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Iboga Blog
2020
27th January 2021
The Addiction Treatment Industry: A Closer Look
The addiction treatment industry is full of committed professionals doing their best to help addicts escape from the nightmare of addiction. We would like to preface this post expressing our gratitude, love, and support for all of those remarkable individuals devoting their lives to the struggle against addiction. But as in any industry, there are a number of problematic trends, profit-motivated businesses, and self-serving individuals and institutions that are preying on the afflicted, and lining their pockets as their clients suffer. Today we’ll be taking a look at the major problems we see in the drug rehab industry.
The Costs
This problem is particularly pronounced in America, but it exists around the world. This recent Vox study explored the astronomical costs of treatment, telling the stories of families taken to the brink of financial ruin by their attempts to save a loved one. The National Survey on Drug Use and Health conducted in the US in 2018 concluded that approximately 314,000 Americans wanted and needed treatment in 2018, but were unable to afford it because they weren’t covered by insurance. Another study found that drug treatment services were over 10x more likely to be excluded from insurance plans than other medical services and that the disparity was growing larger.
Insurance companies have also done a poor job of selecting treatment providers within the rehab industry, often pushing clients to cheaper centers in Florida rather than more expensive facilities closer to home. An influential article published by the New Yorker last fall details the “Florida Shuffle”, a phenomenon where addicts are funneled into sober homes who profit from insurance payouts while offering minimal services beyond 12 Step meetings and urine tests. In fact, many of the treatment centers and sober homes in America were charging insurance companies up to $20,000 per month for the urinalysis of a single patient, while offering sub-standard care.
The New Yorker article tells of one such center, Good Decisions, operated by Kenneth Bailynson, who bought the Green Terrace Condominium complex and opened a urinalysis lab. As the New Yorker writes:
The Palm Beach Post reported that Bailynson turned Green Terrace into “an armed camp, where guards with guns made sure addicts did not leave.” At his detention hearing, Jim Hayes, the Assistant U.S. Attorney for the Southern District of Florida, described Good Decisions as a “piss farm,” in business “only to harvest residents’ urine.”
Facilities like these often attempted to lure patients in with smartphones, gift cards, and free rent. Many of the sober homes and treatment centers in the existing rehab industry have condoned drug use on their premises, and confined patients against their will. As John Lehman of the Recovery Outcomes Institute noted, South Florida became “the relapse, rather than the recovery, capital of the world.
Enduring Questions
Because relapse is so common, facilities are subject to so little regulation, and the fact that we still have an incomplete understanding of the neurological processes that underlie addiction, it’s difficult to pinpoint exactly what treatments, or elements of treatment programs, work. As one analyst told Vox, There are 4,000 quality control measures for Medicare and Medicaid services in America. “There are none for addiction - zero.”
Shatterproof, an American organization dedicated to establishing national standards of care for addiction treatment is looking to change this reality. They’ve teamed up with many large insurers to try to “identify, reward, and promote” treatment providers who scrupulously follow the scientific evidence and provide a high standard of care. While cynics might speculate that this is the result of insurance companies losing lawsuits against the families of those victimized by the Florida Shuffle and insurance coverage that discriminates against the addicted (the case Wit vs. United Behavioral Health found the company guilty of wrongly rejecting 50,000 claims, and other lawsuits abound), the move toward national and even international standards is largely positive.
But the fact remains that studies of treatment outcomes are largely conducted by the facilities themselves. They generally rely on self-reporting from past clients, with no verification of claims of sobriety. And the treatment centers are incentivized to select data points, or even falsify data, in order to appear more attractive to potential clients. While Shatterproof aims to become similar to Yelp! and allow potential clients access to data from patients, insurance companies, and providers in order to accurately assess facilities, we’re a long way from having the information we need.
The Influence of Stigma
Because of the dangerous stigma which surrounds addiction, many promising treatments, and public health policies are neglected. Opioid replacement therapies, needle exchanges, safe injection sites, and promising alternative therapies like ayahuasca and ibogaine remain illegal in a host of jurisdictions. As the opioid crisis rages on, and more lives are lost to overdose every day, the stigma of addiction often prevents lawmakers from utilizing approaches that have been proven to save lives and experimenting with treatments that have the potential to win the war with addiction.
While the scientific evidence that addiction is a medical problem occurring in the brain has become overwhelming, people and governments in many countries around the world are stubbornly clinging to misguided moral notions that force us to battle addiction with one hand tied behind our backs. Can you imagine if potentially lifesaving cancer treatments were neglected, hospitals’ mortality rates went unrecorded, or those with hypertension were told that their inability to lower their blood pressure was a personal failing? Most of the problems we are experiencing in the rehab industry could be overcome if the public demanded that addiction be dealt with as a common health problem.
At Iboga Tree Healing House we are deeply committed to the safety and well-being of our patients. We will continue to advocate against the stigma of addiction, and for the strictest possible standards in patient safety and quality of treatment. If you feel that you need a treatment center that is devoted to the health and well-being of its clients, get in touch with us today!
24th November 2020 • Sticky Post
Iboga in 2020
Iboga has come a long way in 2020, both figuratively and literally. The psychoactive root bark of an African shrub which is a fundamental sacrament of the Bwiti spiritual tradition has been making its way around the world since American Howard Lotsof stumbled upon its efficacy in treating heroin addiction decades ago. In late 2018 the 5th international ibogaine conference, the European Ibogaine Forum was held in Porto, Portugal. The event was co-organized by Iboga Tree Healing House in concert with the Global Ibogaine Therapy Alliance (GITA) and Ibogaine for the World.
Iboga Tree Healing House also proudly exhibited amongst the top rehab centers from around the world to spread the word about iboga help and other recovery tools to academics, scholars, medical and mental health practitioners at the 2019 iCAAD conference in London. iCAAD is a platform dedicated to expanding knowledge, exchanging ideas, advancing well being and the prevention and treatment of Behavioural, Mental, and Emotional Health issues.
As the global opioid crisis continues to rage around the world, iboga treatment programs have been popping up in every corner of the globe, and medical science is finally beginning to awaken to the benefits it can provide in battling addiction and dealing with psychological disorders. Iboga has been in the news a great deal, with celebrity/lifestyle-guru Gwyneth Paltrow recently invoking its effects in an interview with the New York Times, and Hunter Biden, son of US Presidential hopeful Joe Biden, discussing the role iboga played in his journey towards recovery in a lengthy New Yorker profile. But is the renewed attention finally going to lead to the long-term studies needed to push this powerful treatment into the medical mainstream? Let’s take a look at where iboga is, and where it’s going, in 2020.
Iboga And The Law
In America iboga is still a schedule 1 drug, which means those desperate for treatment are forced to go abroad, often using Mexican clinics with varying levels of professionalism and attention to patient safety. While a study seeking to gain FDA approval began in the 1990s and demonstrated promising results, a host of factors including complaints from the pharmaceutical industry, mounting costs, and an ongoing lawsuit conspired to end it before legal approval could be achieved.
But while iboga is still illegal, a pair of scientists working at the Universities of Vermont and Albany Medical College have developed a substance called 18-Methoxycoronairidine (18-MC), a derivative of iboga that aims to offer the same addiction-fighting benefits without the negative physical side-effects and psychoactive potency of the original substance. While many iboga advocates feel that the psychoactive effects are an essential part of the addictions treatment process, there’s little doubt that removing them will make the substance more palatable to the FDA.
Word of iboga’s addiction-healing effects is reaching more ears (and eyes) than ever before in 2019. An independent film about alternative addiction treatments like iboga called ‘Dosed’ is already creating a furor in Canada. It highlights the amazing progress being made in this area of study, as well as the antiquated laws and regulations holding it back.
As Psychedelics Today reports: “In 2014, a company called Savant HWP began pre-clinical and Phase 1 trials with 18-MC funded by the National Institute on Drug Abuse. These trials were successful, and Phase 2 trials are set to begin this year. If clinical trials continue to be successful, 18-MC could be an FDA approved treatment for addiction within the next decade.” While we at Iboga Tree Healing House are committed to the transformative effects of the traditional iboga journey, we would advocate for any tool that has the potential to free millions of people from addiction.
It is also worth noting that clinical trials in the US on MDMA as a treatment for PTSD are entered the third, and most rigorous phase of clinical trials last year. If successful, these trials could have a dramatic impact on attitudes and legislation regarding psychoactive substances as a part of addiction treatment and mental health. As cities and states across the USA move forward with the legalization of psilocybin, which has shown great potential in treating depression, alcoholism, and other ailments, it appears that the public will grow more receptive to treatments like iboga, and the pressure on regulators will mount.
A Time Of Progress
As news of the positive effects iboga is having on addiction reaches the public, some countries have taken positive steps. “Ibogaine is not included in the UN International Narcotics Control Board’s (INCB) Green List, or List of Psychoactive Substances under International Control,” according to the Global Ibogaine Therapy Alliance (GITA). GITA also provides a helpful map indicating the legal status of the substance in countries around the world.
It’s difficult to predict the future of iboga regulation, but we would expect a growing number of countries to embrace the harm reduction principles which have worked so well for Portugal, while also following Canada and the USA in their moves to decriminalize increasing numbers of substances such as cannabis products and psilocybin, which are used recreationally and therapeutically and have little potential to create addiction. The influential thinker Tim Ferriss has recently been investing a great deal of time, energy, and money into researching the benefits we can reap from psychedelics, and a fascinating recent podcast details much of his research on psilocybin as a therapeutic tool.
While widespread acceptance and promotion of iboga therapy are unlikely to come in the next few years, trends indicate that the push to legalize this invaluable addiction interrupter will only grow stronger in the coming decade.
Grey Areas: Using Ibogaine in 2020
Iboga is illegal in a lot of countries, and its legal status is murky in a host of others. While eyes are opening to the good it can do, we still have a ways to go before those who would benefit most from the treatment can access it safely in a setting of their choice. But as the scientific community and the mainstream learn more about psychedelic and oneirogenic substances, attitudes are primed to change. As we’ve learned from the process of decriminalizing medical marijuana, once a tipping point is reached in terms of changing attitudes and accepting scientific results without the baggage of puritanical, prohibitionist prejudices, society can move quickly. As best-selling books like Michael Pollan’s “How to Change Your Mind” and Ayelet Waldman’s “A Really Good Day” teach society that these substances are, in many instances, safer than the drugs pushed on sufferers by “Big Pharma”, we’d expect to see changes begin in the very near future.
Until those changes take shape, we’d recommend seeking iboga therapy in a country where you can have a safe experience. This means choosing a country where the substance is legal, or one where its use is decriminalized. Don’t forget that this is a powerful medicine, which can cause severe side-effects, and that there is a small but real possibility that you might need urgent medical attention. At Iboga Tree Healing House we look forward to the day when iboga’s power to end addiction is available to ease the pain of addicts around the world!
13th November 2020 • Sticky Post
Harm Reduction in 2020
Harm Reduction can be defined essentially as a range of policies designed to minimize the impact of behaviors with negative social, physical, and psychological consequences. The term is generally used to refer to a number of public policies related to substance abuse and addiction. Policies that fall under the umbrella of harm reduction would include needle exchanges, safe injection sites, opioid replacement therapy, and the decriminalization of drugs of abuse.
Harm reduction gained traction as a strategy for dealing with drug abuse in the 1980s, as the AIDS epidemic was at its height. A coalition of academics, activists, and public officials looked to limit the spread of the disease, and decrease the human and financial burdens created by addiction. As the concept developed over the years advocates of harm reduction have pointed to programs like supervised injections, needle exchanges, alternative sentencing measures, and decriminalization as ways to create better outcomes for both addicts and taxpayers. The concept has come to include creative measures such as “Illegal” magazine, a Danish publication provided to addicts which allows them to earn money by selling the publication in the manner of “The Big Issue” rather than resorting to crime or sex work.
Perhaps the greatest coup the movement has scored was persuading the Portuguese government to wholeheartedly adopt the strategy in 2001. Portugal decriminalized all drugs and began to treat addiction and substance misuse as a health issue, a tectonic shift that ended a great deal of the stigma and dehumanization that too frequently surround issues of addiction. Over the past two decades, Portugal has seen dramatic drops in the spread of HIV, deaths from overdose, and drug-related crime. Yet few countries have adopted this successful approach. Let’s take a look at the state of harm reduction measures in 2020, and explore the question of why the Portuguese model hasn’t been more widely adopted.
We can see mentalities to illicit drug use changing, as cities, states, and countries move towards decriminalization of certain drugs. Canada, South Africa, and an ever-growing list of American states have recently legalized cannabis, a shift that signals that attitudes towards illicit drug use, if not addiction, are changing in the "First World". Meanwhile, Canada, Australia, and 10 European countries are currently operating safe-injection sites for intravenous drug use. This seems like progress, but if you consider the fact that these sites are proven to save millions of dollars in health-care costs by preventing overdoses and the spread of HIV and hepatitis, it’s shocking that these facilities aren’t more widespread. A similar problem exists with needle exchange programs. Even with an indisputable array of evidence demonstrating that needle exchanges prevent the spread of diseases associated with intravenous drug use, according to Wikipedia, only 14 countries around the world provide this service, and in the USA there is a federal funding ban on these exchanges.
Portugal’s decision not to arrest or incarcerate anyone for drug possession allowed the country to provide more funding for health-care services instead of law enforcement. Decriminalization has saved the government millions of Euros and changed public conceptions of who the addicted are. According to The Guardian, people who used to be called “drogados”, a derisive term for addicts, are now referred to as “people who use drugs.” And this has happened in a country that used to employ the slogan “Drugs are Satan!”
Meanwhile, in countries like the United States, the UK, and Sweden, attitudes, and policies for dealing with the addicted remain mired in moral condemnation of drug users. 47% of the inmates in American federal prisons are incarcerated for drug offenses, while in the UK 15% of adults and over 20% of juveniles currently incarcerated are serving time for drug offenses.
Outdated policies based on moralistic views of drug users have made the toll taken by the global opioid epidemic even more horrific. People who began using prescription drugs for genuine pain are now being forced into the black-market to procure the substances they’d been encouraged to use by healthcare professionals, a process that leads to incarceration and even death. Meanwhile, promising treatments including psilocybin, ayahuasca, and ibogaine are languishing in the wings while the problems they could help solve rage on unabated.
Attitudes towards the addicted are changing, and that gives us hope for a brighter future. We just hope that governments can accelerate their adoption of this new paradigm.
Harm Reduction in the Developing World
Countries like Ghana and Colombia have been pushing to decriminalize drugs, and reform draconian laws which too often ruin the lives of young and poor people. In Ghana, someone caught with a single joint of marijuana was subject to 10 years of jail time. Many activists in the country feel that the popular reforms are being stalled by a police force and judiciary who fear the change would weaken their hold on power. Meanwhile, reports from Colombia show that the number of people in jail for drug offenses jumped by 250% following legal changes in 2009 which decriminalized possession of small amounts of cocaine and marijuana.
For intravenous drug users, the 2017 Lancet Global Health Report found that lower and middle-income countries (LMICs) experienced chronic under-funding for needle exchanges and other harm-reduction measures aimed at halting the spread of HIV. This is especially troubling because injection drug use is now far more prevalent in these countries than in the developed world.
In Asia, harm reduction seems even further away. The region leads the world in executions for drug offenses, and many of the continent’s largest countries, including Thailand, China, India, Korea, and Vietnam view drug trafficking as a capital offense. While harm reduction programs have appeared, the NCBI reports that they are generally small programs that reach few of the people in need.
Structural issues are a major barrier to significant harm reduction in Asia, as the social stigma surrounding drug use is far greater than in the West, and harsh penalties for simple possession keep many of those in need of treatment from accessing healthcare systems. In the Philippines, the situation is extremely grim for drug users, as President Duterte’s misguided drug war has taken the lives of an estimated 20,000 people who’ve been targeted for extrajudicial execution.
The Future
As firm believers in harm reduction who have watched firsthand as Portugal’s progressive, humanitarian policies transformed thousands of lives, we find reasons to be both saddened and encouraged by the global progress of harm reduction. At Iboga Tree Healing House we dream of a day when governments around the world adopt the fiscally prudent, deeply compassionate policies that fall under the umbrella of harm reduction. For the time being, we would recommend that addicts in regions with outmoded, repressive laws and policies regarding addiction venture abroad for treatment.
