High hopes: The American right is hallucinating over ibogaine

Conservative evangelism, veteran politics and a fragile evidence base are colliding around one of the riskiest psychedelics. ​

AI generated: psychedelic donkey

“I am 100% persuaded that these substances are divine medications that are engineered from on high,” declared Bryan Hubbard, head of Americans for Ibogaine, on The Joe Rogan Experience last January. He went further, describing ibogaine and psychedelic 5-MeO-DMT as gifts so “we can heal… and be affirmed by the love of our creator which is eternal and almighty.” As endorsements go, that’s about as strong as it gets.

On Rogan’s show, Hubbard appeared alongside former Texas governor Rick Perry. Both men argued passionately for ibogaine. This is quite a stretch for a traditional conservative. Ibogaine is a potent psychedelic derived from a West African shrub and is increasingly being promoted as a treatment for brain injuries, substance-use disorders and mental-health conditions. Texas is all in on the idea. Earlier this year, the state approved a $50m study of ibogaine for opioid addiction.

They are not alone. Former House Speaker Newt Gingrich, Congressman Morgan Luttrell (R-Texas), and legislators in states such as Kentucky, are among the conservative figure pushing to expand access. Their interest is part of a broader rebranding of psychedelics in America: from countercultural threat to a patriotic medicine. In this new narrative, psychedelics exist to heal veterans, restore families and redeem fallen soldiers–and ibogaine has been placed at the centre of that story. Once symbols of defiance, they are being raised up as tools for recovery and resilience.

There is some justification for enthusiasm. Psychedelics show promise as treatments for a range of mental health conditions. But this particular narrative shift has been powered above all by the well-meaning desire to do more for veterans living with brain injuries, addiction and post-traumatic stress. Yet that political and emotional momentum is converging on one of the riskiest drugs in the potential psychedelic medicine bag.

The new administration has signalled openness to psychedelics as medicines. Yet there are many reasons to worry about the push to cast ibogaine as a miracle cure. Unlike most other psychedelics in development, ibogaine carries substantial safety concerns, particularly in the form of cardiac side effects. (Ibogaine and its long lived metabolite block cardiac potassium channels, prolong the QT interval, and have been linked to a range of unwanted cardiac sequelae–including sudden cardiac death.)

Ibogaine is a potent, long-acting psychedelic and not remotely for the faint hearted. It can induce vivid, dream-like experiences, and in some cases even mania and a persistent disorder in perception. It often causes nausea and vomiting, large drops in blood pressure and a range of cardiac abnormalities. To try and manage these risks, clinics have emerged in Mexico and elsewhere to offer intensive medical support, with pre-treatment screening, continuous cardiac monitoring and a team of doctors and nurses are present with emergency equipment on hand.

This level of care is expensive. Wealthy patients who take ibogaine can pay upwards of $12,500 at high end clinics like Beond in Mexico. Ambio offers a cheaper rate for shorter stays with less time for preparation or integration of the experience afterwards. Beyond and Ambio (also coming in Malta) seem to have created a model that works for an affluent subset of patients. Advocates say it can restore brain health, and heal families of veterans from the mental wounds of war, and lift the burden of addiction from individuals and their families.

The problems come in three parts. First, the loudest advocacy comes from a self selecting group: people who have had strikingly positive experiences and those around them. Shaped by transformative trips and dramatic personal stories they are often inclined to see taking this drug purely as a solution. They are unlikely to see or emphasise its structural or safety problems. Secondly, there is an evidentiary gap wider than the Rio Grande. The risks and benefits are poorly defined. Third, and most serious, is a simple question with no clear answer: how on earth ibogaine can be scaled safely?

Even with a strong political tailwind, the federal drug regulator is unlikely to ignore its safety profile and approve a drug based on ibogaine. That raises the question of how advocates imagine making it available. Perhaps through state-level workarounds, or overseas clinics? Yet with such evangelical advocacy the concern has to be that those who are mentally unwell, or addicts, may not be able to judge how much risk they should run for a chance at getting well even if there was good data. Which there is not.

To be fair the Texas trial might help some of these data gaps. What it cannot solve is the larger question of whether a drug with this profile can ever be delivered safely at scale outside of highly resourced specialist centres. The current wave of evangelism and high cost access is just helping to normalise underground and recreational use by those trying to get well with obvious risks.

Even if insurers and non-profits step in to cover some or all of the expense, the pressure to cut corners could ultimately collide with ibogaine’s narrow margin of safety. The proliferation of ketamine clinics is a cautionary tale: standards slipped as services multiplied and competed on price. Ketamine used properly has a relatively wide therapeutic window. Ibogaine does not. There is far less room for error.

Texas with its large population of veterans is the spear tip of a political and cultural campaign to widen access. Groups like Americans for Ibogaine Non Profit are courting policymakers across the country to raise money for trials and treatment. But amid this push, patients should not be encouraged to see their recovery, or the survival from a high-risk drug, as a gift from the heavens. Drug safety comes from unglamorous and unfashionable things: careful science, rigorous regulation and close medical supervision.

Over the longer term the obvious path forward is not to sanctify ibogaine but use it as the launch pad for something better. Drug-makers are already working on safer analogues that hope to preserve any therapeutic benefits while leaving the toxicity behind. Until then the line between a powerful drug and the mythology being used to promote it needs to be drawn far more clearly.

Previous work on Overmatter