[Photo by Karolina Grabowska from Pexels]
In the battle against the opioid crisis, Kentucky made waves earlier this year by proposing to allocate $42 million to investigate ibogaine May 31, 2023, a potentially risky psychedelic that can curb opioid withdrawal and cravings. The state’s Opioid Abatement Advisory Commission has recently selected Attorney General-elect Russell Coleman’s appointment of Christopher Evans as the new executive director, marking a possible shift in the state’s strategy in evaluating ibogaine.
While not dismissing ibogaine outright, Coleman has signaled plans to focus more comprehensively on opioid use disorder prevention. Coleman also appointed a new executive director, Christopher Evans, a veteran of the Drug Enforcement Administration (DEA).
A more conservative approach in tackling opioid use disorder would be in line with a view of some medical experts, who have questioned the safety and efficacy of ibogaine.
A schedule I drug
DEA has classified ibogaine, an African-plant derived compound, as a Schedule I, in the same class as heroin, LSD, MDMA and marijuana. The federal government considers Schedule I compounds to have a high potential for abuse and no accepted medical use in treatment.
The federal government is currently considering reclassifying marijuana to Schedule 3, in the same class as benzodiazepines, which have moderate to low potential for physical and psychological dependence.
Ibogaine could face hurdles in finding sanctioned use in the U.S. The FDA requires all drugs to undergo cardiac testing, and ibogaine is known to cause prolonged QT intervals, a cardiac risk factor. QT intervals on an electrocardiogram (ECG) refer to the time it takes for the heart’s ventricles to depolarize and repolarize. In other words, a QT interval is the time from the start of the ventricular contraction to the end of the relaxation. Prolonged QT intervals is a cardiac risk factor that can lead to serious arrhythmias and sudden cardiac arrest.
Additionally, ibogaine’s status as a Schedule I drug complicates the legal and regulatory landscape for its research and potential use.
Advocates praise Kentucky commission’s past support for ibogaine research for opioid use disorder
The non-profit organization Reason for Hope released a statement praising Kentucky’s Opioid Abatement Advisory Commission for its past support in exploring ibogaine as a treatment option. In its statement, the organization highlighted the significant contributions of the previous chairman, Bryan Hubbard, in championing the cause.
Yet, the controversy surrounding ibogaine’s use persists. Dr. Mark Haigney, a cardiologist, shared concerns about its cardiac risks and the unlikelihood of FDA approval in the near future with the Kentucky Lantern in October.
Other experts have argued for the necessity of exploring all potential treatment avenues, especially given the severity of the opioid crisis in regions like Kentucky. “We really need novel treatments…after years of countless me-too drugs with minimal advances in patient outcomes, the entire field, both regulatory and scientific and clinical, recognizes the limitations of existing treatments, and thus the need to explore outside the box,” said Dr. Walter Dunn, a health sciences professor at UCLA and member of the FDA Psychopharmacologic Advisory Committee,
Dunn praised the efforts of the Kentucky Opioid Abatement Advisory Commission under the guidance of former chairman Bryan Hubbard, saying “the dollars are needed to do the research.”
The position aligns with that of Reason for Hope, which was founded to prevent “deaths of despair,” which refer to those linked to mental health issues and substance use disorders. Leaders of the organization include the retired Marine three-star Lieutenant General Martin Steele; Lynnette Averill, PhD and Brett Waters, Esq. The organization helps draft legislation, prepare policy proposals, and educate legislators to support the use of treatments such as ibogaine, especially for veterans who have not found success with traditional methods.
The emergence of fentanyl has worsened the opioid crisis in recent years.