Opioid addicts turn to psychedelic plants to treat withdrawal, but doctors warn of risks
'There are too many unknowns,' doctor says of ibogaine and ayahuasca for addiction treatment
Maria Michaelides, 36, thought there was no way out.
The Kitchener, Ont., woman started taking Percocet for chronic pain five years ago. At first, she used the medication as prescribed.
At the time, Michaelides was caught in an abusive relationship that chipped away at her emotional resolve, and she says she began to see Percocet as an escape.
Before long, she found herself buying pills from street dealers. She dabbled in morphine and Oxycontin — anything that would prevent withdrawal symptoms, such as vomiting, pain and devastating depression.
"I realized I had a problem," she said. "I didn't know what to do."
Michaelides is among a number of Canadians who have turned to psychotropic plants in an effort to stop using opiates when they feel conventional treatments, such as the opiate-replacement drugs methadone and suboxone, aren't working.
Advocates say the plants, called entheogens on account of their mind-altering effects, induce a reflective mental state that allows users to confront the psychological roots of their addictions.
Iboga, a shrub found in West Africa, is one of the plants being used to supplement conventional addiction medicine in the face of a growing opioid crisis.
Ibogaine, the active chemical compound isolated from the dried root bark of iboga, causes hallucinations that can last as long as 36 hours when ingested.
Ibogaine promising but toxic, researcher says
Mark Haden, a public health researcher at the University of British Columbia and chair of the Multidisciplinary Association for Psychedelic Studies Canada, says ibogaine is "profoundly effective" at chemically interrupting the intense withdrawal symptoms experienced by people dependent on opiates.
It has also been reported to induce dream-like states and flashbacks to childhood memories that can help a person meditate on past trauma.
But Haden says despite its benefits, he is no longer interested in studying the drug.
Ibogaine is too toxic. It has a chance of death, and we can't take that risk.- Mark Haden, public health researcher
"Ibogaine is too toxic," he says. "It has a chance of death, and we can't take that risk."
Ibogaine can decrease a person's heart rate, resulting in cardiac arrest in some cases. At least 19 deaths have been linked to ibogaine worldwide since 1990, according to a 2012 study.
Health Canada lists seven reported cases of adverse reactions to the drug, which range from vomiting to seizures.
A 2016 case study co-authored by Dr. Evan Wood, director of the B.C. Centre on Substance Use, noted that although ibogaine appears to chemically reduce cravings for opiates, scientists don't really understand how the drug works on the brain.
'It saved my life'
When Michaelides realized she needed help with her addiction, she went to a doctor for methadone, the most widely used opiate addiction treatment in Canada.
But according to Michaelides, the methadone caused lethargy and weight gain, and she says it even damaged her teeth. She says she couldn't come off the synthetic opioid, either.
"I tried to stop and just couldn't handle the withdrawals. The depression was so severe."
Michaelides turned to black-market prescription opiates once again — and eventually to heroin.
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After smoking heroin for three months, Michaelides was ready for another shot at treatment.
This time, she visited Liberty Root, a private, unregulated ibogaine-treatment centre in Vancouver that promises to take opiate users on a "spiritual" journey to recovery using ibogaine.
While the drug is legal to possess, "the sale of health products containing ibogaine in Canada is not permitted," according to a statement from Health Canada.
But ibogaine treatment is available. Michaelides paid $8,000 for her 10-day retreat in B.C.
"I had to go to my parents to ask them for the money," she said. "I was very lucky that they agreed to pay for it because it saved my life."
Thanks to a single dose of ibogaine, she says, she is no longer dependent on opiates. Other users opt to take smaller doses over time
Private Vancouver clinic treated 200 people
Trevor Millar, who founded the Liberty Root clinic in 2013, says he has always taken extensive measures to prevent harm to his clients.
"We're trying to do everything legitimately," Millar said.
He says his patients were required to submit electrocardiogram results and were monitored by a registered nurse after ingesting the capsules of powdered iboga root he provided.
He recently decided to close his clinic but says in the time it was operating, he administered ibogaine to about 200 people. Only one person ended up in the emergency room, but that individual submitted fraudulent ECG results, Millar said.
Millar says others have left his program feeling like they've made progress in tackling their addiction.
One of them was the 25-year-old son of Colleen Hanson. The Calgary man was addicted to fentanyl, and as with Michaelides, conventional therapies weren't helping. Hanson says ibogaine saved her son's life.
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"When I picked … [him] up from the airport, he had rosy cheeks and a smile on his face," she said. "And a light in his eyes I hadn't seen in two years since he started taking fentanyl."
Hanson had another son who died from an opiate overdose. He had been living at a sober living facility but had also signed up to attend Liberty Root for ibogaine treatment.
"The weekend my son died, 20 other people died. I thought I was putting him somewhere safe," Hanson said. "The [opioid] problem is just so huge. Ibogaine is the only answer."
Ayahuasca eyed as alternative treatment
Ayahuasca, a concoction of plant materials found in the Amazon and used in Indigenous ceremonies in the region, is also touted as a potentially promising treatment for addiction.
Like ibogaine, ayahuasca induces visions, but the active ingredient — dimethyltriptamine, or DMT — is known to induce more intense hallucinogenic experiences, and DMT doesn't chemically interrupt withdrawal.
DMT is a Schedule III substance in Canada, meaning it's illegal to possess or trade as an isolated chemical.
But it's legal to own or sell plants containing DMT.
In one 2013 study conducted in B.C., the hallucinogenic brew was given to 11 treatment-resistant participants who were addicted to a variety of substances.
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Dr. Gerald Thomas, director of alcohol and gambling policy with the B.C. Health Ministry and a collaborator with the Centre for Addictions Research of B.C., led the study. He said he saw encouraging results, with eight participants reporting a positive experience and some users reducing or quitting substance use entirely.
Thomas says he would like to see more research into ayahuasca, and since pharmaceutical companies don't seem interested, he said the support for that might have to come from federal and provincial governments.
Ayahuasca a 'powerful tool'
Dr. Kenneth Tupper, who worked with Thomas on the B.C. study, calls ayahuasca a "powerful tool," one he studied in depth during his time as a drug policy expert for the B.C. Health Ministry.
But Tupper, now a director at the B.C. Centre on Substance Use, cautions that it must be used wisely.
"There's an optimal setting," he said.
Tupper said the chanting, tobacco smudging and other ceremonial rituals are a crucial part of experiencing the full effect of ayahuasca.
Drinking ayahuasca recreationally or "treating it like a toy" probably won't work, he said.
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Like Tupper, Gerald Thomas urges those bent on trying ayahuasca to seek out an expert.
"I wouldn't recommend doing it alone," he said. "It's really scary. It takes you into your deepest fears."
Ayahuasca temporarily alters brain function, Thomas explains. In everyday perception, the brain's frontal cortex does most of the work, which creates a "normal" awareness. But psychedelics disrupt that hierarchy, allowing other aspects of consciousness to work their way to the surface.
Once accessible, patients can then confront old emotional wounds. "You have to feel it to heal it," Thomas said.
But not everyone is convinced.
'There are too many unknowns'
Dr. Bruce Hollett, who treats addiction in St. John's, cautions against using either plant. Hollett says that conventional treatments, when used and prescribed correctly, are still the preferable option.
"There may be some possibilities with these plants, but you're playing Russian roulette," he said. "That's scared off most medical doctors."
But Hollett says he would be interested in medicines derived from the plants.
If a drug company would take [these chemicals] and run trials, maybe we'd have something. But not with a piece of bark out of Africa.- Bruce Hollett, physician
"All of us in addictions would love to have a magic bullet. If a drug company would take [these chemicals] and run trials, maybe we'd have something," he said. "But not with a piece of bark out of Africa. There are too many unknowns."
Dr. Benedikt Fischer, an addictions researcher at the Centre for Addiction and Mental Health in Toronto, agrees.
"There's definitely not sufficient evidence to say they are viable treatment options," he says of ibogaine and ayahuasca.
But Fischer says the scant research that has been done encourages further study in a field he thinks could use alternative treatments.
"We tend to make categorical statements about methadone and suboxone," he said. "They work to some extent, but not perfectly, obviously, or else we wouldn't have an opiate problem."