"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 preexisting 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' Tijuana clinic. She says two involved patients who had cocaine in their systems, and the third victim had a preexisting 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 scientists 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 course of eighteen 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.
"Cocaine, meth, nicotine, morphine — we did the same studies with 18-MC, and it worked as well or better than ibogaine," Glick says. "We also have data that it will be useful in treating obesity. In animals, it blocks their intake of sweet and fatty foods without affecting their nutrient intake."
Glick and his cohorts have yet to determine whether their synthetic ibogaine has psychedelic properties. The rats, after all, aren't talking.
"You look at an animal given ibogaine, and you can't tell if they're hallucinating. But they look positively strange," Glick says. "You give them 18-MC and you can't really tell. But we hope when it gets to people, it won't produce hallucinatory effects."
The first human testing of 18-MC is scheduled to begin later this month in Brazil. But scientists there won't be studying its effect on addiction. They'll be investigating the drug's potential as a cure for the parasitic infection leishmaniasis, an affliction similar to malaria that is common in tropical climates. Through pure coincidence, 18-MC is chemically similar to other drugs used to treat the disease.
The Americans jumped at the chance to test their product in South America. Although 18-MC has shown promise and no observable side effects in animals, not a single pharmaceutical company has shown interest in developing it as an anti-addiction product.
"We're fortunate we have this other disease apart from addiction where we know it can be tested," says Kuehne, a veteran of big pharma who worked for Ciba (a predecessor of Novartis). "Pharmaceutical companies don't like cures. Really, they don't — that's the sad thing. They like treatment. Something for cholesterol or high blood pressure that you [take] for years and years, every day. That's where the profit is."
Further complicating matters is the fact that 18-MC has proven difficult to manufacture. Obiter Research, a company based in Champaign, Illinois, that specializes in synthesizing experimental chemicals, spent nearly two years refining the process before successfully creating about 200 grams of the substance — just enough to send to Brazil to be administered to human subjects.
"Imagine a Tinkertoy Ferris wheel," says Bill Boulanger, Obiter's CEO and a former chemistry professor at the University of Illinois. "It's like taking that apart, then trying to using half of the parts to build a fire engine. Ibogaine is a natural product, and sometimes Mother Nature does a better job than the lab."
Boulanger is convinced there's money to be made from 18-MC. With Obiter, he plans to patent the manufacturing process and secure intellectual-property rights. He and two partners also created a separate company, Savant HWP, in hopes of eventually opening addiction clinics across the United States that administer 18-MC in conjunction with conventional rehab techniques such as twelve-step programs.
"One part is resetting the trigger that's saying, 'Oh, I've got to have it,' " Boulanger says. "That's helping the people fight withdrawal, and that would be part of the whole operation. But it's just one facet. It's got to be holistic. Just handing out a pill and sending them on their way is a bad idea."