Celebrities, Deaths, Drugs

Who’s To Blame For Ibogaine? A Debate Over Whether Big Government Or Big Pharma Is Keeping Heroin Addicts From Getting Well

I didn’t know Phillip Seymour Hoffman, the gifted and apparently bedeviled actor who died of a heroin overdose this week. I have, however, known more than one friend who died from the same drug. They were middle class, suburban guys, honors students, active in their churches and communities. They would now be in their mid- and late-thirties, had they lived. But they didn’t live.

Even as a growing number of states begin the process of piecemeal decriminalization of marijuana, hard drugs like heroin remain another matter. Many people from both sides of the political spectrum agree that our marijuana laws ought to be radically reformed. I’ve written before about the economics of legalization. Civil libertarians, both right- and left-leaning, argue that prohibition offends principles of personal autonomy. Pot, though, is relatively safe — no more dangerous by most metrics than alcohol or tobacco, for however much that means. The fact that, as a general rule, people don’t die from smoking weed makes decriminalization an easier sell for legal reformers.

Heroin, on the other hand? The Drug Enforcement Administration reports that 3,038 people died of heroin overdoses in 2010, the last year for which the DEA has published statistics. A federal survey suggests that 335,000 people used heroin in the U.S. in the past month. (Compare this to an estimated 19.1 million pot users in the same time span, with nary an overdose among them.) Even when an overdose doesn’t kill, the addiction often leaves the user with an abysmal quality of life. Heroin addiction is also a perniciously treatment-resistant dependency. Abstinence rates for recovering opiate addicts are about 10 percent after one year.

Opioid replacement therapies like methadone offer one possible avenue for recovery from heroin addiction, but they are fraught with a lot of their own problems. Under federal law, methadone must be administered primarily at heavily regulated clinics often located in seedy neighborhoods. Also, methadone is a maintenance drug — instead of using heroin daily, an addict uses methadone daily for the long term. Furthermore, methadone carries its own alarming rate of overdose.

Ibogaine, a Schedule I drug in the United States, is available in many other countries, including Canada, South Africa, the Netherlands, Mexico, Norway, and the U.K. among others, where it is used to treat addiction. Unlike methadone, ibogaine is not a maintenance therapy: addicts typically experience relief after one or two doses. Its efficacy rate is reportedly extremely high. So, why isn’t this potentially life-saving anti-addiction drug available in the United States?

Who’s to blame for the legal unavailability of ibogaine?

Derived from the iboga plant, ibogaine’s therapeutic potential for addiction was discovered by Howard Lotsof in 1962. The compound apparently works by blocking the receptors in the brain that trigger cravings, halting the horrible withdrawal symptoms associated with opioid detox. Controversially, ibogaine also acts as a hallucinogen. While many recovering addicts who have used ibogaine report that the hallucinatory experience is a meaningful part of their treatment — helping them to uncover underlying psychological reasons for their drug dependency — ibogaine treatment typically only involves one or two doses to effectively break a heroin habit. So, it’s not like advocates of ibogaine are recommending that the drug be used for ongoing recreational trips.

In 1967, the U.S. government banned ibogaine because of its hallucinogenic properties. Lotsof, the early advocate of the drug’s therapeutic benefits, established a private clinic in the Netherlands. Other clinics sprung up around the world in the many countries where ibogaine remains unregulated.

Researchers like Deborah Mash, a neuroscientist specializing in addiction at the University of Miami, and Stanley Glick, a neurobiologist at Albany Medical College, have studied ibogaine’s anti-addiction effects. In 1995, Mash and Howard Lotsof secured approval from the FDA to study the drug’s potential for use in humans. Unfortunately, the research trials fell through for lack of funding. So, ibogaine remains illegal in the U.S., despite the hope it may provide for addicts.

After her trial was discontinued, Mash opened a private ibogaine clinic in St. Kitt’s in 1996. Many Americans now travel to clinics outside the U.S., especially the many Mexican clinics located just south of San Diego, for treatment that is illegal within our country’s borders.

Some proponents of ibogaine blame its unavailability in the U.S. on the pharmaceutical industry for not developing and marketing the drug. They argue that Big Pharma has the funding necessary to vet ibogaine to the FDA’s satisfaction, but drug companies choose not to do so because it wouldn’t make good business sense. Research trials like Mash’s are often financed by pharmaceutical companies.

Beyond this issue of research funding, lobbying efforts for the reclassification of ibogaine would be more effective coming from pharmaceutical companies than from the recovery community. Congress is not known for its keen responsiveness to the pleas of heroin addicts.

Big Pharma’s development of ibogaine might be a great thing. Why blame the companies, though, for not pursuing something they don’t deem in their best interests?

Countries that permit ibogaine use don’t have the backing of Big Pharma any more than here in the U.S. What they don’t have is Big Government creating a regulatory blockade for preventing addicts and treatment professionals access to a potentially life-saving therapy. Ibogaine treatment elsewhere typically takes place in private clinics, staffed by medical personnel administering ibogaine hydrochloride while monitoring the patient’s heart rate and other vital signs. If ibogaine were not classified as a Schedule I drug in the U.S., such private clinics would be possible here. Right now, only American opiate addicts fortunate enough to have the resources for “medical tourism” are able to travel outside the country for treatment.

Unregulated ibogaine treatment is not without danger, but neither is being a heroin addict. Individuals trying to get well deserve to evaluate the relative risks and have the opportunity to choose for themselves whether to pursue ibogaine therapy to aid in their addiction recovery. The U.S. government should not stand in the way.

My prayers go out to Phillip Seymour Hoffman’s family and friends, especially his three children. I know the pain of losing someone to heroin. May no one ever have to mourn this sort of loss again. And may no one have to suffer from this addiction a day longer than necessary, especially when there may be effective treatments available.

Tamara Tabo is a summa cum laude graduate of the Thurgood Marshall School of Law at Texas Southern University, where she served as Editor-in-Chief of the school’s law review. After graduation, she clerked on the U.S. Court of Appeals for the Fifth Circuit. She will be working at the Center for Legal Pedagogy at Texas Southern University during the 2013-2014 academic year. She looks forward to a career of teaching and writing about, but never practicing, law. You can reach her at tabo.atl@gmail.com

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