Copyright 1992 Newsday, Inc.
November 19, 1992, Thursday, NASSAU AND SUFFOLK EDITION
SECTION: PART II; ADDICTION & OBSESSION; Pg. 68
Other Edition: City Pg. 72
LENGTH: 4505 words
HEADLINE: Howard Lotsof insists he has the cure for drug addiction. Some authorities are beginning to take him seriously.
BYLINE: By Spencer Rumsey. STAFF WRITER
AFTER SPENDING almost an hour trying unsuccessfully to shoot heroin into her badly scarred veins, 39-year-old Sharon Baker looked at herself with disgust. The Manhattan businesswoman was a bloody mess. Then Baker called the number she’d been carrying around in her pocketbook for nearly two years. It belonged to Bob Sisko, one of the conductors of a so-called junkie underground railroad that would, for a negotiable fee, usher American addicts to another country where they would be treated with a psychedelic drug derived from the roots of an African rain-forest shrub.
The drug was called ibogaine, classified by the U.S. government in 1967 as a Schedule One drug like LSD, which meant that it had no medical value and a high potential for abuse.
Wanting to end her addiction, Baker (a pseudonym) reached Sisko last year, and he told her the bad news: that train didn’t run anymore. Sisko, the founder of the International Coalition for Addict Self-Help (ICASH), was a zealous believer in ibogaine’s powers, especially since he credits it with ending his own 10-year drug problem. But he had agreed with his best friend, Howard Lotsof, that the notion of ex-junkies treating junkies without medical supervision jeopardized their health. Also Lotsof, who has held worldwide patents since the mid-1980s on ibogaine treatment as an interruptor of cocaine, heroin, alcohol and nicotine addiction, had threatened to sue ICASH for patent infringement.
Sisko and Lotsof say that, separately, they have treated a total of more than three-dozen addicts. And they say that the majority of those treated have been able to stop using cocaine and heroin for at least six months. The two cannot provide precise statistics on longterm success, because they have not been able to keep track of all the participants.
“We’re not looking at treating a hundred to two hundred addicts,” said Lotsof, now president of his own company, NDA International, which hopes to market his ibogaine treatment program under the brand name, Endabuse – if, that is, the Food and Drug Administration approves the drug. “We’re looking at treating thousands.”
There are an estimated 200,000 heroin addicts in New York City alone, according to the New York State Office of Alcoholism and Substance Abuse Services. In the United States there are an estimated 1 million heroin addicts and 2 million cocaine addicts.
Sharon Baker had been an addict for 25 years. But when Sisko referred her to Lotsof last year, Lotsof told her she would first have to undergo a battery of medical tests and raise $ 5,000 for the treatment. Her treatment, overseen by a psychiatrist, would occur in Holland, which does not classify ibogaine in Schedule One. The $ 5,000 would barely cover the cost of plane fare to Holland for Baker, Lotsof and his assistants, plus accommodations. Normally Lotsof charged $ 15,000 for the twoto three-day session, but he agreed to make an exception in Baker’s case. She was HIV positive.
Before she flew to Amsterdam in April, Baker had been taking methadone to get through the day and heroin to get through the night. But on Easter morning, hours after she had swallowed capsules of ibogaine, she woke up in a dingy Dutch flat without any signs of withdrawal – no shakes, no chills, no diarrhea.
“It was a miracle,” said Baker, who had tried to kick her habit in the past. “I hadn’t had a fix in twenty-two hours, and I wasn’t dope-sick.” What she had experienced was a psychedelic trip – a grueling experience that left her exhausted. “I felt my armor had been stripped away,” she recalled more than a month later. “You see millions of visions when you close your eyes. But when you open them, you come back to where you are. You realize it was all mental.”
From Amsterdam, Baker flew directly to Florida, where two researchers studying ibogaine at the University of Miami School of Medicine examined her. The two, Dr. Juan Sanchez-Ramos and Dr. Deborah Mash, then proceeded with their application to the Food and Drug Administration to run a clinical experiment on 10 cocaine addicts. And, if the FDA grants approval – as the researchers believe it will – it would be the first time in almost 50 years that ibogaine would be tested on human subjects in the United States within the rigors of science and with the blessings of the government.
“Addiction in our society is not going to go away,” said Mash, a pharmacologist. “We need to reevaluate the way we think about drug abuse and addiction. We as a society don’t look at it as a disease.” Drug addiction is also associated with the spread of the deadly HIV virus.
“We need a magic bullet,” she said. “Is ibogaine the magic bullet? I don’t know, but I think it’s something that should be looked into.”
The idea that one drug – a psychedelic one at that – could stop cocaine and heroin habits with one dose strikes many as crazy. Yet, that’s what Howard Lotsof has been claiming for more than two decades. Some experts have called him a crackpot, a charlatan and a zealot. Some drug authorities have labeled ibogaine “snake oil.” And they regard Lotsof’s supporters – a committed coalition of ex-yippies, former Black Panthers and ACT-UP AIDS activists – as paranoid radicals.
Ibogaine itself was introduced to readers of political satirist Hunter S. Thompson in 1972. Thompson, covering the presidential race for Rolling Stone magazine, wrote a piece about the Ibogaine Effect as a “serious factor” in Sen. Edmund Muskie’s unsuccessful bid. He said the candidate was “far gone in a bad Ibogaine frenzy.” That was perhaps the only time that many people, including Muskie, had ever heard of the drug.
Now, as he endeavors to get ibogaine approved for clinical use, Lotsof will have to win over many key officials and agencies: the National Institute on Drug Abuse, the FDA and even the Center on Addiction and Substance Abuse, a Manhattan-based drug-policy think tank headed by Joseph Califano, who was President Jimmy Carter’s secretary of health. And Lotsof will have to raise a great deal of money. “It’s extraordinarily expensive to get a drug approved, twenty to thirty million dollars,” said Dr. Marvin Snyder, director of pre-clinical research at NIDA.
Even those who have listened to Lotsof remain skeptical.
“Ibogaine is this weird, complex alkaloid,” said Dr. Carlo Contoreggi, medical officer at the Addiction Research Center in Baltimore, Md. “Think of it as a gem with all sorts of different facets, and all these facets have very potent chemical actions – not only in the brain, but in the heart, the blood vessels, the liver. We don’t understand how it works, we don’t know if it does work.
“I’ve interviewed several people who’ve taken it, and I do believe what they tell me: that they’re able to stop using opiates without the usual withdrawal syndrome,” Contoreggi said.
But he thinks FDA approval is “way down the line.”
“It’s going to be very difficult to justify a drug that any time you give it, you get visions for twenty-five hours,” he said. “But if you can show efficacy, then you’ve got a much stronger model. In my view, drug addiction is a fatal disease, so maybe it’s worthwhile taking the risks.”
This summer the FDA’s Drug Abuse Advisory Committee met in Rockville, Md., to reevaluate its decades-old policies toward hallucinogenic research. “I think the FDA is beginning to look at [psychedelic drug research] as a means of helping people,” said Corinne Moody, a consumer safety officer in the FDA’s pilot drug project, as quoted in a newsletter published by the Multidisciplinary Association for Psychedelic Studies. An FDA spokeswoman confirmed that the FDA has begun to reexamine hallucinogens. And that, to Howard Lotsof, means his years of perseverance may not have been in vain.
Dr. Andrew Weil studied the roots of tabernanthe iboga, from which ibogaine is synthesized, at Harvard University in 1961 with the world’s foremost ethnobotanist, Dr. Richard Schultes.
“I’m a little suspicious of the uses that are being proposed for ibogaine,” said Weil, who has met Lotsof. Weil, author of “The Natural Mind” (Houghton Mifflin, 1972), doubted that the psychedelic’s molecular structure would mesh with the brain’s neurochemistry normally associated with opiates and stimulants. Instead, he believes that ibogaine exerts a placebo effect on those addicts already motivated to quit. “I would love to see research done to check it out.”
Iboga is common to Gabon, in West Africa, where initiates of the Bwiti cult consume bowlfuls of the bitter root scrapings – “it tastes as repugnant as heavy oil,” one priest was reported by anthropologists as saying – over the course of a day-long ceremony. Finally, when they’ve ingested enough “to break open the head,” they “meet their ancestors” in a rite of passage. According to anthropologists, hunters would often chew iboga shavings to allow them to sit awake and motionless while waiting for game to approach.
In 1901 iboga’s principal alkaloid, ibogaine, was isolated by two pairs of European scientists. And in 1955 Dr. Harris Isbell gave ibogaine to eight former morphine addicts in Lexington, Ky., in a study comparing its hallucinogenic effects with those of LSD.
“If Isbell had administered ibogaine to currently addicted persons,” Lotsof said, “he, not I, would have probably discovered ibogaine’s ability to interrupt opiate addiction.”
Lotsof is a slender, slightly stooped man. The 49-year-old Staten Island resident has angular features, a wispy mustache and graying hair. He seems easy-going, almost ethereal, until he starts discussing ibogaine. Then passion wells from within, making his chin jut, his mouth harden and his blue-gray eyes burn. He emits a combustible mixture of hubris and humility.
He concedes that his quest isn’t entirely altruistic – that he dreams of retiring as a millionaire. “Right now we’re running on empty,” he said. “I make my rent, my utilities and enough food to get by.” But while he has raised and spent almost a million dollars since 1984 – from donations, private stock offerings, celebrity contributions (Stevie Wonder, for one) and treatment of affluent addicts – his company, NDA International, still consists of filing cabinets stacked in the living room of an old apartment house that he shares with his business partner, his wife of 29 years, Norma Alexander, her mother and a cat, which has a nasty habit of unplugging the fax and answering machines. Early each day Lotsof gets up to communicate with his European contacts, and he spends the rest of his time raising money and disseminating research information. “I feel so close to accomplishing my goals,” he said recently.
Lotsof stumbled upon ibogaine when he was 19 and about to drop out of Fairleigh Dickinson University, where he’d been a history major. It was the dawn of the ’60s.
“College was becoming less and less interesting, and I was becoming more and more troubled – as were many of the youth of my day,” he said earnestly. He started experimenting with drugs and connected with a small but expanding group of like-minded people. He set up a pseudo-laboratory at his parents’ home in Bergenfield, N.J., and obtained pharmaceutical supplies from wholesalers.
One morning Lotsof was having breakfast with a chemistry student who had experimented with LSD in the 1950s. Rummaging through his refrigerator, the man came across a dosage of ibogaine. He asked Lotsof if he wanted to go on a 36-hour trip. Lotsof passed the 500 milligrams to a friend.
About a month later Lotsof got a call in the middle of the night. A low voice said, “You know that drug you gave me? It’s not a drug – it’s a food! We must inform Congress!” Years would pass before Lotsof would try to inform Congress that ibogaine was a possible drug-abuse cure.
After he left his parents’ home and moved to the East Village, Lotsof obtained a supply of ibogaine from a New Jersey pharmaceutical company, and he set up a loose experiment with 20 people, including himself and Alexander, his future wife. Seven subjects were strung out on heroin; none was looking to quit. But after their 36-hour psychedelic experiences, complete with repressed childhood memories unleashed like a Freudian volcano, they all woke up with no withdrawal sickness, no craving for more junk. The year was 1963.
Lotsof believed he was on to something, but he could not get support from his peers in the budding drug scene.
“Ibogaine was totally different from LSD, and people involved with LSD didn’t like it,” Lotsof recalled. “It wasn’t a party drug.” Taking it was like watching a motion picture, he said, recalling his first trip on ibogaine. “I was walking up a ladder leading to a 10-foot diving board over a pool,” he said, describing one “Oedipal hallucination.” “As I dived into the pool, my mother appeared beneath me with her legs open, and I was diving into her vagina. As I got closer, she changed into my sister, who changed into an infant. Then I went into the water, and that was it. The vision changed to a new one.”
In 1966, Lotsof was involved in a drug scandal that had nothing to do with ibogaine. Federal narcotics agents raided his laboratory and charged him with conspiracy to sell LSD.
Once out of jail, in 1968, Lotsof got addicted to heroin again. Then he joined a methadone drug treatment program, which was just coming into wide use. Under its protocols, addicts give up heroin for daily dosages of methadone, a less intoxicating though still addicting opiate.
“Methadone saved my life,” Lotsof said. “It allowed me to get off the street, to stabilize myself and to return to the university and get a degree in filmmaking.” But methadone isn’t the ultimate answer, he says. “The difference between ibogaine and methadone treatment is the difference between being an addict for the rest of your life and being free.”
Armed with a New York University Film School degree, Lotsof labored for years making mostly industrial films, until an old injury disabled him.
Then, in the early ’80s, he became involved as line producer in the Rock Against Racism concert series in Central Park. But fighting racism with rock music proved frustrating. At age 38, he was looking for something else. “I knew that if we could develop ibogaine and make it available, that would be a significant and permanent accomplishment.”
The impetus had come at a Christmas party in 1981 when a woman told him about her boyfriend, who had a heroin habit. Lotsof told her about his experience with ibogaine. She gave him a small grant, and Lotsof set to work. Encouraged by their initial findings, Lotsof, with his wife, set up a foundation. Alexander tried, without success, to get funding for ibogaine research from other nonprofit institutions. Most instead were funding anti-drug education.
So Lotsof turned to the government and made his first big mistake. He had managed to get several prominent drug researchers to agree to serve on his foundation’s medical advisory board, among them Dr. Herbert Kleber, then at Yale, who later became President George Bush’s deputy drug czar, the second most influential drug expert in the country.
“He said money was not an issue,” Kleber recalled recently. “Then I got calls from across the country. Howard was using my name to raise money to do this research.” Kleber had agreed to serve on the advisory board because he was interested in the ibogaine research. But he did not want his name used to obtain funding for ibogaine. He resigned from the board.
Today Kleber sounds almost annoyed when asked to evaluate ibogaine. “There are no double-blind controlled studies that say it works in humans,” he said. “My issue is not with ibogaine but with Howard Lotsof. I don’t want to tar a chemical with the personality of the person pushing it.”
In 1986, Lotsof formed NDA International and with a small band of friends, lawyers and investors, secured the worldwide use patents on ibogaine.
In 1987 Lotsof and Bob Sisko flew to Gabon at the invitation of President Omar Bongo, who met them at Libreville with his science adviser, Dr. Jean-Noel Gassita. “Iboga will be Gabon’s gift to the world,” Bongo told Lotsof, promising to make supplies available for research.
In the world of pharmaceutical companies NDA International is an amoeba among whales. “It’s three officers and nine lawyers,” said Alexander, including her, Lotsof and the senior vice president Bruce Sakow, their first investor, who is a commercial screenwriter.
“I’ve known Howard since the early Seventies,” Sakow said. “He told me about ibogaine way back then. When I put my money in I thought I was throwing it away. I didn’t think he would ever get as far as he has.”
Lotsof ran out of money in 1989 after he had contracted with Dr. Stanley Glick at the Albany College of Medicine to test ibogaine on morphine-addicted rats. Under the terms of the contract, Glick had to send Lotsof a report, which at that time had only preliminary data. But to Glick’s embarrassment, he said, “Lotsof sent that data to two dozen people around the world!” Glick was glad that Lotsof couldn’t pay him the rest of the money, because it allowed him to break the contract without stopping his ibogaine research.
Although he’s owed about $ 9,000, Glick says he has no animosity toward Lotsof. “He comes across initially as a missionary zealot who does not inspire belief,” Glick said. “But ibogaine is a very interesting compound, and it has some very interesting effects that we did not anticipate.”
Glick discovered that ibogaine binds to a particular kind of opiate receptor in the brain even though it isn’t a narcotic. In one experiment ibogaine continued to interrupt rats’ self-administration of morphine long after the alkaloid had been processed out of their bodies. And he found that ibogaine blocked the ability of morphine to release the brain’s neurotransmitter dopamine. Glick also discovered that ibogaine did ameliorate opiate withdrawal symptoms in rats.
“There’s a great deal of territory to be covered to substantiate Lotsof’s claims,” Glick said. “But to Lotsof’s credit, the notion has gained some credence in that more and more people are beginning to work in this area and that NIDA has taken it seriously.”
Three other scientists – Dr. Patricia Broderick of the City University of New York Medical School, Dr. Henry Sershen of the Nathan Kline Institute in Orangeburg, and Dr. M.R. Dzolic of Erasmus University in Rotterdam – have published studies on ibogaine and cocaine in animals. Broderick found that ibogaine decreased the release of dopamine in the brain’s pleasure pathway without blocking it completely. Sershen reported on his studies with mice that ibogaine “could possibly reduce the craving for cocaine.” Dzolic presented findings in June that his rats stopped taking cocaine after a single dose of ibogaine.
But, for humans, ibogaine may border on the unacceptable, considering its hallucinogenic effects. Glick and a partner are exploring the development of an ibogaine analogue, which would interrupt addiction without inducing hallucinations.
To Lotsof and his supporters, the hallucinations are integral to ibogaine’s efficacy. According to Lotsof, a person’s repressed memories first flood his consciousness, next the person reevaluates these experiences intellectually and then that reevaluation becomes incorporated in the individual’s personality. Lotsof has said that the hallucinatory phase, which lasts for only the first three to four hours, “seemed necessary, that bringing up of all the traumatic, emotional information seemed required.” Certainly, there is no way to learn how important this phase is by studying rats, mice and monkeys alone.
So while Lotsof waits to see if the FDA will give a green light to the studies in Miami, he plans to hold an international ibogaine symposium in Europe in a few months, enabling researchers from the United States, Germany, France, Israel and The Netherlands to observe a series of treatments. But those subjects will likely be volunteers who, like Sharon Baker, want to stop taking drugs. No one can predict with certainty whether ibogaine will work on those who aren’t as motivated
– like Sharon Baker, who says she is still drug-free.
Lotsof has backed off from some of the more grandiose claims he used to make. He admits that ibogaine is not the magic bullet he may have once thought it was. “The vast majority of people using drugs don’t want to stop,” he said.
But, as in the fable of the tortoise and the hare, through patience and persistence Lotsof has forced the drug establishment to take ibogaine seriously. Three years ago it was dismissed as “an herbal” and stricken from the final draft of the Senate Judiciary Committee staff report on pharmacotherapy. That wouldn’t happen today, said one NIDA scientist, requesting anonymity. “I don’t think the old guard can deny that there is something there. Howard Lotsof is finally going to get what he wants.”
“Ibogaine interrupted my addiction,” Lotsof said. “And I’ve seen it work on others, so I know I have a product that is needed in our society. If I didn’t think I could get anything out of it, no, I don’t think I’d do it.” But though he hopes his years of struggle will pay off handsomely, he insists the reward won’t be only financial.
“At one point I was discussing our lack of financing with an addict we’d treated, and she said, ‘Isn’t what you’ve done for me enough?’ On the bottom line, I had to say yes. We had handed her back her life.”
THE SEARCH FOR ALTERNATIVES
TREATING drug abuse with other drugs is not a new idea. Heroin was developed at the turn of the century in part as a cure for morphine addiction. It proved to be a highly addictive alternative.
So far the most successful drug treatment is methadone, which the Nazis synthesized during World War II as a painkiller. Working at New York City’s Rockefeller Hospital in the 1960s, Dr. Marie Nyswander and Dr. Vincent Dole developed methadone as an effective treatment for heroin addiction. Studies of former addicts showed a decrease in arrests and an increase in steady jobs. Yet, methadone, less intoxicating than heroin, was as addictive an opiate. Patients dubbed the medication the “orange handcuffs,” because they took it orally in orange-flavored liquid.
Finding an alternative to methadone is one goal of research sponsored by the National Institute on Drug Abuse.
Naltrexone and naloxone are two narcotic antagonists that block heroin’s pleasurable effects, but they must be used at least three times a week to be effective. Studies have shown few patients continue the regimen once out on the street. A long-acting form of naltrexone, now in development, might last a month.
Researchers have been testing a longer lasting form of methadone, called LAAM, which would enable patients to come in three times a week for treatment.
In the 1970s clonidine, marketed as an antihypertensive for lowering high blood pressure, was discovered to reduce narcotic withdrawal symptoms. It was the first non-narcotic able to cope with narcotic withdrawal. Lately, some researchers have found that naltrexone paired with clonidine could induce withdrawal and reduce withdrawal symptoms all within a week’s time. The danger with clonidine is that it might lower an addict’s blood pressure precipitously, so it requires constant monitoring.
For the past two years researchers have run human clinical trials on a promising medication called buprenorphine, which was developed as an analgesic. Taken at low dosage levels, buprenorphine mimics an addictive substance, but at higher levels it became an antagonist like naltrexone, so it might switch an addict off heroin and into treatment. For the dosage to be effective a patient must hold the liquid under his tongue for 10 minutes a day.
Buprenorphine is an opiate, and a patient can become hooked psychologically, experts admit. Yet, its proponents, principally Dr. Herbert Kleber and Dr. Thomas Kosten, who developed it together at Yale University, claim buprenorphine holds promise, because its withdrawal symptoms are milder than methadone’s and it has been shown to curtail cocaine abuse, which is prevalent among heroin users. That unexpected result revealed that a substance acting on the brain’s opiate receptors could also affect the brain’s pleasure pathway, which responds to a different set of neurotransmitters.
Designing the equivalent of methadone to treat cocaine addiction is complicated by the pleasure pathway’s neurochemistry. Blocking cocaine’s euphoric effects could also rob the patient of ability to experience any simpler pleasure. Researchers know that severe depression characterizes cocaine withdrawal. So far the most effective medications studied for cocaine addiction have been antidepressants such as desipramine, flupenthixol and carbamazepine. Perhaps the most promising of these, flupenthixol, was found in a preliminary study in the Bahamas to enable addicts to abstain from cocaine for an average of six months. But all these substances, as reported by the Senate Judiciary Committee’s report on pharmacotherapy in 1989, carry the risk of potentially severe side effects. MORE HARDCORE
CASUAL COCAINE use among young people and the middle class seems to be tapering off, but hardcore cocaine and heroin use is increasing, according to a nationwide study released in October by Dr. Louis W. Sullivan, secretary of Health and Human Services.
A record number of hardcore cocaine users are going to hospital emergency rooms, according to the study. During the first three months of 1992, 30,103 visits were reported, a 12 percent increase over the past three-month period. The previous record was set in the summer of 1989 with 29,939 visits. Emergency room visits by hardcore heroin users were up 15 percent. Drug experts said that the increases are a result of long-term users, who tend to be in poor health, being able to get purer quantities of cocaine and heroin at cheaper prices than before.
In May Mark A. R. Kleiman, a Harvard University professor and adviser to Bob Martinez, who is director of the Office of National Drug Control Policy, warned that because of the low price and higher potency, heroin seems to be reaching “pre-epidemic” levels. Between 1982 and 1991 heroin purity increased from 7.1 percent to 27.6 percent, according to the General Accounting Office; the per-milligram price dropped during the same period to $ 2.12 from $ 2.72, and last year heroin-related hospital emergencies rose 24 percent.
The New York State Office of Alcoholism and Substance Abuse Services reported in July emergency treatments for cocaine had gone up a third and for heroin by more than half in the first nine months of 1991 compared to the same period in 1990. The agency also found last summer the price of a standard “dime bag” of heroin had been cut in half, and that a dose of crack was being sold for 75 cents – an all-time low.
GRAPHIC: 1) Newsday Photo by Ken Spencer- Lotsof, at home on Staten Island, hopes to treat thousands with ibogaine, a hallucinogenic drug he says interrupts narcotic addiction. 2) Albert Landrin Illustration, 19010- Ibogaine is synthesized from the roots of the tabernanthe iboga plant, right, which grows in rain forests. Lotsof hopes to get FDA approval to market his ibogaine product, Endabuse. 3) Tyles Photo- Shooting heroin and 3) Newsday Photo by Bill Daivs- snorting cocaine are on the rise among hardcore addicts; more are ending up in emergency rooms. 5) Newsday Color Cover Photo by Ken Spencer- Howard Lotsof (NS only)
PTS-LOAD-DATE: 1992 Week 03
LOAD-DATE-MDC: January 18, 1993