bitter medicine
September 7, 2018 9:22 AM   Subscribe

My Boyfriend Tried a “Miracle Cure” For Heroin Addiction - "Later that night, we met up for a coffee. Instead of speaking in slogans or wanting to talk about the Steps, it was during that first date that Mark introduced me to ibogaine."

As America's opioid and heroin crisis rages, some struggling with addiction are turning to a drug illegal in the US. Jonathan Levinson went to one clinic offering the treatment in Mexico.
Kicking Addiction by Going from Heroin to Methadone to Ibogaine
How an illegal psychedelic drug could help treat opiate addiction


Opioid Crisis: What People Don’t Know About Heroin

Dying to get clean: is ibogaine the answer to heroin addiction?
Jay flew back home and in the 10 months since he hasn’t had a single relapse. “I went to a stag do recently and all my friends were taking cocaine and I didn’t. Back in the day I wouldn’t have been able to say no. I’ve developed a new sense of confidence. I’ve got a new job, got a new girlfriend. I feel like I’m an actual functioning member of society.”

Jay has become an ibogaine evangelist, but there’s a caveat. Just ahead of his flight home he began having palpitations, and once he was back in England was rushed into hospital and diagnosed with a congenital heart problem – something he said could have been exacerbated by taking ibogaine.

A review of medical reports of heart issues associated with ibogaine published in 2015 notes that “alarming reports of life-threatening complications and sudden death cases” associated with ibogaine had been accumulating. The review found that in addition to lowering the heart rate, it interacts with the heart’s electrical signals – which probably explains “ibogaine’s potentially life-threatening cardiotoxicity [damage to the heart muscle].”

It’s estimated that one in 400 people die from taking ibogaine, because they have pre-existing heart conditions, from seizures due to acute withdrawal from alcohol or other drugs not recommended for treatment with ibogaine, or else from taking opioids while under the influence of ibogaine.
posted by the man of twists and turns (37 comments total) 28 users marked this as a favorite
 
Treating Addiction with Psychedelics

Interactions between ibogaine, a potential anti-addictive agent, and morphine: an in vivo microdialysis study [PDF]I.M. Mabnneuve, R.W. Keller, Jr. and SD. Glick, European Journal of Pharmacology, 199 (1991) 35-42

The putative anti-addictive drug ibogaine is a competitive inhibitor of [3H]MK-801 binding to the NMDA receptor complex, Piotr Popik, Richard T. LayerPhil Skolnick, Psychopharmacology, May 1994, Volume 114, Issue 4, pp 672–674

Ibogaine and addiction in the animal model, a systematic review and meta-analysis, M Belgers, M Leenaars, J R Homberg, M Ritskes-Hoitinga, A F A Schellekens & C R Hooijmans, Translational Psychiatry volume 6, page e826 (2016) - " Our results warrant further studies into the clinical efficacy of ibogaine in SUD patients in reducing craving and substance use, but close monitoring of the patients is recommended because of the possible toxic effects. In addition, more work is needed to unravel the neuropharmacological working mechanisms of ibogaine and to investigate its effects on heart rhythm."

Ibogaine treatment outcomes for opioid dependence from a twelve-month follow-up observational studyGeoffrey E. Noller , PhD, Chris M. Frampton , PhD & Berra Yazar-Klosinski , PhD, The American Journal of Drug and Alcohol Abuse, Volume 44, 2018 - Issue 1

Treatment of opioid use disorder with ibogaine: detoxification and drug use outcomes, Thomas Kingsley Brown , PhD & Kenneth Alper , MD. The American Journal of Drug and Alcohol Abuse, Volume 44, 2018 - Issue 1
posted by the man of twists and turns at 9:30 AM on September 7, 2018 [3 favorites]


it didn't help Ed Muskie
posted by the phlegmatic king at 9:34 AM on September 7, 2018 [13 favorites]


Ibogaine was featured (in a slightly rose-colored-account) in an episode of Law And Order SVU back in 2010. While - as stated - their take a was a little rose-colored, it wasn't that far off, according to accounts.
posted by EmpressCallipygos at 9:50 AM on September 7, 2018 [1 favorite]



Safe injection sites were thought to reduce drug overdoses. The research isn’t so clear.
A new meta-analysis reviewed the evidence on safe injection sites. There's bad news
posted by robbyrobs at 9:56 AM on September 7, 2018 [1 favorite]


That meta analysis is crap. Significant methodological problems, misuse of the underlying data, and the researchers who did the studies that were included have asked that it be rescinded.
posted by gingerbeer at 10:12 AM on September 7, 2018 [35 favorites]


I read about ibogaine about 30 years ago, raised the topic when I was running in Illicit Experience circles, and came up empty. Of course, I only wanted to stop biting my nails (which took another 25 years), but it's funny how little I wound up being misinformed. I probably should have taken up with the Serious Experimenter scene rather than the party scene, but they were a bit too serious and not so much into music.

In short, go ibogaine!
posted by rhizome at 10:16 AM on September 7, 2018 [1 favorite]


Safe injection sites were thought to reduce drug overdoses. The research isn’t so clear.
A new meta-analysis reviewed the evidence on safe injection sites. There's bad news


Just scanned the Vox article, but was the study looking at OD rate among safe injection site users, or the total OD rate in a particular jurisdiction (for example, Vancouver's Insight serves the Vancouver Coastal Health region, which track OD rates for that locality)?

One reason why safe injection sites don't scale well (as the articles hypotheses) could be due to the sheer scale of the the opioid epidemic in British Columbia.

Another reason could be that not all opioid users use safe injection sites -- and there are a lot of users. Can't recall the stats off the top of my head, but in B.C. something like at least 30% of opioid users started off with a prescription from a doctor. More than 50% OD victims are housed (i.e., don't live on the street, and street culture is more familiar with Insight).

A safe injection site is not the solution, really. The solution is to legalize / decriminalize opioid consumption, and provide easy access to a safe supply of the drug. Fentanyl is killing more people than AIDS ever did at the height of the epidemic.

And then provide detox beds. And more mental health/addictions support...

Safe injection sites are not a comprehensive solution, but they're a start...
posted by JamesBay at 10:25 AM on September 7, 2018 [14 favorites]


A new meta-analysis reviewed the evidence on safe injection sites. There's bad news

I don't know anything about the research in this area, so I won't claim to say safe-injection sites are good or bad, but geez, that Vox article is terrible. And I'm talking about the Vox article itself, not the research articles on which it is based (gingerbeer seems to know something about this, I'll leave that to them). The Vox article can't seem to distinguish between a review and a meta-analysis, uses this weird scare-mongering tone about odds-ratios instead of just explaining what they are (so yeah, you can't tell how many people from the odds ratio without some baselines, but it does tell you how the intervention affects the likelihood. You can't tell how many people from a percentage, either), and it's not at all clear on what the comparison being made that worked out unfavourabley is (e.g. is it overdose rates among safe injection site users vs. users who don't use safe-injection sites, overdose rates in places with safe-injection sites vs. similar places without, continuing use vs. recovery rates (for safe-injection site users vs. others, or in locations with vs. without). What? It seems like an article this long could have fit in a lot more actual content and explanation.
posted by If only I had a penguin... at 10:50 AM on September 7, 2018 [13 favorites]


One of the reasons why I scanned the Vox article is because Vox is usually pretty worthless.
posted by JamesBay at 11:09 AM on September 7, 2018 [2 favorites]


Safe injection sites
new meta-analysis
safe injection sites
vox
vox
vox



:'(
posted by the man of twists and turns at 11:11 AM on September 7, 2018 [1 favorite]


There was a pretty good episode of the Us and Them podcast focusing on N'ganga Dmitri, another advocate for ibogaine. Worth listening to.
posted by demonic winged headgear at 11:12 AM on September 7, 2018 [1 favorite]


It's worth noting that many drugs cause QT prolongation. In a few cases, it has resulted in a drug being withdrawn from the market (e.g., cisapride) or placed in a special monitoring program (e.g., dofetilide). But in many other cases, the risk is known but is considered small enough that the drug continues to be used. Whether that risk is clinically relevant depends on the drug, the patient's risk factors, and whether there are multiple such agents being used, since the effect can be cumulative.
posted by dephlogisticated at 11:25 AM on September 7, 2018 [4 favorites]


At least one person was shown relapsing in the doc I'm dangerous with love, also about Dimitri.
posted by brujita at 11:26 AM on September 7, 2018


It's worth noting that many drugs cause QT prolongation.

Methadone is somewhat known for it, in fact. I think some buprenorphine formulations carry a warning now, too, though from what I've seen the evidence it's a problem is much weaker. But an acute risk of an acute treatment is something people think about differently from a chronic risk of a chronic treatment. I'm sort of skeptical of acute treatment for addiction other than palliative support for withdrawal but that's a different issue.

(despite the name I am not a pharmacologist, pharmacist, or MD)
posted by atoxyl at 12:00 PM on September 7, 2018 [2 favorites]


A safe injection site is not the solution, really. The solution is to legalize / decriminalize opioid consumption, and provide easy access to a safe supply of the drug. Fentanyl is killing more people than AIDS ever did at the height of the epidemic.

It's pretty hard to imagine any sort of sweeping, expansive (not to mention expensive) action being taken regarding opiate addiction, when simple things like giving first responders Narcan is considered "controversial" and a potential "moral hazard" that could "enable addicts".

I mean—and there are some pretty straightforward and ugly comparisons to AIDS in the Reagan era—there's a non-trivial percentage of people, even in the areas where opiate overdoses are really out of control, who don't want Narcan to be widely available, at least not at public expense.

Scratch the surface just a bit, and you realize they see the OD deaths as a feature, not a bug—or at least their actions seem damn consistent with that belief, since nobody can say what someone else is really thinking.

My guess is that when the opiate crisis has its Ryan White moment, suddenly you'll see resources get assigned, and laws will get reformed to favor treatment instead of catch-and-release punishment cycles. But until that happens—as long as the people dying from opiate ODs are easy to write off as "junkies"—it'll always be just a tiny bit too expensive to do anything really effective.
posted by Kadin2048 at 12:01 PM on September 7, 2018 [19 favorites]


It's pretty hard to imagine any sort of sweeping, expansive (not to mention expensive) action being taken regarding opiate addiction, when simple things like giving first responders Narcan is considered "controversial" and a potential "moral hazard" that could "enable addicts".

Ah, sorry, I just think in terms of Canada -- some state-level governments proactively provide access to Naloxone kits to the general public. The Vox article also uses Insight in Vancouver as an example.

Not sure about safe injection sites where you are... are they effective?

The opioid OD crisis is very bad here in Victoria, as we have the highest OD death rate per capita in North America. It's fucking brutal and scary here.

So, not sure about what's happening in the US. Happy to help explain what's happening in Canada, though.
posted by JamesBay at 12:06 PM on September 7, 2018 [3 favorites]


Back to Ibogaine...

I’m glad this is hitting the mainstream more. Even aside from its anti-addiction uses (which are WILD, btw), I’ve always been interested in a three day trip where people talk to God.

I’m betting with more research we might get more info on dosing, and maybe that could help scale it. It won’t be cure all for everyone, but a) a cure all for some people is actually pretty fucking great, and b) any help in the process of overcoming the most tenacious addictions is a boon to public health.

I mean, we have a national opioid crisis, and a treatment you only have to take once is a treatment that scales. I’m very much into it.
posted by schadenfrau at 12:27 PM on September 7, 2018 [4 favorites]


I though the point of Safe injection sites was clean needles and available medical help in the event of an overdose (and potentially treatment for other issues if social services are onsite).

Do people really claim it would prevent the consequences of someone taking the drug somehow?
posted by srboisvert at 12:32 PM on September 7, 2018 [4 favorites]


I'm pretty sure all the drugstores around here have a little sign at the pharmacy desk saying "please ask for your free emergency overdose response kit." I get the sense they're meant for just whoever, not necessarily people using opioids or who are around people who do, it's just for whoever, just in case, though I've never thought to get one myself (it seems very unlikely someone would overdose in my home where i would presumably keep the kit).
posted by If only I had a penguin... at 1:25 PM on September 7, 2018 [1 favorite]


It's worth noting that many drugs cause QT prolongation.

Not listed: the ⅓ pint of strongish ale that put me on the floor of a Toronto pub. Somewhat embarrassing for this Glaswegian, let me tell you.
posted by scruss at 1:37 PM on September 7, 2018 [4 favorites]


Do people really claim it would prevent the consequences of someone taking the drug somehow?

AFAIK, people who are revived with Naloxone will have experienced brain damage due to oxygen deprivation. And another big health problem is how to care for survivors who have been revived several times and, and due to brain trauma, can no longer care for themselves on the street.
posted by JamesBay at 1:45 PM on September 7, 2018


I wonder if this could also treat people with severe OCD who are having trouble letting go of their compulsions.
posted by en forme de poire at 1:56 PM on September 7, 2018 [1 favorite]


having access to sterile needles greatly reduces the spread of HIV, which the stinkbug veep learned when he shut down places that offered them in Indiana.
posted by brujita at 2:16 PM on September 7, 2018 [12 favorites]


Burroughs, who was a terrible asshole and a raging addict, tried Ibogaine in Naked Lunch. That movie really messed with my mind when I saw it at age 17. So this is not a new thing, I think, but maybe it’s just that the scale of the problem is pushing people to consider treatments that would have seemed extreme before. We’ve had a heroin epidemic in Chicago for decades, so I’m all for it.
posted by mai at 4:58 PM on September 7, 2018 [1 favorite]


Second hand from the 60's or so, heroin addict had the brilliant idea to move to Algiers (or thereabouts) to live cheaply and get access to the drug closer to the source for quality and cheaper. Discovered that caught using was a literal death sentence. Also discovered that hash was virtually free and no problem. Got himself off smack.
posted by sammyo at 5:51 PM on September 7, 2018


AFAIK, people who are revived with Naloxone will have experienced brain damage due to oxygen deprivation.

Depends on how long it takes to get to them.
posted by atoxyl at 9:48 PM on September 7, 2018 [4 favorites]


> It's pretty hard to imagine any sort of sweeping, expansive (not to mention expensive) action being taken regarding opiate addiction, when simple things like giving first responders Narcan is considered "controversial" and a potential "moral hazard" that could "enable addicts".

Like a lot of other inadequately-addressed social problems, this issue is being handed off to public librarians. Who needs first responders when you can just give a librarian with no other medical training an afternoon-long training course?
posted by The Card Cheat at 6:26 AM on September 8, 2018 [7 favorites]


Depends on how long it takes to get to them.

This is literally correct, yes. However, in actual practice, what we are experiencing supports my comment.

The more times someone is revived with Naloxone, the higher likelihood of brain damage. This is how biology works.
posted by JamesBay at 9:41 AM on September 8, 2018


Ok, so then what are you suggesting? That O2 be onsite at safe injection sites (of which there are currently none in the US, though San Francisco may be changing that very soon)? That nalaxone not be used unless we know the full history of the person who is overdosing? I’m really not following your point.
posted by rtha at 10:51 AM on September 8, 2018 [5 favorites]


The more times someone is revived with Naloxone, the higher likelihood of brain damage. This is how biology works.

In 100 percent of cases where someone is treated after the onset of permanent brain damage, it would have been worse had they not been treated. There are a lot of statements you could make here that are true - I responded to your first comment because I thought it was somewhat misleading regarding the best-case scenario.
posted by atoxyl at 12:20 PM on September 8, 2018 [5 favorites]


One thing I'd be curious to learn about is whether or not ibogaine helps prevent long-term relapse.

It's not uncommon to have someone get clean and stay clean for a long time only to turn back to their drug of choice when they're hit with a sudden crisis (the classic example is death of a loved one.) There's a reason why folks often will still consider themselves addicts even if they haven't used in years and they don't plan on using again.

Something that could permanently reshape that relationship with drugs would be, well... a true miracle.
posted by -1 at 1:24 PM on September 8, 2018


Ok, so then what are you suggesting?

It's a fact that OD'ing results in lack of oxygen to the brain. Naloxone doesn't help that.

What I would suggest is:

> Decriminalize possession of opioids
> Provide users with a safe source of opioids -- the epidemic in OD deaths is because fentanyl contamination

In short, I would argue that harm reduction be adopted.

Yeah, sure, we have to overcome social attitudes towards opioids. I'm not a user, but I see it as my responsibility as a citizen to encourage my government -- municipal, state-level and national -- to adopt harm reduction.

If you're in the United States, and if harm reduction seems like a good strategy to you, you can do the same thing. It's going to take a massive campaign to save lives.

Naloxone is just a small part of the solution.
posted by JamesBay at 1:52 PM on September 8, 2018 [2 favorites]


Of course it is - and harm reduction is known and practiced in the US in many places. We don’t have prescribed opiates but hey it could happen. But having a safe place for users to use, where people can keep and eye on them and can reverse an overdose before the user dies, including by using nalaxone seems like a good way to reduce harm. It is a small but important part. I guess I was not understanding what what seems to be a major objection you have to it.
posted by rtha at 3:00 PM on September 8, 2018 [2 favorites]


I don't have an objection. It's just an observation.

And also identifying an ancillary healthcare problem that we here at Ground Zero of the opioid epidemic in North America are facing: drug users with brain damage who can no longer care for themselves.
posted by JamesBay at 3:34 PM on September 8, 2018 [1 favorite]


I don't have an objection. It's just an observation.

You didn't really put your original observation in context, so people took it either as a misleading assertion that naloxone doesn't do what it is claimed to do or some other sort of weird crypto-anti-harm-reduction point. Seems like it's really just this semantic argument between people who apparently mostly agree:

It's a fact that OD'ing results in lack of oxygen to the brain. Naloxone doesn't help that.

I mean, sure it does, that's how it works. The observation you're making is that turning lethal overdoses into sub-lethal overdoses results in fewer deaths but more disability - which is true, but could be said of all sorts of medical interventions. That the key factors in the best possible outcome are minimal time to getting the drug in your system - and in more severe cases, availability of artificial ventilation - is why the push among harm reduction people is definitely not just for putting naloxone in the hands of EMS, but for putting it in the hands of users and introducing supervised drug use sites.

It's true that this will only ever go so far, though - you can bring the risks of overdosing with another person in the room way down but you can't do much for someone who overdoses alone in their bedroom.
posted by atoxyl at 10:40 PM on September 8, 2018 [5 favorites]


Safe injection sites were thought to reduce drug overdoses. The research isn’t so clear.
A new meta-analysis reviewed the evidence on safe injection sites. There's bad news


Special Response: Over 100 Researchers and Practitioners Respond to Rod Rosenstein on Safe Injection Sites
posted by rtha at 8:17 PM on September 21, 2018 [1 favorite]


> That meta analysis is crap. Significant methodological problems, misuse of the underlying data, and the researchers who did the studies that were included have asked that it be rescinded.

Just to follow up on this -- the meta-analysis that supposedly showed that supervised injection services don't work (the basis for that Vox article) has been withdrawn by the journal for severe methodological problems and not actually finding any results.
posted by gingerbeer at 5:08 PM on September 26, 2018 [4 favorites]


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