Ibogaine: is it legit?

Ibogaine is a drug that has been getting a lot of attention lately because of its purported use in helping people to detox from active drug use.

Even though this drug has been known been for centuries, its effect of reducing withdrawal symptoms and cravings from drugs of abuse wasn't known until the 1960s. However, despite the urgency of finding drugs to treat addiction, ibogaine remains largely ignored by the research community.

What is ibogaine?

Iboga (Tabernanthe iboga) is a shrub that grows wild in the rainforests of western central Africa. The roots and bark of this plant contain a number of psychoactive compounds, one of which is ibogaine. Ibogaine is a psychedelic and hallucinogen (like LSD, magic mushrooms, or Salvia).

Ibogaine has properties of both of the two types of hallucinogen drugs:

• "Classic" hallucinogen: causes hallucinations, which are visual, auditory, or touch sensations that feel real,
• Dissociative: causes a feeling of being separated from body and environment, and out of control.

For hundreds of years, ibogaine and related compounds from the iboga plant were used by the central African pygmies and the Bwiti of Gabon, the native peoples where the iboga plant grows . They chewed the bark of the plant for medicinal uses and for the hallucinogenic effects during all-night vision-quest rituals. Must have been quite a thing to observe!

French colonists brought the drug back to France in the mid-nineteenth century, where it was marketed in low doses as a stimulant under the name Lambarène (named after the capital city of Gabon in central Africa).

Prior to its use for addictions, ibogaine was used to boost the analgesic effects of opioid pain medications, and there appears to be some merit to its use in this capacity. More commonly, it was used by some psychiatrists who felt that it helped their psychotherapy patients retrieve memories.

Ibogaine is used legally in some countries as an aid for withdrawing from drug use. It is banned in many countries, including the U.S. but is commonly sold on the illicit drug market. In Canada it is in a weird legal grey area, with the drug being legal to possess, but illegal to sell. According to a recent BBC report, many Americans with addictions are going to Mexico to access ibogaine.

Why isn't ibogaine being legally used for addiction treatment?

At the present time ibogaine is the subject of intense interest – and controversy – because of reports of its effectiveness in reducing withdrawal symptoms and cravings in people withdrawing from opioid addiction.

The controversy around the use of ibogaine as a treatment for addiction is based on four main factors:

• The drug is dangerous, and a number of deaths have been attributed to its use
• The drug is illegal in the U.S. and many other countries
• As a hallucinogen ibogaine itself has potential for abuse and addiction
• The drug has not been well studied for use in treating addiction

The ibogaine controversy requires proper research to settle the issue of whether or not it should be embraced as a mainstream part of treating addiction. That is the process that any drug goes through in order to obtain FDA or Health Canada approval for use.

However, there are a couple of barriers to getting this research done. First of all, nobody can patent ibogaine, so there's no financial incentive for big pharma companies to spend millions of dollars in researching the drug. Second, the drug's legal status is an impediment. Third, because of the multiple side effects of the drug, it may be difficult to get approval to study it in humans.

The U.S. National Institutes of Health tried to initiate a research program for ibogaine in the mid-1990s, but the program got bogged down in licensing and commercial rights arguments and never got off the ground. Meanwhile, the drug addiction epidemic is taking many lives (more than 130 per day in the U.S.; in Canada it has actually lowered the country's average life expectancy).

The current position of the U.S. National Institutes of Health and the National Institute on Drug Abuse, who hold the purse strings for ibogaine research, is that the iboga plant compounds are neurotoxic and therefore unsafe for study in humans.

However, ibogaine supporters can take heart: researchers published findings in 2019 that they have worked out how ibogaine works on the brain, and that a version of ibogaine with all the therapeutic properties but without the hallucinogenic and other dangerous side effects is likely on the horizon.

Does ibogaine work?

Although the focus of ibogaine use for addiction has mostly been for opioid addiction, there are indications that single-dose ibogaine may be useful for other substance addictions as well:

• Cocaine,
• Alcohol,
• Amphetamines,
• Nicotine.

Statistics for the effectiveness of ibogaine as an aid to substance addiction are very difficult to pin down for a variety of reasons:

• Ibogaine has been studied almost solely for opioid addiction,
• Most of the studies that have been done were very small,
• Many of the studies were done before proper controls were in use (the first studies date from 1962),
• A wide variety of vague end-points for the research were used.

Ibogaine’s effect on drug withdrawal was discovered quite by accident in the 1960s. The drug was being used to boost the analgesic effects of opioid pain medications so that people were able to take smaller doses with the same pain relief effect. It was noticed that the people who were using ibogaine with their opioids experienced greatly reduced withdrawal symptoms when their opioid medications were stopped.

While the research data on ibogaine use for detoxification for drug use has been spotty, a recent small but well designed clinical trial demonstrated “substantive” effects of ibogaine on opioid withdrawal symptoms and drug use. The study subjects were all people who had been unsuccessful with previous treatment attempts (not involving ibogaine). The study participants were followed at regular intervals for their first 12 months in recovery, giving excellent end-points for the study.

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What are the concerns with side effects?

Ibogaine has not passed through the usual safety and efficacy trials required by the FDA and Health Canada, so users should beware of the uncertainty and risks involved.

There are some serious concerns about the safety of ibogaine use:

• Persistent psychosis: induction of symptoms similar to schizophrenia, which may be permanent,
• Hallucinogen Persisting Perception Disorder (HPDD): random, unexpected recurrences of “drug trips,”
• Death: there have been at least 30 attributed to ibogaine use, but there may have been more given that it is an illicit drug and is used covertly.

Statistics for ibogaine

In the absence of large, independently-funded, placebo-controlled randomized clinical trials with significant measurable end-points (for example, maintenance of abstinence from drug use at 1 year) it would be misleading to try to come up with a statistic to describe the effectiveness of ibogaine for substance use disorder treatment.

Bottom Line

In the absence of FDA or Health Canada approval and all the research evidence that goes with it, there appears to be overwhelming anecdotal evidence that single-dose ibogaine does reduce withdrawal symptoms - including cravings - for various drugs of addiction. However, there are also some serious safety concerns about the drug, too.

It must be remembered that ibogaine – or any other drug – is not the complete answer to substance addiction. At best, drugs may help with detoxification from the drug of abuse and may help curb cravings for a period of time. However, for most people with addiction the drug abuse long ago was no longer about getting high, it was about escaping from painful mental and emotional dysfunction.

As such, any drug used for treating withdrawal and detox must be viewed as only a small piece of the overall approach to bringing the affected individuals back to a healthy and productive life in long-term recovery.

As well, there is a high degree of comorbidity (occurring simultaneously) between substance addiction and mental health disorders (see "The Link Between Mental Health and Addiction" click here). The nature of comorbidity requires that both conditions must be treated at the same time in order to expect any reasonable measure of success. Ibogaine does not treat any mental health disorders and may even exacerbate them. As well, because ibogaine is self-administered, people with comorbidity may be missing out on a proper assessment and diagnosis.

At best, ibogaine will be a small piece of the answer for addiction, helping people get through the withdrawal and detox part of recovery. Like other drugs it does nothing to take care of the underlying causes of addiction and the mental and physical damage that is caused by active addiction

References:

Alder, Kenneth; Lotsof, Howard, Kaplan, Charles. “The ibogaine medical subculture.” Journal of Ethnopharmacology, 2008.

Antonio, Tamara; Childers, Steven; Rothman, Richard; et al. “Effect of iboga alkaloids on μ-opioid receptor-coupled G protein activation.” Plos One, October 16, 2013.

Brown, Thomas; Alper, Kenneth. “Treatment of opioid use disorder with ibogaine: Detoxification and drug use outcomes.” American Journal of Drug and Alcohol Abuse, May 25, 2017.

Levinson, Jonathan. “Americans going abroad for illegal heroin treatment.” BBC News, April 11, 2018.

Mash, Deborah; Duque, Linda; Page, Bryan; et al. “Ibogaine detoxification transitions opioid and cocaine abusers between dependence and abstinence: Clinical observations and treatment outcomes.” Frontiers in Pharmacology, June 5, 2018.

Multidisciplinary Association for Psychedelic Studies. “Ibogaine therapy.” June 16, 2017.

National Institute on Drug Abuse. “What are hallucinogens?” April 2019.

Noller, Geoffrey; Frampton, Chris; Yazar-Klosinski, Berra. “Ibogaine treatment outcomes for opioid dependence from a twelve-month follow-up observational study.” American Journal of Drug and Alcohol Abuse, 2018.

Proteomics & Metabolomics. “How a shrub may enable the ‘impossible’ in treating addiction.” April 25, 2019.

Toxicology Data Network. “Ibogaine.” September 4, 2014.

Volkow, Nora; Collins, Francis. “’All scientific hands on deck’ to end the opioid crisis.” National Institute on Drug Abuse, May 31, 2017.

Volkow, Nora; Collins, Francis. “The role of science in addressing the opioid crisis.” New England Journal of Medicine, July 27, 2017.