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Exploring the new frontier of psychedelic addiction therapy by Kia Momtazi March 1, 2006 - sdcitybeat.com
Ray slips his shades back over his eyes and leans against the window as the van crosses the border into Mexico. It?s noon on Monday, Oct. 31, and he hasn?t slept in three days. He thinks about the bag of chronic he threw out the window on the way to meet the guy from the clinic. He thinks about the pipe load of meth stashed in the seat of his motorcycle back home. Ray is skeptical?will he really be so changed by Friday that he?ll be able to go home and throw it away?
Ray is a 33-year-old meth producer, dealer and addict. So far, Ray?s missing fingerprints are the only physical evidence of his addiction?they gradually peeled off after repeated contact with so many chemicals.
Six months ago, after a stint in prison and more than two years clean, he relapsed and took a leave of absence from refrigerator-repair school ?to go run amok.? The past few months, says Ray, ?have been out of control?. I won?t do anything unless I smoke first. I feel like I just have to do it.?
He?s afraid that either death or jail is imminent if he doesn?t change his life.
?I find myself doing stuff that I would never even do normally,? Ray says. ?I have a pocket full of money, but I?m out there robbing warehouses and things?Target warehouses, Wal-Mart?just to do something. I?ve got $2,300 in my pocket and I?m sitting there trying to break into a Coke machine at the Embassy Suites.?
Reluctant to quit partying but desperate to curb his destructive behavior, Ray is traveling to the Ibogaine Association, a Tijuana clinic originally founded in Mexico City that treats patients with a powerful psychedelic?ibogaine?rumored to be able to stop addiction in its tracks. Legally accepted as an experimental therapy in most countries, ibogaine is classified as a Schedule 1 substance in the United States, believed to have a high potential for abuse with no accepted medical value.
Every Monday, program director Nathen Gabriel meets new patients at Urban Grind, a caf? located just north of Balboa Park, and shuttles them to the clinic, where they stay until he picks them up Friday morning.
Program director since March 2005, Gabriel has a background in psychedelic healing and a doctorate in naturopathic medicine. He?s a lean, compact man in his early 40s with a gaunt face and large eyes that seem to take everything seriously. He looks like a mystic only from the neck up, where an elaborate tattoo of serpents twining around a lotus flower crowns his shaved head and creates the illusion of a third eye at the base of his skull.
Though he?s worked at the clinic less than a year, Gabriel?s talent for the job emerges during the 30-minute drive. He?s friendly and sincere with each patient, asks them straightforward questions about their addictions and absorbs their answers without judgment. They invariably ask questions about ibogaine, and when they do, excitement creeps into his responses.
He explains that ibogaine comes from the root bark of Tabernathe Iboga, a shrub that grows in Central Africa, and has been used for centuries in various ceremonies of the Bwiti tribe.
A man named Howard Lotsof, Gabriel says, took ibogaine in 1962 as a 19-year-old junkie chasing a new thrill. After enduring 36 hours of harrowing visions, Lotsof awoke to find he had no desire to use heroin and was totally free from any symptoms of withdrawal. He has spent the rest of his life trying to make ibogaine more readily available for those in need.
Gabriel himself has taken ibogaine twice, he says?once to better relate to his patients and again recently in an attempt to curb his pot habit. Gabriel describes his own personal experience of ibogaine as ?completely hellish? but hastily adds that everyone experiences it differently.
Before leaving San Diego, Gabriel stops the van at a downtown Days Inn to pick up another patient. Ted is in his early-50s, has red hair and a red beard and wears a faded blue-gray polo shirt, green shorts and athletic socks under Birkenstock sandals. He?s been on Vicodin for seven years to treat his chronic neck pain?a result of getting hit by a car while crossing the street 10 years ago?and currently takes 15 to 20 pills every day. He wants to stop and has tried to quit cold turkey ?numerous times? but finds it ?physically impossible.?
Though he?s emphatic that the pain he now experiences is from Vicodin withdrawal and not from his injury, he hopes that at the very least ibogaine will reset his tolerance to the Vicodin, enabling him to once again get full relief from a couple of pain pills instead of 20.
Preston Peet, a 38-year-old New York writer, told CityBeat in a phone interview that he uses ibogaine for just that. Ever since a car accident 24 years ago, Peet says he has suffered from chronic pain in his back and legs. Until he took ibogaine for the first time in 2004, he took four MS-Contins (a morphine-based pain killer) and more than 12 Dilaudids every day for the pain. He?ll live with chronic pain for the rest of his life, he says, but periodic boosters of ibogaine enable him to keep his painkiller intake down to a mere two MS-Contins per day.
The van arrives at the clinic?a nondescript house in Tijuana?s most affluent residential neighborhood?shortly after noon. On the inside, the four-bedroom house looks more like a travelers? hostel than a medical clinic. The only medical equipment in sight is a heart-rate monitor on the nightstand next to each bed. The walls are sparsely decorated, the furniture secondhand, and paisley tapestries are draped over the couches. It was once a grand house, full of high ceilings, chandeliers and pink marble. The contrast gives it a haunting air of abandoned opulence.
Gabriel shows Ted and Ray upstairs to their rooms. In turn, they submit to a blood test, which will be taken to a lab for analysis before they take the ibogaine later that night. Gabriel collects the $4,000 fee before their blood is drawn, and a staff member searches their bags for drugs. At no point does anyone search the patients or their pockets.
When Ted?s wife calls on his cell phone, Ray goes out on the balcony for a cigarette.
He leans against the railing and smokes pensively.
Hundreds of cigarette butts have collected on the ledge beneath, a reminder that so many people before Ray have stood smoking on that same balcony, all probably pondering ibogaine?s power to change them for good.
Greg Douglass, a musician and recovered heroin addict who?s been clean since he took ibogaine in 2003, told CityBeat that the visions he experienced with ibogaine were what changed him the most.
?The whole time I was hallucinating, I didn?t feel like I was hallucinating,? says Douglass. ?I felt like I was being shown something for a reason. All of a sudden it was right there for me to see? it?s really marvelous to be on this planet and part of this universe. Why didn?t I see that before? And all of a sudden it was like this big black hole got filled in.?
But Ray is skeptical that he will have a psycho-spiritual epiphany with ibogaine.
?I never saw no ray of light when I was sober,? he says matter-of-factly. He gloomily predicts the ibogaine won?t work and he?ll end up being ?burned four grand.?
Ray perks up when he remembers that he still gets to trip out one last time before he?s supposed to turn his life around.
?I want to fry,? Ray says smiling, his eyes lighting up. ?Let?s do it.?
Although Ted and Ray are eager to get the treatment underway, hours remain before the blood tests come back. To kill time and give them a better picture of what they?re about to experience, Gabriel shows a documentary about ibogaine called ?Ibogaine?Right of Passage.?
Before it ends, Gabriel leaves Ray and Ted in the hands of the medical staff. Gabriel, whose role is more administrative than medical, won?t see either of them until he returns on Friday to pick them up and take them back to San Diego.
Ever since his discovery, Lotsof has reportedly endeavored to make ibogaine legitimate in Western medicine. He quickly passed some out to his junkie friends for more informal testing, but things got complicated in 1970 when the American government cracked down on psychedelics, making ibogaine illegal along with LSD and psilocybin.
Lotsof gained some ground in the mid-?80s when he obtained patents for the use of ibogaine to treat symptoms of multi-drug dependence, but they were never picked up by any pharmaceutical companies and have recently expired.
Nevertheless, since ibogaine remains legal in most other countries, a scattering of informal clinics like the Ibogaine Association have emerged as testimonies spread through personal networks and?more recently?over the Internet.
When Gabriel returns Friday morning, Ray and Ted await him anxiously at the kitchen table. They giggle conspiratorially like two schoolboys who?ve bonded during a week at summer camp, cracking jokes about the stray dogs outside and the boredom of their post-ibogaine confinement.
There is more color in Ray?s face, and he appears physically illuminated from within. He smiles in spite of himself, and his eyes sparkle. But despite the obvious improvement in Ray?s appearance, he says he?s not sure how effective the treatment was. He says he?s feeling good without meth and plans to get rid of the pipe in the motorcycle, but he says he?ll probably keep smoking weed. He is disappointed that he didn?t experience any visions.
?Everything is just alright,? he shrugs. ?I still didn?t see no ray of light.?
Back on the road to San Diego, Ray?s quiet until someone on a motorcycle zooms ahead of the van. His eyes light up all over again.
?That?s what I want to do,? he says, ?go for a ride.?
The change in Ted is different. No longer in a Vicodin haze, by Friday morning he?s grouchy and cursing. He rubs his shoulder repeatedly through the neck of his T-shirt but says the pain he?s feeling now is from Wednesday night?s overzealous Thai massage. Still, he?s full of praise for the medical staff and leaves a hefty tip for the night nurses.
His hallucinations were much more memorable than Ray?s.
?I saw myself in the Civil War,? Ted tells Gabriel on the ride back to San Diego. ?There were themes of honor and courage,? he continues. ?I got stabbed in the back by someone with a bayonet, but I didn?t feel fear.? So far he doesn?t regret his decision to come, he says, but isn?t sure he would want to take ibogaine again.
A week after his return, Ted reflects on his experience with a much more optimistic tone.
Now that he isn?t living through a mix of pain and Vicodin, Ted says, his biggest pleasure has been spending more time with his children. ?I?m really hoping the effects stay around for awhile,? Ted concludes. ?It does feel like my life?s better because of it.?
Despite the fact that most addiction specialists today seem to regard psychedelic addiction therapy as a bygone fancy of Timothy Leary and his ilk, a small community of researchers still strives to find a place for ibogaine in mainstream medicine.
Dr. Stanley Glick, chairman of the department of pharmacology and neuroscience at the Albany Medical Institute, has been studying the effects of ibogaine in drug-addicted rats since the late 1980s. Though he?s published data that confirms ibogaine?s ability to block opiate withdrawal and cravings in animals, initiating clinical research on ibogaine in humans has been trickier.
Though the FDA approved initial stages of clinical research on ibogaine in humans in 1993, protocol was still being developed for the studies when the National Institute on Drug Abuse (NIDA) pulled its funding in 1995.
Frank Vocci, director of the Division of Pharmacotherapies and Medical Consequences of Drug Abuse at NIDA, says NIDA?s review panel made the decision not to go forward with the research based on evidence that ibogaine was a neurotoxin in rats and posed other potential health risks like bradychardia (slowed heart rate) and grand mal seizures.
That much of the data NIDA reviewed of ibogaine?s effect on humans came from observations of informal treatment in the Netherlands, rather than clinical research that had passed through peer review, seems to have added to the medical establishment?s already disdainful view of psychedelic therapy.
?I think that we need some published data on ibogaine,? said Vocci in a phone interview. ?That?s where I really think this whole issue is, in terms of both safety, metabolism and possible effects.?
However, ibogaine supporters like Patrick Kroupa, a heroin addict for 16 years who recovered with ibogaine and now runs an online discussion board called the Ibogaine List, believe ibogaine will never make it out of Schedule 1 status because pharmaceutical companies?some of whom have representatives on the NIDA review board?don?t see big dollars in the development of a one-time-use drug for a stigmatized population, especially a drug that has known hallucinogenic side effects.
?The pharmaceutical industry exists for one purpose: to make money for their shareholders,? Kroupa said in a phone interview. ?There is no pharmaceutical company that could even recover the money it would have to spend to get [ibogaine] through the FDA.?
?To take a drug through the FDA is very expensive,? confirms Dr. Deborah Mash, a professor of neurology and pharmacotherapy at the University of Miami who responded to NIDA?s withdrawal of financial support in 1996 by moving her human research on ibogaine to a facility in the Caribbean. She published her first batch of data in 2000 and then went back to work collecting more evidence.
?The data that was collected from there supports the development track that we?re trying to do with the FDA here,? says Mash. ?I?m getting ready now to re-convene the clinical studies in the U.S.?
However, until she does, it seems there won?t be any shortage of people desperate enough for relief to cross national borders for ibogaine treatment.
The Monday after Ray and Ted?s visit to the clinic, three new patients meet Gabriel at the caf?. This time, they?re all there because of heroin.
One of the men changes his pants behind a dumpster as the other two pile into the van. The vibe among the patients is considerably different, but Gabriel?s approach doesn?t change. He remains unswervingly calm and again seems at once respectful and intrigued by his patients? take on their addictions.
Joe Alex is 51, Hispanic and has a droopy graying moustache. When his withdrawals cause him to sweat, he peels off his sweatshirt to reveal an upper body covered almost entirely in tattoos. He is the oldest of the three passengers but by far the most upbeat. He calls Gabriel ?doc? and engages him in friendly conversation.
He says casually that he?s used heroin on and off since he was 18, when he started ?out of curiosity.? He?s been in and out of jail many times since, with one four-year sober stretch, during which he became a certified substance-abuse counselor. He says he enjoyed the work and that people told him he was good at it. But he relapsed when he stopped counseling to take part in a family real-estate venture.
?I?ve stopped a thousand times,? he says good-naturedly. ?The problem is staying stopped.?
He proves his point as he counts aloud the different times and ways he?s detoxed: cold turkey ?about a dozen times,? in the hospital ?about two dozen times,? four or five times in Christian homes and six or so times in secular facilities.
He says he hopes he can find his passion, something that will give him something else in life to look forward to.
?I got a Harley I?m passionate about,? he adds, ?but I can only keep it clean so much.?
Josh is a former heroin addict currently on methadone, and at 32 is the youngest patient in the past two weeks. He is white and tall, has short brown hair, wears jeans and a green hoodie and carries James Frey?s recovery ?memoir? A Million Little Pieces. His skin is yellowish and sallow, and the color of his lips span the spectrum from green to purple. There are dark circles around his eyes and he leans listlessly against the window in the same seat Ray occupied just a week before. He?s shy, and his story emerges haltingly. ?A bad roommate? introduced him to heroin nine years ago.
?Six months later, I realized I was in trouble,? he recalls. ?The whole time I was doing heroin I wanted to stop.?
He used heroin for four years straight, got clean for three years, but a year ago ?a bad breakup? sent him back to the needle. He transitioned to methadone four months ago but is ready to get off it so he can go back to school for shoe design.
It turns out Josh has already been working through a recovery program. He goes to group and individual therapy on a weekly basis and feels like he?s already worked through a lot of the ?psychological stuff? that caused his addiction. He isn?t looking for a spiritual awakening with ibogaine, he says?he just wants a fast, easy way to detox off the methadone.
The third man in the van, Jesus, like Joe Alex, has been using drugs since he was in his teens.
?I know why I use?I grew up around it,? Jesus says bluntly. ?My brother did it, and I wanted to be like my brother.?
Jesus has a jet-black moustache and wears black jeans, a gray sweatshirt, a baseball cap and a dog tag around his neck that says ?father of a soldier.? He has spent 18 of his 41 years in jail, makes not-so-veiled references about gang involvement and is clearly terrified of ibogaine. His watery eyes?a common sign of early opiate withdrawal?dart back and forth around the van like those of a caged animal. He confesses he almost ran away from the van when it stopped at the bank but couldn?t reach anyone from the pay phone. He dominates the conversation in the van, another question pouring out of him while Gabriel is still answering the one before. He?s had bad acid trips before, he says?is this one going to be like that? He?s going to break parole when he crosses the border?what about that? What if they get the blood tests back and find out he can?t take the ibogaine?what will they do for him then? He has overdosed before and his heart has stopped?could that happen again?
Gabriel patiently and repeatedly tries to calm him, but with marginal success.
At the clinic, Jesus chain-smokes on the downstairs patio. His withdrawal symptoms continue to worsen, and even though he is afraid of the ibogaine trip, he tries to persuade Gabriel to let him take it sooner. Instead, Gabriel shows them the ibogaine documentary, hoping it will distract Jesus and help calm his nerves. He wishes them all well?just like last week, he won?t see them again until Friday.
By the time the acupuncturist arrives on Wednesday night, Jesus is already long gone. According to Gabriel, who was contacted by phone in the middle of the night on Monday by one of the night nurses, Jesus remained agitated even after they gave him the ibogaine and was ultimately sent home when he became disruptive toward the other patients.
?Dr. Paula,? who gave Jesus his capsule of ibogaine, said at the time that she personally saw him put it in his mouth.
But the fact that Jesus was active and mobile a few hours after pill was given?highly unusual for someone under the effects of ibogaine?compounded with his vocalized fear of having a bad trip, suggests to Gabriel that Jesus never actually ingested any ibogaine.
Jesus? own account is quite different. A few days later, over the phone from his home, he says he did take the ibogaine but could still feel painful symptoms of his withdrawal and wanted more drugs to knock him out. When the night nurses wouldn?t give him any, he demanded that they call Gabriel. Once he realized Gabriel was not coming to his aid, Jesus tried to roust Joe Alex, who he believed had methadone. It was around this time that Gabriel instructed the night staff to call a taxi and get Jesus out of the house.
?He treated me with indifference,? Jesus says of Gabriel. ?He should have come down, or sent Dr. Paula. His solution was to put me in a taxi and send me on my way.?
Jesus took the taxi all the way home to San Bernardino; his family had to pay for the $300 ride.
?My family didn?t believe in this shit?nobody believed,? Jesus says angrily. ?The next thing they see is I?m looking to them to cop some dope. That was so difficult. It was just disappointing.?
It turns out Jesus? fear of ibogaine may have been more than paranoia. On Jan. 31, a man named Jason Sears died at the Ibogaine Association while receiving treatment for his heroin addiction. Nineteen hours after Sears ingested the ibogaine, his heart monitor sounded, alerting the staff. Gasping for air in the arms of the doctor, Sears died of pulmonary thrombosis, which is the end result of a blood clot that forms in the body over time and eventually travels to the lungs.
Like all the patients who come through the Ibogaine Association, Sears? heart and liver functions were checked for abnormalities before he was given the ibogaine, says Dr. Medina, who treated Sears at the Tijuana clinic and prefers his first name not be used.
?Evidence shows that ibogaine can slow the pulse of the heart, so it?s a red flag when you have a patient with previous heart disease or rhythm abnormalities,? Medina explains. ?That?s why we do an EKG prior to the administration of the ibogaine. He had a perfectly normal heart?. His liver enzymes were completely normal.?
Though Sears wasn?t technically killed by ibogaine, there have been a handful of fatalities reported during informal ibogaine treatments worldwide over the past two decades, none of which have been good publicity for the drug.
Mash, who collects her data in a traditional clinical facility with much more extensive medical scrutiny, is afraid her work will eventually be derailed by such ibogaine-related fatalities.
?I get concerned? the more dead bodies we have,? she says. ?And at some point the door is going to shut tight forever because of this behavior.?
However, many ibogaine supporters don?t seem overly worried about standards of care at the smaller, informal clinics.
?With all due respect to her opinion,? says Kenneth Alper, associate professor of psychiatry and neurology at New York University and co-author of A Contemporary History of Ibogaine in the United States and Europe, ?my approach is simply to appreciate the fact that they exist.?
In contrast to Jesus, Josh and Joe Alex experience ibogaine without incident. Even by Wednesday, Josh?s physical transformation is remarkable. His lips and cheeks are pink again, and he?s much more vibrant and alert. He?s still shy while he describes his trip, but, just like Ray, he seems unable to contain his smile.
?It wasn?t as intense as I expected it to be,? he says. He didn?t have many visions but does recall feeling shame and embarrassment.
?I had probably every feeling,? he says, and then reconsiders. ?I wasn?t really scared.?
While Josh didn?t gain too much insight into his addiction, he repeats that that wasn?t his expectation. ?I feel almost the same as I did the day before I took [ibogaine],? he says confidently, ?but I know I don?t have to do methadone anymore.?
Perhaps because he?s 20 years older, Joe Alex doesn?t recover as fast and is still groggy on Wednesday evening. After some ear-acupuncture, Thai massage and a guided meditation exercise, Joe Alex curls up on the carpet and weeps softly, murmuring that it?s hard to forgive himself, that he is feeling powerful shame and guilt.
When Gabriel comes to pick them up on Friday, Joe Alex?s condition has improved. He and Josh sit side by side on the couch as they wait to depart the clinic, both more mellow and less anxious to depart than Ted and Ray before them. Both men have been through excruciating heroin withdrawals before and seem stunned by their ability to function and feel relatively normal so soon.
By now, Joe Alex is invigorated and chatty. He talks animatedly about all the unfinished business he wants to take care of, like getting his teeth fixed, building another motorcycle and helping his daughter buy
?I?m glad I did this,? he says firmly. ?It?s definitely the best detox I?ve ever had.?
On the way back to San Diego, Gabriel stops at a gas station for a pit stop.
?Hey, Doc!? cries Joe Alex like a proud child as he clambers back into the van, ?I can feel I?ve got a little spring in my step!?
For Lotsof, Glick and Mash, progress and legitimacy lie in ibogaine derivatives.
There?s not much money to be made in psychedelic drugs, it turns out, and now that Lotsof?s patents on ibogaine have expired, there?s not really much incentive to try.
But second-generation drugs have not yet been patented and look like they might be as successful as ibogaine, in terms of stopping cravings and withdrawal. Glick has already developed one such drug, a synthesized version of ibogaine called 18 MC.
Mash is also working in a similar direction.
?All the data we?ve obtained to date suggests that ibogaine gets converted to an active metabolite and that the active metabolite holds promise as a drug candidate,? Mash explains. ?The ibogaine causes the visions. The active metabolite is what blocks opiate withdrawals, the cravings and the desire to use the drugs.?
Until Glick and Mash secure funding to test these non-hallucinatory derivatives on humans, one question remains: how big a part do the visions play in the overall healing process?
One biologist and former crack addict, who asked that his name not be published, told CityBeat in a phone interview that ibogaine presented him with a clear choice to surrender to death or keep on living.
?It doesn?t seem like random images that come up,? he explained. ?I saw a man with graying hair. He was sitting alone in a motel room, and I suddenly realized it was myself, and I had to make a decision whether I was going to kill myself or decide not to and lead a healthy life. That was an image I tried to get rid of, but it kept popping up, like that was the crucial thing I was supposed to see.?
Because of testimonials like these, over the years the media has repeatedly portrayed ibogaine as a possible ?magic bullet? cure for addiction. But even the most ardent ibogaine supporters say this is hogwash.
?You have to do a tremendous amount of work,? affirms Kroupa, the former heroin addict. ?One thing that is absolutely certain is that after ibogaine, you need to have some sort of aftercare plan in place. Whatever that means for you [because] problems will not magically vanish. Ibogaine will not hand you a brand new life.?
CityBeat followed five desperate men to the Ibogaine Association in Tijuana to see firsthand how ibogaine really works. Four of them returned visibly healthier, free from cravings and relatively optimistic about their future. But how far away from their former lives did ibogaine really take them?
As of press time, Ted remains unreachable by phone and e-mail.
Ray has been in jail since Dec. 21, his mother told CityBeat.
?It was almost like he was on a mission once he got home to get back in jail,? she said. ?I know that that?s not exactly the case, but that?s what it seemed like. He just went berserk. I was actually glad that he wound up in jail; I was expecting a worse phone call, to be honest.?
Joe Alex checked into a sober-living home at the beginning of December and stayed there for a few weeks. Once he returned home to San Bernardino, he ?had some slips? and says he ?hasn?t been completely clean.? He is now taking methadone and thinking of going back to the Ibogaine Association for a second treatment.
Josh is still clean, goes to Narcotics Anonymous meetings twice a week, and was on his way to a job interview when CityBeat called to follow up.
?If I ever got in that situation again, I wouldn?t even think twice about doing [ibogaine] again?. I was practically dead before,? says Josh. ?I hope I don?t. I?m still kind of blown away at how well that worked and the opportunity it?s given me.?