Imagine having a chronic condition with debilitating symptoms that modern medicine cannot relieve. Sweats, chills, bodyaches, physical and emotional pain, intense cravings, depression, anxiety, suicidal thoughts. Now imagine one day you discovered a treatment that would take away your pain and suffering but you can’t get it. That’s the premise of Of Night and Light: The Story of Iboga and Ibogaine which premiered at the Tribeca Festival. British filmmaker, Lucy Walker, introduces us to lifelong ibogaine activists, Norma and Howard Lofsof. Equally importantly, she lets individuals who have undergone ibogaine treatment tell their story, including marine corp veterans, model Carré Otis and writer-activist Patrick Kroupa who had been addicted to heroin for 14 years.
“When you’re in it, opioid addiction can seem insurmountable with no way out,” said Kroupa who received the psychedelic years ago and is now a long-time ibogaine treatment expert. “It provides an exit and gives you the opportunity to write a new script for your life.”
Walker, who lost her first boyfriend to an opioid overdose, agrees. “Seven years ago, I first heard about a psychedelic medicine that was being used in scores of clinics worldwide to interrupt opiate addiction.” Fascinated, the Oscar-nominated director of Waste Land immediately boarded a train to Tijuana, Mexico to visit an ibogaine clinic. “I became convinced that it was real. It’s the closest thing to a miracle I’ve ever seen.” As she dug deeper, she learned that the entire lineage of ibogaine treatment centers – about 80 have come and gone over the past three decades – could be traced back to Howard Lotsof, a 19-year-old New Yorker who accidentally discovered the healing effects of an African plant on his heroin addiction (and whose activism landed him in jail for 18 months). But first, a look back at this unique class of drugs…
Brief History Of Psychedelics
Psychedelics are a class of drugs that can have mind-altering effects. The psychoactive properties of MDMA (a.k.a. ecstasy), ketamine and psilocybin (the active ingredient in magic mushrooms) have been known for ages. In fact, psychedelic plants have been used by non-Western cultures as sacramental tools for thousands of years: ‘soma’ appears throughout Sanskrit texts in Hinduism; and the ancient Greeks gave initiates a drink infected with LSD-like substances.
Despite decades of research demonstrating medical and psychiatric benefits (which I discuss later), the U.S. government had long demonized psychedelic drugs, tracing back to the 1960s when then-President Richard Nixon’s “war on drugs” and counterculture fight led to his signing of the Controlled Substances Act which classified drugs into five “schedules,” presumably based on medical benefit and risk of misuse, but in reality were based on stigma and fear.
“Sadly, Nixon put ibogaine on schedule 1 of illegal drugs which means the government considers that it has no accepted medical value and high potential for abuse, both of which are blatantly untrue,” states Walker.
The Persistent Activism of Howard and Norma Lotsof
Of Night and Light tells the story of Lotsof who, in 1962, had noticed that a single dose of ibogaine had eradicated his heroin habit. Throughout his life, Lotsof and his wife, Norma, worked relentlessly to understand ibogaine. In Gabon, they learned about cultural and religious rituals associated with ibogaine. The Lotsofs spoke with countless individuals who credit ibogaine for their recovery, as well as scientists and governing bodies to secure federal funding to explore ibogaine’s therapeutic potential. Howard Lotsof was not subtle about his political views: “The war on drugs is racist.”
“If I could canonize Howard, I would,” said Walker. “He worked tirelessly to help those in need, along with his wonderful wife, Norma.” The film captures Howard sitting at his home office reviewing data on his large desktop computer, surrounded by shelves of medical books and stacks of folders on his desk. He ruefully reflects on the vast number of people who are struggling and have died from their substance use disorders (SUD): “Addicts are treated terribly.”
In another poignant moment of the film, we see multiple researchers, patients and activists including Howard speak about ibogaine’s health benefits at a public hearing before the National Institutes of Drug Abuse (NIDA). After presenting years of scientific data from researcher Deborah Mash, PhD – featured in the film – and others, in 1996, NIDA rejected the investigational new drug application, reportedly due to a “narrow toxicity window.”
Howard Lotsof sadly died of liver cancer in 2010. But at age 85, Norma Lotsof continues their lifelong advocacy. She’s joined by medical and scientific professionals worldwide.
Therapeutic Impact Of Ibogaine
Scientists have long known of psychedelics’ health benefits. Clinical applications of LSD, psilocybin and MDMA in psychiatry, for instance, include the ability to improve the depth and speed of psychotherapy. Other clinical applications include ibogaine’s anti-addictive properties as well as treatment of depressive symptoms and psychological trauma. Stanford’s Nolan Williams, MD, a neuroscientist and psychiatrist prominently featured in the film showing imaging and lab data – and who “took on career risks by starting a clinical trial on ibogaine” – believes ibogaine is the “most promising pharmacology for neuropsychiatric illnesses.” He’s not alone.
“Research suggests that ibogaine may have the ability to interrupt addiction patterns, and reduce cravings and withdrawal symptoms associated with substances like opioids,” describes Martin Polanco, MD. The Mission Within founder adds: “For the treatment of mild traumatic brain injuries, we have seen improvements in mood, cognition and memory. Most patients also report better sleep and less anger.”
During my interview with Dr. Polanco, he explained that over 800 special operation veterans have been treated at The Mission Within in Tijuana, “with consistently positive results.” The film depicted heartbreaking stories from several veterans including Erick: “I haven’t gone a day without alcohol in 10 years. I want to deal with my demons.” Post-ibogaine treatment, he reports being in full recovery. Another veteran and patient in Dr. Polanco’s clinic, Ranger Brad Shepard “knew many veterans who died by suicide.” After treatment with ibogaine, Shepard along with several other veterans report having no more tremors, depression or other PTSD-related symptoms.
For Kroupa, ibogaine provided a “reset,” allowing him “to return to a pre-addicted state, wherein I am no longer dependent upon opioids. It gave me an opportunity to establish new, healthy patterns of behavior.” Clinics like The Mission Within carefully monitor patients by connecting them to an I.V. and telemetry and observe vital signs. A small capsule is given orally (“test dose”), followed by a full dose. Medical staff accompany patients for the next 10 hours. Within 36 hours, patients in the film (mostly veterans) reported a resolution in almost all symptoms. No daily, long-term pills required. In contrast, Kroupa points out, medications like methadone and buprenorphine (a.k.a. “Suboxone”) need to be taken daily and indefinitely.
Challenges And Concerns
Perhaps the biggest challenge is not medical but regulatory. Ibogaine is neither readily available nor legally accessible in the U.S. because of its classification as a Schedule I controlled substance. Ongoing data, education and advocacy will hopefully lessen the restrictions.
Despite the beneficial results suggested by animal studies and case reports, clinical trials to assess ibogaine’s safety and efficacy are lacking. Its mechanism of action is also not fully understood. While thousands of patients experiencing opioid use disorder have been treated with ibogaine, Mash explains that clinical efficacy data are difficult to compare, and reports on outcomes vary widely.
Another challenge is administration. Because of potential cardiac toxicity and other side effects, patients must receive ibogaine under medical supervision. Researchers attribute ibogaine-associated fatalities to the its underground status: patients are not being properly screened beforehand and medical professionals are not the ones overseeing the drug’s administration.
Addiction experts like Stefan Kertesz, MD, MSc find the case reports compelling, but question one-time treatment for a chronic condition. “I’m skeptical of single-dose medications for lifetime problems,” says the Alabama VA Health Care System physician. “It sounds almost ‘too good to be true.’” But Dr. Kertesz does not rule out ibogaine’s potential and hopes to see more research.
Travel-related costs are another concern. None of the 80 or so ibogaine treatment centers are located in the U.S. so people need to take time off work, leave their families and self-pay for travel and treatments – nearly impossible tasks for many people with active addictions to cocaine, opioids, etc.
What Needs To Happen Next?
It is tragic that ibogaine has been ignored by funders for more than a half a century. Activists and experts have long maintained that randomized control trials and other clinical studies are required to carefully assess the safety and efficacy of ibogaine and other psychedelics. This requires federal funding. The good news is that NIDA and other agencies are now conducting and supporting research on psychedelic drugs.
We also need to train medical and nursing students and the healthcare workforce on psychedelics’ benefits and harms. Part of that training, however, needs to include broader education in addiction and mental illness as preventable and treatable conditions of the brain; NOT moral failings. Right now, we’re not doing a good job in addressing addiction: less than 10% of people with an SUD receive treatment. Therefore, we need to be open to ALL potential treatments – including ibogaine.
In the film, during former President Reagan’s 1986 address to the nation, he says: “Drugs are menacing our society.” As an addiction medicine doctor, let me be clear: drugs are NOT the problem. Humans will ALWAYS seek pleasure: food, sex, music … and drugs, including alcohol. Remember, most people who use drugs do so recreationally; very few ever develop an addiction (1 to 10%, depending on the substance). We need to focus on prevention (especially among children and teens), education and treatment. As much as I favor ibogaine and buprenorphine, it’s going to take more than a medicine to mend broken lives. We need to address the underlying reasons why people use drugs and develop an addiction (e.g. illness, death, homelessness, divorce, unemployment, sexual assault), using compassion and science including harm reduction approaches.
Based on my experiences serving underserved patients and working at Duke Medical Center and Massachusetts General Hospital, a history of trauma correlates strongly with the development of an SUD. Model and actress Otis bravely discusses her trauma in the film: “I was trafficked by the modeling industry, raped multiple times. I became addicted to heroin.” She was also a high school dropout who developed an eating disorder. Ibogaine helped her heal: “None of this was my fault.”
Many people use drugs to relieve their pain (physical and emotional) and suffering – NOT because they’re weak, lazy, dumb or criminals. Instead of shame, judgement and criminal punishment, let’s connect people with addiction to housing, education, jobs, clothing, marriage counselors, medicines and therapists. Let’s LISTEN to people with SUD and mental illness and get them what they want and need. It’s not drugs they crave; it’s a sense of dignity. Lucy Walker’s film was a major step in humanizing people with addiction and mental illness, while celebrating the heroic efforts of Howard and Norma Lotsof.