POTENTIAL ADDICTION 'CURE' LEFT IN LIMBO

What if addiction, whether to cocaine, heroin or alcohol, could be broken
by taking a single pill?

That's the audacious claim behind ibogaine, an extract of an African shrub.
But don't look for it at your local treatment center any time soon.

Ibogaine is stuck in limbo.

Yes, anecdotal reports of addiction-breaking power go back some 30 years.
There have been some intriguing animal studies and initial studies on
humans. And the federal government has spent more than $2 million on
preliminary ibogaine research.

More than 150 papers about ibogaine have appeared in scientific journals,
said Dr. Kenneth Alper, who directed a recent conference on the drug at the
New York University School of Medicine.

"This is a drug development project in which a lot of work has already been
done," he said.

But ibogaine is stuck short of the final step. Nobody has done the big,
more elaborate studies that could convince mainstream addiction specialists
that the stuff really works--or doesn't. And neither the government nor the
pharmaceutical industry is jumping in to take that on.

Ibogaine is illegal in the United States, but it's available through an
international black market. It is also used in clinics in Panama City and
the Caribbean. And, for $1,500 and up, you can get it from a nurse or
psychiatrist on a boat cruising international waters off South America.

"It's not a matter of debate whether ibogaine should be made available,"
said Geerte Frenken, who helped organize a group called International
Addict Self-Help in the Netherlands to offer treatments. "It already is
available."

Ibogaine advocates say it suppresses the painful withdrawal symptoms that
can make it difficult to give up physically addictive drugs.

Furthermore, they say, ibogaine halts or reduces drug cravings for weeks to
months. That can be long enough for a person to get psychological help and
learn to live a clean and sober life.

"It's a honeymoon period, a very precious time," said Eric Taub, of
Gainesville, Fla., who arranges ibogaine treatments outside the country.
Although ibogaine doesn't work for everyone, he said, it's still "the most
humane way of interrupting addiction on the planet."

What makes the ibogaine story even more curious is the experience of taking
it.

First come visions: four to eight hours of fantasies such as floating in
space or fast-forward reviews of one's life. For another eight hours or so,
addicts mull the meaning of those visions, a step some advocates say can
provide insights that promote staying clean.

Ibogaine comes from the roots of a 4-foot-tall, flowering African shrub
called Tabernanthe iboga. Its root bark is chewed in rituals in Gabon. Chew
enough, it is said, and you see your dead ancestors. Just a little prevents
fatigue.

Ibogaine was purified from the root bark around the turn of the century,
and low doses were sold in France from 1939 to 1970 as a tonic for fatigue
and depression.

The notion of using it to break addiction goes back to 1962.

Howard Lotsof, a 19-year-old New Jersey history major, had been using
heroin for a few months. One day, just to see what would happen, he tried
some new stuff called ibogaine after a chemist friend mentioned it.

"Thirty-three hours later, I was no longer a heroin addict," Lotsof said.
Five of the seven addicts in his crowd who tried a single dose stopped
using heroin for about six months without withdrawal symptoms, he said.

He didn't jump on the discovery right away, he said, because "what does a
19-year-old kid know about anything?" But in the 1980s, he patented
ibogaine treatments for a variety of addictions and set out to interest
pharmaceutical companies, the government and scientists.

"The first time Mr. Lotsof called me up and told me about this, I thought
he was a lunatic," recalled Dr. Stanley Glick, chairman of the pharmacology
and neuroscience department at Albany Medical College. "My colleagues hear
about this, that's their first reaction."

Contradictory Studies, Deaths Raise Questions

Yet as Glick and others looked at ibogaine's performance in lab animals,
they found evidence that it did act against addiction to cocaine, alcohol
and opioids, the class of narcotics that includes heroin. Their results
began showing up in scientific journals about a decade ago.

Around that time, two addict self-help groups began offering ibogaine
treatments to a few heroin addicts in the Netherlands, with positive
results. Frenken's group found that seven of the eight addicts stayed clean
for an average of six months. The eighth addict said he just liked the
lifestyle of heroin use.

But not all the history of ibogaine is so positive. Rat studies suggested
it may kill brain cells, a concern Glick now calls overblown. And the field
has been haunted by the deaths of two women who took it.

One, a 24-year-old heroin user, died about 19 hours after ibogaine
treatment in 1993. The cause of death wasn't established, but she might
have taken heroin after the ibogaine, and some evidence suggests ibogaine
magnifies the effects of heroin.

Previously, a Swiss woman who'd taken ibogaine during psychotherapy in
Europe died a few hours after. She had a history of heart disease.

Those deaths were one reason that advisors to the National Institute on
Drug Abuse recommended in 1995 that NIDA not launch an extensive program of
ibogaine research in humans. The brain damage in rats was another, and some
dog studies suggested a risk of seizures and cardiac arrest. Some advisors
also were unimpressed with the human evidence that ibogaine actually works.

Overall, the consultants "just felt it was essentially going to be an
expensive, time-consuming, ultimate failure," said Frank Vocci, NIDA's
point man on ibogaine.

Vocci stressed that NIDA has not declared that ibogaine shouldn't be tested
in people, just that NIDA won't pursue that research. The institute remains
open to paying for such studies by others if the proposals get favorable
reviews from outside scientists, he said.

Scientists disagree on whether such applications have much chance of a
favorable review. Glick suspects not, saying ibogaine's reputation has been
too tarnished.

What's more, he notes, ibogaine emerged not from a research lab, but from
the experiences of addicts--not exactly the royal road to scientific
acceptance.

Lotsof hasn't been able to sell drug companies on ibogaine either. He says
company officials have given him a variety of reasons for not touching it,
such as legal liabilities in treating a population more prone to dying than
usual, the stigma attached to drug abuse and lack of profit in a medicine
taken only once or a few times.

There's no sign that ibogaine itself is addicting, Lotsof said. The
dream-like "visions" don't cause any LSD-like euphoria that would tempt
people to repeat them.

"I would say 90% of the people who are provided with ibogaine do not want
to take it a second time," Lotsof said. "It's exhausting. You're up for 36
hours."

The latest news on ibogaine comes from a clinic on the Caribbean island of
St. Kitts, where the drug is being used with addicts who weren't helped by
conventional treatment.

A Weapon Against Withdrawal Symptoms

They were "self-destructing, at the end of the road. . . . This thing
really spins them around," said Deborah C. Mash of the University of Miami
School of Medicine. She has studied more than 80 addicts treated with
ibogaine at the clinic.

Although her work is preliminary, she's finding it "extremely effective" in
blocking withdrawal from opiates like heroin and morphine, as well as the
"crash" from stimulants like cocaine and amphetamine.

"It's a very gentle detox," she said.

What's more, she said, her studies suggest that a single dose of ibogaine
can block craving for opiates and cocaine for at least 30 days. It also
lifts depression and anxiety, making addicts more amenable to counseling,
she said.

Ibogaine also shows effectiveness against withdrawal and craving with
alcohol addiction, with less evidence of efficacy in kicking crack cocaine
and no sign of an effect on smoking, she said. But Mash emphasized she has
studied too few patients to make definite statements.

So what now? Lotsof figures ibogaine will break out of its limbo someday,
but he says he doesn't know how.

For scientists, ibogaine still presents some basic puzzles. How does it
produce its apparent effect on addiction? How can the effect persist long
after the stuff is gone from the body? Are the dreamlike visions important
or just a side effect?

And is ibogaine just a steppingstone to something better?

Glick and Mash think the future lies not with ibogaine, but with related
substances. Glick is studying a synthetic derivative called 18-MC in rats.
And Mash thinks that noribogaine, which the liver makes from ibogaine, is
the real source of the anti-addiction effects.

In any case, Mash hopes scientific data from her work on St. Kitts will
provide the rationale for somebody to pay big money--finally--to develop
noribogaine or some other ibogaine-related substance.

"I would hope we can get enough of a tail wind going here that we can
launch this boat," she said.