Kentucky Shelves Plan to Use Opioid Settlement Cash for Ibogaine Pilot

    A plan in Kentucky to create an ibogaine treatment and research pilot with opioid settlement funding has run aground. It would have allowed people with opioid use disorder to participate in clinical research with the plant-based psychedelic, which can ease withdrawal symptoms and cravings. The outcome of a recent election seems to have put an end to the idea—which had both supporters and opponents, including within the harm reduction community.

    In May 2023, former Kentucky Attorney General Daniel Cameron (R) and his special counsel Bryan Hubbard unveiled the “Kentucky Ibogaine Initiative.” Its goals were to help develop legal, regulated ibogaine therapy in the state for substance use disorder and mental health conditions like PTSD, and to potentially speed up United States Food and Drug Administration approval.

    At the time, Hubbard was chair of the Kentucky Opioid Addiction Abatement Advisory Commission (KYOAAC), responsible for allocating $842 million of settlement money received through nationwide lawsuits against opioid manufacturers, distributors and pharmacies. The Kentucky Ibogaine Initiative proposed allocating $42 million of that total toward bringing ibogaine treatment to the state.

    “Vocal opposition to our endeavor was confined to two contrary voices that occupy significant centers of power.”

    Cameron’s campaign as the Republican nominee in Kentucky’s November 2023 gubernatorial election added visibility to this effort. But Kentucky voters re-elected Andy Beshear (D) to a second term as governor. They also voted in new Attorney General Russell Coleman (R) to replace Cameron.

    According to Psychedelic Alpha, Coleman then asked Hubbard to resign from the KYOAAC, and replaced him with former high-level Drug Enforcement Administration official D. Christopher Evans.

    The Lexington Herald-Leader quoted Coleman as saying, “There’s been a lot of ink spilled on ibogaine,” and that Kentucky needed to focus more on addiction prevention. A resignation letter from Hubbard, dated December 26 and reviewed by Psychedelic Alpha, stated: “[V]ocal opposition to our endeavor was confined to two contrary voices that occupy significant centers of power”—which he named as Gov. Beshear and the University of Kentucky Center on Drug and Alcohol Research.

    Ibogaine is derived from the shrub Tabernanthe iboga, native to West Central Africa. The powerful hallucinogen has a long tradition of use, including for spiritual practices, among Indigenous groups in the region.

    Research has substantiated the drug’s efficacy for opioid use disorder, at least over a limited period of time. However, there are real concerns over risks for people who become abstinent after ibogaine treatment, then later resume opioid use without tolerance, as Carlyn Zwarenstein recently reported for Filter.

    “This is a treatment for wealthy individuals who can pay for hospitalization with intensive monitoring.”

    In the US, ibogaine is categorized as a Schedule I controlled substance under federal law; it’s illegal for any use, including medical. A handful of other countries, including Mexico, Brazil, South Africa and the Netherlands, do allow its use, and it’s available on prescription in Australia and New Zealand.

    Particularly when used in unregulated settings, the drug can pose risks, including heart problems, to certain people. For this reason, organizations like the Global Iboga Therapy Alliance publish detailed guidelines on safer provision and use for people with different medical histories and drug-use patterns.

    In Kentucky, concerns about the drug’s safety profile divided some experts as the KYOAAC held public hearings throughout 2023. Ibogaine users and their families, military veterans, doctors and mental health practitioners, and even high-profile figures like an NBA player and a former Texas governor, all presented testimony. In October, Dr. Mark Haigney, a Walter Reed National Military Medical Center physician, argued that ibogaine would not be FDA-approved and safe for use for at least another 10 years, because of its effects on the cardiac system.

    “This is a treatment for wealthy individuals who can pay for hospitalization with intensive monitoring,” he told the commission, and would not help people “who struggle with opioid dependence.”

    Harm reductionist Dmitri Mugianis, who once received ibogaine treatment for substance use disorder and also became an underground provider, has been another critic of the Kentucky plan—for its focus on post-treatment abstinence; because “it won’t move the needle” on the overdose crisis, as he previously told Filter; and because it would divert precious funds from other areas.

    “It is crucial to allocate resources towards evidence-based practices that are proven to improve and save lives while addressing the specific needs of the affected communities,” Mugianis wrote in a Courier Journal op-ed in December. “Instead of diverting funds to an exotic research project, they should be utilized to address pressing issues for drug users and people in recovery, such as housing, education, transportation, job training, overdose prevention and access to medication assisted treatments.”

    “It raised awareness nationally and brought a lot of interest that the movement can build on.”

    Another harm reduction expert reached by Filter described the Kentucky initiative, though stalled for now, as successful in bringing national attention to the issue and galvanizing support. Psychologist Andrew Tatarsky, a leading proponent of harm reduction psychotherapy and psychedelic-assisted therapy, believes the visibility in Kentucky will encourage other states to pursue ibogaine therapy more boldly.

    Kentucky’s process “had hearings that brought together an amazing, diverse group of advocates including veterans, their families, researchers, clinicians, to testify on behalf of the value of ibogaine,” he said. “The overwhelming majority of the testimony was positive and compelling. It raised awareness nationally and brought a lot of interest that the movement can build on.”

    Dr. Tatarsky acknowledged that there is a legitimate and unresolved debate over how much of the opioid settlement money now flowing into state coffers, if any, should be used for such projects.

    “There are mixed opinions about the use of opioid abatement settlement funds for research, because that is unlikely to bear fruit for many years, and many more millions that need to be raised,” he said. “It’s an uncertain future … Some people feel the people suffering … should have funds put to much more immediately helpful measures like increased naloxone, test strips, overdose prevention sites, harm reduction services and counseling.”

    Besides the debate over use of opioid settlement funds, there are other concerns around any ibogaine program moving too quickly. Kevin Franciotti, founder of Psychedelics in Recovery and a recipient of ibgoaine treatment for opioid use disorder in 2011, warned of consequences if governments—and the media—are quick to publicize the benefits of ibogaine without adequate public education. These could include, he said, misleading people about potentially dangerous or life-threatening side effects of unregulated ibogaine use, and negative environmental and social impacts on African nations where the plant grows.

    “People will be compelled to seek out personal ibogaine treatments on their own,” he told Filter, “and there is a thriving market of people involved in the illicit drug trade and even the animal poaching trade in Africa that are tearing up wild-grown iboga to meet the demand of people who learned about ibogaine from a sensationalized story, then seek out Facebook vendors to buy things from.”


    Photograph of Tabernanthe iboga by Ji-Elle via WikiMedia/Creative Commons 4.0

    • Alexander is Filter’s staff writer. He writes about the movement to end the War on Drugs. He grew up in New Jersey and swears it’s actually alright. He’s also a musician hoping to change the world through the power of ledger lines and legislation. Alexander was previously Filter‘s editorial fellow.

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