The medical use of psychedelic drugs has achieved a level of respectability that was unthinkable when Harvard’s Timothy Leary was encouraging widespread use of LSD back in the 1960's. Most of the writing and research has focused on the use of psilocybin mushrooms, LSD, and ayahuasca. But a lesser-known compound, ibogaine, has been gaining attention, aided by an executive order from President Trump pushing federal agencies to accelerate research.
Supporters say ibogaine could treat PTSD, addiction, and traumatic brain injury. Dr. Peter Grinspoon, a medical cannabis specialist and instructor in medicine at Harvard Medical School, spoke with GBH’s All Things Considered Arun Rath on the topic. What follows is a lightly edited transcript of their conversation.
Arun Rath: Super interested to talk with you because ibogaine is not one of the drugs that Michael Pollan tried in How to Change Your Mind, so I know almost nothing about it. Can you tell us about what exactly is ibogaine?
Dr. Peter Grinspoon: Well, first of all, it’s a supposedly very intense experience. It lasts 12 to 24 hours. It’s considered the Mount Everest of psychedelic drugs. So, it is not for the faint of heart. Ibogaine is not taking mushrooms in the woods with your friends. It is a very, very intense and immersive experience.
It comes from a shrub, the iboga plant in West Africa. It is a compound that has garnered incredible interest, initially to help people with opiate addiction. It’s really weird, we need much better research on this, as we do for all things psychedelics and cannabis, but seemingly people have been going down for decades to get over their heroin habit, and they use ibogaine. They just end up not taking the opiates anymore, not going into severe withdrawal and not having these intensive cravings. It seems to derail the addiction process.
It’s of incredible interest now to researchers, not just for addiction, even though I can’t emphasize how strangely compelling the evidence so far, the limited evidence, is for opiate addiction. But also, as you mentioned, for traumatic brain injury, there’s some good research, and particularly for PTSD. There is a groundswell, like a tidal wave of interest in this. Republicans — Rick Perry, President Trump, as we’ll talk about — there seems to be nobody right now that is not interested in evaluating ibogaine.
This intensive, immersive, long-acting psychedelic for the potential treatment of PTSD, for anybody with PTSD, but particularly it’s being studied for combat veterans. The one thing I should say, there is one health concern with ibogaine. Beyond the fact that it’s an intensive 12-hour trip that can be, if you have a bad trip, be an unbelievably scary and awful 12 hours, but also it can affect your cardiac rhythm and can cause cardiac arrhythmias. So, while there’s tremendous excitement to research this, and veterans are going down to Mexico or to other places down south — not in the U.S., because it’s still illegal to use it — there is a concern about cardiac arrhythmia and sudden cardiac death. So it is not by any means a free lunch in terms of helping people.
Rath: This first wave of people who have been trying it therapeutically, how is it being administered? Are they doing it in the same sort of ritual context that has been done traditionally?
Dr. Grinspoon: Yes, they are. It’s done under supervision. I mean, ideally, there’s a cardiologist there for the cardiac problems ... The veterans are doing it, as I understand, with each other. There’s a lot of group support, social support, camaraderie, and nobody’s just going and doing the drug alone in a room. They’re monitored. There are therapists involved. The most important thing is these brothers, these veterans, are doing it together, and they’re overcoming this together. Both with group support and with the use of this really powerful, but seemingly very healing, psychedelic drug.
Rath: You said that there is some very compelling initial research. What additional research needs to be done, and how will President Trump’s executive order help that?
Dr. Grinspoon: There’s a signal that this might work, but then you need really good, rigorous studies to prove that it actually works. In medicine, we like to have the double-blind, placebo-controlled, randomized studies to make sure it’s not the placebo effect. Obviously, you can’t do a placebo-controlled study with ibogaine because most people would know if they’re tripping intensively for 12 hours versus if they’ve received a placebo. So, that makes it a little bit harder to study.
There are ways to study it, and they’re working on it. The most important thing for me to study, in addition to the efficacy, is how to make it safe. Sudden cardiac death is, obviously ... a catastrophic side effect. President Trump’s order will help destigmatize the use of ibogaine, and it frees up a lot of money — I believe $50 million to contribute to ibogaine research, which will contribute to the million or so that they just approved, believe it or not, in conservative Texas.
That’s how much interest there is in this. They’re freeing up research in these deep red states. Furthermore, President Trump directed them to kind of expedite the research and, especially if there’s initial promising research like a good phase three trial... It’s still very early to really have the FDA focus on fast-tracking these medications. In a variety of different ways, they’re really rolling out the red carpet for the research into this compound.
Rath: While we have you here, we have to ask you, because it is your specialty, President Trump’s executive order regarding cannabis. Tell us what that was and what it means, especially for researchers like you, who are researching medical cannabis.
Dr. Grinspoon: Well, since 1970, the beginning of the Controlled Substances Act, cannabis has been put in Schedule I, which means no medical utility and high abuse viability. Now, that obviously flies in the face of the tens of millions of medical cannabis patients in this country who are using cannabis with good benefit.
President Trump [recently] rescheduled it from Schedule I to Schedule III. Schedule III is where you have drugs that have potential harms, but also great medical benefits, like ketamine, Tylenol with codeine, and anabolic steroids. Medical marijuana is now in a category where, after 50 years of war on drugs, the U.S. government now concedes and supports the idea that it’s a medicine.
This is going to really help patients who are suffering from pain, anxiety, insomnia, chemotherapy-induced nausea and vomiting, use it with much less stigma, fear and judgment. It’s gonna help open doctor-patient communication about cannabis use, which is critically important to the doctor-patient relationship.
It’s going to lower barriers to research because it’s very difficult to do research on Schedule I substances, because you need a special DEA license. Everything’s under lock and key. It’s hard to get good samples to study. With Schedule III, nothing’s going to happen overnight. Research takes time, but it’s going to open up the doors. It’s going to make less red tape, less restriction, less security, and open up for a lot of investment from universities.
