn't work and this is an opportunity for the government Play to be one step ahead. "

Not everyone is convinced. Edward Conn, a consultant who is now based in the north of England, administered ibogaine at his home in London before the Psychoactive Substances Act left the drug in a kind of legal limbo, and today he is far from the cheerleader he used to be . "In terms of treatment, the scene is a mess at best," he told me, adding that Ibogaine was being overwhelmed, risky, and persecuted by extremely vulnerable people. “There is no shortage of people who are impressed by reports of ibogaine remedies. I've seen it for 20 years. How many official clinics are there? None. Ask yourself why. "

Ibogaine, Conn said, was now offered for every illness under the sun, "from a bad mood to grief, fear of ADHD to pure self-interest". It particularly targets those who believe that it somehow teaches people about their addiction by giving them deep insight into their psyche and saying, "Ibogaine is a chemical, not the embodiment of an anthropomorphic mind," who, like he said, "the position of pre-rational New Agers and their magical thinking."

I now understand why it is so heavily licensed and banned in some countries.

Aden

According to Conn, however, at best Ibogain can change the direction of a person's drug use and give the user the opportunity to get clean. “Ibogaine works for some. It is most effective for people who have stopped their drug-consuming lifestyle and are stable with low-dose methadone, and least effective for those who still use drugs. "

What is the answer for people like Jay who see ibogaine as the only solution? An American pharmaceutical company believes it knows. Savant HWP has started developing a drug that mimics the effect of ibogaine on addiction, but without its hallucinogenic properties or dangerous side effects: 18-MC is scheduled to be tested in humans early next year.

"When we carried out the first human tests, there was no evidence of psychoactive effects or arrhythmias," said Stephen Hurst, CEO of Savant. He said they chose Brazil so they didn't have to deal with the bureaucratic hassle of testing a List 1 drug. But what about the addicts I spoke to who doubted 18-MC would work because they said, "Ibogaine without visions is like wine without alcohol"? Hurst said that 18-MC in animal studies appears to reverse the underlying brain disease that is at the heart of addiction.

"No treatment approved today does this," he told me. "All treatments today are substitution therapies – for example heroin with methadone." But 18-MC displaces dopamine in the brain's reward centers. In other words, your brain will tell you that you won't get anything pleasant with a fix.

“It is completely new and that is vital. We are still working on raising money and my entire retirement went into the program, ”said Hurst. “We have the potential to make a big difference here. I just wish the patients didn't have to wait any longer. "

Some names were changed

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