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Tuesday, December 5, 2023
Dec. 5, 2023

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An illegal psychedelic could change how KY treats opioid addiction. It’s not without risk


LEXINGTON, Ky. — Jessica Blackburn didn’t know she was addicted to opioids until her body’s first withdrawal.

It was 2004, and she was 18. For the last year, she’d swallowed oxycontin recreationally at high school parties in Betsy Lane, her Eastern Kentucky hometown. The first time her body responded to a deficit of pills, Blackburn thought she’d caught a bad case of the flu. It was her high school boyfriend who explained that her body had become dependent.

“It all just kind of clicked,” Blackburn, 36, said recently by phone.

Her active use defined and derailed the next decade of her life.

Blackburn’s parents pulled her out of college and forced her into the first of many stints at a residential treatment center for her opioid use disorder. She tried abstinence-based recovery using the 12-step model. She tried taking buprenorphine, or Suboxone, to help wean her cravings. She was repeatedly arrested on drug-related charges. But no recovery attempts or her lengthening criminal record dissuaded her from returning to oxycontin.

“Using was almost like a romantic relationship, just in terms of how it made me feel,” she said. “It made me very confident, gave me energy. I didn’t feel any physical pain. It was a psychological craving.”

After years of trying to stop, to no end, her dad told her about ibogaine, a psychedelic drug he’d read about. An alkaloid derived from the root bark of an iboga shrub native to West Central Africa, ibogaine had a burgeoning international following among war veterans who’d taken it to treat post-traumatic stress disorder. Her dad learned the drug had also long been used in some countries to treat substance use disorders.

In late May, the chair of Kentucky’s commission charged with doling out opioid lawsuit settlement funds proposed using a portion of that money to research the experimental drug as a potential therapeutic for opioid addiction. But addiction researchers and some commission members are pushing back, citing its health risks. Ibogaine remains a Schedule 1 drug in the United States and is not approved by the Food and Drug Administration for distribution. Fifteen years ago, when Blackburn decided to try the psychedelic as a last ditch effort to save her own life, accessing that treatment required — and currently requires — international travel.

In 2008, with roughly $6,000 in cash, Blackburn traveled alone to Jalisco, Mexico. There, in a house in a small village, she took two doses of ibogaine under the watch of strangers. The only medical device present was a battery-operated blood pressure cuff.

For the next 24 hours, Blackburn lay in a bed, largely immobile with ataxia, a side effect of the drug. She sweated, her heart rate slowed and accelerated, and she hallucinated vividly.

“It was not a fun trip,” she said. “It was violent, like being choke-slammed by God.”

Many of the hallucinations did not directly resonate with her substance use, but some did. She gawked at a disembodied hand opening and closing drawers in her brain, taking old things out and putting new things in.

Her most pivotal and visceral hallucination, one that continues to haunt her today, was when she attended her own funeral in the body of her mother, surrounded by everyone she’d been close to in life, even people who had died.

In that moment, she said she was her mom, and felt sharply the indescribable pang only a parent who loses a child can understand. It was a level of empathy she’d never come close to conjuring. The intensity of it was physically painful, Blackburn said.

She’d last taken oxycontin the day before she flew to Mexico and expected to wake up the following morning in cold sweats from withdrawal. But she didn’t. When her hallucinations stopped, she was dead-tired, but her craving for oxycontin had diminished entirely. So, too, had her withdrawals. Surreal, it felt like her brain had reverted to a pre-addiction state.

As she moved throughout this new world, she discovered ibogaine had curbed other long-term habits. Even though she’d no intention of quitting smoking, Blackburn had no desire to smoke cigarettes, and largely hasn’t in the 15 years since. She also stopped compulsively biting her nails, a habit she’d nurtured since childhood.

Not only did ibogaine truncate her physiological cravings, she said it wholly shifted how she viewed her addiction on an emotional and spiritual level.

“I was young, and I was very selfish,” Blackburn said. “I hadn’t really taken into consideration what I was doing to other people who loved me. I remember my mom telling me, ‘Your life is not just your own,’ and it never made sense. Finally, it made sense.”

‘Essentially a failed model’

On a hot day in late May, a few dozen people stood and clapped for Republican Attorney General Cameron in Frankfort after he vowed to help the state explore a “new approach” to stemming the tide of opioid addiction.

Cameron was flanked by Bryan Hubbard, head of Kentucky’s Opioid Abatement Advisory Commission, who called the news conference that day to publicly float a lofty proposal he hadn’t yet presented to the commission: invest up to $42 million over the next six years to partially fund clinical research into the use of ibogaine as an eventual FDA-approved treatment for opioid use disorder. Hubbard, an attorney, proposed using funds from the nearly $900 million in opioid lawsuit settlement money

He called it a “breakthrough opportunity” to tamp down the “gravest existential threat to this state’s future.”

In a Republican-controlled state like Kentucky, one of the last states in the country to legalize medical marijuana in March, a proposal to invest millions in researching an experimental psychedelic is notable. But it’s also a pitch some experts and commission members watching that day questioned. Clinical research with the goal of bringing a drug to market is expensive, for one; recent studies peg that process costing upwards of $2 billion. Ibogaine has also caused severe, even fatal, side effects on some past patients because of its effect on the heart.

While there are FDA-approved medications available to help people maintain long-term recovery, opioids continue to kill tens of thousands of people nationwide each year. In Kentucky, more than 9,000 people have died of an overdose since 2018, according to state data. Though 5% fewer Kentuckians died last year of overdose than in 2021, 90% of those 2,135 deaths were caused by opioids. The rise of fentanyl, a highly-addictive, fully-synthetic opioid lethal in small quantities has exacerbated the crisis.

Cameron, Hubbard and others who support a state-funded investment to research the psychedelic cite these deaths as proof of the available treatment model isn’t working.

“Existing addiction treatment models have modest success rates,” said Cameron, who’s running for governor to unseat Gov. Andy Beshear, a Democrat. Plus, current treatment is costly, he said. From January 2017 to late May 2023, Kentucky Medicaid was billed upwards of $1 billion for roughly 102 million doses of Suboxone, according to Cameron.

Seven out of state guests, five of whom were veterans, joined Hubbard and Cameron that day in championing research into ibogaine. Like Blackburn, nearly all shared emotionally-wrenching stories of their personal addiction experience, and how their longtime cravings ended after taking ibogaine.

“I felt I’d shifted from a liability to an asset,” Bobby Laughlin, CEO of California-based New Course Enterprises, said tearfully.

Marcus Capone, CEO of Veterans Exploring Treatment Solutions, cried as he explained that not only did ibogaine treat his post-traumatic stress disorder, but he no longer relies on any prescription medication to treat anxiety, the inability to sleep, or pain.

“I sleep without medication and do not need to use my nerve stimulator, which I used to run 24/7 for several years straight,” he said.

Paria Zandi, a marriage and family therapist in Los Angeles, said ibogaine is the dividing line in her life.

“I consider my life pre-ibogaine and post-ibogaine. The best way I can explain it is ibogaine gave me a fresh pair of eyes with which to see the world and myself,” she said. This August she’ll celebrate 10 years of sobriety.

“If this anecdotal evidence can be clinically validated,” Hubbard, an attorney, told the few dozen people who’d been invited to the event, “ibogaine will represent a transformative therapeutic treatment of opioid use disorder.”

Ben Chandler, executive director of the Foundation for a Healthy Kentucky, supports Hubbard’s proposal.

“Our model of treating opioid use disorder is essentially a failed model, and the numbers bear that out,” Chandler said. Ibogaine “could be the key to unlock successful recovery.”

As psychedelics are increasingly studied in clinical settings for their potential as therapeutics for a variety of ailments, initial FDA approval to study a drug like ibogaine as a treatment for addiction would be historic. Dr. Deborah Mash at the University of Miami received FDA approval in 1993 for the nation’s first clinical trial for ibogaine. But after the National Institute on Drug Abuse revoked its funding to test the drug on humans, the plug was pulled on the trials in 1995.

Though anecdotes and case studies show ibogaine reduces withdrawals and cravings, it has also caused “ severe toxic adverse events,” detailed in the Journal of Substance Use and Addiction Treatment. More than 30 deaths associated with ibogaine ingestion have been reported in peer-reviewed scientific literature, according to the Multidisciplinary Association for Psychedelic Studies.

Kentucky is also already in the throes of National Institute of Health-fundedresearch and implementation of a complex treatment system that’s built on expanding use of addiction medications already approved by the FDA —an endeavor still stymied by state policy and stigma. Since ibogaine is nowhere near FDA approval, some question the proposal to invest millions from a finite, public fund to study an experimental drug for which there have been few controlled clinical trials showing that it definitively decreases morbidity and mortality.

“I feel like investing in something largely untested (in the U.S.) doesn’t make a lot of sense when we have so much effort that needs to be poured into making sure we are ensuring this kind of equitable access to the three FDA medications at our disposal,” said University of Kentucky’s Dr. Margaret McGladrey, a researcher with the $87 million grant-funded HEALing Communities study. The goal of this grant is to build a model with community partners to reduce opioid overdoses by 40% in 16 Kentucky counties. If successful, that model will be applied to the rest of the state.

This research, like most mainstream clinical research into opioid dependence, hinges on the finding that opioid addiction is a brain-altering disease. For this reason, long-term recovery is often made possible with the help of medication. There are three drugs formally approved by the FDA: methadone, buprenorphine, and naltrexone. Each has a slightly different effect on the brain, but all work to suppress withdrawal symptoms and cravings.

Ibogaine’s exact impact on the brain is less clear. The drug induces a profound psychedelic state, altering one’s conscious experience. Typically, participants who use ibogaine are given an eye mask and noise-canceling headphones while they hallucinate, according to scientific literature and people interviewed for this story.

The drug does show promise for its ability to curb withdrawals and cravings, but its impact on cardiac activity is what makes it risky. Ibogaine blocks what are known as the hERG potassium channels in the heart, which help to regulate a heartbeat, said Dr. Bill Stoops, a behavioral science professor at UK who specializes in human laboratory and clinical trial research for substance use disorder treatments.

Drug-induced blockage of hERG channels, widely considered a harmful side effect, can cause an irregular heartbeat, or a cardiac arrhythmia, and prolong the time it takes for one’s heart to relax between beats. Ibogaine, specifically, has caused fatal heart attacks, according to the National Institute of Health. People with pre-existing heart conditions are at a greater risk for this happening.

“I like the idea that Kentucky could perhaps invest in understanding psychedelics as a substance use disorder treatment,” Stoops said. But typically when a drug seeking FDA approval is shown to interfere with those channels of the heart, driving up the risk for a heart attack, “very rarely is the FDA going to allow you to move forward with any clinical work,” he said.

For this reason, “I would not start with ibogaine,” he said.

But to Hubbard, that’s exactly why ibogaine should be explored in a controlled, clinical setting.

“I believe the opioid epidemic must be beaten by any and all humanitarian means necessary,” Hubbard said by phone. “Anyone who would question the wisdom of pursuing this should be asked: are you satisfied with what we have?

If we are satisfied with the compounding nature of the opioid epidemic, expressed through record overdoses, record death, and a traumatized generation of children coming out of these communities that will repeat the cycle over the next 25 years, then there’s no need to pursue alternatives.”

But to addiction researchers working with FDA-approved drugs, that equation is arguably too simplistic.

“Overdose deaths are unacceptably high, but I would argue that’s not the fault of whether medications are effective or not,” Stoops said. “I think it’s an issue of access.”

Substance use disorder, particularly to opioids, will never be eradicated completely, but there’s a need to expand access to FDA-approved treatment proven to decrease morbidity and mortality across all areas, especially in the criminal justice system, said Dr. Michelle Lofwall, the Bell Alcohol and Addictions chair at UK’s College of Medicine and co-lead researcher for the HEAL grant.

Strengthening harm reduction and treatment infrastructure to maintain long-term sobriety in a state long plagued by opioid addiction is a massively complicated, costly endeavor that hinges on one basic goal: make evidence-based forms of treatment widely available so all people, no matter where they live or whether they’re incarcerated, have an equitable chance at recovery.

This is not currently the reality in Kentucky, people interviewed for this story said.

“The problem with opioid use disorder is that active use involves illegal activity,” which is why so many people are arrested for reasons relating to their addiction, Lofwall said.

The effects of substance use disorder don’t stop behind bars, but most Kentucky jails and prisons still do not screen for opioid addiction, or offer any of the FDA-approved medication for opioid use disorder to inmates, greatly increasing the potential for overdosing upon release.

It’s a notable blind spot in the state’s multi-pronged effort to support people in recovery, said Lofwall. Why not invest opioid settlement money into first fixing this problem?

“We keep applying an acute model to something that’s chronic. We don’t have a continuum of care where people with opiate addiction get to stay on their medicine,” she said. “We haven’t fixed this. And we wonder why we keep having people die.”

‘I did have a choice’

Despite the lack of clinical research, Blackburn lives with the success of her ibogaine treatment every day.

The shift she experienced from taking the psychedelic was unrivaled to any treatment she’d tried before. She came to see addiction as something she had control over, because suddenly, she did.

Soon after her first ibogaine treatment, Blackburn moved to the Mexican village. She lived there for two years, working with people recovering from their own treatment.

“It was harder physically on certain people. Age was definitely a factor,” she said. “But the mental clarity, the loss of compulsion and a restoration of your brain to a pre-addictive state was always present.”

She lived there, fell in love with a man and was sober for two years. One night, her partner died of a heart attack in his sleep next to her in bed. He was 32.

“That wrecked me,” Blackburn said.

She moved back to the U.S., to New York City, and “that’s when I started using again,” Blackburn said.

For many people with substance use disorders, relapsing is a part of long-term recovery. But even her relapse following ibogaine felt different. It wasn’t induced by an underlying craving or withdrawal, as it had been in the past. Her choice to use again was lucid.

“It was the first time I used that I was very conscious of what I was doing. It was important to realize I did have a choice,” she said. “I knew it was the wrong one, I was just so miserable and broken that I didn’t care.”

Another ibogaine treatment helped her maintain sobriety for a few years after that, until her dad was diagnosed with a terminal illness, and she relapsed again. This time, she violated felony parole. She spent three months in jail before a stint at a residential treatment facility where she was given a Vivitrol (naltrexone) implant to suppress her cravings, and it worked.

Blackburn has been sober for six years. For her, ibogaine’s critical imprint on her life isn’t diminished by her relapsing. Maintaining long-term recovery is a constant pursuit in self-actualization and self-accountability, and no medication or narcotics anonymous meeting has helped her more toward that goal than ibogaine, she said.

“When you’ve been in addiction for some years, you have a big deficit in your soul, because addiction takes that from you.”

Ibogaine “helped me separate myself from that guilt and shame,” she said. “People deserve to have that option.”

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