Highly dubious treatment endorsed by President we can only wish would rise to the level of "highly dubious"

Joe Rogan will probably start gushing over Trump again because he got him to sign a (possibly fairly meaningless?) directive to get his former drug taking, brain worm attacked, Health Secretary to look into getting ibogaine approved as an elixir for mental health:

President Trump signed an executive order on Saturday calling for the acceleration of research on certain psychedelic drugs as treatments for depression and other conditions. Podcaster Joe Rogan stood with him as he signed the order—and Trump indicated that Rogan was a major inspiration behind the push to fast-track legalizing ibogaine, which is used outside the United States to treat post-traumatic stress disorder.

Rogan has championed ibogaine for years. A year ago, on his podcast, he said “Ibogaine, in particular, has helped a lot of people. It gives you, like, a review of your life, apparently.” Two weeks ago, he interviewed the CEO of Americans for Ibogaine, who also stood by as Trump signed his order to ease access to the drug. 

I posted a few months about the bizarre way the American Right has rushed to endorse it, despite its obviously seriously dangerous side effect of stopping (some) hearts:

Because ibogaine lengthens the time between heartbeats, a user who gets the wrong dosage, is taking other drugs, or whose heart rate is not being monitored during treatment, can go into cardiac arrest. Even under the most scrupulous of circumstances, ibogaine therapy is a long and grueling inward journey that Ms. Sinema described as “the opposite of a pleasant experience.”  

It has other possible dangers too:

Ibogaine’s most significant barrier to clinical adoption is its safety profile. The drug is known to prolong the QT interval on electrocardiograms, increasing the risk of fatal arrhythmias such as torsades de pointes [18], [19]. Sudden cardiac deaths have been reported in individuals undergoing ibogaine therapy, particularly those with underlying cardiovascular disease, electrolyte imbalances, or concurrent substance use [20], [21]. Ibogaine also exhibits neurotoxicity at high doses in preclinical models, particularly in cerebellar Purkinje cells, and has been associated with adverse neurological events in humans, including ataxia, tremors, and psychosis [22], [23].

 

The drug’s complex pharmacokinetics—marked by a long half-life and active metabolites—further complicate dosing. Inadequate medical supervision, polypharmacy, and pre-existing health conditions can increase toxicity risk. A review of ibogaine-related fatalities emphasized the need for pre-treatment cardiac screening, inpatient monitoring, and electrolyte management to reduce adverse outcomes [16].

And are the results really worth the risk?

Two double-blind, placebo-controlled trials—one in opioid-dependent individuals and another in cocaine users—reported modest reductions in dependence symptoms, although both were underpowered and inconclusive due to small sample sizes and methodological limitations [12]. 

I wonder how you do a double blinded placebo test for a drug that, if you have the real one, makes you feel deathly sick and tripping?   I mean, I guess you could mimic the nausea by a vomit inducing drug in the placebo, but surely you can't replicate the hallucinogenic aspect unless you use another hallucinogen.

A retrospective survey of 88 individuals treated with ibogaine in Mexico found that 54 % remained abstinent from opioids for six months or more, and 30 % reported complete long-term abstinence [14]. A qualitative study involving 73 individuals documented long-lasting psychological benefits such as enhanced emotional regulation, increased meaning in life, and greater authenticity, suggesting ibogaine’s potential role in improving psychological well-being beyond substance use cessation [15]. 

 Increased authenticity?   

Now the problem is that there are no doubt some people with serious problems who legitimately gain an insight this way that they can't imagine gaining in any other, so it feels wrong to dismiss its potential totally -  but when you're talking about a drug with serious potential side effects, this seems right up there with the "worst" of them.    (The articles all suggest that the way forward may be to work on analogues to the drug that don't have the heart stopping side effect - but it sure sounds as if that will be a slow process.)

But it's clear that, as with all of the revival in interest in psychedelics, there are vested interests promising way too much way too early.  And making money has a lot to do with it. Back to the Mother Earth article:

 Billionaire tech investor Peter Thiel has spent the better part of the past decade investing heavily in psychedelic pharmaceutical companies. He’s a major backer of Compass Pathways, a British company seeking to commercialize psilocybin, the psychoactive ingredient in magic mushrooms, in particular for therapeutic use. He’s also invested in AtaiBeckley, a German company working on hallucinogens. On Thursday, the stocks of both companies spiked on news that Trump would likely be giving his stamp of approval to ibogaine this weekend.   

I guess I can't say that it's always a safe bet to bet again whatever Trump endorses healthwise, given that he was a proponent of COVID vaccines until he decided that anti-vaxxers are more his type of people (that is, dumb and prone to conspiracy beliefs.)  But really, Trump hardly gives off a sense of, um, common sense when he makes jokes like this:

At the White House Saturday, Trump didn’t talk much about the money behind all this. Instead, he asked if he could get some ibogaine.

“Can I have some, please?” he said. “I’ll do whatever it takes…I don’t have time to be depressed. If you stay busy enough, maybe that’s what works too, that’s what I do.”