What is Ibogaine?
Ibogaine is a naturally occurring psychoactive substance that has been demonstrated to interrupt substance use disorders,1as well as possess other neurological and psychological benefits. It is found naturally in a number of plant sources, principally in a member of the Apocynaceae family known as Iboga (usually Tabernanthe Iboga), which has been used for centuries by traditional communities in West Africa for ritual and healing purposes.
In lower doses, Ibogaine acts as a stimulant, increasing energy and decreasing fatigue in a way that is distinct from other central nervous system stimulants like amphetamines and cocaine.2 In larger doses, Ibogaine produces oneirogenic effects, meaning that it stimulates a dream-like state while awake, as well as closed eye imagery and the retrieval of repressed memories.
Its physical effects can include ataxia, nausea and vomiting, sensitivity to light and sound, tremors, and cardiac effects.4 In the early 1960’s, the Chilean psychologist Claudio Naranjo conducted 40 Ibogaine sessions with his clients and was the first to scientifically describe the experience. He reported that Ibogaine helped people to view difficult experiences in an objective way, and that it helped to facilitate closure of unresolved emotional conflicts.
The occidental use of Ibogaine, especially its application in the treatment of substance use disorders, was pioneered by Howard Lotsof. In 1962, 19 year old Lotsof serendipitously found that a single dose of Ibogaine not only interrupted his physiological dependence on heroin, it also took away his craving to use, all with no withdrawal symptoms. Lotsof spent the rest of his life advocating for the development of Ibogaine as a prescription medicine.
In the early 1990’s, the US National Institute on Drug Abuse (NIDA) began the development of Ibogaine by fully funding pre-clinical animal trials as well as Phase 1 safety trials on human subjects under the auspices of Dr. Deborah Mash at the University of Miami. The results confirmed that Ibogaine decreases the self-administration of stimulants, opiates and alcohol, as well as a significant reduction in the withdrawal symptoms from opiates.6 ((Popik P, Glick S. Ibogaine, a putatively anti-addictive alkaloid. Drugs of the Future. 1996; 21:pp 1109-1115.))
Unfortunately, the development research was ended prematurely because of intellectual property disputes, its high cost and complexity relative to NIDA’s existing resources.
Phase 1 safety trials conducted by NIDA found that Ibogaine is not neurotoxic. However, there are a number of fatalities that have been temporally associated with the ingestion of Ibogaine. These were attributed to a variety of factors, including pre-existing medical conditions, especially cardiac conditions, as well as seizures resulting from acute withdrawal from alcohol or benzodiazepines, and in other cases the co-administration of one or more drugs of abuse.
One of the causes cited is that Ibogaine potentiates the effects of opiates, as well as their lethality if co-administered. It does this not by acting as an opiate agonist or antagonist, but by enhancing opiate signaling.8 Another is that, in addition to attenuating withdrawal symptoms, Ibogaine has been shown to reduce developed tolerance to opiates9 and alcohol,10essentially returning the user to a novice state. Using substances after administration of Ibogaine without taking this into consideration presents a significant risk of overdose.
In the late 1980’s, the first regular Ibogaine-assisted detox sessions were conducted by the Danish Drug Users Union in Amsterdam. Over the last several decades a global community of Ibogaine therapy providers, which has been dubbed a “medical subculture,” has developed to include former drug users and physicians. In 2007 it was estimated that over 3,400 therapy sessions for substance use disorders, as well as for personal and spiritual growth, had been conducted worldwide.11 This number continues to grow annually, as well as the number of clinics.
Ibogaine-assisted detox efficacy has been explored in two recent studies being conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS), attempt to track the long-term efficacy of Ibogaine-assisted detox therapy. The studies, in Mexico and New Zealand, have reported preliminary results of between 20% and 50% rate of clients remaining free from their primary substance of abuse for at least 12 months. Factors influencing this range were suggested to be the ease of follow-up in the New Zealand study become of closer proximity, as well as other factors such as plans for continuing care.12 Ibogaine therapy may have promising results in the treatment of other conditions, including Hepatitis C, Parkinson’s disease and Tourette’s syndrome.
Conditions treated by Ibogaine?
The most common application of Ibogaine therapy is in the treatment of substance use disorders. Ibogaine has been shown to decrease the self-administration of stimulants, opiates and alcohol, as well as to significantly reduce the withdrawal symptoms from opiates after a single administration.1 Other research shows a reduction of developed tolerance to opiates2and alcohol,3 and a significant decrease in cravings for opiates and cocaine for an extended period of time after treatment.
Ibogaine-assisted detoxification was pioneered by Howard Lotsof. In 1962, 19 year old Lotsof serendipitously found that a single dose of Ibogaine not only interrupted his physiological dependence on heroin, it also took away his craving to use, all with no withdrawal symptoms. Lotsof spent the rest of his life advocating for the development of Ibogaine as a prescription medicine.
Since the 1980’s, Ibogaine has been used in the treatment of substance use disorders, first in peer-to-peer treatment networks such as the one conducted by the Danish Drug Users Union. Today, there are therapists and centers throughout the world that offer various programs, usually lasting from five days to two weeks, with some longer programs that focus on integration of the Ibogaine experience and early continuing care.
Is Ibogaine-assisted detox successful?
In the conventional addiction treatment industry, programs of this length are referred to as detoxification programs, and are distinguished from complete treatment programs, which often range between 30 to 90 days in length. Statistics show that conventional detox programs, which do not involve maintenance with methadone or buprenorphine, and which are not followed by complete treatment programs, have low completion rates, let alone long-term success rates, and practically never lead to long-term abstinence.
While these programs vary widely in the scope of what they offer, several studies into Ibogaine-assisted detox efficacy have confirmed that even short-term programs have results that are comparably better than much longer conventional treatment programs. This may not always be the case, and there are several factors that were shown to have a strong impact, such as continuing care programs.
How does Ibogaine-assisted detox work?
Some aspects of Ibogaine’s effects and pharmacology are understood, while others remain unknown. What is clear is that Ibogaine works on multiple receptor sites, and has effects that are both physiologically and psychologically therapeutic.
Physically, Ibogaine resets neurotransmitter receptors to a novice state, and has demonstrated neuroprotective effects on dopamine receptors. It has been shown to increases levels of GDNF,5 a protein that facilities the development of new neurons, producing a period of neuroplasticity, during which it is easier to learn new habits. Ibogaine’s oneirogenic effect, or waking dream state, has been reported to help people to view difficult experiences in an objective way, and to help facilitate the closure of unresolved emotional conflicts,6 which is often a cofactor in severe substance use disorders.
Is Ibogaine Therapy Safe?
Ibogaine therapy shows a definite promise in the treatment of substance use disorder. In general, Ibogaine can be administered safely and without incident, especially when done with proper preparation and supervision. However, there two interrelated issues have stood in the way of further development of Ibogaine as a prescription treatment: the lack of clinical research, and the issue of safety.
Phase 1 safety trials funded by the National Institute on Health (NIH) found that Ibogaine is not neurotoxic. However, because of Ibogaine’s systemic effects, there are certain contraindicated conditions that can pose serious health risks if not identified during a careful screening process.
Between 1990 and 2008, a total of 19 deaths were reported to be temporally associated with the ingestion of Ibogaine. These incidents were attributed to a number of factors that include pre-existing cardiac conditions, seizures resulting from acute withdrawal from alcohol or benzodiazepines, and in other cases the co-administration of one or more drugs of abuse while under the influence of Ibogaine.1
- It is crucial that patients with childhood congenital heart defects, prolong QT intervals, a history of heart failure, enlarged heart, any history of blood clots, stroke, transient ischemic attacks, pulmonary embolism, deep vein thrombosis, or irregular heart rhythms do not attempt to take Ibogaine because of these risks. Other pre-existing heart conditions should be carefully examined and a risk/benefit assessment taken into consideration.
- Other conditions that should prevent someone from taking Ibogaine are certain psychiatric conditions, such as bipolar disorder, schizophrenia, depersonalization disorder, cerebellar dysfunction, epilepsy, non-substance induced psychosis, organic brain disease, and dementia. While there may be exceptions, these conditions usually do not see an improvement, and could be exacerbated by taking Ibogaine.
- Impaired liver or kidney function, dehydration, and depleted electrolytes can also prevent serious risks.
- Ibogaine does not attenuate withdrawal symptoms from alcohol or benzodiazepines, and seizures, which are commonly associated with withdrawal from these substances, pose a substantial health risk. It is very important that acute alcohol detox be completed under medical supervision prior to taking Ibogaine, and that benzodiazepine use be stabilized and continued throughout the treatment. Detoxification from benzodiazepines should be managed by a gradual taper after Ibogaine treatment, under the supervision of a medical professional.
- One of the other causes cited in research on adverse events is Ibogaine ability to potentiate the effects of opiates, as well as their lethality if co-administered. It does this not by acting as an opiate agonist or antagonist, but by enhancing opiate signaling.2 It is very important that substances are given an opportunity to fully leave the system before Ibogaine is administered, and that half-lives of all substances are taken into careful consideration. This process is especially sensitive with long-acting opiates such as methadone and buprenorphine.Although many people seek out Ibogaine treatment for its ability to mitigate withdrawal symptoms from short-acting opiates, it has been suggested that the safest route is to fully detox prior to ingesting Ibogaine.
- In addition to attenuating withdrawal symptoms, Ibogaine has been shown to reduce developed tolerance to opiates3and alcohol,4 essentially returning the user to a novice state. Using substances after administration of Ibogaine without taking this into consideration presents a significant risk of overdose.
These statistics about adverse events associated with Ibogaine have been presented as a case against the development of Ibogaine as a prescription medicine. However this argument does not take into consideration that those suffering from substance use disorder are a high-risk population, more than 4 times more likely to die of unnatural causes than the general population because of many of the factors associated with substance use.
Even though these statistics took into account Ibogaine administration that happened in a wide variety of settings, some which included medical supervision, and many that did not, these mortality rates remain similar with those reported from methadone treatment, which is one of the most conventional treatments prescribed for opiate addiction.
In 3,414 Ibogaine treatment episodes reported between 1989 and 2006, 11 resulted in a fatality. That is 1 Ibogaine-related fatality per 427 treatment episodes.6 In Australia between 2000 and 2003, 282 fatalities met the criteria for methadone-related death occurred in 102,615 TEs, which is 1 methadone-related death on 364 treatment episodes.78 In 2004, 110 fatalities in which the medical examiner mentioned methadone as a cause of death occurred in Utah in 52,350 methadone prescriptions, which is 1 methadone-related death on 476 methadone prescriptions.
It is for this reason that GITA strongly advises against the self-administration of Ibogaine, and that the information presented throughout the rest of this site is considered in the context of supervised Ibogaine therapy. Research supports the suggestion that professional standards for the administration of Ibogaine could have a significant impact on making Ibogaine therapy safer and more effective.
What is Noribogaine?
Ibogaine-Assisted Detox Efficacy