A Nevada marijuana legalization initiative picks up a key endorsement, Iowa joins the ranks of the CBD medical marijuana states, Tennessee's governor gets ready to roll out a new plan to address prescription drug use, thousands march for legalization in Santiago, Chile, the Peruvian president backs away from forced coca eradication, and more. Let's get to it:
[image:1 align:left caption:true]Marijuana Policy
Nevada's Largest Newspaper Endorses Legalization Initiative. The Las Vegas Review-Journal, by far the largest circulation newspaper in the state, has endorsed the state's fledgling legalization initiative, which has set its sights on 2016. Click on the title link to read the Sunday editorial.
California Sen. Feinstein Opposes Cutting Federal Funds for Medical Marijuana Raids. Just hours after the US House approved an amendment that would block the Justice Department and the DEA from using taxpayer funds to go after medical marijuana providers in states where it is legal, Sen. Dianne Feinstein (D-CA) said that "if a similar amendment were offered in the Senate, I would strongly oppose it." She said that while she sympathizes with patient needs, "rogue medical marijuana dispensaries, which require little or no medical bona fides and are prevalent throughout California, present major challenges for communities across the country." The 80-year-old politician credited the feds with closing more than 400 "rogue dispensaries" and worried that "the House amendment would prevent these critical enforcement activities from continuing."
Iowa Governor Signs Limited CBD Medical Marijuana Bill. Gov. Terry Branstad (R) last Friday signed into law Senate File 2360, which will allow people suffering seizure disorders to use high-CBD cannabis oil with a neurologist's recommendation.
Illinois Senate Approves Medical Marijuana for Minors, People With Epilepsy. The state Senate last Friday approved a bill that would allow minors and people of all ages suffering from epilepsy to use medical marijuana. The legislation is Senate Bill 2636. It has already passed the House and now goes to the desk of Gov. Pat Flynn (D).
Tennessee Governor to Unveil Plan to Address Pain Pills Tomorrow. Gov. Bill Haslam (R) will announce tomorrow a seven-point plan to address rising levels of prescription opiate use. One official said drug treatment will be a key component. In recent years, Tennessee has enacted prescription monitoring legislation and cracked down on doctors accused of over-prescribing opiates. Just last month, a committee of physicians appointed by the health commissioner agreed on new prescribing guidelines that set limits on daily doses doctors can prescribe. The program to be announced tomorrow is supposed to have seven points. Stay tuned.
Homicide Charges for Heroin Overdoses Rise in Wisconsin, But…. In a fine example of investigative journalism, the Gannet Wisconsin Investigative Media Team has released an analysis of the increasing use of homicide charges in heroin overdose cases in the state. Under Wisconsin law, anyone who makes, sells, or delivers a controlled substance that leads to an overdose death can by charged with first-degree reckless homicide by drug delivery. The report finds the number of such prosecutions spiking, but that sentences all over the place and the likelihood of being prosecuted depends largely on which county you are in. A good read.
In Warren County, Kentucky, the Drug War Dominates the Court Docket. The latest batch of indictments is out from the Warren County grand jury in Bowling Green, and more than half of them are for drug offenses. Nineteen people were indicted, 11 of them for drug offenses. There were four for possession of meth precursors, three for drug trafficking, two for marijuana trafficking, and one each for meth manufacture and drug possession. There was also one assault, one grand theft, and some drunk driving and "flagrant nonsupport" charges. Drug charges accounted for 58% of all the indictments.
Peru President Backs Off on Forced Coca Eradication in the VRAE. In a televised speech Sunday night, Peruvian President Ollanta Humala said he is indefinitely postponing plans to forcibly eradicate coca crops in the valleys of the Apurimac, Ene, and Mantaro Rivers (VRAE). The announcement came just days after Humala fired Carmen Macias as head of the anti-drug agency DEVIDA. Macias had been a strong advocate of a militarized eradication in the region, which produces more than half the country's coca crop and is also home to remnants of the Shining Path. Critics had warned that an aggressive eradication campaign would only help such rebels.
Uruguayan Presidential Candidate Who Vowed to Undo Marijuana Legalization Loses in Primary. "We are going to overturn this law that legalized marijuana growing. Nobody plant anything! Don't plant anything because we're going to knock it down!" National Party presidential nomination favorite Sen. Jorge Larranaga said ahead of Sunday's primary election to see who would get a chance to succeed outgoing President Jose Mujica. But instead, Larranaga lost in a surprise outcome.
Thousands March for Marijuana Legalization in Chile. Thousands of people marched through the streets of Santiago, the Chilean capital, Sunday in support of marijuana legalization. "Don't drive and drive, smoke and fly!" read one sign. Much open marijuana use was reported. Demonstrators demanded decriminalization and legalization, specifically including the right to grow their own.
New Bermuda Premier Says No to Marijuana Legalization, But Leaves Door Open for Decriminalization. Incoming Bermuda Premier Michael Dunkley said last Friday his administration has no plans to legalize marijuana, but could get behind a decriminalization scheme. Dunkley's comments came during a debate on the findings of the Cannabis Reform Collaborative, whose report earlier this month called for medical marijuana, decriminalization, and eventual legalization. "I think it is important to reiterate that the government's public undertaking has related to decriminalization and any potential wider use of cannabis," Dunkerly said. "Let me indicate early in this debate that at this time, the government is not prepared to consider personal cultivation, licenses for commercial cultivation and sale or blanket legalization of cannabis. In so far as this report recommends those things, they do not represent this government's current intentions."
A Tampa, Florida, police SWAT team attempting to carry out a drug search warrant shot and killed a man they said pointed a gun at them Tuesday night. Jason Joseph Westcott, 29, becomes the 19th person to die in US domestic drug law enforcement operations so far this year.
[image:1 align:right]According to Bay News 9, citing police sources, the residence had been under surveillance after undercover officers bought "narcotics" there on several occasions since March. A SWAT team was used in the raid because police knew Westcott had guns in the home.
The Bay News 9 story used anodyne language to describe the raid, saying only that police "entered" the residence. It is not clear from the reporting whether this was a no-knock raid or how the police entered the residence.
Police said one man in the front of the house surrendered when the SWAT team entered, but that Westcott, who was found armed in a back room, pointed his gun and officers and was then shot.
Although police repeatedly referred to "narcotics," the only "narcotic" Westcott was accused of selling was marijuana. Police found a hydroponic marijuana grow in his home.
Westcott had no prior criminal record except for one incident of driving without a license.
special to Drug War Chronicle by Douglas Greene
Three dozen ibogaine providers, researchers and advocates gathered from May 7-10 in Durban, South Africa for the 4th International Ibogaine Provider's Conference, sponsored by the Global Ibogaine Therapist Alliance (GITA).
[image:1 align:left caption:true]The cover of the conference program guide and report features Esu, a deity in several religions with a multitude of responsibilities, including protecting travelers, roads (particularly crossroads), power over fortune and misfortune, and the personification of death. The illustration was highly apropos -- 52 years after the discovery of ibogaine's interrupting effects on opioid use disorders by Howard Lotsof, the father of the modern ibogaine movement, ibogaine advocates and providers are at an existential crossroads, with serious concerns about sustainability, safety and efficacy.
The last GITA conference was held in October 2012 in the harm reduction heaven of Vancouver, Canada. For this conference, GITA wanted to get back to the medicine's root -- iboga, a rainforest shrub native to West Central Africa that is sacred to practitioners of the Bwiti religion. After years of ibogaine's increasing popularity to treat Westerners with substance use disorders, iboga is under intense ecological pressure, and could be extinct in its native habitat of Gabon by late 2016, according to Yann Guignon, who wrote a report on the status of iboga for the Gabonese government in 2011-2012.
Guignon comes from an unusual background. He was born in France, but has been in Gabon since 2006, when he was initiated in the Dissumba branch of Bwiti. In 2007, France banned iboga after a death that had only an incidental connection to iboga.
Guignon gave the attendees a full report on the parlous state of the plant. "Over 90% of the iboga has disappeared from the country," Guignon said, and what it left is unaffordable -- the price of iboga has risen tenfold in less than decade. A bottle of 300 grams of medium quality root bark costs 100 euros (about $136), in a country where the 30% of the population that is employed has a minimum salary of 120 euros (about $163) per month.
There are also many factors endangering the supply of iboga: increasing land development and urbanization, the growing political and social power of evangelical Christians and climate change. As a result, "fake iboga" is now being marketed as iboga root bark and causing fatalities due to its cardiotoxic effects. And some Bwiti have started using alcohol instead of iboga in their ngenza (practice).
In response to these formidable threats to iboga's future, GITA and Guignon are taking action. GITA has proposed undertaking a collaborative effort with the Ethnobotanical Stewardship Council to launch the Iboga Dialogues, a multi-stakeholder engagement process to develop fair trade and safety standards for global use of iboga and ibogaine. Meanwhile, Guignon and his associate Jean-Nicolas Dénarié have started a few plantations on private land, and are in discussions with the Gabonese government to develop a plantation in one of Gabon's national parks, with the eventual goal of having a plantation in each of Gabon's 13 national parks.
Concerns about safety have been part and parcel of ibogaine's history as a drug detox. It's not just potent psychologically (about 75% of people treated experience intense personal and transpersonal visions -- not hallucinations, as often described in erroneous media reports). On a physiological level, it can produce bradycardia (a slow heartbeat) and/or arrhythmias (irregular heart rhythms). Last year alone, four of the 12 citations for ibogaine on the medical database PubMed were about deaths and toxicity. And rumors of deaths at clinics (as well as sexual assaults and thefts of intellectual property) have served to undermine the disorganized and reputationally disadvantaged ibogaine subculture.
[image:2 align:right caption:true]However, some pioneering providers are attempting to improve ibogaine's safety profile, not just by taking what should be common sense precautions (using medicine that has been tested for purity, extensive medical screening and monitoring of treatments by qualified medical professionals), but by using cumulative, low dose psycholytic protocols that include iboga root bark, TA (an extract that includes all twelve alkaloids found in the plant) and ibogaine hydrochloride.
According to Clare Wilkins, Director of Pangea Biomedics, this approach has several advantages over the standard practice of using a flood dose of ibogaine hydrochloride: it uses scarce iboga more efficiently, and allows for treatment of high-risk individuals who are normally excluded from ibogaine treatment. Most importantly, it allows clients to be conscious and gradually integrate the insights they glean about their substance use disorders into their awareness and daily practices.
Safety practices were also discussed by Kenneth Alper, MD, an associate professor of psychiatry at the NYU Langone Medical Center and Jeffrey Kamlet, M.D., FASAM, a Miami Beach-based specialist in addiction medicine, both during the conference and in a post-conference seminar devoted to provider discussion of treatment protocols and practices. Topics included patient electrolyte levels (the "number one problem in treatment" according to Kamlet), treatment of bradycardia and withdrawal from Suboxone, methadone and alcohol prior to treatment.
Although there's been an enormous amount of anecdotal evidence for ibogaine's efficacy, there has been a lot more popular media than medical articles about ibogaine (including a few stories after the death of actor Philip Seymour Hoffman and a major Al Jazeera piece that aired shortly after the conference). Consequently, most major drug policy reform organizations have remained silent on ibogaine. Even the Drug Policy Alliance, which honored Lotsof in 2009 just before his death with its Robert C. Randall Award for Achievement in the Field of Citizen Action, offers only a tepid endorsement of ibogaine research. ("Our take on ibogaine is that is shows interesting potential to assist some people in recovering from substance dependence. It should be more widely researched," says DPA harm reduction manager Meghan Ralston.)
[image:3 align:left caption:true]Despite ibogaine being an oneirogenic (a substance that produces dream states) rather than a psychedelic, MAPS (the Multidisciplinary Association for Psychedelic Studies) has emerged as a major institutional supporter of ibogaine research. MAPS Founder and Executive Director Rick Doblin has spoken enthusiastically about his experience with ibogaine, and MAPS is currently collecting data for two observational studies of ibogaine's long-term efficacy in treating opioid dependence at clinics in Mexico and New Zealand. The lead researchers for these studies presented the assembled iboganauts with the latest updates.
Thomas Kinsgley Brown, PhD of the University of California, San Diego, reported on the preliminary results of the Mexico study. Data entry for the study was completed in April. According to Dr. Brown, "[i]n the first month, 11 of the  participants relapsed, another seven in the second month, one person in the third month, another four in months for through six, one person in the seven month and as many as five went all 12 months without relapsing."
These numbers may not be too impressive -- but as GITA's Development Director Jonathan Dickinson has pointed out, most ibogaine providers are using the drug as a detox, not as an ingredient in a comprehensive treatment plan. Dr. Brown also emphasized that six of the 30 participants had some continuing care in the first few months after ibogaine treatment, and suggested that it might be valuable to compare the ASI (Addiction Severity Index) subscores and/or months to relapse of the participants who received continuing care and those who did not. Factors that Dr. Brown suggested might be determinative of successful ibogaine treatment are a patient's drug use history, age, outlook and expectations of treatment, as well as the integration, type and suitability of fit of any continuing care they receive.
Although in an earlier stage of the study, the results in New Zealand tentatively appear to be promising, according to lead researcher Geoff Noller, PhD and Tanea Paterson, a substance use practitioner/ibogaine provider at Ibogaine Te Wai Pounamu (New Zealand's only current ibogaine treatment provider). The study enrolled its 14th and final subject in April. Seven of the participants were tracked for all 12 months of follow-up (as well as one who was lost to contact at 11 months), and of the six participants still being monitored, three (50%) remain opioid free. Noller and Paterson hypothesized that the differences between the results of the Mexico and the New Zealand studies could be attributed to (among other factors) ibogaine's status as a non-approved prescription medicine in New Zealand, which allows for an integrated system of care between physicians, pharmacists, ibogaine treatment providers and continuing care providers.
"In Durban we saw some important steps on a long road towards uniting the therapeutic and sacramental communities that use ibogaine and iboga. The important factor was outlining a sustainability dialogue that will affect both communities deeply, and I think beyond the practical function of planting trees this dialogue will have an evolutionary impact for everyone involved. What we have seen is that the situation we're facing with iboga's sustainability is grim, but that contained within it is a massive opportunity for cultural dialogue and healing. I believe that here we have been successful in initiating that," said Dickinson.
A conference report is available here. Ibogaine has a long way to go to achieve mainstream acceptance, and potentially safer ibogaine metabolites and analogs, such as noribogaine and 18-MC, are being aggressively developed. But as this conference demonstrated, there is a passionate, committed group of providers and researchers who are working globally to advance the states of the art and science of ibogaine practice.