State Lawmakers Propose Studying Effectiveness of Ibogaine for Treating Opioid Use Disorders

March 29, 2018|10:36 a.m.| ASTHO Staff

Throughout this year’s state legislative sessions, legislatures continue to pass and enact laws aimed at improving treatment and recovery options for substance use disorders, particularly opioid addiction. For example, Utah’s governor signed HB 99, which authorizes the state’s division of substance abuse and mental health to establish training and certification requirements for providing peer supports services to individuals with a substance use disorder and/or mental health disorder. The division is to develop rules for the types of services a peer support specialist may provide, as well as the supervision and continuing education requirements for peer support specialists.

In Oregon, the legislature passed a bill (HB 4143) instructing the department of consumer and business services, in consultation with the Oregon Health Authority, to study and report on the barriers to substance use disorder treatment and recovery services. The report must include findings on access to medication-assisted treatment (MAT) in rural and underserved areas and treatment options other than MAT. Meanwhile, Kentucky’s legislature passed HB 124, a bill directing the cabinet for health and family services to review current state licensure and quality standards for substance use disorder treatment and recovery services, and then develop enhanced licensure and quality standards for those services, including MAT. Both the Oregon and Kentucky bills are awaiting governor approval.

Current evidence shows that MAT is effective for treating opioid use disorder through the combination of counseling and behavioral therapies with one of three FDA-approved medications (i.e., methadone, buprenorphine, and naltrexone). However, a few state lawmakers are looking at alternatives to the approved medications. For example, some states recently attempted to allow medical marijuana as a treatment for opioid use disorder. Several states are also looking to fund or facilitate studies on the effectiveness of ibogaine, a naturally occurring, psychoactive compound derived from the root bark of the Tabernanthe iboga plant, for the treatment of opioid use disorder. Ibogaine is a Schedule I controlled substance in the United States; however, addiction treatment centers that administer ibogaine are found in Canada and Mexico and stories about Americans traveling abroad to receive ibogaine treatment are prevalent. In 1993, the FDA approved a clinical trial to study the effects of ibogaine on humans, but the sudden death of a study participant led to an end of human-ibogaine studies. More recent studies based on evidence collected in New Zealand and Mexico have found ibogaine to be effective in reducing opioid withdrawal symptoms and use. These promising conclusions have led to calls for additional studies in the United States. For example, bills in Vermont (H 741), Maryland (HB 1207), and New York (AB 5449) seek to fund or facilitate research into ibogaine as a treatment for opioid use disorder. (A hearing on Maryland’s HB 1207 occurred on Feb. 27 before the House Committee on Health and Government Operations. The relevant portion of the video begins at 0:47.)

Limited access to and availability of MAT services often drives the desire to expand treatment options for opioid use disorder. States are exploring ways to expand access to MAT. For example, West Virginia’s governor just signed a bill (SB 273) that exempts office-based MAT programs from state registration requirements if they provide services to no more than 30 patients and comply with promulgated rules. Additionally, at the federal level, the CARA 2.0 Act of 2018 includes provisions for expanding access to MAT by allowing states to raise patient caps for MAT services under certain circumstances.

Finally, improving access to effective treatment and recovery services is one of the key strategies of ASTHO’s Preventing Opioid Misuse in the States and Territories framework. As states, territories, and the federal government develop and adopt policies focused on treatment and recovery and other strategies, ASTHO will continue to update and inform its members.