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Participants in Brown's study fill out questionnaires that ask them to rate the intensity of different aspects of their trip, on a scale of one to five.
"People have been circling a lot of fours and fives," Brown says. "One of the things we're trying to look at is if the intensity of the ibogaine experience correlates with treatment success. I strongly suspect there's some sort of psychological component. I doubt it's just a biological phenomenon."
Some scientists beg to differ. Foremost among them are Deborah Mash and Stanley Glick.
"The hallucinations are just an unfortunate side effect," Glick asserts, explaining that ibogaine works on the brain like a "hybrid" of PCP and LSD. "Part of the problem is that when you go through this thing, it's so profound you've got to believe it's doing something. In part it's an attempt by the person who's undergoing it to make sense of the whole thing."
Generally speaking, Glick's research on rats has shown that ibogaine "dampens" the brain's so-called reward pathway, reducing the release of neurotransmitters like dopamine, which cause the highs associated with everything from heroin to sugary foods. The compound has also been proven to increase production of GDNF, a type of protein that quells cravings, and to block the brain's nicotinic receptors, the same spots that are stimulated by tobacco and other addictive substances. In other words, ibogaine doesn't work in any one particular way or even on one specific part of the brain, and it's these multiple "mechanisms of action," researchers say, that make it so effective for so many different types of addiction.
People who've taken ibogaine say it can have the unintended consequence of temporarily turning them off a substance other than their drug of choice. Lauren Wertheim traveled from her hometown of Omaha, Nebraska, to a rehab center called Awakening in the Dream House near Puerto Vallarta, Mexico, and used ibogaine to kick her meth habit.
"Ibogaine resets all your [tolerance] levels to zero, like you've never done drugs," she says. "Even coffee — the first cup set me off like a rocket launcher. That's when I was like, 'This stuff is for real.'"
Mash, the researcher from Miami, is convinced that ibogaine works long term because it is stored in fat cells and processed by the liver into a metabolite called noribogaine that possesses powerful detoxifying and antidepressant properties.
"If you gave somebody LSD or psilocybin and they were coming off opiates or meth, they'd go right back out and shoot up," Mash says. "There's evidence that it's not the visions that get you drug-free; it is the ability of the metabolite to block the craving and block the signs and symptoms of opiate withdrawal and improve mood."
Though they don't question its effectiveness, both Mash and Glick believe it's unlikely that ibogaine will ever be widely accepted in the United States. It's not just that ibogaine makes people hallucinate. It can be fatal.
Since 1991 at least 19 people have died during or shortly after undergoing ibogaine therapy. Alper, the NYU professor, examined the causes of death in the fatalities, which occurred between 1991 and 2008. His findings suggest that ibogaine itself was not the culprit; the patients died because they had heart problems or combined the hallucinogen with their drug of choice. (By way of comparison, a study published last year by the Centers for Disease Control found that between 1999 and 2006 more than 4,600 people in the United States died from overdoses involving methadone.)
"It's knowing who to treat and who not to treat," Alper contends. "None of [the 19 fatalities] appear to have involved a healthy individual without pre-existing disease who didn't use other drugs during treatment. Two deaths occurred when they took ibogaine in crude alkaloid or root-bark form — they didn't know what they were taking or how much."
Three of the deaths occurred at Clare Wilkins's Tijuana clinic. She says two involved patients who had cocaine in their systems and the third victim had a pre-existing heart condition. Wilkins says she's now more selective about her clients and requires that they undergo a drug test.
"The learning curve has been difficult at times, but people need to know this can be safe," Wilkins says. "We have to show people how far we've come."
Some of the scientists, however, think they've found alternatives that will make the risks — and the tripping — associated with ibogaine unnecessary.
Mash has devised two ways to isolate the metabolite noribogaine and administer it: a pill, and a patch similar to the nicotine variety. She hopes to begin testing the products on humans by the end of this year.
"It has all the benefits without the adverse side effects — including no hallucinations," Mash says. "I spent a lot of years really pushing ibogaine as far as I could, both in preclinical and clinical studies. But everything that I've learned in the course of 18 years of working on ibogaine has convinced me that the active metabolite is the drug to be developed."
Glick, meanwhile, teamed up with a chemist named Martin Kuehne from the University of Vermont to create and research a chemical called 18-MC (short for 18-methoxycoronaridine) that mimics ibogaine's effect on a specific nicotinic receptor. Just like ibogaine, 18-MC appears to work wonders on drug-addicted rats.