The outlawed cure for addiction that could save 190,000 UK addicts from hell

By Jerome Burne

Last week it was officially declared that the rapidly increasing number of people in the UK addicted to prescription opioid pain killing drugs was a ‘public health crisis.’ (Organisation for Economic Co-operation and Development). We have an estimated 190,000 people unable to come off these drugs and, according to the Sunday Times (We are sleepwalking towards carnage in our communities. February 24 2019), 2000 people die from them a year, an increase of 40% in the last ten years.

What is clearly needed is a way of getting people safely and effectively off addictive drugs. As it happened, I recently met a doctor with long experience of a treatment that can do just that but as a plant hallucinogen, it is illegal to possess or use it. This is obviously absurd and immoral given the highly addictive properties of the prescription drugs handed out in their millions.

Telling a deadly lie

The opioid crisis, which is even more severe in the USA, is yet another story of ruthless and unethical drug promotion, especially by the manufacturers – Purdue Pharma – of the most powerful of these drugs – oxycontin – and the total failure by UK authorities to notice that anything was happening.

Back in 2007 Purdue Pharma (owned by the famously charitable Sackler family, now embroiled in multiple compensation cases) ‘agreed to pay’ $634 million for a ‘fraudulent marketing campaign’ that had claimed that the drug was ‘less addictive than other pain medications’ so it could safely be used more often in larger doses. A deadly lie.

This, however, triggered no alarm bells in the offices of the MHRA, our drug regulator, and between 2006 and 2016 the prescription of opioid drugs here doubled. It wasn’t until February of this year, however, that the agency decided to ‘begin’ a review of their benefits and risks.   

Carnage in our communities

One of the many inadequacies in the way the drug industry is set up and regulated, highlighted by this ‘carnage in our communities’, is the almost total lack of facilities for treating prescription addiction. This is partly because the companies go to great lengths to deny that their products have any addictive potential and partly because the medical profession is reluctant to recognise its responsibility for turning law-abiding respectable citizens into junkies.

Ironically there are public health run facilities for street junkies but what they offer is limited with a low long-term success rate. You can try to come off by ‘tapering’, having a little bit less every day or week, but it’s hard and relapse is common. Or, in the case of the opioids like heroin and Oxycontin, you can be given a prescription for methadone which, like many prescription drugs, treats the symptoms of a lack of an opioid but does nothing to treat the underlying disorder.

So, when I received an invitation to meet the world expert on an outlawed hallucinatory plant called ibogaine that has been known for over 50 years to be able to get long-term heroin addicts off the drug with no withdrawal pain within 24-hours, I was seriously interested.

Dr Jeffrey Kamlet was one of the speakers at an addiction conference (ICAAD) held recently in London where radical ideas about using banned hallucinatory plant extracts to treat psychological conditions such as addiction and depression were on the agenda.

Frightening memories of hate-filled families

Ibogaine comes from a shrub found in West Africa where it has long been used in initiation ceremonies. Its effects are dramatic – violent vomiting followed by vivid hallucinations which often seem to relate to trauma and distressing experiences in childhood. Something that can often be linked to later drug abuse.

The visions can be dreamlike – sometimes blissful, sometimes terrifying but they can also be realistic replays of a difficult childhood. Parents shouting at you, one or other leaving home, flushed faces, harsh word, all combined with your own fear and anger. It’s only a memory but it’s a turbo-charged memory. Think holiday snap compared with a film shot in Imax.  

Two other speakers from the Priory – a private psychotherapeutic clinic – described recent research into the potential for the mushroom-derived extract psilocybin as a treatment for depression, which also puts patients through an eight to 12-hour trip marked by powerful visions that can generate psychological insights. Psilocybin is inching into the mainstream; Denver in Colorado has just decriminalised it.

The anti-addictive properties of ibogaine were discovered in the late1960’s by an American heroin addict Howard Lotsof, who was taking part in an Iboga (the name of shrub) ceremony because it seemed a cool thing to do. His visions were intense and extraordinary, but the real surprise was that within 24 hours his heroin craving had vanished. He was so impressed that he invited six of his addicted friends to try it too and five reported the same result

An underground network of guides

News of Lotsof’s experience spread rapidly among drug users and hippies seeking transcendental experiences (despite the vomiting) but gathering evidence of its effectiveness with controlled trials was virtually impossible because of the lack of drug company interest. Firstly, because as a plant product it couldn’t be patented – no blockbuster potential – and, more seriously it was too effective. Maintenance prescriptions that must be repeated are where the money is.

But it is a testimony to its effectiveness that addicts who have benefited have set up an informal underground network of guides, most of whom have no medical training, who will support other addicts through the eight to twelve-hour hallucinatory trip the treatment involves. This is not ideal because as with any powerful compound, a few people can have bad reactions.  

Dr  Kamlet is the respectable medical face of ibogaine treatment and research. Among his medical credentials are being a fellow of the American Society of Addiction Medicine, President of the Florida Society of Addiction Medicine, Medical Director for several emergency departments in Southern Florida, and a member of the board of the Florida American Heart Association.

He has supervised over 1000 treatments as well as researching ibogaine’s biochemistry. For 15 years he ran a clinic on St Kitts in the Caribbean and conducted a seven-year clinical trial of 380 people addicted to a variety of drugs; opiates, cocaine methamphetamines, alcohol and tranquilizers and sleeping pills. Unfortunately, the data from this ground-breaking research is currently tied up in a legal dispute.

Safer than most prescription drugs

Before an ibogaine treatment, you have to check for any physical or psychological vulnerabilities that could lead to problems,’ says Kamlet. ‘Every session should involve a medical expert to provide reassurance and deal with any issues that may come up.’

He conducts a rigorous pre-screening to check the patient is suitable and that they are not taking other drugs, especially benzodiazepines – sleeping pills or tranquilizers – which can trigger an epileptic fit in combination with ibogaine. Other potential problems include low blood pressure, a slow heart rate and stress on the liver.  ‘When proper medical care is available however,’ says Kamlet ‘this treatment is far safer than the great majority of prescription drugs.’

Dr Kamlet had come to the conference with several other ‘ibogonauts’ dedicated to getting ibogaine’s huge potential in the field of rehab recognised. One of them was Rachel Martin, who had become involved in 2004 when her then-partner, with a 25+ year drug habit, was ‘unsprung from opioid dependence in three short days.’ Since then she had become an ‘activist, advocate and avid supporter of clinical research on ibogaine.’

All the psychiatrists excited by the potential of hallucinogens agree that larger double-blind studies are needed if they are going to become a standard treatment. But getting them underway is hard because ibogaine, along with other hallucinogenic drugs, such as mushroom derived psilocybin, are illegal Class A drugs (meaning they have ‘no currently accepted medical treatment use’) in many countries including the USA and the UK.

SSRIs: a high risk of addiction

Both, however, offer a solution to this serious failure of the pharmaceutical model. The addictive potential of prescribed opioid painkillers has been effectively ignored for decades. A failing repeated by psychiatrists who have ignored and denied the addictive qualities of SSRI antidepressants. For over 20 years patients and a few renegade psychiatrists, have campaigned to have it recognised as a serious problem.

Last week, a letter to the BMJ, signed by 14 international experts on the drugs, called for NICE to bring their guidelines into ‘line with the scientific evidence’ for the high risk of addiction they pose. 

While Ibogaine has some promising evidence for effectiveness and safety, the evidence for psilocybin is further advanced. One trial with a small number of patients suffering intractable depression found 67 per cent were depression-free one week after treatment and 42 per cent were still in remission three months later.  

No SSRI has produced results close to that and, as with ibogaine, there is also no sign from considerable clinical experience of any risk of addiction. Contrast that with the findings of the psychiatrists concerned about SSRIs and addiction which found that 50% of patients reported withdrawal problems, half of which were serious. 

Mushroom extract kept in two-ton safe

So, given the huge number of people being seriously damaged by these two types of prescription drugs and the inability of the drug approach to treating it, it is obviously absurd that both these plant extracts remain illegal, making research virtually impossible. The researchers who conducted the psilocybin depression study at Imperial College in London had to store this extract from a mushroom in a special 2-ton safe, following procedures designed for radioactive material. Fear of mind-altering drugs has kept the medical use of marijuana away from patients for 50 years. The justification was that this protected them, instead it clearly did major harm.

It’s now clear that ibogaine and psilocybin can both have an impact on the brain that is far deeper, wide-ranging and potentially longer lasting than the current generation of psychiatric drugs. Todays’ antidepressants work by targeting the ‘feel-good’ brain chemical serotonin (although there is a debate about this) and so do ibogaine and psilocybin, although in a far more dramatic way.

Psilocybin affects just one of serotonin’s 14 different receptors, called 2a, while ibogaine is broken down into a ‘metabolite’ called noribogaine which raises serotonin levels and remains in the body for several months. [Read]

Another similarity is that the two extracts don’t just target the symptoms of depression or addiction, as prescription drugs do, but they change brain chemistry temporarily, which means their immediate and striking biological effects won’t last without counselling  allow the new insights to become permanent. Making use of this time is essential if the immediate benefits are going to be maintained.

‘Once the treatment session is over,’ says Kamlet ‘there is a 90-day window when patients must have therapy and counselling to help them integrate those intense experiences into an altered world view.  It is a wonderful opportunity to compress years of therapy into a relatively short period. Then later organisations like AA or NA can be very valuable. But if the initial opportunity isn’t taken, they are likely to relapse.’

The entry of these hallucinogens into the world of psychiatry and psychology has the potential to match the kinds upheavals are sparking the fierce debates in nutrition and lifestyle medicine. Pressure for their adoption in both fields has come from patients and those actually involved with them. The way the extracts abolish the division between the physiological and the psychological makes them a perfect fit for the emerging discipline of functional medicine.

Jerome Burne

Jerome Burne

Jerome Burne is the editor of HealthInsightUK. He is an award-winning journalist who has been specialising in medicine and health for the last 10 years and now works mainly for the Daily Mail. His most recent book “10 Secrets of Healthy Ageing” was written with nutritionist Patrick Holford. He blogs at “Body of Evidence” – jeromeburne.com. 2015: Finalist for 'Blogger of the Year' award from Medical Journalists' Association.

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