On May 31, Kentucky Attorney General Daniel Cameron and his special counsel Bryan Hubbard were joined by a host of advocates to announce plans to use state funds to study ibogaine-assisted therapy. It calls for allocating $42 million, a historic devotion of public funds to psychedelic research.
The funding would come from a portion of the $842 million dollars of settlement money Kentucky has received in lawsuits against major corporations accused of propelling the opioid-addiction crisis, which has hit the Bluegrass State particularly hard.
“This administration recognizes that the opioid epidemic is one of the most tragic and visible symptoms of spiritual affliction which pervades our society,” Bryan Hubbard, head of the Kentucky Opioid Addiction Abatement Advisory Commission, told the audience. “That affliction is often met with treatments which anesthetize the soul and euthanize the body. We must do better.”
While state-funded psychedelic research is not new, Kentucky’s plan is notable for its focus on ibogaine, a relatively obscure psychedelic compound, instead of more commonly researched substances like psilocybin, MDMA, or ketamine.
Ibogaine is derived from the bark and roots of an evergreen shrub, Tabernanthe iboga, native to Central Africa, and induces deep dissociative and visionary states of consciousness inpatients, lasting up to 48 hours. Since the 1960s, ibogaine has made waves for its efficacy in treating opioid dependency by diminishing physical symptoms during withdrawal.
“No other known synthetic or organic modality can do anything like ibogaine” said Hubbard. “It takes an individual at least 14 months, and in most cases 18, to recover normal neurochemistry [after taking opioids]. If one receives methadone and suboxone, they never achieve this restoration.”
Dr. Nolan Williams, an associate professor at Stanford University’s department of Psychiatry and Behavioral Sciences and the director of the Stanford Brain Stimulation Lab, is currently working on a study of ibogaine assisted therapy and its effects on victims of traumatic brain injuries as a result of blast concussion. His study of ibogaine’s impact on 30 human subjects, many of whom are US Special Forces veterans, is due to be published later this year.
The Challenges of Ibogaine-assisted Therapy
As Americans become more aware of psychedelic-assisted therapy’s potential in general, ibogaine has found its way back into the conversation. Studies like the ones conducted by MAPS in New Zealand and Mexico have indicated iboga’s potential as a breakthrough therapy for those struggling with trauma and substance abuse disorder.
However, despite ibogaine’s potential to treat opioid dependency, the plant in some cases has cardiotoxic effects, and requires close clinical supervision. The primary risks, says Joseph Barsuglia, a clinical and research psychologist, and psychedelic medicine expert, are cardiac events, which have occurred in patients who weren’t properly screened prior to taking ibogaine.
To address these risks, Hubbard and his team have been reaching out to a range of experts in treating trauma, addiction, psychotherapy, and the medical applications of ibogaine.
“There’s a lot of news about psychedelics that have come out, but ibogaine requires by far the most supervision and medical observation,” said Barsuglia. “Proper clinical care for ibogaine patients must include housing for several days, and live cardiac monitoring.”
According to Barsuglia, there’s a host of physical and psychiatric exclusions for who can and who cannot do [ibogaine] safely, and he firmly believes its safe use requires an inpatient level of care. “There’s the cardiac risks, there’s metabolic risks with people that have organ dysfunction or metabolic conditions. On the psychiatric side, people that have had psychotic disorders or bipolar disorder sometimes are too mentally unstable to go through an iboga experience.” The commitment of resources to clinical research is a critical next step in creating access to ibogaine treatment, says Barsuglia.
Barsuglia and other medical experts display optimism for the Kentucky plan, especially compared to the haphazard attempts at ibogaine treatment initiatives in other states. “They’re not going to go maverick and just start ibogaine clinics, which Maryland and Vermont proposed in the last 10 years. They proposed these pilot clinics with iboga that were kind of patient-led, but they didn’t have a drug development strategy,” said Barsuglia. A phase 1 clinical trial for ibogaine to treat opioid dependency is now being completed in the UK.
Kentucky has tried more conventional approaches to tackling opioid use disorder as well. Last month, State Attorney General Daniel Cameron committed $8 million to two dozen addiction treatment, recovery and prevention grants for organizations fighting the opioid crisis across the state’s 120 counties.
In his remarks, Hubbard acknowledged that the widely accepted medications for opioid use disorder (MOUD), including suboxone, remain necessary, since they represent a statistical improvement on strictly abstinence-based programs. “Nonetheless, [MOUD] comes with consequences. Treatment access in Kentucky is plentiful. Between 2017 and May 26, 2023, Kentucky’s Medicaid program paid for over 101,000,000 doses of suboxone and had been billed over $1,000,000,000 by its manufacturers and distributors. Access isn’t the problem. Results are.”
Following the recent announcement, the KYOAAC will organize public hearings and potential town halls around the state to speak with Kentuckians about how the council ought to proceed. Once stakeholders have had their say, the commission will seek to initiate and oversee clinical research into the use of ibogaine for the treatment of mental health disorders including PTSD, and addiction to opioids and other substances. The state government hopes to establish public-private partnerships with local clinical psychologists, nurse practitioners, and other licensed physicians to develop research studies.
Hubbard hopes the KYOAAC will be able to vote on committing the funds this fall, and then begin to develop the necessary criteria for the announcement of a research grant opportunity in early 2024. This grant would give clinical research teams from around the country the chance to come to Kentucky to help develop an ibogaine therapy model, as well as best practices for its application to opioid use disorder.
According to Andrew Tatarksy, a psychologist with 40 years experience treating substance use disorder patients, the announcement is historic for multiple reasons.
“First, the recognition that, in order to maximize the effectiveness of ibogaine, it needs to be administered in the context of a comprehensive set of best practices, in a state of the art addiction treatment program,” Tatarsky said. And secondly, “that the therapeutic part of the plan would be informed by integrative harm reduction psychotherapy during the initial evaluation and preparation phases of the treatment protocol. […] It doesn’t require that people commit to a particular goal like abstinence, which has been a major stumbling block for addiction treatment in this country that has been dominated by an abstinence only approach.”
“We open our hearts to people, wherever they are, to begin a positive change journey. That’s really a very unique way of beginning to create safety in treatment,” continues Tatarsky. “We’re not presuming the nature of people’s problems are what their goals should be, we want to create a safe space to help them discover that for themselves.”
A Sound Investment
At the public announcement, a reporter from the Woodford Sun asked Mr. Hubbard how the commission came to the sum of $42 million dollars to fund the program, given the state being awarded $842 million.
“The total settlement amount coming to the state, with half going to the political subdivisions of the counties, cities, and towns, and the other half coming to the commission. The commission’s half is $421 million,” Hubbard explained. “We are currently funded by City Bill 90, which is a criminal justice reform program targeted at individuals who are afflicted by opioid addiction and co-occurring mental health disorders in 11 counties over the next four years to the tune of $42 million.”
Hubbard reiterated the preliminary nature of the day’s announcement, saying the Commission believes that $42 million would be a sound investment into exploring ibogaine’s potential, considering what ibogaine-assisted therapy could mean for the recovery of the state and the nation. “We want to make sure that the money we put up to be matched by clinical research teams will be an adequate sum to get us across the finish line. We do not want to stall out before we have reached the tape.”
Jesse MacLachlan, the State Policy and Advocacy director for Reason For Hope, agrees. “Kentucky is taking a bold leadership role in addressing the opioid epidemic by exploring the opportunity to fund clinical research of the potentially life saving intervention of ibogaine treatment. This is a prudent and measured approach to explore innovative solutions to the greatest addiction crisis our country has experienced in its history.” Reason for Hope advised on the KYOAAC program and announcement.
“This is an opportunity we have,” Hubbard said, “not just to change the dynamics within our state on a profound level, but to change the dynamics across the United States.”
Featured image: The Kentucky capitol building. Courtesy of Noah Daly.