Ron Price needs his milkshake. It's 10 o'clock on a Monday morning, and the baldheaded, barrel-chested former bodybuilder is shuffling around the kitchen of a posh rehab clinic in Tijuana, Mexico, wearing slippers and a blue Gold's Gym T-shirt. Price is a stockbroker in New Mexico, but his training regimen has left him with debilitating injuries, causing him to undergo 33 surgeries in less than a decade. His doctor prescribed Oxycontin, and Price quickly became dependent on the potent painkiller. More recently, he started snorting cocaine and chugging booze to numb the pain. Now, 53 years old and three weeks into rehab, all he wants is a milkshake and to crawl back into bed.
Clare Wilkins, the vivacious 40-year-old director of Pangea Biomedics, pops the lid of a blender to check the consistency of the concoction that Price craves: peanut butter, soy milk, agave syrup, hemp protein powder, and a few scoops of chocolate-flavored Green SuperFood.
Oh, and a half-teaspoon of root bark from the tabernanthe iboga plant.
Taken in sufficient quantity, the substance triggers a psychedelic experience that users say is more intense than LSD or psilocybin. Practitioners of the Bwiti religion in the West African nation of Gabon use it as a sacrament to induce visions in tribal ceremonies, similar to the way natives of South and Central America use ayahuasca and peyote. Wilkins is one of a few dozen therapists worldwide who specializes in the use of iboga — specifically, a potent extract called ibogaine — to treat drug addiction.
She pours the thick, chocolatey liquid into a Mason jar and agrees to hand it over to Price on one condition: that he stay out of bed and interact with his fellow residents and the staff. He grudgingly agrees and takes a seat at the dining-room table. Sunlight pours in through a sliding-glass door that opens to a terrace with a sweeping view of the Pacific Ocean.
"Ron, I remember when you called me [three weeks ago], you were crying on the phone. You were so devastated, you couldn't leave the house," Wilkins says gently. "When you use, you end up alone in a bathroom or something. You need a community. As weird and misfits as we are, we need this sense of community. You need to learn to deal with being in your body each day instead of relying on the fucking ibogaine."
Ibogaine and iboga root bark are illegal in the United States but unregulated in many countries, including Canada and Mexico. Wilkins, though, is hardly alone in her belief that iboga-based substances can be used as legitimate treatments for drug addiction. Researchers at respected institutions have conducted experiments and found hard evidence that the compound works — as long as you don't mind the mind fuck.
"All drugs have side effects, but ibogaine is unique for the severity of its side effects," says Dorit Ron, a neurology professor at the University of California–San Francisco. "I think ibogaine is a nasty drug. But if you can disassociate the side effects from the good effects, there is a mechanism of action in ibogaine that reduces relapse in humans."
Now, scientists have devised ways to make ibogaine non-hallucinogenic. The trouble, say Wilkins and others who have found relief through ibogaine, is that the psychedelic journey carries the secret to the drug's success.
It was Hunter S. Thompson who introduced ibogaine to a wide audience in the pages of Rolling Stone. The gonzo journalist was covering the 1972 presidential election, reporting what would eventually become Fear and Loathing: On the Campaign Trail '72. When Democratic contender Edmund Muskie acted strangely during a campaign stop in Florida, Thompson suggested that the candidate was taking ibogaine, "an exotic brand of speed" that "nobody in the press corps had ever heard of."
The notion of Ed Muskie on an ibogaine bender was absurd, and Thompson knew it. Most experienced users say the drug is extremely unpleasant when ingested in large doses, causing severe nausea, vertigo, sleeplessness, and visions that can be nightmarish. The effects last up to 36 hours, and some users are bedridden for days after.
"I only took one capsule of extract. It was very weak, but it was still strong enough to make me puke for six hours," says Dana Beal, a New York-based activist and longtime lobbyist for ibogaine legalization. "I don't ever want to take it again."
Thompson brought ibogaine into popular parlance, but credit for discovering the drug's medicinal potential has been widely attributed to a man named Howard Lotsof. In the early 1960s, Lotsof was a junkie living in New York. Having bought some ibogaine for recreational use, he was astounded to find that when the hallucinogen wore off, he no longer craved heroin. Days passed, and he didn't experience any of the excruciating withdrawal symptoms associated with kicking a dope habit.
Lotsof, who died earlier this year of liver cancer at age 66, devoted his life to making ibogaine available as an addiction treatment. He experienced a significant setback in 1967, when the U.S. government banned the drug along with several other psychedelics. And in 1970, officials categorized ibogaine as a Schedule I substance, on a par with heroin, marijuana and other drugs that, as defined by the Drug Enforcement Administration and the Justice Department, have "a high potential for abuse" and "no currently accepted medical use."
Lotsof shifted his focus and began using ibogaine to treat heroin addicts in the Netherlands. In 1985, he obtained a U.S. patent for the use of ibogaine to treat substance abuse.
By the late '80s, doctors and scientists were confirming what Lotsof knew: Ibogaine blocks cravings and withdrawal symptoms for many types of drugs, especially opiates.
Dr. Stanley Glick, a pharmacologist and neuroscientist at Albany Medical College, was among the first researchers to test ibogaine on rats. Glick hooked up the caged rodents to IVs, with levers that allowed them to inject themselves with morphine.
"If the rats do it, you can be pretty sure that humans will abuse it if given the opportunity," Glick explains. "It's really the time-tested model of any human behavior."
Strung-out rats dosed with ibogaine stopped pressing the levers that gave them morphine. Glick and other researchers have subsequently replicated the morphine results with other addictive drugs, including alcohol, nicotine, cocaine and methamphetamine.In the early 1990s, Lotsof teamed with Dr. Deborah Mash, a neurologist and pharmacologist at the University of Miami, to study the effects of ibogaine on people. Mash received approval from the Food and Drug Administration to give ibogaine in 1993 and was able to test the drug on eight people before the experiment came to an abrupt halt.
"I was unable to get it funded," Mash says. "We had the rocket ship on the launchpad, with no fuel."
A few months after the FDA gave Mash the green light, a committee of academics and pharmaceutical-industry professionals, assembled by the National Institute on Drug Abuse (NIDA), concluded that the U.S. government should not fund ibogaine research. Earlier that year, a researcher from Johns Hopkins University had found that rats injected with massive doses of ibogaine suffered irreparable damage to the cerebellum, the part of the brain that controls balance and motor skills. According to Dr. Frank Vocci, former director of treatment research and development at NIDA, the fact that ibogaine increases the risk of seizures for people addicted to alcohol or benzodiazepines, such as Valium, raised eyebrows as well.
"The question that was posed to them was, 'Do you think that this could be a project that could result in, essentially, a marketable product?'" Vocci recalls. "There was concern about brain damage, seizures and heart rate. But it wasn't so much that the ultimate safety of the drug was being damned; it was just felt that there were an awful lot of warts on this thing."
Lotsof went his own way, mentoring fellow former addicts who opened ibogaine rehab centers abroad. Mash opened a private clinic in the Caribbean and administered ibogaine to nearly 300 addicts. "It really works," Mash says now. "If it didn't work, I would have told the world it doesn't work. I would have debunked it, and I would have been the most outspoken leader of the pack. That's my scientific and professional credibility on the line."
Wilkins, keeper of the magic milkshake, is one of Lotsof's protégés. Born in South Africa and raised in Los Angeles, she got hooked on heroin as a 20-year-old at Cornell University. Drugs led to depression, and she dropped out her senior year. Years later, while still trying to kick her habit, her younger sister learned about ibogaine on the Internet. Wilkins, then 30 years old and employed as a bookkeeper, read up on the subject, started saving up and, in 2005, shelled out $3,200 for a session at the Ibogaine Association, a clinic in Tijuana.
The trip — in both senses of the word — changed her life.
"I received a direct message that I was washed in love," Wilkins says of her first encounter with the hallucinogen. "That the universe in its entirety is full of love, and that courses through us and was there for me. There was this soul body, this light body that had no beginning and no end. My fingers had no end. There were atoms coming in and going out.
"It got me off methadone completely," she says. "My sense of shame about my addiction was washed away without having to practice with a therapist and talk, talk, talk."
The experience was so profound that she elected to stay on at the clinic as a volunteer. Confident and chatty, with long brown curls and a disarming smile, Wilkins feels that she has a knack for guiding patients through their ibogaine-induced spiritual awakenings.
"On ibogaine, all your walls come down," she says. "You can't lie. You get an opportunity to look at yourself honestly and see how you respond. My role is to be there as a comfort. People compliment me by saying, 'You knew exactly when to hold my hand.'"
In 2006, Martin Polanco, director of the Ibogaine Association, offered Wilkins a full-time job. She had heard rumors that he was considering selling the clinic in the coming year, and on a whim she offered to buy the clinic.
"It was one of those 'can I put that back in my mouth?' moments," Wilkins recounts with a laugh. "I didn't have the money. I didn't even have a car."
Wilkins borrowed $3,000 from her mother for a down payment, changed the clinic's name to Pangea Biomedics and made monthly payments to Polanco for the next year and a half.
Having paid off the $65,000 debt, Wilkins' first order of business was to relocate. Tijuana residents — and rehab clinics in particular — have been terrorized during Mexico's ongoing drug war. Late last month, gunmen stormed a clinic and murdered 13 people, execution style. (The mayhem wasn't random. Drug gangs operate such facilities as safe havens for their foot soldiers.) Wilkins' primary concern, however, was noisy neighbors in the duplex, not narco violence.
"We'd hear cell phones ring through the wall and ranchero music — you'd hear everything," she recalls. "You'd try to go into a guided meditation and hear someone hammering a nail."
Wilkins now rents a lavish four-bedroom home on a hill overlooking Tijuana's upscale Playas neighborhood. Amenities include a hot tub, a weight room, a fireplace, and a veranda with a panoramic view. Safety was not overlooked: The subdivision is gated, and security guards inspect every vehicle that enters.
Stays at Pangea aren't cheap. For the standard 10-day detox, Wilkins charges $7,500, travel not included. She employs a staff of 10, including two Mexican physicians, a paramedic, a masseuse-acupuncturist and a chef. The chef, Wilkins' sister, Sarah, is a recovering addict who credits ibogaine for kicking her drug dependence.
To date, Wilkins says, she has treated more than 300 patients. "Sixty-two percent of our clients are chronic-pain patients," she says. "You're not talking IV [heroin] addicts or crack addicts. You're talking grandmas on Oxycontin."
Some people come for "psycho-spiritual" purposes. Ken Wells, an environmental consultant from Northern California, says he underwent conventional counseling for depression for 15 years before trying ibogaine as a last-ditch effort to save his crumbling marriage.
Three days after taking ibogaine for the first time, Wells compares the experience to "defragging a computer hard drive."
"It was outrageously powerful," Wells says. "It was like the inside of my eyeballs was an IMAX screen. It was all-encompassing, just a multitude of images, like 80,000 different TVs, all with a different channel on — just jillions of images, shapes and colors."
Did the experience help him find what he was looking for?
"I think I'm different," he says. "But I don't know."
It's easier to track ibogaine's effect on hard-core addicts. Wilkins, who keeps tabs on former clients, estimates that one out of every five stays off his or her "primary substance" for six months or more.
Tom Kingsley Brown, an anthropologist at the University of California–San Diego who describes his area of study as "religious conversion and altered states of consciousness," recently began recruiting Pangea patients for an independent assessment of ibogaine's long-term efficacy. Brown follows up monthly with opiate addicts for a year following their ibogaine treatment, to gauge whether their quality of life has improved.
"People I've interviewed at the clinic have had really good results, especially in the first month or so," reports Brown, who has enrolled four study subjects to date and hopes for a group of 30. "We know ibogaine interrupts the addiction in the short term, but what we're really curious about is: Does that translate into long-term relief from drug dependence?"
Participants in Brown's study fill out questionnaires that ask them to rate the intensity of different aspects of their trips, on a scale of one to five.
"People have been circling a lot of fours and fives," Brown says. "One of the things we're trying to look at is if the intensity of the ibogaine experience correlates with treatment success. I strongly suspect there's some sort of psychological component. I doubt it's just a biological phenomenon."
Some scientists beg to differ. Foremost among them are Mash and Glick.
"The hallucinations are just an unfortunate side effect," Glick asserts, explaining that ibogaine works on the brain like a "hybrid" of PCP and LSD. "Part of the problem is that when you go through this thing, it's so profound, you've got to believe it's doing something. In part it's an attempt by the person who's undergoing it to make sense of the whole thing."
Generally speaking, Glick's research on rats has shown that ibogaine "dampens" the brain's so-called reward pathway, reducing the release of neurotransmitters, such as dopamine, that cause the highs associated with everything from heroin to sugary foods. Ibogaine has also been proved to increase production of GDNF, a type of protein that quells cravings, and to block the brain's nicotinic receptors, the same spots that are stimulated by tobacco and other addictive substances.
Mash, the researcher from Miami, is convinced that ibogaine works long term because it is stored in fat cells and processed by the liver into a metabolite called noribogaine that possesses powerful detoxifying and antidepressant properties.
"If you gave somebody LSD or psilocybin, and they were coming off opiates or meth, they'd go right back out and shoot up," Mash says. "There's evidence that it's not the visions that get you drug-free; it is the ability of the metabolite to block the craving and block the signs and symptoms of opiate withdrawal and improve mood."
Though they don't question its effectiveness, both Mash and Glick believe it's unlikely that ibogaine will ever be widely accepted in the United States. It's not just that ibogaine makes people hallucinate. It can be fatal.
Since 1991, at least 19 people have died during, or shortly after, undergoing ibogaine therapy. Alper, the NYU professor, examined the causes of the fatalities, which occurred between 1991 and 2008. His findings suggest that ibogaine itself was not the culprit; the patients died because they had heart problems or they combined the hallucinogen with a drug of choice. (By way of comparison, a study published last year by the Centers for Disease Control found that between 1999 and 2006, more than 4,600 people in the United States died from overdoses involving methadone.)
Three of the ibogaine-related deaths occurred at Wilkins' Tijuana clinic. Two involved patients who had cocaine in their systems, she says, and the third had a pre-existing heart condition. Wilkins says she's now more selective about her clients and requires that they undergo a drug test.
"The learning curve has been difficult at times, but people need to know this can be safe," Wilkins says. "We have to show people how far we've come."
Some of the scientists, however, think they've found alternatives that will make the risks — and the tripping — associated with ibogaine unnecessary.
Mash has devised two ways to isolate the metabolite noribogaine and administer it: (1) a pill and (2) a patch similar to the nicotine variety. She hopes to begin testing the products on humans by the end of this year.
"It has all the benefits without the adverse side effects, including no hallucinations," Mash says. "I spent a lot of years really pushing ibogaine as far as I could, both in preclinical and clinical studies. But everything that I've learned in the course of 18 years of working on ibogaine has convinced me that the active metabolite is the drug to be developed."
Glick, meanwhile, teamed up with a chemist named Martin Kuehne, from the University of Vermont, to create and research a chemical called 18-MC (short for 18-methoxycoronaridine) that mimics ibogaine's effect on a specific nicotinic receptor. Just like ibogaine, 18-MC appears to work wonders on drug-addicted rats.
"Cocaine, meth, nicotine, morphine — we did the same studies with 18-MC, and it worked as well or better than ibogaine," Glick says. "We also have data that it will be useful in treating obesity. In animals, it blocks their intake of sweet and fatty foods without affecting their nutrient intake."
Glick and his cohorts have yet to determine whether their synthetic ibogaine has psychedelic properties. The rats, after all, aren't talking.
"You look at an animal given ibogaine, and you can't tell if they're hallucinating. But they look positively strange," Glick says. "You give them 18-MC and you can't really tell. But we hope when it gets to people, it won't produce hallucinatory effects."
The first human testing of 18-MC is scheduled to begin later this month in Brazil. But scientists there won't be studying its effect on addiction. They'll be investigating the drug's potential as a cure for the parasitic infection leishmaniasis, an affliction similar to malaria that's common in tropical climates. Through pure coincidence, 18-MC is chemically similar to other drugs that are used to treat that disease.
The Americans jumped at the chance to test their product in South America. Although 18-MC has shown promise and no observable side effects in animals, not a single pharmaceutical company has shown interest in developing it as an anti-addiction product.
"Pharmaceutical companies don't like cures," says Kuehne, a veteran of big pharma who worked for Ciba (a predecessor of Novartis). "They like treatment. Something for cholesterol or high blood pressure that you [take] for years and years, every day. That's where the profit is."
Further complicating matters is the fact that 18-MC has proved difficult to manufacture. Obiter Research, a company based in Champaign, Illinois, that specializes in synthesizing experimental chemicals, spent nearly two years refining the process before successfully creating about 200 grams of the substance — just enough to send to Brazil to be administered to human subjects.
The notion of hallucination-free ibogaine (whether it's ever manufactured) rubs the drug's die-hard supporters the wrong way.
"With methadone, they just removed euphoria from opiates," says Dimitri "Mobengo" Mugianis, an underground ibogaine-treatment provider. "This is the same process they're doing now — removing psychedelic and visionary experience. Ibogaine works. What are they trying to improve or fix?"
A former heroin addict, Mugianis kicked his habit with the help of ibogaine administered at Lotsof's clinic in the Netherlands. The experience was so extraordinary that Mugianis traveled to Gabon to be initiated into the native Bwiti religion and was trained by local shamans. He says he has performed more than 400 ritualistic ceremonies on addicts, most of them in New York City hotel rooms.
Despite his strong belief in the power of ibogaine, Mugianis does not see it as a miracle cure for addiction.
"The 12-step approach really helped in combination with ibogaine," he says. "I say it interrupts the physical dependence, because that's what it does. There's no cure. It's not a cure. It allows you a window of opportunity, particularly with opiate users."
Efforts are afoot to legalize — or at least legitimize — ibogaine in the United States. But persuading doctors and elected officials to support a potent, occasionally lethal hallucinogen can be a tough sell. And the pitch becomes doubly difficult when some of the ibogaine enthusiasts inspire skepticism.
One of ibogaine's most outspoken advocates is Dana Beal. An eccentric character who helped found the Youth International Party (more commonly known as the Yippies) in the 1960s, Beal travels the country giving PowerPoint presentations and touting the benefits of ibogaine and medical marijuana. In June 2008, he was arrested by police in Mattoon, Illinois, and charged with money laundering. He was carrying $150,000 in cash in two duffel bags, money that he claims was going to finance an ibogaine clinic and research center in Mexico. Beal maintains his innocence and is free on bail as the case heads to trial.
Folks such as Beal, pharmacologist Glick says, keep ibogaine and 18-MC from being embraced by the medical mainstream.
"There's a lot of baggage that comes with ibogaine, some of it warranted, some of it unwarranted," Glick says. "It's really a stigma. Drug abuse itself has a stigma, and unfortunately so does ibogaine. It has really hurt the science."
Beal shrugs off the criticism, arguing that grassroots activism is the only way to ensure that politicians will endorse ibogaine. Besides, he adds, the government stopped funding ibogaine research long before he was arrested.
"[The scientists] think if they stay away from us activists, NIDA will bless them," says the self-styled rabble-rouser. "NIDA is not blessing them. They're washed up and on a strange beach. How will they get they get FDA-approved clinical trials without activists?"
Earlier this year, Beal contacted the legislative offices of U.S. Rep. Russ Carnahan. The St. Louis Democrat is the sponsor of the Universal Access to Methamphetamine Treatment Act, and Beal aimed to persuade him to earmark federal dollars for ibogaine research. Carnahan turned him down.
Beal jokes that the best advertisement for ibogaine might be an episode of Law & Order: Special Victims Unit in which a heroin addict who needs to testify in court is administered ibogaine to make his withdrawal symptoms disappear overnight. "Maybe Congress will watch SVU and say, Maybe we should check this out — wow! — it works for methamphetamine, too?" he says sarcastically.
In truth, ibogaine's effectiveness against meth has already helped it gain acceptance abroad. Lawmakers in New Zealand, where meth use has skyrocketed in recent years, recently tweaked the nation's laws to allow physicians to prescribe ibogaine. Dr. Gavin Cape, an addiction specialist at New Zealand's Dunedin School of Medicine, says the nation's doctors have been reluctant to wield their new anti-meth weapon.
"[There are] no true controlled studies to give evidence as to its safety and effectiveness," Cape says. "There is a strong advocacy group [in New Zealand] for ibogaine, and it may turn out to have a place alongside conventional therapies for the addictions, but I'm afraid we are a few years away from that goal."
Last month, dozens of ibogaine researchers, activists and treatment providers gathered for a conference in Barcelona, Spain. Alper was among the attendees who gave presentations on the benefits of ibogaine to the Catalan Ministry of Health. The NYU prof believes that ibogaine's most likely path to prominence in the United States will be as a medication for meth addiction, for the simple reason that doctors and treatment providers have found that small daily doses — the kind that drug companies prefer — seem to work better for meth addiction than the mind-blowing "flood doses" used on opiate addicts.
"The visions have some psychological content that is salient and meaningful," Alper says. "On the other hand, there is no successful treatment for addiction that's not interpreted as a spiritual transformation by the people who use it. It's the G-word. It's God. We as physicians don't venture into that territory, but most people do."
Recently, Wilkins has been experimenting with such small daily doses for people with heart conditions or other health problems that make the "flood dose" inadvisable. The non-hallucinogenic regimen seems successful, she says, citing the case of Ron Price, the former bodybuilder, in particular.
Price first went to Tijuana for ibogaine in 1996 and has been back six times, including his recent October stay. "Every time I feel like I'm getting out of control, I come here," he says, his voice a gruff mumble. "The very first time, I had a bit of visuals. It's supposed to take six months to get off methadone. With this it was one day. It was incredible. I haven't had a craving for methadone since then."
That first time, Price took a "flood dose," enough to keep him tripping for hours on end. During this stay, Wilkins started him off with a tiny dose and gradually increased the amount that he ingested each day. At the same time, she was weaning him off Oxycontin.
"We reduced your Oxy dose from 240 milligrams to 120 milligrams, in what, two weeks? That's rock and roll!" she says.
"He was fantastic," she adds. "He developed a routine in his day. He was getting up and watering the garden and not staying in bed and watching TV. He was walking the dog and wanting to go out — he was eager to go home, not scared."
Now, seated at Pangea's kitchen table, Price reflects on what has been most helpful during his time in Mexico. The ibogaine has lessened his cravings for drugs and alcohol, he says, but eventually the effect will wear off.
"It's no magic thing," he says. "It's creating good habits and creating a support system. Ibogaine just strips you of the cells and walls you build up for yourself. It allows you to go to AA meetings, which I'll do when I get home. It at least gives you a fighting chance to make your own decision."