ADDICTION RESEARCH: Ibogaine Therapy: A 'Vast, Uncontrolled Experiment' -- Vastag 308 (5720): 345 -- Science

ADDICTION RESEARCH: Ibogaine Therapy: A 'Vast, Uncontrolled Experiment' -- Vastag 308 (5720): 345 -- Science
Brian Vastag

Despite potentially harsh side effects, an African plant extract is being tested in two public clinical trials--and many clandestine ones
On a snowy President's Day, an odd group of activists and scientists devoted to treating addiction gathered in an art gallery in the Chelsea warehouse district of New York City. As an all-night, all-day rave throbbed next door, panelists outlined the latest developments in a decades-long movement to mainstream a West African plant alkaloid, ibogaine, that purportedly interrupts addiction and eliminates withdrawal.

Sustained by true believers who operate largely outside the academic medical world, research on the vision-inducing drug is gaining attention, despite its U.S. status as a banned substance. The Food and Drug Administration (FDA) approved a clinical trial in 1993, but the National Institute on Drug Abuse (NIDA) decided not to fund it after consultants raised questions about safety.

The plant extract can be neurotoxic at high doses and can slow the heart. Yet a handful of scientists continue to study it for its potential in treating addiction. The enthusiasts who gathered in New York reviewed efforts to tease apart its antiaddictive and hallucinatory components.

Although a PubMed search for "ibogaine" pulls up some 200 articles on laboratory studies, clinical reports cover just a few dozen patients. That's because patients seek treatment clandestinely. "Whether the FDA likes it or not, the fact of the matter is that ... hundreds, probably thousands of people ... have been treated with ibogaine," said Stanley Glick, a physician and pharmacologist at the Albany Medical Center in New York who has documented ibogaine's antiaddictive potential in rodents. At the meeting, Kenneth Alper, a Columbia University assistant professor of psychiatry, estimated that more than 5000 people have taken ibogaine since an organized (but unregulated) clinic opened in Amsterdam in the late 1980s. Boaz Wachtel, an ibogaine advocate in Israel, believes that 30 to 40 clinics operate worldwide. Listed alongside heroin, LSD, and marijuana on the U.S. Drug Enforcement Administration's schedule I of banned substances, ibogaine is nevertheless legal in most of the world.

"There's basically a vast, uncontrolled experiment going on out there," said Frank Vocci, director of antiaddiction drug development at NIDA. The agency spent several million dollars on preclinical ibogaine work in the 1990s before dropping it.

Ibogaine's promoters yearn for the legitimacy that a successful clinical trial can bring. They may soon get their wish. Later this spring, neuroscientist Deborah Mash of the University of Miami in Coral Gables, Florida, will launch a phase I safety trial in Miami. A second safety and efficacy trial, of 12 heroin-addicted individuals, is slated to begin this fall at the Beer Yaakov Mental Health Center in Tel Aviv. Both are being funded in an unusual fashion: by anonymous donations--$250,000 for Mash, a smaller amount for the Israeli study.