Could a plant from equatorial Africa be the source of a radical new treatment modality 6,000 miles away in snowy Vermont? The iboga shrub is the source of ibogaine, a naturally occurring compound that is used to interrupt substance use disorders (especially those related to opioid use). Its effects are also known to provide other neurological and psychological benefits via the deep personal insights ibogaine can open up in its users. People who undergo ibogaine treatments often do so in Mexico and other countries where it is not illegal. Recently, reality TV star Scott Disick — known for his appearances on Keeping Up With The Kardashians — made headlines when he announced his choice to undergo ibogaine treatment at a center in Costa Rica. Most people who use the substance report a complete and lasting reversal of their addiction symptoms immediately following treatment, which is usually performed under the guidance of a shaman. Ibogaine’s reported benefits are immense, but it is not without risks. It can have cardiovascular impacts that have caused complications and even death in people with underlying health issues, and in the U.S., ibogaine is listed as a felony Schedule I controlled substance.
Since, over the past few years, Vermont has become the synecdoche for national concerns over opioid use disorders, the state is looking to the controversial natural medicine as a potential way to mitigate the problem. According to data from the 2012-13 National Survey on Drug Use and Health, Vermont ranks in the top tier of states for illicit drug use in the past month among individuals aged 12 or older, as well as illicit drug dependence in the past year among individuals aged 12 or older (among other measures).
According to preliminary data from the Vermont Department of Health, the number of deaths involving heroin reached 35 in 2014, an increase of 66 percent from 21 deaths in 2013 (though overall opioid fatalities were down slightly, from 72 to 67). Last year, Governor Peter Shumlin devoted his entire State of the State speech to the topic, in which he cited Vermont’s 250 percent increase in treatment for heroin and 770 percent increase in treatment for all opiates since 2000.
The state is no stranger to progressive drug policies. Since 2004, it’s had a medical cannabis program and is frequently mentioned as one of the next states likely to tax and regulate cannabis for adult non-medical use. The RAND Corporation issued a study of cannabis legalization in January in which the state was prominently featured, and a tax and regulate bill was introduced in February.
But now a bill has been introduced in the state’s House of Representatives that would create something far more radical than taxed and regulated cannabis: a pilot program to use ibogaine in the treatment of substance use disorders. On March 10th, Rep. Paul Dame (R-Chittenden-8-2) and Rep. Joseph “Chip” Troiano (D-Caledonia-2) introduced H. 387, an act relating to the dispensing of ibogaine for substance abuse treatment. The bill was referred to the House Committee on Human Services.
As presently drafted, the bill would direct the Commissioner of Public Safety, in consultation with the Commissioner of Health, to develop and implement a three year pilot program to dispense ibogaine for the treatment of individuals addicted to drugs or alcohol. To be eligible to participate, a person must be diagnosed with a severe and persistent substance abuse disorder by a health care provider in the course of a bona fide health care provider-patient relationship. The health care provider must also verify that reasonable medical efforts have been made over a reasonable amount of time without success to reduce or terminate the patient’s reliance on drugs or alcohol. The Department of Health would contract with a nonprofit organization to operate an ibogaine dispensary.
Rep. Dame called ibogaine treatment “an interesting idea that has shown results in other countries.” He said it has the potential to save the state millions of dollars in reduced treatment costs and cut down wait lists for treatment programs.
“We talk a lot about protecting people’s freedoms, and here is a way we might be able to help Vermonters free themselves from a serious addiction,” he said.
The bill’s prime mover is activist Bonnie Scott. Her group, Vermonters for Ibogaine Research, was founded after Governor Shumlin’s 2014 State of the State speech.
In a press release to announce the bill’s introduction, Scott said, “Vermont has led the U.S. on so many political issues, and has made tackling opioid dependency a priority. Different types of treatment will appeal to, and work better or worse for, different individuals. Vermonters and their physicians should have access to ibogaine as one of their treatment options.”
Unfortunately, the bill will not receive a Senate companion this year, as the crossover deadline has already passed. (In order for a law to be passed in Vermont, both the House and Senate must vote on and pass similar legislation.) Ultimately, this means that the bill can’t move to Governor Shumlin’s desk until next year. It also means that advocates will have the rest of 2015 to fine tune the language of the bill. As Scott (who suggested that Rep. Dame base the bill on Vermont’s medical cannabis program) and drug policy reform experts who have reviewed the bill admit, it has major flaws, so this could be an opportunity in disguise.
Scott and veteran ibogaine activist Dana Beal are also considering the possibility of a state sponsored clinical trial of ibogaine vs. 18-MC, an ibogaine–related molecule that was co–developed by Dr. Martin Kuehne of the University of Vermont. Although early animal trials on 18-MC have indicated that it’s less cardiotoxic than ibogaine, there have not yet been clinical trials looking into its efficacy on humans.
Bill proponents may want to examine how another state thousands of miles southwest is proposing to use a Schedule I drug to treat opioid use disorders. On March 13, Nevada State Senator Richard “Tick” Segerblom introduced Senate Bill No. 275, which would create a four year pilot program of heroin–assisted treatment. Heroin–assisted treatment programs have been successfully established and experimented with in several countries, but not in the United States, where even the more conventional forms of medication–assisted treatment for opioid use disorders remain woefully underutilized. S.B. 275 got a hearing in the Senate Committee for Revenue and Economic Development on April 7, but no further action on the bill is allowed this session.
Vermont’s H. 387 appears to be the first piece of legislation related to ibogaine in the United States since 1992, when late New York State Senator Joseph Galiber introduced a bill that would have required the Office of Alcoholism and Substance Abuse Services to encourage and aid research into ibogaine as a treatment for heroin and cocaine addiction. Like S.B. 275 and most bills, it never moved out of committee. And if H. 387 hopes to avoid a similar fate, Vermonters, treatment professionals and ibogaine advocates need to convince Committee on Human Services chair Ann Pugh to hold a hearing on the bill.
Both Nevada’s S.B. 275 and Vermont’s H. 387 represent two dramatically different and radical new approaches to medication–assisted treatment of opioid use disorders. Are these states really ready to explore heroin maintenance or ibogaine detox and interruption?
Nevada probably won’t consider heroin maintenance until its next regular legislative session in 2017, while H. 387 needs amending to be legally viable and has no hearings scheduled. In the meantime, to paraphrase R.E.M., the treatment world is collapsing around our heads. But if we turn up the radio, we hear the sound of courageous activists and legislators like Dame, Scott and Segerblom and groups like the Global Ibogaine Therapist Alliance, the Multidisciplinary Association for Psychedelic Studies and the Drug Policy Alliance singing new songs based on science, choice and compassion. Stay tuned.