I began this blog on my return from going deep with ibogaine with my friends at Iboga Quest in Tepotzlan, Mexico. What incredible medicine, especially for folks in the throes of opiate addiction. Ibogaine interrupts withdrawal and resets the dopamine system, while precipitating an intense “life review” psychedelic experience, giving insights into behavior, thought patterns, and underlying traumas. It opens the opportunity for people to work on their underlying issues without intense physical withdrawal and craving. But it’s no magic bullet: the root causes of addiction aren’t resolved in a day. Rather, attention to diet, exercise, mindfulness practice, and therapy are crucial tools or relapse can occur. A person needs to really want to quit for themselves not because they were caught, arrested, criminalized, or because others are telling them to.1
The issue of opiate addiction hit home recently and tragically with the death of a friend from an opiate overdose. He had been struggling to quit and relapsed at the sober living house he was living at. He initially struggled with addiction to opiate painkillers after knee surgery in his teens, and then moved on to heroin. This article documents the pernicious marketing of Oxycontin by Purdue as relatively benign and non-addictive, when in fact it is a major contributor to the current opiate crisis and wave of addiction that’s sweeping the country. This quote captures the essence of what happened to my friend:
Unfortunately, the pandemic made life worse for [people struggling with addiction]: social isolation made escape into oblivion particularly attractive; pandemic-induced changes in suppliers made potency more variable; and reduced access to addiction treatment made supervised withdrawal harder. Hopefully, economic normalcy will reduce opioid mortality. That said, addiction treatment will need to be massively scaled up to safely reduce addiction (Lopez 2017).
While it might seem counterintuitive, a key harm-reduction addiction treatment is to provide a safe supply of the substance to someone who is struggling with addiction until the person is ready to quit, so that they don’t accidentally overdose. While we should do everything we can to keep people from getting addicted in the first place, while still making sure we’re helping people control intense and chronic pain, when someone becomes addicted either via pharmaceuticals or street drugs, we should not condemn them to death. Unfortunately, when my friend relapsed, because there is no safe supply of heroin, he got something of unknown potency or some kind of fentanyl that’s so common on the street now. Later I was talking to a friend who was chewing his nicotine gum, and it hit home how we should be taking a similar approach to heroin: smoking cigarettes isn’t the most healthy and it is good to quit, but it’s not a criminal issue. One can just smoke outside and chew nicotine gum inside until they’re ready to give it up. Similar with alcohol: we typically don’t call up the police to arrest our uncle who’s struggling with alcoholism, versus try and steer him into treatment. And historically we know how horrible alcohol prohibition was for society: as bad as alcohol abuse is, prohibition made it ten times worse, with mafia gangs gunning people down in the streets and methanol-contaminated alcohol leading to overdose.
My friend should have been able to get a safe supply of heroin if he was struggling that bad, of known strength and purity—not at a corner liquor store but by prescription, until he was ready to quit. It makes no sense to get people struggling with heroin addiction onto Methadone and Suboxone, which are even more addictive and harder to quit, and people often will still layer heroin on top. When someone knows the amount and dose of heroin relative to their tolerance, heroin is a relatively safe drug. In fact, the protocol at an ibogaine clinic for someone who wants to quit Soboxone or Methadone is to transition to a short acting opiate until the Soboxone or Methadone is washed out, and then administer a “flood dose” of ibogaine, that floods the dopamine receptors and resets the system. The documentary “Dosed” does a great job showing the struggles of a heroin addict to free herself and the protocol used by Iboga Soul, another great team of iboga and ibogaine providers, to help her.
In the deeply insightful “Drug Use for Grown-Ups,” Carl Hart makes the case for a safe supply for all drugs for responsible adults, primarily in the frame that it’s our God-given right to pursue happiness and pleasure that is foundational to the Constitution, so long as we are not harming others. He notes that most people don’t get addicted to hard drugs and that we should help those that do, not further traumatize them with arrest and incarceration. He also points out that heroin is relatively safe to use even over the long term, so long as the dosage is known and appropriate. Most overdose deaths are due to unknown purity, strength, and contamination with other substances. He relays that opiates promote a sense of wellbeing, numb emotional and physical pain and can even heighten creativity.
I spent a year on Paxil when I was going through a rough time with anxiety, and was able to right my ship (with therapy, exercise, diet) and eventually disengage from the medication. I remember the feeling when I missed a dose—it was like lightning bolts in my head. And it was a real pain to taper off of. Even while SSRI’s gnarly side effects are acceptable and are expected to be taken every day for long periods of time, opiates that might help someone struggling with psychosis to calm the voices in their heads is judged unacceptable; yet per Hart it is common knowledge among homeless advocates that opiates often play that role. Hart notes that the same junk science that plagued cannabis research, where the National Institute for Drug Abuse (NIDA) historically only funded studies that show the harms of cannabis, plagues research with all other controlled drugs. He used the analogy that it’s as if every time we talk about cars all we did is focus on how deadly and dangerous cars can be, versus their positive attributes when driven responsibly, and failed to educate how to safely drive a car. We must ask: why do we fail to educate on how to safely engage with drugs?
In his awesome new book, “This is Your Mind on Plants” Michael Pollan covers similar territory, focusing on opium, caffeine and mescaline (in a similar format to his excellent “Botany of Desire” that focused on apples, tulips, cannabis and potatoes). With regards to opium, he notes the ancient Greeks understood its double nature, and that while using it the Romantics were divinely inspired to write some of their most beautiful and gorgeous poetry, such as “Kubla Khan” by Coleridge. Pollan notes the 100-year-old apple tree in his garden that was and is only good for making hard cider and apple jack, used to be illegal but now is legal, versus the gorgeous opium flowers he was growing that were fine but now are not, and the different and arbitrary societal judgments at different times around licit and illicit drugs. There is even a strong case to be made that the ancient and famous Soma that inspired the writers of the Vedas in India, was a brew of cannabis, opium and ephedra (containing alkaloids that are in the amphetamine family).2
In his chapter on caffeine, Pollan basically concludes that if you can afford your drug habit and it’s not interfering with your life or anyone else’s, it’s OK. Caffeine is so culturally accepted we don’t think much of it, or appreciate what a powerful stimulant it is.3 But other drugs that people get addicted to are much more stigmatized, even if most people are able to function, hold down jobs and otherwise handle their responsibilities. Heroin maintenance programs have shown the future: people can manage heroin addiction like a diabetic manages with insulin. And then when people are ready to quit they can do so, helped by psychedelic medicine and therapy programs we are now integrating into society, but in the meantime have access to a safe non-problematic supply. Other stimulants, even methamphetamine, can be used in a safe and even sacred way, as Soma attests, and cocaine has been used by many musicians to keep rocking all night long. MDMA, increasingly embraced as a therapeutic ally, has a strong amphetamine component and is in the amphetamine family as much as being psychedelic. Air Force fighter pilots are given amphetamines for long combat missions, as are kids with ADHD. It’s not so much the drugs themselves that fuel addiction versus deplorable societal conditions and trauma (e.g. addiction in inner cities and reservations).
The consequences of prolonged addiction on physical and emotional health can be severe, fueling disconnection and separation from the world and other people. But prohibition makes everything much worse. Instead of a safe supply, we have fentanyl-laced street drugs of unknown strength that lead to overdose and fuel violent cartels and gangs. We should have much more compassion and understanding for people struggling with addiction, commit to getting them the help they need, and not effectively sentence them to death. A safe supply of drugs they are addicted to until they are ready and able to quit is a key part of the solution. No drugs are all bad or all good. Psychedelics can be incredibly healing and it’s my passion project in life to integrate them as fast as possible.4 But there’s real psychological risks and downsides if they are not used correctly, for instance when used by people who are contraindicated by schizophrenia.
Summarizing the main point, as Michael Pollan advises in his excellent New York Times editorial on the drug war, instead of waging war on the people who use drugs, we should decriminalize personal possession, increase addiction treatment including psychedelic therapy (like measures 110 and 109 recently did in Oregon)5, and crucially also, integrate a safe supply of drugs. We need to wage war on poverty and heal trauma instead, the true breeding grounds for addiction in this country.
1Note that there are cardiac contra-indications for ibogaine which responsible providers screen for; not doing so is risky and can be fatal.
2This speaks to the power of ceremonial intentional use of substances versus more casual and recreational: that any drug can be used in a sacred way or not. Tobacco is the master plant in the Native American tradition, that focuses prayer and brings one into alignment with spirit. Its use is very powerful in a ceremonial container with intention; less so when smoked regularly without much thought.
3When I wasn’t such a caffeine fiend myself, I remember how powerful an experience it was: I would choose to drink coffee before my commute instead of at the office, because of the visionary ecstatic state I could get into riding amazing music on my 20 minute ride in on that initial caffeine rush, seeing and feeling God/dess’s deep Love for the world.
4Jamie Wheal, in his new book “Recapturing the Rapture” talks among other things about how when we approach sex, drugs, and rock n’ roll in an intentional way, they can be an incredibly powerful way to experience the sacred. He explodes our categories of the sacred and profane, and often what is considered “spiritual” is ossified and institutionalized and as far from spirit as possible, whereas a secular rock concert can be a profound life-changing experience leading to direct experience of sacred reality and love. Wheal shares a formative experience at a Grateful Dead concert, reminding me of when I saw Roger Waters perform “The Wall” at the Anaheim Ducks stadium on a mushroom chocolate. I felt like I was in Plato’s Sacred Cave where the cables coming down from the roof were like the roots of the Tree of Life, and I was getting the mega download and insight into the human condition in all its messiness and glory.
5As discussed by Pollan in his chapter on mescaline in “This Is Your Mind on Plants,” the Native American Church shows how intentional spiritual use of plant medicine (peyote) and prayer is also effective at helping people struggling with addiction and underlying individual and collective trauma. Intentional use of other plant medicines (such as mushrooms, ayahuasca, San Pedro and iboga) is similarly helpful and effective, sometimes called “ceremonial healing” or “community-based healing” as well. Following the example of the UDV and Santo Daime, the Sacred Plant Alliance of churches, an organization incubated by the Chacruna Institute, is hard at work to enable more and more sincere and authentic churches to flourish above-ground legally and learn best practices from each other. The ceremonial approach shows the power of mutual support and deep connection that group healing provides, and psychedelic-assisted therapeutic approaches championed by MAPS and others are starting to expand to include group models as well. Note that peyote is in a state of collapse in the wild and in response the National Council of the NAC has launched a multi-pronged conservation effort via their Indigenous Peyote Conservation Initiative (IPCI). They have requested that non-natives who are not formal members of an NAC chapter use other mescaline-containing cacti such as San Pedro (also known as Huachuma) in healing ceremonies instead. Having just participated in a Huachuma ceremony Saturday night (with Santo Daime singing and praying nearby), I can attest to the power of using this medicine in a ceremonial intentional way.