Ibogaine

Simon Witter

A shorter version of this article appeared in the Times (London)

It may change society and save the lives of hundreds of thousands of people (at a conservative estimate), but ibogaine development is being tied up in a bitter legal war that has already almost ruined the man who discovered it. Is this the blessed chalice, the cure to drug addiction and more? Is it the greatest pharmaceutical discovery of the late 20th century? Or will it turn out to be just another story of a maverick visionary being shafted, and all benefits lost to mankind? Simon Witter investigates....

Suzie's head felt like it had been split open. Light was everywhere. She could see her cleansed brain, and it shone with a brightness that was hard to look at, but she knew she must try. Images flickered around the screen of her consciousness, illuminated one-by-one by a dazzling beam of light, which moved on speedily, picking out new subjects with a relentlessness that she coud not control.

Suzie is entering the second phase of a 36-hour experience that may well cure her addictive behaviour for ever. A few hours ago she took a dose of ibogaine, and now she lies in a waking dream, being ravished by dramatic visions that she must interpret to make sense of the way her life has turned out. Suzie’s hope is that, without suffering the pain of withdrawal, she will wake from this trip and never feel the need to take heroin again. The evidence of hundreds who have gone before her point to her chances being very good.

Ibogaine, an alkaloid derived from the root of the african plant tabernanthe iboga, is a hallucinogenic substance used in the initiation ceremonies of the Gabonese Bwiti society. In the 90s, its ability to block opiate withdrawal symptoms while delivering intense therapy has put it at the centre of a raging scientific debate. If it can be brought to the mass market at an affordable price, and if it works as well as its many advocates claim, ibogaine's potential is quite extraordinary. Painlessly curing opiate addiction is in itself one of the holy grails of the medical world, but the ibogaine experience is also said to be highly effective in curing cocaine, alcohol and even tobacco addiction, as well as a variety of other addictive behaviour patterns.

Around 300 people have been treated with ibogaine this decade but, at present, it remains an extremely expensive affair. While it is legal everywhere else, ibogaine is restricted in Belgium and Switzerland and illegal in the US where, ironically, it is classed in the same category as the hard drugs from which it provides relief (a result of the panicky, post-psychedelia 1970 Controlled Substances act).

The three main players in the world of human ibogaine treatment are Howard Lotsof, Dr Deborah Mash and Eric Taub. Lotsof, the man responsible for the new interest in ibogaine, occasionally treats people in a 7-day hospital programme in Panama at a cost varying from $8,000- $20,000, while University of Miami neuro-pathologist Dr Deborah Mash has established a competing 14-day programme in St Kitts ($10,000). Devout ibogaine advocate Eric Taub used to treat people on a boat in international waters. He now has clinics in Costa Rica and Italy ($2,200), and is the source of most satisfied experience reports.

There may be up to a dozen underground outfits in the Taub mould, and the internet occasionally features mail-order deals for the crude botanical (root bark) from Africa, but until ibogaine is legal, affordable and widely available, the people taking it will largely be the priviledged rich, in many cases paying through the nose to be research guinea pigs.

"I remained at each level until I was comfortable with it", remembers Bob, one of Taub's patients. "Then a very strong wave hit me and things began to escalate rapidly. There were sapphire blue tendrils that moved up the wall and became flowers, as well as other moving configurations of light. They were beautiful. I began to hear music, voices, a cacophony of other whirring, drumming, and creaking, rushing sounds. Although I was scared, I liked it. It seemed that things remained awhile until I got comfortable, then went beyond anything I had ever experienced. I was floating in a sea of physical sensations and began to close my eyes. I saw a whole universe behind my eyelids which I can only describe as the creative mind. My eyelids were the window to an array of visions floating in a void."

"The whole time my normal thought processes continued and things or people would appear visually or music would play if I thought of it. I had a sense that things I needed to find or understand were located in this mind, also that thought creates an infinite number of realities. I could open my eyes and still had a sense of being in the room but the hallucinations there were extraordinary. I felt through all of this that I might be resolving a number of different conflicts within myself very rapidly, that Iboga was teaching me. I began to sense a threshold, a jumping off point if you will, that would totally disconnect me from this reality, but at the same time I would resolve my deepest conflicts. I would reconnect to something I've lost; I would see the face of God. I became terrified, fearing for my life and sanity, and I vomited, which immediately pulled me back from the threshold."

As wild as this memory of an ibogaine trip may sound to the average reader - and it is by no means the wackiest of the many different experience reports circulating - it is just one of a hundred first-hand testimonies to the effectiveness of a new drug that is provoking a flood of scientific interest. There have been around 4,000 research papers on the subject so far, including snappy, layman-friendly stuff like: "Quantum Coherence in Microtubules: A Neural Basis For Emergent Consciousness?".

In the 1950s and 60s, American psychologist Leo Zeff and psychiatrist Claudio Naranjo were using it in their practice, and chemical giant the CIBA corporation (now CIBA-Geigy) was investigating its usefulness as an anti-anxiety drug, but ibogaine's potential to painlessly release people from the craving for drugs was discovered quite by accident.

In 1962, Howard Lotsof - a Jewish film student from New York - was given a single dose of ibogaine. Deciding that a 36-hour hallucinogen sounded too exhausting for him to want to take, he gave it to a much more experienced friend, who came back and told him that this was a completely new kind of drug. Howard was part of a focus group of 20 or more friends self-experimenting with psychoactive drugs like Mescaline, DMT, psilocybin and LSD (all legal at the time). Some of the drugs were euphoriant, some weren’t. They took ibogaine as part of that experimentation, with no intention whatsoever of giving up any kind of drug use, but 33 hours later Lotsof discovered that he was no longer dependent on heroin. For six months after that one dose he also stopped taking cocaine and all other drugs. The effect on the rest of the group was much the same.

Lotsof was 19 at the time, and knew very little about pharmaceutical development, so nothing became of this accidental revelation. As an active member of the counterculture, he spent the 60s ferrying student strikers from one area to another during the Free Speech Movement in Berkeley, California, re-acquainting himself with heroin in 69 and finally detoxing and stabilizing his life in one of the first methadone programs in 1970, after which he ran a plumbing business in New York, studied film and television again and worked as a line producer for Rock Against Racism concerts. But in the 80s he began to feel that his youthful discovery was "too important not to pursue", and started hunting for pharmaceutical grade ibogaine to conduct research with. In 1986 he had founded a New York corporation, NDA International, Inc., whose purpose was partly a humanitarian mission and partly the marketing of a proprietary pharmaceutical preparation, Endabuse, composed of capsules of ibogaine hydrochloride. He had filed patents for the use of ibogaine to treat addiction, and was well on the way to bringing this treatment to the needy millions.

Initial, over-simplified reports of the way ibogaine works suggested that the subject re-lived their entire childhood in 36 hours, during which they identify the holes they are filling with their addictive behaviour. Having understood why they're behaving this way, they wake up cured of those urges. If one dose of ibogaine really did deliver a lifetime of therapy, it would be quite simply the greatest pharmaceutical breakthrough of the late 20th century - curing all addictions, and thereby not only freeing up all the millions tied up in fruitless drug wars, but also putting therapists all over the planet out of work.

"During my look into the void," says Bob, "I had seen all of my loved ones who are still living, and had the experience of vignettes of my relationships with them, accompanied by a profound and compassionate love. In this, my second much less dramatic phase, I lay in bed for 12 hours, experiencing hundreds of vignettes, very much like day dreams, but more vivid and in great detail. The difference was the rapidity and incredible number of vignettes and their detail and sometimes very abstract quality. These daydreams eventually just devolved into mind chatter that became annoying. I got a little something to eat, and read myself to sleep. I awoke feeling refreshed, ten years younger, and more at peace than I have been in years. I also have a sense that there are more things in heaven and earth than our eyes have ever seen."

"Ibogaine does not preclude the need for therapy," Lotsof insists. "Quite the opposite. It opens up the soul of the most repressed person, freeing old memories and making them immediately open to intense therapy. Part of the resistance to ibogaine may be that it requires doctors and therapists to work very much harder over a short period. There's no saying: 'I have a space for you next Thursday'. Someone who has taken ibogaine is ready to go right now!"

Ken Alper MD, assistant professor of psychiatry and neurology at New York University, has no problem with the spacier descriptions of the ibogaine experience: "I crossed the threshold of belief," he says, "when I saw a young man go down to Panama on 70mg of methadone a day, and come back on nothing. And he was comfortable. Pharmacologically, I don’t know any other substance that can do that."

It should be noted that, while the vast majority of ibogaine experience reports are very positive, the drug does create very different experiences in different people, and some recipients have been quite the opposite of happy with the results. Janet, a Californian alcoholic who paid $10,000 to undergo ibogaine treatment (along with ten heroin addicts) as part of Dr Mash's St Kitts programme last December, remembers it not working at all.

"It's like acid times one million. I was also seeking God in a pill" along with all of the other entheogen advocates. I saw God alright - I talked to him. And I was so sure it was real. But it wasn’t. It wasn’t an all-loving God. It was someone who scared the crap out of me. Some of the "addicts" became Jesus Christ and were crucified or had aliens rape them. Ibogaine worked for me for a month - you know why? Because it makes you so physically sick you can't even stand the thought of eating, much less drinking or doing drugs. The "visions/trip" were so excruciating I never wanted to be altered again. I felt I was near death during the trip because I was having trouble breathing. "God reminded me to breathe. The embarassment of paying such a price for a bogus deal. (I was told there was a 100% success rate with alcoholics). Those are the reasons I was able to go a month without a drink."

"I understand that there are people who believe ibogaine ended their respective addictions. Great! I would have loved the same results. But, it didn't work for me, and it didn’t work for anyone else that I met who took it. After you are given ibogaine, you are supposed to follow up with antidepressants and therapy. If ibogaine ended addictions, why in the hell would you need anything after it?! All I’m saying is that addictions are tough. And so far, there is no magic bullet - not even ibogaine."

So just what is the success rate for ibogaine treatments? "If you're looking at opiate detox," says Lotsof, "I'd say almost 100%. If you're talking about interruption of chemical dependence, I'd say 10% are immediately cured, 10% aren't cured at all and the rest require three to four treatments over a two year period, because we're not just talking about a pharmacological reversal of chemical dependence. Chemical dependence is a learned behaviour that has to be unlearned. Ibogaine is an unlearning tool, as well as a substance that blocks narcotic withdrawal."

Good therapy is something all ibogaine patients stress as being a vital component of treatment. "The longterm successes of ibogaine have been compromised," according to Ken Alper, "by the lack of a systematic plan before and after the experience. Ibogaine just buys you a window of time. It doesn't substitute for therapy. It's like a near death experience - white light, a torrent of information that allows you to review your life and unstring associations from their obsessions. But how you interpret that is crucial."

"It is the best opportunity for psychological self-exploration and healing I have ever experienced," says Laura. "But it is not a penicillin shot, where the healing is done unconsciously. It requires cooperation. The most significant gift I have received from Iboga is the freedom to play without guilt. I am much more vitally in touch with all of life, less separated, more unified. I have a more awakened sense of taste and am enjoying flavors with a heightened pleasure. I am in awe of the intricacy and beauty of nature in an ecstatic way. I no longer feel a need to fix anything in me or anyone else, no need to accomplish anything although I may do either: I am relaxed into the simple joy of just being. For about seven days after my experience, I continued seeing the light energy flowing through all matter, particularly upon awakening. It shimmered all around me and I could conduct its movement by waving my arm. What fun! Now, one month after the experience, I see myself as positive, confident, free and serene."

This sounds utterly fabulous but, during her experience, Laura also saw images of her own death and vomited the drug out, later regretting her failure to grasp the opportunity to "go through the death experience into the next dimension". Each patient clearly brings a lot of their own baggage to the ibogaine experience, but even some of the most subsequently-happy recipients have reported an element of terror, not to mention visions of the past, present and future co-existing. The idea of treating drug addiction with a psychoactive drug is one of the more controversial aspects of ibogaine - a possible hurdle on its path to mainstream acceptance - and, in view of the dramatic nature of the trip, it might be fair to assume that patients should be psychedelically experienced.

"I don't think so," Lotsof insists. "You can be naive to any other hallucinogens and simply receive the treatment. It's not an LSD-like drug. There are no significant mood swings. You're not going to experience significant euphoria or depression. It's very neutral which, to me, makes it a very safe drug. My concern would be people with cardiovascular disorders, because of the exhausting nature of the experience. To be awake for 24, 36, 48 hours, I don't want to place that kind of stress on a person who already has a serious medical condition. The data we're getting from the animal model suggest that ibogaine is actively an anti-seizure drug, but so far we haven't accepted anyone for treatment who has epileptic or seizure disorders. The patients most difficult to treat are those that come in with a focused anger. It almost overrides the psychiatric benefits of ibogaine. It's anger at somebody - that woman, that father, that mother - and throughout the entire experience they use that anger to focus on anybody but themselves."

Recent medical research suggests that ibogaine has a number of wondrous physical properties. Many patients have described the experience as being like a re-setting of their controls, and Ken Alper found that it physically did exactly that to the abnormal brain waves of crack addicts that he monitored before and after ibogaine ingestion. "Drug addiction is nature's sadistic joke," he explains. "The addictive brain is out of balance, its chemistry deviates from the normal. Ibogaine normalises the EEG, it resets the brain."

Patrick, a London-based multi-media visionary, has been disappointed by the emphasis on ibogaine as an addiction cure. "Nobody seems to be talking about its general usefulness as a tool of self-learning," he complains. But, while its power to attenuate opiate craving is so spectacular, many patients have been people wanting to revisit their past as opposed to get off drugs. "Ibogaine," Lotsof confirms, "is the most effective substance I've ever come across in terms of its use in psychoanalysis or psychotherapy."

Sarah Emanon, a therapist in her mid-50s who assists Eric Taub, has taken ibogaine three times herself, reporting spectacular success with her quest to understand her lifelong feelings of isolation. "I went back to being with my adopted mother as an infant while she was holding me. My head was bobbing, and my nose was banging into her neck - I could feel it physically. I can still feel it - it is such an interesting sensation. Then I smelled her, and it didn’t feel right. I can still remember that reaction. I didn't want to be near her. I was trying to get away because it didn't smell right........ For me, this was the beginning of owning my own process rather than projecting it onto others. I had had years and years of therapy, but I had never gotten to that piece. And I found myself witnessing that I had never bonded to that mother. And for the first time, I really experienced that lack of bonding, and why it never occurred: She didn't smell right, and there was no connection."

"I found myself asking the question: Can I remember my birth mother? And soon I was back in this other experience in which I was totally merged into another being. I could kind of feel my distinction, and yet not feel my distinction. I could kind of feel where I was this small infant, but I was part of this vast amount of soft skin also. And I could feel the warmth and the smell, and everything was me! It was bigger than me, but it was me. And I could feel this woman’s tenderness. And there were points where I could feel tears hitting my body. I could feel her sadness, and it was my sadness. It was a sadness I have felt throughout my life. Then there was the experience of being taken away and being alone. It wasn't particularly painful, but it was very alone. That was my deeper understanding of what it is that I do. There was nobody to take care of me, so I learned how to take care of myself, how to be okay, and be alone. And so, throughout my life, I would have to get alone to become okay. I would be with people and lose myself, and then have to go and be alone in order to kind of gather myself again."

Long before Ken Alper's brainwave research, Emanon believed that ibogaine reset the body's chemistry. "Somehow the ibogaine seems to effect some kind of basic change that does not depend on conscious insight and memory of what is learned during the session. My hunch is that while we are working with psychological process, there is a physiological, chemical change going on. For example, when working with hypnosis, and a person is in a trance, there is the possibility of reaching the memory on the cellular level, or the level of chemical imprinting. In an ibogaine experience, the body is physiologically and chemically open so that when the memory comes and it is re-experienced viscerally, the chemical correlates of the insight are also experienced physiologically. Perhaps the body chemistry is reset somehow in a way that prevents the repetition of the patterned behavior."

Any abuse of ibogaine is surely precluded by the stressfulness of the experience. "I do feel it's important for anyone considering ibogaine to know," says Randy, who took it to explore the human mind, "that it isn't a party drug. It's a serious encounter with the self. You are there, with everything you've got. And that’s all there is."

"During the worst (or best) of it, I thought more than once I must be crazy to get myself in this miserable state", remembers one female patient. "This morning I still had my doubts, but tonight I feel very positive about the whole thing, and could conceive of doing it again in a few years. This experience reminds me of two things. Lying on the bed and experiencing this, with the accompanying suffering associated with bringing forth something new and precious was just like lying in labour, silent, with no complaint, struggling to give birth to my sons."

The appearance of ibogaine on the illegal drug market was reported in 1967 by the police of Suffolk County, N.Y., on a single occasion, when it was used to dilute heroin, and after Haight Ashbury it was reportedly used by young addicts in San Francisco as a substitute for LSD. Ibogaine suddenly disappeared from the market and it seems that the drug dealers rapidly became aware of the fact that its use would deprive them of part of their clientele. It has also been reported that a Mexican clinic recently refused to carry out ibogaine research for fear that it would provoke the wrath of local drug lords.

Frankly, whether drug barons approve of ibogaine or not is by the by. The bad news is that ibogaine - which should have been about three years away from public availability - is not going to be with us in the near future. The laborious and expensive process of bringing a new substance to the mass market has been temporarily stopped by two killer blows.

Ironically, it is a legal tussle between the two people most vital to the development of ibogaine research that is standing in the way of immediate progress. According to Lotsof, the critical toxicity studies that were required for FDA approval (without which no drug can be marketed) have been stopped by Deborah Mash, who has now patented several ibogaine-like substances. Lotsof sued her for breach of contract, both for stopping the tests and patenting analogs which (under the terms of the contract) should belong to NDA. But Mash countersued, and Lotsof didn't have enough money to go to court. One day before he lost the case by default, he was offered the services of an attorney on a contingency basis (no win, no pay). The trial is now set to go ahead in the next few months, but for Lotsof it may already be too late.

"Putting myself aside," he says, "the way the FDA development of the drug has been held up for years is terrible. Though ibogaine is a restricted substance in the US, the FDA gave a go-ahead for human testing and the DEA is cooperative on the matter. That work should have been completed by now. It has simply been stopped while competing products have been developed, which are nowhere near the stage of ibogaine. They're a series of ibogaine-like drugs called Bioactive Trycyclic Ibogaine Analog and, as far as I know, they haven't even gone into animal studies yet."

Dr Mash, unsuprisingly, vehemently disputes Lotsof's version of events, insisting that the Tryclic Ibogaine Analogs are a whole new class of compounds synthesised by a collaborator of hers at the University of Minnesota, independently from her clinical trial in humans with ibogaine or from the Endabuse procedure. She also says that her 1992 contract with Lotsof covers "findings relating to the procedure of administering ibogaine", and that when (during that research) she, Juan Sanchez-Ramos and Doctor Lee Hearn discovered an active metabolite called Nor-ibogaine (a wholly new molecule), and disclosed their findings, Lotsof came down to Miami and discussed the new finding, agreeing on a 50/50 split with the university, then went back to New York, announced it was all his and threatened to sue. Though Mash had borne all the development costs, the University of Miami - fearful of litigation - assigned the rights to Nor-ibogaine to Lotsof, in lieu of a 12% royalty string. He then demanded half a million dollars from the University for the first patent application, while putting through a second patent that names him as the inventor and sole owner.

"It was a such a stupid thing," says Mash. "Here's the only academic environment that has ever offered him the chance to test his drug in a scientifically credible way, and he immediately turns round and bites the hand that's feeding him. At that juncture the ibogaine project was dead for lack of funds. I worked my tail off to get the FDA to approve the tests, and when I got FDA approval to go into humans, I increased the value of his patents signifcantly, but he still can’t bring in any money at all. It takes a lot of money to get a drug through FDA approval. I don't have it, and it's not my job to pay for the development of ibogaine so he can make all the money off it later. Nor-ibogaine, which I'm very excited about and think holds real promise, is at the point of being abandoned. We tried to negotiate with Mr Lotsof, we asked for a meeting and offered him money and a share. But he doesn't want that. He wants full control. Lotsof's ego won’t let anyone else be a part of it. He has poisoned every well."

On top of the bust-up with Dr Mash, NIDA (the National Institute on Drug Abuse, a branch of the National Institute on Health in Maryland), which has already pumped many millions of dollars in grants into ibogaine research, seems to have gone cold on the whole idea. One of many theories about why this has happened is that there is a "methadone mafia" entrenched in both NIDA and the scientific/medical community that feels deeply threatened by the prospect of a proper cure to addiction. Lotsof himself is not so sure about this conspiracy theory. "Even some of the methadone people are beginning to swing around. The responsible ones would like every tool at their disposal to help people dependent on drugs, but any new technology is met with resistance by the old guard. NIDA had no just cause not to proceed with Ibogaine development. They know full well that in hospital-administered safety studies there would be little chance of medical emergencies, and their concern relating to neurotoxicity has been shown to be nil."

Dana Beal, AIDs activist, Yippie movement founder and co-author of The Ibogaine Story, feels strongly that NIDA has a problem with Howard Lotsof's background, that his roots in the counterculture and his ultimately sensible views on the state's idiotic "war on drugs" make him someone they would rather demonise than help, however good his product. "Things Deborah Mash said to me before we stopped talking indicated that NIDA had a problem with Lotsof. Howard was too close to people like me. ONDCP (the Drug Czar) has been under instructions not to deal with legalizers since mid-93 at least."

"I spent four years working with Howard Lotsof," says Frank Vocci, Director of The Medications Development Division at NIDA, who takes great exception to this idea. "There's no way I would spend several million dollars of taxpayers' money - and we did - just to basically parry someone off in a clever fashion. I'd tell them flat-out to get lost."

Though he admits that NIDA is now concentrating on its own specific cocaine-blocking products, Vocci sighs with frustration at the suggestion that ibogaine is being held back to further them. "I'd say the converse is true. It was a major project here, and we gave this our best shot and spent an awful lot of resources and staff time on it we could have spent on something else. In 95 we asked a group of outside clinicians if we should go ahead with this drug. We got nine serious NOs and four tentative YESses. Our current policy is that we will not initiate any research from within the institute, but we will fund research on ibogaine that gets through the peer review process with a fundable score."

NIDA's decision to backpeddle on ibogaine had a lot to do with the separate deaths of two women who had taken ibogaine. As these were later demonstrated to have not been caused by ibogaine, cancelling the programme altogether seems a very harsh response. "I know," says Vocci. "But it happened and I'm sorry. You have to live with that. Two deaths in about a hundred patients, a safety risk and a pharmacokinetically variable substance with a method of toxicity that appears to be unknown - this is not what gets a drug development project a head of steam. We were presented with ibogaine as a total cure, then the ratios went down to about one in eight patients totally cured. We can do that well with non-pharmacalogical treatments that are a lot less risky. And the effectiveness of ibogaine has been questioned. When we do clinical trials, we're very concerned about bias, known or unknown, and the people reporting these successes are a self-selecting sample who can afford to pay $15,000 to get off drugs. I'm not saying for a minute that they're getting a placebo - ibogaine definitely effects the brain - but they may have reason to want to believe that it works."

In a long and fascinating letter to Frank Vocci dated 3/10/95, and released a year later after a Freedom Of Information action was filed, Curtis Wright (Medical Review Officer of the Pilot Drug Staff of the FDA) outlines why - though ibogaine is a very good thing - he feels that NIDA should support but not directly develop it themselves. "Drugs that NIDA develops directly should be, as far as possible, EASY WINS’ where the pharmaceutical development questions are minimal......Ibogaine is too big a job for your team at this time. It may prove a black hole, sucking all your resources down a single venture capital’ project......What is not speculative is that a significant number of members of the public that we serve feel that the drug deserves investigation. You face the problem of deciding how far to expend research dollars funding their desire to see the drug evaluated."

As a NIDA-approved researcher, Dr Mash noticed the organisation's change of attitude when, in a last ditch attempt to raise funds for ibogaine research, she applied for a grant to research its use in treating cocaine addiction. "They turned down my grant application, which has never happened to me before, in language that made it clear they didn't want to know. I wept when I got that, because I didn't believe we'd see that, and I thought then that ibogaine was dead". She continues to research and treat with ibogaine at her recently established Healing Visions Institute for Addiction Recovery in the Caribbean but, when trying to get investors for this venture, she found that intellectual property was a real issue, and is now petitioning the court for a designation about the Nor+ patent, "because we feel that Lotsof is not the inventor".

If ibogaine works so well - and the Mash/Lotsof legal tussle suggests that they know its future potential only too well - corporations and capitalists everywhere should be falling over each other to invest in a slice of the pie. George Soros, the billionaire businessman with an enlightened attitude to US drug policy, regularly sponsors ibogaine seminars in New York, but big business backing is palpably lacking.

"Despite what appears to be a huge market for a drug that could interrupt drug addiction," says Don Allan, "ibogaine does not fit the profile of a prescription drug that can make money for a pharmaceutical manufacturer. Most prescription drugs are administered daily over a period of weeks, months, or years. Ibogaine is generally used once in a single dose, and then followed up with several months of psychotherapy."

"Over the last 15 years," says Lotsof, "I have contacted many of the larger and some middle level pharmaceutical companies, as well as many investment houses and venture capitalists. From capital the answer is a question: Do you have FDA approval? When I respond no, they one-and-all said: 'No thank you, we've been burned before'. There has been and will be very little interest in major companies developing new medications to treat addiction. Addicts are dying at a much faster rate than the general population, and in a country like the U.S. there is a much greater chance of legal actions by the families of those who die, for whatever reason. Thus, when a pharmaceutical company makes a decision on what drug they will develop or not, they must take into consideration the risks related to litigation. The key is legal liability, and a fear of having their medications associated with addiction, treatment or not."

This may sound like a glib view of pharmaceutical philosophy, but it has some background. Swedish pigs are currently the only beneficiaries of amperozide, an anti-addictive substance discovered by accident at the turn of the decade. In 1992, Swedish police, intrigued by accounts of cure-seeking junkies breaking into farmers' barns, asked the Upjohn Corporation what amperozide was, and were told that it wouldn't be developed because "substance abuse was not a proprietary interest".

If this sounds like a gloomy prognosis for the drug, Eric Taub - who stands by his mission statement to try to treat 1% of the world's 140 million addicts - has no doubt that ibogaine will get out. "We don't have to be so bent on having it legal here. We can embarrass the US by having so much efficacy throughout the world that they will eventually come around. I have a Chinese chemist who can, in a two-to-three-year period, create 40,000 grams of the most active synthetic ibogaine. Then there’s the organic. There are lots of different technologies. We've got a vegetative cloning technology where a chemist of mine can create over a million potted seedlings in 9-12 months, to be grown anywhere in the western hemisphere, just from a five-inch biomass of the plant. There's a corporation in the making that will enable us to get the seed money to develop these technologies within the next couple of years. My vision is to have an Ibeginagain ibogaine centre in every city in the world where it's legal."

"Ibogaine is a paradigm shift," says Ken Alper. "That's why it's being resisted. That is consistent with the history of every truly new development in science. The 'movement' should be less bitter. That an informal self-help culture of addicts has got this far is quite amazing. These people have no political power, no big industry connections. It takes $20-50 million to bring a drug to the market. They're halfway through that phase with no sponsor. That's not bad. And it's not over yet."

Presented at
The Eighth International Conference on Drug Related Harm
Washington, DC
November 19, 1994

Introduction
I have been working with chemically dependent patients, some having dual diagnoses, for twelve years in outpatient settings. My observations have been that the earliest phase of recovery, the first ninety days, is the most difficult for the therapist and the patient. I would like to compare and contrast certain issues seen as obstacles by patients, some of whom were treated with the Lotsof method and some treated in traditional outpatient settings.
My observations are based on a small sample of patients seen in the U.S. and overseas. These observations are inconclusive and my work is ongoing.

My involvement with Ibogaine began in June 1993, when I was approached by the International Coalition for Addict Self-Help (ICASH) and requested to provide after care for five patients who were treated with Ibogaine and were eager to share their experience and struggles. Four of the group were white males ranging in age from early thirties to mid forties. One was a female in her thirties. Their dependencies were to heroin, Methadone and/or cocaine. Additional substance use included marijuana, alcohol and psychedelics. This group met once a week for the duration of one year.

Concurrent treatment was provided to one member of this group on an individual basis. This patient, who we will refer to as ³M² is still presently under my care. ³M² is thirty-three years old and formerly heroin/methadone/cocaine dependent. He has been using drugs since the age of fourteen.

My most recent involvement with Ibogaine has been with NDA International, Inc. where I participated in the treatment of three patients using the Lotsof method in Panama. All three patients were white males in the thirty to forty age range. Two patients¹ major drug of choice was cocaine. The route of administration for one patient was nasal and smoking. The second patient also administered cocaine by IV route. The third patient was heroin/cocaine dependent and occasionally used methadone in attempts to curb his habit. All patients had used drugs from six to sixteen years.

One of the most difficult aspects of treatment is getting the patient to enter treatment. The three major obstacles are the fear of detoxification, lack of insight, and the inability of patients to control their urges to use drugs. These are the areas where I have observed the benefits of Ibogaine treatment versus traditional methods.

Fear of Detoxificatin
Across the board, addicts who enter outpatient treatment programs report that their fear of detoxing from drugs has prevented them from attending treatment. Although withdrawal from cocaine is not as severe or obvious as that from opiate narcotics, there is a fear of the psychological pain of never being able to use again. There is also a dread that once drug free, feelings that have been blocked by self-medicating will surface and be too overwhelming for the patient to handle.

Most heroin addicts are petrified of withdrawal symptoms and are afraid of hospital detoxification. Outpatient clients have stated to me that they have delayed treatment to avoid this anticipated discomfort.

My observations with Ibogaine treated patients have been that patients are eager to be treated when they know that Ibogaine promises to eliminate painful withdrawal, takes one administration with up to seventy-two hours of supervised care, and promises to interrupt their urges to use drugs.

Three patients: Panama
Patient '1' had used approximately $100 each per day of heroin and cocaine by IV administration for twenty of the thirty days prior to Ibogaine treatment.
Patient '2'', prior to treatment was using $80 per day of cocaine and alcohol.
Patient '3' was using $50 of cocaine on a daily basis via IV injection and smoking. He had previously been heroin dependent.
I observed during treatment with the Lotsof method, all of the three patients treated appeared calm and comfortable and exhibited no signs of withdrawal. This is significant considering the extent of the level of their drug use prior to treatment with Ibogaine.
For these patients to have had little discomfort during withdrawal, speaks to the importance of the use of Ibogaine in the beginning of the recovery process. As patient 'M' had stated, 'Ibogaine is a much more humane and dignified approach to detox'.

Obstacles Within Traditional Treatment
Returning to the obstacles of treatment, the second being the patients' lack of
insight. Insight is necessary for patients to be able to focus and develop goals while in recovery.
Patients in traditional outpatient groups who have less than ninety days clean, spend more time struggling with their urges to use and dealing with their defenses, specifically denial. They do develop insight into their problems, however, it takes at least one year of group treatment meetings one or two times a week on a regular basis.

In contrast, my involvement with providing after care for the Ibogaine treated group showed these patients as having tremendous insight into their own issues, their feelings, and what might have caused them to use in the first place.

After their Ibogaine treatment, patients began to see their drug use as destructive. This realization, coupled with psychotherapy, has allowed these patients to work on how to stay clean and to focus on what they must do to maintain a less destructive lifestyle.

The reason for this insight developed by these patients appears to be the release of repressed material during the visualization stage of Ibogaine treatment. This material includes both images and racing thoughts, which somehow get processed to allow patients to have a better understanding of their emotional histories.

The urge to use drugs again, is the highest cause for people to drop out of traditional treatment. Relapse, I think, is clearly inherent in the definition of substance-related disorders. In working with people treated with or without Ibogaine, my observations have been that relapse at some point is certain.

However, according to members in the Ibogaine group, Ibogaine had reduced their urges to use, anywhere from two months to more than one year. This advantage allowed these patients to get a head start in their recovery, whereas clients in traditional outpatient treatment have a great deal of confusion around how to control their urges. Consequently, those patients have to learn very basic and concrete ways to stay clean as taught by self-help meetings, and emphasized in psychotherapy. The Ibogaine after care group did not appear to need self-help type assistance to reduce their urges, but seemed to benefit well from psychotherapy.

Conclusion
In conclusion, there is difficulty treating the drug addicted patient, particularly in the early stages of recovery, because of their fear of detox, their lack of insight, and their urges to relapse.

Thus far, there is no opportunity for Ibogaine treatment within the United States. It is my recommendation that there be future research done with Ibogaine, so that
some of the above mentioned observations are supported by more conclusive data.
The prospects for a painless withdrawal method makes Ibogaine an attractive alternative to traditional treatment methods. Because Ibogaine interrupts substance related disorders, it gives patients a head start in their recovery. It also increases the patients¹ receptiveness to psychotherapy, which is a necessary component to the recovery process.


* Barbara E. Judd, CSW
156 Fifth Avenue
Suite 725
New York, NY 10010
USA

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