Should Kentucky spend $42 million on ibogaine research? 5 Questions for drug abuse researcher William Stoops

Stoops discusses the viability of ibogaine as a potential treatment for opioid use disorder.

In a 2023 national poll, the majority of respondents had heard of psychedelics like LSD and MDMA, but just 12 percent had ever heard of ibogaine. Ibogaine is found in plants like the iboga bush, and in recent years, researchers have been investigating its potential use in addiction treatment. In May 2023, the Kentucky Opioid Abatement Advisory Commission’s director, W. Bryan Hubbard, introduced a proposal to spend $42 million on ibogaine research. The group was formed when the state negotiated a $842 million settlement with companies that manufactured and distributed opioids, including McKesson and Johnson & Johnson. In an interview with the Daily Beast published back in October, a committee member said the ibogaine proposal “came out of the blue.” During the Opioid Abatement Advisory Commission hearings in the fall of 2023, the committee heard from a parade of out-of-state guests testifying to the potential benefits of the drug in treating substance abuse. In the midst of this proposal’s consideration, a new Attorney General was elected, and he appointed a new director of the commission, leaving the future of the $42 million ibogaine proposal in question. 

While some Opioid Abatement Advisory Commission members have expressed enthusiasm for the ibogaine proposal, others in the state are not convinced that it’s viable, let alone the best use of $42 million. The Microdose spoke with University of Kentucky professor and drug abuse researcher William Stoops, who studies opioid abuse, about the viability of ibogaine as a potential treatment for opioid use disorder, and what the future of ibogaine research might look like in Kentucky.

How have you and other addiction researchers in Kentucky reacted to this $42 million ibogaine research proposal? 

I can't speak for all researchers, but I can speak for myself, and I know that what I think is not controversial among the field of addiction researchers both here in Kentucky and nationally. I believe this proposal comes from a good place; we have a major issue we need to address, as we’re in the midst of an addiction and overdose crisis. I can understand why there's frustration with current treatments, but I don't necessarily agree with what's been said about some of the current treatments. I think they are effective, and that a lot of the problems that people have with them are access issues rather than effectiveness issues. Buprenorphine is not going to work 100 percent of the time, nor is methadone. But I would argue that's not necessarily a pharmacological issue. It’s more of whether people can get the dose they need, and the support they need, and can they pay for it? That's where I think we need to be doing better. There's this thought that ibogaine is a cure, and I would love for it to be. When somebody comes forward and says, ‘I took ibogaine and I never used again,’ that is a great testimonial. I'm heartened by that. But we don't have the rigorous science we need to say ibogaine could be a cure. There's some promising case studies and observational studies, but we don't have that sort of gold standard work, like a Phase 2 or Phase 3, placebo-controlled, clinical trial. Getting to that gold standard is really where a lot of the complication lies. 

What are the complications?

Currently, the case studies we have come from people going to other countries and getting access to ibogaine, but we don't really know exactly what was in the substance they received.

The other complication is that ibogaine interacts with heart channels in a dangerous way. I’m not a cardiologist, but I know that this is not a bug or a fluke of ibogaine; as you increase the dose, you're going to prolong a heart measurement called the QT-interval, which can lead to arrhythmias – and that can be fatal. That does not mean that every time you take ibogaine it's going to kill you. But if you take a big dose, that can be dangerous. The specific channel that ibogaine acts on in the heart is called the hERG channel, which mediates electrical currents in the heart. There's FDA guidance out there about what to do if you've got a drug that affects the hERG channel. It’s essentially a no-go to develop. If you did go ahead with developing it, its use would be severely restricted: you would have to screen anybody participating in your trial so heavily that you’d then have to question the generalizability of the trial. 

Does that FDA guidance on drug development and the heart’s hERG channel affect how ibogaine research would be carried out in Kentucky?

In a world where that Kentucky ibogaine proposal passes, and the money is allocated to researchers, those researchers would need to issue an Investigational New Drug application to the FDA before beginning their work. And if the FDA did allow them to do this work, it might be under limited circumstances where patients would need to be screened. For instance, we know that heart issues are comorbid with opioid use disorder, so those folks probably aren’t people you want to give a drug that interacts with the hERG channel. So I'm not sure actually how, in the United States, we would get the gold standard evidence we’d need to move ibogaine research forward. Of course, the FDA would be the ones to decide this, but they might say we can't study this drug in humans knowing what it does to the heart, given their previously published thinking on testing and evaluating drugs that have hERG-channel activity. At the very least, there might be a lot of restrictions and requirements around safety. 

If this money were doled out, I’m not even sure that we could actually do this at the University of Kentucky, and this is one of the most sophisticated places doing work like this. I think you would need to do it in a very specialized private clinical research organization that would allow for a high level of coordinated expertise between specialists like cardiologists, psychologists, psychiatrists. 

That level of coordination — and the involvement of a specialized clinic — sounds expensive. Forty two million seems like a lot, but how far would that money actually go in moving ibogaine research forward?  

In our field, the number people bandy about as the amount to bring a drug to market is $2 billion. $42 million is still a lot of money, though — maybe that gets you a Phase 1 study, or a small phase two efficacy trial, but there would still be a long way to go in terms of bringing the drug to market. There’s a reason pharma companies are generally the ones bringing drugs to market: it requires a team of people to coordinate the work, and a lot of money to gather this data. 

As a researcher studying addiction, how would you like to see that $42 million spent?

That's the $42 million question! Well, I’d start with this: my understanding is that the Opioid Abatement Commission aims to expand access and knowledge about evidence-based treatments for opioid use disorder. If it were up to me, I would go back to the basics: we know methadone and buprenorphine are effective. We know buprenorphine is effective, we know naloxone reduces overdose. Let's spend money on getting access to those drugs or figuring out novel models of care that bring treatments to people who need them. Maybe we prioritize behavioral interventions; we know that addiction is driven not only by pharmacology but social factors. 

Would it be nice to see some R&D on novel compounds? Sure. I think it’s worth looking at psychedelics as a possibility, like psilocybin, MDMA, maybe ketamine, which has shown some promise for cocaine use disorder. But I just would have never started with ibogaine.

This interview has been edited and condensed for clarity and length.