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People who've taken ibogaine say it can have the unintended consequence of temporarily turning them off a substance other than their drug of choice. Lauren Wertheim traveled from her hometown of Omaha, Neb., to a rehab center called Awakening in the Dream House near Puerto Vallarta, Mexico, and used ibogaine to kick her meth habit. "Ibogaine resets all your [tolerance] levels to zero, like you've never done drugs," she says. "Even coffee — the first cup set me off like a rocket launcher. That's when I was like, 'This stuff is for real.'"
Mash is convinced that ibogaine works long term because it is stored in fat cells and processed by the liver into a metabolite called noribogaine that possesses powerful detoxifying and antidepressant properties. "If you gave somebody LSD or psilocybin and they were coming off opiates or meth, they'd go right back out and shoot up," she says. "There's evidence that it's not the visions that get you drug-free; it is the ability of the metabolite to block the craving and block the signs and symptoms of opiate withdrawal and improve mood."
Though they don't question its effectiveness, both Mash and Glick believe it's unlikely that ibogaine will ever be widely accepted in the United States. It's not just that it makes people hallucinate. It can be fatal.
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Between 1991 and 2008, at least 19 people have died during or shortly after undergoing ibogaine therapy. Alper examined the causes of death. His findings suggest that ibogaine itself was not the culprit; the patients died because they had heart problems, or combined the hallucinogen with their drug of choice. (By way of comparison, a study published last year by the Centers for Disease Control found that between 1999 and 2006, more than 4,600 people in the United States died from overdoses involving methadone.)
"It's knowing who to treat and who not to treat," Alper contends. "None of [the 19 fatalities] appear to have involved a healthy individual without preexisting disease who didn't use other drugs during treatment. Two deaths occurred when they took ibogaine in crude alkaloid or root-bark form — they didn't know what they were taking or how much."
Three of the deaths occurred at Wilkins' Tijuana clinic. She says two involved patients who had cocaine in their systems, and one who had a preexisting heart condition. She says she's now more selective about her clients and requires that they undergo a drug test. "The learning curve has been difficult at times, but people need to know this can be safe," she says. "We have to show people how far we've come."
Some of the scientists, however, think they've found alternatives that will make the risks — and the tripping — associated with ibogaine unnecessary.
Mash has devised two ways to isolate the metabolite noribogaine and administer it: a pill, and a patch similar to the nicotine variety. She hopes to begin testing the products on humans by the end of this year. "It has all the benefits without the adverse side effects — including no hallucinations," she says. "I spent a lot of years really pushing ibogaine as far as I could, both in preclinical and clinical studies. But everything that I've learned in the course of eighteen years of working on ibogaine has convinced me that the active metabolite is the drug to be developed."
Glick, meanwhile, teamed up with Martin Kuehne, a chemist at the University of Vermont, to create and research a chemical called 18-MC (short for 18-methoxycoronaridine) that mimics ibogaine's effect on a specific nicotinic receptor. Just like ibogaine, 18-MC appears to work wonders on drug-addicted rats.
"Cocaine, meth, nicotine, morphine — we did the same studies with 18-MC, and it worked as well or better than ibogaine," Glick says. "We also have data that it will be useful in treating obesity. In animals, it blocks their intake of sweet and fatty foods without affecting their nutrient intake."
Glick and his cohorts have yet to determine whether their synthetic ibogaine has psychedelic properties. The rats, after all, aren't talking. "You look at an animal given ibogaine, and you can't tell if they're hallucinating. But they look positively strange," he says. "You give them 18-MC, and you can't really tell. But we hope when it gets to people, it won't produce hallucinatory effects."
The first human testing of 18-MC is scheduled to begin later this month in Brazil. But scientists there won't be studying its effect on addiction. They'll be investigating the drug's potential as a cure for the parasitic infection leishmaniasis, an affliction similar to malaria that is common in tropical climates. Through pure coincidence, 18-MC is chemically similar to other drugs that are used to treat the disease.
The Americans jumped at the chance to test their product in South America. Although 18-MC has shown promise and no observable side effects in animals, not a single pharmaceutical company has shown interest in developing it as an anti-addiction product.
"We're fortunate we have this other disease apart from addiction where we know it can be tested," says Kuehne, a veteran of Big Pharma who worked for Ciba, a predecessor of Novartis. "Pharmaceutical companies don't like cures. Really, they don't — that's the sad thing. They like treatment. Something for cholesterol or high blood pressure that you [take] for years and years, every day. That's where the profit is."