SMART Policy Podcast
Podcast by the UT SMART Initiative. Host Jeremy Kourvelas speaks with experts from across the recovery ecosystem - representing healthcare, prevention, law enforcement and more - about local, state and federal drug policy to find out what is and isn't working to make this fight against addiction a little easier.
SMART Policy Podcast
Controlled, Unpleasant, Unpatented, and Potentially Life-Saving: the Ibogaine Question
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On April 18th, 2026, President Trump signed Executive Order 14401, which directs federal agencies to accelerate research into psychedelic medications for the treatment of serious mental illness, including substance use disorder. One of the most prominent substances mentioned in this EO is the alkaloid ibogaine.
As of this podcast episode, ibogaine is a Schedule I controlled substance in the U.S., meaning that legally it is considered to have a high potential for abuse without any known medical benefits. Its scheduled status also makes it extremely difficult to research. However, treatment with ibogaine is legal in other countries and some promising studies do exist, including a seminal paper by Stanford University looking at brain health in combat veterans with traumatic brain injury.
Meanwhile, in the same month, the Tennessee legislature passed Public Chapter 1119, which authorized research into ibogaine in secure, clinical contexts.
This month, we are joined by W. Bryan Hubbard of Americans for Ibogaine and Rikki Harris of TN Voices, two of the organizations advocating for this body of research to expand both here in Tennessee and across the country.
Ibogaine is not like most psychoactive substances. It is reportedly an intensely unpleasant experience that lasts for many hours, involving vomiting and the risk of heart arrhythmias. There is no illicit market for it like there is for psilocybin or other psychedelics. Further, the original patent has expired, meaning that the private sector has no significant profit motivation to develop this drug on their own. As such, one of the policy options being explored in this debate is a multi-state research compact, where the public sector would effectively be taking a unique role in developing a new medication.
As always, this episode is intended to be educational, and any opinions expressed in this episode reflect those of the guest, and do not represent the opinions of the University of Tennessee.
Learn more:
Magnesium–Ibogaine: the Stanford Traumatic Injury to the CNS protocol (MISTIC)
https://pmc.ncbi.nlm.nih.gov/articles/PMC10878970/pdf/41591_2023_Article_2705.pdf
Americans for Ibogaine: https://www.americansforibogaine.org/
TN Voices: https://tnvoices.org/
SMART: www.smart.tennessee.edu
https://smartpolicypodcast.buzzsprout.com/
Policy Push For Ibogaine Research
SPEAKER_03You're listening to the Smart Policy Podcast, a production of the University of Tennessee's Institute for Public Service. On April 18th, 2026, President Trump signed Executive Order 14401, which directs federal agencies to accelerate research into psychedelic medications for the treatment of serious mental illness, including substance use disorder. Now, one of the most prominent substances mentioned in this EO is the alkaloid ibogaine. Meanwhile, in the same month, the Tennessee legislature passed Public Chapter 1119, which authorized research into ibogaine in secure clinical contexts.
SPEAKER_00Ibogaine has a significant potential to essentially resolve opioid withdrawal syndrome among opioid-dependent individuals by restoring the brain's neurochemistry to a state of health that existed before the person ever consumed the first opioid.
SPEAKER_03As of this podcast episode, Ibogaine is a Schedule I controlled substance in the United States, meaning that legally it is considered to have a high potential for abuse without any known medical benefits. Its scheduled status also makes it extremely difficult to research. However, treatment with ibogaine is legal in other countries, and some studies do exist, including a seminal paper by Stanford University, which looked at brain health and combat veterans with traumatic brain injury.
SPEAKER_00There was a dramatic restoration of functionality, and functional disability scores went down dramatically. And as you observe, those results, subjectively reported by the veterans, have been sustained over time.
SPEAKER_03This month we are joined by Brian Pubbard of Americans for Ibogaine and Ricky Harris of Tennessee Voices, two of the organizations advocating for this body of research to expand, both here in Tennessee and across the country.
SPEAKER_02And I could get a sense that my colleagues were looking for answers to problems they can no longer solve, this treatment-resistant problem. We spend so much more money and time and energy on looking at other chronic diseases, and it's not even comparable to what we do in addiction and behavioral health.
SPEAKER_03Ibogaine is not like most psychoactive substances. It is reportedly an intensely unpleasant experience that lasts for many hours, involving vomiting and the risk of heart arrhythmias. There is no illicit market for it like there is for psilocybin or other psychedelics. And further, the original patent has already expired, meaning that the private sector has no significant profit motivation to develop this drug on their own. As such, one of the policy options being explored in this debate is a multi-state research compact where the public sector would effectively be taking a unique role in developing a new medication.
SPEAKER_00Having direct federal partnership of that nature with the states for drug development is a project that is unique, the first of its kind, and historic. And Tennessee is now legally positioned to be a part of this endeavor as it moves forward.
SPEAKER_03As always, this episode is intended to be educational,
Meet The Advocates And The Stakes
SPEAKER_03and any opinions expressed in this episode reflect those of the guests and do not represent the opinions of the University of Tennessee. Ladies first.
SPEAKER_02Okay. Well, hello, I'm Ricky Harris. I'm the CEO of Tennessee Voices, and um I'm an ambassador for Americans for Ivy Game because I uh, as part of my role in Tennessee Voices, I serve as an advocate for people with mental health and addiction needs. And my role in advocacy is always to find the most innovative and safe opportunities for people to continue to find the way forward. One of my biggest concerns in this last year has been people with treatment-resistant SUD and depression. So we'll dive into the conversation later about why I got involved with Americans for Ibogaine, but that is that is me in a nutshell.
SPEAKER_00My name is Brian Hubbard. I'm the CEO of Americans for Ibogaine, co-founded with former Texas Governor Rick Perry. Our organization is devoted to the medicalization of Ibogaine within the United States as a breakthrough therapeutic for opioid use disorder, co-occurrent substance use disorder, as well as any other mental health or neurological conditions for which this medication demonstrates efficacy. I come to the position that I hold as the grandson of a couple of grade school-educated co-miners raised in the far southwestern corner of Virginia. I went to law school at the University of Kentucky, held a series of leadership roles in state government here, and I've seen the opioid epidemic play out from its beginning all the way to today, from every conceivable angle, and very much believe that government needs to be about the business of creating opportunities to improve the human condition. And as potential breakthrough medical treatment, Ibogaine holds great promise to produce
What Ibogaine Is And Its Origins
SPEAKER_00that kind of breakthrough.
SPEAKER_03All right. Well, to get us started, despite all the publicity, there are still a lot of people who don't really understand what ibogaine is. And I'm sure you've already answered this question a thousand times in the past month alone. But if I could get you to just to for either of you, uh, what is ibogaine?
SPEAKER_00Ibogaine is one alkaloid which is derived from the Tabernanth Eboga tree, a tree that is indigenous to the Congo basin in South Central Africa. The Tabernanth Eboga tree and its bark have been known for centuries by indigenous African tribes to hold substantial properties when it comes to internal experiences that I would describe as visionary. The Eboga tree has been a part of cultural and religious practice there for centuries. In the mid-60s, an American by the name of Howard Lotsoff came into contact through a Buidi tribe in Gabon, Africa, and a Dr. Gasida, who had knowledge of its properties, in contact with Ibogaine. Howard Lotsoff had been a heroin addict for about nine years, and he wanted to understand what Eboga and Ibogaine would do. So he consumed it. He underwent an experience that was roughly 12 hours in duration. That experience was one which produced a certain degree of physical debility described as ataxia. He was in a state of semi-paralysis. He also happened to be very nauseous and threw up several times through this 12-hour physiological experience. It was not pleasant, it was very difficult. However, on the other side of the acute effect of ibogaine, he did not desire heroin. Not only did he not desire heroin, but he did not experience the most uh dramatically difficult aspect of opioid dependency, which is opioid withdrawal syndrome. So the fact that he did not desire heroin, never experienced opioid withdrawal syndrome, and never went back to using heroin, touched off what has been a 60-year odyssey of broad-based observational studies that are now a mountain high and decades wide, which established that ibogaine has a significant potential to essentially resolve opioid withdrawal syndrome among opioid-dependent individuals by restoring the brain's neurochemistry to a state of health that existed before the person ever consumed the first opioid. It was a mouthful. But that is in a nutshell what ibogaine is, where it comes from, and how its properties were initially discovered.
SPEAKER_03Very detailed. Thank you, because uh there's a lot of people who have questions
Veterans Data And Brain Imaging
SPEAKER_03about this. Where did it come from? How long have we been talking about this? Uh, there was one study, I think I may be mispronouncing this, but uh Kieran et al. just from 2024, and that was a small-scale study observational on about 30-something special forces veterans. And this looked at brain functionality both immediately after treatment and a month later, looking at depression, anxiety, PTSD outcomes, and they saw immediate and sustained changes. I understand a lot of the conversation has been around its utility in treating veterans, especially with PTSD. What are some of the clinical effects that we've we've seen measured?
SPEAKER_00Well, as you know, there was a study that was conducted by Stanford of 30 U.S. special operator veterans. And by way of the background on that study, in 2018, eight years ago, U.S. war fighters who were coming home from repeated deployments, deployments that, frankly, in terms of their recurrence for the individual soldier, were and continue to be unprecedented. You had a number of veterans who were coming back and experiencing debilitating symptoms of post-traumatic stress, treatment-resistant anxiety, and depression. And they would go to the Veterans Administration hospitals in their communities and essentially would be given an array of medications that were designed to address symptoms of physical pain, much of which was opioid medication, and then given the usual cocktail of SSRIs to address depression and anxiety symptomatology. As they consumed these medications, none of them seemed to in any way restore functionality to alleviate symptoms in some total. They essentially anesthetized these veterans and in no way resolved what became their underlying desire to not live in. And so we have seen statistically the explosion, veteran suicide after September 11, 2001. We've lost far more soldiers by suicide here at home than have been lost on battlefields abroad since that time. So by virtue of a history that I'm not really clear on, first a couple and then dozens and then hundreds and now thousands of U.S. special operators have gone to Mexico to what are a constellation of Ibogaine treatment uh providers of varying quality by way of safety and efficacy as a desperate last-ditch move to save their lives. And as these veterans have gone and received the treatment, they were coming back with what are just unbelievably spectacular reports of recovery. So a philanthropist wanted to know what was going on to explain these really unbelievable stories of restoration for gentlemen who were really at the end of life. So a researcher by the name of Dr. Nolan Williams conducted a study whereby the brains of these veterans were imaged before I began treatment and then after. A variety of intake assessments were made of their symptomatology related to post-traumatic stress, suicidality, anxiety, depression, and also functional disability. All of these 30 U.S. Special Forces veterans were almost homebound, certainly not capable of doing anything that resembled the pursuit of a dignified life of autonomy, truly a prisoner within themselves. So they all went for treatment. They came back. Their subjective reports of symptomatology indicated that virtually all of those experiences of post-traumatic stress, anxiety, and depression had been resolved. There was a dramatic restoration of functionality and functional disability scores went down dramatically. And as you observe, those results, subjectively reported by the veterans, have been sustained over time. The most dramatic aspect of the Stanford study related to pre- and post-MRI image comparisons, functional MRI images. And essentially what those images revealed is that Ibogaine has a dramatic neuroregenerative impact on the brain that is unparalleled in the history of Western medicine. Each of these veterans had pretreatment spots on their brains that were indicative of dead brain areas from the concussions or traumatic brain injuries that they had experienced that really were at the root of their symptoms. Post-treatment MRIs revealed that all of those dead spots were gone. The white matter that covers the surface of the brain, the highway across which all of our thoughts and impulses travel, grew and thickened in size. The centers of the brain responsible for emotional regulation and executive function grew in size. And the Stanford researchers, comparing the veteran brains against an algorithmic database of hundreds of thousands of healthy adult brains covering the human lifespan, were able to quantify that the average reversal of brain age for the cohort of 30 was one and a half years, with the top five veterans seeing their brains reverse in age by five years. There is a fabulous physician and neurobiologist at the University of California at Berkeley by the name of Dr. Gould Dolan. Dr. Dolan is a pioneer in a field of research related to what we call the brain's critical period. And I'm going to quote her as best I can. I'm a lawyer, not a scientist, which means that uh I lack significant informational skill in the Sure. But Dr. Dolan explains that the brain's critical period is essentially that time window, usually between the ages zero and three, where all of the foundational imprinting of our mind occurs by way of the experiences that we have in early life. That hard wiring is what sets us on a course for our adulthood in terms of who we are, what we do, and the life that we build for ourselves. What Dr. Dolan's research has established is that among those things that are plant medicines are what we call psychedelics, that they have the unique capacity to unlock the brain's critical period so as to provide a window of really dramatic neurological reconstruction with the appropriate therapeutic supports put around the individual, customized for their circumstances. And among all the psychedelics, Ibogaine has the greatest impact on the brain and produces the longest reopening of that critical period. Why is that significant? When we look at our systems for mental health and addiction treatment, we see a turnstile repetition of relapse and repetitive rehabilitation efforts by individuals who just cannot overcome the problems that they have. Much of that is tied into the fact that that brain is hardwired and conditioned in many ways to drive the individual to produce repetitive behavior patterns. And if we think about the capacity to essentially reopen the brain's critical period so that an individual can have a wide open lane to re-establish thought patterns, to re-establish behaviors, to learn a new way to relate to themselves and the world, the potential to improve treatment outcomes individually and at scale is immense.
SPEAKER_03Now, our our conventional treatment modalities are intended to do that, to relearn new behaviors, to reassess one's connection to the world, connection to their community. Ricky Bryan laid out some interesting perspectives. The notion that we are anesthetizing some people as opposed to treating underlying trauma. You know, there's lots of talk of books like The Body Keeps the Score. We do know a lot about how trauma has really significant impacts on the brain and all sorts of conditions. I was wondering if I could get you to talk a bit about what is our current treatment landscape, what are its strengths and weaknesses, and what does an Ibogaine treatment, specifically the magnesium
Where Current Treatment Falls Short
SPEAKER_03ibogaine stand for traumatic injury to CNS protocol, where where does this fit in and what might this change?
SPEAKER_02Thanks for the question, Jeremy. I I have been thinking about this a lot as a CEO of a mental health organization that provides treatment to people every day. And I'll tell you about two years ago, I started getting really concerned because of the recidivism rates, because of the rate of addiction in our state, because of the amount of suicide. And one of the burdens of my heart is the amount of veteran suicide. We have a high number of veterans that live in Tennessee. And when you think about in context, and I have many family members who are veterans, their service to this country and their misery after the fact, I just felt really burdened to figure out a path forward for them. I had been learning a ton about what the special operators were doing for themselves and seeking treatments, alternative treatments outside of the U.S. So that started to kind of interest me in 2024 to figure out why they were seeking alternative treatment, what's not working for them now. And then in context, we we continue to see rise in data. I've specifically focused on Tennessee because that's the population I serve. The rise in data in opioid use disorder, the rise in data in young adults who are dying by suicide, all of that continues to burden me as the leader of an organization who's meant to advocate for people's needs. Then this term treatment resistant, fill in the blank, treatment resistant substance use disorder, treatment-resistant depression, anxiety really became the buzzword. I was hearing in 25 at every conference I went to, at every uh professional setting I was in. And I could get a sense that my colleagues were looking for answers to problems they could no longer solve. This treatment resistant problem was now arborin. And we had to figure out a path. And that's where I began looking around outside of the industry I've spent my entire career in to say who's looking outside of our current models, who's looking outside of our current opportunities, and paving a new path or doing research or looking at innovative solutions. And I came across the Nolan Williams study that Ryan has referenced, and I was compelled by the brain scans, and I was compelled by the regeneration of white matter in the brain. And I I just had to lean into this and say, how much do we actually do research in behavioral health comparative to all of the other chronic diseases that we research? And when I looked at that, I was like, whoa, we spend so much more money and time and energy on looking at other chronic diseases, and it's not even comparable to what we do in the efforts to research and innovate in addiction and behavioral health. So I I was just that therein lies like the crisis of my heart and my my desire for an advocacy organization to say, can we push the system? Can we push on the system to look harder, to go further, try new things? And I don't mean experiment on humans, but I mean let's start phase one studies, let's look at safety, let's see what's happening with the people already going out of the country to get this medicine. And then let's come back and decide if this is something that we need to consider. And so this medicalization pathway was really interesting to me, which is why I ended up linking that with Brian and all the efforts of Americans for aggregate. So we have a crisis in our industry. We need research, we need more solutions, and we're just sort of sitting around saying, let's let's keep trying what we've always been trying. And I think that's the definition of insanity. So I don't do that.
What Tennessee’s New Law Enables
SPEAKER_02Right.
SPEAKER_03So so we did have a law passed in Tennessee. That's public chapter 1119. And it's a two-page bill, but it does a lot in a way. That's that's the uh the law that allows research on ibogaine, a controlled substance, to be conducted in Tennessee. During those committee hearings, there were a lot of questions, even from policymakers. Wait, if it's a controlled substance, how can we study it? Of course, there were other legislators with medical backgrounds pointing to yes, depends on the context, and there's rules and regulations and so on and so forth. So, what exactly does this law do? What might it look like in Tennessee in the context of an Ibogaine study?
SPEAKER_02Simply put, I mean, you said it, it allows researchers to engage in research on a Schedule I drug, Ibogaine. One of our greatest champions was our bill sponsor, Dr. Brian Terry, and he's a physician. We had lots of great conversations with him. Additionally, he engaged all the physicians in the General Assembly and talked to them about what this was, what we don't know, what we do know, and what we'd like to learn. And I will say we had massive support from the physicians in the General Assembly who were very interested in solving the problems of addiction in our state. Additionally, the veterans and the veterans' caucus were extremely supportive of this vaccine. They brought their testimony of already having experienced many of the special operators and SEAL team members that live here in Tennessee, already experiencing the healing power of Ibogaine. So their testimony of being free from addiction, no alcohol or drug use for six, seven, ten years, some of them testified. That was such a huge piece of this advocacy because their real life testimony told the story of the experience from the human perspective. And then our physicians who are sponsoring it could understand it from the medical perspective. And we're very open. We also had support from a pharmacist in the General Assembly who said, you know, I understand this and I understand the abilities and the potential here. Studying something shouldn't be a barrier. It's not harmful to look at a new idea. So there was a lot of support there. You know, we had we had some concern and question about whether we in Tennessee should get into, you know, the drug development conversation. And this bill really doesn't address that. This bill is simply saying, let's allow our physicians to look at this potential breakthrough medication and do the research.
SPEAKER_03Yeah, interesting.
Multi-State Compact And Federal Partnership
SPEAKER_03Yeah, Brian, you there was some questions you answered during these hearings. Looking at the bill, it allows either a research institution to go it alone or to join a multi-state compact. There is such a compact, correct?
SPEAKER_00There is the infrastructure for a federal multi-state partnership is in place from a legal perspective. Just let's see. I think we're sitting here on June the 10th. Tomorrow, June the 11th, 2026, will be the one-year anniversary of Texas Governor Abbott signing into law the Texas Ibogaine Initiative, which began as the Kentucky Ibogaine Initiative. In the case of Texas, they currently have on the table $100 million to initiate an FDA-approved drug development trial with Ibogaine to drive it all the way through the FDA's drug development process so that it can, on the other side of that, be an approved medication that can be accessed throughout the United States. And the aftermath of the passage of the bill in Texas, once January of 2026 rolled around, there were a number of states with what I would describe as bold and visionary leaders who introduce bills just like the one that is passed in Tennessee to join Texas as a partner in that drug development trial. Whenever you do an FDA drug development trial, it takes a number of years. The cost is oftentimes very substantial. In the case of Ibigaine, the cost is estimated to be about $300 to $350 million. FDA drug development trials must also be geographically and demographically diverse. So while the Texas commitment is massive and fabulous, Texas can't do it alone. And so Americans for Ibogaine worked with leaders in a number of states, and we continue to do so to secure either the legal framework for the state's joinder or a legal and financial framework in which states have committed funds through their legal infrastructure to enable joinder into Texas as a partner in the trial. On April the 18th, the President of the United States signed an executive order to advance breakthrough mental health treatment. And essentially that executive order focuses on the expedited development and deployment of psychedelic medicine through the United States. Part of that executive order calls on the Federal Department of Health and Human Services as well as its research arm, the Advanced Research Project Agency for Health, or ARPAH, to partner directly with states to provide technical, regulatory, and financial assistance to execute one unified FDA trial with Ibogaine to get it through the federal government system. Having direct federal partnership of that nature with the states for drug development is a project that is unique, the first of its kind, and historic. And Tennessee is now legally positioned to be a part of this endeavor as it moves forward.
SPEAKER_03Yeah, that I'm glad you brought up the executive order. And kind of touching on how
Why Private Pharma Isn’t Rushing In
SPEAKER_03you summarize this, Ricky, is this the public sector looking at drug development? And Brian, as you say, this such a such a research apparatus is the first of its kind. This is really unique. If we compare, and I understand this is kind of like comparing carrots to steak, but looking at, say, cannabis, the private sector is all over it. And uh we've known about cannabis for centuries as well. Why is this different? Why aren't we seeing the same level of private sector energy, we'll call it, and why are we looking at a public sector uh research wing into this? Uh they're both now, admittedly, uh they're both Schedule I drugs, of course, asterisk on the the the cannabis aspect of this for other reasons beyond the scope of this show. But yeah, what what's going on here?
SPEAKER_00So there are a number of reasons why private pharmaceutical development around ibogaine is not nearly the viable pathway that the creation of a publicly funded model is. And let's begin with that distinction between cannabis and ibogaine.
SPEAKER_01Right.
SPEAKER_00As everyone in your audience knows, while medical cannabis legislation has been passed in the vast majority of states, and while evidence suggests that cannabis has definitive medical benefit for people with chronic pain and other issues that it can address, the history of cannabis in the United States is one firmly rooted in recreational use. We know that, we know it well, and that is a history which makes it very distinct from ibogaine. There is no recreational party use for ibogaine. I often say if your idea of a party is laid in a floor in a state of semi-paralysis, requiring assistance to and from the bathroom while you throw up repeatedly, then you're going to have a blast. If that's not your idea of a good time, you're not going to have one. For every substance for which there is a recreational use, all the way from cigarettes to fentanyl, there is a street economy which facilitates their distribution across the country and across the world. We hear about, you know, all kinds of you've never heard of an Ibogaine rave. You're not going to go to your street dealer and find ibogaine to get high. It just doesn't work that way. So, in terms of an industry that would crop up to engage in ibogaine distribution because there are collateral benefits that a person can experience through self-administration, that's not at play here. The other and perhaps most consequential aspect of ibogaine is that it is not patentable. Ibogaine was patented originally as an opioid use treatment back in the mid-90s. That patent has since expired. So, unless a pharmaceutical company wants to take the ibogaine molecule and pair it with some other synthetic molecule to create a unique medication that would not be ibogaine, then you're not going to have it developed through the conventional pharmaceutical process.
SPEAKER_01Okay.
SPEAKER_00And then the third issue is because of what has been the highly hyped, but very real, cardiac risk that comes with ibogaine treatment, that risk being the potential for ibogaine if not administered properly to prolong the beats between heartbeats, or what's called the prolongation of the QT interval. Phenomenon which, if it happens too much or too long, can produce a cardiac arrhythmia called torsades. And then once tors develops, the individual has to be rapidly stabilized, or else they could go into cardiac arrest and die. And what are known to be about 10,000 ibogaine treatments globally, I think since the year 2000, there have been 13 deaths. Now, you know, uh every death is unfortunate, and there are always risks that go with serious medical treatments. Right. And I would observe that even within methadone treatment, which is the most effective, as measured statistically, treatment for opioid dependency, 3,000 Americans die every year from methadone overdose, with methadone legally prescribed right out of the pharmacy clinic to the individuals who receive it. Drug development around Ibogain requires the public dollar also because of the nature of the result that is delivered. If you look at the prevailing model of pharmaceutical development, many medications are developed to treat symptoms of an underlying condition chronically, oftentimes over the course of someone's life. Whether we're talking about insulin for diabetes, whether we're talking about SSRIs for chronic anxiety and depression, whether we're talking about opioid maintenance treatment for opioid dependency, these are medications of chronosity. And while they can help and in many cases save lives, the business model depends upon recurrent use for a patient who may very well be dependent upon these medications for the rest of their lives. In the case of Ibogaine, I have never met anyone in my time around this who has received the treatment more than four times. The individuals I can think of who've received it four times have had traumatic brain injury that have been severe and saw steady, improved progression of improvement with each one, but nonetheless had to get three or four in order to get back to what they consider to be optimal condition. I've never met anyone who received ibogaine for treatment of opioid dependency who had more than two relapses. Now that's not to say that it couldn't happen more. Ibogaine is not a now and forevermore cure. What it does is provides an unparalleled window of physiological restoration of the brain so an individual can pursue clear-headed, clear-minded, linear recovery with a biological restoration that nothing that we currently have can give them.
SPEAKER_03So it's not just with our opioid use disorder medications, which stabilize, hold off cravings, you know, bring normality to dopamine spikes and as a you know, bringing those down creating a stability wherein cognitive behavioral therapy, other treatment modalities from a psychological, sociological perspective can come in. This is a similar in that it creates stability, but unparalleled in that there's neuroplasticity in the brain, there's healing in the brain that we're not typically seeing with other medications. So you mentioned four doses was the most you've heard of. That's definitely not the case with many of these other treatments. I
Chronic Maintenance Versus Lasting Recovery
SPEAKER_03think chronicity was a good word for that, I think. That to put this in terms that we hear a lot, switching one drug for another. This has been a concern with psychedelics broadly, too. I'm I'm sure you guys have heard this as well. So how is this different or similar than from that uh concern?
SPEAKER_00Well, again, I think you get back to the differentiation between those treatments that are treatments of chronosity versus those treatments which can produce curative results. Let's just take the opioid-dependent individual. You know, opioid withdrawal syndrome is the constellation of physiological and psychological symptoms that go with an individual's inability to produce dopamine and serotonin, absent escalating dosages of opioid consumption by whatever means they can secure it. Opioid maintenance treatment is designed to prevent the onset of withdrawal by delivering opioids at lower dosages, often with in the case of suboxone, a a blocker naltrexone that is paired with the opioid to keep the individual from being able to get a high off of either suboxone or anything that they may ingest outside. Now, what we know statistically is that suboxone treatment has about a 50% rate of attrition six months from at the six-month period up from intake. And among those who are retained in treatment, it has about an 18% success rate as measured by the individual who is receiving the treatment abstaining from taking any other illicit substances. So you lose 50% of patients at intake at six-month mark, and among those that remain, you have an 18% compliance rate. Why is that? For those individuals for whom Suboxone works, it does allow a return to normalcy because it prevents the onset of protracted withdrawal. It does so by keeping opioid craven satiated with the delivery of opioids.
SPEAKER_01Right.
SPEAKER_00In the case of ibogaine, you're talking about a medication that provides a pathway opportunity to complete and total abstinence, where the individual never has to be opioid dependent ever again. How does it do that? When a person comes off opioids, and in the case of abstinence treatments, you've got about a 7% success rate. The reason you can't have more than about 7% is because folks can't get through the 18-month window that it takes the brain to begin to produce its own dopamine and serotonin through just an organic biological recovery process that is very painful and almost impossible to navigate. In the case of Ibogaine, the evidence suggests that for 80% of people who take one treatment, dopamine and serotonin production is restored within 36 to 48 hours to that which existed before the person ever took the first medication. That number goes up to 97% with a second supportive dose for those who could may experience lingering symptoms of withdrawal. So the opportunity around Ibogaine for opioid dependency really centers upon its unique capacity to rapidly resolve the underlying cause of opioid withdrawal syndrome, which is the shutdown of the brain's dopamine and serotonin production due to long-term injurious exposure to opioid consumption.
SPEAKER_03And that duration, Ricky, this is we see from brain scans that it takes a year for brain function to return to the to a similar state as we see in completely abstinent control groups undergoing similar similar brain scans. So, for example, uh methamphetamine use will have significant shutdowns of core functionality in the brain, especially in the brain stem and fear processing centers, decision making, prefrontal cortex, et cetera. 12 to 14 months, we start to see that return to normal. This this sounds like a very different situation. This sounds like it would be completely different from an insurance perspective, from a hospital stay perspective. I was wondering if I could get your thoughts on that.
SPEAKER_02Yes. I want to go back to Brian's reference to Dr. Gouldan's critical period research and then pair that with my understanding and my knowledge as a person that's been running clinics that deliver therapy services and medication management for 15 years. One of the things that you cannot manufacture is that critical period when you can get in there and do the immense amount of work on the trauma or the processing of the trauma that exists. This is something that I think we need to know more about and we need to understand those critical periods, the the duration of those periods, how much is going on with someone, how much time we need. This would shorten that window. You're talking about that long window of time that it takes for a person to completely achieve recovery. There are a couple of things I wanted to comment on. One is the freedom from the ongoing medications to help with recovery. There is something about a person who is seeking recovery from an addiction. And I know this because I've helped a family member navigate through this. I had a family member who had a tooth infection and was given an opioid, and that is where their opioid addiction began. It was never someone seeking, you know, self-medication and some of the things that we often think about as going on with a person who becomes addicted. Once that whole addiction became a reality and the realization that they were dependent, we started to look for treatment options and we pursued all the traditional publicly offered treatment options that there were, and they were unfortunately ineffective long term. We ended up helping this family member who's now receiving suboxone. And there's no end in sight. And so that family member still feels like a slave to the addiction. And that's the kind of freedom that the the Ibegain can offer is that freedom from continuing to need something, to continue to stay in recovery, to continue to be part of the healing process. There is a freedom in not having to continue to take a medication to be okay. There is a freedom in not continuing to need help every single day just to make it to work and be okay. And I think that is the root healing, the root cause, you know, application of this, healing at that very foundation that is so attractive to me and to so many people who are searching for that long-term healing recovery that we've had a really hard time helping them find. It's not to say that there aren't great recovery programs, because my family member participated in several of them. Right. Uh, but there is this sense that that family member is
Safety Protocols And Care Model Basics
SPEAKER_02still not free.
SPEAKER_01Yeah.
SPEAKER_02And that's really, really disheartening for a person looking for complete recovery.
SPEAKER_03Fair point. And a very common story. And we hear a lot of concerns even from the world of recovery. That now people are familiar with what methadone clinics or or you know, outpatient treatment. Uh, you go in, you get your prescription or your dose, you go home. There are there are different laws and regulations for these. Uh, but there's a people have a sense of what this looks like. Would an Ibogaine treatment protocol would we've heard uh from journalists who have gone to Mexico to some of these clinics, and and Brian, you said earlier that or Ricky, I believe you as well, that there's significant variability in how these places operate. Under this model that Stanford developed that involved an infusion of magnesium to help contradict or counteract, excuse me, the risk of prolonged QT intervals. Is this a hospital stay, uh like a 12 to 48 hour, depending on potential reactions, and I guess a psychiatric consult? Is there indication of what this looks like, or is this what we need to figure out with the research?
SPEAKER_00We understand the basics of what it needs to look like. As with any other medical treatment that has a number of practitioners who do things their own way, right? There needs to be the development of what we would call the absolute best practices for a platinum standard ibogaine treatment delivery model, recognizing that this does not necessarily need to be a frontline treatment. It does need to be something. That is in the arsenal as an available therapeutic choice for individuals who either don't want to have to be physiologically dependent on any substance to maintain symptom remission, or for those individuals for whom other treatments have failed. In terms of what it looks like, there certainly needs to be a preparatory support process in place where an individual can be prepared for the treatment. I was very much persuaded that if I were going to advocate for this and be credible, I needed to receive it myself, though I didn't have any substance dependency issue. And I underwent a series of uh telephone calls with a psychotherapist who understands what ibogaine is to prepare me for what that experience would be. I went into it with a great degree of um anxiety, uh, realizing that this was something that was going to be a difficult experience, if for no other reason than because of the physiology of what it does. You probably need to have what I would call an Ibogaine treatment center that is able to have individuals uh inpatient for about 48 hours, and then they can be migrated and transferred over into what would essentially be the customary 30-day inpatient rehabilitation model that we currently have, and upon discharge, then follow with regularity with the delivery of post-recovery support and integration. Right now, our current model is one that calls for essentially 30 days of inpatient treatment, 90 days of intensive outpatient treatment, and then the delivery of weekly recovery support services over the course of a year. So we're talking about one year and a hundred plus 120 days with what we have. We can probably shorten the acute treatment window to probably 45 days and then move immediately into the delivery of weekly recovery support services without necessarily having to go through the 90-day intensive outpatient process that, at least in measured in 2022, Kentucky Medicaid dollars costs $72,000. Right. Evidence suggests that the capacity to dramatically improve individual treatment outcomes so as to cut down on the potential for relapse, recidivism, and the necessity to re-deliver treatment could be significant, in which case you're going to be able to resource other aspects that recovery support to allow an individual to rebuild the a shattered life in a way that we currently can't because of how much we're spending on that initial 120-day stabilization model that we currently have.
SPEAKER_03Okay. And the thinking with this as it's directly targeting trauma, this is not limited to treatment of any one particular substance.
SPEAKER_00That is correct. You know, based on my experience, and Ricky, I'm sure you could speak to yours as well. You know, an individual who is opioid dependent often comes to the table with a constellation of either substance dependencies as well as traumas they have experienced in life that are the foundation of their substance dependencies. Because of what these observational studies, as particularly around veterans, suggests, hypocaine has the capacity to go right to the foundation that exists within the human psyche that has driven the individual to seek essentially the removal of that psychological and spiritual pain through the consumption of drugs that, in some total, anesthetize their ability to fill that pain.
SPEAKER_02And I can put a little color on that by just saying the number of veterans that I have personally engaged with here in Tennessee who have had the treatment told me that they went into the treatment thinking that they were addressing their PTSD related to combat. And they came out recognizing it was not the combat PTSD that was prominent in what they experienced in their processing. It was a lot of childhood-related trauma. So I think that you know, we really need to understand the value from a trauma perspective because there's a processing that occurs that you you cannot create in a standard therapeutic situation in a 50-minute session. If that makes sense.
SPEAKER_00Jeremy was in a helicopter accident at the height of the Iraq War. He was a member of a 13-member Marine team. The helicopter crashed, and he was the only one who lived through it. Christy reached out to me to advise that she and her husband had heard an interview I had given Joe Rogan about Ibogaine, and that they had decided to pursue the treatment together. Jeremy had been just crippled for 20 years with survivors' guilt, alcohol dependency, and just the anguish that had haunted him ever since he lost his comrades. She wrote to say how thankful she was that they chose to receive that experience and described how within his visionary experience with Ibogain, Jeremy saw all of his brothers in arms who he had lost, and that they had told him that it was okay to go on and to live a happy life, that they were okay. And then he saw himself as an old man standing beside their graves, and that he felt finely that he had permission to live freely and with gratitude for the life that he now has to live into old age. It instantly released him, according to Christie, from all of that survivor's guilt, all of that pain, and it eliminated his desire to use alcohol. I received an email about a month ago, and again, I want to be very careful here and make sure that it's understood that Ibigaine is a highly individualized experience. It's not necessarily for everyone, and it's not going to fix your world. It's going to fix your ability to engage the world oftentimes. I received an email from a woman just about five weeks ago who just explained that she had spent twelve years addicted to heroin and meth and that she was going to die. And she, as many often all the stories of Ibogaine treatment, she heard an interview about it and wanted to see if it would work. And at the time that she emailed me, she was 21 days out, not taken or having any desire to use heroin or meth. And it was just a message of thanks. Thank you for getting information out here that this exists. I have never been able to go this long in 12 years without without heroin and meth. I mean, just fantastic. Is it for everybody? No. Is it now and forevermore? No. Should it be an additional therapeutic option that people should be able to choose for whom our existing choices do not work? Absolutely, yes.
Kentucky’s Overdose Reality And Settlements
SPEAKER_03Beautiful examples, really powerful stuff. And and you know, something that I've been thinking about in the back of my mind, the chair of our opioid abatement council, uh Dr. Stephen Lloyd, he's a treatment provider himself, an addiction clinician, and he himself is in recovery from opioid use disorder and benzodiazepine use disorder. He says that you cannot understand the opioid crisis if you don't understand eastern Kentucky. I just thinking about all these experiences, you were also on the Kentucky, the Kentucky Opioid Abatement Advisory Commission. I I would love to get your reflection on that time, what's happening with the overdose crisis broadly. I mean, we're dealing with so many different substances. Of course, how Ibogaine might fit into this, but as well, just just this, your thoughts on your experiences here and how this translates to your work now.
SPEAKER_00Well, you know, I think Kentucky is in many ways a microcosm of our broader national reality. You know, when we look at the United States in the timeframe between 2015 and 2025, we lost 1.5 million Americans to drug overdose, suicide, and alcohol-related disease, a figure that exceeds the total number of all U.S. soldiers killed in all war, going back to 1776. I happen to believe that at the heart of trauma and addiction is profound spiritual affliction. That certainly is the case in Kentucky, where generational poverty, joblessness, and trauma run deep. Your audience may know that Lyndon Johnson kicked off the war on poverty, you know, 60 years ago in Inez, Kentucky, right there at the border of the state with West Virginia. There has been a generational cycle of endemic political corruption and abuse of the people here that have left a tragic legacy. A people that should be very prosperous and wealthy based on the Cold Wealth on which they were born and have lived, have had all of that stripped and extracted away. And significant portions of the state live in poverty and all the conditions that come with that. This is the soil in which the opioid epidemic was seeded with oxycontin and was produced in what I have to describe as the gravest engineered humanitarian catastrophe that has played out within the United States since the end of the 19th century. I was the first chairman of the Kentucky Opioid Commission, and my job was to oversee the administration and distribution of about a billion dollars in settlements that were achieved in litigation between all the states in the country, including Kentucky, who received relative to the impact of opioid addiction on their populations. Settlements from opioid manufacturers and distributors for their role in creating and perpetuating the crisis. Having served in state government at that point for seven years and looking at the unacceptably mediocre results that were being delivered by available treatment options, I propose that we take 5% of the state settlement funds to set aside for the research and development of something that could be a breakthrough therapeutic for treatment of opioid dependency. I just observed that what we have is not doing enough to get us out in front of what are generationally compounding dynamics of opioid dependency, destruction, and death. Every treatment failure produces a seismic effect through a family and through a community in which you plant the seeds for the next generation to just go through the exact same thing. And while deaths are down fabulously and wonderfully, mostly due to the availability of Narcan as it has been distributed across the country, there is a noticeable absence of statistics related to the degree to which dependency still exists and the degree to which overdose that does not result in death still exists. I believe it exists at scale and has not changed measurably. You have to get oftentimes to the root core of what afflicts the individual before you can address the physiological manifestations of that despair. And so from the Kentucky Opioid Commission, I said, hey, Ibogaine appears to have some very profound breakthrough potential for everything that goes into the human condition that yields prolonged and treatment-resistant sepsis dependency. Let's take 5% of the money and drive it through the FDH drug development process. The opponents who came out of the woodwork immediately, and that is the opioid industry, which is also the opioid treatment industry. Again, I don't want to vilify or stigmatize opioid maintenance treatment. It works for many people. It should be an available therapeutic option. But let's just get real. It has limited efficacy. The National Institute of Drug Addiction and the National Institute of Health years ago recognized that we have to drive innovation within the world of addiction treatment if we're going to improve outcomes, and outcomes need to be improved. The only people who seem to disagree with that position and be wedded to everything they have are those who have either not seriously examined the human toll of systematized failure or who are absolutely wedded to everything they have because they have a personal or professional interest in its perpetual promulgation to the exclusion of all other opportunities to innovate. And that is contrary to the purpose of government, which is to try to serve the freedom and dignity
Final Thanks And How To Follow
SPEAKER_00interest of every person who lives under its umbrella.
SPEAKER_03Do you have any final comments you'd like to add?
SPEAKER_02I'll make a quick mention since you brought up Dr. Stephen Lloyd. I know him well. I've talked to him about this, you know, advocacy effort around Ibigaine throughout the entire process here in Tennessee. I really admire his leadership in our state and many other states on addiction and his openness to hearing me on this topic. And thank you for bringing that up. And I'll say I want to also thank the lawmakers in Tennessee who have heard the testimony, who have looked at the opportunities, who understand our needs and our problems in our state and are willing to go a little bit further to help us find a path forward for new and innovative treatments that can move the needle. To Brian's point, we have to, we are responsible to the people who need us to keep caring about them enough to do the research and find the way forward.
SPEAKER_00I'd like to thank you, Jeremy, for hosting us for this discussion. I'd like to thank the leadership and people of Tennessee for putting their arms around this opportunity to make Tennessee a player in what will be, if successful, the creation of a new scientific frontier that has the capacity to improve the human condition and scale. And as a postcript to the Kentucky experience, uh given the next-door neighbor nature of our two states, I want to thank the legislative leadership of Kentucky who, in this last legislative session, overwhelmingly through both chambers, passed Senate Bill 77, which will allow Kentucky to finally become a part of IBGIN's development in partnership with Tennessee, Texas, Mississippi, Louisiana, Oklahoma, five Native American tribes that are based out of Oklahoma that represent almost 900 Native Americans collectively, as well as potentially the state of Michigan, which is Cent Bill be introduced and ready for movement within this session. Senate Bill 77 was passed overwhelmingly, dutifully vetoed by Andy Bashir, who was within two days later, overwhelmingly overridden on that veto. So, and thank you, Jeremy, for letting me for letting us have this conversation with you.
SPEAKER_03Thank you both truly for uh joining me on the Smart Policy Podcast. I really do appreciate it.
SPEAKER_00Thank you, sir.
SPEAKER_03For more episodes on in depth discussions on Tennessee policies related to substance use disorder by a range of local experts. Please subscribe to us wherever you get podcasts and visit our website at smart.tennessee.edu. I'm Jeremy Corvillis. Thank you for listening and see you next month.