Could Ibogaine Help Address the Opioid Crisis?

What started as a taste of heroin at 16 years old turned into a daily, and costly, habit for Phil Tricovich. After dabbling with opiates in his late teens and early adulthood, he was prescribed pain medication for a back injury in 1997, which “sealed the deal” on his addiction. “It amplified my underlying addictive issues,” he says. 

At his worst, he was taking 100 milligrams of Oxycodone and $500 worth of heroin a day, along with methadone. “I was stocked for World War III in my medicine cabinet,” Tricovich recalls. 

In 2004, Tricovich was introduced to Dr. Jeffrey D. Kamlet, a leading expert in addiction medicine and ibogaine administration, by a pharmacist who felt he might benefit from meeting the physician who had been successfully treating opiate dependency with an unorthodox approach. 

For the next five years, Tricovich repeatedly declined Kamlet’s suggestion that he try ibogaine, skeptical that a strange drug he had never heard of could be the solution to his problem. 

Tricovich attempted to quit cold turkey several times – once under Kamlet’s supervision – managing a stretch of two years without touching an opiate before going right back to it. 

“You can only go through [quitting cold turkey] so many times. It becomes more difficult,” says Tricovich. “Addicts don’t know that. I didn’t know either.” 

Acute opioid withdrawal, which lasts 7-14 days immediately after quitting, is a notoriously hellish experience. “If there is such a thing as the Judeo-Christian model of hell, it’s kicking opiates cold turkey,” says Kamlet. “You’re freezing cold, burning up, shaking, and unable to control your body temperature or bowel movements.” 

It’s different from any other substance withdrawal states, explains Kamlet, because your brain lacks the chemicals that would normally protect you from physical or psychological pain, making it the “ultimate fight or flight panic experience. It’s brain gone haywire.” 

Acute opioid withdrawal is followed by 60-90 days of post-acute withdrawal syndrome (PAWS), during which the individual feels restless, irritable, discontent, and “craving opiates like oxygen,” says Kamlet. 

It’s common for people to act unlike themselves when attempting to quit opioids in order to mitigate their suffering, Kamlet explains. “It will turn the best people into bad people. If the most honest of people had an opiate dependency and were going into acute opiate withdrawal, they would steal 20 dollars from their mother’s wallet to get a fix.”

How Effective is Ibogaine Treatment for Opioid Addiction?

According to the U.S. Centers for Disease Control and Prevention, opioid-related deaths increased to 75,673 in the 12-month period ending in April 2021, up from 56,064 the year before. Opioid addiction has claimed a half million American lives since 1999. 

“Opiate dependency and opiate-related overdoses are predicted to be on a steady incline due to the fact that most of the heroin being sold on the streets today is in fact the synthetic opiate fentanyl and its analogues,” says Kamlet, “which can be hundreds of times more potent than heroin.” By the time the reader finishes this article, approximately 3-5 people will have died from an opiate overdose, he adds.

Ibogaine could “absolutely” have a huge impact on the opioid crisis, says anthropologist and ibogaine researcher Thomas Kingsley Brown, PhD due to its ability to “reset” the brain to its pre-addicted state, effectively bypassing acute opiate-withdrawal and the 90 day PAWS. 

“From the first time I witnessed it, I saw this miraculous treatment. I almost thought it was too good to be true,” says Kamlet, who considers himself to be a medical skeptic. 

In 2009, Tricovich found himself at a critical point, knowing his opiate usage would inexorably lead to jail or death. On the surface, things were going well – he was newly wed with a pregnant wife, and successful in his executive position in a tech sales company. But he couldn’t shake his habit. Desperate to try anything, he finally decided to head to Cancun with Kamlet, admittedly “without high hopes,” to try ibogaine treatment at a clinic Kamlet was taking his private patients to personally oversee the treatments.

After Kamlet administered the dose, Tricovich waited restlessly, sweaty and irritable from 12 hours of no opiates, convinced this was a complete waste of time. 

“All of a sudden,” says Tricovich, “this tremendous peace came over me. And I noticed – I’m not sick anymore.” 

Aside from ibogaine’s “reset” effect, the mental and emotional journey induced by ibogaine was therapeutic for Tricovich. He recalls the life review – typical to many ibogaine experiences – in which he witnessed his entire life on a “million movie screens at the same time.” 

Facing those memories was crucial for Tricovich, who partly attributes not having properly dealt with his adolescent PTSD and “undiagnosed depression” to why he previously relapsed. “It goes through every shitty thing you did to another human,” forcing you to confront those incidents head on. Addressing the root causes of addiction, which commonly involve unprocessed trauma, is also a key part of ibogaine treatment. 

After his treatment, Tricovich wasn’t just craving-free – he felt like a new person. 

“It changed everything about me. It changed the way I look at everything. It changed the way I view myself. It changed the way I view the world.”

Is Ibogaine a Cure?

Kamlet is firm that the recovery process is lifelong, and does not end after taking ibogaine. “Ibogaine is not a cure for addiction. It’s the cure for withdrawal symptoms from opiates, as well as other commonly abused substances, including alcohol.” 

Patients tend to emerge from ibogaine experiences feeling rejuvenated and excited to be alive. It is hypothesized that ibogaine is metabolized in the liver into noribogaine, which is stored in the fatty tissue for about 90 days, and functions somewhat like an antidepressant. “The day after a flood dose of ibogaine, patients have a 90 day window of opportunity where they are extremely teachable and open to integrating healthier behaviors,” explains Kamlet. 

Kamlet advocates that ibogaine treatment be followed with talk therapy and support groups, such as Narcotics Anonymous (NA), 12 Steps, or other recovery programs that the patient feels comfortable with. 

“We have a sustainable success rate that far surpasses anything seen in the United States for people who actively integrate into a life of recovery, be it therapy or meetings,” says Kamlet, who serves as chief medical officer of the Mexico-based ibogaine clinic Beond. Brown agrees that ibogaine is hugely effective “when combined with other treatment modalities.” 

On their own, traditional programs may not be as effective. In the typical U.S. model of patients entering residential detox followed by 30-90 days of residential rehabilitation, the relapse rate is thought to be about 90%, says Kamlet. 

“There is every reason to do what Beond is proposing to do,” says Brown, who authored a promising MAPS study on ibogaine in 2017. “Have addiction counseling and psychotherapy before and after treatment.” 

Tricovich waved off Kamlet’s recommendation of going to meetings after his treatment at first, not realizing his pronounced mood boost was temporary. He relapsed once more before taking Kamlet’s advice seriously, and began attending regular NA meetings after his second ibogaine treatment. To this day, he’s been sober for 10 years. 

“It’s not a cure. You have to do the work,” says Tricovich. “But it helps you get to the place where you can do the work.” 

Image: Nicki Adams