Ibogaine Treatment and the Opioid Crisis: Past, Present, and Future

Ibogaine Treatment and the Opioid Crisis: Past, Present, and Future

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00:09
a lot to tell you about I want to be able to tell you the full story without being overly verbose so I'll try to keep things moving but essentially what I want to talk about today is treatment with ibogaine for what's called substance use dependence and mostly for people who are trying to get off of opioids like heroin and oxycontin I also want to look a little bit at the opioid crisis which I'm sure that you are becoming more and more aware of because it's in the news more and more so I'm gonna start out with a
00:41
testimonial I I went on to Facebook which I I am look to do but I went on to Facebook sometime last week and the first thing that came up in my feed was from a Canadian provider of I began who who wrote I just had a dad call me to thank you again for helping his son kick a kick toe couple years ago and I had coffee yesterday be the guy I treated a year ago that he wasn't too sure was going to make it he's more than a year clean now and loving life this medicine needs to be made more available and soon so this is a guy
01:13
who's treated scores maybe a couple hundred people up in Canada and he's getting calls like this from parents and thank-yous from people and it's it's quite miraculous so my entry into this whole world was back in 2009 and I started interviewing people at a clinic and and Baja California just south of the border in San Diego where I live and the first person I ever interviewed was this woman sandy Hartman she had just
01:46
about a month and a half but prior to that received treatment for for her dependence on opioids 12 years earlier she'd been in a auto accident and the doctor has put her on I think it was oxycontin it was on the prescription painkillers and she became dependent on those painkillers for 12 years tried to kick that habit and had horrible nutrition for years and years and she for her 60th birthday in 2009 she drove
02:17
across the country she was living in Tennessee she sold her farm literally sold the farm and moved to Mexico to get this treatment with her dog yuppie and so she had received this treatment and she was doing great and she told me her story and I immediately this was this I mean immediately was sure that there was something here that needed to be studied further and fortunately Maps funded a study that I I'll tell you about to where I was able to get some
02:48
quantitative data they showed that the yeah began really works so the opioid crisis everyone's going to becoming more and more aware of it this is this graph is showing the increase in overdose deaths from opioids by type of opioid from 2000 to 2015 so it's a few years old but if you look at 2016 data the increases continue in the same in the same fashion so if you look at that top line any opioid so that includes all the ones listed below and
03:20
if you look down further you'll see that there's this there's this Purple Line natural and semi synthetic opioids that would include things like oxycontin oxycodone and that line you can see kind of steadily increasing from 2000 to 2015 and then very recently the heroin overdose deaths have really spiked quite rapidly and also deaths from really potent synthetic opioids like fentanyl have been really increasing rapidly I
03:52
also want you to notice that methadone is in there methadone is one of the treatments for opioid use disorder and that has also been causing deaths what those deaths have been decreasing in recent years probably because people are using other things so it's been shown that the rates of opioid prescriptions to things like oxycontin preceded the higher rates of opioid overdose deaths and the this drug these two charts of
04:23
the US are showing and it's a little bit hard to see I'm sorry to say but the more intense colors in the purple on the left are higher rates of opioid prescriptions in 2012 and then on the right you've got rates of drug overdose deaths in 2015 so three years later the more intense darker red are the rates over the places what their death rates are higher and you can see there's a pretty strong overlap between those two and research has shown that up to 80% of Americans who use heroin reported misusing prescription opioids
04:54
before they started using heroin so the the prescription opioids are for the gateway opioid and people switched to heroin because it's cheaper but it's also much more dangerous because there's no there's no quality control and it's also mixed with things like fentanyl which can kill instantly so one of those since semi synthetic opioids is something called oxycontin and this is something that was introduced on the market in 1996 by Purdue Pharma and it was marketed aggressively by Purdue
05:25
Pharma they created a film at an eight-minute film called I got my life back patients in pain tell their story and they distributed this to 15,000 or so physicians in the United States saying that that opioids are not as dangerous as people think and not as addictive as people think they are and that they could be used for chronic pain up at that point opioids were really specifically used for acute pain and Purdue form I wanted to market this for
05:58
chronic pain use so here's a still shot from that film I got my life back this is dr. Alan Spanos who was a spokesperson for Purdue Pharma and in the beginning of the video he says you know we know that opioids are the best thing for pain relief and and it's clear to us that they're not as dangerous or as addictive as people think they are and we can use these for chronic pain and so this is marketed aggressively the doctors in this same film so I got my
06:33
life back is actually a quote from this gentleman Johnny Sullivan in the original film from this which came from 1998 just a few years in after they marketed they initially put this on the market so he said you know he had had an accident as a construction worker and wasn't able to work and he started using oxycontin and he was able to work again and he felt great he said how it felt I felt the best I've felt in a long time I got my life back so you know they
07:03
say oh he's able to come back to work they had a couple other case studies I think they had six people and all so they're saying you can you spend time with your kids you can be active you can you can return to work but then in 2008 he died in an auto accident he fell asleep at the wheel his truck flipped and he was killed instantly his his wife said that he'd been falling asleep constantly the opioids were causing him to fall asleep all the time and she had
07:33
she knew that they were gonna kill him eventually and she just didn't know how and the stories are heart-wrenching in this video you can the the video itself isn't available because Purdue doesn't want anyone to see it but but there's a video about this and that's that's the link in the youtube if you want that link just contact me or or someone with maps afterwards and I'll get that information to you so more recently it's been clear that the New York Times has
08:04
had some articles this meant some investigative reporting that has shown that Purdue Pharma knew about the dangers of oxycontin very early on and they knew that it was that it was more addictive in fact it doesn't it's supposed to be a slow release and it doesn't actually last for as long as as opposed to but there are more serious problems and that Purdue Pharma knew that the oxycontin was being crushed and snorted and abused in this way that it was being stolen from pharmacies and so this drug spoon sculpture was placed
08:34
outside there Purdue farmers headquarters in Connecticut in on June 22nd of this year as a way to Samarkand responsible in large part for the opioid crisis so given that we had this opioid crisis you know what are the current treatments for it and how good are they the the standard treatments were for substance Yusuf's order for opioid dependence is called opioid replacement
09:07
therapy or ort and this is the idea is that you replace the problematic drug like heroin with something that is considered safer and it doesn't have the same euphoric effect so the most common ones are methadone which has been used for many decades and buprenorphine which is a newer newer replacement therapy on the scene so it's called replacement therapy because you're what you're doing is you're taking one opioid and you're replacing it with another opioid like methadone or buprenorphine and the idea
09:39
is that you will eventually you can kind of you replace that one opioid then you gradually reduce your dosage you wean yourself off of this drug and you eventually stop using the opioids all together it's kind of a neat idea in theory and it doesn't work that that typically doesn't work that that way in that quickly it's typically around seven to twelve years of being on a replacement opioid before you're able to wean yourself off if you can make it that far and you have to do this every
10:11
day or else you miss a dose you will go into a Thrall because it's an opioid you become dependent on it so how are effective are these treatments I have to look at my notes to get that because I don't have it in my head right now but so as I said o R T depends on you having to take something a day in and day out every day basically until you are able to stop using it because you wean your del self down to just a low level that really be the only way you could
10:42
successfully stop using it right so so it's important for us to look at what are the dropout rates if you're if you're on a maintenance program how likely is it you're going to stay in that program and I have the numbers from this is from a extensive comprehensive review called a coconut review of all the literature on on the topic and this the review of the literature recently revealed that after only five months five months after starting treatment about 37%
11:14
of methadone patients and almost half 47% of buprenorphine patients have dropped out already after five months of this they're not using it anymore and they'll also want to look at relapse rates right so again extensive usable literature showing that after detox so one way you can if you want to very you know in a very short term help someone who is say hooked on heroin you can give them methadone replace that and they won't get when to withdrawal
11:45
right and that's called a detox it's very short-term and you can you can stop them from using that and studies have shown that if you'd simply do a detox and then don't follow up with maintenance no long-term maintenance so with methadone after only a month and a half only 26 percent of the people who are on that may on who are detox are abstinent from illicit opioids and for buprenorphine its words only eighteen percent after four or more weeks are absent from those illicit opioids
12:16
another study showed that after four or eight weeks of maintenance on view for nor Fein if that maintenance is tapered and then they stopped so they've tapered them down in a very controlled program and they they stopped the use of the buprenorphine after eight weeks eight point six percent of those people are having a treatment success they're not using the opioids anymore so it's it's kind of marginally effective at the best and that I must say though
12:48
that it's the best standard treatment that we currently have it has saved many people's lives and it allows people to have more or less normal lives now people have I've heard stories of people on methadone and suboxone it's not a very pleasant thing but it's better than being on heroin which is much more dangerous so now go to let's go to ibogaine and it's to get this out of the way so I say ibogaine some people say Hebo game either way is okay I think I just heard the first time I heard someone talking about it they said
13:20
ibogaine so I that's how I say it but I think either either use is okay so this man is man who is responsible for discovering that the ibogaine could interrupt addiction his name is howard lotsof and in 1962 he was living in Brooklyn he was 19 years old he was part of a laid drug experimental group but mostly early twenty-something people who were trying different psychoactive drugs because
13:51
they wanted to kind of experiment and see if they maybe they could be used for psychosis and it's like the therapeutic purposes so one day Howard a chemist friend of his said oh I've got this thing you got a try it's called ibogaine it's a 36-hour trip it takes seven hours to come on but it's it's it's really it's really something so on his own one day Howard decided he was going to take the ibogaine and he thought well we've got seven hours before it comes on and so I'm gonna go
14:23
to my therapy appointment and then you know it'll kick in afterwards only on the on the ride there to this therapist he it starts coming on and he he gets out of the out of the car and he's having these intense visions like versions of himself coming out of his body and goes into this therapist office and says I'm on ibogaine turn on your tape recorder and I'll tell you what I'm seeing so so that about then I have to this long intense journey that he has and the visions the intense part of the
14:55
visions stop and he goes back home and about 20 hours later he gets home in Brooklyn and he's exhausted and he thinks why would anybody want to do this ever I'm gonna sleep for for two days and I'll never touch this stuff again only he goes to sleep he wakes up three hours later fully refreshed and he he doesn't really know what's happening yet cuz he doesn't take the ibogaine to stop using heroin but he walks outside of the of his family's home and he gets this street meet he stops he realizes
15:26
sideling i'm not inherent with roe I haven't had heroin for more than a day oh wow and and he got a quote from him this is also from a YouTube video I love YouTube so he said I stopped dead in my tracks on the street and suddenly I realized I wasn't in Herring withdrawal and immediately after I realized that I wasn't in heroin withdrawal I realized that my perception towards heroin had entirely changed or previously I had viewed heroin as a drug which gave me comfort I now viewed heroin as a drug which emulated death and the very next thought in my head was I prefer life to
15:58
death so he eventually made ibogaine treatment his life's work but it was only a few decades later as well I'll tell you in a moment but he made it his life's work and and eventually started treating people with ibogaine in the in the late 80s see okay so so what is ibogaine so ibogaine is one of the alkaloids found in the inner root bark it's concentrated most highly in the inner root bark of the iboga shrub which is indigenous to west central Africa and so you can see the
16:31
structure there it's kind of a crazy structure but so it's extracted it can be extracted from this plan this is the root of the plant you can see us a gentleman has shaved off the outer root bark to get the inner root bark the inner root bark which is the most concentrated place for the for the offal though it's including ibogaine so it's got a dozen different alkaloids in it and we don't really know what the effects of the other ones are very well okay so in in West Central Africa and
17:02
Gabon Cameroon a few other places they use this in many different ways but in the btu religious tradition they use massive doses once maybe twice in the life of a person where they prison will take massive doses of this root bark and will go on a journey and they have a ceremony they called in and go Z which which typically lasts overnight so these ceremonies have been there have been a traditional practice for hundreds of at
17:33
least hundreds of years and possibly millennia and there are a sacred use of this plant they're typically overnight and sometimes longer these pictures are from a friend Murrah Reitman so thanks to Marrero for these for these photos in this one also is from Mora so these ceremonies are transformational they are initiative ceremonies the initiative the land of the dead and goes undergoes a process of death and rebirth and has
18:04
given a new name anthropologists that James Fernandez his book on the booty said the iboga visions are part of God an important part of the breaking open over the head and the open up the opening up to the four possibilities of self and of universe which i think is relevant to what happens with people with ibogaine too as we'll see just taking a quick look as i know someone's kind of keeping track of time and i want to see what that person is okay great thanks so gabon and in 2000 declared he
18:38
boga that you book a plan to be a national treasure and that's in recognition of its long sacred use but it also it was in recognition of that they were aware that ibogaine by this point had been used in clinics at various places around the world will see to treat opioid addiction and other kinds of addiction and i was also being used for psycho-spiritual purposes so they declared a national treasure in 2000 which is in great contrast to how
19:08
our government is treating ibogaine and other other psychoactive substances so howard lotsof dr. howard this is a picture from 1990 and the the apartment building there is a site of some of the very early treatments in 1989 this treatment provider on the left is shown with norma and howard lotsof outside her apartment where she was doing some of the treatments early on this photos from
19:39
Boaz doc dole and thanks to him for these photos as well so we we went he went on to see there the growth of these of these treatments actually want to go back to this for a moment because I want to mention that in the early years from 1989 to 1993 it was estimated that about 45 people were treated with ibogaine and this is primarily in the Netherlands and also in New York City those are the two places where you could find ibogaine treatment under in New York it was underground because I began was declared illegal in the late 60s and
20:10
also put on Schedule one in the United States and some European countries and Australia followed suit all right so there was activism in the early 90s trying to get research done on ibogaine treatment and also to you know get it off of Schedule one and make it an available treatment for people so there's someone at a rally in New York City in 1993 this is a flyer for a rally which ended up being a very small rally
20:40
but this poster storm night of her four ibogaine the idea was to storm the National Institute of drug abuse and advocate for ibogaine treatment availability and this was modeled after a something called storm the NIH for AIDS there was a some overlap between the activism for ibogaine and for AIDS activism especially in New York City we had groups like act up which were and then the overlap has to do with injection drug users who are also
21:11
contracting HIV at much higher rates than gentlemen the general population and the picture I don't have here that I wanted to include is a picture of Howard and normal lotsof standing outside the FDA building in 1993 they howard lotsof with credentials being a film degree from NYU convinced NIDA to embark upon a ibogaine project and they funded some preclinical animal studies of ibogaine
21:40
and ibogaine derivatives and that was a two million dollar project by night NIDA and in 1993 the FDA approved a Phase one clinical trial of ibogaine which was halted due to lack of funding it was privately funded and it was halted due to lack of funding so they got pretty far there but they were halted in their efforts to get ibogaine treatment going so the ibogaine medical subculture this this comes from an article by my colleagues Ken Alper and Charlie Caplan
22:12
and also howard lotsof so as I mentioned by 1993 there are maybe 45 treatments well at this point by 2006 there were ibogaine treatment centers on four different continents and these dots show you where they are and so at this point in time there are 13 different treatment sites that were known there were also some underground treatments in the United States and elsewhere and these you can see from the
22:42
map here those ones that are near the United States are actually not in the u.s. they're in Canada and Mexico you also see Central America the Caribbean Brazil and a couple of scattering and there's one in South Africa and a scattering of of European countries and the these authors call this a the medical the ibogaine medical subculture a science writer Brian Vesta also referred to this in 2005 as a vast uncontrolled experiment because you have people treating with ibogaine and there were no they were just figuring out how
23:14
to do it as they went along and and there were there it's kind of the Wild West in a way of treatment but that's what they had they didn't have any approval from any any governments to do research and so they woge to head with the treatments anyway because they knew that they worked so that from that same paper the I became a medical selva culture from 2001 to 2006 the number of treatments that they could verify went from to under 900 to almost 3,500 they're estimating that during that period there was an annual growth rate
23:46
of about 30 percent of the number of treatments per year and so here we go from 2006 this is the map I showed you earlier and then eight years later and this is a business and work that I did I do that kind of about quick and dirty well the 2006 that ibogaine medical subculture paper was an exhaustive study here I was trying to figure out I was trying to contact clinic directors and people who are doing treatments and I found 35 treatment sites I could verify
24:16
and there may be as many as 50 that I thought existed you can see the number has grown and I'll go back to this one so you see a lot more treatment sites especially in Mexico and we've got that the the blue dots are ones where ibogaine treatment had not existed there in countries that where ibogaine treatment had not existed prior to that that in the in the earlier study and the green dots which is it is really fascinating in three countries that by this point ibogaine was made available as a legal prescription medication those countries are Brazil South Africa and
24:48
New Zealand and then just last year this is from someone I met at a conference and ibogaine conference in Europe there were 80 treatment sites around the world so this is still rapidly going look all the ones in Mexico they're there overlapping on each other and you've gotten a number of countries that are having ibogaine treatment available for the first time as well so so yeah this is happening around the world and you know it may not be growing as fast as it
25:20
was but it's still growing and these treatment sites are popping up all over the place and so we want to know how effective is this treatment we've there a lot there's law there's a lot of anecdotal evidence for many years but back in 2010 Maps funded the study of ibogaine treatment and Mexico which which I was in charge of and and then a few years later they funded a study that was done in New Zealand I'll tell you
25:52
about that his studies in a bit so we want to know how effective this stuff is and so we did some quantitative measures in our study so my colleague Ken Alper and I published this last year we we asked two questions about efficacy of ibogaine there were two basic things we were looking at is it good on this short-term does it help with detox does it help you reduce the withdrawal symptoms you would get when you stop using your opioids so primarily people coming in using heroin and oxycodone and
26:24
we want to look and see does ibogaine as reported does it alleviate with your withdrawal symptoms like it did for howard lotsof so the other thing we're looking at is does it help you stay off of the problem drugs on the term so we did follow-ups for monthly for one year to see if that was the case and the main thing we were using for our measure was something called the addiction severity index we're getting good counts of how much they're using how often they're using different things
26:54
and also how how severe their drug use is based on you know do they think it's problematic and they think they need treatment right now and the the ASI addiction addiction severity index also has six other subdomains including psychiatric well-being social and family status things like that so our major findings and this article is thanks to two maps has been made available for free online so you can find this online and download a PDF of
27:29
it we showed that a yes ibogaine is effective for detox their withdrawal symptoms following treatment go down quite substantially quite significantly and in the few days after a treatment where at a time when you'd expect that they'd be getting worse because they'd haven't been on their opioids and what we're showing is that the the strength of that effect is on par with if you gave someone methadone so you give them a replacement opioid it's actually no better than giving them ibogaine and so
28:00
in with ibogaine they're not on the ibogaine anymore they have this this treatment and then they stop doing it and so we're showing that are the effectiveness of the alleviation of withdrawal symptoms is on par with methadone right and we're also showing that there was a reduction in opioid use and problematic opioid use that lasted for 12 months and that was a very strongly significant finding and I think almost as importantly maybe even more importantly and we showed that there was a long-term improvement in social and family status and what this is really
28:31
saying is that following ibogaine treatment people's relationships are improved with the people that matter most in their lives family members close friends coworkers and so on so their their quality of life has improved they're much happier and so that was our study and there was also this study which also came out last year and in the same journal the American Journal of drug and drug and alcohol abuse Geoff Knoller and colleagues did this study in
29:03
New Zealand and this one found similar results to ours in terms of the drug use severity the drug use was much less severe and problematic over the 12-month follow-up period they also found that depression scores were reduced for the entire 12-month period so you had using the Beck Depression Inventory that people were less depressed in the during the 12-month follow-up period an earlier study this is from 2014 also shows that that ibogaine works for cocaine dependence and by the way howard lotsof
29:35
got patents for ibogaine treatment for opioids for stimulants like cocaine for alcohol for nicotine and for poly drug use and those other ones haven't been studied yet scientifically but this retrospective study shows that it helps people stay off of cocaine as well and also poly drugs and so we had this evidence that it works now so why isn't it available why can't we you know just have people go and get an i began treatment well first of all it's illegal
30:07
and schedule one and why is it illegal and this is a common misunderstanding I see when people talk about whether you're asked a question of like why can't you get ibogaine treatment well let's say it's because it's dangerous or and there are risks associated as I'll mention but really the reason is that it's it's illegal and it's illegal because it so it's it's psychoactive it's considered a hell Lucian hallucinogen and it was kind of lumped together with all these other hallucinogens and in the late 60s and when LSD and psilocybin and I'll and
30:38
scores of other things were made illegal they just put I've again in the list even though almost nobody knew what it was at the time and so it's still it's still illegal it's still Schedule one and it's very hard to move something off of Schedule one there are risks associated with ibogaine treatment is particularly if you have pre-existing heart condition and of course people coming in who are addicted to opioids for years are in not very good physical shape to begin with so they're it's a little riskier when you're when you're doing that so it makes it also riskier
31:11
for drug development but but the big pharma I'd say small potatoes for big pharma because this ibogaine treatment it doesn't fit with this kind of pharmaceutical model where you you start taking something and you just take it every day for on and on it's something that typically works in one or two treatments so the the financial incentive is they are and it's quite quite expensive as we have seen from the the MDMA Phase II trials what is a twenty six point
31:41
something million dollars to to get that going and so you know the financial incentive has to be there for these pharmaceutical companies and also it's a it's a natural product ibogaine is and so it can't be patented itself so there's not much interest in exploring that alright so I was saying that the reason it's it's illegal is that it's psychoactive and some people think that the psychoactive effects are sort of a
32:11
hindrance or an unwanted side effect but I think that they're actually important for the in the healing process and I want to show you some narrative Osito from people I interviewed before I started the the Maps funded study and also people from this map study and so you if I entered when I interview people before their treatment they would say things like this I had no motivation to do anything nothing was fun or interesting it was a slow suicide isolated myself more and more and I gave up all of my interests you don't feel
32:44
what joy you don't feel pain you don't filled up you don't feel at all so people are depressed they're they're oftentimes suicidal so then they have this ibogaine treatment what's the experience like it's it is a very lengthy experience it tends to it can be 24 to 36 hours for three different phases or that are great different from each other it's physically and emotionally difficult can cause vomiting difficulty moving around but it also causes these dreamlike visions which are primarily there when you have your eyes
33:13
closed a common theme is a panoramic recall of things in your life that you might have might have forgotten about even but you have this this recall it's like I'm watching a movie inside your eyelids and some of the common experience well themes that come out of treatment are insight regarding the the roots of the addiction visions of an alternative past or present or future if they wouldn't have been using the the opioids mystical experiences so people reach these great heights
33:44
despite the the experience and also a reconciliation and forgiveness with family members and other people that they feel like they've harmed over the years through their addictive behaviors so here are some quotes from people's descriptions this is from the from the map study where people were talking about what they saw during their during their experience I began allowed me to see what was making me so miserable the person said I saw instantly why I became addicted I'd
34:15
been in a tremendous in tremendous emotional pain related to an upbringing in an abusive household I was very good at intellectualizing my pain and my problems I'm sorry I'm not feeling the pain I'll another person said I'd acquired from dad a relentless and very negative voice in my head during my journey this voice left me it was extraordinary there was like a tape loop in my head broke and the tape spun off into space it was so noticeable that I could sense the space in my mind that was freed up by its departure I was able to stop that
34:44
and open myself up to real life or maybe the first time in my adult life and I mentioned reconciliation and forgiveness this these themes came up and you recall that one of the strongest findings we had in our study was that that relationships were improved and listen to what these people said about their experiences one person says I felt a profound sense of love for my family and their love for me and an intense almost piercing agony as I was overwhelmed with the remorse and the waste and loss playing empathy with my family over all
35:15
their hopes for me - by my relentless pursuit of drugs another person says and this is person who grew up in a very abusive household his father shot him up with heroin when it was 15 on the tenth day after they started treatment while still at the clinic I woke up and realized suddenly that all of my life experiences made me who I am today and with that realization I totally forgave my mother and father before I began I hated my father and now I'm thankful for all that I learned from him so that's that's a powerful transformation so
35:46
after treatment people are saying that they have transformed some one person says I have my life my personality is back I want to be more social again and recall what this guy said about oxycontin these are people whose lives are saved but with ibogaine so it's it's it's quite traumatic and and the person said ibogaine treatment it's like having your life handed back to you and this is a quote from howard lotsof and buz vaak tell who wrote a manual for ibogaine treatment we don't really know how
36:16
ibogaine works but you know still and this is in 2003 they said that ibogaine value is not only in the interruption of withdrawal but by mechanisms not fully understood to assist the patient in changing learned behavior and becoming more aware of their behavior in order to change it after I began their appeal any patients become more agreeable to change am i doing on time ten minutes okay great all right so what I want to do for the rest of this time is to I was hoping to leave Q&A time but um I want to talk
36:49
about what are the barriers to access for ibogaine treatment I mentioned why we don't have it available here in the US and in many other countries as well but I want to talk about why is it that you know somebody say in this neighborhood who wanted to have an eye began treatment wouldn't be able to get it the main barriers I can see are legal which I mentioned because it's not legal here in the US people have to go to places where it's unregulated or where it's legal to do it or that you would underground here in the US and that's risky at best
37:19
there are also geographical barriers to access that is now if you're living here in Pittsburgh and you need to go to Mexico or to Vancouver or or to Costa Rica to get a treatment you know you're not where you need to be for the treatment and also that occur that involves financial barriers you got to be able to pay for not only the treatment itself maybe six thousand seven thousand dollars for the treatment itself playing fair and so on so you can
37:51
see that there are enormous barriers here and so who currently has access to ibogaine treatment well people in countries where it's legal those who can afford to pay for travel and and can get a passport if they need to go to another country or if they're in that country they need to at least be able to afford the treatment so and also people who can afford to take time off from are you gonna do you need to go down you tell your boss I'm gonna go to Mexico and I'm gonna have this thing because they know I've been hooked on opioids for the last you know seven years you know and or people who don't have to
38:22
work so you can see that it's it's not an easy thing to be able to do so I want to mention a little bit about the demographics from this study because we don't have a lot of like hard data on who's getting ibogaine treatments but we do have information from the study that that I did so this is a very busy slide I'm Paul apologize for that but the main things I want to point out here and this is only thirty people but they're all residents of the US and over the con Roman period is there were 67 people who
38:54
went to the two clinics that I worked with and almost all of them were from the US right and in the thirty people in our study twenty seven ninety percent were Caucasian one Hispanic one Asian one other who I think was Asian and Caucasian mixed and the other thing I wanted to highlight here well Oliver residents the u.s. more than more than a third within California they're coming down to Baja California so it's relatively you know closer but six were from northeastern states are a couple
39:25
from New York City from New Jersey and so you know all around the u.s. some some from the southern states Midwestern states and they tend to be somewhat educated and a little bit of college education on average and this is despite the fact that some of the people were so young that they couldn't been in college for more than a year so there are some efforts in the u.s. to - currently underway by States and I think this is actually it's a good idea to try to work state-by-state as we've seen by the way
39:57
it's worked for medical marijuana and also for legalization of marijuana in the US and there are some additional her will strive again but there are some states who've been trying Vermont in New York and I'll talk about Maryland in a moment again a busy slide but the main things I want to point out here are that Vermont had two different kinds of bills one was sort of a it was modeled after medical marijuana dispensary and that was I think not a very well we'll consider law because I mean if it would have gone
40:27
into effect which it didn't just handing out ibogaine or iboga to people is not a good thing to do and by the way you can get this online don't don't do it and it's you don't know what you're getting for one thing and you should really only be having ibogaine treatment if you have some supervision get some heart monitoring beforehand get it checked out by a physician and make sure that you're that you're being monitored during the treatment so the other thing that Vermont did and this is the same thing that New York and Maryland
40:58
followed up with as well as they they had a bill that would have funded an ibogaine study New York did the same thing Maryland also very recently in fact there's a bill I think that's still being considered it might have gone to committee at this point but none of these bills have gone in the law and none of them have made it out of committee even but they're trying to fund ibogaine studies which I'm all in favor I think that we could use some more research but I would like to see these laws be really aimed at trying to
41:29
increase to provide the availability of treatment for people in this country despite the fact that it's illegal in schedule 1 I have a few minutes ok five minutes thank you so just really briefly to go to the question of what if we make ibogaine treatment legal and available here in the US how would things be different and to refer to my notes but so one of the main things would be that
41:59
we would increase the access to a wider range of the US population pot if it was done on a state level maybe people replying to those states where there was treatment you'd have a much lower risk of adverse reactions or risky or you know bad outcomes from the treatments because there would be the possibility of regulation from one thing people would know whether or not there was medical monitoring and there would be the reduced temptation for people to try
42:29
it at home on their own or or have somebody give them ibogaine at a hotel or in their apartment and also there would be refinement of the treatment methods I think we would be seeing that we would be seeing what works best but our best practices also we look and see what what the potential is for looking at aftercare and integration psychotherapy afterwards how can we combine ibogaine treatment with other treatment modalities to make our treatment success as great as possible
43:00
now what if we don't make ibogaine treatment legal in the u.s. basically it's going to continue around the world with or without us but it's going to continue to be the status quo and I think we're going to we're going to see more and more activism around this as as the years go by thank you very much [Applause]

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