As Colorado considers how to regulate ibogaine therapy, it faces a difficult but familiar policy question: how to responsibly expand access to a potentially life-saving treatment that carries real risk.

In 2024, over 1,300 Coloradans died by suicide, at least 14% of them veterans. Over 1,600 died from drug overdoses. These deaths represent a public health emergency that has resisted conventional solutions.

Ibogaine, a naturally occurring psychoactive compound, has shown unusual promise in treating both opioid and cocaine addictionand severe psychological trauma, particularly among veterans. For many patients, a single treatment appears to interrupt addiction and suicidal ideation in ways few other interventions can.

But ibogaine is not without danger. In rare cases, it can cause fatal cardiac complications, even when administered carefully. That risk has understandably raised concerns about whether clinics should be allowed to operate at all, and whether providers could face crushing liability when adverse outcomes occur.

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If Colorado allows fear of rare but tragic outcomes to determine policy, access to ibogaine will remain scarce or driven underground, where oversight is weakest and risks are greatest. A more responsible approach would acknowledge both the benefits and the risks, and design a legal framework that allows patients to make informed choices while encouraging safe, regulated care.

Fortunately, the law already offers a workable model. Colorado need not invent a new ethical framework to address ibogaine. It can adapt one that has long governed other high-risk, high-benefit interventions.

The first is vaccines. A tiny number of people suffer severe adverse events from vaccines, and some die. Yet we do not treat those deaths as proof that vaccines should be banned or that doctors should be exposed to unlimited civil liability. Instead, the federal government created the National Vaccine Injury Compensation Program: a no-fault system that compensates those harmed.

Workers’ compensation follows a similar logic. Dangerous jobs sometimes result in injury or death, even when employers follow the rules. Rather than forcing families to prove negligence in court, and rather than exposing employers to existential lawsuits, society struck a bargain. Injured workers receive guaranteed compensation; employers receive predictable, limited liability; and essential work continues.

Ibogaine demands a comparable framework at least until the treatment has received full FDA review and approval, when evidence-based risk evaluation and mitigation strategies and medical liability insurance will begin protecting conscientious providers.

The uncomfortable reality is that even when administered with rigorous screening, cardiac monitoring, and best practices, ibogaine will occasionally result in deaths. That fact should not be minimized, but neither should it be allowed to eclipse the far larger truth: Not providing access to ibogaine also kills people, at vastly greater scale.

If Colorado treats ibogaine like an ordinary medical intervention, subject to standard malpractice liability, it will all but guarantee scarcity. Clinics will not open. Insurance will be unobtainable. Only underground providers or offshore clinics will remain, where oversight is weakest and risks are highest.

That outcome would be morally indefensible.

Colorado should instead create a statutory safe harbor for licensed ibogaine providers who meet clearly defined standards of care. Patients would give informed consent acknowledging the known risks, including death. In exchange, providers would be shielded from traditional tort liability for adverse outcomes absent gross negligence or fraud.

To protect patients and families, the state could establish an ibogaine injury compensation fund, financed by modest per-treatment fees and supplemented if necessary by public funds. When tragedies occur, and they will, families would receive swift, guaranteed compensation without years of litigation, while providers would not be punished for offering a treatment that society has deemed worth the risk.

This approach does not trivialize death. It takes the risks of ibogaine seriously enough to plan for it honestly.

Most importantly, it respects the moral agency of those most affected. People who already face a high probability of dying without intervention should be allowed to choose a treatment that offers real hope, even if it carries danger.