THE ADDICT'S LAST REFUGE?

B.C.'s Iboga Therapy House is following in a decades-old tradition of
underground rehab-administering a drug called ibogaine, which has the
reported side effect of curbing addiction.

But can these activists take their experiment mainstream?

The drug rehabilitation facility is an ordinary split-level house in
a sleepy residential neighbourhood in a small town on B.C.'s Sunshine
Coast. Inside, the many bookshelves contain everything from
psychopharmacology textbooks to psychedelic graphic novels.

Visitors are welcomed by a small, dark-haired woman named Sandra
Karpetas. Though she has no formal training in medicine, she speaks
knowledgeably about neurochemistry.

The people who come here need help. They're looking for a substance
called ibogaine, a psychotropic drug that is reported to be an
addiction interrupter. Iboga Therapy House is often the last hope of
people wishing to free themselves from addiction to heroin, cocaine,
prescription painkillers or other substances. A potentially powerful
tool in the treatment of addiction, ibogaine is unregulated in
Canada. In the U.S. it is a Schedule I controlled substance,
alongside heroin, cannabis and LSD.

For decades, an underground network has administered it to addicts in
need worldwide. But ibogaine's profound effect on the recipient's
mind and body, which is what makes it an effective treatment, may
also be its biggest obstacle to acceptance as a medicine.

Now, Iboga Therapy House is where ibogaine may be recognized as a
legitimate medical treatment.

The original Iboga House was founded in 2002 by Marc Emery, B.C.'s
infamous marijuana activist and seed merchant.

Financed by his marijuana seed sales, Emery helped deliver ibogaine
for free to addicts in the Sunshine Coast, personally administering
it to close to 70 people.

Two years later, when financial and legal troubles forced Emery to
close the house, he encouraged Karpetas, a comrade in the project, to
continue the work. In 2005, she registered the house as a non-profit,
and reopened it the following year at a rented property about an hour
and a half from Vancouver.

The location was chosen to be peaceful and isolated, and kept secret
for the confidentiality of both clients and staff.

Karpetas professionalized Emery's operation, setting up protocols for
screening patients for mental and physical problems at Iboga Therapy
House, to reduce potential danger and prevent fatalities. Iboga is
now a non-profit company, with 10 people on call, including a
registered nurse, two EMTs, several facilitators, two substance
counsellors and one follow-up coordinator. There is also an MD who
acts as a consultant. Karpetas, now Iboga's program director, is one
of two full-time employees.

So far, 59 people have undergone treatment at Iboga House.

The not-for-profit, which is no longer free-the five-to seven-day
course of treatment costs close to $5,000-can generally accept only
those who can afford it. "There are people in every class who use
substances and it's not just people who live on the street who become
dependent, necessarily," says the 32-year-old Karpetas, though the
clinic does sometimes donate services to addicts in need. Ibogaine,
like other detoxification methods, is not enough on its own to get
people off the streets, and works best on people with support systems in place.

People seek out Iboga House after learning of it through word of
mouth or on the internet.

The candidates for treatment are screened for a variety of medical
conditions, including psychiatric problems, epilepsy, heart problems
and HIV, and must submit a general medical evaluation from a doctor,
along with details on their social support network and their plans
for recovery.

Karpetas is primarily self-educated, but has a background doing
harm-reduction counselling with addicts. "I have some of the best
mentors in the world," she says. "I didn't go to university. But my
self-education has included a lot of workshops, a lot of conferences,
reading books, talking to people, particularly on the topics of harm
reduction, psychotherapy, drug education and facilitation. There
really is no training program for what I do."

Karpetas first heard of ibogaine in the late 1990s, through Jonathan
Ott's book Pharmacotheon: Entheogenic Drugs, Their Plant Sources and
History. At the time, she found herself moving in two different
worlds; in one, she saw people using psychoactive substances for
therapeutic and self-explorative purposes; in another, she saw people
inflicting great harm on themselves through drug abuse.

Ibogaine seemed to bridge the two worlds, a substance that could
fight addiction by awakening the mind. Despite her interest, Karpetas
didn't know there were people distributing ibogaine in B.C.

She planned a trip to West Africa to test ibogaine out, but instead
had a chance encounter with a colleague who told her about Emery's project.

She immediately contacted him, and toured the facility the following
day. "I could see that there was some really good potential for
philanthropic work," she says, "but I could also see that, unless
they instituted a number of changes to the way they did things, that
it could also be potentially dangerous." There have been several
known fatalities associated with ibogaine, though not necessarily
caused by it. For example, in 2005, a 48-year-old woman died in a
Mexican ibogaine clinic from acute myocardial infarct and acute
coronary syndrome.

In 2006, a 38-year-old U.S. man died at an ibogaine clinic in Tijuana
from pulmonary thrombosis. Karpetas says, "They seem to be related to
improper medical screening, improper monitoring during the therapy,
and just a basic lack of education on the part of the individuals taking it."

The present-day Iboga House provides a controlled setting that
minimizes these risks.

Clients go through a thorough medical screening and wait 12 hours
from the last dose of their drug. When they arrive at the house,
clients are lead to its lower level, where one room serves as an
altar-like space with elements of many different religious traditions.

The individual takes a small test dose of ibogaine to ensure no
adverse reactions, then the full dose in capsules an hour later.

The drug causes a temporary loss of co-ordination, but also minimizes
withdrawal symptoms, which can typically include diarrhea, stomach
cramps, leg restlessness, the inability to sleep, extreme agitation
and depression. "The symptoms of withdrawal can be very much like the
most intense flu you've ever had. It lasts for weeks and can be
extremely painful," says Karpetas. "None of that occurs with ibogaine.

I haven't seen anything like [ibogaine] anywhere, ever." The
rehabilitating trip is intense.

Once dosed, the patient experiences a dream-like state lasting
anywhere from 24 to 36 hours.

An RN and an EMT watch the client constantly during the first 16
hours, with a portable defibrillator kit, an oxygen tank and a full
medical bag close at hand, and the local hospital is five minutes away.

Karpetas avoids calling ibogaine "psychedelic," saying instead that
it's an oneirogen-a dreaminducing substance. "It's like a prolonged
waking dream experience," she says. "It has a totally different mode
of action than most of what are termed "psychedelics."

She also emphasizes that ibogaine is no miracle cure. "People really
have to have a number of things set in place in their life that are
going to assist them in recovery," she says. "They should have
factors such as housing, social support, employment or employability
skills, or a career of some sort, and long-term follow-up and aftercare."

Because of ibogaine's murky legal status, there are few studies of
its effectiveness. Dr. Ken Alper, an assistant professor of
psychiatry and neurology at New York University School of Medicine,
conducted lengthy clinical trials of ibogaine detoxification in the
1990s. In a study of 33 opioid users, 25 were found free of
withdrawal symptoms 24 hours after ibogaine treatment, and they
showed no drug-seeking behaviour 72 hours later. Testing on animals
yielded similar results.

Used in the initiation rituals of the Bwiti people in Gabon and
Cameroon, ibogaine's addiction-treating properties were discovered by
a young American man named Howard Lotsof in the early 1960s. A drug
user, Lotsof took ibogaine, which is derived from the bark of a West
African bush, and experienced a 36- hour trip full of Freudian imagery.

Lotsof noticed after coming down that "for the first time in months,
I did not want or need to go cop heroin.

In fact, I viewed heroin as a drug that emulated death; I wanted life."

He ordered more ibogaine, an uncontrolled chemical at the time, and
administered it to an informal focus group.

Out of the 20 people he tested, seven heroin users had no withdrawal
symptoms and five had no desire to use heroin again during the
six-month monitoring period.

However, hippie culture had no use for ibogaine, which was not a
party drug, and the U.S. government was criminalizing psychedelic drugs.

Lotsof continued his ibogaine research, despite limited resources and
a 14-month prison term for conspiracy to sell LSD, and succeeded in
getting a U.S. patent on the use of ibogaine in narcotic dependency
interruption in 1985. However, drug companies were indifferent,
seeing no profit in ibogaine, which is a natural product that can't
be patented, and is administered in a single, large dose instead of
regular, ongoing doses, like methadone.

Meanwhile, knowledge of ibogaine's therapeutic use spread by word of
mouth, and an underground detoxification movement grew in many
countries. Professional, above-ground clinics in Europe, Mexico and
the Caribbean provide it, and lay practitioners administer it to
addicts in their homes or makeshift clinics.

Iboga House is not the only above-ground ibogaine clinic in the
world, but it is the first to contribute to the slowly growing body
of research on the drug, in partnership with U.S.-based
Multidisciplinary Association for Psychedelic Studies (MAPS), a
nonprofit research organization studying the application of
psychedelics and marijuana.

When Rick Doblin, MAPS founder and president, met Karpetas at a
conference in 2001, he had long been interested in studying ibogaine.

He couldn't do so in the United States, so jumped at the chance to
work with Iboga House, once that became an option five years later.
"[Karpetas] was willing to be honest, to look at the data of how well
the treatment worked," Doblin says. "She welcomed the research into
the therapeutic context of the clinic, and also the spotlight that it
would put on her methods."

Since 2006, Iboga House and the MAPS study have worked in parallel.

The clinic medically screens and treats clients, after which MAPS
phones them once a month for a year to administer the standard
addiction severity index interview recognized by the U.S. Food and
Drug Administration and the National Institute on Drug Abuse, which
tracks many aspects of a person's life, including drug use.

Ibogaine must be compared with other forms of medicated
detoxification, which include using general anesthesia in a clinical
setting to make the patient unconscious through the withdrawal symptoms.

Other treatment programs have high rates of dropouts.

A 2004 American study found that only 16.6 percent of methadone users
completed their programs, and even detoxification programs only had a
completion rate of 62.3. The remainder of participants drop out or
are discharged. Treatment programs can also leave the patient
dependent on regular doses of drugs such as methadone.

In contrast to the more institutional programs, Iboga House's
philosophy and goal is harm reduction, not abstinence. If, after
taking ibogaine, people reduce their drug use or switch to less
dangerous drugs, that's still viewed as an improvement. "If they do
happen to relapse and they need support," says Karpetas "they can
call us or the follow-up co-ordinator and say, 'Look, I'm feeling
like I'm going to relapse or I have relapsed once or I had a one-time
binge or something.' We're there to support them through that period
to make sure they essentially understand that even if they relapse,
they're not complete failures, that they can still work toward
improving their life." She adds, "Generally, we find people who have
not succeeded in religion-based or 12-step-based programs might have
a better chance of succeeding in a program like ours."

Karpetas's goal is that, once demonstrated effective, ibogaine be
recognized under Canada's Natural Health Products Regulations, as a
product to be used in a specific protocol in a clinical setting, with
Iboga House as the model and the results of the MAPS study as
evidence. "We would like to get accredited in the future," she says.
"But that would have to go hand-in-hand with demonstrating the
effectiveness of ibogaine, and trying to get it regulated through the
Natural Health Products program." A Health Canada official stated in
an email that no ibogaine containing product has yet been licensed,
and it is up to the manufacturer to prove that their product is safe,
effective and high quality.

Also, the Vancouver Coastal Health Authority inspected the house in
April 2008 and found that it didn't come under the Community Care and
Assisted Living Act because it didn't have the facilities to treat
three or more people.

Karpetas says that her house meets all the requirements of the act otherwise.

Ibogaine's therapeutic use has grown in the grey area outside medical
and scientific authority because of the need for better addiction
treatment than methadone dependency or anesthetic detox.

Underground treatment providers continue to operate in the U.S.,
where ibogaine is highly illegal, because they feel people need it
enough to take risks. One American provider told Karpetas that, if
anything went wrong for his clients, his emergency procedure was, "I
call emergency services and I jet."

Regardless of whether legal and medical authorities legitimize
ibogaine, people will continue using it, just as people keep using drugs.

Vancouver's "four pillars" drug policy already includes safe
injection sites and prescription heroin for harm reduction.

Ibogaine programs like Iboga House could be part of the treatment
pillar, recognizing that in addiction the mind, as well as the body,
needs to be healed.

Paula, a 42-year-old woman who had used cocaine intermittently since
age 19 and recently graduated to smoking crack, says that 12-step
programs didn't work for her because she was constantly being
reminded she was an addict. She went through the ibogaine treatment
in January 2008. Five weeks after her treatment, she says she feels
no cravings, has improved her health, reconnected with her daughter
and is in the process of getting her business back. "I know what it's
been like going through a treatment centre for seven months, and it's
not like this," she says. "I don't taste cocaine, smell it, want it,
crave it, dream it. Nothing at all. I feel like I've got a second
chance at life, where before I was just going day by day, step by
step. I don't feel that with this. It's gone."