What’s to Gain with Ibogaine? The Science of Ibogaine Addiction Treatment
Today I am talking about Ibogaine. This was actually a suggestion from Miles Cuñha, a subscriber on YouTube. Thank you Miles!
Proponents of Ibogaine claim that it is a natural cure for opioid use disorder and withdrawal. What does the science say? Can you cure addiction with a single Ibogaine treatment? Who offers treatment with Ibogaine and is it legal? What are the risks? We'll talk about all that and more today!
Before I begin, I must remind you that nothing we talk about in today's blog should be considered medical advice. If you have a personal question about addiction treatment, you should speak with a medical professional. Always speak with your doctor before starting any course of treatment.
With that disclaimer out of the way, lets begin!
What is Ibogaine?
Ibogaine is an alkaloid drug which is isolated from the West African plant Tabernanthe Iboga. The tree produces a sweet, pulpy fruit which you can eat without experiencing psychedelic effects because they contain no alkaloids. The bark and roots, however, contain a number of psychoactive alkaloids, including Ibogaine, which makes up 80% of these alkaloid chemicals. Pure Ibogaine is a white to off-white crystalline powder that is extracted from the roots and bark of the tree.
Ibogaine is not the only psychoactive substance in Iboga, but it is the one most studied. People have used both the raw plant Iboga and pure Ibogaine for the treatment of opioid withdrawal and addiction. This makes accessing the efficacy and safety difficult, as is impossible to predict the quantity of active drug in a given amount of plant matter, which makes reliable dosing difficult.
We still are not fully aware of how Ibogaine and its related chemical influence the human brain. What is known is that people who take Iboga experience psychedelic effects, characterized by hallucinations, geometric patterns, the sensation of time slowing or speeding up, depersonalization, and spiritual experiences, including the feeling that one is near-death or has died and entered the afterlife. Iboga alkaloids can also induce adverse physical experiences which include dry mouth, nausea, vomiting, abdominal cramps, convulsions, paralysis, palpitations, and even sudden cardiac death in high doses.
These intense mental and physical experiences are used by some cultures as a rite-of-passage ceremony in which young men are encouraged to drink a large quantity of tea brewed from Iboga over the period of 1-2 days. The resulting experience is very meaningful and serves as a transition from boyhood into the responsibilities of manhood.
Iboga has developed a cult following of practitioners and patients who use the drug not for ritual purposes or recreation, but rather as a way to treat drug withdrawal and addiction. It is marketed as a treatment which both relieves acute withdrawal and stops drug cravings with a single treatment.
Ibogaine is scheduled in Class I by the DEA, which makes it a controlled substance which is illegal to possess in the US without special permission from the DEA for research purposes. This includes the plant material as well. Therefore, no medical clinic or addiction treatment facility in the US can offer Iboga treatment to their patients, unless part of an approved research project.
Additionally, the drug is banned or at least highly regulated in Belgium, Denmark, France, Hungary, Ireland, Italy, Norway, Switzerland, Sweden, and the UK.
Patients seeking Iboga therapy typically travel to a foreign country, often Mexico in the case of US citizens or The Netherlands for EU citizens where the drug is not regulated. The clinics offering Iboga treatment can vary greatly in quality, depending on the regulations and force of law in that country. It's very difficult to accurately assess the quality of treatment in another country, especially while suffering from addiction or withdrawal; buyer beware.
How does Ibogaine Work?
Lets return to the medication itself. No one knows exactly how Ibogaine creates the effects on the human brain that it does. We have learned that the drug has action on numerous different receptors in the body. The major psychedelic effects are probably due to its action as an NMDA receptor antagonist and agonism at multiple serotonin receptors. To put this in context, ketamine is an NMDA receptor antagonist and LSD is a serotonin receptor agonist. Additionally, it acts as a serotonin reuptake inhibitor, similar to SSRI antidepressants. The drug also has action on the adrenergic system, which controls “flight or flight” reactions and on the acetylcholine system which controls muscle signaling and memory. It even has action at mu- and kappa-opioid receptors, though this is minor contributor to the effects.
The takeaway is that Iboga induces powerful and complicated changes in the human brain. No wonder it creates such meaningful experiences.
What Does the Science Say?
Many people report that their Iboga experience is life-changing, even if it is unpleasant in the moment. I don't dispute the veracity of these reports, but is there any evidence that Iboga can treat addiction?
Unfortunately, there is little meaningful data regarding the use of Iboga for addiction treatment. One of the most substantive studies was published by Brown and Alper in 2018. In this study, the researchers observed 30 people who underwent a single Iboga treatment session.
They found that these patients experienced a drop in their withdrawal score from 31 to 14 over a 4-5 day period. This is a significant drop, but it is possible to achieve similar results with buprenorphine or methadone. It also does not show how long this reduction in withdrawal symptoms lasted, as the researchers did not follow the participants any longer.
They also found a significant drop in drug use from three to twelve months after treatment. At one month after treatment, 50% of patients reported no opioid use in the prior 30 days. However, this benefit waned over time and by twelve months, only 23% of patients reports abstinence in the prior 30 days.
Abstinence from drugs is not the most important factor in recovery, however, as I have stated before. The researchers did observe that the patients did enjoy improvement in social and legal status at twelve months after treatment. This means that the patients had better relationships with friends and family and were less likely to have legal trouble. Employment status improved after one month, but this improvement was not sustained afterwards.
Worryingly, it appears that these patients may have increased their alcohol consumption twelve months after treatment. Could this indicate that these patients are replacing opioids with alcohol?
Overall, the results are interesting but far from definitive. The lack of a control or comparison group and the small study size lessens the value of these data.
Another observational study, by Noller, Frampton, and Yazar-Klosinski in 2018 studied 15 patients being treated at an Ibogaine clinic in New Zealand, where it is legal.
They also found a drop in withdrawal scores up to 84 hours after administration.
At 12 months after treatment, they found an improvement in Drug Use scores but no improvement in employment, social, legal, or psychiatric scores. Unlike the Brown and Alper study, there was no trend towards increased alcohol use.
The most concerning finding of this study is that one of the 15 participants died during treatment. There is little explanation of the details of this death, but the authors of the study note that the New Zealand Health and Disability Commissioner declared that the treating physician breached their duty of care to the patient and that the coroner's ruling supported this declaration. It sounds as if this participant may have died as a complication of Ibogaine treatment.
What Are the Risks of Ibogaine?
Ibogaine is a powerful drug and it has real risks. Many people experience severe nausea and vomiting, which can lead to dehydration or electrolyte abnormalities without proper medical attention. For this reason, it's important not to attempt this treatment without proper medical supervision.
More worryingly, Ibogaine is also a cardiovascular toxin at high doses. The drug and its related compounds can cause lethal cardiac arrhythmias by blocking the hERG potassium channel on heart cells. This prolongs the period of heart repolarization, the process of charging up for the next beat.
If a pacing signal occurs during this repolarization period, the heart will begin to beat very rapidly and ineffectively. This rhythm is called Torsade de Pointes, which is French for “twisting of the points” and describes the appearance of the ECG tracing, which rhythmically increases and decreases in wave height.
The heart cannot pump blood efficiently during torsades de pointes and this leads to loss of consciousness and death, typically within minutes, without immediate treatment. Drugs like magnesium sulfate and treatment with electrical defibrillation can return the heart to a normal rhythm, but treatment is not always successful. Thus, it's important to prevent it in the first place.
Certain medications can delay the repolarization period of the heart and therefore increase the risk when taken with Ibogaine. Electrolyte abnormalities, such as low potassium, can also delay repolarization and make a person more prone to lethal arrhythmias. Therefore, prudent clinics will screen patients before treatment and monitor them continuously throughout treatment.
These risks underline the danger in taking Ibogaine unsupervised or in a setting with poor medical supervision.
Conclusion
We've talked a lot about culture, chemistry, case studies, and cardiology, but what's the bottom line on Ibogaine? To me, it's too soon to make a strong recommendation for or against Ibogaine. With more study and proper procedures to mitigate risk, it is possible that Ibogaine could become a useful tool for the treatment of substance use disorder.
It's important to emphasize that last point. At best, Ibogaine is a potential tool for the treatment of substance use disorder. It should not be considered the solution to addiction. Physical dependence is only one aspect of substance use disorder and even if Ibogaine could perfectly ameliorate that dependence, it wouldn't be a “cure” for addiction.
The limited scientific evidence we have suggests that Ibogaine may be a promising candidate as a treatment for substance use disorder, but it's not clear just how effective it is compared to standard treatments for addiction, such as buprenorphine and methadone. It certainly has risks which are more serious than those treatments and therefore it would need to offer a strong benefit to balance those out.
It's legal status is also a barrier to treatment, which mandates that patients travel to a foreign country and receive care in a clinic that they must trust sight-unseen or risk obtaining the drug illegally to use unsupervised. It would require years of effort and an obscene amount of lobbying money in order to petition the government to remove Ibogaine from schedule I. Until that happens, it will never be a mainstream addiction treatment.
I don't recommend that my patients seek out Ibogaine for these reasons. There are safe and effective treatment options which don't have the legal and medical risks of Ibogaine. If you are certain that you want to try Ibogaine, don't attempt to use it without medical supervision and be certain to research foreign treatment centers carefully before committing to treatment.
Do you have experience with Ibogaine? If so, leave your opinions in the comments below.
If you or someone you love is suffering from problematic drug or alcohol addiction use and is seeking treatment, contact the clinic by calling or clicking the “Get Started” button in order to schedule a discovery call and initial evaluation, both of which are free.
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North Tampa Executive Health Clinic is directed by Dr. Jack McGeachy. He provides confidential and comfortable addiction treatments and therapy for opioid and alcohol use disorder. Rather than a rehab or detox, meaning that each patient is cared for one-on-one by a medical doctor, in contrast to other treatment programs. Heed Help? Book your in office appointment in the Tampa office or via video conferencing today.
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