A new generation of medicines promises to cure the pervasive and highly destructive “diseases of civilization,” partly behavioral, implying that individual actions play a role over time.
Is it true that all we need is medication to avoid life-affecting conditions such as obesity or addiction? Would the new pills “cure” obesity or, say, alcoholism, or they’d merely treat the physical expression of conditions that can’t be disentangled from our lifestyle and behavior, needing a permanent intake to avoid their comeback?
It’s still early to know whether the new drugs can achieve the status of a temporary treatment that permanently cures or whether they’d become more of a permanent medication, just like insulin for diabetes.
Do we need lifestyle changes to cure obesity and addiction?
We have entered a new era in medicine in which two scientific schools will measure their hypotheses concerning some of the big malaises of our time. These two groups debate whether behavior or chemistry can change our relationship with food and drug addiction forever.
The first group of experts believes that these conditions are mainly behavioral, and their impact increased as pop culture exploited our instinctual predisposition to instant gratification. Our amygdala, or the core brain we share with other vertebrates, evolved when our species had to favor any sugar, fat, or impulse to fight environmental scarcity.
The signal saturation in contemporary society could overrun some people’s ability to control their intake of rich food or addictive substances and behaviors and also worsen the psychological effects of trauma derived from violence, mental sickness, war, etc.
New advances in treatments have nurtured a new approach to these so-called diseases of civilization associated with the pervasiveness of processed food and poor lifestyle choices that favor a constant nervous stimulation and shortcircuit our ability to avoid the neurobiological loops of addiction. When instant gratification becomes a loop, we aren’t only affected by the chemistry but what does that chemistry to our brain (that’s why there are addictive behaviors that follow the same gratification loop, not only substances, like gambling or social media addiction).
Tinkering with our biochemistry
A second group of researchers suggests that obesity and substance addiction (to alcohol, to opioids like oxycodone, etc.) should be perceived as a “chronic medical condition” such as diabetes, and therefore medicated during long periods —or even for life— with affordable, eventually over-the-counter pills that could end the struggle with food and drugs.
Are the hopes of curing obesity (and the main risk of metabolic syndrome, or the risk factors associated with excessive weight such as heart disease, stroke, and diabetes) and substance addiction with over-the-counter medication overblown, or the hopes related to the new treatments are justified?
As medicine experiments with new treatments and gathers knowledge of how our nervous system reacts to the biochemistry of, for example, some psychedelic substances, thousands of people are already using medications that they consider effective and life-changing. They help determine our body’s biochemistry and nervous system: in weight loss, the new drugs have evolved from previously successful diabetes treatments that control blood glucose levels, enhancing the effects of naturally occurring hormones like GLP-1 (Glucagon-like peptide-1), which stimulates insulin secretion.
Is using GLP-1-based drugs to lose weight instead of, say, sticking to a healthier lifestyle or treating addiction with medication instead of a holistic behavioral program more momentarily patching a problem than tackling its underlying causes?
The response to this question is complicated, given the lucrative industries that are growing around diabetes drugs adapted to weight loss and hallucinogenics use in addiction and trauma treatments, despite the FDA’s ambivalence (or, in the case of ibogaine, outright prohibition) of such substances for the uses they are being popularized.
A chemical message your brain wants to hear
The new family of weight-loss pills contains a synthetic version of GLP-1 to boost the naturally-occurring hormone’s full signal in the brain, triggering a decisive chemical message:
“You’ve had enough to eat. Stop eating, you’re full.”
GLP-1-based drugs replace or amplify the signal in our bodies that we secrete in our gut as we eat, sending the decisive signal to the brain. Feeling satiated, food will lose its attraction, especially when stress hormones override natural GLP-1 peptides to the point of turning the signal residual, making it more difficult for the brain to say “stop.” Besides this task, these artificial peptides lower blood sugar and stimulate insulin release, hence the medical niche they first covered. But are their derivatives going to be as beneficial for those who want to use them as an alternative to conventional weight management strategies?
The new drugs are very similar to the diabetes counterparts they derive from, like Ozempic. Some of them, like Wegovy, use the same molecule (the GLP-1-like semaglutide) to do the trick on our brain. Some doctors, personal trainers, and individuals are banking on the safety of one simple strategy: don’t change your lifestyle (i.e. eat as poorly as you want, don’t exercise much or at all, etc.), just take your weight-loss medication —and you’ll lose weight.
When feeling full is liberating
Can you trick your brain into a GLP-1-based strategy over the long term without other health consequences? There aren’t longitudinal studies confirming the safety of such medications over the long term.
One of the reported experiences that patients of GLP-1s share is their transformative relation with food, which stops being problematic and/or obsessive. Now, with a more satiated feeling, lowered blood sugar levels, and higher natural insulin production, they report reinforced self-esteem and agency.
Given this transformative promise with food and one’s image without the need to take more proactive, traditionally perceived as more shaming strategies, GLP-1s are taking social networks by storm —and the phenomenon concerns experts. If their use is mediated by the Internet (say, through motivational videos and Reddit threads), from online purchase to use, there’s a higher risk of abuse and potential health harm.
Whether public health boards like it or not, the perception of obesity may enter a new era, what Julia Belluz has called in a Vox article “the age of Ozempic.”
The weight-loss “miracle drugs” have already entered the Hollywood gossip mills, whereas personalities such as Elon Musk and Michael Rubin, have used the drug to, in Musk words, get “fit, ripped, and healthy.”
Is anybody confident there’s no Catch-22 in the trend?
Neurostimulation to rewire your brain on addiction?
The also promising advances in addiction treatment come from another realm that is finally entering the world of medicine after decades of ostracism: neurostimulation. At least one dissociative psychedelic substance that stimulates anti-addictive mechanisms, ibogaine, is showing promising results in patients dealing with long-lasting trauma and addiction.
Could substances like ibogaine (and, to some degree, other psychedelic substances historically associated with the stigma of illegal drugs such as MDMA, LSD, ketamine, or ayahuasca) treat addiction by helping patients rewire their neural circuits of self-identity, mood, and stress control?
Ibogaine is a substance derived from Tabernanthe iboga, a plant that grows in the rainforest of Central African countries surrounding Gabon, the plant’s epicenter. Used by traditional medicine for centuries, the plant derivative had helped the Fang, Mitsogo, and Punu people of the Congo Basin as a stimulant if brewed and in large doses for Bwiti ceremonies. The rites trace their remote origins to the Central African traditional forest foragers, the Pygmies, called Bambuti in the Congo Basin, who passed their knowledge to Bantu populations.
But the interest in ibogaine multiplied as researchers and drug developers analyzed the outcome of trials treating addiction and its inner causes, such as trauma and PTSD.
Now, the expectations deposited on both families of drugs, their promise, and the amplifying effect of social networks, represent a potential risk. Hormone-regulating drugs designed to treat diabetes are being used without prescription for weight control without enough data to analyze the consequences of their health effects over time beyond weight loss.
Tapping into ancestral sources of pain relief
The use of ibogaine has also skyrocketed, creating an industry of trauma and addiction treatment in countries specializing in medical tourism, such as Mexico. Tom Feegel, CEO of Beond, an ibogaine therapy provider based in Cancun, Mexico, estimates that there are already 150 ibogaine centers worldwide, although only 10 or so would have all the required credentials required for accredited medical clinics.
Administered in high dosages, ibogaine is a dangerous drug. Several studies address the substance’s lethality in at least twenty-seven reported fatalities following its ingestion. Ibogaine interferes with the heart’s electrical signals and lowers or speeds the heart rate, which could cause potential cardiovascular arrest in predisposed individuals. It can also strain the kidneys and liver.
Though this risk has made the drug illegal in the US and other countries (list), its use is still sparse and controversial. In France, the old colonial power in Central Africa, ibogaine was sold and prescribed as an antidepressant and stimulant for over three decades until the 1960s, although it had first been classified and described by French botanists in the 1860s. In 1885, Joseph-Henri Neu, a French missionary, described how locals ingested root bark scrapings in elaborate ceremonies “to discover hidden things and to tell the future.” In 1905, it was prescribed to combat “fatigue,” providing “energy to work.”
Édouard Landrin isolated the substance from Tabernanthe iboga and named it ibogaine at the beginning of the twentieth century, providing the first method for its extraction. Landrin and colleagues conducted extensive experiments on animals to learn about the physical and behavioral effects of the drug, published in 1905. He even suggested potential applications as a neurasthenic in chronic fatigue treatments, as a cardiac regulator, or as a nutrition stimulator. But the drug’s pharmacological effects remained under scrutiny, associated with ethnomedicine.
Why is ibogaine illegal?
Over a century after, the hallucinogenic’s medical use is legal in Mexico. Thousands of Americans are willing to assume its use’s known risks, traveling to clinics and hoping for the best. Their expectations of curing addiction and trauma are, this time, at least partially based on people exposing themselves to the substance’s therapeutic effects. Wired condensed the dilemma presented by ibogaine in one September 2019 headline: “A detox drug promises miracles —if it doesn’t kill you first.”
Rachel Nuwer writes about the consequences of the substance’s blurry legal definition in an article on National Geographic:
“The patchwork of global legislation has led to an explosion of ibogaine-related medical tourism, with 80 to 100 iboga providers—primarily in Mexico, Brazil, Costa Rica, Colombia, and South Africa—serving mostly North Americans and Europeans who often pay $5,000 to $15,000 for a single therapeutic session.”
And, as a consequence:
“Estimates of the number of people outside Gabon who have tried ibogaine since the 1960s vary from 10,000 to 40,000, according to Tobias Erny, executive director of the Global Iboga Therapy Alliance, a nonprofit dedicated to supporting sacramental and therapeutic uses of iboga.”
Anecdotal evidence accumulated since the 1960s hasn’t changed the substance’s status in the US as Schedule-I controlled drug, and ibogaine is not authorized by the FDA as a treatment drug, despite evidence of the drug’s ability to adjust brain chemistry in medically useful ways.
Ibogaine is more than one hallucinogenic placebo
Can one hallucinogenic rewire the nervous system in such a way that people experiencing withdrawal symptoms stop having cravings? Studies using low oral doses (and therefore potentially less dangerous to patients) of ibogaine showed decreased addiction cravings and alleviated depression symptoms, and the effects seemed sustainable one month after the trial.
In Spain, a recent study (last updated on August 31, 2022) has tested ibogaine on 20 people trying to wean themselves off methadone. Similar qualitative experiences are taking place in Brazil and elsewhere.
The advantages seem to be real, and a growing number of testimonies claim quantifiable, life-changing benefits of ibogaine treatments. Those who directly benefited from the use of ibogaine are coming forward to explain their story, which seems to confirm the self-reported effects of patients participating in trials. For heroin and opioid addicts seeking rehabilitation, ibogaine could represent their liberation from long periods of dependence on methadone and Suboxone, themselves highly addictive opioids widely used as medications to treat opioid use disorder.
Ibogaine has been reported as useful in treating dependence on several other substances, including alcohol, cocaine, methamphetamine, or nicotine.
Suppose the hallucinogenic can rewire some patterns in people’s brains, altering compulsive behavioral patterns. Could its use benefit anyone experiencing addiction and obsessive-compulsive disorder, even when there’s no abuse or chemical dependence from any substance?
Ibogaine as a portal to treating PTSD in veterans
Retired US Navy SEAL Marcus Capone believes so. After 13 years of service, life back as a civilian didn’t come easy: depression, anger, headaches, anxiety, alcoholism, impulsivity, and violent dreams. He’d get upset at noon, then binge-drink for 12 hours. With the help of his wife, who was experiencing his cognitive decline in real time, he took the advice from another veteran to travel internationally and try ibogaine.
He traveled to Mexico and got ready for the hallucinogenic trip. According to him, “the medicine” is just going to go down there and “basically pull up any traumas, anything hiding in your subconscious that may be affecting you that you don’t even realize.” To him, it felt liberating, as if he had shredded a heavy load. It didn’t make any sense for him to want one drink after another. He felt he could think clearly again, feeling no anxiety, no shade of depression lurking around.
Almost ten years ago, Paul O’Heron, a 29-year-old drug addict from Missouri, arrived in Cancun to try ibogaine after struggling with substances for 12 years: snorted Ritalin, cocaine, meth, Oxycontin, and, eventually, heroin. O’Heron claims that the hallucinogenic experience helped him come to terms with dark moments of his past as if the drug would disentangle at a molecular scale trauma paths wired on people’s experiences over time.
Still, on a high dose of methadone when he had flown to Cancun, he didn’t need the substance at all to cope after leaving the clinic.
Context and behavior can’t be eluded, even in “miracle” drugs
But Deborah Mash, neuroscientist and addiction researcher at the University of Miami who pioneered ibogaine trials in the early ’90s in the US with approval of the Food and Drug Administration, reiterates that the substance is, if anything, one “addiction interrupter” and not a “cure to addiction.” Now she operates an ibogaine clinic outside the US.
A “cure” for addiction doesn’t exist yet, she says. Addict’s behavior is affected for years of abuse and profound changes in the way the brain is wired, she explains, and these chemical changes affect the person’s pleasure perception. Impulsivity in addicts is a drive so strong that it overrides any rational analysis of consequences derived from poor decisions. Ibogaine can be really useful in breaking these self-defeating patterns, targeting the drug-taking pattern of behavior. In this sense, it can feel like a “reset,” a return of the brain to a “pre-addicted state.”
To the potential danger of taking a high dose of ibogaine by people with an already weakened or compromised immune system, there’s also the cautionary tale of relapse after the hallucinogenic’s initial success. Zina Lyons grew up surrounded by drug users and eventually fell into a crack addiction. She went to a clinic on the Caribbean island of St. Kitts and detoxed successfully but relapsed within a year after going back to the environment where she had become addicted.
Our environment affects our behavior in constructive and destructive ways, and substances (those to treat illness, those producing an illness) can be as good and effective as we are predisposed to expect. Though, this time, even the so-called lost causes are beginning to see some hope after years of frustration and misunderstandings.